4.3 Case Studies

A mother holding her sick child in her lap.
Photo Credit: Red Cross (Benin)

Case 1 – Voiceless

You are treating a young woman who presents to the emergency room in a dishevelled, confused state. The woman is a newly arriving refugee who you suspect may be suffering from malaria. You notice, however, the ER staff is not treating her with respect, not acknowledging her complaints.

Question: How do you manage you inner health advocate – a feeling that contravenes your sense of social justice around a particular patient?

Read the video transcript

We need to pay attention to our inner health advocates when we feel a patient, such as this refugee woman in the emergency room, is unjustly served or discriminated against, based on language, social background, or even disease. Examples of interventions for health settings to improve access and quality of care include: advocating for interpretive services, engaging patients and underserved communities in developing education and self-care models, and supporting training for healthcare staff to delivery quality care. Despite many practitioners needing to connect with their inner advocates, there is a high risk of burnout when working in resource limited settings. Often there is a need for alternative levels of involvement, individualized paths, and flexibility. One should not underestimate in the most basis of advocate actions, such as writing to one’s elected member of government about an issue that one feels strongly about. One should never underestimate the power a few committed individuals.

Duration: 1 minute 19 seconds

Health Advocacy and Practitioners’ Responsibility

Health Advocacy demands an understanding that the practitioners’ responsibility goes beyond the care of an individual patient.3

It requires:

  • Adaptability: a flexibility, resourcefulness, resilience
  • Neutrality: a non- judgemental attitudes
  • Mobility: a willingness to reach out to those with greatest needs

A commitment to marginalized people is a founding value of the medical profession and should not be eclipsed by the modern technocratic medical model.

Case 2 – Social Isolation in the Elderlysocialisolation

You are a family physician treating Ms. G at your clinic. Ms. G is an older lady who migrated to Canada from Columbia 4 years ago with her husband. Ms. G’s husband unexpectedly died last year and she is currently living alone. She reports not having any contact with her extended family and that she has not made any friends since arriving in Canada. Ms. G is functionally illiterate in both English and French and has never obtained her driver’s license. Ms. G describes herself as feeling very lonely and depressed. You are worried about her psychological well-being.

Question 1: Describe the risk factors for social isolation in older immigrants and refugees.

Social isolation is a complex issue that affects many seniors in our community. As individuals age they can face significant life events, such as the loss of loved ones, and experience changes in their physical abilities. This can significantly limit their daily activities. Immigrant and refugee elders can also be challenged with language barriers, lack of established ties to their local community, differences in culture, and separation from their friends and family back home. These risk factors are intensified by the fact that opportunities for older individuals to integrate and meet new people can be limited by the fact that they are often no longer in school or in the workforce—two settings that often provide social opportunities.

In this case Ms. G’s social isolation is perpetuated by her limited access to transportation and her illiteracy in English/French. These factors will greatly impede her awareness of community events and resources, as well as affect her ability to establish social networks.

Question 2: How can you apply the 3 principles of advocacy to Ms. G’s case.

1) Adaptability

  • Older immigrants and refugees represent a heterogenous group.
  • Avoid assumptions and acknowledge that ethnic elders may differ from the majority population as well as from each other.
  • Be aware of the resources that exist within your community. Obtain a thorough understanding of what Ms. G identifies as her most significant limitations and adapt resources to advocate for her accordingly.
  • If gaps in resources exist, your role as an advocate can transfer into lobbying for the delivery and funding of services to vulnerable populations.

2) Neutrality

  • As a healthcare provider you will often be entrusted with personal and intimate details about your patients’ lives.
  • When learning about the challenges faced by an individual, it is important to create a non-judgemental and supportive environment.
  • Ms. G should feel confident to discuss her struggles and not feel that she is being judged for her circumstances.

3) Mobility 

  • As a health professional, it is important to advocate and reach out to the most vulnerable.
  • Ms. G vulnerability is increased, not only by her older age but also because of her refugee/immigrant status and language restrictions.
  • Services must be made accessible to individuals facing barriers to care, whether these barriers are linguistic or physical.
  • An equity lens should be applied to interventions and services available to Ms. G.

Tips for Global Health Electives

Photo of David Ponka holding a baby and standing next to its two parents.

Early Career

  • May involve student placements with little continuity between projects
  • High idealism
  • Limited focus
  • Variable impact

Photo of a young lady holding a baby boy.

Mid Career

  • Often high intensity (e.g. successive placements overseas, often with partner organizations)
  • High potential for burnout or cynicism

Photo of a child and an older man next to one another.

Established Career

  • Often very effective advocates by motivating and guiding others to get involved through writing, reflection and inspiration.
  • Integrated and ongoing involvement and mentorship.







Case Studies –(Revisited)

Duration: 1 minute 19 seconds

Note: For additional case studies and information, you can complete the optional Blackbelt section.