Health

Thursday, 12 March 2015 02:24

Why Vaccines are Crucial for New Canadians

Written by

by Dr. Ubaka Ogbogu (@UbakaOgbogu) in Edmonton

What role do immigrants play in the introduction of infectious diseases to Canada? Historically, immigration was a major factor in the introduction and spread of diseases such as smallpox and cholera. In the 18th and 19th centuries, immigrants arriving at coastal regions such as Halifax and Quebec brought diseases with them – for instance, among 98,000 immigrants that arrived at the port of Quebec in 1847, over 8,000 were hospitalized for infectious diseases and over 5,000 died of typhus fever.

The threat of imported immigrant diseases led to the establishment of the earliest infectious disease prevention and control measures, including quarantine, inspection, isolation, hospitalization and treatment of new immigrants.

Today, the importation of infectious diseases into Canada remains a significant public health threat. For instance, since 1997, outbreaks of measles – a highly contagious but vaccine-preventable viral disease, and one of the leading causes of death among young children globally – have either been imported into Canada or associated with imported cases.

[quote align="center" color="#999999"]Although new immigrants to Canada are generally healthier than settled immigrants and Canadian-born persons – a phenomenon termed the “healthy immigrant effect” – this advantage is lost when it comes to certain infectious diseases.[/quote]

Similarly, between 1996 and 2011, cases of congenital rubella syndrome – an otherwise mild viral infection, which can cause miscarriages or fetal malformations in infected pregnant women – were linked to immigrant women who acquired the disease before arrival in Canada.

Although new immigrants to Canada are generally healthier than settled immigrants and Canadian-born persons – a phenomenon termed the “healthy immigrant effect” – this advantage is lost when it comes to certain infectious diseases, such as tuberculosis and HIV, which are endemic to the immigrants’ origin countries. Mortality from infectious diseases is also higher among immigrants compared to the Canadian-born population.

Immigrants Not Only Importers of Diseases

It is important to note, however, that immigrants are not solely to blame for disease importation, as the class of potential “disease importers” includes Canadian residents returning home from travel abroad and other types of migrants, such as refugees and temporary residents. Still, the fact remains that immigration does play a role in the introduction and transmission of infectious diseases to Canada.

[quote align="center" color="#999999"]Barriers to accessing health services upon arrival in Canada may prevent new immigrants from taking steps to protect themselves from infectious diseases.[/quote]

The reasons why immigrants contribute to disease importation into Canada are not well established, but certain factors have been identified in academic literature. Many immigrants, for example, arrive in Canada from countries with high rates of certain infectious diseases, including countries, which have a high population exchange with Canada. Suboptimal immunization coverage in immigrants’ origin countries is also a factor.

While immigrants to Canada generally undergo pre-immigration health screening, including mandatory screening for HIV, tuberculosis and syphilis, they are not required to declare immunization status or to get immunized against infectious diseases prior to arriving in Canada.

Barriers to accessing health services upon arrival in Canada may prevent new immigrants from taking steps to protect themselves from infectious diseases, and the unprotected may become re-exposed when they travel back home to visit relatives and friends.

What Can New and Arriving Immigrants Do?

Many infectious diseases are vaccine-preventable, and the simple act of getting immunized can both provide immunity to and help eliminate or reduce the transmission and spread of common infectious diseases. In Canada (and many other countries), vaccines are offered without charge to the public and can be obtained from public health clinics and community health centres. New immigrants should ensure that they inquire about and obtain the required doses of available vaccines in their origin countries before arriving in Canada.

This ensures that arriving immigrants are protected and that they do not serve as disease transmitters in the period between arrival and eligibility for health care insurance coverage under provincial and territorial health plans.

[quote align="center" color="#999999"]Many infectious diseases affect young children more severely and disproportionately, so it is critical that parents inquire about getting their children immunized before, or upon, arrival in Canada.[/quote]

It is also imperative to arrive in Canada with documentation showing vaccination status, as this will assist Canadian health authorities in determining whether updates or outstanding vaccines are needed. New immigrants should also seek out and obtain outstanding vaccines upon arrival in Canada. Many infectious diseases affect young children more severely and disproportionately, so it is critical that parents inquire about getting their children immunized before, or upon, arrival in Canada. Screening tests and health assessments prior to, and upon, arrival in Canada is also recommended.

Information about immunization and screening programs can be obtained from most health care institutions or by placing a call to a provincial or territorial health services helpline. Useful online resources include the Public Health Agency of Canada, Immunize Canada, the excellent ImmunizeCA app (available on iTunes, Google Play and BlackBerry World), the World Health Organization Immunization Portal and the Alberta Health Services Immunization Portal.

Taking preventative action against infectious diseases does not just protect immigrants and Canadians from dangerous and deadly infectious diseases, but also ensures that one of immigrants’ greatest gifts to their new country – the “healthy immigrant effect” – is maintained in an area that is of utmost importance to the health and well-being of their adopted country. 


Dr. Ubaka Ogbogu is an assistant professor in the faculties of law and pharmacy and pharmaceutical sciences at the University of Alberta.

{module NCM Blurb}

 

Sunday, 15 February 2015 13:44

Canada Halts Imports of 16 Drugs Made in India

Written by

Canada has stopped the importation of several drugs and drug ingredients from two Indian factories, as concern mounts in North America over health products sourced from the multi-billion dollar South Asian pharmaceutical industry. The products on the Canada blacklist range from medicines like blood pressure pills to chemotherapy drugs, anti-psychotics and painkillers.

Canada’s action comes after a U.S. trade representative's special investigation noted: "Reports indicate that anywhere from 10 to 40 per cent of drugs sold in Indian markets are counterfeit and could represent a serious threat to patient health and safety."

India produces nearly 40 per cent of the generic drugs used in the U.S. and Canada and has been stepping up production in anticipation of increased demand. 

At Health Canada's request, Canadian importers have agreed to quarantine health products from the following two India-based sites due to data integrity concerns: Dr. Reddy's Laboratories in Srikakulam, India and IPCA Laboratories in Pithampur, India.

It said the action comes in light of recent information from a trusted regulatory partner that raises concerns about the reliability of the laboratory data generated at these sites. 

A quarantine means that the Canadian importers have agreed to stop the importation and distribution of products from these two sites. At this time there is no identified risk to health, and Health Canada is not requesting a recall of any of the products.

Health Canada said it will continue to work with international partners and Canadian importers to gather and assess information regarding the situation and take action as needed to help protect Canadians.

Amir Attaran, Canada research chair in law and population health at the University of Ottawa, questioned why Health Canada has not blocked the sale of those medicines that had arrived on shelves earlier from the factories.

"How can the product be too dangerous to import, but safe enough to go down a Canadian's throat?" Attaran said in a interview with the National Post.

He said the integrity problems could range from relatively innocuous data-entry shortcomings to clearly fraudulent behaviour, such as fudging results on drug-stability tests.

Canada's increasing use of Indian-made medications, coupled with India's antiquated regulatory system, points to the need for more drastic action, such as barring all imports if the country fails to modernize its rules, Attaran said.

A newspaper in India reported that inspectors from the U.S. Food and Drug Administration had earlier found problems at the plants - Dr. Reddy's Laboratories in Srikakulam and IPCA Laboratories in Pithampur. 

The Indian government has said it is investigating reports of generic versions of some medicines being manufactured without proper testing.

Health Minister J.P. Nadda. said that the government was aware of the reports regarding manufacturing of generic versions of some drugs without proper testing.

"The Indian Council of Medical Research has taken up the matter with the Drug Controller General of India (DCGI) for action against such erring companies," he said.

Earlier, as part of efforts to ensure that Indian pharmaceutical products meet international standards, New Delhi said it is spending about $500 million to build the capacity of the country's drug regulators.

National drug controller G.N. Singh said part of the money is to be used to set up a National Drug Regulatory Academy to train professionals who test drugs in the laboratories.  Singh said the government was also compiling a national pharmacopia to guide in the manufacture of drugs. 

He said the government's zeal to bring about affordable quality drugs to the people could only materialize if the government's zero tolerance for poor quality drugs was monitored by implementing laws that punished those who violated the rules.

Sudhanshu Pandey, joint secretary in the ministry of commerce and industry, said Indian generic drugs have become globally accepted and respected, and for this reason, there was the need to send a loud message out that the government was ready to ensure that the manufacturers met the standards required of them.

Pandey said patents for about 160 drugs would be expiring soon and that would give manufacturers more opportunities but, at the same time, he cautioned that it meant that innovations in the industry will have to be transparent so that global regulators would not question the standards.

Pharmaceutical Export Council of India (Pharmexcil) says that eight out of the world's top 25 generic companies come from India. 

Re-published with permission from South Asian Post.

Friday, 29 August 2014 17:22

Desperately Seeking Normalcy

Written by

by Abbas Somji (@abbassomji) in Toronto

Nishaat Sheraly shuffles into a small lounge area, tugging at her IV tube as her husband, Munsif, escorts her. As she sits down, she adjusts the black-and-white silk scarf carefully wrapped around her head, concealing any wayward strands of hair.
 
She gives a weak smile, almost apologetic. It’s perhaps all Nishaat can muster after her latest round of in-patient chemotherapy at Toronto’s Princess Margaret Hospital. It is a bitter case of déjà-vu for this 37-year-old mother of two boys.
 
Nishaat was first diagnosed with leukemia in 2011, just a week before Christmas. Several rounds of chemotherapy later and she was in remission. But midway through July this year, a routine check-up revealed a dangerously low platelet count. She had relapsed.
 
The Richmond Hill area high school teacher barely had any time to process the news before she was whisked away for aggressive treatment. It soon became painfully clear – she would once again have to spend a month at the hospital, be isolated from much of her family, undergo chemo, have her blood assessed and wait to find out when – if ever – she’d be ready for a bone marrow transplant.
 
Beating the odds
 
Bone marrow transplant is a procedure that restores stem cells that are destroyed by high doses of chemotherapy and/or radiation therapy. It is done by extracting the flexible tissue found in a healthy donor’s bones. A successful transplant usually depends on the patient’s age, how aggressive the leukemia is and the quality of the match.
 
Finding a match, however, is a challenge. Nishaat has been on the international bone marrow registry for more than two years and there hasn’t been a single match for her – anywhere in the world.
 
“For any patient that's been diagnosed with a disease that requires a stem cell transplantation, you only have a 25 per cent possibility that you’re going to find a match within your family,” says Mary-Lynn Pride.

Pride is the Patient and Transplant Liaison Specialist for Canadian Blood Services. She walks patients through the search process of finding a bone marrow match.
 
“We recognize that for any patient that needs a stem cell transplant, their best hope of finding a match is going to be from their own ethnic community,” says Pride. In Nishaat’s case, that would mean a South Asian donor. But that in itself, is another challenge.
 
Fighting ignorance 
 
According to CBS, approximately 342,000 Canadians are registered, but only 3.6 per cent are from the South Asian community.. Another one per cent is from the Black (or Caribbean) communities and the First Nations communities respectively. The lion’s share is made up of Caucasian donors with 71%.
 
Munsif attributes the shortage to “a lack of awareness, a lack of education, anxiety around the process and apathy.”
 
“I think people are just so afraid of the process,” adds Nishaat. “They really feel like you’re taking something from them that cannot be replaced. When you look at minorities, even religiously speaking, the whole notion of organ donation is a major issue. So when it comes to bone marrow or stem cells, I think some of that falls into the same category. In terms of the mentality.”
 
The cultural stigma is so strong that some discourage their family from accepting donated organs even if a match is found. In one case, a Stanford professor had found a match for a South Asian couple’s 20-something son, but the young man’s parents convinced him at the last minute to refuse the donation.
 
[toggle_box]
[toggle_item title="Donating"]Donors must be between 17 and 50 years of age to be eligible, although the ideal age range is between 17 and 35, as younger donors provide better post-transplant recovery for patients. They must be in overall good health, readily available and have Canadian health card coverage. The Canadian Blood Services (CBS) is particularly looking for male donors from different ethnic communities. CBS says donors can return to their normal activities within a day or two; their stem cells reproduce within four to six weeks. Moreover, the quality of their health is not impacted.
 
CBS supports the OneMatch Stem Cell and Marrow Network as well as the National Cord Public Blood Bank. OneMatch is a program that has been in existence since 1988 and is mandated to find stem cell patients.
 
In the event that an adult donor cannot be found, a patient can receive a transplant from umbilical cord blood after the birth of the child, but the donor blood still must be a match. The National Public Cord Blood Bank already has centres operating in Ontario, with another two set to open in Edmonton and Vancouver later this year.
 
If a donor is a match, there are usually two ways to donate:
 
1) Bone Marrow procedure: This is considered to be a surgery, done under general anesthetic. Doctors make small bandage-sized incisions at the top of the hipbone as guides that go into the actual bone itself to extract the stem cells required. The donor may have a bit of tenderness or bruising after the procedure.
-OR-
2) Peripheral Stem Cell procedure: This is similar to blood donation, in that a needle would be inserted into their arm. The blood travels through a sterile machine, which then extracts the required stem cells. All other blood products - white blood cells, red blood cells, and platelets – subsequently return to the donor through another needle in the other arm. Prior to the procedure, the donor is given injections of a medication that overproduces the stem cells in the marrow to ensure they will flow out into the circulating blood.[/toggle_item]
[/toggle_box]
 
Community outreach
 
'South Asians 4 Life' is one group partnering up with CBS in trying to combat the deep-rooted stigma through awareness campaigns. According to their website, 5,000 South Asians have registered with the OneMatch Stem Cell and Marrow Network**. As of 2011, there were nearly 1.6 million South Asians living in Canada, the largest visible minority group in the country (StatsCan). At the time of this article, 28 Canadian patients of South Asian descent were also reportedly waiting for a match.
 
“People actually have the opportunity to change the numbers,” says Munsif. “To make a positive impact. If they knew about it and if they thought or understood it could happen to their loved ones, they would have no hesitation to do it.”
 
Munsif says various community centres in the GTA have been “very supportive and extremely accommodating,” of their cause, by holding bone marrow donor drives more than two years ago in Nishaat’s name. From there he realized there were many misconceptions about signing up to be a donor.
 
“People equate the process to breaking bones and pulling stuff out,” he says, adding some attendees asked if the procedure was dangerous. He insists the processes of donating (or even recovery) are not painful.
 
The grim reality of donor shortages is hitting home for many ethnic groups across the country. In Toronto, multiple “Swab-a-Cheek” drives are being organized at religious and cultural centres throughout the month.
 
Western Canada is also taking part, using Bollywood as a catalyst for change. Famed singer Shreya Ghoshal will reach out to a Calgary audience in late August. The Alberta event is joining forces with CBS, with part proceeds from ticket sales going to a fundraising initiative for Canada’s National Public Cord Blood Bank. The concert will also help urge its South Asian audience to become donors.
 
Donor drive
 
Meanwhile, the Sheraly family is once more banding together with their Vaughan-area mosque – the Jaffari Community Centre – to host a donor drive on Aug.31.
 
If a donor doesn’t materialize by autumn, Nishaat says her medical team may explore other options, including clinical trials and reaching out to the National Public Cord Blood Bank, which could require living in another city for months on end for treatment. More than anything, all they want is to return to the way things used to be.
 
“I think for us, this is the journey of life and we’ve hit the pause button,” says Munsif, who says the experience has taken a toll on their seven and 10-year-old sons. “We would like nothing more than to return and resume our journey in life.”
 
“We just want that boring life,” adds Nishaat. “I just want to be with my family, watch my kids grow, watch them play hockey, build that ice rink in the backyard. Just normal. 100% so badly. I just want normal.”
 
To find out how you can be a Bone Marrow Donor, visit www.onematch.ca or dial 1-888-2-donate and request a swab kit. To follow Nishaat’s story, join the “NishStrong” Facebook group.
 
{module NCM Blurb}
by  in Ottawa
 
Canada’s doctors must develop and adopt measures of “meaningful accountability” if they’re to rehabilitate their increasingly tarnished reputation, outgoing Canadian Medical Association President Dr. Louis Hugo Francescutti argued Tuesday.
 
“Fat cats” and “hobby docs” are terms that are increasingly applied to Canadian doctors, while their status as leaders in the health care system substantially declined in the public’s mind between 2003 and 2013, Francescutti said in his valedictory address to the CMA’s 147th annual general meeting.
 
Lack of compassion
 
“Patients, I guess, aren’t quite as happy with their doctors as they used to be,” Francescutti said, citing surveys which indicate that the public perception of physicians plummeted with regard to measures ranging from their availability to the quality of their performance.

With respect to compassion, for example, just 35 per cent of Canadians believed doctors were compassionate in a 2013 survey, as compared with 61 per cent in 2003.

“Never, ever, at least in the 30 years that I’ve been practicing medicine, have I felt that there’s a greater need to really stand up and look like the profession that we have the potential to be,” Francescutti said.

Francescutti added international comparisons of the performance of the Canadian health care system are equally unflattering to physicians. In a recent Commonwealth Fund report, Canada only ranked higher than the United States and only because Americans sink far more money into their system. Otherwise, “Canada would rank last.”

If the health care system was viewed as a patient, “I think our patient is kind of traumatized. What we have to do is step up and find ways to make our patient better.”

[quote align="center" color="#999999"]With respect to compassion, for example, just 35 per cent of Canadians believed doctors were compassionate in a 2013 survey, as compared with 61 per cent in 2003.[/quote]

Francescutti also noted that a U.S. Institutes of Health report indicated there is in the neighbourhood of US$750-billion in waste within America’s $2.8-trillion health budget.

The same algorithm applied to Canada would suggest that there’s “at least $30-40-50 billion” in health care spending north of the 49th parallel that is “not being used efficiently,” he said.

“Quit pointing the blame at everyone else,” Francescutti told delegates.

New Measures 

Among the measures that physicians could adopt to improve the health care system are new accountability models, such as the Cleveland Clinic’s use of one-year contracts to pay physicians, to determine what approach might be suitable for Canada, Francescutti added.

In other developments Tuesday at the CMA’s 147th annual general meeting:

  • Former Quebec Premier Jean Charest argued in an education session on readiness for the 2015 federal election that governments around the world are all grappling with the impact of technological change, aging populations, structural changes resulting from the economic crisis of 2008, climate change as it affects economic growth and human health, as well as “unprecedented militarization and radical nationalism.”
     
    Among specific challenges faced by the Canadian health care system is designing compensation models that would be suitable for various health care professionals (doctors, nurses, etc.) that provide care, Charest added. Others include finding a way for the federal government to make a contribution to the administrative costs associated with health care, possibly by paying for such costs as they relate to health infrastructure, such as electronic medical records.
  • Proponents of “active living” often don’t back up their words with action. Not so Canadian Medical Association President-elect Dr. Cindy Forbes. In fact, the family physician has three medals to prove it, including a gold medal from the C4 200 m. 40+ Women sprint canoe/kayak race, and a pair of bronze medals in K1 and K2 events, at the 8th World Masters Games in Torino, Italy in 2013. Forbes, who hopes to promote more active lifestyles and participation in sports during her tenure as president, which commences in August 2015, also believes Canadians need to turn their attention to developing “national” solutions to some of the endemic problems the health care system faces. “We’ll all be better off” for it, she says.
     
    In campaigning for the presidency, Forbes identified positioning the CMA “as the national leader in providing physicians with opportunities to develop and implement practical and effective solutions that will result in improved patient outcomes” at the top of her list of objectives. 
     
    “We can make this happen through appropriate use of resources, reducing unnecessary tests and procedures, improved information systems, advancing electronic decision and e-Health tools, and national strategies for pharmacare and caring for the elderly,” she added.
     
    Other objectives included a promise to “focus on physician wellness and work-life balance as areas of top priority for the CMA,” and to pursue the development of a national physician human resource strategy. An active runner, scratch golfer, paddler and war canoeist, Forbes and husband Greg have two adult daughters, Andrea and Kristie. She also amuses herself gardening and is an aficionado of mystery novels.
  • Canada’s Chief of Defence Staff Tom Lawson awarded the Canadian Forces Medallion for Distinguished Services to the CMA for its efforts in providing support to Canadian soldiers during their stint in Afghanistan, particularly the recruitment of physicians willing to serve abroad, the training of medical staff and the provision of treatment to soldiers and their families.

Re-published with permission.

by Ranjit Bhaskar (@ranjit17)

Adrian is proud of his eight-year old son’s facility with English and his general ease in adapting to the ways of his new Canadian surroundings. “He is now our family’s interpreter when we visit our doctor,” says the newcomer father from Romania. What he doesn’t know is that his case is not unique. His son is among the horde of children doing a task they shouldn’t be doing.

Health care providers and managers say this is not an ideal situation as children might be getting exposed to health information about their parents that they either can’t comprehend or isn’t appropriate for them to know.

With various studies conducted over the past few years indicating that language is an enormous barrier for many newcomers when accessing healthcare, iamsick.ca, a social enterprise, has come up with a solution to bridge the gap. “With the support of the broader community, we are leveraging Canada’s diversity to reduce barriers through web and mobile technology,” says Ryan Doherty, its president and co-founder.

Using publicly available data, the site provides a curated listing of all emergency rooms, urgent care centres, walk-in clinics, and pharmacies. It also helps you find physicians and pharmacists who speak your language. The service, currently available only in Ontario, has a database of healthcare providers who can speak 25-plus languages other than English or French.

“Translation can be expensive and not accessible. It’s common to have children of immigrants translating for their parents on medical issues,” Dr. Meb Rashid, clinical director of the Crossroads Clinic at Women’s College Hospital in Toronto was quoted as saying in the Toronto Star. “You do need a more sophisticated command of the language. Something like this, that acknowledges the difficulty in language access, is a tremendous help.”

Expanding into British Columbia

Fresh from a crowd funding campaign that raised over $3,000 but fell short of the $9,000 goal, Ryan, a University of Toronto Medical Biophysics doctoral candidate, was optimistic of expanding into British Columbia by July. The west coast province was selected as it received most votes from supporters of the fundraiser.

“While reaching our funding target would have allowed us to expand quicker, it isn’t holding us back from our vision of leveraging technology to help everyone access healthcare in Canada,” says Ryan.

He and his multi-disciplinary team, that includes tech advisor and co-founder Sherry-Lynn Lee, are now looking at establishing more partnerships with healthcare providers and organizations.

“Later this year, we will be piloting a few new features that focus on access beyond just awareness. They are related to family medicine and will improve same-day and after-hours access to family doctors.”

One-stop resource

Initially the online guide was just a locator for nearby health facilities with information on opening hours. The team came up with the idea in 2012 when some of their fellow University of Toronto friends complained about not knowing where to go when the campus clinic closed.

Even as a simple locator it had its uses. “It was a one-stop resource for answering ‘Where?’” says Jemy Joseph, a University of Ottawa medical student, from her clinical experience. “Even during a rotation in Moose Factory [a very remote island in Ontario], I was able to tell my patients when the pharmacy was open!”

It was only this spring that the language filter was added to the website. Ryan estimates a potential audience of more than 700,000 users across Canada who could use an interpreter due to language barriers in healthcare.

Apart from language and the dangers involved in using children and youth as interpreters, there are other gaps the iamsick.ca project could help bridge. These include cultural differences brought about by ethnicity, a care provider not knowing how to use an interpreter appropriately, a lack of reliable professional interpreter services, and lack of printed information in the patient’s first language.

Re-published with permission from Maytree Conversations

[message_box title="Caption:" color="red" show_close="Yes/No"]NCM contributor Maria Assaf spoke with Ryerson's Dr. Usha George about immigrant health disparity[/message_box]

by Maria Assaf

A struggle to find employment and a lack of understanding of the medical system are the main reasons for the “healthy immigrant effect,” a phenomenon of new immigrants’ health decline within their first five years of arriving to Canada, said Maya Roy, executive director of Newcomer Women’s Services, at the Immigrant and Racialized Women’s Health (IRWH) project conference on February 21 at Ryerson University’s Ted Rogers School of Management.

The event brought together researchers from Ryerson, York and the University of Toronto who, along with healthcare practitioners, community activists and policy makers, shared their ideas with the public on how to improve immigrant women’s health in Ontario.

“When immigrants arrive in Canada, [they] say…‘I’m in good health.’ Or their health state is seen as good. Over four or five years of being in Canada or even much later, that good health state kind of declines one or two points to modest health,” said Dr. Usha George, dean of Ryerson’s faculty of social work and one of the project members. “There is a lot of evidence indicating that minority populations have less access to health, more diseases and the severity of their diseases is also very high compared to the normal population.”

The cause, she explained, is “mainly lifestyle changes and a lack of understanding about the system itself and access to health care and even the quality of healthcare they receive.”

Declining immigrant health

Part of the problem, said Roy, is that government health promotional materials are geared towards middle-class Canadian-born women and do not take into consideration the social and economic landscape of most Canadian new immigrants.

Newcomers, who, according to the panel account for 12 per cent of Toronto’s population, have lower incomes, said Monica Campbell, director of Healthy Public Policy. They also have a higher unemployment rate and are paid less than native Canadians in similar jobs – with the gap being much worse in Toronto, Vancouver and Montreal, the top three immigrant destinations.

Immigrants who are concerned about finding suitable employment don’t have the time to join a sports team or exercise regularly, said Roy, who summarized new immigrants’ views on this matter with the slogan: “less jogging, more jobs.”

She said new immigrants need to be further included in social and political life. A lot of the time, immigrants’ professional qualifications from their native countries are not recognized in Canada, leading to underemployment. 

Campbell said once they settle in Canada and their incomes improve, immigrants’ activity levels and overall health increase again.

[quote align="center" color="#999999"]Immigrants who are concerned about finding suitable employment don’t have the time to join a sports team or exercise regularly, said Roy, who summarized new immigrants’ views on this matter with the slogan: “less jogging, more jobs.”[/quote]

Analyzing health disparity

The IRWH project was funded by the province of Ontario. Three years ago, a team comprised of professionals from all over Ontario set out to analyze and summarize academic literature to find out the causes behind health disparity among new immigrants in comparison to those born in Canada. 

The conference included 12 speakers, three moderators and 175 attendees from across the province. Conferences like this one allow non-industry professionals to get access to academic research about important health matters.

“We believe that health literacy, that is knowing much more about health issues, will enable people to manage their health better,” said George.

Most of the speakers agreed that the three-month Ontario Health Insurance Plan (OHIP) wait for new immigrants should be eliminated. In Ontario, most arriving or former residents returning to the province have to wait three months before they can get their healthcare covered under OHIP (there are some exemptions).

A great number of immigrant women are of childbearing age, said Campbell, so a lot of them need antenatal care. This makes the three-month waiting period difficult.

Manavi Handa, assistant professor at the Midwifery Education Program at Ryerson, said non-status immigrants who do not get any health care coverage experience the greatest difficulties.

Difficulties accessing health services also increases the rates of mental health problems for both the mother and the offspring. “Post-partum and antenatal depression can cause long-term consequences for children,” she said.

Another problem, she mentioned, is that children of uninsured parents are not often taken to health care facilities when needed. This can happen because of parental fears and misunderstanding of the policy.

The highest dollar expenditure in Canadian health care is on post-natal care, said Handa, and increasing spending on pre-natal care is not only humane, but also financially beneficial for Ontario’s health care system. “Every one dollar spent on prenatal care saves two to three dollars to the health care system,” she said.

Campbell said the province also needs to deal with important issues such as racism and better healthcare for refugees. She said 67% of people in Toronto have experienced racial discrimination and this can cause depressive symptoms, which, along with work and life stress, can cause mental health complications for new immigrants.

[quote align="center" color="#999999"]67% of people in Toronto have experienced racial discrimination and this can cause depressive symptoms, which, along with work and life stress, can cause mental health complications for new immigrants.[/quote]

Health discrepancies

Cultural differences can also have serious health implications. About 15 years ago, George conducted a study about mammograms for immigrant women. “We found that family doctors were reluctant to prescribe mammograms for immigrant women simply because they thought that they would not go anyway, so why prescribe it,” she said. “They make some assumptions around their health beliefs or their health practices and therefore [they] may not provide the kind of prescriptions that are required for preventive kind of healthcare.”

Dipti Purbhoo from Toronto central’s Community Care Access Centre (CCAC) talked about the challenges and needs of providing health care in Toronto, one of the most diverse cities in the world.

She explained it is important to focus on prevention of diseases like TB, since the incidence rate of this disease in Toronto is three times higher than the provincial average. HIV/AIDS rate in Toronto is 11.3 times higher than Ontario’s average. 

Purbhoo also talked about the value of home-care workers and their need for higher wages, pensions and benefits. This mostly female workforce helps bathe seniors, clean homes and prepare meals for the city’s elderly for very little pay – $15.57/hour - with no benefits. They make less money than cleaners, so a lot of them have to take up cleaning jobs on the side to make ends meet.

Near the lunch break, Roy presented an emotional video about issues affecting elderly women in Canada. The video showed grandmothers from new immigrant communities talking about their desires.

A lot of their needs included access to cultural food, getting access to free transportation, feeling valued and respected by the youth and being independent.

Addressing the health needs of immigrant women is vital to ensuring a healthy province, and ultimately, a healthy country. 

{module NCM Blurb}

by Aparna Sanyal

Imagine that you are an Afghan refugee. You are a single mother of two children who has fled an abusive marriage, and survived two rapes, including one in a refugee detention centre that resulted in pregnancy. You have endured separation from your supportive parents, who die in Afghanistan while you are still awaiting asylum. While attempting to cope with all this, together with unemployment, isolation and ostracism from your ethnic community, you hear that your refugee claim has been denied. In despair, you threaten to kill yourself and your children.

The immediate response of mental health care professionals? A stark recommendation that your children be placed in protective custody.

The preceding scenario is unfortunately all too real, and representative of an ominous deficit in Canadian mental health care: a lack of training in treating immigrants and refugees. The case is one of many staggering examples cited in the work of Dr. Jaswant Guzder, head of child psychiatry at Montreal’s Jewish General Hospital, and co-founder of Canada’s first cultural consultation service. She notes, in a 2011 paper titled “Second Skins: Family Therapy Agendas of Migration, Identity and Cultural Change,” that many mental health issues dealt with by immigrants and refugees “are not necessarily intra-psychic but rather related to social suffering, institutional or host society issues.”

The urgent need for cultural mental health care training is underscored by a fact reported in a February 2014 Globe and Mail column by Margaret Wente: four-fifths of students in Toronto public schools now have at least one parent who was born outside the country.  

In a recent interview via email, Dr. Guzder answered questions about her groundbreaking work as a cultural consultant:

AS: In your published work you repeatedly describe suicidal ideation among South Asian female immigrants. Are certain mental health problems more common among immigrants, and among certain communities? 

JG: We have studies in Canada that confirm that immigrant women are at higher risk for post-partum depression and psychosis, a factor that puts infants and mothers at high risk and has long-term consequences. In addition, many of these mothers refuse treatment of their depression. We have good documentation that migration increases risk for psychosis and affective disorders, especially where racism is an issue in the host society. Black populations in Europe have well documented escalations of psychosis on migration versus a comparable population that did not migrate. South Asian women that I see who have serious depression risk are often those who have survived political conflicts such as the Sri Lankan war, have a domestic abuse history, suffer social isolation, or do not have the support of their family of origin to negotiate better options for conflict resolution or for divorce when the marriage breaks down.

The mythology is: South Asians, Chinese, Blacks and other minorities underutilize mental health services, so that means they don’t have significant mental health risk or mental health problems. It would seem from our community research that the situation is more complex than that. It involves stigma, accessibility of health care, support of family, language access, etc.  Our study of high-risk parents suggests that general practitioners under-refer minority families. We are not sure whether cultural stereotyping, that these minorities are not ‘psychologically minded,’ is a factor, or whether the patient minimizes any mental health needs -- it is not clear. There is good evidence that minorities benefit from psychotherapy as well as the host culture clients.

AS: In case studies you've noted that clinicians in a host culture can mistakenly think that condemning a taboo in an immigrant’s culture as "primitive" is a form of help. Please explain.  

JG: The host culture often misinterprets ethnic minorities through a lens of stereotyping, or does not gain access to a full account of mental health or systemic issues due to language barriers or lack of culture brokers [professionals who bridge, link, or mediate between cultural groups]. The projections onto Others who are not part of Euro-North American groups are often complex to uncover or deconstruct, as we are now living in an increasingly globalized and technologically adept world of cultural identities that are hybridized or creolized. Assessing the mental health needs of immigrants includes openness to exploring cultural formulations to elicit the meaning of symptoms, and an understanding of such factors as family silencing, rituals, gendered hierarchies or post-colonial issues. A presenting complaint has to be explored to understand the suffering behind the symptom; many cultures do not, for example, have a framework for depression or have very strong taboos on reporting domestic abuse. We must be sensitive to the systemic and family settings where people construct their distress or try to gain support from others. Our voice and agency are generally constructed within a cultural matrix. Often women have greater options in Canada if they shift from patriarchies to egalitarian values, while men find that these values diminish their power and agency within families.

AS: What are some of the ways a cultural consultant can navigate barriers to treatment such as social stigma?

JG: The cultural consultation is always done with an interpreter and, if needed, a culture broker. Our primary aim is to establish cultural safety, and explore all aspects of the presenting complaint.

Sometimes the clinician has a stereotyped approach, has not had interpreters available, or is unaware of crucial cultural factors. For example, there was a case where a Tamil Sri Lankan woman was told by her family doctor that it was best she return home as she might be homesick. But she had been a war victim: the therapist had little information on the Sri Lankan civil war and did not know that she had no home or family to return to. Her symptoms were related to a strain with a psychotic mother-in-law and a triangulation with her husband. After multiple suicide attempts and no response to medication trials the clinic had sent her for a [cultural] consult. The clinic did not realize that the patient was enmeshed with [emotionally dependent on] her interpreter as she was socially isolated, and the interpreter was advising her to convert from her religion to Christianity to save herself from depression. The patient had also never taken the antidepressants consistently or understood the prescribing instructions. All this was evident in the consult, but the clinic had not fully explored these issues nor the familial background, and projected blame onto the husband as a stereotype of a patriarchal abuser -- while in fact, as a son, he was also caught in a difficult familial situation. 

AS: You've mentioned that the lack of translation services in mental health care is a major problem.

JG: Lack of translation services impacts all of our minority patients, as it impedes us in doing an assessment and offering therapy. The government has been slow to acknowledge that interpreters are vital to quality of mental health care delivery.

AS:  What is the potential long-term impact of cultural training among Canadian mental health care providers?  

JG: We are working towards a wider acknowledgement that training in cultural competency should be part of the curriculum for all mental health professionals, including teachers, nurses and medical students. The potential gains are: the reduction of stigma; the reduction of institutional racism (difficulties reflected in attitudes towards minorities); wider access (currently our studies have shown that many communities associate mental illness only with psychosis and need to feel safer, with options of care modified for their cultural group); and encouragement of collaborations with cultural communities to address modifications in approach (e.g. work has been done to modify mental health care approaches for First Nations, Black, Chinese communities, etc.) Trauma and wellness have to be framed within the cultural norms of the communities:  their ways of presenting distress or modifying protective factors that help them become functional and more resilient.

(This interview has been condensed and edited for clarity.)

Aparna Sanyal is the former editor of the Montreal Review of Books. You can find more about culturally safe and competent mental health care for Canada's diverse population at www.multiculturalmentalhealth.ca

{module NCM Blurb}

Friday, 21 February 2014 17:55

How Children Cope with Migration

Written by

by Maria Assaf

A recent panel discussion on immigrant children provided interesting insights into how school-going kids cope when their families move home from one country to another.   

Monica Valencia, a Master’s graduate on immigration and settlement studies from Ryerson University, did something uncommon. A lot of her key research interviewees were aged between 9 and 11 years old.

Ms. Valencia set out to study the reasons for poor academic performance among Latin American youth in Ontario schools and its connection with the experiences of new immigrant children.

She researched the adaptation process of a group of Latin American children who had arrived in Canada less than five years ago. Her project “Yo Cuento,” which translates in Spanish to either “I narrate” or “I count,” aimed to find out how children truly felt after moving countries.  

Leaving folks behind

To gain insight into what they experienced, Ms. Valencia gave them paper to draw and write.

“A lot of their significant experiences were getting separated from their grandparents as well as cultural and language barriers at school,” she said.

She showed a slide of a child who drew himself crying and holding on to a house while being dragged by his mother into a car.

As for the interviews, she had to improvise methods to make the children talk more freely. “I told them my story and then let them say theirs,” she said.

She said her hypothesis changed as the investigation advanced. “A lot of them talked about the help they received from classmates.”

Ms. Valencia found that those children who had already gone through the process of learning English and fitting into a classroom often helped and taught language skills to new ones.  

[quote align="center" color="#999999"]She said having children as participants was a vital key part of her research. “People rarely ask children how they feel or encourage them to tell their stories.”[/quote]

“Participation of children in research is limited,” she explained to the audience. Limitations can arise from having to obtain parental consent, but also because children are rarely viewed as credible sources of information.

“English mania”

Valencia was followed by Eunjung Lee and Marjorie Johnstone, who discussed the South Korean student migration experience and the effects it has on families.  

Ms. Johnstone provided a historical account of Canadian government policies that, she said, have consistently and successfully fostered and promoted the arrival of South Korean students to generate revenue for Ontario schools suffering budget cuts, since the 90s. “Immigrant policies were suited to allow students to come here to study,” said Ms. Johnstone. “They didn’t even ask [South Koreans] for visas.”

A move towards the North Americanization of education through an international high school system helped make it easier for youth to come to Canada for school, the team explained

The team said half of all South Korean parents want to send their children to study in North America. They explained this may be linked to the “English mania” in South Korean culture.

The final presenter, Aamna Ashraf, encouraged the audience to become involved in neighborhood organizations working with new immigrants. She is part of the Peel Newcomer Strategy Group.

The group works with local government agencies, the settlement sector, as well as community leaders to help arriving families in the Peel region.

This CERIS panel took place on Jan. 31 at the Factor-Inwentash Faculty of Social Work, University of Toronto.  

{module NCM Blurb}

Written by Dr. Ferrukh Faruqui

 Undeterred by what is arguably a significant hurdle to the pleasures and experiences of daily life, Arshina Kassam, a twenty-six year old Muslim of African background wakes each morning charged with her faith in God and confidence in her own ability to navigate the logistics of living life virtually blind.

Page 4 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