Left:
Dr. Meb Rashid and Semhar Musael
Twelve years ago, while working at a community health centre in Toronto, Dr. Meb Rashid began to identify an urgent need for a refugee health clinic – a concept that was being introduced in other urban centres around Canada, but was distinctly lacking in Toronto.
According to the UNHCR 2022 Global Trends Report, in the last decade, the number of people forcibly displaced around the world has seen a concerning rise – nearly doubling since 2012 – marking a worrying trend of people forced to flee their homes due to persecution, conflict, violence, human rights violations, or events seriously disturbing the public order.
Most of these people have experienced immeasurable violence, trauma, poverty, and discrimination – with women and children facing disproportionately higher rates of exposure to deep-rooted discrimination and extreme vulnerability. Coupled with the urgency of finding housing and employment, culture shock, and learning a new language, healthcare is often lost – leading to late interventions, potential healthcare risks and complications.
Recognizing this gap in the existing health care system, Dr. Rashid put together a proposal to create a health clinic dedicated to the unique needs of refugee patients. He met with a number of different hospitals, but it wasn’t until he presented the idea to Women’s College Hospital that the Crossroads Clinic came to be – Toronto’s first, hospital-based refugee health clinic, where Dr. Rashid is currently Medical Director.
The mission and purpose of the Crossroads Clinic, besides providing primary medical care, is to address barriers and solve for gaps in care that are distinct to newly arrived refugee populations – complementing the long-standing work being done by our community partners across Toronto.
“The clinic is based off a model of care that’s unique to these populations,” Dr. Rashid says. “We see conditions that would perhaps be a challenge to colleagues in the community, like tropical diseases, language discordance, differing insurance coverage, and the manifestation of trauma.”
And of course, the clinic is cognizant of the distinct challenges, outside of healthcare, that may present themselves when moving to a new country. This is why their mandate goes far beyond medical care, but also encompasses an entire ecosystem of support, such as social workers, nurse practitioners, and the newly appointed, fully donor-funded position of Peer Navigator.
Based off a globally adopted model of peer support, the Peer Navigator works to support patients emotionally and practically – harnessing their own lived experience to guide patients going through similar experiences. While the idea of peer support is far from novel – the practice of solidarity, care, accountability, and trust has always existed – the Peer Navigator role aims to take this a step further.
Feeding in to WCH’s model of care that sees each patient as a whole person, the role aims to close gaps in care that span challenges surrounding language barriers, province-policy questions, and feelings of isolation, among a few. Most importantly, the goal of the Crossroads Clinic is to allow their patients to dream – to feel as though there are a multitude of opportunities that lie in front of them, and they have everything they need in order to reach them.
“When our patients first come to us, they aren’t dreaming,” says Semhar Musael, an immigrant to Canada herself, and now the clinic’s first Peer Navigator. “When your basic needs aren’t being met, and you’re trying to navigate an entirely new world, you can’t dream. We wanted them to dream.”
Semhar recalls a patient who had missed her scheduled colonoscopy procedure five times but hadn’t left a reason for the missed appointments. “It turned out that she was obligated by hospital policy to have someone accompany her, but she didn’t have any connections here in Toronto,” acknowledging this as a common and often debilitating barrier to care, Semhar offered to accompany the patient and drive her home.
Research has shown that refugees do very well in Canada when followed out and supported for a sustained, adequate period of time. Rates of employment are high, and rates of mental health issues remain at similar levels to those who are Canadian born. “What we do find is that people need help when they arrive,” says Dr. Rashid. “Often, we’re seeing people who have never connected with primary care, and there are also unique particularities about the journey of refugees that’s different from other immigrants.”
According to CBC, one of the world’s busiest migrant corridors runs from Central America through Mexico, which is a three-to-five-month journey where migrants face extraordinary threat. Dr. Rashid recounts a patient who completed the journey five months pregnant, recalling haunting memories of bodies, smugglers, and little food or water.
“There’s trauma in the migration process. Both pre-migration, where people are taking dangerous and circuitous routes to get here, but also when people arrive – there is so much that challenges them,” says Dr. Rashid. “There are also the thoughts of the sister, brother, cousin, or parents they may have left behind, and the anguish that comes from that.”
“These are the survivors. It’s a very resourceful and industrious community. How we support people and how we ensure that their human capital is preserved becomes critical to ensure they succeed.”
And that is, ultimately, the hope of the clinic, for its doctors, staff, and for Semhar. That at the end of the longest journey many of them will ever take, there is still hope. That it was all for something – something bigger than just being here.
“It’s about the idea of human connection, to feel like they have someone who understands, listens, and supports them. It is so beyond just helping them fill out forms or schedule appointments. It really is being a friend, a safe haven for them,” says Semhar.
She recalls a story of a patient who came in one day without an appointment. When she saw Semhar, she told her she was only there for a hug.
Both Semhar and Dr. Rashid say their experience at Crossroads has been life-changing on a multitude of levels. Life-changing for the clinic’s patients, who have found a community and support system, and life-changing for Semhar and Dr. Rashid, who experience first-hand the resounding resilience of the communities they serve.
“I just feel like there’s such an opportunity, that if we can provide people with support and bridge that really critical period, there’s a lot to gain,” says Dr. Rashid.
The critical position of Peer Navigator was made possible through the generous support of donors and partners including The Slaight Family Foundation, J. Susan Monteith and the Vohra Miller Foundation – all of whom are helping newcomers, refugees, and refugee claimants reach their full potential through their support of this vital work.
Learn more about the Crossroads Clinic, Toronto’s first hospital-based refugee health clinic:
https://www.womenscollegehospital.ca/care-programs/crossroads-clinic/.
