An elderly Iraqi couple gave me warm smiles and friendly handshakes when I entered the room. They both were on half a dozen daily medications for the treatment of several medical conditions, including type II diabetes mellitus and open-angle glaucoma. However, they were concerned because they had recently lost the short-term health insurance that they were given upon moving to the U.S., and they did not have the resources to pay for their medications or their upcoming specialist visits. Their profound need was demonstrated to me when they said, “It does not matter if the medications are $1 or $100. We do not have any money to pay for them, even if they are $1.” They were in a position of extreme situational poverty, due to the circumstances that had led them to flee Iraq and come to the U.S. Now they were at an age where they were ready for retirement, but despite their life work in Iraq, they were now left without funds to even pay for their basic medical needs. Fortunately, our interdisciplinary team at Siloam has experience in working through financial barriers. We collaborated with pharmacy and social work to ensure that this couple had affordable options for their medications and specialist appointments.

Medications on a home visit

A few days later, I was given the opportunity to go on a home visit with a pharmacist and an experienced medical assistant (who acted as our Arabic interpreter) to check in on this couple. We were overwhelmed with their Iraqi hospitality, as they made great efforts to make us comfortable and set a variety of foods and drinks before us during our visit. We talked with them about their role in preventing the complications of diabetes, and we also discussed the more affordable alternatives we had arranged for their medications. It was truly a privilege to be welcomed into their home and treated with such generosity.

Home visits have an immense value in the refugee population to increase patient education and compliance with treatment and allow providers to assess and overcome barriers to care that result from lack of resources in the home. Additionally, home visits are perhaps one of the most meaningful ways that we can demonstrate to patients that we genuinely care for them. When a provider makes the extra effort to go into a patient’s community to interact with them and evaluate how their treatment is progressing, that provider is demonstrating their commitment to ensuring that the patient has the adequate knowledge and resources to properly manage their condition. It is far too easy, especially in urgent care clinics and emergency departments, to send a patient on their way with prescriptions and instructions that they can neither understand nor afford. We must hold ourselves responsible to ensuring that our patients can realistically apply our treatment plan. This requires explaining our plan in a language and at an educational level that the patient understands. It also requires selecting treatment modalities that are affordable and agreeable to our individual patients and ensuring that our patients have the means for reliable follow-up. Home visits are an effective way to encourage and enable patients to participate in managing their health.