While filling out the paperwork to see a doctor at a free clinic in Hoover, Semina Tawar sat in a Hoover waiting room that becomes a melting pot of cultures every Sunday.

The multilingual staff speaks English, Urdu and Arabic. Spanish interpreters are available when needed. Since Tawar's family legally moved from India to the United States a few years ago, their health insurance options are almost nonexistent due to their immigration status. After years of relying on home remedies, like turmeric and aloe vera, Tawar was able to communicate her eight-year-old daughter's needs in Hindi, her native language.

"Here, they can understand me," Tawar said. "If I can't speak (English) very well, they can't understand me."

Many Muslim doctors across the nation have opened their own facilities funded primarily through donations to help the poor and the uninsured. The trend, which started a little more than a decade ago, is taking root in Alabama. The Red Crescent Clinic of Alabama operates out of the Hoover Crescent Islamic Center on Hackberry Lane. From 2 p.m. until 6 p.m. every Sunday, classrooms are converted into healthcare hubs where flu shots, vaccinations and lab work costs are nonexistent for patients. Prescriptions can be found at a steep discounts. A team of 16 Muslim physicians sees patients for free regardless of income, religion. The philosophy allows the clinic fills a gap for people who have limited medical options in the greater Birmingham area.

The Henry J. Kaiser Family Foundation estimates 420,800 Alabamians, or nine percent of the state's population, were uninsured in 2016. Aly, who didn't give his last name, started visiting the clinic after hearing about the facility from a friend. Aly said he is on a strict budgeted income and can't afford insurance, yet.

"This is good," Aly said about the clinic. "With all the free services and all the professional doctors, it's just nice to be here."

'We were taught to be compassionate'

Like many Muslim-led clinics across the nation, the creation of Red Crescent was a response to the negative social climate towards the Islamic faith.

Co-founder Talha Malik immigrated to New York City from Pakistan in June 2001 to study internal medicine. Seeing foreign-born residents running hospitals was an inspiring sight and a different environment from his home country where someone's future is determined by their socioeconomic status, ethnic group and religion, Malik said.

Just a few months after his arrival, terrorists destroyed the Twin Towers. Details about the 9/11 attacks fueled hate crimes against the Muslim community that Malik would rather not speak about. He said the discrimination was sometimes subtle, and other times brutal. But that didn't stifle Malik and other Muslim doctors' passion to want to help indigent patients.

"I don't think that the negative perception of Islam is driven by ill-will in everybody. It's kind of misperception that Islam teaches violence or there is violence in Islam," Malik said. "But we were taught to be compassionate to help the widow, poor and those who have less than us in the same way any civilized society would bring their kids up."

In 2011, Malik said a group of Birmingham doctors of Pakistani descent gathered for dinner to discuss opening a clinic. Providing free services would allow them to illustrate the servitude of their faith by helping those who couldn't afford primary healthcare. After receiving support from the Birmingham Islamic Society and other donations from the Muslim community, the clinic was opened in 2012.

"A physician can basically see patients and helps them," Malik said. "To do it for compensation or reimbursement is just doing your job, working and making money to take care of your family. If we take time away from our families and actually serve the community, that to me is noble and representing something good."

Being the safety net for those in need

What started as a mission to dispel negative stereotypes, soon expanded. The clinic saw 396 patients in 2017. Malik said 40 percent of the patients are non-Muslims. The number of non-Muslim clients has grown over the years as they started to add psychiatric and pediatric services that complement the community's needs, Malik said.

Sammy Kaphner was able to detect a medical condition during an annual health fair organized by the doctors. Dozens of people filled the Hoover mosque to receive free glucose tests, blood pressure checks, doctor consultations and other primary needs. Kaphner was diagnosed with high cholesterol, which can cause severe heart problems if left untreated. He was able to make follow-up appointments at the Red Crescent Clinic.

The clinic's philosophy keeps people like Kaphner from slipping through the cracks of the healthcare system. Gallup, which has been measuring the national uninsured rate since 2008, saw an increase from 10.9 percent in 2016 to 11.7 percent in 2017. Kaphner, who is a U.S. citizen, has children who are covered by the Children's Health Insurance Program, also known as ALL Kids. But Kaphner is in between jobs and has to provide his own insurance - a $1,000 monthly expense. He said the clinic fills an important gap for his family.

"It's a good safety net knowing that someone has your back if you don't have a private clinic," said Kaphner during a recent visit. "My situation is not unique. It's probably more common than people think."

Primary care as the core of healthcare

Most of the kids seen at the clinic are children from refugee families or families who recently immigrated to the U.S, Malik said. A pediatrician started seeing patients once every three months in 2016.

Zeenat Islam, who trains volunteers, said the clinic is providing free services to those who face barriers when it comes to healthcare. On a federal level, non-citizens qualify for Medicaid and CHIP coverage five years after they receive legal immigration status. Exceptions are made for refugees, asylees, or lawful permanent residents who used to be refugees or asylees.

Alabama isn't one of the 25 states which expended CHIP to children who are lawfully in the U.S. or one the six states which give CHIP to children regardless of their immigration status.

"Recent immigrants, generally, do not have access to proper medical services due to not for qualifying for many healthcare measures whether that be as part of Obamacare or Medicaid," Islam said. "This is either due to many have temporary status and/or otherwise can't afford many of the healthcare costs."

Ehtsham Haq, one of the clinics founding members, has worked in psychiatry since 1998. What was once a service that was provided as needed at the clinic became a necessary service that Haq now provides once every three months. He said the clinic needed someone to diagnose, prescribe medication and provide follow-up care to patients. Most of his patients who have insurance have high deductibles, which creates high copays. Along with that, Haq said there isn't enough people providing outpatient mental health care.

"There is a shortage of psychiatrists in this state. There are about 400 psychiatrists and there is a need of 700 plus," Haq said. "So if some of them serve at a clinic for free or somewhere else, that will be helpful statewide."

Malik said the clinic will continue to build its services as the years go on. The staff would like to add subspecialties like oncologists and cardiologists to their rotation and provide imaging services, such as ultrasounds. Malik said clinic staff have actively talked about having a mobile clinic that will travel across the state once a month and provide free healthcare in the parking lot of churches, synagogues and other Islamic centers.

Red Crescent is taking shape of what primary care should look like in the United States, according to Malik.

"By practicing screening and preventive measures that are wholly practiced in primary care, we have been able to increase the lifespan of people by about 20 years," Malik said "By keeping primary care at the core of all healthcare in this country and trying to ensure that we can provide good-quality healthcare to as many people in this county regardless of their ability to pay to for it, we will not just save billions of dollars in healthcare. We will also save millions of lives and we'll increase our lifespans and will productivity of each human being as well."

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