The Fresno County Refugee Health Volunteer Project: a case study in cross-cultural health care delivery.

Beginning in 1979, Fresno County received a 2nd dramatic influx of Southeast Asian refugees. There are now approximately 20,000 of these refugees, including the largest population of Hmong in the US. This community includes about 2000 Cambodian, 14,000 Hmong, and 4000 Lowland Lao. Altogether, Southeast Asian refugees comprise nearly 10% of the population of Fresno. These demographics provide the backdrop for significant problems in health care service delivery. Some barriers include: 1) stress, loss, dislocation, poverty, illness, and unemployment that are part of the refugee experience; 2) language differences; 3) cultural isolation; and 4) cultural beliefs and practices whose spiritual, wholistic, and natural forms of care often run contrary to the West's scientific, specialized, and technological treatment modalities. The Health Department began to recognize some difficulties related to health services for refugees and developed a strategy to combat these. This strategy was named the Refugee Health Volunteer Project and its goal was to enable individuals, families, and community groups to better meet their own health care needs. Goals were to be met by 1st creating a community-based health promotion network to 1) identify health needs, 2) communicate health information, 3) train community health volunteers, and 4) build a greater capacity for self-care that would last beyond the end of the program. The program's goal would also be met by overcoming the access problems with the service system by 1) communicating community-identified needs, 2) identifying specific barriers in the service system, 3) initiating broad participation among service providers in designing more accessible approaches to service delivery, and 4) improving coordination between service providers. Significant progress has been made in a very short time. The Project demonstrates that a fairly common, bureaucratic organization can be responsive to extremely unique community needs. The project is demonstrating the effectiveness of a network approach as a model for service delivery to ethnic communities experiencing language and cultural barriers to health care. The project staff have served as a catalyst for initiatives which are creating ways in which the broader health delivery system can be more accessible to refugee clients. What is emerging is an approach to health empowerment that builds on the strengths, skills, knowledge, and experience of community people and those organizations which support their efforts.