THE STANDING SENATE COMMITTEE ON OFFICIAL LANGUAGES
EVIDENCE
OTTAWA, Monday, June 3, 2024
The Standing Senate Committee on Official Languages met with videoconference this day at 5 p.m. [ET] to study matters relating to minority-language health services; and in camera, to consider a draft report on the subject matter of those elements contained in Division 24 of Part 4 of Bill C-69, An Act to implement certain provisions of the budget tabled in Parliament on April 16, 2024.
Senator René Cormier (Chair) in the chair.
[Translation]
The Chair: I am René Cormier, senator from New Brunswick and chair of the Standing Senate Committee on Official Languages. Before we begin, I would like to ask all senators and other in-person participants to consult the cards on the table for guidelines to prevent audio feedback incidents.
Please take note of the following preventative measures in place to protect the health and safety of all participants, including the interpreters.
If possible, ensure that you are seated in a manner that increases the distance between microphones. Only use a black approved earpiece. The former grey earpieces must no longer be used. Keep your earpiece away from all microphones at all times. When you are not using your earpiece, place it face down, on the sticker placed on the table for this purpose. Thank you all for your cooperation.
Now, I wish to invite committee members participating in today’s meeting to introduce themselves, starting on my left.
Senator Poirier: Rose-May Poirier from New Brunswick.
Senator Mégie: Marie-Françoise Mégie from Quebec.
Senator Moncion: Lucie Moncion from Ontario.
The Chair: Thank you and I wish to welcome all of you and viewers across the country who may be watching.
I would like to point out that I am taking part in this meeting from within the unceded traditional territory of the Algonquin Anishinaabe nation.
Tonight, we continue our study on minority-language health services by welcoming organizations able to address the theme of vulnerable communities, one of the seven themes of our study.
For our first panel, we welcome in person Catherine St‑Hilaire, assistant coordinator at the Francophone Immigration Support Network of Eastern Ontario. Welcome, Ms. St-Hilaire.
We also welcome our witness joining us by video conference, Salwa Meddri, manager at the Réseau en immigration francophone du Manitoba. Welcome, Ms. Meddri.
Good evening to both of you and thank you for accepting our invitation. We will now hear each of your opening remarks. They will be followed by questions from the senators.
Catherine St-Hilaire, Assistant Coordinator, Francophone Immigration Support Network of Eastern Ontario: Thank you. My name is Catherine St-Hilaire and I am assistant coordinator at the Francophone Immigration Support Network of Eastern Ontario.
Honourable senators, members of the Standing Senate Committee on Official Languages, thank you for this opportunity to address you as part of this study on minority-language health services.
I would first like to thank you for inviting the Francophone Immigration Support Network of Eastern Ontario to testify as part of your study. The Francophone Immigration Support Network of Eastern Ontario — hereinafter referred to as the network — is an Immigration, Refugees and Citizenship Canada program that’s been coordinated by the Economic and Social Council of Ottawa-Carleton since 2007. Through consultation, planning and promotion of immigration partnerships and initiatives with regional stakeholders in various areas of eastern Ontario, the network aims to foster the successful attraction, welcoming, settlement and socio-economic integration of francophone newcomers throughout eastern Ontario, from Kingston to Hawkesbury and Ottawa to Cornwall, up to the Quebec border.
In January 2023, the network created a health component with a “francophone immigration” lens in its secretariat, with a resource person dedicated to its coordination. This person is responsible for reaching out to health stakeholders in eastern Ontario who work closely or remotely with francophone immigrants to bring them on board the health sector working group so that they can highlight challenges, successes, needs and actions to be implemented within the sector.
The working group now has over 40 members, and it keeps growing. For the first stage, they were asked to respond to a study devoted to drawing up a summary report on the overall health services — physical, psychosocial and mental — available to francophone immigrants in eastern Ontario.
Thanks to that status report and the comments that emerged from the various discussions with our partners over the past few years, here are some of the findings and suggestions we’d like to share with you.
The topic that came up repeatedly — and, in our view, the Canadian government should play a leadership role in this area — is the need to identify a person’s language preference on the health card, in our case in Ontario, to ensure that they are served in French or given the choice, where possible.
People could make this choice beforehand, and when immigrants arrive in Canada, they would choose their language of immigration, French or English. It would be very simple to add this to their card or file, so that they can obtain services in French when they are available. It would make things easier, especially since the language question isn’t always asked at the reception desk.
In addition, it would be an excellent way for Health Canada to obtain data on francophone patients and gather statistics with which to make progress on other work points. It would also help newcomers understand that there are French-language health services in our regions and that they have the right to request them.
On the issue of the population in general, people are aging and they need health services more and more. This is a reality we need to keep in mind, while also taking into account the shortage of health care workers; the two realities intersect.
Francophones working in health care are also aging. That’s why it’s important, from an “immigrant lens” perspective, to address the issue of recognition of prior learning and diplomas, to enable foreign-born and trained health care professionals to offer services in French, to serve the people in French and to offer culturally adapted services, therefore with added cultural competence, thanks to the fact that they also come from different cultures.
We also need to make working in health care in French more attractive so that young people decide to study in the field. Once again, it’s important to have examples and models from immigrant backgrounds and cultures who are practising health care professionals; this is vital for young people from immigrant backgrounds. It enables them to see themselves in the future as doctors, pharmacists, surgeons, nurses and so on. So having someone who looks like them helps them project themselves into the future and become an integral part of our francophone health services in this country.
We also need to encourage physicians and health care professionals to go outside the major urban centres. The network has a mandate to regionalize immigration to help our small francophone communities maintain their vitality; however, if essential services such as early childhood services, but especially French-language health services, are not available in those regions, it’s very hard for us to fulfill that mandate.
Finally, I’d also like you to focus your thinking on the needs for mental health services in French across Canada, and of course in eastern Ontario. It’s important to have prevention services, awareness services — to counter taboos — an understanding of well-being and more formal mental health services. It’s essential that the services be offered in French, culturally adapted and respectful of the journey the person has just been through, whether they are an economic immigrant arriving before their family, who will join them in the months or years to come, a refugee from a war or conflict zone who is in a crisis situation due to their family being displaced or a lack of housing, or another of many more situations. We could go on and on about the mental health situation. If you have any questions, I’d be happy to answer them.
Thank you for your attention and I hope my talking points resonate with you this evening.
Salwa Meddri, Manager, Réseau en immigration francophone du Manitoba: Members of the Standing Senate Committee on Official Languages, thank you for inviting me to appear tonight.
My name is Salwa Meddri, and I’m the manager of the Réseau en immigration francophone du Manitoba.
One of our network’s mandates is to work with various organizations, institutions and levels of government to improve the francophone pathway for people from immigrant backgrounds. This pathway, which focuses on settlement services, is inexorably linked to health care.
As you already know, the issues identified in your study are interrelated. However, I’m going to focus on a few of them, namely the inclusion of language clauses in federal health transfers; the shortage of health care professionals in institutions that provide services to official language minority communities; and finally, the needs of francophone post-secondary institutions outside Quebec.
As for including language clauses in federal health transfers, designating certain sites as bilingual is a good start. However, this initiative must be reinforced with other measures.
The “by the community, for the community” approach often takes a backseat when budgets are being allocated in the provinces and territories.
It’s therefore crucial to encourage active supply and to equip ourselves with what we need to achieve that. For example, this could include a language proficiency test to assess the language skills of health care staff in health care establishments and get an accurate picture of the situation. Language performance indicators could also be put in place to evaluate and monitor the delivery of health services in both official languages. This would help to ensure that services are indeed offered equitably and efficiently.
With respect to the shortage of health care professionals in establishments providing services to official language minority communities, it’s important to point out a few key elements. I’ll use Manitoba as an example and benchmark. When we look at the workforce forecast in Manitoba up to 2026, among the sectors that will be in short supply, the health sector will have a rate of 69%. Among the 10 professions most affected by the shortages are nurse practitioners and psychiatric nurses, to name but a few. Nurses are number three on the list.
When it comes to vacant positions designated as bilingual, as part of a pilot project conducted in Manitoba in 2021, 52% of clinical positions within the Winnipeg Regional Health Authority, or WRHA, were found to be vacant or under-filled. It should be noted that clinical positions include nurses, mental health workers and social workers.
That brings us to the needs of francophone post-secondary institutions outside Quebec. Francophone post-secondary institutions outside Quebec face specific challenges in recruiting, training and supporting future graduates in health disciplines — and by that I mean people from francophone immigrant backgrounds. Those challenges include very demanding language admission criteria.
Strict language criteria often exclude potential students before they even have a chance to enrol; barriers also exist for access to nursing tests and for those who decide to take the plunge. I always use the National Nursing Assessment Service, or NNAS, and the requirements of the colleges in the various provinces and territories as an example, so there are major issues and obstacles to overcoming this barrier.
On the other hand, some potential solutions could be considered; in particular, barriers could be eliminated by simplifying and standardizing procedures for foreign-trained health care professionals to facilitate their integration into the Canadian health care system.
We could also develop partnerships with foreign countries to offer training that would be recognized right away in Canada, instead of making people start the process over again once they arrive in the country.
We could also offer incentives for francophone employers. There are francophone employers outside health care establishments, because some private sector organizations are potential employers and they recruit this skilled workforce.
Providing incentives to recruit qualified francophone staff and supporting employers through these steps could therefore be another avenue to consider. As Ms. St-Hilaire also mentioned, cultural competency training is certainly another challenge that needs to be tackled in parallel, to support current and future health care providers.
To achieve this, cultural competency training should be made mandatory for health care professionals to help them explore their values and attitudes towards their patients’ cultures. This would promote more effective communication and reduce the uncertainty and misunderstanding that sometimes lead to clichés and stereotypes.
As you can see, the immigrant population plays a dual role: It can contribute as a skilled workforce to the health care provided to the general population, but it’s also a beneficiary as a vulnerable community.
Thank you for your attention, and I remain available to you for any further questions or discussions.
The Chair: We will now go to questions.
Esteemed colleagues, being mindful of the time available to us, I propose that five minutes be given to each person for an initial round, including the question and answer.
I’ll start with Senator Mégie; the floor is yours.
Senator Mégie: I’d like to thank our witnesses for being with us.
Ms. St-Hilaire, you’ve proposed some very good solutions, but I’m not sure how the federal government could get organized to move all those issues forward.
I have another subquestion. Regarding someone’s preferred language being indicated on the health card, it seems to me that other witnesses have told us at other meetings that people were reluctant to identify themselves as francophones so as not to have the mental burden of being responsible for speaking French in their clinic.
Since it’s not really the role of the government, is there another way or are there other incentives that community organizations or others could work on?
Ms. St-Hilaire: You mean there are patients who feel uncomfortable having —
Senator Mégie: No, not patients, health care professionals they are trying to identify as francophones to ensure distribution in the communities. That would show who is receiving services in French. However, they are reluctant to identify as francophones.
Ms. St-Hilaire: First, that proves that being a francophone in an English-speaking environment often leads to loneliness, because you find yourself being asked to meet every need for service in French, which is often very cumbersome; I get that.
It also shows that we need more people working in health care who can speak French and serve patients.
In immigration agencies, when people start working they often ask them what languages they can work in, because sometimes they welcome people from abroad who have chosen French as their language of immigration but would be more comfortable in Arabic, Spanish or other languages.
That comes naturally to us in the community sector; so I think it would be worthwhile if everyone in health care could be identified based on the languages they can speak.
If there’s a heavy workload in terms of serving everyone who requires care in French, in my opinion, that’s an opportunity, not a problem situation. They should take advantage of that to get more members who speak French, instead of simply saying that it shouldn’t be indicated — if I understood your question correctly.
Senator Mégie: Witnesses told us so.
Ms. St-Hilaire: That’s fine; I get that.
Senator Mégie: I have another question.
Making things attractive once again falls on the community sector; governments don’t do it. However, isn’t the incentive to move to the regions a provincial government responsibility, not a federal one? How is that done in Ontario?
Ms. St-Hilaire: It can be the provincial government, yes. Technically, health care is a provincial jurisdiction.
In my opinion, to a certain extent, making a community attractive is also about promoting Canada as such, promoting French abroad and promoting our communities abroad; it’s a way to attract talent from our regions and abroad.
Again, if those individuals are selected for their skills, experience and diplomas, and we don’t necessarily recognize them, they have to start all over again so sometimes they have to choose a location where it is easier.
If we make it easier to have diplomas and prior learning recognized, then we can promote outside the major urban centres. Obviously, if they come here knowing they are going to have to go back to school or do something else, they’re going to move closer to the places that have post-secondary institutions — usually the larger urban centres — so they are going to move there as a family and stay put.
Senator Mégie: Actually, we’ve heard from other witnesses that when someone immigrates to Canada, even though they are told they will be part of the francophone community, that they will be welcomed and all of that, apparently the forms they have to fill out and the exams they have to take are all in English. What do you think of that?
The Chair: Ms. Meddri, would you like to respond?
Ms. Meddri: Certainly. This refers back to an example I gave earlier of the outright exclusion of francophone candidates in the health care sector. Again, if I take the example of foreign-trained nurses, they’re required to pass two levels of testing. The first is at the federal level and it’s administered in both official languages, French and English. Hold on to your hats: That test is administered by an entity in the United States. It’s even paid for in U.S. dollars. The second test is administered by the colleges that govern the provincial or territorial accreditation standards. It’s administered by these colleges under provincial or territorial jurisdiction and it’s subject to their discretion, willingness and ability to offer the test in both languages.
That said, the language issue keeps coming up because the people we spoke to told us they weren’t able to pass that language challenge. Even the technical vocabulary hadn’t been translated for the tests offered in French. The translation was not adequate enough to allow the individual taking the test to complete it in the official language of their choice. That’s one thing that’s been shared with us.
Senator Mégie: Do you think a government entity could do something about that?
Ms. Meddri: The point is precisely to standardize the approach in terms of testing. For example, if you were to take things upstream and think outside the box, if I can put it that way, it would be worthwhile to have agreements with international colleges to offer programs that meet Canadian standards. That way, the compliance criteria would already be eliminated. As a result, the same program administered here in Canada would be administered abroad. This would help people pass the tests, obtain the same qualifications and be assessed based on the same criteria as candidates here in Canada.
At the same time, we can all agree that in a minority context, especially for francophones, English is a necessary evil. When I talk about providing support measures, I’m referring to support for employers. They could provide incentives, such as on-the-job English learning opportunities and mentoring and coaching programs, so that people can practise English on the job, learn on the job and, of course, be functional and operational.
We’re not forgetting that there are also employers with fully French-speaking sites; however, to obtain the certifications and license to practise the trade, you need to have an English‑speaking qualification. We need to start looking at employers who are 100% French-speaking, and explore that potential so as to build and capitalize on it, in order to offer and extend that pilot project or initiative to other stakeholders and other employers, and by extension to other sectors.
Senator Mégie: Thank you both very much.
Senator Poirier: Thank you to both witnesses for being with us. You’ve mentioned many of the things we’ve heard from other witnesses, such as workforce challenges and shortages in various health care positions. You also made suggestions for improving credential recognition for French-speaking foreign professionals in minority or bilingual communities.
I’m going to ask my question from a different angle. There’s been a lot of talk about the labour and skills shortage, and what we can do to change it, but my question is more about immigrants coming into the country. Can you share with us the main challenges immigrants face in francophone minority communities in Manitoba and Ontario? When they arrive in these communities, what do they experience? We know there’s a labour shortage, but what are the other challenges? I’d like to hear from both witnesses.
Ms. St-Hilaire: You’re talking about the health challenges facing francophone newcomers to our communities. Like everywhere else, we usually bring them in as economic immigrants or as entire families. The goal is to have a generation with us. They arrive with their families, and they’re often looking for a family doctor. They come with young children or elderly parents.
Understanding the country’s health system starts with the family doctor; then there are professionals or specialists. The family doctor is the direct entry point to health professionals. Then, of course, there’s everything relating to mental health needs. There are new programs we want to put in place — or at least are trying to — such as working with settlement organizations to refer people to mental health services when needed.
These people have basic training in mental health first aid, but as soon as the situation becomes more complicated, we need to refer them to professionals. Newcomers arrive with a wide range of experiences. As we were saying earlier, it could be trauma that happened in their home country or trauma due to moving with their family to a new place where there might not be any affordable housing. Perhaps they don’t know where to find work, whether they can study or whether their education will be recognized. It’s a stressful situation that can affect anyone.
That’s what mental health needs are all about. If we think about other health needs, I know we’ve talked about some physical health needs, but there’s also everything from nutrition to violence against women.
All those families arrive with similar needs, if we’re talking about the general immigrant population, but it’s a different kettle of fish when we’re dealing with refugees. This is the only immigration class that can arrive in Canada with major health needs. When they arrive, their files often contain a list of health issues. They often need to see a specialist for a specific health issue. There’s a whole list. When they come to a settlement assistance program, like the one in French in Cornwall, they come with a list of needs. These are also people who, again, need mental health services.
Consequently, these families need a number of French-language services. We want French-speaking immigrants, we want to welcome them, we want them to settle here and feel comfortable. They need to be in good health to do that and they need access to those services.
The Chair: Thank you. Ms. Meddri, did you want to say something?
Ms. Meddri: Yes, to add to what Ms. St-Hilaire said about French-speaking immigrants. They need access to French‑speaking doctors, period. Now, the challenge is to bring that nuance and clarification to the health care system, to the way it works and the difference between the countries of origin of the immigrants we serve here in Manitoba and the Canadian health care system. We’re thinking in particular of the role that nurse practitioners can sometimes play to complement or replace family doctors who aren’t available.
We’re highlighting some of the health services available in French. Clearly, there’s a shortage of places to obtain French‑language social services in Manitoba. For people who dare to ask for mental health counselling and support services, access to French-speaking social workers and therapists isn’t easy. The waiting list is very long in Manitoba, even at the one place offering services.
Manitoba has a settlement assistance program for refugees. We have an agreement with an organization that looks after the primary health of government-sponsored refugees. Once accepted, they’re referred to this organization, which assesses their health.
The parallel challenge is to get all pharmacies to recognize federal medical coverage. This work is done on an ongoing basis with pharmacists, to try and explain to them that this coverage exists and that it takes effect on such and such a date, so that they can provide refugees with access to the medications they need.
Another challenge is making pharmacists aware of the various documents issued by the federal government.
Senator Poirier: What role do you think the federal government should play in improving access to French-language health services for immigrants when they arrive in our communities? What else could it do in the immediate future to help immigrants arriving in Canada?
Ms. Meddri: That’s where the active offer comes in; I mentioned incentives earlier, to which the federal government could attach indicators or conditions when transferring funds to the provinces. The government could make sure that there are required eligibility criteria. It could allocate a certain portion of the budget for French-language health care to the provinces and territories, so that this care isn’t dependent on the goodwill or colour of the government in power at the time the funds are allocated.
This would help guarantee the active offer of French-language services in the provinces and territories.
Ms. St-Hilaire: I completely agree with Ms. Meddri. I’d also like to add that it would be interesting for the federal government to fund the community sector from a health perspective. Often, organizations assisting French-speaking immigrants and seeking funding are referred to Immigration, Refugees and Citizenship Canada (IRCC).
Immigration also affects employment, education and health. These people who come to this country have needs, and they are recipients. If Health Canada or other government departments could provide funding and enter into collaborative agreements with non-profit organizations to work together, be it in mental health or at medical clinics, this would ensure the provision of direct services, and the process would be a little easier for newcomers. At the very least, newcomers would have a first contact with the French-language health care sector, which would also ease the workload. It would be a good idea for these people to have access to this gateway with funding to connect to this type of service.
Of course, it would be wonderful if there were a lot of services available. I’ll just say that I know some organizations serving the francophone population would like to have someone in-house to help newcomers and direct them to services. When you arrive with your family or go through a pregnancy, you’re told what the next step is and who you need to see. If we could have services or programs to bridge the gap between immigration and health, some organizations might be willing to consider that option.
The Chair: Before giving the floor to Senator Moncion, I’d like to ask a follow-up question on this subject; my question is for both witnesses.
You talk about the challenge, in a way, of having a concrete link between the immigration sector and the health sector, at all levels of government. What’s your assessment of the degree of collaboration, for example, between IRCC and ESDC, or ultimately Health Canada? Can you tell us about the degree of collaboration between the provinces and the federal government on these issues? What can you tell us about that?
Ms. Meddri, on the one hand, you spoke to us about language clauses and, on the other, about bilateral agreements. In fact, there’s information to the effect that the immigration and health sectors work in silos. Could you tell us about the challenges and possible solutions you see in that respect? I’ll start with Ms. Meddri, followed by Ms. St-Hilaire.
Ms. Meddri: Thank you very much. Clearly, this is something that the federal government, including IRCC, is becoming increasingly aware of, in the sense that the goal is to work more collaboratively with other levels of government and other departments.
Of course, we’re not going to dissect immigrants by portfolio. We’re talking here about the needs of individuals; the sphere of needs is broad and it certainly touches on the respective mandates of each department.
Over the years, we’ve seen IRCC and ESDC collaborate on initiatives. We want to invite entrepreneurship to create innovative initiatives; similar approaches exist in the housing sector, for example; it’s something the department is working on.
However, it’s something we need to encourage other government departments to do more often. As for collaboration between the federal government and the provinces, there are talks. However, the way in which that translates concretely on the ground is that, to date, there’s no visibility or feedback on those things.
Ms. St-Hilaire: Indeed, in the field of employability and economic development, we’re starting to see more and more interest. I think this is due to the situation. It might be a good time to develop this health care agreement.
I know that the new francophone immigration policy launched last January indicated that one of the priorities is to encourage discussion between the different levels of government and between departments, with a view to ensuring greater coordination. That’s something we’re happy to hear, and we can’t wait to see the results.
I don’t think there have been any projects that combine health and immigration or that benefit organizations on the ground that want to help newcomers. I’d like to point out something that we weren’t prepared for and that we thought was great. It’s IRCC’s new request for proposals for 2025-30, which closed at the end of January. This funding request for subsidized settlement organizations was an opportunity to participate in the settlement of francophone newcomers and to offer short-term counselling services.
At that time, I know that francophone settlement agencies in our regions raised the fact that they don’t specialize in the field. They can’t necessarily offer that service directly to newcomers. They would have preferred for mental health agencies to obtain the funding IRCC was offering to develop a services branch or even to employ other people to serve the French-speaking immigrant population. Since it was a request for proposals managed by IRCC, only organizations that worked directly with francophone immigration could more easily obtain the funding.
We worked to set up a collaborative multipartite project in which the three francophone organizations in the eastern Ontario region all applied for a joint project aimed at recovering funding to enable francophone mental health organizations in those various regions to hire staff to serve people according to the targets we identified. The project has been submitted. Will we see the results? We don’t know.
In discussions with francophone settlement agencies and francophone mental health organizations, we realized that the problem was that the term “short-term counselling” didn’t mean the same thing to IRCC as it does to health care. Short-term is not the same length of time, nor does it offer the same diversity of services. We had to make sure to change the vocabulary and our understanding. We wanted to put an “awareness” section back in because these services can only be offered if people fully understand what mental health is in a wellness system; it’s not just a person who’s not doing very well.
We had to go back to the drawing board and work on something that might be a situation. We thought those small steps were a very good first step, but it made things tricky for a major call for proposals, where a new box could be added. Still, we had to make the most of the opportunity, so we put as much effort into it as we could. That was from IRCC. Could it come from another department, such as Health Canada? For sure. Why not let francophone immigration organizations work with francophone health care organizations to submit proposals? I think that would be beneficial, and it would enable us to be more directly and meaningfully connected to the needs on the ground. We’d be able to anticipate some of the more significant needs that might emerge in the future if we served the entire immigrant population when they arrive in the country. We would be able to evaluate needs. Why not evaluate health needs and orient immigrants right away?
The Chair: Thank you. That was very clear. Thank you for your remarks.
Senator Moncion: Still on this topic, I’d like to dig a bit deeper. Can you comment on collaborative agreements, given that organizations often work in silos? Every region figures out how many doctors and nurses it needs. You have a pretty good idea of the needs in each region, and I imagine someone does the math to determine how many professionals are needed to meet the needs in each region or province.
Can you comment on what kind of coordination happens around those numbers and where the educational institutions are at? We often look at the funding the federal government sends to provincial governments for education. Colleges and universities receive the funds, and then there are programs with limited enrolment that allow only a certain number of people to register. I’d like your thoughts on that coordination. Does someone have a sense of the needs and how to meet those needs everywhere faster? I’m talking about the kind of coordination where everyone works together to solve certain problems. I’m talking about your province and Manitoba, and the work they’re doing on that.
Ms. St-Hilaire: For Ontario, any assessment of health care needs isn’t necessarily done at our level. There are health care networks that inventory needs in the regions and determine what’s needed and what’s problematic pretty much everywhere. In our case, we don’t necessarily see the exact figure or number. All we see is what’s happening in the community versus the needs. That makes for a lot of frustration within the francophone community, because people want services in French, but it’s hard to access primary health care. There are family doctors, but accessing specialists who speak French is another problem.
As to figuring out needs in the province, I’m not in a position to give you a number. All I can tell you is that services are lacking, especially services in French and in the regions outside of major centres. That’s how it was explained in the general approach. Our main role is to work with what immigration needs and can provide, so if we talk about the principle of post-secondary educational institutions and quotas, we don’t have all the information. If people want to register for programs from abroad and are denied, we hear about that, because some of the answers people get aren’t necessarily the ones they want for the francophone community and international students and so on. All we have is a general impression from the community that health care in French is, for all intents and purposes, practically unavailable to newcomers.
Senator Moncion: Perhaps I’m not explaining myself well. You represent a large territory. How many doctors are you short in your territory? Do you have that figure? How many nurses are you short? Of course, it has to be done by territory or region, but then the province still needs to have accurate information on this shortage and these needs. Then, how do we work with universities and colleges to start filling those needs more quickly? We’re still working in a very compartmentalized way across the board. I guess it’s easier to manage small projects than to look at the big picture and adopt more concerted approaches to become more effective.
Are you involved? Do you provide figures? There’s a shortage of professionals, but has anyone done any accounting? A doctor appeared and told us that Canada was short 137,000 nurses. Okay, we’ve got a figure. Now, how do we work with the universities to fill the gaps? Is there any work being done in Ontario or Manitoba to help us solve the problem?
We’re talking about a two-tiered system where some doctors are no longer part of the public health system and have opened private practices. How many private practices do you have in your regions? How many people no longer use the public health system and pay for access to a doctor? It’s important that you have these statistics. You talked about health cards that would show certain data if they were identified — I’m sure the provinces don’t want to do that, because they don’t want to know the figures — and that would also show the data needs.
The Chair: Does Ms. Meddri want to chime in?
Ms. Meddri: I can give the Manitoba perspective. There are certainly workforce projections, both generally and by sector. Depending on the period, the anticipated shortages, in terms of forecasts for sites that are designated bilingual, is work that’s done at the board level. They have these statistics and projections to make forecasts, in particular to fill the workforce by region, the challenges and the opportunities they represent.
How does that translate into training in universities? This is something that’s taken into account in our region, to the extent that this is how additional spaces were allocated to the Université de Saint-Boniface, Manitoba’s francophone university, to provide additional spaces for health care students in Manitoba.
Where and when do community organizations come into play? For the province’s forecasts, it’s a matter of always trying to attract the attention of specialists and keeping in mind that francophone lens, because that’s something that’s very important for us. The challenge is that, relative to the absolute numbers, our realities and our numbers are granular. As a result, it becomes difficult to provide estimates or even to identify and give accurate evidence for a sector. For example, if we can talk about regionalization, about gaps by region, it becomes a bit difficult and complex at that level.
We need to work with other stakeholders, particularly the boards, to take into account the needs of the francophone workforce during training, of course, but we also need to see how the needs and profiles of immigrants can also be taken into account in this range of training and support. We need to see what profiles we have, what the barriers are, how we can get around them and what innovative ways we can use to better support these people so they can come to our country. This is in response to a societal problem: an aging population and an increasingly glaring workforce shortage at all levels, especially in the health care sector. We are privileged to see initiatives starting to emerge, particularly here in Manitoba, thanks to funding from Health Canada, with employers in the field. There is an impact on the ground because of the fruits of federal-provincial collaboration and with community stakeholders.
The Chair: Okay. Thank you.
Senator Clement: Good evening to both witnesses. Thank you very much for your testimony.
I really appreciated my colleagues’ questions. I had the same questions. I’d like to come back to the community issue. We’re in the process of carrying out a very interesting study, and we’ve heard some remarkable testimony. I’m working on some recommendations for the final report. What interests me is the fact that the community seems to be filling gaps. What you said earlier, Ms. St-Hilaire, about funding for community organizations and the example you used in response to Senator Cormier’s questions, the short-term counselling, the call for proposals…. Did the federal government consult you before issuing this call for proposals? Would that have been a sensible way to get funding in a community context?
My other question is for Ms. Meddri. You mentioned mandatory cultural competency training. I’d like to hear a little more about that. Also, I wonder if you could comment on what you’re hearing on the ground about systemic racism in the health care system. Are your clients, stakeholders, and people talking about this? Is this an issue that concerns the communities? Ms. St-Hilaire?
Ms. St-Hilaire: Thank you for the question.
Did the government consult us about the call for proposals? Not necessarily a formal consultation, no. However, I believe the pandemic exacerbated all mental health issues. It’s a topic that’s been discussed, and several components were added to this year’s call for proposals, which was different. We’re talking about truth and reconciliation, we’re talking about GBA Plus, we’re talking about several components that were added this year to meet the needs of the population and the community sector, needs that have been raised over the past five years, in the last call for proposals, which ends in mid-2024.
I think it was more a reaction to a test to see how the process could be set in motion in the communities and in the community sector and to see how people would use this type of service if we decided to add it. With the settlement agencies, we decided to work with other community mental health organizations to adopt this approach, but there are many ways to use this tool, which is now available in the call for proposals. Perhaps it was an attempt to assess that possibility.
If we had been consulted, would we have asked for even more? Probably, because that’s a good thing. However, this type of call for proposals is rarely expected to include much that is outside of direct scope of IRCC. For us, it was a really interesting opportunity. We decided that we had to move forward as much as possible. We all want to say that, if it works well, there will be a follow-up, that it will be possible to have more services and several types of services within this project, within this small note, because it wasn’t necessarily an important section of the call for proposals, but a small possibility that we’ve all noticed. The vocabulary used in the call for proposals talked a lot about mental health, the well-being of newcomers and everything that happens around the integration process.
Senator Clement: Would a consultation have been worthwhile?
Ms. St-Hilaire: Probably.
Senator Clement: Do you have forums where the federal government comes to the community to say that it’s bringing everyone together and that it’s going to tell you about its intentions?
Ms. St-Hilaire: There are consultations for certain projects. There have been some recently. When we find that the discussion isn’t sufficiently developed, we also talk about it, and they offer us possibilities. They also come to our various forums. Last summer, a provincial forum took place in Ontario, and there was a delegation. Eight or ten people from IRCC took part in the various workshops and presentations during which they presented good practices or needs that they wanted to highlight. There were probably a number of things they noted at the time. We feel relatively listened to.
However, we’ve never really pushed hard for more health services through IRCC. We know very well that we can try to have a little more funding services through IRCC for employability; we can get a little, but to a certain extent, because that’s not just for that department. However, working with a number of departments could open some very interesting doors. If there were a consultation with Immigration, Refugees and Citizenship Canada and Health Canada to approach community organizations to determine whether they’re interested in building something together, you’d have a lot of people around the table.
Ms. Meddri: I’ll jump in regarding the second part of your question, about mandatory cultural sensitivity training and the racism aspect.
It’s definitely something the community sector could support. I suggested it because of what we heard from health care workers in 2021, when we asked them whether they felt ready and equipped to provide the immigrant community with health services, be it primary care or mental health care. The short answer was no. That is why cultural sensitivity support is absolutely necessary and should be mandatory.
You expressed quite explicitly the point I made in a roundabout way, which is that some health care providers think in terms of clichés and stereotypes. As a result, the people we work with tell us about situations of discrimination and systemic racism that they’ve experienced in the health care sector, experiences that others share. That emerges quite clearly in what we hear from people.
Certainly, cultural skills training makes it possible to provide that support, giving health care providers the benefit of the doubt because it’s assumed that they want to do their jobs well. The idea is to make them understand that just because someone is different, they aren’t any less capable of dealing with their health, caring for their children — and the list goes on and on.
The Chair: Thank you very much. That concludes this panel.
Ms. Meddri and Ms. St-Hilaire, thank you both for your participation, your observations, your suggestions and your recommendations, which will all be very helpful when it comes time to write our report. Above all, thank you for the work you’re doing on the ground in your respective provinces. We appreciate the significant challenges you face, but it’s clear how enthusiastic and passionate you are about serving your communities. Your work is invaluable and very inspiring to us all. Our thanks to the both of you.
[English]
Colleagues, we are resuming the meeting to continue our study on minority-language health services. We have some witnesses suggested by the Community Health and Social Services Network who are here to recount their personal experiences as users of minority-language health services in Quebec.
We now welcome, in person, Mr. James Robson, Patient Navigator, Committee for Anglophone Social Action; Ms. Brittney Chabot, Executive Director, English Community Organization —Saguenay-Lac-Saint-Jean; and Chloe Régis, stay-at-home mother. They are accompanied by Jennifer Johnson, Executive Director, Community Health and Social Services Network. Welcome to you here in the Senate.
By video conference, we welcome Steve Guimond, Patient Navigator, Community Health and Social Services Network; Kayla Kippen, Director of Health Initiatives, Lower North Shore of Quebec, Coasters Association; and Mr. Hugo Bissonnet, Executive Director, 4Korners. Welcome, and thank you for being with us. Let’s start with opening remarks.
Mr. Robson, the floor is yours.
James Robson, Patient Navigator, Committee for Anglophone Social Action, as an individual: Mr. Chair and members of the committee, thank you for having me today. I am happy to have the opportunity to share some of the challenges that our English community has living in Quebec with regard to access to the health care system.
As said, my name is James Robson. I am a patient navigator for a community organization called the Committee for Anglophone Social Action. I help our English population access health care and go through the whole process when there are language barriers, so there is quite the great need.
Today I have three stories to tell you. One of them is personal and two of them are from what I have seen in my job. I will start with a woman who was one of the first people that I helped. She had to have treatment in Rimouski Hospital, which is about four hours from where she lives. A lot of times, in the Gaspésie, the region I work in, we have to travel quite a bit any time we want to go anywhere, especially for health care services.
She contacted me. She was extremely nervous to go to Rimouski Hospital. She had never been there before. She didn’t know where she was going. I asked her if she would like me to be there with her and she gladly said yes. Prior to that, she had explained that she hadn’t been sleeping for weeks.
The day after I told her I could be there, I called her to confirm some details, and she said, “James, last night I slept.” This was very significant to me because the stress of having cancer and going through the treatments was not what was keeping her from sleeping. Rather, it was the stress of knowing that she’d have to go to a hospital where nobody would be able to speak English to help her get through and that the signage in the hospital wouldn’t help her either.
My second story is about a social worker who I work with in the area. She called me concerning somebody whom she had been trying to help for months, and it was still unclear to her what that person needed. I went to speak to the person. Half an hour later, I left their house, drove back to the social worker’s place of work and plopped a list down on the table of all the things she needed. After months of work, this person didn’t get access to health care. It was something I did in half an hour because I could speak English. That’s months of not getting the health care they deserve. That doesn’t sound equal to me. That’s a problem.
The third one is my own personal experience. I was a paramedic before I became a patient navigator and chief of operations in our region, so I know the health care system quite well. I was taken off the road in 2019 with PTSD. It was a harrowing experience, to say the least, but luckily I knew the system quite well and I am also bilingual. I was able to get a lot of the help I needed, but when dealing with mental health, it is so intricate and different for everybody, so you really need to be able to explain yourself well. I requested an English psychologist. I was unable to get one. I had to go to New Brunswick to find myself one, along with the other professionals I was working with. Along with being able to access an English worker, which I could not do in Quebec, along with being bilingual, along with knowing the system, I still hit rock bottom. If I had been a unilingual anglophone in the area, I don’t know that I would be here today talking to you.
It is an honour to serve the anglophone population. I hope I did them justice today. I would like to finish by saying that I was very nervous about today. People often ask me if I am nervous about certain things, and I always like to answer, being a former paramedic, “Is anybody going to die?” And with my PTSD, I try to work on not getting anxious or stressed about things that don’t matter. But when it comes to life and death, I do get nervous, and I can tell you that today, I am nervous — it is a matter of life and death. Thank you.
The Chair: Thank you, Mr. Robson. I will turn now to Ms. Brittney Chabot. The floor is yours.
Brittney Chabot, Executive Director, English Community Organization — Saguenay-Lac-Saint-Jean, as an individual: Esteemed members of this committee, my name is Brittney Chabot, and I would like to thank you for the opportunity to share my personal experiences with the Quebec health care system today, as well as share the sentiment of the community that I serve in my role as the Executive Director of the English Community Organisation of Saguenay-Lac-Saint-Jean, known as ECO-02.
I have been fortunate, through my husband’s job in the Canadian Armed Forces, to have lived all across Canada — in Ontario, where I was born and raised; in Alberta from 2014 to 2016; in Saskatchewan from 2016 to 2021; and now in Quebec, where we have lived in Saguenay and have since July 15, 2021. Having experienced four different provincial health care systems, I can say with absolute confidence that of all the times I have sought and obtained health care across Canada, Quebec has not only been the most difficult to access but also the most limited in access.
Before I arrived there, I was warned by fellow military spouses living in Quebec that if you spoke English, the hospitals would either ignore me or refuse me services and I would be treated as a second-class citizen. I chalked this up originally to stereotypes, as my husband is Québécois. Not only did I learn that this is the truth, I now guide others through the often difficult terrain of navigating this challenging health care system.
My first experience with the CIUSSS was on April 1, 2022, when I ruptured my Achilles tendon. With my husband out of the country for work, I decided to join a local intramural rugby team to make friends. During a practice, my body went in one direction while my foot stayed in the same place. I was transported to hospital in Jonquière by a fellow player, and upon arrival, I asked for an interpreter. I was informed over and over that, “There are no interpreters.” I reminded the triage nurse that the CIUSSS pays for access to the National Translation Bank and that I have the right to be treated in English, as per the 12 user rights. I was told that that is only for appointments, not for emergencies.
Because of this refusal, what was a 15-minute triage became 40 minutes because I had to think about how to describe what happened to me and how my body felt before translating it into French and using parallel metaphors and roundabout comparisons. I was forced to play this game of “related words” multiple times over the course of the evening before being discharged alone, without crutches, and told, “Good luck,” with nothing but a referral to a surgeon.
[Translation]
At this point, I’d like to show you that, even though I speak French quite well, I will never be fluent enough to discuss my physical or mental health with a medical professional in a nuanced way.
In June 2023, I decided that it would be better for my mental health to resume the anti-anxiety medication I used to take. I needed to have my old prescription renewed, so, once a week, I would call Info-Social 811 to try to get a doctor’s appointment. I always got through to a bilingual nurse, but would then be told that a nurse in my region would call me to discuss the matter further and book an appointment.
When a nurse in my region would call me back, she could never speak English. I would spend 40 minutes on the phone, trying to explain my situation in French, but was never offered an interpreter. This is how the phone call always ended: “Sorry, madam, no appointments are available in your region. If you hurt yourself, go to emergency.”
[English]
My breaking point was when, on the fourth attempt, the nurse who called me back told me, “Please stop calling. There are no appointments. We cannot help you. If you think you’re going to hurt yourself, go to the hospital.”
The only reason I was able to receive mental health care was because, as a military spouse, I was able to access a special pilot program offered by the Bagotville Military Family Resource Centre. They had received special funding for the 2023-24 fiscal year to cover the appointment costs of private clinicians so military family members could receive immediate mental health services. To be clear, I was only able to access this mental health service due to my status as a military spouse and because of a specially financed pilot project that was limited and run by the Bagotville MFRC.
[Translation]
From the outside, you might think my experience with the health care system was merely inconvenient, highlighting the fact that you have to speak French well if you’re going to live in Saguenay. However, ladies and gentlemen, think about this: I’m virtually bilingual, so if I have trouble explaining myself in French when I’m hurt or sick, imagine what it’s like for someone whose French isn’t very good.
The English-speaking community in the Saguenay—Lac-Saint-Jean administrative region may be just 2,150 people, or 0.8% of the population, but we all need access to health and social services.
The biggest problem I encounter is that front-line workers are in the dark about the services that are available. While far from adequate and challenging to access, supports do exist. Nevertheless, we face a lack of respect, a lack of services and a lack of access because the available information doesn’t get where it needs to go.
[English]
Members of this committee, I would ask you to please work on developing an action plan that integrates and supports better communication between departments, management tiers and staff to ensure a base knowledge of available resources to service the linguistic minority, whoever that may be. Studies have shown that health outcomes improve when individuals are able to communicate in the language they are most comfortable.
I look forward to continuing my work advocating for the English-speaking minority in my region and assisting our local health care network with improving access across the board. Thank you.
The Chair: Thank you, Ms. Chabot. Ms. Régis, the floor is now yours.
Chloe Régis, stay-at-home mother, as an individual: First, I would like to thank you for inviting me to share my experience before this committee meeting. While I live in Chicoutimi today, I immigrated there from Virginia in 2019 to be with my husband. I am a wife and a mother to three young children.
As a newcomer to Canada, I expected some cultural adjustments. However, the most profound and persistent challenge I have faced has been navigating the Quebec health care system. During my testimony this evening, I will be highlighting my experiences as a pregnant person with health care professionals and their attitudes.
I would also like to mention that due to the trauma of my experiences with the health care system, my family has been forced to make the difficult decision to move away from the only home my husband has ever known.
Twice I have given birth and twice I have been failed by Quebec. Both times, I was discharged without any documentation, and my husband was forced to be the middle man in either sourcing that information or contacting the necessary specialists after the fact.
My first pregnancy occurred during the COVID-19 pandemic, and I was left to navigate prenatal care alone due to the restrictions, on top of being denied access to translation services. Induced early, with no communication, I will never forget the five medical professionals swarming around my hospital bed, shouting at me in French, trying to get me to change positions while looking fearfully at my husband each time as he tried to direct me.
A few hours after my son was born, he was transferred to Québec City due to seizures without me. I was left to cope with the physical and emotional aftermath of giving birth in isolation, with no tools to kickstart lactation after being separated from my baby. Fourteen hours after giving birth, I was forced to travel two hours away from my home to be with my newborn with no sleep, in pain and distressed over my son’s condition.
My husband and I decided he would have to communicate with the new care team, as I couldn’t, and so I was left alone to process all of this on my own again. Nurses refused to pay me any attention, making it difficult and anxiety-inducing to try and call for help. When I did attempt to request an English-speaking nurse, I was berated and told it was a ridiculous request.
When I learned I was pregnant for the second time, I went to the emergency room with concerning symptoms. I was told that things were fine, but I had to come back the next day for more blood work. My husband asked multiple times if there would be a translator, and we were told “yes.” But once again, when I arrived, no one could help. My husband spent hours on the phone, from home, trying to find out more while I sat in the emergency room with no direction. Eventually, Dr. Mélanie Rowen informed me that I was likely miscarrying, and I would need to wait another week to confirm.
After the hospital declared my miscarriage complete, I suffered for the next four months with increasingly more frequent periods of significant bleeding. I called the hospital multiple times only to be repeatedly ignored. Finally, Dr. Rowen called me back and, while dismissive of my symptoms, agreed to send me for an ultrasound, where it was discovered that my miscarriage was, in fact, still ongoing and I would need another procedure.
During my third pregnancy, I had several panic attacks before appointments, fearing a repeat of my previous experiences. There were five doctors on my care team, as my pregnancy was at high risk for twins. When I asked about delivery plans early to avoid another traumatizing induction, I was told, “You don’t get to decide how you give birth,” by one doctor and that I “wasn’t thinking of my babies’ well-being” by another.
It was Dr. Suzie Dubois, the only care provider to speak to me in English for the full appointment, who made me feel seen and heard as a patient. She listened and took my concerns seriously, and made me feel like my opinion mattered.
My daughters were born premature, and during the emergency C-section, I had a panic attack on the table. Afraid and alone, I tried to ask for my husband to be there, and the doctors instead tried to begin the procedure.
As my daughters are twins, it is unknown if they were fraternal or identical. Dr. Dubois mentioned getting them tested, but when I asked their pediatrician, I was told, “That test doesn’t exist.” I later learned this was untrue, and that, instead, the test was simply not covered by RAMQ.
These experiences have taken a toll on my physical and mental well-being, and instilled a deep sense of anxiety and distrust in medical professionals. During the most sensitive moments of my life, I have been made to feel like a burden rather than a human being in need. Now, my family will be moving near Thetford Mines for a fresh start as I hesitate to seek care without my husband present to translate. Now, I worry about my children’s well-being in a system where I cannot confidently advocate for their needs, as medical terminology and nuance will always be difficult for me, even with basic French proficiency.
I urge Quebec health care providers and policy-makers to prioritize language accessibility and cultural sensitivity. No one should endure the experiences I have faced. Every individual, regardless of their language, deserves compassionate, comprehensive and quality health care.
Thank you.
The Chair: Thank you, Ms. Régis.
Ms. Johnson, do you have an opening statement? Please go ahead.
Jennifer Johnson, Executive Director Community Health and Social Services Network: Thank you for the opportunity to come and speak to you today regarding the challenges faced by the English-speaking community in Quebec to access English‑language health and social services.
I actually came here last year and did a presentation here, but you’re not likely to remember.
As you have heard a couple of times during your study, language non-concordance between the patient and the health professional can have severe consequences, as Chloe has just described. The ability to express your health concerns and understand the diagnosis and treatment of your illness is primordial to good health outcomes. Language barriers can create poor patient assessment, misdiagnosis, delayed treatment, increased medication errors and many other undesirable outcomes, including, in extreme cases, premature death.
You will be hearing today from several representatives of the community who will speak about those challenges that they face in accessing services. To help you understand their experiences more, I want to give you a quick resume of how English-language health services are organized, as that might put things in better context.
First, the provincial government has approved access plans for each CIUSSS territory, and those plans identify which services should be available in English in each of the institutions. These access plans are available on the websites of each of the CIUSSS, but they are very difficult to find and often not easy for a patient to understand. It is up to the CIUSSS and the local community organizations to ensure that the community understands what services are available and how to access them. This is a constant challenge for all involved, in particular because institutions cannot make an active offer of service.
There are 69 institutions in Quebec that are identified as “designated,” which means that all of their services are offered in both English and French. Of those 69, 37 are located on the island of Montreal. Of the remaining 32 institutions of the island of Montreal, 10 of them are long-term care facilities and rehabilitation centres. Of the 22 remaining, 9 of the sites are small CLSCs in the villages of the lower North Shore, serving a very isolated and largely unilingual population. Another eight CLSCs are serving the Outaouais region. That leaves five institutions covering the rest of Quebec.
As you can imagine, that means the vast majority of English‑speaking communities across the province don’t have designated institutions available to them. They must rely upon their local institutions implementing access plans that I spoke of earlier.
It is also a very difficult time for human resources. Obtaining and keeping bilingual professionals can be very challenging in the face of OQLF requirements, the right to work in French and the demands of unions. Institutions are also still waiting for the directives and Ministry of Health and Social Services and the OQLF on the implementation of Law 14 within the health system. That, too, might increase the challenges faced by patients and professionals.
In 2021, the CHSSN surveyed 3,000 English speakers and asked them about their satisfaction in accessing services in English. The good news is that 53% of the respondents actually said they were satisfied with the services. The bad news was that 47% are not. The level of satisfaction also changes depending upon which region you live in. In some regions like Laval, the satisfaction reaches 56%. In the regions with the smallest communities, the dissatisfaction rises to 86%.
As you can imagine, the CISSS locations on the island of Montreal have satisfaction levels that are relatively higher than the rest of Quebec, with the exception of the east end of Montreal where the dissatisfaction levels are similar to those communities off the island of Montreal.
I also have to underscore that complete revision of the health system and the creation of Santé Québec has once again reduced the influence of the English-speaking community. They will abolish all the boards of directors of the CISSS and CIUSSS that used to have a seat dedicated to representing the English‑speaking community. A single provincial board of directors will be responsible for all institutions, including those institutions that were created by the English-speaking community. We were able to salvage the regional access committees that are representatives from the English-speaking community, but their roles and responsibilities have yet to be determined.
These are some of the influencing factors on patients’ ability to receive services in English. Let’s hear from the other witnesses about their challenges.
The Chair: Thank you, Ms. Johnson. I will now turn to Mr. Steve Guimond. You have five minutes, sir. Thank you for being here.
Steve Guimond, Patient Navigator, Community Health and Social Services Network, as an individual: Thank you. Good evening, members of the committee. My name is Steve Guimond. I am a patient navigator in Quebec City. Thank you for having me. I’ll be presenting to you on the Quebec City Patient Navigator Project.
Quebec City is a hub for specialized medical services and patients arrive for treatment from all over eastern Quebec. At a very difficult period in their life, patients are forced to travel great distances, sometimes upwards of 1,000 kilometres, to receive health care and are often required to stay in Quebec for extended periods.
The money provided by the government for this displacement does not cover the real cost of lodging, transportation and meals. Add to this experience an often inhibiting language barrier and no social support network, and you have extremely vulnerable patients.
After hearing numerous stories about largely unilingual English-speaking families living in the eastern Quebec having difficulty when travelling to receive these services, several community organizations joined forces and undertook a community-based action research project to authenticate this anecdotal evidence. From 2015 to 2017, they conducted surveys, focus groups and interviews with residents of the Gaspésie, les Îles-de-la-Madeleine, Bas-Saint-Laurent and Côte-Nord.
The findings revealed that individuals and families were in dire need of support and can greatly benefit from a person in Quebec City to help with their particular needs. As a result, the Quebec Community Health and Social Services Network, in collaboration with the community organizations involved and the CIUSSS Capitale Nationale, created the Patient Navigator project. This program offers English-speaking adults and children from outlying regions the benefit of a patient navigator to assist them with their aforementioned needs prior to and during treatment in a Quebec City hospital.
The patient navigator is, therefore, responsible for assisting with travel logistics and local transportation; providing information about the city, lodging and the hospital; visiting patients and family members and, where necessary, accompaniment and translation; facilitating the provision of health services by ensuring good communication between health care providers and patients; raising awareness with all levels of the hospital staff to the needs of the English-speaking patients, and their responsibility to respond to those needs; providing emotional support to patients as they deal with fear, loneliness and being overwhelmed by their medical condition; and, finally, standing in for family members so that patients are not left alone, particularly children.
Since the launch of the service in March 2018, over 500 individual clients have been helped. When return visits are factored in over the intervening years, nearly 1,200 clients have been served.
Each patient is unique. We have encountered a vast range of situations, from standard support for transportation, friendly visits and appointment accompaniments, to more stressful situations of a child being flown to Quebec City on a medevac without accompaniments, to a patient who was a victim of a crime as well as countless patients who found themselves alone in the city for treatments for months at a time. Most of these patients hail from small villages far from Quebec City. Most are older, adult clients who are often quite ill and endure long, difficult voyages to get here.
By having the Patient Navigator working with the patients and their families, we repeatedly see that the support decreases stress levels and the risk of misunderstanding between health care providers and patients. The patient navigator improves the experience of receiving care in an unfamiliar hospital and city for everyone involved.
Six years of on-the-ground service has provided us with a unique perspective regarding the realities faced by English speakers within Quebec City’s health establishments.
Despite a recent, restrictive provincial government language directive, what is happening in the hospitals and clinics across the city paints a different picture.
Positively, communication between nurses and doctors with their patients has improved. At the doctor level, this is not surprising given the fact that the international language of medicine is in English and many have, at one point, studied outside of the province.
A more pleasant surprise is found at the nursing level where staffing has recently undergone a major renewal, with a younger generation now occupying much of its ranks. It is a generation that, for various reasons, is much more comfortable expressing themselves in English.
However, barriers do still exist with front-line staff. Despite these barriers, the efforts made by the Quebec City health employees to ease them are always apparent. At the heart of these jobs is the health of the patient and that fact does not consider a patient’s first language. Nevertheless, most of these health establishments do not have clear guidelines to deal with English patients and most of the methods used are ad hoc.
Given the imposing size of the hospitals here in the city compared to the regional establishments our clients are familiar with, the lack of English signage is another restrictive barrier faced when attempting to navigate within the buildings.
From what we have witnessed first-hand and heard second-hand, medical documentation is the most worrying aspect for our clients. Save for a few select and random items, the literature is uniquely available in French. From important presurgery directives to sensitive post-surgery information, the instructions are provided in the language that our users are not comfortable with.
Despite efforts by some of the city’s hospitals to better accommodate English speakers at the documentation level, worrying holes exist. Sadly, the Quebec health system itself has created these serious issues for which they have not yet provided the remedies.
Thank you and I look forward to any questions you may have.
The Chair: Thank you, Mr. Guimond.
Ms. Kippen, the floor is yours.
Kayla Kippen, Director of Health Initiatives, Lower North Shore of Quebec, Coasters Association, as an individual: Good evening, Mr. Chair and all members of the Senate committee. My name is Kayla Kippen. I am the Director of Health Initiatives at The Coasters Association, a community organization on the Lower North Shore of Quebec.
The Lower North Shore is a very unique region in the province of Quebec. It consists of 14 communities grouped together into five municipalities, with a total population of 3,345 residents, 85% of which are English speakers according to our last census.
Our region faces one of the most notable population declines within the province, with the majority of that being in youth and families. Obviously, this has led to a very aging region, with 25% of our total population 65 years old and older.
It is also important to note that the older adult demographic also has very low levels of bilingualism. All this is to say that we have some of the most devitalized communities in the province which are majority anglophone.
The Lower North Shore is also vastly isolated and remote, with no direct road connection between the communities and the rest of Quebec. As a result, our health and social services are very decentralized. We are seeing more and more decentralization that ever before. Patients with specialized needs or emergency services are required to travel by airplane to the regional health centre, or to larger centres in Sept-Iles, Baie‑Comeau or Quebec City.
So what does this all mean in terms of access to health and social services for the English speakers in my region? I can tell you stories of English-speaking seniors who have refused medical appointments in Quebec City because of their fear of the language barrier.
I can tell you stories of patients who have not received any of their pre- and post-operation documentation in English, heightening the stress and anxiety for many of our citizens, especially our seniors.
I can tell you a story of a four-year-old boy who was restrained by three medical staff so he could receive an echocardiogram. None of the medical staff could speak English. The boy was terrified and confused, unable to comprehend what he was there for. His mother was told over and over, “Please tell your son to calm down. We cannot get a good picture.” No one in that room could communicate with the child but her. She was forced to be a translator to the best of her abilities that day, going back and forth between the child and the medical staff.
I can also tell you a story of an elderly woman who was called to be in Quebec City for a medical appointment the next day, requiring her to be at the local airport that evening for her flight. This woman stood in the airport, in her hometown, on the phone with the francophone health centre in Quebec City trying to understand where she needed to go and why. It was only by pure luck that someone was in the airport that evening to grab the phone and be the translator for her. She travelled over 1,000 kilometres that evening — alone, vulnerable, afraid of the language barrier when she would arrive.
You see, there are, unfortunately, many stories like this for the English speakers on the Lower North Shore. We have seniors and parents with young children travelling 1,000 kilometres on a Beechcraft 1900, 18-passenger plane for a 20-minute appointment, and many return weeks later.
Despite these challenges, we are fortunate to have programs that are fundamental for our English-speaking patients travelling for extra-regional services.
The Patient Navigator Program in Quebec City — Steve Guimond — has changed lives for patients travelling on their medical journey. Of his clientele, 70% comes from my region. Hundreds of patients have expressed how Mr. Guimond’s services have drastically changed their outcome in accessing services in English.
With all that being said, there are three critical messages I hope you take from my five minutes today.
First, the English-speaking communities in rural and remote regions in the province of Quebec are some of our most at-risk citizens. Not only do they face a barrier in accessing services because of where they live, they then face the risk of not being able to receive that service in their mother tongue, the only language they know.
Second, provincial and federal programs are often developed in the urban context, and unfortunately this is at the detriment of rural and remote communities. Although this may not be a priority for this committee today, it is crucial to understanding that this puts rural and remote official language minority communities, or OLMCs, at even greater disadvantages, stressing that — at the very least — these communities must be given the opportunity to discuss their health in their mother tongue.
Last, with programs like the Patient Navigator Program and with the contribution of Health Canada through the federal action plans to the Community Health and Social Services Network, or CHSSN, community organizations like the Coasters Association Inc. are better equipped to strengthen our communities and adapt the health system to better respond to the unique needs of the OLMCs on the Lower North Shore.
Thank you very much for your time.
The Chair: Thank you, Ms. Kippen. Last, we will hear Mr. Bissonnet’s opening remarks. The floor is yours.
Hugo Bissonnet, Executive Director, 4Korners, as an individual: Dearest members of the Senate, thank you for having us. My name is Hugo Bissonnet. I’m the executive director of 4Korners, a community-based organization in the Laurentians. 4Korners offers a wide range of programs for the Laurentians’ English-speaking population that focuses on a healthy lifestyle and mental health, fosters creativity and provides support for youth, families, individuals, seniors and caregivers.
The Laurentians region saw the highest percentage population growth in all of the Quebec administrative regions from 2007 to 2017, which was an increase of 13%. It is the fourth-largest region in Quebec behind Montreal, Montérégie and Québec City. Within 15 years, the region is expected to have the highest proportion of people over 70 in Quebec, and there are 47,000 people speaking English in the region, which represents 7.5% of the community. This is an increase of a full 1% since the last census in 2016.
Research from the Québec Survey of Child Development in Kindergarten, or QSCDK, in 2017, shows that one out of three kindergarteners whose mother tongue is English are likely to be considered vulnerable compared to one out of four of their French-speaking peers.
Especially with few services in the region available in English — specifically in autism — sometimes parents are being told to move to Montreal if they want to have services for their kids. Sometimes travel time for speech language pathologists are included in the time they provide, so they have less time with the students or parents
A bit more about health and social services. The region represents 7.9% of the full province population, but receives 4.5% of its health care resources. The population growth is set to continue, already accelerated during the pandemic by urban dwellers moving into the region. As a result, the health care infrastructure is no longer up to the task of the Laurentians.
As well, 20% of their care and 33% of their surgeries are outside of the region, either in Laval, Montreal or Hawkesbury in Ontario. The Centre intégré de santé et de services sociaux, or CISSS, des Laurentides calculated that the Saint-Jérôme Regional Hospital, which is in the capital of the region, would need around 200,000 square metres to meet the demand. Currently, they have 70,000 square metres.
CHSSN spoke earlier about a survey about the exclusivity of services in English. Sadly, the region of the Laurentians has the lowest score on all accounts; 55% of people were not served in English when going into a local community services centres, or CLSC when the average is 33%; 46% were not served in English when calling Info-Santé or the Info-Social hotline when the average is 32% in Quebec; 42% were not served in English at the hospital emergency room or at an outpatient clinic, and the average is 27%; also 33% were not served in English at the hospital when they stayed overnight for services; and 29% were not served in English by the doctor they saw, and most of them are going to private clinics.
As well, 28% were not served in English by a health care professional for a mental health issue and the average is 16% in the province. So, to increase the access of the public sector for family doctors, 12% of the English speakers in the Laurentians access family physicians through the private sector. This proportion is 90% in the rest of the province, and only 4% of francophones in the region use private doctors.
In the English-speaking community, 31% did not feel comfortable asking for services in English; 59% said they did not feel comfortable due to the attitude of the staff as a result of similar results across the province, which is 56%.
While talking about access to English services to the English speakers in the region, from 80 to 90 people who speak English say that they would be more comfortable and would desire services in English to be able to understand the treatment.
With Law 14 that just passed, which makes French the official language of Quebec, we cannot overlook this impact. This law has an impact on our organization’s operation. It takes sometimes twice as much time to do the work. It also reopens the wound from Bill 101. There is an additional perverse effect on people who have lived through Bill 101 and Bill 14: It creates a stigmatization and self-stigmatization when it comes to demanding services in English based on the bad experiences they had before.
There is also a waiting list system for English speakers in the Laurentians, who are waiting for a bilingual professional to serve them or a bilingual professional that feels comfortable serving them. It is not about goodwill. It is about missing the staff to provide services in English, whether it is an assessment or more acute services. People are on the wait list and sometimes are put back down on the list until a bilingual staff member can come in. Human resources is an issue everywhere.
As a result, many people hesitate before seeking help and end up in a worse health situation that could be reduced or avoided.
Because there is so little service, they are scared to file a complaint because they are scared to be identified when filing complaints against the system. The admin staff who are struggling to give them services or because they had next to no services as well. So, it is difficult to evaluate their challenges because they want to keep silent. I see that as well in my team. Sometimes when there is an odd decision taken by the public health system, they are not sure if it is because we are anglophones or because it is just a question of management.
The Chair: I will ask you to conclude because you are over your time, but we will have time during the question and answer period, in which you will be able to give more information. You have time to conclude.
Mr. Bissonnet: I was done. Thank you very much for your time.
The Chair: Thank you to all of you for your testimony and for sharing all the information you provided to us. We will now open the floor to questions. I invite my colleagues to be concise with their questions, and for participants to be concise in your answers. We want everyone to have the capacity and ability to speak.
Senator Moncion: To be concise, I would like to hear more about the Patient Navigator Program — how it works — and cultural training.
Mr. Robson: Steve Guimond spoke specifically for people travelling to Québec City. I work in the Gaspésie region — I cover all of southern Gaspésie — and I can be there to accompany people throughout the whole process. So that can be making an appointment, understanding the appointment and any documentation that they receive. In my work, I also travel to hospitals such as Rimouski Hospital and meet with the oncology team to ensure that we can give services in English. I can go to the hospital with patients as well. So, it is really open up to almost anything.
Very frequently, I’m also contacted by health care providers like social workers at the CLSCs and navigation nurses at hospitals. I find that in our region, there is a willingness to communicate in general with the anglophone population, but with Law 14, it is very difficult and it is getting more and more complicated even for the health care professionals to know what they are allowed and not allowed to do in English. They are reaching out a lot for our help.
Senator Moncion: Going further with that question, how many of you are there to do this work? Are you alone?
Mr. Robson: In my region, I am alone, yes.
Senator Moncion: How many patients are there? What’s the potential?
Mr. Robson: Last year, I served 60 with about 125 interventions. The year before, it was about the same.
Senator Moncion: Okay, but what is the population size?
Mr. Robson: We have about 8,000 English speakers in Gaspésie. It is about 10% of the population.
Where I serve in the southern part, we joke that the north has about one family. In the southern part of the Gaspésie, I don’t remember exactly, but it is between 15% and 20%. Most of the anglophone population is from Matapédia to Gaspé.
Senator Moncion: Just so I understand, are you financed by the provincial or federal government?
Mr. Robson: I am financed by CHSSN, which finances the CISSS, and the CISSS finance us through adaptation funding.
Senator Moncion: We usually try to have one doctor for every 800 patients, and you are one for about —
Mr. Robson: I’m a patient navigator.
Senator Moncion: I understand. It is just the size of the population that you have to serve.
Mr. Robson: It is an extremely vast population, especially the anglophones. They are very spread out. It is complicated to get them to their appointments, especially when they are nervous about speaking French.
Senator Moncion: How many patient navigators exist in Quebec?
Mr. Robson: I can’t answer that with certainty, so I’m not going to. I know of myself and Mr. Guimond.
Senator Moncion: Is that the five we were talking about before?
Ms. Johnson: Currently, there are two patient navigators, one in Quebec City, one in Gaspé, but then there are other variations. Santé Québec has navigation support. The Abitibi had a patient navigator in the hospital for the person staying in the hospital. The Côte-Nord in the Baie-Comeau area has a navigator in the hospital, but they are not called a navigator, they have a different name. It is developing based on the need of the community.
I see it as something that is falling through a crack, because there is not really a funding envelope that is easy to identify for something like that. The federal government often gets very nervous about service delivery, so we have to convince them that it is not a service, this is something where we’re supporting people to access services. We have had discussions with Health Canada, which is our principal funder, about that. For now, we have actually had to remove the patient navigator from the Health Canada funding because they were very uncomfortable with it. I have had to get funding from the United Church of Canada Foundation, the RUISSS of Quebec City, the CISSS, and even the Secretariat for relations with English-speaking Quebecers is now contributing. These are pockets of funding that I am looking for.
I am trying desperately to have resources not just for these two navigators by 2026, but to have one in each of the territories designed to support the type of service that each region — like the Saguenay would have a different one; probably more like James than Quebec City, because in Quebec City, it is people coming to the region, not so much locals accessing services, although he does do that as well.
Senator Moncion: Thank you.
[Translation]
Senator Mégie: Thank you to the witnesses for sharing their stories with us, especially Ms. Régis, whose account was quite moving. My question is for whoever can answer it. It’s a well‑known fact that when someone doesn’t receive health care in their language, mental health care, in particular, they are at a high risk of being misdiagnosed, which can be devastating in many ways. That is borne out in the literature as well as in everyday life, and everyone know it’s true. Are you, as a minority language organization, in contact with francophone organizations in other provinces? Do you communicate with them to talk about your challenges, actions that can be taken to improve the situation? Do you have those kinds of meetings or relationships?
Ms. Johnson: Yes, we’re in regular contact with Société Santé en français. Antoine Désilets and I have good discussions about certain challenges. Sometimes we visit other regions. I was just in northern Ontario, meeting with Franco-Ontarians in Thunder Bay and Sudbury, and we talked about what they’re doing to improve access to services. We have great discussions like that. Right now, I’m organizing an event for all our networks in Quebec and all the francophone networks. We’re holding an event in February 2025, so, no doubt, we’ll have fruitful discussions and share best practices.
Ms. Chabot: There was mention of a regional average. I know the head office is more provincial, but it does provide us with funding support. I work a lot with my partners in Saguenay. How can we refer people to the services they need? Proportionally speaking, we’re the second-smallest English-speaking minority community in Quebec, so it’s important for our community members to know what services are available to them.
Our organization developed a tool that we just launched in May. It lists the mental health services available in the region. I sent out a survey — and I know there are more organizations out there — but of the 12, only 3, excluding Info-Social 811 and Aire ouverte, were able to provide any service, and it was generally information and guidance. There was no therapy, counselling or front-line service available. “You have a problem? Here’s the information you need.” There’s no actual care.
Senator Mégie: I have a third question. How could the federal government play a role in improving your situation, especially in Quebec? I’m not sure whether you’ve raised that with the Quebec government.
Ms. Johnson: Absolutely, community vitality is paramount, first of all. The support provided to community agencies is paramount. That is how they’re able to bring the community together, convey its needs and be its voice in the region. Second, I think a great way for the federal government to help is by supporting the capacity for liaison programs, like the Patient Navigator project, where the community is at the heart of the initiative. That kind of role is important.
Ms. Chabot: In my region, I do what Mr. Robson does for my client community. People call me and say that they’re afraid to go to the doctor, they’re afraid to go to the emergency department or they need to see an occupational therapist, but they don’t know where to go. Often, the bulk of our funding comes from the CHSSN and Health Canada. We aren’t allowed to provide services. The support and guidance I provide to people who need it is on my own time.
When it comes to mental health, paying for services through private clinics isn’t even an option. The Military Family Resource Centre in Bagotville received special funding for a pilot project to give military members and their families access to mental health care. As an organization, we are not allowed to use our funding to enter into an agreement with a private clinician who could support the English-speaking community and provide immediate access to care. Funding is the biggest hurdle as far as access to care goes.
Senator Mégie: May I ask a third quick question? When it comes to francophone minority communities, many of us push for the inclusion of language clauses in the federal‑provincial agreements.
On your end, in terms of the English-speaking community in Quebec, do you think including language clauses in federal‑provincial funding agreements would help?
Ms. Johnson: I just want to be sure I’m clear on what you’re asking. Are you talking about federal funding and funding in the provinces?
Senator Mégie: Yes. The idea is to ensure that a certain share is allocated to the English-speaking community for specified services.
Ms. Johnson: I’m not sure. I don’t think I understood your question.
The Chair: Senator, if I may.
The senator is talking about bilateral agreements, the federal health transfers to the provinces. She’s talking about the requirements for the delivery of services to the minority English‑speaking community in Quebec. She’s asking you whether you think it would be beneficial to include language clauses in the health transfer agreements, so that Quebec would be obligated to provide those services.
Ms. Johnson: Yes, absolutely. An obligation would be a good idea to ensure that the money the federal government transfers makes it to the English-speaking community.
I think the funding for health care is a lot lower than it is for education. Negotiations to obtain more funding are under way, so if that happens, yes, absolutely, there should be guidelines around how the funding is allocated in the province.
I have some personal concerns, as well. Right now, a lot of the money goes to the communities, not to the provinces. If the money were redirected to the provinces instead of the community sector, what you described is exactly what would happen. In other words, how could we be certain that the money was going to the English-speaking community? There needs to be a framework for how that money is used.
Mr. Bissonnet: I think what’s important is for funding to be transferred to the provinces. Oftentimes, a lot of the funding has to cover administration costs in public institutions before it comes back to the community institutions. There are some important parameters. Historically, Quebec doesn’t appreciate federal interference in areas under provincial jurisdiction, as we know. That means it isn’t quite that easy, even if funding were transferred to the region.
At the same time, we need to work on ensuring that professionals are able to provide their expertise in English. Most of the groups here this evening have access to Health Canada funding through McGill University, under the Dialogue McGill initiative, which provides professionals with English training so they are better equipped to provide health and social services in English.
However, access to the training is limited when it comes to community groups. They have their own expertise in mental health, rehabilitation, peer-to-peer support and food banks, so they, too, would appreciate being able to take advantage of that training to better serve the English-speaking community. The interest is definitely there, but we’re limited in our ability to deliver training to the community, as well as professionals in the health and social services sector and community sector. At the same time, if more people were empowered to better communicate in English, the idea that regions also have the ability to support, assist and welcome English-speaking communities would be more evident and more sustainable. That’s something to consider.
[English]
Senator Poirier: Thank you all for being here and for your testimony. I really appreciate it.
We have heard a lot about the issues and challenges during this study on accessing health care services in a minority language, whether it be a francophone or an anglophone, in Quebec. However, we have not heard a lot about good experiences or best practices out there. I want to thank you because you have shared some tonight, Mr. Robson, with the patient navigator; and Mr. Guimond and Ms. Kippen, with the programs that you have in place — all of you. Those are good practices that are important and it is equally important that the federal government understands and recommends them.
Since we are on a good path, with good practices. If there are any witnesses who can come up with any other good practices that you have seen in Quebec that could be beneficial for any other communities in a minority situation across the country, whether it be francophone or anglophone, and could be heard by the federal government, that could help.
I open it up to anybody. Mr. Robson, you had your hand up immediately. Maybe we can start with you.
Mr. Robson: I wanted to add on to what Hugo said. He mentioned the McGill dialogue. As I mentioned, I work closely with the Rimouski Regional Hospital in the oncology department. More often than not, the hardest part for our anglophone population is getting through the establishment because the administrative staff and the welcoming staff are less likely to be bilingual. More often than not, doctors are less likely to be bilingual. Nurses are better, but getting through the hospital is very rough.
We have talked about that and they started implementing that in the hospital. Every time that I’ve gone in, I have noticed that a new secretary there will say, “I will speak English to you.” They are always so proud. One of the guys at the front spoke English to me last time and he was so proud. Pushing that McGill dialogue and initiating things like that really help if we can find the right people and get the right people to follow through.
Senator Poirier: Is there anyone else with good practices to share?
Ms. Chabot: One of the biggest successes that we’ve had in our region in the last few years as an organization is the partnership work that we’ve done with our community partners.
We are a small organization. I am executive director and I have three staff, two of whom are community coordinators, and we service the entire 02 region. A lot of our work is done in conjunction with our partners. The biggest stumbling block I often encounter with them is francization.
I have to explain that.
[Translation]
Of course, people come to Saguenay because they want to learn French and integrate into the community.
[English]
But they have to get comfortable first. That is really important. I often make reference to the CHSSN community mobilization model that they developed as a way to work with my community partners to say, “Listen, you guys are anxious about speaking English; my folks are anxious about speaking French. How can we bridge that gap and help each other understand that Quebecers don’t hate English-speakers?” That’s generally the consensus but I find that it’s not true most of the time. We are just afraid to share. Being able to break those barriers by working together as community organizations and community partners is absolutely the key to being successful.
My region is a great example of that. We’ve managed to get three English story times in our local library run by Ville de Saguenay. It is frequented by both English and French children. We have an English story time and a bilingual story time. We have our Maison des familles de Chicoutimi, which runs a parenting program that is bilingual and is hosted at our Maison des familles. We are bringing people to these community organizations to take advantage of local services. The partnership work bringing these two communities together is the biggest element that needs to be looked at.
The Chair: I think you asked a question that a lot of people want to answer.
Ms. Kippen: Thank you so much. I’m actually glad that you raised some positives because it’s important to highlight the successes that we have had. One success I want to highlight is one that we had in working with the regional access committee. That is, the regional access plans that Jennifer mentioned earlier.
In our CISSS de la Côte-Nord, we implemented a program called the ALLO program, an assistance linguistic liaison officer program. The health professionals in the institutions, in the CISSS de la Côte-Nord, who are English and can speak in English wear yellow badges. They have yellow name tags so the user can better identify that the individual is able to speak with them in English.
The program was launched within the last few years so we are still working through publicity, but there has been really great reception from it. Recently today, we met as a committee. Two other regions in Quebec have adopted this program. They’ve identified yellow as the colour to identify English speakers. One institution has a sunflower and the other region hasn’t necessarily identified but they are using the colour yellow.
I think that’s a unique example of a best practice. That’s something that could be implemented throughout the province. And hats off because we were able to come together as a committee because of my position and were able to really put together this project, which has been a great benefit to the English population. So that’s a great success, I would say.
Mr. Guimond: I would like to highlight a few good practices that are easily attainable but that we don’t see currently here in Quebec City’s health system. One of them is something that was mentioned on the first panel at five o’clock in terms of getting ready for English speakers arriving here in Quebec City; it is flagging them in their dossier, an English speaker is arriving. Therefore, it warns the system we need to think about how we are going to approach this particular patient.
Linked to that as well — also a problem within the system — is the issue of translation of documentation that I brought up during my presentation. Here the city is basically separated into five hospitals that fall under the CIUSSS network and you have the Heart and Lung Institute. I’ve been sitting on the committee for CIUSSS since 2019. This was supposed to ease access for English speakers into the health system here. Sadly, five years later almost nothing has been accomplished. The first goal was to translate certain important documents, but five years later they have not been able to decide how to proceed with the translation and at the same time, it has not been able to decide what documents to translate.
Five years ago, I raised the point that English institutions exist in Montreal where you have the English and French systems. The documents are there. The response I got was, “Well, it is institution-specific here in Quebec City.” Five years later, almost nothing has been translated despite these documents existing here in the province.
Mr. Bissonnet: To follow up on Kayla, the Laurentian is also going forward with the yellow badges so it is easier for English speakers to try to identify staff who are comfortable speaking English. That’s a thing.
Translation is an issue. I also chair, for the Laurentian, the Access Committee for CISSS, so sometimes we have some sort of negotiating level to see what we should prioritize in terms of translation. Of course, funding is an issue because there are so many tools and things that need to be translated. But I agree with Steve; we should be able to pool some resources together because it is the same assessment form. So we should be able to try to find ways to work better with what exists before we reinvent the wheel. We do a lot of funding and we have to be creative.
Also, there is an initiative that some systems have access to a specialized translator, not just in English but in other languages. Organizations like CISSS and CIUSSS can call a bank and get a translator. It is not widely known by professionals and it is also always the department that pays per translation as well. So they are not super keen to say, Hey, go ahead, we have access to a translator, but it is part of the solution — at least part time — while we find a better, stronger solution to be more bilingual or support people from other languages who need dire services and care.
That’s also something we can maybe try to explore to see if we can expand that, bank a translator for a community-based organization that works in health and social services and maybe make it more robust in terms of access. So we can also tell the community members, “You have the right to ask for services or a translator,” and that will be also helpful to empower the community in giving them their rights so they can ask to be served in their official language, in English. That might also be part of the solution.
Senator Poirier: Thank you very much for all those good answers. I appreciate it.
Have any of you ever used the interpretation services? If yes, what was your experience like? Was it good? Was it bad? How did it go? If it didn’t go good, why? Can anybody share?
Ms. Régis: Well, I mean, I would get denied using them, so we don’t get to use them.
Ms. Chabot: We can’t or it’s for appointments or it doesn’t exist or they don’t know. What I’ve actually done in the Saguenay is that I’ve spoken to get the policy number for this particular policy. I carry it in my wallet so that when I meet with partners who work in public health at the public health institutes or the CLSCs or community partners that work in the hospitals, I can say, “This is the policy number on your internet you have access to.” It is a 14-page document, but it outlines exactly how to access this resource for individuals. But I am one person, versus an institution that has not figured out how to get it from the top to the front-line workers.
Senator Poirier: Are there any other experiences from anybody else?
Mr. Bissonnet: It is by the head of the departments of the CLSCs to decide whether or not they allow their staff to call for translation. It is difficult to say if it is good or bad because we don’t have access to it, but [Technical difficulties] created a health passport, which is a bilingual tool in both languages with key terms, that we distribute to health care professionals and also community members, which at least can pinpoint key words in terms of physical illness, follow-up, training. So it might be something also that we share collectively with the network of community-based organizations. We do share resources.
It might be something to explore — bona fide — to at least give some more access. In the Laurentians, we are adding all sort of electronic devices and software that are free to support translation for patients that would be able to have a phone and have access to an app to have a decent translation.
Ms. Kippen: There is actually an interpreter service in my region at one of the main health centres in Sept-Îles. It started as pilot project and has proven to have a lot of success. The interpreter speaks five languages and does support the Indigenous communities that come from the North as well.
It is a great success and the program has proven to be beneficial for the population. It is just the fact that there are not enough hours in the day for the interpreter. It is not enough staffing. One interpreter for the entire population is just not enough.
Ultimately, that individual is able to service the population and many people, but there are still many people who are not able to receive the interpreter’s services when they do go. So it is a great program and when people access it, they are very appreciative of it, but it’s a human resource shortage.
Mr. Guimond: The big issue I see here in the Quebec City is the fact that many employees within the health system don’t even know about the wonderful interpreter bank we have here. It is symptomatic of the top-heavy bureaucratic issues we see in the system here about transmitting information from the top down to the employees.
Senator Clement: Thank you to all of you for your testimony. It is good to see you again, Ms. Johnson. I’m glad to hear that you went to northern Ontario to collaborate with the folks in Sudbury. I think the key is to collaborate.
I want to focus my attention on the three people who shared personal experiences. This is a very hard thing to do in any setting but in this setting as well. You know, Mr. Robson and Ms. Chabot, you also work in the field, but you came to read your own personal experience into the record and I appreciate that.
I want to ask the question to Ms. Régis. This country — the provinces and the cities — doesn’t want people to leave. That’s the whole point of this country. We really don’t want people to leave. We want people to come and stay and flourish, right? So it was hard to hear you say that you had to leave. We have language battles. We battle in schools. We have all kinds of issues in retail, just even getting stuff done in our daily lives. Why is it that in health, the language issue is more important than all of those other things?
Ms. Régis: Because I can get by in those other situations. Dealing with the pharmacy or my son’s school or his speech programs, I can navigate those fine. It’s not the best, but it’s still there. When I go to the hospital and there is no one who can help me and there is no one to bridge the gap, I can’t do anything. Even if I was perfectly bilingual, I will never be able to say in French the things I need to say if I am in pain, or if I am distressed over my child or anything else where I can’t just pass by.
Senator Clement: Beautifully said. Thank you. Ms. Chabot, you said it as well and you showed us your fluency in French, but when you are sick, it is your mother tongue you go to.
Ms. Chabot: A lot of times when we are talking about pain or injury when it comes to physical health, sometimes you do not have a word for it. Oftentimes, it is like, how do I describe this strange feeling? When I ruptured my Achilles tendon, I didn’t feel anything but a vibration and a weird, odd feeling, but everyone in the room heard a snap except for myself. I didn’t know what had happened to me. One minute I was standing up. The next minute I am on the ground.
How do I describe to the triage nurse what was happening in the moment and how did my body react and feel? It becomes a game of playing, well, I know this word. And what’s the closest word to that? I know this phrase, but it is not that, but it is like that, so you end up with this game of Whack-a-Mole trying to find the right words. Even if you are almost perfectly bilingual there are nuances to medical vocabulary that health care providers know that civilians don’t. To describe how your body feels when maybe there is no word in English to describe it, how do you navigate that?
Senator Clement: Mr. Robson, paramedics are very important. Thank you for your service there. PTSD is a big issue for paramedics. I know that from my time in Cornwall as well. Thank you for your work in continuing to work as a patient navigator. Thank you to you all.
Senator Moncion: Ms. Régis, how are you and how are your children? Are they healthy and good? How are you?
Ms. Régis: They are healthy and great. I just have a lot of anxiety about everything.
Senator Moncion: I can understand. I will tell you a story later.
The Chair: Thanks to all of you for your participation and for the very important human information that you gave us.
We hear about data. We hear about technology. We hear about all kinds of things, but I think it is so important to hear people telling their stories. This will, of course, be part of our report, and it will help us to better understand the issues and how to bridge the gap. That’s important. We will keep that in mind also. Thank you to all of you.
(The committee continued in camera.)