Leveling the playing field – Al Shifa Clinic

Published Tarrant County Physician July 2009  

Al-Shifa Clinic offers free preventative education and medical care for immigrants and indigent residents of Dallas Forth Worth area.

by M. Basheer Ahmed MD and HujefaVora, MD

We are all well aware of the playing field. Diseases such as diabetes, hypertension, coronary artery disease, and cancer, do not respect the lines created by race, color, nationality, financial status, or immigration status. Rather, just as the founding fathers expressed it so many years ago, all men are created equal. One in four Americans afflicted with hypertension are completely unaware of their illness. About one in four Americans with diabetes also are unaware of their disease. Obesity is reaching epidemic proportions, further contributing to diabetes, heart disease, and a host of other medical problems. Most of these can be predicted and prevented by the available tools for early diagnosis, and by the pursuit of lifestyle changes. When we speak of these issues, we must concern ourselves with two overriding issues, access to health care and education. While there are some minor differences in the incidence of these problems among different groups individually, collectively all groups are affected by them.

The currentpresidential administration has brought these issues to bear most recently before the AMA. While access to affordable health care in America continues to be a challenge, the access to health information and education is not so difficult. Asking Americans to take charge of their own health and make healthy living a priority remains a bigger challenge. This aim requires resources many do not have. The escalating cost of health care delivery and increasing number of uninsured and underinsured remains a serious concern to all of us. The number of uninsured Americans has been rising inexorably over the past eight years due to a variety of reasons. Insurance premiums are ever on the rise. Many employers reduced their share of contribution to premiums. Many employees are unable to pay high deductibles. Uncovered employees are unable to purchase affordable insurance on their own. With unemployment on the rise, only one in ten workers chooses to sign up for COBRA coverage. And to compound these issues, the number of uninsured children has also jumped sharply, reaching over nine million, partially due to a decline in government funding.

This burden is further exacerbated by a growing number of immigrants who remain uninsured. In Tarrant County, over ninety-seven thousand immigrants do not have insurance coverage. Regardless of age, legal status, or insurance coverage, immigrants receive far less health care than the average American. A high percentage of recent immigrants remain uninsured. Beyond the financial issues, language difficulties and cultural differences create further barriers to access to health care. A recent analysis showed that immigrants consume 55 percent less services than non-immigrants. Immigrant children had a 74 percent lower per capita health care expenditure when compared to U.S.-born children.

In 1995, a group of concerned citizens founded the Muslim Community Center for Human Services (MCCHS), with the objective of providing education for health maintenance and disease prevention to the residents of the DFW Metroplex, focusing on immigrant residents who lack this fundamental access due to the above-mentioned language and cultural barriers. The MCCHS has actively participated in health fairs, providing health screenings for diabetes, cholesterol, hypertension, and numerous conditions. Initially, this delivery of education and services was met at the point of need, with screenings held at Islamic community centers, Christian churches, public libraries, and centers of higher education.

Responding to ever-increasing barrier: to health care, the MCCHS opened the Al-Shifa Clinic in October of 1998

Our goal evolved to provide culturally appropriate primary care to this medically-underserved population. Today, weekend clinics serve Tarrant County’s indigent population, immigrant residents, as well as visitors from overseas without insurance coverage. Our efforts center strongly around prevention. We provide services for general medical problems, focusing on diabetes, hypertension, dyslipidemia, and infections, conditions that when untreated can lead to more serious problems such as heart disease, stroke, or kidney failure. All complicated cases, specifically surgical patients, are referred to the public hospital system. Our staff of fifteen volunteer physicians comes on rotation on Saturdays and Sundays. The staff represents several primary care groups, including internal medicine, family practice, cardiology and emergency medicine. Additional support is provided by local medical students and premedical volunteers. Laboratory services are provided at a discounted rate in agreement with area labs. Generic medications are prescribed and pharmaceutical samples are dispensed routinely by the physicians.

As our populations needs have evolved, the Al-Shifa Clinic and MCCHS have also evolved. In July of 2008, a monthly eye clinic was organized to address minor ophthalmologic problems and corrective lenses. There is a regular women’s clinic which further addresses the cultural issues of our served population. Later this year, Al-Shifa plans to open a dental clinic as well.

Service to our community should never be short-sighted. It should continue to evolve, with the fundamental goal of expanding the scope of our service to our community. In 2009, MCCHS would like to develop a network of physicians in the Dallas-Fort Worth area who can offer medical services to patients referred by the primary Al-Shifa Clinic for a flat fee in their own offices.

  • The Al-Shifa clinic served 1,400 patients in 2007 and 1,800 patients in 2008. We project growth to 2000 in 2009.
  • 95 percent of the patients at the clinic are adults. Children are seen when a pediatrician is available.
  • Almost 70 percent of the patients at the clinic are female, 30 percent male.
  • The most common problems treated at the clinic are: diabetes (30 percent); heart disease including hypertension and high cholesterol (40 percent); infections and other minor ailments (15 percent); and depression, anxiety and other psychiatric problems (15%).

volunteering physicians to accept, as an example, $35 flat fees for a visit and evaluation. Patients will be encouraged to pay in cash, so no billing is involved. Volunteering physicians could limit their cases to one or two patients per month. Most physicians provide some charitable services, and we believe that these cases will not be an additional burden on their practices. This network will provide a unique opportunity for specialists to provide medical services to those in need. It will also further the mission of Al-Shifa Clinic and the MCCHS exponentially.

The Al-Shifa Clinic needs internists, pediatricians, and other primary care physicians to give four hours of their valuable time, one weekend every two months, to provide services at our clinic in North Richland Hills. We also are actively recruiting specialists to provide medical consultations at their own offices for minimal charges (or free!) at a rate of one to two cases per month. The people of Tarrant County need further scope of services, and it is our honor to serve the underserved. We would strongly encourage interested physicians to contact Dr. Basheer Ahmed at mbahmedc>3@ hotmail.com or 817-907-6080 for further information and support.

We are well aware of the playing field. Our goal of expanding access and providing education and services to the underserved can only be achieved with the support of a strong medical community. We are well aware that with strong resolve and united efforts, we can cross cultural and language barriers, and delimit these access issues. We are well aware that we can level the playing field. These preventable diseases do not respect the lines of nationality, financial status, or immigration status. They cross these barriers freely. Our goal is to eradicate these barriers completely.

We are thankful to the following physicians for their volunteer services at the Al-Shifa Clinic: Drs. M. Basheer Ahmed, Iqbal Ahmed , Yama Amin, , Khawaja Anwar,Daud Ashai, Sobis Ghazali, Riaz Haider, Ladi Haroona; Laila Hirji, Siraj Hussain, Jalil Khan. Muhammad Khan, Nusrat Khan, Mehreen Malik, Iqbal Mughal, Anila Patel, Imran Patel, Nadeem Patel, Nikhat Qureshi, Shabnam Qasim, Hujefa Vora, Hamid Burney and Mona Alvi. Dr. Basheer Ahmed is a former professor of psychiatry at UT Southwestern Medical School. He has been in private practice in psychiatry in Fort Worth, Texas, since 1980. He is the founder and current chairman of Muslim Community Center for Human Services, North Texas. Dr. Hujefa Vora is the past president of Tarrant County Medical Society, Arlington branch and is in private practice as an Internist.