Peterborough Public Health (PPH) is facing several compounding health crises: the third wave of the COVID pandemic fueled by the Omicron variant and the epidemic of opioid-related deaths. In the midst of these concerns, the organization has taken on a new medical officer of health, Dr. Thomas Piggott.
Piggott took up the post in December, moving to Peterborough from Labrador, where he was medical officer of health for Labrador-Grenfell. Prior to that, he worked in the Democratic Republic of Congo with Médecins Sans Frontières.
His first few months as head of PPH have been focused squarely on responding to the COVID wave as well as working aggressively to secure interim funding for a safe drug consumption site. Alongside this work, PPH staff have had to respond to protests outside their office, and outside of Piggott’s home.
Hear Dr. Piggott speak on his work, recent challenges and how he approaches public health in this interview.
Ayesha Barmania 0:02
Hello and welcome to the Peterborough Currents podcast. My name is Ayesha Barmania. Today on the show, I have an interview with Peterborough’s medical officer of health, Dr Thomas Piggott.
Doctor Thomas Piggott is a public health and preventive medicine specialist,. He got his Masters degree in Public Health at McMaster University. He’s also a practicing family physician. And prior to Peterborough, he was medical officer of health for Labrador-Grenfell. Before that he worked as a field doctor with Médecins Sans Frontières – AKA Doctors Without Borders. He is also actively involved in research and teaching on public health.
And before I get into the conversation, I wanted to give you a little bit of background. So, as I record this, it’s February 2022. I spoke to Dr. Pickett about a week ago. And we’re coming up on the two year anniversary of the WHO declaring a global pandemic caused by a novel and highly infectious coronavirus, which we all know now as COVID-19.
Over the past two years, the world has seen COVID mutate into increasingly infectious and worrisome variants. First it was the Alpha variant, then Delta and just in the last few months, Omicron has picked up steam. It is a drastically more contagious variant than previous strains of COVID. And right as Omicron hit Peterborough, our new medical officer health started his job – that was the beginning of December.
As he came into his new position here in Peterborough, he knew COVID was his top concern but not his only concern. As we’ve reported on here at Peterborough Currents, our community is facing an ever-worsening health situation and that is due to harms stemming from the opioid crisis.
Three months ago, our team reported that 43 people lost their lives in what public health calls ‘opioid-related deaths’ here in Peterborough in 2020, which is up from 29 the year before. My colleague Brett Throop found in his reporting that opioids have become increasingly contaminated with other drugs, in particular benzodiazepines and stimulants. Our reporting found that of the opioid-related deaths in 2020, the majority involved a contaminated supply.
One solution to ease the number of opioid related deaths has been proposed by a coalition of local agencies that work with people who use drugs, including Peterborough Public Health. The solution they say is a supervised drug consumption and treatment site – called a CTS for short.
At the site people can use drugs while health workers and support staff are on hand to save lives in case of overdose as well as direct folks to treatment and harm reduction resources.
Health Canada has approved the location on Simcoe Street for the CTS to open and for over a year, the agencies have been waiting on an application for provincial operating funding. Tired of waiting, in the last two months, Dr Piggott has been approaching multiple sources for funding to open the CTS as soon as possible.
In my conversation with him, we talk about the opioid crisis, the pandemic, and I also asked him about recent protests that have occurred outside of the public health office and outside of his own home. There have been multiple incidents in the last two months of people protesting measures intended to limit the spread of COVID – protesters call for ending lockdowns, mask requirements and capacity restrictions.
Okay and with all of that said, I think I’ve given you all the background you need for us to hop into the interview. One last thing I’ll say is that if you like our reporting and if you find it does help you to understand more about this community, I’ll ask you to please support Peterborough Currents with a financial donation. Reader contributions are the single greatest source for our financial stability. Signing up plays a big role in helping our little newsroom plan for the future. Help us to stick around! Head to peterboroughcurrents.ca/supportus
Ayesha Barmania 3:52
Well, thanks so much for joining me today. I really appreciate you making some time, Dr. Piggott.
Dr. Thomas Piggott 3:56
Ayesha Barmania 3:58
So I just wanted to start out by asking you a little bit about how you’ve been finding your first few months as a medical officer of health for Peterborough?
Dr. Thomas Piggott 4:05
Well, it’s great to be here in Peterborough, my family and I arrived in November. I started my job December 1, so little over two months now and for me, the community has been incredibly, overwhelmingly welcoming and kind. You know, it’s not been without some ups and downs so far. And there’s been lots of challenges, especially as we’ve faced the Omicron wave, which has been the most deadly wave of the pandemic yet for our region. I’m so proud and happy to work with the group of people that I do. It’s an incredible team and people very dedicated and passionate about caring for this community.
Ayesha Barmania 4:45
Yeah, I’m glad to hear that side of it’s been going well. It must be hard coming in mid-pandemic – like folks are, I’m sure, burnt out. How’s that transition been coming in?
Dr. Thomas Piggott 4:56
The pandemic has been ongoing for over two years now, and people are tired. It’s been a challenge to continue and to pace ourselves through this pandemic, it has been a series of sprints. And every time we round the corner, we realize there’s a whole new sprint or race in front of us. And, and that’s tiring, when you don’t know where the finish line is, when you don’t know how much longer this is going to be going on. It’s tiring, it’s been a challenge. But I think that we have begun to learn to pace ourselves and to make sure that our response to this pandemic is sustainable. And that’s been a big focus of my work, is ensuring that we have the team and the capacity to continue our work on the COVID 19 pandemic, because it is not over yet.
Ayesha Barmania 5:44
Mm hmm. And I know, on top of, you know, the usual work and what you’re trying to get done being very difficult. On top of all that there’s been protests outside of the public health office, and outside your own home, but I wondered if you could just take us through what happened there. And what’s been the ramifications for the team and, and for yourself?
Dr. Thomas Piggott 6:06
Yeah, no, thank you for that. Unfortunately, there’s not a lot that I can speak to, because it’s still a matter of an active police investigation. But, you know, the discontent we’ve seen, has been unfortunate, and really difficult for our team. You know, I understand that people are tired and sick of the pandemic. And you know, I’ve heard many very reasonable voices share that, and I share that too. I’m tired and sick of this pandemic as well. I recognize that some people are more vocal, and some people have wanted to express their discontent in different ways. And in this country, in this democracy, we have the enshrined right to protest. But unfortunately, the experiences we’ve had have gone far beyond that, have been intimidating, have been harassing, and have been very difficult for not just me personally, but our entire team. And at a time when we are tired, when we’ve been trying to do our best, trying to save lives through the pandemic, seeing the toll that this is taking in our community. And it’s been difficult, I think, for the community to see as well. And that’s I think, evidenced by the outpouring of support we’ve seen in the aftermath of these events. And I’ve been so heartwarming to see how much I love and kindness and appreciation came in the aftermath of what happened at our offices at my home. I think that that is just a true testament to the real caring nature of this region.
Ayesha Barmania 7:38
Is this something that you were prepared for coming into this role or in previous roles as a public health official?
Dr. Thomas Piggott 7:47
Well, I think there are always challenges in public health. And in the work that I’ve done, there are always some people that will disagree and express some concern with, you know, interventions and ideology. Concern with vaccines is not something that’s new to the pandemic, it’s been something I’ve been working on in my entire career in public health. I mean, I’ve worked in a variety of settings now. And this is by no means the hardest context that I’ve worked in, in my time with medicine South honcho in the D.R. Congo, in a conflict zone – in active conflict zone – the challenges were far greater, the insecurity was far greater, I think, in some ways that probably has prepared me to have the confidence to keep going and the capacity to lead our team through this difficult time. But you know, for many people on our team, it is difficult to continue to manage and to deal with this and to cope. Because not only are they working incredibly hard, long hours exhausted, but then to have and be on the receiving end of this kind of intimidation is just that last straw that is very difficult for people to take.
Ayesha Barmania 9:00
I think it’s been really interesting and kind of refreshing for me to see, like, it feels like you’re not pulling your punches at all. You’re not afraid to condemn the protesters or the convoy folks who are, you know, waving Confederate flags and things like that on your own Twitter account. Do you think that’s important for you to take those kinds of stands and be clear about what is acceptable and what is not acceptable?
Dr. Thomas Piggott 9:26
Well, I think it is important as I look at the consequences of different actions and impacts that I speak to my job, which is to help our team, our Peterborough public health team, and to help make our community more fair. And where that intersects with recent events is being defensive and strongly taking a stance that I will be in front of my team and I will not tolerate harassment and intimidation. And I think it also comes up because when we see negativity injected as part of this, and it’s not my place to comment more broadly on these issues, but if we see racism, if we see hatred, if we see sexism, these are things that ultimately impact the health of our communities greatly and severely. And so I think as a leader, it’s my job to speak out about those things as best as I can, when I can.
Ayesha Barmania 10:25
One other question about the protest, before I move on to a couple other questions, but I know some of the signs that the protesters were holding outside of your own home, in particular reference, one of the tweets that you had put out, in regards to the protests that were happening at public health, you had said that that was unacceptable. So they said, If you don’t like us protesting outside of public health will come to your house. Did that incident affect your thinking about social media? Did it make you question whether you should be posting things like this?
Dr. Thomas Piggott 11:00
No, I’m always very careful and reflective, I think it’s, it’s very important to be careful and reflective in that. But ultimately, at the end of the day, I’m doing what I think is needed. This and nothing is in personal or even organizational interest. It’s around the health of our community. And that’s what I’m here for. That’s what my job is.
Ayesha Barmania 11:26
Yeah. And so I wanted to also ask you a bit about – and you touched on this a couple of questions ago – but what do you see as the role of public health in terms of things like promoting health equity? And can you speak to your philosophy of public health?
Dr. Thomas Piggott 11:41
Yeah, sure. I think that what we have seen in society is an increase in inequity or an increase in unfairness in our society in recent years. So to put this into context, I’ve got a quiz question for you. Do you know what the life expectancy of the average Canadian was at Confederation in 1867? Take a guess.
Ayesha Barmania 12:06
1867? I would guess something low like 45.
Dr. Thomas Piggott 12:11
Oh, you’re good. It was 42. And do you know what the life expectancy of the average Canadian is now?
Ayesha Barmania 12:23
It’s different for men and women, but I think it’s somewhere around like 85, 88 years old.
Dr. Thomas Piggott 12:29
A little less, it’s 82. So in a little over 150 years, 154 years since Confederation, we’ve seen a doubling of the life expectancy of people living in this country. And that’s nothing short of incredible.
That’s not just public health’s work. That’s not just the healthcare systems work. You know, we’ve seen jobs become safer, we’ve seen, you know, communities become healthier. And, you know, we’ve seen the introduction of vaccines and other life saving treatments, especially early in life that help people to live longer.
But when we look at that life expectancy, 82 is an average. And when we look at subpopulations, there’s dramatic differences between different groups of people. So for instance, people experiencing homelessness, their life expectancy is at least 15 years younger than the Canadian average. People who are Indigenous, you know, as a group, among Inuit men, the life expectancy is dramatically lower, around 67. And so people who are Indigenous, people who are experiencing homelessness, people who are otherwise marginalized in various ways, have a dramatically less likely chance of living as long as the Canadian average.
And so as much as there has historically been effort to try to reduce diseases, we’ve made tremendous progress. But all the while the gap is growing. And so I think that that is evidence that public health’s main focus needs to be in its roots, which was addressing the inequalities, the unfairness between different groups and trying to help to narrow those gaps in different ways. And so that’s where I believe a key focus of public health needs to be.
It has been through the pandemic, think about the equity lens that was used in the rollout of the vaccine. Think about our extra and enhanced focus on high risk settings for outbreaks, whether they be shelters, other congregate living settings. We know that different groups need different attention. And that’s what equity at the end of the day or fairness is all about is everyone doesn’t mean the same thing from us and public health. And we need to do what we can to get people what they need to obtain the best health But they can.
Ayesha Barmania 15:02
You’ve also written about underserved communities, as you call it and edited a book about it. Can you take us through what an underserved community is and how it relates to the kind of this idea of health equity that you’re just talking about?
Dr. Thomas Piggott 15:15
Yeah, sure. So you’re talking about the book that I coedited with Dr. Arya, who is a family physician and researcher in Kitchener-Waterloo. And that book was about a four-year really exciting project that culminated in its publishing in 2018. We worked with people, researchers, practitioners all across the country to compile not only the evidence on underserved populations, but a lot of stories and experiences from people with lived experiences. And it was a really good learning experience for me as well about these issues and about the ways in which populations are underserved. The language of that was intentional.
When we talk about people being marginalized, or people being vulnerable, that language reflects an intrinsic problem with that population. And it essentially says, you know, it’s somebody’s own fault that they’re vulnerable, when in reality, it’s that the service needs perhaps if somebody’s experiencing homelessness or somebody who is a new refugee to our country aren’t being met. And that’s why underserved focusing on the service needs, from the health and social system was the intentional terminology used in that book. So I think that work continues to guide a lot of my thinking and work in public health to this day, because like we’ve discussed already, you know, health equity or fairness, justice, are really important priorities for us to help with in public health.
Ayesha Barmania 17:03
And to bring it back to that idea of average life expectancy. So rather than framing it in terms of like, “I’m a person of color, so I’m going to die five years earlier than a white colleague, and that’s my fault for being vulnerable.” It’s more about, you know, if, if that does happen to me, it would have been because I was underserved, or in some ways failed by the health care –
Dr. Thomas Piggott 17:25
Yeah, because we have to ask the questions. There’s no inherent underlying biological reason, just like there isn’t really a good underlying biological reason for the gap between male and female life expectancies. Often that’s attributable to, you know, a lack of accessing health care or higher risk employment conditions. And for people who are underserved.
There aren’t biological or otherwise inevitable differences. It is all a matter of the access and service, both from a health system standpoint, but also throughout the life course. Right? It may mean that your educational opportunities were the same, or it may mean that people in their early years– and the early years is something I’m really passionate about, because it’s a time that we can really change the life trajectory, we can do more. And I think public health spends a lot of time trying to look at those ways that we can do more and provide service and provide supports to help to narrow that gap.
Ayesha Barmania 18:26
Absolutely. And to bring it back to the pandemic and what we’re thinking about previously. Do you see folks who are in these anti-mandate anti-science anti-vaccination movements as its own community? And are they potentially underserved? Have they been failed in some way by healthcare institutions?
Dr. Thomas Piggott 18:51
I think it’s an interesting question. It’s something that I am trying to continue to understand with a lens of kindness and empathy, which I think is important. You know, in the face of even the most negative hatred, the response should not be counter hatred. It should be kindness should be justice, if there’s laws broken and wrongs committed.
But ultimately, at the end of the day, there probably are underlying determinants. Whether they’re right or wrong, I think are value judgments that I’m not prepared to make, but if people do not understand and believe in vaccines and science, is that not in some ways, a failing of our educational system?
You know, we spend a lot of time on things in elementary and high school that sometimes I think back and don’t remember anything about, but, you know, have we done our job to not only teach about the safety of vaccines, but the scientific process.
People don’t necessarily understand that in the pandemic and with the science of the COVID-19 vaccines. That has been incredible science. We’ve given over 10 billion doses. And we have data on the safety and effectiveness of all of those doses. We have, you know, had an incredible imploring of investment, to do science really rigorously and well, so that we know that something is safe and highly effective. But we’ve also had, you know, an acceleration of this because of people.
There’s a Trent University professor here, I want to just take a second and talk about Professor Christopher Kyle, his focus, his work is on forensics. And that’s his life, career and work. But he stepped forward in this pandemic, to contribute to science, and he’s leading the wastewater surveillance for COVID-19 here in our community, not because that’s an academic interest or priority or area of focus for him, but because he was just passionate about doing his piece and helping out. And around the world, there are 1000s, maybe millions of stories of people that have contributed to this.
So, you know, coming back to this, I think, I’m tremendously encouraged by all of the science that’s happened in this pandemic, but a lot of people, perhaps for ideological reasons, or for reasons and misinformation that they’re being fed, do not believe that.
I think that one really important area of education focus, too, is when there is misinformation circulating, sometimes people don’t critically assess it enough. Sometimes the source of misinformation is actually commercial interests, because somebody is trying to sell some other cure, you know, snake oil type alternative to what the science says is important. And, people don’t necessarily pick up on that. And, with social media, the misinformation spreads quickly. And it does make it challenge to counter but I do think, and we’ve been trying our best in public health, to actively counter misinformation and make sure people get the facts straight. But certainly we have a lot of work to do in our schools and in our education system, and in our society to help people to understand this.
Ayesha Barmania 22:06
And I’ll hold myself back from asking more about that area, because it’s my own personal interest, but move on to a couple other questions. So we’ve been kind of talking about the pandemic response, as a major part of your work. But we’ve also seen recently, and I’ve been impressed to see this kind of aggressive approach you’re taking to funding and opening the supervised drug consumption and treatment services site. Can you take me through why it’s so urgent for you to get that open?
Dr. Thomas Piggott 22:37
Well, we’ve been looking at the data on overdoses for some period of time now, this is an issue that has been in our community and in our province for a number of years now. But what we’ve seen and what we saw when we really delved into the data was an acceleration of this through the COVID19 pandemic, when you look at the number of visits by ambulance, for people experiencing overdose, from 2020 to 2021, they doubled. When we look at deaths in the past five years, deaths in the region have gone from 10 to 44. Last year. It’s at the point where we’re nearly experiencing one death every week in this small region. And that is tragic. And that is a crisis. And that is something that we need to do more about.
So I’ve been asking questions, I’ve been working with our local MPP in the region, as well as, you know, trying to better understand how we can increase the availability of services or variety of services, but in particular, one service which is access to a safe consumption and treatment site, a CTS that would potentially decrease the number of deaths and adverse experiences from overdose that we do experience, I think it would be an incredibly life saving and important thing for our community.
And we’ve been asking questions, as we understand, you know, it’s actually been since 2020, that the application went in, what else does it need? How else can we help to advance that? And if ultimately there is not going to be the funding? Is that something that we can attain local funding to support and to start on because we know it could be life saving?
Ayesha Barmania 24:30
Yeah, so there’s the Health Canada exemption that lets the service operate. And, in theory, the province of Ontario funds CTS locations around the province and the application has been in for over a year for the Peterborough site. The funding doesn’t necessarily have to come from the province in order to open it. And you just received the first plank of funding from the Board of Health $250,000 You’ve said that the CTS will reduce deaths, but we know that it won’t be an end to the opioid crisis, some have said that decriminalization might be a path towards that. Is that something you support? And what do you think decriminalization would ease this crisis?
Dr. Thomas Piggott 25:12
Yes, I do. I do. I think that the criminalization of drugs is a big part of the reason that we have the crisis that we do have. I often talk and compare it to alcohol, which we learned that alcohol prohibition in the 1920s didn’t work and we backed down off that. Alcohol continues to have a lot of negative consequences, our community, but it is not in the same way that the overdose crisis is impacting.
If instead of getting alcohol from the liquor store, you had to go to the street and you had to buy it from somebody who was potentially involved in organized crime, and you didn’t know: are you getting water? Are you getting moonshine? I think that that is the experience that people who use drugs, people who use opioids have on a daily basis.
And the criminalization also then further exacerbates the problem by you know, filling our prisons with people who have a mental illness or substance use disorder, as opposed to getting people treatment that they need to send them on the path of recovery.
Harm reduction, which this consumption and treatment site is, is about meeting people where they’re at, it’s about helping to save lives. So that means, maybe tomorrow, they might be able to seek treatment, it is not necessarily an end of itself. And I think that it’s important that we provide other solutions and other interventions, including trying to prevent this in the first place. And there’s evidence around things that we can do, trying to help people access treatment when they’re ready. But as anyone who has been impacted personally by addictions, well, no, it is a very difficult, long journey. And we need to help people while they’re on that.
Ayesha Barmania 27:05
I understand that medical officers of health in Toronto and Ottawa have recommended to their boards of health that – regionally I believe – opioids become decriminalized. Is that something you would recommend to Peterborough’s Board of Health?
Dr. Thomas Piggott 27:20
We have been in the early phases of exploring. But I think that it is a very wise move in other jurisdictions, because when that approach is taken, the evidence is the amount of drug use doesn’t actually go up, there’s nobody that’s going to go start using a drug because it’s decriminalized. But what it does do is it actually enables better access to supports and better access to treatments.
And it helps to deal with this dangerous drug supply. That is the reason that people are overdosing. No person who uses drugs, wakes up in the morning and decides I want to overdose today, I want to take a lot of this drug and I want to overdose today. But they’re playing roulette every time they buy drugs and use those drugs, and they have no idea what’s going to be in them. And so the criminalization of drugs, the, you know, the monetary benefits that go to organized crime, the uncertainty that therefore results for people who use drugs is a big driver and a big part of the reason that we have the overdose crisis that we’re in today.
Ayesha Barmania 28:33
Absolutely. One of my last questions, I know, we’ve gone over time, and I so appreciate your patience. There’s other ongoing public health services, clinics and things like that. I understand they’ve been suspended. And I don’t think they’re back up and running again, is that something that we can expect to keep being suspended? And how do you see the role of those like ongoing health clinics in the overall community health?
Dr. Thomas Piggott 28:56
We’ve already started bringing some activities back online, including the sexual health clinics and some other priority activities. We did have to slow down or stop on some of those during the omicron wave, largely so that we could redirect all of our resources to getting the vaccine, getting booster doses out so that we knew we would be able to save lives from that.
But I think that over the coming weeks and months, we’re going to start to bring other activities and other work that we have a backup back online. And we’re going to do it strategically. We’re gonna do it as quickly as we can, because we know the other work that we do is important, the pandemic has been critical.
The pandemic response has saved I couldn’t even tell you how many lives in this region. But at the end of the day, there are other public health issues that are really important as well the overdose crisis being one of them, but there’s so much work that we do, whether it’s, you know, inspecting restaurants and beaches, whether It’s helping newborns and their mums, whether it’s getting vaccines, other vaccines other than COVID, whether it’s dealing with other infections that are also important, whether it’s dealing with, you know, other mental health issues, chronic diseases and prevention of disease, promotion of health, there’s so much work that we do that’s really important that we need to get back going on. It will be a journey because this pandemic has been very difficult for our organization and for public health. And there will be time to heal and recover. And we need to recognize and respect that. But ultimately, at the end of the day, there’s a lot of work that we need to continue doing to protect the health of this community. And we’re really prioritizing getting back on.
Ayesha Barmania 30:53
Awesome, it’s a lot to juggle and thank you so much for all your work that you’re doing on it. And thank you for being on our podcast. I really appreciate your time and your clear explanations of everything.
Dr. Thomas Piggott 31:04
I really appreciate the chance to join you today. It was a really lovely discussion and I’d be happy to come back anytime and chat and good luck with the podcast. I look forward to listening to this and lots of other ideas from folks locally. I think it’s wonderful to be here in Peterborough-Nogojiwanong region and I’m just looking forward to the weather getting a little better and getting outside and really getting to see what this region has to offer.
Ayesha Barmania 31:38
Thanks for listening to today’s episode. It was produced and hosted by me, Ayesha Barmania. The guest was Doctor Thomas Piggott, Peterborough’s medical officer of health.
Music in this episode comes courtesy of Erika Nininger. Check out her music on Bandcamp.
This podcast is a Peterborough Currents project – we’re a local news outlet doing long-form and in-depth reporting on our community. We aim to connect you to the people making news and report on our community in a way that helps you understand the bigger picture. Our ability to do this work depends entirely on audience members supporting us financially. If you find our work is useful, please support us with a monthly donation. Head to www.peterboroughcurrents.ca/support-us to sign up.
That’s all for today. Thanks so much for listening. Bye for now.
Interview was edited for length.