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Practice

Caring for a newly arrived Syrian refugee family

Kevin Pottie, Christina Greenaway, Ghayda Hassan, Charles Hui and Laurence J. Kirmayer
CMAJ February 16, 2016 188 (3) 207-211; DOI: https://doi.org/10.1503/cmaj.151422
Kevin Pottie
Bruyère Research Institute, Department of Family Medicine (Pottie); Department of Pediatrics, Division of Infectious Diseases (Hui), University of Ottawa, Ottawa, Ont.; Division of Infectious Disease (Greenaway); Division of Social and Transcultural Psychiatry (Kirmayer), McGill University, Montréal, Que.; Department of Psychology (Hassan), Université du Québec à Montréal, Montréal, Que.
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  • For correspondence: kpottie@uottawa.ca
Christina Greenaway
Bruyère Research Institute, Department of Family Medicine (Pottie); Department of Pediatrics, Division of Infectious Diseases (Hui), University of Ottawa, Ottawa, Ont.; Division of Infectious Disease (Greenaway); Division of Social and Transcultural Psychiatry (Kirmayer), McGill University, Montréal, Que.; Department of Psychology (Hassan), Université du Québec à Montréal, Montréal, Que.
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Ghayda Hassan
Bruyère Research Institute, Department of Family Medicine (Pottie); Department of Pediatrics, Division of Infectious Diseases (Hui), University of Ottawa, Ottawa, Ont.; Division of Infectious Disease (Greenaway); Division of Social and Transcultural Psychiatry (Kirmayer), McGill University, Montréal, Que.; Department of Psychology (Hassan), Université du Québec à Montréal, Montréal, Que.
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Charles Hui
Bruyère Research Institute, Department of Family Medicine (Pottie); Department of Pediatrics, Division of Infectious Diseases (Hui), University of Ottawa, Ottawa, Ont.; Division of Infectious Disease (Greenaway); Division of Social and Transcultural Psychiatry (Kirmayer), McGill University, Montréal, Que.; Department of Psychology (Hassan), Université du Québec à Montréal, Montréal, Que.
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Laurence J. Kirmayer
Bruyère Research Institute, Department of Family Medicine (Pottie); Department of Pediatrics, Division of Infectious Diseases (Hui), University of Ottawa, Ottawa, Ont.; Division of Infectious Disease (Greenaway); Division of Social and Transcultural Psychiatry (Kirmayer), McGill University, Montréal, Que.; Department of Psychology (Hassan), Université du Québec à Montréal, Montréal, Que.
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  • An Open Letter to Refugees From Canadian Medical Students
    Koray Demir
    Posted on: 31 May 2016
  • Refugees and public health concerns
    Lawrence C. Loh, MD, MPH, CCFP, FRCPC, FACPM
    Posted on: 22 February 2016
  • Posted on: (31 May 2016)
    Page navigation anchor for An Open Letter to Refugees From Canadian Medical Students
    An Open Letter to Refugees From Canadian Medical Students
    • Koray Demir, National Officer of Human Rights and Peace

    As medical students, we are encouraged and inspired by physician leaders, including the authors of this piece, who are invested in the health of refugees. To add our voices to this conversation, over 500 of us from diverse backgrounds and medical students across the country have signed onto the attached open letter, reaffirming Canadian medical students' commitment to the health and wellbeing of refugees in our communiti...

    Show More

    As medical students, we are encouraged and inspired by physician leaders, including the authors of this piece, who are invested in the health of refugees. To add our voices to this conversation, over 500 of us from diverse backgrounds and medical students across the country have signed onto the attached open letter, reaffirming Canadian medical students' commitment to the health and wellbeing of refugees in our communities.

    --------

    To our newly arrived friends and neighbours,

    We, the undersigned, are medical students from around Canada. We work daily with patients in communities all over the country, and will soon be practicing physicians in Canada's hospitals and clinics. As our government prepares to welcome many refugees from areas of conflict, we would like to take a moment to say hello - and reaffirm our commitment to working hard for the wellbeing of you and your loved ones as you begin a new chapter of your lives.

    For one, we understand that navigating the healthcare system of a completely new country will be challenging. Still, we hope that you will never hesitate to seek care for yourselves or your families should you need it. When we meet you, we pledge to be patient, understanding and empathetic, such that your experience in the Canadian healthcare system is as positive as possible.

    We commit also to acknowledging the particular challenges that have been part of your lives prior to arriving in Canada. We will consider them carefully in speaking with you and in understanding how they may have shaped your health, and how we can play a part in helping you to move forward.

    Our role as future physicians does not end at offering care in clinics and hospitals. When we see injustices and inequity in health, we are bound to advocate for better health on a broader level. We will use our voices to ensure that your physical and mental wellbeing are considered priorities for policymakers.

    In particular, we understand that the conditions of your daily lives are the most important factors in determining the long-term health of you and your families. We will continue advocating for your access to adequate housing, education and employment, among other social factors that may influence your health.

    In this vein, we will reject discriminatory or hateful rhetoric if it arises. Threats to your human rights and dignities are an offense to our core values as medical students and as Canadians. We will stand by you and defend your rights with conviction.

    We are eager to do our part such that you feel comfortable, welcome and, most importantly - at home, here in Canada. We hope the years ahead bring you and your families happiness, and we look forward to sharing them with you as healthcare professionals, advocates for health and as neighbours in your communities.

    From medical students around the country, welcome to Canada.

    Signed, sincerely:

    Name Medical Faculty Graduating Year

    1. Abdelhakim Khellaf, McGill University 2019

    2. Abdul Raheem, University of Alberta 2018

    3. Abdulkarim Muhaseen, University of Toronto 2019

    4. Adam Rocker, University of Ottawa 2019

    5. Adam Stich, University of British Columbia 2019

    6. Adriana Mejia-French, University of British Columbia 2016

    7. Adriano Mollica, University of Toronto 2019

    8. Ahmad Mousa, University of Toronto 2019

    9. Albert Vu, University of Alberta 2018

    10. Alexa Clark, University of Ottawa 2016

    11. Alexander Dodd, University of British Columbia 2018

    12. Alexandra Dansen, University of Manitoba 2019

    13. Alexandra Rice, University of British Columbia 2019

    14. Alexandre Coutin, University of Toronto 2019

    15. Alexandre McDougall, University of Western Ontario 2018

    16. Alexandria Chen, University of Western Ontario 2018

    17. Ali Damji, University of Toronto 2017

    18. Alison Berzins, University of Western Ontario 2018

    19. Alison Spurr, Dalhousie University 2018

    20. Alison Sumner, University of Toronto 2019

    21. Aliza Moledina , University of Ottawa 2016

    22. Allison Clay, University of Western Ontario 2016

    23. Allison Hudson, Dalhousie University 2018

    24. Alvin Yang, University of Toronto 2019

    25. Alysha Rasool, University of British Columbia 2017

    26. Alyssa Archibald, University of Manitoba 2019

    27. Aman Gera, University of Manitoba 2018

    28. Amanda Dancsok, University of British Columbia 2017

    29. Amanda Glenn, Dalhousie University 2019

    30. Amanda Sauve, University of Western Ontario 2018

    31. Amanda Whitten, University of Calgary 2017

    33. Amina Allalou, University of Ottawa 2019

    34. Amir Parsoei, University of Saskatchewan 2017

    35. Amy Chung, The University of Ottawa 2018

    36. Amy Cook, University of Alberta 2019

    37. Amy Li, University of Calgary 2018

    38. Amy Macdonald, Dalhousie University 2018

    39. Amyna Fidai, University of Calgary 2018

    40. Anam Irshad, University of Calgary 2017

    41. Anand Lakhani, University of Toronto 2018

    42. Andrea Kulyk, University of Manitoba 2018

    43. Andrea Moir, University of Calgary 2018

    44. Andrew Ajisebutu, University of Manitoba 2019

    45. Angela Cung, University of Manitoba 2016

    46. Anish Naidu, University of Western Ontario 2019

    47. Ann Lin, University of British Columbia 2016

    48. Anna McLean, Dalhousie Medical School 2019

    49. Anna Mierzwa, University of Western Ontario 2018

    50. Anna Schwalfenberg, University of Alberta 2017

    51. Anne-Sara Briand, McGill University 2018

    52. Anthony Bismar, Universite de Sherbrooke 2018

    53. Anthony Emmott, University of British Columbia 2019

    54. Anthony Wong , University of Calgary 2018

    55. Ari Cuperfain, University of Toronto 2019

    56. Arnav Agarwal, University of Toronto 2018

    57. Aselin Weng, McGill University 2019

    58. Ashley Tse, University of Alberta 2017

    59. Ashley Yip, University of British Columbia 2018

    60. Asma Amir Ali, Western University 2019

    61. Ateshia Walker, University of British Columbia 2018

    62. Austin Yan, University of Ottawa 2022

    63. Ayan Dey, University of Toronto 2018

    64. Ayesha Nazarali, University of Alberta 2019

    65. Azalea Lehndorff, University of Calgary 2018

    66. Bandeep Kaur, University of Western Ontario 2019

    67. Ben Schwartzentruber, University of British Columbia 2017

    68. Ben Sheppard, University of British Columbia 2017

    69. Bernice Fonseka, University of Calgary 2018

    70. Bethea Shute, University of Alberta 2018

    71. Betty Wang, University of Alberta 2019

    72. Blake Lerner, University of Manitoba 2019

    73. Bogdan Beca, Dalhousie Medical School 2019

    74. Bon Lam, University of Calgary 2018

    75. Bonnie Liu, University of Saskatchewan 2019

    76. Boris Virine, University of Western Ontario 2019

    77. Brandon Evtushevski, University of British Columbia 2019

    78. Brandon McIlmoyle, University of British Columbia 2019

    79. Brandon Yau, University of British Columbia 2019

    80. Breanne Carey, University of British Columbia 2016

    81. Brendan Cassidy, University of Western Ontario 2019

    82. Brendan M. Wong, University of Ottawa 2018

    83. Brendon To, University of Calgary 2018

    84. Brian Tran, McGill University 2019

    85. Bridget Gibson, University of Calgary 2017

    86. Brittany Boorman, University of British Columbia 2019

    87. Brittany Gillis, Dalhousie University 2016

    88. Brock Randolph, University of Alberta 2018

    89. Brooke Edwards, University of Western Ontario 2019

    90. Bruce Gao, University of Calgary 2018

    91. Caitlin Lee, University of Alberta 2019

    92. Caleb De Putter, University of British Columbia 2016

    93. Camille Paradis, McGill University 2019

    94. Carl Severson, University of Calgary 2017

    95. Carly Yim, University of Alberta 2019

    96. Carmen Wong, University of British Columbia 2019

    97. Carolyn Wonneck, University of Manitoba 2018

    98. Casey Wang, McGill University 2019

    99. Catherine A Wassenaar, University of Western Ontario 2018

    100. Catherine Hart, Dalhousie University 2018

    101. Catherine Liu, Universite de Sherbrooke 2016

    102. Ceilidh Kinlin, University of Calgary 2017

    103. Ceinwen Pope, University of Ottawa 2018

    104. Chaitanya Gandhi, University of Alberta 2019

    105. Charissa Chen, University of Calgary 2016

    106. Charles Yin, University of Western Ontario 2018

    107. Charles-Antoine Barbeau-Meunier, Universite de Sherbrooke 2019

    108. Charles-David Clayton, University of British Columbia 2019

    109. Chelcie Soroka, Dalhousie Medical School 2016

    110. Chelsea Hart, University of Northern British Columbia 2019

    111. Cheryl Gascoyne, University of British Columbia 2019

    112. Cheryl Young, University of Toronto 2018

    113. Cheyenne Lawton, University of Saskatchewan 2017

    114. Chloe LaBrie, University of Calgary 2018

    115. Chris Harper, University of Toronto 2018

    116. Chris Picheca, University of Calgary 2018

    117. Christine M. Kennedy, University of Northern British Columbia 2018

    118. Christine Patterson, University of Alberta 2019

    119. Cindos Barakat, University of Western Ontario 2019

    120. Cindy Zhu, University of Western Ontario 2018

    121. Claire MacKinlay, University of British Columbia 2019

    122. Clara Hong, University of British Columbia 2018

    123. Clara Van Ommen, University of British Columbia 2019

    124. Clara Westwell-Roper, University of British Columbia 2016

    125. Claudel P-Desrosiers, Universite de Montreal 2018

    126. Colin Maslink, University of Toronto 2019

    127. Colin Siu, University of Alberta 2017

    128. Colton Lewis, University of Alberta 2019

    129. Connie Drewbrook, University of British Columbia 2017

    130. Connor Dietz, University of British Columbia 2019

    131. Connor Hawkins, University of British Columbia 2018

    132. Connor McGuire, Dalhousie University 2019

    133. Craig Olmstead, University of Western Ontario 2017

    134. Cynthia Kong, University of British Columbia 2016

    135. Cyrus Thomas, University of British Columbia 2019

    136. Dan Cojocaru, University of British Columbia 2018

    137. Daniela Keren, University of Calgary 2018

    138. Danielle Murray, University of British Columbia 2018

    139. Danielle Thordarson, University of Manitoba 2019

    140. Danika Leung, University of Alberta 2017

    141. Danny Aceytuno, University of Calgary 2018

    142. Dave Lincoln, University of Calgary 2018

    143. David Benrimoh, McGill University 2016

    144. David Galiano, McGill University 2018

    145. David Kishlyansky, University of Ottawa 2019

    146. David Van de Vosse, University of British Columbia 2016

    147. Deanna Lammers, University of Ottawa 2018

    148. Deborah Isabel Reid, University of Ottawa 2018

    149. Devin Hasanally, University of Manitoba 2018

    150. Devin Masyk-Neumeier, University of British Columbia 2016

    151. Dima Saab, University of Toronto 2019

    152. Dorothy Yu, University of Manitoba 2018

    153. Elise Van Brummelen, University of British Columbia 2018

    154. Ellen Snyder, University of Ottawa 2016

    155. Ellie MacBain, University of British Columbia 2019

    156. Emily Macphail, University of Calgary 2017

    157. Emily O'Reilly, Dalhousie Medical School 2019

    158. Emily-Lauren Simms, University of Saskatchewan 2019

    159. Emma Boyce, University of Calgary 2018

    160. Emma Jackson, University of British Columbia 2019

    161. Emma Mitchell, University of British Columbia 2019

    162. Erfun Hatam, University of Western Ontario 2018

    163. Eric Wong, University of British Columbia 2018

    164. Erica Cleto, University of Western Ontario 2019

    165. Erica Hoe, University of Western Ontario 2016

    166. Erik Hopkins, University of Calgary 2017

    167. Erin Campos, University of Western Ontario 2019

    168. Erin Love, University of British Columbia 2017

    169. Ernest Chan, University of Western Ontario 2017

    170. Evan Ailon, University of Western Ontario 2016

    171. Evan Batten, University of Toronto 2019

    172. Fatima Mahdi, University of Calgary 2018

    173. Fei Fei Shao, University of Western Ontario 2019

    174. Frances Morin, University of British Columbia 2019

    175. Franco Rizzuti, University of Calgary 2017

    176. Gabriel Dmytryszyn, Universite de Manitoba 2019

    177. Gabriel Lavoie, Universite de Montreal 2018

    178. Galilee Thompson, University of Saskatchewan 2018

    179. Gaya Narendran, University of Calgary 2018

    180. Gayathri Narendran, University of Calgary 2018

    181. Gisele Adam, University of British Columbia 2018

    182. Golden Gao, University of British Columbia 2017

    183. Greg Costello, University of British Columbia 2016

    184. Gurinder Grewal, University of British Columbia 2016

    185. Gurmeet Kaur Sohi, University of Manitoba 2018

    186. Hailey McInnis, University of Calgary 2017

    187. Haley Butcher, McGill University 2018

    188. Hamzah Qureshi, University of Toronto 2016

    189. Han Yan, University of Western Ontario 2017

    190. Hao Li, University of Western Ontario 2016

    191. Harjot Bedi, University of British Columbia 2018

    192. Hayley Levinson, University of Calgary 2017

    193. Heather O'Halloran, University of Toronto 2018

    194. Helene Babakissa, Universite de Montreal 2018

    195. Helene Morakis, Queen's University 2019

    196. Henry Annan, Dalhousie University 2018

    197. Ian Armstrong, University of Alberta 2016

    198. Inas Slim, Universite de Montreal 2018

    199. Ismat Ali, University of Calgary 2018

    200. Izn Shahab, University of Saskatchewan 2019

    201. Jacob Matthews, University of Western Ontario 2018

    202. Jacqueline Bobyn, University of Calgary 2018

    203. James B, University of Toronto 2019

    204. James Fowler, Dalhousie University 2019

    205. James Welke, University of Alberta 2018

    206. Jamie Gregg, University of Alberta 2019

    207. Janine Reid, University of British Columbia 2016

    208. Jarad Plato, University of Northern British Columbia 2019

    209. Jasleen Grewal, University of Western Ontario 2019

    210. Jasmine Lo, University of British Columbia 2019

    211. Jason Elzinga, University of Western Ontario 2019

    212. Jeanette Pedersen, University of Calgary 2017

    213. Jeanine McColl, University of Calgary 2017

    214. Jeff Friesen, University of Western Ontario 2016

    215. Jeff Gustafson, University of Western Ontario 2019

    216. Jennifer Day, University of Calgary 2017

    218. Jennifer Kirkpatrick, University of Manitoba 2019

    219. Jennifer Zhang, Western University 2018

    220. Jenny Guo, McGill University 2017

    221. Jenny Peng, University of Ottawa 2018

    222. Jenny Saunders, University of Calgary 2018

    223. Jeremy Cepek, University of Western Ontario 2018

    224. Jessica Bednarz, University of Manitoba 2018

    225. Jessica Bryce, University of Western Ontario 2018

    226. Jessica MacIntyre, Dalhousie University 2019

    227. Jessica McLellan, University of Calgary 2017

    228. Jessica Reiniger, University of Saskatchewan 2019

    229. Jessica Siu, University of Western Ontario 2018

    230. Jessica Tamura-Wells, University of Calgary 2017

    231. Jodie Roberts, University of Calgary 2017

    232. Joe Truong, University of Western Ontario 2019

    233. Joel Mohr, University of British Columbia 2018

    234. John White, University of Western Ontario 2019

    235. John-Jose Nunez, University of British Columbia 2017

    236. Johnathan Lau, University of Ottawa 2019

    237. Jon Herriot, University of Saskatchewan 2016

    238. Jonathan Fuller, University of Toronto 2019

    239. Jordon Charlebois, University of Western Ontario 2016

    240. Joseph Goody, University of British Columbia 2019

    241. Josh Taylor, University of Ottawa 2019

    242. Joshua Aquin, University of Manitoba 2018

    243. Joshua Nicholas, University of Calgary 2018

    244. Julia Wright, Dalhousie University 2019

    245. Julianna Deutscher, University of Alberta 2018

    246. Justin Neves, McMaster University 2016

    247. Justin Tabah, McGill University 2018

    248. Justine Hames , University of Alberta 2018

    249. Justyne Morrow, University of British Columbia 2016

    250. Karl Narvacan, University of Alberta 2019

    251. Kate Knuff, University of British Columbia 2018

    252. Kate Reilly, University of Western Ontario 2016

    253. Katelyn Postnikoff, University of Saskatchewan 2018

    254. Kathleen Deering, University of British Columbia 2019

    255. Katie Girgulis, University of Alberta 2019

    256. Kavithan Abbu, University of Manitoba 2018

    257. Kay Fung, University of British Columbia 2016

    258. Kayla Feragen, University of Calgary 2017

    259. Kayla McGowan, University of British Columbia 2019

    260. Kayla Simms, University of Ottawa 2017

    261. Kaylynn Purdy, Northern Ontario School of Medicine 2018

    262. Keely Hammond, University of British Columbia 2019

    263. Keely Loewen, University of Manitoba 2018

    264. Kelcie Lahey, University of Calgary 2018

    265. Kelly Huang, University of British Columbia 2019

    266. Kelly Lau, McGill University 2017

    267. Kendell Pon, University of Saskatchewan 2018

    268. Khue-Tu Nguyen, University of British Columbia 2018

    269. Kia Dullemond, University of British Columbia 2019

    270. Kiersten Amos, Dalhousie University 2019

    271. Kim Kaspy, McGill University 2016

    272. Kinjal Patel, University of Alberta 2019

    273. Kiran Rikhraj, University of British Columbia 2019

    274. Kirsten Marr, University of Calgary 2017

    275. Kit Moran, Dalhousie University 2019

    276. Koray Demir, McGill University 2018

    277. Kristin Burles, University of Alberta 2017

    278. Kristyn Kurio, University of Alberta 2016

    279. Kriti Kumar, University of Western Ontario 2019

    280. Kyla Adams, University of British Columbia 2018

    281. Kyla Barrie, University of Manitoba 2018

    282. Kyle Ng, University of Ottawa 2018

    283. Lahoud Touma, McGill University 2018

    284. Laura Faulkner, Dalhousie University 2019

    285. Lauren Crosby, University of Western Ontario 2019

    286. Lauren G, University of Calgary 2018

    287. Lauren Kan, University of British Columbia 2019

    288. Lauren Standerwick, University of Calgary 2018

    289. Lawrence Yau, University of Ottawa 2018

    290. Leah Sinai, University of Western Ontario 2019

    291. Leandra Wellmeier, University of Calgary 2018

    292. Lebei Pi, University of Toronto 2017

    293. Lee Bauer, University of British Columbia 2019

    294. Leora Day, University of Toronto 2016

    295. Lerly Luo, University of British Columbia 2019

    296. Lidiya Luzhna, University of Calgary 2018

    297. Lina Cadili, University of Calgary 2018

    299. Linda Liu, University of Calgary 2017

    300. Linda Zhang, University of British Columbia 2019

    301. Lisa Pinto , Memorial University 2016

    302. Lisa Wang, University of Saskatchewan 2018

    304. Luke Wiseman, Dalhousie University 2019

    305. Lydia Gindy, University of Manitoba 2018

    306. Lydia Schramm, University of Calgary 2018

    307. Madalena Dearden, University of Alberta 2017

    308. Maddison Bibby, University of Toronto 2019

    309. Maggie Siu, University of Western Ontario 2016

    310. Magnus Bein, McGill University 2019

    311. Majd Mustafa, University of British Columbia 2015

    312. Marc Sonntag, University of Calgary 2017

    313. Marcus Cunningham, University of Calgary 2018

    314. Marguerite Heyns, University of Calgary 2017

    316. Marie-Faye Galarneau, Universite de Montreal 2018

    317. Marie-Rachelle Felizaire, McGill University 2019

    318. Mark Levitan, University of Ottawa 2019

    319. Mark Woo, McGill University 2018

    320. Marlise Sovka, University of British Columbia 2018

    321. Mary Elrick, University of British Columbia 2018

    322. Mary Koziol, McGill University 2018

    323. Mary Lynn Beaulieu, University of Saskatchewan 2019

    324. Maryam Eslami, University of British Columbia 2018

    325. Mattan Lustgarten, University of Toronto 2018

    326. Matthew Kochan, University of Manitoba 2019

    327. Matthew McAdam, University of British Columbia 2019

    328. Matthew Van Otterloo, University of Manitoba 2019

    329. Maxime Leroux-La Pierre, Universite de Montreal 2016

    330. Maxine Aird, Universite de Montreal 2018

    331. Megan Blades, University of Calgary 2016

    332. Megan Ruth, University of Calgary 2017

    333. Meghan Plotnick, Dalhousie University 2019

    334. Melissa Govindaraju, University of Ottawa 2019

    335. Melissa Ng, University of British Columbia 2017

    336. Meri Kieksi, University of Calgary 2017

    337. Michael Gritti, University of Toronto 2019

    338. Michael Multan, University of Calgary 2018

    339. Michael Rizzuto, University of British Columbia 2019

    340. Michael Wong, University of Alberta 2016

    341. Michael-Anthony Ferrato , University of Western Ontario 2019

    342. Michelle Giles, University of Alberta 2018

    343. Mieke Heyns, University of Calgary 2018

    344. Miles Hunter, University of Calgary 2017

    345. Mimi He, University of British Columbia 2016

    346. Mitchell Elliott, University of Toronto 2019

    347. Mitchell Webb, University of British Columbia 2016

    348. Mohammad Pannu, University of Manitoba 2017

    349. Mona Maleki, University of British Colombia 2019

    350. Monica McKeown, University of British Columbia 2019

    351. Monique Marguerie, University of British Columbia 2018

    352. Montana Johnston, University of Manitoba 2018

    353. Munaha Mostofa, Dalhousie University 2019

    354. My-Linh Ma, McGill University 2016

    355. Naomi Macrae, University of British Columbia 2017

    356. Natalia Binczyk, University of Alberta 2019

    357. Nathan Stefani, University of British Columbia 2017

    358. Nathan Toh, University of British Columbia 2018

    359. Nathan Turner, University of Alberta 2018

    360. Nelson Chow, University of Western Ontario 2019

    361. Nicholas, University of Western Ontario 2018

    362. Nick Sajko, Dalhousie University 2019

    363. Nicola Smith, McGill University 2018

    364. Nicole Hong, University of British Columbia 2018

    365. Nicole Mensik, University of Alberta 2017

    366. Niko MacLellan, Dalhousie Medical School 2019

    367. Nima Omid-Fard, University of British Columbia 2019

    368. Nina Nguyen, Universite de Sherbrooke 2016

    369. Nolan Lee, University of British Columbia 2019

    370. Noren Khamis, University of British Columbia 2018

    371. North de Pencier, University of Western Ontario 2019

    372. Obaidullah Khan, University of Western Ontario 2019

    373. Omar Abdel-Razek, University of Ottawa 2016

    374. Omar Zghal, University of Western Ontario 2017

    375. Osama Jarkas, University Of Manitoba 2018

    376. Osman Raza, University of Ottawa 2019

    377. Paige Durling, University of Calgary 2018

    378. Paige Williams, University of Western Ontario 2019

    379. Parnian Riaz, University of Alberta 2018

    380. Parveen Brar, University of Calgary 2018

    381. Patrick Hemmons, University of British Columbia 2018

    382. Paul Dolinar, University of Western Ontario 2018

    383. Pavitra Patel, University of Manitoba 2019

    384. Paymon Azizi, University of Toronto 2019

    385. Peter Cordell, University of Western Ontario 2016

    386. Qadeem Salehmohamed, University of British Columbia 2019

    387. Rachel Boyle, Dalhousie Medical School 2019

    388. Rachel Loebach, University of Western Ontario 2018

    389. Radhika Singh, University of Alberta 2019

    390. Rameeshay Mubasher, University of Toronto 2019

    391. Rameez Imtiaz, University of Ottawa 2018

    392. Rami Elzayat, University of Manitoba 2019

    393. Raymond Li, Memorial University 2016

    394. Razvan Purza, University of Manitoba 2016

    395. Rebecca Buttar, University of Calgary 2018

    396. Rebecca MacLean-Angus, University of British Columbia 2019

    397. Rebecca Manion, University of Calgary 2018

    398. Rebecca Manion, University of Calgary 2018

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    490. Tori Henderson, University of Northern British Columbia 2019

    491. Tracy Leach, University of Saskatchewan 2019

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    493. Tyler d'Entremont, Dalhousie University 2016

    494. Umair Sajid, University of Alberta 2019

    495. Vanessa Giesbrecht, University of Calgary 2017

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    497. Victoria Brzozowski, University of Western Ontario 2019

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    499. Victoria Smith, Dalhousie University 2018

    500. Vitaliy Chernenko, University of British Columbia 2019

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    502. Wade Coutinho, University of Alberta 2019

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    504. Waleed S. Ahmed, University of Toronto 2018

    505. Warren Koo, University of British Columbia 2019

    506. Wendy Marina Davis, University of British Columbia 2017

    507. Wenzhen Zuo, Universite de Montreal 2018

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    509. Wynn Tran, University of British Columbia 2018

    510. Yalda Karimi, University of Western Ontario 2019

    511. Yara Abou-Hamde, University of Western Ontario 2019

    512. Yasi Xiao, McGill University 2018

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    514. Yi-Hong Shao, McGill University 2019

    515. Yimeng Wang, Western University 2019

    516. Youn Tae Chung, University of Manitoba 2019

    517. Yuhao Wu, University of British Columbia 2019

    518. Zara Zalnieriunas, University of Western Ontario 2018

    519. Zoe Polsky, University of Calgary 2018

    Conflict of Interest:

    None declared

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    Competing Interests: None declared.
  • Posted on: (22 February 2016)
    Page navigation anchor for Refugees and public health concerns
    Refugees and public health concerns
    • Lawrence C. Loh, MD, MPH, CCFP, FRCPC, FACPM, Associate Medical Officer of Health

    Pottie and co-authors are to be commended for their timely and helpful Decisions piece on providing care to a Syrian refugee family. As those affected by the worst humanitarian crisis of our time make their way to our shores, our focus should give some measure towards promoting and preserving health beyond solely treating infirmities, and understanding the complex interplay between public health and primary care. In that...

    Show More

    Pottie and co-authors are to be commended for their timely and helpful Decisions piece on providing care to a Syrian refugee family. As those affected by the worst humanitarian crisis of our time make their way to our shores, our focus should give some measure towards promoting and preserving health beyond solely treating infirmities, and understanding the complex interplay between public health and primary care. In that vein, a few points in the article stand out to me.

    Firstly, concerning tuberculosis, the authors state that a chest radiograph is used to rule out active pulmonary tuberculosis (TB) and discusses screening for latent TB in a separate section later on in the paper. No mention is made, however, of federally-mandated TB medical surveillance. While the merits of this practice are heavily debated, (1) the screening chest x-ray is presently also used to identify refugees with inactive TB that would need to report to public health for medical surveillance upon landing. These patients undergo clinical and public health assessments soon upon arrival, and, if deemed necessary, undergo TB follow-up for up to a two-year time period.(2,3)

    A second recommendation put forward by the authors is to not offer routine HIV testing on arrival. This is at odds with guidance from the Public Health Agency of Canada, which recommended that the consideration and discussion of HIV testing be made a component of periodic routine medical care, given the potential benefits demonstrated through early detection. (4)

    Finally, and most importantly, I found it noteworthy that an early paragraph saw the authors qualitatively discuss trends of scabies, head lice, measles, leishmaniasis and louse-borne fever in this refugee population with the opening statement that "No major public health concerns have been reported thus far [in this population]."

    This statement poses several issues. Firstly, it significantly narrows the communicable disease control scope of public health. Not soon after this paragraph, the authors note that only around 50% of Syrian children have received primary series vaccines (diphtheria, pertussis, tetanus and polio.) As the authors are doubtless aware, vaccination is a cornerstone of communicable disease control and low rates are of significant public health concern, especially if they fall below the threshold required to maintain herd immunity.

    The second more critical point is that we must remember that public health's remit is far more than communicable disease alone. When considering a broader determinants of health framework, one easily recognizes that incoming Syrian refugees face significant public health concerns, such as potential barriers to accessing shelter, employment, and social support as well as cultural and language barriers that may impact community integration, education and personal health habits.

    To distill potential public health responses work around the refugee crisis to a sundry list of diseases is to ignore the important role that broad, wrap-around health and social services must play in integrating this community into their new home and ensuring that they remain both physically and mentally healthy.

    REFERENCES

    1. Khan K, Hirji MM, Miniota J, Hu W, Wang J, Gardam M, Rawal S, Ellis E, Chan A, Creatore MI, Rea E. Domestic impact of tuberculosis screening among new immigrants to Ontario, Canada. CMAJ. 2015 Nov 3;187(16):E473-81. doi: 10.1503/cmaj.150011. Epub 2015 Sep 28.

    2. Immigration, Refugees, and Citizenship Canada. Medical Surveillance. Available at: http://www.cic.gc.ca/english/resources/tools/medic/surveillance/surveillance.asp (Accessed February 22, 2016)

    3. Toronto Public Health. Tuberculosis (TB) Medical Surveillance for Newcomers. Available at: http://www1.toronto.ca/wps/portal/contentonly?vgnextoid=acd12f763c322410VgnVCM10000071d60f89RCRD&vgnextchannel=833b2f763c322410VgnVCM10000071d60f89RCRD (Accessed February 22, 2016)

    4. Public Health Agency of Canada. Human immunodeficiency virus (HIV) testing and screening guide. Available at: http://www.phac-aspc.gc.ca/aids -sida/guide/hivstg-vihgdd-eng.php#a (Accessed February 22, 2016)

    Conflict of Interest:

    None declared

    Show Less
    Competing Interests: None declared.
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Canadian Medical Association Journal: 188 (3)
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Caring for a newly arrived Syrian refugee family
Kevin Pottie, Christina Greenaway, Ghayda Hassan, Charles Hui, Laurence J. Kirmayer
CMAJ Feb 2016, 188 (3) 207-211; DOI: 10.1503/cmaj.151422

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Caring for a newly arrived Syrian refugee family
Kevin Pottie, Christina Greenaway, Ghayda Hassan, Charles Hui, Laurence J. Kirmayer
CMAJ Feb 2016, 188 (3) 207-211; DOI: 10.1503/cmaj.151422
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