Azeb Yusuf is living out her childhood dream in the United States, but not exactly in the way she thought.

Growing up in Ethiopia during the 1970s, she remembers wanting to go to the U.S. because “that was the place where people could do the things they love.”

And what she wanted to do was become a nurse.

“I always wanted to be a nurse and help people because, in Ethiopia, I always heard there is not enough doctors or nurses, so I wanted to help,” Yusuf said during a phone interview with Direct Relief from her Houston home.

Since arriving in the U.S. 38 years ago, Yusuf, 50, has helped many thousands of people access care as a health center executive and community organizer. She is the chief development officer for Bee Busy Wellness Center in Houston, a federally qualified health center that serves over 10,000 patients annually. It was this experience that primed her to succeed in what would be one of the biggest challenges of her life.

Harvey’s Exponential Hardship on Immigrant Communities

Hurricane Harvey devastated Houston in 2017, with more than 100 people dying as a result of the storm. It was caused $125 billion in damage — the same amount as Hurricane Katrina, making them the most financially destructive storms ever. While the whole city endured acute hardships, immigrants and undocumented individuals from African countries faced uniquely onerous challenges in the aftermath.

“The situation was unimaginable,” Yusuf recalled. “For example, some people didn’t have their asthma medications, and they couldn’t get it from the pharmacy because they could not get their prescription.”

Making matters worse, Yusuf explained that widespread distrust and unease with the healthcare system, especially mental health care, was pervasive among the communities she was most engaged with, including people from Ethiopia, Somalia, Eritrea, Congo and Kenya.

Yusuf said mental health is something that is traditionally handled by religious or spiritual leaders in these communities. She also said that there is widespread concern about being judged negatively in the community, deported, defrauded and otherwise maligned when accessing health care in general.

Knowing this, and understanding the best entry points to gain trust, Yusuf went beyond her work duties and started to engage two trusted faith communities, represented by the Ethiopian Christian Fellowship Church and by the Islamic Society of Greater Houston. She also brought in local elected and business leaders for additional support, including Mahmood Marfani, director of Shifa Community Services, who was instrumental in bringing in Pakistani physicians to the outreach effort.

To bring the leaders of diverse groups together, Yusuf stressed that, despite differences, “we are all here to save lives.”

It worked, and at the first health fair held in the wake of Harvey, over 500 people showed up for care. The event’s positivity extended beyond health as well. Yusuf said that the fair represented the first time many of the Muslims in attendance, both patients and physicians, had been inside a church.

The shared sense of purpose and need broke down other external barriers, and have led to 20 subsequent health fairs, the most recent one being held in April this year. Yusuf said she fields regular inquires from diverse communities asking when the next church fair will be, how they can help, and how to apply her leanings to future events.

“It was extremely exciting because the outcome of this was to open the door for Muslims and Christians to work together,” she said. The two religious communities were able to build a connection beyond work as well, such as sharing a traditional Ethiopian coffee ceremony.

Asking the Right Questions

Yusuf was uniquely poised to save lives after Hurricane Harvey owing to her background in the community over the past decades. An immigrant herself, she was drawn to more recent émigrés and worked to help them acclimate to life in a new country. This took the form of leading them through government bureaucracy, teaching them English, and assisting them in accessing health care.

“They have a hard time to understand the system, and many are even illiterate in their own languages,” Yusuf said. “I took the initiative to see what refugees need coming to this new wonderland. They don’t have that many guides, and everyone’s pushing them to go to work, work, work. but not to school.”

While language and bureaucracy present barriers, more insidious challenges lay in cross-cultural differences, even when everyone involved comes in with the best of intentions. Yusuf brought up mental health screenings for refugees as an example.

As part of the standard procedure, mental health care providers will ask them whether they have had suicidal thoughts or plan to kill anyone.

“This is tricky for a foreigner. They get confused, and for them it’s very offensive,” said Yusuf, explaining that refugees she has worked with will infer that the provider is suggesting that they kill themselves or even that the provider is offering to help them do so.

“It’s not a welcoming question and so they end up running away from it and don’t want to go back,” she said.

Being so heavily involved in the community helped her think of ways to help them access care, for example, creating a hotline where people could call in anonymously.

These kinds of cultural and linguistic challenges have sweeping implications in Houston, which added the second-most foreign-born residents in the U.S. from 2000-2010, and its county added 4,818 refugees from 40 countries in 2014 alone.

Helping Beyond Health

Currently, Yusuf is focusing on an upcoming back to school drive, in which she aims to get 3,000 kids set up with essential supplies, such as backpacks notebooks, and writing utensils.

She is also championing the effectiveness of mobile care, which helps serve individuals who cannot easily get to clinics for a host of reasons, including a lack of mobility, finances, or awareness.

“There is a huge need, to go from one place to another. The need is overwhelming but the communication is receptive now,”” Yusuf said. “It was mobile care units, from a logistical standpoint, that allowed Bee Busy to care for so many new patients after Harvey.

But even for someone as plugged in as Yusuf, knowledge gaps still exist. She was surprised by the necessity of a recent diaper drive. Houston Diaper Bank and Order of the Eastern Star Radiance Chapter #1045 helped give over 200,000 diapers to needy families, though many more families had to be turned away due to lack of supplies. A survey at the event revealed that nearly 35% of the people polled had not visited a doctor in over 5 years, and 43% needed mental health services.

“The need is greater than people think of,” Yusuf said.

Looking ahead, undeterred by such imposing figures, Yusuf remains focused on assisting everyone in being able to access healthcare, and their dreams.“I should leave a legacy and open up the doors for others,” she said.

Additional reporting contributed by Donnie Hedden