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Many of the thousands looking for doctors in Atlantic Canada are on society’s periphery. They live in poverty. They live in rural areas. They live in First Nations communities. They’re transgender. Newcomers or long-time residents, they are marginalized and have stories about their doctor search, about how something important is missing — a connection with a physician who knows them and cares about their health.
Percentage of Atlantic Canadians who are “very confident” or “moderately confident” Canada’s health-care system will be there to help if they faced an unexpected medical condition or disease.
— Research Co.
3 REASONS ARE
The top three reasons Canadians visit emergency departments include abdominal and pelvic pain, throat and chest pain, and acute upper respiratory infection.
— Canadian Institute for Health Information
Percentage of Canadian doctors who live in rural areas.
— Canadian Collaborative Center for Physician Resources
For many, locking down a family doctor is a big deal. That’s why when a receptionist calls a new patient to say they’re covered, for some, it’s like winning the lottery. Often there’s sobbing and thank yous. And relief.
In St. George’s, N.L., the last doctor packed his bags years ago and few are feeling that relief. A nurse practitioner visits twice a week. Good luck getting an appointment any time soon.
Alison White, St. George’s resident and member of the Qalipu First Nation, recently called and got an appointment that “was like a month off.”
“So, it’s a month to see somebody or else you have to go to the emergency room, which a lot of people do in (nearby) Stephenville because they need attention; maybe it’s not an emergency but also you don’t want to wait a month to deal with it.”
Finding a doctor has been a struggle in the town of 1,200 people for a while. White remembers rushing an elderly friend to the ER in Stephenville 20 years ago and then waiting all day.
“By the time they saw him and he was admitted, I think he was dehydrated at that point … I don’t know if that would have made a difference to his outcome, but he died a week or two later.”
While fishing one crisp January morning near her home of Whycocomagh, N.S. (We’koqma’q First Nation), Yvonne Cremo said walk-in and hospital doctors just don’t know her family and their medical history.
She has five children, ages nine to 31. Two have health issues.
“Our doctor used to have folders so they can look back. On computer, it goes back certain years, but the (folder) files go back to since they were born.”
Her doctor in Baddeck retired in 2017. She visits a physician in Inverness, but it’s farther away, and he is difficult to see.
She doesn’t trust walk-in doctors much. Her daughter, who has kidney problems, was misdiagnosed by one once. Cremo said her daughter complained of breathing trouble and skin irritation. The physician advised her to change her body wash. It was later determined she had eczema and pneumonia.
“It’s not just the native community, it’s off the reserve communities as well have a difficult time and they get frustrated. It’s not fair. If money is a big issue, they should put money away for that,” Cremo said.
Marina Pogy expected more of the Canadian health system after moving to P.E.I. from St. Petersburg, Russia, four years ago.
“Before moving, I was told about the system of family doctors in Canada, and I thought that is how it works. Did not know that there are walk-in clinics, too.”
She was told to put her name on a doctor wait list and to call often. She gave that up a year ago.
Pogy said in Russia, each patient has a medical journal so a walk-in doctor can access a full medical history. Not so here.
“It is all up to me to remember what should I tell to a therapist on my next visit.”
“The whole process is undignified.” — Tara Kinch
Every day Tara Kinch and Joanne Thompson help people at their lowest point. Many are homeless, deep in poverty and addicted to drugs.
Kinch, who works at Chebucto Connections in Halifax, said for many clients, going to a walk-in clinic instead of a family doctor makes a big difference.
If someone with a health concern wants more than the basic entitlement on their income assistance, they often need a letter from a doctor.
“They have to go to a walk-in clinic and have to pay between $40-$70,” she said. “That’s an extra barrier to getting access to financial supports they require.”
And without a doctor tracking their medications, they can fall behind. Many have multiple health needs or mental health issues, or live in risky situations.
Many outreach centres like Chebucto Connections and The Gathering Place in St. John’s, host clinics staffed by family doctors and other health professionals who give frontline care.
Thompson, executive director of The Gathering Place, said clients look to find a dedicated family doctor once they’re out of immediate crisis.
“The point is helping someone reach that highest form of being and what that looks like … it’s that ability to start to reclaim parts of your life, to begin that process of self-care. We have three women today we know have nowhere to sleep tonight and are acutely mentally unwell or on IV drug use and that’s what we’re trying to balance right now. That care cannot be separated from the physician, nursing and social work care. It’s that primary care piece.”
Twice recently, women have cried in Tara Kinch’s office. They were struggling financially, and had incontinence problems. To get $10 from government to pay for pads, they needed a doctor’s note, plus two quotes.
With no family doctor, they had to wait in a walk-in clinic and pay for a doctor’s note.
“It’s embarrassing enough for the women to come in and ask for help from me and disclose they’re having these issues,” Kinch said. “The whole process is undignified.”
Percentage of Indigenous people who, in 2015, were more likely to report they did not have a primary health care provider compared to the non-Indigenous population (16.1 per cent).
— Statistics Canada
Percentage of patients identified on their medical chart as transgender or gender diverse who did not self-identify as transgender, but selected female. The percentage who selected male was 15.4.
— Canadian Medical Association Journal
A recent editorial in the Canadian Medical Association Journal called for a single national electronic health record for primary care to improve the health of Canadians.
— Canadian Medical Association Journal
THE 3 KEY ISSUES
In our conversations with Atlantic Canadians, some common themes emerged about the impact of doctor shortages:
WALK-IN/ER DOCS LACK PATIENT CONNECTION
Marina Pogy, a Russian immigrant, is a little worried about seeing a different doctor every time she visits a walk-in clinic, especially since they don’t have a thorough history of her previous health complaints.
“Our walk-in clinic’s therapist would always say: ‘It is nothing serious, should be gone soon.’ I just hope that all my complaints were about nothing, and one day I die because of natural cause in the middle of my dreams at night not because some disease I did not see it is coming.”
Having a thorough history of patients is the main difference between a regular family doctor and a walk-in clinic, she said.
CONNECTING POVERTY AND HEALTH
There is a great need for people in poverty to access health care. In fact, there’s a proven link between poverty and ill health.
The World Health Organization says poverty is the single largest determinant of health, and ill health is an obstacle to social and economic development. The WHO states poorer people live shorter lives and have poorer health.
“There’s a direct link to poverty and quality of life and health, and that’s physical and mental,” said Tara Kinch, who works at Chebucto Connections in Halifax.
TRAVELLING FOR TREATMENT
The health clinic in Whycocomagh, N.S., was named Theresa Cremo Memorial Health Centre, after Yvonne Cremo’s mother.
Years ago, when designing the clinic, they wanted to include a dialysis component, but that never happened.
Cremo’s daughter, who requires dialysis, has to drive to a health centre in another community — no matter the weather, no matter the time it takes.
“Some people travel 45 minutes to an hour, 15 minutes,” she said. “If they had dialysis close by, at least they’d be safe on the road coming home.”
FOR SOME IT'S A LIFE AND DEATH THING
Sebastian Gaskarth is transitioning and doesn’t have a family doctor. For them, and other transgender people, that can affect mental health, well-being and the wait time for sex reassignment surgery.
“Because there’s a shortage (of doctors), it’s putting us in an already vulnerable situation even more so,” said Gaskarth, Pride Centre co-ordinator at Mount Saint Vincent University in Halifax.
Transgender people often face job loss, family discord, housing discrimination and a long wait (plus expense) for surgery. If they don’t have a family doctor, the road is definitely longer and harder, Gaskarth said.
There’s a reason suicide is a major concern in the transgender community.
“And I’m white, which is one thing, but when you start talking about transwomen who are people of colour, Indigenous, black, that whole thing with the racism, the stats are worse,” said Gaskarth, who recently helped open a health clinic on campus for transgender, non-binary and questioning students.
In order to get surgery, a transgender person requires assessment and letters of approval from health-care providers. Without a family doctor, those letters can be more difficult to get, Gaskarth said.
“I have friend that it’s five years (for surgeries) or they get lost in the system. They were supposed to get a referral but they’re waiting a year still to get a letter.”
Gaskarth goes to the Halifax Sexual Health Centre, but appointments can be difficult to get due to the demand.
Unknown doctors’ clinics can be stressful and humiliating for transgender people. Gaskarth said some refuse to use a person’s preferred name and call out their birth name in the waiting room.
“There’s folks like me: I’m non-binary, I don’t consider myself to be a man or a woman, but they’ll keep lumping me into one of the boxes. It’s already a traumatic thing because you’re going there to get help — not just for a cold — for a huge thing, and every time you go, you’ve got to explain your story. Every time.”
And even if a transgender person has a family doctor, they’re far from home free. Some doctors don’t prescribe hormones like testosterone or don’t want to work with a transgender person at all, Gaskarth said.
“It’s so much bigger than the shortage. Even if you find a doctor you’ll have to think about if they’re willing to work with you, will they respect your name … and pronouns. Maybe they’ll continue to call you a woman when you’re a man.”
Transgender people face all this plus they don’t feel right in their own bodies, Gaskarth said.
“It adds a weight that I don’t know one can actually understand unless they experience it. It’s heavy.”
Read Part 1: Atlantic Canada needs more doctors: Where are they?