Dr. Mohamed Abounaja looks over Aicha Kettat who suffers from gout at the Muslim Welfare Centre's free clinic Wednesday Sept. 5, 2012.Tim Fraser/The Globe and Mail
Free medical clinics in the GTA are seeing a growing tide of refugee patients whose coverage under the Interim Federal Health Program has been cancelled and doctors are scrambling to find more resources to help them.
Changes restrict health-care coverage for some refugees to only treatments of an urgent nature, or in cases when public health is at risk. Those affected include claimants from designated countries of origin (DCO) – places considered safe by Ottawa and not normally sources of refugees – rejected claimants and resettled refugees. Since the new federal health program provisions came into effect at the end of June, free clinics have been swamped, and doctors fear that recent additions to the list of DCOs are going to send even more people their way.
"We are at capacity for our non-insured population. … This is posing a huge challenge for us because, ethically, we are committed to treating our patients even if they don't have funding, so we are scrambling, trying to figure out how to find that funding – including approaching the province," says Bill Worrell, director of the LAMP Community Health Centre in south Etobicoke.
Funds that would normally go to uninsured patients, such as people without health cards like the homeless, are being spent on refugees, he says.
"These are people with extremely complex situations; many of them are Roma; many of their health needs are very complex and their social needs are very complex," says Mr. Worrell.
In December, Immigration Minister Jason Kenney announced changes to Canada's asylum system that put 27 new countries on the DCO list: 25 from the EU, soon-to-be EU member Croatia, and the United States.
While emergency care is still covered for refugee claimants, the cutting of funds for basic medical care, preventive medicine and the monitoring of chronic conditions is having serious repercussions, says Dr. Paul Caulford, founder of the Scarborough Community Volunteer Clinic, near Markham and Ellesmere roads.
"We see diabetes, we see pregnancies. We see everything. We see heart failure; we see hypertension. But we see it at its worst because these have been unattended and they've been beginning to complicate the lives of these individuals," he says.
Dr. Caulford says the new Interim Federal Health Program is confusing and has led to practitioners not registering and requiring cash payments instead, or simply rejecting patients outright. As a result, the free clinic is packed.
"It is an unprecedented situation. It is overwhelming," he says. "It is a disaster on the front lines since June 30. Someone is going to die."
After several patients came to Dr. Caulford's clinic with cancelled IFH cards, he set up a meeting of representatives from Scarborough-area clinics, including the Muslim Welfare Centre, Community Health Centres and Local Health Integration Networks.
"We're trying to bring our organizations on the same page when it comes to the uninsured and improve availability, capacity, sustainability," Dr. Caulford says, adding that their meetings are ongoing.
"Right now if I refer [patients] to a specialist, you have to pay for it," says Arieg Badawi, a volunteer doctor at the Muslim Welfare Clinic.
Scarborough's Muslim Welfare Centre offers three free clinics a month, of three to four hours each, to the uninsured. Housed in a strip mall on McLevin Avenue that is also home to the centre's food bank, the clinic has seen its patient caseload more than double.
The clinic was started in 2009 by the late Major Muhammad Abbas Ali and his wife, Sarwar Jahan Begum, both immigrants from Pakistan, who founded the adjoining food bank in 1993.
The medical clinic is solely funded by donations. It also receives its medicine samples from pharmaceutical company Teva Canada, formerly Novopharm, and from its volunteer doctors. However, because the medicines are in sample portions, there is a scarcity of resources.
"We need more doctors – that's number one – to volunteer," says Dr. Badawi. "We need more nurses. We also need more supplies, for example, for lab investigations."
In a letter to the federal government about the restrictions to refugee health care, provincial Health Minister Deb Matthews called the changes "a mounting concern in Ontario's health care system, particularly among hospitals, community health centres and doctors." She also challenged the government on its claim that money would be saved.
"While we won't know the full impact for some time, one downtown Toronto hospital estimates $1.3-million in annual costs to care for refugees," Ms. Matthews wrote. "This cost could rise if they have to contend with unchecked medical conditions."
The projected cost savings of the IFHP changes is $100-million over five years. Overall health-care spending in Canada amounted to about $200-billion in 2011, according to the Canadian Institute for Health Information.