“You never do these things on your own. Your team is incredibly important. My career is really the result of being in the right place at the right time. The University of Alberta’s medical school – supported by the Government of Alberta – was committed to establishing and supporting subspecialty care for kids. They were willing to pay for the teams to support our young patients.”
Dr. Frances Harley of Edmonton introduced pediatric nephrology into the care of Alberta’s infants and children suffering from kidney diseases, while teaching future physicians to continue this critically important work. She has dedicated her career to helping vulnerable and underserved groups, inspiring others to follow her lead.
Frances Harley was born on April 30, 1940, in London, Ontario, the youngest of three girls. From an early age, her mother taught her the importance of helping those in need. Frances’ mother recognized the courage of refugees coming to Canada after the Second World War and often hosted strangers. At the request of a distressed mother in her church, Frances’ mother also started a school for cognitively impaired children, which was the forerunner of inclusive public education for these children.
After obtaining a BA from Smith College in the United States, Frances went on to complete her medical degree at the University of Western Ontario in 1965. While a student, she met and married Dr. Raul Urtasun, who had come to London from Argentina to study radiation oncology. Frances went on to complete her pediatric residency in Baltimore and Montreal, while Raul held faculty positions. The couple moved to Alberta in 1970 where Frances continued her training in nephrology, spending her time working with adults while she built the program for infants and children from the ground up.
Throughout her studies, Frances loved a challenge. “The reason I went into nephrology was that I found kidney physiology really hard in med school,” she laughs. The challenges didn’t stop there. While adult patients provided Frances with hands-on experience, infants, growing children and youths required different care.
“I learned the intricacies of infant and child hemodialysis by visiting centres like the University of California San Francisco while Raul was a visiting professor. I was welcomed to observe procedures, discussions, methodology and team performance. By attending U.S. and British meetings, I grew many helpful connections. I could pick up the phone and call for advice. Drawing on these international resources, the department of pediatrics was able to not only host visiting speakers, but also begin to build a nephrology program for children,” explains Frances.
The sole pediatric nephrologist in Alberta for some years, Frances provided service in both Edmonton and Calgary, attending clinics and taking calls for the province. In time, her team’s service expanded to include all of the Northwest Territories and parts of Yukon, Nunavut, British Columbia and Saskatchewan.
Frances championed live donor transplants for children at a time when the procedure was only performed at a few centres in North America. She partnered with the University of Minnesota, home of one of the most successful pediatric transplant programs in the world. Several young Alberta children received transplants there and returned to Alberta to receive ongoing care from Frances. She even accompanied some young patients to the U.S. for surgery. Her advocacy helped save lives.
Frances and a few other colleagues across the country defined pediatric nephrology in the 1970s and 1980s moulding it into the strong subspecialty it is today. Early on, she felt distanced in Alberta, so Frances and a colleague co-created the Canadian Association of Pediatric Nephrology to share information and provide up-to-date standards of care.
Frances was interested in finding innovative ways to improve children’s lives beyond hands-on care. She helped Alberta children on dialysis go to kidney camp in Alberta. She persuaded the University of Alberta Hospital to provide special after-school and night-time dialysis, so children could attend their neighbourhood schools, rather than being tied to a hospital school. One of her main goals was to help parents achieve normal developmental milestones for their children.
Frances was even instrumental in changing corporate policy regarding pediatric kidney care. For smaller patients on dialysis, smaller bags of dialysate fluid are needed. With persuasion, the factory was encouraged to produce bags as much as one-tenth the size regularly produced for adults. This was and continues to be a small market.
In addition to children with kidney disease, Frances also advanced medical care for children with cystic fibrosis and asthma in her role as the first director of the cystic fibrosis clinic at the University of Alberta. She joined forces with a medical school classmate to develop a clinical trial for cystic fibrosis, something rarely done at the time. And she teamed up with another colleague to introduce a trial using National Institutes of Health guidelines to standardize and improve care for asthmatic children in emergency rooms. She was also a member of the Canadian Cystic Fibrosis Clinic committee, which involved her visiting clinics across Canada and supporting clinic directors.
With the addition of new team members, Frances was able to take on increasing and sometimes demanding administrative roles at the University of Alberta. She became the first woman to chair the department of pediatrics in an acting capacity, twice, while the search for the new chair took place. She was asked to represent female medical school faculty members at Canadian and U.S. academic meetings, a position that allowed her to observe other systems’ treatment, support and advancement of women in faculty positions, both scientific and clinical.
But Frances didn’t let her administrative duties keep her from continuing to traverse northern Canada to follow up with children receiving home dialysis. “For me, and I think the whole team, the geography, cultural differences and weather challenges make pediatric nephrology practice and delivery of care so interesting and, when successful, so exciting and rewarding.”
Her long road trips and flights into remote and often underserved areas awakened a passion that would follow Frances throughout the rest of her career: working with Indigenous Peoples. As a result, Frances volunteered to introduce a renal component to the existing diabetes clinic at Maskwacis and provided public health messaging on local radio. She specifically focused on ensuring the most vulnerable kids and adults and their families had equitable access to care.
“Over 13 years, I visited monthly and was exposed to the effects of colonialism, residential schools, poverty, social issues, courage, resilience and honour in these Indigenous people. Their views of their relationship to the existing health care system were impactful.”
This experience led Frances to help fund Indigenous leadership and management programs at Banff Centre through a scholarship for Indigenous women. Frances and Raul also fund The Raul Urtasun-Frances Harley Scholarship for Young Emerging Artists from Argentina. After being invited to attend the Banff Centre’s Summit on Truth and Reconciliation, Frances decided to support the Edmonton Public Schools Literacy Seed Kit. This book purchasing program helps urban Indigenous children and others, including teachers, see themselves in carefully selected books illustrating and honouring Indigenous culture. Looking forward, Frances is learning more about the barriers facing First Nations youth aging out of foster care.
Concern for children with disabilities hits close to home for Frances, whose daughter Gabriela is disabled. “All parents of children with disabilities worry about their child’s future financial security. I decided to call and email across Canada to see what other provinces have in place to support families like mine,” she says. With support from informed and engaged parents like Frances, the Alberta government passed An Act to Strengthen Financial Security for Persons with Disabilities in 2018.
Recognizing that food insecurity can be a problem with renal disease and pediatrics, Frances became involved with food banks. She served first as a board member for Food Banks Canada and then Edmonton’s Food Bank, where she is still celebrated for her thoughtful and thought-provoking input that strengthened both boards. She consistently ensured that discussions focused on food security, compassion and health.
In 2005, Frances received the Alberta Centennial Medal for her meaningful contributions to the people of the province. The Alberta Medical Association recognized her lifetime of contributions with a Medal for Distinguished Service in 2019.
Many adults and children owe their lives to Frances’ compassion for the most vulnerable, as well as her innovation, her exceptional skill, and her wish to help kids grow up to be productive adults and make illness a tiny part of their lives. To Frances, though, it has always been a matter of doing what is needed and hopefully right. “My favourite description of me has always been the word ‘relentless.’ If you see the goal and you know what needs to be accomplished, you have to be relentless,” she says.
Frances and Raul have three daughters – Gabriela, Adriana and Seabird – and six grandchildren.