When refugees come to the United States from abroad, they often speak little English and know even less about how to approach life in what for them is still a New World. Social support is limited, and refugees are often left to struggle to find decent-paying jobs, to perfect their English, to figure out how to get needed prescriptions, and even to understand what their children are supposed to be doing for homework.

Jobs, once again, are a key stumbling block for resettling refugees. Refugees often find not only that is it difficult to gain employment in this economy but also that despite perhaps high levels of education and prestige back home, they are expected to start at the bottom of the U.S. labor force. Re-certification poses a major problem for physicians and other professionals.