Settlement workers take the mystery out of Canadian health-care system

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A distraught mother rushes into Credit Valley Hospital’s emergency department with her young son. He is despondent and appears to be in distress. The woman is Punjabi. Although she speaks some English, there is clearly a communication deficit due to the stress of the situation.

The triage nurse immediately calls for assistance – not from a nursing colleague or doctor, but from one of six settlement workers supporting newcomer and immigrant patients at The Credit Valley Hospital.

Within minutes Fareeha Najm arrives in the ER to hear an assessment of the situation from the triage nurse. Fareeha calmly addresses the young mother in Punjabi. Immediately the woman begins to calm down. She is able to describe the onset of her son’s distress and give a medical history.

Fareeha stays with the mother to assist her in communicating with the health-care professionals, relaying their instructions and diagnosis in Punjabi. The child is very ill and needs to be transferred to another hospital by helicopter. The mother will not be able to accompany the child. Fareeha calmly explains, in Punjabi, that the space in the helicopter is very limited and it’s important that the health-care professionals accompany her child.

Fareeha stays with the young mother as her child is whisked away by helicopter. When her husband arrives, Fareeha calmly provides detailed instructions for the couple – how to get to the other hospital, who to see, what will happen once they arrive. An hour or so later, the distraught couple calls Fareeha from the new hospital. Again, the language barrier is complicating the situation on the other end. Fareeha asks the parents to put the nurse on the line. Fareeha is once again the go-between and quickly reduces the parents’ anxiety and through her, the nurse on the other end is able to connect the parents with their child.

Each year over 20 per cent of the approximately 150,000 newcomers landing in Ontario settle in the region of PeelÑsecond only to Toronto. What these newcomers experience in Peel is, however, quite unlike Toronto. Significant geographical and social gaps in service provision exist across Peel. Accessing services through public transit can be challenging. The services that do exist to support newcomers are often not recognized or understood as the newcomers struggle to locate or understand a myriad of brochures and papers in a language that is unfamiliar.

Nine months ago, the Inter-Cultural Neighbourhood Social Services (ICNSS) and the Credit Valley Hospital (CVH) in Mississauga began talking about a partnership to support immigrant and newcomers who arrive at Credit Valley often without health-care coverage, little knowledge of the health-care system, and little if any ability to communicate their physical malady.

ICNSS has a successful immigrant and newcomer program in the Peel Public and Catholic School system. Credit Valley and ICNSS developed a task force to investigate the feasibility of a pilot project modeled after the schools’ settlement worker project.

Although the primary need voiced by newcomers is typically the securing of employment commensurate to their skills and training, foundational to entering the workforce is the newcomer’s ongoing health.

Acute and sudden illnesses, whether affecting one’s self or one’s household, seriously hamper the newcomer’s integration process. A stable income is a determinant of health. Likewise, health is a determinant of employability. Newcomers uncertain of how they can access the medical system in a cost-effective way are therefore caught in a vicious cycle that often leads to poverty and despair.

The IN@CVH Task Force (short for Immigrant and Newcomers at Credit Valley Hospital) and ICNSS developed a proposal for submission to Citizenship and Immigration Canada (CIC) for funding. By that time the end of the school year was approaching. ICNSS offered to expedite the pilot project at Credit Valley utilizing six of the schools’ settlement workers during the summer recess.

The six settlement workers at Credit Valley speak Urdu, Punjabi, Mandarin, Cantonese, Hindi, Polish and Arabic. Settlement workers at Credit Valley respond to urgent needs, helping newcomers understand medical procedures and how to best access ongoing medical support. They provide assistance with interpretation and/or familiarization with the Canadian health-care system. The settlement workers also assist health-care personnel when they are unsure of customs or cultural norms or if the health-care professional suspects that the patient/family may need additional “newcomer” support once they leave the hospital.

Joanne Courtney, a nurse in Credit Valley’s busy emergency department can’t say enough about the positive impact of the settlement workers. “I had a Punjabi patient who arrived with his daughter. He was reluctant to tell me, or his daughter, what was troubling him but it was clear he was in a lot of pain. I was having difficulty communicating even though his daughter was translating for him. I suggested we ask Babar Chaudry, one of our settlement workers, to assist. As soon as he arrived, everything changed.”

Babar recalls, “He pointed to his lower extremities to indicate where it hurt. This is not something that a Punjabi gentleman would discuss with a female. He needed to relieve himself but had been afraid to go to the bathroom because he’d been told to stay in the emergency department and not to eat or drink anything. The gentlemen thought that meant he couldn’t go to the bathroom either. He was relieved when I told him he could go to the bathroom. When he returned he handed me a tiny rock… it was a kidney stone that he passed when he was in the bathroom.”

Joanne Courtney says this is just one of many examples of how the settlement workers have assisted in breaking down cultural barriers that impact patient care on a regular basis. She says the settlement workers complete the circle of care. “The patient left with a smile on his face. He had found a new friend in Babar. Their professionalism is a model for Credit Valley staff to emulate.”

Settlement worker Fareeha says they are much more than translators. “Our work is a combination of culture, language and compassion. We cannot isolate one from the other. That’s what helps us to help the patients.”

The pilot project at Credit Valley ran from July to mid-August. Often the settlement workers were called even though the patient didn’t speak one of the above languages. Settlement worker Lina Elassi says often body language – a gentle touch, a kind smile, an understanding nod – puts the patient at ease and assists even when words cannot.

ICNSS and Credit Valley are proud of the success of their pilot project and have applied to Citizenship and Immigration Canada for funding to continue the project.