The Ol’ Spring-Break-in-Beijing Classic!

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The Ol’ Spring-Break-in-Beijing Classic!

Whaa?? Where am I? Oh, hello!

(*dusts himself off and looks around to get his bearings*)

Returning to this blog feels (I can only assume) like falling through a hole in space-time, like Lucy discovering Narnia, or Jack Skellington finding himself in Christmastown. But maybe this Twilight Zone-esque bewilderment is an appropriate metaphor for a Western traveller whose first foray into Asia was a week-long sortie into one of its busiest, most ancient metropolises (metropoli?).

Though going to China for a single week seems preposterous, the planetary alignment in this case (Sara having an actual Spring Break due to a clerical error the previous year / that Spring Break coinciding with mine / both the aforementioned Spring Breaks coinciding with the end of her medical exchange in China) was too good to pass up. We decided that the best way to immerse ourselves in this wildly different world was to spend the entire week in the bustling city of Beijing.

 

The sprawling 3,000-year-old Imperial palace, ominously known as the Forbidden City, is practically synonymous with Beijing. Standing in its first plaza, vast and paved enough to put an IKEA parking lot to shame, one gets the impression that the sole intent of this place was to intimidate visitors, to suggest the size of the army that could be assembled in such a gathering place. And then, after crossing that infinite expanse of concrete, one passes through the extravagant arch on the other side and enters…ANOTHER INFINITE EXPANSE OF CONCRETE! AND ANOTHER! These plazas repeat themselves almost to the point of absurdity, with decadent names such as Hall of Eternal Happiness and the Hall of Infinite Prosperity, finally culminating in the Imperial Garden, a refreshing Eden of exotic trees that feels like the organic nerve centre of this massive geometric body. The effect is staggering.

Breathing the fresh air of the Imperial Garden.

 

Sara making herself at home in the Hall of Literary Brilliance.

 

The next day we took the metro (which, incidentally, is a great crash course in Mandarin characters, since all the stops are just some combination of the words for north, east, south, west, gate, bridge, lake, and river) to the Temple of Heaven Park: equally majestic, but with the intimidation factor replaced by lush tranquility. Here we saw the mellow side of the otherwise frenetic Beijing lifestyle: people dancing, elderly folks doing gravity-defying tae chi, and parents playing with their kids.

 

I insisted we take a fairly lengthy metro detour to see one of my favourite architectural wonders (/anomalies): the CCTV Headquarters, aka THE PANTS!

If you are ever in Beijing, you absolutely must visit the Wangfujing Snack Street. Yes, it’s touristy, but it’s also delicious and completely unique. Where else can you find live scorpion kebabs, heaps of tentacles, or whatever donkey wallow is?

Our final major destination was the Yongzhe Lama Temple, Beijing’s largest Buddhist establishment. If the Forbidden City was formidable and the Temple of Heaven tranquil, then the Lama Temple was, in a word, reverent. A ubiquitous blanket of fragrant smoke keeps each individual alone with their thoughts, free to explore the sacred maze. I was fascinated by the worshippers, recognizing the looks on their faces but not the bells, flags, wheels, and statues that held such meaning for them.  Being an outsider in a place so intimate made me think of the old parable of the blind men who each touch a different part of an elephant and thus think they are touching something different entirely. What I was witnessing was indeed a very new and different part of the same proverbial elephant than I’d grown up with.

 

Lastly, I would be remiss if I didn’t mention Beijing’s hottest travel destination, and although you won’t find him in Lonely Planet, I’m sure he wouldn’t mind being referred to as such. My friend and fellow teacher, Travis, played the role of perfect host throughout this trip, letting us stay in his apartment, keeping me up til 3:00am on the night of my arrival to break me of any potential jetlag (watching him play hockey in a freezing cold arena for two hours helped, as did the copious amounts of beer and jianbing at the local expat bar afterwards!), helping us with everything from buying a metro pass to asking for less slippery chopsticks in restaurants (the wooden ones make it a LOT easier, okay!!), inviting us to hang out at the Canadian embassy after a ball-hockey game to partake in the finest hoser beverages in all of China, driving us to and from the airport, and finding the best spots for Peking duck (thanks Han!), hotpot, and malatong. T-Rav, I can’t believe we ACTUALLY got to take you up on your invitations to see you in your natural habitat. Xiexie for a fantastic time!

Sara and Travis greet me at the airport with a sign taped to a hockey stick using a band-aid.

 

A first and unforgettable experience of Peking duck.

 

A toast to Canada’s finest spirits, hockey team, and expats!

Shant-outings*

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*Thanks to Joshua for the oh-so-punny title

As mentioned previously, Shantou is tucked into the coastline of the South China Sea, making it the perfect jumping off point for day trips to the numerous surrounding islands. On our first weekend in China, myself and the other Canadian exchange students took the ferry for 1 yuan (~20 cents) across the Shantou Harbour and landed on the idyllic shores of Queshi island. We were greeted by a woman expertly dissecting pineapples with a machete and neatly skewering the slices onto long skewers. An entire pineapple for 7¥ ($1.5) seemed a reasonable price to pay for a snack as we walked along the island’s meandering paths.

View of Queshi from the Shantou side of the sea

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Our goal was the pagoda we had seen every morning we walked along our side of the harbour. On our way up the mountain, we explored a series of naturally formed granite caverns with such enchanting names as “Rainbow Lying Cave,” “Happy Fate Cave,” “God’s Shoe,” “The Platform for Watching Sight of Flame Mount,” and “Three-Tier Cave Toilet” (on second thought, maybe that last one was 2 separate stops…)

View of Shantou from the Queshi side of the sea! 

Terrifyingly steep steps into the caves!

Lovely lunchtime stop
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Giant Buddha (only after an entire photo sesh with G.B. did we realise we had been sitting in front of a sign that read, in Chinese, that pictures cost 2¥ each… and consequently a terrifying encounter with the giant security guard ensued)

After eating lunch in the pagoda at the mountain peak and paying our respects to giant Buddha back down on the ground, we headed back to the ferry. Before we had even landed back on mainland, we were already receiving WeChats from our host students, inviting us out for an evening of quintessential Chinese cultural fun: KTV.

KTV (aka karaoke) is more than just a past time in China… it’s practically an art form. Whole streets are lined with massive KTV buildings, each hosting a multitude of private rooms where groups can order food & drinks and custom-create a karaoke setlist of K-Pop and the newest Swifty singles. At KTV, the most stoic and shy of students suddenly comes into their own and discovers their latent pop stardom, belting out sexy ballads with no restraint or reserve whatsoever!

Post-KTV, we were up bright and early to board the bus taking us to a village about 2 hours from Shantou. Interestingly enough for a self-declared Communist country, healthcare is not publicly funded in China, and therefore many citizens cannot afford basic medications or even a simple doctor’s visit. Thanks to Guangdong-born Hong Kong billionaire philanthropist, the Li Ka-Shing foundation has instituted numerous charitable works to address health inequities across the country, including the one we were participating in that morning – Medical Aid for the Poor (MAP). Once a month, MAP physicians set up free clinics in villages near Shantou, providing free medications, blood pressure readings, and specialist consults. They also provide home visits for any rural citizens unable to transport themselves to the clinic.

My lunch at MAP won the honour of being the most interesting food I have ever eaten to date: I was so proud of myself initially for trying what I was convinced was liver, since I had never had that before. But when I checked in with my Chinese friend, she blithely corrected me: “Oh no, those are blood clots. Maybe pig? Probably dog.”

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Home visits & tour of the village temple

Since we were spending so much time in “small town” China (remember that Shantou’s population is a mere 5 million), we thought we should grab the chance to see big city China at its most iconic: Hong Kong.

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For being so close to Shantou, it was a headache and a half to actually make our way to HKSAR. A chartered car, a bullet train, a subway, a walk through two sets of customs, and another subway later, we were finally in our Hong Kong home for the weekend – an itty bitty hostel room on the 14th floor. The rule was that some part of each person had to be touching their bunk at all times, otherwise there was not enough space for us all in the room!

Hong Kong had some noteworthy features: milk tea, pork floss toast, the mind-blowing bus ride up to Victoria Peak (call me small town, but I have never seen buildings rising up higher than the surrounding mountains!!), and the hilarious experience of finding our way up to the “Highest Bar in the World” and negotiating with the hostesses and fellow patrons for rented pants so our male compatriots could actually enter the bar (because apparently, while shorts are incredibly offensive and inappropriate, ankle-skimming polyester gems passed around to 3 different gentleman in 1 hour are far, far more acceptable). However, in general, I do not feel the need to go back to HKSAR. I feel so privileged to have spent the majority of my time in “small town” China that actually felt unique, and not simply like a crowded version of any forgettable kitschy American town.

Buildings, buildings everywhere…

The day after arriving back in Shantou from HKSAR, we were again packed into a bus, this time to trek several hours to Nan’ao island, where we spent a lazy day hiking up to yet more pagodas, watching our bus driver carve roast chicken with his bare hands, and getting yelled at by locals for daring to swim in the ocean (apparently, that’s just not done).

All in all, our Shant”outings” made an already memorable exchange even more extraordinary. And after three weeks of this, I still had a week of true holidays left…
(To be continued!)

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Barefoot to White Coat

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Having returned from my three months of out-of-province electives, I settled back into the swing of things at home… at least for the next two months 😉 I was at home just long enough to do some CaRMS interviews for my upcoming residency specialty training, complete my final undergraduate OSCE (a lengthy clinical exam with actors pretending to be patients suffering from a variety of weird and wonderful ailments), and spend an incredible month working with the Program of Assertive Community Treatment (aka PACT), a service provided at home to individuals with severe and persistent mental illness, helping them stay out of hospital and maintain their independence in the community.

March 1 was Match Day, the day where medical students all across the country are informed which specialty program they have been accepted into; or in other words, the day we find out what type of medicine we will be practicing for the rest of our careers. I was beyond thrilled to match to my first choice of Family Medicine – Northern-Remote stream, a specialized Family Med program designed to address inequities in access and quality of healthcare for Canadians living in rural and remote areas, particularly those of Indigenous descent. While every Family Med program across Canada offers excellent medical training, I was drawn to the Northern-Remote stream for its unique decolonizing vision and immense scope of practice. And now, as of July 1, I will be a member of its team!!

“Plan B” theme party on Match Day Eve – Joshua and I showed up as WWOOFers, to nobody’s surprise!

Match Day!!

Even after some epic Match Day celebrations, the adventures were not over! Two days after the Match, I boarded a plane along with three other med students, and two days after that, we landed in Shantou, China, a “small town” of only 5 million people in the Guangdong province, nestled on the coast of the South China Sea.

Our apartment complex and view from my window

Seven minute walk from my apartment to the harbour!

The four of us had the immense privilege of being chosen to participate in an international medical exchange with one of our sister universities. Every day for three weeks, we toured two different hospital wards, ranging from Neonatology to Hepatobiliary to Orthopedic surgery. An English-speaking physician was assigned to us on each ward and would accompany us on bedside rounds of their patients.

The brain tumour research hospital… appropriately shaped.

Shantou “Hospital #1”

Bedside rounds & teaching


There were a number of striking differences in the Shantou hospital wards compared to our Canadian wards, but the most notable by far was the organization of care. In North America, family physicians (known in the past as “GPs”) are the first stop for the vast majority of patients. Sore throats, earaches, slipped discs, period problems, prostate problems, depression, pregnancy… most health concerns can be treated directly by a family doc, but if need be, the patient is then referred to the appropriate specialist for more unusual and complicated health conditions.

This type of healthcare organization, aka with a “primary care” focus, is rare in China, and the vast majority of individuals in China bypass primary care physicians and attempt to access specialists directly for all healthcare concerns. In other words, if you have a headache, you try to see a neurologist. A cough and sore throat? You hope to somehow snag an appointment with a respirologist. Partly this is due to cost: with China’s three-tiered system, individuals are required to pay for most services out of pocket, so patients do not want to risk having to pay a family physician and subsequently pay another fee to a specialist. Furthermore, there is a strong historical component that has cultivated a sense of mistrust towards the idea of primary care.

Several decades ago, the concept of “primary care” referred to farmers in rural areas who received a mere 3 months of training by urban medical professionals, in an attempt to address healthcare access issues for the enormous rural Chinese population (which represented 80% of the total Chinese population during the 1970s and 1980s). While these “barefoot doctors,” as they came to be known, provided some relief to the healthcare crisis, their training and medical expertise was understandably unequal to that provided in tertiary care centres staffed by fully trained physicians. The barefoot doctor system eventually collapsed under economic policies introduced during the Cultural Revolution.

Family Medicine was only introduced as an official specialty in Chinese medical schools in 1999. In 2009, new health reforms were put in place in response to rising public frustrations over difficulties in accessing professional medical care, as well as the steep prices associated with healthcare. The Chinese government instituted a goal of training 300 000 family physicians by 2020; even this impressive number, however, would still only provide 0.2 family doctors for every 1000 citizens (in comparison, consider that there are 1.17 family docs per 1000 Canadians – ~6x more than in China – and that is still woefully inadequate!!)

Some may think that China’s approach to healthcare is actually more effective; after all, cutting out the middle step of a family physician should likely result in faster and better service, right? On the contrary. Since 2009, primary care use in China has decreased, while visits to hospitals and specialist services have increased significantly. And sadly, death from all causes, money spent on healthcare, and inequity between rural and urban health measures have also increased in China. Multiple studies have shown that regular primary care improves health outcomes and reduces time spent in hospital. But unfortunately, in China, people with multiple different health concerns tend to use specialist and hospitalist care over regularly seeing a family physician. Moreover, people with lower incomes tend to have poorer access to primary care services, and therefore are at a higher risk for poorer health outcomes in general.

The partnership between our university and Shantou has been an exciting adjunct in addressing the primary care gap in China. While in Shantou, Canadian Family Medicine faculty and residents were very involved in giving lectures to and leading discussion groups with Shantou medical students and residents.

It was fascinating to discuss both the differences in clinical approaches between China and Canada, but also realize just how many similarities existed between our sites. As one preceptor stated, “We are all just trying to provide the best care possible to our patients.”

Piqhiqpaa? Piqhinngittuq.

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ᐱᖅᓯᖅᐹ? (Blizzard; Is there a … ?)
ᐱᖅᓯᙱᑦᑐᖅ. (Blizzarding; It is not .)

When one kind of accidentally realizes they’re going to be away from home for 3 months, the option of trying to see one’s spouse occasionally comes to mind. Josh and I tossed around endless possibilities, trying to find what made most sense: Should he come to Toronto, about the halfway point of my travels, which would also give him the chance to see his cousins? Should he come to Ottawa, getting to stay with my family and one of his best buddies, but then would that be silly if I was going to be in Winnipeg (albeit very briefly) the next weekend? At the back of our minds in all these discussions was the dream of him visiting me in Rankin, but it remained firmly in dreamland. While I knew his intrigue for Nunavut was at least equal to my own, we also knew that flights to the Territories are prohibitively expensive at the best of times, let alone for a brief weekend visit.

Air miles, on the other hand? Apparently cheaper to get to Rankin than Ottawa.

And suddenly our complicated decision-making got a whole lot simpler!

His flight blew in Thursday night, just hours ahead of a blizzard that would shut down the town the next morning, leaving us with an open day to explore Rankin in the daylight. With sunset sweeping the skies by 2:30PM, extra daylight hours are not something to take for granted!

11:30AM

2:30PM

Josh’s welcome feast of leftover birthday kwak and maqtaq… I assured my host he most definitely would NOT mind leftovers, particularly of this variety!

Josh trying his hand at the ulu, under Aanak’s watchful eye

Aanak’s expert ulu wielding

Sadly leaving Josh at home, I blindly made my way to clinic through the gusting snow on Friday morning, only to be informed an hour later that we were now shut down. Apparently there’s an Environment Canada gnome who sits on high and makes the call of Blizzard or Non… and apparently he slept in on Friday. Gnome needs to get his act together!

As I struggled back home and was swept in through the door by the winds, I was greeted by my host and her friend having coffee. “Pshh” they scoffed. “This isn’t even a real blizzard. You can still see the car in the driveway.”
…I’d love to know what Toronto would think of this system.

Josh’s visit fortuitously fell on a Flea Market weekend, where the whole hamlet gathers at the arena to hawk traditional felted banners, sealskin gloves, hand-sewn parkas, and spring rolls from the Filipino family in town. We continued our shopping expedition by combing through every inch of the tiny but packed craft store Ivalu, stocked by artisans throughout Nunavut.

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We then holed up at The Matchbox Gallery for a few hours, hearing the fascinating history of the ceramics studio from the artist-teacher gallery owner Susan Shirley. After the original nickel mine closed in the 1960s, Matchbox was first opened as a government-run program to train ex-miners in a new craft: sculpting and ceramics. When government funding ran out, Jim and Sue Shirley took over the gallery and continued coordinating art classes and studio space for local artists, “preserv[ing] the reputation of Rankin as the only community producing Inuit fine-arts ceramics in the world.” You can find Rankin work at the National Gallery of Canada, the Winnipeg Art Gallery, and throughout Europe and the USA.



Sunday however, was my favourite day, when we finally did what I’ve been wanting to do since I first arrived: Venture out of town and onto the land.

Perfect weather for an adventure!

Sea ice waves still struggling to surge in the tide of Hudson Bay

Dabbing at Char River … inevitable when one of your hosts is 9 years old

Photos could not begin to capture the ethereal beauty of this deep port bay

Classic Canadian method of warming up frozen toes and fingers

This time, it was only a weekend. But we will continue to seek out those beautiful and wild places we may one day call home together!

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For anyone who read to the end of this most momentous post, congratulations!!! Thank you for sharing in saratreetravel’s ONE HUNDREDTH POST!!! The first person to post a comment containing a limerick or haiku about their favourite travel adventure will be contacted personally by saratree and receive a Northern prize (that may or may not be fermented walrus, depending on the rest of Calm Air’s passengers feel about that… but I have a feeling they’d be down).

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ᖁᕕᐊᓱᒃᑐᖓ (quviahuktunga!)*

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Being the youngest of four kids with nine years between my older sister and I, the (almost) youngest of a large extended family, and a December baby to boot, I am in the unique position of having a long period of observation of others celebrating birthday milestones before it is my own turn. This year in particular has seen high school friends one after another celebrate / bemoan / shrug off / enthusiastically embrace the big 3-0.

30 seems to strike more significantly than 20. At 30, many people around me have long graduated from post-secondary training, are more settled in long-term relationships, are starting to gain confidence in their current career… and sometimes more importantly, are truly starting to question if they are comfortable where they are and what they want to do about it if not. At 30, we are in the unique position of having gained some essential life perspectives, and are now wanting to go back and apply that needed perspective to all the important decisions we made during our 20s!

For myself, I am still in school (and damn Med still makes me call it an “undergrad”), having taken a number of years between my first undergraduate degree and entering Medicine. I have already had one life-changing career as a biochemical technician in an interdisciplinary research lab, but even at the time, I knew it was a career that would not be permanent. I am in a relationship with the same individual I have been with since I was 20 (!!!), but both him and I have changed so much and spent just as many intense days living our individual lives apart from each other as together that it sometimes seems as though we have had a number of different unique and life-changing relationships with each other. And through everything, I have never stopped questioning if I am comfortable where I am at, and what I should do about it.

My difficulty in making decisions is a running family joke, whether it’s ordering ice cream at BDI or choosing a university degree. I’m often tempted to succumb to the general mantra that I should be done university already / have a permanent career already / have bought a house already / have kids already / spend more time with my husband already. But I am thankful that I was raised with a joy of pursuing the unique and the unknown.

Talk about people paving their own way… who needs a road when a field is right there!

I grew up with a conservative small-town Ukrainian Baptist mom… who eschewed all norms and moved to Flin Flon on her own for her first nursing job. A cousin who, when I wistfully talked about wanting to take a trip after graduation, asked, “Well, where are we going?” and sent me an email the next day with flight itineraries to Rome. Inspiring preceptors who see their role as physicians to recognize inequity and take action now to address it, no matter how unpopular it makes them with more mainstream medical colleagues. A best friend I met at camp when I was just 14, who also loved spontaneous road trips and was willing to move to Argentina for a year to live in a tent and wanted to learn firsthand from Northern Manitoba populations and threw himself wholeheartedly into recording an album when he already had a full-time job.

And yet another of my heroes: The Nunavut Cyclist

As I sat down on the eve of my 30th birthday to contemplate life and things (as I felt one should do on the last day of their 20s), I realized just how thankful I am to have surrounded myself with people who not only recognize the life-shaping value in pursuing the unique and unknown, but have embraced it for themselves.

With pursuit of the unique and unknown as my guiding philosophy for the last 3 decades, it seemed very fitting to celebrate this decade turnover in Nunavut, living with an Inuit family, learning a craft that inspires and terrifies me (aka Medicine), and surrounded by one of the most beautiful landscapes in the world.

Impromptu breakfast performance by my host and her “throat singing soulmate”

The morning of my birthday, I heard my host yelling to her 9-year old son, “Run to annanaqa’s (auntie’s) and grab the maqtaq for tonight!” After a busy day at the health centre, I walked home and found cardboard already spread on the ground, graced by 2 massive chunks of frozen meat: maqtaq (beluga) & tuktu (caribou). My host busily laid the cardboard table: uluit at the ready for slicing thin strips of tuktu, small dishes of soy sauce and hot butter and onions for dipping, Greenlandic Aromat spice. It was enlightening chatting with my host’s sister the other night, who told me, “I hate it when Southerners assume we’re all poor because we eat on the ground. We always eat on the ground for certain foods, even if we have a table. You can’t cut maqtaq on a table.” Or as my host put it, “People with food on the floor are rich.”

“These Pampered Chef knives have a lifetime warranty. I’ve already had 3 replaced. The last time, the customer service rep asked me what I did to the knife, and I told him I was trying to cut a caribou head open. He told me, ‘Ma’am, you probably shouldn’t do that again.’”

Aftermath!

I still catch myself looking for a restart button on my decisions. Yes, I could have been graduated from Med at this point and been an attending physician already for 3 years. But then I wouldn’t have toured Great Britain with my chamber choir while at Prov for a year, igniting my passion for music and travel. I wouldn’t have built on my French at CUSB. If I didn’t work at camp all those summers, sacrificing some connections in the city, I never would have been on the drama team, wouldn’t have been at FRBC that night, wouldn’t have asked Josh for a ride or Michelle for her mom’s contact information for a lab job. If not at the lab, then I wouldn’t have learned about social determinants of health or interdisciplinary collaboration, or first been challenged by my own racism. If not for those 2 years in Nursing, I wouldn’t have built my interviewing skills, wouldn’t have taken Economics or Native Studies. If not for all my university wanderings, I wouldn’t have run into Josh again at Fort Garry campus – so no band, no Argentina, likely no learning a third language, definitely a lot less love. I wouldn’t be me, with all the experiences and empathy I can offer to my future patients.

I also struggle with the trap of worrying about how much time I’m ‘wasting’ before getting to start living my life. The only thing that is a waste of time is that thought. A life does not start once I start receiving a regular paycheque or making regular down payments or having a regular address that my bills can be sent to. All these things that I’m doing or have done – studying, arguing with MPs, putting my thoughts in order on this blog, exploring new locations for a week or for 8 months or for 10 years, putting in sutures for the 1st time and the 50th time, going to my mom’s for supper, going to Nunavut for supper – This is my life and I’m living it right now!

While hard to see in the moment, it was an incredible exercise to sit down on December 4 and trace the path where my decisions have led me thus far, all I would have missed if I had chosen differently, and all the unknown opportunities still open before me. I am so thankful for this life, shaped by the pursuit of the unique and unknown!

* “Quviahuktunga” (ᖁᕕᐊᓱᒃᑐᖓ) = Happy (I am…)

Truer North

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Nunavut.

The word evokes such longing and mystery, perhaps in part because I actually remember the announcement of its creation as a territory (also perhaps because that memory occurred while I was sitting in a junior high science class, a location that also evokes feelings of longing [but to leave] and mystery [but of acids and bases, which I still don’t fully understand]). While both the sara and the tree authors of this blog are titillated by the thought of any travel, the far North of Canada holds an especially strong fascination for each of us.

Which is why, when an inspiring physician mentor asked me rather out of the blue if I’d be interested an elective in Rankin Inlet, I couldn’t stammer out my acceptance fast enough. It turns out that she was offering an elective that did not quite exist yet: While the site took pre-clerks for summer early exposures and resident physicians for part of their Family Med specialty training, Rankin had never before been a part of the electives list for Med 4 students. Like so many other decisions I made this fall, trying to apply for an elective we were creating on the spot made my elective application process exceptionally interesting!

Hiccups (like finding out only a few weeks ago that one apparently needs a special educational permit to practice in Nunavut which normally takes months to procure… but I got that bad boy with days to spare, thankyouverymuch!) and weather advisories (apparently the day of my flight here was one of the few days this month they didn’t have a blizzard!) aside, it has actually been a remarkably smooth transition to this, my last out-of-province elective of these crazy 3 months away. After a rapid-fire but perfect 36 hours home in Winnipeg (huge thanks to Tree and our lovely roommates Scott & Laura for making that happen 🙂 ), I repacked my bags, traded my spring jacket for my new long down parka, and climbed aboard a tiny plane for a bumpy ride north.

Serendipitously (although the more remote you wander, the more frequently serendipity seems to become the norm), my host’s son and an indeterminate amount of cousins were on the same flight from WInnipeg as me, so I was welcomed at the airport by a bevy of friends and relatives who all seemed to pile into the car with us for the drive home. After a late night supper of delicious homemade ribs (my host apologized that they had just run out of caribou meat, but assured me her dad is going hunting this weekend!), I crawled into bed and had already drifted off by 10PM… when suddenly at 10:30 a crashing knock at my door sent me bolting upright. “Sara!! We’re sorry to wake you, but there are bears at the dump!!”

My host had seen her friends posting on Facebook pictures of a momma polar bear and cub meandering through the town, a rare sight in this town that is normally too far inland for bears to venture. We hopped into her truck and tore along the rimy roads to the dump, where we were greeted by the lights of 20 other trucks already sitting for the show. (Un?)fortunately, the wildlife rangers had chased the bears from town by the time we arrived, so we had to content ourselves with the ominous beauty of a massive harvest half moon, and the thrill of trying to back the truck down a narrow ice ridge lined by looming piles of snow and trash.

ᖁᔭᓐᓇᒦᒃ / qujannamiik / quana / ma’na (just starting to learn the difference between Inuktitut dialects!) for the first memorable day of many…

The Revolutionary Practitioner Manifesto

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My electives adventure all started by securing a spot with the University of Toronto’s Health of the Homeless elective, and building the rest of my schedule around it. Even knowing what we do about the connection between social determinants (such as income, housing, race, and gender) and health, I had never seen another medical elective specifically designed to address the populations most in need of medical services.

Inner City Health Associates (ICHA) is a group of over sixty physicians dedicated to providing care to those who truly need it most – those without housing, without income, without identification, and often with complex health struggles for which they have been repeatedly refused care. Our existing system has been carefully built to ensure that those who could stand to benefit most from health care are effectively barred from accessing it. For example, even in our “free” Canadian healthcare system, care is extremely difficult to access if you do not have proper identification, like a provincial health card. However, in order to access a health card, you need proper identification… Hang on a second. Something isn’t adding up…

ICHA docs see this paradox and work to correct it through education and advocacy at all levels of the system (the public, policy makers, and other healthcare professionals), reminding people of the undeniable connections between things like income, housing, and health.

Higher income and social status are linked to better health. The greater the gap between the richest and poorest people, the greater the differences in health.
World Health Organization

I say “remind” because we first learn about the social determinants of health as early as UNICEF Halloween presentations back in Grade 1 (or if you’re evangelical by trade, then World Vision sermons before you were even out of the womb), where we are taught that poor kids are sick and need our help. Crude and incomplete, but built around an important truth: Poverty contributes to a lack of health. And many factors contribute to poverty. “The social determinants of health are the conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power, and resources at global, national, and local levels” (World Health Organization, 2017).

When I am one of the privileged wealthy (and by that, I mean I can read, have stable housing, food in the fridge, safe drinking water, and a physician who won’t refuse to see me because of my housing/sexual orientation/age/illness), I need to look at how I am contributing to – or at the very least, not working to change – those factors contributing to other people living in poverty.

And this is what moved me most about the ICHA docs. Their ultimate goal is for public perspective and the Canadian healthcare system as a whole to shift towards a system that is truly equitable, accessible, universal, portable, and comprehensive (hmmm… sound familiar?) So ICHA docs are dynamic teachers in the hospital, devoted mentors of medical students, passionate advocates on Parliament Hill, and constantly working with policy makers to encourage systems level change (I myself had the privilege of attending a breakfast meeting with the Law Commissioner of Ontario to discuss a new policy of palliative care). But in the meantime, if they cannot convince others to join them in providing quality care to those who need it most, they just go out and do it themselves.

For example, I worked with 2 physicians at a refugee health centre, a tiny room nestled within a shelter for newly arrived refugees. For many who have arrived in Canada fleeing persecution, there is a lag between when they arrive here and when they have their court hearing to actually receive their refugee status (ironic, because these individuals have been experiencing persecution for years, but are only recognized as a refugee once they are safe in a country defined as free from persecution). This lag, which can be many months, is a time of immense vulnerability for these folks, since they are not only fleeing immense trauma, not only adjusting to a new culture and climate, and not only trying to accomplish the daily tasks of living we all must do (families have to eat, kids have to get to school, spouses occasionally want to talk), but if they get sick, accessing healthcare can be immensely complicated (remember the ID/health card shenanigans described above??) Furthermore, it’s not just the usual pneumonias and UTIs that can get them down. Many come from countries where immunizations were unreliably accessible and where certain infectious diseases and genetic conditions are much more prevalent. When you are focused on daily survival in a refugee camp, screening for genetic blood conditions may not seem high on the list of priorities. But when you trying to live peacefully in Canada with hopes of surviving past age 45, suddenly that condition takes on a new importance.

In every new clinic I worked in (and I had the privilege of working in many… too many for a single blog post!), I made a point to ask the physician “How??” How did they end up here? How did they get the funding, the building, the equipment organized? How did they make it a reality to provide care to a population where literally no care existed? And their answer was almost always the same. They’d shrug and say something along the lines of, “Well, I knew it had to be done… so I just did it.” For the incredible docs at the refugee clinic, “just doing it” included rummaging in the basement of the major TO teaching hospital for discarded but still usable supplies. It meant 2 docs carrying each end of an old examination table to get it up the street from one clinic to this one. It meant these same 2 guys coming in at midnight after their workday to paint the new clinic room themselves. It meant them going to hospitals and administrative boards and other physicians and saying, “It would help so much if you could provide funding and staff. But if you can’t, we’re going to be doing this work anyways.” They continue to volunteer their time one day a week to provide healthcare to undocumented refugees who simply could not receive care anywhere else, and they also donate their money earned on other days to an emergency fund for their families who cannot afford their prescription medications.

I met psychiatrists who literally went into ditches and bus shelters to provide emergency mental health care where it is so desperately needed most. I worked with a palliative care doc who zips around Toronto in his little car, bringing comfort, dignity, and company to beautiful people who would otherwise be dying alone in back alleys and basements because they were refused care everywhere else. I carefully stepped around and over bodies jam-packed into a shelter common room to get to a woman so ill with uncontrolled diabetes that she could not come up to the clinic to be examined. On my first day working with one doc, they handed me a copy of their own personal Manifesto of a Revolutionary Practitioner.

“I only realised at age 60 that I needed to articulate my vision for practicing Medicine,” they told me. “I hope you will write your own much sooner than that.”

As a skilled professional, so much has come to me – opportunity, education, mentorship, social standing, income (one day!) Have I worked hard for it? Absolutely. But me working hard is not the point. We have put barriers in place to stop people who need care from coming to us. So the time has come for us to go to them.

What can we practically do? Most importantly, start to notice our own reactions to people who are homeless, poor, struggling with health problems. These are not the people we should be uncomfortable having in our hospitals – these are the people who most need care. Next, take the opportunity to start conversations with friends or families who may talk about the vulnerable people in our communities less than kindly. Heck, send them to read this blog! When you vote, look at how your representative talks about things like housing, access to clean water, autonomy for Indigenous populations. We know that upstream action ultimately is most profitable for all involved (sorry guys, “trickle down economics” isn’t a thing; actually, the opposite is true**), so make sure we’re supporting policies that will support all of us. And ultimately, I want to remember the ICHA docs: If something needs to be done, maybe we just need to do it.

In other words, if you find yourself painting a clinic at midnight, give me a call – I’d love to join you 🙂

Getting to a new clinic every day meant a LOT of public transit adventures…

A much needed evening of renewal at a BYOM Poetry Open Mic (Bring Your Own Mug for tea!)

** The IMF and the OECD have found that there is an inverse relationship between the increasing income share of the wealthiest and overall economic growth. If the income share of the top 20 percent increases by one percentage point, GDP growth is actually 0.08 percentage points lower in the following five years, suggesting that the benefits do not trickle down.
Shimman & Millar, 2017