1. Presentation to the National RAP Conference Chris Friesen, Director Immigrant Services Society of BC Dr. Kerry Telford, Physician Leader Bridge Community Health Clinic

2. An example of a promising practice in primary health care for refugees.

6. Background Established in 1994 in response to the growing unmet health care needs of refugees (with or without legal status) Merging of three existing refugee and immigrant- specific clinics Intentional decision to keep the clinic within the formal health care system rather than in an immigrant serving agency Considerable debate within community whether the clinic would further marginalize refugee population Initially located within hospital ward

7. Purpose To improve the access to primary and preventative health services To provide a “bridge” for refugees and new immigrants to access health services within the community

8. Goals To improve health outcomes for refugees To provide integrated, culturally appropriate primary and preventative health services To liaise with and develop partnerships To encourage client’s access to existing health and settlement services To advocate for culturally and linguistically appropriate services in the community

9. Target Population Refugees: –Government assisted –Group sponsored –Refugee claimants All during the initial period of adaptation (up to three years)

10. Existing Partners Primary – formal written agreement Vancouver Coastal Health Immigrant Services Society of BC BC Multicultural Health Services Society Associate - Providence Health Care Vancouver Association for Survivors of Torture BC Women’s Hospital and Health Centre British Columbia Children’s Hospital BC Centre for Disease Control

11. Funding VCH – Operating budget, administration, nursing, support staff and services Physician sessions from the Alternative Payment Program Some funding from IFH billings ( IME’s) Free services/support from the other partner agencies

12. Staffing Community Health Nurses2.5 FTE Sessional Physicians1.5 FTE Community Liaison Worker1.0 FTE Clinical Assistant1.0 FTE Registration/Booking Clerk1.0 FTE Mental Health Counsellor0.2 FTE (12 hours per week on contract) Additional services provided by Adult/Older Adult Occupational Therapist, Physiotherapist and Respiratory Therapist

13. Services Health Screening and Prevention CD (Parasites, Hepatitis, HIV, TB, Other) Immunizations Mental Health Women’s Health Health Assessment / Treatment Counselling and Support Community Referrals

14. Specialized Clinics Immigration Medical Exams Prenatal Clinic Mental Health Counselling Chronic Disease Management Newcomer’s Pediatric Clinic Internal Medicine Consultation

15. Who are our clients? ~ 8,000 client visits per year ~ 1,800 new clients per year 70% Adults, median age 29 years old Gender evenly distributed Come from over 70 different countries 42 different language groups 79% of clients require interpretation 4.4% of clients had no form of health care coverage

16. Top 3 Clinic Visit Reasons RankReason for Visit 1General Medical Concerns 2Mental Health 3Screening for Infectious Diseases

17. Clinic Rationale - Findings Why is it critical to undertake primary health care screening for government-assisted refugees? What have we found? What has been the impact?

18. CD Screening Hepatitis B – 61% tested – 79% not immune (all were offered vaccine) – 1.4% carriers (all counselled and contacts immunized) Hepatitis C –53% tested –3.5 % tested positive (all counselled)

19. CD Screening HIV 50% tested 5.1% tested positive all had post-test counseling Syphilis (RPR) 45% tested; 2.6% were positive (7 cases) 4 treated, 2 had proof of previous treatment, 1 lost to follow-up

20. CD Screening Ova and Parasites 70% tested 23% had at least one parasite All were treated. TB 37.5% had a chest x-ray 7% had evidence of latent TB All referred to TB Control

21. STD’s Screening Chlamydia 28% tested 6% (10 cases) tested positive 9/10 treated, 1 lost to follow-up Gonorrhea 25% tested 2 tested positive 2 treated

22. Other Screening Pap smear 56% women over 19yo tested 6% dysplasia, all were treated Body Mass Index Underweight – 5% Normal – 51% Overweight – 32% Obese – 12%

23. Burmese Statistics 115 Karen refugees screened 2006 Parasites - 31% positive Hepatitis B - 12% positive Hepatitis C - 6% positive HIV and syphilis- No positives Hemoglobin – 17% abnormal G6PD deficiency – 26% abnormal TB less than 11years old - none

24. GAR Processing Notification of arrival received by ISS ISS staff book appt with Bridge Clinic nurse (built into RAP orientation schedule) ISS secures interpreter and makes arrangements to transport GAR to clinic GAR healthcare screening and assessment done. Follow-up arranged if needed. At the time of check-out from reception centre – electronic transmission of GAR permanent address sent to clinic for follow-up purposes

25. Challenges Interpretation Services – in and outside the clinic Lack of Mental Health Services Responding to Changing Refugee Characteristics IFH – limited coverage / client knowledge / healthcare provider knowledge Health Settlement –Education (health system, access to community services)

26. Challenges (continued) Discharge planning – lack of family physicians Responding to uneven GAR arrival flows Managing non-appointment culture – impact on referrals Dental care funding Poverty – impact on follow-up and treatment plan