Tag: healthcare

The Good Life in Canada in Peril

April 9, 2023

I walked into the garage and stumbled in the dark towards the garage door handle to release it from the cable so that I could push up the garage door by hand; the power was out. We had an ice storm yesterday and the local hydro was still fixing the lines. It was getting cold in the house when we woke up in the morning without power.

When I pushed the garage door up, I saw our neighbor walking towards me up the driveway with a cup of coffee in his hand. And I heard a loud generator working in his driveway, explaining his coffee. He came to offer coffee or whatever we needed. That was nice of him. I told him we were just going to find an open restaurant to warm up and enjoy our coffee and breakfast.

Over our meal, I wondered what a nice lifestyle our neighbor has living in a five-bedroom house with one child. And he works at home allowing him to take a bicycle ride for a break and do chores around the house during working hours.

Canada offers a charmed life for many people, educated here and with a job. I socialize with them and enjoy their company most of the time. They are relaxed and enjoy the good life, although some are smug.

And their smug attitude in believing they deserve what they have bothers me. They truly believe that they worked and earned their status in life. And their good life makes this generation comfortable, less ambitious, and more complacent. Less achieving. I think that this is sad. This attitude, in my view, has pervaded the way Canadians and government look at issues.

I thought of the immigrants coming into this country and fully understand why they want to come here when they see what some people here have. But the immigrants have challenges. They do not speak the language fluently, if at all; they are not familiar with local culture; they have no local experience. And no local contacts.

And now the country allows half a million immigrants a year into the country for the next few years; bumping up the population when a recession threatens, there is a housing shortage and affordability gap, on top of a healthcare crisis. All these issues affect immigrants.

Although we identify these issues with some recalcitrance,we resolve them slowly, if at all. Often, we ignore them, thinking it doesn’t affect us, so no need to do any planning.

Potholes on the streets? No problem, it is the weather. This view is nonsense. The northern states in the US have similar climates with excellent roads.

Healthcare crisis? No problem, we’ll let in more foreign nurses and doctors, ignoring the fact that they have to be locally licensed, a time-consuming exercise that can take years.

Housing crisis? No problem, we’ll let in more construction and tradespeople, forgetting that they also need local licensing, and we also need land to build on.

No land to build on? No problem, we’ll just make our cities denser. We’ll let three units be built on single-family lots in Ontario, starting this summer, which will destroy some older, attractive neighborhoods.

Food price inflation? No problem, the government provides a subsidy; prints money, and just increases the national debt. Debt is for future generations to resolve.

It may be only me but methinks we do not solve problems but delay them, thereby creating fresh problems.

I think the country has become too complacent and downright lazy. We havelost our edge, our dynamism. We sloganeer about equity, diversity and inclusion, and LGBTQ…., matters, and forget that these ideals are impossible to materialize without creating jobs and opportunities and investing in technology and the future. You cannot have equity, diversity, and inclusion in the abstract, it exists in organizations employing people.

So, let’s get back our work ethic and get off our collective fat butts and build the economy by providing the opportunity for future generations.

The Nuclear Stress Test of the Heart

December 18, 2022

I drove over to the east end of Ottawa to the Cardiovascular Center in a strip mall. It was a bad move on my part to hit the road in rush hour, especially with all the construction going on. It was difficult sometimes to find the lanes toward my destination with all the traffic cones, although this was my second trip there. The first time they injected some dye into the blood flow to track the circulation. This time, they would track the circulation after stressing my heart out.

The Cardiovascular Center is in one of the most inauspicious strip malls. And within the mall, the center is between an optician and a pharmacy. The other small stores in the mall range from dog obedience school and physiotherapy to a Middle Eastern restaurant with Arabic writing on the storefront.

Driving to the Cardiovascular Center made me relax; I usually get nervous going to medical buildings. This place in the middle of a nondescript shopping mall is certainly not like going to a hospital and seeing uniformed nurses and doctors rushing around the hallways with official tags around their necks.

I checked in with the receptionist sitting behind a plastic window and sat down in the waiting room on a seat away from the sun that was shining through the floor-to-ceiling windows, making the room feel like a hot greenhouse.

The people in the room were all older, like me, some required canes for walking. One couple was talking loudly, otherwise, the room was quiet and I read my cell phone to pass the time.

It did not take long for a nurse to call me into a room furnished with a hospital bed, monitoring equipment, and a treadmill. Aha, I thought I will use the latter for the stress test.

Then the nurse asked me to take off my clothes from the waist up and lie down on the hospital bed. She put a blood pressure monitor on my arm while talking to me, then put electrodes on my chest. The last connection was an IV needle.

Finding a good vein to insert an IV is always a challenge for nurses. Although I drank a lot of water that morning to help show veins, and she said that she saw the veins, she could not find one large enough for the needle around my elbow. After poking me twice by my elbow, she put a smaller IV needle into the top of my hand.

In the meantime, we had a great chat about Ottawa that relaxed me and brought down my blood pressure, which is always high when I visit a medical facility, even if it is in a strip mall.

She started my IV drip with saline solution to help the veins; she explained it is used to deliver medications. After the saline solution, some nuclear material dripped into my veins to stimulate the heart. All this time she kept asking whether I felt nauseous, had a headache, was dizzy, or was just lousy. I did not have any of those symptoms but was getting anxious, as I started imagining that perhaps I should have those symptoms if the test were working. But she repeated the same questions in a few minutes, and I assured her again that I was fine and told her if she did not badger me, I could fall asleep on the comfortable bed. The lack of any sickness on my part was a good sign, she said, and that made me feel good.

The nurse also explained that if I felt sick because of the nuclear material, she would give me an “antidote” via the IV. Since I was not feeling bad, I am not sure if she gave me any antidote.

The bottom of my arm, which had the IV in it, was getting painful with pressure building up in it, and told her so. She explained that it is the rush of the liquids coming from the IV needle and because the veins are small in the lower arm, the flow of the liquid puts pressure on the walls of the veins.

The only other impact beyond the pressure in my arm was my pulse rate exploding from its normally low rate in the fifties. Perhaps it was the anxiety of doing the test. While the IV drip was going on, the nurse was in front of a monitor watching my performance.

After a while, she said that it is time to inject some dye into my veins for the “gamma” camera to track the movement of blood in my veins, especially around my heart. I said that was fine with me; she could have put any liquid, even alcohol, into my IV.

When we finished with all the cocktails entering my veins, she told me to go outside into a small waiting room and eat the snacks that they had directed me to bring. But I asked her, “When are we going to do the stressing”? and pointed to the treadmill. She replied that the stressing was already done and explained that the nuclear material injected into me made the heart race and mimic the action of the heart when one is exercising. Ah! So that was it. I did not feel like I exercised at all – I did not sweat – and felt gypped not having the chance to jog on the treadmill for a little exercise, but glad the first phase of the testing was over.

So, I went into a small waiting room and snacked. I was hungry by this time; as I had been told to fast for four hours before the test.

After a half hour in the waiting room, they took me into another room with a dentist-type chair. On the left side of the chair, there was the gamma camera, a huge L-shaped machine that covered my chest, and the left side. She moved the camera over my chest and told me to sit on the left side of the chair so that the other side of the L was next to my left side, where the heart is. The camera buzzed for four minutes and then after a break, we did it over again, for four minutes. Then I was done.

I felt quite relaxed coming out of the Cardiovascular Center. It was not only because the staff were pleasant but also because of the venue. We were in a strip mall, and I thought this visit was more like going for coffee at Starbucks than getting a medical exam. Maybe we should have all medical clinics in shopping centers instead of medical buildings. Now I just must wait for the results, which may come in a few weeks.

The Minister of Immigration’s Foggy Response to my Questions on Inreased Immigration to Canada

December 2, 2022

I wrote to the Minister asking if he considered the impact of his bumped-up immigration targets on the Canadian housing market (where there is a severe shortage) and on Canadian healthcare (which is bursting at the seams).

Although it is desirable to have more immigrants to grow our economy, can we provide housing and healthcare to them when Canadians are experiencing a housing shortage, and millions are without a family doctor?

I received an automatic acknowledgment, promising a response in six weeks if my questions are worthy of a response:

“Thank you for your email addressed to the Honourable Sean Fraser, Minister of Immigration, Refugees, and Citizenship. Please note that all comments and questions are taken seriously, and although Immigration, Refugees and Citizenship Canada (IRCC) cannot provide a personalized response to every message, we will review and consider all comments received.”

“…the service standard for a response to correspondence addressed to the Minister is six weeks if it is determined that a reply is warranted. “

A couple of weeks later, I received a form-letter providing officious government bumph but no response to my questions.

“The Government of Canada is committed to an immigration system that contributes to economic growth, supports diversity, and helps build vibrant, dynamic and inclusive communities. The 2023-2025 Immigration Levels Plan, tabled in Parliament on November 1, 2022, projects continued growth in permanent resident admissions with targets of 465,000 in 2023; 485,000 in 2024; and 500,000 in 2025.”

“The Levels Plan sets out a path for responsible increases in immigration targets to support economic growth and address labour market shortages. Over half of all planned admissions are dedicated to the economic class.”

“In 2022, Canada is on track to welcome 431,645 new permanent residents, and the 2023-2025 Levels Plan builds on this momentum. Increasing immigration will help cement Canada’s place among the world’s top destinations for talent, while reuniting family members with their loved ones and fulfilling Canada’s humanitarian commitments, including on Afghanistan resettlement”.

“For further information, I invite you to read the 2022 Annual Report to Parliament on Immigration.”

Ok. There is no mention of the availability of housing for immigrants, or the ability of our current healthcare system to provide healthcare to immigrants.

But wait, I thought there may be more information in the 2202 Annual Report to Parliament on Immigration. So I read the entire report and found the only remotely relevant text under “settlement and integration services”:

“IRCC supports the successful integration of immigrants to Canada through a suite of settlement and integration services. In 2021–22, IRCC funded more than 550 service provider organizations and provided settlement services to more than 428,000 clients. Services include pre-arrival and post-arrival orientation and information services, needs and assets assessment and referrals, language training, employment-related services including mentorship and apprenticeship programming, and services that help newcomers connect and contribute to their communities.” 

Again, nothing on housing and healthcare for immigrants.

Canada’s population of 38 million occupies 16 million housing units, with an average occupancy of 2.3 people per household. Applying this number to the 500,000 immigrants to be welcomed annually in a few years, we would need over 200,000 housing units annually, just for immigrants. But that is the number of units that Canada builds in a typical year. Even if we assume immigrant families double up, the housing shortage would get worse, resulting in even more unaffordable housing prices than we have today. Has the Minister not thought about the availability of housing for immigrants at affordable prices?

What about healthcare? Canada has 2.7 physicians per 1,000 population (in 2021) compared to the Organization for Economic Co-operation and Development (OECD) average of 3.5 (2017 or the nearest year). We do not compare well to OECD countries relative to the number of doctors per 1,000 population.

Applying the ratio of 2.7 physicians per 1,000 population, the half a million immigrants the Minister wants to bring to Canada each year would require 1,350 additional physicians. Would Canadian healthcare deteriorate further due to increased immigration? Would the 2.7 ratio be reduced?

Half a million immigrants annually would require thousands of housing units and doctors if they wanted to live the life that Canadians are used to. The Minister has not responded to my questions on how he would house the immigrants given the already shortage of, and high price of, housing in Canada. And he has not responded how our already overburdened healthcare system would grapple with an annual inflow of half a million of immigrants. Were these subjects an oversight by the Minister? Are we muddling ahead without an analysis of the consequences of our actions?

My Questions for the Canadian Immigration Minister

November 5, 2022

The Minister announced yesterday that Canada will welcome 500,000 immigrants annually. He said the country needs to move up immigration targets because of the low fertility rate and a million vacant jobs in Canada. But, Mr. Minister, have you fully considered the costs of a sudden surge in immigration, and the impacts on healthcare and housing in Canada?

Canada used to welcome a quarter million immigrants annually, ramping up to 300,000 recently. The number jumped to over 400,000 in 2001 and is likely to approach 500,000 this year.

Immigration policy in Canada has evolved. Initially, immigrants were invited in the 18th century to colonize the west, coming mostly from the British Isles. Central Europeans came early in the 20th century. People coming to work in Canada created the “economic class” of immigrants, and their families followed them (called the “family reunification” class of people). The “refugee” class of people was created under Prime Minister Diefenbaker, who welcomed 37,500 Hungarian refugees escaping their country after the 1956 Hungarian revolution. Sixty percent of immigrants today fall into the “economic” class. India is the source of 32% of today’s immigrants, followed by China at 8%.

Besides economic development, demographics have become a new policy issue for Canada because of our low fertility rate of 1.5%, the replacement rate is 2.1%. So, the question comes to mind: have we tried to influence fertility rates? Many countries have tried it with limited success (Russia, and France, for example). Changing behavior is difficult, so let’s bring more people into the country to boost our population.

But the devil is in the details. Of the two major sources of immigrants to Canada today, India’s fertility rate was 2.1% in 2021 and China’s 1.7%. If immigrants from these two countries continue to follow their culture, they may not help with Canadian fertility rates. But would this flow of immigrants help with the economy?

A target group for the Minister is the science, technology, engineering, and math people (STEM). Yes, we have a million vacant jobs, but most are in the service industries, the hospitality and retail industries, and not in STEM. So this group of immigrants may not help fill the vacant jobs we have in Canada, especially when technology people are being laid off these days (Amazon, Apple, Facebook, Twitter).

A related question I have for the Minister is: what do we do with the one million unemployed people in Canada and another half million people who stopped looking for work? We have one and one-half million people who could be employed. Retraining may make them employable. It may not be in the Immigration Minister’s mandate to solve labor shortages via retraining, but it begs the question: should we look at the unemployed and the stay-at-home people for filling vacant positions in Canada before filling these jobs with immigrants?

And the Minister has not talked about the cost of immigration, except for the benefits to the GDP and the income taxes immigrants will pay. But clearly, immigrants need services like healthcare and housing, provided by lower levels of government. We, the taxpayers, pay all government taxes – federal, provincial and local – so perhaps it is time to reflect on the costs of immigration.

At a time when healthcare is already breaking at the seams with doctors’ shortages and nurses retiring, an increase in immigration will put an additional load on the system. (Six million people in Canada do not have a family doctor. Some emergency rooms have closed due to a lack of nursing staff). You say that, of course, we should target doctors and nurses in the immigration program. Makes sense. But do you realize that both professions require certification by relevant authorities and the reality in Canada is that foreign doctors and nurses must qualify before they can practice?

For example, I had a technician perform an ”ultrasound” procedure on me and I found out that she was a medical doctor from Belarus and took all the Canadian exams to become a doctor but failed to get residency in a hospital required for certification and was forced to take a technician’s job.

Yes, Mr. Minister, we have a supply problem: we need more doctors and nurses and immigration will not provide a quick fix because of certification barriers.

And immigrants need housing. On average, 200,000 housing units are built in Canada annually. The half million immigrants coming to Canada each year could use a few hundred thousand units and drive-up housing prices, especially given the present housing shortage (for example, the Premier of Ontario recently announced a sweeping housing plan to ease the shortage of housing).

Preserving and increasing the value of current homeowners’ units may be good for the homeowners, but difficult for young Canadians who would like to get into the housing market. Has the Minister thought through how the half million immigrants coming into the country each year impact housing markets?

And my questions to the Minister would not be complete without asking about “absorption rates” for immigrants in Canada. Absorption refers to the ease with which immigrants assimilate or integrate into Canadian society: get a job, acquire housing, have their children in school, and become a part of their local community.

Ethnic groups like to settle near each other for comfort. When a large group of immigrants settles in an area – that often happens – ghettos may result and integration into Canadian society may take the back seat. Has the Minister studied how many immigrants can Canada absorb annually?

There are costly impacts on education and social services at the local level when immigrants arrive. Teaching the official languages of Canada to immigrants is a significant cost for school boards. For example, Quebec has 23% of Canada’s population and could take up to 117,000 of the 500,000 immigrants, but the Premier said their capacity to teach the French language is limited to 50,000 people annually. Has the Minister discussed how many immigrants each province would take?

I am for immigration; I was an immigrant myself and found my journey to assimilate into Canadian society has been challenging but tremendously satisfying (it never stops). But I ask the Minister whether he has thought about the impact immigrants will have on our healthcare system, our housing situation today, and our experience with integrating immigrants successfully into our society when suddenly we’ll receive a half million newcomers each year.

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.