Hospitals

Navigator helps anglophone patients find their way in Quebec City

Navigator helps anglophone patients find their way in Quebec City

Ruby Pratka, Local Journalism Initiative reporter

editor@qctonline.com

There was a time when walking through the doors of a Quebec City hospital was the last thing Steve Guimond ever wanted to do again. He and his family were living in Montreal and had to make regular trips to the provincial capital so his children could receive care for a long-term medical condition. The family found the three-hour road trips, bureaucracy and navigating the health system in two languages exhausting.

“We had no choice but to come here [to Quebec City] and our experiences were not great. My wife and I actually told ourselves that after the situation with our kids was over, we would never come back here again,” said Guimond, a bilingual anglophone originally from Saguenay who has lived most of his life in greater Montreal.

A decade later, perhaps ironically, helping English- speaking patients get in and out of Quebec City hospitals is Guimond’s full-time job. He works as a patient navigator for the Community Health and Social Services Network (CHSSN), a Quebec City-based provincewide nonprofit promoting access to health care in English. When patients from isolated English-speaking communities in the Gaspé, the North Shore or the Lower North Shore need to come to Quebec City for medical appointments, Guimond is the person they call.

“The way the health system is set up in the province is that anyone living east of Quebec City – and that’s a very large region, the Lower St. Lawrence, the North Shore, the Lower North Shore, the Gaspé and the Magdalen Islands – [is] usually sent here for specialized health services, because the services they have access to in their own regions are pretty minimal. Anytime you need an MRI, you have to come here.”

For someone from the Lower North Shore – the stretch of isolated, primarily English- speaking villages between Kegaska, where Route 138 ends, and Blanc-Sablon – this means several days of travel, often by ferry or snowmobile and then by plane. Once a patient arrives at his or her destination, the culture shock of going from an anglophone village of a few hundred people to a mostly French-speaking city of close to one million can be intense, especially for patients who never learned French or who aren’t comfortable in the language. “You have the stress of the medical aspect, the stress of the travel – the Lower North Shore has a very unreliable air carrier – the stress of arriving in a big city where you potentially don’t know anyone, the stress of not knowing much about the hospital or where you’re staying … and the stress of actually going to the hospital, which is much larger [than health facilities patients are used to]. There’s also the language barrier.”

Jody Lessard is executive director of the North Shore Community Association, which helps connect the estimated 2,500 anglophones of the upper North Shore – between Forestville, across the river from Rimouski, and Natashquan, until recently the end of Route 138 – with services in their preferred language. “If you’re an English speaker from a small town of 20 or 200 people, there’s a lot of fear [when you arrive in Quebec City]. By just having someone like Steve there to pick you up when you arrive, that fear is gone,” she said. “He provides a sense of security. This is a great project and it’s highly needed … and he’s the only one doing it.”

Both Lessard and Guimond said they believed the project, currently run by the nonprofit CHSSN, could benefit from increased government support. “We’re basically stepping in to deal with the problems or the issues that are created by the health system. It’s like the health system should be the one making sure that these measures should be in place, but they’re not,” Guimond said. People from remote communities and people living with chronic conditions often pay the price, he observed.

As a patient navigator, Gui- mond often drives patients to and from appointments at hospitals in Quebec City and Lévis, helps them get admitted, helps patients find long-term places to stay and acts as a translator and patient advocate. No two days are ever the same. “It takes a lot of flexibility, foresight and ingenuity, I guess, but people are great – they understand I’m the only person doing this, so there are times I can’t be there exactly on time.”

Guimond said he has noticed that health-care professionals are increasingly willing and able to ensure patients who need service in English get it, despite a recent raft of confusing and contradictory government guidelines on the use of languages other than French in health care. “There’s a real disconnect between what the government is trying to instill [in terms of the prevalence of French] and what is actually happening on the ground,” he said. “The patient comes first, and no one is going to be refused service because they can’t speak French. I’ve seen people go out of their way to make sure patients are comfortable and make sure there’s someone around who can communicate with them.” Even so, he pointed out that not all written documentation handed out to patients is available in both languages, due in his estimation to inter-agency communication challenges within the health system.

He advised anyone preparing for a medical appointment, even if they live in the city and don’t need directions or help getting to the health facility – to make sure they have their health insurance card on them at all times – “that’s like your passport.” He also told patients not to hesitate to ask for English service if they need or prefer it. “That’s your right.” For more information on the health navigator program, visit travel4health.ca/going-to/quebec/patient-navigator.

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Nurses, government accept new collective agreement

Nurses, government accept new collective agreement

Ruby Pratka, Local Journalism Initiative reporter

editor@qctonline.com

The Fédération inter- professionnelle de la santé de Québec (FIQ) has accepted a collective agreement proposed by a mediator, bringing an end to more than two years of negotiations with the provincial government.

Members of the FIQ, the province’s largest nurses’ union, voted in an online poll held Oct. 15-17 and briefly paused due to technical difficulties. About two-thirds – 66.3 per cent – of voting members chose to accept the agreement. Voter turnout was estimated at 75 per cent. The FIQ rep- resents about 80,000 nurses, nursing assistants, respiratory therapists and IV technicians in public-sector health facilities across the province.

The vote came six months after members rejected an initial proposed collective agreement by a similar margin. One of the major sticking points in the negotiations, union representatives said, was staff mobility – the idea that a nurse could be assigned, on short notice, to fill in at a facility far from her home or in a capacity that didn’t correspond with her experience (for example, an ER nurse being given a shift at a CHSLD).

“We’re not in celebration mode right now, we’re in ‘we got to the end of it’ mode,” FIQ vice-president Jérémie Rousseau told the QCT. “Two years is a very long time. There’s a huge difference of visions between the government and the health professionals [which creates] an issue with retention. I hope the government will take time to see what is going on on the ground.”

Rousseau noted that the union made some “important gains” in terms of holiday and overtime pay, and secured a 17.4 per cent pay raise over the next five years, identical to the raise public sector workers in the Front Commun union bloc received in their most recent collective agreement.

Nurses secured some concessions from the government around mobility – under nor- mal circumstances, a nurse can only be asked to fill in at a second facility if it’s less than 40 kilometres away from her primary facility and if she will be asked to provide the same kind of care. However, members also agreed to be part of voluntary “flying teams” sent as an occasional stopgap to understaffed facilities in remote regions.

“In addition to helping improve working conditions and providing increased flexibility, the agreement will enable government objectives to be achieved while improving the services offered in the public network,” Treasury Board president Sonia Lebel, Health Minister Christian Dubé, min- ister responsible for social services Lionel Carmant and minister for seniors’ affairs and associate health minister Sonia Bélanger said in a brief joint statement on Oct. 18.

The agreement will be in force until March 31, 2028.

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The critical condition of crowded Canadian emergency rooms

An overcrowded ER can cause excess deaths, it is estimated 8000-15000 Canadian patients die unnecessarily per year. Photo India Das-Brown

India Das-Brown
Local Journalism Initiative

On a July night in 2021, Zoe Katz, then 20, went to the Montreal General Hospital after fainting and hitting the back of her head. She waited eight hours to be treated with stitches.

“I touched the back of my head and my fingers were wet [with blood],” Katz said.

After a few hours of waiting in the emergency room, Katz asked to be given a temporary solution. She was given a “flimsy bandage” by a nurse with “no other words about what would happen.”

“I felt like she didn’t really care whether I lived or died,” said Katz. “I cried a couple of times because I had read news about people being very neglected by the medical system and just undergoing really scary medical mishaps in ERs (Emergency Rooms).”

“It’s really jarring seeing blood come out of the back of your head and not really having a measure of where or how deep the wound is.”

According to Katz, she was in the third priority (urgent condition) range out of the five levels at the ER. Katz entered the ER at midnight and left around 8 a.m. that morning.

“The one takeaway I got [from my experience] is that I want to live my life in a way that minimizes my exposure to the ER,” said Katz. “I don’t want to be there and I don’t want to be in hospitals, so I just live my life as healthily and away from harm as possible.”

In the wake of the COVID-19 pandemic, the strain on Canada’s healthcare system has increased, with emergency departments growing more overcrowded and workers more overworked. According to the Canadian Association of Emergency Physicians, an estimated 8,000-15,000 Canadian patients die unnecessarily each year as a direct result of hospital crowding.

Dr. James Worrall, an emergency department physician at the Ottawa Hospital, said ER crowding and wait times are “just as bad or worse” following the pandemic.

“The situation almost every [public] hospital in North America faces is that there is not a bed available,” said Worrall. “So, the patient waits in the emergency department for a bed. That wait may be hours, it may be days. This reduces the ability of the emergency department itself to accept and care for new patients.”

A crowded emergency department does not mean huge crowds in the waiting room. It means all of the hospital’s care spaces and stretchers are occupied by patients who have been admitted and are waiting to move upstairs to a hospital bed. “Sometimes all our stretchers are full, and we’re packing people away in corridors,” Worrall said.

Before moving to Ottawa, Worrall worked at the Royal Victoria Hospital in Montreal from 2005 to 2007. “We would have patients waiting for a week in the emergency department,” he said. “I mean, things are bad where I work now, but not that bad.”

In Quebec, there is a centralization of control and decision making around healthcare at the provincial ministry level. Municipalities lack the ability to hire as many doctors as needed, or to create innovative solutions that work for their hospital or their region, according to Worrall. Because decision-making power is decentralized in Ontario’s healthcare system, there is more municipal autonomy with governance, decision-making and regulatory matters.

The Plans régionaux d’effectifs médicaux (PREMs) were established two decades ago with the aim of promoting a fair distribution of family doctors throughout Quebec. The PREMs are assigned by region. All doctors employed in the public system must have a PREM and dedicate at least 55 per cent of their practice to the region where it was granted—otherwise they are docked 30 per cent of their pay and prevented from reapplying for three years.

The permits are distributed assuming that a doctor will manage a full patient load alongside their additional duties. However, if a physician takes parental leave, gets sick, or scales back their hours for any reason, there is no measure for other doctors to pick up the slack.

PREMs are also non-transferrable. If a physician like Worrall leaves the province, moves to the private system, or retires, the permit is lost forever. This means that hospitals can be left understaffed, and further, overcrowded.

“[PREMs are] just so centralized and bureaucratic, it is far less efficient,” said Worrall. “Another difference in Quebec is within hospitals, there is far greater acceptance of the idea that patients don’t need to come to the emergency department; they’re using the system irresponsibly. And when people get admitted, they can just stay in the emergency department hallway for days and days.”

Patients are often blamed for visiting the ER inappropriately, when in reality, Canadian health care systems are designed to funnel patients towards the ER, said Worrall.

Dr. Bianchi, a 45-year-old emergency department physician at the Hôpital de Verdun—granted a pseudonym for privacy reasons—said the majority of people waiting in ERs are there inappropriately.

“As a doctor, you’re tired and you just intubated a baby. You had a person that died in front of you because he had a car accident,” said Bianchi. “And then you see this person who has a runny nose and he doesn’t want to go to work tomorrow. This is the reality.”

In 2021, Bianchi was working in Verdun when a patient suddenly suffered a cardiac arrest. “There was no space [in the department] and there were no monitor pads [available], so it was complete chaos. Of course, we took the monitor pads off one of the patients, because this one was literally dead,” he said. “At some point it’s too much.”

In Montreal hospitals, emergency department occupancy rates hover well over 100 per cent in most cases, sometimes topping 200 per cent. According to the Index Santé website, only four of the 21 hospitals in Montreal were reporting occupancy rates under 100 per cent on Nov. 27. The highest traffic was reported at the Royal Victoria Hospital, with an average waiting room time of over 10 hours and an average time spent waiting on a stretcher surpassing 32 hours.

“We need a model of care where the inpatient parts of the hospital have to be able to accept whatever comes their way,” said Worrall. “They need to be able to flex up and bring in more people when needs are higher and then flex down when demands are lower.”

In 2004, the Department of Health in England set the target of a maximum four-hour wait in Accident and Emergency (A&E) from arrival to admission, transfer or discharge. The aim was to reduce waiting times and control crowding. This target was initially set at 98 per cent compliance, and adjusted to 95 per cent in 2010.

Studies have shown that this standard has yielded positive outcomes for patient care. The standard has been linked to better hospital bed management and reducing patient waiting times and mortality rates. Within a year of visiting A&E, patient mortality reduced by 0.3 percentage points, representing 15,000 fewer deaths in 2012-2013.

Data from England’s National Health Service also shows that in 2002, 79 per cent of patients spent less than four hours in A&E, while in 2005 (after the target was introduced), that level was 98 per cent.

“It starts with the government saying, ‘We’re not accepting the current status quo,’” said Worrall. “The emergency department is effectively the waiting room for the rest of the hospital, and that’s not okay.”

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