Lewiston, Maine has become home to a growing population of refugees and asylum seekers. Known as New Mainers, the majority of these newcomers are from Somalia, but many are originally from other countries in Africa as well. Recently, a community forum indicated that New Mainers face a significant barrier in accessing healthcare due to being unaware of or lacking knowledge about the existing transportation options and resources available to them. This results in missed appointments and increases in emergency room visits. In turn this presents a public health problem and an increase in healthcare costs, which extend beyond the New Mainer community to affect Lewiston as a whole. Healthy Androscoggin, a public health oriented NonProfit made up of a coalition of community members and partner organizations, received a Common Good Grant to further explore and address this issue. We assisted Healthy Androscoggin’s efforts by exploring the barriers and trying to identify their root causes and potential solutions. The reality surrounding barriers New Mainers face while trying to access healthcare extends beyond lack of knowledge and awareness about the existing transportation infrastructure and resources. Our project assessed barriers to New Mainers accessing healthcare through a threepronged approach. We completed a review of relevant literature, conducted interviews, and sent out a survey. The relevant literature included scholarly articles, research about cities dealing with similar issues, and reports and documents from organizations in Lewiston. Our interviews focused on transportation providers, healthcare providers, and members of the New Mainer community. To expand our outreach to New Mainers, we utilized local community organizations. Finally, the survey was sent out to transportation and healthcare providers through our key contacts at transportation and healthcare organizations. We received 46 total survey responses. Our research identified several barriers in addition to lack of knowledge. We inductively coded the barriers into the broad categories of infrastructure, communityhealthcare relationship, cultural, and money. Our data and results can be seen in Appendix I. Overwhelmingly, the issues came down to ineffective and inefficient transportation infrastructure. For New Mainers eligible for MaineCare, the outofstate forprofit vendor contracted by the state, Logisticare, presented several barriers. Problems included but were not limited to: ● Inclimate weather cancellations ● 48hour advance notice required to schedule a ride ● Racist drivers ● Inability to accommodate cultural needs, such as preference to travel with children For New Mainers without cars and ineligible for Logisticare, the public transportation system also presented several barriers. Problems included but were not limited to: ● Limited options ● Limited times ● Limited routes ● Unreliable schedules ● Cost ● Inability to accommodate cultural needs, such as preference to travel with children 4 Furthermore, neither logisticare nor public transportation take into consideration people who struggle with mental illness, are traumatized, and/or feel vulnerable while waiting in public for rides. The analysis of our results showed that amongst the relevant community focus groups ,healthcare providers, transportation providers, and New Mainers, there was a lot of overlap in identified barriers. There were also barriers that lacked overlap as not all community focus groups identified them. What is clear is that the relevant community groups are not all on the same page about what the barriers are, what the barriers mean, and how the barriers impact New Mainers. There must be a coming together of representatives from all parties to create shared understanding of the issues and address them from there. It is particularly important that New Mainers play a central role in this process. We have provided a contact sheet of people and organizations we believe have a role to play in addressing this issue going forward. The contact sheet can be found in Appendix II.
Caldwell, Josh; Metsch-Ampel, Dykan; and Moise, Isa, "Addressing Barriers for New Mainers in Understanding and Utilizing Transportation Resources to Access Medical Care and Finding Culturally Appropriate Solutions for the Barriers" (2018). Community Engaged Research Reports. 60.