MAKING IT BETTER
Ottawa’s influx of Syrian refugees has improved services at CHEO, writes Andrew Duffy.
Mouhamad Al Rahmou had a small farm on the outskirts of Aleppo when war descended on his family.
“The different militia and the army, they were fighting over the heads of the civilians,” he says, speaking through a translator.
“The civilians suffered the most. Life was very difficult, very harsh.”
The breaking point for Al Rahmou came as he drove his wife to the hospital for the birth of his son, Hassan. Their car was repeatedly bombed en route.
“Thank God, we were saved,” he says.
Al Rahmou fled with his family to Lebanon, where he registered with the UN refugee agency. Two of his seven children, Hassan, 3, and Shahad, 4, suffer from the same incurable genetic disorder and AlRahmou was desperate to find them health care. The UNHCR arranged for the family to move to Canada as government-sponsored refugees.
The family arrived in Ottawa on Jan. 8, 2016.
Hassan was admitted to the Children’s Hospital of Eastern Ontario one week later and placed in intensive care with severe respiratory problems. Hassan’s genetic disease compromises his major organs.
Hassan stayed in CHEO for five weeks; Shahad was admitted to hospital during the same period, and stayed for three weeks.
Both children are now “much, much better,” says Al Rahmou, who wrote letters to his children’s doctors, thanking them. “I cannot find words to describe what it (CHEO) means,” he says. “It means hope.”
CHEO has been a key part of the medical response that Ottawa has mounted to last year’s influx of Syrian refugees. More than 2,000 government and privately sponsored refugees from the war-torn country arrived in the city last year, many of them suffering from neglected chronic illnesses, development issues, post-traumatic stress and other ailments.
Family doctors, pediatricians and Ottawa’s community health centres have addressed most of the refugees’ health problems; CHEO has dealt with their medical emergencies and complex care needs.
The influx has presented a significant challenge to the hospital, which first began to see Syrian refugees appear in the emergency ward in December 2015.
CHEO’s Suelana Taha was working as a clerk the night that six Syrian refugee children from four families came into the emergency department soon after landing in Ottawa. Taha, an Arabic speaker, was called in to help triage the patients, and to translate for them.
“I realized these families had no idea how to navigate our healthcare system,” Taha says. “And many of these refugees had lived in camps for two years or more with minimal medical care.”
Those first six children would be the first of 227 Syrian refugees to come through the CHEO’s doors in 2016. They would generate 240 emergency visits and 750 outpatient appointments.
Some of the refugee children came with heart and respiratory problems and other highly complex medical needs.
Dr. Tobey Audcent, a CHEO pediatrician, established an ad hoc working group to address the logistical challenges posed by the arrival of the Syrian refugees, most of whom landed in Ottawa during the first three months of 2016. “We knew a whole bunch of people arriving in a short period of time might cause some flow and capacity issues,” she says.
One challenge was to accommodate so many new patients in the already crowded schedules of specialists and outpatient clinics.
But there were also more basic problems. Many of the Syrian newcomers spoke no English so they had difficulty just finding their way around the hospital, much less conveying complex medical information and approving treatment plans.
Suelana Taha put together a binder for emergency department staff with anatomical pictures that included the corresponding words in Arabic and English.
CHEO’s Gerardo Quintanar, manager of spiritual support services, also stepped into the breach: He emailed everyone on staff and came up with a list of 25 Arabicspeaking staff members willing to help. Quintanar also recruited more Arabic-speaking volunteers and medical interpreters.
Twenty interpreters — specially trained to translate medical information — are now on call at CHEO: They provided more than 4,000 hours of translation at the hospital last year.
What’s more, Quintanar ensured that Syrian refugees such as Mouhamad Al Rahmou were aware of the hospital’s third-floor prayer room. The prayer room made a deep impression upon Al Rahmou. “The best thing is that you have a prayer room for all, for everybody,” he said. “Christians can pray here, Jews can pray here, and Muslims. Everyone can pray in this room. It means so much peace and solidarity among everybody.”
Suelana Taha was formally appointed as CHEO’s newcomer navigator in March. In that role, Taha helps Syrian refugees — and all newcomers — understand the medical system, co-ordinate appointments and care for discharged children.
She has an interpreter call families at home to remind them of appointments, and helps when necessary with travel arrangementsand buses or taxis.
Sometimes, Taha serves as a patient advocate. She has worked with public housing officials to help a Syrian family move when cockroaches invaded a child’s breathing device, and has worked with the Ottawa Children’s Treatment Centre to obtain wheelchairs for disabled children.
“A lot of these families just want their kids to get better so they can go to school and make a new life here,” she says.
Dr. Audcent says the refugee influx has provided a stress test of sorts for CHEO: a means to identify weaknesses and gaps in the hospital’s service delivery. “It’s been quite an amazing experience,” she says. “This has been a great opportunity for learning and transformation and growth.”
Improvements made to patient navigation and community outreach, Audcent says, will benefit patients from other groups made vulnerable by poverty or collective trauma.
Hospital CEO Alex Munter says the hospital has been proud to be part of the city’s broader response to the Syrian refugee crisis. “I think it will make us a better, stronger organization,” he contends.
Ottawa has a growing child and youth population that is also increasingly diverse, he says, and learning to respond to the needs of Syrian refugees has equipped staff with skills that can be transferred to other patients and their families.
“For any parent, coming to a hospital with a sick child is among the most stressful experiences a person can have,” Munter says. “So imagine going to the hospital and not speaking the language well, and not understanding the processes, or how things work.
“I think for us to think through how we individualize care for the needs of these (Syrian) patients is the same question we should be asking ourselves for every patient.”