I Landed Running

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I still call myself a newcomer in Canada. This is my fourth year, but I’m still in the process of integrating. Adjusting to everything: the weather, the people and the work. I immigrated from Sudan with a family of eight. My husband and children were refugees in Jordan for two years before we were resettled. I stayed on in Sudan because I had a job with UNICEF, and had to work to support my family. My youngest child was three years old. It was very hard to stay away from her but, since my husband’s life was threatened, he had to leave the country. I joined them in Jordan three weeks before we immigrated to Canada in October 1997.

I landed running. I found out where people were and began to be active, organizing within my ethno-cultural community. I grew up in Uganda, East Africa so most of my basic education was in English and my comfort with the language allowed me to organize workshops and projects on different aspects of life in this country—gender roles, family life, laws, the Charter of Rights and Freedoms and employment standards—basic information to help people integrate and become employed.

I now work as a Health Educator with the Sexuality Education Resource Centre (SERC), a non-profit community-based organization. I work with newcomer communities where there is a priority need for intergenerational communication due to the gap created between first-generation immigrant parents and their children who assimilate into a ‘Canadian lifestyle,’ especially involving sexuality.

I help develop programs and resources for education. I also do awareness-raising with service providers and professionals such as medical students, public health nurses and physicians. I talk on particular areas of health, one of them the practice of female genital cutting or mutilation practised in a number of Sub-Saharan African countries including my own. I also do awareness-raising on other aspects of women’s health from the immigrant and refugee perspective. The process of migration constitutes a major life change. Whether you come at will or are forced to leave your country, the number of countries of transition you’ve been through, how long it’s taken before you are settled, the conditions with which you are received in the host country, the level of preparation for adjustment you have been given are all factors unique to this population. Integration into the work force is also critical. A lot of people, even with one or two degrees, have to do odd jobs. This experience has a negative impact on them, and services and policies should be designed to accommodate it.

Population Health, a policy framework adopted by Health Canada, lists 12 determinants of health. If you had a ladder of these determinants, the immigrant-refugee population would be at the very bottom. The migration experience itself should be included in the list so people can begin strategizing around it. How can we help the process become more smooth? What is required? In developing countries, primary health care delivery is based on a Population Health model that uses the principles and practices of community development. The goal of the United Nations is to bring in all those sectors involved in the determinants—agriculture, forestry, water, health—with the objective of developing a comprehensive tool that assesses every need of a community. It’s a complex process, but if there’s a commitment, a political will, it can work. The UN has some very beautiful frameworks, but those have to be visualized on a wide basis. It’s difficult to change a system that has been established over a long time.

The Canadian system is based on a Medical Model that treats a person like a machine. If something goes wrong in a body, it goes straight into that part and fixes it. Using that model, you don’t need to talk about diversity. You don’t need to talk about women. Because it’s obviously universal.

But history and experience has taught us that it doesn’t work. That’s why movements started—the women’s movement, the health movement—to criticise that model. Recognizing women as a separate group, the Population Health model considers them in terms of geographic origin, ethnicity, sexual orientation, as Aboriginal, immigrant, refugee, rural, urban, visible minority and white—diverse groups whose health is affected differently by factors they interact with in their environment. This diversity needs to be acknowledged in designing a program.

Immigrant and refugee people are often referred to as a single category. But refugees migrate under circumstances of fear while immigrants, under more relaxed circumstances, can choose where they want to go. Each is affected differently by the experience of relocation.

It’s not enough to bring immigrants from different countries and leave them here and let them be. There has to be a system of support and community care. Canada is essentially built on the energy of immigrants and depends on them. A system to take care of integrating the knowledge and experience people come here with is an investment in the future and economy of Canada. Resources need to be directed toward this process.

There is also a problem with a welfare mentality. “These people, we brought them in, they are very poor, we need to help them, so we give them day-to-day bread to live on, so we are very nice people and very kind.” If you want to develop good fisher persons, you don’t give them fish. You give them fishing tools. That’s the best way to sustain results.

Language is one of the greatest barriers faced by immigrants and refugees and existing programs are not related to the purpose for which people need language. More effective programs could be done in stages, to offer practical skills appropriate to work and social environments. Population Health may not be the panacea for all ills, but it goes a long way in addressing people’s total needs. Bridging is needed to help immigrants access existing services. Services should be designed to be more inclusive. This can be achieved by involving those who use them to identify their needs and to help design and implement the programs. It’s easy to say this person does not understand the language, because that need is obvious, it can be heard. But the problem is more than just language. The need of the person is much more than that.

Catherine Hakim is an advocate for immigrant-refugee program development and a Health Educator with SERC. In 1999 she co-authored ‘An Analysis of Barriers Facing Immigrant Women and Their Families in Accessing Health and Social Services’ funded by the Status of Women Canada for the Immigrant Women’s Association of Manitoba (IWAM). It can be found at http://www.swc-cfc.gc.ca/resource.html [Link no longer active. Feb. 22, 2005 - ed.].

12 Determinants of Health Identified by Health Canada

  • Income and Social Status
  • Employment
  • Education
  • Social Environments
  • Physical Environments
  • Healthy Child Development
  • Personal Health Practices and Coping Skills
  • Health Services
  • Social Support Networks
  • Biology and Genetic Endowment
  • Gender
  • Culture