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...