Presentation%20to%20Fraser%20Health%20Authority

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

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

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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

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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

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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 clients access to existinghealth
  and settlement services
• To advocate for culturally and linguistically
  appropriate services in the community

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Target Population

• Refugees
• Government assisted
• Group sponsored
• Refugee claimants
• All during the initial period of adaptation (up
  to three years)

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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 Womens Hospital and Health Centre
• British Columbia Childrens Hospital
• BC Centre for Disease Control

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Funding

• VCH Operating budget, administration, nursing,
  support staff and services
• Physician sessions from the Alternative Payment
  Program
• Some funding from IFH billings ( IMEs)
• Free services/support from the other partner
  agencies

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Staffing
Community Health Nurses 2.5 FTE
Sessional Physicians 1.5 FTE
Community Liaison Worker 1.0 FTE
Clinical Assistant 1.0 FTE
Registration/Booking Clerk 1.0 FTE
Mental Health Counsellor 0.2 FTE (12 hours per week on contract)
Additional services provided by Adult/Older Adult
Occupational Therapist, Physiotherapist and
Respiratory Therapist
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Services

• Health Screening and Prevention
• CD (Parasites, Hepatitis, HIV, TB, Other)
• Immunizations
• Mental Health
• Womens Health
• Health Assessment / Treatment
• Counselling and Support
• Community Referrals

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Specialized Clinics

• Immigration Medical Exams
• Prenatal Clinic
• Mental Health Counselling
• Chronic Disease Management
• Newcomers Pediatric Clinic
• Internal Medicine Consultation

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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

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Top 3 Clinic Visit Reasons
Rank Reason for Visit
1 General Medical Concerns
2 Mental Health
3 Screening for Infectious Diseases
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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?

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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)

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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

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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

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STDs 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

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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

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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

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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 forfollow-up purposes

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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)

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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

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