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The transcript has been edited for brevity and clarity
Ashraf Rushdy (Project Officer, Office of Public Affairs): Thanks Lita and John for joining us to talk about the value of service in our response to coronavirus. Would you mind each briefly introducing yourselves?
Dr. Lita Cameron (Family Physician): My name is Lita Cameron. I’m a family physician working in Hamilton, Ontario. I work as a primary care physician, taking care of patients of all ranges; and then I do special care with newborns in hospitals as well as with our newcomers and refugees at one of our volunteer-based clinics in the city.
Prof. John Milloy (Director, Centre for Public Ethics, Martin Luther University College, Wilfrid Laurier University): My name is John Milloy. I’m the director of the Centre for Public Ethics at Martin Luther University College, which is a college federated with Wilfrid Laurier University. I’m also a professor of public ethics and teach in the Christian Studies and Global Citizenship Program that we offer in partnership with Laurier. Before that, I was a member of Provincial Parliament and Cabinet Minister at Queen’s Park and spent eleven years representing the riding of Kitchener Centre.
Ashraf: Thanks for joining us. It’s nice to have you both here with us virtually, recording our first podcast in the series that the Office of Public Affairs is launching about our response in Canada to COVID-19. I’m wondering if we could begin by describing some of the difficulties that we’ve seen Canadians facing? John, do you mind starting us off?
John: I think of two groups. As a former Member of Provincial Parliament, I’m still connected to our community and those individuals who are homeless. For those who are struggling, this has been a monumentally difficult time. Just the idea of physical distancing, of social distancing, how do you do that when you’re in a hostel or sleeping in various friend’s couches night after night?
Then the other group that I think of are those front-line people. You know, kudos to front-line medical staff – including my colleague here. But also, those people who are working in the retail sector. Those people who are collecting your garbage. Those people who are providing care to the elderly. I think they are people who are on the front lines and are putting their lives at risk literally every day. And they don’t have that luxury of sitting in a home office and Skyping with their students.
Ashraf: Thanks John. Lita, what are you seeing as a family physician?
Lita: In terms of the physicians, nurses, administrators, cleaning staff, and everyone in the hospital providing care, it’s been a complete change in the way that we operate and think. Every day is posing a risk, and every action can have a ripple effect. One thing that I’ve noticed and have experienced speaking with my colleagues is the concern that we all have that we are a carrier without knowing it. We may be distributing this virus among other people because we’re in contact with other patients who may or may not have that disease. That everyday anxiety and fear affects how we function as clinics, as well as our interaction with our patients – to try to reduce risk as much as possible.
As a primary care physician, the way that our clinic is structured has changed substantially in order to reduce potential transmission. We provide care as best as we can through video or telephone consults, and then when patients actually need to be seen we bring them into the clinic. We have certain strategies in place to reduce any potential risk to our staff and to the patient themselves. So, we’ve really re-evaluated and reoriented how we provide primary care.
Ashraf: Maybe we could carry on from that point. You had mentioned that there’s this environment of heightened anxiety and fear, and a growing concern amongst everyone who has to come into contact with others. How, in that context, is the ethic of service shaping the response of the health care system? How are we seeing this sense of duty and the desire to serve others arising in the midst of this kind of chaotic condition that we find ourselves in?
Lita: What’s been quite impressive and moving for me, as a clinician, has been this rallying unity of vision that exists among individuals working within the health sector. I’m speaking specifically about the health sector, but I know that it exists in other sectors as well.
We recognize that there is this universal force or impact felt on our society, on our community and our patients. That has really rallied a collaborative and coherent approach to providing care, with the motivation and the purpose of ensuring the wellbeing and safety of patients. That is the underlying theme that influences all the decisions that are being made. The way that an ethic of service is being implemented is around that: making decisions around what is urgent care, what can be deferred, and what is elective. The way that medicine and care is being provided has shifted. Every patient’s situation is re-evaluated based on that model. The whole purpose is to reduce potential exposure and risk.
Our most vulnerable patients are often the ones who may not be accessing care when they most need it. So, strategies are put in place to be able to reach out to homeless and vulnerable patients. Certain structures are in place with groups of physicians in Hamilton that already work with the most vulnerable. They also have strategies in place to be able to assess and treat at a much faster rate an individual who has the benefit of living in their home and who can self-isolate without difficulty. I think there is also the general sacrifice that people feel to be able to say everyday: “I want to contribute to this process, I want to give in some way to be able to help others.”
Ashraf: Thanks, Lita. Now, John you also served for many years as a minister in the Ontario government with various portfolios. How does a crisis like this generate a sense of purpose and mission among the public service?
John: It’s an extraordinary time at Queen’s Park, and you have to give a lot of credit to the leadership there. Not just the political leadership, but that of the public service and those who are involved in public health and making decisions about how we need to steer this health care ship so that it meets this horrible crisis. So, it does bring people together. It becomes a lens no matter where you’re working; you are going to be thinking about how do you change what you are doing, or modify what you are doing, or perhaps put a hole in what you are doing in order to deal with the crisis.
It’s a very positive experience on one level, but these crises also unfortunately have, I guess, the opposite of a silver lining. I don’t know what that would be; a copper lining, a bronze lining…. The fact is that everyone is so transfixed, I imagine, on what’s happening with COVID-19 that there are important things which are having to be put aside – which is totally understandable.
I also wonder if there’s a lot of time to think about what comes after. I’m not simply talking about the mechanics. The mechanics are going to be very important. Do we wear masks? Does one sector come back first? Does someone need to have some kind of health certificate in order to go back to work? I’m sure those discussions are going on, but it’s what does the new post-COVID world look like?
We spoke a few minutes ago about the challenges facing those in low-wage jobs. We talked about health care for the homeless, for people who are in crisis around the margins. There’s a whole range of issues which become so stark because of COVID-19. We have some wonderful facilities for seniors in our province, but we’ve also seen other facilities that aren’t living up to snuff. So, how is this new world going to look? How are we going to treat seniors in the future? How are we going to treat precarious workers? What are we going to do about personal support workers who are paid meagre salaries, or meagre hourly wages, and are on the front lines. I’m hoping that we’re going to see change. But that’s going to require some folks thinking it through, and the downside of the crisis is that you’re thinking about what’s happening now, which is totally understandable. You’re thinking about some of those mechanics around what happens next. But, what does the long-term future going to look like? I’m hoping that there is going to be a bit of a momentum that’s going to cause government to think through some of these things and hopefully garnish some public support.
Ashraf: Thanks, also you mentioned you are a professor of public ethics at Martin Luther University College in Kitchener/Waterloo. I wonder if you could take us through the response of the government to this crisis through that lens of public ethics.
John: We have a very specific definition of public ethics. I mean, it doesn’t take it that far from what the generic understanding would be, but we think of the public as a group of individuals that get together. So, we often talk about “publics”; that our society has different groups, or “publics’’ that get together. It could be a faith community, it could be a service club, it could be a geographic community. But these are individuals that get together and bring their deepest convictions, their deepest beliefs, and try to apply them to some of the challenges and problems facing our world.
We say public ethics, but we’re often talking about a situation where the existing system no longer works. And obviously, with regard to COVID-19 that’s on two levels. The first is that we can’t function normally as a society. So, in terms of public ethics, how do we come together and support each other in this brave new world where we have to stay six feet apart? Where we can’t visit an elderly friend or relative in a long-term care home? Where we have whole swaths of society that have been laid off, that can’t pay bills? So that is a huge public ethical issue and you know we’ve seen people rise to the occasion.
I know locally here in Waterloo Region, we have groups and organizations that are working with the homeless, working with the marginalized. On an individual basis we have people who are checking in on seniors who are neighbours, keeping social distancing, obviously. But then there’s a second piece which goes back to my comment about government and some of the thoughtfulness that I hope is going to be there. Our system doesn’t seem to work anymore. A system where so many of our seniors are put in long-term care homes and in many cases seemingly forgotten. A system where we house the homeless or the marginalized in large hostels, systems where we have front-line workers who are paid minimum wage that often keeps them below poverty. How do we rethink that coming forward? That is a huge issue around public ethics.
I think there’s room for all sorts of groups – for “publics” – to come forward. Whether we’re talking about faith communities or community groups or people of like interest to come forward and say: hey, the old ways aren’t going to work anymore - in fact we’ve seen that maybe they didn’t work that well in the past – and how do we think about it differently? You know what, these are really tough questions, but they have to be addressed.
Ashraf: Thanks John. I think this brings us up to the central role that we see communities playing in the response to the coronavirus. I wonder Lita, as a family doctor, how you’ve seen our response to coronavirus highlight this role of the community in contributing to patient health and wellbeing.
Lita: It’s a challenging time for people on many levels – from the mental health perspective, spiritual, social, and economic. Patients are facing different types and degrees of hardships in the context of this forced social isolation. Whether it’s loss of jobs or loss of that community interconnectedness. A recurrent theme that I’m noticing with the patients I’m interacting with in this new form of health care provision, is the role that community has played in their wellbeing. An important aspect of who we are as human beings and how we live our life is that interaction with our neighbours, our communities, our faith groups, our service groups, our charities, our working colleagues, is an important part of who we are.
Another thing that I’ve noticed in terms of this community interconnectedness, is that there is a recognition that our actions impact others. The individual has an impact on the wider community – we see that in the context of virus transmission. When conversing with patients around whether they need to seek imaging, or have some blood work, or come into the clinic, the primary concern is around potentially transmitting that virus to other people, or putting other people at risk. Like you mentioned, people won’t be visiting their family members or elders in the community because they’re worried about their wellbeing and not necessarily their own. That just reinforces an understanding in our society that we have an individual responsibility to make decisions that protect the wellbeing of our most vulnerable.
Ashraf: You mentioned earlier this heightened awareness of the need for community in the face of these deeper challenges that you were just talking about. So, given that there’s this increased awareness of the need of having a connection to the community, I was wondering what are some of the constructive things that you hope would come out of this crisis for the patients you serve, or the healthcare system as a whole?
Lita: As John has mentioned, the world post-COVID will hopefully be different from the world pre-COVID in some constructive ways. There are many strengths to the way our system is structured currently, so we are very fortunate to live in a country that provides health care to any population and any individual, regardless of their social and economic background, regardless of their religious background, or ethnicity. It does not matter in Canada in terms of that ability to access care. Of course, the experience of access to care may differ based on this imperfect system, but people are all able to access the care that they need.
However, there are many ways that our healthcare system is currently structured that will need to be re-evaluated in the context of the pandemic. One aspect that I feel has been reinforced by this is the role that each individual is playing in the wellbeing of a whole population. So, as John has mentioned: how are we caring for personal support workers (PSWs), for the front-line workers in the long term care facilities, or providing care in homes for patients that require more than they are able to do on their own? How are we seeing the role of nurses and the role of administrative staff? The housekeeping staff in hospitals has a crucial role to play in the prevention of transmission of this virus.
Do we appreciate and recognize that each of these component parts are necessary parts of the system that are structured in a way that provides care? They’re all foundational elements to a strong health care system, so do we acknowledge and appreciate them to that degree? I hope that in in this process of evaluating and reflecting on our experience that those roles and those responsibilities will be heightened and recognized as a crucial, as a crucial element of a strong healthcare system.
Ashraf: Thanks Lita. John, I want to come back to the same question. But before that: you’ve thought a lot of the role of religion in public life, so I want to ask you what role you think religion can play to build resilience in response to this crisis.
John: I think faith communities have a huge role in terms of encouraging their followers to get involved. Perhaps it’s going to be indirectly, because of the physical circumstances, but you know: to make a donation, to help out where you can, to help on an individual level but also to be voices at the forefront when we start to have that conversation or as we have that conversation. These are discussions we need to have as a society, and they fit with the mandate of so many faith communities, as far as a preferential option for those that are on the margins. I hope this is a wake-up call.
One of the basic tenets of most, if not all, faiths is our human connectedness and our responsibility for each other. We live in a world that is divided all the time by economics, by geography, by politics, and yet here’s one case where we literally are all in this together. Hopefully that sense of shared humanity will be something that lives on after this and will strengthen our world.
Ashraf: Thank you both so much for joining us on this first podcast series that’s going to explore the reaction in Canada to COVID-19. You’ve opened up so many different areas of questioning – all representative of our collective reflective moment here in Canada that this crisis is bringing to us. So, thanks again for joining us.