'We've had to make difficult choices': N.W.T.'s medical director reflects on her tenure

In a 27-minute Zoom conversation with the Northwest Territories' outgoing medical director, the word "risk" was said 14 times. 

"I often talk about balance of risk," Dr. AnneMarie Pegg said on Monday.

Over the last year and a bit, she went on, her team has often been forced to make a choice between two bad options. 

She said it's come down to, "which of these has the risk that we're willing to accept, and which of them has the risk that we're not willing to accept."

Pegg became what the Northwest Territories Health and Social Services Authority calls the "most senior physician administrative leader" in November of 2020. On March 4, she will step aside after a little more than a year in the position. 

In an exit interview of sorts with CBC News, Pegg talked about the challenges of weighing risks, and allocating health resources when resources are limited. 

It was one such evaluation that led to the suspension of birthing services at Stanton Territorial Hospital in Yellowknife — a decision, Pegg said, that was not led by physicians. 

The N.W.T. health authority has said the transfer of nearly all expecting parents to Edmonton from Dec. 10, 2021, through Feb. 21 was the result of a staff shortage.

"That was a decision that was really, really wrenching, I think, for everybody who had to make it," said Pegg.

She said it involved weighing the risks to patients' mental health and "family cohesion," with the fear that if something were to go wrong in the birthing unit, it "would be really difficult for us to justify and to live with."

"We weren't really able to accept the risk that would come with putting those families in a situation where they may not be able to be optimally cared for," she said.

Pegg had hoped to stay another year

Pegg took the job of medical director during the first year of the pandemic, knowing that difficult times lay ahead.

Though she didn't have much "physician executive experience," she said, she did have experience managing teams through COVID-19 and outbreaks of other diseases in her previous job as a clinical lead for epidemic response and vaccination with Médecins Sans Frontières (Doctors Without Borders). She had also spent stretches working in the N.W.T. in the past.

Pegg signed a one-year contract — unusual for an N.W.T. medical director, who typically serves a three-year term — and is leaving now because of some "fairly complex personal situations" involving her family, she said. 

"I had hoped to see out at least another full year," she said, "but unfortunately, life sometimes throws some things at you."

Vaccination campaign, successive outbreaks

Shortly after Pegg started as medical director, the territory launched its vaccination campaign, which she called an "an enormous success." 

In the N.W.T., 79 per cent of the eligible population is fully vaccinated. Across Canada, that figure is nearly 83 per cent. 

It wasn't long though, before Pegg was faced with a community outbreak in Fort Liard. That was followed by an outbreak at N.J. Macpherson School in Yellowknife, the Delta wave and now Omicron. 

"We knew it was coming," said Pegg of the outbreaks. "We knew we weren't going to be immune."

Pegg also spoke about limiting contact tracing and access to testing in order to maintain other health care services. 

Again, she gestured toward balancing risks: focusing energy on who is likely to get most sick from COVID-19 to "hopefully avoid some bad outcomes," while continuing to uphold services in other areas, "because if we completely ignore those, then we're going to have bad outcomes on the other side, too."

"We've had to make difficult choices, and the outcome of that has probably meant that other areas of risk have gone up, and there's no way around that," she said.

Given this reality, Pegg encouraged her successor to be open with the public about why certain decisions are made. 

After her departure, Pegg plans to have "a few weeks of nothing," and eventually, return to the territory as a locum physician.

As a final note, Pegg gave credit to her colleagues.

"There were a lot of people who worked so many hours, you know, evenings and weekends and early mornings," she said.

"Whoever takes on that position and also inherits that team, so they're lucky."