For Vancouver health outreach worker Byron Cruz, the calls started coming steadily in 2012.
Stephen Harper's Conservative government had just made sweeping cuts to refugee health care, and Cruz was part of a vocal coalition protesting the cutbacks in British Columbia. At the time he says it was mostly pregnant women with pending asylum claims calling for help, certain they couldn't afford a $1,600 visit to a hospital delivery room.
Today, Cruz says he fields between 20 and 25 emergency calls a week from people who don't want to deal with regular authorities for fear of deportation. "My phone is the 911 of the undocumented community," he tells me over chai tea in an East Vancouver cafeteria. "It's like I'm having in my hands the lives of many people."
The calls can range from harassment complaints to requests for a reference at the food bank, but mostly he helps people see doctors and nurses. Since a lot of the people who call him work construction and cleaning jobs, he's often sent photos of workplace injuries.
"It's a scary thing because we don't know exactly what is the nature of the situation, or what risks are involved," says Cruz. "Every time someone calls me I try my best to assess what the person needs."
Once Cruz gets a call like this, he pretty quickly has to decide between two courses of action: either try to get them a formal appointment at a clinic that takes undocumented patients, which can take a while, or put out a more urgent request to a network of off-duty doctors and nurses. "If it's something not too urgent, I will try to make use of the services of the public health clinics," he says, "but I always have to clarify it might take a few days to get an answer."
The battleground for accessing healthcare with uncertain immigration status in the Lower Mainland has already shifted significantly over the last several months. Since August of last year two major health authorities in the region, Vancouver Coastal Health and Fraser Health, have in principle agreed to stop calling border services on patients—though in practice Cruz says those internal policy changes aren't consistently implemented.
In December 2015, a freedom-of-information request by the Georgia Straight found that the Fraser Health Authority, which covers many Metro Vancouver suburbs including Burnaby and New Westminster, had previously referred about 500 patients to border services between January 2014 and October 2015. In a Facebook post in mid-January, Fraser Health announced it would stop doing this, but Cruz says so far proof of the change has been lacking. Vancouver Coastal Health, which runs Vancouver's two main hospitals, is still working to fully implement its own internal policy for undocumented patients, but has told media it no longer makes referrals to immigration officials without consent from the patient.
For Cruz this is good news—both victories worth celebrating, he says—but it hasn't really slowed the stream of emergency calls. Undocumented families want certainty, and in the face of uncertainty, some are still too scared to see a doctor.
"Just this afternoon I was talking to a woman who needed to go to Vancouver General Hospital," Cruz tells me. "I called to see how the visit went, as she was seeing a specialist. She said, 'Byron, I didn't go because I was afraid. If I have to die of cancer, I'll die, but I don't want to go to the hospital and be deported.'"
Cruz has plenty of stories like these from his years as an informal dispatcher—of babies born in apartments just around the corner from the hospital, or of veterinarians offering to stitch up a guy's face. He recalls yet another undocumented construction worker who had pneumonia for a few days before he finally went to get real medical attention. "Unfortunately when he went to the clinic, he was too late," he tells me. "He died within two days."
Having arrived in Canada as a refugee from Guatemala more than 20 years ago, Cruz has an understanding of the kind of fear that pushes people to avoid the health system. He tells me it's a social determinant of health, and he's doing everything he can to try and change that. "Being undocumented is not a choice. Most of the times it's the last resort to save their lives or to be safe," he says. "How many hundreds don't go to the hospital because they're afraid?"
As I think about this question, Cruz's phone starts to buzz.
"Is this a 911 call?" I ask.
"No," he tells me, "this is a good call."
Later I ask Cruz what it feels like to be on the receiving end of someone's 911 call at any moment of the day.
"It's a mix of feelings," he replies, admitting they can come in any time, day or night. "I'm happy that at least they make contact with us and we can help them, but it's very frustrating because many times we don't find the right place for them. It might take weeks and weeks to get responses from the clinic. Then we have people who go to the clinic and they say 'We can only see people with [insurance].' ... We have to always be clarifying, advocating and opening those doors."
Cruz says he's constantly smoothing over relations with clinic managers, and starting over again when a new one takes over. And when he's not working on the health system, he's doing the same kind of door-knocking across Lower Mainland school boards. New Westminster was the latest to commit to developing a new policy to help undocumented kids attend school without risking their parents' status in Canada. He's been in conversation with Burnaby's schools, too, in hopes they'll agree to the same.
All that clarifying, advocating and door-opening recently resulted in the City of Vancouver unanimously passing a policy that guarantees access to city services without risk of being reported to immigration (unless a warrant or other court order requires it). That guarantee does not extend to Vancouver police or social housing, but does include things like fire and rescue and homeless outreach.
With that "access without fear" policy in hand, Cruz has set his sight on a new target: getting BC Medical Service Plan coverage for undocumented kids who are born here. It's a step that comes with a hope he'll receive fewer 911 calls.
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