With immigration at the forefront of many national policy debates, the Ohio University Heritage College of Osteopathic Medicine convened a group of care providers, policy experts and community activists to help first-year medical students understand how immigration policy may affect them as physicians, and what it takes to effectively and compassionately serve immigrant populations.
During the college’s fifth annual Health Policy Day Feb. 9, students heard two panel discussions on the responsibilities of care providers and public health advocates in a time of immigration policy change. Punctuating the event were videos by nine Heritage College students, sharing personal experiences with immigration policy or working with immigrant patients.
Dan Skinner, Ph.D., assistant professor of health policy, organized the day with Berkeley Franz, Ph.D., assistant professor of community-based health, and Sarah Rubin, Ph.D., assistant professor of medical anthropology. Setting the tone for the discussions to come, Skinner stressed that immigration policies “have real ethical and moral dimensions” and directly affect real people who need health care.
Panelists addressed topics including health problems they see in populations they serve, the need to build trust and connection with patients, and ways in which policy impacts care.
Cat Gossman, M.S.W., refugee health and wellness program manager for the Columbus nonprofit Community Refugee & Immigration Services, reported that in the population served by CRIS, common health issues include latent tuberculosis, hypertension, substance abuse and “just a wide plethora of different mental health needs.”
For many immigrants, care must extend beyond the clinic to encompass such things as whether they can get to appointments. “Transportation is really a need for them,” said Mary Mutegi, M.A., program coordinator for Physicians CareConnection, which provides care coordination for vulnerable populations in central Ohio. Another need, she said, is to feel secure physically, legally and emotionally – that “when you come to our location, we are a safe place for you.”
Making immigrant patients feel safe can take time, panelists said, as caregivers must work to overcome language and cultural barriers. “You have to expect to spend more time,” said Francis Blais, D.O., associate director of the college’s Rural and Urban Scholars Pathways program and longtime volunteer with Physicians CareConnection. He advised asking patients about their lives; “That’s when you really begin to understand their culture.”
Listening to health care needs and concerns goes a long way toward helping any patient feel more comfortable, panelists said. “Put yourself in their position,” said Isiseme Ikharebha Green, M.P.H., executive director of Physicians CareConnection. “What would you want as a patient?”
Carole Merckle, R.N., M.S.N., assistant director of the Heritage College’s Area Health Education Center and Community Health Programs, agreed that it’s crucial “to really listen,” and make sure patients understand what they’re told. Often, she said, “patients don’t tell providers that they don’t understand something.” CHP’s mobile health clinic staff connects with and serves immigrant workers in the Racine, Ohio, area.
Caroline Kingori, Ph.D., assistant professor of community health in the OHIO Department of Social and Public Health, discussed the importance of getting to know a community from inside. Although she comes from the African nation of Kenya, she had to hire people from the Columbus-area Somali community to help her with research on this group. What this taught her, she said, is that to help immigrant populations, “we have to forget about ourselves and our goals and our intentions, and not do unto them, but work with them.”
Other panelists addressed the nation’s changing immigration and health care policies and how they impact the work of caregivers. Kingori noted, for example, that while documented immigrants can get Medicaid coverage (after five years), and refugees are eligible for Medicaid immediately, undocumented immigrants are not eligible, and thus are very likely to lack health coverage.
Those individuals often rely on receiving care at community clinics such as those in central Ohio operated by PrimaryOne Health. Buhari Mohammed, M.D., M.B.A., senior director of quality improvement and clinical support for PrimaryOne Health, said that while there’s a lot of need in the communities they serve, “we don’t turn anyone away, insured or uninsured.” He said that by increasing the number of insured patients, the Affordable Care Act allowed the nonprofit to serve more patients overall. With the threat of repeal, he added, PrimaryOne began drafting contingency plans considering “which clinics are we going to close down?”
Suha Abushamma, M.D., an internal medicine resident at Cleveland Clinic, described another way immigration policy may affect health care – by reducing the number of internationally trained physicians in the United States. Abushamma was detained by customs officials upon returning to the United States from Saudi Arabia during a 2017 travel ban because she is from Sudan. She was later allowed to return.
Abushamma praised Cleveland Clinic for supporting her, and urged other hospitals and health systems to stand up for immigrant patients and staffers. “If it weren’t for the Clinic, I wouldn’t have come back to the United States,” she said.
The Rev. Joel Miller, pastor of Columbus Mennonite Church, said faith-based communities have a role to play in the immigration issue, providing a kind of “immune response, when something is terribly wrong in the environment.” His church is providing sanctuary to a Mexican woman the U.S. government is trying to deport.
Meredith Gartin, Ph.D., a visiting assistant professor of global health in Ohio University’s College of Health Sciences and Professions who has done community-based research on immigrant populations in Arizona, urged students who want to work with such populations to get involved now. One way, she suggested, is by taking advantage of “all these really amazing international experiences” available through OHIO programs like the Global Health Initiative.
MacKenzie Reece was among the medical students attending Health Policy Day; his interest in immigrant health has led him to design a research project, under the mentorship of Dr. Rubin, to gather perspectives of heath care providers who work with refugee populations in northeast Ohio.
Reece said he found much in the event “eye-opening,” including accounts by his classmates of their own struggles with immigration laws; the debunking of the popular misconception that immigrants are a major drain on the U.S. economy; and Dr. Abushamma’s reminder of how many U.S. primary care physicians come from other countries.