June 25, 2008

Family Weighs Leaving P.E.I. Over Lack of Family Doctor in Rural Town


KILDARE CAPE, P.E.I. - Noralee Harper is thinking about moving from her home nestled in Prince Edward Island's picturesque countryside because she can't find a family doctor for her twin seven-year-old sons, who have had serious illnesses.

She says health care will be the key deciding factor in whether she and her husband, Michael, and their four boys decide to stay in Kildare Cape.

Harper, 32, is deeply attached to her home amid picture-postcard farms and neatly tended potato fields, and knows she can count on the help of nearby relatives to help her bring up her boys.

But even though Brett has been treated for non-Hodgkin's lymphoma and his twin brother Brendon has cerebral palsy, she can't find a doctor.

"It's a fun area to grow up. It's beautiful and you don't worry about crime, but when you look at the fact we have four children, it's probably a smart decision for us to move off the Island," she says in an interview.

"We have deep roots, but ... we don't have a family doctor that we can rely on ... who will follow us year-to-year in our lifetime and track our health."

Dr. Ron Matsusaki says based on his experiences with patients in rural P.E.I., he believes the lack of physicians in rural Atlantic Canada is encouraging young families to leave small towns.

"The younger people are moving out, not only because they're looking for better paying jobs, but also because they're afraid of what's going to happen to themselves and their families because of what's happening to their parents," he says.

Meanwhile, the population of Prince Edward Island is declining. Since 2004, about 1,300 have migrated out of province.

Dr. Preston Smith, the head of the family medicine department at Dalhousie University in Halifax, acknowledges that access to a family doctor is a problem in rural areas.

"If a family doctor leaves in a rural area, it's a disaster," he said, noting that it can rapidly lead to an unbearable workload on the remaining two or three physicians in an area.

Statistics compiled by the Society for Rural Physicians in Canada in 2005 showed there was one rural family doctor in Prince Edward Island for every 1,598 people, compared to national average of 896 people per family doctor in urban areas.

But Smith says he knows of no firm research showing a decline in health care plays a role in people moving from rural areas.

He also suspects that migrants to urban areas won't find improved medical care.

"People in downtown Halifax and downtown Calgary can't get a family doctor either," he says.

"Employment, education level and social well being are more important to your health than whether you have access to a doctor. ... If you want to live in a community where your children are healthier, you're likelier to consider if they can get a good job and education."

Matsusaki quit his job last year at the Western Hospital - a small 25-bed facility in Alberton, P.E.I., that serves about 14,000 people - after an incident involving Ralph McNeill in March 2007 and because of an exhausting on-call schedule. He has moved to a hospital in Digby, N.S.

McNeill's problem arose from congestive heart failure, which caused his lungs to fill with fluids. He was losing his breath and struggling to walk.

During three medical visits over a period of time, the 75-year-old says he was told he had an infection and was given antibiotics.

When he was wheeled into the Western Hospital, the emergency physician on duty was Matsusaki, who says it took eight minutes to diagnose the problem and set about saving the former farm worker's life by siphoning three litres of fluid from his body.

"I don't think the doctors are taking enough time to check you out like they should," says McNeill.

Matsusaki says in rural areas, there is a large ratio of patients to doctors and "there is a tendency to go through patients faster."

Nicole Davies, 23, of Digby takes a similar view, based on a frustrating 10-year experience with rural medicine in Nova Scotia.

For over a decade she visited various family physicians and doctors complaining of fainting spells.

She said she was initially diagnosed as suffering from anxiety, but the problem persisted.

"There were only a few doctors. They saw the file said 'She has anxiety attacks,' and they'd just keep that diagnosis and send me away," she recalls.

Last year she met Matsusaki at the emergency ward in Digby after he'd moved from Prince Edward Island.

He gave her a blood test that measured her sugar levels over a period of six hours and diagnosed reactive hypoglycemia - blood sugar low enough to cause fainting.

A change in diet has brought her illness under control and ended a decade of worry.

"Now this is something I can control. ... It's changed my life incredibly," Davies says.

"These kinds of problems are not isolated to me. I hear so many stories of people who are sick and suffering and never get the proper care because their doctors don't have the time," she says.

The problems Davies says she encountered with rural medicine could also cause her to move.

"I won't live here if I want to have children," she says. "I want them to have a doctor."

Smith says efforts are being made to improve health care in rural areas.

Nova Scotia has announced it will fund 10 places at Dalhousie's medical school for students who promise to practice in rural areas.

There are also residency programs being created in five Maritime communities with the goal of encouraging young physicians to practice there. A program will begin in Charlottetown in 2009.

And, Smith says, rural communities are introducing more nurse practitioners into health clinics to help reduce the workload on doctors.

Smith says the painful reality is that improvement to rural health care will be slow, and may involve hard choices by communities that are losing population.

"I think a lot of these changes will take a long time to make any impact. I think five to 10 years at least."

In western P.E.I., a local leader says the time has come for tough decisions.

Claude Dorgan, 53, a lobster fisherman who sits on the board of the Western Hospital, says his community of Tignish must recognize that the population is shrinking and that three small hospitals in the area should be merged into one.

He argues that would lessen the requirement of doctors and staff to divide their on-call time between three hospitals within 100 kilometres of one another.

"We're trying to fundraise in local communities to buy basic equipment, when I think with one good hospital in the local area, you'd look after those needs. You'd be buying as a group," he says.

Combined with stronger local health centres, highly trained paramedics and some fresh doctors, Dorgan believes the problems can be solved.

Amalgamating hospitals is politically unpopular as residents argue that losing an emergency ward would be a blow to a town's identity and economy.

The previous Conservative government's plan to make such changes died after the last provincial election, as the victorious Liberals brought in a 30-month moratorium on the idea.

"Something must be done though," says Dorgan. "The doctors' workload is so heavy. They see 125 people each day. ... They're worked to death."