Papers, please

Just in time for the summer – and the new identification rules to get into the United States – picked up my new Special passport yesterday. Green cover, and it’s a bit thicker and heavier than the regular blue passport: not just the gravitas of being On Her Majesty’s Service , but it’s got double the pages (48), and hidden somewhere in the cover, one of those high-tech new radio-frequency electronic chips!

The info guide says it’s only detectable within 10cm of a properly-encoded reader, and for extra protection some of the data can only be picked up if the passport is open, and the machine-readable area (the bits at the bottom with the “>>>” characters) is scanned by a regular optical reader. The guide also says not only to safeguard it like a regular passport, but also clean, dry and unbent, like an “electronic device”.

There’s also a special note on the observation page that, even though the passport’s valid for five years, if you’re not actually on duty anymore you shouldn’t be using it, and have to return it to the Passport Office forthwith. So you can’t just use it instead of coughing up 87$ for a regular blue one to use for international trekking and backpacking that’s not at Her Majesty’s pleasure – sorry, no freebies here.

Despite all the high-tech measures, it’s still got all the classic essentials of a passport: on the front cover, the Canadian coat of arms, and on the reverse, a scripted request from the Minister for Foreign Affairs (and perhaps International Trade, depending on what the department wants to call itself at the time) in the name of Her Majesty for free passage “without let or hindrance” and “such protection and assistance as may be necessary”

And, most classic of all: an actual embossed stamp! You can just feel the official-ness with your fingertips

Passports are pretty neat. Last time I was at the Foreign Affairs and International Trade headquarters – “Fort Pearson” – there was a display of passports through the ages. The first one ever was just a regular letter-sized slip of paper with a note to the effect of what’s still on the inside-front cover today. English Royal seal at the top – the Canadian-ness only indicated by the “Passport, Canada”. (“Passport – by the way, Canadian.”) No photo of the bearer – just a name, their job, where they live, and a signature

Official Canadian Bilingualism (at least for the fields, not necessarily for the entries) and descriptors beyond job came along by 1922. Photos too, though it doesn’t look like there was a designated spot on the page for it, it was kind of just glued on in a convenient space on page 3. A bit more secure, but not quite the same standard expressionless mugshots you have to use now though

By the ’30s, things were looking a bit more official. Still had employment as the number-one descriptor, the language of entries were still at the whim of the passport clerk, and the separate “Wife-Femme” column suggests only men would be allowed to hold passports (unless there was a women’s edition they just didn’t have on display I didn’t see). But now there’s at least a proper space for the photo

Foreign Affairs and International Trade (or whatever it is calling itself nowadays) saves the most convenient documents for themselves though: simple credit card-sized IDs you can keep in your wallet, no booklets to forget or misplace

Who knows, maybe booklet passports will go the same way too. Visas and stamps replaced with electronic “permission” tags added to your chip as you cross the border. You won’t even have to show your card anymore – you’d just walk up, and as you approach the radio-frequency reader it would “stamp” the chip, and you’re set! No more lines to queue through, no more cold sweats standing in the immigration line as you hear your flight being called for boarding

Yet there is still something irreplaceable about the passport. It’s the tangible, legal expression of nationality; anyone can tack a flag on their backpack, but a passport – you need at least two years of permanent residence, a guarantor to vouch for your identity, and 87$ for that. People move, marry, invest in other countries just to get one; it’s what you wave at the embassy gates when you need help in a foreign land. At the airport you can’t help but peek at what documents people have in hand – colours of almost 200 nations distilled into blue, red, green or black with gold-embossed coats of arms

And, of course, the stamps. You can Photoshop yourself onto the Eiffel Tower or the Great Wall, and mail-order Andean sweaters and handfuls of Sahara sand – but you haven’t really been anywhere unless you’ve got a stamp to prove it

Looking forward to stamping the crap out of the new passport this summer!

Round and round, to the edge of town

Bus terminals are fixtures of Downtowns across Canada’s cities. Without fail, you can travel from coast-to-coast and manage to see what every city has to offer the moment you step off the coach. Wherever you are, arriving and departing from Downtown you’re guaranteed a first impression and last look to remember.

There’s Victoria’s, steps from the Inner Harbour, across the street from the Royal BC Museum, and kitty-corner from the Legislature

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Vancouver’s is co-located with the train station – fantastic ambience, and easy access to the Skytrain

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Edmonton’s is just at the edge of Downtown

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and so is Calgary’s

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Saskatoon’s is within a block of the city transit interchange

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and Regina’s across from the Casino – chance to cash in on a quick stopover

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Winnipeg’s brings you within spitting distance of Portage and Main

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while Toronto’s gets you right into the thick of the action at Dundas Square

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Ottawa’s is a bit of a hike from Downtown, but at least Bank St is entertaining as you head uptown

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Montreal’s drops you off in the middle of the Village

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and Halifax’s train/bus station, like Vancouver’s, makes for classic arrivals and farewells like you see in the movies

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It’s not just about giving travellers an attractive welcome to the community; nor is it just about making life convenient for rural commuters from the area to work Downtown; or promoting environmentally-friendly public transport by making it more attractive or useful; or supporting financially-conscious passengers like students who can’t afford hidden costs like taxi transfers to inconvenient stations.

Downtown terminals are part of what distinguishes destinations and places to be, from mere waystations you can’t wait to move on from. Even if it’s not your destination, city planners know that if you get a good impression of the place as you pass through and stop over, you’ll probably at least get off, look around – and spend – and maybe even want to come back. More importantly, you won’t think of the place as just another crappy highway backwater stop between real cities.

Since bus travellers truly are a “captive audience” as they cross the country, bus terminals are a fantastic opportunity for vibrant, desirable cities to establish and maintain their positive vibe. Comparison and competition between communities is inevitable when you’re on the bus – you see them all. Even moreso than airports – aircraft on hub-and-spoke routes cast all the attention to the big three (Vancouver, Toronto, Montreal); but bus terminals are where every Canadian city has a chance to make an impression.

Fredericton, however, is looking to lose its textbook-perfect Downtown bus terminal – with all the convenience, aesthetic appeal and tourist/traveller services like restaurants and cafés (ie, opportunities to spend money in the local economy) that comes with a Downtown location

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in favour of a middle-of-nowhere rental space at 150 Woodside Ln – with all the convenience, aesthetic appeal and services that come with a highway pullout (ie, none of the above)

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According to CBC Radio, taxi fare to the proposed site could run around 20$ or so depending on where you’re coming from. Seeing as how the bus fare to, say, Halifax is only 67$ (57$ for students and over 60s), that’s not just a minor inconvenience – you’re making travel 25-30% more expensive, just like that.

It’s not the bus company’s fault – after twenty years at Regent and King, they “would love to be downtown, but we just can’t find accommodations” since their landlord ended their lease this April. There is the abandoned train station site that would be perfect – walkable to Downtown, lots of open area, maybe an opportunity to get that same ambience as Vancouver and Halifax – and even the Planning Advisory Committee says it “might be expensive to redevelop, but it would be a choice location”.

I don’t know what’s stopping the City of Fredericton from coming up with a solution, intervening and making it happen. It could offer a loan, mediate with the current landlord, buy the land itself and operate a city-owned terminal (just like an airport), or even pull off a land-swap trade deal as it has before to secure the space – maybe another business that doesn’t really need to be Downtown would sell or exchange for a more appropriate plot the City might happen to own already.

Hopefully there’ll be some public outcry about this – too bad it’s come up just when a big chunk of the terminal’s primary users (ie university students) are all away for the holidays. (Hmm, coincidence?) It’s not just about making life convenient for us residents – but promoting a positive image and leaving a good impression with our visitors, and providing facilities you’d expect from a Capital City.

Seriously, a middle-of-nowhere highway pullout – “Welcome to Fredericton”? Definitely not what a city should be.

The best defence we’ve got

Late last month, a military intelligence officer just deployed to Afghanistan in mid-April, was found dead in her quarters in Kandahar. A Globe and Mail article that day reported “all evidence points towards a self-inflicted gunshot wound”, though the investigation into her death is still underway as of now.

If it turns out it was a suicide, it would be of the kind that knocks the wind out of us physicians. All reports suggest her death was totally unpredicted. I see depressed, angry people fairly regularly, and many have thoughts of hurting or killing themselves; I haven’t had any of my patients suicide so far, but there are a handful walking around out there who I honestly wouldn’t be surprised to get a deceased report any any time.

I don’t think that’s being insensitive – it’s just the reality of things. It’s the ones I’m not expecting that would leave me shocked and speechless.

I was on Psychiatry service in med school when my preceptor got word one of his patients killed himself that morning. 35-year-old, in-and-out of the Psych ward for bipolar disorder the past 10 years, Dr L had taken care of him every time. He was last in hospital two weeks before; he wasn’t actively suicidal and in crisis when he was discharged, but still despondent enough to have weekly clinic appointments, and an outreach team call on him at home every other day. That morning, there wasn’t an answer at the door.

“Oh,” Dr L said. “Thank you.” And we carried on with rounds – it was like, it was ok, no worries. I was floored. By then I’d already done Internal Medicine and Surgery, I’d seen what happens when patients die whilst still under active treatment or just shortly after hospital discharge – unless they’re clearly terminally-ill, end-stage and palliative, it’s a big deal when you lose a patient unexpectedly. You go back and double-check your records, looking for anything to explain – not just to soothe your sense of shock or guilt, but because you’d have to answer for it at Morbidity and Mortality Rounds the next week.

I asked Dr L – the loss of a patient seemed so casual compared to Internal and Surgery. “Ah – but do you know what end-stage depression looks like?” I didn’t. “Often times, you can’t tell – it’s obvious when they’ve got the pills or gun in their hand, but usually, you never know what puts someone over the edge. Once you’ve made the diagnosis, they’re depressed, they’re bipolar, whatever – anything goes. Do what you can, but remember moods can go end-stage at the drop of a hat, not like kidneys and hearts and organs that take their time shriveling away.”

Kind of comforting, I guess: diagnosis made, assume the worst – then you’re both motivated to do the best you can to avert disaster; but if it happens anyway, at least you were expecting it.

No comfort when something comes out of the blue though. If last month’s death turns out to be suicide, it definitely would’ve been out of nowhere: “she thrived in the intellectual and athletic pressure cooker of Royal Military College”… “she brought an energy & a compassionate human element to any group”… “she was an accomplished soldier… a scholar of war”… “she left us with no goodbyes or signs”.

The military does its best to seek out problems that can lead to self-harm, especially around deployments. There are psychological screenings by doctors and social workers before anyone goes overseas, and again when people come back. Pretty much every week I get a referral to see a new patient picked up in the post-deployment screening process; doesn’t necessarily mean they’re in immediate danger of suicide – or any specific mental health problem for that matter – but suggests a closer look.

As far as reducing suicides, maybe it works: the military’s suicide rate is less than the general population – about 25% less, when you compare to civilian stats adjusted to match the mostly-younger, mostly-male armed forces demographic. However, there’s no data actually tracking the relationship between deployments and suicides – or any specific mental health problem for that matter – so it would be a leap to say deployment screening is saving lives.

And if it is, one could argue that we should be screening people more often, not just post-deployment or at their 5-year medicals, and reduce that rate even more.

The thing is, I already think we do – at least informally. Everyone has a chain of command with people whose business is looking over those under their authority, and making sure people are functioning well. And most importantly, like they drill into you in Basic Training, you look out for each other: “No one gets through as an individual”. There’s no way to prove it, but whether it’s from enemy action or self-harm, I think that attitude’s what’s saving lives when it counts.

However last month’s death turns out in the end, it’s always worth repeating: “No one gets through as an individual”. It’s the best defence we’ve – you’ve – I’ve – got.

How the tables have turned

Got my wisdom teeth out yesterday – I don’t know what the usual waiting time for elective, non-emergency wisdom teethectomy is, but getting it done within one business day of meeting the dentist for the first time and getting told to get them out is pretty good service, I think. My brother, who is actually having pain with his, is still on a waitlist after starting to have issues a month ago.

I have to say, it’s fascinating being a patient, being on the other side of the desk for once. Do I really sound like that? You realise how predictable doctors’ and dentists’ assessments are: greeting (“Hi, I’m Dr [name]“), idle chit chat (“How about those [local sports team]?”), figure out the problem (“Tell me about your [symptom]…”), have a look (“Let me check your [relevant body part]“), get to the point (“You’ve got [diagnosis]“) and plan (“You need [treatment]“), explain the pros and cons (“A [medication/procedure] should help with your [diagnosis]; the most common adverse effect is [complication]“), get buy-in (“So what do you think about [treatment]?”), cover your back side (“Please sign this [release form/acknowledgement]“), and voilà. Another life saved.

I don’t think the dentist recognised me as one of the doctors from next door. We don’t cross paths much, the docs and dentists. We’re in the same building, but on opposite ends. They have their own entrance, and I think they have their own lunch room too. I was in my shirt-and-tie uniform, and I guess the red stripe on my shoulder rank bars isn’t as obvious as the “MEDICAL” patch on the usual green combats.

It’s funny, the interview was totally textbook. The scripted conversation, the obvious avoidance of medicalese and detouring into long-winded explanations in layman’s terms. “Your wisdom teeth on the top and bottom are all coming in sideways, and pushing in against the teeth next door and the gums… this can cause pain, and food and bugs get trapped under the gums and lead to infections because your toothbrush can’t get there”, instead of “The mandibular and maxillary third molars are horizontally-impacted; the occlusion and inaccessible operculum predispose to pain and periconitis”.

The tone kind of changed once we were talking doctor-to-doctor: quicker, more going through the motions. I guess it was an unspoken recognition that “Ok, you probably know all about this and what needs to be done, just let’s get on with it.” No need to try to convince or explain the obvious further.

Then again, it could’ve swung the other way too. “Oh, you probably know all about this – so you probably have your own idea on what should be done – what do you think?” The NICE guidelines actually say “impacted wisdom teeth that are free from disease should not be operated on”; a Cochrane review of interventions for treating asymptomatic impacted wisdom teeth found no evidence to support or refute routine prophylactic removal. Basically it comes down to a gamble – take a chance on nothing ever happening, or save the potential trouble down the road and do it now. No major risks really, just the pain and swelling for a few days anyway.

The day before, I picked up my meds

a bottle of 0,1% chlorhexidine anti-bacterial mouthwash – rinse twice daily for the next fortnight; ibuprofen 400mg tabs – two every eight hours; a tub of maple walnut ice cream since I won’t be eating anything solid or liable to break into tooth socket-sized bits for the next few days; a bunch of ice packs; and two other tabs I’ve given to patients before but have never had the opportunity to try myself

For pain relief, codeine 30mg/acetaminophen 300mg/caffeine 15mg, or Tylenol 3s – though these are a generic version, “lenoltec 3″s – one tablet every four hours as needed. The codeine gets metabolised into morphine, which not only helps cut down the pain, but I hear is supposed to give a bit of an opioid buzz. Patients ask for these by name all the time – you’d think Tylenol was mass marketing these like Viagra (the other pill patients ask for by name). Personally I can’t tell what the fuss is about: I didn’t feel anything, buzz or otherwise, but that’s likely because of these

For pre-op sedation, triazolam 0,25mg – two tabs an hour and a half before. I’ve only prescribed this once before, to someone I was putting a chest tube into. Helps to calm nervous nerves, mellow you out, and if you’re not essentially dozed-off, it’ll stop you from remembering what happened. Same class of drug as Valium or Ativan, but a shorter on- and off-set (ie crash and rebound) which makes it not so useful for anxiety or sleep problems. I only took one, because I was still seeing patients myself before getting my teeth done and thought having my wits about me was probably still a good idea for that.

24h later – can’t remember much of anything. Four teeth poorer, cheeks slightly swollen, everything still tastes like blood, including that maple walnut ice cream. I only vaguely remember getting home – I think one of the Sergeant medics gave me a ride, and I have a fuzzy memory of him putting some ice packs in the fridge, and saying I have a nice bike, but that’s it.

Hopefully didn’t say/do anything that’ll haunt me later – probably not the best idea to have someone you’re supposed to lead and teach see you when your guard’s down; but then again, probably better than having someone up the chain of command witness something that’d best not make it to my next performance evaluation.

Rx: jail

So I sent one of my patients to prison today. I mean, I didn’t convict or sentence him or anything, but one of the things military doctors have to do sometimes is certify their own patients as medically-fit for detention. (As opposed to civilian GPs, who don’t have to sign-off when civilian patients go to jail – there’s docs at the jail itself for them.) First one I’ve had so far.

25-year-old, history of alcoholism since at least high school; on counselling and probation for the same since last autumn, conditional on staying dry and sober for six months. Found in violation of probation around Christmastime, and sentenced to three weeks in prison, starting as soon as I sign him off “fit for cells”.

It’s one of those gray areas in medicine and the doctor-patient relationship – obviously some might object and decline a medical assessment that would send them to jail, and some might not be so willing to trust a doctor who’s bound to pass them on to prison, but it’s one of those things where patient consent isn’t necessarily the final word.

Of course you have the usual commandments, “Consider first the well-being of the patient”, “first do no harm” and all that, but being in uniform you also have your responsibility to the military. It’s the third key principle of Canadian military ethics everyone learns inside-out in Basic Training, “support lawful authority”. (The first two being “Respect the dignity of all persons” and “Serve Canada before self”, in that order.)

The other thing they drill into you in Basic Training – at least, the version for medical officers – is that you’re not just a doctor for the patient in front of you, but you’re also looking out for the broader military at large. It’s more than the responsibility to community that goes without saying to all physicians in general – you actually have a duty to consider how your patient’s health might affect mission objectives, required military tasks and the rest of the team.

Not that this is just a military thing. Emerg physicians do this all the time too, giving (usually) inebriated belligerents a once-over before police take them off to cool down in the Drunk Tank. When I was working Emerg I never had anyone refuse a check-up; of course they knew as soon as I signed off they’d have to face the music, I guess they figured they’d already been caught, no sense delaying the inevitable. Most were all “been there, done that”, just going through the motions anyway.

Back in Inuvik and Masset it used to be the most frustrating thing about Emerg, getting called out in the middle of a (usually) Friday or Saturday night. Nurses in the North are really good at sorting out all the real emergencies, and taking care themselves of the worried-well coming in at ungodly hours of the night. But for the “fit for cells” and all the medico-legal baggage that comes with it, a doctor had to actually give the blessing.

At least it got easier the longer you worked there – you’d get to know the regulars and their background stories with each visit, so you’d get quicker and better at picking out what was for real, and what was same-old same-old. You’d also get to know the cops bringing them in – at least, the ones who tended to worry most about patients/prisoners going bad in holding cells; the more veteran ones grow their own spidey sense for “sick” and “not sick” and can make the call without having to stop by Emerg.

You’d also get to know the court schedule – the night before, you could be sure at least one person out on bail would try to pull something to get out of their day with the judge. Suicide attempt, drinking binge, you name it. Of course when they do, they get admitted involuntarily; judging by the number of times they’d later leave against medical advice, it’s probably no better than taking the jail time.

Anyway, I guess the complicating thing with this case today was, he’d been set up with an addictions counsellor and psychiatrist since his first violation, and still had some follow-up appointments to attend; if he goes to jail, he’d miss one.

Bit of a judgment call – what do you think? I figured, if he still was breaking probation despite counselling and Psychiatry, one missed appointment wouldn’t change anything with him; maybe 3 weeks in jail will actually hit home and do the trick. What’s more, interfering with a sentence imposed by “lawful authority” for the sake of counselling that isn’t working anyway (yet?) wouldn’t exactly send the right message about the justice system.

He didn’t seem all that bothered about it, kind of the like the ones I see in Emerg actually. “Been there, done that”; no surprise for him apparently. Likely I’ll be getting used to seeing it too.

Baseball on Valium

I’ve never thought of cricket as a particularly “spontaneous” sport. Unlike something like hockey, where more often than not all of your buddies own a stick and ball/puck and you can just meet up at any random driveway or side-street and pick up a game. But not so much cricket.

The first time I saw people playing cricket – live, amateur, just for fun – was in Singapore on the greens near the Esplanade. Everyone in white shirts and shorts, the lawn perfectly manicured – much too well-organised to be a pick-up kind of game

The first time I saw it in Canada was pretty much the same – on the tended grass of Stanley Park in Vancouver, looking all professional-like

But passing the Wolseley warehouse near Fredericton’s Crosstown trail last week – I guess you can play pick-up cricket after all

Not quite a regulation 22 yards, but does the trick

And dropping the white “uniform” makes it a lot less pretentious too

I’ve never seen pick-up cricket anywhere else in Canada yet. Maybe it’s a Fredericton thing.

Blues and twos

The police is running a contest to design Fredericton’s Next Police Car. Right now it looks like

PoliceCanada.ca

The public image of a police department isn’t usually part of urban planning discourse, but I think it’s actually one of the most visible contributions cities make to the community fabric. Quick – name the first municipal service that comes to mind. For most people, it’s the city’s police department.

Out on the street, police cars are probably the most-often seen tangible product of municipal taxation, other than traffic lights or street signs. As such, they’re also the service that lends best to branding with the City’s identity. (Of course the streets themselves are City products – but you can’t really put logos or colours right on them.)

Unfortunately, there’s only one city I’ve seen that actually does this well: Ottawa manages to coordinate its police, fire, ambulance and even parking authority with the signature O-swoosh logo and consistent fonts on street signs and such

But I digress – back to police cars… On film and on TV, producers go to great lengths to match prop police cars and such with the look of the real thing. Though Toronto’s CN Tower or Montréal’s Place-Ville-Marie might show up in a scene trying to pass for New York or Los Angeles, a passing white-and-blue NYPD or black-and-white LAPD cruiser is enough to suspend reality and keep the plot on track.

Of course there’s no pretense of Fredericton’s police vehicles making it on the big screen anytime soon, but every time a car runs a patrol or attends a scene, it’s not just ferrying constables across town – it’s establishing a presence, asserting authority, making society’s values and laws tangible. And when bad things happen, it’s extending the community’s concern, keeping a promise To Serve and Protect.

I remember biking by a crime scene in Vancouver. Some store got robbed, and it looked like the bad guys beat a few people on the way out. The police must’ve just arrived, because constables were rushing in, escorting injured people to ambulances, blocking off traffic with their cars and sealing off the area.

The Vancouver Police recently re-did their cars, and I guess some of those freshly-done cruisers were on the scene: a thick blue waving ribbon – I think it was a Aboriginal stylised animal head – ran down the side like racing stripes; a jaunty half-maple leaf peeked towards the tail; and the door was open, announcing the “Vancouver LICE” were on the scene – they made the word “POLICE” too big to fit.

You could tell the officers were definitely doing their jobs professionally and taking the time to help everyone that was hurt; but with the sirens wailing and people still yelling and crying in shock, the gaudy, happy ribbons and racing stripes really looked odd. Almost trivialising, insensitive in such a terrible situation.

I don’t know what goes into police car marking design, but some of them don’t look like police cars at all! All the fancy racing stripes and swoopy swooshes look like any other commercial truck or car trying to catch attention and sell itself. Even the word “Police” is dolled-up with bubble letters, multicolours and drop-shadows. There’s a new pattern up the highway in Miramichi

PoliceCanada.ca

I guess it looks festive and happy and friendly, but if there was an emergency and you needed to wave a passing cop over, you wouldn’t recognise that as a police car. It just doesn’t scream “Police” when you look at it – a big white Impala or Crown Vic with multicolour stripes is mostly likely a taxi, trying to catch your attention and make fares. You’d have to actually read “Police” on the door, see the constable in the driver’s seat or the flashing lights and sirens to tell what it really is.

And most of all – when you need the police to come over, you don’t go looking for festive or happy or friendly. You need something authoritative, solid and trustworthy – something that says professionals are on the scene, things are under control, and everything is going to be ok. Nike swooshes and Photoshopped gradients when people are in distress – at best, it’s just a little awkward, no?

Anyway, threw together something mock-ups: nothing fancy, but I think they’re cleanly and instantly “Police”, there’s no mistaking them for a taxi or a courier service; the blue-and-red are already recognised police colours, and the black-and-white is pretty obvious; there’s the City logo; with the doors open it won’t say “ICE” or “LICE”; and if it shows up in a newspaper photo of a crime scene or carrying Fredericton’s Most Wanted, it’s not looking trivialising or insensitive

I also re-drew the badge – current on the left, edits in the middle and right. The middle one switches the leaves for a standard radiating shield, police tradition since the first modern force, London’s Metropolitan Police Service; on the right, trying to match the official Canadian Heraldic Authority style

Also re-did the City’s coat of arms – the existing triple-shield-within-a-shield coat of arms seems a bit wonky

According to Terrence C Manuel KStJ CD FHSC (don’t know who that is, but lots of letters after the name, so he must be an expert), “the arms for the city were designed by Dr James Robb, a professor at King’s College (now University of New Brunswick), who was also a member of Fredericton’s City Council. The arms were drawn without regard to the laws of heraldry and were not recorded nor approved by the College of Arms in Britain”. Instead I wonder if simply dividing a shield in four would work, like

Anyway, we’ll find out soon how that contest turns out.

The sailor’s new clothes

The Navy released some photos of the new Naval Combat Dress last week. It’s the flame-retardant working blue/black uniform usually worn on ships and naval bases, so they’re not as commonly in the public eye as the fancy high-tech digital green or desert camouflage gear as seen on TV from Afghanistan and such, or the traditional dark double-breasted suit you see in official photos and parades. (And the pictures parents always like to take too.)

Since I work on an Army base I actually wear the relish-suit everyday myself, but being Navy I was looking forward to what the Naval Improved Clothing and Equipment project – NICE! – was going to come up with. The Army’s equivalent Clothe the Soldier programme prompted a quantum leap from the 50s-era olive drab solid colour combat gear to what you see now, so there was a lot of anticipation for what NICE would propose.

Some before pictures

Canadian Forces

Canadian Forces

Canadian Forces

In Uniforms: Why We Are What We Wear, historian (and WW2 American infantry Second Lieutenant) Paul Fussell describes the ideal everyday military uniform

Those who have worn military uniform know how it feels when constrasted to civilian clothes. I’m not talking about the glory of full-dress uniform, white gloves and all, but what is sometimes called “walking-out kit”, the way you’d dress leaving the post for the evening… [This is now simply what you wear at work - no need to change before or after.] It is crucial the jacket fit snugly, with shoulders emphasised by straps or epaulets with a crimped-in waist. The trousers must fit closely, with, of course, no pleats, it being a precious military myth that no soldier is even slightly obese and thus is in need of such waist camouflage.

The shape delineated by the uniform is that of an ideal combatant – athletic, obedient, wonderfully self-controlled, tightly-focused, with no looseness or indication of comfort about him.

So… the sailor’s new clothes

Canadian Forces

Canadian Forces

Canadian Forces

Actually the only thing new I can pick out is the jacket: different cut and collar, Canadian flag flap on the left shoulder, different pockets, and replacing the traditional ship’s patch and name tag on the right, a name tag with “Navy (maple leaf) Marine”. Underneath the changes are subtle – the blue shirt looks pretty much the same, but now with a black T-shirt underneath, with new police-style perma-crease cargoes and boots with white thread highlights.

Reaction seems negative: “The new NCD’s in the posted picture actually kinda look sloppy IMO”… “That Navy / Marine name tape is unfortunate”… “kinda looks like the security guard at polo park mall”… “white stitching on the boots make them look like some sort of bowling shoes”… “The shirt is the worst part of the whole thing. I always feel like a postal worker when I wear NCDs. I am convinced that the bureaucrats in Ottawa are conspiring to make us look as silly as possible!”… “they do look extremely sloppy and in my own humble opinion, are worn sloppy by way too many. The new NCD – not impressive at all. I have always been a firm beleiver that something as trivial as optics always plays an important role in military life. Looking like a bag of slop is just bad form”…

I think the biggest loss is the ship’s patch – the Army has its regiments, the Air Force its squadrons, all with their traditions and imagery. Losing that on the uniform to a generic “Navy – Marine” seems a shame; especially in default Arial font, makes it look like any civilian company name-embroidered custom-wear windbreaker – mall security guard was mentioned.

But that said, it doesn’t look all that different from some other Navies in the world. Maybe it’s tradition, following the Royal Navy: other than the name tag (on navy work clothes, Canadians put it on the right like the other uniforms), they’re almost identical in the postal blue shirt and pants – similar issues with shirts easily going crumpled and untucked and thus potentially sloppy-looking when doing anything remotely strenuous

Royal Navy

Royal Navy

Instead of blue tops and black bottoms, the Singapore Navy goes all black for a professional military appearance, but with reflective stripes for visibility, a ship’s crest for team spirit, and a removable flag for field work. A one-piece coverall – nothing to get untucked or fall out, and easy to strip off when heat and confined spaces make skivvies more appropriate working gear (and back on when emergencies or impromptu inspections threaten)

Republic of Singapore Navy

Republic of Singapore Navy

The American Navy is actually switching from a blue shirt/pants or blue coverall uniform

Wikipedia

to an Army camouflage-style digital pattern, except in shades of blue – no it’s not so the enemy can’t spot the sailors hiding against a marine background (whilst aboard their big gray ship?), but because wrinkles and oil and grease spills (common occupational hazards) don’t stain and show up as badly (and permanently) as on solid colours

US Navy

Obviously I haven’t tracked down every naval uniform out there, but the new Australian Navy uniform is hard to beat, probably the best designed set up of all

Royal Australian Navy

Royal Australian Navy

For visibility, there’s reflective stripes like the Singaporean coveralls; two-piece for mobility, but designed to go untucked for ventilation, so no issues with shirt flaps going sloppy; light-gray dominant colour to stay cool under the sun; removable ship and unit patches; camouflage to appear clean, and since it’s also designed for intervention and boarding teams, the obvious “military” look is essential to the job – and what’s more, like the digital CADPAT pattern being distinctly Canadian, the rounded AUSCAM blotches are signature Australian.

As mentioned on army.ca, “Take the most common paint and grease stain colours found aboard ship and digitize them into a pixelated camouflage pattern. For a Canadian Naval camouflage pattern, you could call it either NAVPAT, or CADPAT-N/M (Navy/Marine).” Don’t know if that necessarily means a perfect “athletic, obedient, wonderfully self-controlled, tightly-focused, with no looseness or indication of comfort” design, but if it works for Australia, could work for us too!

I’d wear it, anyway.

The “real” Bylaw Z-2.645

I stand corrected. Bylaw Z-2.645 was about neither the Costco nor the gas station to go along with it on the UNB forest preservation lands – both were already quietly approved years ago by the City’s internal planning committee, before all this drama came to light – but a carpark extension to cover up part of the wetland. (And, in the end, Fredericton votes unanimous “yay” to more parking lot.)

As has been pointed out, it would’ve been kind of nice, and less frustrating and time-wasting – and, of course, professional – for the City to’ve been clear from the start what we were actually debating. Since Council’s now voting on a different issue, it would make sense to re-open submissions of public objections and support – if Council didn’t know the subject at hand, obviously the rest of us don’t either, and all the hearings to date can’t count for anything.

I remember back when I was on Council – high school Student Council – something like this happening after we switched our vending machine supplier from Pepsi to Coke. There was a mix-up and the details were wrong. Fair enough – we were all caught up planning the Hallowe’en Dance at the same time. But this is when you would shelve the issue, and come back to it once everyone had a chance to review the topic, get class feedback, and actually debate the merits of the case with at least some sense of due democratic process.

If Fredericton could’ve done the same, they might’ve done some research (ie, Googled “big box store parking”), and could’ve quickly found that “developers routinely build more parking spaces than required by zoning… Research now shows that typical zoning regulations require more parking spaces than are actually utilized” (University of Connecticut). In 2001 – well before the word “Costco” were spoken in Fredericton – the US Department of Transportation already completed studies to retrofit 1990s big-box retailers.

Closer to home, Toronto City Council established design guidelines for parking lots – part of Toronto Green Standard – which, unlike Green Matters Fredericton, establishes concrete zoning and design mandates to achieve actual performance measures. And this is in 2007 – right about the time the City planning commission would’ve (should’ve?) been doing their research on urban design standard practices.

If Council couldn’t let the public have a chance to review once they figured out what was really going to the vote, surely they could’ve delayed the vote for 10 minutes just to check online if there’s better ideas than rubber-stamping more parking; they’ve got free wi-fi in the city, after all. Seriously, if you just Google around for 10 minutes before you decide something – I do this all the time before seeing patients, just to make sure they don’t whip out “something they read from the Internet” they didn’t teach in med school – you make more informed, better, safer choices.

This is not an ideological, political, anti-development issue at all – it’s just common sense. There’s actually a lot of good things they could’ve gotten for us if they pondered it a little. Like one of my Trauma Surgery preceptors said, “Don’t just do something – stand there and think!”

Bylaw Z-2.645

Bylaw Z-2.645 – alias “Municipal Plan Amendment, Rezoning, and Subdivision – 1600 and 1650 Regent Street (Terrain Group Inc – Costco)”, or the plan to build a Costco and gas station on the UNB forest in the south end – goes to City Council for final yay/nay tonight. Been there, done that, got the T-shirt; most everywhere else in the country has long caught on that big box stores and suburban sprawl make for crappy neighbourhoods – moreover, unsustainable and more expensive ones at that.

Now one could excuse blank-slate Regina for sprawling no-holds-barred over wide open Prairie; but Fredericton, “Noble Daughter of the Forest”, you’d think razing mature forest and wetlands for such blandness would be a non-starter. Especially with people nowadays tripping over themselves to be so green and enviro-keen – Council debating over chopping down a woodlot for a Costco is like the College of Physicians and Surgeons deliberating on, say, shaking babies for colic.

So the fact that this actually led to local controversy and is even being considered for a vote is kind of depressing.

Unfortunately, it looks like it’s not just the city planners who dropped the ball on nipping this plan in the bud, but Frederictoners at large too. Concepts like good urban design, sustainable planning, what makes neighbourhoods and communities work, comparing ourselves to other cities, or adopting best practices from the rest of Canada – other than this one blog post there’s no sense of self-reflection or vision at all in reading the paper, eavesdropping on conversations around town, or at the last Council hearing two weeks ago.

Most everyone’s been using a straight-up environmental argument – either because of the UNB Woodlot’s important ecology, or that the project encroaches on an 80m buffer that’s required in the plan, or the dangers of having a gas station over wetlands that lead to our water supply, climate change and “death by a thousand small cuts” like this, etc. Some tried to remind Council of its own “Green Matters” commitment, to protect irreplaceable resources like wetlands and woodlots. You can always put a Costco somewhere else, but you can’t rebuild a forest.

Some tried out political stances, like big box stores just pacify us with cheap imported goods we don’t need, and some raised the doomsday spectre of peak oil, but otherwise not much ideology or anything far out. I actually tried to play the medical perspective – hey, it’s in the Principles of Family Medicine after all, to be “community-based”, and “a resource to a defined practice population” – and wrote out a letter to point out the obvious:

For reasons of public health, and based on personal experience with urban planning best practices in varied places from Kingston to Toronto to Victoria to Vancouver to Singapore, I suggest Council reject such placement in favour of a more central location.

Let me make clear I don’t oppose the establishment of a Costco in Fredericton – on the contrary, I believe it will be a useful addition to the city’s retail scene, and in particular know many of my patients desperately need any opportunity to find cheaper options for their shopping needs. However, because a Costco would be such an important commercial “magnet”, its location in the city must be carefully considered.

The proposed placement in the city’s extreme south end will exacerbate Fredericton’s urban sprawl. Its pronounced disconnection from the city’s centre of mass undermines an efficient, compact urban form. As a retail anchor, it will have a snowball effect and encourage further commercial encroachment in the area, forcing residents to travel even greater distances. The site is accessible only by car; it is beyond walking distance from any established residential community, and any potential bicycle routes force users through heavy, high-speed traffic.

Urban sprawl is associated with several public health risks. The Ontario College of Family Physicians recently completed a review of research illustrating the hazards cities impose on residents when they fail to restrain such development, and the benefits individuals and communities can enjoy when alternate plans are made. The “Report on Public Health and Urban Sprawl in Ontario: A review of the pertinent literature” indicates:

- Urban sprawl leads to increased motor vehicle use not only because of greater distances, but also because it makes adequate public transit services less financially feasible;

- Greater dependence on personal vehicle use leads to an increase in air pollution. The effects of air pollution include increased respiratory diseases (such as asthma) and cardiovascular disease;

- Air pollution has also been linked to reproductive health problems and rare cancers (such as childhood leukaemia);

- Compared with people in more efficient and higher density communities, people in car-dependent communities walk less, weigh more and are more likely to suffer from obesity, high blood pressure, diabetes and cardiovascular problems;

- Longer commuting distances lead to increases in traffic fatalities (one of our population’s leading causes of death), injuries and disabilities to motorists, pedestrians and cyclists; and,

- People in sprawling communities are more likely to suffer from mental health problems due to long commutes, isolation and loss of social capital than people in better planned communities.

Four brief summaries emphasise the health impact Council should consider in its decision:

1) Air Pollution
2) Road Injuries and Fatalities
3) Obesity
4) Social and Mental Health

Because of the importance a Costco will have on the city’s commercial scene and overall development, choosing its location provides an opportunity to implement good planning practice. Alternative sites should be considered, such as the Two Nations Crossing complex, or the abandoned train station Downtown – sites within close, convenient proximity to established neighbourhoods and readily accessible to the greater area.

They would make use of already-open areas, reinforce existing focuses of development, and are more consistent with a compact, environmentally-sensitive urban form. They are already reached by transit, would not require expensive extensions of city services such as sewage or refuse collection, or strain emergency response times due to distance. Moreover, they would not entail the ecological damage of the current proposal at the Woodlot.

Other cities, such as the ones I have lived in above, are actively curbing sprawl and directing projects away from suburban/decentralised development, with direct health benefits to the community, and I believe Fredericton can and should do the same. For example, Vancouver’s EcoDensity and Kingston’s Urban Growth strategies have measures that would relocate projects like our Costco proposal.

In medicine, we often talk about “evidence-based” decisions: research and known outcomes must inform our treatment choices. And of course, to “first do no harm” to those for whom we are responsible. As a physician and city resident, I believe the same mindset should guide Council in its decision – and leads to the conclusion that this development, as currently located, is not good practice.

No doubt – Fredericton is sprawling. And urban sprawl is a health issue too; I definitely see people here less healthy than where I’ve worked before. The local stats speak for themselves: 64% of men and 45% of women in Fredericton area are obese or overweight (vs 40% nationally); only 50% of residents themselves feel they’re in good health. This is part of the cost that Council is imposing on citizens by allowing sprawl to continue.

I guess this is so frustrating, because otherwise, Fredericton’s actually been a pretty great place the past year.