Sylvia Reitmanova

''They Can't Understand It'': Maternity Health and Care Needs of Immigrant Muslim Women in St. John's, Newfoundland

ObjectivesThe purpose of this qualitative study was to document and explore the maternity health care needs and the barriers to accessing maternity health services from the perspective of immigrant Muslim women living in St. John’s, Canada.MethodsA purposive approach was used in recruiting six individuals to participate in in-depth semi-structured interviews. Data were analyzed using a two-step process of content analysis. Three metathemes were identified and compared to previous research on maternity health and the care needs of immigrant women.ResultsWomen experienced discrimination, insensitivity and lack of knowledge about their religious and cultural practices. Health information was limited or lacked the cultural and religious specificity to meet their needs during pregnancy, labor and delivery, and postpartum phases. There were also significant gaps between existing maternity health services and women’s needs for emotional support, and culturally and linguistically appropriate information. This gap was further complicated by the functional and cultural adjustments associated with immigration.ConclusionsMaternity health care information and practices designed to meet the needs of mainstream Canadian-born women lacked the flexibility to meet the needs of immigrant Muslim women. Recommendations for change directed at decision makers include improving access to culturally and linguistically appropriate maternity and health related information, developing the diversity responsiveness of health care providers and the organizations where they work and establishing social support networks and partnerships with immigrant communities. Changes that address the needs of immigrant Muslim women have the potential to create more inclusive and responsive maternity health services for all Canadian women.

Teaching Cultural Diversity: Current Status in U.K., U.S., and Canadian Medical Schools

In this paper we present the current state of cultural diversity education for undergraduate medical students in three English-speaking countries: the United Kingdom (U.K.), United States (U.S.) and Canada. We review key documents that have shaped cultural diversity education in each country and compare and contrast current issues. It is beyond the scope of this paper to discuss the varied terminology that is immediately evident. Suffice it to say that there are many terms (e.g. cultural awareness, competence, sensitivity, sensibility, diversity and critical cultural diversity) used in different contexts with different meanings. The major issues that all three countries face include a lack of conceptual clarity, and fragmented and variable programs to teach cultural diversity. Faculty and staff support and development, and ambivalence from both staff and students continue to be a challenge. We suggest that greater international collaboration may help provide some solutions.

Mental Health Needs of Visible Minority Immigrants in a Small Urban Center: Recommendations for Policy Makers and Service Providers

This qualitative pilot study explored the mental health needs of visible minority immigrants in St. John’s—a small urban center in Atlantic Canada with limited ethnoracial diversity and ethnospecific infrastructure. The study examined the facilitators and barriers to maintaining immigrants’ mental health and their perspectives on availability and access to support services and programs that support mental health. Our findings revealed several determinants of the mental health of visible minority immigrants: social support, income, employment, culture, physical environment, coping skills, gender, and availability, accessibility and cultural appropriateness of mental health services. We offer 18 recommendations framed by Health Canada determinants of health that may be of interest to decision-makers in government, health agencies and social services in similar small urban centers.

Twelve tips for teaching diversity and embedding it in the medical curriculum

Despite growing recognition of the need to increase cultural diversity undergraduate education in the UK, the US and Canada, there is a lack of cohesion in the development and delivery of cultural diversity teaching in medical schools in these three countries. This article highlights 12 tips for developing cultural diversity education in undergraduate medical programmes by integrating it in institutional policies, curriculum content, faculty development and assessment. These tips can be used to help ensure that students gain needed knowledge, skills and attitudes consistent with a view of patients as complex individuals with unique needs.

Primary mental health care information and services for St. John's visible minority immigrants: gaps and opportunities.

This article draws on an environmental scan and interviews with visible minority immigrants in a small urban Atlantic community to report on gaps and opportunities for improving access to information about primary mental health care services and barriers to utilization of these services. Information about services was limited and did not specifically address the complex health-related concerns of immigrants with diverse religious and cultural backgrounds. Accessing information about mental health care services was challenging for some visible minority immigrants because of physical and financial constraints and limited computer and language literacy. The major barriers to the utilization of primary mental health care services were lack of information, language and literacy issues, a mistrust of primary mental health care services, the stigma associated with mental illness, long wait times, lack of finances, and religious and cultural differences and insensitivity. A list of nine recommendations, which may be of interest to mental health decision-makers and service providers in small urban centers with limited ethno-cultural diversity, is provided.

How are we 'doing' cultural diversity? A look across English Canadian undergraduate medical school programmes

Background: Cultural diversity education is a required curriculum component at all accredited North American medical schools. Each medical school determines its own content and pedagogical approaches. Aim: This preliminary study maps the approaches to cultural diversity education in English Canadian medical schools. Methods: A review of 14 English Canadian medical school websites was undertaken to identify the theoretical approaches to cultural diversity education. A PubMed search was also completed to identify the recent literature on cultural diversity medical education in Canada. Data were analysed using 10 criteria that distinguish pedagogical approaches, curricular structure, course content and theoretical understandings of cultural diversity. Results: Based on the information posted on English Canadian medical school websites, all schools offer cultural diversity education although how each ‘does’ cultural diversity differs widely. Two medical schools have adopted the cultural competency model; five have adopted a critical cultural approach to diversity; and the remaining seven have incorporated some aspects of both approaches. Conclusions: More comprehensive research is needed to map the theoretical approaches to cultural diversity at Canadian medical schools and to evaluate the long-term effectiveness of these approaches on improving physician–patient relationships, reducing health disparities, improving health outcomes and producing positive learning outcomes in physicians.

Cross-Cultural Undergraduate Medical Education in North America: Theoretical Concepts and Educational Approaches

Background: Cross-cultural undergraduate medical education in North America lacks conceptual clarity. Consequently, school curricula are unsystematic, nonuniform, and fragmented. This article provides a literature review about available conceptual models of cross-cultural medical education. The clarification of these models may inform the development of effective educational programs to enable students to provide better quality care to patients from diverse sociocultural backgrounds. Summary: The approaches to cross-cultural health education can be organized under the rubric of two specific conceptual models: cultural competence and critical culturalism. The variation in the conception of culture adopted in these two models results in differences in all curricular components: learning outcomes, content, educational strategies, teaching methods, student assessment, and program evaluation. Conclusions: Medical schools could benefit from more theoretical guidance on the learning outcomes, content, and educational strategies provided to them by governing and licensing bodies. More student assessments and program evaluations are needed in order to appraise the effectiveness of cross-cultural undergraduate medical education.

Rethinking immigrant tuberculosis control in Canada: from medical surveillance to tackling social determinants of health.

Current tuberculosis control strategies in Canada rely exclusively on screening and surveillance of immigrants. This is consistent with current public health discourse that attributes the high burden of immigrant tuberculosis to the exposure of immigrants to infection in their country of origin. The effectiveness of control strategies is questionable given the evidence that many immigrants are at higher risk of tuberculosis reactivation because of risk factors such as poverty, malnutrition and overcrowded housing. This paper argues that the absence of policies that address poverty-related disadvantages among immigrants makes these populations more vulnerable to the reactivation of their tuberculosis long after they have been exposed in their countries of birth. Policies for tuberculosis prevention in the Aboriginal population attend to their poverty and other social determinants of health. Effective health prevention policy for tuberculosis within the immigrant population must take similar direction.

Coloring the white plague: a syndemic approach to immigrant tuberculosis in Canada.

Objective. In this article, we adopt a syndemic approach to immigrant tuberculosis (TB) in Canada as a way of challenging contemporary epidemiological models of infectious diseases that tend to racialize and medicalize the risk of infections in socio-economically disadvantage populations and obscure the role of social conditions in sustaining the unequal distribution of diseases in these populations. Design. A syndemic approach unravels social and biological connections which shape the distribution of infections over space and time and is useful in de-racializing and de-medicalizing these epidemiologic models. The socio-historic framework allows us to examine social factors which, refracted through medical science, were central to the development of TB control in Canada at the beginning of twentieth century. Results. We expose the ideological assumptions about race, immigration, and social status which underpin current policies designed to control TB within the immigrant population. We argue that TB control policies which divert the attention from structural health determinants perpetuate health and social inequities of racialized populations in Canada. Medical screening and surveillance is an ineffective control policy because the proportion of TB cases attributed to immigrants increased from 18 to 66% between 1970 and 2007. Conclusion. More effective TB control policies require shifting the focus from the individual disease carriers toward social inequities which underlie the problem of immigrant TB in Canada. In addition, de-racialization and de-medicalization of the contemporary epidemiological models of infectious diseases entail an in-depth exploration of how the categories of ethnicity, culture, and immigration status are played out in everyday health-related experiences of racialized groups.

Exploring the Mutual Constitution of Racializing and Medicalizing Discourses of Immigrant Tuberculosis in the Canadian Press

Drawing on critical discourse analysis of Canadian press coverage of the immigrant tuberculosis problem, we expose the complex relationship between press-constructed discourses of immigrant health and current tuberculosis control policies in Canada. The focus of these policies is on screening and surveillance of immigrants rather than addressing social inequalities underlying the problem of immigrant tuberculosis. The biomedical focus and racializing character of current policies were reinforced in the Canadian press by depicting tuberculosis as a biomedical (rather than a social) disease imported to Canada by immigrants. The status of the immigrant body as health threat was produced by and through preexisting and mutually constitutive racializing and medicalizing discourses materialized in press coverage and tuberculosis control policies. Deracialization and demedicalization of health information disseminated in the press are potentially important factors to be considered when revising health policies that would address the socioeconomic and political factors that determine the health status of Canadian immigrants.