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Realities of regional health care

Dr. David Thomas, Chief of Staff at the Dr. Charles L. LeGrow Health Centre, says there are several issues that must be addressed before the health care system can improve for patients living in the West and Southwest coast region. – © File photo

By RYAN KING – with files from Jaymie L White

SOUTHWEST COAST – Nearly 99,000 individuals in NL do not have a family doctor but recently the province unveiled initiatives to strengthen the health care system.

These initiatives will include the creation of two Collaborative Team Clinics in St. John’s, establishing another of these Clinics in both the Central and Western Health regions, issuing Request for Proposals (RFPs) for developing a Health Human Resource Plan, establishing a Provincial Health Professional Recruitment and Retention Office, further facilitating immigration pathways for international health profession graduates, increasing virtual care services, and two pilot projects to attract more medical graduates to family practice.

The two pilot projects will see financial support for the first two years for new family doctors who open a new clinic or join an existing one, and physicians who stay at the clinic for five years will receive up to $100,000.

In addition, the number of graduates from Licensed Practical Nursing Programs will be increased by 40 per cent, Personal Care Attendant Program graduates will increase by 20 per cent, and the seats in the Bachelor of Science in Nursing Program will increase by 25 per cent. A Bachelor of Science in Nursing program will be offered in Happy Valley-Goose Bay, Gander, and Grand Falls-Windsor starting in Sept. 2022, which will include a rural program with remote teaching.

Paired with the recent announcements supporting paramedicine, bursary programs, and the Family Physician Renewal Program, the initiatives amount to an investment by the province of $30 million annually. These initiatives will act as the basis to create recommendations from the new Health Accord, which was created in Nov. 2020.

“These are significant actions we are taking to address the current challenges associated with access to primary health care. Our focus remains on the continuous improvement of a health care system to support better health outcomes for the people of Newfoundland and Labrador,” said Dr. John Haggie, Minister of Health and Community Services, on Oct. 18.

Later that day during the fall sitting of the House of Assembly, Haggie observed that good policies take time to write, and that COVID has put a halt to some efforts, which has resulted in more delays.

“Each time a wave passed, we started again, and another came along,” said Haggie. “We’ve had challenges with COVID. We have mounted those challenges and succeeded where few other jurisdictions in the world have done it, and it’s the same people who are going to write the right policies to get health care fixed in this province.”

The lack of family doctors and access to other in-person health resources has impacted many. This includes Port aux Basques resident, Ashley White, who has struggled to have her daughter, Julia, diagnosed with autism since March 2020. Without an official diagnosis, Julia cannot avail of certain programs.

“It has put us behind big time in getting Julia diagnosed,” said White. “We believe she has autism and been now trying get answers. Back in March 2020 just before we got shut down, I asked her family doctor to be referred to a peds doctor. He was sending a referral. It’s October 2021… still have not seen a peds or even know when or who my child will see.”

Other members of White’s family have also been adversely affected.

“My grandmother required monitoring for 48 hours after she had a cardiac episode. Our hospital had the monitor that was needed, but due to staff shortage she had to be sent to Corner Brook for monitoring,” said White. “My mom was told, ‘We can’t reach anyone to come in to work. No one is answering their phone.’ We didn’t complain and accepted that it was unavoidable, but then my Nan ended up being in Corner Brook for 14 days because she had to wait for a bed to become available again in order to be transferred back to LeGrow. While she was in there, my grandfather was admitted, and due to bed shortage, he was transferred to Burgeo hospital to wait for a bed to become available here. He was in Burgeo two weeks before he got transferred back to LeGrow.”

Another gap that has been identified is the inability to donate blood on the west coast. There are occasional mobile unit blood drives that venture into central NL, but otherwise the only place to donate is in St. John’s. Trish Smith, Strategic Communications Specialist with Canadian Blood Services, noted that collecting donations on the west coast stopped in 2015.

“The closure of the Corner Brook satellite donor clinic was based on decline in hospital demand. We know there are dedicated donors in western NL, and the decision to close the site was not based on their support. We currently have enough donor events to meet hospital demand on a consistent basis in NL,” stated Smith.

Dr. David Thomas, Chief of Staff for the Dr. Charles L. LeGrow Hospital in Port aux Basques, also addressed the doctor shortage.

“It seems to have certainly gotten worse over the past few years,” said Thomas. “Now, in our area here on the southwest coast, we’ve actually been really fortunate that most patients here actually had a family doctor. We have very few unattached patients in our area. We do have some, but we have very, very few. And that’s because we’ve had quite a few people, quite a few physicians, who have been in the community for quite some time. There has been some turnover, but a lot of our providers have been here a long time, and we’ve worked really hard. Western Health has worked really hard. I’ve been chief of staff for 13 years and worked really hard to recruit both a mixture of Canadian grads and international grads here to function as a team, to do both the primary care in the area, as well as the emergency and hospital coverage.”

Thomas agreed there are advantages to having a family physician.

“A family doctor is like the preventative healthcare that we all seek, right? So we’re able to do the preventative maneuvers that will keep people, hopefully, from being sick,” said Thomas.

These include screens for cancers or early onset of diseases.

“We’re trained to be able to follow our patients along and notice when things are changing,” said Thomas. “And if we don’t have family doctors working in the system with other professionals to keep the people out of the hospital, then that’s when our system collapses.”

A lack of family doctors can cause a chain reaction to the health care system.

“Port aux Basques in the past has been (caught) with a very low number of family doctors, and during that time emerge(ncy) visits were up,” said Thomas. “There were certain diseases getting picked up much later. Now with more (doctors) in the Port aux Basques area, with most people being attached to a family doctor, I mean, access has been better. I think we always struggle with making access perfect, but access has been better, and that can avoid some of the some of the big catastrophes that we see, right?”

The initiatives from the new Health Accord make note of developing interpersonal team clinics, which is something the region’s healthcare workers are accustomed to already.

“I think that Port aux Basques has been sort of a team-based place for quite some time, not to the degree that we’d like it to be,” said Thomas. “We’d love to see, like, a fully integrated patient’s medical home type model introduced for our area that includes professionals across the spectrum working at full potential, working as a team, working for the patients, so that the patient can have the right access at the right time. But Port aux Basques, to be honest, has had, you know, we’re big enough to have professionals from every sort of area – so physio, occupational, social work, all working within our community. And certainly, at LeGrow Health Centre there’s been awards won before for the interpersonal team that was set up there, and the communication and everything, and the work that was done. We still work as a team there, and that’s still the model of care that most of us want to participate in.”

Thomas said that tends to appeal to new medical graduates as they enter the profession.

“They want to practice in a team-based setting and, unfortunately, in many places in Newfoundland that’s not an option. That’s one of the things that drives them away,” said Thomas. “I think most of us would absolutely like to work in a team-based model. I don’t think any of us replace anybody else, right? I don’t do the job of a pharmacist, a pharmacist can’t do my job, but together, working to our full potential for the patient, we can be a very effective team.”

Thomas believes that to resolve the situation, at least several issues need to be addressed.

“I think the system does need to be looked at seriously. There’s no doubt,” said Thomas. “I think the health accord might go a ways to hopefully addressing some of these concerns. I mean, there’s always the question of remuneration and negotiations and everything else, and I do feel that there needs to be a competitive package for family physicians to practice in our province. We can’t operate in a system where there’s a big discrepancy across the country. But there also needs to be supports for our family physicians, so that they can take their breaks, and they can get their time away if they need it. They can have a meaningful practice and still live in the community without being burnt out and working all the time. So like, I do feel there are solutions that can be had, but we really need some serious thinking to make it happen.”

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