In Vancouver: A Clinic Accountable to the Community It Serves
In this episode, Dr. Tara Kiran travels to Vancouver, British Columbia, to visit the Umbrella Multicultural Health Co-op Clinic — a clinic built by and for newcomer communities. Umbrella pairs physicians and nurse practitioners with cross-cultural health brokers who act as language and cultural interpreters, helping bridge gaps not just in communication, but in navigating the healthcare system itself. Tara tours the clinic with Naomi Armstrong, Director of Integrated Health Programs, and then sits down with Dr. Mei-Ling Weidmeyer, family physician and clinical lead. Together, they discuss Umbrella’s origins as a mobile clinic for migrant farm workers, its cooperative governance model, and how culturally safe, community-accountable primary care can have a meaningful impact on people’s lives.
Donate to UmbrellaUmbrella relies on donations from the public to continue offering services to newcomers–especially for those without insurance coverage. To donate to Umbrella Multicultural Health Co-op, head to their website umbrellacoop.ca
Research and programs mentioned in this episode
Learn about the OurCare Standard and how it was developed
Watch this 3-minute video about Umbrella
Read a research paper or short report on how Umbrella is integrating cross-cultural health brokers in primary care
Find out more about national efforts to bring cross-cultural health brokers to primary care
MAINPRO CREDITS: Family doctors can claim Mainpro Credits by completing a linking learning exercise.
More about Primary Focus:
Subscribe to our Substack newsletter
Have an idea for an episode? Email primary.focus@unityhealth.to
-
In Vancouver: A Clinic Accountable to the Community It Serves
Primary Focus Podcast
Arriving in New Westminster
Dr. Tara Kiran (00:04) Friday, March 21st — a rainy, gray spring day in Vancouver, BC. I'm here in New Westminster. I just got off the SkyTrain and I'm walking a couple of blocks to the Umbrella Multicultural Health Co-op Clinic, where I'm going to be meeting the team to hear more about how they serve newcomers here in Canada.
Umbrella is in an urban area of New Westminster, home to many small ethnic shops and service centres on a long, sloping street. I see a Vietnamese restaurant, a nail spa, a barbershop — passing a Banh Mi bar, a vintage clothing store, an Indigenous arts store — and here we are.
From the street, the Umbrella Multicultural Health Co-op Clinic looks pretty nondescript. It takes up about three storefronts, with shaded windows and a simple vinyl logo on the middle storefront window.
[Two months later — revisiting the audio from the visit:]
Dr. Tara Kiran (01:01) Classic Vancouver. I'm in clinical risk of not taking my umbrella. I think there's some wind chill by my glasses.
Inside the clinic, I'm met by Dr. Mei-Ling Wiedmeyer and Naomi Armstrong, who give me a tour of Umbrella.
Dr. Mei-Ling Wiedmeyer I am Mei-Ling Wiedmeyer. I'm a family physician, and I work here as both a family physician and also as the Clinical Lead. So I provide some direction and leadership around the clinical care and planning for our service.
Naomi Armstrong My name is Naomi Armstrong. My title here is Director of Integrated Health Programs. I try to support most of the programs we have here. I don't have a clinical background — it's more public health, health equity, and non-profit management.
Dr. Tara Kiran I first connected with Mei-Ling and Naomi because Umbrella was part of the Our Care roundtables. And it struck me that the way they approached care for newcomers exemplified three of the six Our Care standard elements. Their team provides culturally safe care that supports overall well-being by addressing social determinants of health, and ultimately is accountable to the communities it serves.
At Umbrella, they have registered patients who receive primary care, including mental health services, but they also have a health promotion program that serves anyone in the community, whether or not they receive primary care at the clinic. And they have services for migrant workers. This last group is a unique and underserved population, and serving them is really at the foundation of how this clinic came to be.
Today, we're in Vancouver to tour a clinic that started in a rental trailer — but now routinely serves patients in five different languages, with a team that's deeply integrated into the community.
Introduction
Dr. Tara Kiran (03:00) Welcome to Primary Focus. I'm Dr. Tara Kiran, and I'm on a journey to bring you stories from innovative clinics across Canada that are offering primary care that meets the Our Care standard — a set of principles that define what every person in Canada should expect from the primary care system.
If you listened to our episodes on Costa Rica, you'll know we focused on the role of the community health worker, who acts as a link between the primary care clinic and the broader community it serves. There are some examples of similar roles here in Canada. But at Umbrella, they've developed a role that's unique: the cross-cultural health broker. To understand how this came to be, we need to go back to the origin story and finish our tour. After that, I'll sit down with Mei-Ling for a conversation about her experience working at Umbrella.
Clinic Tour: How Umbrella Began
Dr. Tara Kiran (04:00) I'd love to hear more about how Umbrella started out.
Naomi Armstrong So we were sort of hosted in the beginning by another nonprofit organization, and originated as a co-op — really with the idea that healthcare decisions for newcomer and migrant communities should be guided by those communities themselves, not a top-down model.
Dr. Tara Kiran One important thing to note about Umbrella is that it was built under a healthcare cooperative model. That means 80% of board members must be from the community it serves, and those board members play a direct and structured role in its governance and decision-making.
Naomi Armstrong There was a group of initial board members, all of whom self-identified as having, or having had, language or cultural barriers to accessing healthcare. So they formed the initial board back in 2010 as a co-op. We started with really tiny programs — a mobile primary care clinic for migrant farm workers, with some grant funding, and some very small health promotion programs.
Dr. Tara Kiran Vancouver is one of Canada's most diverse cities. According to the 2021 census, Vancouverites identified with 244 different cultural origins, and half of residents reported they were born outside of Canada.
We know that across Canada, newcomers often struggle to access primary care — and there are clear reasons why. Finding a family doctor is hard enough for everyone. But can you imagine if you don't have documentation, or you don't even know what primary care is because family doctors didn't exist in your country of origin? Or you don't speak fluent English? Imagine how hard it is to navigate the system we have — even communicating with a doctor can be a challenge.
As an aside, I'm using the term "newcomer" as a catch-all for different groups: immigrants, refugees, migrant workers. Each has a distinct origin story, but they all face challenges here in Canada accessing primary care — and those challenges can actually extend years after they've arrived. When I say Umbrella serves newcomers, some of the people they serve have actually been in Canada for over a decade, but still have challenges that require the support of Umbrella.
The Migrant Farm Worker Program
Dr. Tara Kiran (06:25) While Umbrella now serves many different groups of newcomers to Canada, it all started with migrant farm workers. It's fair to say that most of us in Canada are not really aware of migrant farm workers and their role in our agricultural system. One reason is that most people never see or interact with them. These are workers from Mexico, the Caribbean, and Central America who come to Canada seasonally on closed work permits — meaning they can only work for the employer who sponsors them. They usually live on-site in very rural locations that lack public transportation, and many are Spanish-speaking.
While they're now eligible for provincial health insurance in BC after a three-month wait period, that doesn't always mean they're signed up for it. Back in 2010, they only had access to private health insurance, which wasn't always accepted in nearby clinics — if they could actually get to those clinics. And so Umbrella started up as a mobile pop-up clinic to serve these migrant farm workers.
When Umbrella started, they did have a small room in a local community health centre that was given to them for free. But to provide care to migrant workers, they had to go to them.
Naomi Armstrong Back then, we used to rent U-Haul trucks and set up the clinic in the back of the U-Haul truck every time, in different locations — going out to the areas where the farm workers are. Here in the Lower Mainland, there are also farm workers on Vancouver Island and in the Okanagan, that some other organizations are serving to some extent now. But there are very few other services for them, hence the mobile nature of the program.
In Langley, we've been going there now for over ten years — probably since 2012 or so. We partner with a church that has a Mass in Spanish. Volunteers bring migrant workers who want to come to the Mass; they provide transportation and a huge meal after. So we sort of piggyback on that — use their space, take advantage of the fact that people are already there.
Dr. Tara Kiran Now, Umbrella also serves the migrant worker community through virtual clinics, usually one or two evenings a week. Naomi said it used to be a lot of men who used their services, but more and more they're seeing migrant women and their children join.
It's amazing that you're filling this gap. Who is it that goes out? Is it doctors, nurses, other people? Do they speak Spanish or do you have translators?
Naomi Armstrong Almost all of our programs are provided through what we call a cross-cultural health broker model.
Dr. Tara Kiran (08:45) This is actually one of the reasons I'm here: the cross-cultural health broker model. Umbrella not only offers primary care to migrant workers — they provide care that pairs traditional primary care professionals with a staff member who's from the same community and speaks the same language as the patient.
Naomi Armstrong Cross-cultural health brokers are bilingual, bicultural staff members at Umbrella. Most of our health brokers have a background as medical professionals in their home country, but they're not licensed here. So for example, with the mobile clinic, we have cultural brokers — one is a doctor from Mexico and one was previously a lawyer from Mexico. So they're employed with the clinic. We work with one doctor who's on staff with us full-time, and others who are volunteers.
Dr. Tara Kiran But Umbrella didn't stop with their mobile clinic model. In 2016, they opened as a family practice to serve more people — starting in the basement of a music school. At the time they were operating mostly on grants, but by 2019 they were able to secure ongoing provincial funding as a community health centre.
This funding provided them with security and helped them expand clinic services and recruit a whole team of nurses, physicians, and counsellors who work on salary. They were actually only the second clinic funded under the community health centre model in BC. That funding accounts for about three-quarters of their expenses, with grants covering the rest.
Now, Umbrella serves patients either from their New Westminster location or through their mobile clinic.
Tour of the Clinic
Dr. Mei-Ling Wiedmeyer (10:35) We only have two clinic rooms. We're quite small — we're not like a St. Michael's-sized operation yet.
Dr. Tara Kiran And like with their mobile clinic for migrant farm workers, they brought their cross-cultural health broker model into the clinic — starting with Spanish-speaking brokers and then slowly adding communities over time as needs emerged.
Naomi Armstrong (11:04) So currently we're serving four main language groups, although there's a variety of cultures and countries of origin within those. Arabic-speaking folks, primarily from the Middle East. Tigrinya-speaking people from Eritrea and East Africa. Spanish-speaking from Latin America — which includes a subset, another community: migrant farm workers from Latin America. And people from Afghanistan, who might speak Farsi, Dari, or Pashto.
Several of those communities began being served by Umbrella because there was a crisis and a clear need amongst community members that we were connected with and felt responsible to, right?
Dr. Tara Kiran (11:55) Although Umbrella now works under BC's community health centre model, the co-op is still the backbone of the organization — meaning decision-making is guided by the community and their needs.
To serve the diverse newcomer community, Umbrella understood it needed to involve community members who could help bridge not just the language barrier, but also the cultural gap when it came to accessing primary care. Naomi says every patient is assigned a cross-cultural health broker — referred to internally as CCHBs — and these brokers work as a triad with the patient and the physician, both translating and supporting cultural understanding within the clinical care setting. They also help patients navigate the system — booking specialist appointments, getting blood work done, visiting the pharmacy to understand their medications.
It's a pretty unique role — one that I actually haven't seen in another clinic. I know Umbrella is trying to spread the model, and I do think it's one that deserves much more attention.
The Social Determinants of Health Team
Dr. Tara Kiran (13:01) Umbrella's clients don't just face cultural and language barriers — there are also challenges accessing resources and programs in the community. So in addition to cross-cultural health brokers, Umbrella actually has a separate team dedicated to addressing social issues. In a lot of clinics, this would be the role of social workers, but here the role is treated a little differently.
Dr. Mei-Ling Wiedmeyer This is just our social determinants of health team space — it's kind of a drop-in area. We have a couple of workers — we just call them SDH, social determinants of health workers — and they just address social issues. They're amazing. They just solve problems. Does the baby need formula from the food bank? Go. They just solve it. Most of our staff are also from the communities we serve, so there's just a different flavour to it — they tackle things, you know. There are just not a lot of limits. They're willing to engage with any problem.
Dr. Tara Kiran The cross-cultural health brokers can handle some social support, but issues related to social determinants of health — food, housing, settlement issues — are largely covered by this team. Interestingly, the health brokers actually rotate in and out of the social determinants of health team to pick up more expertise that they can bring back to their core role.
Between the family practice and the mobile clinics, Umbrella employs about a dozen cross-cultural health brokers. They also have a team of medical office assistants, who Naomi says tend to come from communities they serve — several speak Spanish, and one also speaks Tigrinya; one assistant is a floater who also works with the mobile clinic.
The mental health team is made up of two clinical counsellors — one speaks Spanish, the other Farsi — both with experience working in immigrant and refugee health. They're available for crisis counselling the same or next day, and also run group sessions and try to connect patients with community resources.
Umbrella also has three part-time nurses and three social determinants of health workers. And there are only three part-time family doctors — one of whom you'll hear from shortly — and one part-time nurse practitioner. Together, the family doctors and the nurse practitioner add up to a total of two full-time equivalents. That's a small team of doctors and nurse practitioners, far outnumbered by the rest of the team. But I'd say that ratio is proportionate to the needs of the communities they serve.
Lastly, they also have a few administrative roles, including an executive director, a finance manager, and Naomi's role as Director of Integrated Health Programs.
Accountability to Community
Dr. Tara Kiran I think one thing that struck me — and one of the reasons I came here — is that Umbrella is an organization that is very responsive and accountable to the community it serves. I'm wondering how that plays out on a day-to-day or year-to-year basis. How does the organization continue to be accountable to the community and responsive to its needs?
Naomi Armstrong A lot of it we've tried to build into our structure — the structure of being a co-op. The vast majority of our staff are also from the same communities that we serve, again, intentionally, through the structure and the models and programs that we use. Staff members are cultural brokers, community health workers are members of the same communities they're serving, and they're typically leaders in those communities — and they're present day-to-day, which can be really challenging for them sometimes.
For example, we have at least monthly meetings of the team where cross-cultural health brokers are asked to describe what trends they're seeing in their community, and then we'll try to brainstorm: is there something we can do? Sometimes it doesn't feel like there's something that's a perfect fit, but maybe there's something.
Dr. Tara Kiran (17:14) Right now, for example, there's a reduction in funding for settlement across the country, and some programming for families is closing in the Lower Mainland.
Naomi Armstrong We don't have a lot of programming for families, but we have some capacity in the counselling area. Can we offer some kind of mental health counselling paired with parenting support, to help fill some of the gap? So there's constant conversation with community members and internally, to try to understand what resources we have — even if they're not perfect — and how we can get creative to do something that helps.
Dr. Tara Kiran Naomi says one big piece of feedback they often hear is that community members want to know: how can they become a patient? But Umbrella is unfortunately working at capacity. At the time of my visit in March 2025, they had two vacancies — for an RN and an NP — which they eventually did fill in September.
Naomi Armstrong Our structure is very different. Our patients' needs tend to be quite complex, sometimes quite different from what people are used to seeing in other settings. So it really needs to be the right person who joins us. Cross-cultural health broker capacity is also sometimes a limitation for us — and again, would require more resourcing, more funding.
Despite these challenges, we're dedicated to pushing our model forward, growing our teams, and eventually possibly serving more communities. There are obviously many communities in need that we're not serving. We do constantly watch what's happening in the world, who's coming to Canada, what new populations are underserved.
But we are quite structured in who we provide services to, because we really believe in this cultural brokerage model — which means that in order to serve a certain community, we really want to have the staff capacity, the folks working with us who are from that community, to serve them in their first language and support the cultural brokering. So we limit, to date, the number of communities we serve more than many organizations would, because it's so important for us to have that in-house language and knowledge of those cultures.
Dr. Tara Kiran (19:34) It will likely continue to evolve —
Naomi Armstrong — but I don't imagine we would ever move away from the cultural brokerage model. It would always follow the process of recognizing that there's a new community that's underserved, scanning who else is serving them, trying to obtain resources so that we could have people working with us from those communities, and then beginning to serve them — rather than beginning to serve communities and then trying to learn the language, the culture, or how to serve them well after the fact.
Dr. Tara Kiran At the end of my tour, Naomi had to run to meet a grant application deadline. So Mei-Ling and I got the chance to sit down together and talk about our experience working in this very unique model. Because while Umbrella has a small footprint, it serves a big purpose — and it's a great example of how primary care can be accountable to the communities it serves.
Here's that conversation.
Conversation with Dr. Mei-Ling Wiedmeyer
Dr. Tara Kiran (20:50) Tell me a little bit about yourself — what you do and how you ended up here.
Dr. Mei-Ling Wiedmeyer I've always been interested in immigrant and refugee health. When I did my training in Toronto, I worked at a place called Access Alliance — that's where I did my longitudinal family medicine training. Then when I came out to Vancouver, I worked for a while at the Bridge Clinic, which was also a refugee clinic, but was closed down by the health authority in 2017. We had sometimes partnered with Umbrella, because Umbrella does longitudinal primary care, whereas the refugee clinic does transitional primary care.
At that time, Umbrella was looking to expand their family practice — they had direction from their board and their community, and people really, really wanted to have primary care. They were meeting with different family physicians and nurse practitioners to try to build a primary care program. So they brought me on at that time.
Dr. Tara Kiran I wanted to also ask about the governance and funding model for Umbrella. You mentioned that when it started out, doctors were paid fee-for-service. This is, at its core, a nonprofit co-op providing lots of different services. So how does it get its funding? How is it governed? And how does it make the physician piece work?
Dr. Mei-Ling Wiedmeyer It's evolved over time. Once we got our funding contract through the Ministry of Health, they gave us some core funding for a few of our positions. So right now, all of our clinicians are salaried — everyone is salaried.
Dr. Tara Kiran (22:54) When you say everyone is salaried — you mean the doctors, the nurse practitioners, the nurses, the social determinants of health workers, the cross-cultural health brokers?
Dr. Mei-Ling Wiedmeyer Yes, everyone is salaried. And the Ministry of Health funding pays for most of it — I think in terms of the total organization, they pay for maybe 85% of salaries and some of the overhead. The rest is through grant funding.
So we do have staff members here who are applying for grants as part of their job. And it's not exactly off the side of their desk — everyone plays multiple roles here, because that's the only way we can make it work. We have people with diverse skill sets and they apply them in different places in different ways. We have to be nimble. That's the only way we've managed to survive.
But I think it's been very useful for me to understand over time that keeping the core idea really intact, and then just being flexible around it, is a way to build sustainability. We try different things, and when they don't work, we try something else. That flexibility has served us well and has allowed us to be a little more creative — which is how we came up with things like the social determinants of health workers.
That is fundamentally how we roll. Efficient and practical — but without compromising on the quality of care.
Dr. Tara Kiran You mentioned keeping that core idea central. What do you think the core idea here is?
Dr. Mei-Ling Wiedmeyer Is it putting the community first? Is that it? This is the care that the community wants and deserves, and we don't compromise on that. We always keep that front of mind. And then we flex around that.
I think sometimes in larger, more bureaucratic health delivery structures, it's much easier to let these more grassroots, on-the-ground programs go when cuts are being made. But then you lose your relationship, and you lose your core values around what you're really doing. And I think people feel that. I think that's reflected in the care.
Dr. Tara Kiran Absolutely. I mean, the sixth Our Care standard is that primary care should be accountable to the communities it serves. That was one of the fundamental reasons I wanted to come visit today — I know this is a clinic that takes that principle really seriously.
And I know from our past conversations that some colleagues were maybe skeptical about whether that could work in a primary care centre — maybe feeling that if we gave power to the community, what that would mean for them as a physician or clinician. I wanted to get your thoughts on that professional reluctance to orient services toward community even further.
Dr. Mei-Ling Wiedmeyer That's a really interesting question. I understand where people are coming from when they're reluctant. When you're looking at something you've never done before, your mind goes to all these places — I don't want someone telling me what to do, or deciding how I practice. Can they fire me if they don't like me? And I think it gets a bit lost in our training, because our training is very hierarchical. In fact, most of allopathic medicine is pretty hierarchical. We're used to being in charge and making decisions for people — not having people do that to us.
So I think it creates a barrier in our imagination about what's possible. And I actually think it creates conditions for burnout, because you lose that sense of care — both for what you're doing and for yourself.
The other thing we haven't gotten to talk about is what it's like to work as a clinician in this kind of team.
Dr. Tara Kiran (27:32) Tell me, because —
Dr. Mei-Ling Wiedmeyer It feels like a collaboration. It feels like we're all working together toward a shared goal. We might have different ideas about how we can get there, and that often leads to really rich discussion — we learn a lot about each other in that process, and about different communities and their needs. But it always feels like we're working together toward something. And that is really rich.
It keeps people coming to work. It's great for retention. Because you believe in what you do. There's purpose. You see the effect. You see how people stabilize when you treat them as whole people, as part of a community that you are also a part of. It feels collaborative, rather than like I'm just a service provider. And that is a really different mental state — and a really rich one.
I really appreciate learning from my colleagues, from the community through the board or at the general meetings, and through the other ways they interface with us about what they see as their needs. Because I can't see the whole thing from where I am — I can only see one slice. So it just makes sense to hear from people about what they need, and then work together with them to try and meet those needs. I feel like — what else am I supposed to be doing? It just made sense to me in a way that is really both simple and profound.
Health Equity and Efficiency
Dr. Tara Kiran (29:40) You know, I think it has been a tough time to practice in primary care. At the same time, I think sometimes it does us a disservice to focus too much on that, because it takes us away from focusing on the things that actually provide us joy in work — which is service to the community. That's why so many of us went into medicine to begin with.
I wanted to pick up on something you've said a couple of times — how you guys are really efficient and try to do a lot with a little. I think it's important to put this in context for people listening and thinking about their own practices. You mentioned there's maybe two FTE — a family doctor and an NP — attaching maybe 1,100 people together. That may feel like not a lot of people compared to what another kind of practice might attach. Plus there's all this additional team. I know the team is serving more people than just the primary care piece. But tell me a bit more about the efficiency in this model. Is this something that can be scaled up?
Dr. Mei-Ling Wiedmeyer Maybe it doesn't need to be scaled up to everything and everybody, because it's also serving a very specific kind of need. But yeah — I guess it depends on whether or not we care about health equity. And I know there's a stated belief in that in most of our institutions.
I think the simplest way to explain it is: in the classical health equity picture — that slide I'm sure many people have seen, with people standing in front of a fence and needing different-sized boxes to see over it — we're the big box. We're trying to provide more services to people who need more support in order to achieve the same level of health as others. I think everybody deserves the opportunity to thrive, but not everybody starts at the same place. So for me, the real question should be the opposite: why do certain groups of people continuously have poorer health outcomes? We've been documenting this for decades. At some point it becomes questionable to me to continue documenting it, because it almost normalizes it — normalizes a practice of not doing anything.
I really do hear this a lot: "You see so few patients." And I guess that's true, but the patients I see genuinely improve. They're not just kind of half-scraping along through life, abandoned by almost every system. And one of the things we do — and the reason we appear to expend more resource on fewer people — is that we're filling gaps across the entire system. I'm saving the social system money, I'm saving other healthcare providers' money, I'm saving everyone else's budget by taking on some of that work. And that's kind of what primary care is supposed to do: take people who are complicated — or just regular people — and help them get what they need, and then appropriately use acute care when they actually need it. But that's not what's happening in reality right now. It happens more in this type of service.
And I think, yes, we are working with a highly marginalized population. But to be perfectly honest, I actually think everybody deserves some level of care like this — where they feel cared for and part of something. I really do.
Dr. Tara Kiran I think what you're doing here is partly providing people with more cultural capital to support themselves in being well. Some people in our society don't need that — they can navigate the lab, make their appointments, know how to get through. But the people you serve don't. And so I think it's important to see it in that broader light.
Cultural Safety and Language Access
Dr. Tara Kiran (34:19) The other thing I wanted to reflect on is Our Care standard five — the idea that people deserve culturally safe care delivered from a workforce that reflects the diversity of the community it serves. What I'm hearing from you today is just how much of the workforce here at Umbrella actually reflects the diversity of the community you serve, and how integral that is to the success of both your primary care services and your health promotion work. Could you reflect a bit more on that?
Dr. Mei-Ling Wiedmeyer Yeah. That has actually been a learning for me. I think there's something about cultural safety in theory that we hear a lot about. And there's something different about when you see it in practice. There is something different about being able to feel recognized in the space you're in. For so many people who come here for so many different reasons, it can be really profoundly alienating out there — people get a very clear message that so much of what exists isn't for them. So then to come into a place where it is for you — it's just a different feeling of belonging. And I think that's something people both crave and deserve.
Given our country's history of using culture as a tool of oppression, especially for Indigenous people, it speaks to the power of culture in sustaining people's communities, sustaining their lives, sustaining their existences as groups and communities. So I think it just shouldn't be underestimated. There's a lot of talk about it, but there's not a lot of doing — and I think that really needs to shift.
Dr. Tara Kiran And a very pragmatic piece that we heard again and again in the Our Care roundtables was around language accessibility. When we did the Our Care roundtable with you in 2023, it was simultaneously translated in five languages — English, Arabic, Spanish, Tigrinya, and Farsi. It was a complicated undertaking, but eventually successful. And it speaks to the importance of language if we want to build something that's truly inclusive.
Dr. Mei-Ling Wiedmeyer It's really basic. Everyone should just be able to communicate. It's very basic — and it's not actually being done. And these things need to be built into our health delivery. Because it's complicated. It requires a little bit of practice. It's not easy to throw together for the first time. But once you've done it, you know a little more and you can do it again, and you get a little better — and soon enough it's just how you do things.
When you design services just for one group of people and then try to tack on one extra thing — like "just get an interpreter" — it's friction-y and hard, because everyone is working in a system that nudges them to do one thing. And so everyone feels time-pressured and thinks it takes too much time. And we've seen so many mistakes happen just from that.
I'm lucky I'm in a centre where we use a language line. And to be honest, it's a very efficient way of doing it — it doesn't take much pre-planning. In a matter of minutes, or sometimes thirty seconds, you can have someone on the phone who can interpret.
Dr. Tara Kiran I wonder — are there any other reflections from the roundtable that stick with you?
Dr. Mei-Ling Wiedmeyer I think just the requests that people have are very straightforward. They just want care that is truly accessible to them and that considers them in their wholeness. And that is entirely attainable. I reflect on that a lot, because I think sometimes when these conversations happen without actual community members at the table, administrators and bureaucrats think people are asking for so much. And they never are. They're always asking for basic humanity.
So I always reflect on that when people hear what we do and say, "That is so much." I just think: is it? Is it really that much? Or is it just care — fully realized — which we just haven't seen very much of before?
Dr. Tara Kiran I mean, I think it's also care that's grounded in the needs of the community — you're listening to what people want and using that as your North Star. And I think that all too often we move away from that. That was our attempt with Our Care: to try to bring that North Star back.
Integrating Internationally Trained Health Professionals
Dr. Tara Kiran (41:15) When I go back to standard five about the diversity of the workforce, one thing we heard again and again from Our Care participants was how we need to do a better job integrating internationally trained health professionals. And I noticed that Naomi mentioned your cross-cultural health brokers — that many of them are actually foreign-trained physicians or health professionals from another country who can't qualify or practice here.
I wanted to ask — how do you find them and how do you train them? And with staff coming from five or more different cultural communities, how do you manage the cultural friction that must sometimes come up?
Dr. Mei-Ling Wiedmeyer That's a really good question. I think we train people over a long period of time. We have them initially rotate through some of the different programs — like the social determinants of health team — just to get a flavour for what those programs do. Then they do some observation. It's a slow onboarding.
We find people the way we do everything — through the community. These are people who are part of larger networks who know each other. When we're looking for people, we put out the word through all those channels.
We have a fairly intensive interview that asks a lot of different questions around how people understand social determinants and barriers to health access, how they problem-solve, and how they work through conflict. Because those are all very real for any team. Any team is going to have some level of friction, because that's natural for humans.
We've started to invest more over time in team building — we've gotten grants that allowed us to do workshops and training on communication, and on working through our values to understand what our truly shared values are. We return to that in our conversations. We're trying to get better at quality improvement — collecting some data and using it to inform decision-making, or trying to understand how data collection even applies in our setting.
Those are all pieces that help us construct our identity as a team and decide how we want to work together in a way that's consistent with our core shared values. And yes, sometimes people disagree, and sometimes we've had to learn that different cultures express themselves in different ways — different tones, different affect. We've had to do some learning about each other's cultures, which in the end has been really rich. People enjoy that a lot. Anytime we have a fun conversation — even something like "Mother's Day is celebrated on different days in all these different places, and what does that mean and how does that look" — little things like that help us build bridges with each other.
So I'd say it takes maybe six months for a new cross-cultural health broker to really settle into the team. It's a process and a commitment.
Patient Stories
Dr. Tara Kiran Just as we close out — would you want to share a story of a patient, family, or community member that has been served here?
Dr. Mei-Ling Wiedmeyer (44:27) I think there are two different ones.
One is a patient who had to overcome a very difficult trauma. Just by being able to come and slowly be allowed to just be heard over time — we are always really clear with people, and I think this is so foundational to primary care: we will not abandon you. We are here with you, walking alongside you, for as long as you wish. We won't leave you. We can take the time to work through this together.
And that steady, compassionate accompaniment, I think, is just enormous for people. We slowly pulled on all of our different expertises — I used my medical knowledge to support, medication for example; we used the social determinants of health team to really support income, and some immigration and family reunification. Family separation is one of the biggest issues in our practice — it's a huge determinant of mental health. And we've also learned that if we apply ourselves with a lot of rigour and dedication, we can often push to have families reunified. And that is magnificent. There's nothing like that: to see someone suffering from separation and then have their family brought back to be whole again.
And the social determinants of health team found housing. When kids were experiencing racism at school, we were able to address that with the school and school board. Just understanding people as they exist in their community and as people. This person is now an advocate herself — someone people go to for help, who is seen as established and who knows how to navigate the system. And she often tells us that the relationship with Umbrella was really foundational in allowing her to step into that empowerment. And that, for me, is primary care — in a real way.
The second is more recent. We often get referrals from the children's hospital or acute care settings when they see someone who has immigration-related complexity and they're just not sure what to do. We had one recently where a parent with a sick child was experiencing a lot of difficulty communicating with the acute care team, even though they were using an interpreter. Things just weren't getting across, and she was feeling really distraught — and feeling quite judged as a parent.
She was able to bring that up with us, with the cross-cultural health broker present, in a way where she just felt free to say it. She was very distraught, but felt free to explain. And then we were able to go back to the acute care team and say: "Did you know this was happening?" We actually had our team members attend some of the appointments subsequently. And then — it was really funny — after that, the acute care team, because this is a child who has ongoing needs at that level, they said: "Can you actually have your team member attend all the appointments? Please come all the time." Now they're emailing us all the time. It's the kind of collaboration we want.
We approached it not to say "hey, your care has been bad," but just: there's been a mismatch and some miscommunication, we're here to help. They were totally stunned — they had never experienced a primary care team reaching out like that or structured the way we are. So we had to explain who we are. And then we've developed this collaborative relationship. The patient feels so supported. And now they can move forward with part of their care that had been held back because the team wasn't sure the family could handle it.
These are things that are really impactful. This is that "big box" work — largely unseen in so much of the data, and in the resourcing decisions. But that's what it is.
Dr. Tara Kiran Those are great stories. It's good work.
Dr. Mei-Ling Wiedmeyer I really like coming to work.
Dr. Tara Kiran Anything else you want to say as we close out, Mei-Ling?
Dr. Mei-Ling Wiedmeyer (50:32) I'll just comment on that one piece — that I really enjoy coming to work. I feel really lucky, in the healthcare landscape right now, to have that. And it's not an accident — it's a series of deliberate choices that our team has made.
The team cares about each other in the same way that it cares about the patients. That has been an important learning for me. That same lens is applied. People on our team are humans too — they've had their own health challenges, family health issues, all the things. And when they've needed to take time off, they just get the time off. We flex around it. We adjust to support that.
And that means people feel able to also take care of themselves. And I think that is really huge, and it's really going to contribute to our sustainability over time as well.
Dr. Tara Kiran That's lovely. Thanks for having me here.
Dr. Mei-Ling Wiedmeyer Yeah, thanks for coming. That was really fun.
Closing Reflections
Dr. Tara Kiran (51:25) To me, Umbrella exemplifies how primary care can be accountable to the communities it serves — in this case, a historically underserved community. When I think about it, the best models I've seen of primary care serving the community have actually been developed directly by community members themselves. In the case of Umbrella, those primary care services arose from the cooperative advocating for those services to exist. And then, through hard work and persistence, the team was able to build a model that eventually was funded by the province.
The role of the cross-cultural health broker is unique, and I'd love to see aspects of it integrated into primary care clinics serving newcomer communities across Canada. I recognize there are limited dollars in primary care — but I do think more of that money needs to go to supporting people who have historically struggled the most.
As we talked about in our Costa Rica episode, one of the challenges is that our primary care funding and public health funding are siloed. So when we see gains because of prevention, the same ministry isn't necessarily reaping the rewards.
But most of all, when I reflect on this visit, I would love to see other clinics embrace the kind of community governance and accountability exemplified by Umbrella. I think it's the best way of ensuring that the services we design are truly meeting the needs of patients and communities.
Credits and Closing
Dr. Tara Kiran (52:57) A huge thank you to Naomi and Mei-Ling for welcoming me to the Umbrella Multicultural Health Co-op. For more information on Umbrella and to see photos from my trip to the clinic, head to the link in the show notes or primaryfocus.substack.com.
While Umbrella receives some funding from the BC government, it still relies on grants and donations. If you're interested in donating to Umbrella, head to the show notes for more details.
Primary Focus was created by Dr. Tara Kiran and is made possible by funding from the MAP Centre for Urban Health Solutions, the St. Michael's Foundation, and the Max Bell Foundation. Maryam Danesh is our research assistant. Seema Marwaha and Emily Holton are our creative advisors. Our producer is Avery Moore Kloss.
If you'd like to read more content from Dr. Kiran about Canada's primary care system, join the Substack newsletter at primaryfocus.substack.com, or visit primaryfocus.ca. For more information on the Our Care standard and the public's vision for a better primary care system, visit ourcare.ca.
Family doctors in Canada listening to this episode can claim Mainpro+ credits by completing a Linking Learning exercise. See the show notes for more information.
And finally, if you're enjoying this podcast, please share it in your networks. It's only through enlarging the conversation about primary care in this country that we'll ever really affect system change. If you have ideas for topics or places to visit and feature, please reach out at primaryfocus@unityhealth.to.
The information shared in this podcast is for educational and informational purposes only. It is not intended as medical advice and should not be used as a substitute for professional medical care, diagnosis, or treatment. Always consult with a qualified healthcare professional before making any medical decisions or changes to your health routine. Views expressed in this podcast are those of the speakers and do not necessarily reflect the views of any organizations the speakers may be affiliated with.
Side effects of listening to this podcast may include: a strong impulse to help fix the primary care crisis in Canada; a feeling of anger over how many Canadians do not have access to primary care; increased feelings of empathy toward primary care professionals who are just trying to make it work; and intermittent visions of hope that we can find a better way.