Years after arrival, some refugees still struggle to navigate health care in Nova Scotia

Thousands of newcomers to Nova Scotia have benefited from the dedicated health clinic in Halifax that ushers them toward care in the early days after arrival, but when it comes time for them to leave the clinic, accessing health care often isn't easy.

The influx of Syrian refugees to Nova Scotia that began in 2015 was the largest wave of newcomers to settle in the province in recent history, and researcher Emma Stirling-Cameron recently analyzed some of their health-care experiences. 

Stirling-Cameron, who studies health promotion at Dalhousie University, interviewed about a dozen Syrian women who were displaced from their home country during the civil war and resettled in Halifax.

All the women later gave birth in their new city. 

In one especially striking case, a labouring woman in Stirling-Cameron's study said she had no access to language interpretation during eight hours of labour, and couldn't get anyone to understand her request for pain medication.

"She was desperately trying to explain to the health-care team that she wanted an epidural by pointing to her back and … just trying to motion to what she needed, but the team just thought that we wanted a back massage," said Stirling-Cameron.

"She explained that she was in the worst labour pain of her entire life and she couldn't get anyone to give her any kind of pain relief."

A spokesperson for the IWK Health Centre, where the woman gave birth, said they couldn't comment on individual cases for privacy reasons, but that multiple methods of language interpretation are available at all times.

The reason why this woman couldn't access those services is unclear, but Stirling-Cameron said it's a sign that access to interpretation needs to improve. That's one of the takeaways from a paper she published in November. 

In a second study, published in December, Stirling-Cameron found the pandemic has exacerbated existing barriers to care for newcomers.

The Newcomer Health Clinic was designed precisely to break down those barriers, but it isn't equipped to provide all types of care, and patients are meant to transition away from it within two years of their arrival.

Stirling-Cameron said the clinic provides a "hugely important" service that the women she interviewed spoke of highly, but she said there's more work to be done to ensure newcomers' needs aren't forgotten when they leave the clinic.

The challenges that await newcomers in the broader health-care system leave some, like Moustafa Alkrad, wishing they had never left the clinic.

Alkrad and his family were patients at the clinic for about two years after their arrival from Syria in 2017. With the help of clinic staff, they found a new primary care provider, but just a year later, she retired.

"You will feel yourself helpless," Alkrad said of the search for a new provider. "It really makes you feel depressed, because it's not easy at all."

Finding an opening in a family practice is a challenge for many Nova Scotians. As of Jan. 1, Nova Scotia's health authority had nearly 83,000 people registered to its waitlist for primary care. That challenge can be layered for newcomers.

Alkrad added his family to that list in early 2020, and also started making calls and visits to every clinic he could find in the Halifax area, pleading for one to accept his family as patients.

In November, after two years of searching, Alkrad found a clinic in Dartmouth that agreed to take his family, but it might not have taken so long if not for the family's size.

By Canadian standards, the Alkrad family is large, with two parents and five children. But families with seven people are the average among Syrian refugees who arrived in Nova Scotia at the same time as the Alkrads.

Alkrad's large family proved to be a barrier to finding a new primary care provider. He said he sometimes found clinics that could take him, individually, for temporary stretches, but not his whole family.

Even at the clinic where they're patients now, only four family members were initially admitted. The other three were accepted a short time later.

Stirling-Cameron said some of the barriers newcomers face could be solved by newcomers themselves.

She suggested making it easier for foreign-trained health-care workers to get Canadian accreditation — the goal being to decrease the need for interpretation services and cultural competency training by having more providers with similar backgrounds to the newcomers they treat.

It would have the added benefit of easing the widespread staffing shortages felt by all Nova Scotians.