Healthcare in Canada

  I realized that not many non-Canadians are aware of the state of the Canadian healthcare, specifically in Ontario. The following is a description of our recent experience, which is very characteristic of what is to be expected.

Our preschool-aged child contracted an intestinal viral infection, vomiting continuously for five days and unable to retain even water without vomiting. Last week there was some improvement in the morning, but by afternoon the vomiting resumed. Unfortunately, when we called our family doctor at 3 pm, the office was just closing. Weighing our odds of having to go to a walk-in clinic and wait for hours, knowing that any tests that may be necessary would have to wait until at least the next day, since no blood testing or other tests are done in clinics, one has to go to a lab (2+ hour wait and only open 9am-5pm at best). So, we decided to drive to a hospital emergency room. We waited 8.5 hours to be seen by the doctor only to be told to continue with small sips of PediaLite. All together, we were there form 9 pm until after 7 am, since the doctor wanted to monitor her fluid intake for a little while after we finally go to see him. All that time we were taking turns holding our sleeping, lethargic, child while sitting in a chair. It was exhausting.

This is by no means uncharacteristic of the system. Couple of years ago I went with my three year old to a children's hospital in Toronto. My child had a bad ear infection and was running 41oC+ fever. Naturally, I was concerned about her going into seizures, but to my total dismay I was told that "seizures are normal". Not only that, we waited more than 9 hours to be seen by a doctor. At that point the physician called his colleagues to see how bad the ear infection actually was. Still, we were sent home and given an appointment with a specialist two days later. By the time we came to see her, my child's infection has drained in the waiting room. I know that in Europe severe ear infections were usually drained by the physician. The theory was that an artificial, clean, cut was more likely to heal without a loss of hearing, than a rupture of the eardrum. The specialist we seen at the hospital had no idea that this procedure even existed, what more, we were told us that such procedure was impossible, as if we made this up.

There are a number of shocking things that  one learns only when the need for emergency care arises. Not many years ago I was in the vicinity of a large central teaching hospital when I experienced an excruciating abdominal pain. Based on the location of the pain and knowing that I was less than two weeks pregnant, I strongly suspected an ectopic pregnancy. I barely made it the one block to the hospital. By the time I walked into the emergency entrance, I could barely walk and I was in so much pain, I could scarcely speak. I explained to the nurse that I was pregnant and that the symptoms are indicative of ectopic pregnancy. Due to the nature of the emergency, I was actually seen by a doctor within an hour of my arrival. I arrived before 4pm and was seen by 5pm. I was told by the doctor that the diagnosis is likely what I have suspected, but that it has to be confirmed by an ultrasound, at which point I can be given medication to terminate the pregnancy, sparing me surgery. 

Unfortunately, the ultrasound service closes at 5pm in all the hospitals of the central Toronto teaching hospital network. I had to wait 8 hours for a man with a portable ultrasound to come by and perform the ultrasound!!!! (And it was quite an experience, as I had to guide the probe, because there were certain things the patient had to do herself. I was in so much pain, I was barely able to move, little less hold the ultrasound probe. That was an awful experience.) The entire 8 hours I was in incredible pain, on strong pain killers. But, worse was yet to come. Within 30 min of the completion of the ultrasound, the ectopic pregnancy burst and I began to go into shock. The last I remember was feeling cold, shaking, absolutely covered in cold sweat and collapsing to the ground as I was returning form the washroom. All I thought was that I didn't want my teenage daughter, who happened to be with me, watch me die. It is possible to die within minutes of blood loss in a case of ruptured ectopic pregnancy. Because by now it was very late at night, being past midnight, the surgical team had to be called in from their homes and it took at least another hour for the emergency surgery to be performed. I was kept two days in the hospital thereafter, due to blood loss. I cannot even imagine the costs for the nearly 10 hours of emergency room space, the surgery costs, all of which could have been avoided if there was one single ultrasound technician available within the central network of Toronto teaching hospitals. I could have ended up taking a pill, rather than risking my life and going through surgery. I hope that this summarizes the Canadian healthcare system for the reader. The current approach of dealing with this crisis is a massive spending on adds posted all over Toronto, featuring healthcare administrators and doctors of the Ontario Medical Association, telling us that our "Your Life is Our Life`s Work". Well, at least we know who to thank. I wish I could say that these were my only dismal experiences, but I could list a number of other instances, equally serious in nature.

Kindergarten registration - GTA

Assumption #1 - the school would post the dates when parents can register their children for Kindergarten on their official school board-operated website.

Assumption #2 - your two children would be allowed to attend the same school.

Both assumptions appear to be false.

When I could not find any information on-line, I called the school board, but no one there knew the dates for registration. I tried to call the school on a couple of occasions, but I couldn't get through. I was, however, told by the school board that the dates will be announced in the local newspaper. I feel like I am living in the 19th century.

Our older child is attending a French-immersion school and we were hoping, and falsely assuming, that our younger child could attend the same school. Unfortunately, since Kindergarten is not French-immersion, our child has to attend a school we are assigned to and switch at grade one. This, of course, means that we will never get the after-school care spaces in Grade 1, which will be taken by children entering at the Kindergarten level and a mile long waiting list will exist by the time our child wants to enroll. By the way, after calling and trying to get space for our older child months before the school started, we are still on the waiting list and we are told that the list is so extensive that we should not hope to ever get a space in the after-school care. It's now eight months after I first contacted them. Why am I not surprised, I still get phone calls from day-cares asking if we still want to remain on waiting lists we placed our younger child on almost two years ago.

School bus adventure continued

The morning of the second school day. All parents were again waiting at the north side of the street, as we were originally instructed.

All of a sudden, a bus arrived on the other side of the road again. It was the same driver as yesterday. I signed to her that she is not our bus, but she kept waving us over. Another parent finally went over to her and after brief conversation came back and said that this time the bus has the sign up and it's the correct route. It really was the correct route number posted on the bus. So, how could this have been the “wrong” bus yesterday? So, reluctantly, we put the kids on.

I asked the driver how come yesterday she was the “wrong” bus, and today she is the “correct” bus, referring to the bus numbers given to us by the school. She answered that the numbers given to us by the school have nothing to do with the route numbers and that she does not even know which school-issued number she is. Ok, so I asked how come she was the wrong “route” yesterday and today she is the correct route? She only answered that today she is route #XYZ that our kids should be on.

While this was going on, an enormous traffic pile-up was building on this busy, main street, increasing the risk that someone will drive through and injure our children.

Thankfully the school called, again, very apologetic. I talked to the principal who unequivocaly assured me that my child will without a doubt be put on the correct bus on the way back.

I made it clear that having the bus come on the wrong side of the street is unacceptable.
I also stressed that I was terrified not knowing where my child was for an hour and that for these problems to still not be sorted out two bus runs later is really a huge organization failure.

Sigh of a relief. Afternoon should be fine.

Well, afternoon came around and our child was nowhere. Fighting back that panic feeling one gets when they lose the knowledge of the whereabouts of a small child, knowing the probable cause, we again went an to making phone calls to the school. Other parents waiting at the stop were also understandably very, very upset by this time.

Turns out that our child was about to be put on the "correct" bus, but the bus driver refused to take the children who shared in this ordeal. She even radioed the dispatch that said that these children are not on the list (according to her). I know that at least our child definitely is on that route, since I had to get her entered manually and I repeated all the information back to the administrator twice, just to make sure.

So, she was put on the wrong bus yet again and arrived more than half hour late.

Now this experience is beginning to traumatize my child and I am sure that the other children are not taking it lightly as well. To my great surprise, I received an apology form my child and when I asked what it is for, I was told that it was an apology for blaming me for all these mishaps with the bus and that, even though I didn't know it, my child was initially very angry at me. Then I was told that my child no longer wishes to go to the school, because of fear of being misplaced and lost by the bus service and fear of not seeing parents again. Way to start the school year.

I share the same sentiment, I don't feel that my child is safe with a bus driver that cannot figure out her routes or with a company that fails to figure out theirs or hires drivers unable to fulfill the requirements of their job. I would have expected for the driver to learn her route long before she even drives a school bus through it. She could end-up in a dangerous situation by not knowing her route and having the added distraction of a full bus of children. Also, labeling the buses with two sets of numbers, one by the school and another by a route number, without any reference given to the parents and without any of these numbers being displayed on the bus, was an incredibly bad judgment call, as was not paying attention to the route numbers attached to a child's backpack, which we filled out as instructed.

First day adventures

So, as I mentioned in a previous post, the bus information that was supposed to be available on August 25th was still nowhere to be found on the 29th. After calling the bus company, I finally had our child entered into the system.

Despite calling several times, the staff at the YMCA-run after-school would not let me speak to anyone else aside from the designated person, because this person WILL get back to me within 24 hours. The day of school and many phone calls and messages later, we still have no after-care. No one ever called back.

Morning of the first school-day. Parents are waiting at the bus stop with, as it happens, all first-graders. About 10 min after the designated time and a bus passes us by. Then another one stops in the opposite direction, on the other side of the road. The traffic is piling up, since no one is supposed to pass a stopped school bus. Finally, a couple recognize the bus driver from last year, their child went to the school for kindergarten. The bus driver tells us that she is from our school and that she confused her route and is going in the wrong direction. So, turns out, it really is the bus our children are supposed to take. Thankfully, all children had their parents there, otherwise they would either be left behind, being confused as to what bus this is, or would have to cross a busy street, with cars just barely fighting the nerves at this point not to drive through, as the confusion is being sorted out. It took a few more minutes as parents somewhat reluctantly load their children into this unlabeled bus Being a little hesitant, I went to the school to wait for their arrival.

It took at least another half hour before they arrived, about fifteen minutes after the last of the other buses of arrived. I think the driver was lost. At first I was satisfied with the way things were handled, One of the staff boarded boarded the bus and gave the children stickers as to which bus they will be taking home. The problem was, these numbers had nothing to do with the actual route numbers given to the parents, who were told to write them on the tags and attach these to their backpacks. I think you can see where this is going.
Anyway, in the mean time, the children came off the bus and were told to go around to the back of the school. All by themselves. I was happy I was there to escort my child, especially when I saw the back of the school, which is a soccer field, full of children and adults, trying to sort out where their children belong. The teachers were holding up small signs with their name, which didn't help, as we were not told who the teacher will be. To my surprise, there was no organized way of catching the children as they enter and escorting them to their group. It looked like a mayhem. I'm really not sure how a lone first-grader would find their teacher, with all the towering adults, blocking any possible chance of seeing a sign with a name, even if the first-grader knew who the teacher was and could read the sign. Perhaps they mopped-up the last few lost souls when the crowd dispersed?

I was able to catch one person with a list who, eventually, after wondering if we are registered at all, did find my child's name and sent us in the right direction. Once in the group, I was satisfied that my kid had a fighting chance making it to the classroom and I left.

What else could possibly go wrong? After all, I called the school to make sure that there would be no more hiccups with the bus and they assured me that our child will get onto the correct bus. So, everything should go smoothly now, right?

End of the day. We were waiting for 35 minutes for the school bus, then we started making phone calls. I called the school inquiring about my child. Finally, another 10 tense minutes and a bus approached, we were relieved, our child was there. Finally the school called back, we were told that our child was on the wrong bus, among a couple of others, and that they are being taken back to school. They were surprised when we told them that we have our child already.

Turns out that the bus in the morning wasn't our bus after all, although it went to the right school. Because it wasn't labeled, we didn't realize that there are two routes on that street for the same school and neither did the bus driver. The fact that she said that she confused her route and that she is going in the wrong direction assured us that this is the correct bus. So, by getting on the wrong bus, getting the wrong sticker on arrival and the bus numbers having no connection to the sticker numbers indicating which bus the kids should board on their way home, therefore making the school bag tags useless, our kid and the others who boarded the same bus in the morning, got sent home on the wrong bus, arriving about 40 min later than they should.

I sure hope for a smoother ride to morrow!

Toronto, the city that decided to cut itself off from the rest of the world?

There seems to no longer be a way to get into Toronto. Between 9am an 9:30 we made it from the suburbs to the level of Lakeshore exit off the QEW/Gardiner highway. Then the traffic stops and one is allowed to progress at 10km/hr at the most, so staying on Gardiner is not an option. Everyone is trapped from that point until the Spadina exit, sitting in their cars, barely moving at all, for about 45 minutes. Lakeshore is one option, but since everyone has learned their lesson on Gardiner, this route too is averaging 10-20km/hr and today a construction has added more hassle and further reduced progress, cutting 3 lanes to 1. Are we really reduced to 1 lane from the three on Gardiner, now unusable, and three on Lakeshore? This is the only major route from the entire west suburbs.

Leaving even earlier form the highway, one could take Parkside, but that is only one small exit and the traffic is often at standstill. Then one has to make a very slow progress through the city, not much of an option either. The only other major route is the north end of the city, on 401, far out of the way and no less packed with cars. It seems that the city has decided to cut itself off the rest of the world, making it just impossible to commute in. Perhaps this is the only way to force people to live within its confines. (For an explanation on why I don’t take the public transit, see earlier post on the topic.) Personally, I would far prefer to work and live in the suburbs, so if I would have to choose to work in Toronto or in the suburbs, there would be no contest. I am just waiting for a chance to stop working downtown.

Since the exodus from the city, the suburbs became nothing like the old stereotype. We have far more entertainment and shopping options than anyone in Toronto, yet ironically, entertainment access is still the biggest argument of Torontonians for why some of them still stay in the city. If I want to get to the movies, I can pick from 3 to 5 theatres in the nearest area and many more fairly close by, all with convenient parking and a slew of restaurants and other entertainment, such as laser quest or mini golf, etc., etc. In Toronto, we actually gave up on going out at the thought of having to park or use TTC, which stops running at 1 am anyway. Not to mention that it is so much safer in the suburbs (another point on which Torontonians are somewhat deceiving themselves. The level of dissociation became from “not in my neighborhood” to “not on my block” to not reading the stats, which in any case became hard to come by these days. Not knowing has become the new option.). In the suburbs, I have so many restaurants to choose from. We have at least three a walking distance away, including a pub. Not to mention services such as a hair dresser, a store, a coffee shop, three different ethnic European bakeries and cafes, etc. The design and accessibility to services has greatly improved since the early subdivision designs. I find the selection of theatres and art centers comparable, if not better, and much more accessible.
Another benefit of being in the suburbs is that there is far less concrete, so we don’t face the heat that the concrete absorbs and then gives off, making Toronto an oven. I also don’t miss the inescapable noise, something one gets used to and blocks out while living in the city and only realizes its presence coming to the city from the suburbs in the morning. I suppose Toronto is bearable for the single person that can bike around, but once children come and car becomes a necessity (I can’t imagine taking a sick child to the doctor on a bike in the winter, or grocery shopping for the family, with kids in tow, on a bike), living in Toronto gets progressively less enjoyable and less feasible. Not something I would have said fifteen years ago, but so much has changed since then. Not necessarily the fact that I am no longer a young university kid, but the way that the livability of the city has changed. Except for one of my married friends, who has no children, all have moved out of the city.

Working at an academic institution in Canada.

I can't do much better than this article, so here is a link to "Taxing times for Canadian postdocs : Nature News".

Daycare and schools

Daycare
When I went to look for daycare in Toronto, I was often told that the waiting list is about 2 years long (for an 18 month old to get in). So, I would recommend registering at a number of daycares before having a child, in some cases I was told that people register when they first start trying to get pregnant.
When I looked for daycares in the suburbs west of Toronto, I called about 18-20. I am still receiving phone calls from daycares, not even that I would be at the top of the list, but that they are checking who is still actively on the list. From the 18-20 daycares in my area that I called, I was very lucky and a spot suddenly freed-up in about 2 months, I happened to be available when they called and take the spot right away. I did not receive another phone call that there is actually a spot available at one of the daycares until  about six months later and none since. The other option is home care and placements are more readily available there, but one has to trust the care giver that she will not run her errands and clean her house while taking care of your child. We did try this option while waiting for a daycare spot and did like the care giver, as did our child, but were concerned that all day is spent with much younger children and that our child may need interaction with someone her age and age-appropriate learning experience.
On the other hand, the current daycare center my child attends seems very stressful for the children. Often the little toddlers are in the hallway, all crying, while being rounded-up by an overwhelmed worker, to go to the yard. This stresses the older kids coming in, who then go from happy to distressed, crying and not wanting to separate from the parents. It seems disorganized and I am not particularly happy with the daycare, but given the shortage of daycare spaces, what choice does one have. At least in the suburbs the daycare playgrounds are not at a busy intersection. It made mi cringe every time I though of my child playing during the day steps from cars on two sides of the daycare play yard. There should be a law setting a minimum distance of a playground from a busy road. During traffic, i.e. most of the day in Toronto, the streets were full of bumper to bumper traffic. And this was supposed to be one of the "better" daycares in Toronto. It was actually about a third more expensive than most daycares, with special attention to languages and education, which was fine, but we chose it only because we couldn't find a space anywhere else (ok, we did find one, but the yard was pure concrete and there were graffiti on the wall).
Costs: in suburbs daycare costs about $41-$45 per day. I never got a call from the $41/day, I assume those spots are extremely hard to come by. In Toronto it used to be about $55/day or more, but lately I am being told that the prices are more in the range of $60-$75/day. Not sure how accurate that is.

Grade School options – Public or private
Private:
Private costs about $1,100 per month plus after-school care, which totals about $1,700. From my experience with the private system, there is a wide range in the quality of education these schools provide. I find it difficult to rate them, since the information obtained in an interview is of little use. Best is to look around, if most pre-teens wear their skirts extremely short, one can make a judgement about the focus of the students and of the school. Did they participate in science competitions? The odd student doesn't count (credit parents in that case), good portion of a science class should be involved. The education is not "easier", as suggested by some public school proponents, by no means. For the most part the children do extremely well on the provincial tests, mainly because they do get more attention and better resources. Retrospective look at individuals I know who have gone through the public vs. the private system, the private system alumni seem to have done very well in life and not necessarily because their parents are well off. There is usually much more involvement by the staff in training the children to be responsible, goal-oriented individuals and to complete their work, which are important skills in life. The schools themselves were usually well organized.

The other option is catholic or public, which are pretty much the same thing, except for the religious component. We chose public due to finances and we will wait and see what our experience with the public system will be.

Public:
Registration went smoothly enough. The only drawback is that you fall within a catchment area of a school and that is your only choice, regardless of the quality of education within that school.
The bus information was supposed to be available on August 25th, but the bus website, which was supposed to list the bus routes was still blank on the 26th. The lists which were supposed to be posted at the school, of course, were not there when I passed by the next morning. The school office informed me that they “aim” for the date, but things often don’t happen until much later.

After-school care. That is still an open issue, a week before the school starts and the person responsible is "on training" until two days before the first day of school, so I will have to wait an see if anyone gets back to me at some point. If you wonder why I still don't have after-school, it took since about March to sort out where our child will go. From my previous experience, the after-care is usually full and parents aren’t given any other option but to either hire someone or to work part-time in order to be home early when the child is dropped off. The school ends at 3:45pm. In Toronto, a friend of mine had her daughter attend a school far from their house just because no school in their area had after-care spaces (how she got her daughter into a school not in their catchment area, I don’t know). It took from junior kindergarten until Grade 2 before she reached the top of the list (3 years) and even then she only got in partly due to luck. Another friend waited from senior kindergarten until Grade 4, having to hire a High School student to watch her daughter.