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Global Health

  • Refugee and Immigrant Clinic

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. 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.  

Refugees

Refugees

Training

Residents rotate through the Refugee and Immigrant Clinic during their Family Medicine Outpatient and Community Medicine rotations. 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

Asylum Forensic Evaluations

  • Since 2013, Dr. Jeffrey Walden has worked with the Physicians for Human Rights (PHR) Asylum Network and the Elon Humanitarian Immigration Law Clinic to provide pro bono medical forensic evaluations for persons seeking asylum in the United States.  Physicians can provide a critical step in documenting evidence of prior torture for those seeking legal asylum in the United States.  Dr. Walden has undergone Asylum Training through Physicians for Human Rights, was an inaugural member of PHR’s Train the Trainers course, and has led PHR trainings for medical professionals to learn how to conduct the exams. 
  • Since 2013, several dozen applicants have been evaluated at Cone Health Family Medicine.  The majority of these patients originated in Central America, but clients from central and western Africa as well as Eastern Europe have also been included.  The majority have been granted asylum as a result of their medical evaluations.  

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 Dr. Walden 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. 

  • Originally a collaboration between Cone Health Family Medicine and the UNC student chapter of Physicians for Human Rights and Elon Humanitarian Law Clinic, this clinic has since expanded to include faculty and residents from UNC-Chapel Hill and Piedmont Health Services, as well as law offices from Church World Service Durham.  Through expanding our base we are able to reach more clients throughout central North Carolina, not just those in the greater Guilford County area.  More information here:  https://www.med.unc.edu/oia/phr/ 

  • 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, social workers, medical students and residents, advanced-practice providers, public health professionals, mental health practitioners, and other community service providers.

  • Look for information on Greensboro AHEC’s website beginning in fall 2019. 

Click here to read more about a Syrian refugee family who relocated to Greensboro. 

For more information about our clinic, please contact Jeff Walden at jeff.walden@conehealth.com