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A mother’s road to medical school

At the age of 31 and a mother of four, Dawn Armstrong hasn't taken the typical route to the Queen’s School of Medicine.

[Dawn Armstrong]
Dawn Armstrong isn't afraid of a challenge and now is a first-year medical student at the Queen’s School of Medicine. (Supplied Photo)

This article was first published on the Faculty of Health Sciences Dean’s Blog.

When she was working as a welder in northern Alberta after graduating from high school, Dawn Armstrong had no idea that she would one day go to medical school. She wouldn’t even really start to think about pursuing a career in medicine until several years later, when she was in her late 20s with three children working towards a bachelor’s degree at Acadia, double majoring in neuroscience and biology and completing an honours thesis. Now, at the age of 31, Dawn is a mother of four, a strong Aboriginal woman, and a first-year medical student at the Queen’s School of Medicine. 

Dawn’s path is clearly not the one that we typically associate with medical students. But she doesn’t want us to think of her as an exception; she wants us to look at her story and realize that anyone from any background at any stage of life can pursue a medical education.  

While Dawn was growing up in a rural Nova Scotia, her family did not make her feel as if education was something especially important. Her father was a golf pro and her mother was an artist; neither had gone to university and neither ever made Dawn think that she should make a point to earn a degree. 

After high school, then, she did not bother applying to any universities, and instead moved to Edmonton. She did not know anyone there, but she thought of Alberta as a place that had a lot of opportunities. 

At first, Dawn worked as a bartender at a golf course, but her career took a sharp turn after getting to know a regular customer. This man worked as a welder and, while talking about his job one day, he bet Dawn that she couldn’t hack it in welding. Always up for a challenge, she took his bet and accepted a job at Strike Energy. 

Dawn did not take up welding just to win a bet. She considers herself a very hands-on person who likes work that blends problem-solving with manual labour. In many ways, then, welding seemed like it might make for a perfect profession for her. 

She started this job when she was 18 and enjoyed working with her hands and traveling around Alberta and British Columbia on various assignments. The man who had bet her was impressed by her and became a mentor. 

[Dawn Armstrong]
A mother of four children, Dawn Armstrong already had a busy schedule before arriving at Queen's University's School of Medicine. (Supplied photo)

But he was also the person who eventually encouraged Dawn to leave welding. He had been warning Dawn for some time that the work is very hard on the body over the long run. When she became a single mother at 21, Dawn ultimately left welding and switched her career track by earning a certificate from a community college. From there, she worked as an educational assistant, helping learners with special needs. 

Outside of work, Dawn’s life also continued to change, as she got married and started to move around the country with her husband, who is in the Air Force. Eventually, Dawn needed to go back to Nova Scotia to care for her mother after she suffered a severe stroke. 

When Dawn thinks back to this period in her life, she sees the seeds of her interest in medicine being planted. Caring for her mother made her realize how fulfilling the work can be, but she also had two other meaningful experiences that made her consider pursuing medicine. 

First, Dawn had agreed to become a surrogate mother for a couple wanting to have a child. One of the men was a family physician, and she found it reassuring to be able to talk to him throughout the experience. 

This experience taught Dawn just how meaningful doctors can be in people’s lives. She learned that healthcare providers do so much more than make diagnoses and prescriptions: they give peace of mind to those in their care. Dawn wanted to be a source of support for others in the way that this physician was for her.

Secondly, she had started an undergraduate degree program at Acadia University and found herself particularly invested in her biology coursework. For the first time, this made her think that she had a strong interest in science. While pursuing her three-year degree, she had two children, one being the surrogate baby. By the time she graduated she and her husband had three children.  

All of these different experiences – caring for her mother, raising children, surrogacy, and her coursework – made her decide to apply for medical school. 

By the time she reached the interview stage of the admissions process, Dawn was close to the due date for her fourth child (not counting the surrogate pregnancy). When Queen’s offered her the opportunity to interview, she had to ask if they could accommodate her schedule, since the original date they proposed was very close to her due date. 

Asking for this kind of accommodation, though, was scary. What if it hurt her chances at being accepted? What if they just said no and she couldn’t even interview at all? Even if they agreed to help her, would they be annoyed? Dawn had no idea how the school would treat her as an expecting mother. 

To her pleasant surprise Queen’s was more than accommodating. She was able to schedule her interview to after she gave birth, and was assured that every possible arrangement would be made to guarantee her comfort.  Two weeks after giving birth Dawn traveled to Kingston to interview at Queen’s. When she was offered a seat in the class of 2022 a few weeks later, she had no trouble choosing to accept. 

Dawn is well on her way to meeting many of her goals. She has now completed her first semester of medical school, and is completing a few research projects. She aims to be a dermatologist and knows Queen’s will prepare her well for this specialty. 

Dawn’s ability to be a mother and a medical student at the same time is impressive. When asked  how she finds the energy for school, she says that she has the energy because she loves it. In some ways, she sees her classes as a nice reprieve from parenting. “School is my break,” she says with a smile. 

What I love about Dawn’s story is the way that it overturns so many stereotypes about who can and cannot go to medical school. We usually don’t think of people who didn’t go straight to university after high school as going on to medical school. Or people who were young mothers, or people in their 30s, or people who have four children.  But all of these things apply to Dawn, and she is thriving at the Queen’s School of Medicine. 

 As Dawn’s story shows, all are welcome at the Queen’s School of Medicine. 

Dean Reznick thanks Andrew Willson for his assistance in preparing this blog.

Getting the mental health conversation started

  • Panel and Heather Stuart speak during Let's Talk Mental Health
    A panel of students and Cross-Cultural Counsellor Arunima Khanna shared their experiences with mental health on campus during a special event on Tuesday, Jan. 22 in Mitchell Hall. (University Communications)
  • Bell Chair in Mental Health and Anti-Stigma Research Heather Stuart
    Bell Chair in Mental Health and Anti-Stigma Research Heather Stuart speaks during Tuesday's Let's Talk Mental Health at the Rose Innovation Hub in Mitchell Hall. (University Communications)
  • Bell Chair in Mental Health and Anti-Stigma Research Heather Stuart, Let's Talk Mental Health
    Bell Chair in Mental Health and Anti-Stigma Research Heather Stuart hands the microphone so that an audience member can ask a question of the panel members. (University Communications)

It was an opportunity to talk about mental health at Queen’s University on Tuesday.

Facilitated by Bell Chair in Mental Health and Anti-Stigma Research Heather Stuart, a special event called ‘Let’s Talk Mental Health’ was held in the Rose Innovation Hub at Mitchell Hall, with the goal of sharing “real stories, real conversation, and real experiences.”

Emceed by Rector Alex Da Silva, the event brought together a panel featuring Arunima Khanna, Cross-Cultural Counsellor with Student Wellness Services, as well as students Constantina Venetis, Jake Bradshaw, and Tom Ellison, who all discussed their own experiences with mental health and answered questions from the audience.

The talk is one of a number of events being held leading up to Bell Let’s Talk Day on Wednesday, Jan. 30.

Other events include #BellLetsTalk games on Saturday, Jan. 26 for the men’s and women’s basketball and volleyball teams as well as the men’s hockey team.

On Bell Let’s Talk Day booths will be set up from 11 am to 2 pm in Mitchell Hall and the Queen’s Centre to share information about mental health resources on campus

Elsewhere on campus, Queen’s Residence Life will host a Bell Let’s Talk booth event at Leonard Dining Hall from 11:30 am to 2 pm. Later in the day Residence Life will host a film viewing and open discussion on mental health at Victoria Hall A011 from 6:30 pm to 9 pm, which is open to students living in residence.

Virtual exhibit examines the digital future

Showcasing innovative Queen's technology projects that could change the way we live.

Close-up of hands using computer (courtesy of Glenn Cartens Peters, Unsplash)

Last fall, experts and audience members gathered at Queen’s University to discuss the future of research, knowledge sharing, and the student learning experience in the digital age at the first-ever Principal’s Symposium.

Hosted by Principal and Vice-Chancellor Daniel Woolf, and emceed by CBC Radio’s Nora Young, the symposium examined advances in artificial intelligence, data analytics, and data governance, as well as how ongoing digital transformation is influencing post-secondary students, Indigenous communities, and people in developed and developing countries.

“The speakers and panelists at our symposium shared a broad and detailed picture of how digital innovation is reshaping learning and discovery both here in Canada and abroad,” says Principal Woolf. “With their insights in mind, as well as those being revealed by researchers and students at Queen’s, we can build upon our institution’s digital framework and take advantage of the opportunities future technologies will surely present.”

The symposium also marked the launch of a supporting virtual exhibit – Imagining Our Digital Future – to highlight digital planning initiatives currently underway at Queen’s and in the Kingston community.

“For decades, Queen’s faculty and students have been leveraging technologies to advance learning and research,” says Principal Woolf. “Technological innovation will continue to change how we live, so our ongoing exploration of this new frontier is not only important, but essential to the future of knowledge, truth, and healthy societal progress. Sharing our ideas and efforts across disciplines will help us stay concerted in our efforts to create an open, inclusive, collaborative, and innovative digital future.”

The virtual exhibit features over 40 digital technology projects happening at Queen’s and in Kingston that have the potential to impact our daily lives, and create previously unimaginable learning and research opportunities across the disciplines – with plans to showcase new projects on an ongoing basis.

Currently, featured projects include everything from “smart” surgical instruments that will help doctors more efficiently remove cancerous tumours and state-of-the-art camera technology used for analyzing human movement, to online database technology used to help preserve Indigenous heritage and art or reunite communities with their history. There are also projects focused on augmented reality and VR simulators, ambient and artificial intelligence, astroparticle physics research, archaeology, surveillance, and more.

Faculty, staff, students, and Kingston community members engaged in interesting digital initiatives are welcomed to submit their project for possible inclusion in the virtual exhibit. Contact the virtual exhibit curators using the online form.

How building a culture of feedback is developing better doctors

Competency-based medical education (CBME) is creating a culture in which everyone is comfortable asking for, giving, and receiving feedback.

[Julia Tai , Department of Internal Medicine]
Julia Tai is a second-year resident in the Department of Internal Medicine at Queen's University.

For Julia Tai, a second-year resident in the Department of Internal Medicine, competency-based medical education (CBME) is closely associated in her mind with a regular event in her department: Feedback Friday.

During Feedback Friday sessions, one resident must leave a team-wide meeting so that all the other members of the team – the attending staff, medical students, and other residents – can discuss the absent learner’s performance. After the meeting, the resident who left the room receives a detailed assessment based on the discussion.

The first time Dr. Tai was the subject of Feedback Friday, she was terrified. After she walked out of the room, all she could do was wait and try not to think about what they might be saying. As scared as she was, though, Dr. Tai also says she was excited because she knew the assessments that were going to come out of the meeting were going to make her a better doctor.

Feedback Friday is one tool among many that Internal Medicine is using to implement CBME, and the idea behind it is to give all the members of the program a chance to develop honest, constructive criticism for each resident. Dr. Tai sees Feedback Friday as evidence of the culture that CBME is creating at Queen’s – a culture in which everyone is comfortable asking for, giving, and receiving feedback.

When Dr. Tai was choosing which schools to rank for the Canadian Resident Matching Service (CaRMS) process, she was attracted to Queen’s for many reasons, but one unique feature stood out: the fact that it would be launching CMBE across all specialty training programs when she would start.

What makes CBME exciting for Dr. Tai is the fact that she is encouraged to take a leadership role in her own education. Under CBME, Dr. Tai and her fellow residents are always expected to ask their preceptors for feedback and check in as to whether they are progressing satisfactorily through the stages of the program. If they think they’ve worked on a case that builds one of the skills they are trying to develop, it is completely normal for them to ask a faculty member to provide an assessment on their progress.

The residents in the Department of Internal Medicine, though, do not always need to initiate the conversations about their progress. Every four months, Dr. Tai meets one-on-one with her academic advisor. In these meetings, the two of them review her work and evaluate how well she is moving toward her goals.

Based on these regular meetings, Dr. Tai’s advisor develops a report on whether or not she is ready to move on to the next stage of the program. This report is then submitted to the Competency Committee, who makes the final decision on a resident’s progress. There are four stages in the program: Transition to Discipline, Foundations of Discipline, Core Discipline, and Transition to Practice. Each one of these stages provides residents with different skills to focus on and different goals to reach. All residents progress through these stages at their own pace, so what they are learning is dependant more on their level of competency rather than on how much time they have spent in the program. The stage of the program a learner is in is also kept confidential, which enables residents to focus on their own progress rather than on comparing themselves to others.

Halfway through her three-year program, Dr. Tai is proud of how much she has learned and how far she has come as a physician. And she believes that her growth has been greatly assisted by CBME, which has enabled her to have a sense of ownership over her education. 

Hormone could slow Alzheimer’s progression

Queen’s University researcher discovers potential new treatment for Alzheimer’s disease.

Queen’s University researcher Fernanda De Felice (Psychiatry), along with co-authors from the Federal University of Rio de Janeiro, have identified an exercise-linked hormone that could slow the progression of Alzheimer’s disease. This research was recently published in the high-profile publication, Nature Medicine.

Fernanda De Felice has identified a hormone that could slow the progression of Alzheimer's disease. (Supplied photo)

The findings show that irisin, a hormone that is boosted by exercise, plays an important role in the brain and that Alzheimer patients carry less of the hormone. This discovery moves scientists one step closer to developing a medication that reproduces the effects of exercise-induced irisin production in the brain.

“In the past few years, researchers from many places around the world have shown that exercise is an effective tool to prevent different forms of dementia such as Alzheimer’s” says Dr. De Felice, a researcher in the Centre for Neuroscience Studies at Queen’s. “This has led to an intense search for specific molecules that are responsible for the protective actions of exercise in the brain. Because irisin seems to be powerful in rescuing disrupted synapses that allow communication between brain cells and memory formation, it may become a medication to fight memory loss in Alzheimer’s disease.”

The new research is important, explains Dr. De Felice, because curing dementia is one of the greatest current and future health care challenges. Unfortunately, despite 30 years searching for treatment drugs, there is no effective medication for Alzheimer’s disease. She adds it is also important to remember that the vast majority of patients with dementia can be disabled due to other age-related illness (e.g. arthritis, heart disease, obesity, visual problems, and depression). Furthermore, it can be challenging to engage a patient in regular physical activity.

A drug that increases irisin in the brain could be the key.

“It is important to keep in mind that Alzheimer’s is a very complex disease and it is truly hard to treat Alzheimer’s patients before irreversible damage occurs in their brains. This is because when a patient is diagnosed with Alzheimer’s disease, their brain has already been damaged," Dr De Felice says. "Finding new protective routes, such as the identification of an exercise-linked component, may be an optimal strategy to heal the brain before brain cells die and dementia becomes irreversible.”

The next step in Dr. De Felice’s research is investigating the most effective way of delivering irisin to the brain.

Read the full paper here.

Helping newcomers access the healthcare system

[Setareh Ghahari]
Setareh Ghahari, an assistant professor at the School of Rehabilitation Therapy, created ACHIEVE. a program that helps immigrants and refugees learn about how they can get the care that they need. (University Communications) 

As a newcomer to Canada, Setareh Ghahari experienced first-hand some of the challenges faced by newcomers in attempting to access health services.

Despite being a registered occupational therapist with extensive knowledge, experience, and access to resources, she experienced difficulty accessing health-related services. These experiences provided motivation to develop and launch an innovative new program aimed at supporting newcomers to Canada (including groups such as immigrants, refugees, and international students) as they navigate a complex and unfamiliar health system. 

After completing some research, it became clear to Dr. Ghahari that her experience and the barriers she faced in accessing health services were fairly representative. These difficulties are often compounded for immigrants or refugees with significant language barriers, or who are experiencing traumatic personal circumstances. Dr. Ghahari concluded that there was a gap in resources. In other words, there needed to be something in place that could enable newcomers to access the Canadian healthcare system. They need to be educated about what services are available and how they can best be accessed, but newcomers also need help with building networks of support to enable this access to services.

Dr. Ghahari decided that she would develop a program to do this work.

Since coming to Queen’s as an assistant professor at the School of Rehabilitation Therapy in 2014, following the completion of a postdoctoral fellowship at the University of British Columbia, Dr. Ghahari launched Accessing Canadian Health Care for Immigrants – Empowerment, Voice and Enablement (ACHIEVE). ACHIEVE is a seven-week program that brings immigrants and refugees together to learn how they can get the care that they need in their new country. The program features one two-hour session each week, covering different topics, such as screenings and preventions, finding a family doctor, mental health, and prevention.

Some of the aspects of the program that Dr. Ghahari has found most useful for participants are those that teach newcomers how to use English to communicate about illness. This addresses a serious issue, because immigrants and refugees will wait too long to seek out healthcare because they don’t feel comfortable talking about their conditions in English, even if they are otherwise capable speakers. While many of the newcomers in ACHIEVE have very strong English skills, that does not always mean that they know the specific words to convey pain or sickness. Reinforcing language skills around health is especially important, Dr. Ghahari explains, because people need them most in highly stressful situations – exactly when people often have trouble speaking precisely in their first language, let alone their second.

As a critical part of this work, Dr. Ghahari built partnerships with several community organizations in the Kingston area, including the KEYS Job Centre, Loyola School of Adult and Continuing Education, and Immigrant Services Kingston and Area (ISKA). Immigrants and refugees frequently seek out services at these different centres, so they make for a convenient place to hold the classes. No less important, they are also spaces in which newcomers feel welcome and comfortable.

When ACHIEVE first started, Dr. Ghahari taught every session herself, but now the program has grown and she has trained students in the Queen’s occupational therapy program to deliver the sessions. To help ACHIEVE expand beyond Kingston, she is training ESL teachers and healthcare practitioners, and she is developing online modules that can both deliver the program and train new facilitators.

Even when the program is online, Dr. Ghahari will encourage individuals to participate as part of a group, as this is a fundamental aspect of ACHIEVE – to build a community of support for new Canadians. This all feeds into Dr. Ghahari’s ultimate goals for ACHIEVE: to build and empower communities of newcomers, thereby enabling their access to Canadian healthcare systems while also reducing feelings of vulnerability or social isolation.

This article was first published on the Dean’s Blog. It is written by Richard Reznick, Dean of the Faculty of Health Sciences, with support from Erika Beresford-Kroeger, Online Programs Manager in the School of Rehabilitation Therapy, and Andrew Willson, Senior Communications Officer, Faculty of Health Sciences.

A national honour

Three Queen’s faculty members now invested as Officers of the Order of Canada.

  • Kerry Rowe promoted to Officer of the Order of Canada
    Kerry Rowe, a professor in the Department of Civil Engineering and former Vice-Principal (Research), is congratulated by Governor General Julie Payette upon being invested as an Officer of the Order of Canada. (Photo by Sgt. Johanie Maheu, Rideau Hall. © OSGG, 2018)
  • Elizabeth Eisenhauer promoted to Officer of the Order of Canada
    Professor Emerita Elizabeth Eisenhauer, the former director of the Canadian Cancer Trials Group, shakes hands with Governor General Julie Payette after being invested as an Officer of the Order of Canada. (Photo by Sgt. Johanie Maheu, Rideau Hall. © OSGG, 2018)
  • Paul Armstrong promoted to Officer of the Order of Canada
    Governor General Julie Payette congratulates Paul Armstrong, an adjunct professor in the School of Medicine, after he was invested as an Officer of the Order of Canada. (Photo by Sgt. Johanie Maheu, Rideau Hall. © OSGG, 2018)

The Right Honourable Julie Payette, Governor General of Canada, has recognized three Queen’s faculty members for their outstanding contributions to the country. Announced as recipients in January 2018, both Elizabeth Eisenhauer and R. Kerry Rowe were invested as Officers of the Order of Canada this month in Ottawa, while Paul Armstrong received the honour in September.

The Order of Canada is one of the country’s highest civilian honours and it recognizes those who make extraordinary contributions to the nation as exemplified in its motto Desiderantes Meliorem Patriam – “They desire a better country.” Since its creation in 1967, about 7,000 people have received the honour.

According to the Office of the Governor General, the Queen’s faculty members are recipients for the following reasons:

Elizabeth Ann Eisenhauer, O.C. (MD’76, Professor Emerita, Department of Oncology, former Director, NCIC Clinical Trials Group Investigational New Drug Program)

“Elizabeth Eisenhauer is an international leader in clinical cancer research. Professor emerita at Queen’s University and former director of the NCIC Clinical Trials Group Investigational New Drug Program, she has played an influential role in helping shape cancer treatment through key advancements in clinical trials. Notably, she led the design of criteria to evaluate the response of tumours to therapy, and evaluated numerous new drugs now used routinely in cancer treatment. Renowned for her experience and expertise, she has served on numerous international professional and institutional committees, benefiting oncology research worldwide.”

R. Kerry Rowe, O.C. (Professor, Department of Civil Engineering, former Vice-Principal (Research))

“Kerry Rowe is a passionate leader in the safeguarding of Canada’s natural resources. A professor at Queen’s University and a pioneer in geoenvironmental engineering, he is responsible for many of the designs, techniques and materials now used to manage waste disposal in the developed world. His seminal research on landfills has led to critical advancements in protecting land and water from contamination. Renowned for his dedication to the advancement of this field, he has served at the helm of numerous professional societies and institutional committees.”

Paul W. Armstrong, O.C. (Arts’63, MD’66 – Adjunct Professor, Queen’s School of Medicine)

“Paul Armstrong is a pioneering investigative and clinical cardiologist whose work in acute cardiac care has had global reach. A professor at the University of Alberta, he has conducted transformative research in the treatment of acute heart attacks and was instrumental in implementing this pre-hospital treatment in Alberta’s ambulances, which is credited with increasing patient survival rates. He is also recognized for his leadership in health care institutions, including as founding president of the Canadian Academy of Health Sciences and as director of the Canadian VIGOUR Centre, an international enterprise that conducts global-scale clinical trials in cardiovascular medicine.

For more information on other Order of Canada recipients with Queen’s connections see the Queen's Gazette and the Governor General's website.   

A seniors’ oasis

Unique model of active aging in place expands from Kingston to other parts of Ontario.

[Oasis Wii bowling]
As part of the Oasis Senior Supporting Living program Pearl Larson tries her hand at Wii-bowling, while Norm Fournier and Evelyn Farrar look on. (Supplied Photo)

With an aging population, it is critical that seniors living in the community receive the support they need. It is important that new effective and cost-efficient strategies are developed to help seniors live where they want to live and prosper in their chosen communities.

The Oasis Senior Supporting Living program, is a unique model of active aging-in-place originally developed with a group of seniors living in an apartment building in Kingston. While Oasis has been cherished for many years by members and the many people who work with them, its value and potential has recently been recognized outside the city.

Professors Catherine Donnelly and Vince DePaul from the School of Rehabilitation Therapy at Queen’s University are leading a research project to expand and evaluate the Oasis Model into seven new communities in four cities in Ontario. In this project, they have partnered with the seniors at the original Oasis program at Bowling Green II apartment in Kingston, the Oasis Board of Directors, and researchers at Western University in London, and McMaster University in Hamilton.  

 “The Oasis model is a unique model that’s seniors driven,” says Dr. Donnelly. “Isolation can be a major issue for seniors who are living alone and who may have challenges getting out and about. With Oasis, there is a support system naturally built in to where they are living. Members can connect with others in their familiar space.”

Each Oasis building features an Oasis members committee, a community board of directors and onsite program coordinator. Oasis members drive the program and direct the programming, including communal meals, social activities, and exercise and activity programs. The onsite program coordinator supports all aspects of the program delivery, working with the members. The community board offers oversight and governance support and has been instrumental in supporting Oasis.

All programming occurs in the apartment building where seniors are living ensuring that Oasis brings the services they need to them. Programming includes everything from a Wii bowling league, exercise classes, creative writing workshops, and daily coffee times. Three days a week, catered meals are served to Oasis members in a communal dining space.

“This was a very grassroots, seniors-driven, community-supported idea. The original Oasis building opened about 10 years ago in the Bowling Green II apartment owned and operated by Homestead Landholdings,” says Dr. DePaul. “Homestead has been very supportive from the beginning, including providing space for the program to operate. They continue to be very supportive as we move forward to expand the program to other buildings. We have also received support from another Kingston landlord, CJM, to open an Oasis program in one of their buildings here in the city. It’s these partnerships that are critical.”

The project has been funded through three separate grants from the Ontario Ministry of Health and Long-term Care, the Baycrest Centre for Aging and Brain Health Innovations, and the Ontario Ministry of Seniors and Accessibility. The funds from each grant are being used to support the expansion and evaluation of Oasis into different buildings. The project team includes colleagues from Western University, McMaster University and Queen’s. Work began on this project this past summer and will continue for the next 18 months. Kingston is now preparing to open its second facility.

This new funding will allow this multidisciplinary and multi-community project with new programs being put in place, and the model evaluation with an eye on refining the process and, potentially, bringing new aging in place communities on board.

For more information, visit the website.

The Conversation: How the opioid crisis is disrupting hospital care

Canadian hospitals are ill-equipped to deal with the inpatient opioid crisis. Lack of specialist addictions care puts patients and staff at risk.

New York Ambulances
Few medical schools offer training in addictions medicine and most doctors feel they lack the specialist expertise to deal with the inpatient opioid crisis. (Photo by Benjamin Voros/Unsplash)

 

“… there is always soma, delicious soma, half a gramme for a half-holiday, a gramme for a week-end, two grammes for a trip to the gorgeous East, three for a dark eternity on the moon…”

In Aldous Huxley’s 1932 novel Brave New World, citizens are trapped in a chemically induced state of docility and compliance. Their fictional drug of choice: Soma. Throughout North America and in some parts of Europe today, people are rendered into a diminished state (and killed) by an all too real version of soma: Opioids.

The misuse of these powerful narcotics is leading to an epidemic of addiction and death. As doctors and researchers, we want to highlight an often overlooked face of this epidemic — its emergence as a major disruptor within Canada’s hospitals.

Images of paramedics resuscitating people who have overdosed on the street are common within the news media. But the face of the inpatient opioid crisis is equally sinister and must be addressed simultaneously.

Some hospitalized patients are engaging in extreme behaviours — violence toward staff and other patients, theft and other antisocial actions — that disrupt the care of others and put patients and staff at risk.

We are initiating a program at the Kingston Health Sciences Centre (KHSC) called START (The Substance Treatment and Rehabilitation Team). Programs like START can perhaps better handle the inpatient crisis using a dedicated multidisciplinary team of practitioners.

Specialists from addictions, family, emergency and internal medicine, along with those from psychiatry, anaesthesia, social work, public health and nursing, work together — to competently manage care of patients with substance abuse disorders and coordinate care with outpatient services.

A growing epidemic

Let’s start with one person’s story. Crystal was a 29-year old patient who was frequently admitted to hospital due to her diabetes and its complications (kidney failure, blindness). She was prescribed opiates to relieve her pain but over time became dependent on them.

Crystal required dialysis and had multiple bouts of sepsis, a serious full-body infection. Her pain was poorly controlled and we believe she lost hope. She was found dead in her hospital bed after self-administering a lethal dose of narcotics.

Unfortunately this story is not unique or even unusual anymore. Opioids are responsible for one in six deaths of young adults aged 24 to 35 in Ontario. Almost 4,000 people died in Canada in 2017 from opioid-related causes. And in the United States, accidental overdoses now claim more lives than car crashes.

Despite public attention, this number continues to grow. The problem is prevalent across the country. Rural and mid-size communities are affected as well as big cities like Vancouver and Toronto.

Patients create a street supply

The causes are complex but doctors over-prescribing opiates and the emergence of new potent forms of “street” opiates have contributed to the crisis. Drugs laced with the potent opioid fentanyl, smuggled from China, often cause sudden death due to a complete cessation of breathing.

Over-prescription of opioids by doctors fuels addictions in people that drives them to use these dangerous street drugs. Diversion of prescription drugs and theft or misappropriation of drugs from pharmacies creates a supply of narcotics on the street. More than half a million prescription drugs, mostly opioids, are stolen from pharmacies each year.

Within hospitals, patients addicted to substances — notably but not exclusively opioids — are often involved in this drug theft and diversion. Diversion means they move their own prescription narcotics prescribed to the street, often selling them right on hospital grounds.

It’s estimated that one third of all opioids on Canada’s streets result from diversion of prescription drugs. Greed allows these diverted drugs to be laced with fentanyl (which is cheap and powerful) by criminals, and people are dying.

While many patients who come to hospital are addicted, health-care providers feel inadequately trained to deal with them. Indeed the medical profession has been slow to recognize that there is a direct relationship between our rate of opioid prescriptions and mortality, even after adjusting for predictors of adverse outcomes, such as age.

The overuse of prescription narcotics is not accidental but reflects cynical marketing by certain pharmaceutical companies, notably Purdue Pharma, that claimed potent opioids like oxycontin were “less addictive.”

Canadian doctors have been slow to recognize this sinister side of pharmaceutical hype.

Addictions specialists are needed

Treating patients’ complications from their addictions, while neglecting the root of their problems, is frustrating for clinicians and often feels futile.

At the Kingston Health Sciences Centre, we address this issue by working with community partners such as Street Health to offer education and support to staff so they can better understand patients who suffer from addictions. KHSC is also looking at ways to provide additional funding and a more coordinated approach to address addictions.

The START team recently surveyed our hospital’s doctors and health-care professionals. For one month they collected reports of inpatient encounters where a substance-use problem was suspected (124 unique patients).

In 87 per cent of the reported cases, the physician felt managing the addiction was not within their scope of practice. In 98 per cent of cases, they felt the patient would benefit from an addictions specialist consultation.

Further complicating matters is that few medical schools offer training in addictions medicine, leaving a significant unmet societal need.

START’s goals include facilitating transitions of care from inpatient to outpatient, connecting patients with community treatment programs, providing specialized and consistent inpatient care plans including pain and withdrawal management, methadone or buprenorphine/naloxone treatment when appropriate and educating hospital staff and medical students.

These are all missing pieces from our current response to the unfolding crisis.

What has happened since Crystal’s death? At least two more patients have died from accidental overdoses in our hospital.The Conversation

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This column was written by Stephen Archer, Professor, Head of Department of Medicine; Chris Smith, Associate Professor of Medicine, Division Head, General Internal Medicine, and Raistlin Majere, General Internal Medicine Physician, Queen's University

This article was originally published on The Conversation, which provides news and views from the academic and research community. Queen’s University is a founding partner. Queen's researchers, faculty, and students are regular contributors.

The Conversation is seeking new academic contributors. Researchers wishing to write articles should contact Melinda Knox, Associate Director, Research Profile and Initiatives, at knoxm@queensu.ca

Welcoming Indigenous staff voices

Queen’s has added new staff positions to provide greater support to Indigenous students and those working with Indigenous communities.

In recent years, Queen’s has been devoting additional resources to supporting and recruiting Indigenous students at Queen’s. This effort has only increased since the release of the Truth and Reconciliation Commission task force report, which featured multiple recommendations (6, 9, and 14) centred on hiring more Indigenous staff and offering greater support to students.

The Gazette sat down with some new members of the Queen’s community (or, in some cases, familiar faces in new places). Please note this is not a complete listing of Indigenous staff members of the Queen’s community, and many positions supporting Indigenous students continue to be posted on a regular basis.

Office of Indigenous Initiatives

Haley Cochrane, Coordinator

[Queen's University Office of Indigenous Initiatives Haley Cochrane]
Haley Cochrane. (University Relations)

Job number one for Kanonhsyonne (Janice Hill) when she was appointed Director, Indigenous Initiatives in 2017 was to determine which supports she needed to fulfill her mandate.

Haley Cochrane was the first person she hired, in May 2018. Prior to joining Queen’s, Ms. Cochrane worked at another Ontario university in an Indigenous recruiting capacity.

“When I saw this position, it was appealing because of all the Indigenous work happening at Queen’s and the momentum that has already been built,” she says. “It has been a pleasant surprise to see just how much is going on here, and how many allies there are. That kind of commitment makes the work more fulfilling.”

Since that time, Ms. Cochrane has been instrumental in the recruitment of a Cultural Advisor and a Knowledge Keeper to the Office of Indigenous Initiatives, and spearheading many other events and initiatives such as the recent Indigenous Knowledge Symposium.

Ms. Cochrane was raised in Whitby and she is of mixed ancestry. Her father is from England, and her mother is Algonquin from Pikawakanagan First Nation (Golden Lake), in the Ottawa Valley area. Haley is a member of the Bear clan. 

Te howis kwûnt (Allen Doxtator), Cultural Advisor

[Queen's University Office of Indigenous Initiatives Allen Doxtator]
Te howis kwûnt (Allen Doxtator). (University Relations)

Te howis kwûnt (Allen Doxtator) sees his role as focused on education, and bridging the divide between Indigenous and non-Indigenous Peoples.

“There has to be a lot more opportunities for Indigenous Peoples to teach at schools so that people are more aware of the truth of what has happened to Indigenous Peoples in Canada,” he says. “We are not trying to make people be oppressed by what we’re saying – we are trying to make people understand why we are oppressed. We need to be able to pull ourselves together – both Indigenous Peoples and settlers – and stand up for each other, and support each other.”

To that end, Mr. Doxtator is encouraging Indigenous Peoples on campus to share their stories and ensure their stories are presented in their own words. He also encourages non-Indigenous People to speak up and take action to support Indigenous Peoples, rather than dwell in the past or take pity.

“I am a strong believer in change and being able to make ourselves change, especially as Indigenous People,” he says. “We can make ourselves not feel that oppression of colonization, and it can make us grow into a better and stronger people and find our way back to our way of life.”

Mr. Doxtator originates from Oneida First Nation of the Thames near London, Ontario, and is a member of the Bear Clan. He brings more than 45 years of experience as a social worker and in related fields to his role at Queen’s.

Grey Thunderbird (Tim Yearington), Knowledge Keeper

[Queen's University Office of Indigenous Initiatives Grey Thunderbird Tim Yearington]
Grey Thunderbird (Tim Yearington). (University Relations)

“It’s about helping people learn and remember,” Grey Thunderbird (Tim Yearington) says of his new role. “It’s about helping people learn and remember the traditional ways, which are really about being better people.”

In his first four weeks, Mr. Yearington has had many opportunities to do this. He has helped host education sessions with staff, advisory sessions with PhD candidates conducting Indigenous research, and participated in recent Indigenous events on campus such as the Knowledge Symposium and Research Workshop. But the process is not always so formal.

“Sometimes we just meet people out and about and have conversations with them about what they’re going through, what they’re struggling with, or what they want to learn,” he says. “In the academic environment, which is about head space and intellectual thinking, we try to balance that out by helping people understand how to learn through their hearts, their being, and their spirit. We also help people break down their fears and barriers so they can learn about traditional Indigenous knowledge and let go of their preconceived notions.”

Mr. Yearington is Algonquin-Métis from Kitchizibi (the Ottawa Valley). He previously worked for Correctional Services Canada in Kingston.

Faculty Resources

[Queen's University Faculty of Health Sciences Cortney Clark]
Cortney Clark. (University Relations)

Cortney Clark, Indigenous Access and Recruitment Coordinator, Faculty of Health Sciences

She began in a new position focused on recruitment, student support, and academic and cultural programming at Queen’s Faculty of Health Sciences in August. This new role was created following recommendations from the faculty's Truth and Reconciliation Task Force and from multiple student requests – in fact, when Ms. Clark was hired, she was given a large stack of ideas and offers of support from students.

“There are so many exciting things going on within our faculty – both Indigenous and non-Indigenous initiatives – to address gaps within higher education,” Ms. Clark says. “For instance, later this month we are hosting the National Indigenous Health Sciences Circle to demonstrate our allyship and leadership on this important topic, aimed at driving greater representation of Indigenous Peoples among the health professions in Canada.”

She works closely with other Indigenous student support advisors on campus, ensuring a wide breadth of coverage for Queen’s and Queen’s programs during recruitment activities, and ultimately for overall student recruitment, support, and success through their time here at Queen's.

Ms. Clark is of Mohawk descent and is a member of the Wahta Mohawk Territory in Northern Ontario.

Ann Deer, Indigenous Recruitment and Support Coordinator, Faculty of Law and Smith School of Business

[Queen's University Ann Deer Goodes Hall Smith School of Business Faculty of Law Chipewyan McCrimmon Amanda Kerek]
Ann Deer (centre) speaks with master's student Chipewyan McCrimmon (left) and Smith School of Business staff member Amanda Kerek (right). (University Relations)

“It has to be a team effort in order to be successful,” Ann Deer says, as she reflects on the key lesson she has learned in the two years since she was hired at Queen’s.

Her role has evolved in that time – what started as a recruitment-focused position for three separate faculties has now become centred on recruitment and Indigenous student support for Smith School of Business and the Faculty of Law.

That teamwork approach extends not only across faculty lines – it also extends to students. A pair of Indigenous students - Chipewyan McCrimmon, a student registered in the Master of Management Innovation and Entrepreneurship program, and Lauren Winkler, second-year Juris Doctor degree student – a planning a new conference focused on economic reconciliation to help create greater community resilience and economic prosperity for Indigenous Peoples. Ms. Deer is supporting this initiative with the coordination of administrative assistance from the Faculty of Law and School of Business.

“I am really excited about the support I have received for new ideas to engage the students,” she says, referring to both the conference and an annual start-of-term gathering she organizes for Indigenous students.

Another way she has engaged both students and community is through a series of coffee chats that she launched in the Faculty of Law. This initiative has resulted in a relationship with Akwesasne Mohawk Territory where students make an annual trip to learn about its unique Indigenous court system.

She notes Queen’s is ahead of the curve in its Indigenous recruitment and outreach – when she encounters other school recruiters, many have one person for the entire institution. Mr. McCrimmon, who is Dene and originates in the Northwest Territories, noted the fact that Smith had its own Indigenous support person was a key reason he decided to enroll.

Ms. Deer is Mohawk of the Wolf Clan, and hails from Akwesasne Mohawk Territory.

Four Directions Indigenous Student Centre

Adamina Partridge, Indigenous Events & Programs Coordinator

Adamina Partridge’s first couple of months at Four Directions have been busy. 

In addition to the re-opening of Four Directions following its expansion and renovation, Ms. Partridge has been organizing a number of cultural events including an exercise event based on Indigenous powwow dancing and a traditional Anishnaabe hand drum-making workshop.

Ms. Partridge is Inuk from Kuujjuaq, Québec, though she has lived among various Indigenous communities growing up. She hopes to bring some of her culture into the programming mix at Four Directions.  

“We are hoping to have an Inuit feast coming up if we can get some northern foods in, such as caribou, and possibly some Inuit events next semester,” she says.  

Ms. Partridge also notes she has had the opportunity to share her culture with students, and learn from them. One Inuit student at Queen’s has expanded her knowledge on traditional sewing projects, for example. 

[Queen's University Four Directions Indigenous Student Centre Keira LaPierreAdamina Partridge]
Keira LaPierre (left) and Adamina Partridge (right) of Four Directions Indigenous Student Centre. (University Relations)

Keira LaPierre, Indigenous Recruitment Representative

While recruiters such as Ms. Clark and Ms. Deer focus on specific programs and faculties, Keira LaPierre helps to paint the overall picture of Queen’s Indigenous supports for prospective students.

Ms. LaPierre’s role connects her most frequently with high school students considering Queen’s. Her expertise mainly lies in the Indigenous admission policy at Queen’s, and in explaining the university’s Indigenous support resources including Four Directions.

“Indigenous students want to know about services we provide and ensure they won’t be disconnected from community during their time here, especially if they have strong ties and may be leaving home for the first time,” she says. “Having a centre like Four Directions is very beneficial to these students, and we want to ensure they access the people and spaces we have here.”

Ms. LaPierre is not on campus much throughout the fall, as she is mainly on the road giving presentations and speaking with prospective students and their families. Her work takes her as far as James Bay in Northern Ontario, though most of her time is spent in eastern and southern Ontario.

Ms. LaPierre is Algonquin, with her father hailing from the Golden Lake area near Pembroke.

Other Indigenous staff and faculty at Queen's
Wednesday, Apr. 11, 2018 - Inclusion in the classroom (Dr. Ian Fanning)
Wednesday, Dec. 20, 2017 - New support for Indigenous students near and far
Wednesday, Jun. 21, 2017 - Two 2017 Queen's National Scholars announced

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