Alberta Medical Association recognizes Frances Harley's contributions as pioneering pediatric nephrologist

Cultivating relationships across North America helped lead to the many firsts contributed by the professor emerita to this specialized form of care.

Sasha Roeder Mah with files from Kirsten Bauer - 03 February 2020

A pioneer in the province's care of children with kidney disease, Frances Harley was one of the first pediatric nephrologists in Alberta-and the only one for a number of years-and is now a professor emerita of pediatrics at the University of Alberta. The Alberta Medical Association recently recognized her lifetime of contributions with a Medal for Distinguished Service.

"The reason I went into nephrology was that I found kidney physiology really hard during med school," laughs Harley. It's a good thing she enjoys a challenge, as she faced many during her early years in the field.

Building foundations

"When I arrived here, it was early days for subspecialists in Edmonton. There was no neonatologist," she recalls. "It was the very beginning of this work here. I didn't really grasp what that meant-that I'd be working alone-until years later."

Working alone certainly didn't slow her down. "Dr. Harley defined pediatric nephrology in the 1970s and '80s and built it into what it is today" in the province and nationwide, says Verna Yiu, '86 MD, one of her early residents and today a pediatric nephrologist and the president and CEO of Alberta Health Services.

As professor of pediatrics, over the years Harley established the Division of Pediatric Nephrology at the U of A, along with the first residency program in nephrology, of which she was director. She also took on the demanding role of acting chair in Pediatrics for two terms and co-founded the Canadian Society of Pediatric Nephrology (CAPN), which today remains the sole national association for all Canadian pediatric nephrologists.

John Dossetor, director of the adult Division of Nephrology and Immunology during Harley's early years at the U of A and the person who hired her, was a crucial ally in helping her build the field of neonatology in Alberta. While he brought her on to work with adults, he was a passionate believer in the importance of children gaining equal access to the best health care available. His drive, and the fact that here, pediatrics was located in a general hospital rather than in a separate children's hospital, helped ease the beginnings of pediatric nephrology in the province, says Harley.

Connecting for success

Still, Harley remembers, because she had been hired to work with adult patients, she had to conduct her own research on her own time."I learned the intricacies of infant and child hemodialysis by flying down to places like the University of California, San Francisco (with husband, radiation oncologist Raul Urtasun, who would be doing his own research on these trips), and asking to observe procedures."

"I was very fortunate in that by going to a lot of meetings, I grew many helpful connections in the United States," says Harley. "I could pick up the phone and call, a lot." Not only could she supplement her training through these connections, but when an infant needed a live donor transplant, Harley could refer families to U.S. centres doing the procedure. Today, she remains grateful for the unwavering support and trust of the provincial government in those cases. And the gratitude goes both ways: In 2005, Harley was honoured with an Alberta Centennial Medal for her meaningful contributions to the people of the province.

Harley would sometimes accompany her young patients to the U.S. for surgery. "I will never forget how those children were impacted by Dr. Harley's kindness and thoughtfulness," says Yiu. But it wasn't just kindness-her boundless intellectual curiosity also motivated her to go, observe and learn from the operations.

The knowledge she gained during her travels helped make her instrumental in changing corporate policies regarding pediatric kidney care. Harley convinced dialysate producer Baxter to start supplementing their existing line of two-litre bags with smaller prescribed dialysate bags suitable for children. "I wanted them to know not just that there was a market here, but that this was the right thing to do," says Harley.

A passion for serving the underserved

Harley took her expertise on the road, traversing northern Alberta to follow up with children receiving dialysis. These long road trips into remote and often-underserved areas awakened in Harley a passion that would follow her throughout the rest of her career. "I made many trips to the Arctic," she says, "and that helped determine my interest in working with Indigenous patients."

Harley regularly attended U.S. Public Health Indigenous research conferences over the years, and after her university retirement, she worked one day a month for 13 years at a nephropathy clinic in Maskwacis. "I learned a lot there," recalls Harley, "about colonialism, residential schools, poverty, social issues" and the many systemic problems that negatively impact Indigenous people's relationship with the health-care system. After attending a summit on Truth and Reconciliation at the Banff Centre for Arts and Creativity, she was inspired to help fund the centre's Indigenous Leadership program, something she still does to this day.

"Dr. Harley has dedicated her life to serving others," says Yiu, who says her own work in the field has been inspired by Harley's leadership and unflagging dedication.

To Harley, though, it's always simply been a matter of doing what's right. "My favourite description of me has always been the word 'relentless.' If you see the goal and you know it's the right thing to do, you have to be relentless."