ONLEY firstname.lastname@example.org_county.toronto.globe_and_mail 2008-06-03 published
Sheela BASRUR, 51: Physician
At the height of the 2003 crisis that stunned Toronto and caused the rest of the world to stay away from Canada's largest city, she worked three weeks straight. At one point, she said it was like 'ripping a bandage off one wound to stop the bleeding on another'
By Gloria GALLOWAY, Page S8
Ottawa -- Toronto's hotels were half empty, people on the streets were wearing medical facemasks, the city's Chinatowns were ghost towns, and there was one reassuring voice pleading for calm.
Sheela BASRUR was Toronto's medical officer of health when severe acute respiratory syndrome arrived in her city, stealing in from Hong Kong and unleashing its deadly force on a population taken fully by surprise.
Suddenly, the diminutive doctor was thrust onto the national stage. The world's health community turned a concerned eye on Toronto. Reporters from across the country were calling to demand answers about the deadly and previously unknown threat.
Amid the chaos, she became a trusted general in the fight against the disease.
In the beginning, Doctor BASRUR and her team were working in a knowledge vacuum. "What kind of control measures, what kind of investigation might be needed? How many contacts might there be?" she once said describing the questions that arose in the early days of the crisis. "We had no idea that we might be facing hundreds of contacts even in the first weekend and 23,000 by the end of it."
With the first deaths, the apprehensions of the entire city - and, to some extent, the rest of Canada - came to rest on her five-foot frame. It was a weight she shouldered with remarkable competence.
Sheela BASRUR had always wanted to be a doctor.
She was born in Toronto to Vasnath BASRUR and his wife, Parvathi, who had arrived from India as graduate students during the 1950s. Vasnath was an oncologist; Parvathi was a veterinary geneticist who managed to obtain her degrees despite growing up in a poor family of 10 children.
When the BASRURs moved to Guelph, an hour's drive west of Toronto, they were conscious of being what seemed to be the only visible minority family in the community. When Parvathi BASRUR breezed by in her sari, people on the street would stop and stare.
The young Sheela penned poems and essays for sheer amusement. She was also a skilled flautist and told the Toronto Star, in one of the many profiles that paper wrote about her over the years, that her artistic nature led her parents to believe she would one day be a writer or a musician.
But the biological subject matter of the BASRURs' dinner banter led her in a different direction. After high school, she obtained a science degree at the University of Western Ontario in London and then headed to the University of Toronto to study medicine.
The newly graduated Doctor BASRUR returned to Guelph, where she practised as a family doctor for a year. But adventure called and, in 1985, she headed on a trip around the world.
It was in Nepal, and then in her parents' homeland of India, that she decided to pursue a career in public health. She told a reporter that visits to hospitals and clinics in those countries convinced her of the importance of community medicine. In one village, she encountered a woman with tuberculosis who could not afford the full treatment for the disease but whose husband needed her to be well enough to return to work on the family farm.
When she returned home, Doctor BASRUR sought her masters degree in health science as a specialist in community medicine. Her first forays into public health were adventures. She was, for instance, the chief investigator of a massive recall of shellfish along the Eastern seaboard.
Then she returned to Toronto and first became the medical officer of health in East York, the smallest of the city's suburbs. Starting in 1998, she was made head of a huge department that formed when all of the suburbs amalgamated.
In her private life, she enjoyed classic rock 'n roll, especially The Who. She tried her best to be a vegetarian but was not always successful. She did yoga every day before the sun came up. And she was a needlepoint fanatic. "I just find it very therapeutic," she once said.
An early marriage did not last. However, out of that she gained a daughter, Simone, who was the love of her life and her companion through her final difficult years.
Dr. BASRUR's early days at the Toronto Board of Health were spent supervising the merger of the various boards and handling ordinary local issues - children's food programs, smog alerts, and the first posting of the results of restaurant inspections.
And then, in March, 2003, came severe acute respiratory syndrome which was eventually determined to be a disease caused by the coronavirus. A genus of animal virus named for their crown-like appearance under a microscope, they are among the leading causes of the common cold. Until the onset of severe acute respiratory syndrome, they had been known to cause severe diseases only in animals.
However, by April 2003, several labs had uncovered evidence of a new coronavirus that had infected at least some patients with severe acute respiratory syndrome. By then it had struck more than 2,600 people and killed 103 worldwide.
Suddenly, people were dying in Toronto. It was a disaster that had to be contained.
Like many of those on the front line, Doctor BASRUR worked three weeks straight after the first cases were discovered. As severe acute respiratory syndrome spread through the city, she and her team charted its course, trying to build firewalls between the infected and those who were sitting vulnerable in its path.
At times, just when they thought they had stemmed its spread in one direction, the disease would pop up somewhere else through an unanticipated line of transmission. Mass groups of students and factory workers were quarantined. People were told they could not go to the funerals of loved ones. Health workers were dying along with their severe acute respiratory syndrome patients.
At one point, she described the fight against severe acute respiratory syndrome as "ripping a bandage off one wound to stop the bleeding on another."
Dr. BASRUR and others were also puzzled as to why 40 per cent of severe acute respiratory syndrome patients failed to demonstrate evidence of being infected with the new coronavirus. What's more, other people who did carry the virus did not have severe acute respiratory syndrome, or severe acute respiratory syndrome symptoms. Also troubling was the fact that the coronavirus carried only four to 10 genes and were infamous for mutating with every replication and for swapping genes with other viruses.
All things considered, it is not surprising that misjudgments did occur. It took nearly a week for the members of a 500-person religious community to be sent into quarantine after being exposed to severe acute respiratory syndrome because health officials did not realized the contacts had been made. Asked about the delay, Doctor BASRUR said: "It's a fair question… hindsight is absolutely my best friend."
There was the odd humorous moment, like the Abbott and Costello routine she played with Toronto Mayor Mel Lastman. As the elected head of Canada's largest city, he was experiencing his first encounters with such organizations as the World Health Organization (WHO) and the Centres for Disease Control near Washington.
Upset by a press conference about a travel advisory that had been imposed because of severe acute respiratory syndrome, he railed against the warnings that had been announced by "this Centres for Disease Control group, whoever they are."
"WHO," whispered Doctor BASRUR.
"Who?" he shouted.
"That's right, WHO," said the doctor trying to control her laughter.
But, as 44 people lost their fight to the disease, there were many frustrating and difficult weeks. And through it all, Doctor BASRUR - the face of calm and reason - became one of the acknowledged heroes.
A female co-worker remembers bumping into her one day during the crisis as she emerged from a washroom. The co-worker told Dr. BASRUR that she looked wonderful and the doctor responded by saying she felt tired.
"And I said, 'Sheela, you're great. The whole city loves you and is counting on you. And this morning on the radio I heard the host of the morning show say that he knew it was okay to go out because the little doctor with the glasses said it was.'"
Dr. BASRUR laughed and hugged the woman in delight and went off to try save more lives.
Several years later, the co-worker e-mailed Doctor BASRUR and asked if she remembered the incident. "And she said 'yes, but I believe he said the cute little famous doctor with the glasses."
Those who worked with her during that time say it was a huge privilege to be part of her team. Bonnie HENRY, who was Toronto's associate medical officer of health, said Doctor BASRUR's great strength was her ability to communicate.
Months after the crisis, the two doctors were walking through an airport together "and people would come up to her in the airport and say 'I feel like I know you,' said Doctor HENRY. " She was always very gracious. She was really touched by the fact that people responded to the way that she was able to communicate things."
Dr. BASRUR's tireless efforts during severe acute respiratory syndrome made her the first choice of the Ontario government when it went looking for a new Chief Medical Officer of Health in January, 2004. Her mandate was to revamp the way health programs were delivered in the province and to do whatever possible to prevent another severe acute respiratory syndrome. She took on such big jobs as instituting a rigorous anti-smoking policy and a provincewide healthy-eating program.
Then, in November, 2006, a pain in her lower back that she had been feeling for some time became excruciating. It was caused by a tumour on her spinal cord.
Concerned that she could become a paraplegic, her surgeons removed it immediately. But the prognosis was still not good. She had hemangiopericytoma, a rare vascular cancer that started in her uterus and spread throughout her body.
All at once, the doctor had become a patient. Even so, the disease did not incapacitate her. A week after stepping down from the job of Ontario's top doctor, she returned to the provincial parliament to see the introduction of legislation establishing a new public-health agency - an agency she helped create and one that has been named after her.
The months after the diagnosis were like a gift wrapped in barbed wire, she said. "It's like being given the most beautiful bouquet of roses you can imagine being placed in your arms and thinking 'whoa, they've got thorns on them.' "
Dr. BASRUR said she preferred to focus on the "rose petals," like the fact that, after a lifetime of hard work, she had been able to devote time to her daughter, now 17.
In April, she was awarded the Order of Ontario in her hospital bed by Lieutenant-Governor David ONLEY. The next day, she rallied and attended a fête organized in her honour by the Registered Nurses' Association of Ontario.
Ontario Premier Dalton McGuinty told the crowd they must not been fooled by her size. "She's tough when she needs to be - a regular Mighty Mouse."
Ontario Health Minister George Smitherman said later that he could not agree more. During severe acute respiratory syndrome, "she was the one that lifted us on her shoulders, even though she wasn't that tall. For a little person, she proved to be awfully mighty."
In difficult times, he said, it's particularly important that clinicians communicate in a way that is accurate, concise and understandable. "Not everyone has that gift."
In the end, Friends say Doctor BASRUR was accepting of the fact that she would die at 51. "If I can help more people have a great life," she once said, "then I'll have a great life."
Sheela BASRUR was born in Toronto on October, 17, 1956. She died June 2, 2008, of hemangiopericytoma, a rare vascular cancer, at Grand River Regional Cancer Centre in Kitchener, Ontario She is survived by her daughter, Simone KOVES, and by her parents, Vasnath and Parvathi BASRUR.
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