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

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


Access alliance and the arrival of the karen refugees in toronto 2006

Canada's New Government Welcomes Burmese RefugeesOttawa, 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 Canada’s pivotal role in an international effort to provide solutions for Burmese (Myanmar) refugees stranded in camps in Thailand for more than a decade


Background to aa s involvement

Background to AA’s 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


Karen nation

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

-


Karen refugees in thailand

Karen Refugees in Thailand


Karen refugees in thailand1

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


Mae la oon

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


Mae la oon1

Mae la Oon


What was unique about the karens for aamchc

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)


Initial assessments

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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


Challenges

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


Experiences

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


Successes

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


Access alliance and the arrival of the karen refugees in toronto 2006

Canada to welcome 2,000 more Karen refugees

London, February 9, 2007 — The Honourable Diane Finley, Minister of Citizenship and Immigration, today announced that Canada will welcome an additional 2,000 Karen refugees from Burma (also known as Myanmar) over the next two years.


Anticipated challenges

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……


Anticipated challenges1

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


Where do we go from here

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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