Kami, public health officer

"Gaps that exist in peacetime will be chasms that exist during emergency time"

Kami’s story

My name is Dr. Kami Kandola. I’m the Chief Public Health Officer for the Northwest Territories.

Public health is my passion. Medicine is my passion. If you are looking for a structured kind of a role and you need lots of time to prepare, this is not a good fit.

You can be working on a file and then get a call, and say, in an hour, you need to be on the media to talk about this specific subject. And so you need to switch and learn quickly and then present it.

So you have to deal with the problem, synthesize the problem, and then articulate the problem — not only for the public, but for the politicians and for other healthcare workers and other governmental departments.

When I look around, I realize that not everyone is suited for that type of work style and that could be highly stressful for people. Whereas for myself, I thrive off of the change.

The Northwest Territories is considered a remote isolated region. We have 33 communities scattered across 1.2 million square kilometres, and Yellowknife has about 40 per cent of the population.

Many of the communities are hard to access. During the summer, it’s fly in. In the winter, the bulk of them can be accessed by ice road.

In those communities, healthcare access can consist of a health centre staffed by nurses. In some communities, there’s not even that. There’s a health cabin where nurses visit.

There’s only a few areas that have basic, hospital-type services, which is Inuvik and Stanton Hospital in Yellowknife.

From a legislation point of view, I implement the Public Health Act and all the regulations. But simplistically, it’s the three H’s. It’s about health protection, health promotion, and health prevention. Those are my three domains.

We were starting to hear about a cluster of atypical pneumonias happening in Wuhan, China. And I think it was December 31st, New Year’s Eve, 2019, that the Chinese government made this public. And the reality hit.

When Canada experienced the first importation of coronavirus into Toronto, there were tourists on that plane that subsequently flew to Yellowknife. All of a sudden, it wasn’t something that I was reading through my email or watching on the news — that we’re all 24 hours away from a novel coronavirus.

I knew in the Northwest Territories — because I’ve been here 20 years, and given our small communities and how highly concentrated they are — that when you get your first case of pertussis, the first case of influenza, it will spread and you will have lost control.

And so at that moment, I realized that the best decision I could make, the best control I could have over this novel coronavirus, is to declare a state of public health emergency before we got our first case.

Once I started to understand that people expressed fear, anxiety in different ways, it helped me try to balance as much as possible on looking at the data, trying to learn about the virus and then pivoting my measures as we understood more and more about COVID-19.

In Indigenous cultures, Elders are highly esteemed. They’re highly valued. They are knowledge holders. They share wisdom. So when you have Elders living in their 80s and 90s, they become that much more valuable, because they have so much to pass on. They knew they’d be very vulnerable if the virus entered their communities.

So the balance was wanting to protect our Indigenous communities, protect our Elders — because at the end of the day, the highest rates of COVID severity and intensity did come from our Indigenous populations, which is what we see with the other scenarios as well. Because of crowding, they had a higher opportunity of more frequent, intense, prolonged exposure to COVID.

At the same time, we kept the infrastructure open, in that we needed essential workers to work and to be able to run essential supplies and also provide central services like health.

That was the balance.

I was the Chief Medical Health Officer during the H1N1 pandemic. I remember the day I was planning my son’s first-year birthday party, which is a big deal for me. And so I missed it. It was very traumatizing because that was something you look forward to as a mother, and it was what it was.

With H1N1, it was five months and it was over. With COVID, it didn’t seem like it was ever going to be over. Like, this is never going to end. Like, we are chasing our tails.

During that period, because it was such a long time, and because public health personnel was so short, I just didn’t know: Would I be able to maintain my sanity? Would I get through this?

At the same time, my husband’s at home and my son’s at home, and I come home late and I’m eating cold supper and they’ve moved on. But they’re bonding and they’re developing memories, and those ones I’ll never — I won’t be able to get that back.

One of the struggles I had was that there’s only a few of us. All the fear, anxiety, and anger was bundled to a very small amount of people. My staff and I were working late evenings and we were working weekends. We were working more than we’ve been ever asked to work, but it was never enough. So even the next day they said, well, you need to do more.

And my fear was that there are not enough hours in the day to do more. There’s no more to do. I could work 24–7. We could all work 24–7. And it wouldn’t have filled the need.

It was that big black hole of it’s not going to be enough. Like, how am I going to stay level-headed?

Because of that, necessity drives invention. So we became very creative. Everyone had different superpowers and they were allowed to work within their superpowers, whether it was EPI, communicable disease, enforcement, surveillance.

They all worked in the areas that they knew their role and they took greater responsibility, because a pandemic is not a scenario where you can micromanage. You just cannot do it. You would burn yourself out.

I took on more of the role of communicating to the politicians, communicating to the media, communicating to Indigenous governments.

The hardest part was that I had my staff and they had to work incredibly hard. Some of them were single parents and some of them were in relationships. And some relationships suffered because of their not being available. There was a price people paid. And I was more than happy that I paid the price. But it was so hard to see them pay the price. But the problem was there was no one else.

The NWT’s COVID-19 public health emergency was in place for two years, ending on April 1, 2022.

After the pandemic was declared over, we did do a full-day retreat. We did do a debriefing. Our staff, it took us a full year to grow out of it.

And now sometimes, some of my staff — something will happen and there’ll be a level of intensity and they’ll go, “Oh my gosh, I’m getting PTSD all over again.”

It was very hard for them to slow down. They were used to going home at 10 p.m. at night or having suppers or living around the table. It took them a long time to leave at a normal time again. I said, “You guys, you can go home now.”

What kind of mental health supports were in place?

During the one-day retreat where everyone talked and was able to express their feelings, this was discussed — about accessing mental health supports as they needed and to reach out.

We became like a family, we were all going through this together. So we all pulled ourselves out together.

I’m a woman of faith. My prayer life increased. And so, pretty much, I became very dedicated to prayer, and then I had churches pray for me. It was my connection to God, to a higher power, that got me through and gave me wisdom. And it kept me strong throughout those two years.

When it was all over and I went to visit communities, a lot of people grabbed me and said, “Oh, I miss hearing your voice on the radio.” It’s a really strange mix of professional and personal. The stories matter, the people matter, because you know them. You know their names, you know where they live.

It’s not like in a province where there’s millions and millions of people. The stories don’t have a face. Here, the stories have a face. I need to hear those stories to have a balanced perspective.

Going forward, the question is, how do you control a pandemic strain in a northern, remote, isolated population with limited resources, but not infringe on people’s personal liberties and their businesses and have that economic toll?

We started the pandemic at a deficit. If you look at this health system as a whole, it was already stressed. Gaps that exist in peacetime, will be chasms that exist during emergency time. It doesn’t matter what emergency happens, but if you don’t deal with the small gaps, if you don’t try to figure it out during peacetime, that is what it’s going to cause an unraveling of the response.

What did the pandemic teach you about leadership?

As a leader, I could easily say this is not about me, and my family knows that too. As much as I love my family, and I miss spending time with my son, I did sit down and say, “Guys, this is not about you, this is about every other family in Northwest Territories. This is about Northwest Territories. So you’re not going to get me, but it can’t be about me.”

So that’s how I just rolled with it.

A special note of thanks from Healthcare Salute

Over the course of the COVID-19 pandemic, healthcare providers from across Canada have participated in our research on “COVID-19-Related Stress, Moral Injury and Minority Stress in Healthcare Workers and Public Safety Personnel in Canada.” Their struggles, heartbreak, courage, and resilience have inspired and moved us, and formed the bedrock of our research for this project. We are deeply grateful and committed to sharing their experiences.

We would also like to express our heartfelt thanks to our funders, the Public Health Agency of Canada, for giving us the opportunity and the autonomy to share our research with the larger Canadian audience without bias or restriction. This work would not have been possible without their generous and arms-length funding support. We also wish to thank our collaborators and supporters — McMaster University, St. Joseph’s Healthcare Hamilton, Homewood Health, and Homewood Research Institute.

After viewing, visit “Applying cultural competency in practice,” an education module for mental health providers and peer supporters.