By Belen Febres-Cordero in Vancouver

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

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

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

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

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

Canada has some of the highest allergy rates

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

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

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

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

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

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

Ethnic foods may help

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

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

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

Published in Health
Tuesday, 26 April 2016 15:23

Helping Ecuador’s Earthquake Victims

by Belen Febres-Cordero in Vancouver

As an Ecuadorian living in Canada, Lucy Guerrero felt powerless when she first learnt about the 7.8 magnitude earthquake that struck Ecuador last Saturday, April 16th“I would have liked to take the next plane to go and help,” she says.

The therapist Josy Valero-Frias explains that immigrants may experience feelings of sadness, fear, shock, lack of control, and disbelief when a disaster strikes their countries of origin.  She adds that these can be due to limited communication with loved ones, lack of or partial knowledge of the situation, and inability to change it.

Valero-Frias also says that other citizens in the country of residence likely do not always empathize, which can make immigrants feel isolated. She recommends finding or creating a community of support. “Donating can also help with the feelings of helplessness and guilt,” she suggests.

Support from Canada

After the earthquake, Ecuadorians across Canada have united both to strengthen their community in this country, and to raise funds by organizing events, raffles, and contests; selling traditional food; and offering concerts of Ecuadorian and Latin American artists.

“It is nice to see how we have come closer in these circumstances,” says Guerrero, who is one of the organizers of the “Toronto Unites for Ecuador” event that will take place on Friday, April 29th. All the funds raised will be given to Guerrero´s daughter, who now lives in Ecuador, so that she canalizes the help directly from there.

Christian Basantes, president and member of the Ecuadorian Association of British Columbia, also replaced his initial feelings of powerlessness with gratitude towards the people who have expressed their support and solidarity to the country. On Sunday, April 24th, this Association held the “Ecuador Earthquake Emergency Fundraiser” event, which took place in Vancouver. “In this way, we are building our country from another country,” says Basantes.

On the same day and with the same objectives, the Comité de Solidaridad SOS Ecuador (Committee for Solidarity SOS Ecuador), formed by almost 20 Ecuadorian and Latin American people living in Montreal as a fast response to the country’s needs, held the Tarde Solidaria Cultural (Cultural Afternoon for Solidarity). 

The three organizations plan to have similar events in the future.

Nicolás Trujillo, Ecuador´s Ambassador in Canada, explains that the Embassy has coordinated help at a federal, provincial and municipal level. He adds that people interested in donating can also do so through their webpage or by delivering articles at the Embassy and Consulates in Ottawa, Toronto, Vancouver, and Montreal.

He highlights the importance of donating only the requested articles, as those will help to cover the most urgent and essential needs; and invites people to look for more information at the Embassy´s Twitter and Facebook accounts. 

Another option is donating to the Red Cross. Diego Castellanos, spokesperson of Red Cross Ecuador, explains that this organization has worked on actions of immediate response by offering pre-hospital care, psychosocial support, restoration of family links, water and sanitation programs, humanitarian assistance, and damage assessment and needs analysis.   

He encourages people to make monetary donations instead of sending clothes, food, or medicines from abroad. “The money spent in buying and sending them by plane could be better used getting construction materials or hiring people at the affected zone to reactivate the economy of many families.”

Raquel Freile, volunteer in the area, considers that people living outside the country can also contribute with ideas of projects and initiatives from abroad that can be implemented in Ecuador.  

Help, for what?

This earthquake is the strongest that the country has had in decades. Six Ecuadorian provinces are now on red alert.

According to the latest official assessment, there are 655 deaths, 48 people disappeared, 29,067 people sheltered, 113 people rescued with life, 6,998 buildings destroyed, 2,740 buildings and 281 schools affected, and 17,638 people who have been medically attended since the earthquake.  

The doctor Eduardo Noboa assisted in an area. He explains that in these situations there is a lack of attention to people suffering from chronic diseases. “There is also a lot of anxiety, people are overwhelmed and they do not know what to do.” He adds that that lack of medical infrastructure is another problem, and that this is worsened by a workplace absenteeism of doctors because many of them were also injured.

Freile describes that the situation in general is difficult. “There is a lot of people without access to clean water or food. Many of them have lost their homes or the places where they work, so they have no source of income.”

Castellanos explains that there are three phases when offering help in disasters such as this one: emergency, rehabilitation, and reconstruction. He highlights that help is needed throughout the three phases, which will last at least two years.

“This is a marathon, not a sprint,” says Trujillo, who is thankful for the help from Canadians.

Freile concludes by encouraging people to maintain their solidarity.  “Let´s help bring life back to these places that are now completely destroyed, but have the desire and strength to forge ahead.”

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Published in Top Stories
Thursday, 04 February 2016 14:54

'Onus on Parents to Immunize Kids'

by Belen Febres-Cordero in Vancouver

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

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

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

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

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

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

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

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

National and provincial policies

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

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

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

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

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

Challenges unique to newcomers

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

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

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

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

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

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

Ways to get informed

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

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

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

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

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

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Published in Health
Thursday, 03 December 2015 19:05

Hepatitis B Education Crucial for Newcomers

by Belén Febres-Cordero in Vancouver

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

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

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

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

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

Urgent need for education

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

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

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

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

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

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

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

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

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

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

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

Getting screened

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

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

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

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

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

Debunking myths

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

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

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

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

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

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

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

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Published in Health

by Belen Febres in Vancouver 

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

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

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

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

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

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

Art as therapy 

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

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

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

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

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

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

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

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

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

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

Benefits for newcomers

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

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

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

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

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

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

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

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

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

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

Non-verbal methods of expression

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

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

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

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

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

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

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

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

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

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

Video By: Samantha Lui for New Canadian Media

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Published in Health
Thursday, 15 October 2015 11:42

Health-care Options for the Uninsured

by Belén Febres-Cordero in Vancouver

As a signatory of the Universal Declaration of Human Rights, Canada acknowledges the right to adequate health care for all. However, uninsured individuals living in Canada still face barriers that limit their access to appropriate care.

According to Health For All, anywhere from 200,000 to 500,000 people are living without health insurance in Canada.

The reasons for the lack are diverse, including precarious immigration status, lost documents, and refused refugee claims. Also, Quebec, British Columbia, and Ontario have a three-month waiting period before newcomers get health insurance, while other provinces do not.

“This creates inequities in the access and the type of health care people receive across the country,” says Steve Barnes, director of policy of the Wellesley Institute.

Health-care options

Barnes explains that uninsured people in Canada have four main health-care options: community health centres, clinics and grassroots initiatives, hospitals receiving patients without insurance, and midwives.

Community health centres (CHCs)

CHCs – publicly funded health-care facilities currently located in all Canadian provinces and territories – are an option for people both with and without health insurance.

[quote align="center" color="#999999"]Since the cuts to the Interim Federal Health Program in 2012, many people have lost access to insurance.[/quote]

Scott A. Wolfe, executive director of the Canadian Association of Community Health Centres, explains that the programs at each CHC vary because they respond to the priorities of the community.

“What unifies CHCs is that they offer a team-based approach to frontline health care that wraps services around the individual’s needs so that people get the right type of care from the right providers at the right time,” he says.

In this way, CHCs take a holistic approach to health based on the collaboration of different health practitioners, such as physicians, nurses, and therapists.

Patricia Dabiri, manager of the Multicultural Family Centre at REACH, explains that another characteristic of CHCs is that they also focus on the social and environmental factors related to health and well-being. “For this reason, CHCs have a greater range of services than other health-care institutions,” she says.

Wolfe explains that the 800 CHCs that currently exist in Canada have different services and programs focusing on removing barriers to access the health system, building better community capacity and improving individuals’ overall health and wellness.

He adds that since the cuts to the Interim Federal Health Program (IFHP) in 2012, many people have lost access to insurance, and CHCs are working to fill that gap.

“A major wave of people has presented at CHCs because they have been turned away from other institutions. CHCs do not always have the capacity or the funding to absorb this challenge,” Wolfe says.

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

Clinics and grassroots initiatives

Clinics for non-insured patients and grassroots initiatives are another option.

Byron Cruz co-funded the grassroots initiative Sanctuary Health in 2012 as a response to the IFHP cuts. “We started as a network to advocate for health care,” he says. Now they serve populations with a vulnerable immigration status through a network of health practitioners who volunteer to treat them.

The Health Network on Uninsured Clients, convened by the Wellesley Institute, is another network of collaboration among professionals addressing health for uninsured populations.

Clinics for uninsured clients are an option too. There are a variety across the country, such as the Non-Insured Walk-In Clinic (NIWIC) and the Canadian Centre for Refugee and Immigrant Health Care (CCRIHC). They offer medical treatment, support, and translation services, among others.


Cruz explains that sometimes people can only be treated in hospitals, and some across Canada treat uninsured patients. However, “because of the changes in immigration laws, there is confusion among health-care providers, and usually people are denied care even if they qualify for it,” he says.

Cruz also notes that the uninsured cannot always afford the costs. “Even if people eventually access primary care, they can rarely pay for treatment, laboratory tests, or medicines.” Wolfe draws attention to the need of finding alternatives, such as a national drug coverage program, to reduce these costs.


Manavi Handa, a midwife and activist focusing on health care for marginalized populations, explains that uninsured pregnant women are particularly vulnerable because they cannot bridge from care.

[quote align="center" color="#999999"]People who do not access appropriate primary care may end up at the emergency department, where care cannot be denied.[/quote]

Midwives are an option because their services are less expensive than that of other health professionals. Uninsured women in Ontario can access their services without cost because midwives in this province are publicly funded to provide care regardless of immigration or insurance status.

However, Handa says that there are some barriers. “For example, midwives are often at capacity. Also, newcomers may be unaware of their services.”  For this reason, Handa coordinates a group of midwives through NIWIC to connect uninsured pregnant women with appropriate care.

Public sexual-health clinics are another option for uninsured women. Among other services, these offer assessments for contraceptive methods, tests, and counselling. 

A combined effort

“The way in which we exclude some populations from health care is not benefitting anyone,” says Barnes. He explains that people who do not access appropriate primary care may end up at the emergency department, where care cannot be denied.

“The diseases patients present at that point are usually serious and expensive to treat, but could have been prevented if addressed on time.”

He concludes: “We need to combine our efforts to provide services, advocate, and promote changes in the institutions’ policies and the political system to continue improving the health of uninsured residents and of the Canadian population as a whole.”

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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Published in Health

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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Published in Health
Wednesday, 26 August 2015 15:48

Addressing Newcomer Maternity Health Concerns

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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Published in Health

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