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The Current Transcript for December 12, 2016

Host: Anna Maria Tremonti

STORIES FROM THIS EPISODE

Listen to the full episode

Prologue

[Music: Theme]

SOUNDCLIP

One of our funeral directors on staff here was actually, it was at Disneyland, Space Mountain. And somebody was ahead of them on the rollercoaster scattering their loved one off the rollercoaster.

ANNA MARIA TREMONTI: Smirk if you will but novelty efforts to scatter a loved one's ashes to the winds may have to become more common or more monitored in the future. As countries from North America to Asia simply run out of burial grounds or reclaim them for urban development. Already in the Toronto area, burial plots may now be the most expensive piece of real estate going. There's a black market in gravesites in Istanbul and Jerusalem’s building underground chambers dozens of stories deep. In a moment, accommodating the dead among the living. Also today..

SOUNDCLIP

JUSTIN TRUDEAU: Tonight they step off the plane as refugees, but they walk out of this terminal as permanent residents of Canada.

AMT: In the years since Prime Minister Trudeau's memorable public gesture welcoming Syrian refugees to Canada, other governments and organizations working with refugees have been tracking Canada's private sponsorship system. They will meet in Ottawa this week to consider whether it can work elsewhere to address the ongoing worldwide refugee crisis. We'll hear from those heading into those meetings in half an hour. And it was jarring news in Toronto a week ago that reminded anyone listening that allegations of domestic abuse know no economic barriers and fit no stereotype.

SOUNDCLIP

The accused in this case, Mohammed Shamji, 40-years-old of Toronto is charged with first degree murder in the death of his wife.

AMT: Every six days a Canadian woman is killed by her intimate partner and many never make the news. Now there's a call for all primary care doctors to start asking basic questions to try to screen for those at risk. We'll bring you that story in an hour. I'm Anna Maria Tremonti, this is The Current.

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What happens when cemetery space runs out?

Guests: Nicole Hanson, Tony Walter, Ruth Toulson

SOUNDCLIP

Death is now an equity issue for those in GTA and Toronto because we're going to be out of space within five to ten years. Planning talks a lot about waterfront developments and bike lanes and housing affordability and these things are all important but they were not addressing the main issue and planning for spaces to die.

ANNA MARIA TREMONTI: Well, Nicole Hanson plans for death in cities. She is a cultural planner with a specialization in what is called cemetery urbanism. She's taking The Current’s Julian Uzielli on a tour of the Maple cemetery in Vaughan, Ontario. And as she explains, the Greater Toronto Area is facing a looming shortage of space for cemeteries.

SOUNDCLIP

[Sound: footsteps crunching in snow]

NICOLE HANSON: And so you can start to get a feel of how many people are located within the space and how much space is left. So this cemetery still has paths, which is very interesting because most cemeteries in the GTA don't have a lot of paths left because there's a lot of infill development going on to accommodate the dead and so they're making more space. Now, what's interesting is we see the path actually ending. And so they decided to keep the path up to here but we now see some more internments that have been taking place along the pathline, so they are running out of space.

JULIAN UZIELLI: You can tell just by looking at the way things are laid out that they’re running out of space.

NICOLE HANSON: Oh definitely, yeah. Definitely I can see that.

[Sound: cars passing]

NICOLE HANSON: Well, I specialize in cemeteries because it's the only type of landscape that we use in perpetuity. So once this land is zoned in an open space area, we are using it once and we're using it forever. You can never build on a cemetery. You know, there's not much land left here because the cemetery still needs to be accessible by the public. All the paths and roads cannot be pulled out from our graves, where are you going to walk?

JULIAN UZIELLI: Aside from the obvious problem of not having enough space, what other problems does it create when a city runs out of space to bury the dead?

NICOLE HANSON: It creates an elite system of who has access to be buried in the cemetery. The extremely wealthy will be able to dictate this narrative and say well, I can afford to be buried downtown, I can afford to have my house downtown. Each price is very different but you're looking at about 25,000 roughly, with taxes included, just for one lot. That's not including your marker, that is just including the lot itself, opening and closing of the grave which also comes at a price.

JULIAN UZIELLI: Dying’s expensive here.

NICOLE HANSON: It is expensive, it's extremely expensive. And you need to know what you're getting into.

AMT: Dying is not just expensive in Toronto. Across North America, Asia, parts of Europe, burial real estate is at a prime and as many continue to bury their dead in ever shrinking numbers of available grave plots. Tony Walter is an Honorary Professor at the Centre for Death and Society at the University of Bath in the United Kingdom. And that is where we have reached him. Hello.

TONY WALTER: Hi there Anna Maria.

AMT: Well, Toronto has a looming shortage of burial plots. How common is this in North America?

TONY WALTER: I think it's pretty common in North America, it’s pretty common in Britain. It's not at all common in continental Europe.

AMT: And why is that?

TONY WALTER: Well, if you go back to the Middle Ages, back in Britain and in Europe, people lived in villages and when the grave digger was digging a grave, he became across dry bones, he would pick them up and put them in an osier, a bone house, and he could just recur and reusing a village churchyard like that for centuries and centuries and centuries. And they did. And then by the 18th, 19th century, the population was expanding like mad. And you had big huge new cities in Britain. Places like Leeds and Birmingham but obviously in North America as well, places like Toronto. But certainly in Britain and in America when gravediggers were digging a grave, they were coming up against rotting flesh, not just bones because the burial rate was too high. And this became a real scandal in the first half of the 19th century in many many countries in the West. And what happened in continental Europe was in pretty much all of those countries, they devised a much more rational system of reuse. So they'd look at the soil condition and at the death rate and they say well, in our community we'll give people eight year leases or give people 15 year leases, that's enough for the the flesh to decay and for it just to be bare bones. And then once the lease is up, if people want to pay to renew the lease they can. So nobody is forcing any grave to be reused against the family’s will. But if the family no longer are interested in the grave, then it can be reused. In Britain and in America and in Canada, they came up with this idea of building large out of town cemeteries where people will be buried in perpetuity. And that's what's created the problem.

AMT: And so how many people actually renew gravesites versus just let them go, do you think? Like, what’s the percentage?

TONY WALTER: Oh, in continental Europe.

AMT: Yeah.

TONY WALTER: I mean, it'll vary enormously from one place to another. But certainly, one study which was done in Britain about 30 years ago found, in London, found that the typical grave would be visited for about ten years or so and then after that a spouse would have died, children will have moved away and so forth. And it may well be for another ten years or so the family would have some kind of interest in it. So I think in continental Europe, you know, if you've got a 12 year lease for example, that might get renewed once but it is not going to get renewed typically for 50, you know, 60 hundred years. But I mean, in countries which has got perpetual burial or else 99 year leases, I mean, that's far longer than the average family needs it.

AMT: And so are you suggesting that to get rid of the sort of the crunch in land, that people look to what continental Europe is doing?

TONY WALTER: Well, it certainly is not only the most rational solution but it does take account of people's emotions as well because nobody's ever forced to have a grave reused against their will. And the advantage of short term leases is that if you're talking about a lease of 10, 12, 14 years, when the council posts the notice on the grave saying, you know, if you don't contact us within the year this will be re-used, or they may well still have records of the family, they can inform the family. If you talking about a 50 or 99 year lease by, you know, by that time, almost certainly the cemetery authority can't contact the family, they've lost trace of them. So they then reuse the grave, this is beginning to happen in Britain. And then, you know, three years later some relative from Canada or Australia turns up [chuckles] and what’s happened to my great great grandfather’s grave? So actually, short term leases work much better with families emotions and feelings.

AMT: What about the historical record? Because it's not solely families that go through graveyards and gather information or find.

TONY WALTER: Yeah, absolutely. Well, I mean, it's really important for historical and genealogical purposes that there are proper digitized records. And of course, that's much easier now than it used to be because it can all be put online and that's what people ultimately need. In terms of historic importance, I mean, if you look at buildings for the living, houses, homes, as they age, you know, a lot of them get demolished and we have redevelopment in cities. But most countries, you know, have some kind of register of historic buildings which are of historical, architectural importance which get preserved. And I think it would make a lot of sense to have a similar system for graves, so that, you know, if you’ve got the grave of a famous person like Karl Marx who's in Highgate Cemetery in London, you know, there's no question of that being reused, you know, that would be put on the preserved list. So I can't see why we can't have a similar system for houses of the dead that we have for houses of the living. We identify the historical and architecturally important ones and preserve them.

AMT: How acute is the looming burial plot shortage then?

TONY WALTER: Sorry, could you say that again?

AMT: How acute is this shortage?

TONY WALTER: Oh, it depends enormously, depending on the city you're talking about. But certainly, some parts of London, it's very very acute and you will find cities in North America where that's probably the case as well.

AMT: Well, what about the idea of building cemeteries way out, out of the cities?

TONY WALTER: Yeah, you see, that was the idea in the 19th century, that the city would buy a plot of land on the very edge of the city and it would become a cemetery. Because people knew the population was expanding and they knew the city was expanding. The idea was that after 20, 30 years the cemetery would be largely full up, they would have lots of beautiful fine specimen trees and fine specimens of moorish architecture and so forth. And by that time, it would be surrounded by the expanding suburbs of the city. So this was the idea in the 1840s, 1850s. And the idea was that when the cemetery was full up, a new cemetery would be built on the new outskirts of the city and the old full up cemetery would be enjoyed by the suburban residents who lived around it as a place to admire fine trees and fine architecture. Trouble was by about the 1870s, the urban park movement, which was developing in tandem, had really taken off and most people who lived in British North American cities said actually, we prefer to go for a walk in the park rather than the cemetery. So it's actually the urban park movement which kind of did for this British North American notion of the cemetery.

AMT: OK. Tony Walter, we have to leave it there but fascinating. I'll pick up on this with my next guest. Tony Walter Honorary Professor at the Centre for Death and Society at the University of Bath in the UK.

SOUNDCLIP

NICOLE HANSON: People say well, cremation is going to absorb casket burial but no, not everybody can be cremated. We have Muslim communities, Jewish communities, Christian Orthodox communities that cannot be cremated and they need to have full body burial. So we need to start planning for it. I'm Christian and so I believe in the coming of the Messiah. And that I would need my body to be resurrected. So I would like to have full body burial. Also, more importantly I would like a place for my daughter to go to. There's something about the body still being buried that people can connect with, I find.

AMT: OK. Nicole Hanson again, for the specialization in cemetery urbanism. The dwindling space available for graves is especially worrying to religious communities that do require full body burials. Countries such as China have already started to relocate existing graves and ban future ones. And that's been deeply upsetting for those who have already laid loved ones to rest. My next guest looks at the intersection of burial rituals and faith. Ruth Toulson is a cultural anthropologist at the Maryland Institute College of Art. She's in Baltimore. Hello.

RUTH TOULSON: Good morning Anna Maria.

AMT: Let's start with China because we were just talking about Europe but let's move to Asia. What is China doing with their cemeteries right now?

RUTH TOULSON: Well, in mainland China then, for a long time there's been absolutely no space for burial in overcrowded cities. So those cities have, since the 1970s, cremation has been the only way. However in the last few years, probably in the last five years, you see a massive movement of bodies, perhaps ten to 15 million bodies have been shifted. Cemeteries been destroyed, families getting the letter that says you have two months, move your dead. So in mainland China, we're looking at the biggest movement of bodies in human history, massive migration.

AMT: And that’s because of development?

RUTH TOULSON: In many places it’s because of development, particularly as cities spread. In fact, with colleagues at Stanford, with Tom Mullaney, we're tracking the movement of these bodies digitally and you can see that bodies move and then cities expand. So partly it can be to do with the expansion of cities but also and some point places in China, it's been to do with corruption. People think oh, I'd like that land to build my new hotel on, maybe they know somebody in the government and so that's the thing that prompts graves to be cleared.

AMT: And does China now have a policy where cremation is the only choice?

RUTH TOULSON: In multiple provinces yes. And in fact, in certain provinces in the north when this came in in 2014, when the announcement was made that from this date cremation will be your only option, there were multiple cases reported of old people committing suicide because they decided I would rather take my life and die by this day to have the certainty of burial than wait and know that cremation was my only option.

AMT: Is that something. How important is it to bury the dead in Chinese culture?

RUTH TOULSON: It is perhaps the most important thing that you can do for your parents. You know that if you love your parents, the most loving act is seen as the fact that you bury them. And then once they're buried, you worship them as ancestors. And something that's important too, I think, in your American culture, we think about the destruction of a cemetery is something that's deeply disturbing and perhaps, you know, we think it somewhat is an act that destroys memory. In Chinese society, the well-being of the dead is connected absolutely to the well-being of the living. So if something goes wrong in your life, perhaps you get sick or your child's exam results are bad, something you might do is go and look at your ancestral grave, is it flooded, is it dirty? Because if the dead are unhappy, then the living will be too.

AMT: So this has implications as well then obviously?

RUTH TOULSON: Oh definitely, definitely. In my other work in Singapore, also a Chinese population. Singapore is a place where the cemeteries there, all the cemeteries will be destroyed apart from one, cremation is presented as the only way. This movement of the dead is something that the state has used to try and change the way people think about themselves and their identities. Highly politically fraught act.

AMT: And we know that in Judaism, Islam, many strains of Christianity, the dead are required to be buried. How is this affecting things, will religious practice change?

RUTH TOULSON: I think that religious practice will change eventually. When you look for instance at the Chinese example, in Singapore then people used to say, you know, it's central to our religious practice to be buried. Now people say well, to cremate is to be Chinese. So there there’s been a radical shift. In Istanbul at the moment, there is a black market in burial plots because the cemeteries are so crowded. And there they’re thinking about building multi story, up into the air places for the dead and there’s discussion of well, is this burial in Islam? Is this appropriate for burial? And so the movement is slow because I think, you know, that these ideas about the dead have such long histories. But the movement is shifting.

AMT: And what about Jerusalem?

RUTH TOULSON: In Jerusalem at the minute, partly because the city is so crowded, the cemeteries are full, partly because certain cemeteries, the very very big ones are in very contested areas and difficult to get to, you see a new project that at the minute has been dug 22 stories down. So they're burying the dead deeper and deeper and deeper under the ground, still fulfilling the Jewish requirement to bury but using cemetery space in ways that we've never imagined before. And that project is happening at the moment. And there was talk from engineers that I've spoken to there, of perhaps we can go down to 40 layers. How deep can we go?

AMT: That’s extraordinary. So as our population continues to grow, what changes do you expect to see in the way we honour the dead?

RUTH TOULSON: I think something the first person you spoke to talked very clearly about how yes this is a planning issue. One thing we've got to keep in mind is that spaces for the dead are also spaces of ritual, space of memory. So we've got to be very careful about what we do with them. I would say though that sometimes cremation, the move away from burial to cremation is presented as the answer. But even cremation has significant environmental impact, cremation also, because people tend to store that cremated remains, has space impact. So maybe we need to even move beyond cremation. In the Columbia University, in the architecture school there's a group of architects there who are looking at well, can we make bodies into compost but do it very quickly? Can we generate electricity from bodies? Can we have call them bury where we store the ashes but store them at sea? That's a new project in Hong Kong at the moment.

AMT: So what you're talking about is the need for really a political solution as well. We have to leave it there Ruth Toulson, but thank you for your insights.

RUTH TOULSON: Thank you.

AMT: That is Ruth Toulson. We want to, she is the cultural anthropologist at the Maryland Institute College of Art. And she's in Baltimore. The world does have interesting, bizarre, sometimes disturbing rituals with the dead. We've got just a few for you to hear.

SOUNDCLIP

[Music: old folk music]

VOICE 1: For some cultures, the best way to honour the dead is by eating them. Endocannibalism is said to connect the living and the recently deceased. It's practiced by some tribes in Papua New Guinea and the Yanomami people of the Amazon.

[Sound: chime]

VOICE 1: Sky Burial is the tradition of cutting up the dead and letting animals, most often birds, eat the remains. It is common among Tibetan Buddhists, who feel no need to commemorate the body, something they see as an empty vessel.

[Sound: chime]

VOICE 1: In Taiwan, exotic dancers are known to strip during funeral ceremonies, sometimes even at the gravesite of the deceased in front of the coffin.

[Sound: chime]

VOICE 1: The rare practice of self-mummification was outlawed in Japan in the 20th century. Monks would adhere an extreme diet to rid themselves of body fat and eat poisonous roots and tea in order to vomit and lose bodily fluids. Eventually, they would lock themselves into a tomb, which was sealed from the outside. Over 20 bodies, mainly practitioners of Shingon Buddhism have been found mummified.

AMT: We want to hear what you think about this story and what do you expect to happen to your body after death? You can find us on Facebook, tweet us we are @TheCurrentCBC, email us through our site cbc.ca/thecurrent and click on the contact link. And stay with us, the news is next. And then, the world has noticed Canada's response to the Syrian refugee crisis. This week, international refugee organizations will gather in Ottawa to take a page out of our books. We'll talk about what they expect. I'm Anna Maria Tremonti, this is The Current on CBC Radio One, Sirius XM and online on cbc.ca/thecurrent.

[Music: Extro]

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World refugee experts consider Canada's private sponsorship model

Guests: Gregory Maniatis, Brian Dyck, Jennifer Bond

ANNA MARIA TREMONTI: Hello, I'm Anna Maria Tremonti and you're listening to The Current.

[Music: Theme]

AMT: Still to come, she was a mother, a friend and a doctor. A murder in Ontario has reignited calls for medical professionals to screen patients for sign of domestic abuse. But first, Canada turned a sense of despair about the Syrian refugee crisis into a plan. Now other countries are asking how they can do it too.

SOUNDCLIP

The cumulative effect of all of these global problems and hearing about the people caught up in these global problems does kind of create a sense of despair. But then all of a sudden you realize wait a minute, I can do something, even if it's just for a couple of people, you know, it’ll help to relieve this sense of despair I have.

AMT: Well that is Andrew Fitz-Gerald from the Ripple Refugee Project in Toronto. It's one of the hundreds of private sponsorship groups that sprung up across the country in response to the Syrian refugee crisis.

SOUNDCLIP

VOICE 1: There were two options. Just sitting there being angry and feeling paralyzed by the enormity of the situation or do at least something to help at least one family. We thought it was the better option than just sitting there complaining.

VOICE 2: We have a moral responsibility for a year to help this family. But I think everyone involved is actually hoping it's going to be far more than that. I have great hopes for them but my great hope is also that we'll be friends for life.

VOICE 1: This is really hands on. This is really where you can change someone's life here in Canada, which I find really amazing.

AMT: Well, we brought you the story of the Ripple Refugee Project one year ago, when the family the group sponsored arrived in Canada. We will have an update from them later this week. Today, we're taking a closer look at Canada's private sponsorship program. It has resettled more than 288,000 refugees since it began in the late 1970s and helped 13,000 Syrian refugees make new homes in places from Haida Gwaii to Nova Scotia over the last year. Experts from around the world are gathering in Ottawa this week to ask if Canada's private refugee sponsorship program can work elsewhere and help alleviate the global refugee crisis. Jennifer Bond is organizing this week's meetings. She's chair of the Global Refugee Sponsorship Initiative. She's also a Law Professor at the University of Ottawa. She joins us from Ottawa. We're also joined by two participants. Brian Dyck is the migration and resettlement coordinator for the Mennonite Central Committee Canada. He is Chair of the Sponsorship Agreement Holder Association. Brian Dyck joins us from Winnipeg. And Gregory Maniatis is a Senior Adviser at the Open Society Foundations. He's with us from Berlin, Germany. Welcome to you all. Good morning.

MANY VOICES: Good morning. Thank you.

AMT: Jennifer Bond, let's begin with you. Why do you think this is a model that can work elsewhere?

JENNIFER BOND: Good morning Anna Maria and thanks for having me. I think that Canadians were able to demonstrate what happens when we give tools to mobilize the compassion that lives in our communities. And I think we believe that communities around the world, not only in Canada, have that compassion and we need to find ways to give them the same kind of tools that we've seen be so effective here in Canada.

AMT: Gregory Maniatis, in Berlin. What do you think makes the Canadian private refugee sponsorship system appealing to other countries?

GREGORY MANIATIS: Well, as Jennifer said it is an outlet for the compassion that we know exists in communities all over the world. But there is currently not much organization for those who want to help refugees. In Greece, last year alone there were 50,000 individuals who went on their own to a single island, the island of Lesbos, to help refugees there. We need to build the infrastructure in other countries that Canada has in order to be able to welcome refugees into our communities.

AMT: So Gregory, you're saying it's a good system. But why haven't countries tried to do it already?

GREGORY MANIATIS: So there have been some experiments, some pilot projects in other countries but for the most part, refugee resettlement in other countries is on the one hand, quite small. Canada and the United States do the lion's share of resettlement. And on the other hand, it tends to be government run, government controlled. And so this is an opportunity that we have now to elevate the prominence of the Canadian model and to allow other countries, other communities to see its value, which is not just for refugees but it's of great value to the hosts and to the country.

AMT: Well, Brian Dyck, let's get some on the ground views from you. We've heard of some of the benefits, what about the challenges in the Canadian system?

BRIAN DYCK: Well, it's a system that we've been working with since 1979. And I think we've worked out a lot of kinks but over the years new ones arise. I think one of the challenges, I think, a lot of groups point to is well, the Syrian movement was very quick, a lot of people around the world who are waiting for other refugees have had to wait for a long time. And so making sure that there's a fair, equitable distribution for this program, making this program a little simpler. But beyond that, I think there are so many benefits, so many ways that it benefits Canada and it benefits people who resettle. I think that picking up on some of the things that were talked about before, I think one of the things that makes it really work is a good partnership between the Canadian government and the civil service and the people who are volunteering. I think that connection is one of the things that has really made it a success.

AMT: And what are the benefits versus government sponsorship? With this private system?

BRIAN DYCK: Well, I think that both have their role. I think that government assisted refugees have a professional who is helping them get settled and that's great. The advantage of a private sponsorship and the blended program that we've had in the last few years is that you have people who this is their passion, it's something they're doing as volunteers. And that really strengthens the settlement, it also strengthens our understanding of global issues.

AMT: Jennifer Bond, what do you see as the major problems with the way Canada's private sponsorship system is operating now?

JENNIFER BOND: Well I think Brian's nicely articulated some of them. There's definitely some questions about how quickly processing is occurring, not only for non-Syrian populations but also for recently sponsored Syrians. And I think that actually speaks to the power of the program. We can, of course, debate and should debate within Canada how we're operationalizing the system. But it's really amazing to see the mobilization of Canadians and I daresay that I think it's unique right now in the global context that Canadians are pushing our government to do more to respond to refugees, where we're seeing a fairly dark scene in many other states. So I see this as a vehicle that lets compassionate people really mobilize in a very tangible way and that both impacts the communities and the way Brian`s already described, definitely helps refugees but also I think has an important political dimension, that it sends a clear message that people in Canada are excited and happy to support this important work and that facilitates other forms of political mobilization as well.

AMT: Brian Dyck, what do other countries need to keep in mind if they want to implement something like this?

BRIAN DYCK: Well, I think they need to know that at the beginning in ‘79 and in the last number of years, certainly as well, this was something that was driven by the general public, it was volunteers. And so you need to look for where you find that in your society and nurture that and nurture that with support for settlement, for helping them through the process. So making sure that you know that the people are with you on this and that's what drove it here and I think that's what would drive it. And there are places globally where that will go.

AMT: So Gregory Maniatis, you made the point that there were 50,000 individuals in Greece who wanted to reach out to refugees arriving on the shores, Syrian refugees, was there a way that the government could have harnessed that grassroots want, willingness to help in a different way?

GREGORY MANIATIS: Well, that's an excellent question. And there was not. I think that what's missing is the infrastructure to allow private citizens and faith groups and community groups to help. The European Union last week launched a solidarity corps for the first time, where young people can spend a year in different types of community projects, including with refugees and asylum seekers. But that's the pent up desire that we see in many places around the world that hasn't been met with infrastructure. There are in Europe, many cities that have tried to bring in more refugees but they're blocked at the national level. So there is desire to help, there's capacity to help and there need to be outlets to do that. And happily, I think that there are now a lot of governments that are looking to Canada, are inspired by how Canada has dealt with the Syrian refugee crisis, have now been exposed to the inner workings of the Canadian refugee resettlement system, including private sponsorship and are very interested in learning more. And we have I think eight governments coming this week to Ottawa to look more intensively at the system. And we expect that there will be many other governments too over the course of the coming year, looking at this system and learning from it.

AMT: Brian Dyck, that becomes important huh? Because you're talking about the grassroots but if you go back to the seventies, both Conservative and Liberal governments, depending on the time, were instrumental in bringing, in creating the infrastructure to allow refugees to come in.

BRIAN DYCK: Absolutely, it was really important that this was something that was started under Liberal government and then for the short period of the Clark government it was expanded and then continued on. So it was something that was a part of both governments and it was something that we continue to see strong support for, certainly in the present. So having that working relationship with the government is really important but taking the key or taking the cue from the general public as well.

AMT: And so, Gregory Maniatis, how much appetite is there among residents in countries such as Germany and Great Britain right now, and the US in doing this kind of thing?

GREGORY MANIATIS: Well, I think that there is a lot. I mean, if you look at Europe, look at Germany, I think there have been close to 800,000 asylum seekers brought into Germany over the past, who came to Germany, not brought in, who came to Germany over the past two years. And Germany has more or less been successful in receiving them, in setting up infrastructure without much warning really, to be able to house them and to bring them into schools and into the labour market. It's a slow process but it's happening now rather systematically. Bringing in a private sponsorship program, of which there have been pilots here in Germany, doing that more systematically will allow the German public to engage with newcomers, with refugees and asylum seekers in ways that are more structured. And where they can really do what private sponsorship does best, which is help newcomers integrate. And as I said earlier, this isn't just for the benefit of refugees, it's also for the benefit of communities who, as Brian said, learn more about the world, feel a sense of purpose in being able to contribute to the lives of others who are needier than they are.

AMT: And yet you are in Europe now, Gregory, we have seen a great deal of animosity toward migrants in Europe.

GREGORY MANIATIS: And I would argue that a great deal of that animosity has to do with the chaotic way in which the past two years have unfolded here. There was not infrastructure to support refugees in the Middle East, in Lebanon, in Jordan and Turkey. Because that infrastructure didn't exist, the kids couldn't go to school, their parents decided ultimately to take this incredibly dangerous journey across the Mediterranean to walk up through the Balkans and up in places like Germany and Sweden. We need to avert that chaos next time, we need to have the systems in place to provide protection before people take those dangerous journeys and to have destinations that are willing to receive them. And that's where the private sponsorship piece fits in.

AMT: Jennifer Bond, what's your sense of the timing politically, to be trying to spread this, in a time of Brexit and Donald Trump, with some of the incendiary political comments that have been made about migrants. Can this happen?

JENNIFER BOND: Well, look, I'm very encouraged, as Gregory mentioned, we have eight countries coming to visit and be part of our meetings this week and we anticipate outreach to a lot more countries over the next year and I'm very encouraged by that uptake. I think it indicates the level of support there is for exploring these initiatives. And as I mentioned already, for me it's really important that we find vehicles to tap into the compassion that's in our communities. So regardless of what's being said, and I do think it is dangerous, some of the high level narrative. Regardless of what's being said there, if we can champion tools that allow individuals to mobilize, I think it holds a lot of power. And I want to commend the Canadian government for reaching out to partners. We're working closely with the Open Society Foundations, the United Nations High Commissioner for Refugees, [unintelligible] Foundation and the University of Ottawa are all working together on this, really to try to figure out how we can most effectively mobilize given some challenges in the political environment. And I think we're making great progress.

AMT: Brian Dyck, we talk about this at sort of the wider level, higher level, but what's the reality on the ground with the private system? What kinds of things do sponsors run into, how tough can it get sometimes?

BRIAN DYCK: Well, yes, it isn't always easy but there is a lot of rewards with it. Challenges include, you have people who come and they have been through a war. And that brings a lot of challenges, medical issues that they suffer with, making sure that they learn English or French, make sure that they find a job, get integrated in society. That's a long process. It seems sometimes to be very slow but then sometimes you look back and you think oh, they've really come a long ways. But it is it is a long term process and as one of the pieces that you played at the beginning, it's something that the relationships can last a lifetime and it is something that I think really shapes not only the individuals but I think it is something that has shaped the way Canada views the world.

AMT: And you--

JENNIFER BOND: [interposing] Can I just jump in on that point too?

AMT: Yeah, go ahead.

JENNIFER BOND: So I just wanted to add, in case it sounds as though we are only convening these state representatives this week, that we really are also reaching out to community organizations across the world, recognizing as Brian said, the importance that this is a partnership. So I just wanted an opportunity to stress that we're putting together a very diverse table, lots of different representation to really figure out how we can build capacity not only in government but also in communities around the world.

AMT: Right, well, that’s why we got, you know, we're talking to Open Society Foundation and the Mennonite Central Committee Canada because of that, right? You've got organizations like that coming to the table as well, right?

JENNIFER BOND: Exactly, that's right.

AMT: Right. Now, but Brian, I understand you've sponsored a family as well, right? You're part of a group that's doing that.

BRIAN DYCK: Yeah. I'm usually in the position of telling other people how to do it but a few months ago, my wife and I were part of a church in southern Manitoba that sponsored a family about 20 years ago. We got together with them and they're doing quite well and we said to this group so we want to do this again, and the family we sponsored from Bosnia said absolutely let's do this. And so we had an arrival in October. And it's certainly interesting to see the challenges firsthand again but also the excitement. My wife took them to the store the other day to beef up their winter clothing a little bit and after she'd finished paying for the things, the clerk came up to her and said are these the refugees you're hoping? And she said yes and she gave her a big hug and then she gave the two children there or three children there a big hug and said I'm so happy you're doing this. And so, there are so many affirmations that people get. I mean, there are other times when people look at you and wonder why you're doing this. But this is something that I think a lot of people are with us on.

AMT: And you make the point, you know, and we don't doubt the excitement but there must be moments when it's hard too? I mean, these are families who have their own idea of what their life should be like.

BRIAN DYCK: Sure.

AMT: How do you navigate that?

BRIAN DYCK: Well, the keywords we often use is managing expectations. And that's managing expectations by the sponsors or for the sponsors but also for the newcomers. I mean, you come and perhaps the only experience you have of the US or Canada is television or soap operas and life isn't like that. At the same time, you know, sponsors have this maybe glowing vision of what it's going to be like. And, you know, these are real people and they have real problems and sometimes there are challenges with that.

AMT: So Gregory Maniatis, if there was a different refugee system in place in Europe, how might the current migrant crisis have been different?

GREGORY MANIATIS: Well, if you had a system by which we raised the necessary amount of money to allow refugees in Turkey and Lebanon and Jordan, where there are upwards of four and a half to five million at least, to be able to live decently, to be able to go to school, feed their families and get a job, I don't think that we would have had the kind of chaotic flows across the Mediterranean that we've experienced these past two years. So that's the first point, is that we don't raise nearly enough money to support refugees in the countries where they first arrive. If we had subsequently an outlet for those families that wanted to go to Europe, many of them would want to stay, I think, in the Middle East but some might want to go to Europe. You could imagine a system whereby you have two or three or 400,000 resettlement spots in Europe every year. But where people do not have to pay smugglers to go on an unsafe boat across the Mediterranean. But instead, there is a processing capacity in Jordan and Lebanon and Turkey. Canada built that up in pretty much record time last November when the Trudeau government came in and I think sent 500 civil servants to Jordan primarily, to be able to identify the Syrian refugees who were brought over in the first four months of the current government.

AMT: Mm.

GREGORY MANIATIS: That infrastructure doesn't exist.

AMT: Jennifer Bond, what do you want to see come out of these meetings then? What kind of new partnerships might you want to see happen?

JENNIFER BOND: Well, I think that our initiative has two big goals. And one is to really understand the Canadian model and figure out how we can best share lessons learned in other places. And the second is to figure out how we can best capitalize on this powerful partnership that we have created to build capacity for the adaptation and implementation of that model. It can't just be one size fits all. And we want to figure out how we can help states and communities make this work. So I'm hoping very much that this week helps advance us to that goal. I should mention that we have some very exciting actors coming Argentina, Brazil, Chile, in addition to some of the European states we've already mentioned. So I think it's an opportunity to talk together, learn together and also try to advance those common objectives of improving protection for refugees, which is of course the the ultimate objective of all of this work.

AMT: And Brian, what do you hope to see? What kinds of things do you hope to share then?

BRIAN DYCK: Well, I think making sure that as I've said before, that this is something that requires a strong partnership between the volunteers and the government and the settlement agencies, I think that's an important lesson I think for us. And making sure that this is something that adds to resettlement spaces and not just changes it from a government responsibility to private.

AMT: Gregory?

GREGORY MANIATIS: I'd like to see fear, which is dominating right now, be transformed into a sense of hope and opportunity. Which I think by systematically determining how to resettle refugees into communities with the participation of those communities, I think we can get there.

AMT: OK. Well, we have to leave it there. Thank you all of you for your thoughts on this. And we'll look forward to seeing what comes out of your meetings. Thank you.

MANY VOICES: Thanks very much.

AMT: That is Jennifer Bond, Chair of the Global Refugee Sponsorship Initiative. She's a Law Professor at the University of Ottawa. She's in Ottawa. Brian Dyck is the migration and resettlement coordinator from the Mennonite Central Committee Canada and Chair of the Sponsorship Agreement Holder Association. He's in Winnipeg. Gregory Maniatis is the Senior Advisor of the Open Society Foundations. He's in Berlin. They'll be involved in meetings this week in Ottawa, looking at how is Canada's private sponsorship can be adopted elsewhere. We want to hear your experience with private sponsorship. If you're involved with a group, what's the experience been like for you? Tell us about the challenges and the rewards, you can email us through our website cbc.ca/thecurrent. We're on Twitter @TheCurrentCBC, search for The Current on Facebook as well. Now, over the coming weeks we'll be featuring stories about Syrian refugees in Canada, from education to integration to the second migration. We'll meet some of the people living in different parts of the country to see how their first year in Canada is going. And one of the people we want you to hear very soon is 27-year-old Isaiah Aya Helani, she arrived in Vancouver last May.

SOUNDCLIP

When we applied to come to Canada, I apply me and my mom and my sister. But there was some questions for my sister and my mom, so I came before them, before two months. I came here by myself, I still remember when I was in the plane, just looking, I can't imagine this huge distance. You can notice that in the map but when you feel it, it was so incredible. I can't express how I feel that because you just, I remember when I was sitting in the plane just looking from the window, I didn't see anything, just sea, just the sea, it's a huge ocean. The first month was, I still remember when I wake up, I just look around me, so where I am. [laughing] I couldn’t notice that I am here, I am home. I am in Turkey because I traveled to Turkey before I came to Canada. So yeah, I feel lost in the first month.

AMT: The highs and lows of a new life in Canada. Still to come, this week on The Current. And stay with us, coming up next in a high profile case in Ontario, a woman's husband is charged with her murder. One doctor says it's a sad wakeup call. And doctors need to screen all of their patients for intimate partner abuse. We'll be talking about that in just a few moments. A reminder, if you're joining us partway through, you can listen online or you can always take The Current with you on the CBC Radio app, it lets you browse through past episodes of our show. You can start listening in in just a few seconds. You can hear the day's top stories, make your own playlist of what you want to hear, listen right on your smartphone or your tablet. Go to the App Store or Google Play. I'm Anna Maria Tremonti, this is The Current on CBC Radio One.

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Doctor calls for screening of potential domestic abuse

Guests: Dr. Sohaib Gandhi, Dr. Kari Sampsel, Farrah Khan

ANNA MARIA TREMONTI: Hello, I'm Anna Maria Tremonti you're listening to The Current. In this half hour, a subject that is still hard to talk about openly but one some doctors say they have to stop shying away from.

SOUNDCLIP

VOICE 1: I never knew that there was any violence between them.

VOICE 2: It's very very difficult for people to accept that somebody that they know is being monstrous to somebody else.

VOICE 3: Like, such a helpless feeling because she never talked to anybody, never shared, like, we could have helped her, you know? Because of all of the signs and yet that was all within the month before he murdered her.

AMT: Well, those are voices from the documentary The War at Home which is a CBC firsthand documentary about domestic violence in Canada. Every six days, a Canadian woman is killed by her intimate partner. It is a statistic that hit close to home for the Toronto medical community after the grisly murder of a fellow doctor.

SOUNDCLIP

A lot of concern on Friday when she didn't come to the clinic to see her patients. And our worst fears. When I saw her Wednesday, which would be last Wednesday. She was quite upbeat, quite happy that she had, you know, finally filed for divorce and was looking forward to getting her life on a different track or back on track but certainly didn't. Anyway, there was no apparent apprehension.

AMT: That is Dr. Larry Erlick speaking with CBC Radio's As It Happens about his late colleague and friend Dr. Elana Fric. She was murdered, her body found on December 1st, one day after she was reported missing. According to police, she died of strangulation and blunt force trauma. Her husband, Dr. Mohammed Shamji has been charged with first degree murder in that death. The killing has left many wondering whether anything could have been done to prevent her death. And now, some in the medical community are calling for hospitals and doctors to start routinely screening patients for intimate partner violence. It's something that already happens in parts of this country and in the US, but Dr. Sohail Gandhi would like some screening to become the norm. He's a general practitioner. He's in Stayner, Ontario. Hello.

DR. SOHAIL GANDHI: Hello.

AMT: What did you think when you heard about this murder?

DR. SOHAIL GANDHI: So I never knew Dr. Fric but Ontario's physicians are generally a close knit community. And I think like all physicians, I was absolutely stunned by the tragic news. And it was a mortifying experience to sort of hear about the stories of, you know, allegedly how things occurred and like all physicians, I think my thoughts immediately went to the children and how they must be coping with this situation. So I think absolutely horrified is probably what sums it up the best.

AMT: Why was this a wake up call for you?

DR. SOHAIL GANDHI: You know, it's interesting because I've heard of intimate partner violence before and that's one of the questions I asked myself in the article I wrote about this issue, is why did it take this particular case. You know, because this is an issue that's prevalent right now unfortunately in Canada. I think you pointed out the statistics, about every six days a woman is murdered by her intimate partner. I think that when a tragedy hits close to home, it really makes you rethink how you do things, how you practice. In my case, it made me really wonder whether there wasn't something more that I could have been doing all along. Was there something that I’ve missed in the past in patients of mine? And, you know, how could I do a better job of looking out for my patients who may be suffering in the same situation or a similar situation.

AMT: So you're advocating screening. What would that look like?

DR. SOHAIL GANDHI: So we're very fortunate in my area. I'm part of the Georgian Bay family health team in Collingwood and we have an electronic medical records system that routinely screens for various illnesses. So for example Anna Maria, if you were to come to my office and you had a sore foot, we have a screening program built into our records that would flag if you were overdue for certain tests or for example, if you are overdue for a mammogram or a pap smear or a colonoscopy, even though you came in for a sore foot, there’d be a pop up that said you know what, it's time to screen for these other tests, so not only would you get your foot treated but you'd get these tests done if it was the appropriate interval to do that. And it got me thinking that one of the things that, you know, the American Congress of Obstetricians and Gynecologists, the Society of Obstetricians and Gynecologists in Canada as well have suggested, is that we should be screening on a routine basis for intimate partner violence. And--

AMT: [interposing] How would you do that? Are you talking about seeing signs of abuse or are you talking about asking everyone?

DR. SOHAIL GANDHI: So both organizations suggest screening all women of childbearing age and at regular intervals. And so how I would suggest that would happen and what I'm looking at doing in our neck of the woods, with the leadership of the family health team, is to see if we can build that same kind of electronic reminder. So if someone came in with an unrelated problem but it was just time to ask that question and say to our patients because, you know, violence against women is an endemic problem, we routinely ask such and such questions and then ask them the question about whether they’re in an abusive relationship.

AMT: And would you expect them to just tell you?

DR. SOHAIL GANDHI: You know, one of the things that I've discovered in my own practice is that sometimes they don't and sometimes it takes time. I know of a couple of patients of mine that I've seen suspicious signs of, and I've asked them and they've denied it, and they said no no everything's fine, we're fine. But, you know, suspicious situations continue to occur and a couple of years later you ask them again and sometimes they admit it and sometimes they don't. And sometimes a third time you ask them. And it's a process that takes time for people to admit to and it’s a process that is something that should be ongoing and one of the things I feel very strongly about is it's a process that should come from a family physician, someone who has a relationship with that patient, that has a long term relationship, hopefully, with that patient as opposed to some of the screening tools that have been implemented in the United States, for example.

AMT: Mm. You make the point that your colleagues death has really shocked you.

DR. SOHAIL GANDHI: Mmhmm.

AMT: Partly because you didn't expect that would happen to a doctor.

DR. SOHAIL GANDHI: You know, you can read over and over again in a journal or a paper that intimate partner violence, you know, crosses, transcends class, transcends culture, transcends race and ethnicity. But until an example, unfortunately, is presented to you, sometimes that just doesn't click in and I guess that's a failure, that's human nature.

AMT: Because many woman would be afraid to report because they don't want to be judged. And if there's that inherent bias, then if a doctor asks them, how do you get the trust for them to actually tell, if that inherent bias is already there? That only certain people this happens to.

DR. SOHAIL GANDHI: Right. And so that's why I'm suggesting a regular screening program by a physician. If we look at some of the screening programs that have been done in the United States, which actually suggests that screening doesn't make a difference because there are some. If you look at the methodology that was used, what they did was they screened women, they excluded women who couldn't be separated from their partner, which already is a warning sign, like, if, you know, you're not being allowed to go somewhere without your partner, that's a warning sign. And so abused women were excluded from the studies but then their method of screening was to put these women in front of an audio assisted computer device, where a computer asked you questions and you entered them. I don't think that that's going to work. And that's why I'm suggesting a reminder in an electronic medical record that most of us have, where you can talk privately and confidentially with someone you already have a previously existing relationship. And a lot of times when it comes to questions like this, it's not the actual question that's asked, it’s how you ask the question and the manner in which you approach your patient and whether your patient senses from you that this is someone that they can trust. And that's not quantifiable, that's a gut feeling, that's not something a computer can quantify or a study can put into numbers, right?

AMT: OK. Well, Dr. Gandhi, thank you for your time today. We're going to talk to somebody who's actually looked at how this works. We'll hear from her next. So thank you.

DR. SOHAIL GANDHI: You’re welcome.

AMT: Dr. Sohail Gandhi, general practitioner calling for routine screening of patients for potential abuse in intimate relationships. He joined us from Stayner, Ontario. There are some jurisdictions where screening for intimate partner abuse does occur. And my next guest has studied the effectiveness of such screening in clinics in the US. Dr. Joanne Klevens is an epidemiologist with the Division of Violence Prevention at the Centers for Disease Control in the US. And she joins us from Atlanta, Georgia. Hello.

DR. JOANNE KLEVENS: Good morning.

AMT: What were you looking at in your study on screening practices?

DR. JOANNE KLEVENS: In the study, we want to know whether asking women in primary care a few questions, there were just three, about their experiences with partner violence and then giving them information about the partner violence resources available in their community would improve their health. We also tested whether giving women information on the resources available in the community, without asking the questions, also had any kind of impact on their health.

AMT: And how many women were you looking at? How did you do this?

DR. JOANNE KLEVENS: Yes, these were 2,700 women and this was a randomized controlled trial. So as they came in, they were allocated randomly to one of these three groups.

AMT: OK. What did you find?

DR. JOANNE KLEVENS: Well, what we found was that there were no significant differences between the three groups, in terms of their physical or mental health, the date that they [unintelligible] from work or household activities, their use of health services or even of the partner violence related services, and even in the recurrence of partner violence.

AMT: So what does that mean? What does that tell you?

DR. JOANNE KLEVENS: Well, I think it's important to note that this is just one study and we hope that it will be considered together with others to inform decisions about the kinds of questions and interventions that may be beneficial to women. But what we think is it doesn't rule out asking women about experiences with partner violence. We think that more intensive interventions are probably necessary to see some health benefits and reductions in partner violence.

AMT: Mmhmm. So tell me a little bit more though of your conclusions. Are you saying that asking didn't necessarily, like, lead them to get the help they needed? What are you saying?

DR. JOANNE KLEVENS: Asking and just providing a referral is not sufficient is what we saw.

AMT: Mmhmm.

DR. JOANNE KLEVENS: And in many places that's all they get is just a referral.

AMT: And they wouldn't follow up or they wouldn't be able to follow up or?

DR. JOANNE KLEVENS: Well, they didn't follow up is what happened. And in fact, across the three groups, only 14 per cent of those that were experiencing partner violence actually contacted a partner violence resource. And it didn't matter if they had been asked the questions or not.

AMT: Hmm. Over how long a period did you follow them?

DR. JOANNE KLEVENS: three years.

Amt: And so what do you conclude? that you need better screening? what does it tell you you need to do?

DR. JOANNE KLEVENS: We think that the intervention needs to be more intensive. And we know of at least two studies that have shown a more intensive intervention to be effective in reducing the recurrence of partner violence and in improving health.

AMT: Uh huh. And so if you look at what Dr.Gandhi is suggesting, how effective do you think routine screening by a GP or family practitioner would be?

DR. JOANNE KLEVENS: Well, one of the things that we saw in the pilot study for this randomized controlled trial was that we compared health care providers to the IU computer system interview. And actually, we found that the computer was much more consistent in screening patients. The health care provider forgot in a good proportion of the time. So we have evidence from other studies showing that women are more likely or individuals are more likely to report conditions that could be stigmatizing to a computer than they are to a health care provider. So although he mentioned that maybe it was better to have a good relationship and I'm sure having a relationship with your healthcare provider would lead to much better rapport. Sometimes that doesn't happen, at least in the United States. That's not the norm to have one health care provider, it's whoever's available when you go in.

AMT: Mmhmm. And when you did this study, did you have a range of women, different economic backgrounds, different racial, cultural backgrounds?

DR. JOANNE KLEVENS: Yes. It was an urban population, so we can't say anything about rural populations. And it was predominantly a minority population, it was 55 per cent African-American and 37 per cent Latina. More than a half had a high school education or less. So it was a less educated population and 57 per cent were uninsured.

AMT: And does that tell you anything?

DR. JOANNE KLEVENS: It means that this is actually a higher risk group, even though we always say that partner violence cuts across social class. Lower income, less educated are much more likely to experience partner violence.

AMT: OK. Well, Dr. Klevens, thank you very much for sharing your results with us today.

DR. JOANNE KLEVENS: You’re very welcome. Thank you for having me.

AMT: That is Joanne Klevens, epidemiologist with the Division of Violence Prevention at the US Centers for Disease Control. She joined us from Atlanta, Georgia. Well, the emergency department at the Ottawa Hospital has been screening for intimate partner violence since 2009. Dr. Kari Sampsel is an emergency room physician and the Medical Director of the Sexual Assault and Partner Abuse Care Program at the Ottawa Hospital. She's joining us from Ottawa. And Farrah Khan is joining us in Toronto. She's the coordinator of Ryerson University's Office of Sexual Violence Support and Education and a long-time advocate working against sexual assault and violence against women. Welcome to you both.

DR. KARI SAMPSEL: Thank you for having me.

FARRAH KHAN: Good morning.

AMT: Farrah Khan, I just want to get your reaction to that study and what Dr. Klevens found.

FARRAH KHAN: Yeah, I think it's really interesting to see that a lot of the women that she was interviewing and looking at were women from marginalized communities. And thinking about, we talk about leaving a domestic violence relationship. There are so many more barriers when you may not have the economic access, you may not have the access to legal supports, you know, be able to afford to leave. A lot of times we see women say it's easier to stay with my partner, protect my children, than to go to a police station that they may not believe me based on their assumptions about my race, my gender, my ethnic background, my immigration status, even my education. And so it's really important to see how all those factors create so many barriers for women to be safe.

AMT: Dr. Kari Sampsel, why did the Ottawa Hospital Emergency Department commit to screening patients for abuse?

DR. KARI SAMPSEL: Because we believe it is something that is important. We believe that because the emergency department is the only place that’s open 24 hours a day, seven days a week, 365 days a year, if somebody is experiencing violence in any form, we’re the only place that's open, we're the only place that can take care of them anytime, anywhere. And as people had mentioned earlier in the program that, you know, domestic violence and sexualized violence occurs to anyone at any time. So I wanted our people to be looking at this as a public health and awareness type of thing more so than a judgment or anything. So I wanted it to be as normal as checking someone's blood pressure when they come in, so that they are screened for violence.

AMT: So how does it work?

DR. KARI SAMPSEL: So basically, you come to the emergency department for any reason, we have a standardized triage form that our nurses fill in. And at the bottom of the presenting complaints, so you come in saying I have stubbed my toe, there is a set of checkboxes that have prompted questions on them that says do you fear for your safety? And have you ever experienced or are you currently experiencing violence? And it is a bit of a barrier for people to get over that, but once they ask people two or three times, it becomes as normal as asking somebody about their allergies. And then the big piece that Dr. Klevens was talking about this morning, that we put in place here in Ottawa, is that people don't ask because they're afraid if somebody says yes and they don't know what to do next with that. So we put a huge amount of training into our nurses, as well as having a established, really well-run sexual assault and intimate partner violence program that's available 24/7 to basically take over and help these patients out of whatever situation they find themselves in.

AMT: Farrah Khan, what do you think of hospitals and doctors doing that kind of screening?

FARRAH KHAN: I think it's fantastic. I think it's one of many systems we need in place to support survivors of domestic violence. Do I think it's the only thing we need in place? No. And I think, but it's a one important piece. I think it's great when dentists also do that screening.

AMT: OK.

DR. KARI SAMPSEL: Absolutely. And we've been trying at the Ottawa Hospital, our next phase is to have it not be just the emergency department, we want it to be in orthopedics clinics, in obstetrician visits and various other places because these are places where women and men who are victims of violence end up going because they have something happen to them.

AMT: So how do you measure that the program is working Dr. Sampsel?

DR. KARI SAMPSEL: We haven't done a formal study in the same way as Dr. Klevens has done. We are in the process of getting that up and running. But I know that from within the emergency department, our job is to kind of have a spidey sense about what's happening and the number of people that our nurses come and approach our program with and say you know what I'm getting a weird sense off this person, can you come and check in with them? And they'll come and talk with them and find out that yes, they are having issues with violence and we can provide them information and provide them shelter or anything else that they are needing. And sometimes the information we provide is just, you know, we're here all the time. If you are feeling scared or unsafe or you want to make a change, come on back and see us. So we've also been involved with human trafficking rings and various other things that have gone the legal route of things. So it's been working but just we haven't studied it in an academic kind of way.

AMT: Farrah Khan, how well equipped do you think the medical community is to support and treat someone who is being abused by their partner?

FARRAH KHAN: It matters from doctor to doctor. I think we need more extensive training in our medical schools around this, in our nursing schools around intimate partner violence and sexualized violence. I think it's really important and I think actually, we need all employers also to know about domestic violence and sexualized violence. And we've seen that in inquest and also from the recommendations in the Death Review Committee that these kind of trainings are important across institutions. And that allows us to know that I think judges need more training, I think police officers need more training. This is across the board.

AMT: And Kari Sampsel, why do you think it is not mandated across the board? Your hospital’s doing it, there are places in Toronto, there's places in Calgary but it's not across the board.

DR. KARI SAMPSEL: You need a me. [laughs] You basically need somebody like me who is very strongly involved with this work and advocates for it, basically. There are a myriad of causes and issues and everything that take up everybody's time, so you just need somebody to champion this within your own institution to make this happen. It's not difficult, it just takes time and training.

FARRAH KHAN: But you need a mandate, you need a mandate from our province and we need a mandate from our governments, all levels of government to take this really seriously. You said earlier in the show, every six days a woman is killed by their intimate partner. That is a devastating number.

AMT: And well, there are people who know. If we look at the latest story in the news, there are friends who now are talking. So there's also the issue of empowering women to come forward. And we just heard, and I'm not picking on our first guest, but we hear again people who say we can't believe this would happen to someone of this economic class, with this kind of education. Is it surprising that a number of women, so many women don't want to come forward, there's still a shame factor. How do you empower women to be able to come forward Farrah Khan?

DR. KARI SAMPSEL: Keep talking about it. Make it as normal as anything else.

FARRAH KHAN: Yeah and I think making sure that people know that there's no shame and stigma with that. And I think there's a lot of times where women do, when they do disclose, people say well, why did you stay? Why are you saying this relationship? We need to understand the factors why women stay, why they stay for custody and access issues, fear of losing their children, the threat of violence that can further happen to other family members, hoping that maybe they'll change, I love the person, I want them to stay in a relationship with me but I just want the violence to end. That hope, that hope. And I think community stigma is a really big one. And this that came up with this latest case, is this idea that someone in a social economic background this can’t happen to them, that somehow they're superheroes. And I think when it comes to screening, yes, we can have screening at hospitals but if I'm a doctor, I may not go to a hospital to get a screening. So it's important to know about other parts and everyone being educated about here's a resource in my community, here's what safety planning looks like, here's who are experts in safety planning. Because here's the piece that I think is important to know with this case is that are coming through is that the most dangerous time for women is when they leave. Yet we tell women to leave. But when they leave, it's the most dangerous time. So we need to think about what are the supports in place, be it our police, our judges, our court systems, our community supports that can hold space so it doesn't become the most dangerous time.

AMT: Kari Sampsel, what do you think?

DR. KARI SAMPSEL: I totally agree. It has to be a community and culture wide thing, basically. You know, doctors are very comfortable in the hospital but they don't want to show weakness. They don't want to have that, you know, their personal life intruding into things but, you know, if it becomes something that is a entire society wide thing saying this is OK to talk about, this is not tolerated and we believe you, then I think the tides will change.

FARRAH KHAN: I love that you said and we believe you because I think that’s sometimes the most powerful thing we can say to a survivor is I believe you and it's not your fault.

DR. KARI SAMPSEL: Mmhmm.

FARRAH KHAN: Because too often we hear that, survivors being blamed, yeah.

DR. KARI SAMPSEL: Absolutely.

AMT: And how do you reach the person who does come in with the intimate partner, who does stay by their side so they can't talk to you?

DR. KARI SAMPSEL: There's all kinds of sneaky ways to get people out of the way, to talk to people in private. Sometimes we will use medical testing as a way to get people to talk to you. Sometimes we are saying that, you know, what, we're kind of overrun over here, we're not really allowing visitors right now. And the nice thing is is that hospital policy and hospital thing is put into place to keep the patients safe. And so we can invoke that any way we can to try to keep someone safe.

AMT: And so if you have this kind of screening and you have it in every hospital Farrah Khan, what other things do you have to have in place so that when someone says yes I do need help, that there's something to send them to, there's something to help them with?

FARRAH KHAN: I think you need adequate funding and support for violence against women services that provide that safety planning. We need our police systems and our justice systems to be able to support a woman when she says she's being violated, that they won't have to worry about losing access to their children. I think also we need to have education across the board for people in positions of power such as doctors, such as nurses and also teachers when they're listening to children coming in that witness violence and maybe disclosing things in schools. This has to be across the board because this is a community issue.

AMT: And again, you're saying that the shame that so many people feel has to be eradicated.

FARRAH KHAN: Absolutely. And I think understanding the dynamics of violence, that it can happen to anyone, that we stay in relationships to protect our children and we stay in relationships to protect ourselves, that we're scared to leave. I think also thinking about the fact that this has an impact on the family and community. And sometimes families say just stay together and maybe work it out, maybe you're just having a little bit of conflict. If you know that something's happening in someone's family, if you have a friend or a loved one say to you this person is hurting me, I'm scared, you need to step in and check in.

AMT: And Kari Sampsel, so if we're looking at changes in hospitals, that's a provincial change, right?

DR. KARI SAMPSEL: Absolutely.

AMT: Every provincial premier could change this.

DR. KARI SAMPSEL: Absolutely.

AMT: OK, well.

DR. KARI SAMPSEL: It would be a very simple thing for them to do and something that would have a massive societal impact.

AMT: OK, well, thank you both.

FARRAH KHAN: Thank you.

DR. KARI SAMPSEL: Thank you very much for having us.

AMT: Dr. Kari Sampsel, an emergency room physician and the Medical Director of the Sexual Assault and Partner Abuse Care Program at the Ottawa Hospital. She's in Ottawa. Farrah Khan, coordinator of Ryerson University's Office of Sexual Violence Support and Education. She's in Toronto. Let us know what you think of what they're saying. You can tweet us, we’re @TheCurrentCBC, find us on Facebook, go to our site cbc.ca/thecurrent and click on the contact link. That is it for us today. I'm Anna Maria Tremonti, thank you for listening to The Current.

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December 12, 2016 full episode transcript

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