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After a stroke left him locked in his own body, Rabbi Ronnie Cahana has found ways to lead an incredibly full life. Then the pandemic came. It swept through Quebec, leaving a trail of devastation. Today, Rabbi Cahana is one of the thousands of Quebeckers left stranded in the middle of one of the worst disasters in modern Canadian history.
COMMONS: Pandemic is currently focusing on how COVID-19 is affecting long-term care in Canada.
Featured in this episode: Aaron Derfel (Montreal Gazette), Tamara Sussman, Kitra Cahana, Ronnie Cahana
To learn more:
“Once a retirement plum for Quebec elders, nursing homes are now symbols of neglect” by Les Perreaux in The Globe and Mail
“The incredible stupidity of not putting Dr. Joanne Liu in charge of Quebec’s response to the coronavirus” by André Noël in Ricochet
“How Montreal’s CHSLDs mirrored the Diamond Princess outbreak” by Aaron Derfel in the Montreal Gazette
This episode is sponsored by Wealthbar
Additional music from Audio Network
“I Am a Man Who Will Fight for Your Honor” by Chris Zabriskie, adapted.
TRANSCRIPT:
EPISODE 9 – “MEND THE WORLD”
[COLD OPEN]
[ARSHY MANN]
Ronnie Cahana grew up in the shadow of the Holocaust. His mother, Alice Lok Cahana, was 14 years old when she was kidnapped from her home in Hungary and taken to Auschwitz and eventually to the Bergen-Belsen concentration camp. 70,000 people died at Bergen-Belsen, but Alice Lok survived.
So, when Ronnie Cahana became a rabbi, he focused on people like his mother.
[KITRA CAHANA]
He always wanted to be a rabbi for Holocaust survivors, and to kind of usher them out at that phase of their lives. So a lot of the congregations that we were at, we were drawn to because of the Holocaust community that existed there.
[ARSHY]
That’s Kitra Cahana, Ronnie’s daughter. Their family moved around a lot, living in communities in the United States, in Sweden and in Canada. And by 2011, Ronnie was living in Montreal and serving as the rabbi of Congregation Beth-El. But that year, Ronnie suffered a severe and debilitating stroke. At age 57, he was left completely paralyzed.
[KITRA]
When I first found out that he had a stroke, I thought that this was going to be one of the most traumatic experiences for a family. You know, everything was lost. That’s how I went into his room when I first found out that he had a stroke.
[ARSHY]
Ronnie had locked-in syndrome. His brain was functioning perfectly fine, but it had been cut off from almost all of his body. At first, he was only able to communicate by blinking. But slowly, with a lot of physical therapy, he’s regained a small amount of movement and speech. And though Kitra initially felt devastated by her father’s disability, Ronnie took it very differently.
[KITRA]
He immediately felt that this was a blessing, that he had been given a second chance at life and that he was going to use that additional breath, that additional life, to live it to the absolute fullest and to be the most profound man that he could be.
[ARSHY]
Ronnie wanted to live at home with his wife, but he required a very high level of physical care that was impossible to provide there.
[KITRA]
The only option available to us as a family was for him to go into a long-term care facility.
[ARSHY]
So eventually he was moved to the Maimonides Geriatric Centre in Montreal. And despite his changed circumstances, Ronnie continued to live a full life.
Using a joystick with his mouth, Ronnie would write poetry and sermons on his computer, his congregation would come and visit him, and Kitra says that he views himself as a fuller man than he was before the stroke.
[KITRA]
His experience was that his body was teaching him how to live a more meaningful life, a slower life, but a life with more intention and purpose.
[ARSHY]
But, of course, earlier this year, the COVID-19 pandemic struck. And it struck hardest in Quebec. Today, Rabbi Ronnie Cahana is one of the many Quebeckers trapped in the province’s long-term care homes where thousands of people have died.
I’m Arshy Mann, and from CANADALAND, this is Commons.
[PART ONE]
[ARSHY]
Kitra Cahana remembers spending a few hours reading about COVID-19 in late February and early March.
[KITRA]
And immediately, immediately, it was so clear how endangered my father’s life was, and every other resident of a long-term care facility. And so it just became very clear that, if the government did not put into place comprehensive and pointed policies to ensure and to save the lives of those residents, than they would all be at risk. That was completely obvious right from the beginning.
[ARSHY]
Her first instinct was to try to evacuate her father from his long-term care home immediately.
[KITRA]
We need to figure out a plan to bring him home. Because, you know, I don’t trust the government. I don’t trust that Legault is going to act quick enough and deliberately enough to save the lives of the residents and to protect the lives of the workers.
[ARSHY]
And Kitra’s instinct proved to be entirely correct. Quebec’s long-term care system has been devastated by COVID-19. Three months out, over half of the Canadians who’ve been killed by the virus have been residents of Quebec’s nursing homes.
[AARON DERFEL]
To date, the pandemic has killed, in Quebec, more than 4,600 residents of long-term care centers and, and seniors’ facilities. So, it’s been quite brutal that, that death toll. Obviously, no one expected it would be that horrific.
[ARSHY]
That’s Aaron Derfel, the health reporter from the Montreal Gazette. You probably remember him from our very first episode in this series. And, since then, Derfel has become the essential English-language journalist covering the epicentre of the pandemic in Canada. It’s been the regions of Montreal and Laval that have been hit the hardest. At one point, there were more than 180 outbreaks in long-term care and retirement facilities on the island of Montreal.
Quebec’s long-term care homes, known by their French acronym, CHSLDs, were once the pride of the province. So how did they end up as the sites of one the deadliest Canadian disasters in the modern era?
For the first half of the twentieth century, the Quebec government didn’t involve itself in any kind of senior care. It didn’t even have a role in health care. Instead, in the years after the Second World War, older Francophones relied on the Catholic Church, and Anglophones were served by local charities. Even then, these were mostly reserved for people without families.
But as with so much in Quebec life, that all changed in the 1960s. Jean Lesage’s Liberals came to power, ushering in the Quiet Revolution.
[JEAN LESAGE]
The people of Quebec have had enough of the present system. It’s time for a change!
[ARSHY]
For the first time, the Quebec state took an active role in health care, building up a public system from scratch. And the same was true for elder care. Throughout the 60s and 70s, Quebec built thousands of nursing home beds. By the end of the decade, the province had nearly 60,000. These were seen as plush retirements, with good food, comfortable lodging and plenty of entertainment.
But social norms began to shift. The next decade saw a move towards deinstitutionalization, towards making sure that older Quebeckers could stay at home instead of having to move to a nursing home. Beds began to shut down and the government promised to fund home care instead.
But the money never came. Quebec was squeezed economically as big business fled because of the threat of separatism.
[NEWS CLIP 1, MALE]
The largest insurance company in Canada says it intends to move its head office from Montreal to Toronto. The president of the company says the move is necessary because most of its policy holders are English-speaking.
[ARSHY]
And the nursing home system was allowed to stagnate, without enough money in home care to offset it.
Soon, long-term care was reserved for people with only the most dire medical conditions, and the need for beds continued to grow as the population got older.
[TAMARA SUSSMAN]
The solution in Quebec was not to invest in more publicly funded nursing homes, as far as I’ve seen. And that created a market.
[ARSHY]
That’s Tamara Sussman. She’s an associate professor at the school of social work at McGill University, whose research focuses on long-term care.
By the 1990s, the state of Quebec’s nursing homes was becoming a scandal. An investigation by La Press found that at least 400 residents had died of neglect in Quebec’s nursing homes over a ten-year period. In the early 2000s, other changes were coming down the pike. Bernard Landry’s PQ government was determined to modernize the way the health care system functioned.
[SUSSMAN]
From about 2003, there’s been this vision that we’ve got to be more efficient and get skinnier. And the idea… And it’s… You know, many provinces follow suit in different ways is, if we’re connected as an organizational structure, we will not only be more efficient, but we will also be more collaborative. So in 2003, what was cut was a lot more front-line workers.
[ARSHY]
But hospitals were never integrated into the new structures the government had created. In 2015, a new series of reforms were instituted. The mandate was to try to integrate hospitals into these networks.
[SUSSMAN]
The approach was, “We’re going to create these health networks. These health networks are going to include hospitals, they’re going to include long term care homes, they’re going to include rehab centers, and we’re going to get rid of all this costly management. So, we’re gonna get rid of about thirteen hundred positions.
Now we’ve only got 28 boards instead of 183 boards. They’re all ministry appointed. Some people have accused them of being friends of the minister. It’s very centralized. But when you have these super entities, and on paper they might be one organization. On the ground, they don’t feel like one organization. The sort of decisional capacity of the more localized units has been lost.
[ARSHY]
And none of this reformist zeal had meant an increase in funding for older Quebeckers. Long-term care continued to be a low priority for governments. Today, despite having three times as many seniors, Quebec has just two-thirds of the long-term care beds it had at the beginning of the 1980s.
[PART TWO]
[ARSHY]
This was the unfortunate state of Quebec’s long-term care system when the novel coronavirus arrived. And the system was compromised quickly. Aaron Derfel likens it to what happened to the Diamond Princess, the cruise ship that was struck by an outbreak in February.
[NEWS CLIP 2, MALE]
The Diamond Princess is being called a floating prison by passengers. It’s been called something else by scientists. Not a quarantine facility, but an incubator. About 10% of the ship has now contracted COVID-19. Something went wrong.
[DERFEL]
The Diamond Princess was the first indication of something that went horribly wrong in the pandemic.
[ARSHY]
Japanese authorities wouldn’t let passengers disembark from the ship and instead quarantined them in place for 14 days.
[DERFEL]
And the thinking is that, uh, you know, the people who were infected would stay infected, but it would not spread. Of course, that turned out to be false. It spread like wildfire throughout the ship.
[ARSHY]
The workers on the Diamond Princess shuttled back and forth between the rooms and different sections of the ship. And they got infected, spreading the virus to other passengers and other workers. The outbreak became amplified. When outside health workers came onto the ship, they would get infected too.
Derfel says that you can think of Quebec’s long-term care system, especially in hotspots like Montreal and Laval, as one big Diamond Princess. The residents were confined, and the long-term care workers would get infected caring for them.
[DERFEL]
And they were shuttling back and forth between the institutions, much like the workers were delivering the meals were shuttling back and forth, you know, between the rooms aboard the Diamond Princess.
[ARSHY]
And then each CHSLD would become an incubator for the virus.
[DERFEL]
There was at least one nursing home where 100 percent of the residents were infected. I mena, think about that. One hundred percent of the residents getting infected. And so the virus was everywhere.
[ARSHY]
When new workers were brought in to replace the sick ones, they, too, would get infected and bring the virus home with them. And this is an important point that I think gets lost in this coverage. The outbreaks in long-term care facilitate community spread. The pandemic gets worse for everyone when institutional outbreaks aren’t handled properly.
Kitra lives today in Arizona. So, even though she was in a different time zone and in a different country, she tried to find ways to get her father out of long-term care.
[KITRA]
But at a certain point, my mom kind of sat me down and she said, “Kitra, this… We just can’t do it. It’s too labor intensive, it’s too much. You know, we’d have to become our own infection control team and ultimately we can’t. We can’t bring him home.”
[ARSHY]
At first, Maimonides Geriatric Centre, where her father lives, appeared to be spared. But soon, Kitra’s fears came true
[NEWS CLIP 3, MALE]
Three patients and four staff members have tested positive for COVID-19 at the Maimonides Geriatric Centre in Côte Saint-Luc.
[ARSHY]
The first case of COVID-19 was detected in Maimonides Geriatric on April 9.
[KITRA]
And so at that point, it just became clear to me. OK, well then I have to advocate, with everything I have, to try to put better policies into place, try to protect the workers, try to protect the residents. And in order to do that, we need transparency and we need to be networked.
[ARSHY]
Kitra got to work. She started up a Facebook page for family members, which now has close to 400 members. And she took it even further. She organized WhatsApp groups related to individual floors in the building. That was important for families because each floor had its own rhythms.
[KITRA]
I mean, my father talks about this a lot, that every shift is a different ecosystem for him. Every shift is a different political landscape for him to navigate his care.
[ARSHY]
Kitra is an artist and a documentarian. She’s never done this kind of work before. But she felt compelled.
[KITRA]
I’ve never been an organizer prior to the pandemic. This is not an area that I have any experience in. In Judaism, we have this idea of “tikkun olam,” which means mending or healing the world. And this idea resonated very strongly in me, especially because my, my grandmother is a Holocaust survivor, and that responsibility that each of us has to mend the world.
[ARSHY]
But the virus continued its steady march through the facility. And then in May, all of a sudden, there was a huge surge of cases. Over 30 people tested positive on just one floor.
This kind of story was playing out throughout so many CHSLDs in Quebec. By the end of April, 1,859 people had died in Quebec, most of them in long-term care.. A month later, that number was up to 4,439. And again the vast majority were residents in care. We have never seen such concentrated death in Canada since the Spanish influenza.
Aaron Derfel says that many mistakes were made by the Quebec government and public health officials.
[DERFEL]
So authorities, really, I believe have no excuse.
[ARSHY]
Some of them, you’re probably already familiar with. Families were banned from visiting facilities, with no plan to make up for all of the unpaid care work that they do.
Here’s Tamara Sussman again.
[SUSSMAN]
The first decision, and it wasn’t unique to Quebec, was to make this blanket statement. Don’t let families visit. We have to control the spread.
[ARSHY]
Long-term care homes had very limited supplies of PPE.
[DERFEL]
In Montreal, the Jewish General Hospital was very quick to order all kinds of personal protective equipment. So, it was well stocked. Why wasn’t the rest of Quebec well stocked? Some of the other provinces purchased equipment en masse earlier.
[ARSHY]
Despite assurances from the Quebec government, testing of both residents and staff lagged significantly behind other provinces. And even though the pandemic was concentrated in Montreal and Laval, the government response team was run out of Quebec City. Legault didn’t even come to visit Montreal until two months in.
And then there’s the case of Doctor Joanna Liu. Liu is a world-renowned physician, the former president of Médecins sans frontières, and a Quebecker. Liu was at the forefront of battling cholera epidemics in Yemen and in Haiti, and she helped lead the fight against Ebola in West Africa. In other words, Quebec had, at its disposal, one of the most experienced pandemic warriors in the world.
But the government never called her up.
[DERFEL]
This was never done. You know, it’s just a glaring shame that it wasn’t.
[ARSHY]
All of this was exacerbated by the 2015 health reforms, which made launching a coordinated strategy incredibly difficult.
[DERFEL]
It was just a bureaucratic jigsaw puzzle that made no sense. To give you an idea of how ridiculous the system was set up, you had the West Island… the West Island health authority, right? It’s based in Pointe Claire on the western part of Montreal. But, for some odd reason, it was put in charge of the Grace Dart Extended Care Centre in the east end of Montreal. It doesn’t make any sense.
So, what happened at one point is that hospitals were reluctant to transfer some of their staff to the nursing homes, which were depleted of their staff. This would have been much easier done had there had there been one central authority.
[ARSHY]
Kitra Cahana has watched in horror as all of this has unfolded.
[KITRA]
Why are family members not at the table discussing and guiding policies? Why are residents not asked what they need? Workers are not being asked what they need. In fact, workers are being threatened and being told that if they speak out, they will lose their jobs.
You know, that tells me that this pandemic is being led by a PR campaign, not by science and evidence-based facts.
[ARSHY]
Part of that may be because the pandemic response has in fact been given over to a PR specialist. Since mid-April, Daniel Desharnais, the former director of TACT Intelligence, a public relations firm, has been the one directing the fight. In other words, instead of going with the internationally renowned doctor famous for taking on Ebola, they chose a flack.
And throughout the pandemic, the Legault government has seemed very interested in keeping up appearances.
[DERFEL]
They seem to be patting themselves on the back, that they’re doing this great job and they haven’t been doing this great job. Because you just have to look at the numbers.
[ARSHY]
The premier has even taken to attacking reporters. Namely, Aaron Derfel. On multiple occasions, Premier Legault has singled out Derfel, accusing him of fear-mongering and misreporting.
[FRANÇOIS LEGAULT]
I like to read, uh, certain journalists at the Gazette, the specialist in health. Sometimes I really disagree with him.
[ARSHY]
At one point, the Premier even blocked Derfel on Twitter. After Derfel tweeted about that, the Premier went after him personally. Legault and six senior government officials amplified accusations that Derfel was harassing the premier.
[DERFEL]
I simply pointed out that, contrary to his claims about certain things, the facts showed otherwise.
[ARSHY]
Aaron Derfel has been reporting on this pandemic day-in and day-out for months now. And he still can’t get what happened at Residence Herron–which we talked about in the first episode of this series–out of his head.
[DERFEL]
I’ll never be able to forget the–the tragedy at–at the hearing, which has come to symbolize all that’s gone wrong in–in the pandemic in the country. It’s–it’s traumatized me. Speaking to–to the workers at that long-term care facility, speaking to the co-owner, speaking to families and hearing what they’ve had to put up with… That–that’s something that I’ll never forget. It’s been very emotional for me.
[ARSHY]
For Kitra, her work during this pandemic has continued to expand. Not only has she organized family members, but she’s focused on making sure that people can’t just look away from what’s happening. She’s gotten together a petition with 70,000 signatures demanding that people in long-term care are protected, that residents and staff are all tested and that the workers get dignified wages.
But what she worries about most is what would happen if her father gets sick. When her grandmother, Alice Lok Cahana, who survived Auschwitz and Bergan-Belsen, died, Kitra was there holding her hand. She wants the same for her father.
[KITRA]
It breaks my heart thinking that if my father dies in the pandemic, that his body won’t be honored through our religious burial practices, that his body won’t be washed in the way that we wash every Jewish body that dies.
[ARSHY]
Many of the residents of Maimonides Geriatric are Holocaust survivors. Some of them, like the majority of people in CHSLDs, will have cognitive disabilities. They may not know what’s happening to them. They are confined. They are without their loved ones.
[KITRA]
There is a level of trauma happening here that’s unimaginable.
[ARSHY]
Kitra spoke to Jordan and I over a Zoom call from Arizona, and as we were getting close to the end of the interview, she asked us if we wanted to talk to Ronnie ourselves.
Now, during this series, we have spent a lot of time talking to family members, to journalists, to experts and to workers about what’s happening in long-term care. But we haven’t talked to any residents. And there’s a reason for that. As you know, most residents in long-term care have some form of cognitive disability, and even for the ones who don’t, communication is so limited right now. So, of course we wanted to talk to Ronnie Cahana. And then, all of a sudden, there he was.
A dimly lit image shows up on the screen. His hair is dark, streaked with grey. He was lit in a way so that it looked like his eyes were entirely black pools. And he spoke to us.
Well, perhaps a better way to put it, is he gave a sermon. He is a Rabbi, after all.
[RONNIE CAHANA]
I have to get into character. Be a Rabbi. Be a Rabbi.
[ARSHY]
If you didn’t catch that, he’s saying that he has to get into character. “Be a rabbi. Be a rabbi.” Ronnie’s a bit difficult to understand, so I’m going to repeat for you what he says. Because we were all speaking on Father’s Day, and we had just been peppering Kitra with questions about her dad, I asked Ronnie to talk about Kitra.
[RONNIE]
Oh, Kitra. The sweetest, purest heart. The most refined. Always growing. Always reaching. Always making every moment relevant. She has depth of soul. Always experiencing life by doing and recording and drawing out the depths of every moment. Meaning surrounds us and she knows that virtue in her own life.
[ARSHY]
“Oh, Kitra. The sweetest, purest heart. The most refined. Always growing. Always reaching. Always making every moment relevant. She has depth of soul. Always experiencing life by doing and recording and drawing out the depths of every moment. Meaning surrounds us and she knows that virtue in her own life.”
He spoke to us about the workers in the home.
[RONNIE]
A lot of adventures together. We laugh a lot. A lot of joy with each other and appreciation. And mostly from Kitra organizing… that, we’re so thankful for each other.
[ARSHY]
“A lot of adventures together. We laugh a lot. A lot of joy with each other and appreciation. And mostly from Kitra organizing… that, we’re so thankful for each other.”
He sermonized about our responsibilities to one another.
[RONNIE]
Believe that you can affect the world and you’re already doing it. Believe that you will elevate the world and you elevate yourself. Everything is what you believe.
[ARSHY]
But Ronnie made it clear. He doesn’t want to be in an institution. He wants to be at home with his wife.
I’ve been doing this reporting for months now. And it wasn’t until I spoke to Ronnie face-to-face, or as face-to-face as is allowed today, that I really felt the enormity of what’s happening in this country. All the people who are so alone, who may not even know what’s going on, who are scared.
I thought of the last time I saw my own father years ago, lying in a bed with a severe brain injury, unable to get any words out, suffering. He died before we could even find a spot for him in long-term care. And honestly right now, in my most selfish moments, I’m thankful for that, that he was spared the pain and isolation that tens of thousands of people are experiencing right now.
Recently, Rabbi Ronnie Cahana wrote a letter to Premier François Legault. We asked him to read it for us.
[RONNIE]
My name is Rabbi Ronnie Cahana. I am 66 years old. I have lived at the Maimonides Geriatric Centre in Côte Saint-Luc for the last eight years. I am not a statistic.
[ARSHY]
“My name is Rabbi Ronnie Cahana. I am 66 years old. I have lived at the Maimonides Geriatric Centre in Côte Saint-Luc for the last eight years. I am not a statistic.”
[RONNIE]
I am a fully sentient, confident human being, who needs to have my humanity honoured.
[ARSHY]
“I am a fully sentient, confident human being, who needs to have my humanity honoured.”
[RONNIE]
These days, in long-term care, every person is speaking desperately to the Maker Of Us All, to The Holy Creator of Life.
[ARSHY]
“These days, in long-term care, every person is speaking desperately to the Maker Of Us All, to The Holy Creator of Life.”
[RONNIE]
We are pleading for our lives.
[ARSHY]
“We are pleading for our lives.”
[RONNIE]
Mr. Legault, each of us is crying to be heard.
[ARSHY]
“Mr. Legault, each of us is crying to be heard.”
[RONNIE]
We say, “More life! Please! We are not afraid of the future.”
[ARSHY]
“We say, ‘More life! Please! We are not afraid of the future.’”
[RONNIE]
We are afraid that society is forgetting us.
[ARSHY]
“We are afraid that society is forgetting us.”
[RONNIE]
Our life force, our dignity, our ownership of the love of life that we can teach others.
[ARSHY]
“Our life force, our dignity, our ownership of the love of life that we can teach others.”
[RONNIE]
I have always celebrated every gift of breath, and now it is being challenged.
[ARSHY]
“I have always celebrated every gift of breath, and now it is being challenged.”
[RONNIE]
A civilized society is defined by how we treat our elders, how we honour our parents, and now we are defining ourselves either for goodness or for neglect.
[ARSHY]
“A civilized society is defined by how we treat our elders, how we honour our parents, and now we are defining ourselves either for goodness or for neglect.”
[RONNIE]
Thank you.
[OUTRO]
[ARSHY]
Tamara Sussman doesn’t blame any one person or institution for what’s happening in Quebec.
[SUSSMAN]
Honestly, I think it’s on all of us. We have been comfortable just hiding older adults who are really frail away, hoping to God they’re taken care of okay, and going about our business. And honestly, all of us are to blame. And I think all of us need to be part of the solution.
[ARSHY]
Quebec is starting to organize for a second wave. The government is hiring thousands of new care workers. The Minister of Health has been replaced, and we’ll find out soon enough if these changes will be meaningful.
As for Kitra Cahana, she’s continuing to organize and trying to get society to understand the suffering people in long-term care are facing.
[KITRA]
I hope that the pandemic is a wakeup call for society. It’s been very discouraging. Maybe I shouldn’t have been surprised, but I’ve found very few young people fighting for this cause. It seems like most of the people who are fighting for the lives of people in long-term care, either family members or health care workers. I really feel like this is an important movement. I think it’s the movement that people don’t know that they want to be a part of.
But I see this work as just another– another vehicle towards that tikkun olam, trying to mend the world and make it a better place for all of us.
[END CREDITS]
[ARSHY]
That’s your episode of Commons for the week. If you want to support us, click on the link in your show notes or go to commonspodcast.com.
This episode relied on reporting done by Aaron Derfel of the Montreal Gazette, Les Perreaux and Tu Thanh Ha at The Globe and Mail, André Noël and Rick O’Shea, the team at Global News Montreal, Nora Loreto, and many others.
A special thanks to Innis Ingram for putting us in touch with Kitra Cahana.
If you want to get in touch with us, you can tweet at us at @COMMONSpod. You can also email me, Arshy@canadalandshow.com
This episode was produced by me and Jordan Cornish, with additional production by Tiffany Lam. Our managing editor is Andréa Schmidt, and our music is by Nathan Burley.
If you like what we do, please help us make this show. Click on the link in your show notes or go to commonspodcast.com
