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LKINS, W.Va. — Dawn has yet to break when Dr. Chalak Berzingi begins his winding commute to this working-class Appalachian town — a town that, on the surface, would seem unlikely to welcome him.

Elkins, population 7,000, is nearly 97 percent white and overwhelmingly conservative. It’s the kind of town where kids go straight to work at the mills and flooring factories after high school; where chain dollar stores have crept in alongside quaint diners downtown; where the American dream, while still more alive than in the coal towns a couple hours south, has started to slip out of reach. The region voted strongly for President Donald Trump. Many here support Trump’s travel ban on refugees and immigrants from seven majority-Muslim nations.

They are wary of foreigners. Yet they entrust their hearts to Berzingi, an Iraqi Muslim immigrant who works as the primary cardiologist here.

Many foreign-born doctors work in rural communities because that lets them stay in the US after their medical residency instead of returning home for two years. Berzingi, though, had already earned his US citizenship when he chose to work here. He gave up the chance at a more lucrative private practice, accepted a grueling commute that takes him from his family — and has stuck with it for the past five years, logging more than 100,000 miles to get to the Elkins clinic three days a week.

“I wanted to be in a place where I felt I was needed,” Berzingi said. “In Elkins, I was really needed.”

The local hospital, Davis Medical Center, has had trouble attracting physicians for decades. It’s a picturesque region where the trees burn red in the sun atop snow-covered mountains that stretch in nearly every direction. But it’s remote: an hour to the nearest mall, more than two hours from Pittsburgh, and four hours from the nation’s capital.

Back in the mid-1980s, federal officials designated patches of the county where Elkins is located as “medically underserved.” They still carry that label today.

Dr Berzingi
Bill Hartman, a Democratic state legislator, says it’s hard to find specialists to work in rural towns like Elkins.

“Once upon a time, family practitioners were no problem to find, but that’s starting to drop,” said Democratic state legislator Bill Hartman, who also serves as a board member of Davis Health System, which serves the region.

“There are now a number of specialties where you just can’t find anybody,” Hartman said.

Immigrants fill the gaps. One in six doctors who practice in Randolph County, where Elkins is located, attended medical school outside the US, according to a STAT review of state medical board records. (That number doubles if you count doctors from abroad who fill in on temporary assignments at clinics and hospitals.)

“I know they’re not all terrorists. I don’t know how we can weed out the bad from the good.”

Eugene Smith, cardiac patient

Here in Elkins, Davis Medical Center employs a Filipino urologist, an Egyptian anesthesiologist, and a Nigerian ER doctor. Then there’s Berzingi, the Iraqi cardiologist, who works at a clinic run by WVU Medicine in partnership with Davis.

Berzingi thinks, sometimes, about if — or, rather, when — he will face the sting of discrimination as he travels the back roads of West Virginia. His two oldest daughters, Seher and Sara, both of whom are in college and looking to attend medical school, have drawn nasty stares for wearing a hijab.

“I had people come up to me to say: ‘As soon as Trump becomes president, you’re not going to be allowed here anymore,’” Seher said. “Things that were previously unacceptable to say about Muslims in public have become completely standard.”

But so far, Berzingi hasn’t experienced such hatred.

He has embraced Elkins. And his patients have embraced him.

“The five years I’ve practiced there have shaped my life in ways beyond anyone’s imagination,” Berzingi said. “Day after day, I have stronger connections to my patients and to their families. They know me — and I’m still there.”

Dr Berzingi
Eugene Smith, 57, has driven to Elkins regularly to see Dr. Berzingi for an irregular heartbeat.

Trusting Trump — and an Iraqi cardiologist

On a recent Thursday, Eugene Smith drove to his cardiology appointment in a rusty red Chevy Suburban with a rebel flag in the front license plate holder and the letters T-R-U-M-P hand-painted on the back window in Mountaineer yellow.

A one-time construction worker, Smith, 57, hasn’t worked for four years due to a back injury. Every six months he drives into Elkins from nearby Buckhannon so that Berzingi can monitor his irregular heartbeat.

“Doctors have a tendency to establish a good rapport. … When they’re able to do that effectively, where they’re from and what their religious background is, is not a concern.”

State Senator Greg Boso

On this trip, he felt nervous. A doctor in the ER had recently told him he might need heart surgery. The prospect scared Smith to death. But he trusted Berzingi to make the call. “I’m real impressed with everything about him,” Smith said. “His mannerisms, the way he treated me, he’s kind to me.”

Smith said he had never considered that Berzingi was Iraqi. Or Muslim. Or a refugee like the ones now unable to seek asylum in America.

And after Berzingi told him he didn’t need surgery, Smith said none of those things mattered.

“Color, skin, or nationality don’t have a thing to do with it,” he said, pointing to his chest, before heading out to his Trump truck. “It’s what’s right there in the heart.”

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Smith said he felt badly that good doctors like Berzingi might get swept up in Trump’s temporary travel ban. Berzingi, for instance, had wanted to bring his father to the US for glaucoma surgery. That’s now off the table. “I feel for people like him,” Smith said. “That makes me feel bad his family can’t come over here.”

But Smith said he still backs travel ban as perhaps the only practical way to protect America. “I know they’re not all terrorists,” he said. Then he added, “I don’t know how we can weed out the bad from the good. That’s our problem.”

Berzingi reviews electrocardiograms at the hospital in Elkins.

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Items on the wall in Berzingi’s office.

A profound love of medicine

Berzingi sees about two dozen patients a day in Elkins. He rarely takes a break after he throws on his white coat around 8 a.m. He doesn’t even eat lunch, not just because he feels it makes him sluggish, but also because he wants to see every patient — even the drop-ins.

There are always drop-ins.

This past week a Gallup poll found that West Virginia had the lowest well-being among all 50 states. It also has the highest obesity rate in the nation, and cardiac complaints are the most common reason for ER visits in the regional health system.

“Every time someone meets someone from another country face to face, it builds a relationship. But Appalachia is so isolated from that.”

Tina Hord Vial, Elkins resident

Berzingi walks back and forth between the clinic where he works and the local hospital across the street, where he reads EKGs and echocardiograms and consults with other physicians.

Affable and enthusiastic, Berzingi takes pride in his family’s love of medicine. At the dinner table, he and his wife, Mayada, discuss the kinds of patients they saw that day. He brought his oldest daughter, Seher, to Elkins where she learned the art of the echocardiogram.

He knows his long drives to the clinic, listening to NPR, can be tough on his family, especially since his son, Dana, who is autistic, requires around-the-clock care. Before Berzingi leaves for work, he soothes Dana by taking him on joyrides in his BMW SUV through the hilly streets around their home in Morgantown. They do it again after work — except those drives often detour to Walmart, his son’s favorite destination, so the doctor can buy Dana his beloved gummy snacks.

Berzingi, who’s slender and spry, tries to maintain a healthy diet low on carbs and high on protein. But he has a sweet tooth, too; it draws him to the stash of sugary Turkish delights that he keeps on hand to offer guests.

Berzingi’s unlikely odyssey to Elkins started more than 6,000 miles away near the Iraqi Kurdistan capital of Erbil.

Dr Berzingi
Berzingi and his wife, Dr. Mayada Issa, spend a few moments together before a meal at their home in Morgantown, W.Va., 90 minutes from the clinic where he works in in Elkins.

His father owned a factory that crushed stone, but Berzingi longed to be a doctor from an early age. Those dreams were threatened during the Iran-Iraq war and the Saddam Hussein regime’s genocide campaign against Iraqi Kurds. Eventually, though, Berzingi made it to medical school at Baghdad University — becoming chief resident of over a staff of younger residents that included the woman he’d eventually marry, Dr. Mayada Issa.

“He trapped me,” she quips.

Later, Berzingi provided medical care in rural parts of Kurdistan alongside aid agencies like UNICEF and Northwest Medical Teams. But in August 1996, Hussein decreed that any Iraqis who worked with humanitarian groups risked punishment.

Berzingi, his wife, and their two baby daughters were granted asylum in the US, along with 4,000 other Kurds who feared death. He brought a single bag for himself and some medical supplies — and said goodbye to his homeland, not knowing where they would be resettled.

“Iraq went through tough times,” he said. “I never had a sense of belonging to that country because I was never treated right.”

Arriving in San Diego, Berzingi soon realized that starting over in the US also meant starting his medical training again. He and Mayada traded off caring for the girls while the other studied for the US medical licensing exam. Night shifts at a nursing home helped pay the rent.

In 1999, Berzingi moved his family again — this time across the country for an internal medicine residency at Prince George’s Hospital just outside of Washington, D.C. The medical school at West Virginia University offered him a cardiology fellowship eight years later.

So in 2007, the Berzingi family drove four hours west to Morgantown, population 31,000, a place that had very little in common with the nation they left a decade beforehand. Only one thing — the mountains — truly reminded them of home.

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State Senator Greg Boso stops to talk to a constituent along Third Street in Elkins.

When foreign doctors build bridges

State Senator Greg Boso, a Republican who represents Elkins, believes in the travel ban.

He worries about it, too.

The civil engineer knows districts like his need foreign-born doctors. That’s not just because they provide vital care. It’s also because their very presence in isolated, nearly all-white communities can break down stereotypes and encourage tolerance, he said.

“Doctors have a tendency to establish a good rapport, ask questions, and analyze the ailment of a patient,” Boso said. “When they’re able to do that effectively, where they’re from and what their religious background is, is not a concern.”

Bruce Siegel, CEO of the advocacy group America’s Essential Hospitals, which represents nearly 275 hospitals nationwide that provide “safety net” care to low-income and hard-to-reach residents, echoes concern about the travel ban.

Trump’s executive order, he said, might disrupt the “community fabric” that exists within many hospitals, uniting patients and providers from different worlds.

“I wanted to be in a place where I felt I was needed. In Elkins, I was really needed.”

Dr. Chalak Berzingi

But there is, undeniably, still tension. Two weekends ago, a handful of protesters rallied against Trump’s travel ban near a statue in Elkins. The president’s supporters showed up waving Trump flags or drove by revving their engines and hollering “Trump!”

“It’s so easy to latch onto this fear-based mindset with the terrorism we’ve experienced in this country,” said Elkins resident Tina Hord Vial. “It takes intentional effort to counteract that. Every time someone meets someone from another country face to face, it builds a relationship. But Appalachia is so isolated from that, even though Appalachia is made of immigrants.”

Dr Berzingi
A statue of former senator and coal company owner Henry Davis overlooks Elkins.

The duty of an American citizen

Berzingi had hoped to work again someday in rural Kurdistan. He believed Erbil was where patients needed him most.

But that dream has evolved over time as he’s immersed himself more in Elkins. It’s allowed him not only to treat people in need, but also to transform health care in the region.

He’s come to see the work at the Elkins clinic as part of his duty as an American citizen.

The long-term relationships Berzingi has developed with Elkins residents, allowing them to build bonds with their heart doctor, has laid the groundwork for a partnership between Davis Health and WVU Medicine.

Last year, WVU Medicine agreed to move its heart clinic — one that resembled a brick ranch house more than a medical building — across the street into Davis’s outpatient wing. By pooling their resources, bringing together WVU’s staff with Davis’s equipment, the partnership should allow the clinic to increase staffing. It’ll also allow for around-the-clock cardiac consultations for the very first time.

Vance Jackson, the Davis Health CEO, said the goal is to grow cardiac services in Elkins to the point that locals won’t need to travel to Morgantown, a drive that can take three hours one way in bad weather.

Now and then, when that commute takes its toll, Berzingi considers leaving Elkins to take a position back in Morgantown, near his family. He’s never put in a transfer request, though.

He thinks of his patients’ tokens of gratitude — unscheduled visits to simply say thanks, Christmas cards calling him “angel,” and mostly recently, expressions of concern following the travel ban. They energize him.

When he does leave Elkins, Berzingi said, it won’t happen due to discomfort or discrimination. It’ll happen when he’s sure there are enough cardiologists to take care of the people who need help.

That work, when it’s done, will be Berzingi’s sign that it’s time to travel home.

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