Dr.Martina Scholtens – The Refugee Health Vancouver Website. [PDF]
Martina Scholtens, MD, MPH, CCFP
Dr. Martina Scholtens is a family physician and clinical instructor with the Faculty of Medicine at the University of British Columbia. She worked for ten years at Bridge Refugee Clinic in Vancouver. Her book about this work, Your Heart Is the Size of Your Fist, was published in 2017. In addition to clinical work she has lectured on mixing art and medicine, given workshops on refugee health, and acted as a consultant when British Columbia settled over 3,000 Syrian refugees in 2015 and 2016.
LEARNING OBJECTIVES
After reading this chapter, you should be able to:
- Name four barriers to refugee healthcare and explain how a website might address those.
- Understand the source of the materials posted to the RHV website.
- Name three possible sources of financial support for a project such as this.
From 2004 until 2017, Bridge Clinic in Vancouver was the only clinic in British Columbia with a specific mandate to care for newly arrived refugees. Operated by Vancouver Coastal Health, the clinic provided initial health assessment and screening, public health assessment and immunizations, and ongoing primary care to approximately 1500 newly arrived refugees in Greater Vancouver each year. Staffed by family physicians, nurses, consulting specialists, a social worker and (for a time) a trauma team, the clinic cared for patients until they could be transferred to community family physicians, typically in 6 to 18 months.
The chief countries from which the clinic’s patients originated fluctuated with the world political climate. Over the years the clinic saw surges of refugees from Myanmar, Afghanistan, Bhutan, Iraq, Somalia, Iran, Eritrea, and Syria. 80% of patients required interpreters, which the clinic provided.
Medical care of refugees is complicated by multiple issues. These include language, culture, unique medical diagnoses and nonstandard medical coverage. These challenges make finding a family doctor – already a difficult task in British Columbia – even more difficult for refugee patients, further impeding access to care.
In 2011, clinicians associated with Bridge Clinic pooled their expertise in refugee health to launch Refugee Health Vancouver (www.refugeehealth.ca), a website designed to enhance healthcare delivery to refugees in Greater Vancouver by providing community clinicians with one-stop access to comprehensive refugee health care resources. The website is comprised of four sections:
1. Categories & coverage.
This section provides an overview of the categories of refugees, the Canadian settlement process, BC’s Medical Services Plan, and the Interim Federal Health Plan (limited, temporary health care coverage for refugees), including what’s covered and how to bill. This section of the website aims to help providers navigate the often bewildering system of healthcare coverage for refugees, thereby improving patients’ access to services.
2. Guidelines & tools.
Some medical diagnoses among refugees, such as strongyloidiasis and post traumatic stress disorder, may be less familiar to Canadian care providers. The guidelines on the Refugee Health Vancouver website provide a succinct, practical summary of current British Columbian, Canadian and/or international evidence-based clinical guidelines, as well as links to further reading. Also included are tools to improve mental health assessment and promote health literacy.
3. Patient handouts.
Several hundred pamphlets in thirteen languages cover such topics as mammography, bed bugs, hepatitis C and managing stress.
4. Cultural profiles.
Backgrounders prepared by Bridge Clinic physicians on current common source countries give the care provider a succinct overview of the political and epidemiological context of the patient’s home country.
The organization of the website launch was a voluntary initiative on the author’s part. The writing and gathering of site material was volunteered by physicians associated with Bridge Clinic, as well as medical students, residents, interpreters and nurses. Financial support from the BC College of Family Physicians and the Frontline Health program (a corporate citizenship initiative of AstraZeneca Canada), paid the initial web developer costs. In 2015, the BC Refugee Readiness Fund — part of the WelcomeBC umbrella of services, made possible through funding from the Province of British Columbia — provided funding to coincide with Canada’s commitment to resettling Syrian refugees. Until Bridge Clinic closed in 2017, Vancouver Coastal Health provided ongoing financial support for the operation of the website, including website hosting and maintenance costs and a half hour of physician time per week to update the site. Since then, the author has maintained a streamlined version of the site on a voluntary basis.
In 2014, Calgary Refugee Health (www.calgaryrefugeehealth.com), a resource for refugee patients of Calgary and Southern Alberta and their clinicians, was launched by University of Calgary medical students, using the Refugee Health Vancouver website as a template.
The Refugee Health Vancouver website is well-used, with 1200 page views a month by 650 visitors. The most popular topics are health insurance, mental health, and patient handouts. It appears to be filling a gap in the provision of health care to refugees in British Columbia.
Under-Served 