“At least a dozen rural hospitals in Tennessee have closed since 2010.” | Pexels

Rocky Times in Tennessee

Immigrant doctors don't always see “America at its best”

“At least a dozen rural hospitals in Tennessee have closed since 2010.” | Pexels
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If you walk into the lobby of Comprehensive Arthritis Care in Hendersonville, Tennessee, you’ll see a brown framed sign that says “We choose NOT to prescribe narcotic medications in this office.” If a patient needs narcotic pain medication, it advises, they should contact their primary care provider. The sign, which Dr. Hana Ali put up herself, was necessitated by the last public health emergency that hit this far suburb of Nashville: when patients addicted to opioids began to knock on their doors demanding prescriptions for oxycodone and fentanyl, and the addictive truths of opioids had become obvious.

That sign, of course, is of little help now that Covid-19 has left the lobby empty. For Dr. Hana Ali, one half of the husband-and-wife team of medical doctors who run Comprehensive Arthritis Care, the first few months of the pandemic have been spent stuck on the phone. The reason is not entirely surprising: days after President Trump announced that he had a good “feeling” about hydroxychloroquine, patients who had been taking the medications for years suddenly could not get it. Almost overnight, pharmacies like CVS instituted “prior authorization” requirements on the drug. This meant that providers’ offices suddenly had to fill out pages of additional paperwork just so their patients could get a drug that was previously dispensed without any problem. Phone calls from frantic patients, worried about how to get their prescription medications, come in every day; and every day the office tries to keep up, to do what they can.

As doctors of Pakistani origin, the Alis are among the nearly 30 percent of all U.S. doctors who are immigrants. They ended up in Tennessee because they were looking for a place that had a reasonable cost of living, where their kids did not have to be closeted up in small apartments. Hendersonville, about eighteen miles from downtown Nashville, with a main street that is called “Johnny Cash Parkway,” seemed to fit the bill. As Dr. Ali tells it, “We felt it would be a place where we could provide the kind of personal care that only a truly independent and small practice can. They needed us, and we felt that we could make a difference.” At the time that they got there, Hendersonville had been looking for a rheumatologist for years.

So they came, and they have stayed. It took only a little while for them to wonder if they had been naïve in their desire to move to an under-served community in the Mid-South. “After the election of President Barack Obama, we started seeing a backlash and anger against minorities,” Dr. Ali says. That was nothing, of course, compared to what would happen after the election of Donald Trump, when harassing calls and vandalism of local mosques became repeating occurrences. Many of the thirty-eight known hate groups tracked by the Southern Poverty Law Center in Tennessee have a presence in the Nashville area. It was only after the election of Trump that they began to hear patients tell the receptionist that they would not see a brown doctor.

This has taken place under the general backdrop of hospital closures in rural Tennessee. At least a dozen rural hospitals in Tennessee have closed since 2010, and according to the Tennessean, at least a dozen more are losing money or at risk of shutting down. Despite the dire situation that leaves hundreds of thousands without access to health care, the Republicans who dominate the state legislature refuse to expand Medicaid. Now all those underserved rural residents have little recourse against the deadly Covid-19 epidemic coursing through the country.

Against this larger backdrop of ignorance and want, immigrant doctors like the Alis are trying to stay the course.

Against this larger backdrop of ignorance and want, it is immigrant doctors like the Alis who are trying to stay the course. In 2018, Hana Ali made an unsuccessful bid for the state legislature, running on a platform of expanding Medicare and Medicaid to help rural residents of Sumner County. She did so in part so she could show Hendersonville that if they wanted to take it, they had an alternative choice in leaders.

The Alis ardently believe in setting down roots in a community and actually knowing their patients, instead of treating them as if they were on an assembly line. Maybe it is just that sort of commitment to patients that makes Dr. Ali worry about what will happen after the immediate crisis is over. “A huge number of our patients will lose their jobs, and when they lose their jobs, they will also lose their health insurance, then they will stop seeing health care providers, prioritizing food over care. And in this state, where they have not expanded Medicaid, where will they go? What will happen to them?”

At the moment, the Alis are attending to the crisis at hand. They have filed the paperwork to register as “Pandemic Partners” with the State of Tennessee so they can provide storage space or workforce assistance if the state asks for it. Even before that, Dr. Ali was on the phone arranging care packets for Sumner Regional Medical Center that are full of personal protective equipment.

Another development has also taken place. In recent days, the Comprehensive Arthritis Care office has started to receive a new and odd kind of inquiry. People who have never been patients, or those they have not seen for years, are calling to ask if they can get a prescription for the Trump-touted hydroxychloroquine. Dr. Ali has been telling the callers that they cannot provide a prescription over the phone because the drug requires careful monitoring via blood tests.

Even as she responds to these inquiries, Dr. Ali wonders whether, here in Trump Country, there is already a black market for the drug recommended so fervently by the president. It makes her concerned about the lupus and arthritis patients who rely on the drug, but who may now be tempted to sell their prescriptions to provide for their families. But it also makes her worry about the people who would buy it from them, people who will take an unproven drug because Trump believes it could be a cure for Covid-19. The Alis’ predicament presents a challenge for our plague-ridden present: Could a brown, immigrant doctor ever persuade the people of Hendersonville that a white supremacist president can be very dangerously wrong?

Rafia Zakaria is the author of The Upstairs Wife: An Intimate History of Pakistan (Beacon 2015) and Veil (Bloomsbury 2017). She is a columnist for Dawn in Pakistan. She writes regularly for the Guardian, Boston Review, The New Republic, and The New York Times Book Review.

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