Union Matters Episode #3: Crisis in Health Care

On this week’s podcast, we speak with Chris Parsons, Provincial Coordinator for the Nova Scotia Health Coalition and Gordon MacDonald from Capers 4 Health Care about the crisis in health care in Nova Scotia.

In June, the government suddenly announced the shuttering of two hospitals in Cape Breton leaving Cape Bretoners in a highly uncertain situation. Gordon MacDonald discusses how this has affected his community. Chris Parsons discusses the real cost of P3 hospitals and the threat of increased privatization in health care as well as the social and economic determinants of health.

“Health Care represents all these wider questions about the kind of world we want to build. As Nova Scotians, when we ask about who should make decisions about what is best for the public – the public should make those decisions and they should be democratically arrived at. We see an assault on that when we see the decision to close to hospitals in Cape Breton without any public consultation.” Chris Parsons

“[the closures of the hospitals] were a complete surprise to everybody. Nobody knew what was coming. That was not the message they [government] was giving in the legislature. They had been asked many times by the opposition members of the legislative assembly Tammy Martin and Eddy Orrell, who represent people here in Cape Breton. They were told the hospitals were safe and they were not closing – that the problem is the emergency rooms and they have to get some doctors – and that will all be taken care of….But lo and behold, that proved not to be the case.” Gordon MacDonald

Note: Capers 4 Health Care and NS Health Coalition representatives are participating in a rally at Health Care Minister Randy DeLorey’s Constituency Office in Antigonish on November 16th to call for answers after hospital closures in Cape Breton. To register for the bus trip or to find out more information, there is a Facebook event – click here: https://www.facebook.com/events/322056565255514/

For more information about Capers4HealthCare visit their Facebook page: https://www.facebook.com/groups/1782949211817955/

For more information about the Nova Scotia Health Coalition, visit their website at: https://nshealthcoalition.ca/

Please let us know what other issues you’d like us to tackle on upcoming shows! You can send your ideas and feedback to communications@nsgeu.ca.

Thanks, and happy listening!

See below for a full transcript of this week’s podcast:

Hello and welcome to Union Matters Podcast. Today’s topic is the crisis in health care and I’ll be your host, I’m Deedee Slye. Today we have two guests Gordon MacDonald from Cape Breton he’s a postal worker and a community activist. He became involved in the healthcare crisis when the Liberal government announced the closures of Northside General Hospital and New Waterford Hospital in Cape Breton back in June. Welcome Gordon.

GM Thanks, Deedee

DS And we also have Chris Parsons. He’s the Provincial Coordinator for the Nova Scotia Health Coalition, one of nine provincial health coalitions across Canada. The coalition goes back to 1979 when it was founded at a Medicare conference, and they are Medicare’s watch dog. They work across the country to protect, strengthen, and extend public health care. Welcome, Chris.

CP Thanks for having me.

DS Thanks for being here. I just wondered if we can start maybe on how you both got involved in health care advocacy. Maybe, Gordie? Do you want to tell us how you first got involved in being an advocate?

GM I’ve always been involved in some capacity. I’m a pretty active community member my whole life. Been a part of the regional government (when regional government was tossed upon us back in ’93, ’94). Was part of the group that was helping them promote and support the Cape Breton Regional Hospital during the ’90s, at the same time back in ’94 or ’95 when that was being built. So I’ve always been active in my community, but what bought me into the health care end of it into where I’m an organizer of the events was because I recently had some surgery back in April of this year. I had some follow up post surgery stuff. I was in the North Side General Hospital getting some tests done. I’m flipping through my social media and I see that our premier Stephen MacNeil here in Nova Scotia was coming with Health Minister Randy Delorey and our two local MLAs here, Geoff MacLellan and Derek Mombourquette, and they’re going to make an announcement concerning health care in Cape Breton. At the bottom of that post said that they were going to announce the closure of North Side General Hospital and the New Waterford Consolidated.

DS Yeah that was a complete surprise to you.

GM It was a complete surprise to everybody, to myself, to everybody that was in the place, to our local representatives on regional council. Everybody. Nobody knew what was coming. That’s not the message they were given in the legislature. They had been asked many times by the opposition, members of the legislative assembly, Tammy Martin and Eddie Orrell, and those people that represent us here in Cape Breton, they’d asked and they’d been told no, those hospitals were safe, they’re not closing. Problems with the emergency rooms, got to get some doctors, but that will all be taken care of. But, lo and behold, that proved not to be the case.

DS What did you know about the closures there, Chris?

CP I think like everyone else it sort of blindsided everyone. I think members of the legislature that represent those areas that were affected asked on the floor of the legislature and were told that there is no plan to do it. I think that it’s not just a problem for Cape Breton — this came out of no where, there’s no consultation — but it’s a real problem for other communities in Nova Scotia, in rural Nova Scotia in particular, who, on the one hand are being told by the provincial government to work on economic development, work on stemming the flow of out migration of young people in the communities. Being told to recruit doctors and all those things are completely undermined when they can’t guarantee to people — who are considering moving, who are considering staying there — there’s still going to be a hospital in six months. I think the uncertainty that that announcement created is a big deal not just for Cape Breton, but I think is a really serious big deal for a lot of communities in this province and I don’t think the provincial government took that seriously.

DS What’s the current state of health care in Cape Breton right now?

GM So, with the health boards and the fact that they eliminated our health board and decided that they’re going to run the whole ship from Halifax? They were forewarned about that, they were forewarned by — they did this pilot project in BC and Alberta some years back prior to the Liberal Government being elected here in Nova Scotia, so when they first announced the platform they were forewarned that this kind of a crisis would eventually happen. You no longer have any autonomy. Cape Breton Island is a fair sized body. We no longer have any autonomy, we have no so, we have no decision making, we can’t recruit our own doctors, we’re always relying on someone in Halifax to tell us in Cape Breton what’s better for us. It hasn’t worked. Since this happened our emergency rooms are constantly closed. All they ever are anyway now is walk in clinics. They’re only open from eight to five or something. They’re just basically a walk in clinic for people that don’t have doctors. Just recently with us we have a bit of an issue with them. There’s so much pressure on emergency rooms you’ve got no services at the regional emergency and the amount of wait times and stuff. People on the north side start heading to Baddeck, and the small little community emergency was overstressed. That became so overstressed that the emergency room doctor there decided that the province still was not doing anything for her, even though she was relaying all the issues, that she left and she went to Prince Edward Island. And then we had a part-time doctor, Dr. Monica Duff, who I know very well. They wouldn’t help her set up her part-time practice here and she ended up moving to Northern Ontario because she was doing other things. They could have taken Dr. Duff, put her in Baddeck, alleviated that problem and we would have had two doctors still available in Nova Scotia, here in Cape Breton. But we have no decision making, because we have no local autonomy and that’s one of the biggest issues I personally have. That people in Halifax make decisions for us.

CP The creation of a single health authority has basically created too many levels were people can actually demand accountability at the local level. We need to talk about ways where we can democratize health care more broadly. Right, so, I think that is a really small level, that’s democratizing the decisions that are made between a patient and doctor. A lot of patients talk about that. They want to be involved in their own treatment. We know that there are improved therapeutic outcomes from that. But I think that at a bigger level it’s making sure that our elected officials at the top level are responsible. We’re seeing the opposite move with that with public accounts not being able to look at health care issues right now. We’ve seen that with the refusal to answer questions. We’ve also see that with the fact that all these major health announcements have made by the Premier, not the minister that’s responsible for that, Health Minister Delorey. Also, I think, when we look at that we have to look at is, even in the later years of the existence of the various health authorities at the local level, people who actually sat on those — I’ve talked to people who sat on the Capital Health Authority Board — said that they were ignored as well. We’ve seen it with the IWK as well due to lack of board oversight there that actually lead to the former CEO of the IWK now being charged with fraud. So what we’ve seen is this move away from democratic control of our institutions that are important to us and that hasn’t just been in healthcare. We’ve seen that with the elimination of school boards, which is, in some ways sort of wild that happen so easily. It was a huge change in the way we govern one of our most important public services that we have in the province. So I think that when we talk about the forced merger of the health boards into the Nova Scotia Health Authority and into the IWK. We need to think about that as sort of a symptom of a wider problem, which is an attack on the way that we govern ourselves, and part of that is an attempt to make it easier to roll back the services that we actually take for granted. Services like education, services like health care, things like social services and social assistance, things like public housing, which basically doesn’t exist anymore in this province. As regular Nova Scotians, we increasingly have very little control over the things that are actually important to us.

DS And those things are health or related to health. Absolutely. Poverty it’s related to health — health outcomes. Housing. Those are all part of the healthcare coalitions — you know you’re always looking at all those things?

CP Yeah, I mean, the way I always phrase it is, people like to talk about emergency rooms in particular as being the most obvious symptom of the healthcare crisis. I always say that the overcrowding of emergency rooms, the closures of emergency rooms, people going into emergency rooms because they don’t have a family doctor, that’s a result of problems elsewhere in the public healthcare system. So that’s the result the fact that you can’t get a family doctor, you can’t get long-term care, you can’t get home care. That’s because you can afford your pharmaceuticals. Things that you need. But all of those problems, and the reason you enter into the health care system at all, the reason you’re entering that is because of problems elsewhere further up — what’s basically been a decade long assault on the Canadian welfare state. Which means you can’t get public housing. If you don’t have that housing, is all of your income is going to sub standard slum housing, you’re going to be more sick. If you don’t have access to a job, if we design cities that you can’t walk around in, if you don’t have access to nutritious food because you simply can’t afford or you don’t have time to prepare it because you’ve got family obligations as well as work obligations — all of these things force you into the health care system in the first place and then the lack of things that primary, long term, and home care force you into the emergency system. So we’ve seen is that the actual cost of doing things like operating emergence rooms has gone up because we’re not spending that money earlier in the healthcare system. More importantly we’re not spending in public health initiatives, which include things like maintaining a proper welfare state, which is ultimately just about Canadians taking care of each other. Unfortunately there’s been a long term erosion of that over the last several decades.

DS What do you think of that, Gordy? How are things in Cape Breton economically?

GM Chris has some real good points as far as housing and poverty and things of that nature because we happen to in one of the most, as far as poverty goes, we’re really high up on the poverty list across the country here in Cape Breton. Mark Eyking’s riding here is ranked number 2, which is shameful that that’s happened when it comes to poverty. More and more people are homeless here in Cape Breton. Recently we just had a doctor retire, another doctor’s gone off sick. 5,000 more residents here with no family doctor to go with the thousands of others here in Cape Breton that have no family doctor. When you have people that are hungry and can’t get health services — you’re right. It’s all about health care. And the fact that they’ve eliminated the decision making in each — in all — parts of Nova Scotia is contributing to the way we apply services in these areas. As someone who has been a letter carrier out on the streets for a long time, you see it more and more and you see it with the social issues that are happening here as well. For them to come in to announce closures of hospitals with no direction about what kind of health care we’ll have left in these communities when they’re done. Emergency rooms are absolutely a number one issue here in Cape Breton. I don’t know if anybody’s been to an emergency room lately, but the conditions in these places and the wait times are eight to twelve hours, sometimes more, sitting in a not very nice area.

DS I’m also thinking this moving away from democracy fits in with a larger concern that we’re seeing all over the place.

CP It’s important to think about healthcare in two ways in this province. One of them is that the health care crisis is a moral crisis and I think it’s important to think about what it means when we say that we’re not going to invest in health care. What we’re saying is that rather than tax the Irvings and the Sobeys and the Stronschs of the world, of the country, the people we have in this country with massive wealth, rather than tax them at the same way we taxed them at fifty years ago, we’re willing to let people die in the hallways of our hospitals. In 2018 in Canada we’re one of the richest societies in the history the world. We have access to medical science and technology that was undreamable. We couldn’t even imagine that forty years ago. You look at the medicine you see on Star Trek and that is barely better than what we have today. In some ways we’ve out paced it. Yet we are making that decision collectively that we don’t care about our neighbours, our family, strangers, that we don’t owe them a duty morally to take care of them when they get sick. That everyone this country and everyone in this province should have equal access to health care regardless of how much money they have in their pocket, and to me that is a significant moral and ethical failing that I don’t think people have taken seriously and I think that political decision makers — elected officials — need to answer to. They need to, quite frankly, tell us that they believe that making sure that bankers and investors and the wealthiest families in this country deserve their wealth more than everyone else deserves to essentially survive or live a dignified life. So I think that’s one way we need to think about it. The other thing I think we need to think about on a larger political level is that one of the reasons why Canada has, up until very recently, appeared to be much more immune to kind of what’s often called reactionary or right wing populism. What I would call an anti-democratic impulse. I think populism is sometimes a shorthand that’s used for, but it’s essentially driven by elite interests. One of the reasons why Canada has been able to have some sort of bulwark against it has been a strong welfare state. And that, for a lot of people, things like a reasonable level of health care, a reasonable access to things like social assistance, the possibility of retirement, did those things as was as feeling like your voice matters in some way, are the things that keep people from siding with strong-arm dictators. It’s when things become horrible, when people lose hope, that they’re able to find themselves in the thrall of reactionary demagogues. So if we’re actually concerned about things that have happened in places like Brazil or are emerging in the United States. What we need to do is actually protect things like health care and I think that in particular, the fact that Halifax is doing pretty reasonably well for the most part, that’s not true for everyone in Halifax, but statistically, in terms of health care, employment, and incomes, Halifax is doing alright. But the rest of the province, especially rural parts of this province are doing very poorly economically and in terms of access to social services, means that there is an increasing divide in Nova Scotia that I think is a real political problem that for those of us who care about protecting a social safety net that we need to take that seriously, because those are the conditions actually give rise to people who were willing to side with reactionary demagogues and strongmen. That’s what we’ve seen historically both internationally and including in Canada. Moments for things like social credit and other natural reactionary movements in this country have really gotten a hold.

DS I was thinking and also what comes out of a failing or an overly stressed public health care system is that those people who can barely afford it, or can afford, it who are richer, they look to private. They’re more likely to go somewhere else. How do you see a threat of private health care? Is that growing in Canada? Are we seeing expressions of that? Should we be worried?

CP Absolutely. In Nova Scotia in particular we’ve seen really — the problem is we already have a lot of privatization that people don’t think about. The ambulance system is a good example of that. It was sold out to private contractor years ago and that’s not a slight against the people, the very good people, who work in emergency medicine as paramedics. I think that we also see it in things like Scotia Surgery which is a private surgery clinic in Dartmouth. But also we see it in other things like the emergence of private clinics. A big one is eye clinics. People are often being double billed for eye surgeries. We know there’s a handful of clinics doing that. We’ve seen it recently with the introduction of an attempt by some committees to profit off of the lack of access to primary care and are looking — say that if you can pay thirty dollars you can jump the queue and get into see a nurse practitioner, for example. So we have those aspects which are creeping in and there is a real danger that what can happen is that I we’ll see the wealthy or those who are desperate enough to pay for it and are being exploited and forced to pay for it essentially out of desperation, create one system for themselves, which will siphon off resources out of the public system. So if you think is a problem where there aren’t enough doctors and nurses now, imagine what happens when the wealthy can buy a whole new system for themselves. But it also makes it much easier for those who can pay to say, “Why am I funding the public system at all? I’m not getting anything out of this.”  So it erodes the very social solidarity that underpins health care in Nova Scotia and in Canada. I think we need to think about health care as a promise that we make to other Canadians. That it is a promise that when you get sick, whether you’re my family, my friend, or a complete stranger, I’ll chip in to take care of you. And when we introduce privatization into that system were breaking that promise, and we’re eroding the very underpinnings that allow that promise be kept. I think that’s a serious concern for the health coalition and it’s important for us to not just think about ways in which we can stop privatization, but things that have been private and making them public. So for us, and I know for many — for all — of our allies in labour have stood firmly to say that we need a public pharmacare system that will alleviate some of those problems in the emergency system to see that people will get medication they need, but also that will bring back into the public sphere something has been the purview of for-profit insurance companies and pharmaceutical companies for too long and that has put private profits head of the public needs of patients and Canadians as a whole.

DS What do you think about privatization, Gordy? Do you see any of that kind of stuff in Cape Breton?

GM That’s some of the big fears we have in Cape Breton with the closures of the hospitals. What’s going to happen to our long-term care? Is that going to go from public to private? Things are tough enough in long-term care now, as it is. Imagine that going private. When you go private it’s for profit. They’ve got to make money off it, so those people come into the two-tier health care and you got lots of money, I guess you can get some good care. But if you’re just regular, middle class working person, who’s struggling to get by like the majority of people in most of Canada, what kind of care are you going to get? You don’t have to look any further than what was recently going on with bed sore in these facilities and the kind of care that was happening in those places. So you can imagine farming this kind of stuff out to the private sector? We’ve never had any good success going for public to private. It’s never been beneficial to the regular Canadian. It’s all about making more money. The fact that the elite are continually holding on to their money while the rest of Canadians are struggling on a regular basis to get by and government are supporting this kind of action…it’s not helpful to regular Canadians like myself and you guys. I have a very big fear of what’s going to happen with private enterprises. The announcement from the government about the QEII P3s and how much that’s going to cost Nova Scotians — billions of dollars. And we have no control over anything until the thirty years. It gives away our ability to have any say or any control. It’s very concerning to me, these private clinics opening up when you can pay the extra money to get some kind of health care. Again, they scare me. It seems like we’re all forgetting about the generations that are coming up behind us. I’m 56, I’m at the other end of that spectrum. But that doesn’t mean that I don’t have — I have seven grand kids that are young enough to have to come up through it, so what’s going to happen to them, to their health care. The lack of transparency coming from our government here in Nova Scotia — it’s really sickening how secretive they are. They don’t discuss anything. It’s not above them to straight-out lie to the public. They straight-out lie in the legislature, and they continually get away with it. There are enough words spewing out that some people pick it up as truth. These things are problems. You mentioned earlier about eliminating the school boards, well, I still wonder in my head, how do you take a democratic body like elected school board members and eliminate them? If that’s the case, why don’t we find someone who can say “Let’s eliminate this government? They were elected, too! Let’s put somebody else in there.” Lot’s happening with the way this capitalist society is working. It’s not working for regular Canadians or regular Nova Scotians and the private enterprise, when it comes to health care, scares me a lot. It didn’t work for the schools, it didn’t work for Nova Scotia Power, it’s not going to work for healthcare. It’ll pit the rich against the poor.

DS This thought that it’s going to be more costly…do you think communities are going to have to bear that cost, Chris, into the future? What will it cost Nova Scotians?

CP Absolutely. A good example of this is the proposed P3 model they call P# mode (proposed private partnership model) to be used to replace the services and buildings that were at the VG site in Halifax and they were going to move some of those to an out-patient clinic in Bayer’s Lake, which is it’s own nightmare, but also next to the HI site. They’re talking about a two billion dollars deal to build a new facilities and that number is incredibly high. I mean two billion dollars is higher than we would assume it would cost to build that if you look at comparable facilities in places like British Columbia or Ontario or even in Nova Scotia. But we don’t know what those numbers look like, really, because the report that they’re basing it on from Deloitte, who are themselves have a huge, huge interest in promoting P3 system deals, these privately financed schemes where private industry is brought in to “partner” with public bodies to build public infrastructure. In reality end up being privately owned or at least essentially privately maintained by the private industry. The report that Deloitte prepared for the provincial government isn’t being made public. Frankly, I don’t think we can trust those numbers even if they were made public. But if we knew those numbers we could look at them and analyze and figure out whether or not they are real. But the provincial government is saying that they’re not going to release them and that’s just sign of more to come. That’s what these so called P3 deals do. They obscure where public money is going and claim that it’s a necessity because of a trade secrets. But when we think about that we think of the fact that in BC there was recently a report from the Columbia Institute saying that it costs something like one point three billion dollars over the last decade extra to build P3 infrastructure instead of normally publically procured infrastructure. In Ontario we saw numbers north of four billion dollars over nine year period there in money that was wasted by going into P3 models in P3 deals on instead of using normal public procurement models. So if we look at in Nova Scotia, if we’re talking about spending a billion dollars that was unnecessary on a hospital that was essentially just subsidizing private profit, that’s mean that’s not going into the front line services. So if you think about that every time the government says that there’s no money to spend on health care, they’re just giving that money to a consortium of private companies that are going to design, maintain, and build a hospital we should build and own and maintain ourselves. It’s the same thing, too we look at one of the things that really concerns me is as Gord said is this question of “What are we going to do for the next generation?” I myself am 33, just recently turned 33, on the younger side I suppose, and I think about the fact that McNeil and higher ups in the Nova Scotia Health Authority, in ten years’ they’re going to be on very generous pensions that I can ever dream of having, and they’re not going to have to worry about these things. But as someone who still going to be living in Nova Scotia, hopefully having a family in Nova Scotia, it scares me think that we’re going to have this bill due onP3 hospitals. This P3 hospital, the P3 highways that are being built, but also the fact this government refused to play hardball and negotiate a deal around the Canada Health Accord and demanding a Health Accord that actually kept pace with the funding needs of the province and the federal government is giving us over the next ten years nine hundred and ninety three million dollars less than we need under the Canada Health transfer, which is another ticking time bomb. And that is the result the fact that this provincial government is willing to play hardball and quite frankly be unfair when it comes to negotiating with nurses and teachers, but when it comes to negotiate the federal government, they rolled over and were the second province to sign these bad bilateral deals. If you look at the fact that we’re going to be almost a billion dollars short on the Canada Health Transfer, because of the changes to the escalator clause there, if you look at the fact that we’re probably going to spend north of a billion dollars more, potentially, on public infrastructure than is necessary, this is money that is coming directly out of frontline services. That’s money that’s not producing new long term care beds, that’s money that’s not producing — that’s not training new doctors and new nurses not offering incentives to have them stay here, that’s not innovating in frontline delivery. So we’re essentially leaving money on the table and giving it either to private companies or refusing to demand it from the federal government in exchange for them not having to make a difficult political decision of raising more revenue through things like natural resources, royalties, or through corporate taxation. All of these are things that I guess we’re leaving on the table, that’s not being spent on Nova Scotians. You combine that with the fact that we are having significant demographic challenges going forward and elderly population, aging population, a population that’s going to have increasing acuity when it comes to health care needs. I’m scared for the future of the province and I think that it’s something that’s not be taken as seriously by, particularly, the party in power, but quite frankly all the political parties at this point. The really significant challenges going forward that are not being thought about in terms of how we actually budget for public health care in that there isn’t, as far as I can tell, any sort of long term plan for what public health care is going to look like in fifteen years. I worry that that’s because people in power think that we aren’t going to have a public system, or at least a single tier universal public system in fifteen years.

DS How are you organizing there in Cape Breton, and what are your next steps? What do you think are some solutions? What would you like to see?

GM All the things that Chris was referring to are all the reasons that we here in Cape Breton are taking on. We’re going to take the grass roots approach. A group that’s called Capers 4 Health Care — you can find us on Facebook — that’s where we’re doing all of our push from. The push-back, the fact that Canadians and Nova Scotians know very little about the discussions that we’re having here. The fact that there’s no transparency from this Nova Scotia government, they’re just charging ahead and not listening to anybody that has any inside knowledge and they’re just steam-rolling through. So we’ve taken the stand that — and again, I come from a postal worker background, so I have a fairly militant background behind me when it comes to this kind of stuff — and I for one, personally believe that we, as a society have become much too nice to government. We’ve been very nice to allow them to do all the things to us that they have done. I think it’s time to get back. To be a little more militant and to use a more “squeaky wheel gets the grease” kind of approach. What we’ve done here in Cape Breton, we’ve — when these announcement come up — we’ve organized. A couple of us got together and said we’re sick of politicians. We want to have a town hall. We want to hear from the community. We want to hear from the people that — our government is going out in public and saying “Oh, we’re talking to everybody.” well, we wanted to find out. So we had two town hall meetings. One in North Sydney that got over 400 people. One in New Waterford that brought in upwards of 250 people on a Sunday afternoon. Both of them we were challenged in those rooms to do more. So what we’ve done, we said — because we had our MLAs: Tammy Martin, NDP, Eddie Orrell, PC — both of those are rep people that the hospital announcements were in those ridings. So we had them and the Premier and directly asked Health Minister Delorey to come to those meetings, answer some questions from the people and shamefully, Minister Delorey had absolutely no ability to answer a one word sentence. “Mr. Minister, can you come to Cape Breton to these town hall meetings?” He didn’t know what yes or no meant, so he babbled about all kinds of other stuff that still didn’t answer the question so he avoided the question, he refused to come. The Premier didn’t show up, the Health Minister didn’t show up, the two MLAs here in Cape Breton that represent the people here didn’t show up, so we said, “the hell with you, if you don’t want to come to us I guess we’ll go to you.” On November 16, 2018 we’re going to Minister Delorey in Antigonish. Our plan is to — and we’ve been fund-raising now for the last week — we have enough funding to lease one bus, possibly two or three by the looks of things, we’re having a motor-cade put together, and we’re inviting anybody who has any interest in health care here in Cape Breton to join us on this adventure. We’re going to get ourselves up the causeway. We’re inviting the media. We’re going to get off the buses, we’re going to walk across the causeway in a very organized fashion, we’re going to hopefully be assisted by the RCMP. We’re not planning on closing the causeway down, we’re going to leave one lane open so traffic can be mobile. Hopefully it won’t take any more than 30-35 minutes to get across the causeway so we’re not tying people up to long. And then we’re getting back on the buses and we’re driving them over to Minister Delorey’s office, where he has knowledge we’re going to be there. Whether he’s there or not, that’ll be up to him. We will be there. We’ll be there and we’ll be making the noise that seem to be so against. If Minister Delorey’s not thee, I guess we’ll sit at his office until either he shows up or somebody shows up to escort us out.

DS What are you asking for? What will you ask Delorey?

GM We want answers. We know nothing about our hospital closures. We know nothing about the health care we’re going to have. We know nothing about where the services are going to be. We know nothing about the long term beds that are in those hospitals. We know nothings about our emergency rooms. They’re saying that they’re closing our emergency rooms. We’re saying “How do you put 50,000 more people over at the Regional Hospital Emergency Room?” Whether you expand it or not, you don’t have the doctors to be able to work it, you don’t have enough doctors to take care of patients here in Cape Breton. We are sitting on an announcement that says “We’re taking your hospitals away, and we’re not telling you anything else!” And that’s where we’re at. And we’re not accepting that. We demand answers. We’re not asking for answers, we’re demanding answers at this point. We want to know what’s happening to our long term beds. We want to know what’s happening to the workers in those buildings. We want to know if any of those workers are losing their jobs through any kind of attrition that they may have in mind. We want to know if long term going to be private or public. We demanding to know if our emergency rooms are staying in place in both North Sydney and New Waterford in some capacity, whether it’s anew building or not, irrelevant. It’s about the health care that’s provided in these communities. We’re hoping that we can fill 4 or 5 buses. We have a motorcade that’s going to take us forever to get across the island to Antigonish. People are shut out. They know they haven’t been involved in any of the information and we listened to what our Premier and the Minister said over the last two years about these hospitals blatantly telling our reps that these building were safe, they weren’t going to be closing. Because we’re in a blind zone — we have no information. It’s like a media black out with the Nova Scotia government. We’re going to get answers. If we don’t get answers there, then we’ll stage something else where we will get answers. We’ll follow these guys around until we get the answers we want.

DS That sounds like something we have to do these days, is just demand accountability, demand answers, because the uncertainty Chris was talking about, that’s what’s plaguing Cape Breton right now. What do you thing about this, Chris?

CP As I said, it’s not just plaguing Cape Breton. I think that it’s a very real problem for all parts of this province that, without any warning, without any discussion with the community, without any input, with clear denials just weeks before in the legislature, this government went ahead and shuttered two hospitals. When I’ve talked to people in other municipalities, including elected officials — and we work with other health coalitions. We helped found the Rural Nova Scotia Health Care Crisis Working Group, which is made up, largely of folks from the south shore, but we have people across the province — people in those municipalities are terrified because they don’t know. So whenever there’s chronic closures in, say, the Roseway Hospital in Shelburne, the questions everyone has is, “Is this just the pre-cursor to our hospital being shut down? Are we going to have to drive 15 minutes in either direction to go to Liverpool or Yarmouth?” Same thing in Digby. Is the reason they don’t have doctors because they don’t want doctors there? People don’t know, and that is difficult, not just when planning health care, it’s difficult when it comes to planning things like economic development. It’s difficult to think about as a young family, whether or not you’re going to live outside of Halifax. Right now my partner and I had a conversation about whether or not we were going to leave Halifax in the spring. Did we want to be 45 minutes out and commute in? At the end of the day there were all kinds of reasons why we didn’t, but one of them was, we’d never get a doctor. What do you do? Are you going to have to drive into down town to go to the hospital? To access out patient services? All of those things, so that’s a very real decision for people and what it means is that economic inequality between people in HRM and places outside of the HRM is only going to grow as a result of this. So we certainly, I can guarantee you, Gord, there’ll be at least two cars’ worth of people from Halifax that will make their way to Antigonish on the 16th. And, on October 13th we held rallies in five communities, including Digby, Yarmouth, Sydney, demanding action on rural health care and to say we’re not going to let this slide off the agenda and for the Nova Scotia Health Coalition, our general meeting is coming up on January 18, and we’d encourage folks to also go that and think about ways in which we can organize, not just for the next 12 months, but 24, 36 moths out, to make sure that we hold the government to some accountability. We’re at most 12 months away from a federal election, but it could be called earlier as has happened previously. We need to think about what demands we’re making of the federal government. I do think that right now the economic situation in Nova Scotia is one where there isn’t a ton of wiggle room financially. The reason for that is because the federal government has stepped away from its responsibilities for things like post-secondary education, social programing including public health care. We need the federal government to re-enter into public health care through both a public national pharmacare program, but also in terms of core funding, to make sure that our hospitals, our doctors, and our nurses, our long term care facilities are properly funded. The federal government has stepped away from that. That’s been a decades long project. We need to think about ways in which to do things like the folks in Cape Breton has done. To once again make politicians scared of us.

DS Are we talking about also the mental health services and physical health services? It’s interesting, some people don’t think if that. They think of mental health as being separate some how. What do you think about that?

CP I think one of the challenges that we have is that when it comes to acute care, the emergency care, the long term care, the home care systems, we have a public health care system that’s in crisis there. What we don’t have is a public mental health care system at all. So it basically can’t be in crisis because it more or less doesn’t exist. If you want to visit a psychologist or a counsellor, you almost definitely have to pay out of pocket or you have to have private insurance. There’s virtually no public health care system when it comes to mental health. Part of the problem is that privatization has become so deeply embedded in the way that health care is understood when it comes to mental health. They way that creeps in is incredible in terms of things like mental health care, like the role of pharmaceuticals, and I think pharmaceuticals certainly play and important role in managing mental health. It’s not the only way, but it is largely how we research is funded, quite frankly. Also in terms of the way research is happening, the way it’s commercialized in our public universities to be exported to other countries, but also to be used her. The ways in which psychologists — I know psychologists who have tried to get hired in the public system, who believe in the public system, but go into private practice or can get part-time work in the public system through schools and universities, or the IWK and then also have to set up a private practice to charge people. If you want to not charge people for your services as a clinical psychologist, it’s almost impossible in this province. You can’t make a living. Particularly when we talk about doctors being underpaid. I think there’s a lot of resentment around how much doctors do make, but part of the big problem is a lot of those doctors are carrying $250,000, $300,000 student loan debt. Same thing happens to psychologists. Same thing happens to nurses. So we’ve incentivized the system to where you have to increase the wages of doctors and nurses because we’ve asked them to take on massive public and private debt in order to actually fund their education. A lot of them just want to go out and help people and it bars people who might come from lower backgrounds who can’t take on the risk of large debt from entering the profession at all. When we think about mental health, part of the problem of the crisis in health care and just how bad the problem is when it comes to emergency room and long term care and access to primary care in terms of doctors and nurse practitioners, is that we have this massive problem that needs to be solved because people are dying right now. It doesn’t give us the room to think about how do we solve things like dealing with the fact that we don’t have a public mental health care system that functions in any way and is seen as an extra. It shouldn’t be an extra. It should be the bare minimum of what we demand. To go along with that, we also need to think about the ways in which this crisis has prevented us to think about the ways in which different communities are impacted by the health care crisis. So there’s a health care crisis, but different communities are impacted differently. For example, if you’re a woman, no access to a nurse whose trained to give you care after you’ve been sexually assaulted is a massive problem. The fact that that is a gender issue. The fact that you can’t access pre-natal care and can’t have your child delivered in your community, that you have to travel from, say, Shelburne to Bridgewater to access a pre-natal check up or to actually have your child delivered because there’s no doctors who do that anymore, but also because there’s chronic lack of access to midwives, that’s a gender issue. We haven’t even begun to address the fact that there are differential needs for First Nations, immigrant, and African Nova Scotian communities in this province because all of our energy is focussed on trying to deal with the problems around universal access to primary care. In fact, we don’t even address the differential needs of those communities, and the cumulative harm of structural racism against those communities is also a huge problem. It’s difficult because sometimes the health care crisis can be so daunting you don’t know where to start. Taking on the things that are happening in our community is a starting point. For some places and people that looks like taking on mental health care, but the real challenge for folks that are trying to take on mental health care, including the mental health care coalition is, you don’t know where to start because, as bad as the primary and acute and emergency and long term care systems are, the mental health care system just straight up doesn’t exist as a public entity, or it’s so small it might as well not exist.

GM Chris said it very well, and I’d just like to point out there’s not’ one child psychologist left here on Cape Breton and we just lost our lead psychiatrist as well. Mental health services, and with the crisis we have going on here with the opioids and the over doses and the addictions, those kind of problems with mental health are even further set back because presently not one single child psychologist here on the island.

CP As we wrap this up, I think a good thing to think about is the way in which health care represents all of these wider questions we have about what sort of world we want to build. We need to think, in Nova Scotia, who should we ask about who should ultimately make decisions abut what’s best for the public. And we should say, the public should make those decisions. They should be democratically arrived at. We see an assault on that when we see things like the decision to close two hospitals in Cape Breton without any public consultation. We ask about, do we want a society where we care for each other. We answer that question when we say we would rather have people suffer and die in the hallway of a hospital rather than charge fair taxation to those who can afford to pay for it. That’s what’s interesting about health care and the fight for healthcare, it is ultimately a fight for the question of what sort of society do we want to live in? We can’t passively allow that society to be transformed, be made worse. That’s why we fight to health care, why all of us do. That’s why we have to keep fighting for it.

DS All right, Gordie, thanks for being with us today. I so appreciate it. I hope all is well in your world.

GM Absolutely, thanks for inviting me. It’s been good talking to you, Chris.

DS And don’t forget, November 16. What do you want to tell people?

GM Be there! They’re going to hear our voice on November 16 at Minister Delorey’s office in Antigonish.

DS Thank you very much Gordon and Chris for being with us on this Union Matters podcast. I’ve been your host, Deedee Slye. I hope you’ve enjoyed it. You can look for it on iTunes and YouTube and Soundcloud and Facebook and posted on our web site. Lots of ways to find our podcast. Have a great day!