Medical officer of health Sheela Basrur has proved to be the city's real leader in the fight against the virus. It's no surprise, writes JOHN BARBER. She has always been outspoken, determined and progressive

By JOHN BARBER
Saturday, April 26, 2003

Lori of Toronto, as the call-in show identified her, spoke for an entire frightened, black-flagged city when she described her response to a just-televised press conference in which shaken civic leaders lashed out at the World Health Organization, just hours after it had declared Toronto a medical pariah on par with disease-ridden Shaanxi, China.

Led by an angry, unsteady Mayor Mel Lastman, clearly suffering from the debilitating effects of ongoing therapy for hepatitis C, the Torontonians put on a brave face. But Lori was worried.

"I have such faith in Dr. Basrur," she said, referring to the city's diminutive, 46-year-old, single-mother medical officer of health, who had followed the mayor's performance with a lucid and persuasive, fact-by-fact deconstruction of the WHO analysis.

"She is so honest and you know she has such integrity," Lori said, hesitating slightly before plunging forward. "Please don't let Mayor Mel represent us on CNN!"

In the actual event, it was appropriately Mr. Lastman who first proclaimed Toronto's outrage to the world via Aaron Brown at 11:30 p.m. Thursday. But by that time, after an emergency meeting in which a galvanized city council launched a fusillade of SARS-related initiatives, the real leader of the city's increasingly confident struggle with the disease was even more obvious to all. It was Dr. Sheela Basrur.

Nobody knew that better than Mr. Lastman and his party, who have spent the past five years cutting the city's public-health budget while treating its leader with suspicion and even outright hostility. At the end of Dr. Basrur's latest comprehensive and reassuring presentation of actual facts regarding severe acute respiratory syndrome in Toronto and the world, the grateful leaders rewarded her with a standing ovation and a bouquet of flowers.

Deputy Mayor Case Ootes, who has tangled with the good doctor in the past, hailed her as "the personification of excellence in every respect."

Dr. Basrur has become "a household name not just in Toronto and in Ontario but really across Canada," health board chairman Joe Mihevc enthused, singling her out in a glowing tribute to the city's exhausted public-health workers. "They appreciate, Dr. Basrur, the clarity, the integrity and the straightforwardness of your presentation of this disease."

Toronto needs a Rudy Giuliani? Just look down. There she is, "five feet and shrinking," she allows when pressed, a woman of colour with the physique of a Cornish hen, large expressive eyes shining behind her glasses and the unmistakable ways of a born leader.

Sheela Basrur is a New Age leader who came to prominence the old-fashioned way, much to her own surprise, as a down-and-dirty fighter in the infection-control trenches. Working in isolation, her department was almost overwhelmed trying to track down and gather up the far-flung cases that exploded out of Scarborough Grace Hospital last month. As the crisis widened to engulf the entire regional health-care system, however, it was her talents as a communicator that came to dominate.

Fearsomely articulate, logical and frank in her assessments of the epidemic, Dr. Basrur worked steadily to allay fears about rampant contagion in Toronto. Although little heeded at the height of the alarm, she emerged as the steadiest, most credible public spokesperson on SARS. By the time WHO hit, nobody was prepared to hit back harder.

Neither city council nor the Toronto public was necessarily receptive to a message of hope and calm in the wake of this week's devastating news from WHO. Mere facts seemed feeble in the face of that titanic judgment, which instantly decreed more hardship for a swath of the SARS-affected populace.

Wagering her entire boodle of carefully gathered medical credibility, Dr. Basrur took the opportunity to proclaim victory over SARS.

"All signs at this point are giving me cause for optimism," she declared in a big, steady voice at the end of her bravura presentation to the demoralized city councillors, laid out with every new fact battened down.

"We do not have further spread in the community. We do not have widespread disease in hospitals. We have localized transmission in high-risk environments, and the people who have been exposed are either in hospital being treated or at home in quarantine, where they belong."

What did we do wrong, one downcast politician asked.

"Bad luck and worse timing is the answer," Dr. Basrur replied. "There is no other rational explanation for it."

Nothing is going wrong in Toronto, she insisted. On the contrary, Toronto is once again showing the world how to do things right. "Proper infection control works," she said. We proved it. What's bad luck for us will be "an effective learning experience for others."

So listen up, silly WHO: "We absolutely do not have a medical emergency."

The time has come, Dr. Basrur concluded, to manage SARS "in a way that is realistic and responsible, not overly panicked and fear-driven." To get back to normal life, as quickly as possible.

"What we need most is the renewal of public confidence in this city, and that begins with us."

The standing ovation, the flowers, the tearful tributes, the relief: At last, a clear road forward.

Wide-eyed and clear-complexioned, Dr. Basrur shows none of the fatigue she must feel when she settles down a few hours later for her umpteenth disquisition on SARS. Her bag lunch goes uneaten as she talks on.

"I guess that's why I'm shrinking," she says. No time to eat.

She laughs at being called a diminutive dynamo, admitting to have taken one day off since the crisis began, a victim of the sniffles. "It was the type of thing where I had to follow my own advice," she says with a shrug. "So I stayed at home with two lines going on the cellphone as well as the land line and the Blackberry, watching the press conference on television with a box of Kleenex."

Things are easier now, with SARS under control. But now that the dirty work of corralling the disease has been accomplished, the need for effective communication is even stronger, according to Dr. Basrur. "At this point, the overreaction is worse than the disease," she says, "especially if the disease is on the wane and panic shows no sign of abating. That would be a very, very bad thing."

Toronto's SARS crisis is a Walkerton-style wakeup call in her view, "a very useful reminder to all of us that if we don't take care of the basics, our health will be imperilled." For a public-health official in Toronto, she says, the main lesson of SARS is that "we have a very, very limited capacity to respond to the unexpected."

That's bound to change; one senses Dr. Basrur will have more money in her budget next year.

Born in Toronto -- at Women's College Hospital, she notes proudly -- Dr. Basrur never intended to spend her life here, preaching an old-fashioned sanitation gospel, when she completed her medical studies at the University of Toronto. Public health was her worst subject, she laughs, "if that's any consolation to the current cohort."

But her life changed with a round-the-world backpack odyssey in the mid-1980s, when she spent more than half a year in Nepal and also India, her parents' native country. "What I saw there were huge opportunities for prevention that were systematically missed because the infrastructure wasn't there to enable anything but treatment of the cases that could make it to hospital," she says.

She had already experienced the frustrations of a revolving-door general practice, so she threw herself into another four years of study in community health.

Nepal remained a long way off when Dr. Basrur took her first job as associate medical officer of health in the now-defunct borough of East York. Putting her dreams of an international career on hold, she raised a child -- a girl, now 12 -- and climbed the local ladder instead, emerging as the first MOH of amalgamated Toronto in 1997.

Although Dr. Basrur earned plaudits for implementing Toronto's first restaurant-rating system, she remained an outsider in Mr. Lastman's city hall regime -- annoyingly resistant to the place's endemic gamesmanship, yet stubbornly progressive all the same. A very quiet yet determined troublemaker.

She refused to declare a health emergency during Toronto's garbage strike last summer, thus failing to enable the swift passage of back-to-work legislation. (Her provincial counterpart, Dr. Colin D'Cunha, did it instead, while Dr. Basrur stepped aside and bit her lip.) She also infuriated Mr. Ootes and other members of the mayor's party when she insisted that expansion of Toronto's waterfront airport was a serious health threat. Her department remains the most seriously understaffed in the entire municipal establishment.

But the Toronto public health department is also a storied service whose always-independent leaders have collectively made more history in this city than any number of mayors. Dr. Basrur situates herself firmly in a long line of hard-nosed, determined advocates stretching back to Victorian times, "doctors who were very active reducing the burden of communicable diseases by tackling malnutrition, bad housing, bad air, unclean water, unsafe food -- the same issues that even a century later are confronting us."

"Often we give voice to those who don't have a voice," the unrepentant progressive continues, her uneaten sandwich going stale while she talks on. "People who are homeless, people who are marginalized in society, those with very low incomes, with poor English skills, people who are out of work. They may be trained professionals in their countries of origin, but they're delivering pizzas here. People who suffer needlessly from health problems.

"It may not be as stark as suffering from tuberculosis in Nepal, untreated for years on end, but it's still a problem in our society that should be dealt with. If I can't speak to those issues, who will?"

Currently, she says, the most marginalized citizens are the thousands who have been brushed by the bug, many of whom now suffer from serious discrimination as the disease abates. She spoke movingly to council about one family of 24, of whom 14 are sick and two dead.

Even before SARS began to make headlines, Dr. Basrur was testing the patience of her Queen's Park counterparts with sharp criticisms of what she considered their inadequate preparations for the region's next microbiological onslaught -- West Nile disease. Those concerns remain, she says.

So she is not going off the air any time soon. From Walkerton to SARS to West Nile, public-health capacity -- or the lack of it -- has emerged surprisingly as the greatest challenge facing 21st-century Ontario. It will be easier for Torontonians to face with a proven leader firmly in charge of the job.

Proper infection control works, Dr. Basrur says. "If you can't manage that, you shouldn't be in the business."

Believe it.

John Barber is The Globe and Mail's City Hall columnist.

Märkmed: