Health

by Florence Hwang in Regina, Saskatchewan 

Immigrants not only have to learn a new language when they arrive in Canada, but also adopt the values of Canadian society. This can often impact their parenting methods. 

“This is part of how we should be settling new immigrants into our community,” says social worker Gary Direnfeld, who has 33 years of experience and works out of Dundas, Ontario. “I’m of the view that there should be a structured approach to that. More often it’s kind of a haphazard approach. They have to pick [parenting methods] up almost by osmosis and trial and error.” 

With the Liberal government contemplating revoking Section 43, the corporal punishment section of Canada’s Criminal Code, otherwise referred to as the “spanking law”, some immigrants to Canada may be forced to rethink their parenting methods. 

Separating discipline from anger 

Alden Habacon is the founder of Schema Magazine, an online magazine described as “a blend of pop culture and identity for the interculturally-minded.” He was born in Manila, Philippines and raised in western Canada. 

He refers to an International Parenting study that examined “criminality trends” of over 11,000 university students in 15 different countries, showing that spanking was associated with higher rates of criminal behaviour. 

[quote align="center" color="#999999"]Spanking teaches children that there is an acceptable time for physical violence.[/quote]

He says that after watching a documentary that made a correlation between spanking and prison incarceration, he was convinced not to spank his two sons. 

“The documentary found that spanking actually leads to more violent behaviour as an adult,” he explains. “That all incarcerated men were spanked. True? I don't know. But it won me over.” 

He has told immigrant parents that it is hard to separate discipline from anger when using spanking. 

“Spanking does not necessarily teach children about the consequences of their actions,” he says. “What it does demonstrate to them is physical violence [causing pain] is acceptable in some circumstances.” 

While Habacon says there might be a "right way" and “wrong way” to spank children, he wonders if it is worth the risk. 

“Are you disciplining or just acting out in anger towards someone who has no defence? Hard to know when you are overwhelmed with emotion,” he points out. 

[quote align="center" color="#999999"]“It took me a long time to resolve the resentment."[/quote]

The choice not to spank

Clara Chung Der, who was born in Malaysia, remembers being spanked until she was about 11 years old. She vividly recalls having to either stick out her hand for ‘lighter punishment’ or pull down her pants and lie over the edge of the bed, face down, for more severe ones.   

“I remember feelings of fear and anger towards my mom and because she is not one to work through emotions,” says Chung Der, who now has four children and lives with her family in Regina, Saskatchewan. “It took me a long time to resolve the resentment, which is one of the main reasons I do not spank my kids.” 

Chung Der once tried spanking her eldest daughter when she was a toddler.   

“I was angry and frustrated with her actions and did not know how else to communicate for her to stop, so I slapped her arm, which took her by surprise and she ended up laughing, which woke me up to my actions,” she says. “We decided then, we did not want to resort to a 'violent' act to communicate with our kids.” 

Now, she and her husband parent based on being relational with their children. 

Using strategies that don’t shame 

Direnfeld agrees that spanking can run the risk of children becoming resentful for being shamed or being hurt by their parents. 

He notes that while spanking seems to correct the child’s behaviour, they may act out in different ways. 

[quote align="center" color="#999999"]"[T]he child believes, ‘If my parents can hit me, then certainly I can hit another child.’”[/quote]

“So instead of being openly defiant, maybe now I steal from your purse. So superficially the parent thinks I’ve dealt with it,” he says. 

He adds that corporal punishment can create a new set of behaviours for parents to correct. 

“Now this child goes to school and somebody offends the child, and the child believes, ‘If my parents can hit me, then certainly I can hit another child,’” says Direnfeld. “So we’re inadvertently role-modelling behaviour that clearly, if acted upon by the child, is going to be deemed inappropriate.” 

He recommends using other strategies that don’t shame, demean or hurt the child, but continue to hold the child accountable. 

“Strategies could be loss of privilege, time-out, restitution, returning something or doing something on behalf of the party that was hurt, apologizing, talking with the person who may have been hurt or offended so that the offender better appreciates the impact of their actions on others and can develop empathy – you don’t get any of that from a smack on the rear end,” he says. 

When parents spank their children, they lose opportunities to teach children lessons and learn about the impact of their behaviour on others. 

“It’s what the child internalizes in what we call a conscience that facilitates the best behaviour,” Direnfeld adds.

This is the third and final part of our series on spanking and what it means for new Canadian parents. The first and second articles in this series sparked a lot of debate on social media. Here is just a sample of what some people had to say:


{module NCM Blurb}

by Carlos Tello in Vancouver 

A new food guide combines recipes from British Columbia’s immigrant communities with local seafood options to teach new Canadians how to incorporate B.C. fish into a healthy diet. 

“You have chefs from all over the world, and then you make them cook this local product,” says Siddharth Choudhary, the executive chef of Siddhartha’s Kitchen, a Vancouver restaurant that specializes in Indian food. “So people will be able to make dishes with ingredients they can find in any grocery store. It’s kind of a nice mix.” 

A recent survey commissioned by Vancouver settlement organization MOSAIC, the B.C. Salmon Farmers Association and local newspaper, The Province, found out that although immigrants tend to generally eat the suggested amount of meat, fish and alternatives by the Canada Food Guide, they are less aware of how to ensure ‘healthy-heart’ diets. 

This type of diet keeps cholesterol low, prevents heart disease and includes foods high in Omega-3 acids like salmon and other types of local B.C. fish. 

[quote align="center" color="#999999"][I]mmigrants often don’t know how to incorporate salmon into their diets.[/quote]

According to Jeremy Dunn, the executive director of the B.C. Salmon Farmers Association, this could be because immigrants often don’t know how to incorporate salmon into their diets. 

“One thing we hear a fair bit from people with respect to salmon, especially with respect to making it at home, is that either they don’t know how to cook it, or they don’t know more than one way to cook it,” he says. “And so it gets boring.” 

In order to address this, MOSAIC and the B.C. Salmon Farmers Association recruited chefs from different backgrounds in order to produce the Eating Resource Guide, titled A Mosaic of Flavours, comprised of six recipes by six different chefs. 

The guide showcases different ways to cook meals that utilize B.C.’s local fish and seafood. Of the six recipes presented in the guide, four have salmon as a main ingredient. 'Indian Baked Salmon' and 'Salmon Chinese Way' are two examples.

Guide a nod to B.C.’s multiculturalism 

“Apart from the nutrition factor, the guide gives you different types of recipes. It gives you a little bit of Korean, of continental, of Indian, and more,” says Choudhary. 

For the chef, the fact that the guide mixes local and international ingredients and spices showcases the multicultural nature of B.C., a province in which visible minorities represent just over 25 per cent of the population. 

[quote align="center" color="#999999"][T]he guide mixes local and international ingredients and spices ...[/quote]

Moreover, Choudhary says the guide also highlights the stories of the chefs who come from a variety of ethno-cultural backgrounds. 

“By reading the guide, you can learn about these chefs coming from different countries who are working very hard in order to be successful,” he says. “I think it sets an example.” 

For Choudhary, being fluent in English and spending almost a decade working in Europe and Asia didn’t relieve him from the struggles many immigrants face when they settle in a new country. 

Choudhary moved to Canada with his family seven years ago and a year after settling in Vancouver, he opened Siddhartha’s Kitchen. 

“When I first arrived, I was very confused about what to do and how to do it,” he shares. 

At the time, Choudhary wasn’t aware of the existence of immigrant settlement agencies. After learning about the services these organizations provide to newcomers, he became eager to help. 

[quote align="center" color="#999999"]“We want to create awareness amongst newcomers on the relationship between healthy eating and heart disease.”[/quote]

His opportunity arrived last month, when he learned that MOSAIC was looking for chefs to compile a healthy eating guide. 

“I thought it would be a great idea to come up with a new recipe,” Choudhary says. “I wanted to incorporate my skills, to [do] whatever I could to contribute with MOSAIC.” 

Healthy diet is not enough

The purpose of the guide is not only to provide newcomers with ideas on how to incorporate more seafood into their diets, but also to start a conversation about the benefits of eating healthy. 

“We want to create awareness amongst newcomers on the relationship between healthy eating and heart disease,” says Ninu Kang, MOSAIC’s director of communications and development. “Our focus with this guide is to have newcomers start to think about their diets, and to create awareness about the different healthy foods that are available.” 

The Heart and Stroke Foundation reports that 600,000 Canadians are living with heart failure. A 2015 study found that some aspects of Western culture, like fast food and cigarettes, can contribute to declining heart health among immigrants when they arrive in Canada. 

According to the same study, immigrants from South Asia had the highest rates of heart problems. 

Dr. Manjeet Mann, a cardiologist based in Victoria, B.C., says eating oily fishes like salmon at least once a week is a good start towards a healthier lifestyle, but he warns that it is not enough. He recommends also discussing food choices with a dietitian and doing moderate exercise daily. 

“A guide is only useful if it can be applied to your day-to-day practice, and I find that without dietitian consultation, it tends to be very generic,” he says.

{module NCM Blurb}

Monday, 15 February 2016 00:58

Spanking Kids: Culture is No Defence

Written by

by Florence Hwang in Regina 

Cultural differences in childrearing require settlement organizations to provide newcomers with information and support in understanding Canadian laws on corporal punishment, also known as 'spanking', say experts. 

Nothing is more indicative of culture than the process of raising children to become adults, explains Justin Ryan, public education and communications co-ordinator with the Multicultural Association of the Greater Moncton Area (MAGMA). 

He describes a rite of passage for boys of a Brazilian tribe as an extreme example. A glove or gauntlet is made of grass. Bullet ants, whose bites feel like bullet shots, bite the young boy’s hand. He is not allowed to cry out in pain. 

“Here, that would be the most violent consideration of child abuse possible. There, it’s the process which you become an adult,” says Ryan. “If I did that to my daughter, they would take her away.” 

New immigrants coming to Canada may be conflicted on Section 43, Canada’s law on corporal punishment, which the government agreed to revoke late last year as a result of the Truth and Reconciliation Commission's recommendations.

This is often because they are coming from vastly different cultural backgrounds  some from strongly patriarchal societies with very little infrastructure and where domestic violence is relatively common, Ryan notes. 

[quote align="center" color="#999999"][I]n a developing nation ... there may be a law that says parents can’t strike their children, but there is little follow-up or action taken.[/quote]

In some cultures, for example, a father backhanding his child for speaking back, or not cleaning up or not being obedient is acceptable. 

Ryan says the most common response he gets from immigrants is surprise that there is a law regarding corporal punishment and that the government reinforces it. 

He explains that in a developing nation that has little infrastructure, there may be a law that says parents can’t strike their children, but there is little follow-up or action taken. 

Understanding of Canadian way is vital 

Gary Direnfeld, a social worker who has 33 years of experience helping parents manage behaviour with children, says many immigrants come from countries where they place high value on respect, particularly for elders. 

“That is a kind of respect that comes without questioning, where we expect the child to heed what the elder has to say and follow through and all will be well, so to speak,” he explains.

Contrast that with Canadian culture, which has more value on individualism and freedoms, which the children are often influenced by. Meanwhile the parents may come from a country where corporal punishment is sanctioned and considered reasonable. 

[quote align="center" color="#999999"]"[T]he thought of a children’s aid worker coming to your home is more than frightful.”[/quote]

“The child, having learned of their rights and freedoms, in the Canadian context, may then complain about the corporal punishment and that brings the parent to the attention of child protection services,” says Direnfeld, who is based out of Dundas, Ontario. 

“If you come from a war-torn country, where one is fearful of the political structures and institutions, the thought of a children’s aid worker coming to your home is more than frightful,” he says. 

“As disconcerting as it is to have a visit from the Children’s Aid Society with concerns of abusing your kids, for these families, those concerns are amplified given their lack of trust and faith in institutional services.” 

Direnfeld says this issue of corporal punishment is deeper and broader than the average non-immigrant Canadian often appreciates. In acclimatizing new immigrants to Canada, settlement organizations should help them to appreciate our parenting approaches, he suggests.   

“If you take a cross-cultural perspective on what [parenting expectations] are, then this gets a lot murkier a lot faster, which means we have to work a lot more closely with clients to communicate and make them understand what the implications are of Canadian law,” adds Ryan. 

Lost in translation   

Ryan notes that in the case of immigrants, language is also a barrier in communicating with, for example, social services. These barriers may also make it impossible to understand subtle, but crucial, differentiations. 

He says that a classic example would be, when asked, “How do you discipline your child?” they may reply, “I beat them,” when what they really mean is “I spank them.” 

“They simply don’t have the language skills to choose the word that has the right connotation and correctly carries the reality of what they’re doing.” 

[quote align="center" color="#999999"]"[T]he Canadian government is far more involved with managing family dynamics than most other countries.”[/quote]

MAGMA works to ensure that all parents understand the Canadian standards of child care. This is particularly the case with refugees, due to the recent influx. Child protective services delivers group sessions to proactively address these issues, such as explaining what is considered acceptable measures of discipline in Canada. 

“One of our primary requirements is to instruct our clients [on] what our appropriate Canadian values are starting as soon as they get here regarding the stuff that’s likely to get them in trouble with the law,” Ryan says. 

As to the impact of repealing Section 43, which would effectively criminalize even those actions such as corporal punishment, organizations like MAGMA have to be even more proactive in passing on that understanding to their clients. 

“Part of that is that the Canadian government is far more involved with managing family dynamics than most other countries,” Ryan explains. “Generally elsewhere … the government is not seen as having a role in such private matters. It’s therefore an adjustment for both sides in this equation when Canadian governments become directly involved in the lives of immigrant families.”

{module NCM Blurb}

Thursday, 04 February 2016 14:54

'Onus on Parents to Immunize Kids'

Written by

by Belen Febres-Cordero in Vancouver

New approaches to immunization may help newcomers get the information they need to ensure their children’s records are up-to-date, though barriers still exist across the country.

In June 2015, Ottawa implemented the immunization strategy Every Child, Every Year. Marie-Claude Turcotte, manager of the vaccine-preventable disease program at Ottawa Public Health (OPH), explains that it is parents’ responsibility to provide updated immunization records to OPH. “We do not receive the information directly from the doctor’s office,” she says.  

Through this strategy, parents are informed if their children’s immunization records do not meet the requirement of the Immunization of School Pupils Act (ISPA). They have a month to send the updated information to OPH. If they do not want to immunize their children for religious or medical reasons, they can provide an exception. 

“We try to make this process as easy as possible. Parents can give us the information by phone, fax, online, mail or in person,” says Turcotte. They also provide information in different languages and they have translators available.  In addition, they offer immunization clinics for individuals who do not have a family physician, where health insurance is not required. 

If parents do not provide the update on time, the child can be suspended for up to 20 school days.  

[quote align="center" color="#999999"]Improved access to clean water and vaccinations are the main reasons why longevity has increased over the last century.[/quote]

According to data OPH provided by email, between December 2015 and January 2016, OPH has issued suspensions to approximately 3,100 students. As of January 21, parents and guardians of 99% of students who were suspended between the same period have updated their immunization records, and these students have returned to school.

“It is crucial to have the system up-to-date because if there is an outbreak of a disease, we can see which children could be at risk and we can intervene on time,” says Turcotte. 

National and provincial policies

Most Canadian provinces do not meet national immunization targets for key diseases. Different efforts aiming to achieve these targets have been implemented across the country, but the approaches vary from province to province. 

While in Ontario immunizations are usually given at doctors’ offices and data is not officially recorded until a child enters school, provinces like Alberta and Newfoundland and Labrador have a nurse-led model focusing on early interventions that start at birth, says Colin Busby, senior policy analyst at the C.D. Howe Institute.  

Sofía Vargas emigrated from Chile and had her baby in Vancouver. She notes that in British Columbia interventions also start promptly. “There is a preoccupation to motivate parents to immunize their children,” she says. “As soon as the baby is born, the doctor explains why you should do it.” 

[quote align="center" color="#999999"]“Immunizations are safe and effective ways to prevent diseases. There is no effective treatment for many of them once they are contracted, so prevention is our only strategy.”[/quote]

Busby clarifies that each province has its unique features, and a policy that works in one is not necessarily effective in another. However, he believes that compelling parents to make a vaccination decision is an initial step to be considered nationally.  

Challenges unique to newcomers

Improved access to clean water and vaccinations are the main reasons why longevity has increased over the last century, Busby explains. However, finding accurate and timely information about immunization can be difficult for newcomers. 

“In a study conducted among immigrant women in Edmonton, we found that the reason why their children are not being immunized is that mothers are not being told where, when or how to receive vaccinations,” says Stephanie Kowal, knowledge translation coordinator in the School of Public Health at the University of Alberta.  

Dr. Ubaka Ogbogu, assistant professor in University of Alberta’s faculties of law and pharmacy and pharmaceutical sciences, identifies language barriers and challenges accessing health care as other difficulties newcomers may face.

[quote align="center" color="#999999"]Parents can access information about immunization in Canada at national and provincial websites.[/quote]

Moreover, vaccines used in Canada are not always part of immunization programs globally, and immigrant families may have lived in circumstances where health care is limited or unreliable, explains Dr. Noni MacDonald, professor of pediatrics at Dalhousie University in Nova Scotia. 

She highlights the need for addressing this issue. “Immunizations are safe and effective ways to prevent diseases. There is no effective treatment for many of them once they are contracted, so prevention is our only strategy.”

Ways to get informed

Parents can access information about immunization in Canada at national and provincial websites. They can also download an app created by Immunize Canada

However, Kowal believes that comprehensive information, communication and delivery services tailored to immigrants’ needs are lacking. 

Although there are some resources provided in languages other than English and French, Dr. Ogbogu says that most of the information available is not translated. 

Another challenge is that most information is online, leaving families without internet access behind, explains Kowal. She suggests seeking information through local libraries or family doctors; not being afraid of asking questions; and looking for translation services, available at some clinics and hospitals at no cost.  

Vargas adds that there are provincial phone numbers people can call to ask for medical information. She encourages parents to look for resources and get involved. “Vaccines are a remarkable milestone in public health,” she says. “It is our duty as parents to be responsible in this scientific development that translates into the safety and health of our children.” 

{module NCM Blurb}

Thursday, 21 January 2016 11:01

Spanking: Lots of Studies; Little Change

Written by

by Florence Hwang in Regina

Experts say revoking the law that allows parents to spank their children can help clarify for newcomers the "mixed messages" they receive about corporal punishment in Canada.

Parents want to understand the law in Canada and how it fits in with their parenting style, notes Jean Tinling, the family program director at Mosaic Newcomer Family Resource Network.

“Their worries are reduced when they realize that they have a choice about keeping the best from their culture, adding in the best from Canadian culture and creating their own new third culture here in Canada,” she says. “They relax when they gain a better understanding of the law and when they realize that CFS [Child and Family Services] does not want to take their children or destroy their culture.” 

[quote align="center" color="#999999"]Researchers and parenting experts agree that overhauling section 43 is long overdue, as it infringes on the human rights of children. [/quote]

Tinling feels this confusion for all parents can be done away by changing section 43 of the Criminal Code.

The Liberal government has agreed to remove a section of law that allows parents to spank their kids following the recommendations of the Truth and Reconciliation Commission, which was set up to inform Canadians about the experiences of indigenous children in residential schools

Children’s rights

Researchers and parenting experts agree that overhauling section 43 is long overdue, as it infringes on the human rights of children. 

“It’s overwhelming talking about the harm of physical punishment,” says Ailsa Watkinson, Faculty of Social Work graduate studies coordinator at the University of Regina’s Saskatoon campus. 

Watkinson says she thinks children should be treated like any other human being. It’s important to maintain warmth and connection between parent and child and to build on mutual trust while understanding the child’s stage of development, including physical, mental and emotional, she adds.

Dr. Joan Durrant, Social Studies professor at the University of Manitoba, says that mild physical punishment has consequences for some children, and cites research that shows it is linked to aggression and mental health problems that can continue into adult life.

[quote align="center" color="#999999"]Already, 48 countries have banned all forms of corporal punishment of children.[/quote]

Durrant has been studying the physical punishment of children for about 25 years. She points out that spanking raises the risk of injuring the child, makes the child fearful of the parent, and affects the child’s brain.

In Saskatchewan, the Victims of Domestic Violence Act protects those who are abused by their partners. If there is a child who observes their mother is being beaten, that child is considered in need of protection; but if that child is being beaten, he or she is not protected under the Act, says Watkinson.

Making changes

Already, 48 countries have banned all forms of corporal punishment of children. Canada and the U.S. are not on that list.

Most parents – newcomers and Canadian born – parent the way they were parented, unless they learn and believe there is a more positive alternative, says Tinling. Physical and humiliating punishment is a very common method used to control children’s behaviour around the world, she adds.

“However, worldwide, it has been my experience that all parents love their children and want what is best for them,” says Tinling. “They want their children to learn to be respectful, to have positive social skills, and they also value having a positive relationship with their children.” 

“Using aggression against a person does [the] exact opposite,” says Durrant.

She says she finds section 43 illogical, as there are laws that protect all other segments of society from physical harm, but not children. 

[quote align="center" color="#999999"]“That’s why we need a very black-and-white law saying don’t do it. Ever. At all.”[/quote]

“When it comes to your child, the law gives you a green light. There’s a message to parents that it’s not only OK, but actually the law says it’s justified,” she says. “It’s placing children at risk. And I find that absolutely unjust.”

Every culture thinks it is their tradition to spank their children, she notes. Durrant feels it isn’t a tradition, but an entrenched habit that people have a hard time giving up because they haven’t seen viable alternative solutions. 

“There’s an assumption there that they are incapable of change,” notes Durrant, who doesn’t believe this assumption is correct.

Judy Arnall is an author and parenting expert. She takes issue with section 43’s wording of “reasonable force,” which she feels is very subjective.

“That’s why we need a very black-and-white law saying don’t do it. Ever. At all,” she says. 

It’s an age-old issue.

“I remember talking to reporters 20 years ago and not much has changed. I think it is time [for this law to be abolished]. I tell my kids, ‘In your lifetime, I’m sure we’re going to change the law on this, because 48 countries have,’” she says. 

{module NCM Blurb}

by Tazeen Inam in Mississauga, Ontario

According to the 2015 child poverty report for Toronto, newcomer children, children of colour and children with disabilities are among the largest groups living in poverty. Families that fall into more than one of these groups face even more grim circumstances.

Sean Meagher, Executive Director of Social Planning Toronto suggests that immigrants with non-European backgrounds taking care of children born with disabilities face financial crises often.

“English speaking [people], compared to the significant number of immigrants who are not from that background, are successful in getting jobs and we do have a racially segmented employment market [that] people with coloured skin face.”

Sacrificing to take care of family

Those taking care of someone with a disability often relinquish their own plans, as is the case of Ottawa resident Maryem Hashi (name changed for privacy).

Hashi has three younger siblings between the ages of 22 and 26 years old who all have disabilities. She gave up her university studies and a full-time job to fulfill her responsibilities at home.

[quote align="center" color="#999999"][I]mmigrants with non-European backgrounds taking care of children born with disabilities face financial crises often.[/quote]

 

Hashi, who moved here from Pakistan, recalls her initial days in Canada, when her mother had to face the ordeal of raising her siblings, without much access to Internet. With difficulty in speaking and understanding English, she had to navigate things like funding, health care and programs that suit the needs of her children.  

“My siblings didn’t receive any government funds and didn’t go to any specially designed programs to cater to their needs as my parents were not aware that some services were available,” explains Hashi. 

Hashi’s siblings have delayed development, which usually starts showing up after a child is two to five years old. It is a “mild” condition that affects their ability to do things “independently.”

“They tend to forget things easily and [have an] inability to do things on a daily basis like managing money, packing a [backpack], remembering directions, etc. and the challenge is to keep them in conversation,” shares Hashi.

Today, Hashi is a program assistant and works part-time in occupational therapy, serving children with disabilities under the age of three to five years old.  

What happens after 21 years old?

For Hashi’s siblings, a crucial time came when they each turned 21, as that is the cut-off age for school programming for kids with a disability.

“Due to the lack of government funded after school programs, people with disability after 21 years of age usually stay at home as there is a long waiting [lists] to get into programs suitable to their needs,” says Hashi. 

[quote align="center" color="#999999"]"[P]eople with disability after 21 years of age usually stay at home as there is a long waiting [lists] to get into programs suitable to their needs.”[/quote]

 

She says that such programs are a support for caregivers too, and allow the young person not to lose what they have learned from school.

“My siblings [have been] home for a couple of years, and [are] alone with depression and low self esteem; it’s hard to deal with their ordeal,” she shares. “If we take programs privately, it starts at $90 a day, which is unaffordable with multiple siblings [with a] disability.”

Rabia Khedr, executive director of the Canadian Association of Muslims with Disabilities, runs a program in Mississauga, Ont., DEEN (Disability Empowerment Equality Network) support service, which is an extended-hour day program and works on the capacity building of individuals with disabilities who have aged out of school programs.

“It will be an 8 a.m. to 8 p.m. program,” explains Khedr, “and gives enough time range to caregivers – particularly those who are striving to earn.”

The school has a sliding scale fee structure and the rest is fundraised through charitable donations.

In the long run, Khedr is planning a residence service, especially for people with disabilities who do not have caregivers. She shares that in Ontario alone 12,000 people with intellectual disabilities are waiting for housing.

Khedr’s extension of the school in Ottawa, where Hashi will provide some of her services too, is at the initial stage and individuals with disabilities will get three hours of activities on Sunday only starting in the new year.

[quote align="center" color="#999999"]"[W]e want at least medication to be cost-free for all.”[/quote]

 

Making ends meet

Every year on Dec. 3 is the International Day of Persons with Disability. The theme in 2015: Inclusion matters, access and empowerment of people with all abilities.

According to the department of finance, in 2011 the Canadian federal government transferred almost $4 billion to low-income families and spent $19.9 billion on Employment Insurance benefits alone.

Still for some, medications, dental care and eye check-ups are not included. And in the cases of people with disabilities things like electronic gadgets, crutches, wheelchairs and scooters to assist in daily life are also not fully covered.

“They have to hire special vans to take these individuals from place to place. This all has a cost,” says Hashi. “And we want at least medication to be cost-free for all.”

Khedr says that people who don’t have the experience of poverty won’t understand how choices can become increasingly limited when a person is on welfare assistance.

She suggests, “The solution lies in a combination of a few hours of activity and government funds.”


Journalist Priya Ramanujam mentored the writer of this article through the NCM Mentorship Program.

{module NCM Blurb} 

Thursday, 03 December 2015 19:05

Hepatitis B Education Crucial for Newcomers

Written by

by Belén Febres-Cordero in Vancouver

Immigrants from Asia are three to 12 times more likely to get hepatitis B than their Canadian-born counterparts, says a new public education campaign launched by S.U.C.C.E.S.S., an immigrant-serving organization in British Columbia.

Dr. Eric Yoshida, professor of medicine at the University of British Columbia and head of the division of gastroenterology at the Vancouver General Hospital, explains that the high prevalence of the hepatitis B virus (HBV) among newcomers can be attributed to mother-to-child transmissions at birth or early childhood in countries where infection rates are high, and where vaccination is uncommon. 

Infection rates are also impacted by the lack of systematic testing and treatment for new immigrants arriving to the country, as well as high costs of medications, lack of awareness, and difficulty accessing medical care.

“I know many HBV carriers who ignore the infection because they can’t find a stable doctor or a doctor who speaks their language,” says T.H., who migrated to Canada from Taiwan when he was 12 years old and is an HBV carrier.

Another difficulty he recognizes is that the resources available are mostly provided in English, or are too technical.

Urgent need for education

Aiming to reduce the barriers that newcomers may face when accessing these resources, S.U.C.C.E.S.S. carried out the Let’s Talk About B: Hepatitis B (HBV) Public Education Program.

[youtube height="315" width="560"]https://www.youtube.com/watch?v=GOotj_Ihyco[/youtube]

“We recognized the urgent need for the program after conducting 1,000 surveys among different groups, through which we discovered that most people don’t know much about hepatitis B,” explains Queenie Choo, CEO of S.U.C.C.E.S.S.

Financed by a grant of the provincial government, S.U.C.C.E.S.S conducted 68 educational workshops and participated in 105 community and outreach events to raise awareness about the risks, prevention, diagnosis, treatment options, and self-management tools of hepatitis B among the general public and Asian immigrants in particular.

It reached almost 30,000 individuals of all ages among Chinese, Korean, Filipino and South Asian communities in Vancouver and the Lower Mainland.

“Every community is unique and each one requires different information. The resources available need to adapt to each population so that people are more likely to engage with them,” says Alan Huang, S.U.C.C.E.S.S. HBV program manager.

“For this reason, the materials we created were culturally appropriate,” he adds. The workshops were given by facilitators who spoke the language of the communities they focused on, were provided in places where these populations usually congregate, and addressed cultural beliefs that could prevent people from getting involved.

[quote align="center" color="#999999"]HBV is diagnosed through a simple blood test that can be performed for free at family doctors’ offices and walk-in clinics.[/quote]

Huang also says that they focused on Asian populations because they tend to have a higher risk of getting hepatitis B. There are approximately 60,000 to 100,000 chronic carriers in B.C. Near 70 per cent of them are immigrants, and among those, over 85 per cent are of Asian descent.

Dr. Yoshida explains that while several factors increase immigrants’ risks of getting infected, HBV is also prevalent in other regions of the world. T. H. considers that educational programs such as Let’s Talk About B “can raise awareness and help people understand that HBV is not just an immigrant disease, but something we should all be aware of and encourage people around us to get tested.”

According to a S.U.C.C.E.S.S. press release, around 75 per cent of the participants discussed HBV with their primary care providers and/or got screened. The organization continues engaging community-based organizations and public health officials to promote and deliver health campaigns among other populations across Canada in the future.

Getting screened

Hepatitis B (HBV) is a type of liver disease caused by a virus. Billie Potkonjak, director of health promotion and patient services of the Canadian Liver Foundation, explains that one of the main risks of HBV is that if it is not diagnosed and treated on time, it can increase patients’ chances of developing liver cancer and other chronic conditions, such as cirrhosis.

However, HBV is a “silent killer,” according to Choo. Dr. Jessica Chan, family physician and chair of the Hepatitis Medical Advisory Committee for S.U.C.C.E.S.S., says that the condition is likely to go undiagnosed because symptoms do not appear immediately

HBV is diagnosed through a simple blood test that can be performed for free at family doctors’ offices and walk-in clinics. Nevertheless, as Dr. Chan points out, unless people specifically tell their doctor that they want to be tested, physicians will assume that somebody else has already performed the screening.

[quote align="center" color="#999999"]Fear of deportation is present among immigrants, but Canada does not deport people because of the disease.[/quote]

Hence, Potkonjak highlights that “it is extremely important to talk to your doctor, so that they can diagnose the disease if you have it, and prescribe appropriate medication to stop the virus from destroying your liver.”

Debunking myths

Stigma can prevent people from seeking appropriate care. “HBV is somewhat of an unknown disease in Canada. It is not a topic I like to discuss openly, in fear of being rejected,” says T.H.

One of the myths around HBV is related to its transmission. Dr. Chan explains that although hepatitis B can also be transmitted by blood or body fluids, the majority of people worldwide get infected during childhood or infancy.

Dr. Yoshida adds that it cannot be transmitted through food, coughing, or casual contact. “It is not contracted because you had lunch with somebody or sat on a crowded bus.”

The difference between hepatitis A, B, and C may also be unknown to the general public. 

Fear of deportation is present among immigrants, but Canada does not deport people because of the disease, and individuals should not be discriminated based on health status in the country, explains Dr. Yoshida.

A person who migrated from Hong Kong and has lived with HBV for 35 years recommends people to engage with projects such as the Let’s Talk About B Program and the Living with Liver Disease Program offered in different provinces by the Canadian Liver Foundation. 

“It is important to stay positive and get in charge of your own health,” he says. “Don’t be afraid of talking to your doctor, getting tested, and receiving treatment if you need it. There is nothing to be ashamed of, and this can save your life.”

{module NCM Blurb}

by Belen Febres in Vancouver 

Immigrating to a new country can put a strain on a person’s mental health and well-being. Art therapy, one of the disciplines being recognized in November as part of arts and health month, can have positive benefits for newcomers’ mental health. 

“Moving to another country can be an exciting experience, but it can also be nerve-racking or sad,” explains art therapist Debbie Anderson. “Art making can help people find the inner peace that they may have lost in the migration process.” 

According to Arts Health Network Canada (AHNC), arts and health is an interdisciplinary field that embraces different forms of art to promote health, prevent diseases and enhance health service delivery. There are multiple arts and health initiatives available across Canada. 

AHNC’s communications coordinator, Zara Contractor, mentions that the World Health Organization (WHO) defines health as an individual's complete physical, mental, social, emotional and spiritual well-being, and not only as the absence of disease. 

“The arts can positively impact all these dimensions in different ways,” Contractor says. 

[youtube height="315" width="560"]https://www.youtube.com/watch?v=T68D1MlIF5Q&feature=youtu.be[/youtube]

Art as therapy 

Contractor highlights the importance of making a distinction between expressive or creative arts therapies from other arts and health practices within the field.  

Expressive art therapy focuses on art making as a therapeutic process, while other arts and health practices focus on engaging people in the arts for reasons such as enjoyment, education, distraction from illness, social connection and self-exploration.

Different materials and techniques, such as colouring, painting, collage, clay and weaving are used in expressive art therapy.

[quote align="center" color="#999999"]“People may think that they are not artists, but everybody can use art as a means of expression.”[/quote]

Moreover, expressive art therapies are regulated by professional associations and require a postgraduate or master’s degree.

Mehdi Naimi, president of the Canadian Art Therapy Association (CATA), explains that only qualified art therapists graduated from programs regulated by specific standards can practise this profession in Canada.

Tzafi Weinberg, CATA’s advocacy chair, explains that emphasis is placed on safety, confidentiality and unconditional acceptance in a non-judgemental atmosphere throughout the whole therapeutic process.

She adds that the focus of the therapy is not the final product, but the creation process instead. For this reason, no previous experience in art is required.

“People may think that they are not artists, but everybody can use art as a means of expression,” says Jannika Nyberg, co-founder of ArtQuake, a grassroots organization that connects young people through the arts in Vancouver.

For this reason, Nyberg encourages everyone to try different artistic forms. “In this way, you may realize that you enjoy these activities and that they can be a positive outlet to deal with your emotions.”

Benefits for newcomers

The sessions in art therapy can be individual or in a group. While some people can feel more comfortable in individual sessions, group sessions can contribute to creating a sense of community and allowing interaction with people from different backgrounds.

“They also offer a space to find collective support, input and understanding,” explains Tanissa Martindale, a recent art therapy graduate and the registrar and practicum coordinator of the Winnipeg Holistic Expressive Arts Therapy Institute (WHEAT).

[quote align="center" color="#999999"]“Art has allowed me to express my longing for my family and my country, and to explore my journey and my identity.”[/quote]

According to Anderson, group sessions can be particularly beneficial for newcomers because by sharing their stories, people discover that they have similar experiences as others, and share attributes of resilience and strength.

Newcomers can bring their own culture into the session through the use of symbols, materials, and images that are familiar to them.

Therapists do not interpret the artwork in this process. Instead, they guide the individuals to find its meaning.

“People are their own experts, they know what they need and all the answers are within them,” says Weinberg.  

Hana Pinthus Rotchild, a registered social worker and art therapist working with different populations including immigrants and refugees, explains that this approach allows people to recreate the reality they left behind and process any grief or anxiety they may be experiencing.

Through different art projects, she has reflected on her own migration process from Israel to Canada in 2003.

“Art has allowed me to express my longing for my family and my country, and to explore my journey and my identity,” she shares. “It has also been an avenue to cope with my losses, separations, and transitions, while helping me to stay connected with my roots.”

Non-verbal methods of expression

People of all ages suffering from different conditions like depression, grief, anxiety, trauma and eating disorders can benefit from art therapy.

Anderson explains that this is possible because non-verbal methods can be effective in helping people express themselves.

By encouraging individuals to make art instead of talk about their own emotions and ideas, art therapy can provide gentle, healthy and positive communication outlets and coping mechanisms.

[quote align="center" color="#999999"]“In art therapy, people can express through their own visual voice without the need of words.”[/quote]

This can also break the language barrier that newcomers may face.

“In art therapy, people can express through their own visual voice without the need of words,” says Pinthus Rotchild.  

Naimi explains that once people express what cannot be said through other mediums, they find relief, process their experiences, improve their self-esteem and envision the future they want for themselves.

“In this way, art therapy encourages therapeutic healing and creative problem solving,” he adds.

For Nyberg, art has also been a means for personal transformation.

“Art is the one place where I can get out of my mind and into my body to express and process my emotions,” she says. “If I didn’t have that outlet, I don’t know where all those emotions would have gone.”

Video By: Samantha Lui for New Canadian Media

{module NCM Blurb}

by Kyle Duggan in Ottawa

The new minister of health can expect a flood of petitions on her desk on the topic of implementing a rare disease strategy for Canada.

Durhane Wong-Rieger, president of the Canadian Organization for Rare Disorders, told a crowd of health experts and industry stakeholders at an event put on by the Economic Club of Canada in Ottawa Monday that if they’re not writing letters to the new health minister and prime minister, they’re not doing their jobs.

“This strategy is long overdue,” she said. “We are way behind other countries.”

Her organization has been championing its plan for a national strategy since May, but sees an opportunity in the new federal government.

“I see it as low hanging fruit … a quick win for the party and the government if they were to bring this forward and implement it.”

Tougher for people with rare diseases

The strategy calls for improving early detection of rare diseases, improving quality of care for patients and introducing a policy framework for “orphan” drugs — those developed specifically for rare diseases. It also suggests measures aimed at creating a better information network for rare diseases, including a possible registry.

Monday’s event heard from Jonathan Pitre of Russell, Ontario, often called the “butterfly boy.” Pitre has an incurable skin condition called Epidermolysis bullosa (EB). He’s one of about 5,000 people with some form of EB in Canada, which causes his skin to blister and burn.

[quote align="center" color="#999999"]“For most common conditions or diseases it’s a little bit easier, there’s more knowing about them … resources dedicated to them.”[/quote]

He told the crowd about the prolonged frustration of waiting for doctors to properly diagnose his condition, about the lack of appropriate adult care centres for those with rare diseases and the prohibitive cost of his medication.

“For most common conditions or diseases it’s a little bit easier, there’s more knowing about them … resources dedicated to them,” he said. “For rare diseases … it’s a bit tougher for us.”

There’s no treatment for EB in Canada – a bone-marrow transplant would cost $2.5 million, on top of the cost of travelling to and staying in the U.S. for an extended period of time.

“I think you guys noticed that’s not pocket change,” he said. “That’s unreal.”

“That’s the truth of it. Just to get that treatment that may help us … I may not live to 20. Just to be able to keep fighting we need that much money and that much resources … We can do definitely better.”

Lack of coherent, rational approach

Former Alberta health minister Fred Horne said a Canadian rare disease strategy could help deal with cases like Pitre’s in the future, and pointed to a rare drug framework as something the new government could move on quickly.

[quote align="center" color="#999999"]“Instead of worrying about whose jurisdiction it is, let’s look at what are the opportunities to really work together and make something happen.”[/quote]

“Rare disease coverage for patients, where it exists, it’s very sporadic across the country. Some provinces have a specialized program off to the side where they can provide some assistance, but there’s no really coherent, rational approach to this. It’s a public health issue, it affects three million Canadians – that’s the call to action.”

He said a catastrophic drug coverage plan for rare diseases is critical, adding that from his experience it’s “pretty hard in a smaller budget to provide reimbursement for these drugs” because some cost hundreds of thousands of dollars a year.

Setting national standards and pooling financial resources, he said, “could do better for Canadians than we’re currently doing.

“Instead of worrying about whose jurisdiction it is, let’s look at what are the opportunities to really work together and make something happen.”

Wong-Rieger also spoke about the need to get more Canadians with rare diseases into clinical trials.

“That’s your lifeline, that’s your hope,” she said. Missing out on clinical trials can be a “major, major tragedy,” she said.

Her organization estimates that about three million Canadians – about eight per cent of the population – has a rare disease.


Published in partnership with iPolitics.ca.

Monday, 02 November 2015 01:58

Family Not the Best Interpreter of Maladies

Written by

by Lucy Slavianska in Toronto

Language barriers can have a negative impact not only on initial access to health services, but also on the quality of health care and treatment outcomes.

In Canada, three main groups of patients can face language barriers: newcomers who still haven’t gained enough fluency in one of the official languages; French speakers with limited English living outside Quebec or English speakers in Quebec with limited French; and some members of First Nations and Inuit communities.

For immigrants and refugees, language barriers are generally considered a "newcomer" issue, which is overcome once the immigrant learns enough English or French to become independent of interpreters.

However, even after several years in Canada, some immigrants are still not sufficiently able to understand the official language of the province they reside in. According to a Health Canada report, “Language Barriers in Access to Health Care,” such immigrants are “more likely to be women with young children, the elderly, poorly educated or those suffering traumatic events or psychological disorders.”

The report also says that some immigrants are able to communicate adequately in everyday situations, but face difficulties in coping with “highly stressful health-related events in a second language.”

[quote align="center" color="#999999"]Lack of privacy and confidentiality, embarrassment, and other kinds of psychological discomfort are some of the disadvantages of using family members and friends to translate.[/quote]

Pitfalls of using non-professional interpreters

For patients who face language barriers, it is a common practice to visit hospitals and physicians’ offices accompanied by family members or friends acting as interpreters.

This practice has its advantages – these non-professional interpreters are easy to find, often compassionate, and in most cases accompany the patient at no cost. The stress of falling sick and visiting a hospital in a new country can be reduced if the patient feels supported, physically and psychologically, by loved ones.

But this experience is not always the case.

Soon after Aiko (not her real name), a 15-year-old girl from Japan, came to Canada to join her father, she started to experience menorrhagia – excessive bleeding that lasted more than seven days each month.

However, with no knowledge of English, she was reluctant to see a doctor. She felt uncomfortable talking to her father or her stepmother (with whom she had a conflict) about her problem, and couldn’t imagine going to a physician’s office with one of them as the interpreter and talking about her period in their presence.

A few months later, she started feeling weak and tired, and she fainted one morning in the kitchen. At the hospital, a blood check showed that Aiko had developed iron-deficiency anemia as a result of the untreated heavy bleeding.

Her father translated during the examination. She was embarrassed when the physician asked her about her menstrual cycle.

“The doctor was a woman and I might feel okay talking only with her in the room,” Aiko remembers, “but because my father was there, I didn’t want to answer. It was terrible.”

[quote align="center" color="#999999"]Even if good intentions are present, the use of untrained interpreters still carries serious risks of errors in translation that can lead to misdiagnosis and improper treatment.[/quote]

Aiko had to answer all the questions and eventually made a full recovery, but until her English improved, she dreaded seeing a physician again.

Lack of privacy and confidentiality, embarrassment, and other kinds of psychological discomfort like those Aiko experienced are some of the disadvantages of using family members and friends to translate.

But there are other, even more serious disadvantages: sometimes the interpreter may not act in good faith and can twist the information in a way that can harm the patient. Also, important sensitive information – about domestic violence, psychiatric illness, substance abuse, sexually transmitted diseases, and so on – may be hidden from the physician or distorted. 

But even if good intentions are present, the use of untrained interpreters still carries serious risks of errors in translation that can lead to misdiagnosis and improper treatment.

A 2003 research paper, “Errors in Medical Interpretation and Their Potential Clinical Consequences in Pediatric Encounters,” concluded that mistakes in medical interpretation are common, and errors made by untrained interpreters are significantly more likely to have potential clinical consequences than those made by professional interpreters.

Professional interpreters: specially trained

For all these reasons, hospitals in Canada often use independent and specially trained interpreters.

In Toronto, for example, many hospitals find professionals though RivInt Interpretation and Translation Services, managed by the Elspeth Heyworth Centre for Women (EHCW). The centre has a roster of about 600 professionally trained people who cover more than 80 languages. 

[quote align="center" color="#999999"]The good news for the patients is that they don’t pay for interpreters – the expenses are covered by the hospitals.[/quote]

“Since our clients are most often hospitals, our interpreters are mainly specialized in health care,” says Sunder Singh, executive director of EHCW.

“We don’t take anyone who is not language tested and trained. One of the main elements of the training is mastering the medical terminology. The participants have to become familiar with all kinds of medical words and learn their equivalents in their own languages.”

Singh adds, “Another important element is the understanding of the responsibilities of the job. For example, interpreters have to be aware that the information communicated between the patient and the medical staff is strictly confidential. Interpreters who don’t obey that rule would not be called to work again and will lose their income."

Training is provided by different colleges and organizations like Seneca College, Barbra Schlifer Commemorative, Multilingual Community Interpreter Services and others.

“Training is expensive,” Singh says, “usually between $800 and $2000, but if the participants become good interpreters and the hospitals are satisfied by them, they are called again and again. And if the language is on demand, then there is a quick return on the investment.”

The good news for the patients is that they don’t pay for interpreters – the expenses are covered by the hospitals.

“The hospitals pay [the fees for] the language services to us,” Singh explains, “and we pay the interpreters at market rate. The federal budget, unfortunately, doesn’t pay a lot for interpreters’ services, so the hospitals keep aside some budget for that – because they understand how important professional translation is.”


While across Canada there are organizations that provide new immigrants with information about the Canadian health-care system, there is a growing number of newcomers who still don’t know about these resources. As such, this is part of an occasional series by NewCanadianMedia.ca that will look into access to health care for immigrants.

{module NCM Blurb}

 

Page 2 of 4

New Canadian Media provides nonpartisan news and views representing all Canadian immigrant communities. As part of this endeavour, we re-publish aggregated content from various ethnic media publishers in Canada in an effort to raise the profile of news and commentary from an immigrant perspective. New Canadian Media, however, does not guarantee the accuracy of or endorse the views and opinions contained in content from such other sites. The views expressed on this site are those of the individual writers and commentators, and not necessarily those of New Canadian Media. Copyright © 2019 All rights reserved