Stranger in the Land

Packing your bags, bidding goodbye to friends, family and the mores you have known until then, and pitching your tent in a faraway country where everything is alien to you, is surely one of life’s most daunting challenges. Talk to any immigrant to Canada – recent arrivals or old-timers – they will have a story or an anecdote of a Canadian friend or a neighbour who lent a helping hand. This help could have been as simple as showing how to start a lawn-mower or how to lace up skates, or it could involve being a mentor, enabling them to make a successful transition to life here.

In my own early immigrant days, a number of people helped us, in both big and small ways. For example, we heard that a physician at a local health care centre was looking for new patients while chatting to a complete stranger at a bus stop. This tip that a kind stranger passed on helped us find a family physician within a few months of arriving as new immigrants to Canada. We still hang on to her for dear life!
Our neighbours, two elderly sisters in their 80’s, often invited us to their house and over a coffee and some baked goodies, gave us insights into life in Ottawa. They advised us not to let the kids play in the grass (those were the days when pesticides were still widely used), and which grocer to visit to get the best fresh produce. Their son found the time to take us skating on the Rideau Canal and introduced us to that wonderful Ottawa treat – Beavertails.

Who can forget the kindness of those who gave us rides when we needed them, gave us tips on job searches, invited us to their homes and introduced us to Canadian cuisine? We had arrived friendless and with no family in Canada. I am sure that none of these individuals who helped us thought they were doing anything extraordinary. But by their simple act of reaching out, they made an enormous difference to our immigrant journey. It helped us feel at home (“acculturate”) a lot faster and prevented us from retreating into an ethnic silo.
Such bonds forged in the early days of immigration are most often for life. Ottawa-based artist Barbara Gamble once shared with me how she housed two refugee families for several weeks in her house when they first arrived. The grateful families have stayed in touch with her for more than 20 years.
When I heard that WOW 2014 was planning to celebrate the hospitality that makes Canada a great place to immigrate, I was thrilled. I have so many people who I would love to celebrate. It would be a really hard choice to pick just one person who made a difference to my life. I commend this initiative by the Ottawa Local Immigration Partnership (OLIP) to recognize the vital role that a community plays in welcoming the stranger in the land. Welcoming communities need both generous hosts and eager newcomers: it’s a two-way street.
WOW 2014 is looking forward to hearing your story. We would like to hear about one individual who made a difference to your immigrant journey when you first arrived in Canada. It could be your neighbour, your teacher, your landlord, your colleague, your pastor or a perfect stranger who made a world of difference. Submit your story before June 4^th and you could be chosen as a WOW ambassador along with your nominee.

Champlain LHIN addressing diabetes among new immigrants

A.P is an engineer who worked for the nuclear industry in India. He migrated with his wife to Canada twenty years ago. Both are highly educated, English speaking - the model immigrants that Canada is always looking for. Both husband and wife found suitable employment in Toronto and were leading a typical middle-class life.

Like a lot of immigrants, A.P does not believe in preventive health. While they do have a family physician, he does not go for an annual check-up. "I feel fine, so what is there to see a doctor for?", was his refrain. This lackadaisical approach was the reason why physicians were unable to catch the onset of diabetes. The delayed diagnosis cost A.P dearly as he was forced to amputate his leg. He had to quit work and stay at home for a lengthy period of time to recuperate.

A.P is not an outlier when it comes to preventive health among immigrants. There are numerous studies that show that Canadian immigrants are laggards when it comes to preventive health. Exercising, eating healthy food, consulting a physician annually are all concepts that are alien to the vast majority of the immigrant population. These habits, if inculcated early should prevent a diabetes epidemic among immigrant populations. The Globe and Mail (http://bit.ly/12cuYHY) writes that diabetes rates are highest among South Asian immigrants, while immigrants from Latin America, Caribbean and African countries showed rates that were double that of the Canadian population.

In this context, the current initiative by the Champlain LHIN, to bring  diabetes awareness to Canadian immigrants is a step in the right direction. The Diabetes SCREEN Project plans to conduct, "diabetes risk assessments, education about healthy eating and physical activity, cooking demonstrations, a community meal and identification of people with diabetes using a blood sugar test". Those identified as pre-diabetic or having diabetes will be referred to diabetes education programs and self-management programs in the area.

The beauty of the SCREEN project is that it is managed  by health leaders from the immigrant community. Health information is available in Hindi, Nepali, Spanish and Somali, in addition to English and French. This approach is a step in the right direction, since studies have shown that cultural awareness should form part of any health promotion efforts. Watch an interesting video produced by the project here:

When words fail--- it's impact on Canadian health care

I remember this anecdote that was narrated by the CEO of Hamad Medical Corporation (Qatar), where I worked a few years ago. He was also the Director of the Cardiology department and it was at a Cardiology conference hosted by our hospital that he shared this example to highlight the importance of adequate communication between doctors and patients.
Dr. H. was treating patients at the out-patient clinic when a Bedouin woman walked into the room. She kept silent despite his questions about what her symptoms were. He was forced to turn to her companion and ask why she was not responding to his questions. At that point the woman blurts out, “You are the doctor, you tell me, what is wrong with me”.
This of course produced gales of laughter from the medical professionals who were gathered there. But the CEO was using the story to drive home the point that doctors are not gods to arrive at their own conclusions. They had to use two-way communication to ensure that the patient got the right care.

This thought came back to me when I was reading the newspapers this week which were all about the increasing numbers of people who were using the non-official languages in Canada. There is no doubt that Canada is slowly but steadily becoming a polyglot nation.

While English and in some areas French still dominates as the tongue of the majority, immigrant languages are increasing in numbers.
The 2011 census reveals that 6.6 million people, who comprise about 20% of the total population, speak a language other than English or French at home. Of these, 2.1 million speak only their native language at home. These languages include Punjabi, the various Chinese dialects, Arabic, Tagalog, Persian, and Urdu, reflecting the nations that are the sources of immigration today.
What do these growing numbers portent for health care in Canada? The inability to communicate between health care providers and patients because there is no common language between them could prove disastrous for the health of immigrants and a public health nightmare for Canada.
Patients who cannot read, write or talk in either English or French will not be able to access health care, read health information, communicate with health professionals or comply with instructions. Health care professionals will find it a frustrating exercise communicating through interpreters and translators. Often times it is the children of these patients who are forced to act as interpreters for their parents. How much would anyone be willing to divulge of one's health condition through a third-party?
When patients cannot find words to describe what they are going through, they would either decide to forego treatment or get the wrong treatment and when the situation gets worse, will end up in the emergency, where the costs for treatment is exponentially higher.
What can Canadian health care do to ensure that language barriers do not stand in the way of providing adequate health care? If you have any ideas, thoughts,suggestions, I would love to hear from you. Thanks for reading!

Immigration as a social determinant of health: Waiting for OHIP

In Canada, health falls under the mandate of provincial governments and when immigrants land in the country, they have to apply for their health cards from the province they land. Ontario, one of the provinces where most immigrants choose to land, do not give them Ontario Health Insurance Plan (OHIP) on arrival. Immigrants have to wait for three months before they are eligible for health care in their adopted country.

In the mean time, what do most immigrants do? A few who are financially very stable and know the pitfalls of living here with no insurance, purchase private health insurance. The rest of the immigrant population will continue on with life without a health card and no private insurance. When they fall sick, they either pay out of their pockets, or worse, choose not to visit a health care provider.

I did a pilot study a few years ago, based on a few immigrants living in Ottawa on what they did during this interim period when they were not eligible for the health card.Of the seven interviewed, only one had purchased private insurance.

S.R. and her family, which consisted of husband and two children under the age of 12, migrated from India and arrived in Ottawa. They decided to go without private insurance during the first three months when they were not eligible for OHIP. S.R. remembers clearly the day her little son fell down and broke his arm. This required a trip to CHEO, and this newly arrived family who did not have a job back then, incurred considerable medical expenses.

Singh and his family moved to Ottawa in 2002. He had lived in the Middle East for more than a decade and had some savings when he moved to Canada. When he arrived in Canada with his pregnant wife and young daughter, he purchased private insurance. Unfortunately, the insurance did not cover his wife's "pre-existing condition" and Singh found himself holding a very hefty bill along with his newly arrived baby daughter. This bill ate into the savings which he had been hoping to use in the months when he was unemployed in Canada. Singh was upset and angry that immigrants are not given information on how health care works in Canada, before they land here. He says that had he known, he would have arrived a few months later after his baby was born and saved himself a lot of money.
Read a CBC story here of another immigrant who faced a similar woe: Babies cost 22K

Canadian provinces follow different policies when it comes to providing health insurance to newly arrived immigrants. Alberta, PEI, Newfoundland, Saskatchewan, Nova Scotia and Northwest Territories provide comprehensive health coverage to all newly arrived immigrants.While the province of Quebec does have a waiting period before health coverage is given to new immigrants, it provides coverage for certain conditions. These include pregnancy, childbirth, abortion, domestic violence and infectious diseases.

The rationale behind this waiting period is that it saves the provinces money. The Ontario Medical Association in a policy paper however disputes the notion that denying health insurance for three months is a cost saving measure for the health care system. The OMA finds that this is one of the reasons why those who do not have insurance coverage land in the hospital emergency departments (which tends to be more costlier health care than primary health care). OMA argues that it is high time to extend health insurance coverage to newly landed immigrants.

It is interesting that landed immigrants who have to pay taxes from the day they arrive in Canada, are denied this basic right to health care. Time for a change, Ontario!

Why talk about immigrant health?

I am not a doctor, nurse or a public health professional, but someone who is passionate about health issues.

This blog is not about another health advocate joining the ranks of the zealots out there. I am sure these folks understand health issues and can probably articulate it better than I can.

But the issues that they choose to highlight in their columns stay, so very "mainstream". Although I have been in Canada for nearly a decade, I have very rarely come across nuanced discussion on immigrant health in the media.

I can see some raised eyebrows and the question, "What is so peculiar about immigrant health"? Immigration is now considered a crucial factor along with the other social determinants of health, in deciding whether someone would enjoy good health or not.

What exactly are these "social determinants of health". What it means is that your living conditions determine how your health will turn out to be. Are you poor or rich? Are you chronically stressed at work? Where do you live? Do you walk or drive everywhere? Are there sidewalks in your neighbourhoods that would encourage healthy living? Are you a man or a woman? (In certain parts of the world, this one factor alone can determine how good your health will be). Your race is another factor which decides the quality of your health. Aboriginals and other racialized minorities have health issues that are rarely discussed in mainstream society.

When an immigrant moves to Canada, he or she is vetted for health problems before the permanent residency card is issued. Which means that Canadian immigrants are healthy on arrival (Canadian immigrants here mean economic immigrants, not refugees). Studies have shown that this good health often declines after about a decade here and they are often more ill than Canadians who have lived all their lives here.

This slide into bad health is precipitated by the stresses related to migration and resettlement. What exactly are those migration related stresses?
To be contd...