World Refugee Day: Building knowledge and trust to support refugee care

Sign that says, "Reufgees are human beings"By Jane Gadd

With refugee numbers surging worldwide and Canada pledging to increase its intake to unprecedented numbers, Canadian doctors need new skills and greater insight into trauma in order to care for vulnerable newcomers, says Dr. Kevin Pottie, Western University's Ian McWhinney Chair of Family Medicine Studies.

Pottie has co-authored a curriculum framework that he hopes will become part of the core competencies acquired by all future medical students, here in Canada and also in Europe or even worldwide.

"We have a world destabilized by COVID-19," said Pottie. This has not only added to forcible displacements of people due to conflict and human rights violations but has worsened the barriers to care that refugees often encounter in their new homes, he says.

UNHCR, the United Nations refugee agency, reported last month that the number of people forcibly displaced from their homes worldwide has risen to 100 million, with up to 40 per cent leaving their own country.

Canada has pledged to accept more than 76,000 refugees this year, from crisis zones such as Syria, Yemen, Colombia and Afghanistan. That number does not include the tens of thousands of Ukrainians being fast-tracked for visas without getting formal refugee designation.

These numbers are too much for Canada's existing networks of refugee doctors to cope with, says Pottie, and all medical professionals are going to have to step up.

Published in BMC Medical Education, the undergraduate curriculum framework, co-authored by Pottie, the University of Ottawa's Dr. Douglas Gruner and colleagues, would provide medical students with evidence-based guidelines for treating refugees, as well as a grounding in trauma-informed care to maximize their well-being and integration into educational and working life.

It could also be used by nursing and pharmacy students – in fact, the authors have already received many inquiries from nursing organizations.

The framework supports Schulich Medicine & Dentistry’s commitment to research and scholarship in health equity – a goal in the School’s five-year Strategic Plan. 

Current medical training on refugee care is inconsistent across the country, Pottie and his colleagues found in a survey of 14 medical schools. In a few larger cities, some training on refugee health care is offered, but the authors want this to become part of the core CanMEDS competencies all medical undergraduates must acquire.

Central to the new framework is the concept of "trauma-informed care," which essentially means knowing how to build trust with people who have experienced violence and loss, and to work with sensitivity for their cultural context.

Dr. Kevin Pottie"In my own teaching for medical students, I use My Octopus Teacher, a documentary that won an Academy Award. It shows a very sensitive, trauma-informed approach to an octopus by a swimmer," Pottie said.
"You need a caring approach so that over time a person will trust you, and at the same time provide evidence-based medical care and not take advantage of them."

Too often, doctors who lack the skills to care for refugees, or don't know how to access medical interpreters, will push them out the door as quickly as possible, Pottie explains.

"Sometimes when you have five people waiting and you don't have the skill to handle the cross-cultural communication or the use of an interpreter, you realize you could lose time or you could gain time by treating them like they're not a full-fledged human and just usher them out. They don't have a lot of empowerment to make a complaint or do anything about it."

The new curriculum would teach the skills to provide quality care that may not look exactly like the care a Canadian would receive, he says. "The relationship of trust is what can eventually make someone vulnerable feel safe. When they feel safe they can learn, they can organize their family, take some risks to try to find a job."

While Westerners might be comfortable using the term "mental health" to describe the goals of trauma-informed care, for example, Pottie points out that this is a loaded phrase for many refugees.

"In my world, I'm very nervous with the term mental health or mental illness. There's additional stigma in developing countries because there are insane asylums, they still exist, and people get locked up in them. You can use the term mental health, but I would suggest that's not a very trauma-informed approach."

On the issue of Ukrainians fleeing the war and being fast-tracked for Canadian visas, Pottie has concerns.

"It's a special approach, but it doesn't bring all the protections you'd normally want with refugees because it’s an accelerated visa program."

He fears this might leave some vulnerable to sexual or commercial exploitation, and believes more public debate on this approach is required, as well as a careful evaluation by the UNHCR.

On World Refugee Day (June 20), Pottie and other members of the 250-strong Canadian Collaboration for Immigrant and Refugee Health will be participating in an online conference, Life as a Refugee, an initiative of Western's Network for Social and Economic Trends.

"It's exciting," Pottie said. "Settlement groups, community leaders and health-care providers will be coming together, working together, because this is what we do in our world of refugee care."