A different perspective on health

TheStar.com – Atkinson – A different perspective on health
November 07, 2008. Carol Goar

Because he is only Ontario’s “acting” medical officer – and he’s a self-effacing guy – David Williams doesn’t have much of a public profile.

But the genial epidemiologist, who stepped into the breach two years ago when Sheela Basrur resigned to battle the cancer that would eventually claim her life, is worth getting to know. He is not a by-the-books doctor. Nor is he a cautious provincial bureaucrat.

After completing medical school at the University of Toronto, Williams headed to Northern Ontario to be a fly-in doctor, serving remote aboriginal communities.

He quickly learned that medicine doesn’t have all the answers. He remembers one case of an aboriginal family whose boat capsized on the way home from hunting camp. All four children died in the accident, despite their parents’ frantic efforts to save them.

The stricken couple, who had attempted suicide several times, was brought to Williams. He knew that neither drugs nor conventional psychiatry would work. There was nothing in his black bag to provide relief.

So he turned to native elders. He found out as much as he could about the tragedy and its aftermath, then sought their advice. “Send them to the medicine man.”

Williams followed their counsel. A year later, he visited the reserve. The couple was living under a different name. The medicine man had taken away their old identity, releasing them from the past. Everyone in the community accepted their new status.

For the young doctor, it was a powerful demonstration of the difference between health and medicine.

Next Williams went to Nepal to serve as director of the United Mission Hospital. He spent eight years there.

There, too, he learned about the delicate balance between health care and community support.

He recounts one particularly poignant story. A farmer from a remote village came to the hospital with his desperately ill wife and a flock of children.

A few tests were enough to confirm Williams’s fears. The woman had an advanced brain tumour. There were no facilities in the region capable of performing the high-risk surgery she needed. The cost of sending her to a big-city hospital was far beyond her husband’s means.

“Have you planted your crops?” Williams asked.

The man said he hadn’t. He was poised to sell his land – sacrificing both his standing in the community and his children’s prospects – to pay for his wife’s treatment.

“Go home and plant your rice,” Williams told him. “Nothing can be done for your wife. Keep her as comfortable as you can.”

Medically, it was a white lie. Morally, it was the right choice. The man and his children needed to be part of a strong, cohesive community.

Williams came back to Ontario in 1990 and was appointed medical officer of health for the Thunder Bay region. He returned to his old specialty: communicable diseases. He rose through the ranks, becoming associate chief medical officer of Ontario by 2005.

But the lessons he had learned stayed with him. They are especially relevant in his current role, Williams says. He is acutely aware of the need to address the root causes of illness and disease.

The big three are poverty, isolation and hopelessness, he says.

By poverty, Williams means more than lack of money. “Poverty and poorness are not the same. Poverty is much harsher. It is a disconnected place from which there is no escape.

“People can move from poorness to independence or deeper into poverty. When community supports are there, they have a much better chance of staying out of debilitating poverty.”

Income, affordable housing and children’s benefits are important too, of course, Williams says. But what is too often forgotten is how lonely poverty can be.

It is a shame the province’s chief public health officer is only asked to comment if there is a food recall, an infectious disease outbreak or a tainted water scare.

He has so much more to say.

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