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Running Head: REFUGEES' ACCESS to HEALTHCARE in CANADA I View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by British Columbia's network of post-secondary digital repositories Running head: REFUGEES’ ACCESS TO HEALTHCARE IN CANADA i REFUGEES’ ACCESS TO HEALTHCARE IN CANADA by Michel Ndiom B.A. English and French Literature, University of Buea 2003 B.A. Leadership, Trinity Western University 2013 B.S.W., University of Victoria 2018 MAJOR PAPER SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SOCIAL WORK IN THE Faculty of Social Work © Michel Ndiom 2020 UNIVERSITY OF THE FRASER VALLEY Spring 2020 All rights reserved. This work may not be Reproduced in whole or in part, by photocopy or other means, without permission of the author. REFUGEES’ ACCESS TO HEALTHCARE IN CANADA ii Approval Michel Ndiom Master of Social Work Refugees’ Access to Healthcare in Canada Examining Committee: John Hogg, PhD, School of Social Work and Human Services Senior Supervisor: Lisa Moy, PhD, School of Social Work and Human Services Second Reader/External Examiner: Robert Harding, PhD, School of Social Work and Human Services Date Defended/Approved: REFUGEES’ ACCESS TO HEALTHCARE IN CANADA iii Abstract Canada is a nation with a policy of multiculturalism and a deep history of Welcoming refugees from around the world. As Olsen et al. (2016) state, “the integration of refugees into Canadian society is promoted as a source of pride and nation-building, adding to the richness and diversity of the Canadian population” (p. 58). However, the influx of refugees in Canada with diverse and complex health needs has presented a number of challenges within the healthcare system (Joshi et al., 2013, p. 2). Unfortunately, refugees experience various barriers when accessing healthcare services such as racism, discrimination and othering. These barriers are systemic and are influenced by a Eurocentric worldvieW, Which does not alWays take into consideration other Ways of knowing. As a result, this paper suggests that implementation of culturally safe practice could bridge the gap betWeen health providers and refugees. Also, this paper demonstrates that unsafe cultural behaviours and actions continue to deny healthcare access to refugees. Rousseau et al. (2008) writes, “from a human rights perspective, regulations and administrative policies highlighted by this study target specific vulnerable groups within Canada and are completely at odds with the Equality Rights set out by the Canadian Charter of Rights and Freedoms” (p. 291). Finally, this paper calls for an attitude change toward refugees, and corollary changes in policies, Which Will positively impact the health trajectories of refugees and reduce health inequality in the Canadian health system. REFUGEES’ ACCESS TO HEALTHCARE IN CANADA iv Acknowledgment Throughout the writing of this paper, I received a great deal of encouragement and assistance. First, I would like to thank my instructors at the School of Social Work, who challenged me to become an effective Social Worker and Whose guidance has allowed me to move into neW ways of community practice. Specifically, I would like to thank my supervisor, Dr. Lisa Moy whose influence and time were invaluable in formulating my research topic and the applied methodology. Dr. Lisa, I want to thank you for listening, your availability, and patience, Without which I would not have been able to juggle my family life, work commitments and educational pursuits. Also, I would like to acknowledge the University of Fraser Valley’s Master of Social Work cohort for their team spirit, amazing collaboration during our various projects, Blackboard postings, and countless hours of course discussion. I would also like to thank my tWo supervisors: Chery Mosher with the Ministry of Children and Family Development and Andy Sebanc with Green Timbers Covenant Church. Their support and accommodation of my schedule allowed me to remain motivated and to be successful in completing my MSW. In addition, I would like to thank my family: My wife, Viviane Ndiom, and my four children, Shekinnah, Shiloh, Zoe and Joshua, for their patience and love towards me during the process - you are alWays there for me. Finally, there are my friends, Who were a great at boosting my confidence, providing insight, as well as a happy distraction and balance during this process. I cannot mention all of you here since there are so many - you know Who you are. REFUGEES’ ACCESS TO HEALTHCARE IN CANADA v Table of Contents Approval .......................................................................................................................................... ii Abstract ........................................................................................................................................... iii Acknowledgment ............................................................................................................................ iv Table of Contents ............................................................................................................................ v Introduction ..................................................................................................................................... 1 Background and Contextual Information .................................................................................... 1 Research Questions and Sub-Questions ...................................................................................... 3 Social Location ............................................................................................................................ 3 Methodology .................................................................................................................................... 6 Theoretical FrameWork ................................................................................................................ 6 Anti-Oppressive Practice (AOP) .............................................................................................. 6 Critical Race Theory (CRT) ..................................................................................................... 9 Cultural Safety as a Criterion for Refugees’ Successful Access to Healthcare ..................... 11 Methods of Orientation .............................................................................................................. 13 Demographic Focus ............................................................................................................... 13 Intersectionality of Resources ................................................................................................ 14 Literature RevieW .......................................................................................................................... 15 Refugees, Characteristics and Misrepresentation by the NeWs Media ...................................... 15 Refugee Population, Characteristics and Different Categories .............................................. 15 Canada’s Commitment to the World and to Its Population as a Humanitarian Country ....... 17 Misrepresentation of Refugees in Canada .............................................................................. 20 Westernized WorldvieW in a Pluralistic Society: Oppression and Systemic Discrimination .... 22 REFUGEES’ ACCESS TO HEALTHCARE IN CANADA vi An Obsolete Medical Paradigm in a Changing Immigration Landscape ............................... 22 Lack of Agreement Around the Concept of Health Creates Poor Service Delivery .............. 25 Conflicts in the Health Provider-Refugee Patient Relationship ............................................. 26 Healthcare System Reconfiguration Needed to Serve Refugees Effectively ............................ 30 Discrimination and Othering as Norms in Healthcare ........................................................... 30 The Impact of Policies on Healthcare of Refugees ................................................................ 32 The Role of Cultural Safety in Healthcare Settings in Canada .............................................. 35 Acculturation as a Barrier to Utilization of Care within the Healthcare System ................... 37 Social Work Implications .......................................................................................................... 40 Implications for Practice ........................................................................................................ 40 Implication for Further Research in the Areas of Systemic Discrimination in a Multicultural Society .................................................................................................................................... 42 Implications for Policy Creation and Implementation ........................................................... 44 ReneWal of the Role of Social Worker as an Agent of Change in the Community ............... 47 Conclusion ..................................................................................................................................... 48 References ..................................................................................................................................... 50 REFUGEES’ ACCESS TO HEALTHCARE IN CANADA 1 Introduction This paper highlights the need for Canada a, leading country in the field of immigration to, create a healthcare system which would better support refugees fleeing from war, conflict, and natural disasters around the world. As Cheng et al. (2015) affirm, “With
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