Rude interruption… Good reasoning…

A Canadian medical student and physician interrupted a press conference with the minister of health to announce their dislike for the new cuts and policy changes that will change funding and provision of health care to refugees in Canada.

Here is the video.

I don’t necessarily agree with their tactics.  As Patrick said, it was like they were bullying the minister.  And it was rude to interrupt the press conference.

I like to think there are other ways to approach these issues.  But, I know it is a struggle to get meetings with such officials.  And that the current government has been making questionable decisions that sometimes have not reflected perspectives of the majority.

This is something that needs to be said.  It seems that the current government has been making cuts in areas that matter to us and areas that are a point of pride for our country, like universal health care, education and the general welcoming attitude.

I don’t profess to understand politics.  But, I do understand people.  And I know that the changes that are proposed and happening affect people.

My medical school had a fabulous program where the first and second year medical students do full histories and physicials on new refugees to aid their family physician.  They, in partnership with a supervising physician, do urgent consults for any particular needs and do groundwork to get people cared for in an efficient manner.  Often, this is done through a translator.

In doing this program, I met people from around the world who had seen terrifying things.  I referred a young man with kidney stones who had never seen a physician to a urologist.  I helped another young family get in contact with a dentist to help remove and repair the rotting teeth of two of their children.  I met a woman who delivered all three of her children at home on the floor who had never seen a physician and had never had a pap smear… And encouraged her to get preventative care.

This program made me aware of the fears and struggles of refugees.  That these people have nothing.  They come with the clothes on their back.   They don’t have money for medications or dental care or, well, anything in some cases.  So, the fact that our refugees get medications covered temporarily always seemed obvious to me.  Otherwise, they will just get really sick and need even more care.  It seems like the right thing to do.  Protect those you took in to protect.

The people trying to voice their opinions in this video have seen this too.  They understand the value in refugee care.  That it is more than dollar signs.  And that because we provide the extra care temporarily means that they are saving money overall.

The thing is, when we care well for immigrants, they stay in the country.  They become more healthy and can bring skills to the table.  They become contributing members of society.  They aren’t freeloading.   They are simply getting on their feet to take part in our society.

As physicians, we took an oath to “do no harm.”  Doing nothing can be passively doing harm when something can be done.  Refugee and immigrant health care are places where something can be done.

This physician and medical student are taking a stand for what should be valued and maintained.  Where cuts should be avoided.  When you can’t get meetings, when your viewpoints are avoided, sometimes extreme measures need to be taken.  Especially when speaking for people who don’t have a voice for themselves. 

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Iceberg dead ahead!

Today, Patrick and I took a friend that Patrick made at International Christmas out to lunch (at Cora’s… How Canadian of us).  More on that part of the adventure another time.  While there, we were admiring the view of the harbour and Signal Hill and we discovered that he had never been up to Signal Hill before.  Well, one thing one cannot miss when in town is Signal Hill, so we decided to take him up.

It was a unseasonably beautiful day… Not in temperature.  I lost feeling in my hands almost instantly upon exiting the car.  And the wind was, as usual, blow you off the edge of the cliff if you’re not careful.  But, it was sunny and clear.  

We were in for a special treat.  A few icebergs from last year have recently floated their way near the harbour and were visible from Signal Hill.  Usually this only happens in late summer, so this is a pretty big deal.  Plus, most of the really good ones are usually seen from other parts of the island.  But somehow, a few have floated down near enough that they can be seen from a place that I usually consider the most beautiful in the city.

The icebergs were very small, especially at surface level, but that doesn’t change how amazing they are.  These icebergs made a massive journey from the north.  They have been steadily shrinking.  And yet they are here.  And they are interesting to see, even though at face level they weren’t.  You see, most of the iceberg is under water.  Much like people, we only see the surface, but things go much deeper than that.  And they come from a long history that we often can’t even really imagine.

Icebergs! Woot!

Wee berg.

Despite the cold, the beautiful scenery gave me hope for spring and reminded me of the beauty that comes from a mix of nature and history.  I am glad we got to share it with our new friend from far away.

Mountains Beyond Mountains

Image via the Partners in Health website. Click on the photo to link to PIH.

I finished a rather fabulous book on the way to Vancouver.  I am there and in one piece now (YAY).

The book is Mountains Beyond Mountains by Tracy Kidder.  I vote that it should become a to-read for anyone in health care or interested in international affairs.  I would say this impacted me more than reading The House of God (coincidentally read during my Internal Medicine rotation).  The book was a Christmas present from Patrick, which he picked out for me, one because it said on the cover it was about a doctor and two it has a rather colorful cover that screamed “Trisha.”

The book narrates the story of the life of Dr. Paul Farmer and his colleagues who work in international infectious disease control, namely Human Immunodeficiency Virus (HIV) and Tuberculosis (TB) management.  Dr. Farmer is a passionate and intelligent gentleman who continues to practice medicine currently.  I don’t want to spoil the entire story, but quintessentially, he began his medical career while touring Haiti for research in anthropology and became convicted of the suffering and inequality occurring in that nation.  He then went on to medical school and specialized in Infectious diseases.  Thereafter, he undertook public health projects promoting better treatment of multi-drug resistant TB in Peru and Russia while continuing to maintain teaching ties to his hospital of origin in Boston and managing a self built hospital in Haiti.

The book is well-written and personal.  You get to know characters from their beginnings and see them grow over time.  You get bits of others’ perspectives.  The only negative would be that there isn’t more on where he is today other than practicing medicine.  And there is some language to it… Many F-bombs.  Direct quotes, direct context.  I felt they were used as needed and relevantly.  These are real people, after all.

A few things struck me from the story.  First off, the history present in this.  The elaboration on the HIV epidemic and how we have come to manage TB today, although there is a long way to go in many countries.  Then, there was the human side of it.  The portrayal of this man’s passion and sacrifice to help prevent and cure disease, as well as protect a nation.  He gave up most of the comforts we know and love and take for granted.  The medicine in the entirety of the book was sound, based on what I know.  The details of some of the cases were enough to make you feel compassion, to wish you were there to help, to understand better the suffering and decision making behind practicing medicine in such an impoverished country.

Dr. Farmer was portrayed as the center of the story, though, throughout, it was mentioned that this would not have been what he had desired.  Reading about his life and passion, I feel insignificant, as if I can not make a difference the way he does.  I know we all have different purposes and places to do our work.  This man was called to Haiti, he had a passion for the nation and a passion for infectious diseases.  He had perspective.  He used his time effectively (using airport layovers to check emails and flights to sleep), but often missed out on time with family due to his commitment and travels.  I wouldn’t want to sacrifice family to the extent he did.  Infectious disease is not my passion.  I found it interesting though, he looked at things differently.  He states at one point that his wasn’t the life for everyone  and there is a place for specialists in large centers.  He spoke of how inequality should not be present in this world.  That you should have access to STANDARD care wherever you are.  Something we struggle to provide in many regions and nations.  That those who are poor or imprisoned should not have to pay for their care.   At times, they airlifited patients to hospitals for physicians to provide pro bono care.  I would be up for that. At another point, he mentions that it costs $20,000 to air lift a dying patient from Haiti to Boston.  This is a great sum of money and could do a lot.  But then again, that may have saved a life.  But that large sum of money is 1/5 of what many salaried physicians make when starting out.  1/5.  When you look at it like that, it isn’t much.

The main thing is this book made me think.  It made me want to do more.  It showed me what people are capable of in this world.  It reminded me of the need in this world and how diseases like TB that seem controlled in much of Canada are still on the rampage in other parts of the world.  It reminded me  that, unfortunately, medicine comes at a cost.

Little things

Never worry about numbers.  Help one person at a time, and always start with the person nearest you.  ~Mother Teresa

Sometimes little things mean a lot to people.  The small details.  Things you do that you don’t really see making a tangible difference, but they wind up making a big difference to those people sometimes in ways you don’t even see.  Sometimes these sorts of things are helpful, others hurtful.

At work today, I had one patient ask me for her pathology report for her family doctor.  Apparently this physician keeps getting his mail mixed up with another physician of a similar name, and often doesn’t have information he needs or wants in his office.  He didn’t have the report, even though it had been available for weeks.  Other than the obvious system flaws that should be remedied, I was struck by this woman’s helpfulness in offering this service.  This summer, I spent 8 weeks in rural family practice and we were forever missing information, but thankfully had access to an electronic medical record that could fill in some of the gaps.  Here though, there is no such option for physicians out of the city.  We were grateful when people brought us information from specialists.  I can imagine that this physician would, as well.

Another patient today came in bringing some of his left over wound care supplies that he no longer needed.  He was asking if we knew of anyone who could use them, as they would expire in a few months and he did not know what to do with them.  Ironically, in the room next door, someone who had a large tumor removed from his shin and was now dealing with post op wound infections.  He was using some of the same materials this other man had brought in.  He asked the nurse if he could get any extra supplies, as his homecare nurse had not brought enough for this next week.  This saved someone from inconvenience and cost.

Last week, Jag (our car) was in getting fixed and took longer than we had anticipated.  Patrick had to take a taxi to work (which costs a small fortune) and I had to get from the hospital to the car dealership in rush hour the day after a snow storm.  I called a taxi and was told it would be at least 20 minutes.  While waiting, the resident I was working with came out of the hospital and asked what I was still doing there.  I told her I needed to get the car and was waiting for a taxi.  She volunteered to drive me, despite the traffic because it was only a few minutes out of her way.  She saved us $20 and me a bunch of time.

Our small group did a study almost two years ago now (wow, time flies) called “The Good Samaritan.”  It was all about being a good Samaritan based on Biblical principles.   The lessons are universal.  Loving people no matter what.  Doing the big things, but also taking care of the little things.  Not just in your home or work or school.  Not just in your immediate community or country.  Not just with a global focus.  Love is not always evident in our world today.  We see many hurting people.  It is easy to get bogged down with it all.

Patrick and I were talking today about different cities and stereotypes.  Newfoundlanders are prototypically friendly, people from Toronto less so, etcetera.  Those are just stereotypes.  I have met dreadfully mean people from Newfoundland and delightful and joyful individuals from Toronto.  Similarly, professions are stereotyped.  Religions are stereotyped.  We like to put people into boxes.  I love boxes and categories.  Sometimes these boxes and categories prevent us from loving people the same way we should.  Sometimes they distance us or give us a false sense of security.  We need to look beyond stereotypes and guard against actions that hurt people, stereotyping included.

My question in life is how do we truly show love to people?  I have been hurtful in the past and I am sure I will be again in the future.  Lately, I have been reminded that sometimes the little things, the things we don’t even consider can tip the balance.

Sometimes, I feel if I can’t do the big thing, maybe I just shouldn’t be involved.  I will pray, but really, I am not involved otherwise (prayer IS involvement, don’t get me wrong).  But, lately, I am remembering that little acts of service, prayers and even offering a helping hand to those involved in outside ways or with outside things can be a help.

International Christmas (http://www.totallyinternational.com) is an event put on by InterVarsity groups across Canada.  The goal is to bring International students out to camp and have them experience a truly Canadian Christmas complete with trees, a turkey dinner, carols, skating and the true Christmas story.  The main goal, however, really, is to show Christ’s love to students who may not have heard the Christmas story before or who are alone and scared in a new country.  It is a beautiful thing, International Christmas.  Canadian students and volunteers run the program and befriend students.  They have a talent show and an international meal to share cultural norms and dishes.  There is opportunity for conversation and growth and long-term relationships.  It is part of a bigger ministry to international students that seeks to support them emotionally, socially and educationally, to show Christ’s love and to help them truly experience Canadian culture.

I have never actually participated in International Christmas, though I have always wanted to.  Scheduling never really worked.  I have prayed for the event.  This year, Patrick is going to go, as he is stuck here while I am home for a rotation.  It is very exciting.  I wanted to help and didn’t know how.  But then, my opportunity arose.  They decided this year that it would be nice to give each student who participates a gift.  A scarf.  Many students when they come to Canada don’t have appropriate clothing for our winters.  This is practical.  It is also kind of symbolic.  So, I am knitting a scarf.  A lovely brightly colored scarf.  I hope it becomes someone else’s “little thing.”

The scarf 3/4 completed.

On a somewhat unrelated note, the pattern for this scarf is quite easy and available online at: http://knitting.about.com/od/knittingpatterns/p/farrowscarf.htm.