Expanding and Building our Partnerships to Improve Access Health Canada ~ Health Services Integration Fund (HSIF) Project

Portrait of the Situation for English-speaking First Nations: Accessing Health and Social Services in English in the Province of Québec

Final Research Report October 21, 2013

Portrait of the Situation for English-speaking First Nations: Accessing Health and Social Services in English in the Province of Québec

Final Research Report By: Amy Chamberlin, M.A.

Submitted to: Onkwata’karitáhtshera and Coalition of English-speaking First Nations Communities in Québec (CESFNCQ)

October 21, 2013

Cover design: Doug Lahache, KSCS Communications

Layout: Marie David, KSCS Communications 2 Front Row Missing: Monique Raymond Back Row (lefttoright) HSIF Steering Committee Members (lefttoright):Robin Decontie, Donna Metallic, RheenaDiabo, Eleanor Pollock : Jimmy Peter Einish, Joyce Bonspiel-Nelson, David McLaren CESFNCQ October 2013 3 APPENDIXES RECOMMENDATIONS...... 41 7. CONCLUSION...... 39 6. 5. FINDINGS...... 23 PROFILES4. COMMUNITY ...... 19 3. BACKGROUND...... 11 2. METHODOLOGY...... 9 1. INTRODUCTION...... 5 5.3 Strategies andsolutions...... 34 5.2 Exposing issuesandchallenges...... 23 5.1 Overview...... 23 4.2 Coalitioncommunities...... 19 4.1 First Nations communitiesinQuébec...... 19 3.6 First Nations’ Rights...... 3.5 Québec’s Health andSocial Services Act...... Services 3.4 Access Programs...... 15 3.3 Québec’s Network ...... responsibilities...... 12 Government 3.2 3.1 Aboriginal healthlegislationandpolicyenvironment...... 2.4 Methods...... 10 2.3 Activities...... 9 2.2 Research approach...... 2.1 Goal andobjectives ...... 1.5 Data collection...... 7 1.4 Scopeandlimitations...... 6 1.3 Health Canada:mitigatinggapsinhealth...... 6 1.2 Mandate andpurpose oftheresearch...... 5 1.1 Foreword...... 5 ...... Contents CESFNCQ October 2013 .9 9 43 11 13 16 17 4 CESFNCQ October 2013 5 Canada, 2012:4.PDF file. safety forAboriginal peopleinurbanhealthcare 1 governance’ and in termsofboththeadministrationservices community well-being isfundamentallylinkedwith‘self- tionate burden ofillnessinCanada”; theauthorsarguethat O’Neil that:“Aboriginal etal.assert Peoples bearadispropor the healthconcernsfacingAboriginal People. For example,John more, numerous studiesandreports have raisedconcernsabout affect thehealthand wellness of Aboriginal peoples. effects ofcolonizationand residential schools,continuesto lying issuessuchaspoverty, coupledwiththeintergenerational from historicalandsocialinjustices.Generally speaking,under language, andforFirst Nations there are accessissuesresulting federal andprovincial systems.There are obstaclesbecauseof from the many challengeswhenattemptingtoaccessservices In Québec, English-speaking First Nations communitiesface asthatofthemainstream Québec population. access toservices English-speaking First Nations donothave thesamelevel of accessible forFirst Nations intheEnglish language:assuch, that there isalackofexistinghealth,socialandrelated services Nations organizations,identified healthandsocialservices Coalition, madeupofdirectors andkeyindividualsfrom First munities beganworking togethertoaddress accessissues.The In April of2012,theEnglish-speaking First Nations com geographical areas (remote, andurban). rural and Timiskaming. Thecommunitiesare locatedindifferent Kahnawake Eagle Village First Nation /Kipawa,KitiganZibi, ties: Kawawachikamach,Gesgapegiag, Listuguj,Kanesatake, Mohawk, andAlgonquin,from eightFirst Nations communi Coalition iscomprisedoffournations–Naskapi, Mi’gmaq, infederalandprovincialand socialservices systems.The (CESFNCQ) inorder toexposeandimprove accesstohealth English-speaking First Nations CommunitiesinQuébec The goaloftheproject wastoestablishacoalitionamong Mohawk communityonthesouthshore ofMontréal). agency thatoversees inKahnawake(a healthandsocialservices (HSIF). Theproject issponsored by Onkwata’karitáhtshera; an funding from Health Canada’s Health Integration Services Fund Improve Access” isathree-year in2012with project thatstarted The project “Expanding and Building our to Partnerships 1.1 Foreword Health CouncilofCanada. Empathy, dignityandrespect: Creating cultural . Toronto: Health Councilof

[1] CESFNCQ October 2013 Further

- 1. INTRODUCTION 1. - - - - to: research project. The overarching objectives oftheproject were of English-speaking First Nations ofQuébec oversaw aone-year burden ofillness’ carriedby Aboriginal Peoples, theCoalition In working towards solutionstomitigatethe‘disproportionate and socialconcernsprevalent inFirst Nations communities. is criticalinorder tobeginaddressing themanypressing health access to,andmakingdecisionsabout,healthsocialservices the healthandwell-being ofAboriginal population. Meeting. (CESFNCQ). “HSIFProject Launch.” Québec City, 28Jan. 2013.Research 3 Purich, 1999: 139–142.Print. Aboriginal Self-Government inCanada 2 research 1.2 Mandateofthe andpurpose accessing healthandsocialservices. positive experiences,andproposed solutions—withrespect to throughout thereport tocapture theirperspectives—challenges, vincial andfederalsystems.Participants’ commentsare included ing First Nations from pro accesstohealthandsocialservices research toimprove ofanongoingeffort ispart English-speak come before thegovernment withonestrong voice. the CoalitionenablesFirst Nations towork together, andto While eachFirst Nation communityhasitsown distinctneeds, CoalitionofEnglish-speaking First Nations Communities inQuébec O’Neil, John, etal.“ oversaw thedirection oftheresearch, andOrganizational lish from federalandprovincial systems.TheCoalition inEng people whenaccessinghealthandsocialservices of thesituationforEnglish-speaking First Nations The mandateforthe research wastodocument aportrait i) ii) social services inEnglish; and social services facing First Nations whenaccessinghealthand Create ofthespecificissuesandchallenges aportrait services. services. recommend, onhow toimprove accesstothose Nations communitieshave inplace,orwould Identify strategiesthatEnglish-speaking First Community Healing andAboriginal Self-Government.” . 2nded.Ed. John Hylton. Saskatoon: [3] [2] The Assuch, - - - 6 Services IntegrationServices Fund 7 2011: 9.Print. sion. 6 Canada. 2Oct. 2013. Web. Oct. 2013. ing Access toHealth -First Services Nations andInuit Health Canada 5 (KSCS). training businesswithinKahnawakeShakotiia’takehnhas CommunityServices 4 projects. access issuesandgaps,including,butnotlimitedto,theAHTF the research buildsuponprevious work andprojects addressing This research initiative wasfundedundertheHSIFinitiative; meet thehealthcare needsofFirst Nations, Inuit andMétis. ning involving multicommunitiesandprojects inorder to is amulti-year initiative geared collaborative plan tosupport Specifically,face whenaccessinghealthcare services. theHSIF initiative alsoaddresses thechallengesthatAboriginal Peoples initiative: theHealth Integration Services Fund (HSIF).This Then, in2010, Health Canadaannouncedanothersimilar when accessinghealthandsocialservices. about thebarriersandconstraintsthatAboriginal Peoples face AHTF projects, helpingtoraiseawareness andunderstanding the province ofQuébec, Aboriginal communitiesengagedin dians by improving accesstoexistinghealthservices.” health statusbetween Aboriginal andnon-Aboriginal Cana projects thataddressed(AHTF), whichsupported “the gapin Canada launchedtheAboriginal Health Transition Fund access issuesforFirst Nations. For example,in2004,Health In recent years, Health Canadahastakenstepstomitigate in health 1.3 HealthCanada: mitigating gaps Canada.Health Canada.First Nations andInuit Health Branch. “ First Nations ofQuébec andLabradorHealth andSocial Commis Services Canada.Health Canada.First Nations andInuit Health Branch. “ Organizational Development (ODS)isaFirst Services Nation consulting/ The purposeofthe research wastoexposeandidentify: fortheproject. support Development (ODS)provided Services management Compendium ofProjects: Aboriginal Health Transition Fund • • challenges Strategies andsolutionstomitigateaccessissues First Nations Access issuesandchallengesfacingEnglish-speaking .” Health Canada.4Feb. 2013. Web. Feb. 2013. [4]

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. FNQLHSSC, CESFNCQ October 2013 [5] .” Health In In Health Improv - - [7] -

- access issuefacingEnglish-speaking First Nations. requested that‘additional research’ preliminary onaspecific Following thereview ofthedraftresearch report, theCoalition Projects ofCoalitionCommunities). various barriers whenaccessingservices. satake andKahnawakeconductedAHTFprojects toaddress communities ofEagle Village, Listuguj,Gesgapegiag, Kane foster lastingandsustainablestrategiestoimprove access. tion Fund (AHTF)projects touncover bestpracticesthatcould who hadbeeninvolved inprevious Aboriginal Health Transi This research alsoincludedtheperspectives ofkeyinformants with chronic healthconditions). their caretakers), parents withyoung children, andindividuals tions) andFirst Nations communitymembers(i.e.Elders (or First Nations Health andSocial communityorganiza Services First Nations communityresources (keyinformants working in research wastoseekouttheperspectives ofEnglish-speaking sultant todesignandconducttheresearch. Theintentofthe In November of2012,theCoalitionengagedaresearch con 1.4 Scopeandlimitations data related toEagle Village’s AHTFproject. gapegiag, Listuguj, Kahnawake, andKanesatake.It wasnot possibletoaccess 9 and provincial providers) service CompendiumofProjects. formal andinformallinkagesbetween Aboriginal providers healthcare service tional issues),andalsoidentifiedstrategies toimprove access (i.e.fostering culturalappropriateness, andjurisdic (for example,English languageservi.e. 8 Some ofthelimitationsthisresearch: attempting toaccesshealthandsocialservices. andurbanareas—facerural obstaclesbecause oflanguagewhen demonstrates thatEnglish-speaking First Nations—in remote, The answers tothequestions the varied; nevertheless, research improving access. solutions theyhave inplace,orwouldrecommend, towards Furthermore,accessing services. were participants askedabout language andculture, aswell aspositive experienceswhen on thefollowing areas: generalaccessissues,issuesrelated to provincial andfederalsystems.The research questionsfocused from the experiences whenaccessinghealthandsocialservices ofthesituation.Participantsa portrait were askedabouttheir to seekouttheperspectives ofFirst Nations, andtodocument Focus andquestionnaires were groups, interviews, conducted Interviews were Interviews conductedwithkeyinformants engagedinprojects inGes TheAHTFprojects (2004-2010)addressed barrierswhenaccessingservices • • best toconductresearch withandforFirst Nations ous protocols (writtenandunwritten)abouthow Accessing Information – Working through thevari research; tocontributethevarious aspectsofthe partners Time Constraints–Availability oftheproject [9] (Appendix A:AHTF [8] The ------7 services, provincialservices, boundaries,andalack ofclaritybetween access issuesresulting from jurisdictional issues—corridorsof Some described or lackofpublic transportation. participants pitals, difficultiestravelling becauseof poor road conditions Generally, First Nations spokeaboutlongwaittimesathos Research findings 1.5 Data collection • • • • ° ° ° intheresearch.)took part work(ed) orlive intheFirst Nations’ communities small numberofnon-Native individualswhoeither weremajority ofparticipants First Nations, anda (the In tookpart all,atotalof130participants given more timetoconducttheresearch. that more communitieswouldhave participated timeframe.Itand wasconductedinashort islikely Oct. 11,2013.This only,research waspreliminary Additional Research wasconductedfrom Oct. 4– March 12–July 24,2013. ing communitiesover afive-month periodfrom research liaisonassistants,from theeightparticipat All datawascollectedby theresearcher, orby communities. of theparticipating was gathered equally(breadth anddepth)from each Data Collection –Ensuring thatdata(perspectives) ensure thatdatacollectionwasconsistent;and, researcher worked closelywithcommunitiesto a distance’ (videoorteleconferencing), thus,the communities. Most oftheresearch conducted‘at ° ° ° tionnaires’ ofthisresearch. aspart key informantscompleted‘Follow Up Ques Follow upresearch (questionnaires): Three (3) members.) vices), andfourwithFirst Nation community nine keyinformants(healthandsocialser Health Transition Fund (AHTF)projects; key informantsinvolved withAboriginal (semi-structured) were conducted(sixwith Interviews: members.) munity resources andfourwithcommunity structured) were conducted(tenwithcom Focus groups A total of 19 individual interviews Atotalof19individualinterviews : Atotalof14focusgroups (semi- CESFNCQ October 2013 - - - - - work? CanFirst Nations from thenetwork? Are accessservices raised. For instance:How doestheprovincial healthsystem Finally, throughout theresearch process there were questions ments orplacephonecallstomitigatelanguageissues. stated that:“[we] rely onbilingualcolleagues” totranslatedocu ofEnglish-languageWhile otherFirst services. delivery Nations and have successfully draftedagreements andprotocols forthe tions have withprovincial worked inpartnership institutions Forobstacles whenaccessingservices. example,someorganiza Participants describedthestrategiestheyusetoovercome thattheyneeded. received theservices who went above thatindividuals andbeyond tomakecertain “culturally sensitive” nurses,doctors,andsocialworkers—those There were alsopositive storiesabout “compassionate” and andhealthneedsasFirstabout theirculture, history Nations. challenges becauseofalackunderstandingandawareness whileothersspokeabout ing toaccessEnglish-language service, hospital.” Participants expressed whenattempt theirfrustration population andinfluenceswhentheyare willingtogothe divides the between thehospitals…[Theboundary] forth Nations communitymember:“People are bouncedbackand federal andprovincial by aFirst authorities.Asarticulated request health and social services inEnglish? request healthandsocialservices ment whendelivering healthcare toFirst Nations? And,canwe are theresponsibilities ofthefederalandprovincial govern individuals abletochoosewhereWhat theyaccessservices? - - - - 8 CESFNCQ October 2013 9 226–227. Print. 10 groups andinterviews. inthefocus assisted inbringingpeopletogethertoparticipate to theresearch, andkeyindividualsfrom eachcommunity wascritical mation from thecommunities.Communitysupport identify questions,anddecideonthebestwaystogatherinfor The researcher worked withthemembersofCoalition to deciding onacourseofaction. process—determining questions,gatheringdata,reflection, and that allows to be directly participants involved intheresearch research) isawayofconductingresearch(or participatory perspectives ofEnglish-speaking First Nations. Action research This project usedanaction-research approach todocumentthe 2.2 Research approach The research objectives: systems inEnglish. from thefederalandprovincial andsocialservices services English-speaking First Nations peoplewhenaccessinghealth The goalofthe research wastoseekouttheperspectives of andobjectives 2.1 Goal Chilisa, Bagele. • • can besustainedinthelongterm. Finally,social services. determinehow thesestrategies Nation communitieswhenaccessinghealthand how these(andother)strategiesmaywork inFirst from theprovince. andsocialservices Exploreservices challenges ofaccessingEnglish-language health practices) utilized by First Nations toaddress the Explore strategies English from federalandprovincial systems. in andsocialservices when accessinghealthservices challenges thattheFirst Nations communitiesface Expose challenges Indigenous Research Methodologies

–Share andexplore strategies(best –Identify thespecificissuesand [10]

. California:Sage, 2012: CESFNCQ October 2013 2. METHODOLOGY - The activitiesinvolved inthe research project included: 2.3 Activities • • • • • • • • • • • • Projects by theFirst (AHTF)undertaken Nations Scan reports from Aboriginal Health Transition speaking populationofQuébec. forEnglish- andsocialservices ing healthservices Scan reports andrelevant materials regarding access HSIF Coalition. Review the Access Project proposal prepared by the Submit final research report. tional research. Review draftresearch report, andconductanyaddi Draft research report. Analyze informationreceived. Transcribe focusgroup andinterviews. Conduct focusgroups andinterviews. and communitymembers). Nations communities(communityresource people First from theparticipating of potentialparticipants Work withFirst Nations communitiestosetupalist and research questions). Develop andtestresearch tools(i.e.consentforms Attend project meetingsasrequired. partners. - - 10 Share findings–finalize research report. processes. collected through thefocusgroups andinterview Analysis –Compile,organize, transcribe,andreview thedata Nations communities(focusgroups andinterviews). local HSIFResearch Liaisons togatherinformationfrom First ers toprepare ascheduleforthedatacollection. Work with Data Collection – Work withCoalitionandProject Manag tion Fund (AHTF)reportscommunities. from theparticipating from provincial institutions;review Aboriginal Health Transi andsocialservices accessing English-language healthservices Literature Scan–Gather documentsandreports related to Nations communities. ensure thatmethodsare relevant andappropriate fortheFirst ology; develop research questions/tools;testresearch toolsto Research Design –Develop anappropriate research method The research methods were asfollows: 2.4 Methods CESFNCQ October 2013 - - - 11 Research Report. 12 et. al.] for Aboriginal Health inLegislationandPolicies: 1970to2008 bia: UNorthern British Columbia,2011:1–3.PDFfile.[ Aboriginal Health LegislationandPolicy Framework inCanada 11 a foundationuponwhichFirst Nations andInuit coulddeliver Peoples required a shift; that is, the Three Pillars policy provided Thishealth policyfor and privateAboriginal medicalservices). the componentsofhealthcare system (includingprovincial federal government, and( firm thetraditional relationship of Aboriginal peoples with the Aboriginal healththrough communitydevelopment, ( for healthidentifiedwithinthispolicyinway:( ment. In theiranalysis,O’Neil etal.,reiterate thethree pillars relationship between Aboriginal Peoples andthefederalgovern According toHealth Canada,thispolicystemsfrom theunique ment brought theThree forward Pillars / Indian Health Policy. tion have evolved over the years. In 1979,thefederal govern there isaneedtocriticallyexaminehow thepoliciesandlegisla jurisdictional responsibilities aswell asthe‘fear ofnegotiations’, To understandthepresent situation,thelackofclarityover between thefederalandprovincial governments. speaking First Nations feartheupcoming2014negotiations First Nations’ abilitiestomanage;andasaresult someEnglish- their capacityandcompetency;there are assumptionsabout that:thereFNCQ) asserted isalackofunderstanding about English-speaking First Nations CommunitiesinQuébec (CES Throughout this research, in various ways,membersofthe decisions didnotfavorably impactFirst Nation communities. and negotiatedwithoutFirst Nations atthetable,resulting care. Aboriginal Peoples accessto“appropriate andresponsive” health ity over jurisdictionalresponsibilities hasnegatively impacted Aboriginal governments. Generally speaking,thelackofclar legislation andrelationships’ amongthefederal,provincial and Framework inCanadaasa‘complex patchwork ofpolicies, is describedinThe Aboriginal Health Legislation and Policy ments. Over theyears, whathasemergedforAboriginal Peoples under theresponsibility ofbothfederalandprovincial govern forAboriginalIn Peoples Canada,healthandsocialservices fall environmentpolicy 3.1 Aboriginal healthlegislation and CESFNCQ.Steering CommitteeMeeting. September 2013. Review of National Collaborating Centre forAboriginal Health (NCCAH). [11] Also, when federal and provincial governments have met 3 ) strengthen therelationships among Synopsis ofLooking [12] , by Josee Lavoie . British Colum 1 CESFNCQ October 2013 ) restore 2 ) reaf The - - - - - 3. BACKGROUND - - - third resources. party thatwere notcoveredhealth services by eitherprovincial or Health Benefits Program (NIHB)toprovide fundingforsome As well, thefederalgovernment establishedtheNon-Insured and theCommunityHealth Representative Programs (CHRs). National Native AlcoholandDrug Abuse Program (NNADAP) have suchas: taken over ofprograms andservices thedelivery ernment. Overdecades,First thelastfew Nations communities ties through thedevolution ofprograms from thefederalgov more control over intheircommuni healthandsocialservices From theearly1980s,Aboriginal communitieshave gained aswell ascommunityhealthnursing.) services, munities hadalready assumedcontrol over healthandsocial their own communityhealthservices. 18 Preliminary Research Presentation. 17 Québec “ same basisasotherhospitalsintheProvince ofQuébec”. (Macaulay, AnnC. as a“hospitalcentre”. Since thattimetheKaterihasreceived funding“on the the Ministère desAffaires Sociales du Québec designatedthecommunityclinic the KateriMemorial Hospital Centre (“the clinic”) openeditsdoors.In 1973, the Mohawk CouncilofKahnawaketookover In 1970, the hospitalservices. 16 15 14 13 intendedfortheir communities. social services of theplanning,implementingandevaluation ofhealthand control isthatAboriginal communitiesare notfullyincontrol community needs”. whether ornottheprograms “are responsive truly toAboriginal therenevertheless, remain about questions,andfrustration, through federaltransfersandagreements;ing more services thatcommunitiesareWhile itistrue administering anddeliver their plansaccordingly. health andsocialneedsoftheircommunitiesdeveloping Today, manycommunitiesare actively engagedinidentifying ment between KahnawakeandtheGovernment ofQuébec. preventative asaresult ofa“nation-to-nation” services arrange Kahnawake, establishedin1955,todayprovides curative and example, theKateriMemorial Hospital Centre (KMHC)in self-government forAboriginal people. ofhealthservices The various community-control initiatives have promoted the The History of The History Successful Community Operated inKahnawake, Health Services O’Neil, etal.:140. CESFNCQ.Steering CommitteeMeeting. Montréal, May 29,2013. Hospitalhave existedinKahnawakesincetheearly1900s.In services 1955, Ibid: 139. Ibid: 139–142. O’Neil, John, etal.: 137. .” CanadianFamily Physician 34(1988).PDFfile.) [18] [14] Thecriticismtogainingadministrative [17]

[13] (Althoughsomecom

[15] For [16] - - - -

- 12 Preliminary Research Presentation. 21 20 nance Centre, 2012:69.PDF file. Children Living inFirst Nations Communities Health Survey (RHS) 19 This reference documentwasputforward by the Ministère dela Aboriginal People (First Nations andInuit)— Frame ofReference andFundingDelivery ofHealth for andSocialServices Services vices. Thefollowing sectionsummarizes informationfrom the andfundingof healthandsocialser conditions forthedelivery agreements withtheprovince of Québec, there are different whether ornottheFirst Nation communityhasentered into both thefederalandprovincial governments. Yet, dependingon First from Nations andsocialservices mayaccesshealthservices 3.2 Government responsibilities provincial institutions. from federaland impact theiraccesstohealthandsocialservices through aclearconsultationprocess, topolicies,whichmay respond, tomeaningfully organizations wanttheopportunity ernments. AstheCoalitionputit,Aboriginal communitiesand policies andrelationships withthefederalandprovincial gov have anactive role inresponding to,developing, andshaping emerged—Aboriginal communitiesandorganizationsneedto patchwork ofpolicies,legislationandrelationships’ thathas toadequatelyaddress the‘complexand socialservices—and communities.” own intheir healthprioritiesandtomanagedelivery Aboriginal communitiesare “betterpositionedtoidentifytheir Policy Framework inCanada Finally, asstatedwithin Québec the obstacleoflanguagemagnifiesaccessissues. population. thanthatofthegeneralCanadian less accesstohealthservices under 40%(38.6%)ofFirst Nations adultsfeltthattheyhad Nations Regional Health Survey (2008/10),reveals thatjust agreements, theaccessissuesremain. To thispoint,theFirst Despite the changestolegislation,andsubsequenttransfer English. there’swho are toaccessservices, disabledtrying nobodyin Idon’tservice, know toomanythatare inEnglish. For those rier creates obstacles…Ithinkifyou’re accessinganyprovincial Speech therapy forchildren isanotherplacethelanguagebar in There services English. isalackofaccesstospecialized Kitigan Zibi, Algonquin |Anishinabeg CESFNCQ.Steering CommitteeMeeting. Montréal, May 29,2013. First Nations Information Governance Centre. First Nations Regional The Aboriginal Health Legislationand Policy Framework in Canada [19] For English-speaking First Nations peoplein [20] With thisinmind,toimprove accesstohealth Phase 2(2008/10)National Report onAdults, Youth and [21] The Aboriginal Health Legislationand

there isagrowing awareness that . Ottawa: First Nations Gover CESFNCQ October 2013 :5. - - - . - a. ‘not underagreement’, aswell asthose‘under agreement’. Santé sociaux(MSSS)forcommunitiesthatare etdesServices Social Services forAboriginalSocial Services People: 9–10 ( not takenchargeofthedelivery Temiscaming. With Kanesatake and respect tosocialservi.e. Temiscaming have Kanesatake,Eagle delivery: Village/Kipawa, and taken chargeofhealthservice 23 and Inuit) –Frame ofReference Funding of Health forAboriginal andSocialServices Services People (First Nations 22 With respect totheCoalitioncommunities, thefollowing have notyet Québec. Ministère de laSanté sociaux(MSSS). etdesServices under agreement’ Health provided andsocialservices incommunities‘not • • • • • • • Funding of health services and social services pro Funding andsocialservices ofhealthservices delivery.taken chargeofservice depending onwhetherornotthecommunityhas of Aboriginal authoritiesorfederalgovernment, are theresponsibility andsocialservices services Program development andtheorganizationofhealth (Northeastern Québec Agreement signedin1978). includes: The Naskapi Nation ofKawawachikamach The Coalitioncommunitythatis ‘under agreement’ Timiskaming. Kanesatake, KitiganZibi, Eagle Village/Kipawa, and ment’ include:Gesgapegiag, Listuguj,Kahnawake, The Coalitioncommunitiesthatare ‘not underagree Addictions andmentalhealth. ing disease communities focuson“ Generally, provided thehealthservices inAboriginal Services. Community Health andEnvironmental Health is fundedby Québec). (Note: TheKateri Memorial Hospital ofKahnawake ered by theRégie del’assurance maladieduQuébec. federal government, except forthemedicalcare cov vided inthecommunitiesisresponsibility ofthe ” (front-line services). ” (front-line services). . Quebec, 2007.PDFfile. Delivery andFundingDelivery ofHealth and Services .) promoting healthandprevent [23] Delivery and Delivery [22] - - - - 13 of Health for Aboriginal andSocialServices Services People centres are locatedin La Tuque andSept-Îles, respectively ( Kanesatake; andthe Walgwan Centre inGesgapegiag (foryouth). Theothertwo Treatment inGesgapegiag; Services theOnen’To:Kon Treatment in Services in Coalitioncommunities:the Wanaki CenterinKitiganZibi; theMawiomi 25 Health forAboriginal andSocialServices Services People: the basicprescription insuranceplan(c.A-29.01,r.2)”. ( Québec’s basicprescription insuranceplanundertheRegulation drug respecting Nations peopleandInuit are covered undertheNIHB,they are “not covered by Non-Insured Health Benefits of First Nations’ (AFN). (CanadaandFirstcrisis intervention. Nations. Health CanadaandAssembly care, dentalcare, and medicalsuppliesandequipment, transportation, 24 b. There are treatment sixalcohol anddrug centres, fourofwhichare located TheNIHBprogram provides suchas:prescription vision drugs, services ‘under agreement’: Health provided andsocialservices inthecommunities • • • • • • • services forcommunitiesunderagreement. services Québec isresponsible forfundingnon-insured health (Cree, Inuit andNaskapi). communities underAgreement withtheprovince providedhealth andsocialservices intheAboriginal Québec assumesresponsibility forthefundingof not regarded asinstitutionsoftheQuébec network. in Aboriginal communities‘not underagreement’ are The facilitiesthatprovide healthandsocialservices difficulty, andfostercare. hours ofcare perday, group homesforpeoplein ing independencewhorequire lessthantwoandhalf violence, residential centres forpeoplewithdecreas for womenandchildren whoare victimsoffamily Indian numberofsafehomes Affairsfundsacertain of peoplewithdisabilities. tance, familyviolenceprevention andtheintegration childandadultplacement,homeassis adult services, are provided inthefollowing areas: child,familyand Indian Affairsand AffairsCanada.Northern Services Social –Aseriesofprograms Services are fundedby adults, whileoneisforyouth. centres forAboriginal people,five ofwhichare for Health treatment Canadafundssixalcohol anddrug health services. Health Canadafundsaprogram ofnon-insured Your Health Benefits: A Guide for First Nations to Access . Ottawa, 2011.PDFfile.).Therefore, because First [24] [25] 11). Delivery andFundingDelivery of : 8). Delivery andFundingDelivery CESFNCQ October 2013 - - for thefuture. systemandtopropose solutions the healthandsocialservices mandate toholdpublicconsultationsdiscussissuesfacing At thattime,thegovernment establishedacommissionwith foritspopulation. ofhealthandsocialservices ing itsdelivery In early2000,theGovernment ofQuébec setaboutchang accessible…” andsocialservices ing asetofhealthservices and restore thehealthandwell-being ofthepopulationby mak according totheMSSS,itsobjective isto:“maintain, improve Health andSocial Services (ChapterS-4.2).Generally, Services vices sociaux(MSSS),whichisregulated by AnAct Respecting administrative authority, theMinistère delaSanté etdesSer fallunderone In andsocialservices Québec, healthservices 3.3 Québec’s Network Sept. 2013. 29 R.Y. Bourhis.Montréal: CEETUM,UdeMontréal, 2008:4.PDFfile. Vitality ofEnglish-speaking CommunitiesofQuebec: From Decline toRevival in Quebec? 28 PDFfile. 2001. Commissionofstudyonhealth andsocialservices. 27 Quebec, 2008:3.PDFfile. 26 inEnglish. to services the restructuring hadoncommunitymembers’ abilitytoaccess vices system—andmore specifically, thedetrimentalimpactthat Nations duringtherestructuring ofthehealthandsocialser the Government ofQuébec’s lackofconsultationwithFirst network, membersoftheCoalitionspokeabout social services In theirdiscussionsabouttherestructuring ofthehealthand English language. speakers, includingFirst Nations inthe peopleseekingservices language politics’ for English-language affected accesstoservice (i.e.networks) andthe‘sanctioningof thehealthservices of inEnglish.” ofservices delivery sanctioning oftheintroduction oflanguagepoliticsintothe system;and of thehealthandsocialservices implementation ofrighttoservices events changedthe“political andadministrative” contextforthe Quebec?” James arguesthatfrom 1994–2003,twomajor Carter Future“What in forEnglish-language healthandsocialservices speaking Quebecers engagedindiscussions.For instance,in Québec, there are questionsastotheextentthatEnglish- CESFNCQ.Steering CommitteeMeeting. Research Meetings. Nov. 2012– Carter, James. “ Québec. MSSS. Québec. MSSS. • ” [CommunityHealth andSocial Network Services (CHSSN)] agency. Côte-Nord (Region 09)healthandsocialservices its own CLSC,whichisundertheauthorityof The Naskapi communityofKawawachikamach has [27] What Future forEnglish-language healthandsocialservices Althoughtheseconsultationswere heldacross Report andRecommendations: Emerging Solution The Québec Health andSocial System –inbrief. Services [29] [28] Boththetransformation i ) “Radicaltransformation ii .) Government . Quebec, [26] - The . Ed. - -

- 14 33 32 tres 31 tres 30 stated oneparticipant. in English,”a corridorthatdoesnothave oroffertheservice “Weor corridorofservice. are beingrefused andredirected to theyneedfalloutsideoftheirdesignatedzone if theservices lenges forEnglish-speaking userswhennavigatingthesystem general) inEnglish. This research exposedsomeofthechal (specialized and presenting challengeswhenseekingoutservices English-speaking First Nations, ‘corridors thenew ofservice’ are For for theEnglish-speaking population,andinparticular tion responsibilities).” needs ofthepopulationswithintheirassignedzones (popula “institutions withinanetwork mustconcentrateonmeetingthe wasimpacted.Asstatedby Carter,individuals accessservices andconsequentlyhoworganizations deliver theirservices, restricted. The changedthemanner by which restructuring individuals’ ‘freedom to choose’ is theinstitutionforservices lish-speakers’ because inpart accesstoEnglish-language services Generally speaking,however, thecorridorshave impactedEng andsocialservices. general andspecialized healthservices that allmembersofthepopulationcouldeasilyaccessboth services.” of thepopulationeachterritoriestoultra-specialized has assigneddesignatedcorridors—“inorder tofacilitateaccess networks thateachofthelocalservices asserts system, Carter toward aneffective service.” the user”, determinetheindividual’s needsand“guide him ing totheQuébec Ministry, thesystemisintendedto“welcome would beabletoeasilyaccessservices. those nearingtheendoflife,frailseniorsandtroubled youth” fering from mentalillnesses,healthproblems orchronic illness, thatthosewhoareto makecertain mostvulnerable:“people suf vices. In settingupthenetworks,was thegoalofMinistry all membersofthepopulationwouldbeabletoeasilyaccessser were intendedtoensurethe MSSS,corridorsofservice that care networks. systembyAccording introducing localservice to By 2004,theGovernment ofQuébec hadreformed itshealth Really challenging. assessmentsdone. togetspeechlanguagepathology trying first…I have seendelaysofa year-and-a-half totwo-years here…Sometimesservices havingtogothrough acommittee ent region] only tohear, ‘No, we willnotgive you English waiting months[toreceive atahospitalindiffer services Ihave hadchildrencannot accessthoseservices. caught Now they saythatifyou are notfrom thatregion you Kanesatake Mohawk|Kanien’keha’:ka, .” Santé sociaux,Québec etdesServices 2013. Web. Feb. 2013. .” Santé sociaux,Québec. etdesServices 2013. Web. Feb. 2013. Carter. 98. Carter. 97. Québec. MSSS.“ Québec. MSSS.“ [32] In sum,thecorridorswere intendedtomakecertain Local Services NetworksLocal Services andHealth Cen andSocialServices NetworksLocal Services andHealth Cen andSocialServices [33]

[31] In hisanalysisofthenetwork [30] Furthermore, accord CESFNCQ October 2013 ------tion, coordination andorganizationofservices. local, regional andcentrallevel; andinallareas—policy direc would require involvement atalllevels ofmanagement—atthe For English-speaking First Nations, navigatingthesystem theeaseby theyare abletonavigateisquestionable. services; supposed tonavigatethesystemfrom generaltospecialized ties by mainstream society. In sum,althoughallmembersare because there isalackofawareness ofFirst Nations communi in theplanningnotonlybecauseoflanguageobstacles,butalso for English-speaking First Nations communitiestoparticipate ofservices.”ning anddelivery to ensure thattheirneedsare takenintoaccountintheplan tion ofEnglish-speaking communitiesattheinstitutionallevel Québec Ministry, asstatedby Carter, “encourages theparticipa The ofprogramsered andservices. intheplanninganddelivery As well, the needsofthepopulationare supposedtobeconsid 34 Ibid: 99. [34] However, there are challenges

- - - - - 15 37 and specialized centres (CHSGSs).(Ibid.) (CLSCS), residential andlong-term care centres (CHSLDs),andgeneralized 36 2013. Web. Feb. 2013 and Health Centres andSocialServices 35 English- (CHSSN) commissionedapollingfirmtosurvey 2005, theCommunityHealth andSocial Network Services In speaking populationtoaccesshealthandsocialservices. there continuedtobeissuesandchallenges fortheEnglish- section 3.6). plans(theseAccess Programslanguage service are describedin Notably, in1999,theQuébec Government adoptedEnglish- inEnglish. the English-speaking populationcanaccessservices In Québec, there are that programs inplacetomakecertain 3.4 Access Programs Central Local Regional ment Level Manage Governance social network Table 1.Listofthegovernance structure ofthehealthand 94. Carter: The CSSSs were establishedin2004 by merging localcommunitycentres Information inthistablefrom: Québec. MSSS.“ - [37] [35] services and social services inEnglish. andsocialservices services Provincial Committeeontheprovision ofhealth (Note:Services report totheMinister ofHealth andSocial * Fourteen Boards) organizations(Advisory resources, follow upandevaluation). network (planning, funding,allocatingfinancial ofthe andassessestheservices social services) (MSSS) establishespolicydirection (healthand Ministère delaSante sociaux etdesServices and social service centres (CSSS). and socialservice networks, known(95) localservice ashealth There*Corridors ofService: are ninety-five services Local healthandsocialservices authorities. *There are atotalof18 regional administrative territories. theservices and organize Health agencies andsocialservices Function

Although theAccess programs were inplace, tothepopulationofaterritory. .” Santé sociaux,Québec etdesServices Among theseorganizationsisthe intheirrespective Local Services NetworksLocal Services networks deliver [36} ) coordinate

[35] CESFNCQ October 2013

and infactthereport confirmsthat: Nations communitieswere includedintheconsultationprocess, English-speaking communitiesacross Québec. 2005 survey, andalsofrom theresearchers’ consultationswith ing Population 2013–2018,drawsonthefindingsfrom the Health andSocial Priorities Service ofQuébec’s English-speak commissioned toconductresearch. Their research The report, the Québec CommunityGroups Network (QCGN)was speaking communitiesfortheyears 2013–2018.Subsequently, outlining thehealthandsocialservices’ prioritiesforEnglish- CHSSN wasrequested by Health Canadatoproduce areport inEnglish. to healthandsocialservices Road Map, Health Canadafundedinitiatives toimprove access the Road Map forCanada’s LinguisticDuality. Through the yearsA few later, in2008,theGovernment ofCanadalaunched community vitality. speaking personsacross Québec onarangeofissuesrelated to tion 2013–2018 41 May 2012.PDFfile. on aconsultationofmember’s ofQuebec’s English-speaking population orities ofQuebec’s English-speaking Population 2013–2018–ADocument Based 40 2013 39 38 the accesschallengesandissuestheyfaceoutsideofthose tofullyvoice wouldhave hadlimitedopportunity participants deliveredthe programs by andservices theMSSS:First Nations In addition,thequestionsusedinconsultationsfocusedon profiles. understanding oftheirspecificdemographicsandcommunity responsibilities’ forEnglish-speaking First Nations withoutan quently, itwouldbedifficulttodrawout Québec’s ‘population not specifically refer tothe First Nations population.Conse report refer toEnglish-speaking Quebecers asawhole,anddo facing First Nations. For instance,thedemographicsin less, thefindingsdonotfullycapture theissuesandchallenges include English-speaking First Nations’ perspectives, neverthe Although theQCGN’s consultationsintentionallysoughtto socio-economic disadvantages, andracism.” language are “more intense” becauseof“cultural differences, Network, First Nations’ experiences ofobstaclesresulting from language; however, asaffirmed by QuébecCommunity Groups becauseof citizens facesimilarobstacleswhenaccessingservices As indicatedinthepassageabove, First Nations andQuébec The Health andSocial Service Priorities of Quebec’s English-speaking Popula Quebec CommunityGroups Network. Community Health And Network SocialServices Ibid: 94. cultural differences, socio-economicdisadvantages, and experienced more intenselyasaresult oflanguageand English-speaking butsomeobstaclesare citizens, ence manyofthesameobstaclestoaccessasdoother First Nations communitiesandtheirmembersexperi racism. [41] : 52 [39] [38] [36]

The Health andSocial Service Pri [39] . 2012.CHSSN. Web. Feb. [37] At thattime, the [40] [38] Some First . [Quebec], ------16 Oct. 2013. Web. 11Oct. 2013. intheEnglishfor services language 43 681–755. PDFfile. inQuébec:Social Services ALegalandPolitical Analysis see:Silver,language healthservices, Richard. “ a legalandpoliticallegislative contextofthelegislative guarantees forEnglish oftheFrench22) andtheCharter Language,1977(known asBill 101).For and Québec’s languagepolicy, OfficialLanguage Act,S.Q.1974(known as Bill ognizes French andEnglish astheofficiallanguagesofCanada” (bilingualism); the federalgovernment’s OfficialLanguages Act(passedin1969),which “rec inEnglish includes: ofprogramsforms thebackdropandservices tothedelivery officiel du Québec2013 42 la Santé sociaux(MSSS). etdesServices population intheEnglishand socialservices languagefortheEnglish-speaking of reference fortheimplementation ofprograms ofaccesstohealth The following sectionsummarizes informationfrom the the province. from linguistic rightswhenaccessinghealthandsocialservices raised theissueandaskedquestionsabouttheircultural (both communitymembersandresources workers) Throughout the research,intending toservice. participants to considerthedistinctcharacteristicsofpopulationitis Social Act.) Services In addition,theAct stipulatestheneed in theEnglish language.(Appendix B:Excerpts –Health and English-speaking personstoreceive healthandsocialservices recognizing therightof andsocialservices, of healthservices ter S-4.2). An Act Respecting Health andSocial Services (Chap Services In systemisregulated by Québec, thehealthandsocialservices Act Services Social 3.5 Québec’s and HealthServices from bothfederalandprovincialaccessing services systems. into accountissuesandchallengesthatFirst Nations faceswhen anyconsultationprocess wouldneedtotake social services, and when itcomestodeterminingprioritiesforhealthservices authority ofbothfederalandprovincial governments, therefore jurisdictional areas. Given thatFirst Nations fallunderthe love you!’ to meinEnglish. She stayed withme,andIsaid‘My God, I Finally,nervous. anursecameover andexplainedeverything talked tomeinEnglish. Iwas sitting there, and gettingangry French, whenhewent forhisoperation noonecameand spoke onhislungs,everybody When mysonwent inforsurgery Listuguj, Mi’gmaq Québec. MSSS..Quebec, 2006.PDFfile; Québec. MSSS.“ An Act Respecting Health (chapterS-4.2).Éditeur andSocialServices Services [42] , areference documentproduced by theMinistère de [40]

The Act provides guidelinesforthedelivery Québec. Web. Feb. 2013Thelanguagelegislationthat

.” Santé sociaux,Québec. etdesServices 11 The Rightto English Health and [43] The .” McGill L.J.45(2000): Frame ofrefer CESFNCQ October 2013 Access Programs Frame - - - English inQuébec Right to in Access HealthandSocialServices programs for English-speaking personsinQuébec. ence specifiesinformationaboutlanguagelegislationand Access • • • • ° ° nated institutions. inEnglishreceive at healthandsocialservices English-speaking personsinQuébec have arightto must seektheopinionsofregional committee sible fortheregional accessprograms. Theagencies At the ° ° ° available inEnglish atvarious institutions. gram Agencies are responsible todevelop an Act,and SocialServices Article 15 Access Program ( inEnglish, whichare listedinaregion’sservices English-speaking personsmayaccessprograms and ° ° ° ° ° outlining the services andprograms thatare outliningtheservices regional level region ofMontréal (06). institutions are locatedintheadministrative The majority(29of42)thedesignated 508.) Québec’s Health Act andSocialServices (Article oftheFrenchthe Charter Languageandunder the English language.( accessiblein andsocialservices health services in Québec), whichare designatedtomake (of approximately 200publicinstitutions In Québec, there are atotalof42institutions 348 ( andapprovedServices by theGovernment tabled withtheMinister ofHealth andSocial Once developed, theAccess Program is respective regions. and English-speaking representatives oftheir agencies, incollaborationwithinstitutions The Access Programs are developed by the intended. of thepopulationforwhomprogram is reflect thediverse needsandcharacteristics years. The Access Programs are These programs are three tobe revised every Québec’s Health Act, andSocialServices Article ). Indicated Services , there isacommitteerespon As perArticle 29.1of As ). ) ( intended to Québec’s Health Access Pro desig - - - 17 People (First Nations andInuit)—Frame ofReference and Funding ofHealth forAboriginal andSocialServices Services tutions. Thefollowing informationisfrom theMSSS’ People, from provincial toaccesshealthandsocialservices insti askedabouttheirrights,asAboriginalAs well, participants 3.6 First Nations Rights forwarded tothem. nication thing[First Nations] don’t have enough information health care. [We need]tobemore It’s informed. alsoacommu [in theNorth] theythinkit’s aprivilege, notaright,tohave People aboutwhatare need tobeinformed theirrights.Here Kawawachikamach, |Naskapi • • • • hospitals, etc ( or from provincial institutionsofQuébec’s network First Nations’ organizations healthandsocial services Thus, First from either Nations mayaccessservices ° ° like allQuebecers. oftheQuébec network andsocialservices services Québec, Aboriginal people,“regardless ofwhere theylive in (c.A–28); ance Act (c.A–29)andtheHospital Insurance Act Aboriginal peopleare covered by theHealth Insur Act, 509). Article of eachregion. (Québec’s Health andSocial Services with respect totheapproval oftheaccessprograms sociaux enlangueanglaise pour laprestation desantéetdesservices desservices At the Health andSocial Act, 510). Services Article when developing theiraccessprogram (Québec’s such as CLSCs (local community service centres),such asCLSCs(localcommunityservice ° ° central level their own communities. thatare available in andsocialservices services First Nations’ membersmayaccesshealth from languageforEnglish-speaking clientele. Quebecers’, there are accessissuesresulting Although entitledto‘equal access’ like‘all are entitledtoequalaccessthehealth ). (provincial) the advisestheGovernment Comité provincial ; CESFNCQ October 2013 Delivery Delivery - , - - 18 CESFNCQ October 2013 19 spoken by Aboriginal Peoples ofQuébec. note: Further research isneededtoobtain anaccuratefigure forthelanguages data from Statistics Canada,2012“ and Northern Development Canada Development Canada. “Welcome totheFirst Nations Profiles.” Aboriginal Affairs Inuit communities(languagesspoken): 45 eter, December 31,2012.]Québec. 27May 2012.Web. March 2013. Quebec 44 social services. respective Nations and developing policiesforhealth services diverse histories,culture, languagesanddemographicsoftheir need formore awareness andunderstandingofthedistinct First Nations inthisresearch whotookpart spokeaboutthe Québec 4.1 First Nations communities in history, culture andlanguages. Nations’; aswell asrespect andawareness aboutFirst Nations’ ofrespect:the importance Respect for‘who we are asFirst At spokeabout manyof thefocusgroup sessions,participants Approximate figure baseduponinformationabout First Nations and Québec. Secretariat aux affaires autochtones.“ .” [Aboriginal Affairsand DevelopmentNorthern Canada, Indian Régi • • • Traditional language. is thefirstofficiallanguagespokenaftertheir own resident population)eitherspeaksEnglish, orEnglish lation (andanestimated(71%ofthecommunity/ Approximately 64.5%ofthetotalAboriginal popu 69,900 residents and26,667non-residents). Inuit) intheprovince ofQuébec is98,731(with The total Aboriginal population(First Nations and the province, andfifteen Inuit communities. Firstis atotalofforty-one Nations communitiesin nal nations(includingFirst Nations andInuit); there In theprovince ofQuébec, there are eleven Aborigi 4. COMMUNITY PROFILES 4. COMMUNITY . 16Jan. 2013. Web. Oct. 2013;andwith Aboriginal Population inQuebec [45] Canada. Aboriginal Affairs and Northern

Aboriginal Population in CESFNCQ October 2013 .” Author’s [44] - - - Myth toReality Official Languages. 48 file. guicide withBilingual Education 47 tion 46 Laurentides, Montérégie. Témiscamingue, Côte-Nord, Gaspésie-Îles-de-la-Madeleine, eighteen publichealthregions, including:Outaouais, Abitibi- comprise theCoalitionare situatedwithinsixofQuébec’s and remote geographicareas. The First Nations thatcurrently are locatedthroughout theprovince ofQuébec inurban,rural / Kipawa,KitiganZibi, and Timiscaming. Thecommunities Listuguj, Kanesatake,Kahnawake,Eagle Village First Nation communities: KawawachikamachNaskapi Nation, Gesgapegiag, Mohawk andAlgonquin;from eightFirst Nations of Québec iscomprisedoffournations:Naskapi, Mi’gmaq, The English-speaking Coalitionof First Nations’ Communities 4.2 Coalition communities and French), whichhasincreased steadilysince1991. tongue isEnglish, there isahighrateofbilingualism (English parison, forthemainstream English population whosemother processes ofdecolonizationandempowerment. “enhancement” ofAboriginal heritageandlanguageisvitalto French after. Indeed, studiesconfirmthatthe “protection” and pants, thepriorityistoretain thetraditionallanguagefirst,and for manyAboriginal communities,asindicatedby partici of therespective nations’ traditionallanguages.Furthermore, language spoken,stillthere are manyspeakers,andlearners, (First Nations andInuit), English hasbecomethepredominate speak French). language, whileothersalsospeakEnglish andasmallpercentage their traditionallanguageofNaskapi; forsomethisistheironly Kawawachikamach, themajorityofcommunitymembersspeak main languageinwhichbusinessisconducted.(For instance,in either becomethepredominant languagespoken,oritisthe For themajorityofCoalitioncommunities,English has a.) Languages . CLSCNaskapi. Janvier 2005:1.PDFfile. Taylor, Donald etal.,“ Canada. Parliament. House ofCommons.Standing Senate Committeeon Des Roches, Michel. . Ottawa: Senate ofCanada,2011:7.PDFfile. [46] The Vitality of Québec’s English-Speaking Communities: From Although inmanyAboriginal communities Portrait demographique etsociosanitaire delapopula Aboriginal Languages inQuebec Fighting Lin .” Diversité urbaine (2008):69–89.PDF

[47] In com [48] - -

- -

20 People].” Our Community 53 McGill University Nation ofKawawachikamach (Quebec) |ICIHRPRoots ofResilience Project - 52 ity 51 Statistics Canada.2May 2013. Web. March 2013. for First Nations andnon-Aboriginal population, provinces andterritories, 2011 50 file Aboriginal Canada 49 First Nations CommunitiesinQuébec. oftheCoalitionEnglish-speaking ern communitythatispart Naskapi spirituality. supply, of isattheheart andformanyrawmaterials.Harvesting oftheirfood hunting, fishing,andtrappingforalargepart communitiesmanyNaskapinorthern People rely onsubsistence The mainlanguagespokenis Naskapi, andsimilartoother kapi continueaspectsoftheirtraditionalwaylifeandculture. chikamach means“the windingriver.” fifty kilometerssouthofthetundraline.ThenameKawawa by “rocks, trees, andwater,” thecommunityissituatedjust region ofQuébec ontheQuébec–Labrador border. Surrounded The Naskapi ofKawawachikamachlive withinthenorthern Naskapi c.) Nations 35 years. under theageof35hasdecreased significantly over thepast in Québec, thepopulationisageing;numberofpeople With regards tothemainstream English-speaking population age forthenon-Aboriginal populationis41years ofage. First Nations populationis31years ofage,whilethemedian life expectancy. rateandalowerpopulation becauseofthehighbirth overall population. Aboriginal communitieshave afargreater younger and younger populationthanthatoftheoverall Canadian Aboriginal communitiesacross Canadahave afastgrowing Structure b.) Age : 7 Naskapi Nation ofKawawachikamach.“ McGill University, Culture &Mental Health Research Unit. “ The Vitality of Québec’s English-Speaking Communities: From Myth to Real Canada. Statistics Canada.National Household Survey, 2011.“ Adelson, Naomi. “

[51] [47] .” McGill. 13May 2011. Web. Dec. 2012.

.” CanadianJournal ofPublic Health. 96(2005):49.PDF [49] [45] The Embodiment of Inequity, Health Disparitiesin Likewise, inQuébec,Likewise, themedianagefor [53] . n.d. Web. Dec. 2012. [49] Kawawachikamach isthemostnorth Overview [The Overview Nation andthe [52]

[48] Today, manyNas CESFNCQ October 2013 Naskapi Median age [50] [46] - -

.” .” - - of Peace. The Kanien’kehá:ka Nation iscomprisedofeight an allianceandformofgovernance known astheGreat Law six nations,theHaudenosaunee were joinedtogetherunder present-day North northeastern America.Asaconfederacyof saunee extendedover avast territory, encompassingmuchof Haudenosaunee). Thetraditionalhomelandsofthe Haudeno make uptheSix Nations (Iroquois) Confederacy(alsocalledthe heritage. Kanien’kehá:ka isoneofsixIndigenous nationsthat The Mohawk (Kanien’kehá:ka) have arich,vibrant,andunique Mohawk |Kanien’kehá:ka Listuguj andGesgapegiag. munities inQuébec ofwhichtwoare membersoftheCoalition: ofMaine. part the northern ofNewfoundland ofQuébec, parts and parts andLabrador, and we know todayastheAtlantic Provinces, theGaspé Peninsula ismadeupofseven districts,whichencompasswhat territory The homelandofthe Mi’gmaq nationiscalled Mi’gma’gi. The Mi’gmaq Stories nesiik Sark. 56 Oct. 2013. Kahnawá:ke) 55 na Naqtmueg. Listuguj: Mi’gmawei Mawiomi Secretariat, 2007 54 Kipawa, KitiganZibi, and Timiskaming. of whichthree are membersoftheCoalition:Eagle Village/ There are nineAlgonquincommunitiesinprovince of Québec ofthecircle oflife. stone,ispart plant,every animal, every strong elementoftheAnishinabegbeliefsystemisrespect; every people’, have lived on Turtle Island forthousands ofyears. A Algonquin, orAnishinabeg,whichmeans‘the people’ or‘first Algonquin |Anishinabeg awake are oftheCoalition. part State. communities, locatedinQuébec, Ontario, andNew York Doerfler, Jill, Niigaanwewidam James Sinclair, and Heidi Kiiwetinepi Mohawk CouncilofKahnawá:ke.“ Mi’gmawei Mawiomi Secretariat. . Winnipeg: UofManitoba, 2013.Print. [55] [51]

Centering Anishinaabeg Studies –Understanding the World Through .” Mohawk Councilof Kahnawá:ke.3Seskehkó:wa 2013. Web. The Mohawk communitiesofKanesatakeandKahn

[54] [50] Nm’tginen Memnaq Ejiglignmuetueg gis Tsi Nitiohtón:ne Oká:ra of (History There are three Mi’gmaq com

. Print. [56] - [52] - - -

21 ment Canada,Indian Régieter, December 31,2012.] Quebec. 27May 2012.Web. March 2013. 57 [53] NationsCommunities d.) First Nation Timiskaming First Kipawa | Eagle Village Kitigan Zibi Kanesatake Kahnawake Listuguj Gesgapegiag Kawawachikamach Community Table 2.CommunityProfiles –Location, Population, and Administrative Regions Information forthistablefrom: Quebec. Secretariat auxaffaires autochtones. “ community withOntario). mately 600kmfrom Ottawa the headofLake Temiskaming, approxi Timiskaming First Nation islocatedat with Ontario). bank ofLakeKipawa kilometers west of Temiscaming, onthe Eagle Village First Nation islocated10 with Ontario). and Riviere Desert by Rivierebound onthenorth del’Aigle ofGatineau/Ottawa.meters north It is Maniwaki. Thecommunityis130kilo is situatedjustoutsidethemunicipalityof The Kitigan Zibi Anishinabegcommunity (Ottawa River). the banksofRivière desOutaouais ‑west ofMontréal,kilometers north on Kanesatake issituatedapproximately 60 southwest ofthecityMontréal. of theSt. Lawrence River, 10kilometers Kahnawake islocatedontheSouth Shore munity withNew Brunswick). province ofNew Brunswick of theRestigouche River, across from the banks munity issituatedonthenorthern by theAppalachian Mountains, thecom oftheGaspé Peninsula.part Surrounded Listuguj islocatedinthesouthwestern of Bonaventure). Cascapedia Bay (about45kilometerswest shoreGaspé coast, onthenorth ofthe Gesgapegiag islocatedonthesouthern on theQuébec-Labrador border. ofthetownters northeast ofSchefferville end ofLakeMatemace, about16kilome Kawawachikamach issituatedatthesouth Location

(Border community (Border community (Border com CESFNCQ October 2013 (Border - - - - - Aboriginal Population inQuebec of thecommunity). living withinand1,586outside Total population3,672(with2,086 of thecommunity). living withinand740outside Total population1,412(with672 munity.) and 313livingoutsideofthecom (with 857livinginthecommunity Total populationof1,170persons Population of thecommunity). living withinand1,285outside Total population 1,923(with641 the community). ing withinand675livingoutsideof Total population 951(with276liv of thecommunity). living withinand1,428outside Total population3,021(with1,593 of thecommunity). living withinand938outside Total population2,321(with1,383 of thecommunity). living withinand2,591outside Total population10,336(with7,745 [57] .” [Aboriginal Affairsand DevelopNorthern - - Rural la-Madeleine (11), La Gaspésie-Iles-de- Rural la-Madeleine (11), La Gaspésie-Iles-de- Remote La Côte-Nord (09), Region Administrative camingue (08),Rural Abitibi-Témis camingue (08),Rural Abitibi-Témis Rural L’outaouais (07), Rural Laurentides (15), Urban Montérégie (16), - - - 22 CESFNCQ October 2013 23 cies inListugujon February 6,2013. agen the researcher andsocialservices withfront lineworkers ofhealthservices project launch.Québec City, January 28,2013.Research toolswere testedby 58 are not mentionedby nametoensure confidentiality. Finally, names ofthecommunitiesare included; however, individuals institutions are The included,ifmentioned by the participants. were notincludedinthereport; however, thelocationsof minutes inlength.Thenamesofprovincialthirty institutions werelasted from twotothree generally hours,whileinterviews forms atthebeginningofeachsession.Eachfocusgroup session group signconsent consensusorby havingtheparticipants andconsentwasobtainedeitherby explained toparticipants, held itsfocusgroup inNaskapi andEnglish. The research was exception ofthecommunityKawawachikamach,which in writtenformat.Thesessions were heldin English, with the hadtheoptiontoreply totheresearchor interview questions ticipants whowere unabletoattendthefocusgroup session audio wastranscribed,orthere wasanotetakerpresent. Par were The focusgroup sessionsandinterviews recorded; the onsiteorwithvideoconferencing/telephone. and interviews The researcher (or research liaison)conductedthefocusgroups facilitated thesessionsandgathered thedata. whileinothercommunitiestheliaison groups orinterviews, ing. In somecommunities,theresearch liaisonsetupthefocus their respective communitieswhoassistedwiththedatagather Guide). Coalitionmembersidentifieda research liaisonfrom (AHTF)’; Appendix E:HSIFFocus Group andInterview Guidedix D:‘Interview forAboriginal Health Transition Fund then testedwithFirst Nations’ front lineworkers. consent forms)were developed, reviewed by theCoalition,and In thewinterof2012,research tools(research questionsand Focus Groups, Held, Interviews andQuestionnaires.) individuals withchronic conditions).(Appendix C: Table. members (Elders, caregivers, parents withyoung children, and andFirstboth healthandsocialservices) Nations community First Nations communityresources (front lineworkers from were conductedwithtwomaingroups:groups and interviews out theperspectives ofEnglish-speaking First Nations, focus sought todocumentsolutionsthesechallenges. To seek from provincial andfederalsystems.In addition,theresearch speaking First Nations whenaccessingEnglish-language services The goalofthis of researchEnglish- wastodocumentaportrait 5.1 Overview Research methodologyandtoolswere reviewed by theCoalitionat [58] CESFNCQ October 2013

(Appen - - - - challenges The following isacompilationofthe a.) Key accessissuesandchallenges 5.2 Exposingissuesandchallenges Lodging). Coalition (Appendix F:Questionnaire – Transportation and research) aboutaspecificaccessissuethatwasidentified bythe was developed togatheradditionalinformation(preliminary following thereview ofthedraftresearch report, aquestionnaire First Nations CommunityResources are marked withanasterisk(*). (health andsocialservices’ workers andcommunitymembers) in order ofpriority, andanyissuescommontobothgroups • • • • • • • Access to general services, ineitherFrenchAccess togeneralservices, orEnglish. First Nations. andFederal/Provincialservice, responsibilities for Jurisdictional issues:provincial borders, corridorsof Communication –languagebarriers.* Cultural discrimination/lackofculturalsensitivity.* ments). Training docu inEnglish (includingsupporting ° Documentation andinformationinEnglish.* Access inEnglish. tospecialized services identified by participants. Theaccessissues identified by participants. are listed ° 5. FINDINGS services. services. policies intheareas ofhealthandsocial to understandprovincial legislationornew tion protocols, ambulanceforms,information sites, government sites,updatesforimmuniza training information,assessmenttools,web Key areas: patientrecords/medical charts,

key accessissuesand - -

- 24 Common issuesidentified by all First Nations Communities i.) General accessissuesandchallenges included inAppendix Hofthisreport. The findingsforeachindividual First Nationcommunity are because oftheirgeographiclocation—remote, orurban. rural those issuesthatare shared by somemembersoftheCoalition challenges are commonamongallthe communities,aswell The research datawasanalyzed todeterminewhichissues and compiled andorganized intofourbroad areas: was The datacollectedfrom thefocusgroups andinterviews b.) Compilationofdata Nation communityare included inAppendix Gofthisreport. The keyaccessissuesidentified byeachparticipating First First Nations CommunityMembers • • • • • • • • • iv.) iii.) ii.) i.) provincial network about where andhowfrom the toaccessservices First Nations lackinformation andknowledge charge from provincial institutions). inEnglish (i.e.assessments,dis Quality ofservices First Nations: Provincial orFederal authorities). Funding (lackofclarityaboutwhoisresponsible for being understoodbecauseoflanguageandculture). Attitudes and perceptions (fear, anxiety, andnot Cultural discrimination/lack ofculturalsensitivity* Communication –languagebarriers.* Documentation andinformationinEnglish.* (emergencyroom anddispatch). Emergency services inEnglish. services andeven longerwaitfor Long waittimesforservices, General Access Issues andChallenges Issues Resulting from Language Positive Experiences Issues Related toCulture . The responses varied among

CESFNCQ October 2013 -

• • • • • ° ° the individualstaffand/orinstitution. care wasamatterof‘luckthedraw’, dependingon areasand rural with medicationandclients’ appointment;in reported that‘errorsparticipants are beingmade’ Concerns aboutqualityofcare. inQuébec. English-language services) (in particular urban) reported notknowing where toaccessservices and cial institutions(i.e.CLSCs),whileothers(rural from provinunaware thattheycouldaccessservices Inparticipants. Participants reported issues associated withfunding vices atinstitutionswithintheir corridorofservice. available toaccess ser lack ofpublictransportation from of distance(lackgoodroads), whileparticipants in Travel. because ofage-related issues. at hospitals clients have tonavigateandfindservices needs. Others describedthedifficultythatelderly specialists andaskingquestionsabouttheirhealth ficulties thatelderlypeoplehave communicatingwith population. Ageing testing). (specialists, Long waittimestoaccessservices from theprovince.around accessingservices members spokeabouttheir‘fears’ and‘anxiety’ perceptions aboutthequalityofcare. Community tions (hospitals,CLSCs,etc.)becauseofnegative from provincialreluctant toaccessservices institu from provincial institutions. Perceptions andbeliefswhenaccessingservices ° ° remote areas andrural urban areas in thathisfilewasconfusedwithson’s, which couldn’t managetodoit.He alsohadaproblem member triedtogethisaddress corrected and you don’tup inadepartment even want.One When you call you getbouncedaround andend house. (Kawawachikamach) same, butthemedicationwassenttowrong medication. Thenames[ofclients] were the There wasacasewhere there wasanerror in sick togothere [hospital](Gesgapegiag). don’t thoseguys,Ihave tobepretty trust damn could have resulted inasignificantaccident.I Mixed responses For from participants. those , participants reported thatqualityof , participants rural areasrural reported difficultiesbecauseofa Participants described thedif there are challenges because , some participants were, someparticipants Participants were In In remote areas urban , - - - - 25 Remote & Rural Areas (general accessissues) • • • • • • • ° ° ° language areas formedicalreasons ( from Transportation andlodging. (i.e., dialysisequipment,wheelchair, walkers,etc.). Lack ofaccesstomedicalequipmentinthearea Difficult tofindafamilydoctorin Québec. ineitherEnglish orFrenchservices Lack ofgeneralandspecialized healthandsocial (travel).Distance toaccessservices private care). (publichealthvs. their waytoquickerservices.’” care system’ andthat‘for afee’ individualscan‘buy for clients,there isan“emerging ‘two tiered health Two-tiered healthcare. make upthegapinservices. and First Nations communityorganizationsneedto fewerservices, impacting healthandsocialservices: (provincial andfederal),generallyspeaking,are vices. Government cutbacksinfundingtohealthser Health Benefits (NIHB). for travel through Health Canada’s Non-Insured ° ° ° rural andremoterural areas Participants reported thatgovernment cutbacks homes. expressed concernaboutthesafetyofboarding provider) is“complicated”; andparticipants with thethirding reservations service party modations; theaccommodationprocess (mak lodging; there are “mix-ups” withtheaccom ing; specifically:lackofchoicewith respect to Participants expressed concernswiththelodg English forcomprehension purposes. trated inthatthedrivers donotspeakenough clientsareissue withthetransportation; frus Some notedthat languageisan participants andlodgingservices. with thetransportation naires), are participants ‘somewhat satisfied’ Based research onpreliminary (question ). Participants reported that general accessissueand whentraveling tourban Challengesforthose . CESFNCQ October 2013 - -

- - - - Common issuesamongallFirst Nations communities. ii.) English languageaccessissues • ° nurses, front lineworkers, andreception. specialists more likelytobebilingual,lesssofor Language barriers(communicating)–Doctors and ° ° ° ° ° ° ° ° ° ° ° Sometimes nursesyell ifpeoplecan’t understand of where theywouldliketostay. a different language.Theyshouldhave achoice insomeoneelse’sfortable homewhere theyspeak Lodging isthebigproblem. People don’t feelcom required. theservices ing tosupport on theirown needs,andwithadequatefund andlodging)based program (transportation the that communitiesshouldbeabletorun alternative accommodations.Recommended organizations are subsidizingthecostfor Key informants indicatedthatFirst Nations diagnosis and service plan.(Kahnawake) diagnosis andservice affects me—Imaynotunderstandthe further and Idon’t understandwhattheyare saying,it have anurse/doctortellingmewhatiswrong If Iamsick,itisalready enoughandifI scary (Eagle Village |Kipawa) mother tocomealongforthesamereasons. and whenever we gotothehospitals,Igetmy my mothertocallbecauseIcannotspeakFrench, who are difficult. Theyonlyspeak French.Iget his doctorspeaksEnglish, butit’s thereceptionists Some ofthedoctorsspeakEnglish. For myson, are saying.(Listuguj) interpreted inthewayandmeaningofwhatyou thatwhatyou arecomfortable sayingisbeing to have someonewhoisfluent…you wanttobe They won’t openup,theywon’t talk. You have get themtogocounseling.Theywon’t goback. ask ‘why amIgoingthere?’ It’s hard enoughto this persondoesn’t really understandthem,they’ll a placeandthey’re gettingtheimpression that Mental Health If Services: thepersonwalksinto gapegiag) French, asifspeakinglouderwouldhelp!(Ges - - - 26 language barriers. Calling provincial institutionsisdifficultbecauseof • • • because clients’ in informationmaybecharted of languagebarriers Tracking clients’ information isdifficultbecause ° ° ° materials. Training Information—lack ofaccesstoEnglish Protocolscal Alerts, andMedical Information; and to meetingsabout‘English Access’ programs); Medi invitation lettersfrom theprovince (includinginvites province; reports, assessmentsanddischargepapers; bec (OTSTCFQ); signage;informationfrom the des therapeutesconjugauxetfamiliauxduQué Professional Orders (Ordre destravailleurs sociauxet French. Documentation from theprovince ismainlyin (Kitigan Zibi) it’sthem theinformation, hard becauseofthelanguage. togive and Imyselfamnottotallybilingual,buttry it’s French. Theywanttoknow why you are calling, If you have tocallCLSCsafter4 ° ° ° gerous. (KitiganZibi) five years old. It’s notrightanddownright dan don’t know how is—maybe oldtheinformation from isoutdatedfrom theoldertranslation, I IcandrawQuébec] andtheonlyinformation about thePIQ [Protocole d’immunisation du But sayamotherrequires someinformation that [theprovince] provides forusinEnglish. We dohave basiclittlehand-outsfor[clients] what itallmeans,andmakedo. (Kahnawake) like respiratory problems. Theygetthesense of you whatbox theyneedtotickoffforsomething translate whatthingsmean,buttheycouldtell use them.Theymightnotspecificallybeableto the first to responders have adaptedandlearned are forms forms—the allinFrench, butallof tions maybe100%inFrench. Ambulance organizations inEnglish, however, theinstruc nity Care’) are senttoFirst Nations’ community Some templates(i.e.for‘Home andCommu translate documents.(Listuguj) is?! Longwait period whenrequesting province to you can,butdoyou realize how expensive that Ifrials orforms: you wanttotranslate ityourself gual; lackfundingtotranslate documents,mate from organizationsthatdeemthemselves bilin indifficult toobtaininformation English, even French, togetitinEnglish andtotry it’s hard; thatweA lotofinformation getisalwaysin

Participants highlighted . Participants describedobstacles : Information from p . m . oronweekends, CESFNCQ October 2013

------• • • ° Limited accesstotraininginEnglish inQuébec. ° translations. and treatment canbedelayed whilewaitingfor Translation are services limited:lackoffunding English (homecare stats,vaccines. reports). centres) trackcommunitymembers’ informationin in somecommunitiesnurses(communityhealth speaking communityresource workers. However, French, whichthenrequires translationforEnglish- ° ° (i.e., autism,learningdisabilities). youth forindividuals( ologists, andservices speech languagetherapy, audi mentalhealthservices, across theregions spokeaboutdifficultiesaccessing: Many from accessing specializedparticipants services. whilein services, difficulty accessingbothgeneralandspecialized lish. inEng Lack ofaccesstohealthandsocialservices ° ° ° ° ° ° In In ) withphysicalanddevelopmental challenges not beacceptedby Québec andtheinformation get ourtraining from out-of-province, itmay to goOntario fortraining inEnglish. If we Courses are mainlyoffered in French. We need going tobesomeissues.(Eagle Village |Kipawa) your sickness withinthoseofficehours,there’s a week withinofficehours. So, unless youtime on siteatthehospital,andIbelieve it’s fourdays The Agence delasantéhasprovided atranslator then a lot of services arethen alotofservices pulledback…It’s not aren’t capableofreceiving inFrench, services in theschoolare lacking.Because ourstudents providedThe services tothestudents by the CSSS (Gesgapegiag) syndrome are limited,even off very reserve. inEnglishServices forchildren with Down’s autistic childbecause[there is]noneinthearea. from Newbrought inservices for Brunswick difficult.is very First Nation Health Centre Access forfamilieswithspecialneeds toservices saying. (Timiskaming) is tounderstandwhattheinstructor struggling ing whenyou’re somethingwhile tolearn trying worker whoisnotfullybilingual;It’s frustrat It canbedifficultto receive training from a be different between provinces. (Timiskaming) (guidelines, recommendations, procedures) may remote areas andrural urban areas there were obstacles , participants reported , participants in particular in particular - - - 27 • • ° ° boundaries, funding,andlongwaitinglists.) inEnglish. services andtreatmentLimited detoxification services ° ° lish. inEng Limited accesstomentalhealthservices ° ° ° ° ° ° patient becausetheychange—Ihave namesof difficultto I finditknowwherevery to refera you sendreferrals andtheygetlost.Sometimes not localsandcanonlybehere onceamonth, to getnamesofdoctors,andbecausetheyare hospital, another, athird hospital,afourth, need tofindaplacesendthem,callingone With Ontario doctorsrefusing ourpatients,we not there. (Eagle Village |Kipawa) is acceptable—long delaysandqualityofservice for theirspecialneedschildinEnglish isnot province theyget altogetherbecausethe services uncommon forparents tojustupandleave the Québec). (KitiganZibi) clinics forEnglishinthe province services of privatepeople from thecommunitytolong-term invested oneyear by thecommunitytosendthree for English(approximately $75,000 services send afewmemberstoprivate clinicsinQuébec [Our] Communityhaspaidoutconsiderably to (Gesgapegiag)clientele hasbeenserved. accepting referrals from Québec aftertheirown agreements, some provincial institutionsare only However,tion services. despitehavingservice New andNova Brunswick Scotiafordetoxifica First Nations organizationsare sendingclientsto cost ofdoinganassessment.(Kahnawake) pay tohave assessmenttranslated, increases the provided inFrench andorganizationneedsto ments (non-insured, Report psychiatrist services). poolforconductingassess Assessments—limited Limited optionsforpsychologists inEnglish. tals isanissue(strain onfamily/community). mental healthpatients.Dischargefrom hospi hospitals, yet nopsychiatrists available forthese Waiting listseverywhere: patientsare leaving (Kanesatake) obtain services. translating forthemto personalinformation the languagebarrier. Clientsneedassistancewith The mentalhealthissuesare more impacted by again. (Timiskaming) anymore andyou needtodothisresearch allover psychologists, psychiatrists, andtheyare notthere (Jurisdictional issues,provincial CESFNCQ October 2013 - - - - • • ° withintheprovince—tofarther—but accessservices. the province ofQuébec,” even iftheyneedtotravel reported thattheyare beingencouragedto“stay in dor. In intheirownto them,inorder corri toaccessservices farther, available andwithlesspublictransportation because ofprovincial corridors:clientsmusttravel commentedthattravel isalsoanissue participants to closesthospital(by ambulance).In inEnglish ifsent any typeofmentalhealthservices language pathology).Others reported challengesfor delays inassessmentsandtreatment (i.e.,forspeech inEnglish. seeking services (corridors) canpresent obstaclesforindividuals TheprovincialCorridors ofService. network members to access emergency services. In members toaccessemergencyservices. remote areas obstacles becauseoflanguageandculture Emergency General Services. accessissuesand ° ° individuals (paramedics). forEnglish-speaking nities andtrainingopportunities reported thatthere isalackofemployment opportu of ambulanceformsavailable inFrench only, and forexample documentation with emergencyservices, munities. In response timeis‘even slower’ inFirst Nations’ com access issuesandlanguageobstacles,theemergency remote areas ° ° ° we are beingshutoutbecauseofourpostalcode of theArt” are medicalservices ontheislandand whichareservices, almostallFrench. The“State we are beingdelegatedtotheSouthShore for referred backtoSouthShore. More andmore hospitals inMontréal isrestricted, clientsbeing for peoplelivingontheSouthShore. Access to have beenchanged The corridorsofservice ties. It’s abigcircle. (Eagle Village |Kipawa) awayfrom ourcommuni andfurther up further However, becauseofthelanguageissuewe end Québec [rather thangoingout-of-province]. in English. There’s pressure onus tostaywithin in Québec, iftheycouldprovide thoseservices region…we wouldn’t have anyproblem staying inthe government wantstokeepeverything There’s aconstantstress inthattheprovincial address. (Kahnawake) (Kawawachikamach) isn’t itthesamehere region? inthenorthern ambulance willbethere atyour doorstep. Why If you live inthecity andyou dial911,that border andremote communities , participants reported thatinadditionto , participants , there are challengesforcommunity urban areas , participants reported issues , participants Participants reported urban areas , participants , participants rural and rural . In , -

- - - 28 that abilingualworker willbeavailable forthosein criticalcare. areas wasidentifiedasachallenge,whilein of havinganescort who were in‘critical care’. In language whileatprovincial hospitalswithfamilymembers Critical Care participants saidthatinstitutionscannotalwaysensure participants • • • ° example). apy, for mentalhealthservices, rehabilitation services, because oflanguagebarriers(speechther pants report havingtowaitlongergetservices inEnglish Long waittimesforservices ° tion, cost). with thetranslationofdocuments(qualitytransla In available inEnglish in services and theprovincial system.There court are limited of withtheDepartment interfaces Youth Protection Judicial. Issue ° ing, language,andculturalissues. the province. There are obstaclesassociatedwithage from community membersare notseekingservices among allcommunitiesthatelderlyFirst Nations’ population. Ageing ° ° ° ° ° ° ° urban areas . Participants spokeaboutissuesbecauseof road inthe community. (KitiganZibi) tofindthe spending 10or15minutesjusttrying waiting, andlongerdelays:theambulancedriver I thinkwe’ve lostlives becauseofit.Because of big barrier. (Kanesatake) on thepatient,theyspeakFrench…that’s beena and theambulancedriver andtheoneworking I’ve goneonemergencycallsinanambulance, you to determine ifyouyou are todetermine passingbenchmarks to communicatewithpeoplewho are assessing person isincriticalcare, thenyou needtobeable anddiagnosisisfinishedthe Once surgery client. (Gesgapegiag) problem ofconfidentialityandprivacy forthe translation…Using aninterpreter alsoraises the thefactsgetlostin so muchbackandforth, It’s becausethere confusinginthecourts is go togethelp.(Kawawachikamach) if you don’t where trust you are goingyou won’t where you are goingyou willgoandgethelp,but CLSC becauseofthelanguage…If you trust serious. And, theyare goingto notcomfortable pain. In theendtheymayhave somethingvery A lotofElders don’t gotothedoctors iftheyhave , the main issue for judicial services is , themainissueforjudicialservices s with language where social services s withlanguagewhere socialservices remote areas andrural General concern expressed remote areas. andrural . Partici , theissue CESFNCQ October 2013 urban - - - - Rural &Urban Areas (languagebarriers) Remote &Rural Areas (languagebarriers) • • • • • • Nations’ communities. within organizationsofEnglish-speaking First for First Nations whocannotspeakFrench, even regions reported thatthere isalackofopportunity Employment andhiring tions. from provincialof care whenseekingservices institu withquality language barriers:isinterfering becauseof individuals avoid usinghospitalservices English-speaking. Some reported that participants were beingdiscriminatedagainstbecausetheyare institutions. from provincialindividuals willseekoutservices Perceptions andbeliefsinfluencewhetherornot community organizations. senting obstaclesintheworkplace forFirst Nations’ are pre andsocialservices available inhealthservices reported thatthe‘Frenchparticipants only’ databases available inFrench. Provincial databasesand software are mainly ° from outofprovince.when seekingservices andmentalhealth), issueswithfunding services province suchastreatment (e.g.,denialofservices outof individuals seekingEnglish languageservices Provincial boundaries situations (e.g.,violence,sexualabuse). vices inEnglish forwomen/children/families incrisis Crisis Situations possible sideeffects). in writing,English (e.g.,how totakemedication, reported obstaclesreceivingparticipants information, Medication andPrescriptions. ° be available. (Kahnawake) always abletoensure thatbilingualpeoplewill vulnerablein very situations.The hospitalisnot understand themandcommunicatetheirneeds community membersfeelthatpeoplewillnot or deteriorating. It’s thatlackofconfidence willing togothehospital.(Listuguj) the populationandinfluenceswhentheyare divides depending ontheissues;[Theboundary] the hospitalsinNew andQuébec Brunswick People are between bouncedbackandforth Participants reported thattheyfelt . Participants reported alackofser In both are presenting barriersto . Participants from all rural andurbanareasrural In In remote areas , - - - 29 Urban Areas (languagebarriers) • • • • • not solelyinFrench. the writinginsideofambulanceisinEnglish and English-speaking that communitiesneedtomakecertain reported obstaclesbecauseoflanguage. participants Medical vehicles (ambulances) speaking) donotseekoutservices. mation). Participants reported thatyouth (generally require infor (i.e.transportation, additional support Youth inEnglish seeking services ° orremoterural areas familiar withInfo Santé incomparisontothosefrom or USlines.Participants from ers reported thattheyrely onoutofprovince lines line numbersbecauseoflanguage.Communitywork from provincialobstacles whenaccessingservices help Provincial Help Lines not thetoppriority. areas from Anglophone communities,participants funding). Althoughthere the are agenciesthatserve andissueswith region isdifficult(corridorsofservice andtransferringtoadifferent of limitedservices, needs isdifficult ments foradultsandchildren withsevere special Negotiating andplace English-language services and networking becauseoflanguagebarriers. tions Liaising andnetworking withprovincial institu ° ° ° reported thatEnglish-speaking First Nations are . Participants spokeaboutthedifficultyliaising (Kitigan Zibi) to waituntilthatdatabaseisavailable tous. comparison withtherest oftheprovince, we have the standard andtracking ofdelivery ofdata,in is stillnotavailable inEnglish. To keepupwith to First Nations communitiesinQuébec, butit They’ve triedtomake[thedatabase]available French. (Listuguj) toaccessthat1-800number,they try it’s all do theycall?’ Where dotheygo?Because when anElder is beingabused,who question ‘When members. We’ve alwayscomebacktothatsame difficult toaccessforalotofcommunity The Elder abuse,thehotlinenumberis very . There are challengesbecause . . Participants reported urban areas . In . Teensmay urban areas CESFNCQ October 2013 were more

urban ,

- - - - Common Issues amongallFirst Nations Communities iii.) Access issuesrelated toculture (Aboriginal) • • ° ° speaking First Nations’ communities. Provincial legislationcreating barriersforEnglish- and resources forhealthandsocialissues,inEnglish. services difficulty accessing programming, support Support Resources Services/ ° ° ° ° ° ° ° ° ° ° can speakEnglish butmanysimplydonotwant Many communitymembersbelieve thatnurses linguistic) are notbeingrespected. that theirrightsasFirst Nations (culturaland there are additionalissuesbecausemanyfelt inEnglish.receive For services First Nations, French intheworkplace andclients’ rightsto a balancebetween theworkers’ rightstospeak ticipants spokeaboutthedifficultyofstriking Language Legislation(Proposed Bill 14).Par are doing.(Kahnawake) even insomecases,thefedsdon’t know whatwe nities’ capacity, delivery service theprovince and Lack ofunderstandingFirst Nations commu community. (Kahnawake) spirituality, senseofidentitythechildand not takeintoaccountFirst Nations culture, The newsystemfor Foster Care placementsdoes proposed changes. First Nations were notconsultedaboutthe with language,there are alsoissuesbecause issues andgovernance). In additiontoissues Bill 49,Act forFamily Resources (language able inFrench only. documents, meetings,andtrainingare avail oftheProfessionalto bepart Order, however, munities on‘conditional basis’ only. Required (nurses andsocialworkers) maywork incom English-speaking communities;professionals English-speaking professionals towork in Bill 21:Obstacles torecruit andretain more problems. (Gesgapegiag) new languagepolicy[Bill 14]iscreating even to, “they wantyou tospeakFrench.” Québec’s . Participants reported - - - - 30 • • • ° ° when accessingservices. Non-Insured Health Benefits(NIHB). Obstacles ° ° ° obstacles accessingfundsbecauseoflanguage. for First Nations’ and healthandsocialservices, Funding. Reported alackofadequatefunding ° ° make upforthegapsinservices. that they are ‘going beyond theirmandates’ to being met.Communityorganizationsreported First Nations’ healthneedsandprioritiesare not ° ° ° ° ° ° ° reported thattheyare spendingalotoftime ticipants (First Nations healthcare workers) Case management/ Translation Services—Par identified wasambulance/emergencyservices.) region (Note: In included inthepopulationcountfor First Nations despitebeing toaccessservices Participants reported thatitisdifficultfor medication) under theNon-Insured Health (i.e., Obstacles accessingpaymentforservices duetothelackofclarity.services members are ‘caught payingbills’ forhealth NIHB. Participants reported thatcommunity is covered andwhatisnotcovered through Lack ofclarityandinformationaboutwhat lasting solutions.(KitiganZibi) known, there isalackoffunding toimplement First Nations’ healthandsocialissuesare well- French). project proposals needtobesubmittedin ment toaccessfundingforprojects (funding/ an issuewhensubmittingproposals togovern Proposals –Theperception isthatlanguage services). funding (i.e.,lackoffortranslation provide withthesamelevel of more services, First Nations’ organizationsare expectedto for theirclientele. beyond theirown responsibilities, fillthisneed are bilingual,andwillingtogoabove and members atFirst Nations organizationswho documents, placingphonecalls).Thus,staff (translating available for translationservices appointments, andfollow up).Funding isnot because oflanguageissues(referrals, booking and energyoncasemanagement,primarily remote area , apriorityissue CESFNCQ October 2013 - - • ° ° ° ° ° ° ° services. cial governments creating barrierswhenaccessing Jurisdictional overlap between federalandprovin ° ° ° ° ° ° ° ° ° wondering, ‘Do theypayforthedrops atthe their eyes done,there’s alittlebitofbarrier, For anElder thatgoesinandwantstoget through NIHB. Limited Coverage forMental Health Services who are receiving socialassistance. provincial programs geared forindividuals covered undertheNIHBincomparisonto Participants reported inequitiesinwhatis providersservice willacceptNIHB. paper work involved forclients, andnotall Participants reported thatthere isalotof forpalliative carein particular patients. Not allmedicationsare covered underNIHB, reimbursement from Health Canada. need topayoutofpocket,andthenwaitfor Benefits (NIHB) program. may Participants to disputesover responsibilities. fiduciary vices forphysicallyhandicappedpersonsdue Participants reported thatthere isalackofser to services. andfunding),which affects access of services (delivery who isresponsible forwhatservices there isalackinformationandclarity about ernments, however reported that participants from bothfederalandprovincialservices gov First Nations have accesstohealthandsocial the situation.(Kahnawake) gram approval process inOttawa, itisworsening the decisiontocentralize thebureaucratic pro There isagrowing issueof “delay ofcare” dueto may notreceive theirmedication.(Kanesatake) ered.’ If apersondoesn’t have moneytopay, they say, andthepharmacists pharmacies, ‘it’s notcov Theygoto them enoughaboutthatinformation; optometrist?’ Is itreimbursable? Theydon’t tell - - - - - 31 • • • ° ° ° First Nations Rightsare notbeingrespected. ° ° ° discharge. provincial organizations/institutions–gapsin Communication between First Nations and ° ° insufficient. Consultation andengagementhealthplanningis ° ° ° ° ° ° ° ° decision-making withtheprovince: linguistic inhealthplanningand ties tofullyparticipate for English-speaking First Nations communi Participants reported thatthere are difficulties tem forhealthrecords). (i.e., Québec’s changestocomputerized sys Nations, aboutchangestohealthpolicies. English-speaking population,includingFirst consultationwith conducting meaningful Participants reported thattheprovince isnot ‘afraid torock the boat’, andotherswere not statedthatthey weretions—some participants make formalcomplaintstoprovincial institu First Nations reported thatitwasdifficultto Nations from theprovince. canaccessservices of informationabouthow andwhere First reported alack cial institutions:participants from provinhave arighttoaccessservices Some First Nations are notaware thatthey what theyare saying. institutions] talkaboutyou, butyou don’t know being violatedbecause“ they don’t speakFrench. Client’s rightsare if members are “beingtakenadvantage of” Participants commented thatcommunity summaries are allinFrench. Language isanobstaclebecausethedischarge discharged. (First Nations andprovincial) whenclientsare Lack ofcommunicationbetween institutions vices (notsatisfiedwithqualityofservices). the hospitalandcommunityhealthser maintained inthecommunicationsbetween that patient’s confidentialityisnotbeing First Nations communitymembersreported Nations healthpriorities. obstacles andlackofaccommodationFirst ” (Kawawachikamach) workers [atprovincial CESFNCQ October 2013 - - - - - • • ° Discrimination andlackofculturalsensitivity. ° ° ° ° Language andculture ° ° ° ° ° ° ° ° ° by provincial workers. Some reported that,or respect fortheirculture and“feeling judged” spokeaboutalackof many participants and socialcontext.In awareness aboutAboriginal history, culture with thelackofculturalunderstandingand Participants spokeabouttheirfrustration are. (Kawawachikamach) respect given tousforwhowe are andwhatwe have theright tobeinformed. We don’t have any we day. have tofightforthemevery We don’t rights thatare already givenelse.But toeveryone tion…We have tobefightingallthetimefor facing racism. There isanattitudeofcoloniza Not onlytheNaskapi, butallNative peopleare writing. ing First Nations tolodgetheircomplaintin reported assistingEnglish-speakparticipants familiar withcomplaintprocesses. Bilingual about ceremony. (Listuguj) standing culture andhistory. There isalackofunder knowledge andawareness aboutFirst Nations Provincial institutionsandspecialistslack (Kahnawake) cannot expectyou tochangeyour languageagain. nal languages]were replaced withEnglish, they There wasa loss oflanguageonce,and[Aborigi once, learningEnglish. First Nations have already losttheirlanguage to have tolearn/speakFrench, given thatsome to expectFirst Nations communitymembers language andculture. Some saiditwas‘unjust’ remote andurban Participants from allcommunities ( of your skin.(Eagle Village |Kipawa) you andtreat you differently becauseofthecolour There are stillsomepeople outthere wholookat persons, andasNative people. Double discrimination—asEnglish speaking from provincialservices institutions. tion andculturalstereotyping” whenseeking their clients,have experienced“discrimina …there isalackofunderstanding ) spokeaboutissueswith remote areas andrural rural, rural, - - - - , - 32 • • • • ° ° ° Medical Transportation available forelderlypopulation). not abletoaccess‘escort/liaison’ (primarily services clients whoneedassistancebecauseoflanguageare services Escort/liaison between detoxification andtreatment services. from theprovince. Participants spokeaboutthegap vices fordetoxification andtreatment (rehabilitation) appropriate care forFirst Nations whenseekingser spoke aboutthelackofculturallyandlinguistically Detoxification andtreatment services ° ° ° PopulationAgeing ° ° ° ° ° ° you talkabout Elders…first ofalltheirfirst They fallthrough thecracks alot,becausewhen ger ‘reliving residential schoolexperiences.’ obstacles becauseoflanguage,whichmaytrig Elders whoneednursinghomecare face many Elders are ‘falling through thecracks.’ issues associatedwithageing.Reported that guistic issuesandchallengesrelated tohealth There are challengesfor Elders becauseoflin was needed.His sonhadasmallsurgery, asmall English]: Our Elder that spokeabouttheescort [Elder’s experience,translated from Naskapi into ments’. with drivers resulting in‘missed appoint pants describedbeingunabletocommunicate traveling tourban areas, from rural partici are notalwaysavailable inEnglish. When Some services reported thatthetransportation services). out English-language orculturallyappropriate (whichclientsneed ifseeking ridor ofservice ‘outservices ofprovince’ orinadifferent cor tion isnotalwaysavailable whenaccessing (generally speaking).Funding fortransporta Lack offundingformedicaltransportation do withthatpaper.” (Kanesatake). with cancer?Because theydidn’t know whatto them, how are theyever goingtobediagnosed gave methis paper,’ soifnobodyisgoingtohelp need todoandtheysay, ‘Idon’t know. Theyjust they are goingalone,soyou askthemwhatthey with themtohelp.Okay, thisisthefirsttime language isMohawk. Theyalways have someone

. Participants reported that . Participants CESFNCQ October 2013 ------the province. Thefollowing isacompilationofcommentsfrom from spoke aboutpositive experienceswhenaccessingservices participants At thefocusgroup sessionsandintheinterviews, iv.) Positive Experiences Remote areas areas: the First Nations communitiesin • • • • ing aboutFirst Nations andculture. history French)—lack ofrespect, awareness andunderstand Language andCulture (Naskapi, English and cultural protocols. because oflanguagebarriersandalackrespect for work programs). Participants reported obstacles field canbeproblematic (i.e.,interndoctors,social Training inthecommunityforstudentshealth ° ° ° services. and provincial institutionsare improving accessto Agreements between First Nations organizations ° ° and First Nations –positive outcomes. Projects thatbringtogetherthefederal,provincial ° ° ° ° ° chikamach). there were (Kawawa nofundsforanescort that timehewasnotprovided with onebecause bypass. He butat wasgoingtohave anescort, community organizations. English-speaking workers from First Nations’ Hospitals are toaccommodate makingefforts Mental (suicideprevention): health services for theinclusionofculturalpractices. tions andprovincial institutionshave allowed Agreements between First Nations organiza health). for First Nations insomeareas (i.e.,mental Agreements have resulted inincreased access from theprovincialaccess services CLSCs. munity membersthatFirst Nations may There isanincreased awareness amongcom through jointprojects. relationships withlocalprovincial institutions First Nations are buildingconnectionsand

remote, andurban rural, - - - - 33 • • • ° institutions, includinghospitalsandCLSCs. areServices available inEnglish atsomeprovincial haveservices notbeentoolong. reportedSome participants thatwait timesfor ° ° ° ° ° ° ° provincial institutions. satisfied withthequalityofcare received whileat Quality of care. reported Some participants being ° ° ° ° ° ° ° ° ° ° Some reported thattheyare participants undergoing surgery. willing tospeakEnglish withpatientswhen Participants describedcompassionatenurses, ations. to First Nations communityduringcrisissitu Building relations—Hospital isreaching out ing someonewhospeaksEnglish. centres available tothem.Inservices the larger ticipants spokepositively aboutthequality of in English, par When abletoaccessservices VeryRAMQ services: helpful andefficient. would call,allcommunicationwasinEnglish. the clientwithadateandtimewhenthey making anappointment,theCLSCprovided from localCLSC:when Efficient services als (knowing where, how, whatisrequired). Staff atCLSCare helpful—assistingindividu autistic. out ofprovince, forayouth whoisseverely inEnglish, fromaccess rehabilitation services CLSC socialworker whoassistedamotherto spokepositivelyOne abouta participant lish andwere “attentive” and“caring.” providersthat emergencyservice spokeEng vices inEnglish. reported Other participants “understanding”, and“willing” toprovide ser Staff atprovincial institutionsdescribed as tive.” described as“excellent” and“culturally sensi at provincial institutions:somehospitals satisfied withthequalityofcare andservices , there were “usually noproblems” find CESFNCQ October 2013 urban ------• • ° ° ° ° ° ° Resources andNetworking ° ° Availability ofEnglish languagedocuments. ° ° ° ° ° ° ° ° ° ° (Listuguj). to communicateusingeachother’s language.” “cooperation beingwilling andbothparties of session commentedontheimportance to you atthe in English. Anotherparticipant staff[athospitals]willspeak of thesupport If theyknow thatyou speakEnglish, some together. positive attitude andawillingnesstowork Participants commentedontheneedfora provide English documents. tospeak SomeEnglish or staffpeopletry was alwayssomeonearound tohelpusout.’ always say, ‘You know, it’s nottoobad.There all French, andwhentheycomeback, be afraidaboutgettingaround, becauseit’s in English are good.Sometimes, clientsmay areas There are hospitalsin Québec (inlarger organizations ( tions are available inEnglish from community chronic condi forcertain Support services services. in givingdirection forfinding English regional representative helpful (regional office)is very Participants reported thattheHealth Canada screening. number ofcommunitymemberswhowent for anincreasecancer screening; inthe observed English tocommunitymembersaboutbreast provincial institutionsentinvitationlettersin Participants described positive results when in English ( and informationisavailable from pharmacists Participants reported thatthedocumentation from theprovince. ing English-speaking clientstoaccessservices Doctors atprovincial hospitalsare encourag suchasMontréal) where theservices rural andurbanareasrural urban areas ). ). urban - - 34 is acompilationoftheirresponses: place Participants were askedaboutthe a. Strategies inplace 5.3 Strategies andsolutions to address obstacles when accessing services; thefollowing toaddress obstacleswhenaccessingservices; • • • ° Protocols between institutions ° ° ° Agreements andpolicies ° ° ° Relationship building ° ° ° ° ° ° ° English. are available in ing tofindoutwhatservices First Nations are networking andresearch Protocol and Speech Language Therapypro Nations clients(for example,Mental Health forFirst ofservices tions) aboutthedelivery (provincial hospitalandFirst Nation organiza Rural Area ing more difficulttoenter. pants report thatsuchagreements are becom other administrative regions; however, partici special agreements from toreceive services Urban Areas take)). Aboriginal Health Transition Fund (Kanesa cultural practices,establishedthrough the practicesfollowingpitals forbirth Mohawk are policiesinplaceatsomeprovincial hos protect culturalpractices(forexample,there Nations andprovincial institutions,which Policies have beenestablishedbetween First riers becauseoflanguageandculture. liaison positionstoassistclientsovercome bar with provincial institutions;forexample, First Nations are enteringintoagreements and priorities.” “gain understandingofthe communitiesneeds munity (informationsessions),andinturn Professionals are visitingFirst Nations’ com including culturalteachings. contacts persons)andshowcase bestpractices, and working withtheiropennesstohelp(key Building onrelationship withtheAgency

: Protocols between agencies : First Nations have entered into strategies thatthey have in CESFNCQ October 2013 ------• • • • Accessing services inEnglishAccessing from private services institutions ° inEnglishAccessing from otherjurisdictions services ° ° ° ° Training inEnglish ° ° ° Complaints process ° ° ° ° ° ° ° ° ° ° U.S. inthe also, someclientsare seekingservices Brunswick, Ontario andalsoNova Scotia); also from out-of-province (primarily, New inQuébec and from other corridorsofservice care, familydoctors,andspecialized services) Participants (primary reported seekingservices dures whendischargingclients. Letters senttoprovincial hospitalswithproce (in English). organization andsomeprovincial institutions Referral Tool establishedbetween First Nation clientele). toAnglophoneandFirstservices Nations tocol were developed in Seek traininginEnglish from outofprovince. at training. First Nations request simultaneoustranslation complaints. with provincial institutionstoaddress issues/ First Nations’ organizations setupmeetings required.)(translator services asked towriteupformalcomplaintsforclients First Nations organizationsare sometimes cultural), (“squeaky wheel”). complaints aboutdiscrimination(languageor Clients are encouragedtomakeformal and alsodevelopmental needsforyouth). detoxification/rehabilitation, health services, inEnglish inQuébecvate (i.e.,mental services nizations and/orindividualsare payingforpri Participants reported thatFirst Nations orga rural areasrural toprovide - - - 35 • • • ° Discrimination andculturalsensitivity ° ° ° Advocate andescorts ° ° ° ° ° ° Translation services ° ° ° ° ° ° ° ° ° ° ° ° out formsthatare inFrench). Staff translateforclients(assisttofill phone callsforco-workers. Bilingual stafftranslatedocumentsorplace and socialservices. HSSC) hasoffered English trainingforhealth and Social Commission(FNQL Services First Nations ofQuébec andLabradorHealth Nations andprovincial; withachangeover providers,workshops forservice bothFirst First Nations offerawareness trainingand to getaround. pitals—visiting patients,andhelpingpeople Community membersare volunteering athos transport. Elders included with (55+)canhave anescort theyneed. and services forclientstohelpthemgetthetreatmentport spend alotoftimebeinganadvocate andsup First Nations organizationsreport thatthey (Kahnawake). to speakinbothlanguageshasopeneddoors” in withagoodattitude”; “Using myability French: “You dogetbetterreception ifyou go Organizations report promoting theuseof ments). patients (generalinquiriesortobookappoint Bilingual familymembersplacecallsfor grandparents). translation (i.e.,grandchildren willaccompany patients totheirappointmentsandhelpwith Family memberswhoare bilingualwilltake provided by FNQLHSSC. are late documents;sometranslationservices First Nations needtocover thecosttotrans CESFNCQ October 2013 - - - - - • • • ° ° /crisissituations Emergency services ° ° ° ° ° ° ° Information andawareness ° Transportation ° ° ° ° ° ° ° ° ° ° ° ° put someoneoneachshiftwhoisbilingual.” Urban area services. member withthemwhenaccessingemergency Participants reported takingabilingualfamily and culture-based.” rights”; “Perseverance”; and“Being creative spoke “Being andknowing assertive your To enhanceculturalawareness, participants studying healthandsocialservices. Awareness andSensitivity’ trainingforthose Work withuniversities todevelop ‘Cultural being implemented. of staff,needtocheckifthetrainingplanis presentations inthecommunityEnglish. from outofprovince, deliver workshops and Doctors andspecialists,someofwhomare English from pharmacies. Information aboutmedicationisavailable in from out-of-province. mation abouthealthconditions)are obtained Documentation (i.e.,pamphletswithinfor ince (inwritingandcalling). Request materialsinEnglish from theprov to printoutmaterials. Search onvarious websites tofindinformation inEnglish). locally ortoobtaintheservice isnotavailable (becausetheservice services forclientswhoneedtotravel toaccess services First Nations are providing transportation out ofprovince. from shelters seek English-language services ing crisissituations,communityorganizations Rural Areas, someborder communities : Paramedics reported that“try to : Dur - - - 36 compilation oftheirresponses: improve thefollowing accessandexpandpartnerships; isa Participants were askedaboutany b. Proposed solutions • • ° ° ° ° ° Relationship building ° ° ° Leadership andvision ° ° ° ° ° ° ° ° ° ° online presentations). of with localorganizationsinthedelivery videoconferencing andwebinars (networking tations inEnglish incommunitiesthrough Rural Areas: munities. inFirstinternship opportunities Nations com withuniversities: Establish partnerships collaboration). to overcome accessbarriers(networking and tions inplaceforAnglophonecommunities Cooperate withlocalnot-for-profit organiza Boards. First Nations needtohave aseatonAdvisory institutions. Form withprovincial partnerships andlocal ‘think tank’.) (share informationforcontacts,work together, providers andprovincial agenciesisneeded Collaboration between First Nations service the Table withtheprovince.” Council needtoaddress thehealthsectorat Political leadershipisneeded.“Chiefand from theprovince.services or bodytoshare informationaboutaccessing Establish a‘Health andSocial Services’ forum inEnglish. access toservices how English-speaking First Nations cangain Develop aconcrete strategicplanoutlining

Specialists are delivering presen solutions , whichcould CESFNCQ October 2013 - - - • • Access to services inEnglishAccess –priorityareas toservices ° ° ° ° Agreements andpolicies ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° responsibilities andgapsinservices. (political willrequired)—address jurisdictional nations, provincial andfederalgovernments Need agreements tohave tripartite withFirst ized nursing, IVs/VAC, dressings/support.) suchasoccupationaltherapy,services special CLSCs, hospitals(needconsistentpoliciesfor Improve relationship atthelocallevel with inEnglish. services at provincial institutionsifclientsrequire Suggested thatFirst Nations establishacode tions toensure proper implementation. between First Nations andprovincial institu Periodically review agreements andpolicies issues andquality ofcare). through First Nations healthcentre (privacy hospitals work withclients,directly and/or Referral andfollow up:Address how doctors/ provinces (ifunavailable inQuébec). inEnglish from other tinue toaccessservices English-speaking residents ofQuébec cancon Provincial Boundaries:Need to ensure that of Service. care providers, ratherthanaccept theCorridor hospitals andfrom English-speaking health atEnglish-speaking need accesstoservices English-speakingCorridors ofService: clients vices atprivate clinics. Private Clinics:Long-termfundingforser institutions. inEnglish from privateable toaccessservices immediately, fundingneedstobemadeavail Crisis are situations: needed When services health care needs. are neededtomeettheir and English services for Elders) First Nations populationisyoung developmental needsforyouth, careservices, priorities (i.e.,detoxification, mentalhealth geared fortheirown healthcare needsand Ensure thatFirst Nations canaccessservices - - - - - 37 • • • ° Training andemployment ° ° ° Aboriginal culture andtraditionallanguages ° ° ° Aboriginal Rights Rights andResponsibilities –English languageand ° ° ° ° ° ° ° ° ° ° ° Services Act) to access services inEnglish. Act)Services toaccessservices legislation isneeded(i.e.,Health andSocial Information aboutlanguagepoliciesand needed. Ageing population:Support forElders is speak withanEnglish-speaking agent. Telephone to reception services—Option English-speaking trainers.) Training fortrainers(increase thenumberof their language,culture, andhealthneeds. nity, theyneedtorespect thepeople—respect Respect: When outsiderswork inthecommu province. Aboriginal Peoples from the toaccessservices pictures visibleinthebuildingstoencourage tions needtohave First Nations’ designsand Visibility ofFirst Nations: Provincial institu government,” Naskapi Nation. even ifit’sthe healthservices from theprovincial the picture. Theyneedtobeputinthepicture for vices toourElders. Because ourElders are notin to work inourlanguage. We couldprovide ser to bemadeavailable inthelanguage. First Nations need whoare speakers,services Peoples culturalpracticesandlanguages.For Health fieldneedsto recognize Aboriginal First Nations communities. Advocate for forEnglish-speaking services one persononstaffwhoisbilingual. therefore theyshouldensure thatthere’s atleast provide toFirst Nations services communities, Provincial agenciesreceive per-capita fundingto Bilingual staffatprovincial institutions: CESFNCQ October 2013 “We need - - - • • • ° ity Address discriminationandimprove culturalsensitiv ° ° ° ° Translation services ° ° ° Complaints process ° ° ° ° ° ° ° ° ° ° ° ° tions. for staffat First Nations andprovincial institu Cultural Awareness workshops andupdates lodging, rented vehicles, outingallowance). nal workers towork inthecommunity(i.e., Remote Areas forstaff). opportunities Promote bilingualism(i.e.,through training in thecommunity. Native peoplewithuniversity degrees working It tohave important social services. isvery the communitiesinareas ofhealthand Recruit Aboriginal professionals towork in inEnglish. services) More (healthandsocial trainingopportunities sible. are notacces does nothappenandservices Identify possiblelong-termeffectsifchange Track accessissues. and culture). complaints from clients(related tolanguage Establish aprocess togatherandaddress ofhealthandsocialservices. delivery tional ways,andFirst Nations languagesinthe There needstobe respect forculture, tradi ties. available inthecommuni culture andservices fessionals/organizations aboutFirst Nations Orientation sessionswithvarious healthpro : Incentives for(local)Aborigi ------38 • • ° ° ° ° Information andawareness ° ° ° services Liaison andsupport ° ° ° ° ° ° ° ° ° ° ° ° ° gate through theprovincial network). (phone calls,filloutforms,andhelptonavi Liaison personforEnglish-speaking clientele language. primary Referral Forms—Need toindicatetheclient’s translate intoEnglish. Identify andprioritize whichdocumentsto Funding required fortranslation. tutions. from provincialabout accessingservices insti Address First Nations perceptions andbeliefs specialized services. Telemedicine: Access to video conferencing for sentations, andworkshops). radio,website,(i.e., newsletters, posters,pre Share informationusingdifferent methods turnover rate). providerslist ofbilingualservice (issue:high vincial institutionsinQuébec (i.e.,create a from proaccess English-language services Share informationaboutwhere andhow to are facing.” (KitiganZibi) like thatwouldfixalotoftheproblems that we someone onhandtounderstandandtranslate they couldsay, ‘Go seethis person…To have Aboriginal liaisonthere wouldbeadoor, and building, andthere’s nodoor. At leastwithan There’s thisbigbuilding,and we’re atthe navigate provincial institutions). Escort/Support Person (translationandto CESFNCQ October 2013 - - - - 39 culturally competent waywhenproviding services.” andculture, ina understand theirhistory andtobeableperform toproperlyneed toconsiderhow itisfortheirpartners important inthisresearch,an individualwhotookpart and tobuildrelationships basedonrespect. In thewords of between provincial, federal,andFirst Nations’ organizations, spokeabouttheneedtobreakparticipants down barriers as First Nations. Languageandculture are closelyconnected; tion’ thatthey face:asEnglish-speaking individuals,andalso Many spoke aboutthe‘double oftheparticipants discrimina in whichwe live,” inalanguagethatwe canunderstand,andin theprovinceservices inEnglish.how toaccessservices about thepressing needformore informationaboutwhere and inEnglish. Aswell, Firstservices Nations spoke participants to speakFrench intheworkplace, andclients’ rightstoreceive ficulty andtheneed” tostrikeabalancebetween workers’ rights wastherecognition andawareness about“theinterviews dif A commonthemeamongthemanyfocusgroup sessionsand ing anequalnumberofkeyinformants. a totalofthree communitiescompletedquestionnaires, involv complete aquestionnaire inorder togatheradditionalresearch; clusion oftheresearch, to eachcommunityhadtheopportunity were conducted.Finally,total ofnineteeninterviews atthecon communities;anda held, involving alleightoftheparticipating focusgroup sessionswereas communitymembers);fourteen research aswell (keyinformantsfrom healthandsocialservices, inthis tookpart A totalofonehundred participants andthirty research.) hadtherehave participated beensufficienttimeto conduct the time frame.It isanticipatedthatmore communitieswould research only, waspreliminary andwasconductedinashort conducted from October 4–October 11,2013.(Thefollow up from March 12untilJuly 24,2013.Additional Research was The datacollectiontookplace over aperiodoffive months, intheNaskapithe north, Nation ofKawawachikamach. gan Zibi, andEagle Village |Kipawa;theresearch concludedin the Algonquincommunitiesof Timiskaming First Nation, Kiti the communitiesofKahnawakeandKanesatake;thenwest, in tuguj; theninformationwasgathered from Mohawk in territory the east,inMi’gmaq communitiesofGesgapegiag andLis from provincial andfederalsystems.Theconversation beganin that English-speaking First Nations facewhenaccessingservices This research wasconductedtoexposeissuesandchallenges saidoneparticipant. “We have therighttoaccess “First Nations

CESFNCQ October 2013 ------6. CONCLUSION accessing services forEnglish-speaking Firstaccessing services Nations: The following are thekey priority areas with respect to exposing commonissues. administrative regions, theissuesandchallengeswere discussed, In urbanandremote rural, areas from sixofthe province’s challenges facing English-speaking First Nations whenaccessing The research exposedthe challenges whenaccessingservices. This research was conductedtocreate ofaccess aportrait • • • • • • • • • • • First Nations. andFederal/Provincialservice, responsibilities for Jurisdictional issues:Provincial borders, corridorsof cating withworkers. Communication—language barrierswhencommuni Dissatisfied with the quality of services in DissatisfiedEnglish. withthequalityofservices tion andliaisonworkers). Funding suchastransla (lackoffundingforservices dispatch). (emergencyroomEmergency and /Crisis services Lack ofavailability oftraininginEnglish inQuébec. inEnglish. services andeven longerwaitfor Long waittimesforservices, inEnglish). services remote areas Access inEnglish (* tospecialized services and culture). will bealackofunderstandingbecauselanguage Attitudes andperceptions (fear, anxietythatthere tivity. Cultural discriminationandlackofculturalsensi­ Access todocumentationandinformationinEnglish. : lack of access to general services and : lackofaccesstogeneralservices rural and rural - - 40 community healthandwellness. their commitmenttoseeklastingsolutionsthatwilllead the challenges,manyEnglish-speaking First Nations voiced from provincialaccessing services andfederalsystems.Despite stemming from languageissues,when difficulties, inparticular this research recognize thatEnglish-speaking First Nations face care in system,changewillbepossible.Thosewhoparticipated ening therelationships amongthecomponentsofhealth Aboriginal Peoples withthefederalgovernment; andstrength munity development; reaffirming thetraditional relationshipof of theThree Pillar Policy: thatis, restoring healththrough com challenges notedinthisreport. Reflecting backtotheprinciples there initiative tobeusedaddress isaneedfortripartite the relationship withbothgovernments—federal andprovincial, provincial andfederalsystems.Because ofFirst Nations unique ships toimprove from theiraccesstohealthandsocialservices Nations’ long-termvisionofexpandingandbuildingpartner The research isintendedtocontribute English-speaking First Nations.” the Tables, thendecisionsshouldnotbemadeonbehalfofFirst adequately consulted,andifcommunitiesare notrepresented at speaking First Nations ofQuébec, government. Similarly, asexpressed by theCoalitionofEnglish- the province (local,regional, andcentral);withthefederal levels with non-governmental organizationsandnetworks; with atall ofservices engaged intheassessing,planninganddelivery English speaking First Nations needtobeactively involved and common amongallthecommunities,wasperspective that to improve In accesstoEnglish-languagegeneral, services. face, aswell asthestrategieseitherinplaceorrecommended First Nations communitiesspokeaboutthechallengesthatthey Over thecourse ofthisresearch, from thevarious participants the research alsoidentifiedsolutionstothosechallenges. from provincialhealth andsocialservices andfederalsystems; Simply put, “First Nations needtobeatthe Table.”

“If First Nations are notbeing CESFNCQ October 2013

- - - 41 3. 2. 1. ° of English-speaking First Nations. cial institutionsbasedonthe needsandpriorities Establish protocols andagreements withprovin ° ° ° ing First Nations toimprove accesstoservices. and culturalneedsprioritiesofEnglish-speak Develop astrategicplanthatreflects thelinguistic ° ° ° provincial partners withfederaland Expand and buildpartnerships ° ° ° ° ° ° ° levels ofgovernment (federalandprovin Develop protocols whenworking withboth continuity ofunderstanding andcommuni Formal mechanismsare neededtoensure a and forEnglish-speaking First Nations). emerging issues,challenges,andsolutionsby munities (thatis,continuetoidentifythe issues andchallengesinFirst Nations’ com Establish formalmechanismstotrackaccess facing English-speaking First Nations. Address the‘issues,challengesandstrategies’ Nations. meet thelinguisticandculturalneedsofFirst contribute todeveloping lastingstrategiesthat Pillars /Indian Health Policy), which could bec’s Three Act forhealthandsocialservices. Identify thelegislationandpolicies(e.g.,Qué cerns andchallenges. Meet regularly todiscusscon withpartners responded toappropriately andeffectively. of English-speaking First Nations are being toensure thattheneeds ofservices delivery involvedbe meaningfully intheplanningand levels). English-speaking First Nations needto vincial institutions(local,regional andcentral Establish andfosterrelationships withpro Nations whenaccessingservices. cial) tomitigatejurisdictionalgapsforFirst 7. RECOMMENDATIONS

CESFNCQ October 2013 -

------4. 7. 6. 5. services forEnglish-speaking peopleinQuébec. services organizations andnetworks toimprove accessto Collaborate andnetwork withnon-governmental ° ° issues andchallenges. toeffectivelyexpand partnerships address access Long-term fundingisrequired tobuildand ° ° federal systems. are available forFirst Nations from provincial and which vices (includingEnglish-language services), Share information andraiseawareness aboutser ° ° sensitivity. –fostercultural planning anddelivery ofservices Integrate First Nations and culture history intothe ° ° ° ° ° ° challenges intheimplementationstrategy). proper implementation (identifyothergapsor First Nations andtheprovince toensure Evaluate protocols andagreements between discussions, etc.) (i.e., regular meetings,committees,roundtable levelorganizations –attheprogram delivery cation between First Nations andprovincial cultural andlinguist needsofFirst Nations to cial governments needto be abletomeetthe Transfer Payments: The federal andprovin province. First Nations from the canaccessservices Provide informationabouthow andwhere partners’ institutions. available attheir the programs andservices institutions needaccurateinformationabout First Nations’ organizations andprovincial from provincialservices institutions. obstacles forFirst Nations whenaccessing Identify anymisconceptionsthatmaycreate gaps ofunderstanding. Cultural awareness workshops helptobridge

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- 42 8. ° from provincialservices andfederalsystems. and culturalneedsinorder toimprove accessto ing First Nations toaddress theiruniquelinguistic Formalize theCoalitiontoenableEnglish-speak ° ately. Nations’ accessissuesare addressed appropri language toensure thatEnglish-speaking First intheEnglish of healthandsocialservices the Provincial Committeeforthedelivery Representative oftheCoalitiontositon from provincial andfederalsystems. improve accesstohealthandsocialservices CESFNCQ October 2013 - - 43 THE ACT OBJECTIVE OF culture: Table. Excerpts from ‘An Act Respecting Health and Social Services’ ChapterS-4.1,whichrefer tobothlanguageand Appendix B:Excerpts –Health andSocialAct Services Kipawa ~ Eagle Village Kanesatake Kahnawake Listuguj Gesgapegiag Community First Nation Appendix A: Table. Coalition’s Aboriginal Health Transition Fund (AHTF)Projects Eagle Village Health Center Kanesatake Health CenterInc. munity Services Kahnawake Shakotiia’takenhas Com Listuguj CommunityHealth Services Services Gesgapegiag Health andCommunity Organization appropriately. thatconcernhim; theuseristobeprovided in thecare andservices withinformationtouseservices respects his“dignity, autonomy, needsandsafety”; theuseristobeencouragedplay“an active role” 3:TheusermustbetreatedArticle with “courtesy, fairness, andunderstanding” andin awaythat (geographical, of individuals,families are 2: Services tobeprovidedArticle oncontinuousbasistomeetthephysical,mentaland socialneeds outtheirroles intheircommunity.carry are 1: Services to“maintainArticle andimprove” anindividual’s physical, mentalandsocialcapacityto linguistic, and groups. sociocultural, CESFNCQ October 2013 - Eachregion’s distinctive characteristicsmust be takenintoaccount vices. Chaleurs andtheGesgapegiag Health andCommunitySer the Centre sociauxdelaBaie-des- deSanté etdesservices between2.) Development ofaplanforcontinuityservices needs oftheGesgapegiag andListugujcommunities. 1.) Improved adaptedtothe accesstodetoxification services Village First Nation community(MM). the healthcare andfollow-up amongthemembersofEagle 1.) Miwijiwa Minomatisiwin: project focusingonimproving Hospital andLiaisonforKanesatake. Services 2.) Cultural Adaptation ofPre-Hospital, in-Hospital andPost- Kanesatake. 1.) Assessing,Enhancing andIntegrating Health for Services Onkwata’karitashera. 1.) Exploring Partnerships—AHTF Integration Project— and New Brunswick Collaborative Development. 1.) Improving Access toHealth Care Listuguj,Québec Services: ethnocultural Project Title(s) APPENDIXES andsocioeconomic). - 44 AUTHORITY AND LOCAL NETWORK SERVICES AND SOCIAL LOCAL HEALTH PROVISIONS GENERAL ORGANIZATIONS COMMUNITY ASSISTANCE BY COMPLAINTS EXAMINATION OF USER’S RECORDS USERS RIGHTS OF Article 5: Article To receive continuouscare inapersonalized andsafemanner. 4: Article To available inhiscommunity. beinformedabouthealthandsocialservices order anddeterminetheirlevel toinvolveofsatisfaction. people intheorganizationofservices 99.8: ThelocalauthoritymustusedifferentArticle methodsofinformingandconsultingthepublicin characteristics ofthepopulation. tive characteristicsofthepopulation. 99.5: Thelocalauthorityis Article responsible toidentify: “the socialandhealth needsandthe to abroad andsocialservices.” rangeofgeneral,specialized andsuperspecialized healthservices among providers have ofthenetwork “continuous andtoensure thatthepeopleinterritory access 99.3:Thepurposeofestablishingthenetwork istofoster Article “greater senseof responsibility” served byterritory it. preventative orcurative nature andrehabilitation orreintegration services ofa centre istooffer“healthandsocialservices 80:Themissionofalocalcommunityservice Article collaborate inproviding requested anyassistanceandsupport by auser. 76.6: Article When auserwishestoaddress acomplaint,thecommunityorganizationsinvolved must rights andobligationsofusersthecodeethics. 33:ThecomplaintcommissionershalldistributeinformationtoincreaseArticle understandingofthe institution. directors ofevery qualityandcomplaintscommissionermustbeappointedby theboard 30:Alocalservice of Article examination procedure. 29:TheboardArticle institutionmustmakea ofdirectorsby-law toestablishacomplaint ofevery record assoonpossibletoanotherinstitutionorprofessional. 24:At therequestArticle oftheuser, aninstitutionmustsendacopy, orextractoftheuser’s summary must beprovided totheinstitutiontakingchargewithin72hoursaftertransfer. oftheirinformation 19: Article When aninstitutiontransfersausertoanotherinstitution,summary program.’ lish, 15:E Article welfare. 10:EveryArticle inanydecisionmakingaffectinghisstateofhealthor userisentitledtoparticipate 9: Article When receiving care ofanynature, hisconsentmustbegiven. orsocialservices. services 6: Article To choosetheprofessional orinstitutionsfrom whomorwhichhewishestoreceive health keepinginmindtheresources (humanandfinancial)thatare available andthe regional ‘Access nglish-speaking personshave therighttoreceive inEng healthandsocialservices ” CESFNCQ October 2013 ” ”, “Supply required services given the to thepopulationof needs and the particular needs andtheparticular distinc - - 45 (Regional Agencies) DIRECTORS BOARD OF Institutions) AGENCIES (Regional SOCIAL SERVICE HEALTH AND INSTITUTIONS OF PUBLIC DIRECTORS BOARDS OF FUNCTIONS (including communityorganizations needs ofthevarious populationgroups… which health orsocialservices 100:ThefunctionoftheinstitutionistoensureArticle provision ofsafe,continuousandaccessible and demographicgroups oftheagency, oftheterritory of various parts thesectors ofactivityandthe 397.3: Article When appointing board members,theMinister musttakeintoaccountrepresentation characteristics ofthoseculturalcommunities. inamanner,the region, facilitateaccessibilitytohealth andsocialservices whichis 349: Eachagencymust,withbodiesrepresentingArticle culturalcommunitiesand theinstitutionsof years. resources oftheregion). Program mustbeapproved by theGovernment three andrevised atleastevery jointly withotheragenciesofanotherregion (takingintoaccountthehuman,financialandmaterial intheEnglish languagefor theEnglish-speaking populationofitsareasocial services 348: Agencyshallcollaboratewithinstitutionsto Article accessible andii.)identifytheneedsofpopulation(foritsmulti-year strategicplan). 346:Agencyshall:i.)ensureArticle thatinformation onhealthofthepopulationisuptodateand committees). 343:Agencyshallensure (i.e.,users’Article implementation ofamechanismforpublicparticipation rights advocacy. tinctive characteristics and coordination between institutions;develop informationandmanagementtools adaptedtothe 340:Eachagencyshall:prepareArticle amulti-year strategicplan;ensure mechanismsforreferral 339:The GovernmentArticle shallestablishanagencyforeach region. characteristics oftheusersandhumanfinancial recourse oftheinstitution. and takingintoaccountthe 171:BoardArticle ofdirectors shallestablishstrategiesfocusingonthepopulationstobeserved… by theinstitutions. served better sociocultural,ethnocultural,linguisticanddemographicrepresentation 138:SelectionArticle ofboard membersmustensure a“betterrepresentation and oftheterritory 130:TheboardArticle ofdirectors mustbemadeupofanequalnumbermenandwomen. co-opted ( 129:TheboardArticle ofdirectors iscomposedofpersonswhoare elected,designated,appointedor requiredhealth services by theuserofinstitution. 108: Aninstitutionmayenterintoanagreement withanotherinstitution:fortheprovision ofcertain toanotherinstitutionorbodythatprovides services them. certain way thatreflects theneedsofpopulationitserves those provided by otherinstitutionsandresources oftheregion, agreement; arehas entered iii)ensure “continuous aservice thatservices andcomplementary” with provide therequired directly healthandsocialservice orfrom anotherinstitution 101:EveryArticle andassesshisneeds;ii.) institutionmust:i.)receive anypersonwhoneedsservices including twoindependentpersons ofthoseinstitutions;develop amechanismto CESFNCQ October 2013 , aswell asthedifferent agegroups. distinctive geographical,linguistic,socioculturalandsocioeconomic respects therightsandspiritualneedsofindividuals ). elicit andfacilitatethecooperationwithotherkey players electedby thepublicinanelection). ; iv)refer personstowhomitcannotprovide develop aprogram ofaccesstohealthand and that services areand thatservices organized ina protect theusersandforuser sociocultural, linguistic ofthepopulation respectful of the …respond tothe withwhomit …or develop dis

- 46 the research. timeframe.Itin ashort isanticipatedthatmore hadthere communitieswouldhave participated beensufficienttimetoconduct research timeframe,from Oct. wasconductedinashort 4–Oct. 11,2013.This only,research waspreliminary andwasconducted The datacollectionforthis research tookplace over aperiodoffive months, from March 12until July24,2013. Additional Data Collection Gesgapegiag Cmmunity First Nation Appendix C: Table. Focus Groups, &Questionnaires Interviews ACT OF THIS ADMINISTRATION • • • • • Questionnaires: Three keyinformantscompleted‘Follow Up Questionnaires’ ofthis aspart research. and4withFirstservices); Nation community members.) –(6withkeyinformantsinvolved withAHTFprojects; 9keyinformants (healthandsocial 19interviews Interviews: Focus group sessions:14focusgroups: 10withcommunityresources and4withcommunitymembers. members. women); Key informants(Aboriginal Health Transition Fund project—AHTF), communityresources andcommunity caregivers; parents withyoung children; andindividualswithpeoplechronic healthconditions,bothmenand Target Groups –Community resources inHealth andSocial CommunityMembers Services; (Elders and/ortheir andAHTFkeyinformants)30communitymembers. (health andsocialservices inthisresearch. tookpart A totalof130participants Total 130individuals(100 communityresources participants: (11) de-la-Madeleine La Gaspésie-Iles- Rural Zone Administrative Region and persons. accessibleintheEnglish languagetoEnglish-speaking andsocialservices to makehealthservices oftheFrench29.1 oftheCharter language(chapterC-11)) 508:The GovernmentArticle shalldesignate(from amongtheinstitutions recognized undersection cations toaccessprograms. advise theagencyaboutaccessprograms developed by theagency;ii.)evaluate andsuggestmodifi 510:The GovernmentArticle shallprovide fortheformationofa evaluation andmodificationofeachaccessprogram developed by anagency. the Government intheEnglish language;ii.)approval, on:i.)dispensingofhealthandsocialservices 509:The GovernmentArticle shallprovide fortheformationofa Questionnaire Interviews Focus Groups Collection Data Health andSocial Service Key Informant (AHTF) Community Members Health andSocial Services Target Groups CESFNCQ October 2013 1 1 1 1 Sessions Number of those institutions,whichare required 1 1 8 6 regional committee provincial committee Participants Number of 16 Individuals 1 Questionnaire 1 interview 2 focusgroups Total thatshall: advising

- 47 chikamach Kawawa Timiskaming ~ Kipawa Eagle Village Kitigan Zibi Kanesatake Kahnawake Listuguj - (09) La Côte-Nord Isolated camingue (08) L’Abitibi-Témis Border Rural camingue (08) Abitibi-Témis Border Rural L’outaouais (07) Border Rural Laurentides (15) Rural Montérégie (16) Urban (11) de-la-Madeleine La Gaspésie-Iles- Border Rural - - Focus Group Focus Group Focus Groups Questionnaire Focus Groups Interviews Focus Groups Interviews Focus Groups Questionnaire Interviews Focus Groups Social Services Health Services and communitymembers Health andSocial Services Health Services Community Members Health andSocial Services Key Informant Community Members Health andSocial Services (community members) Key Informants Key Informant (AHTF) Health andSocial Services (Community Resources) Key Informants Key Informants (AHTF) Services Health andSocial Services Key Informant Services) & Key Informant (Health Key Informant (AHTF) Community Members CESFNCQ October 2013 4 1 1 8 3 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 TOTAL 4 1 10 10 3 7 5 1 1 1 8 5 8 participants 130 9 9 6 8 1 4 13

15 Individuals 5 interviews 1 focusgroup 25 Individuals 11 interviews 2 focusgroups 24 Individuals 1 Questionnaire 2 interviews 3 focusgroups (follow upreearch) 3 questionnaires 19 interviews 14 focusgroups 9 Individuals 1 focusgroup 9 Individuals 1 focusgroup 14 Individuals 2 focusgroups 18 Individuals 1 Questionnaire 2 focusgroups

48 partners. First Nation communities,andtheirfederalprovincial The results ofthe research willbeshared withthe ataforum of thesituationby documenting: research project. Thegoalsofthe research are tocreate aportrait ofthiswork, theCoalitionisoverseeingAs part aone-year inEnglish. with respect toaccessinghealthandsocialservices faced by First Nation communitiesintheprovince ofQuébec One oftheCoalition’s objectives istoaddress thechallenges Kahnawake. Kitigan Zibi, Kawawachikamach,Kanesatake, Timiskaming and munities: Eagle Village First Nation, Listuguj,Gesgapegiag, in Québec (CESFNCQ)iscomprisedofthefollowing com The Coalitionof English‑speaking First Nation Communities Currently, there are eightFirst Nations communitiesinvolved. The goaloftheproject istoformallyestablishaCoalition. the southshore ofMontréal). inKahnawake(aMohawkand socialservices communityon Onkwata’karitáhtshera, whichisanagencythatoversees health IntegrationServices Fund (HSIF).Theproject issponsored by 2012-2015, withfundingfrom Health Canada’s Health Improve Access The project ABOUT THERESEARCH tion Fund (AHTF) Appendix Guide D:Interview forAboriginal Health Transi Thank you. complete theconsentformat endofthequestionnaire. you are interested, pleaseread through thequestions,and usingthefollowing questions.If duct atelephoneinterview We willbecontactingyou tomakearrangements tocon initiative. previous Aboriginal Health Transition Fund (AHTF) speaking First Nations communitiesdeveloped through information aboutthesuccessfulstrategiesthat English- the research, are interviews beingconductedtoseekout conduct research fortheHSIFAccess Project. An independentresearch consultanthasbeen mandated to • • challenges of accessing services inEnglish. challenges ofaccessingservices The strategiesandsolutionsneededtoaddress the in theprovince ofQuébec. inEnglish when accessinghealthandsocialservices The challengesandissuesthat First Nations face Expanding andBuilding ourPartnerships to , isamulti-year project thatwilloperatefrom As part of part As CESFNCQ October 2013 - - - tion Fund (AHTF)initiative: community developed through theAboriginal Health Transi To Iwouldliketolearnmore start, abouttheproject thatyour Part 1Questions onChallenges,Issues andGoals Questions AHTF –Interview contact: Should you have anyquestionsabouttheHSIFAccess Research close. project andwhathappenedaftertheproject initiative came toa The following questionsaddress thelong-termimpactof Part 3Questions onLong Term Impact project. We wouldliketohearmore aboutwhat resulted from the Part 2Questions onOutcomes Kahnawake, Québec (ODS) Services Organizational Development Winnifred Taylor Dale Jacobs ManagementProject Team 2. 1. 4. 3. 2. 1. examples. related tolanguage,from thisproject. Please provide Did you identifyothergapsorneeds,particularly may have resulted becauseofthisproject? Can you tellmeaboutanychangesoroutcomesthat through theproject? What were you hopingtoaccomplishorrealize end goal?Please provide examples. through thisprojectundertook toaccomplishyour What were themainactivitiesthatyour organization any accessissuesrelated tolanguage). What gapswere toaddress? (In you trying particular, project? Generally, canyou describeyour community’s AHTF

Listuguj, Québec Amy Chamberlin,M.A. Project Researcher: - 49 responses ______We willprepare answers to thequestionsandemailour preceding questions_____ We basedonthe donotaccepttohave atelephoneinterview Questions’______We basedonthe‘Interview accepttohave atelephoneinterview ______Community: CONSENT FORM Thank you for your time. Part 4Closing PLEASE CHOOSE: CONTACT PERSON: TITLE OF AHTF PROJECT(S): 1. 3. 2. 1. make? Are there anyothercommentsthatyou wouldliketo Describe the lessonslearned. your community developed toaddress accessissues? munities benefitfrom thestrategiesorsolutionsthat In your view, how mightotherFirst Nations com has alastingimpact? long term? What isneededtomakesure thestrategy oped through theAHTFprojects besustainedover the From your perspective, how canthesolutionsdevel been happening. tive continue inanyway?Please describewhathas After theAHTFproject cametoaclose,didtheinitia ______

______

______CESFNCQ October 2013 - - - EXPANDING ANDBUILDINGOURPARTNERSHIPS Guide Appendix E:HSIFFocus Group andInterview Thank you agencyofKahnawake. social services (HSIF) andsponsored by Onkwata’karitáhtshera, ahealthand under Health Canada’s Health Integration Services Fund ing ourPartnerships toImprove Access intheresearchparticipate fortheproject I, ______,(your name)voluntarily agree to CONSENT FORM FIRST NATIONS –FOCUSGROUP Health Integration Services Fund (HSIF)Project TO IMPROVE ACCESS VIEW: LIST OF PARTICIPANTS FOR TELEPHONE INTER 4. 3. 2. 1. NAME 7. 6. 5. 4. 3. 2. 1. Closing Roundtable Discussion – Where dowe gofrom here? and Top Access Issues) Group Activity –ChallengesandIssues (Group List HEALTH BREAK Group Discussion –Sharing Experiences Group (ConsentForms) Introduce HSIFResearch andPurpose oftheFocus Roundtable Introductions Welcome andOpening Prayer ZATION ORGANI - TION INFORMA CONTACT . Thisproject isfunded

Expanding andBuild - listed above) one project is (If more than PROJECT AHTF

- - 50 Date ______Facilitator ______Participant (focusgroup orinterviewee) ______Signatures: Organization: Community name: Please indicate research project. Your assistanceisappreciated. inthis Thank you fortakingthetimetoparticipate partners. First Nation communities,andtheirfederalprovincial The results ofthe research willbeshared withthe ataforum For theresearch: Québec. inEnglish intheprovinceaccessing healthandsocialservices of trait ofthesituationforEnglish-speaking First Nations when research liaison.Thegoalofthe research istodocumentapor Chamberlin (researcher), withassistancefrom acommunity I understandthattheresearch isbeingconductedby Amy • • • •

so withoutexplanation. process Iwishtowithdrawforanyreason, Imaydo answering. Ifcomfortable atanypointduringthe and Ionlyneedtoanswer thosequestionsthatIam isvoluntary,I understandthatmyparticipation be usedforthereport. I agree thatpictures /videomaybetaken,which recorded. maybe I agree thatthefocusgroup and/orinterview view. I agree inafocusgroup and/orinter toparticipate ______

CESFNCQ October 2013

- - PRIORITY AREAS PRIORITY WHATIS WORKING IDENTIFYING CHALLENGES&BARRIERS,AND The following questionswillbeusedtoguidethefocusgroup: Health Integration Services Fund (HSIF) SOLUTIONS may arrange (15-30minutes). telephone interview forashort may respond tothequestionsinwriting;or, ifyou prefer, you If inthisHSIFfollow-up you wish toparticipate research, you recommended) toovercome thosechallenges. the questionnaire istoidentifysolutions (eitherinplaceor urban centres formedicalreasons. Aswell, thepurposeof clientele) mayhave encountered whentravelling tolarger into anychallengesorissuesthatyour organization(or The following questionnaire wasdeveloped togaininsight Access Issues andChallenges:Transportation /Lodging 5. 4. 3. 2. 1. 7. 6. As agroup, whatare thefive mostpressing chal and culture). (generalaccessissues,related tolanguage services the challenges,issuesandobstacleswhenaccessing (Group Exercise –Optional): Listoutinpointform working). from theprovinceing services (highlightwhatis Tell usaboutyour positive experienceswhenaccess what,where?).guage andculture? (Who, Did you experienceanychallenges becauseoflan faced whenaccessinghealthandsocialservices? What were someofthegeneralobstaclesthatyou role? Describe waystoovercome barriers. best waystoshare information?Canculture playa vices inEnglish from theprovince? i.e., What are the and your clientelecanaccesshealthandsocialser In your view, whatisneededtomakesure thatyou province? inEnglish from the ing healthandsocialservices overcome thebarriersthatyou facewhenaccess Describe waysthatyou (oryour organization)have from theprovince? with respect toaccessinghealthandsocialservices lenges, issuesorconcernsthatneedtobeaddressed - - - - - 51 Lodging Appendix F:Questionnaire–Transportation and Any othercommentsorquestions? CLOSING COMENTS 2013. tionnaires mustbereturned nolaterthanOctober 11, willbeheld October 8-11,2013. The interviews 8. 7. 6. 5. 4. 3. 2. 1. Any additionalcomments? orlodgingservices? portation Do you have anyrecommendations toimprove trans tion orlodgingservices. address anychallengesorissueswith eithertransporta Describe strategiesthatyour organizationhasusedto /lodging satisfied withthetransportation Services: Explain thereasons (whyorwhynot)thatyou are ______Somewhat satisfied______Yes (satisfied)______No (notatallsatisfied) centres? (checkone) when travelling, formedicalreasons, tolargerurban thatyour organization(orclientele)accesses services Are you satisfiedwiththetransportation/lodging ______Contact information(emailortelephonenumber): ______Organization’s name: ______Your nameandpositionwithinorganization:______

b.) Lodging(comments): a) Transportation(comments):

All ques CESFNCQ October 2013 -

- - Community Resources &CommunityMembers Kawawachikamach for Nations EnglishSpeakingFirst Appendix G:Key Access IssuesandChallenge Community Resources Gesgapegiag • • • • • • • • • • • in French. and correspondence from theprovince are primarily Documentation North. munity andfrom theprovince ischallenginginthe Accessing English languageservices: are available inEnglish from theprovince. information aboutwhere andhow toaccessservices First Nation andprovincial institutionsandlackof Language barriers(communicating) Respect: and asFirst Nations. Double discrimination in French. and correspondence from theprovince are primarily Documentation Québec. Training in English from theprovince. information aboutwhere andhow toaccessservices First Nation andprovincial institutionsandlackof Language barriers(communicating) eral andspecialized bothgen Lack accesstohealthandsocialservices areEmergency (ambulance)services inadequate. Québec. Training forculture andamongpeople. : limitedtrainingavailable inEnglish in : limitedtrainingavailable inEnglish in : Forms, documentation,resources : Forms, documentation,resources (English orFrench). : English speakingpersons : between : between inthecom - - 52 Community Resources Listuguj Community Members • • • • • • • • • • • • ents under Youth Protection. inEnglish Lack accesstojudicialservices provide withsamelevel offunding. more services Lack offunding out ofprovince. infederal). DifficultEnglish from toaccessservices Jurisdictional issues sensitivity. Cultural discrimination/lackofcultural in English from theprovince. information aboutwhere andhow toaccessservices First Nation andprovincial institutionsandlackof Language barriers(communicating) addictions). English in Access tospecialized healthandsocialservices federal orprovincial systems. available toFirstabout services Nations from either Rights andresponsibilities: from theprovince.access services Lack information specialized services). Long waittimes Cultural discrimination. in English, privacy issueswhentranslationisneeded. lackofdocumentation issues whenseekingservices, inEnglish Quality of services always available inEnglish. Emergency services (specifically for mental health services and (specificallyformentalhealthservices (atemergencyhospitalandfor : First Nations expectedto services aboutwhatwhere andhow to atprovincial hospitalsare not (local,regional, provincial and Information lacking : Communication : between CESFNCQ October 2013 forcli - Community Resources Kanesatake Community Members Community Members • • • • • • • • • • • • • • unwillingness toprovide inEnglish. services Attitudes andperceptions forNativesupport people). Need services liaisonandescort ments) forhealthandsocialservices. Lack offunding in English. Long waitlistsforservices language andculture. tion, beingalone,notunderstoodbecauseof Attitudes andperceptions sitivity). Cultural discrimination (dispatch Emergency phoneservices English in Access tolocalgeneralandspecialized services (despite previous AHTFwork). Lack ofaccesstoprovincial services outside ofthecommunity. Cultural discrimination inEnglish. access services Jurisdictional –corridorsofservice in French. and correspondence from theprovince are primarily Documentation inEnglish. Long waittimesforservices inEnglish. seeking services Legislation (psychologists, familydoctors). : Québec’s languagelawscreating when : Forms, documentation,resources (provincial andfederalgovern : ignorance(culturalinsen : Lackofculturalknowledge : province’s general : Fear, anxiety, frustra : longer wait for services : longerwaitforservices (translationand —difficultto ) –French only. (specialized) - - - 53 Community Resources Eagle Village –Kipawa Community Resources Kahnawake • • • • • • • • • • medically required care.) charges for ‘out pointofservice services; ofprovince’ from provincial institutionsinQuébec; Translation at private clinics,whenunabletoaccess services Funding treatment plan. Documentation Québec.) Training bers). added costandstress toindividualand familymem the province (extradistancetoaccessthoseservices, inEnglishAccessing specialized services ing. “Theyobligate” usbut “do notaccommodate.” should beproviding ustheabilitytotaketrain manner,expect ustodothingsinacertain they Québec. If legislature isfrom theprovince andthey Training to daylife.Impact forindividualgetscompounded. language barriersandatsametimedealingwithday Time-frames information from doctor/nurse,orinstitution. Communication the Montérégie. inEnglish in isachallengetoobtainservices service for clientsclosertohomeinEnglish—corridors of Jurisdictional issues/accessibilityofservices in French. and correspondence from theprovince are primarily Documentation tutions notwillingtospeakinEnglish. Attitudes andperceptions (Funding forEnglish languageservices : limitedtrainingavailable inEnglish in (limitedtrainingavailable inEnglish in for accessing services (longwait)dueto foraccessingservices –follow upreports, feedback,and : Forms, documentation,resources : Need abasicunderstandingof : Staff atprovincial insti CESFNCQ October 2013 from

- - - Community Members Community Resources ZibiKitigan • • • • • • • • • • • • between provinces. Funding hours away. a one-hourappointment,whereas Sudburyisonlytwo my fatherhastotravel twodaystotravel toMontréal for province. “ inEnglish outsideofthe to accesscloserservices “forced” tostayinQuébec, ratherthanbeingable Jurisdiction –provincial boundaries/travel Documentation (lack oftranslators). at provincial institutions(reception, doctors,nurses) Communication assessments. inEnglish Quality of services of province. provincial)—difficult in Englishout to accessservices with different levels ofgovernment, bothfederaland Jurisdictional issues Québec. Training culturally sensitive. Cultural discrimination in French. and correspondence from theprovince are primarily Documentation cial institutions. Language barriers(communications) lish from theprovince. inEngAccessing specialized andgeneralservices inEnglish-language. wait timesforservices Long waittimes –NIHBanddifference inpayrates : limitedtrainingavailable inEnglish in It’s difficult todealwiththelong travels… ” –Forms, letters,information. : Forms, documentation,resources, for specialized services, andlonger forspecialized services, – Verbal communicationwithstaff (provincial boundaries,and : Racism,needtobemore –evaluations and withprovin : Being - - 54 ings from all 14 of the focus groups, as well as the interviews ings from all14ofthefocus groups, aswell as theinterviews The Community Findings sectionisacompilation ofthefind Findings English-speaking First Nations Communities–Community Appendix H:CommunityFindings Community Resources Timiskaming Community Members • • • • • • • • • •

cial jurisdictions,andtransportation. provin becauseofcorridors ofservice, access services Jurisdictional issues discharged; dischargesummariesare allinFrench. munication between institutionswhenclientsare –gapsindischarge Quality ofservices in French. and correspondence from theprovince are primarily Documentation Québec. Training audiologist, treatment centres). your choice inthelanguageof Accessing specialized services because oflanguage. Communication (forms andinformation). Documentation understand. inthelanguagetheycan health andsocialservices rights. Communitymembershave arighttoreceive Attitudes andperceptions care) isneeded. ate care forageingpopulation(longtermresidential Care forElders gency response time’ (ambulanceservices). Emergency service : limitedtrainingavailable inEnglish in (i.e.,speechandlanguagepathologist, –Linguisticandculturallyappropri : Forms, documentation,resources –Receive documentationinEnglish –withspecialistsisdifficult s –Need toaddress the‘Emer : Lackoffreedom ofchoiceto : Respect forbasichuman : Lackcom CESFNCQ October 2013 - - - - - or interviews were heldseparatelywiththetwogroups; two or interviews the majorityofcommunities(five ofeight),focusgroups Nations communityresources and communitymembers.For Specifically, data wascollectedfrom twogroups—First communities; namely: Firstheld witheachoftheeightparticipating Nations’ communities basedontheirindividualneedsandpriorities. Nation communitytodevelop actionplansfortheirrespective These finding are includedinthe toenableeach report First The findings were grouped intofour broad areas: deliberate representation from bothgroups.) Members, becauseonefocusgroup wasconductedwith presented together, CommunityResources andCommunity For thecommunityofKawawachikamach,findingsare Community Resources; and was collected,andthecompositionofgroups; assuch: Thus, thedataispresented to reflect themannerinwhichit and communityresources). with representation from bothgroups (communitymembers community members);andonehelditsfocusgroup resources are only(notethatmostoftheparticipants withcommunity communities heldfocusgroups orinterviews viii.) vii.) vi.) v.) Kahnawake iv.) Kanesatake iii.) Listuguj ii.) Gesgapegiag i.) Kawawachikamach iv.) iii.) ii.) i.) Positive experiences. Access issuesrelated toculture (Aboriginal); and English languageaccessissues; General accessissuesandchallenges; Timiskaming First Nation Eagle Village |Kipawa Kitigan Zibi

b.) Community Members. (Note:

a.)

55 language barriers. inmeetingswithprovincialparticipate workers because of workers). Participants spokeaboutbeingunabletofully French), andlesssofornursesreception (front line that doctorsare more likelytobebilingual(English and Language barriers(communicating)–Participants stated ii. English LanguageAccess Issues names duetocommunicationissues. Quality ofcare –‘errors are beingmade’, mixingupclients’ (travel).Distance toaccessservices the region (ineitherEnglish orFrench). in Lack ofgeneralandspecialized healthandsocialservices i. General Access Issues andChallenges vices) andCommunityMembers: a.) CommunityResources (Health andSocial Services Ser 1. Kawachakimachach NASKAPI • • • • • • • • can’t speakEnglish. language, togoandseetheprofessionals where they hardvery for a communitywhere thatistheirsecond The firstlanguage[attheCLSC] isallin French, it’s expired. medication andthethatshereceived was ter hasamedicalproblem, epilepsy. She received English) Elder’s experience(translated from Naskapi into medication wassenttothewrong house. tion. Thenames[ofclients] were thesame,but There wasacasewhere there wasanerror inmedica They sentthewrong patientto Sept-Îles. was anotherpersonwhosupposedtogo. the doctortoldherthere’s nothingwrong withyou. It My sisterwassenttoMontréal forsomething,and Costly totravel (lackfunding). any roads here. We onlytravel by planeorby train. Distance toaccessspecializedWe services: don’t have kinds oftests. ists we have togodown south. To getascanorall We don’t have anyspecialists.For allkindsofspecial : Our Elder wasexplainingtous,hisdaugh CESFNCQ October 2013 - - - - phone back.’ and callback;however, concern that,‘some people willnot speaking worker. Communityresource workers maypersist they were beinghungup,whilewaitingforanEnglish- provincial institutions(hospitals,CLSCs).Some statedthat waiting foranEnglish speakingprofessional whencalling guage barriers.Participants describedthelongdelays Calling provincial institutionsisdifficultbecauseoflan monthly basis,andfrequently onlyspeaks French. professionals. Apsychologist visitsthecommunityona spoke aboutthelackofEnglish-speaking mentalhealth inEnglish –ParticipantsLack ofmentalhealthservices English. medication andprescriptions isnotreadily available in Medication/prescriptions: Information (inwriting)about • • • • • • • • send metosomeoneelse,buttheyhungup. So, I know how tospeakinFrench. Theysaidtheywould they askedmetospeakinFrench, andIsaiddon’t I phonedthe[hospital]toaskforinformationand the province becauseoflanguagebarriers. Community workers are notattendingmeetingswith speaks French. government, thatdoesn’t oneofus meanthatevery Just becauseit’s by theprovincial aCLSCrun having difficultycommunicating]. It’s dangerous [ifprofessionals very andclientsare fighting, butIkeepdoingit. [in writing],buttheyare allinFrench. Iamtired of rephrase inEnglish. Then,theygive you instructions foruseareinstructions inFrench. Thenurseswill When theyorder medicationstocomein,alltheir scribed. depression pills,sleepingpills),when theyare pre the sideeffectswiththesemedications(relaxation, Sometimes thedoctorsdon’t talkaboutwhatare them? Easilymixupthemedication. different medications,how do you know how totake how totakethem.If theygive themthree orfour in French. Andtheywilltranslate and tellthepatient Doctor prescribes medicationandwritesprescription you theminEnglish [inwriting]. areAll theinstructions inFrench, andtheywon’t give speak inEnglish. phoned rightback,andfoundsomeonewhocan

- - 56 the system’. CLSCs becauseoflanguageand there in is a ‘lackoftrust pants statedthattheelderlyare goingtothe notcomfortable ‘Elders don’t gotothedoctorsifthey have pain.’Partici Elders are from provincial notseekingservices institutions. population– CommunityresourcesAgeing reported that of availability ofEnglish-language documentation. spoke aboutbeingimpededintheirwork becauseofthelack (forms, posters,clients’ records). Communityresources Documentation from theprovince isprimarilyinFrench language services. translator isunabletokeepupwiththedemandforEnglish the provincial hospital;however, noted thatthe participants Translation are services insufficient–There isatranslatorat • • • • • • • their backgrounds. It impedesme. French. Ican’t helptheclientsbecauseIdon’t know records. Ican’t read thembecausetheyare onlyin I’m asocial worker and Ihave access topeoples’ files, chikamach, theirsecondlanguageisEnglish. doesn’t meanwe have tospeakFrench. Kawawa Just becausewe work fortheprovincial government this anEnglish-speaking community.’ phoned thembackandsaid‘Please senditinEnglish, all sentinFrench. Ithrew itallinthegarbageand is All theinformation,allposterseverything English hospitalwithatranslator? With anescort? Sept-Îles isFrench. Why can’t theysendthemtoan to room totranslatefortheElders. Thehospitalin time. Thattranslatorisn’t goingtogofrom room times there are twoorthree clientsthere atthesame one translatorinabighospitallikeSept-Îles. Some In Sept-Îles we have atranslator, butwe onlyhave one outsideofthecommunity. look foratranslatorregarding thatletter. He found was writteninFrench around and andhehadtorun cal examinationtheysenthimawrittenletter, andit this morning,whenhewent down southforamedi Regarding healthissues,whenIwent toseetheElder language isFrench]. Our community’s secondlanguageisEnglish [third forthemedicationsareAll theinstructions inFrench. speaks French. only onceamonthhecomeshere andhefrequently have huge problems regarding mentalhealthandit’s psychologist we have here comesonceamonth. We We alsoneedanEnglish psychologist. Frequently the CESFNCQ October 2013 - - - - the documentsmore difficult. dentiality mustbemaintained,whichmakestranslationof obstacle whenaccessingaclient’s reports/assessments. Confi areited services available inEnglish. Languagepresents an Youth Protection andtheProvincial System—lim Court Judicial: of withtheDepartment Socialinterfaces Services • • • • language. Youth Protection –accessissuesresulting from you are goingyou won’t gotogethelp. you willgo andgethelp, butifyou don’t where trust cer iscaughtintime.If where you trust you are going something iswrong theygotoseeadoctortheircan down if south,whohave access toalltheservices months. Alotofpeopleoutsidethecommunity know thatwithcancer, theyare deadwithinafew Elders won’t tell.Theywon’t sayanything.Ijust because ofthelanguage. serious. Theyare goingtoCLSC notcomfortable pain. In theendtheymayhave somethingvery A lotofElders don’t gotothedoctorsiftheyhave ° ° system (divorce,Court custody, childprotection.) ° ° ° ° ° ° ° ° ° ° ° ° proceedings doneinEnglish. They were given of timesinorder andhave togocourt Even we hadtocomplainalot inthecourt, one totranslatebecausetheyare confidential. I can’t takethesedocumentsandgive toany chikamach theyare inFrench. Ican’t translate, When thepapersarrive here inKawawa the residential schoolsystem. They saythatthe Youth Protection here islike toEnglish. translating theinterviews is translation.Theyneedtohave someone chikamach faceregarding Youth Protection The challengesthatpeoplehere inKawawa province. documents (assessments)are rejected by the Requests fortranslationof Youth Protection French. of Department Youth Protection iswrittenin Every documentthatisprocessed through the understand anything. in French toparents—they [parents] don’t The sendseverything Justice Department ------57 [general accessissueandobstaclesbecauseoflanguage]. generally speaking,whichisonlyexacerbatedby poorroads. to payfortheambulance).The response timeis slow,very is alackofinformation aboutfunding(whoisresponsible or provincial healthcare professional placesthecall.There an ambulancewillonlygotoindividuals’ homesifanurse withthesystem,forexampleitwasstatedthat frustration bilingual emergencyworkers. Participants describedtheir becauseoflanguage—therelance services isalackof ThereEmergency services: are challengesaccessingambu • • • • • that…If you live inthecityandyou dial911,that ambulance willcomeintoour land. Theywilldecide lem andtheyare thepeoplewhowilldecideif go outandevaluate theproblem, assesstheprob ing. Thenursewillaccept your calland theyhave to you calltheCLSCfirstthing you getisa record At theCLSCwhenthere isanemergency, andwhen community. It’s notthere rightnow. get more improved forourpeoplehere inour services more have toimprove. andmore services We have to too stable. We know we live inanisolatedarea, but here inourcommunityarethink thattheservices not in French. He refused togetthatambulancein…I away. We kepttalkingtothenurse,hewasspeaking Sheto me,shediedinmytruck. wasalready fading I hadtotakeanElder totheCLSCthatnightand around allover theplace. attackintheambulanceit’sa minorheart bumping road isreally bad.It’s notpaved, ifapersonishaving withapatientinthere, our goes backtoSchefferville English]: Even whentheambulancearrives andit [Elder’s experience,translatedfrom Naskapi into And theElder diedattheCLSC. one hourandhalf, fortheambulancetocomein. the caseshere are severe. We hadonethattookover town tohere. tohere, from Schefferville Sometimes trained. It takesalongtimetogetambulancefrom Îles have intheambulance.Idon’t know iftheyare equipment thatQuébec City, Montréal, orSept- They are notequipped,theydon’t have thecertificate speak inEnglish. speak onlyinFrench, they’re nottoogoodwhenthey They are allin they French. Ambulanceservices, We alsohave badexperiencewithambulanceservices. ° ° the prosecution. Your lawyer won’t saidby translateeverything English. letters before individualcasesare heard in in French andyou have tocomplainandwrite CESFNCQ October 2013 - - - Limited accesstotraininginEnglish inQuébec. in French. Order; however, thedocumentsandcorrespondence are all aresocial services required oftheProfessional tobepart nurses, socialworkers andotherprofessionals inhealthand Nations’ communitybecauseoflanguagebarriers.Further, ing professionals maybelimitedtoworking onlyintheFirst the First Nations communityisachallenge.English-speak Recruiting andretaining English-speaking professionals in iii. Access Issues related to Culture (Aboriginal) • • • • • • • are inQuébec.’ English hewastold‘You have tospeakFrench you face-to-face confrontation, butwhenhewasspeaking cal checkup, whenhegottothehospitalhada English]: Our Elder went down southforamedi Elder’s experience,translatedfrom Naskapi into inEnglish.to receive services rights tospeakFrench inworkplace andclients’ rights difficulty ofstrikingabalancebetween theworkers’ inEnglish: Participantsing services spokeaboutthe Language legislationcausingbarriersforclientsseek French. are allinFrench. Ican’t gobecauseIdon’t speak year,supposed tobegettingevery alltheworkshops, [Social workers/nurses]: Allthe educationthatIam the samehere region? inthenorthern ambulance willbethere atyour doorstep. Why isn’t it French, onlysocialworker, Iamareserve butIpay thing issenttomeinFrench. Because Idon’t speak The Professional Order of Social Workers—every because ofthelanguageproblem. Native nurses[English-speaking] aren’t comingback here attheCLSC. stressed. Happening inQuébec, everywhere and and doesn’t know whatishappening.Getting more Patient issittingthere listeningtothisconversation in front ofthemtoexplainthecaseinFrench. Nurse willtalktothedoctor, explainthecaseright They were talkingin French. mation aboutwhatwashappeningwithmymother. that withmymotherdied.Ididn’t getmuchinfor to meacoupleoftimesattheCLSCIexperienced and you don’t understandanything.Thathappened At theCLSC,nursestalktoeachotherinFrench, - - - - - 58 and awareness aboutAboriginal history, culture andsocial withthelackofcultural understanding their frustration cial institutions.Community resource workers spokeabout stated thatFirst Nations are facingdiscriminationatprovin Discrimination andlackofculturalsensitivity– Participants health. and they maynotbeaware ofwhatishappeningwiththeir particular, are vulnerable:manyelderlyonlyspeakNaskapi, you, butyou don’t know whatthey are saying.”Elders, in lated because“workers [atprovincial institutions]talkabout ifthey don’tof” speakFrench. Client’s rightsare beingvio stated thatcommunitymembersare “beingtakenadvantage First Nations’ rightsare notbeingrespected. Participants • • • • • • what we are. don’t getanyrespect given tousforwhowe are and day. We don’t have therighttobeinformed. We else.Buteveryone we have tofightforthemevery ing allthetimeforrightsthatare already given to Our work isnotgoodenough…we have tobefight dren, we alldrinktoomuch. We smart. are notvery than theNaskapi values. Thatallofusare justchil White values, theFrench values are more important ing racism.There isanattitudeofcolonization. The Not onlytheNaskapi, butallNative peopleare fac tothem. information forwarded also acommunicationthingtheydon’t have enough right, tohave healthcare. To bemore informed.It’s are theirrights.Here theythinkit’s aprivilege,not they have to. People needtobeinformedaboutwhat If theydon’t nurse,theyare wanttoseeacertain told in English. patients’ rights! You needtogetalltheinformation know ofthe whatisgoingon.Andthatpart may talkFrench, buttheElders themselves don’t Elders over here onlyspeakNaskapi. Theirescorts saying, your rightsare violated. Talking aboutyou, butyou don’t know whattheyare they said. You can’t complain. anyone what theysaidbecauseyou don’t know what [Community members]can’t talkback. You can’t tell about you. Theyknow you don’t understand. about you, butyou don’t know whattheyare saying They are really takingadvantage of you. Theytalk people whodon’t speakFrench inthiscommunity. [As anurse],Ifeelthattheyare takingadvantage of to documents,Ican’t even askquestions. else,$600. the sameduesaseveryone Yet, noaccess CESFNCQ October 2013 - - - - - respect forculturalprotocols. community: Obstacles becauseoflanguageandalack Provincial trainingprovided tohealthprofessionals inthe judged’ by provincial workers. context. Many spokeaboutthelackofrespect and‘feeling i. General Access Issues andChallenges Services): a.) CommunityResources (Health andSocial Services 2. Gesgapegiag MI’GMAQ Funding fortravel issues–inparticular services. andescort • • • • • • • respect tosaysomethinglikethat. ents.’ Thisistheattitude,there isacompletelackof told me,‘Naskapi peopleare notfittobefosterpar It’s aconstantbattle—oneyouth protection worker tality. drinksinthecommunity.think everyone Thatmen At theCLSC, theysometimesare judging—they discriminatory. Health Centre orintheNative community. It’s very … Someone likethatshouldnotbeworking inthe comes from ourpockets.It’s mymoney, Ipaytaxes.’ French. [Theprovincial worker said], ‘this money One time, there wasaconversation thatwasin funds foranescort. was notprovided withonebecausethere were no He butatthattime he wasgoingtohave anescort, needed. His sonhadasmallsurgery, asmallbypass. English]: Our Elder that was spokeabouttheescort [Elder’s experience,translatedfrom Naskapi into people whentheydon’t have whattheyneed. can’t sendElders onthetrain.Still it’s hard very on get themoneyfortravel. In order tosave moneywe get anotherCLSC.In themeantime,we don’t always year. We have tostaywithin thatbudget,orwe won’t Travel isaccording tohow muchmoneywe getevery Imagine how highriskwe are! can’t practicealone.Theytreat uslikeguineapigs. The doctorstheycomeinhere topractice,butthey cols, culture, andlanguage. North fortrainingneedtorespect communityproto Education institutionsthatsendstudentstothe - - - 59 is inadequate, in particular formentalhealthservices. is inadequate,inparticular receive inEnglish. Further, services thefundingforservices and mentalhealth.Clientsneedtogooutofprovince to treatment specialneeds,speechlanguagetherapy, services, fordetoxification and pants spokeaboutthelackofservices inEnglish –ParticiLack ofaccesstospecialized services ii. English languageaccessissues Quality ofcare. Gaps indischarge from provincial hospitals. vincial institutions. Perceptions atpro andbeliefsaboutthequalityofservices (travel).Distance toaccessservices (specialized). Long waittimeforservices the region (ineitherEnglish orFrench). in Lack ofgeneralandspecialized healthandsocialservices • • • • • • • reserve. Downs syndrome children limited,even are off very because noneinthearea. inEnglish Services for from Newin services Brunswick forautisticchild difficult.very First Nationhealthcentre brought forfamilieswithspecialneedsis Access toservices ment services. inEnglish fordetoxification andtreatLack services to bepretty damnsicktogothere.” a significantaccident.“Idon’t thoseguys,Ihave trust confused withhisson’s, whichcouldhave resulted in to doit.He alsohadaproblem inthathisfilewas tried togethisaddress corrected andcouldn’t manage you don’tin adepartment even want.One member When you callyou getbouncedaround andendup out at3 offered, andbecamefrustrated. Security threw him hospital forhelp. He didn’t wantthemedicationthey A clientsufferingfrom PTSD who went tothe need becausetheybelieve it’s goingtobefrustrating. Clients sometimesdon’t theyreally gotogetservices distance andthetravel involved. becauseof Challenges accessingspecialized services French inthisregion. It ineitherEnglish or isachallengetoaccessservices a.m. andhehadtowalkhome.

CESFNCQ October 2013 - - - Judicial: of withtheDepartment interfaces Social services hospitalsandemergencyroom services. nity services inEnglish atlocalhospital:mater Lack ofaccesstoservices are lesslikelytospeakEnglish. Language barriers(communicating)–Nurses andreception English foryoung offenders. in system;lackoflocalservices going through thecourt maintain ifinterpreters are used;issueswithfairness when ‘Facts getlostinthetranslation;confidentialityisdifficultto available inEnglish. Participantsservices commentedthat Youth Protection andtheProvincial System –limited Court • • • • • • • • • • not bilingual,except attriage. At [localhospital], theemergencyroom nursesare issohigh. though theGesgapegiag birthrate areLabour andbirth notensured inEnglish, even mustpay.Community Services seling iscovered, andthenGesgapegiag Health and Funding issues—Under RAMQ,10hoursofcoun ince forindividualcounselling,etc. Clients are beingreferred toinstitutionsoutofprov Mental limitedinEnglish. are very healthservices forEnglish languagespeechtherapy.Lack services French, asifspeakinglouderwouldhelp! Sometimes nursesyell ifpeoplecan’t understand Montréal, asthere locally. are noEnglish services theirtimein Long-term young offendersmustserve to speedthingsup.’ clients are pleadingguiltywhenthey shouldnot,just ing inFrench. Workers reported that‘sometimes tospeedthingsupbyand lawyers proceed are trying but itistheclientwhohastoask.Often thejudge Clients have arighttolegalproceedings inEnglish for theclient. also raisestheproblem ofconfidentialityandprivacy the factsgetlostintranslation.” Using aninterpreter “that’s confusingasthere issomuchbackandforth, with theJustice aboutyoung Department offenders, assistance withtranslationfrom co-workers todeal Young offenders—First Nations’ socialworkers seek - - - - 60 because clients’ information inFrench, may becharted Tracking information –Participants describedobstacles from Centre dejeunesse. English Access Plan; forms from theprovince; directives ments/records; documentation from theprovince about to patientsabouttheirrespective conditions;clientassess French. Examples provided include:information provided documentation from theprovince ismainlyavailable in Participants describedthe difficultyintheirwork because Documentation from theprovince isprimarilyinFrench. province linesorU.S.lines. because oflanguage.Communityworkers rely onoutof Issues from provincial accessingservices helpline numbers attempting tospeakwithsomeoneinEnglish by phone. guage barriers–clientsandworkers faceobstacleswhen Calling provincial institutionsisdifficultbecauseoflan • • • • • • • • Centre dejeunessedirectives comeonlyinFrench. Forms are inFrench only. English cameonlyinFrench. in Invitation tomeetingaboutaccessservices Access Plan. Documentation isinFrench onlyaboutEnglish only imaginewhatourclientsare going through.” ceedings are inFrench Ican only:“If Iamstruggling ers is received in French pro only and often the court Social Alldocumentationonyoung Services: offend withnothingbutFrenchservices) documentation. scary. Theycomebackfrom Rimouski(forspecialized the hospitalnotsure oftheinformationandsoit’s when hearingdiagnosis,etc.,theycomebackfrom in English isinadequate—peopleneedreassurance For follow-up care, forexample,documentation province linesorU.S.lines). peopleinEnglish (rely onoutof capable ofserving before givingthemouttoclients,andmanyare not providersService needtochecktelephonehelplines when shewasdealingwithanemergencysituation. actually hunguponaworker [communityresource] message forthem.Once someoneatthehospital understand whattheyare sayinganddon’t leave a telephone messagesso[communityworkers] cannot Even providers bilingualservice leave French-only CESFNCQ October 2013 - - - - provided tothosewhocompletetheirtreatment. may completetreatment because‘return transport’ isonly ‘somewhat ofproblem’, however italsoensures thatpeople is stated thatthedistancetoobtaindetoxification services tres becausethey are ‘from out-of-province.’ Participants nevertheless someclientsare beingturned awayfrom cen there are agreements service inplacebetween provinces, primarily from New andNova Brunswick Scotia.Although stated thatclientsare outofprovince, seekingservices fordetoxification services ‘out ofprovince.’ Participants Provincial boundaries–Obstacles forclientsseekingEnglish care nursesandclientsthemselves. which thenrequires translationforEnglish-speaking home Funding fortrainingcanalsobeanissue. toaccesstraininginEnglish inQuébec.limited opportunity workers are required by lawtohave training,yet there is Limited accesstotraininginEnglish inQuébec –Health • • • • • • • First Nations organizationsare sendingclientsto speaks English, theyhave tohave themtranslated. French) thengotoahomecare nursewhoonly English speaking community. Thesesummaries(in inFrenchchart even iftheywork inaFirst Nation If nursesare French speaking,theymaychooseto Nurses inFrench have theoptiontochart orEnglish. ° Québec. Training inEnglish are opportunities limited in where (outofprovince). we feelcomfortable ratherthan Being forced intocorridorsofservices vided forpeoplewhocompletetheirtreatment. treatment cycle becausereturn isonlypro transport ensures thatmore peoplestaytotheendoftheir ofaproblem,While thedistanceissomewhat italso forclients. services ment, sothere shouldbenodifference inaccessto Québec andNew agree Brunswick have aservice first. Miramichi doesnotfollowrule. thatsame referrals, except afterallNew Brunswick patients Campbellton [detoxification centre] willnotaccept services. New Brunswick andNova Scotiafordetoxification ° not available inQuébec. New Brunswick insteadofhere becauseitwas We are taking thementalhealthtrainingin - - - 61 obstacles anddiscrimination. resultingto makeupforthegapsinservices from language community resources needto ‘go beyond theirmandates’ Discrimination andlackofculturalsensitivity. First Nations included inthepopulationcountforregion Difficult for First despitebeing Nationstoaccessservices responsibilities). physically handicappedpersons(disputesover fiduciary ernments: inthecommunity, there for isalackofservices Jurisdictional issuesbetween federalandprovincial gov iii. Access Issues related to Culture (Aboriginal) • • • • • • • gaps. often gobeyond theirown mandatestomakeupfor First Nation membersmeansFirst Nations’ resources inEnglish anddiscriminationagainst Lack ofservices clients. their own community:imaginewhattheysaytothe that First Nation clientsshouldgethealthcare in [Hospital] nurseshave toldFirst Nation’ workers figures for Québec healthcare? when we know theyare countedinthepopulation Why are Natives notgiven equalaccesstoservices either.services the province arguestheyshouldnothave toprovide the federalgovernment doesnotprovide and services cally handicappedpersonwhoislivingonthereserve: Health ishavingahard timewithaphysi services Funding fortrainingcanbeanissue. lar training,butaccessinEnglish isoftenaproblem. Under needstokeepupregu Law21,healthservices ° ° Issues withthequalityoftraining, whentranslated. ° ° ° ° phones onallday. great qualityandit’s tiringhavingthehead- because sometimesthetranslationisnota its traininginEnglish withFrench translation The Commissionshouldarrangeforsomeof I don’t getthefullimpactifit’s translated. Workers seektrainingintheMaritimes. CESFNCQ October 2013 - - - iv. Positive Experiences health andsocialservices. intheprovincialtrust institutionsresponsible forproviding Quality ofcare –Participants describedtheirgenerallackof i. General Access Issues andChallenges b.) Gesgapegiag CommunityMembers: • • • • • • • • • the community. (soutienàdomicile)into give homecare services has anagreement withtheCSSStohire ournurses Agreements withtheprovince necessarily trickledown tothefront-line workers.” withtheCSSSmanagers;however,rapport itdoesnot improved. At themanageriallevel, there isagood we have someprotocols inplace andsomethingshave institutions. Participants commentedthat,“as aresult Nations communityorganizationsandprovincial relationships atthemanagementlevel between First tion Fund (AHTF))–Projects have helpedtofoster Nations Joint projects between theprovince andFirst If Ilearnanything IwilllearnMi’gmaq, notFrench. speaking andFirst Nations). Feeling ofbeingdoubly-discriminated—(English- able. “He isbeingheldagainsthiswill.” might aswell beathomewhere heismore comfort fallen inthehospitalandalso arehab centre, sohe in thehospitalbecausehemight fall—buthehas An Elder whowouldliketobeathomeisbeingkept sorry.” afraid anddefensive. “And theynever saytheyare The yelling by thehospitalstaffmakespeoplefeel body isnotusedtothat.” tokillme.Myon medication.“Ifelttheywere trying butalltheywanted todowasputher health services, hadgoneinformental Another time,aparticipant in] seeconsistentlypoorservices. Those whogooften[tothehospitalemergencywalk- impacts thequalityofservices. Too manyresidents practicingatthehospital, (i.e., through Aboriginal Health Transi

–Health services - - 62 (reception). bilingual, however lesssofornursesorfront lineworkers Language barriers(communicating): Doctors may be inEnglish. services Language legislationcausingbarriersforclientsseeking ii. English languageaccessissues (travel)Distance toaccessservices isanissue. and atemergencyrooms inhospitals. toaccessspecialized services Long waittimes,inparticular institutions –Participants describedtheirfearandanxiety. Perceptions from provincial andbeliefswhenseekingservices • • • • • • • • • members whose English or French isnotasgood. Participants oftenhave tocallthehospitalforfamily spent atthehospital. has pickedupmostofhisFrench from extensive time according toonecommunitymember. He saidhe policy [Bill 14]iscreating even more problems, want you tospeakFrench.” Québec’s language new speak English butmanysimplydonotwantto,“they Many communitymembersbelieve thatnursescan cametocheckonthechild. every waiting room andhadtowaitforhours,butnobody tookachildwithfeverOne tothe participant specialist. waitedthreeAt leastoneparticipant years toseea treatment. therefore theyare deprived ofprevention medical members avoid goingtothehospitaloutoffear, and There wasgeneralagreement thatmanycommunity need becausetheybelieve it’s goingtobefrustrating. Clients sometimesdon’t theyreally gotogetservices ally understandwhatisgoingon. They donotwanttoaskquestionsandsousu Elders are afraidtogothehospitalby themselves. see consistentlypoorservices. Those whogooftenattheemergencyinhospital generally it’s alwaysthesamestaffmembersthere. The emergencyward and istheworsedepartment,

CESFNCQ October 2013 - Discrimination andlackofculturalsensitivity. iii. Access Issues related toCulture (Aboriginal) from provincialservices institutions. withqualityofcarelanguage isinterfering whenseeking Perceptions andbeliefs–Communitymembersstatedthat governments). forFirstble tofundservices Nations (federal andprovincial Jurisdictional issues–Lack ofclarityaboutwhoisresponsi • • • • • • as English-speaking clients.“Thefirstthingtheyask twice discriminatedagainst:firstas Natives, andthen There wasgeneralagreement that First Nations are goodplaceforNativevery people. There wasageneralfeelingthatlocalhospitalisnot take thetimetogetknow you. They arerude if you can’t explainin French anddon’t ment shewasreceiving. not understandfullytheimpactofcancertreat One community memberlost40poundsasshedid about goingtothelocalprovincial institution. [First Nations’] clinic?”She bad wasmadetofeelvery aren’ttold “Why atyour own you gettingservices due toaninfectionandothercomplications,shewas there. When shehadtouse[localprovincial] services away]andsaysshewastreated[further muchbetter atahospital had togoforasurgery One participant with theblockade. nurses through,’ althoughtheyhadnothingtodo recent road blockade,‘You shouldletthedoctorsand towards natives. One personwastoldduringthe being native. There seemtobestereotypical attitudes [Staff atprovincial institutions]look down at you for killers whentheyare needed.” like French orEnglish patientsandnotdenied pain “Pain ispain;First Nations peopleshouldbetreated becauseshewasnative. ers afterhersurgery believes theydidnotgive herstrong enoughpainkill it wasdiscovered shehadovarian cancer. She also her painandsenthome.In aboutonemonth when shesaidwasnotpregnant. Theydismissed whowas17atthetime,notbelieved participant, you asaNative personisifyou drinkorsmoke.” One

- - - - 63 access services from theprovince.access services Lack information andknowledge aboutwhere andhow to the region (ineitherEnglish orFrench). in Lack ofgeneralandspecialized healthandsocialservices i. General Access Issues andChallenges Services): a) CommunityResources (Health andSocial Services 3. Listuguj services. nications between thehospitalandcommunityhealth confidentiality wasnotbeingmaintainedinthecommu –Communitymembersfeltthatpatient’sQuality of services – lackinformation aboutwhere andhow toaccessservices. from provincialaccess services institutions(suchasCLSCs) Some First Nations are notaware thatthey have arightto • • • • • • • • English. for healthconditions,even iftheexplanation isin It isdifficult tounderstandthemedicalterminology orspecialistsintheprovince.how tofindservices Do nothave enoughinformationaboutwhere and the region. Difficult tofindfamilydoctor—longwaitinglistsin ince (ineitherFrench orEnglish). Difficult from the toaccessspecializedprov services members directly tosetupappointments,etc. medical situations,ratherthancallingcommunity Gesgapegiag Health aboutpersonal CenterServices It wouldappearhospitalpersonnelare dealingwith care rights. suggested we makesure peopleknow theirhealth They have aright togotheCLSCforservices. munity membersrealized forthefirsttimethatthey During themeeting,anumberofFirst Nations’ com money theyare getting. They don’t care about you, theyonlycare aboutthe about needapsychiatrist by the timeyou comeout. the province orthefederalgovernment? You just passing you around,They start whoisgoingtopay; CESFNCQ October 2013 - - - communicating. becauseoflanguagebarrierswhen feeling offrustration workers because oflanguageobstacles.There isageneral fullyatmeetingwith provincialdifficulty ofparticipating formentalhealth.Participantslish services describedthe staff. support describedtheneedtohaveParticipants Eng and lesssofornurses,reception (front lineworkers), and doctors are more likelytobebilingual(English andFrench), Language barriers(communicating):Participants statedthat ii. English LanguageAccess Issues (travel).Distance toaccessservices guage barriers – Participants described theirfrustration Calling provincial institutions isdifficultbecauseoflan • • • • • • • • The doctorsallspeak English, butit’s thesupport members tourbanareas formedicalreasons (costly). Difficult forcaregivers toaccompanyclients/family Costly totravel (lackfunding). Distance isanissue. toaccessspecialized services services]. People are sotheydon’t frustrated want togo[seek notes, andyou’re exhaustedby theendofday. listening andwe’re watchinglips,we’re totake trying devices allthrough meetingsfordaysonend,we’re punished. We’re theone’s havingtowear translative meetings, andbecausewe’re English, it’s likewe’re Obstacles becauseoflanguageatmeetings: When at mate.” communicate withotherpeople,oreven theirroom most ofthepatientsare French-speaking sotheycan’t hospital inQuébec, they’re aboutitbecause grumpy Long termcare athospitals:“If you sendthemtothe meaning ofwhatyou are saying. you are sayingisbeinginterpreted inthewayand thatwhat who isfluent…you wanttobecomfortable open up, theywon’t talk; You have tohave someone to gocounseling.Theywon’t goback;Theywon’t ‘why amIgoingthere?’; It’s hard enoughtogetthem person doesn’t really understandthem,they’ll ask place andthey’re gettingtheimpression thatthis Mental If thepersonwalksintoa healthservices: the difficulty. staff whocan’t, ordon’t wantto,speak English. That’s - - - 64 means delays in services. means delaysinservices. funding totranslatedocuments,andwaitingfortranslation Examples include:forms, information, andmaterials.Lack Documentation from theprovince isprimarilyinFrench. from provinciallanguage services helplinenumbers. Participants describedthedifficultyofaccessing English atreception.services tocallinstitutionsandthelackofEnglish when trying • • • • • • • • just say‘Oh, we never gotthattranslatedyet!’ in English. Sometimes we don’t even getthem,they French andwe have waitayear ifnotlongertogetit all oftheirforms,andinformationisin EspeciallywithCentre[Social Jeunesse, services]: delays. lish orourliaisonwilltranslateforus.Thatcauses province] inFrench, needtoaskforreports inEng Reports [for Youth Protection] comeback[from the late documents. Long waitperiodwhenrequesting province totrans but doyou realize how expensive thatis?! forms: If you wanttotranslateityourself you can, Lack fundingtotranslatedocuments,materialsor from organizationsthatdeemsthemselves bilingual. A lotofinformationthatwe getisinFrench, even number, it’s allFrench, allFrench. toaccessthat1-800 they go?Because whentheytry Elder isbeingabused,whodotheycall?’ Where do an always comebacktothatsamequestion‘When to accessforalotofcommunitymembers. We’ve The difficult Elder abuse,thehotlinenumberis very options orlimitedforEnglish services. Elders abusehotline,sexualassaulthotline:no they mightcomeback. find someonewhospeaks English! Ten minuteslater, will say‘Canyou holdonamoment,we’re goingto When you callaninstitution,thepersonanswering

CESFNCQ October 2013 - - English (even is closerinanotherprovince). iftheservice Québec rather thangoout-of-province in toobtain services Participants are beingencouragedtostayintheprovince of and fullreimbursement from theprovince isnotguaranteed. funding andclientsneedtopayoutofpocketforservices, tion, becauseclientsare from ‘out ofprovince’; issueswith forth’, fordetoxifica inparticular beingdeniedservices, province’: jurisdictionalissues,being‘bouncedbackand inEnglish from ‘outof barrierswhenseekingservices of Provincial boundaries–Participants describedarange Provincial databasesare mainlyavailable inFrench. • • • • • • • • on theissues. hospitals inNew Brunswick andQuébec depending People are between the bouncedbackandforth nization andupdatesare available inFrench only. Health Database systemforvaccine immu services: care tobetranslated—it’s beenover oneyear. Management System from theprovince forthefoster SocialWe’re services: stillwaitingfortheInformation urgency ofthisrequest.” cated thatshewasputonawaiting list,despitethe Brunswick. Because sheisfrom Québec itwasindi pregnant inNew ladyinquired aboutdetox services are from Québec (New Brunswick clientsfirst)—“a New Brunswick are putonwaitinglistsbecause they Patients from someinstitutionsin seekingservices andtreatmentDetoxification services: services the provinces! can’t seewhyanagreement can’t be madebetween There’s not thatmanyborder towns in Québec, I clinics). isn’t reimbursed forthefullamount(i.e.,methadone and thengetreimbursed [from theprovince]; Patient Funding: For you have payupfront, someservices, of coursetheculturalcomponents. what Iamreally with,languagebarrier and struggling will have aFrench speakingperson,andnot dealwith nearby bilingualhospitalinNew Brunswick], thenI up inanambulanceallthewaytoMaria [ratherthan If you are withmentalhealthissues,end struggling for Québec residents (attheNBregional hospital): Psycho‑social care isnotaccessibleinNew Brunswick ences whentheyare willingtogothehospital. dividesthepopulationandinflu [The boundary] - - - - 65 jurisdictional issues.) inEnglish inQuébec (distance,longwaitinglists, services Rehabilitation centres (addictions,Elders, youth) –Limited available inEnglish (legalandfollowservices upcare.) Youth Protection andtheProvincial System –limited Court Judicial: of withtheDepartment interfaces Social services inEnglish Long waittimesforservices find English speakingspecialists. chronic conditions; andpatientsare ‘leftontheirown’ to inEnglish forspecialneedsand group services of support and languagespecialists,physiotherapists;there isalack specialists inareas speech suchasmentalhealthservices, ticipants notedthatthere isaneedforEnglish speaking inEnglish –ParLack ofaccesstospecialized services • • • • • • • • numbers of mental illness coming forth, we’renumbers ofmental illnesscomingforth, doing In we are myarea seeinghigher [socialservices], [follow upcare.]lish speakingservices Brunswick. Montréal iswhere we wouldaccessEng are from theprovincealmost 90%ofservices ofNew intheprovinceers thatwe seeforservices ofQuébec, Under Youth Protection andadultcare—many barri lengthy. Difficult involved,process for everyone tendstobe tion. Difficult forfamily, difficultforusas workers. andalotofourclientsdon’tto court have representa accepting legalaidfor Youth Protection files. Going [In ourregion] there are noEnglish-speaking lawyers waiting list,sometimesuptoayear. speak English. It it’s tendstodelayservices, alonger number ofpsychologists orpsychiatrists whoactually cal assessmentdonebecausewe are limitedtothe The waitinglistislongif we needapsychologi disorders, suchasautism). (mental illnesses,physicaldisabilities,ordifferent inEnglish forfamilies group services Lack support the therapyinEnglish. do anassessment,butyou can’t findsomeonetodo You canalwaysfindapsychologist orpsychiatrist to tions inEnglish inQuébec. People foraddic have problems accessingservices language specialists,physiotherapists). speechand (for instance,formentalhealthservices, We don’t have manyEnglish speakingspecialists CESFNCQ October 2013 ------riers [generalaccessandobstaclesbecauseoflanguage.] from theprovinceto accessservices becauseoflanguagebar Crisis situations (trauma,crisis,andemergency)–Difficult cial organizations Lack ofcommunicationbetween First Nations’ and provin iii. Access Issues Related toCulture (Aboriginal) clients mayaccessinEnglish from theprovince. Lack ofinformation andknowledge aboutwhichservices Limited accesstotraininginEnglish inQuébec. • • • • • • • before you seeanyone whospeaksEnglish. speaking staff—you couldbewaitingalongtime And ifyou are keptthere, theyonlyhave French side] soyou have togothrough theprocess twice. gated, assessed,thensentto[hospitalontheQuébec speaking hospital,outofprovince], theyare interro language. If theywanttogothe[nearby English inthearea becauseofthe will notaccesstheservices There are peoplethatare intraumaorcrisis,they inNewalways accessservices Brunswick. for addictions—centres are faraway, andwe can’t Another barrierwithclienteleisrehabilitation centres we canhave accessto. their own, we don’t inQuébec that have anyservices mental illnessesandcannotlive independentlyon more placementsforyoung adultswhosufferfrom language barrier. treatment,start andthenthey’re confronted witha placesbeforefew theyarrive atwhere theyneedto Trial by error, experience.[Aperson]maygotoa English? We’re lackinginformation. in What are therightsofclientstoaccess services to gooutofprovince. Health services—Training islimited,we usuallyhave English. Social services—We haven’t hadanytrainingin spoke English. for someoneat4 4 received acallfrom [Québec hospitalinthearea] at Recently, I whileIwasoncall[socialservices] a.m. forasexualassaultvictim.They were looking a.m. , andthere wasnoonewho - - - 66 impact communities. fullyindecisionsthat consultation andabilitytoparticipate Rights asFirst Nations are notbeingrespected –lackof is responsible (delivery andfunding). forwhatservices ments, butthere isalackinformation andclarityaboutwho from bothfederalandprovincialand socialservices govern Jurisdictional issues:First Nations have accesstohealth provide more withthesamelevel services, offunding Funding issues:First Nations’ organizationsare expectedto • • • • • • • • • • to findqualified socialworkers to replaceourworkers tered with theprovince…we’ll bescramblingaround Under 21,andhavingpeople whoare Article regis communities). Nation communities notconsultedaboutimpacton tion aboutchangestolegislation(i.e.,Law21,First We’re thelasttobeconsulted,there’s noconsulta are covered).services approval from Ottawa, lackofclarityaboutwhich whilewaiting for (paper work, delaysinservices from thefederalgovernment services) orthodontic Difficult toaccessdentalcare for (inparticular forpeoplewithdisabilities. Lack ofservices by Federal government. Lack ofclarityaboutwhichmedicationsare covered cial systemsabouttheissues. There’s nocollaborationbetween federalandprovin vincial. It’s allonetothem. [Non-Insured Health Benefits] NIHB,whatispro It’s awareness—people don’t understandwhatisthe issue forus. Non-Insured Health Benefits (NIHB)isa real sources of funding. that fundingcanbecutandit’s thesamewithall same amountoffundingandalwayswiththethreat funding, theywantyou todox,y, andzwiththe vices, buttheyare notproviding you withadditional You are expectedtodomore reports, andprovide ser are beingprovided?what services the peoplewhowork there now, dotheyknow about have decisional trees—but, dotheylookatit?Do The CLSC,CSSS,andListuguj Health Centres all CESFNCQ October 2013 ------Nations history, culture andsocialcontext. lack ofculturalunderstandingandawareness aboutFirst Discrimination andlackofculturalsensitivity. There isa health prioritiesandneeds. fromServices theprovince are notmeetingFirst Nations’ • • • • • • • • • not apriority. ground, population’s needs.[AsFirst Nations] we’re Not beingacknowledged asAboriginal, ourback emony, it’s allhocuspocustothem. ing…there isalackofunderstandingaboutcer that more andmore. There isalackofunderstand because oflanguageandculturalsensitivity. You hear tory. You feelasthoughyou are hittingabrickwall and awareness aboutFirst Nations culture andhis Provincial institutionsandspecialistslackknowledge vices] inMi’gmaq. rights are notbeingmet.People are askingfor[ser As English speakingMi’gmaq people,ourlanguage a voice and thisimpactsourcommunities When itcomestolawsandlegislation,we don’t have adults, andwe’re seeingdeeprooted issues. we’re seeingmore mentalhealthissueswithyoung more children diagnosedwithdifferent disabilities, That’s the reality ofour worldtoday. We are seeing coming offmethadone. or babiescomingoffmethadone,theirmom’s There are specialized needs forchildren withautism, same issuesthatwe sawfive years ago. The needsare alwayschanging. We’re not seeingthe work. Institutions don’t eachother. trust resources are fragmented,lackfaithincommunity fromThe view outside resources isthat Aboriginal a priority. a definitelackofunderstandingandIdon’t thinkit’s that speaksvolumes. Thisisall relevant, butthere is who have nointerest and orknowledge ofourhistory outside ofthecommunityare donesowithpeople Moston andsoforth. ofthereferrals thatare done historical losesregarding residential schoolandso marginalized already. There’s intergenerational issues, are most ofthepeople[whoneedsocialservices] There’s alitanyofissues—from aculturalcontext, - - - - - 67 i. General Access Issues and Challenges b.) ListugujCommunityMembers: iv. Positive Experiences • • • • • • • • • Long wait times to access services (specialists). Long waittimestoaccessservices It isdifficult togetafamilydoctor. projects. ships withlocalprovincial institutionsthrough joint First Nations are buildingconnectionsandrelation someone toread myassessmentofa client. over theinformationinEnglish, thentheywillfind other [becauseoflanguage]thehospitalhasmefax speaking withsomeoneandwe can’t understandeach workers from communityorganizations. When I’m are toaccommodate English-speaking makingefforts Mental (suicideprevention): Hospitals healthservices and thehospitaliscallingus. them, asking forcommunitymemberstosupport during crisissituations—victimsofsexualassaultare Hospital isreaching outtoFirst Nations community limitations. [attitude] haschangedsincethen,butthere are still they wouldsay, ‘You have your own people,” that wouldcalltheCLSC our office[socialservices] from theprovincial CLSCs.For alongtime,when nity membersthatFirst Nations mayaccessservices Today, there isincreased awareness amongcommu willsuffer.who really needtheservice thepatients the fundingformedicaltransportation, Medical there are services—If transportation cutsto have difficulty accessing professional services. deal withthejurisdictionalissuessothatwe don’t make thosechangeshappentoincrease thefunding, one atthetoplevel, atthosetableswhere theycan someone willbeadvocating onourbehalfandsome ends. It hastobetakenourleadership, that’s where It here, canstart planttheseedbutthisnotwhere it Nations] approach itisunique. ing pregnancy? Allthatstuffandhow we [as First sexual abuse?Dealing withhavinghadalcoholdur deal withpeoplefrom ahumanplace?Deal with We needtoaddress historicaltrauma.How doyou

CESFNCQ October 2013 - - - - when requesting inEnglish. services barriers. Participants andfear describedtheirfrustration staffcanbedifficult across language specialists andsupport Language barriers(communicating):Communicatingwith ii. English LanguageAccess Issues English forcaregivers. in facilities fortheelderly;there services isalacksupport population–Languagebarriersatlong-termAgeing care for anEnglish-speaking person. andbeing‘hungupon’for English services, while waiting experience,longdelayswaiting guage barriers–frustrating Calling provincial institutionsisdifficultbecauseoflan • • • • • • • have towaitanothermonthseethatspecialist. work, anditwillbeputonthebackburner, andI’ll always getscared thatthey’re goingtolosemypaper repercussions tothemselves ortheirloved one’s: I the boat”inEnglish, forfearof oraskforservices saidtheydidnotwantto“rockOther participants themselves andworkers athospitalsover language. Some described“confrontations” participants between Try tocommunicateinFrench, butyou’re off. brushed the translation.It’s frustrating. always abletocommunicate.Ihadahard timewith Even if[thespecialist]speaksEnglish we’re not with him. I don’t understand.He couldn’t saywhatwaswrong ing tohiminFrench, sohedoesn’t understandand term care facilityintheregion]. They were speak I hadafamilymemberwho aproblem at[long hang upandthenIhave tocallthemback.” 9. I’m nothangingup.I’m waiting.Sometimes,they you backwhospeaksEnglish.’ No! Itellthem,dialed what comeson?French. Theytellme,‘Someonewill call number forEnglish, thatnumberforFrench—dial 9, “You thattheyhave knowonthephone,that the services with someone,resulting inincreased frustration. tion notalwaysavailable inEnglish, delaystospeak Difficulty recep withautomatedtelephoneservices: No, Idon’t wanttowait.Put someoneon.” on whodoes!Theysaid well you have towait.Isaid, speak English? Theysay‘No’, well thenputsomeone hospitals andtheycomeon,Iaskthem,‘Do you Icalledthe forpatients:“When English isfrustrating Calling hospitalsandwaitingforapersonwhospeaks - - - 68 munications/information from theprovince (notices). Examples include:forms, reports from specialists,andcom Documentation from theprovince isprimarilyinFrench. bilingualism. receive inEnglish; attitudesandperceptions services about to speakFrench inworkplace balancedwithclients’ rightto vices inEnglish: Striking abalancebetween workers’ right Language legislationcausingbarriersforclientsseekingser • • • • • • ° Reports from specialists ° ° ° ° Forms, questionnaires anddocuments it’s notright. around. They’re notallowed. Languagebarrierthere, on lookingaround toseeifthere were anynurses The nursetalkedtousin English, butshekept that’s whatshesaid. she gasped. We’re notsupposedtospeakEnglish, talkinginEnglish andthen came tous,andstarted don’t wanttospeakEnglish. There wasonenursethat English. A lotofthemdospeakEnglish, butthey a littlewhilewe keptonpushingthemtospeak At first we hadproblems with thenurses,butafter to speakit. They [staff]understand [English] theyjustdon’t want cate withoneanotherbecauseoflanguagebarriers. long-term care facilitieswhenunabletocommuni Participants describedpatients’ difficultiesatthe ° ° ° ° ° French, hedoesn’t understand… from [Québec hospitals],andhecan’t read in My doctorinNew Brunswick getsreports garbage, Idon’t care. I throw theinformationinFrench inthe [to thehealthcentre]. they know IspeakEnglish? Ibringmystuff Why are theysendingmeaFrench formwhen it wasaboutfive-pages longandallin French. have someonefilloutthequestionnaire forme, Filling outquestionnaires ischallenging:Ihadto write itout,butIcan’t. The formsare allin French! Theytell youto CESFNCQ October 2013 - - - Nation community. couldbeofferedhealth services ataclinic inthe First responsibilities?’ Some askedwhetherornotincreased are asked,‘What ourrights? participants What are our tion breakdown. With respect toaccessingmedicalservices, pants statedthatthere ismisinformation andcommunica clients mayaccessinEnglish from theprovince –partici Lack ofinformation andknowledge aboutwhichservices inEnglish. services Provincial boundaries–Barriers forclientswhoare seeking because oflanguage. provincial hospitalsinQuébec. [ in English at ficulty seekingemergencyorwalk-inservices whencallingforanambulanceaswell asthedif frustration communitymembersdescribedtheir Emergency services: • • • • • • • • • now. that wastwenty years ago!Theywon’t let you choose specialist—eitherMontréalsee aheart orHalifax, but I hadachoiceformydaughterswhentheyneededto work [for out ofprovince clients]. Depends on thedoctor, somedon’t wantthepaper from another province. Need more informationabouthow toaccessservices told her‘We have totakeyou toMaria, My son When myauntwasbrought tothehospital, they in English. there because Iknow that someonewillspeaktome Brunswick], ratherthanon theQuébec side.I’ll go in[NewI’ll gotheemergency[walk-inservices] get anyEnglish speakingperson. I justthrew thephone,Iwas soupset.And,Ididn’t I triedcallingtheambulanceandtheyspokeFrench. there, forrenewal, that’s it. at thelocalCLSCs:Ionlytakemymedicalcare card are available Lack informationaboutwhatservices have ourown clinichere? going outofprovince, seekingprivate care. Couldwe Québec’s dime?Idon’t know. In themeantime,we’re the righttoaccess,forinstanceaphysiotherapist,on As aresident oftheprovince ofQuébec, doIhave What are ourresponsibilities? whatare ourrights? As aclientofthemedicalservices ] General accessandobstacles - - - 69 iv. Positive Experiences with otherpatients. Mi’gmaq andthey are notabletocommunicatewithstaffor care facilitiesthere are challengesbecausemanyElders speak population–ForAgeing someElders whoare atlong-term people, you’re supposedtopass,buttheygoaheadofyou. son’s English orNative, theyputthemdown, thentwoorthree [gestures, putsontop].And,I’ve seenthemdothat.If theper your file, they putitrightthere, thentheygetanotherfileand Native people.I’ve noticedsomethingattheCLSCs,theyget Double discrimination to thewrong hospitalandmissedappointment. reasons. English for clientstravelling tourbancentres formedical areMedical services notalwaysavailable transportation in iii. Access Issues related toCulture (Aboriginal) • • • • Participant unabletocommunicatewithdrivers went and talkedtome inEnglish. Iwassittingthere, French, whenhewent forhisoperationnoonecame onhislungs.Everybodywent inforsurgery spoke patients whenundergoingsurgery. myson “When compassionate nurses,willing to speakEnglish with Quality ofcare—Some described the participants that’s myhappy story.” It but tookacrisistobeableaccesstheservices, ince ofNew Brunswick formysonwhoisautistic. (rehabilitation) from theprovable toaccessservices happen themotherdescribesherexperience:“Iwas to and althoughittookacrisisfortheintervention she hadbeenwaitingfor10years toaccessservices, who isseverely statedthat autistic.Theparticipants from outofprovincebilitation services forayouth CLSC socialworker assistedaclienttoaccessreha don’t understandher.’ ‘Wenurses know whatisgoingon.Thenursesaid, didn’t understandnothing…we wouldhave toletthe used totellthemshefeltpainhere orthere, butthey aunt wasalwaystalkingtotheminMicmac. She don’t understandthatthispersonisnotfluent. My Micmac, andthey’ll talktoanyone inMicmac they speaking They [elderly]forget English. Theystart staff doesn’t know] ifsomethingissore. stands whatthedeviltheyare talkingabout.[The care] andtheydospeakMicmac andnobodyunder A lotofElders are attheseinstitutions[longterm hospital myself! this stretcher thisinstantandIwilltakehertothe said, ifyou are goingtotakeherthere, getheroff —as English speakingpersons,andas CESFNCQ October 2013 - - - - services athospitals. services the difficultythatelderlyclientshave tonavigateandfind asking questionsabouttheirhealthissues.Others described that elderlypeoplehave communicatingwithspecialistsand population–ParticipantsAgeing describedthedifficulties i. General Access Issues andChallenges vices): a.) CommunityResources (Health andSocial Services Ser 4. Kanesatake MOHAWK |KANIEN’KEHÁ:KA • • • • • Some ofthemhave broken English, butatleast I have somethingthatIdon’t understand,I’ll ask. each other’s language.“You have tocooperate.If beingwillingtocommunicateusing and bothparties ofcooperation pant commentedontheimportance them inEnglish, theyunderstand.” Anotherpartici will speaktoyou. Some ofthem do. Andwe speakto staff[athospitals] speak English, someofthesupport willing tospeakinEnglish, “If theyknow thatyou Some staffare reported thatsupport bilingualand they allspokeEnglish.” I’ve spoken toninedifferent doctorsalltogether, and doctors theyallspeakEnglish. French andEnglish. specialists, butI’ve never hadanyproblems withthe Doctors andspecialistsare bilingual,“Iseealotof institutions, includinghospitalsandCLSCs. areServices available inEnglish atsomeprovincial stayed with me,andIsaid‘My God, Ilove you!” over tomeinEnglish. She andexplainedeverything Finally, andnervous. getting angry anursecame help from astranger.” stand, and[elderlymaninhis eighties] neededtoget were French speakingandtheystilldidn’t under difficult timenavigatingtheir wayathospitals: “they Some elderlypatients,andtheircaregivers, have a when goingtoappointments.] or problem. [Elderly withthem takinganescort what thesituationiswhenitcomestoahealthissue lot oftimesclientsare tooscared toeven askorknow proper questionsthattheyneedtoask…becausea You’ll getthatwithalotofElders, notaskingthe because Iunderstandjustalittlebit.” they’re And,we’re trying. tospeakFrench, trying - - - 70 ing phonecalls. guage barriers–Elders are reporting difficultieswhenplac Calling provincial institutions isdifficultbecauseoflan services). rehabilitationaccess thecorrect (forexample,drug services thatthey can ing emergencysituationstomakecertain inEnglish. Clientsrequireto obtainservices dur escorts ParticipantsEmergency services: describedtheobstacles staff. cating withspecialistsandsupport the difficultybecauseoflanguagebarrierswhencommuni Language barriers(communicating):Participants described ii. English LanguageAccess Issues specialists) Long waittimes(accessingappointmentstoseedoctorsand from theprovincialaccess services network. Lack information andknowledge aboutwhere andhow to • • • • • • them in order to access the right services. them inorder toaccesstherightservices. we willhave tosendsomeoneFrench alongwith tion, shouldweoften have tosendsomeoneout,very I know from therehab centre, inanemergency situa stand English. and even attheemergencydesktheydidn’t under I went toemergencyaboutamonthandhalfago, patient, theyspeakFrench…that’s beenabigbarrier. the ambulancedriver andtheoneworking onthe I’ve goneonemergencycallsinanambulance,and glass ofwaterwithiceatthehospital. [who couldspeakEnglish], justfor[hertoaskfor]a It tookthree people before theyfoundsomebody [Support staffunableorunwillingtospeak English]: a littleFrench. have doctorsspeakEnglish. Thank God Iunderstand to explainthemandit’s to likepullingteethtrying patients,there’sWhen Iescort timeswhenI’m trying your condition andwhat’s wrong. teaching hospitals,themore complex,dependingon then theywouldsendyou tothebighospitals, of all,you’d needtogotheregular hospital,and understand…what hospitalyou needtogoto. First oftheproblem, becausepeopledon’tThis ispart

CESFNCQ October 2013 ------health services, forexample). health services, barriers (speechlanguagetherapy, mental rehabilitation services, report inEnglish. ParticipantsLong waitingtimesforservices assistance withtranslation. mental health.Confidentialityisanissuewhenclientsneed inpants reportedEnglishfor difficultiesaccessingservices inEnglish –ParticiLack ofaccesstospecialized services the provincial network. Others reported challengesforany from pathology becauseofthecorridors toaccessservices ments andtreatment, suchasspeechlanguage forservices –ParticipantsCorridors ofservice reported delaysinassess institutions becausethey are English-speaking. Participants reported feeling‘pushed aside’ atprovincial face becauseofattitudesandperceptions around language. inEnglish. Participantsservices describedtheobstaclesthey Language legislationcausingbarriersforclientsseeking documents (legalaid). tion/documentation forclients.Lackofaccesstotranslated Participants report thatthey are totranslateinforma trying Documentation from theprovince isprimarilyinFrench. • • • • • • • • having to wait longer to get services becauseoflanguage having towaitlongergetservices information relevant forthemtoobtainservices. Clients needassistancewithtranslatingpersonal language barrier. The mentalhealthissuesare more impacted by the tions, whichare inFrench. Difficult tounderstandphonedirections/instruc ask questionsormakechangestotheiraccounts. Some Elders have ahard timecallingthehospitalsto verse withthemtoletknow exactlyhow Ifeel. we are beingpushedaside,butnotenoughto con understand. But Iunderstandenoughtoknow that a doublestandard becausetheyknow you don’t speaking hospitalandyou know onlyEnglish, there’s Double standards—If you gotoafrancophone inyour languagepreference.services Social Act Services becauseyou are entitledtoreceive There’s aprivacy issue; itgoesagainst Health and lish services. Now becauseoflegislationit’s harder toaccessEng their attitude.It’s frustrating. It’s theattitudeaswell. Ithinkthat’s thebigthing— ------71 to accessfundingforprojects. guage isanissuewhensubmittingproposals togovernment Submitting proposals forfunding–perception thatlan iii. Access Issues related toCulture (Aboriginal) can have proceedings inEnglish, theircourt ifrequested. lation whengoingthrough thelegalsystem.However, clients delays becauseoflanguage.There are challengeswithtrans under accessing services, Youth Protection, are experiencing available inEnglish. Participantsservices statedthatclients Youth Protection andtheProvincial System –limited Court Judicial: of withtheDepartment interfaces Social services hospital (by ambulance). inEnglish ifsenttoclosest type ofmentalhealthservices • • • • • • • in French anditwas accepted. not accepted.Thispast year proposal wassubmitted andthree years inarowment forelderlyservices is example, aproposal submittedtoQuébec govern an issuewhensubmittingfunding proposals. For There are strong perceptions oflanguagebeing English, thentheyhave to. They’ll ask you ‘French or English?,’ andif you say tion, either. Their languagedoesnotalwaysmatchtheirtransla will doit. are searching alittlebitmore fortheirwords. They It maytakealittle bitlonger, becausethelawyers ridors ofservices. We can’t inEnglish ifyou follow getservices thecor following them. ment totheirmedication,by thedoctorwhois all theyneededwasa72-hourwatchoranadjust person mustgothrough assessmentsagain,when go tothelocalhospital,whichposesproblems. The if theyare goingby ambulance,thentheyhave to have any type ofmentalhealthissues,oranxiety… In ourcommunity, whenitcomestopeoplewho pathology assessmentsdone. togetspeechlanguage a-half totwo-years trying a committeefirst.Ihave seendelaysofa year-and- give here. you Having English togothrough services tal inadifferent region onlytohear, ‘No, we willnot atahospi caught waitingmonthstoreceive services Ihave hadchildrenyou cannot accessthoseservices. Now theysaythatifyou are notfrom thatregion

CESFNCQ October 2013 ------who are receiving socialassistance. comparison toprovincial programs geared forindividuals reported inequitiesinwhatiscovered underthe NIHBin Insured Health Benefits(NIHB)program. Participants (medication)undertheNon-obstacles accessingservices ‘caught payingbills’ Reports about forhealthservices. and federalresponsibilities Clientsare forhealthservices. Jurisdictional issues–Lackofclarityaboutprovincial ing through thecracks’. associated withageing.Reported thatmanyElders are ‘fall of linguisticissuesandchallengesrelated tohealthissues population–ThereAgeing are challengesfor Elders because Discrimination andlackofculturalsensitivity. • • • • • • • • • they payforthedrops attheoptometrist?’They done, there’s alittlebitofbarrier, wondering,‘Do For anElder thatgoesinandwantstogettheireyes the province, are notcovered. andwhatservices areLack ofknowledge covered aboutwhatservices by stuck payingforbills. tion dealswithHealth Canada, ifnottheycanbe People needtofindoutaheadoftimeiftheinstitu to offer. thatHealth toaccesstheservices Canadahas trying There are alotofdifferent issues I’m facedwithwhen and issuesassociatedwithageing. Elders faceadditionalchallengesbecauseoflanguage, help. Mohawk. Theyalwayshave someonewiththemto talk aboutElders…first ofalltheirfirstlanguageis They fallthrough thecracksalot,becausewhen you There’s anotherbarrierthere, soculture playsa role. There’s asecondbarrier, whentheyknow you’re native. as natives, ourmedicines. I findtheydon’t know abouthow we are asanation, father, your aunts,your uncles,’ it’s thewholefamily. our version family, itisnotexactly, ‘your mother, your on how we are asanation,versus ourrealities, how oftenfindthatthere’sI noknowledge thattheyhave may notreceive theirmedication. covered.’ If apersondoesn’t have moneytopay, they go topharmacies,andthepharmacistssay, ‘it’s not

- - 72 ists are unwillingtospeakinEnglish, despitebeing ableto. guage. Participants reported thatthey feltthatsomespecial specialists abouthealthissues isdifficultbecauseoflan Language barriers(communicating)–Communicatingwith have togoanotherprovince forhealthcare inEnglish. inEnglish Lack ofaccesstoservices communicate. dispatchers. There are whenunableto delays inservices wait timeandneededtore-explain emergencytodifferent because oflanguagewhencallingforanambulance:long ParticipantsEmergency eervices: reported difficulties i. English LanguageAccess Issues CommunityMembers:b.) Kanesatake iv. Positive Experiences • • • • • • • comes to my own needs or my own services, I would comes tomyown Iwould needsormyown services, For myself, I can getalongfinein French, but when it emergencies.”that managesthereserve one dispatcher, you “Iwillforward tothedepartment to different emergency responders andwastold by ized uponcalling911,Iwastransferred fourtimes for medicalemergencyandneededtobehospital When my76‑year-old fatherrequired anambulance VeryRAMQ services: helpfulandefficient. (knowing where, how, whatisrequired). Staff atCLSCare helpful—assistingindividuals speak English orprovide English documents. and “culturally sensitive”. to Some staffpeopletry institutions: somehospitalsdescribedas“excellent” atprovincialwith thequalityofcare andservices Some reported thattheyare participants satisfied protecting rightstopracticeculture). policy toallow parents toobtainplacentaafterbirth, Aboriginal Health Transition Fund establisheda practices following Mohawk culturalpractices(i.e., sion ofculturalpractices.Policies inplaceforbirth provincial institutionshave allowed fortheinclu Agreements between First Nations organizations and before. crazy becausethey’ve never heard thatlanguage where thestaff[athospital]thoughtthey were It’s happenedtoElders whospeakMohawk first, ; It’s notrightthatwe CESFNCQ October 2013 - - - - in English. –presenting Corridors ofservice obstaclestoobtainservices were beingdiscriminatedbecausethey are English-speaking. cial institutions–Participants reported thatthey feltthey Perceptions from provin andbeliefswhenseekingservices providers spokeEnglish andwere “attentive” and“caring”. English. reported Other participants thatemergency service as “understanding”, and“willing” toprovide in services Quality ofcare –Staff atprovincial institutionsdescribed iii. Positive Experiences Discrimination andlackofculturalsensitivity. ii. Access Issues Related toCulture (Aboriginal) • • • • • • • • region. Issue formental forpatientsrequiring services Ambulance isrequired togoclosestfacilityinyour treated unfairlyduetolanguagebarrier. getting laughedatbecauseIwasAnglophone. I hadanappointmentforphysiotherapyandwas French well. very I remember beinglaughedatbecauseIdidn’t speak could notspeakEnglish. Specialist towhomIwasreferred forphysiotherapy precisely whatadoctor, anurse,isactuallysaying. much prefer itinEnglish sothatIcanunderstand with thetransition. English. He isfrom ourcommunity, sothathelped ately tookchargewasattentive, caringand hespoke gency wasfantastic.Theparamedic whoimmedi The ambulanceteamthat responded tomyemer to communicate. Some understandingand willingtotry staffare very name inMohawk, callingmemoccasin. sotheystarted The hospitalnurses were unabletopronounce my tion intheircorridorofservice. buttheambulancehastogoinstitu lish services, You maywanttogosomewhere else,toreceive Eng they are already receiving services. health issuesandtheycannotgotohospitalswhere

- - - - - 73 (public healthvs.private care). “for afee” individualscanbuytheirwaytoquickerservices there isanemergingtwotiered healthcare system,andthat Two‑tiered healthcare: Participants reported thatclientssee Long waittimesforservices. Lack ofaccesstodoctorsandspecialists. they are payingthedifference outofpocket. inces. Participants report thatforsomeprovincial services Provincial rateofpay(feeschedule)varies amongtheprov i. General Access Issues andChallenges vices): a.) CommunityResources (Health andSocial Services Ser 5. Kahnawake • • • • • • • • • • • system, butwe cangetresults if we are willing to pay. in English. We are toldwe don’t have atwo‑­ If you youcanget your payforprivateresults services they canwork, forfeeyou canmove uptheline. appointments? Doctors are gettingcappedonhours or ing patientswhentheyare waitingfor surgery How manypeoplegetbumpedby private pay Doctors are beingcappedforhours(public). (private). For afee,you couldbuyyour waytoquickerservices isaproblem.Rescheduling ofsurgery Long waitingliststoseedoctors(specialists). specialists istoolong Length oftimethatpatientswaitforareferral to will impacthealthcare. Lack ofclarityabouthow Montréal’s ‘super-hospitals’ histories. Quality ofcare—need adoctorwhoknows family long termcare withthatGP. the province ofQuébec andbeingabletoremain in Huge issueisaccesstoageneralpractitioner(GP) in pediatrician). Health crisisduetofewerdoctors andspecialists(i.e.,

CESFNCQ October 2013 tiered - - - ii. English LanguageAccess Issues impacting healthandsocialservices. reported thatgovernment cutbacks(provincial andfederal)are Government cutbackstohealthservices depending onindividualstaffand/orinstitution. wasamatterof‘luckthedraw’, hospitals: goodservice satisfaction (generally)withthequalityofcare atprovincial Quality of care spokeabouttheirdis –Some participants provincial workers becauseoflanguagebarriers. ticipating inmeetingswiththeprovince andnetworking with staff. support spokeaboutthedifficultyofpar Participants and lesssofornurses,reception (front lineworkers), and doctors are more likelytobebilingual(English andFrench), Language barriers(communicating) andresources services port inEnglish. Participants reported difficultyaccessing programming, sup • • • • • • • the hospitalyou are going. riences dependingonwhoisworking andwhere in ‘Luck ofthe draw’—everyone hashaddifferent expe friendly, complicated. itcanbevery Navigating thesocialandmedicalsystemisn’t user service. Roulette: Shifts athospitalsdeterminecaliberof ° ° impacts qualityofcare. Communicating withphysiciansandnurses— French, whichcanbetroublesome. mostly French. Theinitialintakeforclientsisin The doctorsare mostlybilingual,but thenursesare are notalotofresources. Finding resources inEnglish isanotherstory. There thing isinFrench. Lot ofprogramming outthere forclients,butevery ° ° language barrier. that you are talking fornothingduetothe Sometimes, withnurses,you getthefeeling Sometimes theywillonlyspeakFrench. Sometimes attriage,nursesaren’t bilingual. : Participants stated that –Participants

- - - - - 74 support services inEnglish. services support Difficulties accessingdiagnostictesting, respite,andgeneral (generalandspecialized). Lack ofEnglish-language services • • • ° ° Auditory services English services. you willexperiencedifficulty accessingservices outside theMontréal area andyou require health testing, respite, inEnglish. If andgeneralsupport DifficultGeneral toaccessdiagnostic services: ° ° ° Meetings. ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° more anxiety-riddensituation. because ofthelanguagebarriermakesita Sickness isscary. Lackofunderstanding plan. diagnosis andservice affectsme—Imaynotunderstandthe further and Idon’t understandwhattheyare saying,it have anurse/doctor tellingmewhatiswrong enoughandifI If Iamsick, itisalready scary tors offices are French only. because mostofthehospitals,clinicsanddoc People whoaren’t bilingualhave ahard time testing) and the whole process is very confusing. testing) andthewholeprocess isvery (auditory Long waittimesforEnglish services Montréal (different corridor ofservice). from whenseekingaccesstoservices services testing Clients turnedawayfrom auditory ficult becauseoflanguage. Trend now isconference calling.Canbedif they are saying. language sometimes.Idon’t geteverything Conversations getcomplicatedbecauseof I can’t keepupwiththeFrench. During meetingsitishard sometimesbecause not alwaysbilingual.It intimidating. isvery Everything isfast,vast andnotpersonal Even hospitalsthemselves aren’t userfriendly. the language. Understanding ishard ifyou don’t speak CESFNCQ October 2013 - - Long wait time for services in English. Long waittimeforservices care’. provincial hospitalsforfamilymemberswhoare in‘critical Critical care –Participants reported issueswithlanguageat • • • • • ° ° ° Speech languagetherapy ° waiting listfor a specialistwassixmonths. French. togetanotherhospitalthe When trying providers andthosethatare available onlyspeak Difficult toseeaspecialist—notenoughhealth care long waitinglists. Hospital out-patientorotherEnglish programs— ing doctorsislongandspecialistsare mostly French. The waitinglistsforaclienttobeseen by English speak bilingual peoplewillbeavailable. tions. Thehospitalisnotalwaysabletoensure that vulnerablesitua communicate theirneedsinvery members feelthatpeoplewillunderstandthemand rating. It’s thatlackofconfidencecommunity determine ifyou are passingbenchmarks ordeterio communicate withpeoplewhoare assessingyou to person isincriticalcare, thenyou needtobeable anddiagnosisisfinishedthe Once surgery ° ° ° ° ° ° speech therapy[inMontréal region]. A motherwasturnedawayforherchild’s until ageoftwo. pital inMontréal region onlyseesachildup Thehos frustrated. parents/clients getvery and timeisoftheessenceinmanycasesso We can’t getEnglish/Anglophone specialists within agoodtimeframe. forspeechtherapy Lack ofEnglish services accommodations. because otherhospitalshave thesekindsof one tohelp. Thisisspecifictoourhospital, becausethereharder isno togetservices Memorial Hospital Centre (KMHC),itis no translators(signlanguage)attheKateri fordeafclients,there areLack ofservices vices were provided inFrench only. their pre-school childandwere toldthatser for region] toobtainspeechtherapyservices Clients went tothehospital[Montérégie - - - - - 75 ity the services are predominately offered in French.” offered predominately are services the ity real “in but services, bilingual offer to claim centres some stated participants problematic, is services language lish of Eng Quality Québec. in families for centres treatment few very are There travel). and services (for the funding for obstacles presents which U.S., the or in out of province either services seeking are Clients Québec. in regions tive administra other in services English access to lists waiting are long There treatment. and detoxification for English in of services availability limited the about spoke pants – Partici services treatment and services Detoxification • • • • • • • • • • Québec], buttheyare probably inFrench. place tostayafterdetox; we mighthave themhere [in There isa recovery homein Ontario thatoffersa homeless men,andthehomes for themare limited. One ofthebiggestclientdemographics is single going intoatreatment centre. a medicaldetox (washout).Theyneedthatbefore Some ofthemneedthelongerperiodtimefor have afacilitythatwillacceptthemfor5–10days. [in Québec], theywillrelease them,andwe don’t Continuity ofcare: If [clients]are senttothehospital cation issues,coupledwiththeneedfortreatment). French, butitdoesn’t work(communi foreveryone We have hadsomeclientsdotheirtreatments in arebut inreality mostlyavailable inFrench. services dependency) claimtooffer English/bilingual services, Centres inthearea (i.e.,forlongtermchemical need tobepaidfor. There are alsoAmericanfacilitiesfordetox, butthose predominately inFrench. [fordetox] inourcatchmentarea areof theservices in English. accommodate usandofferservices Most We are havingdifficultyfindingplacesthatwill will turnawayclientswhoare intoxicated. French. Theywilldomedicalintakes fordetox, but Psychological ward inthecorridorispredominately regions (i.e.,inMontréal region). Not abletoaccessbedsinotheradministrative Montréal region). (i.e.,inLong waitinglistsfordetox services enced detox restrictions foranumberofyears now. adolescent inQuébec inEnglish. We have experi Not foradults/youth/ manydetox services/support CESFNCQ October 2013 ------Lack of mental health services inEnglish Lack ofmentalhealthservices inEnglish. services Provincial boundaries-barriersforclientswhoare seeking “extra step” oftranslation(reports, assessments). noting thatthere canbe“serious delays” becauseofthe Participantsservices. questioned thequalityoftranslations, tions donotreceive additional resources fortranslation by English-speaking clients.Further, communityorganiza whichare andtranslationservices, needed of liaison(escort) Translation –Participants services report that there isalack Québec’s languagerequirements). ambulance isinEnglish andnotsolelyinFrench (becauseof thatthewritinginsideof nities needtomakecertain obstacles becauseoflanguage.English-speaking commu Medical vehicles (ambulances)–Participants reported • • • • • • • • Waiting patientsare listseverywhere: leavinghospi fortheclient. services health clients,andthisisneededinorder toaccess It ishard togetadiagnosisinEnglish formental Funding issues(detoxification services). only English oneswe have available. which isnotaccessibletous.Thiscentre isoneofthe however, theyare changingtooutpatientservices, We hadaccesstotheCornwalldetox [inOntario], Have tosendfamilysouthwestern Ontario. will work with themotherandchildren atsametime. treatment program intheprovince inEnglish that For withchildren womenusingdrugs there isno ing Québec requirements. inside willbeinFrench becausetheyare meet Saskatoon andifwe don’t watch,thewriting Issues ordering ambulances. We getthemfrom doing anassessment. to have assessmenttranslated,increases thecostof provided inFrench andorganizationneedstopay ments (non-insured, Report psychiatrist services). Assessments—limited poolforconductingassess We have limited optionsforpsychologists inEnglish. (strain onfamily/community). health patients.Discharge from hospitalsisanissue tals, yet nopsychiatrists available forthesemental - - - - - 76 • • • • • • • • • • ground inorder totranslate. terminology. Someone needstohave amedicalback just anyone fortranslationbecauseofthemedical [Paramedics]: We can’t justsenda document to cial institution. speak English whencontactingsomeoneataprovin Verbally, orallyhave tofindsomeonewhois able to and deadlines. Delay [fortranslations]:impactsdecision-making problems. liaison, butwhenshewasonleave, itposedsome translation, ortransferringofpeople. We have a sometimes cantakeuptotwoweeks becauseofthe Dealing withtheMontérégie (askingquestions) programs. statistics forcertain lead tomisinterpretation, thusinaccuratedataor of thewording.” Concernthatsuchtranslationsmay the “translator mayhave beentooliteralwithsome with “new” translations,alongwithastatementthat lection purposes),communityworkers were provided about translateddocuments(reporting fordata col When communityworkers askedforclarification response inFrench orpoorEnglish translation. timeconsuminggetting lish questions.Thisisall very English, delayinwaitingtogetresponse toourEng serious deadline. When we finally getdocumentsin have afull understandingofdocuments.May missa Waiting fortranslationcreates delaysbecausecan’t someone tohelp. standing requires tofind anextrastepoftrying need tohelpthepatientsandourlackofunder sense fortranslation.Thisisdangerous because we French, theyuseabbreviations thatdon’t makeany [Home care nursing]: When doctors writein suming, meaning‘lost’ intranslation. Quality of translation—Attitude/beliefs, timecon Cost oftranslation—Lackfunding. training/teaching/documents). withintheOrderservices ofNurses ofQuébec (re Provincial are services—There notranslation CESFNCQ October 2013 ------titles. Some participants notedthatifFirsttitles. Some participants Nations wanted bases ‘requires time’ togetusedtheFrench menusand are notyet available inEnglish. Working withFrench data pants commentedthatdatabasesforprevention programs Provincial databasesare mainlyavailable inFrench –Partici guage barriers. Calling provincial institutionsisdifficultbecauseoflan as ‘breast cancerscreening clinics’); signage atprovincial invitation letters(forexample, prevention programs such by law, tobemembers);Clients’ assessments;reports, professionals suchasnursesandsocial workers are required, For example,information from Professional Orders (which Documentation from theprovince is primarilyinFrench – then we have tohave themtranslated.” orders—everything comesinFrenchtranslation ofcourt and available inEnglish. services Youth Protection andtheProvincial System –limited Court Judicial: of withtheDepartment interfaces Social services only beavailable inFrench. to usedatafrom CLSCsusingtheprograms, thedatawould • • • • • • • • French telephone-trees are aproblem (athospitals). becomes atwopronged challenge. population (50+),andif[themessage]isinFrench, it Recorded messagesare notalwayseasyfortheolder tion whoneedtospeaksomeone. not mindfulofAnglophonesandtheolderpopula Problem callinghospitalsforappointments,theyare toaccessservices. miss theopportunity recorded inFrench. If you don’t waitthrough it,you Calling hospitalsisachallengebecausemessagesare base thatisinFrench only. used toFrench menusandtitleswhenusingadata For English-speaking users,itrequires timetoget can do,butitisonlyavailable inFrench.’ Jeunesse (PIJ) program: ‘We likedwhattheprogram Centre Jeunesse ofQuébec—Programme Intégration the datawouldonlybeavailable inFrench. access anydatafrom theCLSCsusingthisprogram, Nations communities,thusifFirst Nations wantedto I-CLSC program (English version) isforuseby First French toEnglish. program hasyet tobetranslatedcompletelyfrom Enhanced Prevention Programs—access toI-CLSC

“There are problems withthe

- - - - - 77 training information. andprotocol procedures;institutions; medicalalerts and • • • • ° ° Reports, assessments,forms, dischargepapers. ° ° ° ° ° ° Information. ° Signage. ° Professional Orders ° ° ° ° ° ° ° ° ° ° the French language. ters orinformationmailed)isprovided onlyin sources of documentation(includinganylet their informationonwebsite andother familiaux duQuébec (OTSTCFQ): Allof sociaux etdestherapeutesconjugaux Information from Ordre destravailleurs are in French. own hospitalfile:documentation/charts Difficult toobtaininformation from your mation/details canbelostintranslation. Hospital reports are inFrench. Specific infor informed decisions. documentation inEnglish tobeablemake languages. We needinformation,written to provide informationinthetwoofficial government sites.Should beanobligation Documents are onlyavailable inFrench on this isachallengefornurses. A lotofliterature issenttousinFrench, documentation inFrench. Discharging patientsonlyhave medicineinfo take medication. as shecouldnotexplainwhyclienthadto nurse spokeinEnglish butthisdidnothelp Documentation given athospitalinFrench; except laws(inboth). Government literature isalwaysinFrench ments onlyinFrench. Provincially institutionsprovide run docu French signsmakehospitalnavigationdifficult. CESFNCQ October 2013 - - - • ° ° ° ° ° ° ° Letters from province– French only. ° ° ° ° ° ° ° ° ° ° ° adapted andlearnedtousethem.Theymight French, butallofthefirst responders have Ambulance forms—Theformsare allin 100% inFrench. in English; however, maybe theinstructions Care) are senttocommunityorganizations Some templates(i.e.,Home andCommunity the information. medical/social, you needtobesure about English, but thequestionsare French. For Information formscanbeanswered in first. mation becausethingsneedtobetranslated English, never receive it.Delays relay ofinfor in thetranslation.Even whenrequested in French. When translatedthere are thingslost Receiving clientassessmentsandreports in Requests forEnglish reports have beendenied. box thattellsyou where to getitinEnglish. understand theyjusttossit.There isasmall tion cameinFrench If toeveryone. theydon’t Québec healthrecords: allthedocumenta is allinFrench. says. Contactcanbechallengingbecauseit is notuncommonforclientstoaskwhatit from provincial hospitalisinFrench—it Breast cancerscreening invitation letter discharge paperinEnglish]. reported difficultyobtaining participants hospitals thatare supposedtobebilingual, I have someFrench, butitcanbehard. [At The dischargepapersare usuallyin French. but otherplacesinQuébec, notsomuch. tréal hasmore accesstoEnglish documents, Discharge papersare usuallyinFrench. Mon means, andmakedo. problems. Theygetthesenseofwhatitall need totickofforsomethinglikerespiratory mean, buttheycouldtellyou whatbox they not specificallybeabletotranslatewhatthings - - - 78 “shy andscared” togoprovincial institutions. that theelderlymaymissappointmentsbecausethey are too homecare nursingandfamilymembers.Participants noted is anissue(English reports), withadditionalstrainfallingon providers (andfacilities)forElders. Discharge from hospital English. There isalackof English-speaking, longterm care in population–obstaclesforEldersAgeing toaccessservices • • • • • • from Kahnawake,whichisalwaysinEnglish. For come theElders, themajorityofservices homecare /familycommunity. Discharge from hospitalsisanissue—placesstrainon needs aswell. There isnoplaceforclientsto go. intheareafamily members.Thisistrue ofspecial hospitals andtheircare fallstohomecare nursingand We have alotofclientsthatare senthomefrom facilities forElders. Lack ofEnglish-speaking, long-termcare providers/ ° ° ° materials. Training information–lackofaccesstoEnglish ° ° ° Medical protocols andmedicalinformation. alerts, ° ° ° ° ° ° lish i.e.,Immunization Protocol. Need working documentsinEng important policies andprocedures)—French only. Nurses: Working documents(immunization step oftranslation. else,becauseweup toeveryone have anextra us inFrench, toplaycatch constantlytrying diate protocol changesthatare alwayssentto Paramedics: We andimme getspecialalerts training wasonlymadeavailable inFrench. Program where adocumentprovided atthe ing atrainingsessionforContinuingCare For example,amanagerspokeaboutattend they justdon’t wanttodoitinEnglish. don’t know thattheyneedtotranslateitor, translated English documentstouse.Some information. There isoftenadelayingetting There isaprocess totranslatetraining ited—all inFrench. Networking/teaching/client informationlim CESFNCQ October 2013 - - - - not the‘top priority’. statedthatEnglish-speaking Firstparticipants Nations are nizations mandatedtoserve theAnglophonecommunities, andissueswithfunding).Althoughthereservice are orga transferring toadifferent region isdifficult(corridors of inthearea,challenges becauseoflimitedservices and children withsevere specialneedsisdifficult.There are andplacementsforadults Accessing English services in theirown corridor. available tothem,inordertransportation toaccessservices an issue:clientsmusttravel farther, andwithlesspublic almost allinFrench. Participants statedthattravel isalso restricted. available inthe South The services Shore are Shore, inMontréal accesstoinstitutionsand services is changed intheprovince. For individuals ontheSouth have –Thecorridors ofservice been Corridors ofservice tation isanissue. Access issuesforyouth inEnglish. seekingservices Transpor • • • • • • is adifficultygettingpaymentsmade. area—we have touse[facilityinMontréal], butthere there isalackofEnglish facilitiesinMontérégie funding forplacementstofacilitiesontheisland— Province difficultintransferringthe hasbeenvery Placements inourlanguageofchoiceisdifficult. isdifficult to negotiateEnglish services Child/adult placements:Severe specialneeds—trying also, butmostlywiththeelderly. shy andscared togothere. Thishappenswithothers Elderly won’t gotoappointmentsbecausetheyare South Shore. Montréal isrestricted, clientsbeingreferred backto living ontheSouth Shore. Access tohospitalsin have beenchangedforpeople The corridorsofservice are notpaying. Montréal Province services: isresponsible forit,but Finding funding tosendadults/children toEnglish dren from communitiesundertheagency’s mandate. is notatoppriority—issueforEnglish speakingchil English facility. Told by theagencythatKahnawake in aFrench placementforonenight tillcanfindan we are underthem.Canhappenthataclientisput not ontheirprioritylist.Theirclientscomefirst,and finding facilityforplacement,ourorganizationis theAnglophonecommunity]:assistin that serves ones thatspeakEnglish. Partnership with[anagency Group homeandinstitutionalcare: problem tofind

- - - 79 Limited accesstotraininginEnglish inQuébec. • • • • • • • • • • • • ments comeinFrench. Websites ormail. French you won’t know there istraining.Initial docu offered, butitisin French soif you don’t understand Social work order hasEnglish speakingtraining being Training offered by hospitals,butitisallin French. anymore fortraining. government. Not abletosendanyone toNew York they gothrough aprogram recognized by theQuébec Paramedics: We can’t getparamedics trainedunless ties are offered onlyin French. wholly inFrench. Language,educational opportuni always offered in English forthosenotcomfortable Nursing: Education sessionsfornurses’ order isn’t hospitals inMontréal are only10–15minutesaway. make sensetobeusingsouthshore hospitalsbecause are availableEnglish inthecity. services It doesnot our community. keypeoplewhoarewith certain stillwilling tohelp bureaucrat mindframe. We have builtupanetwork providersthey shouldbegoing.Service are notin We ignore sectorizationandtakeourpatientswhere ortovisitfamily). ficult toaccessservices Hospitals are faraway(dif inourcorridorsofservice to getonIsland. Mental healthsector—confinedtocorridorsiftrying us offbacktosouthshore. tosector tocallontheislandtheytry When you try ifoutsideoftheadministrative region.particular in Lack informationaboutwhere toobtainservices, South Shore. [hospital inMontréal] andsenttohospitalsonthe It wasstatedthatsomeoneturnedawayfrom address. and we are beingshutoutbecauseofourpostalcode “State are oftheart” ontheisland medicalservices Shore whichare almostallFrench. forservices, The More andmore we are beingdelegatedtotheSouth

CESFNCQ October 2013 - - - because oflanguagebarriers. ticipants spokeaboutthedifficultyliaisingandnetworking Liaising /networking withprovincial institutions –Par for approval forfunding. government, there isadditionalwaitingtimewhile First Nations. For thatare services covered by thefederal andequipmentforis responsible services tofundcertain pass ustotheprovince.’ There are gapsinterms ofwho in thevortex’: ‘We are federalresponsibility andthey Participantssocial services. statedthatthey are ‘Caught federal responsibilities towards First Nations healthand Jurisdictional issues–Lackofclarityaboutprovincial and iii. Access Issues related to Culture (Aboriginal) • • • • • • • • • • • guage inEnglish. It’s frustrating. lan Given around oftenbecauseprimary therun speak French. tonetwork—consistently askedifI When trying community. I don’t outsideofthe really network withservices There isn’t alwayssomeonewhospeaks English. a lotofbilingualism,butitishitormisssometimes. My experienceliaisingwithhospitalsisthatthere is the listoftrainingisinFrench. Staff two requiredyears, but totaketrainingevery medical transportation medical transportation Financial cutbacks—impactingspecialneeds and eral government iscomplex. Funding from provincial fordetox services andfed had inthepastorpresent. No onecatchingdiscrepancies—no trackingwhatwe vincial: whopays? because there isnothingbeingdone. federalvs.pro The “Jordon Principle” has tobeinplacenow there isagapinwhatFirst Nations receive incare. government issupposedtocover otherthings,but We fall underMedicare thingsandfederal forcertain and theypassustotheprovince. Caught inthevortex—we are federalresponsibility

- - - - 80 provincial institutions. fromLimited availability ofculturallyappropriate services Nations accesstohealthandsocialservices. Provincial legislationisimpactingEnglish-speaking First • • • • detoxification. There in Ontario. are culturalservices inEnglish inourprovincelanguage service for Detoxification services—We don’t have anycultural/ them becausewe don’t have theamountofstaff. but[Kahnawake]can’tservices always accommodate Urban First Nations take care oftheirfamilymembersliving onreserve. side community. Family andhomecare nursingmostly We approach thingsdifferently onvs.the out Reserve ° ° ° because offundingsources. ting, liketherest ofQuébec, are beingdeniedtous equipment. Simple devicesthatwe shouldbeget There isinequitywhenitcomestohealthcare and ° ° ° work intheir languageofchoice,yet whatwill inEnglish. Billservices 14entitlesworkers to viduals whowanttoreceive healthandsocial the impactoflanguagelegislationforindi Bill 14:Participants expressed concernsabout identity ofthechildandcommunity.” First Nations culture, spirituality, senseof Care placements“does nottakeintoaccount proposed systemfor changes.Thenew Foster First Nations were notconsultedaboutthe tion tolanguage,there are alsoissuesbecause database isonlyavailable inFrench. In addi database calledthe‘STRIFsystem’; however, (criteria)) willneedtobeinputtedintoa data (from the‘accreditation’ and ‘Grid’ Database System (STRIFSYSTEM)—The working ontranslating toEnglish theform in French. Note: criteria foraccreditation isonlyavailable Informationcare aboutthenew services. Resources, whichwouldimpactthefoster Bill 49:Impact oftheAct forFamily workers) whoare English-speaking. retain professional workers (nursesandsocial requirements makesitdifficultto and recruit fessional Order, whichbecauseoflanguage Bill 21:There were concernsaboutthe Pro inEnglish? health andsocialservices be theimpactforthosewhowanttoreceive callforculturallyappropriate The Health Commissionis

CESFNCQ October 2013 . - - - - - Discrimination andlackofculturalsensitivity. thatare toaccessdetoxificationtion services ‘out ofprovince.’ in English. Clientsneedtopayoutofpocketfortransporta accessing fundingtopayfortravel inorder toaccessservices Medical –Participants transportation spokeaboutobstacles about theloss of languagethatFirst Nations have already Respecting therightsofFirst Nations –Participants spoke • • • • • • • • Some [clients]experiencechallengesbecause priate. inMontréalServices are notalwaysculturallyappro out ofprovince. train, bus)whenaccessingdetoxification services We needtopayforourown (i.e., transportation inEnglish.in order toaccessservices that are distance,travel mayberequired pastacertain Medical doesn’t transport tosomeservices transport (generally). services transportation Funding cutbacksare impactingaccesstomedical didn’t speakFrench.” take meoutbutIwouldn’t leave, especially sincehe because itwasagainsttheirpolicy. They triedto ing problems withthemlettingmestaythenight myhusbandwasat[hospital], we were“When hav commented,or familyvisiting.One participant when itcomestosomeonestayingover night, made forsevere illnessandmore traumaticinstances numbers. Culturally, accommodationsshouldbe because we alwaysgotothehospitalforvisitingin pital. We don’t fitintothemainstream wayofthings Culturally, we oftenhave lotsofpeopleinthehos can helpus. know about.Ihave toexplainthemthatthey maybe thatthere are specialneedsthattheydon’t feel aboutNative people.Theythinksometimes, Sometimies, there isalsoataboointhewaypeople in theirenvironment. what’s goingonwiththemandalsowhat’s goingon express oftenthattheyare unabletounderstand procedures; Pamphlets are usuallyinFrench. They Elders have ahard timetounderstandpapersor or from Kahnawake. (orbest)becausetheyare Nativethe wholeservice they’re Native. Theyfeelthatmaybe theydon’t get

- - - - 81 Nations organizationsofEnglish-speaking communities. First Nations whocannotspeakFrench, even withinFirst Employment andhiring–There for isalackofopportunity guage again.” with English, they cannotexpectyou tochangeyour lan of languageonce,and[Aboriginal languages]were replaced experienced, whichcannotberepeated. “There wasaloss • • • • • • • the information. have totakethetimetranslateitandthenrelay They don’t have itin English unless you askforit.I Everything thatIgetfrom hospitalsisallinFrench. in myposition,theywouldhave areally hard time. work, butIthinkithelped…If someoneelsewere Bilingualism wasn’t forthepositionI necessary have French speakers. always have non-Natives, butit’s becausewe don’t hire ortotrain.There are questionsaboutwhy we [Paramedics]: We needtobringinnon-Natives to don’t have tospeakFrench. be French. Theyforgetthat we were here first,so we It’s notacceptablewhenpeoplesayQuébec hasto in theirlanguageofchoice. First Nations people.Theyshouldbeoffered services However, you cannotcramitdown thethroats of a similartitlelikeallotherlanguagesandcultures. I believe French becauseithas shouldbepreserved isFrench.when goingoutsideandeverything they don’t have tospeakFrench, sothere isnegativity Some peopleinKahnawakehave thismentalitythat money goingthere, andwe are entitledtoit. provincial hospitalsinourcorridor, becauseitisour We wanttheoptiontoreceive at English services your language again. with English, theycannotexpectyou tochange was alossoflanguageonce,anditreplaced tant. Theycannotforce you toknow French. There their rights…Making theneedknown isimpor First Nations. People needto beginstandingupfor There needstobeadvocating forinformation CESFNCQ October 2013 - - iv. Positive Experiences • • • • • ° ° ° no problems findingsomeonewhospeaks English. to them.In thelargerurbancentres, there were usually availablespoke positively aboutthequalityofservices inEnglish, participants When abletoaccessservices in French. in English, however, clients’ filesare mainlyavailable As well, some ofthehospitalsdoprovide information information available from pharmacistsisinEnglish. Participants reported thatthedocumentationand of English-language services available. of English-language services inEnglish; othersstatedthatthere was a lack services helpfulandabletoprovidepants foundtheservice inEnglish from Infoto services Santé. Some partici Info Santé—There were mixed responses aboutaccess also helpfulgettinginformationanddirection. Aswell, theHealthregional services. Commission is helpfulingivingdirection forfinding very English the Health Canadarepresentative (regionalis office) Resources andnetworking—Participants reported that (for example,theAlzheimer’s Society). available inEnglish from communityorganizations chronic conditionsare forcertain Support services ° ° ° ° ° ° ° ° ° experience. Expecting English inFrench envi alsoimpacts Attitude ofpersonseekingservice andhelpunderstand. everyone There are peoplewhodothebesttohelp together. “A lotdependsonattitude.” positive attitude andawillingnesstowork Participants commentedontheneedfora wait toseespecialistscanbelong. however, theprocess can bedifficultandthe for ‘addictions anddetoxification services’— andhelpful,inparticular can besupportive Many ofthepsychologists andpsychiatrists information you need. There are peoplewhoare helpfulandwhogive experience. One–on–one callinghasbeenpositive ronment canbedifficult. - - 82 services inthearea).services for addictions,andalackof‘after care’ addictionstreatment centres (detoxification, specialized rehabilitation treatment pants reported thatthere isalackEnglish treatment service andtreatmentDetoxification – services aervices Partici ii. English LanguageAccess Issues access mostservices. are limitedinthearea,social services clientsneedtotravel to the region in Lack ofgeneralandspecialized healthandsocialservices i. General Access Issues andChallenges vices): a.) CommunityResources (Health andSocial Services Ser Zibi6. Kitigan ALGONQUIN |ANISHNABEG • • • • • • • plan) clientsneedtotravel aboutonehour anda For (i.e.,methadone maintenance aftercare services centre are translatingfor[thecounsellors]. French really quickly, orotherclientsatthetreatment Our First Nations clientsneedtolearnspeak programs totheEnglish-speaking clientele. not speakenoughEnglish tobeabledeliver their counsellors do supposed tooffer English services: There are issues withcentres in Québec, whichare intheprovinceservices of Québec) community tolong-termprivate clinicsforEnglish by thecommunitytosendthree peoplefrom the (approximately $75,000investedservices oneyear members toprivate clinicsinQuébec forEnglish Community haspaidoutconsiderablytosendafew additional cost,ofthoseprivate treatment centres. because Health Canadawon’t subsidize thecost, private treatment centres, whichhave anaddedcost, ment fortheirproblems inQuébec, inEnglish, it’s If communitymembersdoaccessspecialized treat far away. A lotoftheEnglish speakingtreatment centres are Health Canada. tres, andwe have tochoosefrom alistprovided by There’s hardly any English speakingtreatment cen (ineitherEnglish orFrench). Because healthand CESFNCQ October 2013 - - - - the traumatic history ofresidentialthe traumatichistory schooling. tional challengeswhenneedinginstitutionalcare becauseof neglected’. In addition,someFirst Nations Elders faceaddi English. There isalanguagebarrierandare fearsof‘being people faceobstaclesaccessinglong-term care facilitiesin population–ParticipantsAgeing reported thatelderly staff atprovincial nursinghomes. themselves acting as‘translators’ between elderlyclientsand elderly atnursinghomes.Participants notedthatthey find chronic illnesses.Communicationcan beachallengeforthe andunderstanding diagnosisfor mental healthservices theredoctors andnurses,inparticular are difficultiesfor difficulties becauseoflanguagewhencommunicatingwith Language barriers(communicating)–Participants reported information from theprovince (reports/assessments). programming, communicatinginformation toclients,and available for commented onthelackofEnglish-services inEnglish –ParticipantsLack ofmentalhealthservices • • • • • • • It’s thelanguagebarrier. Andthefear, fortheElders not aware ofanyEnglish-speaking nursinghome. The nursinghomesintheprovince are all French. I’m Nations, theydoacceptourclientele. anyone from Québec. If we tellthemwe are First accepts ourclients,althoughtheydon’t usuallyaccept We’ve beenlucky, inCornwall thedetox services access services. Limited inourarea, we needtogoOntario to challenge. half tocontinuewiththeirplan,distanceisanother about them,orwhythisstuffisbeinggiven tothem. Our clientswillnotunderstandwhat’s beingsaid in French. Everything isinFrench. If we getreports, they’re clients, especiallytheEnglish speakingclients. munity, andit’s bigbarrierforour goingtobeavery lot oftheirprogramming isdonefortheFrench com a real issuewith[mentalhealthhospital]becausea We go,we have have, asfar asmentalhealthservices get there. Thatthey’ll beneglected. scared theyare notgoingtobeunderstandoncethey themselves, whenthey’re gettingtransferred, theyare

- - 83 from government fortranslationservices. that communityorganizationsdonotreceive anyfunding spondence, protocols (immunization).Participants reported Examples include:information from theprovince, corre Documentation from theprovince isprimarilyinFrench. barriers –bilingualstaffnotalwaysavailable toanswer calls. Calling provincial institutionsisdifficultbecauseoflanguage • • • • • • • • • mother requires someinformation aboutthePIQ [the province] provides forusinEnglish. But say a We dohave basiclittlehand-outsfor[clients] that protocolnew cameout. translate itintoEnglish. Andthat’s justrecent—the We’ll have tomakea case tohave Health Canada outdated English version. It’s notregularly updated. do itannually. If there are anychanges,there’s an immunization protocol] years ago,buttheydonot Health Canadaprovided atranslation[ofthe it’s notgoingtobe madeavailable tousinEnglish. protocolnew forimmunization,and[we were told] One ofournurseswent toSanté Publique togetthe for this. obtained from theprovince, nofundingprovided translatesdocuments Community healthservices Discharge reports are allinFrench. puts theirlives atrisk. it’s really hard formyclientstofollow thoseorders, it given tothem,andit’s alwaysinFrench, andsince but thepatienthastounderstandinstructions thing isdoneinFrench. Yes, we have todecipherthis, correspondence between meandahospital,every speak English, toaccesshealthcare here, whetherit’s As ahealthcare professional, it’s hard becauseIonly of thelanguage. togive themtheinformation,it’stry hard because calling, andImyselfamnottotallybilingual,but ends, it’s French. Theywanttoknow why you are If you have tocallCLSCsafter 4 ‘translator’ (yet nofundingprovided forthisservice). ers oftenfindthemselves actinginthepositionas At theseniors’ home,First Nations communitywork chronic illnesses. andwhenreceiving diagnosisfor health services nurses) are tellingyou, especiallycriticalformental Being able tounderstandwhatthestaff(doctors, p.m. oronweek CESFNCQ October 2013 - - - - available in English. Thedatabasesare(both healthandsocialservices). not yet to enterandmanageinformation intheFrench databases available in French. Participants reported thatitisdifficult Provincial databasesandsoftware programs are mainly province are inFrench only.) andbecauseletterssent byince (Régie)the topayforservices province are becauseofthelength oftimeittookfortheProv for First Nations, andreports thatrefusal from outsideofthe thatareservices) outofprovince. (treatmentaccess tosomeservices centres andmental health are inEnglish –Clientsare seeking services beingdenied Provincial boundariescausing barriersforclientswho • • • • • speak English. bit hard tomaneuver around thatwhenyou only our computersandit’s onlyinFrench. It’s alittle There’s animmunizationprotocol program on Ontario. information thattheydoreceive inEnglish isfrom inEnglish. Any example, pamphlets)aboutservices do notreceive informationfrom theprovince (for Community resource workers confirmedthatthey downright dangerous. mation is—maybefive years old. It’s notrightand older translation,Idon’t know how oldtheinfor information Icandrawfrom isoutdatedfrom the [Protocole d’immunisation duQuébec] andtheonly the French version? input ourdatainEnglish, andwillitbeconducive to the Panorama toolinEnglish andwillwe beableto a French region, are we goingtobeableaccess Canada): Buthealthcentre in asanEnglish service Panorama (databasetotrackimmunizationacross until thatdatabaseisavailable tous. parison withtherest oftheprovince, we have towait standard andtrackingofdata,in com ofdelivery available inEnglish. So forustokeepupwiththe Nations communitiesinQuébec, butitisstillnot They’ve triedtomake[thedatabase]available to First ences allthetime. ing outhow itworks. We hadtochecktherefer it, it’s really hard justtodosomethingbasic,figur It’s hard towork withFrench databases,ifyou have (Additional paperwork - - - - - 84 professionals. fessional Order will‘create barriers’ forEnglish-speaking Nations ‘Bill 21’Pro accesstohealthandsocialservices. Provincial legislationisimpacting English-speaking First • • • • • • • • • but more soforEnglish oneswho donothave the That’s abigissueforall First Nations in Québec, on ourclients. assessmentsin thecommunityandperforming Barriers forusasEnglish-speaking professionals ing issuesbecauseofthelanguage. If we donotbelongtoanorder, there willbelicens French] theygotfrom theRégie. them tobepaidby theRégie, andalsotheletters[in Ontario] becauseofthelengthtimeittookfor There’s alotof refusals [from thehospitalsin mental healthservices. live intheir[mental]stateifwe cannotaccessproper members. We don’t know how longthey’re goingto There’s alotofconcernaboutsomecommunity tal] inOttawa. Ottawa! But, we’re noteven acceptedatthe[hospi you intouchwiththe[mentalhealthhospital],’ in a referral form,andtheworker said,‘Oh, we’ll put [hospital centre] inGatineau togetanaccessform, I wasdoingafollow upononeoftheprograms at thatthiscommunityisgoingtoget. services istheextentofmentalhealth health services] do withthem? We’re pretty muchit.[Community worker at a level theycouldnotget. What canwe and neededcommunicationwithamentalhealth with ourclientswhocannotspeakFrench really well here. Go away. Go backtoQuébec.” We were left here, you cannotaccessmentalhealthtreatments away. We were told,“You cannotaccesstreatments the [mentalhealthhospital],buttheywere turned we needed, sowe triedtomove toOttawa toaccess they didnothave theEnglish mentalhealthservices to network withlocalmentalhealthhospitals,but When theyranintomentalhealthproblems, we tried Ontario’s provincial institutions. we sendclients toreceive from treatment services We are required if tofillinalotmore paperwork health card (OHIP). and theydonotgrantaccesswithoutanOntario Most English treatment centres are inOntario, CESFNCQ October 2013 - - - seeking trainingoutofprovince. provided inEnglish. Therefore, togainclinicalskillsnursesare ing tomaintaintheirlicensesinQuébec, thetrainingisnot although there isarequirement by lawtoreceive yearly train (forexample,fornursesandsocialworkers). Forparts nurses, attain thesamelevel oftrainingasFrench-speaking counter Limited accesstotraininginEnglish inQuébec with physicalchallenges(disabilities). forindividuals lar forspeechlanguagetherapyandservices inEnglish –inparticu Lack ofaccesstospecialized services • • • • • • nobody inEnglish. there’s toaccessservices, who are disabledtrying don’t know toomanythatare inEnglish. For those I thinkifyou’re accessinganyprovincial I service, language barriercreates obstacles. Speech therapyforchildren isanotherplacethe sionals have inQuébec. French trainingbackground thattheotherprofes French] onehouraway.” have togoaboutsixhoursaway, whenit’s offered [in to receive traininginEnglish “It’s sadbecausewe Required togooutofprovince toOntario inorder stops. It’s notthatwe don’t try. I didtry, andfollow up, andthenallofasuddenit timeImadearequest, itgotlostsomehow.but every one from theprovince] tocomedown fortraining, ForSocial services: tocall[some training,Ididtry Order)? it goingtobeconsidered valid (by theProfessional able todothat?If theygotoanotherprovince, is is notavailable inEnglish how are theygoingtobe maintain theirlicencesinQuébec, butifthattraining ment—that thenursesare supposedtoobtain There isa requirement—a 20hourtraining require skillsarenew needed. to doasfardelegationofresponsibilities andwhat to know whatthenursesare abletodoandnot ible andcomplywiththelawsinQuébec: we need Ontario. However, thetrainingneedstobecompat cal skillsinQuébec, butfornow we sendthemto Québec are togainclini attaining.Theyare trying the samelevel oftrainingthattheFrench nurses of Kitigan Zibi English speakingnursescannotget

–Cannot ------85 residential school experiences.’ face issuesbecauseoflanguage,whichmaytrigger‘reliving population–EldersAgeing whoneednursinghomecare Nations becauseoflanguage. Lack ofcommunicationfrom theprovince withFirst Discrimination andlackofculturalsensitivity. uptothelevel that we able tooffertheservices require.” though theprovince receives per-capitafunding,theyare not ing, however donotmeetcommunity’s services needs. First Nations are includedintheprovincial per-capitafund iii. Access Issues related toCulture (Aboriginal) province where andhowinEnglish from the toaccessservices Participants reported thatthey lackinformation about • • • • • • all otherkindsoffeelings. it’s abasiccommunicationchallenge,andittriggers speaker goingintoaprimarily French environment, Language isabigfactorthere. If you’re anEnglish trauma. where theyare notunderstood.For someofthemit’s are takenfrom ahomeenvironment andputsome they feelare reliving thatsituationwhere they institutionalized. For thosewhocannotspeakFrench, for themit’s like reliving thatexperienceagainbeing dential schoolorashared environment experience, For someof[theElders] whohave lived inaresi read French you willmissoutonservices. local paper, butthepaperisinFrench, soifyou don’t They dopublicize [information]inthepaper, the have beenupdatedwiththerest oftheprovince. wheninactualitywe should go toaccesstheservices and we don’t findoutaboutthesechangesuntil we They don’t have anybodyin English toupdateus, Nations healthcentre] and theprovincial system. There’s alackofcommunicationbetween [First judge quickly. with ourcommunitieswhodonotunderstandand Professionals providers andotherservice interacting therapist). in English (forexample,gettingaspeech find services It’s uptothe[communityhealthorganization]

CESFNCQ October 2013 “Even - - - b.) Kitigan Zibib.) Kitigan CommunityMembers: federal responsibilities. Jurisdictional issues–Lackofclarityaboutprovincial and need assistancebecauseoflanguage. whenclients services Lacking offundingforescort/liaison the region (ineitherEnglish orFrench.) in Lack ofgeneralandspecialized healthandsocialservices i. General Access Issues andChallenges • • • • • • • • • • the responsibility ofthefederal.’ because we’re Theprovince onreserve. says, ‘they are be theprovince’s responsibility, butit’s achallenge Québec, [the federalgovernment] thinksyou should [The clients]are played likea yo-yo. If you live in who cannotspeakFrench. toaperson way tobringthesemuchneededservices a problem from thebeginning,sowe needtofinda program. Atportation anadministrative level, there’s cover thatcost.Theytookitoutofourmedicaltrans or thetranslationservices—HealthCanadadoesnot An obstaclewe faceinaccessingassistance,escort, rural town.rural it is.Theseare the realities oflivingina small, areas come inmaybeonceamonth.That’s theway We onlyhave physicianswhospecialize incertain “realities town.” oflivinginasmallrural Travel –DistanceThe toobtainspecialized services. (travel).Distance toaccessservices nant, you needtotravel tothecity. area. Anyappointmentyou have whenyou’re preg Lack ofobstetriccare—you can’t have ababy inthe no specialists. all thedoctorsare generalpractitioners. There are There’s nopediatricianoranythinglikethat,and all thetime. Dentists. There’s onlyonedentistandthey’re full bilitation. We have totravel twohours tothecitygetreha Lack ofgeneralandspecialized services.

- - - 86 with specialists and support staffcanbedifficult because with specialists andsupport Language barriers(communicating): Communicating because oflanguagebarriers. using hospitalservices tutions: Participants reported thatEnglish-speakers avoid Perceptions atprovincial andbeliefsabouttheservices insti ii. English LanguageAccess Issues however, thecommunity‘hasnotyet beenmapped.’ iar withtheFirst Nations’ community:they rely onGPS; additional delaysbecauseemergencyworkers are notfamil area.generally speakingintherural Participants reported –emergencyresponseEmergency services timeisslow Long waittimesfortesting. equipment, wheelchair, walkers,etc.) Lack ofaccesstomedicalequipmentinthearea (i.e.,dialysis • • • • • • • • don’t wanttodealwiththelanguage barrier. pital unlessyou absolutelyhave to.’ becausepeople I know there’s ageneralfeeling, ‘Don’t gotothehos Even for community members staying at the hospital. might makeadifference. It mightsave lives. If theywouldhire somebodyfrom thecommunityit hasn’tGPS, butalotofourreserve beenmappedyet. community ofKitiganZibi, sotheymostlyrely on workers it’s thefirsttimethey’ve steppedintothe cover thejurisdiction.For manyoftheemergency minute wait.There are onlytwoambulancesthat For inmostcases,it’s ambulanceservices, a30–40 keep waiting.It tookayear. I wasonthewaitinglisthere andtheytoldmeto I’ve tests,forsixmonthsorayear. waited,forcertain It tookmeayear togetmysontestedforhisallergies. If you needawheelchair, you needtogotwohours. area,comes withlivinginarural too. or three pieces.AndIguessthat weeks forcertain Another thingisequipment. We’ll have towaittwo Medical equipmentnotalwaysavailable (i.e.,dialysis). inthecity.hours toaccessservices hour andahalfminimum;it’s generallyabouttwo Distance we travel toobtainspecializedan services: CESFNCQ October 2013 - - - that you canunderstand. to receive information aboutyour healthinthelanguage expressed theviewthat,‘It’s a‘basichumanright’ tobeable stress’ onfamilymemberswhoare bilingual.Participants of language.Participants reported thatthere is‘additional Lack of mental health services inEnglish. Lack ofmentalhealthservices • • • • • • • • • • medical terms. For olderpeople,it’s alsohard understandingallthese family members. and comewaittospeakwiththedoctors.It’s hard for speak French, soIwasconstantlyaskedtostayhere attack, andI’m theonlyoneinfamilywhocan I hadafamilymemberinthehospitalforheart quickly. It’s abigbarrier. happened toanswer inFrench, theywillspeakreally I myself, IcanspeakFrench togetby, butonceI do—but mostofthemonlyspeakFrench. At theCLSCs notallthenursesspeakEnglish, some tion getsthrough.” called injusttotranslateandmake sure theinforma “If theworker doesn’t speakFrench, we have tobe First Nation communityworkers askedtotranslate: almost impossible. but ifyou’re inEnglish it’s togetservices trying Theyalready have limitedfacilities, health services. It’s difficulttoobtainan Englishworker formental to writeitoutsoIcangohomeandGoogle it. exactly sure whatthey’re tosay. trying So, Iaskthem nosed with.Likewithmykid,child—I’m not You needtoknow exactlywhatyou’re beingdiag human right. language thattheyunderstand.It’s abasicright, that kindofinformation[abouttheirhealth]ina I thinkit’s abasicrightofanindividualtoreceive something fatal. you’re dealingwithyour healthcouldturnouttobe understand becausealackofcommunicationwhen to speakinthelanguagethattheirpatientscan It’s providers tohave service important beable very No atthehospitaltohelpclients liaisonservices - - 87 tion toclients. some staffunabletoexplain English (written)documenta For example:forms, information, signage.Reports that Documentation from theprovince isprimarilyinFrench. therapy, rehabilitation services.) suchasphysiotherapy,or English) –forservices speech (ineitherFrenchLack ofaccesstospecialized services • • • • • • • • • • hospital, it’s allinFrench andIdon’t know how they Any posteroranylittlethingyou seearound the of writtenexplanation. than that,Ican’t recall ever bringinghomeanyform ation, how totakecare of your bandages. But other tion onhow totakethatmedication,andpost-oper When Iwent forsurgery, theywillgive you informa he wasallergicto. I’m notsure Ireally wouldhave understoodwhat gave meapamphletinEnglish, thankfully, because When mysonwasgettinghisallergytesting,they that’s allinFrench. French. Andwhenyou’re admittedintothehospital, At thehospitals,emergencyconsentformisin city forthat. physical rehabilitation, theyallhave togothe If theyneedspeechtherapy, mentalhealthissues, isassignedthissamephysicaltherapist. reserve like there’s memberofthe onlyone,becauseevery and sotheyassignedmeabilingualone,itseems first therapistassignedtomewas French-speaking, here, andthat’s where intoproblems. The Ididrun I myselfamdoingphysicaltherapyatthehospital the city[toaccessEnglish languageservices.] prove you’re really athreat togetareferral down to hospital, theywillbelessafraid.But, you needto people toseethemgointothere. But ifit’s inthe the community. Theyare embarrassedanddon’t want People are worriedaboutseeingatherapisthere in booked up. There’s onepsychologist here andthey’re always inManiwaki. services We here. There lackmentalhealthservices are no all thetime. munity half-a-dayaweek, andtheirscheduleisfull A childtherapistandpsychologist cometothecom CESFNCQ October 2013 - - - - Discrimination andlackofculturalsensitivity. iii. Access Issues related toCulture (Aboriginal) inEnglish services Provincial boundaries–Barriers forclientswhoare seeking Aboriginal language. forElders whospeaktheir services members; lackofsupport and longterm care facilitiesforFirst Nations’ community term care facilitiesfortheelderly;lackofassistedliving population–Languageandculturalbarriers atlong Ageing • • • • • • quality ofcare thattheyshould. it’s prejudice—it’s racist.Theyfeeltheydon’t getthe they dogointhere. It’s notonlyalanguagething, all costs.Number one,theydon’t understandwhen In ourcommunity, theywillavoid thehospitalat aren’t acceptingthemedicalcards. English language. But now we’re beingtoldthey We inOntario, becauseofthe usealotofservices written inEnglish there. expect ustounderstandthis. You never seeanything French intheprovince, andtheneighboring town institutions. It’s thelanguage, theculture. It’s all ‘long termcare’] theyare transferred toprovincial community [thosewhorequire Level Three and Four, care than whatiscurrently offered inthe First Nation When elderlycommunitymembers require more providers.cultural awareness tothehealthservice ears. Andthat’s something we couldtry, toprovide that’s whattheythink, I’ve heard itfrom myown wholive off whole bunchofdrunks welfare. Because lent inourcommunity. There’s a reason. We’re nota nity. addictionissoprevaWhy alcoholismanddrug There needstobeunderstandingaboutourcommu And itisracism. there forthat. You’re there foranillness,notalesson. community membersifshewere onshift. You’re not You shouldspeakFrench’. She woulddothattomost insist, saying,‘You live intheprovince ofQuébec. because you’re intheprovince ofQuébec. She would spoke French whenever you walkedintothehospital, There whousedtoinsistthat wasanurseIknew you witnessed itmyself. I’ve heard talkoftheracism…inhospital.I’ve

- - 88 iv. Positive Experiences Lack ofclarityaboutNon-Insured Health Benefits(NIHB). there isalackoffundingtoimplementlastingsolutions. First Nations’ healthandsocialissuesare well-known, yet provincial authorities. Jurisdictional issues:Lackofclaritybetween federaland • • • • • • • • Wait have notbeenlong. times for services tions are covered.’ wasn’t covered. Ipaidforitmyself. ‘Not allMedica Times store, Iwent tothedrug themedication that thistimewe willseesomeresults. things—funding, jurisdiction,etc.—andIreally hope It’s becausewe allmentionthesame frustrating stuff? Big money’s spentbut we don’t get results. what’s next? When are theygoingtoimplementthis affairs—there’s alwaysstudies,but That’s anotherissue—Health Canada, Aboriginal to getsomeassistance. Nations community.’ You’re inacircle trying running say, ‘No, you’re undertheprovincial, oryou’re aFirst ‘No, you’re underthefederal.’ Andthefederalwill Say togetstufffrom theprovince, we try we’re told, Another issueisjurisdiction—whodowe belongto? unacceptable. communicate withthismanfortwoweeks.’ That’s ‘We’veto translate.Thedoctorsaid, to beentrying asked, ‘Do you speakAlgonquin?’ Ifoundsomeone I wasvisitingahospitalandoneofthedoctors One and Two care, homecare/ residential care). Nations’ communitiesintheprovince (offeringLevel There are onlyseven residential care facilitiesin First language, where it’s notculturallyadaptableatall. and we’re placingthemwhere theycan’t speaktheir and now we’re doingthesamewhenthey’re Elders, who were takenoutoftheircommunityaschildren, And alotoftheseniorsare residential schoolsurvivors, system, there’s notanEnglish onehere whatsoever. When Elders have tobetransferred toaprovincial nity members. isFrench.everything So that’s abigissueforcommu CESFNCQ October 2013 - - ii. English LanguageAccess Issues i. General Access Issues andChallenges vices): a.) CommunityResources (Health andSocial Services Ser 7.) Eagle Village |Kipawa delays and quality of services isnotthere.”)delays andqualityofservices these areas forEnglish-speaking studentsare lacking(“long in services commentedthatsupport system, participants therapy, specialneeds,occupationaltherapy. In theschool forthefollowing:services nutritionist,speechlanguage ticipants reported difficultiesaccessing English-language inEnglish –ParLack ofaccesstospecialized services • • • • • •

Distance to access services (travel).Distance toaccessservices Difficult toaccessspecialized services. pist, pharmacistshave allbeenEnglish speaking. ambulance attendants,nurses,doctors,physiothera theyhave receivedwith respect totheservices inthat dialysis onaweekly basis—theyhave “luckedout” institutions. Her sisterhasbeen receiving kidney pant describedhersister’s experienceswithprovincial Bilingual staffatprovincial institutions:Apartici ° Speech languagetherapy. ° Nutritionist. ized care, thenlanguagebecomesanissue. just from thenon.Once you gettothemore special inEnglish, it’sno issuesasfarreceiving services physician,there areWhen you gottoseeaprimary ° ° a weekly basis. but we don’t thaton have someonetosupport the studentsandsetsupprograms forthem, board, shetravels twiceayear tomeetwith We dohave speechpathologistwiththeschool inEnglish. services nutritionist, we hadproblem accessingthose centre], we wouldoftenrequire thehelpofa For thediabetesprogram [atthehealth

- - - - - 89 detoxification in English. services for – DetoxificationDifficult toaccesslocal services • • • • • [detoxification], andtobefaraway, it’s difficult. ily whenyou are goingthrough somethinglikethat [out ofprovince]. You from your needsupport fam away, rather thanbeingabletogo45minutesaway If thepersongoestoMontréal, it’s about 6or7hours Montréal; shesaid,‘Idon’t speakFrench.’ Ontario. Iwasspeakingwithaclientaboutdetox in closest onethatwe have isinNorth Bay, andthat’s in treatment centres are inEnglish, butfordetox the it’sDetoxification services, hard forclients.The ° ° inschool(elementary). Support services ° Occupational therapy. ° disorder. forchildrenSupport withautismspectrum services ° ° ° ° that achildwouldbegettinginOntario. kids, butit’s notthestandard certainly ofcare towork withthese is puttingalotofeffort littleEnglish. Iappreciatespeaks very thatshe provide [Theworker] cominginnow services. There isahugelaginactuallybeingableto happening becausetheycouldn’t hire anyone. the Centre Réadaption, butithadn’t been supposed tobereceiving through support theyweretem, around theautismspectrum, There were twootherstudentsinoursys quality of service isnotthere. quality ofservice in English isnotacceptable—longdelaysand theygetfortheirspecialneedschild services and leave theprovince altogetherbecausethe It’s notuncommonforparents tojustup speak French.’ They’ll say, ‘we can’t offeritbecause wedon’t French, are pulledback. thenalotofservices students aren’t in capableofreceiving services students intheschoolislacking.Because our providedThe services by theCSSSto that tomystudents? might befabulousinFrench, but what goodis string twowords inEnglish together. They working with mystudents,buttheycanbarely You know, Ihave anoccupationaltherapist

CESFNCQ October 2013 - - Lack of mental health services inEnglish. Lack ofmentalhealthservices eye forprimary Lack ofservices care inEnglish. dealing withtheissueathand.’ toaddresswas spenttrying thelanguageissueasopposedto English-speaking youth). Participants statedthat‘more time (developmental services port andoccupational)required by communicating withspecialistsatmeetings(i.e.,forsup staff. support however,Participants, difficulties reported that doctorsare more likely tobebilingual,lesssofor Language barriers(communicating):Participants reported inEnglish.Shelters forwomen–lackofservices • • • • • • • • it’s Theyare uptothemseekouttheseservices. ment tofindoutiftheirchildhasspecialneeds,then system]—If aparent requests apsychological assess Psychological assessmentforstudents[intheschool counselling forourstudentsisalmostimpossible. Mental health[intheschoolsystem]:Psychological French andsowe have noaccesstothatservice. individual downtown [ataprovincial institution]is With regards topsychological assessments,the see anoptometrist. I hadtotakemychildren outsideoftheprovince to Benefits (NIHB), butit’s notavailable in English. get glasses,it’s covered through Non-Insured Health Optometrists: Specialists don’t speakEnglish—just to ° Doctors are staff: bilingual,lesssupport inEnglish. any services The sheltersforwomenthatare close by, don’t have some issueswithlanguage. It’s whenwe into gettomentalhealththatwe run it themselves. being directed [outofprovince]. Theyare payingfor ° limited inthat area. help outwiththeclient,baths. Very, very staffcomingintothe rooms to the support selves—they were allA1, bilingual—it was into someissues.It’s notthe physiciansthem onbothsides,andthey ran it wasfrustrating come intoavery, difficultsituationand very communicating tothenurses’ aides.They’d bec, forsurgery, andhehadalotoftrouble We hadaclienthospitalized inAmos,Qué

- - - - 90 written documents. (immunization). There isnofundingfor translationof ments, correspondence, traininginformation, andprotocols For example,information (publichealth),reports, assess Documentation from theprovince is primarilyinFrench – guage barriers. Calling provincial institutionsisdifficultbecauseoflan able tospeakFrench. worker maybe funding anditisonlybecauseaparticular However, isprovided thisservice ‘on theirown’—there isno from provincialfor clientsseekingservices institutions. community organizationsare providing translationservices Participantslation services. reported thatFirst Nation Translation –There services isalackoffundingfortrans • • • • • French-speaking. secretaries inhospitalsordoctor’s offices are only When itcomestobookingappointments,oftenthe with thoseofficehours,there’s goingtobesomeissues. within officehours. So,unless youtime yoursickness site atthehospital,andIbelieve it’s fourdaysaweek The Agencedelasantéhasprovided atranslatoron all inFrench. province], whichclientsneedtranslatedbecauseit’s Sometimes it’s thingstheygetinthemail[from the ° Quality of services. ° ° Meetings. ° ° ° Réadaption], we’re tofigure sittingthere trying Two hourmeetingwithspecialists[Centre de I cangetthrough ameeting,butit’s difficult. French tothem.It’s ahugechallenge. kids can’t tospeakin handlesomeonetrying municated intheirlanguageit’s them:these there are anystudentswhoshouldbecom speak almostzero English, is difficult. If withtheirteam,whenthey participation] some students.Meetings [coordination and Centre deRéadaption provides for services communicate withthechild? assessment possiblybewhentheycan’t even even understandthechild?How cantheir true How canthespecialisthelpwhentheycan’t to work with thischild.It’s frustrating. very out thelanguageissue,asopposedtohow best CESFNCQ October 2013 - - - - computerized systemforhealthrecords). about changestohealthpolicies. (i.e.,Québec’s changesto meaningful consultationwith English-speaking population feltthattheprovincethe participants isnotconducting health planninganddecision-makingatmeetings.Further, als from in English-speaking agenciestofullyparticipate Participants reported thatthere are difficultiesforindividu • • • • • • • • translate it.Theyare not required by lawtotranslate able toread itandadministerit,becausetheywon’t of thatisonlyavailable inFrench. You have tobe Information forvaccines, even thenotationsandall Protocole d’immunisation duQuébec trainingsessions,allcomesinFrench.to theparticular get itallthetime.Theinvitationletters,invitations Information abouttrainingissenttousinFrench. I Montréal todoitinEnglish. Theyputonworkshops, gotpeople an effort. from lot ofEnglish workers inthearea, theyare making individualsunderstandthattheresince afew are a more oftenthannot,it’s onlyinFrench. However, With Agencedelasanté,publichealthinformation, teachers whoare English-speaking. in French—that’s what’s goingtotheparents and All reports from theCentre Réadaption are coming Problems withformsandreports. is inFrench. tal (CSSS)isallinFrench. Allthecommunication all inFrench. flash Thenews weget from thehospi isallinFrench,headquarters thebulletin board is bulletinscomingoutofourprovincialThe news through theprovince. translation ofthoseaswell. It wasnottranslated from timetotime,butHealth Canadatookonthe believe there are translatedformswe afew receive For theformsare allinFrench. healthservices, I stopped translatingit. I wouldusethatmanualdaily. But now theyhave translated by Health Canada,andmyselfasanurse, underneath Québec protocols, thePIQ wouldbe because ourcommunitiesare inQuébec we worked was anicegift. We gettheQuébec manual[PIQ], translated directly through Health Canada,which For awhile,we were havingallourdocuments it—that’s whatwe’ve been told.

(PIQ):

- - 91 ments) are obtainedatthehospitalinOntario. testing,assess (childbirth, vital’ –mostspecialized services ticipants reported thatthe‘linkwithhospitalinOntario is on theprovincial border don’t offerbilingualservices. Par however,services; it’s notreciprocated: Québec institutions province. ‘Border communities’ inOntario offerbilingual for insured thatare services supposedtobecovered by the inanotherprovinceservices mayneed‘to payupfront’ vate clinics).Participants reported thatclientswho receive not alwaysacceptedinQuébec (from bothpublicandpri inEnglishreports Assessment fromservices ‘out ofprovince’ Provincial boundaries–Barriers forclientswhoare seeking • • • • • • • where you are, butbecauseoftheprice differences, it nomatter not aprivate clinic—thisisinsured services is wanted thecashupfront. Andthisissurgery—this to receive theirsurgery, becausetheanesthesiologist I hadtogive mycredit card numberforapatient vices inEnglish. Iremember goingtoahospitalwhere sometimes inahospitalsetting.Andthisistohave ser the specialist,ifit’s notinahospitalsetting,andeven Often there willbeadditionalcharges,depending on the government. to reapply, parents hadtobeinvolved incalling turned down forahandicappedvehicle, theyhad picky aboutacceptingreports. One studentwas The Québec government isgettingmore andmore cal reports forstudents. they wantthingscoded,forexamplepsychologi accepted inQuébec. waysthat Québec hascertain Assessment reports from ‘out ofprovince’ notalways policies (computerized healthrecords). English-speaking populationaboutchangestohealth ‘Informed consent’ isnotbeingobtainedfrom them, too. toreachpopulation, you thinkitwouldbeimportant ofEnglish-speaking peopleinyourlarge portion tices andyou have three largecommunitieswitha If you are providing healthcare andbestcare prac nately inFrench. Decision-making andplanningboards are predomi True, consultationisnothappening. meaningful consultation is. consulted, butwe have adifferent definitionofwhat be doneinFrench. Andthey’ll itasyou view being becauseit’speople whocanparticipate, allgoingto tals isallinFrench. Basically itlimitstheamountof The board ofdirectors meetingforoneofourhospi Health planninganddecision-making (meetings): CESFNCQ October 2013 ------Corridors of service –‘greaterCorridors ofservice pressure tostaywithinthe language pathologyfortheirchildonaregular basis.) tance (i.e.,parents whoneedtotravel twohoursforspeech while,andthenjuststopaltogetherbecauseofthedis short fora challenge: sometimesclientswillcontinuetheservice in order inEnglish. Thetravel toobtainservices presents a to stayinQuébec they are required totravel away further region’. Participants reported thatbecausethey are required • • • • • • • • • huge as far as all health services are concerned. huge asfarallhealthservices minutes away[toahospitalinOntario] ishuge.It’s Family available toaclienttraveling support only45 patients we takefrom Québec.’ with Ontario folksnow, and we are limitingthe North Bay hospital[inOntario] says,‘We are full the more serioustesting.There maybeatimewhen babies inNorth Bay, theOBGYNsare there, and general practitionercangive. We’re havingour otherthanwhatawhere we goformostservices The linkwithahospitalin Ontario isvital—it’s the provincial border don’t offerbilingualservices. it’s notreciprocated: Québec institutionsthatare on vices from theotherprovince [i.e.,Ontario]. However, In aborder community, you canaccessbilingualser dollars andwaitforreimbursement. puts usinapredicament where we have todishout are far away. Even ifyou stayinQuébec, sometimesthoseservices allows. corridor ofservice Québec). Clientsare beingreferred towhatever their Ontario), ratherthanareferral several hoursaway(in We have tofightgeta referral that’s closer(in institutions on recruitment ofbilingualworkers atprovincial Merger ofinstitutionshasleadtolessemphasis they couldprovide inEnglish. thoseservices We wouldn’t have anyproblem stayinginQuébec, if physicians whenwe shouldpayQuébec physicians.’ system, we’re notinthebusinessofpayingOntario You usedtohave achoice. We’re told,‘Stay inthe has nochoicebuttogothehospitalinQuébec. (ambulance)]:Theambulance [Emergency services intheregion. ment wantstokeepeverything There’s aconstantstress inthattheprovincial govern - - - 92 under NIHB.Participants reported thatthere isalotof andseekreimbursementservices from Health Canada, First Nations’ clientsare required topayupfront forsome Non-Insured Health Benefits(NIHB). Limited coverage forMental Health through Services iii. Access Issues Related toCulture (Aboriginal) training inEnglish (forexample,fordiabetes). accepted inQuébec. Health Canada doesprovide limited challenges toensure thattrainingtakenoutofprovince is to accessrequired traininginEnglish. There are additional pants report thatthey needtogooutofprovince inorder Limited accesstotraininginEnglish inQuébec –Partici • • • • • • • therapy. Thoseare someofthechallenges. follow thetensessionsoftherapy…it’s likefastfood the treatment plantoHealth Canadaandithasto in English, andsowe gotoNorth Bay. Theysubmit isnotavailable from theprovinceservice ofQuébec hospital [inOntario] forpsychological This support. opens upforus—andthere’s anagreement with There’s atthehospitalthat still acorridorofservice it’s inEnglish, butyou really needtowork togetit. The trainingfordiabetesisthrough Health Canadaand [in Québec]. Ontario, atrainingcourse,it’s notalwaysaccepted The challengeisthateven if you findsomethingin available inQuébec. and Ineedtogooutofprovince forallthat.It’s not tion coursesbecauseyou needthemforyour licence, French. togetcontinuingeduca Ihave beentrying Anything fornursingtraininginQuébec isonlyin orders isonlyinFrench. that typeofthing—andoftenthetrainingforthese orders—psychologists orders, nursingorders, and Often, of all our professional staffneedtobepart Especially inthewinter-time,thesearen’t goodroads. parents week tobetravelingwiththeirchild. every a speechpathologist…it’s ahugecommitmentfrom Parents were drivingthemtwo hourstomeetwith from our communities. It’s abigcircle. away andfurther language issuewe endupfurther than goingout-of-province]. However, becauseofthe There’s pressure onustostaywithin Québec [rather

CESFNCQ October 2013

- - community, culturallyappropriate care). Participants com gearedDetoxification services for First Nations (inthe will acceptNIHB. paper work involved providers forclients,andnotallservice services inEnglish.) services province, from aprivate clinic(required by clientstoobtain funding fortravel are whenservices obtainedfrom outof Medical –There transportation are someissuesaccessing tion’ andtreatment services centres. mented thatthere are gaps between theexisting‘detoxifica • • • • • • • • • Few andfewerspecialistsare acceptingNIHB. the onestodealwithprocess ofreimbursement. make thempayupfront, sothattheywillneedtobe deal withNIHB,’ butwhentheclientgetsthere, they I have called providers andI’ve beentold,‘Yes, we for funding. ing togetanappointment,justthepaperwork The clientsarerun around theoneswhohave try to Canada reimburse themlater.’ can gettheclienttopayupfront andhave Health shouldImanageit,when are tosay‘Why starting seek reimbursement from Health Canada.Providers andthen Clients needtopayupfront forservices tion coststothose clinics. speech therapy]theywon’t cover medicaltransporta suchas a private clinic[forEnglish languageservices The problem isthatwith Health Canadaif you goto funding fortravel whenwe gooutofprovince. another province—which leadstoissuesaccessing do so. At times,thenearest ‘point ofservice’ isin need togoagainstthegrainofframework The issuewiththetravel fundingismostlythat we’d problem. Canada driven, sotheyare inEnglish. It’s nota areAll theforms[formedicaltransportation] Health centres. It’s thecontinuityofcare forFirst Nations. tion. There are gapsbetween detox andtreatment For we needtohave detoxificationatransi services, people, theculture. would makeadifference, beingwith First Nations but itwouldbenicetohave ourown detox. That First Nations community. We have treatment centres, It wouldbenicetohave ourown detox centre ina - - - - - 93 Long wait times for services. Long waittimesforservices. good, especiallyinwinter. (travel),Distance toaccessservices roads are notalways i. General Access Issues andChallenges b.) Eagle CommunityMembers:Village |Kipawa iv. Positive Experiences into English). Protocole d’immunisation duQuébec (PIQ) from French translate documentsneededforprevention (i.e., services basis only. Further, theprovince isnotrequired by lawto do notspeakFrench maywork inQuébec onaconditional rather “ithastodowithlanguage.”Some professionals who munities andithas“nothing todowithcompetence”, but nurses) are experiencingdifficultiesworking inthecom als. Participants reported thatprofessionals (forexample, 21) iscreating obstaclesforEnglish-speaking profession Nations Legislation(Bill accesstohealthandsocialservices. Provincial legislationisimpactingEnglish-speaking First • • • someone around tohelpusout.’ say, ‘You know, it’s nottoobad.There wasalways it’s allFrench, andwhentheycomeback,always clients maybeafraidaboutgettingaround, because inEnglish arewhere good.Sometimes, theservices There are hospitalsin Québec (inlargerurbanareas) guidelines isonlyavailable inFrench.) du Québec (PIQ)—the vaccination protocols and English. (For example,theProtocole d’immunisation by lawtotranslatedocumentsfrom French into Translation ofdocuments:Province isnotrequired ° ° Bill 21(Professional Order): ° ° with language. nothing todowithcompetence,ithas orders, andthere’s someissues,andithas they have toregister tothese[professional] be English. But, whentheygettoQuébec, for [professional workers] bestlanguageto From amanagementperspective, Ilook yet training inEnglish islimitedinQuébec. 21)—required tobelongaprofessional order, Licensing issuesbecauseoflanguage(Law

CESFNCQ October 2013 - - for services inEnglish. for services inEnglish. Others reportedto accessservices delayswaiting Participants reported thatthey needtogo‘out ofprovince’ inEnglish. Lack ofaccesstogeneralandspecialized services ii. English LanguageAccess Issues mixed experiencescommunicating inEnglish withdoctors, Language barriers(communicating) –Participants reported • • • • • • • • • • lish, andthey’re closer—onehouraway. We go toOntarioinEng rightnow toget services not goingaway. needs alotofhelpandthisispermanentthing.It’s would have moved toOntario, becausemychild special needs]:If mymomdidn’t speakFrench, I forchildren whohave andservices [Lack ofsupport see herearlier, sixmonths. every upset aboutthat,andshemadesure hewouldgetto months andittookayear. His doctorwasreally My sonwassupposedtoseeadoctorwithinsix I thinkthelongwaitsare rightacross Canada. they are. You don’t need towaitthree months.’ And, ‘If you needthesedocumentsinEnglish, here not, ‘We willgetsomeoneinfive daysorsomething.’ That’s‘We thewayit should be. have somebody,’ when itis. We’re inCanada,notsomeothercountry! there rightaway, nomatterwhattimeofdayitisor English, theyshouldbeabletobringsomeonein if you walkinthere andthere’s nobodywhospeaks You know, ifyou gotoahospital,inQuébec, and English speechtherapistaround here. for examplespeechtherapy. You’re notgoingtofindan Some thingsyou have nochoice,buttogoOntario, in English. I wouldn’t know where togoinQuébec forservices tists. We are referred toOntario. For generalphysiciansandspecialists,too,likeden you’re stuck. and ifthedoctorshere don’t wanttorefer you, then You needtogetreferred toseeaspecialistinOntario, eventually Iwillhave togothrough Québec. have noproblems, butI’m worriedbecauseIknow All myappointmentsare inOntario, sorightnow I

- - 94 ments becausevoicemails are leftinFrench only. guage barriers.Participants reported thatthey missappoint Calling provincial institutionsisdifficultbecauseoflan language barriers. ‘worried’ aboutgoingtoprovincial institutionsbecauseof Perceptions andbeliefs–Participants reported thatthey are staffaresupport bilingual. staff.Overall,nurses, andsupport lesslikelythatnursesor • • • • • • • • French…I getby through signlanguage.Pretty much This isfortreatments, appointments,andit’s allin the phonecallsinFrench andIdon’t understandit. ‘YouThey tellme, missedanappointment,’ butIget would bepretty scary. [the hospital]andnotknowing what’s goingon,that but I’m worried aboutitforlater. Having togo I haven’t foundtheseproblems yet [withlanguage], nurses andthereceptionists. For English language,there were problems withthe tionists andit’s hard becauseit’s allinFrench. doctor we needtospeakto…andwe’ll calltherecep problem where we can’t seemtogetthrough tothe things, phoningforappointments. We have alittle understand English. Just your medicare number, little to getyour informationacross becausetheydon’t hospital, you’ve togobackyour French gottotry In ourcase,it’s beenthereceptionists. You arrive toa English, sothat’s theendofthat. don’t understandFrench, andthey don’t understand four o’clock inthemorning,goforit.Itoldthem they were saying,butiftheyneededtotakebloodat French speakingandIdidn’t understandanything At thehospital, thenursesonnightshiftwere along forthesamereasons. and whenwe gotothehospitals,mymothercomes get mymothertocallbecauseIcannotspeakFrench, tionists whoare difficult.Theyonlyspeak French.I Some ofthedoctorsspeakEnglish, butit’s therecep The doctorknows shehasthisproblem andshetries. the timeyou canaskforanursewhospeaksEnglish. The doctorintown doesn’t speak English. Most of more thanshespeaks. munity whodoesn’t speakEnglish—she understands We have aFrench-speaking doctorinourlittlecom CESFNCQ October 2013 - - - - - provincial institutions. For example,assessments,forms, andlettersreceived from Documentation from theprovince isprimarilyinFrench. English-speaking clients. of liaisonatprovincial institutions,whichare neededby Translation –Participants services report thatthere isalack pocket. some provincial they are services payingthedifference outof varies amongtheprovinces. Participants report thatfor [with Ontario] open’. Provincial ‘rateofpay’ (feeschedule) inEnglish: ‘It’sseeking services tokeepthelink important Provincial boundariescausingbarriersforclientswhoare • • • • • • • • French first,buttheysentmean English translation needs]: Theygave methedoctor’s assessmentin [Assessments andreports forchildren withspecial on Thursday. available on Thursdays. So I guess Icanonlybesick I there. There’s noonethere 24hours. on work hours, andifshe’s notthere, there’s nobody [The liaisonworker] atthehospitalisonlyavailable to cometalkyou, whoknows bothlanguages. sign language,orfindsomeoneinanotherdepartment and theyonlygave mehalf theprice.It’s becausethe biotics, andIcamehome,sent theformtoQuébec, pneumonia lastyear andItopayformy own anti Lack ofconsistencybetween provinces forfees—Igot Later you’ll getyour moneyinthemail. because Québec wastoolateinpayingtheirbills. and you bringthereceipt tothehealthoffices, There’s an optometristwhomakes you payupfront, becauseQuébec wasslowbury payingtheirbills. told me,becauseshecouldn’t sendmebacktoSud she referred me toMontréal, andthereason was,she I hadanissuegoingtoOntario. When Ifirstgotsick, [Letters]: We’ve lettersinFrench, hadafew too. French, butIwrote [myanswers] inEnglish had togetmymomtranslate;Theforms were in their healthcards wasallin French. andeverything I [Forms]: When Ihadmybaby, alltheformstoget but ittookthree monthsorso. later. Theyoffered togive ittome,whichisgood,

called andtheysaid[liaisonperson]wasonly

- - 95 Issues underNIHB. withfundingforservices who isresponsible (delivery andfunding). forwhatservices ments, butthere isalackinformation andclarityabout from bothfederalandprovincialand socialservices govern Jurisdictional issues:First Nations have accesstohealth Discrimination andlackofculturalsensitivity. iii. Access Issues related toCulture (Aboriginal) • • • • • • • • by theprovince. thatare supposed tobeprovidedamount forservices provinces. We’re notalwaysreimbursed thefull and there are between different ratesforservices We are being madetopayoutofpocketforNIHB, (long waittimes). coverage anissue through NIHB—qualityofservices Staff atpharmaciesare notalwaysaware aboutthe by NIHB. Not alwaysclearifthemedicationwillbecovered reimburse you.’ when it’s authori.e. you can comebackandwe’ll ada—They say, ‘Oh, you canpayforitnow, and then waitforreimbursement from Health Can Clients needtopayforprescriptions upfront and you can’t waitforsomething. hasthatkindoffunds,andsometimes not everybody Indian Affairstakestoolongto reimburse. Imean, They mademepayupfront becausetheysaidthat [Dental health]:My littlegirlneededherteethfixed. skin. and treat you differently becausethecolourof your There are stillsomepeopleoutthere wholookat you and there’s noEnglish upthere. sent to[hospitalinQuébec]: theroads are terrible here, theysendyou to[Ontario]. Idon’t wanttobe Even forx-raysandultrasounds,iftheycan’t doit If there’s alinktoOntario, you wanttokeepitopen. want you to stayinQuébec. But, Icanseethatcomingtoastopbecausethey I won’t intoQuébec thanIamrightnow. gofurther ments withspecialists,butItellmydoctordown here I gotoOntario forallmymedicationandappoint bec andOntario are different. government pricesfortheantibioticsbetween Qué

CESFNCQ October 2013 - - - - vices): a.) CommunityResources (Health andSocial Services Ser 8. Timiskaming First Nation able, dependingonwhere you were going. gual. Participants were reported thatbilingualservices avail In iv. Positive Experiences services ‘out-of-province.’services Some reported thatthey are experiencingobstaclesaccessing speech languagepathologist, audiologist,treatment centres.) and howin English from theprovince toaccessservices (i.e., pants mentionedthatthey lackinformation aboutwhere in English – ParticiLack ofaccesstospecialized services ii. English LanguageAccess Issues Quality ofcare canbe achallenge. (travel).Distance toaccessservices inEnglish for services (specialized), longerifwaiting Long waittimesforservices i. General Access Issues andChallenges urban areas • • • • • •

understand. Most ofthedoctorsare English. English but they’ll muddlethrough andmakeyou lish. At some hospitalsthenursesdon’t understand was surprisedthatthehospitalswere mostlyEng It dependswhere you’re going.At somehospitals,I coming from Montréal. A lotofthenursesknow English. They’re mostly All mydoctorsspokeEnglish at[urbanhospitals]. and understandingtheirhealthissues. challenges toclientsintermsofcontinuitycare Clinics thathave rotating doctorsonstaffcanpresent specialized assessments. There isabigdistancebetween ourcommunityand inEnglish). services 4 years onthewaitinglist(longeriffor and waitfortheirappointments.It cantake3or Waiting listsinQuébec are long,peoplewait , doctors,nursesandspecialistswere bilin

- - - - - 96 services. experience,delayswaitingfor guage barriers–frustrating Calling provincial institutionsisdifficultbecauseoflan time you are more inEnglish. likelytoaccessservices depending onwhenyou were intheday accessingservices: that there were issueswithcommunication athospitals Language barriers(communicating)–Participants reported • • • • • • • • here, ask forher,’ andI’ve already beenwaiting. please callbacklaterandwe’ll makesure thislady’s ‘Sorry, goodEnglish, couldyou Idonotspeakvery call intheafternoon,andwhenIbacktheysay, So whenIcallforanappointment,you canonly call back,it’s really frustrating. English andwon’t answer myphonecall.Ihave to When Icallthepharmacist,clerk maynotspeak spoke English. timestofindsomeonewho had totransfermeafew Sometimes Ihadtocallthematthehospitalandthey they toldme.’ saying,‘Idon’tpatients struggle, understandanything English totranslate,butatevening andatnightthe are more people,sowe canalwaysfindsomeone At hospitals,inthedaytime,it’s easierbecausethere they getlost. only behere onceamonth,you sendreferrals and of doctors,andbecausetheyare notlocalsandcan tal, another, athird togetnames hospital,afourth, need tofindaplacesendthem,callingonehospi With Ontario doctorsrefusing ourpatients,we there [institutioninQuébec].” I don’t speakEnglish.’ Icould notaccesstheservices was told,‘You bettersendthemtoOntario because English from Québec system. Acommunityworker Difficult toaccessspeechandlanguagetherapyin ing withOntario. specialists inQuébec, whenwe’ve alwaysbeendeal available in Québec. Thechallengenow istofind Lack oftimetosearch outspecialiststhatmaybe doctors, are French speaking. strictly, thatIknow of. Most ofthecaregivers, or There’s no English, there’s hardly anythingin English CESFNCQ October 2013 - - - - letters, forms, information, andsignage. Documentation from theprovince isprimarilyinFrench: barriers. Crisis situations more challengingbecauseoflanguage reported thatitis‘difficult to understand trainerswho materials are notreadily available inEnglish. Participants Limited accesstotrainingin English in Québec – Training pay’ (feeschedule)varies amongtheprovinces. are becauseofthe provincial issuesaccessingservices ‘rateof residents are now beingrefused Reported thatthere services. inEnglish, from Ontario.obtain services, Further, Québec reportedparticipants thatthey lackfreedom ofchoiceto Provincial boundaries–Becauseofprovincial boundaries, • • • • • • we limited. canhave isvery becausewefew cannotusethem.Thedocumentation normally we needtodiscard themandonlykeepa most ofourmaterialdoesnotcomeinEnglish, so come inallFrench. Sometimes it’s aboutsuicide,but information…and alotofourpamphletsandposters we getalotof With theagencyofsocialservices, material inEnglish here difficult. inQuébec isvery The prevention work we doatthecentre here, toget us tomakephonecalls. ent wantstobesafenow, notwaitahalfanhourfor navigate intheheatofmoment,becausecli an English speakingcounsellor, whichwashard to shelter [foraclient],Iwouldneedtoseeifthere was In crisissituations,especially, ifIhadtoaccessa a longtimetobereimbursed. rates between provinces, andthedoctorshave towait Québec patientsbeingrefused becauseofdifferent refusing ourpatients. problem isthatmore andmore thesespecialistsare would besenttoanOntario specialist.But now the Ontario side,andiftheyneededaspecialist English speaking,theyhave alwaysgonetothe in Québec, andbecauseourpatientsare mostly Our villagesitsontheborder ofOntario, butwe’re to gobecausethesignswere allinFrench. appointments becauseitwasnever clearwhere Ihad really clearwhere Ihadtobe,wouldmissmy Itunderstand thesigns.Iwasfrustrated; wasnever make mywayinthehospital,becauseIcouldn’t ers]: Even inthehospital,ifIread thesignsIcan’t [Personal experiencesreported by communitywork - - 97 from provincial institutions. nation andculturalstereotyping whenobtainingservices stated thatthey, ortheirclients,have experienceddiscrimi spoke aboutthelackofculturalempathyandrespect. They Discrimination andlackofculturalsensitivity. Participants iii. Access Issues Related toCulture (Aboriginal) speaking clients. training inEnglish tobettermeettheneedsoftheirEnglish- language isFrench statedthatthey wouldprefer toreceive are notfullybilingual.’Further, someworkers whosefirst • • • • • • • • We’ve beentoldthatnumerous times. there for hoursuntiltheysoberupandcanbeseen. hospital, ismaybeintoxicated, isNative, theywillsit We are told becausethispersoniscominginthe tofindstuff. struggling lators, andtheydon’t offeritanymore. Now we’re courses inbothFrench andEnglish through trans once ortwiceayear fortraining,andoffered the Canada butnotsomuchanymore. We usedtogo We used tohave alotoftrainingwithHealth from French intoEnglish formyclients. the materialinEnglish, ratherthanhave totranslate English, even thoughIamFrench. It iseasiertolearn When Igofortraining,liketohave thetrainingin issaying. instructor tounderstandwhatthething whilestruggling It’s whenyou’re frustrating tolearnsome trying who isnotfullybilingual. It canbedifficultto receive training from aworker recommendations) fortheprovince ofQuébec. the accurateinformationthatyou need(guidelines, training out-of-province doesn’t provide you with nized by theprovince. Others expressed concernsthat obtained from out-of-province anditisstillrecog There issomefreedom inthattrainingcanbe We dogotoOntario fortrainingatthesametime. not becausetheydon’t have thenumberstoaccount. will saytheyare goingtoofferitin English butdo it inEnglish ifenoughpeoplesubscribe.Often they is offered in French, andtheysaywillalsooffer [Training fornurses]: When we have courses,oftenit train ourstaff,ortoprovide workshops, in English. [Front lineworkers]: Itto isdifficulttobringpeoplein Difficult toobtaintraining resource materialin English. CESFNCQ October 2013 - - - - Case management–Participants (First Nations healthcare summaries are ‘all inFrench.’ discharged. Languageisanobstaclebecausethedischarge institutions (First Nations andprovincial) whenclientsare Gaps indischarge –Lackofcommunicationbetween iv. Positive Experiences and follow up). language issues(referrals, bookingappointments, energy oncasemanagement,primarilybecauseof workers) reported thatthey are spendingalotoftimeand • • • • • am Iactuallygoingtobetreated withrespect? sitting there forhours? Will Igettheattitude?Or I think,How amIgoingtobetreated? Will Ibe don’t becauseIwonder, amIinfortoday?’ ‘What sometimes Ishouldgoseekmedicaladvice,but want tobetreated likethat.It’s frustrating… very go back,unlessyou’re dying,becauseyou don’t end. It’s andyou almostdon’t frustrating wantto I willbesittingthere forhoursandon worker]: Generally, anyhospitalnearreserve, [Personal experiencereported by community that way. because you’re native, theyexpectyou tobetreated alcohol before willbetreated inthesameway. Just Sometimes patientsthathave never touched mammograms. The technicianexplainedthe proce English, theygetalotmore peopletogotheir are in English, and now thattheirletters are in year—or maybeittooktwoyears—their letters were in thescreening—the notparticipating next French, andthenalotofpeopleaskedmewhywe community justchuckeditasidebecausewasin all inFrench andmostofthepeoplefrom the [As reportedTheletters bywere oneparticipant]: of communitymemberswhowent forscreening. cer screening: there wasanincrease inthenumber English tocommunitymembersaboutbreast can Provincial institutionssentinvitationlettersin the community. in English (homecare stats,vaccines, reports) for At thehealthcentre, nursestrackinformation forhours,hoursonend.”forth Sometimes. you canbeonthephonebackand management we do. It isalmostunreal theamount. work: “It issurprisinghow manyhoursofcase care)—bilingual staffpersonisneededforthis booking appointments,following upwithafter time andenergyoncasemanagement(referrals, First Nations’ healthworkers are spendingalotof

- - 98 • • • • • your friendswe speakEnglish.’ she said,‘That’s good.I’m very gladtoseethat. Tell ‘My doctor’s here now, we moved toQuébec.’ And your communitycomingtoQuébec?’ AndItoldher, Québec? You don’t see many English peoplefrom Québec, theyaskedme‘How comeyou cameto worker]: When Ihadmybaby atthehospital in [Personal experiencereported by acommunity province. from theEnglish-speaking clientstoaccessservices Doctors atprovincial hospitalsare encouraging pretty fast. all Ihave todoissignanauthorizationform.It was English, nowme backandthepersonspokeperfect call mebackonaspecificdateandtime.Theycalled children Ilookafter, andtheclinicsaidtheywould worker]: I hadtocallmakeanappointmentfor [Personal experiencereported by acommunity tion wasinEnglish. date andtimewhentheywouldcall,allcommunica appointment, theCLSCprovided theclientwitha from localCLSC:whenmakingan Efficient services encourage them.” courses forpeopletolearnEnglish atthehospital,to Iguess.Andtheydogive do, insomedepartments, there’s beenabigimprovement. There’s stilllotsto over years. thepastfew “Over thelastcoupleyears reported thatthere have been ‘bigimprovements’ English training available forprovincial workers, patients inEnglish. dure inEnglish anddocumentationwasprovided to CESFNCQ October 2013 - 99 Health CouncilofCanada.Empathy, dignity andrespect: Creating culturalsafetyforAboriginal peopleinurbanhealthcare. First Nations ofQuébec andLabradorHealth andSocial Commission.CompendiumofProjects: Services Aboriginal Health Tran Doerfler, Jill, Niigaanwewidam James Sinclair, and Heidi Kiiwetinepinesiik Sark. CenteringAnishinaabeg Studies – Understand Des Roches, Michel. Portrait demographiqueetsociosanitaire delapopulation.CLSCNaskapi. Janvier 2005.PDFfile. Chilisa, Bagele. Indigenous Research Methodologies. California:Sage, 2012.Print. –––. Steering CommitteeMeeting. September 2013.Review ofResearch Report. –––. Steering CommitteeMeeting. Montréal, May 29,2013.Preliminary Research Presentation. –––. Steering CommitteeMeetings. 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