Dr. Matthew Behme has encountered many challenges in his time as a physician working in the Einstein Refugee Wellness Center, a program designed to help reestablish “a path to health” for refugees fleeing persecution and oppression in their home countries.
“We had a couple who were refugees from Cuba,” he says. “One of them had a terminal illness. They were not the type of refugees who needed vaccines, help getting their licenses, and other routine care.”
It’s a sad story, he reflects, but Dr. Behme hears many such stories from refugees whose new life in the United States begins, in part, with medical and often psychological care and support from the Refugee Wellness Center’s multidisciplinary team. Center clients are not undocumented immigrants; rather, they are persecuted people who could face the prospect of torture and even death if they remained in their home countries. “These are people who can never go back,” Dr. Behme says.
Helping those often helpless patients is a mission that began at Einstein relatively recently. Dr. Behme, board certified in internal medicine, is associate director of the program, which is a joint collaborative between the departments of Internal Medicine and Pediatrics. The program was founded by pediatrician Dr. Morgan Leafe, and opened in 2012.
“I knew about refugee medicine from my time at Thomas Jefferson University Hospital and Nemours duPont Pediatrics,” says Dr. Leafe. “We had been asked at Jefferson to see refugee patients. At the time, I was a third-year resident.
“When I started working at Einstein in 2011, I met some resident doctors from other countries, including one from Iraq who spoke Arabic. He was a refugee. I said, ‘This is perfect. You’re an Arabic-speaking refugee, and there are a lot of Arabic-speaking refugees in North Philadelphia.’ I reached out to resettlement agencies, and it just went from there.”
Before Einstein established its center, she adds, many refugees from the area surrounding Einstein Medical Center Philadelphia were traveling great distances throughout the city to get help. “There was a huge need in this neighborhood and in the Northeast as well,” Dr. Leafe says.
So where are those refugees coming from?
“They come in waves from different areas,” Dr. Behme says. “We have seen a long and sustained surge from Iraq. Many of these refugees helped the United States in some capacity. Those who escaped from Syria have a particularly sad story, suffering first during the civil war and then through everything that followed. Many of them saw families tortured and killed. They took their kids and suitcases and made a run for it.”
He recalls the case of a family who took smartphone pictures of their house and their car parked at the curb just before they fled. “They were Pakistanis who worked for a Christian church. They had received death threats,” Dr. Behme says. ”It was a beautiful home. It was just so remarkable. It made them so sad. It makes me think about what it would be like to leave my house, with my car parked at the curb—to take my family and suitcases, and flee in the middle of the night.”
Over time, he says, the center has seen more patients from Nepal and several African nations.
Regardless of where they come from, says Dr. Leafe, refugees come with their own cultural differences and unique medical issues, many of which pose challenges to the provision of care.
“We had a lot to learn about refugees from the Congo,” says Dr. Leafe. “There’s more tuberculosis, a lot of different parasites, and mental health issues that might present differently because of cultural differences. For example, depression. If you’re born in the United States, you go to the doctor and you say I’m sad, I’m depressed. But in some countries that’s not a culturally acceptable to say. It takes a lot to learn that it’s an emotional issue.”
Perhaps not surprisingly given the circumstances of their exile, many refugees suffer from mental health issues, such as post-traumatic stress.
Some cultural differences have a bearing on how care must be provided, and by whom.
Women from Middle Eastern nations, for example, may require care by female clinicians for religious and cultural reasons. “Screening for them is a particular struggle,” Dr. Behme says. “We have to ask very sensitive questions, and they’re not used to being asked sensitive questions like that.”
Out of all the obstacles the refugee center providers encounter, the language barrier can be among the most difficult.
For some languages, interpreters are readily available. For others, the center has access to professional interpreters by phone.
All of these differences can be perplexing … but for Dr. Leafe and Dr. Behme, that’s part of what makes this particular undertaking so appealing, and also educational. Residents working with the center, for instance, find the experience incredibly useful, says Dr. Leafe.
Add to the educational benefits the sense of fulfillment and satisfaction derived from helping people who have emerged from the kinds of horrors the rest of us can only imagine.
“I’ve always had the dream of doing something like Doctors Without Borders,” Dr. Behme says. “This is Doctors Without Borders without leaving home.”