Refugee Letter Dr. William Weiler, University of Saskatchewan · Dr. William Weiler, University of...

Refugee Letter

Dr. William Weiler, University of Saskatchewan

Back in April 2012, the Harper Government implemented significant cuts to the Interim Federal

Health Program (IFHP), which provided medical care for refugees in Canada until they were

covered by provincial or territorial programs. Instead of focusing on how to provide better

services to the Canadian population in general, the government chose to decimate the services

available to some of the most vulnerable people in our society. This resulted in significant cut-

backs across the board, barring access to preventative medicine and essential non-emergent

services for some categories of refugees (for example, pre-natal care and deliveries would not

be covered for specific categories of refugee claimants). Those deemed to be from "safe"

countries were not covered even in emergency situations, unless their condition was a direct

danger to public health. Ethics aside, restricting coverage for preventative medicine delays

access to care until more expensive, emergent services are needed. Inadequate treatment of

chronic and acute illness can ultimately lead to disability and, consequently, even more cost to

the system in supportive therapies, not to mention the risk of having people dying at our

hospitals’ doors.

These cuts were challenged in court and in July 2014, it was ruled that these changes were a

"cruel and unusual" treatment. The government was given four months by the Federal Court to

reinstate the former program. A stay was requested in October, which was denied. However, at

the four-month deadline, the Harper Government did not restore the IFHP as mandated by the

Federal Court ruling. Instead, some categories of refugees had their benefits restored, while

others did not, in violation of the court ruling. This was a significant success for those refugees

now covered by the new temporary program, including all children and all pregnant women.

But the new changes leave too many without a safety net, while adding complexities to the

already mind-bending administrative chaos that the changes brought in 2012. In addition, this

was very clearly labeled a “temporary” program. This raises serious doubts about the long-term

intentions of the Harper Government to comply with the Federal Court's decision.

As disappointing as it may be, the Harper Government has the right to appeal the Federal Court

ruling. However, no one, not even the government, has a right to disregard or violate such a

ruling. The Harper Government, whether they recognize it or not, are beholden to the same

laws that each and every Canadian citizen is. They have demonstrated contempt for the Federal

Court by refusing to fully comply with its mandate.

If the Harper Government will not listen to Canadian law, what will they listen to? As we enter

an election year in 2015, it is our duty as Canadian citizens to remind the Harper Government

that they are not above the law, and to elect a government that will not only make intelligent,

evidence-based policy, but will also uphold Canadian values, including compassion for the most

vulnerable among us.

Spotlight on Community Paediatrics!

Dr. Veronica Chan, University of Ottawa

Considering community paediatrics as a career? Residents don’t often get the opportunity to

explore the full breadth of community practice as most of our learning takes place in the

tertiary academic environment. 4 community paediatricians – each with very different practices

and areas of special interest – kindly agreed to talk to us about their journeys and careers

below.

Dr. Michelle Gordon

(1) How did you decide on a career in general/community paediatrics?

Through residency I enjoyed all my subspecialty rotations, and did not see myself doing only

one area. I also was interested in living in a smaller community. I did a number of community

electives, and found that I really enjoyed consulting community pediatrics in a smaller centre.

(2) Please describe your current practice setting.

I practice in a community of 30 000, but we serve a population of 300 000, with 5 level 1

hospitals (and surrounding communities) relying on us for their paediatric care. I have a hospital

based practice with on call for our pediatrics unit and level 2C NICU as well as an office practice.

(3) What would your typical day look like?

There is no typical day - the variety is what makes it interesting! Every day starts with hospital

rounds, usually from 8-10 am. I am on call typically 1 in 6, and on those days will provide

emergency consultations and care for sick infants and children. We do antenatal consults, see

sick babies, see ER consults, and provide care for our oncology patients, etc.

On non-call days I have a number of clinics I do for the day, each typically 1-2 times a month,

including: diabetes, asthma, complex care, neonatal follow-up, general pediatrics office

practice, clinic in a surrounding community (Parry Sound), multidisciplinary development clinic

in Parry Sound. 2 of the other pediatricians also run our POGO clinic.

(4) Do you have opportunities to get involved in medical education, advocacy, or research in

your role?

We are a teaching site for the Hospital for Sick Children and McMaster medical school, so we

have a medical student and a resident with us at all times - we do lots of teaching! One of our

MDs also sits on the PGME committee at HSC, and we also present at resident rounds at HSC

once a year. There is lots of opportunity for research - I do not do as much with my

administrative duties, but one of our MDs has written many papers.

There is an unbelievable amount of opportunities for advocacy - perhaps even more than in a

big centre. In a small centre, our voices are heard and it is easier to effect change. I have done

a lot of advocacy work particularly around our children’s complex care navigation program,

working with our LHIN and our community to secure funding and ensure ongoing access to

services for these children. We are also frequently asked to speak to the media and schools

around important child health issues.

(5) Do you have any special clinical interests or projects you are pursuing as a part of your

community practice?

I am particularly interested in neonatology, and started out neonatal follow up clinic when I

started work here 11 years ago. I am very interested in children’s complex care, and started our

clinic here about 6 years ago.

(6) Any words of advice for residents considering community paediatrics?

Consulting community pediatrics is an exciting and rewarding career - it gives you an

opportunity to use all the skills you learned in residency, and really make a difference!

Dr. Sloane Freeman


I enjoy the variety that comes with general pediatrics- I can see patients with autism, anemia

and asthma all in the same day.

(2) Please describe your current practice setting. Do you practice in an urban or rural

environment? Is your practice clinic-based, hospital-based, or both?

My practice is at St. Michael's Hospital and is focused on social pediatrics in an inner city

population. It is primarily clinic based and I go to various outreach clinics including a school-

based health center each week.


I do not have a typical day. Each day is different and will involve either an inner city outreach

clinic, research, teaching, administrative responsibilities, or all of the above.


your role?

I am fortunate to work at St. Michael's Hospital which is a teaching and research hospital and

therefore have many opportunities to be involved with all of the aforementioned activities.

Advocacy in particular is a large part of my role with outreach and social pediatrics.


community practice?

I run a school based health center program, a partnership between our pediatric department

and the Toronto District School Board. The program provides health care to students through a

clinic located at an inner city school and targets high-risk children facing barriers to health care

access.


A career in community pediatrics can look like many things. It may involve outpatient and

inpatient medicine. It may involve research and teaching and advocacy. My advice it to keep

an open mind, be creative with your career and focus on providing the best possible health

care.

Dr. Leigh Fraser-Roberts


While I was a resident, I enjoyed the clinical presentations of all specialties, and the age

spectrum within pediatrics. I believe in the strength of being a generalist, and did not wish to

spend all time working within a narrow scope of medicine. Although I considered a specialty in

Neonatology, I couldn't imagine only doing newborn care and living an intensivist lifestyle.

Within general pediatrics, there are many options for developing a practice with a specialized

focus that matches your interests. I have always been committed to the health of under-

serviced groups, and general/community pediatrics allows me to work in rural and remote

areas of Canada, such as Nunavut.


I am currently employed by CHEO and the Ottawa Hospital. My main responsibilities include

Medical Lead for newborn care at TOH (General campus), newborn call and I am part of the

high-risk newborn developmental follow up clinic team. I also provide consulting pediatric

services to the Wabano Centre for Aboriginal health in Ottawa and outreach to communities

Nunavut. I thus have the opportunity to practice in both an academic centre as well as in

community clinics in the city, and in remote health centres in northern Canada. I have provided

inpatient care for many years both at CHEO and at the Children's Hospital of Winnipeg. I also

am one of the general pediatricians providing regional e-consult services.


My weeks often vary depending on my clinical duties, so there is no typical day as such.

Overall, I run several half-day clinics per week at CHEO and Wabano. Academically, I

participate in educational activities with CHEO and the Faculty of Medicine. My administrative

duties are often flexible, as I may work on policies, and projects and other administrative issues

the remainder of the week around my clinics. I am frequently interacting with other specialists

and community service providers in my clinical, educational and administrative duties.


your role?

Yes, absolutely. I have held many educational administrative roles over the years and continue

to teach and mentor students and residents. There are always opportunities to get involved in

teaching and supervision of clinical care through the university. I also have many opportunities

for advocacy in my work, both in the city and remote northern regions.


community practice?

Yes, within my practices at Wabano and Nunavut outreach. I aim to improve the health of First

Nations and Inuit children, and work on many levels towards that goal. I tend to have a few

projects both at CHEO and in the community on the go at all times.


I would encourage residents who wish to work in general pediatrics to develop their consulting

skills and perhaps create a focus of clinical interest in their practices. I do not believe the future

of general pediatrics lies within provision of primary care services, although it is very rewarding

and enjoyable. One of the benefits of general pediatrics is the flexiblity of work environments

and myriad of opportunities. Having a comfort level with resuscitation and management of

level 2 neonates is important for consulting work at community hospitals. Consider spending

time working as a locum after graduation to have the opportunity to explore different practice

settings. Keeping up a teaching/supervisory role with students and residents supports

continuing education and is edifying. Find a passion with advocacy projects.

Dr. Fabian Gorodzinsky


My interest in the field stems from early experiences during my rotating internship in Israel. I

was assigned to a community-based site for paediatrics at the time, and found myself enjoying

the high level of responsibility and autonomy that I assumed here. I subsequently pursued

subspecialty training. However, due to the attractive opportunity to pursue primary to tertiary

level general pediatrics in London, I adopted a community pediatrics practice.


My practice is mostly in an urban setting, with time spent as CTU attending physician in the

London Health Sciences Centre, doing office-based consults and primary care, as well as being

on-call for well newborns. In addition, I often travel to peripheral communities north of London

to see patients in consulting clinics.


My days are different depending on whether it is a hospital-based or clinic day. On days when I

am acting as ward attending, I typically spend mornings rounding on inpatients and doing

teaching for my team of residents and medical students. On office days, I see 5-6 consults per

day in diverse topics such as behavioural problems, ADHD, abdominal pain, headache in

addition to primary care.


your role?

There are many opportunities for medical education in my role. I often act as lecturer for

undergraduate medical students, as well as supervise students and pediatric residents during

clinical rotations. I am also the program director of the community pediatrics fellowship at

Western University.


community practice?

I have a special interest in advocacy and global health. I have been leading mission trips to

Honduras to bring medical supplies and work in local pediatric clinics since 1998. We often have

residents join these trips as well.

(6) Any words of advice for residents considering community paediatrics as a career?

It is important to have a good level of comfort in acute care and resuscitation if you are

interested in working in a smaller community centre. If you’re interested in having your own

clinic or private practice, there is a need to develop some entrepreneurial skills such as being

able to manage income and expenses, an area often overlooked in medical training. Most

importantly, I would advise that residents should strive to maintain interests outside of

medicine.

Medical Moment

Dr. Haley Fishman, Northern Ontario School of Medicine

It was 7am, and the high-pitched, rhythmic drone of my alarm clock awoke me from sleep.

While arousing from yet another 7-hour sleep that came and went too quickly, I peered out my

window to see the sun had risen and a new day was well under way. Like the movie ‘Ground

Hog’s Day’, my morning ran according to routine, on autopilot. Roll out of bed, avoid tripping

on cats, urinate with cats as audience, feed cats, feed myself, pack lunch, try to fashion outfit

that makes me feel cool and hip but professional at the same time, check out outfit in mirror

while making mental note to lose 10 lbs, use make-up to feign a well rested sleep, steep a

thermos of tea, and then out the door. I always feel like such a cool, young professional while

strutting to my car like I am running two minutes behind, with the sound of my heels clicking, or

rather the silence of my Marc Jacobs flats that have the cutest cats designed on the toes.

I plug my iPhone into the ‘aux’ cord, and blast some Janis Joplin. Listening to some 60’s hippie

rock on my 8 to 10 minute drive to work is my mini Woodstock solace, and reminds me of my

free spirit, buried deep underneath my stethoscope. I envision myself in a field of greens,

wearing nothing but a string of fresh flowers in my hair, dancing with eyes closed and a full,

open heart, feeling the music like it was created to be felt.

As I pull into work with two minutes to spare, I make a mental vow to take my steroid puffer on

a nightly basis. Speed walking 500m, followed by 2 flights of stairs is never an easy feat with an

audible wheeze. Yes, lose 10lbs and nightly puffer. That should make me feel better.

Handover begins and I am only 45 seconds late. Minutes later, a trauma code is heard

overhead. The team of residents and staff I am sitting with look at each other with fear but

mostly excitement, knowing that our day in the ICU may be getting some unexpected activity.

Mere seconds later, there are stat calls for neurosurgery, ENT, and Respiratory Therapy. We

continue with handover knowing that the ED is well staffed with a surplus of physicians and

residents keen to get their hands dirty with some action.

As the morning draws on, word reaches the ICU that a 3-week old infant was viciously attacked

by the family dog, a Husky, who had been with the family for six years. Fueled by jealousy and

territorial instincts, the dog had left the infant with an unattached ear, compound skull

fractures, and extrusion of his brain. The dog literally treated the baby’s head as a chew toy,

ripping the stuffing of white matter out and strewing it on the carpet. There was chaos, and

blood, everywhere.

My heart went to the dog; the family pet for 6 years. The anger and rage confused with love

and attachment for such a sweet and loyal family member. My chest ached for the newborn.

What an unfortunate welcome into the world. The parents, who just had their bundle of joy,

their little miracle, ripped apart, physically, in front of them. The emotional damage and

scarring this would leave them with.

One morning, we wake up and we have everything we could have dreamed of. A loving and

committed partner rests beside you in bed. Lying still in the crib beside your bed, a beautiful 3 -

week old creation, who has already inherited more of your love than you thought possible.

Down by your feet, your 6 year old bud whose been by your side in so many memories.

Then all of a sudden – it is gone. Strangers in white coats are asking you about this dangerous

creature and inquiring about rabies and tetanus. It is assumed you will be getting rid of this

devilish animal with a ravage temper. Your baby, whose face is unrecognizable, is whisked off to

the operating room.

You feel empty.

I tried to feel for this family. It hurt too much. I imagined being in their position; to feel what

they felt. I felt shock, anger that this had to happen to me, and emptiness. The kind of

emptiness you feel in your chest. The physical pain deep in your chest whose tightness steals

your breath away. The hope, and dreams, and potential of a beautiful life; simply stolen in mere

seconds. The imagination alone was too much to handle.

Putting ourselves in our patients’ shoes is necessary. The emotions and the pains are real, and it

needs to be felt, not only by our patients. We need to grieve with them. Be there with them in

every way possible. Live through this agony-laden journey with them and support them through

it.

Every day we need to be grateful. Grateful for what we have, and for what we’ve learned

through the things we have lost. We need to treasure each moment and live every day as if it’s

our last. I know this statement is cliché and we have all heard it before, but it never resonated

with me as much as it had in that glimpse of time.

What am I going to take away from this encounter? I am going wake up at the sound of my

alarm at 7am and choose to be happy. I will embrace my furry morning audience as I urinate. I

will strut like a cool, young professional to my car and breathe in fresh air - really breathe and

fill my lungs to their fullest capacity. I will feel pain – my own and my patients’ – because feeling

pain is being human. I will love with all my heart. I will use my gift of humor to make others

laugh. I will write about my experiences and through my writing, I will infect the world with

happiness and be a ray of light in gloomy hours. Life is too short. It needs to be lived with the

best of intentions.

Islands & Algorithms: Wellness Day Initiatives at CHEO

Dr. Sara Citron, University of Ottawa

Everyone warned us that residency would be somewhat grueling; residents all emphasized the importance of having a support system around – for laundry handoffs and food donations; and to rant to, commiserate with, and share every emotion in between. Having never considered myself a particularly emotional person in the past, I was shocked at how easily a post-call comment could offend me, or set me off spiraling negatively down a path of bitter thoughts. I’m tired and struggling. I don’t know how I’m doing. I feel incompetent. I would try to explain to friends and family outside of medicine how my call had been the night prior – how little I had slept, how difficult my patients’ families had been, or how many admissions I was trying to manage in addition to my ward patients. But there’s no true way to describe it to someone who hasn’t experienced it. Which is where fellow residents – strangers to me less than a year ago – have stepped in to play an integral part in preventing me from falling to pieces on more than one post call day. From PGY2-4, there is no shortage of residents who will take a break from what they’re doing, no matter how busy they seem to be, to ask a PGY1 how its going, and to truly and genuinely listen to what you’re saying in response. I cannot express how grateful I am to have met such a wonderful group of residents who go out of their way to make sure we’re all doing ok. When it comes to the daily life stresses of residency, it seems everyone can always relate.

Yet, despite spending at least triple the amount of time with fellow residents as compared to friends, partners and families, we still seem to know a superficial amount about one another. We spend most of our time talking about patients or medical queries, or how we plan to spend our precious weekend off call. But we may not know that PGY3’s favourite TV show or most hated food – things we would definitely know about a close friend after spending this much time together. Enter the Wellness Island Initiative (for anyone who has ever worked in leadership, on a team or at a camp, this may be familiar to you): this year, as part of our Residency Wellness Day (and in addition to a delicious brunch, a skate on the canal, and some entertaining karaoke), each resident created their own ‘wellness island’ – essentially, a list of items that could make that individual feel better in a pinch. Most islands were filled with specific coffee orders, a variety of chocolate treats and or particular cafeteria requests. Others had movies, favourite songs, or certain hobbies that would lift their spirits. We tried to keep them as tangible (and hospital appropriate) as possible. The Islands are now stored in the residents’ lounge for everyone to have access to, with the idea that should you encounter a resident needing a pick-me-up, you’ll know exactly what you can do to help the out. Some residents even made algorithms: (“post call? don’t hug, just bring coffee, and back away slowly.” “Not post call? try a hug. Or chocolate. Or a Friend’s Episode, time permitting”). No matter how well we know one another now, we’ve got strategies in place to help. (At the very least, we know who needs coffee and not a hug post-call).

From the Inside Looking In – A Physician’s Perspective on Healthcare Dr. Alison Nutter, University of British Columbia My story began on January 29th, 2015 when, during an early Saturday morning walk with My dog, I found a mass on the right side of my neck. As a 3rd year pediatric resident physician, I immediately felt anxious and concerned. I knew that this was an abnormally firm mass, and based on its location it could be a supraclavicular lymph node. I followed--‐up with a visit to a walk--‐in clinic, where I met a wonderful family physician, who would end up taking me on as a patient long--‐term. I am so grateful that I happened to walk into Dr. HM’s office that day! Dedicated to her profession and patients, she listened carefully to the many questions of my partner and I, and took the time needed to answer all of our concerns. She reduced our initial anxiety of the ‘unknown’ with an exceptional calmness and confidence of care. I had many questions those first few medical visits before the confirmed diagnosis – could I actually have cancer at 28 years old? Or could it be TB from my previous volunteer medical work overseas as a student? Or best--‐case scenario, was it simply a reactive lymph node? Or perhaps a thyroid nodule as my GP initially hoped? In the two weeks that followed, I had a variety of diagnostic tests in rapid sequence; a cervical ultrasound, then an urgent biopsy, followed by a more extensive excisional biopsy, subsequent CT scans of my neck, chest, abdomen and pelvis followed by a PET--‐ CT. Finally I had my answer: Hodgkin’s lymphoma. The diagnosis was not a surprise. By this point I had completed a great deal of personal research, and was hopeful that if the mass was a lymphoma, it would be the ‘good one’, actually the rarest type that is relatively ‘curable’ and has an established therapy. So, all things considered, it was a relief to learn that I had Hodgkin's lymphoma. I now had an answer to my symptoms, and a defined disease that could be treated. I could put my energy towards managing the situation and get back to my healthy self as soon as possible. Although I’ve always greatly valued personal privacy, I was motivated to write this article so that I could share with other healthcare professionals the unique challenges and benefits of being a physician as well as a patient. As a physician, I understand only too well the physiological processes and consequences of cancer. I have ready access to a variety of professionals and comprehensive resources. I have worked with children and their families while they cope with different forms of this terrible disease. This scope of knowledge and experience is both helpful and potentially debilitating. I am simultaneously a patient and a physician, and so, medical statistics, hospital experiences, and training dominate my thinking. I am accustomed to monitoring patients for the most common or most serious complications, and have often been required to manage worst--‐case scenarios. It is very difficult (if not impossible) to suppress my physician’s habits of inquiry. At the same time, my professional knowledge and training has enabled more informed conversations and choices with my healthcare providers. I am able to come to my medical appointments fully prepared; I know what questions to ask and possible complications to look for. Along this part of the journey, I have met many wonderful healthcare providers, notably the

Numerous nurses whom I now work with from the perspective of a patient. As a physician, I recognize we sometimes take for granted a nurse’s irreplaceable knowledge and exceptional abilities for patient care. As a patient, I have deepened my appreciation for their ability to provide practical suggestions and solutions. The training of a physician does not often expose us to many of the hands--‐on (and essential) care strategies that are common knowledge to nurses. In my case for example, these included: using a hot pack to relieve severe abdominal cramps from chemotherapy, and using vitamin E oil on my scalp for pain relief during the first few weeks of hair loss. The nurse’s training, daily contact and personal communications with their patients allows for the accumulation, and then sharing of a wealth of information. This even includes key, but somewhat less accessible details such as the names of the best wig shops! As a patient, these are the practical solutions I require most in the short--‐term to ease the transition into a cancer--‐ patient status. For this support I am deeply grateful to my nurses. I appreciate their empathy and generosity; they have humanized a very difficult period in my life. Their sensitive manner during painful procedures or chemotherapy infusions, and carefully redirected conversations provided a needed distraction and allowed me to manage difficult aspects of treatment. During my last chemotherapy visit, I was surprised to encounter he same nurses who I met at my first appointment more than two weeks earlier. They smiled readily and were genuinely pleased that I had received my port‐a‐cath in time for this upcoming chemotherapy treatment. Their friendly recognition was a surprise, and deeply touching. Each time I interact with my nurses, I know that this battle is a team effort and this certainty makes it manageable. As my oncologist said at my first appointment: Hodgkin’s lymphoma will be a “bump in the road”, “I will get through this” and it will “seem like a distant memory soon enough”. This article is written to thank all the wonderful healthcare providers I have met on this journey who have helped me to adapt to my new situation and adopt a positive perspective. Thank you for showing me, with your exceptional professional knowledge and skills, that a serious illness is manageable. I believe this experience of being a patient from the inside, looking in, will forever shape my thinking and practice as a physician. When this 'bump in the road' is in the past, I will always remember the empathy and kindness I have received. I will be sure to give this fullness of care to my own little patients and their families in my future as a general pediatrician in this community.

Healthy Blueberry Muffins Dr. Erin MacDonald, Dalhousie University Bowl 1: 1 egg ½ cup low fat buttermilk 2 mashed ripe bananas ½ cup brown sugar 2/3 cup unsweetened apple sauce 1 tsp. vanilla extract Bowl 2: 1 cup all purpose whole wheat flour ½ tsp baking soda 2 tsp. baking powder ½ tsp. salt 1 cup quick cooking oats ½ cup flax seed For blueberry version: 1 tsp cinnamon ½ cup mini semi sweet chocolate chips ½ cup frozen blueberries For pumpkin version: 1 tsp. pumpkin spice ½ cup crushed walnuts ½ cup pumpkin purée Preheat oven to 350 F and grease mini muffin tin pan Bowl 1: In large bowl combine egg, buttermilk, bananas, sugar, apple sauce and vanilla. Bowl 2: In separate bowl sift flour, baking soda, baking powder, salt and oats. Combine wet and dry ingredients and add the final 3 ingredients based on what recipe you want or make up your own flavour Bake in mini muffin pans for 15-20 mins or until brown. Or use larger muffin pans and adjust time. Remove from pans and cool on wire rack. ENJOY!!

Original Art Work – Travel Buddy in Residency Dr. Andrea Tam, Northern Ontario School of Medicine An original painting of a beloved family member, a little cat who travels with me despite a busy NOSM and CHEO schedule. This little friend has been all over Ontario (Ottawa all the way to Dryden plus most of the cities in between).

Refugee Letter Dr. William Weiler, University of Saskatchewan · Dr. William Weiler, University of...

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