Global Woman of Vision: Dr. Kathryn Dong
This emergency room physician is helping change the culture of the acute care system to better address the needs of the community.
November 19, 2017
photography by Cooper & O'Hara
Dr. Kathryn Dong has always loved people, so when she began her medical career as an intern in the emergency department at the Royal Alex Hospital, she became concerned about the rising number of high-risk users – patients with addiction issues, mental illness or homeless – and how the medical system wasn’t set up to deal with them.
“I love emergency medicine but what about preventing people from having to come there in the first place?”, was the question she asked herself as she began her research at Streetworks, an Edmonton non-profit serving the inner-city community. It was there, handing out needle kits and other harm reduction supports, that Dong met a man who inspired her to look at the bigger picture.
“He was quite sick, laying in the snow in the middle of winter, and he told me he would rather die than go back to the Royal Alex hospital,” says Dong. “How could we have people who really needed to access care that felt that they couldn’t go to our hospital? In my mind that was a huge problem that we needed to look more deeply into why that was.”
Very quickly she understood that breaking the cycle was not about offering a new treatment or delivering new interventions. The whole culture of the acute care system needed to be changed. “We are experts at treating your heart attack, your pneumonia or surgery if you get stabbed in the chest,” says Dong. “But we didn’t do as good a job in dealing with the fact that you were smoking crack every day, or that you were involved in the sex trade and had experienced repeated trauma. And so, we needed to develop more expertise to complement the care for the acute medical problem and to look more holistically at the patients when we had the opportunity.”Dong and her team continue to press forward with their visionary view of healthcare, and she has high hopes for the future. “I do dream of a world where you get this excellent treatment for your substance use disorder as you do for whatever reason brought you to the hospital. I do dream of a world where we see harm reduction everywhere, and that’s just not controversial anymore,” says Dong. “This is just normal that we follow the evidence and we do what’s good for patients. I would love to see this just normal practice, what we do.”
In 1994, with $4 million in funding from the Royal Alexandra Hospital Foundation, Dong launched the innovative Inner-City Health and Wellness Program, a 3-year pilot project. A team of 6 doctors, all trained in addictions medicine, work alongside a nurse, social worker and addictions counsellor. In addition to delivering advanced frontline clinical services through ARCH, or the Addiction Recovery and Community Health Team, the program includes research – to study, document and measure the results – and education, developing programs for medical residents.
Many factors make this program unique, among them how it recognizes the importance of social factors in health, and works with other agencies to offer support. This includes Homeward Trust Edmonton, which helps homeless patients to find a stable place to live – because if patients don’t have a home address, they can’t get photo ID, or an Alberta healthcare card, which means they can’t get in to see a family doctor or specialist to deal with their addiction issues. “Getting immunizations or pap smears are very low on the priority list when you don’t have a place to sleep, you have no income and you have nothing to eat,” says Dong. “Those things for any of us would take a back seat.”
Also unique to this program is having a member of the team who patients can relate to — a peer support worker who was once homeless and dealing with addiction issues.
“There is so much mistrust in the health care system that does make it hard for patients to open up. But Rob brings credibility that I don’t have,” says Dong. “I can go in as a physician and say these are your treatment options and this is what I would recommend. But Rob has the ability to show people what life is like on the other side. He can help patients see what can be possible. I can’t do that. So that’s why this team works.”
This fall, the program became a part of the core services offered by the Royal Alex, and next spring, the hospital will be the first in North America to offer supervised consumption services to in-patients.
The program is also being considered in other Canadian cities as a new model for delivering acute care services, with Dong recognized as a “Different Maker” by the National Centre for Addiction and Mental Health.
“I do dream of a world where you get this excellent treatment for your substance use disorder as you do for whatever reason brought you to the hospital. I do dream of a world where we see harm reduction everywhere, and that’s just not controversial anymore,” says Dong. “This is just normal that we follow the evidence and we do what’s good for patients. I would love to see this just normal practice, what we do.”