Medicine

Transcription

Medicine

LE
SPÉCIALISTE
LE MAGAZINE DE LA FÉDÉRATION DES MÉDECINS SPÉCIALISTES DU QUÉBEC
Vol. 14 no. 4 | December 2012
Medicine
North of the 49th
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PUBLIREPORTAGE
TABLE OF CONTENTS
7
Le Spécialiste is published 4 times per year by
the Fédération des médecins spécialistes du Québec.
EDITORIAL COMMITTEE
Dr. Bernard Bissonnette
Dr. Raynald Ferland
Maître Sylvain Bellavance
Nicole Pelletier, APR
Patricia Kéroack
A WORD FROM THE PRESIDENT
What Are We Waiting For?
EnGLISh VERSIon IntERnEt onLy
9
TO CONTACT US
11 DID YOU KNOW...
EDITORIAL CONTENT
✆ 514 350-5021  514 350-5175
[email protected]
DELEGATED PUBLISHER
Nicole Pelletier, APR, director
Public Affairs and
Communications
✉
RESPONSIBLE FOR
PUBLICATIONS
Patricia Kéroack,
Communications Consultant
www.magazinelespecialiste.com
FEDERATION AFFAIRS
15 LEGAL ISSUES
ADVERTISING
✆ 514 350-5274  514 350-5175
✉
[email protected]
DOSSIER
17
REVISION
Angèle L’Heureux
Isabelle Boucher
Fédération des médecins
spécialistes du Québec
2, Complexe Desjardins, porte 3000
C.P. 216, succ. Desjardins
Montréal (Québec) H5B 1G8
✆ 514 350-5000
MEDICINE NORTH OF THE 49TH
• Northofthe49thParallel
18
GRAPHIC DESIGNER
Dominic Armand
PUBLICATIONS MAIL
Postal Indicia 40063082
• GoNorth,Doctor!
20
ADVERTISING
France Cadieux
LEGAL DEPOSIT
4rd quarter 2012
Bibliothèque nationale du Québec
ISSN 1206-2081
• APassionfortheNorth
23
• The“Autochthonization”
ofOrganizations
27
All pharmaceutical product advertisements have been approved by the
Pharmaceutical Advertising Advisory Board (PAAB).
• TheNorthwardRush
30
CCAB audits the medical specialists and residents
database (11,505 copies audited for December 2011) The
FMSQ also distributes around 1,000 copies to
Researchers and Professors of the 4 Medical Faculties in Québec, as well as
managers and leaders of the Québec healthcare system.
• WhenPhysiciansGetInvolved-
NOtoUranium
33
The authors of signed articles are solely responsible for the opinions expressed
therein. No reproduction without previous authorization from the publisher.
36 GREAT NAMES IN QUÉBEC MEDICINE
The mission of the Fédération des médecins spécialistes du Québec is to
defend and promote the economic, professional, scientific and social interests
of the medical specialists who are members of its affiliated associations.
The Federation des médecins spécialistes du Québec represents the
following medical specialties: Adolescent Medicine; Anatomical Pathology;
Anesthesiology; Cardiac Surgery; Cardiology (adult or pediatric); Clinical
Immunology and Allergy; Colorectal Surgery; Community Medicine; Critical
Care Medicine (adult or pediatric); Dermatology; Diagnostic Radiology;
Emergency Medicine; Endocrinology and Metabolism; Forensic Pathology;
Gastroenterology; General Pathology; General Surgery; General Surgical
Oncology; Geriatric Medicine; Gynecologic Oncology; Hematological Pathology;
Hematology; Infectious Diseases; Internal Medicine; Maternal-Fetal Medicine;
Medical Biochemistry; Medical Genetics; Medical microbiology and infectious
diseases; Medical Oncology; Neonatal-Perinatal Medicine; Nephrology;
Neurology; Neuropathology; Neurosurgery; Nuclear Medicine; Obstetrics and
Gynecology; Occupational Medicine; Ophtalmology; Orthopedic Surgery;
Otolaryngology-Head and Neck Surgery; Pediatric Hematology/Oncology;
Pediatric Emergency Medicine; Pediatric General Surgery; Pediatrics; Physical
Medicine and Rehabilitation; Plastic Surgery; Psychiatry; Radiation Oncology;
Respirology (adult or pediatric); Rheumatology; Thoracic Surgery, Urology and
Vascular Surgery.
Dr Jean Robert, Microbiologist, Infectious Disease
Specialist and Community Physician
39 PROFESSIONALS’ FINANCIAL
40 SOGEMEC ASSURANCES
42 LE MOT DU PRÉSIDENT
Qu’est-ce qu’on attend ?
43 SERVICES AUX MEMBRES
Avantages commerciaux
THIS EDITION’S ADVERTISERS:
• Desjardins
• Telus
• RBC Banque Royale
• Financière des professionnels
• IMS Brogan
• Congrès canadien sur la santé respiratoire
• Club Voyages Berri
• Le Parchemin
• La Personnelle
• Sogemec Assurances
• Groupe Conseil Multi-D 2
3
4
6
8
11
13
13
38
41
44
LE
SPÉCIALISTE
LE MAGAZINE DE LA FÉDÉRATION
ES DU QUÉBEC
DES MÉDECINS SPÉCIALIST
2012
o
Vol. 14 n 4 | Décembre
Medicine
th
North of the 49
TOUT SAVOIR
SUR LES RENTES
Voir texte p. 40
LE SPÉCIALISTE IN ENGLISH?
GRAB YOUR eCOPY
ONLINE AT FMSQ.ORG
5
vol. 14
no. 4
LS
Michel Pitre MBA, Pl. Fin.
Conseiller
Consultez votre conseiller : il pourra vous renseigner sur toutes
les options qui s’offrent à vous!
*
* Membre - Fonds canadien de protection des épargnants
WORDfROmThePResIDeNT
DR. GAÉTAN BARRETTE
WhatAreWeWaitingfor?
I
t is a great pleasure for me to address you today. It is also
with great motivation and, especially great conviction, particularly in these volatile times, to say the least. However,
there is one thing that does not change: politics! By the time
you read this, the government of Quebec will have brought
out its first budget and will certainly have explained that the
situation is worse than expected, that the world economy...
and that the state must choose. Granted. This is the price you
pay to get elected, since the truth has rarely, if ever, elected
a government.
In this same category, we have to point out the incredible
about-face of the new minister of Health and Social Services.
The FMSQ has, in these very pages, presented several
analyses and taken position regarding the faults that persist in
our public healthcare system. In particular, we reaffirmed the
importance of its “public” nature. We have also said that, to
survive, the system would have to draw up clear boundaries,
to choose the services it will offer the population. With regard
to medical manpower, the FMSQ has maintained the principle
of 1 physician for 1,500 citizens on average for the front line,
a standard criterion applied everywhere in the western world.
During the last election campaign, this approach, adopted
and defended by a political party, was completely ridiculed
by the other parties who called it simplistic, unrealistic and
heaven knows what. But, surprise, surprise! Our notorious
approach is now being taken up, without being named, by
the current minister! For proof, on November 5th, during the
broadcast of Que l’Estrie se lève (107.7 FM Sherbrooke), the
minister was asked the following question: “When you talk of
family medicine groups, how many patients can a physician in
an FMG accept?” To which, minister Hébert replied, “Between
1,000 and 1,500. In fact, our goal is 1,500 and that goal will
increase because adding other healthcare professionals will
save the physician time and allow him or her to take on new
patients as well.” Yes… increase!!! Over the following days, the
minister and other voices from the field of front line medicine
even tossed in the figure of 1,800. Stop, we’re bursting at
the seams!
Among our front line colleagues, we hear that, although
the RAMQ statistics indicate there are approximately 8,400
“billing” physicians (2012 projection based on 8,180 in 2010),
in reality, we should only count 7,200, since the others, while
not inactive, only have a marginal practice (expert opinions,
evaluations, industries, etc.). Okay. So, here we go again! If
7,200 physicians spend 40% of their time at the hospital, we
have to consider that 2,880 physicians are full-time equivalent at the hospital. Therefore, 4,320 are in the office. If we
suppose that the other 1,200 (i.e. 8,400 less 7,200) are worth
180 FTE (which is 15% of 1,200... is this estimate too high?) in
office, we end up with a nice round figure of 4,500. Let’s apply
the minister’s doctrine here, that is 4,500 physicians multiplied
by 1,500 patients. Astounded? 6,750,000 Quebeckers should
have a family physician following them in office (7.2 million if
we use the international ratio of 1,600 patients or 8.1 million
using the 1,800 patients ratio)… for a current population of
approximately 8 million. Wow! And yet, we keep hearing that
2 million Quebeckers do not have a family physician... In fact,
the number of general practitioners in Quebec is on the rise.
We are happy to see that the Parti Québécois government
also endorses what we have been saying… despite all opposition. As the ad says, “That’s Good for You Too!”
This is without adding personnel. Yes, we all know that what
doctor’s offices need the most is nurses, technicians and
nurses aids... and they are there. They’ve been retired for less
than five years and any number of them would be happy to
work part-time in a less demanding environment like an FMG.
Why not develop a dedicated program?
All of this is also important for medical specialists. You know
that your practice can include up to 20% of front line services,
a proportion that greatly slows down your specialized practice
and that, as a result, creates a problem of access to your
services. It’s about time we settle all of this so that we can
start working in step with our colleagues for the greater good
of all, especially that of patients.
I cannot end this without mentioning negotiations. First off,
Ontario has reversed itself on the drastic cuts it wanted
to force on its physicians last May. Not only has Ontario
moderated these cuts, it has allocated some minor increases.
The same thing happened in Alberta. It’ll soon happen
elsewhere as well. All of this in the context of significant
provincial budget deficits, in general worse than in Quebec.
This means one thing: in a society where goods and services,
no matter what their nature, are “paid” according to the
“perceived value” this same society accords them, our remuneration is easily defensible and is in fact, normal, as is the
case elsewhere. A lot is asked of us: in training, schedules,
responsibility, competence, excellence. And when we make
mistakes, the punishment is harsh.
Over the last six years, we have battled together to attain
normality in our situation. We have battled with success.
Yes, we believe in a public healthcare system, and we will
never reverse course. Expertise has a price. Period.
Yours in solidarity!
S
L
7
vol. 14
no. 4
LS
Concours Prix IMS Brogan 14e édition
Deux bourses
de 3 000 $ à gagner
DESCRIPTION DU CONCOURS
RÈGLEMENTS
Le Conseil consultatif d’information sur la santé d’IMS
Brogan a créé les Prix IMS Brogan pour souligner les travaux
de médecins et pharmaciens concernant l’utilisation clinique
efficiente des médicaments. Ces prix représentent une valeur
totale de 30 000 $ qui est répartie de la façon suivante :
L’auteur principal (premier auteur) de l’article doit être un
médecin spécialiste membre d’une association affiliée à la
Fédération des médecins spécialistes du Québec. Tout article
original paru dans une revue pharmaceutique ou médicale
spécialisée (excluant les entrevues et articles de journaux)
au cours de l’année civile (de janvier à décembre 2012)
peut être soumis à condition qu’il appartienne à l’une des
catégories précisées ci-dessus. De plus,
▪ à la Fédération des médecins omnipraticiens du Québec
(FMOQ) et à la Fédération des médecins spécialistes
du Québec (FMSQ) deux prix de 3 000 $ à chaque
fédération pour un article sur l’utilisation appropriée
des médicaments;
PUBLICITÉ
PLEINE PAGE
▪ aux pharmaciens, par l’entremise de l’Association
québécoise des pharmaciens propriétaires (AQPP), deux
prix de 3 000 $ chacun pour un article sur l’utilisation
appropriée des médicaments;
▪ à chacune des quatre facultés de médecine, un prix
de 2 000 $ à un étudiant pour la meilleure note en
pharmacologie;
▪ aux facultés de pharmacie (Université de Montréal et
Université Laval), deux prix de 2 000 $ aux étudiants
méritants pour un stage à l’extérieur du Québec.
▪ les traductions, adaptations ou reproductions d’articles
ne sont pas admissibles;
▪ les articles acceptés pour publication mais non encore
publiés ne sont pas admissibles;
▪ les articles en deux parties comptent pour un seul texte;
▪ si un article a été rédigé par plus d’un auteur, le prix
sera remis à l’auteur principal.
SÉLECTION DES ARTICLES
Les articles seront soumis par leurs auteurs qui devront les
faire parvenir, avant le 31 janvier 2013, au directeur de
l’Office de développement professionnel de la Fédération
des médecins spécialistes du Québec, 2 Complexe
Desjardins, porte 3000, Montréal (Québec) H5B 1G8. Ils
seront ensuite évalués par un comité de sélection mis sur
pied par l’Office et composé d’un représentant de chacune
des quatre facultés de médecine du Québec.
IMS Brogan
DESCRIPTION DES PRIX DÉCERNÉS
Deux bourses de 3 000 $ seront décernées à deux médecins
spécialistes (ou deux groupes de médecins) s’étant distingués
par l’excellence de leur article sur l’utilisation efficiente de
médicaments, à titre d’exemple :
▪ importance de l’observance du traitement médicamenteux;
▪ meilleur traitement dans le cas d’une maladie donnée;
▪ revue de l’utilisation de médicaments dans un contexte
clinique;
▪ utilisation efficiente de médicaments les uns par rapport
aux autres dans un contexte clinique.
Le directeur de l’Office communiquera à IMS Brogan le
nom des auteurs des deux articles retenus comme étant les
meilleurs. IMS Brogan remettra officiellement le prix lors
d’une conférence de presse.
FEDERATION AFFAIRS
WelcomeInsidethefmsQ
The new director of the Office of Professional Development (OPD) is none other than
Dr Sam J. Daniel,anotolaryngologistwith themUhC.ThefmsQisproudtobeabletocount,
amongitsmanagementteam,thisleadingexpertwithcutting-edgemedicalandorganizational
knowledge.DrDaniel’sexperienceandaccomplishmentsareimpressive.Lespécialistemet
withhim.
DR DANIEL, YOU ALREADY HAVE
AN ADMIRABLE CAREER AT THE
MUHC. WHY DID YOU DECIDE TO
ALSO GET INVOLVED AT THE FMSQ?
It’s because I’m passionate about
continuing professional development (CPD). For the past 10 years,
I’ve been a member of various CPD
committees whether it’s for the OPD
here at the FMSQ, for the Canadian
Society of Otolaryngology-Head and
Neck Surgery or for the Association of
Oto-rhino-Laryngology and Maxillofacial Surgery of Quebec, where, in
the case of the latter two, I’ve been
director of CPD. I had the honour of
being selected by the Royal College of Physicians and Surgeons
of Canada as CPD Educator and this gives me even more
reason to involve myself in this field, a field I have to admit I
find fascinating.
Thanks to the enlightened vision of the FMSQ’s management and its pragmatism, I will be able to continue practicing
medicine at the MUHC. I consider it important for the person in
charge of CPD to be immersed in the clinical reality of medical
specialists in Quebec.
SO YOU ARE SAYING THAT CPD MUST BE AT
THE HEART OF MEDICAL PRACTICE…
Keeping up to date, it’s almost learning at every moment. The
more we learn, the more we open ourselves up to all the facets
of our practice. Physicians have to develop this approach and
CPD committees within each association can come to their
assistance. This is the role I foresee for my team: to supply the
most up to date data so that everyone can quickly benefit from it.
The FMSQ gave birth to the concept of an Interdisciplinary
Education Day (IED) in 2008: the fifth edition was another
success this year. We have to continue in this vein and especially enrich this education day for years to come. Medical
practice adapts to multiple new ideas and scientific discoveries.
The IED will also adapt in order to be in tune with the needs
of medical specialists.
THE FACE OF CPD CHANGES CONTINUOUSLY
WITH INNOVATIVE PROGRAMS AND TOOLS
AS WELL AS WITH THE OBLIGATIONS
SET UP BY THE COLLÈGE DES MÉDECINS
DU QUÉBEC AND THE ROYAL COLLEGE OF
PHYSICIANS AND SURGEONS OF CANADA.
WHAT WILL BE YOUR PRINCIPAL CHALLENGE AT THE FMSQ?
It won’t be a single and principal challenge, but many challenges.
To start with, I want to make CPD interesting and attractive
for all medical specialists. We will make sure we supply the
support and tools needed by the affiliated medical associations so that they, in turn, can reach the maximum number of
members possible.
CPD needs to be part of our working environment from now on.
We have to direct it towards improving the performance and
especially the quality of care we give to patients. We need to
make sure that medical specialists understand the importance
of CPD in their daily practice. We live in a very demanding
period for healthcare professionals whom we expect, in their
practice, to be simultaneously experts, managers, collaborators, communicators, scholars, healthy living promoters,
partners and... professionals! And CPD can help physicians
seize all the opportunities that are offered by interdisciplinarity:
this is knowledge that we must constantly develop.
WHAT ABOUT ACCREDITATION FOR AFFILIATED
MEDICAL ASSOCIATIONS? DO YOU HAVE
A PLAN OR A PROJECT IN MIND?
Everything is a question of carrying on with the work accomplished to date and giving medical associations the best tools
possible to help them obtain their accreditation. The face of
CPD changes continuously with innovative programs and
tools as well as with the obligations set up by the Collège des
médecins du Québec and the Royal College of Physicians and
Surgeons of Canada. My dream is for the FMSQ to become
a global reference offering some of the most enriching CPD
available, which will also need to be interdisciplinary and touch
on the greatest number of skills possible with the ultimate goal
of providing the best quality of care to our patients.
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FEDERATION AFFAIRS
The5thIeD:AGreatsuccess!
The FMSQ’s 5th Interdisciplinary Education Day (IED) was held
on November 9th. Once again, this activity broke all records
with more than 600 participants, which makes it the continuing
professional development conference with the greatest attendance in North America!
Thank you to participants, to speakers (there were more than
70 for this IED edition), to affiliated medical associations who
presented sessions as well as to the organizers, without whom
this day would not have been possible.
The next edition of the Interdisciplinary Education Day will take
place on November 15, 2013.
TheffmsQhasAlreadymadeaLotofPeoplehappy!
Afterlessthanayear’sexistence,theFédération des médecins spécialistes du Québec foundationhas
alreadybecomeakeypartnerwithinthenetworkofresourcesofferingsupporttocaregivers.
The Foundation took advantage of the 2012 edition of Caregivers
Week (November 4-10) to visit a few of the organizations that
received financial support.
Thus, President Barrette visited the Réseau d’Amis de
Sherbrooke (an organization associated with the Regroupement
des aidantes et aidants naturels de Sherbrooke) where a
relaxation workshop was developed especially for caregivers;
the Association sportive des jeunes handicapés de l’Estrie to
which the Foundation provided support for various projects
such as a summer day camp, gym activities, adapted daycare
and workshops; and the Centre Philou where the Foundation’s
help added 200 relief periods (regular or emergency) for the
year. More visits to organizations we helped are planned for
the coming weeks.
The Foundation also launched a media campaign, in particular in
regional media, to broadcast information on the financial support
given in the 10 regions of Quebec. The aim of the campaign was
two-fold since, at the end, the cause benefited from the visibility.
We must remember there are more than one million informal
caregivers in Quebec. These individuals, who look after close
relatives who cannot look after themselves or who are ill, devote
themselves body and soul, often at the cost of their own health.
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“During each visit, as we saw how the financial support provided by the
Fédération des médecins spécialistes du Québec Foundation allowed us
to make a real difference among caregivers, our intentions to do even more
grew apace. These people who spare no effort to help others are fighters,
true heroes.”
– Dr Gaétan Barrette
DID YOU KNOW...
PRIZES AND AWARDS
PRIX DU QUÉBEC
Dr Guy Rouleau, a neurologist and the
director of the Sainte-Justine University
Hospital Research Centre, is the winner of
the 2012 Wilder-Penfield prize.
This is one of 11 prizes awarded each year
by the government of Quebec as part of
the Prix du Québec. The Wilder-Penfield prize is given to a
researcher in recognition for his or her career as a whole in the
biomedical field.
Dr Rouleau is the 6th medical specialist to receive this prize.
CANADIAN MEDICAL HALL OF FAME
One of the pioneers of pediatric
gastro-enterology, Dr Claude Roy,
has been inducted into the Canadian
Medical Hall of Fame in recognition
of the major role he played both for
the transformation of the SainteJustine University Hospital Centre in
Montreal and for his research and teaching as well as his
clinical involvement. A great humanist, Dr Roy concentrated his research on infant nutrition, chronic liver disease
in children and the gastrointestinal and hepatobiliary manifestations of cystic fibrosis.
PRIX PERSILLIER-LACHAPELLE
Dr Marie Jeanne Kergoat, a geriatrician
at the Institut universitaire de gériatrie de
Montréal was awarded the Prix PersillierLachapelle to highlight her exceptional
career within Quebec’s network of health
and social services institutions.
For the past 30 years, Dr Kergoat, a truly passionate physician,
has helped uncounted numbers of Quebeckers with her
knowledge, her research and her teaching. She took part in
setting up the training in geriatrics offered today at Université
de Montréal’s Faculty of Medicine.
Congrès
canadien sur la
santé respiratoire
2013
Each year, the Canadian Medical Hall of Fame (with 95
members today) raises a small group of people from
among the most brilliant minds in Canada to the status
of laureate. These laureates are among those who have
pushed back the frontiers of discovery and innovation
beyond what was thought possible in order to make ours
a better world.
More than 20 Quebec physicians have been inducted so
far into the Hall of Fame.
À inscrire à votre agenda!
Centre des congrès de Québec
Ville de Québec (Québec)
11 – 13 avril 2013
Pour tous les détails du programme et pour
s’inscrire, visitez le site www.poumon.ca/crc
En collaboration avec
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DID YOU KNOW...
PRIZES AND AWARDS (CONT’D)
PRIX D’EXCELLENCE EN ENSEIGNEMENT 2012
Dr Raoul Daoust, in charge of emergency
medicine at Hôpital du Sacré-Cœur de
Montréal and a professor at the Faculty of
Medicine of Université de Montréal has
received the Prix d’excellence en enseignement for postdoctoral medical studies for
the year 2011-2012. This award was given
to him at the graduation ceremony
last June.
ROYAL COLLEGE OF PHYSICIANS AND
SURGEONS OF CANADA PRIZE
The RCPSC has granted its annual awards
to crown the work done by clinical
researchers throughout Canada. Dr
Jonathan Afilalo, a cardiologist at the
Jewish General Hospital of Montreal, is the
recipient of the Royal College Medal Award
in surgery for his research entitled “Gait
Speed as an Incremental Predictor of
Mortality and Major Morbidity in Elderly
Patients Undergoing Cardiac Surgery”.
As well, the Mentor of the Year Award
(Region 4) was presented to Dr Ann E.
Clarke, an allergologist and clinical immunologist as well as a professor at McGill
University’s Faculty of Medicine. This award
highlights the significant role played by
Fellows of the Royal College in the professional development of students, residents
and colleagues.
EUROPEAN SOCIETY FOR PÆDIATRIC
ENDOCRINOLOGY PRIZE
Dr Johnny Yvan Deladoëy, an endocrinologist at the Sainte-Justine University
Hospital Centre was given the Henning
Andersen Prize for the most highly-rated
clinical abstract submitted to the ESPE’s
Annual Meeting. This prize was given to
him for the discovery of a new adrenal
insufficiency mechanism: the secretion of
a bio-inactive ACTH by the pituitary gland.
CHUS PRIZES
The board of directors of the Centre hospitalier universitaire de
Sherbrooke (CHUS) presented its prizes for excellence and its
annual awards among its professors, clinicians, researchers
and employees. Dr Marc Bellavance, a pediatric cardiologist received a Prix Mentorat, while the Prix Rayonnement was
given to Dr Jacques Pépin, an infectious disease specialist
and epidemiologist, Head of the Department of Microbiology
and Infectiology, and to Dr Michel Nguyen, a cardiologist and
Head of Cardiopulmonary Care. As for Dr Frédéric Bernier, an
endocrinologist, he received the Prix Relève.
DIAMOND JUBILEE MEDALS
To mark the Diamond Jubilee of Queen
Elizabeth II, some 60,000 Canadians will be
recognized for their merit, their accomplishments and their contributions.
To date, close to a dozen medical specialists have been so honoured and received the
medal, including:
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•
Dr Michel G. Bergeron, microbiologist and infectious
disease specialist;
•
Dr Sherif Emil, pediatric surgeon;
•
Dr Nabil Fanous, otolaryngologist;
•
Dr Sam Fanous, ophtalmologist;
•
Dr Angela Genge, neurologist;
•
Dr Gilles Julien, pediatrician;
•
Dr Neil McDonald, hematologist-oncologist;
•
Dr Paul Talbot, cardiologist.
Dr Michel G.
Bergeron
Dr Sherif Emil
Dr Nabil Fanous
Dr Sam Fanous
Dr Angela Genge
Dr Gilles Julien
Dr Neil McDonald Dr Paul Talbot
Partner organizations chosen by the Canadian government have until February 28, 2013 to finalize the nomination process
and award the medals to recipients.
DID YOU KNOW...
NATIONAL ALLIANCE FOR RESEARCH ON
SCHIZOPHRENIA AND DEPRESSION AWARDS
CANADIAN DIABETES ASSOCIATION AWARD
Dr Johanne Renaud, a psychiatrist at
the Douglas Mental Health University
Institute, received an honourable mention
for the Klerman Prize which rewards outstanding clinical research by young
NARSAD investigators.
ASSOCIATION DES DIPLÔMÉS DE
L’UNIVERSITÉ DE MONTRÉAL PRIZE
Dr Jean-Claude Tardif, a cardiologist and
the director of the Montreal Heart Institute
Research Centre, was honoured by the
Association des diplômés de l’Université
de Montréal for his professional accomp l i s h m e nts th ro u g h o u t h i s c a re e r.
CANADIAN UROLOGICAL ASSOCIATION AWARD
Dr Yves Fradet, a urologist at the Laval
University Cancer Research Centre and a
professor of surgery at the Faculty of
Medicine has received the Canadian
Urological Association Award in recognition
of his contribution to the science of urology.
The award was granted to highlight his
career as a whole.
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Dr André Carpentier, an endocrinologist
at the CHUS, professor at the Université
de Sherbrooke’s Faculty of medicine and
health sciences and researcher at the
Centre de recherche clinique Étienne-Le
Bel of the CHUS received the Young
Scientist Award 2012 from the Canadian
Diabetes Association.
This award seeks to support exceptional research efforts on
diabetes undertaken by young Canadian scientists. It is a very
prestigious award, granted to a researcher under the age of 45
for his scientific accomplishments in Canada.
CANADIAN PSYCHIATRIC ASSOCIATION AWARD
Dr Pierre Beauséjour, medical director of
the customer care program in mental
health and of the Department of Psychiatry
at the CHUS, was awarded the Special
Recognition Award by the Canadian
Psychiatric Association.
This recognition was given to him to highlight the value of his
contributions to the mental health of Canadians, in particular for
having founded the Mental Illness Awareness Week.
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vol. 14
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DID YOU KNOW...
LA FMSQ
BIEN PRÉSENTE
SUR INTERNET
fmsq.org
SOCIÉTÉ CANADIENNE FRANÇAISE DE RADIOLOGIE PRIZES
Three Quebec radiologists were honoured by the Société
canadienne française de radiologie, an organization responsible for providing continuing professional development in this
medical specialty.
Dr Denis Bergeron, a radiologist at the
CHUS and tenured professor in the
Department of Diagnostic Radiology of the
Faculty of Medicine of the Université de
Sherbrooke, was awarded the AlbertJutras Prize to highlight his overall career.
Dr Julie David, a radiologist at the CHUM,
received the Personnalité SCFR Prize for
her overall work as an expert within the
Association des radiologistes du Québec’s
steering committee with regards to the
practice of mammography.

ESP
ESPACE
SÉCURISÉ
POUR LES
MEMBRES
Dr An Tang, a radiologist at the CHUM,
was awarded the Bernadette-Nogrady
Prize, to highlight the remarkable contribution of a young radiologist working in his
environment through his research, his
teaching and the quality of the care he
provides to patients, all with less than 11
years of practice.
NATIONAL ASSEMBLY MEDAL
Dr Gilles Julien, a pediatrician, received
the Medal of Honour of the National
Assembly which is awarded on an exceptional basis to persons who have earned
the recognition of all the members of the
National Assembly.
NEW PUBLICATION
POUR EN FINIR AVEC LES MAUX DE TÊTE
(AN END TO HEADACHES)
SUIVEZ-NOUS ÉGALEMENT SUR
facebook.com/laFMSQ
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@FMSQ et @DrBarretteFMSQ
Dr André Bellavance, a neurologist,
has published a practical guide Pour
en finir avec les maux de tête with
Éditions Marcel Broquet. His aim with
this book was to provide people
suffering from headaches, and the
people close to them, with various
pieces of information to allow them to
recognize the warning signs,
symptoms and most appropriate
treatments for most types
of headaches.
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LEGAL ISSUES
BY MAÎTRE SYLVAIN BELLAVANCE
Director, Legal Affairs and
Negotiations – FMSQ
TelephoneConsultations
The issue of telephone consultations was the subject of one of the most interesting
negotiationsever.Itgenerated,andstilldoes,variousreactionsonthepartofgovernment
representativesandphysicianswhomightbenefitfromit.Let’slookbackattherecenthistory
ofthisnegotiationandanalyzethestakesinvolved.
From the start, representatives of the department of health
and social services (MSSS) who were at the negotiating table,
showed surprise and hesitation when faced with this Federation
demand. Their initial reaction was lukewarm and their fear
apparent. And yet, the Federation was not being especially
innovative on the question. Other provinces had already blazed
the trail.
We decided to take the bull by the horns and start by giving
the MSSS representatives a picture of the situation outside of
Quebec. We showed that remuneration for telephone consultations is already a fact of life in several other Canadian provinces.
This is so everywhere west of Quebec, from Ontario to BritishColumbia. While the acts covered and rates applicable may
vary, the fact remains: Quebec is once again lagging in this
respect when compared to other provinces.
Once the MSSS representatives informed, we needed
to reassure them. Indeed,
although they recognized the
impor tance of the medical
specialist’s role as a medical
consultant and the need to
provide him or her with the
tools required to allow him
or her to fulfill this role (vis-àvis general practitioners as
well as for certain specialist
colleagues and other healthcare professionals), their fears
were varied. The main stake was, and still is, the costs that
would result from remunerating telephone consultations:
faced with limited budgets, the MSSS representatives fear
that a much greater use than anticipated could generate significant expenses. We were faced with the government’s usual
accounting logic. Although resorting to telephone consultations could have positive repercussions within the network,
the cost of this measure for medical specialists still needed to
be circumscribed!
WE SHOWED THAT
REMUNERATION
FOR TELEPHONE
CONSULTATIONS IS
ALREADY A FACT OF
LIFE IN SEVERAL OTHER
CANADIAN PROVINCES.
In order to calm their fears and to carry this negotiation through
to success, the case of Ontario was used as an example. In
fact, eight new telephone consultation acts were introduced in
Ontario during 2010. Introducing these acts did involve a significant amount of work, both by the Ontario Medical Association
(OMA) and the Ontario Ministry of Health and Long-Term Care,
in order to clearly establish the framework within which these
telephone consultations would be used and to raise awareness
among Ontario physicians. Thus, precautions were taken at
two levels:
•
The text of the agreement: this clearly defined the type
of consultation involved and the various criteria to meet
in order to claim payment. It included the type of consultation, documentary requirements, consultation delays,
maximum by type of consultation and by day, as well as
applicable exclusions.
•
Physician information: to this end, an information bulletin
was jointly prepared by the OMA and the Ontario Ministry
of Health and Long-Term Care and was sent to all physicians so as to fully inform them on the ins and outs of
telephone consultations.
As you can see, there is no doubt that the authorities in Ontario
had the same fears at the start as those expressed by the
representatives of Quebec’s MSSS. In turn, we established
the criteria that would be applied to claim fees for telephone
consultations, not only to ensure their correct use, but also to
calm the fears expressed by the MSSS regarding the possibility
of excess costs.
QUEBEC’S REQUIREMENTS
While using the Ontario experience for inspiration, the
Federation wanted to make sure applicable requirements and
limits were constrained in order not to dissuade people from
using telephone consultations. Thus, certain Ontario criteria
were not retained, including those requiring a minimal length
for the telephone consultation and prohibiting a claim for
such a consultation for a patient when a visit had taken place
the same or the next day. Apart from these exceptions, we
used the Ontario model and that of other provinces to clearly
define the consultations involved and establish inclusion and
exclusion criteria.
We do not wish to reproduce all the information that was sent
out to you regarding this subject via the INFOnégo bulletins,
which remain available on the Federation’s portal. However,
the table provided on page 16 summarizes once again the
type of consultations involved, as well as inclusion and
exclusion criteria.
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LEGAL ISSUES
Type of consultation
1. Telephone
consultation for
an opinion on
a diagnosis or
regarding a patient’s
treatment
2. Telephone
consultation for
a therapeutic
adjustment to a
prescription
Requirements
Exclusions
Addressedtoamedicalspecialist
xx
Initiatedbyanotherphysicianor
xx
healthcareprofessional
Concerningadiagnosisora
xx
patient’streatment
Involvingawrittendocumentationbythe
xx
consultedphysicianandbytheinitiating
physician(seeagreement)
maximumofonetelephoneconsultationper
day,perpatient
Usingtheappropriateactcode
xx
xx
Addressedtoamedicalspecialist
xx
Initiatedbyapharmacist
xx
Aimedatobtaininginformationordetailson
xx
thepossibilityofatherapeuticadjustment
maximumofonetelephoneconsultationper
xx
day,perpatient
Usingtheappropriateactcode
xx
COSTS
Always with a view to restricting potential cost overruns,
the MSSS representatives also insisted on limiting fees for
telephone consultations. This approach was rejected by the
Federation: our negotiation rather aimed at instituting a fee
schedule equivalent to that of Ontario. For the Federation, fears
of cost overruns could not justify implementing non-competitive remuneration. The department’s representatives finally
accepted the fairness of this approach and the fee schedule
adopted for telephone consultations, for opinions or diagnoses,
is equivalent to the one applicable in Ontario.
Whenaresidentphysicianactsasinitiatingphysician
xx
orconsultant
Discussiondoesnotconcernaspecificpatient
xx
Consultationbetweenaphysicianandapatient
xx
Consultationbetweentwophysicianspresentwithin
xx
thesameestablishmentduringtheconsultation
Consultationconcerningahospitalizedpatientwhen
xx
theconsultantphysicianisalreadyinvolvedinthe
careepisode
Consultationfor
xx
settinganappointment
xx
planninganexamination
xx
discussingtestresults
xx
planningateleconsultation
x
x
Consultationbyfax,textmessageoremail
xx
Clarifyinganincomprehensibleprescription
xx
Renewingaprescription
xx
Consultationbyfax,textmessageoremail
xx
WHAT NEXT?
The new measures for remunerating telephone consultations are now available to all medical specialists. You can be
sure that your use of these measures will be put under the
microscope during upcoming months. Insofar as costs are
concerned, opinions remain divided. Some physicians think
that the criteria imposed for billing these consultations, especially the requirement for written documentation, will limit its
use by physicians and thus generate costs that are lower than
those allocated. Others are more of the opinion that adopting
these new measures will be more extensive than projects and
that costs will explode!
When it comes to persistent fears regarding
the costs of this new measure, the Federation
Insofar as it is concerned, the
THE FEDERATION BELIEVES
and the department have instead agreed
Federation believes it has set up a
IT HAS SET UP A CRUCIAL
to adopt a letter of agreement in order to
crucial measure aimed at the orgaMEASURE AIMED AT THE
ensure monitoring to start concurrently with
nization of and access to specialized
its introduction. Letter of Agreement 195
medical care. Costs will need to be
ORGANIZATION OF AND
provides that an annual amount of seven
examined with a rigorous discipline,
ACCESS TO SPECIALIZED
million dollars ($7,000,000) be allocated to
but the benefits of this new measure
MEDICAL CARE.
financing telephone consultations. An audit
will probably be more important than
of real costs will be performed and evaluated
the costs generated.
each year based on billing data from medical
specialists. Should real annual costs associated with telephone
So, betting is open... We invite you to take advantage of these
consultations differ from the projected budget of $7,000,000,
new measures, while respecting both the text and the spirit of
it was agreed that discussions would take place, at that point,
this new agreement. If you have any questions, please refer to
regarding measures to be taken, which could in particular
the Federation’s portal (www.fmsq.org) or get in touch with us.
result in the possibility of revising the applicable fee schedule.
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DOSSIER
Medicine
North
of the
49th
Quebec’s North, a large area of approximately
1. 2 m i l l i o n k m 2 l o c a te d n o r t h o f t h e
49th parallel, has been at the centre of
political and economic news in Quebec for
the past few years.
In this vast and isolated territory, where
even the vegetation becomes rarer as we
go further and further north, where some
communities have lived for thousands of
years and where natural resources are
abundant; in a territory where culture and
customs differ greatly from those in Southern
Quebec, how is healthcare organized?
This corner of Quebec is destined for great
changes. The region has been the object
of all kinds of speculation for years and its
abundant natural resources (wildlife, fresh
water, ores, etc.) are greatly coveted.
Le Spécialiste casts an eye on what is going
on in the North, from medical services to the
numerous development projects that could
see the light of day or not, either because
of the population’s health concerns, or for
economic or political reasons.
WATCHIYA, TUNNGASUGITSI, WELCOME
to the land north of the 49th parallel!
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BY PATRICIA KÉROACK
Northofthe49thParallel
Theterm“North”referstoseveraldefinitionsdependingonwherewearelocated.Inmontreal,
when we speak of the North, we think of the Laurentians; in Quebec City, it’s the Réserve
faunique des Laurentides et du Saguenay.But,wheredoestheNorthofQuebecstartexactly?
Atthe45th,49th,55th,60thparallel?It’seasytogetlost!
The administrative region called Nord-du-Québec is located in western Quebec, north of the 49th parallel, and includes two very
different territories: the James Bay Cree Territories and Nunavik. That’s why, contrary to Quebec’s other administrative regions, it
has two healthcare management entities: the Cree Board of Health and Social Services of James Bay and the Nunavik Regional
Board of Health and Social Services. These two entities manage resources for their territory and ensure the format and governance of their territorial organization fit in with those of the rest of the province.
IN JAMES BAY
The James Bay Cree Territories, today called Eeyou Istchee, is
located between the 49th and the 55th parallel on the western side of
Quebec. The regional hospital is in Chisasibi and there are two CLSCs
spread out over eight service points: the Coastal CLSC serves the
villages of Whapmagoostui, Wemindji, Eastmain and Waskaganish,
while the Inland CLSC looks after the communities of Mistissini,
Waswanipi, Oujé-Bougoumou and Nemaska.
IN NUNAVIK
Nunavik is located between the 55th and 62nd parallel. The 14 village
service points are traditional “Nursing Stations” that played the role
of infirmary or dispensary. Today, in the context of an integrated
approach and network uniformity, these “CLSCs” are locations that
offer basic healthcare and social services using a curative AND a
preventive approach. It is the notion of support for prevention that
is new. The change was made in an attempt to renew the traditional
approach to the community: rather than going to the Nursing Station
when one is ill, one goes to the CLSC for services and, by the same
token, to avoid becoming ill.
The geographic location of the mini-hospitals was established in
the wake of negotiations between the government and the people
of the North. Locations were chosen as being most strategic taking
into account demographics, regional needs and a strategic positioning along the North’s East-West axis (that is, the Ungava and
Hudson coasts).
TERRITORY
• theNorthrepresents72%ofQuebec’s
totalterritory,twicethesizeoffrance
• 63towns,villagesandcommunities
(Inuit,Innu,CreeandNaskapi)
• 200,000km2ofcommercialforests
• oneofthelastuntouchednatural
territoriesintheworld
• oneofthemostimportantfresh
waterreservesintheworld
• importantwildliferesources,
includingsalmonrivers
• hasnickel,cobalt,zinc,platinumelements,
ironmineralandilmenite,gold,vanadium,
uranium,diamondsandrareearthelements
• strongpotentialforhydroelectric,wind,
tidalandsolarenergyproduction
POPULATION
120,000inhabitants(representing1.6%ofQuebec’s
population),including43,000aboriginalpeopleandInuit
• Inuit:10,000individuals(14villages)
• Cree:16,000individuals(9communities)
• Innus:16,000individuals(9communities)
As for the rehabilitation centres, they are intervention centres mainly
offering youth protection services. Like youth centres located in the
South, two of these rehabilitation centres offer services aimed at
youngsters who committed felonies and who need rehabilitation,
support and psychosocial assistance services. The third centre offers
services to a clientele with mental health problems.
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• Naskapis:1,000individuals(1community)
AND THE FAR NORTH?
When the government speaks of development projects
(mines, energy, etc.), it refers to a territory including the
following administrative regions: the North Shore (east of
Quebec City), the Nord-du-Québec and the portion of the
Saguenay-Lac-Saint-Jean region north of the 50th parallel.
This is what we call the Far North.
Medicine
North of the 49th
HOW HEALTHCARE IS ORGANIZED IN THE NORD-DU-QUÉBEC ADMINISTRATIVE REGION
NUNAVIK
eachofthe14villageshasapointofservice(CLsC)
Twohealthcentres(mini-hospitals)
Puvirnituq(InuulitsivikhealthCentre)andKuujjuaq
(TulattavikhealthCentre)
Threerehabilitationcentres:Puvirnituq,salluitandKuujjuaq
xx
xx
xx
xx
x
IVUJIVIK (301)•
î✈
BAIE-JAMES
Oneregionalhospital(Chisasibi)
TwoCLsCswithpointsofservicein8communities
intheeast(Whapmagoostui,Wemindji,eastmainand
Waskaganish)orintheinterior(mistissini,Waswanipi,
Oujé-BougoumouandNemaska).
xx
xx
•SALLUIT(1 069)
î✈
•KANGIQSUJUAQ(526)
î✈
•QUAQTAQ(282)
î✈
AKULIVIK (451)•
î✈
PUVIRNITUQ (1 403)•
âîÙ¢✈
Ì
Regional Board
â
Health Centre
î
Point of Service (CLSC)

Rehabilitation Centre
Ù
Halfway House
¢
Service for patients
•KANGIRSUK(432)
î✈
•AUPALUK(174)
î✈
•
•KANGIQSUALUJJUUAQ(745)
TASIUJAQ (210)
î✈
î✈
•
KUUJJUAQ (2 075)
ÌâîÙÙ¢✈
INUKJUAK (1 294)•
î✈
•WHAPMAGOOSTUI-KUUJJUARAPIK(657)
î✈
•CHISASIBI(4 484)
âî✈
WEMINDJI•
(1 267) î✈
EASTMAIN•
(561)
î✈
•NEMASKA
•
î✈
WASKAGANISH (650)
(4 484) î✈
WASWANIPI•
(1 503)
î✈
•MISTISSINI
(3 163) î
•
OUJÉ-BOUGOUMOU
(670) î✈
Sources: Internet sites of the Nunavik Regional Board of Health and Social Services, of Ressources naturelles Québec, of the Cree
Board of Health and Social Services of James Bay and from Wikipedia.
19
vol. 14
no. 4
LS
INTERVIEW AND TEXT
GoNorth,Doctor!
With a baggage of experience in international cooperation, when he saw the posting of the
positioninthefarNorthin1997,DrDérysaidtohimself:“Whynot!”heandhisspouse,with
theirtwochildren,tookofftolivethisnewadventure.Aftertwoyears,especiallybecauseofthe
schoolingneedsofhiseldestdaughter,hereturnedtoliveinthesouthwhilestillretaininghis
positionasPublichealthDirectorinNunavik.
DR SERGE DÉRY
Community Health
Public Health Director
Nunavik Regional Board of Health and
Social Services
Dr Déry is always on the front line when it’s a question of the
health of Inuit populations, an immense task, reflecting the
vast territory covered. There is so much to be done for these
communities. In addition to sharing on-call duties with other
colleagues, Dr Déry compiles, analyzes and processes health
data, looking for solutions to improve the health of populations in
remote regions, in particular by improving their living conditions.
A STATE OF HEALTH THAT IS VERY
DIFFERENT IN THE NORTH
“Living habits are very different from those in the South. There are
specific health concerns, such as oral diseases, mental health
problems, obesity, smoking, etc. In the document Pour guider
l’action : portrait de santé du Québec et de ses régions, we can
see the evident difference between the North and the South for
certain common problems (see table summarizing a few statistics
taken from this document).
“In the North, the main causes of death are cancer as well
as intentional and non intentional trauma (suicide, accidents,
drowning, etc.). The leading cause of hospitalizations are respiratory infections in children as well as in adults, because of
unsanitary living conditions (without sufficient financial resources,
we often see several families living together under the same
roof), smoking, COPD, influenza, etc. Recently, the village of
Kangiqsualujjuaq experienced a true epidemic of tuberculosis
which resulted in more than 10% of its residents becoming
infected and declared active cases (more than 90 cases in the
community). Such an outbreak had not been seen for decades.
A few cases were also recorded in other villages.
20
vol. 14
no. 4
LS
WHEN LIFESTYLE HABITS ARE MODIFIED,
EVERYTHING CHANGES. [...] THERE IS CLEARLY
AN INCREASE OF PRECURSOR CONDITIONS
SUCH AS OBESITY, METABOLIC SYNDROME, ETC.
THE DETERIORATION OF THESE SIGNS
LEADS US TO PREDICT THAT THE RATE OF
DIABETES WILL INCREASE RAPIDLY.
“We are also starting to see cases of cardiovascular disease,
even though the traditional lifestyle of these populations used to
protect them. But, when lifestyle habits are modified, everything
changes. Diabetes, at present, is comparable to the rest of
Quebec. However, there is clearly an increase of precursor conditions such as obesity, metabolic syndrome, etc. The deterioration
of these signs leads us to predict that the rate of diabetes will
increase rapidly.
Source: RRSSS 17 Photo Library
“The psychosocial stakes also have an impact on public health
in Nunavik: substance abuse, sexual abuse, alcoholism etc.
These are problems that affect the entire population, in particular
children. These conditions are often exacerbated by other factors
such as a very low rate of scholastic success, a significant lack of
housing, nutritional insecurity (low revenues, high cost of food).”
Medicine
North of the 49th
PORTRAIT OF HEALTH IN QUEBEC AND ITS REGIONS – A FEW REGIONAL STATISTICS
social
environment
andmental
health
Infectiousdiseases
(rateofincidence)
Adjustedrate
ofincidenceof
cancer
Lifestyle
habits
healthofmothers
andbabies
mortality
(adjusted
rates)
Overallhealth
Demographicand
socioeconomicconditions
Year of data
compilation
Description
Province of
Quebec
Region 17
Nunavik
Region
18 Cree
Territories of
James Bay
Region 10
Nord-duQuébec
14,186
Totalpopulation
2011
N
7,946,832
11,860
15,922
Age0-17
2011
%
19.1
40.2
38.2
21
Age18-64
2011
%
65.1
56.6
56.6
68.3
Age75andover
2011
%
childrenper
woman
15.8
3.2
5.2
10.8
1.62
3.22
3.31
1.75
%
23.7
40.5
29.2
20.6
fertility
singleparentfamilieswithchildren
under18
Welfarerecipients
2004-2008
2006
2010
%
7.6
7.2
3.7
4.3
Lifeexpectancy–men
2005-2008
years
78.3
64.5
74.9
77.4
Lifeexpectancy–Women
2005-2008
years
83.1
68.1
81.3
82.3
Lifeexpectancyingoodhealth–men
2006
years
66.5
51.3
61.5
66
Lifeexpectancyingoodhealth
–Women
2006
years
68.3
54.6
64.1
67.1
malignanttumours
2005-2008
/100,000
238
466
204
258
Circulatorysystem
2005-2008
/100,000
192
269
207
183
Respiratorysystem
2005-2008
/100,000
64
336
119
79
Pregnancyatage14-17
2003-2007
/1,000
14.2
83.5
65.7
13.9
Birthstomotherswithlessthan11
yearsofschooling
2006-2008
%
7.3
50.7
38.2
16.1
Low-weightbirths
2006-2008
%
5.7
6.6
3.7
6
Infantmortalityrate(per1,000live
births)
2005-2008
/1,000
3.3
20.3
10.6
n/a
sedentaryduringrecreation
2007-2008
%
25.8
n/a
n/a
16.9
smokers(12yearsandmore)
2007-2008
%
24.2
n/a
n/a
24.2
Alcoholabuse(12yearsandmore)
2007-2008
%
17.3
n/a
n/a
21.2
542
Allcauses
2003-2006
/100,000
511
654
391
Colon,rectumandanus
2003-2006
/100,000
69
135
68
86
Lung,tracheaandbronchi
2003-2006
/100,000
90
231
n/a
96
Breastinwomen
2003-2006
/100,000
133
n/a
90
154
Prostate
2003-2006
/100,000
125
n/a
n/a
109
Campylobacteriosis
2005-2009
/100,000
30
n/a
n/a
13.4
salmonellosis
2005-2009
/100,000
14.5
16.1
39.5
16.1
Invasivepneumococcalinfection
2005-2009
/100,000
10.7
39.4
27.3
n/a
Chlamydia trachomatis genital
infection
2005-2009
/100,000
181.7
2,475.4
1,465.3
195.8
Gonococcalinfection
2005-2009
/100,000
18.5
921.3
136.3
n/a
hepatitisC
2005-2009
/100,000
26.3
n/a
19.1
n/a
Adjustedmortalityrateduetosuicide
2005-2008
/100,000
15.4
99.6
15.2
n/a
Dropouts(publicsystem)
2008-2009
%
21.3
80.5
91.6
15
2006
%
39.3
15.4
4.4
50
Populationaged75andmoreliving
alone
Data extracted from Pour guider l’action: portrait de santé du Québec et de ses régions, MSSS, 2011.
21
vol. 14
no. 4
LS
WHAT ABOUT DEVELOPING THE NORTH?
“I believe developing the North will certainly have an impact on
several communities, mainly for those in proximity to mining
projects or construction sites. Some sites in development are
very close to communities, such as Aupaluk, whose population numbers approximately 200 individuals. Workers there are
already going to local CLSCs for consultations. Eventually, with
the arrival of 2,000 workers, the population to be served would
be multiplied by 10. It’s unthinkable! Not only could we not
undertake this, but we would have to see how to react to such
an increase in population. Normally, the mine supplies health
services for its workers, but if they have access by road and if
they’re residents of Quebec, we cannot refuse them our services.
“These are questions to which we are trying to find answers at
the regional board. We also have to discuss the situation with
the mining companies. It also has an effect on emergencies and
medical emergency evacuations. If the aircraft that are available
for medical evacuations (EVAQ or the agreement with Air Inuit)
are used to evacuate mining personnel, the region’s population
may suffer. So, how do you find the right balance in an environment that is already fragile?”
DIRECT IMPACT OF MINING DEVELOPMENT
ON THE NEED FOR MEDICAL SERVICES
“Developing the North will bring its
“DEVELOPING
load of changes and impacts both on
THE NORTH WILL
the population and on other aspects
that we forget too often, including the
BRING ITS LOAD
environment. Think for a moment of the
OF CHANGES AND
caribou’s migration territory. Hunting
IMPACTS BOTH ON
still plays a primary role in feeding the
THE POPULATION
Inuit. It is also a central element of their
culture. A mining project located at
AND ON OTHER
the centre or near a migration territory
ASPECTS THAT WE
would certainly have an impact on the
FORGET TOO OFTEN,
animal and, as a result, on the hunter. If
INCLUDING THE
the animal changes its migratory route,
will the hunter still have access?
ENVIRONMENT.”
“How will the animal react to frequent dynamiting, to the influx
of road and air traffic and to other major changes in and around
mines? All of this, without forgetting the biochemical effects of
mining development on the
soil such as acidifying
and contaDÉCOUVREZ
COMMENT
minating the earth and water
streams,
are
indirect
factors
that
VOS ASSURANCES
can have an impact on the health of the North’s inhabitants.”
POURRAIENT ÉVOLUER
AU MÊME RYTHME
QUE VOTRE STYLE DE VIE
ET VOS BESOINS.
AN EMBLEMATIC INNU
Dr Stanley Vollant, a surgeon originally from Pessamit, is
the first aboriginal medical specialist in Quebec. Greatly
involved with his community, Dr Vollant has become a real
symbol of success and a source of pride for his people.
His message, full of hope, has revived the spirit of many
youngsters in his community. As a matter of fact, not only
is he often asked to give conferences on scholastic perseverance and the importance of having a goal, a vision and
hanging on to it, but he is also involved in specific actions
to support this undertaking.
DR STANLEY VOLLANT, A SURGEON
ORIGINALLY FROM PESSAMIT, IS THE FIRST
ABORIGINAL MEDICAL SPECIALIST IN
QUEBEC. [...] DR VOLLANT HAS BECOME A
REAL SYMBOL OF SUCCESS AND A SOURCE OF
PRIDE FOR HIS PEOPLE.
22
vol. 14
no 4
LS
Since 2010, Dr Vollant undertook a long initiation walk, a
kind of pilgrimage to Compostela in America, over a route
extending 5,000 km. Called Innu Meshkenu (The Innu Trail),
Dr Vollant will visit all First Nations communities in Quebec,
Ontario, New-Brunswick and Labrador. Throughout his long
voyage, which will take him 5 years, he will invite members
of the communities to join him in order to know or learn, for
themselves, the teachings he dispenses during his meetings
and conferences.
POUR
EN SAVOIR
PLUS
:
At present, Dr Vollant is
coordinator
of the
aboriginal
1
800
361-5303
section of the Université de Montréal Faculty of Medicine.
514 350-5070
/ 418 990-3946
Last June, he was awarded
the Médecine,
culture et
société Prize to highlight his exceptional career and his
contribution to improving
Par courriel ou Internet :
the wellbeing of aboriginal
[email protected]
communities. Because ofwww.sogemec.qc.ca
his
extremely heavy schedule,
Le Spécialiste was unfortunately not able to interview
him to learn more on how
healthcare is organized in
Innu communities.
DR STANLEY VOLLANT
General Surgeon
Coordinator of the Aboriginal
Section
Université de Montréal
SOGEMEC
ASSURANCES
Faculty
of Medicine
filiale de la
Source: innu-meshkenu.com
Medicine
POUR TOUS VOS
BESOINS D’ASSURANCES
North of the 49th
INTERVIEWS AND TEXT
APassionfortheNorth
Grâce au
SERVICE PRÉFÉRENCE
Doesonehavetobealoveroffreshair,ahunterorasocialworkertowanttogoworkin
LAISSEZ Quebec?
LIBRE COURS
À VOS
PASSIONS
Northern
Not
at all!
Physicians who choose to practise north of the 49th parallel
haveapointincommon:theyadorethekindofmedicalpracticetheyfindthere,theculture
andexchangingwiththepopulationand,evenmore,theyfeeltheygrowwitheachstay.
SOGEMEC ASSURANCES
ÉVOLUE
AVEC
VOUS
How
healthcare services
are organized
in the Far North results in no full-time medical specialist being present in one of the hospital
centres. Certain family physicians live and practise inside communities, while others travel back and forth between CLSCs. Medical
specialists all provide itinerant medical services in accordance with the terms of Appendix 19 (entitled La rémunération différente
Qu’il
d’assurance
professionnelle
pour
les s’agisse
services assurés
fournis
dans les territoires insuffisamment pourvus de professionnels de la santé).
ou personnelle (vie, invalidité, auto, habitation),
notre
service
vous
Here
is what
twoPréférence
physicianspersonnalisé
who regularly
go up north have to say, whether it’s for a few days or a few weeks, each in
permmettra
trouver rapidement réponse
a different
workde
environment.
à vos questions.
DR JACQUES JULES CÔTÉ
Anesthesiologist
Hôpital Enfant-Jésus Québec
– Saint-Sacrement
Paired with the Innulitsivik Health Centre
LENDING A HELPING HAND TO OFFER
SERVICES EVERYWHERE IN QUEBEC
It was in 1995 that the anesthesiologist Jacques Jules Côté
discovered the Nord-du-Québec region when he accepted a
professional colleague’s invitation who could not travel there in
accordance with the agreement. This first experience charmed
him. Since then, he has been going there frequently to do the
rounds of dental clinics, pediatric clinics and others. Dr Côté’s
work is the same as the one he does in the South, except...
for the quantity of equipment available. “You quickly learn to
manage with the equipment that is there.”
DR CÔTÉ’S WORK IS
THE SAME AS THE
ONE HE DOES IN THE
SOUTH, EXCEPT... FOR
THE QUANTITY OF
EQUIPMENT AVAILABLE.
“YOU QUICKLY LEARN
TO MANAGE WITH THE
EQUIPMENT THAT
IS THERE.”
SOGEMEC ASSURANCES
filiale de la
In his opinion, northern people
benefit greatly from the care they
receive in their community. Apart
from a notable reduction in costs,
it avoids travelling, which is often
more damaging for the individuals
(the patients), as they find themselves in an environment that is
very different from their own and,
for some, does not necessarily
offer the same benefits as they
would get by being able to stay in
their village.
D r C ôté onl y ta ke s pa r t in inte r ve ntions p e r for m e d
on aboriginal people. When mines or construction sites are
located near villages, it is very rare for workers not to come
to CLSCs or northern hospitals for care. In his opinion, these
workers have access to internal resources (health clinics on
site) and, if needed, they can be evacuated by the companies
they work for.
Dr Côté hopes to continue his North/South practice for a long
time, a practice that, although very demanding because of
long working hours, helps him to grow and allows him to live
various life experiences.
23
vol. 14
no 4
LS
DR JOHANNE MOREL
Pediatrician
Montreal Children’s Hospital
All Far North health centres and Cree Board
of Health and Social Services of James Bay
A REAL LOVE STORY
“My life? It’s the Far North. No joke!” she says with a burst
of laughter.
To start with, Dr Johanne Morel says her practice is 90%
directed to the communities in the Far North. Since she
obtained her medical diploma in 1981, she has been spending
the major part of her time providing care directly to northern
communities on location or at the Montreal Children’s’ Hospital,
within the framework of the Northern and Native Child Health
Program, with a team dedicated to children from First Nations
communities. This team, offering consultation and liaison
services, is on site, or can be reached by email or by telephone
(and now, via videoconferencing).
Dr Morel’s first stay with the James Bay Cree was to practise
general medicine right after having obtained her medical
degree. A few years later, by then equipped with a specialization in pediatrics, she continued with this type of work, covering
the entire area of James Bay and Nunavik, sometimes alone. “I
didn’t choose this life, it chose me. When I graduated, I didn’t
quite know what I wanted to do. A friend, who was already used
to this region, invited me to come with her. I knew nothing about
the North. I even had to get my atlas out to learn more. I had a
vague idea that there were people living there, but nothing more.
My friend stayed for six months, while I’m still there! It was a
case of love at first sight. To start with, it was for the beauty of
the landscape, then for the medical practice that I found there.”
Since the beginning of the years 2000, Dr Morel essentially
covers the Inuit communities of Ungava as well as the CreeInuit community of Kuujjuarapik. Now, she travels there a dozen
times a year for stays lasting approximately one week at a time.
But, she’s no longer alone: several pediatricians now undertake
stays like hers in northern communities.
In her role of liaison pediatrician, she supports the work of
nurses and general practitioners who are either based in the
communities or who visit the smallest villages. A real production
line is offered to these communities, where the nurse is on the
front line. Services are organized in such a way that a team
has access to various subspecialties as needed. The team
pediatricians follow up with young patients, whether on site or
after returning to Montreal with the other dedicated specialists
(endocrinologists, cardiologists, etc.).
24
vol. 14
no. 4
LS
This method of working is optimal. Each northern community
is visited by a pediatrician from the Northern and Native Child
Health Program, Montreal Children’s Hospital, at least twice
a year. Moving the children to Montreal would be much more
expensive for society as well as for the young patient, not only
because of the financial costs (the children need to be accompanied by a parent or a guardian and a one-way plane ticket
costs approximately $3,000), but also because of the social
costs (adapting to a new environment can have a negative
impact on healing or on the handling of a patient).
EACH NORTHERN COMMUNITY IS VISITED BY A
PEDIATRICIAN FROM THE NORTHERN AND NATIVE
CHILD HEALTH PROGRAM, MONTREAL CHILDREN’S
HOSPITAL, AT LEAST TWICE A YEAR.
“THEY’VE BECOME MY FAMILY”
Her personal relationship with the people of various northern
communities is beyond price. Dr Morel is grateful to them for
everything: they gave her confidence in herself and helped her
discover the multiple facets of their rich culture. And yet, she
had feared not being able to adapt to this lifestyle, this culture
and the requirements of a different kind of work.
She is very close to the people and has managed to invite
herself into the centre of their lives. Some of the women she
helped deliver have given her name to their baby. She took part
in survival, hunting and fishing outings with villagers who taught
her many things and who laughed when she made mistakes...
Her stays with the James Bay communities have left their mark
on her. She finds joy in renewing contact with the members of
each of the communities she visits.
Medicine
North of the 49th
The greatest difference occurred when she went even
further north. Everything she had known with the Cree
was different with the Inuit. She thought the differences
would be minor, like changes in clothing and food; but,
it was something else. The values and the customs are
at the opposite extreme of what we live, what we know.
For example, the masculine and feminine forms of names
have little importance. At birth, babies are invested with the
spirit of an ancestor or a recently-deceased elder of the
community. We see boys with feminine names and vice
versa. Also, these children receive all the respect we used
to reserve for the person in life. Parent-child relationships
are in fact deeply coloured by this spiritual investment.
LANGUAGE AND CULTURE BARRIERS
“The Inuit culture is very different from ours. Whether it’s
regarding concepts, facts, or notions, there is sometimes an
entire world we need to know to be able to understand these
people. For example, I realized that the Inuit are anchored in
the present. There are therefore certain concepts to which I
need to adapt to establish clear communications with them as
a physician. If I tell someone to take his medication twice a day
for 14 days, the notion of time as we know it may not exist for
him. Therefore, if I don’t clearly understand this specificity, the
patient will (maybe) come back in two weeks and there won’t
be any improvement in his condition.
“Someone who knows nothing of this culture could make a
negative judgment regarding the patient. But, that is not the
case: we have to find points in common to ensure we are well
understood. This can make the whole difference in how we
approach patients.”
Inuktitut is a highly developed language: its beauty resides
in the fact that simple things are simply said. The Inuit have a
great capacity to describe the three-dimensional space around
them. Thanks to hunting, they have developed a way of indicating an animal’s position as exactly as possible with words
“BEFORE PUTTING MYSELF IN THE HANDS OF AN
INTERPRETER TO COMMUNICATE WITH MY PATIENT,
I HAVE TO MAKE SURE THAT QUESTIONS WILL BE
UNDERSTOOD AND HAVE SOME KIND OF MEANING IN
RELATION TO NORTHERN CULTURE, RATHER THAN
USE QUESTIONS THAT COME STRAIGHT OUT FROM
WESTERN CULTURAL CONCEPTS.”
of two syllables or less. Thus, the word “here” can be said in
many ways to indicate that things are high, lower, behind, etc.
Each culture develops words to represent what is around them.
Let’s take the example of the colour spectrum. In English and
in French, there are many words to differentiate between the
various tints of blue and green (azure, marine, indigo, turquoise,
etc.). In Inuktitut, there is only one word for both blue and green.
Another example is the number “7”, a simple digit pronounced
as one or two syllables, no matter in which language. However,
one needs no less than eight syllables in Inuktitut to try to
explain what the digit represents as it has no connotation at
all in their culture as opposed the South.
“Before putting myself in the hands of an interpreter to communicate with my patient, I have to make sure that questions will
be understood and have some kind of meaning in relation to
northern culture, rather than use questions that come straight
out from western cultural concepts. Otherwise, even my interpreter will not be able to help me. The best way for me to
integrate and to develop the best communications possible is to
learn their language and their culture. Workshops are available
to learn the language and we also need workshops to teach the
culture. We can also benefit from valuable advice from village
elders if, for example, something we do is not acceptable to
the Inuit culture; that is how we’ll become better physicians,
better partners in health.”
A MEDICINE THAT IS ABOVE ALL CULTURAL
“Speaking of culture, I asked a mother one day if she was
worried by her child’s delayed language skills. In fact, she had
never worried or even paid attention to the question. “I learnt
much later that a delay in acquiring language skills is considered
a gift in certain communities.”
“In aboriginal children, the rate of obesity is beyond our understanding. It is 20% higher than our rate for this same age group.
But, obesity is not problem among the Cree, and even less so
among the Inuit, where it’s cultural. It doesn’t worry anyone if
several members of a family are obese. So, when a general
practitioner refers a case to a pediatrician, parents don’t understand why most of the time. And, in order to treat the patient, the
pediatrician needs to find the best way of interesting the patient
and his or her family in a treatment plan that is compatible with
his or her culture.
25
vol. 14
no. 4
LS
TREATING HUMANS ACCORDING
TO THEIR CULTURE
“I believe we’ve succeeded in developing a jewel of healthcare
in the North. I am trying to set up a similar organization in the
South with production lines to maximize the input and interaction with all stakeholders whether they are medical specialists,
general practitioners or specialized nurse practitioners. This
kind of work allows you to benefit from each person’s expertise.
“I BELIEVE WE’VE SUCCEEDED IN DEVELOPING A
JEWEL OF HEALTHCARE IN THE NORTH [...] WITH
PRODUCTION LINES TO MAXIMIZE THE INPUT AND
INTERACTION WITH ALL STAKEHOLDERS [...] THIS
KIND OF WORK ALLOWS YOU TO BENEFIT FROM
EACH PERSON’S EXPERTISE.”
“As a pediatrician, I’m on the second line for the general
practitioner and I can decide if third-line care from a medical
subspecialist is needed. I can be the link if I’m in a committee
or decide, as the case may be, to direct my patient to another
resource. In a committee, I can often get the resources needed
to treat the patient myself. This is the way we can optimize
specialized and subspecialized medical care and services.”
SOCIAL NEEDS THAT CONTINUE TO INCREASE
There have been many media reports showing the seriousness
of the social situation in certain isolated communities. Dr Morel
is of the opinion that coverage by child psychiatrists and the
arrival of social pediatricians are now needed in these communities. Several types of care could be revised if problems were
corrected at the source. For example, we could avoid recurring
pneumonia in babies who sleep with a bottle. This problem
is frequent in households made up of several families where
calming the baby is preferred in order not to disturb the elders,
even if other complications occur. The community in Inukjuak
plays the role of leader at the moment, as social pediatrics are
being developed there.
WHAT ABOUT DEVELOPING THE NORTH?
Dr Morel is very worried by various development projects in
the North, as much for the communities as for how care is
organized. “There is talk of mining developments a few kilometres from villages like those of Aupaluk or Kangirsuk: a mine
with several hundred workers, almost all of them men. Imagine
what could happen!” If, according to Dr Morel, companies
themselves were to guarantee healthcare services for their
workers, the reality could be very different. “Cohabitation
could be difficult for neighbouring communities: certain social
problems make us fear the worst (rape, prostitution, etc.).”
26
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According to Dr Morel, these workers are technically in good
health and several companies have announced their preference
for fly-in, fly-out arrangements, whereby workers would come
to work for a period of about two weeks before returning home.
But information is in short supply and Dr Morel, like her colleagues, is keeping an eye open for these types of developments.
A QUESTION OF KNOWLEDGE
Dr Morel gives a series of conferences entitled L’ignorance
de l’ignorance. “When people go to the Far North, they know
nothing. In fact, they don’t know that they know nothing. Worse,
they think they know, and therefore they judge. These people
think that only their own values are universal and that, if there
are differences, such differences are minute. And yet, everything
is different in the Far North. Contrary to the South, it’s up to us
physicians to thank patients for having come to see us. Values
are at the opposite end of the vision held by someone from the
South and time is needed to learn and to understand.” Dr Morel
has developed great respect for these values and recognizes
that there are still a lot of difficulties in the relationships that
people from the North have with Whites. Since there is no
solid northern economy, they remain tributaries of the southern
economy and of decisions emanating from the South. “And yet,
we have so much to learn from these people who have become
my life and whom I love.”
In a school yard in Kuujjuarapik
Physicaleducationteacherstriedtoorganizearace.Todothis,
allthechildrenwerelinedupatthestartinglineandtheteachers
gavethesignaltogo.Atthesoundofthebeep,nothing!Noone
jumpedforwardthewayweoftendohere.Why?Competitionis
notacceptableinnortherncommunities.huntersdonotcompare
themselvestooneanother;theysimplysay“thecaribouwentby
theotherhunter;tomorrowit’llbemyturn.”
InInuitandCreecultures,thenotionofcompetitionhasa
negativeconnotation.Itdisturbstheharmonyofthegroup
andcreatesuselessjealousy.Onedoesn’tcompareoneselfto
another;nooneisbetterthanthenextperson.everyoneisthe
same;everyoneisequal.
Medicine
BY YV BONNIER VIGER*
Public Health and Preventive Medicine
North of the 49th
An Emerging Solution to the Complexity of Healthcare and Social Services
The“Autochthonization”ofOrganizations
TheNord-du-Québecregionoftheprovinceisaterritoryof1.2millionkm²withapopulation
densityofoneinhabitantper10km²andthreeverydifferentcultures.Organizinghealthcare
and social services in this context is a very special challenge. The aboriginal population is
dividedinto14Inuitcommunities,10Iiyiyiu(Cree)communitiesand1Naskapicommunity.Itis
immediatelyapparentthataccessproblems(geographicalandcultural)aresignificantandthat
weneedtohaveaverywelldevelopedsystemofreferrals.
There are thus six boards of directors (three Inuit, one Cree,
one Naskapi and one non-aboriginal) to manage the health
and social services in this immense region. Four hospitals
service the territory: Chibougamau, Chisasibi, Puvirnituq and
Kuujjuaq. Everywhere else in the villages, there is a dispensary,
sometimes with a physician, but most often, with local nurses
and social workers who depend on sporadic medical visits.
Regional teams therefore play an extremely important role in
terms of support, training, and referrals. Third line services are
provided by the McGill RUIS6 throughout the territory.
Source: makivik.org
The Kawawachikamach1 CLSC, the institution that serves
the Naskapi community, reports to the Agence de santé
et de se r vices sociaux de la Côte -Nord ( in another
administrative region).
The Nunavik Regional Board of Health and Social Services2,
located in Kuujjuaq, serves the Inuit community through two
institutions: one, in Puvirnituq, offers its services to the communities along Hudson’s Bay and the other, at Kuujjuaq, serves
the communities of Ungava Bay.
The non-aboriginal communities of the Municipalité de la
Baie-James are serviced by the Centre régional de santé et
de services sociaux de la Baie-James3, which takes on the
roles both of agency and institution. The Cree have their own
health and social services act4, based on Quebec’s law, but
with certain notable differences. The Cree Board of Health
and Social Services of James Bay 5 acts as both agency
and institution.
The Inuit have developed a local network of well-trained
midwives7 thus allowing births to take place in most communities. For the Cree and non-aboriginals, childbirth must take
place either in Val-d’Or or in Chibougamau. Labour and birth,
which are very important moments in all cultures, thus tend
to lose their unifying character in these communities by exiling
the mother for some three weeks around the event.
The main challenges faced
THE MAIN CHALLENGES
by these systems of health
FACED BY THESE SYSTEMS
and social ser vices are
8
OF HEALTH AND SOCIAL
cultural in nature. The
perception of health and
SERVICES ARE CULTURAL
wellbeing, family relations
IN NATURE.
a nd socia l re sponsibilit y towa rds the young
by society have very different connotations in these three
cultures. For the Inuit, the Cree and the Naskapi, the effects
of colonization and the relatively recent process of fostering a
sedentary lifestyle, have long-lasting effects. In the non-aboriginal community, we are faced with a cultural diversity that is
significant, in part because of the rapid migration of numerous
workers on various sites, but also because of the attraction
these regions hold for people who recently immigrated to
Canada. The combination of cultural diversity with distance
and isolation between communities can, even if it sometimes
inspires creativity, be a source of fragility. And, if you add in
drugs and alcohol, the situation can become dangerous...
(*) The author is a medical specialist in public health and preventive medicine. The main subject of his master’s degree in administration (IMHL McGill) deals with the
‘autochthonization’ of organizations. He knows the aboriginal culture in depth from having lived and worked there for many years.
27
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“AUTOCHTHONIZATION”
How should we react to this situation? A combination of
good practices and approaches are suggested by international experience and are starting to be implemented
here. We can label these practices overall with the term of
“Autochthonization” of organizations9. The main practices of
an aboriginal organization are:
A COMBINATION OF GOOD PRACTICES AND
APPROACHES ARE SUGGESTED BY INTERNATIONAL
EXPERIENCE AND ARE STARTING TO BE
IMPLEMENTED HERE. WE CAN LABEL THESE
PRACTICES OVERALL WITH THE TERM OF
“AUTOCHTHONIZATION” OF ORGANIZATIONS.
USE THE LOCAL LANGUAGE
Language is not only a vehicle for knowledge, but also for
culture and ways of thinking. Language carries values and a
vision of the world. Implementing the use of the language of
the local majority in day-to-day business is fundamental. Public
service organizations can be very powerful standard-bearers
to disseminate this message.
IMPLEMENT PROGRAMS TO PREVENT A BRAIN DRAIN
Local, well-trained, professional manpower is attractive to
outside markets. To prevent the loss of valuable resources
and to increase retention, you have to plan for various incentives, such as increasing revenues, stimulating environments,
financial compensation from professionals who leave, a
minimum number of years of service required, etc.
ENSURE CULTURAL SAFETY WITHIN DEPARTMENTS
Cultural safety means making sure you understand the world
view and the spirituality of users in order to create a good fit
between beliefs and actions within the process of interaction.
This goes far beyond the hiring of local workers.
EDUCATE THE POPULATION
It is essential that basic education be provided so that
members of the community have the ability to express their
needs and to take an active part in the management of health
and social services. Also, personnel must be trained so that
they can be ready for meetings with educated clients.
HIRE AND TRAIN LOCAL MANPOWER
Hiring aboriginals to care for aboriginals is certainly one of the
most powerful strategies that increases the desire for cultural
competence within the organization.
Training local personnel is a sine qua non condition to implementing the strategy of local hiring. Unfortunately, it is not
always taken into consideration in real life. This is why it is
so important to increase the population’s general level of
education, to suggest specific training for non-professionals
and to offer training as part of employment.
SUPPLY CULTURALLY-ADAPTED TRAINING
A culturally-competent organization must also provide services
that are safe and appropriate. Culturally inadequate schooling
can become a way of alienating people.
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INVESTING IN MAKING PROFESSIONS INDIGENOUS
There remains a profound contradiction between the
perception of the universal character of science and the
cultural bias of western science. A culturally adequate service
is not only a service provided by a culturally competent person.
Also it is not just a simple translation of knowledge, but rather
the production of new knowledge and a reflection on the
professional paradigm starting from local reality.
INCREASING THE CULTURAL COMPETENCE
OF NON-ABORIGINAL MANPOWER
It has been shown that services offered by a culturallycompetent person, even if not an aboriginal, is effective.
RECOGNIZING THE HOLISTIC APPROACH
TO HEALTH AND WELLBEING
All around the planet, aboriginals share the same holistic view
of health and wellbeing. This implies control over the physical
environment, dignity, respect for the community and justice.
Medicine
North of the 49th
ENSURE COMMUNITY PARTICIPATION AND CONTROL
AS WELL AS INTEGRATED LOCAL SERVICES
“Autochthonization” includes community involvement and
control of the services the community receives from its internal
organizations. This process is part of the development of a
community. The advantages of control by the community are
numerous, including better access to health services, a single
access point, culturally appropriate care, cultural pride, etc.
GETTING INVOLVED IN A PROCESS OF DECOLONIZATION
The poor health and lack of wellbeing of most aboriginal
communities are linked to colonization. Decolonization
must not only be effected in individuals, communities and
organizations, but also in professions.
MOBILIZING THE ELDERS
At the local level, the elders act as lawyers, resources, role
models, traditional authorities, motivation interpreters, sources
of knowledge, advisors and links with traditional healers and
traditional authorities.
PROTECTING TRADITIONAL KNOWLEDGE
Over the course of hundreds of millennia, humanity discovered numerous healing processes. Aboriginal people are
the guardians of the most ancient formulas. This traditional
knowledge must be protected and recognition granted to
communities who have preserved it until now.
In the same way, “Autochthonization” should allow us to
resolve the contradiction between western medicine and
a holistic view of health and wellbeing. In fact, it has been
observed that synergy between classical and traditional
approaches can be attained when it is possible to institute
collaboration between the two approaches.
INTERDISCIPLINARITY AND INTERSECTORIALITY
Holistic approaches to care demand interdisciplinarity.
Qualified professionals as well as non-professionals must
work in a team, with the patient at the centre as an active team
member. To keep track of all health determiners, local health
and social service organizations must collaborate closely with
other organizations who have the power to change things that
will have an enormous impact on the health and wellbeing of
the population.
APPROPRIATING GOVERNANCE
Self-management is a characteristic of organizations that
have succeeded in furnishing culturally adapted services to
their population.
THE NORD-DU-QUÉBEC REGION IS GROWING
ON THE BASIS OF ITS THREE MAIN CULTURES.
UNLESS WE DECIDE THAT THE NORTH IS ONLY
GOING TO BE AN IMMENSE BACKYARD TO THE
SOUTH WHERE WE’D SIMPLY GO TO EXTRACT
RESOURCES, THE “AUTOCHTHONIZATION” OF
HEALTH AND SOCIAL SERVICE ORGANIZATIONS
IS A PATH WE MUST EXPLORE.
DISPOSING OF REALISTIC FINANCIAL RESOURCES
AND CONTROL OF THE TERRITORY
All good intentions are evanescent and are only dreams if
financial resources are not sufficient to support their implementation. Links to the earth and to territory are sacred in
all aboriginal cultures. It has been clearly established that
alienation from the territory impacts the health and wellbeing
of these people.
The Nord-du-Québec region is growing on the basis of its
three main cultures. Unless we decide that the North is only
going to be an immense backyard to the South where we’d
simply go to extract resources, the “Autochthonization” of
health and social service organizations is a path we must
explore. In fact, both the Inuit and the Cree have begun this
exploration and several “Autochthonization” characteristics
of their organizations are already in place. Non-aboriginals
also insist that organizations resemble them. All that is
left is for us to understand, support and develop these
emerging organizations.
References:
1
http://www.agencesante09.gouv.qc.ca/Document.
aspx?id=673&lang=EN, accessed on November 26, 2012.
2
http://www.rrsss17.gouv.qc.ca/index.php?option=com_content&view=fr
ontpage&Itemid=2&lang=en, accessed on November 26, 2012.
3
http://www.crsssbaiejames.gouv.qc.ca/1/accueil.crsssbaiejames,
accessed on October 10, 2012.
4
http://www2.publicationsduquebec.gouv.qc.ca/dynamicSearch/
telecharge.php?type=2&file=/S_5/S5_A.html, accessed on
November 26, 2012.
5
http://www.creehealth.org/, accessed on October 10, 2012.
6
http://www.mcgill.ca/ruis/, accessed on November 26, 2012.
7
http://www.rrsss17.gouv.qc.ca/index.php?option=com_content&view=ar
ticle&id=74&Itemid=91&lang=en, accessed on November 26, 2012.
8
Bonnier Viger Y. Strategies used by aboriginal people to ensure
autochthonization of their health and social services: an introduction,
a literature review (Master’s Thesis) IMHL, McGill, 2008. Bonnier Viger
Y. Strategies used by Iiyiyiuch of the Cree Board of Health and Social
Services of James Bay to ensure autochthonization of their health and
social services: critical appraisal in light of an international literature
review, (Master’s Thesis) IMHL, McGill, 2008.
9
Petit JG, Bonnier Viger Y, Aatami P, Iserhoff A. Le système de santé et
de services sociaux des Cris du Québec et ses défis, in Les INUIT et les
CRIS du Nord du Québec, Presses universitaires de Rennes and Presses
universitaires du Québec, 2011, pp 217-235.
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TheNorthwardRush
The North’s development (called the Plan Nord by the preceding
Liberal government) is a project that stretches over a period of
25 years and, in a context of sustainable development, aims to
develop natural resources in the areas of mining (see page 32),
energy, forestry, bio-food, tourism and wildlife.
In and of itself, the Plan Nord represents public and private
expenses in excess of 80 billion dollars and should create
thousands of jobs. However, the economic benefits of the
project, varying from one source to another, are very vague. The
Charest government created a subsidiary, the Société du Plan
Nord, and entrusted it with managing the project, in particular
coordinating public investments and project implementation, as
well as negotiating the financing package.
According to its detractors, the Plan Nord is simply a “marketing”
veneer covering development projects that were just waiting for
the right economic conditions before being launched. Some
of these projects have already been the subject of discussion
for some twenty years. With the appearance of several new
consumer products (cars, cell phones, computers, etc.) the
demand (and prices) for certain resources has literally exploded.
Quebec’s soil is chock-full of these ores (iron, gold, nickel, etc.)
in addition to metals (niobium, lithium, etc.) and rare earths.
The Charest government took over several of these projects,
initiated others and added tourism development, one aspect in
high demand by stakeholders in this sector.
ONE MINE – ONE VILLAGE
Operating mines requires qualified human resources, even
if processes are highly mechanized. Such resources are not
plentiful and several (if not the majority) of mining companies
could supply their own manpower and equipment.
This method, labelled “fly-in
fly-out,” involves temporary
m a n p owe r, s u p p l i e d by a
company, from anywhere on
the planet, but it could be the
source of as-yet unevaluated
health issues. Stakeholders
have even expressed concern
for the health of local populations (mainly in the case of
mines that will be flanking
Inuit village s ), where they
worry especially that women
could become the victims of
a massive albeit temporary
i nva s i o n of a n e s s e nti a l l y
male contingent (prostitution,
rape, unwanted pregnancies,
violence, alcoholism, etc.).
For this temporary manpower, plans are needed to provide
housing, sanitary services, food, medical and social services,
day-care and schooling (if the family is relocated), recreational
equipment, support, etc. In fact, complete and secure villages
will need to be built for these workers.
And, if the mine is close to a well-established community
(Sept-Îles, Chibougamau, etc.), plans will have to be made for a
rapid and radical increase in community resources and services.
Already, the cost of an apartment in Sept-Îles is similar to that
of one in a large urban centre like Montreal and the town of
Val d’Or has recently had to recruit personnel from abroad for
various positions.
THE NORTH FOR EVERYONE
sincetheelectionofthe Parti Québécois,accordingtostatementsmade,onewouldtendtothinkthatthepreviousgovernment’sPlan
Nord has already been buried. The new government, recognizing prevailing favourable economic conditions, does not reject the idea of
developingthenaturalresourcesoftheregionbutwantstoreviewtheoverallprojecttoensuretheprovincedrawstangiblebenefitsfromit.
Thefinanceminister, Nicolasmarceau, has stated: “We do want to see roads and power lines there, but we think that it’s up to the corporationstocoverthesecostsiftheywanttoexploitourores.”1TheministerofNaturalResources,madamemartineOuellet,ontheother
hand wants to review the royalties paid by mining companies. These royalties were redefined in the last budget tabled by formerminister
Bachand,butthenextreportfromtheAuditorGeneralwillbeneededtoensuretheseroyaltiesarebeingcollectedappropriately.
On the international level, the context is more than favourable. A good number of emerging and manufacturing countries need raw materials.
Quebeccanthusmanoeuvreintelligentlyandbenefitfromthecurrenteconomiccontext.Wecanexpectthecurrentgovernmenttopresent
an improved project and to use the opportunity to clean up its own laws and regulations before implementing a project that, day after day,
revealsgapsandobstacles.
30
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LS
for example, in early October, the media reported that the Transport Department had to increase projected costs for the construction of the
roadleadingtotheOtishmountainsandtothestornowaydiamondmine.Theseconstructioncostshavealreadyballoonedoutby60%,
well before the work is finished. A bit earlier, environmental groups had protested the absence, in the government’s plans, of protected
areasorterritories.Thegovernmenthadquicklyrepliedthatitwouldmakeitarequirementthat,by2020,atotalsurfaceareaof20%of
the North be zoned for protection.
Medicine
North of the 49th
PRINCIPAL MINING PROJECTS
Parallel to mining development, and in support of it, the government had forecast the development of energy resources and
infrastructures. Thus, within the $80 billion projected to come
from the government, $33 billion were to be dedicated to infrastructure (roads, railroads, seaports and airports), with the rest
going to energy.
INFRASTRUCTURE (TRANSPORTATION PROJECTS) 2
extension of Route 167 towards the Otishmountains;
Rehabilitation of Route 389 between Baie-Comeau
andfermont;
Airport improvement;
extension of Route 138 between Natashquan
andKegaska;
Project coordination to rehabilitate the railroad between
emerilJunction(Labrador)andschefferville;
extension of Route 138 by building a link between
KegaskaandBlanc-sablon;
feasibility studies for the construction of a land link (road
orrail)fromKuujjuaqtothesouth;
feasibility studies for the development and viability of a
deep-waterportatWhapmagoostui-Kuujjuarapikandfor
theconstructionofalandlinktoRadisson.
x
x
x
x
x
x
x
x
ENERGY3
Developing hydroelectric power stations to generate an
additional3,500mWofcleanandrenewableenergy;
Developing projects not connected to the main power
gridinordertorespondtothespecificenergyneedsof
industrialprojects;
feasibility studies for the development of tidal farms;
Pilot project to link wind and diesel power generation for an
isolatednetworkinaNunavikcommunity;
Carrying on with the development of projects described in
hydro-Québec’sstrategicplan.
x
x
x
x
x
Mining and Health
Apart from the well-known problems of dust, the acidification
ofsoils,andpollutionduetothechemicalproductsusedinthe
extraction process, and others, mining is being revealed as a
sourceofproblemsanddangersforhumanhealth.
On April 12th, inmalartic, a thick orange cloud of nitrogen dioxide
emanatingfromtheCanadianmalarticminecausedpeopleto
fear the worst for the population. The cloud was concentrated
nearthemineandtooksometimetodissipate.Theministère du
Développement durable, de l’Environnement, de la Faune et des
Parcs (mDDefP)issuedafewnoticesofnoncompliancetothe
company,evenrequiringtheinstallationofdetectiondevicesto
testforthepresenceofthis
gas used in blasting operations.Threedeviceshave
sincebeeninstalled,but
othercloudshaveappeared,
in particular on August 10th.
Source: Journal de Montréal
Emergency Healthcare, Transporting
and Evacuating the Wounded
Therearewaysofevacuatingapersonwhosestateofhealth
requiresurgentcarethatcannotbeprovidedinthevarious
existingpointsofservice.
ThegovernmentofQuebechasmedicalevacuationaircraft,
oneChallengerandoneDAsh-8.AsecondChallenger,used
forthePrimeminister’stravels,canalsobeusedtoevacuate
theillorwounded.TheDAsh-8canbeusedfortransportation
thatdoesnotrequireaphysicianandmedicalpersonnelon
board.ThecurrentChallenger–calledahospitalplane–is
nearingtheendofitsusefullife.Onmarch1,2012,anewcraft
waspurchasedandarequestforproposalsisunderwaywith
aviewtotransformingitintoahospitalplane.
Thegovernment’smedicalevacuationprogram,knownas
eVAQ,existssince1981.Itcoversthewholeoftheprovinceand
ensuresmedicalorsafetyevacuations.Thecoordinationcentre
formedicalevacuations(eVAQ)hasbeendelegated,since2006,
totheCentre hospitalier affilié universitaire de Québec (Hôpital
Enfant-Jésus).
Aswell,thereareagreementsinplace
withairtranspor tcompanieswho
servicethefarNorth(inparticular
withAirInuit)toprovidetransportation
betweencommunitiesandtheminihospitalsinPuvirnituqorKuujjuaq.
AsforAirmedic,aprivatecompany
thatdeclaredbankruptcyin2008,itis
backinoperation.Thecompanyoffers
medicalevacuationservicesbyhelicopterandbyairplane.Today,Airmedic Source: RRSSS 17 Photo Library
operatessixaircraft(oneairplaneand
fivehelicopters)basedinfiveairports
(saint-hubert,theLaurentians,QuebecCity,saguenayand
Chibougamau).Thecompanyoffersserviceswithinaradiusof
350kmfromthesebasesandispursuingitsexpansionprojects.
Paramedicalteamsarepermanentlybasedintheseairportsand
mobilisationtimebetweenreceiptofacallforhelpandtakeoff
isamaximumof10minutes.
Inthecaseofmines,thecompanieshavetheobligation
andresponsibilityofensuringaccesstomedicalcareforits
personnelonsite.Generally,onlybasichealthcareservicesare
availableinthemines.somemineshaveaspecializednurse
whomanagesalocaldispensary;theCssT,infact,requires
thepresenceofanurseassoonasacompanyhasmore
than20workers.Theminetakescareofevacuatingwounded
workersorthoseunabletocarryontheirdutiesbecauseofa
healthcondition.
somecompaniescanalsosupplyhealthcaretomining
companies.Thisisthecase,inparticular,withtheQuebec
companysécuri-soins,whichspecializesinstaffingmedical
personnel(nurses,paramedicalpersonnel,physicians)for
companiesandfortraveltoremoteareas.Thecompanycan
supplythestaff,theequipmentandfirst-aidtraining.
References
1
Statement by Finance Minister, Nicolas Marceau, during the television
program Tout le monde en parle, on Sunday, October 14, 2012.
2
Source: http://plannord.gouv.qc.ca
3
Id.
31
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MAJOR MINING DEVELOPMENT PROJECTS IN THE FAR NORTH UP TO 2016
32
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LS
Saguenay-LacSt-Jean
Côte-Nord
Nord-du-Québec
Region
Type
Mine
Annual estimate
Investments
(in $)
Jobs created
Owner
Uranium
Matoush
2 million pounds
343 million
300
Strateco Resources (Quebec)
Uranium
Lavoie
n/a
110 million
n/a
Abitex Resources (Quebec)
Diamond
Gold
Gold
Gold
Gold
Gold
Gold and other
metals
Renard
Osisko
Bachelor Lake
Vezza
Éléonore
Johanna
2 million carats
600,000 ounces
60,000 ounces
40,000 ounces
600,000 ounces
100,000 ounces
802 million
1 billion
40 million
45 million
1.4 billion
187 million
400
450
210
150
400
160
Stornoway (Vancouver)
Osisko Mining Corporation
Metanor Resources (Toronto)
N.A. Palladium (Toronto)
Goldcorp
Aurizon Mines
Lac McLeod
2.1 million tons
210 million
250
Western Troy Capital (Toronto)
Gold, copper and
zinc
Bracemac-McLeod
80,000 tons (zinc)
10,000 tons (copper)
160 million
250
Donner Metals /Xstrata
(Switzerland)
Gold and zinc
PD1
n/a
160 million
250
Iron
Iron (expansion
project)
Kami
8 million tons
989 million
268
Donner Metals (Xstrata
(Switzerland)
Alderon Minerals and Hebei
Monts Wright
24 million tons
2.1 billion
900
Arcelor Mittal
Iron
Bloom Lake
16 million tons
650 million
200
Wisco
Iron
Hopes Advance
20 million tons
3.7 billion
n/a
Oceanic Iron Ore Corp
Iron
Iron, titanium and
vanadium
Nickel
Duncan
12 million tons
4 billion
1000
Wisco
Black Rock
3 million tons
600 million
165
Black Rock Metals (USA)
Raglan
31 million pounds
465 million
960
Xstrata Nickel (Switzerland)
Nickel
Nunavik Nickel
1.6 million tons
800 million
500
Jillin Jien Nickel Industry (China)
Nickel
Dumont
141 million pounds
2.2 billion
1000
Royal Nickel Corporation
Lithium
Projet Rose
25 tons lithium
carbonate
270 million
n/a
Critical Elements (Quebec)
Lithium
Wabouchi
1 million tons
185 million
70
Nemasca Lithium (Canada-China)
Rare earths
(yttrium and zircon)
B-Zone
1.4 metric ton
565 million
190
Quest Rare Minerals (Montreal)
Iron
DSO
4.2 million tons
335 million
235
Iron
KeMag Taconite
22 million tons
4.7 billion
1000
Iron
Fire Lake North
(Attikamagen)
n/a
1.4 billion
475
Champion Minerals (Toronto)
Iron
Lac Otelnuk
50 million tons
2.5 billion
2000
Adriana/Wisco (Toronto-China)
Apatite
Arnaud
1.2 million tons
750 million
300
Ressources Quebec/Yara Int'l.
ASA (Quebec/Oslo)
Niobium and
tantalum
Crevier
178 kilos tantalum
and 1.8 million kilos
niobium oxide
320 million
150
Northern Mining Explorations
Apatite
Lac-à-Paul
3 million tons
750 million
340
Ariane Resources
New Millenium/Tata Steel Minerals
(Toronto-India)
New Millenium/Tata Steel Minerals
(Toronto-India)
sources:Annualreportsandcompanypresentations,Ressources naturelles du Québec,CBC’sinteractivemapofthePlan Nord Medicine
BY ISABELLE GINGRAS
Psychiatrist
North of the 49th
WhenPhysiciansGetInvolved:NOtoUranium
The development of a uranium mine destroyed the peace and quiet of sept-Îles, a town of
some25,000residents.Becausetheywantedtoprotectthelivesandhealthofthosesharing
their environment, certain physicians resorted to drastic measures to prevent the company
from moving forward. Le Spécialiste asked one of the leaders of the group of physicians to
provideasummaryofevents.
In 2008, physicians in the municipality of Sept-Îles, on the North
Shore, learnt from Engineer Rasvan Popescu,1 of the existence
of a regional uranium exploration project. The firm
of Terra Ventures was undertaking the exploration of potential uranium deposits at Lake
Kachiwiss, ten kilometres from the limits
of the Town of Sept-Îles. At that time,
several municipalities in Quebec, including
Sept-Îles itself, already worried about the
health and environmental impacts of
this type of project, were demanding the
imposition of a moratorium on uranium.
In the month of November of the same year,
a group made up of 34 physicians from the local
community service centre, the Centre de santé et des services
sociaux de Sept-Îles - a group of which I am a member - took
position publicly against any project involving the exploration
or operation of uranium mines in our region, for reasons of
public health. At the time, Dr Raynald Cloutier, Public Health
Director (DSP) for the North Shore, told us that our reaction
was exaggerated since the project in question was still only at
the embryonic stage.
To add to our file, a citizens’ vigilance group (Sept-Îles sans
uranium) informed us that Terra Ventures did not even respect
its own environmental standards.2 The company acted rapidly,
because the price of uranium had gone up substantially in
previous years and it wanted to draw a profit quickly. Everything
was starting to meld together and alert the population.
In the fall of 2009, Terra Ventures obtained a permit to build
a road linking the city to the exploration site. For our group of
physicians, it had become clear that the firm had the intention
to eventually move from exploration to extraction or to sell the
project to a larger company. We had been expecting, at this
point, that the Public Health Directorate would intervene in the
file, but their silence was deafening. Disappointed, we decided
that we would have to take action ourselves. On December 4,
2009, some twenty physicians from Sept-Îles (including me)
sent a letter to the Minister of Health at that time, Yves Bolduc,
announcing our resignations should a uranium mine see the
light of day in our region. The letter had the effect of a bomb,
generating a tidal wave of media reports.
The next morning, we learnt that the Mayor of Sept-Îles had been
dragged from his bed at 5:00 a.m. by reporters. The management of the hospital, who had not been informed in advance
of our action, was awaited resolutely by a pack of journalists.
Telephone operators at the hospital centre were inundated by
calls from patients who thought we had already resigned. The
managing director called me at home joking that he needed a
psychiatrist. It was front page news, a national headline, the
one news programs opened with on television. My colleague
Bruno Imbeault, a respiratory specialist, and I were invited to
all broadcast public forums. I was even interviewed in English
for the ROC (Rest of Canada). As each day passed, our story
took on the look of a soap opera. It was surreal! Geologists
hated us. The Collège des médecins du Québec (CMQ) even
got involved briefly to make sure the public was protected in
view of our threat to resign, since our code of ethics prohibits
physicians from resigning outright in a concerted fashion. We
had to reassure the people at the CMQ regarding our intentions.
On December 11, 2009, or a week A FEW DAYS LATER,
later, our story was still on page one
SOME 2,000 CITIZENS,
of newspapers. Tension was high: Dr
Alain Poirier, from the Institut national EQUIVALENT TO A
de sa nté pu bl ique du Q ué be c CROWD OF 250,000 IN
( INSPQ ), and Raynald Cloutier, MONTREAL, STEPPED
the regional Public Health Director,
OUT INTO THE STREETS,
announced they would come to meet
with the physicians in an attempt to FIRST OFF, TO OPPOSE
calm things down (and as a public THIS TYPE OF PROJECT
relations operation). Following this AND, SECONDLY, TO
meeting, Dr Poirier announced the
formation of an ad hoc committee to SHOW SUPPORT FOR
evaluate the health risks of a uranium THE PHYSICIANS.
ore project on the North Shore. The
committee would be presided by Dr Raynald Cloutier; Dr Bruno
Imbeault and I were chosen to represent the group of physicians within this committee. But creating a committee did not
cool down the population’s feelings concerning the project. A
few days later, some 2,000 citizens, equivalent to a crowd of
250,000 in Montreal, stepped out into the streets, first off, to
oppose this type of project and, secondly, to show support
for the physicians. Then, an opinion poll ordered by the City
of Sept-Îles showed that more than 90% of the municipality’s
population was against the project.
33
vol. 14
no. 4
LS
Opposition to the project spread well beyond the region. After
a slew of media reports, several physicians from other regions
added their support, including Dr Jacques Levasseur, a general
practitioner representing the Regroupement des médecins pour
un environnement sain (RMES); Dr Pierre L. Auger, a specialist in
occupational medicine, also with the RMES; Dr Eric Notebaert,
emergency medicine specialist representing the Canadian Association
of Physicians for the Environment
(CAPE) and Physicians for Global
Survival (PGS); Dr Jean Zigby for
CAPE and Dr Michael Dworkind for
PGS, both general practitioners, as
well as many others.
On March 26, 2010, a press release
was issued by the Public Health
Directorate for the Côte-Nord (North
shore); it related that its Public Health
Director and the ad hoc committee
h e wa s p re s i d e nt of c o u l d n o
longer ignore the public’s disapproval and that several issues had
to be analyzed in depth. This press
release was needed to clarify the
DSP’s position following the publication of a letter dated March 17,
2010 emanating from the Ressources
naturelles et de la Faune Minister, Serge Simard, and addressed
to the House Leader, Jacques P. Dupuis, refusing to grant the
moratorium demanded via a petition signed by approximately
14,000 citizens. In this letter, Mr Simard stated that the department of public health maintained its position regarding the lack
of danger associated with exploring and extracting uranium. The
minister seemed to afford more importance to the uranium industry’s reaction than to the possible bio-psycho-social impacts
linked to this industry.
34
vol. 14
no. 4
LS
consultation. Luckily, since I became a member of CAPE, I had
the privilege of being invited to take part in the coalition Pour
que le Québec ait meilleure mine (QMM), and as a member of
this group, that had a right to express its opinion before this
new parliamentary commission, I did express the views of all
the physicians who had signed our white paper. This is how our
lobbying group managed to again table
the physicians’ white paper.
LOOKING BACK,
LOOKING FORWARD
Because of my involvement as a physician
and a citizen, I was called upon to travel
a lot during this period since, as a militant
physician, one becomes something of a
life preserver for other groups tackling the
same kind of problem. In our eyes, they
see the light of hope to which they want
to cling. As a matter of fact, a group of
Inuit in Nunavut invited me to take part
in a mini-tour of the villages of Iqaluit and
Baker Lake. I also made two trips to Cree
territory to speak during audiences since,
at present, the most developed uranium
project is north of Mistissini, in the heart
of Cree territory.
This is the Otish Mountains project which
does not have any “social acceptability” as far as the Cree are
concerned. At the start, it was only the Cree of Mistissini who
opposed the project. Since the Spring 2012 audience, the
Grand Council of the Crees (with Chief Matthew Coon Come)
clearly said no to the project and insisted on a moratorium on
all uranium exploration and extraction projects. According to
the Grand Council of the Crees, these projects go against the
fundamental values of their nation.
No matter where we come from, no matter
NO MATTER WHERE
Far from giving up, the citizen opposition movement WE COME FROM, NO
where we live, as citizens, we need to
continued its activities. During the summer of 2010,
know what are the stakes associated with
we took part in the Parliamentary Commission on MATTER WHERE WE
the question of uranium. Uranium mines
the reform of the Quebec Mining Act (an archaic LIVE, AS CITIZENS, WE
create, on their own, millions of tons of
law dating back to... the gold rush!). We presented NEED TO KNOW WHAT tailings that retain approximately 80 to
a white paper containing more than 50 pages and
85% of the radioactivity originally present
ARE THE STAKES
entitled Exploration et exploitation de l’uranium au
in the ore. These tailings constitute radioacQuébec : pourquoi nous demandons un moratoire3. ASSOCIATED WITH
tive waste that needs to be completely
isolated by physical barriers sufficiently
This white paper was endorsed by more than 50 THE QUESTION OF
impermeable and erosion-resistant for
colleagues from everywhere in Quebec. The most URANIUM.
thousands of years. There is at present
discussed subject at this commission was “social
acceptability.” In fact, the situation in Sept-Îles was
no proven method to eliminate the risks of
often referred to as an example. The work of this commission
contamination that this waste presents in the long term for the
has since been shelved. The following summer, the government
environment and for human populations. The problem associated
created another parliamentary commission, but consultations
with uranium is the same as the one present at Gentilly-2, the
were by invitation only. Strangely enough (!), all the physicians
power station that the new government has decided to close,
and other specialized stakeholders who had appeared to present
for economic as well as for environmental reasons.
white papers either regarding the issue of uranium extraction,
or the issue of asbestos mining, were not invited to this new
Medicine
North of the 49th
In Canada, both British-Columbia and Nova Scotia as well as
the state of Virginia, in the USA, have moratoriums on uranium
mines, mainly because of the specific risks for the environment
and for humans.
In December 2011, the prestigious National Academy of
Sciences published the results of its study entitled “Uranium
Mining in Virginia: Scientific, Technical, Environmental, Human
Health and Safety and Regulatory Aspects of Uranium Mining
and Processing in Virginia”4. The Academy concluded that even
if the moratorium in Virginia were lifted, there would still be many
obstacles to overcome before being able to operate a uranium
mine safely.
After several uranium mine operation projects were subjected to
strong opposition by affected populations over less than three
years and at the request of more than 340 municipalities and
regional county municipalities (RCM) in Quebec who have been
demanding a moratorium on uranium mines since 2009, it is
time for Quebec to carefully study the risks and impacts linked
to this industry. The new Minister of Natural Resources, Mme
Martine Ouellet, and the Environment Minister, Daniel Breton,
recently proposed launching a strategic environmental evaluation
(generic BAPE) on uranium mines in Quebec. A generic BAPE
with a broadened mandate and public audiences throughout
Quebec would be both pertinent and necessary. Naturally, to
be consistent, no uranium mining project should be authorized
during this evaluation.
We believe that this file will not have been in vain and that a
moratorium on uranium exploration and extraction in Quebec
will become reality. Developments can thus be expected! We’ll
be there, for the health of the population of Sept-Îles, whom we
have defended to the full extent of our powers and for the overall
population of Quebec.
References:
1
Rasvan Popescu, of Romanian origin, worked for several years in a
nuclear power station in Romania. He lost his mother and his friends in
the accident at the nuclear power plant at Chernobyl.
2
See article in the newspaper Les Affaires at http://www.lesaffaires.com/
imprimer/vision-durable/innovations/uranium-sur-la-cte-nord-c-est-malparti/527036
3
White paper available at http://www.protegerlenord.mddep.gouv.qc.ca/
memoires/medecins-sept-iles.pdf
4
Available at http://www.nap.edu/catalog.php?record_id=13266
In the Eye of the European Union…
Quebechasanenormousstockofnaturalresourcesthathavebecomeessentialtotherestoftheplanet.In
fact,thissummer,GermanChancellor,Angelamerkel,whileonavisittoOttawaforabilateralmeeting,said
that“Thesupplyofcommoditieshasbecomeastrategicallyimportantissueformany,manygovernments
intheworldandthisiswhywearehappytohavecloseco-operationwithacountrythatisasrichinnatural
resourcesasCanada.” Canada.com, August 16, 2012.
Expertise has a Price
When the Federation Gets Involved
Quebecisindeedchock-fullofresources!GoodnewsforQuebec’seconomy!Thefinancingofoursocialprogramscouldcome,in
part, from the economic benefits of developing the North.how does one go about recovering a fair share of the profits generated by
thecompanieswhoexploitQuebec’sresources?The Fédération des médecins spécialistes du Québec studiedthisquestionwithinthe
framework of its campaign “expertise has a price.” This was, in fact, our answer to the government infebruary 2010, a government who
keptrepeatingthatthetreasurywasemptyandthatwehadtocometotermswiththestate’scapacitytopay.Thus,thefmsQcameup
with 10 economic measures that could allow the state to find additional revenues without dipping into taxpayer pockets.some of these
couldeasilybeappliedtocompanieswhoarewaitingonthevergeofournorthernterritories,forexample:
• Taxingwaterusedinindustrialprocesses;
• Reviewingthepriceofelectricityforlargeenergy-consumingcompanies;
• Reviewingroadconstructioncontracts(Quebecpaysupto35%more–astheCharbonneauCommissionhas
easilyproven);
•enforcingtheQuebecminingAct(decontaminatingsoils,payingminingroyalties,etc.).
***A lltheinformation,advertisementsandreferencedocumentsareavailableonthefederation’sportalatwww.fms.orgoronthecampaign’sownsite
atwww.lexpertiseaunprix.com.
35
vol. 14
no. 4
LS
GREAT NAMES IN QUÉBEC MEDICINE
humanityandhope
Inthepreviousissueofthismagazine,ourGreatNameinmedicinehadworkedonidentifying
thetracesthatleadtotheoriginsofthegreatAIDspandemic.Today,ourGreatNameisatthe
otherendofthespectrum:beyondtheprovenanceandsourceofAIDs,hewantedtohelpthe
peoplerejectedbythesystemoncetheirhIV-positivestatuswasunveiled.
Absolutely nothing predicted that Jean Robert would practice
medicine. In fact, he claims he never chose to become a
physician. His father was a notary in a small neighbourhood
practice and, quite naturally, he thought he would follow in his
father’s footsteps. However, as he was nearing the end of his
classical education at Collège Sainte-Marie in Montreal, his
friends, all of whom had already selected medicine, invited him to
join the group: “It’ll be easier for you because we’ll all be together.
You have the talents needed. You’d be a great doctor,” were the
comments he heard at the time. Attracted by his colleagues’
opinions and influenced by his biology professor, he decided
to make the leap! Before entering university, he made sure he
paid a visit to one of his uncles who was involved in research
with Dr Hans Selye, just to see the laboratory and get a taste for
what the work environment would be like. He realized that if he
went into medicine, it would not be to undertake fundamental
research, but to help those really in need.
“Among all the possible careers
FOR SOMEONE WHO
I was faced with, this was the
EXPECTED A VERY
best,” he admits today. For
QUIET CAREER IN AN
someone who expected a very
OFFICE, HE FINALLY
quiet career in an office, he
finally found himself at the heart
FOUND HIMSELF AT
of the action during a period of
THE HEART OF THE
major changes in society. With
ACTION DURING A
a medical diploma in hand, he
decided he would be a general
PERIOD OF MAJOR
practitioner for a while. Hired
CHANGES IN SOCIETY.
by Hydro Quebec, Dr Robert
took off to replace a colleague
working at the Manic 5 dam site.
Then, after his return to Montreal,
he pursued his training in respirology at Hôpital Saint-Luc, with a
few former colleagues from Collège Sainte-Marie. His supervisor
noticed his special talent for using a bronchoscope, a tool that
used to be rigid and difficult to manipulate. But his dexterity cost
him: after a year of performing bronchoscopies, he diagnosed
himself with tuberculosis and had to be admitted to a sanatorium,
the one he used to send his own patients to for treatment.
36
vol. 14
no. 4
LS
Recovering his health took a year. After being discharged from
the sanatorium, but still weak and emaciated, he was strongly
advised by his director not to pursue his specialization (that
would have required him to be on call every three days) but
rather to undertake a master’s degree in science where he
could choose between anatomical pathology, biochemistry,
experimental medicine, pharmacology or microbiology, which
latter immediately interested him. He liked the clinical side of
DR JEAN ROBERT
microbiologist,InfectiousDisease
specialistandCommunityPhysician
this science. It’s no surprise that his master’s thesis dealt with
the microbiology of bronchial secretions in patients with chronic
bronchitis. Once his specialization in microbiology and infections
diseases completed, he added a fifth year in internal medicine.
Tuberculosis had a direct influence on his medical direction. “We
often hear of someone choosing one branch over another. In my
case, it’s the branch that chose me.”
It was no surprise that he worked as a microbiologist at
Saint-Luc’s. In 1976, when departments in community
health were being set up, he was offered the position of
director of this department. He hesitated for many months
before saying: “I’ll try, but only part-time for the first months,
in order to make the transition from one type of practice
to another the right way.” He stayed for twenty years, but
always part-time: this meant that he dedicated 70% of his
time to it, while the other 30% was spent on his clinical
practice in infectious diseases.
Dr Jean Robert was in the front ranks when the healthcare
network was reorganized to better serve the population. At
that time, the territory covered by his department measured
approximately 30 km2: in other words the central part of
Montreal, with 450,000 residents in addition to some 200,000
daytime workers. Dr Robert supervised the CLSC Centre-ville
and CLSC Centre-sud and took part in the foundation of the
CLSC Plateau Mont-Royal as well as that of Park Extension. Then,
he merged into his department Montreal’s Health Department,
the Bruchési Institute and the Laboratoire de santé publique de
Sainte-Anne-de-Bellevue (where he had previously been named
scientific director) and this, until the creation of the Institut national
de santé publique.
In parallel, he obtained a specialization in community medicine.
Called up to teach, he gave his practical classes on Saturday
evenings on Sainte-Catherine Street, in direct contact with
prostitutes, drug addicts and the homeless. His students from
those days now work, for the most part, in community clinics
in the downtown area (l’Actuel, l’Alternative, Quartier latin, etc.).
GREAT NAMES IN QUÉBEC MEDICINE
During these years, he witnessed a radical change: a virus was
illness has a code and a name while the patient’s name is
sowing panic throughout the entire planet and ravaging several
being forgotten. Today, when we want to look after people, we
community groups. AIDS hit hard; the world’s medical community
plan information campaigns by printing brochures, launching
was in turmoil; it really was a pandemic. At the request of Pierreadvertising campaigns, Internet sites, etc. We make splendid
Marc Johnson, Minister of Health at that time, Dr Robert left on
brochures without wondering if people even know how to read.
an official mission in the name of the Quebec government and
There is little left, in these magnificent campaigns, for direct
visited England, the Netherlands, Switzerland, Italy and France
contact with the patient and even less with the system’s rejects...”
where he met, among others, Professors Luc Montagnier
and Françoise Barré-Sinoussi from the Pasteur Institute
The hidden side of these vast public
“THE PEOPLE
health campaigns has become
(joint winners of the Nobel prize in Medicine in 2008).
WHO COME TO SEE
D r R o b e r t ’s m a i n c o n c e r n a s a
Dr Robert came back to Quebec with a sample of the
ME ARE THOSE
first strain of AIDS in his pocket, enough at least to carry
humanitarian. “Needs are sometimes
on his own research in the Laboratoire de santé publique
so simple that we don’t even think
WHO HAVE THE
of the m.” For example, some of
du Québec. AIDS being a hot topic on the news, the
GREATEST NEED
government appointed Dr Robert as a special consultant.
Dr Robert’s patients don’t even have
OF MY SERVICES,
a health insurance card because they
BUT WHO ARE
His expertise was rapidly recognized: so well in fact that
have no address, no fixed domicile.
he was invited to work abroad. He received mandates for
“The people who come to see me are
FORGOTTEN
the World Health Organization and for Africa, teaching
those who have the greatest need of
BY EXISTING
all over the world, including 26 years of giving courses
my services, but who are forgotten
PROGRAMS.”
by existing programs. We promote
on AIDS, hepatitis B and other diseases at the Faculty
of Medicine, Paris Diderot University.
screening campaigns for HIV-positive
patients, then we delegate to the judicial system the responsibility
Then, in the early 1990s, community health departments were
of declaring guilt and meting out punishment – we’ve already
reorganized, moving from a clinical environment to a more formal
seen this with tuberculosis, syphilis and smallpox! Aren’t we
structure, educational as well as bureaucratic. This change in
forgetting that an effective preventive action is demonstrated
direction was no longer welcoming to Dr Robert’s multiple
by the absence of new infections? Shouldn’t we rather promote
projects and expectations, but he remained in his position until
HIV-negativeness in order to protect and maintain it? The problem
the complete abolition of his department in 1996. He would say
is how to justify the funds to find fewer cases.”
later that bureaucratizing the healthcare network greatly changed
the face of community healthcare organizations.
Today, there are between 15,000 and 20,000 people living with
HIV in Quebec. HIV is still fatal 20 years later, but under what
The Hôtel-Dieu de Saint-Jérôme then offered him a full-time
conditions. “We live longer, of course, but under the obligation of
position in microbiology. He accepted, but maintained his
continuously taking antivirals. And the stigma and the rejection
teaching and research privileges at the Université de Montréal
remain.” Quality of life is seldom proportional to the quantity.
and decided at the same time to help a small community
Dr Robert will never get used to seeing his patients die. He says
organization that looked after a clientele of high risk or destitute
that the death of a patient makes him accept the reality that we
patients (AIDS, hepatitis C, infections, STDs, drug addictions,
will all die one day. These passing lives often bring him to reflect
homelessness, as well as the condition of prisoners and
on the human condition. “Sometimes, we need a major shock
prostitutes, etc.). His expertise, his innumerable contacts and
to wake up; for some, an earthquake is needed to get them to
his knowledge of the environment were all assets for this little
take hold of themselves.”
group created at the end of the 1980s by families of people with
AIDS (the Centre Sida Amitié). Born from sharing ideas around
But there’s always hope. “We developed tools to help improve the
a cup of coffee, the Centre’s principal mandate today is to look
quality of life of patients. It’s not a question of how many years
after people with HIV-AIDS and hepatitis C. The Centre offers
we have left to live, but how we want to live those years.” And
medical services, temporary shelter, salvaged clothing, goods
projects to eradicate AIDS are progressing: Dr Robert has great
and furniture, food, a reintegration centre (supervised housing),
hope for the latest international research project supervised by
medical transportation services, screening services, a syringe
Françoise Barré-Sinoussi, whom he knows well.
exchange program for the Laurentians as a whole and other
community programs.
On the verge of retirement, Dr Robert says he’s ready to pass
on the torch. He is still trying to find someone who would carry
In 2000, Dr Robert left the Hôtel-Dieu de Saint-Jérôme to
on in the area where he spent a large part of his career. “There’s
dedicate himself fully to his private practice, closer to people
certainly a young physician somewhere who is going through an
and their suffering. “People who are sick are often marginalized
earthquake in his or her life. That person may have the humility
or completely excluded. At the Centre, they are entitled to my
and the reflex to come and see how my practice has been
full attention.”
beautiful and gratifying.” And if no one wants to follow him, he’ll
have no choice but to close the door... for good.
“ Looking back, I can understand at what point our system lost
its humanity. Faced with this bureaucratization, sick people are
Dr Jean Robert, a man with an extraordinary heart, a humanist
to whom society should lift its hat and say thank you.
rejected. Medicine has become immensely skilful at dealing
with illness and decreasingly so, at caring for the sick. Each
S
L
37
vol. 14
no. 4
LS
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a bonus before the end of the year to increase your contribution
to the maximum. In 2012, an earned income of $132,334 is the
maximum on which you can make contributions to your RRSP
for 2013, i.e. $23,820. And, if your tax instalments are late, the
time is right to send in a significant amount of your bonus in
order to avoid having to pay interest on your taxes.
Finally, paying yourself a bonus from a corporation can result
in a tax deferral. Your corporation could declare a bonus to be
deducted in the fiscal year in which it is payable, but this bonus
could, in reality, be paid up to 6 months after the end of the year.
Thus, you could defer generating personal tax on the bonus until
it is actually paid and thus profit by having the bonus continue
to generate income for the corporation until that time.
OPTIMIZE YOUR CHARITABLE DONATIONS
If you have set yourself goals on the charitable front, you can
benefit by planning your donations carefully. When an asset
is donated to a registered charity, the result is a transfer of
ownership, which could result in capital gains. Nevertheless,
there is no capital gains tax when the donation consists of listed
securities or mutual funds units. It could thus be extremely
advantageous to donate securities with unrealized capital gains
to the registered charity that interests you, thus negating any
tax you would otherwise have to pay. The value of the donation
would be calculated on the market value of the securities.
Financial planning consists of a set of strategies and actions to
take, according to your own situation while respecting evolving
tax laws. Do not hesitate to consult a Professional’s Financial
advisor in order to discuss all the ways in which you could reduce
your tax burden.
39
vol. 14
no. 4
LS
OUR SUBSIDIARIES
SOGEMEC ASSURANCES
BY CATHERINE FELBER
Assistant Manager,
Business Development
everythingYouNeed
toKnowAboutAnnuities
Asafinancialsecurityadvisor,Iamoftenaskedwhatthepurchaseofanannuitycanofferinthecontext
ofdecreasinginterestrates.myanswerregardingannuitiesasprovidingpotentialadditionalrevenues
at retirement is the result of a long-term vision. I have thus chosen to offer you, in this article, an
interviewwithfrancysBrown,ataxexpert,whohadtheprivilegeinthecourseofhiscareerofworking
foroneoftheoldestinsurancecompanies,acompanythatspecializesinparticularinannuities.here
isourexchangeinitsentirety:
The Gazette used to print a table showing the
amounts available by age and gender. Are there
other publications who do this for clients?
The annuity market is an area that is often ignored by clients.
Most brokers have access to the Cannex System – which
provides a sampling of the revenues offered by various
companies. You have to realize that some values are not
indicated; for example, a 20-year deferred annuity. However,
it is possible to access Globe Investor Markets via the internet
to view a good summary of the amounts available by premium
deposits by age. Results are not personalized, but are market
indicators by age, i.e. 55, 60, 65, 69, 70, 75 and 80.
In spite of decreasing interest rates, would
you recommend purchasing an annuity?
Yes, but not systematically. I recommend it for those who are in
the process of cashing in at retirement. Receiving 25% to 33%
in the form of regular payments from a pension gives the client
security and maximizes his or her revenue.
Is there a starting age at which you
recommend the purchase of an annuity?
In order to maximize pension revenue (taking life expectancy into
account), a person should, in most cases, purchase an annuity
starting at the age of 60 or 65, if the first payment is immediate.
For those between 50 and 60 years of age, a deferred annuity
may be the better solution.
Clients are often advised to convert
approximately 25% of their overall portfolio in
annuities. Is this recommendation valid?
Investment advisors are now more conscious of the cashing-in
market. Aging demographics and long life expectancy are the
reality. At a certain age, a fear of market fluctuations can also
have an influence. We can easily see a client with 40% of his or
her portfolio in bonds turn to the purchase of an annuity for the
revenues it can generate.
40
vol. 14
no. 4
LS
Is the annuity payment based on a single rate or
on various short, medium and long-term rates?
The term associated with the annuity is often based on the rate
of the paired investment, whether it is a provincial, corporate or
mixed bond or even a 20-year commercial mortgage. It must be
said here that the payment of the annuity is often a combination
of principal and interest.
Does the annuity have to be purchased
with registered funds or not?
This is often decided on a case by case basis. For people who
do not need additional revenues, a deferred registered annuity
starting at age 71 would allow them a superior return while taking
advantage of tax deferrals over a longer period. A good number
of annuities are purchased with registered funds – either at the
RRSP/RRIF level or from a pension fund. Prescribed annuities
that benefit from preferential tax treatments may be of interest
to those individuals who have substantial unregistered assets.
As a result, these are the two most frequent types of annuities.
Do you agree with the prevailing school of
thought that holds that an annuity could be
an integral part of an investment portfolio, as
a source of fixed revenues, for example?
In a practical sense, you have to look closely at the total of
consolidated assets along with the client’s profile. It is true that a
percentage of revenues derived from the purchase of an annuity
would guard against stock exchange fluctuations. This is the
long-term view. However, it is important for everyone to respect
the investor’s profile. It is sometimes difficult to have knowledge
of all of a client’s assets.
Is the back-to-back annuity strategy or that
of an insured annuity often used?
This strategy links together life insurance and a prescribed
annuity (the latter benefitting from a preferential tax treatment).
For this strategy to be viable, pensioners have to be insurable
in order to recover the capital for the estate. As the return can
be very interesting, this strategy is often considered.
We wish to thank Mr Francys Brown for his contribution to
this article.
Pleasenotethat,inadditiontoofferingyouaninsuranceplan
designedforQuebec’smedicalspecialists,sogemecAssurances
hasadvisorswhocanassistyouinplanningyourretirement.Ifyou
haveanyquestionsregardingannuities,pleasedonothesitateto
getintouchwithoneofouradvisorsat1-800-361-5303.
OUR SUBSIDIARIES
SOGEMEC ASSURANCES
BY GILLES ROBERT, MD
President
howWellDoYouKnow
thefmsQGroupPlan?
Since January 1, 1997, the Fédération des médecins spécialistes
du Québec, through its subsidiary Sogemec Assurances, has
been under the obligation of providing drug insurance coverage to
its members to comply with the Act respecting prescription drug
insurance. However, it is important to remember that, before the
implementation of the drug insurance plan, the FMSQ had set up
health insurance protection for its members.
WHY OFFER HEALTH INSURANCE?
The answer is simple: medical specialists, as self-employed
workers, do not have access to benefits programs. It was therefore
important to make plans available that would allow them and their
immediate families to acquire insurance coverage for healthcare
services that are not covered by the government plan (ambulance,
orthopedic devices, physiotherapy, etc.).
NO MEDICAL QUESTIONNAIRE
You may not be aware of it, but the FMSQ plan is available to all*
its members, without requiring a medical questionnaire. Whether
it’s for yourself or your family, you can be certain you have obtained
the protection you need. This is an important benefit since other
association or individual plans require you to fill out a health questionnaire, which may result in coverage being declined if you or
one of the members of your family has a health problem.
TRAVEL AND TRIP CANCELLATION INSURANCE
You no longer need to worry, or make calls a few minutes before
departure, if you have just realized you forgot to purchase travel
insurance. You can travel at any time and be assured you have
travel insurance and cancellation coverage that can protect you
in case of a sudden and unexpected health problem abroad. The
coverage offered by the FMSQ plan will protect you for any stay
abroad lasting 182 days or less; for those of you who are planning
on a longer stay abroad, such as for a fellowship, your protection can be extended for the full duration of your stay without
additional cost.
INSURANCE TERMINATION AGE AND
EXTENSION OF COVERAGE AFTER DEATH
Many of you have asked: up to what age can I keep this coverage?
You will be happy to learn there is no age limit and your coverage
will remain in effect as long as you wish. Your spouse will also
be able to retain this health insurance coverage after your death,
thus allowing you to ensure the coverage of your immediate family
after you are gone.
Don’t wait, get in touch with Sogemec Assurances to sign up for
YOUR health insurance plan.
* Certain conditions apply. Please get in touch with us to check into eligibility
criteria.
4575_SOGA_annonce_FMSQ_2012_expedition_7x4.5_Layout 1 4/2/12 2:15 PM Page 1
POUR TOUS VOS
BESOINS D’ASSURANCES
Grâce au
SERVICE PRÉFÉRENCE
LAISSEZ LIBRE COURS À VOS PASSIONS
SOGEMEC
ASSURANCES
ÉVOLUE AVEC VOUS
• Vie
• Médicaments
• Invalidité
• Maladie
• Frais généraux
• Dentaire
• Maladies graves
• Automobile
• Soins de
longue durée
• Habitation
• Entreprise
POUR EN SAVOIR PLUS :
1 800 361-5303
514 350-5070 / 418 990-3946
Par courriel ou Internet :
[email protected]
www.sogemec.qc.ca
SOGEMEC ASSURANCES
filiale de la
41
vol. 14
no. 4
LS
LemOTDUPRésIDeNT
DR GAÉTAN BARRETTE
Qu’est-cequ’onattend?
C’
est avec grand plaisir que je m’adresse à vous
aujourd’hui. Grande motivation aussi et, surtout,
grande conviction, particulièrement en ces temps
volatiles, pour dire le moins. Cependant, il y a une chose qui
ne change pas : la politique ! Quand vous lirez ces lignes, le
gouvernement du Québec aura déposé son premier budget et
aura certainement expliqué que la situation est pire que prévue,
que l’économie mondiale… et que l’État doit faire des choix. Soit.
C’est le prix à payer pour se faire élire, car la vérité fait rarement,
voire jamais, élire un gouvernement.
Dans la même catégorie, on notera l’incroyable volte-face
du nouveau ministre de la Santé et des Services sociaux.
On se rappellera que la FMSQ a, dans ces mêmes pages,
présenté plusieurs analyses et pris position quant aux travers
qui sévissent dans notre système public de santé. Plus
précisément, nous avons réaffirmé l’importance de la nature
« publique » de notre système de santé. Nous avons aussi dit
que, pour survivre, ce système devait se donner des balises
claires, choisir les services qu’il offre à la population. Quant
aux effectifs médicaux, la FMSQ a soutenu le principe de
1 médecin pour 1 500 citoyens en moyenne, en ce qui a trait
à la première ligne, un paramètre standard appliqué partout
dans le monde occidental.
Durant la dernière campagne électorale, cette approche,
reprise et défendue par un parti politique, a été complètement
ridiculisée par les autres partis qui l’ont qualifiée de simpliste,
d’irréaliste et de quoi encore. Mais surprise ! Voilà que la
fameuse approche est maintenant reprise sans être nommée
par l’actuel ministre ! Preuves à l’appui : le 5 novembre dernier,
à l’émission Que l’Estrie se lève (107,7 FM Sherbrooke), la
question suivante était posée au ministre : « Quand vous parlez
des GMF, un médecin par groupe de médecine familiale
peut prendre combien de patients ? » Et le ministre Hébert
de répondre : « Entre 1 000 et 1 500. En fait, l’objectif c’est de
1 500 et cet objectif-là va augmenter parce que l’ajout d’autres
professionnels de la santé va permettre de libérer du temps
de médecins et permettre de prendre de nouveaux patients
également. ». Oui… augmenter !!! Dans les jours suivants, le
ministre et d’autres voix du milieu médical de la première ligne
ont même lancé le chiffre de 1 800. N’en jetez plus, la cour
est pleine !
42
vol. 14
no. 4
LS
Chez nos collègues de la première ligne, on affirme que, bien
que les statistiques de la RAMQ indiquent qu’il y a environ
8 400 « facturants » (projection 2012 basée sur 8 180 en 2010),
en réalité, il ne faudrait en compter que 7 200, les autres ayant
une pratique marginale, mais pas nulle (expertises, évaluations,
industries, etc.). Bien. Alors, rebelote ! Si 7 200 médecins font
40 % de leur temps à l’hôpital, il faut donc considérer que
2 880 médecins sont des équivalents temps plein (ETP) à
l’hôpital ; alors 4 320 sont donc en cabinet. Supposons que les
1 200 autres (soit 8 400 – 7 200) valent 180 ETP (soit 15 % de
1 200... est-ce trop comme estimé ?) en cabinet, on a un beau
chiffre rond de 4 500. Appliquons ici l’approche du ministre,
soit 1 500 multiplié par 4 500. Stupéfiant : 6 750 000 Québécois
devraient être suivis aujourd’hui en cabinet par un médecin de
famille ! (7,2 millions si on prend le ratio international de 1 600 et
8,1 millions si on se rend à 1 800)… sur une population actuelle
d’environ 8 millions. Ouf ! Pourtant, on martèle que 2 millions
de Québécois n’ont pas de médecins de famille… Au fait, le
Québec est en croissance nette d’omnipraticiens. Nous sommes
heureux de constater que le gouvernement du Parti Québécois
endosse, lui aussi, ce que nous affirmions… envers et contre
tous. Comme la publicité le dit : « Ça aussi, ça fait du bien. »
Tout ceci sans l’ajout de personnel. Pourtant, on sait tous que
ce dont les cabinets de médecins ont cruellement besoin, c’est
d’abord des infirmières, des techniciennes et des auxiliaires…
et elles sont là. Elles ont pris leur retraite depuis moins de cinq
ans et plusieurs seraient enclines à reprendre un peu de service
dans un environnement moins envahissant comme celui des
GMF. Pourquoi pas un programme dédié ?
Cela dit, il en va aussi de l’intérêt des médecins spécialistes.
En effet, vous savez que votre pratique comprend parfois
jusqu’à 20 % de première ligne, portion qui vient grandement
ralentir votre pratique spécialisée et qui, en conséquence,
génère un problème d’accessibilité à vos services. Il est grand
temps que cela se règle pour qu’enfin l’arrimage entre nous et
nos collègues se fasse pour le bénéfice de tous, particulièrement pour celui des patients.
Je ne peux terminer ce mot sans parler négociations. D’abord,
l’Ontario est revenue sur les coupures draconiennes qu’elle
voulait imposer aux médecins en mai dernier. Non seulement
l’Ontario a-t-elle modulé ces coupures, elle a alloué de minimes
augmentations. Idem en Alberta. Et bientôt ailleurs. Tout cela
dans des contextes provinciaux de déficits budgétaires importants, en général pire qu’au Québec.
Voilà qui dit une chose : dans une société où produits et
services, peu importe leur nature, sont « payés» selon la «valeur
relative » que cette même société leur attribue, notre rémunération est on ne peut plus défendable et est, en fait, normale,
comme c’est le cas ailleurs. On exige beaucoup de nous : en
formation, en horaire, en responsabilité, en compétence, en
excellence. Et quand on erre, on nous punit beaucoup.
Durant les six dernières années, nous nous sommes battus
ensemble pour normaliser notre situation. Nous nous sommes
battus avec succès.
Oui, nous croyons en un système public de santé, mais nous
ne reviendrons pas en arrière. L’expertise a un prix. Point.
Syndicalement vôtre !
S
L
NOS FILI ALES
www.sogemec.qc.ca
1 800 361-5303
www.fprofessionnels.com
1 888 377-7337
NOS PARTENAIRES
U
EA
V
OU
N
www.rbcbanqueroyale.com/sante
1 800 807-2683
www.chateaubromont.com
1 888 276-6668
www.groupesolution2.com
1 877 795-9399
www.manoir-victoria.com
1 800 463-6283
www.manoir-saint-sauveur.com
1 866 482-5449
www.desjardins.com
1 800 CAISSES
www.westinmontreal.com
1 888 625-5144
www.estrimont.ca
1 800 567-7320
www.esterel.com
1 888 378-3735
www.montreal.hyatt.ca
1 800 361-8234
www.sogemec.lapersonnelle.com
1 866 350-8282
www.hotel71.ca
1 888 692-1171
www.telusmobilite.com
1 855 310-3737
www.multid.qc.ca
1 800 363-3068
www.fairmont.com
1 800 441-1414
www.rbcbanqueroyale.com/sante
www.centrecongreslevis.com
800 838-3811
807-2683
1 888
www.centrecongreslevis.com
514 288-8688
888 732-8688
838-3811
11 888
514 305-1155
1 888 910-1111
450 655-4717
Pour tout savoir sur les avantages commerciaux réservés aux
membres de la Fédération des médecins spécialistes du Québec
et pour connaître nos nouveaux partenaires commerciaux, visitez
le site Internet de la FMSQ au www.fmsq.org/services.
www.fmsq.org
Pour information :
[email protected]
ou 514 350-5274

Medicine

Transcription

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