How to prevent it from happening again

The University makes 10 recommendations after reviewing the circumstances surrounding Sukaina Mohsin Ali’s death last April

Graphic by B. Shiva Mayer

The University has revealed 10 recommendations following a review into the death of Sukaina Mohsin Ali.

Ali, a first-year international student from Pakistan, died of a cardiac arrest in her dorm room in April. She suffered from anorexia nervosa and depression.

Following Ali’s death, Vice-Principal (Academic) Patrick Deane launched a review into the circumstances surrounding her death.

“My review was intended to look at the circumstances around the death and see if we can understand what went on in residence, what issues she was dealing with … what kind of problems faced her as an international student and what lessons we can learn from this,” Deane said. “I’m hoping that we’ll now follow with addressing issues that may have been a problem for her … the lessons of this are not something you want to sit around and wait to take action on.”

Recommendations include the clarification for parents of the relationship the University has with students and their families, and the way the University deals with information families give them.

At the time of Ali’s admission to Queen’s, her parents sent the University a Karachi psychiatrist’s letter detailing her condition and recommending that she have continued medical monitoring and care.

Following Ali’s death, no one at the University was able to confirm the receipt of the letter, because it was kept private in Health, Counselling and Disability Services (HCDS) files.

Deane said medical information is something that is traditionally well-protected under protection of privacy regulations.

“The basic rule is always that you always confide the information in as few people as possible to achieve the goals you want,” he said. “The assumption in Canada is that if you have a health problem, it in the first place is your responsibility—it’s your decision who you tell about it, it’s your decision what action needs to be taken about it and it’s not either the custom nor desirable for institutions to proactively refer you to a doctor or compel you to seek medical treatment.

“That’s the premise on which this whole business of filing the letter is founded. You come to the University, you’re deemed to b in charge of your own health.”

Deane said the University’s policy on medical information submitted in the admission questionnaire is dictated in part by Canadian privacy laws.

“When a student completes that form and identifies some kind of medical issues, that is information that’s held in confidence and it’s housed in Health, Counselling and Disability services … It can only get activated by the student herself,” he said. “One of the tragic things about Sukaina’s death is that residence had none of this information and she did not, I believe, ever attend Health, Counseling and Disability Services to ask for assistance.

“The result of that is that the letter was not activated.”

Deane said one lesson that has come out of this is that the University needs to rethink the way it deals with medical information from people from a different culture who may not know that when they provide this information that it isn’t going to be widely disseminated.

“The University’s looking at ways we can reconcile Canadian standards with a practical response to this issue so if a student does have problems, the right people do get to know about it,” he said. “It really is a matter of how Canadian norms about privacy and medical issues can become misaligned from the cultural assumptions of people, particularly international students.”

Deane said this will probably take the form of making it clear on the health questionnaire exactly what will happen with the information included with it.

“When I think of the painful lessons to be learned from Sukaina’s story is that one that cultural morays are not as uniform across cultures as one assumes they might be,” he said. “I don’t know with what understanding Sukaina and her family submitted that information, but what we do know is the way in which the Canadian system typically deals with such information.

“If you’re asking for information, you have to make very clear to people what’s going to happen to it.”

One option is for the University to respond to information regarding serious medical conditions when they’re received, before the student comes to Queen’s.

“Some kind of response could be sent back to the student and the family to say, ‘Well, you understand, the Canadian system works this way, are there some particular measures you want to put in place to address this problem, because you can’t ordinarily assume that it’ll be taken care of,’” he said. “One of the options would be to respond directly to these things before the student is even here to encourage the student to make specific decisions in cooperation with the University to address the problem

“I don’t think you need to compromise the principle of privacy, because that’s still an important one no matter what culture a student comes from. There are ways to respect the privacy of the information and minimize the likelihood of important information not being known that would be germane to the wellbeing of the student.”

Deane said it can be hard to actively look out for a student’s wellbeing if a student doesn’t seek assistance him or herself, however.

“Sukaina was, on occasion, asked about her health. Students in the residence did perceive that her eating habits were not necessarily healthy ones, and they did try to prevail on her to eat more--they offered to share their food with her, they recommended her to Health, Counselling and Disability Service. She appeared unwilling to do this.

“There’s also the question, too, that she tended to dress in a way that made it not so obvious that she was losing weight.”

Ultimately, Deane said, the University deals with students, not parents, and the expectation is that students are self-sufficient, to a certain degree. He added that it’s important not to make the assumption that this expectation is universal.

“The assumption is that students are prepared to be the ones responsible, and the supports are there if they choose to ask for them,” he said. “It appears Sukaina did not avail herself of all the supports open to her.

“We need to be at least self-questioning about our presumption of what adulthood means not every culture has the same model of late teen self-sufficiency.”

Deane said he heard contradictory things about how much Ali knew about the health resources open to her.

“She certainly had opportunities to learn how properly to access those services--she certainly was present at events where the information was given.”

However, Deane said Ali’s friends said she was confused about how the health system worked.

“We’re trying to drive a review of as many practices as possible from a cross-cultural perspective, look at systemic obstacles to students from different countries and different backgrounds,” he said.

A lot of what needs to happen is a look at cross-cultural communication: between the University and a student’s family before the student comes to Queen’s, as well as between members of the Queen’s community and international students.

Deane said Health Counselling and Disability Services’ cross-cultural counselor will now be spending about 40 per cent of her time in residence, “developing cross-cultural competency” among students there.

As well, a group called “Beyond Diversity” came to campus from the U.S. to teach student leaders, including dons, about cultural understanding.

The University is also trying to increase education about eating disorders, Deane said.

“We’re stepping up a program that will improve the ability of students in general but particularly their peer leaders to have the tools in identifying victims of eating disorders,” he said.

Deane said the University is also looking at changing don training or altering the current system.

“I think rare situations like Sukaina’s bring to light the level to which oversight in the residence may need to be augmented,” he said. “There is the basic question of whether, good though the don system is, it doesn’t need to be complimented.”

Dean of Student Affairs Jason Laker said this year’s dons got additional cross-cultural training, as well as training in recognizing the issues new students face at university.

Laker said that, ultimately, dons aren’t therapists and it can be difficult for them to intervene in the health of students on their floors.

“What can be really difficult is the issue of courage,” he said. “When you tell somebody, ‘You don’t look well,’ or ‘I’m worried about you,’ sometimes people either blow it off or deny it or even act defensively.”

Laker said he’s trying to implement more support systems in residence, both by increasing in-residence staff and fostering partnerships between dons and staff with departments such as the International Centre or HCDS.

“People like dons are residence life co-ordinators--their job really has them doing everything,” he said. “There are a lot of other partnerships to be made that would foster a more open community and different types of support networks.”

Deane said he sent a letter on Friday to Ali’s family in Karachi, Pakistan, describing the review’s results and the lessons the University has learned.

“It also indicates to them that wer’e supporting a proposal for a fund to be established in her name that would be of assistance to students in a similar kind of position,” he said. “The details of that have to be worked out.”

Deane said members of STRIVE, the AMS environmental organization of which Ali was a part, have been lobbying for a tree to be planted in her name.

“We’re going to do everything we can to make that happen,” he said.

Deane said one challenge Ali’s case underscores is the difficulty of balancing the need to make the campus accessible while retaining what makes Queen’s culture unique.

“It’s just a matter of recognizing that you shouldn’t take things for granted, you shouldn’t take it for granted that someone will understand what seems a transparent element of our culture,” he said. “If you recognize these things aren’t universal, you can then make it possible for people to navigate them while not compromising their local culture.

“I don’t know if that’s the answer, but I think we have to assume we want to maintain those aspects of our culture that define us positively … If you take the issue [of universality] to its logical conclusion, you end up in an absolutely bland universe in which every university is devoid of local and cultural attributes. And who wants to go there? I mean even if it were possible to go there, who wants to?

“That’s a bind.”

The University’s recommendations

1. The nature of the university-student-parent relationship for international and immigrant students and their parents needs to be clarified. In particular, the role and limits of the University with respect to students’ non-academic life need to be communicated. Parents may not understand that under our regulations and practices students are assumed to take primary responsibility for their lives at Queen’s, for their health no less than for their academic programs.

2. Notwithstanding #1, the University at large and the residences in particular should consider the ways in which assumptions about “adulthood” and the capacity students make decisions and handle independent living will vary across cultures. It is recommended that a special program of outreach to international and immigrant students be initiated to asssess freshly the needs of this group.

3. Instructions and information that are sent out with respect to the university-student-parent relationship, pre-entrance heallth questionnaires, student services and resources, should be systematically reviewed from a cross-cultural perspective and revised if necessary.

4. With all due consideration for prevailing Canadian norms and standards regarding the need to safeguard student information and protect students’ privacy, the University should explore ways in which confidential information pertaining to the health and well-being of resident students might, where appropriate and in the absence of specific direction from the student, be passed along to individuals in a position to assist the student.

5. Further training for residence staff on cross-cultural sensitivity, knowledge and skills should be implemented. This should be augmented by review of the efficacy of residential programming for international and culturally different students.

6. Ways of sharing information on an ongoing basis about health, wellness and nutrition, especially about where to find ethnic and religously prescribed foods, such as Halal meat for Muslims, should be developed. First-year students not on a meal plan need to be targeted to receive this information.

7. Residence staff and students should be sensitized to hazards and symptoms ssociated with eating disorders, and guidelines developed for dealing with this problem. Residence-based information and educational programs in this area should be initiated.

8. Special attention should be paid to the ways in which conflict between a student and her or his Don is dealt with. If necessary, new guidelines for this process should be developed. Steps should be taken to ensure that the information provided to all students, but in particular international students, is clear about the role and expectations of a Residence Don and the nature of the Residence environment.

9. The availability of culturally competent and directive counselling for affected international students, especially those who are often reluctant or ambivqalent to seek such services, must be ensured.

10. The demands placed on student staff should be reviewed, to determine if more professional, full-time staff are needed to meet the needs of our student residences as well as the expectations of our community, including more oversight on residence floors.

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