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Refugee and Immigrant Health

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

  1. Provide comprehensive, culturally sensitive primary care for refugees from diverse backgrounds
  2. Use the best available evidence to provide care for newly arrived refugees
  3. 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 Outpatient Family Medicine and Acute Care 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. Additional time requirements range from two to four months.

  • 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.
  • Attend the annual Refugee Health Forum, a conference coordinated and crafted by Greensboro AHEC and Dr. Brown.
  • 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 in countries as wide-ranging as the Democratic Republic of Congo, Sudan, Iraq, Eritrea, the Central African Republic, Southeast Asia, and Syria as well as Central and South American countries.

Refugees

Refugees

Training

Residents rotate through the Refugee and Immigrant Clinic during all three years of residency. Residents spend time in the clinic during outpatient rotations in the first year and during the Community Medicine rotation in the second and third years. 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 Physicians for Human Rights Chapter and Cone Family Medicine 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.
  • Based on our work, the clinic was awarded a prestigious NC Schweitzer Fellowship for 2018-2019.

Collaborations and Resources

Further Training

  • Cone Health Family Medicine and Greensboro AHEC have held annual statewide Refugee Health Forums in Greensboro, NC to meet the challenges faced by refugees as well as to help those caring for this population learn best practices, establish networks, and hear from former refugees.
  • Held generally in March of each year, the conference has hosted speakers from the Centers for Disease Control (CDC), the Office of Refugee Resettlement (ORR), Georgetown University, Duke University, the University of North Carolina–Chapel Hill, Elon Immigration Law Clinic, the University of North Carolina–Greensboro, the NC Division of Public Health, and numerous other refugee agencies from across the state and southeast.
  • The conference is geared toward those interested in providing care for refugee patients, and remains a training opportunity for physicians, nurses,
  • Look for information on Greensboro AHEC’s website.

Read more about a Syrian refugee family who relocated to Greensboro.

For more information about our clinic, please contact Dr. Carina Brown at carina.brown@conehealth.com.