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Canadian Journal of Rural Medicine
CJRM Winter 2001 / hiver 2001

Commitment from Calgary!

David Topps, MB ChB, MRCGP, FCFP, CCFP

CJRM 2001;6(1):41-2.


More than 300 rural doctors and other health care workers from 30 countries came to the 4th WONCA (World Organisation of Family Doctors) World Rural Health Conference in Calgary last August. The conference was an unusual collaborative effort between the University of Calgary, the Society of Rural Physicians of Canada (SRPC), the Alberta Rural Physician Action Plan, the College of Family Physicians of Canada (CFPC), the Canadian Medical Association, Memorial University, the University of Alberta, and the WONCA Working Party on Rural Practice.

The Canadian International Development Agency (CIDA) agreed to provide $60 000 for 20 delegates from developing nations. This sponsorship enabled participation of many poorer nations that have been under-represented at previous WONCA rural conferences. This CIDA grant also acted as a catalyst for other groups — a further $20 000 in voluntary donations was raised from individual rural physicians and their organizations.

A healthy media interest in the conference was helped by the attendance of Federal Health Minister Allan Rock, Provincial Health Minister Gary Mar, and the President of WONCA, Dr. Bob Higgins.

The main focus of the conference was to share practical solutions to the everyday problems of rural health. Maldistribution of resources, compared to needs, is a theme common to both poor and wealthy nations. It has become clear that an essential component of the conference series is to generate global policy recommendations on issues that are relevant to rural health. This process was very strong at the Calgary conference and produced a number of powerful statements.

Foremost among these was the Calgary Commitment,1 which was best summarized by the following quote.

The Calgary Commitment to Women in Rural Practice will make visible the work of women. This is particularly important given the increasing presence of women in rural medicine, the challenges facing women in rural practice, some of which are unique to women and some of which are unique to rural practice and the inequities of commitment to, and resources for, these issues around the world.

Barb Doty from Alaska has taken on the task of being provisional chairperson. She urgently requests submissions (bdoty@alaska.net) from female doctors involved in rural practice. This topic will be a central theme at the WONCA World Conference in Durban in 2001.

Dr. Peter Hutten-Czapski led a collaborative group from the SRPC and the CFPC; this group presented the Canadian Coalface document. The document summarized many of the issues that are key to rural medicine in Canada today. Examples of such issues were maternity benefits, locum programs and practice-diversity payments. In particular, more action is needed on spousal and family support, retention measures such as long-service leave, rural rotations for specialty training programs, early and repeated exposure of students to rural life, rural focused education streams and even the possibility of a new rural/northern/aboriginal medical school. Other issues include support for rural focused CME, information technology and connectivity support for rural communities.

It was noted that all provinces now have rural recruitment plans and that there is a growing number of rural research centres. However, this could be better coordinated and directed with a structure within the newly created Canadian Institutes of Health Research. It should be reinforced by the establishment of Chairs of Rural Medicine and Health, and Offices of Rural Health in medical schools.

The WONCA Policy Document on Rural Practice was first ratified in Malaysia at the previous conference, in 1999.2 Considerable effort was given to refining this and to including some of the key elements that arose from discussions at this conference. Some of the more noteworthy new recommendations to be included in this document were integrating cultural awareness into the undergraduate curricula; integrating rural training across undergraduate, postgraduate and CME; advanced skills training; providing a major portion of training within the rural context and specific measures to retain women in rural practice.

The Durban Declaration3 was initiated at the 2nd World Rural Health Conference in Durban in 1997 and ratified by the WONCA Executive at the 1998 WONCA World Conference, in Dublin. In continuation from the Durban Declaration it was further recommended that health services and governments that employ doctors from developing countries should be required to make a contribution to the support of rural doctors in their country of origin and that each country should be encouraged to meet their own needs for a medical workforce.

It was gratifying to note that Canada is at the forefront in driving these policies and shows exemplary commitment to the majority of the recommendations. However, much work remains to be done. We anticipate that the momentum from this conference will push us onward to more effective research and educational practices for rural health.


Dr. Topps is with the Department of Family Medicine, University of Calgary, Calgary, Alta.; and Chair of the Organising Committee, 4th WONCA World Rural Health Conference (Aug. 15–19, 2000)

Correspondence to: Dr. David Topps, Assistant Professor, UCMC Sunridge, 3465 26th Ave. NE, Calgary AB T1Y 6LA


References
  1. Birks K, Doty B, Johnston M. The Calgary Commitment to Women in Rural Practice. Proceedings of the 4th WONCA World Rural Health Conference; 2000; Calgary, Alberta. Available: www.ruralnet.ab.ca/wrhc/Calgary%20Commitment.doc
  2. WONCA Policy Document on Rural Practice and Rural Health. 1998. Available: www.wonca.org/working_groups/rural_training/parta.htm
  3. The Durban Declaration. Proceedings of the 2nd WONCA World Rural Health Conference; Durban, South Africa; 1997. Available: www.healthlink.org.za/wrhc/proceed/ddecl.htm

© 2001 Society of Rural Physicians of Canada