Welcome to Refugee Health - Vancouver

Refugee Health Vancouver is a practical resource to support clinicians who provide care to refugees in British Columbia.

Need a patient handout on diabetes in Farsi? Looking for a Spanish-speaking dentist in Vancouver who offers reduced fees? Not sure what convention refugees are, why they would flee Myanmar, or how you can bill to care for them? This site pulls together the answers for you.

For comments, suggestions and corrections please contact us.

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Students & Locums

Location 

Evergreen Community Health Centre

3425 Crowley Drive
Vancouver BC V5R 6G3
(t) 604.872.2511
(f) 604.432.6632  

Tonie Castro and Zainab Alwarid, Bachelor of Science in Nursing students at Langara College, developed a video to help patients find their way to Bridge Clinic. The video is available in English, Arabic, French, Farsi, Spanish and Somali: 
 

Overview of Bridge Clinic

Welcome to Bridge Clinic! 

We provide primary care to refugees in the Greater Vancouver area, from arrival until they are connected with a family physician in their community. Bridge Clinic sees approximately 1500 new patients each year. Care is typically provided for up to one year, but occasionally for longer periods when exceptional barriers to care exist. 

Bridge Clinic patients often present with health care needs that are atypical to conventional family practices, such as PTSD, thalassemia, G6PD deficiency, tuberculosis, malaria and parasitic infections such as strongyloidiasis and schistosomiasis. An overview of these conditions can be found hereOur patient population has numerous health challenges particular to the refugee experience, such as bereavement, settlement concerns, literacy and language issues, poverty, and the physical and emotional aftermath of torture.

The Bridge staff consists of four part-time family physicians;  a nursing team comprised of a full-time nurse, two part-time nurses, and a part-time nurse practitioner; and front desk team. In addition we have a pediatrician, psychiatrist and internist providing consulting services to our patients, and adult Bridge clients may access the services of a respiratory therapist.

We have a steady flow of learners through our clinic, from first-year medical students to fourth-year psychiatry residents. Most of our residents are from family medicine and community medicine programs.

Medical students and residents wishing to arrange elective time should contact MeiLing.Wiedmeyer@vch.ca with details, including specific dates, and whether you are requesting to shadow (a day or half day), a block elective (consecutive days or weeks) or a longitudinal elective (eg every Monday for three months). 

All allied health students (including nurses, social workers, counselors) interested in placements at Bridge must contact VCH Student Placement Services (cathy.petry@vch.ca).

Bridge Clinic cannot address volunteer offers directly. Please contact the VCH volunteer program.

Getting here and settling in

 

WHERE TO FIND US         

Evergreen Community Health Centre
3425 Crowley Drive
Vancouver BC V5R 6G3
604.872.2511


PARKING

There is no on-site parking available for Bridge staff during Mon-Fri 9-5 working hours. There is some free street parking in the residential areas to the south of Evergreen. If you require 2 hours or less of parking, there is street parking around the clinic but read the signs as they are regularly checked!


TRANSIT

Evergreen CHC is located a short block from the Joyce/Collingwood sky train station. Numerous buses also stop at this station including: 26,27,28 and 41. Please see the Translink website for further details


BICYCLES

The BC Parkway bike route runs underneath the sky train line, just a block from the clinic. This bike route runs from Vancouver to New Westminster and is a mix of off-road and quiet streets.

There are several bike racks located just outside the clinic door. There is also a secure bike locker in the underground parking area of the building, but it is challenging to access. 


CLINIC ROOMS

As a locum at Bridge, you will generally be working out of the room assigned to the clinician for whom you are covering. The front staff will get you set up.


WASHROOMS

There is a locked staff washroom located off the hallway between Bridge Clinic and the addictions clinic. You will need a key to access it (see the front desk for this). In addition, there are two all-access washrooms off the waiting room. There is also a staff washroom on the second floor that has a shower. You will need a swipe card to access this floor.


LUNCH ROOM

There is a lunch room located on the third floor of the building, directly across from the stairwell. You will need a swipe car to get to the third floor. The room is equipped with microwaves, cutlery and dishes. 


EMR

Bridge Clinic uses Profile EMR. 


UPTODATE

We have a clinic subscription to UpToDate, accessible on all clinic computers.

 

Safety and security

 

On your first day at Bridge Clinic, please do the following:

  • Introduce yourself to the front office staff and tell them how long you will be at Bridge Clinic. 
  • Wear a name tag.
  • Orient yourself to the various safety mechanisms in the clinic (see below)
  • Locate the various exits for the building. Note that in the event of a fire or evacuation, the marshaling station is outside the southeast corner of the building.
  • Be aware of patient names highlighted in red lettering on Electronic Medical Record (EMR) (see below for further details).


CRASH CART

In case of a medically unstable patient, there is a crash cart equipped with an AED, oxygen tank and portable suction located in room #115.

 

SECURITY

There is security present at a desk near the front door of the clinic in the morning until 1130h and again at 1630h until 2100h.

 

CODE WHITE

Any staff person may initiate a CODE WHITE when they feel unsafe and require assistance with an individual's behaviour. Designated phones within the clinic rooms have red buttons that are connected to an emergency phone at reception. In addition, staff can call CODE WHITE on phones that are not designated by picking up the receiver and dialing 88 and announcing CODE WHITE and the location 3 times.

 

AGRESSIVE PATIENTS

Patient names highlighted in red lettering on EMR usually indicate a history of aggression. Please check with a regular clinician at Bridge or the front desk staff to see if the data is up-to-date and or correct before you see the patient. It is not appropriate for a resident or medical/NP student to see a patient with a history of aggression without first consulting with their preceptor.

In the majority of instances, clients whose names are in red will also have an alert in the EMR. This appears as a banner superimposed on top of the screen when you open the client's case. This alert will give you the details of the client issue. 

Clinician of the day

A “Clinician of the Day” (COD) is assigned for each day in Bridge. This is indicated in EMR. If the assigned COD is away, that physician's locum acts as the COD. 

The three primary responsibilities of COD are:

1. Act as the "go to person" for urgent phone calls or patient presentations

2. Review and act on EMR abnormal (red) results of clinicians not in the clinic on that day.  Lab results are uploaded each morning, and a second time at around 3:30 pm each day, so please review results at least twice a day.

3. Review all new scanned documents (eg specialist consults, radiology results, and some labs) and act on those that are abnormal. Scanned documents do not show up as red when they are abnormal, so all must be reviewed. 

Patient visits

  1. The doors of regular clinicians at Bridge are always open.  Please feel free to ask any of us for help any time.  
  2. Mornings in Bridge are all booked appointments. In general each appointment is 30 minutes in length. Each afternoon, one MD and an RN run a walk-in clinic, while the other clinicians have booked appointments.
  3. When you see a client as “waiting” on your EMR screen, you know that you can go out to the front and call your patient. 
  4. As you get your patient, you may need to bring an interpreter. There is a daily booking sheet at the front which tells you which patients that day have an interpreter booked. 
  5. Please see if there is an alert for the client indicating they have medication waiting. The Bridge clinicians frequently use the Harvard Pharmacy, located relatively close to Bridge, as a place to order and receive parasitic infection medication from. These medications are kept in the breezeway.
  6. Please make note of any outstanding “tasks” in the patient’s EMR chart and act on them as appropriate.  Please remember to “complete” a task in the EMR if you have addressed the issue during the patient visit and the electronic reminder is no longer required.

Interpreters

In 80% of cases, Bridge clinicians depend on interpreters to communicate with their patients.

Initially, most patients are seen with on-site interpreters. Bridge purchases most of our interpretation services from Welcome House, through the RAP program. Please see Raj if you require an interpreter booked. Where possible, avoid the use of family members as interpreters.

Phone interpretation services, provided by Provincial Language Services (PLS), are available. There is a laminated card in each Bridge clinical room outlining how to access this service.

We are unable to supply interpreters to accompany clients off-site (for example, to specialist appointments).

IFH and Medavie Blue Cross

Citizen and Immigration Canada (CIC) determines the range of health care services available to refugees arriving in the country. Refugees are granted Interim Federal Health (IFH) coverage under various service umbrellas. CIC has given the administration of IFH to Medavie Blue Cross. More inforation here

Medications

Bridge Clinic has purchased a small cache of medications for RC clients without coverage or means. The medication supply we have on hand is small and limited to some of the most generic treatment choices for common chronic diseases and other health issues affecting our patiens. Please ask one of the Bridge clinicians to show you the medication dispensing process.

As well, we carry a small, changing inventory of pharmaceutical samples. 

We also carry STI medications and some stock medications including OCPs, non-narcotic analgesics, antibiotics, and lice and scabies treatments. 

Staff and services

 

NURSING TEAM

The Bridge nurses provide many services designed to promote health, prevent illness and achieve optimal recovery or adaptation to health problems. The Bridge nurses screen all Government Assisted refugees during the time they are at Welcome House. They provide immunizations; ensure clients are allocated to a Bridge provider; triage clients in need of immediate medical intervention; and do communicable disease follow-up and case management. The nurses work closely with the other members of the team in a shared care service delivery model. Specifically, the nurses can also provide the following services:

  • Phlebotomy
  • Triage of Clients presenting to Walk-In Clinic.
  • Well Women’s screening: PAP tests
  • STI and Contraceptive Management: The Bridge RNs have certified practice in these two areas which provides them the scope of practice to diagnose, treat and dispense medicines for certain STIs and dispense certain contraceptives and Plan B.
  • Immunizations
  • TB screening
  • Public Health Follow-up
  • Discharge Planning
  • Medication administration, e.g. Depo-Provera

While the nursing staff performs many clinical functions necessary for health care delivery, they also actively perform non-clinical functions including participation in quality improvement initiatives and nursing education.


FRONT DESK TEAM

The Front Desk Team carry out administrative duties including answering telephones, registering patients, scheduling appointments and sending specialist referrals.

As the Front Desk Team is often the first to interact with patients at Bridge Clinic, they support MD/NPs and Nurses in triaging patients for urgent assessments, e.g. patient presents with chest pain or altered LOC. They play an integral role also in communicating behavioral concerns, e.g. patient presents intoxicated or with threatening behavior.


ALLIED HEALTH CARE TEAM FOR RAVEN SONG/BRIDGE

Dr. Stephan

  

 

  • Accepts EMR referrals
  • Two afternoons/month
  • Consultation and assessment

Louise Arney

  

Respiratory Therapist

  • Accepts EMR referrals
  • Tobacco Dependence Clinic

Dr. Warda Toma 

Bridge Pediatrician

  • at Bridge once or twice monthly

Dr. Mei-Ling Wiedmeyer

Pre-Natal Clinic

  • Tuesday afernoon

Addictions Dept.

Counselling/Methadone Maintenance/Withdrawal Management/Tobacco Dependence Clinic

  • Accepts self referrals/internal referrals
  • M-F (8:30-4:30)

 

IMMIGRATION SERVICES SOCIETY OF BC (ISSBC)

The Bridge clinicians work closely with Immigrant Services Society of BC. When GARs first arrive in Canada, they live in a building in downtown Vancouver called Welcome House for approximately the first 2 weeks.  All GARs have an umbrella of services during their transition to life in Canada. Each patient/family is assigned a Settlement worker through the Resettlement Assistance Program (RAP) who is responsible for securing, amongst a host of other services, housing. To date the majority of our Bridge clients move to the geographical area served by the Fraser Health Authority. Resettlement in the Surrey/Tri-Cities/Fraser Valley areas is driven by the high cost of living in Vancouver. This creates very unique challenges related to relationships and access to services for Bridge clinicians and clients. We maintain relationships with Settlement workers and frequently call upon them to help us with issues related to cultural competency and navigation. We ask Bridge Clinicians to be aware of the complexity of booking family members across multiple days as opposed to booking them, where possible, as a block. Also, we attempt to coordinate service to multiple providers at Bridge in order to decrease the travel and associated costs to our clients.

We have a limited supply of bus tickets to support patients, without means, who require them to travel to Bridge.


CONTACTS

Evergreen CHC Building Coordinator

Julie Hayre | Julie.hayre@vch.ca | local 4661
Julie is the person to talk to about clinic keys, computer access, business cards and building orientation. 

Bridge Clinic Manager
Maylene Fong | maylene.fong@vch.ca

Medical Coordinator
Dr. Shiv Grewal | Shiv.Grewal@vch.ca

Medical Director
Dr. Michael Norbury | Michael.Norbury@vch.ca

Written by Maureen Mayhew, Martina Scholtens, Patti Zettel (December 3, 2012)
Reviewed/updated by Martina Scholtens MD, Annette Floyd RN (February 23, 2015)

Patient Handouts

Translated educational handouts on health issues.

Other Patient Handout Catalogues

Settlement (Orientation, Screening, Legal)

Child Health & Parenting, Other Patient Handout Catalogues

Anemia

Mental Health

Women's Health & Pregnancy

General Medical

Diabetes, Nutrition & Lifestyle

Child Health & Parenting

Diabetes, Nutrition & Lifestyle, Anemia

Infectious Disease

Community Resources

Dentists, physiotherapists and other community resources who speak other languages, accept IFH or offer reduced fees.

Pharmacy
Cross cultural mental health
Midwifery
Cross cultural mental health
Settlement, Legal, Parenting, Cross cultural mental health
Optometry
Parenting
Parenting
Settlement, Cross cultural mental health
Parenting
Podiatry + orthotics
Physiotherapy
Physiotherapy
Physiotherapy
Parenting
Disability
Disability
Dentistry
Settlement, Cross cultural mental health
Cross cultural mental health
Cross cultural mental health
Settlement
Cross cultural mental health
Cross cultural mental health
Physiotherapy
Physiotherapy
Physiotherapy
Settlement
Legal
Recreation
Recreation
Physiotherapy
Legal
Lab/radiology
Cross cultural mental health
Settlement
Settlement
Pharmacy
Cross cultural mental health
Physiotherapy
Settlement, Parenting, Cross cultural mental health
Settlement
Physiotherapy
Pharmacy
Physiotherapy
Podiatry + orthotics
Cross cultural mental health
Cross cultural mental health
Legal
Recreation
Recreation
Legal
Cross cultural mental health
Settlement, Legal
Cross cultural mental health
Physiotherapy
Cross cultural mental health
Settlement
Settlement
Pharmacy
Cross cultural mental health
Physiotherapy
Parenting
Cross cultural mental health
Settlement, Legal
Cross cultural mental health
Cross cultural mental health
Cross cultural mental health
Cross cultural mental health
Cross cultural mental health
Pharmacy

Cultural Profiles

An overview of the main countries from which Canada receives refugees, with a focus on political and health issues.