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Dr. Isra Levy became the city’s top public-health doc a decade ago, amid an ugly public dispute over giving out clean needles and crack pipes to drug users.
Levy’s predecessor Dr. David Salisbury all but stomped off the job after just a couple of years, exasperated by politicians who insisted on putting politics ahead of science. Salisbury insisted harm-reduction programs like clean needles kept diseases from spreading and kept people alive. Politicians wanted one-for-one needle exchanges, which scientific evidence didn’t support, and voted to kill a clean-pipe program.
“I arrived in a storm, certainly,” Levy says.
Now Levy’s talking about his own impending departure in a borrowed office a few metres from the health unit’s new supervised drug-injection site. The two-stall site was rigged up in a weekend this fall, shoehorned into a warren of cubicles and medical rooms on the first floor of a public-housing building on Clarence Street.
Half the space is the unit’s sexual-health clinic, half is a needle-exchange and centre for people who use drugs. They put in the two carrels for supervised injecting over a weekend; one wall, separating the carrels from a back hallway connecting the two clinics, is just a curtain with handwritten signs on it warning passing staff to respect users’ privacy: “NO PEEKING.”
A machine outside the building dispenses packs of needles to clients who’ve been given tokens for them. Things have changed in 10 years.
“My pride in this kind of service is total,” Levy says, pointing down the corridor. Health professionals meeting people in need where they are, caring for them without judging them. “Being here where the work is done is what energizes me.”
Kira Mandryk, a nurse at the new interim supervised injection service (SIS) in Ottawa, sorts through medical supplies.
And yet it’s not public-health work at its very best. “Ideally, the services would be very rarely used,” Levy says. “The endpoint isn’t having them. The endpoint is not needing them.”
For now, with superpotent fentanyl and carfentanil tainting street drugs in Ottawa and poisoning users who can’t know the strength of the drugs they’re shooting, the health unit is sure supervised injection sites are services we need.
The health unit’s site has had about 1,000 visits in six weeks. Nobody has had to be revived from an overdose but eight people have been put on oxygen, kept awake and monitored closely until they were OK. Elsewhere, they’d have been naloxone-and-paramedics cases. Or they might have just died.
“It wasn’t Dave Salisbury and it isn’t Isra Levy who creates this discussion,” Levy says. “This is a societal discussion that we’re a part of. And the reason that some of these issues galvanize attention in a historical context is that they’ve challenged the prevailing societal norm, and perception of what is the norm and what is acceptable for the community.”
Once upon a time, public-health officers contributed scientific and medical perspectives to tense discussions about birth control and sex education.
“They’re issues that are at the interface of our personal beliefs, our perceptions of morality, our perception of greater forces than humans — religion comes into it, science, the debate between science and religion comes into it. All of it to say that I think that in public health, we end up at the cutting edge of the things that society is grappling with,” Levy says.
To a public-health doc, these things often seem easy: the literature on what promotes health and saves lives can be pretty straightforward. But scientific certainty sometimes comes across as pigheadedness to people who don’t agree.
“The political representatives of the community represent that cross-section of views. Sometimes our conviction in what seems right isn’t winning the day in a discussion because other things are coming to bear and we just have to understand what those other things are and keep making the case,” Levy says.
How to help people who use drugs is a set of big questions that have bookended Levy’s tenure. The health unit also handles everything from restaurant inspections to anti-tobacco efforts to breastfeeding supports for new moms. It chased down tainted beef that sickened kids whose parents ordered food for them at school; it investigated an endoscopy clinic with bad decontamination practices; it shut down unqualified medical practitioners. Early in Levy’s run, in 2009, the unit stood up to an emergency vaccine campaign against the dangerous H1N1 flu virus.
The public showed up at the Kanata Recreation Centre as early as 2 a.m. one day in October 2009, to start the wait for a bracelet to get the H1N1 vaccine.
Above all, the health unit simply tries to help people live healthier lives. Collectively, we drink too much, eat too much, exercise too little. It’s making us sicker than we need to be.
“When you’ve been doing this job 10 years, I mean, it’s really obvious,” Levy says. “The hard thing is knowing what to do about it.”
We can warn people away from drugs — most people don’t take opioids, or only for limited medical reasons. But we all have to eat. There’s social pressure on our diets and drinking habits. We have demands on our time that make fitness hard.
Levy’s vulnerable to all this himself. He laments his own weight and fitness.
“I’ve got a sweet tooth. I can’t beat that,” he says. “My behaviour around chocolate in many respects mirrors addiction behaviour. I think science is going to tell us stuff in the future about addictive behaviours, addictive patterns.”
A headhunter recruited Levy for his new job at Canadian Blood Services, which he’ll start early next year.
A phlebotomist holds a unit of blood after a donor had blood taken from him in Ottawa in 2013.
Inconveniently, he was interviewing and thinking about the job at the same time as the health unit was struggling with the renewed push for supervised injection sites. He went for a first interview out of curiosity and it piqued his interest; by the time they asked him in for a second, he’d decided he wanted the job.
“I had, I have to be frank, a mini existential crisis,” he says. “I expect I have 10 years left in the workforce, so it started off from the perspective of, ‘What am I going to be doing for the next 10 years?'”
As vice-president of medical affairs at the blood agency, he’ll be dealing with everything from “vein to vein” in the blood-donation process, from who can donate to how blood products are processed and distributed. Demand is going up and supply isn’t. His ambit includes donations from men who’ve had sex with men, paying plasma donors, and increasing organ-donation rates. Canadian Blood Services keeps donor and recipient registries and co-ordinates among provinces.
“The scope is just tremendous,” he says, and it’s at a globally renowned agency.
The new job also pays a bit better. Levy’s $300,000-plus salary puts him at the top of Ottawa’s list of highest-paid employees. That’s common for top public-health docs. MDs with epidemiology expertise, political sense and the capacity to manage $50-million budgets aren’t sitting around with nothing to do. But they’re ultimately paid like high-end public-sector managers. At CBS Levy will be paid like a senior hematologist.
It’s not about the money, he says, turning a bit pink. “At my level of remuneration — it’s enough. More is nice, but it’s enough.”
After 10 years, the health unit deserves a new leader anyway, he says, especially now that the same issues are coming around again.
Ottawa’s acting medical officer of health, Dr. Vera Etches.
Levy is being replaced temporarily by his deputy, Dr. Vera Etches. She has the package of scientific chops, managerial skill and work ethic to take over permanently, Levy says. Unlike him, he says, she can “cut to the chase in a dialogue.”
Levy slid into the job in a similar way, filling in after his former boss quit and impressing so much so quickly that city council scrapped a competition. How Levy’s permanent successor will be chosen is up to the board of health, a decision it’ll likely make in the new year.
dreevely@postmedia.com
twitter.com/davidreevely
查看原文...
Levy’s predecessor Dr. David Salisbury all but stomped off the job after just a couple of years, exasperated by politicians who insisted on putting politics ahead of science. Salisbury insisted harm-reduction programs like clean needles kept diseases from spreading and kept people alive. Politicians wanted one-for-one needle exchanges, which scientific evidence didn’t support, and voted to kill a clean-pipe program.
“I arrived in a storm, certainly,” Levy says.
Now Levy’s talking about his own impending departure in a borrowed office a few metres from the health unit’s new supervised drug-injection site. The two-stall site was rigged up in a weekend this fall, shoehorned into a warren of cubicles and medical rooms on the first floor of a public-housing building on Clarence Street.
Half the space is the unit’s sexual-health clinic, half is a needle-exchange and centre for people who use drugs. They put in the two carrels for supervised injecting over a weekend; one wall, separating the carrels from a back hallway connecting the two clinics, is just a curtain with handwritten signs on it warning passing staff to respect users’ privacy: “NO PEEKING.”
A machine outside the building dispenses packs of needles to clients who’ve been given tokens for them. Things have changed in 10 years.
“My pride in this kind of service is total,” Levy says, pointing down the corridor. Health professionals meeting people in need where they are, caring for them without judging them. “Being here where the work is done is what energizes me.”
Kira Mandryk, a nurse at the new interim supervised injection service (SIS) in Ottawa, sorts through medical supplies.
And yet it’s not public-health work at its very best. “Ideally, the services would be very rarely used,” Levy says. “The endpoint isn’t having them. The endpoint is not needing them.”
For now, with superpotent fentanyl and carfentanil tainting street drugs in Ottawa and poisoning users who can’t know the strength of the drugs they’re shooting, the health unit is sure supervised injection sites are services we need.
The health unit’s site has had about 1,000 visits in six weeks. Nobody has had to be revived from an overdose but eight people have been put on oxygen, kept awake and monitored closely until they were OK. Elsewhere, they’d have been naloxone-and-paramedics cases. Or they might have just died.
“It wasn’t Dave Salisbury and it isn’t Isra Levy who creates this discussion,” Levy says. “This is a societal discussion that we’re a part of. And the reason that some of these issues galvanize attention in a historical context is that they’ve challenged the prevailing societal norm, and perception of what is the norm and what is acceptable for the community.”
Once upon a time, public-health officers contributed scientific and medical perspectives to tense discussions about birth control and sex education.
“They’re issues that are at the interface of our personal beliefs, our perceptions of morality, our perception of greater forces than humans — religion comes into it, science, the debate between science and religion comes into it. All of it to say that I think that in public health, we end up at the cutting edge of the things that society is grappling with,” Levy says.
To a public-health doc, these things often seem easy: the literature on what promotes health and saves lives can be pretty straightforward. But scientific certainty sometimes comes across as pigheadedness to people who don’t agree.
“The political representatives of the community represent that cross-section of views. Sometimes our conviction in what seems right isn’t winning the day in a discussion because other things are coming to bear and we just have to understand what those other things are and keep making the case,” Levy says.
How to help people who use drugs is a set of big questions that have bookended Levy’s tenure. The health unit also handles everything from restaurant inspections to anti-tobacco efforts to breastfeeding supports for new moms. It chased down tainted beef that sickened kids whose parents ordered food for them at school; it investigated an endoscopy clinic with bad decontamination practices; it shut down unqualified medical practitioners. Early in Levy’s run, in 2009, the unit stood up to an emergency vaccine campaign against the dangerous H1N1 flu virus.
The public showed up at the Kanata Recreation Centre as early as 2 a.m. one day in October 2009, to start the wait for a bracelet to get the H1N1 vaccine.
Above all, the health unit simply tries to help people live healthier lives. Collectively, we drink too much, eat too much, exercise too little. It’s making us sicker than we need to be.
“When you’ve been doing this job 10 years, I mean, it’s really obvious,” Levy says. “The hard thing is knowing what to do about it.”
We can warn people away from drugs — most people don’t take opioids, or only for limited medical reasons. But we all have to eat. There’s social pressure on our diets and drinking habits. We have demands on our time that make fitness hard.
Levy’s vulnerable to all this himself. He laments his own weight and fitness.
“I’ve got a sweet tooth. I can’t beat that,” he says. “My behaviour around chocolate in many respects mirrors addiction behaviour. I think science is going to tell us stuff in the future about addictive behaviours, addictive patterns.”
A headhunter recruited Levy for his new job at Canadian Blood Services, which he’ll start early next year.
A phlebotomist holds a unit of blood after a donor had blood taken from him in Ottawa in 2013.
Inconveniently, he was interviewing and thinking about the job at the same time as the health unit was struggling with the renewed push for supervised injection sites. He went for a first interview out of curiosity and it piqued his interest; by the time they asked him in for a second, he’d decided he wanted the job.
“I had, I have to be frank, a mini existential crisis,” he says. “I expect I have 10 years left in the workforce, so it started off from the perspective of, ‘What am I going to be doing for the next 10 years?'”
As vice-president of medical affairs at the blood agency, he’ll be dealing with everything from “vein to vein” in the blood-donation process, from who can donate to how blood products are processed and distributed. Demand is going up and supply isn’t. His ambit includes donations from men who’ve had sex with men, paying plasma donors, and increasing organ-donation rates. Canadian Blood Services keeps donor and recipient registries and co-ordinates among provinces.
“The scope is just tremendous,” he says, and it’s at a globally renowned agency.
The new job also pays a bit better. Levy’s $300,000-plus salary puts him at the top of Ottawa’s list of highest-paid employees. That’s common for top public-health docs. MDs with epidemiology expertise, political sense and the capacity to manage $50-million budgets aren’t sitting around with nothing to do. But they’re ultimately paid like high-end public-sector managers. At CBS Levy will be paid like a senior hematologist.
It’s not about the money, he says, turning a bit pink. “At my level of remuneration — it’s enough. More is nice, but it’s enough.”
After 10 years, the health unit deserves a new leader anyway, he says, especially now that the same issues are coming around again.
Ottawa’s acting medical officer of health, Dr. Vera Etches.
Levy is being replaced temporarily by his deputy, Dr. Vera Etches. She has the package of scientific chops, managerial skill and work ethic to take over permanently, Levy says. Unlike him, he says, she can “cut to the chase in a dialogue.”
Levy slid into the job in a similar way, filling in after his former boss quit and impressing so much so quickly that city council scrapped a competition. How Levy’s permanent successor will be chosen is up to the board of health, a decision it’ll likely make in the new year.
dreevely@postmedia.com
twitter.com/davidreevely
查看原文...
