In the exam rooms at Samuel U. Rodgers Health Center in Kansas City, nurse practitioner Greg Nurrenbern sees a lot of health problems other health providers don’t.
“I will say, like, ‘How did you get this injury?’” Nurrenbern says. “And it’s like, ‘I fell off a camel,’ or ‘I got bit by a lion.’”
Nurrenbern specializes in refugee health care, and he gives many patients their first health checkup in the United States.
Many of them have fled violence or persecution, and the stress and trauma of their previous lives – plus the shock of coming to the United States – can still be palpable.
“Their blood pressure can show that they’re anxious,” Nurrenbern says. “Or during a physical exam, you realize they’re profusely sweating or kind of shaking a little bit.”
For many refugees, Kansas City is the promised land. So the goal of the U.S. refugee program and local organizations like Samuel Rodgers and Jewish Vocational Service, Kansas City isn’t just getting them out of harm’s way. It’s getting them employed and self-sufficient.
Programs like these have been fairly successful at finding refugees jobs in industries like meatpacking, hotels and manufacturing. Male refugees are typically employed at a higher rate than U.S.-born men, and employment among female refugees is about equal to those born in the U.S., according to the Migration Policy Institute, a Washington, D.C.-based think tank.
But these kind of success stories are becoming more infrequent among newer groups.
Fartun Mahdi, who is in her mid-40s; her husband, Ali Shamun, who thinks he’s in his mid-40s but isn’t really sure; and their children are still getting settled into their new apartment in northeast Kansas City.
The family arrived in the U.S. with their children in December, escaping the violence in their home county, Somalia, after years of trying.
On a recent afternoon in their still mostly bare home, Mahdi was dressed modestly, with a black bati covering her head. Shamun wore a lavender-colored sarong-like garment called a macawis that contrasted sharply with his polo shirt, which was emblazoned with the Kansas City Chiefs logo.
“We were always in a worry,” Fartun says through an interpreter. “We were always afraid that we were going to be next.”
Somalia has been steeped in chaos for decades, rocked by civil war, genocide and most recently, the murderous Islamist extremist group Al Shabaab.
Mahdi’s sister was killed in the violence and the couple now raises her son along with their own six children.
Mahdi says that, now that they’re in the U.S., she’s optimistic for her children’s future.
“We’re looking forward to having our kids go to school and learn a lot and get office jobs,” she says.
For decades, most Kansas City refugees came from countries like Cuba, Vietnam, Russia and other Soviet bloc countries. Some had helped the U.S. in conflicts abroad and many were well educated, even more so than most American-born citizens.
But in the mid-1990s, the U.S. refugee strategy started shifting to help people escape some of the world’s most violent hotspots.
Today, refugees arriving in Kansas City come overwhelmingly from places like Somalia, Myanmar and the Democratic Republic of Congo.
“A lot of these are some of the poorest countries in the world. And because the countries are so poor, a lot of that has to do with the kind of background that will make it more difficult for them to integrate here in the U.S.,” says Randy Capps, director of research with the Migration Policy Institute.
Capps is an author of a recently published a study on the long-term socioeconomic outcomes of different refugee groups.
He says many of these new waves of refugees, who have sometimes lived for decades in war or refugee camps, are at a disadvantage compared to earlier groups because of their lower levels of education or literacy.
The sheer diversity of the new groups can create problems as well.
As Galen Turner, a refugee team leader at Jewish Vocational Service, Kansas City, explains, they’re not just coming from different countries like Myanmar but from different groups within those countries that have their own languages and cultures.
“If you are Karen, you speak Karen or Burmese, usually, and you’re of one ethnicity,” Turner says. “If you’re Karenni, you’re of an utterly different ethnicity, and you don’t even speak a language that’s understandable. It’s a totally different language. To us, these gets really confusing, because we’ve had some Karenni arrive as Karen and we have no way to speak to them.”
Newer groups are also arriving in a post-recession U.S., when it can be harder to climb out of the lower economic rungs than before. On top of that, they have been forced to deal with reduced social services as governments institute fiscal cuts.
As recently as 2000, refugee families who had been in the U.S. for 20 years showed no economic difference with native-born families. But Capps says that’s changed in the 21st century.
“The refugees more recently, when we looked at them with the 2010 data, weren’t doing quite as well,” he says. “They’ve still seen their incomes rise over the long period that they’ve been in the U.S. but not rise as quickly.”
Refugees in the Midwest are probably better positioned for success than others because the region generally boasts lower housing costs and experienced less economic fallout from the recession.
But to reach the level of achievement of earlier groups, Capps says, newer refugees could use extra help with their English and job skills. And he says it may be time for a new approach to mental health issues like depression and PTSD, which are especially common among people who have lived through war.
“Mental health is a little trickier because it’s cultural,” Capps says. “It’s not the same for everybody, and finding people who are qualified, trained in mental health, but also can speak the right languages and address the cultural issues in these refugee communities is very difficult.”
On a recent afternoon, Samuel U. Rodgers care coordinator Fatima Mohammed, whose family is Somali, gives a refugee orientation in a room filled with a few parents and lots of children.
These early refugees from newer groups are paving the way for future group members. Experts say that as a community becomes more established, it’s more likely that new members will thrive.
But the corollary of that is that parents who struggled through war to bring their families here are unlikely to benefit from their new lives as much as their children.
“I think the first generation never really feels at home here,” Turner says. “But the second generation, usually – if they’re young enough – they speak usually without an accent. They grow up with American ideas. I don’t think the parents ever reach that level of comfort.”
Alex Smith is a reporter for KCUR, a partner in the Heartland Health Monitor team. You can reach him on Twitter @AlexSmithKCUR