This project began two years ago in the basement of a community organization. The room was lit with the yellow glare of bright fluorescent lights, which reflected starkly off pale green walls. I sat in the midst of a ring of women who looked uncertainly back at me. When I met their eyes, I could read the distrust that lay within. These women were guarded — and with good reason. They were undocumented immigrants. They lived lives below the public radar and none had ever been approached to participate in a research study. I sat with them explaining the reasons why I wanted to understand their experiences in the Canadian health care system.
The Canadian Border Services Agency considers undocumented immigrants to be in the country illegally. All the participants in this study were being actively sought by the agency for deportation. For obvious reasons there is scant literature about undocumented immigrants in Canada and there is even less information about their experience accessing health care — information that is crucial to improving their health.
The women were disbelieving and cautious: Why did anyone in Canada care about their experiences accessing health care? Their encounters with people in positions of authority — doctors, the police, health professionals and immigration officials — were, to say the least, not good. It took months to establish relationships with these women, but many ultimately agreed to participate in the group meetings and one-on-one interviews that formed the basis of the research study.
The broader study involved three groups of immigrants: six refugee claimants, six permanent residents and nine undocumented immigrants. Not surprisingly, the undocumented immigrants reported substantially greater problems accessing health care. The official system was the option of last resort; often these women sought black market health care. They had notable, unresolved mental health issues and many were victims of domestic abuse. They talked of the trauma of being chased by Canadian immigration officials, how they feared being reported by the police or health care professionals should they seek treatment in emergency departments, and their struggles with dental health and food security. Stories were shared of the events that provoked them to seek shelter in Canada. Horrific stories of rape, of torture and of violence in their home countries were challenging for both me to hear and for the women to tell; they were touching on raw, unresolved traumatic issues that resurrected suppressed images and emotions.
Toward the end of the data collection, the participants and I were sitting in a circle discussing next steps for the research, when one of them addressed me through the interpreter:
It is great that you like words, Ruth. I know doctors and researchers like words. You aren’t capturing everything though … We [the participants] have been talking. We want to do an art project to capture this. Then maybe your colleagues at the hospital, doctors, policemen and the public will understand us.
Based on this discussion, I established a photography team led by photographer Kevin Kong and supported by my two research assistants who had a trusting relationship with the women. The women worked with Kevin to transform hundreds of pages of research transcripts into images. Kevin took photographs in their homes and at places that held meaning for the women. Some photographs depict the food banks that denied them access because they lacked the required identification. Others capture an emotion, an experience, an object of significance or unidentifiable parts of their faces. The women then selected a series of twenty images that conveyed the essence of the emotions and experiences they had endured.
We are now looking for funding and support to help us stage this photography exhibition.
This exhibition will be their way of speaking to the public and to the doctors, health professionals, police and immigration officials who have shaped their experience of health and illness in Canada. Their inspiration and drive has led the project through a metamorphosis. Two years on from that starkly lit, green basement, research has been turned into art and art will, hopefully, turn into understanding.
Acknowledgements
The author thanks the incredible women who sparked this initiative, the dedicated research and photography assistants, Andrea Ortiz and Jennifer Szabo, the transformative editor, A.G. Klei and talented photographer, Kevin Kong.