FGHL Kate CallaghanWhat must it be like to leave everything and begin again in a foreign land? This was one of the questions I kept asking as I observed the refugee intake day at the Siloam Family Health Center this past week. This is a procedure that every refugee in Nashville goes through when they arrive to the US.

Siloam splits the medical intake up into three parts. The first appointment consists of vital signs, vision screening, a meeting with the behavioral health consultant for a mental health screening, lab work, and immunizations for children. During my day of intake there was a family from the Republic of Congo, two from Afghanistan, another from Nepal, and lastly one from Burma. All had been in the US for less than one month. I had the opportunity to walk through the intake experience with one of the families from Afghanistan.

As I sat with this couple and their 16-month-old son, I was struck by the reality that both husband and wife spoke English. Spending time with them that day, I learned that the husband had been an interpreter for the U.S. military, work that made him extremely proficient in English. Additionally, his wife had the opportunity to take a few educational courses in English in Afghanistan. As I sat in a room with them and these other families, I realized that their language abilities were somewhat unique in this group. In some of the families, no one spoke English. In other families, there was one strong English speaker and no others.

Along with their language abilities, the couple shared with me that they had a friend they had known in Afghanistan who was now in Nashville as well. This friend had been instrumental in helping the couple adjust to their new surroundings during their first month in the US. They shared that he had been able to help them navigate transportation and grocery shopping, and they were grateful for the way he had accompanied them thus far in their journey.

I left my time with the family struck by the strength of connection they seemed to have to here, in their new country, even though they had only been here a month. I found myself asking a lot of questions about social integration and what healthy psychosocial adjustment looks like for these populations. Surely this couple’s English proficiency and their connection to a friend from their native culture, now also resettled in Nashville, was an aid in their health, but why?

As I researched this topic and explored the effects of social integration on psychosocial adjustment, I discovered that, indeed, English proficiency is crucial to healthy psychosocial adjustment. An ability to communicate in the language of the new culture is integral to refugees finding belonging in their new home. However, not only has the literature shown that engagement in the new, “host” culture is important, but also numerous articles have highlighted the importance of maintaining engagement with one’s native culture. In the case of this family I observed, it was clear that their Afghan friend was instrumental in facilitating the engagement with the new culture as well as fostering for the couple and their son a connection to their native culture.

Wendell Berry notes in his essay “Health is Membership” that health, in its fullest sense, is “wholeness … not just the sense of completeness in ourselves but the sense of belonging to others and to our place.”11

As I left this encounter, I was reminded that while healthcare professionals and the generous volunteers at the clinic do facilitate the “health” of patients, ultimately, a fabric of support, which includes but does not stop with the healthcare team, is needed for these individuals to truly flourish.

Kate Callaghan is a Frist Global Health Leader working at the Siloam Family Health Center with refugee, immigrant, and other underserved individuals.

1Berry, Wendell. “Health is Membership.” The Art of the Common-Place: The Agrarian Essays of Wendell Berry. Ed. Norman Wirzba. Washington: Counterpoint, 2002. 144-158.