New primary care physician shares her experience caring for refugees from Nepal, Afghanistan, Ukraine, Syria, Somalia, Tanzania. ‘It’s been a real joy to work at the Center for Refugee Health,’ she says
By Chris Motola
Q: We’re interested in hearing about your work at Rochester Regional’s Center for Refugee Health.
A: I finished my residency in internal medicine in June of 2022 and then accepted this job through Rochester Regional. I work at the Center for Refugee Health for part of my time and then I’m over at Unity Faculty Partners teaching residents for the other part of my time. The Center for Refugee Health does the initial intake medical evaluations of newly arrived refugees. It’s part of the official refugee resettlement program through the government. And then in addition to those initial examinations, it keeps them on for primary care, which is where the bulk of my work comes in. I take care of refugees after they’ve been resettled in the United States like any other primary care doctor. Of course, there are a lot of unique challenges that come with working with that population. It’s been a real joy to work there.
Q: When it comes to Rochester’s refugee population, where are they generally arriving from?
A: They’re coming from all over. Because we’ve had patients who have been here for quite some time — that includes people who have been in refugee camps in Nepal. Right now we’re getting new arrivals from Afghanistan and Ukraine. Previously we’ve gotten patients from Syria, Somalia and Tanzania. We also have refugees from Cuba.
Q: How do you deal with the language barriers? Especially for languages that aren’t as common in North America?
A: A lot of languages I don’t speak. So we have, in every exam room, iPad interpreters that are using a video interpretation service. We also have front desk staff and patient navigators who are from some of the refugee communities that we serve and speak some of the languages that our patients speak if we need on-the-spot interpretation.
Q: Do some patients eventually end up becoming interpreters?
A: We have a number of staff members who were former refugees, but they weren’t always necessarily our patients. They arrived previously. But it is really nice to have people who are well-known within these communities and speak other languages.
Q: How big is the program?
A: We see — it depends on which number you pull — between 4,000 and 5,000 patients. Closer to 5,000 that we see on a regular basis.
Q: How large is the medical staff?
A: We have three attending physicians, and we’re all either family medicine or internal medicine. The family medicine attendings take care of children as well as adults. In addition to that we have two nurse practitioners and a physician’s assistant. We have two on-staff social workers on site as well as two patient navigators who help with making appointments.
Q: Aside from communication barriers, what other challenges are there in working with a refugee population?
A: A lot of it is navigating the health system for people who are completely new to the U.S. health system. Teaching people where to go for an emergency, what constitutes an emergency, when to call the doctor. A lot of issues with communication go beyond what happens in the office, but also how do they call to make an appointment with a specialist if they don’t speak the language or understanding the instructions for their medications. Many of our patients can’t read or write in their first language let alone in English, so we have to figure out how to instruct people to take medications in a way they can understand and then do. So that’s definitely a lot of the big challenges. The other challenge is around mental health access. A lot of our patients, because of what they’ve been through, have issues with depression, anxiety and PTSD and being able to get them connected to psychiatric care is on ongoing challenge. I think that’s true across the United States, certainly in Rochester. Just getting people to be able to see a specialist in a timely fashion is always a challenge.
Q: How do you get around the medication issue you mentioned earlier?
A: It means being creative. Usually we can get the pharmacies to color-code different medications and have them correspond to when they should be taken. For example, yellow for morning. Things like that that are different visual cues. And, of course, enlisting family members helps. Many of them have strong family structures and are resettled with their whole family, so they have a bit more family support than other kinds of immigrants who come to this country.
Q: In addition to the psychiatric issues that come with having been in a crisis area, what kinds of health issues do you see in this population that are different than our native one?
A: It really depends on what country they’re coming from. Some come from countries with really robust health systems where people are diagnosed and their chronic illnesses managed in a similar fashion to the United States. Others are coming from countries where they may not have had access to health care. That includes never having been diagnosed with routine things like hypertension or diabetes. So a lot of times it’s the same chronic illnesses, but they’re being diagnosed at a very different stage. And finally there’s infectious disease diagnosis and treatment for diseases that may not be as common in the United States. That’s a big part of the initial evaluation that the government requires for refugees coming into the country.
Q: As far as resources and insurance, what’s available to refugees?
A: The good news is that, because they’re officially accepted and resettled through the government, they do tend to get access pretty quickly. Their first two evaluations are paid for by the government, but the rest is paid for the same as anyone else in the U.S. They generally get enrolled pretty quickly.
Q: What got you interested in refugee care?
A: I’ve always been interested in the social determinants of health and medicine. When I was in medical school I worked with the asylum clinic at Mount Sinai, and that involved doing forensic medical evaluations for people applying for asylum. That got me interested in working with newly arrived migrants. And then throughout medical school and residency, I worked quite a bit with different immigrant populations. My clinic and residency was in Chelsea just north of Boston and it’s known for having an immigrant population. So while not all of them were refugees, it was a similar population.
Q: Are you picking up any new languages?
A: I speak some Spanish, but we don’t have that many Spanish-speaking patients. But I’ve got to start working on my Nepali, my Arabic and my Dari. There’s a lot to learn.
Lifelines
Name: Hazel Lever, M.D.
Position: Primary care physician at Rochester Regional Health Center for Refugee Health
Hometown: Spartanburg, South Carolina
Education: Massachusetts General Hospital, residency (2019-2022); Icahn School of Medicine at Mount Sinai, Doctor of Medicine and Master of Public Health (2015-2019), Harvard University (2009-2013)
Affiliations: Rochester Regional Health
Organizations: Society of Refugee Health Providers; American College of Physicians
Family: Partner, dog
Hobbies: Seeing dance and theater, going to museums