Oppression by omission

Since its formation last spring Rainbow Health Ontario (RHO), an organization based out of Sherbourne Health Centre with the mission of improving queer healthcare across Ontario, has recruited a team of part-time reps to do outreach to the various cities, towns and rural areas that make up this huge province. The 14 reps — one for each LHIN (Local Health Integration Network, community-run nonprofits created by the Ontario government in 2006 to deal with regional health issues) — cover a lot of ground and are tackling many challenges, including how to deal with a health system where rural ‘mos often have few options other than to trek to an urban centre for queer-sensitive services.

In a previous installment Xtra caught up with four RHO reps responsible for LHINs encompassing urban centres outside of the GTA to find out about the state of queer healthcare in their areas. This time we turn our attention to the LHINs that cover the areas in and around Toronto.

Phyllis Waugh, Toronto Central

The Toronto Central LHIN is home to nearly 1,146,800 people — nearly 10 percent of the province’s population — and a higher proportion of immigrants and visible minorities than the rest of the province, as well as a substantially greater proportion of people living in low-income situations.

Phyllis Waugh, RHO rep for Toronto Central, got involved with the organization through Rainbow Health Network, a grassroots, volunteer-run group founded in 2001 by the now-defunct Coalition for Lesbian and Gay Rights Ontario (CLGRO). “I’ve been involved with RHO since the beginning. I have a long background of activism with various issues — women, labour and LGBT.

“My LHIN, Toronto Central, is different from all the rest of them because it is totally an urban LHIN,” says Waugh. “We do have a fairly high concentration of LGBT-specific services and programs. It’s still nowhere near meeting the needs, but in comparison to the rest of the province, it’s where the services are located.”

Still, access remains an issue in Waugh’s opinion. “Once you leave the downtown core, even if you’re in urban Toronto, you don’t have that range. So people report they may have to travel to come downtown or, similar to other LHINs, they may be faced with health providers who don’t know much about their issues.”

The number-one issue for queer healthcare, in Waugh’s opinion, is that “LGBT people are often reluctant to approach healthcare providers, because they have experienced discrimination or they fear they will, thanks either to their own direct experience or to stories from other people.”

As a result, “By the time LGBT people come into the healthcare system they have neglected basic care and get screening tests later, so their conditions may be more advanced and not properly managed. So homophobia has an impact no matter where you live.”

When it comes to homophobia in the healthcare system Waugh feels the situation is mixed. “There are several different things happening at the same time — lack of awareness, lack of knowledge and homophobia in healthcare and everywhere else. At the same time there are a lot of people who are LGBT-positive and who want to learn and serve their clients better.”

The lack of queer-specific training for healthcare providers “is something RHO is working on. RHO has five workshops that are available to present by RHO staff, and also on the website we have a trainer’s database.”

According to Waugh, RHO is also networking with medical schools and other institutes that train healthcare providers.

“RHO is one of the few organizations like this,” Waugh points out. “There aren’t many places in the world where there’s a government-funded program like this one. The advances we’ve made over the last decade, there’s been a lot of change. With the winning of same-sex marriage, we have legal rights and now the challenge is in social attitudes.”

Barb Urman, Central

Central is the most highly populated LHIN in Ontario, with more than 1.6 million residents living primarily in the 905-area suburban communities north of the city and along Highway 400. The LHIN has the province’s highest proportion of immigrants, a large percentage of visible minorities and a significant number of low-income residents concentrated in northern Toronto and remote rural areas.

Barb Urman, a social worker and RHO rep for Central LHIN, says, “This region and this LHIN is easily 10 years behind the times. A lot of work needs to happen here.”

For starters, she notes that it’s hard to get a picture of queer health needs in the area. “People just aren’t out in this region so there’s a tremendous amount of work just to gather information.” When she held a focus group with Pflag and Rainbow Youth, “I found out that not having resources, parents and kids alike turned to medical doctors when kids were initially coming out, and the doctors had no clue — no idea what to tell them, where to send them, how to be with them.

“I always talk about homophobia in York as being oppression by omission. It’s the not-in-my-backyard syndrome. Don’t talk or think about it.”

Urman says there are now more services for queers in the York region, “but that’s compared to nothing. People didn’t even speak queer before three or four years ago. People didn’t even think in those terms. Now organizations are starting to look at policies, programs, how resources are being created.”

According to Urman those resources include a recently founded lesbian potluck social group, a Pflag chapter that meets in Richmond Hill and a Rainbow Youth Group, also in Richmond Hill. York Region Pride, which took place in June, had more extensive programming in 2009 than in past years.

Varying demographics pose a challenge, however. “In a community like the one in Sutton, people are isolated, it’s very insular and homophobic there, and it takes three hours by public transit to get from one end of the LHIN to the other.”

Urman’s concerns are particularly strong when it comes to isolated youth. “If you think about a 13- or 14-year-old coming out as trans in a community like Sutton or Georgina, those kids have no opportunity to connect with other kids, no transit, no role models, no services. It’s a nightmare.”

She’s confident that RHO will have an impact on the LHIN’s mainstream medical service providers. “With them, the work has to happen intensely one-on-one, connecting with people in their own communities. Being the RHO contact, a live person, will make a huge difference. In a nutshell, the challenge is just to get queer people acknowledged in some way by the health profession.”

judy robertson, Hamilton-Niagara-Haldimand-Brant

The Hamilton-Niagara-Hamilton-Brant LHIN encompasses the counties of Brant, Haldimand, Niagara, and most of Norfolk, as well as Hamilton county, which includes the towns of Burlington and Hamilton. With approximately 1.4 million people it’s the second-most populated LHIN in Ontario. It’s home to two First Nations reserves, two designated French-language service areas and Canada’s largest port of entry for refugees (Fort Erie, in Niagara).

RHO rep judy robertson is a longtime social and union activist who has worked for many years with Niagara Child and Youth Services focusing on youth mental health. She says there’s a range of queer realities in her LHIN.

“The LHIN is very diverse in that it incorporates very rural areas and urban metropolitan areas,” says robertson. “It’s a spectrum right across those areas as to even whether queer health is on the radar or being spoken about or identified as existing.”

In some areas of the LHIN there are promising developments. In Niagara a community health centre is in development — “they’ve stated they will be a centre for excellence for LGBT health.”

Robertson also cites Hamilton’s centre The Well, which serves the local queer population, but she adds that while healthcare providers use the space one or two days a week the centre does not provide healthcare services directly. In addition the Hamilton Positive Space Initiative is working to increase awareness among local service providers.

Still, robertson feels that visibility is a problem; she sees RHO creating greater awareness of queer resources that already exist and helping the services themselves connect despite regional differences. “Service providers don’t always know that services are available in their own communities,” she says. “When someone self-identifies as LGBT the service providers are at a loss to know where to send them for support.”

She also cites access to centralized healthcare as a major issue. “In Hamilton they have a transportation system so people can get in to access the healthcare that exists. But in the Niagara region that system doesn’t exist. So access is one of the large challenges that isn’t always addressed with how healthcare dollars flow.”

She points to satellite service models as an option, “But for LGBT health that sets up its own set of challenges. How many people in a small town will be comfortable going to see the queer healthcare provider who comes in on Thursdays? Changing the atmosphere and the conversation around LGBT issues in general needs to happen.”

That conversation, according to robertson, needs to extend from media awareness right into healthcare providers’ offices. She feels that the training sessions RHO provides to healthcare workers will help them gain awareness of how materials such as intake forms with queer-inclusive questions, posters showing diverse families and reading materials with inclusive language can create a queer-friendly atmosphere. “Service providers don’t intentionally go out to not make their services positive,” robertson says. “A lot of the times it’s done without being aware that it’s impacting someone that way.”

Bill Taekema, Central West

The Central West LHIN has a population of nearly 773,000, more than half of which live in fast-growing Brampton. The LHIN is home to the highest proportion of visible minorities in Ontario, which account for about 40 percent of its population. Its territory spans from the northern tip of Dufferin County to the northern section of Peel Region, covering densely populated areas such as Rexdale, Malton, Brampton, Orangeville and Woodbridge.

RHO Bill Taekema has lived in the area for 15 years and works in private practice as a psychotherapist for the queer community.

“My LHIN has some very well-established LGBTQ community supports,” Taekema writes via email. “From community agency supports that are focused on youth to those who are offering social supports, all of which are mainly found in the Brampton-Mississauga areas.”

Among others, Taekema mentions the Positive Space Coalition, which has been operating for 16 years and brings together 14 community agencies, including school boards and health services and Peel Pride, an annual picnic with associated social and fundraising events. There’s also the local Pflag chapters, the Peel HIV/AIDS Network and various social groups, as well as Rainbow Ridge Resort, a gay and lesbian trailer park and campground.

“We have community-run agencies that offer positive supportive services, with great social networking activities available. And yet they are disconnected from the medical community.”

Taekema says he’s not aware of any queer-positive medical community support listings or how to find such providers in the LHIN. “Being able to come out to a local GP in order to deal with LGBTQ-specific health issues can be difficult and may not be met with the sensitivities needed.”

Taekema sees knowledge gaps. “Researching what the LGBTQ community members feel is the priority for support services is a tall order. And my LHIN has a large area north of Brampton that is largely unexplored for LGBTQ community supports.”

He feels it may be a challenge to find community medical offices that will be open to talking about queer healthcare needs, but says he intends to start that dialogue nonetheless. He’ll also be encouraging locals to turn to the resources on the RHO website, Rainbowhealthontario.ca. “This site will become the hub of information of all support services in my LHIN and across Ontario, so I will be encouraging my community to use it and sign up.”

j wallace, Mississauga-Halton

The Mississauga-Halton LHIN includes the southwest portion of the GTA, the south part of Peel Region and all of Halton Region except for Burlington. It also includes the municipalities of South Etobicoke, Mississauga, Halton Hills, Oakville and Milton.

RHO rep j wallace works as a consultant to the Halton District School Board on issues of sexual orientation and gender identity, so his work already takes him into most of the LHIN’s communities.

“I grew up in Oakville,” says wallace, “so I feel a connection to the region. And if we recognize that homophobia is a social determinant of health and that people in homophobic environments have significant health detriments — smoking, drinking, mental health issues — then those of us who have been dealing with homophobia are doing health work, not specifically medical health but health in the sense of creating community space.”

One of the immediate community needs that has been brought up by many in wallace’s LHIN is competent care for trans people. “There is not a single doctor that people know about in the Peel region that is willing to provide primary care [for trans people]. One of the people at a Peel youth service community organization told me that of seven young trans people he knows, not one has primary care,” wallace says.

“There seems to be a feeling that if we just get people to Toronto or Hamilton, they’ll get looked after, so we don’t have to do it here…. It’s not fair to build it into a system to expect people to travel over an hour to get their healthcare.”

Wallace points to RHO’s efforts to develop training for primary care doctors as a solution, along with the Sherbourne Health Centre’s “Guidelines and Protocols for Comprehensive Primary Health Care for Trans Clients,” launched last month and available on the RHO website.

When it comes to lesbian, gay and bisexual healthcare, “I’m not hearing LGB people say they can’t find a doctor, but my experience is invisibility, and a significant lack of awareness.”

He notes the intermittent presence of programs that serve specific needs — for example, a lesbian cancer survivor group — “but there isn’t a queer health centre. There is a community centre in south Mississauga that does great work with LGBTQ people, but that’s largely the work of a couple of dedicated staff. There are not many LGBTQ services in the LHIN and adults who are able, use the ones in Toronto, leaving people in poverty and youth sort of stranded.”

Still, he is optimistic RHO’s outreach work will build awareness among queers and service providers alike, especially around the RHO website’s service providers’ registry. “I don’t feel like I’ve met resistance from service providers. The medical officer of health for the region of Halton is willing to meet and to send out RHO material as part of his regular process. And I’m really excited about what’s on the site, there are some really excellent resources there.”

Blair Groves, Waterloo-Wellington

Home to 685,400, the Waterloo-Wellington LHIN includes the County of Wellington, the Region of Waterloo and the City of Guelph, as well as part of Grey County.

RHO rep Blair Groves has a background working with marginalized people in community and social services — “and I’m a gay dad and I live on a farm,” says Groves.

Groves points to the split between the urbanized areas and the large rural area in Waterloo-Wellington. “When they think rural, some people get an image in their minds of Old McDonald’s Farm. But rural communities are diverse communities as well.

“There are the existing dilemmas in rural or remote communities, for anyone in Ontario” — Groves cites overall poor health status, shorter life expectancies, higher death rates, higher infant mortality rates, significant distances to cover to reach healthcare services and an aging population with changing healthcare needs — “and all of that is compounded by what happens to marginalized people who face discrimination. So whether it’s First Nations folks or people from other backgrounds, they face health and social issues, and the same ones apply to LGBT folks as well.”

The rural-urban split takes on a specific flavour in Waterloo-Wellington, due to the large Amish community. “When I drive through my area we see horses and buggies and people who have no electricity and who work the fields with a horse and plow, and that’s common and prevalent…. If you’re a young Amish teenager and you know that you’re queer or you’re questioning, that’s something that’s not even talked about, not recognized, not addressed. If anything, it’s the equivalent to sin.”

On the other hand there’s a strong queer presence in the LHIN’s city centres. The local queer landscape includes recreational groups as well as two AIDS services and queer youth counselling services. Plus Waterloo-Wellington is home to three universities — Wilfred Laurier, Waterloo and Guelph — and a community college, all with active queer groups. “We’ve got the largest proportion of young people aged 14 and under throughout the province overall, so some unique things are going on with that,” says Groves.

Groves says he’s optimistic about RHO’s efforts to support local work in queer health, saying that he’s made inroads within the LHIN’s official structure to discuss how RHO can inform health services in the area. “We’re already planning to work together and consult to identify needs, best practices, protocols.

“You want to be optimistic and hopeful [when approaching health services], but there’s something about marginalization, discrimination, homophobia… for a lot of us we’re thinking, ‘How well will be received?’ So when we find a group that’s welcoming, we’re relieved.

“I think everyone’s doing their best, but I think there’s a feeling that RHO might be the gel that binds existing services and structures together. So there’s excitement and talk about this.”