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The Current Transcript for March 2, 2018

Host: Piya Chattopadhyay

STORIES FROM THIS EPISODE

Listen to the full episode

Prologue

[Music: Theme]

SOUNDCLIP

VOICE 1: The Truth and Reconciliation Commission of Canada calls on us to understand the gaps in Indigenous health as result of previous government policies.

VOICE 2: Discrimination against Aboriginal people it is in fact pervasive in the health care system according to this study which says ongoing racism has had a major impact on Aboriginal people's health.

VOICE 3: Many Aboriginal people don't use mainstream health care services. They don't feel safe from stereotyping or racism.

VOICE 4: You're somebody that's wasting their valuable time that they could be spending on you know somebody else more deserving.

PIYA CHATTOPADHYAY: Hello everyone. We are taping this show in front of a live audience at CBC Vancouver. This is the second in a series of public forums we're hosting on racial identity and racism in Canada. And today we're going to hear how race impacts health care here in British Columbia. But these are stories and issues that are playing out right across our country. First up today we'll hear directly from two Indigenous nurses about the discrimination they not only witnessed while on the front lines of health care but also experience themselves. In half an hour we will wade into the stigma of talking about mental wellness in some East Asian Canadian communities, and hear what cultural sensitivity in psychiatry might look like. And after that you'll meet the man that many temporary migrant workers call when they are afraid to go to a doctor because that could end up costing them their jobs and their livelihood. And then it will be your turn to talk with us. We'll be hearing from you here in our audience today about your experiences and questions about race in the health care system. My name is Piya Chattopadhyay and this is Facing Race. A special edition of The Current.

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'It has eaten a hole in my heart': Indigenous nurses call out systemic racism with life-or-death consequences

Guests: Tanya Dick, Diane Lingren

[Music: Theme]

PC: Racism against indigenous people in Canada's health care system is well documented and it has had life and death consequences. I have two nurses with me who are indigenous to talk about the sometimes life threatening prejudice they witness while on the frontlines of health care from emergency rooms to bedsides, but also how they're intervening to make a difference. Tanya Dick is the president of the Association of Registered Nurses of British Columbia and she is a member of the Dzawada'enuxw First Nations of Kingcome Inlet and Diane lingren is a Metis nurse and the provincial chair for the Aboriginal Leadership Caucus at the B.C. Nurses Union. Hi to both of you.

TANYA DICK: Hi

DIANE LINGREN: Hello.

PC: Tanya. Let's start with you. Start with your origin story. Why did you decide to be a nurse?

TANYA DICK: I actually went to school and wanted to apply for medical school but my grandmother got sick so I had to stay home with her. She didn't have much longer to live and I ended up going to nursing school to get some sort of undergrad to get into med school but fell in love with nursing and just stayed the course. My mum was a nurse as well so she had a huge influence on me.

PC: So this runs of the family. Diane, how about you? How did you come into nursing?

DIANE LINGREN: I had my children young and I was married young. I had always kind of made an arrangement with myself, an agreement that by the time my youngest son was in grade one that I would go back to university. So actually when Elijah was in grade two way I managed to go back to school and I married to this wonderfully supportive man that just did everything in his power to make my dream come true.

PC: When you were thinking about going into nursing did you, and if you did, how much did you think about the intersection of nursing and Indigenous health?

DIANE LINGREN: Not even a tiny bit. It never crossed my mind.

PC: And now?

DIANE LINGREN: It has eaten a hole in my heart. It makes me cry regularly. I've had issues with RCMP officers in the hospital that I work in and I beg them to not take people away in handcuffs. There's just such a huge discrepancy.

PC: And so tell me about when you have had a patient come in to the healthcare facility where you work and there's an RCMP intervention. What does that look like when an Indigenous person comes in and the RCMP are called in for whatever reason?

DIANE LINGREN: We could have a non-indigenous person that came in intoxicated and you know that person can be quite lively and acting out and causing some problems. What I see happen with them is they're given food, told to settle down and then they get a cab ride to one of the halfway houses or one of the like the night places that we have that open up, some of the churches open up spaces at night. With indigenous people I see the RCMP called. I see the RCMP handcuff those people. I see them handcuff their ankles to their wrists so they can't walk, they can't run away so they won't be a problem. I see those people get taken away in the police cars. And I've often tried to intervene and explain that my patient is a residential school survivor. Please don't tie them up. I will take them out. I will put them in your car I'll put their seat belt on. No. I am told by the RCMP that they're doing that for their own protection.

PC: I want to mention a response we got from the RCMP about some of the ways you said your patients have been treated by them. Here's part of what the RCMP has sent to us: "In any interaction with the public RCMP members are guided by the RCMP bias free policing policy which is based on the principles of equality and non-discrimination. Bias free policing means equitable treatment of all persons by all RCMP employees in the performance of their duties in accordance with the law and without abusing their authority regardless of an individual's race, national or ethnic origin, sexual orientation and so on." It's hard to talk about, huh?

DIANE LINGREN: Very hard, yes.

PC: And I guess what must also be hard is that the call to the RCMP come from your colleagues. We all have colleagues and so what do you say?

DIANE LINGREN: I tried to educate. I try to come from a place of peace. I try to- I get a lot of hate. I am a union steward at my workplace. My phone number is everywhere. I get phone calls, I get texts, I get Facebook messages. I get all kinds of things that come back to me. I get complaints put in to my employer. It's really really brutal

PC: And without going into the name calling and the denigration that you get, they say these things to you because they think you're what? You're doing something wrong? What is the assumption that they're making?

DIANE LINGREN: I am told that I am prejudiced against white people. That's the basic explanation of what happens.

PC: Tanya Dick, give me a sense of the kind of racism that you have seen in patient care.

TANYA DICK: From a personal perspective I just think about the Brian Sinclair case in Winnipeg back in 2008. The individual who had passed away in E.R. after 36 hours. My family has a Brian Sinclair story. We brought my aunt, my mum's sister, into emerge. She had presented herself after firing in the bathroom, it was unwitnessed fall, hit her head, was kind of staggering a little bit confused when she arrived. We ended up having an inquest and the ER form stated she was under the influence. As we progress, and this happened over about 18 hours, didn't progress to a higher level of care. Her head injury increased and she died as a result of it. And I think when we went through the inquest and we looked through every point of care; she was seen by the physicians, the nurses, the care aides, the RCMP, the ambulance crew, back to the RCMP, back to emerge again. It was 17 contacts with health professionals and that incident wasn't caught and every single one of them believed she was under the influence of alcohol. So she didn't get the proper care she required. It was a preventable death just like Brian Sinclair's were. And then I have the privilege and opportunity with the rule that I am in to travel throughout different communities and everywhere I went they had a Brian Sinclair's story.

PC: I want to talk about the assumptions and let's just call them what they are. So I'm an Indigenous person and I slipped and hurt my foot and I come into a health care facility whether it be in B.C. or anywhere in our country. What are the assumptions that are made about me as you see them?

TANYA DICK: It's drug seeking behavior and labelled as such, wrapped up, casted up, done whatever is needed but not even given anything for pain management or pain medication that anybody normally should. And they actually say that, I actually hear people say that. You know I'm sitting in the emerge room with my cousin who just got hurt on the soccer field and has played soccer around the world and they're accusing her of drug seeking. And it's like she's the healthiest person I know and the squarest person I know and it's just so unfair.

PC: For anyone who is injured or hurt going to a hospital, it's daunting. It's stressful. Tell me more about what you see that sets indigenous people's experiences in healthcare apart from everyone else. What other kinds of things are you seeing, Diane?

DIANE LINGREN: As a nurse and someone who has worked very closely with surgeons for many years. Two have them come to mind who have openly stated and actually give an education to the nurses and the surgical unit about how indigenous people have different pain receptors and do not need the same level of narcotics for surgeries.

PC: And what does nurse Diane say to that point?

DIANE LINGREN: The first time I try to gently pull them aside and have that conversation with them and explain that I am Metis. I feel pain and that I don't think I'm different than anybody else. That doctor then told me that he'd actually been to a Forum that had given him that education. So he's not the only one out there. I've seen those Brian Sinclair times more often than ever should have happened across Canada. Period. People who come in that have like Tanya's auntie had a bad fall, have a head injury, right away 'oh, there was alcohol in the house. They are drunk'. They come in, no C.T., no blood work, put in a bed and left in a corner. When I have taken that patients or those types of patients as own patient for the 12 hour shifts that we work I always - it doesn't matter who they are - I always go back and do research on each person. I want to know how they got to where they are and what I can do to support them, if there's something that's been missed. I don't trust anybody. It's my licence that's on the line for these things, too. And not only that but just the morality of having that person who has loved ones in my care is such a gift to me when I find discrepancies like this I do report them. I've had really supportive doctors that have come to my aid and really stood by and thankfully, but then I get these little meetings that I am called in to and I am told that I should probably be careful that people that like to dig for things get in trouble. So I just say what am I digging for? I was looking into my patient chart because there are my responsibility for that 12 hours.

PC: I imagine that both of you get sometimes: Your job is to be a nurse and you know put the bandage on, put the cast on, make the patient feel comfortable. Your activism needs to be left on the side. You say what to that?

TANYA DICK: I've been challenged that a number of times and I'm fortunate to have some leverage that I work in an indigenous community that you have to bring that advocacy into the workplace. And I think as nurses across the board and across the country it is part of our practice, it is part of our scope. And it's something that we sign off on our licence that we're going to do in an appropriate manner for all people. So when people do challenge me on that - and I'm challenged regularly that advocacy piece that I do with nursing within the healthcare as an Indigenous woman, I have to let it roll off my back. I will respond but I will continue as well.

PC: Given that these, they just come together; who you are and what you do. They come as a pair. How much pressure does that put on you, not only on your day to day job but speaking about it publicly? Because here we are speaking about it publicly. We're naming out. We're talking about it. You said you get some blowback from your colleagues.

DIANE LINGREN: I do.

PC: I imagine you might get some after this.

DIANE LINGREN: Probably.

PC: And how much pressure does that put you under?

DIANE LINGREN: It's an immense amount of pressure. I'm not afraid to talk in front of people. I am afraid of the backlash.

PC: That in your thinking might look like what?

DIANE LINGREN: Might my youngest son said to me when he was about, I think it was 12 or 13 years old, he said Mum you're going to get shot one day. That's pretty brutal. Just because I stuck up for somebody.

PC: I want to play a clip for you both. Nadine Caron first indigenous female surgeon in Canada - Look at the smiles on your faces - [Laughter] And here she is talking about a first nations patient's reaction when they met.

SOUNDCLIP

An example patient walks into my office. She is a First Nation is maybe that's travelled a distance. And I walk in and I ask her what nation she is from. She tells me and I explain, 'Oh you know I am Anishnabwe I am from the other end of Canada' and she starts to cry. She just breaks down crying. She's, I don't know, in her early 80s. She says I never thought I would ever ever see and come to talk to and Indian doctor. Eight decades. You gotta meet my grandkids. You gotta talk to them, you gotta come to my community. You gotta tell them that this is possible. So there is that element of it where you just see this relief sort of wash over her face.

PC: Tanya Dick what are you thinking as you hear what Nadine Caron is saying there?

TANYA DICK: I was visualizing my last set of shifts back home. The phone rings in the front and you have to walk through the trauma room in emerge room to the door to let them in. And then when they saw my face they literally were jumping up and down outside the door. It is so cute because as terrible as it is. They're just excited to see this brown face. They're excited to see one of their own and that they weren't going to have to deal with or experience what they were afraid or assume that they were going to deal with when they walked into the door to get help for whatever their issues were. And that happens literally every shift. So the answer they say we want to increase numbers of nurses and physicians and healthcare professionals of indigenous ancestry to help kind of project that. But that's part of it. Right. But we have to come at it from the other angle too because people- I don't like people jumping up and down outside the door of an emerge department but they should be happy to see whoever is there and feel safe and not have to worry about what they're walking into.

PC: And Diane Lingren when you hear where Nadine Caron said and when you got to work- Because you are white passing, right. People may not immediately assume that you are Metis. So when you hear Nadine Caron and Tanya say people jump up for joy when they see people who are indigenous being at the front lines of health care. That says what to you?

DIANE LINGREN: It's immense but it's a daily occurrence. I've been called a 'Windian' I've been called..

PC: A 'Windian'.

DIANE LINGREN: A 'Windian'. I am a White Indian.

PC: Whoa.

DIANE LINGREN: 'White eyes', or 'Whitey'. I've had managers saying 'well what are you?' And I just - it's a rhetorical question I say 'what are you? I am a nurse.'

[Laughter]

PC: ,Know we're having these series of town halls not only to illuminate the problems that our country is being challenged by, historically and in modern times, but also to try and bridge the divides, come up with some solutions. We know that there is systemic racism in the healthcare and you two have been talking with me about the individual experience, the day to day. So let me ask you both this. What's it going to take- It's a big question. You ready? What's it going to take to confront and tackle the racism you say you both face along with your patients?

TANYA DICK: This moment is kind of a turning point in my career. It's these platforms that we need to have, these difficult conversations that leading up to the days to this night and we're just getting more and more out. It was a great situation to put ourselves into to talk about our profession and our colleagues and a system that we work in and identify with that hurts people, but it's such an important conversation to have. The change will not happen until we have this conversation and in a way it's a two way conversation it's not being talked to as indigenous people and indigenous people talking to non-indigenous.

PC: Thank you to both of you. Thank you.

[Applause]

PC: Tanya Dick is the president of the Association of Registered Nurses of British Columbia and she is a member of the Dzawada'enuxw First Nations of Kingcome Inlet, Diane Lingren is a provincial chair of the Aboriginal Leadership Caucus for the B.C. Nurses' Union. I want to mention we reached out to the Canadian Nurses Association to ask them about what they're doing to address conscious and unconscious bias in health care. They told us they're working with communities, federal and provincial governments to implement the Truth and Reconciliation Commissions health related recommendations. The association also says and I quote: "Indigenous people can count on CNA's unwavering support for meaningful and continued reconciliation and in efforts to counter stereotypes and racism contributing to unsafe care and poor health outcomes".

[Music]

PC: We followed up on some of the more serious concerns we just heard. Diane lingren works with the Interior Health Authority in B.C. and we ask the authority if it was aware of concerns she raised about some health workers not adequately medicating indigenous patients for pain, because of false assumptions that they feel less pain than others. And we also asked what their policy was on calling RCMP officers to deal with patients. Here is part of what they sent us: "Concerns raised about the treatment and experiences of Aboriginal patients and staff are taken very seriously. There are no clinical practices or policies at Interior Health which are based on race or ethnicity. Involving the RCMP and situations in emergency departments is a last resort. Staff are trained to deal escalate challenging situations safely and respectfully". We also contacted the College of Physicians and Surgeons of British Columbia. Here is part of what they sent us: "The college has never received a complaint or even heard anecdotally that a physician didn't medicate an indigenous patient appropriately based on a belief that she or he feels less pain than a non indigenous patient. Denying such care would be completely inappropriate and may lead to allegations of discrimination which would be carefully investigated'. We will have these full statements along with more of the RCMP response to the concerns raised about hand cuffing patients all at our Web site at cbc.ca/thecurrent.

[Music]

PC: Coming up we will be talking about mental health in East Asian Canadian communities and why mental health experts are advocating for culturally sensitive psychiatric care. We have a pretty full house here at CBC Vancouver and in our last half hour we'll be taking questions for our audience right here, in the flesh and from all of you watching on Facebook live right now. I am Piya Chattopadhyay in Vancouver and you're listening to Facing Race a special edition of The Current on CBC Radio One.

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'The unspoken ones': How race and culture complicate Asian-Canadians' access to mental health care

Guests: Sally Lin, Queenie Choo, Hiram Mok

PC: Hi I'm Piya Chattopadhyay. And you're listening to Facing Race, a special edition of The Current

[Music: Theme]

PC: We are in front a live audience here in Vancouver and streaming live on Facebook. And we'll be hearing from both audiences in just a little while, during our town hall discussion. Before that and still to come, we'll hear from the Vancouver men, migrant workers call for medical help instead of taking a potentially risky trip to the hospital or doctor. But first we're talking about something that's only whispered about in some communities; mental health and the stigma of admitting you could use a hand.

[Music: Theme]

SOUNDCLIP

So there is this perception I think in a lot of Asian families that honor are is very important. Like if you do something that is going to bring shame on yourself, you are going to bring shame on your family to. And you are going to bring shame on your children and you're going to bring shame on generations to come. You're like you're airing out your dirty laundry, i.e. mental illness or mental health issue, and there's this pressure cooker when it comes to education. Like there's a lot of competition, there's a lot of fear over not succeeding and that's a lot to handle when you're young. So I think that's a barrier too, is that if you can't handle your own education well, shame on you. That's a weakness.

PC: That's Larissa Ho author of Becoming Silver Girl talking about the toll of feeling intense pressure to succeed and its impact on mental health for some people. No matter who you are, it is not easy to talk openly about mental health. Stigma exists for many many people but sometimes cultural barriers provide an added layer of difficulty that keep some Canadians from reaching out for help and when they do it can be difficult to find culturally sensitive mental health care. We've got three people with me here on stage to talk more about the challenges of getting adequate mental health care in Chinese, Korean, Filipino and other East Asian communities in our country. Dr. Hiram Mok is a clinical professor at the University of British Columbia's Department of Psychiatry where he is currently conducting research on Asian men's mental health. Sally Lin is a Victoria based writer interested in the intersection of race, culture and mental illness and Queenie Choo is the CEO of Success. It is a multicultural Immigrant Settlement organisation hello to all three of you.

GUESTS: Hello.

PC: Sally Lin let me begin with you. When you just listened to Larissa Ho and what she was saying in that tape what are you thinking about?

SALLY LIN: Everything she said really resonated with me. So I emigrated to Canada when I was eight years old from China. I took a lot of pride in my hyphenated identity of being Chinese-Canadian but definitely having both cultures have really impacted the way that I understand mental health. So when we first came to Canada it was it took a while for us to get set up just the basics you know work and school. So we had to basically 'eat our bitterness'. So this is the term that my parents said to me all the time but I didn't really start thinking about it until recently. They would say things to me like 'bitterness first sweetness later', constantly about everything from food I didn't want it used to real hardship that I experienced. And then so when I went to undergrad I did my degree at McGill studying psychology and anthropology but what drew me to psychology was that in psych 101 were learning about depression anxiety and I thought 'I think these things resonate with me but I've never heard of them before' because we never use those words and in fact earlier I was asking Queenie and Hiram how do you see depression in Chinese because I don't know. But I did hear a lot about eating bitterness and all of that and it wasn't until undergrad that I went to see a counsellor for the very first time. But the process of talking about what was bothering you felt like a process of vomiting up bitterness, because essentially what it felt like. All of these things that had accumulated was coming up.

PC: Is it fair to say that the translation for 'eating bitterness' would be 'suck it up sunshine'?

SALLY LIN: Something like that, yes.

PC: And help us understand for those of us who don't know your cultural background and the values. It is one thing to have a saying but help us understand the cultural underpinnings of 'eat bitterness, sweetness later'. What are the values?

SALLY LIN: In Chinese culture physical health is really prioritized so you know what to do today I got here a little bit early and I was walking in downtown it was really windy, and I could just hear my mother's voice say 'put a hat on'. I put a hat on and zipped up my coat. It was physical health that was always prioritized but mental health was never really talked about in my family at least beyond the bitterness part. Because if you look at Chinese history in the last century, just six revival was so important, physical survival that being able to talk about mental health in this forum I feel very very privileged.

PC: And so for you did you ever look for help in the mental health system?

SALLY LIN: Yes. I mean realising it is the first step and for me it was literally final second year. I was studying for a course that I had to memorize wordings. I was sort of memorizing you know making notes and I was like I don't need to memorize this. I am experiencing it right now, or a panic attack and I go 'yes panic attack. I think I'm having a panic attack. I should probably go see someone'. But after university you know a lot of mental health therapy it's not cheap, it's quite expensive actually. And that brings on another element, too, of feeling like is this valuable. Is spending this money on myself as opposed to you know the values of saving your money or supporting your parents or extended family. I feel pretty selfish. I actually had to call my mom and say 'hi mom, I am going to see therapists. It's not covered. You know it's like hundreds of dollars'. I feel really bad about this and I had to basically get her blessing to say 'no it's okay you can spend this on yourself. It's not bad that you're not saving this money you're investing it' or whatever.

PC: When you told your mother 'hey mom I'm going to go get some mental health care from myself'. What was your mum's original response to you?

SALLY LIN: She was quiet for a little bit and then she said- You know she loves me a lot and she's obviously sacrificed a lot. She was a nurse in China and she couldn't practice here. And so she sacrificed being close to her family you know for me and I think a lot of immigrant parents do that. And so when I hear anything about any immigrant parent anywhere I get really emotional. And so she, after thinking about it for a while, she said Well whatever will make you happy. So but I didn't tell her- I definitely didn't tell her how much it cost, like the exact amount.

[Laughter]

PC: Queenie Choo I'm curious how familiar Sally's story is to you.

QUENNIE CHOO: Well this is a very good question because my personal story. I am also and immigrant 30 years ago and definitely I can identify being a parent as Sally talk, describing the parents. But to me because of the stigmatization of mental- Well in Asian community we don't call it as mental health because mental health at least is health, but rather in Asian community we talk about mental illness. So you change the whole consultation. I think that really kind of didn't help the situation as Sally mentioned the example that even if you have some sort of need for some counselling therapy but sometimes that you could have been you've gone deeper into the situation and yet people didn't get help soon enough before they can get themselves out of the situation of being helped. So I think to me this is so real in the Asian population and compounded with being an immigrant.

PC: I have heard this anecdotally from friends are who are part of the East Asian diaspora, often kids of immigrants who when we talk about mental health they say well my parents would say to me or have said to me 'White people have mental health challenges not us' or 'don't tell anyone because you will bring shame onto our family'.

QUENNIE CHOO: Correct.

HIRAM MOK: Yes.

SALLY LIN: Uhmm.

PC: Familiar to all three of you.

QUENNIE CHOO: Absolutely. Because people think they're you know is considered mental health issues. 'Are you serious? Are you crazy?' You know that's what people are talking about. And this definitely is the dirty laundry in the household; who want to unfold the dirty laundry to somebody else that you don't know, it's somebody else's issues. Again the whole denial you sets in to the issue and totally. Why would you go to see a therapy of counsellor when you actually don't have a mental illness because this is all that denial. They don't even admit that.

PC: Hiram Mok, so pick up from where Queenie just left out and why it's important that we study mental health in specific cultural and racial groups. What are we trying to learn more about?

HIRAM MOK: As in cultural factors are important it plays a very significant role in the detection, in how people view their problems and also in how did access help and how they get into the treatment process. As Queenie has pointed out, the conceptualization of mental illness in different cultural groups is very different and sometimes they are very skewed. They tend to be very poor kinds of closing from very severe to normal versus not normal. So it is not over spectrum. And then we also have what Sally has just brought up. There is the collective loss of shame. There's also the culturally valued traits like stoicism and tolerance and if you go and get help is seen as weakness. Why can't you pull their socks up? You've got to eat the bit bit of fruit fruit? And in Chinese we don't also talk about [indistinct]. Is there a life of Destiny. You got to rely on your destiny.

PC: Is there a danger though, Hiram, in veering in to cultural stereotypes while trying to provide appropriate and in this case culturally specific care?

HIRAM MOK: Yes there can be some pitfalls. So one needs to be able to ethically match services and the language specific services.

SALLY LIN: I just want to add to that too because I think in my personal experience some of the therapies that I've encountered have kind of taken on a colorblind care approach. And I think the nurses were kind of talking a little bit, were they basically treated me like a young white woman and a lot of the recommendation that they provided were just not terribly applicable to me.

PC: Like what?

SALLY LIN: You know telling me to do breathing exercises to go to yoga and you know certain things. I can't go to a yoga class without thinking about cultural appropriation. I just think too much about these kind of things generally to be able to breathe actually elevates my breathing.

PC: [Laughs]

SALLY LIN: But that's just me. I think it does help a lot of people. So for me you know I kind of had to take things into my own hands where I thought 'okay. I am spending X amount of money on therapy. I'd rather you know come to Vancouver, go to Richmond, go for dim sum, some congee because that's actually makes me feel confident'. And you know I do want to make light of it because I think cultural practices really do ground us and then and I wish you know my dream is to walk into a room for a therapist to really see me and not to avoid the issue of race. I think a lot of therapists especially weight therapists and I know most of the therapist I encountered have been weight don't want to talk about it. It is an elephant in the room and so they really dance around it and I think that there should be more training may be provided for these therapies to know how to talk about it, because I feel like as a patient I don't want to have to explain certain things to them. You know how feeling like work perpetually a foreigner, perpetually seen as a forerunner and how that impacts my mental health. Or the like I was mentioning earlier the model minority myth of how you know when I was in school everyone in my class expected me to do really well in math but when I said I wanted to try track and field they said 'no Asians don't run' [laughter] but why not? You know I have legs. And when I want to try for the [unintelligible] team they thought it was really strange because I should be this and that obviously had an impact on me, those expectations, but I shouldn't have to teach those concepts to the therapist, because if I did they should be paying me $100.

[Laughter]

PC: Queenie Choo, in working with community members within your community what have you learned about the impact and the link between culture and mental health from your work?

QUENNIE CHOO: Well actually we've seen them every day. You know in terms of- especially for migrants who came here as refugees. I still remember many of them actually suffer a lot from their traumatic experiences. And you know I remember that in the 70s were the boat people from Vietnam who came and arrived in Canada, many of them you know lost everything in their life, livelihood, including some of their loved ones. So I mean just imagine just imagine for a minute how much trauma they have went through before they'd landed in a place in Canada. And not only that, I think that very often is, again, the cultural aspect, the language barriers are so amazingly important. I will stress that because these are the people are the unspoken ones. They are not able to communicate whatever they have in their mind and never mind about having some interaction with a therapist.

PC: Hiram Mok you're studying right now, specifically you are studying East Asian men's mental health.

HIRAM MOK: Right.

PC: And so as you you're doing your research what are you learning? Why are you focusing on this group of people? But beyond what we've heard in terms of the cultural context of all this, what are you learning about East Asian men and their relationship to mental health care?

HIRAM MOK: What is very shocking not too shocking is that we know that there are many large epidemiological studies all across the world showing that lifetime prevalence of depression, which is the more common disorder in the world right now, is that depression is more common in women than men. It is like two to one, right. Yet the suicide rates in men is four times higher. Men by five years younger than women in general - our lives are shorter, men - because they do drugs, they smoke, they drink alcohol, they don't look after their diet, they have heart disease, they have depression, they don't look after their psychological needs. There are many reasons and so the scholars in depression research have proposed there are some reasons that there may be a male type of depression. Because women when depressed become doctor's office, they cry, they lose sleep, they can concentrate, they have energy issues, but men when they are depressed they don't talk about it. They are withdrawn, they lose self-esteem, they have no self-respect, they are angry. We're trying to do this thing and I got this [unintelligible]. So I tried to do that Asian males, in Chinese men because in Vancouver 25 percent of people speak Chinese at home. So we been in 50 males in the outpatient clinic of Vancouver Hospital and also and some are GP clinics. So it shows that most of these scales that were used to measure male depression in Caucasians are not code specific for Asian males, which is not a surprise but we know that in the news you know you see a lot of Koreans or whatever, Asians they tend to present very late in the news that this statistic in the news that there's a violence, there is homicide. So a lot of these undiscovered cases where there's violence at home it could be the male being depressed and there's depression not being treated. So we need to be more.

QUENNIE CHOO: I will be curious too. I think that next after your study to do it on female, I think. And I think the female are actually are in a different situation where traditionally men go to work and female left the role bringing up the children. And it's another type of stress, I think.

HIRAM MOK: Yes, definitely.

QUENNIE CHOO: Certainly kudos to your study but I think that next phase we could do it on women raising their family. I think there another stress too.

HIRAM MOK: Definintely.

PC: Let me ask you this, Queenie, because you have worked for a long time in your community and we've talked about the barriers to accessing health care being language, cultural stigma. So my question for you working with Success is how are you trying to change that through Success?

QUENNIE CHOO: Certainly there are different way of handling the situation. We do we run out counselling services. We actually fundraise for that because I know Sally you talk about how expensive they are doing therapies. So we actually fund raise for that. And we are actually looking at different situation and progressing whether it is appropriate to do individual or family or the group, because very often in an Asian population in general there are also three generations living together or two generations living under the same rules. And that's kind of the family dynamics happened. So we tried to also look at group therapy, to look at group dynamics and making sure whoever the person who's perhaps is driving situation that the family members are in power equally in terms of the situation, rather than one takes on the role as the family kind of breadwinner and has all the control and power and the rest is kind of the follower and causing the stress within the family situation. So we do a bit of those as well and also we do kind of health fair annually to actually promote the programs to ensure people understand is it's not something to be feeling bad about. This is something actually you can access it. We can speak the language too so that you can understand what's happening. So we do hold workshops and mental health day. We said mental health day. So we didn't say mental illness day. So I think in a way to gradually changing the connotation of mental health in the East Asian population for sure.

PC: We are here today doing this town hall about race and racial identity as it connects and doesn't connect with our health care system. Hiram put this in the context of what we know about the connection between the impact of racism - and Sally spoke to this a little bit earlier about wanting not having to explain the racism that she has faced and faces every day to the therapist and not have to have to do that heavy lifting. But talk to me about the impact of racism on mental health in Canada.

HIRAM MOK: There is a whole lot.

PC: I mean do you see that in your practice?

HIRAM MOK: Yes and No. I mean in the first I certainly witnessed some of that when I do my shifts in the emergency room, some times, but not all the time. So I've seen some stereotyping going on. But in my own practice, because I do a lot of cross cultural work myself, I see a lot of that?

QUENNIE CHOO: Let me try to answer your question a little bit. Certainly Success as an organisation we are so very multicultural in nature. We have multilingual staff to address, to make sure the language there is being overcome. And certainly you know when we held the last forum on anti-racism and discrimination, in downtown Vancouver, certainly we actually release our statement in looking at anyone who feel that there is any distress being because of- It could be discrimination flyers in some community where the hate sentiment being circulated in community. Certainly there is certainly an uncomfortable feeling within the individuals or within the community and those needs to be addressed. I think to a certain extent, yes, there is some concern about that. We need to say we would like to offer those help to the individual or the groups that they need a bit of support in those areas because no one want to be targeted. And no one want to come to this country and being not welcome. So I think those cultural barriers definitely we want to make sure, in terms of racism and discrimination, those needs to be addressed.

PC: We will have to leave it there. Thank you to all three of you. Appreciate your being here.

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PC: Dr. Hiram Wok is a clinical professor for University of British Columbia's Department of Psychiatry. Sally Lin is a Victoria based writer interested in the intersection of race culture and mental illness. And Queenie Choo is the CEO of the immigrant settlement organisation Success. All right. Coming up next we are going to take questions and hear from you and our audience. And a reminder if you are tweeting about this problem please use the hashtag CBCFacingRace. I am Piya Chattopadhyay. This is a special edition of The Current on CBC Radio One from CBC in Vancouver.

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Why migrant workers call this man for medical help instead of seeing a doctor

Guest: Byron Cruz

PC: I'm Piya Chattopadhyay in Vancouver and you're listening to Facing Race, a special edition of The Current on CBC Radio One.

[Applause]

PC: This is the second in a series of public forums The Current is hosting race and identity in Canada. Today we are looking at how they shape our physical and mental well-being and influence our experiences with the health care system. Now to learn more about this town hall and others in our series please go to our website cbc.ca/thecurrent. In just a little bit, we'll be hearing from you here in our audience in Vancouver but before we get to that we have one more conversation to have about the challenges of health care access for migrant workers, workers like Danny.

SOUNDCLIP

Hello my name is Danny from Caribbean. I have been here nine month. I came here for working [unintelligible]. Now I am pregnant, so I need help because I'm feeling good. I am bleeding. Yes. I don't have medical coverage because I applied already but they did not answer my requests. I need Byron because he has some connection to can help me in some hospital. If I didn't have his help to me is like- I can't be lived in my situation. It is very difficult. I don't have any help and the city is so expensive. I can't go to the hospital by myself without medical insurance.

PC: That is Danny, she is here from the Caribbean and as you heard her say she is pregnant and the man she goes to for help is Byron Cruz an outreach worker with sanctuary health here in Vancouver. It is an organization that helps migrant workers navigate a sometimes precarious healthcare system. Many undocumented workers in Vancouver call Byron cellphone instead of going to see a doctor. They're often afraid of doing that because their names might be turned over to border officials. But there is also another group of workers in B.C. who have been calling Byron's phone. They're seasonal farm workers who have come to Canada with a illegal work permit and many do have health insurance and yet they still call Byron. Byron Cruz is here with us now. Hi.

BYRON CRUZ: Hi.

PC: We just heard about Danny. How common is that kind of situation?

BYRON CRUZ: It is very common. I was just texting with Danny, she cannot hear us today because she's working. She's working 14 hours today.

PC: And just so I understand this correctly, Byron, there are people who are working here in Canada legally. They have their work permits. They have health insurance but there is a waiting period before that insurance kicks in. Is that right?

BYRON CRUZ: Yes there is no illegal in working. Working is a human need, is a human activity to survive. And yes people who come here for example who we are talking about temporary workers who come to work in the fields they might have a private insurance. But with the private insurance might not cover pregnancy may not cover- Actually when they went to hospitals we had situations with a migrant worker went to a hospital [unintelligible] the only thing that he had was a private insurance and the hospital say no we don't take it. He said but I don't have money to pay and then they call [unintelligible] police. Police show up and unfortunately another advocate was called to come. She came to help the migrant worker and the officer said Yes I don't have nothing to be with this case.

PC: And so no matter what situation but for those that - I mean I shouldn't say that because there may be a delineation, but for people who have health insurance, right, who are coming here to work in Canada, what is the disconnect for them? What are they afraid of in calling for help through official channels?

BYRON CRUZ: In our work at Sanctuary Health we work with people with precarious Immigration status and precarious immigration status mean many many types of status. It can be the migrant worker that comes with a working permit and it's precarious because temporary migrant workers do not have the right for a permanent residence. Temporary workers do not have the right to work with other employer. So if they are abused in the farm thay can not change to another farm..

PC: So when they come to work can the employer that hires them, they have to work for that employer or leave.

BYRON CRUZ: They have to work with the employer. And imagine that this female migrant workers will get pregnant. We've had situations when they had to hide the pregnancy for many months because they are afraid. And also we have people who get injured at work. The only thing that they use is the Tylenol or the aspirin that the grandma put in their back pack when they came to Canada because they're afraid of going into the hospital because the owner of the farm will know that they are sick or they got injured. And for sure that this will have an impact and next year they will not come back because the owner will say you get sick too often. That's nothing nothing compared to the different abuses that they are having in the farms. They have GPS. Migrant workers have GPS in some farms where they had to turn on the GPS every morning. They had to mark when they want to pee. This count at the end of the season this come in the summary and if they went to the washroom many times they are not allowed to come next season.

PC: So the migrant worker who is here for say eight months of the year, goes back to their home country, that employer has the right to hire them again next year. What I think I'm hearing from you is what you're saying if a migrant worker breaks his leg at work working in the fields he or she doesn't go to the hospital to get healthcare.

BYRON CRUZ: Well depending on the farm but in many many firearms there are so afraid to do it. We had situations in the farm. This was a different story was a migrant worker playing soccer who had a fracture and then the physician needed him to be immobilised for a few weeks, have a cast. And basically he refused. He said sorry. I don't want it because of the owner of the farm realise that I am using it, he is definitely going to send me back home. And then he was on pain medications for a few weeks trying not to show his pain and this was a farm where the owner beat the one of the workers and the worker dropped a tomato and he came- He was not the owner he was the manager. He came and hit him on the face because dropping a tomato phase. Then 40 workers working there were so afraid of denouncing what was going on in that farm. This is Canada.

PC: So when they call you Byron and say 'Byron I slipped or was playing soccer and I broke my leg and I'm too scared to go to a Canadian hospital' because of all the consequences that you have- potential consequences that you have spoken to. What do you tell them to do?

BYRON CRUZ: Well it is really scary. If it is a phone call, we usually we ask people to send us picture of the jury. And I recently sent to CBC one of the fingers that had a nail that went through the finger and the worker was so afraid of going to the hospital because hospitals are also point of entrance to Guyana that border service agency. Many physicians many specialists in the Vancouver coastal health area called CBSA when there is a worker who cannot pay for the service. We situations when surgeons and anaesthesiologists call Immigration Services when a woman go for having a labour in the hospital we have rule that we will be calling sometime soon [unintelligible] of decisions to make all of these nonsense that are happening in the Vancouver coastal health area.

PC: I got to say that there are some people listening right now who are saying 'Byron you seem to be talking about things that we hear about the United States, not in Canada, that people aren't seeking care in our health care facilities because they are scared that they will have an immigration official show up at their door.

BYRON CRUZ: Definitely there are so many people were afraid with a lot of the reasons. Hundreds or phone calls went from the hospitals in the Fraser health authority few year ago, they call immigration so many times for workers that were injured there? What for? Just because there is a law, there is an internal policy that allows them to [unintelligible] workers who are too sick? What is about? Where is privacy? Where is the confidentiality? 10,000 migrant workers come to BC every year and they are not respected, their confidentiality is not respected. And then we had a campaign against Fraser Health. And finally we are happy to say that in our last resort since January last year official no phone calls have been gone from the hospitals of Fraser health to Canada Borders. We hope that does not going to happen again. If it happen again they will hear been from us.

PC: Okay. I want to play a bit of tape from you. This is Harsha Waliaa the community organizer here in Vancouver and she says the migrant worker program was designed with specific certain goals in mind.

SOUNDCLIP

The migrant worker program actually started, its kind of genesis was that it was workers from the Caribbean that were brought into Canada and particularly because Canada wanted people to work as cheap labor but did not want to change the ‘Whitness’ of Canada. And so the migrant worker program has its roots in this philosophy of white Canada forever and particularly in anti-Black immigration policy. And even though you know now it's not as explicit in its racism, like you won't to see those words anywhere but the intent is exactly the same. I would argue ensuring that racialized people, particularly black and brown people, are in Canada but only under the position of subjugation and to perform labor and then be removed.

PC: Byron Cruz when you hear that what do you think? Do you echo what she's saying?

BYRON CRUZ: I definitely support her statement and this is a system of exploitation and they know that having brown people like us we are going we would call for rights to unionize. We're coming with lots of fears because we have been oppressed and repressed in our countries and here we have been oppressed now and we know have the boys because if the migrant workers raise their boys they will come next year.

PC: What do you tell these migrant workers?

BYRON CRUZ: We are always terrified to see what the situation is. If we have someone who had an injury who needs emergency right away we are always clear to people 'you need to go to emergency. We might accompany you. Then we start asking our collective members to see what can accompany them to the hospital. At least for the hospital to see that someone is behind them supporting them. And then if we have the time to assess we will assess. But sometimes we have a situation like someone who had an injury on his face he needs the stitches. We couldn't find a nurse who could do these stitches. It was three hours, four hour trying to find a community centre that could do it. We were told 'No. No. We can do it' and then a member of the collective who is a veterinary guy he said 'if no one does it I will do it because I have done that on the cow before'. For sure he would do the best job. But fortunately a nurse practitioners called on time as well. He went to a community clinic but many practitioners still has 'sorry Byron. I cannot doing in the clinic but I do it after my shift. Byron sorry I'm having my dinner' This guy with a dislocated arm and then the doctors say 'I'm having my dinner. But ask the guy to come near and I will help him'. The guy went to the behind the restaurant and his arm was returned to his place. This is Canada. And many people ask 'is that legally? Are doctors doing this legally?' Of course if they are helping people. If they are preventing death, they are preventing something to go wrong, they are totally on the legal side. There is nothing illegal about that. It is like a harm reduction. When the society realise that there were hundreds, thousands of people dying on the street. They were not doing anything but suddenly harm reduction - The activists of harm reduction came strongly and said we need to save lives. Drug users are first nations. Drug abusers are poor. Drug users are part of the community and then harm reduction came as an important model and the society realised that there was a problem and they needed to face that problem. What I'm seeing right now is that we have a problem. We need to face that problem as a society.

PC: Byron Cruz thank you very much appreciate your time. Thank you very much.

[Applause]

BYRON CRUZ: [Indistinct language]

PC: Byron Cruz is an outreach worker with Sanctuary help here in Vancouver. By the way I want to mention we contacted B.C.'s Ministry of Labor about this issue. It told us 'all workers in this province are entitled to the same protections regardless of their immigration status'. But they did acknowledge that temporary workers are vulnerable to abuse and intimidation in the workplace. The ministry also says it plans to create a provincial temporary foreign worker registry that will help protect vulnerable workers from exploitation and enable them to track the use of the program.

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PC: All right. We're just about to get to the Q and A with our audience in Vancouver but I want to let you know that we followed up on Byron Cruz's concerns about some hospitals in Vancouver Coastal Health are making calls to Canadian border officials. Here is part of what they said about their policy: "Vancouver Coastal Health that is focused on providing health care for those in need. And we are not involved in immigration matters. VCH policy regarding privacy and confidentiality of patient information limits the circumstances under which we release client information to law enforcement. Information can only be shared if the client has authorized us to do so or if there is an active police investigation or court warrant'. And with that, back to the town hall in Vancouver and our first question from the audience that kicked off our Q and A.

JADEN RAYLESS: Hi my name is Jaden Rayless. I have been a mental health patient and I have been fortunate enough to have the support of my family and be able to access the system. However in my group therapy I did observe certain races especially Aboriginal people that did not have the exact access to the support. So for example when this individual was having a crisis the only number he could reach out was 911 because ambulances and mental health services, psychologists and all of this is not an essential service. And the psychiatrist system in Vancouver, it's really amazing and we're fortunate to have that. However again not everyone is going to have the access to this systems. So what happens with those people who are like different races, who are in the lower brackets of society, who cannot afford this?

PC: Tanya Dick, why don't we start with you?

TANYA DICK: Good question. I just think about the practice at home when we have people - we fall under the federal program for health services for health benefits that don't cover psychologists. Some psychiatrist work but the act like you said the access isn't the same that disparity is there through policy and legislation and budgets. So those things can very easily be changed. I think in all fairness when it comes to mental health that work needs to be done across the board that yes, there is a disparity for indigenous people and vulnerable populations but in particular indigenous people, but I think the general population we have to fear the mental health system overall. Those gaps are huge and a lot of societies filing through them.

PC: Okay. I want to take a question from Facebook live. This comes from Jocelyn Laymen on Facebook and her question is to Diane Lingren and Tanya Dick. Here's Jocelyn's question: What would you like a young person considering nursing as a career to know about the calls to action and reconciliation? Diane.

DIANE LINGREN: I would like to acknowledge the territory that they're on to do their best to educate themselves on whether that's through reaching out to someone like Tanya or I. I just I just ask for allyship.

TANYA DICK: I think the work that the truth and reconciliation commission did with their final report was an amazing framework. It's laid out for all of Canada to follow. I've always felt it very important for individuals in this country to define reconciliation for themselves as individuals and as professionals. And what does that mean in their day to day life whether it's personal or professional and utilizing those frameworks to move throughout their practice. It's a role model, what's in there because it's hard for the indigenous people to do ads for Canadians to do. It's for all of us.

PC: Do you have a question? We have time for one or two more and if you could just tell us your name and then ask your question or tell us your story.

JEFF IBONTE: Sure my name was Jeff Ibonte and I am a mental health commissioner and have been so in Vancouver for the last 17 years. Am here as a father to my son and I'm very proud to have him here and witness your bravery. My question to you is: I constantly need to be an advocate because I am a father and a husband. And I get tired and when I get tired I find my allies. I talk to my wonderful wife and my friends and so forth. How do you keep the fire going in this fight that concerns all of us?

TANYA DICK: I actually lately have really found a lot of my inspiration and wind in my sails coming from the younger youth nursing students. I say they mouldable but its more their keenness, they're inspiring, they see the change that needs to happen and they're rolling up their sleeves and asking and trying to figure out ways to make that happen.

PC: Sally you want to add something?

SALLY LIN: So I'm not a nurse or a practitioner but I've been exploring poetry as a way of self-care and self-mental care because as I have shared it's difficult for me to find the type of mental care that I'm looking for. And so I find the arts really inspiring whether it's music or movies or poetry. And so really simple things just trying to find joy in my life as I'm learning more about how to support different groups, migrant workers, indigenous people, through you know simple things like going to see Black Panther. I am going to go see it again because it was great. It made me feel really hopeful, listening to music [unintelligible] we have so many indigenous musicians who are just doing so well. And so when I feel down after reading the news you know Colten Bouchie that was really a tough weekend. I needed to balance that out a little bit in my own life. So I listen to [unintelligible] who has really uplifting music and things like that. You know it's we have to build that into our into our lives if we want to make this sustainable as individual advocates.

PC: We have a question here in the front row. What's your name?

CATHY BROWN: Hi my name is Cathy Brown I'm a senior. I'm blind and I'm a pretty active disability activist. And I applaud all of you for your advocacy because in our community we face a lot of skewed perception's and ignorance and fear and hostility. And I wonder within your new release and also within the health care system if you find the physical disabilities, especially invisible ones that people don't understand, add another layer of challenge to how you deal with the healthcare system? Thank you.

PC: Who wants take this one? You're on the front line, Diane? Diane Lingren go ahead.

DIANE LINGREN: Absolutely they definitely add another layer. You get labelled as a complex patient whatever that word means. As soon as you have more than you know two or three things collaboratively wrong. I'm a complex patient myself and it's not easy and I have to go to the doctor every two weeks and it's so time consuming and it's draining and it takes away from other things that I want to do. Absolutely adds other layers and impedes access in many ways too because they say 'Oh, look it's her again. Frequent flyer'.

[Laughte]

PC: We have to have a one or two more questions in the room here.

OMAR: Hi my name is Omar. My questions for a final speaker. We heard the recording of a woman who was pregnant and having trouble accessing healthcare. I think you mentioned it as well in your talk, you spoke about migrant workers coming pregnant and I wanted to ask you to elaborate a little bit more about the challenges of finding maternal care and what happens to the babies once they are born.

BYRON CRUZ: We have many situations you know. A woman who is pregnant who has some issues with medical insurance, if they go to the hospital, at the point of entrance they will let them know that they can access the hospital and the cost of delivering a baby will be 15,000 dollars if it's a normal delivery and it can go to 30,000 if it's a C-section. Unfortunately this is the case by case. It means people to accompany people to advocate one by one in order to access prenatal and delivery services, not to mention termination of pregnancy. It is expensive as well and there is a lot of barriers to access termination of pregnancy. But there are lots of barriers in terms of pregnancy. And then we had the situation if B.C. woman will not assist this specific migrant person they might end the work hospital. Well there are terrible terrible experiences because that's when I was referring to specialist as that make phone calls to patients daily and telling them 'if you don't come and pay in cash, we'll call Immigration Services because we are legally obligated to call immigration services'. There is nothing like the legally obligated. They should not be calling immigration services. That's the illegality of that. Then there are many barriers that migrant woman are having when they get pregnant and we hope to have this discussion provincially and at a federal level as well because it's scary. We don't anyone to die. We don’t ant a woman to die. We don't want a baby top die. Then it is case by case if situation doesn't work because so many people have, if they don't know us, if they don't know any advocate how can they get into the service. We are so afraid.

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PC: We will have to leave it there thank you to all six of our guests today.

[Applause]

PC: I would also like to thank the people involved in putting this forum together. This forum was produced by Yamri Taddesse, Pacinthe Mattar , Leanne Stopnow, Anne Penman, Nich McCabe Lokos, Lara O'Brien, Kathleen Goldhar, Cathy Simon. Our digital producer is Ruby Buiza. Our technical team is: Bruce Whiteford, Brad Stewart, Johnny Wildcat, Colin Fode, Bryan Chan, Matt Innanen, Matt Brown and Bill Wouterloot. Our camera operators are: Richard Grundy, Mike Zimmer and Colin Fode. Our makeup artist is Meaghan Zwick. Our photographer is Wendy D. A special thanks to Lien Yeung, Caroline Ewald, Nadia Greenidge, and our communication teams in Vancouver and Toronto. And most of all thanks to our listeners, the ones who are here in person, and all of you out there online. Thank you. You can find photos from this event and more on our Web site by going to cbc.ca/thecurrent. Check out our Facebook for more information about our series. I'm Piya Chattopadhyay at CBC Vancouver. Thank you for being part of Facing Race, a special edition of The Current.

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Friday March 2, 2018 Full Episode Transcript

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