Supporting the North

By Dr. Brian Postl, Winnipeg Health Region President & CEO

As regular readers of Wave know, I normally like to use this column to highlight some of the stories we have prepared for our magazine.

And given the lineup for this issue - a cover story on Olympian Cindy Klassen and feature articles on the impact of concussions on young athletes and the negative health effects of consuming too much salt - there is certainly a lot to talk about.

This time, however, I'd like to stray from the script a bit and use this space to talk to you about something else: access to health care in the North, and the role the Winnipeg Health Region could play in improving it.

As most readers will know, people living in the remote communities of northern Manitoba and Nunavut face numerous challenges. Many of these communities are accessible only by air or winter road. Living conditions are tough: housing is often poor, drinking water is frequently only available by truck, and health-care services are sporadic.

I first learned about how difficult life can be in the North almost 40 years ago. At the time, I was a medical school student and took a summer job at a nursing station in Shamattawa, which is located about 800 kilometres north of Winnipeg.

It was, to say the least, an eye-opening experience. One could not help but notice the poverty and the social and health issues that flowed from it. Back then, the biggest health problem in Shamattawa centred on the pandemic of gasoline sniffing among children - some as young as two and three years of age. It's a problem that hasn't completely disappeared.

hamattawa did not have much in the way of a medical infrastructure back then. The nursing station was not exactly loaded with modern medical technology, even by the standards of the day. It did, however, have some good, committed people working there.

In particular, I remember one nurse by the name of Sheila Bryant, who immigrated to Canada from Jamaica. Bryant was a brilliant nurse and a midwife; I probably learned more from her about obstetrics than I did at university or any hospital.

My time in Shamattawa solidified my interest in the North. I worked for two-anda- half years in Churchill upon graduating from university, and I was for seven years the Director of the Northern Medical Unit, an organization based at the University of Manitoba that provides health services to some northern communities.

I still make regular trips north, working in various communities as a pediatrician, which is my area of practice. These trips serve to remind me of the services that are lacking in these communities, services that we in Winnipeg take for granted.

I am not alone in this view. A number of us here at the Region have had experience working up north, and we've all long realized that more needs to be done to improve access to care in these communities. We've also concluded that the Winnipeg Health Region has a role to play in this effort.

As noted earlier, the key provider of services right now is the Northern Medical Unit. While this agency has done a remarkable job of providing services to the North over the years, it is currently running into some difficulty recruiting doctors. I'm told that nearly half of the agency's physician positions are open because of this challenge in finding doctors.

Here is where the Winnipeg Health Region can help. Currently, the Region has a number of health clinics that provide services to people in our community. Compared with the Northern Medical Unit, we generally have an easier time recruiting doctors, nurses and other healthcare professionals because working for us means living in a large city, with all the amenities and opportunities that entails.

I am proposing that we increase the staff at these Region health clinics, and then give them additional responsibility for providing care to some northern communities. So, for example, a Region clinic currently employing 10 physicians would recruit three more doctors. Then, all of the doctors in that clinic would be responsible for providing care to certain communities in the North. In essence, that would mean each doctor spending a week or so up north every two months.

There are a number of benefits to this model. First, it should make recruitment easier. A doctor who isn't interested in working up north full-time, but would like to work part-time could have the best of both worlds - a full-time appointment in Winnipeg, with regular trips north. The people living in the North would also benefit: patients who see physicians from the same clinic on a rotational basis would receive enhanced continuity of care. The taxpayer would also benefit because the model outlined above should reduce overhead and make the delivery of care more efficient.

We at the Region have already had some discussions with the province, the Manitoba Assembly of Chiefs and the Northern Medical Unit about this idea, and they are supportive. We haven't had a conversation with the federal government yet, but I suspect they would be in favour of anything that improves the quality of care in remote communities. The next step in this process will involve working out a funding agreement with the various levels of government and then launching a pilot project to test its effectiveness.

In the longer term, I can see this model being used to provide a broader range of health services to northern communities. In addition to doctors, the program could be expanded to include physiotherapists, occupational therapists, speech and language specialists and registered dietitians - all specialties that are hard to come by in northern communities.

How soon can we get this off the ground? I'm not sure, given the various issues and government jurisdictions involved. But one thing I am sure of is that the Winnipeg Health Region is the largest health-service provider in Manitoba, and one of the largest in Canada. If we can't step in to help improve access to care in the North, who will?

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Wave is published six times a year by the Winnipeg Regional Health Authority in cooperation with the Winnipeg Free Press. It is available at newsstands, hospitals and clinics throughout Winnipeg, as well as McNally Robinson Books.