By: Shan Qiao in Toronto, ON
Cindy Leung drops off her husband, Chuck, to a day program at a Scarborough, Ontario long-term care facility. Waving to social worker, Benny Choi from her car she watches Chuck being pushed away in a wheelchair.
Going through this daily routine, she reflects on where it all started. Eight years ago, Chuck had a massive heart attack and fainted at home. Rushed to the hospital, he was resuscitated after his heart completely stopped beating for minutes that seemed to go well past 60-second intervals. Luckily, he was revived. But after suffering from severe brain damage, he was eventually transferred to a day program following intensive care. And through rehabilitation on weekdays, he has been able to slowly recover his ability to speak coherently.
“My husband was a chef working in [a] restaurant and I was the waitress. Life was quite satisfying until that day he had [a] heart attack. He was only 45 years old at that time,” Leung explains in a voice that exudes calm.
Although her workload at home has increased, financial constraints have kept her from seeking any additional time at work. Supporting the household as well as emerging medical expenses as the sole source of income, she points to the solace she finds in maintaining a routine.
“We do receive some medical benefit and social assistance, but I cannot stop working. We still have a child in college. Working is one way to support the family financially and another way to support myself psychologically,” she continues.
Social worker Choi knows what Leung is going through. “Many of our patients encounter stress and frustration when dealing with their inability to talk and walk. It often causes tension towards themselves and their family,” he explains. Most of the patients that come to the facility are males, most of whom receive care from their middle to old-age wives.
It’s a story that’s known all too well across the country, women who are forced to take on dual roles within the household and the professional workplace. An astonishing 72 per cent of women caregivers aged 45 to 65 in Canada are also in the labour force. Always thankful for the support systems provided, Leung praises a healthcare system that has afforded her options that nationals of other countries can only dream of.
“I drop him off to this day program from Monday to Friday when I have to work. During [the] weekend, our children can chip in and make it possible for me to take some extra shift[s]. I receive daily feedback [about] him mostly from social workers like Benny. Sometimes, they probably talk to him more than I do. I really appreciate it. [It is] the whole Canadian health care system that gives my husband a second chance.”
Looking back on life before the near-fatal incident, brings back memories of her husband as a genial and tall man, shouldering all the responsibilities that come with family life.
Leung, who works in a restaurant as a floor manager, oversees a venue with a 500-seat capacity. Never one to complain, she cherishes having the ability to work while caring for her husband.
On the other hand, Emily Liu discovered her true career passion as a breastfeeding activist and prospective doula (a person trained to provide advice, information, emotional support, and physical comfort to a mother before, during, and just after childbirth) after becoming a mother and main caregiver to her two young kids.
“I was a chartered accountant, worked for one of the Big Fours. I made a lot and yet lost a lot in personal time. I can work up to 70 to 80 hours during busy tax seasons until, one day, I noticed a mental meltdown while I was pregnant with my first one. Then I know I have to take a pause,” Liu says.
Motivated by her own baby, Liu made a move to “downgrade” her work portfolio to a local small accounting firm in Mississauga. Taking on a partner role, she was able to make her work hours flexible so she could juggle work with the responsibilities of raising a child.
In the end, Liu terminated her partnership, opting for a career as a freelance accountant. That was until two years ago, when she completely withdrew from the accounting business.
“I slowly find out my keen interest in breastfeeding and promoting it, something I really enjoy doing while raising up my kids,” she stresses. Since then, Liu takes her kids to the La Leche League Canada’s breastfeeding leader training class.
“This is the solution in my case, working while babysitting and I love doing both,” she giggles. Liu quit one labour market to enter another, one that’s been more welcoming to mothers and caregivers.
Moving across continents
Caregivers can come from a variety of sources, but it is extremely common to see family members step in as figures of support, sometimes flying across continents. As in the case of 65 year old Elvira Vergara, when the call came from her late husband’s cousin, there was only one choice to make.
Single with a grown son, residing in Columbia, Vergara moved in. Now 80 years old and widowed, her patient suffered from high blood pressure as well as diabetes. Taking the position as a live-in caregiver, they’ve been cohabiting for eight months and both feel positive about one another’s roles.
When asked why she chose Vergara, the cousin shrugs her shoulders and beams, “I’ve seen her great attitude working as a house cleaner. My kids probably can’t do a better job than her. We know each other from the past. I trust her,” she nods.
“Gracias,” Vergara replies in Spanish.
Although Vergara was able to fill a fulltime position through caregiving, thousands of women are forced to manage dual roles as they maintain their professional positions. It is essential that the support systems built to help these individuals are not only readily available but that they also instill their trust. With nearly half of women caregivers declining available arrangements based on the potential impact on their careers; its clear that more awareness must be brought to the benefits. Only then can these services be deemed helpful and accessible to all Canadians.
by Gayathri Naganathan in Scarborough
I was born at the Vavuniya General Hospital in the winter of 1988, in a town that is often referred to as the gateway to the northern Vanni region. As so many other families before us, we fled Sri Lanka during the civil war, amid death, destruction and uncertainty.
We arrived in Scarborough, Canada, in the early 90’s, in what would become the single largest Sri Lankan Tamil diaspora community outside of South Asia. I grew up speaking Tanglish (a blend of Tamil and English), eating string hoppers and spaghetti, and listening to A.R. Rahman and the Backstreet Boys.
In short, I am a ‘third culture’ kid, a blend of the home we left behind in Jaffna and the home we worked hard to create in Canada. So as a Canadian medical student when I was presented with the opportunity to spend several weeks training in any field and in any country around the world, the natural choice for me was to go “back home”.
Having spent over two decades away, I didn’t quite know what “back home” would mean on this first visit back. After months of phone calls, emails and planning, at the end of June, I arrived at the Jaffna Teaching Hospital, ready to start my five weeks of electives in internal medicine and general surgery. Unsurprisingly, I spent the first few days overwhelmed by the experience.
I have been volunteering, working, and learning in hospitals for most of my life. For most, hospitals are places that cause anxiety and stress, but for me, they are often a place of familiarity and comfort, somewhere where I feel engaged and useful. Despite years in this environment, the Jaffna Teaching Hospital felt foreign to me. The wards, the equipment, the staff uniforms, the very rhythm of the place was completely alien.
The most obvious difference was that everything was done by hand. There was not a single computer in sight. Having worked in a health system that is increasingly digital, this was a big change for me. I also soon discovered that patient records are not kept locked away in a filing cabinet at the clinic or hospital.
Rather, the patients themselves carry their clinic books, lab reports and even MRI scans to each appointment with them. While cumbersome and running the risk of losing documents, this system gives full autonomy to patients over their personal health records and also allows for the mobility of those records from one site to the next.
Despite (or perhaps because of) this system, the consultants (in Canada, we call them “attendings”) are able to see a massive case load in a very short period of time. This was most obvious on clinic days where upwards of 40 patients were assessed, treated, and dismissed and/or given a date for follow up, all within the span of two to three hours. It’s a whirlwind of papers shuffling, names being called, patients shifting in and out of the examination rooms, and notes hurriedly scrawled into clinic books.
I was equally stunned the first time I stepped into the casualty theatre – a carryover, it seemed, from Sri Lanka’s civil war, when trauma patients would flood into the hospital every day. Two tables, with one anesthetist each, for procedures that require general anesthesia.
All other procedures were conducted under local anesthesia on stretchers flying in and out of the large operating theatre. And, at the centre of it all, a group of dedicated and talented registrars and surgeons operate on everything from in-grown toenails causing infection to inguinal hernias, all using proper aseptic and clean protocols.
As a student, it was incredible to move from one table to the next and see so many different techniques and procedures happening simultaneously.
To me, this was controlled chaos. And this phrase echoed through my mind again and again as I proceeded through my weeks of training in Jaffna.
But beyond the differences, the language of medicine remained a constant thread to which I could hold. Human anatomy is the same the world over. And I marvelled as I watched my general surgery preceptor carefully reveal the facial nerves of a patient with a suspected tumour over his jaw bone. Like the branches of a tree, the branches of cranial nerve seven spread out across one half of the patient’s face, beginning to divide and separate just in front of the ear. It was like I was looking at a diagram in a textbook, the dissection down to the tumour was so precise and clean.
Acetaminophen too is the same all over the world. Whether we call it Panadol, Paracetamol or Tylenol, all three can be used to bring down a fever, all three can be used to relieve pain.
Though the medicine was fascinating, the most enriching aspects of this journey to Jaffna were the people that I had the privilege of meeting. From the patients, nursing staff, and fellow medical students to the registrars and consultants who served as my teachers and mentors, the people I met throughout my five weeks at the Jaffna Teaching Hospital made the experience unforgettable. They worked to bridge the cultural and linguistic gaps between us, provided thoughtful and insightful answers to my questions, and facilitated opportunities to practice clinical skills and learn new techniques.
What do you do, for example, with a patient with diabetic foot ulcers who can’t afford to buy shoes? Or having to label an otherwise medically fit patient as a “poor candidate” for kidney transplant because all such surgeries are done in the private sector and require hundreds of thousands of rupees to carry out?
I feel honoured to have had the opportunity to be a learner in Jaffna, and to speak to patients and practise medicine in my mother tongue, Tamil. I feel especially privileged to have met the dedicated, passionate, and talented physicians and medical students who propel medicine forward in Jaffna. Despite systemic barriers, low resources and a significantly complex patient population, they persevere, they innovate and they thrive.
As a teacher and friend from my general surgery elective in Jaffna so poignantly stated, “We have the resilience gene”. And I could not agree with him more.
Gayathri Naganathan is a second year medical student at McMaster University in Ontario, Canada. She is a daughter of the Tamil diaspora and a proud “third culture” kid.
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.
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.”
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.
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
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.”
This content was developed exclusively for New Canadian Media and can be re-published with appropriate attribution. For syndication rights, please write to email@example.com
This content was developed exclusively for New Canadian Media and can be re-published with appropriate attribution. For syndication rights, please write to firstname.lastname@example.org
by Samantha Lui in Toronto
As Syrian refugees make their way to Canada, medical professionals and volunteers across the country are busy prepping to assist in medical care services.
About 900 to 1,000 refugees are expected to land in Canada – primarily at airports in Toronto and Montreal – daily in the coming weeks.
With those numbers, Dr. Paul Caulford, the co-founder of The Canadian Centre for Refugee and Immigrant Health Care (CCRIHC), says there is a need for more volunteers to help out with medical care.
“[We’re] looking at issues like settlement, housing and mental health,” Caulford says, noting that his volunteers are hoping to increase the hours they work, as well as operate a clinic on Saturdays.
“We have a shortage of providers as it is. We are trying to ramp up our volunteers.”
So far, nurses, midwives, pediatricians and social workers have offered to assist the influx of refugees coming to Canada. Medication such as antibiotics has also been donated to help with the effort.
“We don’t know the level at which these individuals are going to be injured, traumatized, wounded, sick or unhealthy,” Caulford says, noting that he’s seen refugees with bullet wounds and deformities as a result of being shot.
He adds that pediatric care and mental health also remain a priority.
“I think [the best thing] for children and youth new to Canada is to have their full family unit together and to get those kids into playgrounds and schoolyards as soon as we can, so they can kick a soccer ball and not run away from a bomb,” he says.
“That’s been shown to be one of the healthiest things you can do for mental health and post-traumatic stress disorder. It’s to get them playing with the other children.”
But while he and several volunteer medical professionals are busy prepping for refugee arrivals, Caulford concludes that the stress of it all will ultimately benefit Canada’s health-care system in the long run.
“We think this is going to make us better at managing surge issues and managing increasing demands within the health-care system,” he says.
“It’s going to teach us of other surges that are to come [and teach us] how to organize ourselves better.”
WelcomePack Encourages Canadians to Welcome Newcomers
Something as simple as saying “hello” is all it takes to welcome a newcomer to Canada.
WelcomePack Canada has launched the Welcome a Newcomer campaign, an initiative that taps the spirit of acknowledging new immigrants and encourages Canadians to reach out to a newcomer and send them a virtual greeting card.
The e-card showcases the beauty of the Canadian landscape, people and values. It also has a poem encouraging newcomers to experience Canada’s national parks and cultural events.
Along with the e-card, newcomers will also receive a free WelcomePack gift box that includes a guide giving them tips on how to settle in a new country among other items.
“We meet many newcomers to Canada in our community, our workplace and at social engagements,” says Andrew Srinarayan, vice president of WelcomePack, in a press release.
“Through this act of friendship and hospitality, let us reach out to make them feel welcome in their new home country and make a new friend.”
Young Immigrants Achieve Higher Success Rates in School
Immigrant students have a higher success rate in education, according to a study by Statistics Canada.
The study takes a look at the education rates in regions across the country, including Ontario, Quebec, Alberta, British Columbia, Manitoba, Saskatchewan as well as the Atlantic provinces.
In every region, those who immigrated before the age of 15 had high school and university completion rates that were higher than third- or higher-generation Canadians.
In Canada as a whole, 40 per cent of immigrants from the ages 25 to 29 had a university degree in 2011.
Only 26 per cent of third- or higher-generation individuals were in the same group.
The study also examines the regional differences in the reading and math skills of immigrant children aged 15. The Programme for International Student Assessment (PISA) measured these stats between 2000 and 2012.
At the national level, immigrant students scored similarly in math, but had slightly lower reading scores than third- or higher-generation students.
The lower reading levels likely reflect the fact that neither English nor French is the first language of many immigrant students.
But while immigrants were more likely to have degrees in all provinces, there were differences among the regions.
British Columbia had the highest proportion of immigrants with a university degree in 2011 at 44 per cent.
The university completion rates of immigrants were lower in the combined region of Manitoba and Saskatchewan (29 per cent) as well as in Quebec (32 per cent). (Photo Credit: Leland Francisco via Flickr CC)
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by Lucy Slavianska in Toronto
Language barriers can have a negative impact not only on initial access to health services, but also on the quality of health care and treatment outcomes.
In Canada, three main groups of patients can face language barriers: newcomers who still haven’t gained enough fluency in one of the official languages; French speakers with limited English living outside Quebec or English speakers in Quebec with limited French; and some members of First Nations and Inuit communities.
For immigrants and refugees, language barriers are generally considered a "newcomer" issue, which is overcome once the immigrant learns enough English or French to become independent of interpreters.
However, even after several years in Canada, some immigrants are still not sufficiently able to understand the official language of the province they reside in. According to a Health Canada report, “Language Barriers in Access to Health Care,” such immigrants are “more likely to be women with young children, the elderly, poorly educated or those suffering traumatic events or psychological disorders.”
The report also says that some immigrants are able to communicate adequately in everyday situations, but face difficulties in coping with “highly stressful health-related events in a second language.”
Pitfalls of using non-professional interpreters
For patients who face language barriers, it is a common practice to visit hospitals and physicians’ offices accompanied by family members or friends acting as interpreters.
This practice has its advantages – these non-professional interpreters are easy to find, often compassionate, and in most cases accompany the patient at no cost. The stress of falling sick and visiting a hospital in a new country can be reduced if the patient feels supported, physically and psychologically, by loved ones.
But this experience is not always the case.
Soon after Aiko (not her real name), a 15-year-old girl from Japan, came to Canada to join her father, she started to experience menorrhagia – excessive bleeding that lasted more than seven days each month.
However, with no knowledge of English, she was reluctant to see a doctor. She felt uncomfortable talking to her father or her stepmother (with whom she had a conflict) about her problem, and couldn’t imagine going to a physician’s office with one of them as the interpreter and talking about her period in their presence.
A few months later, she started feeling weak and tired, and she fainted one morning in the kitchen. At the hospital, a blood check showed that Aiko had developed iron-deficiency anemia as a result of the untreated heavy bleeding.
Her father translated during the examination. She was embarrassed when the physician asked her about her menstrual cycle.
“The doctor was a woman and I might feel okay talking only with her in the room,” Aiko remembers, “but because my father was there, I didn’t want to answer. It was terrible.”
Aiko had to answer all the questions and eventually made a full recovery, but until her English improved, she dreaded seeing a physician again.
Lack of privacy and confidentiality, embarrassment, and other kinds of psychological discomfort like those Aiko experienced are some of the disadvantages of using family members and friends to translate.
But there are other, even more serious disadvantages: sometimes the interpreter may not act in good faith and can twist the information in a way that can harm the patient. Also, important sensitive information – about domestic violence, psychiatric illness, substance abuse, sexually transmitted diseases, and so on – may be hidden from the physician or distorted.
But even if good intentions are present, the use of untrained interpreters still carries serious risks of errors in translation that can lead to misdiagnosis and improper treatment.
A 2003 research paper, “Errors in Medical Interpretation and Their Potential Clinical Consequences in Pediatric Encounters,” concluded that mistakes in medical interpretation are common, and errors made by untrained interpreters are significantly more likely to have potential clinical consequences than those made by professional interpreters.
Professional interpreters: specially trained
For all these reasons, hospitals in Canada often use independent and specially trained interpreters.
In Toronto, for example, many hospitals find professionals though RivInt Interpretation and Translation Services, managed by the Elspeth Heyworth Centre for Women (EHCW). The centre has a roster of about 600 professionally trained people who cover more than 80 languages.
“Since our clients are most often hospitals, our interpreters are mainly specialized in health care,” says Sunder Singh, executive director of EHCW.
“We don’t take anyone who is not language tested and trained. One of the main elements of the training is mastering the medical terminology. The participants have to become familiar with all kinds of medical words and learn their equivalents in their own languages.”
Singh adds, “Another important element is the understanding of the responsibilities of the job. For example, interpreters have to be aware that the information communicated between the patient and the medical staff is strictly confidential. Interpreters who don’t obey that rule would not be called to work again and will lose their income."
“Training is expensive,” Singh says, “usually between $800 and $2000, but if the participants become good interpreters and the hospitals are satisfied by them, they are called again and again. And if the language is on demand, then there is a quick return on the investment.”
The good news for the patients is that they don’t pay for interpreters – the expenses are covered by the hospitals.
“The hospitals pay [the fees for] the language services to us,” Singh explains, “and we pay the interpreters at market rate. The federal budget, unfortunately, doesn’t pay a lot for interpreters’ services, so the hospitals keep aside some budget for that – because they understand how important professional translation is.”
While across Canada there are organizations that provide new immigrants with information about the Canadian health-care system, there is a growing number of newcomers who still don’t know about these resources. As such, this is part of an occasional series by NewCanadianMedia.ca that will look into access to health care for immigrants.
by Shan Qiao in Toronto
Scholars and students recently gathered at Canada’s top health education institute to discuss racial health inequities experienced by immigrants, refugees and racialized groups.
The eighth annual Dalla Lana student-led conference titled Racial Justice Matters: Advocating for Racial Health Equity took place at University of Toronto’s (U of T) Dalla Lana School of Public Health this past weekend.
Approximately 200 undergraduate and graduate students from U of T, along with academics and researchers, health policymakers and members of immigrant community agencies were in attendance.
The goal was to share trans-disciplinary thoughts and solutions to achieving racial health equity in the Greater Toronto Area. The organizers hoped the conference could shift the conversation in public health by reframing racism as a public health issue.
“We chose this theme for our conference because of the staggering inequities faced by racialized individuals in Canada that not only affect their social outcomes, but health outcomes as well,” says Anjum Sultana, one of the co-chairs of the conference and a student in the masters of public health program at the Dalla Lana School.
The two-day event examined topics ranging from racism and health inequities to immigrant mental health services, refugee health insurance, culturally safe patient care and indigenous study. Specific subjects such as sexual health promotion for racialized communities were also addressed.
Culturally competent services
Dr. Lin Fang, one of the conference’s speakers held a session titled “Culturally Responsive Mental Health Services for Racialized Groups”.
She shared that despite how important “culturally competent” services are to immigrant communities the government still worries that branding services as such will discourage social service inclusiveness.
“It’s scary (to them),” she admits.
Fang, an associate professor at University of Toronto, specializes in mental health services for immigrants, refugees and racialized groups and is also the board chair for Hong Fook Mental Health Association, a community agency that has served East and Southeast Asian communities for three decades.
Immigrants are not immune to suffering from mental health issues, explains Fang.
“[Just over six per cent] of immigrants [have] had at least one major depressive episode,” says Fang, “[and] 0.5 per cent of immigrants reported experiencing problems related to alcohol dependence. First- and second-generation immigrants were at elevated risk for psychosis.”
In Hong Fook’s annual report one of its clients describes how such services helped:
“During the Lunar New Year, I was back to square one with my depression. I did not pick up the phone at all, and my mental health worker ended up paying me an unscheduled visit, and helped me to connect with my family. She knows my culture and the meaning of the Lunar New Year for me, and I value her support a lot,” the client said.
Factoring in poverty
Factors contributing to immigrant mental health issues include pre-migration events and post-migration stress.
A large part of post-migration stress can be tied to income. For example, in Toronto, the poverty rate of some immigrant groups – 69.5 per cent for the Somali community, 27 per cent for the Tamil community and 56 per cent for the Afghan community – is much higher than the city’s 17 per cent average.
Not to mention, many immigrants arrive highly educated, but are forced to work in unrelated ‘survival’ jobs just to make ends meet due to a lack of Canadian experience or their foreign credentials not being recognized.
“[The results of this conference] will definitely not disappear,” promises Meena Bhardwaj, co-chair of the conference and also in her second year of the masters of public health program at Dalla Lana.
“We have a website. Every single talk will have notes that will be available online. We also have some forward direction that we will take after the conference.”
Sultana adds that Toronto is well positioned as a city in which real change can happen.
“After the conference, what we really want to do is find an institutional solution to improve our responses to aboriginal and indigenous people, immigrants and refugees,” she says. “We are going to ask our faculty here to start pushing forward.”
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.
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.
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.
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.
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 NewCanadianMedia.ca that will look into access to health care for immigrants.
by Deanna Cheng in Vancouver
One outreach worker is creating a bilingual volunteer program because there's not enough support for Chinese seniors, especially those in Vancouver's Chinatown.
Chanel Ly, a 23-year-old outreach worker who is part of the Downtown Eastside SRO Collaborative, initiated the Youth for Chinese Seniors program because when she sees all these seniors – who are predominantly female – she thinks of her grandma. She cannot imagine not helping them out.
"I can't stand seeing seniors being neglected. It's disrespectful."
She points out that it's part of the Chinese cultural values to care for elders.
Ly will connect bilingual youth volunteers to seniors in the Strathcona area, the city's oldest neighbourhood.
Tasks for volunteers include translating legal documents, taking seniors to the doctor's office or the pharmacy, and informing seniors about their rights as tenants.
One of the biggest challenges Ly faced while building this program from scratch was the amount of work required because there was no previous infrastructure, despite the demand for service that was culturally appropriate and in Chinese.
The program will run from this month to March next year, Ly says, because that's when grant funding ends.
"The goal is to improve the quality of life for Chinese seniors."
Addressing Chinese seniors’ challenges
The biggest problem for Strathcona seniors is affordable housing. With condo developments in the area, rents are going up and pushing out the original residents.
Vancouver activist Sid Chow Tan believes the Chinese benevolent and clan associations should contribute to Chinatown by providing their buildings and property for social housing. These associations, grouped either by provinces in China or last name "clans," were community centres.
Historically, most of the association buildings were community homes and bachelor suites for Chinese immigrants, a demographic regularly ignored by the government and institutions, Tan says. "It's sad to see space that used to house hundreds and hundreds of bachelors are now used for mahjong and ping-pong."
Another concern for seniors is health, says Ly. "Doctors are not always accessible. Drop-in clinics are not always available. Or opened only during certain hours."
Volunteers will help by accompanying seniors to the doctor's office and translate if needed.
Racism against Chinese seniors does happen at community centres, due to an unfounded belief that there's no such thing as poor Chinese people.
"There are poor Chinese," Tan said at a July event where bilingual volunteers and seniors met. "The Chinese poor doesn't want to be seen as poor. They just bear it."
Tan says they don't want to "lose face." In Chinese, the phrase means losing a combination of self-respect, honour and reputation.
Despite the barriers they encounter, these seniors survive by banding together. "They're always self-sufficient and resourceful. They have their own networks," Ly says.
However, Mandarin-speaking seniors are even more marginalized, she says, because what little support there is, it's usually for Cantonese speakers.
Tan says the boomer generation couldn't leave Chinatown fast enough, but the "echo-boomers" came back. "They see something to save and protect. It's sacred ground to Chinese people.”
"It was where people organized to vote, worked to send money home," he says. "Now it's sullied by market forces, economic greed and political entitlement within the community."
The program also promotes intergenerational interactions. Says Ly, "We want to fill in the gaps between the generations."
Ly started collecting volunteers before the summer and will have check-in meetings with youth once a month. At the moment, she has 15 dedicated volunteers lined up.
The online volunteer form is comprehensive, even asking for preferred pronouns. The program organizer says she wanted the volunteers to feel comfortable.
When asked if seniors – especially those with a traditional mindset – would be upset with transgender volunteers, Ly says the seniors might accept them.
She says they'll notice more that the volunteer is a young, Chinese-speaking person. They'll be grateful for the assistance, and would get to know them as human beings with good intentions.
Seniors’ health care: the numbers
A report titled "2015 National Report Card: Canadian Views on a National Seniors' Health Care Strategy" by Ipsos Reid Public Affairs for the Canadian Medical Association said seniors today represent 15 per cent of the population. In 1971, seniors only represented eight per cent of the population.
Three in five Canadians say their families are not in a good position, financially or otherwise, to care for older family members requiring long-term health care, the report said.
Respondents 55 years of age and older indicate they want more home care and community support to help seniors live at home longer as a key priority for the government.
Ninety per cent of Canadians surveyed believe we need a national strategy on seniors' health care that addresses the need for care provided at home and in hospitals, hospices and long-term care facilities, as well as end-of-life care.
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.
“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.
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.
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).
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.
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.”
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.”
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.”
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.
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.”
-- Canada's economic development minister Navdeep Bains at a Public Policy Forum economic summit