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"The Basketball Game" is a graphic novel adaptation of the award-winning National Film Board of Canada animated short of the same name – intended for audiences aged 12 years and up. It's a poignant tale of the power of community as a means to rise above hatred and bigotry. In the end, as is recognized by the kids playing the basketball game, we're all in this together.

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Tag: Michael Klein

Stories with a message

Stories with a message

Michael Klein recently had his first book published. (photo from Michael Klein)

Dr. Michael Klein has published almost 200 scientific articles. Earlier this month, he launched his first book, Dissident Doctor: Catching Babies and Challenging the Medical Status Quo (Douglas & McIntyre).

Klein, who, with his wife Bonnie, splits his time between Robert’s Creek and Vancouver, is professor emeritus of family practice at the University of British Columbia, adjunct professor of family practice McGill University in Montreal and senior scientist emeritus at B.C. Children’s Hospital Research Institute. He was recognized as a member of the Order of Canada in 2016 for playing “a vital role in placing maternity care at the heart of family medicine.”

Klein has had a significant impact on the way the Canadian medical system has come to view midwifery and he played a prominent role in midwives becoming part of the healthcare system, first out east and later in here in British Columbia.

“I’m on the board of Canadian Doctors for Medicare, an organization that is trying to save Medicare from various encroachments from private interests, including U.S. multinationals,” Klein told the Independent. “We are about improving and extending Medicare. We are not about justifying things as they are. But, we are very much unhappy with the way privatization is going, which is a solution that is worse than the disease.”

book cover - Dissident DoctorAbout his new book, Klein said, “It began as something that I was writing as stories for my children and grandchildren … and, it got out of hand.”

At it happened, publishers at Douglas & Macintyre heard Klein tell a few of these stories and wanted them made into a book.

Klein set about developing them thematically. “I had to find out what the storyline was,” he said. “It’s a great deal about birth, but it’s not a birth book, per se. In many respects, birth is a metaphor.

“It’s about birth, family practice, midwifery, social justice, and about improving our rather challenged healthcare system. At the same time, I’ve deliberately chosen stories that have a message. For example, there are stories about people who were not supposed to get better but did. Many of the stories are actually detective stories. What I mean by that is that I try to make the stories go beyond the actual patient issue…. In what context does this illness take place? ”

Klein feels this approach to storytelling makes the point that, to provide really good care, you need to understand the patient, the full breadth of their situation.

He hopes the book also serves as a primer on how to advocate for yourself and your family in the complex medical system.

“Misunderstandings and mistakes in the healthcare system are actually inevitable,” said Klein. “I talk a lot about advocacy and the importance of making sure that, if things don’t seem right, they probably aren’t right.

“Because of my involvement with Canadian Doctors for Medicare, the whole issue of privatization is explored. For me, I have a special need to express this, because I’m in a unique position. I’ve practised in Canada before Medicare. I’ve practised in the States and ran health centres without Medicare – that wasn’t a lot of fun. And, I’ve practised back in Canada with Medicare.”

The main point Klein wants to impress upon readers is that humane, holistic care in the context of a person’s whole life is the ideal. “I am not putting this out as a dispassionate physician-scientist, but as somebody who really understands the big picture and can situate the patient or the system within a very large context of where we are going as a society,” he said.

The book is almost completely free of medical jargon, although it deals with complicated issues. Klein said the book is equally accessible to medical trainees, people in the profession and to the general public.

The stories he chose, the themes he discusses and the politics, he hopes, will be easily understood by anyone who has ever encountered the healthcare system. “Not just pregnant people and their partners, but anybody; also family physicians, midwives, obstetric nurses, dulas,” he said.

Klein showed the manuscript to people in all these categories, and, he said, “it seems to work for them.”

The feedback Klein has been getting is that people love the book’s advocacy stories. He even includes his wife’s experiences following a series of strokes, when she was told she was inoperable and would die. A surgeon in London, Ont., saved her life.

“There are a series of stories of my patients and other peoples’ patients who defied the odds, and where patient advocacy has been absolutely essential,” said Klein. “Whether they are physicians or laypeople, they became engaged in the right way with the health providers and improved their outcome.

“People relate to that very strongly, regardless of whether they are patients. The experiences they’ve had when their children, spouse or parents were sick and, either they were sidelined by the system or they embraced by the system. It varies enormously with who is providing the care and what their attitudes are. I cover that in the book.”

Other stories in the book tell of how Klein battled with the U.S. army and avoided going to the Vietnam War.

He also delves into his strong support for midwives. “People wondering if home birth is safe are very interested in that section,” said Klein. “Home birth is clearly safe. However, safe in the right kind of system, with the right kind of supports and back up. In other words, an integrated system like we have in British Columbia, as opposed to the chaos of the U.S.”

The launch event for Dissident Doctor took place in Toronto on Oct. 9.

Rebeca Kuropatwa is a Winnipeg freelance writer.

 

Format ImagePosted on October 26, 2018October 25, 2018Author Rebeca KuropatwaCategories BooksTags health care, Medicare, Michael Klein

Safety in home births

With only about five percent of Canadians giving birth at home, one might think the practice is dangerous and that is why the number is so low. On the contrary. Studies show that, as long as the mother is at low risk, it is as safe to give birth at home as it is to give birth in a hospital.

Dr. Michael Klein is a family physician, pediatrician, newborn-intensive-care specialist, maternity care researcher and senior scientist emeritus at Vancouver’s Child and Family Research Institute.

“I am a part of a number of ongoing research projects,” said Klein. “We look at old and new technologies and assess them in relation to birth. I’m about normal birth – not complicated birth – keeping birth normal.”

photo - Dr. Michael Klein
Dr. Michael Klein (photo from Dr. Michael Klein)

In 2009, Klein worked on a study that looked at the safety of home births, evaluating three groups of births: home births by a midwife, hospital births by the same midwives, and a matched sample of physician births. The researchers looked at women who were identical in their risk profile and found that, regarding fetus development and the newborn baby, there was no difference in these three groups.

“Home birth seemed to be as safe as hospital birth, whether by the doctor or by the same midwife,” said Klein. “There are now two other studies from Ontario that show the same thing.

“Home birth is integrated within the health-care system in B.C.,” he continued. “Midwives are supported and part of the system, so when the midwife needs help from a hospital backup system, she gets it.

“Of course, what you also see is dramatically more interventions on the physician-hospital side than at home. And you find, interestingly, that the midwives – the same midwives delivering in hospitals – have results in terms of interventions of various sorts that are closer to the doctor’s side than they are to themselves at home.”

Klein attributes this observation to the influence of the hospital itself, a setting that is anxiety-driven. There may also be differences in the population, with women wanting a midwife in a hospital differently motivated from those wanting a midwife in a home setting.

In terms of the methodology of the study, it was very important that, once a woman was beginning her labor at home, no matter if the birth ended up being in a hospital or not, that she was counted in the home birth column or category.

“Roughly, a third of midwifery births will be home births,” said Klein. “That’s because this is what women are requesting. The model is what is called a ‘woman-centred model.’ If a woman wants a home birth and she meets the criteria in terms of her risk profile, then the midwife is obligated to deliver that service in the way she wants.

“I think there’s no question that we should have more home births. You may be unaware, but the minister of health in B.C. has supported that notion – that home births should be … I wouldn’t say promoted, but certainly made available.

“Women need to know what the options are and they need to know if they need help during labor that they will get it. A home birth, to be safe, needs to be within 30 minutes of an operating room. Contrary to what most people believe, things don’t suddenly go wrong. They evolve.”

Something else that can be a limiting factor in increasing home birth numbers is the lack of midwives across Canada.

“The joke is that you have to register with a midwife before conception,” said Klein.

In British Columbia, the midwifery class recently doubled in size. Why not quadruple the class size to keep up with demand? The simple answer is that the system is not currently able to support that, although it is estimated that a home birth costs the system between a third and half as much as a hospital birth.

“I think it’s too complex,” said Klein. “What we are talking about now is a serious planning exercise. That’s not happening. I think it will take time for the system to collapse a little bit more before it happens.

“The other player in all of this, which we haven’t talked about yet, is the doula. That movement is, of course, gaining more and more popularity. In some settings, it’s been so successful that some hospitals are supporting the doulas’ salaries.”

According to Klein, doulas are successful in lowering the caesarean-section rate and other interventions. “When you lower the c-section rate, it has a big impact on the hospital budget, because a person who has a caesarean stays twice as long in the hospital than one who has a vaginal birth,” he said.

Avoiding a c-section means less likelihood of a uterine scar in subsequent pregnancies. “Once a pregnant woman has a uterine scar, the whole reproductive trajectory is changed,” said Klein. “One is more likely to have a whole series of problems, complicated next pregnancies, placental attachment problems, ectopic pregnancies, stillborn births and infertility. With the c-section rate at four percent in home births and up to 30% in hospital births, that many more women will end up with a uterine scar and be at higher risk of complications.”

photo - Dr. Brian Goldman
Dr. Brian Goldman (photo from Dr. Brian Goldman)

Dr. Brian Goldman, an emergency physician at Mount Sinai Hospital in Toronto, and the host of White Coat, Black Art on CBC Radio One, has, for years, had an eye on the growing demand among women in Canada for licensed midwives.

“Midwives are experts in low-risk, uncomplicated births, as are family doctors,” said Goldman. “However, even though low-risk birth is a core part of the training of family physicians, very few of them want to attend low-risk births once out in practice.

“In Canada, we have a situation in which the vast majority of births – high-risk and low-risk alike – are attended by obstetricians. These specialists have tremendous knowledge, skill and experience which, in my opinion, is best put to use managing women who are likely to have a complicated pregnancy and birth. We need more professionals like midwives and family doctors to attend low-risk births.

“Most family doctors run busy practices and find it difficult for practice, family and social reasons to devote a significant amount of time to attending women in labor through the night. To me, midwives represent the likeliest prospect for increasing the pool of professionals qualified and interested in attending low-risk births.”

Rebeca Kuropatwa is a Winnipeg freelance writer.

Posted on February 26, 2016February 25, 2016Author Rebeca KuropatwaCategories NationalTags Brian Goldman, Child and Family Research Institute, doula, home birth, Michael Klein, midwife, pregnancy
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