Family and friends of Saandra Salim allege that an Ontario hospital’s eight-month delay in communicating Salim’s biopsy results allowed cancer to spread untreated to the 27-year-old’s liver, spine and uterus.
Her family says the Conestoga College international student visited Grand River Hospital in Kitchener, Ont., in October 2022 complaining of stomach pain and bloating.
“They misdiagnosed her and asked her to take medication for gas problems,” Hrisheekesh Sudarshan, Salim’s husband, alleged in an interview.
In November 2022, when Salim returned to the hospital with severe abdominal pain and bloating, surgeons removed a 27-centimetre ovarian cyst. Following the surgery, Sudarshan says Salim asked for her cancer test reports several times by email and phone but never received them.
Months later, in June 2023, Salim went to the hospital with severe back pain and Sudarshan said they told the doctor about her history of surgery and the lack of access to the cancer test results.
“Instead of checking Saandra’s medical records in their system, they gave her Tylenol and recommended physiotherapy,” he said.
Grand River Hospital said in a statement to New Canadian Media that under the Ontario health care system, when a laboratory finds abnormal results on a test or biopsy, those results are shared with the patient’s physician/care team for follow-up with that patient.
They stated that Grand River Hospital also follows this standard process for pathology results processed in their laboratory. However, citing the requirements of the Personal Health Information Protection Act, they didn’t comment on the alleged delay or provide any further information.
However, the biopsy results weren’t shared until July 29, 2023, when Salim was back in the emergency room at the same hospital, unable to walk after a fall. She waited for eight hours to be seen by a doctor, said her mother, Smitha Saleem.
“That day in the hospital, my daughter was in terrible pain,” said Saleem in a telephone interview from Trivandrum, India. “I was only able to watch her writhing in pain via video call. It was unbearable.”
Tests found that the cancer had spread aggressively, Sudarshan said. “The doctors told Saandra that she had only a few weeks to live. Only then did we know that Saandra had cancer.”
“I wouldn’t say we could have saved Saandra’s life, but if the doctors and hospital staff had shared her biopsy results with her soon after her surgery, she could have had a better quality of life with her loved ones and less trauma, pain and agony.”
Salim’s family allege that they experienced multiple instances of medical negligence throughout her care at the hospital, and the family is considering legal action.
Following spinal surgery at Grand River Hospital in August 2023, Salim travelled to Kerala, India for further treatment and after four months of cancer treatments, she died Jan. 11.
“My daughter Saandra for whom dance was her biggest passion, lost movement in her legs first,” Saleem said, breaking into tears.
“We sent Saandra to Canada thinking that we were sending her to a safe country.”
Sooraj Venugopal, secretary of Samanwaya Cultural Association in Toronto, and a member of the Justice for Saandra coordination committee member, started a change.org petition with a few other friends and associations. The petition calls for a full investigation into the medical care Salim received.
“In Saandra’s case, it’s a clear case of medical negligence and a sort of secondary citizen treatment just because she was an international student,” he said.
“We don’t even know if Grand River had her biopsy results on file. We don’t even know if or when they entered it into their records. What we do know is that it was withheld from her for eight months. That’s a terrible mistake on their part.”
In August 2023, when Salim was about to be discharged after surgery to remove her corroded and fractured vertebrae, Venugopal said she requested her biopsy results. “Initially, the Grand River staff claimed that they had destroyed the files,” he said.
Venugopal alleges that this was after Salim’s family filed a complaint with the hospital’s patient relations department about the delay in communicating Salim’s biopsy results. He said after they pressed and asked for a written statement that the records had been destroyed, the staff provided the biopsy results.
“Here Saandra was dying, they didn’t tell her the results of her biopsy for eight months, and after she had lost all faith in Canadian health care, when she asked for her records so she could go to India for medical treatment, they tried to withhold it,” said Venugopal.
International students in Ontario pay for medical coverage through their Canadian college or university, but not all institutions offer it and the health plan may not cover everything. Students also don’t have family doctors.
Ashika Niraula, senior research fellow and project lead at Toronto Metropolitan University, said international students should have the same access to health care as any other resident in the country.
“It’s time that we start talking about the inequalities in access to health care for international students or temporary migrants,” Niraula said. “We talk about revenue for the colleges, and now we’re talking about the housing crisis. But then we often forget about international students and their health care.”
Niraula’s research focuses on the financial and emotional precariousness that recent immigrants face as they navigate a lack of access to health care in Ontario. “Canada has a universal, publicly funded health care system. In the case of international students, they add to the labour force and also pay taxes when they work.”
The number of international students in Canada now exceeds one million. In 2018, international students spent $22.3 billion on tuition, accommodation and discretionary spending in Canada, according to a Global Affairs report.
From 2021 to 2023, Salim spent $35,500 on tuition fees in Canada, her husband said.
About 76 per cent of all tuition fees paid in Ontario colleges come from international students, says a report by Higher Education Strategy Associates. The report also states that students from India alone will generate $2 billion in operating revenue for Ontario colleges by the 2023-2024 school year.
“International students are increasingly seen as the future high-skilled workers,” says Niraula. The Canadian government is creating pathways for them to apply for post-graduate work permits, then permanent residency and eventually citizenship. “So it’s absurd that they wouldn’t give them access to universal health care.”
Minu Mathew is a writer and communication consultant who has worked closely with brands like Philips, 3M and Microsoft. She has a book of poems titled ‘In the Garden of Rain’ published on Amazon. Minu has lived in India, Sweden, US and UK. She currently lives in Toronto, Canada with her husband and two children.