TWILLINGATE, on Newfoundland’s northeast coast, is the sort of place where pictureperfect icebergs drift spectacularly past the harbour. It’s also the sort of place that’s large enough and remote enough to warrant its own hospital. The Notre Dame Bay Memorial Health Centre is one of the first things you see on the way into town on the road from St. John’s, 5 1/2 hours to the south. That isolation, however, has meant that the 48bed facility has traditionally had a hard time finding—and keeping—doctors. Dr. Mohamed Ravalia, senior medical officer at the health centre, is a notable exception. Trained in Zimbabwe, he arrived in Newfoundland in 1984 to fill a temporary opening, and stayed. He offers a diplomatic explanation of why so many other doctors left. “I’d prefer that the majority of people who had passed through here had stayed—but for reasons of professional development, spousal issues, family connections or whatever, they don’t tend to be interested.”
Whatever the reasons doctors shun rural
areas, the problem is not unique to Newfoundland. There’s a shortage of physicians in many remote regions of Canada—a serious impediment to providing rural residents with suitable treatment close to home. But in Twillingate, the tide has started to turn: for once there’s the full complement of seven doctors on staff. They’re staying thanks to an innovative use of teams that reduces their workload as well as their sense of professional isolation. A patient may see any of a number of health-service providers, from nurse practitioners and pharmacists to physiotherapists and social workers, in addition to—or instead of—a doctor. The health centre is one of seven in Newfoundland and Labrador that has adopted this integrated approach, putting the province at the forefront of a nationwide move to revolutionize the traditional physician-centred model of patient care.
The system wouldn’t work without modern technology. Through satellite and dedicated digital connections, doctors in Twill-
ingate can be in immediate contact with their peers. For instance, they can send digital X-rays to an orthopaedic specialist in Gander for advice on a possible fracture instead of sending the patient there, an hour’s-plus drive in an ambulance. The technology also enables Ravalia to be on the faculty at Memorial University’s medical school, even though the school is 400 km away.
Also crucial to making the system work are nurse practitioners. Specially trained to take over some traditional doctors’ duties, they can do routine procedures such as screening for high blood pressure and provide regular care for such conditions as diabetes and asthma. And prevention, Ravalia points out, is both cheaper and easier—and more likely to fall into regular office hours—than critical care. That’s a very tangible benefit for rural doctors. “I don’t have to be here every second night, every third night, and that is critical,” says Ravalia. Still, at the end of a Sunday morning interview, he loops his stethoscope around his neck and heads off to check on his patients—even though it’s actually his day off. Says the doctor, “I have found my Utopia.” RUSSELL WANGERSKY
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