Article by Sara Eftekhar
When Canadian students think about “Global Health”, they often imagine health disparities in vulnerable and underserved populations across the globe. Many students feel that in order to capture a taste of global health, they must travel and work abroad. However, Dr. Maureen Mayhew experiences health from an international perspective in Vancouver when she provides care for her refugee patients at Bridge clinic.
Bridge is a health clinic that provides immediate primary and preventative healthcare services with interpreters for government assisted refugees and refugee claimants in BC. The staff members at Bridge are dedicated to educating refugees to access medical services. Bridge acts as a transition clinic during the first year that refugees arrive in BC hoping that by the end of the first year of their arrival, the refugees can be successfully transferred to family doctors in the community.
Dr. Mayhew was not exposed to refugee health as a medical student at McGill University but she had always been interested in the cross cultural aspects of health. As a medical student, she knew she wanted to work internationally to gain a better perspective of the diversity of people living around the world but it seems that that diversity has come to her as she is now an advocate for refugee health in Vancouver and working at Bridge as a family physician.
Each year British Columbia accepts approximately 850 government assisted refugees and roughly 1,150 refugee claimants. Some of these Refugees in Canada have been ravaged by war, disease, drought, poverty and their health issues range from unusual infectious diseases to problems with transitioning in their new home.
“Refugees have lived through conditions you and I cannot even imagine living through. A typical day doesn’t exist for me at Bridge as everyone who comes into my office is so unique. One day my patient could be somebody with PTSD, then it could be a woman who doesn’t know she’s pregnant or it could be a broken down family or it could be ten people in my room with five kids under the age of seven. So, it can be very varied, there’s a lot of psychology involved and then there’s a lot of real medicine. It’s worthwhile, yet challenging.” Says Dr. Mayhew.
When refugees first arrive, they go through many traumatic components; adaptation to Canadian culture and Canadian systems is only one aspect of the many struggles they face upon arrival. As well, many refugees face other barriers to health including poverty, unemployment, housing, illiteracy and social isolation. It costs about $10 for a round trip from New Westminster and Surrey (where the majority of refugee populations reside) to Bridge Clinic and this presents a barrier for them to seek care at Bridge. Therefore there are many areas of health that are in need for improvement.
Having a Master’s in Public Health from Johns Hopkins Bloomberg School of Public Health, Dr. Mayhew is also very interested in finding alternative and culturally sensitive ways to reach out to refugee populations for health promotion and prevention. She recalls a story of an elderly man who brought his grandson into the clinic worried about his grandson being underweight. When Dr. Mayhew asked what the grandson had been eating, the grandfather replied “he likes things in the bag at the grocery store” meaning his grandson was living on junk food such as potato chips and candy in nicely packaged boxes and bags. As a result of a language and cultural barrier, the grandfather had been mislead by the advertisements on products at grocery stores, thinking they must be nutritious if they are served in Canada.
“This man did not speak the language of any of the public health messaging that we have grown up with. It seemed ludicrous to him when I said not to buy food products in the “bag”. He thought to himself, “the bag says its nutritious…so why wouldn’t I buy them?” It’s really interesting to get inside his brain and try to figure out what’s the motivation and messaging that need to happen in order for him to value better food. I told him to eat what he used to not what he thinks we Canadians eat. Public health messaging is huge and we as medical doctors often underestimate it. This is why prevention is a worthwhile investment.” Explains Dr. Mayhew.
In addition to working with the refugee population in Vancouver, Dr. Mayhew has a wide variety of experiences nationally and internationally. Being involved in global health projects has been a “gradual evolution” for her. She has worked in Inuit villages all across Canada and has been continuously involved in child and maternal health projects in Afghanistan. She views global health in a way that includes rural and remote cross cultural aspects of health and health care delivery. She also teaches a graduate level class on remote and rural health at UBC. Despite her busy schedule, Dr. Mayhew remains committed to improving refugee health in Canada. She is working on several research projects involving refugees in Vancouver in terms of how they look at their own health, access health. By her research efforts, she hopes to link health policy to ground level providers. “My ultimate goal is to be that link to the ground level work but yet speak the speak of the policy makers and do the research that changes the policy.”
As for advice to health science students, she says “if you think futuristically, we are accepting lots and lots of immigrants and refugees and our population is shifting. I think all students and residents should gain experience of cross cultural care…this could be in the Downtown Eastside…it can be with refugees and immigrants…or it can be remote health care. To me, it’s about approaching a person and understanding that they might not think the same as you, so you really have to think about how you’re going to care for them in innovative ways in a language that they understand”
It is no surprise that in Canada’s multicultural and multiethnic society, health care professionals must be culturally competent and understand that refugees in Canada bring with them their stories of hardships and strength as many of them have been victims of complex humanitarian disasters. These stories challenge health care workers in Vancouver to ask questions of how do poverty, gender, environment, and globalization reinforce existing health disparities, and what can be done in these areas to improve health right here at home?
The UBC Global Health initiative had their first workshop on Global Health in Canada, for more information about refugees in Canada and to access the presenter’s slides visit: GHI Workshop Presentations