National Physicians’ Day 2020 – Dr. Richard Stanwick

To pay tribute to the many dedicated physicians practicing at Island Health and in honour of National Physicians’ Day, we are profiling some of the doctors leading innovations and delivering high quality service to show the human behind the profession. Dr. Richard Stanwick started out as a pediatrician before earning his Masters degree in epidemiology and a fellowship in public health and preventative medicine. He grew up in St. Boniface, Manitoba. He completed medical school at the University of Manitoba before traveling to McGill University in Montreal as a Robert Wood Johnson Clinical Scholar. A Fellow of the American Academy of Pediatrics, Dr. Stanwick returned home and rose to the rank of professor of community medicine and pediatrics at the University of Manitoba. After transitioning to being Winnipeg’s Medical Health Officer, he was recruited to Victoria in 1995.

  • Why did you chose medicine and your speciality/field?

During my medical training, I saw lots of opportunity to address health problems a little more upstream. In residency, I had done many of the subspecialties, hematology and neonatology, and was offered an allergy fellowship, but the idea of doing things at a population level to influence more than one patient at a time was appealing.

Winnipeg has a very significant First Nations, Metis and Inuit population and I certainly saw some of the consequences of the social determinants of health there. I thought there must be a better way to approach providing care for these groups with the same scientific rigour of the specialties in the clinical domain. McGill offered me the opportunity to take the training in epidemiology and also continue to practice clinically.

  • What is most meaningful to you about your work in medicine?

I think the overlap of pediatrics and public health is meaningful. Some would say that you could blame the origins of all chronic disease on pediatricians – if we had only done a better job with children, we would not see the diabetes, heart disease, cancer later in life. There is a lot of truth to that.

The emergence of so many preventative opportunities, like immunization and safer environments influenced me. Early on, I became very involved in tobacco and children’s health and injury prevention. Not only could we rigorously collect the epidemiologic information in a fashion that was publishable, but it also allowed people to see changes possible in the creation of healthy public policy. This merger of the two fields of study allowed me to use my methodology skills and my experiences with individual clinical cases to advocate for change.

For example, there was child I saw on an Emergency Room shift who went down the basement stairs in an infant walker and sustained a serious head injury. The mother thought this should not have happened, as the product was being sold for children, in a major department store. The same situation with children being burned in highly flammable loose and flowing cotton sleepwear. I kept coming across serious and at times fatal individual cases that spurred me to collect the data for epidemiology and use it for broader advocacy purposes.

  • What are your professional interests and notable achievements?

Early in my career I saw things happen that should not have happened, and some businesses were profiting from doing things that were hurting children. I felt anger and indignation. I was reminded by one of my professors at McGill that, “Indignation without action is froth.” That has always stayed with me and helped motivate me to advocate for change.

The epidemiological data that I collected helped me to advocate to reduce certain sleepwear burns, ban infant walkers, enact smoking bylaws and mandate infant car seats.

I am very proud of having Victoria become the first city in Canada to go smoke-free indoors – something that is commonplace and expected now.  

In most instances, you need a level of tenacity to make change. It can be three to five years of work. I was very much involved working with Marketplace in the late 1980s to get rid of steel-tipped lawn darts. We were seeing significant injuries and we got a minister to take quick action but that is more the exception than the rule. Changing public policy starts with good epidemiology, good evidence, then building a team around your to cover everything including legal, and making sure the people affected are represented, then convincing our elected representatives with the authority that it’s the right thing to do.

This experience is serving me well during this pandemic because it’s going to be a marathon to really be successful. Patience and perseverance are serving me well today.

  • Where do you go, or what do you do, to recharge your batteries?

Normally, I love to read and walk. During pre-COVID days, I would not touch my vehicle all weekend but my wife and I would go to the library, the coffee shop, the grocery store, walk downtown, all on foot. We really enjoy being outside. I am privileged to have all these amenities so close and that I can walk to three different beaches within 45 minutes (although not during the pandemic). I am very fortunate and to explore and appreciate the beauty of Victoria. I valued this previously, now I treasure it. 

The first time I was going to cut the lawn this year, I was going to wear a facemask to reduce my allergy symptoms. My wife said, “What are you doing? You’ve been telling people you don’t need a mask then you go out there and the first thing they see is the mask.” Therefore, I did cut the grass without a mask to follow my own advice. I need to model the expected behaviours at all times.

  • What is the last book or podcast you enjoyed?

Right now, I am reading “Grove of the Caesars” by Lindsey Davis. She has written a series of books about a private detective or informer as they are referred to in ancient Rome, and her adventures. This book follows the so-called informer as she solves mysteries. The author takes you back to ancient Rome in 89 AD with rich detail of everyday life of that time.

I‘m also a science fiction buff - I like to think about what could be. My reading is a combination between some historical fiction, some science fiction and occasionally I enjoy a good old pulp paperback mystery.

I really enjoy watching Still Standing. It is a CBC TV series hosted by comedian Jonny Harris. He travels to small towns and explores the locals then sums it up with a stand-up performance. Humor is important. Occasionally, I have been known to use some pretty bad puns. It helps me with perspective.

  • What change has occurred on during the COVID-19 pandemic that you want to remain? 

After SARS, we had the Naylor report and everyone was going to do something about preparedness. Then SARS went away and we had H1N1. We had Tamiflu for treatment and because we had familiarity for the requirements of a vaccine, that helped inform our accelerated response to that public health crisis.

I think COVID-19 is going to force us to embrace the idea that we have to have an ongoing and sustained degree of preparedness. We cannot just ramp up the system to respond. As soon as we start going back to normal, we cannot collectively forget the resources to be in a state of preparedness.

There will be time to help solidify the changes we have made so far and ensure we have the resources, people and capacity to prepare. I have had my teams working flat out since February, working to trace travellers who could have been infected, well before the WHO declared an official pandemic. The benefits are evident with only five people currently hospitalized here. Significant changes and investments in public health are needed to prepare and strengthen our system to ensure we are able to respond now and in the future. There is no guarantee the next pandemic will not happen sooner than a century from now.

I worry that the interface between community and the system needs to be protected with measures that really make a difference. We have been able to learn from other health authorities on how to most effectively to prevent and manage an outbreak in a long-term care facility. The sustainability of what we have been able to accomplish needs to be entrenched. People have come to expect a level of care and I don’t want the public health team to let them down.

  • What is your hope for the future of health care in Canada?

I am worried about the impact of the pandemic on the health care system and the rest of the world. There are so many people who were barely getting by each month, many who were previously working two jobs, for low wages. There has been a differential impact and the people with the smallest safety margins will be affected the most. The economic damage will be significant. I even wonder at times if we will be able to afford the health care system we rely on with the funds that will be available after we ride out this pandemic. How will medicine respond to these challenges?

I worry that a two-tiered system could grow between the haves and have-nots. I do believe we will be able to create a new public health care system that we can still take pride in – for all. It’s what makes us truly Canadian.