Meet Dr. Neb Kovacina, a family physician who fought in the frontline of COVID-19
By: Yasmine Elmir
Dr. Neb Kovacina has been a family physician at GMF-U St. Mary’s since 2009 and became, in 2017, Director of the Quality Improvement Program in the Department of Family Medicine. Dr. Kovacina completed his medical studies at McGill University, where he subsequently pursued his residency in the Department of Family Medicine. In addition, he completed the Enhanced Skills Program in Maternal and Child Health in the Department of Family Medicine in 2009 and earned a Master’s degree in Health Administration at the Institute of Health Policy, Management and Evaluation at the University of Toronto.
“Family Medicine is the best discipline in medicine to be able to take care of the patients in all aspects of their health and well-being. It provides the opportunity for the continuity of care that I find crucial for patient-doctor relationship and success of physician intervention in patient care,” shares Dr. Kovacina. Motivated by equity, physician engagement, advocacy, change and innovation in healthcare, Dr. Kovacina was quickly interested in the creation of a Quality Improvement (QI) Program. “QI is the best way to implement innovative practices and has been used more and more in healthcare, especially in hospital setting,” he says. After meeting with Dr. Howard Bergman to discuss the Department’s strategic priorities, Dr. Kovacina connected with the leadership at the University of Toronto to learn from their experience and build capacity in the McGill Family Medicine Groups (GMF-U). Dr. Kovacina is also the president of the working group on QI, based at the College Quebecois des Médecins De Famille (CQMF), reuniting all four Quebec Departments of Family Medicine and the College itself. Their goal is to implement QI practices in non-university GMFs in Quebec.
Since the COVID-19 pandemic hit the province of Quebec in March 2020 it has shaken up everyone’s reality, including healthcare workers. Dr. Kovacina, who was already a physician working at CIUSSS Ouest-de-l’Ile, joined the CHSLD Jean de la Lande (part of CIUSSS Centre-Sud) to act as a nursing assistant in mid-April. “After the start of the pandemic and the crisis of the CHSLDs in April, I wanted to go there to help in any way possible. There was an important lack of nurses in the CIUSSS Centre-Sud,” recalls Dr. Kovacina. After working in a red zone for one week, Dr. Patrice Tremblay from St. Mary’s Hospital contacted him to provide help at CHSLD Grace Dart (CIUSSS Ouest-de-l’Ile) since they were in need of physicians. “The situation on the ground was critical. There were many deaths among residents, and one among the personnel (PAB),” shares Dr. Kovacina. “On the units that I was assigned, residents who were COVID positive were not assessed for many days. The local physician was severely sick of COVID and the others were covering by phone. Because of the lack of nurses and PABs, personnel had no time to call physicians and so, the care provided to those patients was suboptimal.”
“Doctors were still getting sick from cross-contamination four weeks after the outbreak had started,” shares Dr. Kovacina. “Personnel was changing the equipment very often, due to the presence of negative and positive patients on the same unit, and the stations for stocking clean equipment were not well kept and possibly contaminated.” In addition to offering medical and basic care to patients, together with Dr. Élise Boulanger (former McGill Family Medicine graduate), Dr. Kovacina took the role of medical coordinator with the objective of improving the prevention and infection control. They were in charge of re-organizing the units and zones, and also sharing information with nurses and other workers on the virus and the latest evidence on its transmission. “There was a lot of confusion regarding this in the first wave, with government and public health having sometimes mixed messages, and a lot of false information available on the internet,” explains Dr. Kovacina. “There is a need for a strong local leadership, ideally a co-management model with an administrator and a clinician. The epidemic evolved quickly, and it is important to be able to take decisions based on the global clinical picture.” Within two weeks, Drs Kovacina and Boulanger were able to control the transmission of COVID-19 at CHSLD Grace Dart by quickly implementing changes that stopped COVID-19 transmission among the residents and personnel.
Dr. Kovacina remains involved with the community of practice of physicians working in CHSLDs (www.cpmchsld.ca) by networking and exchanging best practices between physicians. The focus of the group right now is on COVID-19; they currently have 350 physician members who host webinars on COVID-19 management. When asked about the role of family physicians during this pandemic, Dr. Kovacina shares, “Family physicians understand well the reality on the ground, they are able to balance the scientific knowledge with clinical judgement, they are able to function on a transversal level, and also have an implicit authority within the team. This makes them the best people to lead their teams in time of crisis in order to improve the processes and implement innovative solutions that are needed to stop the outbreaks.”