Some physicians at the Health for All FHT

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I am a fraud, a poster-girl and a champion. That’s how I started my plenary address at the closing session of the Multicultural Health conference in Toronto yesterday.

My first impulse was to come out of the closet and declare myself a fraud.  I didn’t belong at the front of a room giving the impression that I’m an expert in multicultural health research. Feeling like a fraud is a common sentiment among academics. The “ Impostor Syndrome” has been well described and is known to afflict many of us. We find ourselves stumbling into roles for which we don’t feel fully prepared or completely qualified. We’re driven by the scholarly needs that surround us and our passion to participate in the important work of teaching and research. Then suddenly we find ourselves asked to play a role that stretches us beyond our self-perceived capacity – whether it is in teaching, research or some other kind of leadership. That’s how I feel about the wonderful fact that I count myself among the Governance Committee of the Ontario Multicultural Health Applied Research Network (OMHARN).

Yet the fact that I was invited – not only to participate – but to share in the leadership of OMHARN is a testament to the fundamental fabric of the organization. Who is OMHARN? It is a network of researchers, providers, and policymakers in the field of multicultural health. We are committed to two things. The first is the priority of “doing” multicultural health research. The second is the commitment to use the findings of such research in health planning, practice, and policy. The organization is motivated to ensure that health services in Ontario are culturally safe, effective, and equitable.

OMHARN is one of the most open and enabling bodies with which I have the pleasure to work. I was invited to be part of OMHARN not because of my research expertise but because of my role. I have the distinct privilege of being Chief of Family Medicine at Markham Stouffville Hospital. The Markham Stouffville area is one of the most fascinating communities in the country. Markham has a population of over 300 thousand people and the highest proportion visible minorities in Canada – with over 65 per cent of population self-identifying in that category. Four years ago, when I was asked to take the role of chief (which would include the task developing a Family Medicine teaching unit and an academic Family Health Team), I knew that we would require a strong base of evidence about how to provide high quality care in such a marvelously diverse community. Beyond the provision of care, we need to know how to teach providers from diverse cultural backgrounds about the provision of primary care in a multicultural community like Markham.

The great thing about feeling like a fraud in the midst of the talented leadership team of OMHARN is that my colleagues in the organization have refused to let me wear that hat. No one is excluded from participation. If you acknowledge heartfelt learning needs; if you have a deep desire to contribute to a body of knowledge about multicultural health in Ontario; if you want to live and work in a place where health planning, practice and policy are driven by serious efforts to understand the realities of our diverse communities – then OMHARN is the place to engage. It is not an organization where you will be told that you don’t have enough background to contribute. It is an organization where you can come with brilliant questions; innovative visions; and a unique set of talents – and you will be encouraged to run with them. No one will let you call yourself a fraud. This is a research network founded on diversity and inclusivity.

So I have abandoned the role of the fraud. The second title that I gave myself was that of poster-girl. What I mean by this – is that my experience could be used as a model to inspire others to join with this endeavour to enhance and expand multicultural health research in Ontario. OMHARN makes no claim to have initiated multicultural health research in Ontario. But it does the great service of collecting us all under large intricately woven umbrella. Then beyond the benefit of giving us a place to gather, this kind of network becomes the catalyst for new questions and new opportunities.

I am offering myself as one of the OMHARN poster-children because the beginnings of my journey as a multicultural health researcher have been spawned and nurtured under this umbrella. I think you get selected to be a poster-child because your story has the potential to inspire others. I believe the story of my multicultural health research journey is not inspiring because of the depth or complexity of what we are trying to accomplish in Markham but because of its simplicity and practicality. It seems to me that we are in desperate need of health solutions that motivate people to participate by the very nature of their simplicity and practicality.

Some physicians at the Health for All FHT

Let me give a couple examples. Some of our scholarly work in multicultural health falls into the category of educational research. For example, we’ve been asking the question: How can we build a better health care provider – someone who can serve well in a multicultural environment? One of my favourite scholarly projects that sprung from this question relates to an intervention that we have introduced in our Family Health Team (FHT). It is an inter-professional monthly Balint group. The Balint group concept is name after British psychoanalyst Michel Balint. It was recently described by Toronto’s Michael Roberts as “… a purposeful, regular meeting among providers, with a trained facilitator, to allow discussion of any topic that occupies a clinician’s mind outside of his or her usual clinical encounters…”

Our Balint group has met monthly for about 2 ½ years. Our focus is on discussion of the provider-patient relationship in culturally discordant clinical encounters. It is our hypothesis that the Balint group will be part of how we build a better health care provider, learn to provide better care and contribute to healthier communities. Our educational research is founded on the belief that the Balint-group technique is vastly under-utilized by health care providers as a means of improving our clinical effectiveness in multicultural settings. Once we are able to fully test our hypothesis and document its effectiveness, this could be an important contribution to the broader primary care community.

The second example of a simple study that we have undertaken in our FHT is called “Learning about diversity in primary care”. It is a patient survey we are conducting to understand the ethno-linguistic makeup of the patient population in our FHT. A better understanding of the demographic profile is expected to help improve the quality of health care provided through the provision of services and staff to support care that is culturally and linguistically appropriate. It should also help improve the training of the Family Medicine residents and inter-professional staff of the academic FHT by building the understanding of the nature of the defined patient population. We also hope this data will provide a base for further research related to the ethno-cultural determinants of health.

When a small group of clinicians (who find themselves providing service in one of the most ethnically diverse communities in the country) start asking questions and taking steps to find out the answers, we are all a little closer to providing health services in Ontario that are culturally safe, effective, and equitable. I’m happy to be a poster-child – to show it can be done.

But the last role that I’m happy to accept in this gathering is that I am a champion for multicultural health research. It is impossible to overemphasize the chasms that exist in our understanding about how best to care for one another in this province. Health care providers have always known about gaps of understanding that exist between ourselves and our patients – even when we try to provide care in a relatively homogeneous culture. But nothing is homogeneous about health care in 21st century Ontario.  Society is increasingly complex. Our population is ever more delightfully diverse. Both providers and policy makers face a growing struggle to integrate a fragmented health care system.

We cannot practice clinical care nor teach providers using the assumption that there is a “one size fits all” approach to health in our communities. In fact we are urgently in need of a strong foundation of evidence that will help us do better. We could give countless examples. When our family medicine residents learn to deliver palliative care – they need to know how to approach the end-of-life priorities and expectations they might encounter in a culturally diverse community like Markham. Our social workers need to inform their practice with evidence about which interventions may be most helpful when they are working with patients whose cultural framework differs markedly from that of the care provider. And our administrative team needs information about how to solve issue in access to care for new Canadians who may find our labyrinthine health system to be a navigational nightmare.

So this is the bottom line and it’s why I’m a champion for OMHARN: We need outstanding health research specifically designed to help us understand and care for our richly diverse communities in Canada. I am thankful for those who work at this task of discovery every day throughout the year. May it bring us ever closer to a society that genuinely enjoys health for all.

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