Dr. Fern Hauck was nervous when she moved to Charlottesville more than 20 years ago to take a position at the University of Virginia Medical Center.
She worried that the area wouldn’t be as diverse as she was used to — but then she found out about the International Rescue Committee’s local refugee resettlement program.
Hauck, a family medicine doctor, wanted to provide refugees and immigrants in the area with a medical home, and in 2002, she opened the International Family Medicine Clinic, which has become a model in providing health care to refugees and has served thousands of patients.
Staffed with doctors and nurses trained in trauma-informed care and working with interpreters, the clinic is the first stop for refugees, providing them with an approachable and accessible introduction to American health care.
“It’s amazing for our families,” said Harriet Kuhr, executive director of the Charlottesville IRC office. “… It’s a place that’s specifically welcoming. They don’t have to be put down because they don’t speak English.”
The local IRC branch can resettle as many as 250 refugees each year. Last year, 200 refugees moved to the area.
When Kuhr took over the Charlottesville IRC office in 2010, Hauck was one of the first people she met.
“I just always list her as one of my heroes,” Kuhr said of Hauck. “It’s one thing to have a vision, but to actually make it happen and in a university structure …”
Kuhr’s grateful for the clinic, which is unique to this community.
“In areas that have refugees, everyone wishes they could have something like [the clinic],” she said.
Clinic staff meet with all newly arrived refugees to conduct an initial health screening and start addressing their medical issues, which range from chronic conditions such as high-blood pressure to acute mental health concerns. Many of the refugees have experienced trauma.
“For refugees especially, many of them have been traumatized, moved from place to place and might arrive with some mistrust and fear, lots of fear of the unknown,” Hauck said. “It’s having a place where they feel pretty comfortable with familiar faces, not just us physicians but our nursing staff and others.”
Hauck has worked to make the clinic — and medical care overall — as accessible and approachable as possible.
“Over the years, we have developed protocols and we’ve done a lot of training,” she said. “All of our residents and nurses know how to work with interpreters, and we do a lot of education about the different groups of people.”
Throughout the Medical Center, interpreter phones are at the ready to help doctors and patients communicate.
The clinic has evolved since it opened in 2002.
“We’ve learned a lot along the way,” Hauck said. “… When we started, it was me and one other doctor, and one nurse who kind of worked with us.”
Now, resident doctors at the Medical Center are required to work in the clinic; those who show an interest can take on more patients. In August, staff members started a Little Free Library of non-English books in the clinic’s waiting room.
Over the last 18 years, Hauck said it has been rewarding to watch refugees build lives for themselves in the Charlottesville area.
“I have seen my young patients become college students and graduate school students, and then move into their professional careers, and start families of their own,” she said. “I have seen adults move up work ladders to become supervisors and some even able to go back to school.”
Hauck said she feels it’s important for her to advocate for refugees, especially as the federal government moves to reduce the number of people allowed into the country. This year, the U.S. will accept 18,000 refugees, down from the previous limit of 30,000 and a fraction of the 110,000 allowed in 2016.
“Our country has been built on the contributions of immigrants and refugees, and that should not and cannot end,” she said. “We will all suffer if it does.”
Hauck wanted to be a doctor from a young age and was especially interested in global health. In the 1980s, she worked for a year in Thailand at a camp for Cambodian refugees who had fled genocide.
“I really found it to be a very meaningful experience,” she said.
Hauck said working with refugees requires a special skill set, which is important for residents and medical students at UVa to learn as they move to communities throughout the United States that have refugee or immigrant populations.
“There are lots of differences by culture, and you have to be able to understand where people are coming from and what their cultural backgrounds are,” she said. “It’s teaching them how to ask the questions, how to get the information, how to communicate, how to build trust and how to talk to people who’ve been traumatized.”
Bridging the cultural divides is imperative, especially when it comes to teaching refugees about American medical practices, such as prevention.
“It’s challenging, too, because they often have different viewpoints about medication and illness,” she said. “They don’t want to take medicine. We do a lot of education and negotiating.”
The clinic’s approach is more hands-on than other clinics at UVa. If doctors prescribe medication or order a test, staff members might walk families to the pharmacy or lab.
“You can’t just say, ‘go to the pharmacy,’” she said.
If a patient doesn’t show up for an appointment, the clinic’s care coordinator or social worker might call and check in.
“Lots of people are complicated,” Hauck said. “The refugees add another level of complexity, that’s for sure.”
Hauck said there are other kinds of clinics set up to help refugees, but UVa’s model is “fairly unique,” she has found.
“I really like the fact that a family can come to one location, because it’s such a stress for them to figure out the health care system, know where to go and have to find a doctor,” she said. “So, it’s what I like for them — that they can have a home and feel comfortable.”