Caring for Refugee Women in the “Ellis Island of the South”

The women began arriving from Afghanistan in October of 2021, spending time sequestered on a military base before being resettled in Clarkston, Georgia.

“It was scary for those who were there…and then they evacuated, and they were in camps for months,” said Muzhda Oriakhil, a community liaison and new community engagement manager at Friends of Refugees, a Clarkston-based NGO that offers support to refugees resettling in the United States. “Mentally they are really exhausted.”

Many of them were also late in their pregnancies, and some were experiencing difficulties. One mother of eight who had never before had pregnancy-related health problems began having severe headaches and contractions. Another told Oriakhil that she felt ashamed and uncomfortable staying with all her children in a single hotel room.

“The trauma, the anxiety…can impact their pregnancy and does require special treatment,” said Virginia Tester, the director of Embrace, a program under the larger umbrella of Friends of Refugees that focuses on pregnant and postpartum women.

Harrowing though it was, their journey was more expedited than most. According to Friends of Refugees, people who flee their country, fearing their safety, will spend an average of 17 years in refugee camps. The process of seeking safety in a new country is a fraught and complex one.

“In general, they may have spent years in a refugee camp, so their health and their experience may vary greatly,” said Tester of the pregnant women the Embrace program supports.

When a pregnant woman arrives in the U.S. with refugee status and no health insurance, she qualifies for Medicaid. But the processes of signing up, getting access to social services, and finding prenatal care can prove daunting for someone newly immersed in a different language and culture.

That’s where Embrace often comes in.

“The Spirit of Friendship”

In the mid-1990s, Clarkston transformed quickly from a small Southern town to one of the country’s most diverse areas, called “the Ellis Island of the South.”

Its first refugees were from Serbia, fleeing the Yugoslav Wars, explained Friends of Refugees Executive Director Kendra Jeffreys.

Retired nurse and Clarkston resident Pat Maddox saw that these new arrivals needed help – getting to doctor’s appointments, navigating paperwork – and founded Friends of Refugees.

Today, the organization focuses on supporting refugees in the United States, with particular emphasis on education, employment, and health and well-being. The Embrace program, which became part of Friends of Refugees several years ago, falls in the last category.

It’s not often that a nonprofit organization can boast proven results. But Embrace is an exception. A 2021 study found that participation in the program “was significantly associated with 48% lower odds of labor induction…and 65% higher odds of exclusive breastfeeding intentions.” The program was also associated with positive trends for reduced cesarean sections, higher full-term gestational age, and reduced low birth weight.

“We conclude that community-based, culturally tailored pregnancy support programs like Embrace can meet the complex needs of refugee women,” the study’s authors wrote.

Today, Embrace works primarily through word of mouth. The organization’s community liaisons, which provide information and outreach, are well known and trusted among women in their work communities. Oriakhil, for example, might find herself serving as a translator for a pregnant woman at an obstetrician appointment one day and answering questions about the Covid-19 vaccine in a group session the next.

“Friendship is so essential to our core,” Jeffreys explained. “We always say we’re not an aid agency. We come along with people in the spirit of friendship.”

“If you don’t know how to speak English, it’s going to be harder”

For the women they work with, Embrace serves a number of functions. The program helps women navigate the process of applying for Medicaid, getting food stamps or other social services, and establishing care with a provider. Community liaisons provide interpretation services for women at doctor’s appointments.

“I feel like people in my community, especially women, they need a lot of help. Usually they are stay-at-home moms, but they also have to take care of the children,” said Mu Naw Naw, a member of the Karen community of Myanmar who is Embrace’s new client services manager. “It’s not only about their everyday life. Sometimes they need help going to the doctor or teacher. If you don’t know how to speak English, it’s going to be harder.”

Naw helps pregnant women make a doctor’s appointment – and sometimes takes them. Her role also involves helping them to apply for Medicaid and WIC – the U.S. supplemental nutrition program designed to support woman, infants, and children with healthy food.

“This is the kind of work that I already wanted to do since I was young. I want to give back to my community as much as I can,” she said.

In addition, the Embrace program offers a culturally specific and sensitive class, called Healthy Moms, designed to introduce mothers to healthy eating during pregnancy, hospital and obstetric office procedures, and techniques to help during labor.

Aku Dogbe, a community liaison who is now Embrace’s health education manager, teaches a version of the class in French, primarily for women from African countries. In Togo, where she’s from, she worked as a midwife, and educating women was an important part of her work.

“This class is where they can learn about the health system and also…what they need to do to have a healthy pregnancy,” she said. “I love to do it, because this is how I help.”

Dogbe remembers one woman who had chronic high blood pressure and was extremely worried about her pregnancy. Through the class, Dogbe was able to educate her about her health and what to expect from the process, as well as share her own pregnancy journey. The woman ended up having a healthy baby and a smooth delivery.

“When the moms can take everything we teach them, and they can apply these things during pregnancy and then get a better outcome at the end, is what’s important to me,” Dogbe said.

The class format has been so successful, in fact, that other organizations providing services to refugee communities have requested access to the curriculum. Embrace is training one group in Missouri to teach a similar class.

Some women decide not to have their partner at birth, often for cultural or childcare-related reasons. For these women, Embrace offers a birth support person who also serves as an advocate in the room.

Among the Rohingya community in the area, that person is Rahina Kamal. “She’s been there for almost every birth in her community,” Tester said.

Kamal explained that partners often stay at home with the children while women attend prenatal appointments and give birth. Since many of the women in her community don’t speak English, she acts as both translator and advocate during women’s pregnancies and the labor process.

For Kamal, who experienced an abusive marriage in Myanmar and who has family still in the camps in Bangladesh, assisting at births is a way to ensure that other women have a more positive, supported experience than she did. “When the baby comes, the delivery is so exciting,” she said. “In my life, I had a…hard time. I try to help people.”

But being a resource for refugee communities often means taking on additional work, whether it’s bringing food to a new family, dropping off flowers for new arrivals, or even helping people when they’re – quite literally – lost.

Tester described one woman who got on a bus to do her grocery shopping and ended up off at the wrong stop, late at night, with her groceries. “That’s when they’ll call Muzdha [Oriakhil],” she said.

“I feel like they’re seen now”

Friends of Refugees’ Embrace program is the recipient of a $120,000 grant from Direct Relief’s Fund for Health Equity. Embrace is using the funds to promote Oriakhil, Naw, and Dogbe from community liaisons to these new, more integrated positions.

“The trust that Mudzha provides and secures, that sometimes takes years to build,” Tester explained.

The choice to place women from refugee communities in staff positions, and to amplify their voices, has been a deliberate one. “We are elevating them to a place that feels like they have more room to share their gifts, their knowledge, their experience with the world,” Tester said.

In addition, the funds will be used to provide phones and tablets to the community liaisons who care for women in refugee communities, and to train them as postpartum doulas, so that they can offer support to new mothers in the weeks after their babies are born.

Embrace’s core staff will do the training with their community liaisons, working with a trusted program, to ensure that the process is supportive and interactive.

Embrace’s staff recently completed a training with the Center for Victims of Torture, designed to help them provide trauma-informed care. The training taught them to identify signs of trauma, connect people to resources, and care for themselves while working with refugees experiencing trauma.

“Especially as we watched hundreds of new Afghans arriving last fall…that feels like an essential part of what a refugee-serving organization should do,” Tester said.

Tester, a certified nurse-midwife and family nurse practitioner, feels acutely aware that it’s not traditional health care interventions that the women she serves need most. Instead, she said, it’s a birth companion like Kamal, or a knowledgeable resource like Oriakhil, Naw, and Dogbe.

“As a health care provider, it means a lot to me that Direct Relief sees this: that our community liaisons are essential, are effective, make positive change in the community in a better way than I ever could – despite having a master’s degree,” she said. “I feel like they’re seen now.”