The arrival of thousands of Syrian refugees presents a major challenge for Ontario’s health and social service agencies. “It will take many different systems working as a sophisticated ecosystem to ensure a seamless migration experience,” says Debbie Douglas, Executive Director of the Ontario Council of Agencies Serving Immigrants. "Community Health Centres and other community-governed primary care models are supporting this “ecosystem” in a very rigorous, coordinated and integrated way."

Ontario’s Community Health Centres (CHCs) have a long history serving refugees. In mid-October, AOHC’s CEO Adrianna Tetley wrote Minister of Health and Long-Term Care Eric Hoskins assuring him that once again CHCs are “committed to step up to provide a one-stop solution to meet the health care needs of refugees arriving in our communities.” Since then across the province, CHCs as well as Community Family Health Teams and Nurse Practitioner-Led Clinics, have been mobilizing in many different ways. Not only are they preparing to serve more refugees in their individual centres. They are also supporting, and in some cases playing a leading role, in system-wide planning.  For example in Ottawa, it was Somerset West CHC that first hosted a multi-stakeholder group that has now transformed into Refugee 613, the coordinating planning body for the whole city.

“Our mission demands that in situations like this we act and act quickly. We don’t wait to hear from senior levels of government.  We roll up our sleeves, take action and learn as we go,” says Somerset West CHC Executive Director Jack McCarthy.

Representatives from the Champlain Local Health Integration Network are among the many groups sitting at the Ottawa planning table. “Community Health Centres have experience and expertise in reaching out to vulnerable populations and working in partnership with other agencies to maximize efforts,” notes the LHIN’s CEO Chantale LeClerc. “In the Champlain region, Community Health Centres have proven time and again that they are able to face community-wide challenges and achieve rapid results when time is of the essence and stakes are high.”

In several other parts of the province, CHCs are also taking on strong leadership roles. “CHCs are already deeply integrated in our communities so we are well equipped to nimbly support that process,” says Hersh Sehdev, Executive Director of Kingston Community Health Centres (KCHCs).  Sehdev is part of a planning table in the South East LHIN and regularly coordinates and communicates with the four other CHCs in the LHIN to ensure they are also kept informed of the fast moving story and latest developments. In addition to its coordination role preparing for an influx of refugees, KCHCs is ‎already serving six privately sponsored Syrian families and is preparing to receive another five. Dental issues are a major concern and some of the new arrivals have already received services in the centre’s dental suite.

Meanwhile in the South West LHIN, the London Inter-Community Health Centre, that serves clients from over 80 countries, has been asked to take on a similar convening role. Last week staff at the centre hosted a meeting that pulled a wide range of players together: other primary care providers, hospitals, mental health and psychiatrists, settlement agencies, the Public Health Unit, as well as CCACs.  Explains the centre’s Communications Manager Megan Cornwell, “Because we are always adjusting our practices in response to new waves of newcomers, we have a lot to share in a situation like this.”  

Hamilton Urban Core CHC (HUCCHC) is another centre sharing its expertise. Every year the centre conducts initial health assessments for over 300 government sponsored refugees who arrive in the city. HUCCHC is now preparing to increase its capacity serving refugees by engaging the MacHealth DNA student led clinic, a unique program within the Centre run by MacMaster University medical students. In addition, Hamilton Urban Core CHC has identified an additional nine volunteer physicians who all speak Arabic who will join the Centres response team. The centre is also participating at the leadership table led by Wesley Urban Ministries, sharing its standardized refugee triage process and coordinating cultural safety information with other Hamilton agencies and health providers who will also be providing services to the newcomers.

In areas where there are multiple CHCs, interprofessional teams are pulling together to ensure efforts complement each other and avoid duplication. In Toronto, all 17 CHCs are coordinating efforts to ensure new refugees get initial health assessments, urgent care, and then a connection to a regular primary care provider to address ongoing health needs. Smaller centres are also stepping up to provide support.  For example Port Hope CHC is already supporting seven Syrian families and Grand Bend CHC is part of a community group sponsoring another.

“Our centres want to maximize their contribution,” says AOHC CEO Adrianna Tetley. “That’s because our Model of Health and Wellbeing is especially effective serving people with complex needs.”

Experts concur on the need for specialized approaches to refugee care. “Their conditions require longer appointment times, like those available at Community Health Centres, and require appointments where clients can discuss more than a single health issue,” says Michaela Hynie from the Centre for Refugee Studies, at York University. “Many refugees also arrive in Canada speaking neither of the official languages and thus require the type of interpretation services offered in CHCs. These accommodations play an important role in refugee integration, not only facilitating their access to services, but also contributing to a norm of welcome, respect and acceptance.”

The depth of CHCs’ interprofessional teams is another benefit for refugees, many of whom are dealing with an array of non-medical problems that put stress on their physical and mental health: poverty social isolation, difficulties finding employment or adequate housing.  To address these issues, in addition to clinical health centre providers, CHC teams also include social workers, mental health counsellors and dieticians. In many cases CHCs, anchor multi-service agency hubs that include settlement agencies, legal aid clinics, and employment support centres.

Another key component of CHCs’ Model of Health and Wellbeing is to ensure new refugees feel welcomed. Research demonstrates that when people feel they are a valued part of their community they are more likely to be healthy.  And so CHCs mount a wide range of programs to support that support a positive experience for refugees as they into their new homes: fitness groups, art expression classes, community gardens, cooking classes and special programs for youth and seniors, to name just a few.

“We bring community and connection,” explains Lise-Marie Baudry, the Executive Director of Centre Francophone de Toronto which is planning for the arrival of Syrian refugees whose mother tongue is French. “We create a sense of family.”

The CHC model also addresses racism and other forms of social exclusion. As you’ll read in Voices profile of Ranjith Kulatilake, refugees coming to Canada can often find themselves moving from one hostile environment to another.  “We understand that Syrians coming to Canada may experience racism and anti-Muslim sentiment within the community. This is an area of expertise for us, we understand this and would like to assist them in navigating the process and managing expectations,” says Denise Brooks, Executive Director of Hamilton Urban Core CHC.

As frontline CHCs continue preparations to welcome Syrian refugees, AOHC is liaising closely with the Ministry of Health and Long-Term Care, the Ontario College of Family Physicians and the Canadian Association of Community Health Centres to share information and resources.  “Our members are proud to be part of this positive nation-wide response,” says Tetley.  “We’ve been serving refugees for decades and we’re committed to leverage this experience so that all refugees find a welcoming new home in Canada — a home that supports their best possible health and wellbeing.”