For many immigrants, U.S. health care is a maze without a map

What America's most diverse square mile teaches us about health care access

Somali Plaza in Clarkston, Georgia is the heart of its East African community, a place where Somali, Arabic, and other languages fill the air. People browse shelves stocked with traditional foods, prayer mats, and clothing, part of the rich cultural tapestry in what is often called the "Ellis Island of the South." Immigrants, many once refugees, are from over 150 countries and speak more than 60 languages. Half of its roughly 14,000 residents were born outside of the United States, but they share one common struggle: access to health care.

Happy, a Congolese volunteer health care interpreter who requested to share only her first name, helps guide others through a health care system that often feels like a labyrinth. Her experience with the system does not spare her own family from its barriers. [Editor's note: Harvard Public Health is not citing the full name of Happy and several other interviewees to protect them and their families, due to concern about anti-immigrant sentiment and also cultural norms within some immigrant communities.]

Happy's younger sister, Nastrinia, has suffered for months from persistent hand tremors and frequent vomiting. Their parents, desperate for answers, have taken her to multiple clinics, only to leave each time with uncertainty. One doctor prescribed nausea medication. Another suggested it might be stress. But no one has given them a clear diagnosis. The language barrier makes every visit more frustrating, given that her parents struggle to communicate their daughter's symptoms in English. "It's scary to watch," Happy says. "And it takes a toll on our family."

She sees similar struggles play out when she volunteers, watching mothers try to explain their children's symptoms in broken English, only to be misunderstood repeatedly throughout their appointments. She sees elderly refugees struggle to fill out complex paperwork, their frustration mounting. And she sees the fear in their eyes, the fear that the system will fail them as their hopes for a better life are met with the same hurdles they've seen so many others face.

Across Clarkston, which lies about 10 miles northeast of downtown Atlanta, residents face systemic obstacles, language barriers, financial constraints, and a U.S. health care system that often lacks cultural competence. A former medical scribe who requested anonymity to protect his professional and academic standing recalls assisting an Afghan father seeking specialized care for his child. The process required a four-way exchange between the scribe, a Pashto-speaking interpreter, a nurse practitioner, and the family. Despite their best efforts, translation errors led to incorrect appointment details, forcing the family to restart the process. Every mistranslation costs two things many people in Clarkston lack: time and money.

Humaira Shirzai and her husband, both originally from Afghanistan, often skip doctor visits to avoid the upfront appointment fees, and forgo necessary medications due to costs. They don't have Medicaid, but she says people who do still face barriers—including limited provider acceptance, upfront costs for care, and delayed reimbursements—which can leave them in financial limbo and delay necessary care.

Clarkston's leaders recognize the urgency of these issues. Mayor Beverly Burks previously worked as a community engagement director at Fulton-Dekalb Hospital Authority, and City Councilwoman Sharifa Adde, who came to the U.S. as a refugee, have spent years advocating for refugee and immigrant families. Both stress that while progress has been made in recent years, the health care system remains difficult to navigate for many. Omar Shekhey, founder of the Somali American Community Center, works to address these barriers by building trust with residents about their health care needs. "Trust means knowing who you can open up to," he says. "Without it, people hesitate to seek care until it's too late."

Editor's note: Vngle is a grassroots news and intelligence agency dedicated to amplifying the voices of underrepresented communities. It collaborates with and offers journalism training to members of communities it reports on. Vngle spent nearly a year working with residents of Clarkston, Georgia, for this piece. Vngle's reporting process is backed by a system of provenance records, ensuring the authenticity and traceability of the stories shared, even with anonymous contributions. This project was initially supported by the Starling Lab for Data Integrity, co-founded by Stanford University and the University of Southern California.