The Centre intégré de santé et de services sociaux (CISSS) in Abitibi-Témiscamingue is consulting its population to determine how to improve its English-language health and social services. The region is an important healthcare hub for Cree patients.
“We have to get better as an organization,” said Marie-Élaine Lemay, community relations officer for CISSS Abitibi-Témiscamingue. “When you don’t have access to services in your own language, there are so many poor health results. It’s not acceptable to let people have poorer health just because they can’t communicate.”
This development follows numerous recommendations in the Viens Commission report to improve communications with Indigenous communities in English and Indigenous languages. A provincial government study last year likewise found that a significant number of English-speaking Quebecers “face language barriers in their daily lives” when accessing healthcare.
“We are doing what’s called the access program, which aims to make a range of health and social services available in English that is as comprehensive and close as possible to the living environment of the people,” Lemay told the Nation. “The Commission Viens is like leverage for me. I can always say we have to do this because it’s a call to action – we have to act.”
During the consultation process, the region’s 14 health directors each completed an analysis of the accessibility of their services while a local anglophone committee led focus groups. An online survey is available until August 28 on their website and associated Facebook pages.
“For Cree people who receive services from our organization, each client receives a written invitation to complete the survey at the Val-d’Or Wiichihiituwin,” Lemay explained. “If they need assistance, there is an interpreter who can do it with or for them. Some Anishinaabe communities wanted to have hard copies so the Elders could complete them.”
While the survey results are not yet known, Lemay is aware that English-speaking clients are concerned that voice messages and most documents are available only in French. The region’s Anishinaabe population, which is spread between Ontario and Quebec, would prefer to be able to consult in either province without affecting the continuity of services.
“It’s complicated for us because we would have to have agreements to do that,” responded Lemay. “Anglophone First Nations sometimes feel they experience double discrimination because when they’re not treated well, they don’t know if it’s because they’re Indigenous or speaking English.”
While language access is often a heated political issue, Lemay argues that healthcare communication is a basic need that must be answered. Miscommunication can lead to poor diagnosis, medical errors and an unnecessary exposure to risk.
“When people can’t communicate, they don’t come to the emergency room when needed and when they come their problems are way worse,” said Lemay. “You don’t feel at ease speaking with the person, so you wait. When you go it’s worse and harder to treat.”
In Abitibi-Témiscamingue, 3.1% of the population’s mother tongue is English, which is significantly lower than the provincial average of 7.6%. However, each Quebec region has referral centres or “corridors of care” depending on the healthcare procedure; orthopaedics patients, for example, must travel to Amos, where English is nearly non-existent.
“I’ve had patients come to me over the years saying they didn’t understand what a specialist said,” noted Dr. Darlene Kitty, Quebec’s only Cree doctor who has been Chisasibi’s family physician since 2006. “The language barrier definitely poses a problem for their understanding of what treatment they might need. It’s important to understand what’s going on with their body or condition.”
With many Elders fluent only in Cree, interpreters generally accompany patients traveling south for services. Yet language barriers remain as they translate between Cree and English. Lemay said there are French-English liaison agents who can be called by the hospital or CLSC in some communities but not currently in Val-d’Or, which receives most Cree patients in the region.
“Language is an important part of culturally safe care,” Kitty told the Nation. “If the patient feels safe in an interaction with the health professional, they’re partners in the health of that patient. The professional appreciates their community’s political and social history, and recognizes what support that patient might need, from minor surgery to mental health issues to ongoing follow-up.”
Kitty wants professionals to learn more about Cree cultural realities, such as the impact of residential schools. While the CISSS currently offers employee training on cultural safety and English, it isn’t mandatory. In addition, Bill 101 prohibits them from requiring bilingualism during recruitment.
While certain treatments will always require Cree patients to travel south, Chisasibi’s coming hospital and other healthcare advances will help keep more patients in Eeyou Istchee. Integrating emerging services with cultural safety is a key priority for the Cree Health Board.
“I was sitting on the board of directors, recognizing the needs of the population for the next 25 years and how the hospital will help to achieve that,” said Kitty. “We’re already making changes in health projects and programs to better help patients by appreciating the challenges they face. We have to be prepared for a diverse population and provide resources as needed.”
Besides providing more interpreters, Kitty suggested there could be more proactive communication and collaboration between the CISSS and the Cree Health Board, rather than merely “putting out fires” when problems arise. As a doctor herself, she understands that medical terminology can be another language barrier for patients to overcome.
“If the doctor says ‘MRA’, they don’t know what that is – even if they say, ‘magnetic resonance angiography’, they still don’t know what it means,” Kitty said with a laugh. “Doctors can be guilty of that. If patients are given the opportunity to ask questions and spend a little more time with them, they’d have more clarity and compliance.”