The 'lost' population

PHOTOS BY JOEL SPRING

Student-run clinic brings health care to those fleeing violence and persecution

Second-year medical student Fadi Al-Asadi examines Rezijebad Fardzadeh, a native of Iran.

Second-year medical student Fadi Al-Asadi examines Rezijebad Fardzadeh, a native of Iran.

In the triage area, second-year medical student Fadi Al-Asadi, who was born and raised in Iraq and whose first language is Arabic, bends down to try and wake a sleeping toddler in a stroller. “Bon jour,” Al-Asadi says jovially to the French-speaking child from Cameroon in West Africa.

Across the way, nursing student Christina Potts is busy processing new patients. There’s a three-generation family from Burma, followed by a couple and their children from Bhutan. Next up is an elderly, white-bearded man from Iran wearing a woven, white prayer cap. The “waiting area”—chairs lined up and down the hallways—is crowded with refugees, each with a personal story of fleeing violence, persecution and war. The place is teeming with sound and color, the cadences and rhythms of world languages and bright ethnic dress from Africa, the Middle East and the Indian subcontinent.

And they keep coming through the doors of the makeshift clinic at St. Francis Episcopal Church on Bluemel Road, near the South Texas Medical Center. Sniffling babies, stooped men and stoic women, all seeking health care.

This is a San Antonio health clinic like no other. It is the Health Science Center’s student-run, free San Antonio Refugee Health Clinic, a blessing for refugees and a teaching tool without parallel for the students who volunteer.

Back in triage, Al-Asadi, who was a teenager in Baghdad when the U.S. invaded Iraq in 2003, is moving from patient to patient, listening, learning, treating. He spent a year in Syria as a refugee himself before coming to the States in 2008, and so has “a personal connection” to the patients.

“Compassion is about 90 percent of the whole deal,” he said.

Governments create borders. Diseases do not follow those borders. If we’re not educating our students in global health, we’re doing a great disservice.”
—Andrew Muck, M.D., medical director for the Refugee Health Clinic

 

A helping hand

The Refugee Health Clinic, which operates weekly, began in 2011, building on a School of Nursing effort. It is one of five student-run clinics that operate through the Center for Medical Humanities & Ethics, and is by far the most interprofessional with medical, dental, nursing and physician assistant students and faculty advisers.

It is estimated that 4,000 to 5,000 refugees live in a small area off Wurzbach Road in northwest San Antonio, within three miles of the Health Science Center. About 1,000 arrived in 2014 alone. They hail from dozens of countries, including Iraq, Cuba, Burma, Afghanistan, Iran, Bhutan, Congo, Somalia, Eritrea and Ethiopia.

Most refugees who are resettled in the United States are given temporary health benefits by the federal government that typically run out after six to eight months. Many of those who rely on the student-run clinic have no insurance, few resources and are without regular medical care. The Refugee Health Clinic plays a vital role in filling this gap, treating an estimated 500 patients a year.

“It’s really a lost population,” said Victoria Petty, one of the nursing student leaders at the clinic. “When you think of refugees, you think of New York or Miami. You think of these big portals of the U.S., not San Antonio. But we really have a population here that’s not even recognized.”

Patients mirror those from any outpatient clinic, with general health concerns, said Al-Asadi, one of the medical student leaders.

“We get patients who are there for back pain, for the flu, for uncontrolled diabetes, for hypertension, for rashes, for dental problems. We even get pediatric cases,” he said.

The students, under the guidance of faculty mentors, provide basic care and referrals, all at no charge.

“The point of the clinic is not to always have them come back to the clinic, because it’s an outpatient clinic,” Al-Asadi said. “The point is to treat them at that moment and try to get them linked to the health care system here in San Antonio. If they don’t qualify for the [Affordable Care Act], we try Carelink, a financial assistance health care program through University Health System. And usually we’re successful with that.”

 

Listening, learning, treating

Nursing student Alizain Maneshia (top left), medical student Nichole Michaeli (with stethoscope) and dental student Peggah Hammat observe as Dr. Farokhi, dental faculty adviser to the clinic, points out a dental problem in a patient.

Nursing student Alizain Maneshia (top left), medical student Nichole Michaeli (with stethoscope) and dental student Peggah Hemmat observe as Dr. Farokhi, dental faculty adviser to the clinic, points out a dental problem in a patient.

The refugee clinic provides unique challenges and opportunities for the future health care providers. One is the interprofessional nature of the setting. Teams are made up of a medical student, a nursing student and a dental student. They all observe each other’s role in the patient’s treatment and report as a team to their faculty advisers.

“I feel like I’m applying nursing school [lessons] even before I’ve graduated,” said Petty. “You learn the behind-the-scenes of a clinic, you learn how doctors interact with patients, how dentists interact. It’s all-encompassing. You get more information there than you’d get in a regular classroom.”

Students are able to learn from each other, said Peggah Hemmat, a fourth-year dental student and first-generation Iranian-American.

“As a dental student, I’ve learned so much about the medical aspect and how to interview patients and what questions to ask,” she said.

“I remember a patient who had periodontal disease, bone disease. And they had no idea what that was. We had to sit with them and explain why this is happening, what are some risk factors and how do we make sure you don’t lose all your teeth. Not only was it a learning experience for the patient, it was a learning experience for the nursing and medical students.”

A particular test for the students comes with the nature of the patient population itself.

“One of the greatest challenges is dealing with so many different cultures, so many different languages,” said Eden Bernstein, one of the medical student leaders. “We try to have adequate interpreters, but a lot of times we have to improvise and be very patient with the patients that we see. There’s not really an easy answer, it’s just kind of being resilient and focusing on the task at hand.”

Many of the students, as well as the faculty advisers, have some sort of international background or experience, and many are bilingual. There are Arabic speakers such as Al-Asadi, the medical student. Hemmat, the dental student, speaks fluent Farsi. Alizain Maneshia, a nursing student and native of Pakistan, speaks Hindi. Others speak French and Spanish.

In some cases, one member of a patient’s family speaks enough English to translate. But still, at times, interpreters have to be hired. Aside from the language differences, many refugees have had little experience with health care and find it difficult to describe symptoms or illness progression.

You don’t have to do mission trips in another country to learn about the world.
The world is here in San Antonio.”
—Moshtagh R. Farokhi, D.D.S., M.P.H., clinical assistant professor in comprehensive dentistry and dentistry adviser for the Refugee Health Clinic

 

Stepping out of the box

If the cultural challenges are steep, the gratification is abundant, the students agreed.

Fourth-year dentistry student Peggah Hammat examines Nar Kami, from Bhutan, at the Refugee Health Clinic.

Fourth-year dentistry student Peggah Hemmat examines Nar Kami, from Bhutan, at the Refugee Health Clinic.

“Every time I leave the refugee clinic, I know that I’ve impacted this population just a little bit more,” Hemmat said. “Every one of these cultures is very family oriented. So if you tell them just a little about oral hygiene or teach them how to take care of their teeth, it will permeate through the rest of their [family circle].”

Bernstein, the medical student, contrasted his experiences at the clinic with classroom work.

“Going through the curriculum for the first years of medical school—it’s the preclinical medicine where we focus on the disease process, on the science,” he said. “It’s very textbook-oriented learning. So any time that I’m able to step out of that little box and glimpse what I’ll eventually see as a doctor and how I can potentially make an impact in the future, it’s invigorating and exciting.

“Every once in a while I see a patient and I’ll refer them out to receive care from a different place or we send them to get labs at University Hospital, and we follow them up at the next clinic and I see that the treatment that we gave them worked and they’re better. It’s very refreshing to feel that you’ve made this impact.”

Petty, the nursing student, pointed to the inherent altruism in health care fields.

“I wanted to be a nurse because I like pus and broken bones and blood,” she said, only half-jokingly. “And it’s exciting. And at the end of the day, whether it’s something as outrageous as that or something as simple as helping a Nepalese man to overcome the flu at our clinic, you’re helping someone.”

Al-Asadi remembers a refugee who came to the clinic suffering from severe anemia. He was able to diagnose it and get her the proper treatment.

“I felt happy,” he said, “because I thought that was the gratification I was looking for. To make people feel better and to feel gratified, I think that’s part of the payment. It’s not necessarily financial. It’s a humanitarian profession, and we all signed up to serve people. And we should keep that always in sight.”

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