Rural Care in Disrepair

Monday, November 14, 2022

Can this patient be saved?

By Geoff Geddes

THWACK! As he rolls up the drag hose, it pulls apart, striking him in the head and knocking him out. Frantic, his wife calls 911. The medics find her husband seizing and unresponsive, his skull having shattered into eight pieces. WHOOSH! Into the ambulance … lights flashing … siren blaring … time is of the essence … life-saving care within reach … at last, arriving at Emergency and finding it … closed?!

Fortunately for dairy farmers Becky and Remco DeWit, the ER at St. Marys Memorial Hospital in Ontario was open this night, but that is no longer assured. With the recent closures of rural emergency departments and reduction of services, many Canadian farmers are facing a downward spiral of health care, with no clear end in sight.

"We are currently seeing a real reduction in rural health services across Canada," says Dr. Katharine Smart, past-president of the Canadian Medical Association and a pediatrician in Whitehorse, Yukon.

"Some 25 per cent of Canadians live in rural settings, where the next hospital might be far away, so losing services has a real impact. One of the principles of the Canada Health Act is reasonable, universal access, and we're just not achieving that right now."

As a result, there is a growing concern among rural residents that the system might not be there for them when they need it most.

"It could be a farm accident, a heart attack or a child getting croup," says Dr. Smart. "These are called 'emergencies' because they are time sensitive. If you show up and the ER is closed, the fallout can be severe."

While the problem is multi-faceted, there are a few glaring issues that really raise the ire of medical professionals.

People power

"There is a crisis in human health resources, as a lot of people – especially nurses – exit the system due to burnout and we have no clear strategy going forward," says Dr. Smart. "This in turn leaves facilities short-staffed, which drives even more burnout and creates a vicious circle."

The challenge of recruiting and retaining staff has been ongoing in rural communities, and is only getting worse, according to Dr. Smart.

"When you lack a clear plan and have no real supports in place, you are asking doctors and nurses to take a huge chance in moving to areas where resources are already stretched thin," says Dr. Smart.

"They start to envision themselves working 24/7, so it becomes a tough sell."

Family first

Another big piece of the puzzle are family doctors and their critical role in smaller centres. Those doctors are getting older and not always being replaced upon retirement, and the impact is significant.

"Family doctors have a broad skill set: emergency medicine, delivering babies, performing some surgeries and looking after people in long-term care," says Dr. Smart. "If we are not nurturing and supporting those doctors, and training more, that breed of a true rural generalist will die, and with it, the healthcare in many communities."

In large part, the problems in rural healthcare today stem from a system that has not evolved on critical fronts to remain relevant and effective.

Get with the times

"Our present system was designed in the 1960s, and primary models of care have failed to modernize," says Dr. Smart. "We are asking people to work in antiquated conditions that are not outcome driven, lack accountability and fail to use data in monitoring results."

In fact, the issues facing family doctors are a prime example of this failure to evolve.

"The average fee paid to general practitioners for a patient visit has risen only $6 in the last 20 years," says Dr. Smart. "You pay more to get your nails done than what these doctors are paid to see you. If rent, heat or staff costs rise, they are actually paying money to work, as they have to carry these costs themselves."

As an analogy, Dr. Smart likens the challenge to asking teachers to build their own schools and provide the desks, chalk and toilet paper at their own expense.

"For family doctors, it's not economically viable. On top of that, the work is no longer fun or satisfying as they don't have the time to really focus on their patients, and that's not a nice feeling. The system as it stands today is stealing a lot of the joy that people used to find in medicine."

While the stakes are high for medical professionals, they are even higher for the patients they serve.

Local lifeline

"I was diagnosed with breast cancer in 2019, and I was grateful to have a nearby hospital," says Jackie Kelly-Pemberton. In addition to serving on the board of the Ontario Federation of Agriculture (OFA), Kelly-Pemberton runs a beef cow/calf operation and cash-crops about 200 acres with her husband in Dundas, Ont.

"But across the province, hospitals and emergency departments are closing, so farmers have to go farther afield. Even with my situation, I had to travel to Ottawa for radiation, and others have it much worse."

From OFA members, there is concern around retiring family doctors and the inability to find new ones, as well as the wait times at local hospitals.

"Waiting longer for an appointment can cause a minor problem to become major, so there's a lot of risk and stress involved," says Kelly-Pemberton. "If you're a grower at harvest time, or a dairy farmer trying to get medical attention in between milkings, it's tough to spend six hours in emergency. People with a regular job can call and say they'll be late, but the cows won't wait."

For some in rural communities, having that local hospital can make a world of difference.

"The hospital at St. Marys really helped my husband on his road to recovery," says Becky DeWit. "It is so valuable to our community, and it allowed our kids to bike or walk over after school and be around their dad as part of the healing process."

In reflecting on how times have changed, farmers like DeWit see peace of mind as a casualty of healthcare decline.

"Over the years, we have been to St. Marys when the kids cut their fingers or someone had a dislocated shoulder, and we knew we could count on that facility," says DeWit. "Faced with a bad accident or injury, I never dreamt I would need to check if emergency is open before I go. If it's not, the extra time to go elsewhere could make all the difference."

Though rural issues in healthcare are similar across the country, some provincial discrepancies may add to the problem.

"We had a good doctor in our community who moved to Alberta because his wife, who is a nurse, couldn't meet the requirements in Manitoba," says Robert Misko, chair of the Manitoba Crop Alliance and head of council for the municipality of Roblin.

For Misko, such barriers just add to the frustration he has faced for the last 10 to 15 years when there has "always been a shortage of something.

"Why does the health authority get to decide if our community survives or not?" asks Misko.

"How can your credentials be good enough to work in Alberta or Saskatchewan, but not in Manitoba?

"If I'm travelling through Saskatchewan and get sick, should I check if their doctors meet the Manitoba requirements and, if not, just keep on driving?"

Laws of attraction

In the search for solutions, a common theme is needing to attract more doctors and nurses to rural communities.

"The government must invest in infrastructure at a level that people would expect elsewhere," says Kelly-Pemberton. "Things like good roads, excellent schools and high-speed internet all contribute to quality of life. We need to start now, because this all takes time, as does the training of new nurses and doctors. Can there be accelerated training for those nurses and doctors who immigrate to Canada and yet don't meet Canada's medical standards?"

As with any issue in life and in farming, however, you must admit there is a problem before you can fix it.

"We are continually moving from one crisis to the next in healthcare," says Dr. Smart. "Some provincial leaders are saying publicly that access to rural care is adequate, and that is false. Leadership means acknowledging the challenge and finding answers rather than gaslighting people."

For physicians on the frontline, some of those answers are clear.

"The government needs to build more long-term care facilities, sign physician contracts, and create more rural incentives," said Dr. Parker Vandermeer to CTV News in an August interview.

Dr. Vandermeer is a rural physician based in Westlock, Alta.

"These are things that are going to cost money now, but are going to save money and benefit the patient, the system and society in the long run."

Fearing that the longer governments take to address the crisis, the worse it will get, Dr. Smart is calling for a coalition of the federal and provincial governments that will give this issue the attention it deserves.

"This is a widespread problem across the country, and it won't solve itself," says Dr. Smart.

"We need to put politics aside and recognize that we all have the same objective in the end. Canadians aren't worried about who has jurisdiction over this; they just want good healthcare." BF