Outburst! The Young Muslim Women’s Project is a peer led project by young Muslim women for young Muslim women formed in September 2011 by the Barbra Schlifer Commemorative Clinic. It is a movement of young Muslim women breaking the silence and speaking out about violence. Outburst emerged as community centered response to the intensive attention on violence against women in Muslim communities i.e. the murders of Aqsa Parvez & the Shafia sisters Zainab, Sahar, Geeti.
About the author: Outburst!
The Outburst! Project offers an opportunity to work with young Muslim women as they determine the ways to define and access safety. In our work around sexual and reproductive health, we work with women who have experienced sexual violence and/or are pregnant, among others. We work with health care providers on best meeting the needs of this group, many of which are newcomers. We also provide basic sexual health information to ensure the safety and wellbeing of our clients. Much of our work requires referring women who are or were in violent situations to clinics and doctors that we know or hope will provide the quality care that they deserve without the fear of shaming, assumptions and stereotypes getting in the way. We advocate for accessible, safe, free, inclusive and non-judgmental spaces for the provision of the comprehensive care that diverse/religious communities, including newcomers, require, including comprehensive sexual and reproductive health care. We also recognize the layers of complexity that are added when the individuals that are seeking care are from diverse groups.
Join the Conversation
While many of the tips below also speak to the experiences of newcomers, it is of great importance to not assume there are no distinctions between “newcomers” and “diverse communities”. It reinforces the stereotype that Muslims, other religious and cultural groups, as well as racialized people are *always* newcomers. We need to get beyond treating people of color as if they are perpetually on the doorstep of Canada despite how many have been in Canada for generations. While some of the following interventions do speak to the realities and needs of newcomers in Canada, the resource aims to speak to diverse ethnic, religious and/or cultural communities, without erasing the diversity and heterogeneity of those populations.
Informal and formal practices that are informed by assumptions a health care provider may have about a community group or a culture as a whole can really get in the way of building good relationships with their patients and, as a consequence, subject them to sub-standard health care, which in turn, impacts their health. This can look like practitioners who are judgmental of certain religious practices, for example, choosing to wear the niqab, or who refuse ultrasounds to pregnant patients because of the community or religion the patient is from, or assumed to be from. It can also look like overstating cultural differences between their patients, which also get in the way of real and open interactions. For example, rather than asking “how do I treat this Muslim man who has an STI?” ask yourself “how do I treat this STI?”
Be mindful of the stereotypes you may hold and of assumptions you or your patients make and, if left unaddressed, get in the way of offering important health care services.
If your patient identifies with a certain religion, culture or is from a certain region of the world, do not assume that they have specific beliefs, understandings or expects specific health care supports. Similarly, do not assume they have had cultural medical procedures done on them.
Tip: Recognize that every patient is unique. How they identify does not necessarily reflect the behaviours of other patients who identify similarly. Ask your own questions in ways that do not judge, shame or “other” your patient and instead, create space to comfortably disclose and discuss important health information.
Avoid passing judgment on your patient’s work/job.
Tip: Racialized people are disproportionately represented in low-wage jobs and precarious work, including service jobs, care work, industry work, agricultural work and sex work. Do recognize that all patients have the right to support themselves in any way they see fit. As a healthcare practitioner, provide the best care in addressing their health care needs, including the ones that may be specific to their occupation. Create a safe space that is respectful and maintains the dignity of your patients. Do ask open ended questions about someone’s employment and the challenges they may want to discuss with you and respond to what the need they identify as opposed to what you believe should be addressed.
Avoid solely focusing on health care needs without paying attention to other matters like housing, employment, schooling, etc.
Tip: Do recognize that many racialized people from diverse ethnic, cultural or religious communities, including newcomers, have a greater risk of living in poverty so may be juggling multiple priorities, not just their health care. Understand that for many, survival is a priority and it might be difficult to focus on anything else if basic needs are not met. You are part of that process and journey for them and support in the ways you can via referrals, signing the necessary forms, educating yourself on what programs you could contribute your time and expertise to, etc.
Do not assume all patients know about confidentiality and limits to confidentiality when they first come to the office seeking healthcare support and do recognize that some people have a long history of mistrust with the health care system and other institutions.
Tip: Do explore the role of historical experience in contributing to mistrust and underutilization of services by people of color. If service providers don’t go beyond clinical history gathering and do not recognize and acknowledge the larger historical perspectives from which they and their patients of color draw conclusions and make decisions contributes from, it can contribute to a feeling of disconnection between patients and their care team. Work towards building a trusting relationship with your patients, which involves open communication and taking cues to appropriately pace the building of that rapport. Explain your policies of confidentiality including what can be limits to confidentiality. Build trust with patients in order to advocate effectively on their behalf. First impression matters. Express that your primary role is to provide care and that this space is safe as many patients may come from communities who are often targeted, criminalized, villainized and stereotyped, including when accessing health care.
Do not assume your patient does not want to talk about sexual or reproductive health
Tip: Do question your assumptions about, for example, someone who walks in wearing a hijab or a niqab. Do initiate the conversation on sexual and reproductive health by making it clear that asking about sexual health concerns is a routine part of your care. Talk directly without dancing around the subject. Patients want to know their questions will get answered, particularly if they are sexually active or are pregnant. Do assume your patients can make informed choices and provide them with the information they need to make important decisions about their health and their bodies. Inform patients that they can be alone for these conversations and that they do have that right.
Do offer support, resources and tools proactively. Make sure you share important basic sexual and reproductive health information during your interactions with patients. Understand patients may feel uncomfortable asking for some things or do not know how to ask. Express that you are ok with discussing matters of sexuality or of reproductive health by making it a part of your routine intake questions or having a few prompts ready to make it clear that it is an appropriate space to ask questions or bring up these issues. Make the conversation interactive: “Are you ok with this? Would you be more comfortable with this option?” “Is there anything else you wanted to know?” This allows for the exchange to become a conversation rather than being one-sided. Respect your patients’ boundaries, which can also be clearly expressed via body language and non-verbal cues.
Do not assume a patient’s cultural or religious beliefs are inherently oppressive
Tip: Widely held stereotypes about religious communities can get in the way of a relationship with patients and of offering the care people need. Examine your beliefs about religious communities and understand the diversity that exists among even groups of people from the same region/religion/country, etc. Create a space and environment that is inclusive so people know they are welcome. Does it celebrate the experiences or even presence of diverse communities? Can diverse people see themselves in the imagery, pamphlets, information material you have around in your practice?
More to the point, examine your personal values and if you feel that they can interfere with the care that the patient requires, refer them.
Do not assume sexual orientation/preferences/behaviors as well as gender identity because of someone’s ethnicity or race or ties to a religious and/or cultural community
Tip: People from racialized and/or religious communities who are LGBTQ are not always given the appropriate care to address their sexual and reproductive health needs, sometimes because they are not “read” as LGBQ or trans/gender diverse. This can mean that they may not be offered the necessary referrals, information, or get asked the right questions about important topics like STI prevention, pregnancy, or in safely administering hormone/testosterone shots, etc.
Do not make assumptions about who you are seeing and about patients’ sexual orientation, gender identity or even what kind of partnerships they are in. Use open ended questions to get the information you need and a more complete picture of who your patient is. Have resources available for LGBTQ people on STIs and other sexual health matters that are culturally relevant, and make a list of appropriate referrals and services you can direct people to. Allow patients to pace disclosure but continue to make it clear you welcome discussions about sexuality. Engage with and learn about organizations and doctors who work with LGBTQ communities and refer patients to the appropriate care that they need.
Gently check-in with the patient and ask how they self-identify or make sure you have inclusive intake forms that may signal that you are open to discussion on diverse sexual orientations and gender identities. You may also want to remind them about your commitment to confidentiality.
Do not assume that a single program will meet the needs of all – or even several different – communities of a particular racial/ethnic/religious group.
Tip: A single program will not meet the needs of everyone in a larger community. Your patients who are part of diverse racial, ethnic and/or religious groups may face wildly different circumstances, may also be part of other communities, share other identities, have different needs, speak different languages, have differing customs, and unique cultures and histories. Attitudes toward health and illness, sexuality, and gender may differ widely. Do not ‘delegate’ all care to specialized agencies/programs as if they were one-stop-shops. Do inform yourself on how to work with diverse communities. Stock up on various culturally appropriate materials as something that is appropriate for one group of clients may simply not reach another group of clients.
Do not assume that all patients know his/her/their rights as a patient or what to expect during appointments with health care providers. Alternatively, do not assume that they don’t.
Tip: Do explain to first-time patients their rights as patients and what to expect from this client/provider relationship. This includes the right to share information confidentially and have their privacy respected; the right to see a physician alone; the right to ask questions; express concerns; give or refuse consent to certain procedures; get second opinions; etc. For patients who are in an abusive relationship, this is important, particularly their right to see the physician alone. Concurrently, do not assume someone is not well-versed in navigating the health care system because of what community you assume they are from. Favor open-ended questions and check-ins about the needs they came to see you about.
Check these out! Build partnerships in your region
The MUN Med Getaway Project
St. John’s, Newfoundland – This project serves as a gateway for refugees in Newfoundland by providing pre-medical services.
Immigrant Services Association of Nova Scotia
Halifax, Nova Scotia – This non-profit organization has been working towards opening a refugee health clinic. They were recently successful (April 2015) in securing their first clinic, which operates out of the
Dalhousie Family Medicine Clinic
Dalhousie Family Medicine Clinic located at 6960 Mumford Road, Halifax (Tel: 902-473-4700)
PRAIDA (website only in French) – Montreal, Quebec – This centre provides social and health care services for asylum seekers in Quebec. PRAIDA also has a collaborative program with the YMCA (PRAIDA-YMCA Day Centre for Refugee Claimants) which offers opportunities to meet other refugee claimants as well as offer assistance and support.
The Ottawa Newcomer Clinic
Ottawa, Ontario – This clinic serves government assisted refugees (GARs) as well as connecting patients to primary health care providers. The Clinic is open on Monday, Tuesday, Wednesday and Friday.
Toronto, Ontario – This refugee health clinic at Women’s College Hospital offers comprehensive healthcare to newly arrived refugees for their first two years in Toronto, after which they are connected to a family doctor near the patient’s home. Appointments are booked by calling in.
FCG Refugee Centre Primary Care Clinic
Toronto, Ontario – This clinic offers healthcare services every Saturday and every other Tuesday for anyone experiences barriers in accessing healthcare. The centre also has a mental health clinic every Friday as well as free yoga classes every Saturday. Appointments must be booked by calling in. The centre also offers trainings for service providers and frontline workers.
Canadian Centre for Refugee and Immigrant Health Care
Scarborough, Ontario – This walk-in clinic offers health care services for uninsured immigrants and refugees.
Refuge Hamilton Centre for Newcomer Health
Hamilton, Ontario – This centre provides healthcare services for Hamilton’s immigrant and refugee communities, with a focus on reducing barriers to healthcare.
Sanctuary Refugee Health Centre
Kitchener-Waterloo, Ontario – This centre provides healthcare services for newly arrived refugees in the Kitchener-Waterloo Region. The clinic is open Wednesday and Thursdays and appointments are required.
KLINIC Community Health
Winnipeg, Manitoba – This clinic provides primary healthcare to priority populations (refugees) as well as individuals living in the geographical region.
Regina Community Clinic
Regina, Saskatchewan – Offers primary health care, social as well as educational services to the community, including having a refugee program.
Mosaic Refugee Health Clinic
Calgary, Alberta – This clinic offers health care services for refugees for their first two years in Canada.
Women’s Health Clinic of Edmonton
Edmonton, Alberta – The clinics Health for 2 program offers supports for at-risk pregnancies. The clinic does not depend on nor ask for health insurance.
Vancouver, British Columbia – This clinic, which operates out of the Evergreen
Community Health Centres
Community Health Centres offer public health screenings as well as primary health care for government sponsored refugees and refugee claimants. Community Health Centres, here is a list of centres in Toronto and the surrounding area.
Women’s Health in Women’s Hands (WHIWH )
offers healthcare services for racialized women free of charge.
Sherbourne Health Centre
offers free healthcare, counselling, education and supportive services focusing on newcomer, LGBTQ and urban health. Offers weekly activities for LGBTQ newcomer youth.
offers a variety of programs for newcomer LGBTQ communities in Toronto, including settlement services, and mentorship.
Alliance for South Asian Aids Prevention (ASAAP)
provides sexual health, HIV/AID support services for South Asian communities in the Greater Toronto Area. Check out their “Resources” page for a comprehensive list of organizations and clinics in the GTA and across Canada on and about HIV/AIDs. ASAAP also has Prevention Programs which work towards reducing the risk of HIV through health promotion, education and outreach. Check out a list of their programers by visiting http://asaap.ca/programs/p1/
Planned Parenthood Toronto (PPT)
offers multiple programs for newcomers. They have a newcomer youth program that offers sexual health programming. They offer primary health care for those who do not have an OHIP card. Check out their website for more services and comprehensive lists of resources.
Parkdale Community Health Centre
offers primary health care to individuals in the Parkdale community who face multiple barriers to accessing services. They also have the
Parkdale Parents’ Primary Prevention Project (5P’s) which provides multiple supports to pregnant woman and their families who are living with multiple stressors in their lives such as newly arriving to Canada.
Immigrant Women’s Health Centre
provides sexual and reproductive health services as well as counselling, education and outreach to both insured and uninsured individuals across the city of Toronto. They also have a mobile health clinic which brings sexual health services to the women in their communities. They also have a fantastic resource list of community health centres in and around Toronto.
Access Alliance Multicultural Health & Community Services
provides primary health care services for communities facing multiple barriers in accessing health care. Offers weekly group programs for LGBTQ newcomers and newcomer youth. Have multiple locations across the city of Toronto.
Regent Park Community Health Centre
provides resources, programs and referrals for immigrant and refugees living in the Regent Park community.
Other Services and Resources
Canadian Doctors for Refugee Care
Coalition of Canadian doctors responding to the refugee health cuts that occurred in 2012. Website contains resources for fellow peers and the public on the issue.
Kids New to Canada
Provides an excellent resource list for immigrant and refugees in accessing social, settlement, and health care services across Canada.
Rainbow Health Ontario
Provides excellent resources for Ontario’s LGBTQ communities. They also offer training opportunities about LGBTQ health.
Sexuality Education Resource Centre MB
Promotes sexual health through education. Has comprehensive resources in different languages for immigrant and refugee communities. The website is also full of informative resources, research and community based projects conducted by SERC.
Health For All
A grassroots organization that advocates for healthcare for all regardless of immigration status. Website has information and resources on the recent changes to refugee health care in Canada. Also has a comprehensive list of clinics in Toronto offering services to migrant and refugees. Also check out their educational resources page.
Migrant Sex Workers
A grassroots initiative which seeks to bring awareness to sex worker issues, like Bill C-36. Website includes resources for sex workers and the larger community.
A grassroots organization run by and for sex workers in Toronto. Advocates and support sex workers to live a life that is safe and with dignity. Website library has a comprehensive list of resources for the public, including a The Toolbox: What Works for Sex Workers on better meeting the needs of sex workers, which includes tips for health care providers. *Note: toolbox does not address Bill C-36 as it was written before the
recent legislative changes*
Barriers to Care: The Challenges for Canadian Refugees and their Healthcare Providers , Marie McKeary & Bruce Newbold
Note: though this paper was written before the 2012 changes to refugee healthcare, it still captures many of the barriers highlighted in this guide.
Canadian Council for Refugees
Is an umbrella, non-profit organization that is committed to the settlement, rights and protections of refugees and immigrant populations in Canada.
Ontario Council of Agencies Serving Immigrants (OCASI )
Provincial umbrella organization serving the settlement needs of refugee and immigrant communities in Ontario.
Barbra Schlifer Commemorative Clinic
Violence against women’s agency that provides legal, counseling and interpretation services for diverse women (including newcomers)
An international collaboration between grassroots groups to vision LGBT global human rights. The collaboration has done reports and publications on LGBT refugee rights and experiences in Canada.
Canadian Council for Muslim Women
A nationwide organization committed to social justice and well-being of Muslim women in Canada.
Transitional home for Muslim women and/or their children fleeing violence. Youth Groups
Pomegranate Tree Group
Non-profit group focused on healing justice work supporting diverse communities.
Grassroots collective that aims to provide a creative space for East African youth and allies in the Diaspora.
Outburst! Young Muslim Women’s Program
A program of the Barbra Schlifer Commemorative Clinic that provides arts programming and counseling support for young Muslim women. Also conducts community based research as well as trainings with health care and social service providers on better meeting the needs of young Muslimahs.
Supporting our Youth (SOY)
A program of the Sherbourne Health Centre, which offers supportive services for LGBQ youth in Toronto, including newcomers.
Thank-you’s and acknowledgments
Outburst! would like to thank and acknowledge the following indiviuals. The information above would not have been made possible without the support of Farrah Khan, Coordinator of Sexual Violence Education & Support, Ryerson University, Sobia Ali-Faisal, Salina Abji, PhD Candidate, University of Toronto, Rathika Vasavithasan, Immigration Lawyer, Barbra Schlifer Commemorative Clinic, The wonderful team at ASAAP: Shazia Islam, Suruthi Ragulan, Sudin Sherchan, and Chirring Sherpa, Aamer Esmail, Coordinator – Newcomer/Immigrant Youth Program, Supporting Our Youth (SOY), Krittika Ghosh, Senior Coordinator – Violence Against Women, Ontario Council of Agencies Serving Immigrants (OCASI), Stacia Stewart, Program Coordinator – Parkdale Parents’ Primary Prevention Project (5P’s), Parkdale Community Health Centre – Women’s Connection, Chanelle Gallant, Co-Director, Migrant Sex Workers, Rania El Mugammar, Director, SpeakSudan, Dr. Meb Rasheed, Crossroad Clinic, Women’s College Hospital, The Outburst! Young Muslim Women Leadership team, Pomegranate Tree Group, Our community
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