'A wild ride': N.W.T.'s outgoing medical director reflects on pandemic — and where she's going next

After four years as the Northwest Territories medical director, Dr. Sarah Cook is saying goodbye to her role.

In the last months of her tenure, Cook, like many medical directors across the country, suddenly became a household name as the COVID-19 pandemic took hold.

Along with Chief Public Health Officer Kami Kandola, Cook has frequently been called on to answer questions related to COVID-19 in the N.W.T.

"It has been a wild ride," Cook said this week.

Cook has been with Yellowknife Health and Social Services Authority for the last 12 years and has been the territorial medical director, the most senior physician leadership role, since June 2016.

"It's actually been a real privilege to be a part of the experience of being in the leadership team in response to the pandemic," she said. 

From the outside, it may have appeared that her role was mainly pandemic-related, she says, but that was just a small part of her work.

"When [the pandemic] hit in March, for all of us, that suddenly became the focus of our work, and it really took over for the first three months of the pandemic as we rapidly prepared the system and our workforce," Cook said.

The experience "was incredibly galvanizing" for the leadership team, she says, as it made the team have a common focus and get things done "really quickly."

"One of the biggest lessons is that when we are given the license to move quickly and to work together as a team, we can," Cook said.

"Institutions and systems are being redesigned by necessity through the pandemic."

Cook says the risk isn't just the virus itself — it's the potential effect on the rest of the healthcare system.

"It's the other things that can be ignored, the chronic disease, the screening, the cancer, you know, people not coming in when they might be having an acute heart attack," she said.

That can really have those long lasting effects on people's health and wellness and on the economy and I think on our society as a whole."

Virtual healthcare project

Now, as she steps away from the leadership role, she says she has clarity as to her next move, professionally.

Cook has ideas on how to improve the way medicine is provided in rural areas of Canada, starting in the North. It's a "special" project she's been working on and plans to launch in December — a virtual integrated healthcare team.

She says the initiative would start with her going to Fort Good Hope, N.W.T., on a regular basis as a family doctor. In between those regular visits, she plans to provide virtual support to patients and to the rest of the health care team. That team might include physiotherapy, dietitians, nurses, occupational therapists and more.

"This is all about the vision to try to create care close to home, which is really where I think we need to go with the territory," Cook said.

In small, rural communities, Cook says, based on the experiences she's heard, there are significant challenges with people trusting the healthcare system.

For one thing, there's often a different face every time people go in to see their doctor, as many northern physicians are on rotation.

"People get really tired of telling their story over and over again to new people," Cook said. "Every time they tell their story, the diagnosis changes, the medications change. People get confused, people get frustrated."

Cook says the medical experience currently in those communities is unfair.

"We really need to do a better job of providing continuity of care, consistency of care and bringing care closer to home," Cook said.

The N.W.T. has the second-most expensive system in Canada after Nunavut, she says, and the program, along with the already-existing "Choosing Wisely" campaign she helped with, could eventually help reduce unnecessary patient medical travel.

"We are more than double the per-capita cost of the national average. And in large part that is because of the amount of movement of patients that we do," Cook said.

Seasoned physician to fill her shoes

On a personal level, Cook says she now wants to spend more time with her three kids, aged nine, 11 and 13.

Dr. AnneMarie Pegg, a physician with experience in the North and with Doctors Without Borders, was announced as the new territorial medical director — a "critical" role during the COVID-19 pandemic — as Cook's term came to an end.

Cook says the team she's worked with in the N.W.T. over the years is "incredible."

"It's easy to criticize what's happening in the healthcare system, but I can say with confidence that the team of people running this health authority are incredible and have a unified desire to make things better," Cook said.

"I have every confidence that Dr. Pegg is going to do a great job stepping into this role."