“We live, work and play here. Our relationships with the people in these communities run deep. Faced with a patient in desperate need, how do we say no?”
How bad do things have to get before we make the right changes? What about the death of a baby or the near-death of a young woman?
Doctors are experts at diagnosing problems and designing solutions. They spend years understanding patients, communities and the healthcare system in those communities. So I listen when those same doctors warn: "Healthcare is at a point now that it's no longer a question of if a patient will suffer -- but a question of when."
A newborn baby died 2 weeks ago in Northwestern Ontario — a rare event in a first-world healthcare system.
A woman, pregnant and bleeding, needed emergency surgery. The situation was so dire that her baby died on the way to the hospital. The clock on her life was ticking. The city's one and only anesthetist was away. Frantic calls were made until a Doctor came out of retirement to save her life -- but not her newborn baby.
The exact location of this tragedy doesn't matter -- Fort Frances, Dryden, Sioux Lookout, Red Lake, Kenora, Atikokan, certainly any First Nations reserve. All of Northwestern Ontario has been under-serviced for years.
"We are exhausted from working in unmanageable, unimaginable conditions with little say," admits a doctor in Kenora. "This is a story of what can happen without services. At first, you work harder to fill the gaps... But after a while, the gaps get too wide."
Healthcare resources up North are scarce. Red tape and administrative burden multiply. One by one, Doctors, Nurses, and Allied Health Providers leave, heart-sick and burned out. These days, Northwestern Ontario's healthcare system is down to a skeleton crew.
The doctor from Kenora recalls his own story, hauntingly similar, from a decade ago: "I heard screaming. I ran up to find my pregnant wife standing in a pool of blood. She had felt a tearing sensation. A crash C-section later, I held my anaemic 8-pound baby in my arms. I am indebted to the doctors and nurses who helped us on that fateful day."
He never imagined a future where the doctors and nurses weren't there: "Physicians and nurses working in under-serviced areas are always on call; they can't get sick. We are the system, not the brick-and-mortar buildings we work in."
This is simply not sustainable.
It is inhuman to expect one doctor to be on call 24 hours a day, 7 days a week, 365 days a year. Yet many doctors work like this in towns scattered all across Ontario.
This pressure-cooker system has forced doctors and nurses to work in around-the-clock crisis mode. Not surprisingly, they burn out.
"We live, work and play here. Our relationships with the people in these communities run deep. Faced with a patient in desperate need, how do we say No?"
Kenora is short 15-20 family doctors. Every operating room in Northwestern Ontario is down to half the anesthetists it needs. 4 out of 10 shifts in the Emergency Department are out-sourced. Psychiatry is down to 1 doctor. There is no pediatrician, no gynecologist, no orthopedic surgeon, no internist.
Doctors are irreplaceable in our healthcare system. In fact, as the number of physicians in a community drops, premature death in that community rises. That is what we are seeing now.
However, this manpower crisis is the tip of the iceberg. The failure of a healthcare system is complex.
One thing is clear: those who work in the trenches of Northwestern Ontario's healthcare system feel ignored more often than not, while those who stand outside make all the decisions. Although bureaucrats, managers, hospital or government officials are genuinely trying to help, they don't understand. They can't -- not the way doctors and nurses who soldier every day in this system can.
So the doctors up North are stepping up to the plate. These physicians are creating and innovating ways to save their healthcare system. In so doing, they hope to save their patients, their communities ... and themselves.
Reading their recommendations, I'm blown away by the depth of the problem presented -- and the breadth of solutions offered. So will those who make healthcare decisions engage these doctors?
Our government is investing more money into healthcare. I hope they take it a step further: invest in insightful solutions that transcend election cycles. That is how transformation begins.
(First published in the Toronto Star on July 14, 2017.)