SMA Digest | Spring 2019: v. 59 i. 1 by SMA Communications

A publication of the Saskatchewan Medical Association Volume 59 | Issue 1

DIGEST

SPRING 2019

A VISION

for better Indigenous care in Saskatchewan

Â» WOMEN LEADING

change in Saskatchewan health care

COMBATTING HIV

PASSION & PERSEVERANCE the journey that brought the SMA president from Sri Lanka to Saskatchewan

in the LGBTQ community

CELEBRATING OUR

DIVERSITY

PRESIDENT’S NOTE

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SMA DIGEST | SPRING 2019

PRESIDENT’S MESSAGE

Welcome to the spring 2019 issue of SMA Digest. I am excited about the stories you’ll find within this issue. Our theme is diversity, and as I am sure you are thinking, the word diversity itself can mean many things to many people. Thus, we have tried to provide a range of perspectives on what is a reality for our profession. Physicians, as a community, encompass many backgrounds and perspectives. I myself came to Canada as a young physician and have found the transition from Sri Lanka to Canada deeply rewarding. While I am now a Canadian, I still retain a perspective that only someone who is from away can truly appreciate. On page 10 you’ll read an interesting profile of our latest Physician of the Year award winner,

Dr. Bhanu Prasad. His journey to Canada and his successful career here reflect the experiences of many people practising medicine in Saskatchewan. I am sure it will resonate with many of you. Diversity can also bring challenges. On page 32 you’ll hear about some experiences we wish had not happened to our members and colleagues. The transition to Canadian life is not always smooth, and some challenges are unpleasant and can negatively affect someone for a long time. I often feel the people of Saskatchewan make up for the extreme cold weather by their warmth. My 18 years in the province were overwhelmingly positive, and while there might have been the occasional slight, I chose to ignore it. However, I feel it is important to tell the stories of other people’s experiences. As physicians, and as an association, we can help by actually talking about discrimination and racism. Sometimes admitting that an issue exists is the first step in solving it. Pretending these things don’t happen certainly does not help anyone. You’ll find other perspectives in here too. The LGBTQ community has made great strides in the last few years, and it is encouraging to see how society in general, and the medical community in particular, are showing support. On page 24 you can read about how the work of Dr. Francois Reitz is advancing accessible and preventative HIV treatment, including counselling, for the LGBTQ community. He’s doing this important work in an environment that is safe, supportive and non-stigmatizing. All members should be proud of these efforts. I hope you enjoy this issue of SMA Digest. Diversity is our strength. With the right attitudes and a strong commitment, today’s problems and challenges will become tomorrow’s history. Diversity makes everyone stronger. Different perspectives provide us all with differing, and sometimes very powerful, insights. Happy reading!

DR. SIVA KARUNAKARAN SMA President president@sma.sk.ca

SMA DIGEST | SPRING 2019

“We need to support each other in order to thrive.” Spring 2019 | VOLUME 59 ISSUE 1 SMA Digest is the official member magazine of the Saskatchewan Medical Association. It is published twice per year and is distributed to nearly 90 per cent of practising physicians in Saskatchewan.

Over half of Saskatchewan’s physician workforce is made up of international medical graduates (IMGs). Though many report a warm welcome to Saskatchewan, the unfortunate reality is that this is not everyone’s experience. Bias and discrimination occur. Halima Mela, author of the thesis Perceptions of diversity management of IMGs: How fair is the process?, and Brenda Senger, director of SMA Physician Support Programs, discuss these experiences and explore how a positive change can be made.

Editor:

Maria Ryhorski (SMA staff )

Editorial board

Dr. John Gjevre (physician rep) Dr. Crystal Litwin (physician rep) Delilah Dueck (SMA staff ) Girard Hengen (SMA staff ) Ivan Muzychka (SMA staff )

Upcoming issues

The next issue of SMA Digest will be distributed in fall 2019.

Advertising

The deadline for booking and submitting advertising for the next issue is Monday, Aug. 23, 2019. Rates for display advertising are available upon request. Classified ad placement is free for members promoting physician, locum and practice opportunities; ads should be submitted via email and must not exceed 150 words.

Feedback

Member feedback is valuable and encouraged. Please direct comments, letters, ideas and advertising inquiries to: Maria Ryhorski Communications Advisor (306) 244-2196 maria.ryhorski@sma.sk.ca Saskatchewan Medical Association 201-2174 Airport Drive Saskatoon, SK, S7L 6M6

SMA mission

As the common voice of our members, we serve, represent and unite Saskatchewan physicians. We advance the honour and integrity of the medical profession; advance the professional, personal, educational and economic well-being of Saskatchewan physicians; and promote a high-quality, patient-centred health-care system.

SMA DIGEST | SPRING 2019

Combatting the crisis A Saskatoon physician’s fight to combat the spread of HIV is – for him – as much personal as it is professional. Dr. Francois Reitz, who works in concert with pharmacist colleague and friend Michael Stuber in Regina, offers Truvada as PrEP (preexposure prophylaxis) to at-risk individuals in the LGBTQ community. This preventative treatment has been proven 90 per cent effective at preventing HIV infection despite exposure.

CONTENTS

1 4 8 10 14 18 20 24 27 28 32 36 38 46

CELEBRATING OUR DIVERSITY President’s message Passion & perseverance: SMA president Dr. Siva Karunakaran Making the leap A hero to his patients: Dr. Bhanu Prasad Women leading change Aboriginal Achievement Award winner: Annette Pegg A vision for better Indigenous care in Saskatchewan Combatting the crisis PULSE: Peers share knowledge and give back Planting rural roots “We need to support each other in order to thrive” “We hope to keep him for years to come” How do you stay whole? Physician turned author brings passion for golf to the page

48 EVENTS / CLASSIFIEDS / ANNOUNCEMENTS 49 IN MEMORIAM

Planting rural roots Saskatchewan continues to attract physicians from around the world. Their stories reveal individual motivations for coming, but one overarching theme is that there are no regrets about starting a new life on the Prairies. Dr. Alexandra Akinfiresoye (originally from Nigeria), Dr. Boye Adeboye (originally from Nigeria, pictured right) and Dr. Melissa Fillis (originally from South Africa, pictured left) share their stories of setting up practice in rural Saskatchewan.

SMA DIGEST | SPRING 2019

SMA president Dr. Siva Karunakaran was determined to become a physician. He just had to overcome a few bumps in the road on a journey that took him from Sri Lanka to Regina

SMA DIGEST | SPRING 2019

PASSION & PERSEVERANCE By Girard Hengen

The early years: Education and civil war

Dr. Siva Karunakaran’s story is one of perseverance.

Dr. Karunakaran had to choose a career path while in high school. No one in his family was in medicine. His father worked for the government, and his mother stayed home in what he calls a middle-class family for northern Sri Lanka.

Born and raised in Sri Lanka, Dr. Karunakaran was on track studying to become a physician in his home country. He eventually joined a medical practice in Regina, but not before embarking on a 15-year globetrotting odyssey that saw him and his wife, Kumudhini, flee civil war, come to Canada, head to the Caribbean to resume medical school, move to the United States for residency training, and return to Canada to work with the then-Regina health district. In the midst of it all, the couple had two young sons to look after, while both pursued their medical dreams. By 2000, they were looking for jobs in Canada, and the choice was narrowed to a city in Ontario and Regina. “We felt that somehow Saskatchewan or Regina wanted us more than anybody else and it was like a sign from God. It was a good feeling, and that’s why we came,” Dr. Karunakaran said.

“The community I grew up in is a farming community, but that doesn’t mean you should picture something like Saskatchewan where it could be one or two kilometres before you see another home,” he said. “It’s densely packed. There’d be homes and there’d be agricultural land, and the home I grew up in is on a large plot of land. We had coconut trees and banana trees in our yard, and mangoes, too. That was the way of life back then.” Dr. Karunakaran grew up on an island, but did not spend his time lounging on the beach or plying the waters of the Bay of Bengal. Instead, he studied. Extra-curricular activities such as sports were frowned upon, he says, out of fear that children who got into sports or other activities would neglect their school work.

“We thought we’d set up practice and work here for a couple of years and see how things go. We didn’t know anybody at all. We had no friends, no family. We just blindly came, but things started to work out and there were so many positives. There are no regrets.”

“You basically went to school, and there would be some after-school classes that you attended, because it was very, very competitive to get into university, especially if you wanted to pursue medicine or engineering,” he said. “The best students aspired to become either a doctor or an enDr. Karunakaran’s perseverance paid off, culminating in his gineer, so it was very competitive. The province I grew up in We posed this question to a few physicians for the winter 2017 SMA Digest, and the feature election as president of the Saskatchewan Medical Associa- was academically focused, so it was harder there. It was a lot tion (SMA) at thesospring Representative Assembly in May more competitive than the other provinces in the country. proved popular we are bringing it back. 2018. It’s been quite the trip for the young boy from a small You basically studied all the time.” village near theand city of Jaffna, in northern Lanka. they have to look after themselves in order to best More more physicians areSrirealizing An interest in science led him to medical school in Sri Lanka in 1985. Little did he know, his futurephysically wife was travelling the “I feel privileged to have opportunity to serve, ” Dr. Ka-work look after theirthis patients. Because physicians’ can be all-consuming – both same path. He and Kumudhini are from the same town and runakaran said of his term as president of the SMA. “I don’t and emotionally – they need a release valve. entered medical school together. They knew of each other, look at it as a feather in my cap; that’s not how my mind but didn’t know each other until spending time in the same works. I got into the organization to help physicians and group doing rotations in hospital wards. WHAT DO PHYSICIANS LIKE TO DO IN THEIR DOWN TIME? WHAT MAKES THEM TICK AWAY health-care delivery in the province, and do whatever I can do to improve FROMit.THE JOB? HERE ARE THEIR RESPONSES. “I was in the medical school in Sri Lanka for five years,” Siva said. “By 1990, the year we should have graduated, we were “That is all I really want to do. In that way, I’m happy.”

SMA DIGEST | SPRING 2019

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WE THOUGHT WE’D SET UP PRACTICE AND WORK HERE FOR A COUPLE OF YEARS AND SEE HOW THINGS GO. WE DIDN’T KNOW ANYBODY AT ALL. WE HAD NO FRIENDS, NO FAMILY. WE JUST BLINDLY CAME, BUT THINGS STARTED TO WORK OUT AND THERE WERE SO MANY POSITIVES. THERE ARE NO REGRETS.

only able to complete four years of medical school because of the civil war that was going on.” Because of the war, many of his professors left the region for their own safety. The medical school was closed at times - the war drew near or there weren’t enough professors to teach the courses. Dr. Karunakaran said the teachers who stayed did so at great sacrifice and risk on behalf of their students. When the civil war hit too close to home, Siva and Kumudhini fled Sri Lanka, in 1991, with one year remaining to complete their medical degrees. “The area we lived in was a main area of action, and a lot of back and forth took place there. Pretty much everyone who lived in that area at that time was affected by the war in one way or another, and everyone knew many people who got injured or killed. It was a difficult time.”

‘Come on over’: Setting up in Regina Through it all, Siva and Kumudhini persevered. Kumudhini’s family had previously moved to Winnipeg and the couple followed. They got engaged and married while in Winnipeg, but with one year of schooling to complete, there was some unfinished business. Going back to Sri Lanka was not an option because of the war, Dr. Karunakaran said, so

SMA DIGEST | SPRING 2019

the two looked at starting medical school all over again in Canada, but there were no guarantees they would be accepted. They also looked at offshore options and landed at St. George’s University in Grenada. They were given credit for one year, so had to complete three years, which included clinical rotations in New York. Both decided to specialize in internal medicine, Siva in nephrology and Kumudhini in infectious disease. After graduating from St. George’s in 1995, they applied across the northeastern United States for residency training. They were matched at what was then called the Medical College of Ohio in Toledo, where their first son was born in 1996 and their second son in 2000. Fifteen years after starting medical school, the couple were now in a position to search the job market. They wanted to return to Canada, and in 2001, there was an opening for an infectious disease specialist with the Regina health district. “My wife called them and said, ‘I have a husband, he’s a nephrologist.’ And they go, ‘Oh yeah, we were going to advertise for one but we didn’t get around to putting out the ad yet. Come on over.’ And that’s how we came in, of course not knowing if we would be accepted together. “There is a surplus of physicians in many areas but back then there were only 2 ½ nephrologists in Regina, and I became the third one. For infectious diseases there was only one per-

son there, so my wife was the second. I was given privileges at practice (and) I had to come and set up my own shop so I joined the largest internal medicine group in Regina. They welcomed me and helped me set up the practice.”

The SMA board: ‘A nourishing and nurturing environment’ After a new beginning in Regina, the two physicians focused on their work and on raising a young family. “For the first four or five years there were only three of us (in nephrology), so invariably someone would go away and that would mean you’re on call every second day and every second weekend. With young children it was very hard,” said Dr. Karunakaran. “Once the fourth nephrologist joined us, that gave us some breathing room and I could look outward and see if I wanted to do anything else.” That something else was an opportunity to attend an SMA Representative Assembly as a delegate in 2006. He became active in the Regina Regional Medical Association and as section head of nephrology, at first just wanting to get involved in some way with the profession. His interest in and knowledge of issues grew over time, and in 2012 he joined the SMA Board of Directors. “I didn’t have any ambition to be on the board, to be honest,” he said. “My goal was to just do whatever I could to contribute and improve the practice of medicine, the profession, and the lives of the patients. Initially I said I would just come and explore how things are done and get myself familiarized with the inner workings.” In the first couple of years, Dr. Karunakaran says he wasn’t sure if he was “president material.” But once again, he persevered. More physicians joined his practice, leaving him with time for SMA matters. He found the board and the SMA office to be “a very nourishing and nurturing environment” where people are respectful and collegial. “That’s why I could come this far,” he said.

Growing into his new role Dr. Karunakaran is mindful that his one-year term as president is fleeting. He will take up issues that preceded him, and take on new ones. For example, work on the SMA’s new strategic plan began while he was on the board executive. “I knew it was going to become approved when I became president so I will own it for one year,” he said. One of the four pillars of the strategic plan is to improve physician wellness. This is a “huge concern” and one Dr. Karunakaran wants to focus on. Other issues include negotiations toward a new contract with the government, and challenges that will arise as the Saskatchewan Health Authority

settles into its new, and as yet uncharted role. This includes developing bylaws that are right for physicians. “Like most practising doctors I didn’t really know much about the bylaws and never gave them a second thought until I got involved with the regional medical association in Regina and there were issues related to physician privileges, promotion and discipline,” he said. “Once these issues started to come up at the local level, I got to know more about it and have a better understanding of it. Now I have a good idea of how the bylaws govern physician practices and the relationships with the SHA.” It’s been a roundabout trip to the top of his profession in Saskatchewan, one that started a world away in a village in northern Sri Lanka.

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I FEEL PRIVILEGED TO HAVE THIS OPPORTUNITY TO SERVE. I GOT INTO THE ORGANIZATION TO HELP PHYSICIANS AND HEALTH-CARE DELIVERY IN THE PROVINCE, AND DO WHATEVER I CAN DO TO IMPROVE IT.

“The common question people ask me is, ‘Are you ready?’ ” he said about taking on the SMA presidency. “It’s just like going to medical school. When I started medical school, on day one, if someone would have told me that in 10 years’ time you will be looking after patients with as many problems as they have, that would have been daunting. “It appeared daunting when I stepped onto the SMA board, to look at the prospect of me becoming president and giving the direction that others have given, and dealing with the media. But the way I see it, you grow into this role and we have a really good organization with good support and structure. I never felt alone here; the board and the staff are there to back me up. “I feel I am ready, that I have progressed through the steps just like everybody else who has gone on before me.” ◆

SMA DIGEST | SPRING 2019

MAKING THE LEAP Dr. Mateen Raazi

Provincial head of anaesthesiology, U of S, Saskatoon Originally from Pakistan

Where are you from and what brought you to Saskatchewan? My immediate transition to Canada happened in late 1996 from the United States where I did my residency training and fellowships. I was born and raised, however, in Pakistan and that is where I did my medical school as well. Since most of my close family had already migrated to North America, a desire to stay close to them came to fortuitous fruition when a job opportunity presented itself in Saskatchewan.

What was it like coming here? What struck you? My wife and I came to Saskatchewan in December of 1996, which was a particularly unforgettable time. Neither of us had been to Canada before even though we had lived in the United States for several years prior to that. What struck us both was the vastness and the eerily serene beauty of the snow-covered Saskatchewan landscape as the plane hovered before landing. We soon discovered firsthand the brutally invigorating impact of -40 C temperature on the human senses. In contrast to that, it was also quite apparent how warm and welcoming the people of Saskatchewan are and what a wonderful place this is to raise a family, not to mention how amply rewarding professional medical practice here is from many perspectives.

SMA DIGEST | SPRING 2019

Dr. Mateen Raazi and his family at the end of Ramadan celebrations: daughter Huda, wife Ayla, and son Ozayr.

What is a big difference youâ&#x20AC;&#x2122;ve noticed in Saskatchewan as compared with where you are from originally? Just to carry the climatic analogy and contrast a little bit further, I chuckle at how much of my childhood and youth were spent in +40 C summer temperatures and how -40 C temperatures have become the winter norm for us. Also quite apparent is the contrast between population densities; I grew up in cities with a minimum population of five to six million and it took a while to get used to the almost deserted roads of rural Saskatchewan where you feel like waving a big hello to a total stranger in the occasional car that drives by in the opposite direction.

How does it compare to practising medicine where you came from? Medical practice in most of the developing world including my country of birth, Pakistan, is quite different from Canada. While individual health-care providers are often the same on the skill and quality spectrum, aspects of organization and regulation of medical practice can be strikingly different. What we Canadians take for granted, and decidedly should not, is the universality, accessibility, quality and portability of our health-care system which is truly a shining example of Canadian social values.

What has been the biggest challenge? As with most diaspora families, the biggest challenge for us has been the logistics of staying in close touch with other family members and friends across vast and sometimes continental distances. If long absences make the heart grow fonder, our larger family must be a very loving one indeed.

Dr. Michelle Jagga and her daughters after becoming Canadian citizens.

Dr. Michelle Jagga

Family physician, Swift Current Originally from South Africa

Where are you from and what brought you to Saskatchewan? I was born in a small town called Ladybrand, in the Free State, South Africa. It is on the border of South Africa and Lesotho. My husband and I left South Africa with our oldest daughter in August 2004 and moved to Queensland, Australia. We spend two years there and moved back to South Africa. Unfortunately due to the problems in South Africa we decided to permanently move and also see a bit of the world and other cultures as we did so. We then moved to Palmerston North in New Zealand for four years. In 2009, wanderlust got a hold of us again and we decided to explore the True North. We moved to Saskatchewan in October 2009 and have been here ever since.

What was it like coming here? What struck you? Coming to Saskatchewan was a big adjustment for me, bigger than any other country we had ever lived in. We had never driven on the “wrong side of the road,” and snow was not something we were used to. What struck me though was the kindness of the Prairie people and acceptance we experienced here.

What is a big difference you’ve noticed in Saskatchewan as compared with where you are from originally? Snow and minus temperatures!!! Literally the opposite of both South Africa and Australia.

How does it compare to practising medicine where you came from? In South Africa, I was doing acute-care medicine and due to the high volumes of violence we saw a lot of gunshot wounds, stabbings and other horrific injuries on a daily basis and on a large scale. In Saskatchewan, there is not that volume of violence. I have since given up doing emergency department work and now mostly do family practice in clinic. A big difference in family practice here is the large geriatric population, which we do not have in South Africa. Our life expectancy is not that high in South Africa. So that was a big difference in practising family medicine here that I encountered.

What has been the biggest challenge? Personally it was letting go of my birth country and getting to love a country that I was not expecting to but have now come to love as my home. Professionally my biggest challenge was dealing with the change in my practice, letting go of my acute-care work and focusing more on family medicine.

What do you love most? I love horse riding and have met some awesome people who have taught me to do western riding which I have never done - we rode English style in South Africa. I love the farming community we live in; it is very much like the one I grew up in. I absolutely love summer and spending time with my five travelling buddies who have moved with me all over the world and have taught me so much about love, acceptance and forgiveness. What I miss the most about South Africa? My family that is still there, my only sister. Not having a big family gathering at Christmas with a “braai“ (BBQ), swimming and lots of watermelon fights. ◆

SMA DIGEST | SPRING 2019

A HERO TO HIS PATIENTS DR. BHANU PRASAD RECEIVES 2018 PHYSICIAN OF THE YEAR AWARD

By Girard Hengen Dr. Bhanu Prasad of Regina, who is the Saskatchewan Medical Association’s (SMA) 2018 Physician of the Year, has been called a “hero in plain clothes” by one of his patients, a nurse. The patient was diagnosed with kidney disease in 2011 and has been under the care of Dr. Prasad, a consulting nephrologist. “I feel that Dr. Prasad aims to excel in his profession and not for the acclaim but for the betterment of his patients and medicine,” the patient wrote. “He is truly my personal hero. He made me feel that life was worth continuing for and that together we would find a solution, and we have!”

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The patient is one of many who praised Dr. Prasad in letters supporting his nomination for the SMA award. Colleague and friend Dr. Kunal Goyal noted Dr. Prasad has a keen interest in pursuing research in clinical work and basic science. He has pioneered the use of certain procedures, and has been successful in obtaining national and provincial research grants to study kidney disease. “Dr. Prasad is passionate about the clinical care he provides to his patients,” writes Dr. Goyal. “He believes in a holistic approach and always puts his patients first. He takes the time to go the extra mile by talking to his patients and their relatives, explaining the physical issues pertaining to their health, possible solutions and implications.”

The 2018 Physician of the Year Award was presented during the SMA’s Representative Assembly in Regina on May 4. Dr. Prasad has been a consultant nephrologist in Regina since 2006, and is a clinical associate professor of medicine with the University of Saskatchewan. The SMA visited Dr. Prasad at his office in south Regina. The following is an edited text of that conversation.

about the Canadian health system appeared to be a better health-care system to work in. I suddenly realized that physicians have better roles and more important roles to play in the Canadian health-care system than they were playing in the National Health Service. Also, people are a lot friendlier in Canada, and in Regina. On the whole, a lot of these factors played a role in coming to Regina.

SMA: What was your reaction when you heard you were to SMA: Do you believe physicians in Saskatchewan have it receive the award? fairly well in terms of having a voice in the system, or inBP: I was delighted. When I came to know about it I was put, or even just the work environment? really happy. I wasn’t expecting it. I wasn’t aware that any attempts were being made for it. When I was given the opportunity by my nominators to read the letters of support, which they had collected from my patients and other staff members, it was a moment of pure pride and pleasure. To be appreciated by your peers is the ultimate honour that a physician can receive.

SMA: Where are you from? BP: I was born in Hyderabad, India, in south India. My dad was in the military so we moved from base to base until I joined medical school at 18. After I finished internship and training at 24, I moved to England where I spent the next nine years of my life. We came over to Vancouver, where I spent about a year before coming here to Regina.

SMA: Is there a medical background in your family? BP: There isn’t actually. My maternal cousins, there were lots of doctors there. I think the inspiration probably came from that side of the family.

SMA: What attracted you to nephrology? BP: I think nephrology had a combination of acute illness and chronic illness. Acute illness is the one that gives you the high and chronic illness is the one where you get close to patients and actually have long-term therapeutic relationships with them. The combination of the two was appealing. If it was all chronic then it’s unidimensional, and if it’s all acute it’s unidimensional. It was a good combination of the two. There’s also a very intellectual component from the electrolytes and everything else that we look into. I thought it was a cool profession.

SMA: What did you find appealing about the position in Regina, or about practising in Canada? BP: I was disillusioned by the National Health Service (NHS, the public health service in the U.K.), and what little I saw

BP: They have it well in all three phases. I certainly wouldn’t have had this in NHS. Physicians are heard here, we have a good working relationship with administration, and I think it’s definitely a better system in which to practise.

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HE IS TRULY MY PERSONAL HERO. HE MADE ME FEEL THAT LIFE WAS WORTH CONTINUING FOR AND THAT TOGETHER WE WOULD FIND A SOLUTION, AND WE HAVE!

SMA: Based on the testimonials that accompanied your nomination for SMA Physician of the Year, one of your enduring qualities is going the extra mile for patients. Do you think you go the extra mile or do you do what comes naturally to you? BP: I’m so happy this has been recognized. I’ve always done that. My skillset is probably teaching and more recently, I want to do more research, so I’m doing a lot more research. One of the things I would love to do is to actively participate in some of the pan-Canadian research that is occurring. We have so far been not actively part of it. I think some of the work that is coming out from our centre is helping us engage with other researchers and clinicians across Canada and, in some cases, the United States. We have multiple places that I actively engage with. These connections have helped me definitely become a better physician.

SMA DIGEST | SPRING 2019

SMA: You are also involved in pioneering some innovative procedures. What are some of them? BP: We are now trying to conduct a national study run out of this office on a condition called loin pain hematuria syndrome (LPHS). LPHS is a rare disease which afflicts young adults, and it debilitates them. We’ve had some initial success with a procedure called renal denervation, which when applied to the kidneys, leads to pain relief. This procedure can be repeated and leads to sustained pain relief. We don’t know whether this is a procedure-led improvement in pain or there could be a sham improvement in pain. We are in the process of getting grants and requesting Health Canada to conduct a randomized control trial. It will be run through two or maybe three centres in Canada. Hopefully we will prove once and for all that renal denervation actively works in people and allows them to come off their opioid prescription, and allows them to have a quality of life that young

adults deserve. We’d like to get every single young Canadian afflicted with this disease back into the workforce.

SMA: And this has shown promise in young patients? It’s very, very promising. We’ve had a couple of high-profile publications to prove that. The first one got accepted into the American Journal of Kidney Diseases and the second one was accepted in Kidney International Reports. Both are very prominent journals in nephrology. We will run it out of here with the involvement of Dr. Kunal Goyal, from Interventional Radiology Suite in Regina, and we have urologist Dr. Francisco Garcia from Swift Current. We also have a nurse practitioner, Shelley Giebel, who will be assisting us. We will be involving other sites; a conversation is on to involve London, Ontario, and one more eastern site. The source of pain isn’t clear so we’re doing a very novel study, and that’s an innovation. We’re trying to get a kidney biopsy on these patients. We will be interrogating the biopsy for genetic and molecular markers, and hopefully that will give us a lot more than the current kidney biopsy gives us in terms of the origin of the pain in these individuals. I think that’s going to be a novel way to find out why these people get pain. The majority of the people with hematuria, which is blood in the urine, do not get pain. We will be biopsing 10 people with loin pain hematuria and 10 people who do not have pain but just have hematuria. When comparing their biopsies for some of these molecular markers and genetic markers, we’ll also be checking their blood test and their urine test. I hope that will lead to some solutions as to why they actually get pain. It’s a novel way of identifying the source of pain originating from the kidney.

SMA: Does this excite you as much as seeing patients? It equally excites me. It actually makes me ready to come back to work. I think the skills that you learn and the knowledge that you learn doing things like that you can actively put back into patient care.

SMA: Has it been rewarding coming to Saskatchewan? It has been a fantastic move. There’s no doubt about it in terms of quality of life, happiness at work, friends that we have made both at work and outside. It’s been amazing, a great, great move. ◆

SMA DIGEST | SPRING 2019

MD Financial Management: Here for Saskatchewan Medical Association members. Today and always. Since the acquisition of MD Financial Management by Scotiabank was announced, we’ve spoken with and, more importantly, listened to PTMA members across the country—including members of the Saskatchewan Medical Association. We’ve heard optimism—and concern. Will MD still be for physicians? Will we still put your interests and needs above everything else? Our unequivocal answer is: Yes. In fact, we’ve made four specific commitments that you can hold us to: 1) The same objective, expert and physician-centred advice you’ve always trusted • Our Advisors are not required or incentivized to sell any specific investment products—including Scotiabank’s—that they don’t truly believe are best suited to meet your financial requirements. We’ll continue to put your needs first and foremost—always. • Our Advisors—the people who know and understand physicians’ finances best—remain dedicated to MD, and our staff turnover rate remains far below the industry average.1 • Scotiabank is a world-class organization with scale, resources and capital that we didn’t have previously. With Scotiabank behind us, we can benefit from their tools, technologies and strategic partnerships to provide a better client experience and make it easier for you to do business with your Advisor. 2) The same fees—or lower—and sound investment management • Our fees, which have not changed since the acquisition, are some of the lowest in Canada and continue to be among the most competitive on the market. Our management expense ratios (MERs) are, on average, 29% lower than others in the industry.2 Additionally Scotiabank has committed to keeping our fees the same—or even decreasing them. • As the world—and financial services in particular—becomes more complex, businesses like ours are under increasing pressure to keep up. We have always vowed to manage your investments conservatively and to avoid unnecessary risk; Scotiabank will help us continue to meet those obligations as regulatory requirements continue to evolve. 3) The same strong physician voice • We fully understand that physicians provide an invaluable perspective that strengthens who we are and what we do. That’s why we’ll continue to actively seek your input and feedback through multiple channels, including a physician advisory council. 4) Broader and more innovative choices • We can now complement our existing products and services with the robust suite of category-leading banking products and services3 delivered by Scotiabank—if and when you need them—including a registered disability savings plan (RDSP); lines of credit with preferred interest rates; medical student and resident lines of credit; Private Banking; credit cards; and special mortgage rates.

The job ahead of us is clear: to prove these words with action. You are a part of our DNA. And for as long as we have the honour of serving you, that will never change. We remain invested in physicians.

¹ MD’s voluntary departure rate for 2018 was 5.3%. This is lower than MD’s voluntary departure rate for 2017, which was 6.4%. The industry average voluntary departure rate for 2017, according to the 2017 Gartner Turnover Survey, was 13.2%. Industry average voluntary turnover has remained consistent with a rate of 14.3% in 2015, a rate of 14.8% in 2016 and 13.2% in 2017.

Year 2015 2016 2017

Industry Average Voluntary Turnover (Gartner Turnover Survey) 14.3% 14.8% 13.2%

MD’s Voluntary Turnover 3.1% 5.2% 6.4%

2 MD compared the management expense ratio (MER) for MD mutual funds and MD Precision Portfolios™ (applies to Series A fees only) with the average mutual fund MERs for comparable funds, using data from Investor Economics as of December 31, 2017.

3 Banking and credit products and services are offered by The Bank of Nova Scotia (“Scotiabank”). Credit and lending products are subject to credit approval by Scotiabank. Commissions, trailing commissions, management fees and expenses all may be associated with mutual fund investments. Please read the prospectus before investing. Mutual funds are not guaranteed. Their values change frequently and past performance may not be repeated. To obtain a copy of the prospectus, please call your MD Advisor, or the MD Trade Centre at 1 800 267-2332. The MD Family of Funds is managed by MD Financial Management Inc. MD Financial Management provides financial products and services, the MD Family of Funds and investment SMA DIGEST | SPRING 2019 13 counselling services through the MD Group of Companies. For a detailed list of these companies, visit md.ca.

WOMEN LEADING CHANGE A sea change is happening in Saskatchewan. Health regions have consolidated into a single authority, and the entire health system is undergoing a complete redesign informed by the people who provide care and the patients who receive it. Helping lead this change is a group of dynamic women, mostly physicians, who fill key roles at health-care organizations in the province: Dr. Susan Shaw, chief medical officer, Saskatchewan Health Authority (SHA); Dr. Janet Tootoosis, board member, SHA; Dr. Karen Shaw, registrar and CEO, College of Physicians and Surgeons of Saskatchewan; Dr. Joanne Sivertson, immediate pastpresident, Saskatchewan Medical Association (SMA); Dr. Susan Hayton, director of physician advocacy and leadership, SMA; and Bonnie Brossart, CEO, SMA.

Dr. Susan Shaw, CMO of SHA The following is an excerpt from â&#x20AC;&#x153;Women Leading Change,â&#x20AC;? published in the Canadian Journal of Physician Leadership, vol. 55 | no. 2, and is reprinted with permission. Please view the full piece at: https://cjpl.ca/ryhorski.html 14

SMA DIGEST | SPRING 2019

The SMA had the privilege of sitting down with these physicians to discuss their journey to this point and their thoughts on leadership.

Leadership is...

“

I USED TO THINK THAT BEING A LEADER MEANT TELLING PEOPLE WHAT TO DO — YOU GOT OUT THERE AND HAD YOUR IDEA, SO IF YOU DIDN’T HAVE AN IDEA THEN YOU SHOULDN’T BE A LEADER. I’VE LEARNED THAT LEADERSHIP HAS NOTHING TO DO WITH THAT AT ALL. YOU DON’T NEED THE ANSWERS. YOU NEED THE RIGHT QUESTIONS AND TO BE ABLE TO AMPLIFY THE VOICES OF THE PEOPLE WHO HAVE GOOD SUGGESTIONS. IT’S TRULY A HUGE PRIVILEGE WHEN PEOPLE LET YOU BE THEIR VOICE. - Dr. Joanne Sivertson, SMA

Saskatchewan environment?

“

IT’S BEEN CRAZY, CRAZY SUPPORTIVE. I’M NOT SURE THAT IT IS DIFFERENT IN SASKATCHEWAN, BUT IT FEELS LIKE IT IS. WE’RE SMALL, WE’RE RELATIONSHIPBASED, AND WE HAVE A HISTORY OF SUPPORTING EACH OTHER. WE STILL HAVE EGOS AND ALL THESE OTHER THINGS, BUT I THINK WE’RE ABLE TO FIND COMMON GROUND — TO GET INTO A ROOM TOGETHER, HAVE A MEAL TOGETHER, SOLVE A PROBLEM TOGETHER, ALLOW STRENGTHS TO RISE AND GIVE PEOPLE OPPORTUNITIES. - Dr. Susan Shaw, SHA

Challenges?

“

WE DON’T PUT A LOT OF THOUGHT INTO BEING WOMEN, AND SO THE IDEA OF BEING A GROUP OF WOMEN LEADERS STINGS A LITTLE BIT. WHY DOES THERE HAVE TO BE THAT DISTINCTION? IN MY CASE, I NEVER GET INTRODUCED AS A PHYSICIAN; I’M INTRODUCED AS AN INDIGENOUS PHYSICIAN. AND THERE’S A LOT OF WEIGHT WITH THAT ... BECAUSE THE EXPECTATION THAT I’M GOING TO SOMEHOW CONTRIBUTE IN A MUCH BIGGER WAY FOR A LARGE POPULATION THAT I HAVE NO REAL AUTHORITY OVER, OR EVEN KNOWLEDGE OF FOR THAT MATTER, IS UNREALISTIC. I HAVE MY CIRCLE, MY KNOWLEDGE, MY UPBRINGING, MY TRIBE, MY SPIRITUALITY, BUT WHY IS THAT ALWAYS ON THE TABLE? - Dr. Janet Tootoosis, SHA SMA DIGEST | SPRING 2019

Importance of diversity...

“

FOR MY KIDS, AND PROBABLY FOR ANYBODY WHO HAS DAUGHTERS, SEEING YOU IN THAT ROLE MAKES A DIFFERENCE. MAYBE THEY ALREADY THINK, ‘OF COURSE I COULD DO THAT,’ BUT WHEN THEY SEE A WOMAN LIKE YOU IN THAT ROLE, IT HELPS. THAT’S WHY WE WANT PEOPLE OF DIFFERENT ETHNICITIES AND RACES IN THESE LEADERSHIP ROLES, BECAUSE PEOPLE TEND TO THINK, ‘THAT COULD BE ME.’ - Dr. Susan Hayton, SMA

What I’ve learned...

“

OFTEN, WHEN YOU FIRST START OUT, YOU DOUBT YOURSELF BECAUSE YOU DON’T HAVE ALL OF THE COMPETENCIES AND YOU’RE TRYING DESPERATELY TO GAIN THEM AND BECOME AN EXPERT IN EVERYTHING. SO THE LESSON IS, TRY YOUR VERY BEST TO GAIN ALL THE COMPETENCIES THAT YOU CAN, BUT THE BETTER SOLUTION IS TO SURROUND YOURSELF WITH GOOD PEOPLE. THE MORE DIVERSE THE BETTER. - Dr. Karen Shaw, CPSS

THE LEADERS (Back row, L-R) Dr. Susan Hayton, SMA; Dr. Karen Shaw, CPSS; Dr. Susan Shaw, SHA (Front row, L-R) Bonnie Brossart, SMA; Dr. Janet Tootoosis, SHA; Dr. Joanne Sivertson, SMA Read the full article at: https://cjpl.ca/ryhorski.html

SMA DIGEST | SPRING 2019

2019 PLIs STRATEGIC THINKING FOR RESULTS

May 31- June 1, 2019 | Saskatoon, Sask.

MANAGING PEOPLE EFFECTIVELY

June 21-22, 2019 | Regina, Sask.

SOCIAL SYSTEMS LEADERSHIP: THRIVING IN COMPLEXITY

Sept. 13-14, 2019 | Regina, Sask.

LEADING WITH EMOTIONAL INTELLIGENCE

Oct. 25-26, 2019 | Saskatoon, Sask.

ABORIGINAL ACHIEVEMENT AWARD WINNER HOPES TO MAKE A DIFFERENCE IN HER COMMUNITY

By Girard Hengen The SMA spoke with Annette Pegg, a third-year University of Saskatchewan medical student in Regina. She was a recipient in 2017 of a U of S Aboriginal Student Achievement Award for leadership.

SMA: Tell us a little bit about yourself, your family and background, where you are from, etc. Growing up on Kawacatoose First Nation and in inner-city Regina, I have witnessed the cycles of abuse, addictions and intergenerational trauma first-hand. These experiences have taught me a lot about humility and gratefulness. After having many family members lost too young, I am grateful for each day I get to spend with my family, as they are my world. Some of my family members attended residential school and it wasn’t until much later that I realized how much this affected my upbringing. After years of silence, being able to hear the horrors that occurred in these institutions shook me to my core, but motivated me to learn more about my culture and the traumas experienced by my people. Although I am still learning, I have gained a new perspective on my community, as well as myself; to be more forgiving and understanding.

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SMA: How has your background shaped your decisionmaking as you went through university and to medical school? There was a point in my life where I did not know where I’d be the next day, never mind planning the next year or five. I went down some dark roads but now I feel like they were life lessons that strengthened my motivation to want to lead a better life. I had a hard time making the leap into post-secondary education as it was such a different environment than what I was used to, but this challenged me to grow in ways I never would have otherwise.

SMA: Who are your role models? Do you consider yourself a role model? It was tough to know what to “look up to” growing up with so many negative influences. I am grateful for volunteering as it allowed me to meet some amazing people who wanted to make a difference in our community. I am in a constant state of learning and so I look at my peers, patients and preceptors, and always try to take something away from each encounter. Now, I am very open to being a mentor and helping others to navigate the system as I know exactly what it feels like to embrace this totally unfamiliar system and be overwhelmed by it all. It also doesn’t help that you need to challenge negative views and stereotypes along the way.

SMA: The medical field includes physicians from diverse SMA: What are your thoughts on the need to have diverbackgrounds, as does medical school. How did you find sity among medical providers? the first few days or weeks of school? Having a health-care team that reflects the diversity of our Starting medical school is quite the uncomfortable life transition as you struggle to balance a new routine, an increased workload and the feeling you don’t belong. However, you quickly realize that there is a spectrum of people from different backgrounds and that they all bring unique skills and perspectives into medicine that are valuable, if you take the time to listen and learn.

“

HAVING A HEALTH-CARE TEAM THAT REFLECTS THE DIVERSITY OF OUR POPULATION IS IMPORTANT IN NURTURING EMPATHY AND UNDERSTANDING, AS OUR PATIENTS ARE SOMEONE’S LOVED ONE, SOMEONE’S KOKUM OR MAMA OR SONNY BOY.

SMA: What stage are you at in your training, and have you considered a specialty and the type of practice that most appeals to you? I just started my clerkship. Clerkship is a time where we are expected to start seriously considering what we wish to specialize in and where we are going to ultimately practice. It has been quite difficult to see myself in any particular role as we are told to “find where we fit in” and I already felt like I didn’t belong from the start. I will most definitely be working with an underserved Indigenous population but what that looks like right now is a work in progress. I see so many health disparities during my clinical encounters that I am overwhelmed by the possibilities for where I could have the greatest impact as an Indigenous clinician and an advocate.

population is important in nurturing empathy and understanding as our patients are someone’s loved one, someone’s kokum or mama or sonny boy. No matter their race, gender, socioeconomic status or sexual orientation, all patients deserve to be treated with the utmost dignity and respect. ◆

need a

family

break?

vacation

CME

Book a SMA locum. The Rural Relief Program is booking locums for summer 2019 so send your request now! If you practise in a community with fewer than four physicians, you may be eligible to take advantage of this great SMA program with subsidized locum rates.

Email rochelle.plemel@sma.sk.ca

SMA DIGEST | SPRING 2019

A VISION for better Indigenous care in Saskatchewan

by Maria Ryhorski

Dr. Joel Schindel has a vision of better health care for Saskatchewan’s Indigenous community and he’s expanding his work, previously limited to a rural setting, into Saskatoon’s core. “Wellness is the goal,” says Dr. Schindel founder of the Comprehensive Indigenous Community Care (CICC) clinic model. “The goal is the same for everyone, but how you get there is going to be different for each person and this has a lot to do with culture.”

SMA DIGEST | SPRING 2019

“

I MAY NOT BE ABLE TO REMOVE THAT PERSON’S CHALLENGES BUT I CAN EMPOWER THE PERSON TO KNOW ABOUT THEIR HEALTH.

I CAN FIGHT FOR THEM, ADVOCATE FOR THEM AND GIVE THEM THE BEST CHANCE THAT I CAN WHEN THEY’RE UNDER MY CARE.

Dr. Schindel began providing his CICC clinics in Beardy’s & Okemasis First Nation and One Arrow First Nation two years ago. The model strives to provide holistic care, which has historically been the basis for health and wellness in First Nations communities. The clinics encompass a proactive focus on chronic disease management, mental health wellness, prenatal care, elder services and annual complete physicals. When he was approached to start a similar clinic in Saskatoon Dr. Schindel leapt at the opportunity. The onceper-week clinic, primarily for youth but open to everyone, opened in late March 2018, operating out of Oskayak High School. There is a social worker and elders on site so students and other community members have access to comprehensive care in a space that is already familiar to them. “Kids these days in general are struggling” when it comes to mental health, says Dr. Schindel. “We are struggling as a society. So this is an opportunity for them to have quick access and the ability to just drop in.”

He has the sense that city living presents additional challenges compared to life on the reserve. “The city has a lot more underbelly in a lot of ways,” says Dr. Schindel. “On the reserve, everybody has someone, usually. Whereas here, I find I’m seeing a lot of kids who are really on their own … On the reserve, yes, there may be overcrowding and those sorts of challenges – but at least something inside you tells you, ‘This is my home.’ ” That sense of home and of safety is one of the things that Dr. Schindel hopes to convey by situating the clinic within the walls of Oskayak school. “The school, the teachers, have done an amazing job when it comes to making these kids feel at home and not like the ‘other.’ “ The key to effectively supporting patients is listening, honest dialogue and building trust, he says. “When people are telling you something, you need to make sure that you don’t start jumping in or dictating things.” This can sometimes be a challenge for physicians, he admits. “You need to realize that this is not just a story they’re telling – this is their story.” Understanding a patient’s story is more than just their social history, it’s a critical piece to providing them with appropriate and effective care. Listening for his patient’s stories has been integral to his practice since he began the CICC clinics. “Social history is the best part of history that I need to get fully from the patient … so I don’t make any assumptions. I strive to show that person the respect to allow them to tell their own story. “Knowing where they live, what resources they have, what their experience has been with those resources, who their

SMA DIGEST | SPRING 2019

supports are, where they come from and what are some things that define them – learning those things helps me provide them with care that is appropriate to their situation, care that will best support them in being healthy.”

the best chance that I can when they’re under my care. Ultimately I want them to be empowered to take care of their health because then they can do a lot more for themselves and their community.”

As a Somali-Canadian, Dr. Schindel has an acute awareness of the relationship between culture and health. The importance of providing care rooted in cultural awareness is something that has grown through his experiences supporting medical education in Somalia, as a Muslim chaplain at the University of Saskatchewan and providing care on reserve at his CICC clinics.

The response to Dr. Schindel’s work has been positive. The number of patients coming to his clinic at Oskayak continues to grow and he is pleased to see the families of students using his services. He is honoured by the faith they place in him.

“It all comes back to hearing from people about their culture, their faith, their way of life and the different challenges that they face.” Once Dr. Schindel has an understanding of his patient and has established sincere and honest communication, he can partner with them to take ownership of their health. “A huge part of what is needed is health literacy,” says Dr. Schindel. “I may not be able to remove that person’s challenges but I can empower the person to know about their health. I can fight for them, advocate for them and give them

“They’re trusting me with their stories, and we need to realize that that’s sacred. As physicians, we offer whatever guidance we have within our knowledge to help our patients emotionally, physically, mentally and even to help them embrace their spirituality and support them in writing the next page of their story.” ◆

To learn more about Dr. Schindel’s work please visit:

Indigenouscare.ca

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COMBATTING THE CRISIS WITH THE HELP OF A LOCAL DOC, TRUVADA AS PREP IS STOPPING THE SPREAD OF HIV IN ITS TRACKS

By Maria Ryhorski

A Saskatoon physician’s fight to combat the spread of HIV is – for him – as much personal as it is professional. Dr. Francois Reitz, who works in concert with pharmacist colleague and friend Michael Stuber in Regina, offers Truvada as PrEP (pre-exposure prophylaxis) to at-risk individuals in the community. This preventative treatment has been proven 90 per cent effective at preventing HIV infection despite exposure. “Historically, members of the LGBTQ community have been the hardest hit by HIV,” says Dr. Reitz, who operates a clinic from OUTSaskatoon on the second Saturday of every month. “As members of the community, Mike and I decided that we should do something.” The PrEP Clinic in Saskatoon opened in early 2018 with the goal of providing accessible preventative HIV treatment and counselling to the LGBTQ community in an environment that is safe, supportive and non-stigmatizing. Individuals outside of the queer community are also welcome as long as they are supportive of the safe environment that OUTSaskatoon has built.

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“When speaking with clients, I always compare PrEP to birth control – it is a form of harm reduction and a form of prevention. “We look at, is Truvada an appropriate choice in how they will manage their sexual risk, their HIV risk, with the understanding that everybody manages their risk differently and we are merely there to assist the client with finding a prevention strategy that works for them in that period of their life.” The visit to the clinic includes full HIV and STI screening, a discussion of what it means to be on PrEP, potential side-effects and what follow-up looks like. If the individual and Dr. Reitz agree that the treatment is right for them, they will receive a prescription and a plan for follow-up every three months with the understanding that the individual can come any clinic day if they have concerns and they will be seen. Access to this overwhelmingly effective treatment has improved recently – two dedicated clinics have opened in the province, one in Regina and one in Saskatoon, in addition to full coverage of HIV medications by the Saskatchewan government effective last April. However, access and awareness are still a challenge. Many family physicians are not familiar with Truvada as PrEP. And, particularly among the LGBTQ community, finding even basic medical care without stigma is often still a struggle.

“

IF, REGARDLESS OF YOUR PERSONAL, POLITICAL OR RELIGIOUS BELIEFS, YOU TREAT ALL INDIVIDUALS WITH THE RESPECT THEY DESERVE AND UNDERTAKE TO KEEP AND MAINTAIN THEIR INTEGRITY AS HUMAN BEINGS ... I THINK THAT IS A HUGE STEP FORWARD.

“We live in the Prairies, which is historically a lot more conservative than the rest of Canada,” says Dr. Reitz. “Individuals are still discriminated against here.” Dr. Reitz recalls an acquaintance – a trans man – who is at the point in his transition that by outward appearance, looks like a cis-gendered man. He still requires his annual PAP and unfortunately, his family physician does not feel comfortable providing the service, so this individual has to see a gynaecologist for the PAP, where he is required to sit in a waiting room filled with cis-gendered women. “My mind boggles at the mental anguish that he must experience … having to go through the entire rigmarole to get something that is just basic health care,” says Dr. Reitz. “And that can be translated with any LGBTQ individual.” Doing everything he can to ensure that members of the community have access to safe and sensitive medical care, including HIV prevention, is deeply important to Dr. Reitz. Coming from South Africa, he experienced a place where being gay was a crime up until post-Apartheid. When he worked in a hospital there (prior to the advent of antiretroviral medications), he saw overwhelming numbers of people suffer and die alone as a result of a disease that stigmatized them from their family and community.

“That’s not something anybody should have to do,” he says. “Nobody deserves to die alone. People deserve to die with dignity, with the knowledge that they are loved and cared for.” In Saskatoon, Dr. Reitz ensures that all the care he provides leaves his patients feeling welcome, respected and cared for. “One of the things you have to be responsible for is giving back … Being gay and an immigrant, you want to give something back to other individuals who are either members of the LGBT community or immigrants. “This [clinic] provided a great opportunity.” The opportunity is there for all physicians to make positive change in how health care is delivered to members of the LGBTQ community. “Baby steps,” says Dr. Reitz. “From the training of new physicians to re-education of the older physicians like myself – I think if one provides a safe space, and if, regardless of your personal, political or religious beliefs, you treat all individuals with the respect they deserve and undertake to keep and maintain their integrity as human beings and not just another label, I think that is a huge step forward.” ◆

Continued on next page

SMA DIGEST | SPRING 2019

providing a

SAFE SPACE What does it mean to provide a safe space?

“

Acknowledging and affirming that the space is safe is the first step. Once it is identified as a safe space, people can start to feel more comfortable in the space. Creating a safe space means educating the individuals who work in the space about correct language to use and how to acknowledge certain nuances in clients. It means making an effort to not only avoid offending individuals but to make them feel welcome. Once the individual feels welcome and not stigmatized or discriminated against, they’re more likely to be able to tell you what’s actually happening, what they require from a health perspective.

Dr. Reitz on: The difference it makes...

“

One of my proudest moments in rural practice is still an individual who sat down in front of me in my office. This client was born male in a rural setting in Saskatchewan and said that they would like to be referred for gender dysphoria. There are very few moments in one’s career when you are that proud, when you have that much admiration for an individual, both in the fact that they feel comfortable enough to do that, but also to do that in a setting that is historically more conservative and not necessarily as safe.

Resources PrEP Clinic Saskatoon: OUTSaskatoon, 320 21st St. West Clinic days: Second Saturday of every month www.outsaskatoon.ca/clinic 306-665-1224

PrEP Clinic Regina: 306-766-3935

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Guidelines for physicians through the SK HIV Collaborative https://skhiv.ca/pre-exposure-prophylaxis-prep

Questions? Dr. Francois Reitz at francois@sma.sk.ca

PULSE

PEERS SHARE KNOWLEDGE AND GIVE BACK IN NEW MENTORSHIP PROGRAM

By Colleen MacPherson The realization that students at different points in their medical training have a great deal to teach each other, and learn from each other, led Adam Neufeld to develop an innovative project designed not only to connect students in the U of S College of Medicine but ultimately, to improve patient care wherever they end up practising. Neufeld, who is in his third year of medical education, is the driving force behind PULSE – Peers United in Leadership and Skills Enhancement – which began this fall offering opportunities for first- and second-year students to mentor each other outside the classroom setting. The idea grew out of Neufeld’s own experience in his first two years, when he said he felt “disconnected from students in other years. Unless you knew somebody personally … it was difficult to actually build relationships and I feel like those are really beneficial.” He also recognized the personal benefit of teaching. “I knew I really synthesized information when I taught it to others.” Reading is often not enough, he said, “but when you teach it, you have no choice but to confront those issues. It really helps identify gaps in knowledge.” PULSE is structured to allow first-year students to enrol as mentees and second years as mentors. The students meet weekly in small groups in the Clinical Learning Resource Centre in the college to review clinical skills that are within the scope of their learning, ask questions or voice concerns, all in a safe environment that encourages camaraderie and collaboration. What makes the project unique is that students of diverse backgrounds, levels of learning and capabilities connect with each other “in a way that’s not been offered at the U of S before.” For the mentees, Neufeld said the project allows them extra practice with basic clinical skills “but some are pretty objec-

tive and some are softer skills. Having mentors who have finessed those skills to learn from is really valuable,” building not only confidence but also future professional relationships. L-R: Dr. Neville Van Der Merwe, Dr. Melissa Fillis, Dr. Bronwyn Carroll And for the mentors, PULSE is proving invaluable for building the teaching and communication skills so necessary in the profession. “Doctors are expected to teach themselves on a daily basis, to teach their residents and students, to teach their patients but when in our education do we get taught how to be good teachers? This is something that is given only limited attention in our training. Communication is huge in medicine,” said Neufeld, “so for people to mentor and to teach and to have to adjust their form of presenting is an amazing skill for a quality physician.” The project has just started but “we’re actually having a hard time keeping up to the interest, so that’s exciting.” Looking ahead, Neufeld envisions PULSE expanding to include students in all years “because we don’t see why second years wouldn’t benefit from learning from third years, or even first years learning from third years depending on what the topic is.” But before that happens, Neufeld will meet with mentors to discuss challenges of the position, a common one being handling disagreements, and to offer teaching tips such as, “show them where to look but don’t tell them what to see.” Neufeld said PULSE organizers will be collecting data to measure student wellness and improvements in both learning outcomes and teaching skills, information he hopes to publish and share at medical education conferences nationally. With increased awareness of the need to ensure student wellness in medical school, which Neufeld said includes enjoying learning, being able to ask questions and connecting with other people, “I think a program like this will be well-received and have beneficial implications beyond our institution.” ◆

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Dr. Alexandra Akinfiresoye

Dr. Boye Adeboye

Dr. Melissa Fillis

PLANTING RURAL ROOTS

SASKATCHEWAN CONTINUES TO ATTRACT PHYSICIANS FROM AROUND THE WORLD. THEIR STORIES REVEAL INDIVIDUAL MOTIVATIONS FOR COMING, BUT ONE OVERARCHING THEME IS THAT THERE ARE NO REGRETS ABOUT STARTING A NEW LIFE ON THE PRAIRIES.

By Girard Hengen Consider uprooting a family, moving to a new country, figuring out the minutiae of daily life, seeing new patients, and navigating a different health system – all to serve a small city on the southern fringe of Saskatchewan. That’s what Dr. Boye Adeboye did, but there remains one major concern as he spends his first year in Estevan. Born and raised in Nigeria, he’s never experienced a Prairie winter.

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“My biggest challenge will be - and I’m still waiting to see how it will pan out - the weather,” Dr. Adeboye told the SMA on a relatively mild late fall day. “Everybody says, ‘Wait till winter comes, wait till winter comes,’ and of course it fills you with a little bit of anticipation or anxiety. But I lived in Russia, the southern part of Russia, where it’s still fairly cold. I don’t worry about myself but I’m worried about the kids. “My first son, he’s an athlete and he does sports competitively. He is already saying, ‘I’ll just swap my rugby for ice hockey,’ and in fact, he’s started learning to skate.”

Over the years, thousands of physicians have come to Saskatchewan from points around the globe. Some have stayed, some have left. All have had their own reasons for coming. They have navigated unfamiliar medical facilities in a new health system, while they and their families have settled in towns and cities that often bear little to no resemblance to the places they left behind. Dr. Adeboye is one such physician. Two others are Dr. Alexandra Akinfiresoye, also from Nigeria, who has been living in Swift Current for three years as a general internal medicine specialist, and Dr. Melissa Fillis, a general practitioner from South Africa who has settled in Nipawin. Their stories reveal individual motivations and challenges, but also one overarching theme – there are no regrets about starting a new life on the Prairies.

Dr. Boye Adeboye Dr. Adeboye says he simply wanted a change, heard about opportunities in Canada from a friend, and took the leap. He went to medical school in Russia but returned to Nigeria and started training in obstetrics and gynaecology, which he intended to pursue when he moved to England. He met his wife, who is also Nigerian, and established a general practice in a city about 80 kilometres northwest of central London but after a number of years, a new life beckoned. “I guess like anything you want a change,” Dr. Adeboye said. “After a few friends tried Canada and really liked it they said, ‘Come and experience what it is. It’s sort of a fresh breath of life … and you will be able to do something else.’ “Sometimes you think you’ve done all you can in one place. You just want to experience different things, so that’s one of the reasons why I moved.”

After attending a job fair in London and hearing about Saskatchewan through a representative of saskdocs, he got a phone call from Greg Hoffort, executive director of St. Joseph’s Hospital of Estevan, asking if he was interested. The name – St. Joseph’s – was the same name as his high school, which he calls a “wonderful experience” in his life. Possibly it was fate. When he went for a visit, he found the community had everything he wanted without being too big – from a golf course and church to a Toastmasters club and a Walmart, for convenience. “The name of the hospital ticked the box. The town has everything for me. When they actually asked me to come for a site visit, I sort of felt in my heart of hearts that it was meant to be, and I’m not disappointed,” he said. He arrived late one night and ventured out of his hotel the next day. The reception of the community that day and ever since has been “great,” he said. He has started a running club and is active in his church. “It’s funny because I think I came at the right time. Estevan does not have an adequate number of doctors,” he said. “I came at a time a doctor was leaving. I came in the middle of the night, but there was just no way I was going to sit in that hotel room, even though it was my first day in the city. I went out and of course people saw me and they would wave and come over, and because a doctor was leaving I got asked, ‘Are you the new doctor? Are you taking new patients?’ ” His wife’s job is transferable and she can work in Estevan. She and their two sons, aged 9 and 7, will come to live after the school term. When they arrive, all will enjoy the slower pace of life in Estevan, where his work and children’s school, and everything else he needs, is just around the corner.

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SOMETIMES YOU THINK YOU’VE DONE ALL YOU CAN IN ONE PLACE. YOU JUST WANT TO EXPERIENCE DIFFERENT THINGS, SO THAT’S ONE OF THE REASONS WHY I MOVED. SMA DIGEST | SPRING 2019

Dr. Boye Adeboye

“Something that is a bit of a relief for me is the fact that I am able to drive three or four minutes to work. It’s never happened before,” Dr. Adeboye said. “I was initially shocked when I was told, ‘This is the highway,’ because you read about North American highways being super fast, with four or five lanes. And here, there is only one lane either way. As you drive more you see they aren’t very busy so there’s no point having extra lanes.

and it is colder,” Dr. Akinfiresoye said. “I was actually surprised I got into the program, but I was happy. It’s usually very difficult for foreign-trained physicians to get into a specialty residency position.”

“That, I think, almost de-stresses you, if that makes any sense. You take it for granted because when you live in a fast-paced system, it’s part and parcel of you. You don’t see any other way out. But there is a way out.”

“I came to Swift Current and I did find they were looking for an internist at that time,” she said. “I saw that it was a lot smaller than Saskatoon - there’s very few Nigerians here but because we had adjusted to Saskatoon, we were able to settle into Swift Current, and I’ve been here three years now.”

Dr. Alexandra Akinfiresoye

Toward the end of her training, she started to scout the job landscape, searching for a place where her family could settle down and where her services were needed.

While Dr. Adeboye moved to Saskatchewan for a change of pace, Dr. Alexandra Akinfiresoye came to pursue an opportunity at the University of Saskatchewan.

Dr. Akinfiresoye spent four months of her residency back in Toronto but by then, the stillness of the Prairies had taken hold of her.

After graduating from medical school in Nigeria, she and her husband, a civil engineer, emigrated to Toronto in 2002. There she immersed herself in a large Nigerian community while taking a physician assistant pilot program, where she became interested in internal medicine. In 2010, she was accepted into the general internal medicine program at the U of S College of Medicine, a residency program that took her five years to complete.

“I did go back to Toronto during my training for about four months to do some extra training, but I found I couldn’t stay there anymore,” she said. “It was too noisy and big. Swift Current is not as noisy. I found that the smaller place gives me peace of mind. There’s too much going on in Toronto that it just makes you all hyper.”

“I didn’t really mind where I had to go to get what I wanted so we moved to Saskatoon. All I heard was that it is smaller

Dr. Alexandra Akinfiresoye

One of the biggest challenges involved her first move to Saskatchewan – leaving her friends in Toronto behind. In Swift Current, she feels welcomed despite the fact that the African community is a small one.

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IN SWIFT CURRENT, THEY WERE HAPPY TO SEE ME COME IN. THEY NEEDED THAT SPECIALTY AT THAT TIME AND THERE WAS A LOT OF JOY. EVERYBODY WAS HAPPY AND I WAS ALSO HAPPY TO BE ABLE TO SERVE.

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“People are very nice. They always want to ask questions about my life, because I sometimes go to church and wear my African attire, so they want to know about me, they want to know about my culture. I have found it very interesting,” she said. “In Swift Current, they were happy to see me come in. They needed that specialty at that time and there was a lot of joy. Everybody was happy and I was also happy to be able to serve.”

Dr. Melissa Fillis Port Elizabeth is a beach city on the southernmost tip of Africa. Straight south, the nearest land mass is Antarctica, more than 4,000 kilometres away across an ocean. On the other side of the world sits Nipawin, a firmly landlocked town of 4,000 nestled in the boreal forest of northern Saskatchewan. Dissatisfied with the state of health care in South Africa, Dr. Melissa Fillis made the jump from her homeland for a fresh start in Nipawin. “I have no regrets at all,” she said. “I met my wonderful husband, Kris, here. The wildlife and nature in Saskatchewan are beautiful. I also took up cross-country skiing for the winter, and kayaking for the summer. The safety and low-crime rates are much appreciated, and Saskatchewan people are so friendly and welcoming.” Raised in Port Elizabeth, she studied medicine at the University of Pretoria and completed a two-year internship at Port Elizabeth Hospital Complex. To fulfil a requirement for a year of community service, she worked in obstetrics at Uitenhage Provincial Hospital, about 20 kilometres inland from Port Elizabeth. She stayed for a couple of years and was working in anaesthesia when she heard about Nipawin, of all places, from Dr. Dale Peffer, a friend and neighbour growing up, who worked surgery at Uitenhage Hospital. “He was recruited to Nipawin, and had come back from his site visit. He seemed to like the town, and I asked if I could get in contact with the recruiter. That is how I ended up working in Nipawin,” Dr. Fillis said, noting she completed the clinical field assessment for the SIPPA program in Weyburn. Coming from a place where the temperatures range from an average of 21 C during the coolest months to 27 C in the warmest, Dr. Fillis not surprisingly considers the “never-ending” Saskatchewan winter as a major challenge.

Dr. Melissa Fillis

“This also creates a deeper appreciation of the summer,” she added. “I’ve forgotten to plug in my car in winter a few times. I learned quickly to refrain from doing so.” Practising family medicine in a rural setting has also been a challenge, she says. “One is pulled in multiple directions, including hospital ward rounds, ER, the clinic, anaesthesia and the long-term care facility, and we often have to do work after hours just to keep up.” A final challenge comes when her former home tugs at her heartstrings. ”I do miss my parents, but we manage to see each other once a year.” ◆

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WE NEED TO SUPPORT EACH OTHER IN ORDER TO THRIVE Though many newcomers report a warm welcome to Saskatchewan, the unfortunate reality is that this is not everyone’s experience.

Note: The SMA believes it is important to raise awareness about a serious issue facing many of our members: discrimination and racism within the profession. Strong relationships in the medical community are vital to physicians’ health and well-being. This article is a first effort at illuminating what some IMGs experience in Saskatchewan. It is by no means exhaustive. The SMA hopes this article will start a conversation and inform subsequent steps for the SMA and other health-care agencies. By Maria Ryhorski Despite our frigid winters, we like to think of ourselves as a warm province, full of friendly and welcoming people. Saskatchewan has become home to more than 47,000 immigrants since 2011; about half of our valued physician community is made up of international medical graduates (IMGs). While many report an overwhelmingly positive experience settling in Saskatchewan, the uncomfortable truth is that this is not everyone’s experience. Halima Mela immigrated to Canada from the United Kingdom in 2000, with her husband, Dr. Mansfield Mela. The couple were originally from Nigeria, where Dr. Mela had completed his medical education. As he went through the training process for Canadian licensure, she was shocked at the stories she heard from within the IMG community. Colleagues confided experiences of being belittled and humiliated in front of their peers in the guise of “correction,” as well as many instances of biased and unfair treatment in the workplace. 32

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What she heard motivated her to study for a master’s degree and focus her thesis in human resources management on diversity in the workplace and fairness of process. She interviewed 12 IMGs for her research. Too often, their experiences echoed the themes she had heard. “In the words of one respondent, ‘When our counterparts from other provinces or other non-Canadian but westerntrained physicians ask for help, they get it – it is almost as if they are waiting for them to ask for help - but when non-western physicians ask for help or clarification, we are viewed as inferior for doing so.’ ” Some physicians’ experiences were more overt. Mela recounts another physician’s story, “A well-established IMG who has practised in Canada for over 20 years shared how he was in a meeting with colleagues and one said (in his presence) that they did not understand why Canada continues to allow IMGs to come, and why it makes it easy for them to succeed, because in their view, these IMGs are ‘stupid and unintelligent.’ ” These sorts of experiences are often not shared openly, something Mela attributes to IMGs feeling too vulnerable to speak out, as those involved are often supervisors or colleagues they will have to work with. As a result, it is difficult to say how widespread these types of incidents may be, but according to national and international data, these experiences are not limited to Saskatchewan.

A 2018 study of 27 resident physicians from 21 residency programs representing a range of specialties and locations in the United States found that minority residents face additional challenges. According to the authors, Drs. OsseoAsare, Balasuriya, and Huot, “Participants reported regularly encountering racially/ethnically motivated behaviors from numerous sources, including co-residents, attendings, program leadership, ancillary staff, and patients. Such encounters fell on a spectrum ranging from nuanced interactions to glaring racism. While participants noted experiences of overt bias, the predominant findings were subtle exchanges that sent denigrating messages to minority residents.” In Quebec, the Commission des droits de la personne et des droits de la jeunesse (Quebec’s Human Rights Commission) conducted an investigation that found IMGs face discrimination in the course of the admission process for postdoctoral training in Quebec. The agency shared publicly in 2010, “Throughout the whole process, international medical graduates (IMG) face a series of obstacles that disproportionately disadvantage and exclude them from the faculties of medicine in Québec at the Université de Montréal, the Université de Sherbrooke, Université Laval and McGill University.” While many IMGs who settle in Saskatchewan report a warm welcome and smooth transition, Brenda Senger, director of the SMA’s Physician Support Programs, confirms that bias and unfair treatment unfortunately sometimes occur.

“The Physician Health Program hears about some of the vulnerability that our IMG doctors and residents experience, and we do our best to support them,” says Senger. “These challenges are part of a larger issue that needs to be addressed. We need to challenge the culture of medicine which applauds competitiveness rather than cooperation. These doctors make up over half of our physician workforce and provide invaluable care to the patients of Saskatchewan alongside our locally trained physicians. We should applaud those ‘from away’ who have taken the risk to leave their countries in order to help ours.” Immigrating to Canada comes with a host of challenges including language, adapting to a new way of life in an often drastically different climate, attempting to integrate into a new culture, all while coping with isolation from family, friends and all that is familiar. “As with any colleague, if you see an IMG struggling, reach out and help out,” Senger urges. “This profession demands a great deal. We need to support each other in order to thrive.” There are many things individuals can do to help ease the transition for newcomers, Mela says. Many challenges arise from misunderstandings – often a product of differing cultural backgrounds – so make an effort to learn. She suggests beginning on a personal level. Do some research on the newcomer’s country of origin.

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WHEN TIME IS TAKEN TO GAIN AN UNDERSTANDING, IT CAN HELP TO LESSEN SOME OF THE ISOLATION OR MISTRUST THAT CAN EXIST. BECAUSE ALL OF US HAVE SOME FORM OF BIASES; IT IS HOW WE HANDLE THOSE THAT CAN EITHER GIVE A POSITIVE OR NEGATIVE OUTCOME. Halima Mela

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TREATING PEOPLE IN SUCH A WAY THAT THEY FEEL THAT THEY BELONG AND ARE VALUED CONTRIBUTES TO THE WELLNESS OF THE ENTIRE PHYSICIAN COMMUNITY... Brenda Senger, Director, Physician Support Programs

“Doing a bit of research about the country and culture that they come from can help as it helps to understand their behaviour within the context of where they are from.” She gives the example of a person who does not look you in the eye. In some cultures, meeting the gaze of someone senior to you is considered disrespectful. Looking down or to the side is a way of showing respect. This is quite different from Canadian culture where, if you don’t meet someone’s eyes when speaking with them, you may be perceived as evasive or untrustworthy. “When time is taken to gain an understanding, it can help to lessen some of the isolation or mistrust that can exist,” Mela says. “Because all of us have some form of biases; it is how we handle those that can either give a positive or negative outcome.” “It is equally important to help newcomers understand Canadian norms and expectations,” emphasizes Senger. “As an immigrant, you will likely want to adapt to the local culture. But that can be difficult when you don’t yet understand local customs and the various nuances of day-to-day interactions. And in the workplace, it is also important to understand the roles of those in the health-care system, because those roles may be very different in Canada from what you are accustomed to.” From a training perspective, Mela suggests a peer mentorship program, as part of an IMG’s entry into practising in Canada, would be valuable. “The idea of an IMG preceptor/ mentor is very helpful because these are people who have

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been through the system and jumped the hurdles and thus are able to let the new IMGs know that there is help and that the training is doable, albeit stressful, but doable. Having someone you can relate to who is able to point out where to get help, information or any survival tool goes a long way to help a new, struggling physician.” From a workplace perspective, Mela suggests that every organization have a diversity policy in place as well as offer cultural sensitivity training for staff. It is important that the policy “have teeth” though, she notes, because a policy alone will not ensure a safe and respectful working environment. Also, if you see unfair behaviour, intervene. Be an ally. Modelling good behaviour is critical, according to Senger. “Hold people accountable for demonstrating collegiality,” she says. “Role model inclusion and respect. Just because your training is different from mine doesn’t mean that it is ‘less than.’ It may just be different.” Making an effort to learn and understand behaviour within its cultural context can make a world of difference. “It shows an interest,” says Mela, “and can help newcomers feel safe. At the end, what anyone wants is to feel that they are appreciated and valued for who they are and what they have to offer.” Senger agrees. “Treating people in such a way that they feel that they belong and are valued contributes to the wellness of the entire physician community, and can support us in retaining the doctors who have immigrated to Saskatchewan and contributed so much to the health of our patients.” ◆

Traditionally, physicians in need of care feel guilty about accepting care and shame for needing it. Many physicians struggle with undiagnosed, untreated or self-treated mental health issues. Many others struggle with relationship and family issues, and substance abuse and addiction. There are a number of factors that predispose physicians to these challenges including occupational factors like sleep deprivation, excessive workload, potential for complaints/litigation and witnessing trauma and human suffering.

Let’s start the conversation. Contact the Physician Health Program. Brenda Senger

Director, Physician Support Programs

306.244.2196 brenda.senger@sma.sk.ca

THE THREE

AMIGOS

(L-R) Dr. Mark Brown, Dr. Dalibor Slavik and Dr. Intheran Pillay were each featured on the cover of the SMA Digest in their year as president. These magazine covers are now framed in their homes/offices.

Dr. Mark Brown of Moose Jaw, Dr. Dalibor Slavik of Saskatoon and Dr. Intheran Pillay of Gravelbourg - affectionately known as “the three amigos” - met about 10 years ago when their mutual drive to improve health care for patients and working conditions for physicians led them to the SMA board. They each hail from South Africa originally and settled in Saskatchewan with their families to start a new life. Each served as SMA president, one after the other, and by the end of their terms they were inseparable. They are the life of every SMA Representative Assembly and agree that no matter how long it’s been, when they see each other again, it’s as if they’ve never been apart. SMA DIGEST | SPRING 2019

‘WE HOPE TO KEEP HIM FOR YEARS TO COME’ PATIENT PRAISES NEWLY ARRIVED PHYSICIAN TO HUMBOLDT DR. AMTESHWAR KAPOOR

By Girard Hengen One of Dr. Amteshwar Kapoor’s patients appreciates his service with a smile – or giggle – and hopes against hope the newly arrived physician to Humboldt makes a permanent home in the community. “We really are fortunate to have lots of good doctors in Humboldt, but unfortunately, like any smaller community in Saskatchewan, we can’t always keep them,” said Sandra Hessdorfer. She has seen four of her family doctors leave in the past 12 years. Each time she has had to start over with a new physician. “We really need to do all we can to keep our physicians because the city walk-in clinics are a fair drive and sometimes you want someone who knows you, who knows what you normally look like or how you normally act or your past history,” said Hessdorfer, who praises Dr. Kapoor for the care and attention he has shown her son, Riley. “Whenever we thank him, he always has a humble giggle and says not to because it’s his job. We really feel comfortable putting our boys in his care and Riley really adores him. Our family is thankful that he has moved here and moved into the community. We hope to keep him for years to come.”

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Dr. Kapoor started practising at the Humboldt Medical Clinic in February. His wife, Dr. Punashish Kaur Bhatia, had been working at the clinic for about a year while Dr. Kapoor completed his exams enabling him to work in Canada. Both went through the SIPPA program and were pleased to move to Humboldt.

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YOU REALLY FEEL LIKE YOU CAN TELL HIM ANYTHING AND HE WILL TRULY LISTEN. HE IS VERY PROFESSIONAL AND THOROUGH YET HE ALWAYS HAS A SMILE AND LAUGH.

Dr. Kapoor was raised in the small town of Farid kot, in the Punjab region of India, which has helped him adjust to Humboldt. “The town that I am from is a small town,” he said. “That’s why I can relate better to Humboldt. The town here is small, peaceful, laid back, and it’s just one hour from Saskatoon. I feel I can relate better to Humboldt – the smaller towns.” He left India for a chance to work within Canada’s public health-care system – a system he says is better in terms of administration, regulations, technology, and ethics. The couple first came to Saskatoon, where they spent two years studying while he did odd jobs. Opportunity soon knocked in Humboldt. Dr. Kapoor has had an impact in a short period of time, Hessdorfer said. Riley, who is 9, has had different health issues that have necessitated visits to pediatricians in Saskatoon. She brought Riley to the Humboldt Hospital emergency in spring 2018 when Dr. Kapoor – brand new to the city - was on-call. “The first meeting with Dr. Kapoor turned out to be a great visit,” she said. “Dr. Kapoor really took an interest in Riley’s health and he made sure he covered everything. We left for home after he prescribed some antibiotics feeling good about the care we got, but the big shock came a few days

later when Dr. Kapoor called to check on him. At that point we knew he really cared!” Riley started having pains in his chest so they booked an appointment with Dr. Kapoor, who had researched Riley’s condition and made sure the proper tests were done. “From that moment on we knew that Dr. Kapoor would become our family physician and we have gone to him ever since,” Hessdorfer said. “He talks to the boys like a friend and listens to everything they say. You really feel like you can tell him anything and he will truly listen. He is very professional and thorough yet he always has a smile and laugh.” Dr. Kapoor says he and his wife are gratified at their reception in Humboldt and want to make their own little house on the Prairies. “We never felt like we are outsiders. The clinic and staff, our senior doctors, have never let us feel like we don’t belong here. That sense of belonging - I feel that has been very good for us. “I feel like I could stay here for good. We did buy a house here and we are in the family way as well. I feel like I would want to stay here as long as I can.” ◆

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SMA DIGEST | SPRING 2019

HOW DO YOU STAY WHOLE Wellness isn’t a class you take. It is a holistic approach to life – incorporated into everything we do. It is built by making the time to do the things that bring your life joy and meaning. Here – we celebrate our members doing the things that help them stay whole.

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Dr. Brad McIntyre | Family medicine/ER, Redvers I was born and raised in Alida, Sask., 30 minutes away from Redvers, and grew up on the family farm that has been in the family for more than 100 years. My wife, Robin, holds a double degree in chemistry and teaching. We have two daughters, Elsie and Emma. I completed the rural residency program in Swift Current and moved back closer to home to help farm.

What do you like to do with your leisure time and why? Play hockey in the winter and farm with my mother and father, Neil and Karol McIntyre, in the summer. I spend the rest of my free time with the kids and their activities.

Why do you think it is important for physicians to have outside pursuits? Medicine consumes your life right from med school all the way to retirement. One of my many great advisers, Dr. Jason Gatzke, once told me in residency to find a work/ life balance. The rural physician life is very busy; we are on call for the ER from 10 to 15 days a month, all while working full time in clinic. If you donâ&#x20AC;&#x2122;t separate work from other enjoyments, burnout will quickly follow. Farming provides that enjoyment. Sitting on the tractor listening to the hum of the motor, not having to be attached to a phone, is very therapeutic.

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Dr. Intheran Pillay | Family medicine, Gravelbourg

What do you like to do with your leisure time and why?

Both my wife and I have lived in Gravelbourg, Sask., for 25 years. Gravelbourg is a beautiful, small French Canadian town that is known as â&#x20AC;&#x153;a touch of Europe.â&#x20AC;? Despite being a small community, we have a larger surrounding population that contributes toward an extremely busy work life. We have a community hospital with a 24-hour emergency department as well as an office-based practice.

I love cooking, golfing, skiing, travelling, meditating, dancing and socializing with friends. I am very passionate when it comes to cooking and golfing. Cooking allows me to be creative and artistic at the same time. I often annoy my wife with my OCD traits when plating my culinary creations.

I am very fortunate to work with my wife, Dr. Larita Ramlakhan, and well as Dr. David Coneys and an amazing staff at our hospital as well as in our office. We are very appreciative to have locum coverage provided by the physicians of the Rural Relief Program as well as a group of excellent doctors from Moose Jaw who are on our weekend call roster. The coverage provided by these wonderful physicians has been important to our survival. 40

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Why do you think it is important for physicians to have outside pursuits? There is a lot of evidence to show that having a wide range of outside pursuits is critical in terms of building resiliency and prevention of burnout. This is particularly important for people who bear a tremendous responsibility and have an extraordinarily heavy workload.

Dr. Megan Dash | Family and sport medicine, Regina and White City I grew up a city girl, but my husband has shown me the beauty of ranch life. I have a special interest in mental health, and find my time on our ranch, with our animals and daughter, as a nice escape from the day-to-day stress of being a physician.

What do you like to do with your leisure time and why? I enjoy spending time with our animals and working on our acreage. We have two horses and a pony, one dog, three cats and 15 sheep. I am currently breeding so I have about 10 pregnant mommas! I also have a large garden and love to spend time growing veggies and planting flowers. Sometimes a little â&#x20AC;&#x153;good old fashionedâ&#x20AC;? manual labour (moving bales, birthing lambs, hauling pots, pulling weeds) is just what a girl needs.

Why do you think it is important for physicians to have outside pursuits? Medicine is extremely stressful, and is only getting worse. Finding time to remove yourself from the daily stress is one of the few ways we are going to be able to continue caring for our patients. I hope we can all band together, and support each other more in our external interests. Hopefully this will keep us whole and allow us to battle as a group on internal issues within medicine.

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What do you like to do with your leisure time and why?

Dr. Elliot Wilkinson

The Irvine family: Drs. James Irvine, Jeff Irvine and Stephanie Young, and Dan Irvine and Elliot Wilkinson Jeff, Dan and Elliot are full-service family physicians; Stephanie is the Physician Executive for Integrative Northern Health with the Saskatchewan Health Authority; and James is a public health and preventive medicine physician. All live in La Ronge. James was born and raised in Estevan, graduated from U of S and moved to La Ronge in 1982 as a family doctor. He helped with the creation of the U of S Northern Medical Services as its first director and has been a medical health officer for the

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Dan and Elliot: We have always loved mountain biking and exploring new trails. In fact, our honeymoon was a mountain biking trip to Nepal. We lived and worked in northern B.C. for several years and enjoyed the many outdoor activities the mountains had to offer. In early 2017 we moved back to Saskatchewan and welcomed a daughter, Sylvie. We are active in the local trail organization in La Ronge, Boreal Outdoor Recreation Association, whether by helping build new trails, coaching “learn to ride” lessons or hosting destination rides for mountain bikers from across the province. We have discovered that riding is great year round in La Ronge since we starting fat biking – our daughter regularly comes along being pulled behind in her chariot! In the summertime we also love paddling, and this past summer we took our daughter on her first overnight canoe trip. When the snow falls, the skis come out. Usually we stick around La Ronge and enjoy our vast cross-country ski trails, but we regularly head back to B.C. to enjoy some downhill skiing. We are also blessed to have made some wonderful friendships with other young families in our community.

northern half of Saskatchewan since 1985. His two sons, Jeff and Dan, were born and raised in La Ronge. They both married shortly after medical school to other family practice classmates. After travelling the world for studies, work and pleasure, they returned to La Ronge as family doctors. Stephanie is from rural Ontario and worked in health promotion with the health region in La Ronge prior to medical school. Elliot is from Saskatoon; Dan and she were classmates at the U of S and completed the Making the Links global health program together, where they spent time in Ile-a-la-Crosse and Mozambique. They worked in Smithers, B.C., before returning to La Ronge.

L-R: Drs. Dan Irvine, James Irvine, Stephanie Young, Elliot Wilkinson and Jeff Irvine

What do you like to do with your leisure time and why? James: I enjoy a variety of activities involving nature and the outdoors, physical activity and community. I find contentment and relaxation just being near the lakes and forests around the north either “soaking it all in” or being physically active. I actively train most of the year for Ironman triathlon races, but also enjoy cross-country skiing, canoeing or mountain biking. I also enjoy being involved in the community, helping Jeff and Steph coach the local judo club, helping maintain the cross-country ski trails, volunteering at the Food Bank garden or playing music together as a family. Family time is additionally valued with two young grandkids. Jeff and Stephanie: Family time is important to us, and so is physical activity. With busy lives, combining activity with family time ensures that we can still get both in. This includes mountain and road biking, canoeing and crosscountry skiing. The social aspect of physical activity makes it fun, and encourages each of us to get out even during the times when we don’t feel like it. We started a judo club in town, which we still run many years later with kid and adult classes. We love to be able to share our love of sport and physical activity with others, and the martial art principals

of respect, honour and modesty are ideals that we strive for. We have both competed in Ironman triathlons, as we find they push us past our comfort zone to help us grow physically, emotionally and mentally.

Why do you think it is important for physicians to have outside pursuits? All: Balance in life involving physical activity, family, community and the appreciation of nature sure helps us all “recharge” and maintain our enthusiasm in meeting the challenges of the day-to-day work of medicine. This helps us continue to enjoy work, be more innovative, thoughtful and energetic. Although it takes time to be physically active, we find we are more productive when we are active. We are more patient with our patients, and we are more relaxed in stressful situations. Getting outdoors for the physical activity is that much better. This has been shown in literature as well, with this systematic review: “Compared with exercising indoors, exercising in natural environments was associated with greater feelings of revitalization, increased energy and positive engagement, together with decreases in tension, confusion, anger and depression.” (http://pubs.acs.org/doi/ abs/10.1021/es102947t) We can certainly attest to that.

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Dr. Jill Newstead-Angel | General internist, Saskatoon I was born and raised in Saskatchewan. I went to medical school here and did my residency in internal medicine and general internal medicine in Saskatchewan. I had the opportunity to do a clinical fellowship in obstetric medicine in Rhode Island and spent some time in Alberta and B.C. for my obstetric medicine training. I am married and have two children. My parents live in Swift Current, which is a great place for my family to get away from work and Saskatoon when needed.

What do you like to do with your leisure time and why? I really enjoy running and go for a run almost every morning if able. On the weekends I will go for a longer run. A friend and I have trained and run some half marathons. Running outside clears my mind and helps me deal with stressors of work and life.

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My family and I do family taekwondo, which is a very humbling but rewarding activity. We started TKD so we could do an activity as a family and we have all benefited from it. I enjoy skiing with my kids and travelling to Florida to see my parents in the winter. We have a dog named Oliver who provides unconditional love.

Why do you think it is important for physicians to have outside pursuits? Medicine can be a very consuming career and leisure activities can help us keep our perspective and as my daughter would say, helps to keep me â&#x20AC;&#x153;less grumpy!â&#x20AC;?

What do you like to do with your leisure time and why? My love of painting and lifelong learning recently led me to receive a certificate in art and design from the University of Saskatchewan. I use many media (oil, acrylic, encaustic) and paint various subjects (portraits, landscapes, abstract), often brightly coloured and highly textured.

Dr. Leane Pask | Family medicine, Saskatoon

vacation and study leave (contrasted with sometimes too many meetings or nights of being on call).

Why do you think it is important for physicians to have outside pursuits?

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I know the importance of maintaining balance in life to support mental health and well-being. Challenged by recurrent episodes of depression since my teens, the balance beam is always teetering! Expressing my artistic side through painting helps me stay grounded. Of course, maintaining balance takes more than just a creative outlet, and my other keys to stability are:

Getting back to the basics of eating healthy, exercising regularly and sleeping well (plus sometimes eating ice cream, being a couch potato and being deprived of sleep).

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Taking medication to prevent recurrence of depression (boosted by daily caffeine and the occasional beer).

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Attending personal health and medical appointments (while being the doctor and caregiver for others).

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Spending time with family, my daughter and dog (and missing them when I have to work longer hours as a recent divorcee and single mom).

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Doing work I am passionate about, such as providing and advocating for transgender health care and full reproductive choices (and learning to say no to opportunities when I do not have the capacity).

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Maintaining reasonable hours of work as a family physician at the Saskatoon Community Clinic, with regular

My bottom line? Whether at work or at play, stay real and remember you are human!

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PHYSICIAN TURNED AUTHOR BRINGS PASSION FOR GOLF TO THE PAGE

By Jeff D’Andrea, originally published in the P.A. Daily Herald. Reprinted with permission. James Harris has been a family doctor in Prince Albert for the better part of 35 years, but he has two other passions close to him – golf and history. He combined both of those into a five-year product and his newest book, Stanley Thompson and Icons of Canada. The book is an in-depth, 504-page look at Stanley Thompson, who is credited with designing up to 150 golf courses across Canada and the United States, the Caribbean and South America. Harris discusses every part of Thompson’s life, from when he fell in love with golf as a 10-year-old caddy at the Toronto Golf Club, to designing courses across the country during the Great Depression, and his eventual death in 1953. There are 95 Thompson-designed courses around the world that are still around today. Harris has played on about 30 of them himself and said there is something special playing on a course Thompson envisioned.

The book intertwines itself with other important historical people and events at the time. It goes through everything from Sir John A. Macdonald founding the country of Canada, to the Gold Rush, the Great Depression and both World Wars. There are some local Saskatchewan historical nuggets as well, such as the humble beginnings of Regina as a ‘Pile of Bones.’ Harris goes into great detail about each one of these events and uses them to give context to Thompson’s career and his life. To his surprise, the reviews Harris has received for his work are not solely from golf-heads. “It’s actually interesting. The personal feedback I’ve had has been more from people that don’t golf very much, they just like the book,” Harris said. “They like the history, they like the story and they like what this guy, Stanley Thompson, accomplished over his career—which I found quite fascinating.” This is Harris’ third book, all of which have been about golf with local significance.

“He had a special flare. He was a genius in the golden age of golf architecture of the 1920s and ’30s,” Harris said. “There’s some kind of a feeling, an appeal that people don’t sense right away.”

His first was Prince Albert and its Golf Course, published in 2009 for the 100th anniversary of the course. His authoring journey continued with A Stanley Thompson Masterpiece in 2010.

One of those courses is the Waskesiu Golf Course, which Thompson and company designed and worked on from 1927 until it opened in 1936. Harris talks about the course, and the origin behind the infamous Lobstick tree found on the course’s first fairway.

But what separates Harris’ newest work from his older projects is he had to get sources and documents from all across Canada. It took about five years of compiling and writing to finish.

But Stanley Thompson and Icons of Canada, as the title suggests, is much more than a biography of one of the greatest golf course designers.

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The self-published Stanley Thompson and Icons of Canada is available at Amy’s on Second, the Stanley Thompson Society, and McNally Robinson. ◆

Write your next CHAPTER Life at an Esprit Retirement Community is where the next part of your life story begins. Not just a new address, but new friends, new experiences and a new lifestyle Offering Independent Living, Assisted Living and Memory Care â&#x20AC;&#x201C; with around the clock access to healthcare professionals Riverbend Crossing Memory Care Community 2235 Heseltine Rd, Regina 306-347-7773

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EspritLifestyle.com SMA DIGEST | SPRING 2019

COURSES CONFERENCES

MARCH

ONCOLOGY CONFERENCE May 11 | Saskatoon, Sask. www.usask.ca/cmelearning PLI: STRATEGIC THINKING FOR RESULTS May 31-June 1 | Saskatoon, Sask. www.sma.sk.ca/PLI

JUNE

ORTHOPEDICS CONFERENCE March 30-31 | Saskatoon, Sask. www.usask.ca/cmelearning

PLI: MANAGING PEOPLE EFFECTIVELY June 21-22 | Regina, Sask. www.sma.sk.ca/PLI

MAY

2019 SPRING REPRESENTATIVE ASSEMBLY May 3-4 | Saskatoon, Sask. www.sma.sk.ca/RA

CLASSIFIEDS ANNOUNCEMENTS RETIREMENT: DR. LARSON

SEPTEMBER

PLI: SOCIAL SYSTEMS LEADERSHIP Sept. 13-14 | Regina, Sask. www.sma.sk.ca/PLI

next door. Clinic physicians will work on a fee-for-service basis, with a competitive overhead structure or monthly flat rate. Interested candidates can call Matt Hooper at 306-7005160 or submit a copy of their CV to matthew.hooper@ lindenhealth.ca. We look forward to hearing from you!

FAMILY PHYSICIAN

Saskatoon, Sask.

Dr. Berwyn Larson wishes to announce his retirement from family practice as of Dec. 31, 2018. Alliance Health Saskatoon Clinic will receive his patient files and assume responsibility for patient care after that date.

Willowgrove Medical Group is looking for an ambitious family physician to join their busy practice. Full-time/parttime/obstetrics optional.

FAMILY PHYSICIANS & SPECIALISTS

Saskatoon, Sask.

Our new health centre is currently recruiting family physicians and specialists interested in practising in a bureaucracy and commitment-free environment. Our goal is to create a collegial atmosphere where physicians can focus on their area(s) of interest and collaborate with other physicians on challenging cases. We’ll provide the staff and equipment for you to work as much or as little as you’d like, along with an agile management team that can adapt quickly to changing needs. Located in the heart of downtown Saskatoon, our clinic has 15 exam rooms, offices with windows, Accuro EMR and in-house IT support, as well as an adult psychiatrist accepting new referrals. The building houses an active Obs/Gyne clinic, a pharmacy, a massage clinic and an eatery. There is free staff parking on site and a LifeLabs Medical Laboratory 48

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We are a fully computerized clinic with an X-ray lab on site. We offer primary care, occupational medicine and a wide range of specialty services including circumcisions and vasectomies. We are the company physicians for a number of mining companies in Saskatchewan. •

Large and growing patient base with walk-in clientele

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Extended hours from Monday to Friday evenings

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Weekend and weekday call is shared with all practising physicians

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Currently one in seven weekends

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Each office/exam room is equipped with a networked computer for EMR use

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Competitive expense split - 70/30

To set up a time to discuss the opportunities available, please contact our office at 306-242-0353 or email your CV to willowgrovemedicalgroup@sasktel.net. Enquiries are confidential.

IN MEMORIAM Dr. Robert George Billington 1966 - 2018

Dr. Robert George Billington died on July 23, 2018. Always an overachiever, Rob had degrees in pharmacy, biochemistry and medicine. He was a gifted physician and pharmacist, inspiring educator, loving father and motorcycle enthusiast extraordinaire. Ever ready with a quick joke or silly prank, Rob could always put a smile on your face. Truly a dog’s best friend, he rescued several and donated to help many more. Rob bought his first motorcycle at the age of 21 and over the next 30-plus years, logged many miles. He married Laura Cadrin in 2001 and when dogs joined the family, Rob added a side car and the riding continued. Son Connor (2004) and daughter Erin (2006) made many a trip, first in sidecars, then as passengers behind dad. He is survived by his wife and children.

Dr. Noel John Lowry 1948 - 2018

Noel was born in Dublin, Ireland, on November 23, 1948, to Ann (Rooney) and Charles Lowry. Noel had two older sisters, Rosaleen (died March 2017) and Muriel (Ken Ryan), living in Dalkey, Co. Dublin. Noel was very well educated in the humanities by the Jesuits at Belvedere College, Dublin. He was a bright, keen, if mischievous student. He was torn between studying English literature and medicine, but medicine won out, and English and Anglo-Irish literature became his passionate hobbies. He particularly liked Polonius’ advice to Laertes from Hamlet. “This above all: to thine own self be true, and it must follow, as the night the day, though canst not then be false to any man.” In fact, he modelled his own life on this advice. His mother Ann died when he was 16 and his father when he was 21. He was a poverty stricken student and worked in factories in England to earn his tuition each summer. His good friend Sam always lent him his suit for the exams.

Noel met Margaret McMahon at a high school debate. They became very good friends as they went through medical school together. They were married six weeks after they graduated. Noel won several awards including the gold medal in paediatrics, which is where his future career would lie. Further training and adventure led him to Toronto’s Sick Kids Hospital, where he worked for six years, obtaining his fellowship is paediatric neurology. In 1983 he was offered a position at the University of Saskatchewan and Royal University Hospital. It came with the promise of landed immigrant status and later Canadian citizenship. Noel worked as the sole paediatric neurologist in Saskatchewan for many years. He liked to jokingly refer to himself as “one in a million,” given Saskatchewan’s population at the time. He loved his job and worked tirelessly for his patients. He was proud to obtain his full professorship in paediatrics. He acted as the clinical director of the EEG lab and EMG lab, he was integral in training paediatric, neurology and psychiatry residents, and was the paediatric residency program director for many years. He found his work very fulfilling and greatly appreciated his colleagues and friends, both locally and nationally. Noel and Margaret were blessed with five children: Helen (Alastair, Sophie, and Aiden), Nancy (James and Eden), Catherine (Jascha and baby Leo), Charles, and Kevin (Allison). Noel loved spending time with his family on camping and ski trips, fishing trips, long road trips across North America, and holidays in Ireland. With grown children, he and Margaret had the freedom to take on many world adventures with their close friends, and spend more time enjoying the arts, reading and gardening. His complex illness forced him to retire in November 2017. He never once grew impatient or complained throughout his illness. He always appreciated the support and generosity of his friends and family. Even at the end of his life, Noel maintained his gratitude for the simple things in life, “the delicious” fresh orange juice and “thank yous” for the care provided. His last discernible words were, “Family is so important and I love you.”

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Photo by Dr. Lisa Smith, family medicine resident

Return undeliverable Canadian addresses to:

SASKATCHEWAN MEDICAL ASSOCIATION 201-2174 Airport Drive Saskatoon, SK Canada S7L 6M6

Mail to:

40007031