You Deserve Care – Members of African, Caribbean, and Black communities in Ontario face significant barriers to accessing primary care

BY MICHAEL THOMAS

Members of the African, Caribbean, and Black (ACB) communities have expressed that they face significant barriers in accessing primary care, including language barriers and discrimination in Ontario.

One of my fellow journalists Rushane Ferron spoke to this topic last edition, and it was again brought to our attention by the Ontario College of Family Physicians and an organization called OurCare.

Who is OurCare you might ask? OurCare is a pan-Canadian project to gather input from the public on how to reform our primary health care. OurCare and Ontario College of Family Physicians facilitated this interview that I am about to present to you.

I had the privilege of speaking to Doctor Danielle Brown-Shreves. Shreves opened the first Black-led interdisciplinary clinic of its kind in Ottawa, and she is the CEO, Founder, and Executive Medical Director of Restore Medical Clinics.

Her clinic provides medical care to over 10,000 patients in the Ottawa region and a great number of her patients are African Canadian, Caribbean, and Black.

Shreves explained that one reason for the inadequate care of these folks is that there are not enough family physicians in Ontario to go around.

“We know from OurCare data that over two million Ontarians do not have access to a family doctor and the Ontario College of Family Physicians are expecting that figure to double by 2026 to over four million,”

“When you look at the situation,” she said, “For the African Canadian, Caribbean and Black community, it seems worse; because of systemic racism, and discrimination, they have barriers to accessing care.”

As I listened to this doctor it became clear to me that the list of roadblocks encountered by our people from a medical care point of view was endless.

“Some of the problems encountered are language barriers, where these patients cannot find a provider to provide culturally responsive and sensitive care for them. Then there are also financial barriers, probably not being able to travel to various locations, and we know that income is a social determinacy of health,” she shared.

We spoke of the lack of trust in the healthcare system that is sometimes passed down to another generation.

“As adults, if we experience racism that is impacting our health in whatever form, for example, going to a physician and not being taken seriously. You could be missing out on accessing tests that you should be accessing in a timely manner.

That could lead to higher levels of motility, and we are seeing racial disparity in cancer outcomes, chronic diseases, complications, and maternal health. These are all rooted in racism, and our children see that impact and it also affects them. That cycle just continues.”

However, Dr. Shreves seems confident that she and her team will get things done. “At Restore, which is a Black-led clinic, and a multi-disciplinary team-based model, we try to provide equitable access to care.

Restore also provides culturally responsive care. The evidence shows that when a Black physician takes care of a Black patient, the outcomes are significantly different because there is more trust in what that person is saying.

At Restore we have a number of Black physicians who are able to provide that care. From culturally appropriate care, and trauma-informed, to culturally sensitive care to the community. We also have health care providers who speak over 20 different languages.”

Dr. Shreves said she understands language is a significant barrier, “If you don’t speak the language, it is easy to be misunderstood, or be misinterpreted.”  Restore has a newcomer medical clinic where thousands of folks who are new to Canada are served.

Dr. Shreves had some encouraging words for the Black community on the lack of trust issue, “It is very important that we empower ourselves, and have that knowledge because education is key. When we are empowered, we can make better decisions. Try to advocate for yourselves and continue to speak up if you feel like you are not heard until you get the cure that you deserve.”

It was eye-opening for me when Dr, Shreves touched on the numbers that affected Black women in the breast cancer department. “As a Black woman, just realizing how we are 40% more likely to die of breast cancer than a Caucasian woman despite being at lower risk of being diagnosed with the disease.”

This she said is because they are not taken seriously and are not given access to mammograms earlier.

I asked Dr. Shreves what her plea to the government would be in connection with the plight of her Nubian patients. “We need a commitment to ongoing investment in primary care; more specifically we need strong investment in team-based care. Teams provide higher quality primary care, it is a win-win for everyone, and in the end, it literally lowers the cost of health care.”

Shreves wants to make it clear that since the goal is to serve the community, it is important that the community is being listened to as well.

This assistant professor at the University of Ottawa who was voted Ontario’s family physician of the year believes that Canada can use more Restore clinics. It is important to note that just over 2% of doctors are Black in Ontario as opposed to 4.5% of Black patients. This has the word disadvantage written all over it.

Here are some of the recommendations that were discussed at the ultra-round table last year:

• Mandate cultural safety training in ACB communities, including education on soft skills such as: bedside manner, critical reflectiveness, and emotional intelligence, for all healthcare workers.
• Ensure that health service organizations are integrating a lens that works to address anti-Black racism and transphobia, and that values the voices of equity-deserving communities.
• Increase the number of Black care professionals through post-secondary programs by expanding access to racialized, francophone, and newcomer students in health studies.

Now it is easy to see why Ontario not only needs a few Restore clinics, but a few Dr. Shreves as well.