We often think about Chinatowns as places of historical significance – and rightfully so. However, having this image as the only relevance to society undermines the role in which these types of neighbourhoods continue to operate as spaces of activity for their residents and communities today.
Many Chinese-speaking seniors choose to live in Chinatown due to the fact that it is a central place for culturally appropriate services and goods, which allow seniors to have agency, independence, and the right to age in place.
Yarrow Society’s work functions as an extension and embodiment of Chinatown—a buffer zone to support seniors agency, independence and their ability to navigate spaces outside of their usual paths. Over the years, Yarrow Society has grown from small-scale health fairs where seniors are provided aid in filling out forms and applications to an entire continuum of care.
To meet the demands of these community members, programming and services now extend from weekly phone calls to:
Community Arts Projects,
Food Security Interventions,
Medical Accompaniment, and
During the rollout of the COVID-19 vaccination program, Yarrow Society worked
collaboratively with a number of other grassroots organizations and individuals
within the community to improve vaccine accessibility for Chinatown seniors.
Over a period of 10 months (from March to December 2021), organizers hosted
7 language-specific community vaccination clinics, facilitating over 1,700 doses
of vaccines (primary series and boosters) for seniors who may not have been able
to access them otherwise.
In BC, registration for COVID-19 vaccinations initially could only take place online. This left many people who are not technologically literate or had limited access to internet services behind. A few months later, phone-in capabilities were granted. However, a new set of barriers prevailed—anyone requiring assistance in a language other than English or French would initially need to know how to request an interpreter in English.
Seniors lined up in Chinatown for their COVID-19 Vaccination
where Community Interpreters will be present to help guide them through the process.
For example, to request for the appropriate help, non-English speakers callers would need to be able to listen to an English prompt and say the word “Cantonese” in response at the appropriate time. After community feedback and pressure, this was amended by adding pre-recorded messages in several of the most commonly used languages, which users could indicate choice by keying in the appropriate number (e.g. “For Cantonese, please press 3” / 廣東話 打三).
For subsequent doses of the vaccine, notifications were sent out by automated text message or email, but many seniors missed their openings because they did not have access to a smartphone or computer with these capabilities. At the time, no other alternatives could be provided. As a result, Yarrow staff (in partnership with other community groups) took it upon themselves to closely track vaccinations for clinic attendees and conducted follow-up phone calls for each of them with each subsequent dose.
After receiving a number of complaints, automated phone calls were provided as a band aid solution; however, these took the form of a single phone call, which –if missed– was not followed up on.
An 80 year-old senior living in Coquitlam attempted to sign up for his first dose online, but was told his registration was invalid. Lacking confidence in his English speaking skills, the senior felt too afraid to call supporting hotline to remedy his problem.
After a six month delay, he learned about the community-led vaccination program happening in Chinatown through a trusted community radio station, and booked the first spot he could. Despite needing to drive across Metro Vancouver for his second dose and booster, he felt more comfortable doing so because he was confident that his needs would be met and well taken care of.
For this senior, being taken care of meant having a direct contact and a familiar face that would be on-site on the day of his appointment, and with whom he had built up a relationship of trust.
This senior was ready to sacrifice his day-to-day mobility, because he was left to fall through the cracks.
At launch, local health authorities identified several locations for vaccination sites across the region; many were hosted at local community centres, while a handful were set up as temporary pop up tent locations. However, community advocates noted that the nearest vaccination site to Chinatown was located at Creekside Community Recreation Centre, which is a 20-minute walk for an average able-bodied person.
For an elderly person with mobility challenges, the functional distance is significantly larger. With several unknowns about the transmissibility of the virus at the time, many seniors were uncertain if it was safe to take public transportation. Even if they were able to navigate to the vaccination site on their own, there was also no means to guarantee that an interpreter would be on site on any given day.
In addition to this, most seniors in the neighbourhood are unfamiliar with Creekside as their needs are met by a number of community centres much closer to Chinatown, of which there are many: Strathcona Community Centre, Carnegie Community Centre. However, distance is not always necessarily literal or physical. As per urbanist Kevin Lynch (The Image of the City
), mental maps are key to our understanding of the spaces we occupy and move through. Each person who navigates a given space will have a different environmental image based on the paths, edges, districts, nodes, and landmarks that make up their day-to-day lives; clear environmental images provide us a sense of emotional security and prevent feelings of fear and anxiety associated with disorientation.
In early planning meetings for Chinatown pop-up vaccination clinics, community members brainstormed several potential sites, including suggestions that were physically farther than Creekside, but happened to be along the 22 Knight/Downtown bus route, as it is a route that many seniors were familiar with already.
Trust is a key component to access, and in many cases, these roles cannot be held by institutions. For a variety of reasons including personal and collective history and experience, whether in their homelands or as settlers, many racialized communities have complex relationships with the state. Some may be stateless refugees, have fled corrupt governments, or had their needs neglected upon landing. These and many other factors can contribute to a lack of trust or confidence in the services that institutions provide.
The long-standing relationships that Yarrow Society had already established with their networks helped them support a number of seniors through vaccine hesitancy. One senior was enrolled as a weekly phone call buddy, and was hesitant to get vaccinated at first: the vaccine itself was very new and there were a lot of unknowns. After several phone calls and patient education, they agreed to get the vaccine because they knew that their assigned volunteer would be there on the day of the clinic: a familiar face goes a long way in unfamiliar territory.
Maintaining the presence of organizations and individuals that equity-denied groups trust is important; in this case, the role of institutions is not to step in and take over, but rather to support and make it easy for community members to do the job of relationship-building. Support can be provided by taking on the burden of things that are within the control of the institution. For example, producing translated materials in a timely manner, so that community members don’t have to take on the labour of document translation, layout, and rush printing, and can focus instead on mobilization.
We shouldn’t actually be doing this work.
I think it’s important because we’re connected to the community, and I think that in an ideal world, community groups and organizations would still exist—but not in the way that nonprofits currently function.
I don’t think that is a very sustainable model for thinking through access to essential services for anybody in society.”
In the current regional healthcare system, there is a well-acknowledged system-wide concern about the limited number of family physicians and nurse practitioners (NP’s) who are able to provide services in non-English languages; this number is only decreasing. As physicians are retiring, many patients are left in a lurch, not knowing where to go for care and facing long waiting lists for those who are able to provide care in-language.
Local Facebook groups and message boards abound with posts from the adult children of non-English speaking seniors, crowd-sourcing knowledge from friends and community if they know of language-appropriate physicians or NP’s that are currently accepting patients.
Even if one is lucky enough to have a family physician that they are able to communicate with, patients are unable to personally request interpretation services for specialists and other health-related appointments; they must be requested by the referring physician or practitioner. In many cases, patients don’t even know that these interpretation programs exist, and that they should have their physician add it to a requisition.
Part of [language accessibility] being readily available is having healthcare workers and practitioners who speak the languages of the communities they are working in.
Language accessibility means that appropriate services and materials are readily available: to have to beg for translation and interpretation is dehumanizing. It should not be a privilege to be able to understand what is happening with your body.
Accessibility shouldn’t be an afterthought. You’re not doing us a favour by granting access, this is a right. [… You] can’t pretend that people who don’t speak English don’t exist…
Just because you don’t speak a language doesn’t mean you don’t deserve healthcare