Refugee Healthcare in Clarkston

By: Deanna Altomara

The Clarkston Community Health Center sits in a small brick complex surrounded by gravel and blooming myrtle trees. It is a hot August Sunday afternoon and the waiting room is packed. All of the chairs, both wooden and white plastic, are taken. Most of the patients are women doting over a handful of children playing in a cramped corner; some are quietly nursing, or comforting a crying baby in a stroller. The people are all from different walks of life, some wearing colorful hijabs or head scarves, others in flowy pants or simple t-shirts. But they are all brought here by the same thing: they need help.

Clarkston, Georgia, a small town only 20 minutes from the heart of Atlanta, is an oasis from worldwide violence and terror. Called the most diverse square mile in the United States, this working-class community has hosted over 40,000 recently arrived refugees over the last 25 years.[1] The town has welcomed refugees from around the world, with especially high numbers of Congolese, Syrian, Ethiopian, Bhutanese, and Sudanese immigrants.

Clarkston has proudly integrated its refugees into its identity, becoming a national landmark for diversity and inclusion. A quick drive through town reveals waves of families walking past grocery stores advertising traditional Ethiopian injera, Nepali spices, and halal meats. Newcomers have endured cross-country migrations, genocide, war, and an average of seven years in refugee camps. Finally arriving in America often feels like a dream come true.

But refugees quickly learn that life in the United States brings its own set of hardships, according to Dr. Saeed Raees, a co-founder of the Clarkston Community Health Center. Many refugees have little formal education and struggle to find the employment necessary to support a family. Some parents take on two or three minimum wage jobs, sometimes in the chicken factories north of Clarkston; widows are often left with the task of caring for multiple children by themselves. What’s more, Dr. Raees adds, after eight months, their government-sponsored healthcare expires. Unless they find another source of insurance, they are left completely uncovered. 

This is where the Clarkston Community Health Center (CCHC) steps in. Started in 2015 by Dr. Saaed Raees and Dr. Guljan Harjee, the CCHC is one of the youngest free community health clinics in the Southeast, and the fastest-growing free clinic in Georgia. Four days a week, it offers comprehensive care in the fields of primary care, women’s health, mental health, vision care, and dental care. It even has an onsite pharmacy and lab. All of the doctors and workers are volunteers, except for one administrative worker.

Each week, doctors from as far away as Sparta and Columbus come to care for 150 patients with diabetes, hypertension, and other chronic illnesses found in the general US population. Occasionally they see an infection, but this is rare because refugees must undergo multiple health tests and screenings both before and after their arrival in the US.

In 2016, the CCHC partnered with DeKalb Medical Center to provide 300 free mammograms, which led to the diagnosis and treatment of three women with breast cancer.[2] The clinic also dispenses free medications, including insulin, a life-saving medication whose prohibitively high prices has led to multiple deaths this year. The clinic relies on donated stocks of insulin and other drugs, most of which are approaching their expiration dates. While the CCHC operates like most other free clinics, its work with a primarily refugee clientele adds a distinct undertone to their activities.

The staff collectively speaks over twenty languages and has to navigate a variety of different cultural nuances, such as whether or not a woman can be seen by a male doctor or whether offering counseling regarding traditions like female genital cutting is appropriate. Trauma from years of war and violence is persistent. However, many people are reluctant to seek treatment for mental health conditions–or even acknowledge that what they are experiencing is anything out of the ordinary–because for them, trauma is ordinary.

Dr. Raees explained that when they first opened a mental health clinic, no one came to that clinic out of fear of being stigmatized as mentally ill. Instead, the doctors learned that they had to integrate their mental health services within the overall clinic. That way, no one would know whether a given patient was being seen for depression or, say, diabetes. Since they’ve started offering mental health services, Dr. Raees has noticed that more people are willing to talk about mental health and seek treatment.

Many people argue that the United States cannot support so many refugees, but Dr. Raees and Dr. Harjee are adamant that newcomers contribute to the growth of the country. As refugees themselves, they’ve seen the hardships that families go through in order to find education and employment in the US. They insist that people need to have compassion for refugees, who are ready to work if only given a chance.

But when emergency strikes, refugees, like other people experiencing poverty, are often too afraid of unpayable medical bills to go to the hospital. The care and medicine provided by the clinic helps to reduce the number of emergency room visits by uninsured refugees, reducing the burden on public healthcare costs. However, the clinic itself is constantly struggling to make ends meet.

Their budget–a measly $115,000 a year–is funded completely by donations and grants. But with limited resources and demand spiking, they need to find a way to accommodate over 4,000 patients–and fast. The clinic is currently squeezed into a small building that lacks privacy and forces patients into close contact. But Harjee predicts that the crowding will only get worse, as the CCHC will care for an estimated 10,000 patients within the next five years.

After all, demand is high; over a million people in Georgia lack health insurance and would therefore qualify for treatment at a clinic like CCHC. And here, no one gets left behind. “We can’t just sit here and watch people die,” pleads Dr. Harjee, “[but] we can’t do everything by ourselves.” And it’s not just refugees they want to help–the CCHC serves anyone without insurance, and hopes to expand its services to reach more rural populations who don’t have access to local healthcare.

Dr. Raees and Dr. Harjee are trying to raise funds for a new, bigger building–a project that will ultimately cost $1,000,000, more than 8 times their yearly expenditure. Through a combination of grants and donations, they have already raised $600,000, but they need more. “We can’t grow unless the community works with us,” says Dr. Harjee. To continue to help patients, they need support from local donors and volunteers.

In fact, it’s the volunteers whom Dr. Harjee calls “the real heroes.” They use and seek volunteers and partnerships from every medical specialty, but are in particular need of dentists, hygienists, nutritionists, and physical therapists. Doctors, medical students, and undergraduates make up the core of their team. They are always looking for people to help, but recognize that this is not a one-way street: their clinic changes not only patient lives, but volunteer lives as well. Dr. Harjee explains that many of their student volunteers write about their experience at the Clarkston Community Health Center in the personal statements for medical school, and go on to attend Ivy Leagues. But even more important is the lesson the clinic teaches about humanity. Students “are hurting to see that they are not ready [to make large-scale changes]. They are dying to find solutions.” But Dr. Harjee is optimistic about the future, “I think the new generation is going to do it [find solutions]. Not the present one.”

But as for now, they are not ready to give up. The reason is the same one that propelled them to start the clinic in the first place. “Why?” Dr. Raees is startled to even be asked such an obvious question. “Why? Because there’s a need.”

References: 

[1] Long, K. (2017, May 24). This small town in America’s Deep South welcomes 1,500 refugees a year. Retrieved from https://www.theguardian.com/us-news/2017/may/24/clarkston-georgia-refugee-resettlement-program 

[2] Barron, B. (2017, June 8). Clarkston health center offers free mammography screenings as part of mission to serve the underserved. Retrieved from https://www.mdjonline.com/neighbor_newspapers/dekalb/community/clarkston-health-center-offers-free-mammography-screenings-as-part-of/article_77f576aa-4c64-11e7-8ed9-a30cfca7fe62.html