Easing the Way for Refugee Patients

When Evlyn Samuel sees immigrant families who are overwhelmed by navigating the U.S. healthcare system, she reflects on an experience when she felt the same way.

It happened when Samuel, a third-year medical student at Duke, became ill while studying abroad in Ecuador as an undergraduate at Cornell University. She tried to describe her symptoms to a doctor at a local hospital, but she wasn’t fluent in Spanish. It was only when she was seen by an English-speaking doctor that she began to feel comfortable.  

“Being sick, and reaching out for help, you already feel vulnerable, but living in an unfamiliar place and speaking a different language opened my eyes to an even greater complexity,” says Samuel. “After that experience, I was motivated to learn languages for those of different backgrounds and make them feel less vulnerable.”

Samuel is now doing that as an intern with the Lincoln Community Health Center, federally-qualified health center in Durham that serves a large number of immigrant and refugee patients. The internship, which was launched with a grant from the Duke Global Health Institute, provides an opportunity for Duke students to help refugee patients navigate the healthcare system, while also learning about the many barriers newcomer families face in accessing health services.

Emily Esmaili, D.O., the clinical lead for refugee health at Lincoln and a DGHI adjunct assistant professor, created the internship last year to help make the experience of medical appointments less intimidating for patients who don’t speak English or are new to the community. The internship, which is open to undergraduate or graduate students and does not require medical experience, also introduces students to global health challenges within their own communities.

“If you’re in our waiting room long enough, you’ll see people bringing global health problems with them,” says Esmaili, who has worked at the center since 2015. “You don’t have to travel across the globe for global health work because [our patients’] needs are similar here – poverty, food insecurity and even some tropical diseases.”

Interns work alongside social workers, nurses and doctors to aid refugee patients with their healthcare needs. They help with things like reminding patients about upcoming appointments, connecting them to social services, and arranging transportation for visits. All of the students who have worked in the internship speak a language other than English, which often helps strengthen connections with patients.

Samuel, who now speaks Spanish fluently, says patients may skip appointments when they don’t fully understand where or when to go, or they may fail to pick up a prescription because they aren’t familiar with the U.S. healthcare system.

“Talking to patients in their preferred language puts them at ease,” says Samuel, who began the one-year internship this summer. “It seems simple, but these small changes to support populations that experience disadvantages have an impact. It’s also an opportunity to continue implementing changes to better support our communities.”

Around 700 new refugee patients come to Lincoln’s clinics each year, many of whom were driven from their homes by war, poverty or religious persecution. Esmaili, whose parents fled the Iranian revolution in 1979, understands the stress such displacement can cause.

“This internship has given students a window into the refugee experience and what families face when they arrive here and how these barriers affect their health and wellbeing,” Esmaili says. “While students are learning about these problems, they are also helping families creatively solve them.”

Like Esmaili, Samuel is the daughter of immigrant parents, originally from Grenada. Her parents told her stories about how they were supported as newcomers to the U.S. Her father’s boss let him study for college while working a nightshift as a switchboard operator, and a coworker of her mom’s watched Samuel and her siblings at no cost. She has also lived in Chile and Nicaragua and recalls how families welcomed her into their home and their traditions. She sees the internship as one small opportunity to extend that same kindness to others.

“I encourage people to listen to the needs that are right in front of them and be willing to step into that role even if it’s not a first choice,” she says. “That’s the advice I was given, and it has served me well.”

Students interested in internship opportunities with Lincoln should contact Esmaili at bahar.esmaili@duke.edu.