Andrea Shaw, M.D.

Physician was recently recognized for providing medical care to refugees. She talks about the influx of immigrants to Syracuse and how challenging it is for her team to deal with them

By Chris Motola

 

Q: You recently received the President’s Award from Catholic Charities for your work with local refugees.

A: Yes. So Catholic Charities is a longtime community partner in refugee resettlement. We’ve worked closely over the years to help facilitate getting refugees access to primary care, but also addressing the high-complexity needs of the population that can arise quickly in Syracuse.

Q: What does the refugee population generally look like in terms of age, overall health?

A: In general refugees have spent a long period of time in the transition process and have been in a country other than their country of origin for more than a decade before resettling in Syracuse. In that period of time they tend to have really limited access to healthcare and healthcare facilities. So often there’s an element of resilience. Healthy people do make it here, but we also see a higher risk of chronic disease after a lifetime of chronic stress and they’re usually coming from systems that have a poor ability to diagnose and manage those chronic diseases. So we see the whole range between people who are resilient and don’t need a lot of healthcare to people who really don’t have any insight into the chronic conditions that they have and have limited resources to management them.

Q: How quickly does this population need be examined by a doctor?

A: When people are coming to Syracuse, about 5%-10% of them are so sick that they need to be seen within a week or two of landing. Another 20% should be seen within 30 days because they have a chronic medicine that needs follow-up. The remaining 70%-75% are generally healthy and don’t have chronic disease that they know of; they can be tucked into primary care within 90 days. The state does have a mandated request that we do health screenings for public health purposes within 90 days of arrival, which is hard to do in a healthcare system where the average wait time for a new primary care patient might be six to 12 months.

Q: Immigration and migration is politically a bit of a hot-button issue now. When the system is so stressed for existing citizens, how do you navigate helping this population in need while mitigating any potential resentment from underserved local populations?

A: We do certainly have folks who may look in on this system and say this isn’t fair. Local people are struggling to gain access to primary care, why do we have slot reserved for refugees? At the same time, our country is — through a formal refugee resettlement engagement with the United Nations — one of 30 countries that resettles refugees. So these are refugees who have fled persecution and have been deemed eligible and safe through a two-year vetting process for entry. Syracuse is one of the top three cities in the country for resettlement per capita and has a long history of welcoming immigrants and being a community that supports a safe space for diverse populations. So every year the country accepts a certain number of refugees. We’re at around 100,000 this year. About 2% of what comes into the country comes into Syracuse. When people see 2,000 refugees come into Syracuse and are eligible for resources, it’s the same poverty-level resources that people in America have access to. So Medicaid, food stamps and housing support. These programs are designed to get refugees self-sufficient. Economic data shows that within 10 years their resilience and work ethic usually has gotten them out of poverty and contributing to our community.

Q: How does Upstate handle the intake of new arrivals?

A: So when you look at Upstate’s Center for International Health, what we try to do is center the resources. We’re a small but mighty clinic. We welcome two new families a week. We have built-in things like a reverse-translation line, live interpreters in the clinic and we do a lot to support their social needs along the way so that they can be on more of an equal plane with the U.S. population. And once they have their health insurance and primary care organized, they’ll graduate into other primary care clinics. So the local U.S. population has a lot of resources available to them whether it’s the ability to look at and transport themselves to other places, the ability to work and be eligible for types of insurance other than standard state Medicaid. Refugees have no systems experience and no language skills to navigate the arena. When we look at health equity, we try to give them a platform to launch from. If we don’t, the population becomes sicker within our midst and is less likely to be able to contribute to the community. So this is how we help their healthy assimilation.

Q: What are some of the challenges of treating refugees from the provider perspective?

A: None of our patients come with English as their first language. If they do know any English, it might be their fourth or fifth language. So naturally a language barrier can be a social determinant of health. There are also cultural barriers in terms of how they perceive health and healthcare. And then there are very large systems issues. If you ask any American how they navigate their health insurance, the health office and navigate care, refugees have all those same issues times 10 because they’re just meeting this system for the first time. So if their child gets kicked out of school because they missed a physical or a vaccine, refugee families will be very confused about what’s happening and why. Of course everyone does their best to explain what’s happening and why, but there’s a lot to learn about healthcare and staying healthy in America.

Q: Which languages do you encounter the most? Do you have some on standby with regard to interpreters?

A: So actually this population is coming from all across the globe: Southeast Asia, the Middle East, sub-Saharan Africa and South America. We have over 50 languages registered within our clinic. By law, anyone billing Medicaid insurance needs to provide adequate translation services. We have access to a lot interpreter services, both live and phone consultations. There are a lot of creative ways across companies to book even limited language services ahead of patient visits. So we do our best to accommodate languages in a way that the patient is comfortable, in a dialect the patient understands. For example, we may have a patient who is only comfortable with a certain gender and they may want audio without video. They may prefer to work with a particular interpreter. One of the challenges is that many patients don’t come from a system where self-advocacy is their nature. They’ve lived a lifetime of persecution in very stagnant situations as refugees. So we need to be aware it’s going to take longer to work with this population. They need more to get to the same healthy playing field as the rest of us.

Q: You’re the medical director of international medicine at Upstate. What does that involve, apart from the refugee program?

A: The Center for International Health is a comprehensive primary care office. So we have folks who are trained in internal medicine, pediatrics and women’s health as well as mental health. We try to center those services in the same space because it’s really hard to get some of these primary care services to the patients if, say, they’re moved across town. So we do as much as we can to provide comprehensive care within our clinic at Upstate.

 

Lifelines

Name: Andrea Shaw, M.D.

Position: Medical director of Upstate University’s Center for International Health

Hometown: Manlius

Education: SUNY Upstate Medical University

Affiliations: Upstate University Hospital

Organizations: American Academy of Pediatrics

Family: Husband, three children

Hobbies: Travel, outdoor activities