Feels Like Home

A decade of helping newly arrived refugees flourish in Canada

For Dr. Meb Rashid, no two days are alike – and it has been this way for the past ten years. As the founder and medical director of the Crossroads Refugee Clinic at Women’s College Hospital (WCH), he often finds himself working with a diverse population of patients who each bring a unique set of circumstances and experiences.

“I always say there’s a commonality to the human experience that is universal – but there are also differences that keep us on our toes,” describes Dr. Rashid. “The practice we have now is completely different from what we had five and ten years ago. A decade ago, we saw many North Korean refugees here in Canada, followed by Syrians. A couple of years ago, we set up a clinic in a hotel to support all the Afghan refugees, and now we are seeing many people from Ethiopia, Eritrea, and Nigeria. And every wave is different.”

For the patients of the Crossroads Clinic, stepping through the clinic’s doors is a milestone in an often long and arduous journey. Most of the clinic’s patients are newly arrived refugees or refugee claimants from all over the world, many of whom may have recent experiences of trauma and have never had access to primary care.

First opened in 2011, the Crossroads is Toronto’s first hospital-based refugee health clinic. In the decade that has since passed, the team has witnessed significant changes both to the refugee healthcare landscape and within the walls of the clinic itself.

“There were only three of us when the clinic first opened,” reflects Dr. Rashid. “I was there four days a week, alongside our full-time nurse practitioner and our receptionist.”

Today, the Crossroads team has more than doubled in size and grown into a multi-disciplinary team that includes a social worker, nurse practitioners, physicians, a medical secretary and a peer navigator. In that time, demand for these specialized services has also grown with the number of annual refugee claimants nearly quadrupling to 91,000 claimants across Canada in 2022.

“We know a lot of these people end up in Toronto, with many of them landing in shelters when they first arrive,” explains Dr. Rashid. “So, it was important for us to cultivate relationships with our shelter partners.”

The team started by establishing a satellite clinic at Sojourn House, the largest refugee claimant shelter in Toronto, and now regularly sees patients from half a dozen more refugee and homeless shelters. These partnerships help the Crossroads team get information on the ground as new population groups arrive with unique needs. It is also an opportunity to support the shelter staff, keeping them apprised of healthcare issues. And, most importantly, it is a critical time to connect newly arrived refugees to health and social services.

“When we visit these settings, we are often seeing people within days or even hours of arrival,” explains Dr. Rashid. “Their trauma can be very fresh – we have seen people who, within the past week, were being assaulted or tortured in prisons on the other side of the world. For them to heal and thrive here in Canada, it’s important to connect them to the health system as quickly and smoothly as possible.”

Once a patient leaves the shelter, the team ensures a continuum of care by providing the option to see a Crossroads provider at the clinic located at Women’s College. The clinic provides comprehensive primary care and is set up to address the unique challenges experienced by its patients in terms of settlement, counselling, and language barriers.

“We know that refugees do really well in Canada given the opportunity,” describes Dr. Rashid. “The vast majority of people we see, despite the horrible trauma they’ve endured, are able to put their lives back together. Their major concerns are getting a job, accessing social services, putting their kids in school and figuring out how to navigate winter.”

In fact, it was in observing the difficulties experienced by patients in accessing healthcare services as well as essential community and social resources that inspired the clinic’s new Peer Navigator pilot program. After meticulous community consultation, the Peer Navigator Role was established in May 2022.

“During consultation, patients emphasized the challenges in physically navigating a new city, particularly when they don’t speak English,” describes Dr. Vanessa Redditt, a family physician with Crossroads and the clinical lead for the new Peer Navigator Program. “This helped us to advocate for the peer navigator role to include accompaniment and support activities outside of the hospital.”

Semhar Musael, the clinic’s first Peer Navigator, arrived in Canada just two years ago. In her new role with the Crossroads Clinic, Musael guides patients through their healthcare journey and beyond. Fluent in Amharic and Tigrinya, languages often spoken in the Ethiopian and Eritrean regions, she often finds herself helping her patients – many of whom cannot read or write in English – navigate the settlement process, access housing or childcare services, among many other things.

“I understood the struggles people were going through while trying to navigate a new healthcare system. As someone who was educated and could speak English, it was still hard for me,” Musael shares. “Knowing I wanted to serve my community while using my professional background and life experience, when I saw this job, it was like it was written for me.”

Together with the patient and their primary care provider, she identifies what priorities patients have and what types of support they need. This can include accompanying patients and clients to appointments, navigating phone services, as well as providing emotional support, comfort, advice, and empathetic listening.

With over 1,200 interactions between Musael and Crossroads patients, the Peer Navigator program has already had an impact on patient care and outcomes – and is an indication of how far the Crossroads Clinic has come since it first opened.

Reflecting on the past ten years, Dr. Rashid is also quick to point out how much the community of providers dedicated to refugee health has grown. “Specialized refugee clinics are now expanding all across the country – it certainly wasn’t like that 20 years ago,” he observes. “And part of our mandate is to try to share our experiences to help guide clinicians who don't necessarily see as many newcomers as we do. And I don’t think a day goes by where we don’t have a learner in our clinic.”

Collectively, the Crossroads team has presented at more than 70 conferences across North America and have more than 30 publications, in addition to community-based trainings and workshops. “This is work that we are truly proud of because none of us are really researchers,” adds Dr. Rashid. “But I think it speaks to the importance of getting this information out there.”

Even as the team plans to continue building on this momentum, the core beliefs that inspired them to first open the doors of the Crossroads Clinic ten years ago endure. “Our job is to help our patients flourish in Canadian society,” points out Dr. Rashid. “We are here to provide the best clinical care we can to as many people as we can.”

The Language of Care

Born and raised in Spain and having trained and worked around the world in places like the UK, Switzerland, the Caribbean and Canada, Dr. Blanca Bolea-Alamanac has a global perspective on healthcare. She has seen firsthand the power of language as a tool to enhance care – first with her patients and now through her regular appearances on local Spanish-language radio.

Read This StoryIncredibly, Dr. Bolea-Alamanac is trilingual, speaking French, English and Spanish – and while there are many French speaking doctors here in Canada who can offer meaningful care to native French speakers, Blanca shares that there are major barriers for Spanish speaking communities seeking equitable access to knowledge and resources in the Canadian healthcare system.

“In psychiatry, it’s very important to be able to speak someone’s home language,” says Dr. Bolea-Alamanac, psychiatrist and researcher at Women’s College Hospital. “Different languages have very specific taboos and different flexibility around what feelings are okay to show and to be expressed, so it’s important to have someone who can understand that nuanced terminology in healthcare settings.”

Throughout the COVID-19 pandemic, Women’s College Hospital was looking to share information about vaccines and COVID-related information in multiple languages. As a result, Dr. Bolea-Alamanac appeared as a guest on Radio Canadá Internacional, CBC’s Spanish Radio channel, to discuss the pandemic and communicate important messaging to the Spanish speaking community in Toronto. From there, she was invited to be on CHHA 1610 AM’s Hoy en Toronto (Today in Toronto) – another Toronto based Spanish radio show that she has been appearing on weekly for over eighteen months.

The program, which initially discussed COVID-19 vaccines and ‘needle-phobia,’ quickly morphed into issues surrounding mental health, like obsessive-compulsive disorder (OCD), COVID-19 isolation, trauma and more. The program received an overwhelming response with Dr. Bolea-Alamanac eventually gaining a primetime spot where she fields difficult and personal questions from the show’s audience.

“It was illuminating to realize many Canadian healthcare resources are not available in Spanish,” shares Dr. Bolea-Alamanac. “People are just learning about the health system here in Canada, and I’m able to answer difficult questions and bring on experts to help people navigate what can often be a confusing system, especially for newcomers to the country.”

Dr. Blanca Bolea-Alamanac’s appearances have continued to bolster radio listenership, with over 70,000 listeners now tuning in from all over the world with questions surrounding mental health and psychiatry. As her work continues, Dr. Bolea-Alamanac looks to infuse great healthcare value to the show’s listeners by communicating in people’s native languages, a resource that has proven invaluable to the communities she serves.