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Health officials address rural inequity

Gap in specialized care within Powell River a growing concern
medical graphic

Most people who live in Powell River have known someone who has dealt with the difficulty of obtaining tertiary care within the region’s rural health care system.

Tertiary care is referral to a specialist from a primary or secondary health professional for advanced medical investigation and treatment, such as what is available in Vancouver and Victoria hospitals.

According to Gavin Wilson, Vancouver Coastal Health (VCH) public affairs director, places such as Powell River have never had those levels of advanced treatment.

“Smaller communities are just not going to have the kinds of highly specialized services which would be available in a major centre like Vancouver,” said Wilson. “That’s just the way it has to be because this is where specialized services exist. There are services provided in Vancouver that are one-of-a-kind for the province.”

Former Powell River resident Denise Reinhardt had to go that one step further than travelling to the care she needed. Reinhardt and her partner Paul Schachter, a longtime and well-known community leader in Powell River, made the difficult decision to move from Powell River to Victoria because of Reinhardt’s health.

“I live with a number of health conditions, which meant our life in Powell River was frequently interrupted by trips to Vancouver for consultations and procedures with specialists,” said Reinhardt. “Sometimes the doctors reviewed tests and made diagnoses, sometimes they prescribed medications and sometimes they gave general instructions. Mostly, they felt they could do little or no followup, because the continuing programs were in the Lower Mainland.”

Reinhardt said she found it very challenging to have to constantly leave Powell River for her health care.

“It was enormously frustrating to spend at least two days of travel and the cost of an overnight stay to spend 20 minutes or so with a doctor who was then, in effect, unable to give me the level of service I needed,” she said.

That lack of services is referred to as health care inequities. These inequities exist in health care available among population groups, such as rural and urban, that are considered unfair, unjust, or preventable.

Inequities also exist among income groups and interruptions in regular services.

According to Powell River Division of Family Practice chair Bruce Hobson, those interruptions are an important area that is often overlooked in discussions about health care inequities. In particular, they centre around the management structure of hospitals and other health care institutions.

In the case of Powell River General Hospital, there are four managers.

According to Hobson, if one of those managers was unavailable for the job for any reason, it creates a big gap in the hospital’s ability to deliver services.

Wilson said the reality is some medical cases require highly specialized care on a regular basis, which is not available in Powell River.

“You’re going to have to move closer to where those services are available,” he said.

Schachter said it was extremely hard to leave Powell River, but it did not make sense to stay at the cost of the health of his family.

“It was sad that we weren’t able to access an acceptable level of care for conditions that are part of the aging process for many of us,” said Schachter. “Even the best family practitioner, if you are lucky enough to find one, can only do so much.”

Since making the move from Powell River to Victoria, Reinhardt has been experiencing coordination and followup from specialists and access to programs that were simply out of reach in Powell River.

According to Hobson, there is not access here to some of the tertiary services, specialists, investigation and interventions that a larger city would have and that raises the question of how to get to those doctors.

“A lot of the challenges have to do with transport,” said Hobson. “Having timely transport to be able to get somebody down to get tertiary services is really a piece of inequity that could be improved upon. That’s really a key one that comes up in small and isolated communities over and over and over.”

In Victoria, Reinhardt said she is participating in many excellent secondary and tertiary care programs with the coordinated care of doctors and medical professionals.

“My mobility and enjoyment of life are much improved,” she said. “I credit the care and programs I have now for this result.”

According to Hobson, there are ways in which inequities in care can be improved upon, including new communication technology, such as video conferencing and telephoning, that would even out the playing field between isolated communities and large urban centres.

Wilson said the advent of these new technologies could be somewhat of a game-changer and provide people in more remote areas with increased access to services that are taken for granted in the city.

One of those programs is an initiative for Powell River and Sunshine Coast called TIDES, which stands for Telehealth, Innovation, Deployment, Education
and Sustainment.

“This will be a team-based model to allow for regular support to in-community rehab assistants via a telehealth platform with deployment to the communities on a rotational basis,” said Wilson, adding the rehab team consists of a physiotherapist, occupational therapist and a speech-language pathologist.

Another initiative is a new hub for palliative care at Lions Gate Hospital, which will include a palliative outpatient clinic and is projected to be complete by late 2017.

“It will provide the capability for North Shore palliative doctors to extend their reach via video link to ‘see’ patients living in Powell River, on the Sunshine Coast and up the Sea-to-Sky corridor,” said Wilson.

According to Hobson, video conferencing is currently being used at Powell River General Hospital.

“Being able to have that from any point of care, like in a physician’s office, is something that would really help make things more equitable and life more smooth,” said Hobson.

None of this is to say Powell River does not have specialists, including general surgery, general internal medicine, psychiatry, radiology and ophthalmology. However, some specialist care is performed by GPs on a limited basis, said Hobson, including one doctor who does paediatrics and another doing oncology.

Hobson said VCH needs to address health care inequity and, more importantly, understand it.

“Having people make decisions on how things should work up here without consulting with us because you live in the city, the reference point just isn’t there,” he said.

Hobson said inequity between rural and urban areas is a reality that cannot be completely solved.

“There are cost and geographical limitations and logistics to some of the health services that can never be overcome,” he said. “However, when there are things there could be solutions for, we need to be consulted on those, and if decisions are made we also need to be consulted. We need to be part of that decision-making process.”

Given the cost constraints on Canada’s health care system, solutions have not been easy. Wilson said VCH is constantly restricted to limited resources.

“There are always resource issues,” said Wilson. “We’re working within a certain amount of resources available to us and there’s always that constraint in the health care system. We certainly are aware of these issues.”

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