Women’s College Hospital’s Crossroads: A Refugee Clinic

When he arrived in Toronto as a refugee, Kwan needed to find a place to live, learn English, look for employment and find a school for his daughter. He also needed treatment for his diabetes. With no family doctor, he might have wound up in emergency. Instead, he was referred to the Crossroads Clinic directly from the refugee centre where he accessed other services.

Women’s College Hospital’s Crossroads Clinic is the first hospital-based refugee clinic in Toronto, a city where thousands of refugees arrive every year to build new lives. Access to health care can be challenging for this population for many reasons. Although refugees have some health insurance coverage, factors such as language barriers and learning to navigate the health-care system can be huge challenges. Often, other issues such as housing, income and adjusting to life in Canada take priority over health. As a result, refugees may access health care through walk-in clinics or emergency departments, which may not be ideal.

The Crossroads Clinic provides a bridging system that offers primary health care during refugees’ first two years in Ontario. After two years – when patients are more established here, have gained some language proficiency and can navigate the health-care system – they are referred to a family physician in the community.

“The model is deliberately responsive, not requiring that you have a physician referral,” explains Angela Robertson, director of equity and community engagement, Women’s College Hospital. “That enables access from the community referral point – from the shelters that are serving and supporting refugees, and from the individuals who come to know of this clinic.”

The need for such a clinic is clear: with a staff of three, the Crossroads Clinic was designed to take 250 patients per year. By the end of its first four months in operation, it already had 270 patients.

The Crossroads Clinic has three key objectives: clinical care, education and research. The clinic makes preventive health a priority, focusing on immunization and screening, while also addressing the nuanced health needs of refugees.

“There are language issues, there are cultural issues, there are medical issues in terms of things like infectious disease,” says Crossroads Clinic medical director Dr. Meb Rashid. “In the refugee population we certainly see people who have witnessed horrible trauma, so there’s a tremendous burden of mental health issues in that population also.”

One of the clinic’s goals is medical resident education, and it has already had residents from Toronto and other parts of Ontario.

“New medical graduates fully recognize that working cross-culturally is going to be an essential part of primary care,” says Dr. Rashid.

That’s why it’s so important to share what’s learned at the Crossroads Clinic.

“What I found when I started doing this work is there’s really no guidance in terms of what issues are important,” says Dr. Rashid. “You have to learn this through experience.”

With more than 25,000 refugees arriving in Canada every year, there’s an urgent need for leadership in this area.

“We want to take our experiences and disseminate them,” says Dr. Rashid.“We’re a small clinic, but one that hopefully will provide guidance to other clinicians across Toronto and across Canada.”

Dr. Meb Rashid
Clinical Director
Crossroads Clinic
Women’s College Hospital
Angela Robertson
Director of Equity
and Community Engagement
Women’s College Hospital

 

Ontario’s Action Plan for Health Care, Ministry of Health and Long-Term Care

“At the heart of our action plan is a commitment to ensure that patients receive timely access to the most appropriate care in the most appropriate place.”

“There are still too many instances where patients don’t know how to access the care they need.”