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Refugees experience a threefold challenge to their health and well-being: 1) psychiatric disorders precipitated by the refugee experience, 2) infectious and parasitic diseases endemic to countries of origin, and 3) chronic diseases endemic to host countries. This paper documents the "journey to wellness" in which these challenges are faced in stages by the refugees themselves and by the array of health and social service agencies committed to providing refugee assistance. Using the experience of a consortium of agencies in San Diego as an example, we examine the interaction between these challenges and the mobilization of organizations to develop a program of health promotion and disease prevention for Somali and other East African refugees. This mobilization involves a series of steps designed to facilitate refugee confidence, comprehension, and compliance with prevention efforts through community-provider partnerships and negotiation between refugee and organizational explanatory models of disease causation and prevention.

The difficult adjustment of Cambodian refugees to life in the United States is no more evident than in their use of the biomedical health care system. When forced by circumstances to seek Western medical care, they often perceive the cause of their symptoms to be untreatable by this technological modality of healing. This attitude is understandable because the lengthy and destructive civil war they survived also extinguished their medical system. Many of the refugees had no contact with Western-style health care until they reached the camps in Thailand. As a result, the Cambodians have had to develop ways to integrate centuries-old indigenous and self-care practices, that they know well, with the modern health care services and technologies, that are new to them. In San Diego they have sought what is for them a new kind of provider, Vietnamese physicians who practice medicine that is culturally appropriate and convenient. Although these multiple systems satisfy them in many ways, a significant number of Cambodians are still not getting well. The constant pursuit of healing is time-intensive and expensive, and ignores the emotional effects of refugee status on physical health.

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