University of Calgary Rural Family Medicine residents celebrating graduation.  These doctors will be distributed throughout rural communities across Canada come July 1st, 2015.

By Meagan Williams

Six months into her pregnancy, Lachlan Rempel’s primary care physician in Pincher Creek found that her unborn daughter had Hydrocephalus, a disease that causes water to develop on the brain.  After more tests were run, it was also discovered that Rempel’s daughter was one of the rare few who suffer from Chromosome Micro Duplication 15Q 13.3.  A disease so new and rare, that it doesn’t even have a common name yet.

Micro Duplication means that a small piece of DNA has been copied at specific chromosome. The neurological complications in these effected genes range from Attention Deficit Hyperactivity Disorder to Autism and even Schizophrenia.  Further on down the diagnosis list you will see Rempel’s daughter is unable to speak and is fed by a gastrostomy tube due to her severely limited motor function.

Rempel’s daughter, Ellie Weisshaar, is now three and half years old. Ellie is a prime example of why keeping the doors to rural and remote hospitals open is crucial.

When Rempel described the type of community support her and Ellie feel in Pincher Creek, her voice waivered with emotion.

“One of the biggest perks with having a child in a small community is that everyone knows who Ellie is, they look out for her.” said Rempel.

While some of Ellie’s medical care can be done in Pincher Creek, the local hospital simply doesn’t have the specialists available to treat her complex conditions. The duo make monthly trips to Calgary to see the plethora of physicians that make up Ellie’s care team.  Her care team includes a neurologist, a nutritionist, a cardiologist, a plastic surgeon, a spinal specialist, an ophthalmologist, a gastrointestinal surgeon and a neurophysiotherapist.

Some of Ellie’s appointments can be conducted by the Alberta Health Services telehealth video conferencing system from the Pincher Creek hospital, which reduces the travel frequency and time missed from school and work for the duo.

I asked Rempel why she hasn’t just moved to Calgary.  From an outsider’s perspective, it would appear that life would be easier living in the city where Ellie’s care team practice.

Rempel told me that while the thought had crossed her mind on many occasions, ultimately she doesn’t want to move.  She described the supportive and nurturing relationship that Ellie has with her preschool aid and teachers, of the close relationship that she has with their physician, Dr. Gavin Parker, and how that would be missed if they moved to Calgary. 

“We ran into Gavin at dinner over the holidays and he’d heard that Ellie had been to the ER with an ear infection. Gavin said he’d faxed in Ellie’s prescription to the pharmacy so we could pick up her meds on the way home from dinner.  That’s the benefit of living in a small community.” said Rempel.

Parker is a family medicine physician with additional post-graduate training in anaesthesia. Parker graduated from one of the rural family medicine residency programs in Canada, where he was trained specifically in rural and remote settings to prepare him for practicing in smaller, isolated communities.

Parker was attracted to the rural family medicine lifestyle early on in his medical training.

“For me it was a combination of things, I wasn’t ready to be done with a particular rotation once I was finished with it, which is why family medicine appealed to me. The type of medicine you can practice in rural areas is broader.” said Parker.

Parker identified some of the problems he believes are inhibiting the recruitment and retention of physicians in rural and remote communities. He described how he and his family were welcomed into their town and how they have become an integral part of the community in Pincher Creek.

“People assume just because you’re out in a small town that you’re going to be lonely. Some of the loneliest people on the planet live in big cities. Rural communities are great places to raise a family, they are much more inclusive. It’s cliché, but it takes a village to raise a child, and rural towns live by that mantra.” said Parker. 

Delivering comprehensive healthcare to rural communities is not an isolated problem only suffered by Albertans.  Dr. Ewan Affleck has been practicing medicine in the remote communities of the North West Territories (N.W.T.) for almost 14 years. 

“There have been changes over the years to the costs associated with providing healthcare in the north.  The average cost of providing healthcare in Nunavut is the highest in Canada, followed by the N.W.T.  The average cost per person is double that of provinces in the south. Healthcare workers are paid more, the cost of building facilities is higher, and the cost of shipping equipment is higher.  There are 33 rural and remote communities in the North West Territories, we cannot put a CT machine in everyone of those communities.” said Affleck. 

Affleck went on to tell me that there isn’t even an MRI machine in Yellowknife, so patients requiring that type of diagnosis have to be flown to Edmonton.  Just one example of the costs contributing to high priced health care in the country’s north.

On the east coast of Canada in Happy Valley-Goose Bay, Newfoundland and Labrador, Dr. Gabe Woollam tells a similar story.

Woollam describes the lack of community resources for fitness and lifestyle along with the difficulty in making healthy food choices in northern Canada.

“These things can make it hard to recruit and retain healthcare professionals which results in poor access to primary care.” said Woollam. 

So, how do we get more physicians interested in practicing rurally?  When looking at the research from postgraduate training programs across Canada, there is one common theme.  The earlier that medical students are exposed to rural medicine and the longer they are in rural communities for, the better chance that they will end up practicing rurally.  These results were identified in reports for the Distributed Royal College Initiative at the University of Calgary and the Alberta Rural Physician Action Plan in Edmonton.

Rural exposure in clinical training is something that Dr. Kathy Lawrence, past President of the College of Family Physicians of Canada, believes is imperative.

“I think this is a critical experience.  Not only does it broaden the understanding of physicians about rural practice and life it also provides an important opportunity to understand and practice the full scope of family medicine, tackle complexity, to learn how to make decisions with limited support available, and how to use resources judiciously.” said Lawrence.

In an article by the Edmonton Journal in December last year, the writer called for the closure of nine rural hospitals across the province.  While the provincial government may save a few dollars by closing these facilities, the article doesn’t explore the crushing effect these closures would have on the communities they service.

Hospitals and healthcare facilities are often the lifeblood of rural and remote towns.  Once the healthcare professionals close their doors, the remaining residents are left without immediate access to primary care.

This then begs the question, what do those rural communities do when they need a doctor?  Are they to go without healthcare?  Or will they be forced travel hours and hundreds if not thousands of kilometres to a regional or large city facility that are already struggling to service their ever-growing population.

One rural community that has recently managed to keep their hospital doors open is Milk River.  This area of southern Alberta has been in desperate need for doctors since their last physician left in 2009.  The need was so great that newly retired local physician, Dr. Elizabeth Lewke-Bogle, came out of retirement to fill in while someone new was recruited.

To aid the search for new physicians, the surrounding communities assembled the Quad Municipality Physician Recruitment + Retention committee, which is made up of local ranchers, nurses, business owners and council members.

After six long years of searching and interviewing, two new physicians have signed on the dotted line to start practicing at the rural healthcare facility.  Dr. Petrus Krog and Dr. Adaku Ifebuzor are two international medical graduates from South Africa who are moving to the southern Albertan town to live and work.

While the communities surrounding Milk River are feeling relief, there are many more who are still struggling to find help.  Vulcan, Three Hills, Creston, Whitehorse, all rural or remote locations across Canada that need more physicians.

Back in Pincher Creek, I asked Rempel if her family would be able to stay in their rural town if their local hospital were to stop offering emergency services or close all together.

“Oh, we couldn’t live in Pincher Creek if there wasn’t a hospital.  The types of seizures Ellie has are very complicated so if there wasn’t a hospital, we definitely wouldn’t be living here.  My daughter could die,” said Rempel.