The Viewpoint section welcomes a new feather. The author is an emergency pediatrician and assistant professor in the Faculty of Medicine and Health Sciences at McGill University. He is involved in the Soignons la justice sociale collective and wrote the award-winning book No more aboriginal children torn away. To end Canadian medical colonialism (Lux Publisher, 2021).
“The situation in pediatric emergencies is becoming more and more dangerous. I am afraid of making mistakes that will have harmful consequences on the children. The anguish entrusted to me by this experienced nurse is palpable.
The population is aware of the serious crisis that has been undermining health care for children across the country for the past few weeks. However, the roots are much deeper and are not new. In Quebec, this crisis stems from the chronic state of overcapacity in pediatric hospitals since the sudden and drastic lifting, in the spring, of pandemic protection measures. This has exacerbated the structural factors: a public system itself made sick by the management and restructuring of successive governments with disregard for community and population health (outpatient turn of the PQ, exorbitant increases in doctors’ salaries and the “Barrette reform” of the QLP, etc.).
Add to this the wear and tear of two and a half years of the pandemic suffered by healthcare personnel (do we still care about the well-being of the “guardian angels”?), which adds to the widespread pre-pandemic exhaustion through the network. Coming home for a shift, I asked an exhausted nurse how you were doing. His answer: “Not so bad for a quarterback in January. “The problem? We were in June. At a time when we need health care workers more than ever, there is a severe shortage of staff. We cannot provide dignified care if we do not have dignified working conditions.
Last May, my team had to take care of about twenty children in our observation area and in our resuscitation rooms. A fairly heavy load for a night shift, in the spring, partly because of the lack of beds on the floors. But we had unfortunately grown accustomed to this dangerous shift to an unacceptable “new normal”.
About sixty children and their families waited in the waiting room for hours. Among them is a child in critical condition who went to intensive care in extremis. What would have happened if he had waited a few more hours? If we hadn’t intervened in time? These questions—these “ifs”—still haunt me to this day.
This case would normally merit further analysis to identify the underlying causes to ensure that such scenarios do not reoccur. In the current context where the system is collapsing, the analysis of this “sentinel event” could not be made.
Fortunately, a series of fortuitous factors allowed me to evaluate this child before a more serious tragedy occurred. But incidental factors cannot ensure dignified and safe health care. If the situation persists, we will not be able to feign surprise when a preventable pediatric death makes the headlines.
Remember that an occupancy rate of 85% allows hospitals — adults and pediatrics — to operate safely. We’ve been running at 150% or 200% for months (it’s much worse for some adult hospitals). There is no buffer for severe cases and peak traffic. This drastically reduces the chances of quickly identifying a rare but critical case in the emergency room: finding that needle in a haystack becomes more difficult when the haystack takes on insurmountable dimensions.
In May, many of us were already worried that the situation would get worse if we adopted a wait-and-see approach. Taking into account the limits of an already strained health system, efforts to strengthen access to front-line services absolutely had to be coupled with those to reduce viral transmission.
However, the CAQ government has not formulated clear directives to this effect. Encouraging mask-wearing in crowded, enclosed spaces might have given us some respite. In an election context, authorities seemed more hopeful that the viral storm would die down if ignored long enough.
Magical thinking is not effective in public health: the viral storm has grown stronger. Throughout the summer, several experienced colleagues told me that they had never worked so hard in their lives.
And here we are, in the middle of autumn, with a wave of hospitalizations carried by a veritable “tsunami of viral respiratory infection” (RSV, influenza, SARS-CoV-2) that causes a “disaster” out of a “horror movie” in the pediatric emergency room. The Quebec pediatric system is hanging by a thread. It is quite catastrophic and unprecedented. The Dr Esli Osmanlliu, pediatric emergency physician, made a lucid but disconcerting parallel: “It’s our March 2020 in pediatrics. »
A wave of preventable deaths of the magnitude that has hit seniors is unlikely to occur in paediatrics. However, let us apply the precautionary principle now. After all, we are dealing with a relatively unknown pathogen that still has surprises in store for us, including in its so-called “endemic” phase. We should apply the “layering” of public health protections that have been proven to work. Vaccination and mask-wearing in crowded enclosed spaces, including schools, will help protect our children and our health care system.
However, masks are not a long-term solution: even after this pandemic, it is the optimization of ventilation in schools that will allow our young people to study and socialize there in a safe way.
The only way to get through this collectively is to ensure no one is left behind. Unfortunately, neither public health nor the provincial government have created the social conditions to favor such an approach during this latest crisis. And that’s where the shoe pinches: it’s our children who pay the price.
Tomorrow: SOS, solidarity to counter the pediatric crisis