I honestly wish that I could write this story in French, the language in which most of the action happened.
My French language skills, while certainly functional in a medical setting, were eroded by my eight years in Toronto. My written French, never particularly strong, is not up to the task of being grammatical at the same time as being cogent and witty. So, gentle francophone readers, I apologize.
Those of you who have been living under a rock, or in the ROC (rest of Canada) may not be familiar with the Office de la langue française (OLF), the Quebec governmental agency responsible for the policing of the French language laws in the province. They have investigators, who I assume are true believers, bureaucratic attack dogs, tasked with sniffing out any instances of illegal use of English. They then advise on changes or mete out fines. At worst, they can even close you down.
Even though healthcare Institutions are supposed to be exempt, the OLF decided that there was reason enough to investigate our CIUSSS (Integrated health and social services centres in English). When they decided to grace us with their presence, the general reaction to their visit was, how shall I say this, less than welcoming. This CIUSSS is a complex entity centered about a tertiary care teaching hospital. It includes five community health clinics (CLSCs), five family medicine residency teaching sites, rehab and geriatric hospitals. It is the most culturally and ethnically diverse area of the province, having 38% of its population who are recent arrivals in Canada and 13% who speak neither English nor French. Since funding for CLSCs is based on the number of patients covered by provincial Medicare, we are also financially challenged, having to do more with less.
When we heard that the OLF was about to descend, it caused a lot of stress in the CLSC clinic as our hardworking secretaries, instead of calling people for appointments and using our translators to inform our patients about their hospital visits in a language that they could understand, were running around the building checking posters and writing on the Sharps containers. One of my francophone colleagues had a nightmare that an inspector had posed as a patient and, prompted by what they said or their accent, she had assumed that they were an anglophone, addressed them in English and, as a result, got fired. “I woke up screaming, ‘I do speak French, I promise you!’” she said to me, and we laughed. Everyone was on edge.
I went to see my own doctor, who works at one of our other CLSCs. She told me that she was in the process of doing telephone visits when a team opened the door. They said to her, “We don’t want to disturb you.” “And yet…” she replied. They entered her small office, argued for a moment whether it was OK to leave a child’s drawing captioned with “I love you Dr. M.” on the wall. My doctor asked them if they thought that this activity was a productive way to use taxpayer dollars considering the state of the healthcare system. “You can leave now and let me get back to my real work,” she said. They retreated.
I was not there when the inspector came to our site. This was lucky since I don’t dissemble very well. Someone described her as walking around, tap, tap, tap, on her high heels and dressy suit, pearls around her neck, with her clipboard in one hand and a camera in the other. She stood out among our healthcare workers, in their scrubs and sensible footwear.
At one point, she walked into an office where the student had left the room for a few minutes to review the case with their staff. The patient took the opportunity to go to the bathroom and when she returned, she found that the inspector had walked in and was in the process of ripping posters from the wall. The patient stood in the doorway, looking at the inspector with disbelief and shock. When the staff and her student came back into the room, they found the patient staring at the tattered the remains of the colorful posters which had made the office so welcoming. In a small voice, the patient said, “I thought this was a safe place!”
So many of our patients have experienced violence of different kinds. I have had a patient hit the floor when a door slammed across the hall. So much of what we teach at our CLSC is how to approach patients with our eyes open, prepared to deal with the ongoing effects of trauma.
Preservation of the French language In Quebec is important, and many people feel this deeply. It is also the result of generational trauma. The government makes all kinds of pronouncements that seem to me to be fantasies, and twists statistics to make things look perhaps more dire than they are. Most of the children of immigrant parents speak French fluently and are able to function well with their existing language skills at school and work. Why does the government care what language they speak in the privacy of their homes, or in their bedrooms or their physicians’ offices?
In our clinic where we are struggling to care for people who are among the most vulnerable, medically, economically and socially, pretending that after six months in the province people should be able to negotiate the complexities of the healthcare system in French is not a fantasy we can afford to believe in. Our motley crew of health professionals are ready to do our best to help our patients eat, have a safe place to live, be medically managed, and stay out of the emergency rooms as much as possible. We don’t care that much what language we use to get that done.
By the way, we did very well on our inspection.