Charting a course for rural medicine
John Wootton, MD, CM, CCFP, FCFP
Shawville, Que.
CJRM 1998;3(3):135
© 1998 Society of Rural Physicians of Canada
[ français ]
This month's journal cover is a coup of sorts. Not only are we able to showcase David Blackwood, one of Canada's leading artists, but we are also able to celebrate, through his work, a very successful, some might say historic, rural medicine conference that was held by the Society of Rural Physicians of Canada in St. John's in May.
Blackwood's print depicts the deceptively benign departure of the ketch "Seabird" as she leaves Newtown on her way to the Labrador Sea. It is an apt image for focussing the mind on some aspects of rural medicine. These sailors were on their own when they were at sea. The gathering skies in the upper left of the print and the icebergs on the distant horizon foretell the violence that nature may place in their way, and the organized busyness on deck suggests the experience and ingenuity which will be drawn upon when they are tested. Newfoundland sailing history is full of such tests at sea. Dramatic and at times tragic, many are tales of misfortune, others tales of perseverance, triumph, bravery and endurance.
It may be stretching the metaphor to apply all this to rural medicine, but the small society of sailors who might be found aboard a sailing vessel such as "Seabird," is not unlike a small Newfoundland coastal community, isolated at all times by geography, isolated at other times even more so by weather.
Many of the sessions at the conference dwelt on this theme in one way or another (see Society news, page 157). What local resources are adequate? Nurse practitioners? Solo GPs? Either (or both) with telemedicine links? What to do about emergency transfers? Who to send? Who stays? What if you can't go because of weather? What about on-call frequency? (see SRPC discussion paper, page 139) These and other excellent questions flowed through the sessions, and out into the hallways, and beyond, into the ALARM course which was held the weekend after (for those who had not yet had enough "rurality" for one week!)
Were there answers? Some. It was clear in the presentations at the conference, and in the session on special skills (in an upcoming issue of CJRM) and reinforced by the anecdotes of rural docs themselves, that no matter how glitzy or high tech, machines don't always work. Unforeseen conditions, from bureaucracy to blizzards, may prevent them from getting off the ground. In the end it is people who are manning the ship; medical professionals with links to, and responsibility for, their communities. Like the crew of the "Seabird" they must be well trained and able to depend on themselves. They must have a good ship around them and have a bit of luck. In the end they are the best solution to isolation and the people most likely to get everyone safely home.
