Opening Doors to Medical Care in a New World

Sacramento County has surpassed Los Angeles County in the number of new immigrant arrivals each year. Medical care is only one of the cultural shocks they encounter.

From 1995 through 1997, Sacramento County was second only to Los Angeles County in the number of new arrivals to the state. Since then, Sacramento has been first.

Because of that sharp increase of patients and the addition of new services (CHDP examinations and adult physicals), in October 1999 the clinic was made a separate entity in the County Department of Health and Human Services, no longer a part of the County Chest Clinic.

I have the good fortune to work with a dedicated and caring staff of fourteen-a family nurse practitioner, a bilingual R.N., one LVN, medical assistants (two of whom are bilingual) and an exceptional Clinic Manager, Carolyn Lynch, R.N.

At the Refugee Health Clinic our patients are primarily people from the former Soviet Union. But families from Southeast Asia, Africa and Eastern Europe are also having their first medical experience in their new country. We are determined to set a positive example, to create a feeling of comfort and trust. For many, this is truly a "foreign" feeling about health care. The smiles we receive for our efforts are indeed heart-warming.

The State Refugee Health program charges the clinic with responsibility to complete a comprehensive (nine-page) health history and a physical examination, which includes audiometry, Snellen vision testing, lab testing and immunizations.

We serve apprehensive, non-English-speaking patients and identify problems that need to be referred to the health care community.

The health conditions we find range from anemia to thyroid disease, sometimes related to radiation exposure; from diabetes to previously undiagnosed H. pylori, masking as stress-related, non-specific abdominal pain.

Besides hepatitis A and B, we screen for hepatitis C, and have seen positive results where there is a history of surgery before immigration, because of the high likelihood of contamination from surgical equipment and needles.

Another clinic focus is tuberculosis screening. Mantouxs (PPD) are placed and read, and, if positive, screening chest x-rays and doctor visits are scheduled with the Chest Clinic, which in addition provides chemoprophylaxis or treatment. Many of our patients come from countries in which tuberculosis is pandemic, and our joint efforts with the County Chest Clinic are a critical part of patient care.

We want our patients, even the healthy ones, to have a smooth transition to quality medical care in the community. We refer patients who need semi-urgent care to community specialists, but they typically need help with transportation, simple directions (a major problem when you have been in the community three to six weeks), language, and learning the values and belief systems of a culture that is so different from theirs. The Refugee Health Clinic helps by sending staff interpreters with some knowledge to assist patients as they step into the medical community.

For example, we placed a PPD on a five-year-old who returned two days later with a positive reading. We sent him to the Chest Clinic for an x-ray. The technologist noted a 10-centimeter intrathoracic lesion and immediately brought it to my attention. We made a few phone calls to colleagues in the community, and the boy underwent further evaluation and surgery for removal of a malignancy.

He is doing well, but consider what this meant for this boy and his family: a new home, new doctor, a shocking medical discovery translated to a frightened family, a referral to someone whom I knew but they did not, even a 10-day post-op stay in a community hospital. Our translator accompanied the boy and his family from beginning to end. They needed this cultural buffer, as did our medical community, for it to work smoothly.

To offer quality care to a refugee population now approaching 80,000, our medical community needs to expand its services. To do that and ensure patient compliance, the medical community and these new patients need all the logistical and support services mentioned plus help with the ever-present insurance eligibility and documentation that is even difficult for English-speaking patients.

The Refugee Health Clinic also engages in community interaction and outreach. Through our involvement with the Lead Project we have this year identified more than 20 family members with serum lead values in reportable ranges, the highest a two-year-old with 38.2 micrograms.

Our two presentations on early breast cancer detection, designed for women of former Soviet states, was enthusiastically received. Our WIC referrals have gotten children off to a healthy nutritional start. I sit on the Medical Society's Child and Adolescent Health Committee to give further voice and exposure to the needs of refugee, asylee and parolee clients.

The staff and I invite you to visit our facility at 4603A Broadway (at Stockton Boulevard), Sacramento.

Our phone is (916) 874-9750, where you may find help for serving your immigrant patients. Please help us keep the doors open to a new world of medical care for these new Americans.

smitha@dhhs.co.sacramento.us