In this series, AMS Healthcare addresses the challenges facing healthcare today – particularly in light of the COVID-19 pandemic. The AMS Community promotes compassionate care, development of the leadership needed to realize the promise of technology and the understanding of how our medical history influences the future of our healthcare. A new piece will be posted every Friday on Healthy Debate.
For weeks now, COVID-19 media coverage has captured the haunting images of the de-masked faces of practitioners. Their eyes rimmed in dark circles, their pale cheeks imprinted by the contours of their mask, outward manifestations of vulnerability. Their bodies a roadmap of the tenuous relationship forged between practitioner and PPE technologies. Behind their masks, they are exploring emerging social, political, and economic healthcare dialogues. In Canada, the pandemic has illuminated pre-existing points of vulnerability.
In the midst of it all, health practitioners are trying to re-imagine care and having difficult conversations about inequity and systemic racism, suggesting that we need to move beyond the status quo. Behind their masks, they are making their voices heard.
At the bedside, an unnamed nurse working in a Toronto ICU with patients who are intubated and on paralytic drugs, reflects on caring for COVID-19 patients: “I have to remind myself that it’s a person I’m dealing with but when they’re paralyzed and sedated and ventilated, with no family there, it’s more difficult. (Knowing the patient and family) grounds me, centers me, reminds me why I became a nurse. To treat the person, not necessarily the disease. Now every patient is the disease and we can’t talk to family members. It’s that much harder.”
In the lab, epidemiologists studying testing results in Ontario identify the following social determinants of health-risk indicators: income, being an immigrant and/or member of a visible minority, living in crowded dwellings, working in jobs where social distancing is difficult and/or struggling with chronic illnesses.
In Montreal, a journalist reports the borough of Montreal-Nord, one of the “poorest districts in Canada,” with an unemployment rate “between three and five points higher than the rest of the island” and “half the population from visible minority…40 per cent are immigrants” has the highest number of confirmed COVID-19 cases in the city, called “the epicentre of the pandemic.” McGill University professor Nicholas King is not surprised, given residents work in jobs where “they are likely to be exposed to illness – stocking shelves or working the cash register in grocery stores, or at the bottom rung of the health-care sector, as orderlies and cleaners.”
In Little Grand Rapids First Nation in Manitoba, psychiatrist Dr. Cornealia Wieman stresses: “Historically we have been harmed quiet significantly by pandemics in the past. So, there’s this natural kind of anxiety about that.”
In Ottawa, Ann Seymour, doctoral student in social work and Indigenous peoples at Carleton University, says that while the government’s $305 million COVID-19 package is needed, funding doesn’t address the pre-existing system gaps: “Many Indigenous remote communities are without clean running water, safe affordable housing, education, health and robust economy that support a quality of life. In some remote Indigenous communities, there is a lack of infrastructure, mobility and accessibility to medical care.”
In long-term care, Amy Hsu, Chair of Primary Health Care Dementia Research, and Dr. Natasha Lane note that COVID-19 data focused on Canadian long-term care (LTC) homes is less accessible. They estimate based on available data that although less than 2 per cent of LTC residents in Canada have been diagnosed, “deaths in this population represent approximately 43 per cent of all COVID-19 deaths” (excluding Quebec where the numbers are yet to be reported).
ER physician Dr. Jain in P.E.I argues: “Let’s not do health care the way we’ve done it before. It doesn’t work. Having people on stretchers for hours on end in the emergency department doesn’t work. Having minimal resources in long-term care facilities doesn’t work.”
Family physician Dr. Tanyi-Remarck, practicing in La Loche, Saskatchewan’s “ground zero” (151 of the 199 total cases), stresses community health is “hard and emotional work” and requires “compassion and love” for people. She notes the communities she serves have suffered a range of traumatic events and thinks about how to build stronger communities. “We must plant seeds that will grow strong roots and bear fruit on all fronts: poverty, mental health and everything.”
Dr. Darlene Kitty, director of the Indigenous Program at the University of Ottawa’s faculty of medicine, practiced in her home community of Chisasibi in Northern Quebec during the H1N1 pandemic, urges government to “Work with the community to give them what they need and not just kind of a one-time deal.”
Dr. Amy Tan, a family physician in northeast Calgary, is focused on “safe work environments” and marginalized populations, and is trying to help patients voice their concerns to employers when institutional practices puts them at risk.
Dr. Danielle Martin, a family physician with Women’s College Hospital in Toronto, says virtual care has “exploded” during the pandemic and notes that once relationships are formed, problem solving can be efficient over the phone.
Patient Patricia Costa says virtual care visits are less stressful and reduces: time spent traveling, finding parking, appointment frequency, and childcare pressures.
Practitioners, residents and families across the country are calling political leaders to expand compliance guidelines for “all LTC settings,” including private run facilities and address staffing and workload while also dealing with chronic underfunding.
The challenge now is to keep the conversation going. To question and critique what is happening at the intersection of daily practice, social life, healthcare and political systems while moving toward responsive, evidenced-based adaptive solutions that address issues of inequity and systemic racism as a community.