Study looks to smooth health-care delivery for all

Paul Mayne // Western News

“For those who have experienced discrimination, trauma or violence, this includes feeling that poor health care may bring back the suffering that originally brought on the health issue,” said Dr. Marilyn Ford-Gilboe, professor at the Arthur Labatt Family School of Nursing and one of the Equip Healthcare’s organizers. “What we are trying to do is to help providers think about ways that people’s histories and experiences interact with their health issues.”

It might have been another busy day in a hospital emergency room. But for then-volunteer Shweta Pardel, it was another shift closer to living her dream.

Pardel, 24, is a recent Nursing graduate and cannot wait to get into the thick of it. In December, she began a full-time nursing position at a Toronto Hospital emergency room. “I love people. This is why I am doing this. I want to focus on primary care with a community- based approach. This is where health care should be today.”

Pardel’s philosophy is also being put to the test in a new program at Western.

Outside-the-Gates-Cover

Equip Healthcare is a research-based program consisting of a team of health researchers, health-care providers and various community agencies with the goal of understanding the delivery and impacts of “equity-oriented health care” for both clients and health-care providers.

Dr. Marilyn Ford-Gilboe, professor at the Arthur Labatt Family School of Nursing and one of the Equip organizers, said people who are treated poorly oftentimes avoid health-care services altogether.

“For those who have experienced discrimination, trauma or violence, this includes feeling that poor health care may bring back the suffering that originally brought on the health issue,” she said. “What we are trying to do is to help providers think about ways that people’s histories and experiences interact with their health issues.”

Jason Powel, dean of health sciences at Humber College in Toronto, said emergency rooms today do not serve marginalized groups as well as they should. In Canada, there are large differences in people’s health status. These differences are related to social factors such as low income, homelessness, abuse, addiction, alcoholism, cultural or social identity, gender, discrimination and mental-health issues.

Ford-Gilboe agrees. “There are strong links between these factors and experiences in trauma, including personal, family and community level violence.”

The Equip Healthcare program was funded two years ago based on a five-year grant through the Canadian Institutes of Health Research.

According to Ford-Gilboe, a big part of the project involves implementing an organizational level of intervention that involves working with four clinics, two in British Columbia, two in Ontario, including one in London. Health sector and university partnerships include Western, the University of Northern British Columbia, University of British Columbia, University of Victoria, Public Health Agency of Canada and Provincial Health Services Authority.

“For the program, we have a group of 600 patients who visit clinics that are specifically designed to reach marginalized populations. Everyone we recruit is dealing with some type of adversity.”

These people are followed four times over a two-year period, and are interviewed about their experience in the clinic, services provided and their own personal health-care issues.

For Ford-Gilboe, it’s all about primary health care.

“When people go to a clinic, how are they greeted? Are they made to feel welcome? Do they return? Are they given access to services that help them address their own issues in their lives? And do we see changes in their overall health?” she asked. “We must be sensitive in each and every case.”

This kind of cultural sensitivity is also important to new nurse Pardel.

“Sometimes they don’t trust you. It’s important for us to build that trust,” she said.

Pardel, who lives in Toronto and graduated from York University in June, has received training regarding global issues that specifically addressed cultural sensitivity.

“It’s about not re-victimizing the victim,” Pardel continued. “It’s about understanding the social determinants of a client’s health and what caused that health problem. This is where health care should be, in finding the root problem and understanding it.”