Refugee Health in Buffalo, with Dr. Myron Glick of Jericho Road

Co-host Tia Palermo interviews Dr. Myron Glick, Founder and CEO of Jericho Road, a community health center in Buffalo, on their work attending to the healthcare needs of refugee populations, including coordinated efforts of Jericho Road with Buffalo's refugee resettlement agencies to assist Afghan evacuees. To donate to their efforts, visit https://www.wnyrac.org/ 

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Hello and welcome to Buffalo Health Cast a podcast by students, faculty and staff of the university at Buffalo School of Public Health and Health Professions,

we’re your co-hosts, Tim Palermo, Jessica Kruger and Schuyler Lawson. And in this podcast, we cover topics related to health equity here in Buffalo, around the US and globally. And the first semester of the podcast, we're taking a deeper look at racism and health.

We'll be talking to experts around the US as well as individuals here on campus and

in the Buffalo community who are working to remove inequities to improve population,

health and well-being. You'll hear from practitioners, researchers, students and faculty from other universities who have made positive changes to improve health, equity and inclusion.

Tia:  Hello and welcome to Buffalo Health Care. I'm your co-host here, Palermo, and I'm here today with the doctor of Jericho Road. Welcome, Dr. Glick. Thank you. Here. Thank you for this opportunity to start us off. Can you tell us a little bit about Jericho Road and your role there?

Myron:  Sure, yeah. My wife and I started Jericho Road in nineteen ninety seven.

I'm a family doctor.And when we started, our original purpose was to provide excellent quality family health care to folks on the West Side who needed it, whether they had insurance or not, and especially Medicaid and uninsured folks. And that was back in ninety six, ninety seven. So almost twenty five years ago.

Since that time we've grown a lot. And today we're a pretty large organization in Jericho and Buffalo. I'm still a family doc. See patients deliver babies and I'm also the CEO of the organization.

Tia: That's great. Yeah. Can you maybe tell us about the different parts of Jericho Road and what the different projects and locations do?

Myron: Sure. So I tell folks that we basically do five things at Jericho.

We are. Our main thing is we provide primary health care, medical care to folks here in Buffalo, regardless of what their insurance status is. We have five health centers in Buffalo that provide primary health care and about 40 doctors and nurse practitioners.And so we see a lot of patients and many of our patients, over 50 percent, come to us as refugees and immigrants from other places. They've moved to Buffalo for whatever reason.

And then we have lots of folks who grew up in Buffalo on the east and west side of Buffalo, and they become our patients.

The second thing we do is we long ago realized that providing medical care isn't

really enough if we're really going to have an impact in people's lives.

And so we've started a number of programs that are tied into the medical care that we provide that address or try to address some of the root causes of why people are sick and really the social determinants of health. We can't do it all. But these programs are our logit programs that really impact people's lives where they're at.

The third thing we do is we, in partnership with the University of Buffalo, have a family medicine residency training program at our site, one of our sites. So we know every year we get a three year training program. Every year we get four new recent medical school grads who want to learn about what it means to be a family doctor. And they're here for three years with us. So like right now, we have 12 family doctors in training. And that's a wonderful opportunity for us to sort of give a little bit of our DNA to other doctors. And some of them may work for us in the future when they graduate and others will go other places and make a difference and take a little bit of what they learned with us to those places.

The fourth thing we do is we run a homeless shelter called VVA.

And this homeless shelter is specifically for asylum seekers who have come to Buffalo, come to this country, mostly crossing through the southern border. Many of them have had harrowing journeys that have lasted years to get here. And they're looking for a home for their families, either here or in Canada. So every night we shelter probably one hundred to one hundred and forty people at VA and we provide medical care, trauma based mental health care and legal advice to these folks in addition to shelter and the physical needs that they have.

And then the fifth thing that we do is one that I mean, they're all exciting to me because I'm involved in all of these options But  We have a global health program through Jericho, where we followed some of our refugee friends back home to Sierra Leone,to the Democratic Republic of Congo and to Nepal, and we have we run we operate five health centers in those countries that  are fully staffed by local folks from those countries. We provide some financial support and operational support, but it's really locally run and operated in the blood.

And we're almost seeing as many patients in other countries as we see now in Buffalo.

So that's sort of a quick overview of what we do at Jericho.

Tia:

Right. Thank you for that. It was really great to hear you talk about the social determinants of health in our school of public health and health professions. At the university at Buffalo, we talk a lot about how social determinants of health and upstream factors really affect the access to care that people have as well as their health outcomes. So it's really nice to hear you talk about how you're bringing both sides together in the provision of health care and you're doing so many different things. It's very impressive. 

We brought you here today to talk about Jericho, a Jericho Road role in the effort to assist Afghan evacuees who are now arriving in the United States. I think there's about three hundred and fifty evacuees expected to be arriving in Buffalo. So can you start out by maybe telling us a little bit about the standard refugee resettlement program? So what do refugees get when they get here? And how do refugees differ from other types of immigrants in terms of their legal status?

Myron: No, that's a good question. So refugees are folks who have had to flee their homeland because of war or some kind of horrible trauma and are now being resettled in another country.

They're not choosing to leave their country. They're fleeing for their lives.

Many have lived in refugee camps across the world and many have become certified by the UNHCR United Nations high command of refugees as official refugees and whereas an immigrant would be someone who chooses to come. And they're not necessarily fleeing refugees fleeing for their lives. And then you have asylum seekers who often really are refugees if they're fleeing the same set of circumstances,

they just never got certified by the UNHCR. And so they have to find a different way into the country. So if you think about folks coming to the United States,

I would say there's a category of refugees which are folks that the United States has agreed to take in. And when they get here and they're assigned to Buffalo,

they're on a pathway to citizenship that will hopefully culminate within six to seven years of them becoming actual American citizens. And when they arrive here, they receive a significant amount of support for at least the first three to six months through the federal government.

And that support is channeled through local refugee resettlement agencies in Buffalo.

We have four of them. We have the International Institute, Jewish Family Services Journeys and Refugee Resettlement Services and Catholic Charities. And those organizations get money through the federal government and through the state to resettle refugees to help them find an apartment, to help them get to the doctor, to help them apply for Medicaid and social services and find that first job. That's sort of the pathway that Jericho probably has. Ninety five percent of the folks we see from other countries come as official refugees. We step in and provide the initial medical evaluation within 30 days for these folks and then we become their medical home so that many of those you know, we're the only doctors we've ever seen and they've been here 10, 15, 20 years. We've become their home for their medical care asylum seekers. It's much different. They're coming in through a whole different pathway and they don't get a lot of the services that are offered to the refugees and then immigrants. A totally different story. The challenge with the Afghan evacuees is they're coming in on a different sort of.

Under a different sort of legal status that's much more similar to asylum seekers than it is to the official refugees. And so right now they're being promised like one month of of services through

the federal government that will be given to the refugee resettlement agencies.

So there is a real need for our community to rally around supporting the refugee resettlement agency so that they can actually provide more of a standard amount of services for these Afghan folks who are fleeing their country.

Tia: What are some examples of the medical needs of the refugees that you see in your program?

Myron: So a lot of these folks come and they maybe have had some evaluation in the last year or so, but they're fleeing situations that set them up. I mean, first of all, many countries that are coming from don't have the resources to address problems that we take for granted here.

Problems like hypertension or diabetes, maybe they don't have access to insulin or medications.

Some of them have had trauma because of war. Maybe they lost a limb, but they never got physical therapy or a prosthesis. Some of them, we still see people today who were affected by polio when they were kids and they can't walk or they've lost the use of a limb. So we see children that have had autism or severe developmental disabilities that never got any resources.

So we see, you know, there's there's a real opportunity to get people plugged in to our American

health care system that has more resources if you at least if you have access. And so we do that. And then we also have an obligation to screen folks that are coming here from a public health standpoint for things like TB and and HIV and all kinds of infectious diseases and offer treatment so that, for instance, you don't have someone with active tuberculosis who's in the community and potentially spreading it to other folks. And then there's just basic stuff.

Getting women who are pregnant set up for prenatal care, getting folks, you know, there's children shot so they can attend school.So we it really is a big challenge for us to do that care and do it well. And given that, we'll probably be getting usually the refugees kind of come in gradually over a year basis, not 350 people at one time. So we'll be it'll be a little bit of a challenge for us, but we'll be fine.We'll do it. 

Tia: You mentioned some of the issues that you might see with people coming from different countries. So in addition, when you're providing the medical care, in addition to the language barriers, what are some of the other challenges that might be more prominent in communities that are coming to the US for the first time or that don't have that medical home that you were talking about?

Myron: You mean conditions that we see or you mean like one of our challenges to try to get them good care?

Tia: both.

Myron: Well, I mean, I would say that probably one of the biggest challenges is helping folks recognize

that the trauma that they've experienced is is potentially really affecting them,

maybe even causing some of their physical symptoms and getting folks to recognize what depression looks like and what,

You know, post-traumatic stress disorder is. And, you know, the.

From a doctor's standpoint, in many of the countries we take care of folks from,

there's not a word in their language to even say what depression is like.

There's not a comparable word for PTSD or anxiety. And so these folks have a whole different way that they sort of make sense of those symptoms. And so a huge challenge for us is to understand the cultural difference between how we look at mental health and how, say, someone from rural Sierra Leone looks at mental health. And and if you don't bridge that gap, you're just kind of stuck because, you know,

what's the use of giving them a medication for and for depression or setting

them up for counseling if they don't really understand the basis for it.

So I think even more challenging than the language barriers is helping people understand

the cultural context of the different symptoms and illnesses that we identify with.

And then once I mean, once they do, then getting them good care. It's not easy to come here as a refugee or an asylum seeker or an Afghan refugee evacuee.

You've seen so much trauma more than most people should have to bear.

And then you're coming to a new place with a new language, you know, new weather patterns, everything's new and it's very challenging. So we see a lot of mental health illnesses down the road downstream after we start to really get to know folks.

Tia: Yeah, I think the work that your organization is doing is so amazing and important, coming to a new country and having only a few months of financial support and then having to make your way on your own and navigate new systems. It can be very confusing. I mean, I'm speaking as an American woman. I've lived abroad in another high income country. And even for me, with all the assistance and support that I had, navigating another health care system was very confusing for me. And I had a lot of support. So I can't imagine what it's like coming to a country and having to navigate that with less support.

So for your organization to come in and support these families is really amazing. One of the projects that you have is called Priscilla Project. Can you tell our listeners a little bit about what that project does?

Myron: So the Priscila project provides support to our pregnant moms, especially refugee moms who are new to this country and especially women who grew up here in Buffalo, but maybe this is our first pregnancy or there's other challenges that you're overcoming with this pregnancy. And so we surround these women with support, do home visits to make assessments, provide prenatal education, provide.  Birthing classes, breastfeeding classes, those that need a doula, we provide that either in the language of the country they're from or in English, and then we provide interpreters, live interpreters at the births, which is a huge improvement over, you know,

using a telephone to interpret or a family member to interpret at the actual birth of the baby.

And then there's some follow up after the baby's born. So it really is a hands-on way of helping folks navigate what can be a challenging time.

We will talk about health inequity. One of the things I've looked at over the last couple of years with our folks at Jerrica Road is because we're a federally qualified community. Health Centers are 17 measures that we have to report to the federal government on every year. And one of those measures is low birth weight. So of the babies who are born at Jericho, we deliver about four hundred babies a year.

How many of them have birth weights under twenty five hundred grams?

And I'm very happy that we don't see a racial disparity in birth outcomes at our health center.

So in other words. Black folks and white folks and refugees all are equally prone to having low birth weight babies for the most part, and that's not what the literature would show at large. And I believe that the Priscila project, along with excellent prenatal care and the kind of care that we give it, Jeriko, we really go after people. If they don't keep their appointments, we will run them down, that kind of thing. I think that's why we're seeing the inequity overcome. I have no doubt that the racial inequities in health that we see if we were intentional across this country at providing the extra resources are more like equity, I think that, in other words, do not necessarily treat everyone equally, but put extra resources to where the need is. You can make up these gaps. And I think that's what the Priscila project is helping us make up that gap or close the gap with regards to the outcomes of the women that we deliver it.

Tia: That's such an amazing success story, it's so great to hear how you've identified this issue in the different ways that you've worked to empower women to have healthier pregnancies,

and then you're demonstrating that it works with the hard data in these low birth weight indicators. I mean, it's great to see it all come together that way. And low birth weight is important not only for the survival of the infants,

but addressing low birth weight can have implications down the road for the future well-being of children. So it's a really important program and really great to see the success of that program.

You've talked about what your organization does. Can you maybe take us back a little bit and tell us how you got started and why you do the work that you do?

Myron: Yeah, so I, I. Sort of had a long journey to come to Buffalo and to do this work, my parents were Amish and my wife's parents were Amish. We were born in Lancaster, Pennsylvania. I end up spending 10 years of my life, 11 years of my life in Central American country called my parents were missionaries there is there that as a kid that I got this interest to be a doctor and I think I was because of exposure to the health needs in that country. So when we got back to the United States, still part of the Mennonite community, I didn't really sort of didn't have exposure to the way the poor were treated here in this country until I got to medical school at University of Buffalo and specifically in my third year of medical school. So all along I was thinking, I'm going to be a doctor in another country and address the health needs that I saw there. But in medical school here in Buffalo, doing my third and fourth year, I was honestly shocked by the way the poor were treated on the clinical rotations that I did at EMC and other places where there's no question that there were basically three standards of care for folks in Buffalo. If you had good health insurance, you saw a completely different set of doctors and were treated differently. And if you had Medicaid, you saw residents, medical students in clinics across the city, mostly in big hospitals, never seeing the same person. The next visit will always be someone different. You'd have to wait a long time, handwritten notes, teaching opportunities all the time. And then if you had no insurance, basically didn't access the system at all unless you were really, really sick. And then you went to the emergency room. And it's a generalization, but honestly, that's the way it was. And I'd like to say that it's that much different, but there still is a lot of that, you know, going on in our nation and in Buffalo, still twenty five years, 30 years later. But anyway, out of that experience, I was like, it kind of changed me.

I got basically the call to stay here in Buffalo.

I went away for residents who came back in ninety six with the vision of starting a

medical practice on the West Side in partnership with the local church I was a part of.

So we did that and. You know, it was that my motivation was to try to create a system where people were treated fairly and equally, regardless of what their health insurance status was, whether they're rich or poor, bring folks together and try to provide the same care. I always said whether it's the president of the United States or the Somali refugees off the plane, if they come to Jericho, we're going to try to treat them the same way. And the motivation for this is really out of my faith. I believe in following Jesus seriously and believe that at the core of my faith is this idea of I'm supposed to love God, I'm supposed to love my neighbor and my neighbor is anyone I mean, who's in need, whether here in this country or some other place. And if I you know, as a doctor, since I'm a doctor, then that means how can I make a difference medically for this person? So this idea of loving your neighbor, doing unto others like you would want them to do to you, how would you want your mom to be treated is sort of the challenge I  would give folks at Jericho. And we've really tried to lead the organization that way from the very beginning. We started out as just my wife and I part time secretary and a part time nurse. First week we saw three patients, a mom and two kids, and the first 10 years were really tough.

A lot of challenges financially because as a private practice, taking care of mostly folks with Medicaid or no insurance, there's not much money to be made doing that. So financially, it was a big challenge. But gradually, you know, gradually we just came together.

I think, you know, some changes in Medicaid reimbursement, managed care, Medicaid,

getting a bunch of other people who were mission focused like I was to join us.

And I mean, the need has always been there. There's always patients in Buffalo that need this kind of care. And so gradually we grew eight, nine years ago, we became a federally qualified community health center. And that then finally solved the financial challenges for the basic stuff that we do because we get a lot more reimbursement for Medicaid and Medicare and uninsured folks now. And so it gave us that foundation to be able to really grow. And we have so and we continue to try to go after the folks who need the care the most. And we continue to try to bring people together since we have a very diverse practice. Lots of lots of you know, our staff is incredibly diverse and reflects the community that we serve.

And so. Yeah, so that's why we will be celebrating twenty five years next May.

Tia: Congratulations, that's amazing and such a powerful story. Thank you for sharing that with us. Going back to the Afghan evacuees, Can you tell me a little bit about how the different resettlement agencies are working together

and working with Jericho Road to address some of the needs that these new arrivals will have?

Myron: So I think it's really cool. All the refugee resettlement agencies are coming together along with Jericho Road,

So there's five organizations who've come together and are intentionally pooling our resources to make this work, because like I said earlier, the federal government isn't providing much support for these folks when they arrive.

And so the typical refugee resettlement process, it would be very truncated unless we all work together and unless the community really supported it. And so instead of competing among each other, I think it was very wise to bring everyone together.

And so we're asking the community if they're interested in donating money or their time or resources to this effort to go to the website WNYC which is our five organizations together, and there they'll find resources with regards to how they can donate time or money or effort.

And so, yeah, you know, our road specifically Jericho road's role will be to provide the medical care. The other four organizations will provide housing and get folks plugged in to the community. And so I think working together with folks will be able to do this well.

Tia: So this is really great that you're providing this information of how people can get involved, because I know our listeners are going to want to know how to help.

So we will put that link up with the podcast so that people can know where to go to find you to help you and your partner organizations.

Myron: Right, so the WNYC, our ECG, would be that the right link, not so much our individual organizations with regards to the Afghan evacuees, then whoever's managing that site can can can put people in the right place so that they're most successful in helping us all do this job.

Tia: Wonderful. Thank you. I know, I know people will be really excited to help.

You've talked a lot about what your organization is doing and where you've come from and how your organization has grown in these twenty five years. Where do you see your organization maybe five or 10 years from now?

Myron: What do you see Jericho Road doing? Well, you know, I've always been motivated by the need, so I think. That's going to continue to motivate us. It's not about competition or market share,

It's about are there people who need excellent primary care who are falling through the cracks and how can we make a difference? Things are much different than they were 30 years ago.

Twenty five years ago when we started, there's there's other federally qualified community health centers.

There's a number of like minded organizations that are now filling in more of the gaps.

So I think Jericho Road will look for opportunities where there is a need and try to fill those gaps I think will continue to grow on the east side and west side of Buffalo will continue to look for ways to address the social determinants of health, either on our own or in partnership with other like minded organizations.

I don't think we have to do it all. We can work together. We'll continue to grow our global work.

We need to get better with the work that we do at VVA in terms of where we'll

probably be starting a capital campaign to get a better sort of space for that work.

So we have you know, we have plenty, plenty of challenges ahead,

plenty of ways that I think we can grow not because we have to grow, but because there's still a need. And so once all the patients are taken care of and everyone has good doctors, and then maybe we won't grow anymore. But for now, anywhere we open a site, we start a new doctor.

Within two months, they're filled. So there still is an appetite for excellent primary health care in the Buffalo region.

Tia: Is there anything else you'd like to share with our listeners about the work that you're

doing or ways that people can get involved to help address some of these issues?

Myron: Well, I mean, I think it would be a whole other topic, but there's so much to be said around the inequity that we see in terms of outcomes of care and what can be done. covid has been a prime example of that. When you see we've done so much testing, testing probably thirty five forty thousand people in the last 18 months.

And it's even though you test white folks, black folks, refugees, you see inequity and who tests positive, you see inequity and who gets sick, who gets to the hospital, who dies.

And that's just covid. So I think that definitely the events of the last 18 months are pushing me to think more carefully about how we as an organization can more intentionally do our part to bridge those gaps.

Tia: Well, I can't thank you enough. And it's been such a pleasure to have you join us and to listen about the work that you're doing.We will be really interested to follow up and see how it goes with these Afghan evacuees.

Thank you to you and your organization and all your partners for the work that you're doing to address these inequities in health and health.

And our School of Public Health and Health Professions is here to work with you if there are ways that we can support the work that you're doing.

So thank you so much for taking the time today. We really appreciate it.

Myron: You're welcome. Thank you for the opportunity. I wish you well. Yes.

Let's partner in the future if we can. Thank you.

Tia: All right, take care. It's been another episode of Buffalo HealthCast.

Tune in next time to hear more about health equity in Buffalo, the US and around the globe.