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HALIFAX — Many people change jobs during their lifetime, but for Loai Al Refai the shift was particularly dramatic.

Since moving to Canada more than two years ago, he’s gone from writing medical prescriptions to loading furniture into people’s cars.

Immigrant and refugee doctors have to go through a long, complicated and expensive process to get licenced in Nova Scotia. They must pass written and clinical exams before they get a chance to apply for a medical residency training or a program at Dalhousie University called med-clerkship, which means they need to go back to school.

This is not always doable for those who practised medicine for many years. Some of them believe they have more clinical or surgical experience than the professors who would teach them at Dal.

When he fled Syria in 2013 for Jordan, Al Refai left his post as a resident doctor at the National Hospital in Daraa, where the first Arab Spring protest broke out in the country.

After landing in Halifax, he finished a six-month academic English class at Dal. But he understood that daily communication with people is the best way to improve his conversation skills, so he started working as a parking lot associate at The Home Depot.

“It’s disgusting and annoying,” Al Refai says of his job in Arabic.

“I’m wasting my time… I have been doing this for a year and a half.”

His job requires him to wait for customers at the lot to load furniture into their cars. He works four-hour shifts two to three days a week, making $600-$700 monthly.

Al Rifai doesn’t want to fail in the licensing exams, so he didn’t take them because he isn’t ready, he says.

“The biggest barrier is language,” says Al Refai. “Your language has to be perfect ... It would be a disaster if you misunderstood a patient.”

His wife is a doctor, too, but she stays at home to take care of their three kids — their youngest is only two months old.

The Syrian doctor explains that he lives in desperation and frustration. Therefore, he’s not working hard on preparing himself for the exams. “I study at home for only a few hours a week.”

He used to attend classes to prepare for the exams at Immigrant Services Association of Nova Scotia, a non-profit organization that helps immigrants and refugees to integrate in Nova Scotian society.

The programs manager of this organization, Mohja Alia, says any internationally educated physician has to submit an application to get their credentials recognized as equivalent to Canadian degrees. The assessment time depends on the country of the degree and the university. “It could take weeks or even months,” Alia says.

The next step is to take a set of both written and clinical exams.

Al Refai is afraid that he wouldn’t pass these exams because of his lack of knowledge of the Canadian health care culture since he hasn’t practised medicine in Canada.

If they pass the exams, doctors have three choices. The first is to apply to medical residency to get training for two years. There are only seven spots for international graduates every year. Those are “usually taken by Canadians who studied abroad.” Alia says.

The second choice is to apply for a new program called practice ready assessment in family medicine. To be qualified, the internationally educated doctors need to have a family doctor experience.

“Unfortunately, not so many qualify from our clients,” says Alia.

“The third path is to apply for the Med-clerkship program at Dal. There are only two spots and it’s very expensive.”

Max Al Aqel came to Halifax from Yemen as a refugee last year.

He already passed all the exams, which makes him ready to apply for the Med-clerkship this year. He will apply for the residency training next year.

After he finishes the residency training two years, he has to apply to the College of Physicians and Surgeons of Nova Scotia to become fully licensed.

In the meantime, Al Aqel is working as a co-ordinator in bridging programs for international medical graduates. He says there is more than one factor that makes it hard for many immigrant and refugee doctors to get into the Canadian system.

“The older they are, the less likely to finish the whole process,” he says. In his opinion, It’s hard to go back to school 20 years after graduation.

“I’m still in my late 20s and that helped me a lot.”

According to him, openness to the new concepts is an important issue, too. “Some of my clients are rigid in their thoughts,” Al Aqel says. “When they know the logic behind everything related to the health care system in Canada, they get more flexible.”

To introduce them to the Canadian medical care system, Mohja Alia and her team have designed training programs.

“For people who attend our programs, they see the benefit,” says Alia.

They have to start with employment counselling to discuss their needs and choices. After that they can start training programs in which Canadian practising physicians volunteer to teach immigrant and refugee doctors about the Canadian system.

“If they need financial support to pay for the exams, we have a loan program up to $15,000,” Alia says. They must pay the low-interest loan back over four years after finishing the exams. The program is new and funded by the federal government. It should provide help for a minimum of 600 immigrants and refugees across the Atlantic provinces, according to Alia.

Still, the language barrier makes it difficult for the Syrian doctor Loai Al Refai.

In case he doesn’t get licensed, his choices are limited. He may go back to school, but this time he will study radiology at Dal. “For me, it’s an easy pathway to get a job in medical sector. I’m serious about it.”

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