MB is #1 for the Wrong Reasons

MB is the only province to transport, to the extend it did, ICU patients to neighboring provinces. By the end of June, 2021 an estimated 57 ICU patients were transferred out of province as MB did not have the critical care capacity to adequately care for them (CBC accessed July 13, 2021). Many of these patients have returned to MB and, unfortunately, a number died while receiving care out of province.

Our Premier likes boasting about being “number one”. However, the health care system failures that have contributed to being “number one” in requiring out of province mutual aid for ICU patients need to be humbly and transparently acknowledged.

Prior to COVID the Conservative Government of MB, under Premier Pallister, transformed our health care system including reducing acute, urgent and emergency care capacity at the Seven Oaks, Concordia and Victoria hospitals as well as at the Misericordia Heath Centre. Many of these functions, at least in part, were transferred to Health Sciences Centre, Grace Hospital and Saint Boniface hospitals.

I previously posted on the general impacts of fiscal austerity and “erosion management”. However, one of the specific untoward impacts of MB's “Healing the Health Care System” transformation is the loss of acute care personal, and more specifically acute and critical care nurses.

Although disputed by WRHA the Canadian Institute for Health Information (CIHI) reported a decline in the number of nurses in MB between 2017 and 2018. Darlene Jackson, President of the Manitoba Nurses Union, concurs with CIHI:

“It’s very disturbing to see that we do have less nurses in the system at this time … There are many, many vacancies across the system,” said Jackson.

Jackson said the ongoing transformation of Winnipeg health facilities is fuelling uncertainty that makes it tough to retain nurses, especially as some hospitals lose emergency rooms and other services shift between facilities.

MNU said it represented 5,844 nurses in Winnipeg hospitals in January 2017, which fell to 5,658 in January 2018 and 5,600 in January 2019. (posted July 27, 2019, Winnipeg Free Press, Joyanne Pursaga accessed July 13, 2021).

The NDP tabled Shared Health documents showing that the number of critical care nursing positions continued to drop between 2019 and 2021 (NDP accessed July 13, 2021).

The system, in the short-term, can not replace experienced nurses, especially in critical care settings. Given the uncertainties, and the languishing slow pace of health care transformations (e.g. Fine Art of Muddling Through), it is understandable that many acute care nurses, especially those in the latter half of their careers, may have chosen to retire and move on.

Attempt to quickly “retool” general duty nurses to provide critical care plays into the myth of “a nurse is a nurse is a nurse”. Critical care nursing requires a specific skill set that cannot be gained in a short time period. Also, increasing patient to nurse staffing ratios is not sustainable, not mention the issues of “forced overtime” and staff burnout.

Although hospital wards can be transformed to accommodate sicker patients this is futile without appropriate staffing.

I argue that making our health care system leaner and more efficient, or eroded and cut to the bone, in combination with a slow response to managing the third wave, contributed in large part to our less than enviable position if being number one in being the most “overwhelmed” health are system in Canada.

It is a sad situation when a leader can not, or will not, admit that things could have gone better, even in hindsight. Pre COVID, MB went through radical health care changes in the guise of “healing our health care system”. The result was the loss of many experienced acute and critical health care professionals.

Lately, it seems, that Premier Pallister, is more about blaming other people, including President Biden, for MB’s predicament rather than acknowledging that the good and bad consequences of his policies. Vanity is not a good quality for leaders especially when managing a pandemic or other complicated societal issues.

Pallister seems to be more concerned about people not liking him or claiming media bias against him. His inability to diplomatically stick handle sensitive issues came to a head recently on a separate issue related to the recent toppling of the statues of Queen Victoria and Elizabeth (CBC accessed July 13, 2021).

The good news is we are finally seeing light at the end of the tunnel, largely due to high vaccination rates and most Manitobans rolling up their sleeves. Canada is doing much better than other industrialized countries with over 75% and over 40% (>55% in MB!) of those 12 years or older old having one or two doses, respectively (source accessed July 13, 2021).

Compare this to Australia which had some of the most authoritarian lock downs only to experience significant COVID recurrences as less than 40% of their population having one dose and less than 20% having two doses (source accessed July 13, 2021).

Lock downs do not make unvaccinated populations less susceptible to COVID, vaccination and natural immunity do, with the latter being a consequence of being unvaccinated for whatever reason.

MB has hit its threshold for the next step of reopening, and we should find out this week about changes to Public Health restrictions.

Although having a “two-dose” summer it is a cause for celebration we should not forget lessons learnt from our journey as we still face significant challenges post COVID.

I would be remiss in not highlighting that COVID exposed the many failings in how we care for our seniors. I am afraid that post COVID these shortcomings will not be addressed in any meaningful way unless we, the voters, continue to push for sustainable senior care reform. We will all end up needing senior care and it is in our best interest to effectively engage policy makers. (previous blog entries on this topic, time to face up to how we really treat our seniors, personal care homes to little to late, death and taxes)