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COVID Update

Public Health now posts weekly COVID-19 Surveillance Reports on Thursdays. This week’s report, which is again showing​“decreased activity,” covers the week ending June 18. Highlights include:

  • Severe outcomes from COVID-19​again​“decreased compared to the previous week”. There were 58 hospital admissions, down from 80 the week before. This includes 8 ICU admissions, down from 14 last week. Hospital admissions peaked most recently at 264 the week ending April 16. 
  • There were 6 deaths recorded, up from 3 recorded the previous week. There have now been 2,025 deaths related to COVID-19. 
  • There were 203 lab-confirmed cases reported in Manitoba over the week, down from 228 the previous week. The test positivity rate was 11.3%, up from 9.6% .

The updated wastewater surveillance dashboard shows ongoing activity at much lower levels than earlier this year, decreasing in early June with a slight spike in mid June.

Vaccination for Young Children Poll

With the approval of vaccines for children under five in the US, the Manitoba government is seeking feedback from Manitobans on emerging COVID-19 vaccination plans for young children. The province has launched an EngageMB survey and invites Manitobans, particularly parents and caregivers of children aged six months to four years, to share feedback on COVID-19 vaccination plans and also asks for perspectives on the current COVID-19 vaccination strategy for children aged five to 17 and for the general public overall. The survey will open on July 13. Provide your feedback here.

Rural Care Awareness Campaign Launched

Today we launched a new campaign to raise public awareness about the crisis in rural health care. We’ve heard from many physicians, concerned that ER closures and changing hours of operation could put patients at risk by causing confusion about how to access care. In fact, a critical incident report released earlier this year revealed that a patient died after being taken to a closed ER.

Manitoba has 68 hospitals and health centres in rural and Northern communities:

  • 27 (40%) ERs are anticipated to be open 24/7, though we anticipate this number may get smaller. 
  • 23 (34%) ERs are anticipated to operate part time, with reduced hours or temporary suspensions.
  • 18 (26%) ERs have been closed for more than a year and are not expected to reopen this summer. 

“I’ve been at this a long, long time and I’ve never, never been as concerned as I am now about the stability of our hospitals and our emergency rooms to provide the care to our patients,” explained Dr. David Cram, a physician who has worked for 36 years in Souris, and the Manitoba representative on the CMA’s Board of Directors. 

While RHA’s have a long practice of notifying local communities of ER closures and schedules, not all post this information online.

To help the public with accessing this information, Doctors Manitoba today launched Rural​Care​.ca, a new online one-stop resource about rural and Northern ERs operations, including:

  • Advice from physicians about how to plan ahead given the number of ERs with expected closures or reduced hours. 
  • Guidance about what to do during a medical emergency.
  • The expected status of ERs this summer at all rural and northern hospitals, with links to find updated ER closure notices in each region. 

“There are hundreds of physicians all working to offer high-quality care because we are deeply committed to the rural and northern communities we serve, but severe staffing shortages are making it difficult to maintain our health-care services in many hospitals right now,” said Dr. Nichelle Desilets, a physician in Neepawa and the Doctors Manitoba Board Director from the Assiniboine Medical District.

Dr. Candace Bradshaw, President of Doctors Manitoba praised her rural colleagues for their commitment to their communities. She added that action is needed and Doctors Manitoba will be compiling best practices, seeking physicians’ views, and proposing recommendations over the coming months. ​“This is a conversation that needs to happen with us and with stakeholders, with the province and with Shared Health,” Dr. Bradshaw added, so ​“we don’t have to stay in this constant state of crisis.”

→ Read more about the new resource in this CBC story.

Rural​Care​.ca was created with guidance from a group of rural and Northern physicians. Doctors Manitoba plans to update the site weekly, and we welcome local physicians’ updates on any changes to services at their local hospital. You can email these to Keir Johnson at kjohnson@​doctorsmanitoba.​ca.

Roe v. Wade Overturned: The Local Impact

As has been widely reported today, the U.S. Supreme Court released its decision today overturning Roe v. Wade and the federal protection for reproductive health care. This decision may be difficult or triggering for some physicians, and there are supports available.

The Supreme Court’s decision will enable state governments to pass laws banning, or placing substantial restrictions, on abortion services. In fact, just over half (26) of U.S. states have laws indicating they are certain or likely to ban abortion, according to the Guttmacher Institute.

This includes both North and South Dakota, where abortion could be illegal within days. 

Some groups, including Women’s Health Clinic, predict U.S. Citizens may travel north to seek abortions. Because of this, we have compiled the following information for physicians, should you care for a U.S. Citizen seeking a surgical or medical abortion: 

  • Surgical abortions: patients, including from out-of-province, can be referred to facilities that perform surgical abortions. This includes Women’s Health Clinic and Health Sciences Centre.
  • Medical abortions: all physicians can prescribe Mifegymiso.
  • Manitoba physicians may see an increase in U.S. citizens looking to access abortion services. Manitoba physicians providing care to U.S. patients are reminded to have each patient sign an agreement confirming that Manitoba law (and Manitoba courts) will apply. You can find more information and a sample form here.
  • Manitoba physicians are also reminded that they should ensure they provide clear aftercare instructions to any U.S. patients, given that patients’ access to health care may be limited when they return home.

Some physicians have also expressed concern for their colleagues in some U.S. states, who are being forced to choose between doing what they believe is ethically right in providing medical care to patients, or complying with laws that criminalize that part of practicing medicine. 

The American Medical Association released a firm statement today condemning the Court’s decision, calling it an ​“egregious allowance of government intrusion into medicine.” Dr. Jack Resneck Jr., President of the AMA, said the Association ​“is deeply disturbed by the U.S. Supreme Court’s decision to overturn nearly a half century of precedent protecting patients’ right to critical reproductive health care.” He called it ​“a direct attack on the practice of medicine and the patient-physician relationship” and ​“a brazen violation of patients’ rights to evidence-based reproductive health services.”

Dr. Resneck also points out that ​“access to legal reproductive care will be limited to those with the sufficient resources, circumstances, and financial means to do so — exacerbating health inequities by placing the heaviest burden on patients from Black, Latinx, Indigenous, low-income, rural, and other historically disadvantaged communities who already face numerous structural and systemic barriers to accessing health care.”

He continues by saying that abortion ​“is a medical matter between the patient and physician, subject only to the physician’s clinical judgment and the patient’s informed consent… We will always have physicians’ backs and defend the practice of medicine, we will fight to protect the patient-physician relationship, and we will oppose any law or regulation that compromises or criminalizes patient access to safe, evidence-based medical care, including abortion. As the health of millions of patients hangs in the balance, this is a fight we will not give up.”

The AMA also took to social media to point out ​“states that end legal abortion will not end abortion — they will end safe abortion, risking devastating consequences, including patients’ lives.”

In Texas, where all abortions from the moment of fertilization will be
illegal in the coming weeks, with narrow exceptions only to save the
life of a pregnant patient or prevent ​“substantial impairment of major
bodily function”, the Texas medical Association said that it ​“is unwavering in its stance against intrusions by government or other third parties that impede the patient-physician relationship, and any criminalization of acceptable and appropriate medical practices that may jeopardize that relationship or patients’ safety.”

Ukrainians Need Your Help

The war in Ukraine is not over, and displaced Ukrainians continue to arrive in Manitoba. The health and well-being of these newcomers has been significantly impacted. Thank you to the 30+ physicians who have already offered to provide care to Ukrainian newcomers. We have heard that there could be a need for more, both in Winnipeg and rural areas.

Shared Health has created a resource page about health services for Ukrainians arriving in Manitoba. The provincial government has also created a general information page for Manitobans with information about how to help, immigration resources and information for new arrivals.

Indigenous Peoples’ Day

Tuesday, June 21 was National Indigenous Peoples Day and we were proud to unveil our new Indigenous Logo, which visually reinforces our support of Indigenous physicians, medical learners, patients and communities and our commitment to reconciliation. The logo, designed by Métis artist Shaun Vincent of Vincent Design with feedback and guidance from Knowledge Keeper Leslie Spillett and Indigenous physicians, incorporates many meaningful elements and symbology. We also highlighted and celebrated the contributions of Indigenous doctors, Dr. Catherine Cook, Dr. Marcia Anderson and Dr. Barry Lavallee and the work of ally physician, Dr. Sabina Ijaz.

Learn more about the logo here and read the health-related recommendations from the Truth and Reconciliation Commission of Canada’s Calls to Action.

Civility In a Time of Burnout — May ROUNDS article

With over 50% of physicians reporting high levels of burnout, civility among colleagues in healthcare is more important than ever. Burnout can lead to aggressive behaviours and belittling comments, which have the power to significantly affect a medical learner’s confidence and sense of belonging right when they need it most. The ripple effect of incivility can cause medical learners to want to work less, the quality of their work diminishes, and they may even opt to leave the profession. Medical Student Tess Bortoluzzi believes ​“when we take time to be civil, teams become empowering and inclusive”. 

To foster inclusion and create safe spaces for our members and their colleagues, we will continue to seek opportunities like supporting the Civility Saves Lives campaign and providing pronoun ID badges and safe space decals for practice environments. 

Take the Civility Saves Live Pledge and read Civility In a Time of Burnout in the May issue of Rounds

Watch: Larry Saves the Healthcare System

And now for something completely different: a research-based musical satire of the healthcare bureaucracy! Just in time for the weekend!

Larry Saves the Canadian Healthcare System follows an idealistic young policy analyst seeking a cure for Emergency Department crowding. Instead, he encounters ever-deeper layers of system dysfunction – plus dancing doctors, singing nurses, and the ghost of Tommy Douglas. Winnipeg-based writer/​composer Dr. Sara Kreindler also holds a research chair in health system innovation at the University of Manitoba. Larry was born when her multi-provincial research on patient flow generated findings so absurd that she felt only a musical could do them justice.

The witty musical is broken up into 11 ​“micro” episodes of four to six minutes each. Watch it here!

Health System Updates

Monkeypox Update

Chief Provincial Public Health Officer Dr. Brent Roussin sent an update to all providers this week on monkeypox. Public Health is maintaining a site with public and provider resources. Recent updates include:

MAJOR HSC Investment 

A $100M fundraising campaign aims to bring new surgical and diagnostic technology to HSC. Operation Excellence, which has a six – year plan which will be broken into three phases, aims to create:

  • An immediate impact on the diagnostic and surgical wait list
  • Better patient outcomes
  • Shorter hospital stays through the use of minimally invasive procedures that require shorter recovery periods
  • More efficient systems for surgical referrals and wait list management through advanced software
  • Creating the conditions for HSC to always embrace the next innovations in surgical care
  • Firmly establishing HSC as an employer of choice for leading surgeons and other medical professionals

The planned enhancements to physical spaces, equipment and infrastructure capacity will cut down on wait times, help address the diagnostic and surgical backlog, provide more access to minimally invasive procedures, and may help attract new talent and improve retention of front-line workers.

The province has committed $50M and another $25M has already been raised through corporate and individual donations. Dr. Ed Buchel, HSC surgery director and primary lead on the campaign said, ​“this is a bold plan, it’s a necessary plan, a plan that will position HSC to be among the most advanced hospitals in Canada.”

The campaign will have impacts similar to the investment made by the opening of the state-of-the-art Wilf Taillieu Thoracic Surgery Clinic and Endoscopy Unit, which enables surgeons like Dr. Biniam Kidane to perform esophageal cancer tumor removal by endoscopy, with no incisions. Dr. Kidane notes that lead-up of appointments for patients was halved due to the technology, and what would have otherwise been a seven- to 21-day hospital stay turned into 12 hours.

PCH Staffing investment

More than $16 million in new funding will be invested this year to expand staffing and training in personal care homes (PCHs). This new funding will support the:

  • recruitment and hiring of more than 350 health-care aides to increase the amount of daily direct care provided to residents;
  • addition of 72 new positions for registered nurses and licensed practical nurses combined;
  • establishment of medical leads to provide leadership and guidance to PCH medical services and infection prevention and control enhancements; and
  • investment of $1.5 million in tuition supports and direct care staff recruitment incentives to help build this workforce.

For more information or to read the Final Report of the Provincial Implementation Plan for the Stevenson Review.

Fantastic Physicians

The Association of Faculties of Medicine of Canada (AFMC) has opened up the nomination process for their awards. The deadline to get nominations in is October 15, 2022. If you would like help putting together a nomination package, please email jsie@​doctorsmanitoba.​ca.

Find out more about the AFMC awards here. The awards include: 

  • The AFMC Award for Outstanding Contribution to Faculty Development in Canada
  • The AFMC Charles Boelen International Social Accountability Award
  • The AFMC Clinical Teacher Award
  • The Clinician-Scientist award
  • The AFMC Gold Humanism Award and Lecture
  • The Indigenous Health Advocacy Award
  • The AFMC John Ruedy Awards for Innovation in Medical Education (x2)
  • Learner Changemaker Awards (x2)
  • The AFMC May Cohen Equity, Diversity and Gender Award
  • The AFMC Mentorship Award
  • AFMC President’s Award for Exemplary National Leadership in Academic Medicine
  • AFMC Scientist Award
  • AFMC Wellness Award
  • AFMC Young Educators Award

ICYMI

Upcoming Events

Check out our events calendar for upcoming events for physicians. Here are a few highlights to consider over the next few weeks:

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