Healthcare outside Hogtown

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.

Xtra caught up with four RHO reps responsible for LHINs outside of the GTA to find out about the state of queer healthcare in their areas.

Stephanie Carter, Central East

Extending east of Toronto, the Central East LHIN runs from Scarborough eastward toward Cobourg, northward to Haliburton and west past Lindsay and includes several city centres.

“We know that lots of people from Scarborough, Oshawa and even Peterborough can access Toronto quite easily, whereas others can’t,” says RHO rep Stephanie Carter. “It’s difficult to get general healthcare in the first place in the remote areas, let alone LGBT healthcare. There’s a shortage of doctors anywhere and many of us are not in a position to expect queer-friendly healthcare.

“Social isolation and other factors can contribute to issues with our health and we struggle to get services that we all have the right to.”

Carter, who also works part time doing outreach to queer youth at the AIDS network in Peterborough, says just letting queers know that RHO exists, presents a challenge in the Central East LHIN.

“Certainly in smaller areas, say Lindsay for example — I grew up there — there isn’t really a queer community there, or if there is anything it’s probably quite underground, so people may not be aware of what services are out there. And there aren’t central places to meet where we can poster or advertise.”

In addition to reaching local queers, Carter cites the need to educate doctors about queer health needs — for example, debunking myths around HIV and AIDS and informing them that despite popular belief lesbians do need PAP tests.

“There certainly are great doctors out there and other people who work in the healthcare sector who understand the issues and do a great job,” she says. “Is there enough? No, probably not, and not enough people are aware of the people who do exist.”

Thus far Carter says she hasn’t come up against homophobia from any of the agencies she has contacted in her RHO outreach work. “They’ve all been really receptive and excited. The health units in our area span larger geographic regions and they’ve all been great. There’s a shift happening out there.”

Melissa Spevak, South West

The South West LHIN is huge, climbing northward from Lake Erie to the Bruce Peninsula. Sixty-nine percent of the LHIN’s population is classified as urban, with the bulk of that number centred around London, where RHO rep Melissa Spevak took up residence in September.

“[London] is a safer space for queers, with programs on campus,” she says, referring to the University of Western Ontario, which houses the publicly accessible Pride Library. “Moving here and taking on this position with RHO has been a great opportunity to network and to advocate for the queer community.”

Considering the geographic stretch covered by the South West LHIN, Spevak cites many of the same concerns to those faced in the Central East LHIN.

“There are a lot of rural communities that are very tricky to access,” she says. “In small towns everything queer is underground to begin with, and there appear to be no identifiable resources for queer health.”

Spevak says she’s got a lot of questions about how locals handle their healthcare. “Are the queers driving to Toronto or other bigger cities? Are they just not disclosing or discussing orientation with their healthcare providers?”

What she does know is that there’s a lack of queer-friendly counsellors and a lack in services for trans people throughout the LHIN. “The bottom line is no one knows here where to go,” she says. “They reach out, but everyone’s just kind of stuck. A healthcare provider’s ethic has to be, if you can’t adequately provide for your client, you should refer them. But people are just getting turned away.”

Spevak notes that queers in the region are frustrated with their lack of options. “The community wants a bottom-line answer. RHO puts a face to the name and so everyone’s looking to RHO for answers. We do have a list of service providers, but there is no quick answer to meeting all our healthcare needs. Some service providers need more training to be comfortable. It’s a work in progress.”

Calvin Neufeld, South East

“I have firsthand experience of the shortcomings of Ontario’s healthcare system with regard to LGBTQ concerns and the discriminatory practices and under-education of many healthcare professionals,” states South East RHO rep Calvin Neufeld by email, who identifies as a post-operative transsexual. (See Neufeld’s Snapping Out of It for details.)

The South East LHIN is the most rural LHIN in Southern Ontario. “Doctors in rural areas may be less knowledgeable about LGBTQ-specific health issues and LGBTQ-specific resources are in short supply,” states Neufeld. “It is not uncommon to see queer people in this region travelling to Ottawa and Toronto for healthcare.”

South East’s largest city is Kingston, with a population of about 120,000 people. “The total LHIN has a population of just 450,000 people, less than four percent of the population of Ontario. Almost half of the South East LHIN’s population lives in communities of fewer than 10,000 people.”

Neufeld cites Queen’s University as a major queer-friendly presence in the region, as well as the Kingston-based HIV/AIDS Regional Services, which fields calls from all across the region and about all things queer because of its relative visibility. “There is a serious absence of established, accessible, focused resources to meet the diverse queer health needs of our population.”

Neufeld feels that RHO’s existence will raise awareness of the absence of services and improve access to services that do exist. “I expect RHO will make it very difficult for the government, for healthcare providers and for the general population to continue to overlook an already marginalized group of people who have unique healthcare needs.”

Nevertheless, “Change is slow and all too easy to resist. Service providers may require further education and training. Government policies may require redevelopment. Healthcare facilities may require additional funding, staff, equipment, infrastructure. And historically majority opinion has been less than friendly when it comes to queer issues.”

Barry Deeprose, Champlain

“You’ll notice it’s not the Ottawa LHIN, which is kind of important,” says Barry Deeprose, RHO rep for the Champlain LHIN. “It follows the Ottawa River up the valley, right up to Pembroke, Petawawa, Arnprior and Renfrew. So there is a challenge in having a fairly major city with a fairly established LGBT health network — but you really go just a couple of miles up the river and there’s nothing.”

Deeprose is a longtime queer health activist; he helped to form the AIDS Committee of Ottawa and is the cochair of Ottawa’s Gay Men’s Wellness Initiative. Joining RHO was a natural next step. “I thought, ‘Wow, this is the opportunity we’ve been waiting for, to act provincially.'”

He says it’s unacceptable to ask queers across the province to travel to Toronto for appropriate services. “I think there has to be a real willingness to meet people where they’re at,” says Deeprose. “Toronto has such a large infrastructure. It’s something that many communities can never dream of, and realistically will never happen, they don’t just have the critical mass.

“Ottawa’s in fairly good shape to the extent that anything is,” he adds. “They have a long tradition of having services in place. They’re not adequate, they never are, but they’re there.”

But elsewhere in the LHIN queer healthcare falls apart. “The LHIN has a kind of split personality,” says Deeprose. “I think the challenge is to begin to break ground in essentially the rural areas. Ottawa’s queer community is kind of a catchment for up the valley, people come here to play. For their healthcare needs, though, they’re pretty much on their own. If you’re a young kid in Pembroke and you need a counsellor, you can’t come to Ottawa, it’s two hours away. What are you gonna do, ask your parents to drive you?”

In addition to the inadequacy of existing services Deeprose points to a lack of integration and coordination between groups and initiatives. “Things coalesce and fall apart, over and over. One thing that’s exciting about RHO is that it looks like it may provide a sustainable focus, with core funding from the Ministry of Health and Long-term Services.”