When Dr. Firas Koura, a Syrian immigrant and president of the Kentucky Lung Clinic, looks at his fellow colleagues, one thought occurs: “Most of the patients depend on foreigners for specialized treatments, and many for primary care. Without immigrants, there would be no pulmonologist, no cardiologist, and no nephrologist in this big, regional hospital.”
When Dr. Koura came to the United States in 1988 for his medical residency at the University of Chicago Program B, he planned to eventually return home. But after completing a fellowship in pulmonary medicine at Southern Illinois University, he realized he was pursuing his own version of the American Dream. He could see the opportunities, both professional and personal. So when the opportunity arose to work in an underserved area in exchange for citizenship eligibility, he took it.
In 1996, Dr. Koura moved to the small town of Irvin, Kentucky, where he worked in a 25-bed hospital. He was the hospital’s only specialist. After a few years, a friend mentioned a pulmonologist vacancy in Hazard, Kentucky, a town of roughly 5,000 people. And so, in 1999, Dr. Koura moved to Hazard, where he has been ever since. The region now has two pulmonologists; the other is from Bangladesh.
Rural areas such as these in Appalachian Kentucky rely on foreign-born doctors to provide specialist care and, increasingly, primary care, as well. A 2004 study by the University of Kentucky Center for Rural Health found that two-thirds of Kentucky counties, or 81 of 120 counties, were so short of primary physicians as to be officially designated health professional shortage areas (HPSAs). A decade later, the situation has not improved much. As of 2016, some counties lacked even a single primary care physician.
Most of the patients depend on foreigners for specialized treatments, and many for primary care. Without immigrants, there would be no pulmonologist, no cardiologist, and no nephrologist in this big, regional hospital.
Initially, Dr. Koura found himself dealing with a lot of misconceptions about foreign doctors. “Many people thought that we don’t pay any taxes,” he says. On the whole, though, he has found Eastern Kentucky to be welcoming, and admits to encountering fewer preconceived notions about Middle Eastern people than he had in Chicago.
Dr. Koura became a U.S. citizen in 2002, and although the process then was far from easy, he is aware that younger generations seeking to come here as doctors will have a much harder time. “A lot of people are worried that they will not be able to pursue their dreams. It’s now so uncertain,” he says. Many who had medical residencies waiting for them are now unsure if they will be able to enter the country to take the positions.
He understands the problems that this will cause within an already struggling rural health care system. Kentucky routinely lands at the bottom — 49th out of 50 — in the Gallup-Healthways annual well-being rankings, which consider access to healthcare as well as behavioral and economic factors. Eastern Kentucky fares particularly poorly. Residents cite access to healthcare and health insurance as their third top health concern, behind cancer and heart disease. Across the country, U.S. medical-school graduates prefer to practice and live in urban areas, making immigrant doctors a critical lifeline in rural areas. “To meet a foreigner in Eastern Kentucky,” Koura jokes, “you need to go to the local Mexican restaurant, Chinese restaurant, or the hospital.” Without comprehensive immigration reform, the health of the region is at stake.