ACCESS ALLIANCE AND THE ARRIVAL OF THE KAREN REFUGEES IN TORONTO-2006

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ACCESS ALLIANCE AND THE ARRIVAL OF THE KAREN
REFUGEES IN TORONTO-2006

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    Canada's New Government Welcomes Burmese
Refugees Ottawa, June 20, 2006 On the
occasion of World Refugee Day, the Honourable
Monte Solberg, Minister of Citizenship and
Immigration Canada, and Jahanshah Assadi,
Representative of the United Nations High
Commissioner for Refugees (UNHCR), are pleased to
announce Canadas pivotal role in an
international effort to provide solutions for
Burmese (Myanmar) refugees stranded in camps in
Thailand for more than a decade

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Background to AAs involvement

• Summer 2006 a meeting is called by TPH that
  involved all major TB organizations in Toronto
  AAMCH was invited by COSTI to participate
• AAMCHC offered to receive all 68 karen refugees
  arriving in Canada beginning in Sept 2006
• Due to the concern about pulmonary TB all
  involved felt that there should be an initial
  assessment within 24 hours of arrival
• AAMCHC took the lead in organizing and
  implementing the approach to the initial
  assessment of the new arrivals

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Karen Nation

• -the karens are one of the largest minority group
  in Burma (Burman 68, Shan 9, Karen 7, Rakhine
  4, Chinese 3, Indian 2, Mon 2, other 5)
• -they have been struggling against the central
  govt. since independence in 1948
• -govt activities have become increasingly more
  aggressive in the last 20 years thus resulting in
  140,000 refugees crossing the border into
  Thailand
• -

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Karen Refugees in Thailand
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Karen Refugees in Thailand

• These 140,000 refugees in Thailand are scattered
  over 9 refugee camps along the Thai-Burmese
  border
• The inhabitants of these camps are not allowed to
  integrate into civil life in Thailand and cannot
  return to Burma
• Many have lived in the camps for over 20 years
• Upon request from UNHCR, Canada accepted 810
  refugees from Mae la Oon camp the most remote of
  the nine camps

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Mae La Oon

• 14,000 residents
• Built on hills so prone to mudslides in the rainy
  season
• Rudimentary health centre and primary education
  (to grade 10)
• Information from CIC suggests that TB is a a
  major concern in the camp

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Mae la Oon

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What was unique about the Karens for AAMCHC

• Rarely do we receive such a large group over such
  a short period of time
• In retrospect we feel that it is unlikely that we
  will welcome another group that has lived so long
  in such immense isolation (ie elevators,
  pharmacists etc..)
• Have not had experience working with people from
  this region-(manifestations of illnesses?
  Educational and cultural practices? Mental health
  symptomology?)
• Intensity of surveillance requested by CIC was
  unique (although we would argue that it was
  largely appropriate)

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Initial Assessments

• Toronto received 68 Karen refugees over 5 flights
• All were seen within 24 hours of arrival at the
  COSTI reception centre to deal with urgent
  concerns (malaria, typhoid etc..) and public
  health issues (TB, head lice, infectious diarrhea
  etc..)
• A follow up was arranged at AA within 10 days to
  do a complete history and physical exam

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Challenges

• Coordination with COSTI reception centre,
  consultants from HSC
• Change in flights
• Initial assessments within 24 hours (including
  CXR)
• Lack of information pre-arrival and lack of means
  to share experiences nationally

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Experiences

• Culture of politeness
• Infectious diseases no cases of tuberculosis,
  HIV or Hep C identified as yet significant
  numbers of Hepatitis B, anemias and very high
  levels of enteric parasites and dental
  infections some malaria
• Mental health very private about previous trauma
• Three children hospitalized-all currently doing
  well

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Successes

• Continuity-all 68 patients continue to be
  followed here (not the model anywhere else in
  Ontario from what we know) acquisition of trust
• Thorough screening done on all 68 arrivals
• Incredible dedicated and well trained pool of
  Karen interpreters
• Improving partnerships with COSTI, HSC, TWH
• Dental services from TPH

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Anticipated Challenges

• FOR THE KAREN COMMUNITY
• Anticipate immense issues with poverty and
  acculturation in this community
• We may (or may not) have mental health issues
  that begin to declare themselves over the next
  year
• Unimaginable number of issues around life skills
  training-language skills, employment,
  transportation, nutrition, safety etc

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Anticipated Challenges

• FOR AAMCHC
• Improve information gathering capacity-becomes
  and important tool in disseminating our
  experiences
• Improve communication with other sites receiving
  refugees (listserver/email)
• Integrate health promotion and clinical
  activities
• Refine our screening process of refugees (large
  chart review process underway)
• Continue to cultivate our relationships with
  tertiary care institutions/COSTI

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Where do we go from here?

• We feel strongly that what was done for the Karen
  refugees should be a standard of care for all
  govt assisted refugees
• Addressing next group of Karen refugees
• Streamlining our process of initial assessments
  and screening
• Publishing our experiences to guide other
  clinicians
• Considering to what extent the experience with
  the karens is generalizable to other populations
  and determining how we can serve more (ideally
  all) GARS that arrive in Toronto
• Strengthening our partnerships with COSTI (clinic
  on site?)
• Funding from CIC to increase human resources?
• Advocacy work on issues such as loans to new
  refugees
• Integration of health promotion services with
  needs of clinical clients

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