By Michelle Read
Writer
As someone who understands the critical importance of the social determinants of health, when Dr. Vera Etches accepted a position as associate medical officer with Ottawa Public Health in 2009, she saw not just a chance to have an impact on public health, but the opportunity to work closely with the city on housing, city planning and social services.
“These portfolios are so important to the well-being of a city,” says Dr. Etches, who like many public health experts, feels compelled to improve health not only for the whole population, but for those facing barriers, as well.
But where and how a population’s needs can be addressed plays out differently depending on what level you’re working at, and what additional challenges you’re facing. On the heels of two prestigious honours awarded to her and her team this spring, Dr. Etches shares reflections on lessons learned both before and during the COVID-19 pandemic.
Intervention through community collaboration and data
Early on in her career, Dr. Etches was inspired to reorient the approach to public health and disease prevention from education-only, to addressing the factors underlying health barriers.
“For example, you can’t get people to eat fruits and vegetables if they can’t afford them or they aren’t available in the community,” says Dr. Etches.
Prior to the pandemic, Dr. Etches was leading a group at OPH responsible for knowledge exchange and public health assessment. She prioritized the better use of data surrounding health needs to increase preventative intervention and to improve the health care system.
Appointed medical officer of health in 2018, she worked with a broad range of community leaders on a wide variety of health issues, all claiming their respective share of the population health pie—until the pandemic struck.
As the emphasis shifted from chronic disease to communicable disease, those same tools of health data assessment informed case and contact management and later, immunization—but COVID-19 had also drawn stakeholders closer together.
“We had more conversations with hospitals, partners and the city, assessing which populations are facing the greatest barriers, where we saw the most risk of COVID, where do we need to support people with information,” she says. “It was a good opportunity to build relationships and ways of working with the community to address what’s important with the health system.”
Dr. Etches notes that “co-creation” with communities has been the most important concept to emerge, but says we must build on it further. OPH’s health system partners and city partners see the value of work at the neighbourhood level, where collectively with the community, they can better make an impact where the needs are greatest.
“Some populations are more likely to have challenges with health care: access to education, housing, employment—it’s shown us there is racism at play,” she says. “We must tackle that directly, and the best way is to work alongside communities to understand in their language what their needs are.”
The adjunct professor with the School of Epidemiology and Public Health also supervises uOttawa Faculty of Medicine residents during their management and leadership rotation. Besides standard topics like human resources and IT, she aims to highlight the importance of being data driven and using the best information available at the time.
“Without much information at the beginning, we used what we had to best inform what would be most protective,” she says. “Listening to others, staying open and flexible as data comes in, hearing the communities that are most affected—this way of working will be applicable to other challenges, as well.”
Wellness for effective leadership
Wellness was something Dr. Etches saw as critical, right from the early days of the pandemic. She received advice from a military colleague early on: You must have forced rest to keep going, to be effective and to get the job done.
“We’ve realized the best practice of taking a vacation every quarter—when you come back, plan your vacation for the next quarter, and that helps people,” says Dr. Etches.
Time-pressured situations also need a system that is able to carry on. “Ensure everyone has a back-up they can hand over to,” she says. “I have a wonderful team—I am not indispensable; they are there and ready to carry on, and we take breaks.”
While being an effective leader and worker means taking breaks, it's not just about time away.
“We also need sustainable ways of working—I've been very clear to not send messages on weekends and to really try to limit the hours of work, so people can be healthy to carry on,” she explains. “For me, and I would recommend it to everyone, physical activity or finding something that you enjoy is also a very important part of staying well, mentally and physically.”
Dr. Etches hopes to impress on her medical residents that looking after the team's well-being is a top priority.
“What the team at OPH achieved is impressive, but it came at a cost, with some people's lives quite out of balance because of the hours of work they were putting in.
“I would like future leaders to understand that even in an emergency response, there need to be boundaries and protection for shifts, or limits that enable people to stay well and carry on with the work,” she says.
“You know, I think this is something probably many people have reflected on in the pandemic—that work is not the only thing in life that's important,” she adds. “Remembering to prioritize relationships with people is really key.”
Motivation through acknowledgement
For Dr. Etches, it’s encouraging when people are acknowledged for having done good work and for contributing to better outcomes in the community. Her own good work was recognized by the Ottawa community this past spring.
In June, she attended the Faculty of Medicine convocation ceremony, where she was the guest speaker and was awarded an honorary doctorate. That same month, Mayor Jim Watson presented her and the entire OPH team with the Key to the City.
“It is an honour to be recognized along with the team by the University and by the mayor,” she says. “We really focused on doing our job and, and yet, it's gone on a long time and people have worked very hard,” she says. “As a team we're very thankful; it’s also motivational to keep going—we're not through this pandemic yet.”
She herself is inspired to potentially expand her research to explore the balance of harms between controlling communicable disease, and the effects on the economy.
“I think being able to measure this further, from an economic impact point of view, make the case for prevention in financial terms, would be something I'd be very interested in partnering with people who have expertise in the field of health economics,” she says.
Dr. Etches also hopes her work inspires others to think about public health as a career.
“When I was in medicine, it took me a long time to hear that you could be a public health physician. Perhaps this profile will help recruit people into the field.”
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