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Midwifery professor helps Syrian refugees

Manavi Handa provided prenatal care at Toronto hotel settlement
By: Dana Yates
April 22, 2016
Manavi Handa examines a newborn

Photo: Midwifery professor Manavi Handa examines a newborn at her clinic in Toronto. Photo by Mark Blinch.

For the last four months, external,midwifery professor Manavi Handa has cared for pregnant Syrian refugees temporarily living in a Toronto budget hotel. At the start of the year, though, she had a tough time finding anyone who needed her services.

"Many women are afraid to disclose they are pregnant in case it jeopardizes their immigration status," says Handa, who is with the external,West End Midwives clinic.

Officially, only one woman among the hotel's 500-plus refugees told settlement workers she was pregnant. Handa, however, found that figure hard to believe. On average, the young, government-sponsored refugee families arriving in Canada have five children. Surely, says Handa, more babies had to be on the way.


Through listserv posts from health professionals, she learned few resources had been made available for pregnant Syrian refugees. She approached the non-profit group Access Alliance Multicultural Health and Community Services, which had co-ordinated health services for many Syrian refugees in Toronto, about providing pro bono midwifery services at one of the temporary housing locations. Her initial commitment was for two weeks.

On Handa's first day in the west-end hotel last January, she quickly learned the Arabic words for “pregnant” and “midwife.” Then, with a translator, she roamed the crowded lobby – by then a quasi-town square – looking for women to help. By the end of the day, she had found six clients and had conducted their appointments in a storage closet that had been converted into a makeshift clinic room. Eventually, she held clinic hours every Tuesday afternoon in Room 116, providing prenatal care to more than 30 women, and seeing an equal number of women who were uncertain about their pregnancies.


Handa has a long history of working with immigrant and refugee women. In 2010, she received an award from the Urban Alliance on Race Relations for her work to improve access to health care among immigrant and marginalized women. She has also studied the obstacles women face in accessing prenatal care and how uninsured, non-status immigrant women move through the health-care system. Indeed, her research and advocacy work have been pivotal in securing government funding for non-insured midwifery clients in Ontario to undergo tests, and to receive consultations or transfers to a physician.

Now that the last pregnant Syrian woman has moved out of the hotel, Handa hopes to someday assess the birth and postpartum outcomes of the clients who were under her care. She also plans to research the experiences of translators, health-care providers and volunteers who were involved with the pregnant clients. The goal: to develop recommendations that will assist Canada and other high-income countries when receiving Syrian refugees in the future

To that end, Handa has managed a number of logistical and medical difficulties during the past few months. Most of her clients, for example, had no health records. In addition, complex obstetrical histories and high-risk pregnancies were common, with many women having previously had multiple caesarean sections (the rate of C-sections is extremely high in countries that received Syrian refugees before their arrival in Canada).


There were also joyful experiences, like when Handa arranged for a fellow midwife to care for a woman who delivered her 11th child within weeks of coming to Canada. One of the first Canadian-born babies of Syrian refugees, Azhar Hammoud arrived prematurely and doctors were concerned she wouldn't survive. But after being treated at the Hospital for Sick Children, she is now doing well and living with her parents and siblings in a large house in Mississauga.

That kind of resilience impresses Handa, even though she knows challenges may be ahead.  "Research has shown the trauma of war usually shows up years after the settlement process," she admits. "But I asked one woman how she was coping with what she had been through and how it was affecting her pregnancy, and she simply said, ‘Syrians are strong, we will be fine here.’”


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