Uncategorized

December, 2013

When they arrived as landed immigrants to Ontario, they came to be with family, to support their family. They lived half a world away. Their daughter, her husband and their grandchildren are in Canada.

Like others new to Canada, their daughter and son-in-law came to Ontario as landed immigrants 20 years ago. Like the majority of New Canadians, these newcomers succeeded. They became Canadian citizens. They furthered their skills and education. They took jobs. They started a family. They contributed and continue to do so.

Some years back, her parents applied to come as landed immigrants. Their children had secured the financial resources to support the application. In November, 2013, the grandparents were granted landed immigrant status.

They made their way to Canada to be their family, their grandchildren. They would help with care of the children so the parents could work.

A week after arriving, one of the grandparents became ill. It turned out to be a cancer. There was a chance to cure it with surgery — a major operation.

But, and here it is again, there was deal breaker in the works. The 3 month wait for OHIP. Unable to afford the surgery, doctors bills and hospital costs, and with no guarantee private insurance would pay the bills, they returned home for care.

Coming to Canada is off. Another protracted application will be required – that can easily consume years.

This unimaginable tragedy is more common than most Canadian realize. In fairness, Ontario has shown leadership by providing healthcare coverage to refugee claimants abandoned by the current Federal Government. For this, our Premier and our Health Minister are to be commended for humanitarian leadership.

It is just one more small step to end the 3 month wait Ontario imposes ( one of only 3 provinces to do so). Let’s do it. Its the right step to take.

Uninsured Scarborough Clinic – November 2013

Luma is a 4 year old little girl. She was born in Canada. Her mother immigrated here years back, and is a naturalized Canadian citizen.

Luma has a developmental delay. She is a sweet, active little girl. She loves teasing and interacting, but is non verbal.

Luma was brought in to clinic by her School Principle. She was aware of the free clinic. The Principle was also desperate to help Luma and her mother receive the urgent medical care Luma needed. Luma and her mother had just returned from a war torn country in the Middle East. Her face had become swollen, covered with infection. It had progressed into an intolerable urgent problem.

Her mother had taken her daughter to the ER. She was shocked when she was told both she and her daughter’s OHIP cards were now invalid. She did not have the money requested up front for medical care. She left. Several days later she tried a walk-in clinic. She paid the $75 and was seen for 5 minutes and given a prescription for an antibiotic. Despite this, Luma’s infection worsened.

When we first saw Luma over half her face was infected. Her one eye was swollen almost shut. It had entered her nostrils. Pus flowed out. She was febrile and uncomfortable.

Why did 2 Canadian’s, one a 4 year old mentally delayed child, have invalid OHIP? Why did OHIP reject pleas from the mother, the principle and our clinic to re-instate coverage on medically necessary humanitarian grounds?

All Canadian citizens who leave Canada for more than 212 days are made to wait 3 months upon return for their OHIP to become active. Any payment for illness in this time period is their responsibility.

But Luma and her mom had left Canada for only 3 weeks to visit family overseas. On their journey home they stopped over in another country so Luma could meet, for the first time, her aging and ill grandmother. They planned a short visit.

But the war escalated. Airports closed and flights out stopped – particularly for those with foreign passports. They make better hostages, with more leverage.

When Luma’s mother went to the airport, she was told by armed forces they were not leaving. She went 3 times. On her 4th effort she was told if she returned she and her daughter would be shot dead.

When they finally managed to get out, over 212 days had passed.

When mom, the principle  and our clinic each contacted OHIP, we explained that Luma was out of Canada due to a hostage situation, and not by choice. At first we thought her facial infection was the result of chemical warfare exposure. She was malnourished, as are most children in war zones.

OHIP was unwilling to make any exceptions. Finally, after contacting the Ministry of Health offices, we reached someone “prepared to look into it”. I checked a month after our contact and Luma’s OHIP had yet to be re-instated. All treatment was completed by then and all of it was provided by and covered by volunteer providers on a humanitarian basis.

All’s well that ends well? We hear this all the time. It is an unacceptable response. Lack of health insurance for new Canadians, and Canadian citizens is an unacceptable game of Russian Roulette. How many can volunteers treat, and how far can their care extend when a hospital stay is $2000 per day, and an MRI is $1400?

Luma’s 3 month nightmare is not isolated. Yet it is easily avoidable with less primitive policy. Our next entries will tell you of others.

July 10 2013

– 70% of the Roma we saw no longer come to clinic. We hear they were deported, or simply gave up and went back.

– Miguel’s malaria is treted and he is smiling again. The parents have the large bills

Miguel’s pregnant mother with malaria no longer has fevers. She is feeling better. Donations have let us get her an obstetrician.

– Our patient with Sickle Cell disease and crisis is under a deportation order after 5 years in Canada. Return to his home country where there is no treatment, means death.

– our patient whose IFH was feeling forced into an unwanted termination of pregnancy because of fear of no health coverage with IFH new rules delivered a healthy baby. Some costs for care were excused by providers, others paid from donations, and lawyer helped re-establish IFH after many months of delays.

– Ruth, whose family were murdered in front of her, brought her newborn Canadian child to see us. A beautiful baby. Ruth is on track with her Canadian citizenship. Still no meaning as to why she denied IFH when she came.

– Duncan died from his bowel cancer. No treatment provided. No health insurance. Father, grandfather he was a good man who might be alive with treatment. He was here as a sponsored person, by his daughter. She works in GTA seniors homes, a personal support worker, helping our elderly — and watched her own father be denied treatment and die.

Clinic, July 4th, 2013

When we arrived and picked her up into our car she was panting, short of breath, with high fever from her malaria, 6 months pregnant and anemic, and sitting on the curb at the side of the road. We didn’t know it then, but she stayed at home for a week, with fevers as high as 104, afraid to go to hospital because of costs, money they did not have, money they needed for Miguel’s care.

What we witnessed today was outrageous, shameful government policy and abuse. It is also an unfolding personal tragedy for one new Canadian family. If no healthcare happens it will leave Mom at risk of death and disease that will leave their future child, our future Canadian infant dead in utero, or born damaged for life.

We wrote last week about 1 year old Miguel. He developed potentially fatal malaria shortly after arriving in Ontario with his parents, as Landed Immigrants. Along with over 100,000 other landed immigrants each year, they found themselves stuck in Ontario’s mandatory 3 month wait for OHIP and healthcare access.

One bill for his malaria care has arrived to them. Another larger one is in the mail. And more will follow, as you will read.

Today, we learned Miguel’s mother is now ill with malaria too. She is 6 months pregnant, required to travel to Canada pregnant because of flawed, inhumane Canadian immigration policies and procedures. Her life, and her unborn baby’s life are now at grave risk. She and her unborn are here legally – and in jeopardy.

Her malaria is not her fault. And It went undiagnosed by Canadian health providers at the airport when they arrived.

Mom’s due date is September 15th, 2013. Her wait for OHIP eligibility in Ontario does not end until September 9th. Close call. They may not make it. She may need a C section earlier. And she needs urgent malaria and other pregnancy care.

Already their hospital bills for Miguel’s care exceed the savings they brought with them, savings required for immigration. Already they are near financial collapse through no fault of their own. Pregnancy, malaria and delivery care expenses will leave them totally destitute and in debt as they begin their new lives as Canadians.

And no healthcare will leave Mom at risk of death and disease that will leave their future child, our future Canadian baby dead in utero, or born damaged for life.

And then, 2 weeks after this would happen – their OHIP health coverage will arrive!

Today, when we saw that her blood test showed malaria, we asked Mom to come in for treatment right away. When she was late for the appointment, we called her. They had gotten off the bus 2 miles from the clinic at the wrong stop. With no money for another bus, she tried to walk the final 2 miles to our clinic!

When we arrived and picked her up into our car she was panting, short of breath, with high fever from her malaria, 6 months pregnant and anemic, and sitting on the curb at the side of the road. We didn’t know it then, but she stayed at home for a week, with fevers as high as 104, afraid to go to hospital because of costs, money they did not have, money they needed for Miguel’s care.

The infectious disease specialist from the hospital generously did “a house call” She came from the hospital, to the volunteer clinic that day to see Mom. We arranged this to prevent an ER visit, and to prevent a hefty bill to the family – and hospital – and taxpayer.

Mom is now on treatment. The specialist is an angel. The CVC is providing follow up care and medications from donations and grants.

A hospital ER visit, another huge bill to the family have been averted. And likely a premature delivery and damaged Canadian baby. That would cost millions$ to all.

How all this predicament happened is not in anyway the family’s doing. It never is any landed immigrant’s family’s doing. It is Canadian and Ontario Immigration and Health policy that is at fault .

The family of 3 came to Canada in early June 2013 from Africa, to provide a better life for their son, and to seek safety. Both parents are educated and left good jobs back home. Their homeland is no stranger to political violence. Our clinic sees many from their country afflicted with severe injuries. The mother is a teacher, the dad an architect. Remember Miguel? He is 1 year old. He is an infant.

In 2009 the family of 3 applied for landed immigrant permission to enter Canada After the usual wait time, in 2011 they received their acceptance from Canada.

Next, it took 2 years to wade through the medical exams and other administrative requirements before final permission to arrive was granted. This is the norm. In mid April 2013 the family was informed they had until June 26th 2013 to arrive in Canada or their permission would be revoked, and they would be required to re-apply all over again.

None of this is unusual. But, it is why there is a massive backlog on the ground at Canada’s embassies. It is the mark of a deeply flawed immigration policy. And it why women like Miguel’s Mom, and their pregnancies are put in harm’s way.

Like other Landed immigrants, when you are young, and waiting 4 years in your home country, building a family happens. If they waited till her baby was delivered, in theirr home country, and this is the logical preference of many, then their legal landed immigration permit would be revoked. Their applications would have to start all over again.

And Canada has suspended new applications! That means their immigration and safety would end if they stayed back to have the baby.

Forced to make a decision, the family decided to immigrate during their pregnancy to avoid missing their deadlines, and take the chances with good health, and keep their dream of a better, safer life for their children alive.

What choice did they really have? What would you have done if you stood in their shoes?

A final note:

As part of their final immigration step, they required medical clearance by Canadian medical staff at the Toronto airport upon arrival – to determine they had no infectious illnesses.

So how then, was their malaria missed?

According to the family, those medicals lasted 5 -10 whole minutes. That’s how. And we hear this all – the – time.

When we pleaded to Premier McGuinty and Ontario’s Health Minister a year ago for some funding to help patients, and to END the 3 month wait, the reply through the Ministry of Health in Ontario – “we don’t have the money”.

BS. Yes you do. You just chose to spend it on cancelled gas plant contracts instead, so you could retain power. You chose to save money on the backs of Miguel and his pregnant Mom. And that won’t save anyone of us a penny.

You had a clear choice.

Clinic June 25th, 2013

One year old, and 3 weeks in Canada. Is this fellow one of the “bogus” who get better healthcare than the rest of us?

Mom, father and son are Landed Immigrants ( yes, very legal) caught in Ontario’s 3 month wait for healthcare.

“He” arrived at clinic tonight for follow up. “He” came to Canada with his parents on June 4, 2013. Like the majority of new arrivals, “they” chose Ontario, and then Toronto, and more specifically Scarborough, to settle in.

Three weeks after arriving, Miguel (“he”) suffered  a high fever and  seizure. Keep in mind Miguel is 1 year old, brought here by his parents to Africa.

After a trip to a GTA hospital, and a transfer to the Hospital for Sick Children in Toronto, Miguel was diagnosed with malaria.

Untreated, malaria is fatal. Without follow up, it can be fatal. They were sent here by Sick Kids, for follow up.

Next come the dream ending hospital bills for care – for Miguel, the 1 year old. Hope he has a piggy bank large enough.

On Canada Day 2012 Jason Kenney, Federal Minister of Citizenship and Immigration slashed healthcare benefits for Canada’s refugee claimants and others. Kenney accomplished this by Orders in Council, ducking the usual parliamentary process such matters of national implication warrant.

On June 17^th, a year later, Canadian physicians and other healthcare providers will gather nationwide to shine a spotlight on Kenney’s cuts, and their unhealthy impacts on all Canadians.

How have the Minister’s cuts worked out?

Canada’s Interim Federal Health Program (IFHP) provided health benefits to refugees making allowed claims. Why did Kenney feel it necessary to “reform” a functioning IFHP that wasn’t broken? The IFHP was hardly a pressing ballot box issue when Kenney acted. Why would he feel it necessary to put our most vulnerable new arrivals in harm’s way to fend for themselves when ill? Why does he ask them to pay down our national deficit with their health, a deficit they had no hand in creating? Many are already fleeing poverty and violence. Many are children and youth new to Canada.

Kenney and his spokespersons repeatedly recite the same reasons, as they recently did in an article by Nicholas Keung (Star, June 9^th 2013)

“Canadians have been clear that they do not want illegal immigrants and bogus asylum claimants receiving free, gold-plated health care benefits that are better than those that Canadian taxpayers and seniors receive.”  Said Alexis Pavlich, Kenney’s spokesperson.  Kenney has said the reforms will save taxpayers $100 million over five years.

Really? What Canadians have been clear? How many? What benefits are gold plated? Who is “illegal”? Statements like this must be backed up with data and sources.

It is dubious Kenney’s cuts will save any taxpayer any money. The $100 million he cites translates into 20 million taxpayers each saving a Loonie a year, for 5 years. Imagine knowing your unborn child, a new Canadian citizen, isn’t worth that.

In Ontario, community hospitals and taxpayers are already feeling the financial download of Kenney’s cuts. Toronto is a city defined by more new arrivals than any other (45% of Canada’s annual immigration). Are we surprised to learn in the same Star article that Toronto hospitals are racking up debts in the millions of dollars providing care to persons Kenney cut loose form IFHP?

As the illusionary savings he promised evaporate, some provincial premiers now openly criticize Kenney’s actions, calling his cuts for what they are  — a download of Federal costs onto provincial and municipal taxpayers. The premiers are rightly concerned about the impact the cuts and refugee delays are having on Emergency Rooms, hospital bed shortages, and lengths of hospital stay.

Most refugee claimants denied access to IFHP benefits can’t afford healthcare. At our community volunteer health clinic for the uninsured they arrive, having waited until they are too ill to wait any longer. This includes pregnant women, and ill children. According to the USA Centre for Disease Control, in 2004 a premature low birth weight newborn with brain injury from unattended pregnancy care generates over a million dollars in lifetime costs. Are we saving money yet?

Kenney makes the claim that refugee claimants receive “gold plated healthcare better than Canadians receive”. He talks of “bogus and illegal claimants” taking Canadians for “suckers”. But again, are these accurate facts, or ideology talking? Unfortunately neither Kenney nor his spokespersons have provided the needed evidence. It is time to calm the hyperbole and tell Canadians the facts about IFHP.

All refugee claimants are entitled under Canadian law to make a claim in Canada. This is not “illegal”.  Pre Kenney they all received IFHP healthcare benefits that ended if their claim was rejected. Under IFHP rules doctors have to seek approval for healthcare benefits, benefits Canadians receive without restrictions. These requests can be denied. The ancillary benefits (e.g. vision care) are also available to Canadian residents in similar social assistance plans.

There is no “gold plated” refugee healthcare coverage that trumps what we all receive.

Referring to the impact of the Federal cuts Doctor Meb Rashid of the organization Doctors for Refugee Care and Medical Director of the Crossroad’s Refugee Clinic at Women’s College Hospital commented “It’s an absolute mess”.

We agree. At our Volunteer Clinic that mess is a now a health and financial nightmare for thousands. Kenney turned the IFHP program over to Blue Cross, a private insurer. It is so bureaucratic, almost so unusable that many doctors have declined to sign on, and refugee claimants are afraid to ask.

Others have found more innovative, cost saving and humane solutions. The University of New Mexico Health Sciences Centre, serving a population of 13,000 uninsured newcomers saved 1.9 million dollars in hospital costs per year by providing uninsured newcomers comprehensive, less expensive primary and preventative care in the community. The program freed up beds and reduced wait times. The program worked.

It is a shame that Jason Kenney does not understand this. Or if he does, it is a shame everyone has to pay for his ideologies, while refugee claimants must go without healthcare.  On Monday June 17^th, Canadian physicians and allied providers will make our voices heard for healthcare justice, better government, and real cost efficiencies for everyone.

Clinic, June 18th 2013

This evening 43 patients arrived for medical care. Forty Three! That, is an all time high number. By the end of the “evening” I was fearful my empathy was blunted. It may have become moribund !

What are we to make of this number? The clinic was more crowd control than medical clinic. We asked another 5 patients to come back to the next clinic. It was midnight before we got home. It was hard to maintain the standards of care.

Of the 43 patients, one stands out. “She”, is 2 years old. “She”, arrived with her mother. “She”, is uninsured. “She”, was ill.

What say did “She” have in her immigration? What does “She” know of Jason Kenney’s  “Orders in Council” that denied her IFHP benefits when she became ill? Her mother was also denied.

For a week “She” has been irritable, with a fever. “She” cries when her diaper touches her. “She” cries when she pees.

“She” smiled at the nurse when they distracted “She” form the ensuing exam.

Normally, with a health card, the standard of care would be a urine culture, blood work to assess infection, and possible a trip to the ER.

“She’s” mother could not afford the tests. So, we have “She” on antibiotics for suspected urinary infection and sepsis. I hope we made the correct diagnoses

Why are doctors and other providers being forced into enforcing the Federal Immigration cuts to IFHP? Why must physicians and other providers compromise our standards  and responsibilities to care because of nasty Federal CIC cuts to healthcare that are bent on picking on 2 year girls?

Why? Will some one please tell me this is Canada.

Clinic, May 7th, 2013

” I was hoping… Please, let it wait 2 more weeks” These words were uttered tonight by a 70 year old gentleman, a landed immigrant with 2 weeks left before his 3 month agonizing wait for OHIP was over. We compare that 3 month wait to a type of “medical hazing”, a ritual immigrants must endure before they are allowed into our fraternity.

M.C. had waited some time before asking for help at the CVC. He noticed trouble passing urine for the past few weeks. In the past few days he could barely force it out. It burned, and it woke him up 6 times each night to pee.

Finally in desperation, and unable to handle an ER visit and Hospital cost, he came to the CVC. He was near total urinary obstruction from an enlarged, and a likely now infected prostate. He is now on antibiotics and other meds, and we have our fingers crossed he will avoid the ER and hospital, until his OHIP kicks in.

He might not make that deadline.

Who thinks this up. This poor man will wait 2 more weeks if he can, then enter hospital 2 weeks later when his OHIP arrives, with near total urinary obstruction and probable kidney failure. He may well spend a week or more in hospital, possibly end up on dialyses, and require surgical intervention. The total bill would be $25,000.

And it all would be prevented by a $30 visit to a doctor or NP, and a $45 antibiotic prescription.

Again – please, who really thinks this stuff up?