Delaware is shrinking racial gaps in cancer death. Its secret? Patient navigators

Of interest:

Sussex County, in the heart of southern Delaware’s poultry-farm country, is home to many people like Michelaine Estimable, a 62-year-old native of Haiti who came to work on the factory lines of a chicken-processing plant.

But Estimable hasn’t worked in two years, because of a leg injury that made it impossible for her to drive. Now, she relies on family members she lives with to get rides to medical appointments — one of the logistical headaches that’s kept her from scheduling her mammogram for the past year.

Luckily for her, she’s getting some help this year accessing preventative care from the state of Delaware. At the clinic where she gets primary care, she meets with Margarette Osias, a patient navigator for the Delaware Breast Cancer Coalition, who sets up shop here every Tuesday, hoping to find people in the community due for mammograms or other cancer screenings.

Osias schedules exams for patients, sends them reminders, and arranges rides for them to get there. A bilingual Haitian Creole speaker herself, Osias also deals with insurance — or even goes with patients to appointments to serve as a translator.

Whatever obstacles the patient faces, “I am basically the connection between that individual and receiving that care,” Osias says.

Patient navigators like Osias play a critical role in how the state of Delaware has reduced its cancer death rates, and narrowed — even eliminated — racial disparities in some forms of cancer. Both are high priorities for the Biden administration, which last month relaunched the Cancer Moonshot initiative, pledging to cut cancer deaths in half in 25 years and address persistent disparities in screening and treatment among people of color. Nationally, cancer kills Black people at higher rates than other groups.

Delaware’s approach to cancer care stands out in the U.S. Two decades ago, the state had one of the highest cancer death rates in the country, so it used funds from the 1998 tobacco settlement to set up universal cancer screening and treatment for its residents. Its Screening for Life program will pay for all cancer screenings and, if cancer is found, will also cover up to two years of treatment — even for residents who are undocumented, have no insurance, or earn up to 6.5 times the federal poverty rate.

Now, that program is a model for addressing racial inequity in health care.

But access to screening and treatment can only help if residents like Estimable, who’s lost a sister and a cousin to cancer, know about it — which is where patient navigators like Osias come in.

Osias schedules exams for patients, sends them reminders, and arranges rides for them to get there. She also helps patients with insurance and translates for them at medical appointments.

Every five years, the state identifies zip codes where screening rates run lowest. Navigators then fan out across grocery stores and laundromats in those communities, dropping flyers, setting up booths, and meeting with religious leaders. They arrange mobile screening vans to factories and other workplaces during work hours.

The process is neither quick, nor easy; it takes time to be seen and develop a rapport with people who have a distant or skeptical view of the medical system, says Mary Jo Vasquez, another patient navigator.

People will often approach only after seeing her multiple times, at their church, or where they shop. “They need to trust you,” she says. “They have to learn that we’re there for them, that we want to help them and that we’re not going to abandon them.”

Having patient navigators on the front line is essential, says family nurse practitioner Nadya Julien.

Julien opened Tabitha Medical Care three years ago, and started working with navigators like Osias. The clinic serves mostly her fellow Haitians, as well as some Latino immigrants. She says many are illiterate and didn’t grow up with preventative medicine back home, which puts them at especially high risk of getting late-stage cancers.

The role of navigators isn’t just logistical, she says, they also reduce fears and help people feel supported through a scary and unfamiliar journey, whether it’s screening or treatment.

“When you have the navigator that speak the language that’s can schedule the appointment, that can go to the house and pick them up and also be there with them to translate it gives comfort,” Julien says.

Delaware’s progress against cancer inequities has been slow and steady, and not without its challenges. The state’s overall cancer death rate has gradually fallen from the 2nd highest among states in the 1990s to the 15th highest. Black men’s improvements stand out: From the period of 2003-2007 to that of 2013-2017, the death rate from all cancers declined 26% for non-Hispanic Black men in Delaware, compared to a 15% decline for white men.

The success varies by cancer. The state’s colorectal cancer mortality rates declined 37% among Black men in that time, and compared to 20% for white men. On the other hand, death from breast cancer only decreased by 3% among Black women compared to 15% for white women in that same period.

And a new challenge emerged in the pandemic: screening rates dropped off, temporarily hampering outreach efforts, so — like many other places — the state is now focusing on making up for lost ground.

But solving shifting challenges has always been a big part of navigators’ work. Through trial and error, they’ve discovered they get fewer no-shows if they conduct free screening events on Thursdays, instead of Fridays, for example. They’ve learned to confirm appointments by text instead of by phone, after noting texting helped cut back on confusion and missed appointments.

Learning and tweaking the program like that has helped remove more roadblocks to care, says Stephen Grubbs, a medical oncologist and a founding member of the advisory council of the Delaware Cancer Consortium, which developed the state’s approach.

“This program has been so successful I think because it’s built on data and evidence,” Grubbs says. The state didn’t just screen more people, it also got them into earlier treatment, which ultimately saved lives, he says: “The final end point was, did we change mortality? And the answer was yes. And that’s where you’ve got to get to. If you don’t get there, the other stuff really doesn’t matter, does it?”

Grubbs says it helps that the economics of the program work, too. Catching cancers earlier means less invasive, less costly treatment with better outcomes which, in turn, helps reduce overall cancer costs. All that is possible, he says, because of patient navigators.

“We took the barriers down, the navigators grease the system and made sure it all flowed through — that’s exactly what it was,” he says.

The state now hopes to build on its success, getting more funds to hire more navigators to target other cancers.

Delaware benefitted from having a unified approach, with support from politicians, physicians, community health centers and patient advocates, says Karen Knudsen, CEO of the American Cancer Society. “Having a state cancer plan is something they embrace, and that 20 years of work is starting to bear fruit,” she says.

The state demonstrated the importance of patient navigators, who now play big role in cancer care nationally.

“Everybody knows it’s the right thing to do,” Knudsen says. “And I think there’s a good, strong business case for it as well because of the lower cost of care for patients who are navigated.”

The problem, she says, is insurance doesn’t cover navigation services, which means cancer treatment centers or nonprofits like hers have to fund the cost.

She says she hopes that will change, especially after she spoke to President Biden last month at the White House’s Cancer Moonshot announcement.

“He did not specifically talk about navigators using that word, but he did talk about eliminating disparities and increasing access,” she says. “What I hear when I hear that, I hear “navigation.”

Back at Tabitha Medical Care, after patient navigator Margarette Osias completes scheduling her mammogram, she tells Michelaine Estimable she will call her and send her a text message to remind her.

Then, as she does with every patient she sees, Osias turns to Estimable to ask her to help spread the word: “If she goes to a church or if she’s in the community, if she can share that information with maybe other women that she can let them know that they can come.”

Will she do that?

“Yes,” Estimable answers emphatically. “Yes.”

Source: Delaware is shrinking racial gaps in cancer death. Its secret? Patient navigators

Wolfson: In pursuit of a world-class health data system

Good arguments, challenge given complexity and jurisdictional issues. Some progress through programs like MyChart which makes managing my hospital-based visits and tests so much easier:

Canadians see new and increasingly powerful computerization in almost every facet of their day-to-day lives—everywhere, that is, except for something as fundamental as health care, where systems are too often stuck in the past.

Canadian governments have invested heavily to advance the use of health data, most often without a clear national vision. An incoherent approach for health data is hurting health outcomes, escalating sector costs and expanding inequities.

The health sector relies on data to guide almost every decision, from the choice of an antibiotic for treating an individual’s simple urinary tract infection, to national pandemic policies that affect millions of Canadians.  The challenge is that health and health-related data are so poorly organized and managed in Canada.

While health-care providers create and have responsibility for safe management of records of health care encounters, personal health information in Canada should be available to patients as well.

The reality is that patients continue to have limited access to or insight about data about them, as that remains under the de facto control of myriad and siloed health-service providers. The inevitable result of this scattered provider-centric rather than patient-centric approach is that patient data are typically spread among their various health care providers’ uncoordinated and unstandardized data systems. The result: both providers and patients have to work with incomplete and incoherent information.

The health sector has invested for years in digital technology in the mistaken belief it would immediately solve our health data woes. We have failed to realize the true obstacle to effective health data collection and use is not mainly technological, but a matter of policy and governance.

To realize its tremendous promise, health data in Canada must become centred around the individual. Services would be designed around people and by people. The “life flows” of patients and families would mesh with the “work flows” of providers and institutions. There would be one centrally accessible virtual digital record for each of us.

As patients move from home to care setting, and from provider to provider, data would remain seamlessly accessible for those in the patient’s “circle of care”; no need to repeat your health history for each new provider. Data flows about a person—who sees what—would be transparent to the person involved or to their proxy.

Health-care providers would continue to access personal information for the purposes of individual care, while a new role—health-data stewards—would be mandated to curate population-based data for public good while ensuring privacy and confidentiality.

How can we make this vision a reality in Canada?

This will only happen with a fundamentally reimagined approach to health data policy and governance for the digital age, grounded in mutual trust. Governments need to trust the public by providing clear and complete information, with people in Canada trusted to act for the good of the community. The public would be involved in policies regarding health data collection, sharing, use and communication. And governments need to make real their commitments to respect Indigenous data governance.

Governments must also trust each other and recognize the over-riding importance of coherent pan-Canadian data.  At present, each province and territory has its own health data policies, standards and governance, with very little active coordination across borders. Even in the area of death certification, where the vital statistics registrars have worked together for many decades, we have the current failure to agree on and report COVID-related causes of death in a standardized manner.

Accessing the routinely collected data that do exist is a marathon for fully authorized researchers, for example to study post-marketing drug safety and effectiveness. Even with all the available approval processes in place, it has still proven impossible to analyze these kinds of data for the country as a whole.

These pervasive blockages to generating coherent and timely pan-Canadian information seriously impairs our ability to respond to public health threats and generate insights that could improve health outcomes for all.

Ultimately, we need to rethink—not rejig—how we manage and use health data. The Pan-Canadian Health Data Strategy report, authored by an Expert Advisory group, points out the need for a culture shift in health data use. Public input has to be part of the transformation to person-centred health care and health data systems.

Of course, updating health data systems has costs. But given the tens of billions of health-care dollars the federal government is providing to the provinces through fiscal transfers, it is long past time the federal government leveraged this clout—using both carrots and sticks—so that people in Canada can finally have informed, accessible health data when and where they need it most.

Michael Wolfson is a former assistant chief statistician at Statistics Canada, and a current member of the University of Ottawa’s Centre for Health Law, Policy and Ethics. Vivek Goel is president and vice-chancellor of the University of Waterloo. Both are members of the Expert Advisory Group on the Development of the Pan-Canadian Health Data Strategy.

Source: In pursuit of a world-class health data system

Kaplan-Myrth: Health-care workers have your backs. Please protect us too

From our family doctor:
Those of us who have been the recipients of harassment and intimidation over the last two years — who have experienced the overlap between antivax/antimask rhetoric and anti-semitism, racism, homophobia and misogyny — were overcome by a sense of foreboding as trucks rolled into downtown Ottawa more than a week ago. These events, now spreading to the rest of Canada, are a warning to us all.By now everyone has seen the photos of Nazi and confederate flags on the backs of trucks. Residents of downtown Ottawa are powerless against trucks honking their horns all night, diesel fumes wafting into their windows. Food was taken from the Shepherds of Good Hope shelter. Women survivors of violence, traumatized, cried out for help, unable to safely walk outside the Cornerstone shelter. An employee at a local business was physically assaulted. LGBTQ community members were confronted with transphobic placards; a shop window with a rainbow flag was broken. In a virtual townhall meeting led by Ottawa Centre MPP Joel Harden, the chat was disrupted at one point because of anti-Black, racist comments.

The mayor has declared that downtown Ottawa is “under siege,” in a state of “emergency.” As the hate spreads across the country, health-care workers in Toronto and Vancouver were warned not to dress in scrubs in the streets, to avoid being a target for hate. In response, Dr. Lisa Salamon-Switzman, an emergency room physician in Toronto, posted on Twitter that she would wear her scrubs, that as a granddaughter of Holocaust survivors, she would not cower from those espousing hate.

Source: Kaplan-Myrth: Health-care workers have your backs. Please protect us too

Canadians’ health data are in a shambles

Unfortunately, all too true, with too few exceptions, based upon my admittedly anecdotal experience in Ottawa:

Canadians see new and increasingly powerful computerization in almost every facet of their day-to-day lives – everywhere, that is, except for something as fundamental as our health care, where systems are too often stuck in the past.

When we go to the doctor, we get prescriptions printed on paper; lab results are sent via fax; and typically, medical offices have no direct links to any patient hospitalization data. And while the pandemic sparked a mad scramble to set up many new data systems – to track who was infected, where there were ventilators, who has been vaccinated and with which vaccine – this has happened in a largely unco-ordinated way, with Ottawa and provincial governments each developing systems separately.

As a result, even these newest computer systems are duplicative, and they do not communicate across provincial boundaries, or even within some provinces – not even, for example, to connect vaccinations, infections, the genotype of the virus, hospitalizations, other diseases and deaths so they are centrally accessible. And so Canada’s recent health-data efforts have wasted millions of dollars while failing to provide the evidence base needed for real-time effective responses to the fluctuating waves of COVID-19 infections..

This kind of failure is not new. Even before the pandemic, key kinds of data have long been imprisoned by data custodians who are excessively fearful of privacy breaches, even though the data are generally collected and stored in secure computer databases. A broad range of critical health care data remains unavailable – not only for patients’ direct clinical care, research and quality control, but also for tracking adverse drug reactions, showing unnecessary diagnostic imaging and drug over-prescribing. The result is that major inefficiencies in the systems remain hidden – and may actually cause health problems, and even deaths by medical misadventure.

There are many directions one could point the finger of blame, but as a new report from the Expert Advisory Committee to the Public Health Agency of Canada found, the root cause is a failure of governance. Federal and provincial governments have failed to agree on strong enforcement of common data standards and interoperability, though this is not only a problem of federalism. Health-data governance problems are also evident within provinces where one health agency’s data system is not connected to others within the same province.

What Canada and the provinces have now is essentially provider-centric health-data systems – not just one but many kinds for hospitals, others for primary care, and yet others still for public health. What Canadians want and need is patient- or person-centric health data. That way, no matter where you are in the countryyour allergies, chronic diseases and prescriptions can be known instantly by care providers.

Private vendor-centric health-data software also pose a threat, as do data collected by powerful tech companies from new wearable technologies that offer to collect your health data for you. If Canada does not act swiftly and decisively to establish the needed governance, competing vendor software and individual data will continue the rapidly growing cacophony of proprietary standards. This trend is raising new concerns about privacy, along with untracked increases in health care costs.

The fundamental importance of standardized, interoperable, securely protected health data has been known for decades. There have been repeated efforts to achieve a modern effective health-data system for Canada. But federal cajoling and even financial incentives have failed. Much stronger governance mechanisms are required, and urgently, as the global pandemic has revealed.

The federal government has the constitutional authority to play a much stronger role, given its powers in spending, public health, statistics, as well as “peace, order and good government.” It also has readily available regulatory powers under the Canada Health Act.

Of course, high-quality data collection and data software have costs. But given the tens of billions of health care dollars the federal government is providing to the provinces through fiscal transfers, it is long past time they leveraged this clout – using both carrots and sticks – so Canadians can finally have informed, accessible health data when and where they need it most.

Michael Wolfson is a former assistant chief statistician at Statistics Canada, and a current member of the University of Ottawa’s Centre for Health Law, Policy and Ethics. Bartha Maria Knoppers is a professor, the Canada Research Chair in Law and Medicine, and director of the Centre of Genomics and Policy at McGill University’s Faculty of Medicine. They are both members of the Expert Advisory Group for the Pan-Canadian Health Data Strategy.


Ottawa, provinces must create agency to reform how health data is collected and used, report says

East to agree, hard to implement given provincial agreement needed. Even integration within a province is far from being implemented in a comprehensive manner:

The federal and provincial governments must create a national agency to set standards for the collection and sharing of health data to respond more quickly to threats such as pandemics and to improve patient care, a new report says.

The report, from a federal advisory group to be released on Tuesday, says governments across the country also need to change privacy laws to allow health records and data to be more easily shared – with patients, medical providers and public-health officials. That would require a significant culture shift away from a system that focuses solely on keeping data secure and private, and toward one that ensures health records and data can be used and shared safely.

The report says the systems across the country that aren’t standardized and can’t talk to each other have limited Canada’s ability to respond to COVID-19, including managing vaccines and tracking variants. More broadly, that reality is also hurting patient care, and could hamper the response to other health crises, the report says.

“We haven’t had this concept that people holding this data should be promoting its appropriate use, its timely use for the benefit of the individuals or for the entire population of Canada,” Vivek Goel, a public-health expert who chaired the review and is also president of the University of Waterloo, said in an interview.

The report is the second of three from the Pan-Canadian Health Data Strategy Expert Advisory Group, which the federal government launched last year to examine data problems exposed by COVID-19. While the group’s work was spurred by the pandemic, its recommendations are far broader, and call for dramatic changes to how Canadians’ health data are stored and managed.

The report says the systems for managing health records, and the privacy laws that oversee them, were designed and created for paper records and haven’t sufficiently been updated for a primarily digital system.

Most people can’t access their own health records, which also aren’t readily available to health care providers as patients move through the system, the report says. The document calls for a “person-centric approach” that would give patients control of their records and allow all of their health care providers to access them easily and securely.

“An integrated, person-centric health data structure ensures that all health data follows an individual through the course of their life-long care,” the report says.

It adds that creating a national system would require governments to agree on standards to ensure those records can be accessed regardless of where a patient is or which doctor they see.

While the report does not make detailed recommendations about managing such a system, Dr. Goel said it should be overseen by a body controlled by Ottawa, the provinces and the territories that would recognize – and address – the reality that health care falls under provincial and territorial jurisdiction.

“We need an entity that is co-owned, co-managed, co-supervised by the federal, provincial and territorial governments together in setting those standards,” he said.

It would also require changes to privacy laws. The report says current privacy laws turn health care providers into “custodians” of data, which, in turn, creates a “privacy chill” that prompts them to restrict access even if not required. Instead, the report proposes a model of “data stewardship” that “champions data sharing, access, use and protection.”

Dr. Goel said a system that standardizes health data and facilitates sharing with officials and experts in other jurisdictions would help governments identify and track public-health threats such as infectious diseases including COVID-19. He said the pandemic revealed how ill-equipped federal, provincial and local health agencies were to gather and share data.

For example, he said as new variants of COVID-19 emerge, such as the Omicron variant that is dominating headlines, it is crucial to track who is getting sick and how transmission and patient outcomes are affected.

To do that effectively, health officials need access to information not just from their own provincial or local health unit, but the entire country. That doesn’t require the same system for everyone, just systems designed to communicate.

He compared it to the Interac network, which allows transactions to be tracked between banks even if they are all using different systems. “There are models that we can learn from the private sector.”

Dr. Goel said governments would need the public’s buy-in to increase data sharing in this way, but he thinks they can be persuaded. He says patients may actually be surprised to learn how little information is shared for wider public-health surveillance, such as the details they provide to COVID-19 contact tracers.

Ewan Affleck, a doctor and an expert in health informatics who sits on the advisory group, said he routinely runs into problems accessing his patients’ records from other providers or jurisdictions.

He treats patients in the Northwest Territories, which sends many people to Alberta for surgery and other procedures, but he often can’t access their information easily – or at all.

“I have no means of getting it because of jurisdictional legislation laws, privacy concerns, and this impairs my capacity to provide care,” Dr. Affleck said in an interview.

“So we make mistakes, and those mistakes damage Canadians. This is happening all the time.”

Dr. Affleck said the same issues hamper Canada’s ability to track and respond to population-level health issues such as pandemics.

“Whether it is guiding our response to COVID or whether we’re treating a patient for a urinary tract infection, this is all based on our adjudication of information,” he said.

“Digital health in Canada is legislated to fail. We have to change that model, because it’s an antiquated model from the age of paper-based information, which worked well then, but it works terribly now. And it is actually damaging Canadians.”


Refugee, undocumented health-care workers demand access to permanent resident program

Of note given unsubscribed slots in the permanent resident pathway program for the healthcare stream:

Refugees and undocumented health-care workers are demanding they be allowed to apply for a government program that would grant them permanent status in Canada.

The temporary resident to permanent resident pathway program was announced in April as a way to keep skilled essential workers in the country, with a focus on retaining 20,000 hospital and long-term care workers.

While the government has already received the maximum number of applications for recent university graduates and other essential workers, there have been few applicants accepted to the health-care stream.

The program is set to close on Nov. 5 and has so far accepted only 5,421 applications.

The Migrant Workers Alliance for Change says that’s because refugees and undocumented people are barred from applying and many health-care occupations are excluded.

“I felt humiliated when the eligibility requirement excluded me,” said Fasanya Kolade, a Nigerian refugee and developmental support worker in Newfoundland and Labrador.

Kolade works primarily with seniors and adults with physical, developmental and intellectual disabilities, and said he pulled 65-hour weeks throughout the pandemic to care for his patients.

Despite meeting most of the criteria, he could not apply.

“The only criteria that excluded me was just that I am a refugee claimant,” he said in an online press conference Wednesday.

The program is only open to workers with temporary status in Canada, so even undocumented people with work permits cannot apply.

The program also requires applicants to meet language requirements, and have recent experience in an approved health-care occupation.

Those requirements can also limit eligibility for people who don’t have time to take the proper language tests, the Migrant Workers Alliance said.

The federal government launched a similar pathway program specifically for health-care workers with pending or failed refugee claims late last year, which closed to applications on Aug. 31.

Now with nearly 15,000 spots for temporary residents set to expire in just two weeks, the alliance is calling for the criteria to be expanded.

“Changing these rules, ensuring access for migrants, refugee claimants, undocumented people without economic, occupational restrictions and language restrictions is a no-brainer,” said Syed Hussan, executive director of Migrant Workers Alliance for Change.

“Otherwise these spots will just evaporate.”

Several people have applied, hoping the criteria would be amended, but have been denied.

“When I first heard of the health worker pathway I knew God had finally heard, not only my cries, but also other people in my situation,” said Jane, a Ugandan refugee and personal support worker in Hamilton, Ont. Her full name has been protected because of her lack of immigration status.

She fled her country after leaving an abusive and homophobic relationship and was disowned by her family when they learned she was a lesbian.

She applied for the pathway program with the help of a lawyer and waited, hoping the criteria would be expanded to include people with failed refugee claims, but she was denied.

There are many people with similar stories said Florence, a Ugandan asylum seeker who works in a Toronto residential home for young adults with complex developmental and physical disabilities. Her full name has also been protected.

She was denied because she had filed an asylum claim in the United States.

“Our hands are tied up. I cannot get a steady permit to pursue my dreams,” Florence said Wednesday. “I know there are very many of us like me who need papers.”

Immigration, Refugees and Citizenship Canada did not immediately respond to a request for comment.

Source: Refugee, undocumented health-care workers demand access to permanent resident program

Les agences privées écartées du recrutement à l’étranger

Of note (processing delays and impact on regions):

Des régions en pénurie de personnel auraient pu compter sur plus d’une centaine d’infirmières provenant de l’étranger, mais le réseau de la santé a tourné le dos à plusieurs offres de recrutement provenant d’agences privées, a appris Le Devoir.

Parmi elles, l’agence de placement Serenis, qui n’a pas ménagé ses efforts pour présenter un « projet clés en main » afin de faire venir au Québec une vingtaine d’infirmiers et d’infirmières originaires de la France et du Maghreb. « En ce moment, j’ai 20 infirmières et infirmiers hautement qualifiés qui sont en stand-by », affirme Jackie Lamothe, présidente de trois franchises de l’agence de placement Serenis, pour les régions de la Mauricie, du Centre-du-Québec et de la Montérégie Est.

Selon elle, ces professionnels de la santé ont été choisis par l’agence parce qu’ils sont prêts à aller travailler dans les régions éloignées où les besoins sont criants, comme à La Tuque. Et ils ont tous en poche l’évaluation comparative du ministère de l’Immigration qui indique l’équivalent québécois de leur diplôme.

« J’en ai parlé à des chefs de service des établissements de santé, qui en ont ensuite parlé à leurs supérieurs, et ils étaient tous intéressés. Mais ça finissait toujours par bloquer en haut, comme au niveau du ministère. On a vécu ça partout où on a essayé, même en régions éloignées comme la Gaspésie, le Bas-Saint-Laurent et dans le Nord, comme la Baie-James… »

C’est au début de l’année 2021 que, devant la détresse de plusieurs employés en lien avec la pénurie de personnel, Mme Lamothe a commencé ses propres démarches de recrutement à l’étranger. Neuf mois plus tard et après avoir investi 20 000 $, notamment en analyses de CV, en entrevues et en frais de consultant en immigration, cette ancienne infirmière a été en mesure de dresser une liste de travailleurs francophones « surqualifiés » avec de l’expérience à l’urgence et en pédiatrie, dont la formation allait être facilement reconnue par l’Ordre des infirmières et infirmiers du Québec (OIIQ). « Pour être membre de l’OIIQ, il faut faire un stage de 75 jours dans le réseau public et j’offrais même aux établissements de santé de le prendre sur mon bras », soutient Mme Lamothe. Son agence allait également s’occuper de l’accueil et de l’intégration des travailleurs, comme le logement et la première épicerie. « Je pouvais même signer un papier pour confirmer que ces personnes-là allaient rester dans le public. C’était gagnant-gagnant ! »

Alors que Radio-Canada a rapporté que le gouvernement Legault mène actuellement une opération sans précédent avec Recrutement santé Québec pour faire venir 4000 travailleurs de la santé hors du Québec — dont 3500 infirmières —, des agences privées s’étonnent que leurs offres de recrutement n’aient pas été retenues. « J’ai trouvé ça très dommage. Si le gouvernement avait pris nos services, on aurait déjà une soixantaine d’infirmières pratiquant en Abitibi, ça n’aurait coûté que quelques centaines de milliers de dollars et on aurait pu économiser plusieurs millions en location de personnel », a déclaré Marc Blais, président de l’Agence de placement et de développement internationale (APDI), qui a près de 2000 CV d’infirmiers et d’infirmières de l’Afrique subsaharienne dans sa base de données. « Il y a eu un manque total de vision là-dessus. »

En 2019, son entreprise, qui fait uniquement du recrutement, avait proposé un projet pilote en collaboration avec le Cégep et le Centre intégré de santé et services sociaux de l’Abitibi-Témiscamingue (CISSS-AT) pour offrir une formation de mise à niveau reconnue par l’OIIQ à quelque 400 des Africains de l’Ouest qui avaient été présélectionnés. La force de cette initiative était la promesse que les gens recrutés allaient vouloir s’installer durablement en région, puisqu’ils viennent eux-mêmes de l’extérieur des grands centres. « On a sollicité le ministère de la Santé pour avoir des fonds, et ça a été refusé. [Le gouvernement] préférait travailler à l’interne avec Recrutement santé Québec », a soutenu M. Blais, qui se sent comme s’il s’était fait un peu voler son idée. « Ce programme-là, au fond, c’est nous qui l’avions mis en place. »

Le président de l’APDI constate que les agences privées de placement ou de recrutement sont boudées par le gouvernement. « On dirait que le [ministère] n’est pas très à l’aise avec les agences privées. Lorsque les solutions viennent du privé, il ne les retient pas. On nous met tous dans le même bassin. »

Jackie Lamothe déplore aussi que les efforts de son agence semblent être mal perçus. « Le gouvernement a peur qu’on vole du personnel du réseau, mais ce n’est tellement pas ça ! » lance-t-elle. « C’est le contraire. On prend du sang neuf qu’on met dans le réseau. On évite le [recours au] TSO [temps supplémentaire obligatoire], qui force les infirmières épuisées à partir. »

Longs délais à l’OIIQ

Entreprises privées de personnel soignant du Québec (EPPSQ) dit recevoir une trentaine d’appels par jour de professionnels de la santé de la France et du Maghreb prêts à venir travailler dès maintenant au Québec. « Nous, on pourrait se porter garant, comme agence, de les faire travailler, après validation des acquis et d’un cours accéléré. Mais ce pont-là ne se fait pas », dit Hélène Gravel, la présidente de cette association. EPPSQ a d’ailleurs intenté une poursuite contre le gouvernement, qui veut limiter le recours aux agences privées. Selon elle, le nœud du problème ne se situe pas uniquement dans l’administration du réseau de la santé, mais surtout au sein de l’Ordre des infirmières et celui des infirmières auxiliaires.

« Même pour une personne qui vient de France, c’est très long avant qu’elle puisse venir et gagner sa vie. […] Les délais à l’OIIQ sont encore trop longs. Il va falloir qu’ils s’amenuisent », a-t-elle ajouté.

Selon les données fournies par l’OIIQ, il faut de deux à trois mois pour obtenir une réponse à une demande d’admission par équivalence d’un dossier une fois que celui-ci est complet. À cela s’ajoute un programme de formation de 10 à 14 mois que doivent normalement suivre l’ensemble des infirmières diplômées à l’étranger, sauf les Françaises, qui bénéficient d’une voie rapide en vertu d’une entente France-Québec. S’ajoutent aussi les délais d’obtention des permis d’étude et de travail auprès des autorités en immigration.

À l’heure actuelle, environ 90 dossiers sont en traitement, selon l’OIIQ, qui précise que, généralement, seulement 40 à 50 dossiers parviennent à être complets et sont présentés à son Comité d’admission.

Source: Les agences privées écartées du recrutement à l’étranger

France grants citizenship to 12,000 Covid frontline workers

Quicker than Canada (as of this week, only about 4,300 have applied out of 20,000 slots):

France has granted citizenship to more than 12,000 frontline workers whose jobs put them at risk during the Covid pandemic under a special fast-track scheme.

As well as speeding up the application process, which normally takes up to two years, the government also cut the residency requirement from five years to two.

“Frontline workers responded to the call of the nation, so it is right that the nation takes a step towards them,” said the citizenship minister, Marlène Schiappa. “The country pulled through thanks to them.

“I welcome our new compatriots to French nationality and thank them in the name of the republic. The country also thanks them.”

In September 2020, the interior ministry invited those who had “actively contributed” to fighting the Covid health crisis to apply for fast-track naturalisation. On Thursday, Schiappa said 16,381 had applied and 12,012 applications were approved.

Among them were health professionals, security and cleaning staff, those who looked after essential workers’ children, home help workers and refuse collectors, the minister announced.

John Spacey, a Briton, was one of those given fast-track nationality as a foreigner who had “proved their commitment to the republic” in the eyes of the ministry.

Spacey lives in the Creuse region in central France and works for an organisation that provides domestic care for elderly people. “It genuinely feels like a great honour to be offered citizenship,” he told the Local earlier this year.

“France has been very good to me since my arrival and has given me opportunities I could never have dreamed of before stepping off the Eurostar in 2016 – a home of my own, a wonderful relationship, a 20-year-old Peugeot 106, a 40-year-old Mobilette, the most satisfying job in the world and a very bright future.

“Soon, I’ll be able to vote, will regain my freedom of movement and will finally feel fully European once more, finally feel fully integrated into the nation I’ve already come to love like my own.”

Spacey said he also received a one-off bonus payment from the state “as a kind of merci for services rendered during the crisis … something for which I was very grateful and that I’d not expected, given I’d been paid for my work anyway”.

He added: “Then came another, far more unexpected, thank you – the chance to apply for French nationality six months earlier than would have been possible under the normal rules and to have the process fast-tracked. All for doing a job I love.”

In April 2020, French hospital staff and nursing home workers were awarded tax-free bonuses of between €1,000 and €1,500 as part of the government thank you for their work during the Covid-19 crisis.

In August 2020, France’s 320,000 home-care workers were given Covid-19 bonuses of up to €1,000.

Source: France grants citizenship to 12,000 Covid frontline workers

The Black Mortality Gap, and a Document Written in 1910

Important history:

Black Americans die at higher rates than white Americans at nearly every age.

In 2019, the most recent year with available mortality data, there were about 62,000 such earlier deaths — or one out of every five African American deaths.

The age group most affected by the inequality was infants. Black babies were more than twice as likely as white babies to die before their first birthday.

The overall mortality disparity has existed for centuries. Racism drives some of the key social determinants of health, like lower levels of income and generational wealth; less access to healthy food, water and public spaces; environmental damage; overpolicing and disproportionate incarceration; and the stresses of prolonged discrimination.

But the health care system also plays a part in this disparity.

Research shows Black Americans receive less and lower-quality care for conditions like cancer, heart problems, pneumonia, pain management, prenatal and maternal health, and overall preventive health. During the pandemic, this racial longevity gap seemed to grow again after narrowing in recent years.

Some clues to why health care is failing African Americans can be found in a document written over 100 years ago: the Flexner Report.

In the early 1900s, the U.S. medical field was in disarray. Churning students through short academic terms with inadequate clinical facilities, medical schools were flooding the field with unqualified doctors — and pocketing the tuition fees. Dangerous quacks and con artists flourished.

Physicians led by the American Medical Association (A.M.A.) were pushing for reform. Abraham Flexner, an educator, was chosen to perform a nationwide survey of the state of medical schools.

He did not like what he saw.

Published in 1910, the Flexner Report blasted the unregulated state of medical education, urging professional standards to produce a force of “fewer and better doctors.”

Flexner recommended raising students’ pre-medical entry requirements and academic terms. Medical schools should partner with hospitals, invest more in faculty and facilities, and adopt Northern city training models. States should bolster regulation. Specialties should expand. Medicine should be based on science.

Source: The Black Mortality Gap, and a Document Written in 1910

Why doctors want Canada to collect better data on Black maternal health

Need this for many groups:

A growing body of data about the heightened risks faced by Black women in the U.K. and U.S. during pregnancy has highlighted the failings of Canada’s colour-blind approach to health care, according to Black health professionals and patients.

Black women in the U.K. and U.S. are four times more likely to die in pregnancy or childbirth than white women, according to official data. A recent U.K. study published in The Lancet found that Black women’s risk of miscarriage is 40 per cent higher than white women’s. In Canada, that level of demographic tracking isn’t available.

“For our country, we don’t have that data. So it’s difficult to know exactly what we’re dealing with,” said Dr. Modupe Tunde-Byass, a Toronto obstetrician-gynecologist, and president of Black Physicians of Canada. “We can only extrapolate from other countries.”

Source: Why doctors want Canada to collect better data on Black maternal health