Refugee and Immigrant Health AOC
Family physicians care for individuals from diverse backgrounds across the nation and across the globe. Greensboro serves as a refugee resettlement city. For decades, community agencies have helped refugees relocate and settle in Greensboro. Cone Health Family Medicine partners with these agencies to provide primary care to families arriving from all across the globe---ranging from the Democratic Republic of Congo to Columbia to Bhutan.
Goals and Objectives
- Provide comprehensive, culturally sensitive primary care for refugees from diverse backgrounds
- Use the best available evidence to provide care for newly arrived refugees
- Partner with local agencies and resources to improve the health outcomes of refugee and immigrant populations
Clinical and Educational Opportunities
Every resident has the opportunity to complete initial refugee examinations in the Family Medicine Center. In the first year, residents spend time in the Refugee and Immigrant Clinic on Ambulatory Rotations. During the second and third year, residents have dedicated time for refugee and immigrant care on the Community Medicine Rotation. Residents provide care for refugees as part of their longitudinal clinical experience in our Family Medicine Center each day throughout the three years of training.
The Refugee and Immigrant Health Area of Concentration provides additional opportunities for education and clinical care, as described below. Requirements are flexible and tailored to the interest of each resident and their future career goals.
- Spend time with local agencies and partners providing care to refugees in our community. Partners include, for example, the Congregational Nursing Program.
- Perform N-648 examinations (examination for individuals unable to take the citizenship exam) in conjunction with UNC Physicians for Human Rights.
- Complete an elective focused on asylum seeker care. This can include training in asylum examinations.
- Spend two or four weeks on a refugee health elective, with time dedicated to improving the care of the refugee patients seen on a regular basis in our clinic.
- Complete a scholarly project, which can involve a literature review and summary, conference presentation, quality improvement project, or research using our own database of information.
Refugee and Immigrant Clinic
In an effort to increase access to care among recently arrived residents to Guilford County, the Cone Health Family Medicine Refugee and Immigrant Health Clinic was established in October 2014 by Dr. Jeff Walden, a graduate of Cone Family Medicine Residency. The clinic serves a dual purpose: to provide care for newly arrived and typically underserved patients while also providing education to residents and medical students on the medical, psychological, and social needs of refugees and immigrants.
Patients
Historically, North Carolina ranks in the top 10 states for resettled refugees, and Guilford County receives a high proportion of these, between 800–1000 refugees each year. For the greater Greensboro Area, our patients have originated from countries as wide-ranging as the Democratic Republic of Congo, Sudan, Afghanistan, Iraq, Eritrea, the Central African Republic, Southeast Asia, and Syria as well as Central and South American countries.
Training
Residents rotate through the Refugee and Immigrant Clinic during all three years of residency. Residents spend time in the clinic during ambulatory rotations in the first year and during the Community Medicine rotation in the third year. Residents are also able to spend more time in this clinic during elective time. The first 30 minutes of each clinic are spent as dedicated didactic time, following an established curriculum in refugee health.
Fourth-year medical students from UNC-Chapel Hill can also rotate through this clinic as elective course GLBE 402: Refugee and Immigrant Care.
The Clinic / Services Provided
This clinic serves as an educational opportunity, with time set aside to obtain the often-complicated histories of these patients. Full interpretative services are provided, through in-person interpretation or video interpretation. We work closely with local volunteer resettlement agencies as well as the Center for New North Carolinians and New Arrivals Institute to provide care for our patients.
The clinic serves as an introduction for residents to the refugee and immigrant process. Other important goals for learning include aspects unique to the medical and psychological care of recently arrived persons. We also emphasize teaching the fundamentals of cultural competency, cross-cultural medicine, and working with interpreters.
Other Services
N-648 Clinics
- After a brief time receiving support for case management, social services, and medical insurance, refugees are expected to become self-sufficient. Within a year after arrival, they can apply for Legal Permanent Residence (LPR – aka a “Green Card”), and after seven years can apply for citizenship. Yet many refugees suffer from medical conditions that might preclude them from meeting the language and civics requirements for citizenship.
- A joint task force led by the UNC-Chapel Hill Chapter of Physicians for Human Rights and Cone Health Family Medicine Residency has worked to address disparities resulting from the inability to meet the citizenship requirements by developing an ongoing N-648 Clinic. In this clinic, students, residents, and attending physicians meet with and evaluate refugees to document any evidence of mental or physical conditions. Students conduct the examinations and complete the N-648 paperwork based on their findings alongside qualified attending physicians. This work is done in partnership with Elon School of Law.
- Based on our work, the clinic was awarded a prestigious NC Schweitzer Fellowship for 2018-2019.
Collaborations and Resources
For more information about our clinic or the Refugee and Immigrant Health Area of Concentration, please contact Dr. Carina Brown at carina.brown@conehealth.com.
