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The Current Transcript for November 8, 2022

Host: Matt Galloway

STORIES FROM THIS EPISODE

Prologue

[Music: Theme]

SOUNDCLIP

Putin's only real hope is if he can outlast the West, if he can hold on until we end up getting bored or exhausted and no longer support Ukraine.

DUNCAN MCCUE: It sounds like a tall order. Ukraine has received unwavering support from the European Union, the U.S. and Canada, to name a few. From statements condemning Russia's actions to supplying weapons and slapping on countless sanctions. How Vladimir Putin underestimated Ukraine and what that means for the Russian president at home. That's in 30 minutes. And then, stranded at sea, hundreds of migrants are floating off the coast of Italy, hoping to come ashore. But the Italian government has other plans.

SOUNDCLIP

[Foreign speech]

We are stopping being hostages to these private foreign NGOs that handle the route, the traffic, the transport and the migratory policies.

We'll take you on board one of those ships where passengers are stuck sleeping on the floor with fevers taking hold and supplies are running low. That's in an hour. But we start at your local pharmacy where parents are frantically searching for medication to help their sick kids. I'm Duncan McCue, sitting in for Matt Galloway. And this is The Current.

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Parents scrambling amid shortage of medication for kids

Guests: Neesha Hussain-Shamsy, Dan Flanders, Mina Tadrous

DM: Parents across the country are scrambling to find medications for their children. There is a shortage of both children and infants' ibuprofen and acetaminophen, plus a shrinking supply of antibiotics like amoxicillin. We'll hear more about why this shortage is happening in a moment. But first, Neesha Hussain-Shamsy was caught searching for medication last week for her five year old son. Neesha joins us now. Good morning.

NEESHA HUSSAIN-SHAMSY: Good morning. How are you?

DM: I'm doing fine. What happened to your son last week?

NEESHA HUSSAIN-SHAMSY: He got a small dog bite from our family members' pets. And, you know, it was a minor, it was a minor cut, but big enough where we wanted to get it checked out by a medical professional.

DM: Of course.

NEESHA HUSSAIN-SHAMSY: We took him to the E.R., which, you know, in the context of what's going on, that experience was fantastic and the waits weren't bad. And we were told he needed to go on prophylactic antibiotics just because it is an animal bite. We wanted to make sure that it didn't get infected or anything like that, and the hospital itself didn't have any antibiotics for him in stock to give us then in there, which they had originally wanted to. And so we were just sent home with a prescription and kind of told like, you need to go search for it in a pharmacy.

DM: You need to search for it. What was that like to be at the hospital and here they didn't have the medication for you?

NEESHA HUSSAIN-SHAMSY: I think that is probably one of the more like most upsetting parts of it because you kind of feel like, you know, when you're at a hospital, you expect to have access to every point of care that you should have, including medication. And I think it's also one thing for yourself as an adult to have to go searching for something for yourself, but to hear that for your own child, they don't have the medication that they need.

DM: Yeah. And so your son your son had this dog bite. I mean, what happened? But you did get the prescription. So what happened next?

NEESHA HUSSAIN-SHAMSY: So by that point, you know, he is five. So we're battling bad time because, you know, the day had gone on with the ER wait and we went to a pharmacy, kind of one of the big chain pharmacies, and they had three doses. So a day and a half worth of antibiotics in stock. He needed five days in total. And so we were told, well, take the day and a half worth of antibiotics that we have call when you give the last dose and by that time, we'll have the rest of the prescription in stock for you.

DM: And did they.

NEESHA HUSSAIN-SHAMSY: We said fine. No. So we called back when, you know, once we had run out of the medication and we called back, it was a Sunday evening and they said, we're so sorry. We don't have it in stock. Our two suppliers are backordered. We have no idea when we're going to get it. You'll just have to call around to other pharmacies and find it yourself.

DM: That must be so discouraging and and a bit scary as a parent.

NEESHA HUSSAIN-SHAMSY: Discouraging and scary and also frustrating that there was no kind of more support given for helping us find the medication on a Sunday night. For a monday morning dose.

DM: Did you start phoning other pharmacies then?

NEESHA HUSSAIN-SHAMSY: Yeah. So we started calling other pharmacies. You know, we started in the area near us and kind of had to slowly branch out farther and farther. It was Sunday night. So then of course, a lot of places start closing. So you're also on a time crunch while this is happening. And eventually we kind of gave up on calling pharmacies directly and we started reaching out to our social networks to say, like, you know, we have friends who are pharmacists. So would reach out to them or reach out to our friends and say, like, do you have any family members who work in a pharmacy or are pharmacists or know a pharmacist? And that was how we ended up getting the medication.

DM: And got it through friends.

NEESHA HUSSAIN-SHAMSY: We got it through friends. Yeah. We ended up having a friend who works out of Oakville. We live kind of more in Toronto proper, and so we contacted him on Sunday night and on Monday morning he checked and luckily had, you know, the last two, but we got his last two bottles of the medication that we needed and we had to drive basically an hour to his pharmacy and an hour back home in the middle of the day on a on a working day.

DM: Which is wonderful news, Nisha, that you were able to get those those antibiotics. I mean, how by the way, how's your son doing?

NEESHA HUSSAIN-SHAMSY: He is totally fine.

DM: Okay. That's good. That's good to hear. But I mean, what about parents that don't have friends who are pharmacists?

NEESHA HUSSAIN-SHAMSY: That's exactly it is, you know, my partner and I were talking about how we we felt so privileged in that moment to have a social network that we could reach out to for this and then be the luxury of time to spend two and a half hours of our day in the middle of the workday to go and buy antibiotics for our son. And people without those kinds of luxuries, I don't know what you would do, because I can imagine that if we didn't have those resources, we would just kind of say like we would just shrug our shoulders and say, like, you know, maybe we don't need to finish the course of antibiotics, which is a huge, really problematic thing to say, too, because that's how things like antibiotic resistance build up. It's not safe either and there's a lot of parents who get to that point.

DM: Exactly. And I think we'll try to dig into this a little bit more. Neesha, I'm glad your son is doing better and thank you for sharing your story.

NEESHA HUSSAIN-SHAMSY: Thank you so much for having me.

DM: Neesha Hussain-Shamsy lives in Toronto. The shortage of some drugs for infants and children are also causing some stress for paediatricians like Dan Flanders. He's the founder of the Kindercare Clinic in Toronto. Hello.

DAN FLANDERS: Hi. How are you?

DM: I'm doing fine. How familiar is that story that you just heard?

DAN FLANDERS: Yeah, so very familiar. And I think hundreds of families or parents are having that very experience every day here in Toronto and probably beyond and in Ontario and the rest of Canada. There's a real shortage of some of these medications and it's having real impacts on our on our community.

DM: So the couple of things need to unpack here. Why are so many kids getting sick and needing antibiotics right now?

DAN FLANDERS: Yeah. So since we've unmasked after two and a half years of kind of trying to trying to live in a bubble, since we've unmasked all of the respiratory viruses that we used to be accustomed to being exposed to are now starting to infect us again. And it's really coming at us hard. And there's really, really high levels of transmission of viruses, whether they be RSV, influenza, COVID. Any other number of viral illnesses are happening. And those of many of those are predisposing to bacterial infections. And so we're also seeing a higher number of bacterial ear infections, bacterial pneumonia. And those are the infections, the bacterial ones that need antibiotics.

DM: And why is amoxicillin so important in treating children with with certain infections?

DAN FLANDERS: Yeah, amoxicillin has a lot of qualities that make it very, you know, like the obvious choice as a first line antibiotic for a number of these infections. It's very affordable. It's very well tolerated by children. It has a lower likelihood of selecting for resistance. And so it's really the go to and we really count on it for, as physicians, for our bread and butter infections that we see on a day to day basis.

DM: We heard Nisha say, though, that she was calling around all over the place gradually more and more pharmacies. What are what are yours and other clinics trying to do to try to find that amoxicillin right now?

DAN FLANDERS: Yeah. So that's exactly what our patients are doing. And our 35 doctors are on a group chat and multiple times a day we are trying to connect with each other and trying to share the names of pharmacists around town that, you know, for the moment have stock so we can send our patients there so that they can get the medication that they need.

DM: Also reports that the children and infant ibuprofen and acetaminophen in hard to find right now. So what are you telling parents who are worried about their kids? I mean, if you have a fever or pain.

DAN FLANDERS: I mean, there's not much we can say other than we you know, we encourage them to call as many pharmacists as they can, visit as many pharmacists as they can. Sometimes reaching out to a compounding pharmacist could be helpful. They can sometimes compound special drugs into a formulation that children can can ingest. But but really, there's only so much you can do. I mean, if this keeps on going, there's going to be people who have chronic disability and who have infections that, you know, impact their lives meaningfully.

DM: What if parents take adult medications and say, okay, I'll do the maths here and I'll cut it, you know, try to cut up the pills themselves, is there a concern there?

DAN FLANDERS: Yeah, because sometimes the maths isn't easy to do and sometimes the pills don't cut the way you expect them to. And that is a recipe for problems.

DM: And I mean, what's your concern if this drug shortage continues?

DAN FLANDERS: Yeah. So I mean, some of these drugs, it's actually quite scary. Some of these drugs may be missing or may be very hard to find well into next year, like into February or March. And so my you know, my fear and, fingers crossed this is not going to happen. But my fear is there's going to be children who don't get the treatment they need and there's going to be long term repercussions, whether it be chronic lung problems from pneumonia, hearing problems from ear infections that never got treated properly. And then, you know, your mind can go to worse places like like infections that get so advanced that they lead to in a hospital admissions and, God forbid, death. The other the other problem that I don't think we're talking about enough and that Nisha alluded to is this whole equity conversation. Right. So that the families with means and the families who have good networks and money are going to be the ones who find the drugs. And the people without these resources are the ones who are going to preferentially suffer. And so I think we really need to advocate for, you know, the families and the folks who aren't as good at advocating or don't have the means to do so.

DM: Dr. Flanders, thank you for filling us in on what's happening in your clinic.

DAN FLANDERS: Okay, my pleasure.

DM: Dr. Dan Flanders is a paediatrician and founder of the Kindercare Clinic in Toronto. Mina Tadrous is an assistant professor at the University of Toronto's Lesley Dunn Faculty of Pharmacy. I mean, good morning.

MINA TADROUS: Good morning.

DM: Okay. Help me understand, what are the factors causing this drug shortage right now?

MINA TADROUS: Yeah. Unfortunately, drug shortages aren't something new to the pharmacy space. I think what we're what we're seeing is, what we're seeing play out is a is a common scenario that happens due to a variety of factors. And if you think about just any good, many things that we're seeing play out is because of a supply chain disruption or something that sort of impacts that supply and demand. And so this is a this is a story of an increased sudden spike in demand that was way above what people anticipated. And then what ends up happening is you start to see a domino effect. So if one drug has a shortage, the demand goes up for another product. People switch over and then that all of a sudden sees a higher bit of demand, and then it starts to ripple through our system. And so, unfortunately, you know, what starts as a small sort of shortage start to affect a lot of a lot of drugs within the same space.

DM: You're saying it happens sometimes. But but I mean, when I - hearing Doctor Flanders, I mean, he seems to be describing a shortage that he hasn't quite seen before, especially one that's impacting children. What about you? Have you have you seen something like this?

MINA TADROUS: Yes. So unfortunately, as somebody who kind of pays close attention to shortages, these are common. Right. We've had we've had thousands of shortages over the last number of years. You know, a recent survey found that one in four Canadians with them or somebody in their family experience or be affected by drug shortage within two years. So, you know, it just I think what's hitting close to home here is that, you know, these are you know, we're seeing it of the peak time of everybody getting sick. And it is a very commonly used medication. So I do agree with the doctor that it's sort of the level of this and how close it's hitting to home is a little bit more unprecedented, the number usually. But we've seen it with very common blood pressure medications. We've seen it with drugs that are used for like heartburn. It does have like sort of a ripple effect throughout the system.

DM: Is there a reason why it's it's children's pain medication right now that's affected specifically and not not adult pain meds?

MINA TADROUS: Yeah. So I think what's unique about this situation. Well, not unique in the sense of like that it's any different. But I think what we're seeing here of why these specific medications are being impacted is because the fact that they're a suspension means that less companies often make it and we have a much smaller market. So we don't have a shortage of like the tablets and the adult dosage forms. What we're seeing is because we only have many cases, one or two different suspensions or solutions that could be used by kids. You don't have many options. So when we went back six months ago and one of the companies sort of had a disruption in its supply chain, everyone started using the next drug, and then that drug wasn't used to it. The second thing is because of the seasonality of it, that, you know, there's sort of like a flu season and a season that when it starts getting cold, more and more people get sick. We're seeing a massive spike. And so I think the demand is also unprecedented. Like the previous guest described.

DM: So you've got supply chain bashing up against demand. Let's talk about solutions here for a second. I mean, Health Canada told us in a statement it's taken several steps to try to address this shortage, and it's allowing the exceptional importation of ibuprofen and ibuprofen from the US, it says, and acetaminophen. Acetaminophen from Australia, that means waiving bilingual labelling requirements. Is there more that Health Canada could be doing?

MINA TADROUS: Yes. So I think in the current state, that's one of the best actions we can be taking. So earlier in the pandemic, we had a similar thing happen with inhalers for asthma and so they kind of allowed importation to help fill the gaps while the supply chain fills up. The unfortunate thing about these supply chains is that they they can't do it overnight. You know, there's multiple steps to it and often takes weeks, if not months, to fill back up. And I think what we're also seeing that's kind of making that more challenging is rightfully so, when someone finally does see something on the shelf, they grab a few extra ones. And so that demand continues to kind of pile on. And so you're struggling to kind of dig out of that. You know, I think some things that could be taken into account or that can help sort of the solution is, you know, in some provinces, they've lowered the need for prescription for compounded products by pharmacists. I think working closely with pharmacists and allowing them a little bit more freedom depending on the province that you're in, they want to be able to prescribe and use different types of formulations might be helpful.

DM: What does that mean, compounded?

MINA TADROUS: So I think in some scenarios like, there's special types of pharmacies called compounding pharmacies that will make you sort of think about drugs from scratch in the sense that they have the raw powder of a drug, they have other different products, and they can make a suspension themselves. And so in many cases that may require prescription because it's not using an over-the-counter product. So if you're going in and you need a different type of product, it might be a lot easier. And so in some provinces, you actually need a prescription to be able to compound that. So in Saskatchewan is one example to waive that so that people are actually able to to the pharmacist are able to try to fill this gap while there's an urgency.

DM: Okay. So that's talking about what governments can do. What about the pharmaceutical companies? Johnson and Johnson makes Tylenol. They told us it's maximising its domestic production, working with Health Canada to try to import some of its global supply. We also reached out to GlaxoSmithKline, which makes some of the antibiotics we're talking about, and said they hope the shortage is going to be resolved by late November, December. But they both blamed high demand. So so is there more that drug makers can do?

MINA TADROUS: Yeah. I think, you know, unfortunately their hands are a little bit tied in the sense of how long it takes to kind of meet that demand. Like I mentioned, you know, when you make a product, it doesn't just start in one factory many times for a product end up on the shelves. It's probably had five if not ten different stops with different ingredients flowing in. And so that sort of takes some time. I think allowing them to import from other different countries as they think about what they have available globally is probably a good step in helping them coordinate that. And I think the next thing is just kind of like overstocking in the sense of like knowing that perhaps we were in a new normal for the next few years as as the higher rates of infections occur. And so recalibrating how much drug the country actually needs and asking the companies to kind of make sure that they're forecasting better.

DM: It is not easy when you have a child at home, you know, sick. And I mean, it is both scary and you feel helpless as a parent not having medicine available. I mean, what else do you want parents to think about who have a sick kid in home to keep in mind when they they raised off to the pharmacy and then they they see their shelves?

MINA TADROUS: Yeah. It's and it's troubling and you know, not to meet this person that, you know, I have two little snot monsters myself. I went through a very similar scenario about three weeks ago, rushing around trying to find ibuprofen and Tylenol. I think, you know, it's- there is a huge sort of having the time to do that is a privilege, like many people mentioned. I think we probably need to be thinking about leveraging these community groups and I think it's highlighted the importance of community in a very funny way, which is very frustrating because we probably don't always need to have to turn there. But I think a lot of people are finding like communicating with each other. When it comes to the shortage of, I think of of antibiotics, I think just reminding the public that there's probably a good conversation to be had about do you actually need the antibiotic? In many cases, infections are viral and so not demanding. One, we're not thinking, you know, it might be okay to leave that office, as frustrating as it is from the doctor's office and here that, you know what, this probably doesn't need an antibiotic. But I think knowing that by you not using an antibiotic, you may have saved some, for somebody who was actually going to have an infection that needs it, that's [unintelligible] in this current state is probably a good thing.

DM: I hope your snot monsters are okay.

MINA TADROUS: Thank you very much. They're feeling much better.

DM: All right. That's good to hear. Thank you for sharing your expertise on this.

MINA TADROUS: Thank you very much. Thanks for having me.

DM: Mina Tadrous is an assistant professor at the University of Toronto's Lesley Dann Faculty of Pharmacy. The CBC News is next. And then.

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Russia is banking on that. Time is on its side. Putin may well be wrong in that, but I think in some ways it's all he's got.

DM: Putin's sights are still set on victory in Ukraine, but one historian says putting their hopes on a long, hard winter may not work out the way Russia would like. That's in six minutes. Stick around. I'm Duncan McCue and you're listening to The Current.

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How Vladimir Putin might have underestimated Ukraine

Guest: Mark Galeotti

DM: Hi. I'm Duncan McCue and you're listening to The Current.

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DM: Still to come, hundreds of migrants are stranded off the coast of Italy, sleeping shoulder to shoulder on the floors of rescue ships with supplies running out. We'll find out what it will take for these people to come ashore. But first, underestimating Ukraine.

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[Foreign speech]

Whoever would try to stop us and further create threats to our country, to our people, should know that Russia's response will be immediate and lead you to such consequences that you have never faced in your history.

DM: That was from the BBC. On the night Russian President Vladimir Putin announced a full scale assault on Ukraine. At the time, President Putin gave that warning to the West. It looked too much of the world that Russian forces would quickly take over Ukraine. But nine months later, things look very different. Mark Galeotti is a scholar specialising in Russia's military history. His new book is Putin's Wars From Chechnya to Ukraine. Hello.

MARK GALEOTTI: Hello, there.

DM: What went through your mind on February 24th, 2022?

MARK GALEOTTI: Oh, heavens. I mean, look, first point to make is I have to hold up my hands. This until about a week before, I hadn't thought that Putin was going to invade. I thought it was no more than 30 to 40% likely when it actually happened. Well, obviously, the first thought was precisely, you know, this is going to be disastrous for Ukraine. My second thought was this is also going to be disastrous for Russia. And I have to confess, being a human being, I also thought, well, this is a pain in the backside for me because I have just submitted two weeks ago the manuscript of my book, which is now going to have to be hurriedly revised. So there you go. We are all here.

DM: So you had to do some revisions, but why were you surprised that the Russia actually pulled the trigger to carry out such a large scale war on Ukraine?

MARK GALEOTTI: To be blunt, because it made no sense. The irony is this up to the point when the first Russian soldier crossed the Ukrainian border, Putin was actually winning. He'd assembled this massive force on Ukraine's borders and yet which was on Russian territory. Well, apart from Crimea, which is disputed, clearly. But it was within the bounds of international law. But the point is, under the shadow of a potential Russian invasion, investors were fleeing Ukraine. The Ukrainian economy was in crisis and a steady stream of Western VIPs was heading to Moscow in order to, in effect, try to petition Putin not to invade, putting him in exactly the position he likes to be one of central city with everyone coming to see him. And indeed, some European governments were actually trying to put pressure on Ukraine to make concessions to Russia. And if he really had been this grand master of three dimensional geopolitical chess, sometimes told he to just let that situation continue. But he was impatient. He was arrogant. And so he thought he would actually invade. And I think that's the key thing. It's the degree to which what he did makes sense if you believe what Putin believes, but objectively was a deeply foolish move.

DM: So I like that you described him as a grand master because, I mean, he would certainly like to to portray himself to the West that way. But one of the things your book does is go into a little bit about Vladimir Putin. And I mean, of course, he had a background with the KGB, which is which is the old Soviet spy organisation. But but tell us a little bit about what kind of military background he had prior to that.

MARK GALEOTTI: Well, that's a very, very quick answer. But I mean, almost nothing look like every Soviet university student, when he was at Leningrad State University Reading Law, he had to do compulsory reserve officer training. Now, look, I've spoken to people who went through the same programme at the same time and they said that it was the most derisory waste of time ever. You spend a few evenings being lectured to by some retired military officers, which basically is an opportunity to have a nice doze and then a few weekends off doing sort of exercises, which is just basically so you can begin marching in the woods and that's it. As soon as he graduated because he joined the KGB. He was entitled to opt out of the military reserve, which is what he did. He skipped it. So. Exactly. So this is a man who basically, although you can't walk him past a tank without him wanting a photo opportunity, peering out of the cockpit. But no, I mean, this is you know, this is a man who actually has no military experience, didn't seek it. And that really shows, even though he's trying to micromanage this war.

DM: And so I want to I want to get back to Ukraine. But but but that image of him posing in front of a tank in sitting in a fighter jet cockpit, I mean, why has that been so important to Vladimir Putin in terms of associating himself with with military glories?

MARK GALEOTTI: Well, I mean, one can play all kinds of analyst psychology games. But the key thing is, if we're actually looking at sort of real political things, what Putin found himself is in the position where as far as he's concerned, Russia is a great power and it's a great power not just simply because its nuclear arsenal or anything else, but because in some ways that is Russia's historical destiny. And, you know, he's returned to this time and time again. Now, what does a great power mean now? Now, you or I, the 21st century might think the great power could be conveyed by massive economic dynamism, perhaps, or the kind of soft power that has other countries wanting to basically be your ally. Putin is very, very 19th century in his thinking. I'm to be honest, a Bismarck or a Napoleon would have no trouble understanding a Putin. You know, a great power is a country that can impose its will on those which are subordinate nations around it. And for that, we need a military. Now, given that Russia is actually a considerably impoverished country, I mean, although it's a very, very imperfect comparator, I mean, it has a gross domestic product about the equivalent of Spain's. But nonetheless, because he wanted to convey that sense of strength, he needed Russia to look like a great power.

DM: And so, I mean, you make the point in the book that that from the outset of his leadership, that he put a lot of energy into into the military and, you know, trying to raise the country's position in the world, but also rebuild national myths about pride and glory. How was he viewed as a as a wartime strategist through it, throughout this?

MARK GALEOTTI: Well, look, I mean, in a way I'm going to give you I'm sorry to be very much an academic and break down your question into multiple ones. I'll give you three answers in terms of the military. The professional soldiers, look, they were very happy at the fact that they now had a lot more money. They could buy more toys. They could actually carry out training exercises and so forth. But certainly my encounters with them and look, I mean, until I was banned by the Kremlin in June, I travelled to Russia back and forth a lot, particularly cause I wanted to have conversations like this. But the professional soldiers, there was always a certain reservation. There was always that sense of Putin was ultimately not one of us. And it was slightly so crude phrase. But once I sort of got when I was drinking with some officers and someone saying, look, you know, ultimately I wouldn't want a virgin to tell me what to do on my wedding night. You know, there was that sense that, you know, he didn't really know what was what. So that's the professional soldiers from the population as a whole. It wasn't so much Putin, but they did buy into this myth of Russia as a great military power, particularly the current Defence Minister Shoigu. Whatever else one may say, he's very good at PR and you know, he did manage to kind of get everyone enthused at the idea that Russia was great again. But the final point I think is worth making is back to the outside world. And I think one of the things that is clear is the degree to which actually Putin was really quite effective in selling the idea of Russian military power to us. And we ended up buying into this myth of the great revived Russian bear.

DM: Let me ask him about that. I mean, for for a country that's been at war as often as Russia has in recent years, are they the great bear? I mean, do they have a rugged, experienced army?

MARK GALEOTTI: Well, they had a moderately rugged one. You know, that perhaps the sort of the great polecat. The point is that in some ways, Putin secret up to now have been essentially to pick wars that he knew he could win relatively easy ones and frankly, wars that were largely about bullying smaller neighbours. He fought this incredibly brutal civil war in Chechnya. He invaded Georgia as a microscopic country. He deployed his forces to Syria. But again, very much simply to to bomb people who had no air defences from a safe distance. And he seised Crimea in 2014 at a time when the Ukrainian military and indeed whole government was pretty much in collapse. And anyway, his troops were already there on Crimea because of basing rights. So up to Ukraine, Putin's great strength had always been to pick wars that Russia could win easily. And in the process, actually, the Russian military did improve quite well. The point is, he so dramatically misused them in his February invasion of Ukraine. In so many ways, he has basically squandered 20 odd years of military reform in his first 20 weeks of war.

DM: And that's what I'm leading to, Mark Galeotti. I mean, I'm wondering, I mean, if there were lessons that he learnt and it sounds like they were very different, different approaches. What happened here in Ukraine? I mean, was he given an honest analysis by by his military, his intelligence about how this was going to unfold in early 2022?

MARK GALEOTTI: It's clear that he wasn't given anything like an honest analysis by any of the people around him. But Putin can hardly blame anyone but himself. I mean, for years, he has been, in effect, creating a system devoted to telling him not what he needs to know, but what he wants to hear. So you've had people who are more critical being pushed out of his inner circle. You had the intelligence agencies put into a situation almost like King Lear's daughters from Shakespeare, where they're they all have to praise the old king, and they will get rewards commensurate with how shamelessly they flatter him. So, you know, for years we've known I mean, look, I remember talking back in 2015 to a retired Russian intelligence officer, you know, who admitted this, that basically, you know, we do not now challenge Putin's world view. So, you know, for years he created this this bubble around himself. And this is what happens when when you do that, that will.

DM: But you're suggesting it's just ego.

MARK GALEOTTI: It's a combination of things. Look, he's been essentially the dictator of his country for 22 years. So there was a brief period when he was technically prime minister that he even then, he always pulled all the strings. No one in power for 22 years, especially within an authoritarian regime, does not become something of a caricature of themselves. But also, yes, there is there is a lot of ego. There is that sense of that. The Putin who came to power in 2000 at least, was willing to appreciate that there were lots of things he didn't know. Now, although Putin today, you know, again, he's happy to leave economic management to the specialists and so forth. But I think he had imbibed also that sense of himself as exactly this this geopolitical mastermind, because he certainly imposed his view of Ukraine, which is this bizarre notion that Ukraine's not a real country, the Ukrainians are not a real people, and that therefore they would they would welcome Russians with with flowers and bread and salt. Well, he imposed that on his own sort of elite and his own political structures, and therefore, no one really got a chance to plan a proper invasion.

DM: You make the point in the book that one of the flaws in the Russian planning for the war on Ukraine in Vladimir Putin's planning is is trusting the old metrics. Can you explain that?

MARK GALEOTTI: Essentially, look, there are there are different ways of planning for war and trying to understand military power. And Putin managed to, in frankly, disastrous manner, confuse a whole variety. I mean, first of all, look, there's a simple fact that on the whole, it's going to very, very crude measure. But if you're going to attack, you generally need to have a local three to one military advantage. And Russia never had that because Russia was trying to fight this war on peacetime basis without mobilising its reserves against a Ukraine that was fully mobilised and ready for it. But more broadly, it's what are the metrics of power these days? Now, Putin probably relied just simply looking on the fact that the Ukrainian economy was great and its armed forces weren't especially modern. He didn't in the slightest bit consider the intangible metrics, the will to resist the national morale and the capacity of a leader like Ukrainian President Zelensky to mobilise not just his own people, but the an unprecedented level of Western support. All of these things can just Putin just didn't understand the way the 21st century has gone.

DM: Which brings us to now and in the mess they're in. I mean, President Putin has raised the spectre of using nuclear weapons in this war. Can you tell us, looking through the course of his of his history, I mean, how does he view his nuclear forces as a tool for Russian warfare?

MARK GALEOTTI: Well, doctrinally, nuclear forces are Russia's last backstop. They are they are purely to defend the motherland against an existential threat. So that in theory would mean that there's no chance of that being used. We also have to acknowledge the degree to which Putin himself also uses his nuclear force precisely as a propaganda tool. Look, I mean, his repeated heavy handed hints about nuclear use. We should not take them too seriously at some point in the future. He might feel he's so stuck in a corner that he might want to turn to some low level non-strategic tactical use in Ukraine. Perhaps, but we're nowhere near that yet at present. No, look, he knows that when he talks nuclear, we pay attention and a lot of us get worried. And this is, I think, the main thing. He knows that his best chance of winning in Ukraine is if he can divide and demoralise the West. We are, in a way, the weak link here.

DM: And you say I mean, we meaning the West. I mean, we get worried. What would the response be in Russia if he were to to use tactical nuclear weapons?

MARK GALEOTTI: I mean, I think people would be rightly and understandably horrified, including, I think, the professional military men. And therefore, this is one of the reasons why I think many reasons why I think Putin would think twice and thrice before actually turning into some kind of nuclear attack is because he ultimately must have some sense, because there's people there whose job is to tell him that there is a degree of dissatisfaction within the officer corps. And one of the most dangerous things in this kind of a regime is if you give an order which people will refuse, then in some ways the whole momentum shifts against you. What else are they going to start refusing to do? That becomes the beginning of the end.

DM: And I mean, that raises the question of what we've been seeing in the past few months now is conscription and the state of the forces. I mean, what what is the state of the Russian military as a fighting force right now as a result of what's happening in Ukraine?

MARK GALEOTTI: I mean, it's been savaged and it has to be said that regardless of what happens in this war and ultimately I think Ukraine will win this, it won't be as quick as we and they would hope. But nonetheless, you know, it will leave Russia no longer a credible military power. I mean, the days when we had to be concerned about whether it would attack NATO, it would have long since gone because the best of Russia's forces have taken the overwhelming majority of the losses to date, because precisely they have been used in the kind of the wrong kind of ways, in the wrong kind of war. And increasingly, what we're seeing is the arrival of the so-called Mobix mobilised reservists who are, you know, maybe people in their thirties, people in their forties who did their national service quite some time ago. They probably scarcely remember which is the dangerous end of a Kalashnikov. And we're seeing I mean, some of them are being kept behind to be given some degree of extra training and form some kind of units. But a lot of them are just being thrown straight into the frontline and they are dying at horrific high rates. So I think what we're seeing is that just as Ukraine is beginning to acquire a truly 21st century army, Russia is now beginning to default to a late Soviet one of badly trained and disgruntled soldiers with Kit. That, frankly, was was what was made in the 1970s, as often as not.

DM: So will this dream or a vision of military might, is it at all sustainable just in terms of raw resources, young men? I mean, and women as well, of course. But but I mean, are they going to be able to it or is it just are people going to to vote with their feet?

MARK GALEOTTI: Well, I mean, people have in the current sort of bout of mobilisation that we saw for every soldier who ended up being called to arms, to young or youngish men got out of the country. So, you know, the question becomes at what point actually is Russia likely to introduce exit controls? But that's a whole, whole other matter. Now, I think, look, it has to be said that Putin's dream of this whole new Sparta, this new militarised warfighting state, is dead. Now, Russia has a population of more than 140 million people, has a lot of latent power. To put it very bluntly, that's a lot of cannon fodder that if need be, you can mobilise if you're not worried about popular will, if you're not worried about the impact on the economy. But although this war is likely to drag on for some time, there's no way that in what 10 to 20 years that actually Russia will be able to to regain the appearance of being one of the great military powers of the world.

DM: Okay. So you say it's going to drag on for a while. How do you see this war playing out and ending? Will it when it ends?

MARK GALEOTTI: Yeah, I know that's the real dilemma. And to be honest, this war has very much challenge prediction already. Look, I can't really give you a timeframe. I mean, I think that. I suspect that if we are having this conversation in a year's time. By then, the real active phase of any fighting will have ended. The big uncertainty is this. I think that the Ukrainians are going to be able to basically push, push the Russians in due course next year out of most of the occupied territories. The big uncertainty is Crimea, because Crimea is a peninsula that's not just well-defended. It's a bit of land that not just Putin, but the majority of Russians believe is rightfully Russian. And, you know, I've spoken to people who are ardent anti-Putin activists who nonetheless think Crimea is Russian. That is my big concern is if the Ukrainians trying to actually take Crimea back, whether that's the kind of thing that Putin realises his political career will rest upon and it forces him to escalate in unpredictable ways. So I think that you might say I think what we're going to see is the Ukrainians pushing militarily to the point where they can actually force the Ukraine, the Russians, into some kind of credible negotiations, because at the moment, the Russians talk about negotiations, but they're not serious about it. But the point is that ultimately Ukraine is going to win. Any doubt of that? It just the only question is how far, quick, how quickly and what happens with Crimea.

DM: Well, and it will be interesting if that's what ends up happening, it'll be interesting to see how that impacts President Putin at home. Either way, he's ageing. Will this be President Putin's last war?

MARK GALEOTTI: I think it is. I think it is going to be that because, you know, whatever happens, his military is now in no fit state. So, you know, those those those dreams are gone. And to be honest, I mean, I can't help feeling that for Putin, this was going to be the final capstone of his career, that he thought that it was going to be a two week operation over easily, that he thought, well, that will actually consolidate my position in history. We know that matters to him as one of the great state building heroes of the Russian pantheon. Instead, this war will define him in so many other ways, ultimately as a failure. Who threw away what would genuine achievements in his first two presidential terms? You know, we have to say not a nice man, but nonetheless, you know, from the point of view of ordinary Russians, his first two terms are actually very positive. But all of that is gone now. Russia is relegated to being a pariah state. The military he spent so much on is in ruins. His social contract with the Russian people has been broken. And this is actually how his historic legacy will be defined.

DM: And not the Sparta that he perhaps imagined. But but I guess that begs the question, what what does that leave Russia and its military after Vladimir Putin leaves the stage?

MARK GALEOTTI: I mean, Russia will be faced with a difficult task in some ways, you know, regain its place within the world. I'm I am still fashionably optimistic about Russia's long term prospects. I see Putin and the people around him who are all pretty much of the same age, most of them are likewise ex KGB. I see this very much as the last toxic gasp of the Soviet era and the sort of the people who are shaped by it. So, I mean, I think we will see a different Russia emerging afterwards. On the other hand, look, this is a Russia which is going to be painfully reconstructing its economy. And it will not, I think, have the resources for the kind of Mass Million Man Army, which was kind of Putin's dream. So I think, you know, the most positive outcome is that it's a Russia that is appreciated, that it's no longer an imperial superpower and a Russia that is willing to be, shall we say, a Germany rather than a United States on the world scene, in other words, a significant regional power. But that's about it. And that really offers little role for a huge military.

DM: All right. Well, Mark, it was a fascinating read. Thank you so much for sharing your thoughts on this .

MARK GALEOTTI: My great pleasure.

DM: We'll be watching. I hope we get a chance to talk again. Mark Galeotti. His new book is called Putin's Wars From Chechnya to Ukraine. Well, coming up after your regional update.

SOUNDCLIP

[Foreign speech]

So there are so many of us, nearly 600 people, women, old people and children. We don't have enough space to sleep.

DM: Trapped on board a ship at the Italian coast in their sights, how migrants rescued at sea are now stuck waiting as food and supplies run low. I'm Duncan McCue. Stick around. We'll be back in 90 seconds.

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Italy blocks migrants and asylum seekers from coming ashore

Guests: Angelo Amante, Till Rummenhohl, Karin Marley

DM: I'm Duncan McCue and you're listening to The Current.

SOUNDCLIP

CROWDS: [Shanting] Help us! Help us!

DM: Those are migrants aboard the Geo Barents shouting help us. The rescue ship operated by MSF Doctors Without Borders is docked in Catania, Sicily. It has 214 rescued migrants on board. But Italy isn't allowing them off the ship, and it's not the only ship in the situation.

SOUNDCLIP

I'm really angry and I'm really upset about the fact that I am feeling forced to do an illegal act because the decree which prohibits me from disembarking the people here is illegal. That's what our lawyers made pretty clear. And I have other legal obligations which are for me the highest priority, which is the safety of my ship and the security of my ship.

DM: That's Captain Joachim Ebeling of the Humanity1. He's docked at the same port after his ship rescued 144 migrants at sea. 35 of those migrants remain on the ship. Italy won't allow them to disembark either. Humanity1 is a ship run by the charity S.O.S. Humanity, a German NGO. Till Rummenhohl is the head of operations on the boat. Hello, Till.

TILL RUMMENHOHL: Hi. Hi. Good to you.

DM: What is the situation of the migrants on the ship right now?

TILL RUMMENHOHL: Oh, it's a really bad situation, I would say. You could clearly see a change of the people we saw in over two weeks on board of OSA. The people are depressed, frustrated. They are in fear of being pushed back into international waters by the Italian authorities. They are even in fear of being pushed back to Libya where they fled from. You can see it in their eyes that they don't understand the situation, that they're really suffering on the uncertainty of their future.

DM: Paint a picture for us. What are the living conditions like for them?

TILL RUMMENHOHL: So we are a normal vessel. We don't have proper shelter inside the vessel for the people we rescue at sea. The people are sleeping on the deck in the outside. We having covers above them. They get food, they get clothes, they get blankets from us. But they are constantly sleeping outside, which is even more weird when you have a pier next to you. So the people see the land, the concrete of Italy one metre next to them and they are not allowed to leave this vessel.

DM: What state were these migrants in when he rescued them?

TILL RUMMENHOHL: We found them on really tiny, unseaworthy boats, not having fuel anymore and not having water or food. They didn't had any rescue means with them in the middle of the sea. They were really afraid, exhausted. Some spent many nights and days at sea not being found, not being rescued. They were dehydrated, seasick. Some people we find with months of regular beatings from the detention camps in Libya. They have gunshot wounds and they have a critical mental health. That is for sure.

DM: What were they fleeing? What what were they worried about encountering in Libya?

TILL RUMMENHOHL: In Libya, they are facing detention in so-called detention camps. It's a horrible condition they are in. They are not allowed to leave. It's basically warehouses where they are locked in. Many report about torture, about forced prostitution, about forced slavery. They are regular beatings and daily violence in these camps. They don't get regular food. They don't get regular and clean water. And they are basically victims of this situation and the [unintelligible].

DM: So now they're in Italy. Italy has allowed some of them to get off the ship. Who who were the ones they allowed off?

TILL RUMMENHOHL: This is the new situation. The Italian authorities agreed that the decree saying that only very vulnerable people and people in urgent need of medical help are allowed to disembark rescue vessels. So the people who does embark were basically women, babies and unaccompanied minors and adults, which were in a really difficult health situation.

DM: Which leaves who?

TILL RUMMENHOHL: Everyone who had gunshot wounds, who had illness which could not be treated on board this vessel was allowed, but everyone who was found visibly to be fine. And this we need to make clear they didn't get interviews. They didn't get any possibility to speak to culture, media, speaking their mother tongue, not even having access to a mental health specialist reporting on their mental health. It was just a visible check by the official doctors of the authorities.

DM: Your captain says he's not going to budge on this from the dock. But but Italy has said it's going to fine you up to €50,000 a day. What's your response to that?

TILL RUMMENHOHL: I mean, it was just a warning that there might be a fee if we don't cope with the regulations. But as we find this decree completely illegal, breaching with international maritime law, Geneva Convention and human rights, we also think that these fees are completely illegal and we're taking it to the stand. We are right now in front of the administrative tribunal in Rome asking for suspension and then cancellation of this decree because it's completely illegal and we are fighting that.

DM: So this a turned into a court battle then?

TILL RUMMENHOHL: Yes, for sure. We are filing our different cases first, the one they already explained, and then we also fighting for the rights of the people here on board. We have support of a lawyer who is supporting these 34 persons right now in the civil court of Catania, because right now they are asylum seekers, they all claim for international protection. And it's ongoing right now that our lawyer is in the court of Catania fighting for their human rights.

DM: On its side, Italy says it wants the countries whose flag is flown by the rescue ship to to take that responsibility for the migrants on board. What do you make of that argument?

TILL RUMMENHOHL: Yeah. It's a bit weird bringing it up because the international maritime law is pretty clear on that. This is not the responsibility of the flag state. They are responsible in helping us to communicate with the authorities who are responsible for the rescues. And this is the coastal states which having the maritime rescue coordination centres, basically it would be Malta who is responsible, but they are ignoring our cases since year and Italy is the only one who is responding at least. So Italy is obliged to take care of these rescues. And the problem is that the European Union and the member states are ignoring that there is also a responsibility for them to then take care of the people who are landing in Italy as a joint.

DM: And your position echoes what what Norway's ambassador to Italy, Johan Vibe, told Reuters on Friday. I'll quote here: "Norway has no responsibility under human rights conventions or the Law of the Sea for persons taken on board private Norwegian flagged vessels in the Mediterranean". The Geo Barents ship we heard about earlier sails under the Norwegian flag. What do you see as a solution for migrants to be rescued safely and not become political pawns?

TILL RUMMENHOHL: Yeah. It's horrible that the political game and the political discussions are made on the back of people seeking safety. The most vulnerable groups here are victims of these discussions. We urge within six years for the European Union to find a common solution for this. For sure, Italy cannot be left alone with this situation. But it's clear that we need to have a closest point to disembark these survivors of distressed cases at sea safely. And then the European Union need to find a common solution to relocate these people inside the EU and to help Italy on the big load of registration and location. So this would be a solution. We are asking for this in six years, but there's no solution yet.

DM: Well, you say that you've been talking about it for six years. This has been ongoing for a long time. And I mean, what's happening on the humanity one isn't happening in isolation. So do you expect that there's going to be more migrants in the coming in this coming year?

TILL RUMMENHOHL: Sure. I mean, it's constantly people fleeing. Every day our vessel is blocked here in port means that there are more people dying, more people going missing. This year showed already and a huge increase on people dying in the Mediterranean. We need to see that this is the deadliest migration route in the world just in front of the European borders. And we cannot ignore this and we cannot ignore the part of EU on all of this because they took away the rescue means from their side. So basically it's just the civil actors like our NGO who is trying to fill this gap. And this will go on forever if we don't find a solution in their own countries, but also find a solution for rescue capacities in the Central Mediterranean and how we as the European Union want to deal with asylum seekers and people fleeing.

DM: Thank you for for filling us in on on what's happening on board Humanity1.

TILL RUMMENHOHL: Thank you for covering.

DM: Till Roummenhohl is the head of operations at S.O.S. Mediterranee on board the Humanity One ship. He is in Catania, Sicily. Italy's crackdown on migrants comes just over two weeks after Georgia Meloni was sworn in as Italy's prime minister. She campaigned on a platform of tough migration policies. Now those promises are being put to the test. Angelo Amante is a journalist with Reuters. He's based in Rome. Hello.

ANGELO AMANTE: Hello. Thanks for the invitation.

DM: What is the political thinking behind this response from the Italian government?

ANGELO AMANTE: Well, the Italian government has praised this tough anti-immigrant stance, law and order stance since it took charge at the end of October. I believe on the one hand, they think their electors need this kind of a stance because they want to show they care about security. They care about the law and they believe this is what their elector need. On the other end, I think the Italian government believes this kind of move will force the European Union to arrange a sort of redistribution mechanism across the bloc, which would force the other states to take charge of the migrants landing in Italy. This year, Italy, we had so far around 90,000 people disembarking against around 30,000 two years ago. So migrant arrivals are growing and the government believes this is probably they think this is the best way to achieve some result at the European level.

DM: And I want to ask you about about George Meloni's campaign. But but before I do, just can you update us on the news? Apparently today, 89 people allowed on shore today from a ship run by a German aid group. Can you tell us a little bit about that?

ANGELO AMANTE: Yeah, the r[unintelliglbe] Ship, owned by Mission Lifeline Charity was allowed to land yesterday evening. It reached the port of Reggio Calabria in southern Italy this morning. And all the people have been allowed to get ashore. This was the smallest of the boats at sea and the migrants have been there for five days, so much less than the others.

DM: You had a chance to listen to our previous guest, Till Rummenhohl describe the conditions on on the boats as just not liveable. Does does Italy's government feel a responsibility to that to these people that are that are stuck in their waters and their ports at all?

ANGELO AMANTE: Well, they do. They are trying to play this thing, saying to plan this thing, saying they have allowed the vulnerable to get ashore, leaving on board the boats only those who could still afford this. But of course, this is very difficult to do to say and it's something that is always unclear because even though they've sent doctors aboard the boats, the NGOs still claim this is not possible because all on board the suffering, because they've been at sea for two weeks. But the Italian government is trying to abide to this humanitarian duties by saying the vulnerable have been allowed assistance and they are not on the boats anymore, the vulnerables and the minors.

DM: So I'm wondering how this is playing out domestically then politically, because I mean, this conversation about immigration in Italy has been contentious for quite a while, and people voted in Prime Minister Meloni on this platform of being hard line on on migration. Yet it seems that some people want to see the vulnerable be let off the ships. How much tension is there right now in the country?

ANGELO AMANTE: Well, it's not only Meloni, it's also Matteo Salvini, the leader of the anti-immigrant league or is now deputy prime minister, is been interior minister. So in charge of immigration policies. It's been 2019. And in 2019, we have seen NGOs being kept at sea for days with migrants not allowed to disembark. So this is not the first time an Italian government embraces such policy. Well, of course, now, immigration has always been a contentious issue in Italy. Three years ago, it was the most important topic probably. Now, with the energy crisis, the rising bills, inflation, probably detention of people is on the economic issues, on the economic policy. But the government still is trying to show it cares about law, order and security, probably also because the situation, the economic situation is very difficult. The government wants to show that on the other policy areas it is doing something. It is acting to protect the country and to protect the Italians.

DM: You mentioned that that migration was a significant agenda item a couple of years ago. What has this this mass migration meant for for Italy generally?

ANGELO AMANTE: Well, in general, Italy has never been a country with various ethnicities as the European states, for example, the U.K. or France or Germany. So there are not many foreign people in Italy compared to other European states.

DM: But so how have they been treated by the Italian population?

ANGELO AMANTE: Well, there's no- I, I won't say the Italian are racist. So there is racist agenda in the public opinion. But obviously, many politicians have played a lot in this and they've built much of their political fortunes by saying this. People coming from the sea are threatening our jobs, are threatening our lives, are threatening our families. So the Italians are not I mean, I don't think there are many Italians convinced that these people are a threat. But many politicians have been playing a lot in this. And probably this is causing us all this has called this sort of reaction on the electorate, especially on the right wing side of the electorate.

DM: I mean, Italian Infrastructure Minister Matteo Salvini told Italian radio it wasn't just people who were being trafficked, but weapons and drugs, too. Is there any evidence of that?

ANGELO AMANTE: Well, in the past day we have had a small number of people, obviously, who have been convicted after long after talking Guinea. After disembarking in Italy on crimes related to weapons, drugs or terrorism. But of course, it's just a very small share. The majority of these people, of course, are not criminals. They're just people seeking a better future in Europe, even though, of course, illegal immigration is a crime in Italy. And the government can embrace this tough stance against immigration.

DM: So this tough stance on immigration, where do, in Italy, where do other European countries fit into this? And is there a call for them to to pick up some responsibility for for some of the asylum seekers?

ANGELO AMANTE: Yeah, of course, Italy is trying to enforce this agenda at the European level. They want the government wants the European Union to arrange a sort of mechanism to redistribute migrants across the bloc. So far, we have had some states, including Norway and Germany, the flag states of these NGO boats, who said Italy should take charge of the migrants and allow them to disembark from the boats immediately. France said, the French interior minister said the country would be ready to take care to take charge of some of them. But obviously yesterday there was an EU and an international organisation for Migration statement saying all the 164 migrants out of 88,000 landing in Italy this year have been distributed across the bloc. And of course this number is really small and as the SS Mediterranee responsible said before, this number has to be higher and the European states have to do more on immigration.

DM: So for the migrants that are stuck on board the ship now, you heard I mean, the situation is growing more and more dire for them. So how do you think this is going to play out? I mean, will these ships be allowed to dock and will the passengers be able to get off or are they going to be forced back out to sea?

ANGELO AMANTE: No, I think they will be allowed to disembark sooner or later. But the government first has to obtain some sort of commitment from the other European states to take charge of them just to claim some sort of victory on this. Because, of course, they're going to tell people we have allowed the migrants disembark and we are taking charge of them, even though we had said that we will not we are not I mean, we are not ready to take charge of the migrants. So I think sooner or later they will be allowed to disembark and the government will say, we have obtained this, this and that from the other European states, from the other European Union. So our strategy is paid off.

DM: Okay. Well, we'll keep watching this. Thank you for your analysis.

ANGELO AMANTE: Many thanks to you for the invitation.

DM: Angelo Amanti is a journalist for Reuters. He was in Rome. We did request an interview with Italy's minister of the interior, Matteo Salvini. He declined. I'm Duncan McCue and you're listening to The Current. Over the past few days on the programme, we've heard some ideas on how to deal with a shortage of family doctors. BC's Health Minister explained a new funding model to attract and keep more doctors and nurse practitioners talked about their potential to do more. And then we also heard from you, the current senior producer, Karin Marley, is with me with some of your letters. Hi, Karin.

KARIN MARLEY: Hey, Duncan. Let's start with Kate Daniels-Howard. She writes, Our family doctor retired in July. Our extended family has 18 members, some of whom have been his patients for more than 20 years. One of our daughters is a two year kidney transplant recipient and lives with type one diabetes. The other doc, the other daughter was the kidney donor. We have a total of five grandchildren now without a doctor. My husband has diabetes. I'm a melanoma survivor. We are a family that has ongoing medical care requirements. We live in northern rural B.C., where our local hospital serves the town of Smithers. It handles minor problems, but if there's something that requires extensive treatment, you are airlifted to Vancouver or Prince George. None of the other doctors in our town are taking new patients. There's a walk in clinic that just opened that operates three days a week. Another doctor has just retired and there are an estimated 3000 folks in our area without a family physician. So recently I caught wind of a couple who are both doctors in Alberta looking to make a move in the new year. I took it upon myself to draught a letter that I was able to convince our local mayor, MLA and MP to send to them as an invitation to consider Smithers as a place to call home and start their practises. Sometimes it just takes a bit of ingenuity to help get something going. I'm not saying I'm a genius, but I'm just desperate to get my family primary health coverage. And I'm not above love bombing this couple to give us a chance.

DM: Especially hard in the rural areas. Janice Melanson in Montreal says I was followed by a nurse practitioner in New Brunswick. Her care was equal, if not more compassionate, than most MDs that I have seen. It was rare that I needed to see the doctor in this clinic, but the nurse practitioner did consult and sometimes referred me to see them when necessary. I've seen firsthand how fractured our health care system is as I accompanied my mother post-stroke through a six week stay in hospital and then struggled to find her a place for rehabilitation and long term care. We need to do things differently and nurse practitioners are well-placed to ease some of the increasing health care burden in Canada.

KARIN MARLEY: So this one is from Hannah Riddell and she writes, I'm a registered nurse who lives in rural Ontario. I kept my family doctor as long as I could, even though he was more than two hours away as no local physician had capacity when he retired in the summer, I was left without a physician. I had to turn to a medical app to continue to get my inhalers for asthma. I have called offices many times and signed up for health care connect but do not have much hope as my spouse has been looking for over two years. I am in my mid-thirties and putting off having children without a primary physician to turn to during pregnancy and to take them on as patients. If I ever have them. It causes me stress and saddens me that this is so normal now.

DM: Rosemary wrote, I have lived on Vancouver Island for nine years and was lucky enough to register with a new clinic staffed with nurse practitioners. My nurse practitioner moved to create another new clinic in our village, staffed by nurse practitioners in our ends. I've received nothing but excellent care since I moved from Vancouver, where doctors are in short supply. If my nurse practitioner isn't available at a time when I need a same day appointment, someone else will be available. I have never been more satisfied. I have experienced, kind, thoughtful care with no time limit on my appointment where I can discuss more than one problem at a time if circumstances require.

KARIN MARLEY: Mischa writes, I am a 24 year old, trans, non-binary person living in Montreal. I'm hesitant to get on a waiting list for a family doctor because I'm worried I will not be able to get someone who is trans informed. My current family doctor is through my university and incredibly sensitive to my needs, but basically now I plan to stay at my university for as long as possible so I could keep receiving her care for fear I will not be able to get my needs met elsewhere.

DM: And finally, Pat Lindley writes in My husband's doctor retired last spring, and the past summer was a litany of new and continuing health challenges. Most of it went relatively smoothly until after his echocardiogram. He asked the nurse where the results would go. She answered, Your family doctor and then was brought up short when he answered, I don't have one. There was apparently no plan for how to handle this not uncommon situation and one had to be hastily concocted. Family doctors are the essential glue that holds the myriad of specialist services together. They are the point of convergence for all the tests, diagnoses, prescriptions that accumulate over time for their patients. They see the totality of their patients needs and guide the direction of ongoing care. He's now seeing a wonderful nurse practitioner, but sadly he has been told this is just a stopgap arrangement.

KARIN MARLEY: So those. Are just a few of the many letters we received on this, and we'll continue to cover the health care situation, especially looking for places that are finding solutions.

DM: A lot of them coming in.

KARIN MARLEY: Mm hmm.

DM: Thank you, Karin.

KARIN MARLEY: Welcome.

DM: If you'd like to tell us how you're coping without a family doctor or comment on anything you hear on the show, you can always reach us at the current at Cbc.ca or on Twitter. We're @TheCurrentCBC, and that is the programme for today. Stay tuned to Radio One for. Tom Power will be speaking to Suzette Meier, the winner of the 2022 Scotiabank Giller prise. And tomorrow on the current here Mattes conversation with Jody Wilson-Raybould. She was the first indigenous person to serve as the Minister of Justice and Attorney General of Canada before she resigned from Cabinet in 2019. Hear her new book. It's called The True Reconciliation How to be a Force for Change. I'm Duncan McCue in for Matt Galloway today on indigenous veterans day. Chi miigwetch to all the vets and chi miigwetch, thanks to you for listening to The Current.

SOUNDCLIP

We're in a period of time that is transformative. That is a period of time of transition, and that can be confusing and it can be scary. But for me, I draw great optimism from young people in our communities, in our indigenous communities and beyond becoming more involved and moving beyond young people. It's Canadians are the ones that are driving and leading change and wanting to ask the questions, but also not just asking the questions, wanting to do things to advance reconciliation, true reconciliation or indigenous rights. And that's exciting. And I mean, I can think back to when I was regional chief first elected. In 2009, I gave a speech about what has changed in 50 years, but I can safely say that from that point when I gave that speech to now, there has been more change and we need to acknowledge that that change has happened. Why has it happened? Because Canadians are becoming more aware, more educated, wanting to do and lead in certain ways that assist that happening. And that's, you know, assist in changing the patterns of relationships between Indigenous and non-Indigenous peoples being inbetweeners as I like to talk.

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Tuesday November 8, 2022 Full Transcript

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