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By KATHLEEN NELSON

Sioux Falls, South Dakota, is one of the nation's fastest growing immigrant gateway cities, ranking on the U.S. Census Bureau's top 10 list in 2019 for immigrant population growth in cities with more than 100,000 residents.

The largest group of immigrants hails from Ethiopia. African immigrants make up the biggest foreign-born cohort in Sioux Falls, followed by immigrants from Mexico, Liberia, Guatemala and Nepal.

Many immigrants and refugees are employed in the meatpacking industry, where English fluency may not be required to perform manual labor jobs. But language skills are important when foreigners attempt to access and negotiate the U.S. health system.

Redda

In Sioux Falls, Avera Health's Adane Redda and Moses Idris are community outreach consultants helping bridge the language and cultural chasm that can keep foreign-born patients from getting essential health care and social services.

Idris

Both Redda and Idris were resettled in the U.S. as African refugees. Redda, 73, arrived in Sioux Falls in 1999, having left his native Ethiopia because of political unrest and spending five years in a refugee camp in Kenya.

Idris, 28, arrived in 2010 at age 15 after fleeing Eritrea. Members of the Kunama minority, his family lived in a refugee camp in Ethiopia for a decade before coming to America.

"I didn't have an opportunity to learn English back home," said Idris, who speaks fluent Kunama and English now but joked that as a refugee in Ethiopia, he "picked up some English words from movies — all kinds of bad words."

Connecting to Avera
Before joining Avera, Redda worked in refugee resettlement at Lutheran Social Services' Center for New Americans. He speaks Arabic, Amharic, Oromo, Russian and English, and helped resettle Idris's family in Sioux Falls.

Idris said he developed an interest in a health care career in high school, where he attended his first formal English classes, and thought he could help his community if he became a medical interpreter. He became familiar with Avera in 2018 after suffering a work-related injury that required he undergo surgery on both knees. His college career, part-time job and coaching youth soccer were put on hold.

"When I wasn't able to do any of that, it destroyed the confidence that I had," Idris said. "I wasn't communicating with my family or eating well, so my family took me to Avera."

He spent three weeks at the Avera Behavioral Health Center, he said, where "the doctors don't judge, and they want to help you. That's where I found God's grace. You put your trust in God because he created you to do great things."

Idris and Redda were interpreters for Avera in the early days of the pandemic, when the system collaborated with social service organizations to provide information on testing, symptoms and treatment to employees at a large meat-processing plant where there was a COVID-19 outbreak. "In two weeks, we had reached everyone," Redda said. "I believe we saved many lives."

Ward

Julie Ward, Avera's vice president of diversity, equity and inclusion, was especially grateful for the interpreters during a drive-thru COVID testing event. "Moses, Adane and several others stepped up and spent three days in the cold rain, helping everyone through testing," Ward said. "We could not have done it without them. If I had an opportunity to hire them, I wasn't going to let it slide by."

The interest was mutual, as both Idris and Redda approached Ward about working at Avera. She hired Idris as an intern in the summer of 2020 before he returned to college to finish a bachelor's degree and start a master's in health care administration. He was working part-time in patient care at Avera when the position of community outreach consultant was created. He applied and started in November 2021. Redda was hired in January 2022.

A typical day
Both men provide interpretation on a daily basis for patients, employees and the community. Redda visits hospitalized patients at their bedsides to help them understand insurance benefits and the care they are receiving and to answer questions about follow-up care when they are ready to be discharged.

"This is not the way they got health care back home," Redda said of the employment-based U.S. health insurance system. "It is very difficult to understand their benefits. They need support," someone who understands not just the health care financing system, but their cultural frame of reference.

"Patients are surprised to see me because they didn't ask for help, and they're happy when I ask if they need anything," Redda said. "They are surprised to learn that we have such (personalized support) services, but it is the kind of thing we do to bridge the gap between patients and Avera."

The two also represent Avera at job fairs, helping job seekers with limited English proficiency fill out applications, and they assist new Avera employees with limited English language proficiency fill out paperwork and complete orientation.

They represent Avera in meetings with leaders of the African immigrant communities. "We meet with them to see how we can connect more and how we can improve health care," Idris said. And as they make those connections, they cultivate trust in an unfamiliar system. "When you don't grow up in this health care system, there's not a lot of trust." Idris added that the trust is reinforced when he can connect immigrants with social and wraparound services as well as medical services.

Redda traveled in spring 2021 to an Avera clinic in Worthington, Minnesota, to assist clinic managers in a meeting with leaders of the Oromo ethnic community of Ethiopians. Oromo leaders discussed the supports they thought would be of immediate benefit: an interpreter at the clinic who speaks Oromo, transportation to appointments, sending reminders to patients about upcoming appointments.

"In my opinion, it was successful because the clinic manager understood the issues and offered many ways to help improve the health care," Redda said.

As a youth soccer coach, Idris maintains supportive connections with young immigrants, helping them adapt to their new country and culture and providing an adult presence while their parents juggle multiple jobs in the struggle to earn a living. "Parents will do whatever they can to provide for their kids, take any job and work long hours," Idris said. "But the kids need more support from their parents, and there's a lack of connection there. I've been trying to help out with the soccer program, and Avera has been supporting me in that work."

Expanding to community health pilot
Idris and Redda both completed training as community health workers and are contributing to a pilot program Avera launched in November to help immigrants understand the importance of regular checkups and the coverage benefits available through their health insurance. The pair assists four Avera community health workers who are natives of Mexico, South Sudan and Eritrea. Among the goals is to build trust and encourage immigrants to use preventive care and annual wellness exams, to seek help before health concerns become urgent.

Ward said, "We can help our immigrant groups learn to navigate the Avera system and help educate them about the importance of primary care. But the only way that happens is through trust. And Moses and Adane are two of the most trusted members of their communities.

"I have learned more from these two than they have learned from me. They are so patient with my many questions. They are so generous with their time and knowledge, and are so willing to help us learn. They know their culture but are also immersed in ours," Ward said.

Check out a CHA video and an Avera Health video about the Avera Community Health Resource Center.