2009 annual report - Immigrant Women`s Health Centre

“Serving Immigrant Women for Over 30 years”
August 6, 2009 - Three generations of Farsi-speaking women pose on
the steps of IWHC’s Mobile Health Clinic. Read more about the impact
of IWHC’s commitment to this community from Masoudeh Kazemiashtiani, our Farsi
Counsellor, on Pg 4. Photo by Dr. Erin Johnston
Annual Report 2009
Immigrant Women’s Health Centre (IWHC)
About Us
Located at 489 College Street in downtown Toronto, the Immigrant Women’s Health
Centre was founded in 1975 as the only sexual health clinic in Ontario specifically
designed to serve immigrant and refugee women in their own languages. At the
time, the Centre primarily served women working in the garment factories on
Spadina Ave. Since then, demand for the Centre’s services has grown steadily and
today, we serve between 4,500 and 5,000 women per year in 14 different languages
with an all-female staff and in a culturally sensitive, non-judgemental environment.
Clinics are held regularly on-site and through our popular and highly-respected
Mobile Health Clinic program which takes reproductive healthcare into the communities where women live, study, worship, work and raise their families.
IWHC’s “Big Picture” Perspective
Racism, sexism and discrimination exist within every institution in our society.
IWHC recognizes that these factors impact immigrant and refugee women in all
aspects of their lives, including access to sexual healthcare. But these are not the
only barriers; other social determinants of health such as language, literacy, poverty,
violence against women, immigration/refugee status, homophobia, culture, religion,
limited transportation/means and the necessity of shift-work also contribute to the
low priority often given to sexual healthcare by women themselves.
IWHC Mandate
“To empower immigrant women, through patient's rights and health promotion, to take control of their own bodies, be it in the workplace, at home or in
their cultural life…”
To this end, IWHC works in solidarity and partnership with other organizations and
immigrant women/women of colour groups to ensure that sexual healthcare services
reach the widest possible client base in the City of Toronto. We also work with the
community at large - through outreach, membership in other groups and participation in political and social service advocacy - to promote anti-racist policies and
lobby for the protection of civil and human rights.
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Immigrant Women’s Health Centre Annual Report 2009
Letter from the President, Board of Directors
2009
IWHC Board of Directors
Carolyn Egan,
President
Lourdes Montez,
Vice-President
Mary Di Felice,
Treasurer
Linda Gardner,
Member-at-Large
Desiree Hipplewith,
Member-at-Large
Isabel Mahoney
Member-at-Large
Winnie Ng
Member-at-Large
Blanca Serrano
Member at Large
IWHC Staff
Ayesha Adhami
Florence Agyapong
Filomena Carvalho
Karen Chau
Anna Cioffi
Loida Gacayan
Indra Joshi
Masoudeh Kazemiashtiani
Amanda Richards
Lina Rodriguez
Cam Tran
IWHC Medical Staff
Dr. Susan Keen
Medical Director
Dr. Linda Chou
Dr. Arlene Chan
Dr. Debbie Honickman
Joanne Hunter, RNEC
Dr. Erin Johnston
Dr. Christine Hwang
Dr. Sheila Lakhoo
Dr. Sheila Wijayasinghe
In 2009, the world was reeling from the US stock market crash and its effects on
global markets. While Canada and Canadians fared better in the economic
downturn than many across the globe, here at home, federally, provincially, and
municipally-funded social service, healthcare and settlement agencies began to see
tighter requirements for funding, stricter reporting procedures and much closer
scrutiny on operations.
Thus began a new era in fiscal culpability, one which continues to get more rigorous
and exacting as we go forward.
Over the past few years, IWHC has been working diligently to streamline our clinic
procedures and healthcare offerings to make optimal use of our funding dollars.
Dr. Sheila Lakhoo was brought on mid-year to test the efficiency of “Fast-Track”
clinics: clinics in which shorter appointment times are given to a higher number of
clients for single-complaint visits. So far, the Fast-Track clinics have enabled urgent
client cases to be seen on a more timely basis, but have had little impact on the
Centre’s historical challenge to reduce waiting list numbers. IWHC’s Management
team also implemented a quarterly “Bulletin” to facilitate better communication
between medical staff, Centre staff and Board Members and ensure a wide and
concurrent dissemination of policy and protocol changes.
Over 2009, IWHC reluctantly maintained the number of Mobile Health Clinic (MHC)
trips at 2 per week, per year as decided a few years prior due to the rising costs of
Mobile operations. We say reluctantly only because the program remains incredibly
popular among both agencies and clients, and each visit further enhances the MHC
porgram’s trusted reputation as a healthcare delivery service to women from marginalized communities across the City. We have a particularly large client base in
Scarborough, where women’s health provision is at a premium.
On another positive note, IWHC is proud to report that since 2007, we have dedicated resources to secure a strong relationship with Farsi-speaking women across
Toronto. This has produced regular women’s healthcare delivery to the community
both at our onsite-clinic at 489 College St. and on the Mobile.
Moving into 2010, we anticipate increasing levels of financial accountability, and are
committed to researching and testing new ways of improving clinic efficiency while
maintaining our high standard of quality of care.
I’d like to close my comments for 2009 by welcoming Dr. Sheila Lakhoo to the
IWHC team, as well as Dr. Sheila Wijayasinghe as an on-call doctor and Blanca
Serrano as a new Board Member-at-Large. We’d like to thank Isabel Mahoney - a
member of IWHC’s board since 1995 - who stepped down at the end of this year,
for her commitment, care and support of the Centre. We also acknowledge and
appreciate the efforts of Dr. Susan Keen, who completed a one year position as the
Centre’s Medical Director from 2008-2009. Thanks also to my fellow Board
Members for their ongoing work with IWHC and to the Management Team and Staff
for their dedication and hard work.
Carolyn Egan,
President
Board of Directors, Immigrant Women’s Health Centre
Annual Report 2009 Immigrant Women’s Health Centre
3
IWHC Spotlight: Helping to Break Barriers in the
Farsi-Speaking Community
Sexual health issues not only affect women as individuals, but also influence their
relationships with the people closest to them. Women’s sexual body parts and the
Masoudeh Kazemi Ashtiani
* Farsi Counsellor since 2007
* Former MD from Iran
* Key Agency Clients:
Afgan Women’s Association
Iranian Women’s Organization
of Ontario
diseases related to them have been a taboo in the Iranian culture for a long period
of time. In my work as an MD in Iran, I worked very hard with my patients to remove
some of the stigma about sex and sexual health, and address some of the misinformation that women had about their bodies and about disease. Since moving to
Canada and starting my job at IWHC, I have come to believe that we can break this
taboo in the Iranian community here also and empower women through the use of
workshops and counseling. I also believe that the Mobile Health Clinic is one of our
strongest tools in this regard.
The Mobile Health Clinic has made sexual healthcare more accessible for women in
the Farsi-speaking community here in Toronto. Most of these women are newcomers and not familiar with different parts of the city. Some of the women speak little or
no English; they have difficulty finding out about available health services and how
to access them. Sometimes they even struggle to understand what the doctor is
saying. So, when we bring the Mobile with experienced counsellors who speak their
language, it is easier for them and we can clearly communicate all the information
and options they need to make educated choices about their sexual health.
Because there are cultural barriers in talking about sexual healthcare, many women
are simply uneducated about their own bodies. I strongly believe that through
Immigrant Women’s Health Centre and the Mobile Health Clinic Program, Iranian
and Afghan women have a safe place where they can learn more about their sexuality and the methods to prevent STIs and other sexually-transmitted diseases. They
are also able to obtain information about women’s cancers and doing regular sexual
health checkups to prevent such diseases.
Having an all-female staff on the Mobile and at the Centre is very important for
Farsi-speaking women due to their culture, so they like our services very much.
They are also very happy that their tests will be followed up by their counsellor and
that they will be updated about their results. Another important factor is that all these
services are provided to them for little or no cost at all. Even though all Canadians
have access to healthcare through provincial plans like OHIP, in Ontario, newcomers in the three-month waiting period for their cards can at least get sexual healthcare from the Centre and the Mobile.
Farsi-speaking clients that I have spoken to find all these things to be very important
and as an IWHC counsellor, I am very happy these services are available to them
through our agency.
Masoudeh Kazemi Ashtiani
IWHC Farsi-Speaking Counsellor
4
Immigrant Women’s Health Centre Annual Report 2009
IWHC Service Offerings
* Free Condoms, Pregnancy Tests
* Birth Control Information &
Counselling
* Birth Control at Low Cost
* Pregnancy Counselling/Referral
* Abortion Counselling/Referral
* Counselling/Screening for
Pap Tests & Breast Self-Exams
2009 - The Year at a Glance
IWHC Sexual Health Service Delivery
IWHC continues to deliver sexual healthcare services through two venues: the
site clinic at 489 College Street and its’ Mobile Health Clinic Program (MHC), which
delivers partner-based programming to bring sexual healthcare directly into
communities.
* HIV Testing, Counselling/Referral
Client Visit Comparative 2006-2009
* Screening, Information/Referral for:
- Vaginal Infections
* Health Education Programs on
Women’s Health Issues to
Community Groups
* Resource Materials on Women’s
Health in Multiple Languages
* IUD Insertions (Appointment only)
Client Visits
- AIDS
- STIs
* Free Hep B Vaccines (By
Appointment only)
Communities Served
* Mandarin/Cantonese
* Portuguese
* Vietnamese
* Spanish
* Farsi
* Urdu/Hindi/Punjabi
* Italian
* African/Caribbean
* Youth
While we steadily maintain client numbers well over 4,500, we are noting a trend in
client numbers decreasing slighty every other (odd) year.
Service Offerings
Similar to last year, the majority of medical services provided focused on the
screening and treatment of vaginal infections and STIs as well as contraceptive
counselling, perscriptions and sales. This year’s breakdown of services shows little
variance from last year, except a small increase in HIV-oriented healthcare and a
decrease in Post-TA and Hep B-related service provision. This follows in the pattern
of fluctuation we identified last year. STI, pregnancy and vaginal infection-related
testing and services also show a slight decline from last year.
Comparison of Services
Pregnancy Tests
Contraception
STI
HIV
Post-TA
Vaginal Infections
Hep B
Annual Report 2009 Immigrant Women’s Health Centre
2006
2007
2008
2009
355
460
497
409
1832
1974
1823
1868
136
193
92
102
1829
13
1957
661
1918
1
2093
745
2030
10
2224
457
1956
4
2140
428
5
Infection and STI testing
remain our most-demanded
% Breakdown of Services 2009
service offerings with contra-
ceptive counselling, prescrip-
tions and sales following close
behind.
With respect to positive test
results, IWHC continued to see
its largest number of positive
cases in Bacterial Vaginosis
and Vaginal Chlamydia; the former showed a slight decrease
in percentage of positive cases
from 7.65% in 2008 to 7.4% in 2009, while the latter showed a minor increase in
percentage from 1.95% to 2.1% of clients who tested positive. We also saw minor
increases in positives for Hep B and Herpes. Overall, the total cases tested are
down slightly from last year.
Overall Screening & Positive Results Comparative 2008/2009
Hep B
Herpes
Syphilis
Trichomones
BV
Chlamydia (Oral)
Chlamydia (Anal)
Chlamydia (Vaginal)
Gonorrhea (Oral)
Gonorrhea (Anal)
Gonorrhea (Vaginal)
Total 2008
+s
Total 2009
+s
164
21
139
2053
2057
1
2
4
6
157
106
29
109
1970
1972
6
5
3
6
146
41
7
2041
0
1
11
30
7
1974
0
0
09
40
7
2054
0
0
40
30
7
1974
0
0
41
The number of clients booked for pap tests increased 1.75% to almost 37.7% of our
total client visits, with a small decline in repeat paps. We also saw a minor rise in
results identifying low-grade lesions; however, in contrast, ASCUS and high-grade
Pap Test Comparatives
numbers declined slightly. As per our
2008 2009
Centre practice, clients experiencing any
abnormalities in pap resuts are given
Pap
1750 1780
Repeat Pap
115
112
educational counselling, are referred to
specialists and followed up as needed.
ASCUS
Low Grade
High Grade
6
14
51
9
12
58
7
Immigrant Women’s Health Centre Annual Report 2009
Client Breakdown by Language
Client Demographics
As shown in the chart above, the largest demographics of IWHC clients remain
from the Spanish, Chinese-speaking (Mandarin/Cantonese), Portuguese and
Vietnamese-speaking communities. Numbers have also gone up from the African/
Caribbean/Youth and Farsi-speaking communities, with the Hindi/Urdu Punjabi
community close behind. The number of Korean women seen at the Centre has
also increased to 3% of our
Age Breakdown
2008
2009
clientele and are largely
6%
6%
served on our Mobile Health 60-85 yrs
Clinic (MHC). We also serve 50-59 yrs
12%
15%
about 5% other communities
40-49 yrs
29%
31%
including Somali, Tamil,
30-39 yrs
29%
30%
French, Russian and
20-29 yrs
23%
18%
Tagalog to name a few.
19 yrs & <
1%
0%
Age-wise, our highest demographic is from the 20-49 year range, although our
numbers of 20-29 year old women has dropped 5%. We are aggressively pursuing
more clients in this age range and are expecting our numbers in 2010 to reflect the
efforts of the Centre and in particular, our Youth counsellor. In this regard, some of
the challenges in moving older clients to family doctors for their sexual healthcare is
the lack of family doctors across Ontario, and a surprising rising trend in both male
and female service providers of not giving regular pap or breast exams; in addition,
language, transportation and culture also affect accessibility of services. For these
reasons, procuring sexual health education and medical services is still a challenge
to women in the 49+ age group, despite our having seen sexually active women in
this age demographic presenting with STIs.
Lack of healthcare coverage also remains a problem for about 33% of our clients of
all ages.
Annual Report 2009 Immigrant Women’s Health Centre
7
Service Challenges: Contraception Provision
Photos courtesy Dr. Erin Johnston
Rising costs of birth control methods and demands on clinics from the pharmaceutical industry to purchase higher volumes of birth control units per order is an increasing problem for all smaller sexual health agencies. Aside from the financial cost and
storage implications, the expiration properties of the products do not make mass
purchase a viable option. Over the past few years, IWHC was fortunate enought to
partner with agencies like HassleFree Clinic and The Bay Centre for Birth Control
(Women’s College Hospital) to submit joint orders or purchase from their inventory.
But eventually, the purchase demands became too much for HassleFree as well,
and changes in policy and protocol at the Bay Centre prevented us from continuing
our purchase agreements with them. We continue to offer the more popular birth
control products, but have reduced our offerings significantly as a result of these
pressures. IWHC and other member agencies of the Sexual Health Network of
Ontario have been discussing ways to open a dialogue with the pharmaceutical
companies about these challenges in procuring their products.
IWHC Mobile Health Clinic Program
In 2002, Immigrant Women’s Health Centre
retired its’ original Mobile Health Clinic (a retroYear
Trips Clients
fitted Winnabego purchased in 1980) after 23
2006
42
482
years of dedicated service. Between 2003-2004,
2007
48
620
Centre staff, board and supporters took up a
massive fundraising campaign to raise over
2008
58
585
$300,000 to purchase a new mobile unit, entirely
2009
65
656
designed from the ground up by Centre staff and
management. 5 years after the launch of the new
Mobile Health Clinic in 2005, the program is more popular than ever, with everincreasing demand from agencies, workplaces, community centres, and even
women themselves, organizing in groups at their places of residence. While a minor
dip in numbers can be seen from 2007-2008, the percentage of clients seen per
mobile remained the same as 2008 - 10.1%, with the highest number of clients (17)
seen at Emery Adult Learning Centre in mid-December. The Mobile also made
repeat visits to locations when we were unable to service the high number of clients in
one trip, including Northwood Neighbourhood Services, University Settlement House
and Growing Together.
IWHC has worked extensively at streamlining and improving services on the Mobile;
we have added a new filing protocol for client information and have collaborated
with partner agencies to ensure that the client quota per trip remains between 10-15
women; we continue to provide pap tests, breast exams, STI screening and contraceptive counselling as part of our regular service offerings. In 2009, IWHC completed its partnership obligation to provide the Mobile Health Clinic and Centre staff to
St. Paul’s L’Amoureaux Centre for the delivery of clinical breast exams for their
Breast Health Screening Project, although we were unable to meet all the screening
delivery objectives due to scheduling conflicts on both sides. SPECIAL THANKS!
As every year, IWHC thanks Toronto Western Hospital and Men’s Detox Staff for the
donation of a parking spot for the Mobile at the Men’s Detox at 16 Ossington.
8
Immigrant Women’s Health Centre Annual Report 2009
Mobile Health Clinic Partnerships and Visits 2009
69 SilverSpring Road
Action Resource Centre
Afghan Women’s Association
Anewtex Factory
Arleta Manor (Northwood)
COSTI Immigrant Services (Caledonia)
Chinese InterCultural Services (CICS)
Davenport-Perth Community Centre
Doorsteps Neighbourhood Services
(Wilson)
Doorsteps Neighbourhood Services
(Daystrom)
Elmbank Community Centre
Emery Adult Learning Centre
Flemingdon Neighbourhood Services
Gord & Irene Community Centre
Growing Together
H-MART Supermarkets
Hispanic Development Council
Iranian Women’s Organization
King Edward Hotel
KCWA Family Social Services
Korean Philadelphia Church
Manantial Neighbourhood Services
Northwood Neighbourhood Services
North York Community House
Queen Alexander School
Rexdale Women's Centre
Salv. Army - Evangeline Women's Res
SEAS Centre
Scaddingcourt Vietnamese Wom Grp
Tamil Eelam
TCCSA (Spadina)
Toronto Rape Crisis Centre
Tropicana Community Services
University Settlement House
Working Women's Community Centre
(Gladstone)
St. Paul's Breast Health Project
Outreach and Community Engagement Program
IWHC’s 35 year history of providing sexual health-oriented medical, educational and
outreach services to women from marginalized comunities across the City of Toronto
is rooted in our relationships with partner agencies. These front-line agencies - community centres, ESL/LINC schools, settlement service organizations, etc. provide a
critical service to new Canadians in helping them to navigate their surroundings and
become part of Canadian society.
Most importantly, these agencies serve as a point of access to networks of services
that are available to newcomers as well as “new Canadians” - those who have been
here for less than 10 years. They assist clients with challenges that arise as they go
forward - getting housing, dealing with domestic abuse, navigating through the
healthcare system, getting legal assistance and connecting to all types of social services that they may be marginalized from due to barriers in language, culture, transporation, poverty, employment restrictions, etc.
Our partner agencies provide IWHC’s most crucial connection to the most vulnerable
women in these populations; they give us the space to set up displays and deliver
workshops, so we can provide information on sexual health issues such as condom
negotiation, STIs, cervical cancer screening and HIV/AIDS. We are also able to distribute the Immigrant Women’s Health Handbooks to women - a popular and necessary resource that provides sexual health instruction and information in women’s
own languages and also gives english language equivalents, which enables them to
better convey their concerns and understand their options when dealing with
healthcare providers.
Annual Report 2009 Immigrant Women’s Health Centre
9
In some cases, the Immigrant Women’s Health Handbook is the first resource
women have accessed to receive detailed information about their bodies and sexuality; we frequently hear women say, “I wish I had something like this when I was a
young woman.”
IWHC Partnerships and Community Outreach 2009
69 SilverSpring Road
91 Augusta Ave
Action Resource Centre
Afghan Women Centre
Arleta Manor (Northwood)
ASTRA Zeneca
Barbara Schlifer Legal Clinic
C.A.H.R Conference
Care First
Cecil Community Centre
Central Tech Health Fair
Chinese Cultural Centre
Chinese InterCultural Services (CICS)
COSTI Immigrant Services (Caledonia)
CultureLink
DEP
Davenport Perth Community Centre
DELTA Meadowvale Hotel
Doorstep Neighbourhood Services
(Wilson)
Doorstep Neighbourhood Services
(Daystrom)
Eastdale Collegiate Institute
Elmbank Community Centre
Emery Adult Learning Centre
Eritrean Canadian Community Centre
Flemingdon Neighbourhood Services
Gordon & Irene Community Centre
Growing Together
H-MART Supermarkets
Hispanic Development Council
Jessie’s Centre for Teenagers
Jesuit Centre
KCWA Family Services
Manantial Community Centre
Newcomer Women’s Services Toronto
North York Community House
North York Women’s Shelter
Northwood Neighbourhood Services
Ontario College Leadership Centre
Regent Park Community Health Centre
Rexdale Women’s Centre
Riverdale Library
Royal York Hotel
Salv. Army - Ernestine Women's Res
Salv. Army - Evangeline Women's Res
Scaddingcourt Vietnamese Wom Grp
SEAS Centre
South Asian Women’s Centre
St. Christopher House
St. Joseph’s Health Centre
Syme Woolner
TAIBU Health Centre
Toronto Chinese Association
Toronto Rape Crisis Centre
Tropicana
University Settlement House
Vietnamese New Year Display @ CNE
In 2009, IWHC staff delivered displays and workshops to 58 different agencies
and organizations, providing sexual health-health education to over 750 women.
Our counsellers also shared information through a variety of interviews and articles
provided to Toronto’s wide-ranging ethnic media.
Aside from our work with clients in the community, Immigrant Women’s Health
Centre is an active and collaborative member of service providers working with
immigrants and refugees. Some of our work involves participation in groups, panels,
events, speaking engagements and other promotional activities, to explore and
brainstorm around issues that impact access to sexual health care services.
In this regard, we continued to participate in the TPH Clinic Sharing Group, the
Sexual Health Network of Ontario and the Women’s College Hospital Task Force on
the Uninsured. We also participated in the International Women’s Day organizing
committee and were a community partner of the TCHEC Chinese Health Fair and
Scadding Court Vietanese Health Fair Organizing Committees.
10
Immigrant Women’s Health Centre Annual Report 2009
We continued our partner-
IWHC Community Engagement 2009
Health’s Health Options
Chum City Christmas Wish
Clinic Sharing Group (TPH)
EMS Chief’s Community Advisory Board
Hispanic Development Council
IWD Organizing Committee
Sexual Health Network of Ontario
TCHEC Chinese Health Fair Organizing Committee
TPH Health Options at Work Program
Voces Latinas
Women’s College Hospital Task Force
on the Uninsured
ship with Toronto Public
at Work Program (HOW)
and also participated in a
variety of seminars, workshops and discussions held
by community partners
across the City of Toronto.
Financials
In 2009, IWHC recieved a
cost of living increase from
Toronto Public Health, raising our City-based revenue to $721,258, but we did see
declines in our revenue from Birth Control sales and agency-based donations. The
largest expense increases came from staffing and program expenses, although they
were off-set by an over $42,000 decrease in program expense spending. In most
other other aspects, the financials remain comparable to previous years.
Statement of Operations
Year-Ended December 31, 2009
Family
Planning
Other
Programs
2009
Total
2008
Total
$721,258
$---------88,472
17,311
11,000
1,850
746
111
----------
$721,258
88,472
17,311
11,000
1,850
746
111
----------
$688,926
89,129
22,270
6,600
800
4,000
76
42,862
721,258
119,490
840,748
854,663
460,259
152,372
66,454
40,906
1,267
73,706
26,572
16,835
17,595
533,965
152,372
93,026
57,741
18,862
507,375
144,872
83,070
99,860
18,835
685,202
168,810
854,012
854,012
(15,218)
$ (15,218)
Revenues
City of Toronto
Ministry of Health
Honoraria/Resource Sales
Foundations - Other
Donations
Other Agencies
Interest
Ontario Trillium Foundation
Expenses
Personnel
Contract/Consulting
Administration
Program Expenses
Amortization
EXCESS (DEFICIENCY) OF
REVENUES OVER EXPENSES
Annual Report 2009 Immigrant Women’s Health Centre
$
( - ) $
$
651
11
Notes