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Aid group with Canadian funding leads mission to deliver medical supplies in Ukraine

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POLTAVA, Ukraine — As the Toyota Tundra following a tractor trailer loaded with humanitarian aid heads into dangerous territory in eastern Ukraine, “Promiscuous” by Nelly Furtado and Timbaland plays over the speakers.

The small convoy transporting 20 tonnes of medical supplies is headed for Balakliya in a part of the country that was retaken by the Ukrainian army in September after six months of brutal Russian occupation. Their mission to help the devastated region crosses areas where Russian shelling continues. In Kupiansk, not far from Balakliya, shells continue to rain down.

At the wheel of the Tundra last Friday was Dr. Christian Carrer, a pediatrician from France. With his partner Tetyana Grebenchykova, he runs the Association internationale de coopération médicale, a non-governmental organization that receives support from the Canada-Ukraine Foundation and the Ontario government.

It will take the vehicles, which also include a minivan ahead of the tractor trailer, five hours to travel from a warehouse in Poltava to Balakliya, a distance of barely 200 kilometres. The roads are pockmarked from fallen bombs, and there are frequent stops at military checkpoints on guard against Russian infiltration.

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The strapping pediatrician with the face of an old adventurer has been on the ground since 2014, helping people in the Donbas region after it was invaded by the Russians. Last January, he suspected Ukraine’s menacing neighbour was planning something.

“There were strange gatherings and constant provocations,” Carrer said as he drove. “Everyone knew that clearly, something was going to happen.”

His organization started ensuring various supplies, in particular bandages, were positioned ahead of the feared assault. The last hospital received its delivery on Feb. 24, he said, the day the Russians launched their war.

“The people funding us had confidence in us because we sensed the attack,” he said.

Canada is the third most generous contributor to his group, which has also drawn donations from French, American and British sources.

The organization is well stocked and knows the terrain, and it focuses its aid in a few administrative regions in the northeast of the country. It has more than 800 items available, general or specialized medicines that hospitals and pharmacies in disaster zones can order.

Even in regions that have officially been liberated, the needs remain desperate.

The road crosses sprawling plains, and in one village after another, homes have been destroyed and gas stations and other businesses are shuttered. Crops remain unharvested in the fields. The tires make a constant purring noise as they drive over asphalt perforated by constant tank traffic.

Signs of the suffering and destruction of war are everywhere, and residents have little left to survive on. The occupiers emptied pharmacies and pillaged hospitals.

The convoy passes Chuhuiv, a municipality where the Association internationale de coopération médicale positioned medical supplies ahead of the war but that was later occupied. “The Russians took everything,” says Carrer, who has lived in Ukraine since 2006.

He describes the health condition of those who lived for weeks in shelters as pitiful, looking like “zombies.” Some are even losing their teeth, and he said visiting physicians are shocked by what they find.

As a pediatrician, he is especially worried about the state of pregnant women, young mothers and their children: a large part of that day’s delivery is destined for them.

Once in Balakliya, a desolated city with some buildings completely gutted, the aid valued at $4 million is unloaded in an old warehouse. It will later be distributed among eight municipalities in the area. A small welcoming committee includes the administrative head of Izyum district to the south, Stepan Maselski.

“This aid is very important because we are still at war,” Maselski said in an interview. “The invader destroyed our infrastructures. Just two days ago, we didn’t have electricity or water. The occupation was painful — no medicine, no medical supplies, no good food.”

A forklift empties pallets from the tractor trailer, containing cases and cases of medicine to treat chronic illnesses, epilepsy and heart problems, anesthetics for surgeries, surgical equipment, bandages, gloves, stethoscopes and diapers, among other items. There is also baby formula because infant malnutrition is widespread, Carrer says.

“Often women who give birth have trouble nursing because of the stress and the situation,” he explained. He said Ontario has provided vitamins, and the impact was practically miraculous.

There are also supply kits for those left homeless and even boxes of pet food, which is in short supply.

A special big red bag, which resembles an insulated delivery bag, is handed to Paulina, a medical official who intervenes in the provision of urgent care across the region. It is a kit conceived by doctors in California to treat people in war zones, whether for injuries caused by a landmine or for heart attacks. Paulina says the supplies are of superior quality and they are badly needed.

Suddenly the unloading operation is halted when the forklift breaks down. But the Ukrainians are creative: they tow the old forklift out of the way with a tractor — like their compatriots were often seen doing with Russian tanks on viral videos — and build a wobbly wooden ramp to complete the unloading.

Counting on Ukrainians’ ability to adapt, Carrer’s group has also delivered large numbers of warm blankets as well as small wood-burning stoves manufactured in the Poltava region for residents who have no way to heat their homes due to power outages.

Carrer says there are complex  reasons why the Ukrainian government is struggling to provide basic services in liberated territories. For one thing, he explains, the budget for health spending was cut by about one fifth to fund the war effort. And the annual provision of equipment and funding for the health system comes in February or March, which was when the Russians invaded. The number of refugees has also drained local resources.

“The needs are enormous in all the hospitals,” he says. “And now it’s serious. We see hospitals that are at the end of their tether. We used to deliver two boxes, and now we deliver whole pallets, basic supplies like plaster, gloves, cotton.”

Night falls quickly, and it is cold. The rig is empty, and it is time to leave so the group can make it through all the checkpoints on the way back to Poltava. Carrer knows his group will likely have to return soon with another load.

“Either a good soul is there to help, or they’ll call us back in a month …. We are the first to help, and perhaps the last to help.”

This report by The Canadian Press was first published Nov. 28, 2022.

— Patrice Bergeron is a Quebec-based journalist with The Canadian Press. In addition to two decades of political and general news experience, he was a CP war correspondent in Afghanistan in 2009.

 

Patrice Bergeron, The Canadian Press

Economy

B.C.’s economy, health care and housing to be the focus of throne speech: Eby

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VICTORIA — British Columbia’s economy will be a key focus for politicians as they return to the legislature for the spring sitting.

Premier David Eby says economists are predicating a “global slowdown and potentially recession” and his government is focused on keeping the economy strong by building trade relationships and supporting businesses.

The session starts with a speech from the throne today, which Eby says will outline the government’s key priorities of health care, housing, public safety and the economy.

However, Eby won’t be there for the start of the session.

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He’ll be travelling to Ottawa where Prime Minister Justin Trudeau is hosting a first ministers’ meeting to try to work out an agreement with the provinces and territories for increased funding for health care.

B.C. house leader Ravi Kahlon says the government has plans to introduce more than two dozen pieces of legislation during the session, which is set to conclude in May.

The government will table its budget at the end of the month.

This report by The Canadian Press was first published Feb. 6, 2023.

 

The Canadian Press

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Health

Canada Facing Difficult Battle with Mental Health Struggles

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Mental health is an important health issue that affects us all, and unfortunately, it’s an issue that is rarely discussed openly. According to the World Health Organization, approximately 20% of Canadians will experience a mental illness.

This makes mental health one of the most pressing issues facing Canadians today. Let’s take a closer look at why mental health is such an important issue in Canada.

 

The Need for Better Mental Health Care

In Canada, access to quality mental health care can be costly and difficult to obtain. Many Canadians are unaware of what services are available or how to access them due to a lack of public education about mental health.

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Additionally, there is still a stigma attached to seeking help for mental illness, which can make it difficult for those who need help to get it. As a result, many people cannot access the care they need in order to live happy and healthy lives.

This deficiency can have severe consequences; untreated mental illness can lead to increased risk for suicidal behavior, substance abuse, homelessness, unemployment, and other serious problems.

Additionally, research shows that early diagnosis and treatment can help prevent long-term complications and reduce the overall costs associated with mental health treatment.

Mental health services are especially important for marginalized populations such as Black Canadians, Latinx individuals, LGBTQ+ individuals, immigrants, and individuals with low incomes who have been underserved when it comes to healthcare access.

These communities often experience higher rates of poverty and discrimination which results in an even greater need for quality mental health services but also fewer resources available to them.

Given these facts, it is clear that there is a great urgency for better access to mental health services. To make meaningful progress towards addressing this issue we must first focus on breaking down barriers such as stigma against seeking help as well as lack of information about available services among vulnerable populations.

Furthermore, a greater investment must be made into training more providers so there are enough qualified professionals available who understand how to provide culturally competent care.

Particularly when working with traditionally underserved communities – while also ensuring accessibility through reduced cost or free options for those with limited insurance coverage or financial resources.

 

Mental Illness as an Invisible Disease

Unlike physical illnesses, mental illnesses are often invisible and difficult to diagnose. This makes it difficult for those living with a mental illness to get the help they need as well as understand what they are going through.

It also means that many people do not realize the severity of mental illnesses and the impact they have on the lives of those living with them until they experience it firsthand or hear stories from someone who has gone through similar struggles.

Mental illness affects more people than most realize. It can be difficult to comprehend the depth of mental health disorders, as they are often invisible and misunderstood. Mental illness is a disease, yet it can remain hidden while still having a profound effect on a person’s life.

 

The Impact on Society

Mental illness has far-reaching effects on society as a whole. Untreated mental illness can lead to substance abuse, homelessness, unemployment, and even suicide in some cases.

All of these have ripple effects throughout our communities, from increased crime rates and lower productivity at work to higher healthcare costs and fewer resources available for those in need, making this an issue that affects us all regardless of our personal situations.

We need to create a friendly environment in which those with invisible diseases feel comfortable sharing their stories and seeking help without fear of judgment or rejection.

Mental illness should not be ignored; rather it should be treated with respect and understanding just like any other type of medical condition.

By recognizing the reality of invisible diseases such as depression, anxiety, PTSD, bipolar disorder, and more we can begin to create a world where everyone gets the help they need regardless of whether or not their condition is visible on the surface.

With understanding comes empathy, and empathy leads us toward meaningful change for ourselves and our communities alike.

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Health

Five things to know about health-care talks Tuesday between Trudeau, premiers

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OTTAWA — On Tuesday in Ottawa, Canada’s 13 premiers and Prime Minister Justin Trudeau will sit around the same table in person for the first time since COVID-19 hoping to find a path toward a new long-term health-care funding deal.

Both sides are optimistic a deal will emerge but there are some big divides to overcome, including how much more money Ottawa is willing to put on the table, and how much accountability the provinces are willing to put up in return.

The premiers have been asking for a new deal for more than two years. Trudeau kept punting until the COVID-19 crisis was largely over.

That time has come.

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Trudeau has been clear a deal is not going to be finished this week. But here’s a snapshot of how we got to this point, and what they’re going to be talking about.

Money, Money, Money, Money

This year Canada expected to transfer almost $88 billion to the provinces and territories for health, education, social supports and equalization. The Canada Health Transfer, or CHT, is $45.2 billion, or 51 per cent of that.

In their 2022-23 budgets, the provinces collectively forecast to spend $203.7 billion on health care. Ottawa’s transfer accounts for 22 per cent of that. The provinces want that increased to 35 per cent, which would mean $26 billion more this year alone.

“There’s been continual demands for an increase in the CHT although I’ve never seen quite as large a demand for an increase as this one,” said Gregory Marchildon, a professor emeritus at the Institute of Health Policy, Management and Evaluation at the University of Toronto.

Trudeau intends to put an offer on the table Tuesday. It will not be an immediate increase of $26 billion, but Ottawa has been silent on where it will land.

While it has existed in its current form only since 2004, some sort of federal health transfer dates from 1957, when Ottawa offered 50-50 funding for health care to provinces that agreed to provide public hospital services based on national standards.

It has evolved and changed at least five times since then, including splitting the federal share between cash and a transfer of tax points — when the federal government cut its income tax rates and the provinces could raise their own in exchange.

In 1995, then-finance minister Paul Martin, desperate to turn around Canada’s debt problems, slashed the health and social transfer by 20 per cent, followed by a 15 per cent cut in 1996. Some provinces have said their health systems have never recovered.

In 2004, a new deal was reached between the premiers and Martin, who by then was prime minister, to see the Canada Health Transfer increased six per cent a year for a decade.

The Conservatives under prime minister Stephen Harper kept that in place, but told the provinces that in 2017-18, the CHT increase would be based on a three-year average of economic growth, but with a minimum increase of at least three per cent.

Trudeau and the Liberals have maintained that.

With economic growth, the annual CHT increase has averaged five per cent since 2017-18.

Over the last 10 years, the CHT has increased 67 per cent, to $45 billion from about $27 billion in 2012-13.

An attempt in 2016 to negotiate a new CHT deal mostly failed, resulting in one-on-one agreements between Ottawa and the provinces and territories to share $11.5 billion over 10 years, beginning in 2017-18, to improve mental-health and home care.

Angling for Accountability

In the split jurisdictional world Canada’s governments live in, provinces are the ones who control health-care delivery. So for the most part, the federal government helps fund it and the provinces get to say how it’s spent.

The Canada Health Act, passed in 1984, sets out the guiding principles for recipients of the Canada Health Transfer, including that health-care systems must be universally accessible. Failing to abide by the principles can, and has, resulted in Ottawa clawing back some transfers.

Trudeau has made clear any increase to federal health transfers must be met with provincial accountability to show results. The federal government has been frustrated at the lack of accountability from provinces over transfers for health care made during COVID-19.

It is adamant that will not be the case with a new funding deal, and is looking at a combination of an annual increase to the CHT and separate deals to target specific problem areas, like health-care worker retention and training, access to family doctors, surgical backlogs, and data collection and sharing.

The 2017 deals on mental-health and home care will be a bit of a model. Those deals saw Ottawa promise $11.5 billion over 10 years for the two areas, but in exchange provinces had to agree to a common set of principles and goals, and to report results.

The Canadian Institute for Health Information was tapped to help collect and publish data. The most recent report in December is still laden with gaps and incomplete data. The reports note it will take time for the reporting to lead to change, and that provinces need to harmonize their data collection in order to better compare statistics across provincial lines.

Marchildon said one of the biggest problems for the federal government in demanding accountability is that measuring health outcomes is difficult, and hard targets are rare.

It’s all about the numbers

Of course, it’s difficult to measure progress if you’re not keeping track.

Data — or the lack of it — is a long-standing weakness of Canada’s federalized system, with 13 separate health-care systems working alongside one another but not necessarily in tandem.

In his first public overture to open negotiations with provinces on health funding in November, Health Minister Jean-Yves Duclos told provincial health ministers the federal government would increase the Canada Health Transfer if provinces agree to work together on a “world-class health data system for Canada.”

“It is the foundation for understanding what we’re doing, who’s receiving services, whether we’re making improvements,” said Kim McGrail, a professor with the University of British Columbia School of Population and Public Health.

McGrail was one of several experts the federal government tasked with reporting on what a “world-class health data system” would look like in Canada.

Gaps in Canada’s data tripped up the national health responses in dozens of different ways during the pandemic, from tracking the number of COVID-19 cases to reporting adverse effects from vaccines.

The same is true of tracking surgical backlogs and other information about how well, or not, the health system is working.

“Data informs every part of the way we think about health,” McGrail said, which includes the health of individual patients.

Canadians who move from one province to another can’t easily access their records because the technology isn’t compatible.

It’s a problem that exists even within provinces, as incompatible technology makes records inaccessible between hospitals and clinics.

“We need those technology systems to be able to talk to one another, to be able to to move data back and forth or to send messages back and forth in some way,” she said.

It’s an expensive problem to fix. Just last week, Nova Scotia government signed a $365-million contract to bring new electronic health-care records to the province, which may or may not be compatible with other provincial systems.

McGrail said investments will pay off if important information about the health of Canadians stops falling through the cracks.

The expert panel delivered a report last year that will likely serve as a road map for improving data sharing in Canada. It includes 31 recommendations, starting with provinces, territories and the federal government agreeing on a shared national vision for health data.

Ontario and Quebec have indicated a willingness to work with Ottawa on data, though other provinces have been less firm about it.

Aging gracefully

Provincial leaders have been able to agree with Ottawa on the need to reform Canada’s long-term care homes, though exactly how to accomplish that is still up for debate.

Duclos has said helping Canadians “age with dignity” is one of Ottawa’s priorities for a new health-care deal, and long-term care plays a major role in that.

So does home care, and the 2017 bilateral deals already began to advance improvements on that front.

Long-term care is an entirely different story.

The pandemic cast a glaring light on the dismal conditions in care homes across the country, when COVID-19 outbreaks led to thousands of deaths and inhumane living conditions for seniors. The military and the Red Cross were summoned to help.

In the early months of the pandemic, Canada had the worst record for COVID-19-related deaths in long-term care of the world’s wealthy countries.

Meanwhile, residents were isolated from the outside world and workers struggled to provide basic care and ensure dignity.

Experts and advocates say the problems long predate the pandemic, and have gone largely ignored until now.

“Given the devastation that we’ve seen in the COVID-19 pandemic and the impacts on our health-care system … we’re seeing this unprecedented moment where finally there’s some hope of collaboration,” said Dr. Amit Arya, a palliative care physician and founder of Doctors for Justice in Long-Term Care, which advocates for an overhaul of Ontario’s long-term care system.

Governments are now scrambling to improve the conditions, as the number of people who need specialized care grows every year and the number of workers willing to provide that care dwindles.

Several provinces have already announced plans to increase the number of hours of care residents receive per day and build new spaces for the growing number of seniors who are living longer with more serious cognitive and physical impairments.

The federal government created a $1 billion “safe long-term care fund” during the pandemic to help pay for immediate infection prevention and control measures to stop the spread of the virus.

The government also set aside $3 billion to help provinces bring homes in line with national standards for the design and operation of long-term care, though specific agreements with provinces haven’t yet been signed to deliver that money.

Those standards were publicly released last week but are unlikely to factor into the health-care talks.

Still, there is plenty of work that needs to be done if provinces have a hope of meeting the standards, especially when it comes to the workforce.

“I think we’re stepping into a crisis,” said Dr. Joseph Wong, the founder of Yee Hong Centre for Geriatric Care, the largest non-profit nursing home in the country.

He said Canada will need upwards of 100,000 new personal support workers to provide care over the next 10 to 15 years in order to provide adequate care to residents.

“It is a time bomb,” he said.

Essential Workers

The same could be said of the health system at large.

None of the lofty goals of the federal or provincial politicians will be possible if they don’t find a way to persuade workers to stay in hospitals, clinics and long-term care centres across Canada, said Linda Silas, president of the Canadian Federation of Nurses Unions.

“They don’t have the staff to do the job,” she said.

Staff shortages have been the common theme among some of the most serious issues underlying the public-health crisis in Canada.

Dozens of emergency rooms have been forced to close temporarily or reduce hours because there weren’t enough staff to treat urgent injuries and illnesses. The Canadian Medical Association estimates nearly five million Canadians don’t have a family doctor. And hundreds of thousands of Canadians are sitting on wait-lists for backlogged surgeries and diagnostic tests.

Health unions and professional associations want a national strategy to keep doctors, nurses and personal support workers in their jobs as well as train new staff to bolster their ranks.

Silas said after years of burnout and moral distress over not being able to care for their patients properly, nurses in particular have said, “I’ve had enough.”

Nurses in Ontario have also balked at a law limiting pay increases to one per cent a year.

Data from the Canadian Institute for Health Information shows that because of new graduates, the supply of nurses is still growing. However, many have chosen not to take full-time positions, and existing staff are increasingly eyeing early retirement, Silas said.

The heavier demands of the job since the pandemic, combined with fewer and fewer people to do the work, has created what even the federal health minister calls a crisis.

“We need to stop the bleed,” Silas said.

This report by The Canadian Press was first published Feb. 5, 2023.

 

Mia Rabson and Laura Osman, The Canadian Press

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