SMA Digest - 2020 | vol. 60, i. 1 by SMA Communications

A publication of the Saskatchewan Medical Association Volume 60 , Issue 1 | 2020

DIGEST MAID

geriatric psychiatrist shares journey to MAID advocacy

PHYSICIAN TURNED RESEARCHER engaging “citizen scientists” to reduce health inequities

THE CALL OF THE NORTH

Indigenous physician works to bridge gap between traditional ways and the western world

LEADING IN THE TIME OF COVID TEAM PLAYERS

Sports medicine physicians play essential role in health of athletes

MEDICINE ONE CAREER, MANY PATHS

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the conversation

Many physicians struggle with undiagnosed, untreated or self-treated mental health issues. Many others struggle with relationship and family issues, and substance abuse. If you or a colleague is struggling, please contact the Physician Health Program for confidential support.

Brenda Senger

Jessica Richardson

Director, Physician Support Programs

Clinical Coordinator (Regina)

306. 244. 2196 or brenda.senger@sma.sk.ca

306.359.2750 or jessica.richardson@sma.sk.ca

Advocate | Supporter | Oncologist 2020 | VOLUME 60, ISSUE 1 SMA Digest is the official member magazine of the Saskatchewan Medical Association. It is published twice per year and is distributed to practising physicians, students and residents in Saskatchewan.

Dr. Nelson Leong was first introduced to the field of radiotherapy at his medical school’s sole lecture on the topic. Captured by the promise of a field that combined physics and cutting-edge technology, while still affording patient relationships with direct patient contact and continuity of care, he had found his calling. Fifteen years later Dr. Leong reflects on the many and varied facets of his role as a physician who cares for people living with cancer.

Editor:

Maria Ryhorski (SMA staff )

Editorial board

Dr. John Gjevre (physician rep) Dr. Susan Hayton (physician rep) Ivan Muzychka (SMA staff ) Girard Hengen (SMA staff ) Delilah Dueck (SMA staff )

Upcoming issues

The next issue of SMA Digest is planned for distribution in spring 2021.

Advertising

The deadline for booking and submitting advertising for the next issue is Monday, Jan. 15, 2021. 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 (306) 657-4582 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.

SMA DIGEST | FALL 2020

Living with dying

Dr. Vivian Walker finds deep fulfilment in helping her patients live as fully as possible in the time they have left. She is the director of Saskatoon’s palliative care program and has hosted weddings, birthdays and even Sask. Roughrider parties on the palliative care unit where the team works to bring joy and meaning to their patients’ final days. Still, a key component of end-of-life care has been missing in Saskatoon, and this year Dr. Walker celebrates the collective effort that went into making the city’s first residential hospice a reality.

CONTENTS

MEDICINE: ONE CAREER, MANY PATHS 2 4 8 13 15 17 18 22 28 31 34 36 38 41 43 45 48 50

President’s message Leading in the time of COVID: Dr. Barb Konstantynowicz The face of Saskatchewan’s COVID-19 response New times, new roles Medical students find new ways to care while training is on hold Member’s Corner: 7A & 7B | short story by Dr. Andrew Kirk Living with dying How do you stay whole? Advocate, supporter, oncologist MAID: Reconciling the law, ethics, and clinical care Pediatrician, geriatrician share passion for patient care Team players Physician turned researcher Aboard a Mercy Ship The call of the north Patient’s Medical Home From bedside to boardroom Students stand in solidarity with patients, communities they serve

52 EVENTS / CLASSIFIEDS / ANNOUNCEMENTS 54 IN MEMORIAM

The face of Saskatchewan’s COVID-19 response He could quite possibly be the most high-profile physician in Saskatchewan at the best of times, let alone during a worldwide pandemic that has shut down the province – and indeed the world – on an unprecedented scale. Dr. Saqib Shahab, the Chief Medical Health Officer for the Saskatchewan Ministry of Health, is the face of the public health response to crisis situations, including the spread of the COVID-19 coronavirus.

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PRESIDENT’S MESSAGE Greetings colleagues, As we approach a winter with the COVID-19 pandemic foremost in our minds, this issue of the Digest magazine couldn’t come at a better time. It gives us a chance to stop for a second, take a breath, and read about colleagues who inspire and amaze us. The theme of this issue is: “One career, many paths” – in other words physicians don’t fit into a cookiecutter mould. We all go to medical school, but from there the similarities begin to blur. In this issue you can read about our Chief Medical Health Officer, Dr. Saqib Shahab, who was initially trained in internal medicine, but after witnessing poor health conditions in his home country decided he could make a difference in the field of public health. After moving to Saskatchewan, he rose through the ranks to his current position, where he has become the face of medicine in Saskatchewan during the pandemic. You can also read about the experiences of three physicians who took on new duties during the pandemic. Dr. John Gjevre returned to intensive care; Dr. Eben Strydom, a GP anes-

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thetist from Melfort, assisted colleagues in Prince Albert, and Dr. Myles Deutscher volunteered to work at a Saskatoon COVID assessment centre. With the pandemic closing their medical school, University of Saskatchewan students wasted no time in helping to support the health-care system. Read about their highly successful GoFundMe fundraiser that brought supplies to La Loche when that community experienced an outbreak of coronavirus. Medicine has taken physicians from our sports fields to our hospices – as I said, “One career, many paths.” In this Digest we learn about Dr. Vivian Walker, medical director of Saskatoon’s palliative care program. “People ask, ‘How can you do that work? Isn’t it depressing?’ It is a privilege to be alongside people as health changes and to help make life still rich and fun and storied as best we can.” We also read Dr. Lilian Thorpe’s first person account as a MAID assessor and her views on the challenges that lie ahead for physicians as the eligibility criteria is broadened. Two physicians – Drs. Mike Nicholls and Cole Beavis – also share their thoughts on sports medicine, their beginnings in a field they didn’t know existed when they

were in medical school to their experiences travelling the globe with Canadian sports teams. I hope you enjoy this issue of Digest – that it gives you a welcome reprieve during the pandemic. I hope you learn from inspiring colleagues such as oncologist Dr. Nelson Leong, who writes about the intrinsic rewards working in cancer care, and Dr. Veronica McKinney, who is working toward better health care for Indigenous communities as director of Northern Medical Services. All of the physicians in this magazine started on the same path. Our unique and varied interests took us in different directions, but our goal is the same – to provide the best possible care for our patients, now during the pandemic and always. Have a safe fall and winter, and best wishes.

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OUR UNIQUE AND VARIED INTERESTS TOOK US IN DIFFERENT DIRECTIONS, BUT OUR GOAL IS THE SAME – TO PROVIDE THE BEST POSSIBLE CARE FOR OUR PATIENTS, NOW DURING THE PANDEMIC AND ALWAYS.

DR. BARB KONSTANTYNOWICZ SMA President president@sma.sk.ca

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LEADING IN THE TIME OF COVID 4

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By Girard Hengen

As a member of the first medical school class in Canada with as many women as there were men, Dr. Barb Konstantynowicz felt a sense of duty to be a leader in the profession. She had no way of knowing at the time that her turn to lead would come amid a global pandemic unprecedented in both scale and scope. Dr. Konstantynowicz assumed the presidency of the Saskatchewan Medical Association (SMA) on June 18, 2020, during the first virtual Representative Assembly held by the SMA. Almost 40 years earlier, she was a graduate of the University of Saskatchewan’s College of Medicine, Class of 1981. “We were told it was the first class of 50 per cent women in Canada,” she said, “a group of physicians who had an opportunity to be leaders.” Dr. Konstantynowicz became SMA president as the medical profession, and Saskatchewan as a whole, began to emerge from a strict lockdown imposed after the first case of COVID-19 was detected in mid-March. Uncertainty still drives the health-care agenda as it relates to COVID-19, not knowing what’s going to happen next – or when life can return to a new normal. “We can easily become complacent and think we are OK because there aren’t many cases in our neighbourhoods, but this is a virus that we have to take seriously and keep our resolve up to take care of each other and our patients,” Dr. Konstantynowicz said. She views the pandemic from the perspective of a family doctor who cares deeply about her patients. “As a family physician you treat from cradle to grave. Every stage of life, every health condition, for any gender, any background, or socioeconomic status, family physicians have always been there. We can’t fail our patients now.” With health-care resources and energy being poured into responses to COVID-19, she hopes other patients aren’t forgotten. Dr. Konstantynowicz still remembers starting out her medical career, with the emergence of HIV-AIDS being the biggest health-care challenge of the time. Despite innovations in therapies, HIV rates remain relatively high in Saskatchewan. “That concerns me as a care provider,” she said. “I know in many ways, the COVID-19 pandemic is going to have an im-

pact in many areas of health-care, for example – HIV therapy, mental health, chronic diseases, elders and long-term care – I can keep identifying areas I do not want us to forget about. Despite the pandemic, we have to be vigilant in these areas. “I do think many people are having pandemic fatigue,” she continued. “They so desperately want life to go back to normal. I want life to go back to the normal I have known for the majority of my career. We must adapt to a new normal and it means that we will create new ways to provide care. When we are putting on our PPE and seeing patients or having a virtual appointment, we need to remember to ask how they are doing – with mood, coping, resiliency and isolation.”

Making a day in the life of a doctor better Born and raised in Regina, Dr. Konstantynowicz received a BSc from the University of Regina before attending the University of Saskatchewan. She completed a family medicine residency in Regina and started her career as an emergency room physician and ACLS instructor.

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WHEN I STARTED ON THAT ROAD I REALIZED WE NEEDED TO MAKE A DAY IN THE LIFE OF A PHYSICIAN BETTER. MANY DECISIONS ARE MADE AT A SYSTEM LEVEL – BUT THIS DOES NOT ALWAYS HELP A PHYSICIAN BE ABLE TO PROVIDE OPTIMAL PATIENT CARE.

She did locum work in rural Saskatchewan, including Lampman, Estevan and Melfort. She also worked in Edmonton at the Royal Alexandra Hospital, in academic family medicine. She taught courses in family medicine following a year of study at Western University under Dr. Ian McWinney, Canada’s first chair in family medicine.

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Her first foray into the world of physician leadership came when she was asked by a Regina physician to serve on a committee. The group succeeded in improving family physicians’ access to diagnostic (MRI/CT) imaging. “When I started on that road I realized we needed to make a day in the life of a physician better. Many decisions are made at a system level – but this does not always help a physician be able to provide optimal patient care.” In the 1980s and 1990s medical knowledge was exploding with new therapies, procedures, innovative technologies and better equipment. “There is a rapid pace of change, high workloads and a culture that creates the expectation that physicians will do it all without system supports. The system needs to support all physicians, with the physician’s input. “I wanted the voice of the doctor to be at the table. Many of my colleagues were too busy to volunteer and it was hard to commit time for meetings – which were usually held during office hours – or even be aware we should be at some highlevel discussions.” Dr. Konstantynowicz became a SMA RA delegate in 2014, and joined the SMA Board in 2015. She has served on several committees, including Finance, Primary Health Care, Intersectional Council, EMR and the section of

family medicine. She was elected secretary-treasurer of the SMA for 2018-19, and vice-president for 2019-20. Dr. Konstantynowicz succeeds Dr. Allan Woo as president. She cites the need to tackle systemic racism as a high priority for her term. Physicians can act as influencers, identifying problems and finding solutions within the profession and in society as a whole. “It is such an important topic and it is one that will need time and skill, the wisdom of our membership and the board,” she said. As president of the SMA, Dr. Konstantynowicz has arrived not just at the table, but at the head of the table. That thought among the class of 1981 – that the graduating women had a chance to be leaders in the field – has been fulfilled. “We felt it was an opportunity for us to do something,” she recalls. “Women had gone before us to pave the way for us to get into medicine. What was I going to do with that?” Dr. Konstantynowicz is married to Jeff, a lawyer in Regina. They have two children attending McMaster University in Hamilton. Alexander is pursuing his master’s degree in biomedical engineering, and Jessica just completed her first year of medical school. ◆

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I DO THINK MANY PEOPLE ARE HAVING PANDEMIC FATIGUE. THEY SO DESPERATELY WANT LIFE TO GO BACK TO NORMAL ... WE MUST ADAPT TO A NEW NORMAL AND IT MEANS THAT WE WILL CREATE NEW WAYS TO PROVIDE CARE.

SMA DIGEST | FALL 2020

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SMA DIGEST | FALL 2020

THE FACE

OF SASKATCHEWAN’S COVID-19 RESPONSE He could quite possibly be the most high-profile physician in Saskatchewan at the best of times, let alone during a worldwide pandemic that has shut down the province – and indeed the world – on an unprecedented scale.

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Dr. Saqib Shahab, the Chief Medical Health Officer for Saskatchewan’s Ministry of Health, is the face of the public health response to crisis situations, including the spread this year of the COVID-19 coronavirus.

SMA DIGEST | FALL 2020

By Girard Hengen He could quite possibly be the most high-profile physician in Saskatchewan at the best of times, let alone during a worldwide pandemic that has shut down the province – and indeed the world – on an unprecedented scale. Dr. Saqib Shahab, the Chief Medical Health Officer for Saskatchewan’s Ministry of Health, is the face of the public health response to crisis situations, including the spread this year of the COVID-19 coronavirus. “Knowledge is power and I think the right information at the right time is essential,” Dr. Shahab told the SMA. “When we have a pandemic, for example, it’s important to give clear information about what is our best estimate about what is going to happen and as things change, whether we think it’s going to get better or worse, keep updating the public regularly,” he said. “If people are well-informed and understand how it’s going to play out and what steps they need to take at an individual level, at a family level, at a community level, I think that really helps.”

Public reaction has ranged widely: the province’s initial response was too fast, the province moved too slowly at first, the re-opening is too risky, the re-opening is too cautious. “One always has to have an open mind and to listen humbly and closely to all points of view,” Dr. Shahab said of his public role. “And one has to always course correct based on what new evidence is showing, and what is feasible and possible within a specific context.” *** Dr. Shahab practised as an internist in the United Kingdom and Pakistan, but after several years the public health field beckoned. Born in Britain, he received his education there and in Pakistan. He did his medical degree in Pakistan and moved back to Britain for internal medicine training.

Dr. Shahab holds regular briefings with the media, and through them speaks to the public, on health issues that affect the population, from measles scares, and the advance of the West Nile virus, to pandemics such as SARS in 2003 and the H1N1 virus in 2009.

While in Pakistan in the early 1990s, Dr. Shahab became aware of preventative medicine and how it improves the health of a population. A couple of moments were transformative. One day in his clinic, he saw three patients in a row with typhoid fever. After work he went with them to their village, where the water well appeared clean and up to standards. However, nearby was a septic tank that was contaminating the well. Whoever built the tank did not consult public health bylaws. This lack of awareness and application of basic public health guidelines had contaminated the water supply of the entire village.

The public has been watching and listening to his every word like never before during the COVID-19 pandemic. Sometimes he is praised, sometimes he receives criticism.

Another “watershed” moment was the release of the Whitehall study of British public servants, which showed a steep inverse relationship between social class – as measured by

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WHEN WE HAVE A PANDEMIC, FOR EXAMPLE, IT’S IMPORTANT TO GIVE CLEAR INFORMATION ... IF PEOPLE ARE WELL-INFORMED AND UNDERSTAND HOW IT’S GOING TO PLAY OUT AND WHAT STEPS THEY NEED TO TAKE AT AN INDIVIDUAL LEVEL, AT A FAMILY LEVEL, AT A COMMUNITY LEVEL, I THINK THAT REALLY HELPS.

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occupation – and mortality from a range of diseases. The higher the job classification, the better the outcomes. The World development report 1993: Investing in health, which examined the linkages between human health, health policy and economic development, also had an impact on Dr. Shahab. Slowly, over a period of years, he thought about changing his field to public health. Dr. Shahab completed a master’s in public health from Johns Hopkins University in the U.S. He equates the difference between internal medicine and public health as using a telephoto lens on a camera to view a single task up close (internal medicine), to switching to a wide-angle lens and seeing the big picture (public health). “My viewpoint shifted from a patient or a clinical disease to the population level,” he said. The Whitehall study showed that the more control a person had on his or her life, and the better the income, the better the health. The health system itself could not deal with reducing disparities in health outcomes, Dr. Shahab noted. “Those things really spurred my interest for prevention and outcomes,” he said. “It was a mid-career decision, but currently one that has been really satisfying for me both professionally and personally.” *** Dr. Shahab and his family moved to Saskatchewan prior to his completion of a second reentry residency – this time in public health – at the University of Alberta. He found Saskatchewan and Canada fascinating from a public health perspective. Geographically huge and sparsely populated, the region contrasted with what he had known in Britain and Pakistan. The public health community here is small and tightly knit. Public health physicians in Saskatchewan have an opportunity to work with family physicians as well as specialists across disciplines. He also works with local leaders, school and municipal officials, and First Nations to improve health outcomes for communities. “There’s a very collaborative approach, a really practical and pragmatic approach to things that I enjoy,” he said. “We talk about social determinants of health, how do social determinants like income, education and other factors such as how what happens at home and in the community affects health – we collaborate and talk about that. “That state of collaboration and looking outside the box is the true strength of health care in Canada.” Dr. Shahab worked as a regional medical health officer in Yorkton before moving to Regina in 2009 for the position

of deputy chief medical health officer with the Ministry of Health. He became provincial chief medical health officer in 2012. Dr. Shahab is a past chair of the Medical Health Officers Council of Saskatchewan and past-president of the Saskatchewan Public Health Association. He is currently cochair of the Pan Canadian Public Health Network Council, which has met to coordinate responses to the COVID-19 coronavirus.

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THAT STATE OF COLLABORATION AND LOOKING OUTSIDE THE BOX IS THE TRUE STRENGTH OF HEALTH CARE IN CANADA.

He has become a familiar figure since coming to Regina in 2009, speaking to reporters in print, radio and television. It’s simply part of the job. “It’s a privilege to be able to speak directly to the population of Saskatchewan,” Dr. Shahab said. “The media plays a very valuable role in conveying factual information and it’s been a really positive experience working with the media, working with our communications teams, working with the ministry and the SHA, to get the right information out. It’s an important part of our work.” *** From a public health perspective, the COVID-19 outbreak presented physicians with a “rapidly changing environment,” one that initially appeared localized to China’s interior and a few countries in the world in January 2020, but one that had spread across the world by March. Dr. Shahab said the provincial health system – the Health Ministry, Saskatchewan Health Authority (SHA), public health, primary care physicians, acute care facilities and staff – had to be prepared at the outset, given the rapid spread elsewhere of COVID-19. “We have to create a system that if we were to see limited community transmission in Saskatchewan, how could we try to manage that in a way that we minimize either further transmission in the community, or through public health measures and other measures we slow down the transmission?

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“That’s what pandemic preparedness and response is all about. You initially try to contain, so that the virus will not come into Canada or if it comes, to keep it very limited. But once it becomes established as a global pandemic, we needed to be prepared. What public health measures do we take to reduce the spike of the curve?” The number of cases in Saskatchewan has remained relatively low compared to other jurisdictions, although outbreaks have been affecting communities in the north and communal living settings throughout the province. “So far Saskatchewan has done well, but this is a marathon and not a sprint,” Dr. Shahab said. “At present, it is not back to business as usual but adjusting to a new normal for the next little while.” Dr. Shahab attributes any success the province has had in “flattening the curve” of the pandemic to a “team effort” involving the entire health system, and the people of Saskatchewan, who have by and large followed public health directives.

But someone has to be prepared to face the TV cameras and calm a restless, possibly anxious and afraid, public. Someone has to be labelled by the media – fairly or not – the province’s “top doc.” In Saskatchewan, that job falls to Dr. Saqib Shahab. His philosophy is simple – facts matter. “I think there are some areas, such as public health decisions, that do fall to medical health officers at a local level and the chief medical health officer at a provincial and government level,” he said. “But these decisions are always based on principles of public health practice. “People are highly educated. They’re really involved in their health. I think giving the right factual information is essential, and then explain how your community is at risk for whatever the risk is that people are concerned about, and what can all of us do collectively and individually to minimize that risk.” ◆

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SMA DIGEST | FALL 2020

ED HOBDAY

recieves national honour for lifetime of dedication to Sask. doctors

NEW TIMES, NEW ROLES Pictured above, L-R: Dr. John Gjevre, Dr. Eben Strydom, Dr. Myles Deutscher By Greg Basky During the COVID-19 pandemic, Saskatchewan’s healthcare system has faced unprecedented pressure to be flexible and adapt. Physicians from around the province have risen to the challenge, taking on different roles to provide care where they’re needed most. Meet three doctors who worked in new ways this spring.

Return to ICU When he shifted gears from critical care to sleep medicine five years ago, Dr. John Gjevre figured he’d never again set foot in an intensive care unit. However, when the pandemic struck, he was called back into action by the Saskatchewan Health Authority (SHA). Gjevre rapidly pivoted from interpreting polysomnograms on a computer screen at Saskatoon City Hospital’s sleep disorders lab to running an ICU. He returned to his regular duties in July. While the ICU shifts were not something he ever anticipated, Dr. Gjevre says he was glad to be able to help out where the need was greatest in that moment, and to reconnect with old friends. “It has been great to work with such dedicated and cheerful individuals again,” he said.

He had to brush up on dosages for less common drugs and get used to staying up all night again, but added “you just don’t forget how to do things like intubation or central lines.” While seconded by the SHA, he spent half his time providing daytime and nighttime coverage of Saskatoon ICUs, and the other half carrying on his research, teaching, and administration – the latter two by Webex or Zoom. “We responded to the urgent need and that’s what was most important,” said Dr. Gjevre, whose other clinical work is based at RUH’s outpatient sleep clinic. He was concerned, however, about his sleep patients, many of whom suffer from severe chronic conditions – including obstructive sleep apnea, pulmonary hypertension, and obesity hypoventilation syndrome – and is glad to be back doing sleep medicine. “Those things did not go away for these patients. I could provide some therapy for a while virtually, but I worried that their care needs were not being fully met.”

Part of the P.A. team In the early days of the pandemic, the Saskatchewan Health Authority approached Melfort GP anesthetist Dr. Eben Strydom and colleagues about supporting Prince Albert’s relatively small anesthesia team. At that point, the SHA was anticipating a potential surge of COVID-19 patients and

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IT REALLY BUILDS THE TEAM SPIRIT THAT WE NEED IN OUR SYSTEM BECAUSE MEDICINE IS A TEAM SPORT. KNOWING THE PEOPLE WE WORK WITH AND DEAL WITH IS VERY IMPORTANT.

cancellation of local elective surgeries. Dr. Strydom, along with Drs. Chelsea Wilgenbusch and Robert Steffen, willingly agreed to cover calls in P.A. in April, May, and June. For the 48-hour shifts, that meant driving close to 100 kilometres for an 8 a.m. start, working and staying on-site to provide whatever support was needed – whether that was obstetric anesthesia or coverage for the OR for orthopedic or general surgery cases. Stepping into the new role, even temporarily, was a great opportunity to brush up on medical skills that he and his colleagues don’t use as often locally, according to Dr. Strydom. “There are things that in rural anesthetic practice don’t happen with a very high frequency. So it was good to get exposure again to things like hip replacements, or just more challenging patient cases, in a controlled environment.” Without internal medicine or ICU backup in Melfort, there are limits to the cases that he and his colleagues can safely support post-surgery. “So that was a good experience again to be able to do those cases.” For Dr. Strydom, the best part of wearing a different hat this spring was developing a closer relationship with the general surgeons, gynecologists, pediatricians, and orthopedists that he and colleagues Drs. Steffen and Wilgenbusch talk to on the phone all the time. “It really builds the team spirit that we need in our system because medicine is a team sport,” said Dr. Strydom. “Knowing the people we work with and deal with is very important. It was a good experience to work with our colleagues in P.A. and to be part of that team.”

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Strong urge to help out After signing the pandemic physician services agreement, Saskatoon family physician Dr. Myles Deutscher volunteered to work at one of the city’s two COVID assessment centres where he worked a couple of shifts each week. More recently, he continues to work at the assessment centre but has scaled back to weekly shifts. “I redeployed myself,” said Dr. Deutscher. “I felt a strong urge to help out with the pandemic in some way.” While Dr. Deutscher doesn’t feel particularly anxious about contracting the coronavirus himself, he has adopted a homecoming routine to ease his wife’s concerns: He wipes down his car before he climbs out, strips off his scrubs in the garage, showers in a downstairs washroom no one else in the family uses, then dons clean clothes. “I feel that we’re quite well protected at the assessment centre,” said Dr. Deutscher. “I’ve been well trained in how to put on my PPE and how to take it off. I don’t have any reservations about stepping up.” Dr. Deutscher admits he felt a lot of stress at the outset of the pandemic. He expected a dropoff in visits when physicians were encouraged to limit in-person appointments, but he hadn’t anticipated 80 per cent of his appointments would disappear almost overnight. “There was no revenue being generated, but our costs at the clinic were the same. We were quite worried, and wondering: how are we going to survive this?” Dr. Deutscher was thankful for the pandemic agreement, which he says provided a sense of security for the clinic. ◆

Medical students find new ways to care while training is on hold Pictured top to bottom: Kate Morrison, Hanna Dunnigan, Jessica Froehlich By Greg Basky When the COVID-19 pandemic brought their clinical and classroom training to a halt in mid-March, students in the University of Saskatchewan’s College of Medicine wasted no time offering their support to the health-care system. With help from the Student Medical Society of Saskatchewan, individuals and small teams identified needs and organized a variety of different projects in response: •

Public Health: Early on, some medical students helped staff the public health phone lines, doing contact tracing, daily check-in calls with people who tested positive, and advising others that their test results had come back negative.

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PPE Collection: Students gathered personal protective equipment from local businesses and individuals for donation to Saskatoon hospitals. They were motivated to act by reports of local shortages and the potential risk this posed to patients and care providers.

•

Students Helping Health Care Providers: To lighten the load for physicians who were logging long hours in ICU or emergency in the pandemic’s early days, some students stepped forward to help out by running errands or providing child care.

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Student Senior Isolation Prevention Partnership: Medical students here launched a Saskatchewan chapter of this program, which started at the University of Toronto. Isolated seniors living on their own or in long-term care are paired with a student partner for weekly telephone calls, for social contact and to answer questions.

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Support for La Loche: When an outbreak of the coronavirus hit La Loche, Dr. Kendra Morrow wanted to do something to help. With some administrative support from the SMA, medical students leapt into action, launching a GoFundMe campaign that blew past its original target, then shopping for household supplies, toiletries, and crafts and games, to make life a little easier for residents of the northern community.

SMA DIGEST | FALL 2020

Students motivated by desire to help where they can Second-year medical student Jessica Froehlich has been helping coordinate the various initiatives and recruiting volunteers. She stepped up because she was finding it tough being forced to sit by on the sidelines, with patient interactions and other extracurricular activities that were part of her medical training put on indefinite pause. “I went into medicine because I want to give back to my community and I want to be socially responsive,” says Froehlich. “I have been able to do that by getting involved in these projects.” Kate Morrison has completed her third year of medical school. Earlier on in the pandemic, she helped out with public health efforts by doing callbacks on negative test results and contact tracing. Since then Morrison was paired with a socially isolated senior. She looked up pandemic-related information for the woman, who has access to television but not Internet, and was reluctant to ask her family members, for fear of being “a bother.” While Morrison couldn’t provide medical advice, based on symptoms the senior described to her, she strongly encouraged her to quickly contact her family physician. “I think it’s helpful just to process things with them and be a sounding board for their whole experience going through this,” says Morrison, who also helped out with the La Loche project. “I don’t feel like I’m just calling to say ‘hi.’ There is definitely a need out there.” Hanna Dunnigan, who is going into Year 3 Medicine, did a few shifts of testing callbacks with public health, then helped out a physician who needed support with child care.

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She did seven or eight eight-hour shifts looking after two children under the age of 10. After initially feeling helpless, with free time she wasn’t used to having, volunteering helped ground her. “I felt like I was giving back to the community and helping physicians who were taking time away from their families or feeling some extra stress because of all the change.”

Medical students miss learning, contact with patients For Dunnigan, the biggest struggle was not being able to be part of the aspect of medical school she enjoys most. “I miss being able to interact with patients and clinical skills sessions where I actually get to apply the knowledge we’re learning, because it feels like we’re working toward something and you get to have those interactions and see how what you’re learning can be used to help people.” Morrison says some of her classmates are feeling a sense of loss for what they had anticipated their fourth and final year of medical school would look like. At this point, there are many unknowns about what COVID-19 will mean for completion of their medical training – in particular, how matching for specialty training will be affected. “But I think for me personally, I’ve been really happy to be able to be involved in all that’s going on. It’s been really nice to work with our student body and all of the organizations that are coming together. It’s been like an alternative learning experience.” ◆

Members’ Corner Our doctors are multi-talented and we want to celebrate that! In each issue of the SMA Digest we will highlight our members creations here. If you have something you would like to share – your poetry, pottery, music, writing or anything else – send your submission to maria.ryhorski@sma.sk.ca. We hope you enjoy our first selection!

7A & 7B

A short story by Dr. Andrew Kirk

7A The woman I love sleeps beside me. I’ve never been able to doze on planes myself but Katja doesn’t seem to have any trouble. It’s touching how she leans toward me in her sleep as if she can’t get close enough to the man of her dreams. I notice that her watch says 3:37 while mine’s at 2:37. She’s so cute – still has her watch on Toronto time. I set mine back to Winnipeg time even before I went to sleep last night, before I requested a wake-up call and set my alarm clocks. I really have to chuckle. Whatever would Katja do without me to look after her? Through the airplane window I see that we’re still over the lakey muskeg of northern Ontario – probably passing over that invisible line between Eastern and Central time right about now. I consider changing Katja’s watch for her while she sleeps but decide we can do it together once she’s awake. Her beautiful hands rest on the table tray as she sleeps. I’ll have to watch that she doesn’t knock her work folders off. I shake my head. That girl works too darned hard. No wonder she’s fallen asleep. And it’s just like her to have her name printed on every folder and at the top of every page. She’s so responsible, so meticulous. Maybe that’s what drew me to her in the first place. It’s still hard to believe that we’ve known each other such a short time and already know we’re soulmates. If the company hadn’t sent me to that software convention in Mississauga I’d never have met Katja. Katja – what a lovely name for a lovely girl. I think her parents must’ve been Russian or something. I’ll have to ask her. Aw, now she’s resting her pretty little head on my shoulder. Her long blonde hair tickles my forearm. I keep very still so as not to wake her. She fills my heart with such tenderness. I wonder if everyone on the plane can see how very much in love we are.

7B I wake with a gasp – turbulence, I realize. God, how embarrassing. In my sleep, my head’s sagged over onto the shoulder of that creepy guy beside me. He’s giving me that weird grin again. This is one reason I hate flying so much – having to sit beside bizzaros like him. Ugh - you’d think he could maybe wash his hair once in a while. If the plane weren’t full I’d move to another row. I’d better get back to work. If I can get this next contract I might be able to stay in head office and not have to fly to Winnipeg anymore. Then I won’t have to sit with geeks like this for hours on end. I wish he wouldn’t keep staring at me. Look at him. Who knows what he’s thinking - probably involving me in some sick fantasy or other. Yuk. ◆

SMA DIGEST | FALL 2020

LIVING WITH

DYING and one doctorâ&#x20AC;&#x2122;s passion to bring Saskatoon its first residential hospice

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By Maria Ryhorski “We've had weddings on our unit. We've had birthdays, holiday parties, anniversaries, baptisms, Sask. Roughrider parties, and even a tattoo party. We go out of our way to try and make special events important and fun.” Dr. Vivian Walker is radiant as she describes what makes her chosen path so meaningful to her. The wall behind her is papered with photos and thank-you cards from past patients and families. The love and joy in this space is palpable and defies expectations of what many would associate with death and dying. And yet, this is the field she has chosen – “the coat that fits me well in this season” as she is fond of describing it.

“

YES, THERE IS SORROW. THERE IS SORROW IN MANY THINGS OF OUR LIFE – LIFE ISN’T WITHOUT PAIN – BUT IT DOESN’T HAVE TO BE THAT THE SORROW SWAMPS YOU. THE SORROW CAN BE HELD WITH THE JOY. THEY GO SIDE BY SIDE. THEY CAN LIVE IN THE SAME HOUSE.

Dr. Walker is the medical director of Saskatoon's palliative care program. She stands on the shoulders of the remarkable physicians who have held this role before her and is also one of the persistent voices behind bringing the city its first residential hospice. Despite the fact that her patients are often in the last season of their life, she insists that palliative care is about life, not death – and not just surviving or enduring but about finding peace and meaning in the time that is left. “People ask, ‘How can you do that work? Isn't it depressing?’” she reflects with a smile and understanding for the misconception.

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“It is a privilege to be alongside people as health changes and to help make life still rich and fun and storied as best we can.” “Yes, there is sorrow. There is sorrow in many things of our life – life isn't without pain – but it doesn't have to be that the sorrow swamps you. The sorrow can be held with the joy. They go side by side. They can live in the same house.” That much is evident as I walk through the palliative care unit at St. Paul’s Hospital. Renovations are underway but the temporary walls that line the hall swirl with colourful murals painted by volunteers, family members and even patients. The kitchen is stocked with tea and coffee and the fridge is full of ice cream, popsicles, Ensure, yogurt, and cold drinks as snacks for patients. I’m told the ward is frequently filled with the smell of fresh-baked cookies, courtesy of the unit’s volunteers. The lounge room has couches, books, puzzles, cards, and a children’s area. Nestled in the corner, two glass angels honour those who have recently died. “I think that this attitude of ‘there's nothing more we can do’ when an illness becomes terminal, is kind of nonsense,” Dr. Walker says. “Hopefully we can always show up and bring ourselves full-on to the work that palliative care is and has always been. Care that relieves symptoms whether physical, emotional, social or spiritual. Care that supports the individual to live as fully as possible in the time they have left.” The next step in providing comprehensive end-of-life care for the people of Saskatoon is building the city’s first residential hospice – the Hospice at Glengarda. This 15-bed freestanding hospice will be the first of its kind in Saskatoon and will provide a home-like environment where individuals approaching death can live the last days or weeks of their life with their needs looked after and their family welcomed and supported. There are currently two organizations in Saskatoon that focus on supporting individuals at end-of-life and the care they provide is distinct but complementary to the Hospice at Glengarda. Prairie Hospice Society is a grassroots community organization that matches specially trained volunteers with individuals who are facing end-of-life, to provide companionship and non-medical support in the comfort of individuals’ own homes. Sanctum Care Group supports people living with HIV; its programs include a transitional care home and hospice where individuals with HIV who are nearing end of life receive the care they need in an environment of support and acceptance. The Hospice at Glengarda will fill a long-standing and significant gap in end-of-life care in Saskatoon, by providing a physical space – a home-away-from-home – where indi-

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AT THE END OF THE COURSE, THE DISEASE LABEL MEANS VERY LITTLE. THE STORY IS REALLY ALL ABOUT – WHO IS THIS PERSON? WHAT AND WHO DO THEY LOVE? WHAT IS MOST IMPORTANT TO THEM?

viduals will receive the medical, psychosocial and spiritual care that they need to be able to live the time left as fully as possible. Hospice is the standard of care in many parts of the world and Dr. Walker became acquainted with it while doing palliative care training in the U.K. There has been a 15-year plus movement to bring a residential hospice to Saskatoon. Recently the St. Paul’s Hospital Foundation spearheaded this effort, launching the $20-million Close to Home campaign. “I think people often want to stay at home and they don't realize that it takes a small army to care for someone as illness advances,” Dr. Walker says. “When it comes to handson care and getting to that stage – one person can't do it on their own. Certainly an elderly spouse trying to care for their loved partner, or sandwich-generation adults still working and perhaps raising their own families, can't do it on their own. So hospice is the right care. It's a surrounded care. The family gets to be family again.” Dr. Walker is overwhelmed when she reflects that this dream will soon become a reality. The campaign met and exceeded its fundraising goal on May 12, 2020. “I'm just so grateful for the generosity of Saskatoon people and area that have stepped up and said, ‘Yes, hospice will be a good thing for our city, for our neighbours, friends, and even ourselves.’ ” “I believe that hospice will provide the kind of care that will help people continue to live and tell their life story, and help them to prepare for their final goodbye.” With funding secure, construction on the Hospice at Glengarda is moving smoothly ahead, despite challenges associated with COVID-19.

Dr. Walker hopes that the hospice will also be a place where family physicians in the community who provide palliative care will feel welcome to continue providing care to their patients within its walls. *** Dr. Walker will carry memories of her patients with her always. In her own words, “Every single week I go home with stories that are rich, meaningful and help me ‘not to sweat the small stuff’, to be grounded in my own life and in my own enjoyment of today.” One that comes to mind is of Gord, a young father who was diagnosed with advanced cancer on his birthday. He volunteered to become the face of the Close to Home campaign in an effort to make sure that in the future, families like his would be embraced by the holistic care of hospice. Another is Amanda, a young patient, health-care provider and lover of music. “She was amazing.” Dr. Walker reflects pointing to the beautiful face smiling out from a photo on her wall. “We were so privileged to have this young woman teach us about her living and her dying as we cared for her. She was so feisty!” Dr. Walker smiles back at her. “And it's that kind of person’s story that changes me.” “At the end of the course, the disease label means very little. The story is really all about – who is this person? What and who do they love? What is most important to them? What are they worried about? All those big questions that I think you and I would like to have as part of our health-care journey too when the time comes. I know I will.” ◆

SMA DIGEST | FALL 2020

HOW DO YOU

Savio Nguyen | Year 3, College of Medicine, Saskatoon What do you do to stay whole? Although I’m only three years into my medical career, I have enjoyed every step of the way! I’m regularly reminded of how rewarding this vocation is, humbled by all there is to learn, and grateful for the opportunity to grow as a clinician alongside such amazing colleagues. However, to say that the training has been easy would be inaccurate. From tireless nights of rote memorization to spending prolonged time away from family and loved ones, it’s easy to lose track and forget about one’s wellness. Without instilling a way to keep myself in check, burnout would be inevitable.

For me, I found my reprieve in singing and drawing. Although I have always pursued these hobbies throughout my life, I now engage with them in different capacities than before. A drawing might start as a way to study but quickly becomes an exercise in relaxation and self-awareness. All the stressors around me dissolve and all I’m left with is the stationery in my hand, the canvas before me, and the harmonies in my headphones. SMA DIGEST | FALL 2020

STAY WHOLE

Why do you think it is important for physicians to have outside pursuits? I think itâ&#x20AC;&#x2122;s essential for physicians to have outside pursuits as they are a reminder of the humanity in medicine. Beyond the guidelines, the technological advancements, and the laboratory values exists a patient population with fears, ideas, and expectations. I remember being told in an arts and humanities figure drawing class: â&#x20AC;&#x153;The human body has no straight line.â&#x20AC;? Health-care professionals navigate a field where there is often no absolute, consistently entertaining all shades of grey. We are all artists in our own right, leaving a mark in the lives of our patients, each brush stroke a culmination of years of lessons and mistakes. Through my pastime, I remind myself to take a step back from the intricacies and details and look at the bigger picture.

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Drs. Siva and Kumudhini Karunakaran | Nephrology; In-

fectious diseases, Regina

What do you like to do with your leisure time? Sir William Osler suggested that avocations (leisure activities) in doctors result in an increased sense of vocation (professional engagement) and a decreased level of burnout. Being a two-physician family with children to bring up without any family support close by can be very stressful. When the children were young, our leisure activities were their pursuits, like many other young families. Once the children got to an age where they didn’t need as much from us, we did extensive research into leisure activities that would optimize our work performance and family life. We pursued various fitness activities individually at first. Eventually we started to work out with a trainer. That led to our summer tradition of outdoor running. While fitness is one of life’s necessities, there is more to it. A shared passion certainly enhances the emotional bond. Working out together allows us to share goals, motivate one another and build mutual accountability. Being able to follow the advice we give to our patients is an added bonus. Travel serves multiple purposes: We used to travel as a family, but now that the children are on their own we travel as a couple. For us the excitement builds once we settle on a location. Putting the itinerary together and making the arrangements are all part of the fun. Travel allows us to experience cultures, traditions and rich histories around the world. We have never been to a country we didn’t like, or experienced a culture we didn’t respect. We enjoy the mountains, rivers, and lakes generously offered by nature. We have been in awe of the cathedrals, castles in Europe, the magnificent temples that date over 1,000 years in India and everything else in between. Our knowledge and world view was enriched by the numerous museums we visited around the world. The most important lesson learned was every country has something unique and special to give to humanity. We would be remiss if we don’t mention our loyal following of the Saskatchewan Roughriders. They occupy a special place in our hearts just like in most Saskatchewan homes. The regular season and the sometime playoff forays provide more than football; these are emotional roller-coaster rides we share with family, friends and the community at large.

Why do you do these things? We travel to get away from the daily grind of work and life, and come back to a fresh start. It improves our engagement with the profession, which can be stressful at times. Every single time when we come back our hearts are filled with immense gratitude for the country we live in.

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Dr. Sharon Leibel | Family medicine, Regina What do you like to do with your leisure time? I love to read, walk and spend time with family – which I haven't been able to do with social distancing during the pandemic (they suspect doctors are plague carriers so I don't think they want me around). I have been walking my daughter's American mastiff on grid roads daily as it is peaceful and relaxing, and I can let the 150-lb. dog loose to run in ditches and play in sloughs! In town she has to stay on leash, and though a big marshmallow, she understandably makes people nervous at times. When she heard coyotes on our walk one evening she pretty much tried to climb into my back pocket – not at all brave!

Why do you think it is important for physicians to have outside pursuits? We need to escape demands of our job and patients, and remember we are blessed to live in a free, well-off and beautiful country. Saskatchewan skies help put our problems in their proper perspective – temporary and generally solvable.

Dr. Robin McMaster | Family medicine, Regina What do you like to do with your leisure time? My leisure activities are somewhat divided by the season. I like to stay active, cross-country skiing in the winter and biking/walking in the summer. As well, I sing in a women’s vocal ensemble throughout the year, and I do needle felting during the winter months, which provides a great creative outlet. It is like sculpture with wool! In the summer I love spending time away on the Winnipeg River at Kenora, Ont., where we have a long-term project developing a cottage lot.

Why do you do these things? When I am in the forest close to water, I feel much peace. What I have realized is that my well-being is improved by getting enough exercise, doing something creative, and spending time outdoors in nature.

Why do you think it is important for physicians to have outside pursuits? I believe it helps achieve some balance in life. The work that we do is demanding and can be overwhelming. Hopefully having outside pursuits will provide some guard against burnout and help create a full, well-rounded life. SMA DIGEST | FALL 2020

Dr. Michael Kapusta | Family medicine, Swift Current I’m a father to two young girls, a husband and a family physician. I am fortunate to be able to divide my time between clinic, emergency, obstetrics and teaching. In any given week I find myself being pulled in many different directions. The thing that I like most about my job is that every day is different.

What do you like to do with your leisure time? Variety in work is complemented by variety in my hobbies. I’m fortunate that I am able to share my hobbies with my daughters. From the time they’ve been able to walk we have enjoyed skiing and flying together. I enjoy the flexibility of taking random mornings, afternoons, and post-call days to spend with my daughters.

Why do you do these things? Travel provides a lot of balance for our family. It acts as a reset button for me and allows us to refocus as a family. I have been fortunate to travel extensively before kids and have been excited to share these opportunities with my daughters. We follow the wise advice of always trying to book our next trip before the current one is finished.

Why do you think it is important for physicians to have outside pursuits? I’m lucky to pepper my weeks with kids and my months with travel. I think that frequently stepping away helps me to maintain focus and engagement with a busy practice. My balance, through family and hobbies, lets me step back and see the proverbial forest.

Preston Njaa | Year 4, College of Medicine, Saskatoon What do you like to do with your leisure time and why? A key component of my time away from school and work involves sport and physical activities. I participate in year-round basketball and football rec leagues, and strive for some form of daily exercise whether it be weight training, running, or walking my dog named Jenny. In addition to both the physical benefits of being active and the mental recharge that comes along with it, these activities provide a social boost, allowing me to connect with friends and family while participating. Spending my leisure time with my loved ones helps me regain perspective on what truly matters to me. I am fortunate to get to spend holidays and weekends off at our family cabin at Christopher Lake. During any season, there is a nearly endless amount of activities to enjoy with friends and family. My favourite is spending summer days out on the boat while waterskiing and wake-surfing. 26

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Why do you think it is important for physicians to have outside pursuits? I am soon entering a busy season of life as I begin my first year of residency. By continuing to participate in activities that I enjoy with those that I love, I hope to be able to maintain my wellness while working hard to improve the health and well-being of the great people of Saskatchewan.

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SMA DIGEST | FALL 2020

ADVOCATE | SUPPORTER

ONCOLOGIST Fifteen years after starting down his chosen path as a radiation oncologist, Dr. Nelson Leong reflects on the many and varied facets of his role

Fifteen years ago, Dr. Nelson Leong was introduced to the field Q: In your practice you meet people at one of the most frightening of radiotherapy at his medical school’s sole lecture on the top- points in their life. What roles does that require you to play besides ic. Captured by the promise of a field that combined physics physician? and cutting-edge technology, while still affording patient re- That’s a really nuanced question. It’s true that I’m privileged lationships with direct patient contact and continuity of care, to be invited into a part of patients’ lives that most aren’t Dr. Leong had found his calling. Since beginning his career in privy to. I do truly believe that a physician’s role extends beyond the stereotyped view solely of a provider of medical radiation oncology with the Saskatchewan Cancer Agency in expertise and its associated paperwork. 2013, his chosen path has shown itself to encompass even On a daily basis, I find myself channeling any number of my more than he first expected. The SMA spoke with Dr. Leong to colleagues and allied health-care workers. For example, I’ve hear his experience and learn about the many roles he plays as often been in the position where I’ve needed to deliver bad news to a patient and their family. I’m blessed to have a fana physician who cares for those living with cancer. Dr. Leong practises at the Allan Blair Cancer Centre in Regina. Originally from Calgary, he completed his medical school and residency in Edmonton, and did a fellowship in breast and genitourinary malignancies at the B.C. Cancer Agency.

SMA DIGEST | FALL 2020

tastic multidisciplinary team including social workers, nurses and other allied workers where we can each play to our individual strengths and look to each other as resources. During these difficult times, I often find myself putting on a number of their hats – and imagining what they would do if they’re not present – to help present education, support, and planning for my patients.

Some days, I’m part social worker, like when we’re having a hard discussion about what our goals of care look like, or when we’re brainstorming how to remove barriers to care from a patient that needs to travel to a neighbouring province for therapy. There’s a lot of personal advocating and communicating, especially when trying to convince insurance companies, or workplaces, to fund a treatment or time off. I recall one patient we had who needed to fly to another city for radiation treatment. She didn’t have any family. She had a lot of anxiety about travelling – flying in particular – and she would get overwhelmed with planning, and the stress of getting from place to place. The medical social worker and I organized a hospital admission in the other city, transportation, treatment, and all the little logistics in between. I definitely can’t take all the credit for this one though; the social worker was an enormous help, and literally walked this patient up to the gate to get her on the plane at the airport. On other days, I’m part medical administrator. All of the physicians at the Saskatchewan Cancer Agency assist with providing input in the most patient-centric, yet still efficient, manner to provide care. Implementing new programs and all that new technology requires a separate kind of developed expertise. Since joining the SCA, I’ve found myself on a number of committees for initiatives to improve our care. I don’t think there’s a single week where I don’t get the opportunity to check off all of the Royal College CanMEDS roles at work.

Q: When you decided to specialize in oncology, did you anticipate you’d have to wear so many different hats? I was expecting some of the extended parts of my practice. For example, I anticipated being in the position to have the hard conversations with patients and being able to build relationships over time with patients. These were the aspects of oncology that drew me to oncology over some other, more service-based, procedural specialties. We receive a lot of support and education at the SCA from our allied health colleagues, which helps a lot with the communication piece. At times though, it feels like there’s an overwhelming set of roles I’ve been asked to fill. I was not expecting the active involvement physicians take on as leaders and administrators. Prior to working at the SCA, I couldn’t specifically define the role of a project manager. In the last few years, I’ve had to learn how to take on that role, learn a new language, and help generate things like requests for proposals, Gantt charts, and operational milestones.

Q: What do you find most challenging in your practice? I believe that being an empathetic, engaged, and proficient medical provider requires a degree of personal vulnerability. It is the great paradox of our craft. It takes a lot of mental fortitude and discipline to share and support patients through their emotional highs and lows. A lot of times I feel what my patients feel, both good and bad. Feeling and emotions are good; they provide passion, purpose and connection. However, I still need to be able to

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I BELIEVE THAT BEING AN EMPATHETIC, ENGAGED, AND PROFICIENT MEDICAL PROVIDER REQUIRES A DEGREE OF PERSONAL VULNERABILITY. IT IS THE GREAT PARADOX OF OUR CRAFT.

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provide sound medical advice. Throughout the day, a large proportion of my personal feelings have to be packed up and placed on a shelf until the day is through. Once it’s the end of the day and all the patients have gone home, those feelings are there, and they still need to be processed.

fatigue and stresses of work, after a long day, sometimes it feels daunting – and exhausting – to even think of picking up my camera. However, if I push through that, I remember and experience the joy that photography affords me, and I really do feel better afterwards.

Having several other roles – like the administrator, innovator, educator, and scholar – really reduces the amount of time to decompress, and refill that emotional reserve at work.

Q: What do you find most satisfying about your work?

Q: How do you cope? What do you do to take care of yourself? I’ve really tried to start being more selective about extra roles I’m going to take on. I’m still super keen to improve patient care with new initiatives, but I try to remember that we work as a team, and consequently I don’t have to sign up for every committee. When I need to talk, I’m fortunate to have wonderful family members who are trained listeners. I do try my best to find healthy outlets to refill my emotional reserve when I’m away from work. I’m a recent subscriber to the exercise and yoga routine. I also do my best to revisit my favorite hobbies. Prior to medicine, photography was a big part of my life. With the

There are many intrinsic rewards to working in cancer care. Our cancer care team is second to none, and my coworkers make coming to the clinic each day a joy. Even when things look bleak, I find meaning in helping to provide patients comfort. However, it’s not all bad! As I mentioned before, I do see patients at some of the lowest points in their lives, but the cancer care we provide is truly making a difference. If we look at all comers, we “win” more than half the time ... which is better than I can say about my favourite hockey team. That means that I get to share in a number of patients’ triumphs. This includes sharing imaging scans with no evidence of cancer, ringing that big bell at the end of radiation treatment (it’s a local tradition), or hearing stories from patients who attended life events they might not have been able to without treatment. ◆

EMPATHY LISTENING PATIENCE TIME-MANAGEMENT TRUST

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SMA DIGEST | FALL 2020

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CLARITY

MAID: Reconciling the law, ethics, and clinical care in the context of vulnerable adults at the end of their lives

By Dr. Lilian Thorpe Dr. Lilian Thorpe is a geriatric psychiatrist who completed her medical degree at the University of Toronto in 1982. After moving to Saskatoon with her husband, she did her residency training in psychiatry and later a PhD in community health and epidemiology. Dr. Thorpe has been clinically involved with medical assistance in dying since before Bill C-14 came into effect in June 2016, and has been involved in a large number of related teaching and academic activities since that time.

SMA DIGEST | FALL 2020

s a young intern at St. Paulâ&#x20AC;&#x2122;s Hospital in Saskatoon, I had a very difficult experience with death. A 16-yearold boy was dying of cancer, and as the intern looking after him I spent all my spare time with him and his family. When he died during a long night shift, I became very distressed with the unfairness of such a young person having to die before living the rest of what could have been a wonderful life.

in the dying process, and we had a very productive multidisciplinary group spearheaded by our chair, Dr. Susan Hayton, to work on this.

I was able to be a support for him and his family but I myself felt traumatized. A wonderful nun, whose name I have long forgotten, sat with me after the night shift and talked about the meaning of life, death, and the bad things that sometimes happen to good people. The Grey Nuns were still very much a presence at the hospital at that time and without her I am not sure I could have gotten through the rest of even the next day or weeks.

I became one of the assessors and on rare occasions also a provider. I think I assessed every single person in our health region who had an assisted death up until the end of December 2019! We travelled widely throughout Saskatchewan at first, since few health-care providers were willing to get involved with this very new process. As the only psychiatrist involved I have also been available to provide a second opinion in difficult situations, particularly when mental capacity was unclear.

Throughout that internship year I spent much time thinking about my personal and professional priorities. After working with Dr. David Keegan during an elective, I decided to make a career change from pediatrics to psychiatry and over the years this evolved into a focus on geriatric psychiatry. Assessment of capacity has been a large part of my work in the field, so when Bill C-14 passed, I was approached to be part of the Saskatoon Health Region ethics subcommittee developing the medical assistance in dying (MAID) policy. This began in advance of the anticipated release of legislation permitting physicians and nurse practitioners to assist

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The committee eventually developed a careful, holistic approach, blending legal requirements, ethics, and clinical practice; it still informs most of my approach to medical assistance in dying

I have felt very privileged to be part of the lives of many patients and their families during their journey at the end of life. People going through this are often very open to sharing their experiences, sometimes feeling a great need to talk through unresolved issues dating back to their childhoods. Sometimes difficult stories come up, such as difficult wartime experiences and exposure to very traumatic deaths. Families of patients who have chosen to go through an assisted death often contact me later, to provide an update on how their lives are going. Although death is always sad,

ALTHOUGH DEATH IS ALWAYS SAD, FAMILY MEMBERS ALMOST ALWAYS EXPRESS GREAT GRATITUDE FOR OUR INVOLVEMENT, WHETHER OR NOT THE PERSON ENDS UP CHOOSING AN ASSISTED DEATH. MANY PEOPLE ARE RELIEVED TO KNOW THEY HAVE AN OPTION...

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family members almost always express great gratitude for our involvement, whether or not the person ends up choosing an assisted death. Many people are relieved to know they have an option, and then proceed with the normal dying process, knowing that with all the paperwork completed their suffering could be ended if it becomes totally unbearable. Many challenges lie ahead for all of us in Canada with the broadening of eligibility criteria to remove reasonably foreseeable death, which will likely occur within the next few months. Eventually patients with solely mental health conditions and mature minors will also become eligible, and people will be able to indicate in advance care directives that they want to have an assisted death. All of these changes will need considerable dialogue and collaboration in developing appropriate processes to balance autonomy and vulnerability. I feel strongly that our approach to medical assistance in dying needs to be a holistic one. Initial assessments should be very careful and comprehensive, starting with exploration of the usual geriatric principles of deprescribing, discontinuation of invasive interventions which are no longer contributing meaningfully to the quality of life, consideration of symptom management including with palliative care, and lastly exploring medical assistance in dying. If we provide good, holistic care throughout a person’s lifespan I hope that most will be able to die naturally without an assisted death. However, I think there will always be people whose dying is highly traumatic and no interventions, not even perfect inpatient palliative care, can take away the immense personal distress in the dying process. This is quite clear from our regional data audits, which show us that most people who have had an assisted death have also already had palliative care. Finally, we must continue to work on strong interactive training for assessors in particular, who increasingly will have to deal with complex patients as the public becomes more aware of MAID as an option. Often we don’t know what we don’t know. All assessors should be provided opportunities to learn about the particular vulnerabilities of patients who might request an assisted death, some of whom are going through an exacerbation (which might improve eventually) of a previously stable condition, or who are not yet adapted to a new life circumstance such as a spinal cord injury. In the end, using good clinical processes and remembering that a medical decision is more than following legal recommendations, is what we all need to do in meeting the challenges of this very new part of medicine. ◆

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SMA DIGEST | FALL 2020

Physicians working with children, older adults share passion for patient care

By Greg Basky

Regina’s Dr. Abid Lodhi hadn’t originally planned to be a pediatrician. After he finished his medical training in Pakistan, he was waiting on a surgical internship spot. But after a short, chance stint caring for young patients, he was hooked. “I just liked it so much,” recalls Dr. Lodhi. “It’s quite rewarding. It changed my life from there on, when I started working with children.”

Pediatricians and geriatricians care for people at opposite ends of the age spectrum. While Saskatchewan’s Dr. Jenny Basran and Dr. Abid Lodhi took different paths to their respective specialties and have markedly different workdays, they share a common passion for meeting the care A day in the life of... needs of the patient populations they serve. Dr. Jenny Basran developed her passion for working with older adults early on in life. When she was growing up in small town Cabri, in southwest Saskatchewan, Basran’s parents ran the Chinese cafe. “I spent most of my time with ‘coffee row,’ many of whom were older adults who stopped by as many as three times a day.” The seed was planted to pursue geriatric medicine while she was an undergraduate at the University of Alberta. There she had the opportunity to help a physician who was studying confusion in older adults after orthopedic surgery.

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While Dr. Lodhi juggles some teaching as an assistant professor and administrative duties as the Saskatchewan Health Authority’s area lead for pediatrics in Regina, he spends most of his time caring for children. In a regular day at the office, Dr. Lodhi, who’s been practising pediatrics for eight years, sees 20 to 25 patients, ranging from premature babies and newborns up to 18-year-old young adults. On one “typical” day this year (before COVID-19 reached the province), he treated kids with pneumonia, asthma, ADHA, anxiety, chronic abdominal pain, and constipation; he also saw a couple of well newborns and a pair of extremely premature

babies. On call the night before, he admitted children with epilepsy, complex pneumonia, severe eczema with secondary infection, and croup.

whether that’s broadening access to electronic health information, supporting virtual care, or using analytics to make better informed decisions.

“When a child gets sick, it’s not just one person affected,” says Lodhi. “It’s at least three people. Parents are worried. Kids can’t go to daycare. Parents have to stay home to take care of things.” The goal, says Dr. Lodhi, is happy children and happy parents.

Geriatricians are experts at complexity, according to Dr. Basran. “We look at the entire individual – all their medical conditions, their medications, and the environment and supports they have. In complex situations, you need a guiding light to determine which direction to go, and in geriatrics, we are able to focus on what is important to the patient.”

Although Dr. Basran’s focus is on patients at the other end of the lifecycle, like Lodhi she, too, wears multiple hats: associate professor in geriatric medicine at the U of S College of Medicine, senior medical information officer with the Saskatchewan Health Authority (SHA), and mentor to health professionals working with seniors. While she doesn’t provide direct patient care, Basran understands the importance of her coaching role: “Since there is unlikely to be enough people with extra training in geriatrics, it is essential that we make sure the core knowledge is passed on to anyone working with older adults.” Her two days a week of clinical work is split between the Geriatric Evaluation and Management (GEM) program at Saskatoon City Hospital, and the Community Health Centre at Market Mall. Her position with the SHA, which she shares with emergency physician Dr. Vern Behl, is all about using technology to improve care –

Motivations in their work What gets Dr. Basran out of bed every morning is the belief that in some small way, she’s making things better – “whether at the individual patient level with my advice, the clinician level with my support, or the administrative level with bringing in a geriatrician lens to decision making.” Dr. Lodhi feels flattered that he’s something of a role model for his young patients. “Lots of parents have told me their kids are playing Dr. Lodhi at home.” He finds that the bond he develops with children and their parents is the most rewarding aspect of his work. “It’s not just a one-way street. If you deal with people with care, you get love and respect in return.” ◆

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IT’S NOT JUST A ONE-WAY STREET. IF YOU DEAL WITH PEOPLE WITH CARE, YOU GET LOVE AND RESPECT IN RETURN.

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TEAM PLAYERS Sports medicine physicians play essential role in health of athletes Pictured above: Dr. Cole Beavis; facing page: top, Dr. Cole Beavis; bottom, Dr. Mike Nicholls By Girard Hengen Oh for the glamourous lifestyle of a sports team doctor – the travel, the crowds, the cheering. Dr. Mike Nicholls, a Regina physician, recalls his stint as team doctor for the Canadian national wrestling squad. The team operated on a shoestring budget and on most trips abroad, the medical entourage numbered exactly one. “If we decided to send a physician, often that guy was doing taping and dealing with medical crises and sometimes even massaging or warming up the athletes. It was a real dowhat-you-can MacGyvering in a lot of situations on the fly.” No matter where he went, there were rewards, and challenges, Dr. Nicholls said. “The thing that I enjoyed the most about working with the national wrestling program was these were world-class athletes who toiled away in obscurity in Canada, but who were literally household names in some countries where wrestling is a popular sport. We’d go to places in the world where we always joked it’s not safe to drink the water, and if it’s not safe to drink the water, wrestlers will go there.” Dr. Nicholls played most sports while growing up in Regina, but was not really a master of any. He returned to Regina

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after graduating from the University of Saskatchewan’s College of Medicine, and worked in family practice and emergency. While in emergency he was asked to help the physician who covered University of Regina hockey games. It was an eye-opener. “My initial reaction when I went to a U of R game was, ‘Holy crap, somebody could get hurt here.’ I was impressed by the level of contact and how fast it is.” When the U of R’s physician moved, Dr. Nicholls worked at the university in a small family medicine clinic, and fell into sports medicine almost by accident. He started reading about sports medicine and attending conferences. He joined the Canadian Academy of Sports Exercise and Medicine (CASEM), which grants a diploma in sports medicine to physicians who complete training in the field and write a certification exam. He wrote the exam in 1998 and received his diploma. From there his experiences as a team physician snowballed – from under-18 world hockey championships in Europe to the world junior hockey championships in Moscow in 2001. He continued to work with wrestling teams at the U of R, and the national men’s and women’s teams that travelled to Europe. He was medical director for Wrestling Canada from 2005 to 2013.

Dr. Nicholls is a long-time team physician for the Regina Pats, and for four years has helped with the Saskatchewan Roughriders. He used his family practice to supplement his sports medicine work, but left family practice in 2008 to work at the RCMP Training Academy in Regina. The switch to the civil service and his growing family put an end to his international sports travels, and medical experiences that were neither planned, nor even foreseen, back in his medical school days. “I had no idea throughout my medical training that there was a world of sports medicine,” he said. “I’d always been active and I understood a fair amount. I liked MSK (musculoskeletal) medicine, I knew it was a good practice, but I never thought of it as a specialty in and of itself.” Dr. Nicholls is clinical director of a post-graduate fellowship position in Regina in which a family medicine resident takes a third year training in sports and exercise medicine. That physician then receives Certificate of Added Competency credentials. At the provincial level, the Saskatchewan Academy of Sports Medicine (SASM) has a storied history dating to its establishment in 1975. The president of SASM attends the SMA’s Representative Assembly as head of the section of Sports Medicine. The academy’s founding members were pioneers in recognizing the unique care needs of active and athletic patients, said Dr. Cole Beavis. Dr. Beavis completed medical school and an orthopedic surgery residency at the U of S, and is a faculty member in the department of surgery in Saskatoon. He has a CASEM diploma, and fellowship training in arthroscopy and sport medicine. He hopes more students pursue sports medicine as a career, as there is a shortage in Saskatchewan. The fellowship position in Regina helps, and he is hopeful a second fellowship will be established in Saskatoon.

Dr. Beavis is a team physician for Huskie Athletics and has travelled internationally on 15 occasions for Hockey Canada, Skate Canada and Wrestling Canada. He has also provided sport medicine coverage to many local events. When the Saskatchewan Rush lacrosse team came to Saskatoon, Dr. Beavis reached out as then-president of SASM and a board member of the Sports Medicine & Science Council of Saskatchewan, a diverse group involving many health disciplines. He let Rush officials know Saskatchewan had professionals with the knowledge and skills to support the team, and ended up as medical director and head team physician – a position he has enjoyed. “There’s no question the collegiality, the cohesion, and what makes a team a team – it’s a great environment to be around,” Dr. Beavis said. “I’ve been lucky enough to have worked at the highest levels internationally with various Canadian national teams that go away for two or three weeks. You come back with a spring in your step and are inspired to succeed because that’s what teams do all day. Everything L-R: Dr.do Neville Van Der Merwe, Dr. Melissa Dr. Bronwyn they is singularly focused onFillis, success. JustCarroll being around that is inspirational.” Another attraction to sports medicine is the multi-disciplinary approach to care, which would ideally happen with all patients, but doesn’t, Dr. Beavis said. Barriers don’t exist, and health professionals will discuss as a group how to get an athlete back on the court or field. This team could include physicians, health science professionals, physiotherapists, strength and conditioning experts, dieticians, sports psychologists, chiropractors, massage therapists, and others. “It would be fantastic if every patient in a hospital had all of those professionals working with a single focus to get them back, but it doesn’t always work that way.” ◆

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I’VE BEEN LUCKY ENOUGH TO HAVE WORKED AT THE HIGHEST LEVELS INTERNATIONALLY WITH VARIOUS CANADIAN NATIONAL TEAMS ... YOU COME BACK WITH A SPRING IN YOUR STEP AND ARE INSPIRED TO SUCCEED BECAUSE THAT’S WHAT TEAMS DO ALL DAY.

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PHYSICIAN turned

RESEARCHER engaging “citizen scientists” to reduce health inequities

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By Greg Basky

Digital age a game-changer for researchers

Dr. Tarun Katapally can’t think of a better tool than the nowubiquitous smartphone for engaging people of all ages in solving population health issues, whether that’s mental health problems among youth, or frailty in seniors.

Dr. Katapally hopes his work has a lasting impact on two levels. The scientist part of him would like to see researchers up their methodology game. “We need to change the way we do research in the digital age. Otherwise, you’ll get left behind.” He feels the SMART platform is a great example of what’s possible on that front. The researcher and advocate side of him hopes to minimize inequities among different populations, by addressing gaps between high and

“What does everyone have these days? Everyone has a smartphone. It’s an incredible tool to reach out to people, and it provides a voice to even the most vulnerable populations,” says Dr. Katapally, a population health researcher and associate professor at the Johnson Shoyama Graduate School of Public Policy, University of Regina. ”We are able to engage participants in near-real time across the world using this platform (SMART). They are our citizen scientists. They are equal partners. We share our data with them and we cocreate the knowledge with them.” Through the SMART platform developed by Dr. Katapally, research participants enter information – the level of stress or anxiety they’re experiencing for example, or a barrier they’ve encountered in trying to be physically active – into a custom designed app on their smartphone. Besides collecting data, that same platform can, in response, also deliver behavioural interventions or connect citizens to health-care services. SMART is the underpinning or infrastructure for the Digital Epidemiology and Population Health Laboratory, DEPtH lab for short, that Dr. Katapally established in 2017. Dr. Katapally describes his novel research as working upstream from health-care delivery in order to inform policy – across human services, not just health – that can prevent people from going to hospital. “Most of my work is related to the health of populations and I use technology and advanced methodological tools to prevent people from getting sick,” says Dr. Katapally, who in March 2019 received a Patient-Oriented Research Leadership Grant from the Saskatchewan Health Research Foundation and the Saskatchewan Centre for Patient-Oriented Research. “So what that does is it improves the quality of life of populations, and also minimizes the economic burden downstream.”

Shifting gears from clinician to researcher Dr. Katapally, who practised emergency medicine for three years, says his lane change from clinician to researcher happened organically. Although he didn’t recognize it at the time, he sees now that he needed the “creative space” he didn’t find as a physician. “I guess that’s what brought me to the research area where I’m actually able to use my creativity to think laterally almost every day. I needed the freedom to create something rather than, shall we say, be deskbound, or even hospital- or clinic-bound.”

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I GUESS THAT’S WHAT BROUGHT ME TO THE RESEARCH AREA WHERE I’M ACTUALLY ABLE TO USE MY CREATIVITY TO THINK LATERALLY ALMOST EVERY DAY. I NEEDED THE FREEDOM TO CREATE SOMETHING RATHER THAN, SHALL WE SAY, BE DESKBOUND, OR EVEN HOSPITAL- OR CLINIC-BOUND.

low income populations. “For example, the work we do with Indigenous communities and youth is looking at how we can reduce the gaps that exist between Indigenous youth in rural and remote areas and urban youth – whether it’s mental health, physical activity, or addictions. That’s the kind of work I’m most interested in.” ◆

Related Links SMART Platform: www.smartstudysask.com Digital Epidemiology and Population Health Laboratory: www.schoolofpublicpolicy.sk.ca/csip/research-labs/DEPtHLaboratory.php#Vision

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ABOARD A MERCY SHIP Saskatoon anesthesiologist helping change lives as volunteer on stateof-the-art hospital ship

By Greg Basky For Dr. Gary Morris, the opportunity to make a dramatic difference in the lives of the patients he sees on the other side of the world is what keeps him coming back to West Africa as a volunteer with Mercy Ships. The Saskatoon anesthesiologist recently returned from his ninth volunteer stint with the humanitarian organization, which uses state of the art hospital ships to provide free world-class care to some of the world’s most underprivileged nations. Dr. Morris first signed on years ago because he was drawn to the Mercy Ships model: Pull into port on a ship outfitted with the latest medical equipment, stocked with medication, and staffed with a full complement of medical professionals – then stay there long enough to see all your patients right through their recovery and rehabilitation. Many of the procedures medical staff offer to local residents – such as cleft lip and palate repair, or reconstructive plastic surgery for maxillofacial tumors and pediatric orthopedic deformities – are not available in the countries Mercy Ships visit. The impact of this work can be life changing, according to Dr. Morris, whose tours of duty are usually two weeks long. For example, because of traditional beliefs in some places, children born with a cleft lip are thought to have a spiritual force on them. Child and mother might be banished from their community with no support. “But they come in, have their 45-minute surgery, spend about four days recovering on the ship and remarkably they are now accepted and welcomed back to their community.”

Similarly, cataract surgery – now a pretty routine 15-minute procedure – is common for people living in the developed world. “But for someone who can’t function at the market and needs to be led around by a grandchild, this simple procedure changes their life. Not only is their sight restored but so is their status and impact in the community. You should feel that way about everything you do, but there you really get the impression that you’re making a difference for the people you serve.”

Everyone on board contributes to care Because Mercy Ships vessels are docked for up to 10 months at a time, patients’ procedures can be scheduled to allow for staged surgical reconstructive procedures or for several months of physiotherapy prior to discharge. Careful patient selection, combined with site-appropriate surgical procedures and meticulous post-op care, yield excellent results. The Africa Mercy can accommodate up to 100 patients, with another 400 staff – including medical volunteers – plus all of the crew required to run a ship such as captain and engineers, electricians, food services, and housekeeping. Africa Mercy drops anchor in late August or early September – often in West Africa – then sets sail again in late May or early June. After all of the patients have been discharged, the vessel charts a course for the Canary Islands, where over several weeks it is refitted for the journey to the next port. Everyone who works aboard Mercy Ships sea-going surgery facilities – medical staff, captain and crew, housekeeping, Halima Mela food services – is a volunteer. That creates a pretty special

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atmosphere, says Dr. Morris, because it levels the playing field. “Everybody sees their position as helping provide care for the patients who come in” – whether that’s doing dishes, or preparing meals, keeping the ships electrical systems working, or performing surgery. “Everyone feels like they’re really contributing. Without each team member doing their part, patients would not receive surgery.”

Team World The medical teams are truly international in composition. There can be people from as many as 30 countries aboard, many for whom English is not their first language. “It’s surprising that you can mix these people all together for a short term, perform complex surgical procedures and still get excellent outcomes.” It’s fascinating, Dr. Morris says, to compare notes with providers from other countries about the structure and function of their health systems. “It’s interesting to get that global perspective. I regularly pick up some ideas about different techniques used abroad that we can bring back here to try.” These teams work shoulder to shoulder with surgeons from the local medical community who come aboard. “It’s great to see them working alongside us and have the sense that they feel very welcomed and understand that we don’t see ourselves as having all the answers but rather that we are colleagues, working together,” says Dr. Morris. “We can sometimes learn unique things about patients who are

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coming (to be treated). They can perhaps learn some new skills to take back to their practice. It builds a bit of a relationship and we’re trying to be supportive of the local community.”

More alike than different The only paid staff are the “day workers,” local people who are hired as ward translators, porters, deck hands, engine room, kitchen, and laundry workers. Each Sunday, several of these workers are invited to bring their families on board to join the crew for a meal, followed by a tour of the ship and a brief reception. Dr. Morris says that, although local people may be challenged financially, there is much they can teach volunteers about family, celebration, community, resilience, faith – and the joy of music. “You often think things are so different if you go to Africa, or to some other developing nation. But I’ve been impressed with how similar people are,” says Dr. Morris. “Even though you come from worlds apart and don’t understand the language, you find yourself sitting at a table, sharing a meal, sharing stories, celebrating life as you are welcomed as a part of their family, even if just for a short time. Although economic circumstances are very different, so many of the really important things are remarkably similar.” ◆ Mercy Ships website: mercyships.ca

EVEN THOUGH YOU COME FROM WORLDS APART AND DON’T UNDERSTAND THE LANGUAGE, YOU FIND YOURSELF SITTING AT A TABLE, SHARING A MEAL, SHARING STORIES, CELEBRATING LIFE AS YOU ARE WELCOMED AS A PART OF THEIR FAMILY, EVEN IF JUST FOR A SHORT TIME.

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THE CALL OF THE NORTH By Greg Basky

A pediatrician who cared for Dr. Veronica McKinney when she was a child first planted the seed that she could become a doctor. He had three boys, while Dr. McKinney was one of three girls in her family. “He would say, ‘Maybe we should just do a switch. You could be a doctor’s daughter and maybe you could become a doctor.’ I think even just that little idea (can have a big impact), to keep thinking about these things and keep dreaming.” Today, some 46 years later, she is a Saskatchewaneducated physician and director of Northern Medical Services – a tripartite organization involving the provincial Ministry of Health, Health Canada, and the College of Medicine, University of Saskatchewan. It is responsible for “the medical side of health” in the northern half of the province, explains Dr. McKinney, where the population is more than 85 per cent Indigenous – a percentage she notes is “higher than in the Yukon, the Northwest Territories ... even Nunavut.”

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I BELIEVE I WAS LED HERE SPECIFICALLY TO USE MY UNIQUE TALENTS, KNOWLEDGE AND SKILLS TO THE FULLEST, TO ADVOCATE AND WORK WITH OUR COMMUNITIES, TO TEACH OTHERS, AND TO WALK THE SPACE BETWEEN OUR INDIGENOUS WAYS AND THE WESTERN WORLD.

Dr. McKinney is working on a variety of different fronts – to increase access to care for people living in the north, conduct research that is directed by local communities, build greater cultural sensitivity and awareness among medical students and residents, and encourage Indigenous high school students to pursue medicine through mentoring.

communities. She believes her clinical knowledge equips her to better support and advocate for the care of individuals, families, and communities. She supports northern communities by “ensuring that the Indigenous perspectives of health are honored and acknowledged” within the organizations that she works.

Dr. McKinney began her medical career at the University of Saskatchewan’s College Of Medicine in 1998, after which she worked in emergency medicine in Saskatoon and La Ronge, then moved to B.C., where she continued clinical practice, spent time with an international air ambulance program, and served as site director for an aboriginal residency program at UBC’s College of Medicine.

A calling to serve the north

This experience prepared her well for the leadership of Northern Medical Services. She returned to Saskatchewan in 2011 to take the job because she felt she could have a bigger impact on the health of Indigenous communities if she had a seat at tables where issues such as access and equity were being discussed. “I enjoyed what I was doing, but could see that there were more opportunities to really have some say in what’s being done and how it’s being done,” says Dr. McKinney, whose family is from the North Battleford area and has ties to both the Waterhen Lake First Nation and Sweetgrass First Nation. “I was really feeling stymied and not really having a voice, and saw a lot of people speaking at tables around these things that didn’t have the background.” Dr. McKinney feels her unique knowledge and experience enables her to have a strong relationship with Indigenous

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All of the different roles she plays – drawing attention to inequities, providing a perspective that’s different from the mainstream, and advocating on behalf of Indigenous people living in communities served by Northern Medical Services – contribute to achieving the overarching goal of equitable health for all, according to Dr. McKinney. She says her traditional Indigenous ways call her to make things better for people living in the north, to contribute and help where she can. “I believe I was led here specifically to use my unique talents, knowledge and skills to the fullest, to advocate and work with our communities, to teach others, and to walk the space between our Indigenous ways and the western world,” says Dr. McKinney, who still practises Tuesday and Thursday mornings at Saskatoon’s Westside Community Clinic. “Both are changing and part of my job is to find that middle ground so that health can be experienced by all. It is a tough place to be, but I feel that I am contributing in a meaningful and unique way, especially to our Indigenous communities. This is at the heart of why I am here.” ◆

Brenda Senger, Director, Physician Support Programs

PATIENT’S MEDICAL HOME Drs. Ginger Ruddy and Sarah Bates discuss the Patient’s Medical Home vision for Saskatchewan and the impact of COVID-19.

The SMA recently spoke with Dr. Ginger Ruddy and Dr. Sarah Bates to discuss how the first few months of the COVID-19 pandemic have impacted primary care in Saskatchewan, the robustness of the Patient’s Medical Home (PMH) vision during a pandemic, and the opportunities to advance the PMH model in Saskatchewan. Dr. Ruddy is an assistant professor, Academic Family Medicine and chair of the Saskatchewan College of Family Physicians’ Patient’s Medical Home Committee. Dr. Bates is a family physician and assistant professor, undergraduate director, Academic Family Medicine. Drs. Ruddy and Bates have provided care following the PMH model in other jurisdictions.

The Canadian Medical Association and the College of Family Physicians of Canada heartily endorse the Patient’s Medical Home (PMH) as the future of family medicine in Canada. The PMH is a family practice considered by its patients to be the place they feel most comfortable presenting and discussing their personal and family health and medical concerns. When the PMH vision is fully realized, every family practice will offer the medical care that Canadians want – readily accessible, centred on patients’ needs, provided throughout every stage of life, and seamlessly integrated with other services in the health-care system and the community. The COVID-19 pandemic has, out of necessity, created an environment ripe for advancing many facets of the PMH model: improved access, continuity, connected care, teambased care, funding to support system change and, most critically, patient-centeredness.

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Even though virtual visits have allowed patients to remotely access their family physicians, many physician offices are experiencing significant reductions in the volumes of activity. The College of Family Physicians of Canada has called on policy makers to shift to Blended Remuneration Models post-COVID because of these challenges. The recent, temporary Pandemic Physicians Services Agreement (PPSA) negotiated between the SHA and the SMA allowed physicians to move into a contractual agreement with the SHA and enabled continued viability for many family practices and ensure an available medical workforce in the event of pandemic surges. While the PPSA may not have been perfect, it offered flexibility and demonstrated a willingness for policy makers to explore alternate, permanent Blended Payment Models in the province – a mechanism shown to achieve better health outcomes.

Q: The pandemic quickly changed how physicians provide care. Can you discuss some of these changes and how they are advancing the PMH model? Dr. Ruddy: Unfortunately primary care in Saskatchewan has

evolved little over the past decade. Patients’ access to family physicians and primary health-care teams was still mainly through face-to-face visits, resulting in potentially long wait times. Lack of access to a consistent family physician has often resulted in patients seeking episodic care, which sacrifices the benefits of continuity of care. The lack of any meaningful investment in primary care – including alternate payment models – has inhibited physicians’ ability to provide team-based, patient-partnered care. In these early days of the pandemic, citizens of Saskatchewan worked together to flatten the curve, and those working in the health system – front line health-care workers, administrators and policy makers, adapted rapidly to respond to these known gaps in our primary care system. It is remarkable the breadth and pace of innovation that has taken place in such a short period of time and how aligned these efforts are with the PMH vision for primary care. Within weeks, virtual care codes were made available to help ensure safe, accessible care for patients and safe work environments for physicians and their colleagues. This is a key aspect of the Patient’s Medical Home – that is, using technology to deliver timely, accessible care virtually. Many know that virtual care discussions and negotiations have been taking place for some time now, but in a matter of days, policy was created to respond to ensure accessible, safe care. Are these codes sufficient? No – but they’re a good start.

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The reduction of patient visit volumes has also resulted in the opportunity for a number of physicians to offer patients same day or day of choice appointments (also known as Open Access Scheduling or Advanced Access Scheduling) as the backlog of appointments has presently disappeared. Access is a pillar of the PMH and with the significant shift to virtual visits, many Saskatchewan patients are experiencing improved access to their family physician.

Q: Looking forward to a post-pandemic world, where might the PMH concept be positioned? Will the concept possibly become reality sooner rather than later? Dr. Bates: The COVID-19 pandemic, while highlighting many of the cracks in our health-care system, has also forced a spotlight onto primary care. It has also illuminated some of the limitations in the way most primary care is delivered in Saskatchewan. Out of necessity, the pandemic has created an urgent need for physicians to manage the health needs of their patients in other ways. Many physicians, and other members of the health-care team, have risen to the challenge. Ultimately, COVID-19 is revealing the power of a unified vision in the health system. It continues to show the necessity of stakeholder collaboration and commitment in achieving success. Working together, physicians and others are adapting to an extreme environment and putting patient needs ahead of all else. This is exactly what the PMH strives to do: create a primary care system with the patient at the center. Transformation of Saskatchewan’s primary care system requires many things from all stakeholders: trust, financial investment, and a certain amount of risk tolerance. Our experience to date with COVID-19 has provided a foundation for creating a stronger relationship among physicians, the Ministry of Health, and the SHA. We are working well together

because of a clear, common purpose: safe, accessible care for the citizens of Saskatchewan in a time of crisis. Further, the financial flexibility from the government demonstrated two things: the need for seed money to support system change and the ability of physicians to be good stewards of those funds. Finally (and without 12 months of painful calculations or pilot projects) there was a willingness to jump off the cliff together. PMH in Saskatchewan needs these elements to move forward. The COVID-19 pandemic experience is demonstrating that health system stakeholders do indeed possess the necessary qualities: trust, flexibility, ingenuity, and a penchant for “cliff jumping.” Overall, the pandemic has highlighted the value of the PMH. It has emphasized the need to progress toward this model. The resultant cooperation and commitment of the various stakeholders has provided a solid foundation for improvement and innovation. Ultimately, whether PMH becomes a reality for Saskatchewan citizens depends on how unified physicians and the SMA, the Ministry of Health and SHA are in working toward it.

All Saskatchewan family physicians should take stock of how their practice aligns with the Patient’s Medical Home vision by completing the self-assessment tool and sharing results with the Saskatchewan College of Family Physicians. The College will be using the data collected to advocate for the allocation of more resources to physician practices. Physicians will be reimbursed for time spent completing the tool. Self-assessment tool: https://patientsmedicalhome.ca/self-assess/ PMH reimbursement link: www.surveymonkey.com/r/58FCTCL)

The stage is set. The players know their roles. Now it’s time to act ... Action! ◆

Family Physicians Evergreen Medical Clinic in Saskatoon is seeking family physicians to join our team in our new purpose-built medical clinic. Located at beautiful Evergreen Square in the Evergreen community in Saskatoon, the clinic has in-house laboratory, X-ray, and ultrasound units, as well as a pharmacy. It is a paper-light clinic with offices and examination rooms equipped with networked computers for EMR use. We will provide the staff and equipment for you to work as much or as little as you would like. We have booked appointments and walk-in appointments as well as a minor injury clinic. We have well-equipped treatment rooms and consulting rooms. Our extended hours will make it possible for our doctors to have more opportunities to work if they so desire. We have a competitive expense split ratio of 75/25 for locum doctors and 80/20 for full-time doctors.

To set up time to discuss the opportunities available, please call Dr. George Tuwor at 306-331-0245 or email your CV to gtuwor@evergreenmedicalclinic.ca. SMA DIGEST | FALL 2020

FROM BEDSIDE TO BOARDROOM Physicians accept leadership positions to enact positive change for Sask. MDs

Pictured above: Dr. PJ Vertue; facing page: Dr. Lyle Williams By Girard Hengen After a particularly challenging day, Dr. Lyle Williams wonders why he ever agreed to serve as a chief of staff with the Saskatchewan Health Authority (SHA). Dr. Williams, a family physician from Unity, had been senior medical officer (SMO) for the former Heartland Health Region since 2014 after serving as deputy SMO. It’s not like he didn’t know what he was getting into. “There are definitely days when you ask yourself, ‘Why? Is this really the direction that I want to go?’ ” Dr. Williams told the SMA. “But there are days when it is rewarding to see improvement in the system.” Dr. Williams is passionate about rural medicine – as evidenced by his now 12-year tenure in Unity – and improving emergency care. From his position of chief of staff, northwest, for the SHA, he has a role in managing change. “Through a lot of work in Heartland, we were able to improve the ER sites. A lot of my push in the future will be trying to ensure that our rural ER sites provide as good care as possible,” he said. “I definitely found that being able to enact those changes is very rewarding, as well as seeing the improvement that we’ve had at those sites.”

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Dr. Williams was born in South Africa, raised in Botswana, and returned to South Africa for medical training. While in school he dabbled in student leadership, but it wasn’t until he was established in Unity that he became a physician leader within the former Heartland region. He initially said “no” when approached by co-chief of staff, Dr. Melissa McGee, to look at sharing the role for the SHA’s northwest region. The fact that duties were shared was a benefit. “There was also an opportunity to be a part of something new and different and to be able to watch it develop,” he said. “That was one of the big pulls to apply for the role.” *** Dr. PJ Vertue didn’t go looking for an administrative position with the SHA, but he’s glad it found him. Dr. Vertue, an emergency room physician in Moose Jaw for 12 years, was head of emergency services for two years, in 2011-13, under the former administrative structure. In that time, he came to understand the importance of physicians assuming leadership positions, if not for personal satisfaction, then for the good of the profession as a whole. “From previous experience, I noticed from the low number of physicians who take leadership positions that if you don’t, things will be done for you and perhaps not in a way you’d like,” he said.

Dr. Vertue, who received his medical degree in South Africa, is certified in emergency medicine by the Canadian College of Family Physicians. He wasn’t seeking new opportunities when he was approached to take on the job as area chief of staff, southwest, for the SHA, which is one-day FTE. “I recognized the need for it and so I agreed to slip into this role,” he said. The change has been made easier because he shares the workload – which he says amounts to more than one day FTE – with two other Saskatchewan physicians, Dr. Hein de Klerk, the senior chief of staff, and Dr. Ivo Radevski, a third chief of staff for the southwest area. Dr. Vertue says the opportunity was too great to pass up. “The longer I’ve been working in medicine in general I just see so many of the issues that we’re dealing with is because of the lack of physician leadership in the medical community,” he said. Having physicians within the leadership structure of the SHA is invaluable, he said. “For the first time in a long time the average physician on the street probably has a little bit more faith in what we’re doing just because they know there’s at least a physician sitting at the table, and they’re not just rubber-stamping decisions.”

*** Drs. Vertue and Williams both believe physicians need to learn leadership skills early on – while they are still students in medical school. “I wish there was more emphasis on this sort of stuff at the college level, at the university level, where we need to make sure physicians are equipped to lead from the get-go, not have to do a course when a position is thrust upon them after the fact,” Dr. Vertue said. Dr. Williams notes in the recent past physicians were not regarded as an integral part of the health-care system. They were cast as separate and apart, but that is changing. “As physicians are more embedded in multiple layers throughout the health-care system, and bringing about changes, we will have better patient outcomes,” said Dr. Williams. “That, I think, will be not just what a physician would want to do as a career path, but is something that every physician should have as an integral part of their training – that they can enact change at whatever layer they might find themselves at, whether that is the CEO of the whole SHA or working in a clinic with three or four physicians. Leadership comes about through all of those layers.” ◆

“

AS PHYSICIANS ARE MORE EMBEDDED IN MULTIPLE LAYERS THROUGHOUT THE HEALTH-CARE SYSTEM, AND BRINGING ABOUT CHANGES, WE WILL HAVE BETTER PATIENT OUTCOMES.

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Political advocacy enables medical students to stand in solidarity with the patients and communities they serve By Jessica Froehlich, Class of 2022 Advocacy has a long tradition in medicine. German physician Rudolph Virchow, widely regarded as the founder of social medicine, talked about how “physicians are the natural attorneys of the poor” and “politics is nothing else but medicine on a larger scale.” The privilege of being with patients through their times of struggle and sorrow, while bearing witness to their courageous stories, is one we can never take for granted. And when we learn of the health inequities our patients experience, it is our duty to stand beside them and to act in the face of injustice. I went into medical school wanting to learn as much as I could about socially responsive care and to make a meaningful difference in my community. I was naturally drawn to work based in community engagement and soon found myself being inspired and mentored by like-minded individuals. In my first year of medical school, I joined my peers in advocating for universal coverage for the medical abortion pill, Mifegymiso, which the Saskatchewan government agreed to begin paying for in June 2019. At that time, Saskatchewan was one of only two provinces that didn’t provide universal coverage, leaving few options for people in need of this time-sensitive service. As part of this campaign, we gathered stories and support from physicians, community organizations, and individuals with personal experiences. They told of the barriers people with uteruses are forced to overcome and the impossible decisions they have to make to access basic reproductive health care. These were not stories of distress, but of resourcefulness and resilience.

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This was one of the most meaningful experiences I’ve had as a medical student. I was able to see the necessity of working with governments to improve health equity through education and policy changes, as well as the need to increase discussion around sexual and reproductive health to challenge the stigma often associated with it. Last fall the Saskatchewan Medical Association voted unanimously to support the call for no-cost contraception, after the issue was brought forward by Dr. Christine Lett, an obstetrician and gynecologist in Regina. Around the same time, I started working with a group of 12 amazing medical students from across the country to conduct research and consultations with expert stakeholders on the need for universal access to contraception, as part of the Canadian Federation of Medical Students Day of Action. We shared our results with more than 70 medical students and met with parliamentarians in Ottawa to call attention to the issue. We engaged in conversations about how access to contraception is a human right which empowers people, improves health outcomes, and leads to significant cost savings. The most significant barrier to accessing contraception is cost, especially for the more efficacious forms such as the hormonal IUD, which is upwards of $350. Unintended pregnancies cost Canada more than $320 million annually through deliveries and terminations alone. This could be decreased by $35 million if just 10% more people had access to intrauterine devices1. Furthermore, other countries have shown overall health system savings of seven dollars for every dollar spent on contraception2.

As part of this project, our group also discussed how misconceptions about contraception and stigmatization of reproductive health are a large part of the problem3. Lastly, we discussed the need for ‘task-shifting’ to improve patients’ access to providers of contraception, which is recommended by world leaders such as the Society of Obstetricians and Gynecologists of Canada4 and the World Health Organization5. We echoed the calls of many individuals and organizations who have been dedicated to this cause for years and have worked to raise awareness of how no-cost contraception will benefit us all. Since the Day of Action, I have had the opportunity to continue this work provincially alongside Dr. Lett and Dr. Tin Yen, who have been amazing supports and mentors. I’ve met students, physicians, researchers, and community workers who are dedicated to improving health equity and who inspire me to imagine a world where access to care is not determined by where we live or our ability to pay. I cannot imagine learning medicine without also learning the many ways to stand in solidarity with the communities we serve. Political advocacy is but one. When medical

professionals apply their clinical knowledge and front-line experience to societal advocacy, it can be very powerful. As medical students we have a unique perspective, and our active involvement in politics is one of the most effective ways we can improve the health of our patients. ◆ 1.

Black AY, et al. Unintended Pregnancies in Canada: Estimating Direct Cost, Role of Imperfect Adherence, and the Potential Impact of Increased Use of Long-Acting Reversible Contraceptives. Journal of Obstetrics and Gynaecology Canada. 2015;37(12):1086-97.

Frost JJ, et al. Return on investment: a fuller assessment of the benefits and cost savings of the US publicly funded family planning program. Milbank Quarterly. 2014;92(4):696–749.

Howatt K, et al. Improving Physician Knowledge: A Necessary but Not Sufficient Requirement of Improving Intrauterine Contraception Access in Canada. Journal of Obstetrics and Gynaecology Canada. 2019;41(8):1115-24.

Black et al. Canadian Contraception Consensus (Part 1 of 4) Contraception in Canada. Journal of Obstetrics and Gynaecology Canada. 2015;37(10): 936-8.

World Health Organization. Task sharing to improve access to Family Planning/Contraception. 2017.

Join Greens Medical Clinic Greens Medical Clinic is conveniently located in the most vibrant and fastest growing community in Regina. Space is available immediately. Services and support. • In-house lab, EKG, and spirometry, vaccinations, mental health counselling • Minor surgical procedures • Excellent support staff. • Client billing and clerical support • EMR ( Accuro) (almost exclusively paperless via EMR) • Fully equipped treatment room/nursing station • Medical equipment and modern furnishing - phone, computers and printer in every exam room.

• • • • • •

Pharmacy next door, two other within 250 m distance Training and meeting room facilities available Office equipment and medical supplies. Very welcoming and beautiful ultra modern facility Public transit stop Free parking for patients and staff and accessibility parking at the front entrance.

Flexible terms & very competitive cost sharing or flat amount. Fee depends on space and services required. You’re guaranteed a perfect space and exceptional support services.

Please contact Dr. Fowora if interested at 306-522-1515.

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Celebrat ing our staff

From programs, funds and events that support your health, education and professional life, to the EMR system in your office, to the leadership that is guiding the organization through COVID-19 and spearheading programs to help support you during this time – dedicated SMA staff are at the heart of it all. This year we celebrate three SMA team members – two of whom have dedicated the last five years, and one, the last 50 years – to serving Saskatchewan’s physicians. A full celebration of who they are and what they have done for the profession will follow in the upcoming spring 2021 issue of the SMA Digest.

Ed Hobday | 50 years Administrative Director

Bonnie Brossart | 5 years Chief Executive Officer

COURSES CONFERENCES CONTINUOUS INTAKE CHOOSING WISELY https://cmelearning.usask.ca PAIN & THERAPEUTICS https://cmelearning.usask.ca CLINICAL IMAGING https://cmelearning.usask.ca

OCTOBER CME WEBINAR SERIES Monthly themes | October 2020 to March 2021: October - Pediatrics, November - Older Adults, December Choosing Wisely, January - Heart & Stroke, February - Obstetrics, March – Surgery https://cmelearning.usask.ca THE ROLE OF PRACTITIONERS IN INDIGENOUS WELLNESS Oct. 15, 2020 | Online Course https://cmelearning.usask.ca BUILDING AN AWARENESS OF CULTURAL HUMILITY October 15-December 15, 2020 | Online Course https://cmelearning.usask.ca PAIN & THERAPEUTICS – VIRTUAL CONFERENCE Oct. 24, 2020 | Webex https://cmelearning.usask.ca SMA REPRESENTATIVE ASSEMBLY (RA) Oct. 30, 2020 – Virtual www.sma.sk.ca/utility/32/representative-assembly.html

Charlene Koch | 5 years Practice Advisor Saskatchewan EMR Program

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NOVEMBER EMERGENCY MEDICINE – VIRTUAL CONFERENCE Nov 20-21, 2020 | Webex https://cmelearning.usask.ca

CLASSIFIEDS ANNOUNCEMENTS SEEKING SPECIALISTS

Saskatoon, Sask.

Located in the beautiful Evergreen Square in Saskatoon, this clinic has ample space and is now welcoming specialist physicians. The building is 8,000 square feet and has an inhouse X-ray, laboratory, ultrasound and pharmacy. There are two reception areas and two conference rooms. Individual specialists and groups of specialists are welcome to tour our facility. Kindly contact Dr. George Tuwor at 306-331-0245 and by email at gtuwor@evergreenmedicalclinic.ca.

LAKESIDE MEDICAL CLINIC SEEKS FAMILY PHYSICIANS

Saskatoon, Sask.

Lakeside Medical Clinic is looking for full-time, part-time and locum family physicians. Joining a large physician group, you will have the opportunity to build your practice in the new 24,000 square foot Family Medical department. Featuring 32 physician offices, 68 exam rooms and two procedure rooms, the Family Medicine Dept. is located on the 3rd and 4th floors of Lakeside Centre, a purpose-built medical building located on the east side of Saskatoon. Additionally, there is a 10 exam room, Urgent Care facility located on the main floor, separate from the family practice. The 70,000 square foot Lakeside Centre complex includes a pharmacy, medical imaging, physio, a dental group, an optometrist office and medical specialists.

DR. M. M. ABED RETIRES Dr. M. M. Abed joined the Medical Health Community over 50 years ago as a gynecologist and obstetrician. In addition, he holds the position of clinical professor of OBGYN for the University of Saskatchewan. Dr. Abed was one of the original pioneers of establishing colposcopy in the Regina medical community. Along with his vast knowledge and experience, he was also recognized as a highly regarded surgeon in his field. He enjoys all aspects of medical care and is well known as a caring obstetrician delivering over half a century of second and third generation babies. Dr. Abed has been a long time supporter in his community as well as a participant of both the Regina General and Pasqua Hospitals. With mixed emotions he announces his retirement from clinical practice, effective June 30, 2020. This decision has not been made lightly, as he has enjoyed all aspects of his vast medical career along with sharing his wealth of experience for his beloved Regina community.

Interested physicians must be fully licensed to practice in Saskatchewan. For more information and a photo gallery on Lakeside Medical Clinic, please check our website at www.lakeside.ca. Submit your CV to Dr. Conrad Veikle, physician recruiting partner, by email at jobs@lakeside.ca.

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IN MEMORIAM DR. KING HIM CHAN 1945 -2019

GONE FISHING FOREVER It is with profound sadness that we announce the passing of King, our beloved brother, on August 16, 2019. King was born in China, raised in Hong Kong, and went to medical school in Taiwan. He completed his internship in Winnipeg, MB and held his residency in Hamilton, ON and Saskatoon. King became a physician/surgeon in Saskatchewan in 1978 and a fellow of the American College of Obstetricians and Gynecologists in 1981. He moved to Moose Jaw in 1979/1980 as a baby/women’s health doctor until his retirement in 2007. He loved his work and made Moose Jaw his home for the friendly people, the beautiful nature, and the tranquil life style. Besides his hard work and long hours, he enjoyed fishing, travelling, cooking, photography and hosting parties for friends. Thank you to the medical team and staff at the Dr. F. H. Wigmore Regional Hospital for making the last months of his life as bearable and comfortable as possible. Special thanks to Drs. Rininsland, Majid, Miller, Cheddie, and all of the nurses who provided exemplary care to him. Thanks to his friends for many visits, prayers and cards. The funeral service was held on August 23, 2019 at Moose Jaw Funeral Home. Flowers are gratefully declined. If desired, donations in King’s name may be made to the Moose Jaw Health Foundation or to a charity of one’s choice.

DR. LESLIE RAYMOND CHASMAR MD, CM, FRCSC 1924-2019

After a long, productive and adventurous life, Dr. Leslie R. Chasmar passed away peacefully at his home in West Vancouver on September 9, 2019 at age 95. Possessing almost limitless energy and enthusiasm, Les had a zest for life and

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learning – a quality that he brought to both his personal and professional life. Born in Saskatoon, Saskatchewan in 1924 and raised in Hanley, Les went to work at age 14 to help support the family after his father passed away. It was during these years that he first learned to work with his hands as an auto mechanic, theatre projectionist and bank teller, developing his entrepreneurial instinct along the way. In 1942, he enlisted in the Royal Canadian Air Force and served as a flight instructor at Fort Macleod and Calgary until his discharge after the war. He subsequently completed premed studies at the University of Saskatchewan and medical school at McGill University. He originally intended to go into general practice, but a stint in burn research at the Toronto Hospital for Sick Children inspired him to pursue plastic surgery. Les completed his general surgery and plastic surgery training in Montreal and Toronto and, in 1956, graduated from the Plastic and Reconstructive Surgery Division of the University of Toronto. In 1957, Les was appointed head of the plastic surgery division at the University of Saskatchewan. This was the beginning of his remarkable 52-year career where he proved himself an outstanding surgeon and a true ambassador for the profession. Colleagues described him as a meticulous and artistic innovator – a surgeon’s surgeon who taught and practised with passion, integrity, humility and an unrelenting attention to detail, focusing on his patients surgically and personally. Oft published and a recipient of numerous awards, including the Canadian Society of Plastic Surgeons’ Lifetime Achievement Award, he leaves a legacy of leadership, training, and mentorship. In 1964, Les and Dr. Chuck Knight started the first plastic surgery residency program in western Canada at University Hospital in Saskatoon. By 1992, Les had trained 17 plastic surgeons who have had successful careers, continuing his legacy of quality care and teaching future generations. With increasing demand for cosmetic surgery, Les and three colleagues established Saskatchewan’s first surgical outpatient clinic in Saskatoon. The clinic enabled medical residents to get six months of training in cosmetic surgery following their residency. The availability of new and well-trained

surgeons significantly reduced wait times in the province. Les was always happy to offer his skills freely and, with wife Pat, volunteered with CARE/Medico in Surakarta, Indonesia (1973) and Kabul, Afghanistan (1976) where Les trained the local doctors, who observed his operations, especially cleft lip/palate procedures. After retiring from teaching and surgery in 2009, aged 85, Les moved with Pat to Vancouver. Les’s personal life was as active and fulfilling as his professional career. Les married Marjorie Rennie while at McGill, and they had four children. Sadly, Marjorie died just a month after the birth of their fourth child. Later, Les married Patricia Pirie who had been a close, long-time friend of them both. They had a son and raised their children in Saskatoon. One of Les’s lifelong passions was flying – he never missed an opportunity to fly a plane, attend an air show or tour an aircraft museum. Les was also an avid tennis player, downhill skier and overall fitness aficionado. As recently as 2016, he participated for his seventh year in the annual Vancouver 10K Sun Run! For 10 years until age 92, Les organized an annual heli-hiking trip with his family in the Purcell Mountains. Les and Pat travelled extensively for medical conventions and, other times, to simply enjoy life with family and friends. Everyone who knew Les has a story of his considerate nature, his warmth, his charm, his sense of humour and his ever-positive attitude. He is survived by his wife Pat, children John (Cydnee), Ann (Michael), Hugh (Kathleen), Jean and Robert (Grace) and grandchildren Elizabeth and James; Rennie and Robbie; Katherine, Maggie and David; and Matthew. We will all miss his love, care, stories and laughter, but are grateful he was with us for so many years. In his memory, donations may be made to the Dr. Paul Sugar Palliative Care Foundation or the BC Cancer Foundation.

DR. REYNALDO CARDOSO-MEDINILLA

1945-2019

It is with great sadness we announce that Dr. Reynaldo “Rey” Cardoso-Medinilla, passed away at the Regina General Hospital (RGH) of complications from lung disease on Friday December 27, 2019, at the age of 74 years. Reynaldo was born in Mexico City on July 3, 1945 to Dr. Reynaldo Cardoso Pérez Gallardo and Guillermina Medinilla de Cardoso, followed minutes later by his twin sister “Memi.” Growing up in his family’s maternity clinic, he was motivated by his father’s influence, deciding at the early age of three that he was to pursue a similar career in obstetrics. A 1971 graduate of Mexico’s National University (UNAM) Med-

ical School, in 1969 seeking either opportunity or adventure, he accepted an internship in Canada at the RGH. It was there he met his wife Billie, and discovered an affection for Saskatchewan, its people and health care system. Following his internship, he returned to Mexico to complete his social service year then returned to Saskatchewan for a residency in Internal Medicine. In 1972, he began a residency at the University of Saskatchewan in Obstetrics and Gynecology, completing qualifications to practice his specialty in Canada, the United States and Mexico. He began his practice in Regina in 1976, followed in 1985 with a move to Vancouver to complete a two-year sub-specialty in Maternal Fetal Medicine at Grace Hospital. Declining offers elsewhere, he elected to resume his practice in Regina, returning to the community he had grown to love. He continued his practice until his retirement in December 2017, but continuing on in semi-retirement, delivering his last baby on December 11 in Estevan. During his career, he played a pivotal role in the delivery of maternal fetal medicine in Saskatchewan for patients and medical professionals alike; as a clinician, teacher, mentor and most proudly a student. His legacy will include the thousands of lives he helped bring into the world and the commitment to care he gave to all his patients. He was a driven and passionate physician whose love for medicine was only surpassed by his love for his family. Predeceased by his parents; he is survived by his wife Billie; sons Reynaldo (Candace) and David; and dearly loved grandchildren, James and Elizabeth; his sister, Guillermina “Memi” Cardoso Tello; brothers Dr. Roberto Cardoso Medinilla; and Dr. Rolando Cardoso Medinilla; of Mexico; and numerous nieces and nephews. The Cardoso family is grateful for the exemplary care provided by the Surgical Intensive Care Unit team at the RGH. Their professionalism and compassion was greatly appreciated during this difficult time. In lieu of flowers, family and friends so wishing to do so may make donations, in memoriam to the Hospitals of Regina Foundation, 1874 Scarth Street, Regina, SK, S4P 4B3.

DR. JAMES COUCILL

1945-2020

With deep sorrow we announce the passing of James on May 31, 2020, at the age of 75 years. He was predeceased by daughter Victoria, and parents Clarence and Bridget. James is lovingly remembered by his wife Erna; sons Joost (Trudy), Tim (Jody), and Nick (Dawn); grandchildren Araya, Zach, Tom, Nate, and Gemma; sister Bridget; and brothers Joseph and Gerard.

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He was born in Manchester, England, and obtained his medical degree at Edinburgh University. In 1972, he began working as a family physician in Regina and practiced medicine locally for 32 years. Following that, he worked for the Ministry of Health for 12 years as a medical consultant. James was humble, kind, devoted, and a devout man who loved singing and writing. Throughout his life, he volunteered for a variety of organizations and participated in numerous community endeavours. This dedication to service culminated in being awarded the prestigious Sovereign’s Medal for Volunteerism in 2019. Holy Mass will be celebrated at Christ the King with his immediate family. A graveside service was held at Riverside Memorial Park on June 9, 2020. Flowers are most gratefully declined. Friends so wishing may make donations to St. John Ambulance. To leave an online message of condolence, please visit James’ Tribute Page at www.speersfuneralchapel.com.

DR. MURIEL MARY EUSTACE

1929 – 2019

The family of Muriel Mary Eustace are sad to announce her passing on November 28, 2019, in Saskatoon. Left to mourn are her children; Richard (Christine), and his children, Elaine, Amanda, and Brian; John (Terri), and his children, Ashley (Kris), Ailish (Brandon), and Jessica (Neil); Susan (Ronan), and their children, Michael (Bonnie), Ronan, Nicholas, Fiona, Luke, and Julia; Ailis (Steven), and their children, Barbara, Caroline, and Daniel. Also left to mourn, are her beloved sister and brother-in-law, Dorothy and Padraig Flynn, and sisters-in-law, Margaret and Vera Eustace. Muriel also leaves behind 10 great-grandchildren and many nieces and nephews. She was predeceased by her husband, Brian Eustace, and his brothers, Johnny, Peter, and Dominic. Muriel was born on December 15, 1929, in Dublin, Ireland, to John and May Tynan. She completed her education in Dublin, cumulating in a medical degree from The Royal College of Surgeons, class of 1955. Muriel was one of only two women in her medical school class. During her time in medical school, she fell in love with Brian, another medical student from Galway University, marrying in 1955. Muriel and Brian started their married and working life in northeast England, where their four children were born and she worked as a family doctor. In 1976, they moved their family to Canada and settled in Saskatoon. Muriel continued her career as a family doctor with a special interest in addictions. She worked at both Calder Center and Larson House until she retired.

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Muriel had three great loves in life: family, horses, and skiing. Her move to Canada enabled her to live out her passion for horses. Though she had very little prior experience horse riding, she persevered and she was soon an accomplished rider, competing in equestrian events all over Saskatchewan. Despite settling in the prairies, Muriel skied avidly and made many trips to ski resorts across North America with family and friends. Muriel embraced life and will be remembered for her quick wit, intelligence and quiet determination. The family would like to thank the staff at Luther Riverside Terrace for their kind and compassionate care. In lieu of flowers, please make a donation in Muriel’s name to Inclusion Saskatchewan. A celebration of Muriel’s life took place December 6, 2019 at St. Philip Neri Church.

DR. MOHAMMAD ZULFIQUAR HUSSAIN

1940-2019

Excerpt from ‘The father of our community’: Prince Albert psychiatrist remembered as a builder by Ethan Williams, courtesy of CBC News. The province’s medical community is mourning the passing of a well-known and respected psychiatrist. Mohammad Hussain died Saturday from a heart attack after more than 40 years working in Prince Albert. He was 79. His death came as a shock to many in the community, according to Mizanur Rashid, a family physician who worked with Hussain for many years ... Rashid said Hussain’s work ethic made him stand out. “He [was] working equivalent to two-and-a-half person’s work,” he said. “He was working in the hospital, he was working in his clinic ... and at the same time he was also involved in teaching. “It’s a huge loss.” Hussain came to Prince Albert 48 years ago after a few months in Moose Jaw following his immigration from Pakistan. Prince Albert physician Stan Oleksinski worked with Hussain for more than 30 years. He said Hussain’s warmth and intelligence impressed him through the years. “He had a passion for looking after people,” Oleksinski said.

He noted that while Hussain was an adult psychiatrist, he also trained to become a child psychiatrist later in his career – something that’s rare in the profession. “That’s not easy to do later on in your life,” Oleksinski said. “He was a very bright fellow.” In addition to his work as a psychiatrist, Hussain was also a well-known member of the local Muslim community. He established the city’s first mosque – Prince Albert Masjid – and helped run it up until his death. Rizwan Ali, a mosque board member, said Hussain’s initiative gave Muslims in the city a place to freely practice their faith. “When we were having different occasions, he was standing beside us and was one of the major contributors,” said Ali. Hussain’s philanthropy extended beyond northern Saskatchewan. A few years ago, he founded a school for girls in Pakistan. The first class is now high school-aged. Zubaida Chaudhry Hussain – Mohammad’s wife of more than 50 years – is already seeing the legacy her husband has left. “It gives me happiness given that he’s left [how] he wanted to be remembered,” she said. Zubaida said she didn’t want her husband to quit doing what he loved, but advised him to slow down a bit. “He was enjoying the work,” she said. “He lived working, he moved with his work. [He was] very, very dedicated.” She takes pride in her husband’s achievements, including a lifetime achievement award he received from the Prince Albert Parkland Health Region in 2009. A memorial service was held on Sunday, Oct. 20, 2019, at 4:00 p.m. CST at the Art Hauser Centre in Prince Albert

GLEN HARLEY JONAT

1940 - 2019

It is with great sadness that we announce the passing of Glen Harley Jonat on December 19, 2019, at the Vernon Jubilee Hospital in his 80th year. He leaves to mourn his wife of almost 50 years, Maidrid Jonat, and several nieces and nephews. Glen was predeceased by his parents Rosina and Edward Jonat, and two brothers Lorne and Percy. Glen was born and raised on a mixed farm near Yorkton, Saskatchewan, where he received his elementary and high school education, after which he entered the College of

Medicine at the University of Saskatchewan in Saskatoon, graduating in 1963. His profession led him in many interesting directions while he was employed with National Health and Welfare in several European countries as well as northern Canada. In Saskatchewan he worked as a family practitioner in Biggar and Saskatoon. Glen married Maidrid Peterson, formerly of Wadena in 1970, and they would have celebrated their 50th wedding anniversary in June 2020. Ten years ago, they retired to the Okanagan, where Glen enjoyed cross country skiing, hiking and golf. Glen survived a significant health challenge five years ago, but this past December Glen experienced some issues which unfortunately were serious. After a brief stay in hospital he passed peacefully. Glen will long be remembered as a man with a strong Christian faith, an infectious sense of humour, an extensive knowledge on a variety of topics, and a gracious and gentle manner. He was a gentleman in every sense. A memorial service took place at Faith Baptist Church in Vernon, BC on February 1, 2020, at 11 a.m. In lieu of flowers kindly consider a donation to World Vision or the Kidney or Cancer Society.

WILLIAM GEOFFREY COOTE (GEOFF) LIPSETT M.D., B.Ch., B.A.O., M.R.C.G.P., D.R.C.O.G. 1943-2019

It is with sadness that the family announces the passing of Dr. Geoff Lipsett at the Royal University Hospital, Saskatoon on Thursday, October 24, 2019. A celebration of his life was held on October 30, 2019 at St. Andrew’s Presbyterian Church, North Battleford, with Rev. Kathleen Horwood officiating. Geoff is lovingly remembered by his family, wife Evelyn, son Colin (Kirsten) and grandchildren: Elliott, Isla and Freya of Edmonton, Alberta, daughter Carolyn (Mike) of Edmonton, Alberta, sister-in-law Alison Lipsett of Bedford, England and numerous nieces, nephews, and their families. He was predeceased by his parents, William and Agnes Lipsett, sister Joan Seymour and brother Ralph Lipsett. Geoff was born in Belfast, Northern Ireland on April 23, 1943. He studied medicine at Queen’s University in Belfast, and met his future wife Evelyn there. They were married in December of 1969 and moved to Canada in 1974. They were blessed with two children, Colin and Carolyn. Geoff was one to do what he thought was right, instead of what was popular. Straightforward with advice, he was well-respected for his approach with patients. A supportive husband and father, he loved cycling, cross-country skiiing, gardening and

SMA DIGEST | FALL 2020

reading. As well, Geoff enjoyed travel, including to Hawaii and to his homeland, from where he derived his signature dry sense of humour. These activities fostered a love of learning, hard work and service. Geoff was a complex man, strict while understanding and hardworking while appreciative of leisure. He enjoyed speaking of his earlier days, driving around Belfast, installing pacemakers in patients as they lay in their beds at home, and motorcycling around the country. Geoff practiced medicine in the Battlefords for 45 years and his actions and words evidenced his deep appreciation for the opportunity to serve his patients and the community. Condolences can be sent to www.eternalmemoriesfuneral. ca. Arrangements were entrusted to Robert MacKay of Battlefords Funeral Service (306-446-4200). The family would like to express their sincere appreciation for all the support during their time of loss. Thank you to Dr. Retief and the second floor nursing staff of the Battlefords’ Union Hospital, and to the medical staff at Royal University Hospital Saskatoon, fifth floor, OR, and ICU, for their kindness, care, and compassion. The family extends a special thank you to Reverend Kathleen Horwood for her friendship and service; the pallbearers; Bonnie Phillips, organist; Bob MacKay, soloist; Linda Ard, soloist; St. Andrew’s Sanctuary Choir; and the ladies of St. Andrew’s for preparing the delicious lunch. The family appreciates and extends thanks for the phone calls, emails, cards, flowers and food donations, and to Bob MacKay and the staff at the Battlefords’ Funeral Service for their guidance and professionalism.

DR. JAMES G. MONKS

1923 - 2019

Gerry died peacefully on August 21, 2019, at the age of 96. The Mass of Christian Burial was celebrated on September 20, 2019 at St. Paul’s Cathedral. Condolences for the family may be left at www.saskatoonfuneralhome.com.

DR. WILLIAM ALLAN SILVER B.A., M.Sc. (Immunology), M.D.C.M., F.R.C.S.C. 1932 – 2020

Bill passed away in his sleep with his wife at his side after a struggle with pancreatic cancer. He was predeceased by his parents Harold and Mary Belle Silver (nee Watson), his brother Ray (Eleanor) Silver, his sister Estelle (John) Cobbe and his sons Allan and David. Bill leaves to mourn, his wife, Dr. Hilary Ryan, first wife Eunice Silver, their children Andrew (Kim) Silver, Karen Stewart and numerous grandchildren, great-grandchildren, nieces and nephews.

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Bill was born in Oxbow, SK and lived in many places in Saskatchewan. His initial education was from his mother, a teacher in several one-room schools in the 1930s and 40s. Bill attended Luther High School and College in Regina and moved to Saskatoon to start medical school. He married his first wife, Eunice Black, completed his M.D. in 1956 in McGill in Montreal and started a family. He interned in Tacoma, Washington, returned to Saskatoon for a second year of internship before working as a general practitioner in Porcupine Plain for 5½ years. Bill got his pilot’s licence while there. Returning to Saskatoon he completed an orthopaedic residency earning his fellowship in 1967. He was on the teaching staff at University Hospital for 21 years. After a divorce, he married Hilary Ryan in 1988, moved to Regina and took up private practice for 10 years before becoming an O.R. assistant until November 2019. Bill served the SMA for many years and participated in other medical committees. He had many sporting interests including traveling with Canadian junior soccer teams to many countries, competing in triathlons (swimming, biking and running) achieving the great success of finishing the Canadian IRONMAN in 2002 at age 69, representing Canada in many international Olympic distance triathlons and making firm friends with others in his age group. He was awarded the “Survivor of the Year” by the Stony Plain Great White North triathlon when he was able to return from two broken ankles and complete a race within a year. Bill ran several marathons, lastly finishing the Queen City Marathon in 2016 at nearly 84 years of age and doing the Regina Police Half Marathon the next year. He loved curling, windsurfing, skiing and learned to SCUBA dive at age 58. After retiring from orthopaedic practice, he and Hilary bought a farm and with the help of many good friends created Silver Stream Bison Farm. The most important step in his life was becoming a Christian in 1963. Bill was very active in several churches during his walk with God, serving on church boards, teaching Sunday School and singing in the choir. He was a member of the Gideons for over 25 years. The family would like to thank Dr. Barb Konstantynowicz for her loving and excellent care and friendship, the doctors and nurses of the palliative care unit, and the many friends who called, visited and delivered care packages over the last few months. Flowers are gratefully declined. Those so wishing may donate in Bill’s memory to The Gideons International in Canada or Faith Baptist Church or charity of your choice. A celebration of Bill’s life will be held at a later date.

DIGITAL HEALTH CHECKUP: Surviving to Thriving with your EMR is a series of learning events hosted by the SMA EMR Program in collaboration with some of the most experienced physicians and field experts in Saskatchewan. We are excited to announce that our next lunch-hour webinars will be taking place Oct. 21-22, 2020, Nov. 18-19, 2020 and Dec. 16-17, 2020.

We look forward to seeing you there!

OCTOBER SESSIONS CDM-QIP Best Practices in Accuro Wednesday, October 21, 12:00 p.m. to 1:00 p.m. Hosted by one of your expert colleagues.

CDM-QIP Best Practices in Med Access Thursday, October 22, 12:00 p.m. to 1:00 p.m. Hosted by one of your expert colleagues.

CHECK OUT OUR EVENTS PAGE FOR MORE INFO:

www.emr.sma.sk.ca/events.

Instructions for joining will be posted several days in advance for each event.

Medical Benevolent Society

Submit your application Deadlines are approaching for SMA programs and bursaries. Visit our website to learn more and apply by the deadline. â&#x20AC;˘ â&#x20AC;˘

The Medical Benevolent Society is there to support physicians and their families in need. Through the generosity of Saskatchewan physicians and in partnership with the College of Physicians and Surgeons the society provides financial support as well as educational scholarships, bursaries or fellowships for those who qualify.

Rural & Regional Physician Enhancement Training Program Application deadline Dec. 31, 2020 Family Medicine Resident Bursary Application deadline Oct. 31, 2020

www.sma.sk.ca

To request financial assistance, or to make a donation to the Medical Benevolent Society, please contact: brenda.senger@sma.sk.ca.

SMA DIGEST | FALL 2020

Pride parade in La Loche | Photo by Dr. Lisa Smith, family physician

Return undeliverable Canadian addresses to:

SASKATCHEWAN MEDICAL ASSOCIATION 201-2174 Airport Drive Saskatoon, SK Canada S7L 6M6

Mail to:

40007031

SMA Digest - 2020 | vol. 60, i. 1

Articles inside

Students stand in solidarity with patients, communities they serve

From bedside to boardroom

The call of the north

Aboard a Mercy Ship

Patient’s Medical Home

Physician turned researcher

Team players

Physicians working with children, older adults share passion for patient care

MAID: Reconciling the law, ethics, and clinical care

Leading in the time of COVID

Advocate, supporter, oncologist

Living with dying

Medical students find new ways to care while training is on hold

New times, new roles

President’s message

The face of Saskatchewan’s COVID-19 response