In Praise of Small Towns

October 6, 2022

It would be nice to live in a small town, Kathy commented when we drove through Elgin, Ontario, on the way home from the cottage. Yes, I thought, there is an aura of quiet peace and stillness in the air, one could live a pleasant life here. You do not find ostentatious houses resembling Italian castles on postage-sized lots, as you see in Ottawa. In contrast, you see simple, functional houses here of modest sizes where one can bring up a family without being afraid of huge heating bills. And, yes, we have met many people with no pretensions and who had done work for us without feeling they overcharged. Would it be a way of life for us to live here?

We came from our cottage, which is a boat ride, and then an 8-kilometer car ride from Elgin. According to Wikipedia, Elgin has a population of 300 people but grows by thousands more during the summer, who come from Ontario and the US. Elgin is a crossroads of two major streets and a few spurs. But the town has a grocery store, two churches, a bank, a pharmacy, a library, and an appliance store. It has a regional high school and a public school as well.

 The town has everything for basic needs, except a gas station; there was one, but not anymore. The owner may have retired or sold out. But the gas station was a place where you could return beer bottles. The same situation happened to a place for refilling propane tanks. Now I have to drive a few miles to the next little town. And Abe, who ran Emmons Lumber, retired as well.

Abe came out to our cottage to give us an estimate for our windows that needed a replacement a few decades ago. In a leisurely conversation with us, he said with a smile on his face, his lumber business thrives on the summer cottagers. While his boys were measuring up the windows, Abe settled down with us and discussed life in Elgin. Our encounter was nothing like contractors we dealt with in Ottawa where a young man, while giving us an estimate of window replacements in our house, sat by his computer and generated the estimate in ten minutes, and then left.

When I needed someone to expand our decking, I called on Chuck (not his real name). Chuck came to see us and, like Abe, had a detailed conversation on what we wanted to do. We staked out the deck and then did a quick calculation of materials and labor and that was the estimate. We never signed a contract. And the job turned out very well.

Country folk have a practical turn of mind and get things done. I like that. And there were many other situations where we found problems solved with no fuss. For example, when our son visited us and ran out of diapers for his baby on a Sunday, the pharmacy was closed. A phone call to the marina where we dock our boat resulted in having the pharmacist open up the store so we could buy diapers; what a demonstration of goodwill!

People know each other in a small town. More than that, they know each other’s families going back generations. This closeness often leads to relationships in the community as we found out that the family running the marina has a family member married to the owner of the grocery store and another family member works at the appliance store.

My thoughts returned to living in a small town driving through the industrial east end of Ottawa with heavy traffic. It is much more peaceful in a small town than in a thriving city. But, and there are always buts, you do not find in a small town a choice of restaurants, community centers with programs such as bridge, and a multiplicity of events from classical music to rock concerts. Most importantly, could an outsider fit into a tightly-knit community where most people know each other? Would they accept newcomers?

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.

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.