"Where in the world is rural health?"
David Topps, MB ChB, MRCGP, FCFP, CCFP
CJRM 2000;5(3):125.
As in the traditional Chinese curse, we are living in interesting times as things unfold in the world of rural health. With Canada hosting the 4th WONCA World Rural Health Conference, Aug. 15-19, in Calgary, it is timely to review the world situation and our role in taking things forward. Australia leads the world in developing innovative programs and initiatives that help their rural physicians. But the Society of Rural Physicians of Canada can claim its place on the world stage as a strong and effective body in promoting solutions to the problems that beset rural health care workers the world over.
It's clear from previous world conferences that inequities faced by rural populations are remarkably similar. For rich nation and poor the themes of central and urban ignorance of rural issues ring true. The innovative solutions highlighted at these conferences are surprisingly translatable into a wide variety of situations. We rural docs are good fixers and make the best of limited resources.
The 4th Conference has adopted the theme of "Partnerships." This follows from ideas raised at the last 3 rural/remote medicine conferences. With the widening gap between needs and available supply of rural physicians, it is evident that recruiting efforts alone will not suffice. We need more attention on retention! Sustainability of the current workforce is essential, as is finding ways of making more effective use of clinician teamwork. A pre-eminent example of this is trauma triage and transport -- although Canada can boast some of the best equipped and most effective medevac teams in the world, these teams are only truly effective as part of a chain of survival, integrating rural ground teams from the outset.
Integration and teamwork is just as important in education -- a brief taste of rural life is rarely sufficient to influence the career choices of our graduates. Immersion into rural culture and context by basing them in rural centres has been shown to be much more effective. With the increasing feminization of medicine, greater attention to lifestyle issues and caring for the caregivers will be ever more important in attracting graduates to rural practice.
Clear statements from Kuching and other world meetings have underlined the importance of true community involvement in all aspects of health research. Participatory teamwork needs greater emphasis -- this is especially true in Aboriginal health. The emerging pandemic of diabetes in Aboriginal peoples is rife in Canada -- we can lead the world in addressing these problems.
Communication underpins all teamwork. Telecommunications and the Internet have had a huge impact but, despite significant research and investment, it remains to be seen whether the great promise of telehealth will be a panacea, placebo or pariah. Rural involvement in all aspects of telecommunication development is essential to making this work effectively.
The 4th Conference promises to be as dynamic and interesting as its predecessors in addressing all these issues, and more. With 150 presenters from around the world, this conference represents a unique opportunity to share these solutions and put Canada on the world rural health care map.
Correspondence to: Dr. David Topps, Assistant Professor, UCMC Sunridge, 3465 26th Ave. NE, Calgary AB T1Y 6L4
© 2000 Society of Rural Physicians of Canada
