Learning Cultural Humility While Helping Immigrants
By Susie Phillips Gonzalez
Students from the School of Dentistry at UT Health San Antonio are gaining immense oral health knowledge and skills while also learning about the culture and well-being of thousands of immigrants who visit the San Antonio Refugee Health Clinic (SARHC).
Launched in 2011, the clinic is part of the Student-Faculty Collaborative Practice operating through the Center for Medical Humanities & Ethics. SARHC partners with the Center for Refugee Services of San Antonio, a non-profit organization that seeks to promote the wellness, self-sufficiency and successful community integration of resettled refugees and their families.
“The mission of the SARHC is to serve the refugees, but its other mission is to educate the next generation of clinicians to address the needs of a one-world population,” says Moshtagh Farokhi, D.D.S., M.P.H., dental director of the refugee clinic and associate professor of comprehensive dentistry. “We remind students, ‘You don’t have to go on mission trips. The world is right here in San Antonio.’ Every refugee brings us the gift of their language and culture.”
The clinic is a collaboration of dental, medical and nursing students at UT Health San Antonio who annually serve hundreds of refugees from countries such as Iran, Ethiopia, Thailand, Nepal and the Republic of Congo, among others. Arriving in San Antonio with immigration green cards, the refugees often have an education and job prospects. What they don’t have after their initial eight months of temporary health care is access to long-term, comprehensive health care or insurance.
Held weekly at St. Francis Episcopal Church, the clinic offers students and mentors from faculty and adjunct faculty an opportunity to make a difference in the lives of refugees. Dental students offer free exams and referrals and in some cases apply a topical solution of silver diamine fluoride to treat and prevent cavities. Twice a year, students partner with the San Antonio chapter of the Christian Medical and Dental Association at daylong clinics where local practitioners perform restorative care, extractions and other dental procedures at no charge.
Dr. Farokhi says the clinic has come a long way in its eight years. In the beginning, she says, students spent two hours with each patient. At a recent session, Dr. Farokhi and a team of dental students examined an Afghanistan native who spent eight years translating for U.S. troops stationed in his home country. She greeted him in Farsi but quickly switched to English when she learned his background. Dr. Farokhi referred him to the dental school’s Center for Oral Health Care & Research for a procedure that was estimated to cost $460. When he gave her a look of incredulity, she said the same dental work would cost $2,000 in private practice.
The clinic experience comes with a cultural humility that Dr. Farokhi says leads students to a clearer understanding of how a vulnerable population can navigate the health system.
About 10 third- and fourth-year students attend the clinic regularly each semester as part of a course selective in community service learning with emphasis in oral health literacy. Some are student leaders who mentor younger students and all collaborate with the medical and nursing students. The interprofessional work includes electronic record-keeping and consultation that has broadened each student’s knowledge of the other disciplines.
“I gained an exceptional amount of clinical knowledge compared to my fellow classmates because of my experience at the refugee clinic. It afforded me the opportunity to see various cases of periodontal diseases through a wide variety of patients,” says Jiye Moon, B.S.D.H. Class of 2018, RDH, who emigrated from Korea with her parents in 2004. After witnessing her family’s struggles to obtain affordable dental care, Moon decided to pursue a career in dental hygiene. She found it pleasantly ironic that many students identify with the refugees because they too were once immigrants.
“Being surrounded by students who speak their own native language helped many patients feel at ease because it allowed patients to better comprehend their current medical or dental state. Witnessing this level of communication and empathy with patients was an invaluable experience,” Moon says.
Monica Gerges, a fourth-year dental student, says her first language is Arabic, which she learned from her parents who moved from Egypt to Houston before she was born. Being fluent in Arabic is one reason Gerges volunteers at the refugee clinic, serving as a translator while boosting her dental knowledge.
“Arabic is not something I get to speak a lot in San Antonio,” Gerges says. “I remember one woman who was so thankful for the dental treatment we were able to give her. She became more comfortable as she shared her experience with me in her own language.”
Peggah Hemmat, D.D.S., a first-generation Iranian-American, is an adjunct faculty member at the dental school who is currently a volunteer dentist attending the clinic. She graduated in 2016 after serving as a clinic student leader supervised by Dr. Farokhi.
“When you first enter the refugee clinic, it seems chaotic,” Dr. Hemmat says. “But it’s anything but chaotic. There are so many moving parts with students from the medical, nursing and dental schools and their faculty. You have patients of all backgrounds lining the halls. You hear at least three to four different languages spoken at the same time. It’s really cool to see all the students using their health care skills and languages to bring together care for an underserved population.”
André Jones, D.D.S. Class of 2019, says his eyes were opened by refugees with diseases that are not common in America. Dr. Jones, a native of San Antonio, is now a first-year resident in the Advanced Education in General Dentistry Program. He believes his experience at the clinic has “made me into a better clinician.”
Alexandra Vela, B.S.D.H. Class of 2018, RDH, says her experience before graduating has been invaluable to her work as a dental hygienist at the People’s Community Clinic for uninsured residents of Austin. She says her time at SARHC was both gratifying, inspiring and helped her meet her personal goal “to make a difference for those who suffer from a wide array of dental problems and make a lifelong impact on their lives. This is the type of work I will continue to be a part of.”
For Dr. Farokhi, watching students blossom into community-focused dentists and hygienists while gaining knowledge of global health issues is a bonus to her job, topped only by the appreciation she encounters from the refugees.
“Our students have helped make this clinic what it is, but I’m not sure who benefits more from the clinic–the refugees, the faculty or the students,” Dr. Farokhi says. “This clinic is one of the most rewarding things I do professionally. My reward is what I see in my patients’ faces: their gratitude.”