8 min

Fighting for queer healthcare in rural Ontario

'There's a kind of frontier mentality'

Since its formation last spring Rainbow Health Ontario (RHO), an organization based out of Toronto’s Sherbourne Health Centre with the mission of improving queer healthcare across Ontario, has recruited a team of part-time reps to do outreach to the various cities, towns and rural areas that make up this huge province. The 14 reps — one for each LHIN (Local Health Integration Network, community-run nonprofits created by the Ontario government in 2006 to deal with regional health issues) — cover a lot of ground and are tackling many challenges, including how to deal with a health system where rural ‘mos often have few options other than to trek to an urban centre for queer-sensitive services.

In our first two installments on RHO LHIN reps (Healthcare outside Hogtown and Oppression by Omission) Xtra caught up with folks representing the areas in and around Toronto and those encompassing urban centres outside of the GTA to find out about the state of queer healthcare in their areas. This time we turn our attention to the LHINs that are furthest from Toronto.

Andrew Baker, North Simcoe Muskoka

The North Simcoe Muskoka LHIN has a population of nearly 425,000 and encompasses the District of Muskoka, the bulk of Simcoe County and part of Grey County. It’s home to four First Nations and a significant tourist population, thanks to its popular cottage areas, which affects the demand for health services on a seasonal basis.

RHO rep Andrew Baker sees a connection between queer and Aboriginal health issues. “I am a gay man who’s always been active in the Aboriginal community. Aboriginal studies and LGBT communities have many similarities — similar issues with addictions, depression, isolation. Very different stories, but very similar issues.”

As in many LHINs, Baker sees a big difference between the urban and rural areas. “Barrie is a very big urban centre and Orillia is very quickly growing,” he says. “They are close to Toronto and a huge percentage of the population of Barrie commutes to Toronto. It’s very much a sleeping suburb.

“But when you go [further north] to Muskoka it’s very reliant on the tourism industry with the cottages. There is some connectivity, but there is definitely a southern and a northern division.”

He cites various issues that arise from the geographic scope of the LHIN, including isolation, linguistic issues — “French is present in the Georgian Bay area” — and lack of resources. Baker notes a lack of HIV-treatment options and no resources specific to queer health.

“Most people will seek LGBT-specific healthcare in Toronto,” he says, “and when it comes to counsellors and these things there is a presence that’s LGBT-competent, aware and sensitive in this area, but many people here, at least in the North Simcoe region, are more comfortable going to the city.”

Why go all the way to Toronto for services? “There’s a dynamic of actual homophobia and fear of homophobia. For many people they feel comfortable seeking services outside their home community, for confidentiality.”

Because of a lack of community institutions, info about queer-friendly healthcare providers hasn’t been readily available. “We have a strong LGBT community, or at least a high population, in North Simcoe and there’s quite a population in Muskoka as well, but the community hasn’t formed together the way you might see in a metropolitan area.”

Baker is optimistic that RHO will be able to address many issues in the region. “This isn’t just about HIV, or more importantly, it isn’t just about sexual health. Health in the LGBT community is not just in the bedroom. What are our needs, what are the impacts that affect our health, and what are those effects? Finally we have people looking at this, in terms of the uniqueness of this community. RHO is dynamic, but almost raw, in the sense that it’s building. But building’s good.”

David Belrose, North West

The North West LHIN covers the Thunder Bay and Rainy River Districts and most of the Kenora District and is home to some 242,000. According to David Belrose, North West’s RHO rep, “We’ve got the largest geographical area and the smallest population in Ontario.”

Belrose, who’s lived in the area all his life, says it’s common for queers born up north to relocate to larger centres. “[They] discover or become aware of themselves and move to the larger centres, like Thunder Bay, or even Winnipeg or Toronto. There’s a lot of out-migration.”

Those that remain may choose to stay in the closet. “People tend not to be very open about their orientation or gender identity,” says Belrose. “A large number of very small communities are Aboriginal First Nations communities, which provide even less anonymity, if you will. So it makes it even more difficult to be open with healthcare providers.”

Nevertheless he points to “a significant number of us here in Thunder Bay, although the community itself is not very organized at this time, much less so than it was some years ago.” He says that the only visible, active queer group in the entire LHIN is Pride Central at Thunder Bay’s Lakehead University.

Belrose notes that increased rates of mental health issues like depression and anxiety are common among queers. “It’s difficult to get treatment if you can’t talk to the provider about what the real issues are.”

Addiction is a particular issue in the LHIN. “Issues of alcohol and other substance use occur across the board in this part of the province, and rates are higher still in the LGBT community. To some extent there’s a kind of frontier mentality among people in small communities where there’s not a lot else to do, especially now that you have people losing jobs because the mills are closing down.”

Belrose has his work cut out for him. “I need to make contact with healthcare providers and with the LHIN itself and get them on board to raise awareness that there are LGBT people in the region… and to help them become more culturally competent.”

A founding member of the AIDS Committee of Thunder Bay, Belrose has learned to be persistent. “Over time we made inroads. A lot of the resistance was overcome for HIV and AIDS. So that may make it easier.”

Queer-specific services may be a hard sell in a region with such a small population. “I suspect there will be a sense that the community here is very tiny so what do you expect us to do to address issues for such a small number of people?

“My feeling is that we don’t want anything special, but we ask that you recognize there are such people here and that you address your own feelings around sexual orientation and gender identity.”

Terresa Polehoykie, North East

With approximately 560,000 people across about 400,000 square kilometres, the North East LHIN has only a slightly higher population density than its neighbour the North West LHIN. Francophones represent 25 percent of the LHIN’s population, with the highest number of French-speaking communities in the province. Aboriginal communities make up eight percent of the region.

Terresa Polehoykie took on the task of representing RHO in the region as a way into the queer community. “Despite the fact that I am in a same-sex marriage and I am a lesbian myself, I’d never delved into the LGBT community per se, never done any work or volunteer work, so I was interested in the learning opportunity,” she says. “It’s very much a personal journey for me, but I’m also an advocate.”

A high-school teacher, Polehoykie describes her LHIN as a collection of smaller communities. “There’s no big area. Sudbury is the big area, but they call it Greater Sudbury because there are so many little places all around it. People grow up in these smaller communities and then they leave because there aren’t the services and community they need.”

Polehoykie says difficulty accessing mental health services and a lack of doctors in the area as particular obstacles in the region. She also notes a rising interest in trans health.

“We do have some trans people in Sudbury and being in a northern community regular citizens I think have a problem with it or if not, it’s still very new, so people are unsure about it. I couldn’t even imagine a transgendered person walking through the streets of Timmins.”

Despite an evergrowing Pride celebration in Sudbury she points to the difficulties in sustaining community groups in the smaller communities. “The interest is not always there, the [web] links or the phone numbers don’t always work. It’s a lot of work to get people together and there’s not enough people to do the work for free.”

But Polehoykie is optimistic. She says that so far she’s received positive responses from services and programs when she has approached them about sensitivity training. “Those services don’t have the population like in Toronto, it’s not in the forefront. But when you bring it up to them they’re like, ‘That’s fabulous, this is great.’

“I think the north is ready. I think the interest is there. It is my hope that this position will help raise awareness and it is my hope that the LGBT community can start to feel like they’re part of the community as opposed to the black sheep of the community. If we can just do that then I think we will be raising the quality of life in regard to mental health and many other areas.”

Sarah Fraleigh, Erie St Clair

Sandwiched between Lake Erie and Lake Huron, the Erie St Clair LHIN covers the southwestern tip of Ontario. The region includes Chatham/Kent, Sarnia/Lambton and Windsor/Essex with a total of more than 649,000 people. It’s home to a higher proportion of seniors than average (around 15 percent), with attendant health concerns, and has a relatively high unemployment rate.

The former president of her area’s Pride committee and coordinator for a queer women’s group, Erie St Clair’s RHO rep Sarah Fraleigh worked for many years at the Chatham Daily News before being laid off and turning to queer healthcare promotion. “I’m a single parent, so I needed to diversify some of my talent to pay my bills,” she says, adding that her work with the newspaper left her with many contacts within the community. “Bringing that to RHO has helped me get in the door in some places.”

What does queer health look like in Erie St Clair? “In essence, it doesn’t,” Fraleigh deadpans. She cites a few health resources for youth and a couple of community groups in Windsor, “but there’s a block from 30 to 65, there’s nothing specifically for them and nothing for LGBT health overall. From what I’ve gathered so far there’s just generally a lack of info about LGBT health issues.”

Fraleigh feels that specific issues arise around the question of rural isolation. “There’s the mental component of that, let’s say a young person realizing they’re gay in the middle of nowhere. The social isolation, domestic violence issues in rural situations where they can’t get out of dependence — that happens everywhere but a rural situation exacerbates it.”

The biggest challenges, she says, “are going to be in finding people because it’s very rural so just building an accurate picture of what’s going on is a big first step. And of course getting into the larger organizations in the LHIN such as the hospitals.”

But despite the initial difficulties Fraleigh says she’s seeing results. “In the few connections I’ve made they’re interested in knowing this exists, and sometimes I see a light bulb going off — ‘Of course LGBT people have specific health issues’ — and then they want all the info they can get their hands on.”

Among others she says the Chatham-Kent Women’s Centre has agreed to partner with RHO to learn to make the centre queer-friendly.

Fraleigh next plans to target Sarnia Pride as a way to find out what’s going on in the area. She also wants to look into health concerns specific to the LHIN’s significant First Nations population.

“I’m really exicted and fortunate to be working with the people at RHO,” she says. “They’re so full of information, resources and experiences, even their own personal experiences, that I can learn so much from them to help me in this job.”