Almost no one knew the heartbreaking story behind the alcohol use that often brought a young woman to Harborview Medical Center’s inpatient service.

Carey Jackson, MD, was among the exceptions. As director of the hospital’s International Medical Clinic (IMC), Jackson understood the challenges that brought such patients to the Seattle essential hospital. The clinic provides tailored primary and mental health care to refugees, asylum seekers, trafficked persons, and immigrants — and works to understand their stories.

This patient was 5 years old when her parents were killed in Cambodia. She fled into the forest to survive and joined a group fleeing to the Thai border. There, she lived in refugee camps. But with no family to protect her, she suffered various forms of abuse and did whatever she could to survive. When she arrived in the United States, she had three children with different fathers, and she drank heavily. Her alcohol use eventually caused liver failure, and she died in her late 30s.

“I took care of that type of person for years until she died, and it was always my privilege to explain to the inpatient service why that person is that way,” Jackson says.

Most IMC patients have experienced triple trauma: the initial trauma in their home country that caused them to flee, such as war or torture; the trauma of migrating, such as surviving in refugee camps; and the trauma of discrimination in their host country, Jackson explains. In addition to providing trauma-informed care, the clinic conducts refugee screening and medical evaluations for torture victims seeking asylum.

A health care provider shows a woman with a head covering a file

International Medicine Clinic staff speak more than 30 languages, enabling the clinic to care for patients in their native language. Photo credit: UW Medicine.

The clinic has more than 12,000 visits a year and often cares for patients and their children long-term. Clinic staff speak more than 30 languages to serve patients in their native language while treating their complex medical needs. The IMC hires most of its staff from the communities the clinic serves, allowing staff to use their language skills and work with their own community. This builds a cohesive and inclusive team at the clinic, where everyone is respected and empowered to speak up on behalf of their patients. In patient communities, this practice has built credibility and trust.

This relationship between the clinic and their patient communities was strengthened with the creation of the Community House Calls (CHC) program. CHC serves patients and families with limited English proficiency, as well as their communities. Bilingual and bicultural caseworker cultural mediators provide cultural mediation, advocacy, and education for patients and providers alike. They also assist patients with interpretation, navigating the health care system navigation, and managing their care.

Cultural mediators also educate communities on health topics with a cultural lens and bridge institutional and community viewpoints to work toward positive health outcomes. As the clinic’s credibility within various communities grew over time, the clinic expanded and drew patients into every hospital service.

IMC offers other primary care services with cultural differences in mind. The pharmacy has specialized services, and staff are familiar with the chasm between the U.S. medical system and that of patients’ home countries. For example, patients sometimes bring one prescription bottle that contains all their pills. Pharmacists can help patients manage their medication and avoid adverse medication interactions caused by different prescriptions received in different locations. The clinic also provides nutrition services that work with the patient’s dietary practices, as well as acupuncture. IMC has experience with incorporating native homeopathic remedies or healing ceremonies into traditional medicine when appropriate, although these requests have waned over time due to cultural drift.

a practitioner administers acupuncture to a patient.

Harborview Medical Center’s International Medicine Clinic offers acupuncture, native homeopathic remedies, and culturally competent nutrition services. Photo credit: UW Medicine.

Despite building community trust and cultural understanding, challenges remain for the clinic. Every new wave of refugees is likely to experience difficulties accessing care due to health literacy issues compounded by limited English proficiency and trouble navigating the U.S. health care system. IMC relies heavily on electronic health records and communication, but it is difficult or impossible to accommodate non–English speakers using these systems. Innovations that are tailored to most patients are not easily adapted to serve the IMC patient population, and cultural services, interpreters, and navigators are rarely sufficiently reimbursed.

Regardless of operational challenges and medically complex patients, there is a close community among clinic staff and patients. After serving as medical director since 1992, Jackson is retiring later this summer. He is proudest of the heart and mind it takes to do this work that the clinic team brings with them daily.

“One of the privileges of this work is keeping people safe,” Jackson says.

A clinician helps take a man's blood pressure

Carey Jackson, MD, right, plans to retire this year after 30 years as director of the International Medicine Clinic. Photo credit: Harborview Medical Center

Learn more about the IMC and gain health resources for immigrants and refugees.