By Dr. CHRISTOPHER MORGAN
Share’s October 24 editorial entitled Healthcare and Ethnicity brought to our attention a recent position statement by the Society of Obstetricians and Gynaecologists of Canada (SOGC). The position statement appearing on the organizations website, sogc.org appears below:
The Society of Obstetricians and Gynaecologists of Canada (SOGC) supports the best care for all women. Many procedures and services are time sensitive or may become so without warning.
Provision of these services cannot and should not ever be based on gender, race, sexual orientation, age, practice patterns or religious affiliations of either the patient or the provider.
Hospitals, facilities and on-call practitioners should not be expected to provide alternative care providers for these services.
Individual call groups and facilities should focus on providing these services by qualified individuals without reference to any of the aforementioned characteristics.
Patients can decline the care offered, but should take full responsibilities for those actions.
The fact that the Society of Obstetricians and Gynaecologists of Canada deemed it necessary to create and publish this statement is a clear indication of the rising challenge of meeting the needs of an increasingly diverse population. This is not exclusive to the health care sector but has been a real problem in major sectors of society including education, criminal justice, labour and employment, and government.
In fact, the day following Share’s reporting of this statement, Dr. Jennifer Blake, the chief executive officer of SOGC, appeared as part of a panel on the CBC’s The Current to comment on the association’s position statement. She cited situations in urban centres where physicians in hospitals after working long shifts and are on-call should not be required to return to the hospital when a qualified physician is available on site. Further, she cited situations such as within Aboriginal communities or rural settings where the staffing simply does not allow for selection of doctors based on religion and ethnicity.
I can appreciate Dr. Blake’s comment and can think of other situations, for example, rushing your son by ambulance to the hospital in response to an anaphylactic reaction, or your mother has fallen to the floor with chest pain, or your wife in late month of pregnancy is experiencing lower abdominal pain and heavy bleeding. In these cases we put our trust in knowing that the health facility is staffed with the most competent and skilled professionals they could find and are ready to help your loved one at that critical moment.
In these types of scenarios it may not be medically prudent or practical for a health facility to seek to meet a religious, cultural, gender or other preferences of the patient or family. The health and safety of the individual is the first priority.
Having said that we must recognize that there are legitimate and meaningful reasons why people exercise their preferences in the selection of a health care provider. Outside of the emergency situations mentioned above or other specialized scenarios and excluding those who make choices that are racist in nature based in fear and ignorance, given the opportunity, many people will choose a health provider with whom they feel comfortable – someone they feel they can trust, who is not only excellent at what they do, but whom they feel they may have a connection with, whom they may share some commonality in lived experiences, values or otherwise.
Professionally, over the last 16 years I have experienced patients exercising their preferences when seeking services at our clinic. Both men and women have asked if we have a female registered massage therapist, others have asked if our individual and relationship counsellor is a Christian, and some have asked if we have a dietitian from the Caribbean community.
In our case, our answer has always been “yes”. It makes a difference.
I’ll share another related experience. Recently my mother needed to be hospitalized for a few weeks to undergo a series of tests and observation. On a regular basis I meet with the nurses taking care of her and through my discussions and observations there was one nurse in particular who was significantly more effective in assisting my mother through the daily tasks being asked of her.
This experienced nurse of Jamaican background was able to do much more with my mother with less effort and more cooperation than the other nurses. This was in part due to the cultural connection they made; the understanding this nurse had of an older person from this community, a knowledge of the cultural norms and values, the occasional use of the local Jamaican dialect and references all of which serve to deepen the relationship between the patient and the health care provider and ultimately improve health outcomes.
Beyond a doubt, any decisions surrounding the long-term care of my mother will based in part by the level of cultural diversity and competency of the staff and institution. It makes a difference.
Can some of the skills, techniques and knowledge used by this Jamaican nurse be taught and transferred to others? Yes, I believe most of it can. It’s the goal of cultural competency training to improve one’s ability to interact effectively with people of different cultures. It’s one of several fundamental reasons the Black Health Alliance and its supporters successfully submitted an application to the Ministry of Health and Long-
Term Care in 2004 to establish TAIBU, a publicly funded Community Health Centre (CHC) with a mandate to provide comprehensive health services to the Black community.
Organizations, big and small, that make a concerted effort to meet the needs of the population they are trying to serve will benefit from doing so. However, many are slow or unwilling to change. Recently the Ontario Teacher’s Pension Plan (OTPP) in their document to the Ontario Securities Commission on Requirements Regarding Women on Boards and Senior Management recommended that all Toronto Stock Exchange non-venture issuers appoint a minimum of three female directors to their Board. In their report they referenced several studies including one in which Fortune 500 companies with a minimum of three female directors significantly outperformed companies with zero female directors over a five-year period.
Further, the OTPP report points to the sad reality that, despite good research, institutions and organizations often require strong penalties and legislation in order to comply. For example, the Norwegian government enacted a law that requires a 40 per cent quota for women on Boards and companies that failed to comply would be forced to dissolve.
To reiterate, the challenge of meeting the needs of an increasingly diverse population is not exclusive to healthcare but is being faced in education, criminal justice, labour and employment and government. There are significant social, economic, ethical and practical benefits to be gained if we better utilize the richness, talents and skills within our diverse communities. There are some steps that can be taken to improve the situation such as, but certainly not limited to, creating pathways for people from all backgrounds to enter into fields and professions in which they are currently under-represented; implementation of cultural competency training into the core curriculum of professional programs; better utilization and incorporation of foreign trained professionals, and effective public policy and legislation with real teeth to ensure compliance on issues of equity.
Dr. Christopher J. Morgan is the director of Morgan Chiropractic & Wellness, an interdisciplinary health centre in Toronto, and the Past President of the Black Health Alliance, a network of community organizations, health professionals and community members working in partnership to advance the health and well-being of the
Black community. He can be reached at 416-447-7600 or firstname.lastname@example.org