4. DISCRIMINATION
We asked about the experience of discrimination – patients feeling like they were being ignored or treated poorly because of language barriers and/or because of being minority newcomers – and three themes emerged: (1) feeling unable to be assertive with respect to treatment because of the precarious residency status; (2) physicians assuming patients are ignorant about their own health, when it is physicians who are uninformed about global health; and (3) physicians equated being a “refugee” with being rural and illiterate and incapable of self-care.
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➤ Feeling unable to be assertive because of the precariousness of residency status
Newcomers are in a position of relative powerlessness because of their precarious residency status, and also are grateful to the host nation, which may make it difficult to stand up for their rights. Patients discussed how they sometimes struggled to assert themselves in health care settings.
“It’s not like a fear of like being out, kicking him outside the country; it’s just like a feeling that it’s like, I’m a foreign person so I shouldn’t do this because I’m not in my home country” [Refugee patient 6a: man, Arabic speaking]
“They know I don’t know the system and I don’t know the rules so they just tell, you know, shooing me away like you know. I think this is the most [important] thing. … We are having a very hard time with the wars and running from the dead people, and you know we’re survivors, so I can survive with this mad look [from the nurse] – I don’t care about this you know, it doesn’t matter. It doesn’t bother me at all” [Refugee patient 6b: woman, Arabic speaking]
➤ Physicians assuming patients are ignorant about their own health
Some patients/supporters reported that they believe that family physicians tend not to trust the opinions of patients and assume that patients do not have a correct understanding of their own health care. Sometimes, this was because family physicians were actually not familiar with global health issues, such as variations in the types of infections or parasites that an individual might have. Importantly, it was not the lack of such knowledge that was a concern for patients or supporters; rather, it was having the patient’s own opinion dismissed as uninformed or uneducated that was the issue.
“[When a patient presents to the doctor and reports that they likely have a condition that is common in their own country but not common in Canada] Often times most of the family doctors simply says to the patient, ‘No we don’t have that here. It’s impossible that you have worms in your belly because we don’t have that here’… . What happens is the patient, sometimes mother is diagnosing the child, right: ‘But my children has that, and that’s why we’re looking for a treatment for that.’ And the doctor is like, ‘No, that doesn’t exist, it’s impossible that your children has that.’ … They don’t consider it. They just disregard it. They don’t consider the father and mother’s diagnosis, [they dismiss it as] mumbo jumbo” [Formal support worker 6]
“Then the doctor asked me, like, ‘Why you didn’t bring them [babies] to the hospital because they have a bad situation!’ and I told him, I told him ‘I actually did bring them here three times to the emergency and nobody give me anything, just tell me, “Use that Tylenol.”’ …. So I was like, have a lot yelling, screaming with the doctor, you know. I tell them, ‘We bring our children from the war just to protect them and here they were sick for three months and nobody, you know, give me the right answer’” [Refugee patient 6: woman, Arabic speaking]
At other times, patients told us, physicians treat them as if they are ignorant because of the assumptions patients have about the Canadian health care system, because the physicians are not aware of how the medical systems of other countries work. They do not sufficiently appreciate that in the context of the world’s countries, the Canadian health care system is rather unique; it is not the case that newcomers will know the unspoken rules. This is not because others are uninformed about how health care works; it is because the physicians are uninformed about how health care works in most of the world.
➤ Physicians equating being a “refugee” with being incapable of self-care
Discrimination by family physicians was also experienced in the form of physicians making assumptions about what it means to be a “refugee”, with patients and supporters feeling that physicians were lumping all refugees together and assuming that they were rural and illiterate and that this “poverty of knowledge” was the reason why appointments are missed.
“I have this feeling, I don’t know, like, ‘Oh those people do not know anything. Those people are coming from a new country’ – like I feel like we are, because I’m from [names country of origin] so I have this feeling like I want to tell the doctor, ‘Hey, like see we’re not still living in tribes and those stuff you know; we have technology, we have everything and we are good people – stop doing that’, you know …. I don’t feel that the patients here are really relaxed when they are meeting their family physician, while it should be the contrast” [Formal and informal support worker 5, interpreter, international student, recent immigrant patient]
“Let’s say ‘silly questions’ that the patient will ask; I’m not saying [that the questions are] silly but I mean like for here [Canada] it’s silly to ask, like ‘Can I buy this antibiotic without prescription?’ Like in our country that’s okay, that’s fine, you can buy it – but here like ‘Oh my god that’s so silly, like how could they think a person can buy an antibiotic without prescription?’” [Formal and informal support worker 5, interpreter, international student, recent immigrant patient]