Presentation Title (IN ALL CAPS)

WHY DID MRS. X DIE? MULTI-LEVEL INFLUENCES ON HEALTH AND HEALTHCARE AMONG A REFUGEE WOMAN FOLLOWING RESETTLEMENT IN TARRANT COUNTY

Departmental Affiliation and City, State, Zip for All Authors

School of Public Health, Fort Worth, Texas 76107; Department of Obstetrics and Gynecology, Fort Worth, Texas 76107

Classification

SPH Student (For Competition)

Research Presentation Category

Health Disparities

Brief Narrative or Summary

This case study explored the multilevel influences and conditions leading to the liver cancer death of a 41 year old refugee woman. A review of existing medical records, Building Bridges Initiative case files and medical case management files revealed individual, cultural, family, community, health provider and health care system factors that hindered timely treatment and care, as well as missed opportunities for community education and system improvements.

Scientific Abstract

Why did Mrs. X Die? Multi-Level Influences on Health and Healthcare among a Refugee Woman following Resettlement in Tarrant County Victoria J. Kwentua BA*, Amy Raines-Milenkov DrPH**, Tania Lopez CNM, MS**, Eva Baker MPH, CPH**, Neneh Wurie MPH, CPH**, Ralph Anderson, MD** *School of Public Health, **Department of Obstetrics and Gynecology, University of North Texas Health Science Center, 3500 Camp Bowie Blvd., Fort Worth, Texas 76107 There are several barriers working against the refugee population when it comes to health that result in increasing rates of Hepatitis B (HBV) related morbidity and mortality. Worldwide, there are two billion cases of HBV; refugees make up four million of those cases. The present case study examined the experiences of a refugee woman who died from liver cancer less than four years after resettlement. A review of the patient's medical records, UNTHSC Building Bridges Initiative (BBI) case files, and medical case management files illustrate how multi-level influences prevented her from receiving adequate and timely care. The analysis revealed missed opportunities to address the patient’s liver cancer and HBV status. Lack of insurance and community members advising the patient against chemotherapy may have also impacted the patient’s decision to miss multiple oncology consultations and follow-up appointments after the surgery. Though records supported a gap in the health care system, it is possible that the patient lacked understanding of the severity of her illness, or was unable to sufficiently advocate for herself. Had BBI, or a similar advocacy and navigation service, been in place and accessed at the time of initial diagnosis, perhaps the outcome might have been different for Mrs. X. In the last few months of her life, BBI and medical case management brought Mrs. X back into care, helped her understand her condition, and improved her communication with providers. Without navigation and advocacy services, refugees like Mrs. X might continue to get lost in the U.S. healthcare system. Keywords: refugee resettlement, Hepatitis B, medical case management

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WHY DID MRS. X DIE? MULTI-LEVEL INFLUENCES ON HEALTH AND HEALTHCARE AMONG A REFUGEE WOMAN FOLLOWING RESETTLEMENT IN TARRANT COUNTY

Why did Mrs. X Die? Multi-Level Influences on Health and Healthcare among a Refugee Woman following Resettlement in Tarrant County Victoria J. Kwentua BA*, Amy Raines-Milenkov DrPH**, Tania Lopez CNM, MS**, Eva Baker MPH, CPH**, Neneh Wurie MPH, CPH**, Ralph Anderson, MD** *School of Public Health, **Department of Obstetrics and Gynecology, University of North Texas Health Science Center, 3500 Camp Bowie Blvd., Fort Worth, Texas 76107 There are several barriers working against the refugee population when it comes to health that result in increasing rates of Hepatitis B (HBV) related morbidity and mortality. Worldwide, there are two billion cases of HBV; refugees make up four million of those cases. The present case study examined the experiences of a refugee woman who died from liver cancer less than four years after resettlement. A review of the patient's medical records, UNTHSC Building Bridges Initiative (BBI) case files, and medical case management files illustrate how multi-level influences prevented her from receiving adequate and timely care. The analysis revealed missed opportunities to address the patient’s liver cancer and HBV status. Lack of insurance and community members advising the patient against chemotherapy may have also impacted the patient’s decision to miss multiple oncology consultations and follow-up appointments after the surgery. Though records supported a gap in the health care system, it is possible that the patient lacked understanding of the severity of her illness, or was unable to sufficiently advocate for herself. Had BBI, or a similar advocacy and navigation service, been in place and accessed at the time of initial diagnosis, perhaps the outcome might have been different for Mrs. X. In the last few months of her life, BBI and medical case management brought Mrs. X back into care, helped her understand her condition, and improved her communication with providers. Without navigation and advocacy services, refugees like Mrs. X might continue to get lost in the U.S. healthcare system. Keywords: refugee resettlement, Hepatitis B, medical case management