Friday, May 22, 2015

Gone, but not really

I packed up my office today. Took down the degrees. Placed my text books - now ancient volumes on Economics in a cardboard uHaul box. Miscellaneous other stuff (cute kid photos and what nots took up another two boxes). All of which is now sitting in the basement. It likely will not go anywhere, anytime soon, as my new haunt does not have cubicles or offices that are assigned. Rather, employees float from place to place and have a locker that is assigned to them. It is a a departure that does not feel like a departure...I suppose because technically I am still an employee, merely on secondment with a slated return in early December - but on the same token this leaving feels far more permanent than my maternity leaves.

And yet, my leaving lacked closure. Typically when staff leave, there's a gathering in the lunchroom - a card is sent around to be signed and an envelope takes up a collection. Veggies with dip. Cupcakes. Coffee. Parting words.

My parting words were limited - to a quick, "by the way I won't be here on Monday" tacked on to the divisional "stand-up" yesterday and a rather informal e-farewell I sent this afternoon before I shut my office door for the last time. A formal email had not even gone our by the time I had left early this afternoon (Friday's are half days for me - a modified flex schedule).

A decade, and...goodbyes were foreclosed upon. The formal paperwork only just signed yesterday.

Thankful for my colleagues, who have taken the time to do informally what could not be done formally.

In everything there is tuition value - some of the most valuable lessons bruise the soul.

Tuesday, May 19, 2015

Compassion and Support in Short Supply for Victoria Parents Caught Off-guard

There are times when people step up to the plate to do what needs to be done to see another person through, and then there are times when people demonstrate a lack of compassion and sheer contempt for another person’s plight. Sadly, the tale of Wesley Branch, Ada Guan and baby Chloe is a tale where a young couple is thrown into parenthood without preparing themselves, where the details of their lives are put under a microscope and judged – and ultimately where people are choosing to shove another person down instead of giving that other person a hand up. What is really sad, is that the person who is likely to be harmed the most, weighs less than 10 pounds and did not ask for the circumstances into which she has been born.

Being a parent is not easy – even when a person has had the better part of 9 months to prepare for it. Giving birth is not easy – and I cannot imagine it was easy doing so on board a plane enroute to Japan (there are no epidurals at 30,000 feet). Being under the intense scrutiny of the media is not easy. Being a new mom is not easy. Being young and living in a basement suite in a city that is notoriously expensive to live in is not easy. Indeed, it is difficult to not have some sympathy for this couple and their plight.

Should Ada have known that she was pregnant? Probably. Can I understand how that would be the last thing a 23 year-old young unmarried woman of Asian descent living away from home would want to find out? Absolutely. It is not unimaginable that she was on birth control, possibly even birth control that supressed her periods and it failed – for whatever reason. It is not unimaginable that she may have dismissed her symptoms and neglected to seek medical attention. Was it the right thing to do? No. Is it understandable? Yes. Did it mean that her baby was put at risk? Yes – prenatal care has proven benefits to babies in that mothers who are aware they are pregnant can take steps to ensure a healthy pregnancy, birth and transition into motherhood, baby Chloe as a result of her mother’s lack of awareness or willingness to seek medical care was denied access to prenatal care. Further, if there had been any complications during delivery – Baby Chloe had an increased risk of death due to lack of access to appropriate medical care. Did it mean that Ada was put at risk? Yes. Having an unplanned pregnancy and birth is dangerous to mothers. What would have happened had Ada had a post-partum hemorrhage after the birth or some other complication that merited emergency medical care? Ada, as a result of being unaware of her pregnancy status, also put her own health and well-being at risk.

Both Ada and Chloe are incredibly lucky that the pregnancy and birth did not result in far more adverse outcomes for either one of them. However, both Ada and Chloe continue to be in a high-risk situation.

Ada is now a mother, with all that goes with being a mother. It was not a choice that she made after consideration of what she wants in her life, nor a choice that she has had time to prepare for but rather a choice that has been made for her –at a time when her life has been under intense scrutiny. What choices does Ada now have, under these circumstances and under what circumstances will the outcome for baby Chloe be good?

How can Ada and Wesley be empowered to focus on the best interests of their child and be supported in making the decisions that need to be made and doing the things that need to be done to ensure that baby Chloe’s needs are met?

The community response to date is chilling -people have found it in themselves to not only, not have sympathy but to have sheer contempt and judgement for this couple. Wesley Branch is unemployed and on disability. Ada Guan is a student who works part-time. They are 24 and 23 years of age. And until this past week, were living lives that are pretty typical of 24 and 23 year olds in Victoria. They had the audacity to take a trip to Japan – and to unwittingly become parents.

The community has not stepped up to the plate by doing what needs to be done to support and empower this couple at their time of need. Sadly, the couple’s GoFundMe page has raised a meagre $2,070 to date and has a $5,000 goal – a fraction of the expenses associated with new parenthood. Further, the campaign to raise funds has generated considerable backlash – and has likely left the couple feeling isolated and alienated. Perhaps, sadder still is that money is a small part of what new parents need to succeed – and that these new parents have some considerable challenges ahead. Challenges that crowd-funding is poorly equipped to handle.

Either Wesley or Ada (or both) need stable employment that can provide an adequate income to provide safe, clean housing and adequate nutrition – the living wage in Victoria for two parents working full-time to adequate provide for two kids is currently $18.93 per hour. Wesley and Ada likely need career counselling to determine the jobs that they can qualify for and to give them the tools (ie. a refined resume, training, and help with job searching and interviews) they need to get those jobs. Ideally, they would be able to find jobs that also provide extended health benefits, as many prescription drug costs & dental costs are not covered under the provincial medical services plan. Or perhaps an employer could come forward with an offer of employment to assist this young couple? Alternatively, they may need to apply for employment and income assistance.

Wesley and Ada need to get up to speed on caring for an infant. They likely need a reliable family doctor (sadly I note that none are currently accepting new patients) and would likely benefit from training in infant first aid, basic infant care and parenting information.

Assuming Wesley and Ada find adequate employment, they will need reliable, safe childcare. Finding childcare in Victoria is notoriously difficult with spaces for infants being the most difficult to find. Many parents get on waitlists months in advance of their due date in order to have a space available when they need it. Worse yet, childcare in Victoria tends to be notoriously expensive with many infant spaces costing more than $1,000 per month. Again, Ada and Wesley would be wise to look into the BC Child Care Subsidy to mitigate this expense.

Wesley and Ada need adequate housing – they are currently living in a basement suite in Fernwood and might find that it is inadequate for the needs of a family of 3. Most 2 bedroom units in Victoria rent for more than $1000. Wesley and Ada would be wise to contact BC Housing to apply for a subsidized unit to move into.

Wesley and Ada likely need a range of baby goods including a safe crib, a stroller, a car seat (what I’ve just listed often tallies to more than $1,000 alone), clothing, bedding, diapers, formula (or alternatively a breast pump and nursing bras and clothing and bottles if Ada is to continue working), baby toys, etc., etc., etc. As a parent with small children, I can attest that the list of needs for an infant is nothing short of staggering. Some items may be purchased used and that can save some money or better yet, some items might be donated.

Lastly, Wesley and Ada need a communities of of support like those at the Young Parents Support Network and Parent Support BC and Ada needs to find other moms who can help her figure out motherhood for herself and she might also benefit from the baby and toddler groups offered by Mothering Touch or other local drop-in play groups. I would also encourage Ada and Wesley to check out and access Strong Start .

The decisions in the days, weeks, months and years to come are not easy choices and will require guidance, maturity and hard work – a complete departure from the lifestyle they once knew just a few short weeks ago. While their fundraising campaign drew a considerable amount of backlash as the amount originally asked for was thought extravagant, the reality is that this couple is going to need a lot of support going forward. Ideally, the community would step-up to the plate and offer a hand-up to young parents – the kind of support that helps to ensure that their kid does not suffer as a result of being born into the wrong circumstance.

This couple deserves a second chance and a hand-up – or at the very least their baby does not deserve to bear the consequences for the poor judgement and past decisions of its parents. The very least we can do is step-up for the sake of children and we could start by stepping up for the sake of this child. For the sake of baby Chloe, I am hoping that her parents are empowered and enabled to do what is in her best interests.

Sunday, May 10, 2015

A System that Fails to Care, Will Fail When it Matters Most

Hospitals, doctors, nurses - the entirety of the health system is under incredible strain. Back when I started working as a health economist in 2004/05, an "ideal" occupancy rate for a hospital was seen to be 85 percent. This was a level that was thought to be the sweet spot of providing quality care, a level that allowed for surges in demand to happen and would minimize the number of elective procedures that might need to be cancelled due to a lack of capacity. Even back in 2004/05 occupancy rates often ran above 85 percent - but rarely did occupancy rates exceed 100 percent. Fast forward a decade, and the hospital occupancy statistics in British Columbia are nothing short of disturbing. For many hospitals in British Columbia an occupancy rate less than 100 percent would be a dream. Many hospitals are running over-capacity - and significantly so. Numbers well above a 100 percent in British Columbia are no longer rare.

What does an occupancy over 100 percent mean for patients? It means stays in the Emergency Room that do not last hours, but rather last days and might last the entirety of the care encounter. It means elective surgeries being cancelled or deferred as there is simply no bed to admit a patient to. It means discharging patients without adequately considering what will happen after the discharge. When care capacity is stretched too thin in hospitals - it means quality care, the care that patients deserve and trust that they will receive does not happen. When care capacity is stretched too thin - it means those who work in the system, the doctors, the nurses, the porters, the technicians, the care aides (really everyone), are also put under incredible strain and the risks of error and burn out dramatically increase. Ultimately, when a system tries to do too much with too little - it loses the humanity it needs to delivery quality care and to perform well.

It is heartbreaking to read Mrs. Brenan's tale of care in the Manitoba health system. Mrs. Brenan spent the entirety (4 days) of her care encounter in the Emergency Department of the Grace Hospital, she collapsed on her front doorstep and died of a blood clot that moved to her lungs. Others have been discharged to cabs, only to freeze to death on their porches.

Is the hand-off of care of patients to taxi drivers appropriate - is a taxi service adequately prepared, trained or compensated to handle what needs to be done? Is it the act of a "caring" system or is it what a system stretched beyond capacity does to save a few dollars?

It is easy to reduce the transportation from hospital to home as just being transportation. However, patients are not packages to be couriered from one place to another - and the mere reality of being a patient in an overburdened system is that what is adequate for "an average person, a non-patient" may be entirely inadequate for a patient who has been discharged. The reality is that many patients who are discharged from hospital, are not "non-patients" but rather are still patients who are merely going from one place of care (the hospital) to another place of care (home). As such, the standard of care for transportation from one place of care to another place of care is different from what should be expected from a taxi - the taxi standard of care is a failure, as demonstrated by the experience of Mrs. Brenen and others. I would argue that if "the system" is going to discharge people before they are "non-patients" and treat patient residences as extensions of the healthcare system, that transportation from one place of care to another place of care is also part of the system.

Quality care demands that the reality of patients is considered and that their needs are met. Discharge to taxi is a failure to provide quality care - a failure that needs to be remedied, and a failure that likely results from a system that is simply too lean to care.