Edmonton s Annual Refugee immigration past 4 years pers. comm. S. Gupta, Citizenship Immigration Canada 12.05

6. Edmonton�s Annual Refugee immigrationpast 4 years (pers. comm. S. Gupta, Citizenship & Immigration Canada 12.05) 400 government sponsored refugees (all of whom spend 2 weeks in Reception House (Catholic Social Services) 100 privately sponsored refugees 50-75 �secondary� migrants from other Canadian centres Prominent countries of origin: Sudan, Afghanistan, Somalia, DR Congo, Sierra Leone, Liberia, Columbia, Iran, Iraq, other African countries

7. Experience of 20 Nuer (Sudan) families 100% of women illiterate 100% of the women speak no English 100% of the families were in refugee camps- many for 10 to 15 years; many experienced war-time trauma 100% of the families from rural settings; no urban skills such as using buses, electricity, banks, paying rent, buying food in grocery stores etc. 100% of the children have never seen MD 100% of children have chronic health conditions due to poverty (eg anemia, tooth decay, infections)

8. 20 Nuer families, cont�d 40% of families have a child with a handicap 50% of the women have chronic conditions, e.g. (abdomen, head or chest pain, seizures etc.) which impact daily activities including caring for children 40% have experienced family violence 40% of women have STDs 40% of the families have been homeless in Canada 75% without food at times during the month in Canada Mental illness (PTSD) is common but not diagnosed or treated

9. Determinants of Refugee Health longstanding prior lack of access to curative and preventive health care direct & indirect effects of war psychosocial effects of war trauma and of long stays in refugee camps.

10. Health Problems of Refugees Chronic infections Intestinal parasites Hepatitis B Latent tuberculosis with the risk of progression to active disease HIV

11. Psychological Problems Post-traumatic stress disorder Depression Adjustment problems Somatization Family violence etc.

12. Chronic, neglected problems Hypertension Malignant/pre-malignant cervical lesions in women Neglected disabilities of various kinds Oral health problems Developmental problems in kids

13. Exotic diseases Malaria Onchocerciasis & lymphatic filaria Chagas� disease (T. cruzi, Latin America) Etc., etc

14. Current Health Care Needs *Pregnancy (and contraception) related �Normal� problems: respiratory infections, trauma etc. Updating vaccines etc.

15. Immigration Canada Sorts Them Out Before They Arrive, Right? Immigration Canada Requirements �medical assessment� Syphilis blood test Chest x-ray for adults HIV serology (since Jan. 2002) Not a comprehensive individual health assessment for the benefit of the immigrant.

16. Health Care in Canada is FreeAll They Have to do is See an MD? It is a challenge for anyone new to Edmonton to find a suitable family doc Refugees find it very difficult to negotiate the system A refugee family poses an immense challenge to a busy family doctor The Result Refugees don�t attend early for necessary medical care They use costly and inappropriate services (e.g. Emergency Departments) Poor uptake of preventive services

17. What are we Missingin This Population? We really don�t know! Good prenatal & obstetric care Readily treatable conditions, mundane and exotic Prevention opportunities (hepatitis B & other vaccines, TB prophylaxis) Full participation in the benefits of being a Canadian

18. A Unique Population:Both feasible & necessary to target Clearly defined, readily accessed population Distinctive, relatively well known health problems Needs poorly met by current services Negative individual and societal, acute and long term, health & financial impacts of suboptimal assessment/care

19. The New Canadians Clinic Mission The New Canadians Health Clinic will provide culturally and linguistically accessible expert acute and preventive primary care services to refugees and underserved new immigrants.

20. New Canadians Clinic:Goals & Activities Acute care needs Timely access to appropriate care for acute medical problems Facilitate prenatal and obstetric care

21. Comprehensive health assessment �Routine� health issues (blood pressure, Pap smear) Pediatric assessment: growth, development, dental Screening for psychological disorders Public health/prevention assessment vaccine update, TB testing/preventive treatment STI screening Evidence-based screening for �exotic� diseases, e.g. parasitic infections.

22. Efficient access to specialized services when indicated Infectious diseases Obstetrics Psychiatry Pediatrics *Paediatric and Emergency Dentistry *may require some creative funding

23. Care & Transfer of Care Once appropriate initial screening has been carried out and any acute medical problems resolved, facilitate the establishment of immigrants and refugees in geographically and/or culturally appropriate primary care practices. (New Canadians Clinic would normally provide care to refugees for the first year in Canada) The clinic and its affiliated consultants would continue to serve as a resource to these primary care providers.

24. Education & Research Provide an opportunity for training of students in the health professions in the area of cross-cultural communication and care as well as immigrant and refugee health To promote and undertake research to identify best practices in the provision of health care for culturally diverse populations. To support the ability of existing institutions (hospitals, public health programs) to partner in the delivery of health care as well as network with other centres to generate new knowledge

25. Cross-cutting Principles Culturally sensitive and appropriate care Cultural brokering service Support doctor-patient communication through linguistic and cultural interpreters Family-centred Multidisciplinary team approach

26. Process�How will it work? Contact with all refugees at Settlement House, within weeks of arrival in Edmonton Initial assessment�history, examination and initial investigations according to evidence-based protocol, by nurse or nurse practitioner Review of problems or questions by a physician, mental health worker or social worker as indicated

27. Anticipated Outcomes Healthier New Canadians Reduced inappropriate use of healthcare resources, especially Emergency Departments Greatly enhanced implementation of indicated public health/preventive measures (vaccination, TB screening & prophylaxis) Enhanced competence of students and existing health services

28. Who is Supporting This Mennonite Centre Catholic Social Services Multicultural Health Brokers Immigrant community groups Dr. Val Krinke Dr. Jim Talbot (Dep Medical Officer of Health) Dr. Richard Long (Provincial Director of TB services) Boyle MacCauley Clinic Calgary refugee clinic Faculty of Medicine, U of A (my Dep�t chair asked me to explain why this service didn�t already exist) The Sisters of Providence

29. Do Other Centres Have Analogous Services? Most do, even Calgary! But�Because of the players involved and other local circumstances, we could do it better in Edmonton!

30. So Where Are We At? Main players identified Structure, draft business plan developed Broad support established Support for pilot activity, special services (e.g. children�s dental work) explored Working on an ARP Discussions with CHA Primary Care and CHA Public Health re: model, collaboration & the CHA funding cycl

31. Lack of urban skills, illiteracy, and lack of English makes it almost impossible for families to access services. Not able to make the appointments, or find their way there. Many families need assistance with all appointments and referrals. Once they arrive, they are not able to complete the forms or answer the nurses� and physician�s questions. They have no knowledge of labs or prescriptions.

32. 10 year-old refugee child with severe developmental delay Taken to E.R. because of severe cough. Referred for community follow-up because of the child�s handicaps. Child found to have been in Edmonton for 18 months never had a complete assessment by a physician. not registered in any school or community programs for disabled children & families

33. Communication failure A refugee couple needed treatment for syphilis. Their family physician had referred them for follow-up at the STD Clinic. The family have limited English and were not able to follow through on the referral dispite the STD clinic phone calls and letters. It was only after the woman became pregnant and the woman was referred to a cultural broker did the couple follow through with the recommended treatment.