Transcript Presentation - The Health Care Response in OTTAWA: One Year Later

SYRIAN REFUGEES :
The Health Care Response in
OTTAWA :One Year Later
THE TEACHER in ALL of US
Doug Gruner, MD, CCFP, FCFP
Assistant Professor
Department of Family Medicine
FACULTY RETREAT : OCT 1 2016
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4.8 million registered refugees (UNHCR)
9 million IDPs (internally displaced peoples)
http://data.unhcr.org/syrianrefugees/regional.ph
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Top Accepting countries :
Turkey 2,726,980 registered (August 2016)
Lebanon 1,033,513 registered (June 2016)
Jordan 655,427 estimated (June 2016)
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Grass roots organization being funded to lead
and coordinate the resettlement of the Syrian
Refugees to Ottawa
Housing, Education, Employment, Health
Coordinate, Communicate ,Inspire
Website: resources, links, info
www.refugee613.ca
1.PREPARTION PHASE :
2. PRIMARY CARE RESPONSE : evidenced
based screening, acute care, linking to resources
and transitioning to the community
3. THE TEACHER IN ALL OF US:
Incorporating innovation into our competency
based program .
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The city Ottawa
receives 7,000- 8,000
immigrants each year.
Approximately 1,500
are refugees.
400-500 are
government assisted
refugees that pass
through reception
house each year.
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25,000 Syrian refugees arrive in Canada
between November 2015- March 2016
Ottawa receives 1500 (4x usual numbers)
1136 Government Assisted
397 Privately Sponsored
200 in transit from March-December 2016 (PSR)
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the six Ottawa Community Health Centres (CHCs) and
Bruyère Academic Family Health Team (BAFHT);
Ottawa Public Health (OPH);
the Champlain Local Health Integration Network
(LHIN);
settlement agencies (Catholic Centre for Immigration
(CCI), Jewish Family Services (JFS), Ottawa
Community Immigration Services Organization
(OCISO));
the Children's Hospital of Eastern Ontario (CHEO);
Hospital Emergency Preparedness Committee of
Ottawa and
private sponsorship groups
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DEMOGRAPHICS
PATIENT CONCERNS
CURRENT MEDICAL CONDITIONS/ PAST CONDITIONS
OBSTERICAL HISTORY/ UNMET CONTRACEPTIVE NEED
MEDICATIONS/ ALLERGIES
IMMUNIZATION STATUS
FAMILY HISTORY
SOCIAL HISTORY: SMOKING,ETOH,PAST
EMPLOYMENT,CURRENT HOUSING
DENTAL
PHYSICAL EXAM
SCREENING INVESTIGATIONS
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Plans to provide IMAs at 7 primary care hubs
had to change quickly to respond to urgent
health needs at 3 hotel sites (funding from
LHIN)… required for three months.
OPH on site at hotels for immunisations and
dental screening
High demand for services at CHEO and OCTC
(Ottawa Children's Treatment Center)
NEWCOMER CLINIC
INITIAL MEDICAL
ASSESSMENTS
BRUYERE
RECEPTION HOUSE
PRIMARY CARE
(IMAs)
Thursday Evening
clinics
MENATL HEALTH
CHCs
HOTELS
ACUTE CARE
In hotels
WALK –IN
SERVICES
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very low health literacy of clients, many of whom had
low education levels and were not literate in their own
language;
high numbers of disabled children and children with
terminal illnesses;
very poor oral health (in some cases causing
hospitalization);
large family sizes (average family size is five with many 9
or 10-member families);
internet-connected refugees that shared information
rapidly across the city and across the hotel sites: creating
unrealistic expectations of health care services at times.
clients presenting with minor to moderate needs for
mental health supports sooner than was anticipated
INITIAL MEDICAL
ASSESSMENTS (IMA)
IMA for GARs
20%
IMA
unknown
80% IMA completed by
June 2016
IMA done
80%
PRIMARY CARE
PROVIDER (PCP)
78% have a PCP
PCP for GARs
3%
19%
Linked
In Process
Not Linked
78%
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Total Refugee seen
240
Total Refugee we kept as
patients of Bruyere/Primrose
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205
Total Enrolled with
Bruyere/Primrose
205
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January 14- May 26th
2016
One staff with 1-2
residents saw 6-15
clients each Thursday
clinic.
Arabic speaking IMGs
volunteered as
interpreters
Winner of Bruyere
hospital : “Best Team
Award”
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At Bruyere our mandate and vision has always
had a focus on providing care to the vulnerable
in our community.
Our teachers have developed an expertise in
working with this population .
This initiative in health resettlement has
provided an opportunity to expose our
learners to many of the resources created by
our researchers and taught by our educators.
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Along with their resident learner every staff
physician (13) took on a minimum of one
Syrian refugee family into their practice.
Each resident follows their family for the 2 year
residency and follows the www.ccirhken.ca
checklist for primary and preventative care.
They learn the challenges of working with a
vulnerable population, including working with
interpreters across cultures
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COMMUNICATOR
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COLLABORATOR
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ADVOCATE
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MEDICAL EXPERT
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SCHOLAR
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Two community residents for their scholarly
project looked at some of the data collected at three
sites. Here is what they found:
- 669 of the 1087 IMAs completed were analysed:
- less than 1% with Hep B
-less than 1% with Hep C
- 1% with G6PD
- Anemia in 20% especially in women childbearing
age.
Varicella immunity was high (only 5.6% of Syrians
over 13 were susceptible to varicella)
1. The Bruyere/Primrose team has learned that when
called upon our teachers, our learners and our support
staff rise up to the occasion with leadership, collaboration
and ingenuity and take on difficult challenges with a cando attitude and positive energy.
2. Most innovations occur when resources are stretched
and there is a demand for a new approach.
The early days of 2016 was one such time which has led
to teaching advocacy, collaboration and
communication in a much more tangible way.