Month: September 2022

US/CANADA Border Crossing Regulations for Covid End Next Week

September 29, 2022

The federal government just announced that Covid-related regulations crossing the border will end next week. It has been a nightmare to cross the border for the past couple of years. The danger of people coming to Canada with Covid infections led the government to introduce the ARRIVECAN system, mandating people to fill out a complicated form on a cell phone before arriving in Canada. The Americans responded in kind, but strangely, traveling by air into the US was allowed with a negative Covid test while traveling by car was not permitted (unless you were an American citizen). 

Resulting from the different border crossing policies, I experienced the most bizarre situation last summer. I could not drive with Kathy to Myrtle Beach, South Carolina (driving from Ottawa, one has to cross the border). Since Kathy is a dual Canadian/American citizen, she drove to Dulles airport near Washington, DC while I flew there the same day. Coming home was different; we drove together and entered the country as Canadian citizens. And, of course, we had to fill out the ARRIVECAN form before crossing the border.

I have been crossing the border for dog ages; early on, when I went to graduate school at the University of North Carolina at Chapel Hill from Vancouver, I drove south to California and then across the US on Route 66. But even before, I remember our drive to Seattle from Vancouver with my father, who informed the American border guard he’ll stay in the US as little as possible. That comment did not sit well with the official who hauled us in for questioning and then had the benefit of trying to decipher my father’s heavy accent before letting us go.

I have always had some innate fear of talking with government officials, especially police and border guards, who brought back memories of the Hungarian secret police and the aura of the heavy hand of government officials. Border crossing was a chore for me those days, not immersed in the philosophy the police and similar organizations serve you, the citizens of Canada.

I was apprehensive when, with a friend of Italian origin, we drove to Seattle with my newly minted citizenship card in the 1960s. My friend warned me that border officials would haul him in and question him because of his Italian name. Surprised to hear that, I wondered if government officials had prejudices against nationalities, including Hungarians. And so it happened; we were subject to thorough questioning, but I escaped detailed scrutiny, and they let us go. Although this incident confirmed my apprehensions, my discomfort with government officials waned in time, especially after I had joined the government in 1973.

It was easy to cross the border into the US in the old days; all you needed was identification like a driver’s license, which, of course, I always carried with me. The reverse, crossing into Canada, was the same. But sometimes you did not even need a solid piece of ID, as when my son’s friend, a recent Russian immigrant to the US, came to visit us in a rented car with neither US citizenship nor a valid driver’s license. He successfully talked his way into Canada at the border and confirmed the ease with which one could enter Canada.

Many of our family border crossings started with camping in New York State. An hour’s drive from us in upper New York State, the pine-treed campgrounds were not only cheaper to stay at than comparable Canadian facilities, but were also less crowded. And, we found wine cheaper down there and the challenge was how to import wine to Canada. Some people suggested I should fill up the water tank of our tent trailer with wine coming home, but I resisted; the water container would have had a taste of having been filled with wine, not the taste of choice of family members. (The limit for importing wine was two bottles per adult). Then we discovered ‘two-buck chuck”, the wine distributed by Trader Joe’s, the retailer in the US.

A case of two-buck-chuck, even paying the customs duties was much cheaper than anything we could buy in Canada. Most of the time, the Canadian customs officials just waved us on when we told them we had a case of wine worth US $24, altho once they told us to go into the office and fill out all the customs papers. This experience cost us ten dollars, but I found it to be a real bother and time-consuming affair as well.

My good luck of never having trouble at the border rossing nto the US ran out when I arrived at the border with my carpentry tools in the car. They immediately sent me inside and took apart my car, checking all the tools. I was going to build a deck for my son’s house, but the border officials were suspicious that I had other intentions. They were afraid that I would take jobs away from Americans. It took over an hour to get on my way; I pointed to my gray hair and said I was retired and had no intention of working and taking a job away from the locals. Further, I explained to them I had lived in the US for years but came home to Canada for my career, which was over.

Complications arose when I mentioned I had an expired draft card with a 5A rating. The younger officials knew nothing about draft cards and I tried to describe the Vietnam war and how Americans were drafted for service. This entire episode came to a hilarious end when an older border guard burst out in a boisterous laugh and explained to the younger officials what had happened in the sixties. The bottom line was that they took away the draft card I cherished and carried with me all the time when I worked in Norfolk, Virginia, in the sixties.

But the border is a two-way street and I never forget the incident when I bought a bottle of liquor at the duty-free shop coming home and the Canadian border guard asked how many ounces were in the bottle (there was a limit on how much one could bring back home). I looked at the bottle for information but could find none. I told the official I bought it at the duty-free store and had to be a size permitted for import to Canada. But he would not budge and I was ready to consume part of the bottle when he suddenly decided to just let us go, looking at the lineup behind us. As soon as we crossed the border, I felt some corrugations on the bottom of the bottle, and lo-and-behold; I found the information I had been looking for.

But next week we will go back to the old days, and a passport will be sufficient to enter Canada. The US is already open with a Canadian passport. Hurrah! Were the heavy-handed regulations preventing the entry of people with Covid useful and worth the cost of losing the tourist business? We’ll not know unless the government undertakes a study of it.

Homelessness in Ottawa; an Election Issue

September 22, 2202

One of our mayoral candidates in the municipal election, for Ottawa this fall,

vows to end chronic homelessness in Ottawa, in four years. This is a bold and noble goal. Does this mean that there will be no homeless in Ottawa in four years? Do we know how many homeless people we’ll have in Ottawa in four years? No, we do not. But, OK. This is a lofty goal, and we should not get hung up on details.

I found statistics on homelessness in Ottawa difficult to understand. The best information I gathered is there are between 1400 and 1800 homeless in Ottawa, on an average day.

Compared to other Canadian cities, the size of Ottawa’s homeless population is not the worst. The homeless population in Red Deer is 0.31 percent of the population; in Vancouver and Edmonton, it is 0.27 percent, while in Ottawa, it is 0.18 percent.

Homeless people concentrate downtown Ottawa to the huge displeasure of the area’s residents, while the problem is much less apparent elsewhere in the city.

In a survey conducted on October 27 and 28, in Ottawa, 55 percent of the homeless used shelters while 9 percent slept on the streets. Others bunked down with friends. (Over half of the homeless were racialized, and of all the homeless, over 25 percent were Canadian natives).  

 The mayoral candidate proposes to build “supportive” housing for 250 individuals and provide housing “allowances” for another 250 people and families. Although it is good to have a specific proposal, the downside is that there may be more homeless in four years, in which case, the candidate will not achieve the stated goal.

But, to me, the more important question is whether a sustainable long-term solution to the homeless problem is achievable by building and subsidizing housing. Why have people become homeless in the first place? Surveys show that although housing is important, substance abuse, poverty, mental health issues, and low wages are common characteristics among the homeless. I think these underlying issues will have to be dealt with before finding a sustainable solution. Otherwise, this proposal will be nothing more than a bandaid for the short term.

And if the word spreads that Ottawa is kind to the homeless and provides housing for them, the homeless from other parts of Canada may flock to Ottawa. The homeless population may balloon.

The City of Portland OR is an example, where a sympathetic Mayor tolerated tent encampments to such an extent that in some neighborhoods people are afraid to walk on the streets. Vandalism and robbery have become common. I am sure Ottawan does not want to follow the Portland example.

Providing subsidized housing is one answer to homelessness, but until governments deal with mental health issues, substance abuse, education, and the availability of sustaining jobs, I do not believe homelessness will be solved any time soon.

Morning Musings

September 18, 2022

You have seen the news on TV and in the papers that our hospitals are short of beds. Patients are in the hallways waiting for an empty bed. Hospital administrators express the shortage of beds statistically: the hospital is 110 percent occupied.

The government is aware of this, but hospitals are expensive to build and take years to construct. So, the shortage is not likely to be alleviated soon.

Part of the problem is patients who need an “alternative level of care” or ALC and not acute care provided in a hospital. These patients are ready to leave the hospital but need a level of care that may not be available in their homes or have family willing and able to care for them. They need to move on to long-term care facilities but may be choosy and not willing to take the next available vacancy wherever they may be.

To satisfy the need for beds, hospitals rent entire floors of hotels to place the ALC patients today at an enormous cost to the public but not to the ALC patients, who get a pleasant room and food at modern hotels. No wonder they do not want to leave.

In trying to solve this problem, the government decided to act: next week ALC patients will move to any available long-term care home vacancy within 70 kilometers or pay $400 a day if decide to stay in the hospital or hotel. A drastic but possibly necessary measure to ease the problem of overcapacity hospital use

I got thinking about who will select the ALC patients to move; who will make the arrangements for the move and what kind of negotiations will take place between the patient and the hospital administrators.

The doctors already have signed the patient into the ALC category. There may be dozens of these patients in the hotels and some still in the hospital occupying beds needed for acute patients. The hospital administration will have to establish a group of people tasked with moving these patients into long-term care homes.

I can see a hospital administrator assigned to a patient searching for vacancies in long-term care homes, not more than seventy kilometers from …is it from the hospital or the address of the patient? Then, he will have to negotiate with the patient over the available choices.

The clock is ticking for the patient at $400 a day. A decision would have to be made soon to avoid an expensive hospital stay. And what if the patient refuses to leave? And may not have the resources to pay for an additional stay at the hospital. Surely these patients will not land on the streets as homeless people?

The family of the ALC patient may get involved; they would like to visit their loved one and would prefer a long-term care home near them. Not only that, but some of these homes have acquired a terrible reputation in the past years because their staff and the ALC patient may refuse to move there.

I see a messy process and a difficult one: how to move ALC patients out of hotels and hospitals peacefully. Arguments with family and the patient may erupt and lawsuits started. And I see a huge amount of additional work for hospitals. Only time will tell how successful the program will be.

Experience with Doctors and Pharmacists

September 10, 2022

In late August at the cottage, I had a few cups of black coffee before breakfast. Soon after finishing my coffee, I felt queasy and dizzy. I had to lie down to get my mojo back; it took a few hours to get rid of the dizziness.

The next unpleasant experience occurred during the drive home from the cottage, when I suddenly felt like blacking out, with my vision blurring and experiencing weakness. It took a few deep yoga breaths to get my composure back. Fortunately, I was on the passenger side.

These scary experiences led me to an urgent visit to my medical clinic. There, the nurse practitioner gave me requisitions for blood testing, a Holter monitor (heart monitor) for seventy-two hours, a stress test and an ECG.

The next morning, I still felt dizzy and that made me go to an emergency room (ER) where they put me thru a thorough blood test, urine test and an ECG. After six hours the emergency doctor gave me a clean bill of health and suggested that I follow up with my family doctor should I continue to experience dizziness.

If my heart is all right, what might cause the morning dizziness (by the afternoons the dizziness subsided)? I became suspicious of one new pill I take, prescribed for me a few months ago, and I stopped at my pharmacist to check if some of the meds I take may work against this new pill. The pharmacist found this pill contradicts in its effect with another one I take and recommended a change to one of them. The next day I saw the prescribing doctor, who immediately agreed with the pharmacist’s  advice and gave me a substitution, another pill.

In some ways I was stunned the doctor did not question the advice from the pharmacist at all: but it made me think, do doctors know and understand what they prescribe? What damage could wrong prescriptions cause to patients?

My appreciation for pharmacists went up a few notches; they are knowledgeable of pharmaceuticals and decided that they know more about meds than doctors.

Based on the results of my visit to the ER, we decided to follow up on our vacation plan to go to Myrtle Beach, SC, and meet with family for a few days. It was a two-day trip, and we enjoyed the vacation until I received an email to phone my medical office immediately. When I contacted them, they told me to go to an emergency department ASAP. It was a terrible downer for me, and I asked what the cause or the reason was for going to ER, ASAP. I explained that I was in South Carolina and despite my Canadian medical insurance, it could be an expensive affair. I talked with a nurse at the clinic who did not know why I should go to ER immediately but promised to email the doctor to find out the reason: what was I going to say to the local ER, what was wrong with me which brought me to ER?

The nurse responded by email in an hour, and repeated that I should go to ER and attached two reports and told me to print them out to take with me – the results of the ECG and the results of the Holter report. We consulted with two acquaintances, both doctors, one is an ER doctor, and sent them the Holter report and the ECG, which they found not super urgent to attend to.

Confused by all these views, we decided to see how I felt the next day and still feeling bad in the morning we decided to drive home.

The next phase of my adventure was even more strange; we went to a different hospital ER in Ottawa, where I went thru all the testing again only to be told the Holter and ECG reports did not justify leaving our vacation early. This ER doc consulted with a cardiologist, so the news I received was very comforting to me.

So, what do I make of all of this when my family doctor says I am in dire need to visit an ER and two other docs and a second ER visit give me a clean bill of health? One must conclude that the medical advice from my clinic was misguided or plain wrong. Perhaps the attending doctor on duty at my family clinic was not fully knowledgeable how to interpret Holter monitoring results?  But why did he/she not call me to explain why my situation was bad? Is this expecting too much?

But, if I had gone to a local ER in the U.S. and if they had found my visit unnecessary, my insurance would not have paid for the visit, potentially costing me thousands of US dollars. And it may have given me a black mark in my record for future travel insurance, having a heart issue identified, even if it was wrong.

I think it was wrong of the attending doctor at my clinic not to check with other doctors or a cardiologist before ordering me to visit an ER, ASAP.   But, perhaps more importantly, he should have communicated in person, by phone, to tell me the “dire” news.

Although I felt much better being at home, I still felt a bit weak the next few days in the mornings, and now I was beginning to suspect that it must be my meds that are the problem, since I was fully examined and tested in two ERs over a two week period. So, what do I do? I looked at my meds again and talked to two pharmacists to check out how my meds may interfere with each other and what side effects they may have.

Both pharmacists immediately identified that I should not take two of my pills at the same time and suggested that I take one in the morning and the other in the evening. Not rocket science if you know your pharmaceuticals.

Lessons learned: do not immediately believe what your doctors tell you; ask for explanations. And check with your pharmacist regarding your pills. My appreciation for pharmacists had jumped astronomically after these recent experiences with them.

Canadian Healthcare 2. Patients Dying in ER and Other Critical Issues

September 6, 2022

Canadians pride themselves on having the best healthcare system in the world. Politicians tell Canadians they have the best system. And people believe it is good because it is publicly funded and is universal.  Yet, studies consistently show that the Canadian system ranks often at the bottom in terms of access, etc. among OECD countries.

Private healthcare is anathema to the Canadian public; they have been led to believe it would draw doctors away from the public system and create double-tier healthcare benefiting the privileged classes, which includes politicians, people of influence, and physicians). who can pay.

Yet, eye care, dental care, physio treatments, and other healthcare services have always been provided outside the government’s healthcare system.

The government pays doctors’ fees for their services. Doctors are small business owners, but their practice is controlled by the government paying agreed-upon fees for patient visits, procedures, and other consultations. The fees are negotiated between the doctors’ association and the government periodically, just like union/employer negotiations.

Not everybody has a family doctor. Due to the shortage of doctors, people are encouraged to use emergency rooms in such situations. That is one reason why ER rooms have become crowded, but what other options do people have if they do not have a family doctor? Compounding this problem is the fact that family doctor clinics more and more choose not to provide holiday and weekend coverage – sending people to the ER as well.

Now Ontario faces the terrible challenge of crowded ER rooms where people die awaiting service.

In a recent article on Canada’s worsening health care crisis, the National Post’s Sharon Kirkey quoted medical insiders who said that emergency rooms are now so backlogged that Canadians risk seeing rising numbers of patients killed or permanently disabled by otherwise preventable conditions.

“I never thought I would say that. But those of us working in emergency medicine have seen people with serious problems … not be able to access the actual department,” said Saint John emergency doctor Paul Atkinson.  

Reading this article, an American friend commented (and most Americans think Canada has a great healthcare system):

“Sounds as if the ER situation is seriously dire! Never imagined ERs would ever temporarily close or that triage would fail so miserably. Why aren’t student nurses or even orderlies pressed into service in waiting areas checking at frequent intervals on people as they wait to be seen by doctors, by doing even basic things like talking to people to see if they are still breathing, worsening, or still stable??  Very stressful time for patients, family, and staff. Burnout and attrition among stressed medical staff bound to worsen, just as it has among teachers, school bus drivers, police, etc.—no easy solutions, but the policy makers better try to find more sustainable procedures asap before the systems crash entirely.”

My wife, who has spent many years volunteering in the healthcare field responded to her:

“I know a few years ago at the hospital I am familiar with we wanted to use volunteers in one of the cancer clinics to simply review routine things with patients to prepare them before coming in for some treatments…something we had been doing for several years until the unions decided that should be union jobs, so we had to stop using very capable volunteers. Volunteers have subsequently been limited to, for the most part, helping patients and visitors with wayfinding. When a patient is discharged the family often must find the wheelchair and help the patient into it… nurses are not permitted to do that job or wheel patients to their cars and orderlies are not available.”

“Until a few years ago the hospital could perform MRIs for only 7 hours a day because the province only provided funding for the technicians for that number of hours, despite long waiting lists. Of course, the province had no problem opening the MRI area for members of the hockey team because they were “special” and were allowed to negotiate a contract…but only they could use it. Despite very long lineups for all diagnostics, there is no charge to the patient if they do not show up..often leaving holes in the schedule for a valuable resource. The system is in utter shambles.”

“My family doctor recently sent us a note that the clinic will no longer be doing anything by telephone…all requests, even routine prescription renewals, requisition for massage therapy, physical therapy..both of which you need to activate your insurance, Routine monitoring that they used to do by phone will require an in-person visit. We are no longer able to send an email with a question. Never used it too much, thank goodness, but apparently during COVID the province created a fee schedule that allowed the doctor to get the same fee for telephone and zoom consultations as for an office visit but recently apparently lowered this fee, prompting our clinic’s response.  Also, most, if not all, physician’s office and clinics in Ottawa do not have 24/7 coverage. Some have Saturday morning coverage via their urgent care status, but you must have an appointment…if they are booked you are directed to the emergency dept of the hospital.  Our family health clinic, which has 16 doctors, is in this category; with 16 doctors, they do not see it as their responsibility to do after-hours or weekend coverage…referring you to the emergency dept. It is ridiculous and such a waste of resources….and, of course, is a factor in overwhelming the emergency department, and burnout of triage nurses. Just a total mess, last weekend a local Hospital closed its emergency department, as did one of the hospitals in the Ottawa Valley. Hospitals are divided east and west and have worked out some rotation system for closure, I think, because of lack of doctors…”

No question the delivery of healthcare is complex. But many services could be improved right now. Why do we not do it? For example, highly expensive MRI machines sit idly in some hospitals because of a lack of money to pay for staff for twenty-four-hour, seven-day service. And with no financial penalty for people who have an appointment for an MRI,  but fail to show, while others are waiting months. So, we have the equipment and high demand for MRIs, and we let the machines sit idle. Let’s solve this problem immediately!

As well, we should take a close look at the “myth” of private healthcare as undesirable. We should study countries with private/public healthcare systems and develop one suited to Canadians. We would be joining most of the rest of the western world if we did this, including Europe. And yes, we should train more doctors to alleviate the shortage (or perhaps also look at better/easier ways to accredit the large number of foreign-trained doctors who are allowed to immigrate to Canada because of their medical education but wait years to be able to practice.