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The Current Transcript for March 3, 2020

Host: Matt Galloway

STORIES FROM THIS EPISODE

Prologue

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VOICE: There's a dam and the dam is not holding water any longer. It's overflowing. And we are telling the world community, give us a helping hand and nobody is.

MATT GALLOWAY: The dam is breaking. A humanitarian crisis, a political football or a combination of the two. As Turkey ends its policy of blocking migrants from Syria and beyond, trying to cross into Europe, the Greek government has responded with force. In 30 minutes, we head to the Greek island of Lesbos, as desperate refugees face a hostile reception. And then.

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VOICE: My brain kept asking, OK, so what do we do now? We've done this huge, incredible, amazing thing. I knew right away that I think I was going to have to do it again.

MG: That amazing thing was having a baby for someone who couldn't have one on their own. Surrogacy is booming in Canada, and as the regulations around compensation for the practice are set to be tightened, a CBC News investigation explores the medical risks that remain for women involved. That's coming up in an hour. We begin though, in a very long line at the local bulk store where Canadians are stocking up on everything from coffee and pasta to toilet paper and hand sanitizer as fears of a pandemic loom. Good morning. I'm Matt Galloway and this is The Current.

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'Herd effect': Social media images of empty shelves fuelling panic buying over coronavirus, says prof

Guests: Alison Thompson, Steven Taylor

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VOICE: Somebody with an infection with the new virus could be ill for a week or more. So do you have the fever medication? Do you have the supplies you would need to just limit you having to go out to the grocery store or the pharmacy? These are just practical kind of measures that you can put in place.

MG: Ottawa's Chief Medical Officer Dr. Vera Etches has raised a question worth considering. How does one go about shopping for a potential pandemic? Now, to be clear, we aren't in that territory yet, but as fears of coronavirus continue to spread, many Canadians are loading up on the essentials.

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VOICE 1: There is a lot of toilet paper going out. People are worried.

VOICE 2: Bread, Cinnamon Toast Crunch, egg and beans, milk and snacks and French fry and.

MG: The list goes on and on and on. Shoppers at a Vancouver Costco were emerging from the warehouse yesterday with overloaded carts.

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VOICE 3: Well, I'm here to do my regular shopping and there's not a lot there. Well, there is, but not the stuff that I wanted. Yeah, like the regular pastas and stuff like that are not available that were there a couple weeks ago. You don't want to panic, but here everybody is.

VOICE 4: I have a lot of stuff today because everybody go to buy some stuff because of the virus corona. Yeah. So I'm scared too. And the paper is important. And rice I bought already and I buy a lot of bread and egg and fruit for my family and my sister.

VOICE 5: Just essentials. Toilet paper and cans and things that can run out and just to have for future.

VOICE 6: Are you worried?

VOICE 5: I don't know. We'll see.

VOICE 7: Well, we were here on Saturday then we didn't get half the stuff we needed, so we're back today.

VOICE 8: It's much busier today than I have seen in the past and the parking lot was very busy. We thought that we would get in here and have a quick, easy shop, but we needed our patience caps today.

MG: Patience caps. That's something you probably stock up on. I'm not entirely sure what I aisle that's in, but good luck in finding them. It's not entirely realistic, though, I suppose. Alison Thompson is with me for more practical advice. She teaches public health ethics at the University of Toronto. Alison, good morning.

ALISON THOMPSON: Morning.

MG: What do you think when you hear about people stocking up those people? I mean, they say they're on the regular shop, but then they're trying to buy other things as well and it turns out that maybe those other things aren't available.

ALISON THOMPSON: Yeah. So I think that the key thing here is to walk, don't run. So we don't want to, you know, cause the have the panic cause a problem in terms of supply chain issues. So really there there is no reason to go out and, you know, stock your bunker at this point in time. What a better approach would be to just, you know, add a couple of items at a time as you go shopping. And that way we're making sure that everybody can be prepared.

MG: What should people be buying to prepare for the possibility of the corona virus spreading?

ALISON THOMPSON: Right. So you want to you want to make sure that you're okay if you get sick and you know, you might be stuck inside the house for a few days. So, you know, you might want to have some dried pasta, some tomato sauce, some canned soup, you things like that that are non-perishable but still nutritious. And you want to make sure that you have basic fever medication like acetaminophen or ibuprofen. And if you have children, the right formulation for them, things like Kleenex, toilet paper, all the papers and papers, if they go in, is a big you go to the Costco and then me people have carts and carts full of the toilet paper because they're worried. Yeah. Yeah. I mean, I think we can probably lots of parts of the world manage their toilet paper. So I'm not sure that's the top 10 essential list. But you know, it's it's good to have diapers if you have children, feminine hygiene, project products, things, things like that that you know are things you use everyday. Things like tissue might be more important in terms of the importance of you covering your nose and mouth when you're coughing, it's handy to have a Kleenex box around.

MG: What's going too far do you think?

ALISON THOMPSON: What's going too far? Well, I think we have to keep in mind that, you know, grocery stores are not stocked infinitely. So we are part of the community and we want to make sure that we are not hoarding, you know, and depriving other people of those basic necessities. And so that the approach would be, you know, just add a couple of things at a time when you're going to the grocery store rather than like wiping out the entire shelf of dried pasta and taking it home. Have you tried to buy hand sanitizer recently? I have. And I was just looking yesterday on Amazon because having gone to several drug stores where the shelves are now empty, I went online thinking how how I'll be smart about this, went on Amazon and now Bottle of Purell is about runs around between $88 and $160 for, you know, a multiple pack. So.

MG: $160 for a pack of hand sanitizer?

ALISON THOMPSON: Yeah. So that's another whole story in and of itself. There you go. But what what's going on there? But the thing is, soap and water are just as good, if not better. And there's lots of soap on the shelves. So we tend to you know, all this usually have a bar soap like Rounder, some liquid soap that we can use.

MG: What do you make of the run on face masks? There have been a lot of people who've been trying to get their hands on face masks and whether, again, it's in a bricks and mortar shop or online, very difficult to get a hold of.

ALISON THOMPSON: Yeah, I think that face masks are an interesting thing. They they make us feel better, but unless you're actually sick. They really are not necessary. They will not actually completely protect you from droplets, which is the way that the virus is spread. So your eyes are still exposed.

MG: So you know, it may give you a false sense of security to wear a mask if you're not sick, but if you are caring for someone who has the virus, it's a good idea to wear one just because it does add a little bit of a protection for your nose in your mouth. And you know. But if you are sick, even if you're not sure you have had the virus, you if you have a fever, your cough sniffles it does actually help prevent the spread if you wear a mask. The thing is, you have to use it properly.

MG: Can you understand why people are going out and trying to, it's not filling up the bunker, but perhaps loading up the basement or a spare closet with what they can get a hold of? The Health Minister, Patty Hajdu, said you should make sure that you have enough supplies or someone in your family becomes ill or if you become ill. You have what you need to survive for a week or so without going outside. Isn't that rational behaviour, hearing that to go and try and get what you can get now?

ALISON THOMPSON: I think it is great that everybody wants to be prepared. The thing to keep in mind is, you know, we do have a similar virus in many ways influenza every year. And this doesn't you know, it doesn't seem to have the same reaction for people. So it is always a good idea to be prepared for, you know, even the power, a power outage, something like that. And and the supply list would be very similar. So it's not that it's bad advice. It's just that you don't need to go overboard. And, you know, it's not a virus that's circulating in the community at the moment. What's that line between rational purchases and going overboard? Well, that's a good question. I suppose it's somewhat arbitrary, but I think if you examine your motivations, you know, if you're buying out of panic, then you might want to check yourself and scale back a bit, you know? And the suggestion to just add a little bit every time, like add a couple of Kansas soup the next time you go rather than than taking the whole shelf.

MG: You've kind of hinted at this and maybe that's to the point is taking the whole shelf. In teaching public health ethics, what is, what are the ethical considerations when you're talking to people about how to prepare for something?

ALISON THOMPSON: Right. So I think we tend to focus on ourselves, you know, when we're when we think about this. And it's partly the fault of public health itself. You know, we're able to access lots of information, really good information about how to prepare for ourselves. But I think we've got to remember that an outbreak response is dependent on the community as a whole. Acting in particular ways. And so, you know, the importance of things like solidarity and reciprocity in a pandemic are huge. And we know from recent outbreaks of Ebola that social cohesion is a big predictor of how well in a break is managed.

MG: That we are as healthy as our neighbours and we, you know, ours as a community is tight as we are with our neighbours.

ALISON THOMPSON: Exactly. Yeah. So, you know, while you're preparing, think about is there someone in your neighbourhood that is vulnerable, you know? Are they elderly and they have trouble getting it to the stores? Is there someone you know who's at work? You know, community doesn't just have to be your neighbourhood, it can be your your place of work. It can be a place of worship. It can be your gym. You know, try and think about people who might actually need assistance and try and buddy up. Have somebody on call. You know, he can call up and say, hey, I'm not feeling well, I'm trying to be responsible and not go to work. But could you go and grab me some orange juice or whatever it is that you that you need and having those sort of connections in the community in place is really helpful.

MG: Alison, thank you.

ALISON THOMPSON: You're welcome.

MG: Alison Thompson is a public health professor at the University of Toronto. As she was saying, when it comes to emergencies, there is that fine line between being prepared and being panicked. Steven Taylor is an expert on what that line looks like. He just wrote a book. It's called The Psychology of Pandemics: Preparing for the Next Global Outbreak. Steven, good morning to you.

STEVEN TAYLOR: Good morning, Matt.

MG: Listening to those people in the line at Costco saying you don't want to panic, but and then they have a cart that is loaded to the brim and perhaps into the cart behind them with supplies. What do you think is driving people psychologically when they go and stand in those long, long lines for toilet paper and canned beans?

STEVEN TAYLOR: Well, it's interesting. It's a series of snowballing effects, that seems to happen. It starts out with what seems to be a fairly sensible message from the health authorities stock up for a couple of weeks. But you've got to take in consideration the target audience. Many people, perhaps most, aren't stocked up. So the gunda surge into grocery stores and Costco and so forth. Then what can happen is inevitably there'll be some people there who are overly anxious and they're going to over purchase instead of buying toilet paper for a week, they'll buy toilet paper for six months. And so inevitably, someone will post images on on Instagram or on social media of overstuffed shopping carts and empty shelves in department stores. And that's going to go viral and that's going to create the illusion of urgency and scarcity. And that's going to ramp up the panic buying.

MG: Just like a self-fulfilling prophecy.

STEVEN TAYLOR: Exactly.

MG: That you see the empty shelves and you don't want to be somebody who is standing in front of the empty shelves, so you go and empty the shelves.

STEVEN TAYLOR: That's exactly what happens and so that causes more people to panic and more people to surge into these stores and creates a real sense of scarcity and of. Cause you get things like price gouging, which again creates a sense of urgency and scarcity, which makes things worse.

MG: It's difficult to find that line though, because you can imagine that people have a real sense of anxiety. This story is dominating the news headlines. It'll be the first two or three stories in a nightly newscast. And so how do you calibrate your own anxiety based on what you know about the real risk to public health?

STEVEN TAYLOR: It's a tricky question. I think people need to realise that the the vivid images that are going viral of empty shelves and overstuffed cuts are circulated simply because they're dramatic. Nobody's posting images of of calm shoppers and full department stores or supermarkets. So you need to have some media literacy to when you look at these images, realise that this is not a statement of the way things really are.

MG: What about the messages from Public Health again? The health minister said that Canadians should and should be cognizant of what may be coming and being very careful with her words, but saying you may want to make sure that you have enough to survive for a week if you become ill and you can't go outside.

STEVEN TAYLOR: It's a really complex issue because on the one hand, you don't want to over scare people, over frighten people, because that's going to lead to panic buying. But if your message is too mild, you're not going to motivate people to get out and do the things they need to do. So there's that consideration. And you also need to consider the target audience. You could think, well, maybe the message would be, why don't you buy a few more things than you would normally need just to make sure you have a week's supply. But there's no need to panic or over purchase. Maybe that message would have been better, but who knows?

MG: Social media, as in many things, does it just amplify this and make it worse?

STEVEN TAYLOR: Yes, it does, because people selectively decide what to share. And it's usually very vivid and dramatic stuff that people share online.

MG: It's them In the line of Costco and the line goes all the way out into the parking lot.

STEVEN TAYLOR: Yes, exactly. And that can create a fear contagion effect.

MG: What about the media? I mean, pulling the curtain back a little bit, I could say the word cautious and even having this conversation, we talked about how to have this conversation or whether you would just amplify that or whether you're actually reflecting what's going on. How can the media go about presenting this issue in a way that doesn't just wind people up further?

STEVEN TAYLOR: I think presenting both sides of the story is important. This is what we're doing today and talking to problems like panic buying or purchasing of, you know, having a frank discussion about some of the social problems and pointing out to people that say a social responsibility to shop responsibly and not to hoard or panic buy because that creates needless anxiety in the community.

MG: If you take a look at you, you've just written this book on it, perfect timing in some ways. If you take a look at at other times where people have been feeling anxious about a possible pandemic or something coming and that they have gone and stockpiled, loaded up the basement or the spare bedroom, what are some of those other times that we've seen in history?

STEVEN TAYLOR: We've seen this in all the previous pandemics. I mean, everything that's unfolding currently for Covered 19 has been seen before. And I'm actually waiting on the other things that we've seen in other pandemics, too, to arise this time around. Things like what? The surge of the worried well in hospitals. So we'll see a surge of people who think they have covered 19 when in fact they have a cold, they're going to surge in the hospitals. And there's a real concern that those individuals will overwhelm an already overburdened health care system.

MG: What should we learn from those other experiences?

STEVEN TAYLOR: Then it's really a question of educating the community, of advising people that if they have a cold or a mild fever or cough to stay home, don't go to hospitals. There's that issue that that herd mentality is a really powerful thing, though it is very much so. And that's going to come into play when a vaccine is developed there. Another problem which I'm anticipating is when there is a vaccine for covered 19, many people won't get vaccinated. And this has happened time and again in previous outbreaks, even during the 2009 H1N1 flu pandemic. About half the population did not bother to get vaccinated. So obviously, we can't control an outbreak if people aren't going to go and get a vaccine so that that issue needs to be addressed ahead of time. We need to address that proactivel rather than waiting until the problem arises.

MG: What do you think is different now than, it was interesting, Alison raised the issue of the flu, we'll often hear in the midst of these conversations from people saying X number of thousand people die every year because of the flu and the seasonal flu that sweeps through. What's different about what we're talking about now compared to what happens every single year?

STEVEN TAYLOR: Well, there are a couple of differences. One is, is the uncertainty about COVID-19. About how this whole thing will play out. It seems to spread very rapidly and it is 20 times more lethal than the flu. There's that issue as well. And there's the other thing there that we don't have a vaccine at this point. So those uncertainties, the spread and it's what seems to be greater lethality, are ramping up people's anxieties.

MG: Are we paying enough attention to that anxiety, to the psychological factors in all of this?

STEVEN TAYLOR: Well, that's a really interesting issue. Some people are paying too much attention to it.

MG: What do you mean?

STEVEN TAYLOR: Getting too anxious about this. And they're the people who are panic buying, who are wearing face masks at home when they don't need to. There's that group of people and then there's the opposite end of the spectrum. The people who don't worry enough, who aren't bothering to wash their hands or cover their coughs. And they're the people who actually spread infection. There's that middle ground of people who are expressing appropriate concern, who are following reliable news services sources and doing the basic hand hygiene things.

MG: Go back to those people who are in line at the bulk store. Can you blame them? I mean, you might be media literate and you might be making rational decisions, but at the same time, this is all around us. Can you blame them for going and loading up the cart with things, you know 40 cans of tuna that they're gonna put in a closet somewhere because they're worried about what might happen?

STEVEN TAYLOR: Oh, I don't blame them. But this is a herd effect. This is a classic example of fear contagion. Imagine this. You're on the Titanic and everyone is running for the lifeboats. Are you going to sit around and think about whether the ship is sinking? No you're going to run as well as almost a reflex reaction. And this is this phenomenon of fear contagion. And so if we're seeing everyone rushing to the stores, buying up everything, our immediate response is, oh, I better go and protect myself and my family. And so this gets to the social responsibility aspect of this that people should purchase responsibly and not hoard items.

MG: Not clear the shelves.

STEVEN TAYLOR: Exactly.

MG: What would you say then is somebody who is loading up the car and heading to the big box store?

STEVEN TAYLOR: I would say you need to have a sensible plan. How much toilet paper do you really need for a week? And think about other people in your community and think about the impact that your buying is having on other people.

MG: Is it, do as I say, not as I do? Have you gone to the bulk store and loaded up yourself?

STEVEN TAYLOR: I'll tell you, two years ago I bought a box of N-95 masks, thinking when I first started writing my book on psychology pandemics, thinking that at some point I might need them. The box is still in storage at the moment and I'm not planning on using them. We stocked up with two weeks supply of food months ago thinking that the pandemic is inevitable. So it's a case of I am following the advice that I'm offering.

MG: Steven, thank you.

STEVEN TAYLOR: Thanks very much.

MG: Steven Taylor, professor of psychology at UBC. His new book called The Psychology of Pandemics: Preparing for the Next Global Outbreak. Last word on this goes to the shoppers and the real reason that most people go to Costco.

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VOICE 1: I read online that somebody was saying that Costco was crazy on the weekend and they were saying, yeah, but look at the person who just sneezed and just gave you a sample. So I don't ever have the samples anyways.

VOICE 2: Actually the only thing I sampled today at Costco was the chewy covered chocolate granola bar and it was delicious, but that was it.

VOICE 3: I think sampling food, if you're worried about the coronavirus, is kind of disgusting.

VOICE 4: Nobody seemed to be worried. Everybody seems to be still getting in there to eat those samples.

MG: Your thoughts on this? Are you buying up things? Loading up for the possible pandemic? You can let us know on the website cbc.ca/thecurrent. Tweet us @TheCurrentCBC. This is indeed The Current on CBC Radio One. My name is Matt Galloway. We're back in six minutes. Stay with us.

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Thousands head to Greece after Turkey opens its border to migrants

Guests: Franziska Grillmeier, Aaron Stein, Boris Cheshirkov

MG: Good morning, I'm Matt Galloway and you're listening to The Current.

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MG: Still to come, a CBC investigation about surrogacy in Canada and what some are calling a lack of oversight. That story coming up in about half an hour. But first, growing hostility on the border of Greece and Turkey.

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[Sounds from refugee camp in Lesbos, Greece]

MG: Those are sounds from the Greek island of Lesbos, where 20,000 migrants live in a camp meant for 2000. The overcrowded Camp Moria is at a breaking point. Migrants protesting camp conditions are being met with tear gas and water cannons and meanwhile, a new wave of arrivals are trying to cross into Greece after Turkey opened its borders over the weekend. Franziska Grillmeier is a freelance reporter who lives on Lesbos. Franziska. Good morning.

FRANZISKA GRILLMEIER: Good morning.

MG: Describe the conditions in that camp that would lead to those protests. What is it like?

FRANZISKA GRILLMEIER: I mean it's an old military camp that can only host 2500 people at this point, and it's completely flooded over in the external olive grove fields. So people don't have electricity. They don't have any medical support or legal support. It's people with disabilities, it's the elderly, it's newborns. And nobody has any guardian or someone to talk to because the NGOs on the ground at this point had to close their operations due to the high pressure they're under from the Greek governments that is criminalizing humanitarian aid at this point. And at the same time, also now we face a heavy threat from the local community, which is making the NGOs responsible for the refugees coming in and onto the island. And so there's a blind rage atmosphere at this point just throughout the whole island really. So the people are completely left alone and they don't have any legal assistance and it's really a black hole of human rights and any kind of support that could be given to refugees and asylum seekers.

MG: That sounds incredibly grim and now there are more migrants who are coming in. What would that mean for the people who are already there?

FRANZISKA GRILLMEIER: So, I mean, the people who were already there, they since weeks and months, European member states and actually years are denying any responsibility to to support the people, to give them any a sense of security. So they are highly understaffed. And the people on the ground, I mean, they have to build their own houses with their bare hands at this moment. There is nobody who is, you know, taking care of anyone. And first aid is not given anymore. Even so, I mean, now people coming in, if they can make it, because most of them are now stuck on the beach. There are violent patrols in front of Moria from locals, right wing extremist groups who say we don't want any more people. So the people can't be even registered at this point at the overflowing camp.

MG: Since Turkey opened up its border this week and this is a very controversial step, how many migrants do have a sense as to how many have made their way to Lesbos?

FRANZISKA GRILLMEIER: So we talk about 1000 at this point, more or less, but we can't keep up with any accurate numbers because we simply don't get the information even yet, because also NGO workers, human rights boats who were usually on on the ground in the gays, they were heavily attacked. Journalists are being attacked. I was attacked last night in the car going from the port town to Moria with stones and and sticks in my car. And so it's really everyone who is looking as an outsider at this point. They are being heavily threatened. It's true that we can't even get the information of how many people actually arrived. But at this point, it's around seven times as much as usual. But it's not like in a crazy number like in 2015 or 16 at all.

MG: Tell me about this attack last night. You describe the mood on the island as a blind rage. What happened to you?

FRANZISKA GRILLMEIER: So I mean, I want to also mention that it's not the whole island that is going crazy, but it's organized right wing groups. So, yeah, I mean, we were driving in the car just into a mob, basically off of 100 to 150 blackberrying men. And then they saw that I'm blonde myself, so they see I'm not Greek and started to throw stones and sticks, tried to jump the car, tried to open the doors, but we could turn around and drive very quickly. And weren't followed.

MG: Oh, my goodness.

FRANZISKA GRILLMEIER: We are okay.

MG: I was going say, you're all right, but why are they attacking you? Why is it that the journalists and the NGO workers are being attacked?

FRANZISKA GRILLMEIER: Because also this resentment against humanitarian workers was fed by the Greek government in the last month, saying that people are just getting EU funds. They're just here to make money with the suffering of asylum seekers and refugees. And so it's building up this huge frustration and it's just feeding into that right wing populist party mood. You know, and just like an exploitation of the people's frustration is now completely over spilling into a violent. Yeah. Reaction from people. And groups start attacking, so people just think, look, if we get rid of the humanitarian workers, the doctors of everybody who is who's desperately since years trying to close some of these these gaps that are there in there in the camp, then. Refugees, one stop will stop coming towards us. Yeah. It's like this absolute absolutely absurd logic at this moment of saying out-of-sight. And we will have our our island back and our land back.

MG: We've seen these videos online through social media of the coast guard in Greece trying to topple to overturn these migrant boats, heading the migrants with sticks as well. Are these videos accurate? There are questions as to the veracity of them.

FRANZISKA GRILLMEIER: Yeah. I mean, I couldn't keep up with anything that was happening at sea constantly, but I was at landing's also two mornings ago and there I could see with my own eyes how the Turkish coast guards were circling around a dinghy, making huge waves so that people would either capsise or be drifted into Turkish waters against a disease. I mean, it wouldn't come as a surprise to me if, I'm not sure at this point if it's verified or not.

MG: And these are Greek officials that are doing that?

FRANZISKA GRILLMEIER: Yes. And I mean, this is also what we've seen on the on the border, on the Turkish Greek border. This is what we see now. Heavy, heavy violence being used would tear gas. Also yesterday at the protests in Moria, where people thought they can get out off of the camp because there was a rumour that there's a ferry leaving to the mainland. So they started walking and they were pushed backwards with tear gas. And we can't even report about it. No, we can't, because we are under threat, too. So, I mean, we are at the moment really reporting under heavy pressure and I would say even a security threat, yeah.

MG: Yeah, this is a desperate population. And they are fleeing civil war. They're fleeing to try and get to a better place. And with the borders now open, it seems as though more people will come to try and get into Europe if the migrants continue to arrive on this scale, what's going to happen, do you think, from the locals, but also from the Greek government?

FRANZISKA GRILLMEIER: So the violence is already imploding inwards, yeah. So reaching the most vulnerable and the ones who can't defend themselves at this point. So it's very hard for me to even make an assumption of what's going to happen. But I mean, this is a right to this place at this point, yeah. Even the police is completely overwhelmed. Nobody is there to have legal assistance. You know, there's a few lawyers, Greek lawyers on the ground who are doing amazing work to help us get through it, to report incidents. But it's very hard to keep track on what's happening in Moria, who's hurt, who's killed, what's going on and yeah, I think it's just continuing to be a black box and human rights violations will continue to rise. And if the EU member states are not stepping in at this point and supporting the legal grounds on on these bases, it's already, you know, a broken stage. So I don't know where this can can actually just still speak to. It's we've reached a peak and people are suffering severely.

MG: What is it like on the island today?

FRANZISKA GRILLMEIER: I mean, you know, it's always like this absurd mix. So you have these kids walking in carnival costumes because it's also carnival here and and then you have people just doing their daily job and and the sun is shining. So it's not like, you know, it's just a grim state. But you feel that there is always a sense of fear in the air. There is people taking pictures of journalists to report them in order to maybe attack. So, you know, there is like a constant fear that people will be attacked. And most of the humanitarian workers are either inside or left the island. So nobody is operating inside of Moria at this point. There are a few journalists around, but they also have to be very cautious at this point not to be attacked.

MG: Amd what precautions are you taking just finally?

FRANZISKA GRILLMEIER: I'm at home. I'm at home. I can't movesSince yesterday. I will go out because I can stand not, you know, being out there to see what's going on. But yeah, for now, I'll have to stay inside because I'm kind of a moving target since I also live here since 2018. And I could have the profile for humanitarian worker and yeah, it's not the best profile to have unfortunately at this point where, yeah, any kind of democratic values a failing in Europe.

MG: Franziska, it's good to speak with you. Stay safe.

FRANZISKA GRILLMEIER: Thanks a lot.

MG: Thanks. Bye bye.

FRANZISKA GRILLMEIER: Bye.

MG: Franziska Grillmeier is a freelance reporter who is in Lesbos, Greece. Turkey has long threatened to open its gates to Europe. For look at why, I'm joined by Aaron Stein, Director of the Middle East program at Foreign Policy Research Institute. Aaron, good morning to you.

AARON STEIN: Good morning.

MG: Why has Turkey done this? Why has it opened its borders in this way?

AARON STEIN: I mean, I think it's directly related to the violence that we're now seeing in Idlib province inside of Syria where the regime and the Russians are executing an offensive against Turkish and Turkish backed forces. This has caused a significant move of Syrians to the Turkish border. Now close to a million displacement. So any numbers of hundred thousands of people and Ankara saying we're full. The border has been closed in Syria, since more or less since early 2015 and so these people that you're seeing moving on into you know Greece or Bulgaria are Syrians that were already in Turkey. And Turkey is saying we're at capacity. You have to burden share. We're opening the borders.

MG: There's a couple of things there. One is what's happening in Idlib, which is that the last stronghold of the Turkish based opposition in Syria, 36, at least 36 Turkish soldiers have been killed by Syrian and Russian airstrikes. What does Turkey want now and what is Turkey want to happen now in Idlib?

AARON STEIN: They want to freeze to the violence and a rollback of the regimes advancers to a set of observation posts that were agreed to with the Russians at Sochi in September 2018. The problem is, is that the regime has collapsed those areas, moving of multiples of kilometres beyond that. So Turkey is now trying to push them back and that's why you're seeing Turkish airstrikes. It's really a quite tense situation. Within that, you know, is where you're seeing those people move to the border.

MG: And Turkey is looking also for some sort of support from from NATO allies? I mean we've heard the Turkish leader talking about that.

AARON STEIN: Yeah. So after the Turks were killed in most probably a Russian airstrike. They did go to NATO, but it was under article 4 consultations and there are discussions about what the alliance can do for Turkey. Ankara has reportedly asked for Patriot Air Defence systems andaAt least reporting here in the U.S. is that basically we're not going to send any. So if there's going to be any additional patriots sent, there already is one in Turkey. It's provided by Spain, it would have to come from a European country.

MG: The other part of that, as you mentioned, is the refugee crisis. Turkey has been accommodating something like 4 million Syrian refugees of its own. And this what's happening now in Idlib has created more movement we've been talking about this on the program, the movement of hundreds of thousands of other people as well. What has that created within Turkey itself? What sort of crisis is happening within Turkey itself based on that?

AARON STEIN: Yeah. It's four million total refugees. A number of which are serious. I don't mean to downplay it, but we're talking about millions of Syrians, but also Afghans, there's also Iraqis. But you know what is happening in Turkey, is that, you know, they had an open border policy from essentially the end of 2011 to the beginning of 2015. And so you've seen a complete shift, you know, in certain border towns. You know, they've gone to Turkish, to Arab. You know Turks aren't Arabs. They don't speak the same language. And more recently, you had a difficult down to turn the Turkish economy and so people are starting to turn inward. The government's getting very nationalist and they're basically very similar to a lot of the things that your previous guest was talking about in Greece. These right wing groups that are attacking refugees saying something along the lines of our country is full. We don't want anymore. You're making life more difficult for us. More countries have to do more for us.

MG: And by opening the borders, what is it hoping to achieve?

AARON STEIN: Well, look, it's a deeply cynical move and obviously adds to human suffering and obviously it's not all that nice because Turkey isn't hosting all the people to accuse them of being cynical, but they are being cynical. They're trying to blackmail the Europeans in particular to do more. What they're asking them to do is either provide financial assistance to Turkey, to at least give political support to set up a safe zone in idlib and attached to that is to provide military support. The problem is the Europeans aren't going to do that. It really has to be my country, the United States and we are in the midst of a election season. We have other concerns, potentially about a bio pandemic and so not a lot of people are paying attention to the things going on in northwest Syria.

MG: You used the word blackmail. That's word that Angela Merkel, the German leader, has used as well. What's the reaction been from other members of the European Union in response to this?

AARON STEIN: You know, it's people are calling it blackmail. I mean, the anger is high. I mean, I am American and I have been to Brussels for about three months, so this is all said to pan, but, you know, it's this idea that the Turks are have isolated themselves, even though they are in the right. Their efforts to protect civilians are laudable and come from the correct place, their execution to try and win over European support. It's hand fisted and obviously, you know, extremely sort of cynical is the best word I can come up with and playing with people's lives. Obviously they aren't doing a great job either, but you know it's a vicious circle.

MG: If you talk about ham fisted, I mean, what is the reaction of Greece likely to do to this story? The images that we're seeing of the Greek coast guard splashing, trying to almost overturn some of the boats filled with refugees, poking them at them from higher up with sticks? What is that likely to do to how people see this story unfolding?

AARON STEIN: You know, it's a good question. It's a question for European governments. I mean, but, you know, Europe is better prepared than they were in 2015 to handle a micro crisis and amounts of people as your previous guest said are less than what we saw in 2015. So this idea of caravans or large groups of people walking across the border are probably not going to replicate themselves, but that's because they've imposed very strict measures. And I don't see any European country and again, I'm looking at it as a bystander that want to take more Syrians. And so I think we are looking at a very, very grim situation for these people. You have a very hostile European polity. You have a very anti-Turkey. Brussels. There's a whole other thing about that, with Cyprus, all sorts of other stuff. And you have a Turkey that's involved in combat operations in Idlib, against a large power in Russia. It's a very, very tense situation and the most vulnerable, are the ones who will feel the most effects of those are the Syrian refugees and migrants.

MG: Just finally, we learned this morning that the United States is committing something like $108 million in aid to the people of Syria. The U.K. adding another 89 million pounds to Syria. How is that likely to help?

AARON STEIN: The U.S. has been the largest giver to Syrians since this began. Syrians still suffer. You know the way, yes, good. More dollars are good. That means at least more aid. Nobody should be cynical enough to turn down cash to try and help these people. The only way these people will be helped is if the war stopped and there is absolutely no indication both from the regime side and from the Turkish side, that there was a willingness at this point to stop the war. The war will continue as the war continues. There'll be more people displaced.

MG: Aaron, we'll leave it there. Thank you.

AARON STEIN: My pleasure.

MG: Aaron Stein, Director of Middle East program at the Foreign Policy Research Institute in Philadelphia. Let's just briefly go back to the situation on the island of Lesbos in Greece. Boris Cheshirkov is a spokesperson for the United Nations Refugee Agency and is in Lesbos. Boris, good morning to you.

BORIS CHESHIRKOV: Good morning and thanks for having me.

MG: Thank you for joining us. We heard earlier about stories of violence, scenes of violence being directed at journalists, at NGOs as well. You're there on the island. What have you heard when it comes to your teams?

BORIS CHESHIRKOV: We've been affected as well. The situation has escalated in the last several days. A staff member of ours was attacked verbally and physically as she tried to disperse a group of locals that were pushing back a boat with several families that had just arrived across the water, forcing them to go back and not allowing them disembark. And later that evening, on Sunday night, we have a transit facility on the north shore of Lesbos, which we've used over the last few years to shelter new arrivals during the night, if they come during the night, so that they have a place to change their clothes, get some tea and wait to be registered later in the morning by the authorities. And that was burned down, set ablaze, we understand by locals. There's an investigation going on, but what is important to note here is that Lesbos has been known as the island of solidarity. The compassion, the support that the locals have been showing has been incredible. The level of care that Greeks have been providing to refugees in 2015 since has been laudable. At the same time, and I think this is essential to note, island communities feel that they've been disproportionately left to handle a situation, which hasn't been addressed sufficiently by the Greek government. We now have much just on Lesbos, put a handful of islands, around 36,000 people, families from Afghanistan and Syria living in horrendous conditions in five centres that were designed for fewer than 6000 people. This has been going on for months. We've had an escalation of arrivals in the second half of 2019, coupled with long asylum procedures. People have been kept on these islands and the local community right now are anxious and frustrated and they're expressing with more verbal and public means. But among them, it's a small group that are resorting to these acts of intimidation and harassment. We deplore these acts and we've been calling for calm since Sunday.

MG: The Greek prime minister, I mean, in all of this, we were hearing earlier that mean essentially these refugees, these migrants are being thrown around as a political football. The Greek prime minister just said at a press conference that the Greek Turkish border, he's along the Greek Turkish border, that Turkey has become an official migrant trafficker. That's coming from the Greek prime minister. What does that say to you about where this is going to go?

BORIS CHESHIRKOV: We are a humanitarian organization, so that's our first concern is the humanitarian needs of those that are now between the borders of Greece and Turkey at land that the Everest region, but also those that have been coming in in slightly larger numbers over the weekend. We've had around 1400 people come through and that has been more than the day, the average, but it's still comparable to what we had in the summer, early autumn, months of last year. What is essential that, of course, states, Greece and all the states have a legitimate right to manage their borders, to manage irregular movements. But this has to be done in a proportionate and responsible way.

MG: Do you think that Turkey has acted irresponsibly in opening its borders?

BORIS CHESHIRKOV: Well let's not also forget that Turkey is the largest host of refugees in the world. It has, as your previous guest and yourself also mentioned, four million refugees, mostly Syrians, 3.7 million Syrians, but also other nationalities. It's been showing incredible support to refugees on their territory. But, of course, that has to be supported by the international community and Europe certainly has a share of that responsibility. Let's also not forget that in this era of global displacement, when we have 70 million people displaced, among them are 26 million refugees. They're not in Europe, they're not in the industrialized world. They're not in Canada or the US. And by and large, more than 80 percent of them are in poor and middle income countries, usually the neighbours of those in conflict areas. And certainly more legal pathways for people to arrive in the EU and other countries that can afford it. More ways to reunite family members, more scholarships offered, more ways to get refugee workers to come in. This is important because otherwise then people are resorting to criminal networks, the smugglers, the traffickers to try and get in, sometimes through ajoint family members. But we shouldn't let vulnerable individuals who have fled war and persecution to become the target of the decisions that are made at the political level.

MG: We just have a few seconds left. Is your sense that is that the world is paying attention to this crisis? I mean, this is what's happening in Lesbos right now, but also the situation in northwestern Syria and Idlib. Is your sense the world is paying attention?

BORIS CHESHIRKOV: We have to focus our efforts on northwest Syria. We're facing we're, not us, hundreds of thousands of families with young children are facing a catastrophic humanitarian situation and they have to be helped now. And for that to happen, there has to be a political solution for peace.

MG: Boris, we'll leave it there. Thank you.

BORIS CHESHIRKOV: Thank you.

MG: Boris Cheshirkov is a spokesperson with the United Nations Refugee Agency. He was on the island of Lesbos in Greece. Well, coming up in our next half hour.

SOUNDCLIP

VOICE: We are certain brand of crazy to put it kindly, but we do this because we want to help.

MG: Pregnancy is different for everyone, but if you're a surrogate, there are special risks and some people are saying those risks are often ignored. What could be better done to address those risks? We'll speak about that coming up in about 90 seconds. I'm Matt Galloway. This is The Current on CBC Radio One. Stick around.

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Surrogates face greater risks and complications with pregnancy

Guests: Chris Glover, Marjorie Dixon

MG: Hi, I'm Matt Galloway. You're listening to The Current.

SOUNDCLIP

VOICE 1: I chose to be a surrogate the first time to help a couple. When I realized how satisfying it was, it was almost addictive.

VOICE 2: So this is my way of getting something that is absolutely priceless and will change everybody's life.

MG: Those are two women who chose to be surrogates. It is in many ways a selfless act, since in Canada surrogates cannot be paid other than for expenses. In June, Ottawa will introduce new regulations outlining how much surrogates can be reimbursed. Perhaps you've been hearing the CBC reporting on that this week. There's something else that the CBC investigation has found though. There can be real risks involved of being a surrogate. And the federal government isn't changing anything to do with those medical standards. The CBC's senior reporter Chris Glover has been looking into this. Chris, good morning.

CHRIS GLOVER: Good morning.

MG: Why is there such a demand for women to be surrogates right now?

CHRIS GLOVER: Well, infertility in this country is a growing problem in Canada. One in six couples struggle with it, and the infertility rate has doubled since the 1980s. Now, a big part of the increase has to do with the fact that a lot of couples and a lot of people are waiting until later in life to start having children. We also know that more gay men are turning to surrogates to carry their babies. There are private surrogacy arrangements where someone's friend or family member carries the fetus for them, but that's actually relatively rare. Not many people have a friend who can or frankly, who is willing to do this for them. So many surrogates are women who carry babies for complete strangers, which is all the more surprising when you consider the fact that in Canada it's illegal to pay a surrogate. You can only give her and reimburse her those pregnancy related expenses.

MG: And we've been hearing about that this week. So for people who are doing that, they're not doing it for the money.

CHRIS GLOVER: They're not supposed to. When the government made the lot of ban paying surrogates 15 years ago, their worry was that women would be or could be exploited if money was offered as an incentive. Now, we've definitely found countless examples of that altruistic attitude. Women who just want to help other people. You heard it right off the top of the show. We've definitely found countless examples of that. And some of the women told me that they were motivated to help other people because someone close to them struggled with infertility and they saw how much it impacted them. Others talked to me about how unfair they thought it was that gay men can't carry their own babies. And then there were women who told me that they just liked being pregnant. And, well, they felt that their own family was complete. They weren't done being pregnant and carrying babies. So that's what it was like for Elizabeth Roberts. She's a nurse living in Halifax and she has two kids of her own as well. A busy life. Why did she want to do that? Right. Well, it sounds like her first two pregnancies went really smoothly. And then she ended up seeing a friend of hers act as a surrogate for for another couple. And she decided, hey, that looks really rewarding, I could do that. Have a listen to what Elizabeth Roberts told me.

SOUNDCLIP

VOICE: One day I just decided to bite the bullet and I just Googled surrogacy in Canada. I wasn't quite sure how long the turnaround process was. It turns out it was days. Very, very quick. I basically went from zero to 100 and maybe a week or two of applying and then being matched actually. It was overwhelming. I didn't quite understand what I was thinking my teeth into. I just knew that I wanted to help people. I thought that this was the standard procedure.

MG: Elizabeth says that she had to apply to be a surrogate if a woman wants to be a surrogate. Who is she applying to?

CHRIS GLOVER: Well, if you're doing it for a family member or a friend or even someone that you connected with on Facebook, for example, in a Facebook group, I've seen countless groups like this, so in those cases, you would not have anyone to apply to. But if, like Elizabeth Roberts, you use a surrogacy agency, then you have to apply to that company. And essentially you have to also remember that it is illegal to pay a surrogate. Well, it's also illegal to pay or be paid to arrange a surrogacy. So these agencies are in an awkward legal spot right after the bat, while they aren't expressly allowed under the law. They also aren't specifically banned either. And we've found at least a dozen of these agencies that operate right across the country. They are unlicensed. And because so few women are willing to do this, it's turned into quite the competitive industry as well. Who's paying the agencies, though? It's the people who are looking for a surrogate who pay the agencies and the industry lingo that you'll hear about these people is that their intended parents so agian. Connect the intended parents with the surrogates. And when Elizabeth Roberts signed up with an agency to be a surrogate, she joked that it felt like online dating, which is something that I think a lot of us will be able to kind of quickly wrap our minds around and relate to. She filled out a bunch of personal information about herself. She posted a few photos online with the agency. And then voila, she started getting all these messages from people right out of the blue. And she said the number of people who reached out to her was crushing.

SOUNDCLIP

VOICE: People were messaging me left, right and centre. There's so many intended parents out there and only so many surrogates. So you sort of get flooded with messages and reading their stories. And it breaks your heart because you want to help everybody. But you know that you can't. And it's it's difficult because you have to navigate through that rejection.

MG: It does sound like a twist on online dating in some ways.

CHRIS GLOVER: I know. A little bit.

MG: How many women are doing this in Canada right now?

CHRIS GLOVER: Well, nationally, nobody knows and that is problematic. A lot of people will tell you British Columbia, for example, is the only government that keeps track of surrogate babies born in Canada. And so we know 59 babies were born from surrogates in B.C. last year. The other way that you can cobble together a bit of a national picture is through voluntary reporting from fertility clinics and the most up to date data there shows that for the five year period, between 2013 and 2017, there were 816 surrogate births in Canada.

MG: But you said this is voluntary reporting from private fertility clinics. Does that number tell the real story of what's going on?

CHRIS GLOVER: No, it certainly does not. And let me give you a scenario which I did hear from a few different people that we talked to over the course of this investigation. A Canadian couple who take their Canadian surrogate to an American fertility clinic for the in-vitro fertilization transfers. That is something that I've heard from a few different people. And even when that baby is then born back here in Canada, none of those babies would be included in that number from the fertility clinics in Canada. So there's probably a lot more, especially when you consider this. One of the biggest Canadian agencies tells me that they oversee up to 300 surrogacy births alone.

MG: Wow.

CHRIS GLOVER: And there's 12 of these agencies, right.

MG: Go back to Elizabeth Roberts then. What was it like for her to take this on?

CHRIS GLOVER: It was tough at times. The injections she had to take were painful. Those were for the in vitro fertilization, the IVF and she says the hormone patches that she used really messed with her emotions. But as soon as she delivered, all of that faded away.

SOUNDCLIP

VOICE: And just looking over, seeing the parents hold their daughter and the dad looked up at me and he just had tears streaming down his face and he just said, thank you. And it was just any questions that I had ever had throughout the entire journey were just disappeared in that moment. It made everything worth it.

MG: It's quite a moment.

CHRIS GLOVER: Yeah. Even her retelling of it, you can hear her get transported right back to that moment.

MG: How did she feel after that moment?

CHRIS GLOVER: She described it as a real roller coaster of emotions. So intense, she hadn't really anticipated it and she certainly wasn't prepared for it.

SOUNDCLIP

VOICE: I think a lot of gestational carriers hit this emotional plummet after they give birth because your brain is aware and your mind and emotions are aware that this was the arrangement, that there is no baby afterwards. And so I think a lot of surrogates feel lost. I know I felt lost afterwards. I didn't know what else to do and my brain kept asking, ok, so what do we do now? We've done this huge, incredible, amazing thing, oh, what are we going to do? And so I knew right away that I think I was going to have to do it again.

MG: So she's felt lost, as she said, but then decided almost immediately that she wanted to do it again.

CHRIS GLOVER: Yeah. She told me that it took her all of 30 seconds to decide that she wanted to do this again. And she said she wasn't sure if it was the endorphins or the adrenaline rush. But as she watched the parents hold the baby for the first time, she said something that really stuck with me. She said she felt proud of herself. And she said that that was a feeling, an experience that she wanted to have again. And Matt, within a couple of months, she was the one who reached out to the agency. She was signing a new contract with a new family and she started those medical injections to prepare her body for another go. And then within six months, she was being implanted with another couple's embryo.

MG: How did, all that's happening very quickly. How did that pregnancy go?

CHRIS GLOVER: Again, the pregnancy itself was pretty uneventful, but it was what happened right after the birth that was so problematic. She suffered serious complications. And in the end, she needs to have a hysterectomy later this year.

MG: That's incredibly serious.

CHRIS GLOVER: It is. It certainly is.

MG: And will mean that you can't have any more children, among many other things.

CHRIS GLOVER: Right. So she won't be able to have, she won't be able to do these experiences any longer. And the other thing is, as she waits for that surgery, the pain sometimes gets so bad, she's on painkillers. She can't lift anything over 5 kg. She can't go running like she used toa and when she is home with her kids, she says that she has to be really delicate with them and how she sits with them. And she can't be, as she described, having them climb all over her, like so many parents know that that's how kids act. So it's really having an impact on her.

MG: How is she processing all of this, given what she went through and that desire that she had to help other people?

CHRIS GLOVER: It's really interesting. Her reaction might not be what you would expect. Emotionally, she seems to be in good spirits with it. Listen to how she phrases it.

SOUNDCLIP

VOICE: I'm emotionally, I'm okay with it. I'm not saying that another woman would be though. I imagine that it might be terrifying and scary for somebody else. I think that every single surrogate at some point in their journey questions what they're doing. I think we are a certain brand of crazy, to put it kindly. It is worth every second of it, but you do question every second of it as well.

MG: I could imagine that she's trying to figure out how this happened. Is the sense, are doctors telling her perhaps that it's the back to back surrogacies that caused these complications? What was going on there?

CHRIS GLOVER: Her sense is that certainly it is. And a high risk obstetrician that I spoke to said it certainly would have increased her risk factors, especially with how little time there was in between the two births. Now, I want to be really, really clear about this next point. Robert says she was the one that jumped into the second surrogacy and she did it willingly and she says that the couple did not pressure her to do it. But she says she was allowed to make this decision in the days and weeks right after giving birth. And in the middle of the emotional roller coaster that you heard her explain, and she doesn't think that she was armed with enough information or medical guidance.

SOUNDCLIP

VOICE: I think that psychological screenings should be a little bit more thorough. I think that mental health check-ins should be mandatory before transfer, during transfer, during the pregnancy, postpartum, it should be a mandatory thing. We do get wrapped up in the feel goods and the adrenaline rush of that you get, so why wouldn't you want to experience that again? You just might not be ready. I think that as unfortunate as the term may sound, this is an industry. Whether or not the motivation of these agencies or intended parents are altruistic or business motivated, it is indelicate and insensitive to not regard the surrogates or sorry, the gestational carrier experience. They're not breed mares. We're people and it's an emotional journey.

MG: She referred to that as an industry, which is really interesting. In that industry was there nobody that warned her that perhaps she could possibly be putting her health at risk if she was a surrogate again so soon?

CHRIS GLOVER: She says, aside from her husband, no. She says medical personnel certainly did talk her through general pregnancy risks, but no one explained to her the unique risk factors of being a repeat surrogate. But listen to this. I spoke to a woman who gave birth to a surrogate baby via a C-section and a week after the birth, she told her agency, hey, you know what? I had a great experience, I would like to do this again. And then less than four months later, she got implanted with another embryo and it took.

MG: Did anyone in the medical community say anything to her about this?

CHRIS GLOVER: That's exactly what I wondered as well. And she said the short answer is no. Now, we aren't naming this surrogate because she fears backlash from the surrogacy community, which we know is very small. And a lot of these women are speaking to each other and a lot of these agencies know each other. So we've disguised her voice as well. Here's how she reacted when I asked her if any medical person raised any concern with her doing it so fast.

SOUNDCLIP

VOICE 1: Yeah, no, there wasn't, actually. I was under the suspicion it had to be a year, but when they said, OK, let's start watching your cycle, I was like, wait, what?

VOICE 2: OK. So that was, that was really rapid, but you were kind of on board with the speed of it?

VOICE 1: Yeah. Yeah, absolutely. I totally could have slowed everything down if I felt it needed to be, but honestly, I was okay. The dad was okay. Clinics were on board so it wasn't anything.You know, there was no forcing matters of any sort.

CHRIS GLOVER: And that she also referenced that one year without me prompting her at all.

MG: She knew about that?

CHRIS GLOVER: She had said like, I understand that this is what people are advising. So she knew that, but no doctor had told her in that moment.

MG: In the end, how did it go, was she okay? Did she suffer any any medical consequences?

CHRIS GLOVER: Thankfully, no, she did not. She was fine. But Dr. Kingdom says he would consider her to be one of the most risky surrogate situations in terms of timelines.

MG: There are, as I said, at the beginning of this, new regulations coming in shortly when it comes to surrogacy in Canada. What are the rules going to deal with?

CHRIS GLOVER: In June, federal regulations for the reimbursements of surrogates are coming for the industry, and those will set out rules on the types of things a surrogate can expense, things like milage to doctor's appointments, vitamins, groceries, maternity clothing and that sort of thing. But there is nothing in these reimbursement rules concerning the medical safety of the women involved.

MG: What did the federal government say when you ask them about what you've been talking about?

CHRIS GLOVER: Health Canada said it doesn't have the authority to deal with the kinds of medical issues that we've raised. These, Health Canada said, should be handled by the provinces. So we tried to get an answer from Patty Hajdu's office, the federal minister of health and we were told basically the same thing. So it seems the medical standards Dr. Kingdom is calling for are falling between the cracks here.

MG: Chris, thank you.

CHRIS GLOVER: Thank you.

MG: Chris Glover is a senior investigative reporter at CBC. If most pregnancies come with a certain amount of risk, how heightened is that risk in surrogates? Dr. Marjorie Dixon is the chief executive and medical director at the Anova Fertility and Reproductive Health Centre in Toronto. Doctor, good morning to you.

MARJORIE DIXON: Hello.

MG: What's your reaction to the experience of these two surrogates?

MARJORIE DIXON: It's not entirely surprising, I think, that was a job well done of really ascertaining the emotional rollercoaster that it can be and the types of women that volunteer for these arrangements. They are generally giving altruistic, wanting to do something great for a couple that otherwise couldn't proceed to grow their family. And so they volunteer themselves of their time, their emotion, their body. But we have a responsibility as physicians to ensure that these arrangements are entered into with complete understanding of the benefits and risks. And also, not everybody that wants to be a gestational surrogate qualifies to be a gestational surrogate.

MG: Tell me about the screening and how surrogates would be screened.

MARJORIE DIXON: So you're right. And as much as it depends on the clinic, I suspect I can only speak to what we do at Anova. And we have a fairly rigorous screening process. So, for example, if our parents, who we refer to as the intended parents for the purposes of gestational surrogacy journeys, they intend to parents come to us and they work with the agencies, an agency or a family member, regardless of how the individual is identified. We get a match sheet and then I can accept or reject an individual based on the match sheet alone. So I review a history first before I even accept to screen them as a gestational surrogate. If they have medical co-morbidities, if they have a history of psychiatric illness that would be contraindicated and pregnancy. If they have a history of a difficult delivery, if they have a history of obesity, hypertension, diabetes, pre-eclampsia and other pregnancies. If they've had more than four prior pregnancies, which would make them a grand, multipurse person, too many pregnancies, those would all exclude them from even being screened in the clinic further.

MG: What are the, if you take a look at the additional risks of a surrogate pregnancy, as I said, if most pregnancies come with a certain amount of risk, what are the additional risks of a surrogate?

MARJORIE DIXON: Well historically with gestational surrogacy and when you're using assisted reproductive technologies to achieve pregnancy, in the past, we weren't as good at making a baby with the elect a single embryo transfer of one embryo. Now, with the advent of better technology in the lab and our ability to grow embryos and actually test them genetically before we put them back, we have moved to elect a single embryo transfer. So we don't have as much risk as we used to even five years ago when it was routine to put back more than one embryo and that would bring the risk of multiple pregnancies. And with multiple pregnancy comes the risk of prematurity and risk not just to the babies, but also to the mothers who are the gestational surrogates because they're at greater risk of developing gestational diabetes with more than one baby or pre-eclampsia, which is associated with high blood pressure and seizure in pregnancy, premature birth, fetal growth restriction. All of those things are bring greater risk to the mother, the gestational surrogate and also to the fetuses and that's why you really have to apply your medical acumen and be a doctor first when you're considering you have two patients, three patients. You have the intended parents, you have the gestational surrogate and you have the baby.

MG: You heard in that piece by Chris that there was one woman talking about how there was just a four month gap between pregnancies.

MARJORIE DIXON: Right.

MG: What do you what do you make of that?

MARJORIE DIXON: Well, so she wouldn't have qualified to be a repeat gestational surrogacy in my hands at that time.

MG: How long should a surrogate wait between pregnancies?

MARJORIE DIXON: It depends on her course of delivery. If she had a cesarean section, for example, versus if she had a spontaneous delivery, which was uncomplicated. So it ranges between six months to a year and sometimes greater than a year if they've had a substantial complication. And sometimes when patients come back and want to be a gestational surrogate again for a family, they may not be able to do so, If they had a complicated course of labour and delivery or if they had an operative delivery that resulted in a, for example, a T incision on a uterus. She would not qualified to be a gestational surrogate again.

MG: In both the cases that Chris was reporting on, you said that the surrogates say that they weren't warned of the risks by the fertility clinic, that they wished they had more information. What do you think about that? I mean, how could they have been better equipped?

MARJORIE DIXON: I think knowledge is power and having series like this where we share that education with both the intended parents with the population in general, just understand that there are risks. We look at pregnancy as a beautiful thing and it is in the right circumstances.

MG: But why would doctors allow the pregnancy so close together do you think?

MARJORIE DIXON: I can't speak to the doctors that made whatever decisions because I wasn't in their shoes at the time. And we do consider patients on a case by case basis, but we also have clinic policies and the policies we come to buy critically appraising the literature. And by being well-trained physicians, we understand that there are these arrangements are elective. You don't have to be pregnant and not everyone is cut out to be a gestational surrogate. And when we're talking about safety and with the medical principle of doing no harm to our patient and we just have to be very measured as we embark upon these journeys with these families.

MG: One of the women that we just heard from called this an industry. Do you think that that's fair?

MARJORIE DIXON: I think that's fair. It's become a bit of an industry, but there are many different stakeholders. And as physicians, as the stakeholders, we have a fiduciary responsibility to protect our patients. And our patients are threefold. As I said, the intended parents, the gestational surrogates and the baby.

MG: I guess just finally, if it's an industry and the government is looking at regulations, what should the government do? What's the government's role in this to ensure that, as you say, those three, the three constituencies, the three people, the three individuals who are involved in this are as well protected as possible?

MARJORIE DIXON: You know, I agree that there must be an amount of regulation to this. It can be done safely and it can be done in a measured way where no one is taken advantage of and everyone is managed safely. And regulation is key to that. We are good stewards of medicine and obstetrical medicine as physicians who are well-trained and subspecialty trained as a general rule. But having guidelines and regulations will create a framework where we can ensure that this happens in a way that does no harm to our patients.

MG: And that everybody is operating from the same playbook.

MARJORIE DIXON: Everybody is offering from the same playbook and everyone is accountable. We know what we are doing. It is not a wild west territory and we must be there for our patients because otherwise patients will take matters into their own hands. And just like you said, you stated they would go to another country and then we can't manage and we don't understand what are the real risks. We can't look at it and appraise it and say this is what we have to do to be accountable, if we don't really know what's transpiring.

MG: I really appreciate your time this morning, doctor. Thank you.

MARJORIE DIXON: You're welcome. Have a good one.

MG: And you. Dr. Marjorie Dixon is the Chief executive and Medical Director at the Anova Fertility and Reproductive Health Centre. Also an assistant professor at the University of Toronto's Department of Medicine. Would love to hear your experiences with surrogacy, your stories involved in that, whether you were a surrogate, whether you were one of the intended parents. You can e-mail us at thecurrent@cbc.ca. Tweet us @TheCurrentCBC. Go to cbc.ca/thecurrent and click on the Contact link. And more on the story and Chris's reporting can be found at cbcnews.ca. That's it for The Current today. Coming up on Q, Tom Powers, speaking with Jessie Reyez. She is a pop superstar and finally has an album about to come out. You'll hear her perform it live. Coming up in a few moments on Radio One. It is Super Tuesday in the United States, 14 states voting on who they want to run in November's election. That's the super part of it. Full results coming tomorrow on the program. In the meantime, Tuesdays in general, popular day for voting in the United States. You may have noticed that the U.S. general elections always happen on a Tuesday. Why is that the case? Well to answer that, we're going to leave you with an explanation from Last Week Tonight with John Oliver. I'm Matt Galloway. Thanks for listening to The Current.

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Mar. 3, 2020 episode transcript

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