Mar 01, 2016
Ready to welcome
The federal government committed to bringing in 25,000 Syrian refugees by the end of February. The health-care professionals tasked with preparing for this influx are up to the challenge.
There are an estimated 19.5 million refugees around the world, according to the Immigration, Refugees and Citizenship Canada website. About 100,000 of these people are resettled each year in countries that have resettlement programs; about one in 10 are taken in by Canada.
However, between Nov. 4, 2015, and Feb. 16, 2016, nearly 26,000 Syrian refugees had either already arrived in Canada or had their application approved but had not yet made the trip.
The scale of this resettlement effort is significantly larger than any managed previously, said Scott Wolfe, executive director of the Canadian Association of Community Health Centres. “For example, the Ottawa Newcomer Clinic operated by Somerset West Community Health Centre typically receives about 30 to 40 government-assisted refugees monthly — about 400 to 500 annually — and that number keeps them quite busy. But, recently, they’ve just received about 200 newcomers in a matter of two weeks!” Wolfe explained in January. “So, there is the issue of surge capacity for them and other community health centre partners in Ottawa, and this seems to be quite common across the country.”
In his job, he has a good overview of the refugee care work nurses are doing across Canada, explaining that the work varies based on the extent of the role played by individual community health centres in different cities, the number of refugees coming to that area, and the extent to which various nursing disciplines are funded by the specific provincial government and the specific regional health authority. In all cases, however, nurses are a core part of the interprofessional services and programs offered to arriving refugees by community health centres.
“Nurse practitioners are providing on-site medical care (as well as taking clients on for ongoing primary care at the community health centre)....RNs [and registered/licensed practical nurses] are involved with service coordination, immunization assessments and providing education sessions at temporary lodging sites and at the community health centre level.”
In Regina, all the organizations and agencies that provide services to refugees started to meet early last December to make arrangements to receive the Syrians, said Lorna Knudson, executive director of the Regina Community Clinic (RCC).
“These same [organizations and] agencies work with refugees throughout the year settling newcomers...and are very competent at doing this work. The only real difference with this group [from Syria] is the volume of people coming all at once,” Knudson said.
RCC partners with the Regina Qu’Appelle Health Region and the Regina Open Door Society (RODS) to meet the health-care needs of refugees.
The health region provides a public health nurse to do a basic health assessment upon arrival and starts the immunization process, she said. This health program ensures refugees receive comprehensive coordinated health care.
RODS is the settlement agency for government-assisted refugees in the city. “RODS staff meet the new arrivals at the airport and provide all the necessary support to assist the newcomers with settling in a new community,” Knudson said. An RODS health-care facilitator coordinates medical appointments, including checkups at RCC.
In the snapshots that follow, RNs David Bateman and Nicole Gleeson and NP Christopher Bradley describe some of their efforts in supporting refugees.
Snapshot Erding, Germany:
David Bateman is a member of the Red Cross’s emergency response team. He and 33 other Canadian health-care professionals (about half of whom were nurses) spent four weeks last autumn assisting refugees flowing into Germany.
The welcome centre in Erding, about 45 minutes south of Munich, was established in an old air base, which can house 1,500 to 2,000 people. Bateman said 60 per cent of the refugees were Syrian; the rest were Afghan, Iranian and Iraqi. The vast majority were looking to resettle in Germany.
He said that between 300 and 400 people per day were examined, with help from volunteer translators. “We’d see headaches, fevers, chest infections, scabies, lice, sore throats, dehydration, vomiting, diarrhea, malnutrition and, of course, psychological issues.”
Nurses were also helping reunite families. He recalled two little girls who were travelling with a middle-aged man, did not have any identification and talked about an older woman living somewhere in Germany. Bateman’s team went to work to find a phone number, not having much to go on. “She comes to the camp, but you’re hesitant to hand over kids when no one has any identification. When they finally saw their grandmother, they ran into her arms. Oh, yes, there were a lot of tears of joy watching the reunion.”
Bateman is not new to lending humanitarian aid. Since 2008, he has been in Haiti three times and has done stints in the Solomon Islands and Zimbabwe. He is grateful that his employers have allowed him to take leaves of absence to work for the Red Cross.
Although the work is exhausting, he is always mindful that he gets to go home. “Human migration is an ever-increasing issue that stems from natural disasters, human conflict and people feeling insecure in their own countries. It’s a global problem.”
Thinking and working differently
Staff at the Mosaic Refugee Health Clinic in Calgary, one of the largest refugee resettlement clinics in the country, expect the number seen in the clinic to double or triple from the usual 1,000 refugees it receives each year, said Nicole Gleeson, director of clinical operations.
“We’ve had to think about how we can offer services differently and have had to rely on partnerships with community physicians, community health agencies, and refugee and immigrant serving community agencies to ensure everyone has access to the care they require as soon as they arrive.”
To manage the influx, two models of care were created, Gleeson explained: “one model where we accept refugees into our primary health care home and another where we support the transition of refugees immediately into others.”
Mosaic Primary Care Network, which operates the Mosaic Refugee Health Clinic, offers information sessions to physicians and health-care teams to prepare them for that transition.
“We have only begun to experience the Syrian refugee influx, and we have already witnessed how our entire health-care team has come together to meet the need,” Gleeson said in January. “It has been stressful at times but so rewarding. We continue to analyze and reflect on how each week goes, and then we make little modifications in operations that can provide big gains. We are challenging ourselves and each other daily.”
Christopher Bradley is the primary care provider to several newly arrived Syrian families at Ottawa’s Pinecrest-Queensway Community Health Centre. He sees numerous differences in the response to the sudden influx of Syrian refugees.
“First, the level of community support is unbelievable right now. People from all walks of life are stepping forward to offer a helping hand,” he said. He believes there is a greater sensitivity toward refugees and greater awareness of the current crisis. Pointing to Ottawa’s highly organized response team, Refugee 613, which coordinates the work of various faith groups and civil society organizations, he said, “Some groups have had to turn away volunteers.”
Second, Bradley noted the federal government’s commitment to supporting the health needs of the Syrian refugees. “Access to proper health care is one of the best ways to ensure that newcomers are integrated successfully into Canadian society.”
“We take a team approach to assist our clients. No one profession can do it all,” said Bradley, who has access to telephone interpretation, as well as settlement counsellors and housing workers.
Paying it forward
Mado Mushimiyimana was a nurse in her 20s when she fled Rwanda in 1998 to make her way to the safety of Canada. “I was a brand new mom, and brand new to the country.” She was socially isolated, without friends or family.
She turned to a Toronto community health centre, where the nurses helped her integrate into Canadian society. “I did not feel judged, I was made to feel comfortable.” She remembers one nurse in particular, named Susan, who took time to explain things in basic terms for her. “I remember my first time when I was doing a prenatal class,” she said. “The nurse came with a doll — we were both laughing — and she broke down how to change the baby’s diapers. It was simple, but important.”
It was the help Mushimiyimana received as a refugee that made her decide to pay it forward and become a community care nurse. “Meeting the nurses at the clinic made me want to be like them. I was very curious about how to be a nurse in Canada,” she said. “I reached out to the [College of Nurses of Ontario].”
Later, she worked with newcomers herself while at the Centretown Community Health Centre in Ottawa.
Her advice to other nurses is to make refugees comfortable and to try to put themselves in those shoes. “Don’t assume they understand a medical term. Try to break through to them by asking them how they understand what you’re saying. They may understand basic terms.”
The advice she would give to newcomers is to have faith in the system. “The system accepted me as a new person. All the assistance was there; the health care was there. I am very grateful to have had the help, and the many miles I had to go to reach Canada were worth it.”