Q&A: Dr. Philip Berger

On Friday afternoon, I spoke over the phone with Dr. Philip Berger, one of the organizers behind Canadian Doctors for Refugee Care, about the recent demonstrations by doctors against the Harper government’s changes to refugee health care. The following is a condensed transcript of that conversation.

Q: How organized are these demonstrations?

A: Well, they’re only organized to the extent that when we find out about events, we pass on the information to our physician contacts in the particular locale where the event is happening and leave it up to them to decide if they’re able to show up on short notice and how to conduct themselves—with certain guidelines, like to be respectful of the event itself. Tthe purpose is not to disrupt the event or to show any antagonism to the Pan-Am Games or the Olympics or seniors or kids or anything like that, we make it very clear, then to make a judgment about whether they should interrupt the minister speaking or wait until afterwards, it depends on the situation. But to clearly get our message across that if the government refuses to speak to doctors, including organized national medical organizations, then we’re left with no choice but to use these venues, these public venues.

Q: The decision to pursue this, was this based on something? Was there an example of this having been done in the past? Where did the idea come from?

A: The idea is it’s a number of different strategies that our group is pursuing at a national level, to be quite frank. The first action similar to this was the sit-in at minister Joe Oliver’s constituency office on May 11. That idea originated amongst a few of us in Toronto. This is just a natural extension of that sort of action.

Q: Just so I understand, when you say, “we” and “us,” who are you? Who is behind all of this?

A: There are a dozens of doctors across the country, literally. A lot of the organizing emanates from Toronto physicians, but really it’s claimed by physicians locally who organize their own actions.

Q: And when you talk about sending out to your physician contacts, are these people who have signed up for the cause or…?

A: These are people who are part of our network of contacts of physicians who treat refugees across the country or are sympathetic, supporting what we do. This is, to me, a classic exemplar of what doctors should be doing to advocate on behalf of their patients, particularly the patients who are too terrified to speak and cannot do it themselves. There’s actually a critical opinion piece in the Journal of American Medical Associations on June 27, a commencement address. And the whole thesis of his commencement speech was the duty of doctors to speak out and he talked about speaking out on issues of poverty—it’s called “To Isaiah,” it’s being sent out all over the place. It’s exactly what we’re doing. Doctors have a duty to speak out and should not remain silent when they are aware of conditions, including behaviour of governments, that are making their patients sick. His last paragraph to these medical students was, “Your voice—every one—can be loud, and forceful, and confident, and your voice will be trusted.” And he says, “don your white coats … Society gives you rights and license it gives to no one else, in return for which you promise to put the interests of those for whom you care ahead of your own. That promise and that obligation give you voice in public discourse simply because of the oath you have sworn. Use that voice. If you do not speak, who will?” And this is in a leading medical journal. So we’re just doing our jobs … I’ve never seen anything like this, in over 40 years since I entered medical school and I’m unaware of this ever happening in Canada ever before. Where enough physicians are united across the country that they’ll take direct action and have committed to it and have the endorsement of their positions, their views, from all the leading medical associations  of the country.

Q: Do you and all the other doctors that are involved all, in the course of your profession, treat refugees?

A: The ones who’ve joined all have some connection to refugee treatment. But there are others—we have a number of emergency room physicians, who, it’s obviously not their full practice, but they do see refugees. I’ve just never seen such fury at an action of a government, even when governments have acted against the economic self-interest of doctors, doctors have not reacted like this. And this has nothing to do with self-interest. This is a good example of physicians putting the interests of their patients ahead of any, not only self-interest, but ahead of any risks they may be taking for confronting the state. Which is what we’re doing, actually, we’re directly confronting the state in the public domain, which is at these press conferences. And we have a right to be there and a right to express our opinion. It would be improper to ruin events that are important and we’ve been very careful not to do that. But any of these events, the Pan-Am Games, the Olympics, we don’t shut down the event and we wouldn’t.  They wouldn’t let us do it anyway, nor should they. We are focusing narrowly on the Conservative cabinet minister making an announcement in a public space.

Q: Were you at all encouraged by the change that the minister may or may have not have made, or the clarification or however it ended up being worded?

A: No, because there’s such hubris in this government that it could never admit a reversal of any kind. The minister went way out of his way to insist that it was just a clarification of a position that he had always intended, even though the government record belied that claim. So the hubris of this government is also unknown in Canadian political history, as far as I’m concerned, and there are still thousands of refugees in different categories who have been left without medical coverage. We’ll see the worst of this when the government announces the Designated Countries of Origin, the so-called “safe” or non-refugee-producing countries in the government’s view. Because they get no care. And the ones from those countries who applied before June 30 are unaffected by what will happen to the new ones. So once that list is announced, there will be hundreds of more patients in the situation of no coverage of any kind.

Q: What would be your response to the idea put forward by the government that Canadian taxpayers shouldn’t be paying for health care coverage that goes above and beyond what the average taxpayer gets?

A: It’s absolutely false. Nothing this government says can be believed. The IFH program was brought in originally to provide refugees in all categories with the same level of care that the poorest Canadians get, mostly in social assistance. So the 870,000 Ontario citizens on social assistance get no less than a refugee did under the old IFH system. Basic eye care, very basic dental care, coverage of medications and medical devices like wheelchairs. In Ontario and other provinces, there are various types of plans that guarantee people medicines when they can’t afford it. I don’t know a single Canadian who doesn’t receive the medication they need in my practice, I work in a downtown, poor, inner city-type practice. So it’s not true that the refugees are getting more than the average Canadian. They’re getting the exact same as anybody on social assistance, which is very basic coverage. Secondly, the refugees come here, many of them after years of neglected health and are sick. And part of, I think, our historic qualities as a country is to take care of people who come to our land. And also, refugees who eventually do get accepted or the ones who are sponsored by church groups who have been accepted yet are going to have pay for their own medications, etc.—they’re going to become citizens. And why would you fail to treat them now, just to get sick with, in some cases, permanent consequences that will burden the health care system and taxpayers even more for the rest of their lives? And the idea that refugees come here to seek health care is so absurd that I don’t even have a rationale answer for it. If you think refugees think about, oh, I can get my tooth pulled, so I’m going to run to Canada, that’s the last thing on their mind. They’re just getting out for their lives. And it’s not only, by the way, every major medical organization, you’ve got Elie Wiesel, Nobel Prize winner, who endorsed the statement by the Toronto Board of Rabbis. I don’t know what more this minister wants to hear.

Q: What about the idea, to quote him, talking about the provinces, “I don’t understand why they seem to be more concerned about providing supplementary health benefits like dental care and eye care to, for example, rejected asylum claimants.” This idea that it’s going to rejected asylum claimants. I take it you quibble with that or…?

A: There’s some serious questions about the performance of the immigration and refugee board, number one. Secondly, rejected asylum claimants still have a right to appeal under this country. And so to say they’re failed refugee claimants doesn’t mean that they’re not bonafide refugees. They may not be found to be bonafide refugees in the end. What are we going to do? Just let them not get their insulin, just refuse to treat them. I mean, it’s completely unthinkable.

Q: Are you a typically political individual?

A: Well, I’m the head of the largest academic family medicine department in Canada at St. Michael’s Hospital. I don’t know, what does typically political mean?

Q: Are you a member of a political—

A: I have never been a member of a political party in my life and I would never join one because I could not be shackled by the monolithic policies of any of the parties. But no, I have never been a member of a political party in my life. I value my freedom of expression too much. I mean, to me the test of any country and the power of the state is the freedom that people feel to express an opinion without fear of retribution.

Q: In a letter a week ago there was some reference to, if the government is concerned about efficiently and effectively delivering health care, that the medical associations are happy to talk about it. Is there a solution here that accomplishes—you know the government says they’re worried about spending, is there some sort of solution here?

A: I think there would be, but my opinion would be, if I was a government political advisor to get out because they’re in a mess and I don’t think they realize how deeply. They’re in the deep zone that they’ve never been in before. And it’s just beginning, that’s my opinion. I may be wrong. It’s just I’ve never, ever seen anything like this before. So I think the government has to accept that the denial of health coverage is not the remedy for dissuading refugees from coming to Canada. That remedy has to be found in the legal system. It might be a different fight. But it should not use health care and handcuff physicians and prevent doctors from providing an adequate standard of care as a means of solving what the government perceives as an immigration and a refugee problem. There are other ways of doing it. I say the government should put a moratorium on this, now, consult—they’re not going to want to talk to me, I’m sure they’ve been googling me and investigating (laughs) a few of us all over the place, I presume that— but put a moratorium on it, talk to the established medical organizations who fully understand this and come up with another mechanism that has nothing to do with providing health care. Once people come in Canada, we cannot abandon them.  And doctors cannot abandon them. I think the minister … failed to understand the physicians and all health care workers cannot distinguish patients based on their refugee category or their country of origin. And that is a position that Minister Kenney has put us in and I think that really has provoked this fury that has never been unleashed before. Ever really, by doctors in Canadian medical history, that I’ve seen.

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