The Immigrant Experience in the Canadian Healthcare System - A Conversation with Ottawa-Based RN Mildred Ababio

Canada is known for welcoming immigrants from every corner of the world. The country receives around 235,000 new immigrants per year and it has been doing so since the early 1990s, according to Statistics Canada. Some of them come with a healthcare-related background and are eager to put their skills to good use from the moment they land, which is beneficial for the Canadian healthcare system.

At Caring Support we are all about supporting immigrants who want to enter the healthcare workforce in cities like London, Toronto and Ottawa, which is why we recently sat down with Mildred Ababio, a nurse leader and a second-generation immigrant, with whom we spoke about the immigrant experience in the healthcare system for both workers and patients.

The Immigrant Experience in the Canadian Healthcare System

This is what Ottawa-Based RN Mildred Ababio told us:

Mildred, would you mind sharing a bit about your immigration journey and how you became a nurse with us?

MILDRED ABABIO: My journey was quite difficult, but lots of gains came out of it. I am driven by helping and caring for individuals and I truly believe that better care would lead to better health, which would lead to a better life in this context. Being a second-generation immigrant, in my culture, the only way to help people was to become a physician. We immigrated originally to Quebec where my parents struggled with integrating into the system and navigating it. At a very young age, around 9 years old, I was tasked with the responsibility of becoming their interpreter when they had to go to medical appointments and stuff like that.

I also became a caregiver to my mother and a mother to my siblings. And because of all of this, of the responsibilities that I had on me when I was in school, I didn't have the chance to have the guidance that I should have been given and didn't even know that there was something called student loans. So nursing became the closest profession that I could find that would allow me to do what I love to do best, which is helping and caring for individuals and positively contributing to their health. Nursing was also the only profession that allowed me to be able to fulfill my educational needs as well as fulfill my obligation toward my family. And that is how I ended up going into nursing. And there's been no regrets.

If I had to do it, I would do it over again. But again, having parents that were immigrants that did not know the system and coming from a culture where there was more value given to physicians than nurses, has its challenges. So that's how I ended up becoming a nurse and never looked back. It's a noble profession, and I'm really glad and fortunate that I made the decision to become a nurse.

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Please share about your career so far. How would you describe your journey to become a nurse leader, having worked as a nurse manager and director of care in LTC and other areas?

MILDRED ABABIO: My journey has been a fruitful one. It's had its ups and its downs but nothing stopped me from achieving my goals. I actually started my career while I was still pursuing my diploma in nursing because I come from a different educational system since at the time I was in Quebec.

So I was recruited to work in neurology and neurosurgery even before I completed my diploma. After that, I ventured off to work as a flow nurse because I wanted to gather as many skills and competencies under my belt as I could. I also started working in different cities, in different communities, and in different provinces. So that path took me to work with exceptional people and organizations. I've worked with very rural populations.

I've worked with the Cree population, and I've worked with big, big organizations. I am really grateful for that experience as it allowed me to have a diverse experience with a better understanding of both the Ontario healthcare system and the Quebec one. I think this was the foundation that shaped my leadership style and allowed me to better serve the Canadian population when I shifted my career from being a frontline type of nurse and being a travel nurse and going into leadership. This allowed me to hold a different leadership position than I've held in the past and all the gains that I did in the very first half of my career, having worked with the different regions and different organizations really sharpened me, sharpened my skills. And again, all I strive for is better patient care, patient safety and not losing sight of the reason why I became a nurse, which was really to positively contribute to patients' health and well-being.

The other thing too that this has done for me, is it's allowed me the opportunity once again to help others, to help my peers, to help colleagues and share this experience with them and uplift them and help them through their career journey or career development. So I've been fortunate enough to be given the platforms and given the positions that I've had to give back and channel back my gains and instill them in them and help them in terms of their career development and their career growth.

As a second-generation immigrant, you understand the immigrant experience in healthcare better than anyone. What are some of the challenges that foreign healthcare workers face in the sector and how can they overcome them, as you did?

MILDRED ABABIO: Well, there are a few, but just to name the ones that stand out the most, I would say rejection, alienation, difficulty with integration, lack of opportunity for those who want to climb the corporate ladder and being seen as a potential threat. So it's challenging and it's difficult. How you overcome that is by staying true to yourself, believing in yourself, standing for your morals, what you believe in and your work ethic.

I always tell myself, and this is also what I tell my colleagues and my peers or anybody that's facing some of these challenges, that "every rejection is a redirection." And there is beauty to be seen in the eyes of a storm. One other thing that I would say is to get yourself a mentor. In my time when I was faced with certain adversities, I didn't have a mentor. Now there are lots of people out there that are willing to mentor you.

There are lots of organizations out there that are doing lots of stuff for immigrant nurses, for newcomers, that are helping you with integration. There are people that are willing to help you navigate the system, willing to help coach and mentor you, work with you, look at what your career aspirations are and give you tips and resources to climb the corporate ladder if that's the direction you want to go with. Networking is another big thing. And being part of associations and organizations, even if you're just at a student level since doesn't hurt to know what's out there.

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Now let's talk about foreign patients. What do you think are the biggest challenges faced by immigrant patients, especially the first generation, when they enter the healthcare system and senior care?

MILDRED ABABIO: I was reading an article about a study that was conducted by the CLRI and Bruyere and, you know, just to give you some stats, they were saying that 14% of the Canadian population is age 65 and over. And this portion is expected to reach 23% by 2036. Now out of that number, there's about 20% of the Canadian population that is foreign-born and this number is expected to grow as much as 28% by 2031. And the majority of immigrant seniors live in Toronto, Montreal, and Vancouver. In Toronto there's about 32%, in Montreal there's 11%, and in Vancouver, there's 12%.

The reason I mention this is just to show that there's been a change and there's been a shift. As you are aware, immigrants have different cultures that do not necessarily meet the Canadian culture. A lot of people come from African backgrounds or South Asia or Middle Eastern.

There are cultures you keep mama and papa at home, granny and grandpa at home. Sending a loved one to a nursing home is not something you see in those cultures but now we are starting to see these immigrant patients in our long-term care facilities and in the retirement homes, and the transition for them is unfortunately quite difficult just because there's a culture shock. Some of the stuff that I've seen is social isolation, malnourishment due to unfamiliar food, spiritual isolation based on their religious practice, and lack of participation in therapeutic activities because what we think is therapeutic is not necessarily something that they are familiar with.

For example, if I were to take my grandfather to a long-term care facility and you ask him to play bingo, he wouldn't know what bingo is, because culturally, that's not a game that he grew up playing. Also, another thing that's very difficult for these immigrant patients is their perceived view of healthcare providers and hospitals. In certain cultures, there are certain discussions that are taboo. We don't talk about palliative care because the minute you talk about palliative care, it means that you know you're going to die. Or in certain cultures, going to the hospital was really the last resort. So these are things that are difficult and challenging.

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You have a project to support immigrants in senior care. What is it about? What do you want to achieve?

MILDRED ABABIO: My overall goal is to provide better care, which would lead to better health, which will essentially lead to a better life. My project and my dream is to create an ecosystem of retirement homes and group homes that focuses on culturally sensitive care, that is catered to individuals that belong to indigenous groups that are BIPOC (Black, Indigenous, and people of colour) or belong to the LGBTQ community or the Francophone community.

In essence, I want to create a supportive space for them to thrive in their health and have the opportunity to accompany them through their last bit and this journey that they're going through and allowing them the opportunity to be their true selves and just live in their last days in the most beautiful grace, which will positively impact their health at a certain level. I think the beauty of it is being able to have a space that is designated to you, that is free of judgment, where you could really be your true self and really thrive. I think it's important for me to give back and be able to have this designated place for them that is culturally appropriate and just allows them to really be themselves without any judgment.

An example of this is that in certain communities or certain backgrounds or ethnicity, they eat sitting on the floor and they eat well in this space. So, in the dining area, there will be a space where if you want to sit on the floor and you want to eat with your hands, well, you'll be able to without anybody looking over you or whispering. So that is the project that I'm working on. And really, it's my way of saying thank you to these people for everything that they've been through. And it's my way of giving back to them.

Anything else you would like to add about the immigrant experience in healthcare and how it can be improved?

MILDRED ABABIO: I think the healthcare system has made tremendous headways. For instance, in Durham, one of the long-term care facilities that they're going to build is going to have a unit dedicated to black people. I know that Bruyere and the CLRI did some research in 2018, I believe, where they looked at all of these things that I was talking about and how they were impacting the residents and what things they could do to better support that. So I think the engine is starting to run and the conversation has started.

About the Interviewee:

Mildred Ababio is an astute Nurse leader and visionary skilled at helping business executives achieve proficiency in managing, improving efficiency, maximizing performance, and increasing patients'/residents' quality care. She has extensive knowledge in Hospital & Health Care industry to support business development and strategic planning.

"Those that know me know that helping and caring is what I stand for. I give back to my community. I do a lot for my peers and other nurses like me because I have a goal which is better patient care and patient safety. Everything that I do in terms of my profession and even in my day-to-day life is giving back to these patients and giving back to the seniors. So that is what I stand for and that is all that I am about. I love to help and caring is a passion of mine. So I do that in every capacity that I can on a day-to-day basis" says Mildred.

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To listen to the full interview with Ottawa-based RN Mildred Ababio, visit our Podcast or our Youtube Channel.

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