Nurse volunteers speak the many languages of love in Clarkston

Medical doctor Gulshan Harjee, pharmacist and philanthropist Saeed Raees and the late Rev. Ben Johnson were the co-founders and still are the heart and soul of the Clarkston Community Health Center in small-city Clarkston, Georgia. Volunteer nurses, though, help give the bustling clinic its lifeblood. Established in May 2013, the center is a labor of love and a response to a swelling population of uninsured and multi-lingual refugees in the city of Clarkston and nearby underserved areas in metro Atlanta.

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Clarkston has been described as "the most ethnically diverse square mile in America" or tagged as "the South's Ellis Island." Census Bureau figures estimated its 2018 population at 12,757, with foreign-born residents making up 52.9% of its residents between 2013-2017. Thirty-three percent of the population is uninsured, and one of two of Clarkston's foreign-born residents live below the poverty level.

"For 40 years, a small town east of Atlanta has welcomed people seeking refuge from the world’s wars and persecutions," Carly Berlin wrote in The Bitter Southerner as she introduced her interviews with refugees in the area. "For more than 60,000 refugees, Clarkston, Georgia, has been their first American home, and the town has become the most ethnically diverse square mile in America."

The non-profit clinic's founders, board and team are just as diverse, from Tanzanian-born Harjee, to Saees’ humble Pakistani origins to Vice Chairman of the Board Dr. Arshed A. Quyyumi’s membership in England's Royal College of Physicians.

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But the feel at the clinic is quite the opposite from a Tower of Babel, though the patients combined speak around 60 languages. Instead of each speaking their native language and ignoring the rest, the CCHC is a carefully woven network of providers, interpreters and family advocates who are fluent or native speakers in a total of 30 languages. All the speakers are dedicated to making life easier and health better for this league of nations that has settled outside Atlanta.

Starting in February 2015, the CCHC began providing medical care from a sub-leased office space in what passes as a "downtown" in Clarkston. The goal was to be "culturally and linguistically sensitive for the diverse population of Clarkston," according to the center. Its efforts began expanding almost as quickly as the earlier cultural revolution in the area, as the non-profit collection of sympathetic medical and community stakeholders added mental health services and then a pharmacy as it became an authorized site for Dispensary of Hope. April 2016 heralded a dental clinic providing oral x-rays, cleaning and extractions and CCHC also provides vision health care, mammograms, and free laboratory diagnostics.

Nurses like Daniel J. Smith are in the thick of all this action. CCHC collaborates with Emory University, Mercer University, Clayton State University and University of North Georgia, and their nursing students commonly rotate through the clinic.

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Born to a family of dairy farmers in the United States, Smith said making a connection with the immigrant workers from Mexico on the family farm spurred his interest in learning their language and working with immigrant populations. He majored in Spanish and biology as an undergrad, and working as a bilingual clinical interpreter in North Carolina for a few years confirmed his path. "I enjoyed listening to the stories and I learned the immigrant clinical population was where I wanted to practice and do research."

The registered nurse is currently pursuing a doctorate at Emory with research interests that include vulnerable populations, particularly the issues that impact Latino health in the Southern United States. He has performed charge nurse duties at CCHC since August 2019, including triage, supervising student nurses and assisting with grant writing. He's been intent on expanding the core of volunteer nurses this past year.

A challenge for all the CCHC nurses is setting patients at ease, Smith added. "The patients initially have a lot of fears, especially those who don't have formal immigration status. We must build a therapeutic relationship and let them know we won't in any way jeopardize their ability to live in this country where their entire support system is. If we can make a connection with one family member, that's typically all it takes to get the entire family to come in for treatment, and sometimes their friends as well."

He speaks fluent Spanish, but "it is a true statement that I am working with lots of people who speak multiple other languages, including the physicians, the other staff and the patients," Smith said. "And we have tools and interpreters in place so we’re able to access all of the languages we need to participate with our patients."

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Smith said he realizes the clinic environment can also intimidate nurse volunteers. This is especially true of nurses who have never worked with indigent patients or a single language barrier, never mind the dozens of languages spoken by providers and patients at the clinic. "Luckily, we have a strong presence of volunteers with different language and medical backgrounds, so we can guide nurses who have never done it before through the process," Smith added.

Smith, who completes his PhD in June 2021 and will be certified as a nurse practitioner in December of that year, urged nurses of any background, student nurses and even students and community members with no clinical skills to volunteer through CCHC. "People without clinical experience can help clients determine financial eligibility, check patients in and out, and navigate the flow of the clinic," he said.

He emphasized that it’s critical to be committed to repeat volunteer sessions, since training for one-time efforts can really sap the clinic's resources.

"It all boils down to just giving your time," Smith said. "And if you can't, as cheesy as it sounds, we can always use monetary donations from people who don't have time to give."

As for Smith, he said he couldn't envision a choice that didn't involve working with vulnerable populations. "Early in my education and work life, I saw my set of skills and the privilege I had coming from a well-off white family," he said. "I knew it was my responsibility to use my privilege for good and to give back."

The activity at CCHC never ceases, always moving forward, and a quest for a bigger clinic is the latest initiative. Organizers estimate they'll need another $500,000 to buy a piece of land nearby and build a new clinic.

Nurse practitioner and volunteer Helen Baker emphasized the simultaneous needs to expand and also do what's possible in the present day. Baker holds a doctorate of nursing and is a clinical instructor at Emory's Nell Hodgson Woodruff School of Nursing.

She has been using her French background as she volunteers as a family nurse practitioner in the Wednesday Clinic about once a month. With a background serving in the Peace Corps in Togo, and studying French and anthropology as an undergraduate, she said she sees at least one patient each volunteer slot who is a native French speaker, and "they always appreciate when you can speak their language."

She is thrilled that the clinic has evolved to the point where there are a network of specialists in such disciplines as endocrinology, cardiology and eye care. "It's nice now to be able to refer people if they do need other workups. We're getting very well connected in the Atlanta area."

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And Baker says the work is far more personally rewarding than she ever could have imagined. "I learn a lot from my patients, what's important for them, and they also let me know what's going on in health care systems in other countries," she said. "I also get to meet really interesting other health care providers and volunteers. It's a very collaborative and supportive environment. Everyone is there to help so it's a level playing field." Baker strongly encouraged nurses at every level to come and join "so CHCC can provide services more often and to more people."

She herself will continue to volunteer as long as there's a need. "I get frustrated with our health care system because it has a number of gaps," she says. "I feel like volunteering is a way for me to help fill those gaps, because we only see people who are uninsured or don't have access to health care. This is something I can do in tandem with talking to legislators and saying we need to fix our system. Ideally, we wouldn't have that situation, but showing up and providing health care is a way to improve lives right now."