Tucked behind the food court of a mall in northeast Calgary, the Mosaic Refugee Health Clinic cares for between 800 and 1,000 patients a year, making it one of the busiest in the country.
In the coming months, as many as 2,500 Syrians are expected to arrive in Calgary, a wave of new patients that would swamp Mosaic's resources. So, its staff members are making an offer, asking their colleagues in Calgary to add Syrian patients to their practices, and in return promising to share their expertise on refugee health.
"We don't have the capacity, but we have the knowledge," said Jason Shenher, executive director of Mosaic Primary Care Network, which runs the clinic. "We need to draw on others to help us out."
The first planes carrying Syrians are expected to touch down as early as next week; before they do, doctors and other front-line medical staff are scrambling to make sure they have access to care and those who see them have the knowledge they need. New clinical guidelines specific to Syrian refugees will be published next week, webcasts and seminars are being planned, and networks are forming in major cities to organize care.
Caring for refugees is nothing new for many Canadian doctors, who have built up a strong network to develop best-practices and to lobby for change. What is new is the scale of this wave of refugees and the short and unpredictable time frame for their arrival. That has the experts looking for reinforcements and new ways to care for thousands of new patients. The process, they say, can only improve medical care in a country as diverse as Canada.
Many also are hoping the new Liberal government will quickly fulfill an election promise and reinstate refugee health benefits its predecessor cut.
"This is an unprecedented migration," said Meb Rashid, medical director of the Crossroads Clinic for refugees at Toronto's Women's College Hospital.
Dr. Rashid realized in September that no facility in Toronto could handle the numbers of refugees that might arrive and began working with others on a plan. A partnership of four downtown sites has grown to at least 15 across the Toronto region, including hospitals, community health centres and other group practices.
The aim is to direct new Syrian arrivals to the closest clinic and have them seen within days of arrival. The clinics would look after them for three or four months and then absorb them into their regular practice or transition them to another primary care provider. They could also refer them to specialists.
Ashna Bowry, a family doctor and tropical disease specialist at Toronto's St. Michael's Hospital who is helping co-ordinate the clinics, expects refugees to be in relatively good health. Syria had good medical care before the war, she said, but most refugees have been without basic primary care for four or five years. She anticipates such ailments as high blood pressure and diabetes that is not controlled, trauma-related conditions, poor nutrition, particularly in children, dental problems and vaccinations not up-to-date.
Dr. Bowry said the support from health care providers has been tremendous.
"Essentially, we have done this independently," she said. "We're basically flying by the seat of our pants."
In Vancouver, the Bridge Clinic is asking for help from those who have cared for refugees in the past, planning to operate mobile clinics near refugees, although it has yet to determine where.
In Ottawa, a network also is in place, and Kevin Pottie has been working with others over the past month to update the Canadian Clinical Guidelines for Immigrant and Refugee Health and creating new clinical guidelines for Syrian refugees.
The guidelines, plus a checklist for clinicians and other resources, including on mental health are expected to be ready next week and an article on the topic is being prepared for the Canadian Medical Association Journal website.
Dr. Pottie, a family doctor and scientist at the Bruyère Research Institute at the University of Ottawa, said research shows some health-care providers turn away refugees because they worry they do not have adequate training, or will make a mistake.
The guidelines and expert networks can provide on-the-job training and mentoring now and after, he said.
A website, kidsnewtocanada.ca provides information specifically for young patients.
The federal government has promised full coverage for Syrian refugees, and Immigration Minister John McCallum said this week it will keep its word. "You can expect in coming days, and not too many, that our position will be made clear."
Editor's note: An earlier version of this article incorrectly stated that the Canadian Clinical Guidelines for Immigrant and Refugee Health guidelines would be posted online on Monday. They are in fact expected to be posted early next week.