Meet a small team of doctors giving Syrian refugees care

Dr. Meb Rashid and his family were winding down from a New Year’s Day spent at their local skating rink when an urgent email snapped him back to business. It was his contact at the immigrant-services organization COSTI, asking whether he could come to a hotel near Toronto’s Pearson International Airport to give medical care to some of the 300 government-sponsored Syrian refugees temporarily housed there. Rashid, a 50-year-old GP, agreed, contacted two of his colleagues and prepared to get to work. At 10 a.m. the next day, they walked into the hotel.

As business travellers passed through, the doctors set up shop in the bustling lobby and, over six hours, treated roughly a dozen patients. One child had pink eye “as bad as I’ve ever seen,” Rashid says. “He couldn’t even get his eye open.” As the immigrant- and refugee-health organization Access Alliance took over, the next challenge was getting the refugees to a few of the 27 clinics in the city newly established for their arrival.

Rashid sometimes meets his patients at Toronto refugee shelters, which is where many of them first come into contact with Canadian health care. From there, they’ll head to his workplace, Crossroads Clinic, at Women’s College Hospital. A decade ago, most new immigrants to Toronto were hard pressed to find a family doctor. At Crossroads, one of the country’s few in-hospital clinics dedicated to refugees, their well-being is front and centre. The doctors understand the arduous refugee-claims process, have quick access to interpreters and recognize that finding a job can be as important to a refugee’s health as any blood pressure drug.

The clinic is especially valuable right now, as Canada welcomes a large and swift-moving wave of war-fleeing newcomers, after having committed to resettling 25,000 Syrians by the end of February. But they’re far from the only refugees entering the country: Nearly 20,000 refugee claims were finalized in 2014, with more than 10,000 arriving through government and privately sponsored programs. Since its creation in 2011, Crossroads Clinic has helped more than 1,500 refugees from some 65 countries, including Afghanistan, Ethiopia, Hungary, North Korea and Nigeria, serving as family doctors for their first two years in Canada.

Syria’s refugee crisis has generated indelible images, from the devastating photo of toddler Alan Kurdi face down on a Turkish beach to the scene of Prime Minister Justin Trudeau welcoming the first arrivals at Toronto’s airport. It has provoked huge acts of generosity; it has also prompted conflicted feelings about whether the country can absorb so many newcomers so quickly, at a time of serious economic distress. (In January, settlement agencies in Toronto, Vancouver and Ottawa asked for a pause in the arrivals so they could find homes for those already at their doors.) But with its exclusive commitment to the care of refugees, Crossroads Clinic — staffed by just two physicians and two nurse practitioners  —  can stand apart from all the attention and concern, the questions and rhetoric. In this small string of rooms on a hospital’s third floor, Rashid and his colleagues have created a protected space.

Related: Our health care system should be helping all Canadians

David is trying to make a follow-up appointment but can’t seem to find a date that works. Decked out in a black Blue Jays hat and matching varsity jacket, the 33-year-old towers over the front desk as he banters with the receptionist. They settle on a Friday morning, when he won’t be at his job as a kitchen supervisor at Costco.

Fifteen years ago, David was a former soldier fleeing the Iranian army. His escape took him to Brazil, Bolivia, Costa Rica, Nicaragua, Guatemala, Mexico, then Texas — bouncing to each place hoping to find refuge from those who wanted him dead or detained. When David, sponsored by his uncle in Toronto, first came to Crossroads in 2014, the scars from half a life spent outrunning danger were in full view. “I got shot — they broke my neck, broken hand, broke my teeth, broken nose, everything. Look at my forehead,” he says, pulling his hair from his face to reveal a dent above his eyes. “I have a stab wound in my back, I’ve got knife cuts all over my body. I thought, ‘I’m never going to stay alive.’ ”

When he first met Rashid, David could barely walk after having suffered two strokes while in detention; he says he was “crying all the time.” Rashid treated David's post-traumatic stress disorder (the clinic has a great deal of experience with PTSD), called him a lawyer and helped with paperwork for a refugee claim that’s still pending. He reported David's wounds to the Canadian Centre for Victims of Torture. “Dr. Rashid saved my life,” David says. “He’s like a big brother to me.”

Rashid is himself an immigrant: He left Tanzania for Canada when he was five and attended medical school at the University of Toronto in the mid-1990s. He worked in Zimbabwe, Nicaragua and back in his home country before taking over a practice in Toronto with a number of refugee and immigrant patients. “It’s a population I just felt viscerally connected with,” he says. “These are people who’ve endured things that would be difficult to put on [a] screen, because you wouldn’t believe them.”

That’s why he wanted to create a centre with the expertise and resources to cater to refugees’ particular needs. Before the early 2000s, newcomers would simply show up at a hospital emergency room or walk-in clinic. As doctors began to realize these patients required longer appointments, interpreters and specialized care, designated clinics began popping up across the country, but nothing consistent or particularly well funded. By the end of the decade, Rashid had begun shopping around the idea of an in-hospital clinic for refugees, whose care had been identified by Ontario’s health ministry as a “gap” in the system.

“It was a perfect fit for Women’s College Hospital,” says its chief executive officer, Marilyn Emery. “We have a commitment to equity, and, first and foremost, that means equitable access to care.” But she also understood that “even just walking into a hospital is a very traumatic experience for some refugees, especially for those coming from war-torn countries.” Crossroads, which is largely paid for through provincial funding, was established to be a welcoming place where refugees can get treatment for illness as well as help figuring out everything from the claims process to the city’s transit system. One patient, who asked not to be named due to threats from the Eritrean government, received glasses for the first time thanks to a referral from Crossroads, ending years of headaches and dizziness. Many female refugees at the clinic arrive pregnant or become pregnant within their first year in Canada, so Crossroads offers family planning and prenatal care, and children can get the immunizations neccessary to start school. It is also a place for research and teaching, and patients are introduced to community groups that can help them find employment.

In 2011, its first year, Rashid and nurse practitioner Vanessa Wright thought they’d see 250 patients — it was twice that. Those numbers have doubled every year since; still, appointments are twice as long as at an average family doctor’s office. “My residents laugh at me, because on [the] first visit there’s so much schmoozing,” Rashid says. “I argue we want to address their medical needs, but the intention of the first visit is to make sure they feel safe enough to come back for a second visit. It’s really about the relationship.”

Sometimes the relationship can be built quite quickly: Wright recalls a woman who’d been in Canada a week and a half — with two children in tow and no health coverage — and waddled into her clinic 36 weeks pregnant. She saw that the woman was high-risk and sent her to the ER. “I visited her in the hospital that week and she held my hand for a really, really long time. She was crying, and she said, ‘You’re like a sister to me,’ ” Wright recalls. “She was just so trusting.” Sometimes, the relationship takes longer. Rashid remembers one father of an Afghan family of six. “It took a year and a half [of] to find out he’d been waking up screaming with nightmares every night for the past 20 years.”

“I’m not the same person I was the first time I met Dr. Rashid,” says Saniyah Farid, who has come to the clinic with a sprained wrist. Two years ago, she fled an abusive husband in Pakistan with their six-month-old son. Farid uses the word amazing 15 times to describe the care she has received at Crossroads and her new life in Canada: She’s a human resources assistant who wants to be an HR director. She has just remarried, the henna from the small wedding still visible on her hands. “I can’t imagine what it would have been like without all those supports,” she says. “When I first landed as a refugee, I had nobody. The Syrians will be helped. I know that. And I feel proud.”

Leonie Wizzard ducks her head into the small examination room where Rashid is working. She’s just been hired by Crossroads to take calls and book appointments for the 27 brand new clinics that have been set up in community health centres and hospitals. Those clinics will offer initial checkups to Syrian refugees, attend to any urgent medical issues and provide immunizations so the children can start school. Rashid brings her up to speed about his hotel visit after New Year’s Day and the triage clinic, as well as the 2,200 government-assisted refugees he expects will come to the city in the next two months.

It’s already been a busy few months for Rashid. Even before the Liberals were elected in October, he and his team were hard at work setting up clinics to prepare for the Syrians’ arrival. After Trudeau pledged to bring 25,000 refugees to Canada by year’s end (a date later adjusted to the end of February), they accelerated their efforts, collaborating with colleagues from Access Alliance, Queen West Community Health Centre, St. Michael’s Hospital and Toronto Public Health — to name just a few organizations — to get those 27 clinics operational in the span of a month. Similar clinics are also being funded in cities like Ottawa, Vancouver and Montreal. “You can pay now or pay later,” Rashid says. “It’s much more cost-effective to address [medical] issues early in the migration process and keep them out of the ER. People stay healthy and they can go to work.”

Before Syria’s civil war broke out five years ago, the country was educated and middle-income, with a decent health care system, so Rashid expects to see fewer cases of tuberculosis and more of what Canadians contend with all the time: heart disease, diabetes, hypertension. “They’ve lived through horrific things — I don’t want to diminish that,” he says. “But I think the real challenge will be the numbers.”

There are advantages in those numbers: While they do mean longer hours at the clinic and a higher patient load for Rashid’s team, he believes that they also bode well for the success of Syrian newcomers in Canada. “You’re transplanting full communities, support systems, other people going through the same journey,” he says, which offers some crucial solace. In the middle of much uncertainty — about where 25,000 refugees will be settled, how they will be received, where they will find employment and language training and schools — Rashid’s line of work leaves him feeling confident. “You meet people who show such a tremendous capacity to withstand monstrous events,” he says. “They put their lives back together.”

Related: Our health care system should be helping all Canadians How Canadians are helping Syrian refugees