From the pages of The Canadian Nurse

March 2016   Comments

Canadian nurses have been instrumental in helping refugees escape war-torn countries and persecution and resettle in Canada. In this article from the March 1981 issue, Violet Joe describes the health needs of new arrivals in Ottawa and how services for them were coordinated.

A New Lifestyle in a New Land

The first wave of Asian refugees arrived in Canada’s capitol to begin a new life on a cold December day a little more than two years ago. When PHN Violet Joe made her initial visit in December, 1978 to check for skin rashes, it was the beginning of a learning experience that culminated in the development by her public health unit of a program specifically tailored to these new Canadians.

October 1978 — The Hai Hong, a rusty old freighter with 2500 refugees aboard, escapes from Vietnam but, as the boat is shunted from one port to another, it becomes obvious that no one wants the refugees. Finally, Malaysia grants permission for the freighter to anchor off Port Klang, near Kuala Lumpur. Immigration workers from several countries, including Canada, select refugees to be sponsored by their government. For these people, a new life in a new land begins.

Friday — Today our health department received a call from the housing department asking that a nurse visit a local hostel where refugees were being housed: many of the refugees “seemed to have some type of skin problem.” The hostel is in my area, so I answered the call, arriving to find a group of very bewildered people, all of whom had originally left Vietnam aboard the Hai Hong. […]

Sunday — With the help of interpreters from the Ottawa Carleton Immigrant Services, nurses from the area met and talked with all the new families in the hostel; 47 people were found to need treatment for scabies. We distributed medication which we had obtained from a local drugstore and attempted to convey, through the translators, the correct method of application, i.e. apply the medication tonight and then take a cleansing bath in the morning. We then made arrangements with the housekeeping staff to change all of the bed linen and blankets the next day to ensure that the refugees had a clean bed to return to after the treatment.

Monday — […] We continued our screening procedure, this time at a local former hotel, now being used as temporary quarters for the refugees after the original hostel was unable to continue to provide housing. The new quarters were anything but luxurious. Fitting two public health nurses and an interpreter into one of the typical utilitarian bed-sitting rooms, already crowded with more than its share of refugees, was quite a feat. […]

Winter, 1979 — Many of the refugees had difficulty adjusting to our windy, cold winter, after having lived in a hot, humid climate. Dry skins and symptoms of head colds plagued them. When necessary, medical referrals were made but most of the time it was only a matter of explaining how to overcome minor problems. We suggested adding moisture to forced air heated flats and apartments, applying lotion to dry skin, eating breakfast before going out into the cold and even explained the need for adequate clothing. […] Nutritional problems also surfaced at this time as fresh fruit, vegetables and fish were not as readily available nor as inexpensive as in the refugees’ homeland. […]

As the number of refugees increased, the challenge to our nursing staff increased as well. Health surveillance notices of intestinal parasites, tuberculosis or positive serology were received by our office from Health and Welfare and had to be delivered by the nurses to individuals in their area. Language differences, unfamiliar names and mobility of the individuals involved made it difficult for us to even be sure we had the right person. With the help of translators and community agencies, we were, in most cases, able to deliver the notices and see that the individuals attended the proper medical services and clinics.

Appointments were then made with family physicians in local areas so that ongoing health care could be provided for each family. Medical appointments became a feat of coordination for the public health nurse, since Ottawa Carleton Immigrant Service provided translation for Vietnamese refugees and the Catholic Immigrant Service provided translation for Cambodians and Laotians. Not only did patient and doctor have to be made aware of the appointment but provision had to be made for a translator and, in some cases, transportation to the doctor. Home visits by the nurses in each area required additional planning.

Summer, 1979 — An airlift of 200 refugees arrived in Ottawa. Teams of public health nurses set up clinics in hotel rooms to screen for communicable rashes and to determine whether physician referrals were necessary. Immunization was started and subsequently a weekly immunization clinic was established at a community center. Since very few of the refugees had had complete immunizations, we offered a basic series for all age groups, including MMR for children up to 13 years of age. Translation of immunization schedules as well as a map to our clinic is now provided so that individuals may return by themselves. Although many are immunized by private physicians, close to 900 have been immunized in the first year of our clinic’s operation and new arrivals in Ottawa are usually brought to our clinic as part of their settlement process.

January, 1980 — […] Dental hygienists from the health unit visit all schools regularly throughout the school year so that at least the children of the refugees are being exposed to a dental hygiene program. Also, the health unit Dental Clinic accepts low income children up to the level of Grade 13 for treatment and this provides another opportunity for teaching. The nurses also contribute to the program by giving a toothbrush to each child visiting the weekly immunization clinic.

Orientation programs for the refugees are provided by the Ottawa Carleton Immigrant Service and the Catholic Immigrant Service at the English second language classes. In each five week period of classes, a public health nurse participates for two half days explaining emergency medical services, health unit clinic services, basic nutrition and family planning. […]

Health counseling is also provided at the English Second Language School on a weekly basis by the nurses. We receive referrals from the staff of the school as well as from individuals for problems varying from headaches to fatigue and insomnia. With the assistance of a translator, we attempt to discover a reason for the symptoms and offer a possible solution or refer to a physician if necessary. Although refugees are covered by the Ontario Health Insurance Plan most have not bothered visiting a doctor as they haven’t really felt sick, just out of sorts. School attendance problems have been traced in many cases to difficult adjustment in sleeping habits and to the winter climate. If it is too cold they often stay home.

April, 1980 — One of the public health nurses started a series of pre and post natal evening classes when she discovered that more than 30 people were interested. […]

One problem we identified in the post natal classes was that mothers were discontinuing breast feeding earlier than they might normally have done. As it turned out this was largely due to the fact that attendance at language or orientation classes made it difficult and at times impossible to feed babies properly and regularly. With counseling we hope to be able to help new mothers with solutions to these and other infant care problems.

January, 1981 — The health unit is now working with a group of community agencies in an attempt to develop a program to identify and resolve mental health problems of the refugees. The initial relief at finding a safe haven has now given way in many instances to homesickness and regret at losing a familiar way of life. For many, depression and related symptoms are beginning to surface, compounded by language differences. How can a person tell you how he feels when he does not know the words to use? The development of a mental health clinic where counseling can be provided in the language of origin would be ideal. Perhaps that will be the next step…

– Violet Joe

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