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Helping immigrants navigate the health care system


By Sharon Gray

Medical students at Memorial are helping to improve access to medical care for the refugee population of St. John’s through the Gateway project.

Started in 2006, this project pairs first and second-year medical student volunteers with a newly-arrived refugee client of the Association for New Canadians (ANC) plus his or her translator. The student takes a medical history, summarizes the history into a two-page report, forwards the report to a doctor previously recruited to take on refugee clients, makes an appointment for the client and sends that information to the family doctor for the appointment. The ANC social worker then follows up with clients after their appointment to make sure their introduction to their new family doctor went smoothly.

It took a great deal of work to get the project off the ground. During the 2005-2006 school year, Monica Kidd and Yoella Teplitsky, then in their second year of medical studies, started exploring the idea of a community initiative to benefit new immigrants. Training in history taking with refugees and cross-cultural health care was already in place through Clinical Skills and Medical Ethics, and it was that course content that led to the idea for the Gateway project.

With the support of Drs. Pauline Duke and Fern Brunger, who were teaching cross-cultural training as part of Clinical Skills and Medical Ethics to first and second-year students, and Dr. James Rourke, Dean of Medicine, a proposal was developed to help newly-arrived refugees find family physicians. Dr. Brunger is in charge of overall planning and evaluation of the project while Dr. Duke co-ordinates the program itself.

Dr. Gerard Farrell, assistant dean for Undergraduate Medical Studies, was later added as a third faculty adviser. Dr. Duke’s experience as a family physician and clinical skills teacher with a long experience of working with newcomers to Canada, coupled with Dr. Brunger’s academic focus son cross-cultural issues in ethics, was complemented by Dr. Farrell’s expertise with database development and privacy assurance.

In mid-February of 2006, Monica and Yoella worked with the College of Physicians and Surgeons of Newfoundland and Labrador to sort out a number of legal issues surrounding setting up the program. A letter of support was obtained from the Dean of Medicine to the effect that the university would take ownership of the project and that it was part of undergraduate medical education.

The project was officially named “Gateway” on March 1, 2006. The name was later modified to be officially called the MUN Med Gateway project to distinguish it from other similar groups operating under the name Gateway.

In Early June of 2006 the first interviews were held with refugees. The first interviews were conducted by two groups of two students. Each group conducted two interviews back-to-back with refugees. The project only operated in 2006 for a few weeks before school ended for the year, but medical student Megan Smith was hired to continue work on it through a Summer Undergraduate Research Award.

In early November of 2006, Sara Cutler and Andrea Weirathmueller were elected from the first year class to be assistant co-ordinators to Megan. They later took up responsibility as co-ordinators for the 2007-2008 year.

The co-ordinators for 2008-2009 are Anna Sanderson and Karen Downton.

Anna explained a significant move forward for the Gateway project was the creation of a new electronic database to help with research and confidentiality. Karen added that this was a significant improvement and was implemented during the training of new volunteers from the first-year medical students.

Research assistant Jeff Falardeau was hired on a part-time basis in 2008 to revamp forms for the project, develop a co-ordinator’s package, and complete an evaluation of the initial two pilot years of the project.

From the point of view of the Association of New Canadians, the Gateway project has proved an invaluable resource. “I think it is a wonderful project,” said Ashley Crocker, a settlement worker with the ANC. “We really appreciate the professionalism, friendliness and kindness of the student volunteers. And the feedback from our clients is 100 per cent positive.”

Laura Mullally, the settlement social worker with the ANC, said the Gateway project has been a wonderful collaboration. “Many of our clients have had limited or unequal access to medical treatment in their countries of origin. The care and attention that they receive from the medical students through Gateway is therefore greatly appreciated. Also some families are large or have more complex medical histories and the Gateway program is a way to have a more complete history taken, especially since many family doctors have busy practices.”

Barbara Albrechtsons, a public health nurse with Eastern Health, is also involved in the Gateway project. “My role is in the obtaining of information on vaccinations and communicable disease history from the Gateway interviews. I am in a new role at the Association of New Canadians and provide referral and information regarding health resources for immigrants and refugees. I believe that the medical students provide a great resource. They have a keen interest in the families they see and refer to a family physician. I know the families seen by Gateway volunteers will be off to a good start.”

The future looks bright for the Gateway project. A list of family doctors in St. John’s willing to work with refugees has been compiled. Discussions with Dean Rourke have led additional support to the project in the form of funds for hiring a part-time co-ordinator and assisting with the collection and storage of the information. After a visioning year and two years of piloting, the Gateway project is now an established volunteer program for medical students at Memorial University.

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