Dr. Setareh Ghahari: Helping Immigrants and Refugees ACHIEVE Healthcare Access

TMED Student Society

| 10 February 2023

By: Abhishek Shastry, MSc’24 (Candidate), EDII & SGPS Representative, TMED Student Society

Content warning: Discussions of genocide and violence

January is the month of new beginnings, new resolutions, and new promises that we make to improve ourselves and the world around us. January is also Tamil Heritage Month¹, designated to honour the contributions and histories of the Tamil people in Canada and around the world. The Tamil people are ethno-linguistic groups centred mainly in South India and Sri Lanka. Hundreds of thousands of Tamils immigrated to Canada between the 1980s and the 2000s, both as economic migrants and as refugees of the Sri Lankan Civil War, having been victims of state-directed genocide and ethnic cleansing². Due to this large migration, Tamils account for roughly 1% of Canada’s population and have contributed in immeasurable ways to our society. January 27th also marks International Holocaust Remembrance Day, an occasion to honour and keep alive the stories and memories of those who were murdered and those who survived the Holocaust³. Over 11 million people were killed over their religion, sexuality, disability, and other identities by the Nazi party. We will never forget the plight of victims of war and genocide. Never again.

Canada has had a history of welcoming refugees to live and prosper within its borders. However, healthcare access and utilization by refugees have been historically abysmal due to systemic issues and the lack of addressing the mental and physical toll that refugees experience during and after escaping the trauma of war and/or genocide. It is known that the survivors of genocides like the Holocaust experience greater symptoms of Post-Traumatic Stress Disorder (PTSD) and depression^4,5, which has been noted to be passed down epigenetically to their descendants, as a mechanism of intergenerational trauma⁷. Tamil refugees also largely suffer from PTSD and alienation, contributing to reduced economic and psychosocial integration⁸. In addition, the perceptions and realities of healthcare practice prohibit refugees from accessing adequate healthcare. These obstacles include language barriers, the fear of mistreatment by healthcare professionals, not being taken seriously because of the country of origin, sexism, ageism, and a lack of knowledge regarding war-related mental health issues by both providers and the refugees themselves⁹. The intersectionality of these identities likely has caused many refugees to be directly ostracized from adequate healthcare access. This ostracization has mainly gone unacknowledged by the Canadian political and healthcare systems.

Dr. Setareh Ghahari, an associate professor in the School of Rehabilitation Therapy at Queen’s University, noticed this gap in resources available to refugees and immigrants. To address this issue, in 2014, she developed the Accessing Canadian Health Care for Immigrants – Empowerment, Voice and Enablement (ACHIEVE) initiative¹⁰. This seven-week-long program was aimed to equip refugees and immigrants with the knowledge and practical tools to access the Canadian healthcare system, which includes instruction on finding a family doctor, navigating doctor’s appointments, communicating their symptoms and concerns in English, recognizing where they can access wellness resources, and acknowledging and maintaining their mental and sexual health, among other topics. This initiative was partly informed by the well-described ‘Healthy Immigrant’ effect¹¹, whereby immigrants to Canada are often healthier than the general population on arrival. However, after a few years of acclimatizing to the Canadian lifestyle, their health declines significantly below that of the general population. This phenomenon has been attributed to numerous factors, including a lack of traditional (and healthy) food products from their country of origin¹², the increased consumption of the Western-style diet (high fat, high sugar)¹³, the pressures of acculturation and ‘fitting in’ with Canadian standards of living, and other factors. Without contact with a physician regarding healthy eating options and a lack of health management resources at the outset, it is unsurprising that newcomers to Canada may be left astray given the abundance of negative dietary and lifestyle outlets available.

The ACHIEVE program tackles this issue with classroom learning and focused discussions revolving around healthcare access, as well as what it means to maintain physical and mental well-being after arrival. Dr. Ghahari holds the classes in collaboration with the KEYS Job Centre, Loyola School of Adult and Continuing Education, and Immigrant Services Kingston and Area (ISKA), which are spaces that newcomers are likely to frequent, and allows learners to be comfortable and familiar with these spaces¹⁰. The classes utilize lectures, group discussions, homework assignments, and collaboration with numerous immigrant workers and English as a Second Language (ESL) teachers to facilitate learning and understand participant concerns. This way, the needs of individual students are addressed by the learning modules in a personalized manner, and particular focus can be paid to sections that are of need to the majority of the students. Dr. Ghahari also developed a framework whereby others can teach these classes, although it was initially run by her and her occupational therapy students¹⁴.

In a pilot study conducted to gauge the success of this program, participants reported increased overall confidence in healthcare navigation, participant satisfaction, and healthcare knowledge. In all 7 of the ACHIEVE classroom sessions, which included the topics mentioned previously, participants reported a significant increase in post-intervention test scores compared to pre-intervention; that is, they possessed significantly greater practical knowledge about accessing the Canadian healthcare system and maintaining personal well-being than before the program started. Although community integration wasn’t a main aspect of the study, discussions between facilitators and participants regarding their struggles finding work, fitting into Canadian society, and their trauma as refugees allowed for peer support and built a sense of community among participants. This program was fantastic because it was created in consultation with refugees, immigrants, settlement workers, and ESL teachers. This means that the program was constructed with the needs of immigrants specifically in mind, told from various informed and relevant perspectives. As an inclusive and safe space for sharing experiences, it appears this program increased feelings of community among participants; community is very important for new immigrants, as feelings of loneliness and despair have been known to increase significantly in the years following migration¹⁵. In addition, the partnership with immigration services and job centres allows participants to directly utilize their skills and connections built within the program to reach out to potential opportunities and find networks of individuals that share their experiences¹⁴. Dr. Ghahari is a hero in refugee integration in our Kingston community, and her work has directly benefitted the lives and well-being of refugees in Canada. Just as January is the month of new beginnings, the ACHIEVE program allows refugees to have a brighter and more hopeful beginning in Canada.

References

Bill C-471, An Act to designate the month of January as Tamil Heritage Month, 2nd Session, 41st Parliament, 2014.
Amarasingam, Amarnath. (2014). The Tamil Community in Canada: A Brief Overview. Tamil Culture. Retrieved from https://tamilculture.com/the-tamil-community-in-canada-a-brief-overview.
United States Holocaust Memorial Museum. (2022). International Holocaust Remembrance Day. In Holocaust Encyclopedia. Retrieved from https://encyclopedia.ushmm.org/content/en/article/international-holocaust-remembrance-day.
Barel, E., Van IJzendoorn, M. H., Sagi-Schwartz, A., & Bakermans-Kranenburg, M. J. (2010). Surviving the Holocaust: A meta-analysis of the long-term sequelae of a genocide. Psychological Bulletin, 136(5), 677–698. https://doi.org/10.1037/a0020339
Conn, D.K., Clarke, D. and Van Reekum, R. (2000). Depression in holocaust survivors: profile and treatment outcome in a geriatric day hospital program. Int. J. Geriat. Psychiatry, 15: 331-337. https://doi.org/10.1002/(SICI)1099-1166(200004)15:4<331::AID-GPS118>3.0.CO;2-H
Yehuda, R. and Lehrner, A. (2018). Intergenerational transmission of trauma effects: putative role of epigenetic mechanisms. World Psychiatry, 17: 243-257. https://doi.org/10.1002/wps.20568
Kellermann, N. (2013). Epigenetic Transmission of Holocaust Trauma: Can Nightmares Be Inherited?. Isr J Psychiatry Relat Sci, 50(1): 33-39.
Beiser, M., Goodwill, A.M., Albanese, P., McShane, K. and Kanthasamy, P. (2015). Predictors of the integration of Sri Lankan Tamil refugees in Canada: pre-migration adversity, mental health, personal attributes, and post-migration experience. International Journal of Migration, Health and Social Care, 11(1): 29-44.
Beiser, M., Simich, L. and Pandalangat, N. (2003). Community in Distress: Mental Health Needs and Help-seeking in the Tamil Community in Toronto. International Migration, 41: 233-245. https://doi.org/10.1111/j.0020-7985.2003.00268.x
Reznick, R. (2018). Helping newcomers access the healthcare system. Retrieved from https://www.queensu.ca/gazette/stories/helping-newcomers-access-healthcare-system
McDonald, J. & Kennedy, S. (2004). Insights into the ‘healthy immigrant effect’: health status and health service use of immigrants to Canada. Social Science & Medicine, 59(8): 1613-1627.
Berggreen-Clausen, A., Hseing Pha, S., Mölsted Alvesson, H., Andersson, A., & Daivadanam, M. (2022). Food environment interactions after migration: A scoping review on low- and middle-income country immigrants in high-income countries. Public Health Nutrition, 25(1), 136-158. doi:10.1017/S1368980021003943.
Lane, G., Farag, M., White, J., Nisbet, C., & Vatanparast, H. (2018). Chronic health disparities among refugee and immigrant children in Canada. Applied Physiology, Nutrition, and Metabolism, 43(10): 1043-1058.
Ghahari, S., Burnett, S. & Alexander, L. (2020). Development and pilot testing of a health education program to improve immigrants’ access to Canadian health services. BMC Health Serv Res, 20(321). https://doi.org/10.1186/s12913-020-05180-y
Browne, D. T., Kumar, A., Puente-Duran, S., Georgiades, K., Leckie, G., & Jenkins, J. (2017). Emotional problems among recent immigrants and parenting status: Findings from a national longitudinal study of immigrants in Canada. PLOS ONE, 12(4): e0175023. https://doi.org/10.1371/journal.pone.0175023

Dr. Setareh Ghahari: Helping Immigrants and Refugees ACHIEVE Healthcare Access

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Dr. Setareh Ghahari: Helping Immigrants and Refugees ACHIEVE Healthcare Access

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