Afghan refugees settling in South Bend area receive health screenings, primary care at E. Blair Warner

Dr. Janel Charlton, MD, senior associate director, Beacon Medical Group’s E. Blair Warner Family Medicine Center.

As he nears completion of his three-year Memorial Family Medicine Residency program, Dr. Michael Keller has spent a lot of his time caring for South Bend’s at-risk, vulnerable populations.

But since December, Dr. Keller, his fellow residents and the providers at Beacon Medical Group E. Blair Warner have started providing initial health screenings and offering permanent primary care to another group of patients that he never expected: about 60 refugees from Afghanistan who are resettling in the South Bend area as part of Operation Allies Welcome.

As one of the practice’s 27 resident physicians, Dr. Keller has screened three Afghan men, all of whom have family members who are still in Afghanistan and hope to ultimately follow them to South Bend.

“That’s a heart-breaking aspect,” he said. “They are hoping they are reunited with them, but that’s still up in the air.”

Dr. Keller said the men have displayed demeanors that also have surprised him some.

“There has to be a bit of pain and trauma underneath it all, but I’ve been impressed at how resilient they do seem, understanding that while their circumstances were terrible, that they’re in a place now where they’re safe and they have a good opportunity for a new life,” he said. “You can actually kind of sense a little bit of optimism there underneath that is encouraging and really moving.”

Beacon Medical Group E. Blair Warner staff began working with St. Joseph County Health Department and Indiana refugee coordination leaders in April on establishing a refugee health clinic.

This was before the United Religious Community of St. Joseph County and Catholic Charities of Fort Wayne-South Bend learned they would each be helping to resettle about 30 refugees into the South Bend area in December and January.

Suddenly the state refugee coordinator needed the clinic to adapt its plans.

“We thought it was going to be kind of a slow roll kind of a thing,” said Dr. Janel Charlton, senior associate director at Memorial Family Medicine Residency. “Thirty in a year was what we thought. We’ve had to make a lot of changes to have 60 in two months.”

Resident physicians have received training on Afghan culture and diseases that are unique to the Middle East. Dr. Keller said the team is well prepared for its new mission.

“At our clinic, we’re used to taking care of people who are coming from pretty disadvantaged backgrounds and who have really hard stories, so we were really well-equipped to take on these folks as well,” he said.

“Naturally, they are coming from the other side of the globe, but I still feel like I’m spending a lot of time counseling them on the importance of quitting smoking, eating a good diet that’s diverse, trying to stay physically active, taking care of their mental health — all the things that I talk about with my patients who are born and raised here,” Dr. Keller added.

Dr. Charlton agreed and said she loves the unique teaching opportunity that the refugee screening provides the resident physicians, many of whom have set goals of serving underserved patient populations and doing international work.

“Having the opportunity to host this clinic in a residency program where they can learn that and be aware of these different ways to think about taking care of patients, is awesome,” she said.

SMOOTHER NOW

That enthusiasm seems to have translated into high-quality care for the refugees who have been treated thus far, and it’s making them feel more welcome as they settle in, said John Pinter, executive director of United Religious Community of St. Joseph County.

“I don’t exaggerate at all — the medical, nursing and administrative staff there have been incredible,” Pinter said. “They have provided advice for folks arriving who may have had a pre-arrival condition or illness, made appointment space available when an urgent concern arose, and they have coached the URC volunteers through worries.”

Pinter said BMG E. Blair Warner contracting with the state to be the area’s exclusive refugee screener has been much more efficient than in the past. When he led the American Red Cross of St. Joseph County, that nonprofit organization was a designated refugee resettlement office from 2009 through 2013. At the time there was no single point of contact for the screenings, so a mix of health care providers, nonprofits and state and local governmental groups cobbled together plans for screenings.

“While it worked, it was very much ad hoc and relationship dependent,” Pinter said. “This new venture has made life much more predictable for the resettlement leaders and for the refugee patients. It’s a big adjustment to enter the U.S. medical system, especially for folks who have come from areas that had very limited medical facilities and practices, but the team at E. Blair Warner has made it work.”

Making it work has included dial-up translation services, Dr. Keller said.

“Everything takes twice as long because it’s time for me to say it, time for the translator to say it, time for my patient to ask a question and have it be reverberated back to me,” he said. “It makes us have to be very precise in what we’re saying to make sure that the messages are coming across.”

Dr. Keller noted that if the refugees choose the clinic for their primary care beyond the screenings, the need for translation likely will decrease over time as the refugees learn English.

“History has often shown that people come in and then slowly get integrated and acclimated into a community and a lot of those barriers get broken down.”