“Bonne nuit, monsieur,” said Dianne Uwayo, MPH, warmly, as she bade farewell to a patient leaving a clinic in West Philadelphia. “Bonne nuit,” he replied. Uwayo, who grew up in the American south but who is of African descent, is multilingual. On any given Monday night like this warm April evening at Penn Medicine’s United Community Clinic (UCC) at the African Family Health Organization, a visitor might hear one of 16 other languages not counting French or English.
For the last two years, Michael Beers, MD, the Robert L. Mayock and David A. Cooper Professor in Pulmonary Medicine at the University of Pennsylvania Perelman School of Medicine, has helped to lead a Penn Medicine partnership with the African Family Health Organization (AFAHO), to offer weekly family-medicine/primary care clinics for recent immigrants from Africa and the Carribean.
Uwayo, the Health Programs Manager at AFAHO, AFAHO colleagues, Beers, clinical colleagues and Penn medical fellows, residents, and students take over the AFAHO office on 54th Street, bringing services to a population with many still acclimating to the city and country. The clinic operates on opposite weeks to a similar clinic in the basement of the New River Presbyterian Church, a few blocks from West Philly’s Clark Park, also run by the same Penn Medicine UCC team. UCC runs thanks to grants, the backing of community organizations and Penn, and volunteers.
“Meeting patients where they are helps us quickly build trust with a population who many take advantage of,” said Beers. “Some are refugees, others are just immigrants here for the opportunity to work and start a new life. Some don’t trust big institutions or medical professionals or are intimidated by big hospitals.”
“At the point we are directly interacting with patients, especially immigrant patients, they trust us,” said Madeline Lederer, MD, co-director of UCC and an assistant professor of Family Medicine and Community Health at Penn. “The atmosphere and the fact that they were referred to us by Dianne and AFAHO helps.”
Care across languages
Over the last year, UCC has treated a total of 158 patients at New River and AFAHO. Patients at New River are largely more longtime residents who are uninsured or underinsured while those on AFAHO nights are new immigrants. AFAHO patients also are more frequently followed by clinicians at UCC as they put down roots, while patients who access UCC through New River are more often seeking short-term care whether for employment physicals and health screenings or while they are without insurance.
Patients who visit UCC at AFAHO have scheduled appointments (set up by Uwayo and cultural health navigators who speak English and the patient’s native language), and the care team will see three to five patients each Monday evening over a period of two to three hours.
From check-ups to managing diabetes, treating common illnesses, and X-raying injured extremities, the care team handles a variety of patients’ needs right from the off-site clinics. Penn Medicine Pharmacy Services can provide some medications, like diabetes-management medication, free of charge. If the care team identifies serious health concerns, patients are guided to appropriate Penn clinics for more intensive care and follow up. UCC even helps patients find insurance and navigate America’s complex health care landscape.
“We have always made sure that anyone who needs more serious treatment is set up with an appropriate Penn provider as soon as possible,” said Beers. “But the great thing is that, more often than not, we can provide just what the patient needs right from our clinic.”
"There are certainly more new Philadelphians who need medical care from our clinics than we are poised to serve at the moment," said Lederer. The Philadelphia metropolitan area is home to nearly 100,000 African and Caribbean immigrants and refugees, many of whom are uninsured and in need of healthcare services. In the last year, 78% of AFAHO's clients were uninsured, and 100% of those accessing UCC are uninsured.
“And we want to grow, not just (in terms of) the number of patients we treat but also the types of care and treatments we can provide right from the clinic. I’d love to be able to do pap smear and gynecological tests from our UCC clinics.” Beers hopes the clinic can do more asthma maintenance and respiratory care without requiring patients to visit Penn.
An unlikely leader
Michael Beers, MD
Beers chuckled when recounting the time when he was tapped to lead the United Community Clinic six years ago.
“I’m a pulmonologist,” he said. “That’s not the kind of doctor you usually have running a community clinic. But they needed a medical doctor, I saw the value it would have in the community, and I had the time to give.”
From that point on, he hasn’t stopped, except for a brief hiatus UCC took after flooding destroyed the church (and a lot of medical equipment). But the church was rebuilt, the equipment replaced, and UCC was back at it. Shortly thereafter, they teamed up with AFAHO to serve the African immigrant population.
“Although being with UCC is a highlight of my career, and I have no desire to stop, the addition of Dr. Lederer and the growing involvement of Penn’s Department of Family Medicine and Community Health will only make UCC more robust,” said Beers. “They are experts in this type of work, and that’s an invaluable asset to us and the patients.”
The real unsung heroes of the clinic are the Penn medical fellows, residents, and medical students, said Lederer. Over the last year, Lederer estimates 20 to 30 medical students, 10 or more undergraduates, 10 residents, five to 10 fellows, and five attending physicians have had a hand in UCC.
“We have a variety of young clinicians and medical students at different levels who make UCC run,” she said. “They operate the clinic; they take charge and do the work. Senior clinicians like me obviously oversee patient care and then literally just step in wherever we’re needed.”
And the “work” Lederer mentions extends well beyond patient care at the appointment. For example, it’s not uncommon for a resident to be on the phone with insurance companies early in the morning so that a patient can receive a vital medication or with other specialists late at night so that a patient can be seen or receive a more involved test.
“It’s a wake-up call for a lot of young clinicians to what community medicine is,” said Lederer. “They know medicine but don’t know how complex care in our country can be, especially for those without the resources or ability to advocate for themselves. There are barriers, and the fact that a medical professional can have challenges connecting patients to the right care signifies how hard it is for those who have no medical background and who may not even be proficient in English.”
Meeting patients on a personal level
Kyle Polen, a second year medical student at Penn and one of the student leaders of the clinic as well as clinic’s treasurer, spends a lot of his time ensuring that the clinic is properly funded.
“We’re constantly applying for grants,” said Polen, who seeks a lot of the grant opportunities out himself and works with other students and Penn colleagues to write the applications. “It does not ever slow down, but because we are consistently on the lookout for funding opportunities, we are well positioned to be able to continue this work and expand what we’re doing. New financial support from the Penn’s Department of Medicine is going to allow us to begin HIV screening.”
Polen, an Arizona native, brings a perspective few of his fellow students have. As a high schooler, Polen participated in foreign exchange programs, one in particular with a high schooler in Kenya.
“We’re still friends; he’s a great guy,” said Polen. “I stayed at his home with his family, and he stayed at my home with mine. There was a strong bi-directional benefit. It fostered in me respect for and an interest in other cultures and provided a lens through which to see community.”
Even with significant experience and a year under his belt with UCC, Polen is still learning.
“I went to ask about a patient’s pain on a scale of 1 to 10, and the translator said, ‘I’m not really sure how to ask that. Pain is not quantified like that in this language. Something either hurts or it doesn’t,’” recalled Polen. “I had to change how I assessed their level of pain by asking if it impacts what they can physically do day to day. Something like that was a totally new experience but reminded me that there are so many aspects of a person that you cannot take for granted, especially when working with immigrants.”
Connecting West Philadelphians to health resources at every scale
Outside of Monday-night clinic nights, UCC also hosts health fairs, walk in blood-pressure and blood sugar checks, and vaccine clinics. New River, AFAHO, and other community groups spread the word. Flu and COVID vaccine clinics ran this fall to combat the seasonal spikes expected, and the next community event on the calendar is December 7.
“I administered over 100 finger pricks at the last health fair for diabetes/pre-diabetes testing,” said Polen. “Those large community events are where we have the biggest impact in terms of numbers, but it’s the New River and AFAHO clinics where we’re getting to know patients on a personal level. And that personal relationship allows us to have a greater clinical impact.”
Beers and Lederer continually commend the community partners and the students and stress that they are what keep UCC humming.
“Between all that I do as a physician at Penn, UCC is my favorite part of practicing medicine,” said Lederer. “Working with students, grateful patients, and dynamic community members and colleagues is a gift.”