Again — this is not primarily an “agencies are overcharging” issue, it’s a “the government refuses to pay nurses appropriately, so nurses are saying ‘fuck you’ and going to work for agencies instead.”
Nurses are choosing the pay and flexibility that working for agencies can offer over the stability of a regular position in a facility, and as someone who deeply values the stability of my permanent, unionized nursing position, that says a lot. You’d have to pay me SO much to give that up. But for a lot of nurses, the pay is so shit for what is expected of them that it’s worth it.
Provincial governments need to pony up the money to pay healthcare workers competitive wages or continue to spend millions on agency nurses. Capping agency fees isn’t the answer, in my opinion.
Warning: this article contains distressing detail about people's injuries
A badly burned toddler screaming for the mother he doesn’t know is dead – and screaming because doctors do not have enough painkillers to relieve his suffering. An eight-year-old boy whose brain is exposed as bombing damaged parts of his skull. A teenage girl, her eye surgically removed, because every bone in her face is smashed. A three-year-old double amputee, whose severed limbs are laid out in a pink box beside him.
And in the background is the stench of rotting flesh as maggots “creep out of untreated wounds”.
This is the daily reality at the European Hospital inside the southern Gaza city of Khan Younis, as described by veteran British war surgeon Tom Potokar, who works for the International Committee of the Red Cross (ICRC).
Israeli forces have started to storm Khan Younis, the largest city in southern Gaza, launching what is believed to be the biggest ground assault since a fragile seven-day truce collapsed last week.
Inside the European Hospital, one of the main medical centres servicing the city and surrounding areas, medics struggle to treat the “relentless” stream of wounded, Dr Potokar says. Nearly half of them are children.
“I’ve lost count of the number of children we have treated who have horrific injuries, burns, amputations, who've lost their whole family,” Dr Potokar tells The Independent from inside the hospital compound which, like other medics, he has not left for five weeks.
Palestinian and international medics are sleeping on the floor of the nursing quarters, living off packets of noodles and working 14-hour shifts, he explains. One night Dr Potokar says he was nearly killed by shrapnel which came through a window.
Some medics, including nursing staff and surgeons Dr Potokar worked with, have been killed alongside dozens of members of their family. At least one of the 100 ICRC staffers working in Gaza has also been killed.
This is Dr Potokar’s 14th time working as a medic in Gaza. He has worked in the field as a surgeon in Somalia, Syria, Afghanistan, and Yemen, but this conflict “is without doubt the worst”.
“I have seen far too many children whose lives have been destroyed,” he says. “I’ve treated a four-month-old with significant burn injuries. I treated an eight-year-old that had an open fracture of his skull with an exposed brain. It is just awful to see and it’s so relentless. It's just not stopping, they keep coming in every day.”
Recently Dr Potokar was treating a burns patient in the intensive care unit who had fled the north of the country and whose wounds were septic as the dressing had not been changed for days. On the bed next to the burns patient was a three-year-old boy. “He had [two] above-knee amputations done the night before from an airstrike. I found out afterwards that his father had also had an amputation and the rest of his family didn't make it,” Dr Potokar says. "This is not a one-off event.”
At the European Hospital, at least 360 people are on the waiting list for an operation now, an “impossible number to deal with,” says Dr Pokotar.
“It’s almost like a perfect storm of neglected wounds and then the patients getting malnourished as well which means they won't heal. They've had different procedures at different places and been transferred from one place to another,” he adds. This is compounded by staff shortages as medics are killed at home, or prevented from getting to the hospital because of bombing and destroyed roads.
The nurse who had helped him with the three-year-old double amputee was killed three nights ago along with 12 members of his family, Dr Pokotar says. A senior plastic surgeon, who was also a colleague, was killed with 30 members of his family in an airstrike four weeks back. Every day, nursing staff and surgeons are treating family and friends that are brought into the hospital – many do not make it.
“It's difficult to find somebody who hasn't lost somebody close,” he adds.
“There are just too many patients and not enough staff, not enough theatre time to treat all of them. So you have to prioritise.” Infections are now running rife through hospitals as wounds are not being tended to in time; there is an “overwhelming” number of patients with complex injuries that have been neglected.
Dr Pokotar says anyone who would doubt the devastating impact on civilians would change their mind if they spent a day in his wards.
“If you could bring any person here who was not sure, and you place them here, and you got them to smell the stench of rotting flesh, to see the sight of maggots creeping from wounds of a person who has necrotic flesh and to hear the screams of kids because there's not enough analgesia [painkiller], and they want their mum, who's not going to appear because she's dead – I think people might feel a bit different about this.”
Physicians have a history of antagonism to the idea that they themselves might present a health risk to their patients. Famously, when Hungarian physician Ignaz Semmelweis originally proposed handwashing as a measure to reduce purpureal fever, he was met with ridicule and ostracized from the profession.
Physicians were also historically reluctant to adopt new practices to protect not only patients but also physicians themselves against infection in the midst of the AIDS epidemic. In 1985, the CDC presented its guidance on workplace transmission, instructing physicians to provide care, “regardless of whether HCWs [health care workers] or patients are known to be infected with HTLV-III/LAV [human T-lymphotropic virus type III/lymphadenopathy-associated virus] or HBV [hepatitis B virus].” These CDC guidelines offered universal precautions, common-sense, nonstigmatizing, standardized methods to reduce infection. Yet, some physicians bristled at the idea that they need to take simple, universal public health steps to prevent transmission, even in cases in which infectivity is unknown, and instead advocated for a medicalized approach: testing or masking only in cases when a patient is known to be infected. Such an individualized medicalized approach fails to meet the public health needs of the moment.
Masking as a disability accommodation in health care settings should be recognized as part of physicians’ ethical obligations. Access to health care is a particularly fraught issue, as people with disabilities often require more frequent and specialized health care than nondisabled individuals. Physicians have an ethical responsibility to promote the well-being of their patients and do no harm. Wearing a mask on a disabled patient’s request to protect them from contracting COVID-19, which could be deadly for that patient, squarely fits within physicians’ ethical obligation to provide for patients’ care and to ensure their ability to safely partake in health care settings.
Doctor Beverly Crusher
My sickbay is not a stage. I don't want you to pretend to be anything you're not or to perform being okay. I want you to feel safe enough to let down your guard so I can give you the care you need. Too many of you have terrible HCWs that make you perform! emojis: black heart, blue heart, masked
2:57 PM · Dec 9, 2023
Schools across Ontario will soon be implementing new policies regarding the administration of epilepsy rescue medications for students living with the condition.
The motion, which was passed at Queen’s Park on Nov. 15, will require school boards to implement a comprehensive epilepsy policy, which includes training teachers and staff on the administration of the medication to students having an epileptic seizure.
Epilepsy Toronto calls it a “significant leap forward for epilepsy advocacy.”
“We have policies and procedures in place for students with prevalent medical conditions, such as anaphylaxis and asthma, and staff in the schools are trained in administering lifesaving medications for these students. We don’t have such a policy in place for students with epilepsy,” said Elana Ellison, coordinator of Children and Youth Services at Epilepsy Toronto. [...]
I often get asked how patients should best advocate for themselves in the doctors office. I love this video by @Dor_the_grayt that describes the concept of a differential diagnosis, which is essentially a list of the different problems that you may have as a patient. It’s one of the first things we learn in medical school and is an easy way to broaden a conversation with your physician/ to make sure that your concerns are heard.
1) Ask for the differential diagnosis is. 2) Ask how they ruled out the differential diagnosis. 3) Keep asking and let them get mad
Horrible fact of the day: Chevron just released a new boat fuel that WILL give you cancer.
Not "might", not "could", WILL. It has a cancer ratio of 1.3:1, as in, in a group of 10 people, 10 would contract CANCER.
(Edit: apparently some articles are now saying 1.4:1, and some are saying a little under that. Either way, the consensus seems to be anywhere between a 95-100+% of contracting cancer, with some expectations of this fuel not even needing a full lifetime of exposure for you to get Cancer.)
The EPA's safety limit is 1:1,000,000 as in 1 in a million people get cancer.
The EPA approved it anyways. I am not joking. The EPA approved a boat fuel that has a near 100% chance of giving someone cancer. It has such a good chance of giving someone cancer that if you DIDN'T get cancer YOU WOULD BE AN OUTLIER.
Fuck the oil industries.
Edit: If you find this (rightfully) horrifying, have you considered industrial sabotage? /hj
This isn't something we can vote away. This isn't something the rich are gonna apologize and make a 10 minute apology video for this. They don't care if you starve or wither in hospitals or get blown up in their wars.
If you don't know where to get started:
If you already know what to do, then it's time to do it. Participate in mutual aid, raise awareness in real life as well as online, participate in or train in self defense and emergency medical training classes.
The study itself is titled, “Long-Term Regret and Satisfaction With Decision Following Gender-Affirming Mastectomy,” and sought to study the rate of regret and satisfaction after 2 years or more following gender affirming top surgery. The study’s results were stunning - in 139 surgery patients, the median regret score was 0/100 and the median satisfaction score was 5/5 with similar means as well. In other words… regret was virtually nonexistent in the study among post-op transgender people.
In fact, the regret was so low that many statistical techniques would not even work due to the uniformity of the numbers:
In this cross-sectional survey study of participants who underwent gender-affirming mastectomy 2.0 to 23.6 years ago, respondents had a high level of satisfaction with their decision and low rates of decisional regret. The median Satisfaction With Decision score was 5 on a 5-point scale, and the median decisional regret score was 0 on a 100-point scale. This extremely low level of regret and dissatisfaction and lack of variance in scores impeded the ability to determine meaningful associations among these results, clinical outcomes, and demographic information.
The numbers are in line with many other studies on satisfaction among transgender people. Detransition rates, for instance, have been pegged at somewhere between 1-3%, with transgender youth seeing very low detransition rates. Surgery regret is in line with at least 27 other studies that show a pooled regret rate of around 1% - compare this to regret rates from things like knee surgery, which can be as high as 30%. Gender affirming care appears to be extremely well tolerated with very low instances of regret when compared to other medically necessary care.
The intense conservative backlash, to the point of disputing reputable scientific journals, likely stems from the fact that reduced regret rates weaken a central narrative these figures have championed in legal and legislative spaces. Over the past three years, anti-trans entities have showcased political detransitioners, reminiscent of the ex-gay campaigns from the 1990s and 2000s, to argue that regrets over gender transition and detransition are widespread. Some have even asserted detransition rates of up to 80%, a claim that has been broadly debunked. Yet, research consistently struggles to find substantial evidence supporting this narrative. The rarity of detransition and regret is underscored by Florida's inability to enlist a single resident to bear witness against a lawsuit challenging the state's ban on gender-affirming care.