Jul 7, 2020

Residents Advocate for At-Risk Women Through Local and National Partnerships

Residents delivering meals to shelter

Residents delivering meals to women's shelterWritten by: Imaan Zera Kherani, Dr. Haniya Khan (PGY1) and Dr. Martha Smith (PGY1)

While media outlets are flooded with uncertainty amidst the COVID-19 pandemic, this is a story about unity and partnership. The COVID-19 Women’s Initiative (CWI) is a testament to the power and productivity that accompanies knowledge exchange between health change-makers.

Established by University of Toronto medical students Aman Dhaliwal and Karlee Searle, the CWI propels the passion of 250 Canadian health learners partnered with physicians and community advocates towards espousing that this pandemic is not gender-neutral (1,2). The pandemic has exacerbated societal inequalities including sexual and reproductive health barriers, disheartening surges in domestic violence, precarious job security, and disruptions to the women’s shelter systems. We acknowledge these disparities existed before the virus but we must recognize that current circumstances permit these disparities to flourish, and this necessitates our energy, advocacy, and voices (1,2).

Aman and Karlee reached out to Dr. Emma Skolnik, an Obstetrics and Gynecology (ObGyn) resident fueled by a commitment to social justice, and Dr. Rachel Spitzer, University of Toronto physician and Vice-Chair of Global Women’s Health and Advocacy in the Department of ObGyn. Aman and Karlee speak of the privilege it is to formally collaborate on this agenda with Dr. Skolnik, Dr. Spitzer, and now, over 25 ObGyn residents. While the virus continues to perpetuate systemic harsh inequities, the synergy of this group has simultaneously broken a silo. In the short, rigorous years of early medical training, there are few cherished moments of medical student collaboration with residents, especially outside the clinical sphere.

This partnership between ObGyn residents and health sciences learners has ignited support for our communities in novel ways:

  1. Access: We recognize the angst amidst a pandemic only augments the uncertainty and barriers around reproductive choice. As such, the ObGyn residents and CWI released a Sexual Health and Reproductive Services map, which has reached over 6,000 individuals. This map provides information on sexually transmitted infection screening, contraception, and abortion services that remain available in the Greater Toronto Area with details on hours, contact information, and clinic locations. This updated, user-friendly tool is a step towards empowering patients whilst navigating our health system. After a profound community response, the ObGyn residents are currently facilitating national map expansion with support from Canadian CWI volunteers.
  2. Political Advocacy: Dr. Julie Thorne, ObGyn physician, alongside resident physician Dr. Alix Murphy and colleagues have devoted energy towards writing an open letter to Christine Elliot, Ontario’s Minister of Health, advocating for universal coverage for contraception. This letter is endorsed by Action Canada, a national organization that advocates for reproductive rights. With precarious job loss and its effect on costs associated with accessing contraceptive care, Dr. Murphy states this project “…is not only a health issue, but also a human rights issue.” The letter and requested deliverables have been constructed alongside pharmacy student CWI volunteers, who have offered expertise around our drug coverage systems. We anticipate that this letter will be released with media coverage in the coming weeks.
  3. Food Insecurity: The ObGyn department has been touched by the tokens of gratitude received from our communities. While cherishing meals of appreciation from local restaurants, they are also reflecting on communities struggling with food insecurity amidst the current climate. With a successful infographic-centred media campaign and a #donateyourdatenight Twitter initiative, the CWI and ObGyn department have impressively raised $6,900 for this portfolio led by resident physicians Drs. Rebecca Zur and Siddhi Mathur. Dr. Zur, explains that, “the aim is to encourage healthcare providers to donate the money they have saved…and pay it forward to those at the margins.” To further their community advocacy, the team partnered with Family Meal TO, Little India, and the Depanneur restaurant which is a culinary community committed to newcomer inclusion. The restaurant partnership has provided individually packaged meals in a manner that respects physical distancing precautions. This portfolio supported by community generosity has provided 529 dignified meals so far to Toronto shelters including Sistering, the Redwood, and the YWCA.
  4. Intimate Partner Violence (IPV): With disheartening surges in IPV, identifying individuals at risk is a necessary responsibility (1,2). In encouraging an expectation of physical distancing, we must recognize “home” may not be safe and stable. In response, ObGyn residents, faculty and the CWI in collaboration with the Barbara Schlifer Commemorative clinic have constructed two infographics that are now ubiquitously available in clinics, COVID-19 assessment centres, and other spaces still available to women during this time. Informed by ACOG and SOGC guidelines, the first infographic includes IPV identification recommendations, along with next steps when an individual discloses experiencing IPV (3,4). A patient-centred infographic has also been developed with links to immediate resources (3,4).
  5. Maternal Mental Health: The resilience that pregnant persons are displaying amidst the fluctuating policy changes and uncertainty is a testament to the strength of parenthood. With gracious support from Dr. Beverly Young and Dr. Wendy Whittle from Mount Sinai’s Perinatal Psychiatry and Obstetrics Departments, the ObGyn residents have improved perinatal mental health resources by hosting weekly online meetings for pregnant persons. These webinars cover current health policies, coping strategies during the newborn period, and expectations when delivering. Supported by high attendance and overwhelmingly positive reviews, resident physician Dr. Shira Gold and her team spoke of the atmosphere of gratitude, certainty, and community that was created. The team hopes to continue this service, expanding their reach to our marginalized communities. To support this advocacy, the ObGyn residents and CWI have developed an evidence-based maternal mental health tool kit in the form of a nationally disseminated infographic released on World Maternal Mental Health Day.

For more information about these and other initiatives, including infographics, donation links and ways to get involved, please visit the COVID-19 Women's Initiative website.

We look forward to the incredible strides the CWI and the ObGyn department continue to take together towards uplifting our communities amidst this unprecedented time and furthering the examples of partnership amongst all levels of health science trainees and practitioners.

Signed,

Imaan Zera Kherani, BHSc (She/Her)1
University of Toronto MD Program, Class of 2023
Co-Lead of the COVID-19 Women’s Initiative: Alberta Branch.

Dr. Haniya Khan MD, MSc, BHSc 2
PGY1, University of Toronto Obstetrics and Gynecology Department.

Dr. Martha Smith, MD, BSc2
PGY1, University of Toronto Obstetrics and Gynecology Department.

We would like to thank Dr. Emma Skolnik for her energy and support throughout the writing process.

Citations:

(1) Dunham, J. Women disproportionately ‘bearing the brunt’ of coronavirus crisis, advocates say. CTV News [Internet] 2020 April 22 [cited 2020April 26]; Canada:[full article, about 11 screens]. Available from: https://www.ctvnews.ca/canada/women-disproportionately-bearing-the-brunt-of-coronavirus-crisis-advocates-say-1.4907309

(2) United Nations Secretariat, United Nations Entity for Gender Equality and the Empowerment of Women (UN Women). Policy Brief: The Impact of COVID-19 on Women. New York, 2020 (Available from: https://www.unwomen.org/-/media/headquarters/attachments/sections/library/publications/2020/policy-brief-the-impact-of-covid-19-on-women-en.pdf?la=en&vs=1406; Accessed 26 April 2020).

(3) American College of Obstetricians and Gynecologists. ACOG Committee Opinion No. 518: Intimate Partner Violence. Obstetrics and Gynecology. 2012;119(2 Pt. 1):412-417. Available from: doi: 10.1097/AOG.0b013e318249ff74.

(4) Cherniak D, Grant L, Mason R, Moore B, Pellizzari R, IPV Working Group, Society of Obstetricians and Gynaecologists of Canada. Intimate Partner Violence Consensus Statement. Journal of Obstetrics and Gynaecology Canada: Journal D'obstetrique et Gynecologie du Canada. 2005; 27(4):365. Available from: doi: 10.1016/s1701-2163(16)30465-0.

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