Minoo Shakibai sometimes wants to weep as she examines a patient’s ulcerated feet. Many of the chiropodist’s clients are elderly and diabetic. They come to the Dufferin Foot Clinic thinking she can fix the “small cuts” on their feet.
In severe cases, she sends them straight to the emergency department of the nearest hospital, knowing the lesions are gangrenous. In less urgent circumstances, she cleans and dresses their wounds and tells them to make an appointment with their family doctor immediately. Most don’t.
She’d like to care for their feet herself. She is professionally certified, licensed by theCollege of Chiropodists of Ontario and has 14 years’ clinical experience. But her fees — $35 to $60 per appointment — would consume their modest pensions.
She’d like to send them to a community health centre where chiropody treatment is covered by OHIP, but they would face a three-month wait (if the clinic is even accepting new patients). She’d like to send them to a hospital foot clinic, but one by one they are closing or limiting their services to high-risk patients.
Too often, the young chiropodist watches seniors — mostly Italian and Portuguese immigrants from the neighbourhood — walk out the door, knowing they’ll eventually face amputation.
This month, she launched a one-woman crusade to raise public awareness and get help for seniors with no private health coverage. “They deserve to be taken care of and treated right,” she appealed to then-MP Olivia Chow, who passed her entreaty on to Shakibai’s federal representative, Andrew Cash, before launching her mayoral bid. He phoned Shakibai back and gently explained that health-care services are a provincial responsibility, promising to raise the issue with his counterpart at Queen’s Park, Jonah Schein.
Shakibai doesn’t know much about politics, as she readily admits. She has no allies or advisers. She’s never spoken out before. But she can no longer remain silent. “It seems like a minor problem,” she acknowledged in an interview. “But these people have put too much in the health-care system to receive nothing in return.”
There is little chance Health Minister Deb Matthews will extend OHIP coverage to chiropody services delivered in private clinics like Shakibai’s. The provincial Liberals have been moving in the opposite direction for 10 years, de-listing eye examinations, chiropractic services and some types of physiotherapy.
Nor is Matthews likely to provide hospitals with the funds to reopen their chiropody clinics. She has signalled her intention to keep downsizing hospitals and invest in home care and teams of doctors, nurse-practitioners, nurses, therapists and dietitians working in the community.
To Shakibai the big picture is a blur. What she and other front-line workers see are the gaps in the system; the short-term savings that result in expensive, debilitating surgery; the deterioration of the principle that all Canadians — regardless of the ability to pay — are entitled to medically necessary services.
Although she works in a private clinic, Shakibai doesn’t care where low-income seniors go to receive footcare. She’d be happy to see them treated at a hospital or publicly funded clinic. Although she is one tiny cog in an $80 billion provincial health system($54 billion public, $26 billion private), she believes she can make a difference.
It would help if the sons and daughters of these uncomplaining seniors took more responsibility for their parents’ health. It would help if family doctors checked their older patients’ feet regularly. It would help if long-term care homes opened their chiropody clinics to non-residents in need of footcare. And it would help if some of the 3,500 bureaucrats in the Ministry of Health, the employees of Ontario’s 14 local health integration networks (LHINs), its 14 community care access centres (CCACs) and the dozens of other satellite health agencies the government has set up turned their minds to this hidden problem. With a little creativity, solutions could be found.
It is tempting to dismiss a politically naive health worker who sees a tiny sliver of a huge, complex system. But Ontario needs citizens like Shakibai. They are the sentinels.