When HOPE Clinic, a federally qualified health center located in Houston, Texas, began receiving requests to help people who recently arrived from Afghanistan, they had some idea of what might be needed.

Local refugee resettlement agencies were helping the new arrivals settle into new lives in the area – a familiar process for HOPE’s staff, who care for newly arrived patients from around the world.

But one aspect of the situation was relatively new: Because many of the Afghans were parolees – a temporary status that’s not considered a permanent path to U.S. citizenship – they didn’t have access to the same kind of services that people who have formal refugee status can receive.

“What was familiar…was their confusion about the U.S. health care system. What was different, quite frankly, was the lack of paperwork,” said Karin Dunn, director of programs at HOPE. “If you’re a refugee, your whole life is documented as much as it can be.”

Children were arriving without vaccination records. Pregnant women hadn’t received prenatal care. Some people had never seen a physician in Afghanistan, and, when HOPE Clinic staff began doing medical checkups, were discovered to have undiagnosed diabetes or hypertension.

HOPE staff members were accustomed to providing care to a patient population of many different nationalities. Texas is the second-largest resettlement state in the United States, and many of those who arrive are placed in Harris County, where Houston is located.

In addition, HOPE, which was established by the Asian American Health Coalition in 2002, has a long history of providing services to patients from Syria, Myanmar, Nepal, and other Asian countries. They knew the Medicaid system and American health care in and out. The health center brought a number of skills, such as linguistic and cultural sensitivity, to the table.

But the new arrivals meant increased costs, and to meet those costs, HOPE Clinic staff turned to Direct Relief, which provided them with a $50,000 operational grant designed to help them serve newly arrived patients from Afghanistan.

Since December, HOPE has treated 733 individuals newly arrived in Afghanistan through 1,849 encounters. The services they have offered have included prenatal, dental, optical, and behavioral health care. They’ve done Covid-19 and tuberculosis vaccination and outreach. They’ve made sure that children were up to date on their vaccinations so that they could attend local schools.

And they’ve done it all with a sense of warm welcome – the hope is that patients will continue to receive their care at HOPE for as long as they’re in the area – and with linguistically and culturally appropriate care. Translators and community health workers who represent the Afghan community play a major role.

“You could see the fear in their eyes until they had a language interpreter show up, and they just relaxed, and the way you could see them relax was very physical,” recalled Lulu Toumajian, an outreach specialist at HOPE. “Patients are more forthcoming when it’s their language and their culture, and when their culture is not just accepted but celebrated.”

Dr. Fatimah Lalani, medical director and an OB-GYN with HOPE Clinic, described the affinity she felt for her Afghan patients. “I’m an Indian Muslim, so I identify with the culture,” she said. “I felt a great satisfaction in taking care of them and kind of understood the cultural aspect.”

For many patients, the complexities of the American health care system – such as dealing with prescriptions through a pharmacy – were confusing. Others struggled with transportation and making regular appointments. Still, others were uncomfortable with the pelvic exams or concerned with giving blood for prenatal testing.

In particular, Lalani said, she was concerned about the mental health of many of her patients. They “had been through pretty traumatic situations to come here, and that was obvious. Some patients did have a lot of anxiety and some depression,” she said. Some felt guilt about leaving family members behind, or frightened and lonely in their new homes.

But Lalani said the cultural stigma around mental health issues was strong for many of her patients. “It’s not easy to get them to talk about how they’re feeling,” she explained. “A lot of times they would just decline and say, ‘No, I’m fine.’”

HOPE Clinic’s work is far from finished. Dunn said their next step is to apply the lessons they’ve learned from caring for Afghan and other patients to another newly arriving group – Ukrainians fleeing months of violent war.