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The “hotel clinic” in Toronto
By Hazar Najjar, freelance journalist
After months of anxious waiting and an arduous journey from Afghanistan to Canada, it seemed the Motavakkel family could breathe a sigh of relief when they finally landed in Toronto and were placed in a hotel turned temporary reception centre. As the adrenaline level of the family fleeing a life-or-death situation gradually fell, some previously suppressed health issues started to emerge. A few days after landing, the wife’s foot started bothering her. A toe had become infected. Her husband was trying to get her to see a doctor.
Back home, it would have been a no-brainer for them to walk into a familiar clinic down the street. But now, they were in a vast city unknown to them, in a hotel far away from the city centre, in the middle of a pandemic and the dead of winter. They had no OHIP card yet and didn’t know they would need one for a medical appointment; nor did they understand the health system here which mostly works with appointments, not by walking in.
Before long, Mr. Motavakkel discovered the refugee clinic within the hotel.
The clinic is located on the 8th floor of the hotel, occupying a suite and three standard hotel rooms. The beds have been removed, but the bed lamps and upholstered headboards remain to serve as backdrops for the clinicians’ desks. The decor still retains a hotel room’s look and feel, while the exam tables, medical carts, and other clinical equipment give the telltale sign of a healthcare facility.
Following the Afghan refugees’ influx late last year, Access Alliance, a Toronto community health centre, set up the hotel-based primary care clinic. According to Sheena Wright, the Primary Care Manager of Access Alliance, the clinic has already facilitated over 1,730 encounters with clients between October and March. Initially established in the basement of another hotel, the Access Alliance refugee clinic has expanded its services since it took over from another health organization, at what is now its current location. The other health organization had run a similar clinic in this hotel-turned refugee reception centre until March. Situating clinics inside the hotels (using a mobile or walk-in type model) ensures the easiest access to refugees’ immediate care needs before they find their permanent family doctor or other primary care provider. Today, this clinic is staffed with two nursing practitioners, one nurse, one part-time midwife, one part-time pediatrician, a consulting physician, two full-time interpreters, and two medical secretaries/system navigators, many of whom are redeployed from Access Alliance’s three permanent clinics across the city.
Fariha Temori, a Medical Secretary and System Navigator who speaks Dari, Persian, Hindi, Urdu, and English, serves as the first point of contact for clients entering the clinic, and as a general liaison person.
“Last year during a staff meeting, I heard about the plan of setting up a clinic for Afghan refugees at one of the hotels that are hosting them. I was so excited to join the clinic team, but when I learned that it’s very far from where I live, I was hesitant,” says Fariha.
“Then I went one day to the clinic to cover for one of my co-workers, and because I speak the languages of most of the clients at the clinic, I was a huge help, so my manager decided to keep me as part of the team there, and I’m glad she took that decision,” Fariha adds.
But it’s important to understand that working at a typical urban medical center is very different from being part of a team that serves newly arrived refugee patients, sometimes with medical conditions related to highly traumatic experiences.
“I’ll always remember this senior lady I met at the clinic,” Fariha tells one of the unforgettable stories she came across during her job at the hotel. “She came to see a doctor regarding her high eye blood pressure. She was asked about the history of her illness as we do with all patients. She told us she lost her daughter and her grandkid…she didn’t stop crying since then, and that’s how her eye illness started.” Fariha marvels at how the patient managed to keep a smile on her face every time she greeted the clinic staff. “She touched everyone’s heart at the clinic.”
Yousra Dabbouk, a Registered Dietitian, and a member of Access Alliance’s response team to the Syrian newcomer influx back in 2016 at the Toronto Plaza Hotel, emphasizes the importance of having a counsellor therapist at the hotel who speaks the newcomer’s language, as well as the value of a dedicated space for team members to destress.
“When we were working with Syrian newcomers around six years ago, we witnessed some cases with serious mental health issues, such as severe PTSD. I remember this little girl who was terrified when she saw the policeman at the hotel. We had to calm her down and have the officer reassure her so she could feel better.” Yousra says.
“A safe space for the staff to destress and keep the spirit high is also essential. It can be a very high intensity working space, with all the stories you hear there.” she adds.
Looking back at the resettlement process of Syrian refugees in 2016, Yousra tries to reflect and share some of the lessons Access Alliance learned from that time:
“Info sessions about the health care system in Canada were very necessary, in order to manage newcomers’ expectations, as there are some big differences between Canada and other countries. For example, in many countries patients can consult pharmacists about their illness and get medicine without a doctor’s prescription, or they can go to any specialist directly as there is no need for referrals or a family doctor in the first place.”
This reflected the Motavakkel family’s experience which, unfortunately, started out disappointingly. On their first visit, Mrs. Motavakkel’s toe was treated, however the situation did not improve. Because of limited staffing resources, they were unable to get a follow up appointment quickly which caused them anxiety.
Access Alliance has been able to increase staffing capacity, and several nursing students from two different post-secondary institutions were also placed here to support the clinic. For the Motavakkel family, things got much better from there. The husband has brought several family members to the clinic after the wife’s issue was resolved, and has been happy to see them all well served.
Aided by the husband’s English proficiency, the Motavakkel family was able to overcome many of the cultural differences typical of these reception centres, but for most newcomers, communication has often been the top challenge. Yousra explains that efforts to communicate with Syrian newcomers six years ago through written material weren’t very effective. “We thought translating information and resources into Arabic would be a great way to communicate information with newcomers, but there was a huge percentage at the hotel who didn’t even read Arabic. We didn’t take illiteracy into consideration at the time.”
Access Alliance drew upon this lesson and modified their response to fit the needs of Afghan refugees this time around. According to Fariha, the clinic team enlisted the help of Remote Interpretation Ontario (R.I.O.) to secure interpreters for all clients at the beginning, particularly during lockdowns and winter snowstorms. Later on, the management hired full-time interpreters in addition to offering remote interpretation through video conferencing technology. Access Alliance’s Language Services play an indispensable role in helping the clinic to run like a well-oiled machine.
The Motavakkels agree: “Having a medical clinic right inside the hotel is very helpful. There are more than 1000 people living here, if something happens they can’t reach the emergency immediately. Especially with the Afghan girls who work at the clinic, having them speak our language is very helpful”.
However, speaking the language isn’t the only way to build rapport and communicate empathy. Access Alliance staff are already very experienced in working with vulnerable newcomer populations – that’s what they do. The “hotel clinic”, as most clients fondly refer to it, is able to form a good relationship with clients.
“Not a single one of them left the hotel without stopping by to say thanks and goodbye or even give hugs.” says Fariha proudly. The clinic team never hesitates to share their own personal stories about emigrating to Canada, to help clients feel welcome and not alone.
The only thing that Fariha wishes was different about her experience is that she had joined the team from the beginning.
“I’m very grateful for this experience – I got to meet many people, and hear many stories of incredible people. It also made me appreciate more what I already have and the peace we have in this country.”
About the Author:
Hazar Najjar and her family came to Canada in 2016, fleeing the war-torn Syria. Trained as a journalist in Syria, she now works as Communications Coordinator at Impakt Foundation For Social Change, a nonprofit organization in Toronto.