‘We’re holding up a floodgate’: B.C. fights off superbugs brought home by medical tourists

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The risks involved in medical tourism aren’t just personal. Having surgery abroad could also mean bringing back a drug-resistant superbug and putting people in this country at risk, B.C. officials warn.

That alert comes after the recent discovery that two patients at New Westminster’s Royal Columbian Hospital had been colonized with the multidrug-resistant yeast Candida auris. Though neither patient is infected with the bug, the two join just a handful of cases that have been identified in B.C. since 2017.

Dr. Linda Hoang, medical co-director for the Provincial Infection Control Network (PICNet), said most of these cases have come from travellers who have had treatment overseas, including medical tourists.

It means patients need to do serious research on the facilities they’re considering for surgeries or other treatments abroad, including looking for objective information about the presence of any drug-resistant microorganisms.

« It’s not only a problem in India or Southeast Asia. It is endemic in parts of the U.S. and parts of Europe, » Hoang told CBC News.

« It [antibiotic-resistant superbugs] is a global problem, and the only way to to be aware of them is to make sure that health-care professionals are informed and our residents are informed when they’re seeking health care outside of British Columbia. »

It’s a sobering reminder for those who travel abroad for medical treatments, whether it’s to skip the surgery wait list in B.C., access therapies that aren’t approved in Canada or save money on cosmetic therapy. Some of the top destinations for medical tourists from around the world include India, Mexico, Southeast Asia, Brazil and Turkey, according to the Medical Tourism Association.

But facilities in other countries can sometimes take a more haphazard approach to prescribing antibiotics, and overuse can trigger the evolution of resistance to these crucial drugs.

India a major source of bug

The two colonized patients at Royal Columbian were isolated after the bug was discovered, and the hospital has been aggressively cleaning all areas they had visited, using UV light for disinfection, according to Fraser Health.

C. auris was first identified in Japan in 2009, but it has popped up since then in countries around the world.

It acts much like any other yeast species, causing infections in wounds, the bloodstream and the ears, but the real problem is how to treat it.

« The only real reason why we’re concerned or interested in monitoring Candida auris is because of that potential resistance profile, making it difficult to treat with the anti-fungal agent that we have, » Hoang said.

The biggest risk of infection right now seems to come from Indian facilities, Hoang said.

A microscopic image, at left, shows Candida auris cells. At right is a culture of the yeast in a petri dish. (The Journal of Infection in Developing Countries)

The bug was confirmed for the first time in B.C. in July 2017 in a patient who’d been treated in India. As it turned out, that traveller also came back with infections from multiple other drug-resistant organisms.

B.C. doesn’t track whether infected people travelled abroad as medical tourists or simply required medical treatment because of an emergency during their voyages.

But patients who have had medical treatment outside B.C. for any reason are a major source of these superbugs, she said.

They include so-called CPOs — carbapenemase-producing organisms like Klebsiella, E. coli and Pseudomonas that have become resistant to broad-spectrum antibiotics, which Hoang describes as the « last resort » for treatment.

In 2017-2018, PICNet recorded more CPO cases than ever before, and more than half of them were from people who had accessed health care overseas, Hoang said.

‘There’s only so much we can do’

The key for anyone who chooses to have surgery abroad —​ and anyone who needs medical attention while travelling —​ is to let your B.C. doctor know when you return. That way, the doctor can check you for any drug-resistant bugs you may have picked up and give you the appropriate medication if you get sick.

Being open with that information protects everyone around you.

« If you require health care in British Columbia, you are running the risk of spreading that into our facilities. And that’s not a good thing for your neighbouring patients, who might be very sick and vulnerable, » Hoang said.

She said B.C. is aggressively monitoring returning travellers for drug-resistant superbugs, but the real key to stopping their spread will be eliminating the excessive use of antibiotics that allows these micro-organisms to evolve resistance.

« We’re basically holding up a floodgate, and unless the problems are addressed in these countries where antibiotics are used with minimal regulation and control, there’s only so much we can do, » Hoang said.

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Ron Joyce, billionaire who brought Tim Hortons coffee to the masses, dead at 88

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Ron Joyce, the Nova Scotia native who made Tim Hortons coffee and doughnuts a staple of Canadian diets and created a billion-dollar empire, has died. He was 88.

His family said in a statement he died peacefully in his home in Burlington, Ont., on Thursday with family at his side.

My father had a big vision and a big heart. Through hard work, determination and drive, he built one of the most successful restaurant chains in Canada.– Steven Joyce, Ron Joyce’s son said in the statement

« My father had a big vision and a big heart, » his son Steven Joyce said in the statement. « Through hard work, determination and drive, he built one of the most successful restaurant chains in Canada.

Ron Joyce was born and raised in Tatamagouche, N.S. His mother, who was widowed at the age of 23, raised Joyce and his two siblings in a home that had no water, no electricity and was heated with a wood-burning stove in the kitchen. The only bathroom, Joyce told a CBC interviewer in 2006, was « a nice wooden one outside. »

Joyce, left, and NHLer Tim Horton started their doughnut empire in Hamilton, Ont. (Tim Hortons)

Joyce left home when he was 15 and moved to Hamilton, Ont. He served in the navy and later became a police officer before getting into the coffee shop business.

Tim Horton, who at the time played for the Toronto Maple Leafs, opened his first store in Hamilton in 1964. When he decided to expand, he chose Joyce as the first franchisee.

Joyce said he knew « zero » about making doughnuts when he went in for his first shift.

« But by golly, I borrowed $10,000 from the credit union, and I had to learn in a hurry, » he said in the interview.

4,500 Tim Hortons

After Horton died in a car crash in 1974, Joyce took full control of the business and oversaw its growth into a billion-dollar business. There are now more than 4,500 Tim Hortons locations worldwide, including 3,600 in Canada.

Robert Thompson, who co-authored Joyce’s autobiography, Always Fresh, called him « an icon of Canadian business. »

Without Joyce, Tim Hortons as people know it today would not exist, he said.

« We probably won’t see that kind of invention — somebody just create something that has such broad appeal across Canada that’s so instantaneously relatable to the Canadian experience. We just don’t see that now, and we probably won’t see it again. And so in that regard, he’s a legend. »

Following Horton’s death, Joyce started the Tim Hortons Children’s Foundation in his memory to send children from low-income families to summer camp.

One day a year, 100 per cent of proceeds from coffee sales at Tim Hortons locations goes to funding the seven camps, which include one in the United States and one in Joyce’s hometown of Tatamagouche.

« In his journey with Tim Hortons, he travelled all over the country and considered himself Canadian above all else, » his son said in the statement Friday.

« He never forgot his humble beginnings, with The Joyce Family Foundation donating extensively to support those who are less fortunate, especially children and youth. »

The first Tim Hortons opened in a converted garage in Hamilton on May 17, 1964. (Tim Hortons )

In 1992, he was named a member of the Order of Canada for his work with children. Joyce also created the Joyce Family Foundation, which is focused on making education more accessible through scholarships and bursaries.

In 1996, Joyce sold the business to Wendy’s International in a deal worth $400 million. In 2014, Tim Hortons was bought by another U.S. fast food giant, Burger King, for $12 billion.

Joyce was also part owner of the Calgary Flames between 1994 and 2001.

‘Whatever you can, help’

Joyce has also donated to several Canadian universities and has been awarded honorary degrees from universities including McMaster, Queen’s, Mount Allison, Saint Mary’s, Cape Breton, Calgary and the University of New Brunswick.

In a 2016 video interview with the Association of Fundraising Professionals, Joyce talked about the value of giving back.

Whatever you can, help. Giving can be many things. It can be money or just of your time, but all of it is very worthwhile, in my opinion.– Ron Joyce, in video interview with Association of Fundraising Professionals

« Whatever you can, help, » he said. « Giving can be many things. It can be money or just of your time, but all of it is very worthwhile, in my opinion. »

But Joyce has seen his share of trouble, too.

In 2013, a woman sued him for $7.5 million, alleging he sexually assaulted her in his Burlington home. Joyce denied that, claiming the woman was extorting him. That case is ongoing.

In 2007, he was in a plane crash on the runway of the Fox Harb’r Resort when the private plane he was travelling aboard encountered strong winds as it tried to land. Joyce owned the golf resort and gated community in northern Nova Scotia.

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Hamilton woman searched for 24 years for the daughter she was forced to give up. Then fate brought them together

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HAMILTON—It was the saddest of happy endings.

Darcy Dee was slipping away, her body finally giving in to the breast cancer she’d been fighting for four years.

But Darcy had already won another battle — one that she’d waged for a quarter-century — the struggle to find the little girl she’d been forced to give up in 1991, the baby the system had taken away from her all those years ago after deeming her an unfit mother because of her disability.

At her bedside during those last few days was the 29-year-old woman who had been taken away from her mother as a toddler, fostered and soon adopted, the woman who had grown up and lived most of her life with a loving adoptive family just minutes from the birth mother she never knew. But miraculously, fate had brought them back together in 2015, allowing for three years that would have to make up for nearly three decades lost.

Darcy Dee, 59, died Jan. 20 in Hamilton’s St. Peter’s Hospital. Her funeral takes place Saturday.

She is survived by 10 siblings, and by her daughter — Veronica Ann — the daughter for whom she searched for 24 years.

“Knowing that my mother got her greatest wish, to heal the wound of losing me, has been a huge inspiration,” Veronica said after her mother’s passing. She marvels at how through all those years that they were apart, Darcy essentially built her life around the quest for her lost daughter.

“She formed habits throughout her city to be visible and available so that I might by chance find her,” Veronica said. “She never gave up and I’m so grateful I could be there to show her it was all worth it.”

I told the first chapter of Darcy’s story nearly 30 years ago in November 1990, in the Star, as Darcy was waging a losing battle with the Catholic Children’s Aid Society in Hamilton for the custody of Veronica.

I’d met Darcy by chance in the food court of a Hamilton mall that autumn while I was on assignment. Darcy had been left disabled by a brain injury after being hit by a truck while walking to school on a winter day, when she was 8. She was declared dead at the scene, but somehow survived.

That day in Hamilton, she rolled up beside my table in her scooter, which had a carrier basket full of loose-leaf papers. Once she discovered I was a reporter, Darcy wanted me to read the documents in her basket, notes she’d been typing over the months, the journal of her struggle to regain custody of her daughter. (Over the years, she would type thousands of pages.)

Darcy’s speech was slurred. She had difficulty controlling her movements and articulating her feelings. But her journal read like poetry. Page after page of fluid and heartbreaking detail about how she’d had Veronica with a guy she’d met, and then lost her. Estranged from her family, the fiercely independent Darcy had been living in an apartment in downtown Hamilton.

She contacted the children’s aid society during her pregnancy, and shortly after the baby’s birth, Darcy was deemed unfit as a parent.

“All my life people told me I couldn’t do anything,” Dee said during one of several interviews in her tiny subsidized apartment in 1990. “Well, now I did the thing that is supposed to be the most important of all — I created a life. Now they want to take that away from me.”

After a year of increasingly infrequent and restricted supervised visits, the courts ruled on Feb. 11, 1991, that Veronica would be placed for adoption and that Darcy would not be allowed to see her again.

The system was true to its word, for 24 years.

The story that Darcy shared with me in 1990, the story that continued to unfold in the intervening decades, reads like a screenplay.

She was born in Buffalo in 1959 to John and Rayme Dee, professional actors who immigrated to Canada for work and settled in Ancaster, Ont. Anyone who watched Canadian television in the 1970s and early ’80s would recognize Darcy’s dad, John, who played Al Waxman’s crusty neighbour Max on King of Kensington.

Darcy left home at 21 after getting a Grade 12 diploma from a vocational school. She eventually moved to Toronto, where she took some courses in English and history at Ryerson, without much success. Back in Hamilton in 1982, she sat in on courses at McMaster University and Mohawk College.

When I met her in the small, dingy apartment in 1990, I noticed how she made the best of the lack of space and narrow hallway: because of her limited mobility, she got around by practically bouncing off the walls, propelling herself from the table, to the chair, to the bed.

The journal entries I read in 1990 were heartbreaking and gave voice to the thoughtful, eloquent and angry young woman that the system had written off.

She wrote about when her daughter turned 1.

“Yesterday was Veronica’s birthday. Her very first. I did not get to see her. Although I carried on with my own life, I had a pretty heavy heart, thinking of her. Remember last year at this time, I was in the hospital, in pain, having just had Veronica the night before?

“Yes, but the greatest pain of all is not being able to see my baby.”

Darcy Dee with her young daughter, who she had to give up to children's aid three decades ago.
Darcy Dee with her young daughter, who she had to give up to children’s aid three decades ago.

After losing Veronica, Darcy reconciled with her large family, and her sisters in particular became the champions of her efforts to locate her daughter. Her parents have long since died.

Darcy’s family and friends recall a spunky, unpredictable woman who could fly into a rage at those she felt were putting her down, and just as quickly flash a wide smile and howl with laughter.

“This is the story of a woman who grew up fighting — for her independence after a severe brain injury, for her life with a cancer diagnosis — and then, in the short time left to her, to find the daughter she was forced to give up,” her sister Betsy wrote in an account of Darcy’s struggle.

Darcy and I were in touch sporadically over the years.

In a journal entry on Veronica’s 10th birthday, June 10, 1999, Darcy wrote: “I will never stop praying for you, and loving you, even though I do not know where you are. You could be in the house in front or behind me for all I know.”

In 2007, when Veronica would have been turning 18, I contemplated trying to find her myself, or even publishing the baby photos of Veronica that I had taken at Darcy’s apartment in 1990. But I concluded that would be a violation of the girl’s privacy.

In late 2014, Betsy let me know that Darcy had been diagnosed with breast cancer and that the family was stepping up efforts to find Veronica.

By then they’d already been through years of paperwork, trying to make contact and obtain official records of the adoption. I went to see Darcy in Hamilton in November of 2014. She was very ill and was now confined to a wheelchair. And she still talked about finding her Veronica.

Little did anyone know that the clue to Veronica’s identity and whereabouts was already in Darcy’s possession. After my visit, Betsy sent a follow-up email to share some adoption-related documents that Darcy had received from Service Ontario in response to one of her requests. The key document was the 1992 record of Veronica’s adoption. While all of the adoptive family’s identifying information had been dutifully blacked out, for some reason the document showed Veronica’s legal name at the time of her adoption.

It took a minute on Google to find Veronica, a young web design and marketing consultant who was at that point living and working in Hamilton, blocks away from her birth mother.

Darcy’s sisters were in a quandary. How should they go about confirming Veronica’s identity and making contact? They didn’t share the finding with Darcy until they could get in touch with Veronica. After weeks of deliberating, they dropped off a letter at Veronica’s apartment, informing her of the identity of her birth mother and extending the invitation for a meeting.

Several weeks later, on Jan. 25, 2015, a Sunday afternoon, the family arranged for Veronica to make a surprise visit to her birth mother’s apartment.

Darcy was seated with her back to the door when Veronica entered and made her way into view.

“Do you know who this is?” the sister asked.

Darcy didn’t.

At that point, the striking young woman with blond hair and blue eyes knelt down in front of Darcy’s chair and took her hand.

“I’m Veronica.”

Veronica looks back now on that remarkable reunion and the months that followed.

“My reunion with Darcy was joyful, compassionate, all about doing things together as newly introduced people,” she said. “We went and did fun activities all through the summer. Darcy always pictured us in the sunshine together and she got her wish.”

Veronica was struck by her resemblance to Darcy, in physical appearance, and in attitude.

“She’s passed that focused, never-say-die spirit on to me.”

In the little time they had together, a lot was left unsaid, in part because it had become so difficult for Darcy to communicate.

“Most of what happened between Darcy and I was over coffees and in each other’s hearts,” Veronica recounted. “We couldn’t easily communicate but the wonder and surreal happiness of beating the odds together was our primary emotional story.”

In the days before Darcy’s death, Veronica spent hours at her birth mother’s bedside in Hamilton, still holding her hand. And while Darcy is gone, she has left her daughter a written legacy, thousands of pages of her writing.

Years before, on Nov. 11, 2007, Darcy typed this poem in her journal. After her death, it seems almost prophetic:

I can only hope and pray

That maybe, just maybe some day

That in heaven, or on earth

It will be like a rebirth

We will meet face to face

I will hug Veronica

And hold her

And she? She will touch my shoulder

Never to let go of each other

Allan Thompson was a reporter with the Toronto Star from 1987 to 2003, when he became a journalism professor at Carleton University.

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Is It Ever Okay… To Take Home the Wine You Brought to a Party?

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Welcome to “Is It Ever Okay,” Bon Appétit’s etiquette column. Have a question? Email staff.bonappetit@gmail.com.

If you are hosting a dinner party and invite each guest to bring a +1, how do you handle a guest who brings someone you absolutely HATE?Hateful Nate

I dunno, serve them arsenic-laced wine? Depends on what level on your Hate Scale they’re at. But if you want absolute control over your dinner party, invite all of your American Girl dolls instead and leave humanity out of it. I have a friend who had the gall to marry a man I can’t stand. He likes to interrogate, quiz, and patronize you instead of “hold a normal conversation.” I’m not sure where he learned this technique, but I blame the Boy Scouts. Our last chat ended with me saying, “Well I’ve had enough of this!” Really, he’s harmless, but I’ve decided to hate him for annoying me so much. So I feel you there. When he inevitably comes over, I treat him civilly, like an alien from the planet Mansplainia on a tourism board sponsored press trip to see how we normies live. That is, if there’s any interaction at all (it’s amazing how movement works, you can just…walk away!). Then I talk mad shit the second he leaves. It’s cathartic! This is why post-party debriefs are as essential as the party itself. Let it out.

If someone does something nice for you, like watch your dog or water your plants, while you’re out of town, what is an acceptable gift to give them? Wine, food, a small ceramic something, etc.? And what if you’re broke as a joke?Cashless Carrie

You own a dog or some bougie succulents? You can afford a thank you present. It should be a gift certificate to the nearest grocery store in the range of $25–$100, depending on how many days you were lazing on a beach somewhere, and whether they sang the entire Phantom of the Opera playbook to the plants. If you know this person is a wino, get wine, but who knows if they want that leather booty malbec anyway! Also I’m not into the souvenir gift. This person got near your poodle’s poop—that’s gross. That’s more than a favor. They don’t want a pound of eerily familiar fudge. This is why I like the grocery store gift certificate, especially to Trader Joe’s, because it says: practical. Practically…cash.

natural wine primer tote magnum

Photo by Alexandra Gavillet

Thanks for bringing wine! Now LEAVE IT.

Please settle the proper etiquette when bringing beer/wine to a friend’s dinner party. I always leave the bottle behind as payment for the food, but I’ve had friends take theirs back or split a six pack. I think that’s rude, but I’m also upset to see the liter of natural wine I brought to a friend’s house sit unopened for months.Thirsty Emily

I love how often “natural wine” as a concept comes up in this column. Why is natural wine so linked with asshole-ish behavior? Curious, curious. Anyway, I’d like to take this opportunity to call out my boyfriend’s friend Lock, who used to come over to watch Michigan football every weekend for like three years in a row (it felt like). Bill, my guy, would make elaborate bro feasts: chili, pulled pork, all kinds of Midwestern comfort foods that give you gas. Lock would stop by the pizza spot around the corner, purchase BAKED ZITI, and arrive with a 6-pack of PBR. He’d only drink the beer he brought, and then take the rest home. This is so many layers of bad behavior. How was this man employed? How did he find someone to love him? I had unending questions. Sometimes he sheepishly ASKED PERMISSION to take the beer home, which only merits a solemn head shake in response. Don’t do that. That’s tacky. If you just got out of college and you’re broke, you think there are exceptions to all the rules. You get trashed at the wedding but don’t send a gift. Take all of grandma’s Christmas checks but never write a thank you card (TEXTS DON’T COUNT). Who cares if the host drinks the wine, they can dump it on a campfire for all I care. The point is, you gotta bring the thing. And leave it. Goddammit, Lock, LEAVE IT.

Snack Break

I’m freaking obsessed with these pimiento cheese crackers. I’m making them for every social gathering from now until I croak:

pimento-cheese-crackers.jpg

I hate it when people ask me to take my shoes off upon entering their home—but I do it anyways. With this in mind, would it be too much to ask that my friends deposit their cell phones in a box by the door when they come over to my place? The dinner party scrolling is killing me!Angsty Amiel

It’s a special moment when you realize everyone you know has bad manners except you. This also applies to the principle of driving. Savor it, Amiel! Your friends are rude, selfish, and entitled. Probably millennials. Just kidding—everyone with a phone is addicted to it. Have you seen the memes? Memes are fantastic!! The only way to crawl out of this hole is together, so if you’re going to be a Bossy Host, which I fully approve of, at least cushion it with something self-referential: “I’ve realized I’m really addicted to my phone, it’s keeping me from living in the moment [THIS IS A GREAT MOMENT TO TEAR UP AND/OR MENTION A PET WHO DIED], so could you join me this evening in parking your phone in this Victoria’s Secret bag for the night?” In your other hand is a magnum of wine, which you’ll pour for your shoeless, phoneless, hapless guest. It’ll cushion the blow.*

*Ugh, are your friends new parents? The worst. Look forward to texts with the babysitter all night, the updates read aloud along the way. She sent us a pic of Henry in the bath! He made tooty bubbles! There’s no getting out of that one.

My boyfriend often very kindly volunteers to do the dishes but he never cleans the sink after. Like it’s full of dirty water with pieces of dinner floating in it. How do I ask him to stop this disgusting habit without seeming ungrateful for his dishwashing service?Tidy Tina

At some point, breaking up is easier than confrontation. This is that point.

Is it ever okay to show up at someone’s house at the exact time they put on the invite?Punctual Patty

YES. CAN YOU IMAGINE A WORLD WHERE WE ALL DID THIS?!???? THIS WOULD LITERALLY ACCOMPLISH WORLD PEACE. IT’LL HAPPEN AT 6 P.M.

What is the least gross way to tell your host that you used the last of the toilet paper?Lastly Larry

Show them what you did with it.

oat-and-pistachio-sandies

Peden + Munk

What are some Christmas cookies from the BA archives that I don’t know about?Sugar-coated Susan

Remember these pistachio sandies? An Alison Roman classic! So good. Also a sleeper hit: these peanut meringues that sound and look so French Culinary School but are actually very home-cookable. I make these chewy molasses cookies twice a December, they keep for dayssss. Pretty!! But whenever I see the photo for these curvy peppermint meringues I…feel things.

That’s all for now, but if you have petty etiquette questions or recipe requests for me, email staff.bonappetit@gmail.com and be too specific. I want the juicy details!

Love, Alex

The painting up top is: In a Roman Osteria, 1866. Artist: Bloch, Carl (1834-1890)

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