Nova Scotia's sole health clinic for refugees to expand, restart admissions

With a second bout of breast cancer wreaking havoc on her body, Sawsan Khudhair didn't think she had much time left.

The 61-year old Iraqi woman fled her war-torn country in 2003 with her three daughters. Together they spent the next 18 years as refugees moving around the Middle East. 

While living in Jordan in 2019, Khudhair discovered the breast cancer that had gone into remission in 2001 was back. Access to health care was limited, with long waits or high prices, or both. She received some treatment, but the doctors made it clear: the cancer could not be stopped. Her condition continued to deteriorate.

But then came the break the family had been hoping for. They connected with a private sponsorship group, Open Harbour Refugee Association, which agreed to help bring the family to Halifax.

"It was a long journey until we reached Canada," said Hind Al-Fadly, one of Khudhair's daughters, who spoke on behalf of the family in an interview with CBC. Khudhair knows only a few words of English.

That journey ended in June 2021 when they flew to Toronto and then on to Halifax. Khudhair's health-care journey was just beginning anew.

While in government-mandated COVID-19 quarantine after their arrival, Khudhair had a virtual assessment with a physician from the Newcomer Health Clinic in Halifax. It's the only clinic of its kind in Nova Scotia, specializing in the medical needs of refugees.

Just a few months after Khudhair became a patient, the clinic closed its doors to new admissions because it was so overwhelmed with its existing patient roster. 

But now the clinic is poised to grow, and reopen its doors to new patients, allowing for more opportunities like the one Khudhair credits with saving her life.

During her initial assessment, Khudhair was prescribed pain medication and referred for cancer treatment. She continues to receive hormone therapy.

Through her daughter, Khudhair said she was surprised by and grateful for the experience. 

"She wasn't expecting this," said Al-Fadly. "She was only hoping, 'Oh, I want to live until I get to Canada and that's all.' She didn't expect to get treatment here. It was amazing."

The provincial government recently gave the green light to a proposal from the Newcomer Health Clinic to hire additional physicians, add a social worker to the team and expand the clinic's physical footprint.

Dr. Tim Holland, the clinic's director, said the added staff will bring capacity up to match demand. Since the influx of Syrian refugees began in 2016, Holland said the clinic has been operating at about triple its capacity.

With this expansion, Holland said he expects operations to be sustainable, even as a new wave of refugees arrives in Canada from Afghanistan. About 100 Afghan refugees arrived to settle in Halifax in December and more are expected over the next two years.  

"When the newcomer clinic was closed, a lot of these refugee arrivals had no place to go for health care other than the emergency department. A lot of walk-in clinics wouldn't necessarily accept refugee patients," said Holland.

Expanding the clinic, he said, is not just good news for refugees, but for all Nova Scotians who are trying to access health care in a system under strain.

"Now [refugees] can be seen at the Newcomer Health Clinic, which is a much more cost-effective way to do so, thereby opening up more emergency services for those who would otherwise be waiting that much longer in the waiting rooms."

Government- and privately-sponsored refugees qualify for public health care upon arrival, but their needs are often complex after years of medical neglect. They often require language interpretation and are likely to need help navigating the Canadian health-care system.

The Newcomer Health Clinic was set up in 2015 to address those barriers and prepare refugees to transition to the broader health-care system. While the clinic seems to be succeeding with the former of those goals, challenges remain with the latter.

Holland said ideally, patients transition away from the clinic between six months to two years after arrival, but that often is not the reality. They stay on the roster until they find a new family doctor or nurse practitioner, and with Nova Scotia's shortage of primary care providers, that can take much longer than two years.

Holland said he's optimistic the primary care shortage will ease in 2022 as the provincial government's new health-care recruitment team continues its work, and virtual care options continue to expand.