Global and Community Health: Neurologic Care and a Case Study for Immigrants and Refugees in West Philadelphia

Philadelphia is a diverse city that has experienced an increasing immigrant and refugee population in recent decades. Although many academic medical centers also call Philadelphia their home, lack of accessibility and difficulty with insurance limit access to health care for many of its newest residents. The Social Health and Medical Services (SHAMS) Free Health Clinic was started to help address some of these disparities, especially for immigrant and refugee populations. Despite initial setbacks, the clinic has thrived and even moved locations to accommodate increasing patient demand. While many patients initially presented for primary care, there was a growing need for specialist care and coordinated multidisciplinary management. We present an example of a partnership between an academic center (Hospital of the University of Pennsylvania) and a community health center (SHAMS clinic), whereby patients have access to a dedicated neurology clinic that is run by residents and staffed by neurology attendings. This has allowed patients to have access to outpatient neurologic care, has facilitated referral to inpatient care when needed for serious conditions such as status epilepticus (as in the case study discussed), and has allowed for continuity of care between the hospital and the outpatient setting. Although this clinic is an endeavor to create an academic-community partnership, there is still much work to do to improve medical access in the immigrant and refugee communities.