Sacramento, California – After the Russian invasion, Katie Nelha and her husband could not safely return to their home in Mykolaiv, Ukraine, so they took their chances as refugees. From Poland, where they were working, flying to Mexico in early April, they entered the United States in Tijuana, where they were granted a temporary visa for humanitarian reasons.
Once in Sacramento, Nelha, 24, relied on a county translator to help her enroll in the Medicaid program in California to cover the cost of going to an optometrist. “I need glasses to pass my eye exams and get a driving license so we can start looking for work,” Nelha said through an interpreter. He plans to look for a job at one of the city’s dozens of Ukrainian and Russian restaurants.
The rich Slavic communities in the cities of Los Angeles, Sacramento, San Diego and San Francisco, California, in response to the US withdrawal from Afghanistan, the state has become a magnet for Ukrainians fleeing the war in less than a year of Afghan experience. Many refugees need immediate health care for conditions such as pregnancy, high blood pressure, and diabetes, or for the trauma they have recently experienced.
Earlier this year, the state Department of Healthcare Services issued a recommendation to local governments to enroll refugees in health programs because those who may not qualify for federal services often qualify for state-administered programs, including full-coverage Medi-Cal. There are. Covers doctor visits, vaccinations, screenings and medications.
But the social services agencies responsible for providing most of that care are pushing to keep up with demand. After years of declining funding, they are now desperate for skilled interpreters who can walk new arrivals through the application process and join clinic appointments with them.
“We have four staff who speak Russian or Ukrainian, and we need three more to meet all needs,” said Dr. Sumi Mishra, medical director of the Sacramento County Department of Health Services. “We can’t find them.”
Mishra said the county’s refugee health clinic is recruiting for six open positions. But since language skills are required for the job, the pool of candidates is limited. And a county salary – a recent posting range from $ 37,000 to $ 45,000 for a Ukrainian language specialist – often can’t compete with private-sector offers. The average household income in Sacramento County is over $ 70,000, according to the U.S. Census Bureau’s 2020 data.
The deficit extends to other languages as well. “We can’t find enough Pashto and Dari speakers [for Afghan enrollees] Who will take those positions, ”Mishra said.
Rich Desmond, a Sacramento County supervisor whose district has some unorganized areas where many Ukrainian immigrants have settled, said the epidemic revealed long-term funding and staff shortages in public health. Between 2010 and 2019, funding for public health workers in the state decreased by 14%, according to the UC Berkeley Labor Center. And several Sacramento County health officials have told KHN that they are permanently understaffed.
“It was really empty space where there were gaps,” Desmond said.
The problem seems to be exacerbated in Sacramento County by the influx of refugees into the area. The Los Angeles County Department of Health Services, for example, says it has enough interpreters to meet demand.
Sacramento has the highest number of Ukrainian immigrants, according to the Migration Policy Institute. The federal count of the current increase says about 200 Ukrainian refugees arrived in California between October and June. But Florin Suryuk, executive director of the Slavic Community Center in Sacramento, said 10,000 refugees had arrived in the Sacramento area since the fighting began in late February, most of them Ukrainians.
Undercount extends statewide. County health officials and immigrant support networks put the total number of newly arrived Ukrainians in California at 20,000 or more – an increase of 33% from the 60,000 Ukrainian immigrants already living in the state.
This is a continuation of a chronic pattern. Between 2002 and 2019, California rehabilitated about 108,000 more refugees than any other state, according to the Pew Research Center. Many of them come from Iran, Iraq, Laos and Ukraine. California is home to a Southeast Asian refugee community numbering in the thousands and the end of the Vietnam War.
Most recently, the state welcomed the arrival of Afghan refugees.
Because of the U.S. involvement in Afghanistan, many Afghan refugees can apply for special immigrant visas, which take time to process and give advance notice to states and counties about how many people can get in their way and when, Desmond said.
Not so in the case of primarily Ukrainian refugees. Like Katie Nelha, many arrived in California across the U.S.-Mexico border before the Biden administration stopped allowing Ukrainians to enter in April.
Some Ukrainians resettled in California have come under humanitarian parole or temporary protection status – both are eligible for their Medi-Cal. But most can claim a Medi-Cal status known as a permanent resident Under Color of Law or PRUCOL to qualify for benefits. Since PRUCOL covers immigrants who have applied for legal status but are still awaiting response, there may be a large number of Ukrainians who are eligible for care – and therefore known to local health officials and the immigrant network – even though they are not officially nominated. As refugees.
Desmond said Sacramento County supervisors are pressuring the state to release discretionary funds to address the influx of refugees. The county has recently allocated $ 3 million to provide assistance services to incoming Afghans and could take similar steps for Ukrainians.
When Afghans began settling in Sacramento last fall, the county used state funding to hire shift interpreters, part-time workers, to fill the linguistic gap. It contracts with half a dozen translation services to fill these vacancies, but County Medical Director Mishra said it would be better to hire full-time staff.
Refugees often have stressful health needs.
New immigrants must have a tuberculosis test within 14 days of arriving in the United States, and common health problems include high blood pressure and high lead levels in children with diabetes. Health workers also screen people for region-specific problems – such as a bacterium found in Afghanistan that leads to gastritis and thyroid disease, a potential consequence of the Chernobyl nuclear disaster among Ukrainians.
Concerned about mixed invisible spots.
“Many of these people were suffering from PTSD,” he said. “They came out of a very, very painful situation – in some cases family members are dying. But this is something that is not openly discussed in their community. We often have to ask a lot of questions to express ourselves. “
Noel Sanchez, a spokesman for the San Francisco Department of Public Health, said doctors carefully screened for symptoms of depression, anxiety and post-traumatic stress disorder.
Some of the responsibilities of county translators include guiding newcomers through the stratified U.S. healthcare system. When Russian refugees Andrew Dozdev, 25, and Kiwil Spasky, 21, were asked in Sacramento in June if they had seen a doctor since fleeing their country because of opposition to the war, they both shook their heads and hesitated.
“I hope I don’t need one,” Dojdev finally replied.
County agencies are less staffed and overwhelmed, the work is often unprofitable and falls to the community or religious group. Dimitri Prediuk, a senior pastor at the Revival Christian Center in the Foothill Farms area of Sacramento, said his church is accommodating about 35 immigrants on a short-term basis, providing them with a place to sleep and a bath, food and other assistance.
For care, county health officials say they are committed to serving refugees, although their staff shortages are unlikely to be resolved soon.
“More families are seen at our doorsteps,” Mishra said. “We have decided that we will not return them even if we do not read clearly about their legal status.”
The story was produced by KHN, which publishes the California Healthline, an editorially independent service of the California Health Care Foundation.
KHN (Kaiser Health News) is a national newsroom that creates in-depth journalism about health issues. KHN is one of the three major operating programs of KFF (Kaiser Family Foundation), including policy analysis and polling. KFF is a non-profit organization that provides health information to the nation.
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