CHARLOTTESVILLE, VIRGINIA - When Lubna Abbas arrived in the United States as a refugee six years ago, there were days she could not walk because of a spinal disc problem which could not be treated in her native Iraq.
“After the war, many doctors were kidnapped, killed or ran away. There was nothing, no good treatment or hospital,” she told VOA. “When we came here, I was just surprised with a clean hospital.”
“Clean” was not all she found at the International Family Medicine Clinic in Charlottesville, Virginia. She also got full use of her legs back after her disc was treated. She now has no trouble walking and more. “I can work. I have two part-time jobs,” she says.
The clinic that helped Abbas is dedicated to refugees and immigrants — and all the baggage they bring with them: years of poor or non-existent medical care and the strain of living in a violent or repressive society.
WATCH: Clinic Dedicated to Helping Refugees
A physician at the University of Virginia (UVA) Department of Family Medicine came up with the idea.
“When they come, they have many problems often both medical and psychological,” said Dr. Fern Hauck. “I felt that could be best done in one setting in our clinic where then I could train other doctors, our nursing staff … all to have a much more comprehensive approach to the refugees.”
Hauck established the clinic at UVA in partnership with the local health department and the International Rescue Committee (IRC), the international refugee resettlement agency.
A stately old city by U.S. standards, Charlottesville is also one of 22 American cities that work with the IRC to resettle refugees from around the world. UVA has long attracted foreigners, so their presence is nothing new here.
The IRC set up an office here in the late 90's and ever since, Charlottesville has been welcoming refugees at the rate of 100 to 200 a year. In the beginning, the Bosnian war had recently ended, so many of the first arrivals came from Bosnia-Herzegovina.
Since 1998, Charlottesville has accepted some 3,000 refugees from 32 countries, a lot for a small city of 50,000.
Most of them have been treated at the clinic.
The first visit is a big deal. Patients are provided with an on-site interpreter and spend a full hour with doctors, which is highly unusual in U.S. health care; but, the need to translate takes time, and doctors have a lot of health history to cover and often, a lot of explaining to do.
“A lot of the women, for instance, have never had a mammogram, have never had a pap smear, so we are explaining these tests, why do we do them here, why do we recommend them. So we do also a lot of patient education,” says Hauck.
Follow-up visits are half as long, and interpretation is provided by phone.
Hauck says the clinic sees most of the ailments that it would see in American patients, like high blood pressure and diabetes. In addition, refugee patients report other problems including body pains, headaches, dizziness and stomach aches. Sometimes, these symptoms signal underlying physical problems. Sometimes they point to mental health issues, like post-traumatic stress disorder and clinical depression.
The physical symptoms are often easier for patients to talk about than what they have experienced.
“You can imagine someone has been in a country in the midst of war and seen a family member killed in front of them and maybe threatened themselves and had to flee. They've gone through trauma,” said Claudia Allen, clinical psychologist in the UVA family medicine department.
“So they may be having nightmares. They may be having flashbacks, maybe having intrusive thoughts.” Allen adds that refugees do not thrive in the U.S. unless these problems are treated.
Treatment is paid for by Virginia's Refugee Medical Assistance Program, which is funded by Medicaid and provides medical coverage to refugees for eight months. By then, most refugees have found jobs or started business and either have employer-provided health insurance or buy it on their own.
Healthy members of society
Bimal Chhetri gets a regular checkup at the clinic. Last year, he underwent a kidney transplant at the UVA hospital.
“I would have been dead by now,” Chhetri says, “because I didn't have resources to get dialysis and transplant … in the refugee camp.”
Chhetri spent 20 years in a refugee camp in Nepal after he fled Bhutan where he was born. “I was among those 110,000 people that left the country out of the fear of persecution.”
He is now working at a grocery store, and is a Nepalese interpreter for IRC.
Hauck says the clinic's goal is to produce healthy and productive members of the Charlottesville community, like Chhetri.
“When I've seen a kid when four or five years old and now they're going to the University of Virginia going to medical school,” Hauck says, “it's so gratifying to see the successes and seeing how much we have been able to help.”
Helping starts with a doctor, an interpreter and lots of time to listen.