Winnipeg Free Press

Winnipeg Free Press (Newspaper) - January 31, 2025, Winnipeg, Manitoba THINK TANK COMMENT EDITOR: RUSSELL WANGERSKY 204-697-7269 ● RUSSELL.WANGERSKY@WINNIPEGFREEPRESS.COM A7 FRIDAY JANUARY 31, 2025 Ideas, Issues, Insights Fixing health care requires more nurses T HE recent death of Chad Giffin, a 49-year- old man who experienced homelessness, de- mands our attention, as he had waited eight hours in the Health Sciences Centre emergency department. Alongside are concerns a Regional Health Authority board member’s resignation over “low balled” health budgets. It is not realistic to think the “fix health care” promise could be kept in the 14 months since the election, however that is enough time for a clear public plan that explains how we got here, steps to strengthen our public health-care system and ways to prevent further privatization. First, how bad is it? Manitoba’s record of the longest ER wait times in Canada is well docu- mented. In the ’90s, patients rarely waited more than two hours. Manitoba’s poor health indicators such as high rates of diabetes, chronic illness and poverty, including the lack of housing afford- able to people with low incomes, all place more demands on our system. Emergency departments are expensive shelters. In addition to these factors, Manitoba has the worst nursing shortage in Canada. Manitoba Nurses Union (MNU) reports about 13,000 union- ized nurses, with 20 per cent, or 2,449 nursing positions, vacant. As MNU president Darlene Jackson has explained, the crisis in access to medical services is largely a crisis in nursing supply. It took over 30 years to get to this point. Manito- ba, along with all other provinces in the early 90s, decided all new Registered Nurses (RNs) would need a four-year nursing degree. The two-year RN program was phased out, like the one-year Licensed Practical Nurse (LPN) program. All hospital and college-based RN training programs were terminated. However, the old two-year RN training seats were replaced with new bachelor of nursing seats on less than a one-for-one basis. With fewer nursing graduates each year, and the Manitoba population increasing, the nursing shortage worsened. Fast forward to 2016. The new Brian Pallister government “dusted off” the old two-year RN program, renamed it the new LPN program, and started training more LPNs. LPNs previously were restricted in where they could work and what they could do, but the new LPNs (trained for two years like the “old” RNs) could work almost everywhere while being paid much less. Regard- less of classification, Manitoba has still not been training and retaining enough nurses. To compensate for other Pallister government cuts, around 2017 mandatory overtime became common practice for nurses. Mandatory over- time is the root of the current problem. Imagine coming to work for an evening shift, then being “mandated” to work the night shift as well. In some cases, nurses are required to work two 12- hour shifts back-to-back. Mandatory overtime has driven many nurses to quit their public nursing job and work for private nursing agencies that do not require it. Mandato- ry overtime is driving nurses to private agencies, which charge double, triple or more compared to public nurse pay rates. This is costing our govern- ments a fortune, over $1.5 billion across Canada last year, according to a Canadian Federation of Nurses Unions report. The more “overtime mandating,” the more nurses are driven out of the public system, the more pressure to hire from private nursing agencies and the more expensive it becomes. If we want to fix health care and reduce wait times, the Manitoba government must reverse mandatory overtime and the use of expensive private nursing agencies with a transparent plan. Make all overtime voluntary. Increase float pools. Increase part-time positions which allows more nurses available for extra shifts, instead of private agency staff. Currently, only full-time positions are incentivized. Recruit nurses back into the public system who left for private agencies or left the profession entirely. Respect and support nurses. Listen to nurses, who know best how wards can run more effectively. Mentor new nurses. Reconsider ethically questionable incentives to recruit nurses from developing countries which have not been successful. Train more nurses! The most recent information obtained from MNU projected 981 nursing seats for 2022-23. Es- timates are that approximately 66 per cent grad- uate, according to the most recent 2022 nursing college reports. The College of Registered Nurses of Manitoba reported 443 new grad nurses, and the College of Licensed Practical Nurses of Man- itoba reported 170 new grads, which equals 613 new nurses in total. Approximately 400 additional nurse training seats were reinstated by the pre- vious government. Budget 2024 includes unspec- ified funding for more rural LPNs, possibly as part of $6 million allocated for additional medical specialists. That’s inadequate when considering the number of nurses leaving. MNU reports the number of nurses retiring or quitting from the WRHA/Shared Health was “150 to 250 per year between 2019 to 2022”. Estimating, with a shortage of 2,500 nurses, and graduating 600 nurses per year, minus 200 nurses leaving, nets an estimated 400 new nurses per year. At this rate, it would take more than six years to end the nurse shortage. That’s if more nurses don’t quit or go to private agencies. Promises like “fixing health care” and “ending homelessness” are big and related NDP election promises. These commitments require a clear and transparent plan with targeted investments, including addressing nursing shortages to reduce long wait times throughout the public system. Marianne Cerilli is a former Manitoba MLA. Trump’s actions hold consequences for us all AMIDST the blizzard of madness being un- leashed south of the border, news of Washington’s exit from both the World Health Organization (WHO) and the Paris Agreement were relegated to the second row in the theatre of the macabre. And while there has certainly been plenty to occupy media bandwidth of late, the effect of Trump’s decision to pull out of the WHO and the climate accord inked at COP-21 promises to be tumultuous and quite possibility catastrophic. When the most powerful economic and military power in the world so much as moves, the after- shocks are felt everywhere. At its core, this is an assault on global public health and climate survival efforts. Earth’s human population is still reeling from the impacts of the COVID-19 pandemic. Epidemi- ologists and infection disease specialists prom- ise that new pandemics and other public health crises are not only possible, but likely enough that system planning must treat them as near inevitable. Likewise, while laughable climate science deni- alism still circulates in the mainstream, anthro- pogenic climate change is now indisputably upon us. The once-vaunted 1.5-degree threshold — the tolerable warming above pre-Industrial Age av- erages identified by the Intergovernmental Panel on Climate Change — is now all but dead in the water. The scientific evidence for change span- ning the globe over and amassed over decades shows near unanimous consensus of profound environmental transformation. In a sense, Trump’s orders ending enrolment in Paris and the WHO are consistent. Threats to the climate and to public health are analogous to the extent that they are both existential and global. Furthermore, they are both closely inter-related; human health quite clearly depends on the health of the planet. Rejection of one dovetails seamless- ly with rejection of the other. Contrary to Trumpian thought (an admitted oxymoron), attempts to meaningfully manage these issues require action on a global scope, and international co-ordination is paramount. Nation states, beholden to their corporate mandarins — big pharma and the fossil fuel extraction sector are two prescient examples in this context — have proven largely unreliable and unwilling to provide effective policies when left to their own devices. Trump’s move is in keeping with his ruthless, selfish methodology, but also fits into a larger pattern — one that existed long before MAGA — of placing profit over well-being. Enter the people. The global citizenry must continue to apply pressure on governments to support global co-operation, such as collabora- tive relations on public health challenges. Direct action has also proven effective. Non-govern- mental actors — be they local or international — can have wide-ranging impacts when deployed appropriately. Inspiring and powerful stories of resistance and change emerge from regions the world over. What of those of us in rich countries like Can- ada? There has been much consternation over how to ‘handle’ Trump, a fruitless exercise which disregards how dangerous the normalization of this mindset has become. To make matters worse, the new American administration, in eschewing support for supranational entities like the WHO, emboldens like-minded governments and poli- ticians who may seek to chart a similar course. Pierre Poilievre comes to mind. But even without the absurdity that is Trump and his ilk, risks to public and planetary health have not been sustainably addressed. True, mobilization during COVID-19 was impressive in many jurisdictions. But the pandemic also revealed systemic fragility. The ensuing disarray amongst the Canadian health-care system is a stark example here at home. History teaches us that when society experi- ences a shock — and we are certainly witnessing shock on multiple levels — the volatility that follows provides opportunities for change amidst the carnage. What this change looks like is yet to be determined. History also tells us that ordinary people working together play a role in shaping the outcome. The tired trope, that we are all in this together, is nevertheless true to a certain degree. Ulti- mately, climate and health concerns are inter- connected, superseding national borders, as we saw with coronavirus and we continue to witness with warming trends. Yet, the privilege through wealth of rich countries like Canada means mit- igatory measures — at least in the short term — will provide a buffer to us not available to much of the planet’s population. Moral reasoning suggests that those who ben- efit from privilege — and through that privilege operate in centres of vast power — also hold an ethical accountability that necessitates support to others proportionate to the benefits privilege confers. Just as these problems are global, so too must be our response. For those not interested in satiating the irre- pressible greed of the American oligarchy and their global corporatist allies, another world is possible. While this may take imagination, resolve and hard work, the alternative — to acquiesce to the demands of a wealthy few — holds potential for unimaginable calamity. Epidemiological and climate pattern modelling depict massive and perilous challenges ahead. These are indeed unsettled times. Andrew Lodge is an assistant professor at the University of Manitoba and medical director of Klinic Community Health. Digging under the wall ON Jan. 10, a tunnel was discovered beneath the U.S.-Mexico border in El Paso. Two weeks before that, a tunnel was uncovered near Arizona, the third such tunnel found in the Yuma area within the past year. These latest discoveries reinforce a crucial lesson for the United States from conflicts worldwide: no matter how advanced, aboveground defences often drive adversaries to seek alternate routes underground. Across the globe — in Gaza, Lebanon, Syria, North Korea and other conflict zones — tunnels have served as vital conduits for cross-border operations. As he took office, President Donald Trump repeated his pledge to resume and com- plete construction of the U.S.-Mexico border wall — a project halted by President Joe Biden in 2021 — along the 1,954-mile boundary and signed an executive order allowing the deploy- ment of troops to the region. This renewed push at fortification with additional physical barriers and heightened security measures will almost certainly drive an increase in tunneling attempts. Israel provides a blueprint for dealing with such underground threats. After suffering years of cross-border attacks by Hamas through tunnels, Israel undertook a massive project to create an underground wall along its Gaza border, using advanced detection technol- ogies and engineering solutions. Aboveground, it reinforced the 40-mile Israel-Gaza border with a barrier that extends several feet under- ground and has proved effective at neutralizing Hamas’s cross-border tunnel operations. Similarly, Hezbollah has built and used tunnels in Lebanon and Syria, forcing Israel to constantly adapt its countermeasures. The United States and Israel have partnered for almost a decade on tunnel detection and an- ti-tunneling capabilities, but Washington is still playing catch-up in applying these lessons to its southern border. This needs to change. The discovery of another tunnel in Texas is far from an isolated incident. Since 1990, authorities have uncovered more than 230 cross-border tunnels, primarily for smug- gling drugs, weapons and people, along the U.S.-Mexico border. In January 2020, U.S. officials uncovered the longest known drug tunnel at the time, stretching three-quarters of a mile from Tijuana to San Diego. Many of these tunnels are remarkably sophisticated, featuring rail systems, ventilation and lighting. The cartels behind them continually refine their techniques, mirroring the tunnel warfare strategies employed by groups such as Hamas and Hezbollah. During Trump’s first term, more than 450 miles of border wall were constructed along the U.S.-Mexico border, replacing outdated or ineffective fencing with 30-foot steel barriers. These reinforcements significantly reduced il- legal crossings in key areas, forcing smugglers to adapt their methods. As aboveground routes became more challenging, underground smug- gling operations surged. As the border wall expanded, the number of tunnels discovered by U.S. Customs and Border Protection increased, with 11 tunnels uncovered in 2020 alone — the highest number recorded for that period. With an anticipated surge in border enforce- ment policies, traffickers and smugglers will not stop — they will adapt. Tunnels provide them with a direct, concealed route past sur- veillance technology and physical barriers. The United States cannot afford to focus solely on aboveground solutions; a comprehen- sive border security strategy must aggressively address underground threats as well. Enhanc- ing tunnel detection technology is crucial, requiring the expansion of seismic sensors, ground-penetrating radar and AI-driven surveillance to identify subterranean activity before it becomes operational. In addition, building underground barriers could serve as a formidable countermeasure, though such infrastructure would come at a significant cost. The Israeli border wall project that included the subterranean features cost an estimated $1.1 billion and took more than three years to complete. Equally important is strengthening interna- tional co-operation, particularly with Mexico, to ensure that tunnel networks are dismantled at their source before they can be fully devel- oped. The Arizona tunnel discovery was made possible through the use of both drones and intelligence-sharing with Mexico, underscor- ing the necessity for a multilayered detection approach. Finally, the United States must establish rap- id-response tunnel destruction teams capable of swiftly identifying, neutralizing and demol- ishing illicit tunnels before they pose a greater security risk. Only by integrating all these elements into a cohesive strategy can the United States effec- tively combat the growing underground threat at the southern border. Writing for the Washington Post, John Spencer is chair of urban warfare studies at the Modern War Institute and a founding mem- ber of the International Working Group on Subterranean Warfare. JOHN SPENCER RUTH BONNEVILLE / WINNIPEG FREE PRESS Nurses, like those working at the Health Sciences Centre, are the backbone of Manitoba’s health-care system. MARIANNE CERILLI ANDREW LODGE ;