The Canadian Minister of Health recently announced an investment of almost $17 million to improve healthcare access for Francophones in Western Canada. The funds will go to increasing the recruitment, enrollment, and retention of students in various healthcare fields (eg, medicine, nursing, social work, speech therapy, and personal support) at five postsecondary training institutions.

Approximately 188,392 Francophones live in Western Canada (ie, Manitoba, Saskatchewan, Alberta, and British Columbia). This population represents about 2.3% of Canadians whose first language is French. While French is one of the two official languages in Canada, Francophones outside Québec, specifically in Western Canada, often have difficulty accessing healthcare professionals who can communicate effectively in their language.

According to a survey published in 2016 by the Société Santé en français, Ottawa, and Université de Saint-Boniface, Winnipeg, 74.5% of Francophones in Western Canada said that the lack of bilingual providers was a barrier to obtaining healthcare; 59% didn’t know which services were available in French.

Where healthcare in French is accessible, patients need to know how to go about finding it, which can be hard, particularly for newcomers to Canada, Sabrina Lee, MD, an ob/gyn at Hôpital de Gatineau in Gatineau, Québec, told Medscape Medical News. There isn’t a formal process for Francophones to access care in French, she explained. “Patients would get whoever was on duty when accessing emergency services.” Lee practiced in Manitoba (mostly in Winnipeg) for 8 years and recently completed a fellowship in Vancouver.

“Getting care in French is almost impossible,” Nour Enayeh, executive director of RésoSanté, a provincial nonprofit health network in British Columbia, told Medscape Medical News. RésoSanté now has an online directory to help patients find professionals who can speak French. “But even with that guide, it doesn’t mean that everyone has that access. It doesn’t mean that the person who answers the phone can speak French, for example, or will be able to direct them to someone who speaks French. So, the access is very limited,” she explained.

Reducing Risk

Patients don’t need to speak only French to want or need healthcare in their first language. In times of stress or emergency, it’s often safer for a patient to communicate in their mother tongue to ensure that everything is understood on both sides. As they age, become frail, or develop dementia, patients may forget their second language and only retain the ability to communicate in their first language.

Many Francophones who move west understand that it might be difficult to get healthcare in French, Karl-Stéphane Coyault, coordinator for Francophone Services and Special Initiatives for the Provincial Health Services Authority in British Columbia, told Medscape Medical News. But these patients don’t see it as an immediate concern and believe that they have time to find a physician. After a while, however, they stop looking for Francophone physicians because they can’t find any.

“When they arrive, they do not realize what impact that [not finding a doctor] would have on them, that the main impact is the prevention. They tend to let things go,” said Coyault. “They realize it when it’s too late. Then they have a pathology that is much more difficult to handle because it wasn’t taken care of earlier.” This situation burdens the system overall, Coyault added.

Finding Answers

Solutions to the lack of Francophone healthcare providers in majority Anglophone provinces have been proposed and, in some cases, enacted. Many Canadian children in western provinces attend French immersion schools and graduate with proficiency or fluency in French, said Coyault. But these students stop using the language if they have nowhere to practice. Consequently, they may become shy when opportunities to speak French arise. Encouraging people to use their French skills should be easy, said Coyault.

This is one of the objectives of the Cafés de Paris program, which was launched in collaboration with RésoSanté, he explained. The program provides informal settings in which healthcare providers can speak French, practicing in a low-stress environment so they can be more confident speaking it at work. “It is a successful program,” Coyault said. “Here in British Columbia, it has a waiting list of 200 people. We don’t advertise at all.”

Advertising for Francophone professionals is not necessarily a straightforward approach. If a province were to advertise for physicians from Québec, then the latter province would lose them. “We don’t want to take away,” Enayeh said. “We just want to find the ones who want to leave anyway. We know that there are many professionals who go to the United States. Those are the ones that I want to find. Instead of leaving Québec to go to the US, I want them to come to British Columbia.”

Pan-Canadian licensing, which would allow physicians to practice in other provinces, could help alleviate issues for patients outside Québec, New Brunswick, and Ontario, which have larger Francophone populations. Telemedicine services, while not possible for all medical problems, could be helpful for many. A Francophone in British Columbia could use a telemedicine service from another province to manage simple health issues or follow-ups. For example, a service could provide a Francophone professional to explain what a patient can expect at an upcoming in-person visit with a doctor who doesn’t speak their language.

Some physicians argue that provincial licensing bodies need to make licensing more accessible to immigrants. Getting accredited to practice in Canada can take years regardless of education and experience. “This is the field where we should spend the most energy because there is no point in attracting those doctors if we’re not able to do anything for them,” said Coyault.

Overall, $17 million represents less than 0.2% of Health Canada’s annual planned spending of $9.3 billion. But it means that the government is listening, Coyault said. “It creates a positive dynamic.”

Lee, Enayeh, and Coyault reported having no relevant financial relationships.

Marijke Vroomen Durning, RN, is a freelance health and medical journalist based in Montreal. Her work has appeared in professional and consumer outlets, including The Physiologist, Weill Cornell University, CURE Magazine, WebMD, HealthyWomen.org, and many more.