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The Toronto Sun CareerConnection


Meeting the needs of diversity in health care

By Susan Poizner
Special to The Toronto Sun

Working in the health industry in one of the most multicultural cities in the world can be a challenge. It's much more difficult to treat your patient if you don't understand their language or culture.

But now, Toronto's University Health Network (UHN) has introduced a new position to its three hospitals. Sepali Guruge is Canada's first clinical nurse specialist in culturally sensitive patient care.

Guruge, who has spent the last eight years researching diversity issues, will design seminars to teach UHN nurses how to be sensitive to patients' needs.

She explains that understanding a patient's cultural background doesn't just make their time in the hospital more pleasant. It can also be a matter that determines the success -- or failure -- of their treatment.

"There was a Chinese woman who needed treatment for diabetes in one of the hospitals where I used to work, and all the nurses were fed up with her because she didn't come to her appointments," Guruge explains.

"They called me in and I went to her home and discovered that she couldn't speak English so she didn't answer her phone. She was so ill, she couldn't get to the hospital but she was ashamed to ask for help."

Guruge brought in a translator and learned that the patient, who didn't understand how to use her needles, had been making her health worse by taking double doses of insulin. With help from Guruge she was able to recover.

Sepali says that more than 50% of patients in Toronto come from diverse backgrounds, and her job at UHN is just one of a number of initiatives aimed at supplying foreign-born Canadians with the treatment they need.

This past January the Centre for Addiction and Mental Health initiated a Multicultural Multilingual Memory Clinic that can assess people for dementia using tests in languages including French, Italian, Spanish, Portuguese, Greek, Hindi, Cantonese and Mandarin.

"The idea came to us when we were having a meeting and we realized that between us, the staff spoke 14 languages," says Dr. Luis Fornazzari, clinical director of the Neuro-Geriatric Psychiatry program.

"I thought, we have this memory clinic and we're seeing only people who speak English. Why don't we make a multi-lingual clinic? Then we can assess elderly people for dementia even if they don't speak English."

Using contacts he'd made over the years, Fornazzari got in touch with memory clinics around the world to get copies of the foreign language assessment tests they used with their patients.

The challenge was standardizing the tests. So while the Mini Mental State Examination (MMSE) may be used in Lisbon, the staff members need to know that 24 points means the same thing for them as it does for those applying the English-language test.

While Fornazzari's centre is taking a great leap forward, some aspects of Canada's health-care system are stressful for some cultures. For instance, in some communities, visiting the sick is a social responsibility and visitors stay by the bedside for hours.

But in Canada, limited visitor numbers and hours may make this almost impossible, and as a result, the patient may feel unappreciated, unloved and unimportant.

Until now, there really has been a dearth of this type of information for health workers, and Guruge is planning to put together a Web site to help UHN employees research their questions about cultural issues.

That may take awhile. Meanwhile, Guruge's first project in her new position is to conduct a survey of health professionals at UHN to understand their perceptions and knowledge of diversity practices so she can plan her educational campaign.

Visit and

(Susan Poizner ( is a Toronto-based freelance writer.)

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