Speaking the language of hope
Virginia Tech Carilion School of Medicine faculty and students are part of an innovative partnership that helps children without financial means get mandatory physicals.
Five-year-old Alex dutifully stood behind a line on the floor of the Bradley Free Clinic and quietly identified each object on a vision chart.
“Qué es esto?” (What is this?), asked Patrick Beck, a student volunteer from the Virginia Tech Carilion School of Medicine (VTCSOM) as he pointed to a picture on the chart.
Alex stumbled for a moment.
“Tú lo sabes. Puedes hacerlo,” (You know it. You can do it.) coaxed his mother from the side.
Alex is one of dozens of immigrant and refugee children in Roanoke who are given free school physicals through a collaboration between Bradley Free Clinic, Roanoke City Public Schools, VTCSOM, Carilion Clinic, and the Roanoke City Health Department.
“Physicals are mandatory for all students in Roanoke Public Schools. It’s the law,” said Vydia Permashwar, VTCSOM associate professor of pediatrics, Carilion Clinic pediatrician, and one of the founders of the school physical clinic. “But what are immigrant families supposed to do? They don’t have insurance. They don’t have money. They risk their child being held back if they don’t have a physical.”
In 2019, recognizing an overwhelming need, Permashwar and other volunteers started seeing pediatric patients after hours whenever schedules would allow. The early “pop-up” clinics stayed busy, but scheduling was haphazard. Eventually, school physicals became a monthly occurrence at Bradley Free Clinic. School officials determine who is eligible for the clinic and help families with paperwork and transportation. As of June, 184 students have been served by the clinic.
To be eligible, students and their families must not have access to health insurance. With the emergency relocation of Afghan families to the Roanoke Valley in 2021, there was an increased demand for services. The clinic helped students enroll as close as possible to the beginning of the school year, which was also a critical step in enabling parents to find jobs and build self-sufficiency.
“In recent years, we noticed that it was taking longer to get students enrolled,” Permashwar said.
“The biggest challenge was that students were not always able to complete the enrollment process as quickly as we would like,” said Corey Allder, supervisor of English Language Learners and World Language Programs for Roanoke City Public Schools. “This partnership allowed for quicker support of families, so they could enroll and start school. One of the most rewarding parts of this experience is how our community came together to identify the problem and effectively implement a solution that has been overwhelmingly successful.”
More than 75 countries are represented in Roanoke City Public Schools. The majority of the students who are seen at the clinic are from Central America and Mexico.
For families who qualify, their children receive a complete physical exam, which includes vitals, vaccines provided by the Roanoke Health Department, blood work, and vision screenings. Some of the most common diagnoses are tooth decay, developmental delays, anxiety, and post-traumatic stress disorder from their often long and grueling journeys.
“We also assess their nutrition, social support, and any other conditions that may limit or affect their ability to learn,” Permashwar said. “Most of all, for parents, it’s peace of mind knowing their child can attend school.”
For the medical student volunteers, the clinic is a way of interacting with pediatric patients, practicing their clinical skills, and brushing up on their Spanish. Their involvement lives true to Virginia Tech’s motto, Ut Prosim (That I May Serve).
“We have a tremendous immigrant and refugee population here in Roanoke, and yet many of them struggle to gain access to the social and health resources they need due to cultural, language, or financial barriers,” Beck said. “The clinic gives me an opportunity to develop deeper connections with patients, which helps build that trusting provider-patient relationship that is so critical in health care.”
Beck also volunteers at medical student-run clinics at Bradley Free Clinic. “It’s always such an amazing experience,” he said. “You can see the impact you’re having on people’s lives, and it just makes me want to volunteer more.”
The clinic bustled with activity on one recent afternoon. Doctors, nurses, medical students, and interpreters filled the crowded hallways. A young girl whimpered, fearful about getting vaccines. The waiting room was full of children playing loudly and mothers conversing in Spanish.
Brandon Ganjineh, a fourth-year VTCSOM student, recalled growing up in Los Angeles, where his family was uninsured for many years. They often received care from similar clinics.
“The immigrant clinic is a wonderful safety net for children who would otherwise not receive care,” he said. “I think having a clinic devoted to our Spanish-speaking patients provides a sense of community that is hard to find elsewhere. Helping people who don’t have access to insurance or the ability to pay reminds me of why I decided to pursue medicine in the first place.”
When asked what they would do without the school physical clinic, one mother, with tears in her eyes, spoke through an interpreter.
“There were no other options,” she said.
Alex’s mother said, “The clinic is wonderful. I’m speechless.”
“I don’t think people realize the barriers that immigrants and those seeking asylum face,” Permashwar said. “This is a really innovative collaboration. It’s about overcoming barriers and changing the health system with your patients.”