Helping refugees and newcomers see

There was the young woman who’d suffered an eye injury in an attack and was left with only one functioning eye. The man who had low vision due to blunt force trauma and was desperate to find ways of coping so he could work. The teenager who’d been using a pair of glasses several years old despite her sight having worsened significantly since the last time she’d been able to get an eye exam.

These are the stories of just some of the approximately 200 refugee patients a year Dr. Lisa Woo remembers seeing at the Health Sciences Optometry Clinic (HSOC) in downtown Kitchener, run by the University of Waterloo School of Optometry and Vision Science.

“We work to meet the individual needs of refugees and other newcomers, whether it’s an eye exam with language interpretation or specialized care for someone with complex needs,” says Woo, who is the clinic head of HSOC. “We don’t do one-off visits. We work closely with patients and a range of support organizations to provide the care that will help them thrive in Canada.

Refugees are people who have fled conflict or persecution. Often, their home countries have weak health infrastructure. Sometimes they endure years in refugee camps before they can be resettled in countries such as Canada. It’s therefore not surprising that many haven’t had adequate eye care in years — if ever.

Seeing clearly and comfortably is a vital part of basic human dignity. Vision is even more important for people settling into a new country, as people without properly corrected vision struggle to learn the local language, go to school or find work. Undiagnosed eye disease may threaten sight, while people with vision loss may struggle to navigate new surroundings or perform everyday tasks, especially in an unfamiliar context.

All this is why HSOC runs clinics for refugees of all ages every Wednesday morning, though appointments are also available at other times. Most patients are referred by Reception House or Community Healthcaring — the latter of which is an organization formed by the recent merger of Sanctuary Refugee Health Centre and Kitchener Downtown Community Health Centre.

“Patients have always reported having had good experiences with the University’s vision clinic,” says Tara Groves-Taylor, CEO of Community Healthcaring. “The staff have refugee expertise and experience, so they understand the population, they provide interpretation services, and they know how to bill the various insurance providers depending on the type of claimant.”

The refugee-focused clinics, which have been running in various forms since the early 2000s, are staffed principally by an ocular disease resident, with a faculty member available for the resident to consult with if necessary. This benefits both refugees, who see optometrists that are undergoing advanced training in eye disease, and residents, who gain more experience in culturally sensitive caring for diverse patients.

Also on hand are trained support staff who perform tasks such as arranging interpreters through the Kitchener-Waterloo Multicultural Centre and communicating with the patients’ circles of care.

“It's a big team effort for our organization and our healthcare partners to ensure that newcomers receive the care they need on an ongoing basis,” Woo says.

When patients need more specialized care, they are referred to the School’s Waterloo campus, which offers clinics focused on areas such as low vision rehabilitation, chronic eye disease treatment and eye care for people with developmental disabilities.

While the government’s Interim Federal Health (IFH) program covers eye exams and basic glasses, it leaves significant gaps for people who need more follow-up or specialized care.

For example, Woo saw a refugee family where most members had an eye disease that can result in visual impairment. The condition is often treated with scleral lenses, which are large, rigid contacts that can be specially designed to overcome irregularities in the cornea. However, the cost of fitting a single patient for scleral lenses is about $2,000, an amount not covered by the IFH program.

Patients who can’t afford the care they need can be referred to the donor-funded Community Vision Care Fund. However, with limited resources, not every deserving case can be funded.

“We can fill some gaps, but the needs far exceed what we can cover,” says Dr. Andre Stanberry, clinic director at the School.

Between 2015 and 2020, the Kitchener Waterloo Community Foundation provided a total of $100,000 in funding to help fill eye care gaps for newcomers, low-income seniors and people living with mental health and addiction issues. The School is still working with refugee support organizations, aged care homes and the House of Friendship to provide ongoing care to vulnerable populations, but the end of the funding has made it harder.

Another challenge is that both sheer numbers of refugees and the complexity of their health needs are growing. These increases are driven by federal commitments, a high level of geopolitical conflict and the ongoing effect of pandemic-influenced gaps or delays in both healthcare and resettlement.

“Immigration, Refugees and Citizenship Canada is asking organizations like Reception House to partner with healthcare providers and professionals to make sure we’re meeting new arrivals’ medical needs, but with the number of vulnerable refugees we have coming, it’s difficult,” says Babur Mawladin, CEO of Reception House.

“We’re expecting a 227 per cent growth in refugee numbers over the next four years and we’re not sure where they’re going to get care,” says Groves-Taylor. “We want to be a welcoming community, but to do so, we need to be adequately resourced.”

“My wish is being able to provide continuing care to the population that really needs it without worrying about who’s going to pay for it,” says Woo. “We have a saying at the School — that seeing is belonging, because it’s hard to fully participate in community life if you can’t see well. Everyone deserves both to see and to belong.”