A New Chapter in Immigrant and Refugee Health Care

For decades, Boston Medical Center has stood as a leader in care and a source of healing for immigrants, refugees and asylum seekers. Now, BMC is refining its ability and capacity to support both current and incoming patients through its newly formed Immigrant Health Center (IHC). In a time where BMC is seeing increases in visits from immigrant patients and the current political environment is threatening their health and well-being, the need for the IHC could not be greater or more relevant.

BMC’s excellence in immigrant and refugee health has spanned numerous programs and areas of the hospital, from behavioral health to primary care to obstetrics and gynecology to pediatrics and more. And while each skillfully meets the unique and varied needs of each patient in a dignified, trauma-informed manner, they have been rather siloed. As such, these patients, many of whom may have limited English language skills or may be unfamiliar with the US health care system, must shoulder the task of navigating these services. Therefore, providers took a collective step back to assess the work taking place throughout the hospital, realizing they could better serve patients by coming together.

“We have so many pockets of expertise in immigrant health at BMC,” explains Sarah Kimball, MD, co-director of the IHC. “But we learned it’s still a very complicated system to navigate, especially for our most vulnerable patients. It became clear we could create a better patient experience by centralizing the work and services we offer.”

One of the center’s key principles is to provide wraparound care tailored to each patient. For this, BMC’s longstanding Boston Center for Refugee Health and Human Rights (BCRHHR) was as a source of guidance.

“Our program has been holistic in nature, providing mental health, career development, case management and primary care,” explains Lin Piwowarczyk, MD, MPH, co-founder of BCRHHR. “We take a patient-centered approach to empower people to advocate for themselves while receiving support. Those who have experienced human rights violations have often been placed in situations where they had no choices or power. So we meet people where they are, try to anticipate their needs and offer a menu of services from which to choose.”

With the BCRHHR being the bedrock of the new center, Piwowarczyk sees it as an opportunity to both elevate and sustain hallmarks of the whole-person care model, enhanced by collaboration among providers. “The success of BCRHHR has set the stage for us to provide its level of care to a larger group of immigrant patients,” Kimball adds.

The Immigrant Health Center is described as a “single point of entry into a coordinated network of medical, mental health and social care,” setting out to ensure every patient receives the same high level of services no matter how they arrive to BMC. “The center is a place where patients know they can come to have their needs supported—all of which we consider to be fundamental—in the most efficient way possible, especially when they first arrive and are learning our health care system,” says Kimball. “And we want them to feel safe every step of the way.”

In order to maximize impact, the center unifies several disciplines, including (but not limited to) behavioral health, internal medicine, specialty services like the Food Pantry and pediatrics. As Piwowarczyk notes, BMC is an ideal environment to foster this innovative next step in immigrant and refugee health care, given its commitment to caring for all people and doing so with a special emphasis on tackling social determinants of health. “Often, case management-related needs are very important, like food, shelter and clothing,” she says. “And we’re fortunate at the hospital to have a food pantry [and resources of that nature] where we can immediately refer our patients.”

Ultimately, the hope is the IHC will no longer be needed someday. “Our goal is for immigration status to no longer dictate health. It’s that equity focus that sets us apart,” notes Kimball. “We hope that by doing our job well enough, the health outcomes of our immigrant patients won’t differ from any other patient in our institution. It’s incumbent on us to build the programs to help make it so.” As such, the center will equip patients with care and resources setting them on an upward trajectory in which they continue to thrive. In addition, Kimball says the IHC will conduct research as part of its commitment to moving the field of immigrant and refugee health forward. “This patient population is underrepresented in existing scientific literature,” she explains. “We want to learn from our patients and bring our successes to both the greater scientific and health care community, leading the way for others in this field.”

For Kimball, Piwowarczyk and their fellow colleagues, the work may be challenging, but witnessing how it transforms lives substantiates they are in the right place. “It’s humbling to accompany our patients along their road to healing,” Piwowarczyk says. “We see the best of humanity in our patients who have been exposed to the worst of humanity.”

Kimball echoes the same sentiment, noting that her patients inspire her daily to right the wrongs inflicted upon them. “I work with a tremendous set of patients who are strong, resilient and come here with hopes of contributing to our society, making their lives better and being part of a rich America I believe in,” she concludes. “It’s a beautiful reminder of why our work is so important.”