Coping with a pandemic: Patient navigators and IRIS

In March, when COVID-19 first gripped the country, Fereshteh Ganjavi saw a crisis brewing. As the health care coordinator at Integrated Refugee and Immigrant Services (IRIS), she was besieged with calls from clients worried about the coronavirus pandemic.

“It felt like 5,000 people and just me,” said Ganjavi, who had come to New Haven herself as a refugee in 2011. Her three interns had gone home after spring break, and she was alone fielding calls and finding interpreters. Her job—which involved taking people to doctors’ offices and helping make follow-up appointments—had changed. Much of her time was now spent scheduling tests for COVID-19. Nonessential appointments like dental visits and eye exams were cancelled. She also had to help 10 recently arrived families schedule required medical screenings at Yale’s Primary Care Center. “None of the families had a primary care doctor,” she said.

Around that time, students in a patient navigator program at Yale formerly led by medical students Lucy Kohlenberg and Samer Hassan saw that the refugee community needed help. Since 2015, medical students had been volunteering as patient navigators in the School of Medicine’s refugee clinic. A similar program began in the Primary Care Center a year later; the two programs merged in 2018. The students operate in pairs, working with a family and accompanying them to medical visits; explaining treatment plans and medications; and connecting them with resources like food pantries and social services. Currently led by two second-year medical students, Michael Amick and Chandler McMillan, 40 students work with 55 patients, many of whom come from Afghanistan, the Democratic Republic of Congo, and Syria. The program has long worked with IRIS clients.

“Because of language barriers and technology barriers, it is hard for our patients to get on the phone or laptop and look up resources,” said second-year medical student Divya Ramakrishnan. “We try to bridge the gap between resources and patients.”

Students take on patients after getting a referral from clinicians and social workers, and conducting an initial screening by phone. “We want to get a handle on what the family sees as their needs and goals,” said Kelsey Jug, a second-year nursing student. “The navigators check in with family on a weekly or biweekly basis and see if they’re making appointments, if they are able to contact physicians on their own. The goal is to graduate our patients to self-sufficiency, where they can access community and health care resources on their own.”

As the country shut down and people began socially distancing, the patient navigators switched from in-person meetings to phone calls. And they reached out to IRIS, which had launched its own campaign to inform clients about COVID-19. “We expected that it would be helpful to have students to be hands-on, making phone calls,” said McMillan.

IRIS staff and students crafted a plan. Students called to check in with IRIS clients, often with the help of interpreter services at Yale New Haven Hospital. The students—33 medical students, 13 nursing students, and seven students from the Physician Associate Program—used a fact sheet they’d compiled with information about the coronavirus; what resources are available; where to get supplies; and where to seek care if the clients had symptoms of COVID-19. “We reached out to 113 refugee families,” said Jug. “There turned out to be a huge need for household necessities—diapers, toilet paper, cleaning supplies. With the quarantine, they were not sure how to get necessities.”

The students raised almost $3,000 on GoFundMe, which paid for 8,566 diapers, 612 rolls of toilet paper, 540 bars of soap, 250 masks, 49 pairs of gloves, and 30 bottles of hand sanitizer. The students also got 15 families to sign up with MyChart, an online tool for scheduling doctors’ appointments. “A lot of patients didn’t know what it was and didn’t realize you could use it to have a video visit with your physician,” said McMillan.

IRIS, meanwhile, was raising money to help clients who had been laid off from jobs in the restaurant and hotel businesses pay the rent. The organization also began delivering groceries and other items to vulnerable families. “We had a special care program for refugee families who were affected by COVID-19,” said Ganjavi, who scheduled tests for families exposed to the virus. She arranged for deliveries of care packages that included Tylenol, vitamins, soap, masks, cleaning items, and shampoo.

IRIS is continuing its campaign and planning another fundraising drive. Meanwhile, the Yale students are hoping to expand the navigator program by inviting public health students and undergraduates to join them. “One of our big initiatives is to expand capacity,” said Amick. “A limitation for our group is the number of navigators, who are primarily medical and PA students. With that in mind, the goal has been to open up to more refugee and primary care patients.”