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13Apr

Top-ranked Canadian trampolinist speaks openly, hopefully about having cancer at age 22

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Weeks after winning a silver medal in double-mini trampoline at the 2017 World Games, Tamara O’Brien felt a strange lump under her chin while watching TV in her mother’s Coquitlam duplex.

She received an ultrasound and a biopsy, but life went on as usual for the 20-year-old athlete who continued to train and then flew to Spain for another international competition, where she won silver again. After she returned home, she was summoned to her doctor’s office.

It was Friday, Oct. 13.

“The dermatologist says, ‘So they found melanoma in your lymph nodes.’ And I just started bawling,” O’Brien recalled. “It was this really weird shocking thing that was going on. I thought, ‘Oh my God I just got diagnosed (with cancer).’ I thought, ‘How am I going to tell anyone this?’”

O’Brien’s surprise is understandable, as it is relatively rare for someone her age to get cancer. Just two per cent of the new cancer diagnoses each year in Canada are in people 15 to 29 years old, representing about 2,250 people annually, says the Canadian Cancer Society.

As a result, experts say, there is a lack of programs, and sometimes even treatment, for these young people who are trapped between services for children and those designed for much older cancer patients. 

“We are kind of the forgotten generation,” said O’Brien, who has Stage 4 melanoma.

“Most people think about their 20s as these years of figuring out their shit. And I feel like that all got taken away from me, right? I so desperately would love to move out of my house and start a career and think long-term with my boyfriend. But I don’t get to think about that — that’s not on my priority list any more. It sucks. It’s a really weird stage in your life to be diagnosed.”

O’Brien, who spent her childhood on her sport’s world stage, is now opening up about her difficult health journey. She hopes she can help other youth battling cancer who are struggling, as she initially did, to connect with people their own age.

“I was thinking: What do I want someone to take away from reading this story? A huge part of it is that my life isn’t sad. When people hear I have cancer, they must think, ‘Oh my God, that’s so depressing. She must be so sad. Her life must suck,’” she said.

“But, honestly, I’ve had some of my happiest days. … Your whole perspective changes when death sits right at your door. As morbid as it sounds, that’s true.”

O’Brien has her ups and downs, said her mother Tina Geulen, but “for the most part she is really positive. And she really tries to be.”

The pride in her voice dissolves into sorrow, though, when she talks about the injustice of this illness. “To watch this happen and not be able to have any control over the outcome and what is happening, is the hardest thing in the world.”

O’Brien has transferred her strong work ethic and determination to become one of Canada’s top trampoliners to her task of battling cancer, said former coach Curt De Wolff.

“I’m just so amazed by how it has brought out more passion for life in her,” said De Wolff, who coaches at the Shasta Trampoline Club in New Westminster.

“Sometimes you can look at something like this as an end, but I think it has almost been her second beginning. She has almost treated every day as a new beginning. It’s crazy impressive.”

By her own account, O’Brien has good days and bad days, days of determination and days of dark depression.

When Postmedia met with her just over a week ago, she was having a good day. But she was feeling “crappy” on Monday, when she posted on her blog that she just wanted to be “normal” again — although she wasn’t even sure what normal was anymore.

“Cancer at 22 is not ideal. Well, cancer at any age isn’t ideal,” she wrote. “I wake up some mornings so tired my eyes are literally glued shut wondering how I’m going to get out of bed. It’s a strange feeling knowing that cancer has taken up a huge part of my life and always will.”

The next day she was admitted to Vancouver General Hospital with abdominal pain, where she will remain over the weekend as doctors investigate what is causing her discomfort.

“I realize how powerful my story is to people. I think that is a huge purpose in my life, just being able to share and help, in whatever people decide to take out of my story.”


Tamara O’Brien.

Pam Kriangkum

O’Brien had “an abundance of energy” when she was a toddler. “I used to stack stuff together when I was young and stand on it. My mother put me into gymnastics when I was two.”

She started trampoline at age nine and by age 10 was training 36 hours a week. She made the national team at age 11 in 2009, and competed that year in an international competition in Belgium. When she was 12, she won an unprecedented seven medals at the Canadian nationals, qualifying her for the world championships in Russia.

But the trip to Russia was going to cost $3,500 and O’Brien, who was raised by a single mother, didn’t think she could afford to go.

Publicity from her seven-medal haul led to Elaine Tanner, a 1968 three-time Olympic swimming medallist, offering to help O’Brien find funding, and eventually to Woody’s Pub in Coquitlam offering to sponsor the young trampolinist through its Dare to Dream Foundation.

“Her enthusiasm caught my eye,” pub owner Gordon Cartwright told The Province in 2009.

Woody’s Pub paid for all her travel expenses until she turned 18, for which both mother and daughter are eternally grateful.

“Without that she would never have been able to continue,” said Geulen.

 


Tamara O’Brien (front) with Gordon Cartwright (left), Gordon Kendall Payne (top) and Vicki Cartwright (right) of Woody’s Dare to Dream Foundation in Coquitlam on Oct. 28, 2009.

She estimates the pub could have spent up to $40,000 supporting her daughter.

Medals piled up as O’Brien competed around the world.

“She was a very exceptional athlete. Amazing work ethic and very committed to what she was doing,” recalls coach De Wolff.

After she turned 18, O’Brien worked two jobs to continue to pay for her training and travel.

O’Brien’s discipline of double-mini trampoline — an acrobatic performance involving triple somersaults and twists, first on a mini-trampoline and then on a landing mat — is not in the Olympics, so the highest honour for her sport is the World Games very four years. When she became one of three Canadian trampolinists to qualify for the 2017 World Games in Poland, she changed her diet and trained even harder.

But something didn’t feel right.

“Every single day I was so tired,” she recalled. “I thought, ‘I just need to suck it up. I’m an adult now.’”

She put in the performance of her life, earning her best marks ever, and won silver for Canada.

“It was this really special moment because the hard work had paid off.”


Tamara practising in 2009.

Ward Perrin

After she returned home, she found the lump under her chin. It was near a spot where, the previous year, she’d had a mole removed that would test positive for melanoma.

“I never called it cancer. It didn’t seem like a big deal,” she recalled. “I never in a million years expected it would have turned into anything like it has now.”

O’Brien underwent an ultrasound and a biopsy, then focused on training for her meet in Spain in October.

Soon after, back home, she cried in the dermatologist’s office. “I never thought that this melanoma was going to come back,” she recalled thinking.

O’Brien knew her battle with cancer would force her to quit the national trampoline team and focus her energy entirely on her health.

While the vast majority of melanomas are caused by exposure to the sun or tanning beds, O’Brien grew up inside a gym and when outside always wore sun block. She is among the minority of melanoma patients whose cancer is linked to genetics, doctors have told her.

On Oct. 25, doctors removed the cancerous lymph nodes. “I had no cancer left in my body but there was a 50 per cent chance it could come back because it had metastasized,” she said.

She was told chemotherapy was not successful against melanoma, which made her happy because as a young woman with a boyfriend, she didn’t want to lose her hair.

But about a month after her surgery, a new lump appeared under her chin. The melanoma was back.

“So that was really awful to hear that I had recurrence six weeks after surgery. It was really, really aggressive.” 

She would have four more surgeries, between January and March 2018, but doctors couldn’t remove all the stubborn cancer spreading microscopically through her neck. After a scan in April 2018, her oncologist delivered the worst news yet.

“She said, ‘You have spots in your lymph nodes, in your neck, under your armpit, in your groin. You have spots in your liver, you have spots along your bones. … It’s on your ribs. It’s on your vertebrae. It’s on your pelvic bone,’” a stoic O’Brien recalled.

The cancer was now Stage 4, the most severe.

The next day was April 20 — the date of the annual marijuana counterculture celebration — and O’Brien was starting immunotherapy treatment at the B.C. Cancer agency. “I remember joking, ‘It’s 4/20. I’m getting my drugs.”

Her body reacted poorly to the immunotherapy and the cancer worsened, leading to severe back pain that forced her last summer to quit her waitressing job.

Her grandfather took her to the B.C. Cancer to start radiation, where the staff assumed it was he who had come for treatment.

“I was like, ‘No, it’s actually me,’” she recalled. “The young adults are forgotten. There are supports out there, but I really had to look for it. Which is sad.”

One of the groups she found was Callanish, which provides a space for people to support each other through this life-altering disease. O’Brien counts on the group’s monthly drop-in sessions.

“You basically can sit there and bitch about your problems without anyone telling you how to be or that you can’t feel that way or that your feelings aren’t valid. Everybody in the room gets exactly what you are going through,” she said.

“They’ve helped me so much through my own struggles.”


Tamara O’Brien in 2009.

Ward Perrin

There are a handful of programs and support groups for adolescents and young adults, including the Kristian Domingo Foundation and Young Adults Cancer Canada (YACC).

But there is a need for more, said art therapist Sara Hankinson, who offers an art therapy program in Vancouver for young adults through the B.C. Cancer. Last week, she started an online group using Skype for young patients in other parts of the province.

Participants can discuss issues that are relevant to their lives, said Hankinson, such as body image or fear of losing their fertility after cancer treatments.

“Figuring out how to return to work can be a really big struggle for them. A lot of them are dating or in new marriages, which can often times be really challenged,” Hankinson said.

The challenges can also be medical for this age group, which is dubbed AYA, for adolescents and young adults, in health circles.

The survival rate for this group is improving, but not at the same pace as the advancements for children, said Dr. Karen Goddard, medical director of the Adult Childhood Cancer Survivorship Program at the B.C. Cancer.

“Some of the reasons are that AYA, in clinical trials and research, they are very under-represented,” Goddard said.

These patients often have one foot in childhood and one in adulthood and would benefit from a team approach. England has created special AYA clinics, and the B.C. Cancer hopes to develop one here, too.

“We need to bring adult and pediatric oncology together, so they can better look at treatment planning and psycho-social needs for these patients,” Goddard said. “I’ve talked to guys who say, ‘Everyone else (getting treatment) was over 60 and I’m here and I’m 25.’ They feel completely out of place and sort of abandoned and on their own. And cut-off from their peer group.”

Goddard is creating a program that would give young patients, after discharge, a document that shows their treatments, possible long-term health risks, and how they should be screened years down the road.

In the fall, O’Brien’s doctors put her on new pills that try to slow down the cancer, and they appeared to be working — although the nasty side effects include hair loss.

“I have had two stable scans showing disease regression, so things are getting smaller. They are doing their job for now, which is really awesome,” she said. “The problem with these drugs is that the cancer will become resistant to them, at some point, and it will start growing again.”

When that will happen and what she’ll do next remain uncertain, although her doctor is looking into a clinical trial in Toronto.

A GoFundMe page started for O’Brien last fall raised $16,000. She gave some money to her mom and thinks she may use the remaining $10,000 to fly back and forth to Toronto during the clinical trial.


Tamara O’Brien, centre, with her mother Martina Guelen and boyfriend Jamie Moors at last year’s Cayford Gala, was the first recipient the Forward Foundation, which was created to help terminally ill young adults make the most of their time.

Pam Kriangkum Photography

Geulen is an on-call clerical worker for a local school district, a job that has given her flexibility to be with her daughter during appointments and hospital stays. But the less she works, the less she gets paid, often making it difficult to cover monthly expenses.

“This is just such a surreal life at the moment, and you can’t believe that it’s happening to you and you can’t believe it is happening to your child, and you can’t understand what you did to deserve this and what she did to deserve this,” she said.

After back pain forced O’Brien to quit her job last summer, she went on disability payments. She is grateful for the money, but notes she could never support herself on the meagre payments if she didn’t live with her mother.

“You are 100 per cent in poverty on disability, which I think people don’t even understand.”

She would like to get another job, but doesn’t have the strength to return to waitressing. “I’m trying to figure out what work would be good for me physically, and how I could make some money. So that is challenging right now, for sure.”

A highlight for O’Brien in the past six months was being the first recipient of the Forward Foundation, whose mission is to “provide young adults who are terminally ill with meaningful end-of-life experiences.” It was started by a remarkable young man, Christopher Cayford, while he was dying of cancer, and is now run by his mother, Claire Conde.

O’Brien’s chosen experience was to attend the 2018 Trampoline Gymnastics World Championships in Russia last November, so she could say goodbye to her Canadian teammates.

When she arrived in Russia, she received one heartfelt surprise after another: the Canadian team members wore “We Jump for Tamara” T-shirts, she was asked to be their flag bearer, and Olympic gold medalist Rosie MacLennan gave her one of the bronze medals the team won.


Trampoline gymnast Tamara O’Brien, with gold medallist Rosie MacLennan at the World Trampoline Championships in Russia in November.

Pam Kriangkum Photography

“I ended up walking away from that competition with the exact opposite outcome: It was not a goodbye. It was: My community is with me and they will always be with me,” O’Brien said, adding that she felt Cayford’s presence while in Russia.

“I definitely feel like he’s almost looking out for me. I feel like I know him but we never met. It’s super bizarre, and I’m not one to believe in stuff like that.“

For the last four months, since she returned from Russia, her cancer has been fairly stable. O’Brien has had two recent hospital stays: a two-week admission for a blood infection and her current treatment. To remain as upbeat as possible, she hung a poster board in her hospital room, and recorded the things for which she was grateful: her mom, nurses, friends who visit.


Tamara O’Brien on Apr. 5, 2019 with her hospital poster board.

But the hospital stays taxed her spirit, which happens at other times, too. “I’ve had really dark days, days when I’ve been in the car driving and thinking this would be a good song at my funeral.”

She said, though, that she has good support from her mother, her boyfriend and some “true” friends.

Cancer, she jokes, can be “quality control” for relationships. Some people don’t know what to say and bolt, while others provide unwavering support.

“It was really, really hard initially getting diagnosed and thinking, ‘Well, this is my life now. So how do I introduce myself? ‘I’m Tamara and I have cancer.’ But it’s not a defining feature for me anymore.” she said.

O’Brien has now lived for one year as a stage 4 cancer patient — a thought that brings questions about her future but also relief that she is feeling more or less OK at the moment.

“I think it’s a celebration that I have had this year. And that hopefully I’ll have another,” she wrote on her blog. “I count my blessings each day because what else can you do when a huge chunk of your life is filled with uncertainty and with fear.”

[email protected].com

Twitter:@loriculbert




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3Apr

National chronic pain task force a first step: federal health minister

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‘People with chronic pain are often underemployed or unemployed because they simply cannot work and not all of us have extended health benefits and even health benefits run out,’ says Andrew Koster.


‘People with chronic pain are often underemployed or unemployed because they simply cannot work and not all of us have extended health benefits and even health benefits run out,’ says Andrew Koster.


CHAD HIPOLITO / CANADIAN PRESS files

The federal health minister is forming a national task force to provide input on how to better prevent, treat and manage chronic pain, which affects one in five Canadians and is often addressed with opioids.

Ginette Petitpas Taylor said in an interview Wednesday the task force will provide information on barriers that may prevent people suffering with persistent pain from receiving the treatment they need.

“This is the first step in addressing the issue of chronic pain in this country,” she said, adding the eight members will consult with governments and advocacy groups around the country and provide an initial report in June, followed by two more over the next couple of years.

Petitpas Taylor made the announcement in Toronto at the 40th annual scientific meeting of the Canadian Pain Society, which has long called for a national pain strategy, especially as the opioid crisis has exacerbated the stigma around prescribing and use of the pain killers.

She said she committed to exploring the creation of a national pain task force after a discussion with patients, clinicians and researchers at a symposium in Toronto last year, when she heard people living with pain often feel their condition is misunderstood and services are inconsistent.

“We have to recognize that Canada’s a big country and we certainly know there’s inconsistent services in provinces and territories so I have to really have a good understanding of what’s available and what’s happening out there,” Petitpas Taylor said.


Ginette Petitpas Taylor, Minister of Health, stands during Question Period in the House of Commons on Parliament Hill in Ottawa on Thursday, Sept. 21, 2017.

Sean Kilpatrick /

The Canadian Press

Advocates for pain patients presented the former Conservative government with a plan in 2012, but Petitpas Taylor said it’s too early to say whether such a plan will be introduced.

Andrew Koster, who suffers from debilitating lower back and knee pain from a type of arthritis called ankylosing spondylitis, said he’s concerned the task force’s work will go nowhere if there’s a change in government in October.

“I’m looking for signs from the government that they’re taking this seriously and it’s not just something to state during an election campaign,” he said. “There has to be definite action.”

Koster, who will have surgery on his left knee next month following an operation on the other one last year, said he can no longer afford to pay $100 a week for acupuncture to deal with daily pain after he voluntarily reduced his opioids over concerns about any long-term consequences.

“People with chronic pain are often underemployed or unemployed because they simply cannot work and not all of us have extended health benefits and even health benefits run out,” he said from Victoria.

He said it’s crucial for the task force to identify non-drug costs for patients and provinces for services such as physiotherapy, occupational therapy and acupuncture as part of any strategy it may come up with in its final report.

Andrew Koster, who suffers from debilitating lower back and knee pain from a type of arthritis called ankylosing spondylitis, pictured at his home in Victoria in 2018.


Andrew Koster, who suffers from debilitating lower back and knee pain from a type of arthritis called ankylosing spondylitis, pictured at his home in Victoria in 2018.

CHAD HIPOLITO /

CANADIAN PRESS files

Serena Patterson, a 60-year-old psychologist in Comox, has lived with pain associated with fibromyalgia for over half her life and also developed migraines that prevented her from continuing her teaching job at a college.

She said a three-year task force seems excessive, especially because advocacy groups have enough information on health-care gaps and patients wait too long to see specialists.

“I think we know that people are dying in an opioid epidemic and chronic pain patients are high on that list,” Patterson said.

“I would hope that this three years would be building, not more research. What needs to be built is a network of multidisciplinary team programs that are accessible, that are in rural areas as well as urban areas, that provide not only medical support but psychological as well as social support to help people be full participants in their life and in their community.”

Dr. Norman Buckley, scientific director of the Michael G. DeGroote Institute for Pain Research and Care at McMaster University in Hamilton, said hundreds of organizations, patients, clinicians and researchers came together in providing the federal government with the strategy in 2012. There was no action at the time but he said the opioid epidemic has now made that unavoidable.

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28Mar

Some medical waits shrink, but B.C. still has long waits compared to several other provinces

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Health Minister Adrian Dix tours a hip and knee program replacement program on Vancouver Island last year.


Don Craig | B.C. Government / PNG

B.C. performs worse than several other provinces when it comes to meeting recommended waiting times for various medical procedures, including cancer radiation therapy, a federal report released today shows.

Benchmarks are defined as “evidence-based goals each province or territory strives to meet.” They reflect the maximum waiting time that medical experts consider appropriate to wait for a particular procedure.

The Canadian Institute for Health Information report shows that while there are glimmers of improvement in some categories, B.C. generally lags behind a handful of other provinces.

For hip replacements, for example, 67 per cent of patients got their surgery in B.C. within the recommended six months in 2018, compared to 61 per cent in 2016. The national average in 2018, however, was 75 per cent. And in Ontario, 84 per cent of patients got surgery within the time period; in Quebec, 80 per cent.

Long waiting times are generally a function of operating rooms being available for surgeons and other resources like funding, hospital beds, nurses for the operating rooms, recovery and ward beds.

For knee replacements, 59 per cent of B.C. residents got the surgery within the six-month recommended time. That was an improvement over 47 per cent in 2016, but again, lower than the national average of 69 per cent.

For cataract surgery, 64 per cent of B.C. residents got the cataract removal procedure within the recommended wait of four months for high-risk patients. That was slightly worse than in 2016 when it was 66 per cent of patients. The federal average in 2018 was 70 per cent.

For procedures that are especially time-sensitive, B.C. was near the bottom.

For hip fracture repairs, it is recommended that patients wait no longer than 48 hours. In 2018, 85 per cent of B.C. patients got surgery within the recommended time; the national statistic was 88 per cent.  Alberta was tops at 94 per cent meeting the benchmark. Only Saskatchewan and Prince Edward Island had longer waiting times than B.C. on this measure.

On radiation therapy, B.C. had the worst ranking with 93 per cent of patients getting treatment within the benchmark of 28 days. The other provinces reported that 95 to 100 per cent of patients were treated within 28 days.

The B.C. Health ministry says on its website that the number of patients waiting for radiation in 2017/18 rose to a high of 467 and the number of cancer patients who got radiation therapy in 2017 declined substantially to 10,663, from about 13,000 from 2015. It is unclear if far fewer patients required radiation or whether B.C. Cancer can’t offer it to as many patients as in prior years.

In an emailed statement, Health Minister Adrian Dix said the report shows B.C. is on “the right track” to improving surgical care, especially for case types that have the longest waiting times.

“We are seeing improvements throughout the health authorities. For example, Island Health’s rate for hip replacements within the benchmark went from 45 per cent in 2016 to 49 per cent in 2017 and 66 per cent in 2018. The rate for knee replacements was even more stunning: In 2016, 29 per cent; in 2017, 32 per cent and in 2018, 57 per cent.

“We know there is more work to do (and) our surgical and diagnostic strategy is not a one-time effort. It is a multi-year plan that is supported with ongoing targeted funding of $75 million starting in 2018-19, and increasing to $100 million in 2019-20,” Dix said, noting that targeted funding should ensure that other surgeries, besides the ones benchmarked, don’t fall behind.

Bacchus Barua, associate director of health policy studies at the conservative think-tank, Fraser Institute, said the CIHI reports shows that many British Columbians still do not receive their treatments within “remarkably long pan-Canadian benchmarks.

“Our own annual survey of waiting times reveals that while the total wait time (between referral from a family doctor to treatment) across 12 specialties has fallen in B.C. between 2016 and 2018, last year’s 23.2-week median wait is nevertheless more than twice as long as the 10.4 week wait time in 1993.

“Wait times are not benign inconveniences. They can, and do, have a real impact on patients’ lives,” he said.

 

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Twitter: @MedicineMatters




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20Mar

Jail drugs: Ex-prisoner says no addiction help as life outside loomed

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VANCOUVER — Memories of vomiting, diarrhea and unrelenting stomach pain as he withdrew from opioids in prison had Rob MacDonald repeatedly asking for addiction treatment before he left a maximum-security facility but despite dozens of formal complaints, he says he didn’t get any help.

“I was thinking, ‘Wow, I can’t believe I’m going out onto the street with this addiction,”‘ MacDonald said recently, a week after being released on supervision from the Atlantic Institution in Renous, N.B., his fourth facility in over a decade behind bars.

MacDonald, 41, said he feared his 15-year opioid addiction would cause him to returned to crime while using illicit drugs on the outside so he tried desperately to get treatment from the federal prison service.

“I put 150 requests in, probably 70 complaints, for a 15-month period, trying to tell them, ‘Put me on it. I need it before I get out. I want to get help, I don’t want to go back into the community in a high-risk situation, I don’t want to re-offend,’ ” he said from Halifax, where he lives in a halfway house.

He said he complained to the warden and then appealed to the commissioner of the Correctional Service of Canada. One of his complaints to the commissioner was upheld but he said he was placed on a wait list because there was a limit on the number of inmates receiving treatment.

When he was incarcerated at Agassiz’s Kent Institution between 2017 and 2019 for drug-related offences and robbery, MacDonald said debilitating withdrawal symptoms had him seeking potentially deadly fentanyl-laced drugs that were smuggled into the prison.

“At least eight guys died in the 17, 18 months I was at Kent,” he said.

The Correctional Service linked MacDonald to a clinic in Halifax upon his release nearly two weeks ago and he is now prescribed the opioid substitute Suboxone. But he said he should have received the medication in prison as part of the agency’s treatment program, which also includes methadone, so he could focus on finding a construction job to get his life back on track.

'At least eight guys died in the 17, 18 months I was at Kent,' Rob MacDonald says of the Agassiz maximum security penitentiary.


‘At least eight guys died in the 17, 18 months I was at Kent,’ Rob MacDonald says of the Agassiz maximum security penitentiary.

Darren Calabrese /

THE CANADIAN PRESS

Ivan Zinger, Canada’s ombudsman for offenders, said the Correctional Service has failed to provide adequate addiction treatment, programs and staff at a time when more drugs are contaminated with fentanyl.

“I think when you’re dealing with a large inmate population that has such a long history of substance abuse you should be providing an awful lot more treatment and programming in addition to opioid substitution therapy,” said Zinger, who called for the reallocation of funding to provide those services.

“It’s unclear to me why the budget has remained the same and decreased in the past when clearly the number of incidents is increasing,” he said of overdoses that caused 41 deaths between 2010 and 2018.

Zinger said programs such as counselling are provided just before offenders are released instead of throughout their incarceration.

“That’s a problem when you have a highly addicted inmate population that has a lot of time on their hands and are in sometimes difficult conditions of confinement. They will find ways to bring in drugs.”

The Correctional Service said in a statement that 66 per cent more prisoners have accessed treatment in the last two years, but a jump of 115 per cent has been recorded in the Pacific region, where the opioid crisis is most acute.

It did not respond to requests for information on whether its budget will be increased to meet the demand for more treatment.

Kent Elson, a lawyer for an offender at Joyceville Institution in Kingston, Ont., said the Correctional Service did not accommodate his client’s disability of addiction so he filed a complaint with the Canadian Human Rights Commission last November.

Rob MacDonald, who was released last week on supervision from the Atlantic Institution maximum security facility in New Brunswick after a 10-year stint in four facilities including Kent Institution in Agassiz.


Rob MacDonald, who was released last week on supervision from the Atlantic Institution maximum security facility in New Brunswick after a 10-year stint in four facilities including Kent Institution in Agassiz.

Darren Calabrese /

THE CANADIAN PRESS

Elson said his 50-year-old client, who is serving a four-year sentence, had been on methadone but alleges the medication was withheld without explanation for five days when he was transferred from another facility in November 2017.

“He needed medical help and he got forced, cold-turkey withdrawal in a feces-smeared segregation cell and cruel mistreatment from guards. And it was so unbearable that he tried to kill himself three times,” Elson said from Toronto.

While Correctional Service guidelines state a doctor is required to interview offenders before they are involuntarily tapered or cut off from methadone or Suboxone, Elson said his client was not seen by a physician.

“This whole experience was incredibly traumatic and he ended up with PTSD,” he said.

“The impact on him was terrible but everybody wins if prisoners get the right treatment. Suffering from PTSD is not going to make them easier to integrate back into society.”

The Correctional Service did not respond to a request for comment on the human rights complaint filed by Elson or another from the Prisoners’ Legal Services. The B.C. group’s complaint was filed in June 2018 on behalf of offenders who accused the Correctional Service of discriminating against them.

Nicole Kief, an advocate for the group, said about 100 inmates reported three main concerns: long wait lists for treatment, being cut off Suboxone after false accusations of diverting it and not receiving addiction counselling.

“Of the people that I’ve talked to there has been a real sense of urgency, with people calling me and saying, ‘I’m worried about dying,”‘ she said.

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13Mar

Grand Chief Stewart Phillip: ‘I want my son’s death to be meaningful’

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“There’s no way to describe the enormous shock a parent experiences when you get a phone call informing you … You lose your ability to stand, and you sink into the closest chair. Your heart stops and you just can’t believe it. This terrible wave of shock goes through your entire body.”

Grand Chief Stewart Phillip took that terrible call last August from his wife, Joan. She was nearly hysterical.

“The minute I heard her, I thought, ‘Oh, no. Oh, no.’ She kept saying over and over, ‘He’s gone. He’s gone.’”

It was Aug. 7, 2018, the day after Kenny Phillip’s 42nd birthday. Their oldest son had died alone in a hotel room of a carfentanil overdose in Grand Prairie, Alta.

“I don’t think he knew that he had taken carfentanil,” his father told me. “But nobody was more well-versed in addictions and the variety of drugs available than he was.

“Having gone through so many treatment programs, he had high level of expertise. He knew everything about his addictions, the pattern and so forth. Yet he still was vulnerable to the powerful call of the addiction.”

Kenny struggled with addiction to drugs and alcohol since he was a teenager, and had been to at least half a dozen treatment programs. Still, his father said, “You’re never ready for that phone call.”

His son followed the usual cycle. Bouts of drug and alcohol use punctuated by detox, treatment and periods of recovery. His longest recovery period lasted nearly three years. But this time, his parents were optimistic that it was different.

He had graduated from the Round Lake Treatment Centre. He was working as an apprentice mechanic. He loved it. He had been obsessed with cars since he was a kid. One of the people who worked with him in Penticton described Kenny to me as “a helluva guy.”

After he died, a former co-worker designed a logo with two crossed wrenches, Kenny’s initials with the years 1976 and 2018, and had decals made up so that his friends could honour him by sticking them on their toolboxes.

Phillip says something happened when Kenny went up to northwestern Alberta, triggering his addiction. And given Grande Prairie’s reputation as a crossroads for drugs, he wouldn’t have had to go far to find them.

Northwest of Edmonton, Grande Prairie has had several recent large drug busts. In January, RCMP seized four kilos of crystal methamphetamine, 2.2 kilos of cocaine, 200 grams of heroin, about 5,500 oxycodone tablets and about 950 fentanyl tablets.

A few months earlier, guns, ammunition as well as meth, cocaine, heroin and magic mushrooms were seized in a follow-up to a July raid.

“I have first-hand knowledge,” Phillip said. “I started drinking when I was 15, and was 40-something when I sobered up. It was the hardest thing that I ever did, and I was an alcoholic not strung out on crystal meth and some of the street drugs.

“But I know that at the end of the day, it’s up to the person. The individual.”

Seven years into marriage with, at the time, three children — two daughters and Kenny — Phillip’s wife told him she was finished with the fighting, picking him up when he was drunk, and buying liquor for him. But if he wanted to carry on, he was free to go.

“I thought, ‘Free at last,’” Phillip recalled. “I lasted a month. I was downtown drinking with all my so-called buddies talking about my newfound freedom. One evening in a Chinese restaurant — nobody else was there — I put in an order and was staring at the tabletop. I just broke down. I started crying and then howling.

“The howling was coming from the soul. I was scared stiff.”

At that moment, he realized his stark choice.

“If kept going, I was going to die at my own hand. But to contemplate stopping … which at the time was like contemplating to stop breathing or stop eating because it was such an integral part of who I was.”

What had kept Phillip from suicide, he told the Georgia Strait in May 2018, was the thought of his son. “I thought he would have to grow up with that stigma.”

With the help of Joan and Emery Gabriel, a drug and alcohol counsellor and the only sober friend Phillip had, he got into treatment at the Nechako Centre and has never relapsed.

Every day, Phillip thanks the Creator for sobriety because abstinence has enabled him to take on the work he has done and continues to do as president of the Union of B.C. Indian Chiefs, grand chief of the Okanagan Nation, and as a board member for Round Lake Treatment Centre.

Phillip grieves for the “incredible, amazing young man who touched so many different lives” and for the choice Kenny made last August, knowing full well the risk he was taking in the midst of the opioid overdose crisis.

He speaks openly, and urges others to as well, because those who have died need champions to bring about change.

“I want my son’s death to be meaningful,” Phillip said. “The path forward has to be an abundance of resources to help those who are struggling with addictions. … More treatment centres, more programs, and a greater commitment from governments and society to pick up the responsibility for it.”

So far, governmental response has been “minimalist,” said Phillip.

“This notion of harm reduction is just kicking the issue down the road. It’s not dealing with getting people from an addictive state to where they are clean and sober. That’s what we need to do.”

As for cannabis legalization, Phillip said, “I just shake my head when I think of where we are at and the direction we are going.”

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Twitter: @bramham_daphne


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28Feb

Daphne Bramham: First Nations’ solution to a modern, medical crisis

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Ending Canada’s opioid overdose crisis will likely require much more than sophisticated drug therapies. In fact, it might mean following the lead of First Nations health-care providers and transforming how we think about and deliver medical services.

First Nations people are dying of opioid overdoses at three times the rate of the general population. Hidden in that data are Canada’s most-neglected victims — Indigenous women.

Unlike in the general population where men comprise 80 per cent of the victims, Indigenous women are as likely to overdose or die as their brothers, fathers, husbands and sons.

They are eight times more likely to overdose than other women, and five times more likely to die from an overdose.

It’s not really surprising, says Dr. Evan Adams, the First Nations Health Authority’s chief medical health officer. The terrible numbers track other devastating indicators of how their health and longevity diverge from those of other Canadians.

“A lot of First Nations women who have substance-use disorders are exploited women. They are women who are victimized by the sex trade. They’re victimized by their partners,” said Adams, who worked for five years in Vancouver’s notorious Downtown Eastside, the epicentre of Canada’s opioid crisis.

What the opioid crisis highlights for him is the endemic problem of the western medical model, where people go passively to doctors’ offices and say, “Heal me.”


Dr. Evan Adams is the Chief Medical Officer for the First Nations Health Authority.

Jason Payne /

PNG

“Our (First Nations) model is that the doctor gives you a chance to get better. But, you make yourself better,” he said. “It’s your family that does most of the work of helping you get better, not that doctor who you visit for 15 minutes every week, if you’re lucky.”

Unlike in the western model, healing and wellness in the traditional Indigenous way involve mind, body and spirit. For First Nations men and women to achieve wellness, Adams said they require much more than medicine.

“They need healers who can do ceremony. Maybe they need love. They need justice.

“How can a woman recover from opioid use disorder when you won’t let her see her children? It’s disgusting,” he said.

The day Adams and I met, the FNHA offices were being “swept” by a group of elders carrying cedar boughs and candles using traditional ceremonies to restore the spirits of the people who work there.

“Some people would say an elder is less trained in opioids than an addictions physician,” Adams said. “But wouldn’t it be nice to have both?”

It’s not that FNHA rejects modern medicine. It continues to expand access to opioid agonist treatments such as methadone and Suboxone, which quell cravings, making it available at all FNHA nursing stations and at four of the nine FNHA-funded residential treatment centres. FNHA reimburses treatment fees charged by private clinics and has spent $2.4 million in grants to 55 communities for harm-reduction programs.

Yet, for Adams and his staff, drug therapies are only a small part of what he calls harm reduction’s suite of services.


The Crosstown Clinic in downtown Vancouver.

JONATHAN HAYWARD /

THE CANADIAN PRESS

“Harm reduction is not just, ‘Let’s make sure you don’t overdose.’ It’s the whole person that you have to treat, not just this one aspect of the person that is craving opioids.”

To incorporate First Nations wisdom into other programs, FNHA created two peer coordinator jobs at the Crosstown Clinic in the Downtown Eastside. Its compassion inclusion initiative has engaged another 144 Indigenous people with lived experience across B.C., and its Indigenous wellness team has taught indigenous harm-reduction and wellness programs in 180 communities.

“Opioid use disorder is everyone’s business. It’s yours and it’s mine and it’s everyone around us. It’s not just the domain of physicians with 24 years of training,” he said. “Why can’t Grandma help, or a family member?”

What concerns Adams about the response to the opioid crisis that is heavily grounded in the medical model is that it could widen the gap between his people and mainstream Canadians.

Indigenous people don’t necessarily trust health providers who don’t look like them or where there is no acknowledgment of the historical trauma they have suffered and their unique experiences in the world.

That’s just one more reason why the FHNA, which is unique in Canada, is so adamant that it must transform the way health care is delivered to its people so that they are empowered to help in their own healing within their own circles of trusted friends, family and elders.

This current crisis is rooted in the western medical model. The seeds were sown by an aggressive marketing campaign by Purdue Pharma, which falsely promoted its Oxycodone as being non-addictive. What followed was an epidemic of opioid over-prescription by physicians and other health-care professionals that eventually created a demand for synthetic opioids on the black market.

With so many deaths and no end in sight, this might be the time for all of us to reconsider whether the best responses to this crisis ought to be done within a much broader context of healing and an expanded understanding of what wellness really means.

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Twitter: @bramham_daphne


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27Feb

Dementia law report recommends better oversight on health care consent

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Jim Mann wants everyone to know that he’s more than his dementia.

He was diagnosed with Alzheimer’s 12 years ago, but that doesn’t mean he can’t be involved in making decisions about his health.

The distinction is important for Mann — and many others living with dementia. The Surrey resident is thinking a lot about consent these days after being part of an advisory committee on health care consent for people with dementia. Their report, Conversations About Care, was released Feb. 27.


Surrey resident Jim Mann was diagnosed with Alzheimer’s 12 years ago.

Arlen Redekop /

PNG

Mann, 70, said professionals in health care still make assumptions about people with dementia.

He recalled an emergency room incident when a nurse yelled his name and added “patient only.”

“My wife and I stood up and walked over. Halfway there, she (the nurse) yelled again ‘patient only.’ I got up to her and said ‘my wife needs to be with me. I have Alzheimer’s.’ She turned around and looked me up and down and said ‘well, you look fine.’ “

Mann said that while the public might not always understand that dementia is a cognitive impairment not a physical one and therefore not visible, he believes that kind of language isn’t acceptable in a health care environment.

“Within the medical system, I’m sorry, you should really know this by now,” he said.


Jim Mann says professionals in health care still make assumptions about people with dementia.

Arlen Redekop /

PNG

The two-year collaborative research project that Mann was a part of was undertaken by the Canadian Centre for Elder Law and the Alzheimer Society of B.C. Funding included a $40,000 grant from the Law Foundation of B.C.

The goal of the project’s Conversations About Care report is to ensure that the legal framework in B.C. remains strong enough to protect people living with dementia as well as those named as their legal substitutes.

In 2018, about 70,000 people in B.C. were living with dementia. By 2033, that number is estimated to increase to almost 120,000.

Krista James, national director of Canadian Centre for Elder Law at the University of B.C., said the report is intended to start a conversation about the rights of people with dementia.

“I feel that we’re missing that rights-based lens that recognizes the rights of older people to make choices about what happens to them,” she said.

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“Although the law is different in each jurisdiction, and this report applies specifically to the experience in B.C., we need to open up that conversation to think about the citizenship rights of older people in a health care context. It’s really urgent.”

The report’s 34 recommendations were developed through a process that included consultation with people living with dementia, family caregivers, health care professionals, and others who deal with consent on a regular basis.

James said the origins of the report came from phone calls she received from family caregivers who felt frustrated that decisions were being made without consultation.

B.C. is ahead of many other provinces because of our comprehensive health care consent statute called the Health Care (Consent) and Care Facility (Admission) Act.

“From our perspective, the health care consent law in B.C. is super robust and I think fairly clear,” James said.

“It says if it’s not an emergency, you need to get that prior informed consent. The care facility regulations that govern long term care don’t seem to be consistent. There is a lot more wiggle room.”

That means some physicians, licensed practical nurses and care aids don’t understand the concept of prior informed consent for non-emergency care.

“I have talked to a few people who think that if the person is in the care facility they have consented to all the care that the people who work there think is the right care for them,” she said.

“Some of the staff don’t understand they have to get consent. They confuse admission to the care facility with consent to all the meds.”

One of the report’s recommendations calls for all licensed long-term care facilities to set out rules on restraints, including chemical restraints (medications such as antipsychotics used to control aggressive behaviour).

Other big concerns include the challenge of sorting out situations where family members making decisions about care for someone with dementia can’t agree on what to do. One way to address that, James said, is to have social workers involved in helping families find a solution.

James said the report recognizes that health care providers are never going to be experts on the law.

“They’re not lawyers,” she said. “We shouldn’t expect them to be experts on the finer details of the law. They need to have support so they can properly interpret the law.”

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Recommendations of the report

• Improving health care decision-making laws in B.C. by adding language to recognize that people’s capacity to make health care decisions can vary from day to day and decision to decision, and that they be involved to the greatest degree possible in all case planning and decision-making.

• Address barriers to informed consent experienced by Indigenous people and people who need language interpretation, and create financial incentives to support physicians so they can spend time to talk with patients and families.

• Create a review tribunal to allow people living with dementia to review health care decisions made by substitute decision makers.

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21Feb

Daphne Bramham: B.C. group’s call for legally regulated heroin sales is unfounded

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Desperate times call for desperate and often unfounded measures. And, that’s exactly what a new report from the B.C. Centre on Substance Use is proposing in response to the unabating opioid overdose crisis.

It wants government to immediately clear the way for “heroin compassion clubs.” These would be free-standing co-op stores staffed by health care providers selling untainted heroin — diacetylmorphine — to members at the same price or less than street heroin. It would be free to members who can’t afford it, even though the report acknowledges that the risk of street resale of prescription opioids is greatest when the drugs are free.

And that would all be possible, the report says, because of things like volume discounts and “other economies of scale.”

“It would be precisely measured and dispensed in known quantities and at relatively safe doses,” says the report that was released Thursday. The emphasis has been added.

The heroin would be in powdered form, rather than an injectable liquid, just like it is on the street except this would be untainted heroin, not heroin cut with caffeine to prevent overdoses or any other additives to bulk up the product.

Members would be able to buy a couple of days’ supply and take it home with them.

Membership would be low-barrier, a term that’s not defined in the report.

Applicants would be screened by staff members who are “health care providers,” although not necessarily addictions physicians.

The co-op’s board members would be people with “lived experience” — a.k.a. users and former addicts.

Evan Wood, the head of the B.C. Centre on Substance Abuse, says the proposal is unprecedented so there is no evidence that it would reduce overdose deaths or disrupt organized crime’s role in fentanyl, money laundering or housing affordability, which is what’s advertised on the report’s cover.

“To be fair, we are in an unprecedented situation with fentanyl and the prescription opioids overdose crisis,” Wood said. “We are in uncharted waters.”

The two main goals are keeping users alive and disrupting the evils of organized crime.

These are ambitious albeit inappropriate goals for an organization whose mandate is to “develop, help implement, and evaluate evidence-based approaches to substance use and addiction.”

Using heroin to treat users isn’t new. But every other trial or program has a treatment component whether they’re at Vancouver’s Crosstown Clinic, the PHS Community Services or in European countries.

In Europe, heroin is prescribed with the goal of stabilizing users to a point where they can get jobs, form relationships or switch to other (cheaper) opioid replacement therapies such as methadone or Suboxone. (The annual cost per patient in European prescription-heroin programs ranges from $19,000 in Switzerland to $30,000 in the Netherlands.)

But there’s nothing like this in Canada.

“I’m not aware of the existence of ‘heroin clubs’ anywhere else,” Jann Schumacher from the Swiss-based Ticino, an organization of addictions specialists, said in an email. “In Switzerland the heroin assisted therapy is strongly regulated and always under medical control.

“Our Swiss model (heroin assisted treatment) has strong evidence as a harm reduction method, in getting people into treatment and stabilizing their lives, and in reducing the illegal market.”

To qualify, Swiss patients must have at least two years of opioid dependence and at least two failed tries using other addictions treatment methods. They are only allowed to the drug in pill form and take it with them after being in the program for six months and only if it’s necessary to hold down a job.

Drug-related crime in Switzerland has decreased 90 per cent. But compassion clubs would have no effect on drug-related crimes because members would still have to find some way to buy the heroin.

As for disrupting organized crime, the report suggests that compassion clubs would be competing for sales, influencing both the demand and market for heroin.

“The establishment of a regulated and controlled supply of fentanyl-unadulterated heroin may increase demand for street heroin among persons who use street opioids and force organized crime groups to return to the provision of heroin as part of the illicit drug market,” the report says.

And since violence is criminals’ usual response to unwelcome competition, it seems likely that they will attempt to terrorize compassion clubs out of business.

What makes this proposal all the more absurd is that it is aimed only at British Columbia. Surely, low-barrier access to pure heroin would be a magnet to every opioid user across the continent, let alone Canada.

British Columbia is already the epicentre of the overdose crisis just as it was ground zero for the cannabis legalization movement that began with compassion clubs dispensing so-called “medical marijuana,” which led to an explosion in unlicensed and unregulated pot shops.

It’s also where Canada’s harm-reduction model was birthed with free needles, supervised injection sites and readily available naloxone. But it was supposed to be part of a four-pronged strategy just as Switzerland’s is — a strategy that includes access to treatment and recovery as well as education aimed at dissuading drug use.

But since 2017, the $608 million spent by the B.C. government has gone almost exclusively to harm reduction. Yet, the number of overdose deaths is still rising.

It’s clearly not working and Canadians can’t help noticing now that 9,000 are dead including more than 4,000 in British Columbia. According to an Angus Reid poll released last week, 85 per cent of Canadians want mandatory treatment for opioid addiction. Forget legalization or free drugs, decriminalization was favoured by only 48 per cent.

Although the B.C. Centre on Substance Abuse is proposing a radical and untried solution, Wood dismissed mandatory treatment as an option because it’s unsupported by evidence.

As for decriminalization, Wood said, “The problem with it is that you still leave control of the market to organized crime. The user is not criminalized, but they still have to go to the black market.”

Yet, 20 years’ worth of evidence from Portugal show that paired with assertively promoting treatment and recovery, providing universal access to those programs and enforcing drug trafficking laws, decriminalization works.

There, it not only effectively brought an end to Portugal’s heroin overdose crisis, addiction and usage rates for all drugs including cigarettes and alcohol are now among the lowest in Europe.

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20Feb

Task force set up to tackle sexual harassment at UBC medical school

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UBC medical students are being sexually harassed more often than students in other Canadian medical schools, according to a new report.

An internal memo written by Dr. Andrea Townson, acting co-head of the UBC department of medicine, and sent to medical faculty at the University of British Columbia, refers to the “deeply concerning” results from a 2018 questionnaire of students who graduated from the 17 medical schools across Canada. Sexual remarks, uninvited touching and sexual assault are examples of harassment.

• Twelve per cent of students at UBC reported unwanted sexual advances and touching by faculty, fellow students, health professionals or patients, compared to a national average of 6.5 per cent.

• Thirty-three per cent of students at UBC said they were subjected to offensive sexist remarks, compared to the national average of 25 per cent.

• A third of UBC medical students also said they were subjected to racially offensive remarks, compared to the Canadian average of 12 per cent.

“We aren’t unique or isolated with these concerns but we are obviously not happy to see these high reported rates so it’s launched a number of different initiatives,” said Dr. Deborah Money, executive vice dean of the UBC medical school.

UBC results from the annual report have been “steady” over the past number of years, according to Money.

Money is chairing a dean’s task force meant to find ways to change the culture and environment at the medical school and to prevent mistreatment and harassment at the more than 80 training sites where UBC medical students learn, such as hospitals and clinics.

“Part of our work has to focus on learning from others, so we know what best practices look like.”

Sixty per cent of UBC medical graduates said they had been publicly humiliated. This may include being asked a question by a professor in a group setting, not knowing the answer and feeling shame about it because of, for example, how the instructor reacted.

This raises the question of whether students are becoming more sensitive to these kinds of learning tools.

“That’s a tough question. It’s an old style of teaching and how it’s done or how it’s perceived may be different in each scenario. We have actually made a video that tries to distinguish between being challenged academically and being bullied or called out so much that people feel humiliated,” she said.

Money said staff have collected data on the reported incidents of public humiliation, racially or sexually offensive remarks and unwanted sexual advances experienced by students.

Townson told clinical faculty members in the memo obtained by Postmedia that if they are concerned they’ve made a comment that might have been misinterpreted and want “a safe place to debrief” they should come and speak to her.

She said in the memo that “addressing student mistreatment” is a priority and students need a clear mechanism for reporting concerns. UBC has several satellite sites — Vancouver, Victoria, Kelowna and Prince George — where undergraduate students learn and Townson said in her memo that the disturbing reports are “not isolated to a single site or a single rotation.”

Money said there are about 700 professors in the medical school and about 7,000 clinical instructors. When students complain about a particular instructor or fellow student, an investigation is launched to determine whether coaching or discipline is required. Money said she couldn’t say how often that occurs but said expulsion is “rare and extreme.”

The survey of medical school graduates in Canada covers a broad range of topics about the quality of education and student experience and has been conducted annually by the Association of Faculties of Medicine of Canada since 2015.

UBC is the fifth largest medical school in North America with 288 students admitted each year, and 4,500 students doing residencies and other postgraduate work.

At the same time as UBC is grappling with the mistreatment issue, the Lancet has published the results of an alarming survey showing that sexual harassment — by patients, teachers and peers of medical students — is common in Canada.

The study by researchers in Ontario and Alberta shows that despite policies and complaint mechanisms intended to promote respectful conduct and to prevent harassment, students are subjected to everything from sexist remarks to rape. A total of 807 incidents were reported by 188 respondents to the 2016 anonymous survey. The harassment occurred in clinics, medical schools and social settings; patients requested medical students touch their sexual organs and they groped doctors. One student said she was raped by a fellow student. Faculty members were implicated in about 20 per cent of the incidents that were predominately experienced by female students. Men were the most frequent perpetrators.

The authors say that faculty, peers and victims come to almost normalize sexual harassment. Students try their best to ignore it while at the same time finding it “confusing, upsetting and embarrassing.”

Many don’t report it because staying silent is seen as “less risky than confrontation or official reporting.”

Dr. Susan Phillips, a professor at Queen’s University and co-author of the Lancet study, said it is clear that women who are practising doctors or studying to become doctors are not immune to harassment and sexual assault.

“This is a societal problem. And we have to find ways to decrease the incidence,” said Phillips, who several years ago published a study in the New England Journal of Medicine showing that 78 per cent of female doctors had been harassed by inappropriate comments or conduct by patients.

“Medical schools can’t fix societal problems but they can do more to legitimize student concerns. That means if they hear about a patient or faculty member making inappropriate comments, they don’t let it go. There has to be zero tolerance and in the case of faculty members, it has to be enforced.”

One limitation of the Lancet study is that few medical students completed the survey. There are about 11,600 medical students across Canada and just under 300 completed the consent form to submit answers to the anonymous survey.

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16Feb

Wilson-Raybould resignation leaves veterans feeling betrayed by Trudeau

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OTTAWA — Jody Wilson-Raybould’s resignation from cabinet this week has stoked long-standing frustration, disappointment and anger among Canada’s veterans, who say they have been ignored and betrayed by the Trudeau government.


Canadian Prime Minister Justin Trudeau speaks with Canadian veterans following a ceremony at the Canadian Cemetery No. 2 near Vimy Ridge, France in 2018.

THE CANADIAN PRESS/Adrian Wyld

The Liberals went out of their way during the last federal election to court former service members, as Justin Trudeau promised to improve service delivery and reinstate a lifelong disability pension for veterans after years of Conservative cuts and inaction.

That pension, first introduced after the First World War, was abolished by the Conservatives with unanimous support in the House of Commons in 2006 and replaced by a suite of rehabilitation programs and financial compensation for injured soldiers.

Since then, the Liberals have run through three veterans affairs ministers in as many years — Kent Hehr, Seamus O’Regan and Wilson-Raybould — while making little headway on improving service delivery and breaking their pension promise.

The government has increased some supports and benefits for veterans and unveiled its own so-called Pension for Life program that will roll out in April, but that program has been widely assessed as falling far short of Trudeau’s original pledge.

Our key concern is there’s been a betrayal of the commitment that the prime minister made in the election of 2015

Brian Forbes, chair of the National Council of Veterans Associations

“Our key concern is there’s been a betrayal of the commitment that the prime minister made in the election of 2015,” said Brian Forbes, chair of the National Council of Veterans Associations, which represents more than 60 veteran groups.

“That is felt very strongly in the veterans’ community.”

The Liberals have also been roundly accused of ignoring the various ministerial advisory groups and other mechanisms established after the 2015 election to solicit feedback from the veterans’ community about its needs and concerns.

All of which had sowed seeds of discontent even before Wilson-Raybould was handed the veterans-affairs portfolio on Jan. 14, taking over from O’Regan in a move widely regarded as a demotion from her previous role as justice minister.

Now, while parliamentarians and Canadians at large wonder about the truth surrounding Wilson-Raybould’s discussions with the prime minister’s office about SNC-Lavalin, many veterans feel they have been forgotten. Defence Minister Harjit Sajjan has added responsibility for veterans to his duties, but only temporarily.

It’s like the veterans are the last priority in this story. We don’t have a minister of veterans affairs anymore.

Aaron Bedard, an Afghan War veteran from B.C.

“It’s like the veterans are the last priority in this story,” said Aaron Bedard, an Afghan War veteran from B.C., who led an unsuccessful legal battle against the government to reinstate the old disability pension.

“We don’t have a minister of veterans affairs anymore.”

Even before Wilson-Raybould’s departure, some veterans and veterans’ groups had questioned the number of ministers who have handled the portfolio under the Liberals — and what it means about their importance to the government.

Not that the trend has been unique to the Liberals; all told, there have been seven veterans-affairs ministers in the past decade, not counting Sajjan. The Conservatives had three in less than two years, leading up to the last election.

That in itself creates difficulties, says Scott Maxwell, executive director of Wounded Warriors Canada, which helps former service members with mental-health injuries, because new ministers take time to find their footing.

“It just makes it difficult to get the work done,” Maxwell said in an interview earlier this month, before Wilson-Raybould’s resignation.

“That’s something we’ve tracked as a barrier.”


Prime Minister Justin Trudeau and former justice minister Jodie Wilson-Raybould.

Sean Kilpatrick/The Canadian Press/File

Yet Wilson-Raybould was also different in that many of her predecessors were seen as up-and-comers getting promotions and looking to impress, not senior ministers getting a demotion. While she repeatedly denied that description, insisting that working for veterans was vitally important, it nonetheless stuck with some veterans.

“When you’re saying you’re being demoted and you’re being sent to veterans affairs, it’s a slap in the face for us,” said Daniel Tremblay, an Afghan War veteran from Ottawa who is now struggling with back problems and post-traumatic stress.

“It should be a promotion, not a demotion. That way you know the individual wants to be there and cares for us.”

The Trudeau government is scrambling to contain the damage caused by Wilson-Raybould’s resignation, which followed a Globe and Mail story saying the Prime Minister’s Office had pressured her to intervene in a criminal case against SNC-Lavalin.

Yet her resignation also makes a difficult task for the government even harder, as the Liberals already faced an uphill climb selling their Pension for Life program ahead of this year’s federal election.

It’s difficult to assess how veterans’ concerns affect federal elections given that the community is spread across the country, but anecdotal evidence has suggested many former service members voted Liberal in 2015 — largely because of the disability-pension promise.

That appears almost certain to change in October, though the question is who veterans will actually support. Bedard, who worked with the Liberals in the last election, says the Conservatives have repeatedly reached out to him and others over the past year or so.

Yet others still remember the deep cuts to frontline work at Veterans Affairs Canada that were imposed by Stephen Harper’s government and the Conservatives’ refusal to reinstate the disability pension after a decade in power.

That leaves open the question: Where will veterans turn in 2019?

“The (veterans-affairs) file has been mismanaged for a decade or more,” said Nova Scotia veteran David MacLeod, who was forced to leave the military in 2010 for medical reasons.

“Based on mismanagement alone, I will not be supporting any of the major political parties in the coming election. I’ll support one of the smaller parties or a credible independent candidate.”

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