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The Perspective
The Perspective

July 18, 2017

SickKids residents advocate for health of child refugees and newcomers

Photo of the POP clinic staff
POP Clinic team from left to right: Alisha Jamal, Laura Erdman, Gabrielle Salmers, Stephanie Erdle (not pictured: Lucy Duan).

Drs. Lucy Duan, Stephanie Erdle, Laura Erdman, Alisha Jamal, and Gabrielle Salmers are Paediatric Residents at SickKids and leads of the Paediatric Outpatient Program (POP) clinic. Dr. Hosanna Au is a staff paediatrician, overseeing supervisor of POP, and advisor for paediatric resident advocacy projects at SickKids.

Imagine leaving behind your home – potentially fleeing violence and persecution – to start a new life in Canada. In addition to securing housing and employment, and learning a new language and culture, you also need to access health care.

Newcomers require general health care and also have unique needs depending on exposures, experiences, and access to medical care during migration. Problematically, newcomers often encounter significant barriers to care. Not only is health care a human right, but regular care prevents deterioration and avoids costly trips to the Emergency Department.1

Approximately 50,000 children under 15 arrive in Canada annually.2 In 2009, SickKids residents founded the Paediatric Outpatient Program (POP) clinic in response to a need for paediatric consultation services for newcomer children facing barriers to health care. Located in Scarborough, this volunteer-driven clinic receives referrals from its affiliated primary care clinic, the Canadian Centre for Refugee and Immigrant Health Care.

Our patients are diverse in terms of geographic origin, migration journey, and health status, but are alike in the inability to access the conventional medical system. We see new immigrants during the three-month waiting period before they are eligible for OHIP coverage, refugee claimants awaiting federal health insurance, and other uninsured populations. We see refugees who have federal health insurance, but cannot find a provider familiar with billing for this program, or cannot navigate the health system due to language barriers, costs of transportation, or low health literacy.

If you were to come to the clinic, you would see a busy waiting room filled with children reading enthusiastically with volunteers from our literacy program and munching on healthy snacks. Paediatric residents usher families into clinic rooms, where they try to efficiently address and prioritize multiple health concerns while also striving to understand the patient’s experience and current social situation. Residents review cases with volunteer paediatricians and develop plans of care, while families chat with each other and the clinic nurse. Before leaving, each child selects a book from our donated library, and families receive counselling about literacy and the library system.

We see children with acute concerns such as fever or rash, as well as chronic conditions such as diabetes, asthma, epilepsy, and ADHD. We provide follow-up and ensure the availability of medications to avoid life-threatening complications. In collaboration with Adolescent Medicine colleagues at SickKids, we provide mental health support for our youth population, tailored to their specific needs. Preventative care includes catching up on immunizations, referrals to free dental and child development services, and counselling on nutrition.

In addition to the health concerns that brought them to us, many patients and families struggle with financial stressors and accessing supports, which can just as profoundly impact their well-being and quality of life. Our POP clinic nurse works closely with families, providing health education, arranging interpreters, and ensuring transportation to and from appointments. We regularly refer patients to community organizations that address housing, legal concerns, and food security. We use the power of our voices to advocate to landlords, schools and governments for rights and services that support physical and mental health.

Since its inception, POP clinic has seen over 1,000 children. Our numbers are growing and the cases we see are increasingly complex. This presents challenges as we are completely reliant on volunteers and donations to operate. However, we are strengthened by the incredible resilience of the children and families we serve. They have made arduous journeys to Canada, and continue to experience precarity and obstacles after arrival. A common refrain from parents is: “I did this for my children.” The least we can do is address their health needs so that they may thrive in their new country, and advocate for increased accessibility to health care for all children.


  1. Evans A, Caudarella A, Ratnapalan S, Chan K. The cost and impact of the interim federal health program cuts on child refugees in Canada. PLoS One. 2014 May 8;9(5):e96902.
  2. Facts and Figures 2011: Immigration Overview Permanent and Temporary Residents. Citizenship and Immigration Canada. <www.cic.gc.ca/english/pdf/research-stats/facts2011.pdf>