In launching the Gateway Program, Dr. Pauline Duke is helping medical students provide care to refugees arriving in Newfoundland from war-torn countries.
Written by Celia Milne on February 10, 2012 for The Medical PostA refugee woman—let’s call her “Nyanath”—trudged through a snowstorm for a prenatal appointment with Dr. Pauline Duke, a family doctor in St. John’s, N.L. Pregnant with twins and caring for several children, Nyanath was a testament to what many refugees have survived: war in her home country, poverty, the squalid conditions of a refugee camp and the death of several of her babies. All she wore on her feet on that snowy day was a pair of flimsy canvas shoes and no socks.
Nyanath’s stoic nature had a strong impact on Dr. Duke and the resident she was training that day. “We were both overwhelmed with what she’d gone through,” says Dr. Duke. “She had had a difficult life but felt no different from her female friends. When I first started seeing refugees, it was surprising what they would accept in terms of (what is considered) normal, they’d been through so much.”
In the early 2000s, Dr. Duke, a faculty member at Memorial University of Newfoundland (MUN), began to notice more and more refugees arriving in St. John’s, a novelty for many in that part of the country. “In Newfoundland, we’re all of the same ancestry. There’s not a lot of diversity in our province. I wanted to educate students about issues around diversity, especially as this is very much a unicultured place because of our heritage.”
She told Nyanath’s story to students in her clinical skills and ethics class. The story of the brave refugee inspired two of Dr. Duke’s students, Yoella Teplitsky and Monica Kidd, to develop a program to help such newcomers to Canada. “We approached Pauline to help us start the project because we knew she was passionate about offering new Canadians better care than they were getting at the time,” says Monica, who is now a GP working in group academic practice with Dr. Duke. “We could also tell she was serious about it, not just saying the things she was expected to say. So we knocked on her door one day during final exams before Christmas and told her our idea.”
Thus began the MUN Med Gateway Project, a volunteer program for medical students, which helps newcomers access the Canadian health-care system, as it is new and puzzling to them. Within six months, Yoella and Monica had seen their first patients.
The Gateway Project is now in its sixth year. Dr. Duke quietly and steadfastly stewards the program, which has made a difference in the lives and health of many refugees, and taught dozens of students the importance of caring for those who are vulnerable. “Pauline is a compassionate doctor and teacher and she stands out in being a Newfoundland patriot, while having her eyes and heart wide open to the rest of the world,” says her former student and now colleague Dr. Kidd.
Dr. Duke is modest about her accomplishments. At 55, she has been a family doctor for 30 years—the first eight spent in rural practice, the last 22 in St. John’s. She and her husband, who is a social worker, have three children, ages 28, 16 and 14.
“I don’t see what I do as anything special,” she says. “To a certain extent I feel it’s what family doctors do. We look after not just patients’ medical needs but also their families’. It is important as educators that we show students why it’s important to have social accountability. Because we’re privileged in lots of ways, we’re responsible to help the more vulnerable.”
Plan in action
Here’s how the Gateway Project works. On Tuesday afternoons, first- and second-year medical student volunteers help refugees in a clinic; they work hand in hand with a public health nurse hired by the Association for New Canadians, a settlement agency in charge of welcoming newcomers to the province. This visit usually takes place within two weeks of the refugee’s arrival in St. John’s.
They don’t know about breast exams, contraception and Pap smears. They came from a country where these things were not done.Patients, with the help of translators, receive a mini screening, including history, blood pressure, height, weight, growth charts for children based on WHO guidelines, hearing check, vision check and dental check. “We know these are some of the things initially that are important to do,” says Dr. Duke. “It says, ‘We care about what happens to you. You and your children are important to us.’ ” Patients are matched with a family doctor, who then receives their information. If necessary, referrals are made to a dietitian, dentist, ENT specialist or audiologist.
Dr. James Rourke, dean of medicine at MUN, recently made the project an official part of the medical school. A part-time co-ordinator ensures smooth communication between medical students, supervisors, partners, clients, family doctors, community organizations and institutions. The project is led by a steering committee of physicians, including Dr. Duke, and other MUN faculty members.
Newfoundland takes in 155 refugees a year. The Gateway Program’s clients are from Bhutan, Colombia, Congo, Cuba, Ethiopia, Eritrea, Kenya, Kosovo, Iraq, Nepal, Nigeria, Malaysia, Myanmar, Serbia, Sudan, Thailand and Uganda.
Recent innovations of the Gateway Project include a carseat initiative, which teaches parents how to use these devices properly, a vitamin D initiative in which parents are given the supplement free of charge (through Wal-Mart) for their babies, and an art show in which clients display art, poetry and literary works they have created.
This year, the project is organizing well-woman visits for refugees. “They don’t know about breast exams, contraception and Pap smears. They came from a country where these things were not done. They may be uncomfortable with a male provider doing pelvic exams,” explains Dr. Duke. The services are offered and then information can be forwarded to family doctors.
Refugees are appreciative of the Gateway Project. “Most have lived through war, torture or other difficult situations; some have been in camps for many years—stateless people. There’s a lot unspoken,” says Dr. Duke. Unaccustomed as they are to being looked after, this first access to the health-care system is a very positive one. “Our patients enjoy our students. They tell them, ‘You are the first face of medical care in Canada.’ They shake our hands and say thanks. They make eye contact. How grateful they are for any little thing we do!”
Educational benefits
It has also been heartwarming for students. “Students love the Gateway Project. They love learning where people come from. They learn about caring for others. They are very enthusiastic and keen, and we are very proud of them,” says Dr. Duke.
She encourages her students not only to participate in the more formal project, but also to think outside the box when it comes to caring for refugees and their loved ones. She reckons she has between 60 and 70 refugees in her practice now, and recently treated a family that had come from Africa. Many of the men had perforated ear drums, possibly a result of having chronic ear infections as children. “We sent them to an ENT surgeon, who did repairs of the tympanic membranes. Now these men can hear. To us, it is basic; to them, it is very important.”
Another family, consisting of 15 people of various ages, has proven difficult to treat in an ordinary way because of language and transportation problems. So Dr. Duke and a translator block off an afternoon using several clinic rooms and provide a group appointment for this family. “I think that’s pretty innovative,” says Dr. Kidd of her colleague.
With trademark modesty, Dr. Duke describes her role simply: “I think I’ve just done my best to be an adviser to the program and get students to think how they can be advocates.”
But, she adds, “We’re not just talking about it, we’re doing it.”
Celia Milne is a freelance writer in Toronto.
