As she sits patiently in the waiting room, Gurbachan Samra, a 56-year-old Sacramento resident, chats with an acquaintance in Punjabi, her native tongue. They sit one chair apart against the tan-tinted walls of the clinic. When a doctor approaches her, Samra looks up and continues speaking in Punjabi while she explains the reason for her checkup. When the doctor understands and responds to her in the same language, a look of relief washes over Samra’s face.
Samra and her husband, Satvinderpal Samra, are patients at Shifa Community Clinic, a free health clinic located at 419 V St. in downtown Sacramento. Shifa, meaning ‘to heal’ in Arabic, is a clinic that provides basic healthcare to the uninsured South Asian and Middle Eastern population of Sacramento.
Like many of the patients at the clinic, Samra and her husband recently immigrated from India. And like many of the patients, Samra and her husband are without health insurance.
Samra has been a patient at Shifa since she moved to California five years ago. She comes to the clinic to get check-ups and medication for high blood pressure and cholesterol.
“Other doctors take fees and don’t do the tests or give prescriptions. Here it is easier to get help,” Samra said.
Due the implementation of the Affordable Care Act (ACA) in October 2013, Shifa Clinic volunteers are trying to educate their patients about signing up for health insurance under California’s health exchange, Covered California. However, it remains to be seen if this coverage can provide the same type of culturally conscious care that Shifa Clinic already provides.
Shifa Clinic operates with the combined efforts of volunteer doctors, UC Davis medical students and UC Davis undergraduate volunteers. The clinic is open Sundays and three Saturdays per month. Dr. Shagufta Yasmeen, the current medical director, founded the clinic in 2000 with the help of the neighboring mosque at 411 V St. It became affiliated with the UC Davis School of Medicine in 2005.
Overcoming barriers
Language barriers often arise as they see patients with language difficulties, in particular patients who speak Urdu, Hindi, Punjabi, Arabic, Bengali and Fijian. Rachel Naik, a Shifa Clinic volunteer and a fifth-year psychology and neurobiology, physiology and behavior double major, said breaking through that barrier is the first step to earning a patient’s trust.
Naik recounted one instance when a patient who only spoke Urdu opened up to her because she was able to communicate with her in her native language.
“Oddly enough, we shared a very similar history,” Naik said. “At the end of her appointment she gave me a hug and blessed me, just like a family member would; she then told me that she had not seen a doctor in seven years because she did not have insurance and because of the language barrier.”
Supaksh Gupta, a second-year at the UC Davis School of Medicine and Shifa Clinic volunteer, said communication barriers often arise when discussing certain types of medical conditions.
“Talking to the patients about things like depression or sexual history, it doesn’t translate as well and that makes it harder to discuss,” Gupta said.
Manoj Prasad, a 32-year-old U.S. army soldier, has been bringing his mother-in-law Salima to the clinic because it is the only place where language and cultural barriers are more easily overcome.
“When [my mother-in-law] came from India they couldn’t figure out her health insurance and then she found out about this place,” Prasad said. “It seems like the right place for her; there are no language barriers here.”
Salima needs regular check-ups to monitor her blood sugar levels and refill her medications, and it wasn’t until she came to Shifa Clinic that she fully realized the extent of her condition, Prasad said.
Additionally, Shifa is a nonprofit clinic and all patients are seen free of charge. Most of the clinic’s funds come from fundraisers and donations by mosques, and UC Davis gives funding for lab work, said Narine Abgaryan, a UC Davis School of Medicine student who volunteers at Shifa Clinic.
Shifa Clinic allows anyone who needs basic medical help to become a patient, and the majority are recent immigrants who may or may not be documented, said Harman Grewal, a Shifa Clinic volunteer and a fourth-year exercise biology major.
“We see anyone, we don’t ask if they are documented or not,” Grewal said.
Obamacare and immigrants
Currently, Shifa Clinic is in the process of teaching their patients how to get coverage under California’s health exchange, Covered California.
When Covered California enrollment started in October 2013, many Californians who were previously uninsured were able to enroll in health insurance for the first time. However, for immigrants there is a slight catch; all lawfully-present immigrants are eligible for coverage, but undocumented immigrants are not eligible for health coverage under the federal health reform.
According to an Oct. 17, 2013 article in India West, the U.S. is currently home to 540,000 undocumented South Asians, and 11 million undocumented people of all nationalities.
Ellen Wu, executive director of the California Pan-Ethnic Health Network, a health advocacy organization based in the Bay Area, said that for those immigrants who are eligible the challenge lies in helping them understand how to get coverage in their own language.
“We are making sure outreach and education efforts are culturally and linguistically appropriate,” Wu said in regard to her organization.
Grewal said she has seen some patients experience difficulties because they don’t have access to a computer with internet, struggle with using the website or are not proficient enough in English to go through the process. Shifa volunteers have discussed bringing in someone from Covered California to help educate patients, but it has not been put into motion yet, Grewal said.
“I did meet a patient who said that she didn’t qualify for Obamacare. From what she told me of her family situation, I thought she would qualify for Medicaid,” Grewal said.
According to Wu, under the federal health reform immigrants below a certain income level can qualify for MediCal. Covered California expands the MediCal program to allow those with incomes of less than $15,000 per year to qualify for coverage under MediCal.
However, lawful permanent residents with less than a $15,000 annual income will not qualify for MediCal in California or Medicaid programs throughout the country before five years of residency in the country. New immigrants with less than five years’ residence in the U.S. will qualify for subsidized care if their income is between $16,000 and $45,000.
While Shifa clinic volunteers are trying to teach patients how to get health coverage, Naik said these efforts will not hinder the work they already do.
“We will be educating our patients and others who call to be patients at Shifa about Obamacare and how they can be covered,” Naik said. “That being said, Shifa will always be open to help serve our community.”
