Central Canada - Prairies, reserves and wildfires

megplaster

Jun 3, 2023

6 min read

We have deserts, aboriginal communities and bushfires - while the nomenclature is different, there is so very much that we have in common with our Canadian cousins. Our geographical spread, colonial origins, indigenous displacement and injustices, state/provincial political and health systems are all so very similar across our two countries. So too is the wonderful warm hospitality I’ve received while being here, which I’m confident Aussies would also offer visiting colleagues.

✈️ Many people wondered why I might plan to visit Winnipeg, the capital of a geographically large, but less populous province much like Western Australia. Manitoba was described to me by one Winnipeg resident as a dying province, with not much that comes out of it to sustain itself or attract people to move there. Western Australia does not suffer from this challenge. It was certainly an interesting and somewhat sad city to see, with a tired air of having well past its heyday and what seemed to be a fierce battle to maintain the infrastructure against the ravages of climatic extremes. I did manage to see what I gather are the 2 stand-out attractions of The Forks (a lovely market and cultural space set at the convergence of 2 rivers) and the Canadian Museum of Human Rights (you could almost justify visiting Winnipeg JUST for this!

This architecturally impressive building sits atop a culturally significant hill at the forks, on Treaty One Territory, the Indigenous ancestral land of the Métis.

Internally lit alabaster ramps lead the visitor from floor to floor of the 8 levels, each with a different human rights focus or period, and progressing from darkness on the lower levels, through to light at the top.

In a timeline of human rights on one of the floors, I spotted a couple of notable entries of relevance to my travels:

1803 - 1847 - Europeans deliberately destroy Aboriginal population of Tasmania

2001 - the Netherlands becomes the first country to legalise same-sex marriage

I spent a thoroughly immersed afternoon in this reflective space, reading and watching the diverse array of exhibitions and pondering the things we have yet to realise by way of human rights.

Manitoba’s MAiD program, run by an experienced nurse manager (who strangely also has responsibility for two other provincial services - the Manitoba Ostomy Service and …wait for it…the ‘Tick Collaborative Care Service’ - yes you read that right!) and a lead clinician with backgrounds in intensive care, addictions medicine and palliative care. The province is fairly unique in Canada for its entirely centralised MAiD model, which had many similarities to WA’s model. They serve their 1.4 million population - at least half of whom live in and around Winnipeg - with their team of 10 staff, comprising nursing care coordinators who field referrals, triage and pair people in hospitals and community with MAiD assessors and providers. The nurses undertake what is regarded as a ‘preliminary assessment’ which includes a chart review and phone triage and seeks to determine whether a person has the potential to meet eligibility criteria. (More on this ‘assessment’ process in my report).

While most intake and triage work is done by telephone, the service aims to provide what they describe as a ‘gold standard model of care’ which sees all assessors/providers accompanied by a nurse and a social worker to patient visits. As demand is increasing, particularly with the expansion to include Track 2 patients, this is increasingly challenging and often not achievable for all assessment visits. But they aim to adhere to this for all provision visits. It’s a somewhat controversial model across the country and I heard a variety of opinions about both the sustainability and the merit or evidence supporting what is clearly quite a resource-intensive approach, especially for such a geographically large region. Although increasingly, the work of the northern part of the province is attended by a nurse practitioner who lives in the north of the province. Uptake amongst the predominantly indigenous population in the north has been fairly low. The nurse manager and I discussed why this might be - cultural discord with MAiD, lack of awareness, existing lack of access to health care amongst indigenous populations on reserves, or possibly all of these.

Interestingly, the geographical challenges in Manitoba that we too face in Western Australia, have been mostly addressed by the use of private airlines!!! Apparently they’ve proven to be cheaper than commercial airlines, more flexible and responsive, often flying the team into a region and waiting for couple of hours for provision, before returning them to Winnipeg!! We need to find us one of those airlines 😵👩‍✈️✈️

The team had a fabulous map on their wall with pins identifying all the places within their province that they’ve supported people with MAiD. We’ve been exploring getting a large WA map in the WA VAD team, but hadn’t thought of this wonderful way to capture our coverage of the state.

Rounding out Manitoba was a lovely lunch meeting with the executive director of the Canadian Virtual Hospice, who have a wealth of wonderful online resources about death, dying and bereavement, including some specifically about MAiD, and whose MAiD information for children we’re adapting for local use in WA, with their permission.

https://www.virtualhospice.ca/MAiD

Shelly and I f0und much common ground and shared perspectives, as well as wonderful food!

✈️ Next stop - Calgary, Alberta, where a series of ferocious wildfires had been burning and causing havoc for over 2 weeks. It had been a point of discussion with people as I had moved across the country from Halifax, and arriving to the smoke-filled city reminded me of the apocalyptic scenes in the Perth metropolitan area in 2021 from nearby fires.

I headed straight from the airport to visit with the Calgary MAiD team, facilitated by their wonderful geriatrician medical lead, whom I’d met in Halifax. The team is one of two that cover the fairly conservative, farming province of Alberta with its population of 4.6 million. The Calgary MAiD team tell me that their service model is rather different to that provided in Edmonton, the more northern capital of the province. The Calgary team covers two of the five ‘zones’ that Alberta is divided into, including Calgary and ‘central‘ which they estimate likely serves approximately half of the province’s total population.

The model here is a centralised one, with largely phone-based intake and triage undertaken by 2.7FTE of skilled nursing and para-medically trained staff, which has seen a bit of turnover in recent years. The team refer patients to assessors and providers known to them and held on an unofficial ‘register‘ that they hold of identified clinicians providing MAiD care in the region. Along with intake and triage calls, the coordinators also provide phone-based preparation of people/families for the day of provision, but don’t attend any of these in person themselves. Instead, they utilise a referral ‘pool’ of casually employed nurses who go to the person’s home, cannulate and remain with the doctor who arrives for the MAiD provision. I would see this model used elsewhere across the country also and it led me to wonder about many aspects to this - the relative disconnection between the person and coordinators, the sense of ‘completion’ and fulfilment for MAiD coordinators working to this model, the arrival of a previously unknown nurse into the picture on day of administration, sustainability of our Western Australian model that has care navigators/coordinators continue involvement throughout the process and into bereavement follow up. None of this was with judgement, just interest at different models and wondering how Australia’s services might evolve…or not.

I have also reflected a lot on a significantly different nursing culture to that in Western Australia, at least in terms of cannulation, which is not always core business for nurses outside of specific units and settings (I await the barrage of corrections from my more clinically connected nursing colleagues - I totally acknowledge how clinically out of touch I am! Maybe things have evolved a lot since I was on wards.) But I have come to wonder why it is not a more consistently embedded part of nursing practice in WA, when I think back to my days on wards where we waited, sometimes for many hours, for an over-stretched intern or resident to trek around the hospital re-siting IVCs on patients they’d usually never met and often didn’t know the clinical context for. Not sure about the cost effectiveness, efficiency or person-centredness of this.

I rounded out my stay in smoky Calgary with a generous invitation from Dr J to join her and her family for a BBQ dinner at her house. It was a lovely offer that afforded us an opportunity to chat more, as well as offering me both company and some home-cooking! If only I could have brought with me a bottle of nice Australian wine, instead of the Jacob’s Crap that is largely what’s available on Canadian shelves in the Australian wine sections!

And finally, a clearer day on my penultimate in Alberta, for some wandering, reflection time and marvelling at people floating down the river swollen with spring melt despite its frosty temperature!!!