Once in Sacramento, Nelha, 24, relied on a county translator to help her enroll in Medi-Cal, California’s Medicaid program, to cover the cost of visiting an optometrist. “I need glasses to pass my eye test and get a driver’s license so we can start looking for work,” Nelha said through an interpreter. She plans to find a job in one of the city’s dozens of Ukrainian and Russian restaurants.
The thriving Slavic communities in the California cities of Los Angeles, Sacramento, San Diego, and San Francisco have become magnets for Ukrainians fleeing war less than a year after the state experienced an influx of Afghans in response to the U.S. withdrawal from Afghanistan. Many refugees need health care immediately, for conditions such as pregnancy, high blood pressure, and diabetes or because of trauma they’ve recently experienced.
But the social service agencies tasked with delivering much of that care are straining to keep up with demand. Understaffed after years of dwindling funding, they’re now desperate for skilled interpreters who can walk newly arrived refugees through the application process and attend clinic appointments with them.
“We have four staff who speak Russian or Ukrainian, and we really need three more to meet all the demand,” said Dr. Sumi Mishra, medical director for Sacramento County’s Department of Health Services. “We can’t find them.”
The shortage 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.
“It really laid bare where the gaps were,” Desmond said.
The problem appears to be more severe in Sacramento County because of the influx of refugees to the region. The Los Angeles County Department of Health Services, for example, said it has enough interpreters to meet demand.
More recently, the state has welcomed an influx of Afghan refugees.
Because of U.S. involvement in Afghanistan, many Afghan refugees could apply for special immigrant visas, which took time to process and gave states and counties advance notice of how many people might be coming their way and when, Desmond said.
When Afghans began settling in Sacramento last fall, the county used state funding to hire shift interpreters, part-time workers to bridge language gaps. It contracts with a half-dozen translation services to fill those spots, but Mishra, the county medical director, said hiring full-time staff would be preferable.
Refugees often have pressing health needs.
New immigrants must take a tuberculosis test within 14 days of arriving in the U.S. And common health problems include elevated lead levels in children, high blood pressure, and diabetes. Health workers also screen people for region-specific issues — such as a bacteria found in Afghanistan that leads to gastritis, and thyroid disease, a potential consequence of the Chernobyl nuclear disaster, among Ukrainians.
Mishra worries about invisible scars, too.
“Many of these people were experiencing PTSD,” she said. “They were coming out of very, very traumatic situations — in some cases seeing family members die. But it’s something that is not really discussed openly within their community. We often have to ask a lot of questions for that to reveal itself.”
Noel Sanchez, a spokesperson for the San Francisco Department of Public Health, said doctors screen carefully for signs of depression, anxiety, and post-traumatic stress disorder.
Some of the county translators’ duties include guiding newcomers through the layered U.S. health care system. When Russian refugees Andrew Dozhdev, 25, and Kivil Spassky, 21, were asked in Sacramento in June whether they had seen a doctor since fleeing their country because of their opposition to the war, both shook their heads and hesitated.
“I hope I don’t need one,” Dozhdev finally replied.
With county agencies understaffed and overwhelmed, the task often falls to nonprofit and community or religious groups. Dmitriy Pridyuk, senior pastor at Revival Christian Center in Sacramento’s Foothill Farms area, said his church is housing about 35 immigrants on a short-term basis, providing them with a place to sleep and shower, food, and other assistance.
As for the care itself, county health officials said they are committed to serving refugees, although their staffing shortages are unlikely to be resolved soon.
“More and more families are just showing up at our doorstep,” Mishra said. “We made the decision that we were not going to turn them away even if we don’t have a clear read on their legal status.”
