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As the political debate over refugees in America heats up during this political season, this series explores the experiences of refugees who are settling, and have settled, in Virginia, and the programs that provide services for them. The Harrisonburg and Charlottesville areas lead the way in refugee resettlement in Virginia. Harrisonburg is second only to Northern Virginia in the number of resettled refugees, which numbered 260 in 2013.

Meet the UVa Doctors Who Meet the Unique Needs of Refugees

Those who come here seeking asylum from violence in other countries, often suffer from years of poor -- or even nonexistent -- medical care.  In the next installment of our series on Refugees in Virginia, WMRA's Jordy Yager introduces us to one such patient, and the doctors at the University of Virginia who focus on the special needs of asylum-seekers.

BIMAL CHHETRI: Still I’m alive because of the help and the generosity of the American people and the American government. Otherwise I would have died had I not come here.

Fifty-six-year old Bimal Chhetri isn’t exaggerating. In all likelihood, he really would be dead if he hadn’t come to Charlottesville as a refugee two years ago.

CHHETRI: I came here as a kidney patient. So they had already fixed everything for me, for my treatment in the UVA. So from the first month only, I’ve been under the doctor’s supervision and treatment. It has been more than two years I’ve been getting the best of the treatment, and I’m still alive. I have only 11% kidneys working.

Chhetri was born in Bhutan and spent 20 years living in a refugee camp in Nepal. Today he sits comfortably in the living room of his ground floor apartment. His wife cooks a potato dish for us in the adjacent kitchen. His granddaughter watches cartoons on the couch. Every eight hours he gets dialysis for kidney failure that resulted from untreated high blood pressure. He doesn’t own a car, so once a month he walks the three-mile round-trip to the University of Virginia hospital for a check up.

Chhetri is one of more than 3,000 refugees who’ve moved to Charlottesville through the International Rescue Committee since 1998. When they arrive, the IRC directs refugees to the Health Department, where they get re-screened and receive the vaccinations required by the Centers for Disease Control and Prevention. They’re enrolled in Medicaid and referred to UVa for their health needs.

DR. FERN HAUCK: I’m Fern Hauck. I’m a physician at the University of Virginia in the department of family medicine.

When Dr. Hauck moved here 15 years ago, refugees had to bounce all over UVa, and sometimes all over town, to get the care they needed. Imagine doing that in a foreign country where you don’t speak or read the language. When Dr. Hauck saw this, she collaborated with the IRC and the health department, and created the International Family Medicine Clinic at UVa.

HAUCK: Basically, we agreed that we would be the primary care physicians for all the refugees who come through the IRC into Charlottesville…The thing that’s unique about our program is that we don’t have a separate refugee clinic. It’s incorporated into our Family Medicine Clinic at the primary care center here.

This may seem trivial. But by incorporating refugees into the everyday American experience of going to see a doctor, one significant border — in a country filled with linguistic, social, and cultural barriers — is crossed.

The International Family Medicine Clinic has more than 2000 refugee patients.  At their initial visit, Hauck and her colleagues use an in-person interpreter to explain what a family physician is. Then they try to create a medical history for the patient. 

Some refugees, like those from Iraq and Syria, have lived in cities and had access to relatively good medical services. While others, like the Burmese and Bhutanese, have lived in refugee camps for decades, where chronic diseases such as hypertension, diabetes, and high cholesterol have likely gone undiagnosed and untreated.

Doctors do hearing and vision tests, nutritional assessments. If need be, they refer refugees to a specialist or a local dentist for tooth decay, which is a huge problem. But treatment and diagnosis are a fraction of what Hauck and her colleagues do.

HAUCK: I’d say we spend 75 percent plus of our time doing education. Think about the United States perhaps 30 years ago, and think about where people were, thinking about high blood pressure, for instance. So we really are starting from square one on so many fronts. We’re explaining a lot of disorders and diseases to them. We’re explaining why we need to treat them with medicine and what happens when we don’t treat them with medicine.

In many ways, patients with physical aches and pains are the easiest to care for. How do you explain ailments that patients have yet to feel? Things like heart disease? Or preventative treatments, like mammograms and colonoscopies? Even more difficult are the unseen injuries some refugees have sustained.

HAUCK:  We’ve also worked very hard on the mental health side. Mental health is a huge, huge, huge issue. We’ve talked about people coming from war-torn areas, being displaced from their homes, seeing people killed in front of their very eyes.

Dr. Hauck chokes up when she thinks about the trauma some of her patients have suffered. Some female refugees have been raped or been victims of genital mutilation. Others have been physically tortured. There’s no easy way to raise such traumatic and horrific events, but from a medical perspective, they need to. Studies show that depression and post traumatic stress disorder are more common among refugees than average Americans, and, if left untreated, can lead to suicide.

And that’s where Dr. Claudia Allen comes in.

DR. CLAUDIA ALLEN: A lot of refugees, if not all, have experienced some kind of trauma.

Allen is the director of behavioral services in family medicine at UVA and a clinical psychologist at the hospital’s Family Stress Clinic, where Hauck refers refugees with mental health needs.

ALLEN: So a lot of people do find themselves experiencing symptoms of post traumatic stress disorder.

Not only do mental health issues manifest as physical ailments, like head or stomach aches, they also severely affect day-to-day life — whether you’re a child trying to concentrate in school or an adult trying to adapt to a new job. Often refugees will experience something called hypervigilance.

ALLEN: Their brain might tell them, ‘No, it’s okay now, I’m here in Charlottesville, there’s not a war going on, I’m actually safe.’ But the other part of your brain and your reactions are still very heightened, and so they might be easily startled by loud noises or they might feel anxious around strangers.

Because gaining the trust of their patients is imperative to the mental health process, Allen aims to provide care frequently, a little at a time, over a long time.

While providing refugees with physical and mental healthcare is challenging, both Dr. Allen and Dr. Hauck repeatedly stress that the benefits make their job enormously gratifying. They speak of the unparalleled resilience and strength they see in their refugee patients and their fortified work ethic and perseverance. Hauck’s been invited to refugee weddings and adopted as an honorary family member, but perhaps the greatest joy is the prospect of seeing former patients return, not as patients, but as practitioners.

HAUCK: That’s been an incredibly rewarding piece, especially to see children who I’ve taken care of when they were 6 or 7 or 8 or 9 and now they’re graduating from the University of Virginia. I have one who I just heard about from her mom, that she just graduated this past year from dental school in Richmond. So that’s pretty incredible, I want them to come back here and practice.