Preface: The article will be a summary of the paper “Caring for Pregnant Refugee Women in a Turbulent Policy Landscape: Perspectives of Health Care Professionals in Calgary, Alberta” by Anika Wimm, Erin Hetherington and Suzanne Tough (2018, June 26), published in the International Journal for Equity in Health [1]. All information present is from this paper unless otherwise cited. The Wimm et al. (2018) study was done before the Coronavirus pandemic which has further complicated the situation for refugees around the world, who were already incredibly at risk before the pandemic [2].
The researchers interviewed healthcare professionals from the Mosaic Refugee Health Clinic (MHRC) in Calgary to extract common themes surrounding challenges faced when providing health care to pregnant refugees. The researchers decided to focus on pregnant refugees as pregnancy is a common entry point into the medical system of the country in which refugees settle. From their research 5 themes were extracted:
Pregnant refugees are a heterogeneous population facing multiple barriers to care
Health care professionals specialized in refugee health engage in diverse strategies of care
Funding cuts from 2012 - 2016 created a confusing system which jeopardized care
Syrian refugee influx in 2017 created additional strains on existing problems
Health care professionals unfamiliar with refugee health may be overwhelmed
According to the health care providers, it is important to recognize each refugee patient’s individual journey when providing effective care.
Different refugee populations have a variety of languages that the health care providers had to work with. In order to ensure proper knowledge transfer, they highlighted the importance of quick access to translators or an efficient translating phone service.
A cultural barrier that was mentioned was the patient not agreeing to induction of labour or to caesarean sections based on their personal beliefs and how important it was to learn how to respectfully navigate this situation.
Another aspect that needed to be taken into account was if the patient has and can provide a detailed pregnancy history as patients who arrive pregnant and need to be delivered without a detailed history are more stressful to manage due to added risks.
The last aspect mentioned is the type of refugee they are classified as upon entry - generally sponsored refugees have access to more resources than people who claim refugee status upon entry.
Based on the interviews, these unique issues are complicated when sudden changes in funding and policies are made, taxing the already limited resources for refugee health care. This tenuity was made evident during the reduction of funding for the IFHP (Interim Federal Health Program) in 2012 - 2016. This effort to “save money” put the already at-risk pregnant refugees and their babies in additional danger as they could no longer reliably afford prenatal care essential for the long-term health of both the mother and the child.
The funding for IFHP was restored in 2016, but that resource was suddenly strained again with the large influx of Syrian refugees in 2017 without appropriate increases in resources and preparation time to support the necessary influx of refugees. While the health care providers at MHRC were affected by the sudden influx of refugees in 2017, they acknowledge that because of the media coverage and separate federal funding allocated for the Syrian refugee influx, they were in a better situation to manage the health care needs of this particular refugee population. During the period of funding cuts in 2012-2016 they had to rely on private donors or had to pay for expenses out of pocket.
The health care providers at MRHC also recognized the incredible need for patient advocacy in providing health care, especially health care for a marginalized and at-risk population.
Health care workers emphasized the importance of not only providing medical care but also ensuring their patients knew how and when to access the care needed for their pregnancy - including prenatal and postpartum care. This care was possible in large part because of their particular centre which had a team of professionals including but not limited to doctors, nurses and social workers. This team worked together to plan, procure and deliver the required health care. They mentioned the difficulty of achieving this form of care without proper training and education. In particular, knowledge surrounding the specific resources available to refugees and teams that can provide the required support both to patients and to fellow health care providers alike are essential to high quality care.
Ultimately, this summary just scratches the surface of the important research by Wimm et al. The author of this summary would urge readers to view the article as well to better understand the various issues that health care providers caring for pregnant refugees face, and how they make efforts to overcome these issues to provide the best possible care for their patients.
Sources
Caring for Pregnant Refugee Women in a Turbulent Policy Landscape: Perspectives of Health Care Professionals in Calgary, Alberta - Anika Winn, Erin Hetherington and Suzanne Tough (2018) - DOI: https://doi.org/10.1186/s12939-018-0801-5
Locked Down and Left Behind: The Impact of COVID-19 on Refugees’ Economic Inclusion - Helen Dempster, Thomas Ginn, Jimmy Graham, Martha Guerrero Ble, Daphne Jayasinghe, and Barri Shorey (2020) - https://www.refugeesinternational.org/reports/2020/7/6/locked-down-and-left-behind-the-impact-of-covid-19-on-refugees-economic-inclusion
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