A publication of the Saskatchewan Medical Association Volume 58 | Issue 1
DIGEST
SUMMER 2018
THE RURAL RESPONSE pulling together in the wake of the Humboldt Broncos tragedy
DOCTORS RALLY
»
to save young mother and her son
GLOBETROTTERS
making a difference from Guatemala to Nepal
TACKLING HIV
crisis in Saskatchewan
GOING THE
EXTRA MILE
Going the extra miles Summer 2018 | VOLUME 58 ISSUE 1 SMA Digest is the official member magazine of the Saskatchewan Medical Association. It is published twice per year and is distributed to nearly 90 per cent of practising physicians in Saskatchewan.
In the wee hours of May 21, 2017, 36-week pregnant Amber Hoffus woke up to blood and the very real possibility that she might lose her second child, and perhaps even her own life. In Porcupine Plain, a town of 1,000, the emergency surgery she needed looked beyond reach in the limited time she had left. Against all odds, three doctors from across the province, and a community, came together to show the world what is possible when a team gives everything they have to save a life.
Editor:
Maria Ryhorski (SMA staff )
Editorial board
Dr. Jim Cross (physician rep) Dr. John Gjevres (physician rep) Dr. Crystal Litwin (physician rep) Girard Hengen (SMA staff ) Ivan Muzychka (SMA staff )
Upcoming issues
The next issue of SMA Digest will be distributed in fall 2018.
Advertising
The deadline for booking and submitting advertising for the next issue is Monday, Sept. 24, 2018. Rates for display advertising are available upon request. Classified ad placement is free for members promoting physician, locum and practice opportunities; ads should be submitted via email and must not exceed 150 words.
Feedback
Member feedback is valuable and encouraged. Please direct comments, letters, ideas and advertising inquiries to: Maria Ryhorski Communications Advisor (306) 244-2196 maria.ryhorski@sma.sk.ca Saskatchewan Medical Association 201-2174 Airport Drive Saskatoon, SK, S7L 6M6
SMA mission
As the common voice of our members, we serve, represent and unite Saskatchewan physicians. We advance the honour and integrity of the medical profession; advance the professional, personal, educational and economic well-being of Saskatchewan physicians; and promote a high-quality, patient-centred health-care system.
Opening the door to better refugee health care Among the myriad challenges faced by immigrants and refugees in this country is navigating the health-care system, but those arriving in Regina have an advantage - a care program designed specifically to meet their needs. And for one of the program founders, Dr. Razawa Maroof, the work is as much personal as it is professional.
CONTENTS
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2 4 5 24 30
YOUR SMA President’s message Welcome Siva, 52nd SMA president How do you stay whole? Here to help: Physician Health Program 2018-22 SMA Strategic Plan
GOING THE EXTRA MILE
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10 16 26 28 33 39 41 44 46 50 52 55 56
Going the extra miles Answering the call “If only we could have done more” Bringing life to final days Globetrotters: Physicians making a world of difference Opening the door to better refugee health care From MD to MLA Landing at ‘ground zero’ Students give back Building a road to cultural safety in health care Two MDs, two approaches to tackling HIV crisis Called to serve: Chili cook-off stirs physicians to make a difference Women’s heart health misunderstood
58 EVENTS/ANNOUNCEMENTS/CLASSIFIEDS 60 IN MEMORIAM
Answering the call A call for help from Tisdale physician Dr. Tess Richardson on the night of April 6 prompted six Melfort physicians to drop everything, make the drive to Tisdale, and care for victims of the Humboldt Broncos bus crash. In Nipawin, physicians and staff mobilized, preparing for as many as 20 injured patients. Physicians coordinated a massive medical response in smalltown Saskatchewan to a tragedy of historic proportions. This is their story.
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PRESIDENT’S NOTE
PRESIDENT’S MES Welcome to the summer edition of SMA Digest. I am pleased to be writing as the new SMA president. It is an honour and a privilege to serve the members of the SMA in this capacity. Thank you. I look forward to working for you in the coming year. This edition of the SMA Digest explores the many ways physicians support their communities. Working as a physician almost always demands one go the extra mile, as the saying goes, but I think readers will be genuinely impressed with the sincere and solid dedication displayed in the stories on the these pages. Perhaps the most significant event in the last few months was the bus crash involving the Humboldt Broncos hockey team. This event called upon scores of community leaders, health-care workers and physicians. I am proud of the work my colleagues and all the members of the healthcare team, and many others, did in the wake of the crash. Your work saved lives. On page 16 you can read about some of the personal dimensions to that effort, and how physicians, wherever they happened to find themselves, jumped in to pro-
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vide assistance and care. Their voices paint a moving account of professionals pulling together. Their story also underlines the critical importance of our rural colleagues in the chain of medical intervention which helped so many young team members that fateful evening. When we reflect on this tragedy, our thoughts will never be far from those who died, and those families who lost loved ones in the accident. Supporting and caring for the families and community members in the coming months will also be critical. On page 10, you’ll read the story of Amber Hoffus and her son Vance. It’s a story of luck and last-minute possibilities which will surely amaze you. Medical practice is filled with instant victories and losses, but this story is remarkable for showing how a rural team came together quickly and secured a positive outcome in the face of incredible odds. If there was ever any doubt about the value of teams, and the value of bolstering rural centres, this story will surely erase it. Physician contributions aren’t always about medicine. The Saskatoon Regional Medical Association took
SSAGE some time in February to organize a Chili Cook-off at the Friendship Inn in downtown Saskatoon and this helped feed almost 600 people on Valentine’s Day, 2018 (see page 55). Whether helping with a major highway accident, or dealing with one family facing a crisis, or even a neighbourhood community in need, physicians are almost wired to strive to help, no matter the challenges. It’s easy to overlook the impact you are having and to brush it off with ‘I’m just doing my job.’ In fact, you are all doing an incredible job, and with tremendous impact. I think it’s safe to say that many people’s lives are changed because of it. Have a safe and happy summer.
“
IT’S EASY TO OVERLOOK THE IMPACT YOU ARE HAVING AND TO BRUSH IT OFF WITH ‘I’M JUST DOING MY JOB.’ IN FACT, YOU ARE ALL DOING AN INCREDIBLE JOB, AND WITH TREMENDOUS IMPACT.
Sincerely,
DR. SIVA KARUNAKARAN SMA President president@sma.sk.ca
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WelcomeSIVA 52nd SMA president Dr. Siva Karunakaran is a nephrolo-
gist from Regina. He served as vicepresident of the SMA for 2016-17 prior to his election as SMA president at the 2018 Spring Representative Assembly.
An in-depth feature on Dr. Karunakaran will appear in the fall 2018 issue of the SMA Digest.
He came to Canada in 1991 from Sri Lanka, where he began his medical education. He completed his medical degree in 1995 at St. George’s University in Grenada, and took further training in his specialty at the Medical College of Ohio in Toledo. Employment opportunities for him and his wife, Kumudhini, who is also a physician, came up in Regina in 2001, and they have made the city their home.
Dr. Karunakaran became a RA delegate in 2006, beginning a run of service with the SMA that continues to this day. He progressed through the ranks, from the Regina Qu’Appelle Regional Medical Association to section head for nephrology in Regina to membership on the SMA Board of Directors in 2011. He has served on several Board of Directors committees, culminating in his election as president at the 2018 Spring Representative Assembly.
NEW STRAT PLAN
sets direction for SMA 2018-22
The 2018-22 strategic plan is the result of many consultations with SMA members. These included discussions via the 2017 President and Vice-President’s Tour, facilitated sessions at the 2017 Fall Representative Assembly, direct emails and online surveying of members. Given that staff will play a critical role in achieving this plan, the Board of Directors also met with them directly to ensure their voices were heard. This plan reflects what we heard, and articulates the priorities we need to address to ensure physicians are thriving and enabled to provide high-quality, sustainable care to Saskatchewan citizens.
View the new priorities on pages 30-31. Visit sma.sk.ca/stratplan to read the full plan and our strategy for achieving it. 4
SMA DIGEST | SUMMER 2018
HOW DO YOU STAY WHOLE?
We posed this question to a few physicians for the winter 2017 SMA Digest, and the feature proved so popular we are bringing it back. More and more physicians are realizing they have to look after themselves in order to best look after their patients. Because physicians’ work can be all-consuming – both physically and emotionally – they need a release valve. WHAT DO PHYSICIANS LIKE TO DO IN THEIR DOWN TIME? WHAT MAKES THEM TICK AWAY FROM THE JOB? HERE ARE THEIR RESPONSES.
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Caitlyn Howe | Fourth-year medical student matched to family medicine, Moose Jaw. I was born and raised in Moose Jaw in a family of six. As a teenager while working as a lifeguard, I found my passion for health care. I attended the University of Saskatchewan directly out of high school and obtained a BSc in anatomy and cell biology. To cope with the incredible pressures of applying to medical school, I started running.
What do you like to do with your leisure time and why? I spend a great deal of my leisure time running. I completed my first half marathon the May of my first year of university (2011) and was hooked. I completed my first full marathon the May of my first year of medical school (2015). I achieved my goal of running the Boston Marathon in April 2017. When I am not running, I am in the kitchen with my boyfriend cultivating my culinary skills, playing with my puppy or spending time with family and friends.
Why do you think it is important for physicians to have outside pursuits? It is important for physicians to have interests and goals outside of medicine because the job can be heavy, and at times, all-consuming. It is necessary to have people and activities outside of work to come home to and place your attention on. My interests outside of medicine are my way of de-stressing and have played a major role in shaping me into the person that I am today and, I believe, the doctor that I will be in the coming years. ◆
Dr. John Dosman | Family physician, Saskatoon Community Clinic I was born and raised in Saskatoon, received a BSc in environmental and conservation sciences at the University of Alberta, received an MD from the U of S College of Medicine and took the Prince Albert rural family medicine residency program.
What do you like to do with your leisure time and why? Outdoor pursuits are where I really am able to recharge and reset – canoeing, paddleboarding, camping, hiking, skiing and spending time at the family cabin at Emma Lake. I still play hockey regularly with some of the same minor hockey friends I’ve had for decades. I’m also a year-round cyclist and use a bicycle to commute most days to clinic, hospital and for errands. I’m on the board of Saskatoon Cycles, a local advocacy and education group that strives to promote a city in which cycling is a viable, year-round mode of transportation that is safe and convenient for all ages. I wanted to advocate for something that promotes a healthier natural environment as well as healthier patients. Cycling is a simple solution to many complex social, environmental and health problems.
Why do you think it is important for physicians to have outside pursuits? During medical school and residency my mental health really suffered. A big part of that for me was being completely immersed in my studies and feeling like I didn’t have time for anything else. Getting back into pursuits outside of clinical medicine has been invaluable to me in getting healthier and having more balance in my life. ◆ 6
SMA DIGEST | SUMMER 2018
Dr. Albert Albertyn | Family physician with special interest in surgery, endoscopy and obstetrics, Nipawin I’m a GP with a PGY3 in enhanced surgical skills. I was trained in South Africa and worked in Namibia prior to moving to Canada in 2010.
What do you like to do with your leisure time and why? In my leisure time I enjoy the outdoors. Camping somewhere up north with my family and cooking on an open fire is the best psychotherapy. In the summer you will find me on the lake fishing or somewhere in the bush getting dirty on an ATV. I enjoy a round of golf with friends or sometimes just by myself. In the winter I like to snowmobile and you will see me at the rink, where I look after the Nipawin Hawks hockey team. Sport was a huge part of my younger years and it’s fun putting back what I got from it. It is important for my own well-being to hang out with family and friends and just be an average guy in the community. Snowmobiling is an adrenaline rush for me. It’s impossible to be sad while playing in deep snow. All worries disappear instantly. Being from Africa, snow and ice is a phenomenal
experience. It took me a few years to relax on ice; back home we don’t play on ice, we use it to cool beverages. Fishing is a time of reflection; it calms my soul and the views are fantastic. We recently bought a boat and it’s great to spend time with good company on the water. All of this is possible because we live in probably one of the most beautiful towns in Saskatchewan. This is truly paradise for us and the outdoors is only a few minutes away.
Why do you think it is important for physicians to have outside pursuits? As physicians we tend to put others first and our well-being can often be on the back burner. Making quality time for myself and my family is key in the busy life I have. Like so many physicians I have an outgoing personality with a sometimes anxious mind. The outdoors is my ‘SSRI’ of choice. ◆
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Dr. Andre Grobler (pictured right)
Dr. Andre Grobler | Family physician surgeon, Prince Albert, Meadow Lake and Nipawin I live and mainly work in Prince Albert. I am a GP surgeon working in multiple locations, including Meadow Lake and Nipawin. I do clinics once a week in Sandy Bay (a fly-in clinic – about a two-hour flight by small plane from Prince Albert) and once a week in Big River (a 1 ½-hour drive north of Prince Albert). I am married to Zirkia Grobler and have two boys, Andre Jr., 7, and Daniel, 5. I trained in South Africa and moved to Canada in 2008. I lived and worked in Estevan until 2014, and moved to Prince Albert to do an extra year of training in surgery. We decided to stay in Prince Albert.
What do you like to do with your leisure time and why? I love spending time outside. I enjoy hunting, fishing and flying small aircraft, especially if my family can join me while doing it. I love teaching my boys about nature and it gives me great joy to see the excitement when they have a fish on a hook or come hunting with dad. I also try to incorporate these things into my work. I do flyin northern clinics. In summer we will land at an island (on floats) to catch fish on the way home after the clinic. I am very privileged as not many people can fly, fish, and make a
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day’s wage while doing their job. Doing these things keeps me relaxed and makes me look forward to work so I can do it again.
Why do you think it is important for physicians to have outside pursuits? Work easily takes over a physician’s life if you are not actively involved in other activities. I believe a balanced physician is a better physician. When residents apply for the GP surgical program or ask to work with me, my first question is, ‘What are you doing outside of medicine?’ ◆
Dr. Oksana Prokopchuk-Gauk | Transfusion medicine consultant, Royal University Hospital, Saskatchewan Health Authority, Clinical hematologist, Saskatchewan Cancer Agency
I grew up in Saskatoon and was raised in a family that is deeply connected to our ethnocultural heritage, even though we are fourth-generation Ukrainian Canadians. I’m very proud to be a bilingual speaker of both Ukrainian and English, and an active participant in our local cultural community. My husband and I have a four-year-old son who attends the Ukrainian preschool program at Bishop Filevich School.
What do you like to do with your leisure time and why? I spend my leisure time with family and friends, which allows for a change of environment and break from work. Being part of a cultural community offers many opportunities for family gatherings and celebrations. I particularly enjoy preparing traditional foods with my parents and grandmother. The Easter season is my favourite time, when we bake special breads (paska and babka) and write pysanky (Ukrainian Easter eggs). I am excited that our son now has an opportunity to learn these rituals from family, as well as in a school environment that reflects his heritage.
need a
family
break? vacation CME
Volunteering within our community is important to help maintain the values that reflect who we are in Canada. I’m currently a board member of Museé Ukraina Museum and assist with various fund-raising initiatives to ensure that the amazing story of Ukrainian settlement in Canada is documented. We literally owe our life to those who came before us.
Why do you think it is important for physicians to have outside pursuits? Participation in activities other than medicine helps me to maintain a real-world perspective, and to be a mother, wife and participant within a cultural community rather than solely a doctor to patients. It is important to have a community outside of work, to remain grounded and appreciate that life happens both inside and outside of the hospital. ◆
book a SMA
LOCUM The Rural Relief Program is now booking SMA locums for the fall and winter of 2018. If you practise in a community with fewer than four physicians, you may be eligible to take advantage of this great SMA program with subsidized locum rates. Please make your requests at least three months in advance to ensure locum placement.
Email randall.kehrig@sma.sk.ca Dr. Oksana Prokopchuk-Gauk (pictured centre)
SMA DIGEST | SUMMER 2018
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SMA DIGEST | SUMMER 2018
GOING THE
EXTRA MILES
By Maria Ryhorski
Nine-month-old Vance Hoffus shoots another wide grin at the camera before toppling forward and scooting along on his bum in his own unique brand of locomotion that his mom, Amber, laughingly compares to a Weeble, the children’s toy that wobbles in all directions but never falls down. “He’s a pretty relaxed little fella,” she beams. “Pretty happy – smiley all the time … He is determined he is going to keep up with his big sister.” Watching this vibrant little boy and his mother laugh and play, it’s jarring to think about how close Amber’s husband and four-year-old daughter, Grace, came to losing them both.
Dr. Pieterse quickly diagnosed a placental abruption, a condition that could easily prove fatal, not only for her baby but for Amber as well. He immediately called his long-time colleague Dr. Eben Strydom in Melfort, the nearest surgical centre, but learned that Melfort had no OR coverage that weekend. Next, Dr. Pieterse tried for air ambulance transport to Saskatoon. He learned that STARS is unable to take on maternity cases and that, in addition, the time it would take STARS or Saskatchewan Air Ambulance to get a patient to hospital in Saskatoon would be time that Amber didn’t have. She was deteriorating rapidly. The phone rang. It was Dr. Strydom in Melfort. “Bring her!” he said. He would try to get a team together. Not knowing what to expect when they arrived, Dr. Pieterse and Amber set off on the 100-kilometre drive to Melfort by road.
The crisis Amber’s pregnancy with her second child had been uneventful. That changed for her and husband Aaron, on Sunday of the May long weekend in 2017. She awoke at 3 a.m., four weeks before her due date, bleeding profusely. She immediately called Dr. Gert Pieterse, or Dr. P. as he is affectionately known by his patients in Porcupine Plain.
Amber and Vance Hoffus in February, 2018.
SMA DIGEST | SUMMER 2018
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“
I THINK AT SOME POINT SHE MADE PEACE WITH THE FACT THAT HER BABY MOST PROBABLY WOULDN’T SURVIVE. WE WERE JUST FIGHTING FOR HER LIFE BASICALLY AT THAT STAGE.
The ambulance trip
The ringer
“The ambulance trip was a nightmare,” recounts Dr. Pieterse. A gush of blood accompanied each of Amber’s contractions and about half way there, they were no longer able to find a fetal heartbeat.
Dr. Grobler’s phone rang at his home in Prince Albert at 5 a.m. Dr. Strydom, whom he had only recently met upon joining the SMA board a couple of months earlier, was on the other end. A young mother in critical condition needed an emergency C-section. Could he help?
“Amber and I had some deep conversations,” he recalls. “I think at some point she made peace with the fact that her baby most probably wouldn’t survive. We were just fighting for her life basically at that stage.” “Things were not so good for me,” remembers Amber. She had earlier impressed upon Dr. Pieterse her need for him to be honest with her. “Dr. P said, ‘You know Amber, this isn’t good. This could go either way for you, so if there are things that you need to say to your daughter, you should probably tape them.’ That was a pretty intense thing to hear.”
Meanwhile in Melfort Despite the lack of OR coverage, Dr. Strydom knew that a C-section in Melfort was Amber’s only chance. He began making calls. “That’s where a small town actually makes it relatively easy because everybody knows each other,” says Dr. Strydom. “I phoned the supervisor and they said they would get the nurses … None of these people were on call … so it’s just a stroke of luck and also the fact that people know each other that made it possible.” Everyone he called said yes. The challenge came with finding someone to do either anaesthetic or the C-section, since he would only be able to do one. A colleague who would normally have been available was out of town, and Dr. Strydom’s next call was also unavailable. He was running out of options. Then he remembered Dr. Andre Grobler, a fellow GP with surgical obstetric training. He lived 100 kilometres away but he had a plane.
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Minutes after the call came in, Dr. Grobler raced to the airport and took off in his Cessna 182 for Melfort. “That morning I was just thinking, ‘Just don’t make a mistake,’ ” Dr. Grobler recalls. “Everything was such a rush. I ran from home, rushed to the airport – the plane is heavy to pull out by yourself – then you get in and start up and you have all your checklists that you run and I was just thinking, ‘Don’t miss anything.’ ” Twenty minutes later he landed safely in Melfort, and was picked up from the airport then delivered to the hospital by the husband of a local nurse. Dr. Andre Grobler with a Cherokee 180. He flew a Cessna 182 RG from Prince Albert to Melfort to do Amber’s C-section.
“Looking back, I don’t think I realized how serious it was until I got there,” remembers Dr. Grobler. “When I walked in there, Dr. Strydom said, ‘You need to come now. She’s bleeding heavily.’ ” Amber was on the table and prepped for surgery. They began immediately – working quickly to save her life, unsure whether there was any hope for her son.
“He was alive” According to Amber’s husband, Aaron, the time between when the ambulance arrived in Melfort to when their child was delivered was less than seven minutes. “He said they were all super, super efficient,” says Amber, “and when they got Vance out, Dr. Strydom – I think he was the one who scooped Vance out – he said, ‘Oh my God – this baby is alive!’ ” That is a moment that sticks with Dr. Pieterse. “It was absolute elation when we got little Vance out and he was alive,” he recalls with a smile. “Just that absolute elation when we knew, he’s going to survive. And mom was going to survive. It was just … that was special. That was very special.”
Vance Despite losing nearly half her blood volume, Amber never lost consciousness. But she was put under for the surgery and woke up confused by what she saw. “I remember waking up and looking over and seeing Vance in the unit right beside me and I said to Aaron, ‘There’s a baby … Is that our baby?’ ” She thought their baby had died. “And Aaron said, ‘Yeah, we have a boy.’ ” Amber and Aaron named their son Vance and he rallied from the first moment, surpassing everyone’s expectations. He and Amber were flown by Saskatchewan Air Ambulance to the neonatal intensive care unit in Saskatoon shortly after delivery. He was extubated that evening and taken off low-flow oxygen within two days. By Wednesday he was released from the NICU to the maternity ward, and by Thursday, Amber and Vance were on their way home. Amber would later learn that, despite her extreme blood loss, Vance likely never lost oxygen completely. “It was low for sure but the NICU doctors don’t think that he was ever totally deprived of oxygen. They say that lots of times babies will rally right before their heart stops for the last time
Mom, Amber, and dad, Aaron, introduce big sister, Grace, to Vance in the NICU.
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HONESTLY IT ALL SORT OF FEELS LIKE A DREAM. THERE ARE SO MANY THINGS IN THE WORLD THAT ARE TOTALLY SCREWED UP AND YOU FEEL LIKE, ‘WHY ARE WE THE LUCKIEST FAMILY? HOW DID WE GET SO LUCKY THAT THAT’S US?’
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Dr. Gert Pieterse with baby Vance a few weeks after his birth.
I JUST FEEL VERY THANKFUL, NOT FOR WHAT WE DID – BECAUSE WE JUST DID OUR JOBS – BUT I REALLY FEEL THANKFUL FOR THE FACT THAT OTHER PEOPLE HAVE THE HEART TO DO THAT FOR ONE PERSON … FROM THE SCRUB NURSE TO THE FLOOR NURSE TO THE PHYSICIANS, THE LAB PEOPLE ... EVERYBODY PULLED TOGETHER TO SAVE TWO LIVES.
and that’s when they took Vance out. His heart was just racing and they said that was probably his body’s last push. Had it been another 30 seconds or a minute, that probably wouldn’t have happened.”
A family back together
and her first day of dance. And those are all things that I always assumed would happen and then they almost didn’t. And the only reason they did is because the stars aligned and three really wonderful doctors did more than they ever should have had to. It’s incredible.”
“
“Honestly it all sort of feels like a dream,” says Amber. “There are so many things in the world that are totally screwed up and you feel like, ‘Why are we the luckiest family? How did we get so lucky that that’s us?’
EVERYBODY JUMPED IN ... AND THAT’S WHAT’S SO IMPORTANT WITH RURAL SERVICES. IT’S REALLY A TEAM EFFORT WITH MANY, MANY PEOPLE DEPENDING ON EACH OTHER TO MAKE THINGS WORK.
“It changes your whole world and it gives you a new appreciation for so many things … Because of those doctors, I got to take Grace to her first day of playschool. I could have not been there for that. Now I get to sit there with my two kids and read night-night stories. Vance is there because of those doctors and those nurses and those ambulance attendants. It’s unbelievable to me, and I was there.” Reflecting on all that has happened, her husband wonders, “How do you say thank you to somebody who has totally changed your life?” “We’re still looking for the right words,” Amber admits. “ ‘Thanks’ doesn’t seem like enough. Our lives are totally different. I mean – we have a son. And Aaron’s not a single dad. And I get to take my daughter to her first day of playschool
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Dr. Eben Strydom
“I just feel very thankful” The heroes of this story don’t see themselves that way at all. “I just feel very thankful,” says Dr. Pieterse, looking back. “Not for what we did – because we just did our jobs – but I really feel thankful for the fact that other people have the heart to do that for one person … from the scrub nurse to the floor nurse to the physicians, the lab people – they were fantastic. I just have the greatest praise for them. Everybody pulled together to save two lives. “It was like a hand from above. Everything just worked so smoothly once we got all the gears in place. The fact that everybody was willing to give up their Sunday morning, and for Dr. Grobler to fly his own plane down to Melfort – it was absolutely fantastic.” “For me it was just a real big privilege to be a part of it,” says Dr. Grobler smiling at the memory. “I don’t think I did much really … Honestly, I think, what physician would not go if a colleague phones and says, ‘Listen, I need help.’
The sense that something special happened that day is shared by all three physicians. Dr. Strydom still marvels at how the community came together to save Amber and Vance – from the physicians to the nurses to the nurse’s husband who left work to pick Dr. Grobler up from the airport. “It’s those kinds of things that are quite exciting. It was really the fact that the nurses and everybody, everybody jumped in. It’s not one person. It’s a team effort. And that’s what’s so important with rural services. It’s really a team effort with many, many people depending on each other to make things work. “You know, we see so much bad stuff so these things are really, really important … It makes us proud to be associated with these people. “I think it’s a sign of what we can do with the calibre of support in terms of nurses and the collegiality that we have. I don’t think any of us will ever forget this.” ◆
“But that specific day was very emotional, I must say … It was a big day. It was something special.”
FUN FACTS •
Dr. Grobler and Dr. Strydom had only met a couple of months earlier when Dr. Grobler joined the SMA board where Dr. Strydom serves. Dr. Grobler was Dr. Strydom’s last call – there would have been no one else.
•
Since meeting at the SMA board meeting, Dr. Grobler got a new phone and number. He happened to send Dr. Strydom his new number two days before Amber’s emergency.
•
Dr. Grobler trained in surgical obstetrics under the past-president of the SMA, Dr. Joanne Sivertson.
•
A “kid” that Amber grew up with was the Saskatchewan Air Ambulance pilot who flew her to Saskatoon, Corey Ryhorski. He grew up in Porcupine Plain where Dr. Pieterse was also his family doctor.
•
The writer of this article, Maria Ryhorski, is married to Corey Ryhorski, the pilot who flew Amber to Saskatoon.
Pictured at the 2017 Fall Representative Assembly (left to right): Dr. Gert Pieterse (Porcupine Plain), Dr. Eben Strydom (Melfort), Dr. Andre Grobler (Prince Albert), Corey Ryhorski (Saskatchewan Air Ambulance) and Maria Ryhorski (SMA) SMA DIGEST | SUMMER 2018
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ANSWERING THE CALL RURAL PHYSICIANS RALLY TO ASSIST PATIENTS, COLLEAGUES FOLLOWING BRONCOS CRASH
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Rural physicians may work in isolation, but they are never alone. That was never more clear than on the Friday night of April 6, 2018, when the bus carrying the Humboldt Broncos hockey club collided with a semi on a rural highway halfway between Nipawin and Tisdale. A call for help from Tisdale physician Dr. Tess Richardson prompted six Melfort physicians to drop everything, make the drive to Tisdale, and help out. In Nipawin, physicians and staff mobilized, preparing for as many as 20 injured patients. “That is how we roll out here because you can’t do it alone,” said Dr. Jordan Wingate of Melfort, who helped coordinate the massive medical response in small-town Saskatchewan to a tragedy of historic proportions. Doctors worked in teams saving lives that night in rural Saskatchewan hospitals. This is their story. SMA DIGEST | SUMMER 2018
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By Girard Hengen After working all day at her clinic in Tisdale, Dr. Tess Richardson was just sitting down on the floor with her infant son. That’s when her call came.
“There’s magic to working in a small centre in that people will often rally to help, but there’s also fear and terror and limitations in that you can sometimes feel like you’re on your own. But fortunately in this circumstance, it was only like that for a very short period of time.”
Dr. Eben Strydom spent the day in Saskatoon and was on his way back to his Melfort home. He got his call soon after starting out.
Dr. Strydom says many rural physicians rely on each other for support and to provide services not available in their home communities.
Dr. Bronwyn Carroll arrived at her Nipawin home in midafternoon after a trip to B.C. She got her call just after 5:30 p.m.
“We really depend on each other in rural Saskatchewan. We work as colleagues; we refer things back and forth, meaning Melfort will support Tisdale with a lot of surgical services as well as anaesthetic and obstetric services. People know each other, we know the people working in Nipawin, we do have contact and people talk to each other and have that understanding.
It was late Friday afternoon, April 6. The calls alerted the physicians to a terrible tragedy unfolding at the intersection of highways 35 and 335 about 30 kilometres north of Tisdale. A bus had collided with a semi. There were fatalities and numerous injuries. That’s all the physicians knew, as details were sketchy. “I was about 10 minutes outside of Saskatoon and Dr. Jordan Wingate (of Melfort) phones me to ask me where I am, if I’ve heard there’s been a mass accident,” said Dr. Strydom. “I said to him, ‘I’m on my way to Melfort but I’m still a ways away and I’ll try and get there, but it won’t be for quite a while.’ “I drove a little faster than I should have, and then later I phoned the hospital to get more details. I spoke to one of the nurses, who told me that it was in fact a bus full of hockey players that had run into a semi.” The bus was carrying players and staff of the Humboldt Broncos hockey club to a playoff game against the Nipawin Hawks. Fourteen people on the bus died that day, two died in subsequent days, and the other 13 occupants were injured. The semi driver walked away. Sometime during that evening, or early the following morning, the physicians came to realize they were a part of something bigger – the mobilization of emergency health-care resources on a scale seldom seen in rural Saskatchewan, if ever. Medical personnel of all stripes rushed to help wherever they were needed, in their home town or their neighbours’ community. There were casualties, but medical teams also saved lives that night in the hospital rooms of those small Saskatchewan communities. Dr. Richardson marvels at the support her rural colleagues showed by responding immediately after she called for help in Tisdale.
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“I think that’s where when things like this happen and you get enough help, it’s just one big team instead of people working in isolation.”
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THERE’S MAGIC TO WORKING IN A SMALL CENTRE IN THAT PEOPLE WILL OFTEN RALLY TO HELP, BUT THERE’S ALSO FEAR AND TERROR AND LIMITATIONS IN THAT YOU CAN SOMETIMES FEEL LIKE YOU’RE ON YOUR OWN.
‘You just switch into have-to-do-it mode’ Dr. Richardson was playing with her infant son when a nurse from the Tisdale and District Health Care Centre called, asking her to “please hurry.” There were many deaths at the scene and many injured, and it was not known who was going to be sent where. Tisdale was down to three physicians at the time, one who had left earlier in the day for a conference and Dr. Kamrun Khan, who was on call.
L-R: Dr. Robert Steffen, Dr. Pierre Hanekom, Dr. Eben Strydom, Dr. Michael Stoll Dr. Richardson put in a call for help to Dr. Wingate in Melfort. Meanwhile, she called in two nurse practitioners who had training in the ER and trauma nursing. “You just switch into have-to-do-it mode,” she said. “I phoned Dr. Jordan Wingate after I got here and I found out that lots of physicians were going to be coming to Tisdale from Melfort, but I didn’t know how many patients Melfort was going to get, so I didn’t want all of Melfort to come here. “I just phoned Jordan to say, ‘We’re going to be getting more casualties than we can manage and if they could spare staff to help we’d appreciate it.’ ” Dr. Wingate had also finished work for the day when Dr. Richardson called. He could sense the tension in her voice. “Tess is South African and she’s seen a lot of stuff during her training. But I could tell she was concerned, greatly concerned,” Dr. Wingate said. He knew he would be going to Tisdale and called Dr. Strydom, who was just leaving Saskatoon. When he got to the Melfort Union Hospital, people were already mobilizing. Dr. Danielle Desjardins was on the phone bringing the team together. “Melfort has been through some smaller scenarios than this,” said Dr. Wingate. “I’ve been here 20 years. We’ve had a couple of times – only a couple – where basically everybody’s had to come in. We do have a disaster plan which very infrequently gets used, but I found that from a Melfort
standpoint everything was going smoothly, but I left. They were set up and ready to go.” In Tisdale, the first two patients were coming through the door. The second was critically injured and consumed most of Dr. Richardson’s attention for the rest of the night. In the meantime, Dr. Wingate drove with Dr. Pierre Hanekom to Tisdale. By then, Drs. Richardson and Khan were with patients, and more began arriving, some critically injured. When it became apparent that Tisdale and Nipawin hospitals would see the bulk of the injured, more physicians from Melfort made their way to Tisdale, including Drs. Robert Steffen and Olabode Ige, who travelled together. Dr. Strydom, who drove straight from Saskatoon to the Melfort Union Hospital, saw no patients were heading that way yet. He also continued on to Tisdale with Dr. Michael Stoll, who had just arrived at the hospital too.
‘Your team just formed out of the chaos’ “Pierre and I walked in, we introduced ourselves, and they took us right into the rooms,” said Dr. Wingate, describing the scene. “We gowned up. The team was working very well. They have a strong nursing staff there and strong physicians. I was using the trauma room and when I left that room and took another patient, four or five people just came with me. “You didn’t have to ask. All of a sudden your team just formed out of the chaos, essentially, and we went together
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with our patients. I didn’t know anyone; I had one nurse who does split time in Melfort, I knew her, and I do know the nurse practitioner who was with me, but the rest around me were just doing their jobs. “Everybody functioned really well because it was chaos. I was in a room that wasn’t set up for trauma, but everybody made it work. Everybody rose to the occasion.” Dr. Strydom also remembers arriving in Tisdale to witness a swirling, bustling team effort involving physicians, nurses and staff. “It was incredibly busy. They actually opened the doors as we walked up and they had gowns and gloves. Somebody must have notified them that we were on the way so they showed us to the rooms where they needed more help, so we went in. “Some of the patients were already stabilized, some they needed help with and we just continued to work with the teams who were busy with the acute cases to help with the stabilization. As things go in trauma, you stabilize, reassess and reassess, and you wait for labs to come back, X-rays to come back, and you discuss it. “Some physicians were involved in coordinating the transport while others were working in groups to stabilize the patients and discuss the various findings of the individual patients.”
The night brought back memories for Dr. Richardson, who did, indeed, experience traumatic situations in South Africa, including two bus crashes. The sense of collegiality that exists among physicians in east-central Saskatchewan went a long way to easing an intense situation, she said. “I had two critical incidents like this back home. Each one involved a bus and each one had young people,” she said. “The second one, which was just before I came to Canada, we worked in a hospital that actually had a critical incident plan in place. Everybody knew our roles and we rehearsed it and it still didn’t even go as well as this did. “It was like we’d been doing this all our lives. It’s like we get an incident like this every other week. People arrived, they picked up whatever role needed to be picked up and did it beautifully. We had tons of support locally and it was fantastic to get that amount of physician support because we needed it.”
‘This is bigger than we expected’ Like the medical teams in Melfort and Tisdale, no one in Nipawin, about 30 kilometres north of the crash site, knew what to expect at first. After receiving a call alerting her to the potential crisis, Dr. Bronwyn Carroll, medical staff leader, arrived at the Nipawin Hospital to find three other physicians and herself. Two physicians at the clinic next door were ready to help, and she was able to contact two more to come in.
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YOU DIDN’T HAVE TO ASK. ALL OF A SUDDEN YOUR TEAM JUST FORMED OUT OF THE CHAOS, ESSENTIALLY, AND WE WENT TOGETHER WITH OUR PATIENTS ... I WAS IN A ROOM THAT WASN’T SET UP FOR TRAUMA, BUT EVERYBODY MADE IT WORK. EVERYBODY ROSE TO THE OCCASION. Dr. Jordan Wingate
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IT WAS LIKE WE’D BEEN DOING THIS ALL OUR LIVES ... PEOPLE ARRIVED, THEY PICKED UP WHATEVER ROLE NEEDED TO BE PICKED UP AND DID IT BEAUTIFULLY.
“We weren’t sure where all the patients were going to go and we thought we might be the nearest site,” Dr. Carroll said. “We weren’t sure of the exact place where the accident was and we were wondering if we might get close to 20 or more patients. That’s what we were told. That’s why we tried to mobilize as many staff as possible. “When I say mobilize staff, there were a great number of people, not just doctors, that were there in order to help assist with the situation.” Nipawin received nine patients that night, Tisdale had six and Melfort had one, according to physicians working at each site. Dr. Neville Van Der Merwe works at the medical clinic next door to the Nipawin Hospital. He had been in the hospital ER when he heard that something was amiss. He told staff he would be at the clinic catching up on paperwork if he was needed.
were housed in every available room in the hospital, including the emergency department, a specialists’ clinic and a room used for ICU patients. “There was so much going on you didn’t have time to think,” said Dr. Van Der Merwe. “I moved around a lot from room to room, considering I was doing a lot of the airway, so I would go into a room, the patient needed to be intubated, we’d intubate, we’d get all of that set up and that takes a bit of time. By the time each one was set up, I’d be moved to the next room because the next patient needed to be intubated. “I really didn’t have much time to think about the situation and what’s going on. You’re focused on the person you’re working on, and you do the best you can do and what you’ve been trained to do. As soon as we’d be done with one patient and we hooked him up to the ventilator it would be like, ‘OK, the patient in the next room has got trouble,’ and you whiz in there.”
“It wasn’t 10 minutes later I got a phone call saying, ‘Look, this is bigger than we expected so please come back,’ ” he said. One of the early rumours was that the bus involved was a school bus. “The first thing was, ‘Oh please don’t tell me it was a school bus.’ Then there was the rumour that it might be the Broncos’ bus that was coming here for the game,” he said. “You just start thinking, what are we going to get? What’s it going to look like?” said Dr. Van Der Merwe. “It’s difficult to describe what goes through your head that first moment, but probably that internal, cold feeling of, ‘Oh jeez, this is not going to be good.’ ” The first patient had arrived at the hospital when Dr. Van Der Merwe got to the ER. He helped Dr. Carroll administer an IV before intubating the patient. As more patients arrived they
Dr. Tess Richardson
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L-R: Dr. Neville Van Der Merwe, Dr. Melissa Fillis, Dr. Bronwyn Carroll Dr. Melissa Fillis stayed home sick that day, but was called in to the Nipawin Hospital. She noted nurses on their way out of town turned around and came back to help. Pharmacists from a store in the community prepared medications in advance at the hospital so all she had to do was grab whatever she needed. “We did the best that we could,” she said. “Most of us coming from South Africa, we’re involved in certain things like this, just not on such a big scale. You could have had these cases on your 24-hour on call on a weekend, but not everything at one time.” Dr. Carroll looks back on the evening with gratitude for the work of all of the staff and the teamwork that was on display. Most have dealt with trauma at some point in their careers, but not to this extent. “I have spoken to people just to make sure they are doing OK and they say people keep thanking them, and they are like, ‘We would have done that for anyone, that’s what we’re here for.’ ”
A boy on the bus Dr. Jordan Wingate knows Humboldt. And he knows the Humboldt Broncos. He played for the Saskatchewan Junior Hockey League club between 1986 and 1988 on some of the best teams in Broncos’ history.
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The ties that bind the Saskatchewan hockey community are tight. They span the good times and the bad, including the crash of a Swift Current Broncos bus in 1986 that killed four players. “Saskatchewan’s a small place. I knew a couple of the families with boys on that (Humboldt) bus,” said Dr. Wingate. “It hits home. “I can identify with the boys because I was one of them. And when I played in my first year, that’s when Swift Current had the bus rollover. That came back because I remember we had guys on our team, on the Humboldt Broncos, who had played with some of the boys from Swift. I even had a couple of friends on that team and thankfully they weren’t hurt too bad. That came back.” He describes the week after the Humboldt accident as “rough,” but time heals. He has received support from the SMA, and has relied mainly on family, friends and colleagues. “It does affect you. It’s not like everybody’s a robot out here. It definitely does affect you, but you rely on your community, your medical community and just your community in general. The outpouring of support from my patients and people around Melfort was fantastic.” Dr. Fillis started receiving text messages of support while she attended to patients in Nipawin. She was oblivious to the fact that news of the tragedy raced quickly around the globe.
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PEOPLE WORRY - DID WE DO A GOOD JOB, DID WE DO A BAD JOB - AND MY VIEW IS EVERYONE DID THEIR PART, EVERYONE DID WELL AND I THINK IF YOU FOCUSED ON THE PEOPLE WE SAVED, THROUGH A HUGE TRAGEDY, THAT MAKES A PERSON SLEEP EASIER.
“We were busy at the hospital. We had no idea what was going on in the media, the outside world,” Dr. Fillis said. “A friend from Vancouver messaged me. She said, ‘Oh gosh, I see this is happening in your area. Good luck and God bless.’ A friend messaged me the next morning, ‘What happened there? It’s all over the news?’ I didn’t realize how big it was until afterwards. “My sister is in Australia and she messaged me about it as well. My parents in South Africa, they spoke to me about it. I think it’s very universal because all sports, whether it be hockey, cricket, rugby – you all have to go on a bus. People can relate.” Dr. Strydom, of Melfort, also acknowledged the show of support from the community in the weeks after the crash. He also remembers some of the good things amid the sorrow that night. He was with a patient when the player’s billet mom came to the Tisdale hospital. It was an emotional moment to see the interaction between the two, knowing the player was going to be all right. Later, the player’s dad phoned the hospital and received the news about his son’s condition. “Those kinds of things … that was good, between the bad.”
‘That’s kind of how we roll around here’ Dr. Van Der Merwe still marvels at the mobilization of resources at the Nipawin Hospital on the night of April 6. Among the Nipawin physicians who responded were Drs. Olumide Asaolu, Nkemakolam Eke, Eleanor Francis, Onose Lawani, Olukayode Olutunfese and Devin Ritter.
“People got the call and they dropped everything and they came. Those who weren’t even asked to come came in as well. One of our public health nurses, I haven’t seen her working an ER shift in forever, but she was there to help … That’s kind of how we roll around here.” What’s sometimes lost amid the post-accident debriefings is the fact that rural medical teams saved lives that night, he said. “People worry – did we do a good job, did we do a bad job – and my view is everyone did their part, everyone did well and I think if you focused on the people we saved, through a huge tragedy, that makes a person sleep easier.” Such is the lot of the rural physician – doing whatever it takes to save a patient’s life, said Dr. Wingate. “When you’re on call you have no idea what’s coming through the door and I think that’s the personality that succeeds out here, somebody who can troubleshoot and problem solve independent from a tertiary centre or from help,” he said. But if asked, help will arrive. “Tess calls. We go. And that happens, not to this extent, but that happens more times than not where neighbouring communities are relying on each other, because you can’t do it alone. If you try to do it alone, it’s just not going to work out and you’re going to have negative outcomes for patients. When the call comes, you go. Just like a fireman and a policeman, when you get the call, you go.” ◆
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HERE TO HELP SMA program offers support to those in distress
As the impact of the Humboldt Broncos bus crash recedes with time, physicians who were affected by it should be mindful about signs that they could be in distress weeks and even months after the fact, says Brenda Senger, the SMA’s director of Physician Support Programs. “Ask yourself, ‘How are you doing?’ And if you’re not sure how you’re doing, please ask your colleagues and spouse because they’ll tell you. They know,” Senger says. “Watch for signs and seek help. Reach out, ask for what you need, don’t hide that you’re struggling because that will only intensify the impact.”
Signs of distress •
Irritability or short-temper
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Anxiety
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Difficulty sleeping
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Crying at inappropriate times
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Emotional numbness
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Feeling triggered by things such as walking into the hospital or seeing news coverage
•
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Withdrawal from others
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She said the signs to watch for include: •
Are you irritable or short-tempered?
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Are you anxious?
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Are you sleeping well?
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Are you finding yourself in tears at inappropriate times?
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Are you feeling emotionally numb?
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Are you triggered by things such as walking into the hospital or seeing news coverage?
•
Are you withdrawing from others?
People around the world rallied to offer support in the days immediately after the April 6, 2018, crash. Fourteen people died that horrific night. Two died in the days after the crash. Most survivors have been released from hospital and are contemplating their futures – for many it will be one of rehabilitation, not hockey. The Broncos are making plans to field a team next year in the Saskatchewan Junior Hockey League. Senger notes while the routines of daily life go on, some people, physicians included, may be left battling their own personal demons. “The withdrawal of the intensity of the initial supports leaves some people feeling stranded emotionally. Because the acute phase is over, now people who are struggling in silence may be uncomfortable saying, ‘I don’t think I’m coping really well with this.’ ”
She suggests physicians, whether they attended to the injured that night or not, recognize possible signs that they are in distress and reach out for help. And if they feel a colleague is struggling, reach out to that person. The SMA’s Physician Health Program provides confidential assistance to physicians who are struggling in their personal or professional lives. Mostly it’s about being mindful, says Senger. People think they are in touch with their feelings and self-aware, when in fact they may not be, Senger notes. “What I have found is that most of us have limited selfawareness,” she says. “People think they’re doing really well and they’re not even aware that they aren’t. They’re not even aware that they were impacted by this trauma. They’re not aware that what’s happening to them today could be in relation to that.”
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ASK YOURSELF HOW ARE YOU DOING? AND IF YOU’RE NOT SURE HOW YOU’RE DOING, PLEASE ASK YOUR COLLEAGUES AND SPOUSE BECAUSE THEY’LL TELL YOU. THEY KNOW.
Brenda Senger can be reached at 306-244-2196, 1-800-6673781 or at brenda.senger@sma.sk.ca. For contact information of Physician Health Program committee members visit our website and log in to the members’ area of the website, go to News & Resources, then click on the Resources and Guidance box and go to the Physician Support box. The SMA has created a dedicated resources page for those affected by the Humboldt Broncos tragedy. It can be found at www.sma.sk.ca/humboldt.
Traditionally, physicians in need of care feel guilty about accepting care and shame for needing it. Many physicians struggle with undiagnosed, untreated or self-treated mental health issues. Many others struggle with relationship and family issues and substance abuse and addiction.
Let’s start the conversation. Contact the Physician Health Program. Brenda Senger
Director, Physician Support Programs
306.244.2196 brenda.senger@sma.sk.ca
If you require immediate medical assistance, visit your local hospital emergency room. ◆
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IF ONLY WE COULD HAVE DONE MORE
Two Saskatoon residents share their experience the night of April 6.
Dr. Lynsey Martin I was finishing a day shift in the emergency department at Royal University Hospital on April 6 when I heard about a potential incoming code orange. Given that it was Friday of the spring break week, I decided to stick around the hospital instead of going home for the evening. As time passed, I learned the severity of the accident and number of patients coming to Saskatoon. I became part of the code orange trauma team. The emergency department that I had come to know so well over the last five years was transformed. An entire section was converted into a resuscitation bay with the potential to house multiple patients simultaneously, and an army of staff and resident physicians of all specialties, nurses, respi-
ratory therapists, social workers, unit assistants, security and housekeeping staff (and many more) assembled to care for the members of the Humboldt Broncos who would soon arrive in Saskatoon. Although mass-casualty incidents are something I have learned about as part of my emergency medicine training, this was the first time I had encountered one in clinical practice. It was also the first time our hospital had dealt with an incident of this magnitude. The one thing that sticks out in my mind most is how the members of our medical community were able to rally together to prepare for and treat all of the patients who came through our doors that evening. An incident like this was unprecedented, yet staff from all disciplines, many who had
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AN INCIDENT LIKE THIS WAS UNPRECEDENTED, YET STAFF FROM ALL DISCIPLINES, MANY WHO HAD NEVER PREVIOUSLY WORKED TOGETHER, BANDED TOGETHER... Dr. Lynsey Martin and Dr. Julie Yu
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I WITNESSED BRAVERY, SACRIFICE, SELFLESSNESS AND A CALL THAT WAS ANSWERED FROM MY COLLEAGUES, IN ONE OF THE DARKEST HOURS OF MY YOUNG CAREER. I HAVE NEVER FELT PROUDER OF AND MORE HUMBLED BY MY PROFESSION.
never previously worked together, banded together to ensure that each patient had a fully stocked trauma bay to be seen in, a trauma team to manage their injuries and a surgical, ward or ICU team to provide ongoing care to them and their families. The dedication and teamwork was incredible and something I will never forget. There isn’t a day that passes without me thinking about that night and the community of Humboldt. I am deeply saddened by how many lives were lost, but I am grateful for the lives that were saved and the progress that those who were injured have made since the crash. This tragedy will likely stay with me for the rest of my life. That night will always be a reminder of how precious life is and that I belong to an amazing medical community here in Saskatchewan. ◆
Dr. Julie Yu I woke up Friday evening after working a busy overnight call shift. At 6:30 p.m. the phone rang – a colleague informed me that there was an impending code orange. Social media revealed the image of a devastating bus crash near Tisdale. My husband looked at me and said, “Honey, this could be really bad.” An hour later, I found myself back at Royal University Hospital in the midst of a transformed operating room brigade. With five to 10 times the number of operating room personnel than would usually be present, we prepared five operating theatres, stocking each identically for any disaster. Teams of health-care workers lined the hallway, stretchers at hand. I remember every neurosurgeon in the city was gathered in one area, and that our huddle of anaesthesia
residents stood together. Paper name tags written in bold, hand-written letters were stuck to our scrub tops with medical tape. I was nervous. Time slowed as we waited, ready. Our first arrivals passed through the doors. I remember being squeezed together, manoeuvring around colleagues, everyone working, focused and dedicated. Equipment passed from hand to hand, from the back of the room to the front, from trauma bay to diagnostic imaging, to operating room, to intensive care unit. I see this all now, in retrospect. But in the moment, all I could think about was how I didn’t feel like I could do anything right that night. My fingers fumbled around tubes and lines, I was angry at my own feet as I stumbled down the hallway. At times I couldn’t do more than push a stretcher or run after equipment. I witnessed bravery, sacrifice, selflessness and a call that was answered by my colleagues, in one of the darkest hours of my young career. I have never felt prouder of and more humbled by my profession. The next day, I went to the blood bank and saw people turned away because there were so many willing donors. The week after that, I travelled to Calgary and saw people wearing jerseys in support of those affected. And yet, despite the heroic efforts from my friends, my community, there is one thought that lingers. If only we could have done more. ◆
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BRINGING LIFE TO FINAL DAYS
By Maria Ryhorski
Dr. Vicki Holmes is passionate about helping people live well at end of life – a calling that dates back to her years at St. Paul’s Hospital where she served as a palliative care physician to some of Saskatoon’s most vulnerable patients.
“People think I’m a bit weird that I love taking care of dying people,” Dr. Holmes says with a smile, “but there is something really marvellous about it. There is a spiritual quality to it that I found amazing to be part of – watching people make those transitions.” Having recently retired, she now throws herself into supporting Prairie Hospice Society (PHS), a volunteer-driven charity that provides end-of-life support in people’s homes. “From the time of diagnosis until the time that a patient requires in-hospital palliative care, there is a gap,” she explains. “A lot of people have family members that can fill that role but there are a significant number of people who don’t have that help.” Even things like buying groceries, mailing Christmas cards or just getting out to do something that they enjoy can
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range from difficult to impossible for someone living with terminal illness. That’s where Prairie Hospice comes in. Volunteers are personally matched with clients to ensure compatibility, and they provide a variety of support to the individual and their family. Since its founding in 2012, Prairie Hospice has trained 135 volunteers who have provided support to more than 232 people in Saskatoon and their families. “Our volunteers do everything from helping out around the house or providing rides to appointments to helping write thank-you cards or taking a client on a special outing,” says Dr. Holmes. “For many people this time of their life is the most difficult thing they will ever go through. At Prairie Hospice, we’re trying to improve that time – to give comfort and make it a little easier.” But keeping Prairie Hospice Society in a position to continue providing this service in the community is an ongoing challenge. With no stable funding, the hospice relies completely on personal and corporate donations, as well as on funds raised through its annual Charity Golf Classic. Though direct client support is done by volunteers, funds are needed to pay for annual volunteer training, rent and the organization’s small staff including volunteer coordinators and an administrative assistant. Dr. Holmes serves on
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I THINK THAT SOMETIMES PATIENTS STRUGGLE SO HARD ... TO TAKE THE TREATMENTS AND ACCEPT THE SIDE-EFFECTS ... THEN FINALLY, THERE IS THIS SHIFT AND THIS LETTING GO WHEN YOU SAY, ‘I DON’T THINK THAT WE CAN IMPROVE THIS SITUATION ANYMORE. LET’S TRY TO HELP YOU LIVE YOUR LIFE AS FULLY AS YOU CAN IN THE TIME YOU HAVE LEFT.’ THAT’S WHAT WE DO AT PRAIRIE HOSPICE.
the PHS board, where she works to solve issues like these and helps set direction for PHS going forward. This work has become very important to her.
“You could hear the wind. You could be part of this whole thing and know that you were just relying on the air to get you where you needed to be.
“I think it behooves all of us to be part of a community and to do something to make the world better.”
“I think that sometimes patients struggle so hard to get this diagnosis, and go through the treatment, to take the treatments and accept the side-effects and possibilities of bad things that are going to happen. Then finally, there is this shift and this letting go when you say, ‘I don’t think that we can improve this situation anymore. Let’s try to help you live your life as fully as you can in the time you have left.’ That’s what we do at Prairie Hospice. We do everything we can to bring meaning and quality of life to people’s final days.” ◆
What can physicians do to help? “I think it’s important for physicians to know about us,” Dr. Holmes says, “and learn about what we do so that they can be an advocate for their patients in getting them enrolled in our program. And also, we always need golfers for our golf tournament so they could support us in that way. I think it’s an awareness and getting involved in being part of our team that cares for these people.” Looking back to the beginning of her career, there is a moment that captures the beauty of hospice care for her. “When I was a medical student, I went to Sweden as part of my studies. I met this couple and the man taught people how to hang glide. Normally with a glider, a small airplane pulls the glider up, then they drop the hook and you fly. But this one had a little Volkswagen engine, just enough to get this very light glider airborne.” Then he turned the engine off. “Before that time, this engine was just kind of struggling along to keep us up there, then he turned it off and it was just – WHOOSH – and we were gliding.
Learn more Visit www.prairiehospice.org to learn how Prairie Hospice can help you support your patients. You can also find out how you can get involved, from volunteering to participating in the PHS 4th Annual Charity Golf Classic on August 13, 2018, at the Saskatoon Golf and Country Club! SMA DIGEST | SUMMER 2018
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2018-22 SMA ST Improve physician wellness The medical community recognizes the importance of physician wellness and its impact on personal and professional fulfillment. Healthy, thriving physicians and medical learners are the cornerstone of a high-performing health-care system. Physicians require a sustainable work-life harmony, and thrive when working as part of a broader health-care team. The SMA’s focus on improving physician wellness will positively shape patient experience and the health system so that Saskatchewan can retain physicians and recruit others where needed.
Deliver exceptional member-based service Saskatchewan’s physicians work in a dynamic health-care environment, and every day they strive to deliver the best possible care to their patients. Physicians are not alone in their commitment to high-quality care. Physicians and medical learners rely on the SMA for negotiation and representation in addition to a range of other services. Working in a creative, professional and supportive environment, SMA employees will deliver exceptional service to members.
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OU PRIOR
TRATEGIC PLAN
UR RITIES
Strengthen relationships When physicians are connected with each other, they support, encourage and learn from one another. This builds stronger health-care teams and ultimately improves patient care. When working relationships among physicians, medical learners and their health system colleagues are built on clarity, trust and respect, shared understanding increases, as does the ability to work through adversity. Constructive working relationships with health system partners are essential for promoting a high-quality, patient-centred health system. Active engagement with, and participation from, members is essential to a vibrant, effective SMA.
Grow effective physician leaders High-performing health-care systems are abundant with confident, capable physician leaders. The new Saskatchewan Health Authority has signalled its commitment to this model by creating a solid complement of executive physician leaders. Enabling physicians to provide meaningful and effective leadership contributions to health care in Saskatchewan requires deliberate efforts and commitments to develop this capability. The SMA will provide ongoing supportive learning opportunities and environments for physicians in leadership roles.
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GLOBETROTTERS PHYSICIANS MAKING A WORLD OF DIFFERENCE Compiled by Girard Hengen
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GUATEMALA
L-R: Jill Pikaluk, Dr. Andrea Martin, Dr. Wouter van Eeden, Dr. Mark Brown, Dr. Lisa Smith
MISSION TO GUATEMALA
What was your motivation for going?
The Moose Jaw International Medical Mission travelled to Patzun, Guatemala, for the third time in February 2018, working in rural clinics and at Clinica Corpus Christi, a small hospital and orphanage. The team was comprised of physicians, residents and medical personnel from Regina and Moose Jaw. The surgical team performed 29 general surgery cases, one gynaecology case and four minor cases. A medical outreach team that travelled to local villages saw nearly 600 patients and was able to provide medications and treatments.
Sarah Miller: Global surgery is an often neglected aspect of global health and it is estimated that five billion people worldwide lack access to timely and safe surgical care. With my experience in Making the Links, I always knew I wanted to continue work in this area and this presented an opportunity that was safe, ethical and feasible to do while still a resident. I felt I was at a point in my training where I could actually contribute and I looked forward to the opportunity of providing care to an underserved population while working in a resource-limited and a sometimes challenging environment.
The SMA spoke with three members of the mission. Two of them – Dr. Mark Brown, a family physician from Moose Jaw and former Saskatchewan Medical Association president, and Dr. Lisa Smith, a first-year family medicine resident from Moose Jaw – were on the medical outreach team. Dr. Sarah Miller, a fourth-year general surgical resident in Regina, was on the surgical team. Here is what they had to say:
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Mark Brown: This is the third time that this crew has gone. I wanted to go ever since it started but because of my SMA involvement, and last year I was in South Africa with my family, I couldn’t. This is the first time I’ve actually been able to go, and I plan to go every year from now on.
Physicians doing a world of good
Back row, L-R: Dr. Ryan Pikaluk, Dr. Sarah Miller, Brenda Weiss RN, Dr. James Carter, Stephanie Smith (sterilization) Front row, L-R: Florie (local to Patzun, sterilization), Jody Bodnar LPN, Michelle Wiks (sterilization), Nikki Gibbs RN, Joanne Adorna RN
Have you done this kind of work before?
What did you do in Guatemala?
Lisa Smith: Yes, many times. My first time volunteering in a health-care role was when I was 18 at an orphanage in Chaing Mai, Thailand. I actually attribute going into medicine to that experience. More recently I was with an organization called Floating Doctors in Panama. I had a few months off in between graduation and starting residency and randomly Googled “sailing and doctor” – two of my life’s loves – and Floating Doctors popped up. With FD, we took a boat to rural and isolated communities and provided primary healthcare clinics. It was very similar to what we did in Guatemala, except we travelled by boat instead of by bus.
Mark Brown: The primary care team loaded up every morning and went out to remote villages and actually set up mobile clinics in very remote centres. For two-and-a-half days we brought care into the local community. We would treat the patients, deal with minor ailments along with more significant illnesses.
Sarah Miller: As an undergraduate medical student, I took part in the Making the Links program, a two-year certificate program in global health. This took me from inner-city Saskatoon working at SWITCH (the student-run clinic) to the northern Metis community of Pinehouse Lake, and to Massinga in rural Mozambique. Throughout, I gained a better appreciation for the social determinants of health and the health needs of marginalized populations.
Sarah Miller: As a bit of a summary of our week, on Sunday Drs. Jim Carter, Ryan Pikaluk and I saw 40 patients in pre-op who had been screened by a local Patzun physician. After determining which cases were appropriate, we determined when their surgeries would be done during the week. In the afternoon, we were able to complete three cases. The rest of the week we typically operated all day. The majority of the cases were hernia repairs, lap choles and a couple of excisions (gynecomastia, accessory breast tissue).
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Describe the experience?
Looking back has it affected what you do today?
Lisa Smith: It is so humbling to be able to use my education to give back to the people of Guatemala in such a practical way. It makes me realize how blessed and lucky we are in Canada to have access to physicians and specialists, and diagnostics and medicines. I know not all areas of Saskatchewan have the same level of access as others, but even to have the option and resources to be able travel to a larger centre if need be is something that the poor that we worked with didn’t have in Guatemala.
Mark Brown: The big eye-opener is that we really complain a lot in Canada about nothing, and a very, very little thing in the Third World will make people happy. Simple things like a soccer ball to play with will change a kid’s life around. They really appreciate the small things. You feel like you’re going there and you’re not going to make a big difference, but actually you can and you do.
Mark Brown: We were pulling long days but it also felt like you were getting a bit of a break. It’s a slightly warmer climate, although it was quite cold in the mountains. People think we were on the beach in the sun – no, we weren’t. And it was winter. We were in the mountains of Guatemala where the temperatures, with no central heat, got down to single digits at night. It’s a great place to go and at the end of the day, even though we were working somewhere somewhat different for a week, it was interesting and exciting stuff we were doing and seemed like a bit of a holiday.
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Lisa Smith: This experience has combined with all of the others to make me a more well-rounded and empathetic physician and human being, and I hope that I bring that to the interactions with my patients. In a more tangible way, the trip inspired me to sponsor another child through World Vision; this one is from Guatemala. Sarah Miller: What stands out most about this trip, other than the very appreciative smiles on patients going home, is the incredible teamwork that took place to make it happen. Everyone contributed their skills and countless hours of work to make the week successful. ◆
Physicians doing a world of good
GHANA & ZIMBABWE
Adults L-R: Medical students Dan Haffey, Uitsile Ndlovu and Dia Austin
OUT OF AFRICA
In her own words:
Dr. Dia Austin started the Kids in Ghana project after she completed high school and worked at an orphanage in Ghana. When the orphanage was forced to reduce the number of children, four children were identified as having no support system in place to achieve their potential. Dr. Austin did some fundraising and Kids in Ghana became a personal mission for her. A home was purchased and all of the children’s needs were paid for. The oldest of the four has just graduated from the program.
“My interest in global health started before medical school when I saw how addressing health concerns was an intimate and immediate way to make a difference in someone’s life. I continue to work in this area for a number of reasons. Altruism and wanting to help others in need is definitely one of them, but the truth is more complex than that. As much as I want to give, I know that the truth is I receive as much, if not more, in return. The medicine is interesting; there is a high volume of procedures, and the experience is an adventure. It is my gratitude for these learning opportunities that keeps me coming back with the hope that, with each return visit, I am able to give a little bit more.
Meanwhile, Dr. Austin returned for a fourth time this year to Karanda Mission Hospital in a remote area of northern Zimbabwe. She has worked in the community on outreach services and within the hospital. This year she was a preceptor in the hospital for the four-week stay.
“It’s interesting medicine. I’ve learned a lot through the opportunities that I’ve had. In this program, we’re not doing things beyond the scope of what we would be able to do in Canada, but I do get a lot of hands-on experience and I’m learning as well. It is a bi-directional kind of experience in that more than I’m giving, I’m learning. The experience that I’ve had abroad is beneficial for my patients here.” ◆
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Physicians doing a world of good
GUATEMALA NEPAL
Dr. Peter Kapusta and students
TEACHING IN RURAL NEPAL
In his own words:
For many years Dr. Peter Kapusta trained medical students when they came to Meadow Lake for their residency. He’s still training students, but now the location is on the other side of the world, in Nepal.
“The students are hugely enthusiastic. They want to suck as much information from you as they possibly can and they really, really appreciated the ability to sit on the rooftop informally in the evenings. We’d have ‘educational sessions’ where we would talk about certain patients who presented that day or certain challenges that they had. To sit down and just chat and talk, the experience of doing that, of just exploring and working through a problem and seeing physicians who also have worked through problems and who don’t have the answer at their fingertips – that’s not that kind of exam situation that they’re used to.
For three of the last four years, Dr. Kapusta has taught for one month at the Patan Academy of Health Sciences through a partnership with McMaster University. The Patan Academy is located in the flat plains of southern Nepal near the border with India. A very poor farming region where the work is still done primarily by hand, the local government hospital is poorly equipped and has limited resources, Dr. Kapusta says. However, the medical students he teaches are eager to soak up what they can from the physicians who rotate in for their teaching stints. The physicians live in the same apartment compound as the students, share the traditional dish Dal Bhat with them and socialize at the end of the day.
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“There is a big picture in all of this. You can treat the individual problem, but health care is a big system of components and it goes beyond just the individual physician and the individual physician-patient interaction. You have to look at ways of trying to improve society as a whole, and part of it relates to things like teaching, part of it relates to things like public health and awareness and education of your population. Realizing that it is a big-picture thing whether it’s in your own community or in rural Canada or wherever, you try to make a contribution wherever you can because it is very gratifying.” ◆
Physicians doing a world of good
OPENING THE DOOR TO BETTER REFUGEE HEALTH CARE
By Colleen MacPherson
Among the myriad challenges faced by immigrants and refugees in this country is navigating the health-care system, but those arriving in Regina have an advantage – a care program designed specifically to meet their needs. And for one of the program founders, the work is as much personal as it is professional.
Dr. Razawa Maroof was born and raised in the Iraqi city of Sulaymaniyah. A practising gynaecologist, she fled the genocide in her home country and arrived in Canada in June 1996 as a political refugee. Because she was pregnant, the local Open Door Society referred her to a Regina physician who appeared at the appointment wearing a disposable gown, mask and gloves. “I thought maybe he was sick, that he was wearing the gown and mask to protect the patient,” she said. On a second visit however, this time accompanying a family member who had an earache, Dr. Maroof noted the same attire, and that “he didn’t even look at the ear, he just referred to a specialist.” The message was clear – no physical contact with refugees. Describing another instance but with a different physician, Dr. Maroof said the doctor “didn’t put the stethoscope on the chest, just held it over top.” Even though she was a
trained physician and spoke English (she also speaks Kurdish and Arabic), Dr. Maroof characterized these encounters as “traumatizing,” but they were also the genesis of her commitment to improving the experience for other refugees and immigrants. “I decided that when I became a physician here in Canada, I didn’t want anyone else to go through what I went through.” Dr. Maroof completed her Canadian licensing requirements, including a residency in family medicine, and in 2002, joined the Regina Community Clinic (RCC) where she continued to advocate for the needs of refugees. In 2005, an agreement between the RCC, the Ministry of Health and the Open Door Society marked the start of the clinic’s refugee care program to serve government-supported newcomers. That first year, the program served about 30 patients, said Dr. Maroof. Last year, that number grew to about 650, and refugees account for more than 20 per cent of the patient care provided by the RCC. She said the clinic is particularly well suited to provide the program given its team of multidisciplinary professionals and on-site X-ray and lab facilities. The team meets regularly to discuss issues “and find solutions.” Dr. Maroof said the aim is to provide primary health services to refugees but education in areas like nutrition, exercise, contraception and diabetes management is equally as important. Typically, a patient will remain in the program for about two years before being transitioned into the wider health-care community, but Dr. Maroof said more support is needed, particularly in overcoming “the number one barrier for every single person – language.”
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The RCC employs six part-time interpreters, and Dr. Maroof said some community based physicians and specialists provide interpretive services, but it remains a challenge. “If we had more funding for interpreters, many other physicians could become involved.” In addition to the roadblocks created by language, refugees arrive with little knowledge or understanding of what health-care services are available to them, she said. On the other side of the coin, Canadian health-care professionals lack familiarity with the health issues faced by refugees. These could include everything from parasites to few or no vaccinations to the effects of the refugee experience itself.
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THEY RUN FOR THEIR LIVES TO A SAFER PLACE FOR THEMSELVES AND THEIR CHILDREN, AND THEY ARE WORRIED ABOUT TONS OF THINGS BESIDES THEIR HEALTH.
“They run for their lives to a safer place for themselves and their children, and they are worried about tons of things besides their health.” Dr. Maroof has expanded her advocacy efforts for immigrant and refugee health into her teaching as an associate professor with the University of Saskatchewan’s College of Medicine. “I really want to prepare the new generation of physicians to be aware of refugee needs.” She is also researching the mental health situation for the vulnerable refugee population. “I’m very worried right now because when we transition people out of the (RCC) program, their physical health is stabilized but mental health issues emerge and there are no resources, no support, no training and no interpreters to help.” As the province continues to welcome newcomers from around the globe, Dr. Maroof and her Regina colleagues will continue to be a vital pathway for them into the Canadian health-care system. “It’s complex care but we’re all happy to do this. Our whole clinic is proud and satisfied with the services we provide.” ◆
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FAMILY DOCS Are you interested in contributing to health care and the profession beyond the scope of your practice? The section of family practice receives requests from various agencies and ministries to nominate family physicians who would be willing to participate in committee work. If you are interested, please email Dr. Rizqi Ibrahim with the section of family practice at ribrahim@sasktel.net.
FROM MD TO MLA
By Girard Hengen Dr. Ryan Meili was elected leader of the Saskatchewan New Democratic Party on March 3, 2018, a year and a day after he became the NDP MLA for Saskatoon Meewasin in a byelection. For Dr. Meili, his political achievements represent an extension of his work as a physician serving marginalized and disadvantaged people in his home province and around the world. “The quote that always comes to mind is the quote from Rudolf Virchow, that politics is medicine on a larger scale,” Dr. Meili said. “That’s an idea that has influenced my own personal decision to see politics as an extension of my practice, but it’s also a way to start looking differently at politicians, whatever their profession, and say their job is to improve our health. “And I think physicians can play a great role in reminding politicians of that and being part of pushing for a political system that really has the best outcomes for our patients in mind.” Dr. Meili was raised on a farm near Courval, south of Moose Jaw, and educated in Coderre and Moose Jaw. He attended the
College of Medicine from 2000 to 2004, and completed his residency at the West Winds Primary Health Centre in Saskatoon in 2007. He was a founder of SWITCH, the Student Wellness Initiative Toward Community Health, and the College of Medicine’s Making the Links program, which gives medical students the opportunity to work in northern Saskatchewan, at SWITCH and in rural Mozambique. He was also a founder of Upstream, a movement that aims to build a healthier society by addressing social determinants of health. In 2012 he published a book A Healthy Society: How a focus on health can revive Canadian democracy. He twice ran for the leadership of the Saskatchewan NDP – in 2009 and 2013. Prior to his election as MLA, he was a family physician at Westside Community Clinic and SWITCH. He left his former positions when he became an MLA, but remains on the faculty of the U of S and the advisory board of Upstream. The SMA recently sat down with Dr. Meili in his constituency office to discuss his views on health and the role of physicians in politics.
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SMA: You were drawn to activism early, even prior to entering SMA: What made you focus on addressing the social determimedical school. Where does that activist streak come from? nants of health? RM: Early on in university I didn’t know what I wanted to do RM: My core philosophy, the things that I believe and a pasand eventually sat back and said, ‘What good can I do in the world?’ I thought about what I cared about and what I might be good at. I decided to go into medicine and in particular, to pursue working with underserved populations, and at the beginning really thinking about international work. I went to the College of Medicine and told them that’s what I wanted to do, and in the interview they asked, ‘Where have you been, kid from Courval?” The reality was nowhere, so they encouraged me to come back again another year. I travelled to South America and spent several months in Brazil and other parts of South America. The next year I was part of a project bringing prosthetic limbs to people injured by land mines in Nicaragua. I drove a school bus from here all the way down to do that. In those experiences I really got exposed to what it’s like to live in another culture, what it’s like to work alongside people and hear from them what their issues are and how to work together to address them. Along the way I guess I gained enough experience and improved my marks a little bit, and by the third time got into medical school. By that time I was really interested in the inequalities and the poverty that exists in the world, and the way that was impacting people’s health.
sion for social justice, and then the exposure to what I saw in South and Central America. When I was back here working as a student at the Westside Clinic and up north, to see that those same inequalities and those same injustices are occurring whether a continent away or a few blocks away, that’s what sort of drove me to shift my attention more to addressing the social determinants of health.
SMA: How did your ideas develop during your early years in Saskatoon? RM: I actually took a year off between medical school and residency to start SWITCH. I was the first coordinator working with others to start that program and the Making the Links program. I continued some of those activities through my residency. In 2012 I wrote a book called A Healthy Society in which I talked about how a focus on health really is what our politics is about, that the whole reason to have that body should be to improve the quality of our lives. Our understanding of the social determinants could really influence the way decisions are made at the political level and the government level. I used patient stories to illustrate how social factors play out in people’s lives.
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WE’VE GOT A GREAT ABILITY TO BE ADVOCATES ... WE CAME INTO THIS PROFESSION TO HAVE THE BIGGEST IMPACT ON PEOPLE’S HEALTH. IF WE ARE SEEING PROBLEMS THAT ARE HARMING PEOPLE’S HEALTH, WE HAVE THE RESPONSIBILITY AND THE OPPORTUNITY TO CHANGE THEM BY BEING GOOD ADVOCATES.
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That set of ideas became the core of the group Upstream, which really looked to popularize the notion that health is our primary goal and the social determinants are the roadmap for how to reach that goal. Through Upstream we’ve had a chance to present that idea in every province, work with several provinces on policy projects and engage in a public discussion to get people involved in looking at the political questions of the day through the lens of: What is being discussed that is going to improve or worsen our health?
STEP UP TO LEAD
SMA: How did your experiences lead into the political realm? RM: It started with the international focus, and getting involved with Oxfam and other organizations focused on development and international aid. I got interested in the medicare side of things during the Romanow commission. That transitioned into SWITCH, and through that whole process I started to get more connected to the NDP. Through SWITCH I got asked to present at an NDP convention. That’s one of the times I first got significantly involved. SMA: Why do you think physicians should be involved in party politics and work toward healthy communities from outside the day-to-day operations of a practice? RM: Physicians are exceptional advocates when they’re able to focus their attention on advocacy for a few reasons. Every day we’re in contact with patients who are experiencing the downstream effects of political decisions. We’re witnesses to the struggles of people’s lives. We have that information. We also have the information and the ability to understand the evidence, and know what policies would work to improve things. The other piece is that we’re trusted. When you see the list of most trusted positions, physicians are up there, especially when we’re advocating for our patients’ well-being. We’ve got a great ability to be advocates and I think a responsibility to do so as well. We came into this profession to have the biggest impact on people’s health. If we are seeing problems that are harming people’s health, we have the responsibility and the opportunity to change them by being good advocates. I made the choice to switch from clinical practice to political practice because I felt that while I love seeing patients and want to keep doing that in my life, there is a moment now in Saskatchewan where I feel I can have an influence in changing the way we look at politics, and looking at it through a health lens. I believe if I’m successful that you’ll see a real shift toward health in all policies, and perhaps that will make a significance difference in the health of our communities and our patients. ◆
PHYSICIAN LEADERSHIP INSTITUTE (PLI) The health system is changing rapidly and strong physician leadership has never been more important. Gain the tools to lead in a CMA-SMA in-house PLI course.
COMING THIS FALL CRUCIAL CONVERSATIONS
Whether you’re leading an organization or championing an issue, different opinions and strong emotions can derail your efforts to achieve the best outcome. Crucial conversations will help you develop the skills you need to manage conversations so that all perspectives are heard, and relationships are enhanced.
PROFESSIONALISM AND ETHICS
Recent and profound shifts in health care are bringing about more complex ethical, moral and professional dilemmas. This course provides a foundation of relevant ethical concepts with decision-making tools and resources for commonly encountered challenges.
Watch sma.sk.ca/pli for more information or contact Delilah Dueck @ delilah.dueck@sma.sk.ca.
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LANDING AT ‘GROUND ZERO’ The Prairies are thought to have the highest incidence of multiple sclerosis in Canada, if not the world. MS researcher Dr. Michael Levin has come to Saskatchewan to study a disease he has spent a career trying to cure.
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By Girard Hengen All it will take is one patient. Dr. Michael Levin, the Saskatchewan Multiple Sclerosis Clinical Research Chair at the University of Saskatchewan, has spent a career studying MS. He believes a patient will someday walk through his clinic door and provide the key to determining a cause for a disease that historically has afflicted Saskatchewan and the Prairie provinces to a greater degree than anywhere else in the world. “Philosophically, I really believe people with MS will help cure MS,” Dr. Levin said. “Someone’s going to give me a clue, whether it’s a pocket of people where everyone has it and we can compare it to a pocket of people where they don’t, or someone’s going to give us a clue in the province that’s going to lead us to try to find at least one cause, and it may have more than one cause.” Dr. Levin moved to his new position a year ago, recruited from the University of Tennessee Health Science Centre and Veterans Affairs Medical Centre in Memphis, Tenn. His goal is to develop a comprehensive province-wide MS care plan. The move has brought him to what could be called the ground zero of the disease in the world. Some estimates peg the number of Saskatchewan residents with MS at 3,500 to 3,700. The Prairies are thought to have the highest incidence of MS in Canada, and Canada the highest incidence in the world. “In the States you probably knew of somebody with MS. Here everybody knows somebody with MS,” noted Dr. Levin. “People are touched by it. Scientists I collaborate with usually have someone in their family tree with MS or they have a neighbour with MS or a best friend. I do feel like we’re at ground zero.” Working with the MS Clinic at Saskatoon City Hospital and staff he has hired, Dr. Levin’s goal now that he has been in his position for a year is to wrap his arms around a problem that has many moving parts. His team will look at antibodies that instead of doing what they are supposed to – protecting people – begin to attack the brain and spinal cord. He’s interested in how these antibodies sneak into the brain and begin to destroy nerve cells. At first the coating of the nerve cell is affected, but later the neuron – the nerve cell itself – is destroyed. “We’re interested in trying to block that because it looks like when the nerve cells die, that’s when people start to go downhill,” Dr. Levin said.
Meanwhile, three or four existing databases will be merged into one, more cohesive whole as a step to begin to understand external factors that may contribute to the disease. Another external factor being examined is DNA. Every person carries abnormal DNA or DNA mutations, either inherited or acquired from the environment. Most MS research has centred on inherited mutations, but Dr. Levin is examining acquired mutations. “The first thing to do is to see if people in Saskatchewan with MS have acquired mutations that are different than the rest of the population. Then we can ask the question how they got there.” It might all come to that one patient Dr. Levin hopes holds the answers to his questions. His research has the potential to make a significant difference in the lives of thousands of people in Saskatchewan and, by extension, around the world.
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PHILOSOPHICALLY, I REALLY BELIEVE PEOPLE WITH MS WILL HELP CURE MS ... SOMEONE’S GOING TO GIVE US A CLUE IN THE PROVINCE THAT’S GOING TO LEAD US TO TRY TO FIND AT LEAST ONE CAUSE, AND IT MAY HAVE MORE THAN ONE CAUSE.
Preliminary discussions have been held to create a care pathway for MS modelled along other health-care pathways in Saskatchewan, such as for stroke. “That would really take the patient from, ‘Might I have MS?’ – someone with early symptoms – to diagnosis to a lifelong commitment to their care,” Dr. Levin noted. “We do have a province-wide vision. We know it’s difficult for people to drive to Saskatoon for all of their care and I think this will develop over time. We have a province-wide vision, both with our research and the clinical care pathway. That’s part of what I have been asked to do.” ◆
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Megan Gallagher Sarah Ardell
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STUDENTS GIVE BACK
Adam Neufeld Brianna Hutchinson
ADAM NEUFELD How do you give back? The YMCA has been a part of my life since I became a member at 15 and for the past three to four years, I have offered weekly fitness classes at the Y, to promote health, well-being and social connectedness. I have also used this class as an opportunity to involve medical school classmates and staff. The class is a great channel to educate, inspire and empower others; it promotes healthy living, the value of hard work, goal setting and positivity, and fosters collaboration and teamwork. I also do community outreach work and other events to raise funds for the YMCA’s Strong Kids campaign. Strong Kids sponsors YMCA memberships for local youth and funds their day care and summer camps. This helps them stay active and healthy, and helps them build meaningful friendships in their community. This is particularly important for new Canadian families who may not have jobs secured yet, or who may not be able to afford day care or camps for their kids. Adam Neufeld is going into his third year as a medical student at the U of S and beginning clinical clerkship in August. Due to the demanding schedule he has concluded the class at the YMCA. In addition to his past work with the YMCA, he volunteers at SWITCH clinic, is a peer mentor for the College of Medicine’s PEERSiM program and recently founded PULSE (Peers United by Leadership and Skills Enhancement), a peer-to-peer clinical skills mentorship initiative being rolled out this fall. He recently won the College of Medicine’s 2018 Mentor of the Year Award and the 2018 Canadian Medical Hall of Fame Award.
At home, I am the Saskatchewan representative for Canadian Medical Students Against Human Trafficking (CAMSAHT). When I began my medical education, I learned that human trafficking was something medical students are largely unaware of existing within Canada. As a result, I took on the CAMSAHT role where I am involved in advocacy events and educational talks on human trafficking and how to spot the signs of trafficked victims accessing medical care. I have also been involved in developing resources to equip students to appropriately recognize, respond to and assist patients who may be victims of human trafficking. We hope to see this education integrated further in the classroom. Although these two areas are somewhat different, they come down to a couple of core beliefs: 1. Each individual deserves to be advocated for within their health-care context; and 2. As a future health-care professional, I can play a part in patients’ journeys, not just to receive the health care they need, but to help provide resources and tools for people to be able to be involved in their own health care and health advocacy. I am thankful for the opportunities I have had to learn about advocacy and health in such practical ways, both within my own community and globally. Sarah Ardell is going into her third year as a medical student at the University of Saskatchewan College of Medicine.
SARAH ARDELL How do you give back? I am passionate about global health relating to those with varying levels of health needs in my own community and those across the globe. I recently returned from a month in Honduras where I participated as a student-learner in a medical clinic alongside local physicians and registered nurses as part of Adventure in Missions, a community development organization. I also took part in health education including nutritional education for mothers and children, sexual-health education for high school students, and paediatric care for entire communities such as parasite treatment and providing shoes made by local Honduran shoemakers. This experience taught me how to partner sustainably through global health and deliver culturally competent care – knowledge that I will take forward into my future practice as a physician.
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MEGAN GALLAGHER How do you give back?
BRIANNA HUTCHINSON How do you give back?
Student Wellness Initiative Toward Community Health (SWITCH) is a student-run clinic that operates through the Saskatoon Community Clinic, out of the Westside Community Clinic. I have been lucky enough to work with the amazing group of people at SWITCH for the last four years, and in the capacity of chair of the Board of Directors for the last two years. We provide free, after-hours health care in a culturally safe environment to Saskatoon’s underserved populations. SWITCH provides child care, educational sessions and a hot meal on every shift. In the clinic, an interdisciplinary team of students studying medicine, nursing, pharmacy, nutrition, social work, physiotherapy and more, work together with mentors from all of those different disciplines to see patients.
Last year, I had the opportunity to participate in Miles for Smiles as a volunteer, and it was great to see such a big event put on by already busy students. Miles for Smiles is hosted by the Student Medical Society of Saskatchewan (SMSS) and it includes a 2.5 km run/walk, and 5 km and 10 km runs in support of a local charity. The event often raises anywhere from $10,000-$15,000! Proceeds from the 2018 event will go to the Jim Pattison Children’s Hospital Foundation.
I am passionate about working with SWITCH because our multifaceted approach to health care and the education of future health-care professionals provide me with so many opportunities to be a part of positive change in our healthcare system. I love that our work enables this positive change not only immediately through our day-to-day work with the community, but also in the long term through the training of future health-care professionals. The work we do with students to get them focusing on the social determinants of health, and working seamlessly in interprofessional teams so early in their training, makes me very excited about the future of health care. We work hard so that students in all health disciplines can come to SWITCH, appreciate the barriers people experience in some communities and learn how to provide comprehensive, welcoming health care to people that would otherwise not be able to access it. These aspects of health care are important to me, and it is hugely rewarding to be part of their incorporation into patient care. Having the ability to start this work now gives me such an amazing foothold to be able to incorporate it into my future practice as a doctor. I am so grateful to the volunteers, staff and clients of SWITCH for giving me the opportunity to grow my passion for this work, and enabling me to give back in such a meaningful way. Megan Gallagher is going into her second-year as a medical student at the University of Saskatchewan, College of Medicine.
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This year I am the SMSS fundraising rep so organizing Miles for Smiles is a big part of my role and it is one that I am excited to take on. I think Miles for Smiles is such an important event because it not only raises a lot of money for a charity the students are passionate about, but it also brings together members of the community. While the main population targeted for this event is students, people from organizations such as the SMA, SaskDocs, the College of Medicine and the Alumni Association often like to participate. We often get friends, families and runners from the greater Saskatoon community who also come out to the event. This is a great opportunity to meet new people and form new relationships – and all for a great cause! Brianna Hutchinson is going into her second-year as a medical student at the University of Saskatchewan, College of Medicine. ◆
SOON, ALLERGY SUFFERERS WILL COME TO YOU FOR HELP. MAKE SURE YOU’RE READY. HOW SIGNIFICANT IS THE BURDEN OF ALLERGIC RHINITIS? Up to 1 in 4 Canadians are affected by allergic rhinitis (AR).1 Whether seasonal (e.g., pollen) or perennial (e.g., dust mite dander), AR is much more than a “nuisance”, presenting with a myriad of symptoms that can significantly impact a person’s quality of life.2 As a graduating healthcare professional, it’s important to understand all the options, so that you can recommend the right treatment plan for your AR patients.
WHAT DO THE EXPERTS RECOMMEND? Canadian guidelines recommend a step-wise approach to managing AR. Oral antihistamines are recommended as a first-line treatment option and are a cornerstone of AR treatment, as they effectively relieve its key symptoms — sneezing, itching (eyes, nose, and throat) and rhinorrhea — and have an established safety profile. Newer, long-acting antihistamines (e.g., cetirizine) should be used in most cases.3
Next, adding an intranasal corticosteroid (INS) to your allergy treatment toolkit should be considered due to its ability to reduce inflammation and relieve nasal congestion. Other treatments can be considered if adequate symptom control is not achieved (e.g., leukotriene receptor antagonists). Underlying all treatment is counselling on allergen avoidance.3
HOW CAN I HELP PATIENTS MANAGE ALLERGIC REACTIONS? In any given year, 47% of Canadians will suffer from an unexpected allergic reaction (UAR).4 UARs are unpredictable and can strike at any time because a trigger is not always known. By advising patients to be prepared with the right medication, you can help ensure they quickly manage symptoms. Antihistamines, such as diphenhydramine, effectively treat the common symptoms of UARs, such as sneezing, itching, hives and rhinorrhea.3,5
WITH PRODUCT ADVANCES, THE RANGE OF ORAL ANTIHISTAMINES HAS GROWN CONSIDERABLY – ALLOWING YOU TO TAILOR TREATMENT RECOMMENDATIONS TO EACH PATIENT’S NEEDS. THIS INCLUDES TWO NEW OPTIONS FROM THE TWO ALLERGY BRANDS MOST TRUSTED BY PHYSICIANS AND PHARMACISTS:
NEW REACTINE® RAPID DISSOLVE (cetirizine)
NEW EXTRA STRENGTH BENADRYL® (diphenhydramine)
> Recommend REACTINE® for fast and effective relief of seasonal and perennial allergy symptoms 6
> Help patients be prepared by keeping BENADRYL® on hand for symptom relief of UARs right when they occur 5
> Relieves symptoms such as sneezing, stuffiness, itchy/watery eyes, hives, runny nose, itchy nose & throat and allergic skin itch6
> Provides fast, effective symptom relief from allergies and allergic reactions 5
> Dissolves in seconds and lasts 24 hours — no water needed6
> Extra strength 50 mg dose relieves allergic reaction symptoms with just 1 caplet 5
#1 RECOMMENDED ADULT ANTIHISTAMINE BRAND BY CANADIAN PHARMACISTS AND PHYSICIANS*
#1 RECOMMENDED CHILDREN’S ANTIHISTAMINE BRAND BY CANADIAN PHARMACISTS AND PHYSICIANS*
Please direct patients to always read and follow the label to ensure the product is right for them. 1. Keith PK, et al. Allergy Asthma Clin Immunol. 2012;8:7. 2. Simoens S and Laekeman G. Allergy. 2009;65:85-95. 3. Small P, et al. J Otolaryngol. 2007;36(1):S1-S27. 4. Data on File: Usage & Attitude Study, January 2018. 5. BENADRYL® Label. 6. REACTINE® Product Monograph. August 16, 2017.
DIGEST | SUMMER 2018Market Research. 49 * Based on the Pharmacy Practice+, The Medical Post and Profession Santé 2018 Survey on OTC Counselling and Recommendations,SMA Prepared by Rogers Connect © Johnson & Johnson Inc. 2018
BUILDING A ROAD to cultural safety and responsiveness in health care
By Colleen MacPherson As the first research chair in Indigenous health at the University of Saskatchewan (U of S), Dr. Alexandra King has many plans and projects, all aimed at improving health outcomes for Indigenous people in Saskatchewan and beyond.
Indigenous people and Indigenous health are priorities, “so we need to consider a variety of systemic changes that are needed to operationalize the strategic plan.”
Dr. King took up the position of Cameco Chair in Indigenous Health in October 2017. It was an appealing opportunity, she said, not only because it allows her to combine her interest in both clinical work and research but also because it demonstrated forward thinking on the part of the academic community.
A member of the Nipissing First Nation in Ontario, Dr. King earned her medical degree in 2009 from the University of Toronto and completed a residency in internal medicine at the University of Alberta. Her clinical focus has been HIV/ AIDS and hepatitis C and, as adjunct professor in the faculty of Health Sciences at Simon Fraser University, Dr. King is lead researcher on projects in a number of areas related to Indigenous health including land-based healing, peer navigation and support, and research ethics.
“I thought the position was quite innovative considering there weren’t very many chairs in Indigenous health when it was conceived some time ago.” Cameco made an initial $1.5 million investment to create the chair in 2006, funding that is part of a $3-million endowment established for the position by the Royal University Hospital Foundation. That endowment includes $300,000 donated by academic members of the U of S Department of Medicine.
One project she highlighted is focused on supporting primary care providers in rural areas who have Indigenous patients with HIV/AIDS and hepatitis C. The goal is to connect practitioners with specialists located in larger centres to ensure the primary care needs of patients can be met where they live. “We’re looking at a shared model of care,” she said, “a way to strengthen local capacity and provide services closer to home.”
Although the position has a broad mandate, “I think the chair really needs to focus on Indigenous health and wellness research – what we’re doing and how we’re doing it,” said Dr. King. At the U of S, and its College of Medicine in particular,
Dr. King also sees a need to support practitioners who are recognizing a growing Indigenous component among their patients. “People are reaching out, reflecting on their own practice and looking to make improvement,” she said.
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Research is required to “understand the need and how best to support it,” she said. “It’s about building relationships and learning how to walk together in this.” A key driver in reducing health inequities and improving health outcomes for Indigenous people is self-determination, she said. “It’s through self-determination and reconciliation, and through honouring the rich, rich history of each Indigenous community’s understanding of life, health and ways of healing” that cultural safety and cultural responsiveness will be created in the health-care system. Dr. King is also tasked with enhancing Indigenous health education at the university level, but not just for medical students. “There are a variety of different groups – nurses, physiotherapists, pharmacists – involved and we’re all trying to understand and actualize reconciliation. We need to go down this road together.”
Congrat s
class of 2018
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WE’RE LOOKING AT A SHARED MODEL OF CARE, A WAY TO STRENGTHEN LOCAL CAPACITY AND PROVIDE SERVICES CLOSER TO HOME
Asked what success looks like for the chair, Dr. King mentioned a number of indictors including expanded research capacity in both the university and the community, collaboration among investigators and improved success in the grant application process, all while “ensuring the research is meeting the needs of Indigenous people.” On a personal level, she is looking to carry on her mentoring of faculty and training graduate students, and will continue to address the needs of patients in her clinical practice. “These are all components of success.” Beyond the priority placed on Indigenous people and health by the university, Dr. King said there are some positive initiatives happening in Saskatchewan, including an increased number of Indigenous faculty and students, several innovative Indigenous health research projects, and the commitment to culturally safe and responsive care.
The Saskatchewan Medical Association extends its congratulations to all graduates of the University of Saskatchewan’s College of Medicine! We wish you all the best as you start the next phase of your career journey in medicine!
“It’s very promising. I think we’re on the right track.” ◆
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TWO MDs
two approaches to tackling HIV crisis
Dr. Nnamdi Ndubuka
By Girard Hengen One physician was raised in Calgary, received his medical degree in Saskatoon, did further studies in infectious diseases in Winnipeg, and has settled in Regina. The other was raised and did medical training in Nigeria, received a master’s in public health in South Africa while working in Botswana, and has settled in Prince Albert. Two physicians travelling two different roads to Saskatchewan now find themselves united in common cause – to fight the soaring rates of HIV infection that makes the province an anomaly in Canada, if not around the globe. They are Dr. Stuart Skinner, infectious diseases specialist with the Infectious Disease Clinic based in Regina, and Dr. Nnamdi Ndubuka, medical health officer with the Northern Inter-Tribal Health Authority (NITHA), which is based in Prince Albert and provides public health services to 33 northern Indigenous communities. “It’s very disheartening when you look at Saskatchewan – a First World province – and you look at the HIV rates compared to some of the countries in Africa, specifically Botswana,” said Dr. Ndubuka. “It’s really disheartening what we see today. We’re not supposed to be in this situation. If only we had appropriate resources and commitments from various quarters to really address the situation.”
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In the mid-1990s, Saskatchewan had the lowest incidence of HIV-AIDS in Canada. Now it has the highest, with 2,091 cases reported between 1985 and 2016. The prevalence of HIV-AIDS is 2.5 times the national average, or 14.5 cases per 100,000 people. Saskatchewan is the only province where rates are going up. In 2007, Saskatoon and Regina had almost 75 per cent of all new cases, but in 2016 that was cut to 35 per cent. Remote regions and Indigenous communities are seeing spikes in new cases. In September 2016, a group of physicians called on the provincial government to declare a public health state of emergency over the high number of people diagnosed with HIV, especially in Indigenous communities. “Saskatchewan has led the country for 10 years in terms of HIV rates,” said Dr. Skinner. “There are two things with that. One is the crisis itself – that more needs to be done. The high rate also highlights the underlying issue with HIV in this province. First Nations and Indigenous people are overrepresented, so it highlights those health disparities. “With HIV, though, one of the things that people aren’t aware of is the incredible work going on by all of the frontline providers who work with people affected with HIV, the community organizations working with people affected by HIV and the First Nations communities and their leaders and the work they’re doing,” Dr. Skinner continued.
“There’s some incredible work going on in this province by people who are amazing providers, but there’s no doubt more resources are really needed.”
Dr. Ndubuka said programs like Know Your Status are important because they encourage testing among hard-toreach populations.
Dr. Skinner was recently awarded a $2-million grant by the Canadian Institutes of Health Research to refine and expand a program called Know Your Status, an on-reserve diagnosis and treatment program for HIV and other infectious diseases.
“But this has to be done in consultation with Indigenous communities to ensure that they are ready to move forward with such a program,” he said. “We always like to respect our communities’ wishes and where they’re at.”
The program works closely with Indigenous community leaders and incorporates Indigenous health models with mainstream health. Dr. Skinner travels to 12 outreach clinics in rural Saskatchewan, including the Big River First Nation, which developed Know Your Status to assist community members receive infectious disease and primary care treatment at home.
One barrier to address is concern over systemic racism, which Dr. Ndubuka said could account for some of the high HIV rates in the province.
“What we’re building is a different and unique health-care approach and model, and it’s built particularly for Indigenous communities,” said Dr. Skinner. “It’s built around community led approaches that have partnerships with healthcare providers to bring care as close to the community as we can.” He believes distance and lack of transportation should not be barriers to HIV treatment and care in Saskatchewan. “The one thing I can do as a physician is change where I provide care. My focus is on what I do and how I can improve things, and I try to make care as accessible as I can.”
“We are continuing to hear concerns over discrimination and systemic racism, which tend to create a barrier for First Nations to access care,” he said. “There is a misperception and a judgmental attitude that they face when they access health services, so that creates a barrier in terms of presenting in a timely manner for testing and receiving appropriate care.” Another missing piece of the puzzle to effectively address the incidence of HIV in Saskatchewan is funding, or lack of it, he said. For example, until this year’s provincial budget, full funding of antiretroviral medication for pre-exposure prophylaxis was not available to people who need it. More than anything is a need to address social determinants of Indigenous health. Dr. Ndubuka speaks from experience.
“
WHAT WE’RE BUILDING IS A DIFFERENT AND UNIQUE HEALTHCARE APPROACH AND MODEL, AND IT’S BUILT PARTICULARLY FOR INDIGENOUS COMMUNITIES. IT’S BUILT AROUND COMMUNITY LED APPROACHES THAT HAVE PARTNERSHIPS WITH HEALTH-CARE PROVIDERS TO BRING CARE AS CLOSE TO THE COMMUNITY AS WE CAN. Dr. Stuart Skinner
Dr. Jordan Wingate
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“For those communities that I have had the opportunity to visit, the First Nations people are great. I see resiliency in them, I see strength,” he said. But he’s also seen people living in condemned housing, poor infrastructure, water treatment plants that aren’t functioning optimally – social conditions that can erase gains made in health care. “These are the day-to-day real-life challenges faced by First Nations in the communities, which are not of their own making. These are systemic issues, so addressing the social determinants will go a long way to address some of those health concerns, not just HIV but tuberculosis and other water-borne illnesses.” From his beginnings in Nigeria to his work experience in Botswana and studies in South Africa, Dr. Ndubuka has always had a passion for public health. Now based in Prince Albert as medical health officer for NITHA, Dr. Ndubuka is aware of every case of HIV within NITHA, and said he’s seeing progress, even though the incidence rate of HIV is nearly twice the Saskatchewan rate and four times the national average. Within NITHA, there was a 50 per cent increase in HIV testing from 2012 to 2016, with a 47 per cent decrease in newly diagnosed cases in 2016 (nine cases) from 2015 (17 cases).
“I’m quite impressed with how the communities have committed to addressing the burden of HIV, so in working with them at their own pace, we will be able to sustain the progress that we have seen.” Dr. Skinner believes he, too, is making a difference in the province he now calls home, but as part of a larger effort. “Everything’s about the team and I’m only part of a team,” he said. “The communities where we are working the programs have been really successful, the outcomes have been successful. We’re building these partnerships and relationships to address not only HIV but to build a foundation for some of the other chronic diseases and health disparities,” he said. “I’m driven by the fact that if we look at the way we do things and we do it differently – in partnerships – if we build partnerships we can help support wellness and we can address the health disparities we see. They don’t have to be what they are and if we all work together we can improve it. For me it’s motivated by constant success, which just motivates me to do more.” ◆
Clinic Location: Grosvenor Park Centre #19-2105 8th St. East Saskatoon, SK Hours: M-F 9am to 6pm Contact Us: (T) 343-7776 contactus@north49therapy.ca booking on our Getting your patients back to 24/7 online website at: the important things in life. www.north49therapy.ca
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CALLED TO SERVE
Chili cook-off stirs physicians to make a difference for a day A 36-hour stint walking the streets of Saskatoon penniless and homeless last spring continues to resonate with Dr. Annette Epp. She spearheaded the Love Your Neighbour Chili Cook-off, held February 14 at the Saskatoon Friendship Inn. It was hosted by the Saskatoon Regional Medical Association and the Saskatchewan Medical Association, in partnership with the Friendship Inn. The idea to do something for the community came to Dr. Epp when she participated in the Sanctum Survivor Challenge, where she and others raised money for Sanctum Care Group by spending 36 hours homeless. Sanctum is Saskatchewan’s first hospice with respite and care for people who are living with or are affected by HIV.
“I had 36 hours to walk in someone else’s shoes and see what it was like to have food insecurity,” said Dr. Epp. “It was a very short period of time but it opened my eyes to the fact that if you don’t know where your next meal is going to be, it’s very hard to do anything else in your life.” She went to the Friendship Inn for a meal during the Sanctum challenge and to her surprise, found out it serves free breakfast and lunches but not suppers. A member of the SMA Board of Directors, Dr. Epp enlisted the support of physicians, their families, friends and co-workers, and the Saskatoon Regional Medical Association, for a chili cookoff supper. During the day, teams created their own versions of chili and patrons voted on the best one. The Hot Tamales were declared the winners. ◆
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WOMEN’S
HEART HEALTH
MISUNDERSTOOD Dr. Andrea Lavoie educates women on the nuances of their hearts’ health By Girard Hengen
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“Too many women are unnecessarily suffering and dying from heart disease. They have been left behind because they are under-researched, under-diagnosed and undertreated, and under-supported during recovery.”
- Ms. Understood: Health & Stroke 2018 Heart Report
After setting up practice in Regina in 2010, Dr. Andrea Lavoie started seeing patients – many of them women. As one of two female cardiologists in the province, Dr. Lavoie says that is understandable, but it also led her to insights into women’s heart health, and by extension gaps in the knowledge and treatment of women’s heart disease. “By default I think I ended up getting referred a lot of women,” Dr. Lavoie said. “I started noticing some unique patterns that were a little bit different that really intrigued me in terms of what was going on and what was causing challenges.” Originally from Melfort, Dr. Lavoie received her medical degree from the University of Saskatchewan in 1999. She did her cardiology residency at Dalhousie University in 2002-05, an interventional cardiology fellowship at the University of Calgary in 2005-07, and an intravascular ultrasound research fellowship at the Cleveland Clinic in 2008-10. During her medical training, she noticed trials that revealed many women who have heart attacks don’t have plaque buildup in their arteries. That is different. “They don’t have that same buildup of stuff that everyone else does,” she said. “A lot of them have normal coronary arteries, so I became interested in trying to unravel the secrets within or the differences that we see within the different patient populations. And certainly we started to see that bear out, finding there’s a couple of different and very unique things that we see more commonly in women than in men in terms of causes of heart artery disease.” In educating herself, she also felt it necessary to inform women in Saskatchewan on the nuances of women’s heart health. She was active in setting up the Prairie Cardiac Foundation, which is a kind of “one-stop shop” for information and resources on heart health. Organizers of the foundation felt cardiovascular specialists “were a little too siloed” by their regions of practice, she said. They have held workshops and promoted meaningful dialogue among care providers to address issues, problems and gaps in care in Saskatchewan.
“Health-care systems need to catch up with new evidence that women’s hearts are different; they must incorporate new women-specific diagnostics and treatment. New knowledge must be gathered and translated into better and safer heart health care for women. We must accelerate the pace of change, and reach women in all communities across the country.” - Ms. Understood: Health & Stroke 2018 Heart Report Dr. Lavoie has been a spokesperson for Heart & Stroke, talking about issues around heart health. She helped set up educational programs and galas in southern Saskatchewan that targeted women. She is also trying to raise awareness among physicians that heart disease can afflict young women, not just those who seem to be at higher risk. “People are a little more sensitized because we’ve done a bit more education, but as a whole, there’s still a lot more that we can do,” she said of physicians. “Just think about it. It’s not just someone who has some of the classic symptoms. We tend to have similar pain but oftentimes women describe it a bit differently, which can throw care providers off. It’s really trying to listen to the patient and look at all of the symptoms and add it into your differential, making sure you’re not missing the diagnosis.” She points to research into spontaneous coronary artery dissection (SCAD), which occurs when an unexpected tear develops in an artery. SCAD is the underlying cause of about 25 per cent of all heart attacks in women under 60. “There’s a bunch of different things going on that I didn’t even realize throughout my training as a cardiologist, even. As you go into practice you think, ‘Hey, there’s a different pattern here. There is really something going on here. Maybe we better delve into that a little further.’ “There’s been a real revolution in the spontaneous coronary artery dissection world, that this is much different and we have to manage it a bit differently.” Dr. Lavoie feels the effort in promoting better women’s heart health is starting to make a difference in Saskatchewan. There is greater awareness among physicians, and educational programs are enlightening both women and the people who provide them with care. “There’s been a lot of growth from when I first started to now,” she said, “but I think there’s still a lot of work that we need to do in getting that message out to all parts of the province. That’s something we hope the foundation will be able to do.” ◆
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&
COURSES CONFERENCES AUGUST
MEDSTERS GOLF TOURNAMENT Aug. 25 | Regina, Sask. www.picatic.com/medsters2018
SEPTEMBER
HEALTH INNOVATION SUMMIT Sept. 26 | Regina, Sask. https://healthsummit.ca
OCTOBER
GLOBAL HEALTH CONFERENCE Oct. 20 | Saskatoon, Sask. www.usask.ca/global-health-conference PAIN & THERAPEUTICS CONFERENCE Oct. 20 | Saskatoon, Sask. www.usask.ca/cmelearning
NOVEMBER SAVE THE DATE! 2018 FALL REPRESENTATIVE ASSEMBLY Nov. 2-3 | Regina, Sask. To learn more please visit: www.sma.sk.ca/RA
SEMAC X Nov. 24 | Regina, Sask. www.usask.ca/cmelearning
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LEARN ONLINE THE ROLE OF THE PRACTITIONER IN INDIGENOUS WELLNESS Oct. 1 – Jan. 15 www.usask.ca/cmelearning IS YOUR PATIENT FIT TO DRIVE? MEDICAL LEGAL IMPLICATIONS Oct. 15 – Nov. 30 www.usask.ca/cmelearning METHADONE FOR PAIN IN PALLIATIVE CARE www.methadone4pain.ca
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CLASSIFIEDS ANNOUNCEMENTS ATTENTION:
FAMILY PRACTICE, GERIATRIC FOCUS
Saskatoon, Sask.
SMA DISABILITY INSURANCE PARTICIPANTS
This is your opportunity to move to beautiful Saskatoon. A family physician nearing retirement wants to turn over his geriatric-focused practice to a qualified physician. This practice is ideally located with support services nearby and on-call is shared. No buy-in is expected.
SMA disability insurance certificates are available in the members only area of the website. Should you have any questions regarding your coverage, please contact: insurance@sma.sk.ca.
If interested, please email bxlarson@shaw.ca or call 1-306227-7754.
FAMILY PHYSICIAN
Swift Current, Sask.
GENERALIST OBSTETRICIAN/GYNAECOLOGIST
Saskatoon, Sask.
Seeking two obstetrician/gynaecologists with clinical and academic interests. Responsibilities will include inpatient, outpatient and community clinical and academic service. The successful applicant will work in a multidisciplinary care environment. The successful candidate will have appointments in both Saskatchewan Health Authority and the University of Saskatchewan. There are 5,700 deliveries per year and an active gynecologic surgical department including a women’s health center for outpatient procedures. The new Jim Pattison Children’s Hospital is slated to open in late 2019 and will include all of maternal services. Interested candidates should submit their curriculum vitae in confidence to: Jackie McKee, Physician Recruitment & Resource Planning Practitioner Staff Affairs, Royal University Hospital Email: jackie.mckee@saskhealthauthority.ca
We are a family physician clinic looking for a family doctor to join our team. We have a large patient base with extended hours available to enjoy more time with each patient. Our growing walk-in clinic clientele will provide extra earnings with evening and weekend premiums available. Call is equally shared with each practising physician. For more information please contact us at northside98@ sasktel.net.
FAMILY PHYSICIAN
Saskatoon, Sask.
Broadway Family Physicians is a family practice clinic seeking a permanent part-time physician to join our team. We are a modern clinic, operating with Accuro EMR. Working here, you will have a supportive group of colleagues and a top-notch staff. We provide primary care, prenatal and obstetric care, chronic disease management, and small procedures. Physicians work on a fee-for-service basis, with a competitive overhead structure. We are looking for candidates with licensure with the College of Physicians & Surgeons of Saskatchewan. Interested candidates may submit a copy of their CV to cprange@broadwayfamilyphysicians.ca. SMA DIGEST | SUMMER 2018
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IN MEMORIAM Dr. Hussain Bia
with his wife Rosario, raising his four children, Maria, Anita, Eduardo, and Natalie, is one that his family is still retracing.
Dr. Fakee Hussain Fakee Mahmod Bia died peacefully at home in Saskatoon on March 18, 2018 at the age of 79. Dr. Bia, formerly of Foam Lake, is survived by his wife, Maud, children, Sheila (John) Wilson, Yasmine, Salima (Grant McDougall); grandchildren Melissa, Kearon, Robert, Declan, Maya, and Fiona; younger brothers, Hassen of England and Ally of Mauritius. He was predeceased by his parents and brothers, Dawood and Abdulla.
After completing his medical training in the Faculty of Medicine at the University of Valladolid, Spain, he served as a general practitioner in the municipality of Caravia, Asturias where he travelled the roads that ran along the edges of the Bay of Biscay on his motorbike. But contact with an uncle in Canton, Ohio and the prospect of medical residencies in the US would take him away from this beautiful coastal town by boat over the Atlantic two years later. With limited English, he thrived during his residency in surgery at Canton’s Timken-Mercy Hospital from 1955 to 1957. He went on to complete a one-year residency in urology at Allegheny General Hospital in Pittsburgh, Pennsylvania, followed by a placement as senior assistant resident in surgery at Johnston-Willis Hospital in Richmond, Virginia from 1958 to 1959 and Trumbull Memorial Hospital from 1959 to 1960. His most fondly remembered residency took place at Henry Ford Hospital in Detroit, Michigan, where he completed two years in plastic and reconstructive surgery under the supervision of Dr. Alex P. Kelly, whom he admired deeply. With over 18 years of medical training and several residencies under his belt, Eduardo successfully completed the American Medical Qualification Examination for foreign medical graduates in 1960. He returned to Oviedo, the capital of Asturias, shortly thereafter where he won the first national competitive examination to obtain the position of Chief of Plastic and Reconstructive Surgery at the General Hospital of Asturias in 1963. His oral defense, according to committee member Dr. Vicente Vallina, left the examiners speechless.
1939-2018
Dr. Eduardo Alvarez 1929-2018
Dr. Eduardo Alvarez’s story begins in a small village in northern Spain called Rio Aller in the province of Asturias. Small, brightly painted homes and the pillared wooden hórreos typical to this region are nestled together beneath rocky climbs blanketed by apple and chestnut trees. This is where Eduardo was born in 1929 and raised. He would tend to the land that had been in his family for generations, alongside his older sisters (predeceased), Victoria Alvarez Bigotes and Anita Alvarez Bigotes, and assist his parents (predeceased), Maria Alvarez Bigotes and Eduardo Alvarez Diaz, by taking the cattle out to pasture. Nothing about this childhood or these modest beginnings suggested that he would go on to distant countries to accomplish so much. The impossibility of a life beyond the pastures of Aller seemed confirmed when his elementary school teacher told his mother that he would never amount to much. His parents’ investments, he insisted, should be placed in Eduardo’s sister, Victoria, who had much more academic potential. But Victoria would have none of that. Victoria takes full credit for Eduardo’s achievements, made possible by her midnight escape out the window of her school residence, which shifted his parents’ attention resignedly to Eduardo’s education. The journey that would take Eduardo from this quiet rural region in northern Spain to Regina, Saskatchewan where he settled
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It was in Oviedo where Eduardo met his wife Rosario, who fell in love with this good-looking surgeon newly returned from the US. She and her girlfriends referred to him as a “chulo”: he was cocky, had a magnetic personality, and seemed very aware that women found him easy on the eyes. Rosario also noticed that his pastime as a fairly skilled soccer player gave him a nice pair of legs. Rosario captured Eduardo’s heart by her ability to sing the complex melodic lines of Asturiano
folksongs or tonada asturiana, which he adored. They married and immigrated to St. John’s, Newfoundland in 1963 where their first daughter, Maria, was born. Shortly after arriving in Canada, Eduardo completed his examinations for the Licentiate of the Medical Council of Canada, Fellowship in the Royal College of Surgeons of Canada, and the American Board of Surgery, all in 1964. An opportunity presented itself to establish his practice in Regina, Saskatchewan, which was, at the time, in desperate need of an additional plastic and reconstructive surgeon to join Dr. Jan P. Szlazak. In 1974, he was appointed Assistant Clinical Professor of Surgery at the University of Saskatchewan. He established the burn unit at Regina’s General Hospital where he became Head of the Section of Plastic Surgery in the Department of Surgery in 1975. The following year, he became Head of Plastic Surgery at the University of Saskatchewan’s teaching hospital in Regina, the Plains Health Centre, which he played a pivotal role in establishing. He was promoted to Clinical Associate Professor in the Faculty of Medicine at the University of Saskatchewan in 1980 and was elected President of the Plain’s Health Centre in 1985. Eduardo’s talents in plastic and reconstructive surgery were demonstrated in skilled excisional and reconstructive operations for cancers, hand surgery, and skin grafting in the treatment of severe burns; he published extensively on his research in these areas, particularly in tuberous sclerosis and burn treatment. He was elected to the College of Physicians and Surgeons of Saskatchewan in 1988 and in 1992 was unanimously elected its president. While president, Eduardo took passionate stances on the system of fee-for-service and third-party billing, which he felt depersonalized relations between doctors and patients, led to a public distrust in the medical profession, and produced a form of what he called “7-11 medicine.” He was known for his uncompromising honesty, his unwavering values that prioritized patient care over physician profit, and the tough love with which he demanded the utmost standards in the operating room. He was a direct, spirited, and forceful communicator, which could be intimidating for some, but his formidable presence was softened by his quick wit, sharp sense of humour, and a love for good jokes.
Eduardo devoted his time outside of work to his children and his wife Rosario. His parenting style was no nonsense and reflected his tough upbringing in Rio Aller. He believed in right and wrong and personal accountability. He imparted this to his kids by example and with many lectures. His big heart would display itself with a smile or an act of compassion. He wasn’t known for materialism – no flashy cars or clothes or ostentatious displays of success; his focus was on ensuring that his wife and children were raised with comfort, security, and with a sense of open possibility for the future. He enjoyed table tennis in the basement, squash at the Lakeshore Club, weekly soccer games with his son Eduardo Jr., friends, and colleagues, and intense games of “Parchis” (a popular board game in Spain) or dominos, which he never lost – even in the final months of his life. Eduardo loved to socialize and tell stories with friends and colleagues. He had a sense of irony with his storytelling and can be remembered sitting in the living room or the back patio with a drink in hand, surrounded by friends. Ed enjoyed lively and challenging conversations about life, politics, medicine, and his homeland. He had no patience for small talk and liked to speak directly with strong opinions. In retirement, Ed was a voracious reader and passionate about soccer, which he followed religiously – especially his favorite team, Real Madrid. He kept the love of his home country alive with Spanish wine and pinchos on Friday evenings and loved nothing more than Rosario’s unparalleled paella and tortilla with chorizo. Ed is survived by his wife, Rosario Alvarez Fernandez, his daughters Maria Alvarez, Anita Gottselig (Darryl, children Sarah, Paul, Matthew); son Eduardo Alvarez (Melanie, children Eduardo Rafael, Ryder); and daughter Natalie Alvarez (Rajiv, children Violeta, Zubin), as well as his family in Spain, his beloved nephews Amador Gonzalez Alvarez (Clara), Eduardo Gonzalez Alvarez (Dolores), and niece Victoria Arguelles Alvarez (predeceased Raimundo).
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Photo by Ana Redekop, family medicine resident
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