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For Bhutanese refugees in New Hampshire, language barrier poses challenges in healthcare access

At the Manchester headquarters of the Bhutanese Community of New Hampshire earlier this week, about two dozen refugees brought questions about the New Hampshire Health Protection Program and other health care issues.

Could they still apply for the program, the state’s version of Medicaid expansion, if they didn’t get coverage under the Affordable Care Act?

Yes, Laura McGlashan of the Office of Minority Health and Refugee Affairs assured them.

If someone qualifies for the state’s Medicaid expansion now but his or her income may increase later in the year, what happens?

It would depend on the amount of the increase, McGlashan said, but that person might be eligible for ACA subsidies that would offset the cost of health insurance. She also said it’s always important to report any “life changes” – in family size, for instance – as soon as possible.

And when applying, could someone write directly on the documents in Nepali or another native language?

It would probably be best to get help from someone who could complete the application in English, McGlashan and a colleague said.

Indeed, the language barrier poses recurring challenges to the state’s Bhutanese community when it comes to accessing medical treatment. For many of them, communication can be as much of a challenge as costs or care.

These barriers can be especially pronounced in older community members, said Tilak Niroula, who edits a newsletter for the Bhutanese Community of New Hampshire and produces a show about Bhutanese refugees for ConcordTV.

“They’re in their 80s, 90s, 70s, and they don’t know how to even write their language, don’t know how to read their own language,” Niroula said. “Many of them have language problems and don’t know English.”

Translators, in person and otherwise, are critical, Niroula and others said.

At the Bhutanese Community’s information session, health coordinator CM Niroula and volunteer Roshni Humagai took turns translating questions from Nepali to English for McGlashan, and then vice-versa for McGlashan’s answers. A handout explaining the New Hampshire Health Protection Program was also translated into Nepali and distributed to those at the session.

CM Niroula said issues can also come up when a member of the community tries to contact the Department of Health and Human Services or other agencies with questions about health care. The Bhutanese Community of New Hampshire also tries whenever possible to connect refugees with case managers who can help with scheduling or act as a liaison for doctor visits, Tilak Niroula said.

Staff at HHS have also been trained to recognize when someone calling doesn’t speak English fluently in order to connect that caller to a translation service, McGlashan said.

She also encouraged community members to let her know about any issues they encounter during the application process or in other interactions with the department: “If you encounter problems, let me know and I will try to help.”

About 1,980 Bhutanese refugees have resettled in New Hampshire since 2008 – the largest group from any one country since 1997 – according to data on the state’s Office of Minority Health and Refugee Affairs website. In 2013 alone, according to the data, 176 refugees relocated to the state from Bhutan, 85 from the Democratic Republic of Congo, 52 from Burma-Rohingyan, 77 from Iraq, 15 from Somalia, eight from Sudan, six from Burundi and six from Rwanda.

The Office of Minority Health and Refugee Affairs held additional sessions on the New Hampshire Health Protection Program with other refugee groups this week – including another one for Concord-area Bhutanese refugees – as it has in the past to spread the word about other health care issues, McGlashan said.

The office has also provided training on the Affordable Care Act to other agencies and social service organizations that work with refugees, McGlashan said.

At each session, McGlashan said, she provided a general introduction to the New Hampshire Health Protection Program and tried to answer basic questions. She encouraged those with additional questions or concerns to contact the department directly or refer to information about the program online.

The Bhutanese Community of New Hampshire also provides in-person assistance with enrollment for refugees. Tika Acharya, executive director of the Bhutanese Community of New Hampshire, said the organization stands ready to help those from all parts of the world navigate their health options.

“Even though our name is the Bhutanese community, our door is open to all other communities as well,” he said.

(Casey McDermott can be reached at 369-3306 or cmcdermott@cmonitor.com or on Twitter @caseymcdermott.)

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