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LETTERS TO THE EDITOR: Bandage anyone?

Apologies. This is not meant to diminish in anyway the tremendous life saving work of the Province and Public Health in addressing the tragic COVID pandemic. Both have gone above and beyond to protect the us from the deadly virus. However, it is not hard to come a conclusion after reading a new book on the state of health in the province that our health care system is broken and is in desperate need of repair.

The question becomes do we as a province have the collective will to turn things around? Will it be more money?

Well, money is certainly part of the solution. However, money alone won’t get us on the road to recovery.

Currently the number one expenditure in our provincial budget is health care. By the way, the second biggest expenditure in the province is paying on the money NL owes. It is totally outrageous that provincial mismanagement over the years has put us in a mess where we as a province have to sacrifice much needed cash to stay afloat at a level greater than educating our children. Newfoundland and Labrador has to do better.

Published in the midst of the pandemic, ‘Newfoundland and Labrador: A Health System Profile’, is a must read for anyone concerned with the current state of health care in the province. A quote from its back cover certainly summarizes the overall message.

“It depicts a health system falling short of achieving health outcomes, that appears to have consistently resisted change, and one that is not meeting health goals achieved elsewhere.” – Tom Noseworthy, Professor Emeritus, Health Sciences, University of Calgary

What are the facts as published and co-authored by current provincial Liberal cabinet minister for Children, Seniors and Social Development Hon. John Abbott? Looking at access to the only PET scan in the province, writers Bornstein, Maddalena, Letto, Sullivan, Navarro and Abbott conclude, “This (PET scan) sophisticated form of diagnostic imaging is currently available only in St. John’s, so patients requiring this service from elsewhere in Eastern Health or in other parts of the province have more limited access to it.”

Absolutely! Just imagine, a scholarly piece of writing including 27 pages of references has concluded what individuals on the West and Northern coast have been saying all along. Access limited!

As stated many times over, the new hospital nearing the end of construction in Corner Brook needs the promised PET scan to support the range of other diagnostic tools such as CT scanners and MRI equipment, closing the limited access that currently exists within the province. On the latter, CT and MRI scanners, the province is a leader in the country in availability per population. Providing a second PET scan has to be a priority.

On a not-so-positive note, or maybe positive especially given the struggles of seeing a family doctor compounded with cumulative delays between visits and appointments for diagnostic services, going to emergency department appears to be the route of choice for many in the province. NL leads the country in the extremely high rate.

We visit emergency departments at 981 visits a year for every 1,000 residents. This is 2.5 times the Canadian average of 378 visits per 1,000 inhabitants. Doing the math in a world of increased technology and outreach through such innovations as virtual care and help lines, why are so many still turning up at emergency departments across the province? A shortage of family physicians is certainly a factor here, but not the only one for sure.

Examining the data on the availability of specialist services such as critical cardiac care does not present much optimism for those outside of the Avalon. There are 13 cardiologist in province – 12 in St. John’s and just one in Corner Brook. Once again, it is a reflection of limited access for patient care dictated by distance and travel and a failing grade for provincial recruitment.

St. John’s is the location of the only CATH Lab in the province specializing in cardiac care. It is another example of limited access and not without undue stress related to delays, and expensive for those seeking critical care outside of the Avalon. This is sad and tragic considering NL ranks 10th in comparison to other provinces when one looks at acute myocardial infarction in-hospital death (CIHR).

References to other benchmarks for treatment and wait times across Canada represent a need for provincial health to be better. Outside of a truly remarkable indicator of NL tied with a rank of being first in the country for radiation treatment of a wait time of within 4 weeks at the only location in the province in St. John’s, many of the other wait times requiring medical intervention present a very bleak picture.

For hip fracture surgery within 48 hours, for example, the province has a ranking of 5th. Admissions for ambulatory care sensitive conditions show a ranking of 8th. Hospital deaths are ranked 9th. Potential inappropriate use of anti-psychotics in long-term care-rank of 5th out of the 5 provinces reporting. For 30 day acute stroke in-hospital death NL ranks 10th. Whatever way one considers it these outcomes – given the tremendous input of human resources, provincial and federal dollars supplemented by charitable health foundation and public donations – paint a bleak picture.

There is a tremendous response time on radiation treatments. Based solely on personal experience, NL health care moves very quickly once cancer is diagnosed. However, getting to the diagnoses becomes the concern. Too much valuable time can still be lost in the shuffle of appointments, travel, and diagnostic work. And, while the new hospital in Corner Brook is scheduled to allow for on-site access to radiation, the fact remains that as long as the only location for much of our specialist services are in St. John’s, that is where the doctors and other diagnostic specialties will be found.

Political leaders are not blind to these realities. Our premier is still a working doctor while balancing the political needs and wants of the province. The minister of health is a doctor. Sitting at the cabinet table is a former deputy minister of health. The province now has the report of an appointed Health Accord grasping the knowledge, wisdom and experience of two prominent health leaders at the cabinet table.

The Health Accord offered 57 recommendations, “including implementing a universal basic income, integrating ambulance services, reducing the number of emergency care centres and focusing more on the social determinants of health.” (CBC News, Feb. 17/22). Just what it will cost to implement change for the better will take a little more time as the province waits for yet another report from the Health Accord. Meanwhile, our health care is crippling along and still in desperate need of repair.

Bandage anyone?

John Spencer

Port aux Basques, NL

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