WHEN Dr. Martina Scholtens handed the patient before her - a woman from Myanmar in her 50s - a handout about how to care for her diabetes that was written in her mother tongue of Karen, the woman was overcome with emotion.
Scholtens had been treating the refugee and mother of four for the last year through her role as a family physician at Vancouver's Bridge Clinic.
Thanks to the interpretative services offered at the Vancouver Coastal Health refugee clinic, the only one of its kind in the province, Scholtens and the Burmese woman had been able to communicate. But the handout clearly meant the world to the patient as she burst into tears.
"She could not believe it. She just looked and looked at (it)," says Scholtens, a Deep Cove resident.
"I'm sure that's the first time in Canada someone gave her something in the language that she knew," she adds.
The memory has stayed with Scholtens as it speaks to the success of her brainchild, a new website (Refugeehealth.ca), designed as a practical resource for doctors to help them provide better quality of care to refugees by giving them access to a wealth of pertinent, culturally specific health information at their fingertips.
Refugeehealth.ca offers a variety of content, including: details about medical coverage available to refugees in B.C.; cultural and political profiles as well as information about specific health issues related to countries refugees commonly come from, as well as guidelines and tools for treating common illnesses. It also provides a database of Lower Mainland community resources (dentistry, legal, housing, parenting, physiotherapy, mental health and optometry) that's searchable by city, language spoken and coverage accepted.
The site's patient handouts have proven to be the most popular component of the site, and hundreds of downloadable versions are featured on a variety of topics (including women's health, HIV, hepatitis, mental health, etc.), available in 17 languages. Anyone can access the handouts through the website.
Launched in 2011, Refugeehealth.ca is continuing to grow in terms of its available health information, as well as its user base.
"Refugees already have so many barriers. There's obviously the barrier of language, cultural barriers, barriers in term of most of them living below the poverty level," says Scholtens, describing the vulnerable state those she serves can often find themselves in. A number of Bridge's patients have been victims of persecution or violence, sexual or otherwise.
"They generally come from a huge background of loss - their home, their country, wealth, their job, etc. . . . Accessing health care, that's extremely difficult as it is. So I think, especially with this population, doing what you can to reduce or eliminate the barriers that can be eliminated is hugely important," says Scholtens.
Scholtens, 39, has been working at the Bridge Clinic since completing her residency in 2003. Located at the Raven Song Community Health Centre at 2450 Ontario St., Bridge provides short-term primary and preventive care solely to refugees, ideally for their first six-12 months in B.C.
Interested in family medicine, Scholtens was introduced to the clinic through an instructor who had worked there, tagging along with him and eventually coming to substitute for staffers before she became a permanent physician in 2005. One of four family doctors at the clinic, Scholtens works three days a week and sees patients of all ages - babies through seniors.
She was instantly attracted to the nature of the work, providing an opportunity to engage with people from such diverse backgrounds. "It was just amazing to be sitting there in the clinic room across from someone who had just arrived in the country, sometimes 24 hours previous, from a completely different life from your own," she says.
She was also attracted to the clinic from a medical perspective. While she would see people afflicted with issues like diabetes, hypertension, coughs and colds, and urinary tract infections, typical of any Canadian medical clinic, at Bridge she would also be faced with cases of malaria, tuberculosis and foreign parasites, uncommon by North American standards.
"I also just really enjoyed being involved with this group of patients who were just getting started in Canada and being launched onto a new life. There's just a lot of opportunity to be helpful. It was really quite rewarding just to see how people did," she says.
At Bridge, Scholtens sees two types of refugees: convention refugees, who are government-assisted and are already permanent residents of Canada with no chance of being sent home: and, refugee claimants or asylum seekers, who have claimed status from within Canada and if denied, could be sent back to their country of origin.
According to Scholtens, approximately 880 convention refugees come to B.C. annually, and virtually all are connected with Welcome House, a settlement program offered through the Immigrant Services Society of B.C. Bridge has a relationship with Welcome House and so all convention refugees entering the province are connected with their clinic, at the very least, for a visit with a nurse and some initial blood work. Based on their health, it could be a one-time visit, but typically, the individuals stay patients of the clinic for a while.
As there's no formal means of tracking refugee claimants, they come to the clinic of their own accord so long as they find out about it, at times directed by the Canadian Red Cross or other agencies, she says.
Bridge used to serve approximately 1,600 new patients per year. The clinic is now starting to see a decline in refugee claimants due to federal changes regarding refugee health insurance and the release of a new designated countries of origin list intended to deter abuse of the refugee system by people who come from countries generally considered safe.
At the busy clinic, Scholtens had long been interested in creating a website as a means of streamlining their approach to patient-care. Prior to Refugeehealth.ca, all of their resources were primarily in hard copy form - on posters hung throughout the clinic, for example, bound in binders or in stacks of photocopies, or found on computer drives and in email attachments.
"The resources were there but they were really disorganized," she says.
"Part of it was my own frustration at work in terms of the inefficiencies and recognizing that I was either wasting patient time looking for stuff or not being able to use resources that I knew existed because I just couldn't find it," she adds.
Scholtens was also interested in sharing Bridge's particular expertise with the wider community. Bridge staff work with patients until they're able to settle into their community and attain a permanent family physician, typically within a year of their arrival. Often, their patients move out of Vancouver due to the high cost of living.
"The big impetus behind the website was actually to support people in the community, to make them feel more comfortable taking on some refugees. All I see are refugees so I'm completely comfortable with malaria and parasites, but if you're a regular family doctor on Lonsdale and you have a family of Iranian refugee claimants who come in, it's fully understandable that you wouldn't maybe feel that comfortable. You don't know what their coverage entails, you don't feel completely up to date in terms of these exotic parasites, those kinds of things," says Scholtens.
Scholtens finally put her vision into motion while on maternity leave after giving birth in February 2011 to her fourth child. The site went live the following July.
Calling herself project lead, she hired a website developer and was supported by her co-workers at Bridge and a number of medical students in curat-ing the site's material.
While the site does contain some new information written by those involved in the project, the majority of the content was collected from what was already out there. The site is intended for use by all B.C. health care providers, including nurses, general practitioners, specialists and emergency room staff members - essentially anyone who provides care to refugees.
Refugeehealth.ca has "definitely, absolutely" improved efficiency at Bridge Clinic, says Schol-tens. "It's the first thing I open at work and I use it with I'd say virtually every patient encounter. I use it for a handout, or to print a map, or to refer to what medications are covered for them. So it's been very satisfying that way. I think most of us at the clinic use it. It's just become the go-to place. If someone finds some great resource in the community or another psychiatrist who speaks a certain language, that just all goes up on the website. Everything is in one place now," she says.
Scholtens continues to add to the site, including content she finds or that's sent to her.
"I can see what (visitors) are looking for. If it's something we don't have on the site I will find it and put it on," she says.
Outside of Bridge, the site's user base is continuing to grow. From August 2011 to now, the site has received approximately 36,000 page views, which are steadily increasing on a monthly basis.
The bulk of users are from Canada, followed by the United States and the United Kingdom. In terms of the Lower Mainland, the majority of viewers are in Vancouver, followed by Surrey and North Vancouver, which represents the third highest user base.
"There's clearly many people out there who have this bookmarked and they're coming again and again and using it 25, or 100 or several hundred times. That makes me happy because I know it's definitely useful for some people," says Schol-tens.
A number of other sites have linked to it, including Vancouver Coastal Health, B.C. Children's Hospital, B.C. Women's Hospital and the University of British Columbia's Faculty of Medicine.
"They clearly see our website as credible if they are comfortable putting it on their website," says Scholtens.
North Vancouver resident Dr. Dean Brown, who practises at Lions Gate Hospital as well as at West Vancouver's Continuum Medical Care, shares Scholtens' opinion on the value of communicating with peers, as well as the potential of the Internet to allow sharing of medical knowledge. He maintains his own health information website, Deanbrown.ca, intended as a North Shore resource for family doctors.
"I think it's an under-recognized opportunity that we need to somehow seize and that's why I went to the trouble of creating this website because I just thought the technology is there, the need is obvious, we've got to do it. . . ." he says. "The kind of collaborative communication and collaborative care environments we need to create are supported by the IT that's out there and we're not seizing that opportunity like we should," says Brown.
Brown linked to Refugeehealth.ca on his site. "To me it looks like a very sound and solid resource and I think it's the kind of thing that we want to have available for North Shore GPs," he says.
While similar sites exist in the United Kingdom and different parts of the United States, Refugeehealth.ca is the only site of its kind in Canada.
"One of the hopes with this has been to expand it Canada-wide or see if there is interest in that," says Scholtens, who last month, attended the North American Refugee Health Conference in Toronto, Ont. and gave a presentation on the website. She received some expressions of interest, including one from a doctor in Calgary, and is now looking at getting funding to expand the site.
Contributors' work on the website has all been volunteer, supported by grants from AstraZeneca Canada's Frontline Health Program and the B.C. College of Family Physicians. Vancouver Coastal Health is providing ongoing maintenance support and has permitted Scholtens to use a half-hour of clinic time per week to update the site. For more information on Refugeehealth.ca, to make a content contribution or to financially support the site's growth nationally, visit refugeehealth.ca.