HEALTH CARE

Special delivery: The $5,000 baby

Trish Crawford

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Raisa Khan is a $5,000 baby.

That’s what The Scarborough Hospital charged her parents to deliver her on June 8.

Sabrina Hoque, 28, and Iqbal Khan, 39, are landed immigrants who arrived here from Bangladesh in March with $16,000 to their name.

Hoque has a degree in English literature and taught English back home. Khan earned a B.A. in Bangladesh and a diploma in international business from Virginia International University in the U.S. and worked in business for three years.

They chose to come to Canada, says Khan, “because it is a land of opportunity.”

Ontario welcomed the English-speaking couple and their 5-year-old son here because, like the 110,000 new Canadians who come to this province yearly, they have skills we need. Once here, they can rent apartments, drive cars, enrol their children in school, get jobs and pay taxes.

But they dare not get sick.

Immigrants get “half a welcome” when they arrive in Ontario, say health care advocates, because they must wait three months before being eligible for OHIP. The waiting period, instituted in 1994 by Bob Rae’s NDP government, saves the province about $90 million a year.

“Occasionally the spectre of medx ical tourism gets raised but that’s a red herring,” says Bob Gardner, director of policy for the Wellesley Institute, a health think-tank. He notes immigrants pass an extensive medical examination by a federal government-approved physician in their home country before they are allowed to immigrate.

“We are saying, `Welcome to Canada, and hope you don’t get in an accident or sick in three months.’ It’s contradictory.”

Gardner argues that the waiting period should be dropped: “They are paying taxes as soon as they get here.”

The rule is bringing untold hardship to families, such as the Khans, as they use meagre savings to pay for unexpected illnesses, accidents and medical emergencies that send them to doctors and hospitals.

Hoque’s pregnancy was a surprise: She had none of the symptoms of her first pregnancy. Only when she felt ill, just before arriving in Canada, did she find out she was 5 1/2 months pregnant.

Afraid of incurring medical bills in Toronto, she avoided doctors. The $800-a-month rent for their one-bedroom apartment in the city’s east end was quickly eating up the family’s reserves.

“I didn’t want to go to a doctor even when I didn’t feel well, because we have to pay. It was lot of stress.”

Twice she fainted and had to be taken to emergency where the family was asked for $250 up front. The family also paid an $1,100 deposit toward the cost of the birth.

Even on the delivery table, the mother fretted about costs and ask the medical team to let her try for a natural delivery. But there were complications and the decision was made for her.

“The baby has no heartbeat, we have to do an emergency C-section,” the doctors told her.

Hoque continued to worry about costs during her three-day hospital stay — including $8 for diapers — but her husband reassured her.

He said, “Everything is fine here in Canada. Don’t worry. She (the baby) is a blessing.”

Their savings are almost all gone, but things are looking up. Khan recently landed a job as a clerk at an electronics store at $9.50 an hour. He is hoping to pay back the remaining $3,846 debt to The Scarborough Hospital a few dollars at a time and is grateful the hospital reduced the bill upon hearing of the family’s plight.

The baby was issued a health card at birth. Hoque, Khan and 5-year-old Ishtiaque got theirs 17 days later.

While most provinces in Canada don’t have a waiting period for medical insurance coverage — Ontario had no such provision for more than 25 years prior to 1994 — Ontario, Quebec and British Columbia, which receive the lion’s share of the country’s immigration, do.

However, Quebec exempts pregnant women, as well as victims of spousal abuse and those who have infectious diseases.

“It is appalling there isn’t special consideration (for pregnancies),” says Toronto midwife Jasmin Tecson, who has helped numerous new Canadians during their pregnancies. While her services are covered by the Ministry of Health and Long Term Care, the hospital delivery is not.

She says it is “unsafe” for women to make decisions about birth based on their ability to pay. They are afraid to complain, says Tecson, because, “They don’t want to be a burden and they are afraid it will affect their status.”

“It is an issue of fairness, equity, accessibility and even human rights,” says Ahsan Sadiq, a former OHIP director who is a health care consultant and member of the Right to Healthcare Coalition, which is pushing for the removal of the waiting period for everyone in Ontario.

(Ontarians returning to the province after extensive time away are also subject to the waiting period).

The health ministry defends its actions by saying it wants to “create a disincentive to persons moving to Ontario only briefly for the purpose of acquiring insured medical services.” Spokesman David Jensen argues that preferential treatment is not given to refugees over landed immigrants, because the federal government picks up their health care costs.

It’s a Catch-22 for Ontario hospitals, which are required under federal law to provide care to all emergency cases but the province won’t reimburse them for uninsured patients. Hospitals, which never refuse treatment, must try to get reimbursed by the new Canadians who have turned to them during emergencies.

Meanwhile, fears about racking up unpayable bills leaves many immigrants afraid to go to the doctor at all, causing more problems in the long run.

Lee McKenna, policy and government relations manager for the Association of Ontario Health Centres, which provides basic medical care to non-insured residents, says immigrants can be seriously ill by the time they qualify for OHIP. Although the waiting period to be processed is three months, the paperwork can sometimes take much longer than that.

“At the time of entry, they may have a clean bill of health but the stresses and strains involved in coming here mean people are falling ill. Sometimes things happen that are not foreseen — such as a pregnancy.

“Our point is that it is a false economy,” says McKenna, adding that the coalition is funding a research study into what the waiting period costs is costing Ontario’s economy in the long run.

“We are arguing for fairness,” she says. “They are starting strongly at the starting line but then things happen to set them back.”

Hemorrhaging but asked for a deposit

Sayeda didn’t know she was pregnant when she arrived in Canada from Bangladesh on April 25.

But what might have been a happy circumstance became a medical emergency within weeks when she started to hemorrhage.

“I was concerned and alone.”

At the last moment, her husband had been unable to come to Canada with her because of surgery for a throat ailment, says Sayeda.

Sayeda started frantically shopping for a hospital without a health card and no money to pay in advance. When Toronto East General asked for a deposit of almost $500 to see her, she balked and was directed to a walk-in clinic. There, she ended up paying $534.31 for diagnostic tests, including $163 for an ultrasound.

When the first test results were analyzed by the clinic doctors, they pointed to serious illness. The word cancer was spoken.

“It was pretty scary. I thought, I have to do something,” says Sayeda, who visited three hospitals armed with her test results before finding care at St. Mike’s. She didn’t know the city or its hospitals, relying only on people’s suggestions of where to go.

“I was panicking. I didn’t know the city very well and I was all alone.”

In the end, it was decided that she had a miscarriage and Sayeda continued to have costly blood tests at $88 a shot conducted at a local clinic for two more months.

“I suffered terribly,” says the shy woman, who doesn’t want her last name used.

Now Sayeda is living on meagre savings while her husband sells their store and belongings back home. They dream of setting up a store here and Sayeda, who is trained as an architect, is sending out resumes and looking for work.

She is slowly paying off the hospital bills at $100 a month --- she owes $875. Her health card arrived on July 25.

He fell in front of a train. Then it got worse

When Koroush Horri plummeted onto the subway tracks at the St. Clair station in August last year, he knew he was in a lot of trouble.

But he wasn’t thinking of being crushed by a subway train — he was quickly lifted up to the platform by fellow passengers.

Horri, 41, is a doctor from Tehran, Iran and he knew from the piercing pain in his elbow that he had smashed his arm up pretty badly. It would cost him $5,000 to get it fixed.

Frantic for help, his wife Fariba Darbindi, 34, a nurse, asked the ticket taker what to do. She just got a shrug. Only days in Canada, the couple barely knew the city and had no idea of 911, no change for the telephone to call for help and no clue where the hospitals or clinics might be.

They went home to their apartment before being directed by a friend to North York General Hospital. Required to pony up $360 at in the emergency room, they had to withdraw money from an the instant teller.

The couple had saved to come to Canada with their 5-year-old daughter, but face lengthy years of education and testing before they can qualify to work in their professions Canada. It will take years, with Darbindi scheduled to finish her upgrading in February.

The orthopaedic surgeon who saw Horri was aware they would have to pay out-of-pocket for the surgery. A long holiday weekend was coming up and they were told when they’d would have to pay double the costs for an operation. If Horri waited until the Tuesday after Labour Day, it would be less.

So Horri went home with his arm in a sling and took pain killers for five days for surgery.

Although they had a bank account, they had not yet been issued a credit card or cheques so the couple paid in cash, alerting the bank to their dilemma.

“They (the hospital) wanted us to pay in cash,” says Horri, who adds Canadian prices are about four times higher than hospital costs in Iran.

Horri has nothing but praise for the surgeon who fixed his arm — and reduced his bill upon learning the family were landed immigrants.

“I can move my arm,” says Horri, demonstrating by waving his right arm up and down. “Usually, with a break like this, there is stiffness.”

Babies often have ideas of their own

Seven-month-old Alip Aierxiding was supposed to be born at home in his parent’s modest apartment, but complications sent his mother to hospital at a cost of $3,000.

He is a healthy, chubby delight to his parents who immigrated from western China last November. The baby was born Jan. 22 and less than four weeks later the family had received their new OHIP cards.

But that was not in time for Maolan Aierxiding, 31, a college teacher who taught English and Chinese, and Miheguli, 31, an elementary school physical education teacher.

It took them three years to pass all the hurdles and requirements to get their visa to come to Canada, during which Maolan travelled to Sweden to study and the couple wed.

The baby was on the way by the time they got the go-ahead to come to Canada.

Leery of using up their savings, Miheguli opted for a home birth and used a midwife whose services are covered by the Ministry of Health and Long Term Care. But during the delivery, the midwife decided it was “prudent” to go to hospital and helped Miheguli get checked in at Toronto East General Hospital.

They paid the bill by cheque and it all but wiped them out financially.

“I think Canada is a place of big opportunity,” says Maolan, who recently got a job a Tim Hortons for $9.50 an hour. With rent of $875 a month, not much is left for food or anything else. Miheguli makes pasta from scratch, drying the noodles over the backs of kitchen chairs.

“She’s good at cooking,” Maolan saysThe couple continued to receive visits from the midwife for weeks after the delivery and praised the hospital staff for their excellent care.

Says Miheguli, “There are many kind people here.”

No time to waste

Sometimes you can do everything right and still get it wrong.

Chemical engineer Mohammad Shafique, 45, arrived from Pakistan on Nov. 8 last year , 2008 with his wife and children ages 13, 12 and 3. After working for almost 20 years in the petro-chemical industry, he wanted better opportunities for his children.

“Canada is multicultural,” explains Shafique, adding he had friends who’d already emigrated and were working.

When he tried to enrol his two eldest children in school in Mississauga, he was told they would not be allowed into classes without proof of immunization. The children had received all the required shots at home years ago, says Shafique, and he didn’t know he would have to provide proof.

“I didn’t want the children to have to wait. I said, ‘they have to go to school.’”

(He had brought the baby’s immunization card since she was still receiving inoculations.)

Unable to get his hands on documents thousands of miles away, he was forced to take the two boys to a health clinic, where it cost $60 each for every shot received.

“It was a shock for me, I didn’t know I’d have to pay for this. We had completed all the shots in Pakistan but we didn’t have the card. The boys were older, I didn’t think of this.”

While Shafique acknowledges it is not a large sum of money, the funds are very important to the family of five that is living entirely off his savings. After renting a house for $1,200 in Mississauga, the family recently moved to cheaper digs at $900 a month in the north end of Etobicoke.

Nearby is a community centre for newcomers which helps job-seekers by providing access to computers and assistance writing resumes. Shafique goes every day and is hopeful that the jobs that were so plentiful before the recession will return.

Meanwhile, his 40-year-old wife, Naureen Kaukab, who has always stayed home to look after their children, is looking for work “at Tim Hortons and No Frills.”

‘This bill is impossible’

The letters demanding bill payment are frightening Janet Toledo, 47.

There is no money to pay, and the stress of owing St. Michael’s Hospital $1,700 for an emergency visit that involved a life-saving blood transfusion is making her ill.

To make matters worse, had a mix-up not delayed delivery of documents, she would have been covered by OHIP.

Toledo has three children aged 18, 25 and 28. The eldest, Carolina, has a job in a logistics firm and supports the entire family. The two younger children are students and Toledo, an accountant with poor language skills, has a job cleaning houses once a week.

Her $400-a-month income is desperately needed to help pay the rent of $1,300 a month, says Toledo, who spoke through an interpreter.

“I’ve said to the hospital, ‘This bill is impossible but I can pay a small amount each month.’ But they want $100 and I can’t pay.”

Toledo had been feeling ill for weeks but tried to soldier on, she says. But staff at a community clinic insisted she go to hospital and gave her a letter asking for immediate help in spite of her inability to pay. She was seen quickly — her red blood cell count was dangerously low — and given a blood transfusion

On the day she landed in hospital this past April, she had just picked up documents certifying her landed immigrant status — only to discover a bureaucratic mix-up had sent them to the wrong address months ago. Her status as a permanent resident had been granted four months before, and she would have had her OHIP card if she’d received the papers on time.

She has written to the provincial Minister of Health for special consideration and says, “I don’t want to lose hope.”

The divorced Toledo stayed in Equador when her ex-husband brought the children to Canada. Separated for years, she was heartbroken at their leaving but pleased when Carolina was able to sponsor her.

“I thank God my children have strong hearts and are correct.”

As she waits for reprieve, the bill collection calls keep coming.

“I don’t think it’s fair. They are pressuring and calling my daughter.”

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