Refugee and immigrant health care still fraught with challenges






arrow-redThe Centretown Community Health Centre on Bank St. in Ottawa. [Photo courtesy of Centretown Community Health Centre]

By Sarah Trick

OTTAWA — As a family doctor, Carol Geller is used to having patients come to her with lots of different problems.

But she never expected to be teaching people how to eat Canadian food.

Geller is a family doctor at the Centretown Community Health Centre in Ottawa. Many of her patients are refugees and immigrants, and they deal with complex issues that go beyond a routine checkup.

“Lots of people just don’t understand our food,” Geller said. “I had one patient who would buy radishes and throw out the bulbs. She was eating the greens instead.”

This is only one of the many issues facing refugees as they try to build a new life in Canada.

Refugee health care has been in the spotlight lately because of health care cuts made by the federal government.

Although the Supreme Court recently overturned the cuts, it is unclear whether the federal government will comply with the ruling.

In the meantime, the Centretown Community Health Centre does its best to fill the gaps.

The Centretown Community Health Centre is funded by the province. It provide services to vulnerable populations, like seniors living alone, gay, lesbian, and transgender people, and people who struggle with addiction.

But the refugees and immigrants Geller sees face unique challenges. As well as social isolation, they have to learn to navigate through a foreign health care system.

For example, working with a translator can be difficult, because you can never be certain exactly what you are being told, Geller said.

“A lot of these communities are very close,” said Geller. “They’ll know their interpreters. There are things you’d tell your doctor that you’d never tell your pastor’s wife.”

It takes a long time to build a rapport with patients, and Geller says many visits have to take place before she feels comfortable knowing that the patient has the information she needs.

“For example, how can you explain genetic testing for someone who does not even have that concept in their language and has no idea how that would be of value? You can tell the translator but you don’t know how or if that’s getting across.”

But over time, Geller says she can build that trust.

“You have to build bridges,” Geller said. “But once one person in the community trusts you, they’ll tell others that you’re trustworthy, and then more will come to see you.”

Geller says another challenge she has is persuading her patients of the value of Western medicine.

“A lot of them have the attitude that if it’s not hurting me now, I don’t want to know about it,” Geller said.

This attitude makes preventative care difficult.

Simone Thibault, executive director of the centre, says that preventative care is one of the most important things they try to teach their clients. Sometimes they have more success than others.

But preventative care is difficult with a traumatized population, as is the case for many refugees. According to Thibault, many patients come to the facility with somatic disorders that manifest as physical problems but actually require mental health treatment.

Thibault says the biggest public health concern is surprising—it’s actually the lack of subsidized housing available.

Because of the lack of affordable housing and limited access to healthy food, many immigrants start in good health but it quickly diminishing over time.

Therefore Geller says she sees her most important job as making her patients’ lives easier.

“Most of the time I’m more a co-ordinator of resources than a doctor,” Geller said.

“Often my appointments will consist of finding out where the local pool is, for example.”

This allows the families to make connections and build community.

But the centre can only treat its patients for a year after they come to Canada. Geller and Thibault say that’s not enough time.

“Some patients will never get the health care system,” said Geller. “Their kids will, but for them, they aren’t able to navigate it.”

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