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Refugees need medical care when they arrive in CT from overseas. UConn Immigrant Health has seen more than 1,000 patients and counting.

Refugees need medical care when they arrive in CT from overseas.  UConn Immigrant Health has seen more than 1,000 patients and counting.
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When refugees arrive in the Hartford area, one of their first stops is UConn Immigrant Health.

That’s because each refugee must have a health assessment within 30 days of arrival. UConn Immigrant Health, led by Dr. Susan Levine, has seen more than 1,000 refugees from more than 40 countries for that assessment, as well as follow-up care.

“I am somebody who has had a very long time interest in global health and I do some regular work overseas,” said Levine, director of the program she launched in 2017. The program has three parts: clinical care, education of residents and medical students and advocacy for refugees and immigrants, she said.

Susan Levine, director of UConn Immigrant Health

“The clinical care piece is providing newly arrived refugee health assessments, which is really a sort of CDC-guided specific set of screenings that has to happen for any refugee to the US within 30 days of arrival,” Levine said.

“Oftentimes, the resettlement agency is reaching out to me directly to say, hey, we have this family from wherever they arrived in the US two weeks ago. They need an exam within a week,” she said.

The guidelines call for identifying significant diseases that might threaten public health and updating vaccinations. “A lot of times people may migrate over years through a variety of camps, and they may have little or no record of what vaccines they’ve had before. So there’s a lot of sort of catching up of that,” Levine said.

However, many refugees will stay with Levine as their primary care doctor, she said, and they are given more extensive exams to find out whether they need treatment for a disease such as hepatitis B. The result is a thriving refugee community in Farmington, where UConn Health is located, Levine said.

“I’m actually boarded in tropical medicine, knowing what are the endemic diseases where they come from,” she said. “And could that migration story have anything to do with ongoing health risks? So that’s part of the medical care piece.”

The residents at John Dempsey Hospital and students at the UConn School of Medicine are given training in treating refugees through UConn Immigrant Health.

“Medical students get exposed to refugee and immigrant health and they get to learn about how migration impacts someone’s health care, how it’s important to think about where you were born and where have you lived,” Levine said.

There is a six-month elective at the medical school that focuses on the topic. Among the diseases students study are leishmaniasis, a parasitic skin disease found in Afghanistan, and latent tuberculosis. People from the Mideast may have thalassemia, an inherited blood disorder.

“These patients are fascinating because they can have two or three or four different infections at the same time,” Levine said. “So you kind of have to know when to go looking a little bit further when you have symptoms that just are not completely explained by the data you have so far.”

Many refugees have not received the human papillomavirus vaccine that prevents cervical cancer, for example. A pap smear or mammogram may be given to an elderly woman because she’s never had one, even though pap smears are not given to older women in the United States.

The advocacy part of the program is for those seeking asylum, who do not have the same rights as other refugees until their asylum status is granted, Levine said.

“If an immigrant is seeking asylum, that’s much harder to be successful at than getting a refugee visa,” she said. “In both cases you have to prove that you have a well-founded fear of persecution on account of very specific grounds, either race, religion, ethnicity or belonging to a particular social or political group.”

For refugees, that is “nailed down before someone sets foot on US soil,” she said, so they have federal health benefits and other rights as soon as they arrive.

“But if somebody’s seeking asylum, they don’t have access to any of those things,” Levine said. “They still have to prove that they have been persecuted on those same grounds, but they end up getting referred to immigration court and then … it can take a couple of years to get your date in court and, in between, they don’t have access to health care and all these other benefits.”

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Those seeking asylum must go to federally qualified health clinics or a hospital emergency department to receive their care, Levine said.

While students run the asylum program, act as scribes during asylum interviews and draft medical affidavits, specially trained faculty consult with immigration attorneys, which greatly improves refugees’ chances of being granted asylum, Levine said. Having a doctor consulting with the attorney improves the odds from 30% to close to 90%, she said.

“We are partnered with something called Physicians for Human Rights, which is a big international organization that trained physicians on how to provide forensic evidence,” Levine said. “So the attendings that work with me do a training with PHR as to the students.” UConn is one of 19 medical schools in the country that has a PHR-sanctioned asylum clinic.

Nargis Safi of East Hartford came to the United States with her family on Nov. 18, 2021, with her husband, Waheedullah, who worked with the US Army in Afghanistan, and their three children, ages 1, 3 and 6 (the youngest was 1 month old when they arrived).

She said she appreciates what UConn Immigrant Health has done for her family. “When we come here, the doctors help us very much. They do our vaccinations” and other exams, she said. A dentist performed an oral exam and removed two of her daughter’s teeth, Safi said.

Waheedullah Safi was working in the US Embassy when the Taliban arrived in Kabul. A teacher in Afghanistan, Nargis Safi works part-time at Hockanum early-childhood learning center, filling in for teachers at lunchtime.

Ed Stannard can be reached at estannard@courant.com.

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