Abstract
Our research presents a critique of how barriers to accessing health care experienced by refugee newcomers to Canada have been understood and framed. The literature on refugee health care experiences in Canada, similar to elsewhere, emphasizes logistical challenges, language barriers, and cultural (in)competence. Our study originally aimed to contribute to that literature. We conducted in-depth interviews with newcomer patients, patient advocates, interpreters, health care providers, and community support workers, to identify barriers to care. At one level, our findings reflected what has been reported in the literature. Participants emphasized logistical constraints, patient lack of familiarity with the healthcare system, cultural competency on the part of care providers, and interpretation difficulties. However, inviting patient perspectives on the meanings of those barriers, our findings challenge the current understanding of how barriers to accessing care are experienced. We identified missed opportunities in the way that barriers to accessing health care have been labelled and discussed in the literature: (1) logistical barriers have been linked to patient ‘knowledge deficits’ rather than being understood as a failure of the health care system itself; (2) cultural competency skills of providers have been considered solely in relation to explicit (“exotic”) cultural or religious practices; and (3) descriptions of language barriers inappropriately de-emphasize power differentials. Taken as a cluster, these point to the need for the established solutions for care – specifically, cultural competency training and attention to the social determinants of health – to be re-interpreted through reflection on the culture of the health care system itself.
Presenters
Fern BrungerProfessor of Health Ethics, Centre for Bioethics, Memorial University, Newfoundland and Labrador, Canada
Details
Presentation Type
Paper Presentation in a Themed Session
Theme
KEYWORDS
Refugees, Health Care, Epistemology, Culture, Cultural Competency, Cultural Humility
