1. A light in the darkness of services!
The other day, I met an older lady, who is disabled. Her face was bruised, bruises on her leg, and a cut on her forehead, because she fell down the stairs of the building where she lives. She told me that they had taken her to the hospital. She told me that there was no light in the building where she was living, they turned off the electricity to fix the elevator. They had placed notices about this, but she can not read English or French, so she did not know that there would be no light, and therefore, she fell down the stairs. Then, some people called the ambulance, and, to add insult to injury and to her anxiety, she later received a letter from the hospital, asking her to pay for the ambulance service. She was desperate, asking what can she do, worried that she would be taken to jail because she cannot pay, since she does not have the money. I found out, through another process, that since she is disabled, she qualifies to be in another building or in a seniors' residence. She had all these problems, and she would not have been able to resolve them on her own, because she did not have the language, the information or the self-confidence. I would not have done this either, if I were not also a Lay Health Promoter with Healthy Women, Healthy Communities. My English as Second Language (ESL) work is not about accompanying people with health problems; but, as a Lay Health Promoter, now I am always aware, and I use every opportunity to help women with their health and social integration issues. My consciousness has been raised, and I now have more contacts and skills.
2. I don't want to be a bother with my needs…
When I reached out to a certain woman to carry out the research interview, I discovered that she was very limited in terms of her medical care. Not only had she never had a Pap test in 16 years, because she did not consider it important after her children were born, but she also had a problem in her breast. She was waiting for an immigration decision to continue with any treatment. She believed her immigration status did not permit her to receive any medical care!
This person always said that she was very busy and that she would go [for a Pap test], again and again, but she never did. If I had not gone out to her, this person would never have had any knowledge of the importance of the Pap test, or that she could access some services. Her attitude has always been, that she does not want be a problem, or bother the doctors or the government with her needs. She did not see this as important for herself, she did not have the information that this [health care] was her right. Neither did she have the self-esteem or the language to be able to demand her rights. This demonstrates that we have to continue reaching out to and working with cases like this one.
3. A medical appointment: better late than never!
This lady is in her fifties. She came to this country over twenty years ago. When she first settled here, she had her last child, who is now 18 years old. Since that time, she has never had a Pap test. For several years she kept on having vaginal infections and her doctor never recommended a Pap test but only gave her antibiotics. One day, she became very ill and when they examined her uterus they found that it was completely damaged by cancer. The only solution was to have a complete hysterectomy. Nowadays she is keeping up with her annual check ups. Recently, they have found benign lumps in her breasts and this is why she keeps up her regular check-ups.
4. So many needs… which to target first?
In March of this year I met a woman who had recently arrived in Ottawa. I invited her to participate in the interviews that I was doing for the Healthy Women, Healthy Community project. She accepted the invitation, so I interviewed her. The last week of May she contacted me in a very anxious state, scared to death, because she had felt a lump in her breast and was very worried: she had the idea that she might die from that lump that very night! The woman was in distress, crying non-stop. After listening to all her thoughts and worries, I started to calm her, practising all the skills that I had learned through the Lay Health Promoter training. I explained that having a lump did not necessarily mean she had cancer, and that the best thing she could do was to go to see her doctor and get an expert opinion. After a long time on the phone, she calmed down, and promised that she would make an appointment with her doctor. I told her that she could call me for again if she needed help, and I would be glad to help her in any way I could. A few days later she called me, again in a crisis. She was very upset because she didn’t get an appointment with her doctor immediately. She was really scared because she had to wait for a couple of weeks, and she thought that she might die immediately because she was sure she had cancer. She also told me that her arm hurt a lot and that she was not feeling well. Calling upon all the skills I had, I calmed her, and told her she wasn't going to die that night, but on the contrary that it was very good that she had found that lump on time, and that very soon she would know what it was. I emphasized again that not every lump is a symptom of cancer. A few days later she called to tell me that her friend’s doctor had agreed to see her earlier. She was sent for a mammogram to find out the type of lump that she had.
While this was going on, she also had other problems, such as trying to arrange summer day care for her daughter, while she attended English as a Second Language courses. She gave me the name of her social worker so that I could talk to him to figure out her situation and her needs. The social worker had no idea of what was going on with her; he was new to the case, and had not yet received her files. I insisted, so he found the files and we were able to talk about her case. He gave me some places and telephone numbers to call to find out if they had any day care spaces for the summer. After searching around, I found the information for my client. Unfortunately, this was not what my client had expected. She'd had a very good experience with the social worker who she had the previous year, and now this social worker was not offering her the same options for her daughter. After more phone calls, explanations, and clarifications, I was finally able to find the program that she wanted for her daughter. She was very happy with my services.
While all of this was happening, Social Services also notified her that she was ineligible for a bus pass for the summer months, and brought this to me. I wrote to the social worker explaining that she was learning English as a Second Language on a full time basis throughout the year, and attached a copy of her registration for the summer. This lady also had some problems with her income taxes, but I referred her to the organization which prepared them for her and she got help immediately.
She is connected to LAZO, has been attending the workshops, and is keeping in touch with several of the Lay Health Promoters.
5. One accompaniment makes a big difference !
I had often seen, passing by, a Hispanic lady that walked with three children, a girl who looked about five, a boy about three years old, and a baby about 18 months old. She always seemed in a hurry, as she had to take her eldest child to school. One day, I said hello to her, and we talked for a while. In the conversation she told me “ I wish all my kids already in school, so I could do all the things that I have not been able to do.” She said it with such a worried tone, that I decided to ask her, “What type of things?” When I asked her this question, she had such an expression of happiness in her face that I still have it engraved in my mind. This question helped her to start telling me how lonely she was in this country, because she has no relatives and she only lives with her husband. She told me that her husband worked very much and he did not spend much time at home to help her with the kids. I took this opportunity to ask her about her health and her access to health services. She said that she has a family doctor; what she does not have is the time to go for an appointment, although she wants to see the doctor because she has not been feeling well. She also mentioned that she does not tell her husband that she is not feeling well, because, if she does, her husband might miss work [to stay with her], and she is afraid that if he did this he would lose his job. I asked her if she had gone for her annual tests, such as the Pap test and the clinical breast examination. She answered that she had not been back to see the doctor since the birth of her last baby. So, I offered to accompany her to her doctor’s office, and told her that I would take care of the children during the visit. The lady was very happy, and said that she would make an appointment and she would tell me the day so I could accompany her. And it happened! She is very grateful and told me that I had helped her very much. The doctor reminded her that she should not forget to make an appointment for next year’s visit.
6. A word of encouragement does a lot.
A friend of mine introduced me to a lady in her sixties, who has been in Canada for less than two years and who did not speak English. When I met her she was in school taking English as a Second Language (ESL) classes. I visited her at home, and also did the survey with her, in which she told me she has not had Pap test in 40 years. I talked with her about how important it was to have this test. I suggested that she go to see her family doctor and to ask for the Pap test.
After my visit, her daughter accompanied her to the doctor. In regards to mammography, she did not need one at the time because she had had one two months before coming to Canada and everything was fine. The lady got all the other tests done, and all the results were good.
7. An ounce of prevention is worth a pound of cure? I’l think about it!
In one of the home visits I did, I came across a woman who was very scared of doctors. The main reason for this is because she believes that many things come with age and that all of us have to die one day. Even if something is wrong with us, but we don’t feel sick or anything like that, why go to the doctor? Doctors will only tell you what is wrong with you, and all you will do is worry and suffer more. This is especially so if you have cancer, because she believed that disease has no cure.
In my role as a Lay Health Promoter, I first told her that I understood and agreed with her in some ways. I then talked with her about breast and cervical cancer, and how lives can be saved if doctors find or detect cancer at an early stage, and that the Pap test can prevent cervical cancer. I also told her that in Canada, Nurse Practitioners could do these tests. By the end of the visit, the lady told me that she was going to think about what I had told her. A month later, she called me to say that she was going to go get a Pap test done (she hadn’t had one for over 10 years!). She also wanted to start doing her breast self-examination.
8. Learning to set boundaries as a Lay Health Promoter.
I had helped this lady many times, as a member of the community. As her English is very poor, I often translated for her and her husband at various appointments, be it for health or work related. But ever since I explained to her about the Healthy Women, Healthy Communities project, she started to call me constantly, to help her address various things of a different nature.
I usually feel happy to help her when I can, as she needs a lot of assistance. But I began to perceive that she feels that I am obliged to help her, and many times this has become a problem. For instance, one Sunday she called me at about 8:00 in the evening to accompany her husband to the emergency department in the hospital. When I tried to find out if her husband was very ill, she told me that he was as unwell as usual, but it was better to go to emergency than to wait for the doctor at the clinic to get some tests done. Instead of going to accompany her husband right away, I was able to explain to her that it was better to wait to see his family doctor, and that Monday, the next day, we could make the appointment.
9. Sharing the facts in the market… instead of the myths.
While at the Mercado Latino (local Latin grocery store), I contacted a woman in her late sixties and talked about the Healthy Women, Healthy Community project. This lady's opinion is that breast cancer happens when women breast feed their babies and do not remove all the milk residues from their breasts; this causes cancer to develop. She also believes that cervical cancer starts when you have sexual intercourse after having had a baby, and when you wear sandals that slap against your heels.
I gave her some information about the Pap test, breast self-examination and mammography. I asked her to read the material, and told her that I would visit her at home to talk again, since we were at the store.
10. Can we trust the Canadian health care system?
Some women prefer to go to their country of origin for medical care. One woman I worked with goes to her country of origin to have her annual check-ups, since she does not trust Canadian doctors. A female doctor examines her in her own country. I told her that it was important that the doctor who sees her here in Ottawa should also get a copy of the Pap test and the clinical breast examination results, to put on her file here. I taught this lady to do breast self-examination, and I gave her information about the OBSP clinic, where she could go without a referral, since she was over 50 years old.
Another woman, in her twenties, also told me that she goes to the doctor in Ottawa to consult about anything…. except the breast examination and the Pap test! She gets these done in her country of origin. This young lady has had some lumps in her breast.
I explained in both cases that the community health centres in Ottawa have Nurse Practitioners that are authorized to perform the breast clinical examination and the Pap test. Also, that in case of any emergency, it is important to have copies on their medical records in Ottawa, of the results of tests that were being done regularly elsewhere. I reassured them that doctors here are trustworthy, and that they should not hesitate to consult doctors in Canada.
