In her latest blog update, Helena shares her time with the teams in Toronto. To follow along with her earlier blogs:
Waking up on my last morning in Vancouver to find that my flight to Toronto had been cancelled and scheduled for four hours later was a bit frustrating. Canada is such a vast country, 2088 miles later and a 4.5 hr flight, and time difference of 3hrs meant that I landed at Toronto airport at 2am in the morning. Plans changed quickly, I stayed overnight at the airport, caught up with some plane spotting the next morning before I made my way into Toronto.
First impressions of Toronto: it was a big city, with a traffic problem and loads of construction. Although the view from my apartment was fairly awesome, especially the helipad!
Toronto is in the province of Ontario, situated on the north-west shore of Lake Ontario, approximately three times bigger than British Columbia, with 15.6 million population. Toronto region is the largest region in Ontario at just under 6000 km sq, with about 6.5 million population. However, about 3 million of the population live in the dense heart of Toronto city (640 km sq).
Ontario has a multi diverse population and it is estimated that there are over 200 languages spoken across the province. This in itself presents major challenges when communicating and trying to meet the needs of children with life-limiting conditions and their families. There are four Children’s Hospitals in Ontario – in London, CHEO (Childrens Hospital Eastern Ontario) in Ottawa, McMaster in Hamilton and SickKids in Toronto.
On my first morning I spent the morning with Dr Kim Widger, Associate Professor at the Lawrence Bloomberg Faculty of Nursing at University of Toronto. In addition to her university work, administrative and management position as Associate Dean, Kim also holds the position of Canada Research Chair Tier 2 in Paediatric Palliative Care and has a wealth of publications and research experience. I was able to listen to her lecture to undergraduate final year students.
Later that day I visited Emily’s House, a ten bedded children’s hospice, opened in 2013. Everything about the hospice is ultra modern, flexibility is key with space and rooms adapted to meet the needs of the families staying there. Whilst only 2kms from downtown Toronto, children at the hospice can enjoy the public park next door and the well-maintained green-space garden. The staff are committed to supporting families as best as they can, as well as traditional respite, parents can use one of the flexible spaces for a ‘date night’ whilst their child is being looked after downstairs. Cookie dough is always on hand to quickly bake in the oven creating a homely smell and environment for any new parents dropping in to look around the hospice.
Many of the children are referred to Emily’s House for care from the SickKids Hospital where Dr Adam Rapoport is the Medical Director of Emily’s House and the Paediatric Advanced Care Team Programme at the hospital (PACT).
In 1986 SickKids was one of the very first paediatric institutions worldwide to offer palliative care for children and their families. Over the years, palliative care at SickKids has gone through various phases, but a number of dedicated staff have maintained an ongoing service until the present day. In 2011, the first Medical Director was appointed to the team and by 2012, the Paediatric Advanced Care Team (PACT) was officially born. Today, PACT consists of a multi-disciplinary group of health care professionals who provide a full range of palliative and bereavement care services hospital-wide and throughout the community.
Arriving at the hospital which takes up a whole block, you can see why when the current hospital opened in 1951 with 400+ beds dedicated to children it was considered one of the top health care institutions in the world. The inside atrium with its glass roof is bright and airy, the glass elevators rising in the middle of the atrium taking families to the nine storey 572 beds available across all specialities.
A pedestrian bridge connects the hospital to the brand new Patient Support Centre across the road to house the many professionals working in the hospital. Staff working as part of the PACT programme and the Complex care programme are housed on floor 11, a space providing high level technology workspaces, individual areas, modern kitchens, bright airy spaces for collaboration and sharing.
The current PACT Team is a nurse led service. Two clinical nurse specialists, described as the linchpin for the service, run the service across two teams A, B – defined by specific disease or area eg Leukaemia, NICU, cardiac. Developed first across the Greater Toronto area but soon to be replicated provincially across the other palliative care centres in Ontario, at McMaster, Ottawa, London and Kingston (once a team have been established. Care is delivered primarily in the community by adult physicians (experienced and trained in palliative and end of life care) with the support of the PACT team if needed.
On my first morning with the PACT team I was able to sit in on a PACT Round, virtual and face to face meeting with 20+ health care professionals. During the meeting a number of cases were discussed, including children who were inpatients at SickKids, those in the community, new referrals to the programme, in patients at the hospice and finally children who had died in the last week. Discussions were truly holistic, concentrating on the needs of the child and family, their goals of care, problem solving and accounting for the diverse backgrounds of families. ‘Candies’ helped the flow of discussion.
During the next few days I had the pleasure of spending time with other members of the team including Shaindy Alexander (Psychosocial support, Child Life Specialist), Sheila Atkinson and Lori Ives-Baine, (Grief support coordinators), Francis Macapagal (Clinical Nurse Specialist), Natalie Jewitt, (PACT Fellowship programme), Becca Williams (Nurse Pactitioner) and Dr Sarah Lord, (Lead for IMPACT (branch of PACT) – infant maternal perinatal advanced care team.
I had an amazing few days spending time with members of the PACT team and really appreciating a very different model and approach from what I saw in British Columbia. All staff were very experienced and provide a range of amazing support, opportunities for families and children. For those of you who I didn’t get to meet individually, thank you for your welcome and hospitality. I especially loved the Virtual Reality! I can honestly say I went ‘home’ every night exhausted by all the learning.
Watch out for my last and final blog coming soon when I met the Complex care Team in Toronto.
