Wednesday April 19, 2017

April 19, 2017 full episode transcript

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The Current Transcript for April 19, 2017

Host: Anna Maria Tremonti


Listen to the full episode


[Music: Theme]


The river in front of town did not freeze and therefore we had to go around it. The road we have now is over five kilometres long, so that's a lot longer than just crossing the river straight where the ferry goes, which we normally do.

ANNA MARIA TREMONTI: The people of Dawson City had to take the long way home when the ice bridge never materialized this winter. In another area of Yukon, the Slims river disappeared within days. Around Old Crow, Yukon they're seeing more landslides and the trees are leaning over as the permafrost softens. In southern Canada where most of us live, climate change is something we know is creeping up on us. But in the Canadian north the evidence surrounds them. And a new study published this week underlines just how acute the change can be. We will tell you more in half an hour. Also today, Toronto doctor Rob Fowler was on the very first international medical team to race to West Africa three years ago to treat a frightening and far reaching Ebola outbreak.


All of the schools have been shut down. The local advanced education has completely stopped since the beginning of the outbreak and life is very much centered around their response to Ebola.

AMT: And his response to it all sparked a major change. He suggested treating patients not as if they were all going to die but as if they would live. It was a change that saw the mortality rate drop significantly. In an hour, Dr. Rob Fowler explains how treating a developing world disease with developed world expectations saved lives. And BlackBerry co-founder Jim Balsillie has long criticized Canada's inability to run with ideas to grow a new automated digital economy.


JIM BALSILLIE: The way you get prosperous in the 21st century is through knowledge and ideas and collecting money for them. And Canada doesn't have an ecosystem that takes us to making money off ideas.

AMT: Now the Bank of Canada is raising its own concerns, we're starting there. I'm Anna Maria Tremonti, this is The Current.

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Bank of Canada urges government to embrace automation economy

Guest: Carolyn Wilkins


JUSTIN TRUDEAU: We need education to enable people to learn, think, and adapt. We need infrastructure that supports change. We need policies that encourage science, innovation, research. We need societies that recognize diversity as a source of strength not as a source of weakness. And we need governments willing to invest in making all that happen while recognizing that dynamic innovation that happens in the private sector.

ANNA MARIA TREMONTI: Well that is that Prime Minister Justin Trudeau at the 2016 World Economic Forum in Davos, Switzerland. And while the prime minister makes the case for innovation, there are fears this country is falling behind other nations in adapting to advances in technology. Yesterday the Senior Deputy Governor of the Bank of Canada issued a warning that Canadian business could be left behind if the government doesn't work with corporate leaders to bring in policies to keep up with a changing world. Carolyn Wilkins spoke to the Toronto Board of Trade about potential impacts on jobs and incomes as this country shifts towards a more automated digital economy. Now, if you don't recognize Carolyn Wilkins from the interest rate announcements or monetary policy reports check the bills in your wallet, her signature is on your money. Carolyn Wilkins is with me in Toronto. Hello.

CAROLYN WILKINS: Hello. I'm really pleased to be here.

AMT: Well it's nice to have you with us and you have a very nice signature.

CAROLYN WILKINS: Ah, why thank you very much.

AMT: Not everyone can actually read their signature but yours is very clear. How long has it been there?

CAROLYN WILKINS: It’s been there for about three years now.

AMT: And it's on every bill, every new bill that comes out now.

CAROLYN WILKINS: It absolutely is.

AMT: Well, you see a shift coming that you don't think we are ready for. What are you seeing?

CAROLYN WILKINS: So what I'm talking about is just the great opportunity that we have with technological progress, artificial intelligence, machine learning to increase Canada's productivity. And that's important because we want to increase our standard of living. At the same time there are some things that come with productivity change that we've seen over history that we need to proactively manage, like the cost of the transition when people are displaced and the potential for increased income dispersion.

AMT: What kind of jobs do you fear we will lose to automation?

CAROLYN WILKINS: So what's interesting with this new wave of automation is it's a little bit different from what we've seen in the past. In the past we saw things like machine line robots that were automating routine manual tasks. But now we see the opportunity to more and more automate what I would call routine cognitive tasks, tasks that require some thinking that humans usually did. And, you know, self-driving cars are one of those opportunities. That just happens to be a really popular example but there are also technologies that allow you to get advice for investment from robots or advice from lawyers from robots, and of course while traditionally we think of the workers that are displaced as being less educated workers, less skilled workers, what we're seeing now is the potential for more middle income and more highly educated workers who thought that those jobs were safe, the potential there is for those workers to be displaced as well.

AMT: Even diagnostics from physicians can be handled by some robots depending on what it is.

CAROLYN WILKINS: Absolutely. The thing that for me is very important is not to overplay it. There's a lot of hype out there saying that we’ll have a new world where we don't need workers, we’ll just need robots. My belief is that not anytime soon will we see machines being able to recreate or replace some kinds of human skills. And those are the ones that we all think about as being particularly human like a good judgment, common sense, creativity. Those are things that that won't be replaced anytime soon. So we'll need humans to work, it'll just be different kinds of work and we need to be ready for that.

AMT: What kinds of jobs do you see being created then?

CAROLYN WILKINS: When I read, there's a number of very interesting academics, one’s David Autor out of the US. And, you know, I think that he has a lot of interesting things to say about how we will still need workers like architects, like consultants, health care workers, personal care workers, primary education teachers, those kinds of jobs where you really do need a human brain and you need the human touch.

AMT: And that one on one kind of interaction.

CAROLYN WILKINS: And that one on one kind of interaction.

AMT: And I'm imagining there would be jobs we don't even know about yet that would be created from the more automation we have?

CAROLYN WILKINS: That's right. When you look back at the technological changes that Canada has achieved that have led, I don't know whether you know, but in the last 150 years since Confederation, average income per person has increased 20 times after you adjust for inflation. So it's been a real benefit for Canada. Now, when you looked at what happened in the agricultural sector, it went from one third of every jobs to two per cent of every job today. And that without increasing unemployment at all. So that's a very big change in unemployment and at the time there was a lot of concern that there would be no replacement for these agricultural workers. And that's the same when anytime technological progress occurs. But I would say that in the early 1900s I don't think anybody could have imagined the kind of jobs we'd have today in tourism, in health care, computers that I don't think anybody could have imagined then.

AMT: Well, we've been talking about a changing economy and hearing the kind of the phrases, the digital economy for a while now. But do you see something different happening now? Is there something happening more quickly?

CAROLYN WILKINS: Well some of the technological advances are happening very quickly like fracking in the in the US, which is a technique to extract oil. That happened very quickly. Others though we worry that they're going to happen very quickly, but we need to understand that even some of these changes like self-driving cars can take a long time. I mean, one example from history I find very interesting is the first central power station in the US opened in 1880 and it took four decades for the results of that in terms of productivity to show up in the data. And the reason is pretty intuitive. They had to build power grids, they needed to replace machines, they need to have the infrastructure ready to adopt the technology. And some of the technologies we see today are not much different from that.

AMT: Now, I thought you were a numbers person. Why is this issue on the radar of the central bank?

CAROLYN WILKINS: Most people think of central bankers as looking at the economy over the next couple of years so that we can forecast the economy and also hit our inflation target. And that's absolutely what we do. But to do a good job over time, we really need to understand the longer term forces that are acting on the economy so that we can be ready for it. And as a central banker, I really care about the forces that that affect the structure of the economy because we know that a widening income distribution can lead to worse macroeconomic outcomes, it can lead to potentially less sustainable growth, and it can also change the way monetary policy works through the economy. And we need to be on top of that.

AMT: You've identified small business as slow to adapt to a digital economy in Canada. What are you seeing that makes you say that?

CAROLYN WILKINS: Well one of the things that that economists have noticed is that productivity growth kind of kept up with the US in the 1990s, but then in 2000 slowed down quite a bit while that didn't happen in the US. And there are many reasons you can think of for why. But one of them is just the idea that small businesses in Canada relative to small businesses in the US have been a bit slower in adopting technologies from the information and communications sector. So things that might be like a small company putting their inventory on an electronic platform as opposed to having people doing it manually. Those things have led to slower productivity growth in Canada than the US.

AMT: What does your research say about future job prospects for Millennials? Those young adults who are just establishing or just choosing a career.

CAROLYN WILKINS: One of the things that puts Canada in a very good position is the fact that among the developed countries we have one of the most educated workforce in the world when it comes to youth. In the oil price shock, in the fallout from the financial crisis in 2008, kind of let a lot of young people to go back to school and get more education and also perhaps to become a bit discouraged. And so we see, you know, youth unemployment a little bit higher than we think it will level out. And we see that as the economy continues to grow, and we expect that over the next couple of years, that that youth unemployment rate will come down and that hopefully some youth will be attracted back into the workforce.

AMT: And well, a couple of questions about that. So they're the most educated. Are they educated in the right things or are they the ones on the very cusp, who like the world is changing literally under their feet? Are they ready for that with the education they're getting?

CAROLYN WILKINS: So, you know, what I can say is that young people of today and in fact people who are in their prime working age need to focus on education and training and especially continuous learning. I think that the days have already started where you start with one career and you end up in the same career or you even if you end up in the same career, you do it without having to learn new things. Those days are over.

AMT: Mm.

CAROLYN WILKINS: And so I think the mindset of being flexible and being open to learning new things and perhaps changing careers is going to be more and more important. So one of the important things and, you know, this has been identified by businesses, by governments, is just the need to have more students in what we call the STEM fields, so science, technology and math. And I'd like to add economics to that if I could. Because those are very solid foundations that provide the platform for future learning. If you've got good math skills, good technical skills that businesses require, then if you need to learn new things you've got a very solid base on which to do that.

AMT: I want to ask something else because of your position at the bank and you see some of this. And we're talking about Millennials, the whole issue of affordability for housing for again this cohort of young people. They can't get mortgages for houses that are worth so much if they don't have jobs if they have to keep shifting. How do you see that playing out? How is this changing economy going to affect the ability and the expectation for homeowners in big cities?

CAROLYN WILKINS: So certainly the Bank of Canada has flagged household indebtedness and just housing affordability as an issue when it comes to the macroeconomy and financial stability. And of course it's something that we flag as a risk, not something that we see as a certainty to be a problem. And what we're seeing in large urban centres like Toronto and Vancouver are supply issues. There's not enough houses that can be built to keep up with the demand and that's resulted, as you mentioned, in very strong price growth which makes it difficult for many people to afford a house. In Toronto in particular, what we've talked about last week when we released our monetary policy report was just a bit of a concern that the house price growth that we're seeing in the double digits, up to 30 per cent, is really not in line with what we see as being the fundamentals. And so we think that perhaps there is some speculative activity that's occurring and we've reminded people that house prices not only go up they can go down too.

AMT: Mhm. And as we get more productive using technology, do you see that affecting the inequality gap?

CAROLYN WILKINS: It's possible that it can. When you have technological improvement, what tends to happen is that the people whose skills are enhanced by the technology, use a computer just as an example, if that's what you do in your job and you get a better computer, it's possible that you're going to become more productive and that's a good thing for your earnings. Of course if you happen to be someone who gets replaced by a computer then that same benefit from productivity isn’t going to be there for you. And so it is possible that we could see rising inequality. And that's why the G20 and many governments around the world are talking about inclusive growth. And the Bank of Canada doesn't have tools to deal with the distribution of income. That's the role of governments with respect to their taxation and transfer policies, among other policies.

AMT: And so, and of course you wouldn't set these policies, but what areas would you want to see them working in in terms of policy where government and corporations can work together that would affect economic growth?

CAROLYN WILKINS: So one of the things we need to keep front and centre is just the importance of embracing these changes. And, you know, I worry I have is that people may be too concerned about the technology and kind of close in on themselves and become protectionist. And we see that in the world today a little bit when it comes to trade policy, when in fact that's the opposite direction we need to go in. What we need to do is embrace the technologies in areas where we can make a difference. And I think, and promote productivity, and so those policies are related to infrastructure, public infrastructure, they’re related to making sure that companies that are growing have sources of financing. It's with respect to taxation and finding that right balance in providing the incentives to companies to invest, they want a return on their investment but at the same time making that social choice that governments make about how the benefits of the technology are distributed across people.

AMT: You were talking just a minute ago about some protectionism. We are seeing President Trump just unveil his Buy America policy. What concerns do you have about the direction of the Trump administration on economic and trade policy right now and how it might affect Canada?

CAROLYN WILKINS: Well, Canada is a trading nation and it's benefited greatly from open borders with respect to trade, not only with the US but with other countries around the world. And so moves to protectionism have the potential to undermine the gains that we've already got, that we've already received. And so it concerns me, and we've talked about that in our monetary policy report last week. It's one of the uncertainties that is weighing on the Canadian outlook.

AMT: In fact, last week the report says the possible outcomes are almost certainly negative for Canada.

CAROLYN WILKINS: That's right. There's a very wide range of possibilities, from a border tax to tariffs that are targeted for different products and countries and there's many options. And I think that some of these agreements are pretty old, NAFTA's pretty old, so I'm not saying there's no opportunity to improve them. There could be, there surely are. But if the policies are designed to be protectionist in nature, what they can do at the practical level is maybe undo some of those very productive supply chains that companies have set up in order to produce the goods and services that they export. And if you undo that, you may end up with less productive ways of doing business. And as I said earlier, that's just the wrong direction.

AMT: So how prepared, how nimble is the Canadian economy to deal with whatever comes from the US?

CAROLYN WILKINS: The Canadian economy has shown itself to be very adaptive. Just look at how it has adapted to the oil price shock. One of the features of the Canadian economy that is very helpful is the fact that people are willing to move provinces to find jobs. That interprovincial migration was very instrumental to preventing the unemployment rate from increasing too much in the face of the oil price shock that we had, because people moved from Alberta to other provinces to find jobs. And so the recent interprovincial trade agreement that the government has announced, that governments have announced is another step in the right direction in terms of increasing that flow of people and of goods and services across the provinces. And so Canada is well positioned to adapt.

AMT: And what's the role of the Bank of Canada as the economy evolves?

CAROLYN WILKINS: Well the best thing that the Bank of Canada can do is keep inflation low and stable, because that's a solid foundation for businesses and households as they plan. Either they plan what education they want, what kinds of investment they want to make, this is the kind of solid foundation that's needed for sustainable growth.

AMT: So what do you want Canadians to be thinking about as they consider their futures, their jobs, the kinds of society we want?

CAROLYN WILKINS: I think that Canadians should be thinking about their own degree of openness to change and how they can make the best of it and embrace it in a way that allows them to prosper as well. And when it comes to companies, I mean, creating businesses that are vibrant and dynamic, companies that interact with the education system is all going to be very important. And I think Canadians and businesses should, you know, give us the benefit of their great ideas. We often consult, the government does, the Bank of Canada does, maybe not on these particular issues but on financial issues, and we benefit a lot from the comments that we get.

AMT: Thanks for coming in.

CAROLYN WILKINS: It was a pleasure. Thank you.

AMT: Carolyn Wilkins, Senior Deputy Governor at the Bank of Canada. She's in our Toronto studio. Do you feel prepared for the new economy? Tweet us @TheCurrentCBC, comment on our Facebook page. Send us an email from our website Just click on the contact link. And stay with us, the CBC News is next. And then one of Yukon's Rivers is missing. Scientists say they know the culprit behind the mystery. I'm Anna Maria Tremonti, this is The Current on CBC Radio One, Sirius XM, online on and on your radio app.

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How a Yukon river suddenly vanished in 4 days

Guests: Dan Shugar, Dana Tizya-Tramm, Trevor Bell

ANNA MARIA TREMONTI: Hello, I'm Anna Maria Tremonti and you're listening to The Current.

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AMT: Still to come..


I am declaring the current outbreak of Ebola virus disease a public health emergency of international concern.

AMT: Three years after the World Health Organization's announcement, a Canadian doctor recalls battling the deadly virus and the lessons that were learned from the disaster. I'll speak with Dr. Rob Fowler, a disruptor in the treatment of Ebola, who’s being recognized today for his humanitarian work. But first, the not so cold case of a missing Yukon River.


The Slims river has decided to flip course and head down the Kaskawulsh river, so it's a pretty precarious situation right at the toe of the Kaskawulsh glacier. And yeah, over the last 350 years it's been flowing into Kluane lake, and at present it's decided apparently to go down into Kaskawulsh river.

AMT: Well that's Jeff Bond of the Yukon Geological Survey last June, describing the mystery of the missing Slims river. This week a new study shed some light on the disappearance of that glacial river in Yukon. The report offers stark evidence that small increases in temperature can lead to rapid and extreme environmental consequences. According to scientists, climate change caused meltwater from the Kaskawulsh glacier to change direction. That's known as river piracy, and this is being called the first documented case of its kind in modern times. And while those nearby are used to living in a dynamic region, the loss of the Slims river was unexpected.


My name Sian Williams, I'm the owner of Icefield Discovery Tours, we've been flying planes into the St. Elias mountains supporting scientists and mountaineers since the mid-seventies. We live right at the mouth of the Slims river, our airstrip is about three kilometres from where the Slims comes out into Kluane lake. With our chief pilot Tom Bradley, who first noticed as he came back from a flight and he’s like there's no water coming down the Slims. And he was just like oh my gosh the Slims has no water in it. And he and my husband Lance Goodwin jumped in the plane to go back and take a look and take some photographs of what had happened. The main impact we notice here is the increase in depth because usually every year the water will get higher and higher and it'll flood the whole Slims valley from side to side and then you don't get the big dust storms. So now you have these big exposed delta and there's massive dust storms coming off of that. So that is definitely changing things here.

AMT: Well for more on this, I'm joined by Dan Shugar, he's an Assistant Professor of Geoscience at the University of Washington Tacoma. He's also the lead author of the study that was published Monday in the journal Nature Geoscience. Dan Shugar’s in Tacoma, Washington. Hi.

DAN SHUGAR: Hi. Good morning.

AMT: So this was a raging white water river. What happened to it?

DAN SHUGAR: Well, yeah you're right. The river previously kind of normally is, you know, pretty swift and pretty cold. Essentially, the tap was turned off, if you want to boil it down. The glacier which fed the Slims river but also fed the Kaskawulsh river, as Jeff Bond said earlier, decided to instead of feeding both rivers feed only one of them, feed only the Kaskawulsh river essentially in the opposite direction.

AMT: So it was actually running north into the Bering Sea right?

DAN SHUGAR: Yeah, that's right. And so much of the water from the glacier, the meltwater, would go by the Slims river into Kluane lake and then eventually out to the Yukon River and the Bering Sea. Whereas now the Kaskawulsh river joins the Alsek and then dumps into the Gulf of Alaska over a much much shorter distance.

AMT: And goes south.

DAN SHUGAR: Correct. Yeah.

AMT: So how did that happen?

DAN SHUGAR: Well, the story really took place over let’s say the last hundred years, as the glacier has been receding and also spinning vertically. And so these two rivers, even though their headwaters are only a couple of kilometres apart, they're on either side of this kind of drainage divide set up by the glacier. And the Slims river, the headwaters for the Slims was at a higher elevation than the headwaters for the Kaskawulsh, and the Kaskawulsh was also quite a bit of a steeper river, about five times steeper. And so as the glaciers pulled back and thinned, it's effectively reduced that obstruction, that height of land between them and last summer the headwaters of the Slims were able to actually carve a channel through the glacier in the direction of the Kaskawulsh trying to seek that lower ground.

AMT: OK and how much water are we talking about? What's the flow?

DAN SHUGAR: Well a substantial amount. In the luckily we have a couple of gauges, you know, instruments in the rivers which allow us to measure how much water is going through there. In the Kaskawulsh river and later the Alsek river where we have this Environment Canada gauge, the flow last year was about as high as it's ever been on record. That was several thousand cubic metres of water rushing past every second.

AMT: Wow.

DAN SHUGAR: Whereas the Slims river, you know, the one that's effectively dried up now, the water level dropped by several metres vertically almost overnight, over the period of about four days.

AMT: That's called river piracy?

DAN SHUGAR: [chuckles] Yeah, it's a good term. River piracy is synonymous with stream capture, which sort of brings to mind perhaps a more accurate picture of what's going on here. But essentially it means that one river is capturing or stealing the flow of another river. So here the Kaskawulsh is stealing the flow of the of the Slims.

AMT: And how do you know that climate change is responsible for that?

DAN SHUGAR: Yeah it’s a good question and certainly one that, you know, is an important thing to back up with some evidence rather than just kind of a hunch. So one of our colleagues, Gerard Roe, here at the University of Washington a couple of months ago published another paper in Nature Geoscience where he was able to show for several dozen glaciers as examples in his paper worldwide that if you take out the warming trends that we've seen in the last hundred years or so and expose the glaciers only to the internal variability in the climate system, then there is essentially no chance that they could have retreated to the extent that they have. And unfortunately he didn't model the Kaskawulsh in this global study. But when we were starting to think about well, you know, what could be the culprit here, I gave him some of the data that was collected by myself and my colleagues. And he fed it into his model and found that for the Kaskawulsh, the nearly two kilometres of retreat that we've seen in the last hundred years, it’s only about a 0.5 per cent chance that it could be due to simply the internal variability. In other words, overwhelming likelihood that the glacier retreated that two kilometres due to climate change, of which we of course are contributing the majority of in terms of greenhouse gas emissions.

AMT: So this is quite significant huh?

DAN SHUGAR: Yeah, we feel so. You know, there are some communities that live along the lake but for, you know, for most Canadians the significance isn't about whether their house is going to get washed away but rather what some of the perhaps underappreciated consequences of climate change may bring. You know, this is not been kind of a normal news story that comes out about climate change impacts. But it's, you know, it's significant and it happened almost instantaneously even on human time scales.

AMT: It was like four days in May wasn't it, that this river just suddenly wasn't there?

DAN SHUGAR: Yeah that's right.

AMT: Wow.

DAN SHUGAR: You know, it’s likely that this canyon that was being cut through the glacier had been forming probably for the last year, but it was, yeah, over a period of four days on these instrument data that we have in the Slims river we noticed this precipitous drop in water level.

AMT: Well, in fact you were--

DAN SHUGAR: When we got there, sorry go ahead.

AMT: You were there to study the river and there was no river to study, that's how you got involved in this huh?

DAN SHUGAR: Yeah that's right. My colleague Jim Best from the University of Illinois and I went to the Slims last August and, you know, we had heard that the river was low both from CBC reports but also from Sian Williams that you spoke with a minute ago and Tom Bradley the pilot. But we had no idea it was going to be essentially gone. We were there in 2013 to work on the lake and the river delta and, you know, the river was a powerful river that you wouldn't want to go swimming in. But in 2016 it was, you know, there was barely a trickle, hardly moving at all.

AMT: Wow. So this I guess would be very academically exciting for you but pretty environmentally disturbing.

DAN SHUGAR: Yeah. I'm a geoscientist that’s interested in really rapid geomorphic, geological change, these rapid changes, you can often think of them as geohazards, so things like landslides. And so this was sort of an interesting case where we went to study a relatively slow phenomenon, you know, the river flowing, and we're faced with this very rapid change even on human time scales. So yeah, certainly academically interesting but it turns out to have quite an interesting and relevant story of climate change impacts.

AMT: Yeah, well Dan Shugar, thanks for sharing this with us.

DAN SHUGAR: I appreciate it. Thank you.

AMT: Dan Shugar, geoscientist at the University of Washington Tacoma. We reached him in Tacoma, Washington. The disappearance of the Slims river is a haunting illustration of climate change in Yukon. Old Crow is a small community located in the northwest corner of the territory and it is a community already facing significant change. Dana Tizya-Tramm is a Councillor in charge of Natural Resources and Heritage for the Vuntut Gwitchin Government First Nation. He's in Old Crow. Hello.

DANA TIZYA-TRAMM: [First Nations greeting] Anna Maria.

AMT: A climate change study is underway in Old Crow right now. Why there? What's going on?

DANA TIZYA-TRAMM: Well, Old Crow is a small fly-in community 80 miles north of the Arctic Circle and 60 miles east of the Alaska border. So we're situated in many different contexts as somewhat of the litmus paper of what's to come regarding communities and the coming climate change. We have a series of studies that we are a part of primarily and we partner with a lot of different organizations and researchers as well. And have been doing a lot of studies on the environment and animals, the waters, basically all flora and fauna for a number of years now, collecting a very large wealth of baseline data.

AMT: So how have people in and around your community been affected by climate change already?

DANA TIZYA-TRAMM: Well, I think that we have a lot of sensitivities due to our traditional pursuits. We are a fly-in community by choice. Our elders, it was through their wisdom that we did not build a road to this community and we do have very strong ties to the land through the fish and through the caribou migration, so a large part of our time throughout the seasons is harvesting on the land, whether that be wood or fishing and caribou and moose and all the like. So especially up in the North, where we come from an area we're right just south of the Crow Flats, which is a huge conglomeration of lakes. So with the permafrost and the very wet areas you can already it paints a picture of almost the fragility of the situation.

AMT: [crosstalk] Why is that? What do you see?

DANA TIZYA-TRAMM: And in the winter the freeze ups.

AMT: I’m sorry, what do you see? When you say you can paint a picture, what are you actually seeing?

DANA TIZYA-TRAMM: Well, there's a lot of rapid change and because we are so much a part of the land we really feel and see the change a lot. We're starting to notice now quite easily that when we could go out traveling, let's say in November when everything froze up, now that's delayed by a month. Now it's not safe to travel until December. So we have later freeze ups and we have earlier breakups. We have also now found that there are higher mercury levels in our river systems due to the permafrost melting and a lot of landslides, to the point even now where we have public warnings where we ask our pregnant women and young children not to consume the livers of some of our loach or our whitefish. We have lots of overflow during the year, just simple not freezing up. For example, we have just by the community the Crow River, there is a section of it that didn't even freeze over this year and even some of the elders, our best scientists, you know, have been saying they've never seen this before.

AMT: Mm.

DANA TIZYA-TRAMM: And I’ve been hearing a lot of elders say that this year, that they've just never seen this before. We used to get minus 60 and even minus 50, you know, for a good number of weeks and that's really important to help clean the land as well. A lot of bacteria and pine beetles, it’s just a natural cycle that we just simply do not see any more whatsoever.

AMT: And what about the permafrost? Are you seeing anything on the landscape that indicates how that is behaving?

DANA TIZYA-TRAMM: Yeah, we have started a permafrost monitoring baseline data collection as well and this is changing as well. And this is a major concern when our permafrost is rapidly changing because this is also a carbon sink and it releases more carbon by the melting of it as well as, you know, the Yukon at one time was under water and especially our area up here, it's at the bottom of an ancient lake bed. So with the permafrost melting, it really it's not a very good sign, it’s really holding a lot of that land together.

AMT: And you got--

DANA TIZYA-TRAMM: Start to see lots of phenomenon.

AMT: Do you see, what about trees? Are they?

DANA TIZYA-TRAMM: Yeah. And I was just yeah. You'll see things that they call drunken forests, where if you're on the river you'll see a number of trees leaning over crookedly. And what that is is that's the permafrost melting and it's the land sagging in and falling into the rivers. So you'll see the trees go with them. And this is really happening so rapidly that the trees are slowly bending over with the falling in of the land as well.

AMT: Mm. And Dana, what about the animals that would be hunted? Are you noticing changes in fur or changes in which animals are where?

DANA TIZYA-TRAMM: Definitely. Trapping is one of the subsistence practices and as well economical in the community. So we have a close connection with the animals and it's difficult when for traveling but also for the animals themselves. They need these temperatures and the frequency of the seasons to help with their fur priming for instance. It's deep in the dark Decembers where their fur really gets the best and you'll see lots of stressed populations. You know, when we don't, when we have very strange dumps of snow and then long bouts without it, there's even a small crust that you'll see that begins on the surface of the snow, which really it hinders foxes and owls, it's a very sensitive ecosystem and environment. So these are easy indications to see. We also have a number of birds monitoring, fish monitoring and we're starting to see that the predator species are doing well for the birds, but some of the other species that we used to see we just simply don't see them anymore.

AMT: And so what's the reaction from people in your community? How are they dealing, like how are they reacting to this emotionally?

DANA TIZYA-TRAMM: Well, you know, we are people of the many lakes. That's what Vuntut Gwitchin means. We base ourselves by the land, that's where our identity is and our life is, so for us we've always been a land and animal managers. So we really are looking towards what's in front for the animals. And if the caribou were to stop coming through the community or if our access were to stop, that would really interrupt a very ancient and intimate relationship. So it really weighs heavy on really everybody in the community, but we are going through all of this together so there's a lot of information sharing happening and, you know, we're all very aware of it but even to the point where even the children in our schools now are talking about it and they all very much know about it.


DANA TIZYA-TRAMM: So it weighs very heavy on this small community.

AMT: Wow. Dana, it's really important to hear what you have to say. Thanks for talking to me today.

DANA TIZYA-TRAMM: I really appreciate the opportunity to give our small community a voice for the whole country. I appreciate it very much Màhsi choh.

AMT: OK. Thank you. That is Dana Tizya-Tramm, Councilor in charge of Natural Resources and Heritage for the Vuntut Gwitchin First Nation. He's in Old Crow, Yukon. Well for many of us river piracy can seem like a freak event an abrupt anomaly hurried along by climate change. For those monitoring the vast northern coastline, the only thing predictable about the impacts of climate change is that they are unpredictable. Trevor Bell is a geographer and university Research Professor at Memorial University. Last year he coauthored a Natural Resources Canada report which looked at how our marine coasts are weathering the effects of a changing climate. Trevor Bell is in St. John's, Newfoundland. Hello.

TREVOR BELL: Good morning Anna Maria.

AMT: Well, what's your reaction when you hear about things like what Dana was just talking about and the disappearance of the Slims river?

TREVOR BELL: Well I think the disappearance of the river is obviously very dramatic and it grabs the attention off a lot of us here in the South. But I think the really important voice here is Dana’s and listening to the sorts of changes that are being experienced by northern communities. I think people who live on the land and are closely connected with the land really have observed the changes that have been going on in the North for decades now. Climate change is not something that's going to happen, it is happening, it has been happening in the North. And I think a lot of what northern communities want now is action and they want research that tries to bring solutions to the table. When we're looking at dramatic changes along the coastline, as we thaw that coastline, we raise water levels, we intensify storms, we remove sea ice. It is the perfect storm, if you like, of changing processes in the natural environment and it is having real impacts on communities.

AMT: Well, talk to me a little bit more about the northern coast line because I didn't realize 70 per cent of Canada's coastline is in the North. So what are you seeing?

TREVOR BELL: Well I think a lot of that coastline in fact is frozen, and over 60 per cent of it is made up of loose material like sand and clay and the cold temperature and the frozen condition keeps it bonded together. But as the climate warms you lose that bond and it starts to fall apart. And if it's at the coast of course, rising water levels, we're seeing in many places sea level rise, we're seeing increasing storm surges, we're seeing increasing storms which are bringing wave energy to the coast. So it's very easy to erode that coastline and make it wash into the sea so that in some places you can have two metres, six feet of change in the position of the shoreline each year and sometimes that's, when we have these extreme events, it can be up to 30 or 40 feet or 10 metres in change in a single year.

AMT: That’s pretty dramatic.

TREVOR BELL: Yeah, people are seeing things that they've never seen before. So last summer in Grise Fjord there was high water levels that came right in onto the streets and you could see video off it, you could see their snowmobiles, you could see the sheds, you can see all their subsistence equipment floating in that saltwater. Other places are experiencing saltwater intrusion into their freshwater resources

AMT: And Griese Fjord, is like, isn’t it the most northern community?

TREVOR BELL: That's right.

AMT: Or one of them.

TREVOR BELL: In southern Ellesmere Island.

AMT: Yeah.

TREVOR BELL: Pangnirtung a couple of years ago had an extreme rainfall event that washed out roads and bridges that separated the community into two, and separated emergency services. So it's really dramatic and I think one of the most important things, and Dana mentioned it already, that people are seeing is because they spend most of the year, remember places like Pond Inlet and northern Baffin Island, you know, have sea ice from November through to July. So most of the year is characterized by living, traveling, hunting, feeding a family from a sea ice, from a frozen water surface. We're seeing dramatic changes in the dynamics of that sea ice. Once again, in the South we're always hearing about the polar ice cap and how it's shrinking. But for communities, Canadian communities in the North, the 50 or 60 of them, what's really important is what's happening on their front step.

AMT: On that coastline, yeah.

TREVOR BELL: On that coastline. And it's changing dramatically.

AMT: So what's at stake for the northern seaboard if it continues at the rate that you're already monitoring?

TREVOR BELL: Well I think what's I think a lot of these communities are suffering badly from lack of access to their natural lands, to food that feeds their families, to lack of declining opportunities for the economy. If you think of some of the community fisheries how declining sea ice from the winter fishery means that they can't get as much of the quota that they want. The tourism for instance, if you're having more unpredictable ice conditions at the flow edge where lots of tourists go north to see an experience that, it means that those sorts of opportunities are slowly eroded and lost. So we have to build adaptation tools to try and deal with these sorts of unpredictable conditions. And that's what climate change brings to the North, these unpredictable extreme events, you know, we mentioned earlier for instance in Nain in 2009 it rained the entire month of February almost, when it should have been minus 20. That turned the surface of the sea ice into slush. It really impacted people. People lost their confidence in traveling on the ice, they weren't able to get seals and caribou. One in 12 of them actually experienced falling through the ice.

AMT: Wow.

TREVOR BELL: A huge statistic that if that was extrapolated to the South, we would bring in the army to try and save that sort of situation. But in the North they are trying to deal with these issues and we need to give them the tools into their own hands to try and solve and adapt to those issues.

AMT: Trevor Bell, it's really important to hear what you have to say. Thank you for talking to me today.

TREVOR BELL: Thank you.

AMT: Thank you for coming in. That's Trevor Bell, geographer and Research Professor at Memorial University. He joined us from St. Johns. And stay with us. Coming up in our next half hour, we're talking about life and death lessons about the Ebola outbreak from a Canadian doctor who made a difference. Lots of important issues on The Current today, I'm Anna Maria Tremonti this is The Current on CBC Radio One.

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Canadian doctor Rob Fowler recognized for life-saving treatment in Ebola outbreak

Guest: Rob Fowler

ANNA MARIA TREMONTI: Hello, I'm Anna Maria Tremonti and you're listening to The Current.

[Theme: The Disruptors]

AMT: In 2014, during the height of the Ebola outbreak in West Africa, Canadian doctors were on the frontlines tending to sick patients. Most of the time covered head to toe in protective gear.


DR. ROB FOWLER: We had an area where patients could walk outside the treatment facility for those that were getting better and not yet so sick. I realized that no one had ever really seen my face before and we had about ten patients over 30 that were outside and I walked close enough to be able to talk to people and I yelled over to them and I knew them all by name. After I yelled out to them and said my name, I could see they had no idea who I was by looking at me but they recognized my voice. And there was that look of wait a minute I know you.

AMT: Hm.

DR. ROB FOWLER: And then they didn't realize oh you've got a beard, I didn’t I know what you looked like before. And so there was that bond created. It helps a lot.

AMT: That is Dr. Rob Fowler speaking to me in September of 2014. He had just returned from Liberia, already his fourth trip to the region since the outbreak started that March. Dr. Fowler was one of the first international doctors to go to Africa to help treat infected patients. He and his colleagues set up a new treatment facility and were working to change the way Ebola patients were being cared for. Their work made a big difference, disrupting some of the ravages of the virus, saving lives. Rob Fowler is a University of Toronto Professor in the Dalla Lana School of Public Health. He's an ongoing consultant for the World Health Organization and today he's being recognized for his work on Ebola. He is this year's recipient of the Royal College of Physicians and Surgeons of Canada Teasdale-Corti Humanitarian Award. And as part of our project this season The Disruptors, Rob Fowler is back with me in our Toronto studio. Hello, congratulations.

DR. ROB FOWLER: Hi Anna Maria. Nice to be here again.

AMT: I watched you listening to that clip talking about actually seeing people without all the protective gear. You got a lot of memories from that time huh?

DR. ROB FOWLER: Yeah, I hadn't thought about that for a while. But it's interesting to hear it again.

AMT: Let's talk about what you were doing there. When you first arrived in Guinea early in the outbreak, how were patients being treated?

DR. ROB FOWLER: When I first arrived at the end of March in 2014, there was an increasing number of patients that were getting really sick and not enough people to help care for them. And a lot of the original health care workers that started to treat patients themselves had become sick and many had already died. And so a colleague of mine, Tom Fletcher and myself were there for the WHO as clinicians, which is an unusual role for WHO to put people into, and because we're both sort of specialists in the UK and here in Toronto respectively, we saw things probably from a different angle than maybe the historical approach to Ebola care. And that angle was more about trying to help people stay well enough to survive the acute stages of the illness so that their body could clear the virus after making antibodies and wanting to get people through the first couple of weeks. And that required a lot more aggressive care than people were used to. And at the time it was uncertain whether that was going to help people get through or whether it was putting health care workers at risk.

AMT: So what were the chances of survival for people who had contracted Ebola when this began?

DR. ROB FOWLER: In most of the past outbreaks, the sort of weighted case fatality rate was between 70 and 80 per cent and it varied outbreak to outbreak. But on the overall, about 70-80 per cent of people would die if you were infected with Ebola.

AMT: So some of the treatment was essentially just to care for them as they died?

DR. ROB FOWLER: Yeah, and a lot of times these outbreaks historically occurred in very rural remote areas, so the outbreak was already at its worst before anyone realized an outbreak was happening. You require blood and a sample to be sent to a lab someplace to diagnose the viral infection, and by the time that happens usually the worst has already occurred. So it's really natural history of a disease, oftentimes as you say, untreated that people were witnessing and that was reflected in the usual mortality rates.

AMT: So you guys started pushing for change. What happened? What made you think that this is what you should do?

DR. ROB FOWLER: You know, I think both of us and we were working alongside a very sort of early MSF clinic that was set up in Conakry in Guinea. We both saw these patients as getting really sick but in our home practice, certainly here in Toronto, I work at Sunnybrook Hospital, and used to seeing very sick people from all sorts of infections, but never used to seeing the mortality rates that we would think about with Ebola. And the notion that if we can do it, we would usually do sort of best medical care and that's very very different from anything that we've seen before. If we can treat Ebola like we treat other severe infections, with supportive care until a viral illness runs its course, which oftentimes it does, maybe we can make a dent in the mortality. And so that was the rationale.

AMT: And what kind of care are we talking about? What did you bring in? What did you do?

DR. ROB FOWLER: I mean, initially it was really quite basic medical care that you would find in any emergency room, any intensive care unit, any hospital around Toronto, around the country. And chiefly involved supportive care that would keep people who are in the midst of a bad viral infection from getting really dehydrated at a point where they are sick, they're throwing up, they have a lot of fluid loss through diarrhea and they get both sick from Ebola, but then they also go into what, you know, clinically we would call a shock. So they're not delivering enough fluid to the rest of their organs, they don't have enough oxygen and they start to go into renal failure or liver failure, and this compounds the initial problem with the virus and makes people that much sicker, much more likely to die before their body has a chance to clear the actual virus.

AMT: So did you bring in like equipment for more intensive care, ventilators, things like that? What did you do?

DR. ROB FOWLER: Yeah, initially we were fairly unprepared personally. We were there as physicians to try to take some reconnaissance as opposed to imagining we would be treating people right away. But as we helped MSF set up this first treatment unit in Conakry, we didn't have much for supplies. There was another hospital that had unfortunately borne the brunt of illness amongst their staff after infections during a surgery and first cases. They weren't set up to really treat patients, but they did have supplies. They were really rather well sort of appointed with supplies. And we made a deal with them to take their patients to this new treatment facility if we could have all the supplies that they had on hand. And so we were able to bring in IV fluids and things to set up IVs, electrolyte replacements, try to prevent some of the life threatening complications of kidney dysfunction from killing people prematurely or for reversible things that we could treat while we were waiting for people to hopefully get better.

AMT: You're essentially telling me that you used developed world sensibilities in the developing world? You didn't see, because in Canada and Toronto you'd never say oh well let's just bring them in to die they have an infection, you do everything you can to try to get them through it.

DR. ROB FOWLER: That's right.

AMT: And so that's what you decided to do there.

DR. ROB FOWLER: Yeah. We wanted to treat these patients like we would any place in the world if we had that capability. And although you alluded to some organ supporting care, so mechanical ventilators and dialysis machines, both utterly helpful for a subset of patients and completely unavailable at the beginning of the outbreak. I mean, in Guinea no dialysis machines existed of the intensive care units that were at the the largest of the hospitals there, oxygen sometimes available often not. And really no ventilation outside of an operating room where someone would manually ventilate a patient for a while.

AMT: Did that change?

DR. ROB FOWLER: It took a long time to change, I would say, over the first many months of the outbreak. The notion of actually treating people more aggressively was not taken up initially, and there was this concern that we were putting health care workers at risk needlessly for a condition that was ultimately going to lead to death in the patients that were getting infected and that's what we were thinking wasn't the case. I would say it took until the end of the summer in 2014, just before when we first spoke that people were really starting to say you know what, the the historical standard isn't something that we find acceptable anymore. And we really need to develop ways to bring resources to patients to treat them if they do get infected. And it wasn't for many months later that I would say we really had the first semblance of what I would call intensive care units in West Africa, in Sierra Leone, where you would look around and recognize things that could truly support organ dysfunction in a way that we might see in Toronto and help those sickest of patients get better.

AMT: And you talk about the ethical considerations, these were huge to get health care workers to expose themselves. Talk to me a little bit more about that.

DR. ROB FOWLER: Well, I mean, at the beginning of the outbreak you had health care workers getting sick before people realized this was Ebola. And then even after there was a recognition it was Ebola, because not everyone's practices in keeping themselves safe was at the level that it needed to be, you had ongoing infection in certain places. And as you see people getting infected, your colleagues more and more dropping out of the workforce and then you have the notion of saying let's give more aggressive care to patients. That's sort of met with a lot of skepticism and a lot of concern that you're putting people at risk. So there's definitely that aspect of things. And then the ethical dilemmas for patient care are enormous in that you are trying to bring ideas of treatment that you think will help to an area that just doesn't have any of those capabilities in, you know, in a base case. And then in addition to that, you're focused on Ebola and advocating for more resources to treat sick patients with Ebola, and in the background as hospitals are being closed because of this risk of transmitting to other patients and as people aren't presenting to health care facilities, then you have all of the usual things that get people sick in, you know, in the population, pregnancy related complications and deaths, things that require surgery, etc, that's not being treated. And you're saying you want to bring in more resources for this subset of the population, meanwhile there are huge unmet needs. And so trying to balance those unmet needs and to rectify the idea of bringing in things that aren't usually there just for this presents a whole host of challenges to work through.

AMT: And when did you start to see it turning around?

DR. ROB FOWLER: Well, I think that throughout the summer of 2014, certainly in Liberia and Sierra Leone, things were getting very very bad. Guinea settled for a little while and then had fits and starts again and different outbreaks. But it really wasn't until the fall of 2014, from my perspective, that things started to turn around. And it started to turn around as the health care workforce and the population at large really really engaged in stopping transmission within households and within communities and mobilizing resources that were pre-existing back into this fight. And it was really the West African and pan-African response that turned this around. At the beginning of the outbreak it was tough to mobilize folks because they were so concerned, worried because they saw their colleagues getting ill. But as that changed over the summertime, as more and more people came in you had a tipping point where there were enough people to treat people that were sick and you had enough willingness from other parts of Africa, around the world to bring folks to augment that.

AMT: Right. And so the way that treatment was going now, you went from like 70 to 80 per cent mortality rate to 40.

DR. ROB FOWLER: Yeah, I think that, you know, we can never exactly say that the drop in mortality over the course of the outbreak is because one thing or another thing. But, you know, over time as we tried to improve our capacity to provide better supportive care, mortality did drop from 70 to 80 per cent, dropped eventually to about 40 per cent over the whole outbreak and much lower than that for the tail end of the outbreak. And if you take the subset of patients that were evacuated from West Africa, typically people that were responding to the outbreak from Western Europe or North America, were evacuated back to their home country, receive care in a hospital like we would recognize here in Toronto, mortality in that group of patients was about 18 and a half per cent. And so you have a situation at the beginning of the outbreak where four in five people died and by the end of the outbreak you could imagine that four in five people lived.

AMT: It's quite incredible.

DR. ROB FOWLER: Huge change. Yeah.

AMT: You had a close friend, who, you have a close friend who actually contracted Ebola. What happened?

DR. ROB FOWLER: Well unfortunately I have a number of colleagues that had to be evacuated at one point or another because of either contact or infection. But yeah, I think you allude to one of my close friends who's an American doctor, who responded to this request to come and help and treat people. When we last spoke, he was probably at that time still in Sierra Leone working. And soon after that contracted Ebola because of an exposure and called, you know, called me to let me know that, you know, he had gotten a fever and we talked about it. We thought probably malaria was the most likely. But, you know, we had to get him to a place where he could receive care if needed. So he came back to the US and was admitted to a really well appointed, experienced treatment centre in the US. And he subsequently got really sick, sicker than anybody that would have received aggressive treatment and survived. And he only survived because he was in a place that could provide mechanical ventilation, provide dialysis, he would have certainly have died without it. And now he's well, and as you say, we can still call each other friends.

AMT: Mm. You were worried huh? Like, because you had asked him to come over.

DR. ROB FOWLER: Yeah, very worried and there's that guilt that you're going to feel when you, you know, have a part in bringing someone into a dangerous situation and despite best efforts they get sick, and you're wrapped up in that, you worry that you've, you know, had a direct role in getting someone sick.

AMT: How are people who survived Ebola doing now in West Africa?

DR. ROB FOWLER: Well, there are an enormous number of survivors. Whereas before you had very few people that would survive. Relatively small outbreaks that we think of in relative terms, these days maybe 100, 200 patients becoming infected, 70, 80 per cent dying and so very few that would be Ebola survivors. There was always the thought among these survivors through anecdote that there were problems with joint pains and problems with vision, problems with hearing and kind of a chronic illness, but it's so tough to tease that out when you only have a few people and people change over time and you don't know how to assign sort of causation to one thing or another thing. But now we have so many thousands of survivors and we can see a syndrome that people have termed post-Ebola syndrome, that is somewhat characteristic in that you can imagine people seem to have the residual effects of inflammation in various parts of their bodies that are not so uncommon with many viral infections, but with post-Ebola there seems to be a great number of patients with vision trouble. So inflammation in certain parts of the eye that cause visual loss, accelerated cataract formation, trouble with hearing and then some general joint trouble that would be the sort of thing that ophthalmologists and rheumatologists would take care of. And this is a whole host of complications that people never really would have appreciated before to the degree that we could say this is real.

AMT: And what about the virus itself? Is it still found in the region? Does it show up in anyone?

DR. ROB FOWLER: It's not been the cause of an outbreak over this last year, but it still does show up in bodily fluids of people that were infected but then cleared the virus from their blood, it’s no longer circulating, but there are certain places in the body where this seems to be able to take hold and almost find a bit of a sanctuary and evade the immune system. For a while we've seen the Ebola virus being secreted in breast milk. In males we see that Ebola virus persists in the semen for an incredible period and we actually don't know how long yet because survivors who have been examined and sampled subsequently still have many Ebola virus present.

AMT: So it means it can be sexually transmitted?

DR. ROB FOWLER: It can be sexually transmitted and although we haven't seen that occur as much as we might worry about, that is always a concern that we really didn't appreciate before.

AMT: Where are we in the search for a vaccine?

DR. ROB FOWLER: Well that's a good news story and it's a Canadian good news story in a way, in that we have seen a number of vaccines under development. The one that is the most advanced and the one that has gone through clinical trials in humans actually, was developed by and large in Canada at the Public Health Agency and at the National Micro Lab in Winnipeg. And this is a credit to folks that have worked there for years who have taken a disease that doesn't, you know, cause many people to get sick and have said we want to focus on this. And even before this outbreak had started, had a candidate vaccine that was ready for trials but really without a mechanism to test it. And last year, the results of a reasonably large for Ebola vaccine trials, a study was released and it looks really really good. So the vaccine seems to protect about 70 to 100 per cent of everybody that receives it from getting Ebola. And this is done in the context of having an outbreak where you vaccinate people around the outbreak who could have come into contact, so close contacts maybe in the household, and then sort of going outwards from there and then looking to see how many people get infected and maybe comparing that to a region where the vaccine wasn't deployed, and it looks really really good.

AMT: It's quite amazing huh? What do we need to learn from what you did there with your colleagues in terms of other outbreaks that might occur? Not just in the developing world but maybe especially there?

DR. ROB FOWLER: I think, you know, one of the messages for me that I would take away is that when people get sick and this relates to the kind of clinical work that my colleagues and I, you know, we do every day in the intensive care unit. Often times people get sick and you're not sure why they get sick. And there is not an unusual slate of organ dysfunctions that happen when people get sick from a virus or a bacteria. And although we always think about a very specific therapy that will kill a bacteria or kill a virus, oftentimes especially for viruses, we don't really have a specific therapy. They're very often hard to kill quickly. And what we're left doing is to treat the patient and all of the complications and the organ dysfunction that occur that can kill people just as well and often is the route to death, but those are things that we can treat. And we can treat those with simple things, maybe IV fluids, maybe electrolyte replacements, maybe changing the acid base balance and sometimes mechanical ventilation dialysis. But we can treat people until their bodies are able to generate antibodies that will take care of the offending virus in particular, even if there's no specific drug.

AMT: It's so interesting, we're having a very calm conversation. I remember when you were here last time, you were in the thick of it. You were going back and forth, you were going among three countries Liberia, Sierra Leone, and Guinea.


AMT: You know, I remember when you came in last time I said should I shake your hand?

DR. ROB FOWLER: [chuckles]

AMT: Right? Like it was people didn't know how to react and they had preconceived notions.

DR. ROB FOWLER: Yeah. And I think we might have talked about this before but in some way I think folks that were around at the beginning of the HIV virus outbreaks and the way people interacted with folks with HIV, the uncertainty that we had about transmission at the beginning, the uncertainty that we had about treating people, there are a lot of similarities with Ebola. And this story kind of plays out again and again when you're faced with unknowns, especially in medicine where there are infectious unknowns. And the sorts of things that, you know, we're very limited with respect to medical care to patients that were HIV positive and had AIDS in the late eighties and early nineties before there were treatments, is exactly the same story that we have gone through with Ebola for a long time and certainly at the beginning of this outbreak. These days people would see HIV as, you know, as a chronic disease and one that can be managed and controlled. And oftentimes folks are able to live, you know, a life span that would be, you know, what it would be without HIV. And so the kinds of medical care people deliver now is very different but it's because the way we've really changed our perception, our approach to patients as opposed to something that we can do now that we really couldn't have done before. It's a lot of times the way we approach the problem.

AMT: Mm. And that of course was the key with the treatment of Ebola. You're very modest but by talking about this and actually putting this forward, you changed a lot of things.

DR. ROB FOWLER: There were a lot of people that I think were helpful at the beginning of the outbreak to change the way that people are interacting with patients with Ebola. West African colleagues that, you know, someone from Canada that's going for a month, month and a half at a time, leaving, coming back. But many colleagues that I would work with that every day, day in day out for months and really year at a time going in and treating patients. Folks that responded from Canada and, you know, MSF deserves an enormous amount of credit, the Canadian Forces, Red Cross, Save the Children, all groups that really took people from Canada with this notion of we can treat people in a way that we would here, do it safely, we can try to help people get better.

AMT: See what you're doing, you’re sharing the credit. [laughs]

DR. ROB FOWLER: I hope so.

AMT: Rob Fowler, congratulations and thank you. Thank you for your work and your ideas.

DR. ROB FOWLER: Thanks very much.

AMT: Dr. Rob Fowler, University of Toronto Professor in the Dalla Lana School of Public Health. Ongoing consultant for the World Health Organization. Today he is being awarded the Royal College of Physicians and Surgeons of Canada Teasdale-Corti Humanitarian Award. Rob Fowler joined me in our Toronto studio. That's our program for today. Now remember you can take The Current with you to go on the CBC Radio app. Browse through past episodes of our show, choose what piques your curiosity and start listening in just a few seconds on your tablet or smart phone, free from the App Store or Google Play. Earlier today we heard how climate change is affecting Yukon. Canada's great expanse of northern nature has long captivated our imagination. More than 100 years ago, the great poet Robert Service captured that wonder in his poetry. We're going to leave you today with Canadian folk singer Hank Snow's rendition of Robert Service’s Spell of the Yukon. I'm Anna Maria Tremonti, thank you for listening to The Current.

[Music: Hank Snow]

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