Patient Aminata N'Diaye, left, with Dr. Naureen Zafar.
	Dr. Zafar with patient Maraime Fapp.
	Dr. John Palmer, Executive Director of Harlem Hospital, with leadership of the West African Islamic community.

There are 72,000 West Africans living in New York City, according to the City Planning Department, with significant communities in Upper Manhattan and the Bronx. Dr. Naureen Zafar is Chief of the recently established Medina Clinic at Harlem Hospital Center. Named for the second holiest city in Islam, after Mecca, the clinic is open to all but focuses on providing culturally-sensitive healthcare to West Africans, most of whom belong to the Islamic faith. Dr. Zafar, herself a Muslim, discusses the clinic and its patients.

Q. Why is the Medina Clinic needed?
A. The Harlem and South Bronx communities have seen a large influx of West African immigrants who are facing barriers to healthcare services that include cultural, religious, language, financial and educational issues. Many of the people I am seeing have not been accessing healthcare, either in Africa or in the U.S. They are immigrants who are working all the time and they say they don't have time to go to the doctor. Or, they are afraid of being turned over to immigration authorities. We have to reassure them that their information is completely confidential. The goal of the Medina Clinic is to reach this population that typically doesn't seek medical treatment and fully integrate them into our network of services.

Q. What do you have here that you wouldn't have at other clinics?
A. We have a fulltime interpreter, Assana Coulibaly, who speaks French as well as Bambara and Fulani, so we can communicate with our patients in their first language. Muslims pray several times a day, so we have an area where the patients can go pray and come back and receive their medical care. We have clinic hours on Friday evening and Saturday to make it easier for people to come. We pay attention to modesty issues since Muslim women want to be seen only by a female doctor and some of the men want to be seen only by a male doctor. And we do outreach in the community. For example, on Friday afternoons, we go to the local mosque after services and offer health education, screenings and referrals. We provide people with the support and confidence they need to navigate the healthcare system.

Q. What kind of health issues are you seeing among the patients?
A. Everything is sooner, earlier. They develop illnesses in their 20s, 30s, and 40s that you wouldn't generally see until patients are older. They have high blood pressure, diabetes and gastrointestinal illness. Many of the men have hernias. Many of the women have fibroid tumors that cause heavy bleeding, anemia and problems with fertility and pregnancy. What seems to standout the most is the lack of healthcare which most of us take for granted, and to have to endure suffering as a result of this, especially as they are just struggling to get integrated into the community as immigrants.

Q. What happens if people don't get primary care?
A. Eventually it costs all of us a much higher price in morbidity rates and mortality rates and the resources that get used up. If people don't have primary care they end up much more sick, they use the emergency rooms, they need more expensive procedures. We should all be interested in having a community where no one is without primary health care. I think it's a basic human right.

The Medina Clinic is open Tuesday to Saturday in two locations: Tuesday, Wednesday and Thursday 9 a.m. to 5 p.m. and Saturday 10 a.m. to 2 p.m. at the Ronald H. Brown Ambulatory Pavilion, third floor, 530 W. 137th St. and Friday 3 p.m. to 7 p.m. at the Lenox Avenue Health Center, 115 W. 116th St., second floor.

March 2010