Embedded Files
Bosnia is a country located in Southeast Europe on the Balkan Peninsula. It shares borders with Croatia, Serbia, and Montenegro. After the breakup of Yugoslavia in 1992, Bosnia declared its independence. The Bosnian War followed from 1992-1995. It involved ethnic and political struggles and became known for widespread atrocities including genocide.
Bosnia is a country located in Southeast Europe on the Balkan Peninsula. It shares borders with Croatia, Serbia, and Montenegro. After the breakup of Yugoslavia in 1992, Bosnia declared its independence. The Bosnian War followed from 1992-1995. It involved ethnic and political struggles and became known for widespread atrocities including genocide.
Similar to other immigrant communities, Bosnian immigrants have come to the United States for reasons like education and job opportunities. However, escape from the Bosnian War was the primary triggering event. Many Bosnians have fled ethnic violence, political instability, and conflict.
St. Louis has been a location for Bosnian immigration for many reasons including infrastructure to support immigrants, affordable cost of living, job opportunities, and presence of resettlement agencies and programs. The first influx of immigration started in 1993-1995. St. Louis is currently the home the largest Bosnian community outside of Europe with home to over 70,000 Bosnian immigrants.
Bosnian immigrants face unique healthcare needs and challenges shaped by their cultural background, the trauma of war and displacement, and logistics of resettling in a new country.
Similar to other immigrant communities, Bosnian immigrants have come to the United States for reasons like education and job opportunities. However, escape from the Bosnian War was the primary triggering event. Many Bosnians have fled ethnic violence, political instability, and conflict.
St. Louis has been a location for Bosnian immigration for many reasons including infrastructure to support immigrants, affordable cost of living, job opportunities, and presence of resettlement agencies and programs. The first influx of immigration started in 1993-1995. St. Louis is currently the home the largest Bosnian community outside of Europe with home to over 70,000 Bosnian immigrants.
Bosnian immigrants face unique healthcare needs and challenges shaped by their cultural background, the trauma of war and displacement, and logistics of resettling in a new country.
INTAKE AND COMMUNICATION
INTAKE AND COMMUNICATION
Bosnian immigrants primarily speak Bosnian
Serbian or Croatian may also be spoken
Bosnian interpreters are strongly recommended
Health History and Screening
Health History and Screening
Cardiovascular Disease
hypertension, coronary artery disease, and stroke risk are common
Diabetes
incidence of type 2 diabetes is rising with dietary shifts and urban lifestyles
Cancer
concern for interrupted cancer treatments
Tuberculosis
screening for latent or active disease
Chronic pain
secondary to physical pathology vs somatization (expression of psychological distress in the form of physical symptoms)
Helicobacter Pylori
high prevalence of this bacterial infection in Bosnia and may persist in immigrants
Maternal Health
inadequate prenatal care and malnutrition
Pediatric Health
incomplete vaccination series
malnutrition
behavioral or developmental delays to due displacement or trauma
MENTAL HEALTH CARE
MENTAL HEALTH CARE
Stigma
negative cultural beliefs towards mental illness may limit individuals from seeking help
Post Traumatic Stress Disorder (PTSD)
many Bosnian refugees have experienced war-related trauma, loss of home, and violence
prevalent among survivors of ethnic cleansing and genocide
Depression and Anxiety
high rates of depression, anxiety, and adjustment disorders
commonly affects women who fled with children, elderly who lost support systems, young people coping with interrupted education or career paths
manifestations as somatic disorders
Intergenerational Trauma
children of refugees may develop psychological symptoms from their parents’ stress known as secondary traumatic stress or vicarious trauma
Cultural Considerations
Cultural Considerations
Communication Style
direct communication preferred
use of formal titles and respectful addressing of older adults
reserved interaction style vs expressive gestures/touching
View on Health and Medicine
expect quick testing/prescriptions/referrals based on authoritative medical experiences in homeland
may use traditional remedies
may prefer same-gender healthcare provider especially with reproductive health issues
less familiar with preventive care: immunizations/screening
deference to authority: may hesitate to question a doctor’s opinion
Family and Decision Making
family plays a central role in support and decision-making
religion can be a source of decision-making and comfort
Religion
most Bosnians are Muslim but some are Eastern Orthodox or Catholic
Muslim Bosnians don’t eat pork and some only eat halal food
avoid animal gelatin containing medicine for Muslim Bosnians
have specific end of life rituals
observe periods of fasting
Health Literacy
educational backgrounds vary
simple language, visual aids, teach-back method are helpful tools in providing education
Diet Nutrition
traditional Afghan diet is high in bread, dairy, meats, and sweets
can impact compliance with dietary recommendations
dietary restrictions as above
ACCESS AND NAVIGATION SUPPORT
ACCESS AND NAVIGATION SUPPORT
Transportation
Metro Transit: MetroBus and MetroLink - https://www.metrostlouis.org/
Metro Call-A-Ride: paratransit service for individuals with limited access to public transportation including disabled persons - www.metrostlouis.org/metro-call-a-ride/
Society of St. Vincent de Paul: this organization offers transportation assistance through services like car repairs, purchases, and low interest loans - svdpstlouis.org
Welcome Neighbor STL: this organization coordinates volunteer drives for transportation needs including appointments - www.welcomeneighborstl.org
FindHelp: this platform allows searches for transportation needs among other things - findhelp.org
Marillac Mission Fund: this fund supports programs that address transportation needs for immigrants and refugees in the St. Louis region - marillacmissionfund.org
Interpreter Assistance
Monarch Immigrant Services: offers interpretation and translation services in person, telephonic, and audiovisual - monarchstl.org, (314) 645-7800
LAMP (Language Access Metro Project): provides 24/7 in person and virtual interpreting and translation services - lampinterpreters.org, (877) 240-6398
Bilingual International Assistant Services: provides multilingual support in healthcare with specialization serving elderly and disabled immigrants - bilingualstl.org, (314) 645-7800
Support/Resettlement Agencies
International Institute of St. Louis: leading agency providing wide range of support from English classes to employment help - www.iistl.org, (314) 773-9090
MICA Project (Migrants and Immigrants Community Action Project) - provides legal services, advocacy, and community education - www.mica-project.org
Casa de Salud: provides low cost health care - www.casadesaludstl.org
St. Francis Community Services: provides legal assistance, case management, education, housing help, mental health support, www.slps.org/AdultEd
Refugee Empowerment Program: provides services like ESL classes and workforce development - moora.org/programs/refugee-empowerment-program
Bosnian Organizations
Bosnian Islamic Center of St. Louis: bicstl.com
St. Louis Islamic Center: stlic.org
Holy Trinity Serbian Orthodox Church: stlserbianchurch.org
St. Louis Bosnians, Inc: stlbosnians.org
St. Louis Balkan American Connection: stlbac.org
FOLLOW UP AND CONTINUITY
FOLLOW UP AND CONTINUITY
Information in regards to follow visit summary, follow up appointments, preventive care should be provided in written format
Instructions should be provided in English or a Bosnian language per patient preference
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