Understanding Social Determinants of Health: San Antonio Refugee Health Clinic
By Salwa Choucair
UT Health San Antonio operates the San Antonio Refugee Health Clinic (SARHC) in partnership with the Center for Refugee Services of San Antonio, a non-profit organization with a mission to promote the wellness, self-sufficiency and successful community integration of resettled refugees and their families. A true interdisciplinary and joint effort among nursing, medical and dental students and faculty from UT Health, SARHC addresses the health and social needs of about 5,000 immigrant refugees living in northwest San Antonio.
Open weekly on Wednesday evenings at St. Francis Episcopal Church, the primary goal of the clinic is to serve as an initial trustworthy location for refugees to overcome their inhibitions and adequately address their health care issues and social needs.
SARHC Co-Director Heidi Worabo, D.N.P., RN, FNP-BC, assistant professor/clinical, says nursing students have a great opportunity to not only work with a vulnerable population but to also work side by side with their counterparts in the schools of medicine and dentistry.
“The interprofessional aspect of this clinic is ideal,” Dr. Worabo says. “I learn from the dental and medical students when they are conducting exams, and I find they learn from the nursing students especially when it comes to community engagement.”
At the beginning of each weekly clinic, students participate in a faculty-led presentation, which usually includes a patient case that brings the students together and can be interactive, says Dr. Worabo.
“We collaborate and learn from each other, and that is rare when it comes to a typical nursing, dental or medical education. I didn’t have these opportunities when I was training.”
The SARHC operates as a walk-in clinic, and Dr. Worabo and her colleagues see an average of 15 patients weekly with the majority being adults. Since language is often a barrier to health care in this population, interpreters are available.
“We see quite a variety of cultures,” Dr. Worabo says, “and I tell my nurse practitioner students repeatedly that if you are unable to communicate with your patients or unable to understand their perspective, then a lot of times, they will not listen to your recommendations or treatment.”
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For example, patients from the Nepal culture are generally reserved and while they may nod when a health care provider gives them instructions, they are not necessarily nodding because they understand those instructions. They may be nodding just to be polite. Dr. Worabo teaches students to ask patients to repeat the instructions back to them before they leave the clinic.
As the School of Nursing continues to strengthen partnerships in the community by serving vulnerable populations, students benefit by gaining a broader sense of their chosen profession’s role in health care.
“For me, nursing has always supported a holistic view when it comes to caring for our patients. As a family nurse practitioner focused on primary care, I believe reaching out into the community to keep people healthy is key to preventing them from needing the more acute services. This is what I love about nursing. We go into the community and help patients wherever they need help in order to address whatever health problems they are having. That is our mission.”
