COLUMBIA — Roda Abdi took her first steps in Ethiopia, where her mother had fled to escape war in Somalia. She grew up a foreigner. But her next home would be even more foreign.
Last August, Abdi traveled from an Ethiopian refugee camp with her two young children and stepped off their fifth and final plane at the Columbia Regional Airport. She was the first of her family to arrive in the U.S.
"It was hard to travel with the kids," she said, using a translator named Shukri Hussein.
"Carry this one, push that one, running."
They'd spent seven years at a camp in Jigjiga, Ethiopia, waiting for multiple background checks, medical examinations and a U.S. nonprofit to sponsor them in order to gain refugee status and plane tickets.
Other members of her family joined them in October: Abdi's mother, Amina; her brother, Aidrus; and her sisters, Romla and Halimo. But even after nine months of acclimating to a new culture together, there is still a lot to figure out.
Especially when it comes to health care.
Projects for progress
Kristin Sohl, a doctor at the MU Thompson Center for Autism, knows it can be tough for refugees to navigate the health care system. Especially when it comes to kids.
“We are a community that has an ever-growing population of refugees," she said. "No matter your political beliefs or associated feelings about refugees, they’re here.”
Sohl and a team of MU medical professionals formed a council in March called the Interagency Council of Immigrant Health to discuss how health care providers and community members can better serve refugee families. Members call their current plans Project R.E.A.C.H., which stands for Refugee Education and Access to Child Health.
The council includes medical professionals, local nonprofit leaders, teachers and staff from Columbia Public Schools, librarians and refugees. They hope to pool resources and knowledge in order to help both health care providers serving refugees and refugee families.
The council was formed after Sohl and Kristin Koehn, a pediatrician at MU Children's Hospital, received a grant from the American Association of Pediatrics. The grant is specifically for Columbia's growing East African refugee population. However, Sohl said that will not stop the council from possibly working with other refugee and immigrant communities as well.
Columbia is expected to receive 210 refugees for the 2016 fiscal year that ends in October, according to an email from Grace Wildenhaus, a coordinator at Columbia's Refugee and Immigration Services office. Fifty-seven of those individuals are from the East African countries of Eritrea, Somalia and Ethiopia.
"We, as a community, want to make their resettlement smooth," Sohl said.
Beyond basic needs
Mohamed Dek, Roda Abdi's 2-year-old son, leaned forward. On the TV screen, "Spiderman" teased a princess.
Dek giggled. Laughter has no language barrier.
When the family first arrived, Dek got sick and lost his appetite as his body adjusted to "weather differences," Roda Abdi said. He is getting much better.
The Abdi family has a primary care doctor and a ride to their appointments. Roda and her children have Medicaid, and her mother and siblings are working with the Central Missouri Community Action office to get health insurance.
Yusuf Mohammed, the Abdi's case manager at Refugee and Immigration Services, said the office has 90 to 180 days to help clients get their basic needs covered. That include housing, employment, Social Security cards, a primary care doctor, Medicaid and information about how to ride public transportation.
It's a lot to sort through.
Refugees can continue visiting the Refugee and Immigration Services office for up to five years after their arrival, at which point they are eligible for citizenship and are expected to be self-sufficient, Mohammed said.
The council hopes to aid that process.
One of its top goals is to train primary care providers for more culturally-responsive care. During two different council meetings, Sohl and several other members expressed concern that doctors were not following up with their refugee patients as much as they should. Refugees don't always know what to ask. Even with the presence of translators, there can be a lack of communication, leading to confusion about a diagnosis or a prescription's correct dosage.
Roda Abdi said they haven't had much trouble at doctors visits. As of mid-June, however, she was still waiting for a call about an appointment for her son, which she tried to set up in April. She wasn't sure what her next step should be.
"It was hard for me, I was waiting for them to talk to me, but I don't have a lot of time," she said.
Project R.E.A.C.H. has also helped develop curriculum for resident physicians. Residents from four contributing pediatric programs in Kansas City, Columbia and St. Louis will start the program in July, Koehn wrote in an email. Over a two-year period, participants will partner with refugee and immigrant community leaders to identify needs, develop projects, learn about legislative advocacy and gain a better cultural awareness of their local community.
This training is one of the first of its kind, Koehn wrote.
For the kids
Around the same time that Dek was watching "Spiderman," Muntaaz Deekh, Roda Abdi's 4-year-old daughter, was on her "Frozen"-themed tricycle. She pedaled before the Abdi family, who sat in a circle on couches and chairs lining the living room.
The moment she dismounted, her brother rushed to take over the new toy. A shouting match followed.
Roda Abdi said she would like to do recreational activities with her family, such as going to a park or the library, but they lack transportation and time. They share one car, work at night and sleep in the day.
In order to reach out to families such as the Abdi's, the council has also partnered with a local nonprofit called First Chance for Children, to launch Lend and Learn mobile libraries in the fall. The libraries will make books and toys available for free check out. They will be set up periodically at church services and in neighborhoods where many refugees have settled.
"It's intended to go where they are," Sohl said.
Overall, the council plans to keep expanding its reach because the number of refugees is growing.
As of May 31, the U.S. had admitted more than 41,000 refugees, out of a planned 85,000 for the current fiscal year, according to a refugee admissions report from the Refugee Processing Center
Of those, 908 have settled in Missouri, and, of those, 389 are East African and 245 are Somalian.
But those numbers are missing someone Roda Abdi knows very well.
“The kids’ father is not here," she said. "I need him to get to the U.S."
Roda Abdi's husband, Abdi, is still in Ethiopia with her brother and brother-in-law. Roda Abdi began the long and unpredictable process in August to help the rest of her kin get to Columbia.
For months, they waited. Roda Abdi and two of her siblings went to work at the Walmart on Broadway, while another sister worked as a housekeeper at the Stoney Creek Hotel and Conference Center on Providence Road.
Then in June, Roda Abdi received a letter about her husband's refugee status.
He had been approved.
His case was then sent for further review at the U.S. Citizenship and Immigration Services visa office in Manchester, New Hampshire. Soon, Abdi hopes, her children will be watching "Spiderman" and riding tricycles with their dad nearby.
She smiled wide at the thought.
Supervising editor is Blake Nelson.