Decade of turmoil: A characterization of a specialized refugee health clinic 2011-2020
Abstract
Canadian refugee healthcare has been impacted by periodic upheavals including federal funding cuts, Syrian and Yazidi resettlement programs, and COVID-19. These upheavals will have undoubtedly led to changes in clinic use, shifts in clinic demographics, or clinic policy. Refugees are a vulnerable population with specific physical health, mental health, and social needs. One model of care that can address these needs is a specialized refugee health clinic. Understanding the impacts of recent upheavals on a specialized refugee health clinic’s utilization, its staff and clinicians is critical for future planning. We studied a specialized refugee health clinic in Calgary, AB from 2011 to 2020, across five time periods: Pre-Interim Federal Health Program (IFHP) Cuts (January 2011 – June 2012), IFHP Cuts (July 2012 – October 2015), Syrian Surge (November 2015- January 2017), Yazidi Period (February 2017 – February 2020), and COVID-19 (March 2020 – December 2020). We analyzed quantitative changes as well as conducted semi-structured interviews with clinic leadership. Utilization increased greatly over different policy changes and a pandemic, at a specialized refugee clinic over ten years. These upheavals challenged clinic leadership and providers to adapt. The stress of these upheavals negatively impacted staff wellness and patient care. Understanding how health and immigration policy changes affect care, especially at specialized refugee clinics, is critical for being able to anticipate and thrive through future upheavals as turmoil globally seems to continue.
Notes
Future research / gaps identified:
1) Assess refugees’ healthcare usage outside of primary health clinics (e.g. emergency departments and hospital admissions) and how this changes/does not change with policies and global conflict.
2) Investigate patient outcomes beyond healthcare utilization, e.g. quality of life, satisfaction with care.
Integration timeline: not defined
Key findings:
1) Total monthly appointments increased 576% over 10 years.
2) Key qualitative themes included:
i) Strain on clinic staff and providers’ wellness
ii) Challenges and successes of patient acculturation
iii) Clinic resources increased in amount and type over time
iv) Providers excelled in caring for patients physical health but sometimes struggled to meet patients’ psychological and social needs
v) Factors mitigating stress and challenges
vi) The importance of understanding lived experience
vii) Suggestions for future upheavals.
Location: Calgary, AB
Open access: Yes
Community organizations: Mosaic Refugee Health Clinic
Key populations: Patients and staff at the specialized refugee health clinic in Calgary
Key recommendations:
1) Assess how broader health policies and other upheavals may have downstream consequences on local health clinics, particularly in specialized clinics like those for refugees
2) Prepare for potential impacts on care that may continue to happen as new global conflict, refugee crises, etc. occur
3) Create a comprehensive, holistic model of refugee healthcare utilization to increase the sector’s knowledge and better pinpoint strategies for change.