Mandarin translation below
By Jingyi He, Practicum Student
Canada is an immigrant country. In 2021, one-quarter of the population were immigrants from another country, with numbers projected to increase to 34% of the Canadian population by 2041 (Statistics Canada, 2022). Immigration is a significant life event for many. It comes with the stress of finding a new job, adapting to a new environment, and navigating a new society. A scoping review by Kalich, Heinemann & Ghahri (2016) found numerous barriers facing immigrants when accessing Canadian healthcare. These include language barriers, lack of information about accessing healthcare services, and cultural considerations. These are on top of systemic healthcare issues, such as long waiting times and needing multiple consultations to access specialized services (Ahmed et al., 2016).
In 2019, China was the second largest source of immigrants to Canada. According to the Canadian governmental website, 5.1% of Canada’s total population have a Chinese background (Government of Canada, 2021). Chinese immigrants, along with South Asian immigrants, consist of the two largest visible minority populations in Canada (Statistics Canada, 2017). To care for this population, it is paramount to understand their experiences with accessing healthcare, their unique barriers, and the solutions they suggest to improve our healthcare system. Researchers have identified barriers to accessing healthcare for older Chinese immigrants. According to a survey of 2,214 Chinese immigrants above 55 years of age, the top barriers identified include being unable to find providers to speak Mandarin, having very long waiting times, and being unaware of select health services (Lai & Chau, 2007). Studies have yet to be done to investigate the health barriers for other Chinese immigrant age groups and present an opportunity for further exploration.
Interviews with Chinese Immigrants
Purpose
The purpose of this project is to investigate the lived experiences of newly landed Chinese immigrants to Canada, and the unique barriers that they face when accessing healthcare. This project adds to the existing literature by providing the perspectives of Chinese immigrants who are middle-aged adults (between the ages of 40 to 65) and young adults (between the ages of 20 to 40). The results of this project are summarized in this blog. The discussion section of the blog will provide an analysis of pertinent legislation as it applies to immigration and healthcare access, along with recommendations suggested by the interviewees to help make Canadian healthcare more accessible and inclusive for Chinese immigrants.
Methods
Seven new Chinese immigrants to Canada have been interviewed about their experiences accessing healthcare in Canada. One individual was from the older adult population, three were from the middle-aged adult population, and three were from the younger adult population. Quotes in this blog are shared with the interviewee’s permission, with identification information removed.
Findings
Accessibility
All individuals commented on the need to improve the accessibility to the Canadian healthcare system. Significant concerns were around the (i) long waiting time when booking appointments with doctors, (ii) lack of access to Mandarin-speaking specialist doctors and (iii) presence of a language barrier when communicating on medical issues.
Interviewee A: “When we need to see the doctor for a cold or the flu, we need to book weeks to months ahead. By the time of the appointment, the cold is already recovered.”
Interviewee B: “When I had to get surgery for my knee, I was recommended by my family doctor to a screening specialist and then to a surgeon. A lot of the medical terms I need to familiarize myself. I don’t know what they translate to in Mandarin. I did my research before meeting with the doctor, but I know others may be unable to.”
Interviewee C: “I have no trouble talking with my family doctor because he speaks Mandarin. But when talking to a specialist, some terms were medical and technical, and I needed help interpreting what they meant.”
Seeking Self-Treatment
Interviewees had different coping techniques in response to the long waiting time to see a doctor for scheduled appointments. This can be classified into three sub-categories (i) using Chinese medicine, (ii) using western over-the-counter medication, and (iii) travelling back to China to seek treatment.
Interviewee D: “When I am waiting to see a doctor, my mom just treats me at home with Chinese medicine such as Chicken broth and some other herbs. I also go see Chinese Medicine doctors in the community, where I can get medicine.”
Interviewee A: “I have a lot of health conditions and need different medications. I brought all the medicines I used to use in China to Canada. They are western drugs produced in China and sold to Chinese people. I use them because I am unfamiliar with western drugs and feel more comfortable using the medications I have been using back in China.”
Interviewee C: “I had a friend who was from Qingdao. They are both retired doctors (one pediatrician, one surgeon). The man fell off a chair when reaching for things. That broke his wrist. He waited for 8 hours in the emergency, and the doctor didn’t say anything and didn’t do anything. They had to travel back to China and get surgery the night of landing.”
Benefits of the Canadian Healthcare System
All interviewees agreed that Canada’s free healthcare system is a significant highlight. One interviewee commented on finding Canadian healthcare providers more “responsible” than their Chinese counterparts. For the interviewee, experiences with the Chinese healthcare system often involved additional prescriptions and diagnostic tests, which the interviewee found unnecessary. Because the Chinese healthcare system is not free for patients, the system benefits from patients paying for prescriptions and tests. As such, it is the Chinese healthcare culture for physicians to prescribe more medications or diagnostic procedures.
Two interviewees appreciated that providers in Canada tend to order less unneeded medication and procedures compared to what they are experiencing in China. All interviewees had access to a family doctor who spoke Mandarin at the interview and found little to no language barrier when communicating with their family doctor.
Interviewee A: “The work being done is responsible. They solve every illness at its root. One patient with breast cancer got the doctor to follow up at intervals. Compared to China, where they don’t follow up on you.”
Interviewee C: “The best thing about Canada’s healthcare is that it’s free for everyone. Canadian doctors are generally reliable. For example, they won’t give you a drug you don’t need. Or ask you to get MRI or CT unless you absolutely need it.”
Discussion
Policy and Legislations
To learn about legislation and policy related to immigration, I have consulted with Dr. Yvonne Chiu, the Executive Director of the Multicultural Health Brokers Co-op in Edmonton, Alberta. With experience in immigrant health and policy, I have learned about how our Canadian legislation influences the lived experiences of immigrants in Canada. This section will summarize the key learnings I obtained from Dr. Chiu.
Federal Immigration Policy
The Federal Immigration Policy outlines the number and type of immigrants that can arrive in Canada. There are four pathways of immigration: (1) traditional immigration, (2) refugees, (3) temporary foreign workers and (4) international students. Most immigrants arrive via the traditional economic immigration pathway compared to the refugee pathway. Additionally, the Temporary Foreign Workers pathway satisfies the need business have for contractual workers. These workers come from all over the world and pay Canadian taxes but are not eligible for healthcare unless they have a contract. When Temporary Foreign Workers don’t want to return to their home country because they have settled their families in Canada, they cannot do so because they have lost immigration status. This becomes a social issue that our system needs to address. The last pathway for immigrants is International Students. International Students are integral to helping universities survive because they many times the amount of tuition as regular students. However, with the financial burden, International Students suffer from a lack of nourishment and are accessing food banks to support themselves.
Notably, immigrants account for almost all of Canada’s growth of labour forces. They are paramount to our economic growth and contribute a large share of tax money. However, our healthcare system is unprepared to care for them. Research on the state of immigrant health in Canada suggests that Immigrants were healthier before arriving and settling in Canada (Athari, 2020). This may be due to several reasons. Firstly, healthcare services in Canada are only offered in English and French as official languages, which does not meet the needs of immigrants from other countries. Furthermore, because every country has a diverse culture and each immigrant’s experience of adapting to Canadian society is different, there needs to be culturally aware and trauma-informed care dedicated to this need. Thus, Alberta needs to recognize the role of immigrants in contributing to our economic growth and their unique healthcare needs and dedicate more tax money to building needed infrastructure.
Canadian Multiculturalism Act 1988
The Canadian Multiculturalism Act seeks to promote equitable access to social resources for immigrants while promoting multiculturalism in Canadian society by ensuring appreciation and respect for different cultures in society and workplaces. However, this has not been fully enacted throughout society and has created certain health concerns. For example, when immigrants arrive in Canada, they tend to live in communities with similar ethnic and cultural backgrounds. This creates individual communities with distinct cultures and values within Canadian society at large, which limits intercultural contact. Younger immigrants raised in this environment are conflicted with needing to abide by traditional values at home and switching to western values at work. When the two cultures and value systems conflict, it creates identity strain for the individual and causes intergenerational tension between family members. This affects the mental health of young immigrants. Thus, it is important for the Canadian government to recognize this struggle and promote policies that are more pragmatic when guiding Canada into becoming a multicultural society.
Interviewee Recommendations to Improve Canadian Healthcare
Advancing Telemedicine
Telemedicine may present an opportunity for Canadians to tackle the issue of long waiting times for both acute and chronic illnesses. As suggested by two interviewees, China currently has several online websites that individuals can access to seek virtual healthcare provided by licensed physicians. In the wake of COVID-19 pandemic, Chinese healthcare policies have been adapted to allow for online prescription of medication. Since then, many “online hospitals” have emerged to allow for fast and efficient virtual medical services to be readily accessed by Chinese people while they are in lockdown. Of these websites, WeDoctor is a prominent “online hospital”, providing wide ranging diagnosis and treatment services. These “online hospitals” could be researched by Candian healthcare policy makers to guide the development of virtual healthcare in Canada.
Developing a ‘one-stop-shop’ for Healthcare Services
All middle and older aged interviewees expressed their hope for having all healthcare services accessible in one location compared to multiple locations. In China, services from specialist physician consultation, diagnostic imaging, blood analysis, and surgeries all occur in the hospital. By comparison, in Canada, these services are often spread among different locations in the community. Although the practice of having family doctors located in communities is great, interviewees hoped that more specialized services like blood draw and analysis could be accessed in the hospital instead of in another location. This would save on transportation time, and present more efficient access to healthcare services.
Being Transparent About Waiting Times
Interviewees all understand that the waiting time is long for accessing healthcare in Canada. However, for more significant operations like surgeries, the long waiting time can present as a significant impediment to their freedom of travel. For example, one interviewee identified that, being scheduled for surgery was a blessing. But not knowing where he is in the waiting line, meant that he can only remain in Canada until he is notified the week before the surgery. Because of this, he could not return to China to take care of family issues. The interviewee had to wait for one year until he was finally called for surgery. Had the healthcare system been more transparent about where he is in the waiting line, the interviewee would have been able to take care of matters by returning to China. As such, the interviewee recommends that the waiting time or the relative position in the waiting line, should be made apparent for those seeking major treatments like surgeries.
Improving Awareness of Using Walk-in Clinics
One younger interviewee suggested that, when seeking immediate help for less acute issues, walk-in clinics are a better alternative to emergency rooms, and booking family doctor appointments. She recommends raising awareness about using walk-in clinics, as most Chinese immigrants are still relying on family doctor appointments to check up on illnesses like colds and flu. These illnesses usually subside by the time of the family doctor appointment. As such, she urges more individuals to use walk-in clinics if they seek immediate treatment for minor issues. This may present as a solution for the long waiting time at the emergency or at the family doctor’s clinic.
Closing Remarks
This project is completed by Jingyi He, a fourth-year nursing honours student completing her leadership placement with the Edmonton Social Planning Council. Her experiences as an immigrant to Canada ignited her passion for helping the Chinese newcomer community who may find navigating our healthcare system challenging. Jingyi believes that health is a human right. And access to healthcare has many nuances for folks from different cultures and backgrounds. Jingyi hopes to continue this passion into her future nursing career as she cares for more patients and deepens her understanding of this complex issue.
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据 Statistics Canada 2021 年报告显示，加拿大四分之一的人口是来自另一个国家的移民。由此可见，加拿大是一个移民大国。并且预计到 2041 年，移民比例将增加到加拿大总人口数的 34% (Statistics Canada, 2022)。 对许多人来说，移民是人生中的一件大事，它有着伴随着寻找新工作、适应新环境和适应新社会而来的压力。 Kalich, Heine mann & Ghahri (2016) 的一项范围性综述发现，移民在使用加拿大医疗系统时面临着许多障碍。 这其中包括语言障碍、缺乏获得医疗保健服务的相关信息以及文化差异方面的障碍。 这还不包括存在于医疗系统中的系统性障碍，例如漫长的就医等待时间和需要多个医生推荐才能使用的专科医生服务的问题 (Ahmed et al., 2016)。
2019年的Statistics Canada报告显示，中国是加拿大第二大移民来源国。据Government of Canada, 2021加拿大政府网站显示，加拿大总人口的 5.1% 有华裔背景，中国移民和南亚移民构成了加拿大最大的两个可见少数族裔人口(Statistics Canada, 2017)。为了给中国移民提供较好的医疗服务，我们需要去了解他们在获得医疗保健方面时的体验，以及他们是否面临着特有的障碍，同时需要关注他们对于我们现有的医疗系统提出的建议性解决方案。根据对 2,214 名 55 岁以上的中国移民的调查，老年中国移民使用医疗系统最大障碍包括无法找到会说普通话的医疗服务提供者、就医等待时间漫长以及不了解如何使用医疗服务（Lai & Chau，2007，）他们已经完成了对老年组的相关研究，但尚未完成针对其他中国移民年龄组关于使用医疗服务反馈的相关调查，因此本篇文章会对此进行深入探索。
对中国移民的采访
目的
该项目的目的是了解新登陆加拿大的中国移民的生活经历，以及他们在获得医疗服务时面临的困难阻碍。该项目通过提供中年成年人（40 至 65 岁之间）和青年成年人（20 至 40 岁之间）的中国移民的观点来补充现有文献。 文章的讨论部分将分析适用于移民医疗服务的相关立法和受访者提出的建议，用以帮助中国移民更便捷地使用加拿大的医疗服务。
方法
该项目采访了七名新来加拿大的华人移民，以了解他们在加拿大获得医疗服务的经历。 受访者分别是一位老年人，三位中年成年人，三位青年成年人。 此文章中的引用是在受访者的许可下共享的，但身份信息已被删除。
发现
发现
关于使用医疗服务
每一位受访者都表示, 加拿大的医疗系统的使用门槛较高。主要问题是 (i) 与医生预约时等待时间长，(ii) 缺乏会说普通话的专科医生，(iii) 沟通医疗问题时存在语言障碍。
受访者 A：“当我们因为感冒或流鼻涕需要去看医生时，我们需要提前几周到几个月预约。到预约的时候，感冒都已经好了。”
受访者 B：“当我不得不为膝盖做手术时，我的家庭医生先推荐了我去见诊断专家，然后专家再推荐我去看外科医生。我需要熟悉很多医学术语。我不知道他们用普通话翻译成什么。尽管我在与医生见面之前做了医学术语的研究，但我知道其他人可能没有时间或者精力去这么做。”
受访者 C：“我和我的家庭医生交谈没有问题，因为他会说普通话。但在与专家交谈时，他们使用的都是医学术语，我有的时候听不懂他的意思，并且需要回家自己查。”
寻求自我治疗
受访者们都有不同的方法以应对预约看医生需要漫长的等待。方法可以分为三大类（i）使用中药，（ii）使用自备的西药，（iii）返回中国寻求治疗。
受访者 D：“等医生的时候，妈妈就在家熬鸡汤或者给我吃中药。我也会去社区里看中医，那里可以立马就买到中药，并且见到中医。”
受访者 A：“我在中国的时候就在吃很多不同的药。我把这些药拿出国。它们相当是在中国生产的西药。我使用它们是因为我不熟悉这里的西药，但是真的我很熟悉自己在国内一直吃的药。”
受访者 C：“我有个朋友是青岛人。他们夫妻俩都退休了。丈夫在伸手拿东西时从椅子上摔了下来，把手摔断了。他在急诊等了8个小时，医生什么也没说，也只是简单的处理了一下就让他们走了。所以他们就买机票飞回国了，然后回国那一天就找医院做上了手术。”
加拿大医疗系统的优点
所有受访者都认为加拿大的免费全民医疗是一大亮点。一位受访者评论说，加拿大的医生比中国医生更“负责”。对于受访者而言，中国医生经常会开多余的处方药和诊断测试，受访者认为这是不必要的。当然，因为中国的医疗系统不是对患者免费的，该系统收益于患者支付处方药费用和检查费用。因此，中国的医疗系统下的医生会习惯性开更多的药物或进行更多的诊断程序，就可以赚取更多收益。
两位受访者表示，与他们在中国的经历相比，加拿大的医疗服务提供者倾向于减少使用不需要的药物和检测程序。所有受访者在访谈中都能接触到会说普通话的家庭医生，在与家庭医生交流时几乎没有语言障碍。
受访者 A：“加拿大医生做事很负责，治病会从根本上解决。我有一个朋友是乳腺癌患者，她医生会主动联系她，让她隔一段时间就复诊。在中国他们不会督促你复诊。”
受访者 C：“加拿大的医疗保健最好的一点是它对每个人都是免费的。加拿大的医生普遍靠谱。例如，他们不会给你不需要的药物。或者除非你需要，否则他们不会要求你进行 MRI 或 CT。”
讨论
政策与立法
为了解与移民相关的立法和政策，我咨询了艾伯塔省埃德蒙顿多元文化健康经纪人合作社的执行董事Yvonne Chiu 博士。通过了解她在移民健康和政策方面的经验，我了解到了加拿大的立法是如何影响加拿大移民的生活的。本节将总结我从 Chiu 博士那里学到的主要知识。
系统和人群
诸如医疗保健系统之类的系统旨在为大部分拥有同样特质的人群提供服务。然而，在加拿大，大约 30% 的人过着相对贫穷的生活，而该系统对他们的服务很差。幸运的是，华人拥有的特质非常接近于被服务于该系统的大多数人群特质。主要是因为华人社区是社会上较为富裕的社区，同时华人移民的祖籍国中国，是一个比较强大的国家，中国移民普遍受过更好的教育，而且中国的医疗体系与加拿大的医疗体系比较相似。这为理解中国移民在获得医疗保健时可能遇到的障碍以及这些障碍与其他国家的移民在就医过程中所遇到的障碍有何不同奠定了基础。
加拿大国家移民政策 (Federal Immigration Policy)
该政策规定了哪些国家的人可以移民来到加拿大，移民可以获得多少托儿服务，以及他们来自哪个收入阶层。该政策设定了到达的移民人数。移民到达加拿大有两种主要途径。80% 来自传统技术移民途径，10-20% 来自于难民，通常每年约有 3,000 难民。此外还有两个途径。其中一个是临时外国工人（Temporary Foriegn Workers) 途径。临时外国工人（Temporary Foriegn Workers) 用以满足企业对合同工的需求。他们来自于世界各地，他们需要纳税但没有资格享受医疗保健（除非他们有合同），而且没有资格获得经济适用房，我并不知道他们是否有资格获得托儿服务。这就引起了一个社会问题。当临时外国工人 （Temporary Foriegn Workers) 已经在加拿大安家，并且他们的孩子在加拿大接受教育，而不想返回他们的祖国时，他们却不能这样做，因为他们没有永久移民身份。移民的最后一条途径是国际留学生。国际留学生是帮助加拿大大学财政生存不可或缺的一部分，因为他们支付的学费是本国学生的很多倍。然而，由于经济负担过重，很多国际留学生不得不通过食物补助 (Food Bank) 来满足食物需求。
《多元文化法案》(Canadian Multiculturalism Act)
《多元文化法案》是一项富有远见的法案。该计划是联邦政府带头，其他级政府跟进，以促进移民公平获得社会资源。该法案规定新移民可以前来分享他们的文化。然而，公众们渐渐误解了这个法案的本意。这使得各级政府在执行该法案时不那么积极。为什么？因为移民来到加拿大后，大部分会生活在他们的社区而不是融入更大的社会。这就意味着，移民社区像是存在于加拿大社会里的一个个小社会，大小社会并没有真正地融合。对于移民家庭的孩子们，他们在家里接受的是中国的文化思维，而在社会中却要改变为西方的文化思维。当这种情况发生时，移民的孩子在社会上感受到了歧视，因为他们于西方社会有诸多不同。同时，社会中对于多文化的支持也消失了，因为现实表明，多源文化并没有相融。移民后的孩子们会开始对他们的父母、语言、传统和文化感到羞耻。孩子们会对自己的身份产生认同混淆 (identity confusion)，这会导致家庭内部关系变得紧张。移民青年会有更多的心理健康问题，因为他们的源身份在学校和社会上不受尊重，同时他们的家人也不尊重他们的西方价值观。
政策考虑
Chiu 博士主张我们必须要认识到移民和难民面临的各种社会问题，以及这些问题是如何植根于政策和立法中的。多元文化健康经纪人正在与埃德蒙顿市议会合作，探索社会影响并开发原型系统，以指导制定更好的政策。
受访者建议
开发线上医疗服务
远程医疗服务可以解决求医等待时间过长的问题。 两位受访者表明，中国目前有几个在线医疗网站。人们可以上这些网站来寻求线上医疗服务。 在 COVID-19 大流行之后，中国的医疗保健政策已经调整为允许在线开药。 从那时起，许多“线上医院”被创建了出来，让处于隔离中的国人可以进行线上会诊。 在这些网站中，微医是突出的“网上医院”，提供范围广泛的诊疗服务。 加拿大医疗政策制定者可以参考这些“线上医院” 来发展加拿大自己的线上医疗服务。
将医疗服务都统一在一个地方，而不是多个地方
受访者表示，他们更希望在一个地方获得所有的医疗服务。 在中国，专科医师会诊、影像诊断、血液分析和手术等服务都在医院内进行。 相比之下，在加拿大，这些服务通常分布在社区的不同地点。 受访者希望可以在医院而不是多个地方获得需要的医疗服务。 这将节省时间也会降低使用医疗系统的难度。
让患者明确知道等待时间有多长
受访者都明白，使用加拿大医疗的等待时间很长。 然而，对于手术等更重要的医疗服务，漫长的等待时间可能会严重阻碍他们的行动自由。 例如，一位受访者指出，被安排接受手术是一件幸事。 但他不知道他在等候队伍中的什么位置。这意味着他在拿到手术通知书之前都要一直留在加拿大。 正因如此，他无法回国处理家庭的事情。 如果医疗系统能够告诉他自己在手术排号是多少，或许他就可以返回中国去处理事情。 因此，受访者建议，对于那些寻求手术等重大治疗的人来说，他们应该被告知自己在等待队列里的位置。
让更多的人知道可以使用 Walk-in Clinic 这个医疗服务
一位年轻的受访者建议，在有小感冒或者别的不太严重的健康问题时，大家可以通过 Walk-in Clinic 获得比较即时的食疗。 因为大多数中国移民仍然依赖家庭医生预约来检查感冒和流感等疾病，我们需要让更多的人意识到有这个服务可以选择。 这可以作为急症室等待时间过长或预定家庭医生会诊等待时间过长的解决方案。
致辞
该项目由阿尔伯达大学四年级护理学生何静怡完成。 她小时与家人移民加拿大的经历触发了她想帮助中国新移民适应加拿大社会生活的热情。她在埃德蒙顿社区计划委员会领导的指导下，学习并领导了社区服务。何静怡认为，健康是一项人权，对于来自不同文化和背景的人来说，获得医疗保健是他们最基本的权力，但这其中也会有许多细微差别真实存在于不同人群当中。 她希望随着她照顾更多的患者，随着她不断地加深对这一复杂问题的理解，她可以能够在医疗系统中帮助到更多的人。
References
Ahmed, S., Shommu, N. S., Rumana, N., Barron, G. R. S., Wicklum, S., & Turin, T. C. (2016).
Barriers to access of primary healthcare by immigrant populations in Canada: A literature review. Journal of Immigrant and Minority Health, 18(6), 1522–1540. https://doi.org/10.1007/s10903-015-0276-z
Athari, M. (2020). The healthy immigrant effect: A policy perspective. Sfu.Ca. Retrieved December 12, 2022, from https://summit.sfu.ca/_flysystem/fedora/sfu_migrate/20302/etd20817_MAthari.pdf
Government of Canada. (2021, September 22). CIMM – Canada-China Issues – June 2, 2021. Www.canada.ca. https://www.canada.ca/en/immigration-refugees-citizenship/corporate/transparency/committees/cimm-jun-02-2021/canada-china-issues.html
Kalich, A., Heinemann, L., & Ghahari, S. (2016). A scoping review of immigrant experience of health care access barriers in Canada. Journal of Immigrant and Minority Health, 18(3), 697–709. https://doi.org/10.1007/s10903-015-0237-6
Lai, D. W. L., & Chau, S. B. (2007). Effects of service barriers on health status of older Chinese immigrants in Canada. Social Work, 52(3), 261–269. https://doi.org/10.1093/sw/52.3.261
Statistics Canada. (2017, October 25). Immigration and ethnocultural diversity: Key results from the 2016 Census. Statcan.Gc.Ca.
https://www150.statcan.gc.ca/n1/daily-quotidien/171025/dq171025b-eng.htm
Statistics Canada. (2022, October 26). Immigrants make up the largest share of the population in over 150 years and continue to shape who we are as Canadians. Statcan.Gc.Ca. https://www150.statcan.gc.ca/n1/daily-quotidien/221026/dq221026a-eng.htm
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