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Purpose – This paper's aim is to describe the health experiences of a recently arrived group of refugees, the Karen from Burma, in an American midwestern city. Design/methodology/approach – Four focus groups were conducted in their native language with 40 Karen refugees: one group of ten Sgaw Karen speaking men and one of women, one of East Pwo Karen speaking men and one of women. The focus groups and two additional individual interviews were coded using NVivo-9. Findings – The findings emphasize the significant communication barriers experienced by the Karen. The data provide rich insights into the struggles being experienced by these new Americans in their own words and highlight some of their differences from previous Asian refugees. Research limitations/implications – These data are derived from focus groups with refugees in one city in the USA with few available demographic details. Their experiences and observations may not apply to other Burmese refugee groups in other cities and countries. Practical implications – The data emphasize the complexity of language of this group of Burmese refugees which acts as a significant barrier to accessing health care. Poor or improper interpretation has increased obstacles. Data indicate that many struggle with simple health care tasks that are likely taken for granted by most providers. There appears to be more alcohol and tobacco usage amongst both genders than in other recently arrived Asian groups. Originality/value – This is original research, which supplements a prior chart review and overview paper by the first author and supplements the otherwise scant literature on this group outside Asia. [ABSTRACT FROM AUTHOR]