34 patients last night! A youth and her father.

Uninsured Refugee clinic Aug 21st, 2012

This week, for the first time in 13 years, we sat after clinic and wondered if we would be able to stay open? Our volunteer family doctor had finished her own office in the day, and arrived at 5 pm in the volunteer clinic. When we were finished, we counted. We had treated 34 medically uninsured patients. This was 10 more than the volunteer doctor treated in her regular OHIP practice that day. It is 20 patients more than we used to see before Bill C31 and the IFH cuts from the Federal Conservatives.

A 14 year old daughter brought her 48 year old father to clinic. They waited patiently for 2 hours to be seen. They were 2nd last. The arrived 2nd last. They had travelled by bus. Their trip took 2 hours. They went home together by bus late that night. Public transit in Scarborough is not very good.

Shanthi was the translator for her father, although her father might have managed well enough. Her English was impeccable. She and her father ( from Bangladesh), and their mother used to have IFH. It was now ineffective, despite not being expired..

Shanthi required her immunization list to be updated and transferred to a TDSB / TPH card and paper so she could attend school. Her father is diabetic. He required a blood test, a renewal of his medications, and, ongoing medical care. Together, their doctor now required $100 before treatment visits.

Our nurses and doctor were able to take care of their needs, for now. They were invited back for a follow up for her father’s diabetes.

On the way out Shanthi turned and looked at the nurse. In a soft voice, she said “Thank you”, then, she turned to the doctor, again, “Thank you”.

I noticed she was crying. She walked out holding her father’s hand.





Shades of Residential School thinking? Mr. Kenney’s CIC website cites Australia’s forceable refugee detention policy as justification to do the same. Read the real evidence on detaining refugee children.

Excerpted from an Australian Medical Research Study published in the Journal of Paediatrics, 2004.

Minister Kenney at CIC has signalled Canada will now follow Australia’s lead. Detention (without full legal process) of our children and youth refugee claimants is permitted when DCOs are soon announced. 

“” Article 37 of the Convention on the Rights of the Child states that holding children in detention shall be used as a measure of last resort and only for the shortest possible time.

The Human Rights & Equal Opportunity Commission (HREOC) expressed concern about Australia’s compliance with Convention obligations, and so conducted its own inquiry into newly arrivedchildren in detention in Australia. Detrimental effects of detention were found to be extensive in Australia, as well as in several other countries. The report of the HREOC National Inquiry into Children in Immigration Detention was tabled in Parliament on 13 May 2004. Similarly the United Nations Working Group on Arbitrary Detention (WGAD) expressed concerns about ‘the psychological impact’ of detention, its ‘automatic and indiscriminate character, its potentially indefinite duration and the absence of judicial control of the legality of detention’.

Children are particularly vulnerable to psychological trauma resulting from long periods of insecure residency, exposure to harsh treatment, confinement, deprivation and exposure to unstimulating environments. Such experiences create additional vulnerability in children and adolescents due to their incomplete biopsychosocial development, dependency, inability to understand certain life events51 their underdevelopment of coping skills52 and their experiences of past separation. Detention has been found to undermine parental capabilities with children experiencing suboptimal parenting as a consequence of the stresses of their confinement and creating further difficulties when families are finally resettled.

Being unaccompanied or separated from family members, whether in detention or in the community creates further stresses for children. Unaccompanied minors, mostly adoles- cents, lack social support groups, relatives and other natural mentors. Additionally, fear of being returned to their country of origin whilst awaiting refugee determination status may be psychologically damaging. Many unaccompanied adolescents hold TPVs, making them vulnerable to repatriation and impairing their capacity to feel settled and secure. Preliminary research amongst ( some refugees) reveal that the social deprivations experienced are associated with increased levels of psychological disability. Decreased health service utilization has also been reported as a result of uncertainty and fear associated with status. Unaccompanied and separated children in particular should be provided with appropriate protection and care due to the greater risk of psychological and health problems than their accompanied peers. Providers should be aware of the specific experiences of children who have previously been in detention….”

Unlucky 7’s – Do the Math

AUGUST 17TH CLINIC, 2012 — raising the risk of death and disability in Canadian infants.

Women not provided professional healthcare during their pregnancy are far more likely to experience serious negative outcomes. So is the unborn child they carry. The risk of prematurity, death to mother, and complications such as eclampsia and newborn death are up to 7 times higher when Mom and baby have no healthcare.

Again, this week, a continuing stream of women at all stages of pregnancy arrived in clinic with rejected IFH, deprived access to healthcare for their pregnancies and unborn. This included Amy, 2 months away from delivery. “Desperate”, best describes her emotions. The expiry date on her IFH papers was in the future. When we contacted Blue Cross, the newly appointed ( by the Conservative Feds) insurance carrier that oversees IFH requests and claims ( we have to stop clinic and phone for each patient) we get nothing but rejections. Amy could not afford the fee her doctor was now charging.

The obstetricians we called to help her were either full, or charged. Amy needed every cent to try to cover the delivery / hospital fees. She was in a panic.  A lot of handwringing and discussion ensued. We decided the best pathway for a good outcome would be for us, with the Midwives who give us time, to provide the remainder of her antenatal care, provide her with her pregnancy medical records, and refer Amy through the local ER when she went into labour. What else can we do?

In 1998, a US analyses ( where there are 40 million uninsured) determined the cost to their society of “raising” a damaged newborn, in the NYC area, delivered with prematurity complications from an unattended pregnancy, exceeded $500,000 by age 20. The cost of healthcare for the same pregnancy and delivery, including 24 hours in hospital was $6000.

Do the math. Frankly, we expect better from those who govern us. Irrational, harmful, and very expensive  decisions, all based on biased ideology have no place in the Legislatures of a modern democracy built on fairness and compassion.

The Federal Conservatives have repeatedly told us their new hardline refugee policies will save us all money. Really? Pray tell.


Who thinks this stuff up? Have we gone completely mad?

AUGUST 16TH 2012.

Our numbers of uninsured refugees needing healthcare continue to grow. Tonight’s volunteer free clinic saw more and more patients with rejected Interim Federal Health. In their midst, was a sponsored person, denied healthcare.

Carlos is 47. He came to Canada from South America, via the USA ,when he was 42. He resided in the USA for many years with a valid residency permit. He came here to live with his wife and their 3 children.

Carlos is sponsored by his wife. She has a job, is a Canadian citizen. Carlos is here legally. He desperately wants to work. He cannot – at least legally. Immigration has repeatedly denied him a work permit – for more than 4 years.  This means he cannot earn the money he needs to buy his diabetic treatments, or to see a doctor.  Instead, he receives a small social assistance cheque.

Carlos now needs insulin. His blood sugar has elevated to the point where it is dangerous, potentially life threatening, and certainly life shortening. The pills we are giving him have failed. He cannot afford a doctor to provide care. His eyesight is deteriorating. We have a donation of 3 months of insulin. We gave it to him this evening. We taught Carlos how to inject himself.  When it runs out – then what? If he drifts into a coma, he will need the ER, and likely stay in hospital for days. Our ER’s are already overcrowded. Our hospital’s have bed shortages. We are trying to find a way to get more insulin, to keep his health going, to prevent a hospital visit. We have 3 months supply. We are looking for an eye physician willing to assess Carlos. We prefer he not develop diabetic blindness.

Who thinks a scenario like this up? Who forces a man of 47 who can and wants to work to take social assistance? Who denies him life saving prevention and healthcare, and drives him instead into the ER for care 200 times more expensive than simple insulin?

When those opposed to providing basic health coverage to refugee claimants and other medically uninsured say words like – ” no healthcare for bogus newcomers”, or ” I won’t be taken for a sucker”, do they mean Carlos? Do they realize their words are lethal to a father of 3 children? Is this how they would want to be treated if in his shoes? Are we mad?

I am afraid that one day we will wake up, and realize how severely Canada has deteriorated. I fear that then, it will be too late for all of us.


Ontario’s 3 month wait for Healthcare: An unjust killer.

Ontario is one of 3 Provinces imposing a 3 month wait for health coverage for its landed immigrants – 80,000 per year. A lot can and does go wrong in those 3 months.

Tem was 8 years old when he came to Canada in 2008. Two weeks later he required urgent life saving medical care. He was medically uninsured, in Ontario’s 3 month wait.

Tem’s father was granted admission to Canada from the Darfur refugee camp in 2000, 1 month before Tem was born. His mission was to arrive ahead, and meet the requirements Canada set down to allow the rest of his family to join him. He worked 2 and sometimes 3 jobs for 8 years to save the funds Ontario required. Finally, in 2008, he succeeded. His 2 sons and wife landed as immigrants. Ontario imposed its 3 month wait for their healthcare.

Tem was born in Sudan with severe and lethal heart malformations. He received life saving surgery when he was 3, in the Darfur region where he resided in the refugee camp. Cardiovascular surgeons from Europe came to Sudan to do free open heart surgery. They patched Tem’s tiny heart with a temporary fix. He would need definitive corrective surgery before he was 8 or he would die. Blood was flooding backwards, damaging his lungs.

Two weeks after arriving in Canada, Tem developed a severe pneumonia. His deformed heart was failing under the added strain. He was short of breath, febrile, septic and dehydrated. His father took him to the ER. He was told he needed to pay $500 just for Tem to be assessed. There would more cost for treatments.

Not able to pay, Tem’s family brought him to the clinic. After treatment for pneumonia, and then the gracious generosity of a cardiovascular surgeon at Sick Children’s, Tem survived. His heart is now repaired. His family now live in an apartment in a southern Ontario town where his father works. Tem is a soccer player now with his school team.

The courage and resolve of Canada’s newcomers never ceases to inspire us. They defy and survive death from war and starvation in their home lands, and for Tem, what war and starvation in Darfur could not accomplish, Canada nearly did.

Ironically it was Ontario’s Provincial NDP Government, under Bob Rae, who imposed this regressive and dangerous policy. The NDP’s current leader, Andrea Horvath is in a position to reverse this social injustice that has harmed and impoverished Canada’s newcomers to Ontario. We call on her to do so. The Liberal’s to date have refused.

We and the OMA have presented the financial data to the McGuinty Government proving that providing primary healthcare for medically necessary conditions in the 3 months will save money. The current policy is more expensive, produces ill health and longer hospital stays, and impairs acculturation ( see Kaufman et al, Academic Medicine 2000).

Why is it so difficult for Ontario do the right thing by the newcomers it invites to sustain its future? What is stopping it? What information does it have to support its policy? The OMA and our organization have offered evidence the policy is ill conceived.

It is way past time for Ontario to step out of the past, and into the future of healthcare – for the good of  everyone’s health.


August 2nd, 2012: The clinic doors closed early

August 2nd’s uninsured refugee clinic was a repeat of the last few weeks. The number of patients with revoked and denied IFH asking for medical help, has nearly tripled.

This is unprecedented in our 12 year history of providing uninsured healthcare.

The Nurse Practitioner providing care last night, and the nurses, were overwhelmed. When the clinic doors opened at 5 pm there was a crush of waiting patients.The staff were forced to close the doors an hour early. Many patients were still in the waiting room at 8pm, still waiting to be treated. It was much later before all had been seen.

All the new patients arrive with no medical history, other than what they can tell us. We have never met them before. Some patients are on many medications and needed renewals.  We have never met them before. We worry we know too little about their health status and medical history to safely treat them and prescribe medications. We worry if we do not treat them worse health results will ensue and they will end up at the ER. Some were pregnant, some were children. Some were anxious, their anxiety made worse by the fear of non treatment. All waited patiently to be treated.

We are very confused. The new patients we are seeing have IFH – issued prior to Bill C31, with expiry dates well into the future. Why have these persons been targeted for revocation of IFH health services?  Is this Blue Cross denying services, or the rules of Bill C31, or both? We have tried to seek clarification, but are getting no answers.

Bill C31 is punishing many, turning innocent persons into victims simply because of the misfortune to be ill. It is breeding frustration and anger, amongst both patients and providers. Humiliation and invalidation are felt all around. Nothing positive or good will emerge from this inhumane injustice? It is intolerable to see.

The limited funds we have to provide healthcare are being depleted, very quickly.



What about the Children, their parents? July 31 2012

Scarborough, GTA July 31st 2012

We continue to see growing numbers of refugee claimants seeking urgent healthcare with revoked IFH.  Their doctors – family physicians and specialists, ( and of course hospitals) are now asking for payment up front before providing healthcare to their “former” patients. Tonight’s clinic lasted 7 hours, instead of the usual 4.

Suli is 6 years old. He is more than cute enough to give anyone a run for their money in the arena of public opinion. He arrived in Canada with his family from a violent, unstable part of the world where children are kidnapped for ransom, where religious persecution and violence are rampant, and extortion and the protection racket is the norm for those in the minority. His parents made the journey to Canada, seeking safety, as refugees. They await their IRB hearings. His country will likely be on Canada’s new “safe list”.

Suli had open heart surgery at 15 days of age. Until Canada Day 2012, Suli and his parents had IFH. This covered the basic paediatric cardiology visits he requires. Suli’s teachers have noticed he is falling behind at school. They have asked us for an assessment. Immunizations are needed to prevent disease and attend school. Suli’s dental condition is horrible. A tooth has abscessed. This can infect his heart. That can kill him.

Suli’s family first tried Alberta to find work. No luck. After 7 months they have returned to Toronto, looking for any type of work. Today, their family doctor who had treated Suli and the parents under (now defunct) IFH, requested payment before continuing any care.

How about Lilly? She is a refugee claimant, age 42. She was beaten and left for dead in the streets, amidst the political violence engulfing her home country, in Africa. With her abdomen open and hemorrhaging, she was operated on and lived. She lives with severe, constant abdominal pain. Lilly was new to our clinic tonight. Her doctor would no longer see her because her IFH was terminated, and Lilly cannot afford the care and physician fees.

Roya, from Afghanistan, was ill with fever and cough. She arrived in Canada in 2003. Soldiers freed her, Canada rejected her healthcare. She works as a volunteer, in west Toronto, helping other newcomers to Canada find apartments and shelter.

Jy’s IFH was revoked 3 weeks ago. His leg ulcers are now recurring because his loss of IFH – not mention the Sickle Disease –  threatens his very existence.

Nadia had an ear infection. She is 4. She cried in pain. She escaped from Iran with her parents. Jaf is 40. She escaped too. Her welcome get together in Canada ended when she broke her foot, last week. She could not afford the hospital. We are doing what we can. She is limping without a cast.

Yes, we were busier than usual for sure in the clinic for uninsured refugees.  I wonder how Suli is tonight? I wonder how we will find him the help he needs to stay alive. He is only six years old. What does he know about politics, and IFH cuts? He knows only that he needs adults to help him live. His parents know this too. They also know who cut Suli loose to fend for himself, who dashed their hopes for their son, and a new and safer life. So do I.


And so it Begins! July 17th 2012

Hi Meb, Angela and all

This evening’s Scarborough volunteer clinic for uninsured refugees and immigrants was like no other we have experienced in our 13 years of operation. Refugees with suddenly cancelled IFH cards flooded our waiting room an hour before the clinic opened at 5 pm. We were still in the process of seeing the last patients of our regular day.

The scene was more like chaos and crowd control, than the evening medical walk in clinics for the uninsured we have grown used to. It reminded me of a Code Orange.

It was all very overwhelming and tragic. For a while I lost site of the fact that we were actually providing healthcare, in Canada. Patients with diabetes, hypertension, chest pain, pregnancy, headache, pyelonephritis, fever all crowded in. Suddenly, on Canada Day 2012, their IFH cards were cancelled and revoked. They arrived from their friends house, shelters, motels, by TTC.

One young 24 year old women in Canada 4 years, 35 weeks pregnant, a primip, arrived crying, with severe abdominal pain. She had contacted her OB a week earlier seeking care with the pain. She was informed by the office that her IFH had been cancelled. She was unaware. The expiry date on her IFH document said November 22nd 2012. She was informed that to see her OB she would now have to pay $130 per visit. And then there was the delivery and hospital costs. She stayed at home with her pain, unable to pay the $130. She then came to our clinic tonight. She is sponsored by her Canadian husband.

Another patient, a 61 year old gentleman in a Scarborough refugee shelter arrived because his heart medications had run out days earlier ,and his doctor providing care under IFH was now charging for renewals and care. He could not afford to see the doctor. He had heart failure and atrial fib. He was taking warfarin, and by mistake Plavix. He had run out of all his meds – lasix, cavedilol, amiodarone, coversyl….. He was on 12 meds. He spoke no English and arrived alone, by Public Transit. He was sweating, afraid. He wore a suit for the visit. He had loosened his neck tie because he was perspiring so much but left his suit jacket on until I came in the room.

I am home now, and I still feel ashamed of what Canada is doing. We spent much of the evening apologizing for our country’s regressive, uncaring, humiliating, and harmful behaviour. What I saw tonight, I never dreamed I would see in my country. How is it that a Canadian Government can abandon a pregnant women and her 35 week pregnancy, with pain, to fend for herself? How can that mother, her pregnancy, that infant be so callously cut loose at 35 weeks? How ironic that Mr Kenney is a professed pro life advocate – just lives that serve his policies at the time, I suppose?

I am very, very, angry this evening. I am stunned. Our volunteer nursing and reception team were outstanding! We are not sure what the next clinic will bring. We may need to open another evening, but we have no idea how. Perhaps sharing moments and stories like this with our fellow providers will help? This madness must be stopped.