By Mahima Ginjupalli and Salma Yazji

Call To Action–

UT Health Students Address Need for Accessible Chronic Disease Self-Management Among the San Antonio Refugee Population

By Mahima Ginjupalli and Salma Yazji

Every Wednesday evening, student and faculty volunteers from UT Health San Antonio (UTHSA) unlock the doors of St. Francis Episcopal Church and welcome the line of refugees seeking free, culturally informed health care. UTHSA and the Center for Refugee Services of San Antonio partnered in 2011 and established the San Antonio Refugee Health Clinic (SARHC), with the mission of addressing and promoting the interdisciplinary health and social needs of thousands of refugees living in northwest San Antonio.

The COVID-19 lockdown in the spring of 2020 forced the clinic to abruptly close its doors for the first time in years. The patient vulnerability that resulted from this cessation of services kickstarted the efforts of faculty, medical, dental and nursing students to design and implement the first clinic telehealth outreach. A large-scale needs assessment exposed the heightened struggles faced by refugee patients with diabetes and hypertension without consistent access to care. This discovery led students to develop the Community Service Learning (CSL) project, which is still in operation today.

Backed by grants from UT Health's Center for Medical Humanities and Ethics, the CSL project is a collaboration between faculty, students, family medicine residents, local dietitians, community interpreters and volunteers.

This program recruits refugees with uncontrolled diabetes and hypertension and provides them with culturally and linguistically conscious tools. It also provides the knowledge and continuous support to self-manage their chronic diseases.

These efforts include providing free at-home glucose and blood pressure monitors, hosting regular group seminars and one-on-one consultations with dietitians in patients' respective languages, medication management and regular clinic visits with primary care physicians. Students contact participants monthly to gather glucose and blood pressure readings, ongoing barriers and future needs.

In the late of 2020, 97 identified patients were contacted and 30 patients expressed interests in the program. An average of 14 participants across five language groups (Arabic, Burmese, Nepali, Rohingya, Spanish) attended the educational seminars and scheduled appointments. These participants are a mix of recurring and new members; however, the program has greatest difficulty with patient retention. Patients struggle most with food and transportation insecurity, along with demanding work and home obligations that complicate their ability to regularly attend sessions and record their measurements at home.

Over time, the team has made changes such as offering transportation to the seminars, setting up a multilingual WhatsApp group for carpooling, and increasing community support. The team is also looking to make the sessions and one-on-one appointments accessible on a virtual basis. Given difficulties in consistently recording glucose and blood pressure measurements, student volunteers will triage patients at the monthly appointments to get this data and ask for general averages of measurements at home. Lastly, the team is developing a new partnership with the San Antonio Food Bank for at-home delivery of free groceries for participants with reported food insecurity.

As members of the team transition in and out, the program continues to provide accessible community-based education and follow-up services for refugees in need. Ultimately, the goal is to graduate participants who have shown the ability to self-manage their conditions and can transition with the help of social workers into the traditional healthcare system. The program also aims to implement graduated participants as community ambassadors to shape future iterations of the program in a way that best serves their respective communities. To the team, one thing is clear: chronic disease management does not have a one-size-fits-all solution. This form of primary care, further under-addressed among vulnerable communities, requires the ability of providers to learn from their populations and evolve their care to suit their community's needs in a manner that goes beyond the reading on a blood pressure cuff.

Salma Yazji is a medical student interested in Psychiatry at the UT Health San Antonio Long School of Medicine, Class of 2023. She serves and works as a student co-leader at the Refugee Health Clinic.

Mahima Ginjupalli is a medical student interested in Psychiatry at the UT Health San Antonio Long School of Medicine, Class of 2023. She serves and works as a student co-leader at the Refugee Health Clinic.

Secondary authors: Aden Tadese, Ojasvie Agnihotri, Zachary Harbin, Natalya Ponomareva, Sehwa Nick Kang, Ariana Maleki, Zuha Alam, Serena Luke, Reem Farra RD, Rosalynda Rodea RD, Carolina Gutierrez Garcia, MD, Esther Shin MD, Etny Candelario, MD, Khorshid Amirkhosravi, MD, Tara Toloui, MD, Fehima Dawy, MD, Lizzette Lugo, MD, Armando Flores, MD, Carolina Sanchez, MD, Sabeen Abdullah, Zainab Essaji, Munawar Iqbal, Fozia Ali, MD.