“Sauti! Documenting the Impact of COVID-19 on African Immigrants Living in the New England Region”

African immigrants have been uniquely affected by the coronavirus crisis. There is a need for researchers, health care providers and the health care system to understand their experiences and develop culturally and linguistically appropriate interventions. Sauti, was conducted to document the challenges that African immigrants in New England are facing related to COVID-19. We also captured ways they are coping and being supported through their challenges during the COVID-19 pandemic.

We engaged 103 African immigrants from across the New England region in sharing their experiences using photovoice, a participatory research method that asks individuals to represent their lives, points of view, and experiences using photos and narratives. The visual images and accompanying stories are the tools used to promote action and change.

In each state, participants gathered photostories. Through a participatory data analysis process with participants and regional partners, 9 themes (34 photostories) were identified highlighting challenges African immigrants face during the pandemic across New England, and 7 themes (24 photostories) were defined focusing on strategies participants used to cope with the pandemic.

View the photostories below and share your feedback and ideas for recommendations to researchers, providers, and health care systems for engaging African immigrants in COVID-19 interventions.

THEMES

CHALLENGES

Loneliness and Isolation
Restrictive Movement
Life Changes, New Normal
Experiencing Loss
Systems Challenges

Fear of the Unknown
Difficulties for Our Children
Parental Stress
Coping with Illness

STRATEGIES FOR COPING

Have hope and stay positive
Government Guidelines
Exercising
Home remedies

Communications
Faith
Maintaining Connections

Loneliness and Isolation

People experienced loneliness and isolation during lockdown when required to stay at home and adhere to social distancing guidelines. There was a loss of connection with friends, family members and the community. There was a feeling of being like a prisoner at home.

Locked Out - The fence signifies life during the Pandemic. It feels like I am behind this fence and cannot see or predict what is happening beyond this fence. I went to the Emergency room once and was turned away as they were prioritizing COVID-19 patients.

looking out a window — Basketball is my passion. I played professionally back home in Burundi, and now here in the US I play pickup at a local park. I love basketball so much because it has become an outlet for all the stress there has been in moving here, like having to find a job, pay the bills, and adjust to the new culture. When I play I forget about everything else and I just feel good. But now because of COVID-19 it's no longer safe to play. I look out this window a lot and think about things, like how I miss playing, but also how fortunate I am because my family is okay, and I didn't lose my job. I think about how all the people are doing who weren't so fortunate, like how are they getting through this time? I want to tell them to not lose hope.

Restrictive Movement

Stay-at-home orders required non-essential places to close. People were unable to remain active and engaged in their community. This included not going to places, such as faith institutions, where people typically receive trusted information.

child looking through a glass door — Isolation - My kid In Isolation.

church pews — The Church - Once a place of celebration and reconciliation with God and mankind. Now a place where the peace sign is shared by a wave of a hand at least 6 feet apart.

closed door — Closed Door - Restrictions of movement.

Life Changes, New Normal

The new public health guidelines impacted every aspect of life and people had to adjust to wearing masks in public and getting tested regularly. There was often a shortage of food, PPEs and other supplies.

COVID testing — My COVID-19 testing experience - It’s been the worst thing ever I have experienced. I have chronic shortness of breath which got worse during COVID and I had to do more than 17 tests each time I go to the hospital or I have a procedure either in my car or in the ER. Sickness during Covid19.

empty store shelves — Shortages of supplies (food, PPE, etc.)

wear a face mask sign — Trouble of wearing masks - Having to wear mask always and everywhere is disturbing and sometimes it painful to the ears. Before people used to say, "bless you once sneeze”, but nowadays, once you sneeze no body will say that anymore. At workplace ,once the manager or team leader sees your mask below the nose ,you get in troubles!! One rule One World, mandatory wearing masks make me think about the coming of antichrist or the mark of the beast “666” whereby people won’t be allowed to buy or sale without that mark!

Experiencing Loss

People experienced immense loss, in the US and their home country, as a result of the pandemic – financial, family, lifestyle, and community. Friends and family died because of COVID-19. There was financial loss due to getting laid off, furloughed or not being able to find a job. People were not able to connect at social gatherings, such as church service, weddings, picnics, and outings. In addition, there was a burden knowing that family in their home country did not have the same resources.

coins and a dollar — Unemployed and worried - I have no earnings because I have lost my job. I am very affected negatively financially. My car was taken back by the dealer because I could not make the payments.

sitting on the floro in deep thought — Thinking to myself - Where will you get help? where can you get treatment? you only call 911, you cannot get an appointment with your regular doctor. I am no longer employed. How can I earn money to support my family?

empty wallet — Having no money is hard - This tells us that money has been hard to get. I lost my job in March when everything and everywhere got shut down and I am still searching for a job till today.

New Haven Green - In This picture you can see here at New Haven green, it’s beautiful place where people liked to gathering and partying with full of joy before the COVID-19 but now it’s empty because many people cannot be together in one place, they’re must apply the 6 ft of social distance, which is hard for us too.

globe — Death around the world - Community, protect each other from the virus, everyone together against the pandemic Everyone’s responsibility to take care of our earth. Connected together, time to learn about ourselves, growth - who you are, what you have to do, how you see things. Negative: pretty hard, there is not a lot of stuff we can do. Have to push our boundaries. A lot of stuff we used to do that we can not do anymore. Self restriction.

Systems Challenges: Healthcare, Emergency Response, Food Supply

The public health and healthcare systems had gaps in their response to COVID-19 specifically for refugees. Because hospitals and clinics were overwhelmed with COVID-19 patients, people could not get appointments for non-COVID-19 related health issues. In addition, there wasn’t an adequate emergency response in the community. This caused shortages of food and supplies. The mandate to wear masks made it challenging for people who are deaf and hard of hearing to communicate because they were unable to reads lips in order to converse with others.

BLM protest — These are my children at a Black Lives Matter protest for racial justice - My daughter wanted to go because she is hopeful that there will someday be equality for all people. We must fight for equality by speaking up, by using our voices to be heard. Although this is my 1st protest, fighting for my rights isn't new to me. As a Deaf woman, I'm used to it, like insisting on my right to have a sign interpreter when I see my doctor. I rely on lip reading but now with Covid-19 everyone is required to wear masks to keep safe. This means that since I can no longer read lips I can't follow along in a conversation. Covid-19 has made my life more difficult because there have not been provisions put in place for the Deaf and hard-of-hearing. So I'm here to protest for my right to racial justice, but also for my right to communication access.

closed gate to public transportation depot — Late News. I rely on Public Transportation - One day without any notice the buses stopped running. I waited for the bus for two hours. My English proficiency is limited, and it took me a couple of days to understand the new condensed schedule.

patient in a hospital bed — COVID-19 is a problem in Healthcare - I am someone with pre-condition, but because of COVID-19, it is not easy to see the Doctor. It is hard to get Doctors appointments, most of them are postponed at late date.

virtual doctors appointment — Healthcare Services - Patients and other people fear of accessing healthcare services face to face.

hospital — No visitors during pandemic - My husband was at Maine Medical Center having a surgery and I couldn't visit him because of the Covid-19. There was limited hours only to visit.

Fear of the Unknown

There wasn’t clear information begin released from the government. No definite answers related to transmission, the period of infection, the outcome of getting COVID-19, and if a vaccine will curtail the disease. People also feared others in the community thinking they had COVID-19.

crosswalk — I am confused - My child had a stomach ache. I needed an appointment for my child with her pediatrician , when I called the doctors office, they told me to call 911. I felt very confused because I did not want my child to contract the virus in the Emergency room.

dog under a bed — Keeping it safe during COVID-19 - We can see the dog hiding and taking care not to. Let me hide myself from the world this crisis will not devour me so I’ll stay away and I’ve seen a lot of people get killed by the virus and I be safe to tell the story of how people can’t go out without mask. So I’ll stay here in my safe haven and I hope you do too. The dog also seem to be asking “who can I trust with the information I am getting”.

sitting under a blanket — Temptation - This picture is the picture of my son who had cold and the doctor told him he had symptoms of corona. My son came home and told me “Mama I am going to die. They told me I have corona.” Before I knew it the news spread, I don’t know how, and even when I went to work the same day I wasn’t allowed to work because they said they know a family member has corona, this lso affected my other son who couldn’t work as well because his employers found out the news of my other son’s corona. I was told to quarantine for 14days without any contact with the outside world, even my family members in Tanzania got to hear of the news and told me to steam some veggies and inhale the steam to make my son better because they said corona does like heat and any form of heat will kill it. So inhale steam, bath hot water drink hot water and this was for all 7 members of my family. I was very sad at the separation between myself and my family members which is different from how things were before when people came to see you when you are sick. And we thought some of us were going to die. I felt bad when even Thato couldn’t come into my house or hug me anymore.

Difficulties for Our Children

Children faced many challenges related to using virtual platforms for remote learning. This included technical issues and difficulty paying attention. In addition, some families did not have the technology or parents were unable to support the children because of their limited computer literacy. Overall, children lost socializing with friends. Specifically younger children were not able to learn critical social skills, such as “sharing is caring” and playing nice with others.

student holding a laptop — Struggles of Students - Kids are struggling with distance learning from 9AM-3PM, One day I found my daughter fall asleep on her Chromebook as she got bored and lonely. Also, teachers disturbing parents with calls and messages when student is away from online classes e.g.went to the restroom or get a snack. Sometimes they call parents while they are already at work.

doing homework on a laptop — School Stress

playgrounds closed — Social Life: Children - A place where my daughter can meet other kids and socialize. I was a school teacher when I get to see other kids and that was gone. Again, it was another fear, I was thinking that is the first place kids will get sick.

walking with a bike — No interaction - No interaction is allowed with others during the pandemic, so most things are done alone.

Parental Stress

Parents were dealing with a lot of stress due to children schooling at home. It was challenging to support their kids while also working. Parents feared that their children would be left behind.

child and parent — Struggles of Parents - Kids are studying home while some parents are struggling to work from home with the kids causing distraction. They also distract us parents from our job search.

hiding her face — My Life - I am struggling a lot during Corona. I need my kids to go to school. My child can't really get the same quality of Education as my English is limited. They are also missing out on socializing with their peers. I am affected by how their life has changed drastically.

working remotely — Working from home - I find myself working more hours now I am working from home. I am doing research at up to 2am the next day and filling in any other time when I am not taking care of my family. The expectations from work and from home have risen since quarantine. Now that I am “working from the comfort of my home, I am asked to perform as if there wasn’t a world pandemic happening, as if all my life depended on was to come up with innovative ways to get my job done and nothing else. On the other hand, as a African immigrant wife I am also expected to have a very tidy home as well as many options for diner ready. Now as a mom I am expected to ride bikes, play Legos and pretend all day long without getting tired. And I am supposed to be all of these things with a big smile on my face, without getting stressed, nor angry and I am definitely not allowed to have a break down.

Coping with Illness During the Pandemic

Families had a difficult time dealing with children and loved ones who tested positive for COVID-19. Parents were scared to take their children to the emergency room. Family members were unsure about how to support and take care of their loved ones that needed to be quarantined.

Inability to see a doctor - The child is sick and they bring him to the hospital, he wasn’t feeling good at all. Even with his sickness this child had to always have his mask on though ordinarily as a sick person he should not have anything obstructing his breathing. I was also negatively diagnosed of having Corona so I am using this picture to tell people to be careful of Corona. It can change your life, especially now that its more difficult to see a doctor.

The unknown - This is a photo of my bedroom. My husband tested positive. He is behind this door.

Protect yourself from Corona - For a few days my son hasn’t been feeling well. I thought to myself “give him a warm bath and rub him with some vicks, he is probably reacting to the change in weather from the past few days” the next day he complains of chest and stomach pains as he coughs. I realized quickly that I had to take him to the ER. When were put into a patient room, the doctor came in and informed us that he had to be tested for COVID and get a xray of his chest to check for pneumonia. I didn’t know what to think while we waited for the results of both tests. I found myself worrying about how am I going to work this demanding job with my toddler home from school. Or how much money I would be throwing away paying for his tuition, but he is home with me.

Have Hope and Stay Positive

People were encouraged to stay positive during the pandemic and to persevere through the challenges. There was hope for better days ahead, including a cure being developed and people will eventually feel relief and feel free to move around.

news on TV — New news - I am following the news about the vaccine won't loose hope because the President is giving us hope that there will be a vaccine.

walk way — The Journey of Life is Never a Straight Path - Covid-19 has taken a big toll on me. Before, I supported myself with 3 jobs, and they in turn enabled me to operate an orphanage back home in Ghana. So far I've lost 1 of the jobs, and supporting the orphans has become very challenging because nobody can donate anymore. As a Pastor of the church, I'm no longer able to provide fellowship in person anymore. Doing so over the phone there is a lot of the communication that is left out, like seeing a person's facial expressions. It's more difficult to reach out to members of the congregation and that's hard because so many are suffering either financially from losing jobs or with their health. It's very difficult for them, either navigating the language barrier, not having the foods from back home available because the markets have shut down, and just not knowing how the system works, like where to go for health care if they are uninsured, and where to find basic information. When a member of my congregation gave birth it was a joyous time for a community celebration, but we can't even do that anymore. The day I took this picture was a Sunday when I should have been at church but now the church is empty. I was trying to hold service on the phone and looked outside my window at the path that leads from the front door of my house to my driveway and from there to the main road. I was struck by how this path represents the covid 19-related challenges we are all going through right now. Because of the Africans' hard life and struggle we are able to draw strengths from these things like covid-19. This has taken a heavy toll on us but you will still see smiles and hear laughter. The driveway path is curved, like the curve we have been thrown, but it does eventually lead us to the main road - to where we will also eventually end up.

balcony near trees — The Truth In Death & Resurrection - Not Long Ago All These Trees Had beautiful Green Leaves But They’re Losing Them Now Just To Come Back In Summer. The Question; Where Did The Life In The Trees. Go In Order To Come Back? Human Beings Are No Different. DEATH IS NOT THE END OF YOU.

Government Guidelines and Assistance

To keep their community and family safe, people adhered to the public health guidelines determined by Center for Disease Control and Prevention (CDC) and each state. People acknowledge comfort in having control to keep themselves safe and well (e.g. washing hands). In addition, people were waiting on financial aid from the government to support their families and anticipating the approval of a vaccine.

earth with a mask — Safety - The world is sick, mask up.

Cleaning is never ending - I wash my hands with hot water and soap and sanitize. In March it was hard to find a hand sanitizer. I am glad that scarcity of hand sanitizer is a thing of the past.

medicine bottle — Prevention is better than the cure -Once there is a vaccine my family and I will get it. We can prevent ourselves from getting the virus. We have been lucky so far not to get infected.

washing hands — Washing your hands prevents the spread of Covid-19, I am glad that this is one thing I have control of.

Exercising

People exercised safely as a way to keep physically and emotionally healthy. It served as a coping strategy to mitigate the stress caused by the epidemic and not being able to see family and friends.

puttting feet together in a circle — Walking

Traditional and Home Remedies

People used traditional and home remedies for prevention and when providers said to stay home after they tested positive for COVID-19. Remedies were made from perfumed woods, garlic, fruits, herbs, and honey. Some were made into a drink or used in a steam. They were used to boost the immunity against the virus and cure symptoms caused by COVID-19. In some communities, it was believed that certain remedies have biomedical properties for a cure for the virus, e.g. medicine developed in Madagascar.

Arabic Gum and Garad - This is a photo of arabic gum and garad (Acacia Nilotica Pods)being burned like candles. Usually to make the house smell nice and eliminate bad odors we used other kinds of perfumed wood, however because of their strong medicinal and anti-viral properties my mom likes to burn arabic gum and garad regularly which produce a really strong and not very pleasant smell. Many people think that these are just traditional remedies, however there has been research done which shows their biochemical benefits.

food chart — Importance of eating healthy food/tea

herbal remedy — A proper Medication/Home Remedy - It‘s a gallon of different mixed blended ingredients, ginger, onion, lemon, lime, garlic and honey, which I and my family use as medication for COVID-19 and it’s real helpfully. When COVID-19 started, it sound like a joke then spread almost all over the World. Before I was thinking that white people are very wise, smart and know everything, but now they fail to discover the proper cure of COVID-19, they jump on vaccine which is not the medication rather a prevention.

honey and black seeds — Black Seed - In Islam black seed is mentioned as superfood and that it’s also used for respiratory conditions including asthma, allergies, cough, bronchitus, flu, swine flu, etc. Black seed is helpful during any sickness. Educate myself and get closer to my religion.

lemons and garlic — Lemons and Garlic - This we used for steaming or smelling its fumes. This is a healing products and this is really difficult for my kids because they are not accustomed to the practice of healing using steam of the oils of the product so it was a battle with them. I did this because I heard it’s a cure for Corona.

COVID-19 CDC guidelines — Keeping to Public Health Guidelines - I got COVID-19 information on public health guidelines on how to act or stay safe during the pandemic ,but all in all is to keep praying God because he is the healer above all knowledge and scientists.

Communications and Information Gathering

Social media platforms help family and community members to stay connected. Platforms include: WhatsApp, Zoom, and Facebook and television news. At times, virtual support groups were created to support people having a difficult time. There was also a need to have information provided about COVID-19, including prevention and vaccine development in different languages.

Faith

People held on to their spirtual practices and belief in God who protects them from diseases, including COVID-19. Many faith organizations started virtual services and prayer lines. This helped them face the losses caused by the pandemic.

Maintaining Connections to Family, Friends and Information

Comfort, care, and support came from family, friends, and neighbors. It was important for people to stay connected. Family members, in the US and at home, were able to spend more time together because they were required to stay-at-home. For family and friends who did not stay in the same house, using virtual platforms like WhatsApp, Zoom, and Facebook helped them stay in contact. In addition, people stayed connected to their spiritual family and online platforms to receive accurate information and services.