‘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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Mikael Kingsbury fights off food poisoning for 51st World Cup victory

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Canadian freestyle skier Mikael Kingsbury shrugged off food poisoning enroute to his 51st career World Cup victory on Saturday with a gold medal in moguls in Thaiwoo, China.

Kingsbury, from Deux-Montagnes, Que., won with a final-run score of 90.31, his fifth-straight victory in China.​

Ikuma Horishima of Japan was second with 87.68 and Kazakhstan’s Dimitriy Reikherd was third with 86.92.

Watch highlights from Kingsbury’s golden run:

After battling food poisoning, Mikael Kingsbury prevailed to top the World Cup field for moguls gold in Taiwoo China. 1:03

« It was a very tough day for me, » said Kingsbury, who earned his fifth-straight victory in as many starts in Thaiwoo since 2016. « Yesterday I got very sick and I was not feeling very well. Today I woke up with a little bit of energy, just enough to come and ski.

« I did a few mistakes in the first final round, but I learnt from those mistakes and I was able to put my best run and I managed to get my fifth win here at Thaiwoo. »

This is the third time the Canadian freestyle skiing team has competed in World Cup competitions at this venue, where several competitions will be held in the 2022 Beijing Olympics.

« I don’t know what it is about this place, » said Kingsbury. « It appears to be a run that suits me well. There’s also the fact that the level of competition here is high, as it is elsewhere. Skiers like Dmitriy [Reikherd], Ikuma [Horishima] and Ben [Benjamin Cavet of France, who finished fourth on Saturday] push me to do my best. »

Late comeback

Kingsbury, who lost six pounds of body weight due to the illness, is coming off a Lou Marsh Trophy win as Canada’s top athlete for his incredible 2018 season.

After getting the top score in qualifications, Kingsbury settled for second place behind Horishima after the first run of the finals, but bounced back in the end to capture the gold.

The 26-year-old won his first Olympic gold medal at the Pyeongchang Olympics in February, along with two Crystal Globes for finishing first in moguls and tops among all freestyle skiers on the 2017-18 World Cup tour.

Dufour-Lapointe top Canadian woman

The win marked Kingsbury’s 75th medal on the FIS circuit. He already owns the record for most career wins.

The other Canadian skier in the men’s finals, Brenden Kelly, finished 10th.

On the women’s side, the event was won by American Jaelin Kauf with a score of 83.08, while Chloe Dufour-Lapointe was the top Canadian with a fifth-place finish (72.79).

Dufour-Lapointe’s showing stands as her best single moguls result since finishing fifth at the World Cup in Tazawako, Japan in February 2017.

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Trump fights while Trudeau and Ford roll over on GM plant closure

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General Motors’ decision to close its Oshawa plant is treated by the federal and Ontario governments as irreversible — as the inevitable result of global market forces. It is neither.

Rather it is a self-serving decision made by a multinational adept in navigating the areas where politics and economics intersect. In making it, GM has taken advantage of Prime Minister Justin Trudeau’s fascination with high technology and Ontario Premier Doug Ford’s laissez-faire approach to industrial policy.

True, there is an important economic element behind the automaker’s plan to close eight plants worldwide. Consumers no longer buy many of the cars GM makes, including the Chevrolet Impala sedan manufactured in Oshawa.

Nor are they buying the hybrid Chevy Volt, once touted by GM as the car of the future. The Detroit plant that makes the Volt is one of the eight due to be shuttered.

Rather, consumers are buying gas-guzzling SUVs and pickup trucks — including the Silverado and Sierra models assembled in Oshawa.

So when GM says it wants to focus on developing electric and self-driving autos, it isn’t being entirely straightforward.

What the company really wants to do is shift production from vehicles that people don’t buy — including electric hybrids like the Volt — to those they do buy, such as pickup trucks.

GM would be pleased if, along the way, its engineers happened to develop a revolutionary electric car. But until that day arrives, it will concentrate on the more mundane task of making as much money as possible.

In a nutshell, this is the economics behind GM’s Monday announcement that it will close four plants in the U.S. and three overseas as well as Oshawa.

The politics of the decision has to do with where GM will manufacture those models it still plans to produce.

Its preference is to assemble them in low-wage countries like Mexico. But like all car companies it is willing to be enticed by government subsidies and is susceptible to pressure from government threats.

In strict efficiency terms, it would make sense for GM to shift the production of profitable models to its Oshawa plant. Oshawa’s flexible assembly line can handle both cars and trucks. Oshawa already performs the final assembly stage of two profitable pickup models. GM itself says the Oshawa workforce is one of the most productive in its stable.

But in the real world of politics, GM knows it wouldn’t get away with keeping a Canadian plant open when it was shutting down four U.S. operations. Donald Trump wouldn’t let it happen.

Indeed, the U.S. president has already signalled that he expects GM to backtrack on at least one plant closure in Ohio. If the company can’t make money selling the compact cars manufactured there now, he warned Monday, then “They’d better put something else in.”

What can Trump do? He’s already shown he can use tariffs with devastating effect. I’m sure he’d think of some way to punish GM if it didn’t comply.

But the importance of the Trump threat is that he’s not taken in by arguments of economic inevitability. He knows that when it comes to the auto industry, nothing is written in stone.

By contrast, Canada’s federal and Ontario governments have convinced themselves that nothing can be done. The Trudeau Liberals are so focused on high-tech jobs of the future that they too often — as in this case — forget the needs of the present.

Trudeau, who has spent some time cultivating GM head Mary Barra, appears to have accepted her claim that the Oshawa decision is irreversible.

Ford, for different reasons, has taken the same tack. He blames the planned federal carbon tax in part for GM’s decision, yet insists that nothing can be done to change it.

Both Canadian leaders fail to see what Trump instinctively understands: This is the auto industry we’re talking about; nothing is immutable.

Thomas Walkom is a Toronto-based columnist covering politics. Follow him on Twitter: @tomwalkom

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Putin critic fights to remain in Canada, fears for safety if sent back to Russia

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A vocal opponent of the Russian government who fears for her life says Canada is about to deliver her into the hands of President Vladimir Putin’s secret police.

Russian scientist Elena Musikhina and her supporters are pleading with the Trudeau government to let her stay in Canada on compassionate grounds — with time rapidly running out.

Musikhina believes her family fell into disfavour with Russian authorities for condemning Moscow’s military incursions in Ukraine and for saying Russia illegally annexed Crimea.

In addition, Musikhina says her research work uncovered information about serious environmental hazards and pollution from military activity around the large freshwater Lake Baikal in Siberia.

Her supporters say a half-dozen other researchers and officials who were aware of the data died in mysterious and violent circumstances. Musikhina’s pet dog was shot and she herself had warning shots fired over her head. The Russian FSB, an internal security service descended from the Soviet-era KGB, began asking questions.

Musikhina and her husband Mikhail fled in 2015 to join their daughter, a permanent resident of Canada, in Gatineau, Que. The couple unsuccessfully applied for refugee protection and subsequent appeals have failed.

The status of their application to the Immigration Department for consideration on humanitarian and compassionate grounds is uncertain. Regardless, the Canada Border Services Agency has indicated it will inform the couple next Tuesday of a deportation date.

« Unfortunately, the Canadian government seems to want to send us to the waiting arms of the Russian secret police, » Musikhina told a news conference Tuesday, flanked by supporters and members of her family.

A genuine threat

Green Party Leader Elizabeth May is calling on Public Safety Minister Ralph Goodale and Immigration Minister Ahmed Hussen to halt the removals of Musikhina and her husband.

« This is an emergency. It’s a matter of life and death, » May said.

Elizabeth May, Leader of the Green Party, calls on the Government of Canada to urgently intervene in the case of Dr. Elena Musikhina, middle back, in Ottawa on Tuesday. (Sean Kilpatrick/Canadian Press)

« It’s one of the most desperate cases I’ve ever seen of people on the verge of being deported. There can be no doubt as to the danger posed to dissidents within Russia — that’s well-known. »

Human-rights activist and former Alberta MP David Kilgour, who is also championing Musikhina’s case, said she faces genuine danger if returned to Russia, given the knowledge she has gleaned through her research.

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‘A unique ability to not remember’: Mystery man fights for freedom

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Mohsin Abdelwahep is believed to be Egyptian. But he has also claimed to be Syrian, Iraqi and Palestinian.

He’s used four different names. And Abdelwahep — who is also known as Ali Hassan Ahmed — is either 55 or 59.

One fact about him is certain: he’s behind bars. Not for any criminal act, but because Canada Border Services agents can’t identify him in order to begin the process of deporting him.

But after more than two-and-a-half years of trying to figure out who the mystery man is, the CBSA may soon be forced to set him free.

‘An unknown entity with a history of lying’

A member of the Immigration and Refugee Board’s Immigration Division ordered Abdelwahep’s release last month.

The Minister of Public Safety and Emergency Preparedness has applied in Federal Court for a judicial review of that decision.

The bulky court record — which CBC has reviewed — throws a spotlight on both the contentious issue of immigration detention and the lengths investigators will go to in order to discover credible information about the people in their care.

Abdelwahep has undergone linguistic analysis and had his DNA submitted to an ancestry database. Agents have sent Facebook messages to possible fifth and eighth cousins. They’ve considered going to the media.

He’s drawn the line at hypnosis for fear it might « mess with his mind. »

The Canada Border Services Agency submitted Mohsin Abdelwahep’s DNA to Ancestry DNA in the hopes of finding relatives. They have reached out to possible fifth cousins. (Jason Proctor)

And yet, Abdelwahep’s true identity remains as much a puzzle as it was in July 2016 when one of the many Immigration Division members he has appeared before predicted he could look forward to a « very long time » in detention.

« You’ve demonstrated a unique ability to not remember anything about your own past, to be a person completely and utterly alone in the world, unable to obtain any documents, unable to provide any contacts who can confirm your identity, » Marc Tessler told Abdelwahep.

« You are essentially an unknown entity, with a history of lying. »

All dead ends

Abdelwahep was first detained after making a refugee claim at an inland Citizenship and Immigration Office on April 5, 2016. At that time, he claimed to have arrived in Canada on a ship from Italy.

But his story unravelled when fingerprint analysis showed he had actually been in the United States for many years, including the time he was supposed to have been on the boat.

Further checks found Abdelwahep had — in fact — unsuccessfully applied for asylum in Canada in 2007. He told investigators he spent time in France, Germany, Italy and the Netherlands but only Italy has any record of him.

Fingerprint checks suggest that Mohsin Abdelwahep was arrested in Las Vegas under the name Ali Hassan Ahmed. He was also married in the desert city. But his wife is dead. (Sam Morris/Las Vegas Sun via Associated Press)

Over time, pieces of information have emerged — but all dead ends. He was married to a woman in Las Vegas. She died. CBSA has been unable to find her relatives, and questions about former roommates have gone nowhere.

The linguistic analysis suggests he grew up in Cairo.

According to the court records, the CBSA has yet to supply him with an application for an Egyptian birth certificate or travel documents.

In any case, he has allegedly refused to fill them out if they did.

‘Do I deserve to be treated this way’

Abdelwahep claims that he has consistently told investigators what he remembers — but he doesn’t remember much.

And his stay in a B.C. Corrections pretrial centre doesn’t appear to be helping. The court records include pages of details about in-custody arguments and fights.

He has spent much of his time in segregation and, at one point, suffered a « brain bleed » after an attack by other inmates.

Mohsin Abdelwahep is currently an inmate at the North Fraser Pretrial Centre in Port Coquitlam, B.C. He has spent much of his time in segregation. (Shutterstock)

Abdelwahep expressed his frustration — and his view of the Canadian legal system — in December of last year, when he made a personal plea for his release to yet another Immigration Division member.

« According to the law in Canada, if I kill a person, if I am drunk, they will indict me for three years. What is the reason they put me in prison for two years without committing any crime? » he asked.

« Do I deserve to be treated this way? I’m not a criminal and I’m not a terrorist. That’s why I’m asking you to release me today and I will comply with any conditions that you impose on me. »

No ‘single, simple answer’

The issue of immigration detention has arisen repeatedly in the courts in recent years.

According to evidence given at a 2017 Federal Court case, nearly 5,900 people were detained for immigration purposes in 2016. People can be held if they are deemed to be a flight risk, a danger to the public or unwilling to prove or reveal their genuine identities. But the Immigration Division holds regular hearings for the CBSA to justify continued detention.

One South African man, Victor Vinnetou, was detained for 11 years before he was released. He arrived on a false passport and — like Abdelwahep — was accused of refusing to co-operate with efforts to establish his identity.

South African man Victor Vinnetou was detained for 11 years before he was released. He was accused of refusing to co-operate with efforts to establish his identity. (CBC )

Detainees who signed affidavits as part of the earlier court case have been incarcerated in provincial jails for anywhere from eight months to three years. They included women and men. Several said they had been severely beaten by other inmates.

The judge in the case found that extended immigration detention doesn’t automatically amount to a violation of a prisoner’s rights.

« The reasonableness of an individual’s detention will vary with the circumstances, » wrote Justice Simon Fothergill.

« The question of when detention for immigration purposes is no longer reasonable does not have a single, simple answer. »

‘Detention is an extreme measure’

Toronto immigration consultant Macdonald Scott is part of the End Immigration Detention Network, an intervenor in a number of similar cases.

« Detention is an extreme measure within our society, » he says.

« And to hold someone just because you can’t identify them, you’d never be able to do that in any other context. And what I wonder about is why the Department of Justice is spending Canadian resources to fight what’s obviously a very reasonable decision. »

Immigration advocates argue that the Canada Border Services Agency should not detain immigrants indefinitely over issues of identity. (CBC)

Advocates point out that a release from jail isn’t a release from responsibility. Detainees still have to abide by whatever terms and conditions they undertake in exchange for release.

And Scott says taxpayers wouldn’t have to pay the cost to house and feed them.

‘They’re trying to catch the wind’

Karina Henrique, the Immigration Division member whose release order sparked the Federal Court battle, noted that Abdelwahep is not considered a flight risk or a danger to the pubic.

She put the blame for the delay in identification on both Abdelwahep and the government.

« It does not, however, appear that his identity will be established in the near future and there is potential therefore of his future detention becoming unduly lengthy, » she wrote.

« His detention has been significant, and his future time in detention is unknown. These factors weigh in favour of his release. »

He’ll remain behind bars pending the outcome of the judicial review. The next court date is in November.

The government argues that releasing Abdelwahep would undermine « the very purpose, objectives and explicit legislative intent » of the Immigration and Refugee Protection Act.

Which leaves the mystery man and the CBSA locked in a kind of needle-in-a-haystack stalemate.

At one of his last Immigration Division hearings, the agency explained efforts to reach out to some of the hundreds of people identified as possible cousins through Ancestry DNA.

Abdelwahep’s counsel, Christopher Ghirardi, said one officer described it as « a long shot to establish identity. »

« Mr Abdelwahep used a different phrase with me earlier, » Ghirardi said.

« It seems like they’re trying to catch the wind. »

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