Spruce Hill: African Immigrants Struggle to Navigate City’s Healthcare System

This mosaic outside the African market on Walnut Street is a sign of the immigrant presence in Spruce Hill.

An immigration boom in 2000 helped turn the Baltimore Avenue corridor into a hub for African businesses. Spruce Hill has dozens of restaurants while Woodland and Chester avenues are peppered with African and Caribbean grocery stores.

While no exact census data exists, in Philadelphia, the four largest communities are in order Nigerian, Liberian, Ghanaian and Ethiopian. The Historical Society of Pennsylvania counts communities of 150 or more from nearly 13 African countries, eight of which are concentrated in West Philadelphia.

Among all these nationalities, word-of-mouth remains the best source for information.

“People might come in and say ‘Oh, we saw your card. Somebody gave us your card,’” said Oni Richards-Waritay, director of the African Family Health Organization (AFAHO). “The main method of getting information is from people in your social network.”

In 2009, the Robert Wood Johnson Foundation scholars presented a report on emergency medical preparedness for West Philadelphia’s African population. The study made recommendations to city health officials for improving immigrants’ health care access. However, most direct efforts have been made by community organizations.

The African Cultural Alliance of North America, or ACANA, started offering weekly health screenings through the Philadelphia Department of Public Health in 2010, with blood pressure and blood sugar tests, HIV tests and some counseling. ACANA gives referrals to the public health centers, said staff attorney Chioma Azi.

Chester Avenue is a prime location for African and Caribbean businesses.
Chester Avenue is a prime location for African and Caribbean businesses.

AFAHO expanded its health services from HIV testing, to “broaden the scope of the work we do in order to get more people to come,” Richards-Waritay said.

Once enrolled in one program, AFAHO can set immigrants up with breast cancer and prostate cancer screenings, hepatitis programs and teen pregnancy prevention.

As Azi said, a strong, strong fear can cause patients to only seek medical help in extreme cases. African patients may be uncomfortable with caregivers of the opposite gender. For most of AFAHO’s West African and Haitian clients, language barriers with doctors persist. Most Philadelphia caregivers do not speak French, the largest common language in West Africa, and those who do rarely speak regional dialects. The Health Department has on-site and telephonic interpreters service, covering about 500 languages and dialects. AFAHO’s own medical escort services accompany clients to doctors’ appointments. Cultural barriers, aside from language, can also be an issue.

“Most people from Africa revere medical professionals and don’t think it’s wise to question them,” Richards-Waritay said. “If we see the client shaking his head, we are there to make sure the provider understands that that doesn’t necessarily mean he understands you but, because you’re a medical professional, they feel like they have to agree to everything you say and not sort of question.”

For Ghana-born Helena Kwakwa, director of HIV services for the Health Department, translating a patient’s symptoms can be challenging.

“It’s difficult sometimes to express their illness or their disease as they’re experiencing it in a way that someone trained in Western medicine can understand,” she said.

Her patients mostly hail from Ivory Coast, Burkina Faso, Mali and Liberia. Patients often ask her if they can supplement or substitute homegrown remedies for prescriptions. Immigrants’ health often deteriorates the longer they live in the U.S, largely because immigrants are not eating as much fresh and organic foods, and become more sedentary.

The PHiladelphia Refugee Health Collaborative has a garden on Emily Street for international produce.
The Philadelphia Refugee Health Collaborative has a garden on Emily Street for international produce.

To combat this, the Philadelphia Refugee Health Collaborative maintains a 99-plot raised-bed garden on Emily Street, where families can grow their own native produce. Fifty to 60 families are currently on the waitlist for plots.

Smoking, drinking, larger portions and eating out are commonly adopted by immigrants, the New York Times reported. Kwakwa added that this negative health trend could also stem from the natural aging process of immigrants in the U.S.

Whatever the case, African immigrants do not see the same preventive care they did in their home countries. Most treatment they receive in Philadelphia is general primary care or emergency care.

“I’m from Liberia originally,” Richards-Waritay said. “When I was young, we used to drink this sort of bitter mixture every month, once a month, every month. And that really prevented us from getting sick a lot.”

Stigmatization limits the mental health services available for African immigrants. AFAHO offers a program for children and teens dealing with the migration and blending of cultures, while Public Health Center 3’s has a behvioralist specifically for its HIV clinic. The Refugee Health Collaborative’s mental health programs have seen mixed results. Navigating the American insurance exchange is a major hurdle for Africans immigrants. Coverage eligibility depends on a person’s legal status in the country.

“On the other hand, if they came here on a visitor visa and that was a long time ago and then just stayed, then it’s near impossible for them to get any kind of insurance,” said Patricia Pate, director of Public Health Center 3 on 43rd Street.

Refugees are a special case.

“[Refugees are] also provided eight months of a special kind of Medicaid program called ‘refugee medical assistance,’” said Gretchen Wendel, coordinator for the Refugee Health Collaborative. Refugees have three options after the eight months: insurance through an employer, continued Medicaid or using Philadelphia’s federally-qualified health centers.

Pate and Kwakwa predict the Affordable Care Act will do little to affect undocumented African immigrants’ ability to get health insurance.


  1. Thank you for this article. I ued to live in University City about 10 years ago before the city became a hub for the resettlement of African refugees. It sounds like these important public health care efforts would benefit from some anthropological research and writing to address the communication issues facing these refugee communities as they try to meet their health care needs. I am a local freelance writer who is about to launch a health and wellness blog. I have a background in ethnographic search and writing and would very much like to use my blog to educate the broader Philadelphia community about neighborhood health issues. Please feel free to contact me.

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