Afghan Newcomers Resettlement Project Update 4

Hold Music

“We are experiencing unprecedented call volume. Please wait and an operator will be with you shortly.” We listened to the hold music for an hour. As soon as it came on my mind flashed to the time two years ago when I waited for 7 hours to reach an agent with Arizona’s Department of Economic Security. I cringed, remembering, then turned to the nurse who was humming the hold music. I started drumming the beat on my legs. The father, sitting across from me and dressed in a thin, gray patterned hospital gown, smiled. The music suddenly stopped and for a moment we thought we’d gotten through to the translator. There was a period of silence. We sat very, very still. Then the hold music cut in again and we all sighed and started laughing.

It was a relief to see the father at ease. I’d picked him up at 9 in the morning to take him to a local hospital for a minor medical procedure. He was in severe discomfort and had been for several days. In the week leading up to his appointment with the outpatient surgical clinic, he’d gone to the ER and visited with a specialist. His suffering frightened his wife who was understandably worried about him and about herself and their kids.

On the day of the procedure, the family was out in front of their new hotel room—a two-bedroom suite with a kitchenette. The mother and the kids were catching rides downtown to join a trolly tour of Savannah the resettlement agency had set up. The father held his littlest girl, hugged her, and said good-bye to the others and walked to my car. I looked back at the family and saw that his wife was crying.

There was no traffic. We parked and checked in at the hospital’s outpatient clinic and took seats facing a row of floor to ceiling windows. It was a beautiful, warm day and sunlight brightened the entire waiting room. A soap opera played on a TV behind us. A young couple to the right whispered to each other. I sat beside the father and tried to reassure him by explaining the details of the process as I understood them: someone would escort us to a private room where a nurse would ask a bunch of questions; there would be a translator; he’d meet with the doctor who would explain the procedure; after the surgery he’d wake up from the general anesthesia in a recovery room; I’d be waiting for him there and help take care of the discharge paperwork then take him home.

The father listened and nodded but whether he understood what I was saying, in full or partly or not at all, didn’t seem to matter, now that I think about it. The gesture of reassurance gave us something to share in the time of waiting and before too long the receptionist called his name and we both stood up quickly and walked back.

A nurse welcomed us in a small room, fitted with two chairs, an adjustable hospital bed, several stands, and two carts. To one side, behind a curtain, was a toilet and sink. She motioned for the father to take a seat on the bed. She turned to me and asked if I would translate her questions. I told her I don’t speak Pashto and that we would need translation services. She said, “No problem,” dashed out of the room and spun back inside, wheeling a touchscreen computer mounted on a sleek, compact cart. She tapped the screen a few times, looked at me and said, “Pashto?” I nodded. She nodded and tapped the screen again.

There was a loud ringtone. An operator picked up almost immediately and the nurse explained that we needed someone to translate Pashto. The operator said that she’d try to find someone, but Pashto was in high demand, and we might have to wait a while and if we’re on hold for too long the call would drop and we’d have to call back. The operator apologized for the inconvenience and before the nurse had a chance to ask a follow up question the hold music started.

We waited. The nurse opened the door and stepped out to get something. The father looked at the TV screen mounted on the wall opposite the bed. There was a slideshow of nature images: mountains in winter; an island beach; red rocks. I listened to the hold music knowing I would fall asleep to it that night and then completely forget the melody the next morning.

The nurse returned with an IV bag. The hold music stopped, and the call went silent. The music cut in again. The nurse asked the father a few questions about previous injuries and whether he’d had surgery before and if he was afraid of needles. He said “Soldier” and pointed to different parts of his body, intimating wounds and scars, then, responding to the question about needles, exclaimed, “Afraid!” He laughed. The music stopped. We waited, and finally a voice spoke, a woman’s voice, a kind and clear and confident voice, asking us if we needed help translating Pashto.

The nurse got to work. She asked the litany of questions from the preoperative screening. The translator translated. The father replied. The translator spoke to us in English, and everything thereafter unfolded quickly.

The power of translation amazes me. Our three-way communication up till then had relied on the few words we understood in common, a lot of gestures, guesswork, and trust. Now, complex ideas were flowing back and forth. The father was enlivened by the ability to express “exactly” what he wanted to, and by his confidence that we understood him. The translator became an integral part of the encounter, too. Her gentle yet precise tone of voice and the shape she gave to the words we did and did not understand, drew us together. We felt familiar to one other.

At the end of the call, we each thanked the translator, who thanked us. The nurse turned to the father. She was quiet for a moment, then asked him if he was ready for the needle. In all my time with the family I have never seen him so at ease. Laughter spilled out of him, despite the pain and circumstances. It was so good to see.

The father was prepped. We waited. He fell asleep for an hour or so, then the doctor arrived with two nurses, who asked me kindly to wait in the lobby or go for a walk and grab lunch. I left the room as they wheeled the father to the OR.

I got a call about an hour later from the doctor who told me the surgery went well. The father was resting in a recovery room. A short while later the discharge nurse invited me back.

About three years ago I got sick from a stomach bug. I couldn’t recover, my condition worsened, and I ended up in the hospital. The doctors performed an endoscopy to scope out what was causing the problem (i.e., internal bleeding). After the procedure, as I woke up from the general anesthesia, I found myself in a large room with dozens of other patients. We were separated by thin curtains hung from ceiling mounted tracks. There was lots of talking. Every patient had a nurse attendant and it seemed as though the dozen or so people beside me were pouring out their souls, confessing secrets, sharing intimacies, advancing expansive, speculative claims about pet ideas and experiences more appropriately suited to private conversation. I was quiet, only because I found what the others were talking about so fascinating.

The father was awake when I entered the recovery room. He sat upright when he saw me and grinned. He took some sips of ginger ale and ate a cracker then offered me some. I politely declined but he insisted. He asked me about my wife and my kids and what I do for work and where my parents live. He talked about Afghanistan and his first experiences in the U.S. and expressed several times his gratitude for those of us helping him and his family resettle. He talked about his hope to find work and his desire for a home and his fear of earning a living in the U.S. I had never experienced him talk so openly. We spoke for an hour and then the discharge nurse came in, contacted a translator—this time we didn’t have to wait—and reviewed the postoperative protocols. The father signed a few forms, and it was time to dress, leave, pick up his prescriptions at the hospital’s pharmacy and head back to the hotel.

Prescription Pick Up

The father looked a little shaky as soon as he stood up. The discharge nurse had warned him he’d feel some pain for a few days and uncomfortable for a week or two—which he could manage with prescription meds. As soon as he started walking, he winced and grabbed his left side. He motioned for the nurse and gestured at his arm, suggesting he wanted another shot of the dilaudid he’d been given earlier. She said she couldn’t do that and made like she was swallowing a pill. He shrugged. A nurse appeared with a wheelchair, and he sat down, very slowly.

I hustled to the car and pulled up to the clinic’s entrance and helped the father into the passenger seat. He leaned back and closed his eyes. I told him we’d go to the pharmacy to pick up his medication then return to the hotel. He nodded, grimacing. He had beads of sweat on his forehead.

The pharmacy is in the front of the main hospital building. I parked the car in a spot closest to the entrance and ran inside. I was third in line. The person at the counter pulled out his medical insurance card and the pharmacy technician swiped it through the reader, then handed him his prescriptions. The next person in line did the same thing. After her card was swiped, she chatted briefly with the pharmacy technician while her prescription was being filled. She took her bag and left. Then I stepped up.

I tried to explain that I was a friend of a man, an Afghan refugee, who’d had minor surgery in the outpatient clinic. The discharge nurse should have called in his prescription, and I was here to pick it up. She gave me a puzzled look. The pharmacist suddenly handed her the bag of meds. She smiled and asked about payment. “Well,” I said, and cleared my throat.

I tried to explain that I was volunteering on behalf of a resettlement agency. I talked about the Afghan families arriving in Savannah and mentioned something about a Medicaid application pending approval. She stopped me there and said that was all good but, right now, someone needs to pay for these meds. Luckily, I had a credit card number from the resettlement agency. I pulled out the piece of paper on which I’d written the information: number, expiration date, security code and billing address. The pharmacy tech stared at me like the features of my face were rearranging themselves. The pharmacist must have overheard me talking because he approached the counter and said, “I got this.” He asked me to type the numbers into the card reader and follow the prompts. “Approved” appeared on the tiny screen and the pharmacy tech handed me the meds, still giving me that puzzled, suspicious, and disapproving look.

On the drive back to the hotel and for the remainder of the afternoon and evening, I thought about that moment and encounter. I considered how the father and his family, who have been in the U.S. for many months, still don’t have medical insurance. He was a soldier and fought the Taliban and was wounded in combat and served the U.S. military and fled his home and yet he and his wife and children still can’t receive medical care without being charged for it. I considered how access to medical services is tied to employment—and not understood as a human right—such that people must earn their belonging (and health). I considered how, in my recent application for medical insurance, I was denied a tax credit because my wife and I earn too little. The monthly bill to cover the two of us would total over $800. When we adjusted our projected income upwards by a few thousand bucks, we discovered that we fit the salary bracket that qualifies for a tax credit that would completely cover the monthly expense. Come again?

I believe wholeheartedly that health care is a human right. I recognize it’s a complex system to fix, but to me it seems morally reprehensible that the Afghan families being resettled in the U.S. should face any obstacles, whatsoever, when attempting to access medical services. We put their lives at risk for a future we promised and when the challenge of meeting that promise threatened our self-interest, despite a commitment to resettle the most visibly vulnerable, we haven’t even paved a smooth path for them to meet their health and medical needs. The father from the family we’re sponsoring has shrapnel in his body because of his service to our country (and his). Does this not “merit” health care coverage? It shocks me that he would even need to apply—and given the wealth of our nation, that any of us should have to.

Tea

When we arrived at the hotel, I helped the father to his room. He moved slowly down the hallway and leaned against the wall for support. The door to the suite was open and he shuffled in. His wife was relieved to see him, to talk with him in private, I imagine, but there wasn’t the possibility for that just then. By custom, I think, she felt obliged to offer me tea and it would have been rude of me to decline. Kijin, who’d joined the family for the Savannah trolly tour, was there playing with the two little girls. The mother stepped into the kitchenette to boil water and the father turned to me and said, apologetically, “Sleep” and walked into one of the two bedrooms—the young boys were in the other one, watching TV, periodically poking out their heads and smiling. The father closed the door behind him.

I was relieved to imagine him lying down again. He’d seemed somewhat comfortable in the recovery room, but not since and definitely not on the car ride to the hotel. He had trouble settling into the passenger seat. He fidgeted with his window. His face was pinched from the pain in his side, and he kept wiping sweat from his brow. He sighed when we pulled into the hotel parking lot.

Back in the room, while the mother was preparing tea, Kijin and I talked about the day as the daughters toddled between us and climbed in and out of a car seat on the floor. They giggled and smiled. I showed Kijin the discharge papers and shared some of the doctor’s recommendations, chiefly his encouragement that the father drink more water and cut back on tea, salt and sugar. I recalled something Genki had told me, that many people in Afghanistan don’t have access to clean drinking water and instead rely on tea. Tea, along with foods heavy in sugar and salt—like nuts, a staple of an Afghan diet—often leads to an excess of oxalate, which can cause kidney stones and gout.

The mother brought me tea. It was hot, creamy, sweet, and delicious. I had to sip slowly at first—otherwise I’d burn myself—but I was anxious to finish because I sensed she wanted to be alone with her husband—even if he was already asleep, just to be near him and enjoy the relief of having him back from surgery safely and well (i.e., despite his pain there was no indication he wouldn’t make a full recovery). I noticed some picture cards on the table and the mother watched me look at them and brightened and spoke some words in English. I told her that we would organize another English lesson soon, the following weekend (i.e., we’d canceled the initial one because the father was in the ER). She looked genuinely thrilled.

A few minutes passed and the tea cooled and I swallowed it down. I stood up and Kijin and I started toward the door. I turned to the mother and tried to explain, not so much in words but through the feeling tone of my gestures, that he was going to be OK, that the pain would lessen gradually and that the doctor noticed nothing alarming. I think she believed me, but her eyes looked sad, exhausted, and desperate. Imagine her fear, being roughly transplanted in a totally unfamiliar place, worrying that her husband might be ill and die and what would she do, alone with 5 kids to raise?

We are thin threads in a fabric supporting these families and though the resettlement net is strong in places, it’s weak in others and there are gaps of various sizes without any unified intelligence guiding us how to weave the net whole.

It’s unfortunate that the metaphor of a safety net exists at all, as something to prevent people from free fall. How is it that we’ve constructed a society where, for instance, life’s inevitabilities, such as sickness, old age, and death—to say nothing of the kinds of hardships refugees endure—are regarded as personal faults and failures; where only those who work hard enough—in professions privileged with high wages—can earn access to basic needs like healthy food, quality housing, reliable education, and comprehensive health care?

I don’t think there are safety nets in the Pure Land, but rather gardens so abundant they sustain all beings. Life goes on. People get sick, grow old and die. But instead of clinging to the loosening, frayed ends of threads stitched together to prevent people from free fall, they rest, dignified, in the warm hug of the soil. Grandmother earth has a lap big enough for everybody.

Tucker Sansui Brown