“Paying It Forward” Dedicated to my Filipina Step-Mother, Aunts and Cousins- your examples to me as a child have lit my way on a road less traveled by.
Here I am, taking another step on my journey towards changing the world for Women. In September I start Capilano University’s Rehabilitation Assistant Diploma Program in my adopted hometown of North Vancouver, BC, Canada. There I will earn credentials to work as an assistant to: Physiotherapists, Occupational Therapists, Audiologists, and Speech Pathologists. It will be my privilege to work with their rehabilitating clients; facilitating the programs and care plans these professionals design.
As a student, at a university that has both Rehabilitation Assistant (RA) and Health Care Assistant (HCA) programs, from the 2019-2020 cohorts I intend to build a platform for a unique Interdisciplinary Network of Health Care professionals and the “Assistants” that work with them based on open discussion and mutual understanding. I will focus my efforts especially on recruiting the Southeast Asian Registered Nurses (RNs) and other immigrant women training to be and working as certified HCAs, eldercare providers, community support workers, and RAs while their RN credentials are not recognized here in Canada. Rather than pursue a Diploma in Interdisciplinary Studies, I intend to remain among Front Line Health Care Workers (HCWs) in order to: more closely share their experiences, to continue to learn from them as one of them just I have done in my current HCA role, and (most crucially) continue to uncover how to connect these “Assistant” levels professionals to each other in a way that is essentially led by them and in line with their perspective.
The Toptal scholarship will provide for my tuition and textbooks in full, leaving any further student aid/loans/bursaries/grants to help me secure accommodations when I am placed in more remote locations within my province for at least one of my practicums (or vice versa- the scholarship will pay for accommodations and supplies/costs of my Interdisciplinary project). The Toptal mentor assigned to me will be invaluable coach to help me strategize and organize as to how to best promote this Interdisciplinary Project and facilitate it.
Upon researching the professional landscape within my province (British Columbia- BC) , I recognize there is currently no BC chapter of the Canadian Support Worker Association (CANSWA https://www.canadianswassociation.com), and no independent HCW association within BC either. HCAs are required to register with the provincial governing body: BC Care Aide & Community Health Worker Registry (https://www.cachwr.bc.ca/Home.aspx), but this organization’s mandate is to protect the public. It does not provide protection or advocacy for the province’s HCWs registered with them. More than anything, I believe that the solutions to the challenges HCWs face (low wages, insecure work hours and position i.e. the “casual worker”, lack of benefits, lack of advocacy, difficulty in accessing employment benefits), and the value that they cprovide to other Health Professionals and the health system is not and will not be properly addressed by a top-down approach by academics or managers. These women’s input is vital, and it is time for them to voice HOW they want to draw the roadmap for greater inclusivity in our Health Care system, how THEY would like advocacy services to function, and how THEY want their contributions to be recognized in the Interdisciplinary team space: “Nothing about us without us.”
This is not to say that these women are helpless or don’t have intelligent strategies that work for them. While they may not currently belong to a professional association in BC, they instead have resilient community-based support networks through extended family, their place of worship, and extended social circles of colleagues. These women are very effective at sharing resources and supporting each other. However, as the current standards for private home support agencies do not generally include disability nor health benefits, let alone permanent positions and therefore employment stability, they are put at higher risk than necessary of going untreated and unprotected beyond standard Worker’s Compensation if they are injured at work, or contract a critical illness. It is more socially expensive to lose these service workers’ productivity than ensuring enough resources and protections are provided to them.
I, myself was raised by a network of Filipina women, my step-relatives, as they were sponsored by my Father to immigrate to Canada. Most (if not all) of them became employed as child-care staff (Nannies) or as HCAs after working as a live-in housekeeper in my childhood home. Thanks to them, I had a large extended family and experienced the wonderfully compassionate family-oriented Filipino culture. My UK-born father instilled in me the value of higher education, encouraging me to pursue a university degree and white-collar work after graduating. However, after arriving in the corporate offices of technology companies I discovered that despite enjoying many aspects of the work and the many skills it fostered in me, such as leadership and peer mentorship, I did not feel any deep sense of purpose in the business sector itself. So, when the Great Recession of 2008 hit and competition for office jobs became increasingly heated while corporate offices downsized, I decided to take the opportunity to change careers towards a greater sense of overall purpose and lead through service in the Health Care sector.
For the past 5 years I have worked as an HCA, providing care to elderly people in their homes as they navigate the changes that come with ageing and chronic illnesses, which are often complicated by dementia. Keeping senior citizens healthy enough to safely live in their communities and at home has been deeply rewarding. As soon as I started in this career, I recognized that although all my colleagues are HCWs, often seeing more of clients than the “Professionals”, our HCA role was not included in the Interdisciplinary Team concept. An interdisciplinary approach to health care is heavily emphasized in Health Care literature as a key to positive health and quality of life outcomes, especially for managing chronic health conditions in the community environment. More disturbing than being excluded from this crucial paradigm was noticing that most of my peers were Southeast Asian women who had earned RN certification in their countries of origin, not recognized here in Canada. The expectation of re-training to Canada’s standards after paying thousands of dollars to immigrate can be prohibitively expensive. Whether they attain Canadian RN certification or not, one can see that in the Western service economies, HCAs and RAs are value creators, and deserve to have meaningful participation in the economy- and the economy also needs them to be meaningful participants.
The part of me that inherently recognizes the profound value that these women create in Canada’s social safety net, and how it continues to go unrecognized despite being heavily relied upon, is informed by my experiences while pursuing a Bachelor of Science in Nursing degree. Although the RN role was not the best fit to my strengths, I had an invaluable experience in a ground-breaking Interdisciplinary effort called the Health Mentor Project (https://pcpe.health.ubc.ca/healthmentors 2011-2013). There I was grouped with students of other health disciplines such as Medicine, Physiotherapy, and Occupational Therapy to follow and learn about the experience of a person with a chronic health condition, and how they navigate their lives and Canada’s health care system. A large part of our time was devoted to we students learning about each other’s disciplines, scope of practice, and how we might cooperate to deliver care to our Health Mentor client in an integrated and collaborative interdisciplinary approach. Though I left the BSN program, I continued with the Health Mentor Project in a volunteer capacity serving on their steering committee for two subsequent years (2013-2015). That project continues to guide how I interact and network with my colleagues, encourages me to continuously examine assumptions about how professional skills manifest in practice, to look below surface appearances to recognize value, creativity, and efficacy between cultural contexts, and to recognize the influence and value of cultural emphasis and expression in the professional milieu.
While in nursing school I noted (whether purposefully or not) the rhetoric coming from visiting RN Union leaders and publications carried highly adversarial tones in their critiquing of hiring of HCAs in hospital wards, while simultaneously acknowledging the highly administrative role of today’s RN and the time it takes away from the client. The truth is that Western health care systems are going to continue to require “assistant” level HCWs and hire them to fill the gaps in bedside and community care as the percentage of senior citizens in the general population continues to increase, and as RNs themselves will be retiring large numbers within the next 10 years. It is evident that university RN programs cannot keep up with demand, and bedside RNs are stretched thin as their workload and patient-to-RN ratio continues to increase. In the public health environment these effects are even more pronounced. I have observed that HCAs of Southeast Asian descent are extremely skilled in caring for the elderly and those suffering with dementia because their joyful and compassionate approach is inculcated at an overarching cultural level, rather than through formal education. Western Health Care has a cultural bias towards post-secondary education and an expectation of formal and academic communication style, whereas the HCAs with less formal training communicate through anecdote and examples. These women provide a profound value to their clients and their families, and I hope to connect more of them to advocacy groups and professional associations – perhaps found a BC Chapter of CANSWA- and push from within Rehabilitation Service departments of Hospitals and other institutions to have RAs and HCAs included as an integral part of interdisciplinary health care teams. It’s time to challenge “Professional” attitudes towards HCAs/RAs and appeal to their role as social justice allies, as they are trained to be. Cooperation between Professionals and Assistants in both hospital and public settings is crucial to delivering quality care and ensuring the well-being of the ageing pubic.
I inhabit a uniquely privileged position. My upbringing by Filipinas helps me see the value that Southeast Asian women bring to their work and the health care system overall. I have an appreciation of their communication style through over a decade of constant and intimate exposure, recently refreshed upon working with them as peers following an education that focused on the role of social justice in health care, cultural safety awareness, and interdisciplinary collaboration. Working as an HCA I am very excited by opportunities to liaise between health professionals when they visit clients and my nurse managers. My colleagues trust me enough to ask questions that they are not comfortable bringing to our managers or HR personnel. I have enough formal education that management and health professionals seek out and listen to my feedback and observations- this is the privilege I am accorded by not quite fitting in with either role. In my future role as a Rehabilitation Assistant, that liaison function will be an explicit expectation.
Regardless of whether I receive the Toptal Scholarship for Women, this is how I will change my corner of the world.
Special Thanks to Mariana Mazzucato and her book “The Value of Everything: Making and Taking in the Global Economy” (2018), Alice Rivlin, former Vice-Chair and governor of the U.S. Federal Reserve (1996-1999) and author of “Caring for the Disabled Elderly: Who Will Pay?” (1988) as featured on the Freakonomics podcast “Is Income Inequality Inevitable? (Earth 2.0 Series) Ep. 284, Apr. 19, 2017 (http://freakonomics.com/podcast/earth-2-0-income-inequality, and Ai-jen Poo and Allison Julien of the National Domestic Workers Alliance (U.S) as featured on the feminist Unladylike Podcast Ep. 9, “How to Nanny Up.” (Mar. 20, 2018) https://unladylike.co/episodes/09/nanny-up
Adventuring with Amy Amykins 