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Because your voice matters.

Navigating BC’s Health Care System as a Newcomer

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Categories: My Experience, Patient Voice Mail, What Matters to You

I moved to what is now known as Canada a little over two years ago. Until then, I lived all 27 years of my life in one place. Actually two, but in the same region of the same country. As a child, I had the opportunity to learn English and I had even visited Canada once before moving, so I didn’t think it would be difficult to adjust to immigrant life here. Of course, I was not right.

In my first weeks, I learned that not only was I not ready for winter in these lands, but I was also not mentally prepared for the number of invisible barriers immigrants face daily. In the beginning, I was so insecure and overwhelmed that I made my partner do almost all of the talking for me. Every day, I felt like I had to learn something new to complete simple tasks like paying the bills or applying for a job. Not to mention that I had never heard about Merino wool before or obvious things like keeping the heat on so pipes don’t freeze.

And when I had to access health care, it wasn’t different. Besides knowing that I should apply for a Medical Services Plan, I didn’t know what else to do. There are public and private health care systems in my country and I’ve been a part of both as a patient and a worker. Yet, I found it hard to navigate the health care system as a newcomer immigrant patient in British Columbia. From the lack of knowledge of what a walk-in clinic is to not understanding some health care workers’ instructions –  or the absence of them – I constantly felt disappointed with myself for not knowing the steps to continue my health care assistance.

I read books about the Canadian health system and I searched many websites. Still, I missed some specialist appointment phone calls because I didn’t have a voice mail set up – I didn’t know I was expected to have one. We have to pay for voice mail in my country, so we don’t use them. After many situations like this, I couldn’t stop thinking about other immigrants who are probably in the same position.

But the truth is that I have many privileges compared to most of the immigrant community. I speak university-level English and have permanent residency. I have the support of my partner’s family here, and I know what a rhabdomyosarcoma is. The barriers I face are just a tiny fraction of what some other immigrants encounter.

A group of people all stand or kneel together. They are in the middle of a forest surrounded by trees.
This is a youth group, focused on connecting immigrants in the community as well as facilitating training. Front row L-R: myself, Helen, Haydon, Leili, Vinitha, Kerlinda, Nour. Back row L-R: Kristina, Antony, Daniel, Aman, Jason, Karan, Divleen.

Joining the Patient Voices Network

Feeling a bit frustrated and angered enough to do something about it, I searched for patient communities. This is how I ended up finding Patient Voices Network (PVN). I became fascinated with PVN’s premise – patients and health care teams engaging in constructive and productive talks to enhance health –  and soon after, I started applying for opportunities. But the more I tried to engage as a patient partner volunteer, the more I began to wonder if the patients’ voices being heard were truly as diverse as the province’s population.

PVN’s last annual report shows that diversity exists but there is plenty of room for improvement. Of 1251 patient partners, 112 identified themselves as Indigenous People (First Nations, Inuits and Métis), 90 as people of colour, 85 as persons with disabilities, 56 as members of the LGBTQIA2S+ community and 34 as newcomers to Canada. Considering that some individuals identified with more than one group, and the questions were optional so others chose not to respond, it’s hard to achieve total accuracy. I have gladly started noticing some changes, such as more opportunities tailored for Indigenous patient partners. But let’s be honest: it’s long overdue.

As part of an immigrant minority community, I wonder if those who represent the multitude of cultural backgrounds co-existing in the province have a real say in health care improvements. Are refugees, asylum seekers, temporary foreign workers and international students sitting at these tables with health authorities? Are we considering the diversity inside this diverse group of people labelled as “newcomers” or “immigrants”? Are we incorporating their past and present experiences and points of view to improve the province’s health care? 

Asking “What Matters to You?”

One of my favourite BC Patient Safety & Quality Council campaigns is “What Matters to You?”. This international campaign encourages health care practitioners to investigate what matters the most to their patients and incorporate that information into their health care – a simple concept that often gets lost in the middle of the bureaucracy and time restraints that most health care staff work under. If someone asked me this question right now, I would have difficulty making a shortlist. But one thing that would be in there is to enhance understanding of the barriers immigrants face when accessing health care here and how the system can address them.

My first engagement with PVN was a learning opportunity with the Institute for Healthcare Improvement. One of many things that I took from it was the importance of working with a group composed of diverse backgrounds. That’s why I believe that it’s in everyone’s interest to consider a diversified patient perspective when establishing change in health care. After all, the invisible barriers I face as a non-white, Latin, newcomer, and female patient are probably somewhat different from the experiences of others. The only way we can know that for sure is by guaranteeing that everyone is invited to sit at the table with those who have the power to make improvements a reality for all.

I would like to thank Janet Bauer, my PVN mentor, for encouraging me to write this blog post. Your openness, respect and support mean more than you probably imagine. Our (almost) weekly talks were the highlights of my week. Thank you for being a great mentor and an amazing human being.

Author: Mariana da Silva Jardim

Mariana da Silva Jardim is a proud South American and newcomer to what is now known as Canada. She came to these lands because of love and better opportunities for her new family. Since arriving in this multicultural province, she became interested in immigrants’ and refugees’ health, global health and mental health. As a privileged immigrant, she understood that the least she could do was to advocate for better care, respect and inclusivity for the multitude of cultures in this province. She daydreams about a world where every patient will receive culturally-tailored, good quality physical and mental health care. Her professional background is as an internal medicine physician and she is currently on the long and expensive journey to achieve her dream of practicing medicine here one day. She now doesn’t wear cotton clothes or turns off the heat during the winter.

From Our Community

Laura Palmer

Physician Quality Improvement Coach — Northern Health

Laura Palmer

It has been so rewarding to go from an idea to working with such a great group of dedicated people from so many different organizations towards a very fun and rewarding project. Several extremely engaged PVN members expressed interest in being part of piloting a patient virtual care peer support system. I am confident that this is the beginning of many more exciting collaborations!