News Leader News for January 29, 2008
DR. ADAMS OFFERS SOLUTIONS TO SHORTAGE
"Rescuing Rural Practice"
by Dr. John Adams
Rural hospitals and particularly remote rural emergency rooms in B.C. are in crisis!
Every rural physician in B.C. would agree with this statement! How to solve this escalating problem is under debate and every rural physician and other concerned health worker has their own point of view!
I have summarized below my current personal views based on 24 years in rural B.C. and 22 years as a General Practitioner and Hospitalist in the U.K.
- It is imperative not to short-change the number of rural physicians required for a particular community. Remote rural physician groups need to be at least five strong in the 3,000 to 5,000 population, four strong in the 2,000 to 3,000 population, three strong in the 1,000 to 2,000 population, and two strong below this. This is the only way to prevent burnout! Remote rural practice is a 24/7/365 commitment for emergencies, and on-call is hugely more challenging than urban on-call (I have done both!). - The B.C. populace expects and should receive timely first-world medical coverage in remote rural areas. This particularly applies in emergency situations e.g. when people are critically injured or have life threatening illnesses.
- Communities dealing with high levels of M.V.A.s, skidoo, and mountaineering accidents, require special consideration. They must have an up to date Emergency Department with at least two personnel skilled in Critical Care available 24 hours a day.
- Every person in a Rural Emergency Room setting should be familiar with and able to use all equipment, which should be regularly restocked and kept up to date.
- To be familiar and "comfortable" with the latest standards of care, every remote rural hospital should have at least three 'in house' educational sessions per annum A.C.L.S., A.T.L.S., rural deliveries etc.. A traveling Critical Care team, providing this education, could easily circulate through B.C.'s rural communities. The costs involved would be small compared with the benefits reaped.
- Triage and transport in Rural B.C. is at present under funded and needs a complete revision! Critically injured patients require on the spot stabilization and rapid transfer to a higher care Trauma Centre.
- Alberta has a highly acclaimed critical Care rescue system, (see stars.ca), which utilizes helicopters and emergency Physicians to evacuate patients from the site of their accident to the nearest Trauma Centre. - Rural Communities with a high incidence of critical-care trauma require the full support of A.L.S. crews. They should be suitably rewarded for their isolated situation. They would play an invaluable role in ensuring rapid stabilization and transfer of critically ill patients.
- Young graduates are often intimidated by Isolated Rural Medicine and require full training in Critical Care Medicine with at least three months in anesthetics, obstetrics, and six months in "Hands-on" emergency experience. Adequate funding and tutoring needs to be put in place.
- To enable remote rural physicians, nurses and other personnel to have a balanced lifestyle, they should be guaranteed generous locum coverage for holidays and study leave. (6 weeks holiday and 2 weeks study leave would be appropriate).
- Rural Locum Physicians are a highly valued and very scarce resource. Their numbers need to be at least doubled. To achieve this their remuneration should be comparable to other provinces (particularly Ontario and the North West Territories who at present are employing many B.C rural locum physicians.
- Rules and regulations relating to walk-in clinics should be revisited, particularly with regards to on-call obligations. The Quebec solution is not ideal but a modification of the plan might be considered.
- There are a considerable number of Rural Physicians retiring prematurely or migrating to the city. The various bodies need to be sensitive to the new reality of an aging physician population. They should encourage older doctors to stay in Rural Practice giving day to day care, while adequately compensating younger doctors to cover on-call.
- The mindset that every physician should retire at 65 or be willing to give 'all or nothing' is outdated!
Finally, it is essential to create a pool of emergency physicians and hospital workers able to provide 24 hour coverage to rural emergency departments in crisis. This service is overdue and should be urgently created and activated.
This article is intended to encourage productive debate and I hope is taken in the spirit in which it is intended. Adams, John. "Medical Resources and Manpower." Canadian Journal of Rural Medicine 3.2: (1998):105 at http://www.cma.ca/index.cfm/ci_id/37313/la_id/1.htm
COUNCIL APPROVES STRATA TITLE PLAN
Riverside Motel owners applied to Town Council for a change in the Official Community Plan to allow for strata titling of the motel units.
The subject of strata titling raised some emotions in Council at the meeting following a hearing held on January 21. The public did not appear to raise any strong objections. During the regular meeting, Town Council gave third reading to a bylaw allowing the change, but had some reservations about further strata title applications.
Councillor Jim Manion told Council he has "mixed emotions" about strata titling, but as cabins at Riverside Motel are not family dwellings, he would vote in favour, as the cabins will be upgraded.
Mayor Randy McLean went further, saying any future applications for strata titling of apartment buildings would not get his vote in favour.
Councillor Pam Jones stated, "We should be looking at proper housing for low income people in our community. We should be working on this, we should move to the next step. It's not up to private business, it is up to us."
Mayor McLean agreed with this point, adding, "This Council should take the initiative. We should find out how other communities have done it."
Councillor Maria Sadegur reminded Council there had been two low cost housing projects for seniors in Princeton's past. These are the Silvercrest apartments, an initiative of the Royal Canadian Legion.
Councillor Jarvis said he is opposed to any more low cost housing being strata titled.
Council had received a letter asking them to stop the rezoning of 185 Luard Avenue apartment building to strata or condo. Mayor McLean said no rezoning application had been received for that property.
At the end of the meeting, a man stood up and told Council he had planned to invest in a low cost housing building in Princeton, and had planned to upgrade it but keep it low cost. After hearing the remarks at the meeting, he planned to withdraw his offer to buy the property.
PGSAR REVIEWS PREVIOUS YEAR
Princeton Ground Search and Rescue Society hosted their Annual General Meeting January 22nd at the SAR Hall.
The year end review indicated PGSAR had been in attendance at 5 call outs in 2007. They included a 'carry out' of an injured man at Arrastra Creek in March; a 'body recovery' at Friday Creek in May; another 'body recovery' at Britton Creek in August; an 'overdue hiker search' at Jacobson Lake in September and an 'overdue hunter search' at Connelly Creek in October. The team also received two stand-by calls, a 'lake search' at Merritt and 'overdue hiker search' near Manning Park, both in August.
Although the call out number was half of the previous year, PGSAR Society Secretary Randy Rorvik says the calls they did receive shows a disturbing trend: "People are still going out totally unprepared."
The local Search and Rescue members stayed busy in 2007 with ongoing training programs which include weekly GSAR Course modules, First Aid renewals, Tracker Training, Critical Incident Stress Debrief Program training and Helicopter Training. The group also attended an annual camp out in the Ashnola Valley which brings other regional SAR groups together to socialize, relax and share ideas and plans.
Other highlights over the past year included (as part of the South Okanagan Similkameen SAR Committee) a purchase of a Flood Trailer, a Mock Search in Keremeos and the annual Ashnola Camp Out.
Local SAR highlights include attendance at the Freshet 2007 Conference in Kelowna; assisting Princeton Lions Club with Auction-related support; the digitization of the PGSAR logo for use in clothing and promotional materials; participation in the Rotary Parade; fundraising through a rifle and shotgun raffle; the purchase of over 50 1:20,000 scale topographical maps and an equipment donation through supplier North Water Rescue.
PGSAR President Arnie Powell says support from local groups, businesses and individuals are greatly appreciated and he thanked the following: Osprey Ratepayers Association, Otter Valley Fish & Game Club, Similkameen News Leader, Ron and Loretta Young at Princeton Outdoor Supply, Bill Quinlan of Q-Tech Industries, Princeton Lions Club, Pete Hartinger, Weyerhaeuser, Cpl. Joe Houben of Princeton RCMP Detachment, Town of Princeton Employees and Council, North Water Rescue, Regional District of Okanagan Similkameen and Ken's Janitorial.
As for the election of officers, all seats were filled by acclimation. Arnie Powell returns as President. Brian Hurd (Vice President), Randy Rorvik (Secretary), Erika Leschert (Treasurer) and (Directors) Devin Huff, Lorraine Stubbins and Jim Cranston, joins him.
TEAM STUDIES DAM POTENTIAL
The growing need for water conservation prompted the formation last year of a small international group to study the feasibility of a dam on the Similkameen River. This is not the first time a dam on the Similkameen has been proposed.
The first time was early in the past century, and resulted in the construction of the Enloe Dam south of the border.
The Similkameen River is notorious for major spring run-off and possible flooding, followed by a late summer inadequate flow for irrigation purposes.
Michael McLaughlin, Economic Development Officer for Similkameen Valley Planning Society, attended the January 21 Town Council meeting to update Council on what the joint committee is doing toward a dam on the Similkameen.
McLaughlin stated the group is comprised of five representatives from the Similkameen Valley and five from Okanogan County in Washington State. The group was formed one year ago to gather information about the best place to put a dam on the Similkameen. One of the locations proposed is Shanker's Bend, which would flood a lot of land, including the South Similkameen in Canada. McLaughlin said this is not favoured.
The top priority is ecological benefit, the second is economical benefit. During the past decade, the river is lower in late summer than it has ever been, and the group would like to see water conserved in spring to keep the river depth moderate throughout summer.
Councillor Maria Sadegur asked McLaughlin whether the group had considered the dam proposed by Princeton Light and Power in 1990.
McLaughlin said it was not ruled out, and offered some advantages.
This committee does not have the authority to initiate a dam project, but could lobby for it as a conservation measure.
