Hyperlocal health clinics empower Cleveland immigrant communities

By Michael Indriolo, The Land

Fatumo Ali bit down on her headscarf, wincing as Dragana Zivak, the pharmacy manager at The Centers, pushed a needle containing a dose of Covid-19 vaccine into her arm. Ali was the first in a line of young Somali Americans waiting their turn for the jab.

Dozens more Somali immigrants, who number about 338 in Cleveland, packed the Somali Community Center in the Bellaire-Puritas neighborhood for health screenings, education sessions and Covid-19 vaccinations on Saturday, Feb. 5. It was part of a community outreach effort by The Refugee Response to help connect Cleveland’s immigrant communities to health resources.

“With this health fair and with what we are doing at the center, we are breaking a lot of barriers,” said Idiris Mohamed, the president of the Somali Community Center. “We'll keep going until everybody gets familiar.”

Children participate in a demonstration about dental health at the Somali Community Center.  [Michael Indriolo / The Land]

The health clinic is a project of The Refugee Response’s community advisory board. That board is where local healthcare workers Sami Ahmad, representing the Ibn Sina Clinic, and Ikenna Ogwuegbu, a board member and pharmacy student at NEOMED, came up with the idea to address the cultural, linguistic and systemic barriers that thousands of local refugees face when seeking healthcare in Cleveland. These barriers have worsened during the pandemic, they say.

Yet rather than bringing generalized healthcare to Cleveland’s ethnic communities, Ogwuegbu and Ahmad are letting community leaders decide what services their clinics will offer. The pair then connects leaders with resources to help navigate the healthcare system, Ahmad said.

“We've been trying to work with the communities that we are aiming to serve,” said Ahmad, a vaccine ambassador for the American Muslim Health Professionals and recent graduate of graduate of the Johns Hopkins University, who called America’s healthcare system “unforgiving” for immigrants. “We're not doing to, we're doing with.”

Ikenna Ogwuegbu (left) and Sami Ahmad (right) [Michael Indriolo / The Land]

Economic hardship and the pandemic have made accessing healthcare more difficult than ever for the roughly 20,000 immigrants living in Cleveland, Ahmad said. They, like immigrants across the U.S., face a “ complex maze of service systems,” according to a study in the Journal of Immigrant and Minority Health. In particular, refugees fleeing war or persecution are less likely than other kinds of immigrants to access healthcare, the study found; however, refugees are more likely to have pre-existing health issues and chronic conditions partly from their migration journeys which can often be dangerous, according to another study in the same journal.

“At the end of the day, it's ‘How do I get care? Where do I get care? And how am I going to pay for it?’” Ahmad said. “Those three things take a variety of forms in the United States.”

Different needs for different communities

Cleveland’s immigrants come mainly from Afghanistan, Bhutan, Burma, Burundi, Nepal, Iraq, Somalia, the Democratic Republic of Congo, Syria and Ukraine, according to the local branch of the U.S. Committee for Refugees and Immigrants. With such a diverse range of cultures, backgrounds and languages, each community has its own health needs and faces unique challenges in adjusting to the U.S. healthcare system.

Ogwuegbu and Ahmad know this firsthand. Ogwuegbu left Nigeria at age 11 and Ahmad’s parents fled the Middle East following the outbreak of the first Gulf War.

For example, most of the Somali community had already been vaccinated against Covid-19, so Ogwuegbu, who co-founded the international healthcare nonprofit IKON Health Foundation, brought in African American dentists to provide culturally relevant education about oral health and hand out 100 dental care kits. The Greater Cleveland Food Bank also distributed food and signed residents up for assistance programs while IKON staff performed no-cost blood screenings.

Mohamed said the dental education was especially well done. “They learned a great deal,” he said. “The way they explained it was very, very helpful.”

Another health clinic scheduled later this month will focus mainly on Covid-19 vaccinations for Cleveland’s Congolese community because community leaders identified that as their greatest need amid the recent Omicron surge. The Congolese community is one of the fastest-growing immigrant communities in the city with 718 new migrants settling here between 2012 and 2018.

Navigating the maze

Education about the U.S. healthcare system will be a constant at all their clinics, Ahmad and Ogwuegbu said. One of the main reasons Ogwuegbu started IKON is because American healthcare can be confusing to newcomers, from getting insurance to viewing test results in MyChart or filling prescriptions.

In the Somali Community, Mohamed said many aren’t familiar with scheduling appointments or going to a medical clinic. Somalia doesn’t have an insurance system, and three decades of civil war crippled its healthcare system, which is now largely dominated by unregulated private providers. Still, others like Mohamed come from villages in the country, far off from health clinics of any kind.

Halima Mohamed (left) and Qamar Matingwa (right) hold their children while listening to a presentation about dental health [Michael Indriolo / The Land]

Refugees entering the U.S. get at least eight months of medical insurance through federally funded refugee medical assistance, and some can qualify for Medicaid assistance after that. However, many take on jobs that don’t pay enough to support their family and offer inadequate insurance, but nonetheless disqualify them from Medicaid, which has an income limit in Ohio of $35,245 for a family of four.

Although The Refugee Response doesn’t often provide direct healthcare, the agency specializes in connecting new immigrants to resources that help them navigate challenges like that, said Executive Director Patrick Kearns. It connects refugees with a host of healthcare services tailored for them through Neighborhood Family Practice. The Refugee Response is also translating an educational presentation about the healthcare system to Dari and Pashto, the predominant languages spoken in Afghanistan, to serve the roughly 650 new Afghan refugees who arrived in Cleveland following the Taliban's takeover of the country last fall.

Yet The Refugee Response takes no credit for the clinics, Kearns said. Rather than the agency serving as a middleman between local immigrant communities and the health resources they need, Kearns said he wants to support Ogwuegbu and Ahmad’s approach of directly connecting them, saying it’s “a stronger way forward for sustainability.”

“There's so much challenge,” Ogwuegbu said. “But I believe…if we can help educate and get them acquainted to the system, then we can work on finding the resources, because the resources are definitely there.”

Michael Indriolo is a reporting fellow at The Land