The Doctor Is Out

Diagnosing Capilano University’s lack of initiative and accountability for health and accessibility services on campus 

Sarah Rose // Features Editor
Talia Rouck // Illustration

It feels like the sudden drop in a fast elevator—as if my internal organs are about to be torn from my body through my vagina. Sitting in a bathroom on the third floor of the Fir building, it hit me again. I have endometriosis—a disease where the lining of the uterus invades other areas of the body, causing various symptoms, including severe pain. Although it’s one of the most common gynecological conditions, a web of medical sexism, inaccessibility, and inadequate care can delay diagnosis by seven years on average, preventing over two-thirds of patients from finding effective relief.

Pressing against my innards like I was holding in a gunshot wound with both hands, I forced myself out of the bathroom and towards the campus clinic on the third floor of the Birch Building. Stepping into the clinic is like a step back in time. At one point, Capilano University (CapU) had sports medicine and physiotherapy available on campus. Now, the beige, wood-panel trim walls lined with manilla folders and filled with the same brand of Hilroy paper used in primary schools are all that’s left. At the front desk is the nurse, Mary Ciccone, who books appointments with a pencil and paper system from the 1970s. I told Ciccone I was having an endometriosis attack and needed to lay down and asked if there was any heat or analgesics available to get me through the episode. She turned off the light and offered Tylenol. That was all she could afford to do.

The nature of endometriosis means despite undergoing two surgeries to excise the tissue, it’s a chronic disease with no cure—that gut rending pain can strike without warning. When the clinic was unequipped to help me through the episode, I felt a different kind of anxiety about the state of health services for disabled students at CapU. 

“I’ve never used [the on-campus clinic], and I honestly didn’t think it was real,” said Accessibility Justice Coordinator June Reisner.

A recent review from the focus group conducted by the Capilano Students’ Union (CSU) shows that the majority of disabled students like Reisner and myself rely on external care networks, like specialists and other primary care doctors.

In a campus-wide experience survey, Reisner says 11 percent of the student body reported facing inaccessibility on campus. Five percent reported physical inaccessibility and six percent reported mental health access issues. “Only five percent of respondents identified as having a disability…that’s everyone with a disability and six per cent more,” said Reisner. “If [the clinic] is a service [that] students are paying for, it should be used to its fullest potential and be accessible to everyone.” Neither the Capilano Students Union (CSU) fee breakdown, the CapU mandatory fee statement, or the 2019-2020 CapU statement of financial information provide insight towards how CapU is funding the clinic and its employees. Senior Communications Officer Linda Munro was unable to provide any further details. 

Mary Ciccone says that the campus clinic is no different than any other walk-in clinic on the North Shore. It offers a full range of services, from allergy shots and physical checkups to mental health support. Typically, from the end of March to the beginning of September, the clinic closes and switches to virtual appointments that students must book over the phone. With COVID-19 shuttering the physical campus entirely since last year, the clinic, which is only open Tuesday and Thursday, has been only booking appointments virtually through the telehealth service Doxy. Despite having no computers or webcams that can facilitate an online record system, let alone virtual appointments, Dr. Dawn Cheng, one of the two doctors working in the clinic, uses her personal laptop in the clinic to keep assisting students. “There’s a lot of calls; we’re booked right up until next week,” said Ciccone.

According to Ciccone, students looking for more emergent and urgent care are a fairly small population and tend to come in with migraines or menstrual pain—adjacent to endometriosis. A range of common medications are available, “although most tend to expire before we use them,” Ciccone added, saying the clinic can’t carry stronger non-narcotic analgesics for students presenting with more severe pain due to cost. “The on-campus clinic could be a good emergency type program for students, and maybe it’s not being used to its fullest extent,” said Reisner.

Reisner reached out to Shanti Scarpetta-Lee, Vice President of Equity & Sustainability, to look into students’ experiences with the clinic, but was unable to find corresponding information. “I don’t want to say it’s an easy gap to fill to have a more supportive system there, but there are some concrete things they could do to make it more beneficial for students that have more diverse needs…if they thought about it in a more intersectional way.” 

“If there’s a gap [in care], it would be good to know where,” said Cheryl Kramer, an accessibility coordinator who has been working with accessibility services at CapU for over 20 years. Despite her years of experience working with accessibility services and coordinating with the clinic in certain cases where they help provide students with documentation of their disabilities, Kramer is still left with questions about where emergency services and the clinic intersect. The Capilano Courier reached out to the head of facilities at CapU, Ryan Blades, but has been unable to get a corresponding statement about the details of the clinic’s contract.

Kramer shares that even for students who were able to get accommodations in primary and secondary schools, the process is more restricted in post-secondary. She added that many students are among the 17 percent of people within the province who don’t have access to a primary care provider. There isn’t a continuity of care, which is where two areas of student need for the on-campus clinic intersect. The emergence of a student residence in recent years adds another population that could be primarily served by on-campus clinic services and who may not have any other means to access care.

Between the clinic’s close connection to both the student body and accessibility services, Dr. Cheng feels like there’s a chance to do a lot more for the CapU community than the average walk-in clinic—especially in providing care for chronic conditions and documentation for disabled students to access accessibility supports. “Most walk-in and urgent care centers only deal with acute care. We provide more chronic care, we have a chance to do a lot more,” she said. Despite working with the bare minimum supplies, what the small team of three does at the campus clinic is personally meaningful for Dr. Cheng. “I’m doing a lot more than just [treating] sore throats…I book a lot longer than any other [general practitioner] out in the community.”

… post secondary is a vulnerable time where many mental health struggles such as ADHD emerge, and adequate diagnosis and support can mean the difference between treating her patients as drop-outs or as graduates.

In healthcare, there is already a pain gap. Women and people with uteruses have their pain consistently taken less seriously than men’s—Black women, Indigenous people, women of colour and LGBTQ+ people experience more barriers and potentially dangerous oversights. Research continues to suggest these barriers extend beyond just pain. Women with ADHD are significantly less likely to be diagnosed than their male counterparts, despite affecting both equally. Dr. Cheng describes how post secondary is a vulnerable time where many mental health struggles such as ADHD emerge, and adequate diagnosis and support can mean the difference between treating her patients as drop-outs or as graduates.

“Almost every day I work, I see one or two ADHD patients,” said Dr. Cheng, who adds that she routinely does assessments and provides medications for students struggling to access care elsewhere, whether due to discrimination or long waitlists. With more resources she’d like to have an ADHD coach on campus, but with the current lack of finances, initiatives and inclusion of accessibility, she can’t see it being a possibility. Another barrier she says is that the $248 a year CSU Health and Dental Plan doesn’t cover many of the medications used to treat ADHD, and neither does provincial pharmacare.

Like endometriosis and ADHD, Kramer says that the majority of students at CapU have disabilities classified as invisible. Although I’ve been managing chronic pain for over a decade, I didn’t reach out to accessibility services until well into my second year, when my life began falling apart once again with the pain and a new ADHD diagnosis. A scholarship and the ability to request distraction-free exam rooms helped, but it didn’t detract from the lingering heaviness I carried with me every day across campus—it’s not enough. Disability is a weight that creeps between the lines of consent campaigns and critical discussions around racialized students.

It’s not just the disabilities that seem to be invisible on campus, but a long history of erasure now manifesting as a discussion around accountability for the inaccessibility built into the fabric of CapU. 

“There isn’t enough data from B.C. and [CapU] to describe the [disabled] experience for B.C. students,” Reisner said. An upcoming province-wide survey by the National Education Association of Disabled Students will be the first of its kind to look at the lived experiences of disabled students in post-secondary institutions across B.C.

The COVID-19 pandemic has unintentionally broken down some of the walls around accessibility while also creating new ones in the process, especially for disabled students. Many nonprofit organizations for ADHD report sharp increases in patients seeking diagnoses and support after the switch to remote learning. This is an emerging group of students who could, without access to support, whether through assessment at the clinic or medications not covered through the CSU Health and Dental Plan, potentially fall through the cracks.

“We have been asking to centralize our services for years…[and] we would like to have a psychiatrist on campus,” said Kramer, who has used the same methods during most of her two-decade tenure at CapU. Organizing support for students without resources like dedicated exam rooms for the nearly 3000 exams scheduled through accessibility services every year is not only difficult but a symptom of a bigger, longer dance between pedagogy and inaccessibility.

Remote access for classes has broadened opportunities for everyone, while also bringing under scrutiny the merit of things like no recording policies on lectures, mandatory attendance policies and outdated exam structures.

March 1 is disability day of mourning. It wouldn’t be unusual if many at CapU wade through their usual Monday classes unaware of this. In the past five years, over 700 disabled people have been murdered by parents, relatives or caregivers who decided their lives were not worth living. The month of March is endometriosis awareness month—on March 2 BC Place will bathe itself in yellow, culminating at the end of the month on March 27 for the Canada-wide 2021 EndoMarch.

“I’ve had a variety of experiences with accessibility [at CapU], both good and bad,” shared Reisner, looking reflective for a moment, one knee propped up on her bed. She’s planning on going for a hike later—it’s not something she’s always able to do. “You only really learn about disability issues when they affect you.”

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