Assessment of San Antonio refugee health clinic telehealth response and refugees’ needs during the COVID-19 pandemic

In March of 2020, Texas declared a statewide public health emergency in response to the rapidly spreading COVID-19 virus, forcing the shutdown of many critical operations across the state. The pandemic has had a massive impact on the refugee population worldwide, increasing displacement and limiting opportunities for resettlement, work, and aid. In an effort to evaluate and address the holistic needs of the San Antonio's vulnerable refugee community during the pandemic, the San Antonio Refugee Health Clinic (SARHC) created a COVID-19 response team that screened and triaged the population, collected data, and provided telemedicine and other urgent teleservices. The SARHC clinic has served the mostly uninsured and underserved refugee population of San Antonio, Texas for over 10 years as a Student-Faculty Collaborative Practice (SFCP). With the collaboration of the Center for Refugee Services in San Antonio, the clinic utilizes the site of a local church on a weekly basis to serve refugees via teams of nursing, dental, and medical students and faculty. At the height of the COVID-19 lockdown, teams of student and faculty volunteers conducted a cross-sectional study of patients’ needs by systematically calling and screening patients. Qualitative data on COVID-19 risk, mental wellness, financial needs, food security, dental needs, and medical needs was collected. Quantitative data on number of patients contacted, country of origin, interpreter use, insurance access, internet access, referrals, appointments, and prescriptions carried out was also collected and analyzed. Of the patients called (N = 216), 57% (n = 123) were successfully reached and completed the survey. 61% (n = 75) required language interpreter services. Only 9% (n = 11) of individuals had health insurance. 46% (n = 52) expressed the need for telemedicine services, and 34% (n = 42) reported access to WiFi. 41% (n = 50) reported a medical concern, 18% (n = 22) reported dental concerns, 41% (n = 51) reported social needs, and 11% (n = 14) reported mental health concerns. 24% (n = 30) of patients requested medication refills. Our snapshot of the San Antonio refugee community during the COVID-19 pandemic captures their social, mental, and physical struggles; the pandemic left many families without access to medications, health services, social services, job, and food security. The telemedicine campaign proved to be an effective method of assessing and addressing a variety of patient needs in a virtual setting. Of concern is the high rates of uninsured families and limited Internet access. These findings reveal important considerations for equitable healthcare delivery to vulnerable populations in the face of prolonged unforeseen events, like the COVID-19 pandemic.