My patient/client speaks French,
and I don’t
Webinar One: Francophone Context in
Northern Ontario
Thursday January 23 2014
12:00 pm -1:30 pm
Presenter Disclosure
• Presenters:
- Danielle Barbeau-Rodrigue
- Andrea Bodkin
- Alain Gauthier
- Lee Rysdale
- Estelle Duchon
- Patrick Timony
• Relationships with commercial interests: None
Disclosure of Commercial Support
Health Nexus has received financial support from the Ministry
of Health and Long Term Care in the form of a grant.
Potential for conflict(s) of interest: None
Social Accountability and
Community Engagement
Francophone Competency
• About 22% of Franco-Ontarians
in Northern Ontario
• Ensure all NOSM activities
– sensitive to cultural and linguistic
needs
• All NOSM learners (+ Health
Sciences)
– develop knowledge and
understanding
– history, tradition and culture
– health concerns and needs
Needs Assessment
• Non-medical preceptors from NW
and NE ON (RD, OT, PT, SLP,
Audiology)
– To gauge attitudes, perceived
importance and professional
development needs
– As a practitioner and as a preceptor
• 43-item online survey (Fluid
Surveys©) during March 2013
• Approval from Lakehead &
Laurentian University REBs
Results
• ≥ 50% ill-prepared to integrate
– as a practitioner and as a preceptor
• Top barriers
– lack of exposure to Francophones
– insufficient language skills
– insufficient training opportunities
• Many interested in further training
– in person
– distance education
• workshops and/or lunch and learns.
Danielle Barbeau-Rodrigue,
Directrice, Affaires
francophones, EMNO/
Director, Francophone
Affairs, NOSM
Lee Rysdale,
Practice Learning and
Research Coordinator,
Northern Ontario Dietetic
Internship Program,
NOSM
Today’s Presenters
Estelle Duchon
Bilingual Health Promotion
Consultant, Health Nexus
Andrea Bodkin
Health Promotion Consultant,
Health Nexus
Patrick Timony (M.A) is a Research Assistant with
the Centre for Rural and Northern Health Research
and doctoral student at Laurentian University. His
research interests include tracking students and
graduates of the Northern Ontario School of Medicine
and investigating physician services in rural and
northern communities, with a particular focus on
language concordant patient/physician interactions.
Alain Gauthier (Ph.D.) is an Assistant Professor with
the School Human Kinetics at Laurentian University.
Dr. Gauthier's is primarily interested in health
promotion and chronic disease prevention. He is
currently leading a project in the area of access to,
and quality of, French language health services in
northern Ontario.
Why we are here today
Understanding the contexts and cultures of your
Francophone clients/patients – and how they
affect health- will benefit you AND your
clients/patients
Today’s Agenda
• Introductions and Opening Activities
• Francophone Contexts in Ontario
– History
– Demographic profile
– Experience life from a minority perspective
• Interview with Alain and Patrick
• Questions and Wrap Up
“The most effective way to destroy people is to
deny and obliterate their own understanding of
their history.” George Orwell
“A society that does not recognize its history will
have a difficult time to have a vision for its
future.” François Boileau
An Inclusive Definition of Francophone
Those persons whose mother tongue is French,
plus those whose mother tongue is neither
French nor English but have a particular
knowledge of French as an Official Language
and use French at home.
French Language Services
Commissioner
Francois Boileau
611,500
=
4.8%
Demographic
Profile of
Francophones in
Ontario
Statistics Canada, 2011 Census of Population
Where do Franco-Ontarians live?
1.20%
Distribution
20%
42%
East
Central
5.70%
Southwest
Northeast
Northwest
40%
Statistics Canada, 2011 Census of Population
French Spoken at Home
80.3% of
Francophones in
Northeastern
Ontario speak
French at home
Statistics Canada, 2011 Census of Population
Exogamy
Exogamous families are those where one parent
is Francophone and the other is not
The Diversity of Francophone
Communities
“I am from Russian, my
mother tongue in Russian,
I lived in France, I speak
French, English and
Russian at home, and I live
in Kingston. I am an
Ontario Francophone”
I am Nigerian, my mother
tongue is Haoussa, I
married a woman from
Quebec, I speak French at
home, and I live in
Ottawa. I am an Ontario
Francophone.”
Compared to the population,
Francophones:
• Feel that they experience a high level of stress in their
lives
• Report suffering from more than one chronic disease
• Suffer from asthma, back pain and/or hypertension
• Are more overweight/obese
• Are physically inactive
• Consume less that 5 servings of fruits & vegetables
daily
• Are exposed to second hand smoke
Source: The Health of Francophones in Ontario: A region-by-region portrait developed from the Canadian Community
Health Survey, 2012
Living as a linguistic minority
influences life and health
Symbolic Violence
Action(s) by the dominant group to force the
linguistic minority(s) to speak the dominant
language
Pierre Bourdieu and Jena-Clause-Passeron
Expressions of Symbolic Violence
• I’m sorry but I don’t speak French
• Can you speak English?
• It’s not polite to speak a language other people
can’t understand.
• Why should we offer services in French? French is
not one of our priorities. We have many more
clients who speak other languages.
Externalized Oppression
The unjustified exercise of authority and power
of one group over another
When oppression becomes
internalized…
Francophones believe and act as though the
beliefs, values and lifestyles of Anglophones are
the only reality
Internalized Oppression is manifested
by:
• Discomfort with one’s identity
• Not wanting to belong to the community
anymore
• Fear of not being able to obtain services
• Fear of being perceived as a “whiner” or
“complainer”
• Fear that no one will listen if you speak French
• Believing that English services are better than
French
Dispersion
Addressing
behaviours in the
language in which
they occur
Language and
culture as a
determinant of
health
Sense of belonging
Double minority
status
Interpretation
Using family members as interpreters can
present challenges
Alain Gauthier
Patrick Timony
Family Physicians in Francophone
communities (per 1 000 French pop.)
6
5.6
5
Ratio
4
3.4
3
2
1.3
1
0
Strong
French
Moderate
French
Weak/No
French
Family Physicians in Francophone
communities (per 1 000 French pop.)
By Geographic location
6
5.2
5.6
5
Ratio
4
3.6
3
2
1
1.7
North
2.0
South
1.1
0
Strong
French
Moderate
French
Weak/No
French
Family Physicians in Francophone
communities (per 1 000 French pop.)
By Community Size
6.0
5.4
5.6
5.0
Ratio
4.0
3.5
3.0
2.0
1.0
1.6
Rural
2.0
Urban
0.9
0.0
Strong
French
Moderate
French
Weak/No
French
Barriers for Non-French Speaking
Physicians
• Selected Barriers
– Impacts of the use of an interpreter/translation
• “I was concerned that the doctor/patient relationship might be comprised
through working through a second person.”
• “There may be something lost in translation there as well, when they’re
talking about subtle things like stress or anxiety, depression, situations at
home or things like that...”
– Feelings of inadequacy
• “...you know there are times where I feel extremely inadequate, but I do
my best to recognize that and ensure that person understands that I know
what their concern is and we’re addressing it.”
– French language continuity of care
• “One of the things I do struggle with is some of the patients who don’t
speak any English and I have to make referrals to specialists. In some
cases I know who speaks French and in other cases I don’t or we have a
limited option and I just have to send them hoping that specialist’s office
can provide that francophone person with French services.”
Strategies to improve FLS for Non-French
Speaking Physicians
• Selected Strategies
– Appropriate use of interpreter/translations
• “the nurse practitioner knows their patients and knows what language
they like to have their services, they just book the appointment
appropriately such that I’m booked and they’re booked at the same time
and they come in with me and they translate.”
– Sensitivity to patient language preferences
• “... and some of them will ask can I speak in French and I’ll say sure but I’ll
say to them if I have a problem I may have to get somebody or I’ll flip to
English.”
– Active Offer of FLS
• “we do everything we can to make sure people are aware (that we can
offer French services)... we even have them fill out a questionnaire when
they first start with the centre “saying I would like to receive my services
in French or in English or both”, “I would like my handouts in French or
English or both”, so they’re given the opportunity.”
Questions, Comments and Discussion
Thank you and merci!