“We can clearly see the negative effects of wildfire smoke on the lungs, but there was some hope that it wouldn’t be as severe as the impact of urban air pollution.” (Photograph by iStock.)

Looking at pictures of wildfires wreaking havoc across Canada is enough to make the average person feel a bit sick: the haze; the blood-orange sun; the gargantuan plumes of smoke. For those who do venture outdoors, there’s a general sense of unease, provoked by a faint, unsettlingly sweet smell in the air. The reason behind it all is an unusually early and out-of-control start to fire season, which many experts expect could be the country’s most devastating to date. Environment Canada has already issued “high risk” air quality warnings from coast to coast, and Canadians from B.C. to Halifax are breathing it all in.

Even if we can intuitively understand that all this smoke is bad for our health, it’s too early to tell just how bad the long-term effects will be. Michael Brauer, a researcher with the University of British Columbia’s School of Population and Public Health, has been studying the health impact of environmental phenomena for more than 25 years. And though the data on wildfires is sparse, it’s growing—and the prognosis is not good. For Canadians with pre-existing conditions, he says, living alongside frequent fires could be its own catastrophe. Here, Brauer explains what, exactly, everyone’s inhaling, how it’s affecting Canadians (physically and mentally) and how to stay healthy in a burning world.

You’ve been studying wildfires for a long time. How has the uptick in frequency changed the scope of your work in the last few years?

I was studying wildfires in Southeast Asia 25 years ago. At that time, wildfires weren’t really affecting any of our major cities in North America. It wasn’t until the early aughts that we started seeing bigger fires outside of rural areas in Canada, and in B.C. at least, we started seeing their health consequences on local communities. Now, most of Canada’s major cities are hit with the impacts of fire once or twice a year, if not multiple times. Even when things are relatively good fire-wise in B.C. and Alberta, we’d still be getting hit with smoke from California or Oregon. It’s just everywhere.

Another concerning issue is that Canada’s fire season has lengthened. Out west, it used to be July and August. But last year, there were fires in April. Vancouver now has smoke lingering in October, which is unprecedented. All of this means that the average person is experiencing greater levels of smoke exposure. And you don’t even need to be that close to a fire for that to happen; smoke can affect people thousands of kilometres away. I was talking to someone today from New York City, and the air was polluted there from a fire up here.

So it’s a good time for research, but a bad time in every other respect?

We don’t have a lot of data for how wildfire smoke affects us yet. When I started researching fires, we used to have to chase the smoke. Recently, it’s become relatively easy to study it.

What do we know about what happens inside the human body when someone inhales wildfire smoke?

Our bodies try to fight these airborne particles by mounting an inflammatory response, where our lungs call in all sorts of cells to try to digest these foreign materials. We’re evolutionarily designed to fight bacteria and viruses. We can’t do smoke particles. Our immune systems just keep working overtime, which can start to affect other organs, like the heart, brain and kidneys. It’s similar to gum disease, that long-term level of inflammation. The same thing happens when we’re exposed to this smoke.

So what you’re saying is that our bodies have evolved to respond to our environment—just not this level of environmental ruin.

It’s one thing to stand near a campfire every so often and get smoke in your eyes, which is very irritating. We can walk away from that; we can’t walk away from these fires. It’s getting to the point where you’re only going to be able to avoid them if you move somewhere else.

Is inhaling wildfire smoke somehow worse for the body than breathing in garden-variety summer smog?

It’s not clear that it’s worse than smog, but it’s just as bad. One of the main things I study is the impact of air quality on the body, and wildfire smoke is the main issue contributing to levels of air pollution in Canada right now. We can clearly see the negative effects of wildfire smoke on the lungs, but there was some hope that it wouldn’t be as severe as the impact of urban air pollution. More and more, the evidence is showing that it’s just as hazardous as pollution from traffic or industrial sources. 

The difference between the types of smoke exists at the particle level. If we burn coal, it has a certain chemical signature. With wildfire smoke, the particles contain much more organic material, which is due to all the vegetation that’s being burned. The chemical makeup then reacts with the atmosphere, so the smoke composition changes the further it is from the fire source. When fires are smouldering, we actually tend to see more particles than if it’s burning very, very hot. It’s hard to generalize, but the real problem seems to be the intensity of the fires. In a typical polluted city, air quality doesn’t vary that much from one day to the next. In the case of wildfires, we get this sudden massive amount of smoke, with levels 50 or 100 times higher than what we’re used to. 

Can you give me a real-life example of how this quick-onset intensity can be dangerous?

We know that air pollution can have effects on pregnancy, like lower birth weight and a greater likelihood of premature births. If a pregnant person is living in a city, they’re exposed to that every day. Now imagine that they’re living in a city that experiences a massive smoke episode because of a wildfire. If the smoke coincides with a critical window in that fetus’s development, that could be devastating.

Who else is especially vulnerable to a sudden smoke episode?

People with pre-existing conditions. A smoke episode can be a tipping point for people with a baseline level of sensitivity. For people with asthma, it can trigger an attack. Smoke can worsen the severity of chronic obstructive pulmonary disease, and can set off heart attacks and strokes. It can throw the bodies of diabetes patients out of whack. It can also worsen ear infections and cases of COVID and the flu. We know that generic forms of air pollution can lead to the development of these diseases, but we never used to worry about fires, which used to be a one-week event once a year. It’s not clear yet whether someone who lives in a place where they’re exposed to wildfire smoke every single year will have their life shortened.

I’d imagine that, as these fires approach major cities, there will be an issue with human-made structures burning—and the chemicals that they give off. Is that accurate?

At this point, it’s not a huge concern. By the time houses are burning, there are usually no people around to inhale that smoke. When it does become a concern is when people re-enter affected communities. Materials from burnt structures leave deposits in the ground. A few years ago, when the fire went through Fort McMurray, there was a lot of attention given to the soil—specifically, the heavy metals and plastics and electronics that were deposited in it. In these cases, it’s standard to do a lot of testing and remove about a foot of soil off the top as a precaution.

Aside from the physical effects, I’m sure all the scary visuals we’re seeing outside and on the news—the hazy skies, blurred sun—and general disaster-movie feel of things can’t be having a positive effect on Canadians’ mental and emotional wellbeing, right?

So far, the immediate effects of the fire are hurting a small number of people, but evacuations are a growing concern, especially among Indigenous communities. Evacuations can be very disruptive and cause long-standing mental-health issues—that upending of social structures, and having to stay stuck in a motel in Winnipeg for two months while homes are rebuilt. This is just anecdotal, but when we have major smoke events in Vancouver, you hear people talking about the apocalyptic feeling: of the orange clouds, of not being able to see the sun. It’s certainly not something that makes people happy, and I don’t want to say they’re complacent, but there’s less of a mental-health hit as people get used to the new reality—which is a sad thing. That said, there’s definitely a new uptick in climate anxiety, where people are not having children for fear of what kind of world they’d be bringing them into. We’ve also seen an increase in anxiety and exhaustion in health care workers because of fire events.

Even if we won’t understand the true damage of these smoke episodes on our bodies for a long time, what do you expect the toll will be on the health care system in the interim?

We’re already seeing that. During a smoke event, we experience increases in visits to ERs and family doctors, more hospitalizations and more prescriptions being filled. We’ve seen pharmacies in smaller communities run out of medications during smoke events. One of the things public-health organizations are really trying to communicate is how much of that is avoidable if people with pre-existing conditions manage their diseases in advance. Every spring, before fire season, we put out public service announcements that say things like, “Make sure you have enough medication on hand!” A lot still needs to be done in terms of just increasing public education so that people are prepared. But individuals can also take precautions in their own homes.

So it’s not a matter of learning to live with it—people can actually make moves to protect themselves?

Yes. We strongly recommend that people who have pre-existing conditions, are pregnant or have kids (and can afford it) get an air cleaner or better filtration system for their homes. If they can’t afford it, many cities have clean air shelters, which are usually community spaces where people can go to experience better air quality. These are mostly located out west, but I think people are going to become more aware of them in eastern parts of Canada soon.

That just goes to show that you really can’t escape the effects of a fire, even if you’re inside.

Being indoors helps, but closing up your windows without air conditioning, in a fire zone, can obviously be really hot.

This interview has been edited for length and clarity.

The post How the wildfires are already affecting our health appeared first on Macleans.ca.

Too often, dementia patients are treated as a collection of needs and symptoms to manage, rather than real people with unique life stories, preferences and habits. (Photograph by iStock)

I didn’t exactly have a normal home life growing up. My parents ran a foster home in Alberta and provided kids who had difficult childhoods with a loving home. There were often 30 to 50 kids living with us. This taught me to value connection and community. 

I graduated from the University of British Columbia with a degree in community recreation in 1975 and worked for several years in the recreation department in Richmond. In 1989, an opportunity came up to work as the general manager for a new senior residence in Richmond with a senior living company called Verve. I initially managed existing senior homes, and later had a hand in designing new ones. I wanted seniors to have a sense of community, so I designed solo living units with shared spaces where people could interact and form connections. But we struggled to provide an enriching environment for people living with dementia. The standard approach was to designate a wing or floor of a given building to dementia patients, with locked doors on either end. When the doors wouldn’t open, they would get frustrated and agitated. I’d panic if I couldn’t move about freely—wouldn’t anyone? Newer facilities have doors that open into a fenced-off courtyard instead, but people still feel trapped. The focus was always on their safety; their freedom and connection with others took a back seat. This approach didn’t sit right with me: life should be about more than just safety. 

In 2015, my wife’s aunt developed dementia and could no longer live alone. We moved her into a retirement community near her home. She didn’t adjust well to it: she loved walking outdoors but didn’t have the support to do so safely. She would wander out of the facility, get lost, and then get frustrated and distressed when she was put behind another locked door. In an attempt to provide her with more support and freedom, we relocated her to a care community that I managed near our home. She died six months later, in spring of 2016. Seeing her struggle broke my heart. I knew I needed to do something to help those with dementia live more fulfilling lives. 

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I attended conferences and workshops in the United States, where I heard about innovative models of care for people with dementia. I was particularly intrigued by the Hogeweyk Dementia Village in the Netherlands, where people with dementia live in a real community—complete with a grocery store, movie theatre and barber shop—where they can roam free with minimal supervision. They share houses with other residents, build relationships and live some semblance of a normal life. I wondered why we couldn’t implement a similar approach in Canada.

When I started workshopping the idea of a similar dementia village, I was Verve’s VP of operations for Western Canada. I pitched the idea to my bosses, and Verve became one of the owners (and now day-to-day operations manager) of the project, along with a handful of private investors, which were mostly family trusts. One of the biggest challenges was finding the right location: I needed enough land to create a village-like setting, but rising prices made it almost impossible. Then I came across a newspaper ad about B.C.’s Langley School district selling four unused schools. There was no sale price listed, so we knew it would be a bidding process. The site was perfect—seven acres of land, complete with trees, greenery and real potential to build something remarkable.

We bought the land for $5 million and started building in early 2017. As part of the development, we had to bring in all the infrastructure, including routing the buildings to a sewer from three blocks away. By the time we were done with construction, the project cost just under $30 million. 

In the summer of 2019, we opened the doors to the Village Langley. The site features six houses with 12 to 13 rooms each, accommodating up to 75 residents total. Four houses offer assisted living with some support, and two are designated complex-care environments, which means they’re for villagers with advanced dementia who require more support. The idea is for villagers to move in when they’re mobile, and as their dementia progresses, they move into complex care, where they can hopefully stay for the rest of their lives.

Too often, dementia patients are treated as a collection of needs and symptoms to manage, rather than real people with unique life stories, preferences and habits. One of our residents is a former professor named Peter. One day, I ran into him at reception. He had a piece of paper in his hand, and he seemed quite agitated. It was a letter from the dean of education at UBC commemorating his 25 years as a professor. He wanted to get it copied. When I asked him why, he said: “I need to show copies to the ladies in my house because they don’t know who I am.” 

Another resident was a Japanese-Canadian woman who, in the later stages of her dementia, felt a strong pull to return to Japan. That wasn’t an option for her, and in a traditional setting, staff might tell her so and leave it at that. But in the Village, something different happened. When asked how she would get to the airport, she said she would take a bus. And so outside her house, staff put up a bus stop sign near a bench. She would pack her bag, sit on the bench, and wait. After a while, someone would walk by and chat with her. She would eventually forget that she was waiting to go to Japan, talk to them and get back to village life.

Identity is so important for people, and that doesn’t change if you have dementia. When I went to see Peter in his home, he asked if I wanted to come see a picture book about his life his family made for him. I learned that when he was younger, he and his wife were attacked by a grizzly bear on a hike. He took on the grizzly bear, scared it away and saved them both. Peter was much more than a professor, a runner and a good man—he was a hero. At the Village Langley, we take the time to learn about people. 

The village was designed to feel like a real community with homes that don’t look like assisted living facilities. Each home has big windows, a living room, dining room, kitchen, family room and sunroom. The houses also have double rooms where we can house couples, even if only one of them has dementia. At traditional dementia care institutions, couples are often split up at a vulnerable time in their lives. 

A community centre serves as a gathering place for villagers. There’s also a general store, a café and bistro, a woodworking shop and a beauty salon. There are beautiful landscaped gardens, and even a barn with chickens and goats. Community activities like exercise programs, crafts and book clubs are organized throughout the day. The goal is to engage each person based on their unique abilities and preferences. Depending on the time of day and the residents’ care needs, there are usually two to four facilitators—nurses, PSWs, recreation facilitators or other professionals—present. They’re dedicated to specific houses, which allows them to develop strong connections with the villagers.  

MORE: Canadian doctors say birth tourism is on the rise. It could hurt the health care system.

Our approach to daily life in the village revolves around villager-directed living. We recognize that each person has different interests, abilities and preferences. Some residents rise early and have breakfast, while others have a more relaxed morning routine. Many villagers enjoy taking walks outside, and we’ve designed the village to minimize barriers and restrictions, promoting a sense of freedom. Yes, there’s an eight-foot fence around the facility, but it’s mostly hidden by trees and flowers, so it doesn’t look or feel like a barrier. I’ve only ever heard of one villager attempting to climb the fence. Generally, they don’t encounter physical barriers, and are free to roam as they please, which improves their emotional well-being. 

We want villagers to make their own choices, learn and grow, and be of service to their community. One day, I met a former lawyer named Don who was a new resident at the village. His family had enrolled him when his dementia became too advanced for him to live without assistance. He wasn’t too pleased to be there and had various delusions accompanying his dementia, which added another layer of difficulty. But with time, he settled in. I’m not sure Don had built anything in his life before coming to the village, but he loved our crafts workshop. He built a big clock out of wood, and he was so proud of it. Don would often stop by the village’s grocery store to grab litres of chocolate milk, and eventually, staff asked him to come along on grocery runs. He would push a big cart around, delivering groceries to homes. The team found out what he wanted to do, allowed him to do it himself, and helped him be of service to his community. He now has purpose and joy—a reason to get up in the morning. 

This model of care works, but it’s not for everyone. Since we’re not government-funded, all of our operational costs come out of residents’ pockets. Monthly fees range between $8,000 and $10,000, which is a tremendous amount of money and not affordable for many people who would benefit from living at the Village. But the hope is that with time, organizations or government agencies will recognize what we’re doing is a better model of care for people with dementia. 

We can treat people with dementia like the unique individuals they are, instead of collections of symptoms and risks to manage. We can set up facilities that give them joy and purpose. When you get to know people on a deeper level, you can help make their lives worth living. 

—As told to Liza Agrba 

The post I opened Canada’s first dementia village. Here’s how it works.  appeared first on Macleans.ca.

(Illustration by Maclean’s, iStock.)

Every few years, the phrase “birth tourism” seems to re-emerge in the news cycle. It refers to non-residents giving birth outside of their home country to gain citizenship and, occasionally, health care for their newborns. Birth tourism isn’t illegal in Canada, but it’s a fraught issue that tends to kick up discussions about who deserves access to the country’s health care system, especially in times of low bandwidth. Like now.

Simrit Brar, an OB-GYN at Calgary’s Foothills Medical Centre, is one of many Canadian doctors who claim to have noticed a recent spike in the number of birth tourists arriving out west. But because that data isn’t routinely collected by hospitals, it’s been impossible to understand the real scope of the issue. Last year, Brar was part of a research team that conducted the country’s first in-depth study on birth tourism in Alberta, and this year—for the first time—the Society of Obstetricians and Gynecologists of Canada is forming a working group to study its impact country-wide. Here, Brar reveals what we know so far.

What prompted you to study birth tourism?

Anecdotally, my colleagues and I noticed an increase in the number of cases we were seeing in Calgary hospitals over the past decade or so, but it’s been difficult to draw any real conclusions about the motivations, health outcomes or financial situations of birth tourists. We know they don’t have Canadian health coverage, but sometimes they have their own private insurance plans that reimburse their care costs. Canadian doctors were struggling to provide timely care for our baseline population even before the pandemic. Birth tourism is far from the only factor straining the health care system, but we knew it was an additional cost, and that we didn’t have the data to understand it. We saw an opportunity.

So how do birth tourists differ from other uninsured pre-natal patients in Canada?

Based on our research, birth tourists are typically middle to upper-middle class, with the means to support themselves while in Canada. The people we looked at weren’t necessarily disadvantaged. I want to be clear: refugees, asylum seekers, undocumented migrants and those in similarly precarious situations—like patients whose provincial health insurance has lapsed, for whatever reason—are not birth tourists. A birth tourist makes the conscious decision to travel and give birth here, and generally they have no intention to stay. Piling everyone under the same umbrella misses those crucial nuances and prevents us from making informed decisions, both at the policy level and in day-to-day care.

If you’re right that there’s been an uptick in birth tourism, what do you think is causing it?

It’s hard to say. We saw it slow a bit during the pandemic, given travel restrictions, and now it seems to be picking up again. I think the availability of information via social media is one factor; that spreads awareness that this is even an option. There are also companies that specialize in facilitating the birth-tourism process. They seem to market themselves online and through word-of-mouth.

What did your study reveal about why birth tourists are coming to Alberta? And where are they typically coming from?

About a quarter came from Nigeria, probably because there’s an established Nigerian community in the Calgary region. Birth tourists tend to go where they have friends or family. Smaller portions came from the Middle East, China, India and Mexico. The vast majority arrived with tourist visas, and based on our interviews, they weren’t facing particularly precarious situations back home. Again, I can only speak to the population we studied, but in general, these are women with resources.

What were they seeking?

That majority said their goal was to get Canadian citizenship for their newborns. Many saw it as an easier route to citizenship for their kids than applying through the typical process. Others either wouldn’t tell us their motivations or said they wanted to somehow benefit from quality Canadian health care.

When birth tourists get off their flights, what is the extent of their health needs?

Many travel here late in their pregnancies and arrive close to 38 weeks, which can lead to complications. I’ve seen patients with pre-existing high blood pressure get off a plane with numbers that are through the roof. Often, they’ll show up at a family doctor’s office, who sends an urgent hospital referral. I’ve also seen patients with pre-term twins literally get off a plane and go straight to an emergency room to deliver. Even somebody who might be otherwise low risk but shows up with no medical imaging or other records of pre-natal testing can have adverse birth outcomes, like unchecked pre-eclampsia and gestational diabetes. These aren’t isolated incidents, either.

When you crunched the numbers, what was the total cost incurred by the province to take care of these people?

For the 102 people we studied, the total amount owed to Alberta’s health care system was $649,000. That may not sound like a lot, but this is just one small study. If you were to add up the costs across Canada, you would end up with a significant amount. I also want to emphasize that this is not just about money. Canada’s health care system isn’t like the States’, which is not only fee-for-service but has a much larger population—and accordingly a larger number of health care providers. Our public system has a finite number of doctors, nurses, and anesthetists. Every province has a lengthy surgical waitlist, and we’re struggling to care for insured patients. So even if a birth tourist does pay their bill, if we allow people who have the opportunity to pay to preferentially access beds (and finite human resources), that displaces people here.

Have any solutions been proposed? If birth tourism isn’t illegal, but it is draining resources, how do we move forward?

We’ve discussed developing a standard charge and different systems for collecting it. In Calgary, we’ve established a central triage system, where patients identified as birth tourists are charged an upfront deposit of $15,000 to cover physicians’ fees. They’re refunded whatever part of that doesn’t end up being used. It’s the only measure of its kind in Canada. Transparently, that number is meant to be a deterrent.

Conversations on this topic occasionally lean toward a xenophobic—and even racist—lens, particularly in the States. Media coverage can sometimes paint pregnant women of colour as a national security threat. What are the biggest misconceptions about this issue?

I say this as a woman of colour: in my opinion, this is not a race issue. It’s a social-structure issue. It’s about access to care. When you have money and you have the ability to get on a plane and choose where to go, your options are different. The issue here is the use of a limited public health care resource. It’s about what it means for patients in disadvantaged communities here. Birth tourists have the ability to choose where they want to go, whereas somebody in a marginalized community may not have that ability. If we open the floodgates, we are further limiting people with very limited options.

Birth tourism highlights some really interesting philosophical tension around the Canadian health care system, the spirit of which is to make sure everyone is taken care of. Here, we see the limits of that thinking. Has studying birth tourism changed your perspective?

You hit the nail on the head. I would love nothing more than to have unlimited resources and help anyone and everyone. That would be dreamland. I would love to not have to fight to get things done. And to be clear, I would never deny care to a patient. But the reality is that we operate within a finite system, and even though the conversations around the allocation of those resources are difficult and complex, we have to have them. I would identify wanting to help as many people as possible, and in the best way possible, as a fundamentally Canadian value. But the system is too strained for us to ignore these questions.

The post Canadian doctors say birth tourism is on the rise. It could hurt the health care system. appeared first on Macleans.ca.

(Photograph by Stephanie Foden)

I’m an associate professor at the University of Montreal and a psychiatrist and bioethics researcher at the Centre Hospitalier de l’Université de Montréal. I’ve been involved in conversations about medical assistance in dying since 2015, when Quebec’s Act Respecting End-of-Life Care came into force. That act legalized medical assistance in dying (MAID) for adults with a serious and incurable disease who were at the end of their lives, provided they met certain criteria—among others, being able to give informed consent, being in an advanced state of irreversible decline, and experiencing intolerable physical or mental suffering. Around that time, I joined a hospital committee tasked with implementing the law, which meant thinking about how to assess mental suffering. As a psychiatrist, this caught my attention because assessing suffering is something we do every day. 

My initial work wasn’t related to MAID for people solely with mental disorders, because the eligibility criteria in Quebec—i.e., that a person be near the end of life—made it extremely unlikely that someone with a mental disorder as their sole condition would even be eligible. This was still the case in 2016, when the federal MAID law passed, legalizing it for people whose natural deaths were “reasonably foreseeable.”

That all changed in 2019. Two Quebecers —Jean Truchon and Nicole Gladu—argued before the province’s superior court that restricting MAID to people at the end-of-life violated the Canadian Charter of Rights and Freedoms. Justice Christine Baudouin agreed, ruling that the law was a violation of the “right to life, liberty and security of the person.”  The federal government amended its MAID law in 2021 to fall in line with the Truchon-Gladu decision, but it included a two-year exclusion for people whose sole condition is a mental disorder. Much of our national discussion since then has focused on whether we should extend MAID to people solely affected by mental disorders. But that word misrepresents the situation.  People with mental disorders were never excluded from these laws, so what we’re really talking about is ending their exclusion.

But this February, the government extended that exclusion for another year, until 2024, saying the extension was needed to ensure that provinces, territories and clinicians are ready. What this means is that a small number of Canadians who are suffering intolerably and want to apply for MAID must wait even longer, while their Charter rights continue to be violated. 

I’m concerned about something beyond legal arguments, though—I’m worried about the message this sends about the status of people with mental disorders in our society. In essence, that they can’t be trusted to make their own decisions, and they require the state to exercise control over their lives, an idea we’ve been moving away from in psychiatric care over the past several decades. Quebec has now gone even further, introducing a bill with a permanent exclusion from MAID for people with mental disorders. Rather than trying to figure out an approach to handling the complexity related to these MAID requests, our solution as a society is to take away people’s rights. 

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That’s despite all the work that has gone into grappling with this complexity—work that I’ve been part of. One of the government’s tasks during the two-year exclusion period was to strike an expert panel on MAID for people with mental illness (the government used the expression “mental illness,” though the clinical language is “mental disorder”). I chaired that panel, which brought together people with different perspectives—experts in law and in ethics, MAID providers, psychiatrists, social workers and people with lived experience. We met every two weeks for almost six months, exploring the kinds of complex cases being seen in practice and how they were being handled.  We discussed relevant court decisions, assessment practices and access to resources for people with mental disorders. We talked to experienced colleagues in the Netherlands, one of the small number of countries that permits assisted dying for people with mental disorders. Finally, we discussed the different mechanisms that exist to change and improve MAID practice, and what bodies and levels of government have the power to make such changes.

We delivered a final report last May, outlining 19 recommendations to ensure that complex MAID requests, including those by people with mental disorders, are appropriately assessed. For some, our recommendations weren’t stringent enough, because we did not recommend that the law be changed. 

So why didn’t we? Most of the concerns raised about MAID and mental disorders have focused on how to assess those requests. But the clinicians who perform those assessments work under provincial jurisdiction, even though Canada’s MAID law is under federal jurisdiction. If we want to ensure requests are handled responsibly, changes to federal law aren’t going to get us there. Besides, an entirely new legal structure, applying only to people with mental disorders, would not cover all the kinds of complex cases that are out there. What we need is extra guidance and rules to help clinicians handle all kinds of complex cases. Within our health care system, provincial and territorial regulatory bodies are the ones with the authority to develop rules that practitioners will follow. Most already had a set of rules about MAID—so the panel recommended they develop additional rules for complex MAID requests, including MAID for mental disorders. This was our very first recommendation. Here are some examples:

Canada’s MAID law requires that a person requesting it is affected by an incurable illness, disease, or disability and be in an irreversible state of decline in capability. People often ask how “incurable” or “irreversible” can be defined when talking about mental disorders. And yes, this is difficult, because these terms suggest certainty, and the evolution of many mental disorders is hard to predict. But that’s also true of other chronic conditions. What we do in those cases is evaluate how well someone has responded to past treatment. Unfortunately, some people don’t respond to treatment, no matter how extensive.  This is true in all areas of medicine, and psychiatry is no different. That’s why we recommended that a person has to have had an extensive treatment history before they could be considered eligible for MAID on the basis of a mental disorder. 

This makes clear that the kind of person who could be eligible is not someone simply going through a tough time. The vast majority of Canadians, including politicians and even most clinicians, will never meet a person with the type of severe disorder that could make them eligible for assisted dying. These folks are often well-known to the psychiatric system, and have endured years of mental suffering, attempting all kinds of treatment—medications, neuromodulation techniques, therapy, social supports. Still, they can’t function in their lives. They can’t work or have relationships or engage meaningfully in their communities. Think about what it would be like to be so severely afflicted that you spend most of your life watching it pass you by, and to have its end be your only goal. 

What about questions of consent? Assessing someone’s capacity to give informed consent can be difficult, especially when the symptoms of a condition—like a mental disorder—could affect how they understand the decision. We recommended that assessors undertake thorough capacity assessments—over multiple visits, if necessary. All MAID requests made outside a person’s end-of-life require a minimum of 90 days to elapse between a request and an eventual provision. But it could take longer than that to come to a decision about whether someone is eligible, and we recommended that practitioners take the time they need even if that goes well beyond 90 days.

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The issue of suicidality has also been raised often. The panel looked at the current practice of suicide prevention to inform its recommendation—what we said was that clinicians should continue to use all appropriate suicide prevention efforts, just as they do now. At the same time, it’s important to note that every day, people with and without mental disorders make decisions that could lead to their deaths. They refuse chemotherapy. They stop dialysis. They continue to engage in behaviours—like severe substance use—that are potentially lethal. Do we prevent people from making those decisions, saying they are suicidal? No. We work with them to understand why they make those choices, and we try to help them arrive at the best decision for them, consistent with their own values and beliefs. In some cases we can establish that the person does not have what we call decision-making capacity.  In those cases, a person is legally not entitled to make their own decisions. We can do the same thing with a MAID request. If you are in a mental health crisis, that is not the time to be having conversations about MAID, as the panel made clear.

Over the past few years, the public discourse about mental health has exploded—and that’s a good thing. We want people to be able to feel comfortable seeking help for mental disorders, and to not fear stigma if they do. But we can’t say on one hand how important it is to destigmatize mental disorders, and on the other hand pass laws that single out people with those disorders, portraying them as unable to make their own decisions. It’s important not to underestimate the stigma that already exists: some people our panel heard from—people with lived experience—were worried that even if MAID was allowed for people with mental disorders, their requests wouldn’t be taken seriously. They were concerned that assessors might wrongly assume that they can’t consent, or might underestimate the severity of their suffering. And since the announcement of the recent delay, I’ve heard of patients with potentially qualifying physical conditions who say that they’re going to hide their history of mental disorder because they’re worried it will be used to exclude them. 

The irony is that under the current regime, people with mental disorders already have access to MAID. They just need to have some qualifying physical condition. Imagine someone who has a severe mental disorder who says they want to apply for MAID. They can’t. The very next day they’re diagnosed with a serious cancer. Suddenly all the things that were too difficult and too complex to sort out yesterday–whether the person is suicidal, whether they have capacity to consent, whether the request is a result of unmet social needs–can be figured out today. It doesn’t make a lot of sense. 

I never expected to spend so much time thinking about and working on MAID. But as a psychiatrist, I think it is important that those individuals who, tragically, have experienced severe, lifelong suffering due to mental disorder have the same options as all other Canadians. 

—As told to Caitlin Walsh Miller

The post Canadians with mental disorders shouldn’t be excluded from requesting MAID appeared first on Macleans.ca.

(Illustration by Maclean’s)

For 25 years, I worked as a municipal administrator in Clarington, a small town an hour’s drive east of Toronto. In 2002, I moved 100 kilometres east to my hometown of Marmora to retire at my cottage. When our mayor’s term ended in 2018, I saw an opportunity to give back to the community I grew up in. I came out of retirement at 68, and have been mayor of the town since.

Marmora is a bustling little community of 5,000 residents that combines a tight-knit local population with a growing demographic of newcomers of all ages. People came during the pandemic for our recreational land, lakes, walking trails and bustling fishing and hunting scene. We’re a town filled with history, with a developing downtown scene. It’s a beautiful place but, with 40 per cent of our population being 65 or older, we desperately need more doctors.

Ten years ago, we only had two physicians. Wait times to see a family doctor were increasing, because our population was steadily aging and needed more care. So we developed an incentive-based program to entice newly minted doctors to come work in Marmora: we offer a $100,000 signing bonus, funded by our tax revenue, and a fully-paid-for and furnished apartment attached to our medical clinic. We’re the only municipality in Hastings County that offers living accommodations, and I’m told by provincial policymakers that we have one of the best incentive packages in the country.

READ: Thousands of patients. No help. Meet the lone family doctor of Verona, Ontario.

These bonuses helped attract two more physicians straight out of medical school, and by 2018, our medical team doubled in size. But our recruiting stalled at two as nearby communities matched our incentives. In 2019, we lost one of our doctors to retirement, and the other chose to relocate and work elsewhere. Now we’re back down to two family doctors, each of whom is responsible for 1,200 to 1,800 patients. Their patients are often long-time residents who joined their roster when demand for family doctors was low. These patients can count on immediate or same-day medical care.

But the other 1,000 Marmora residents who don’t have a family doctor have to travel to get medical attention. They see one of three physicians in the Hastings County clinic 20 minutes down the road, or travel 40 minutes south to Belleville or west to Peterborough, or even 90 minutes east to Kingston General Hospital if they need cancer treatment, surgeries, dialysis, MRIs or X-rays. The closest emergency room is 20 kilometres away in Campbellford. The dearth of medical services in Marmora is frustrating residents: their taxes fund the health care system, but they can’t access care when they need it. Our physicians want to take on more patients, but they’re already overworked.

There is hope. News stories helped advertise that rural communities like ours need doctors and are offering good benefits. We’ve had about a dozen inquiries from medical students and physicians who are practising elsewhere but are looking to move to a remote town after living through years of pandemic restrictions in big cities. One medical student even visited Marmora, but he still has a few years of medical school left. The renewed interest is unheard of, but we’re still waiting to sign that third doctor. Our challenge is finding graduating doctors who are the right fit: people who like Marmora’s rural lifestyle so much that they come with the intention to stay for their entire careers, not just for a few years to pocket the money and perks. This is also why we disburse the $100,000 signing bonus over five years instead of all at once. Meanwhile, we miss out on doctors who opt to set up their practice in busy cities, often because their partners work in tech, finance and law. Belleville is the closest city to Marmora, but it’s 45 kilometres away, and Ottawa and Toronto are more than a two-hour drive away.

RELATED: I was a nurse for 10 years in Scotland. So why can’t I get certified in Canada?

We’ve spent a lot of time at city council meetings thinking about how we could sweeten the pot to attract new physicians. The community can’t afford to throw more money at doctors, and I don’t think that’s what we need anyway. On top of the $100,000 we offer, doctors who sign in Marmora also qualify for rural signing bonuses of $150,000 from Hastings County and $81,000 from the province of Ontario. So a doctor would already gain an additional $331,000 over five years to come and practise in Marmora. But nearby, larger rural municipalities with few family doctors also qualify for these stipends, and they’re offering signing bonuses similar to ours. Quinte West is a larger community of 45,000 people and also offers a $100,000 incentive. The right people are out there, and maybe it’s up to us to find new, creative ways to recruit them. Nearby communities like Belleville have created a recruiting department dedicated to connecting with young physicians and attracting medical talent. We might eventually have to resort to that strategy, too.

Residents want to know they’ll be supported if they or their family get sick, and some people worry we don’t have the resources to promise that. It’s not a problem we can solve on our own—I’m anxious to see how provincial and national leaders will address the nationwide doctor shortage. I think a good start would be to ease the rules around licensing across provinces, which could potentially attract doctors to our rural communities. There is also a huge talent pool in foreign trained doctors who come to Canada as immigrants—we need to make it easier for them to retrain. But these measures are beyond my control. My goal right now is to see everyone in Marmora have access to primary health care.

— As told to Alex Cyr 

The post My small Ontario town is offering $100,000 to attract family doctors. It’s not working. appeared first on Macleans.ca.

(Illustration by Maclean’s)

As an internal medicine and obesity physician, I’ve been prescribing Ozempic to my patients since 2018. Lately, influencers and celebrities as well-known as Elon Musk have touted it as a weight-loss method on social media. Oscars host Jimmy Kimmel joked about the drug’s rumoured use among A-listers at this year’s ceremony, and in March, ads for Ozempic casually showed up in the New York subway system. It’s a classic diet craze: Hollywood adopts a certain technique and then it trickles down to the general public. As a result, Ozempic is gaining popularity as a get-thin-quick hack. This is a problem. 

For those who don’t know, Ozempic is one of the brand names for semaglutide, a drug whose core molecule, GLP-1, has been used to treat type-2 diabetes for more than a decade. (Another well-known brand is Wegovy.) In many countries, semaglutide medications have also been approved as treatments for obesity because they imitate one of the body’s naturally occurring satiety hormones, limiting patients’ appetites. When prescribing these drugs, doctors require patients to meet specific criteria: a BMI greater than 30‚ or greater than 27 with one weight-related condition, like non-alcoholic fatty liver disease or obstructive sleep apnea. The benefits of semaglutide can be huge—improved blood sugar control, a reduced risk of diabetes and cardiovascular disease, and a better quality of life. 

READ MORE: What is xylazine, the dangerous new drug fuelling Canada’s opioid crisis?

The worst part of this new fad is that it could create shortages that affect people who actually need these drugs. When Novo Nordisk, the Danish pharmaceutical company that makes Wegovy, launched the drug in the U.S. in 2021, uptake was so high that they quickly ran out of product. In Canada, Ozempic was unavailable in some Canadian pharmacies late last year due to similar shortages. And less than a month ago, British Columbia moved to restrict sale of Ozempic to Americans who were buying the drug from the province’s pharmacies. Then there’s the impact of the Ozempic obsession on my own practice: in addition to my work as a physician, I post educational content about obesity on TikTok. Recently, people with neither diabetes nor obesity have been messaging me to ask if I’d prescribe them the drug to “kickstart” their weight loss. I always respond by saying they should consult their own health care professional. 

RELATED: The Big Idea: Stockpile Canada’s Drugs

Ozempic isn’t intended to help you go from a size six to a size two. Using it in the short term to achieve thinness could lead to serious health issues. Semaglutide is a relatively safe compound, with some known gut-related side effects, like nausea and reflux. But when these drugs are used inappropriately, those gastrointestinal issues can be more severe. Plus, when people stop taking them, they tend not to maintain their new weight—and then they say the drugs were the problem. Weight cycling can have a negative effect on cardiovascular health, not to mention the huge psychological impact. When they’re prescribed for obesity, semaglutide meds should be paired with behavioural supports, like nutrition counselling and cognitive behavioural therapy, so patients can achieve and maintain a healthy lifestyle that’s realistic for them.

Sasha High (photograph courtesy of the subject)

Another problem with the Ozempic craze is that it perpetuates unrealistic expectations about how body shape and weight are viewed in broader society. I understand why the idea of taking an injection and losing five pounds appeals to so many. We live in a culture that glorifies thinness, so we are always going to have people who rely on easy fixes. We may think that members of Gen Z—who have grown up in an era of more body positivity—are not as susceptible to weight-loss messaging, but that isn’t true for everyone. And so many people who grew up in the ’80s and ’90s had Kate Moss–covered magazines by their bedside. Some still really struggle with not meeting that aesthetic. 

MORE: This Toronto social worker is seeing a surge of anxiety and depression in kids post-pandemic

I’ve had many discussions with colleagues about what the ubiquity of Ozempic will mean for our patients. First, more and more people will likely request it for non-medical reasons. (At the moment, this appears to be more common in the United States, where Ozempic is offered by some practices specializing in aesthetic medicine, like botox clinics and plastic surgery centres.) A second, more positive effect is that Canadians with obesity will become more aware of available medical treatments for their disease.  There are still so many missed opportunities to prescribe these medications appropriately. Physicians often tell patients with obesity to “try harder” or eat less and exercise more, then withhold potentially helpful drugs due to stigma and a lack of education. Semaglutide can be the right treatment for the right patient. For everyone else, there is no quick fix.

–As told to Alex Cyr

The post Here’s why Ozempic is popular for the wrong reasons appeared first on Macleans.ca.

“Mental health services are woefully underfunded and it’s worse for children’s mental health” (photograph by iStock)

After working as a social worker in the public sector for 15 years, Jessica Diamond saw a need to offer timely services to children struggling with mental illness. Depression, anxiety and behavioural disorders skyrocketed in children under 12 during the pandemic, and the public health system didn’t have the resources to help them all. In 2021, Diamond opened a private social work clinic for children in Toronto. Diamond now works with 25 kids struggling with mental illness brought on by years of pandemic-restricted social contact.

You worked in children’s mental health for more than a decade before opening your private practice. Why did you make the switch?

In 2018, my then-eight-year-old child was having mental health difficulties, and I thought I knew how to help: I had spent more than a decade as a policymaker in the child welfare sector. But even if you know where to look, mental health services are hard to come by. Parents can wait as long as two years to get off Ontario’s free wait list and see a children’s social worker or psychotherapist—that’s a long time in a kid’s life. So, in 2018, I got my master’s in social work, and in 2021 I opened The Help Hub. We offer therapy for children, youth and families, as well as parent coaching. My opening coincided with an especially tough two years for kids during the pandemic, and my roster of patients grew very quickly. I hired three associates—a social worker, clinical psychologist and an early-childhood family and support specialist—to keep up with the demand.

Who are your patients?

I work with children under 12 and their parents for family counselling. I also have a colleague who works solely with teenagers. For kids under 12, appointments are a mixture of talking and playing: cognitive behavioural therapy with a jar of play-doh.

How has the pandemic impacted children’s mental health?

During the pandemic, these kids’ worlds shrank considerably, and with fewer opportunities to socialize or play outdoors, their screen time rose exponentially. This led to lifestyle changes impacting children’s development, and resulted in social anxiety, depression, weight gain and interrupted sleep. It didn’t help that parents were (understandably) not at their best: their work lives were shifting and they lost relationships of their own. Many experienced burnout, which meant they had less compassion and energy for their kids at home.

RELATED: Inside the mental health crisis at Canadian universities 

Are there groups of kids with specific conditions who have been disproportionately affected by the pandemic?

Kids or teenagers with neurodevelopmental disorders like autism or ADHD suffered because of limited in-person services like therapy and social skills groups that are essential for their socialization and development. Some of those kids are now years behind in their development. One of my patients with a neurodevelopmental disorder now finds it hard to make friends and play with others during recess, despite being able to do so pre-pandemic—they’re out of practice.

Kids from low socioeconomic backgrounds are also disproportionately affected, because they were more likely to lose relatives during the pandemic and likely had limited professional support to cope.

We’re no longer in lockdown. How are kids still feeling the effects of the pandemic?

Children are experiencing an epidemic of anxiety, depression and low self-esteem unseen before the pandemic. I see more and more kids as young as eight in my practice who self-harm or are experiencing suicidal thoughts. Anxiety has peaked as kids have re-entered the world: they’re thrown into social situations without knowing how to play with others, or even read facial expressions because we’ve been masking for so long. We think humans are just born with those skills, but that’s not true. When a kid realizes they aren’t good at socializing or making friends, it can lead to frustration, which can contribute to depression. It’s a vicious cycle that needs to be treated in childhood: the faster we can help these kids, the more downstream issues we can prevent as they age. But we don’t have the resources to help all these kids in the public system, and things are getting worse.

Parents of a five-year-old told me their child began self-harming while they were waiting for an assessment on Ontario’s public wait list. I saw another seven-year-old who’s been on the wait list for seven months, despite a worsening mental health condition. Initially, the child was struggling with some anxiety but was still able to go to school and socialize with others. By the time they contacted me, the child had become disruptive in class and at home, avoiding school altogether some days.

Is our health care system equipped to offer mental health services to kids?

Mental health services are woefully underfunded, and it’s worse for children’s mental health. In Toronto, only two hospitals serve kids under 12 in their mental health units. That’s roughly 20 beds for a city with approximately 450,000 kids. It leads to outlandish wait times: in 2022, Children’s Mental Health Ontario noted that wait times for public mental health services for children range from nine months to two and a half years depending on where you live. Children and families are suffering as a result. Schools are no better. The Toronto District School Board has one social worker per five schools—that’s barely enough to handle the most extreme cases. Other kids fall through the cracks.

Just before the pandemic, I encountered a child who was younger than 12 who needed immediate mental health care. His family doctor didn’t have the training to address mental health issues in children, and his only option—other than a one-off conversation with a stranger on a helpline—was the emergency room. He waited eight hours before seeing a mental health specialist, and then had to wait another five weeks for a follow-up appointment with a child psychiatrist. That’s a common case: family doctors are rarely equipped to help children with mental health issues, meaning kids face long wait times to see professionals in the public care system. It’s a bit of a circus.

READ: The cruel, ridiculous reality of ‘virtual learning’

What needs to change?

We have to fund the public sector, where wages are so low that they can’t attract and retain mental health professionals. Starting salaries for social workers in Toronto hover around $30 an hour. That’s not a livable wage. Coupled with a demanding workload due to staffing shortages, it leads to burnout. That was part of the reason I started a private practice. While my services are more expensive because it’s a private clinic, I offer a reduced fee to families who can’t afford them.

What can parents who can’t afford therapy do?

We’re recovering from years of depleted social contact. I recommend parents spend five to 10 minutes every day connecting with their kid: have a conversation with them, read with them, play outside together. After-school activities or clubs are also a good opportunity for kids to socialize.

Parents should also prioritize their own mental health. It can be as simple as picking up that book you stopped reading or going for that walk after dinner. These small actions will improve your mood and are a good start toward reclaiming a normal family life.

The post This Toronto social worker is seeing a surge of anxiety and depression in kids appeared first on Macleans.ca.

“A renewed interest in pay-for-service clinics creates a huge risk,” says Dr. Leisha Hawker, who has worked in Nova Scotia’s public health-care sector for over a decade (Photography by Matt Madden, Illustration by Maclean’s)

I’ve worked as a family doctor in Nova Scotia’s public health sector for a decade. These days, I’m at a collaborative health centre in Halifax that offers primary care, dental care, mental-health support and other services. I’ve been watching our provincial system inch closer and closer to collapse since I became a physician back in 2013. It’s a story that’s now common to most other provinces, but Nova Scotia has its own specific problems: 14 per cent of the people who live here have no family doctor and, worse, a quarter of our working physicians are older than 60. When they retire, our system will be even more strained. 

READ: Thousands of patients. No help. Meet the lone family doctor of Verona, Ontario.

The sentiment that public health care is failing Canadians has led to the creation of many private health care clinics, which have popped up around the country within the last year, including one in Nova Scotia. I suspect that the idea behind them is to provide patients with more timely care. But, in my opinion, a renewed interest in pay-for-service clinics creates a huge risk—and could potentially restrict health care access for those who need it most. 

Private clinics that are run by nurse practitioners and require Canadians to pay out of pocket for services, while not in contravention of the Canada Health Act, flirt with the spirit of that legislation, which states that patients can’t be charged for medically necessary care. These clinics are still allowed to exist because, when the Act was written in 1984, care from a nurse was not considered medically necessary (and therefore covered under provincial insurance plans), nor was treatment from professionals like psychologists, physiotherapists and dentists. This language should be revised, because the more that professionals in those “non-necessary” categories privatize, the more we risk creating an even greater rift, a two-tiered system that could leave the most vulnerable members of our population behind.

RELATED: An impossible job: What it’s like to work in a pediatric ICU

What’s happening in Canadian health care right now is not dissimilar to how the customs queues work at airports. There’s a priority line for experienced, affluent travellers who are willing to pay for a Nexus card. That line moves quickly, but it still requires personnel to manage it. This pulls workers from the regular line, which jacks up wait times for travellers who are unwilling or unable to pay a premium. There are also two lines in a two-tiered health care system: a private route for those who will pay and a free route for everyone else. Patients in the free line are, on average, less healthy, as low socioeconomic status is tied to worse health outcomes. The effort of treating more complex conditions slows down the queue. As more private-care facilities crop up, many medical professionals may prefer to work in those spaces, with patients who are healthier. Those clinics may also offer more flexible shifts, a real boon for providers burnt out after years of working overtime. But where does that leave the public patients?

At our clinic in Halifax, we work with patients on long-term disability, newly arrived refugees, people struggling with addictions and others who are insecurely housed. They are already at a disadvantage, because the wait for services like public physiotherapy and dental care is very long. In fact, I often find myself treating dental abscesses because of that lack of access. Those disadvantages will only compound if medical professionals abandon the public system for private options. 

(Photograph by MaddenVallis Photography)

Studies have repeatedly shown that not only does a parallel private health care stream not reduce the burdens on the public one, it can actually increase them by reducing the number of doctors available, funding and overall public support. As an example, earlier this month, the federal government clawed back a total of $82 million in health care funding for provinces who were allowing private providers to charge patients for MRIs, CT scans and other tests. That included the $1.2 million that was taken from Nova Scotia. 

MORE: The Big Idea: Stockpile Canada’s Drugs

The worry that the public system cannot care for everyone is definitely out there. I’ve spoken with physicians who say their patients, faced with long delays, feel pushed to resort to private options. This is exactly why it’s crucial to focus on and bolster retention within the public system. One way to do that is to fund more spots in local medical schools and find ways to train and license more professionals. In Nova Scotia, we’ve already begun doing the latter: as of early March, U.S.–certified doctors can practise here without having to first pass a licensing exam. The province also recently announced a $10,000 retention bonus for nurses in the public system, and extended offers to 65 Kenyan refugees, who will begin working as continuing-care assistants as of this summer. All of this is a good start, but our dearth of medical professionals is the result of decades of under-resourcing. It will take years to get out of this hole.

One of the most impactful solutions we should be funding is more of what we in Nova Scotia call “medical homes,” or health centres with a range of medical professionals under one roof. (These are known as family health teams in Ontario, and have other names in other provinces.) These models relieve the workload of overburdened nurses and doctors and ER workers whose job is to focus on treating time-sensitive, life-threatening illnesses, and they offer patients many more options than waiting to see their GP or going to the ER. At our clinic, they can consult with a family doctor, a social worker, a dental hygienist, a psychiatrist, an OB-GYN and more. Together, we collaborate on care strategies for patients whose health problems are multi-faceted. Some of our patients access four or more different services at our centre within a month. That wouldn’t be possible if each service was separate and privatized. 

To be clear, I see the appeal of publicly funded, private health care establishments, like walk-in clinics, for example. Those are important services that alleviate the public system without charging patients. In fact, that’s how the relationship should remain: private as a complement to public, not costing patients money and not exacerbating human resource shortages. It’s worth remembering that health care is not a commodity; it’s a public good.

–As told to Alex Cyr

The post I’m a family doctor in Halifax. Pay-for-service clinics will burden the public system. appeared first on Macleans.ca.

(Illustration by Pete Ryan)

Shoo Lee is professor emeritus at the University of Toronto and former pediatrician-in-chief at Mount Sinai Hospital in Toronto. He was named to the Order of Canada in 2019.

Last summer, my colleagues and I published a paper in the Canadian Medical Association Journal, insisting that pharmaceutical security needed to become a national priority. Months later, we saw why: in the midst of a “tripledemic” of COVID, flu, and respiratory syncytial virus, or RSV, panicked parents scoured pharmacies for children’s Tylenol and found only empty shelves. Sick adults couldn’t get their hands on over-the-counter cold medicines. Out west, the antibiotic amoxicillin was scarce.

As Canadian health-care professionals know, this was an extreme example of an old issue. One quarter of all Canadian drugs (over-the-counter and otherwise) were running short well before the pandemic, but there’s nothing quite like a global health crisis to expose a country’s weak points. To make sure shortages like this don’t keep happening, we need a plan—and the political will—to keep at least six months’ worth of critical drugs stocked on home soil at all times.

Canada’s fundamental problem, for a ​​long time, has been one of foreign depen​dence. The world of pharmaceuticals is attached to a hugely complex supply chain, one that’s easily disrupted by geopolitical problems (like wars), shipping issues (like high fuel costs) and, of course, viral outbreaks (like COVID-19). On top of that, the majority of the active pharmaceutical ingredients, or APIs, needed to make drugs are produced in India and China. And many brands are only supplied by one or two companies. One such drug is Clavulin, an oral antibiotic for children that was recently in short supply. 

In the past decade, the percentage of Canada’s drug spending allocated to imports rose from 74 to 93 per cent, making us especially vulnerable to supply cut-offs. As we saw with COVID vaccines, countries with their own production facilities will always prioritize getting treatments to their own citizens. If your drug-acquisition strategy relies heavily on imports, as ours does, you need mechanisms in place to protect yourself.

The good news is that Canada has run into this problem—and solved it—before. In the 1940s, most of our drugs were sourced from outside of the country. (For a while, we also paid some of the highest drug costs in the OECD.) To fix this issue, in 1969, the federal government amended the Patent Act to allow Canadian companies to manufacture patented drugs by paying royalties to brand-name pharmaceutical companies. This resulted in huge growth in Canada’s own pharmaceutical industry. But with the rise of free-trade agreements, like NAFTA, we buckled under external pressure to reverse that policy. Our companies could no longer compete; many of them went bankrupt or were bought out by overseas firms. To this day, Apotex is the only remaining large manufacturer of generic drugs in Canada. 

The best short-term solution Canada has for its current drug-supply problem is one we can copy from our neighbours. At the outset of the pandemic, the World Health Organization called on all countries to create a list of essential medicines—one that would ensure citizen access to critical drugs. Down south, the Trump administration issued an executive order to the FDA to compile a list of 227 must-have medicines, like aspirin and morphine, as well as their proper dosage methods. 

In Canada, we have no such list, aside from the 12 medicines declared critical by Health Canada during COVID, which include epinephrine and fentanyl. Drawing up our own list isn’t exactly rocket science: Health Canada simply needs to convene a panel of experts—pharmacists, doctors and representatives from the various provincial ministries of health—to decide which drugs should make the cut. For the most part, running out of something like cold medicine is an inconvenience. But people with more serious illnesses, like cancer, can’t afford to wait six months for a restock of oncology drugs. I’d also add things like anesthetics, epidurals, antibiotics and drugs used for diagnostic imaging to the list. Canadians and Americans have similar medical needs; we could very well use the FDA’s template as a starting point.

Once we know which drugs to prioritize, we need a more efficient way of stockpiling them. Like us, the European Union was crippled by a surge in sickness last winter; they began drawing up its own stockpiling plans back in January. Canada already has its own National Emergency Strategic Stockpile, or NESS, which is managed by the Public Health Agency of Canada. It’s available for the provinces and territories to dip into during emergencies. Unfortunately, it’s also riddled with problems. Back in 2010, an audit revealed that many of the NESS’s supplies were expired—some dating as far back as the 1960s. NESS was also short on much of the personal protective equipment we needed at the height of COVID. This cannot happen again.

A six-month stockpile of critical medicines should be readily available for distribution. To keep track of it, Health Canada (or some related federal department) needs to create a more rigorous internal inventory, one that’s digitized and updated in real time with every replenishing shipment or change in drug quantity. Another idea is to store the medicines in warehouses owned by the drug manufacturers themselves. The downside of this is that, in order to pay for the extra space, the government may have to allow producers to increase their drug costs. (To me, this provision is worth the price—especially in a resource-rich country like Canada.) To ensure the stockpile is always full, the federal government could establish a Crown corporation to manufacture these essential drugs. In the event of a national shortage—which, sadly is certain to occur again—production can be ramped up to meet demand. 

The long-term strategy is to create a thriving pharmaceutical industry at home. There are reasons to be hopeful: Moderna planted roots in Quebec back in 2020, with the eventual goal of producing 100 million mRNA vaccine doses every year. Last winter, Quebec’s Mantra Pharma distributed its first domestic shipment of M-Amoxi Clav—a generic of Clavulin. And researchers at the Université de Montréal are pioneering new technologies that could streamline the output of APIs, allowing manufacturers to more efficiently scale up production when our drug supply runs too low. Some people will say that Canada is simply too small a market to compete internationally, but we’ve done it once before. 

Canada again has some of the highest drug costs in the OECD, third behind the U.S. and Switzerland. We need to stop paying through our noses—and looking elsewhere—for medications that are essential to Canadians’ livelihoods. Young children shouldn’t be running fevers because we can’t secure something as simple as children’s Tylenol, and our solution can’t be to order two million bottles to get parents to stop complaining. We can’t wait for the next war—or pandemic-sized meltdown—to motivate us. We should always be prepared.

The post The Big Idea: Stockpile Canada’s Drugs appeared first on Macleans.ca.

For Lindsay Clarke, travel nursing was a means to an end (photograph courtesy of Clarke)

I’ve always wanted to be a nurse, but it was a long road to get here. In 2004, I started working for the Canadian Pacific Railway—on the “gangs,” as they call them. I built and fixed railroad tracks between Port Coquitlam, B.C. and Swift Current, Saskatchewan. I did that for six years, and met my future husband, Ryan, on the job. I told him that nursing was my real dream career. I was in and out of the hospital a lot as a kid, and I still remembered all the wonderful nurses who took care of me. Ryan told me he’d heard good things about the nursing school at Memorial University in Newfoundland, where he was from. In 2008, I applied and got in.

In 2015, two years after I graduated, Ryan and I moved to Calgary in search of more sprinkler-fitting jobs for him. I took RN jobs all over the province, and in many different practice areas: long-term care, dialysis, acute care, and emergency rooms. ERs were my favourite because I got to interact with patients of all ages. At one point, I managed a roster of travel nurses, ones who are employed by private companies and contracted out to medical facilities that are experiencing staff shortages. (They’re sometimes called “agency” or “locum” staff.) I was privy to their hourly rate, which was nearly double my wage—and sometimes more.

READ: State of Emergency: Inside Canada’s ER Crisis

Last spring, after almost a decade in the profession, I started to realize that my full-time nursing job wasn’t enough to sustain our family’s lifestyle and pay off my $55,000 student-loan debt. At that point, I was making $52 an hour working in a hospital in Edmonton. Remembering how lucrative travel nursing could be, I quit my job and, for the last year, I’ve worked with Athabasca Workforce Solutions, a travel-nursing company based in Fort McMurray. I’m licensed to practise in Alberta, Newfoundland, Saskatchewan and even Texas, working on contracts that last an average of six weeks.

RELATED: I began my ER nursing career in Ontario. Burnout and low pay led me to leave for the U.S.

When I arrive on-site, the hospital staff usually greet me with an exasperated “thank you so much for coming,” especially in rural communities. By now, everyone knows about the conditions in Canadian ERs: recently, two people died while awaiting care in ERs in Nova Scotia and in Alberta. Last October, wait times in Red Deer reached 19 hours. I’ve worked with travel nurses from all over Canada, and I’ve spoken with many that weren’t allowed to take breaks. I can remember one particular job where I had 13 high-acuity (or very sick) patients to myself; that’s triple the normal patient-to-nurse ratio. But if we stick to hospitals in our home communities, there’s no one to take care of those people.

MORE: An impossible job: What it’s like to work in a pediatric ICU

To deal with the staff shortages, some provincial health authorities are now paying huge sums to hire travel nurses, rather than renegotiating contracts with local nursing unions to offer them more money. Last year, Nova Scotia’s health authority spent $16 million on travel nurses in just nine months. Since 2020, Alberta Health Services has spent $10 million on travel nurses, and walked back an attempt to slash general RN wages by three per cent in 2021. We worked so hard throughout COVID, so that was a slap in the face. Many Canadian nurses, including me, have come to the same realization: there’s nothing keeping us here. Why would I stay? 

For me, travel nursing was a means to an end: to get caught up on our family’s debts. Gabriel, our eight-year-old son, has autism and ADHD, and I’ve often had to leave him for weeks at a time—most recently, for a contract in Peace River, which is five hours north of where my family lives. My husband is basically a single dad when I’m not there.
I would have preferred to work full-time at a hospital near my home, where I’d be paid appropriately, but that wasn’t possible. 

READ: Thousands of patients. No help. Meet the lone family doctor of Verona, Ontario.

Recently, I took a job even further afield—a permanent one, in the United States. As of June, I’ll be working full-time as a registered nurse in a private hospital in South Carolina. This time, my husband and son will be moving with me. I found the position while searching the hiring platform Indeed for travel-nursing jobs in the States. I got in touch with an American recruiter who was specifically advertising for Canadian nurses, and they made me an offer I couldn’t refuse: a yearly base salary of US$100,000, plus a sign-on bonus of $20,000. I’ll also receive a shift differential, which means that, on weekend nights, I will earn an extra eight dollars per hour. Most importantly, the company is paying for three years’ worth of housing. We can’t afford to own a place in Canada, let alone afford a decent rental. The price of heating my Alberta home tripled last month. Soon, we’ll have our green cards and be American citizens with a home of our own. 

I’m not alone in my decision to move: I know of a few nurses who are leaving the Canadian public system for the American one. Prior to securing the South Carolina job, I applied for a job in Texas. The interviewers were Canadians who moved south for temporary work and never came back. The South Carolina recruiters told me there are 11 Canadians working at the hospital I’m about to join. 

It hurts me to leave Canada. I love the idea of everybody being able to get the health care they need—and not having to pay for it—but our system is broken and needs to change. Sometimes, I feel like I’m abandoning our country right when it’s in a crisis, but I have to look out for my family. In South Carolina, I’ll be able to come home to my husband and son every single night and give them big hugs and kisses after a bad day. And when I log on to the website of my new hospital to check the emergency room’s current wait time, it doesn’t say 19 hours. It says 12 minutes.

–As told to Emily Latimer 

The post I’m a Canadian ER nurse who took a job in the U.S. so my family can survive appeared first on Macleans.ca.

Jen Recknagel is the director of innovation and design at the University Health Network’s NORC Innovation Centre in Toronto.

My grandmother lived in the same house in Cleveland for 50 years. After my grandfather died, she spent 11 of those years alone. Eventually, she developed dementia and had her driver’s licence taken away, which upset her. She soon went to live in Cape Cod with my aunt, who had offered to take care of her. Moving is hard enough, but imagine migrating to a different state in your 80s. Her health declined quickly after that. I knew there had to be a better way to support people at this stage of life. 

Right now, if you’re a senior living in Canada who can no longer live independently, there are two main paths. For those who require around-the-clock medical supervision, there are highly regulated, government-funded long-term care facilities. The other option is retirement homes, which are seniors-only private residences with set meal plans and regularly scheduled activities. But what about seniors who’d prefer to live out their days in the comfort of their own homes? At the University Health Network in Toronto, where I work, we’re exploring another avenue: bringing support directly into areas where high numbers of seniors already live. There’s even a name for these places: naturally occurring retirement communities, or NORCs. 

NORCs might be regular residential apartments, condos, co-ops or even entire neighbourhoods—geographic areas that weren’t specifically designed with older adults in mind, but which have a lot of them regardless. Many seniors who have decided to age in place might not require the intensive support of long-term care. Perhaps they cannot afford retirement homes. What my team at UHN proposes is to bring programming to them, right where they live. This could involve connecting them to health services, organizing community dinner parties or even using space in a condo building’s rec room to set up a wellness hub. NORC programs are tailored to what residents need (and want).

The NORC movement isn’t new. Programs started popping up in buildings around New York City as early as the 1980s. By 1994, New York State had passed legislation to subsidize 10 NORC programs; today, it funds 41, which serve thousands of clients. The concept has been much slower to catch on in Canadian cities, which offer no funding for NORC programs. But currently, in Ontario alone, there are more older adults living in NORCs than in long-term care and retirement homes combined. Almost 2,000 buildings across the province qualify as NORCs. Together, they house more than 200,000 seniors.

While studying NORCs, my team came across a program called Oasis Senior Supportive Living in Kingston, Ontario. Back in 2009, a forward-looking community leader named Christine McMillan—then president of the Frontenac Kingston Council on Aging—got together with residents of the city’s Bowling Green II apartment complex to discuss how to improve their living conditions. They were tired of feeling disconnected from their community, spending days in their houseclothes, and eating tea and toast for dinner because they were too tired to cook. 

With the help of McMillan and her team, the seniors paid a local community college to bring in three-course meals three times a week. Later, they convinced their landlord to let them convert an unused space in the building’s basement into a seniors’ lounge. People living at Oasis were less likely to experience emergency department visits, hospital admissions and falls. Now, Oasis operates similar programs in NORCs in London and Hamilton, Ontario, through a mix of donations and grants. There’s no reason why this kind of customized programming couldn’t be adopted (and funded) by the Canadian health care system at large.

More than ever, Canadians are keen to explore alternative models of senior care. By 2051, one in four of us will be 65 or older. Institutionalizing a quarter of the population isn’t feasible or affordable—for the government, for taxpayers or for families. The pandemic only further strained our already understaffed and overcrowded long-term care facilities. And then there are the demographic shifts: recent data from Statistics Canada shows that more adults over 65 are moving to urban areas than ever before, choosing to live in high-rises instead of detached homes. 

The NORC model addresses some of the most common issues with senior care, the first being financial. The average cost of a hospital bed is $842 per day, while care at home costs the government $42 a day, on average. Spots at retirement homes, on the other hand, can run up to $6,000 a month. If programming comes directly into NORCs, many seniors could delay going into long-term care—or possibly even avoid it altogether. They could continue to pay their own utilities and rent, and the government wouldn’t need to build as many new facilities. Most importantly, all the NORC services—from the flu clinics to the group exercise classes—could be offered at no cost to residents. 

Another good thing about the NORC model is that it allows older adults to maintain their autonomy. We’ve heard from front-desk staff in senior-heavy buildings who say they regularly get calls like, “I can still cook, but can you open this jar for me?” These are small tasks, but ones that usually fall to adult children or neighbours. A well-funded NORC might employ on-site staff to help out with the little things, particularly for adults whose mobility is challenged but not altogether gone. In buildings where higher levels of support are needed, we’re looking into connecting residents with experts who can address issues like hearing loss, fall risks or even mental health. 

Most importantly, NORC programming is driven by seniors themselves. In many cultures, elders are seen as wisdom keepers, but in North America, we ignore them. It’s almost like, “You’re obsolete now.” The NORC model recognizes that seniors have great ideas worth listening to­­­­—that they are the experts when it comes to understanding their own quality of life. 

NORCs aren’t communes, where people are always in your business. Residents can opt in and out of programming. That said, there’s an even greater need for connection as spouses and friends pass away; NORC programs can offer that. We hear from many seniors that they want to continue to live among young people and families—not just play golf or be entertained to death in seniors-only communities. Because NORCs are regular residential areas, they are inherently intergenerational. We’ve seen younger seniors—those who might have recently retired—pitching in to help those who are less mobile. NORC programs can also be customized to suit a building’s age breakdown and evolve over time. What people need between 65 and 75 is very different from what they need (and want) in their 80s.

As it stands, there is no public funding for NORC programming, but we’ve been championing the model at all levels of government. It’s been encouraging to see that, more and more, everyday Canadians are hearing about NORCs. Seniors have told us how programs have transformed their cold high-rises into real communities, and about how their neighbours stop them in the hallway to excitedly grill them about upcoming events. As you age, your world doesn’t have to get smaller. In fact, a lot of fun could be happening right downstairs.

This article appears in print in the March 2023 issue of Maclean’s magazine. Buy the issue for $9.99 or better yet, subscribe to the monthly print magazine for just $29.99.

The post The Big Idea: Help seniors age at home appeared first on Macleans.ca.

When Rebecca Hay was a teenager in Calgary, her father gave her his 2007 Canon Rebel camera and taught her everything he knew about photography. She took photos of the people she saw and the places she went, and fell in love with the art form, fascinated by its ability to help her see the world from different perspectives.

After moving to Ottawa to attend university, Hay began working as a wedding photographer on the side to help pay her tuition. She contributed to a travel photography book on the city and shot portraits in her spare time. But photography was a hobby, not a career: after graduating university, Hay returned to Calgary to attend medical school.

In 2019, during her first year of residency in pediatrics, she was required to work about seven 26-hour shifts per month, along with regular day shifts, all of which left her with little time for rest or photography. She was exhausted, sleep-deprived and constantly on her feet. During rare moments of quiet in the hospital, Hay brought her camera to work. She sat down with friends and colleagues to photograph them and hear about their experiences in health care, sharing their stories on Instagram as part of a series called “26 hr.” It gave her a chance to talk to co-workers about what they were seeing in hospitals, and to share those stories with a wider audience.

READ: Thousands of patients. No help. Meet the lone family doctor of Verona, Ontario.

In November of 2020, during an interview with pediatric resident Caitlin Marchak, the series took on a different meaning for Hay. After caring for her patients and seeing them on their worst days, Marchak said, she left the hospital feeling burnt out with little left to give to friends, family or herself. It was a feeling Hay had long struggled with herself but never talked about openly. “I knew then that I wanted to keep sharing these stories,” says Hay. “If someone could feel less alone because of them, then that would be worth it.”

Hay now lives in Ottawa, where she works as a fellow in pediatric critical care at the Children’s Hospital of Eastern Ontario, or CHEO. She continues to document her colleagues’ experiences, including in a miniseries titled “Invisible Pandemic,” which is about the pediatric crisis in hospitals caused by the surge in respiratory viruses this past fall and early winter.

We spoke to some of the health-care workers Hay has photographed.

Janet Morrison, PICU charge nurse, Ottawa

“For a few months this past fall and early winter, we went from caring for seven patients to 20. We’re only staffed to take care of seven. It was chaos. We overflowed into a second ICU, opened a third, and eventually transferred patients from our ICU to other hospitals. We were constantly waiting for free beds to admit people who needed care and had been waiting in emergency for 24 hours or longer. I worried that I wasn’t supporting my staff the way I should. It was such a busy few months. We’re coming out of it now, but we still don’t have enough nurses to care for the seven patients we’re responsible for. I think you have to be a little bit crazy to work in the ICU. There are easier jobs, but there are none more rewarding.”

Gunjan Mhapankar, pediatric resident, Ottawa

“The surge of pediatric flu, RSV and COVID-19 cases tested the limits of our emergency room and the entire pediatric public health-care system. It also affected our mental health. It seemed like the rest of the world had moved on from the pandemic, but we were in this chaotic situation with more hospitalizations and fewer beds than in the peak of adult COVID-19 cases. No child should be denied a ventilator or a bed or respiratory support, yet these are the kind of decisions we had to make. We had to triage who most needed respiratory support, while watching other kids and waiting.

MORE: I was a nurse for 10 years in Scotland. So why can’t I get certified in Canada?

So many of our ICU staff were burnt out. Many people quit, and others went on extended leave to take care of their mental health. It’s not fair to rely on the altruism and resilience of these wonderful, generous people to compensate for a lack of government planning. That burden is something that every health-care worker carries with them: if I don’t show up to work tomorrow, the sick baby in the ICU is not going to get respiratory care. I remember having to say to a family, ‘I’m sorry. Two months ago your child would have met the criteria for an ICU bed, but now we just don’t have enough beds for them.’ It felt so ethically wrong. It was heartbreaking. You live with a very direct sense of responsibility. But it shouldn’t be up to good people to go above and beyond every day. It’s not a sustainable way to deliver care.”

Chelsea Cadieux, PICU nurse, Ottawa

“Late last year, I admitted a young girl after a bad car accident. Her younger brother had passed away in the same accident. Her mother was at the bedside with me, and she had to call her extended family to let them know what had happened. I remember hearing the screams that came through the phone. They replayed in my head for a long time after.

As a nurse, you try to be strong for your patients. I wanted to cry with them and hug them and let myself feel what they were feeling, but I couldn’t crumble on the ground. I had a job to do. That was the day I realized I needed to talk to someone about all the things I’d seen working in the hospital. But the problem with therapy is that even when you realize you need help, the benefits we have barely cover it. It’s really a pitfall in nursing. You’re expected to deal with all this trauma, but you’re not given the tools to cope with it.”

Christa Ramsay, PICU senior respiratory therapist, Ottawa

“I’ve been working at CHEO in the ICU for 23 years. Before the viral surge, whenever a child died, I always felt like my team and I had done everything we could to save their life. And if it was a life that couldn’t be saved, we hopefully made the dying process as painless and peaceful as possible.

During the surge, we were stretched so thin that it felt like we were never doing excellent work. We had dozens of kids, and we had to choose which ones we were going to treat first, knowing that prioritizing one might be detrimental to others. We just couldn’t do it all. And so rather than providing excellent, timely, thorough care, we were running around putting out fires constantly. I used to dread going into work. When I left, I would get in my car, cry the whole way home, pull into my garage and just sit there, crying some more. It was days upon days and weeks upon weeks of never feeling like I’d done a good job.”

Zoya Thawer, pediatric endocrinologist, Calgary

“The other day was really challenging. I got up at 5 a.m. to catch a ferry, then started my day in a busy clinic where I was helping out a colleague, and I was also on call for inpatients at the hospital. In the afternoon we had a lunch-and-learn, and it was the first time I’d sat down all day. Just as I was about to eat, I got a phone call about an urgent patient. By the time I attended to them and I was done sorting everything out, the afternoon clinic had started and I was back to work. Not only are you physically depleted when you’re working, but there’s also the mental burden of being on call—something could happen anytime that you have to respond to immediately. It doesn’t matter that I haven’t had my lunch or a proper break.

It can be really frustrating when people say, ‘Self-care is really important,’ but then when you actually look at your day, you’re like, ‘There’s nowhere I could have really taken any time for myself.’ And it’s because of how the system is structured and how much we’re expected to work. We talk a lot about burnout and how we can make people more resilient, but it’s really challenging when the system isn’t set up to support you. We’re overworked and understaffed with no time to take care of ourselves. If the system is failing us, there are very limited things the individual can do to make that better.”

The post An impossible job: What it’s like to work in a pediatric ICU appeared first on Macleans.ca.

I got into family medicine in a roundabout way. In my 20s, I did my graduate studies in philosophy in the United States, and after that, I spent nine years working in management and software consulting, which had me on the road nearly 50 weeks out of the year. In 2002, my husband accepted a teaching position at Queen’s University in Kingston, Ontario, so we decided to move to nearby South Frontenac township. At that point, I was 39 years old and had grown disenchanted with my career. I wanted to travel less and make more of a difference in my community. Even back then, I was reading stories about a shortage of family doctors, so in 2009, I enrolled in Queen’s School of Medicine.

I was the only first-year student with kids: ours were five and one, and our third came along in year two. Motherhood forced me to become really good at time management. For four years, I diligently chipped away at my assignments, forgoing most parties and social events in favour of time with my young family. After another two years of residency, I completed my studies in 2015. After graduation, I was recruited by a medical clinic in Verona, a 2,000-person town a half-hour north of Kingston. I was replacing an older woman who was retiring. Despite being one of just two family doctors on staff caring for 1,200 patients, it sounded like a dream job. Early on, it was.

READ: State of Emergency: Inside Canada’s ER Crisis

Verona is a tight-knit community. Soon after I started working, patients began approaching me in public places, like the grocery store, stopping to say hello and, sometimes, asking me about x-ray results. Things got complicated when the clinic’s only other physician decided to return to residency. We had nobody in the pipeline to take his place. Suddenly, I found myself responsible for his patients in addition to my own—2,500 people in total. The workload was daunting, but what other choice did I have? I couldn’t leave Verona’s community without a family doctor, many of whom are elderly and couldn’t commute to Kingston for appointments. If I left, I’d also be putting our staff—a registered nurse, an officer manager, nurse practitioner and four others—in a tight financial spot. We need patient fees to pay our lease, salaries and equipment. In the end, I doubled my roster and promised myself I’d recruit a second doctor as soon as I could.

My first year as a solo doctor was particularly brutal: I worked 80 hours or more every week. I went months without taking a single day off. I enjoyed one weekday supper with my family during that entire year, and I rarely saw my own kids. I’d usually get home after they went to sleep. It’s been seven years and I’m still the only family doctor in Verona, though, now that I know my patients (and their charts) so well, I’ve gotten my weekly commitment down to roughly 65 hours. I see patients in-person (or online). I file paperwork, read bloodwork and analyze reports from specialists. On top of that, there’s the administrative work of managing office supplies, troubleshooting IT issues, shovelling snow, coordinating vaccine clinics and trying to find back-up when staff members (or their children) are sick. I have no choice but to wear a lot of hats. 

RELATED: I was a nurse for 10 years in Scotland. So why can’t I get certified in Canada?

At this point, I’m stretched too thin to be the kind of doctor I want to be; I have to sacrifice quality for the sake of quantity. I receive periodic reports on how I stack up to other family doctors, in my region and across Ontario, on delivery of colon-cancer screening, mammograms, flu shots and other services. I’m below average on a few of them. I’m often too busy reacting to problems to be proactive with preventative measures—and I hate that. It pains me to know that there are likely patients out there with cancers going undetected, ones that could be caught and treated early, because I have no time to reach out.

What hurts the most is that we’ve seen how much of a positive impact our clinic has when we have the bandwidth. About a year ago, a patient came in who had been having difficulty swallowing for months. They had risk factors for cancers of the gastrointestinal tract, so we immediately ordered tests and sent off a referral for an endoscopy. We were able to get them in to see a specialist right away—a good thing because there was, in fact, a problem. Since treatment, that patient is doing incredibly well. But for these seven years, our clinic has failed to provide timely care more than it’s succeeded.

Our phones ring non-stop, and it breaks my heart. Some calls fall through, and we often have no choice but to refer some of our patients to the ER in Kingston. Some patients have become so frustrated with our wait times that they have gotten snarky and abusive with our staff. I’ve started writing letters to them, trying to help them understand the stress we’re under. I sometimes tell them that they’re welcome to seek out primary care elsewhere if they are tired of waiting. Sometimes, I lose my cool, too. I like to think those moments are rare, but the truth is that, most days, I have to psych myself up to work because my tank is empty.

I’ve tried all kinds of ways to recruit a second family physician. I’ve published advertisements on HealthforceOntario and posted on online forums. I’ve even invited medical students to stay at my house to see if working in a small town is a good choice for them. There were a few close calls: one visiting doctor entertained us, but then chose a more urban hospital. Another eventually decided to specialize in obstetrics. A lot of new doctors in Canada are realizing that the family-doctor path often comes with a 2,000-patient roster, so they decide to specialize in something else.

Recruiting people to Verona, specifically, is an uphill battle. Nearby cities like Kingston can afford to offer six-figure signing bonuses, and communities more rural than ours (like Northbrook and Sharbot Lake) can do the same because they qualify for provincial rurality funding. Verona is in the middle—not big or small enough to do either. Why would a medical student who is probably $200,000 in debt come work with me if they can make much more money anywhere else? I sometimes think I’ll be stuck with this unsustainable burden forever.

MORE: I began my ER nursing career in Ontario. Burnout and low pay led me to leave for the U.S.

I say “forever” because, if things stay the way they are, I don’t see how I could ever quit or retire. If I did that, I’d be leaving 2,500 patients without care. That’s a huge responsibility, one I cannot convince myself to shirk. The same could be said if I suffered an accident. For now, all I can do is continue my recruitment efforts, and hope that more family doctors enter the workforce. For that to happen, we need a better funding structure and more encouragement towards family medicine within Canadian medical schools. I’ve noticed that much of the med-school curriculum is taught by specialists, some of whom disparage—implicitly or explicitly—physicians who are just GPs. Instead, we need to communicate to students that family doctors are essential. And that, without more physicians entering longitudinal primary care in the coming years, we will face the complete collapse of our health care system— undetected heart attacks, strokes and cancers; a profound deterioration of Canadians’ mental health; and an angry, sick population looking for someone to blame for their misery.  

I often think of what would happen to Verona if it had no clinic. Recently, a woman came into my office with a sore chest and a heavy left arm. She was not feeling well, but she didn’t want to bother anyone—or drive all the way to Kingston, for that matter. We did an electrocardiogram because I was concerned she was having a heart attack. I was right; she was. Because we called an ambulance to get her to Kingston, she was treated on time. I don’t know if that woman would have survived had we not been close by.

It’s those moments that remind me of the satisfaction and joys of family medicine. I hope new doctors can find that same value in it. Canada’s family doctors are drinking from a fire hydrant right now, but we still have good days—days when patients come to our clinic with an issue, when I can see them immediately and I get to say: Yes! That’s how it’s supposed to work. In those rare instances, I remember that this is my dream job, even seven hard years in. I’m trying to be optimistic that, 10 or 15 years from now, the situation will be different, and that I will be able to retire, knowing that when I leave my patients, they’ll be in good hands.

—As told to Alex Cyr

The post Thousands of patients. No help. Meet the lone family doctor of Verona, Ontario. appeared first on Macleans.ca.

In early January, a team of researchers and physicians from Toronto’s Sunnybrook and SickKids hospitals completed the first step in a world-first clinical trial of a new treatment for pediatric brain cancer. They used MRI-guided ultrasound to temporarily open the blood-brain barrier and deliver chemotherapy to a malignant, inoperable brain-stem tumour called diffuse intrinsic pontine glioma, or DIPG, most commonly found in children. Patients currently have an average life expectancy of less than a year after diagnosis. 

The study’s co-principal investigators are James Rutka, a pediatric neurosurgeon at SickKids Hospital who sub-specializes in brain tumour and epilepsy surgery, and Nir Lipsman, a neurosurgeon and director of Sunnybrook’s Harquail Centre for Neuromodulation. Here, they share what happened during the groundbreaking trial: 

Congratulations on this achievement. To start off: what is a diffuse intrinsic pontine glioma?

Rutka: DIPG is the second-most-common malignant brain tumour in children, and primarily affects kids aged five to seven. Typically, patients present with symptoms that can include facial weakness, double vision and ataxia (or incoordination).

What’s the typical outlook for children with this diagnosis?

Rutka: This tumour steadily and rapidly grows within the brain stem. Without treatment, children survive around six months; with treatment, which includes radiation therapy, they might last as long as 18 months. As surgeons, we feel helpless with diagnosis, because there’s nothing we can do surgically to extend life for those who have it. 

That’s shockingly grim. Why is it so difficult to treat?

Lipsman: DIPG is located in the brain stem—the lower part of the brain connected to the spinal cord—which controls autonomic bodily functions like heart rate, breathing, consciousness, swallowing and many others. One cannot intervene in the brain stem surgically in any capacity, let alone resect a tumour, without risking any or all of these functions. 

In short, the challenges in treating this tumour are many, but one of them is the blood brain barrier, or BBB, the border of cells that prevents certain solvents circulating in the bloodstream from entering the brain. We have chemotherapy drugs that may treat the tumour, but because these drugs don’t cross the BBB, we just can’t get them there.

And here we are, for the very first time in history, using imaging and sound waves to open the blood brain barrier and deliver medication to the brain stem. How did you come to pull it off?

Lipsman: It was a combination of the right expertise at the right time. Dr. Rutka led the pre-clinical work that showed for the first time, using animal models, that it was safe and feasible to use focused ultrasound to deliver chemotherapy for DIPG. Essentially, the technology uses soundwaves to non-invasively make a temporary opening in the BBB, which lets the medication in. His work gave us compelling pre-clinical rationale to translate this to a human population.

At the same time, the work I led at Sunnybrook amassed an experience of BBB-opening in adult patients across multiple indications, including primary and secondary brain tumours, Alzheimer’s and Parkinson’s disease. This gave us compelling data that opening the BBB in human patients can be done safely. 

A five-year old patient is in the MRI during treatment

Walk me through January 4, the day you treated your first patient.

Lipsman: The patient is a five-year-old girl: the youngest allowed for our trial. We all had sensitivities, obviously, to treating such a young patient. There was certainly an emotional element. The patient’s family was hopeful but realistic, and really invested their trust in the research team. 

How many people were in the room?

Rutka: Around 20 people, including nurses, physicists, imaging scientists, anaesthetists, and Dr. Lipsman and myself. The family arrived around seven in the morning at the front doors of Sunnybrook. It was a long time coming—we had initially planned to do the procedure in December, but the patient unfortunately came down with a viral infection, so we had to wait. There was all this anticipation leading up to it, because the family really wanted to start the therapy as soon as possible. 

What happened first?

Lipsman: She was anaesthetized, and then we applied a head-immobilization device, which is essentially a crown or ring that keeps the head steady. That frame was then attached to a helmet-like device that delivers the ultrasound. The patient went into the MRI machine, which is where the entire procedure took place. First, we took about an hour and a half to do detailed imaging of the brain to make sure the tumour hadn’t changed since we last checked. Then we infused the chemotherapy, which we believe has to be actively circulating in the bloodstream when the BBB opens. 

How did you feel approaching this critical juncture in the procedure?

Rutka: We were a little anxious about what would happen, since it had never been done in this region of the brain before. A complication could be devastating in this region of the brain, since it could affect vital bodily functions, and may have led to a termination of the study. As we opened the BBB in a series of layers, we did special MRI sequences to look for things like bleeding and swelling in the brain. The treatment was extremely well tolerated, and there were no adverse events. 

Brain scan showing world-first MRI-guided focused ultrasound opening of blood-brain barrier for delivery of chemotherapy to a common brain tumour in children

That must have been an incredible relief. 

Lipsman: We didn’t see any abnormalities at all, which was the best-case scenario. In fact, the treatment went so well that we wondered if we had successfully opened the BBB in the first place, which we needed to confirm with another MRI with contrast. That’s because contrast will only go to the parts of the brain where the BBB is open.

We confirmed that it was actually open, which means the chemotherapy did get into the brain. That image was very exciting: the culmination of many years of research! After that was done, the patient came out of the scanner and was observed for two hours at Sunnybrook before moving back to SickKids. She was back in the recovery room making jokes two hours after the procedure. 

The next morning, she had another scan—this time, we confirmed that the barrier had closed. The closure is just as important as the opening, since we want to make sure it’s a reversible procedure. 

What happens next for this patient, and for the others in this study?

Lipsman: Every patient will undergo three treatments about four to six weeks apart. If all goes well, we’re looking to treat 10 patients in six to 12 months. 

What has the reaction from the medical community been like?

Rutka: Since we’ve launched the trial, I’ve had no shortage of people from around the world asking what the entry criteria are, since there are so many children worldwide afflicted with this condition. I hope this will be the start of several trials. For this trial, we chose the chemotherapy drug doxorubicin, a potent drug that’s never been used for brain tumours because it doesn’t cross the BBB. But there are a host of other drugs, either singly or in combination, that we can use to treat this disease. In the future, we can hopefully focus on the tumour’s molecular genetics to target the most effective drugs. 

What’s the potential impact of this research beyond DIPG?

Lipsman: This method—getting medication into the brain stem (or another part of the brain) via focused ultrasound—can be used for more than just chemotherapy. In theory, we could open the blood-brain barrier to deliver any promising medication to the brain. Parkinson’s is one we’re actively working on: we recently published a phase-one trial where we showed that in patients with genetic-form Parkinson’s, we can safely deliver promising enzyme replacement therapy. We’re also interested in metastasis: using BBB opening to deliver immunotherapy and antibody treatments for breast cancer that’s metastasized to the brain. 

In short, it’s a broad tool that could be used across many different indications. It’s all part of a larger trend in neurosurgery towards non- or minimally invasive methods of intervening in the brain.

The post Q&A with the surgeons who developed a world-first brain tumour treatment appeared first on Macleans.ca.

When I was growing up in Edinburgh, Scotland, my parents bought me a toy nursing kit with a plastic stethoscope and a blood pressure cuff. I would press the stethoscope to my friends’ chests and listening to their heartbeats. At just five years old, I was obsessed with becoming a nurse.

After high school, I enrolled in a three-year nursing program at Edinburgh Napier University. I already knew I wanted to work with kids and did a placement in a pediatric surgical ward, where I changed diapers and recorded heart rates. I enjoyed the work, but it was challenging: some shifts we had to work 12 hours straight.

When I graduated in October 2007, I got my first job in the neonatal intensive care unit (NICU) of a general hospital. I looked after three babies each shift and was responsible for administering medications, monitoring vitals and communicating with parents and doctors. It was daunting to work with such small and fragile babies, but as I gained more experience, I became better at my job. In the second NICU that I worked at, there was a baby girl born premature at just 24 weeks. She needed machines to help her breathe and antibiotics to prevent infection because her immune system wasn’t strong. She would thrive one day and get worse the next. Most babies with complex needs age out of the NICU after a few months, but she never grew enough to be transferred to a children’s hospital. I did everything for her, from administering her medications to updating her care plan to monitoring her oxygen levels. After six months, she was finally well enough to go home and it was an incredible and rewarding feeling to see her healthy again.

READ: State of Emergency: Inside Canada’s ER Crisis

There are few general hospitals in Scotland that have NICUs offering the kind of complex care I wanted to provide. By 2016, I had already worked at two of them and was promoted to senior nurse. Advancing higher would have meant more paperwork and less time spent with patients, and I wasn’t interested in management positions. Where do I go now? I asked myself. Ten years into my career, I was at the top of the pay scale, yet I was only making $57,000 a year.

Over the years, I had heard countless colleagues describe their experiences working abroad in New Zealand, Australia, and the Middle East. I wanted to leave Scotland, but I couldn’t muster the courage to do it until I met my now-husband, Max McCoy, in 2013. He shared my dream to explore other countries, so in 2016, we decided to immigrate to Canada. My father-in-law lives in Philadelphia, and we had friends in Chicago and Sault Ste. Marie, so we settled on Ontario.

Through my research, I’d discovered that nurses in Canada are better paid than they are in Scotland. There are many hospitals with NICUs across the country, and the idea of practising in different provinces, in a vast and diverse country, appealed to me. I realized I would have to complete some retraining, but I thought, given my experience, it would be relatively easy to get certified. I had no idea how hard it would be until I got here.

First, I submitted an application to the National Nursing Assessment Service, or NNAS, a not-for-profit that processes the documents internationally trained nurses need to submit in order to practise in Canada. The NNAS evaluates your documents, including your education and employment history. Then it sends your file to the nursing regulation body in your province—in my case, the College of Nurses of Ontario—which decides what further education or training you’ll need on a case-by-case basis, if any, before you’re able to write the national nursing exam. I spent hours scouring online websites, forums, and social media, but couldn’t find any consistent information about the process for internationally trained nurses to become licensed in Canada.

RELATED: I began my ER nursing career in Ontario. Burnout and low pay led me to leave for the U.S.

We started our application for a permanent residency visa in early 2017. Most of the points on our visa application came from my nursing qualifications as an RN with 10 years of NICU experience. We landed in the summer of 2018 at Toronto Pearson Airport and for the first four months here, we lived all over Ontario. We earned a living by house-sitting for people we connected with online who were going on on holiday and needed someone to look after their pets. We bought a truck and a trailer to sleep in when we weren’t house-sitting and drove to Port Elgin, Fort Erie and Sault Ste. Marie. Exploring Ontario felt like a dream. We eventually rented a room in a house in London, Ontario. To pay the bills, my husband and I got jobs at a sales company in May of 2019—he started as a marketing manager and I worked as a customer service representative.

For a year and a half after I arrived, I received no update on my application to the College of Nurses of Ontario. In the summer of 2019, the college finally called. The nurse on the line admitted she didn’t know how to upskill me or what I would need to become a qualified nurse. She told me I could start by taking four courses, each 10 weeks long, costing about $1,100 per course. The deadline for the semester starting that fall had already passed, so I waited to apply the following year. I pooled together CERB payments and savings and was able to register for the courses in September of 2020. I completed them the following summer.

MORE: I’ve only been a nurse for eight months. The chaos is killing me.

The next step to getting licensed was passing the NCLEX-RN exam, which nursing students trained in North America and internationally trained nurses are required to write. Each attempt cost $400. Since I specialized in paediatrics—choosing your specialty early is standard in Scotland—my knowledge wasn’t broad enough for the test. I had to teach myself four years’ worth of adult nursing education in a matter of months. After failing my first attempt, I hired a tutor. I did better on my second try, but still failed. I stopped seeing my friends and spent every weekend studying. The test asked about drugs I had never heard of, signs and symptoms for diseases common in adults, and the disease process in adult patients.

After I failed the test for a third time, I felt like asking, “What do you want from me?” I was mentally exhausted and financially drained. Between multiple exams, registration and application fees, I spent about $7,000 trying to get licensed. I’ve since given up on nursing—it’s the only career I’ve ever wanted but I just don’t have any fight left in me. I watched from the sidelines as doctors and nurses experienced staffing shortages during the pandemic. I heard them cry out for more nurses and saw how surgery backlogs and long ER wait times hurt patients. I was scared of contracting COVID-19, but it was frustrating to only watch when I knew I could help.

I’m now a full-time dog trainer at Doggo Den, a dog-training company I started with my husband in 2021. We’ve always loved dogs and hope to expand our business to work with rescues and open a private dog park. In the process of building our business, we’ve also built a community of friends in London. I wish I could have continued my nursing career, but if I knew then what I know now, I still would have come to Canada.

Reading a book and answering multiple-choice questions correctly doesn’t make you a competent nurse. You learn that on the job, and I have plenty of experience on that front. If Canada wants internationally trained nurses to help alleviate the shortage, it needs to revise its licensing system and take their experience into consideration. It shouldn’t be this hard.

—As Told To Leila El Shennawy

The post I was a nurse for 10 years in Scotland. So why can’t I get certified in Canada? appeared first on Macleans.ca.

Created for

When the first MRI pictures of a brain affected by multiple sclerosis (MS) were developed, it revolutionized the diagnosis and management of this disease. In the decades that followed, continued scientific breakthroughs have contributed to the development of high-efficacy treatments and brought about many other changes in the clinical management of MS. However, how disease progression is detected and monitored has remained vastly unchanged.

More than 90,000 Canadians—or one in 400 people across Canada—live with MS, a chronic autoimmune disease that affects the central nervous system. As the disease progresses, the nerves may become permanently damaged, disrupting communication between the brain and the rest of the body, which can impair everything from vision and balance to memory and mobility. MS, though, is an unpredictable disease in which the severity and duration of symptoms vary from person to person and evolve as the disease progresses. As a result, this complex condition requires personalized and adaptive treatment strategies based on individual needs and the rate of disease evolution.

Supporting the MS community

Due to current disease progression monitoring limitations, neurologists often react only once relapses and irreversible progression has occurred. “What we need is to bring innovative solutions that improve the standard of care and help detect disease progression earlier so that people living with this debilitating disease can have access to the right treatment at the right time,” says Andrea Marazzi, Country President of Novartis Pharmaceuticals Canada Inc.

The best way to reach that level of innovation is by harnessing the power of cross-sector collaboration and information sharing. The pandemic showed us just what can be achieved when everyone works together to find solutions to our top healthcare challenges and, given that Canada has one of the highest rates of MS in the world, the stakes are high, so we must work together to deliver the best possible care solutions for this community.

How partnerships drive innovation

In an effort to accelerate the path to solutions and help improve patient outcomes, Novartis Pharmaceuticals Canada Inc. has partnered with Innodem Neurosciences, to study how Eye Movement Biomarkers (EMBs) and Gaze Mapping Biomarkers (GMBs) may support clinicians in analyzing highly sensitive data to monitor and detect subtle changes in disease progression. These non-invasive tests can be done in minutes in a physician’s waiting room—or even by patients at home. Through this partnership, a clinical trial is underway with the goal of giving people living with MS, and their medical teams, a more comprehensive and personalized approach to managing their disease.

“The result would facilitate real-time optimization of treatment strategies for each person’s unique journey with MS,” Marazzi says. “Remote self-testing could also alleviate wait times for appointments and ease pressure on the healthcare system, as well as benefit people living with MS in rural areas, who may not have easy access to a neurologist.”

Not only does self-testing put power back in the hands of people living with MS, it also paves the way for a new approach to how we arrive at healthcare solutions, Marazzi says. When key stakeholders from across different sectors are united, it eliminates internal biases and assumptions while also tapping into diverse knowledge and skill sets. “Partnerships are paramount to accelerating the path to much-needed solutions and to pushing the traditional boundaries of innovation in the Canadian healthcare space,” he adds.

The partnership between Novartis Pharmaceuticals Canada Inc. and Innodem Neurosciences is only the tip of the iceberg for what is possible in advancing our healthcare system, and we must lean into the opportunities for innovation afforded by cross-sector collaboration.

“Breakthroughs in science and healthcare are never easy and require a change in mindset,” Marazzi says. “And that means valuing new and fresh perspectives, a key benefit achieved through knowledge-sharing and collaboration. Ultimately, we must work together to improve access to the innovation that Canadians deserve.”

MLR ID# 251570

The post Re-defining innovation in MS—and the power of partnership to get us there appeared first on Macleans.ca.

My one-year-old son had already been sick for five days with a high fever when, on Sunday, November 20, I heard a familiar crackle from his lungs and saw his skin pulling at his neck and under his ribs as he struggled to breathe. These are sure signs of respiratory distress, that your kid is in danger.

I live in Plateau-Mont-Royal in Montreal with my partner, Willy, and our two boys, a three-year-old and a one-year-old. Earlier this year, my littlest guy was diagnosed with asthma. And this time, our emergency medication—that miraculous blue puffer—was not working. 

On Monday, at around 6:30 p.m., I took him to the emergency department at Montreal Children’s Hospital. On both previous occasions I’d taken him there for respiratory distress, we were triaged in a timely manner and were seen within hours.

READ: State of Emergency: Inside Canada’s ER crisis

This time, it was a different picture. At reception, the nurse looked at my little one for a couple of seconds and told us to sit in the waiting room, where we would get called for registration. Not even triage. Registration, which puts you in the queue for triage, which in turn puts you in the queue for a doctor. 

The waiting room was mobbed. There were no seats. Parents were sitting on the ground with sick kids in their arms. The room was filled with sick children, all crammed on top of each other—coughing, puking, crying, moaning. To make room for us, a woman rearranged her family, seating a kid on her partner. 

After an hour and a half, we still hadn’t been called to registration. Emergency rooms obviously don’t work on a first-come, first-serve basis, for good reason, but I had a one-year-old with asthma who was struggling to breathe. This is usually a high-alert category. Did the nurse, with her seconds-long visual exam, know something I didn’t? Other parents were also struggling with the delays, and, naturally, some asked staff for updates. While people were calm and polite, there was an overall air of disbelief—glances passed from desperate parent to desperate parent, helpless.

Then there was an announcement over the intercom, scolding parents for asking staff about wait times—and informing us that the average wait for all but the sickest children was now 20 hours. I thought, We can’t spend an entire day here. So I took my sick kid and went home. 

MORE: I’m a children’s hospital doctor. Thanks to RSV, we may be in for a ‘tripledemic’ this winter.

On Tuesday morning, at 8 a.m., right when the phone lines opened, we called to get him in at an emergency clinic at my health centre, and were assigned an afternoon appointment. We’re lucky to have this option. It’s only available to us because we have a family doctor; more than a million Quebecers do not. 

My partner brought our little one to his appointment at 2:30 p.m. Over the last few days, we’d watched his vital signs go up and down, the frightening retraction (pulling skin) come and go, the fever peak and dive. His temperature, at its highest, hit 41 degrees. His breathing went up to 60 breaths a minute. But he was relatively stable during the brief appointment, partly because we’d given him meds shortly before. 

The doctor examined him, found that his vital signs were okay and that it was probably just a virus. He wrote us a referral to a semi-private clinic to get an X-ray the next day, and told us to bring the baby back to the ER if he got worse. 

That evening he got much worse: crying, retraction, flopping around, rapid breathing. His temperature spiked again. I knew the situation was dangerous. We took him to Jean-Talon Hospital, which according to my online research was operating at 67 per cent capacity, the lowest we could find at ERs across the city. I called first to see if they took kids, and we arrived at around 7 p.m. 

This time, we got through triage and registration in good time. But in triage, we may have been victims of the same problem that we had at the doctor’s appointment: the nurse was seeing a five-minute snapshot of my kid’s state, and one that my partner and I had been managing with emergency asthma meds. It’s possible that keeping my kid comfortable meant we weren’t getting the proper diagnosis and treatment. But what’s the alternative? Let him deteriorate?

We sat in a waiting room at Jean-Talon, in a little plastic chair, for five hours. The waiting room wasn’t particularly crowded. I could see six examination rooms, but it looked as though only two were in use. Hardly any patients were being called in. And when the nurse did finally call out names, the people often weren’t there. They had given up, I guess. Exhausted, I took stock of the situation. The faces surrounding me in the waiting room had been almost unchanged for five hours. We left after midnight, again, without seeing a doctor.

RELATED: I’m a veteran ER doctor. I can’t believe what I’m seeing. 

On Wednesday, I cancelled work to stay home with my little guy. At this point, he was in bad shape, just flopping and wailing, flopping and wailing. A friend drove us to the X-ray around 11 a.m. I called my health clinic to ask reception to prompt the doctor to check the results. The doctor called me back within five minutes. Pneumonia. My asthmatic child had pneumonia. Pneumonia that should have been diagnosed and treated when I presented at the ER two days before—and which, in pre-pandemic times, probably would have been.

Now we had a diagnosis, and only needed treatment. The doctor sent a prescription for antibiotics to our Pharmaprix and instructed me to start them that day. My partner and I were figuring out who’d go to the pharmacy when a staff member called and they said they didn’t have any antibiotics because of a shortage in Quebec. He said the pharmacy would contact the prescribing doctor to ask for an alternative. I asked how long it would take—would it happen right now? He said, no, it wouldn’t be immediate—the pharmacy had to contact the clinic, the doctor had to contact the pharmacy, and so on. 

In my arms, my kid was burning hot, alternating between crying and nursing, struggling to breathe. He wouldn’t let me put him down for a second.

“This is crazy,” I said to the pharmacy employee, and tried to explain the urgency of the situation. He sneered and asked if I wanted to try to find the drug at another pharmacy. I was enraged. I’m sure he was stressed because of the strain on the health-care system, but—as I none-too-calmly informed him—he was not as stressed as someone with a one-year-old who can’t fucking breathe.

After maybe 30 minutes, someone from Pharmaprix called back. She’d found a place that could make the prescription from raw materials. It was in Youville, about a 20-minute drive away. My partner left work, jumped in a Communauto and waited an hour for this out-of-the-way little pharmacy to mix our baby’s meds.

We were finally able to give our child the medication he needed. Following a three-day nightmare, including two attempts at going to the ER, a delayed life-threatening diagnosis and a mad scramble to find antibiotics, our one-year-old is slowly getting better.

But none of this should have happened. It wasn’t a particularly complicated diagnosis or treatment—but at every step we ran into walls, from outrageous waits to medication shortages to burned-out health workers. If this madness continues, children are going to die here this winter. I believe that. My asthmatic one-year-old had pneumonia and couldn’t breathe properly—let me emphasize, he couldn’t breathe—and we still couldn’t get seen. 

A lot of people are blaming long hospital wait times on an uptick in children’s respiratory illness. That’s a contributing factor, sure, but it’s not the full story. For the public system to improve, we need to invest in it. Instead of incentivizing people to become doctors and nurses, we’re torturing the ones we have. Quebec and Canada need to address the structural problems that have caused this failure of essential social infrastructure—a disaster that was waiting to happen.

—As told to Mathew Silver

The post Inside my three-day nightmare at a children’s ER appeared first on Macleans.ca.

Dr. Earl Rubin is the division director of pediatric infectious diseases at Montreal Children’s Hospital.  

The most important things to know about RSV, or respiratory syncytial virus, are that it’s common and that it’s been around for a long time. Generally, it presents something like a cold in older children and adults. But RSV also usually causes bronchiolitis, which is an inflammation of airways in the lungs. This can cause major respiratory issues in babies, since their airways are smaller; in premature babies, it can be life-threatening. This recent surge in cases, however, has created an unprecedented burden on children’s hospitals’ emergency rooms, ICUs and inpatient units. We are now facing what adult hospitals experienced at the peak of COVID, if not worse. I’ve never witnessed a level of overwhelm like this in my 30 years of practicing medicine—and that’s thanks to this recent wave of RSV.

Typically, RSV season starts in November and continues through March. What’s different this year is that cases are arriving much earlier and there are way more of them. According to recent figures from the the Public Health Agency of Canada, there have been 1,045 detections of RSV, which is well above expected levels for this time of year. Lots of kids aren’t getting tested, so we know that number is actually way higher. Usually the majority of children admitted with RSV are under nine months of age. We’re now increasingly admitting kids up to the age of two—especially if they have a history of asthma or allergies.

                READ: State of emergency: Inside Canada’s ER crisis

At Montreal Children’s Hospital, our ICU is well over 100 per cent capacity; our emergency room is at 200 per cent capacity. If patients need to be admitted, they have to stay in the ER because we don’t have free beds in the ICU or elsewhere, which is slowing everything down. When you walk into the emergency waiting room, it’s so packed that patients can’t find any empty seats. A few weeks ago, people were waiting four to six hours before being seen. Now, we’re seeing wait times that range anywhere from 12 to 24 hours. Imagine being a parent and having to entertain a sick child for that long.

Twice a day, the hospital staff have bed-management huddles to strategize the best ways to handle the influx of patients: we assess who’s waiting to come in, who we can safely send home earlier than we normally would to free up beds and who we can transfer from our ICU to other wards. Nurses are working overtime on weekends in our ICU to keep up with the demand. We’re doubling up on kids in single-patient rooms, and we’ve borrowed ventilators from other wards. Unfortunately, there’s not much else we can do to cope.

There’s one potential cause driving the explosion in cases: prior to the pandemic, about 90 per cent of kids would have been infected with RSV by the age of two, which gave them some residual immunity when they got older. (That meant they wouldn’t get sick the next time they caught it.) The past two-plus years of masking, social distancing and other COVID-prevention measures mean that babies haven’t been contracting RSV at nearly the same rate. That’s why we’re seeing toddlers getting it for the first time, with symptoms severe enough to merit hospitalization. So now it’s babies and toddlers. To make things worse, more parents are taking their kids to emergency due to shortages of children’s Tylenol. Normally, that would help control fevers at home. 

Like the cold, there’s no treatment for RSV beyond care and time. If alternatives are available, my advice to parents is to avoid using hospital emergency rooms as drop-in clinics at this critical moment. Of course, on evenings and weekends—when clinics are closed—there is no other option beside ERs. RSV cases usually peak in January and February during a normal year, but we don’t know what the numbers are going to look like this season. We really have no idea. If the flu arrives in full-force while RSV cases are still mounting, we’re going to face a double whammy. There’s also the possibility of a new COVID-19 variant this winter. That means we might encounter what some have called a “triple-demic,” which makes me very nervous. 

At children’s hospitals like mine, we haven’t really had to deal with the burnout that physicians and nurses at other hospitals experienced during COVID. We’re starting to encounter those issues. Everybody is working harder than they ever have before. We’re all doing our best, but it’s exhausting to do this day after day. We can’t keep up these extreme efforts for too long. We’re aware that—unlike with COVID—there’s an end to RSV season. That’s our light at the end of the tunnel; that makes us believe we can make it through. 

— As told to Ali Amad

The post I’m a children’s hospital doctor. Thanks to RSV, we may be in for a “tripledemic” this winter. appeared first on Macleans.ca.

A few months ago, a middle-aged woman in seemingly fine health came to my ER, feeling under the weather. She had called her family doctor, but he was booked up and couldn’t see her for six weeks. I treated her instead, and when I pulled up her records, I saw a recent scan ordered by that same doctor, the results of which she hadn’t yet learned: cancer, already too advanced to cure. It wasn’t just one tumour; they were everywhere. It was up to me to tell her she had a handful of months, at most, and she should start getting her affairs in order.

There was nothing else to do but hold her as she cried. She asked me what would happen to her spouse—who is older than her and dependent on her—when she was gone. More than anything, I wanted to say I could get her another year, or two or five. Instead, she heard the hardest news of her life from a stranger wearing a mask and a shield, in an exam room steps from the noise of gridlocked hallways and a packed waiting room.

For 39 years, I’ve worked as an ER physician at Great War Memorial hospital in Perth, Ontario, part of the Perth and Smiths Falls District Hospital. After all that time, I’ve become intimately acquainted with life’s fragility—how any of us can be here one moment and gone the next. That’s part of the job. But medicine shouldn’t be so ugly and upfront and harsh. Patients shouldn’t have this kind of news delivered in an overcrowded, underfunded emergency department by a person they’ve never met. More and more often, however, these heartbreaking, infuriating scenes are playing out in my hospital and in countless others across the country. Why? In part because the pandemic delayed checkups and put routine scans on the backburner. More patients discovered how sick they were, or that they were sick at all, during visits to ERs that were already struggling and in no condition to substitute for day-to-day health-care providers.

Yet we can’t simply blame this crisis on COVID—that’s the easy way out. Canadian health care, both primary and emergency, has been buckling for decades, and I’ve had a front-row seat to its slow collapse. For the past 21 years, I’ve been public affairs co-chair of the Canadian Association of Emergency Physicians, the professional association for Canada’s emergency doctors. I’ve always seen our emergency department in Perth as a microcosm of Canada. Everything that happens here is also happening in the roughly 850 emergency departments nationwide: overcrowding, staff shortages, violence, abuse, burnout, patients warehoused in the ER because they can’t get a bed. What happens in Perth happens everywhere, and what’s happening in Perth has never been as bad as it is today.

Wait times for non-admitted patients to see a doctor have shot from one hour to five. Patients who need a bed might wait 24 hours or more (the provincial average for emergency patients is 21 hours). Sometimes it’s even longer: early in October, I came in for a shift to find five patients waiting for admission. When I came back the next day, they were all still there. Admissions take longer, which means treatment takes longer, which leads to more complications and higher mortality. 

Under these conditions, it can be nearly impossible to maintain the compassion and care that should be intrinsic to our profession—the humanity and decency that good doctors bring to their work. A humane ER is not one in which patients are dying in the halls, as we’ve seen in Canada these past two years. It’s not one where seemingly healthy people learn of terminal diagnoses in exam rooms commandeered for brief moments of privacy, or where violence and abuse have become run-of-the-mill. 

Our lowest point in Perth—so far—came in July, when our ER shut down for nearly four weeks. The closure left a town of 6,500 people, and the tourists who flock here in the summer, with only bare-bones access to emergency services. Our closure was unprecedented in its length and severity, but predictable in hindsight. In province after province, reduced hours and shutdowns have become distressingly common. And while the pandemic accelerated the decline, the rot was evident decades ago, in the form of neglect, under-investment and the devaluing of the doctors and nurses who keep our emergency departments running day to day. The decline of the primary-care system has only put more strain on us. For those paying attention, the origins of today’s crisis were visible years ago—even in a little ER like mine.

(Photograph by Johnny C.Y. Lam)

***

I’ve always loved emergency medicine. There’s a wild, satisfying, anarchic breadth to the work. Since 1983, I’ve been a family physician in Perth, serving around 1,500 patients, and I’ve worked as a coroner as well. But emergency is my true passion—I’m hooked on the anticipation and adrenalin, on never knowing what will come rolling through the door. In the ER, you have to master the art of turning chaos into calm, of moving from the tragic to the mundane in the blink of an eye. You may need to leave the weeping family of a cardiac-arrest victim to attend to someone with back pain, or go from a man with terminal liver disease to a guy calling you a “COVID Nazi.” You need to appreciate the good and the bad in humanity and maintain a sense of humour (preferably a dark one) about it all. Rural emergency medicine requires even deeper commitment. Small-town physicians live where we work—our patients are often our neighbours, and we’re personally invested in our hospitals. 

With 49 beds, Great War Memorial is small but mighty, covering a vast rural area and treating 25,000 emergency patients each year. When I got to Perth as a young doctor, after internships and residencies in Montreal, Ottawa and Vancouver, emergency medicine in Canada was barely considered a specialty. Instead, it was something of a dumping ground for old surgeons, or new immigrants who faced barriers to setting up practices. This lack of interest in emerg was especially prevalent in rural hospitals. By the late 1970s and early ’80s, it was becoming clear that it would be beneficial to have physicians who specialized in cardiac and other trauma emergencies. The focus became on educating and training staff to identify and treat life- and limb-threatening crises. 

That’s what we did in Perth, where I made it my life’s work to transform our emergency department. In 1988, I became the department’s medical director, a job I held until 2012. I started by bringing in trauma surgeons and emergency doctors from Ottawa and Kingston to tell us what happened to patients we’d sent to hospitals there, and to help us break down to the minute what we could have done differently with them. Our doctors and nurses took emergency certification courses, and we set up study programs and performance reviews. We did away with onerous 24-hour shifts to make sure doctors and nurses were well rested rather than exhausted and crabby. We committed, in tangible ways, to transforming the department for the sake of our patients. 

I worried our staff would get sick of it and quit; for a small-town ER, this kind of levelling up was unusual. But it paid off. In 2013, CBC’s The Fifth Estate did a special report on Canadian hospitals and gave ours an A+ rating. I was incredibly proud to know that our hard work was being recognized. Patients knew that when they got here, they’d be treated by people who truly cared. 

In ERs from St. John’s to Victoria to Iqaluit, life-threatening emergencies requiring immediate attention make up only a tiny part of the patient load, maybe two per cent. Other patients, who need to be seen within an hour—heart attacks, pneumonia, appendicitis—represent another 20 per cent or so. Then there’s everything else: vague pains, broken bones, wasp stings. One major difference between a rural ER and an urban one is that we see more cases that would otherwise go to a walk-in clinic. Part of our mission is to be there as a stopgap. In recent years, though, that stopgap has been stretched far beyond reasonable limits. 

There wasn’t a single free bed, but patients kept coming. On days like that, there’s no privacy, no confidentiality, no dignity.

The number-one issue today in Perth, as in most ERs in Canada, is overcrowding, and all the knock-on effects that follow from it. Overcrowding—loosely defined as being unable to care for patients within a maximum of four hours—was first identified as a problem in Ontario in the late 1980s. It became so severe in Toronto that in the 1990s, the Ontario Hospital Association launched a task force to tackle it. One major problem identified was a lack of beds. In the last half of the ’90s, the number of acute-care beds in the province fell by 22 per cent, even as demand rose thanks to a growing and aging population. In 1995, the occupancy rate for those beds was 85.6 per cent. That’s not bad—a safe hospital is defined as one with 85 per cent occupancy or less. By 2000 it had climbed to 96 per cent. Some hospitals in Canada now exceed 100 per cent, with patients spilling into any hallway or exam room or other corner that can accommodate them. One Wednesday evening this past July, the Lanaudière Hospital in Saint-Charles-Borromée, Quebec, peaked at 191 per cent capacity. In 2021, the Organisation for Economic Co-operation and Development ranked Canada 31st among 34 countries for acute-care capacity, with 1.97 beds per 1,000 people. (Japan, at the top of the list, had 7.74.) 

We can see the effects of this over-crowding every day. One afternoon this past summer, I came in for my shift and found every treatment stretcher occupied by admitted patients, with more in the OR recovery room. Because the recovery room was full, elective surgeries, for people who’d been waiting months for a knee or shoulder replacement, were cancelled. There wasn’t a single free bed in the building—and still people kept coming. The only place we could see patients was on chairs in the hallways. On days like that, there’s no safe space to assess a patient. There’s no privacy, no confidentiality, no dignity. 

It’s no surprise our ERs have become full of tension, anger and violence, nor that ER staff have been on the receiving end of it, from raised fists and raised voices to streams of expletives to containers of bodily fluids tossed across the room. One patient’s irate husband stomped on, and broke, a doctor’s leg. Another patient reached for a cop’s gun. I once kicked someone out of the emergency department for yelling at a nurse, after I decided he didn’t need further attention. He later stalked my private office. Five years ago, a staff member at our sister site in Smiths Falls was stabbed in the head with a pair of scissors. That same year, a nurse was nearly strangled at a hospital in Montreal. 

The effect of all this is devastating on patients and staff alike. If you’re sitting in the waiting room with a sick child who has an ear infection, you don’t want a guy dropping F-bombs and making racist comments. If you’re lying on a stretcher in pain, it’s exhausting to also deal with somebody screaming beside you.

In 2015, health-care workers had more than twice the number of violence-related lost-time injuries that police and correctional officers had combined. And half of all attacks on health-care workers occur in emergency departments. Nurses, who spend the most time with the public, bear the brunt of it. That drives absenteeism among nurses higher and higher—nine per cent for full-time public-sector nurses in 2016, costing taxpayers an estimated $989 million. 

In spite of it all, Canadians haven’t been deterred from visiting ERs. A 2016 analysis by the Canadian Institute for Health Information found that 41 per cent of the population had used an ER within the previous two years, more than citizens of other Western countries including the United States, France, the United Kingdom, Australia, Germany and Switzerland. Often this is because people can’t get appointments with their family doctor, or they don’t have one. And so the furious cycle continues.

***

COVID devastated our ERs. When it struck ours, we had 15 nurses working full time and part time hours in Perth. They were wonderful people who understood emerg, who were as addicted to it as I am. Nurses are the ER’s lifeblood: they triage, do assessments and exams, assist with dressing changes, coordinate with labs for tests, help patients get home when they’re discharged and much more.

Our nurses had been voicing their concerns about overcrowding and other issues for years with hospital administration and the province, and were often dismissed out of hand. So it wasn’t surprising when, in the first six months of the pandemic, they began leaving for other jobs in health care, like working as a nurse in light industry or at a family clinic—jobs where they don’t work weekends and nights, where they aren’t faced with abuse and threats, where they aren’t in a constant state of burnout. We dropped from 15 nurses to seven, then to five. A couple left on maternity leave, but most left for other, less taxing health care jobs. I can’t blame them. The ones who remained were deeply demoralized. 

They also felt terribly betrayed during COVID. For more than a year, they had come to work, putting themselves in just about the highest-risk place you could find yourself during a viral pandemic. They saw what had happened in New York City and in Italy: doctors and nurses dying, patients’ beds overflowing into parking garages. They stayed anyway. When vaccines finally became available, the province’s chaotic, disorganized rollout meant that front-line workers weren’t necessarily the first to get them. We often saw people doing virtual medicine, and other low-risk professionals, getting shots ahead of ER staff. 

This May, for National Nursing Week, our hospital administration gave each nurse a cookie as a thank-you. All I could think was: These people have been running around in gowns and gloves and masks and shields for two and a half years. And you give them a fucking cookie?

(Photograph by Rodolphe Beaulieu)

***

Once our ER dropped to five nurses in June of 2022, I knew that was it—it’s impossible to run a department with such a small staff. Our nurses were already working a shift, going home, having supper and playing with their kid or dog before coming right back. It was unsustainable. We were doomed. The hospital administration met on a Friday at the end of June to discuss the possibility of short-term closures. One idea was to close overnight through the summer. By Monday, this had leaked to the press. The emergency staff were stunned. Administration simply expected us to accept the idea. 

Then, within days, we lost two more nurses to COVID absences. Suddenly we were at three, a perfect scapegoat for a full ER closure. One staffer reached out to our malpractice association to ask about the repercussions and risks to community members, and to our patients in ICU and the rehab ward, if we closed. What if someone had an embolism after an orthopedic surgery and all the ER doctors were at home on the couch?

The administration agreed to keep one ER doctor in the hospital 24/7, in case someone came in with a real emergency or an issue that was quick and easy to treat, or in case something happened on one of the floors. It felt like a tiny win. 

Beginning on July 2, the ER shut down, a closure that stretched from one week to two to most of the month, until July 24. Those were quiet shifts for me. I treated one guy who came in with an allergic reaction to bee stings. I watched the maintenance crew polish the floors and patch up the walls. I literally watched paint dry. I continued working in my family practice nearby while the ER was closed, and one day, a woman came in alarmingly short of breath. Normally, help would have been 100 metres away in the ER. Her situation was potentially life-threatening, and I had to send her 20 kilometres down the road, to Smiths Falls. She survived, but it could have been much worse.

The nurses who quit didn't disappear into some cosmic black hole. But we're going to have to work very hard to regain their trust.

Politicians still insist the ER crisis is not so dire. In August, Ontario Premier Doug Ford said, “Ontarians continue to have access to the care they need, when they need it.” This was days after approximately two dozen Ontario hospitals reduced service over a long weekend. In Nova Scotia that same month, Premier Tim Houston said, “If you get sick in this province, you will get extremely good care. Shame on anyone who suggests otherwise.” In July, the Nova Scotia NDP obtained freedom-of-
information data showing that 43,000 people left that province’s ERs in 2021 without receiving treatment, presumably due to interminable wait times.

Across the country, more closures are piling up, too many to count. In British Columbia, the Dr. Helmcken Memorial Hospital in the town of Clearwater—one of the only hospitals in a vast rural area—has been closed more than 60 times this year. In Alberta, small-town ERs have been closed, or left with only nurses, dozens of times. Ontario has had more than 80 ER closures so far in 2022, including the shuttering of the ER in the little town of Chesley, which closed in early October due to a shortage of nurses. It’s not scheduled to reopen until the beginning of December. This fall, a leaked report on ER statistics obtained by the province’s opposition Liberals showed that on any given day in 2022, the average number of patients waiting in emergency departments for an inpatient bed was 884—a 53 per cent increase over 2021. 

People’s lives are hanging in the balance here. At Great War Memorial, we’ll never know exactly what patients or problems would have come through our doors if we hadn’t been closed. We’ve since hired a few new nurses, but we’re still relying on agency nurses—temporary workers provided by private staffing agencies. As good as they are, they’re not a lasting solution. The provinces love to talk about tight budgets and yet, across the country, they’re paying agency nurses double what their union counterparts make. 

Even with better pay, nurses aren’t going to come back unless there’s a firm commitment to mitigating violence and burnout and improving patient safety. The nurses who left Great War Memorial haven’t been raptured; they didn’t disappear into some cosmic black hole. They’re out there, and they’re addicted to emergency medicine, same as me. But we’re going to have to work very, very hard to regain their trust.

***

I’ve seen firsthand what it looks like when structural failures strip medicine of its patience, compassion and humanity. In 2010, one of my three children, Hilary, found a lump in her breast. I told her it was probably a cyst, nothing to worry about. I was wrong. Weeks before she graduated from university, she was diagnosed with stage-four metastatic cancer.

I knew Hilary was going to die, but I wanted her to have as full a life as possible. When she was diagnosed, her oncologist in Kingston said, “Don’t treat her, she’ll be dead in six months.” I was so incredibly angry. We found another oncologist, who was very kind, and we got more time together. For six years, Hilary was in and out of hospitals and doctors’ offices, and so was I, beside her. There was chemotherapy, radiation, multiple surgeries. We encountered wonderful doctors and awful ones.

Through my daughter’s experience, I saw medicine from a different angle, and I was shocked. After meeting some of her doctors, I thought, Why are you even here? You’re in the wrong profession. But now I think that maybe they weren’t simply bad doctors—maybe they too were burned out, at the end of their rope, having given all they could. Either way, they shouldn’t be looking after vulnerable people. My wife and I came away wondering what it must be like for patients who don’t know how to advocate for themselves or their families. Our daughter, had she been on her own, would have been lost. 

Hilary’s illness and death in 2016 had a profound impact on the way I treat people. I’ve recommitted myself to being as caring as I can. No matter the day, I try to make every patient encounter meaningful. It’s not just “Here’s the literature, here are your pills, get out.” It’s “How are your kids, your cows, the family dog?” I try to get patients to see me as a navigator through a health system that is extremely complex and often unfriendly. Ideally, I’d give people as much attention as they need, but there is so rarely the time to be as decent as we should be.

I am only one person, one doctor, in one town. We need a systemic transformation to restore a health system in which doctors and nurses have enough time, energy and empathy, where people aren’t learning of terminal illnesses in the ER, where desperately ill people are not warehoused in hallways. 

Governments across the country are putting on a brave face. But there needs to be real talk among the premiers and the federal minister of health, Jean-Yves Duclos, about what is going wrong. I’m hoping for a national study, a forensic audit—efforts with teeth. If you’re going to avoid crowding in emergency departments, you need to avoid crowded hospitals. That means more funding and more beds. It means improved access to home care and long-term care, so patients have places to go besides the ER and don’t spend three months in the hospital after fracturing their hip.

After decades in emergency medicine, I’m still passionate about what I do. At our hospital, we have a great foundation to build on: community support, committed physicians and nurses, and hopefully, leaders who recognize the jewel that they have. If we get through this winter and further COVID waves intact, we can become whole again. The people I’ve met over the decades in emergency represent the very best of what medicine is, and they try extraordinarily hard to make a flawed system work. That’s why the best of us do what we do, and why it’s been so painful to see some of the best of us leave.

This article appears in print in the December 2022 issue of Maclean’s magazine. Buy the issue for $8.99 or better yet, subscribe to the monthly print magazine for just $39.99.

The post State of Emergency: Inside Canada’s ER Crisis appeared first on Macleans.ca.

Perry Bhaskaran started his career as an emergency room nurse in his hometown of Scarborough, Ontario, in 2019—the same year Ontario’s Ford government passed Bill 124, which capped annual salary increases for public-sector nurses and other care workers at one per cent. Bhaskaran initially had no plans to leave the province, but when the pandemic corroded his working conditions and unhappy co-workers left the field in droves, he moved to Houston to continue his nursing career. Here, Bhaskaran opens up about the discouraging landscape for Canada’s nurses, and why repealing Bill 124 is crucial to keep our health-care system from collapsing.

Working in a hospital often means you’re dealing with people having the worst day of their life. Helping those people is exactly what attracted me to the field.

I’ve never wavered in my desire to become an RN. I graduated from Ryerson (now TMU) in June of 2019, and spent nearly a year in the ER at Scarborough General before transferring to Markham Stouffville, the following April, shortly after the pandemic began. The team at Markham Stouffville was amazing, with some of the friendliest, most supportive doctors and fellow nurses I’ve encountered. Sometimes, a hospital environment can be quite toxic for people at the outset of their career, but that was absolutely not the case.

Only six months into my nursing journey, I was welcomed with open arms. The team was so strong that for a time, I was blind to the negative aspects of the job—namely the poor pay and challenging conditions. But as COVID waves hit, I saw some of our strongest staff leave—leave the profession, the province or the country. In time, it became glaringly obvious that our province’s policies—which influence how hospital administration and management behave—signal a total lack of care and respect for health-care workers.

READ: I’m a veteran ER doctor. I can’t believe what I’m seeing.

In 2019, the Ford government passed Bill 124, which is essentially wage-suppression legislation for health-care workers, ostensibly in the name of sustainability. It capped wage and benefits increases for nurses and other care professionals at one per cent. When you’re 21 years old, a starting pay rate of $33 per hour is amazing compared to other professions. But when you work for a few years and realize you’re only ever going to see a 60-cent per hour increase in your pay, it isn’t exactly motivating.

Meanwhile, my job got harder and harder as staffing shortages increased. We were supposed to have around 20 RNs working, yet we would regularly be short around seven RNs at any given time. That makes an enormous difference—especially when you’re missing senior staff in areas like critical care and resuscitation. A lot of our nurses would step up and work up to 16 hours—well past their designated 12-hour shift—with few or no breaks, just to help out the team. You can only keep that up for so long.

Our ER felt like a warzone. We had patients in hallway stretchers testing positive for COVID, and the triage line snaked around hallway corners. We had to go down the line asking, “Who is here with chest pain?” so we could figure out who we should prioritize. It was common to have two nurses for four trauma-bay rooms, nine monitoring critical acute rooms and psych rooms, and two to three nurses in a fast-track area with over 50 people. To be clear: that is not nearly enough, and far fewer than normal.

We were so busy that no one was able to eat, drink or have a break for a full 12-hour shift. It was heartbreaking to watch patients in critical condition come into a completely bed-blocked ER, then have to decide who was stable enough to give up their bed. It was a nightmare, and I was reaching the end of my rope.

MORE: I’ve only been a nurse for eight months. The chaos is killing me.

I wrote emails to the administration letting them know that morale was critically low. It was a cry for help, but nothing changed. We were called heroes, but our deteriorating working conditions remained the same. 

The doctors who stepped in to fulfill nursing roles while we were critically understaffed earned hundreds of dollars in premiums. Meanwhile, the nurses who were being asked to work longer and harder than ever got nothing but overtime pay. The attitude from management felt to me like: We want more and more from you, but we’re not going to do anything else for you. It’s almost as if their message was that by virtue of being nurses, this is the sort of treatment we signed up for.

RELATED: How to fix our broken health-care system

I started forming an exit plan and applying to hospitals in the United States. Since I hadn’t been nursing for two full years yet, which is typically a requirement, I faced an uphill battle. But I was fortunate enough to connect to a woman through the website Indeed who in turn connected me to the HR department at Houston Methodist Hospital, which sponsors and brings over Canadian and other internationally educated nurses.

Last May, they offered me a position. To say my experience here has been a complete 180 would be an understatement. When I accepted the job, I received a $15,000 sign-on bonus, two $15,000 referral bonuses and $4,000 to help with relocation. All my visa expenses were paid for, and my employer even paid for a one-month hotel stay while I looked for an apartment.

Now I have a relationship with the chief nursing officer, Andrea, and her care and commitment are evident. It’s typical here for members of the administration to come down to the ER, get involved and see what’s happening on the ground—a stark difference from my Ontario experience. What’s more, I feel supported and heard. It honestly feels like a family. I was personally welcomed by the hospital CEO, and there’s even a shared governance structure: I have a voice in major changes that affect my job.

What is happening in Canada right now is shocking. There’s no reason clinics should be closing because they’re understaffed, or that people’s lives should be put at risk due to ER wait times. I don’t believe for a second that there isn’t enough money in our publicly funded system. There is—it just needs to be properly allocated. Otherwise, the health-care system will collapse.

If I could sit down with a member of the Ontario government, I would tell them to wake up. Listen to people working on the front lines and repeal Bill 124. This isn’t just about making nurses’ personal lives better. As nurses like me continue to leave the country to seek better conditions, communities will start feeling the pain. They already are.

—As told to Liza Agrba

The post I began my ER nursing career in Ontario. Burnout and low pay led me to leave for the U.S. appeared first on Macleans.ca.

It’s no secret that Canada’s primary-care shortage is a national emergency, but in British Columbia alone, roughly one million people lack access to a GP. To address this systemic failure, a few enterprising clinic owners have abandoned the province’s publicly funded Medical Services Plan, or MSP, in favour of privatized solutions.

Victoria-based Beta Therapeutics, an integrated wellness clinic that offers services ranging from counselling to physiotherapy, is banking on subscription-based primary care: as of November 1, interested patients can shell out $110 per month for regular access to a family doctor. (Think Netflix, but for full-body check-ups.) We asked clinic director Samantha Rocha about how she came up with Beta’s plan to go (partly) private, what patients are saying about the move, and whether doctor subscriptions are the future of care in Canada.

Q: What was the original operating model for your clinic?

A: My partner and I didn’t create Beta with the intention of it being a private primary-care clinic. When we opened in 2018, we didn’t have a family doctor on staff; we only offered services like massage therapy and counselling. We decided later on to hire a family doctor as an independent contractor—one who’d get paid through MSP, the government’s publicly funded plan. Under MSP, family physicians bill the government roughly $31 per patient visit. Then the docs pay their clinic a monthly flat rate—usually around 30 per cent of the fees they bill per patient visit.

How did the doctor search go?

We conducted several interviews, but we couldn’t find anyone who was willing to join us. Lots of B.C. clinics are having trouble hiring. Physicians are struggling to make a living wage within reasonable working hours, and even then, the fees they pass on to clinics are barely enough to cover overhead costs, like staff and rent. When you factor in the rising cost of living—plus student debt—doctors aren’t able to earn sufficient take-home pay in the public system.

What motivated you to consider a private-pay approach?

Beyond our needs as a business, we were hearing from our patients—from all ages and socioeconomic backgrounds—about how hard it was to get the care they needed. When a parent without a family doctor has a sick child, they have to choose between a long wait at an understaffed emergency room or a walk-in clinic whose time slots quickly fill up each morning. We had to figure out a solution so we could keep our doors open, and the monthly access idea came to us at the beginning of this year. By July, we realized we had no other option.

So how exactly does the monthly subscription model work?

First, the doctor has to opt out from MSP so they can bill private fees from patient visits. For us, it’s as simple as announcing the availability of a family physician and enrolling patients who’ve applied to be on their roster. So far, we’ve brought on one physician. They’ll start onboarding their patients this fall.

RELATED: My job as a family physician in small-town British Columbia is a dream come true. It’s also nearly impossible to do.

How did you come up with $110?

A lot of research. We had to take into consideration the cost of keeping our clinic afloat, and we also wanted to offer doctors a fair wage that gave them a reasonable work-life balance.

What about patients who can’t afford the fee? Subscription-based care would cost more than $1300 per year.

We’re not saying $110 per month is an insignificant amount, but our fee is considerably lower than the ones charged by many existing private facilities. We’re constantly going to be monitoring our prices to keep them as accessible as possible.

MORE: Q&A with a doctor in one of Canada’s long COVID clinics on the real dangers of the diagnosis

Do you think this model will contribute to a better standard of care?

Definitely. Because our doctors are getting paid a flat rate per patient—instead of a per-visit fee via MSP—they can spend more time with patients than they otherwise would under the public model. They won’t have to fit as many appointments as possible into one day just to earn a decent income, which in turn means a less stressful atmosphere for everyone.

Can any B.C. clinic (or doctor) do what you’re doing?

Yes, but it’s a bit tricky. Private-pay medicine is legal in B.C., but there’s a reason why every physician who’s struggling to maintain their practice isn’t getting into it. If you’ve treated the same patients for several years, it would be unethical to abruptly announce that you’re now charging a fee and dump all the people who can’t pay it. The College of Physicians and Surgeons of B.C. has bylaws that address the ethics around doing something like that, but we could also see new rules coming into effect to actually prevent that switch.

READ: I’m a veteran ER doctor. I can’t believe what I’m seeing.

Isn’t your model giving credence to a two-tiered health-care system? How do you feel about that?

Private-pay medicine in B.C. isn’t new—it’s co-existed with the province’s publicly funded health insurance for a long time. What we’re doing is getting attention because private-pay care has traditionally come with a price tag that makes it inaccessible to the masses. We aren’t offering “executive” health care that only caters to a small percentage of the population. We’ve set a price point that allows a lot more people to at least consider accessing this kind of care.

What kind of response has the service received so far? 

Our doctor only has 20 per cent of his spaces left in his patient panel, and we opened applications back in July. Every Monday, we run a free information session for anyone who wants to drop by. Some people are really grateful to have more options for care. We’ve also talked to others who feel strongly that what we’re doing is not a good move, and that privatized health care in Canada is not the way to go. That being said, we haven’t lost any patients.

Do you see the subscription service as a short-term cost-covering measure, or is this Beta’s new normal?

Because my partner and I own our clinic, we have the option to abandon our private-pay model if the province comes up with a more sustainable model. The reality is that the kinds of changes that need to happen within the public system will take years to implement—if they ever do. Clinics like ours, and patients throughout B.C., don’t have the luxury of waiting for that to happen. So we’re going to take on another doctor in the next six months. The demand is there.

The post This B.C. clinic is charging $110 a month for access to a doctor. Is this the new normal? appeared first on Macleans.ca.

The lockdown era of the COVID-19 pandemic is—hopefully—over for good, but even as the last of the mask mandates are dropped, many Canadians are still in it for the long haul. Long COVID, which occurs when symptoms of the virus persist four to 12 weeks after infection, has been linked to everything from brain fog to insomnia and even organ damage. Doctors are only now beginning to understand the full scope of the condition.

Dr. Angela Cheung, a senior physician scientist with Toronto’s University Health Network, recently helped to establish 18 long-COVID clinics across five provinces to provide care for Canada’s long haulers—and to map out what they’re in for. Here, she explains the extent of long COVID’s damage, how it’s burdening the already inundated health-care system and why it’s not all in your head.

What inspired you—and other physicians—to open Canada’s long-COVID clinics?

I’m a general internist, so I’ve been looking after COVID patients since March of 2020. In my group practice at Toronto Western Hospital, I was seeing more patients with lingering symptoms. I realized COVID wasn’t just an acute illness—some people weren’t returning to their usual activities after getting it. What we’ve seen with COVID reminds me of the early days of HIV, when people were struggling to understand the disease. At the beginning of the pandemic, I was reminded of a quote by the late tennis player Arthur Ashe, who was HIV-positive. He said, “Start where you are, use what you have, do what you can.” 

How did the clinics get off the ground?

We got funding from the Canadian Institutes of Health Research for the Canadian COVID-19 Prospective Cohort Study, which is the first Canadian study to examine early outcomes for infected patients. Our first one joined the study in August of 2020. After people heard about the clinic we were running, we started getting referrals from physicians and colleagues, and we connected with folks across the country who were willing to help. We’ve had family doctors, general internists, infectious-disease doctors, respirologists and endocrinologists working with us, and we now have 18 sites across British Columbia, Alberta, Manitoba, Ontario and Quebec. We closed recruitment for the study back in March of 2022 after seeing more than 2100 patients, but we’re still treating people.

Are there any cases that stood out to you, in terms of their severity?

I’ve seen marathon runners—who had no other diseases prior to COVID—who now can’t walk a block without being short of breath. When I was working in the COVID ward, I saw 90-year-olds who were quite well and 40-year-olds who had to go to the intensive-care unit. A common idea is that it’s only people who are already unhealthy who will get sick and suffer from long COVID, but it’s not like that.

What kinds of mental health fallout have you seen? 

We see anxiety and depression the most. Take the example of the marathon runner: they used to run without blinking an eye, and now they’re left wondering what the rest of their life will look like. Some patients have post-traumatic stress disorder from losing multiple loved ones during the pandemic. 

There’s so much we still don’t know about long COVID. What do we know?

We know that the COVID-19 virus enters the cells through something called the ACE2 receptor, which is found throughout our bodies. That’s why we tend to see many different symptoms—in our gut, lungs, brain, heart and kidneys. We know that the more recent variants, like Omicron, may pose a lower risk of long COVID compared to previous strains. We also know that it affects women more, usually those between the ages of 35 and 65. Right now, we’re trying to understand why some people can’t get rid of their symptoms. Our group in Montreal has done genetic analyses that show there are two different types of variants that may predispose someone to long COVID. The science is moving forward pretty quickly, so every week, we learn something new. 

What is the prognosis for long COVID? 

We don’t currently have a cure, but we’re treating symptoms and seeing improvements. If a patient has fatigue, resting and pacing themselves is important. If a patient is coughing—and their chest X-ray is normal— we give them steroid inhalers. For congestion, we give nasal sprays. Long COVID isn’t something that goes away in a day or two.

Have any long-haul patients told you they’ve had trouble accessing care?

There is a lot of frustration. People sometimes have trouble getting doctors to believe that they still have physical symptoms of the virus. Some people make assumptions that these symptoms are due to anxiety, not from the virus. Our health-care system is also very overwhelmed—actually, it’s stretched for everything, not just long COVID. I do think that we need to start thinking more creatively in terms of how we can look after everyone. It’s not just physicians who are stretched. 

Do you think governments are taking the effects of long COVID seriously enough? 

I’m not a public health official; I work in a hospital. COVID still exists. My perspective is that we should still be wearing masks, and we don’t need a mandate to wear them. You don’t need someone to tell you to use an umbrella when it’s raining.

This interview has been edited for length and clarity.

The post A doctor in one of Canada’s long-COVID clinics on the real dangers of the diagnosis appeared first on Macleans.ca.

Jacelyn Wingerter became a registered nurse in January and has worked in a Saskatchewan ER ever since. At only 22, she says being on the front lines of a collapsing health care system has crushed her stamina and her spirit. This is her story.

—As told to Carly Lewis 

When I was a teenager, I spent a lot of time in hospitals with my grandmother while she battled breast and pancreatic cancer. I was surrounded by amazing nurses who cared for her and comforted my family. I decided back then I wanted to help others just like they did. I wanted to be there for people on the worst days of their lives, and try to make them feel even the slightest bit better. 

After four years in university, I became a registered nurse eight months ago and now work at a Saskatchewan hospital. I started during the pandemic, so I understood things would be intense. I never could have imagined how bad it would get, or how burnt out I would be at the age of 22. 

Our emergency room is severely over capacity every day. The waiting room has space for about 20 people, but we typically have 40 to 50 patients waiting for care. Patients in the waiting room are crammed shoulder-to-shoulder while we’re still in a pandemic. There’s nowhere for them to go. Right now our average wait time is around eight hours, maybe longer.

In Canada, hospitals use the Canadian Triage and Acuity Scale, or CTAS, to triage patients. CTAS2 is the lowest someone can go before requiring a trauma bed immediately. It’s not uncommon for us to have 10 or more CTAS2 patients in the waiting room with chest pains experiencing possible heart attacks, people with broken bones, or level-two traumas—for example, people who’ve been in a car accident. On a recent shift it seemed as though triage was broadcasting a CTAS2 in the waiting room every five minutes. Most of those patients needed a bed with a monitor and one-on-one care. We couldn’t give it to them. They had to wait. 

RELATED: I’m a veteran ER doctor. I can’t believe what I’m seeing.

We had a cancer patient the other day who was short of breath. They were not well, at all, and had to sit in the waiting room for five hours before getting a bed. Our admitted patients—the people who who made it out of the waiting room—are currently waiting upward of 100 hours in the ER to get a bed on their designated ward. Not a single bed is open. These are patients admitted for neurology, cardiology, internal medicine and oncology and who require a few days in the hospital. We don’t have room for them. When I went in on Sunday night there was a patient who had been stuck in the ER since the previous Wednesday. 

Paramedics line the halls waiting to offload their patients. We’ve had EMS waiting more than 12 hours in our hallway with their patients before they can return to the streets. These issues have a domino effect—not only are emergency rooms scarily overcrowded, but they keep paramedics tied up at the hospital, unable to respond to emergency calls. We’ve also had STARS Air Ambulance stuck waiting in the hallway for a bed. If anyone had needed to be airlifted during that time, they would have had to wait. 

We have 35 beds in our department, and 100 patients needing treatment. We’ve been treating patients in hallways. We recently had to squeeze two beds against our main desk. There’s no privacy, not even a curtain, and patients’ medical information can be overheard by anyone nearby. With the lights on and nurses running around, they can’t get any sleep. These patients come into our care to get better. How can they get better when they can’t even rest?

There was a bad car accident here recently. Two people died. I keep thinking about what we would have done if they’d needed to come in. I don’t know that we would have been able to keep them alive. We just didn’t have the hands, or the beds. 

For the past three months we’ve been short-staffed every shift. It’s not because of Covid—it’s because nurses are burnt out, and many have left the profession. We should have at least 19 nurses on each shift, but sometimes we’ve been nine nurses short, six nurses short. When I left a shift last week we were five nurses short, so we closed down part of the ER for the night. I haven’t seen any improvement. Things continue to get worse. It’s been complete chaos from day one. 

I feel defeated. I’m doing everything I can but it’s not enough. The number of patients is just too high. I leave every day feeling like there was something I missed or something I could have done better, wishing I could have helped more people, the way my grandmother’s nurses helped my family. I wish I’d had time to at least say hi and have a short conversation with my patients and show them I care, but I just run from room to room for my entire 12-hour shift. I have to start IVs, deliver medications, take patient vitals and update charts. I don’t have time to build rapport or provide a therapeutic relationship to my patients. 

My co-workers and I try to take our breaks, but we usually end up skipping a few of them. Sometimes, when we do go on break, we get called back out. We just have to keep going. People need our help, and if we don’t help them no one else can. 

Outside of work, I don’t really cope with it. I don’t recognize myself anymore. On my days off I sleep all the time, because I’m so tired and have no energy to do anything. I used to go to the gym five or six days a week. I played sports, I walked my dogs. Now I’m just too exhausted. My personality has become jaded. I’m carrying a lot of anger and frustration I wasn’t carrying before. It’s hard to sleep when I get home from a shift. I can’t stop thinking about everyone at the hospital. 

I love my job and my co-workers, but I leave every shift feeling incredibly upset at the state of our health care system. Every single staff member is stretched to their limits. In the last two years, many nurses, including myself, have started taking antidepressants. 

The government needs to realize our health care system isn’t collapsing—it has already collapsed. We need more funding and more beds. But even if we get more beds, where is the staff coming from? There’s a lot of work that needs to be done on recruiting and retaining staff. So many nurses are leaving the profession. Even eight months in, I don’t know how long I can continue to work like this. I have at least 30 years to go. At this rate it’s not sustainable. We will literally be killing ourselves if it continues like this. 

Nurses are basically dying to be heard by our government. It’s been months of horror, and no change. I hope they hear us soon.

The post I’ve only been a nurse for eight months. The chaos is killing me. appeared first on Macleans.ca.

Dr. Kashif Pirzada has been an ER doctor in Toronto for 15 years. In recent weeks and months, he’s witnessed the overcrowding and long wait times that patients have been forced to endure. And that was before a new wave of COVID-19. Exasperated with what he says is unclear messaging by provincial governments, he warns that COVID-19 is far from over—and hospital emergency rooms all over the country are bearing the brunt of the crisis. This is his story. 

—As told to Liza Agrba 

Believe it or not, I got into emergency medicine because I watched the show ER in high school. The idea of being someone who could make a difference in a critical scenario—to help people every single day you come into work—was really appealing to me. And that’s what keeps me coming back, despite all the problems we’re experiencing.

Right now, ERs are dangerously overcrowded. Every evening, I face people who have been waiting for six to eight hours, and have to simultaneously assuage their anger with the failure of the system and fix their problem. Being constantly on the defensive trying to explain what’s happening is profoundly demoralizing.

It’s not unusual to come into a shift these days and see that you’re down one third of your usual staffing complement. That means you can’t staff the beds that you have, and you see more and more patients in fewer spaces. When a wave happens, like right now, it starts knocking people out for sickness. They’re off for seven to 10 days with symptoms. And then you cross your fingers wondering who’s going to get long-term symptoms after that.

When we’re stretched too thin, paramedics can’t offload patients because there’s no one to take care of them, so we have 10 to 15 teams of paramedics practising what we call “hallway medicine” before someone can resume care. So you have basically a huge chunk of your active EMS staff sitting in a hallway in the hospital.

RELATED: I’m on a waitlist of nearly 100,000 Nova Scotians hoping to find a family doctor

The other thing is that people wait much longer to get help. When the patients do get to us, they’re understandably very upset. I can’t blame them. But we take the brunt of their feelings, and that leads to people burning out and wanting to leave the field. So all of it comes together into a perfect storm. There’s real moral injury from watching a system fail and collapse when much more could be done to shore it up. The system has never been the greatest with ER and specialist wait times, but it’s significantly worse now.

I recently saw someone who had a brain hemorrhage and needed surgery. Since we don’t do brain surgery at that particular hospital, usually we would quickly send them to a neighbouring hospital with an escort of our own staff. This time, we just didn’t have any staff to spare. We had to wait for a special team to do the transfer. They were delayed too, so this person ended up waiting to get urgent surgery. A few years ago, they wouldn’t have waited at all. This kind of thing is happening more and more. And not only are patients waiting—they’re waiting to see someone who’s already overworked that day.

I saw somebody with kidney stones last week. That is an excruciating condition. If we had more staff, we usually try to pick out these people, give them pain medication right away and line them up for a scan to find out where the kidney stone is. One patient waited for about eight hours before getting any pain medication. They were extremely upset, and I would have been too.

The problem is being exacerbated by a resurgence of COVID cases. It’s become obvious that COVID, unfortunately, didn’t end like we thought it would. It’s continuously mutating and trying to evade vaccines and our immunity, and we’re seeing the evidence of that in the hospital. It’s important to stress that vaccines are still preventing serious illness in most cases. But because we keep having waves, our health care system is under enormous strain.

We test for COVID all the time, and up until two weeks ago, almost all of the tests I’d send out came back negative. But in the last two weeks, I started seeing a major uptake in COVID cases—especially with very young and elderly patients. It’s causing a serious increase in patient volume and major delays in the emergency room.

The first COVID case I saw in the most recent wave was a woman in her 60s. She was triple vaccinated and didn’t present any respiratory symptoms.  She had been nauseous for a week and nobody knew why she wasn’t eating or drinking. Her blood work was a mess: she had inflammation all over her body, and then our COVID test came back positive. We had to admit her to the hospital and start her on antivirals, steroids and other medications that we give people with severe COVID to take down inflammation.

That symptom pattern has held true with many other new COVID cases, which indicates that the new subvariant—Omicron BA.5—is different than previous ones. Some people will present with just weakness. Others come with headaches, neck pain and vomiting.

Another case I saw was a woman with a joint condition that had been stable for 10 years. She came into the ER with COVID and a huge infection of one of her joints. COVID seemed to be the catalyst. Viral infections weakening you and leading to other infections is a well-known phenomenon.

READ: The battle for the soul of Muskoka

Not only are we seeing an uptick in COVID cases, but we have a reduced capacity for dealing with them. We’ve lost a significant number of experienced nurses over the pandemic—especially in the last six months. We’ve lost doctors too, but definitely more nurses. They’ve had it. The stress has been too much, and I can’t blame them.

It takes years to develop an emergency room nurse skillset, like how to pick someone out of a waiting room who’s going to deteriorate quickly. Losing each one of these nurses is a huge loss, and we’ve lost a ton.

Because of the staff shortages, a lot of people have not been getting leave time approved. A lot of these people end up quitting. That’s a common story among nursing and physician staff right now. Everyone is burning out.

I’ve found the issues to exist outside of the ER as well. Once we discharge patients, we rely on sending people out to specialists to deal with the conditions we find. But now specialists are overwhelmed, too. I saw one lady who had a suspicious breast lesion and couldn’t get in to see anyone for three to four weeks. Can you imagine wondering if you have cancer and not being able to get a biopsy or a scan for that long? In another case, someone had a new blood clot, and we couldn’t get them follow-up appointment for months.

We also get all these patients coming with long-term COVID symptoms: fatigue, heart palpitations, brain fog. The specialists we would send them to—neurologists, cardiologists—don’t have capacity to see people. We have nowhere to send them.

Seeing whole families get sick at the same time is definitely a big theme right now. The lack of awareness really frustrates me: people are happily sending their kids off to camp with no COVID precautions whatsoever, and then a whole group of kids get sick, some of whom end up in the emergency room.

I think the summer weather, with people doing activities outdoors, will keep the damage of this wave as low as possible. But what we’re seeing in the ER is probably a dress rehearsal for what’s coming our way in the fall and winter, so right now is a good time, policy-wise, to plan for that. That would entail making sure that all indoor spaces have excellent ventilation by upgrading HVAC and putting in HEPA filters, and improving messaging from the provincial government so the public knows when they need to mask.

Unfortunately, I think ERs will look like this for a long time unless we find a way to significantly beef up capacity. It’s going to be a longer road than we thought.

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As most of us retreated into our homes for the past two years, new research suggests that alongside the drastic shift in our daily routines came another ailment: dry eyes. From wearing masks to spending more time in indoor air-conditioned climates and an uptick in WFH and hybrid work models—as well as online education—the causes of dry eyes have grown in number and frequency with many tied intricately to our day-to-day routines.

Why do dry eyes happen?

The average adult human blinks 15 to 20 times per minute to keep our eyes clean and hydrated—but staring at digital screens can reduce that rate by more than half. And with a dramatic rise of WFH, online schooling and even gaming—along with increased reliance on our phones—we’re looking at screens more than ever before. Over time, the quality and quantity of our tears can deteriorate, resulting in digital eye strain and dry eyes. Air conditioning can also increase the airflow towards our eyes, drying them out quicker. This can be particularly noticeable for those who wear contact lenses.

How can you prevent dry eyes?

Being aware of your blinking habits—as well as consciously blinking often, especially during periods of intense focus and work—can help mitigate dry eye symptoms. The American Academy of Ophthalmology suggests a 20-20-20 rule¹: every 20 minutes, divert your attention away from your screens to look at something at least 20 feet away for 20 seconds. Reducing the brightness and contrast on your screens can also help reduce irritability.

Avoiding open air vents can help minimize drying conditions. Improved sleep habits—which have suffered throughout the pandemic, exacerbated by lengthy home stays and lack of time outdoors—can also factor into relief for dry eyes, according to a 2021 review² of risk factors leading to “quarantine dry eye” worldwide. Drinking more water and adjusting your diet can help prevent dry eyes; look for omega-3 fatty acids, found commonly in fish.

What if I’m unable to minimize screen time?

In today’s digital-first era, it’s not always possible to shy away from screens. For many of us, screens make up a significant part of our daily routine, totalling several hours per day.

The simplest solution? Store a bottle of eye drops at your desk to help keep eyes hydrated and relieve dry eye symptoms. A preservative-free option means you can apply eye drops as needed to soothe your eyes, including before you go to bed.

Preservative-Free Biotrue Eye Drops are available over-the-counter at your local pharmacy, and provide instant natural hydration. Available in single- and multi-dose formats, these eye drops provides instant relief for dry eye symptoms and are suitable for use with contact lenses. The main ingredient, hyaluronic acid, is naturally produced by your body and helps attract and retain moisture while soothing irritation.

Over-the-counter eye drops and artificial tears can help in relieving dry eyes, but if symptoms persist, contact your eye doctor.

To be sure this product is right for you, always read and follow the label. To receive the most up-to-date information on these products, visit www.bausch.ca or call 1-888-459-5000. Code: v2

^{1 Boyd, K. (2020). Computers, Digital Devices and Eye Strain. American Academy of Ophthalmology. https://www.aao.org/eye-health/tips-prevention/computer-usage}

^{2 Napoli, P. E., Nioi, M., & Fossarello, M. (2021). The “Quarantine Dry Eye”: The Lockdown for Coronavirus Disease 2019 and Its Implications for Ocular Surface Health. Risk management and healthcare policy, 14, 1629–1636. https://doi.org/10.2147/RMHP.S277067}

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In the past five years, Canada’s Maritime provinces have enjoyed a dramatic reversal of demographic fortune. Immigration has surged, and the outmigration of youth that long plagued the region has reversed. The pandemic accelerated the trend, but the turnaround began years prior, turning the East Coast into a hotbed of fast-growing cities.

But as with most booms, there’s a dark side. In the Maritimes, all that growth has strained provincial health systems, which were already on unsteady footing. Nowhere is this more obvious than in the shortage of family-care providers. 

The Maritimes don’t have the highest rate of residents without a primary-care provider—that would be Quebec, followed by British Columbia. But they do have the highest rates of residents who report being unable to access care in a timely fashion, and the highest proportion of residents who are unable to find a doctor despite actively seeking one. 

Evelyn Hornbeck, a 31-year-old Halifax resident, is among the 95,000 people currently on Nova Scotia’s waitlist for a primary-care provider. This is her story.

I’ve been lucky—or at least luckier than many. 

“In 2008, I moved from Ottawa to Halifax for school. After I graduated, I was able to get a doctor in Halifax right away. There was a primary-care shortage even then, but my Nova Scotian partner’s doctor, who also took care of his whole family, took me as a patient. We were privileged to enjoy that arrangement for the next 12 years, even as many of our friends struggled to find care, and the health care crisis got worse.

There was always a gnawing sense of “What if something happens to our doctor?” And then, one day last October, my mother-in-law texted my husband and said, “It looks like she’s retiring.” 

READ: Canadian paramedics are in crisis

I know doctors often struggle when they end their practice, and I don’t think our doctor’s abrupt retirement was in her plan. But all of us—me, my husband, his 80-something grandmother and our entire family—suddenly lost that connection to basic health services. We went on the waitlist for a new doctor right away, but there are nearly 100,000 people on it with us. We don’t expect to find one soon.

The anxiety around all this is intensified because I’m on a controlled medication, which walk-in doctors are very reluctant to prescribe, and pharmacists can’t prescribe. 

My medical issues began a long time ago. There were lots of things that didn’t quite add up for me—things that I’ve had trouble with and affected my quality of life. I began seeking treatment in 2019, but my family doctor never felt comfortable diagnosing me, or prescribing the psychiatric medication I required on her own. I had a therapist, who referred me to a different doctor who had some knowledge in this area. 

We spent a year or so trying a few different medications. Nothing quite worked, and I took a break to clear my head. Then that doctor was arrested for possession of child pornography. His practice closed. 

Finally, I found another doctor and got a diagnosis and a prescription—and suddenly things made sense. I was able to succeed at work and in my personal life. It was a situation where I had to be my own advocate—the system was not making any of this any easier. I went from banging my head against a wall to feeling like a door was opening. A lot of people might have just given up. 

MORE: A homeowner’s worst nightmare

The medication has made a huge difference in my life. Watching my prescription run out feels like watching a time bomb ticking down. 

To be clear, my situation is far from the worst out there. But I think that’s why it’s especially important to highlight how difficult it is for a lot of people to access basic care.

My husband and I have been married for five years, and we’re thinking about family planning. But, unable to find a doctor, in a lot of ways we feel in limbo. I need a doctor; my mental health treatment and medication requires medical guidance. 

What am I supposed to do? 

— As told to Matthew Halliday

The post I’m on a waitlist for a doctor with 95,000 Nova Scotians appeared first on Macleans.ca.

For family doctors passionate about delivering quality medical care and maintaining a healthy work/life balance, running a successful practice—while managing the countless administrative tasks that divert their time and energy from patients—can be difficult.

Not at Sault Ste. Marie’s award-winning Group Health Centre (GHC).

The GHC difference

“We feel there’s a link between physician well-being and better patient outcomes,” says Dr. Jodie Stewart, a family doctor on GHC’s Board of Directors and the CEO of the Algoma District Medical Group. “We have a dedicated staff assisting physicians with onboarding, retirement planning, practice transitions, schedule development, dues payments and many other aspects of professional life. At the GHC, physicians are not bogged down by trying to run a business, they’re devoting all of their time to what matters most: the patient.”

The GHC is home to a top-notch, ever-growing medical team, including primary- and specialty-care physicians, nurse practitioners, allied-health professionals and more than 100 nurses. It eschews the quantity-based “fee for service” model for doctors, operating instead with a unique quality-driven blend of stipend- and billing-based payments. And its expansive facilities offer an array of comprehensive services, from diagnostic imaging and cardiology testing to physiotherapy, audiology and a new integrated electronic medical-records system. The result is multidisciplinary end-to-end care for patients and invaluable administrative support and resources for doctors.

“The GHC provides [us] with an office, examination rooms, a nurse, clerical staff and all of the equipment needed to run a modern practice without any up-front costs,” says Dr. Jonathan Bishop, who moved his family to Sault Ste. Marie 10 years ago. “The opportunity to join the GHC was one of the biggest selling points for me. It’s a unique organization that doesn’t fit any of the standard care models.”

Photo supplied by Dr. Jonathan Bishop, who moved his family to Sault Ste. Marie 10 years ago.

Improved work-life balance

Dr. Allison Webb, who moved to “the Soo” in 2015, agrees. “I can enjoy my practice, focus on the medicine and feel well-supported with great clerical and nursing staff,” she says. “I provide a number of services as a family physician, and I love that I’m not needing to simultaneously run a business.” The GHC’s collaborative environment is also a key draw. “I love the sense of community. I’m not working in a silo,” says Dr. Stewart, and Dr. Bishop concurs. “Practicing in the same building as numerous other family physicians and specialists allows for easily accessible discussions, either by phone or in-person, to provide optimal care for patients,” he says.

Photo supplied by Dr. Allison Webb, who moved to “the Soo” in 2015.

Just as appealing for the doctors? What moving to Sault Ste. Marie and working at the GHC has afforded them outside of their practices: enviably short commutes, spectacular natural beauty, endless outdoor-adventure opportunities and savouring a work/life balance coveted by many big-city physicians.

“Even if I don’t get home until six or seven at night, I can still take our kids waterskiing, tubing or fishing right from the beach in our backyard,” says Dr. Bishop. “Being able to come home after work and enjoy a sunset on Lake Superior puts things in perspective as to how fortunate we are.”

To learn more about practice opportunities in Sault Ste. Marie, contact Christine Pagnucco, manager of physician recruitment at PagnuccoC@sah.on.ca.

The post Why doctors are moving to Sault Ste. Marie to join its innovative Group Health Centre appeared first on Macleans.ca.

In November of 2020, Patricia Gauthier walked away from her post as head of vaccine business at pharmaceutical giant GSK to become the general manager—and first employee—of Moderna Canada, a subsidiary of a decade-old U.S. biotech company that had yet to bring a product to market. 

Gauthier, a Quebec-born lawyer who lives in Etobicoke, in Toronto’s west end, had no office, co-workers or blueprint for the task ahead: overseeing the Canadian approval of a new kind of vaccine, then bringing millions of doses into the country at lightning speed.

Eighteen months on, nearly 30 million doses of Moderna’s Spikevax have been distributed in Canada. In April, the company laid a big bet on this country, announcing plans to open a facility in Quebec by the end of 2024 to manufacture mRNA vaccines for COVID-19 and other viruses. 

In May, on her first day at Moderna’s new Toronto headquarters, Gauthier spoke with Maclean’s contributor Christina Frangou.

When did you realize this virus would change your life?

The big moment was when I joined Moderna. It was six months into the pandemic and three weeks before Moderna received approval from Health Canada for its COVID-19 vaccine. The mission was clear. I was not only taking on a new job but creating Moderna Canada from scratch in my home. 

Did the company come to you? Or vice versa? 

A bit of both. I’m very curious. I always read up on new companies and technologies, and I was looking for my next challenge. Moderna caught my eye when they secured their first contract with the federal government in July 2020. I read in La Presse that CEO Stéphane Bancel said the company will open affiliates around the world—10 in the next two years. There was no Phase 3 clinical trial data as I was interviewing. It was like a bungee jump. I was going from a very secure role to taking a leap of faith.

When you became general manager of Moderna Canada, you were working from home, in the same house where your two kids were going to virtual school. What was that like? 

I was just asking my daughter about this the other night: do you recall when we would go for walks after dinner because that was the only thing we could do?

The first thing was accepting that nothing was going to be perfect. I told my kids and husband that I’d be working a lot more. I’d need everybody to step up and be more autonomous. But when you give space to people, it’s phenomenal what they can do. 

Working from home had its challenges. The kids were going through homeschooling. I’m fortunate they love school—it was not a battle each day. I had the benefit of being able to have dinner with them every night.

Were your kids aware of the stakes at your new job?

When I got the offer from Moderna, I also had offers from my previous company to move to London or the U.S. I asked my girls, who were seven and nine at the time, for their thoughts. Either we move and work remains the same, or I stay in Toronto to build a company from the ground up and participate in the effort against a pandemic, and I work a lot more. My oldest said, “Mom, I really want to stay here, but I don’t know how you can work more.” I was, like, “Watch me. You’ll see.” They knew, and were supportive. 

READ: How Anita Anand became the Trudeau government’s all-round fixer

You were thrust into the spotlight as Canadians were demanding vaccines. Moderna had barely started producing its vaccine at commercial scale, and supplies were extremely limited. How did you deal with that pressure?

I have never done as much media as I did during my third week on the job. It was a learning-in-the-moment experience. The scrutiny and external pressure were high. I had to learn to focus on what was critical. 

I felt capable and confident. We were very transparent with the government as to where the situation was. We didn’t even have a manufacturing supply chain a year earlier, and we felt every bump along the road. While these bumps were not pleasing to the public eye, I knew we were doing everything we could to bring vaccines to Canadians. We turned every stone, including bringing vaccines from the U.S. in June last year so everybody could get their second-dose summer, as the Prime Minister had promised. 

What do you mean by “turned every stone”? 

Health Canada had approved doses only from European manufacturing sites. Moderna made the same vaccine in the U.S., but once we found doses there, we had to work quickly with the department to approve the American manufacturing sites. This was done in less than a month.

Did you have to convince American colleagues of the necessity of getting doses into Canada? 

Moderna had to fulfill its obligations to the United States, but Canada wanted to be the first in line after the Americans. I’d been working hard to make sure this country was always a priority market, so that any time we had capacity out of the U.S., Canada was top of mind. 

Before the pandemic, was this country’s lack of domestic biomanufacturing an issue?

For as long as I’ve been in pharma, the federal government has had a pandemic influenza strategy that includes having onshore manufacturing sites, which they have with other drug makers. I was part of that at GSK. 

What we didn’t have in Canada—and other countries did not have either—was a pandemic plan for Disease X, the potential pathogen that can become a pandemic. In 2019, Disease X was SARS-CoV-2. That’s where we’ve tried to create a new solution with the federal government. Our platform, mRNA, enables us to develop vaccines with speed, bring them to clinical trials and scale up manufacturing. It’s a paradigm shift from where we were before. 

MORE: Ahmed Hussen has a plan to solve Canada’s housing crisis

What vaccines will be made here?

Pending Health Canada regulations, we are planning for the COVID-19 vaccine and updates to the COVID-19 vaccine, which include a potential bivalent vaccine we are working on. The vaccine we have now is designed for the Wuhan strain. The bivalent vaccine will be for Wuhan and Omicron together. It gives some cross-protection against other variants of concern and increases antibody response. We are also planning vaccines for influenza, respiratory syncytial virus, and combinations. We could have a COVID-19–influenza combination vaccine. 

Moderna made global commitments to focus on 15 priority pathogens, including HIV. By working with experts for these viruses, we can build a library of vaccines for them in the early stage of clinical trials. Then, should there be a pandemic, we can quickly move them through later phases of trials and seek approval. 

But we need to have a manufacturing site that is always pandemic-ready. You do that by keeping the site warm, manufacturing vaccines for other respiratory diseases that use the same platform. 

The current vials from Moderna have 10 to 14 doses. There’s a lot of wastage in Canada when vaccinators open a vial. Will this change?

Absolutely. The 10-to-14 is the pandemic package, because we wanted to bring as many doses as possible, as rapidly as we could. The 14s were coming from the U.S. It was not the typical Canadian package. We are moving to a five-dose vial that will be available once approved.

The Council of Canadians and others have said the Montreal-area facility will not address global vaccine inequity. What’s your response?

There’s no silver bullet to vaccine inequity. That’s an issue we take to heart at Moderna. We are building a manufacturing site in Kenya to support Africa. We have pledged not to enforce our patent during the pandemic for the Gavi AMC countries. They’re the 92 low- and middle-income countries in COVAX, an international initiative aimed at providing equitable access to COVID vaccines. We have a tiered pricing system, where we sell to Gavi and developing countries at a much lower price adapted to the GDP in their country. 

The manufacturing site in Canada will contribute to building capacity across the world. We hope that, should there be a future pandemic, the world will be more ready. 

This article appears in print in the July 2022 issue of Maclean’s magazine. Subscribe to the monthly print magazine here, or buy the issue online here. 

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Fully stocked, service-ready ambulances are among the most-needed items on the frontlines of the war in Ukraine. In early April, Andrew Mills, 36, and Melissa Sims, 38—two advanced-care paramedics who work on the same platoon in Victoria, B.C.—launched an ambitious fundraising campaign to raise $20,000, fly to Poland, buy an ambulance and drive it across the Ukrainian border. On a three-day journey, with the sounds of shelling in the background, their initial goal transformed into a much greater mission. This is their story:

ANDREW MILLS: Watching from afar, we saw the war shift quickly from a military war to one focused on targeting civilians, paramedics and other responders on the frontlines. The shelling of ambulances hit home for us. There was a plea from volunteer paramedic organizations in Ukraine saying: please, please send us ambulances.

One night, over a glass of red wine, I googled “used ambulances in Europe.” I found one in Poland and sent a message to a group chat of colleagues: “Anybody want to drive this ambulance to Ukraine with me?” Within 30 seconds, Melissa replied with a simple, “I’m in!”

MELISSA SIMS: I never had any real doubts or reservations. After talking to Andrew, I found an NGO called the Pirogov First Volunteer Mobile Hospital (PFVMH)—a group of medics on the frontlines of the war who work with the Ukrainian state—and asked them if they could use another ambulance. They got back to us by the morning with an overwhelming “Yes, please.”

ANDREW: That turned my vague idea into something tangible. But we were unsure if we could come up with that much money. The timeline was tight, because the need was so pressing. We decided we were going to get them an ambulance no matter what.

We set up a fundraiser on Donately and it exploded, in large part because our paramedic colleagues took it to heart and shared it with their family and friends. I think they were similarly inspired by seeing not only the plight of everyday Ukrainians but paramedics and first responders. They got on board in a really big way. We went from an aspirational goal of $20,000 to raising over $120,000 over the course of two and a half weeks, which meant we could afford to get three ambulances and a bunch of supplies.

MELISSA: Finding the ambulances was no small feat. We did our best to source used ambulances in advance, with the help of a Polish colleague in Vancouver, Magda Wegner-Powala, who called dealers throughout Poland. The day before we were set to leave, we found out they had been sold.

***

ANDREW: On Sunday, April 17, we got on the plane to Warsaw with more than a hundred thousand dollars raised—and zero ambulances secured. The pressure was enormous, the stress was immense, and the logistical challenge was very real. Thankfully, while we were flying, Magda and her friend, Lukasz (who ended up being our interpreter, driver and overall fixer) had found multiple excellent options. Meanwhile, we were coordinating two other B.C. paramedics on the ground in Poland—Jeff Burko and his son, Max, who had been working to obtain medical supplies. A new plan was hatched to fill the ambulances with medical gear and deliver them to Ukraine fully stocked.

Inspecting the fleet in Chomeranice, Poland.

MELISSA: On Tuesday morning, we picked up Lukasz at the train station and went to see our very first ambulance in Plonsk, about an hour’s drive north of Warsaw. We were a little concerned because the tires looked bald and we thought there might be a small oil leak. We took it to a heavy-duty mechanic and transmission service nearby. When we asked how much we owed them, they said, “Nothing, thank you for what you’re doing,” and refused to take payment.

On the way to the mechanic, we’d had a long chat with Lukasz, who explained that paramedics were facing shortages of everything from food and water to basic feminine hygiene supplies. We realized that had to be a part of our mission. You can provide an ambulance, but if the paramedics can’t take care of themselves then the ambulance is useless. We spent the rest of Tuesday searching Warsaw for supplies, from water purification tablets and dehydrated meals to portable stoves.

ANDREW: Later that day, we drove south to Krakow, where we picked up Rick, a retired fire captain from the Victoria area on his way to volunteer on the frontlines. He donated some defibrillators to our cause and offered to drive one of the ambulances.

We drove to a small lakeside town in southern Poland called Chomeranice to see our second and third ambulances. We drove our second ambulance to our hotel, but the third one had a mechanical problem with the stretcher.

MELISSA: Unfortunately, they couldn’t fix the stretcher. But amazingly, Lukasz came through and arranged with the seller to purchase a like-new ambulance later in the week after we had left. (Editor’s note: After this interview, Mills and Sims confirmed that Lukasz delivered the third ambulance later that week and made it safely home to Poland.)

As we headed towards the Ukraine border, Lukasz got a message from Centrum Pomocy Humanitarnej w Szegini, the humanitarian organization he had been working with—the only one on the Ukrainian side of the border between Medya (Poland) and Shehyni (Ukraine). They were entirely out of food and sanitary supplies. So we made a stop at a grocery store and stocked four giant carts full of food and sanitary supplies.

(l to r) Rick, Andrew, and Melissa.

ANDREW: It took five hours to cross the border, even taking the humanitarian route. We started handing out chocolate bars to border guards. Guys with big guns were stuffing four bars into their pockets and thanking us in broken English. It was very powerful. When you’re hungry, stressed and tired, a chocolate bar goes a long way.

MELISSA: We were overwhelmed. Lukasz was driving a nine-passenger rental van loaded with supplies, but it wasn’t allowed into Ukraine. So we had to stuff all these supplies into the ambulances, and Lukasz had to turn around and drive our rental vehicle back to Poland. Andrew and Rick the fire captain made it through customs first—I sent them ahead and said I’d meet them on the other side. But when I finally made it through, suddenly my cellphone data failed and I lost the map I’d been using. So now I was driving around the border of Ukraine trying to figure out what to do. I tried calling Andrew, but without data we had no way to get in touch with each other.

It was so chaotic and crowded with people trying to make it into Poland. I was making U-turn after U-turn trying to figure out where to go. Andrew finally found me parked on the side of the road.

ANDREW: Dropping off the ambulances was hurried. We were on the side of the road, exhausted and starving. The PFVMH volunteers had been waiting hours for us at the border. Nobody spoke each other’s languages. We knew that we had to get all the food out of the ambulance, and then they wanted to start driving because there are curfews and nightfall was nearing. They were all wearing army uniforms. One guy gave us both hugs. We were using Google Translate to try to thank them but they just want to get going because, well, there’s a war on and they have things to do. The rest of them gave us quick handshakes and drove off into the sunset, taking Rick with them, who was heading onwards to volunteer with firefighters on the frontlines.

PFVMH volunteers loading supplies in Shehyni, Ukraine.

At this point, having unloaded the food from the ambulances, Melissa and I were standing in the pouring rain on the side of a Ukrainian highway with thousands of dollars worth of food supplies. Our phones weren’t working properly, but I finally managed to get a hold of the humanitarian organization. They sent a car, but it only had two seats. They took all the food, quickly did a U-turn and drove away. Okay, I guess we’re walking back to Poland now.

We were about a kilometre from the border. We had our stuff, including a backpack with about $30,000 in it, because we still had to give the money to Lukasz for that third ambulance. We were carrying cash because there was no time to wait for bank transfers. It was getting dark and we were feeling vulnerable; we knew that paramedics and other responders are actively being kidnapped in Ukraine.

We were just about to walk into the borderline when Lukasz appeared out of nowhere, having finally crossed back into Ukraine from Poland. He gave us both enormous hugs and said, “Come come, you have to meet my friends.” So he took us back into the humanitarian area and introduced us to everybody, including his good friend Roman, a barista from southern Ukraine.

They had set up a makeshift coffee shop in this little shack on the border, with a four-head Italian espresso maker. He had craft beans from all the hipster coffee shops in Ukraine, and homemade baked goods from Ukrainian babushkas. “Do you want a ristretto, cappuccino, cortado, flat white, latte?” Roman asked. It was incredibly surreal. And of course, we were hungry and tired, so coffee and homemade snacks were amazing. He gave us each a bag of coffee from what he says is the best coffee shop in Kyiv. And then he insisted on recording a thank you video to us in Ukrainian, which Lukasz translated live. I’m choking up again just thinking about it.

There was something so human and familiar about being given a bag of coffee in a war zone of all places. This hint of normalcy, and the commonality of humanity. Before we knew it, Lukasz said, “We have to go. It’s getting dark.”

MELISSA: We were at customs waiting in a queue on the Ukraine side when all of a sudden in the distance we heard: Boom! Boom! Boom! In Victoria, we often hear booms like that, but it’s just construction. But it was the shelling. No one seemed phased by it except us. That was the first time I truly felt nervous about our safety. We went in very aware of the dangers, but hearing the sounds of war that close, that’s when it hit home.

By the time we got through the border, it was pitch black and pouring rain. We went with a stream of Ukrainian refugees. Grandmas with endless bags, young children crying and being carried. There was a boy just in front of us who had just turned 18 and was turned away from leaving since adult men can’t leave the country right now. He looked so sad and dejected. The rest of his family had to carry on without him.

We made it through and began the six-hour drive back to Warsaw to get on our flights back home.

Re-entering Poland at the Medya-Shehyni border.

ANDREW: In total, we spent $70,000 on ambulances, $30,000 on trauma and medical gear, $5,000 on personal survival kits for the paramedics—all of those donations were to go to the PFVMH—and $10,000 in food and sanitary supplies to the humanitarian group on the Ukrainian side.

Now that we’re home, we’re still pressing on with our fundraiser. As the PFVMH’s operations shift eastward, where the road network isn’t as developed, they’re doubling down on their appeal for armoured and all-terrain ambulances. Phase two will be trying to cover the cost of one, which is more than $50,000.

The plan is to either do the delivery ourselves again or send someone we trust. This trip underscored the need for people invested in the mission to be present and figure things out on the fly, because there are so many things that can go wrong along the way.

Looking back on the experience, it feels dreamlike. Like, did any of this actually happen? We were running on so little sleep that we were in almost this delirious, intoxicated mindset. We were so fatigued. Yet there was no choice but to press on.

To donate to Ambulances for Ukraine, click here.

The post ‘Anybody want to drive this ambulance to Ukraine?’ appeared first on Macleans.ca.

There are too many patients: too many people with COVID, people who can’t breathe, people who are in psychiatric crises or feel chest pain or have overdosed or fallen or crashed their cars. They want nurses, family doctors, home care, psychiatrists and social workers. They need hospital beds, long-term care homes and affordable mental health programs—all of which are in short supply. But there is 911; there is always 911. The problem is there are not enough paramedics to answer the call.

Emergency medical services across the country are in serious trouble. One COVID surge after another piled even more stress onto a system that was riddled with cracks long before the pandemic began. The number of 911 calls has been rising for at least a decade. At the same time, rampant overcrowding in emergency departments means paramedics get backed up in hospitals, where doctors and nurses are already swamped. During these periods, known as offload delays, they care for patients in hallways and ambulance bays, unable to move on to the next person in need.

A 2017 report commissioned by Defence Research and Development Canada’s Centre for Security Science identified approximately 38,000 paramedics across the country. One-third of respondents said they’d taken a medical leave in the two years leading up to the survey; just over 10 per cent said they’d taken one for their mental health.

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The instability in EMS has roots in a system dating back nearly 200 years. In 1832, a cholera outbreak in the town of York—now Toronto—led to the creation of the first known ambulance service in what would become Canada. The town approved a wooden “cholera cart” to tow sick patients away from crowded areas, sometimes straight to funeral homes. These carters, as they were called, did not provide medical care. They simply carried the dead and dying away from the living. Modern paramedics aren’t just ambulance drivers; the scope of their practice has broadened. In a single shift, they might pull someone out of a wrecked car, lift someone else off the floor and find a social worker for an unhoused person.

Lindsey Boechler, a former advanced care paramedic and a researcher at the Centre for Health Research, Improvement and Scholarship at Saskatchewan Polytechnic, studied paramedics across Canada in the early months of the pandemic. She hadn’t planned on doing a mental health study, but that’s what her research became. Paramedics told her that they anguished over how to care for patients in uncertain times. The rules changed from shift to shift, they said. One participant described a chaotic scene: “Four paramedics showed up and everybody had a different care plan. That’s how many times policies have changed.”

Many EMS services told their paramedics to stop intubating patients or using airway tools during COVID’s first wave, when PPE supplies were in question and the virus was poorly understood. To some, this seemed like a violation of their obligation to patients. “They believed they were inflicting harm and holding that burden on themselves,” says Boechler. EMS workers told her that they turned to alcohol. They missed going to the gym to blow off steam. Some separated themselves from their kids for months, uncertain of what they might bring home. One paramedic said she cried in her truck, undone because she couldn’t find a place to pee. All the public bathrooms were closed.

In the past 12 months, cities all over Canada have reported code reds, meaning there are no ambulances or paramedics available to help—no matter how critical the emergency. Toronto called one in January, and Waterloo, Ontario, called 11 in December alone. Between August 1 and December 6, 2021, Calgary and Edmonton were issuing red alerts every 90 minutes. Out east, Nova Scotia’s Standing Committee on Health heard the same story. The business manager of the local paramedics’ union said, “Today, the system is nearing the point of failure.”

The Canadian Occupational Projection System has estimated the need for another 4,000 paramedics by 2028. In addition to more personnel, experts and workers on the ground have proposed intuitive solutions to the EMS crisis: more trucks; more hospital beds; more of everything. Other ideas, like investments in community paramedics—those who provide care on a regular, non-emergency basis—are gaining traction. Mostly, paramedics seem to want recognition that they are skilled health care professionals, not carters, and that their work is a matter of life and death.

In January, a 95-year-old Vancouver man spent six hours on the floor of his apartment and survived. The next month, an elderly Québécois man died in an ambulance in a hospital garage as he waited to be tended to by staff. Each paramedic has a life, too, full of stories of resilience, coping and, sometimes, barely that. Here, they share their own.

(Photograph by Grady Mitchell)

Dave Deines

Vancouver, B.C.

I always knew I wanted to be a paramedic. I loved watching old episodes of Emergency! on TV when I was growing up. I joined the Canadian Forces as a medic in 1990. I was never deployed overseas with the military, but I’ve been deployed five times as a volunteer with the NGO Canadian Medical Assistance Teams. I went to Indonesia after the tsunami, then Pakistan, Bangladesh and China. I also went to New Orleans after Hurricane Katrina hit.

When I started working in Victoria in 1995, if I did more than eight calls in a 12-hour shift, that would be extremely busy. Now, in Vancouver, crews regularly do 10, 12 or 14 calls every shift. The skills we have today are light years ahead of what we did when I was starting out. In some cases, we’re doing procedures that were historically reserved for physicians—like intubating a patient, or putting a needle into someone’s chest to relieve pressure in their lungs.

I’m the president of the Paramedic Association of Canada, and the provincial vice-president of the Ambulance Paramedics of B.C. I still get out and ride with crews, and I’m part of the urban search-and-rescue team here in Vancouver—that’s when I can just be a paramedic. My stress is different now than it was when I didn’t have these leadership roles. Back then, it was focused on individual patients or catastrophic calls. Now, my stress is more about trying to advance the entire profession.

We’ve seen a dramatic increase in the volume and complexity of the calls. That drives the frustration that front-line paramedics feel on a daily basis. For instance, we’ve been dealing with overdoses forever. What’s new is the substances we’re encountering. We see more potent drugs on the street. Toxic opioids are going around. Drug dealers don’t subscribe to quality control. In B.C., we’re seeing a trend in poly-overdoses, which involve opioids mixed with illicit drugs or other substances. Those patients are difficult to treat, because the respiratory depression can be more profound.

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What makes the current moment unique is a combination of the last three years: not just the opioid crisis, not just COVID, but climate disasters, too. We had the heat dome at the end of June. More than 800 people died, putting a huge strain on the paramedic service. In November, we had flooding and rainstorms. Any external factor that increases call volume puts additional demands on a service that’s operating at close to 100 per cent most of the time.

It’s exhausting to continually operate at those levels. Five years ago, you’d have time after a call to sit down and talk with your partner. We refer to them as “bumper chats,” conversations that allow you to physically, emotionally, psychologically place that call behind you and get ready for the next one. Now, those aren’t there.

Paramedics are resilient. We’re used to working in stressful situations. But from a national perspective, we need more boots on the ground. If you were to ask paramedics, “What’s the number-one thing that can be done?” it would be to recognize what we do, and provide support to help them do their job. It doesn’t matter where you go in Canada. The issues are generally the same. There are too many calls and not enough ambulances.

(Photograph by Erin Leydon)

Natalia Marijke Bourdages

Brampton, Ontario

I was born and raised outside of Tkarōn:to, and I did my undergraduate degree at the University of Guelph in biological sciences. I was thinking about medical school when I noticed an application deadline for a paramedic program at Humber College. I got in and instantly loved it. The job is fast-paced and unpredictable. I now work for Peel Regional Paramedic Services, covering the area where I grew up. Sometimes I even see someone I know during a shift.

For me, the most rewarding calls are the ones where I can get somebody access to the help they need. Before the pandemic, I went to a call for a trans woman who was having a mental health crisis and couldn’t reach her usual support people. She didn’t know what to do but knew she didn’t want to go to the hospital. I sat with her and listened. I opened up about also being a member of the queer community. I asked what helped with her anxiety and she said music, so we found some songs on her phone.

That’s the kind of call where someone is lost in the system. Those calls also put the paramedic in a weird place, because bringing someone to the hospital is what we are trained to do—but maybe that’s not always the best thing. It is an extreme balancing act to sit and listen to a patient when there are so many calls coming in. Of course, that’s not how paramedicine is taught: you learn what medications to administer and how to perform CPR, but the reality is more like community care. And you’re still needed out on the road. There’s no easy answer.

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When the pandemic began, I jumped at the opportunity to go into nursing homes to do testing. At the same time, as an Afro-Caribbean person, I was dealing with the anti-Black racism that became more visible after the murder of George Floyd. It was an extremely hard time to be a racialized person on the front lines. I had to take a mental health leave from work and was later diagnosed with PTSD.

I’m married, and my partner is an Indigenous birth worker. It was scary, trying not to bring the virus home. We’re lucky in that we have similar realms of work and a similar likelihood of exposure during the pandemic. We have been able to lean on each other during the difficult times.

After returning from my leave, I had the opportunity to do some shifts in the vaccine clinics. We were in the middle of the Delta surge, when Peel was hit hard. We were getting calls for people who had oxygen saturations lower than anything I’d ever seen before. Young people were dying. By the time Omicron arrived, all the paramedics were catching COVID. Many of us were already feeling extremely burnt out, and then we started losing our people. It’s a tough time, but I don’t want to make it sound like we’re not here. We are here. You can call 911 and we will be there to help.

(Photograph by Dustin Veitch)

Paul Hills

Saskatoon, Saskatchewan

I’ve been doing this work for about 22 years now. When I started, I didn’t fully understand the gravity of what it would be like to deal with people in their most difficult hours. The idea was: This is a tough job, but you suck it up and do it. We didn’t talk about PTSD back then. It was just like, “Oh, he’s stressed.”

I joined the union leadership 15 years ago and became president about eight years ago. I began advocating for mental health awareness and provisions for our workers. We knew paramedics were struggling with stress, but I didn’t realize the stress going on inside me until it hit a crisis point. In 2016, I was called to the scene of a serious accident. After that, I started having short-term memory problems: I couldn’t even remember the name of my son’s school. My wife is a counsellor, and she’s been an amazing advocate for me, but I felt like I couldn’t even tell her. I was making plans for how to kill myself. I knew who I was going to text so they could come find me, instead of my family. I realized I needed help. I reached out to my family doctor for treatment. Four years later, I found myself in that position again, and got back into treatment. My faith helped me get through it all, too.

Right now, paramedics aren’t getting breaks. The added pressure of COVID is exposing cracks—lack of staff, lack of trucks, lack of adequate mental health treatment within a helpful timeline. It also added time on calls for PPE and decontamination.

Anytime the phone rings, it’s an emergency. And that person’s emergency might trump the ability of the paramedic to do something as basic as eat a meal. It affects our sleep. It affects our home lives. I see ephedrine abuse. I see caffeine pill abuse. If I’d invested in energy drinks 15 years ago, I would be retired by now; first responders drink those like water. These are things that people are using to cope.

It’s common for my dispatchers to call patients every 20 minutes when they’re waiting for an ambulance to say, “How are you doing? We’re really sorry. We’ll get you an ambulance as soon as we can.” Before COVID, we received about 30,000 calls annually. As of late 2021, we were at 38,000.

Some paramedics are working in the back hallways of hospitals, which is a band-aid on a system that’s broken. If we are backed up like that, the emergency department is flooded. If that’s happening, it’s because the hospital wards are full. It was going on before the pandemic, but COVID exacerbated all the existing problems. Hallway medicine is the canary in the coal mine.

(Photograph by Grady Mitchell)

Terrilyn Good

North Delta, British Columbia

When I was little, my dream was to be a doctor. Things panned out differently. I did a course in emergency childcare first aid in 2013, after my baby son had a seizure. After that, I worked as a youth-program coordinator in my home community of Gitanyow, a First Nations reserve along the Skeena River in northwestern British Columbia. I pushed for my employer to get me more first aid training because I spent so much time with kids. I kept thinking, “What if something happens?” My community is a long distance from help.

One evening, I was eating dinner with my kids and I got a call that someone had fainted. I did everything I could with my basic training, and stayed for 45 minutes until the ambulance came. The patient lived, and as the truck drove away, I realized that’s what I wanted to do. I started working with BC Ambulance in Kitwanga in December of 2016, and now I live and work in Delta.

I love not having a set script when I go to work. I see something different every day. It could be an elderly person who needs a lift off the floor or somebody in a life-or-death situation. Most of the time, people really appreciate what we’ve done, and they understand how challenging the job can be. I can see their relief when I walk in the door. Thank you. You’re here.

It’s hard to even remember what work was like before COVID—half of my career has taken place during the pandemic. When it started, I was just a baby medic trying to find my legs. Since then, I’ve visited hundreds of patients with COVID or COVID-like symptoms. Often, they’re very scared of the virus. Sometimes they don’t even want to go to the hospital. They just want reassurance, and someone to check that their vital signs are normal.

One of the first questions we ask now is, “Are you vaccinated?” Most people are, but people who aren’t can get very defensive. I’m not there to question somebody’s reasons for being unvaccinated; I’m there to help. We’re just required to ask so we can protect ourselves with proper PPE.

Everybody I work with seems like they’re one step away from taking leave. It’s not really an option for me because I’m a single mom. I’m proud to be a role model for First Nations women. I’m good at what I do, and I have some seniority in my job, even if it’s organized chaos. I want to do advanced life support training, but I’ll do that once my kids are older.

(Photograph by Ebti Nabag)

Patrick Suthers

Kingston, Ontario

I watched members of my family deal with cancer and chronic disease growing up, so I always wanted to work in health care. I stumbled across EMS through a friend who worked as a critical care paramedic. Five years ago, I decided to take the course at CTS Canadian Career College in Barrie, Ontario. I fell in love instantly. There aren’t many jobs where people willingly invite you into their houses, at any time of day. You meet them at their most vulnerable. It’s a huge privilege to do that.

I was primed to deal with high-acuity 911 calls, like car crashes, but it’s been much more of a social work job. We often deal with people who have fallen through the cracks, so to speak—people who regularly interact with the health care system, like the elderly and the marginalized. A small segment of the population makes up 90 per cent of our calls.

I was interested in why that was happening, so, about a year into my job, I decided to pursue an undergraduate degree in health sciences at Queen’s University. Currently, I’m doing a research project on community paramedicine. Plus, I work as a paramedic on the weekends.

At the beginning of the pandemic, there were so many unknowns, like, “Am I supposed to treat everyone as if they have COVID?” I understood the need for masks, but they made my work more difficult. I’m hearing-impaired and masks hamper my ability to communicate with patients and colleagues. I found that morally distressing. Early on, some services worried about PPE shortages and opted to use P100s, which look like construction masks. I worked on a resuscitation and I couldn’t hear a thing my partner was saying to me. It wasn’t the time to ask, “Can you repeat that?”

There’s not enough staff, not enough trucks, staff burnout and backlogs. The hardest calls now are probably the “VSAs,” which stands for vital signs absent. We tend to spend time with families in the aftermath, getting them a cup of coffee and easing them into the grieving process. Masks make it so much harder for us to be there for them in a non-clinical capacity—as people. We wonder whether we’d be putting people at risk by spending that time with them.

A big issue is that the public perceives us to be a scoop-and-go service, which our education prepares us for. Most calls are lower acuity—falls, mental health crises or the decline of the elderly. Some people are living in terrible conditions: I visited a man in his 80s who was waitlisted for long-term care. He called 911 because he fell off his couch, and it looked like he’d been sleeping there. Food was everywhere. School doesn’t prepare us for those challenges—and I’ve seen more of them as COVID has progressed.

(Photograph by Stephen Harris)

Noor Karfoul

Charlottetown, Prince Edward Island

I moved from Damascus, Syria, to Charlottetown in 2011 with my parents and younger brother. I was 15. My parents brought us here for more opportunity and a better education.

When I was in high school, my grandfather needed an emergency medical rescue back in Syria. He lived in the rural mountainside and got caught in an orchard fire. Military medics were able to stabilize him and get him to hospital. That opened my eyes to the value of EMS. My grandfather needed those medics to stay alive. He made it, but he has long-term health effects from smoke inhalation.

I wanted to go into EMS right after high school, but first I needed money. I worked as a culinary apprentice for a few years, and then went to Holland College to become a paramedic.

COVID started during the last months of my schooling. The day it was declared a pandemic, I was on a truck doing on-the-job training in Nova Scotia. There was so much uncertainty. The school had to reassess the liability of having students on the truck. There were initial concerns about a shortage of PPE and the likelihood of exposures. In the end, we came back to P.E.I. to do schooling online for the last month. I graduated in May of 2020.

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In school, we heard stories about how there was the occasional hard-earned slow day. I missed out on that. Our generation never had those. We work in pairs, mostly doing 12-hour shifts. If you’re lucky, you get to go home after that; most of the time, you stick around a bit longer to help out.

P.E.I. is an interesting situation for paramedics because we send patients to neighbouring provinces for specialized services, like neurosurgery or cardiology. We handle a lot of care for the aging population on the island. For me, the most rewarding aspect is our palliative patient program. We help with symptom management—pain, lightheadedness, nausea. You can’t rush those calls. It’s about bedside manner and patience. Sometimes you find yourself supporting the family, too, because there is a lot of stress involved in caring for a loved one at home.

The nature of the work makes it easy to get drawn in and not see how much it’s drawing out of you. My friends and family are there to say, “You need to take a step back. Take a breath.” I think about my grandfathers a lot lately. One passed away a few months ago; I really wanted to see him before he died. The other, who survived the fire, is sick again, too. I hope I get to see him soon, but I don’t know how to make that happen.

(Photograph by Lindsay J Ralph)

Josh Fisher

Happy Valley-Goose Bay, Newfoundland and Labrador

 I grew up in the United States. I did my paramedic training at Creighton University in Omaha, Nebraska. After I graduated, I went to work in the middle of the state, which is basically the middle of nowhere.

I later ended up moving to Florida for work, where I met Jessica, a woman from Newfoundland who was visiting for holidays. That was that. We knew we wanted to get married, so I decided to move to Canada. I can work 40 hours here and make the same money as I made working 90 to 120 hours in the U.S.  I arrived in Newfoundland in September 2010, the same night that Hurricane Igor landed here. It’s fitting: I’ve been working around the weather ever since

I now work for the air ambulance program based out of Happy Valley-Goose Bay. My job is to serve the north coast and south coast of Labrador and get patients to hospitals—either Labrador Health Centre, which is in Goose Bay, or hospitals out of province. One of the quirks of Newfoundland is that, in the rural areas, they’re just starting to get around to naming streets. In some remote communities, homes have no address. It’s more like, Go to the white house and turn left and go three more houses and turn right and somebody will wave you down in the street.

Most hospitals in Newfoundland and Labrador don’t have intensive care units, and they’re not staffed to handle critical patients. For most of the pandemic, Newfoundland had a low COVID caseload, but the vrisu still affected us. Because there are so few facilities, the backlog and wait lists of patients built up quickly. We noticed our patients becoming sicker—much sicker than what we’re used to. The patients themselves didn’t think their complaints were severe enough to inundate the health system.

I hate having to say no to patients’ family members who want to travel with us. We move people over long distances, heading to hospitals that might be a full-day’s drive on remote roads, plus a ferry ride. We try to tell families that their loved one is in good hands. We call these separations “see ya laters” rather than “goodbyes.”

Paramedicine is kind of an offshoot of the healthcare system, yet never considered an integral part. So our workload has dramatically increased, but our resources have not. The stress is palpable. The quality of life isn’t great. We can’t keep staff. The turnover in the last two to three years is unprecedented. Schools are churning out paramedics as fast as they can but it’s not enough. You would think that as the pandemic winds down, things would ease up. In reality, it has gotten worse.

(Photograph by Colin Way)

Jessica Frith

Baker Lake, Nunavut 

I have been in EMS for almost 10 years and I’m not even 30 yet. I started working in very rural areas in Alberta and Northwest Saskatchewan, and then moved to the city for my Advanced Care Paramedic training in 2018. I ended up liking city life, even though I’m from a Saskatchewan town of 1200 people.

 The shortage of resources has become very noticeable in the last five years. Calgary and Edmonton make a lot of noise about red alerts—that’s when there are no ambulances available to respond to emergency calls—but other places are experiencing the same thing. They just don’t get as much attention. Offload delays are happening everywhere—not just Alberta, but across Canada and internationally, in the U.K. and Australia. It’s been like that for a long time, but it’s only been talked about by the public in the last six to nine months.

For paramedics [in general], there’s the obvious physical exhaustion, but I know so many personally who are off on mental-health leaves or are leaving ground ambulance altogether.

One of the straws that broke the camel’s back for me was hearing about a crew having to respond to a call in the very opposite end of Calgary— and it was for a cardiac arrest. There was desperation in their voices when asking dispatch if they were really the closest. A lot of people don’t move over, even when you’re coming with lights and sirens. 

I’d work overtime almost daily. I could be done work at 6:00 p.m., and if a call came in at 5:58 p.m. that was 45 minutes away, I would still do it. I’d often get into my vehicle at the end of a shift and, the next thing I knew, it had been 10 minutes and I’d still be sitting there, too dazed and tired to drive home. I’m incredibly fortunate that I don’t have a family at home waiting for me to pay them attention because at the end of a shift, I’m a zombie. I dissociate by watching reality TV.

During the pandemic, I responded to a fellow first responder’s suicide. That made me start thinking about my job and my mortality—like, Is this all worth it? It amplified everything that I had already been suppressing. I never had nightmares, but when I was awake, I would think about it a lot. Even now that I’m talking about it, my head is going through the entire scene walking through the building.

I took mental-health leave and worked hard to be able to go back to work. I saw an occupational therapist and psychologist—three appointments every week for about 12 weeks. I have a different job now. I needed a change of pace. I work in a health center in Nunavut. Last night, the entire sky was full of the northern lights. It’s been one of the greatest changes I’ve made.

(Photograph by Colin Way)

Heather Cook

Calgary, Alberta 

When I was a kid, my mom and her then-boyfriend started a private EMS service called Aeromedical. It’s still operating in northern Alberta. We would attend the rodeo and watch it sitting on top of the ambulance. When I got older, I did my own thing for a while: I trained horses. I lived in Europe. I had my kids. But I wanted a job with meaning. At 34, I trained as a primary care paramedic, while working full-time in an office as supervisor of a sales team. I later upgraded to advanced care paramedic in 2018, while working full-time as a paramedic. I took a short mental-health leave in late 2019. I’d been working non-stop. I think the skills I learned helped prepare me for the pandemic.

I don’t know how much more ‘frontline’ you can get than being in someone’s home during COVID. The hardest experience for me was at long-term care facilities. Pre-pandemic, you’d walk in and some resident would be playing a piano, and people would be watching TV together or walking the halls. They were small communities. Early on, I visited a home that experienced one of the first big outbreaks of the virus in Alberta. When I walked down the hall, I saw patients lying in their beds or sitting in wheelchairs. They couldn’t see their neighbours. It felt like they were just waiting to be ghosts. When I got to the hospital, I took off my PPE and sat down. A hospital pharmacist walked by and asked if I was okay. I shook my head and started to cry. I think that, as a society but also as a profession, we’re grieving our past lives. 

I will never forget my first COVID patient who died. He and his wife had COVID very early on, before there was any lockdown. They were married for more than 60 years. As we were getting him onto the stretcher, he said to his wife, “Don’t think you’re going to get rid of me this easy!” I already knew he was going to be intubated. I was literally fogging up my glasses with tears. He kissed his wife, and that turned out to be the last time they interacted. Visitors weren’t allowed in hospitals.

Even though we’re essentially a small emergency department that comes to your house, paramedics weren’t included in the first wave of vaccines in Alberta; I don’t know why. Maybe it’s because we are in an area of healthcare that isn’t thought about until we’re needed.

This article appears in print in the May 2022 issue of Maclean’s magazine with the headline, “Distress call.” Subscribe to the monthly print magazine here.

The post Canadian paramedics are in crisis appeared first on Macleans.ca.

A few years ago, Kathy Collins was running her own art supply store and art school in Calgary when she began to experience troubling symptoms. She had always been a workaholic, capable and driven, but suddenly, in her early 50s, she was having cognitive glitches, like forgetting to place orders for the store. Her older sister Jean Collins noticed that when they spoke on the phone, she was forgetful and uncharacteristically weepy. While Kathy at first hid her struggles, she eventually admitted that things had gotten so difficult that she couldn’t run the business and was filing for bankruptcy.

MORE: The Inuk woman using TikTok to expose high food prices in the North

Jean, who was living on Vancouver Island at the time, went to Calgary to help Kathy through the process. Once she was with her sister in person, the scale of Kathy’s difficulties became clear. She had lost weight because she wasn’t cooking or eating, and she was neglecting personal care and housekeeping, while fixating on repetitive activities like playing mah-jong. Alzheimer’s didn’t occur to them at the time, but it was clear that something was very wrong. Initially, Kathy’s doctor tried medication to treat depression, but she continued to struggle. A few months later, Jean persuaded her sister to visit Vancouver Island for a week. She never left.

It took months of medical visits to get answers, and when Kathy finally learned she had early-onset Alzheimer’s, the devastation of the diagnosis was eased by the relief that she finally knew what was going on. First, the sisters lived together in Jean’s home, and Jean even hired Kathy to work at the residence for adults with disabilities where she was a manager. But as the disease progressed, they both stopped working and moved in with their octogenarian parents in Cobble Hill, a farming village in the Cowichan Valley just north of Victoria.

By the spring of 2020, Kathy had established a routine of swimming and attending a day program on a farm caring for horses once a week, getting around using a transportation service for people with disabilities. But then the pandemic hit. The life they had built was wiped out, and they both suddenly had a lot of time on their hands. One day about two months in, Jean, otherwise a Twitter addict, downloaded the TikTok app out of sheer boredom. They were immediately hooked. “It’s just bursting with creativity, and it’s funny and moving,” Jean says. “So we were just in our rooms scrolling.”

Straight tok

The Kathy Project’s look at life with Alzheimer’s can be moving, or unapologetically funny. A sampling:

August 2020 25,200 views Kathy and Jean do a quiz: who’s had the most success with men (Kathy), who talks the most (Jean) and who is physically strongest (Kathy).

June 2020 90,200 views Kathy talks about her transformation, from not wanting anyone to know she has Alzheimer’s to sharing the experience with the world.

January 2022 51,900 views Kathy and Jean stage a comedic recreation of life with Alzheimer’s, complete with repetitive questions and bloopers.

PreviousNext

After a couple of weeks as admiring viewers, they decided to make their own TikTok. In it, “Jeanie behind the camera,” as she introduces herself, interviews Kathy briefly about having dementia. Kathy explains the sticky notes on her bedroom wall that serve as reminders. She describes the worst part of dementia—no longer being able to drive—and the best: “I can rewatch movies all day long and say, ‘Jean, this is a great movie!’ ” They both crack up at that.

It was their third video that made them bona fide TikTok stars. In it, Kathy stands outside their parents’ house, wearing a long denim jacket, with a bird chirping somewhere in the background like it’s been hired for an idyllic spa soundtrack. Jean holds the camera and offers interview prompts, asking about the big decision they recently made. “We moved into our parents’ basement,” Kathy replies, her eyes widening in comic horror. But while things are hard, they are also great, Jean says, panning to show Mill Bay sprawling below the backyard of their house.

When Jean swings the camera back to her, Kathy leans in conspiratorially. “Living with the parents at this age is just highly unusual,” she says. They explode in more uproarious laughter, and instantly, you understand why 1.6 million people watched this video and 138,000 love the sisters enough to follow them on TikTok now.

As with all of the videos that would follow, it’s matter-of-fact, even buoyant, smart-assed and empowered. As a snapshot of life with disability and serious illness, Kathy and Jean’s TikTok account has little of the treacle or tragedy usually associated with the subject. “My gig is that, yes, I have Alzheimer’s, but there’s more things to it,” Kathy says in an interview.

RELATED: Why TikTok food is ugly and disgusting and completely addictive

On TikTok, they are known as the Kathy Project, which aims simply to spread comfort and love to people with Alzheimer’s and their families. That, and comedy. “Kathy always says those are our stripper names,” says Jean. “She’s Comfort, I’m Love.”
An entire community has grown among the other disability- and dementia-focused TikTokkers they chat with and follow. In comments, a parade of people wish them well, asking nervously for advice about their own dementia worries, or admonishing Jean to talk less and let Kathy talk more. She knows, she’s working on it, it’s been this way all of their lives. People recognize Kathy when they go out shopping, a TikTok celebrity in their midst.

They know there will come a time when the videos will have to stop, to safeguard Kathy’s dignity. But she trusts Jean to know where that line is, and it’s still a long way off. For now, there are their hundreds of thousands of viewers, a steady stream of viral hits and a community where you own your dementia, but it doesn’t own you.

The appeal of the Kathy Project is simple and obvious to Jean: it’s Kathy, and it always has been. “It’s been like that for your life. People have always liked you,” she says to her sister. “Thank you,” Kathy exclaims, as though she has just won an unexpected Oscar. They double over laughing, side by side on the bed like teenagers.

This article appears in print in the May 2022 issue of Maclean’s magazine with the headline, “Sister act.” Subscribe to the monthly print magazine here.

The post After an Alzheimer’s diagnosis, these sisters became Tiktok stars appeared first on Macleans.ca.

Loneliness kills, and friendship preserves. There’s really nothing else—not exercise or even quitting smoking—that matches the positive effect on mental and physical health of having friends, writes the inventor of “Dunbar’s number” in Friends: Understanding the Power of Our Most Important Relationships. Quite simply, he says, friendship is “the best predictor of your chances of surviving from this moment into the future.”

Over a quarter-century ago, Robin Dunbar, the British psychologist who now heads Oxford’s Social and Evolutionary Neuroscience Research Group, established his famous cognitive limit to the number of people—150, give or take—with whom anyone can maintain stable social relationships. In his new book, Dunbar concentrates on humans’ inner circles to understand how those close friendships are made and how they differ in composition by family circumstance, age, gender and culture, while still almost universally capping out at another stable number—five.

By “friends,” says Dunbar in an interview, he means close relationships. “For most of us, the inner five, the shoulders-to-cry-on friends, are made up of two friends plus two extended family members, with the fifth sometimes [being] a friend and sometimes kin.”

MORE: How the most connected man in Toronto came back from death

At 74 and deeply embedded in a globe-spanning web of former grad students and post-doctoral associates, Dunbar can cite reams of evidence to support his thesis about the importance of friendship, which the era of Big Data helped him arrive at. “It’s extraordinary,” he exclaims, “what you can learn from phone records.” In one study, some 18-year-olds—just entering into the “churn” years of their lives, when about 40 per cent of their relationships will change as they enter university or the workplace—were sending over 100 texts a day. The frequency and length of messages to new friends replaced, almost exactly, the attention once paid to others.

Dunbar points to an important difference between the kith and the kin in our social networks. Family is simply there, usually from birth, and is capable of withstanding long periods of neglect, benign or otherwise, without loss of a mutual sense of obligation—what Dunbar calls “the kinship premium.” Friends require hard work to gain and keep. A solid “30 minutes a day on average,” says Dunbar, which is why intimates are so few in number: “The main issue is the sheer amount of time involved,” he says. Distance can actually make the heart grow fonder in regards to family—who can be as annoying as they are dependable—but stretching available time beyond its breaking point tends to destroy friendships.

Although Dunbar believes the evidence shows a “striking sex difference” in the intensity of friendships—with women’s bonds being more fervid—both sexes find that distance simply cannot be bridged by electronic communication. “There is something deeply engaging,” says Dunbar, “about eye-to-eye across the kitchen table—and the ability to touch.”

Susan Pinker, whose book The Village Effect: How Face-to-Face Contact Can Make Us Healthier and Happier has seemed ever more prescient since its 2014 publication, completely agrees. “In-person contact is essential for touch or non-verbal communication, that little pat on the arm,” says the Montreal-based developmental psychologist. Getting together signals “you’re willing to invest the time,” she adds, a calculus we all subconsciously register. “If you don’t sustain a friendship, then it melts away—unless it’s with your intimate family members.”

RELATED: Why pet people are the animal lovers that wildlife needs

Of all the lockdown workarounds for the rituals and emotions of friendship as we knew it before COVID-19, only pets—whose ownership spiked during the lockdowns—offered the possibility of touch, says Pinker, the happy owner of a pandemic puppy: “a big, hairy baby who needs attention and more haircuts than I get.”

Both psychologists see the pandemic as a real-world experiment in how friendship may evolve. Dunbar is cautiously awaiting the results of studies into the corroding effects of isolation, while Pinker is optimistic the lockdowns have acted as a wake-up call. “Before the pandemic, I think there were still a lot of people thinking, ‘Skype, FaceTime, I don’t really need to go out and do this personally.’ Now we all know we need to.” And both, too, know further changes in our social relationships, unrelated to social media or epidemics, are on the horizon. For about a century, Dunbar notes, the Western world has held at about half-family and half-friend in its social circles, down from what was almost entirely family not that far back in history. With families continuing to shrink, so too will the kin share of our inner circles. We are all going to need more friends.

This article appears in print in the March 2022 issue of Maclean’s magazine with the headline, “The BFF quotient.” Subscribe to the monthly print magazine here.

The post The key to survival: Find five people. Hold them close. appeared first on Macleans.ca.

Chika Stacy Oriuwa is No. 37 on the 2022 Maclean’s Power List, a ranking of 50 influential Canadians. Click here to see the full list.

When Chika Stacy Oriuwa arrived at the University of Toronto as an incoming medical student, she found herself the only Black student in a cohort of 259. It was September 2016, and she quickly channelled her disappointment into action, advocating for processes that would increase diversity in medicine and becoming the face of the new Black student application program the following year.

The program, which encourages applications from Black students, has already had remarkable success. When Oriuwa graduated in 2020, she was the sole valedictorian of her class—the only Black woman to receive the honour in the school’s 179-year history—and the university had just admitted 24 Black medical students, the largest cohort ever.

Oriuwa, the daughter of Nigerian immigrants, is now a psychiatry resident at the University of Toronto. “Psychiatry has some of the most marginalized patient demographics in medicine,” she says of her specialty. “When I did my clinical rotations, I knew I needed to do something where mental health was the centre.”

THE POWER LIST: See the full ranking of 50 Canadians

To recognize her impact, Mattel selected Oriuwa for its Barbie Role Models program. In August, she was one of six women working on the frontlines of the COVID-19 pandemic to be immortalized as a Barbie doll. “It was such a full circle moment for me, as a young girl who played with Barbies and always really wanted to see myself reflected,” says Oriuwa. “Not only as a child who wanted to be a physician, but as a young Black girl.”

Her advocacy also takes creative forms, through writing and public speaking. She is an accomplished spoken-word artist who has competed nationally as a slam poet; her recitation of her 2017 poem Woman, Black has been viewed more than 12,000 times on YouTube. “There is a dark side to advocacy, to putting your name and face and work out into the public eye,” says Oriuwa. “I deal with that on a fairly consistent basis.”

But there are moments that remind her of why she keeps going. “I’ve spoken at my high school in Brampton, Ont., and had young Black women tell me, ‘I want to be a doctor because you did it, and you’re just like us,’ ” she says. “To be able to inspire them is so incredible for me.”

“I’m just so excited to be that role model for my own children, to tell them about all the things that their mommy has done,” says Oriuwa, who welcomed her first child in December 2021. “With my son, I can tell him that I drew strength from my pregnancy to do these things. It’s a special experience that I’ve already shared with him in that way.”

The post Medical trailblazer Chika Stacy Oriuwa is using her power to lift others up appeared first on Macleans.ca.

At the top of our annual Power List are the unknown victims of residential schools—hundreds of children who lost their lives before they were finally heard.

Here, in brief, is the thinking behind our decision, which some may consider unorthodox. In 2021, amid report after report of presumed grave sites being found on the former grounds of residential schools, non-Indigenous Canadians undeniably experienced an awakening.

Everyone from random citizens doing TV street interviews to the Prime Minister himself voiced horror and dismay, as if blindsided by the fact that the assimilationist project this country ran for the better part of a century had claimed the lives of children. Many, many children.

We were not blindsided, of course. The deaths of young Indigenous kids at places like Tk’emlúps, Cowessess and Williams Lake, B.C. were shared widely in the accounts of former students, who passed the knowledge to their children and grandchildren. They were meticulously reported by the Truth and Reconciliation Commission in 2015.

We’ve a long way to go to fulfill the essential goals of that commission. But the massive shift in public attitudes that followed the grave discoveries is undeniable. Before making this choice, Maclean’s consulted privately with Indigenous, Métis and Inuit leaders, who unanimously approved of, and in some cases applauded, the idea. The grave finds, they agreed, changed the tone and substance of debate over Indigenous rights. Whether that change yields action, they’re waiting to see.

Go straight to the ranking ↓

As in 2021, our ranking hews toward good-faith actors pursuing positive change, even if their approaches, or their notions of positive, are not universally shared. Pierre Poilievre, the presumptive frontrunner for the leadership of the Conservative Party of Canada, is not everyone’s first choice as a seatmate on a long flight. But the Tory MP excels in his role as an opposition critic, holding the government’s feet to the fire.

And again, we’ve looked beyond mere status. The nabobs of banking, lobbying, telecom and other arms of the establishment must do more than occupy corner offices to merit berths on our ranking.

The result, we believe, is a list that reflects the pressing issues facing the country, and the opportunities ahead. Attentive readers will notice that Canadians who guided us through the first years of the pandemic—public health leaders, epidemiologists—have given way in this year’s ranking to those who will guide us out of it.

It’s our version of cautious optimism. With luck and good sense, we’ll emerge from Omicron into a world where COVID-19 is a managed risk, and we’ll refocus on the challenges that define Canada and its place in the world. As ever, our ability to navigate these problems will rest heavily on our brightest, bravest and most accomplished. Remember their names, and lend them your ears.

The post The Power List appeared first on Macleans.ca.

A few months ago, Alex Fecioru was working two jobs, both of which aligned with his long term goals. He spent half his time mixing live music at a local Eastern European music venue, and the rest freelance sound editing on the side. That he was working only two jobs, and that both involved sound production, was a welcome change. Fecioru, 25, graduated four years ago with a degree in sound design with dreams to work full-time in the music business. For most of his adult life, he’s supplemented his music and editing work by hopping from food-service job to food-service job, toiling in kitchens, scraping by on minimum wage while striving to make the leap to his chosen vocation.

The last few months were supposed to be a pivotal stretch in that transition. Instead, they’ve turned into some of the hungriest of Fecioru’s young life. The monthly rent at his small Toronto apartment is $820, a small sum by the standards of his city, but enough to consume the lion’s share of his income. It leaves him with little to spend on other essentials—like food. 

Worse, the pandemic abruptly closed off his other employment options, including his beloved sound work. He’d no sooner found a position in November as a coat-check attendant at a major art gallery than renewed COVID restrictions forced the museum to lay him off. Even the kitchen jobs dried up, as restaurants closed to in-person dining.

RELATED: The Inuk woman using TikTok to expose high food prices in the North

The result has landed Fecioru within a troubled and growing demographic: young, educated, working Canadians who sacrifice food to meet their other financial obligations. Even when he’s had restaurant jobs, Fecoriu has made tough calls at the grocery store, surviving for weeks at a time on pita bread and peanut butter. 

As the Omicron wave lingers on, his crisis has deepened. To keep a roof over his head and the heat on, he has reduced every cost in his life that is not fixed, including what he eats. He tries not to spend more than $5 a day on food—an extreme measure that saps him of energy he needs to do the work that pays his rent. Sometimes, when he’s desperate, he’ll steal away to his parents’ house for a day, Fecioru says. There, at least, he can get precious, nutritious vegetables for free.

Emotionally and physically, it’s a taxing existence. “I’ve been pushed to a point where I’ve broken down mentally,” Fecioru says, referring to times when he’s worked two and even three jobs at once. He pauses, picking his words. “There have been times where it’s hour 14 of a 16-hour day and I just break down in front of customers.”

Fecioru is far from alone. As the pandemic enters its third year, low-income workers across the country are getting caught in a pincer, with the cost of living escalating rapidly and the labour market thrown into flux. Even as employers report a desperate need for workers, repeated lockdowns, and the increased threat of contracting the virus, have made in-person service work more precarious, forcing workers like Fecioru into long stretches without paycheques. 

On top of these myriad obstacles, many workers are no longer able to rely on the COVID income supports that kept many of them afloat for the first year-and-a-half of the pandemic.

 The effects have rattled down to kitchen tables with alarming speed. In a recent countrywide poll, nearly 60 per cent of respondents—including half of 18-24 year-olds—told the Angus Reid Institute that they’re having trouble feeding their families. That’s an increase from 36 per cent when the question was last asked in 2019.

Even before the pandemic, millions of Canadians were struggling to keep food on the table. A 2020 StatsCan report found that one in seven lived in food-insecure households, up from one in eight Canadians in 2018—a difference of nearly 700,000 people, and the highest rate since StatsCan began recording the information. The food-stressed do not fit tired stereotypes of people who’d rather collect welfare than take a job: at last count, 65 per cent of food insecure Canadians were in the workforce. 

Alex at home in Toronto (Photograph by Lucy Lu)

The problem, says Sylvain Charlebois, director of the Agri-Food Analytics Lab at Dalhousie University, is that the cost of food is far outpacing the money people are making. The “inflation sweet spot” for food prices, he says, is about 1.5 to 2.5 per cent. Food prices are supposed to increase at about that rate every year to keep up with the usual level of inflation of the rest of the economy. If they do, groceries should remain affordable.

But in 2022, food is expected to cost anywhere from five to seven per cent more that it did the year earlier, according to the latest edition of Canada’s Food Price Report, an annual look at the year ahead in food security published by Charlebois and his colleagues at Dalhousie. He attributes this increase mainly to the state of supply chains in Canada: food is moving around the country at a much slower pace due to COVID restrictions. As a result, manufacturers and transporters are incurring greater costs, escalating the overall price of the food they’re delivering. 

But grocery prices, Charlebois stresses, are not at the root of the longer-term crunch. “The real problem,” he says, “is affordability.” And he’s quick to offer up what he sees as the solution: “I think it’s high time for our country to have a conversation about a guaranteed minimum income.”

A guaranteed minimum income involves the government paying a liveable wage to those who don’t have the means to survive financially. It is distinct from a universal basic income, where all Canadians periodically receive a cheque from the government regardless of their economic standing. Guaranteed minimum income would, in practice, look a whole lot like the earliest iterations of federal pandemic income supports.

READ: Has enthusiasm for the CERB paved the way for a universal basic income?

The Canada Emergency Response Benefit (CERB), and its successor the Canada Recovery Benefit (CRB), were vital lifelines to low-income workers during the lockdowns of 2020 and 2021. They provided $500 per week to workers who had lost their jobs or significant chunks of their income for COVID-related reasons, allowing people to focus on staying home and reducing the spread of the virus instead of working dangerous, contagious jobs so they could pay their rents.

They also allowed people to get back on their feet after being knocked down, financially speaking. But the CRB was replaced in late October with the scaled-down CWLB, which is available to workers who have lost work due to regional lockdowns. The federal benefit has been pared back 40 per cent, to $300 per week before taxes. Many people lurching in and out of work don’t meet the eligibility requirements, and if they find employment while receiving the benefit, they might have to pay the money back.

Regardless, the $300 hardly makes a dent in most people’s expenses, and is a far cry from the much more robust programs that preceded it.

Two federal parties, the NDP and the Greens, support a basic income, pointing to CERB as proof that a government-funded income program is both possible to implement and highly effective in fending off poverty. Delegates to a Liberal policy convention last year also overwhelmingly endorsed a basic income program. But the Trudeau government didn’t include it in its summer election platform, and seems focused on other priorities.

“Frankly, in light of our debts and ongoing deficits,” acknowledges Charlebois, “I think it’s going to be a hard conversation to have with Canadians.”

***

Perhaps, but it’s a conversation that could change the course of Rachel McDonald’s life. The 23-year-old works at a small café in Charlottetown, where she was recently promoted from barista to supervisor. For McDonald, the barista job was working just fine—she didn’t go to college or university and only has experience in customer service, so when she was offered a job at the café working for $14 an hour, she took it. 

Then came COVID. It’s cheaper to live in P.E.I. than many places in the country, but the pandemic has hobbled McDonald’s efforts to keep a roof over her head and food on her table. The island’s isolation has spared its residents of the lockdowns plaguing some of the country’s metropolitan areas. But its economy relies heavily on tourism, an industry that effectively came to a standstill when the pandemic began.

McDonald’s hours were scaled back, forcing her to move out of her bachelor pad and into a house with several other roommates. She pays half the rent she did before, but she’s still barely scraping by, unable to squirrel away any money and just making enough to survive. About half her money goes to rent and the rest of it is split between groceries, bills, and minor purchases. 

“A person working minimum wage cannot support themselves living alone,” says McDonald, sighing. “I feel like I have to go out and face the fire just so I can continue to survive.”

This permanent state of fragility carries both economic and human costs, says Frances Woolley, a professor of economics at Carleton University. “We have an economy where things are precarious,” says Woolley, “and when things are precarious and something goes wrong, you may not have the resilience to recover.”

The $2,000 a month that CERB and CRB provided was just around the average living wage for a Canadian, an amount understood to comfortably pay for an individual’s basic needs—food, housing, and child care. But minimum wages in many provinces fall short of living wages for many Canadians, and the gap between what people are able make and what they need to buy food and other essentials has been widening.

Woolley sees the challenge of securing decent wages for all workers as the greatest obstacle in the Canadian economy—one that seems simple to overcome, yet hard to get powerful people to face. “Wages are really sticky,” says Woolley. “As an economist, one of the things that I find the most puzzling about our economy is that when people find it hard to hire workers, they don’t think, ‘Oh, maybe we should be paying people more.’

“It seems to be something about human psychology.”

***

For workers struggling to keep food in their refrigerators, the economic forces Woolley describes—combined with the disruptions of the pandemic—can be crushing. 

Fecioru, for one, thought he’d turned a corner when he landed the coat-check job last December. It wasn’t flashy—a temporary contract at the Art Gallery of Ontario with no guarantee of extension. But it was unionized, and paid a few dollars an hour more than minimum wage. He could pursue his sound-production work free of financial unease, and without gnawing hunger.

The reprieve lasted about a month. In December, as the Omicron variant seeped into Toronto, Fecioru tested positive for COVID. He was forced to isolate just a month after starting his job, and lost two crucial weeks of income. A week after his isolation period ended, Ontario locked down yet again. All of his work ceased. Again.

The day before we spoke, Fecioru received an email from his employers at the gallery. It said if the lockdown in Ontario extended beyond its currently scheduled end date of Jan. 25 then they would be terminating his contract. This was money and work that Fecioru was depending on to survive post-pandemic. As he finished reading the email, he violently paced around his apartment. His anxiety spiked, and at 25 years of age, his heart began to palpitate. 

Mercifully, that worst-case scenario did not come to pass. After Ontario eased restrictions on Jan. 31, the gallery brought him back, and even paid him for the shifts he lost during the lockdown. Still, his hours have been significantly reduced, and COVID still looms, poised to strike as it sees fit.  

“It feels like there’s moments where you can poke your head up above the surface of the water, but then the water keeps rising and you’ve got to keep persevering,” says Fecioru. “There’s not enough time to catch your breath.”

The post Young, working Canadians face a dilemma: eat, or pay the bills? appeared first on Macleans.ca.

On a hazy Friday morning, Gui Rong Ni, 72, is in her element at the neighbourhood garden in Vancouver’s Downtown Eastside. As Ni scatters carrot seeds across the bare sections of soil, Ya Qin Wan, 79, showers Brussels sprouts and bitter melon crops with a hose. At an adjacent plot, Yu Ying Guan, 83, harvests the fuchsia-stained leaves of yin choy. Working in synergy, the women employ knowledge and dexterity retained from decades of experience.

Produce farmers by trade, they once played a crucial role in China’s food system. After moving to Canada in the 2010s, they are now among the 12.6 per cent of seniors in B.C. reliant on public pensions who are food insecure. While old age security helps cover their monthly rent and bills, there’s next to no money left for food. As a result, they count on food banks, charity meals and other programs run by youth-led grassroots initiatives for nourishment.

Long-time produce farmer Yu Ying Guan harvests yin choy at the neighbourhood garden. (Photograph by Felicia Chang)

Only 2.4 per cent of older Canadians are estimated to be moderately or severely food insecure, according to a 2020 study led by researchers at McMaster University in Hamilton, a proportion lower than the 14.6 per cent of the general population reported as food insecure by Statistics Canada in May 2020.

But that figure papers over serious difficulties that many immigrant seniors face in sourcing adequate amounts of nutritious food—populations undercounted, overlooked or excluded from many surveys and studies because they don’t speak English. Struggling under limited fixed incomes, many toil daily to put food on their tables, making use of grocery distribution programs led by outreach organizations and charities. Worse, some Chinese seniors interviewed by Maclean’s in Vancouver say they’ve faced stereotyping, hostility and overt racism while accessing these services.

READ: How an Iqaluit mom’s TikTok videos turned her home into a de facto food bank

“Due to language barriers, many seniors living in Chinatown don’t get the help that they need,” says Teng Lai Lim, the dedicated outreach worker for Chinese seniors at the Downtown Eastside Women’s Centre who organized the garden Guan, Ni and Wan are using.

Xiaowen Shi, 73, and her husband Bing Xu Jiao, 83, rely on the help of Teng Lai Lim, a Chinese Seniors outreach worker with the Downtown Eastside Women’s Centre, with their everyday needs. Teng Lai wishes there was more funding for more Chinese Seniors outreach workers. (Photograph by Felicia Chang)

Lim assists 43 Chinese seniors in situations where language is an impediment, but she often does additional work at the centre off the side of her desk. As a result, she says, she’s at risk of burnout, struggling to accommodate everyone who needs her help within what is supposed to be a 30-hour workweek. “I am doing multiple people’s jobs,” she says.

Lim and others who work with Chinese seniors have asked for more hours and additional staff, saying it would allow them to help more people—but so far to no avail. “It’s sad, because a lot of the [seniors’] problems are not on the surface,” she says. “You have to dig down.”

A genuine personal connection is what many elderly people seek from social workers, Lim says, especially for those who recently uprooted their lives in their homeland. One of the seniors Lim currently accompanies to doctors’ appointments, Xiao Wen Shi, 73, was sponsored by her son nine years ago to come live in Canada, along with her husband, Bing Xu Jiao, 83. They made the move from their home in Heilongjiang—a province in northeast China that borders Russia—to help care for their grandchildren. Most of the seniors Lim works with made the move for the same reason.

Shi, then 65, found work at a blueberry farm to help pay the rent, as she and her husband were living with their son’s family at the time. Through 14-hour workdays, she squatted under the blazing sun, earning 40 cents per pound of berries picked. Eventually, severe knee pain forced her to retire. “Recently, she has had to lie down a few times in between preparing meals, because she is in pain,” a visibly concerned Jiao says of his wife, in Mandarin. “I’m worried about the day she can no longer stand up.”

Xiao Wen Shi, 73 reaches into her fridge for a bag of oranges, one of the items included in the weekly delivery of a subsidized grocery program. (Photograph by Felicia Chang)

When their grandchildren reached their teen years, the couple made their home in Vancouver’s Chinatown, one of the distinct areas that make up the city’s Downtown Eastside. Founded in the late 19th century, the area expanded after the Chinese Immigration Exclusion Act was repealed following the Second World War. Today, it lies within one of Canada’s poorest postal codes, in the sightlines of Yaletown’s luxury condos and only kilometres away from Canada’s richest neighbourhood, West Vancouver.

Yet Asian seniors regard Chinatown as a naturally occurring retirement community. The area offers a kind of subdued facsimile of home, Jiao says, with greengrocers, fishmongers, barbecued-meat stores and dry-goods shops whose owners speak Mandarin or Cantonese. Those businesses are slowly giving way, though, to luxury gyms, vegan restaurants and faddish clothing shops selling $400 sneakers.

RELATED: The grassroots food insecurity initiatives putting an end to the ‘starving student’

All this can be seen from the window of Shi and Jiao’s fixed-rate studio apartment, though their small monthly budget for food leaves little room for staples, let alone edible luxuries. Their son, who is working to feed his own family in the high-cost B.C. Lower Mainland, brings food once a month when he and his family visit, though some of it is consumed during their time together. So the bulk of the couple’s diet is based on food from the local food bank.

Each week, the couple makes the trip down the block together to collect it. Shi clutches her husband’s arm for stability; his other arm tows a foldable trolley they fill with mainstays like eggs, milk and seasonal vegetables. Despite their lack of English, they are welcomed by food bank staff who are aware of Shi’s disability; they often invite her to collect food without lining up.

But positive experiences are not universal. Jing Li, another Chinese resident using food banks in the neighbourhood, recounts hostile interactions the 72-year-old and her friends have had with volunteers from another organization while in the lineup for its streetside food bank.

In the early days of the pandemic, Smoke Signals—an Indigenous-led organization whose primary mission is reconnecting First Nations peoples in the Downtown Eastside with their families and culture—partnered with the Salvation Army in North Vancouver and the Korean American Presbyterian Church to distribute food at an outdoor location steps away from the intersection of Main Street and East Hastings.

Once the food was laid out on a table, the distribution became chaotic; it was common for a frenzy to ensue between volunteers and the people in line, further complicated by miscommunication about the amount of food each person could take.

Chinatown’s youth-led community food-delivery initiatives also encourage relationships and build support networks among neighbours. (Photograph by Felicia Chang)

Li believes that she and her friends were racially profiled, grouped in with others who tend to skip the line and, as she puts it, “grab everything they can” when they see food or essentials available. Li says these individuals dress and present much as she does, but she’s quick to empathize with them: the habit of stockpiling food, she says, is a response to being raised in a food-scarce environment in Asia; for some, doing so was vital to survival.

“When [the volunteers] saw someone who was not Asian walking by or sitting by the street, they would toss them better produce even though they are not in the lineup,” she says in Mandarin. “Then they would shoo us away with a stick . . . I felt terrible when my friends and I were treated that way. It’s disrespectful and unkind.”

When told of Li’s experience, Chris Livingstone, the outreach coordinator and mental health worker at Smoke Signals, says, “I feel terrible,” adding, “Lateral violence and violence in general really has no place down here.”

Livingstone says he’d heard of such incidents involving Chinese seniors before being contacted by Maclean’s, and had removed one volunteer from the streetside food bank due to multiple instances of hostile behaviour. The organization had previously taken steps to repair its relationships with the seniors by adding a Chinese interpreter, Livingstone adds, but abandoned the measure after finding it led to more confusion and disputes between the interpreter and volunteers.

MORE: Demand for Meals on Wheels—and the drivers who make it possible—is soaring

Concerned for the safety of both people in the lineup and volunteers, Smoke Signals discontinued its participation in the streetside food bank two weeks after Maclean’s spoke to Livingstone. He stresses that “happy, grateful Asian and Chinese seniors” comprise most of the lineup for food, but adds that he understands why Li and her friends might be apprehensive when accessing food programs after this experience.

Speaking before Smoke Signals withdrew from the program, he said: “I talk to [the volunteers] and tell them that giving out food should be a happy thing, and that if you’re feeling anger or frustration, then you have to step out of the equation.”

***

Instances of profiling and discrimination against Asian seniors are a long-standing problem at some food banks and programs in the Downtown Eastside, according to frontline workers in the community who spoke to Maclean’s. Mainstream portrayals of Chinese communities “perpetually paint them as better off compared to others,” says a former outreach worker who asked that her name be withheld to protect her current job; the effect, she says, obscures the poverty, marginalization and violence many experience.

Barbara Lee, founder of the Vancouver-based advocacy group Elimin8hate, says the discrimination arises partly from stereotypical depictions of Asian communities in film, TV and media. In this country, she says, the result of these rigid portrayals are racist notions that Chinese people living in Canada are “economic hoarders, that we don’t need assistance, and we’re out here to take up all the space and resources.”

Elimin8hate was created in response to a rise in reports of anti-Asian hate crimes: data collected in 2020 by the organization, in collaboration with another grassroots group called project 1907, revealed that B.C. had the highest number of reported anti-Asian hate incidents per capita in North America. In the first five months of 2021, project 1907 reported a 50 per cent increase in reports of anti-Asian incidents in Canada over all of 2020.

In Vancouver, as the pandemic set in, there was also a 717 per cent increase in reported anti-Asian hate crimes in 2020 over the previous year, according to a log of such incidents kept by the Vancouver Police Department. Lee and other activists who work in Vancouver’s Chinese community believe many experiences like Li’s go unreported.

As unprovoked attacks against Asians made headlines, Chinese seniors voiced safety concerns to volunteers at the Yarrow Intergenerational Society for Justice, a non-profit organization that supports low-income immigrant seniors. The youth-led organization responded by creating a delivery program to supply staple foods of East Asian cuisine and prepared meals to seniors on a weekly basis, in collaboration with the Hua Foundation, S.U.C.C.E.S.S., Bao Bei Brasserie and the United Way.

READ: What happened to the Liberals’ concern about hunger and food insecurity?

A recent grant guarantees that the program will continue for another year, though Beverly Ho, the operations manager for Yarrow, recognizes it as a “Band-Aid solution” to a larger systemic issue. “Ideally, all of us at Yarrow hope we can work ourselves out of a job,” she says.

A group of Chinese Seniors (from L to R: Jing Li, Gui Rong Ni, Yu Ying Guan, and Ya Qin Wan) often meet Teng Lai Lim on Friday mornings at the Downtown Eastside (DTES) neighbourhood house urban farm, where they have the use of two garden boxes. Today, they are planting bok choi and carrots seeds. (Photograph by Felicia Chang)

An organization called the Downtown Eastside SRO Collaborative also runs a weekly grocery delivery program that provides food to people living in single-room occupancy units in Chinatown and adjoining areas. Nicolas Yung, the organization’s Chinatown tenant and community organizer, notes that some single-room buildings—known colloquially as SROs—are infamously lawless and almost uninhabitable due to health and safety code violations. “Individuals living in [them] are often in difficult financial situations where they cannot afford enough food to eat,” he adds.

Once bags of groceries are prepared by workers and volunteers, Yung calls on a “team leader” living at each building to collect the groceries from volunteers outside their buildings and distribute them among their neighbours. “The delivery process requires the tenants to work with each other. So in a way, the food encourages relationships and builds a support network among people who share a kitchen and bathroom,” says Yung.

Anna Lao, the team leader for an SRO on Keefer Street, is also a chef at Gain Wah Restaurant, located on the building’s ground level. Once a month, she distributes coupons to residents living in her SRO and others, which they can exchange for meals at the restaurant, funded by donations and grants to the SRO Collaborative. She glows when recalling how one of her neighbours saved up his coupons for a year to buy Christmas dinner for his estranged son and daughter-in-law, in an attempt to repair their relationship.

Lao says her neighbours often confide in her if they are hungry, and she will always find them something to eat. The hardships she and her fellow tenants face create a perpetual bond, she says; she considers everyone living in the building her family.

***

A portrait of Chinese senior, Yu Ying Guan, 83, who enjoys her Friday mornings in the DTES neighbourhood house urban farm, caring for the vegetables she and her friends planted in two boxes. (Photograph by Felicia Chang)

To Christina Lee, who manages operations and special projects for Hua Foundation, a youth-led non-profit based in Vancouver’s Chinatown, this generosity reflects long-standing cultural values. “Maybe it comes from farming communities,” she says. “But we often convey love and care through food and collective food sharing.”

It is common, Lee adds, “for folks within our community to grow up and call everyone auntie and uncle, even though we don’t know who they are. I think that sense of family toward people who are not related to you by blood really contributes to this feeling of collective responsibility.”

Intergenerational reciprocity is embedded in the upbringing of many Chinese-Canadians, says Lee, which rings true through the work of youth-led initiatives like the Hua Foundation and the frontline workers who grind away to ensure the well-being of their elders.

Back at the garden, as the morning shifts to afternoon, Lim, the women’s centre outreach worker, and the retired farmers begin to wrap up. They’ve been working for an hour, and Lim will be back tomorrow to water the plots, as she does every day, even on her days off.

This day’s harvest of a dozen medium-sized tomatoes and a bag of yin choy will suffice as a side dish for two, and it’s fresher than anything bought at the store. One of the women saunters up to Lim and offers her the bags of produce, forcing them into her hands. The others look on, smiling and nodding.

“They’re all very generous,” says Lim, discreetly placing the vegetables back into one of the seniors’ shopping trolleys. “They grew up understanding the hardship and struggle that people go through. So even though they are poor, they still want to give.”

Nathan Sing writes about food security and hunger issues in Canada. His one-year position is funded by the Maple Leaf Centre for Action on Food Security, in partnership with Community Food Centres Canada.

This article appears in print in the February 2022 issue of Maclean’s magazine with the headline, “In need of a helping.” Subscribe to the monthly print magazine here.

The post Seniors in Vancouver’s Chinatown are battling poverty and racism to put food on the table appeared first on Macleans.ca.

When it comes to getting COVID-19 vaccines into the arms of the 5-11 crowd, there is one clear winner among Canada’s provinces and territories: Newfoundland and Labrador. Since vaccination efforts started across the nation for that cohort at the end of November, the province has built an almost insurmountable lead: to date, it has given first doses to 74.7 per cent of all children ages 5-11, well above the rest of pack—Nova Scotia is second at 61.4 while Quebec has third place at 57.4—and a whopping 26 percentage points above the national average of 48.3 per cent. 

Share of 5-11 age group with first doses:

N.L.: 74.7%
N.S.: 61.4
Que.: 57.4
NWT: 53.3
Yukon: 53.3
N.B.: 52.9
Man.: 50.1
Nunavut: 48
Sask.: 47.5
P.E.I.: 46.9
Ont.: 46.4
B.C.: 43.6
Alta.: 37.5

Source: Health Canada (data up to Jan. 8) 

What is the secret to Newfoundland and Labrador’s success? 

For one, the province has had a focused public health communications strategy, led by its chief medical officer of health, Dr. Janice Fitzgerald. “She’s consistent, she’s clear, she is an excellent communicator to the public, she’s honest,” says Dr. Natalie Bridger, a pediatric infectious diseases physician in St. John’s, who took part in the press conference launching the children’s vaccination effort. “She’s been very, very steady in the past two years guiding us, and has engendered a lot of trust, so people take her advice seriously,” including regarding the need for pediatric vaccines. 

DEEP DIVE: Chronic exhaustion, derailed lives and no way out. This is long COVID.

In Newfoundland and Labrador “there is a background culture of vaccine acceptance,” says Bridger. “We’ve got a bit of a history of being superstars when it comes to childhood vaccines,” thanks in part to a strong public health nursing system, which for decades has overseen those efforts. Newfoundland and Labrador is a notable provincial outlier for its COVID-19 vaccination rates: it’s the only province to reach more than 90 per cent when it comes to first doses, according to data from Health Canada (93.8 per cent to be precise, which is 12 percentage points above the national average); it also has the top spot for two doses: 86.2 per cent, compared to the Canadian average of 77.1 per cent. 

Newfoundland and Labrador got off to a fast start with pediatric vaccines, immediately opening its booking system when the vaccines were approved for children, and having mass clinics operating within days. “We wanted to get as many shots in arms as possible before the Christmas break,” says Bridger. “We’ve got this vaccine–it’s approved–let’s not sit on it forever but get going as quickly as possible.” The province also offered doses to students on-site in schools. “Parents and caregivers really have lots of options for getting their kids vaccinated,” Bridger says. 

And, in addition to press conferences and letters to parents regarding the province’s plans, the province held a photo-op similar to those that marked the very first COVID-19 vaccinations in December 2020, with Dr. Fitzgerald giving two girls their doses while Deputy Premier Siobhan Coady looked on. 

RELATED: Health Canada approves new COVID treatment

Whether other provinces can adopt some of Newfoundland and Labrador’s successful strategies depends on how well they know their own populations, Bridger says. “I think it’s really important for the leadership to understand what motivates people to behave in a certain way.” For those in her province, a big motivator is seeing loved ones: “The inability to see grandparents and great-grandparents has been devastating for a lot of Newfoundland and Labrador children.” 

The province also launched an advertising campaign that emphasized the message that vaccinating children helps prevent COVID-19 from spreading to friends and families while also tugging at heartstrings: “Because my nan needs help with her cookies,” was the tagline on one, featuring a girl behind a cookie sheet laden with dough, while another showed a boy and his grandfather playing a video game, with the caption, “Because my pop needs to play Minecraft.” 

Bridger also points to the province’s culture. Its population is relatively small, and peer pressure, both online and within communities, is a strong factor in getting people to accept public health measures, including vaccinations, she believes. 

And it’s also due to the reputation of Dr. Fitzgerald, who has been the public face for the vaccination effort. She is so beloved that her office is stuffed with gifts sent to her by the public—stuffed toys, needlepoint and children’s artwork. “She is as close to a saint as is possible in our province right now,” says Bridger. “And I’m not exaggerating.

The post How did Newfoundland manage to vaccinate 75 per cent of 5-11-year-olds? appeared first on Macleans.ca.

Welcome to a sneak peek of the Maclean’s Politics Insider newsletter. Sign up to get it delivered straight to your inbox in the morning.

Limited supply: Health Canada approved Pfizer’s antiviral treatment for COVID-19 on Monday, but supplies of Paxlovid are limited, so the Public Health Agency of Canada is asking provinces to prioritize the people most at risk of serious illness, CP reports.

Clinical trials showed the treatment, which helps prevent the SARS-CoV-2 virus from reproducing in an infected patient, was almost 90 per cent effective at reducing hospitalization and death in high-risk patients if given within three days of infection, and 85 per cent if given within five days. The medication requires three pills at a time, twice a day, for five days. It is the first oral COVID-19 treatment that can be taken at home to be approved in Canada but Tam admitted there may be some logistical challenges getting the drug to the right people quickly enough.

Unserious: Chinese health authorities have claimed that Omicron was introduced to a resident of Beijing through a piece of mail from Canada, which experts say is ludicrous, CP reports. A Chinese news outlet first reported that the Jan. 7 infection of a Beijing resident was the result of mail from Canada. Margaret McCuaig-Johnston, a China expert at the University of Ottawa,  said that’s an absurd suggestion: “Unlike the early days, scientists have clarified that it does not stay on surfaces. To suggest that it would be on mail that came over days from Canada is ludicrous.”

Testing goes on: The global Omicron wave is too severe to drop mandatory COVID-19 tests for air travellers arriving in Canada, Jean-Yves Duclos said Monday, the Star reports. Earlier Monday, Pearson airport, Air Canada and WestJet published an open letter to Duclos, asking him to drop the testing requirement and shift testing resources to other settings, like schools. Duclos said no: “At the moment, it’s not going to happen. We are probably, in Canada, not even at the peak of infections.” Some experts argue the testing requirement makes less sense now that Omicron is so prevalent that provincial testing regimes can’t keep up with infections.

Bad call: The Alberta NDP is calling for Justice Minister Kaycee Madu to resign after learning he called Edmonton’s police chief after receiving a distracted driving ticket, the Calgary Herald reports. CBC News reported Monday that Madu was pulled over on March 10, 2021 and fined $300 for being on his cellphone in a school zone. He later called Edmonton police Chief Dale McFee to discuss the ticket.

Bad poll: Speaking of political headaches for Jason Kenney, a new Angus Reid poll says only 19 per cent of Albertans think he has done a good job handling COVID and 48 per cent think he has done a “very bad job,” the Herald reports.

No foul: The federal ethics commissioner says Dominic Barton, Canada’s former ambassador to Beijing, did not violate ethics rules when he accepted an offer to chair Rio Tinto, the Globe reports. Two NDP MPs asked for a probe, suggesting Barton was in breach of the Conflict of Interest Act because he met with executives of Rio Tinto shortly before the end of his time as a diplomat. But Mario Dion found there was no violation because Barton “did not have direct and significant dealings with Rio Tinto while he was Canada’s ambassador in China,” a spokesperson said.

Troops in Ukraine: Canadian special forces have been deployed to Ukraine amid rising tensions between the NATO military alliance and Russia, Global News reports. Sources told Global that the deployment is part of an attempt by NATO to deter Russian aggression in Ukraine.

Distracted driving? Doug Ford was mocked and praised for acting as “taxi” and “snow plow” during a massive snow storm in Toronto on Monday, Yahoo reports. There was so much snow in the city, that the school board cancelled school for two days straight.

Good news: John Horgan has completed cancer treatment, the Vancouver Sun reports. “They had the phasers on stun and my treatment is complete,” Horgan said in a handwritten note he posted to Facebook on Monday. In October, Horgan announced that he had discovered a lump on his neck and that doctors recommended a biopsy.

Election promise: In the heat of the election campaign this fall, the Liberals promised to “table legislation to ensure that every business and organization that decides to require a proof of vaccination from employees and customers can do so without fear of legal challenge,” Campbell Clark reminds us in the Globe. Such legislation might be useful to companies dealing with a raft of such lawsuits, except that four months later there is no sign of the legislation, and likely never will be.

Bile machine: Susan Riley, writing in the Hill Times, laments that Erin O’Toole, “a formerly likeable, middle-of-the-road backbencher and junior minister in Harper’s government—is behaving like an unhinged bile-machine.” He may be bad, she concludes, but the alternatives seem to be worse.

First to be second: Alexa McDonough’s main achievement at the national level could lie in her 1995 victory as the second woman to be elected to lead a federal political party, writes Susan Delacourt in the Star. Delacourt points out that the challenge for women isn’t getting the big jobs — it’s keeping them there.

— Stephen Maher

The post Health Canada approves new COVID treatment appeared first on Macleans.ca.

April, 2020: The world had just counted its millionth case of COVID-19.

The virus was just beginning to spread like wildfire in Canada. Politicians were scrambling to secure their health-care defences against the fast-moving virus.

Ontario Premier Doug Ford was the most bullish.

“Thanks to the hard work and relentless preparation of our hospital staff to build capacity in our hospitals, we are in a position to better allocate resources to sectors that are in critical need and respond to any potential surge in cases,” he said in a statement. It would, he said, give Ontario a “fighting chance against this deadly virus.”

By the end of April, he promised, Ontario was adding thousands of new beds to its hospital system. “The province has added 1,035 acute care beds and 1,492 critical care beds and taken steps to ensure hospitals have the staff available to care for a sudden surge in patients,” a government press release reads. Whatever your opinion of the premier, it was a comforting vow as we stood in the shadow of the worst modern public health crisis.

Every province faced the possibility that, as people fell ill with the new coronavirus, there would simply not be beds available for them in hospital: Not just the physical bed, but the hospital space, the staff support, the oxygen, the ventilator and the necessary equipment. For much of the next year, the Ford government fired out press releases lauding the new ICU beds it had added to the system, preparing the province for the next wave of the virus that was sure to hit.

Ford’s consistent efforts to bolster health-care capacity have been an indication of how seriously he understands the problem facing the province.

It was also complete and utter nonsense.

Before the virus hit, Ontario had 2,012 adult ICU beds. As of October 31, 2021, according to the province’s independent scientific advisory board, there were 2,343.

Two years of the worst health disaster in modern Canadian history and its largest province managed to add 331 beds to its intensive care units.

That story has been repeated straight across the country—albeit without Ford’s trademark ability to make up numbers.

Nearly every province has seen its health system pushed to the breaking point in recent weeks due to the Omicron variant. All the promises that we’ve heard for two years about using the ebb between waves to prepare have turned to sand.

ICUs are full. Surgeries are being cancelled. Lockdowns and curfews are being implemented because governments fear even a modest rise in cases could lead to deaths—not due to COVID-19, but due to a lack of care. The only exception is in the territories and Atlantic Canada, where leaders have—at least compared to their colleagues in the rest of the country—actually shown themselves capable of handling crises. (Admittedly, their geography helps.)

This is not a new problem. Canada has long lagged behind other rich nations in terms of its hospital capacity: Canada’s ICU capacity is less than half of that of the United States and just over a third of Germany’s. (Or, we think so, anyway: Canada’s most recent survey is from 2014. A 2015 study distressingly found “our overall national critical care capacity is unknown.”)

While ICU capacity is not necessarily a sign of the overall quality of a health system—an efficient health-care system can run on fewer ICU beds by diverting patients before they need critical care, and by load-balancing between hospitals and health networks—a modern health system absolutely needs significant surge capacity.

Canada has famously been unable to do surge capacity well, and there appeared to be a general indifference to fixing that problem. When the H1N1 pandemic hit in 2009, hospitals were routinely turning away patients and rescheduling surgeries in order to handle the influx.

“To mount a response to H1N1, public health units pulled human resources from other programs, and many critical services were delayed, suspended or cancelled altogether,” Jeffrey Turnbull, the president of the Canadian Medical Association, told a Senate committee in 2010. “The resources of our critical care infrastructure were stretched to their limits in many hospitals.” Turnbull noted that his organisation has been warning about the lack of surge capacity for over a decade.

“If H1N1 had been the severe pandemic that was expected, and for which Canada had been preparing, our health-care system would have been brought to its knees,” he warned.

That warning was, unfortunately, prescient. 

***

Early in 2021, a team from McMaster University in Hamilton embarked on a study to understand how the pandemic has affected frontline health workers across the country.

Their study interviewed hundreds of the pandemic’s unsung heroes: Respiratory therapists. While they can work in a variety of settings, they are some of the most critical staff in ICUs. Respiratory therapists, for example, are the ones performing the intubations for patients who are no longer able to breathe unassisted. They have often been the ones holding the hands of patients as they die from complications caused by COVID-19.

The study found that at least one-in-five respiratory therapists, the vast majority of whom are still on the job, exhibited the symptoms of post-traumatic stress disorder. What’s more, the effects of the stress placed on these workers corresponded to a significant impairment in their ability to work—the therapists who participated in the study reported they were unable to work, on average, one-and-a-half days out of 30, and had had to cut back on work responsibilities for another four days.

This is, unfortunately, the reality in many high-pressure jobs, especially in times of crisis. But there’s a factor that is magnifying this problem: Moral distress.

Moral distress, in essence, is the psychological response to being unable to do the right or ethical thing because it is either impossible or disallowed. It’s not hard to imagine such distress: Picture yourself in an over-crowded hospital. You’ve got to decide who gets the just-opened ICU bed—the person awaiting critical heart surgery, or the unvaccinated person suffering from COVID-19 whose chances of survival look dire. You’re wearing only a surgical mask, because the hospital doesn’t believe you require an N-95. Your colleague down the hall is proudly unvaccinated, bragging about how they’ve forced the premier to back down on a mandate for health-care workers. You’ve been working double shifts all week because so many of your colleagues are off sick, and you know your performance is suffering. Your floor is half staffed, and the ones who are working are straight out of medical school and in way over their heads. You’re doing your best, but the health-care system is not working as designed.

How could you not be distressed?

The researchers administered an established test to measure moral distress. They presented the respiratory therapists with 27 statements—like ”[I] experience lack of administrative action or support for a problem that is compromising patient care,” and “[I am] required to care for more patients than I can safely care for”—and asked them to rank the statements in terms of how frequently they experience the situation, and how distressing it feels.

The scale goes between 0, meaning the health-care workers feel no real stress at all, and 432. The McMaster study found those respiratory therapists reported an average score of over 133, with those working on COVID-19 wards averaging 141. By way of comparison, a 2019 American study found that an average score of 96 for a random sample of physicians and 112 for nurses. The Canadian health-care workers, in other words, were 50 per cent above the baseline. (Although the comparison is imperfect, given the United States’ for-profit health-care model.)

What is galling about that metric is that it is avoidable. It is not a measure of how difficult the job is—it is a metric of how the health system makes the job difficult. It is a measure of how much our health-care workers feel abandoned and unsupported.

“Categorically, that comes out in the interviews,” says Margaret McKinnon, who led the study. She’s a professor of psychiatry and behavioural neurosciences at McMaster, and has worked as a frontline health-care worker.

“You feel distressed by an institution.”

***

For the past two years, we have heralded our frontline health workers as heroes. We have clanged pots and pans from our windows and put up posters promising “ça va bien aller.” Our politicians have been effusive in their praise of our health-care staff, who form the only bulwark between our delicate status quo and utter tragedy.

Yet, in real actions, what have they done to support those staff?

I asked one health-care worker, a nurse in British Columbia, if she had received any kind of pay bump during the pandemic—certainly, I know my friends on Bay Street have received bigger-than-usual bonuses in recent years, in recognition of their difficult work-from-home arrangements. Why not health-care workers?

She laughed and thought for a second. There was a modest pay bump near the beginning of the pandemic, she said, thanks to a $3 billion federal fund. Nothing since then. 

While money can’t fix the trauma visited upon those health-care workers, it sure doesn’t hurt. It’s a way of recognizing the sacrifice made by those workers. Some provinces, like Alberta and Ontario, topped up the federal program in 2020 but have done next to nothing since then. (Governments in Nova Scotia, New Brunswick, and Manitoba, to varying degrees, have provided more compensation for frontline health-care workers, to their credit.)

On the other side, low pay and wage caps have done the opposite: They have sent the message, as one nurse told me, that these health-care workers don’t matter. “They feel like they’re expendable,” she told me.

In Ontario, Doug Ford’s Bill 124, introduced in 2019, limits wage increases for nurses to one percent per year. More recently, Quebec has cancelled nurse’s vacation time and will force COVID-positive health-care workers back on the job. Alberta actually tried to cut nurses’ wages during the pandemic.

In January, the Registered Nurses Association of Ontario launched a damning indictment of the Ford government—which could readily be applied to governments across the country—accusing him of “turning a pre-pandemic nursing shortage into a full-blown nursing crisis.”

Respiratory therapist positions, meanwhile, are some of the lowest-paid in the health-care sector. They regularly make seven or eight dollars an hour less than nurses. In some provinces, including Ontario, they had to fight to be included in the Ottawa-financed pay bump. Respiratory therapists are also excluded from Ontario legislation designed to provide paid leave for those experiencing PTSD.

The magnitude of the pressure facing these frontline workers can be hard to convey.

Carolyn McCoy, Director of Accreditation and Professional Practice Services at the Canadian Society of Respiratory Therapists, told me that, in normal times, a respiratory therapist can expect to look after five ventilated patients each. “Well, now, they’re looking after eight, nine, 10 ventilated patients,” McCoy told me. Despite their critical role in the pandemic response, she says, respiratory therapists “have not felt recognized or valued.”

“There’s a systemic staffing problem,” the B.C. nurse told me. Whenever there’s a shift change, the job assignment board in the hospital “is like the New York Stock Exchange,” they told me.  “They’re trying to reassign patients and trying to reassign nurses. And then, halfway through the shift, the whole thing happens again. So it’s a very chaotic situation.”

Sometimes, staff feel unable to show up and handle COVID-19 cases. The nurse said that one trick hospital administrators pull is to call up health-care workers and tell them they’ll be working a non-COVID-19 ward—when the nurse shows up, however, they find themselves reassigned to the COVID floor.

Not having the bandwidth to handle COVID-19 patients is understandable. Today, the vast, vast majority of seriously ill patients with the coronavirus could have averted getting sick but chose not to: They opted to not get vaccinated. While health-care workers try and find compassion for those people, sympathy has its limits. What’s more, many of the critically-ill, unvaccinated, patients have a faint hope of survival. “Many feel like they’re providing futile care,” McKinnon told me.

Jonathan Lee is a critical care paramedic with Ornge, the not-for-profit company tasked with providing air and land health transport services in Ontario. Part of his job is trying to balance the load of patients between hospitals and health authorities around the province.

“The hospitals are a disaster,” he told me. “It is not uncommon to walk in and there’s just no staff, there’s just no nurses, there’s an emergency department that normally would run with six or eight—it’s down to one or two.”

We are in a vicious cycle. The past two years have pushed many health-care staff to their breaking point: The stress of fighting this cursed virus has wrecked the lives of doctors, nurses, paramedics, and support staff. Rather than stepping up to support those workers, our governments have systematically signalled that they are expendable. Many have left for more normal, 9-to-5 jobs in public health, or administering vaccines. Others have left for the United States or further afield, where their expertise is rewarded adequately. Others have gone on unpaid, indefinite leave. Still others have just quit.

For every health-care worker who quits, it compounds the work of everyone else in the system. One fewer nurse on shift means the workload, and the stress, is distributed to their remaining colleagues—increasing the likelihood that one of them will walk as well.

On top of that, fewer staff doing more work makes it nearly impossible to do adequate on-the-job training. That means students are either not graduating, further decreasing the overall capacity, or are entering the hospital without the same standard of training they ought to have—that only leaves them unprepared for the work, making them further likely to experience that moral distress, and increases the workload on their new colleagues. The problem is so acute that some of the shiny new ventilators, purchased early in the pandemic as a splashy way for the government to show their commitment to the health sector, have gone unused because there is simply no time to train staff on the new gear.

“There’s a lot of nights where we’re short,” Lee told me. “And, you know, that means we have to drive extra. And that means, because when the hospitals are short—and they’re all short—then they transfer more patients because they can’t take care of them.”

***

This feeling like health-care workers aren’t really valued is highlighted to a sickening degree in provinces’ refusal to provide the best personal protective equipment to health-care workers.

In 2020, the Quebec nurses union had to go to an administrative tribunal and to court repeatedly to force the government to provide N-95 masks to their members in hospitals and other COVID-19 hot spots.

“The public health bureaucrats, far away from what’s happening in the hospitals, long-term care homes, and other health units in the [COVID-19] hot zones, are taking a hard line and maintaining an order that limits access to N-95 masks,” wrote representatives from two of Quebec’s largest health unions, cosigned by dozens of their regional colleagues in the Journal de Montreal last January. They warned: “Our members have simply had enough!”

The Ontario Nurses Association has had a similarly miserable fight, trying to force the Ford government to do the right thing. Even as scientists were publicly admitting that COVID-19 is primarily spread through the air, the Ford government was arguing in court that the virus spread through droplets and, therefore, health-care workers only needed good masks in certain circumstances.

A court ultimately sided with the government, though tacitly acknowledged that nurses ought to have access to the N-95s. The pressure has resulted in the respirators becoming more accessible, although gaps remain. Even today, access can be limited for workers in long-term care homes and other high-risk environments.

Even if access has improved, obtaining the masks can still be a struggle in some settings. In British Columbia, where the courts haven’t weighed in, it’s a nightmare.

Public health nurses were visiting communities where COVID-19 was rampant—spending significant time in tight spaces with poor ventilation. “They were being told…you don’t need N-95s,” one nurse told me. During the summer, some of their surgical masks were literally dissolving in the heat. 

“They’re dealing with incredibly sick people in very unstable conditions and all of a sudden, you’re also having to have a huge fight about access to N-95s,” they told me. Even in the hospitals, staff are regularly denied N-95s. 

A core piece of the moral distress that McKinnon identified as being endemic in our hospitals right now is the feeling that they’re not just struggling against a naturally-occuring virus, they’re struggling against their own government and employer.

“We’re essentially on war-time footing,” she told me. “And one does not want to go into war without armour.”

In some cases, it feels like health-care workers are struggling against their own colleagues. Ontario and Quebec, in particular, announced plans to mandate vaccines for health-care workers, only to stage a hasty retreat.

“It is very difficult to not become resentful of it, especially health-care workers who don’t [get the vaccine],” Lee told me. Working alongside someone who refuses to adopt the countermeasure that is scientifically proven to reduce the likelihood of transmission of COVID-19 is frustrating as hell, he told me. “If you are a health-care provider and you refuse—or you don’t believe that, or you can’t interpret that, the same way as everybody else—are you a competent health-care provider?”

It would be like refusing to perform CPR on the basis of a “personal belief that CPR makes my wrist hurt, so I’m not going to do it,” he said. Pulling someone off the frontlines to do a desk job, while collecting a full salary, isn’t a solution either, he adds.

British Columbia is a rare province that forged ahead with its vaccine mandate for health-care workers. “I didn’t notice anyone leaving,” the B.C. nurse, who was not authorised to speak to journalists, told me.

British Columbia reported in November that just over 3,000 health-care workers, about 2.5 percent of the health sector, are on unpaid leave due to refusing the vaccine.

Certainly, 3,000 is a sizeable number. But consider the risk of tens of thousands of other workers quitting in disgust. The SEIU healthcare union found that more than half of their members in Ontario are considering quitting altogether. “Poor wages and working conditions are 20 times more likely to be the reason for health-care workers leaving the system than vaccine mandates,” they reported.

Lee recently got an email from his employer that highlighted the absurdity of it all.

“They emailed me, in the middle of this entire nonsense saying: ‘You need to get your tetanus shot updated, or you will not be eligible to work.’” (Lee, obviously, got his tetanus.)

***

Someday we will have a taxonomic accounting of where our slothful and lazy governments declined to act, and how dearly we paid for it. Because governments have been unable to build that surge capacity in our hospitals, schools have closed, businesses have shuttered, and we have all taken enormous hits to our personal life and mental health. Some of that was inevitable, but not all of it.

Those measures have all been done in the name of protecting our health-care system, but that is misdirection. Because governments have shown themselves incapable of preparing, there are scores of doctors and nurses who have to worry about their children’s virtual learning, even as they work tirelessly in a system on the brink. Mobs of angry protesters are channelling their anger over lockdowns and curfews towards those health-care workers who had tried hard to buy us time to avert such miserable policies.

Retrospectives are for later. For now, we need to focus on what must be done immediately.

For one, being unvaccianted must become untenable. Vaccine mandates need to be implemented for health-care workers: Forcing doctors and nurses to work alongside colleagues who refused to take the shot is insulting. 

We need to speed up booster doses—just 16 per cent of British Columbians have received their third dose. Dropping the eligibility requirements and allowing non-health-care personnel to administer those doses would be a way to boost demand and supply at the same time.

More importantly, we have to stop accepting that being unvaccinated is a personal choice without consequences for the rest of us. Much like piloting a plane without a licence or playing with dynamite on a busy highway, reckless actions have the clear potential to hurt the rest of us: Not just by transmitting the virus, but by slamming the hospitals where the rest of us need to be treated.

Quebec has forged the right direction there by first requiring a vaccine passport to enter alcohol and cannabis stores, and by vowing to tax unvaccinated people higher. The other provinces would be wise to follow suit. We already tax risky behaviour that strains our health-care system, through tobacco and alcohol taxes, and this should be no different.

Vaccines, one way or another, need to be mandatory.

But the benefit of vaccines takes some time to be seen. What provinces need to do immediately is show health-care workers they are valued, instead of cogs that are expected to keep turning. And, in the process, avoid the further hollowing-out of the entire health system. Immediate pay increases and an explicit policy to make N-95 masks for all staff at all times is a bare minimum. Provinces should, further, endeavour to work between each other to better share resources to try and more quickly offer surge capacity when one needs it more than others. 

Recognizing the health-care credentials obtained abroad (which Ontario is doing) is also one way to boost capacity quickly, but it is not necessarily a fix for immediate staff shortages: Someone still needs to train those new staff.

There has been a lot of talk about protecting health-care workers from the irate protesters and conspiracy theorists who have targeted their workplaces. This can’t be done fast enough. Health-care workers aren’t just facing danger from the hordes of unvaccinated on the sidewalk outside, they’re facing threats and harassment from patients and their families who continue to labour under paranoid delusions about this virus.

There also needs to be considerably more mental health support for health-care workers. Offering pablum from the podium isn’t good enough: Provinces need to pony up the money to hire those resources. “Social support is the single greatest predictor of PTSD,” McKinnon told me. There needs to be mental health support on every unit in the hospitals.

It’s clear the federal government needs to stop watching from the sidelines and get more involved. Ottawa has been ready to transfer money to the provinces without much hesitation. But the federal government has played a passive role, offering up support only when called—relying on the premiers to act, as we’ve all learned, is a dicey proposition. Ottawa dispatched mobile health units to beef up ICU capacity early in 2021, but haven’t during this Omicron wave. A spokesperson for the health minister told me their current status is “stand-by.” Quebec has had the good sense to take up the Canadian Forces on their offer to help administer vaccines—other premiers should follow suit.

While the federal government has hardly been a paragon of competency through the pandemic (vaccine procurement excepted) it’s time it steps up. Ottawa has tests, N-95 masks, money and trained mental health professionals: If the provinces won’t make those things available, perhaps Ottawa should find a way to provide them directly to its own citizens.

Things are bad right now, but there are things our leaders could do right now to make them better.

After this current crisis is over, we need to have a long, difficult conversation about what our health-care system looks like. If we want it to remain public and universal, we will need to figure out how to pay for a resilient and effective system without bankrupting other parts of it. If not, then it’s time to start talking seriously about how to get private industry more involved.

Quite honestly, we should not trust any premier west of Bay of Fundy or south of the 60th parallel to join us in that conversation because they clearly have no idea what the hell they’re doing.

CORRECTION, Jan. 15, 2022: An earlier version of this story said the Ontario Nurses Association won their legal fight against the Ford government. In fact, the Ontario Superior Court of Justice upheld the province’s directives, which denied the reality of airborne transmission.

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“I think it’s reasonable for the majority who are vaccinated to feel some emotion of resentment or to feel moral disapprobation toward the unvaccinated,” says Arthur Schafer, a bioethics professor at the University of Manitoba. 

Those are strong words for an ethicist, and a measure, surely, of the point we’ve reached in this pandemic: the hospitalizations of so many unvaccinated mean pain for others, including having medical procedures such as cancer or heart surgeries cancelled or postponed. Around 500,000 surgeries were delayed in just the first 15 months of the pandemic in Canada, according to the Canadian Institute for Health Information.

Now, as hospitals around the world are again being overwhelmed by patients, many of whom aren’t unvaccinated, governments across this country and abroad are tightening the rules for those who remain unvaccinated. 

French President Emmanuel Macron recently proposed new measures against the unvaxxed, including restricting their ability to travel by public means and barring them from communal venues such as restaurants, theatres and arenas. “When some make from their freedom…a motto, not only do they put others’ lives at risk, but they are also curtailing others’ freedom,” Macron said. “That I cannot accept.” And in Quebec, the unvaxxed now can’t enter liquor and cannabis stores. 

The question is when those restrictions cross ethical lines, and even become counterproductive. 

For bioethicists, who have grappled with a steady stream of moral dilemmas during this pandemic, there is a big difference between rules that restrict access to non-essential venues, and the imposition of taxes. “I think vaccine mandates—restrictions on who has access to restaurants, gyms, concerts, sporting events, liquor stores, bingo halls—are all justifiable,” says Schafer.  They protect the health-care system, those who work in those places and other patrons, he says. 

Kerry Bowman, a bioethics professor at the University of Toronto, agrees that such restrictions are, in principle, fine during a pandemic, though he’d like to see consistent operational definitions of what is and isn’t governed by such rules (such as buying alcohol, which now requires vaccine proof in Quebec but not in Ontario). 

More controversial is a new trend for governments to impose a tax, fee or levy on those who are unvaccinated by choice  (as opposed to those who have very real and rare medical reasons why they can’t be vaccinated and are exempt from such levies). This week, Quebec Premier François Legault said his government was considering such a plan, though the exact mechanism and amount aren’t clear. 

As of now, at least three countries have either announced or are implementing plans to essentially tax the voluntarily unvaccinated. 

• Singapore: Those who are unvaccinated by choice were required to pay their own hospital bills, as of Dec. 8. The government estimates such people could be charged a median price of US$25,000 if they end up in the ICU, reports the Straits Times. 
• Austria: The country is making vaccinations compulsory for residents for a year starting in February. Those who flout the law may be fined up to 3,600 euros every three months. 
• Greece: Its compulsory vaccination program for those 60 and older goes into effect this month, and carries a monthly fine of 100 euros for those who remain unvaxxed.

However, to many experts, such governmental decisions cross a bioethical red line. “In Canada, people are allowed to make any kind of medical decision they choose, as long as it’s informed,” says U of T’s Bowman. “The line we are crossing is, ‘We don’t like the decisions you’re making.’” To him, such fees are essentially punitive, putting pressure on people to do something that curtails basic human autonomy: “It’s an ethical horror show that will do tremendous damage to our society.” 

“Good ethics should be grounded in good science,” Bowman continues, pointing out that Quebecers who get a first dose today won’t be fully vaccinated for six to nine months, based on the timing intervals for getting three doses. By then, the dangers of Omicron will likely have passed. 

Schafer notes that many of those who haven’t got immunized are likely members of marginalized communities, who have historical reasons to distrust the health-care system. “I think that making it an offence punishable by a special tax or fine, or however you dress it up, will be counterproductive,” he says. “Many will see it as unfair.”

Both Schafer and Bowman are alarmed by any consideration that those who are unvaccinated shouldn’t receive the same medical care as those who are. “We distribute health care according to need, and refuse to turn doctors and hospitals into moral judges,” says Schafer. What’s next, the experts ask, when it comes to making such decisions: “Did you have a glass of wine with dinner last night? Do you really need that 10 extra pounds?” asks Bowman. “There is no bottom to this.

“Us-and-them thinking brings out the worst of humankind. It’s not something you want to see.”

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