The ordeal faced by asylum seekers who get sick

The vulnerability of asylum seekers in Canada, and Quebec, is not limited to the difficulty of finding housing, employment, or daycare for their children. It is also not limited to waiting for a work permit that will take them out of exploitation, which is often synonymous with illegal work. For these immigrants, getting sick can become a nightmare. However, once they start the asylum process, they theoretically have access to medical services.

Asylum seekers, who, according to Statistics Canada, were some 176,000 in January 2024, in fact have access to Interim Federal Health Program (IFHP), designed to cover some of their medical needs. It is through the Blue Cross insurance company that these immigrants can access health services, which means that doctors and other health care providers bill the insurer for their services each time they see an asylum seeker.

It is the famous brown leaf, officially the Asylum seeker document (DDA), which allows them to have access to services in hospitals.

This coverage allows them to contact other health professionals, including for antenatal and postnatal care. It also guarantees access to clinical psychologists, psychotherapists, occupational therapists, speech therapists, and physiotherapists, among others.

Although access to medical services seems organized, at least in theory, the journey for an asylum seeker who wants to get timely health care is often long and arduous, even if doctors have no right to reject asylum seeking patients. “Many clinics do, and the Collège des Médecins du Québec does not control this practice,” explains Juan Carlos Chirgwin, family physician at Parc-Extension, the most densely populated neighborhood in Montreal — and one of the most diverse.

The family doctor acknowledges that “things have improved over the last five years, but there is still no follow-up of what is happening on the ground in each clinic.”

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Language and cultural barriers

The journey of these migrants is full of pitfalls. Language is the first obstacle. While information on the Interim Federal Health Program (IFHP) is easily accessible on the Internet, it is only available in French and English on official Canadian government sites.

“I work at the CLSC in Parc-Extension, a neighborhood where newcomers are the majority. There are a lot of asylum seekers, but also immigrants with other statuses. Many of them only speak their native language. These are people who face a very significant language barrier,” explains DChirgwin.

Faced with such an obstacle, asylum seekers often turn to their community, which then becomes a basic source of information for newcomers.

“In many cases, information is passed on by word of mouth,” explains the family doctor. This is despite the existence of the Regional Programme for the Reception and Integration of Asylum Seekers (PRAIDA), whose mandate and obligation is to inform them of the services they can benefit from and how to access them.

However, not all asylum seekers in Quebec are in contact with the agency, as Mr. Chirgwin was able to observe in Parc-Extension. Those who arrive in Canada by air and then seek asylum, for example, are not necessarily referred to this service.

“Thirty percent of the asylum seekers I saw in 2018 and 2019 had no idea what PRAIDA was. They did not know how to access the clinics; they did not know what the brown sheet was, much less that it gave them access to physiotherapy and psychological services, as well as to some dental and vision care,” explains Juan Carlos Chirgwin.

This program has well-detailed information for asylum seekers on its website, but the data is only available there in English and French. However, basic information on PRAIDA in Spanish, Arabic, Creole and Turkish is available on the website of the United Nations Refugee Agency (UNHCR).

We consulted PRAIDA to find out their views on language barriers. According to Barry Morgan, the program's communications officer, “there is no particular approach to linguistic access to medical services, other than encouraging allophone users to be accompanied by a person to make an appointment. Internally, within PRAIDA, users always have access to an interpreting service, if necessary.”

The CIUSSS West-Central Montreal, the institution of which PRAIDA is a member, strives to “facilitate access by offering remote interpreting services that are accessible almost instantly (video or telephone) through Voyce”, adds Mr. Barry.

Language barriers even extend to solutions adopted by the government to try to improve the health system for the general public. However, these measures should facilitate access to health for asylum seekers.

“We now have the First Line Access Desk, which connects a patient to a clinic, but not to a specific doctor. You can access this system by calling 811, option 3. Someone will ask questions to the sick person and can sometimes refer them to a clinic for a one-off appointment. If the person falls ill again, they can call 811 again and be redirected, perhaps to another clinic,” explains Juan Carlos Chirgwin.

But what if a person who doesn't speak French or English calls 811 and explains their need? “Interpreters have been promised, but I have not yet tried to call and speak only in Spanish to see what happens.”

During a test we carried out, the 811 service operator told us that “unfortunately, he did not have an interpreter and that he could only provide assistance in French or English to guide the patient to a medical service.” However, we have been confirmed that an asylum seeker who does not speak French or English can call with the help of a friend acting as an interpreter.

Maira Prado, a physiotherapist at the Cabrini Physiotherapy Clinic, located in Nouveau Rosemont, believes that the interpretation service is not as clear as advertised.

For more than two years, she has been working on a volunteer basis to help asylum seekers access the health system in Quebec. Her passion for the subject led her to participate in several consultation tables and to set up a unofficial list of practitioners who provide services to asylum seekers

Although an 811 operator told us that a relative could contact him on behalf of an asylum seeker as an interpreter, Maira Prado assures us that this is not always the case. This is because of “the legal barrier, which means that in Quebec, if you are over 14, you must represent yourself before health services”. This means that it is not possible to speak on behalf of another person.

“The asylum seeker must therefore persuade the telephone caller to accept the help of the interpreter, who may be a friend, acquaintance or family member. It is up to this interlocutor to show empathy, and this is an important point: the need to raise awareness among all staff in contact with asylum seekers”, she underlines.

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Systemic faults

Beyond language, Mrs Prado discusses other obstacles asylum seekers face that make them somewhat invisible in the province's medical records.

“The problem is that [in the system as designed] they don't have a health insurance card number (...). This makes it virtually impossible to access the medical information of these patients,” she explains.

According to the physiotherapist, the lack of a number or access to patient information explains in large part why doctors do not consult asylum seekers. They say, “I don't know their background, I don't know anything,” stresses Mrs. Prado.

Moreover, asylum seekers are not counted in the health system. The doctors who see them are paid — the Blue Cross pays them — but in the health system, these consultations are not visible electronically. This “void” prevents doctors from meeting the quotas they must meet to receive government grants.

“If doctors in a clinic see asylum seekers all day long, it is as if, in the eyes of the system, they are on vacation,” summarizes Maira Prado.

“We are seeing that asylum seekers are subject to multiple sanctions. The language barrier is important, but the systemic barrier must also be denounced,” she adds.

For the physiotherapist, the system indirectly gives doctors and other health service providers all the arguments for not taking care of asylum seekers. Because, it should be emphasized, registration to take care of them is voluntary.

According to Mrs Prado, many asylum seekers then choose to go to walk-in clinics, but these centers do not give them comprehensive information about the services they are entitled to, she believes. “If it's a patient who needs musculoskeletal care, for example, the staff at walk-in clinics don't mention that there are private clinics that can treat them,” she laments.

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Over a year of waiting for physiotherapy services

Giuliana has been living in Canada since October 2022. Originally from Lima, Peru, this 45-year-old woman came to Quebec via Roxham Road with her husband and their son, who was three years old at the time. The family left their home country after a gang extorted monthly payments of $1,000 from them to allow them to operate their transportation business.

Fernando, their little boy who recently celebrated his fifth birthday, cannot move his right hand properly due to a birth injury. In Peru, he underwent daily therapy to regain his mobility. In Quebec, the situation is quite different.

A mother of three children, two of whom stayed in Peru, Giuliana devotes herself entirely to Fernando, a talkative and affectionate child who calls his injured hand “the champion.” “I work very hard,” he exclaims with a laugh.

Despite this dedication, and although Giuliana has progressed in her integration in Quebec by taking French courses, she only got an appointment with Maira Prado two months ago. However, these consultations are necessary for Fernando to prevent his hand and arm from becoming immobile.

“It has been very difficult for me to get the services that Fernando needs. First of all, there was the language barrier. It is very difficult not to be able to talk to a doctor, to not be able to explain to him what is going on. In addition to her hand injury, we had to go to the emergency room several times for fevers and viruses, and I always have to ask for help,” explains Giuliana.

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A mutual aid channel

The mother found the solution by turning to an organization that helps Latin American immigrants. “The people at the Latin American Family Assistance Center [CAFLA] allowed me to get appointments. I was very worried because Fernando had not been in therapy for over a year.”

At CAFLA, Giuliana received the help of an “angel”, she says, visibly relieved. She talks about Nidia Bravo, an employee of the organization, who helped her find the Cabrini Physiotherapy Clinic where she met Mrs Prado, the physiotherapist Fernando now sees once a week. With her, communication is smooth, as the specialist speaks Spanish.

The search for services continues for Giuliana, as Fernando needs a brace for his rehabilitation. Maira Prado helps her look for this brace. “I found a certified orthotist who speaks Spanish,” says Giuliana.

“I don't know yet if we'll be able to get the device for free. I think it costs over $300, and I'm ready to pay what it costs, but we don't know if they're going to give us the option to have it made or not,” she adds.

She herself had trouble seeing a doctor when she needed one, especially during the first few months in Quebec, when her sudden escape from insecurity in Peru took a toll on her emotional well-being. “I had a lot of headaches and stomachs, and was told it was stress, but right now I'm waiting to see if a gastroenterologist can see me.”

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Existing solutions and to be imagined

Maira Prado and Juan Carlos Chirgwin are two health professionals who want to offer solutions to asylum seekers when they seek medical services.

Maira Prado believes that the health system as it exists could generate a fictional number that would allow the asylum seeker's medical history to be stored, which would encourage doctors to receive these patients. “It would be a matter of willingness on the part of the staff,” she points out.

The Dr Juan Carlos Chirgwin, on the other hand, has put in place a kind of health passport, which includes a summary of the blood tests that the patient performed on his recommendation. “This is an idea that medical students had before the pandemic. When the tests are complete, I write the document by hand, let the patient know by phone, and send it to the patient's home by Canada Post so that they can keep it and use it when they see other doctors in other clinics or in case of emergency.”

The implementation of these solutions would not require major changes to the current system, but depends on the will of the parties involved, including the provincial government.

Maira Prado focuses on the ability of health professionals to work together, as she does with Dr Chirgwin and others. “The asylum seeker is a patient that no one can see alone. More work needs to be done on what is called the “care pathway.” You need to know what happens when asylum seekers have a health problem, what door they are knocking on.”

She considers it essential that immigration centers stay up to date with the information available and, above all, that they have the resources they need to care for this segment of the population. “Community agencies, if they were better off, could refer patients to the health system,” she says.

According to these specialists, asylum seekers will continue to arrive in Quebec for various reasons and under different circumstances. The Dr Chirgwin believes that the discrimination they face must end. “[It] doesn't even allow them to be on a waiting list to see a doctor. This same discrimination can be found, for example, in the government's decision to legally block asylum seekers' access to subsidized childcare services.”

The reality, explains the family doctor, is that “these people, when they arrive and stay, have health problems; they continue to get injured because of the work they often have to do and they have to go through the system several times. What I am doing is trying to be available for them,” he concludes.

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To go further

• Maira Prado has agreed to give her email address to asylum seekers who need help accessing medical services: mprado@actionsportphysio.com.