Commentary: A unique Philly partnership offers health care to refugees

Every Wednesday afternoon, newly arrived refugee families are guided into the exam rooms in the Jefferson Department of Family and Community Medicine. Here they are introduced to the U.S. health-care system and meet the primary care doctors for screenings and vaccinations.

What began 10 years ago with the mission to improve the medical care of newly arrived refugee families has blossomed into a medical home for refugees and become an integral part of the teaching curriculum for the Jefferson family medicine residents and medical students.

This care delivery model for refugee patients began as a pilot by the Nationalities Service Center (NSC) and Thomas Jefferson University's Department of Family and Community Medicine.

Before this, refugees in Philadelphia accessed the health-care system through local health centers, as new arrivals did in many other large U.S. cities. Unfortunately, this model led to either significant delays (often of several months' duration) and limited access to important preventive and life-saving specialty care - two major challenges for refugees seeking to rebuild their lives in a new country.

As the NSC was charged with ensuring appropriate access to health care, partnering with a neighboring academic medical institution made sense. And this close collaboration has not only improved the care of refugee patients, but has also helped them better integrate into the U.S. medical system. Often refugees have been staying in settlements with little or no access to medical care, so this first examination offers an opportunity to receive long-awaited treatment and tell their story to a caring, competent provider.

Since the initial clinic in September 2007, this collaboration has expanded to encompass three resettlement agencies and 13 university-affiliated and federally qualified health centers throughout our region. This model has been recognized nationally as being able to accept some of the most medically complex cases arriving in the United States. Annually, we serve more than 800 new patients and thousands of former refugees, who still obtain care at the medical home where they were introduced to U.S. health care.

During these Wednesday afternoon clinics, resident physicians and medical students help diagnose acute and chronic illness, screen for mental health issues, and introduce the concept of preventative care to the patients.

In addition to learning how to treat common infectious disease (such as latent tuberculosis) and chronic disease (such as diabetes) diagnoses in a culturally competent manner, the residents and students also gain insight into illnesses that are seen in developing countries, but rarely here.

For example, rheumatic heart disease, which can occur due to untreated strep throat, is seldom seen in the United States because of our easy access to antibiotics.

In turn, these families enrich the education of our medical students and residents by providing a unique learning opportunity that cannot be replicated in the classroom. The residents and students learn to communicate through multiple layers of belief systems, cultures, and languages, expanding their diagnostic imaginations.

Most importantly, refugee patients teach these young health-care providers about resilience - how years of trauma, violence, and persecution can strengthen the spirits of individuals and their desire to successfully integrate into U.S. culture.

This unique learning opportunity has had a significant impact on the lives of our learners as they embark on their careers.

"Every time I do an intake, I am amazed at the strength and grace of the families sitting across from me," one Jefferson family medicine resident said. "They have told me about beatings, sexual abuse, losing family members to death by violence, losing family members to chaos and confusion, parents, and siblings, and even children left behind."

Despite some of the challenges that refugees may face in the future, programs such as the Philadelphia Refugee Health Collaborative must continue to provide a service to those less fortunate, while enriching the knowledge of our future medical generation.

Marc Altshuler, M.D., is director of the Jefferson Center for Refugee Health and an associate professor in the Department of Family and Community Medicine at Thomas Jefferson University. marc.altshuler@jefferson.edu