Health

By: Shan Qiao in Toronto, ON

Cindy Leung drops off her husband, Chuck, to a day program at a Scarborough, Ontario long-term care facility. Waving to social worker, Benny Choi from her car she watches Chuck being pushed away in a wheelchair. 

Going through this daily routine, she reflects on where it all started. Eight years ago, Chuck had a massive heart attack and fainted at home. Rushed to the hospital, he was resuscitated after his heart completely stopped beating for minutes that seemed to go well past 60-second intervals. Luckily, he was revived. But after suffering from severe brain damage, he was eventually transferred to a day program following intensive care. And through rehabilitation on weekdays, he has been able to slowly recover his ability to speak coherently.

“My husband was a chef working in [a] restaurant and I was the waitress. Life was quite satisfying until that day he had [a] heart attack. He was only 45 years old at that time,” Leung explains in a voice that exudes calm. 

Although her workload at home has increased, financial constraints have kept her from seeking any additional time at work. Supporting the household as well as emerging medical expenses as the sole source of income, she points to the solace she finds in maintaining a routine.

“We do receive some medical benefit and social assistance, but I cannot stop working. We still have a child in college. Working is one way to support the family financially and another way to support myself psychologically,” she continues. 

Social worker Choi knows what Leung is going through. “Many of our patients encounter stress and frustration when dealing with their inability to talk and walk. It often causes tension towards themselves and their family,” he explains. Most of the patients that come to the facility are males, most of whom receive care from their middle to old-age wives. 

Dual Roles

It’s a story that’s known all too well across the country, women who are forced to take on dual roles within the household and the professional workplace. An astonishing 72 per cent of women caregivers aged 45 to 65 in Canada are also in the labour force. Always thankful for the support systems provided, Leung praises a healthcare system that has afforded her options that nationals of other countries can only dream of. 

[quote align="center" color="#999999"]Caregivers can come from a variety of sources but it is extremely common to see family members step in as figures of support. [/quote]

“I drop him off to this day program from Monday to Friday when I have to work. During [the] weekend, our children can chip in and make it possible for me to take some extra shift[s]. I receive daily feedback [about] him mostly from social workers like Benny. Sometimes, they probably talk to him more than I do. I really appreciate it. [It is] the whole Canadian health care system that gives my husband a second chance.” 

Looking back on life before the near-fatal incident, brings back memories of her husband as a genial and tall man, shouldering all the responsibilities that come with family life. 

Leung, who works in a restaurant as a floor manager, oversees a venue with a 500-seat capacity. Never one to complain, she cherishes having the ability to work while caring for her husband. 

Switching careers

On the other hand, Emily Liu discovered her true career passion as a breastfeeding activist and prospective doula (a person trained to provide advice, information, emotional support, and physical comfort to a mother before, during, and just after childbirth) after becoming a mother and main caregiver to her two young kids. 

“I was a chartered accountant, worked for one of the Big Fours. I made a lot and yet lost a lot in personal time. I can work up to 70 to 80 hours during busy tax seasons until, one day, I noticed a mental meltdown while I was pregnant with my first one. Then I know I have to take a pause,” Liu says. 

Motivated by her own baby, Liu made a move to “downgrade” her work portfolio to a local small accounting firm in Mississauga. Taking on a partner role, she was able to make her work hours flexible so she could juggle work with the responsibilities of raising a child. 

In the end, Liu terminated her partnership, opting for a career as a freelance accountant. That was until two years ago, when she completely withdrew from the accounting business. 

“I slowly find out my keen interest in breastfeeding and promoting it, something I really enjoy doing while raising up my kids,” she stresses. Since then, Liu takes her kids to the La Leche League Canada’s breastfeeding leader training class. 

“This is the solution in my case, working while babysitting and I love doing both,” she giggles. Liu quit one labour market to enter another, one that’s been more welcoming to mothers and caregivers. 

Moving across continents

Caregivers can come from a variety of sources, but it is extremely common to see family members step in as figures of support, sometimes flying across continents. As in the case of 65 year old Elvira Vergara, when the call came from her late husband’s cousin, there was only one choice to make. 

Single with a grown son, residing in Columbia, Vergara moved in. Now 80 years old and widowed, her patient suffered from high blood pressure as well as diabetes. Taking the position as a live-in caregiver, they’ve been cohabiting for eight months and both feel positive about one another’s roles. 

When asked why she chose Vergara, the cousin shrugs her shoulders and beams, “I’ve seen her great attitude working as a house cleaner. My kids probably can’t do a better job than her. We know each other from the past. I trust her,” she nods. 

“Gracias,” Vergara replies in Spanish. 

Although Vergara was able to fill a fulltime position through caregiving, thousands of women are forced to manage dual roles as they maintain their professional positions. It is essential that the support systems built to help these individuals are not only readily available but that they also instill their trust. With nearly half of women caregivers declining available arrangements based on the potential impact on their careers; its clear that more awareness must be brought to the benefits. Only then can these services be deemed helpful and accessible to all Canadians.


This piece is part of the "Ethnic Women as Active Participants in Ontario" series. Writers interested in participating are encouraged to join the NCM Collective for an opportunity.

Tuesday, 13 February 2018 01:46

Understanding the Roots of Abuse

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By: Tazeen Inam in Toronto, ON

One woman is murdered in Canada every six days, according to the Canadian Women’s Foundation. This statistic belies what's been happening in the Greater Toronto Area (GTA) since the beginning of 2018: there has been a dramatic increase in female homicides, with five women killed in a span of six days.

Three were from the Peel Region, one from Halton and another from the Hamilton Region; all at the hands of their male partners.  

Sharon Floyd, Executive Director of Interim Place in Mississauga, calls it “horrific” and says that there is “no specific cookie cutter that can tell what abuse looks like.”

“Women are murdered because they are women, they are not valued in their families and their voices are not heard,” she added.

In the midst of volatile situations, many women often turn to the shelter system which provides a safe haven for thousands annually. And although it may seem like a viable option for many, a lack of resources can force many shelters to turn away prospective residents in need.

The thought can be alarming, considering that in Ontario, 65 per cent of female shelter residents were fleeing emotional abuse and 46 per cent were escaping physical abuse.

Immigrant women more vulnerable

For women who have immigrated from countries that do not share the same gender-neutral values, abuse can manifest itself at even more alarming rates. Studies show that "immigrant women may be more vulnerable to domestic violence due to economic dependence, language barriers, and a lack of knowledge about community resources."

Canada is fraught with examples of this exact scenario and Samira Farah (name changed to protect victim's identity), a Bengali immigrant, endured many forms of abuse before finally finding access to the resources needed to remove herself from a potentially dangerous situation. Following an arranged marriage in Bangladesh, Farah immediately migrated to the U. S. before settling in Canada with her husband. Throughout their 10-year marriage, she was bombarded with emotional, physical, sexual and financial abuse.

Her husband asked Farah to obtain money ($50,000) from her father to pay-off his own debt, but she refused. Instead, she resorted to jobs as a salon worker in a failed attempt to raise money.

Even through emotional abuse and intimidation by her in-laws, Farah gave birth to a baby boy in 2003. Despite the trauma she had experienced, which included multiple miscarriages, positive thinking allowed her to find solace in her newborn.  

Seeking help

However, her husband did not share her joy. With an eye on Farah's inheritance, he tortured her with threats of murder in isolated barren areas. Going as far as physical abuse with a knife in the presence of their then three-year-old son, she knew she had to make a change.

Farah struggled in silence to improve her marriage by opting for marriage counselling. Her counsellor suggested she call the police and later referred her to a shelter home.

“I didn’t want my son to grow in this violent environment, I want to teach him respect for women and that’s when I decided for divorce,” Farah says bravely.

[quote align="center" color="#999999"]Canadians spend roughly $7.4 billion annually to deal with the aftermath of spousal violence alone[/quote]

Every victim is different, however, their aspirations are revived when “they hear that they are not alone”, explains Floyd, who runs a crisis centre for women. “With some initial counselling they learn that it’s not their fault and women are not to blame; this is more of a societal issue.”

Raising Awareness

Farah initially started her mobile beauty spa to make ends meet. But in the process, she has met women from diverse cultures who have been through varied kinds of trauma inflicted by their intimate partners.

She believes that sharing stories with others has helped many alleviate the trauma they have endured.

“I am not the only person who has gone through this, [there are] worse stories out there, but that little bit [of] light of hope can change a lot of things,” Farah says.

Working in different sales and marketing departments, she has now been able to gradually regain her self-esteem. With the support of her co-workers, instructors and mentors she has even followed through on previous plans to further her studies by enrolling in a College program.

“Besides taking action on divorce and get[ting] out of that relationship, I am capable of doing anything that is possible in life,” she says with new confidence.

A woman's self-worth

Generally, it takes a woman 6-7 attempts before she actually pulls away from a relationship because they are not sure of the abuse.Especially when the perpetrator is controlling, it’s important to note that a woman’s security risk doubles when she decides to leave.

Nancy Gibbs, a professor of Community Social Work at triOS College, suggests that education, information and a safety plan must be readily available. Working with victims for over 25 years, she maintains that only through greater public awareness will there be more consistency on what actually constitutes abuse.

“Advertising, blasting social media with what is available to women and what abuse looks like,” she explains, are great ways to spread the word. “It’s important to educate [a] woman [on] her own personal value.” 

What one person would call abuse, another may refer to as just normal behaviour. Gibbs concludes that creating consistency in what is considered acceptable behaviour, stands as one of the first steps to eliminating abuse and ensuring a safer Canada for all. 


This piece is part of the "Ethnic Women as Active Participants in Ontario" series. Writers interested in participating are encouraged to join the NCM Collective for an opportunity. 

Thursday, 01 February 2018 23:15

Being Brown and Depressed

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By: Aparna Sanyal in Montreal, QC

We have yet to understand the impact of covert racism and misogyny on the mental health of Canadian citizens, particularly “ethnic” women. However eager they are to contribute to society, however skilled they may be, they face a unique combination of social isolation and career limitations that can trigger illness.

My personal story perhaps speaks to many women from ethnic backgrounds in Ontario and all over Canada. After all, mental illness accounts for about 10 per cent of the burden of disease in Ontario, yet receives just seven per cent of healthcare dollars. Relative to this burden, estimates show that it is underfunded by about $1.5 billion.

My journey to the depths of despair began somewhere around 2014, when after several years of untreated, chronic depression, I developed psychosis. I remember it as the “terror.” I lived alone, had no family in Canada (although I was born in Sherbrooke, Quebec) and had a precarious job as a freelance writer-editor. Somewhere along the way, I thought moving to Toronto might help, but that turned out to be a disaster as well.

The terror began when my editor at a national publication was promoted, and I could no longer expect regular work. The $250 dollars I received from them every month was significant. I made $500-600 a month in total, if I was lucky; I had looked for over a year for more secure and lucrative employment, to no avail.

But the terror I felt was, I realize, largely social. I feared marginalization more than I feared hunger.  My former editor had been an encouraging man, one who made me feel valued as a writer. When I no longer had that monthly job, it was as though my only railing on a cliff fell away. I had already questioned my worth to myself, and the answer was now confirmed by the outside world. What value was there to me now? It was as though I had seized to exist.

[quote align="center" color="#999999"]39% of Ontario workers indicate that they would not tell their managers if they were experiencing a mental health problem.-Centre for Mental Health and Addiction[/quote]

After this, the terror came upon me, sudden and all-encompassing. Public Health Ontario estimates the disease burden of mental health at 1.5 times greater than that of all cancers put together and I was feeling every bit.

Finding a safe place

I lived in a sort of dormitory house near the University of Toronto, on Madison, a Victorian “bay-and-gable” mansion that had been cut into rickety, rented rooms. We did not have a personal letter box. Our letters were placed on a table near the entrance. I noticed my bank had not sent me the last monthly statement. I became certain my next-door neighbour, a young red-headed man who seemed to be in his room all the time, had stolen it. My problems began to proliferate. I could not find a toenail-clipper, and this only confirmed my suspicions about my neighbour; then I discovered I could not find an old sweater and a journal, and became convinced he had taken these too.

Around that time, I began to smell a strange odour. I thought it might be a noxious drug seeping from his room, but I could not identify it. At night I huddled under my comforter, hoping to protect my lungs from the fumes. As I heard my neighbour moving about restlessly at night, I imagined he was only waiting to do me harm. I also began to think I was being followed, by my neighbours or perhaps by the then-conservative government, whom I thought might have started tracking my strong political beliefs. I began to fret about being anywhere alone, especially in my room. I walked around the city and spent as much time in cafés and parks, as the homeless do. I was unable to sleep at night.

One night, convinced I was under imminent threat — for my neighbour seemed to have banged against my door— I fled the house and called the police. Little need be said about the fiasco that followed, except that one short, tired, blond sergeant shouted at me, and suggested to her two constables, one of Asian origin and one South Asian, that I might be drunk. (I did not drink.)

They had come up to the room with me, and had tried to stir up my neighbour, but he did not answer. At first, they listened to my story. After I told them about the possibility of my neighbour having made a wax key to break into my room, they lost patience. The sergeant threatened to have me charged. I still remember that she kept telling her colleagues, “After all, it’s not as though she works in an office!” My desk, laptop, books, and papers, which were before her, had no significance. I was illegitimate in her eyes because I did not work in an “office.”

The next morning I promptly moved into the Holiday Inn nearby. I called several women’s shelters around town. The sympathetic co-ordinators pointed out that their beds were full. The only one available was too far away, in another borough.

There was no one in the country of my birth for me to turn to. I had, over the previous years, alienated many people from my life. I had lost faith in the Montreal arts community I had worked in for eight years. I had developed an aversion to what I saw as its insular, largely white milieu, and sensed it could only abuse me. This sense, extreme as it was, was rooted in reality.

Overworked and under-paid

My depression had started a couple of years back, after I had left a debilitating job as an Editor and Executive Director of a well-known Montreal publication. The job, I think in retrospect, had been one often taken by women and minorities. It had been given an inflated title, but left one overworked and under-paid. The board of the organization that ran it was composed of local publishers, mainly old, male and white, who had created it as a para-governmental agency. With federal and provincial grants, they had created jobs that the government deemed necessary but refused to do itself or pay for adequately. I had made $18 an hour, a third of what I had made when working for the government a few years before. I had been paid for 30 hours a week, but worked 60.

For almost two years I had worked around the clock. My health had rapidly deteriorated. My employers had been unhelpful and unfriendly. They had rarely responded to my emails when I required information or a signature, and I often had to travel the city to find them. In spite of my difficulties, I had increased the budget and improved the magazine of the organization. Yet I had been invariably criticized by the board. I had begun to cry every night, and occasionally dreamt of suicide. My social skills had become jagged, unreliable. I had snapped at colleagues and clients. I had met a therapist, a European woman, to whom I did not mention my thoughts of suicide. She had suggested I quit my job. I had eventually fought with my board and resigned in a fit of anger, without first securing another job.

After this, I felt hopeless. Each time my mind turned to the people who shared my environment, my heart grew heavy. I could not help brooding on the daily racial slights I endured within an overwhelmingly white community: one well known director, introduced to me, turned away without speaking to me and asked the person introducing me whether I was her “bookkeeper”; that person was someone with whom I shared a large space, and who suggested to me, since I disliked using the air-conditioner in the summer, that my ethnicity made it easier for me to bear the heat. These “micro-aggressions” were little in themselves, but together, happening regularly, as I grew more depressed, they further intensified my sense of alienation.

I had enough money to isolate myself and devote myself to my own reading and writing. When the money began to run out, I made the huge leap to Toronto, where I could start afresh. It was a disastrous decision.

After two days in the Holiday Inn near the Madison house, feeling unsafe, I relocated to an International hostel in Kensington. My terror was so great now that I prepared to fly to Kolkata, India, where I had inherited a house, and would be surrounded by people familiar to me, of my own origin. One day, I spotted a red-headed panhandler near the hostel who looked eerily like my former next-door neighbour; seeing him triggered both my sense of alienation and intense fear of poverty. Inevitably, I felt the need to leave the hostel.

Identifying the Problem

I stayed, during these three weeks of terror, in five hotels. They cost me roughly $10,000 and I received no security from them; each successive place of sanctuary turned into a house of horror. I must have contacted the police five times, expressing my fears. I tried to tell many people about the “drugs” I could smell in my rooms — from policemen to maids to night-managers. But they smelt nothing and were puzzled that I could not specify what I smelt. Only one person told me I should see a doctor. A young, Asian constable in a police station I had run to one night, he said, “All I’m saying is that you should see your family doctor. Because if you are mentally ill, you will be the last person to know.”

I went to a hospital eventually, because I was so anxious I felt I could hardly breathe. The nurse suspected my illness, and asked if I saw things that others didn't see; I said no, for I smelt things others didn’t smell. The medics performed a brain CT on me. It was normal, and I was sent back to my hotel.

I was bitter. I felt I was being forced to flee the country of my birth, and somewhere in my pent-up mind I thought this was because I was a social threat. This happened to be somewhat true, but not in the way my sickness told me it was. Simply put, as a brown, thinking, writing woman, I was negligible in the society I had been born in. Its various attacks on my mind, from micro-aggression to economic hardship to isolation, caused my mental illness and my ejection from that society.

(*For those living in Ontario, the Mental Health Helpline is a free, confidential live service that is available 24/7 to provide callers with information about mental health services in this Province.)


Aparna Sanyal is a writer and journalist who has worked with the Globe and Mail, the Gazette, the Montreal Review of Books, and Rover. She has been an advocate of mental health awareness and is presently pursuing a Master’s degree in English at McGill University. This piece is part of the "Ethnic Women as Active Participants in Ontario" series.

Tuesday, 16 January 2018 23:49

Ushering in the new Health Age

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By: Shan Qiao in Toronto, ON

At the age of 60, quitting a well-paying job to refinance her townhouse and start an entrepreneurial venture was the last thing Helen Poon’s friends thought she would do. But Helen did just that, setting out to build a healthy eating and living co-op so she could hire people who would be compensated by becoming healthy. 

According to a 2017 study, over three ­quarters of Canadians aren't meeting the recommendations of Canada’s Food Guide for fruit and vegetable consumption, this results in an estimated economic burden to society of $4.39 billion annually. While dietary recommendations are made annually by the Canadian government, Poon recognized that a more hands-on approach would be necessary in order to affect more immediate change. The result, the Sprouts Co-Op in Toronto which focuses on specific neighborhoods across the GTA.

The thought of building a community-based healthy food and living co-op had been brewing in her mind for a couple of years, well before Poon decided to quit her job. “You are what you eat,” she continues. Hence the 2017 co-op which is steered by Poon but also receives support from a handful of people that have drawn influence from her. 

[quote align="center" color="#999999"]“I want to create diverse and connected communities that recognize, practice, and advocate for equitable and sustainable food and health systems.” -Helen Poon[/quote]

Poon has never been one to shy from a challenge, so when she learned of the difference sugar alternatives like honey could make, she immersed herself in the subject. Canadians consume an average of 26 teaspoons of it every day, which amounts to 21% of their total daily caloric intake, playing a huge role in many diseases and conditions that have become more prevalent in recent years. Despite her lack of experience in the subject, she has been able to incorporate the ingredient in several recipes without sacrificing taste in any way. 

“Helen was my supervisor at our previous organization we both worked for. At the end of last year, she told me she wanted to start a food and health co-op and hire people with disabilities,” says Daphne Au-Young who holds a Master’s degree in Clinical Psychology and joined Sprouts as a board member. 

“I thought it’s a great initiative to provide affordable healthy food for the community and meaningful employment for individuals with disabilities. I admire Helen’s determination to start an organization at the age of 60. It shows that one is never too old to turn a dream into a reality,” Au-Young explains. 

As an immigrant woman who came to this country after China’s 1989 political turmoil, Au-Young said her parents sacrificed their high paying jobs in Hong Kong for stability and freedom in Canada. The version of Sprouts’ “meaningful employment” makes her very happy to see clients moving past their traumas and living a normal life again. 

A major influence within the Asian community, Poon is also a mentor to young men like Dave Tran. A descendant of Vietnamese immigrants and high school English teacher, Tran is currently the Vice-Chair of Sprouts and considers Poon an inspiration. 

“There have been several important people in my life recently, demonstrating amazing leadership over the years, helping to build a greater diverse community for all. Helen is one of those people. She is quite an inspirational person who is a work horse; she always gives her 100% into anything she does and it can become infectious—in the best way,“ he explains. 

Rui Ping Chen came to Canada 10 years ago as a young girl who also met Helen in her previous job. After learning of Sprouts, she was intrigued. “What kind of dream was big enough for her to leave a management position? She talked to me about Sprouts with so much passion and wisdom that I immediately understood why she did what she did.”

“I believe in what Sprouts is trying to promote ‘we are what we eat’,” says Ping, behind a makeshift reception table that collects people’s membership fees and registration forms at Sprouts’ first product launch event in Markham last November. That night, Sprouts successfully attracted more than three dozen people to join as members, after a year-long endeavor by Helen and the people influenced by her.

As the Sprouts Co-op continues its steady growth, Poon hopes to extend her reach to an even more diverse range of members. And while the Co-op's Toronto base has limited its current operations to the GTA, it will be interesting to see what the future holds for this ambitious startup.


This piece is part of a series titled, "Ethnic Women as Active Participants in Ontario". Writers interested interested in participating are encouraged to join the NCM Collective for an opportunity.

By: Viji Sundaram in Mountainview, California

A much heralded push toward digital patient portals, commonly integrated with electronic health records, may be exacerbating health disparities between rich and poor, instead of reducing them, as they were intended to.

In fact, for a variety of reasons, “you could argue they increase disparities,” said Suneel Ratan, chief strategy officer of Community Health Center Network and the Alameda Health Consortium, who has researched the use of patient portals in Bay Area community health centers.

Last year, MayView Community Health Center’s three clinics – here in Mountain View, Palo Alto and Sunnyvale -- launched their patient portal tool to meet “meaningful use” requirements in order to receive federal incentive checks, a part of the Electronic Health Records Incentive Program. The program was designed to help health care providers move away from a paper-based system. A few mouse clicks allows a doctor to navigate the entire medical history of a patient.

Patient portals, which have been in use for more than a decade in larger hospitals nationwide, are commonly integrated with electronic health records. They are secure online websites that give patients 24-hour access to their personal health information from anywhere with an Internet connection. It’s a way of patients being engaged with their care team and on their own time, with the hope that it will lead to better health outcomes.

Among other functionalities, patient portals typically include online appointment scheduling, bill pay, prescription renewals and the ability to accept patient-generated data on allergies and other health issues. Patients also have access to lab results.

MayView, a federally qualified health center (FQHC), spent about $30,000 in staff time to build its portal, the clinic’s Executive Director Kelvin Quan said, noting that the tool was not only to meet the federal “meaningful use” standard by tethering it to electronic health records, but also to “meet a standard in adopting the patient care model known as ‘Patient Centered Health Home,’” a kind of one-stop shop for patient care.

Soon after MayView launched the tool, many patients enrolled, but enthusiasm seemed to wane after a few weeks, when the program became something like “white noise,” [a collection of sounds that are a mere distraction] as MayView’s Medical Director Dr. Aarti Gupta described it.

Enrollment figures in MayView’s program show that of the clinic’s approximately 6,600 patients, only 600 are currently enrolled. Of them, only 200 are active users.

Quan believes the tool’s low patient penetration is because “technology doesn’t work for our population,” a good percentage of whom are Hispanic and Asian and Pacific Islanders. That could be the reason why East Palo Alto-based Ravenswood Family Health Center, also an FQHC and with a similar patient demographic, has low usage of its patient portal – 10 to 15 percent -- according to Chief Executive Director Luisa Buada.

"The majority of our patients are Spanish-speaking with lower literacy (including health literacy, reading literacy and computer literacy) rates," said Dr. Justin Wu, Ravenswood's Clinical Informatics Officer. "Add to that the current political climate with mistrust around immigration issues and a general hesitancy to give out information or have health information online, and I think it helps explain some of the problems we've been having with patients in using our patient portal." The two clinics reflect a national usage trend that showed that Asian Americans, Latino Americans and African Americans were 23 percent, 55 percent and 62 percent less likely to register for digital personal health record access, respectively, compared to non-Hispanic whites.

First off, “many of our patients can’t afford computers. If they can, their [technology literacy level] makes it difficult for them to navigate the information,” Quan said.

For those who have the app on their cell phone, the font is so small, they can’t read it, he said.

David Lindeman, director, Center for Innovation and Technology in Public Health and the CITRIS program at UC Berkeley, believes that if some of the text were taken out of patient portals and replaced with images and videos the tool could possibly be embraced by more patients.

A study done two years ago by five academics shows why the patient portal program has been relatively successful at Kaiser Permanente, a large grouping of hospital and practices, as well as the nation’s second-largest insurer. By 2015, Kaiser had registered 70 percent of their 5.2 million patients on their portal, well above the health care industry expectation of 50 percent, according to Quan.

The bulk of Kaiser’s patient portal education material – not entirely simply written -- is geared toward white, middle-class people, who are better educated. Patients with a post-graduate education are more likely to register than adults with a high school education or less on to My Health Manager.

“You have to meet the patients where they are coming from,” said Quan.

My Health Manager enrollees can email their care team members with health questions and expect a response within 48 hours.

Most of MayView’s patients are on Medi-Cal (the federal-state health insurance program for low-income people, known as Medicaid in the rest of the nation). Some are undocumented. Care providers at the clinic are already stretched thin, Gupta said, one of the reasons why MayView’s patient portal lacks the e-mail communication functionality.

“If they had to respond to queries from their patients on the computer, it would take time away from attending to patients” who prefer face time with their providers, Gupta said.

Besides, “Medi-Cal will not reimburse them” for computer time, Quan said. 

Ratan said most FQHCs don’t have the resources to implement robust functionality in their patient portals. But at least one he has worked with has deployed a patient portal that includes medical records, in addition to appointment schedules and refills.


Republished in partnership with New America Media.

By Belen Febres-Cordero in Vancouver

Upon arrival, immigrant populations in Canada tend to present less allergies than their Canadian-born counterparts, but prevalence increases with time, a national study finds. However, exposing them to ethnic foods and cultural practices that they were accustomed to may help reduce allergies in this population, according to the researchers. 

There is no definitive answer as to the cause(s) of the definitely noted increase in allergies in immigrant populations when they move to Western countries such as Canada. However, the pattern is real and needs to be analyzed”, says Dr. David Fischer, President of the Canadian Society of Allergy and Clinical Immunology (CSACI).

As first-generation immigrants to Canada, Dr. Hind Sbihi (picture below), Research Associate at the University of British Columbia, and Jiayun Angela Yao, PhD candidate at the same institution, became intrigued by allergy rates among newcomers and conducted a study to understand the role that genetics and environmental factors play in the development of non-food allergies, such as hay fever.

[quote align="center" color="#999999"]“Our best hope to curb the increasing trend in allergic disorders is to prevent it.”[/quote]

The researchers explain that in the past decade, the media, public and researchers have mainly focused on food allergies “It’s critical to raise awareness for non-food allergies given their high prevalence in our population, and posing a big burden to our health care system,” they add.

Canada has some of the highest allergy rates

This is particularly true because Canada has some of the highest allergy rates in the world. According to the American Academy of Allergy Asthma & Immunology, approximately 10-30% of the global population has hay fever. While in the United States roughly 7.8% of people 18 and over has this allergy, almost 20% of the population in Canada is affected by it. Considering these statistics, Sbihi and Yao wanted to understand if immigrants in the country would also display an increase in allergies.

“Our study highlighted the unique opportunity to investigate allergies in migrant populations, who are going through a natural experiment, in which the environment around them changes dramatically in a relatively short period of time,” they explain.   

To conduct the study, the scholars used the data collected in the Canadian Community Health Survey, which gathered information about the health status, lifestyle habits and basic demographics of a large and representative sample of Canadians. In the survey, respondents were asked whether they had non-food allergies – diagnosed by a physician-, and whether they were immigrants to Canada and if so, their time since arrival. “We took the responses to these questions, and assessed the statistical association between non-food allergies and immigration status”, they say.Photo Credit:Hind Sbihi Linkedin

Following this method, the study found that only 14.3% immigrants who had lived in Canada for less than 10 years had non-food allergies, while the rates for immigrants over 10 years and non-immigrants were 23.9% and 29.6%, respectively.

These results suggest that environmental factors, such as pollution, levels of sanitization and dietary choices, carry more weight in the development of allergic conditions in Canada, Dr. Fischer explains, while Dr. Sbihi and Yao add that more research is needed to pinpoint what those factors are, and to better understand how allergies arise by country of origin.

They also highlight the need for undertaking multicultural strategies to improve newcomers’ health.

Ethnic foods may help

Dr. Sbihi and Yao add that it is also important to understand that allergies are symptoms of a loss of internal balance that results from a dysfunction of the immune system. “Providing immigrants with means to access food or cultural practice that are ethnically-friendly may help them transition smoothly into the new environment without perturbing their natural balance,” they suggest.  

“Our best hope to curb the increasing trend in allergic disorders is to prevent it. Prevention can only happen when there is a good understanding of risk factors that come to play in the development of these disorders.” For these reasons, they suggest that raising awareness among health practitioners about the link between immigration, environment and allergies might help in their patients’ management.

“The main role for medical practitioners is to work with patients to recognize if they have allergies, to manage them acutely with their patients and if necessary refer them allergist if there is some doubt about the diagnosis or for more definitive management,” says Dr. Fischer.

Saturday, 20 August 2016 17:36

Medical Student Re-discovers Jaffna

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by Gayathri Naganathan in Scarborough

I was born at the Vavuniya General Hospital in the winter of 1988, in a town that is often referred to as the gateway to the northern Vanni region. As so many other families before us, we fled Sri Lanka during the civil war, amid death, destruction and uncertainty.

We arrived in Scarborough, Canada, in the early 90’s, in what would become the single largest Sri Lankan Tamil diaspora community outside of South Asia. I grew up speaking Tanglish (a blend of Tamil and English), eating string hoppers and spaghetti, and listening to A.R. Rahman and the Backstreet Boys.

In short, I am a ‘third culture’ kid, a blend of the home we left behind in Jaffna and the home we worked hard to create in Canada. So as a Canadian medical student when I was presented with the opportunity to spend several weeks training in any field and in any country around the world, the natural choice for me was to go “back home”.

Having spent over two decades away, I didn’t quite know what “back home” would mean on this first visit back. After months of phone calls, emails and planning, at the end of June, I arrived at the Jaffna Teaching Hospital, ready to start my five weeks of electives in internal medicine and general surgery. Unsurprisingly, I spent the first few days overwhelmed by the experience.

I have been volunteering, working, and learning in hospitals for most of my life. For most, hospitals are places that cause anxiety and stress, but for me, they are often a place of familiarity and comfort, somewhere where I feel engaged and useful. Despite years in this environment, the Jaffna Teaching Hospital felt foreign to me. The wards, the equipment, the staff uniforms, the very rhythm of the place was completely alien.

Patient autonomy

The most obvious difference was that everything was done by hand. There was not a single computer in sight. Having worked in a health system that is increasingly digital, this was a big change for me. I also soon discovered that patient records are not kept locked away in a filing cabinet at the clinic or hospital.

Rather, the patients themselves carry their clinic books, lab reports and even MRI scans to each appointment with them. While cumbersome and running the risk of losing documents, this system gives full autonomy to patients over their personal health records and also allows for the mobility of those records from one site to the next.

Despite (or perhaps because of) this system, the consultants (in Canada, we call them “attendings”) are able to see a massive case load in a very short period of time. This was most obvious on clinic days where upwards of 40 patients were assessed, treated, and dismissed and/or given a date for follow up, all within the span of two to three hours. It’s a whirlwind of papers shuffling, names being called, patients shifting in and out of the examination rooms, and notes hurriedly scrawled into clinic books.

I was equally stunned the first time I stepped into the casualty theatre – a carryover, it seemed, from Sri Lanka’s civil war, when trauma patients would flood into the hospital every day. Two tables, with one anesthetist each, for procedures that require general anesthesia.

All other procedures were conducted under local anesthesia on stretchers flying in and out of the large operating theatre. And, at the centre of it all, a group of dedicated and talented registrars and surgeons operate on everything from in-grown toenails causing infection to inguinal hernias, all using proper aseptic and clean protocols.

As a student, it was incredible to move from one table to the next and see so many different techniques and procedures happening simultaneously.

Controlled chaos

To me, this was controlled chaos. And this phrase echoed through my mind again and again as I proceeded through my weeks of training in Jaffna.

But beyond the differences, the language of medicine remained a constant thread to which I could hold. Human anatomy is the same the world over. And I marvelled as I watched my general surgery preceptor carefully reveal the facial nerves of a patient with a suspected tumour over his jaw bone. Like the branches of a tree, the branches of cranial nerve seven spread out across one half of the patient’s face, beginning to divide and separate just in front of the ear. It was like I was looking at a diagram in a textbook, the dissection down to the tumour was so precise and clean.

Acetaminophen too is the same all over the world. Whether we call it Panadol, Paracetamol or Tylenol, all three can be used to bring down a fever, all three can be used to relieve pain.

Moving mountains

Though the medicine was fascinating, the most enriching aspects of this journey to Jaffna were the people that I had the privilege of meeting. From the patients, nursing staff, and fellow medical students to the registrars and consultants who served as my teachers and mentors, the people I met throughout my five weeks at the Jaffna Teaching Hospital made the experience unforgettable. They worked to bridge the cultural and linguistic gaps between us, provided thoughtful and insightful answers to my questions, and facilitated opportunities to practice clinical skills and learn new techniques.

[quote align="center" color="#999999"]I was truly in awe to see the mountains that these health providers move on a daily basis with less than a hundredth of the resources we have available to us in Canada, and with significantly more challenges.[/quote]

What do you do, for example, with a patient with diabetic foot ulcers who can’t afford to buy shoes? Or having to label an otherwise medically fit patient as a “poor candidate” for kidney transplant because all such surgeries are done in the private sector and require hundreds of thousands of rupees to carry out?

I feel honoured to have had the opportunity to be a learner in Jaffna, and to speak to patients and practise medicine in my mother tongue, Tamil. I feel especially privileged to have met the dedicated, passionate, and talented physicians and medical students who propel medicine forward in Jaffna. Despite systemic barriers, low resources and a significantly complex patient population, they persevere, they innovate and they thrive.

As a teacher and friend from my general surgery elective in Jaffna so poignantly stated, “We have the resilience gene”. And I could not agree with him more.

Gayathri Naganathan is a second year medical student at McMaster University in Ontario, Canada. She is a daughter of the Tamil diaspora and a proud “third culture” kid.

Wednesday, 06 July 2016 22:29

Canadian Pharma: Know Your Patient

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Commentary by Rohit Phillips in Aurora, Ontario

The fast-growing multicultural consumer segment of Canada represents a potential opportunity for pharmaceutical companies, especially if they can improve patient outcomes on a national scale.

For a small or mid-tier drug company battling to make headway in the general market, capturing a large portion of the multicultural market may be the path to improved profitability and growth. 

Ethnic (or “Diversity”) Healthcare is all about the ‘culturally sensitive connection’ to effectively address ‘health and healthcare disparities’ that result from cultural differences. These differences influence the health and well-being of Canada’s growing visible ethnic minority population, which made up to 20 per cent of the total population in 2013 and is projected to grow to 32 per cent by 2031.  

Fifteen years from now, it’s projected that visible minorities will make up 63 per cent of Toronto, 59 per cent of Vancouver, 31 per cent of Montreal.  Together, these three areas will account for 70 per cent of Canadian GDP.

Genetic, Environmental and Cultural Factors 

The factors contributing to varied drug responses are complex and inter-related. Differences in drug response among racial and ethnic groups are determined by genetic, environmental, and cultural factors. These factors may operate independently of one another, or they may work together to influence outcomes.

Biological Factors: The genetic makeup of an individual may change the action of a drug in a number of ways as it moves through the body. Clinically, there may be an increase or decrease in the intensity and duration of the expected typical effect of the drug.

Environmental Factors: Diet, climate, smoking, alcohol, drugs, pollutants —may cause wide variations in drug response within an individual and even wider variations between groups of individuals.

Cultural Factors: Cultural or psycho-social factors, such as the attitudes and beliefs of an ethnic group, may affect the effectiveness of, or adherence to, a particular drug therapy.

Being Culturally Sensitive

Multicultural marketing isn’t just attaching a face to your campaign.

It has more to do with presenting information in a culturally relevant way and context. Isn’t all communication and marketing about better connecting with the audience?

So, what aspects of any ethnicity do marketers and advertisers need to understand to connect their brand messages well?

Here are a few important ones:  

1.       Language: It’s not just about translation from English. The message must be written for and from the perspective of the minority language audience. Health promotion communication should also take into account the visual and oral cultural cues, like pictures and music.

2.       Beliefs: Beliefs can be powerful forces that affect our health and capacity to heal. Whether personal or cultural, they influence us in one of two ways – they modify our behaviour or they stimulate physiological changes in our endocrine or immune systems. Many cultural beliefs have implications for healthcare, which may be direct or indirect.

As an example, many Asians believe that the number four is unlucky because when pronounced in Japanese or Chinese it sounds very similar to the word for “death”. Thus, items arranged in groups of four, such as pills or syringes, can symbolize bad luck for those people who believe in numerology.

3.       Behaviours: Culture has a bearing on the way a person acts in response to a particular situation. Buddhist teachings emphasize ‘’face’’ or dignity. An individual’s wrongdoing causes the immediate family to lose face. Such behaviours have a direct bearing on disease screening and diagnoses as patients may not admit or realize they have health problems, especially mental health problems, as this may bring shame upon their family.

4.       Communication style: Refers to ways of expressing oneself to others and can be very different for a Chinese-Canadian compared to an Indo-Canadian. Older Chinese patients tend to be polite and may smile and nod. Nodding does not necessarily indicate agreement or even understanding of medical facts. Understanding of verbal and non-verbal communication styles of these cultures is critically important during screening, diagnoses and outreach programs.

5.       Notions of modesty: Modesty is highly valued in South Asian culture. An example is an elderly woman who may be soft-spoken and not advocate for herself. Important decisions are made in this culture only after consulting with family members or close family friends. Involving the family and friends in intervention/prevention programs and long-term care for specific ailments like diabetes, cardiovascular disease and cancers can go a long way in increasing compliance, raising awareness and generating brand loyalty.

Despite the many differences among the cultures that make up our nation, we all have the same basic needs: to be able to convey the symptoms and concerns of an illness, to receive competent care, to be acknowledged and valued.

A few fundamentals

When conducting situation analysis and a SWOT analysis of your business plan, the following are important for success:

·         Explore implications of demographic changes (regional and national)

·         Segment patient population by ethnicity

·         Identify differences in disease incidence (determine if your product treats a condition in which a health disparity exists between the ethnic and general populations. For example, is mortality different among ethnic groups in your disease category?)

·         Examine the growth patterns of your customer base

·         Find out from physicians and managed care organizations what issues they encounter in an increasingly diverse population. Then identify challenges and opportunities your company can pursue

·         Find out what your competition is doing to serve the needs of the “emerging majority”

Rohit is a seasoned healthcare marketing and advertising professional with an entrepreneurial instinct and a degree in pharmacy. Rohit is currently employed with The Gibson Group, a healthcare communication agency in Canada.

by Kyle Duggan in Ottawa

As the world struggles against the rapid spread of the Zika virus, the Canadian government is opening its wallet to shell out nearly $5 million for research and international aid.

Health Minister Jane Philpott announced a funding package of $4.95 million before question period Wednesday afternoon, which she called a “significant and important international response” on Canada’s part.

The virus has been linked by health officials to causing microcephaly, a rare but serious birth defect that leads to unusually small heads and hindering newborn development.

“This will fund large international projects that will address the spread of the Zika virus,” she said.

According to the minister’s office, $3 million will go toward in research, through Canada Institutes of Health Research, and the International Research Development Centre. Specifically it goes into researching the link between Zika, microcephaly and Guillain-Barré syndrome, along with developing better ways of testing for the virus, studying how it gets transmitted, and finding better ways of preventing transmission from mosquitoes.

Public Health Agency of Canada will send $950,000 to the Pan American Health Organization for responding to countries hardest hit, and Global Affairs Canada will divvy up $1 million for humanitarian funding to a number of organizations, including the United Nations Children’s Fund, the World Health Organization, and the International Federation of Red Cross.

In the U.S., meanwhile, the White House and health officials have been urging Congress to grant $1.9 billion in new funding to deal with the health threat Zika poses internationally and domestically, and while waiting the administration has raided funding from an Ebola fund to make due.

In Canada, the Zika threat itself has been low because the country doesn’t have the Aedes type of mosquito that spreads the virus. According to Public Health Agency Canada’s last update from last week, Canada has 67 cases identified from travel and one from sexual transmission.

Zika has been around in Africa and Asia for decades, but in the past few years it was introduced into the Americas and has been spreading rapidly.


Republished in partnership with iPolitics.ca

 

by Rosanna Haroutounian in Quebec City

A trip to an organic dairy farm in Ontario was enough to inspire a former Wall Street banker to launch a global search for better ways to treat farm animals. 

“This was an organic farm, but the cows still weren’t treated well,” recalls author Sonia Faruqi. “They were indoors two-thirds of the year and outdoors only one-third of the year, and while they were indoors, they were chained to stalls, which is really unnatural for cows, who are grazing animals.” 

After volunteering for two weeks at the dairy farm, Faruqi visited other Ontario farms, but not without resistance from farmers, who she says are part of a tightly knit community. 

“Everyone they know is a farmer, so if you’re someone who comes from a city, or who’s brown, or even a woman in a very male-dominated industry, you're immediately very different,” explains Faruqi, who was born in Pakistan and raised in the United Arab Emirates. 

She worked at an investment bank on Wall Street in the United States before the 2008 economic crisis, after which she joined her family who had just immigrated to Canada. 

[quote align="center" color="#999999"]“Everyone they know is a farmer, so if you’re someone who comes from a city, or who’s brown, or even a woman in a very male-dominated industry, you're immediately very different.”[/quote]

Faruqi says she used her savings to visit and volunteer at farms in several countries, including the United States, Malaysia and Mexico. 

Her first book, Project Animal Farm: An Accidental Journey into the Secret World of Farming and the Truth About Our Food, documents her experiences abroad and what can be done to create a farming system that is better for farmers, animals and consumers. 

A world view on farming 

While Faruqi says she witnessed many examples of animals being mistreated, such as chickens being kept in overcrowded cages and pigs covered in their own feces, she also visited farms where animals were well treated and healthy. 

In Belize, Faruqi stayed on a farm with female Mennonite missionaries, who she says have a holistic view of the land and do not refer to raising livestock as agriculture or business, but as “animal husbandry.” 

She says the women named their cows and allowed them to graze in fields with ponds and other animals. 

“It was interesting for me to see that kind of affection for the animals and the land.”  

Faruqi also compared the farming practices between Indonesia, Malaysia and Singapore to explore how industrialization affects the treatment of animals. 

[quote align="center" color="#999999"]“It’s all changed to an extremely industrialized, very low-cost system.”[/quote]

She explains that in Malaysia, which has recently experienced rapid economic growth, the popularity of fast food chains like KFC and McDonald’s has led to an increase in factory-farm practices, including artificial insemination, antibiotic use and corn-based diets. 

“It’s all changed to an extremely industrialized, very low-cost system,” she explains. “Local farms, breeds, and knowledge that people have of animals and of the land – all of it is eradicated.” 

By contrast, in Indonesia, which is less industrialized, Faruqi witnessed hens walking freely in villages that only visited their owners’ homes in the mornings for breakfast. 

“I noticed people walking their cows,” she adds. “It was interesting to see that bond that people have with animals.” 

She notes that at some of the farms she visited in Ontario, farmers didn’t visit their farms and relied on automated systems to update them on their animals. 

The many downsides to factory farming

Faruqi says that despite the downsides to factory farming, the government in Malaysia promotes fast food because it symbolizes industrialization and development. 

“The same way people wear jeans and listen to American music, they’re also eating American foods, which are hamburgers and fries and actually not good for you,” she says. 

“There’s tens of billions of farm animals in the world and most of them are being made to suffer to produce cheap food for people, who should not be eating that much meat, milk and eggs to begin with.” 

[quote align="center" color="#999999"]“When people move here, they really want to integrate to the extent that they leave their own food heritage.”[/quote]

Faruqi says consumers have the power to promote good farming habits by eating less animal products and demanding that the animal products they do eat be produced in healthier ways. 

“There’s a misconception that you have to be white and wealthy to even think about this, which is not true, because in the end, everyone’s health is important.” 

A disproportionate impact on immigrants   

She notes that while language or income barriers might prevent newcomers from making healthy choices, many of them come to Canada practising healthy eating habits that they don’t retain. 

“When people move here, they really want to integrate to the extent that they leave their own food heritage.” 

The vegetarian diet that is popular in India is an example that Western societies can learn to value, she says. 

She notes that immigrants can also be disproportionately affected on the production side, because factory farms employ many immigrants in slaughterhouses. 

“Part of the reason is that these are jobs non-immigrants don’t want, for clear reasons,” she says. “Workers have mental and physical health issues, which are not really treated.” 

Faruqi advocates for more government oversight of factory farms and regulations to protect animal rights, as well as the inclusion of more women in agriculture. 

She says that under current laws in Canada and the U.S., a pig has the same rights as a table, “which is really ridiculous when you think about it, because one is an animate being with instincts and interests and desires, at the very least, to not suffer.”


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