DECEMBER 2020
Published since November 21, 1910 Circulation 1750 ISSN 0845-356X Suite 3-04 8900 114 St. NW University of Alberta Edmonton, Alberta T6G 2J7 Advertising execdirector@ gateway.ualberta.ca Website www.gtwy.ca
GENDER & HEALTHCARE
Editor-in-Chief Adam Lachacz
Opinion Editor Mitchell Pawluk
Magazine Editor Tina Tai
Staff Reporter Rachel Narvey
Art Director Sofia Capettini
Webmaster Hugh Bagan
Photo Editor Christien Ford
Acting Executive Director Adam Lachacz
Online Editor Pia Co News Editor Khadra Ahmed Arts & Culture Editor Tom Ndekezi
Business Administrator Sukhmani Kaur Saggu Marketing & Outreach Coordinator Emma Jones
Contributors Sarah Bachmier An Bui Jillian Connolly Mary Frank Areeha Mahal Daria Malin Colette Nadon Sithara Naidoo Christian Sanchez Ortiz Sophie Wei Emily Zhao Cover Travis Erickson
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NEWS • OPINION • ARTS & CULTURE • PHOTOGRAPHY • ILLUSTRATION
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ILLUSTRATION COLETTE NADON, "FREQUENCY"
DEAR READER, The World Health Organization dubbed 2020 as the international Year of the Nurse and Midwife in honour of Florence Nightingale’s 200th birthday. In light of the COVID-19 pandemic, we’ve come to value and appreciate the sacrifices made by nurses more than ever. As an homage to all the frontline healthcare workers, the December issue is centered around the theme of gender and healthcare. As the last magazine of 2020, this edition is a collection of lived experiences and raw emotions that many of us have experienced throughout this pandemic. Flip through our required readings to read about double standards faced by women leaders in healthcare and the balancing act that is required from professionals during this time. Discover the importance of trauma-informed care in Indigenous medicine and read about the challenges that new nurses had to navigate straight out of nursing school. Although the year is coming to an end, COVID-19 does not have a predetermined expiration date. Our hearts go out to everyone who has been, and is currently, impacted by the pandemic. We hope that our University of Alberta community continues to follow guidelines and stay safe throughout the holiday season so that we can meet again in the new year. g Sincerely, Tina Tai Magazine Editor
Sofia Capettini Art Director
DECEMBER 2020 1
ILLUSTRATION DARIA MALIN
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Double Standards An examination of the double standards faced by women leading the pandemic response. Balancing Act Healthcare workers need to carefully balance options for each patient during this pandemic. How has this affected families who can’t be there for their loved ones?
In Critical Condition Read about the learning curves navigated by newly graduated nurses and why our healthcare system is in critical condition.
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Featured Artwork An artist captures symptoms of the virus.
DIVERSIONS
Diagnosing Disparities: The Journey of Women in Medical School What are the challenges faced by women in STEM and healthcare fields? How can we address these issues of inequity?
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Horoscope What should you focus your energy on this month? Read the horoscopes to find out.
COLUMNS
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Crossword Do you have the medical knowledge of a pharmacist-in-training?
Humans of UAlberta: Gezina Baehr Meet Gezina Baehr, the first Indigenous student to graduate from the Doctor of Pharmacy program here at the U of A!
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Advice With Parker the Pepper Should you go home for the holidays? See what Parker the Pepper has to say.
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FEATURES
Banksy's Nurse A creative nonfiction piece about what nursing and healthcare means to a daughter.
REQUIRED READING
TEXT SARAH BACHMIER ILLUSTRATION SOPHIE WEI Women have been holding countries together throughout the COVID-19 pandemic. Leaders like Jacinda Ardern and Angela Merkel have had outstanding successes when it comes to controlling the spread of COVID-19 in New Zealand and Germany, respectively. And those aren’t the only countries that have had women in the lead. Top Canadian health officials like Deena Hinshaw and Theresa Tam are also women, However, despite the successes of New Zealand and Germany and the failures of Canada, the same people get the blame — women. But are our women leaders actually failing us, or are people directing their anger towards women because they are the ones who are in charge of the messaging? One place where many countries are failing is health-messaging. For example, Albertans are being told to limit their cohorts to three, but not whether this means three people in total, three separate cohorts not including work or school, or some other combination. These mixed messages cause frustration with a public that is already suffering from COVID fatigue. Deena Hinshaw, Alberta’s Chief Medical Officer of Health (CMOH), has also been a victim of this mixed health messaging. Though it is true that Hinshaw’s messaging has at times been repetitive and ineffective, many people are putting the blame solely only on her. Hinshaw may be in charge of the briefings, but she holds less power now that Alberta is no longer under a state of emergency. Why are we shooting the messenger when we should look to the choices made by Jason Kenney, who has said that Alberta can remain the “freest province in the country” despite our case count continuing to rise? Many Facebook comments in relation to the pandemic call out Hinshaw for how Alberta
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is handling the pandemic, but there’s no mention of Jason Kenney. Why only call out Hinshaw, when our premier’s actions are just as important — perhaps even more so — in stopping the pandemic? Perhaps it is easier to demonize Hinshaw because it is her face associated with the health messaging. The demonization of women health officials is not exclusive to Alberta, either. Most of Canada’s public health officials are women. Theresa Tam and Bonnie Henry are especially notable, Tam being Canada’s Chief Public Health Officer and Henry the CMOH of British Columbia. Looking at the inconsistent public health messaging — such as Tam changing her stance on masks earlier in the pandemic because of new information — there is a difference between how some officials are interacting with the public. Some officials have been straightforward and upfront, while others have been averting messaging that asks citizens to “do the right thing and stay home.” Of course, during a pandemic, we want people to stay home, but the messaging becomes useless once it has been asked of us for several weeks and COVID cases continue to climb. It is okay to criticize Hinshaw or Tam for these discrepancies, but, we also need to look at why the blame is being put on to them, when it should be shared between the male leaders that work behind them. On the other hand, when countries have successfully handled the pandemic compared to others, there are still people who diminish the efforts of the women in charge. Jacinda Ardern, the Prime Minister of New Zealand, is a good example of that. Ardern does not dance around the pandemic and never shields the truth from her citizens. She has even directly called out COVID-19
deniers, and she is not afraid to be straightforward with her country. New Zealand's strict lockdown, including a border closure, a four-tier system, and mandatory mask rules, have allowed them to eliminate community transmission, twice. Unlike Canada’s women health officials, Ardern is the head decision-maker in the country however whenever someone brings up New Zealand’s success, the excuse is frequently that it is an isolated island, and that its COVID-19 response would not be possible somewhere as large as Canada. My question is: why do people immediately make that assumption instead of looking to New Zealand as a country to aspire towards? Why do we dismiss New Zealand’s success in tracing and eliminating COVID-19 just because they have a smaller population? Why not look at the per capita numbers and translate them to a bigger population? New Zealand may be an island who completely closed their borders, but landlocked countries could also do this — it’s a matter of leadership. I can't help but wonder: would the reaction be different if it were a man in charge of New Zealand? Ardern is not the only woman leader who has had success in the early days of the pandemic. Angela Merkel, Prime Minister of Germany, took a similar stance to Ardern and has been up front with her citizens. Merkel has a scientific background as well; she has a doctorate in quantum chemistry. Furthermore, Merkel drew from experiences as a youth in communist Eastern Germany, telling her citizens that she understands how strict lockdowns can make people feel as if their lives are restricted, but that “such restrictions can only be justified by absolute necessity”. She combined science, reason, and history to lead Germany to the
REQUIRED READING best pandemic response among European nations. Germany is generally known to treat scientists with a great deal of respect, and listening to science should come above all else when dealing with a pandemic. When comparing Ardern and Merkel to Canadian officials, it’s important to note that while Trudeau is handling the pandemic nationwide, health restrictions are up to provincial governments. Now that the entire world is going through a second wave, Merkal and Ardern did not hesitate to impose a second lockdown, even amidst anti-lockdown protests. New Zealand has closed all non-essential businesses and cancelled gatherings in the hardest hit areas, while Germany is closing restaurants, bars, gyms, and theatres. When looking at provinces in Canada, specifically Alberta and Ontario, officials are not taking the same measures. Ontario shut down indoor dining, gyms, and movie theatres for only 28 days, and Alberta’s only provincially imposed restrictions were a two week ban on gym and fitness classes, and bars and restaurants not serving alcohol after 10 p.m. When every region is going through the same pandemic, why are the measures so drastically different? It goes back to messaging. As I’ve previously said, Ardern has always been direct with her citizens, as has Merkel. Both have looked to science to direct their lockdowns, and they do not care that their public approval may take a hit due to strict measures. It is quite the contrast with leaders like Jason
Kenney and Doug Ford, whose messaging has included pleading with citizens to follow rules before imposing any severe measures. Why is there such a discrepancy? Is it simply because of individual differences? Or is there something larger at play? Part of it could be that women in leadership positions are held to a higher standard than men in the same position. According to a study done by the Pew Research Center, 47% of people believe that is the case. If women leaders like Ardern and Merkel are subjected to higher scrutiny regardless of what they do, then they have nothing to lose when it comes to imposing severe restrictions. On the other hand, except for in the Northwest Territories, Canada’s premiers are all male, and six provinces have female CMOHs. Rather than criticizing the provincial leaders, the public has been criticizing the women in charge of public health messaging, even when they are not the ones making executive decisions. None of our leaders are above criticism, but it is disappointing to see women leaders receive the bulk of dissatisfaction and anger from the public — especially those who have had remarkable success controlling the pandemic. We need to acknowledge everyone who is involved in both succeeding and failing, but we need to make sure we’re looking at everyone involved. The way the public has criticized our women leaders,
whether they’ve been successfully handling the pandemic or not, is a reminder that while women make up the majority of the healthcare system and have for years, there will always be someone to dismiss their leadership. This pandemic should serve as a lesson that sexism is still alive in the healthcare industry and the general public. Needless to say, Hinshaw, Tam, Ardern, Merkel and all the other women in power are doing something that no one ever thought would have to be done, and they’re doing a good job at it. These women aren’t above criticism by any means, but they are not deserving of all the criticism they have received. We need to look at these women as an example, and instead of criticizing them, we need to think about the roles they have played, and as their citizens, try to make their lives just a bit easier. g
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FEATURE
TEXT TINA TAI ILLUSTRATION SOFIA CAPETTINI
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ithin the cardiology wards at Mazankowski Alberta Heart Institute, a man sits alone in his room, accompanied only by the soft beeping of his heart monitor. Although he is asymptomatic, he can’t have any visitors until his COVID-19 test results come back negative. A nurse comes in to check on him and he tries to ask when he can see his daughter. She tries to explain that the results will be back soon and that it’s important to wait, but it’s a choppy exchange: he doesn’t speak much English — his daughter usually translates. Isolated and confused patients is the new reality that nurses like Iman Janmohamed have to work with amidst the COVID-19 pandemic. Janmohamed recently graduated from the nursing program at the University of Alberta in April, and since then she has learned to adapt to dwindling supplies, changing protocols, and low patient morale. When the pandemic was starting to make its way across Canada, nursing students in Janmohamed’s class had their preceptorships cut short. Although many of them had
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already completed over half of their required hours, it was clear they were at a disadvantage compared to peers who graduated before the pandemic. Whether her 12-hour shifts are spent in the cardiology wards at Mazankowski Alberta Health Institute or in the emergency room at the UofA hospital, it’s the teamwork that has helped Janmohamed navigate learning curves at record speed. “I didn’t feel like I received all the training I needed. It has taken some time to build the confidence to practice independently,” Janmohamed explained. “As a novice nurse, I appreciate having experienced nurses share their knowledge and expertise with me.” In the fast-paced emergency room, issues can range from minor lacerations to full-on sepsis. Nurses work as a team to divide up tasks such as gathering blood for lab tests, taking patients to diagnostic imaging, and administering fluids and medication. The team dynamic helps ensure that everything moves along as smoothly as possible so that incoming patients in the waiting room can be tended to quickly. Every aspect of a patient’s care is also
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scrupulously documented to make sure no information is lost. Back at the Mazankowski Alberta Heart Institute, Janmohamed — wearing full personal protective equipment — brings a care package of clothes, food, and Tim Horton’s coffee to her patient while he stands away from the door with his mask on. His daughter called Janmohamed to explain her father’s needs and now they stand talking to one another at a distance. He hadn’t had a visitor in days, but Janmohamed had realized that it was culturally important for him to have his daughter nearby. For a while, her presence brought him comfort, and he became more receptive to care.
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n a general surgery ward, a young nurse writes down 12 hours worth of patient care information in her handover report: bandage changes, vitals signs, pain or nausea after surgery. Everything is meticulously recorded and explained to the nurse who will care for her patients for the next 12 hours.
It’s only when she is home and sinks into her sofa that the day’s adrenaline begins to fade. How many patients cried in frustration today because visitors weren’t allowed? How often had she wanted to cry with them? Looking around her empty apartment, she finally acknowledges her grumbling stomach. She thinks about her grandparents a province away and wishes she could have a home cooked meal with them. Going to nursing school was an easy choice for Selena Ho. She liked interacting with people and taking on a caregiver role, and having lived with her grandparents in Vancouver, she had great fondness for the geriatric population. But as a new nurse thrown into a pandemic, the job hasn’t exactly been easy. Like Iman Janmohamed, Ho also graduated in April 2020 and had her preceptorship cut short. Although she was allowed to pass the course, she felt that the extra hours would have helped solidify her organizational and practical skills. In the beginning, she struggled with imposter syndrome and feeling like she wasn’t good enough to be a nurse.
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FEATURE “I think as a new grad, it takes time to develop that confidence as a nurse, and trusting your instincts, rather than doubting yourself,” she said. Though she is much more confident in her abilities now, the pandemic has continued to take a toll on the mental health of patients and healthcare workers alike. Following an outbreak in a ward, Ho’s unit was unable to accept any visitors. “It was difficult to watch my confused patients who are normally settled by having their family members or friends nearby, be so distraught and disoriented,” she said. “I felt conflicted [about] enforcing these restrictions, but the best we could do was call their loved ones or hold our patient's hands to comfort them.” As for Ho, her experience of isolation has been similar to that of her patients. Many of her close friends and family reside in Vancouver, but flying back home is too much of a risk. “I have family members that are immunocompromised, so working in a hospital and having to fly on a plane to see them makes me anxious. As much as I want to see them and eat my grandma's home cooked meals, I don't want to risk it,” she explained. Ho stressed the importance of exercising caution in our interactions with one another as COVID-19 cases rise in Alberta and B.C. For now, she remains in contact with family and friends through video calls and hopes to see them in person next year.
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s the first rays of sunlight peek through the horizon, a nurse in the medical unit prepares to finish her night shift. She’s given medications, wound care, and therapies for nine patients throughout the night. It’s been difficult communicating with elderly patients who are hard of hearing and rely on lip reading. The mandatory masks are yet another challenge to work around, but it’s necessary to keep patients and nurses safe. Nicole Inglis graduated from the UofA nursing program in January 2019. Less than a year after becoming a registered nurse, she was faced with the challenge of moving to another city in the middle of a pandemic. The isolation and stress from moving was exacerbated by fluctuating hospital settings. New protocols were put in place regarding masking, visitor restrictions, and staff screening. Meanwhile, personal protective equipment shortages were happening around the world. “It was incredibly stressful when the PPE shortage issues started emerging; especially seeing the reality of nurses in New York having to reuse PPE,” she said. “Thankfully that never happened at my workplace which I am immensely grateful for.” Although she had adjusted to the transition from student to registered nurse, the sudden pandemic brought the biggest learning curve she’s experienced thus far. Although nursing school touched on emergency responses
“I have family members that are immunocompromised, so working in a hospital and having to fly on a plane to see them makes me anxious. As much as I want to see them and eat my grandma's home cooked meals, I don't want to risk it”
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during disasters and pandemics, they weren’t specifically prepared for COVID-19. Inglis believes there’s no way they could have. “Nursing students are expected to learn, understand, and apply a vast amount of information, and it is not possible to be taught about every scenario that could happen.” Nursing school did however teach important critical thinking skills that are invaluable for tackling the pandemic. “COVID-19 is a new virus, which means learning and applying your ability to critically think through complex situations is incredibly important,” Inglis said. “I believe nursing school provided me with [that], which helped during this situation.” Selena Ho and Iman Janmohamed are both grateful that the UofA nursing program also taught students proper donning and doffing techniques — that is, how to correctly put on and take off personal protective equipment. “Some nurses never learned the correct technique and are now learning during the pandemic,” Janmohamed said. Once out of nursing school, it seems that their greatest strength comes from their fellow teammates. While in school, students have access to preceptors and instructors for support and guidance. Once they become registered nurses, they’re responsible for patients on their own and need to learn how to assess situations by themselves. “I had my fair share of post shift cries, and
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the doubt I had in my ability grew during the beginning of my first registered nursing job,” Inglis shared. “But I had such an incredible support system at my workplace that I felt comfortable asking questions and asking for help as needed.” Inglis learned to become comfortable asking for help from more experienced nurses and to feel confident in asking for a second opinion. She also prides herself in carrying on this collaborative environment and lending support to new nurses wherever possible. She remembers what it’s like to be in a student’s shoes and plans to support others coming into the role. “‘Nurses eat their young’ is a well known phrase in the nursing world, and I am incredibly grateful to have worked in supportive environments where horizontal violence was rare. I have vowed to never be a nurse who believes bullying is ever okay,” she said. Unfortunately, the healthcare field isn’t without its flaws. When it comes to protection for frontline workers, there simply aren’t enough supplies to afford complete protection in every setting. While working in the emergency room, Iman Janmohamed and her colleagues are always in PPE with every patient that comes in. Up in the wards however, nurses only wear their PPE when a patient is displaying symptoms of COVID-19 or when they have been flagged by infection prevention control as being a possible contact of someone who has contracted the virus. This means there’s always a risk of exposure via droplets when a nurse is not fully protected. Last month, Janmohamed worked with a patient who had been in direct contact with a confirmed case. She was not wearing full contact PPE at the time since the patient had not been flagged and they were asymptomatic. “Being a new graduate with student loans, I am grateful to have a job. However, the
Alberta government’s legislation does not support nurses when it comes to being in isolation,” Janmohamed said. Since she was not a full-time employee, she did not get banked sick days. “So while I was waiting for my COVID swab to come back, I couldn’t work on my unit, which means I didn’t get paid for a week.” Janmohamed has also struggled with discriminatory and racist remarks, both as a student and a registered nurse. As a student, it was difficult to stand up for herself when the person making the remarks was in a position of power. Although she is sometimes subjected to these comments from patients, they’re especially jarring when they come from medical professionals. “I believe as medical professionals we should be held to a higher standard, as we are promoting equity, respect, compassion, nonmaleficence, and justice,” she said.
“I have learned that I do not need to tolerate any abuse. In my position, I can educate if I feel like they will be receptive, remove myself from the situation, and report the problem to someone I feel safe with.” Despite facing different hurdles, these new nurses have a clear passion for patient-centered care. In between administering medications, preparing patients for surgery, and performing head-to-toe assessments, Janmohamed works hard to ensure patients are well informed of their situation and remain in constant communication with their family members. With restrictions on visitors, nurses have become the main source of support for patient morale. “Human interaction with a loved one or volunteer can make the biggest difference to someone who is not well,” Janmohamed said.
“I believe as medical professionals we should be held to a higher standard as we are promoting equity, respect, compassion, nonmaleficence, and justice.”
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FEATURE “We try to take the time to sit with our patients, but as staffing issues are arising, this is becoming less possible.” While nurses are busy updating charts, responding to emergencies, and taking care of various tasks, patients are often alone in their rooms. Especially with limited visitors allowed, nurses are a patient’s biggest advocate now more than ever. Nicole Inglis talked about how important it is for nurses to communicate with physicians and families. “We became a main source of support for patients. I was in constant communication with the physicians and family to bridge any gaps and arrange for calls as needed.” She went on to describe how emotionally difficult the situation can be in the midst of visitor restrictions. “Visitors were only allowed during extreme circumstances such as end of life, and even then only two at a time were allowed. It was incredibly hard to have those conversations with families and patients,” Inglis explained.
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Knowing how important it is for patients to be able to connect with their loved ones, Inglis took extra care by using a portable phone — and disinfecting it after each use — to allow family and friends to talk to patients who were too sick to have visitors. It’s not the same as being surrounded by loved ones in our most vulnerable times, but the nurses are doing everything they can to bring their patients comfort. As COVID-19 cases continue to proliferate across Alberta, our healthcare system and the welfare of our frontline workers approach critical conditions. At the time of writing, Alberta is reporting a thousand new cases a day with over 14,000 active cases. It would be an understatement to say that our healthcare workers are bearing the brunt of the impact. Inglis, Janmohamed, and Ho all credit teamwork as the reason they’ve been able to handle everything the pandemic has thrown at them. “If I have a patient that has become incredibly unstable and I need to implement various orders to stabilize them, I reach out for support from my team members to assist my other patients, and I do the same for them if the roles are reversed,” Inglis said. “Though it was scary to be starting as a new graduate registered nurse during a pandemic, it also brought a sense of unfamiliarity to all the nurses in my unit. It was a way I could bond with my colleagues,” Janmohamed said. “I have gained a tremendous amount of knowledge from my coworkers which I plan to continue to implement in my practice.” Ho also has a supportive team around her. “Even if I am on my own as a nurse, I never felt completely alone with the supportive staff members. They understood the struggles starting out of nursing school and asked if I needed help with any tasks or to catch up on my charting.” Even with the most efficient teamwork, nurses are needing to adapt quicker as pandemic policies fluctuate and the pandemic spreads. For Ho, the pandemic has pushed her to mature professionally. “The pandemic has taught me to learn to work with what I’ve got and do what I can in the moment,” she said. She's also thankful to have had clinical experiences that value mental health while still in school. “I think the clinical experiences as a student has helped me consider the
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“A lot of nurses, including myself, are feeling the impact of the pandemic... The toll on mental health has been disastrous to say the least due to the situation we wake up to every day.” situation in a holistic manner, where I’m not only looking at the signs and symptoms of COVID, but also the impacts on our mental health,” Ho explained. In between wound therapies, carrying out doctors’ orders, and responding to emergencies, nurses often forget to take care of themselves. Although innovations allow them to keep in touch with friends and family, the nature of being a healthcare professional in the middle of a pandemic necessitates extra precaution for seeing loved ones. The result is compounded feelings of isolation and burnout. Though she cannot directly speak for her employers or fellow colleagues, Inglis notes that burnout is evident within the profession. “A lot of nurses, including myself, are feeling the impact of the pandemic,” she said. “The toll on mental health has been disastrous to say the least due to the situation we wake up to every day.” Ho also stressed the importance of taking care of our mental health, both for frontline workers and for everyone who is relying on
them. “Nursing school made me realize it’s crucial that we take care of ourselves first. If we’re unable to take care of ourselves, how will we properly care for our patients in a safe and efficient manner?” With issues like PPE and staffing shortages, nurses are taking on more patients each shift while keeping up with meticulous COVIDscreening for every person who enters the hospital. Each new case feels like another straw on the proverbial camel’s back. As for what everyone, frontline worker or not, could be doing, the nurses had an unanimous answer: wear your masks, practice good hand hygiene, and take care of your mental health. “When in the community please wear a mask, social distance when possible, stay at home and practice good hand hygiene. Your actions affect the livelihood of those around you, including your loved ones,” Janmohamed said. g
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THE STUDIO
u N s ' y s k Ban JILLIAN CONNOL K ILLUSTR ATION TE XT MARY FR AN
Near the beginning of the pandemic, a new Banksy piece featuring a little boy holding a superhero decked in a cape, an apron, a familiar red cross, and a white cap reminiscent of Call the Midwife went viral. It must have been a weekend, because I heard my dad let out a thoughtful “huh” from across the kitchen table. He showed me the picture on his phone. “I mean of course, not all nurses look like this,” he said lightheartedly, gesturing to himself. Then, with a wave of his hand, “But this makes the point quickly.” I smiled. I couldn’t think of a single nurse I knew who looked like Banksy’s depiction. I used to think all nurses were men. I wasn’t exactly conscious of this until a childhood classmate expressed utter surprise that my dad was a nurse over the rambunctious chatter of our elementary school classroom. It’s amazing how these deeply gendered ideas seep into our brains, to the point where we expect binaries in every aspect of existence.
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Yet it seems to me that health and care are the opposite of binary. “Health” comes from the Old English hǣlth, which connotes a meaning similar to “whole” or “complete.” Healthcare, then, means to care for someone’s entire being, their whole person. I don’t see much room for binaries there. When I think of the word “care,” I think of my dad. Let me be clear, I have never seen my dad at work, and I don’t pretend to know what his job is like. My appreciation for his role in care stems only from my experience of his parenting and his willingness to check up on every ailment I complain of, from dry skin to a sore throat. The other day I was worried because I had bumps on the back of my tongue that were much larger than tastebuds. They’d probably always been there, but I asked him to look. Soaring COVID cases had me paranoid, and that was the reason I’d been examining my throat in the first place.
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e s r u N He shone his flashlight in my mouth as he had done countless times before, smiled, and said there was nothing to worry about. “Here, wanna look at my tongue? I think it’s the same.” He handed me the flashlight. I felt goofy, but I took it and looked for myself. Indeed, he had the same bumps. “Lots of people have them,” he reassured me. He works in palliative care. End of life care. “Palliative” comes from the Latin word pallium, which is a type of ancient Roman cloak. I imagine this to be a protective cloak, warm and safe. Sometimes my dad refers to his field as “comfort care.” Having never studied or worked in healthcare, I don’t know much about it. All I know is that my dad imbues care into every aspect of his life.
When he first explained the origin of the word “palliative” to me, he was driving me back to my dorm room for the night. I had an inkling then of what a pallium was. I could sense it peeking through the soft light escaping my parents’ half-open bedroom door, touching me where I used to curl up on their bed. I spent nights there, surrounded by the smell of books, carefully following my dad’s instructions to lie on my right side for my stomach-aches. A metal bowl from the kitchen cupboard lay on the ground, just in case. Their bed was made of memory foam, and lying on it I watched the shadows on the ceiling from my dad’s nightlight. Those moments cloaked me in safety and security. The material manifestation of pallium changes from time to time, but the feeling is the same.
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When I was exhausted and coughing up a storm during my first year of university, my dad brought me groceries. He later told me he thought I had the flu. I was too proud to accept his offer of groceries at first, but after looking at my desolate fridge, I called him back. I felt like I should’ve been able to take care of myself, but it seems there are people who sometimes do that better than I can. He bought me bison sausage, gouda, yogurt, red peppers, mixed greens, jam, Tylenol, and Benylin. I could picture the plastic measuring spoon he once used to trickle Benylin into my throat when I was small, in our linoleum-lined kitchen. I remember those ingredients because I made the greatest fried rice with that sausage and pepper. It brought me back to every Sunday growing up when I smelled my dad’s garlic sizzling on the stove as he listened to the radio, cooking the best fried rice on the planet. Even though I was alone and separated from home, I felt as though I was back in my warmly lit kitchen. “Nurse” comes from the Latin nutricia or nutricius, a noun denoting someone, or something, that nourishes. There’s a story my dad likes to tell every so often. When he was dating my mom, he tried to impress her mother by gifting her a box with the Chinese character for “longevity” painted on the lid. Little did he know that this was the kind of thing my grandma would only expect to see at a funeral.
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THE STUDIO But my grandma did live a long life. And near the end, my parents both cared for her in our home. I think this was when the words “comfort care” started to appear before me, in nearly every decision my parents made for those few years. One Sunday morning, my grandmother came into the kitchen and asked for some breakfast, for the second time that day. Though her memory had slowly been going for years, at that point she was chatty and in good spirits. I heard my dad putting eggs on the stove and boiling a pot of tea. My grandma politely commented on the kitchen, the cutlery, and the good make of the plates as they pleasantly chatted over their second breakfast. When my grandma was ready to go back to bed, she said, “Thank you for the tiffin.” That was a new word for him. Tiffin, as it turns out, is a light meal taking place between breakfast and lunch. A meal made for comfort. The word itself is comforting to me, because I picture it as my grandma’s happy banter over my dad’s scrambled eggs in a wood-furnished kitchen. It’s funny how words conjure up images but their meanings are rarely fixed. My love of words came from my dad too. He embodies them all: hǣlth, nutricius, pallium. Maybe Banksy should have given his superhero nurse a warm cloak, instead of a cape. g
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REQUIRED READING
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REQUIRED READING
Balancing Act TEXT SITHARA NAIDOO ILLUSTRATION AN BUI
DECEMBER 2020 19
REQUIRED READING
In the early stages of the pandemic, we were learning to use Zoom and adopting new quarantine hobbies, trying to find ways to pass the time while holed up in our homes. However, not everyone had those same privileges over those few months. I remember hearing stories about families trying to see their parents and grandparents in nursing homes and intensive care, and finding alternative ways to visit their loved ones. Whether it was over FaceTime or via outdoor socially-distanced visitation, families had to cope and adapt. At the time, I observed these situations with an optimistic lens, applauding families for their creativity and adaptability. Little did I understand the difficulties and challenges that accompanied those efforts until my family was in the midst of that situation ourselves. In mid-September, my grandmother was admitted into the hospital. She passed away there a month later. Her personal experience during that month, as well as my family’s, offered us a new perspective of our healthcare system alongside what it means to be cared for during a pandemic. Having to say goodbye to a loved one is difficult in itself, and it is even tougher when you’re not able to physically be with them in their last moments.
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In order to assure safety for patients, staff, and visitors, there were many restrictions on who could visit patients, when they could come and for how long. Only my mom, aunt and two uncles were allowed to visit. It was two at a time, socially-distanced, and of course, with masks on. As grandchildren, it was hard not being able to visit or say goodbye, with FaceTime being our only option to see our grandma’s face. I sympathize with others who have experienced similar events this past year, and have had to find closure while grappling with loss in somewhat unprecedented ways. Alberta Health Services uses five values to guide their vision of a healthy province. Those pillars are compassion, accountability, respect, excellence and safety. Leaning on those values while working together with families is the mission of a patient-focussed system. In a COVID-19 world, these principles are more important than ever.In this new reality, we might ask ourselves if each value should be treated equally. At what point does safety outweigh compassion? What does patient-focused care mean in the context of keeping others safe, and respecting the greater good? These questions reflect the give and take that has been happening during the pandemic, and will continue to happen until our world is safer.
REQUIRED READING
It’s understandable there is a balancing act that has to happen in order for decisions to be made and for a system to run, but there is still a certain fairness to patients and their families that is being left unsatisfied. Whether it be growing pains as the system tries to navigate this new reality or simple negligence, it is not an easy process for anyone. It is convenient to put aside certain values or let them be swept aside with the coronavirus as the excuse, but our system can do better. We can become creative and adapt so that patients' care can be more tailored to their needs, compared to the current onesize-fits-all policy. My grandmother’s unit was put under lockdown because of a COVID-19 outbreak, which left her alone during the final week of her life. It was shocking to see the effects of isolation on her behaviour and mental state. Before the shutdown, she was showing signs of improvement and her cardiologist was trying to get her on oral medications so that she could be discharged home. However, once the unit went into lockdown and she was isolated, she rapidly declined. What made it particularly difficult is that no one was able to advocate for her while she was unable to advocate for herself. Ultimately, this became a question of values and a communication issue. We found it
unnecessarily difficult to communicate with the hospital staff. There never seemed to be a course of action taken or a reconsideration of her care. How can a person be treated if neither they or their family is able to represent them? Over the course of that week, we saw a sacrifice of both accountability and respect for safety. It is hard to judge the institution’s decisions given the context of the pandemic, especially in a hospital environment, however it is still an issue that cannot be ignored. While my family is very grateful for the permissions we were granted and we are respectful towards the hospital, the other patients, and their families, it is still important to acknowledge that there is conflict in the system, that conflict being the sacrifice of accountability, respect and communication for safety. I hope and expect that our hospitals will make changes as time passes, in order to ensure a province that is truly made up of “Healthy Albertans. Healthy Communities. Together.” g
DECEMBER 2020 21
REQUIRED READING
TE X T
Whether it’s discovering the structure of DNA or crunching numbers at NASA, women have always been an integral, but often underlooked, part of scientific discoveries and advancements. Even though Marie Curie, Mae Jemison, and Rosalind Franklin are immediate names that come to mind when thinking of the scientific community, when we draw our attention to our modern scientific community, it’s hard not to notice the continued underrepresentation of women in Science, Technology, Engineering and Mathematics (STEM). I sat down, virtually of course, with Dyanna Melo, a second-year medical student at the University of Alberta over Fall Reading Week. During our conversation, we discussed barriers presented to women
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AHA E HA M
in healthcare, how the position of women in healthcare is developing, and what the future holds for women in medicine and healthcare. As a young girl growing up, Melo always had an interest and fascination in science and medicine. Throughout her life, Melo experienced a lot of death throughout her family from cancer and other health complications. Through this, she observed the impact physicians could make in someone’s life, and how these physicians helped her family through hard times. This is what drove her to pursue a career as a physician. However, the lack of representation of women in medicine created a difficult path for Melo to pursue her dream. Women still face barriers to opportunities within the
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medical environments they work in, but this is what ignited a passion in Melo to continue following her passion. “The barriers that women face in STEM have actually driven me to want to become a physician” Melo explained. “I can be someone that can break some of these barriers, and encourage other women to join these fields.” These barriers come in all shapes and sizes, ranging from pronounced discrimination to subtle microaggressions. Melo explained how being a woman in STEM for both her undergraduate degree and in medical school has led to being increasingly questioned by male colleagues. Melo found herself and other women’s opinions and knowledge challenged more so than male peers.
REQUIRED READING
DECEMBER 2020 23
REQUIRED READING
24 GTWY.CA
REQUIRED READING
“When you’re in group projects, or group discussion settings… I’ve noticed that your opinion and your knowledge will be questioned, and people can tend to cut you off in situations.” Melo further explained some current barriers her and other women face within medical school, which include uncertainty in choosing a specialty. Alongside having their merits questioned, women medical students are presented with complications caused by traditional gender roles. “I have noticed that women medical students still face uncertainty when trying to choose a speciality to practice in, because women are still faced with decisions on how to balance a family and work, which is a decision less often faced by male peers, even though there is equal responsibility.” Melo spoke to how important it is for women patients to have access to medical treatment by women physicians, and how these positive experiences can encourage more patients to seek medical attention. “It’s really important, especially for the patients that are coming in, that they can have more empathy in their appointments and they can have someone who understands what they are going through,” Melo explained. “We’ve definitely seen that a lot of times that women come in with more
woman-oriented complaints, they can be pushed aside or told these issues aren’t actually an issue and told to get over it, especially when seen by male physicians.” These issues don’t affect all women equally. They are especially common for women of colour, who often experience indirect discrimination, according to the Ontario Human Rights Commission. “Indirect discrimination occurs when exactly the same services are provided to everybody… but when for cultural, religious, linguistic or other reasons it is not possible for members of one or more lack and minority ethnic groups to benefit equally from them.” “What might appear to be perfectly equitable access (a small town doctor who sees everyone who needs to be seen) may not be (the doctor is male and Muslim women can therefore not be examined by him).” These issues can be partially credited to the underrepresentation of women, and especially women of colour, in the role of physicians. Through increasing diverse women representation in medicine, patients from marginalized communities have a better chance of receiving more personalized care and having their conditions taken more seriously.
Melo touched on how she didn’t have many women as role models to look up to when growing up. She hopes the younger generation of future physicians continues to see more women represented in medical careers. This representation can result in young girls realising these goals are attainable for them too because it's necessary for women to enter this field, especially women of colour. “I hope the younger generation of [women], as they continue to see more women in STEM careers... will realise this is something they can attain too,” Melo emphasized. “They don’t have to stick to careers within gender norms, and they can push further and do something that seems to be male-dominated.” We concluded our conversation reflecting on the history of women in medicine, and what that means for the future of women in healthcare. “Women have been deprived of this opportunity before,” Melo insisted. “Women just have to continue to pursue these careers that they are interested in. Keep the fight going to break down some barriers of being a woman in a medical career.” g
DECEMBER 2020 25
PAINTING COLETTE NADON, "SHARP BREATHS" ACRYLIC ON CANVAS
THE GALLERY
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PAINTING COLETTE NADON, "INFLICTION" ACRYLIC ON CANVAS
THE GALLERY
DECEMBER 2020 27
Photo: Jackie Chow, PharmD 2022
COLUMNS
Gezina Baehr
28 GTWY.CA
COLUMNS
By 15 years old, Gezina Baehr knew she wanted to work in medicine — not as a physician, but in a field that’s more fun, like designing drugs. Chemistry was always her favorite science, and she especially loved learning about how drugs worked in the body. In high school, Baehr learned about how cough syrup works. “Cough syrup works on the brain to suppress coughing instead of just soothing your throat,” Baehr explained. “I thought cough syrup is just syrup that coats your throat and you don’t have to cough anymore, but it actually affects your brain!” Baehr decided to pursue a degree in pharmacy, and entered the Doctor of Pharmacy program at the University of Alberta in 2016. In June of 2020, she became the first Indigenous graduate from the program. Initially, Baehr experienced some self-doubt and felt like she had misunderstood what the pharmacy program is about. There was only one medicinal chemistry course throughout her entire degree which touched on drug design but most other courses were about biology and the human body. However, Baehr soon fell in love with the patient care aspect of medicine. “Whenever I think about my pharmacy degree, I think about it
being transformational personally and professionally,” she said. “I fell in love with truly helping people through medicine, and that was a really big discovery.” Though Baehr still loves chemistry and has a keen interest in drug design, she’s excited to bring her skills to helping people, especially vulnerable populations. Growing up, Baehr’s family struggled with financial security and she witnessed the socioeconomic challenges faced by vulnerable communities — especially Indigenous communities. She often visited her dad’s side of the family who lived on reserves in Victoria, B.C., where many members of the Songhee First Nations are. Baehr herself is a member of the Songhee First Nations. During her rotation in St. Paul, she had the opportunity to work more closely with patients who struggled with addiction, mental illness, and inability to afford basic necessities. These experiences helped further solidify her desire to help address vulnerable communities through healthcare. “I try to help these people with dignity and as much respect as I can provide,” Baehr said. In providing care, Baehr is heavily inspired by Indigenous healthcare, which takes on a more holistic approach than Western medicine.
TEXT & ILLUSTRATION TINA TAI
DECEMBER 2020 29
COLUMNS
“I’m in pharmacy and I provide physical care: this is how our healthcare disciplines work in Canada. But my ultimate goal is to also provide emotional, mental, and spiritual care,” Baehr said. She talked about drawing inspiration from the Indigenous medicine wheel, which is oriented in four directions and represents different spiritual concepts in health and healing. For Baehr, the four directions also represent emotional, spiritual, physical, and mental health. This holistic approach helps Baehr practice trauma-informed care. “Trauma-informed care is this idea that we go into providing healthcare with the assumption that every single person you come into contact with has experienced trauma and you should work to not re-traumatize them,” Baehr explained. Baehr has taken her knowledge of historical and colonial trauma experienced by Indigenous communities back to the classroom. She taught the third-year pharmacy students a class on trauma-informed care and hopes to continue speaking on the subject through an Indigenous worldview. When it comes to the professional healthcare space, Baehr believes there needs to be more Indigenous healthcare providers within Western medicine. Though Western medicine focuses largely on physical health,
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Indigenous care places a big importance on spiritual and mental wellbeing. Baehr wears a medicine wheel to work to remind her patients to work on all aspects of health. “I wear my medicine wheel at work to let my patients know that I accept all parts of their healing. How they are on their healing journey and what parts of them still need healing — I accept all of that,” she explained. “Because all of us have a healing journey and all of us are on different parts of our healing journey.” She also pointed out that non-Indigenous healthcare providers have been utilized as a form of “colonial assault” that separates Indigenous people from the holistic care that is aligned with the medicine wheel. “When we put Indigenous healthcare workers back in our communities, it’s transformational for a lot of patients. Even just your presence as a non-threatening healthcare provider — it’s not easy but it’s so worth it.” In channeling her energy into caring for vulnerable communities, Baehr herself is healing from past traumas. These days, Baehr is taking language classes to learn ləќw əŋiʔnəŋ, the language of the Lekwungen (ləќw əŋən) or Songhees people. Growing up, however, she had a difficult time settling into her Indigenous identity. On her mother’s side, Baehr
COLUMNS
has a Dutch heritage and has younger half-siblings. “Compared to my mom and siblings, they’re all blond-haired, blue-eyed, so they don’t look a lot like me,” she said. “I always seemed a bit darker so I felt a little out of place when I was growing up.” It was also especially hard for Baehr to come to terms with the stigma that surrounds Indigenous communities. “I experienced racism. And it’s not like racism my dad experienced, or racism my grandpa experienced as a residential school survivor, but it was still really hard for me to find my identity,” she said. What really encouraged her to pursue pharmacy was hearing about Jaris Swidrovich, the first Indigenous doctor of pharmacy in Canada. Baehr credited Swidrovich with paving the way for her to become the first Indigenous Pharm D. graduate here at the UofA. “But when I heard [Jaris] speak, he really inspired me to own my Indigeneity in my professional life as well. That set the path for me to become an advocate for Indigenous health and trauma-informed care.” Just like Swidrovich is a role model for her, Baehr hopes to become a role model for her younger siblings and other Indigenous people who are hoping to pursue medicine. She encourages people from underrepresented communities to be confident in getting involved in healthcare.
“Just do it,” Baehr said. “Your community needs you, you are the only person uniquely with your experiences.” “Creator each gave us a gift and we're supposed to live our lives cultivating that gift so we can give back to others,” she continued. “For me, I’m one of the first healthcare providers in my nation now, and once there’s the first there will be so many more. I’m really proud to be able to follow my path and encourage others to follow their own path.” g
* With files from Pia Co
DECEMBER 2020 31
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DIVERSIONS
HOROSCOPE TEXT CHRISTIAN SANCHEZ ORTIZ VISUALS SOFIA CAPETTINI
ARIES
TAURUS
GEMINI
CANCER
You hold magnetic attraction this month, along with power and strength for all the projects you have started. Give yourself time to put your mind at ease — you won’t regret it!
Your drive to get your projects done reaches a peak. While you can feel easily frustrated and annoyed by coworkers and partners, remember to take a deep breath and keep up the good work!
Your energy is fantastic, you feel motivated and driven like you can conquer the world. Stop your routines and do something you have always wanted to do, use the energy of this month as much as you can.
Keep your emotions under control, don’t let them get the best of you. Direct your appreciation to your loved ones by keeping them close and showing them how much you love them!
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DIVERSIONS
LEO
VIRGO
LIBRA
SCORPIO
A month to balance freedom and responsibility, cut yourself some slack but don’t forget about important projects. A good way to use the energy you are feeling might be through sports or expanding your artistic horizons.
Spend more time with your family. Leave work aside and stay active, exercise your mind and body but don’t overwhelm them. Keep pursuing your goals without forgetting about your loved ones.
Your charm and intelligence will have great effects on your work and romantic relationships. Keep track of how and what you say to others. Talk about your concerns and keep working on your inner peace.
Try to reach a work-life balance, or it will start to stress you and those around you. If you struggle with reaching this balance, give yourself short breaks doing something you are passionate about to improve your inner peace.
SAGITTARIUS
CAPRICORN
AQUARIUS
PISCES
You are eager to communicate with others. Let them know what you think and what you want. It is key that you increase your understanding of topics you are interested in and passionate about.
What you have been working on will finally pay off, now is a little window for you to rest and gain energy for the next round of challenges you will put yourself into. Stay hydrated and in peace so you can fully recover.
December is a month to take slow, don't push any high risk activities as the recognition and career advancement you have been waiting for will finally come. Just enjoy the view of your projects being accomplished.
You’re entering a period of change, in which you might want to focus on following your long term projects or desires. Do some emotional cleaning so you can allocate all your energy to these projects. g
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DIVERSIONS
TEXT & PUZZLE EMILY ZHAO ACROSS 3. Latex condoms can not be used with _______ based lubricants because it can damage the latex. 7. What is the minimum alcohol content that should be in an alcohol-based hand sanitizer for hand hygiene if soap and water are not available? 10. What is the name of the active ingredient used to treat acne that can be found in OTC products? 12. What does the acronym SPF stand for as seen on sunscreens? 14. Which common OTC medication can be used to treat allergic reactions (brand name)? 15. What is the name of the provincial service that can be reached by calling 811 that provides free health advice and information?
Find answers on our website, gtwy.ca
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DOWN 1. Which vitamin is made in the skin from sun exposure and can help calcium to be better absorbed from the intestine? 2. This medication is used to prevent motion sickness (brand name). 4. True or False: A female condom and a male condom should not be used together because it can cause breakage or slippage which may lead to an unwanted pregnancy. 5. This can be used in addition to condoms to increase its effectiveness but it may also increase the risk of urinary tract infections. 6. What is the brand name of the drug used to treat heartburn that was recalled in 2019 in Canada? 8. A mask or face covering containing _________ layers is recommended by The Public Health Agency of Canada for the prevention and spread of COVID-19. 9. What is the brand name for a drug called acetaminophen that can be used to relieve pain and fever?
December Crossword
DIVERSIONS 1
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Across 3. Latex condoms can not be used with _______ based lubricants because it can damage the latex 7. What is the minimum alcohol content that should be in an alcohol-based hand sanitizer for hand hygiene if soap and water are not available? 10. What is the name of the active ingredient used to treat acne that can be found in OTC products? 12. What does the acronym SPF stand for as seen on sunscreens? 14. Which common OTC medication can be used to treat allergic reactions (brand name)? 15. What is the name of the provincial service that can be reached by calling 811 that provides free health advice and information?
Down 1. Which vitamin is made in the skin from sun exposure and can help calcium to be better absorbed from the intestine? 2. This medication is used to prevent motion sickness (brand name) 4. True or False: A female condom and a male condom should not be used together because it can cause breakage or slippage which may lead to an unwanted pregnancy 5. This can be used in addition to condoms to increase its effectiveness but it may also increase the risk of urinary tract infections 6. What is the brand name of the drug used to treat heartburn that was recalled in 2019 in Canada? 8. A mask or face covering containing _________ layers is recommended by The Public Health Agency of Canada for the prevention and spread of COVID-19 9. What is the brand name for a drug called acetaminophen that can be used to relieve pain and fever? DECEMBER 2020 35
DIVERSIONS
ADVICE WITH
Parker the Pepper VISUALS SOFIA CAPETTINI
Q Dear Parker the Pepper, Ever since the semester started, I haven’t been able to visit my family since they live in another city. With COVID-19 cases on the rise again, I’m conflicted about what to do for the winter holidays. I really miss my family but I’m afraid of the risks of transmission if I do visit them. I also don’t have a lot of friends to celebrate the holidays with and it feels lonely being alone over the break. What should I do? Sincerely, AwayFromHome
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DIVERSIONS
A Dear AwayFromHome, I’m not gonna lie, that question is a lot to ask from a pepper with no medical training, but either way, I’ll give it my best shot. I know it might sound like a tired refrain at this point, but it’s absolutely crucial that we continue to trust the experts. COVID-19 cases are on the rise nationwide, and the only way we’re going to change that is if people like you and me take the recommendations from public health officials seriously. I don’t know exactly what city or province you live in, but my number one suggestion would be to look up the public health measures for whatever town or city your family lives in and let those be your guiding light. That being said, I completely empathise with how conflicted you’re feeling right now, and I have three practical pieces of advice that might help you out. 1. Really examine your intentions. There’s a big difference between going back to your hometown and visiting your family for the holidays, and going back to your hometown and visiting your family, your friends from high-school, your basketball buddies you haven’t seen in a while, and maybe going to a party or two. Both of those scenarios might do wonders for your loneliness, but the latter is a recipe for disaster during the pandemic. Ask yourself if you really intend to just visit your family when you go home, and if the answer is yes, move on to the next point. If the answer is no, I would suggest rethinking the trip, and maybe downloading Houseparty or investing in a Zoom Pro account. 2. Think about the specifics of your family. This is another question that you will ultimately have to answer for yourself, but think about the makeup of your family and who you might be putting at risk by visiting. Maybe you have a grandparent that lives at home. Maybe your parents themselves are a little older and at a greater risk of contracting COVID-19. Maybe you have a family member with a pre-existing condition that already lowers their immunity. Maybe there isn’t enough room in the house for anyone to
reasonably be able to self-isolate if they happened to test positive for COVID-19. These are some of the questions that you need to ask yourself before you decide whether or not to visit. Some families are more vulnerable than others in this pandemic, so it’s important that you understand exactly where yours stands before you make up your mind. 3. If after considering the first two points you’re still leaning towards visiting your family, then take every possible precaution you can before you go. If you’re able to, try and get tested before you travel, and in the weeks before you leave for home, really limit your social interactions. In terms of transportation, the less people you have to be in contact with the better. Try to avoid things like flying or buses – if you can drive home or get a ride from a friend that would be great. Once you get home, really take my first point to heart and limit your social circle to just your family. It might be tempting to catch up with friends or extended family, but there’s no need to put yourself or your family members in unnecessary danger. As always, you should also make sure to keep up things like handwashing, social-distancing, and wearing a mask. You’re definitely in a difficult position this holiday season, and the question you asked is one that I’m sure a lot of people are wondering about. Whether or not we’re in a better position come 2021 is going to be down to the decisions that we all make in the coming weeks and months. Although it’s often difficult to think with that kind of long-term perspective, it’s absolutely crucial in a time like this. I trust that you’ll be able to make the right decision when it comes to visiting your family, but even if you don’t, don’t beat yourself up for it. The pandemic caught us all by surprise, and at the end of the day, all we can do is try our best. Oh yeah, and trust the experts too. That one is a must. Take care and always keep it spicy. g Sincerely, Parker the Pepper
DECEMBER 2020 37