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Caring for New Haven’s refugees

Yale Medicine Magazine, 2017 - Spring


Medical students help refugees navigate the health care system.

In the fall of 2016, Tara Torabi met her first patient over the phone, a woman in her 30s with a muscle weakness that has stymied doctors. Since then Torabi has called her patient on the phone every week to check in and make sure she has transportation to her appointments and is taking her medications. Sometimes she calls just to make sure she’s OK.

When she calls, there’s always a third person on the line, an interpreter fluent in English and Arabic. The patient is a refugee from Iraq, and Torabi is a first-year medical student serving as her patient navigator.

Torabi is one of 18 medical students participating in the second year of a program that pairs them with patients from the School of Medicine’s refugee clinic for adults. The refugees, mostly from Afghanistan, Iraq, Syria, and Sudan, are referred through New Haven’s Integrated Refugee & Immigrant Services (IRIS), the largest of Connecticut’s three resettlement agencies.

“I have always felt that service is important,” said Torabi, who came with her family from Iran at the age of three and knows what it’s like to arrive in a strange country. “By participating in service activities, you really feel more connected to the community. It is an integral part of your education.”

The clinic (there’s another one for children) started about 10 years ago when a resident at Yale New Haven Hospital, herself an immigrant from Iraq, saw a need for services geared toward refugees. Two years ago, residents and medical students launched a pilot program to help patients navigate what can be a complex health care system. All refugees go through a health vetting before they enter the United States, but they also need a domestic vetting on arrival. The screenings check for tuberculosis and other diseases, and ensure that the patients have been vaccinated. “The idea is not to keep them from entering the country,” says Ani Annamalai, M.D., assistant professor of psychiatry and of internal medicine, and director of the clinic, “but to get them the necessary treatment.”

Many patients, said Amir Mohareb, M.D., HS ’17, are also at risk of post-traumatic stress disorder. “Even the most resilient refugees end up struggling to assimilate here,” said Mohareb, the resident leader for the program. “There is some level of psychological distress in every refugee.”

The clinic sees up to 250 families each year, about five patient visits each week. After their screening for medical conditions, the families are integrated into the health care system. That’s where the patient navigators enter the picture. Since the pilot program was launched in 2015, it has grown from 10 student volunteers to 18. Paul Bourdillon, a third-year medical student and one of the program’s two coordinators, said that it provides a clinical experience for “preclinical students who haven’t had much patient contact, but have some medical knowledge and some understanding of the way the medical system works.” The patient navigators, added Amandine Godier-Furnemont, a second-year student and the other program coordinator, serve as “a bridge between physicians and patients.”

Chris George, the director of IRIS, said that the relationship with Yale has made his organization the envy of other resettlement groups around the country—New Haven has a world-class medical center with staff dedicated to helping refugees on a regular basis. The resettlement process helps families find jobs, learn English, find their way around the city, find apartments, and learn about health through nutrition and wellness classes. IRIS also refers patients to the refugee clinic.

Last year, IRIS went from resettling about 240 people per year to 530. “The world was facing the largest refugee crisis ever,” George says.

Among the families resettled last year was Torabi’s patient, who came with her mother, husband, and children. The first time Torabi met her patient in person was at a medical appointment in January. “It was slightly awkward because the translator wasn’t there,” Torabi says. “It was difficult to connect, but there are other ways to communicate. You can smile and touch their shoulder.”

Her patient, Torabi said, was grateful for her presence. “Just showing up is important. Just showing someone that you care about them is meaningful, even if it seems like a small thing.”

Torabi helped her patient arrange an appointment with a neurologist to investigate the muscle weakness that required her to use a wheelchair. When she learned that her patient’s wheelchair had broken and that she was sharing one with her mother, Torabi pressed the primary care doctor for a prescription for a new one.

“This experience has sustained me and reminded me of why you enter med school in the first place,” Torabi says, “to help people.”

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