Initiative on Asian Americans and Pacific Islanders Blog

Reaching Rural Hmong Communities

Bruce Thao is being honored as a Health in the AAPI Community Champion of Change.

My family arrived in the United States in December of 1975—greeted by winter in Iowa. Like many other Hmong refugee families, they struggled through poverty, learning a new language, and navigating a maze of systems seemingly built to keep them away from the very services they needed. My parents are proud and resilient and were able to make a better life for us despite having just survived war, refugee camps and leaving all they’ve ever known behind. It is this resilience and indomitable spirit which drives me and my work with Hmong American Partnership (HAP) and its subsidiary, Hmong National Development (HND).

Though the Hmong have come a long way having been in the U.S. for almost 40 years, we still have far to go. In 2010, 1 in 4 Hmong families lived in poverty, which is one of the highest rates across race and ethnic groups in America. In addition, the Hmong community has disproportionately low educational attainment rates and high rates of death from cancer and incidence of other ailments such as Hepatitis B, stroke, diabetes and gout. These health disparities can partly be attributed to a lack of health insurance and not receiving preventative care. By the time they are in front of a doctor they may be in stage 4 of liver or breast cancer.

When the Affordable Care Act passed, HAP and HND knew we had to get information out to our communities, particularly for the growing Hmong communities in Minnesota, California, and the South. While states like California, Minnesota and Wisconsin continue to have the highest Hmong populations (over 200,000 in these three states), we have seen an exponential increase in the Hmong population in the South (now over 20,000 Hmong in southern states). They are located in rural communities that do not have the capacity or infrastructure to provide healthcare outreach or education to the Hmong.

The majority of the Hmong in the South lack health insurance, many had never heard of the Affordable Care Act, and are illiterate in both Hmong and English. So we knew we had a tough task to tackle. In Arkansas, Missouri and North Carolina, HND conducted outreach and created relationships between Hmong community leaders, enrollment agencies and healthcare providers, identifying language assistance and interpreters where available. Through community meetings and conference lines, we connected communities across states and rural areas to educate them. To date we have provided education and outreach to over 500 Hmong farmers and families in the South that otherwise have been unreachable by mainstream agencies.

The keys to our success lie in leveraging community leaders and ethnic media and the power of word of mouth. Our history as a persecuted ethnic minority group has forced us to rely on oral tradition to carry our heritage and our identity. We utilize radio, conference lines, word of mouth and the power of story to get the word out to our communities to know that there are resources available and ways to receive healthcare. Our combined national efforts have resulted in close to 20,000 Hmong and other Southeast Asians learning about the Affordable Care Act and over 2,000 receiving healthcare coverage across the country.

Bruce Thao is Director of Programs for Hmong American Partnership (HAP) and Hmong National Development (HND).

Creating Partnerships and Coalitions to Serve a Diverse Community

Teresita Batayola is being honored as a Health in the AAPI Community Champion of Change.

Forty one years ago, idealistic community volunteers and student activists came together to create a free clinic for low-income, isolated Chinese and Filipino elderly in Seattle’s Chinatown-International District.  As waves of immigrants and refugees sought refuge and a home in the Seattle area, ICHS stepped up to embrace new populations with high-quality, affordable healthcare.  That tradition of activism, volunteerism and inclusiveness continues to be vibrant today.

During the movement for health care reform and the passage of the Affordable Care Act, ICHS networked with coalitions around the state to organize, provide patient stories and testimonies, and contact national and state legislators.  Once the Affordable Care Act passed, ICHS advocated for Washington State’s adoption of expanded Medicaid and the establishment of the State’s Benefit Exchange through postcard and phone-in campaigns, meetings with elected officials, patient stories, media visibility, and engagement of non-traditional health care partners. However, elation for Washington’s decision to expand Medicaid and create a Health Benefit Exchange was short-lived as ICHS quickly shifted gears to prepare for outreach and enrollment. 

ICHS knew that enrolling patients, families and community members into the new programs would be a challenge due to the number of immigrants and refugees who had limited English proficiency, varying immigration status, the mixed eligibility for members in the same family, the lack of understanding about insurance and western health care, and uneven financial abilities to maintain coverage.  Nevertheless, the ICHS team of community advocates, health educators, eligibility workers and others began planning outreach and enrollment even with the uncertainty of any funding available.  Thankfully, ICHS successfully obtained funding from the federal government and a private foundation to hire 6 In-Person Assisters.  ICHS leveraged the funding to obtain training and certification for 25 staffs to provide in-person assistance. 

ICHS’ in-person assisters, community advocates, health educators, and eligibility workers worked to actively help anyone learn about health reform and apply for insurance. All of these staff are bilingual and bi-cultural and provide enrollment support in at least one Asian or Pacific Island language, including Cantonese, Khmer, Korean, Mandarin, Punjabi, Samoan, and Vietnamese. ICHS also partnered with community based organizations, faith-based organizations, grocery stores, community centers, and libraries to meet the community need, sending staffs to train others and scheduling field enrollment sessions in addition to appointments in ICHS clinics.  An example of a key partnership is with the City of Bellevue’s mini City Hall located in a shopping center.  The mini City Hall provided space for the in-person assister and assistance with Russian and Spanish languages, while another partner, Chinese Information and Service Center, provided Chinese interpretation.  ICHS staffs remained positive throughout enrollment even when faced with the challenges of appointments longer than an hour due to interpretation and the complexity of individual or family status, combined with the technical challenges of the Exchange.

Teresita Batayola is the Chief Executive Officer of International Community Health Services (ICHS) in Seattle, Washington.