Two-year-old Hallie Thiessen with her mother, Cari-Lynn Thiessen and older sister Addison at their home in Steinbach, Man. on Dec. 10, 2020.Shannon VanRaes/The Globe and Mail
Two-year-old Hallie Thiessen scoops up a chunk of ice from the front yard of her home in Steinbach, Man., and puts it in her mouth. Since being diagnosed with eosinophilic gastrointestinal disease, ice is all she can eat.
Cari-Lynn Thiessen describes the yard as her daughter’s “buffet” only half-jokingly as a neighbour pulls over to ask how the pair is faring. The toddler’s rare diagnosis is characterized by adverse reactions to all food, a compromised immune system and inflammation of the entire gastrointestinal tract.
A permanent gastrostomy tube into her stomach would free Hallie and her parents from the constant struggle to provide nutrients and medication through a temporary, external feeding tube, but the surgery – deemed elective by the province – has been cancelled three times.
“If anyone could see what it’s like to have to pin down your two-year-old, literally have two people holding her down, while you go and shove a little feeding tube into her nose and down into her stomach while she’s screaming – it’s horrible and she’s gagging and often throws up – if they could see what we have to do, they would not deem a G-tube surgery as elective,” the mother of two said.
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Thousands of operations have been postponed in Manitoba, first as the province tried to prevent the spread of COVID-19 into hospitals, and now as resources are relocated to treat patients with the disease. Shared Health Services Manitoba, a provincial health care co-ordination agency, reported that about 7,000 procedures were cancelled during the pandemic’s first wave, including 5,300 in Winnipeg, although those numbers exclude pediatrics and endoscopies.
Quantifying the impact of COVID-19′s second wave is challenging.
“We stopped reporting the cancelled surgeries because it wasn’t really reflective of the actual numbers that we would have,” said Lanette Siragusa, chief nursing officer for the province. “The surgeons know that we have decreased services, so they’re not booking.” About 2,300 elective and non-urgent adult operations have been cancelled provincewide since rising case numbers began affecting hospital capacity in late October. The number of pediatric operations has fallen by 32 per cent over the duration of the pandemic, Shared Health said.
Information compiled by the Canadian Institute for Health Information suggests the total number of pandemic-related cancellations in Manitoba is about 12,000.
Eric Bohm, an orthopedic surgeon and director of health systems performance at the George and Fay Yee Centre for Healthcare Innovation, said calling surgery elective is almost misleading. “It should be a term like ‘restorative’ or something like that to really reflect the amount of change they have on a patient’s life,” he said.
Surgery defined as elective can include cancer treatment, fracture repair and cardiac procedures. In children, non-urgent operations include reconstructive surgery for birth defects, growth or congenital abnormalities, and trauma.
Erik Skarsgard, chief of surgery at BC Children’s Hospital and professor of surgery at the University of British Columbia, said pediatric procedures are often linked to a child’s growth and development. “There’s a window of time where your outcomes would be optimized,” Dr. Skarsgard said. “So you can appreciate that a delay in surgery could have some impact on the functional outcome of that child.”
Success of childhood interventions has a major effect on long-term quality of life, including the ability to fully participate and contribute to society, he added.
A Deloitte study commissioned by the Canadian Medical Association found an additional $1.3-billion is needed to bring waiting lists for six key procedures – coronary bypass, cataract surgery, hip and knee replacement, and MRI and CT scans – down to pre-pandemic levels nationwide. That research pegged Manitoba’s share of the burden at $68-million as of October, before the current surgical slowdown.
The province contracted two private and three public health facilities at a cost of $2.5-million to help address the issue in August; to date they’ve completed 826 additional procedures.
“I hope that our provincial and Shared Health leadership will be committed to addressing these waiting lists and these backlogs once this pandemic settles down,” Dr. Bohm said. “They are terribly busy with this pandemic and delivering care, I understand that, but eventually, they will have to shift their focus.”
That means finding creative solutions, fine-tuning patient flow through operating rooms, shorter hospital stays, continued use of virtual consultations and other measures, he said.
For the Thiessen family, the backlog can’t be addressed soon enough. Specialized clinics that assist in Hallie’s care are closed, resulting in frequent trips to the emergency room. Both mother and daughter are now recovering from COVID-19.
Had the province used the virus’s summer lull more effectively, Ms. Thiessen believes the surgical glut could have been greatly reduced, along with the suffering of many Manitobans.
“There’s no handbook on how to lead a province through a global pandemic, but I just feel like Hallie is being lost a little bit again and that’s really discouraging,” she said. “I’ve met so many other parents to chronically ill children and the stories that I’m hearing are absolutely heartbreaking.”
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