Analyzing Barriers and Perceptions in Obstetric and Gynecological Care for Congolese Women in the Columbia

Refugee Community
Alexis Vetack, Baccalaureus Artium et Scientiae; Dr. Breanne Grace, Social Work

Background
According to the United Nations High Commissioner for Refugees [UNHCR] (2017), there are currently 68.5
million people who have been forcibly displaced from their homes worldwide. Many of these displaced individuals try to
receive third country resettlement, but the number of those who do receive refugee status in a developed nation with
enough resources to provide for immigrants is less than half of one percent (UNHCR, 2017). In regard to refugees being
resettled in South Carolina, the Refugee Council USA stated that the state of S.C. welcomes less than 1% of the refugees
arriving in the U.S. In 2016 specifically, South Carolina welcomed 350 refugees and 562 unaccompanied children who
were released to the care and custody of sponsors. The federal funding being distributed to aid refugee programs totaled at
$579,735 for 2016, with $418,412 going to specific cash and medical assistance. Typically, after eight months, federal
funding for medical assistance is terminated and the families must apply for Medicaid eligibility in order to continue
receiving medical care. (Morris, Popper, Rodwell, Brodine, & Brouwer, 2009). These requirements place hardships on
refugees seeking resettlement, requiring these individuals to pursue medical resources without the prior knowledge to
navigate a new healthcare system, especially expecting mothers looking to deliver a baby for the first time in the United
States. Despite concerns of such an issue, the current literature lacks an understanding about the new realities for refugee
women in OB/GYN care created by mass migration patterns, especially in cities across the United States. For this reason,
I decided to propose a research project that examines if barriers exist when resettled refugee Congolese women go to
access the available obstetric and gynecological healthcare systems in Columbia, South Carolina. Our project desires to
understand their OB/GYN experiences in the U.S. healthcare system and if any barriers exist while seeking care. With our
findings, our team hopes to share said interviews so that local and national healthcare providers can be more culturally
competent when serving a minority refugee population.
Research Question
The overarching research question to be answered is, "Do Congolese refugee women face structural and cultural
barriers when attempting to access obstetric and gynecological services in Columbia, South Carolina?" and if so, "What
are the current barriers that exist?"
Project Goals and Objectives
 Continue practicing conducting interviews and field observations
 Collect data through various research methods then code the data for repetitive themes identified throughout the
project
 Contribute to existing literature helping to identify OB/GYN barriers for unique ethnic populations in distinct
locations
 Suggest solutions on how to address the identified barriers to healthcare professionals
 Further extend upon my relationship in the local refugee community
Project Significance
Accessing quality healthcare services is an internationally acknowledged human right. An assessment on the
potential OB/GYN barriers female Congolese refugees face in Columbia will provide new tools on how to improve care
for these women in the obstetric and gynecology fields. Using a qualitative approach combined with my established
position in this community will provide insight to barriers this unique population may face. With the data collected, I will
then work alongside my mentor and participants to advocate for equitable health in our local area.
Project Design, Tasks, and Methodology
In regard to data collection, I intend to apply the methods of field-observation and individual interviews with a
research population of ten (n=10). The field observations will help me to better understand the individual’s behavior at an
obstetric or gynecology appointment and to also witness their interaction with their health provider in person. I will
conduct field-observations at various healthcare setting depending upon where their examinations are administered.
Individual interviews will allow me to receive insight into my participant’s perspectives about their experience throughout
pregnancy. I hope to conduct at least two interviews with every participant in addition to the in-clinic observation of their
physical examination. The purpose of two interviews is so that I have the opportunity to review and analyze the first
interview before I ask follow-up questions about certain topics I am curious about at the second interview. All interviews
will require a translator. Dr. Grace, my mentor, is fluent in Swahili and will aid me with the translation for interviews.
Congolese refugees make up part of the majority of the refugee population in Colony East where we will conduct
interviews. In addition, Dr. Grace has led a women’s group in the past with Congolese women, so many of them will
already be familiar with her involvement in the community. No data collection will begin before IRB approval is received.
 This research project will collectively tie together my BARSC major. To prepare for this project, I have worked in
the Neurodevelopmental Disorders Research Lab on their clinical study about infants with autism with the Honors SURF
grant, completed a graduate level qualitative research course (Qualitative Inquiry 731) and honors class called Refuge and
Refugees, as well as spent the past two years serving in the refugee community as an intern and volunteer. In regard to
working with my mentor, I plan to communicate with her on a weekly basis and have in person meetings on a bi-weekly
basis. I will see her at all interviews conducted since she will be assisting with translation. In addition to these instances, I
plan to take on her social work courses in the spring so that I can communicate with her more regularly about the project.
Dr. Grace has conducted multiple research projects with refugees in the past and is an expert in her field. I will ask for
guidance along every part of the project.
Project Timeline
Months(12 total) Oct Nov Dec Jan Feb Mar Apr
Refamiliarize self with
previous literature on subject
area
Prepare interview protocol and
coding forms for field
observations
Schedule when field
observations will occur
Conduct interviews and field
observations
Transcribe interviews
Analyze and code data
Review coding and begin to
draft findings
Revise findings
Present results

Anticipated Results
Based upon my past experience within the refugee community and review of past literature, I anticipate that there
will be barriers the refugees face in regard to their obstetric and gynecological care. To combat this assumption, I will
review interview protocol with my mentor to make sure questions are not biased in a way that leads my participants to
assume this viewpoint as well. The themes that I believe will appear in our data are that of language, transportation,
finances. I am aware that we may face difficulty in scheduling to make sure that interpreters can attend interviews.
Additional problems I foresee being an issue is the ethical issue of vulnerability. Refugees are an incredibly sensitive
population, and I do not want to further subject them to situations that retraumatize them. In order to be culturally
sensitive, I will work closely with Dr. Grace and the head physician, Dr. Rajeev, at CSC. Once our research is completed,
I hope to compose a qualitative journal article and present our results at conventions such as Discover USC. By
presenting, I can then advocate on behalf of more studies to be conducted in refugee communities and advocate for an
increase in culturally competent healthcare to refugees in the United States.
Personal Statement
My major is the Baccalaureus Artium et Scientiae major encompassing public health, social justice, and public
policy on a premedical track. Upon graduation, I intend to pursue an MD/MPP program to fulfill my aspirations of
working as a CDC Infectious Disease Specialist on Global Health Policy Issues. For the past three years, I have served the
refugee community, and I believe my current positionality makes me the best candidate to conduct this research
assessment. I have already established rapport within the community. As I engaged with this population, as a volunteer
and intern, I developed a better understanding of who these unique individuals are in relation to their background,
knowledge that could only be gained by spending many hours with the community. I believe this level of involvement is a
necessary requirement for this population because they are a sensitive in regard to situations they have experienced and
therefore do not need to be exposed to a rotating door of researchers. As I attempt to pull narratives and perspectives from
interviews, my developed relationship with CSC families may encourage them to open up more. In addition, I have
furthered my humanitarian worldview and a desire to help underserved populations by serving CSC and completing
courses related to global health and health inequities. I believe it is this perspective that has provided me with the
compassion and empathy to develop strong relations in the refugee community, and I will continue to use these qualities
as I conduct research to establish further rapport and advocate on their behalf.
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