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Why are so many of Alberta's rural doctors from South Africa? – CBC.ca
In January 2014, Dr. Cornelius Nortje arrived at the Edmonton International Airport, ready to start his new life in Alberta.
Nortje was met at the airport by the chief of staff at the Lac La Biche hospital. The chief of staff had two large down jackets, one for Nortje and one for his wife.
Nortje had never previously been in Canada. The day he and his wife landed, the chief of staff drove them 250 kilometres northeast to their new home town.
“We were probably just looking for a bit of an adventure,” said Nortje, who is now in the chief-of-staff role himself at the William J. Cadzow–Lac La Biche Healthcare Centre.
“Most of the South African doctors know someone that’s either been in Canada or was on their way to Canada, and the feedback we’ve always had from them once they’ve been here has been that it’s absolutely fantastic,” he said.
As the local physician in charge of recruitment, Nortje says he’s never received an application from a Canadian-trained doctor.
Lac La Biche, a hamlet with a population of about 2,300, currently has five doctors, all of them from South Africa.
Overall in Alberta, 6.5 per cent of all practising physicians graduated medical school in South Africa, according to figures provided by the College of Physicians and Surgeons of Alberta.
Outside of Edmonton and Calgary, 13 per cent of Alberta doctors trained in South Africa, the CPSA said. In the North zone of Alberta Health Services, South African-trained doctors represent one-third of all rural physicians.
Across the province, the CPSA website lists more doctors who speak Afrikaans, the Dutch-derived colonial language in South Africa, than those who speak Mandarin, Cantonese, Tagalog, Punjabi, Hindi or Ukrainian.
Amid ongoing physician shortages, the provincial government last month announced it will provide some funding to train more rural doctors.
The CPSA has also responded to the pressure. It launched a pilot to remove some barriers for international doctors from approved jurisdictions to start practising in the province.
Since the 1970s, South African doctors have been one of the largest demographics answering the call in Western Canada’s rural communities.
Community service to community health
South African doctors’ experience at home prepares them for rural medicine in Canada, Nortje said.
The country’s medical training requires an internship at public hospitals, which are under-resourced compared to the separate private system. In addition, medical graduates complete a community service year in which they travel to townships and other communities in need before they register as physicians.
“We get thrown into the deep end,” Nortje said.
“Every physician that finishes [medical school] has to have done 10 C-sections … so everyone’s got a bit of exposure with procedural skills and maybe working a little bit more with less resources available.”
Nortje said hospital rooms designed for two patients would be overflowing with 10, with some patients on the floor and in the hallways. As a medical intern, he would have to monitor intensive-care patients and deliver babies on his own without a supervising doctor, he said.
That experience translates well to adapting in a small community hospital, he said.
When Nortje started, Lac La Biche had nine physicians, but that number has dwindled. And of the hamlet’s five physicians now, only four work in the hospital.
“We do fit in well because you have to be able to do a little bit of anything,” Nortje said of working at the Lac La Biche hospital.
“After 11 o’clock at night, it’s me and one RN in the emergency department. Anyone can walk through that door and you have to be able to deal with it.”
Barriers for International medical graduates
Some Canadian colleges of physicians give doctors with South African training and experience preferential status over their counterparts with other international medical credentials.
Since 1974, South Africa has been on a short list of countries the CPSA recognizes as approved jurisdictions.
Physicians who have trained there are able to skip some evaluation and training requirements that other international doctors need to work in Canada.
The majority of doctors who trained abroad have to complete a medical residency in Canada unless they’ve been recruited to work in Canada in their specialty.
Doctors from Australia, Ireland, United Kingdom and the United States can transfer the skills directly in all specialties.
Physicians from South Africa — and more recently Singapore, Hong Kong and Switzerland — can transfer into some specialties in Canada.
Each province designs its list of approved jurisdictions based around guidelines from the College of Physicians and Surgeons of Canada.
“It does make it easier for South African physicians to come here and to come to Alberta when the training is recognized as similar to Canadian residency training ,” said Dr. Michael Caffaro, assistant registrar with Alberta’s college.
While South African doctors have a more direct path to practising in Canada than most other international medical school graduates, some requirements for doctors from South Africa have become more restrictive over the years.
Physicians must complete competency exams followed by a three-month in-hospital assessment period before becoming registered as doctors here.
Dr. Peter Bouch, who practises in Red Deer, emigrated from South Africa in 1993 after a patient told him about an open position in Canada.
He wanted to travel and Canada was one country that made it easier to transfer his credentials. Thirty years ago he faced far fewer barriers to entry than doctors do now, he said.
“Back in the good old days of faxes I sent a fax off and they said sure,” he said.
Without an interview, a local health board invited him to be the new physician in Whitemouth, Man. He was able to take his competency exams in Canada after he started his practice.
I sent a fax off and they said sure.– Dr. Peter Bouch
Caffaro said he didn’t know if fewer South African doctors are practising in Alberta than before, but the trend over the years has been that more internationally trained doctors from other countries are practising in the province.
In January, the CPSA announced a pilot that will waive certain requirements, such as clinical review exams, and the first three-month assessment for international medical graduates. The program is designed to encourage more doctors from approved jurisdictions to apply to work in Canada.
Caffaro said the pilot could also provide a step toward adding more countries to the list of approved jurisdictions in the future.
“There’s no other jurisdictions yet,” he said. However, in concert with the experts in postgraduate education, the expectation would be that there would be an interest in actually looking at how we can expand the list.”
Medical exodus
For years, the South African government has expressed concerns about the steady outflow of trained physicians to other countries, primarily in the commonwealth.
Many doctors who came from South Africa to Canada described the safety of their family as part of the impetus to move.
South Africa has one of the highest homicide rates in the world, according to a United Nations report. Initially, the murder rate continuously declined post-apartheid, but statistics suggest there has been a rise since 2011.
“Safety is definitely, I think for me one of the biggest things,” said Nortje. “You’ve got alarm systems and response units that people privately hire to monitor their houses.”
Nortje was working at a hospital in Cape Town one night when a physician from Nigeria went to a gas station to get something to eat. But his colleague never returned. Nortje said he found out two days later the man was killed.
Dr. Tracy Lee Lindenberg, another doctor in Lac La Biche who trained in South Africa, said she was held up at knifepoint in her car while stopped at a stop sign in the middle of the day.
She remembered seeing hundreds of people around and a police officer across the street. For years after that, even in Canada, she said she would have heart palpitations while stopped at a traffic light if it looked like someone was approaching.
“It just made it such an easier decision to move,” she said.
Five years ago, Lindenberg moved to Canada with her husband and six-month-old daughter.
She said many medical challenges are similar to her experiences in South Africa and her family has embraced their new lifestyle in Lac La Biche, ice fishing and going on snowmobile trips.
“I really fell in love with the rural aspect,” she said. ” People here were just so inviting and it just made me feel so much like home.”
Doctors wanted
On Jan. 26, the province announced it would provide $1 million to fund four Alberta post-secondary institutions to look for ways to train doctors in Grande Prairie and Lethbridge. It’s part of an effort to train more Alberta doctors who want to practice rural medicine.
Medical resident Topher Mostert, who is currently working in Lac La Biche, is part of a Red Deer-based University of Alberta training program that includes a rural rotation.
Mostert, who grew up in Fort Nelson, B.C., wants to be in rural medicine and said the residency has affirmed his decision.
“I can tell you that I will not be going back to a city. I much prefer small-town medicine,” he said.
“Every day is different. And it’s nice seeing the same patients and having that continuity of care.”
Nortje is hopeful Mostert might join the team in Lac La Biche.
In the meantime, the Lac La Biche medical clinic is looking to address its current shortfall of doctors, with one of its five doctors set to retire this spring.
The community has hired two internationally-trained doctors who are already living in Alberta. One studied in South Africa and the other trained in India.
Both are waiting to complete assessments before they can join the team in Lac La Biche.
Canadians in some provinces and territories will soon be paying a little bit more at the gas station as a federal carbon price is set to go up starting Saturday.
The fuel charge is rising by 30 per cent from $50 per tonne of emissions to $65 on April 1. This will translate to an increase of roughly three cents per litre for gas, reaching a total of 14 cents per litre.
The scheduled increase will apply in Ontario, Manitoba, Saskatchewan, Alberta, Yukon and Nunavut.
Meanwhile, the carbon price jump will go into effect in Newfoundland and Labrador, Nova Scotia, and Prince Edward Island on July 1.
Read more:
Canadians will see high oil, gas prices through 2023, experts say: ‘A very expensive time’
Canada began pricing carbon pollution in 2019.
The move is part of Ottawa’s commitment to tackle climate change with a goal to reach net-zero carbon emissions by 2050.
While Canadians will see an increase at the pumps, the carbon price increase is not expected to have a huge impact on their gas expenses, said Hadrian Mertins-Kirkwood, a senior researcher with the Canadian Centre for Policy Alternatives.
“It’s an incremental increase, but it’s not actually going to be a huge change year-over-year that people will notice ,” he told Global News.
For individuals, it could mean a $1 jump per tank depending on how big the vehicle is, Mertins-Kirkwood estimated. For businesses too, it’s “not a major expense,” he said.
Mertins-Kirkwood said things like oil market fluctuations and gas taxes have a much bigger impact on energy costs.
“Those swings are way bigger than the carbon price.”
What else is changing?
The carbon price increase comes amid some temporary relief for Canadians with lower gas prices reported in February after record-high costs last year. Gas prices in Canada surpassed $2 per litre for the first time ever last year.
On a monthly basis, Canadian drivers paid one per cent less for gas in February, Statistics Canada said in its latest report released on March 21. Overall, gas prices dropped by 4.7 per cent in February – which was the first yearly decline since Jan 2021, StatCan reported.
The agency said the year-over-year decline is partially attributed to the significant jump in prices seen in February 2022 amid Russia’s invasion of Ukraine.
The Canadian national average for gas prices stood at 150.8 cents per litre on Friday morning, according to GasBuddy. The CAA’s estimate for Friday was 149 cents per litre.
The carbon tax will not only raise gas prices, but could make its way into Canadian pocketbooks in other ways too.
For instance, aviation gasoline in the four provinces is also going up by roughly 3.5 cents a litre to a total of almost 16 cents per litre, which could potentially mean higher airfares down the line.
However, the rates for aviation gasoline and aviation turbo fuel will remain unchanged in the territories due to the “high reliance” on air transportation, the federal government says.
Light fuel oil, which is used in household equipment, is increasing to 17 cents per litre – an increment of nearly four cents.
Carbon pricing can have also ripple effects on food prices, other grocery items and shipped goods experts say, as Canada’s truck-based transportation industry will be spending more money to fill up the tank.
“It’s possible it could have an impact on things like shipping, but it’s a relatively minor impact,” said Mertins-Kirkwood.
Will rebates make a difference?
Ottawa has claimed that eight out of 10 Canadian families will get more money back than they pay under the federal carbon pricing plan because of the Climate Action Incentive.
Canadians can claim CAI payments by filing annual federal taxes.
Mertins-Kirkwood said most households, except those earning a high income, are “better off” from the carbon pricing due to the government rebate which recycles revenue back to families.
However, the Parliamentary Budget Officer (PBO), an independent watchdog, said in a report last year that a bulk of Canadian households over the long term will see a “net loss” from the federal carbon pricing by 2030-31.
The PBO said that Albertans in the top income quintile would pay the largest net cost from the carbon tax, while the lowest-income quintile households in Saskatchewan stand to see the largest net gain via the rebate.
— With files from Global News’ Craig Lord
More on Canada
© 2023 Global News, a division of Corus Entertainment Inc.
Authorities have launched an investigation following the discovery of eight bodies in a marshy area of the St Lawrence River in Quebec near Canada’s border with the United States.
The Akwesasne Mohawk Police Service said six bodies were found about 5pm (21:00 GMT) on Thursday in the marsh in Tsi Snaihne, Akwesasne. Two more were discovered on Friday.
At a news conference on Friday, deputy police chief Lee-Ann O’Brien said the dead belonged to two families — one of Romanian descent with Canadian passports, the other Indian. One child under the age of three was among the fatalities, she said.
“All are believed to have been attempting illegal entry into the US from Canada,” O’Brien said at the press conference.
Later that day, the chief of the Akwesasne Mohawk Police Service, Shawn Dulude, said that one of the two additional bodies recovered was that of an infant from the Romanian family.
The deaths came one week after the United States and Canada announced the expansion of a border agreement granting them the authority to expel asylum seekers who cross the nations’ shared border at unofficial points of entry.
O’Brien said the bodies were found near a capsized boat belonging to a missing man from the Akwesasne Mohawk community, which stretches along both sides of the St Lawrence River, with land in Ontario and Quebec on the Canadian side, and in New York state.
Authorities were awaiting the results of post-mortem and toxicology tests to determine the cause of death.
Marco Mendicino, Canada’s minister of public safety, said the Canadian Coast Guard and the Quebec provincial police force were assisting Akwesasne police in their investigation.
“The news coming out of Akwesasne is heartbreaking,” the minister wrote on Twitter. “I’ve reached out to Grand Chief Abram Benedict to express our condolences. As we await more details, my thoughts are with the loved ones of those lost.”
Canadian Prime Minister Justin Trudeau also expressed his condolences to the families. “This is a heartbreaking situation, particularly given the young child that was among them,” he told reporters.
“We need to understand properly what happened, how this happened and do whatever we can to ensure that we’re minimising the chances of it happening again.”
Last month, the Akwesasne Mohawk Police Service and the Saint Regis Mohawk Tribal Police reported a recent increase in undocumented entries through their lands and waterways. The statement said some people required hospitalisation.
In January, the police force noted that people involved in human smuggling had attempted to use shorelines along the Saint Lawrence River in the area.
‘Put human lives at risk’
Trudeau unveiled the expanded border deal, known as the Safe Third Country Agreement (STCA), last week during US President Joe Biden’s first official visit to Canada since taking office.
Since 2004, the STCA has forced asylum seekers to make claims for protection in the first country they arrive in — either the US or Canada, but not both.
That has meant that people already in the US could not make an asylum claim at an official port of entry into Canada, or vice versa, and allowed border authorities to uniformly turn people back at official land crossings.
The expanded agreement unveiled on March 24 closed a loophole in the STCA that previously allowed asylum seekers who crossed into Canada at unofficial points along the border to have their protection claims assessed once they were on Canadian soil.
The White House said last week that the restrictions would now also be applied “to migrants who cross between the ports of entry”.
Advocates slammed the move, saying applying the STCA to the entire 6,416km (3,987-mile) land border between the US and Canada would not prevent people from seeking to cross, but would only force them to take more dangerous routes.
The news coming out of Akwesasne is heartbreaking.
I’ve reached out to Grand Chief Abram Benedict to express our condolences.
As we await more details, my thoughts are with the loved ones of those lost.
— Marco Mendicino (@marcomendicino) March 31, 2023
Migrant justice advocates laid the blame for the most recent deaths on policymakers.
“The Safe Third Country Agreement (STCA) and other immigration laws are meant to deter migration from the global south by making border crossing deadly,” Nazila Bettache, a member of the Caring for Social Justice Collective, said in a statement on Friday.
“Let’s be clear, these deaths were predictable and predicted — and in that sense they are intentional.”
Samira Jasmin, spokesperson for the Solidarity Across Borders advocacy group, added that “these immigration policies put human lives at risk! We cross borders for a better world and instead face death”.
Local authorities disputed the idea that the closure played a role in the most recent deaths.
“Right now what I can tell you is this has nothing to do with that closure,” O’Brien said. “These people were believed to be gaining entry into the US. It’s completely opposite.”
The STCA applies in both directions, however, and US Border Patrol processed 3,577 people who crossed into the US irregularly from Canada last year, CBS News recently reported, citing government data.
Earlier this year, a family of four from India — including two children — were found frozen to death in the central Canadian province of Manitoba near the border with the US.
Authorities said they had attempted to cross over the border by foot on January 19 during severe winter weather and died from exposure.
A Haitian asylum seeker who came to Quebec via a popular, informal border crossing known as Roxham Road was also found dead at the frontier in late 2022 after attempting to go back to the US to rejoin his family.
Terrible – and just days after the US/Canada deal.
Again and again, we see punitive + deterrence-based asylum policies have horrifying and tragic consequences.
Consequences borne by migrants fleeing persecution. Consequences that are getting harder to describe as unintentional. https://t.co/mouezQ6cRF
— Danilo Zak (@DaniloZak) March 31, 2023
Eight people are dead after they tried on Thursday to cross the St. Lawrence River into the United States near Akwesasne — a community which straddles Quebec, Ontario and New York state — according to officials. One other person is still missing.
Police recovered two more bodies from the river Friday, after discovering six bodies and an overturned boat during a missing person search Thursday afternoon.
The bodies are those of six adults and two children: one under the age of three who had a Canadian passport, the other an infant who was also a Canadian citizen, according to Shawn Dulude, the police chief for the nearby Kanien’kehá:ka community of Akwesasne. Dulude spoke to reporters at a Friday news conference.
They were found in a marsh on the riverbank.
They are believed to have been an Indian family and a Romanian family who were attempting to cross into the U.S., according to police.
Casey Oakes, 30, an Akwesasne resident, remains missing, police said. Oakes was last seen on Wednesday around 9:30 p.m. ET boarding a small, light blue vessel, leaving Cornwall Island. He was dressed in black, wearing a black face mask and a black tuque.
Shawn Dulude, the chief of the Akwesasne Mohawk Police Service, says eight bodies have now been found after an overturned boat was spotted in the water on Thursday afternoon.
He was later reported missing, leading to the search efforts that found the bodies. Oakes is a person of interest in the case, said Dulude.
Police located Oakes’s vessel near the bodies, Lee-Ann O’Brien, the deputy chief of police for the Akwesasne Mohawk police service, said on Friday morning. Akwesasne is about 120 kilometres west of Montreal.
The IDs of the victims have not yet been released, pending notification of their next of kin.
A storm brought high winds and sleet into the area on Wednesday night. “It was not a good time to be out on the water,” O’Brien said.
“It could have been anything that caused this tragedy,” he said. “It could have been a faulty boat, it could have been human error and that the investigation will determine.”
Kevin Sturge Lazore, captain of the Akwasasne Fire Department’s Station 3, sent 15 volunteer firefighters to search the river on Thursday after Oakes’s family reported him missing. Another dozen or so volunteers from other stations in the community joined the effort.
The firefighters recovered the boat, its hull dented on the bottom as if it had hit ice or a rock, Lazore said.
Akwesasne Mohawk police Chief Shawn Dulude says they have intercepted 80 attempted illegal crossings into the U.S. through their territory since January.
He and O’Brien said the boat was small, and wouldn’t have been able to safely carry seven or eight people.
“What that boat could handle and the amount of people in it, it doesn’t make a pretty picture,” Lazore said, standing by the fire department dock on the water.
Friday morning, the water was calm and mirror-like. “It can change in the blink of an eye,” Lazore said, noting waves were more than a metre high Wednesday night.
“The river is always the major concern…. Our elders tell us, always be careful, especially in the spring, with the runoff, the current is stronger and the water is freezing.”
Other attempted crossings
The volunteer firefighters were only searching for one person when they discovered the first six bodies.
“It’s hitting them now,” Lazore said, adding they had begun a debrief Thursday evening to process what they had seen, but were interrupted by a call for a structure fire.
Thursday wasn’t the first time Lazore’s team has been called on to search for missing people who have tried to cross the border.
He said they rescue people attempting to enter the U.S. or Canada over the river and its tributaries about three or four times a year.
“It gets hard. It wears the guys down.”
Almost exactly a year ago, they rescued a group of six Indian nationals who had just made it into the United States on the river when the boat they were in hit a shallow bank and got stuck.
They were able to stand up in the boat and were rescued by the volunteers and Akwasasne Police Department — which received $6.5 million from the Quebec government last year to help it deal with the increased flow of human smuggling in the area.
“They were lucky. It could have been a lot worse,” Lazore said.
Police continued the search for two people missing on Friday after the bodies of six people were recovered from the St. Lawrence River near Akwesasne, on the Ontario, Quebec and New York borders.
The fire station is next to a recreation centre where community members gathered Friday afternoon. They sit across a road from the Tsi’Snaihne River.
A police helicopter circled above.
Next to the fire station, a group of men lit a sacred fire early that morning and kept it going throughout the day. Lazore said the fire was to honour the families and Oakes.
Smuggling on the rise
O’Brien, the deputy police chief, said the community has seen an uptick in human smuggling into the U.S. There have been 48 incidents so far this year, she said.
But the recent deaths had nothing to do with the closure of the Roxham Road illegal border crossing, she added.
“That closure was people seeking refuge, leaving the U.S. to Canada. These people were believed to be gaining entry into the U.S. It’s completely the opposite.”
Most of those who try to enter the U.S. through the area are Indian and Romanian families, she said, but she said she “had no idea” why that was the case.
Ryan Brissette, a public affairs officer with U.S. Customs and Border Patrol, says the agency had seen a “massive uptick in encounters and apprehensions” at the border.
The agency saw more than eight times as many people try to cross from Canada into the U.S. in 2022 compared to previous years, he said. Many of them — more than 64,000 — came through Quebec or Ontario into New York.
“Comparing this area in the past, this is a significant number,” Brissette said.
“There’s a lot of different reasons as to why this is happening, why folks are coming all of a sudden through the northern border. I think a lot of them think it’s easier, an easy opportunity and they just don’t know the danger that it poses, especially in the winter months.”
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