3. CAREFULLY CONSIDER THE VISION FOR REFUGEE PATIENT NAVIGATION
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Cultural safety includes ensuring patients can successfully manage health care visits. Hospitals are notoriously confusing for patients, even for those who speak English and are experienced with the health care system generally. The APN program is a success story, because it serves the purpose for which that particular program was designed. The question of whether there should be a patient navigator program for refugees was one that we considered and invited commentary on.
There are three competing models of navigation that have been proposed by refugee health advocates (health care providers, formal and informal support workers, and patients) that we spoke with. One model (which we refer to as the “support to learn the system” model) emphasises independence. This model advocates teaching patients how to become fully functioning members of society, by training patients how to navigate the system themselves. The competing model (which we refer to as the “navigate individual patients” model) emphasises full patient support with navigation and interpretation. A third model is to have on-site navigators for assistance with finding appointments for all patients, regardless of whether they are non-English speaking or newcomers to the province.
Many participants who advocated for a refugee patient navigator referred to the successes of the APN program and Cancer Care’s patient navigation program. However, there are good reasons to argue that these models are inappropriate for support to refugee newcomers. First and perhaps most obviously, such direct assistance contradicts ANC’s model of support, which is one of ensuring that newcomers are able to be independent as soon as possible in the resettlement process. Second, the assistance model would require an enormous pool of volunteers.
Furthermore, the idea of a patient navigator providing both navigation and interpretation is logistically problematic. Most obviously, it would require having a pool of navigators representing the range of languages of newcomers, which would be unsustainable.
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A third model of navigation responds solely to the need for on-site assistance on Eastern Health promises. Several participants suggested moving away from the idea of navigators in the sense of the Aboriginal patient navigators and Cancer care navigators, and instead having volunteers placed in strategic areas throughout hospitals, armed with phones for basic interpretation in multiple languages, to help to direct all individuals – regardless of origin – to where they need to be within hospital sites, a solution that only solves the challenge of navigation within EH premises.
One formal support worker noted that these general health navigators would be very useful because often patients are reluctant to ask strangers for help, even with the clinic name clearly written on a paper that can be shown; and in those circumstances a clearly identified navigator would be easier to approach (Formal support worker 2).
No matter what the plan for navigation might be (if, indeed, one is deemed to be required beyond the navigation currently provided by ANC), the role would have to be conceived with ANC, to support the navigation that is already built into this official resettlement process. As this formal support worker put it:
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"If we were to embark on a plan for funding for a navigator, again, I think I would like it to be very clear what’s the value added and what is the role … because the ANC ultimately – this is their role to deal with people, with newcomers, so they – this has to work with what they want." [Formal support worker 3]