First hospital-based refugee clinic in Toronto leads efforts to welcome newcomers

When Dr. Meb Rashid lectures in front of University of Toronto students, he does so with passion and purpose – he’s teaching them to understand the satisfaction you can achieve helping newcomers to Canada.

Rashid is director of the Crossroads Clinic at Women’s College hospital, the first hospital-based refugee clinic in Toronto. He also teaches in the department of family and community medicine at U of T.

The clinic has been around for four years but it is in the next few days where it will face perhaps its biggest challenge – the influx of Syrian refugees who will be referred to it from several private-sponsored groups in the GTA.

“We are the only clinic that deals exclusively with refugees” Rashid said in an interview with U of T News at his clinic office. Staff have treated people from North Korea, Eritrea, Afghanistan and Iraq and “of course we are getting ready for the Syrians, like many people across Canada.”

There “has been a trickle” of Syrians” coming to the clinic, where the focus is on primary health, Rashid said, including two cases he has personally dealt with, but when he heard the election promise from the then opposition Liberals about bringing in 25,000 refugees “we realized that if it came to fruition, these were huge numbers.”

So Rashid started a program to bring four health care organizations together to run rotating clinics. The first clinic was at the end of October, though the need is obviously much greater now.

One of the first Syrians he treated was “anguished because he had to leave his family behind, knowing the horror they have to deal with.”

Rashid said “every migration is somewhat unique” and the Syrians will experience a “garden variety family practice.  We are not expecting much in terms of infectious diseases. These are not people coming from areas where there is malaria or tuberculosis.

In Syria, there was a “fairly advanced health care system until about five years ago,” but when the war started “the ground disappeared from beneath people. So what we are going to see are in this population will be a lot of people with hypertension, diabetes.

“We imagine we will be seeing a lot of kids who have not had immunizations and child care, and we expect to see some war-related trauma – shrapnel injuries, amputations,” he said.  One major area of concern is mental health issues.

The influx of Syrians won’t be that different from earlier refugee migrations, he said, “except in scale. And the other thing that will be different is that we will be moving a large number of people simultaneously.”

A large number of refugees also mean that people could be already here to support them, and that could be therapeutic, he said, “people who have a recollection of the past.”

The clinic “has put out a call” to private sponsorship groups to make them aware of the clinic’s services. “I hope people will commit to primary care very quickly.  We have a large number of people arriving just as flu season is starting.”

Health care may be low on the refugees’ list of priorities, as they focus on looking for places to live, finding schools for their kids, and getting into language training classes. People often don’t complain about illness.

“I would argue that it is an opportunity to see them early, make sure there is no underlying hypertension or diabetes, make sure that they are fully vaccinated.”

There is some sense that when refugees arrive “there is an initial period of euphoria, a hopefulness, but, many months later that often changes and that is when mental issues emerge.”

So the clinic can do more than simply help prevent sickness, staff can provide a “familiar face, a place you are connected with, and that is critical.” 

Women’s College Hospital is a teaching site and many U of T students spend time there. After the interview Rashid was off to the downtown Toronto campus to lecture to fourth-year medical students, to “brainstorm around health issues that are relevant to refugees” and talk about the Syrian migration.