How would Manitoba handle an epidemic? Tangled trip through health-care system raises doubts
The flu, pneumonia, mumps — we were hitting all the bases as the health-care system kept dropping the ball
My household recently had several serious sicknesses that have left me worried about our health-care system's ability to deal with a fast-spreading illness or widespread emergency.
I got the flu, despite getting vaccinated. (The most active flu strain this year wasn't well covered by the vaccine.)
After days of high fevers, I walked to a Corydon Avenue clinic to see a nurse practitioner because I felt too sick to drive.
Sadly, there was a skeleton staff at the clinic because it was in the process of closing for good as part of the Winnipeg Regional Health Authority's cost cutting and restructuring.
A substitute nurse practitioner who was helping with the move treated me. She suggested an X-ray to rule out complications.
Heading home, I tried to fill the prescription she gave me for Tamiflu. It wasn't available at my local pharmacy, but they said they would check with another pharmacy.
When I got home, I was so exhausted and sick that I went to bed. I wasn't well enough to drive to the Pan Am Clinic for an X-ray.
Surprise! I had pneumonia.
The next morning, a Thursday, I drove myself to the Pan Am Clinic. I had a very high fever and I was drenched in sweat by the time I parked, but I got my X-ray.
The nurse practitioner finally called with my diagnosis on Monday afternoon, four days later.
Surprise! I had pneumonia.
The closure of the clinic — its last day was on the Friday — may have delayed my diagnosis.
Then I learned my Tamiflu prescription had been filled by another pharmacy. Of course, it was too late for me to take the anti-viral.
The next evening, one of my children woke up with badly swollen lymph nodes. By midnight, his neck was so swollen that we guessed it was mumps.
My family is fully vaccinated and we had never seen a case of mumps. We spent the night worrying and Googling.
The next morning, we called Health Links, the provincial telephone health information line. After a long wait, a nurse gave us useful, specific instructions: We should call our pediatrician's office and ask about their mumps protocol. If they couldn't treat us, we should take both kids to the Children's Hospital emergency room after calling to warn them of a contagious disease.
Told me to Google it
It took another hour to get through to our children's doctor's office, with unsettling results.
The nurse I spoke to told me she didn't know of a specific procedure but she couldn't have us "in her clinic" because we'd endanger unvaccinated children. (I didn't want to harm anyone, but the clinic is in a hospital. I wondered how she kept out all the other contagious illnesses.)
I asked for the Children's Hospital triage number. She told me I could Google it just as easily as she could.
Another suggestion was to call a doctor to do a home visit. When I asked how, the receptionist said they didn't know.
There was no specific isolation procedure; we should see the triage nurse like everyone else.
I found the Children's Hospital emergency room phone number and called. There was no specific isolation procedure; we should see the triage nurse like everyone else.
I went to the ER with pneumonia, one sick, contagious kid and a second kid who'd been exposed. We sat in an open area with lots of other people, exposing them to the virus.
After we were triaged, we sat in a clean, quiet isolation room. We had efficient and friendly visits with two pediatricians, an ultrasound, a swab and a blood test for the kid who presented with mumps.
The doctors thought this looked like mumps despite the vaccine. The mumps vaccine's effectiveness has been estimated at 62 per cent to 91 per cent for one dose and 76 per cent to 95 per cent for two doses, the Canadian Immunization Guide says.
Mumps happens much less in a population that vaccinates – but these days, not everyone chooses vaccination. This makes the general vaccinated population more vulnerable to illnesses that should be rare.
I asked the ER doctors how to get more information about what to do; they said there wasn't any hotline or help, because mumps is uncommon. (I learned later that's not true. Manitoba's public health nurses can provide lots of information about how to deal with the mumps.)
If things worsened, I should return to the emergency room, they said. I should call my pediatrician's office for the lab results and confirmation.
Wait for results again
Starting Friday (48 hours after the ER visit), I called my pediatrician's office every day. A nurse acted as gatekeeper and I didn't get to speak to my kid's doctor for a full week.
On Friday, the nurse said there were no test results.
When I called on Monday, no one called back.
On Tuesday, I spoke to a different, more helpful nurse who said the results were negative, but she couldn't offer more information. She said I needed a public health nurse, but she didn't know how to find one. She suggested she might talk to a doctor and get back to me. She never did.
My kids' school gave me the right phone number for our area's public health nurse. (Several numbers listed online were dead ends, perhaps because of the current health-care system flux.)
Nearly a week after the ER diagnosed my kid with mumps, I found a public health nurse to advise us. She confirmed that if the blood test was negative, it meant my kid had a "mumps-like" virus or the patient wasn't shedding the virus when samples were taken – the lab tests aren't accurate 100 per cent of the time.
After a crummy week, my kids' quarantine has ended. My last lung X-ray, after five days of waiting for results, was negative for pneumonia.
Concerns about health of the system
This experience left me concerned about how our health-care system might manage with a public-health emergency.
Multiple health-care professionals said they didn't know Manitoba's mumps protocol. They didn't know how to reach someone who could help.
My pediatrician's office wasn't helpful, even though going to your family doctor is the province's advice. It took a week for my children's pediatrician to speak with us directly.
What would happen in case of a serious infectious disease outbreak? Some of what we experienced must change.
First, Manitoba must communicate lab results quickly.
In three cases in January, I didn't hear promptly about results of tests for serious illnesses (two X-rays for pneumonia and mumps lab work). A lab technician said if I wanted faster results, my only option was to go to an emergency room. Will this be expedited by Dynacare, which took over diagnostic labs in Winnipeg recently?
Second, as part of the province's health-care reorganization, health-care professionals need to know how to respond on the front lines.
Doctors and nurses should know how to promptly handle a suspected case of mumps or serious illness like pneumonia. Professionals should offer correct information and phone numbers when patients call. The pediatrician's nurse should have the Children's Hospital triage number and how to find a public health nurse.
My family was aware of public health risks and educated enough to pursue information aggressively. Not everyone is so motivated.
No one's perfect. Health-care professionals are stressed and overworked. However, it's concerning when the system fails on multiple fronts at once.
We tried to face our health challenges with patience rather than panic, but this is serious stuff. I hope others have a better response and outcome than we had.
Let's hope we never face a provincial epidemic. If we do, we might be in trouble.