Right in the Centre - Crisis should drive changes


By Ken Waddell

Neepawa Banner & Press

Every day, we hear that Intensive Care Units (ICUs) in Manitoba are nearly full, largely due to COVID-19 cases. In response to a question from the Banner & Press about ICUs, a Manitoba Shared Health spokesperson said, “As of May 31, there have been 820 COVID patients admitted to ICU since the start of the pandemic. This includes 246 so far for the month of May, 2021, which is about five times the 50 COVID patients admitted to ICU in April. To date, 71 patients remain in ICU, 543 patients have been discharged or transferred out of ICU and 206 have sadly died while in ICU.” We all know an ICU is a very serious place to be and with C-19 in Manitoba, the death rate in the ICUs is 25 per cent, one in four.

Not many hospitals have ICUs. Some smaller hospitals don’t even have an Emergency Room, some don’t have an ER 24/7. Some have Special Care Units (SCUs) and a few larger hospitals have ICUs. Manitoba’s ICUs are overloaded.

We have been told varying numbers for ICUs, but it would appear that when we went into the C-19 pandemic over a year ago, we had about 75 ICUs. Now that many are taken up with C-19, plus the other ICU patients who may be recovering from accidents or heart attacks, etc.

To get an idea of how Manitoba stacks up with ICUs, it is interesting to note that 75 ICUs is about 0.5 ICU per 10,000 people. Is my math right? 1,400,000 people divided by 10,000 is 140 so 75 comes to less than half an ICU per 10,000 people. North Dakota has 3.8 ICUs per 10,000 people. If Manitoba had the same ratio, we would have 140 x 3.8 = 532 ICUs. The United States averages 2.7 ICUs per 10,000 people. That’s a big difference.

The number of ICUs in North Dakota might be because they are privately funded. The US system cuts down on wait times. As an example, I phoned a clinic in Minnesota once to see how long a person had to wait for a CT scan. The manager apologized as he said it was about three days as they were backed up a bit. They did 15 a day, eight pre-booked appointments and kept seven spots for emergencies. Maybe they do the same in Manitoba, but the wait times seem a lot longer.

Manitoba has known for 14 months that ICU capacity likely would be a problem. So did every other province in Canada. Could something better have been done? Obviously, yes. We have been told it takes a few months to train existing staff to become ICU equipped. One doctor stated it takes eight months. If that’s the case, we have had time to train two batches of ICU workers, nurses mainly, since C-19 began. Why didn’t that happen?

I suspect a combination of cost and wishful thinking. If we have always got by with 75 ICUs, then why would we pay the cost to train so many more people and equip so many more wards to have an excess of ICUs? I suspect that may be part of the reasoning, but I suspect wishful thinking and complacency play a role in the process.

What I do question is why wards can’t be dual purpose. Can they not have the required equipment on stand by? Can staff not be dual equipped? To use what may be a dumb example, I have seen paramedics at the hospitals, between calls, helping out in many ways on the ward, so to speak. They are well trained and could simply sit around between calls, but they don’t. They help out, as needed, with duties that may be well below their highest skill level, but they perform a very useful function, all the while being able to swing into emergency mode when the alarm sounds.

Like a lot of organizations, I suspect health care has become somewhat rooted in rules, bureaucracy and tradition. I know from actual experience with four hospital stays since Nov. 27, 2020 that practises vary from hospital to hospital.

The floor in my ward in St. Boniface was never washed nor the garbage emptied in the five days I was there. That seemed strange. In Brandon, the room was cleaned thoroughly every day. Why the difference? With one aide in Brandon, every patient was given a wash-up in the morning. With another aide, they dropped off a basin with face cloths and towels and the patient fended for themselves. That also seemed strange.

I saw a floor where the staff drank coffee, did jig saw puzzles and made a lot of noise for several hours at night and other wards where they were steadily and quietly busy all night. That seemed strange.

I think the whole point is that health care in Manitoba is very, very good, but it also could be better. We should never be complacent about health care or any other function in our society. If tradition, bureaucracy, unions, rules or regulations are getting in the way of progress, shove them aside.

If C-19 has showed us anything, it’s that we must be willing to change our system. Changes are hard and can be expensive, but not changing and adopting is a whole lot more expensive in dollars and lives.