Region ready to meet refugees’ health-care needs

BridgeCare team
BridgeCare Clinic staff provide government-sponsored refugees with initial medical assessments, screening, and immunizations.

Winnipeg Regional Health Authority
Published Friday, January 15, 2016

As the trickle of Syrian refugees arriving in Manitoba gains momentum, officials with the Winnipeg Health Region say they are well-prepared to provide the province’s newest residents with the health-care services they may need.  

Canada has committed to accommodating 25,000 refugees from war-torn Syria over the next few months, with as many as 1,500 to 2,000 expected to arrive in Manitoba by the end of March.

While health officials have been busy planning for the new arrivals, the good news is that much of the work has already been done, says Jeanette Edwards, Regional Director, Primary Health Care and Chronic Disease for the Region.

“People need to remember that meeting the health care needs of immigrants and refugees is not new for the (Region),” she says. “Statistics show that Manitoba continues to lead the country with the highest immigration rate per capita. Since 2000, more than 140,000 immigrants have settled in Manitoba, the majority making their homes in the Winnipeg region. Last year, according to the Winnipeg Free Press, Manitoba received a record 1,484 refugees, more than any other province on a per capita basis.”

Edwards says the health-care system started adapting to meet the needs of new arrivals years ago, in part by establishing the BridgeCare Clinic.

“We had been hearing from walk-in clinics and private physicians who had immigrants and refugees showing up not being able to speak either of Canada’s official languages, and who needed our support,” says Edwards. “To help close those gaps, we knew we needed to develop a site with a specific focus on government-sponsored refugees, one that would act as their immediate primary care ‘home’ upon arrival. That’s where the idea for the BridgeCare Clinic came from.”

Opened November, 2010 in the lower level of 425 Elgin Avenue, the clinic features a small but dedicated staff who provide government-sponsored refugees with initial medical assessments, screening, and immunizations. In an average year, the clinic sees approximately 500 refugees, each of whom is likely to visit the clinic several times until they can be matched with a family physician for ongoing primary care. The recent influx of Syrian refugees adds to that existing demand.

“We are looking at this not as an emergency but a surge,” Edwards says. “It’s a question of how we can leverage existing resources and build on the expertise we have developed.”

In last several years, she says, Manitoba has put “a huge amount of effort” into primary care renewal.

“We developed our Family Doctor Finder service, which over its first two years, has connected more than 40,000 Winnipeggers with family doctors. We developed My Health Teams to bring various primary care experts together to help ensure patients receive the care they need, when they need it. We’ve taken leadership on improving language access and cultural proficiency by developing trained interpreter services, recognized as a national leading practice.

And because we’ve done those things, we’re in a much better position than ever before. From that perspective, the recent influx of refugees represents an opportunity to bring the work we’ve done together to meet those needs.”

Nevertheless, the BridgeCare Clinic is bracing for the additional demands being placed upon it, says Jade Nayler, Community Team Manager. As of Jan. 9, 2016, Manitoba has welcomed 264 government-sponsored Syrian refugees, a small fraction of the number it expects.

“We’re just beginning to feel the stretch,” she says. “It’s a huge task, but I like to call BridgeCare ‘The Little Clinic That Could.’”

Syrian refugees are all being seen upon arrival by a public health nurse. Given the surge, only those with special needs are referred to the clinic by Welcome Place, a Winnipeg transitional housing unit run by the Manitoba Interfaith Immigration Council, and by and Accueil francophone, an initiative of the Société franco-manitobaine (SFM) that facilitates the establishment of Francophone newcomers into Manitoba. Matching with a family physician is the next priority.

“By the time they get to BridgeCare, they are provided with a Manitoba health card, and scheduled with a Language Access interpreter; an interpreter is needed for almost every refugee who comes through the door,” Nayler says. “Their first visit with be an intake visit with the nurse, who will capture their medical and migration history and perform an initial health assessment, and screening for various diseases. They may also meet with our community health worker, who will provide them with some education about the health system, including information on topics such as when it is appropriate to use an emergency room, when to use Urgent Care or Quick Care Clinics, the importance of keeping appointments, and all the processes related to health."

After their intake appointment, they are booked for complete physical with a physician or nurse practitioner. Where necessary, there will be follow-up appointments for referrals, immunization catch-ups, or other medical issues.

“Typically, we will see them for about 12 to 18 months. Once they get a permanent address, they will be registered with Family Doctor Finder, so they will be assigned to a physician or nurse practitioner in their area who will become their ongoing primary care provider,” says Naylor.

All refugees have an interim federal health number, which gives them access to a year’s worth of extended benefits such as dental care, vision care, mobility assistance, hearing aids, and prescriptions, which are essentials to healthy daily living. But unlike refugees who arrive in Canada from less-developed regions of the world, Canada’s new Syrian refugees are, generally speaking, arriving in comparatively good health.

“Because of the strife in their home country, we’re finding that they may not be fully up-to-date on their immunizations,” Nayler says. “But overall, we’re not seeing a prevalence of any particular health issue.”

They are, however, experiencing something common to many immigrants and refugees: culture shock.

“It’s very difficult coming to a country where their language will not be the language they are expected to speak; where their children will be learning English, and will be influenced by the society-at-large through their schooling. They must adjust to different expectations around child rearing, child discipline, dating – all sorts of cultural differences come into play,” Nayler says. “Even something as simple as understanding whether a price in a grocery store refers to a single item or is priced by kilogram can require an adjustment.”

Another common issue is one of trust.

“They have just arrived from a war-torn country and are not always sure who to trust,” Nayler says. “In their first few months, they are busy settling into a society they know so little about. They are concerned about things like language, housing, transportation, schools, and trying to find employment. They’re so busy, in fact, that any trauma or mental health issue arising from the strife in their home country may not surface for some time.”

Indeed, a “delayed reaction” is a hallmark of Post-Traumatic Stress Disorder (PTSD), says Susan Chipperfield, Regional Director of the Region’s Mental Health Program.

“Much of the current mental health literature suggests that it can be up to a year or more before the signs and symptoms of PTSD are seen. Some evidence suggests that the prevalence PTDS symptoms within the refugee community could as high as 10 per cent for adults and an even higher percentage for children who are only beginning to develop coping skills,” she says.

Chipperfield is quick to point out, however, that the Syrians arriving in Canada have good overall mental health.

“Their resilience is remarkable,” she says. “I think it’s important for Canadians to remember that the human response to trauma is vast and varied. Having been exposed to trauma does not necessarily mean that you will experience symptoms of PTSD, and we want to guard against suggesting that everyone will need to see a mental health professional. The fact is there are many ways to support emotional well-being and promote good mental health. There is a large network of services and supports that are working together to support self-management focused on strengthening emotional well-being for all people. And when help is needed, services can be accessed."

Within Canada, one in four people will require mental health services at some time in their life. "They are your neighbours, your family members, your friends or perhaps even yourself. The mental health needs among refugees are no different than for the general population, and there is no cause for concern,” she says.

Existing mental health resources such as the Crisis Response Center and the Manitoba Adolescent Treatment Centre (MATC) stand together with a broad network of community resources, ready to assist should the need arise, and the Mental Health program has been hard at work to address gaps in servi.

Chipperfield adds, “It’s a trying experience to fit into new country. Housing, employment, and the ability to become self-reliant are critical. If those issues are slow to be addressed, it can have negative impact on people’s emotional well-being. When these issues are addressed quickly and efficiently, the chances of encountering mental health issues are decreased and the likelihood of a positive adjustment is much better.”

That’s why the BridgeCare Clinic, the Region as a whole, and various government and community-based agencies are working so hard to meet the needs of this community of newcomers, Nayler says.

“We’re all asking the same question: How can we respond in a humane way to a very urgent need? Like all refugees entering Canada, these are human beings who need a safe haven. I think Canada has stepped up. And I think all of us in the (Region) are very happy to see that we can respond in meaningful ways. We are determined to work together internally and with our various partners to make it happen and move forward together. It’s what we would want someone to do if were we on the other side of this equation.”

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