Tram Pham tears up recalling how tough life was at first in the U.S. But she also remembers the joy she felt as a 22-year-old refugee from Vietnam when a nurse spoke to her in her native language and guided her through a medical screening required of new arrivals.
Nearly three decades later, Pham hopes to pay that comfort forward as a registered nurse at the same San Jose, California, clinic that treated her family. The TB and Refugee Clinic at Santa Clara Valley Medical Center is screening people from Afghanistan who began seeking asylum in the U.S. after American troops withdrew from the country in August.
Pham can't speak Farsi or Pashto. But she can soothe patients stressed out over the job they can't find or the rent that's due. The other day, she held the hand of an older Afghan woman as she cried out her fears.
"I can see patients from all over the world come in. I see, you know, Vietnamese patients. I see a lot of refugee patients," she said. "I see myself."
The TB and Refugee Clinic joins a vast network of charities and government organizations tasked with carrying out President Joe Biden's plan to relocate nearly 100,000 people from Afghanistan by September 2022. Nearly 48,000 Afghans have already moved off U.S. military bases and settled in new communities, the U.S. State Department said in an email, including more than 4,000 in California.
The operation has been hampered by the need to scale up quickly after steep cutbacks to refugee programs under President Donald Trump. But the community response has been overwhelming and enthusiastic, said Krish O'Mara Vignarajah, president of Lutheran Immigration and Refugee Service, one of nine national resettlement agencies.
"We know that resettlement isn't a weekslong or monthslong process. Success requires years of effort. And so, that's where it's really important to have strong community ties," Vignarajah said.
The nonprofit, which operates in at least two dozen states, has resettled roughly 6,000 newly arrived Afghans since summer, including 1,400 in northern Virginia, 350 in Texas, 275 in Washington and Oregon and 25 in Fargo, North Dakota.
The state of Oklahoma has received about half of the 1,800 people it was told to expect, said Carly Akard, spokeswoman for Catholic Charities of Oklahoma City. Akard said that in their rush to escape, many of the refugees arrived without identification.
"They fled and didn't have anything," she said.
In San Jose, the clinic is scrambling to hire more people and reallocate staff for the more than 800 people expected in the county through September. Not only is the number a large increase from the 100 people the clinic assessed in all of the last fiscal year, but it is uncertain when they will arrive, said health center manager Nelda David.
But David said that won't stop the staff of roughly three dozen from rolling out the welcome mat at the clinic, founded four decades ago specifically to assist Southeast Asians after the Vietnam War. Most of the nurses, assistants and other staff are immigrants or former refugees themselves, and they understand the shock of starting over in a new country.
Medical interpreter Jahannaz Afshar welcomes Farsi speakers at the front door even before they check in for their first visit. In a windowless office, she explains what to expect over at least four visits as part of a comprehensive health assessment, which includes updating immunizations and checking for infectious diseases. A medical exam is required of all refugees.
But Afshar, who moved from Iran in 2004, also explains cultural differences, such as the American preference for personal space and chitchat. She'll tell newcomers how to take the bus or use the public library, and reassure them that in the U.S., people help without expectation of getting anything in return.
Most staff members are bilingual, and come from a number of countries, including China, Myanmar, Sierra Leone and Mexico, said Mylene Madrid, who coordinates the refugee health assessment program. But staff can help even without speaking the same language.
An Afghan woman was tense and nervous when she arrived the other day for her first medical exam. By the end of the hourslong visit, however, she was cracking jokes and sharing photos with public health assistant Nikie Phung, who had fled Vietnam decades earlier with her family.
Another new arrival from Afghanistan dropped by the clinic complaining of chest pains but was so anxious she couldn't elaborate on her symptoms. Pham, the nurse, asked if she could hold her hand. They sat as the woman sobbed, then finally spoke of the stress of having her entire family living in a cramped hotel room.
By then, her pains had receded. Pham noticed that the woman's daughter and son-in-law were upbeat and more comfortable speaking English. She pulled the daughter aside.
"Would you please spend time with your mom?" she asked her. "Talk to her more."
Staff members have gone out of their way to connect patients to jobs, furnish empty apartments and tap the broader community for rent and other relief. They've stocked diapers for babies and handed out gift baskets at Thanksgiving. During a routine visit, a patient mentioned he needed car repairs for work. Within weeks, the clinic had raised $2,000 to give him.
"Your heart is different," says Jaspinder Mann, an assistant nurse manager originally from India, of immigrants' desire to help.
Afshar says she can't imagine what refugees are going through. The former apparel designer and her husband were not fleeing strife and shootings when they chose to leave Iran. And yet, she, too, struggled at first.
"And this is one of the things that I always share," she said. "That even though it's going to be hard, later you're going to be happy because ... you're going to learn so much and you're going to grow so much."
At the clinic, she hops on the phone to arrange an eye exam for Mohammad Attaie, 50, a radio technician who fled the capital of Afghanistan, Kabul, this summer with his wife, Deena, a journalist, and their daughter. Sana, 10, adores her new school in San Jose, but the couple worries about finding work when they can't speak the language.
Still, seeing people like Afshar and Pham gives them confidence.
"They are successful. They're working here. Their language skills are good. I am hoping that in less than a year I can stand on my feet," Deena Attaie said, speaking in Farsi.