Leaving My Child Behind

CASE STUDY - INTERPROFESSIONAL HEALTH EDUCATION

Maya, is 41 year-old female who has been experiencing chronic back pain and has been having
trouble sleeping and eating. Her back pain recently became worse and she is having some
numbness in her left leg. She reports that she has been having chronic back pain for the past 9
months, since she began working as a caregiver for an elderly person with late stage dementia.
Her job is physically straining and involves heavy lifting. Mayas pain recently became more
severe, after a personal crisis related to her immigration status. Maya lives with her 17-year old
daughter; Mayas 19-year old son was deported from Canada last year, soon after he turned 18.
About two weeks ago, Maya reports that CBSA was calling and showed up at their address on
record (which is actually the house of one of Mayas friends). Maya and her daughter were afraid
to be detected by CBSA. Maya continued to work at this time, since they rely on her daily wages
to pay their bills, but told her daughter to stay home and not attend school. Since the CBSA visit,
Maya has unable to sleep and eat; her back pain worsened.
Maya is worried about not being able to continue her job. She has already requested several sick
days and her employer is threatening to fire her. This job is Mayas only source of income since
her refugee claim was denied, and she was cut off from social assistance. Maya is also worried
about her daughter, who has been moody and doesnt want to go back to school.

DISCUSSION QUESTIONS
Patient Level
1. What are some of key health and social challenges in this case example?
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Insecure and precarious employment: As a nonstatus person, Maya has limited rights to
have paid sick leave or receive compensation for work-related injuries
The stress of their immigration circumstances can contribute to poor mental health, for
May and her daughter
Because Maya is uninsured, she has limited options for accessing health care

2. What steps would take go about getting information from and build rapport with this
patient?
- In most cases, health care providers do not need to ask a patient about their immigration
status.
- Depending on your role, you should consider if you need to have information about the
patients immigration status; how would asking this information impact your rapport or
therapeutic bond with the patient;
- If you do learn about a persons precarious immigration status, what steps will you take
to safe guard this information? How would you assure the patient about their right to
privacy?
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3. What are some health and social resources available to patients in similar situations?
- See Health4All handout at http://www.health4all.ca/
Interprofessional - Team Based Approach
4. What do you see as your role in addressing the health care needs of the individual in
this case study?
- Considering the case example above, what role could you play in providing care or
supporting the health needs of this patient?
- What professional values play a role in how you would respond to this case example?
5. How would an interprofessional approach benefit this individual in particular?
- Sharing professional knowledge to address the health needs of this patient/client
- Considering options for optimal health care, considering the structural barriers
- Working collaboratively to address institutional policies practices that may be impacting
nonstatus immigrants
- Working collaboratively to advocate for a specific patient/client; or community
6. How would you handle information regarding this patients immigration status?
- Consider professional ethics and values
- Protect the privacy of this patient client in line with professional ethics/values
- Learn about the rights of non-citizens in Canada
Community/Policy Level
7. What are some of the ways that changes to the immigrant and refugee policies in
Canada have affected health care delivery?
- Cuts to Interim Federal Health created confusion and uncertainty; many health care
providers stopped providing services to refugees (even if they were eligible)
- Negative public perception of immigrants (as bogus, fraudsters, criminals) can lead to
bias and discrimination
- There are more people living in Canada who have a precarious status; as a result more are
uninsured or have precarious access to health care (i.e. temporary foreign workers)
8. What are some strategies for health care providers to advocate for immigrants with
precarious status (at the individual level, organizational level, or policy level)?
- Ensure your organization has clear language access policies and resources to support
people with limited English/French
- Ensure your organization has clear Access without Fear policies (i.e. do not ask about
or share immigration status information with immigration authorities)
- Take part in advocacy campaigns to protect immigrants rights (E.g. health care
professionals took part in the Solidarity City campaign to make city of Toronto services
available to all residents, regardless of their immigration status)

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