Refugee Health Cuts

When I started this blog I was working with refugees for the first time. I was in South Africa and I watched as many refugee claimants struggled to get by in a highly xenophobic society where they faced barriers to accessing essentials such as food, health care, and employment. I will never forget the day when I had to bring two women to the hospital who had severe food poisoning after eating expired food from a shelter they were staying in that had no food or running water.

After returning to Canada from South Africa I was hired as an intern with the Halifax Refugee Clinic. The main focus of my internship was coordinating aspects of the Invisible Women/Concrete Barriers project which sought to help refugee claimant women and their children gain access to resources, including health care, in their community. As part of my work I followed up on research that had been conducted on the challenges facing refugee women in the community and became familiar with the Interim Federal Health Program, which is meant to provide supplementary health care services to refugee claimants and government assisted refugees. At the time in Nova Scotia, refugee claimants who were covered by the program were ineligible for provincial health care coverage which of course caused a number of problems. Fortunately at the time the coverage provided under IFH was enough for refugee claimants and government assisted refugees to access basic health care like seeing a physician and taking prescription medication.

Then I took a break from working with refugees, I worked with the government and I went to Uganada. Now I'm back in Canada and back working with refugees, but this time it's government assisted refugees. As part of my job I help to coordinate a weekly health clinic for newly arrived government assisted refugees and listen as the case workers around me try to find family doctors for their clients. I'm also already acutely aware of some of the health and psychological needs of our clients which require prescription medication,  special equipment and counseling all of which are covered for one year through the Interim Federal Health Program. In Ontario government assisted refugees and refugee claimants are immediately eligible for provincial health coverage.

On July 1, 2012 significant changes to the Interim Federal Health Program will take effect. The cost of prescription medication, medical equipment such as wheel chairs and walkers and services such as counseling will be cut, except in emergency situations. Even worse; if you're a refugee claimant from one of the designated countries of origin, which as of yet have not been identified, or your refugee claim is denied you will only have access to health care if your medical condition is deemed to be a health risk. 

Government Assisted Refugees (GARs) are individuals whose refugee claims have been approved by the International Organization on Migration or the United Nations High Commission on Refugees and who are approved for resettlement in a country such as Canada. They receive a travel loan and when they arrive in Canada they have permanent residence status. Many GARs have spent months or years living in a refugee camp. Many refugee camps do not have proper sanitation and residents do not have access to adequate nutrition which means that individuals arriving from camps may be suffering from malnutrition or water borne diseases and need prescription medication to treat these conditions. A smaller number of GARs are permanently disabled and need access to mobility devices or are chronically ill and need access to medications. Almost all of the individuals arriving in this category have little to no money, particularly if they have been living in camps and cannot afford to cover these costs.

Refugee claimants are often individuals who have fled their countries of origin very quickly. Although they have a variety of financial backgrounds many individuals in this category may face the same health concerns as GARs and may also have injuries or conditions requiring immediate medical intention, particularly if they came on a container ship. This category of refugee is less likely to have been living in a camp situation and does not have permanent residence status. They have less access to resources in their community to support them and face substantial uncertainty until a decision is made about their claim.

Both categories of refugees have significant mental health concerns resulting from trauma, torture and adjusting to a new culture and under the changes to IFH will not receive the support they need. I will never forget when one of the clients of the Halifax Refugee Clinic killed himself after he was deemed ineligible to make a claim because he could not face the prospect of returning to his country where he knew he would be tortured and killed for abandoning the army. 

Refugees living in provinces where they do not receive immediate provincial health care coverage may not even be able to access a family physician.

The government claims that through these cuts it expects to save over 20 million dollars a year. Critics say that the cuts will end up costing tax payers more because of an increase in emergency room visits and public health issues.

When questioned at a news conference by a doctor about the changes, Health Minister Joe Oliver said the government was undertaking the changes to make sure that all Canadians have equal access to healthcare If the Conservatives truly believe that all Canadians should have the same access to healthcare perhaps they should be providing coverage for prescription medication and counseling for everyone rather than cutting access to it for the people who need it most.

If you would like to get involved you should write to:

PM Harper

M.P. Jason Kenney, Minister of Citizenship and Immigration

M.P. Joe Oliver, Minister of Public Health

For more information or other ways to get involved:

 http://www.policyalternatives.ca/publications/commentary/federal-cuts-put-refugee-health-care-danger

http://www.youtube.com/watch?v=TQiSe00HOec

http://www.youtube.com/watch?v=75FmimeFnu8&feature=player_embedded

http://www.nursesunions.ca/news/canadian-doctors-refugee-care

Doing It My Way: My Last Month In Uganda

So I haven't blogged in a while... first I got wrapped up in leaving Pretoria and then I came back to Canada which has been overwhelming in a number of ways. But here I find myself again writing my blog.

I'm going to start with a post on my last month in Kampala and the move on from there.

Overcoming Disappointment

In one of my earlier posts I discussed the shock and disappointment of discovering that the Canadian Cooperative Association would not be sending another peace and conflict officer to fill my place after I left. This meant that much of the work I had done would be unsustainable and fruitless.

My disappointment from this decision didn't result from any personal sense of insult. I knew I had done the best I could. I also knew what I was doing was important. The field staff and cooperative members who I interacted with throughout my stay in Uganda had been excited to engage with a sense of conflict. Many participants in the field training were eager to discuss conflict dynamics within their homes and within their cooperatives. Some also seemed interested in discussing conflict at the community level, including fears over the possible return of Kony to the Lango Sub County and issues involving poverty and relationships between pastoralists and agriculturalists.

While some of the conflict dynamics and situations we discussed were unrelated to the cooperative movement, many were. For example, my colleagues and I learned that land disputes are common throughout Northern Uganda, resulting from histories of violence, displacement, political unrest and inter-clan relations and that some cooperatives choose to endorse crops which require large amounts of land putting even more of a strain on limited resources. In some respects, gender inequalities were also shown to be aggravated within cooperatives and communities through cooperative involvement and there are major concerns over transparency and financial management.

Conflict sensitivity, the idea that development interventions should not only be aware of conflicts among the beneficiaries of the project but also should work not to have a negative impact on such conflicts, would serve to address and ameliorate many of those impacts and make the project I was working with more sustainable in the long run.

Throughout my internship I worked hard to ensure that it would be easier for the intern that replaced me. I worked hard to develop strategic relationships with peacebuilding organizations, to introduce our field and head office staff to the idea of conflict sensitivity and to make sure there were resources available along the way. I also chose to engage in activities which were open ended and would create more avenues for the next intern to take their internship. I saw the importance of what I was doing.

I guess it was about as clear as mud for everyone else. One of my biggest challenges during the internship was communicating and working with my supervisor whose background was in agricultural economics. He was a very good financial manager but not particularly interested in how his staff were feeling. When I would try to talk to him about the relationship between armed violence and development he would often defer decisions to me, which was a bad sign in a culture which prioritizes indirect communication. Later in my internship, his reluctance to work with field staff to coordinate field visits and training sessions and his continual lack of interest in my work gave the distinct impression of someone who wasn't particularly interested in seeing that aspect of the project advance.

While there wasn't much expertise on the subject at CCA either when I found out that the position had been cancelled I assumed the decision came from my supervisor. In a way I couldn't blame him. My understanding was that he had not chosen to open the position in the first place and that his priorities were elsewhere.

Unfortunately, that assumption made it very hard to face work. During my last month in Uganda I stopped going to work on time, which was pretty much the best thing I could have done. Initially I started going in an hour and a half late, which became one hour and then a half an hour. The reason I was late was that in the face of discouragement at work and a one month extension of my contract I decided to focus more on my health. I slept longer and ran farther and slowly my anger subsided, although it is not completely gone. While I was in the office I kept my head down and worked on my research paper which was 25 pages long when I left Uganda and still is, although I do intend to finish it once my life has settled down a bit here.

Something else happened in my last six weeks in Uganda that made the stay more worthwhile, I made some wonderful friends. After I came back from fieldwork my friend introduced me to another Canadian who was into having dinner parties, music and playing board games, all things which I am also interested in. And as it turned out Mark had more friends who did the same and so I found the stable companionship that I had been longing for, for my entire trip. I did of course have friends before that but not ones who were particularly interested in coming for dinner or playing Settlers of Catan and having adventures on the weekend. Some of my weekend adventures included going to the Bahai Temple a second time and seeing a million monkeys for the first time, going to visit the Lubiri Palace and meeting one of the princesses of the Bugandan Kingdom and going to Jinja a second time and discovering a whole new side of it, including a delicious tapas restaurant and a private boat ride. In my last few weeks I also became more involved in Salsa dancing and I feel comfortable saying I now dance with an adequate level of proficiency.

Life threw me a couple of curveballs the last week that I was in Uganda. The first was what I described witnessing in my last blog post which I won't repeat here. The second was that my friend's brother called me to ask for some advice in a job interview, which contributed to a chain of events which now has me working with a community based organization in Kitchener which I'll describe in more detail in my next blog post.

The third was a little bit more personal. I haven't really shared this with many people so I'm not sure why I feel inclined to publish it in a blog post but here goes... I had a friend of interest while I was in Uganda who I was interested in dating. However, after some time of flirting and unrealized intentions I concluded it wasn't going to happen. Things continued along on the same path and then he left Kampala for Kenya. On my last night he returned to say goodbye with a kiss. We haven't spoken since; I don't know where to start.

In my next Blog post I'll talk about the excitement of my trip back to Canada for all the wrong
reasons, readjusting to being in Canada and how helping my friend's brother with a job interview helped me get a job but also gave me more insight about the decision to cancel my internship.

For now please enjoy some pictures from my last month.