International Family Medicine Clinic: breaking cultural barriers (2024)

Alka Walter, MBBS, MS (17R), starts each appointment in the International Family Medicine Clinic by asking her patients what they do. Some of them might say something like: “I work in a meatpacking plant.”

But that’s not the answer she’s looking for.

“I want to know what they were doing in their home country before they came here. You’ll find people who were physicians, teachers, businesspeople, and they’re here because of circ*mstances,” says Walter, a University of Iowa clinical assistant professor of family medicine

“I get to know where in life they’re at, and that helps me understand how they approach medicine.So, speaking with someone who’s spent all of their life living in a refugee camp would be very different from someone who has come as an immigrant as a result of the green card lottery system,” she adds.

Walter and a team of family medicine providers work in the weekly clinic, which was created in March 2020 to offer immigrants and newly settled refugees a place to address their primary care concerns and, sometimes, establish specialized or long-term care at UI Hospitals & Clinics. The clinic is flexible with late arrivals, offers patients more time with providers, and is open evenings to not overlap with workday schedules. Providers also typically see parents and children together, building a relationship with the entire family.

“Our whole clinic—from the schedulers to nurses and medical assistants to physicians—understands that most of our patients don’t speak English,” Walter says. “We also know our patients are not familiar with the health care system. We need more time, not just for the medical explanation but also trying to understand their cultural beliefs about medicine.”

The clinic mostly sees people from Central African countries, considering Johnson County has a significant Congolese population that continues to grow. The team also recently partnered with the Catherine McAuley Center, eastern Iowa’s primary resettlement agency, to offer health care visits to newly arriving refugees.

“As family doctors, one of the best things we can do is really know the people we’re talking to,” says Erin Hayward, MD (18R), medical director of the clinic, adding that cultural differences can impact the understanding of preventive care, chronic illness, vaccinations, and other health topics.

“One of the things that’s really important about our work is teaching people about preventive care and not just going to the hospital when you’re really sick,” she says. “In some places, there’s not really a culture of being seen by a doctor regularly to make sure your diabetes is under control, for example.”

Providers in the clinic also help patients understand other novel concepts, such as establishing insurance, prenatal and postnatal care, COVID-19 vaccines, and mental health care.

Patients may report trauma from being war survivors, living in refugee camps, and experiencing poverty, while also dealing with the isolation that comes with adjusting to a new environment.

“We have to overcome the cultural taboo of talking about mental health,” Walter says. “Patients come in with other symptoms, like, ‘My stomach hurts, I’ve got a headache all the time,’ and it takes a little bit for them to even agree that something else may be going on.”

Past traumas and other stressors are typically addressed during a second or third appointment, she adds.

“Our patients really want the International Family Medicine Clinic to be their medical home, Walter says. “That’s what they want to come back to.”

Providers in the International Family Medicine Clinic include Erin Hayward, MD; Alka Walter, MBBS, MS; Meghan Connett, MD; Aisha David, MD.