Steven Lewis: Saskatchewan needs an occupational therapy school — now


A century’s worth of scientific and medical progress has conditioned us to think that humanity will eventually fight off what nature and time have in store for us.

The University of Saskatchewan Campus is seen in this aerial photo of Saskatoon, SK taken on Sept. 13, 2019. (Saskatoon StarPhoenix/Liam Richards)© Provided by Leader Post

It’s search-and-destroy medicine: Find the genetic, physiological and biochemical causes of disease and outfox them. There is just enough success — some cancers largely beaten, some surgeries remarkably restorative — to sustain the triumphalist narrative.

Yet that vision remains largely a mirage and a virus has reminded us that we haven’t even mastered the basics. Meanwhile, 20 per cent of the population, and nearly half of those over 75, live with a disability. Their goals are more prosaic: Function as independently as possible for as long as possible.

An 85-year-old is less at risk from high blood pressure than not being able to cook a meal or safely take a shower. It’s not the dying of the light we should rage against. It’s the failure to meet the needs of people who aren’t looking for miracles, but a little ingenuity to help them get on with their lives on their own terms.

Forty-odd years ago, I was the research director for the Saskatchewan Task Force on Rehabilitation that laid out a comprehensive plan to modernize and expand rehabilitation services. Delivered in 1980 it was (like a hundred other reports) received, ritually praised and largely ignored.

There’s no trace of it today; it was never digitized and you’d have to go to a library to find a copy.

I lived in Saskatoon at the time, and drove to and from Regina meetings with Margaret Tompson, a task force member and legendary occupational therapy leader and advocate. I was in my 20s, still young enough to be educable.

Margaret used my car as a makeshift classroom where she taught the occupational therapy catechism. Its mission is to free people from limitations imposed by diminished physical, mental or emotional capacities.

Occupational therapists look at people’s total circumstances — individual, environmental, social — and design workarounds tailored to their realities, from exercises to improve balance to assistive devices to modifying the kitchen.

Saskatchewan has university programs in medicine, dentistry, nursing, physical therapy, pharmacy and nutrition and kinesiology. Historically, the medical school has exported more graduates than it has retained. To this day, rural Saskatchewan is almost entirely dependent on foreign-trained doctors.

But the province didn’t flinch at spending hundreds of millions of dollars on a new building and to rescue the program from a threatened loss of accreditation.

The U of S physical therapy program is so far the only offering of the expansively named School of Rehabilitation Science. It takes but 12 faculty to deliver the program.

Not coincidentally, Saskatchewan had 60.5 physical therapists providing direct care per 100,000 people in 2020, roughly the national average, about 10 per cent more than Manitoba, and 10 per cent fewer than Alberta.

By contrast, in 2020 Saskatchewan had 25.8 occupational therapists providing direct care per 100,000 people — the fewest of any province. Manitoba had 41.3, Alberta 41.6 and B.C. 42.5. Those provinces have occupational therapy schools, while Saskatchewan, despite decades of advocacy, does not.

Compared to medicine and dentistry, the cost of an occupational therapy program would be trivial, at most a few million dollars a year. (I wish I could be more precise; try to find a university financial statement that lists costs by program.)

It is hard to imagine a decision more at odds with the needs and aspirations of the public than the perpetual refusal to create an occupational therapy school in the province. Saskatchewan buys 20 occupational therapy seats at the University of Alberta, but obviously that isn’t getting the job done.

The province is woefully and chronically short of an adequate supply. Occupational therapy has been out of sight for so long that it is more or less out of mind.

The result is widespread, avoidable harm, in the form of functional decline, isolation, people left at risk and lost opportunities to thrive in the workforce or age in place.

A province that spends enormous amounts on medical interventions and huge volumes of drugs won’t train and deploy enough occupational therapists to keep people as independent and active as possible.

Wake up, government. Create the school and train as many occupational therapists as possible. There is no viable seniors’ strategy without them. A school would be a small investment with a potentially huge payoff.

The occupational therapists shortage is a self-inflicted wound. It’s high time to fill this embarrassing gap in the health-care workforce.

Steven Lewis spent 45 years as a health policy analyst and health researcher in Saskatchewan and is currently adjunct professor of health policy at Simon Fraser University. He can be reached at slewistoon1@gmail.com.