It’s August 7, 2016, the day after Jamaican Independence Day. I’m in Niagara-on-the-Lake, Ont., sitting on the back of a “jitney”—a truck with the top of the cab chopped off, used to haul crates of freshly picked peaches from the fields to the packing barns. A few men are sipping Labatt’s Blue, while others drink “Christian beer”—Coca Cola. One man, who I now call Chef, stands over a charcoal barbecue. The first jerk chicken goes on at about 5:30 p.m.; Chef is taking the last of it off at 9:30. The man sitting beside me shakes his head. If only they could have had the meat on the barbecue for the whole day, he laments, it would’ve been so tender we could’ve eaten the bones as well.

The men I’m sitting with are migrant workers. I would like to tell you more about them. I’d like to tell you how many kids they have and how old they are so that you might see that you have something in common. I’d like to give you their names and to describe, as they have described to me, their homes and lives in Jamaica. But I can’t. Their presence in Canada is wholly precarious, and as one worker put it, even talking with me as a researcher would be enough for him not to be renewed next year. He doesn’t love his job. He doesn’t even like it. But he needs to do it for his family.

These workers come from Jamaica for up to eight months out of the year. Some have come for years; others count their time in Canada in decades. Each year, they plant, prune, thin, pick, and pack fruit and vegetables. The fields of Niagara-on-the-Lake are filled with grape vines, to support Ontario’s burgeoning wine industry, and tender fruits including cherries, peaches, and plums. These are labour-intensive crops and Canadians aren’t interested in doing the work.

Niagara-on-the-Lake is on the short-list of favourite getaways for most of the people I know in southwestern Ontario. Summer in Niagara-on-the-Lake, “often called the loveliest town in Ontario” according to its website, boasts restaurant patios, winery tours, and the Shaw Festival. Queen Street is lined with independent shops selling clothing, jewellery, and home decor. There is a lot of gelato for sale. It is a town in which those of us who can afford leisure time and travel can “get away from it all.”

But last summer, I spent much of my time exploring a different dimension of in Niagara-on-the-Lake. Instead of seeing the attractions, I met the migrant workers who do the labour that provides the area with its local produce, including grapes for wineries, that tourists like me appreciate. The area is home to 15,400 residents as of the last available Canadian census, from 2011. Each year, about 3,000 migrant workers come to the area as temporary residents. These workers come primarily from Mexico and the Caribbean through the international Seasonal Agricultural Worker Program (SAWP) that Canada has with participating countries. Despite totalling one-fifth of the local population, migrant workers remain largely invisible. This invisibility makes it possible for us—people like me, people reading this article—to celebrate local food and wine, while overlooking the exploitative conditions through which they are produced.

***

When I first started my research, I travelled to Tillsonburg, Ont., about an hour southeast of London, learning from friends and colleagues there were many migrant workers in the area. My first stop was the library. What I was hoping for was a list of organizations that provide services to migrant workers. The response I received was “the Metro parking lot on Friday night.” I was puzzled. “Because organizations set up services for the migrant workers in the grocery store parking lot on Friday nights?” “No, because that’s where the buses drop the workers off for their weekly errands.”

On a Friday evening in May, I travelled with my research assistant to the Food Basics in Simcoe, Ont. Both of us were taken aback by the scene. More than 20 full-size school buses plus a handful of smaller buses, to say nothing of the myriad trucks and vans, were parking in the lot in front of the strip mall. Workers stood under trees for shade. Others leaned against walls or sat in the backs of the vans they came in. Food Basics was packed with dozens of people—the vast majority migrant workers—in each checkout line, purchasing groceries both for themselves and to send back to their families. Giant Tiger, a discount store, was also a hot spot: It houses Western Union, which the workers use to send remittances back to their families.

When we returned to Simcoe, we made a point of speaking with some of the workers. The first man we spoke to simply said “hello” to us and, unlike the many of the other greetings we had not responded to, I turned to say hello back to him. We stood on the street corner at Argyle and Kent and talked for about three minutes. I told him I was interested in learning about migrant workers’ connections with Canadians. Did he get to talk with many Canadians? “This,” he replied, “is the longest conversation I’ve had.”

“All the costs of this food production must be borne by farmers, who are also managing rising energy prices and capital costs, alongside rising wages. While farmers externalize their costs onto their workers, they do so because we as consumers force such decisions through our consumption practices.”

The workers I’ve spoken to regularly work 10-hour days, a minimum of six days per week. An 80-hour work week was not unheard of. One worker told me that in 2015, in the eight months he worked, he had three or four days off—he couldn’t remember exactly.

This is perfectly legal. According to the terms of SAWP, workers are expected to work six days per week and have the seventh off. However, “[i]f your employer asks you to work more than six days a week, you can choose whether to agree to this,” the terms read. Many will take on the extra workload, in part because getting selected for the SAWP is highly competitive. Even though the conditions in Canada are not great—indeed, they are so demanding and poorly remunerated that Canadians won’t do the work—migrant workers can make a relatively large amount of money for their families, money they couldn’t hope to make in their home countries. There are many people willing to take their place on the program either next year or tomorrow. Workers can be—and are—sent home with minimal notice because of injury or “disobedience.” I am extremely aware that speaking with a researcher might constitute such “disobedience.” Within this context, labour becomes disposable either because employers think that it is, or because workers think that their employers think that it is. Ultimately, the “choices” made by many of the workers I’ve met are the choices that their employers think are the best choices, not the choices that reflect individual workers’ desires or well-being.

But the choices of the employers are not without context, either. Canadians are very specific about their peaches (as are our trade agreements). We want peaches that are the same size as those grown in California’s much longer growing season. We want our peaches in clamshells, so they aren’t bruised or mauled by other peach lovers. And we want peaches to be cheap. All the costs of this food production must be borne by farmers, who are also managing rising energy prices and capital costs, alongside rising wages. While farmers externalize their costs onto their workers, they do so because we as consumers force such decisions through our consumption practices.

***

I do not like the heat. I’m from Alberta and I wilt in the heat, especially when it’s humid. While this year was not particularly hot, the summer of 2016 was a hot one. Toronto issued 22 heat and extended heat alerts—forecast high temperatures exceeding 31 C, above 40 C with the humidex.

On those days when it was too hot for me to be outside, migrant farm workers were still out picking. One of my friends was picking peaches while I sat typing at my dining room table in my air-conditioned house. I messaged him to say that he should be sure to drink a lot of water and stay cool. He reported, with much grace, that the day was not so bad for heat; the day prior was much worse.

It was on sweltering days like that this last summer that he and his co-workers not only stood in the sun working for 10 hours—starting at 7 a.m., finishing at 6 p.m., with a one-hour lunch break—but also on top of a thinning machine, a slow moving platform that moves workers along so they can thin peaches without stopping. As his co-worker put it, “You only stop thinning when it runs outta’ gas.” Not only does the machine impose pace on the workers, it imposes more heat. The humidex of 41 C on that day was exacerbated by the heat coming off the engine that propelled the thinner, located right beneath the platform on which they stood.

After their long days, workers return home to accommodation provided by their employer. This accommodation must be approved annually to qualify for foreign workers. Migrant workers’ accommodations are not required to be air conditioned (though some do have it). The guidelines—not requirements—set out in the Government of Canada Schedule F – Housing Inspection Report stipulate that the living space must be able to maintain a temperature of 20 C, but there is no legal maximum. A few years ago, one worker recorded a temperature of 54 C in his room. He stopped documenting the temperature, though, because he was afraid his employer would find the thermometer and get angry. (Since then, the employer has fixed the windows so that they now open.)

One Friday night, I drove a worker home after he bought his groceries in Simcoe. There was bus transportation to the farm, but he would’ve had to wait an extra hour for the bus to leave. The bus would take yet another hour to make the 15-minute drive because of a stop in a nearby town. After a long day in the field, he wanted to get home before 10:30 p.m. He also wanted some time to himself. While in Canada, migrant workers share housing with their co-workers. This worker shared a house with 13 others, with seven men sharing one room. The regulations of the program set out no maximums on the number of workers in a room; the only requirement is that each worker be provided with a twin size mattress, at least eight inches off of the floor, with 18 inches between beds “to provide for comfortable movement.”

While those who work on smaller farms, such as those in the Niagara-on-the-Lake area, can use bicycles to travel between farms and into the nearby towns, the distances between farms and towns in Simcoe and similar areas make bicycles less useful as a means to carve out some independence. Notably, even for those workers who do have bicycles, there is not really anywhere to go. (Workers who cycle are also at risk: Andres Dominguez Moran died on July 31 while being hit from behind by a car while riding his bicycle to Walmart. His co-worker Jesus Sanchez Feliciano was hospitalized with serious injuries.) Parks are few and community centres and libraries are closed in the evenings. Other spaces, like coffee shops or cafés, require workers to spend money. And while in Simcoe, workers claim the grounds of the county building on Friday evenings, in Niagara, the sign outside of the town building states that “ANY PERSON found on this property not having business with the Town of Niagara-on-the-Lake is subject to be charged with trespassing.” So back to the farm it is—where men work together all day, prepare and eat meals in relatively small living spaces, and share bathrooms (hopefully one per 10 workers as set out in Schedule F) and bedrooms.

***

A Canadian friend of mine picked tobacco through high school in the 1990s. She described being hospitalized for both staph infections and tobacco poisoning, the latter when the tar and tobacco juice penetrated her skin. It was “tough” work; it left so much tar on her hands that she had to scrape them with a knife before she could wash them. But she traded hard work for grim conditions and, for a student, good money. Wages were piecemeal then, $0.80/leaf. She could make $2,500 to $3,000 during the six-week harvest (adjusted for 25 years of inflation, $3,880 to $4,660). As she put it, “pretty good scratch for a 13-year-old.”

One of the workers I met in Simcoe used to pick tobacco. Despite the difficulties of the work, he rues the loss of the crop because now he picks strawberries. He spends his days, long ones, bent over in the field. His back is always hurting.

Migrant workers who pick tobacco are not paid piecemeal, but receive minimum wage. Farm employees and harvesters are exempt from provincial labour regulations stipulating overtime and holiday pay. This means that workers are only ever paid minimum wage. Workers repay a portion of their airfare, pay Canadian income tax, and contribute to employment insurance (though SAWP workers can only access EI in extremely limited ways despite contributing, according to the UFCW, $21.5 million in premiums annually). Workers also pay up to $30 per month in rent. Jamaican workers pay $5.40 daily toward the administration of the program. After these deductions, migrant workers in Canada make less than $10 per hour. In 2017, workers received a raise. It was fully absorbed by increased deductions, including increased payment towards program administration. As one worker reports, “I’ve never seen a raise, even though I’ve had a few.”

As I get to know the workers, they open up about the physical toll the work takes on their bodies: foot problems, muscle pain and strain, fatigue, and challenges to their mental health. One worker has pain on the roof of his mouth. It hurts to eat and to talk. I call my sister, a dental hygienist living three provinces away, to get her expert input. “See a dentist as soon as possible,” she says. It’s a reasonable suggestion but infinitely difficult when workdays run from 7 a.m. until 6 p.m. (or later), and employers get upset when workers take time off. In addition to private dental fees (Jamaican workers do not have any dental coverage; Mexican workers have coverage for emergency dental), workers incur the costs of cabs to and from relatively rural areas, as well as their lost wages. One “free” dental consult at a local college cost a worker more than $200, plus his boss’s anger, without including any actual dental work.

Workers are also afraid to report any medical needs for fear of being sent home. In order to ensure the smooth running of the program, liaison officers are quick to push for the repatriation of injured workers. This impetus was clear in 2015 after Sheldon McKenzie, a Jamaican SAWP worker, experienced a traumatic head injury while working on a tomato farm. In a coma and hooked up to life support, McKenzie was unable to work and thus ineligible for his visa and health care coverage. The solution: send him home. Only because of the intervention of McKenzie’s Canadian cousin was he kept under Canadian medical care until his death nine months later. Other workers, meanwhile, are sent home because after they have been injured, they cannot take on “light duties.” (It is unclear what “light duties” actually are and whether they are possible when working in agriculture. Anecdotally, some employers seem able to provide them while others either cannot or will not.) According to CBC, 800 Jamaican workers have been sent home from Ontario over the past 10 years, often with medical conditions resulting from their work in Canada. One worker told me I should do my research in Jamaica, with the thousands of Jamaicans he claimed have been repatriated after receiving injuries, with no compensation and with no access to health care.

***

Sadly, some of the farmers and farm managers I’ve heard about from workers do not come out looking great. I have heard stories about accommodation without hydro; long days made hours longer with five minutes’ notice and without extra food or water; an employer looking for a worker who was up until after midnight fixing machinery to be in the field at 6:55 a.m. While my immediate reaction is either to initiate a direct and very unpleasant conversation with someone, or to make a formal complaint on behalf of a worker, the game doesn’t play that way. Ultimately, the workers want their jobs. They do not want to be sent home for complaining, nor do they want their employers to be barred from the program for violating the conditions of the program.

Alongside these difficult stories, there are many employers who care about their workers, who work alongside them in the fields, who treat them with respect and provide them autonomy, and even travel to the workers’ home countries to meet their families. These employers recognize that without the workers, their farms “would cease to exist.” One of the winery managers I’ve spoken with pushed for one of his workers to have surgery before returning home. He was worried that if the worker did not receive the surgery in Canada, the worker would fail the physical screening required to return in the next year. Another employer offers reduced hours or days off when there are heat alerts. Because spraying the field is best overnight (no people around and no UV to breakdown the chemicals), he lets the worker who does the spraying determine his own hours. He also recognizes that the strict rules of the program are demoralizing for workers and admitted to breaking some of the rules in favour of the workers—none that I’ll disclose here in order to protect both the employer’s access to the program and the workers who come annually to his farm.

“Several workers I have met have lived more of their lives in Canada than in Jamaica.”

The rules, both those issued by the liaison offices (including, for instance, no visitors who have not been pre-approved by the employer) and the legislated rules of the SAWP, are strongly contested. There have been calls from organizations including UCFW, the Agricultural Workers Alliance, the Canadian Labour Congress, the Coalition for Migrant Workers, and Justicia4MigrantWorkers to change the SAWP program to provide greater protections and dignities to migrant workers.

In September 2016, the Standing Committee on Human Resources, Skills and Social Development and the Status of Persons with Disabilities Standing Committee released its review of temporary foreign worker programs in Canada. Among its 21 recommendations, three were potentially relevant for SAWP workers: that employer-specific work permits be eliminated and replaced with geographical and sectoral permits; that programs move from a complaint-driven to a proactive model of ensuring compliance with workplace safety regulations and labour law; and that pathways to permanent residency be reviewed for workers who have integrated into Canadian society and are fulfilling a permanent labour need. The government issued a response in January 2017, indicating that it would commit to “further developing pathways to permanence for foreign workers.” In its April budget, the Liberal government indicated it would strengthen the program. It will provide more money for onsite inspections where migrant workers are employed. It will “continue to examine the best ways to protect foreign workers, especially in low-wage and low-skill sectors” without moving away from employer-specific work permits. And despite providing “smooth pathways for top talent” there is no discourse on pathways for ostensibly unskilled, but critical—read: food security—foreign workers in agriculture.

SAWP workers continue to have no possibility of permanent entry into Canada. Several workers I have met have lived more of their lives in Canada than in Jamaica. Every year they leave their families behind and come to Canada to do work that is available to them because no Canadians will do it. Eight months every year, year after year—perhaps for decades—to provide food for Canadians.

While the workers I’ve met have graciously invited me to be part of their community—including that Jamaican Independence Day celebration last August—they are still not welcome in Canada. One of the local residents in Niagara-on-the-Lake advised me to always lock my door and my car, because of “those people” around.

Niagara’s Peach Festival takes place during the day on a Saturday and Sunday in August. It culminates on Sunday evening with the Shades of Summer dinner on Queen Street. Virtually no workers are able to attend during the day and those who could attend the dinner on Sunday evening are unable to afford $35 plus food per person. However, this year for the first time, workers’ contributions to local agriculture were acknowledged at the Peach Pickers’ Picnic. This event brought Mexican and Jamaican workers together for an evening of food and music and gave them an opportunity for them to be involved in the celebrations of local harvest.

Instead of celebrating peaches in Old Town, this year my family celebrated with the workers who grow and harvest Niagara’s peaches, as well as grapes and other crops. Next year, I encourage you to do so as well so that you can meet and thank the men and women who travel and live internationally to provide us with local produce.

Illustration by Antony Hare

IN 2001, EVELYN ENCALADA TRAVELLED to Leamington, Ont. for the first time. Driving through the province’s tomato industry capital, flanked by farm fields on each side, made her feel like she was entering a different world, rife with exploitation and poverty. Encalada, an advocate for the rights of migrant workers, was there with a group of activists to investigate a tip that several migrant workers had been abruptly deported to Mexico.

Once there, she discovered the tomato farm workers in question had organized a strike to protest unsafe working conditions at their jobs. In response, the company and Mexican consulate officials repatriated the workers—both as punishment and as a warning to deter others. Encalada and her group of activists wanted to know how employers and the Mexican consulate officials (combined with Canadian labour and immigration policies) could possess such power. How could they dispose of people so quickly and with such ease?

While there, Encalada came face-to-face with the cruel and largely unseen realities of Leamington’s tomato industry: Small shack-like boarding houses filled with 15–20 grown men for eight months at a time; exposure to harsh chemicals and limited access to safety equipment; treatment of workers as disposable people who are easily replaced. “I had no idea where Leamington was,” she says, speaking of her knowledge before the trip. “But after that weekend I realized I couldn’t stop going,”

Encalada knew she had to do something. She launched her activist network, Justicia, an advocate group for the rights of migrant workers, soon after. It is Encalada’s way of trying to fill the void where justice should be in Canada’s temporary foreign worker program: organizing communities of migrant workers and strategizing solutions to issues they face, from unsafe working conditions to sexual assault.

Justicia has since intervened on several Ontario Human Rights Tribunal cases, including one in May 2015. The case exposed the former owner of a fish processing plant in Wheatley, Ont. who coerced female migrant workers to perform sex acts under threats of deportation. Justicia served as advocates and interpreters for the workers who were harassed and, in the end, the tribunal awarded one woman $150,000 and another, her sister, $50,000 as compensation for injury to their dignity, feelings, and self-respect.

Meanwhile, the country’s Temporary Foreign Worker programs, like the Seasonal Agricultural Program (SAWP) and also the Agricultural Stream, violate human rights on Canadian soil, says Encalada. In Ontario alone, the SAWP acts as an annual revolving door of 15,000 desperate migrant workers, largely from Mexico and Guatemala, who want to provide for their families. Encalada helps keep Canada accountable through community-building and intervention strategies.

Racialized immigrants and migrant workers are mistreated similarly, she says. They aren’t often seen as people and when they are, they can be perceived as disenfranchising Canadians of job opportunities. An acute feeling of displacement perpetuated by instances of discrimination she’s experienced has enabled Encalada to sympathize with the plight of migrant workers. As an immigrant, she left Chile in 1981 during a period of political unrest following a bloody dictatorship. Her father immigrated to Canada as a refugee from Chile in 1979 and, two years later, sponsored Encalada, who was then five years old, and her mother. But Encalada wasn’t able to shake the feeling that she wasn’t given a choice. This, in part, made her feel displaced: “I never felt like I belonged in Canada because I was always taught I was different.”

Instead of allowing discrimination to immobilize her, she armed herself with knowledge, and is now on her way to completing a Ph.D. in Social Justice Education at the University of Toronto. She has since educated others as a teacher at York University, focusing on diversity issues and social justice in Canadian workplaces.

Lately, she is busy working to alleviate the damaging effects of Canada’s new four-in-four-out rule for temporary foreign workers, which took effect in April 2015. The legislation applies to the many Guatemalan, Thai, Filipino, Honduran, and Indonesian migrant workers who come to Canada under the Agricultural Stream program. It stipulates that workers stay in Canada for a maximum of four years, after which they must return home for another four years before they can apply to work in Canada again. It has forced droves of men and women back to their countries of origin struggling to rebuild their lives and to support their families once again, says Encalada. In response to this mass exodus from Canada, Justicia tries to keep the community of migrant workers united across race, language, and ethnicity. The group trains migrant workers on their rights, but Encalada admits that isn’t always enough:“Often asserting their rights gets workers deported.”

Encalada recently returned from a trip to Mexico and Guatemala. In both places, she encountered young people with dreams of migration. Some asked her what it’s like to travel by plane. Others asked why some people can travel freely while they are stranded with little or no opportunities. She instructed workers in Guatemala to keep their paperwork from the Agricultural Stream and to remain optimistic; perhaps one day they will return to Canada. Encalada says much of what Justicia does is radical— in the sense that it requires envisioning a world beyond capitalism and a dependency on the suffering of others. “If that’s radical,” she says, “then that’s what I am.”

The Force Four Entertainment-produced series, called “Border Security: Canada’s Front Line” is currently on season two and has not yet been cancelled. Thankfully, though, the common sense of others won out in regards to one particularly exploitative episode.

The filming of a March 13 Vancouver construction site raid and the arrests of eight migrant workers will not air as part of the series. Also, there are now restrictions on where cameras are allowed. Filming is done away from the border and kept on the inland enforcement of those with “serious criminality.”

A memo from CBSA cites, “negative public response may continue,” as the reason for the episode’s cancellation. Such negative public response includes: Amnesty International, BC Civil Liberties Association, LeadNow, Council of Canadians, No One Is Illegal and the Canadian Bar Association (CBA), all of which have spoken out against the series, and wish for its cancellation. Thompson’s petition on change.org has over 24,000 signatures and an open letter addressed “To Force Four Entertainment, Shaw Media, Global BC, National Geographic, Canadian Border Services Agency, and all other producers, financiers, and broadcasters of Border Security: Canada’s Front Line,” has garnered 250 signatures from media professionals.

Diana Thompson, wife to Tulio Renan Hernandez , a worker who has been deported to Honduras told the activist group No One is Illegal: “We all feel extremely relieved by the news and are grateful to everyone who spoke out. We want this episode and the whole show cancelled.”

Picture from Diana Thompson's Change.org petition

The show, which follows CBSA, has been criticized for exploiting the confusion and language barriers of people. Or as the Border Security site says, “From confused visitors to phony immigrants.” National Geographic gets more dramatic while describing this trashy TV, “Passengers react in a variety of unpredictable ways—they lie, argue, play the victim, plead ignorance and even threaten legal action.  But they are no match for the investigative tactics of the CBSA officers.  After all, the law is on their side.”

Concerns about the show regard harming not only the dignity of fellow human beings but in some cases putting them further in harm’s way. A letter addressed to Toews from the CBA explains that those seeking refuge for themselves and their family may be endangered further, having their faces filmed for television. The letter also says what many are worried about: “We question whether those foreign nationals participating in the filming can be considered to have provided free and informed consent.”

Though people are asked to sign a waiver, they are filmed first, then asked while they are detained. Language barriers, confusion and fear that not signing will affect their release factor before signing.

Force Four Entertainment released a statement after the raid, saying they were being mis-characterized and that the show was not exploitative tabloid television but a documentary about the CBSA. However the letter originally sent to Toews for approval wasn’t trumpeting education but sensationalism calling the project a, “documentary-style reality television series.” The letter, fit for Tory propaganda continues, “It would be a valuable opportunity to promote important messages about Canada’s commitment to border security to give profile to the agency as a professional and effective law enforcement organization.” And so the show was approved and funded by our federal government.

Josh Patterson, executive director of the BC Civil Liberties Association also appealed to Parliament Hill at a Vancouver news conference in March, “The federal government must respect the rights of every person it deals with, regardless of their immigration status.”

The show airs Mondays at 8 and 8:30 on the National Geographic Channel. For now.

“Have any of you ever felt your life slipping away from your hands?” he told the audience in Spanish (through an English interpreter). “I have.”

His name is Abelardo Javier Alba Medina, and he is one of three survivors of the February, 2012 van crash near Stratford, Ontario that killed 10 Peruvian migrant workers and one Canadian. The crash, believed to be the worst in Ontario’s history, brought migrant workers’ rights and working conditions to the forefront of the Canadian media. And eight months later, there are still many Canadians fighting for the rights of these people.

Medina spoke at Ryerson University in Toronto on Oct. 2 for a panel event titled, “Local Food, Global Labour: Food Justice Needs Migrant Justice.” He called the crash a “very quick life-changing experience,” and explained how hard it is to be in Canada when the rest of his family is back in Peru.

“Love your family a lot,” he said. “Never stop helping your brother and sister. We are all human beings. The only thing we want is the opportunity to keep living and keep surviving; to tell our families, ‘I’m here and I won’t leave you.’”

Another survivor of the crash, Juan Jose Ariza Mejia, also spoke at the event.  He told the audience he remembered looking out the window, while most of his co-workers were sleeping after a long day’s labour—then suddenly seeing a truck coming straight towards their van. Mejia locked eyes with the driver, Christopher Fulton of London, Ont. Fulton’s face, he said, was full of fear and surprise. Fulton veered to the right; if he drove head-on into the van, it’s likely there would have been no chance of survivors. “This is the vision I will keep with me for the rest of my life.”

The room was quiet as Mejia fought back tears, continuing to describe the terror of the crash (“the screeching of brakes”), the immediate aftereffect (“I started to realize I was in pain”), and the heartbreaking aftermath (“we saw the carnage all around us in the van”). He said that his liver bled so much it affected his gall bladder, and that the pain was so intense that doctors had to use medication stronger than morphine.

It was emotional, but it was also important to hear. One of the major issues surrounding migrant workers in Canada is that of deportation. Often when they get injured on the job—if they gather up the courage to speak up to demand compensation and health care, which many don’t—they are sent back to their home country. It’s one of the things that Justicia for Migrant Workers (a presenter at the event) hopes to change. Representatives from Toronto Food Policy Council, Food Secure Canada, and United Food & Commercial Workers Union also made presentations.

A small memorial for the victims of the crash was set up to one side, a silent testament to their sacrifices and a vow to change the fate of migrant workers in the future. It’s easy, as born-and-bred Canadians, to forget about what those who come here seeking a better life have given up; they leave behind family, comfort and familiarity, even language. And as proud as we are of our country, it’s about time we stopped to think: is the Canada that we see the one that they see, too? And if not, is the Canada they see really one we want to represent our country and all it has to offer? If we claim multiculturalism as one of our nation’s strongest qualities, perhaps it’s time we made those other cultures feel a little more welcome. For Medina, Mejia (and many others like them), a crash like the one in February isn’t all that rare—in fact, accidents like this happen often. How we deal with them is perhaps most important.

“This is the biggest obstacle I’ve ever endured but I take it with dignity and with strength,” said Mejia. “Life is a constant battle. You have to fight.”

"Mike Clive, from Jamaica, Stacking Cabbage, Waterford, Ontario" (1987) by Vincenzo Pietropaolo. Image courtesy the artist.

In the fall of 1973, a young photographer arrived at the office of This Magazine with some remarkable photos of strikers outside a small Toronto factory called Artistic Woodwork. Immigrant workers, organized by the Canadian Textile and Chemical Union, were striking for their first contract. The photos were remarkable in both their intensity and intimacy. You were face-to-face with these men, solemn but determined, exercising their right to organize. You couldn’t help but share the photographer’s clear empathy for them.

This Magazine published some of his photos, launching the career of a gifted documentary photographer. For close to four decades, Vincenzo Pietropaolo has photographed the lives of the “invisible” in our society: workers, immigrants, and their communities, people living on social assistance, people with disabilities. He has also been the photographer for significant protest movements such as Ontario’s Days of Action during the Harris era. His hallmark is an engaged and respectful encounter with his subjects: he doesn’t just take their pictures, but appears to enter into a dialogue with them, often writing about them or recording their words and displaying them alongside his photographs.

Pietropaolo, born in 1951 in Italy, has had a long career as an independent, socially committed photographer ever since his first publication in This. He has exhibited around the world and won numerous awards, including the Cesar E. Chavez Black Eagle Award in 2010. His most recent publications are Harvest Pilgrims (2009), documenting the lives of migrant agricultural workers, and Invisible No More (2010), about the lives of people with developmental disabilities.

Protestors march down Toronto's Yonge Street as part of anti-G20 All Out In Defense of Rights Rally, Monday June 21 2010. Photo by Jesse Mintz.

The Toronto Community Mobilization Network kicked off its themed days of resistance to the G20 on Monday with activists converging around a mixed bag of issues including income equity, community control over resources, migrant justice, and an end to war and occupation. It’s an ambitious start­ for the week-long campaigns. On their own, each issue is complex. So wouldn’t combining them create one massively hopeless problem? Not necessarily.

Uniting the struggles sends a clear message:  justice for one means justice for all. Organizing in solidarity weaves together the various conditions of oppression and injustice affecting populations around the world. It gives us a deeper understanding of these conditions, and how to act against them.

In effect, you can’t talk about income equity without addressing migrant justice. The fact is, so-called developed states have built their economies on the labour of underpaid and overworked “temporary” migrant labourers. A recent Stats Can report suggests that throughout the 31 countries that make up the Organization for Economic Co-operation and Development (compare these to the countries that have ratified or signed the UN Convention on the Protection of the Rights of All Migrant Workers and Their Families, or to the G20 roster for that matter), the “temporary migration of foreign workers has increased by 4 percent to 5 percent per year since 2000.”

The same report states that over 94,000 non-permanent residents worked in Canada full time (30 hours per week or more) in 2006. Many came to this country as part of temporary foreign worker programs, such as the Live-in Caregiver Program or the Seasonal Agricultural Workers Program. Activists, academics, journalists, filmmakers, politicians—pretty much everyone—have denounced the current state of both programs for their exploitative policies, racist legacies and harmful social effects. And it only seems to be getting worse for migrant workers as third-party recruiters become increasingly popular.

The fact that business is booming for recruiters means there’s a pool of people willing to put up whatever money they have for the promise of work abroad.  And here’s where we connect the dots from migrant justice to ending war and occupation and restoring control of resources to the people—what has compelled, and continues to compel, the estimated 214 million migrants of the world to leave their home countries in the first place? That’s what migrant justice group No One Is Illegal wants us to think about:

Government and public discourse fails to address root causes of forced migration. On the one hand, because of free trade policies—including Canadian free trade agreements—and structural adjustment programs, governments throughout the global South have been forced to adopt neoliberal policies that have restructured and privatized their land and services, resulting in the displacement of urban and rural workers and farmers. On the other hand, capital mobility has led corporations to create millions of low-wage jobs and to seek vulnerable workers to fill them, both in sweatshops in the global South and exploitable labour sectors in the global North.

Sure, not all migrant workers are explicitly forced to come to Canada as a labourer, as one analyst with the Fraser Institute griped in an interview with The Dominion, but then again lots of people are. Forced migrants are refugees, asylum seekers, internally displaced and trafficked people, as well as survivors of developmental displacement, environmental and manufactured disasters.

Huge construction projects like dams, roads and airports squeeze people out of their homes. Stephen Castles, the former Director of the Refugee Studies Centre at Oxford University, writes that many of these initiatives are funded by the World Bank and displace as many as 10 million people annually. Though World Bank offers compensation for resettlement, Castles concludes:

Millions of development displacees experience permanent impoverishment, and end up in a situation of social and political marginalization.

People displaced by environmental change, by industrial accidents, and toxins generally face similar fates.

That’s why war and conflict, immigration and refugee flows, jobs and wages, and global economics are, together, a “focus” of protest. Far from being separate and unrelated problems, they’re inextricably entangled. And the solutions will be too.

Nurse Jennifer D'Andrade and Dr. Paul Caulford consult with patients at the volunteer clinic in Scarborough. Photos by Arantxa Cedillo.

Dr. Paul Caulford will never forget what happened to Patricia. An 18-year-old girl from Grenada, she had an athletic build, black skin, and black hair cropped at her ears. She had come to Toronto at the age of 15 and her father had applied to sponsor her, but the family split up and Patricia’s father let the sponsorship drop. She had no immigration status, no health-care insurance, and peculiar blood. Patricia had sickle-cell anemia, a condition that’s particularly common among people of African descent. In places where malaria is prevalent, those with sickle-cell anemia were evolutionarily preferred because their blood was too hostile for malaria to survive. But it can also be deadly. When Patricia’s blood cells don’t get enough oxygen, they morph from their regular sphere shape into what look like crescent moons and clog up her smallest blood vessels.

Caulford explains how Patricia had gone to a clinic in extreme pain and the doctor had sent her to the emergency room. She was having a sickle-cell crisis. At the hospital, she was told she’d have to pay at least $350 before seeing a doctor because she didn’t have health insurance. But she didn’t have the money either. Patricia decided to stay anyway, and sat in the emergency room, writhing in pain, until she fell unconscious. Only then was she admitted and given an IV. She spent days in the hospital recovering and racked up a bill in the thousands.

Patricia’s was one of the many stories shared over meals by a group that included Caulford, the chief of family medicine at the Scarborough Hospital at that time, Yasmin Vali, the hospital’s director of community and patient relations, and Jennifer D’Andrade and Cathy Tersigni, two public health nurses working in shelters and with the homeless. Their dinner meetings turned into planning sessions and resulted in Canada’s only volunteer clinic exclusively — and openly — serving the uninsured.

Citizenship and Immigration Canada plans to accept as many as 265,000 new immigrants in 2009, most of whom will settle in Toronto, Vancouver, and Montreal. Those immigrants will spend their first three months without public health care insurance. There are a further estimated 100,000 to 300,000 undocumented workers living in Canada without health-care insurance. Some come as temporary workers, or as visitors, and simply never leave. Others apply for refugee status and remain in the country even if they’re not accepted. Many have an “implied” right to be in the country because they’re applying for certain types of status, or they’re between permits. They are halfway legal, halfway not. They work, have families, buy food and clothing. They go to school, go on dates, fall in love, break up. But if they get sick, they can’t go to the hospital unless they pay up front. Or they can go without money — as long as it’s an emergency — and wait for the bill in the mail.

An accident, a sickness, or a pregnancy can leave an uninsured person with a debt they might never be able to pay off. Just one night in a hospital costs around $1,800. In intensive care it’s around $2,300 or more, depending on the treatment needed and on the hospital. For patients without much money, even a comparatively low cost — $350 up front in the emergency room, for example — can be too much. Vali remembers one man who was paying his debt to a Toronto hospital in installments of $5, every two weeks. It was all he could afford. There are a few clinics in Canada’s “big three” immigrant destination cities that see uninsured patients for free, but they are just stopgaps for a growing problem that needs a sustainable solution. The health-care community is beginning to realize it needs to make more room for these halfway people — halfway between the life they’ve left behind, yet not entirely accepted into the new one they’ve chosen.

Patients waiting for consultations in the Scarborough clinic. Photos by Arantxa Cedillo

“The problem was screaming at us,” says Caulford. In Canada, where everyone supposedly has a provincial health care card, the hospitals didn’t know what to do with people without one. Caulford had heard of many people not getting help, even in real emergencies such as broken bones, asthma, and appendicitis.

Caulford sits in a conference room at a large wooden table, donated by one of the clinic’s many supporters, with a pile of patient files in front of him. He’s volunteering here tonight and loves talking about the clinic that comes to life Tuesday and Thursday evenings, welcoming people living in Scarborough without health-care cards. The clinic opened in 2000, inspired by stories like Patricia’s. Patients arrive and sign in at the reception with Debby James, a social worker whose dark, rounded face beams with energy. When it’s their turn, the patients make their way down a narrow corridor, passing a small lounge, a washroom, three examining rooms, and a nurse’s room before arriving at the conference room, everything coated in pale-blue paint. They spend some time in the conference room speaking with D’Andrade before being guided into one of the examining rooms to wait for a doctor. A group of about 12 volunteer doctors rotate shifts to treat patients and train medical residents and foreign-trained doctors who are working to re-certify in Canada. But the clinic wasn’t always like it is today. It started with Caulford looking for doctors and Tersigni and D’Andrade for space. They recruited doctors willing to volunteer their time and found free space in a community centre and in a church basement, next to clothing boxes and decorations for the Christmas pageant. They brought medications, needles, and syringes to the sites in tackle boxes that Caulford bought at Canadian Tire. (He impressed a cashier who said, “Wow, you really like fishing! How much tackle do you have?”) At night, after seeing each patient and keeping the file for follow-up, they were often left with throat swabs, urine, and sometimes feces samples that had to be brought to the lab the next day. They would bring them home and keep them in their fridge overnight — much to the disgust of their families. Tersigni took to hiding the samples from her husband in a paper bag.

It would take Tersigni and D’Andrade about seven trips to transport all of the supplies from their cars to the MASH-type units. And because the two nurses alternated nights, they would meet sometime between Tuesday and Thursday evening to make “the switch”: they would park their cars at the side of the road and haul all of the tackle boxes and equipment from one car to the other.

They helped a lot of patients and put in long hours, but it still felt like second-rate care. “You don’t do pap smears very well in a church basement,” says Caulford. He has a friendly demeanour, and it’s easy to see how he could put even a nervous non-status immigrant at ease. He feels strongly that uninsured people should get the same level of care as everyone else, so although he was optimistic about the clinic they had put together, he worried that it wasn’t enough. “Why would it be second-rate or third-rate?”

Although the Scarborough clinic is the only clinic in Canada set up exclusively for the uninsured, there are other clinics that accept patients without coverage — but they try to keep that fact under wraps. Dr. Cécile Rousseau, a research and clinical psychiatrist at McGill University, collaborated with a team who surveyed healthcare professionals and community workers in Montreal, asking how they deal with uninsured patients. She says some clinics keep tightlipped about treating these patients because doing so is outside their mandates and they don’t want to be inundated with visits. Other clinics don’t want to draw attention for fear of their patients being targeted by immigration authorities.

Vancouver’s Bridge Clinic serves refugees and refugee claimants who get basic coverage under the Interim Federal Health Program and also has some prenatal programs for uninsured women. But it’s not enough to cover the large and growing needs of the uninsured population.

“We can’t. It’s not our mandate,” says Shirley Alvarez, the clinic’s social worker, “The clinic would be closed if we don’t follow our mandate.” Although they make some exceptions, Alvarez admits that it just scratches the surface.

“There is a need, but right now we don’t have anything to support this need,” she says.

There’s no data available in Canada that exposes the health effects of living without insurance, but research from the United States shows that a lack of insurance leads to lower-quality medical care and a higher incidence of disease. As the number of uninsured people in Canada increases, it’s getting even harder for them to access care. “There has been some tightening of the rules,” says Rousseau. “When it’s just a few people, it’s very easy to take a social and human rights approach and say, ÔOh, we’ll do it anyway.’ But when it becomes a big load on the finances of the hospital, it becomes more difficult.” She says that the first reaction has been for hospitals and clinics to close their doors to the uninsured: there are posters up in some Montreal hospitals warning people who don’t have coverage that they will have to pay. But she thinks more and more people within the health-care community are trying to work together to find solutions and to give care to everyone who needs it.

“show me where the pain is,” says Caulford to his 29-year-old patient. Alberto is standing shyly in the pale blue examining room, wearing black jeans faded in the front, a brown sweatshirt and a Budweiser baseball cap.

“It’s in my lower back. And all the way down here.” He points to his knees. “I feel, like, tingly. My legs are tingly, numb sometimes,” he says softly, with a slight Latino accent. His thin moustache and trace of a beard frame his thick lips. Caulford looks at his chart and breathes out slowly. He knows this is not just muscular pain. It’s more serious and it’s going to take a while to heal.

Alberto’s from El Salvador, the small Central American country where over a decade of civil war between guerrilla fighters and paramilitaries left a generation that grew up knowing nothing but fighting and a place where unemployed youth are often drawn into crime and violence. Alberto fled to the United States and had been living in Maryland for the last two years, working as a forklift driver in a warehouse. When an agent told him he could get a job with the same company in Toronto, where his uncle lives, he paid the agent $500 to get him across the border. He didn’t get the job. He’s been working with his uncle, who is a carpenter, but now he’s in too much pain. He doesn’t have any legal status in Canada so he’s trying to live under the radar.

“Can you stand up?” Caulford stands behind Alberto. “Just bend forward for me.”

“What? Down?” says Alberto, giving a nervous laugh and appearing embarrassed with a female resident doctor in the room. He does as the doctor says, but he can barely bend down before the pain shoots through his back.

“I think you’ve injured your disc,” Caulford tells Alberto. He draws a picture of a spine with its discs and vertebrae on the white paper sheet that covers the examining bed. He explains that there’s no magical cure for this, only medicine to take away the pain. “Avoid bending over, avoid lifting anything heavy, at least for the next three or four weeks, to let this disc heal.” He steps out to get Alberto some pain medication.

In a room across the hall, Adeola, a Nigerian woman in her 40s, is sitting with one of her legs stretched out across the examining bed. She’s wearing a brown toque and a beige-and-white-striped sweater. Her denim pant leg is rolled up and a bandage hangs open, revealing an oozing ulcer on the side of her calf. She came to the clinic for the first time last week and has just been diagnosed with diabetes. In Nigeria, Adeola was a teacher and her husband a civil engineer. Their children were all in school. They applied to Canada as landed immigrants and were accepted. “I wasn’t keen on leaving,” she says in her calm and good-humoured manner. It was her husband’s idea to emigrate.

Adeola and her family, like all permanent residents who settle in Ontario, British Columbia, Quebec, or New Brunswick, have to wait three months before getting access to public health insurance. When her ulcer first started bothering her, Adeola saw a doctor at a walkin clinic. “I had to pay for the consultation,” she says, “but he didn’t treat the wound.” She paid $100 to open a file and $30 for the consultation. But she didn’t go back, nor did she find out about her diabetes. She’s worried. Both she and her husband are having trouble finding jobs — they have no Canadian experience — and her diabetes is out of control.

The clinic is a crossroads of migrants, all arriving in different ways, but all uninsured. Unlike Alberto, who snuck into the country, Adeola and her family came as permanent residents, papers in hand. |But they’re both without public health-care insurance and have found their way to the Scarborough volunteer clinic for the uninsured. The three-month wait period for new immigrants (and for Canadians returning to the country after long stints abroad) has been in place in British Columbia for decades. In the early 1990s, Ontario and New Brunswick adopted it, with Quebec following suit at the start of the millennium. It’s supposed to prevent people from abusing our universal health-care system, but critics argue that it winds up hurting one of Canada’s most vulnerable groups. Although new immigrants are encouraged to get private insurance, they’re often not told until they arrive in the country, and at that point, many are more worried about finding a place to live, buying winter coats, and going grocery shopping than paying for private insurance, something many people didn’t have in the countries they left. Plus, private insurance doesn’t cover pre-existing conditions, so if newcomers have heart problems or diabetes, they’ll often have to pay out of pocket. Most new immigrants will be fine and won’t need any medical care for those months. Others aren’t so lucky.

Rachel Heap-Lalonde, a member of the Health Care for All Coalition in Montreal and a community worker at Project Genesis, a social justice organization, has met some of the unlucky ones. She tells of a Mexican immigrant who was hit with a debt of more than $18,000 when his 13-year-old daughter was hospitalized for appendicitis in 2003. Another couple, whose three-year-old daughter started feeling sick just days after they had arrived from Morocco, waited over a week before taking her to the hospital. The young girl ended up in intensive care with a ruptured appendix and the family was billed for over $29,000 (although the bill was later reduced to just over $18,000). In 2007, a seven-year-old boy, whose family had recently arrived from Algeria, took a nasty fall in the playground that landed him in an intensive care unit with a ruptured liver. He recovered, but his family received a $63,000 bill in the mail. Heap-Lalonde argues that huge debts can make integrating that much harder: “It might only be three months when you come, but those three months can follow you forever.”

Even the Scarborough clinic isn’t able to do much when it comes to those types of bills. Although patients referred through the clinic get a discounted price at the Scarborough Hospital, they still need to cover the cost of their hospital care. The clinic can only cover things like blood tests, throat swabs and some diagnostic tests, but if a patient needs surgery, that’s another story.

Coalitions such as Health Care for All in Montreal and Right to Health Care in Toronto are pressuring their provincial governments to do away with the three-month wait period. The governments’ response has been that the measure is necessary to avoid abuse of the system and to harmonize rules among provinces. There are some exceptions to the rules, like the decision by the Quebec government to cover care for victims of domestic abuse, sexual assault, prenatal care and deliveries, and some infectious diseases during the three-month wait period (services that are not covered automatically in the other provinces). But the ministries of health in all four provinces with the wait period say there are no plans to eliminate it any time soon.

Besides new immigrants, many temporary workers also have to wait three months for coverage. In addition, workers such as livein caregivers often go through several stints without health insurance. Because their permits are tied to the employer, if they are laid off or an elderly client passes away, they lose their work permit and have to reapply, leaving them uncovered until they get a new job and a new permit. Workers given temporary permits for less than six months — which sometimes happens in the case of live-in caregivers — are generally not eligible for public health insurance. As the number of temporary workers accepted into the country increases, the number of people with precarious insurance coverage will likely grow as well.

Refugees and refugee claimants are covered under the Interim Federal Health Program, which gives them a basic level of care. But when some claimants are denied, they stay in the country anyway, trying to keep out of sight and not get sick. Or they’ll apply to stay on “humanitarian and compassionate grounds”: that is, after the time they spent working here, they consider Canada their home and want to stay permanently. In the meantime, they’re uninsured. Others come to the country on a visitor visa and apply to be sponsored by a family member. While awaiting an answer, which can take over a year, they fall into legal limbo, in which the government knows they’re here but because they’re not really allowed, they don’t get health-care coverage. Then there are those who haven’t applied for anything; they’re just trying to get by and not make too much noise.

The fear of mammoth hospital bills, or of getting caught by immigration authorities, can dissuade people from getting help when they need it. Rousseau has heard of kids staying home with appendicitis, and of pregnant women trying to deliver their babies at home without medical help. Dr. Jacques Ramsay, a coroner in Montreal, thinks migration status has been a contributing factor in several deaths over the past few years. One Korean man, who died of a preventable heart condition, had lived in the country with his two children for less than a year. He had a visitor’s visa and had been in pain for weeks prior to his death. “He didn’t have insurance, so he didn’t go get help,” says Ramsay. When people are afraid of going to the hospital, or seeing a doctor, small problems can suddenly become fatal.

A stout, round man in a black baseball cap, red golf shirt, and jeans walks down the hall carrying a container wrapped in paper towel that’s a little wet. D’Andrade tries to introduce him to me; the man goes to put out his hand, then changes his mind and gives a nervous smile. “Steve’s got his urine with him, so go ahead, Steve!” says D’Andrade, laughing playfully.

Steve sits down in the conference room. He has a slight moustache and tanned skin. His hands are rough and weathered from years of manual labour. For eight months of every year since 1988, Steve has worked on farms in Ontario through the government’s Seasonal Agricultural Worker Program. He planted and harvested onions, carrots, celery, potatoes, lettuce, and more. “I can work from nursery to harvest,” he tells me proudly. He’s even worked on a flower farm. “I can’t remember all the names of the flowers, though,” he says with a laugh.

Back in Trinidad, Steve worked on sugar cane and rice paddies, but it wasn’t the same as working here. “Here it’s extensive mechanization. You have plots of 100 or 200 acres,” he says. “I can work all farm equipment, combines, tractors — I know it very well.” He describes working on farms with enthusiasm and says he loves Canada and has learned a lot here. So much so that in 2003 he decided to stay. His wife and sons came to meet him, but soon after, the family broke up. His wife’s sister, who lives in Toronto, helped his wife and their children apply for permanent residence status while Steve was away working on a farm. He still doesn’t have legal status here.

Steve works on the farms in the summer and in construction the rest of the year. Often he’s paid in cash, but says he uses his social insurance number whenever employers ask. “I didn’t get enough money to start an application,” he says. To apply to be a permanent resident costs more than $1,000. It also requires a lot of paperwork — not Steve’s forté.

Two years ago, he started to feel pain in his stomach and had blood in his urine. He stands up and shows me a scar down the left side of his ample belly. He had surgery last spring to take out the stones that were lodged in his kidney, blocking the urine from flowing through to the bladder. “They were rock hard,” says D’Andrade, making a fist to demonstrate. He spent five days in hospital and racked up a $4,000 bill that he’s been paying off monthly.

The wound became infected. It swelled and had to be drained of all the pus and blood that had built up. Although the clinic only ran twice a week, D’Andrade and Tersigni made sure he had it looked at every single day, often going to his apartment on the weekend to change his dressing. It finally healed in August and Steve went to work on the farm until November. He’s not eligible for disability insurance even though he’s been working here for the better part of 20 years. Now the pain on the other side of his belly is becoming unbearable and he’s scared. He doesn’t know how he’s going to survive another summer without working.

Caulford has seen a lot over the years: tuberculosis, cancer, a host of terminal diseases, and even a seven-year-old boy whose ribs had fused to his hip following a Pakistani schoolyard fight involving grenades and Molotov cocktails. You never know what you’re going to see next. But the clinic’s not a depressing place. It’s full of life, of camaraderie and selflessness. And people from all over want to share their stories, or talk about the children they’ve left in their home countries, or the ones they’ve brought to the clinic. There are colouring books and crayons. Nobody looks dangerous. No one looks “illegal.”

Among the certificates, awards, and family pictures in Caulford’s office is a painting of a boat docked in a picturesque harbour. It’s a gift, given to him by the artist, a father who immigrated to Canada a few years ago with his pregnant wife and two kids. The family had come to the uninsured clinic while under the three-month waiting period. Now he works as an accountant and his family has adapted well to life in Canada.

“You pick up the paper and you read, ÔImmigrants cause TB,'” says Caulford, annoyed at a newspaper headline. “These people enrich our lives so much — they’re not just bringing TB!” Adeola comes in for her checkup. She stops outside the reception area where James, the social worker, is sorting through the canned food on a shelf that’s available for anyone who might need it. Chunky New England Clam Chowder, Campbell’s tomato soup, and Ocean’s sockeye salmon wait in stacked cans.

“I found a job,” says Adeola quietly. She’ll be taking care of autistic children. It’s through an agency. Her husband hasn’t found anything yet, but it’s a start.

The following week, the results of Steve’s blood test came in. On top of his kidney stones ordeal, he’s just been diagnosed with diabetes.

“What’ve you been doing? Eating sugar all week?” jokes Caulford as he passes Steve and one of the nurses who are sitting in the conference room looking through a pile of flyers on diabetes. Steve smiles nervously.

In Montreal, Heap-Lalonde of the Health Care for All Coalition has gotten word that the Algerian family would no longer have to pay the $63,000 debt. It was a sigh of relief for the family after more than a year with the bill hanging over their heads — and a wave of hope for the health-care and community workers who oppose the three-month wait period. And there have been other pardons such as this one, where ministers have erased hospital debts, realizing the hardship they cause and the inability of people to pay. But just like the ad-hoc clinics across the country that help uninsured patients, the pardons are unpredictable and irregular. Meanwhile, hundreds of thousands of people living in Canada spend time without healthcare insurance, and if they get sick or have a serious accident, they could be left destitute, or worse.

If we want to keep calling our health-care system “universal,” we need to make a place for these “halfway people” and not keep giving them only half the care they need. Although he’s passionate about the clinic for the uninsured, Caulford would like to see a fundamental change. He’d like to see health-care insurance for everyone living in the country, no matter who they are or how long they’ve been here. As for the clinic, he says, “We’d love a sunset clause. We’d like to put ourselves out of business.”

Names of patients have been changed