Saturday, 26 September 2015 20:56

Navigating Health Care as a Newcomer

Written by

by Lucy Slavianska in Toronto 

When Jasmine, a young engineer from Iran, arrived in Toronto, she immediately applied for the Ontario Health Insurance Plan (OHIP). 

She knew she had to wait three months to receive her health card, but since she was generally healthy, it didn’t occur to her to look for an alternative health insurance while waiting for OHIP. 

January, however, was extremely cold and just three weeks after Jasmine landed, she fell sick. She had a high fever and, due to acute laryngitis, lost her voice. Over-the-counter medicines didn’t work and she had to see a doctor. 

Her visit to a walk-in clinic, as well as her treatment, cost more than $200. “This was so expensive,” she says, “but it could have been worse.” 

Insufficient knowledge is one of the biggest barriers newcomers in Canada face when they seek medical help. Often, the mistakes they make can be prevented if they receive guidance and accurate information about the ways the Canadian health-care system works. 

To avoid unexpected high medical expenses during the first three months after arriving to Canada, Marwan Ismail, executive director at Polycultural Immigrant and Community Services, advises newcomers to buy travel insurance. 

[quote align="center" color="#999999"]“It is really important to be insured. Treatment is very expensive in Canada.”[/quote]

“You go to the doctor,” he explains, “you pay, and then you send the claim to your travel insurance company, which will reimburse you.” 

This is something Ismail’s team at Polycultural underlines for many newcomers who don’t know how health insurance works. 

“It is really important to be insured,” Ismail continues. “Treatment is very expensive in Canada.” 

Ismail cites, for example, that elderly people can easily fall and have a fracture. If they need a surgery and have to stay in the hospital for two or three days, the bill could reach about $50 000. 

“Some newcomers think, ‘Why should I to pay $50 per month just to be insured?’ Well, $50 may save you $50 000 – you never know,” he says. 

Seeking help 

People who have no health coverage at all may be eligible for treatment at a community health centre, but these centres – depending on the location – often have extensive waiting lists and it may take several months to see a doctor. 

Not knowing where to seek medical attention, many newcomers go to the emergency departments at hospitals – even if their conditions are far from critical. 

[quote align="center" color="#999999"]The large number of new immigrants who go directly to the emergency departments has recently provoked discussions at Health Canada.[/quote]

The large number of new immigrants who go directly to the emergency departments has recently provoked discussions at Health Canada. 

“There are newcomers who don’t know how to find family physicians; some don’t even understand what an appointment means,” says Nadia Sokhan, director of monitoring, reporting and partnerships at Polycultural. “But they easily learn what 911 is and can also go to the emergency.” 

Those who are not insured are often surprised with very high bills when they go to emergency. On the other hand, for those who have provincial coverage, their treatment costs much more to the government than if they had gone to family physicians or to walk-in clinics. 

“Each visit to the emergency department costs the Ministry of Health about $975,” Ismail explains. “Even if the person just has a cold, the hospitals would send the Ministry a $975 bill – while if the patient goes to a walk-in clinic or to a family doctor, it would be about $30. So it is very important to educate the newcomers and make them understand the importance of having family physicians – this is in the best interest to everyone.” 

Cultural sensitivities

Finding a family physician, however, can be challenging for newcomers. 

There are some immigrants who prefer to be treated by doctors who come from the same countries of origins, speak their language and understand their culture. 

[quote align="center" color="#999999"]Gender can also be an issue for newcomers from certain parts of the world – mainly the Middle East and South Asia Ismail says – as some would like to see a family doctor who is of the same gender.[/quote]

For an immigrant living in a multicultural city like Toronto or Vancouver finding a family physician with the same cultural background is more likely, but even then the physician’s practice can be far from the place the immigrant lives. 

Gender can also be an issue for newcomers from certain parts of the world – mainly the Middle East and South Asia, Ismail says – as some would like to see a family doctor who is of the same gender. 

Some newcomers find family physicians by asking people from their ethnic communities. Others search online. 

In Ontario, for example, the website of the Ontario College of Physicians and Surgeons offers an “all doctors search” option with information about physicians’ genders, the languages they speak, the areas they practise and their training and qualifications.

Not all the listed physicians accept new patients though and some of them have waiting lists. While waiting, newcomers can still use the walk-in clinics and, if necessary, find interpreters to accompany them.

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 the first of an occasional series by that will look into access to health care for immigrants.

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Wednesday, 23 September 2015 15:33

Surviving Your First Canadian Winter

Written by

by Florence Hwang in Regina, Saskatchewan 

When Fulera Dikki came to Canada last September, she was anticipating the worst about what the cold would feel like – even though it wasn’t winter yet. 

Dikki, who came to Canada from the northern part of Nigeria to study human resource management at the University of Regina, had been told that Canada was cold throughout the year prior to arriving.

“I was so scared. I was really expecting the worst,” recalls Dikki. “When I landed, as God would have it, the day I landed was not too bad because the weather was a little bit mild.”

She was suspecting that when she went outside, she would freeze. She found it surprising that when the snow started falling, it wasn’t as cold as she thought.

[quote align="center" color="#999999"]“There was a particular day that I took it for granted and I really suffered. I almost had frostbite. It was minus 37. It was really, really very cold. I learned my lesson.”[/quote]

“But the cold set in,” she remembers. “There was a particular day that I took it for granted and I really suffered. I almost had frostbite. It was minus 37. It was really, really very cold. I learned my lesson. Anytime I’m going out, I cover myself properly.”

Dikki’s nine-year-old son Moses came to Regina recently. Although the snowfall is not expected for a while, Moses is excited and can’t wait until he experiences his first winter in Canada.

His mother prepared him for winter by getting him a thick winter jacket and boots because she didn’t want him to have the same shock she had when the cold weather arrives.

“The jacket is still hanging in the closet,” notes Dikki.

“I expect snow will be really cold. I want it to be cold because I’m hot,” Moses says.

He wants to go ice-skating and make snowmen and snow angels.

“Life in Canada is fun. I’ve made lots of friends,” he adds.

Getting newcomers ready 

Julia Hardy of the Regina Immigrant Women Centre is ready to help newcomers who have yet to experience their first winter.

“We have some donations of winter clothing that we can share with clients,” says Hardy. “We teach them about keeping warm and the clothing that they will need, how to prepare their car and what to have in an emergency kit, where to get weather and road information, how to weather proof their homes.”

Upcoming workshops will be posted on the centre’s website

The response from clients has been positive, notes Hardy, explaining those who attend regularly seem to settle down faster.

[quote align="center" color="#999999"]Many newcomers, for example, do not know about the wind chill factor.[/quote]

The Newcomer Welcome Centre with Regina Open Door Society also provides helpful classes on how to prepare for the winter season.

Some information the centre provides includes how to shop for thick, down-fill jackets, proper water-resistant boots, toques, mittens, scarves and even ski pants.

The workshops also talk about how to dress in layers and how to interpret weather temperatures.

Many newcomers, for example, do not know about the wind chill factor. This is when even though the weather reports say it is -20 C, it actually feels like -30 C.

Also, sundogs are deceiving for new immigrants. This is when it looks like the weather is warm out with a sun and rainbow, but actually it means the weather is extremely cold.

Other signs that the weather is very cold include when your nostril hairs freeze quickly or when the snow makes a crunching sound as you walk.

Quelling fears of winter

Montreal’s Assistance Crossroads for Newcomers (Carrefour d’Aide aux Nouveaux Arrivants) will hold its information session on winter preparation November 4 at 6 p.m. at Café de DA (545, rue Fleury Est).

[quote align="center" color="#999999"]“They marvel temperature variations, they express their fears of slipping, and they wonder if it is possible to die!”[/quote]

It’s been more than seven years that we offer this information session,” says the centre’s assistant director Audrey Mailloux. “We gave the session four times last year (at our organization in a local library with a high immigrant concentration and twice in a university). In all, over 140 people showed up.”

She advises people to register beforehand for the French session. However, if people don’t speak French, they can ask for a volunteer to translate the session.

Aside from the usual tips on how to dress, where to look for appropriate clothing, they also learn about heating bills, rights and responsibilities of tenants and landlords, what to eat to maintain a healthy immune system and activities they can do in the winter in Montreal.

“Usually people ask details of the types of clothing to wear,” explains Mailloux. “They marvel temperature variations, they express their fears of slipping, and they wonder if it is possible to die!”

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Monday, 21 September 2015 14:43

Debunking the Racialization of Disease

Written by

by Lucy Oneka in Toronto 

There is an ever present bias in the historical theories of racialized people being more susceptible to disease, and these theories have been perpetuated by modern day media, say some Canadian researchers. 

Goldameir Oneka, University of Toronto PhD candidate and author of Extra, Extra, read all about it!: Toronto print news media coverage of type 2 diabetes, says the idea of race being linked to disease has long standing historical roots in biomedical research and practice.  

“If you look at the bio-medical literature – historical bio-medical literature – racialized peoples’ were constantly presented as individuals who were inherently diseased,” explains Oneka (full disclosure: she is the sister of this article’s author). 

“So we see theories that mainly linked the presence of diseases in racialized peoples to their so-called race. If they were sick it was because there was something in their DNA that made them sick. While there are some diseases that are linked to race/ethnicity there are many more that are not, and here is where the problem lies.” 

It is this school of thought that has fuelled the idea that non-White people are more susceptible to disease than White people. 

[quote align="center" color="#999999"]“There was very little connection to economic circumstances or changes that happen when people immigrate to a new country.”[/quote]

Dr. Margery Fee, professor of English at University of British Columbia and author of the “Racializing Narratives: Obesity, Diabetes and the ‘Aboriginal’ Thrifty Genotype” in the journal Social Science and Medicine, indicates that until recently it was generally accepted that race was useful in predicting disease – without examining intersection of ethnicity, race and socio-economic status. 

“There was very little connection to economic circumstances or changes that happen when people immigrate to a new country,” Fee says. “There was very little understanding of those social factors which is hardly surprising because scientists are educated in a very narrow way – with very little in the way of humanities education.” 

Rooted in idea of racial hierarchy 

The racialization of disease can be traced back to Darwin and social Darwinism, Fee explains, a theory that stated there was a kind of racial hierarchy with the White race being at the top, and the so-called ‘fittest’. 

As Oneka points out there are several examples of where this theory has come into play when looking at diseases within particular communities. 

[quote align="center" color="#999999"]“Racialized peoples once again are presented as being ignorant for having the disease.”[/quote]

“If you look in South Africa for example, they had this thing that Blacks who had TB (Tuberculosis) had it because their bodies were not used to civilization,” Oneka recalls. “When they got civilized, their body couldn’t handle it so that’s how they got TB. They needed to go back to the primitive ways of living and doing things.” 

Or, Oneka adds, “In the North American context, there is a lot of talk about the Aboriginal population, Aboriginal peoples have a higher rate of type 2 diabetes because they have a gene – the thrifty gene theory.” 

The role of the media 

In order to counter such ways of thinking, the existence of such schools of thought must first be acknowledged. 

Oneka looked at how what was going on with type 2 diabetes was covered by Toronto print newspapers by conducting a content analysis. She examined things like the language used. 

“Racialized peoples once again are presented as being ignorant for having the disease,” Oneka says of her findings. “They don’t know how to take care of themselves type of thing, and they are inherently diseased too,” she explains, adding articles would at times imply “their genes make them more predisposed to developing this disease compared to the White population.” 

[quote align="center" color="#999999"]“Yes, it’s true that everybody but White people has a higher risk factor for obesity and diabetes. But, it’s connected to poverty.”[/quote]

There is often a part of the story missing in news reports, Fee explains, pointing out that while the research she looked at years ago did show that White people seemed to have a better track record when it came to diabetes, this couldn’t necessarily be attributed to their race. 

“… [They] were demographically better off. As a result, they had a better diet, got more exercise and lived in better neighbourhoods,” Fee explains, adding they, for example, might be able to walk to the grocery store instead of having to drive. 

“Yes, it’s true that everybody but White people has a higher risk factor for obesity and diabetes,” Fee says. “But, it’s connected to poverty. And it is that fact which doesn’t turn up in the warnings.” 

Reporting should ‘reflect reality’ 

Oneka recommends that the media give more thought to how it reports on health. This is particularly important since generally people learn more about disease from the media than their doctor. 

When it comes to diabetes Oneka’s research shows that the media represents it mostly as a lifestyle or individual or genetic issue. 

[quote align="center" color="#999999"]Oneka insists the media should reach out to social scientists that can shed insight on how environmental factors ... play into the development of disease.[/quote]

“These kinds of reporting attributes blame, and makes the individual think it’s their fault that they are sick,” she explains. “If a person does not have a good job, they can’t afford to eat well, and the media needs to cover a more accurate account of the causes of diseases – reflect reality.” 

Part of the problem, Oneka adds, is that reporters are not specialists, and therefore rely on interviews with scientists who mainly have bio-medical backgrounds for their news coverage. 

­­Oneka insists the media should reach out to social scientists that can shed insight on how environmental factors such as the economics, poverty, racism, prejudice and ageism play into the development of disease.  

Fee agrees. “People don’t like to talk about economic disparity,” she says. “Public health is not very popular. People want to find cures for cancer in any way, but [not fix] the environment [which is] a huge systematic and ideological barrier. It’s much more fun to go after a kind of gene or a drug where you can kind of narrow the problem.”

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Thursday, 17 September 2015 11:05

Youth Volunteers Support Chinatown Seniors

Written by

by Deanna Cheng in Vancouver

One outreach worker is creating a bilingual volunteer program because there's not enough support for Chinese seniors, especially those in Vancouver's Chinatown.

Chanel Ly, a 23-year-old outreach worker who is part of the Downtown Eastside SRO Collaborative, initiated the Youth for Chinese Seniors program because when she sees all these seniors – who are predominantly female – she thinks of her grandma. She cannot imagine not helping them out.

"I can't stand seeing seniors being neglected. It's disrespectful."

She points out that it's part of the Chinese cultural values to care for elders.

Ly will connect bilingual youth volunteers to seniors in the Strathcona area, the city's oldest neighbourhood.

Tasks for volunteers include translating legal documents, taking seniors to the doctor's office or the pharmacy, and informing seniors about their rights as tenants.

[quote align="center" color="#999999"]The biggest problem for Strathcona seniors is affordable housing.[/quote]

One of the biggest challenges Ly faced while building this program from scratch was the amount of work required because there was no previous infrastructure, despite the demand for service that was culturally appropriate and in Chinese.

The program will run from this month to March next year, Ly says, because that's when grant funding ends.

"The goal is to improve the quality of life for Chinese seniors."

Addressing Chinese seniors’ challenges

The biggest problem for Strathcona seniors is affordable housing. With condo developments in the area, rents are going up and pushing out the original residents.

Vancouver activist Sid Chow Tan believes the Chinese benevolent and clan associations should contribute to Chinatown by providing their buildings and property for social housing. These associations, grouped either by provinces in China or last name "clans," were community centres.

Historically, most of the association buildings were community homes and bachelor suites for Chinese immigrants, a demographic regularly ignored by the government and institutions, Tan says. "It's sad to see space that used to house hundreds and hundreds of bachelors are now used for mahjong and ping-pong."

Another concern for seniors is health, says Ly. "Doctors are not always accessible. Drop-in clinics are not always available. Or opened only during certain hours."

Volunteers will help by accompanying seniors to the doctor's office and translate if needed.

[quote align="center" color="#999999"]"We want to fill in the gaps between the generations." - Chanel Ly, Downtown Eastside SRO Collaborative[/quote]

Racism against Chinese seniors does happen at community centres, due to an unfounded belief that there's no such thing as poor Chinese people.

"There are poor Chinese," Tan said at a July event where bilingual volunteers and seniors met. "The Chinese poor doesn't want to be seen as poor. They just bear it."

Tan says they don't want to "lose face." In Chinese, the phrase means losing a combination of self-respect, honour and reputation.

Community survival

Despite the barriers they encounter, these seniors survive by banding together. "They're always self-sufficient and resourceful. They have their own networks," Ly says.

However, Mandarin-speaking seniors are even more marginalized, she says, because what little support there is, it's usually for Cantonese speakers.

Tan says the boomer generation couldn't leave Chinatown fast enough, but the "echo-boomers" came back. "They see something to save and protect. It's sacred ground to Chinese people.”

"It was where people organized to vote, worked to send money home," he says. "Now it's sullied by market forces, economic greed and political entitlement within the community."

[quote align="center" color="#999999"]Three in five Canadians say their families are not in a good position, financially or otherwise, to care for older family members requiring long-term health care.[/quote]

Connecting generations

The program also promotes intergenerational interactions. Says Ly, "We want to fill in the gaps between the generations."

Ly started collecting volunteers before the summer and will have check-in meetings with youth once a month. At the moment, she has 15 dedicated volunteers lined up.

The online volunteer form is comprehensive, even asking for preferred pronouns. The program organizer says she wanted the volunteers to feel comfortable.

When asked if seniors – especially those with a traditional mindset – would be upset with transgender volunteers, Ly says the seniors might accept them.

She says they'll notice more that the volunteer is a young, Chinese-speaking person. They'll be grateful for the assistance, and would get to know them as human beings with good intentions.

Seniors’ health care: the numbers

A report titled "2015 National Report Card: Canadian Views on a National Seniors' Health Care Strategy" by Ipsos Reid Public Affairs for the Canadian Medical Association said seniors today represent 15 per cent of the population. In 1971, seniors only represented eight per cent of the population.

Three in five Canadians say their families are not in a good position, financially or otherwise, to care for older family members requiring long-term health care, the report said.

Respondents 55 years of age and older indicate they want more home care and community support to help seniors live at home longer as a key priority for the government.

Ninety per cent of Canadians surveyed believe we need a national strategy on seniors' health care that addresses the need for care provided at home and in hospitals, hospices and long-term care facilities, as well as end-of-life care.

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Tuesday, 15 September 2015 13:47

Addressing Mental Health of Resettled Refugees

Written by

by Leah Bjornson in Vancouver

Canadian party leaders have all pledged to resettle thousands (if not tens of thousands) of Syrian refugees over the next few years, but little has been said to address the fact that for many, the crisis doesn’t necessarily end upon reaching Canadian shores.

A new report commissioned by the UN Refugee Agency (UNHCR) explains that even after refugees have escaped a crisis zone, they must deal with the damaging repercussions of having experienced war-related violence. 

If they are able to find safety abroad, refugees still must confront the daily stressors of displacement, which include poverty, a lack of basic needs and services, ongoing risks of violence and exploitation, isolation and discrimination, loss of family and uncertainty about the future.

[quote align="center" color="#999999"][T]he UNHCR’s report’s aim is to make mental health and psychosocial support (MHPSS) staff aware of the cultural issues they might encounter when working with refugees.[/quote]

According to the World Health Organization (WHO), Syria in particular is suffering from a mental health crisis, with two million or more citizens experiencing mild to moderate mental health illnesses.

Titled “Culture, Context and the Mental Health and Psychosocial Wellbeing of Syrians,” the UNHCR’s report’s aim is to make mental health and psychosocial support (MHPSS) staff aware of the cultural issues they might encounter when working with refugees so that they can better address this group’s specific and acute mental health needs.

The report

“The idea really is to help practitioners equip them[selves] with the knowledge, but also the attitude that they need to have with a Syrian refugee,” explains Ghayda Hassan, one of the organizers of the report and an associate professor in the Department of Psychology at Université du Québec à Montréal (UQAM).

Hassan began working on this report two years ago when the UNHCR and the WHO were investigating how to better support mental health and psychosocial services practitioners following a crisis.

The organizations decided to commission professionals in the field to design a primer for MHPSS staff that would guide them through interventions while educating them of the present cultural context and any cultural issues they might face working with Syrian refugees.

[quote align="center" color="#999999"]Exposure to such devastating events has the potential to create extreme psychological and social distress among refugees.[/quote]

The report begins by describing how the current conflict in Syria has caused “the largest refugee displacement crisis of our time.” Since March 2011, nearly half of the country’s population has been displaced and over 200,000 people have been killed.

Those who have survived have been witness to massacres, murder, execution without due process, torture, hostage-taking, enforced disappearance, rape and sexual violence, as well as the use children in hostile situations.

Exposure to such devastating events has the potential to create extreme psychological and social distress among refugees.

Many are able to establish healthy coping mechanisms such as talking to friends and family, praying or remembering good times.

However, others might have had their social support systems destabilized during conflict, forcing them to develop less effective or negative coping strategies such as smoking, obsessively watching the news, worrying about others back in Syria or ‘doing nothing’, says the report.

When this lack of support is compounded with the trauma they’ve experienced in crisis zones, these individuals are especially at-risk of developing mental health issues or mental disorders.

Idioms of distress

The report intends to tackle this problem by helping “MHPSS professionals and humanitarian professionals become more sensitive – not to stereotype the Syrians, [but] to make them aware,” Hassan says.

One of the most important ways in which mental health practitioners can support refugees is by understanding and using cultural ‘idioms of distress’, which according to the report, “refer to common modes of expressing distress within a culture or community that may be used for a wide variety of problems, conditions or concerns.”

In order to help mental health practitioners communicate their diagnoses in ways refugees can understand, the report provides specific ways to express common expressions used in Western medical traditions. It also outlines common expressions used by Syrians.

[quote align="center" color="#999999"]“Even when we talk about anxiety and depression, anxiety and depression and other disorders are not experienced in the same way [in different cultures].”[/quote]

For example, the phrase in Arabic that translates to “I feel my soul is going out” should be understood as an expression of worry, inability to cope, and a warning sign of a dysphoric mood.

A similar statement, which translates to “It is humiliating to complain to someone other than God” is a reference to shame in asking for help as well as a statement of despair and surrender.

By understanding the true intent behind these expressions, doctors can better understand exactly what a patient is experiencing.

Nevertheless, this issues go beyond simple vocabulary.

“Even when we talk about anxiety and depression, anxiety and depression and other disorders are not experienced in the same way [in different cultures],” Hassan explains. “So we kind of described for instance not only what words a depressed Syrian refugee patient may [use], but also what exactly depression means and how is it existentially experienced.”

Hassan says addressing these issues as complex cultural and emotional experiences rather than solely as diagnoses “really provides the ability for practitioners to be more aware and understand better the emotional and psychological experience of their patients.”

Intervention beyond Syria

While this report is specifically focused on a Syrian context, Hassan explains it has the potential to help mental health practitioners beyond the current refugee crisis.

“The advantage I think to this review is that we have included some advice or information on how to design a contextually appropriate service in terms of mental health and psychosocial support,” she says. “It can be used by any mental health psychosocial service in Canada who is hoping to improve the services that they provide to their population.”

Hassan says this could be especially important for Canada given its multiethnic population.

She ultimately hopes that this report is widely distributed so that both professionals and the public become more aware of the long-term health consequences of refugee situations and how they can get involved.

“Canada has to play [a role] in assisting refugees. And not only waiting here to assist them.”

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by Belen Febres-Cordero in Vancouver

There has been an increased demand for midwifery in Canada over the past decade, with now over 1,300 midwives registered in Canada, while in 2005, there were just 500.

Alix Bacon, elected president of the Midwives Association of British Columbia (MABC), attributes this growth to the personalized care midwives offer to mothers and their families, as they provide continuous support during pregnancy, labour, birth, and up to six weeks afterwards.   

While midwifery’s continuity of care principle can be valuable for all mothers in Canada, Manavi Handa, a midwife and activist focusing on serving immigrant mothers, believes that this model can have particular benefits for women new to the country and its medical system.

For instance, Ali Moreno, an Ecuadorian woman who had her baby in Vancouver, is particularly happy she chose midwives as her health care providers.

[quote align="center" color="#999999"]“They take the time to get to know you, understand your background.”[/quote]

“With doctors, the clock is always ticking,” Moreno explains. “Appointments with midwives last up to 45 minutes. They take the time to get to know you, understand your background, and take care of your emotional and physical wellbeing.”

However, Handa explains, newcomers may not necessarily consider this option when first looking for maternal care in Canada.

“People come here expecting modern healthcare and they don’t always associate midwifery with that because they don’t know how well trained we are or what we do,” she says.

What is a midwife?

Midwives are specialists in low-risk maternal and newborn healthcare.

The midwifery practice in Canada differs from practice abroad in several aspects, such as the number of births attended annually and the level of contact with mothers throughout their pregnancy.

In Canada, midwifery is managed by each individual province and territory and is currently regulated in nine. Services are publicly funded in all regulated locations.

Midwifery in Canada requires all practitioners to have a bachelor’s degree. Handa, who teaches at Ryerson University, explains that the seven midwifery programs in Canada have theoretical and practical components, including two years attending to mothers under the supervision of experienced midwives.

[quote align="center" color="#999999"]“We empower women to make the decisions that are appropriate for them.”[/quote]

People trained abroad can practise midwifery in Canada by completing shorter bridging programs, making it an attractive option for new immigrants.

According to information provided by the Canadian Association of Midwives (CAM), midwives in Canada are registered primary healthcare professionals that are fully trained and have access to all the necessary equipment, diagnosis services, and select medications to provide women and their babies the care they need from pregnancy to postpartum.

However, midwifery understands pregnancy and birth as healthy and normal aspects of life, and as such, aims for the least amount of interventions possible.

“Technology is great if you need it, but medical intervention when you don’t need it can lead to other risks,” Handa explains.

This consideration, together with the continuous support they provide, results in lower rates of medical interventions and shorter hospital stays for women who engage the services of a midwife, according to data from the Association of Ontario Midwives (AOM).

Cultural sensitivity

Midwifery is guided by the informed choice principle, which encourages women to be active decision makers in the care they receive. Handa explains that this principle respects individuality.

“This is of particular importance to immigrants because they may have their own cultural beliefs. We empower women to make the decisions that are appropriate for them.”  

She adds that because women primarily practise midwifery, newcomers from countries where only women attend labour might feel more comfortable under their care.

For Moreno, this was an important component during her pregnancy in Canada.

“The fact that midwives are women makes you feel safe and understood. They know how you’re feeling because they probably went through something similar themselves,” she says.

Organizations also try to eliminate possibly language barriers for new Canadian mothers to be.  Ontario Midwives includes information in different languages, and MABC offers help finding midwives that speak languages other than English inside the province.

The benefits 

Another principle of midwifery that increases the number of options for mothers is choice of birthplace. According to CAM, “people might have the misconception that midwives only attend homebirths, but they can actually choose to have their babies at hospitals or birth centres too.”

[quote align="center" color="#999999"]In Ontario, these cost savings are increased because women can access midwives’ care for free, regardless of their immigration status.[/quote]

Engaging a midwife can also be cost effective. A study of birth costs in B.C., published on July 2015, reports more than $2,300 savings per birth in the first postpartum month among women who planned a homebirth with a midwife compared to a hospital birth with a physician.

In Ontario, these cost savings are increased because women can access midwives’ care for free, regardless of their immigration status.

For women in provinces such as B.C. where uninsured individuals cannot have the services for free, Bacon explains that it would still be more affordable for them to seek care through a midwife than a physician and to have a homebirth instead of staying in hospital.  

What if complications arise?

In specific cases of high-risk pregnancies, each province has guidelines for midwives to consult with or refer women to other health specialists.

Midwives can also provide shared care or transfer the care at any point, if needed.  

“If a more serious complication arises, the most responsible care provider would become an obstetrician, but we would remain in a supportive role,” explains Bacon.

This was what happened in Ali’s case.

She initially planned to have a homebirth, but she had complications during labour.

“I decided to go to the hospital. Midwives, nurses, and doctors were all great,” she remembers. “They worked together and they helped me choose the safest option.”

Journalist Leah Bjornson, through the New Canadian Media mentorship program, mentored the writer of this article.

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by Kayla Isomura (@kaylaiso) in Vancouver, British Columbia

A fourth-year university student in Vancouver, B.C. is asking residents to get to know their neighbours.

Zakir Jamal Suleman, 22, launched The Belonging Project earlier this month to share the struggles and stories of first- and second-generation Vancouverites. Over the period of two months, six videos featuring these stories will be released online.

We’re trying to explore what it takes to belong in Vancouver, the pressures that form people’s lives and people’s individual strategies for belonging,” says Suleman. “The goal of the project was to try to decrease the barrier of entry of meeting someone.”

Suleman came up with the idea after a feeling of disconnect with strangers in Vancouver, a city with a population of more than 600,000 people.

[quote align="center" color="#999999"]"Our research has shown that, in our region, neighbourhood and personal relationships are cordial but lack the depth that lead to more meaningful relationships.” - Lidia Kemeny, Vancouver Foundation[/quote]

“It’s something that you hear a lot,” he said. “You hear a lot of people say it in a lot of different scenarios with different backgrounds.”

A ‘growing sense of isolation’

In a 2012 report by the Vancouver Foundation – a community organization that distributes grants for community projects and programs – 31 per cent of respondents said that it was difficult to make friends in Vancouver, while 50 per cent of new immigrants who responded agreed.

“We need to find opportunities for people to engage with each other in meaningful ways,” said Lidia Kemeny, spokesperson for the Vancouver Foundation. “Building trust between residents is an important ingredient to building connected and engaged communities. Our research has shown that, in our region, neighbourhood and personal relationships are cordial but lack the depth that lead to more meaningful relationships.”

But the issue goes beyond Vancouver.

Canada’s population is growing at a rate of just over one per cent, “the fastest pace of any of the G8 countries,” according to Statistics Canada, and approximately two-thirds of that population growth are newcomers.

“Even the concept of using visible minority and majority is becoming moot in Vancouver,” said Chris Friesen, spokesperson for Immigrant Services Society (ISS) of BC.

For people moving to new communities, they can face countless challenges, whether it’s a language barrier or not having their educational background recognized.

“This is all part of what it means to belong,” he said.

'Belonging' can mean different things

Each video released by The Belonging Project shares a different story with a different take on belonging.

In the first video, first-generation Canadian Tien Neo Eamas, who grew up in Singapore, shares his story of exploring gender identity, while Michelle Williams, a Haida woman, shares how chronic illness has allowed her to “judge which friends are worth keeping.”

[youtube height="315" width="560"][/youtube]

Other videos to be featured will include an individual with bipolar disorder and a community service worker.

“Belonging is an interesting word,” says Neo Eamas. “For me, it does not mean anything except a sense of people trying to find themselves by finding other people of like minds.”

Neo Eamas moved to Vancouver 27 years ago and has since changed his idea of belonging.

First moving here for college at 18 years old, he found his place in the lesbian colour community. During his process of transitioning more than 10 years later, he left that community and eventually came to simply explore what humans can be.

In Williams’ video, she also references the importance of making other people feel welcome, particularly in marginalized communities, such as the city’s Downtown Eastside.

Starting a dialogue

While The Belonging Project allows viewers to meet someone new, Suleman hopes it will also encourage others to share their own stories.

[quote align="center" color="#999999"]For those who would like a way to connect directly with their local communities, resources are available.[/quote]

Starting a dialogue can also raise issues of how to make newcomers feel more welcome and supported, says Friesen, who has partnered with Suleman on the project with ISS of BC.

But aside from a continuing dialogue on belonging, it’s uncertain what’s next.

Suleman has plans to host a celebration to bring people together in a relaxing space “where it’s not intimidating to talk to somebody new” but after that, “it’ll depend on how many people find [the project],” he says.

Resources for newcomer connection

But for those who would like a way to connect directly with their local communities, resources are available.

New immigrants in particular can access community connections programs in their local communities, says Friesen, which are federal government-funded programs across Canada. New immigrants are paired with long-term residents to create a support network.

Another program he recommends is LINC (Language Instruction for Newcomers to Canada), which offers courses to develop English language skills.

In Metro Vancouver, the Vancouver Foundation has expanded their Neighbourhood Small Grants program as a result of their 2012 report, which provides grants to residents in the local region to engage neighbours and members of their community to build connections.

Vancouver also has a number of Neighbourhood Houses, which offer programs to welcome and help newcomers find a place in their city.

The final video on The Belonging Project is expected to be released on September 18. For more information or to view the stories, visit

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by Belén Febres-Cordero (@BelenFebres) in Vancouver, British Columbia

Raquel Velásquez’s objective on her visit to a clinic was to have a prenatal check-up. Instead, the medical practitioner asked her if she was sure she wanted to keep her baby.

Raquel was also encouraged to reconsider her decision at two other health facilities she attended afterwards. “They thought I was too young to be a mother, but they knew nothing about my culture or religion,” she explains.

Navigating a health system where patients’ backgrounds are not fully considered is one of the obstacles that women face when expecting a child abroad.

Irene Santos, who was a pediatrician for 29 years in Mexico, explains that further difficulties may include not knowing the language, the culture, or how the system operates. “Not being a permanent resident and lacking networks of support are also common challenges,” she adds.

Ángela Hiraldo remembers yearning to return to the Dominican Republic when first learning about her pregnancy: “I didn’t have access to the health system and I didn’t know how it worked. When you come to another country, there are so many things you need to do but there is no one to show you the way.”

[quote align="center" color="#999999"]“With the CCHB, I feel that my time is valued because she listens to me and understands what I need; we can talk in my own language, and we explain everything to the doctor together.” - Ángela Hiraldo, immigrant mother[/quote]

Voces Maternas

To help others going through similar situations, Raquel and her team started Voces Maternas (Maternal Voices).

Voces Maternas is one of the programs of Umbrella Multicultural Health Co-op, a member-driven, not-for-profit organization that offers medical services to immigrants facing barriers to accessing health care in British Columbia. Financially sustained by the Vancouver Foundation, Voces Maternas delivers free pre- and post-natal support to immigrant women, their children and partners.  

The Cross-Cultural Health Broker (CCHB) is one of its crucial components. CCHBs are bi-cultural and bilingual health workers with medical degrees, and extensive knowledge of both the community with whom they work and the Canadian health system.

Irene, Voces Maternas’ CCHB, indicates that the goal is to become a bridge between the patient and the medical services in Canada by helping newcomers understand and navigate the health system, and by being an interpreter and translator – in both linguistic and cultural terms – between the patient and the doctor.

“With the CCHB, I feel that my time is valued because she listens to me and understands what I need; we can talk in my own language, and we explain everything to the doctor together,” Ángela says.

Moreover, the CCHB gives workshops that provide immigrant families with information about pregnancy, birth and post-partum so that they feel empowered to take decisions according to their own set of beliefs.

“We don’t try to impose ideologies, areas of interest, or methodologies. We talk about different options so that people can choose what works best for them,” Raquel explains. As a result, they provide a safe and non-judgemental meeting space for parents to connect and support each other.

[quote align="center" color="#999999"]“Sometimes people can’t access the services they’d like to because they learn about them when it’s too late. We assist them so that they can know their options and choose from them on time." - Raquel Velásquez, Voces Maternas[/quote]

Resources for maternity health: an urgent need

Voces Maternas currently focuses on Latin American women, but it aims to include other communities in the future.

Other projects of Umbrella – such as the Umbrella Mobile Clinic, the Pediatric Health Outreach Program and the Many Faces of Diabetes Program – offer services in several languages and work with communities from different parts of the world.  

In an email to New Canadian Media, British Columbia’s Ministry of Health states that “we recognize newcomers may face challenges in accessing health care services, which is why we continue to introduce services aimed at this population,” some of which include the Bridge Clinic, the Global Family Care Clinic, the New Canadian Clinic, and the Newcomer Women’s Health Clinic.  

Similar services are available in other provinces. For example, the Multicultural Health Brokers Co-operative, which functions in Edmonton, Alberta, offers diverse programs where multicultural health brokers provide support to 22 cultural and linguistic communities. 

Both Raquel and Ángela recognize the urgent need to provide more information about the existing maternity health options in British Columbia.

“Sometimes people can’t access the services they’d like to because they learn about them when it’s too late. We assist them so that they can know their options and choose from them on time,” Raquel explains.

Immigrant health: a combined effort

Newcomers can also visit the WelcomeBC webpage to know more about B.C. health services, or the Government of Canada's Health page to learn about health services across Canada. For more support, they can access the Immigrant Services Society of British Columbia or the Community Airport Newcomers Network.  

Improving immigrant health is a combined effort. According to the email from B.C.’s Ministry of Health, “though we strive to offer comprehensive services to new British Columbians, non-profit organizations providing further education and resources are certainly a valuable addition to the system of care.”

In addition, Umbrella highlights the need for people to actively look for information and get involved. Ángela is pleased she did: “I feel empowered thanks to Voces Maternas, not only because I know more, but also because of the bonds I created.”

Raquel adds that “if we surround ourselves with people that support us, we also feed the circle by empowering other mothers to enjoy their experience.” She believes in the proverb that says that raising a child takes a village, “and we want to be that village for immigrant parents living in Canada.”

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by Selina Chignall

The results of the Canadian Medial Association’s report card on health care shows Canadians strongly believe in the need for a national strategy for seniors’ health.

According to the report, released today, 90 per cent of those polled said there needs to be a national strategy for seniors care — which should include support in home, hospice, hospital and long-term care facilities and with end of life care.

The survey also found that 67 per cent of Canadians believe the “federal government has an important role to play in developing a national seniors’ care strategy.”

More than 80 per cent of those polled say if the provincial and federal governments cannot agree to a national strategy, they believe the costs for providing care for the elderly will fall on younger members of the family.

[quote align="center" color="#999999"]“We will just not have enough money to care about anyone.”[/quote]

With no additional funding on health care expenditures for seniors between 2000 and 2011, CMA President Dr. Chris Simpson said the health care system will become completely unable to care for seniors.

“We will just not have enough money to care about anyone.”

Provinces and feds need to work together

Access to quality seniors’ care is cause for concern as the average life expectancy in Canada is 81 years. And when the last of the baby boomer cohort reaches the age of 65, seniors could represent a quarter of the population.

Whoever wins this election, a majority of Canadians say they will need to respond to this demographic shift, and it will require cooperation among the federal, provincial and municipal governments.

“The fact that it’s a messy discussion and these are difficult issues simply can’t be an excuse for not cooperating with other levels of government … Canadians expect the feds and provinces to work on this,” Simpson said.

Despite jurisdictional limitations — as hospitals and doctors are provincial responsibilities — Simpson said the federal government could include health infrastructure in the Build Canada Fund and create tax credits for caregivers to stay at home.

[quote align="center" color="#999999"]“We want people to think about where the parties stand on health when they cast their ballot.”[/quote]

Simpson says he was disappointed the issue of health care wasn’t raised in the first national leaders debate, and the lack of discussion about it during this campaign. Canadians should think critically about the parties platforms on health care when they go to vote.

“We want people to think about where the parties stand on health when they cast their ballot.”

Simpson points to New Brunswick, where 25 per cent of the hospital beds are filled with seniors waiting for placements in long-term care facilities. “That’s the future for the rest of the country whose aging population is following behind.”

Last week in British Columbia, Liberal Leader Justin Trudeau pledged to invest an additional $190 million to expand the Employment Insurance compassionate-care benefit. He promised to extend the benefit to those taking care of seriously ill family members and greater flexibility to caregivers if they need to take time off work.

Currently, the benefit is only available to those who can prove their loved one is at risk of dying within six months. Because of the strict time frame to qualify for benefits, Trudeau said “too often, folks are forced to leave their jobs and drain their personal savings to provide essential care.”

His pledge to extend these benefits is a small step in addressing seniors care, which Simpson says “is not something you can fix overnight. It takes planning and good will … if we can’t even agree that we need a plan then we are in really big trouble.”

Published in partnership with

by Ajamu Nangwaya in Toronto, Ontario

Mental health experts are calling for more culturally appropriate services for racialized immigrants in Canada in light of the recent death of a Sudanese-born father of five who was fatally shot by Toronto police officers earlier this month.

The Canadian Mental Health Association (CMHA) estimates that that one in five Canadians will develop a mental illness at some time in their lives. The association defines mental illness as a health challenge that undermines a person’s capacity to operate effectively in the world or to behave in socially-acceptable ways with others.

Across Boundaries, an ethno-racial community mental health centre based in Toronto’s west end, and the CMHA have both highlighted the heart-rending story of Andrew Loku, who was killed in an apartment complex near Eglinton Ave. W. and Caledonia Ave., Toronto, on July 5. Media reports suggest Loku’s apartment was in a CMHA-leased building that housed those suffering from mental illness.

While Canadian society as a whole grapples with the stigma and ignorance surrounding mental health, Across Boundaries’ executive director Aseefa Sarang says, the challenge facing immigrants is immeasurably more complicated.

“Hiding” the illness 

“The gaps are based on many levels,” says Sarang. “They range from immigrants understanding the mental health system, to stigma around mental health and addictions, to discrimination (all sorts of oppressions) experienced, as well as structural barriers to accessing care. Many immigrants have a tendency to “hide” the illness and not share their condition with others or seek help.”

Immigrants are often faced with more challenges when and if they do seek assistance, Sarang adds. “It is another battle to find the right type of help, with the right type of people and help that is relevant to their needs (i.e. a combination of medical and non-medical supports – Ayurveda, acupuncture, yoga, etc.).”

[quote align="center" color="#999999"]While Canadian society as a whole grapples with the stigma and ignorance surrounding mental health, Across Boundaries’ executive director Aseefa Sarang says, the challenge facing immigrants is immeasurably more complicated.[/quote]

The gaps in accessing services become clear in related research. For example, a 2012 report prepared by St. Michael’s Hospital, “The Mental Health and Well-being of Immigrants in Toronto”, indicates that while recent immigrants and non-recent immigrants experience about the same level of mental health issues like depression and anxiety as those born in Canada, when it comes to treatment for depression, immigrants are less likely to access services (less than seven per cent) compared to non-immigrants (10 per cent). 

A personal story

Mental health survivor Aaqilah Al Massri is all too familiar with the challenges of accessing mental health services.

“The gaps in the system are in the very framework from which we understand and accept what contributes to mental un-wellness, which within a western landscape is derived primarily from a bio-medical model with the interventions being largely pharmacological,” says Al Massri. 

Al Massri’s point is also highlighted in the St. Michael’s Hospital report, which shows fewer immigrants (13 per cent) use prescription medications to combat mental illness than non-immigrants (21 per cent). Furthermore, only eight per cent of immigrants saw a psychiatrist or psychologist in 2011, in comparison to 12 per cent of their non-immigrant counterparts. 

Multi-layered challenges 

Ryerson University School of Social Work professor I. Abdillahi says not all immigrants experience challenges with mental health services to the same degree. This has been illustrated in research examining the mental health experience of specific groups of immigrants and racialized people – for example studies focused on newcomer youth, African-Canadians in Montreal, Chinese-Canadian elders and Afghans in Toronto.

Abdillahi calls on mental health organizations to acknowledge that inequality is in-built into Canadian society, “which certainly impacts not just the day-to-day well-being of racialized people, but they (facets of inequality) have a particular perniciousness and precariousness depending on who are in these groups.”

Al Massri echoes this sentiment – underlining the need to recognize the impact of multiple oppressions.

“Traumatized or wounded people go on to wound and traumatize, and when the individual’s trauma is exacerbated by the very core of their social and cultural identity being under siege in their community (female and deeply questioning of the status quo), and within the larger framework of a largely racist system – in my case being of Palestinian, African and Muslim heritage – barriers become plentiful and that in itself contributes to stress and anxiety.”

Interpreting body language

This type of complex, multi-layered challenge becomes prevalent when examining the African-Canadian community’s relationship with the mental health system, Sarang finds. 

“Based on our experience the black community is over represented in many spheres of the system. Our own experience at Across Boundaries shows that of our clientele, there are about 50 percent black people when the black population in Toronto is way less than that.  This alludes to many layers of issues from racism to anti-black racism and impacts black people from all over the world.”

Loku’s shooting drives home the point. “Today I don’t question whether this is anti-black racism. In fact, this sort of action is a clear and deliberate act of anti-black racism, and the [Special Investigations Unit], the Toronto police and the community need to acknowledge this and seek accountability.”

According to Sarang, Black bodies are understood and interpreted as dangerous, unsafe and disruptive” and, as such, the response to this group can only be combative and fatal. Therefore, anti-Black racism is a cause of mental illness among African-Canadians.

Abillahi indicts anti-Black racism as a force that prevents access to appropriate and relevant services. African-Canadians are seen as “dangerous, unsafe, unwell, ill, untreatable, treatment resistant and non-compliant”. As result of these prejudices, the diagnosis and treatment take on a punitive character.

Offering solutions

Since there are problems with accessing mental health services that address the diverse needs of racialized Canadians – immigrants and refugees in particular – there is a need for the system to respond differently.

“First there has to be a clear acceptance that there is inequity at play in the system, and that there is institutional racism, which is compounded by individual racism,” says Sarang. “From there we can move to address the sources of inequities and finally consider strategies to overcome those inequities. 

Al Massri adds that racialized communities require spaces to share more spoken narratives, and the sharing must be guided by, “compassion, empathy, respect, generosity of spirit and commitment to individual, familial and communal healing.”

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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