Women described multiple systemic barriers in managing their chronic pain including judgment and poverty. The most common theme was that of judgment in the form of stigma. They felt judged for being from a certain area,
You know, people think they’re all scum down here, but you know what, that’s - they didn’t start here. You know, this is just a place they ended up... And some of them don’t know how to get out of it.(Participant 2)
First Nations women felt discriminated against for having a certain ethnic background. Others felt labeled for having a substance dependence. “Like once you’re labeled as an addict, like, in – in so many physicians’ eyes, that’s all you are and that’s all you’re out to get” (Participant 10).
Other common themes that emerged under the topic of barriers were those associated with poverty and the effect of low-income and inadequate housing on managing a chronic condition. Income came primarily from sex work and was largely supplement by disability, welfare and pension payments when unable to work. Prescribed lifestyle changes and therapies for chronic pain were described as inaccessible or unaffordable. One woman recalled, “I should be going to physio but I can’t afford it. You’re only allowed so many a year and then you have to pay the user fee. Who’s gonna pay that?” (Participant 12) while others cited acupuncture and massage as being inaccessible due to the cost.
Women expressed frustration over the cost of prescription medications, especially those that were not covered or those who’s coverage was delayed.
You have to pay 200 dollars for fucking medications. It’s not covered by medical or status. 200 bucks. You can take your fuckin’ meds and shove it up your ass, you’re going to tell me that it’s not covered(Participant 3)
Housing conditions that were affordable were often inadequate. One woman described, “fleas in the carpet, mice in the stove, um, cockroaches in the bathroom. Oh it was a horrible place, and I got stuck staying there for 2 years” (Participant 2).
Women expressed frustration accessing the emergency department as a resource for pain due to stigma as well as frustration with building a relationship with a physician knowing their histories as both a Sex Worker and an addict. One participant felt so rejected that it was easier for her to reject herself, saying,
I don’t wanna go back through not being listened to again, do you know what I mean there, right?... If you can reject it first before somebody rejects you, it’s easier to shut it down. It’s that wall you put up, right? (Participant 4)
Full article at: http://goo.gl/LURUuq
PACE Society, British Columbia, Vancouver, Canada
Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
Department of Family Practice, University of British Columbia, Vancouver, Canada
Stephanie VandenBerg, Email: firstname.lastname@example.org.
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