Care that Builds on Patients’ Strength and Resilience

Sarah Kimball, MD, director of the Immigrant and Refugee Health Program, knows the best way to ensure her patients’ health and well-being is to provide care that looks beyond the biomedical lens.

You specialize in refugee- and immigrant-related medicine. Can you describe what is unique to that field? Why is it so important?

While there is a tremendous amount variability between immigrant populations, many immigrants face barriers to seeking health care which lead to poorer long-term health outcomes. Some of those barriers are due to things that affected them before they immigrated, like their ability to access health care in their home countries or a trauma that caused them to leave their home countries. Some challenges come from issues that occur during their migration, such as a high risk of exposure to violence or food insecurity while crossing into the US. Many of the barriers sadly come from challenges still at play when they are living in the US, such as limited English proficiency, differential access to social service programs based on immigration status and stigma and discrimination in the US. In our practice, it is important to provide holistic care which both addresses these barriers and builds on our patients’ strengths and resilience.

What services does BMC provide immigrants and refugees?

Every department at BMC serves immigrant patients, so there are many providers across our institution who have an interest and expertise in serving this patient population. In addition, we have several programs that specifically hone in on high-risk immigrants and provide comprehensive, trauma-informed care. The Immigrant & Refugee Health Program treats the complex needs of these patients in a culturally sensitive and multidisciplinary setting, offering integrated mental health, case management, women’s health specialty services and immigration legal navigation. The Boston Center for Refugee Health and Human Rights provides holistic care for survivors of political torture. The Refugee Obstetrics and Gynecology program provides comprehensive and culturally sensitive women’s health services to refugee, asylum seeking and recent immigrant communities.

Can you provide an example of how we help patients and their families? What kind of impact does this have on their lives?

For many of our patients, BMC is one of the first and sometimes only places where they can come for support. A recent Ugandan patient came to BMC to get medical care, after recently arriving in the US. He was able to get immigration legal aid to help him find an affordable immigration attorney in the community. He received medical care, particularly focused on diagnosing and healing injuries inflicted on him in Uganda as a result of his political views. He engaged in mental health services focused on healing from torture and trauma. His case managers found him a donated bicycle which he used to go to the local library. Wraparound services like this truly allow people to trust that BMC understands and prioritizes what it takes for them to be healthy. For the high number of patients who have experienced trauma, being able to come to a single environment where they can receive mental health care, medical care, support around social needs and immigration navigation is a crucial step to ensuring they are safe and able to start healing.

What sets refugee- and immigrant-health care at BMC apart from other hospitals?

BMC is an institution dedicated to providing exceptional care, without exception.  This ethic permeates our whole institution and is the seed that allows programs like ours to take root. In order to do this for immigrant and refugee patients, we need to look at what is causing health disparities on a larger level.

BMC’s focus on addressing the social determinants of health, such as housing and food insecurity, has put in place programs to support our immigrant patients. Specifically for immigrant patients, we have programs to support immigration legal needs, train patients in English skills and help them learn to navigate the US health system. This wider lens of what kind of services it takes for immigrants to be as healthy as possible is the big thing that sets BMC apart. At BMC, we are constantly working on the edge of where justice and equity meet health.

Given the current political climate around immigration, why is it even more important to continue providing services and care for this patient population?

Currently, the political climate has created a culture of fear where many of our immigrant patients feel afraid to use crucial services which would support their health, such as food stamps or public insurance. We’re fighting against a tidal wave of fear and stigma, and my concern is it will worsen the disparities our immigrant patients already face.

For me, continuing to provide care in this political climate is an act of social justice, stating we believe that anyone, regardless of his or her immigration status, deserves excellent health care.

What do you see in the future for refugee- and immigrant-health care?

We currently are envisioning building on the expertise of our current programs at BMC to create a cross-departmental immigrant health program. This sort of approach, which I think of as an immigrant-focused medical home, will provide integrated and holistic care for any immigrant patient who needs additional support in order to access health care and navigate the health care system. We envision any immigrant patient who has specialized needs will get the same high level of service, no matter where they access care in our hospital.

How do events like Fall Fête help this program?

Many of the services our immigrant patients need simply aren’t paid for by traditional health care systems or insurance. The generosity of the Fall Fête donors allows us to dream big and create programs that address the root causes of health inequities in our immigrant patients.

In addition, when the political context for immigrant and refugee patients is so challenging, it is crucial to take pause and celebrate how resilient our immigrant patients are. Fall Fête is an opportunity for us to appreciate how impressively strong our patients are, and how much they are able to accomplish with the empowerment of programs at BMC.