For so many in Canada, the concept of a collapsing healthcare system is impossible to conceive. For others, like our own families, the healthcare system has always been unreliable, failing and full of gaps.
Last summer, Alberta dropped almost all COVID-19 restrictions, including masking and isolation for positive cases. What came next was a surge beyond expectation, bringing the healthcare system to the brink. In this aftermath, my own father fell ill.
An ambulance was called for him twice, but hospitals were stretched beyond capacity. Paramedics were doing their best to assess vitals and provide care in the home. On the third 911 call, EMS arrived and my father’s vitals were incompatible with life. Oxygen below 70 percent, barely responsive. He had full blown COVID-19 pneumonia. It was time to take him into a collapsing system where ICU beds and life saving therapies were being rationed.
One week later I would be at his side, in full PPE, as he took his last breaths. I was not able to touch his skin, stroke his hair or kiss his head.
I had raced to the airport for a four hour flight to be with him. I arrived at the hospital and forced myself not to cry in front of the nurse who came to the door and informed me that absolutely no visitor could enter “until death is imminent”. Healthcare workers in Alberta were being crushed in the system. I heard that some died by suicide. I was worried about this nurse, forced to come face-to-face with my grief to say “you cannot see him.” At this time I had been treating COVID-19 patients in Ontario for almost two years.
My father was double vaccinated with AstraZeneca. It would have been enough protection had we not allowed the original virus to mutate into the Delta variant. I spent the days waiting and calling while he was alone inside. The nurses were upbeat on the phone, focusing on the positive, minimizing hard news. I knew things were bad when they said it was hard to communicate “because he only speaks Arabic.” My father was not only fluently bilingual, but the most brilliant and eloquent human being I have ever known — in both Arabic and English.
Then the call came. They could do no more. We arrived at the hospital, lined up to don PPE and sign waivers acknowledging we knew we were entering a COVID-19 ward and we understood the risks. We promised to spend a maximum 15 minutes at a six foot distance from his bed. We could enter one-by-one to say goodbye.
Several months earlier in the pandemic, as vaccines were beginning to roll out, my colleague Cheryllee lost her mother, Margaret, to COVID-19. Her daughter had returned from school with a note: a student in her cohort had tested positive. That night she woke up with a high fever, and Cheryllee took all possible steps to protect her multigenerational household. Despite her efforts, Cheryllee’s partner and mother tested positive, followed by both her sons and herself.
Margaret had come to Ontario to be cared for by her family after years of health challenges where she struggled to access appropriate care. The week was hard. Her condition deteriorated, and reluctantly she agreed to go to hospital, where no visitors were allowed. She feared for her dignity, scared to be alone. Margaret’s situation did not improve by the time Cheryllee cleared isolation. With advocacy from myself and Dr. Janet Smylie — a brilliant Indigenous physician, Cheryllee was able to be at her side when she passed away.
Cheryllee and I are front line responders. She is an incredible Métis exemption midwife, I am a First Nations and Black family physician. We are used to the stories of community members being unable to access medical care when they need it. Many Indigenous communities have no hospitals let alone doctors and ambulances. In cities, structures of exclusion prevent and delay care for Indigenous and Black communities, while systemic racism threatens quality of care accessed.
Its why, together we have become co-Aunties at Call Auntie — an Indigenous primary care and support network providing community-based, culturally grounded, community-led care. Indigenous and Black communities have borne a disproportionate burden of morbidity, mortality, and healthcare exclusion since pre-pandemic times.
Call Auntie began as a hotline, where trusted Indigenous women — or “aunties” as we call ourselves — could provide expert advice on pandemic navigation for Indigenous people and their families in Toronto. We support vaccine access and COVID-19 testing with Indigenous-led clinic Auduzhe Mino Nesewinong, and received expert training from Partners in Health Canada to develop community-led contact tracing and case management. We work to combat vaccine misinformation gently through trust building.
Call Auntie grew from the “Baby Bundle” program, an Indigenous model of pregnancy and parental support developed by Seventh Generations Midwives of Toronto to safeguard family success and integrity. It has since evolved into a network of support and primary care. Our aunties are physicians, midwives, birth workers, harm reduction workers, community outreach workers, and medical learners. With the support of Inner City Health Associates we have expanded our primary care clinic to include pediatric and psychiatry care.
Our communities experience structural failures in healthcare on a regular basis. Critical shortages, dangerous delays, access barriers: conditions of “Code Orange” are a norm we’ve long accepted for these communities.
When these gaps start impacting the rest of us, we call it a system collapse.
Community-led care is key to preventing system collapse. No matter how well designed a health system, there will always be segments of the population not served. Meeting patients where they are, modeling healthy relationships and empowerment, and critically — harnessing problem solving as a fundamental component of healthcare provision is how we close gaps.
With enough community led innovation, not only can we prevent system collapse, we can create a new system that truly works for all communities on Turtle Island.
By Dr. Suzanne Shoush Contributor
Cheryllee Bourgeois Contributor