Finding a Doctor For Galiano…Time to throw in the Towel?

Finding a Doctor For Galiano…Time to Throw in the Towel?

In her article, “Health on Galiano”, Jean Krebs has offered some interesting thoughts on our need to “think outside the box” in finding a way to meet the health care needs of Galiano residents.  I first want to thank Jean for taking the time to write this thought-provoking article.  I certainly don’t think that the GHCS board as a group or I as an individual “have all the answers” and welcome others to join the conversation on where we can go from here.

Jean’s main point is that our attempts to find a full-time physician for Galiano may be futile, given the shortages that exist and the limitations of island life for a physician, of which she lists eight.  She raises concerns about what will happen if we lose our locum coverage, and offers five suggestions as to alternative methods we could use to fulfill our health care needs.  Before responding to Jean’s suggestions, let me outline the situation as it exists now.

For many years Galiano has been allocated a position for a full-time physician under VIHA funding, and that allocation remains in place to the current day.  That physician is required to provide  two types of service:  general medical services to his or her patients during regular clinic hours, and on-call emergency coverage when the clinic is closed.  Although physicians and nurse practitioners (NPs) are required to be available to their patients after-hours, they have no responsibility for those who aren’t their patients, including visitors to the island, islanders who see an off-island physician and islanders who haven’t had cause to see a physician at all.  Further, their after-hours “availability” to their patients can take many forms, ranging from being available any time to see patients in-person to having an answering machine telling the patient to call 911, a physician on one of the other islands or the nearest emergency room.  Simply put, the physician and NP have no obligation to be personally available on-island outside of clinic hours.  The salary of the physician as it currently stands, however, includes money for the physician to be available on-island to handle medical emergencies of both patients and non-patients for at least part of each week.  It is the GHCS’s view that on-island emergency medical coverage is critical for the health and well-being of islanders and also makes economic and just plain common sense.  When there is no physician more people are evacuated off-island which is a very costly process in both human and dollar terms.

Could this be solved by having a full-time NP?  The GHCS board has carefully considered this possibility, and concluded that although we very much value the NP services we currently have it would be inadvisable to replace the physician with an NP for several reasons.  First, the NPs are not allowed to provide on-call emergency services for anyone who is not his or her patient.  Second, finding an NP may be just as difficult as finding a physician.  Although there are many trained NPs who need a job, as Jean points out, only a small minority of them are oriented towards rural general practice.  The large majority of NPs are in fact oriented toward specialty practice in fields like cardiology, chronic disease, psychiatry or obstetrics.  Hence, the pool of available NPs is not necessarily that big.  Likewise, all of the eight deterrents for doctors that Jean lists apply equally to NPs.  Third, there are a number of procedures that a doctor can perform that an NP cannot, and many of these are precisely the procedures that are needed in an emergency situation.  This may include, for example, the ability to suture a wound or give a particular medication.  The bottom line is that although NPs provide valuable services, they are not substitutes for doctors, particularly when it comes to providing emergency services.

Jean also suggested several other solutions, most of which involve having the position on Galiano shared by doctors who live elsewhere, perhaps on Salt Spring, on a rotating basis.  This plan has two major limitations.  The first is that, as a recent Island Tides article by our own David Beaver points out, the doctors in those places are already working to the max and not likely going to want to add us to their “to do” list.  The second is that if we rely on doctors who come for a day or two we lose all of our after-hours emergency medical services.  It might solve the problem for the clinic coverage, but not for the on-call coverage.

Jean mentions a rumour that there is a doctor who is looking at providing part-time services on Galiano.  This is indeed true, and the board is actively exploring this possibility with both the doctor and VIHA, but it is still “early days” so nothing is certain.  I do want to assure people that we will do all we can to make this work out, but it’s not yet a “done deal.”

Jean also raises the issue of locum coverage being cut.  We were told a few weeks ago that we would have our locum coverage cut between now and March and discontinued altogether after that.  After several letters expressing concern were sent to the powers-that-be we recently received letters from both the Minister of Health and our MLA saying that no cuts will occur.  In short, although it looks like this crisis has been averted we’re still in the process of making sure that everyone in Victoria is on the same page on this.  If further threats to our ongoing locum coverage emerge, rest assured that we will be informing the community and asking for your help in fighting such cuts.

More broadly, like Jean, I have great regard for the innovativeness and know-how of Galianoites, and echo her invitation for everyone to get involved in finding ways to solve our health care crisis.  I would ask any islander to feel free to contact me at any time (jschmidt@uniserve.com) expressing concerns, asking questions or proposing strategies we might use.  I’d also encourage interested islanders to seriously consider serving on the GHCS board (we’ll have 5 openings come April) or joining GHCS committees so the society can remain a strong, proactive voice in support of your health care needs.  Again, thank you Jean for your thoughts and your call to action.

 

GANNER DRIVE POLAR BURRRR SWIM-JAN.1ST, 2012

NEWS FLASH…NEW YEAR’S DAY EVENT

GANNER DRIVE POLAR BURRR SWIM

At Azure Beach access 27, Ganner Drive

Fundraising for Galiano Health Care Society

Please come out on JANUARY 1ST, 2012  at 12 NOON SHARP and support the swimmers, or take a New Years Day dip, or better yet, sign a pledge form for the brave folks who will be tasking a dip for Health Care on Galiano.  Pledge forms can be picked up at the Galiano Health Care Centre front desk if you want  to  participate, and for more information please contact swim organizer Ken Kucille at 250-539-3404 or board member Sylvie Beauregard 250-539-3077 for details

THANK YOU FOR SUPPORTING HEALTH CARE ON GALIANO ISLAND

 

Thank you to Gary and Ursula for donating firewood for Health Care

The Society wish to thank Gary Coward and Ursula Deshield for donating $1600 worth of firewood to benefit the Health Care Society. Many residents were happy to buy their much needed firewood and thus contributing to the fundraising efforts toward our new flooring. Thank you Gary and Ursula for your generosity and hard work!

Minutes of Recruitement Meeting August 21st, 2011-James Schmidt, president

On Sunday, August 21, members of the GHCS board and other concerned citizens met with Doug Blackie and Brenda Warren of VIHA, the individuals responsible for recruiting a doctor onGalianoIsland.  The steps that have been taken to date were reviewed, and future steps were discussed.  In particular, a lot of discussion focused on how the position can be promoted more through the web and similar media.  The critical importance of word of mouth and “somebody knowing somebody whose uncle is a physician” was also mentioned repeatedly.

 On a positive note, there is a new potential candidate for the position.  There are still a lot of hoops to be jumped through before we know whether this person is “the one” but so far things look encouraging.  We’ll keep you posted as things progress.  In the meantime, we need to keep up the search.

 Several new ideas have been developed by a working group made up of concerned community members.  These include setting up a support network of retired or part-time physicians on the island with whom the new doctor could consult, setting up a social support network for the new doctor and his or her family to welcome them to the island and help them join our community, providing incentives to the new doctor ranging from free sailing trips to passes at the golf course, and exploring ways in which new technologies can be used to provide the doctor more support from other doctors, medical or radiology labs and so on via the web.

  We found the VIHA representatives to be very open to our suggestions and willing to support us however they can.  In particular, the need to involve us earlier in the process, by doing such things as providing lodging for potential candidates early in their application process so they can come to and fall in love with our island, was emphasized.  Overall, the meeting created a good deal of optimism, but also a clear realization that there is still a ways to go.

  We on the board continue to encourage and appreciate the help and ideas of community members, as well as their pulling whatever

A very successful wine festival indeed! by Dianne Laronde

We’re still looking!  As most islanders will know, not only have we no doctor, but for much of August we were unable to book a locum.  As with family doctors, there simply aren’t enough locums to go around, particularly in summertime and around holiday periods (you may remember last New Year’s Eve). 

Our nurse practitioner, Leanne Hale, and our on-call nurses have been doing yeoman’s duty maintaining some semblance of regular health care on Galiano; Leanne will be covering three days a week (Tuesday, Wednesday, and Thursday) at the clinic until we have a locum.

    VIHA has stepped up to cover the majority, though not all, of the expenses involved in keeping the health centre running while we have no doctor; this has allowed the Society to give some attention to  necessary maintenance issues. 

The Country Dance held on July 17 and the raffle of the wonderful quilt made by the Galiano Needle Guild have raised enough money,  together with generous donations from the community, so that this fall will see the replacement of our ageing and unhygienic carpets with up-to-date, easy to clean, officially approved flooring. 

The annual Wine Festival is the Health Care Society’s main fundraiser, and this year’s Festival was blessed with clear, sunny skies and just enough of a gentle breeze to keep festival-goers and volunteers alike comfortable.  Many visitors were heard at four o’clock as they went out through the gates making plans to be back next year!  A big thank you to the Festival Committee and all the volunteers for producing a successful and tightly organized event.

    The primary focus(s) for the Society continue to be, however, a) to find a long-term medical practitioner for the community, b) to do everything possible to assure availability of care in the meantime, and c) to arrange for the provision of after-hours and weekend emergency coverage.  On July 24, a public meeting was held at the Lions Hall with the dual purpose of informing islanders about the work which has been and is being done to resolve these challenges, and of getting feedback and ideas from the community about possible solutions. 

Vancouver Island Health Authority’s (VIHA) Doug Blackie, as well as Dr. Ron Hiebert, Medical Director for Rural and Aboriginal Health, were in attendance to hear from residents about their experiences and concerns, answer questions, and give us a picture of our options within the challenges facing the entire health system at present..  The Lions Hall was filled with an attentive crowd; many thanks  to the residents of Galiano, who have once again not only given their financial support, but also demonstrated their active engagement.  The turn-out made it very clear that the availability of health care is a major concern for all islanders, part-time and full time alike.  

One of VIHA’s proposals was that we be given a full-time nurse practitioner until a doctor could be found (instead of having locums).  This would have the advantage of continuity of care; however, since nurse practitioners are not presently permitted to do on-call work, it would eliminate after-hours coverage (except for that provided by our stalwart on-call nurses on alternate weekends). 

After Consideration, GHCS Board rejects VIHA’s Full-Time Nurse-Practitioner proposal

 

Letter to VIHA by President James Schmidt:

 

As many of you who attended the recent public meeting with VIHA representatives will recall, a major problem we face is how to provide medical coverage until such time as we recruit a full-time physician.  At that meeting VIHA proposed to put a full-time nurse practitioner on Galiano until a full-time doctor could be found.  The “bad news” part of the story was that this would mean that we would no longer have locum physicians.  Following the presentation of this proposal, there were a number of discussions, both within the board and with islanders more generally, about this plan.  The board recognized that a strong advantage of this proposal was that it would provide regular and consistent care from a single provider over time at the clinic.  However, after considerable discussion, the board decided to reject this proposal.  The concerns leading to this decision are as follows:

 

(1) The nurse practitioner cannot provide many services that can be provided by a physician.  At the meeting concern was voiced about this around such issues as prescribing narcotics.  However, as time has gone on we have seen the same problem arise around other issues, including such things as getting medical certificates for insurance purposes, drivers license clearances etc. More and more islanders are having to make special trips for even minor issues such as these.

 

(2) Although there are of course far more nurse practitioners available than there are physicians, we nevertheless believe that it would take a significant time to recruit such a person, agree on a start date and get them “settled in” on Galiano, etc.; hence it would do little to meet our immediate care needs.

 

(3) Even after such a person is recruited, we are concerned that such a person would not be willing or able to work without medical support over an extended time frame.  Although she has not, so far as I know, complained herself, we have received feedback from patients, etc. expressing concern about the hours Leanne Hale is having to put in and the volume of work that is falling on her shoulders.  I know our administrative staff are very concerned about how much they have to ask her to assume.  As an example, I received the following report on Friday:  “(An island resident) had the first appointment of the day on Wednesday last, got there at five to nine and found Leanne already seeing another patient, and then in the early evening of the same day her son cut his leg and I guess they went down to the clinic and Leanne was still there catching up on paperwork..this was about seven…so she looked at the leg…and then the next day (the island resident) took her some flowers to thank her, and I gather in the course of conversation she learned that Leanne still had more paperwork and ended up staying over at Colette’s and working on that till late Thursday night, and then presumably caught the early ferry for another day of the same on Mayne.”  It is simply not fair or reasonable to expect the NPs to work at this level over the long term. We have similar concerns about the demands on our on-call nurses.  Our emergency on-call nurse last weekend, for example, had already seen six patients by noon on Saturday!

 

(4) Our greatest concern is that getting the NP would mean giving up our locums and hence losing the on-call coverage we have when locums are here.  Nurse Practitioners are not allowed to do after-hours emergency coverage.  Locums do provide such coverage during the weeknights when they are on-island.  That coverage is by no means consistent but is still considerably better than having no coverage at all.  As we have frequently pointed out to VIHA, lack of locum coverage means minor medical problems require excessive personal and financial costs when people who could be treated here by a physician are evacuated because there is no physician.  This can be something as simple as a cut needing a stitch or two. Likewise, more serious medical problems run the risk of becoming much more critical when medical intervention is delayed.

 

Taken together, then, although this idea has some merit, it is the opinion of the board and those we have consulted that, at the end of the day, the problems with this plan, especially with respect to loss of much of the already-limited emergency coverage we have, outweigh its advantages.

 

The board is also continuing to push VIHA and the Ministry of Health to assure that adequate locum coverage is provided in the coming months.  Two problems we are currently being dealt with.  First, at the present time, the locum program requires a locum to be on-island for five days.  We have had candidates who wanted to be on-island for only three or four days but they are not allowed to do this.  While this is not ideal it is nevertheless better than having no locum at all and we are pushing the locum program to revise this policy.  We are also seeking to have locums work on weekends so we have emergency coverage during that critical time.  Second, the locum position on Galiano is often listed only a short time before it is needed. This means that a lot of potential candidates have already accepted positions in other places that were listed earlier.  We are working on this as well in order to try to assure that candidates for the locum positions as sought as soon as possible.

 

A Big Hoedown, Galiano Style

A Big Hoedown, Galiano Style by Jim Schmidt

 On Saturday night, the 17th of July, the South End Community Centre rocked to the sound of Galiano’s own country-western band, Good Company as community members gathered for an old fashioned cowboy (and cowgirl) hoedown to raise money for the Health Care Centre’s new floor.

The cause was a good one.  The current flooring in the clinic is mostly carpet that is now many years old, and impossible to keep clean and sanitary at a level needed in health care facilities.  The board made its replacement one of its top objectives for this year, and Sylvie Beauregard and her committee of volunteers stepped up to the plate to raise the money to make it happen.  And as usual, the residents of Galiano were more than happy to come out and support the Country Dance that Sylvie and her group made the primary fundraising event for this project.

Good Company, Galiano’s (Oh, the heck with it, Western Canada’s) premiere country-western band consists of Galianoites Claudette and Ed Bejtovic, Philippe Buller, Thijs Vermeulen, Shelley Okepnak and Paul Gregory.  Later in the evening they were joined by Galiano guest artists including duets and solos by Linda Ruedrich (aka Linda Ronstad) and Sylvie Beauregard (aka June Carter Cash), Dirk Ouellette and Johanna NewNoon, Heather Macrae, and Jenny Brooklin.  Let me tell you, there wasn’t a dry eye in the house after the Linda/Sylvie duet.

Once the music died down, Andy Turner came on stage to have his golden locks (well just a little gray in there) shorn by Galiano’s own Sweeny Todd, Ken Kucille.  Pledges and donations to support the clear-cutting of Andy’s head and face raised an amazing $2400, and even more amazingly, Andy still has his nose and both ears!  Thanks to all those of you who pledged for this “bare all” event, and to those who bid so spiritedly in the auction for mementos of this truly memorable extravaganza.  Thanks also to all of you who came in costume and participated in the costume contest. 

The evening was a financial as well as a social success.  Overall, we cleared about $4800 which, together with other money Sylvie and her crew have gathered, means that this fall should see the laying of new floors in the Centre.

This event would not, of course, have been possible without a lot of hard work and support from a lot of people.  On behalf of the board, I would especially like to thank Sylvie and all of her volunteers who made this a reality, including Judith Parrack, Anita Braha, Jack Atkinson, Juegen Mueller, Debbie Ritchie, Jane Kalmakoff, Susan Mackey, Bill Ripley and David Middleton at www.davidmiddletoncreative.com.  Thanks also to the GHCS board members and many other community members who supported the event from selling the first tickets to sweeping up the hay from the floor and washing up the last dishes at 1:00 in the morning.  As is always the case, Linda Ruedrich was right in the middle of things, making sure that everything went well and without a hitch, right down to counting how many six-packs of beer there were to be returned to assure that none got “lost” by yours truly before they could be returned to the Corner Store.  I would also like to thank our donors, Huguette Benger (La Berengerie), Max & Moritz, The Montague Harbour Marina and The Grand Central Emporium and Diner.  We would also like to thank the businesses that had pledge forms for and promoted the Andy Shearing Event, including the Galiano Garage, Hummingbird Pub, Galiano Trading Co. and The Corner Store.  Thanks to them as well for their generous financial donations.  Thanks also to Seonaid Renwick and the Trincomali Farm for providing the decorative hay bales, and to Keith Hutchinson for donating part of his winnings of the 50/50 draw to the society.  And of course, once again a big thank you to Andy Turner for so graciously donating his hair to the cause.  Thanks also go out to the band, Good Company and to their wonderful guest artists.  Last but not least, I want to say on behalf of the board a big thank you to all of you Galianoites who once again stepped up to support your health care centre at this difficult time.  A great thing about Galiano is we can find such great ways to help each other out, while having fun doing it!

Public Meeting on Finding a New Doctor on Galiano Island – July 24th, 2pm-Lion’s Hall

Dear Fellow Galiano Resident,

RE:  Public Meeting on Finding a Doctor for Galiano Island

As you are no doubt aware, since Dr. David Beaver left Galiano over a year ago we here on Galiano have been without a full-time physician.  I am writing on behalf of the Galiano Health Care Society to provide you with a brief update and invite you to a public meeting where we will be providing a lot more information about the current state of affairs, what the future holds and what you can do to help us again get a physician on Galiano and restore our former levels of health care. 

As a bit of a preview to that meeting, let me briefly share with you what has happened.  The GHCS this last year has faced a three-pronged challenge.  The first has been to assure that everything is being done to find a new doctor for Galiano.  The second has been to assure that we have adequate medical coverage for islanders in the meantime.  The third has been to maintain some sort of financial viability in the face of greatly increased costs and loss of income for the GHCS.

As to finding a new physician, let me give you a very brief history.  Some years ago, the entire province was divided into five regions, each of which has a “Health Authority” to oversee all medical/health care in that region.  We are under the Vancouver Island Health Authority or VIHA.  The family doctor on Galiano is actually a contract employee of VIHA, not the GHCS, and it is VIHA’s job to recruit candidates for that position.  VIHA has actively worked to find such candidates through a number of channels but to date has been unsuccessful.

Providing medical coverage until a full-time physician can be found is also the responsibility of VIHA, through the Ministry of Health’s locum program.  Coverage consists of two components.  The first is provision of medical services during regular clinic hours.  The second is provision of emergency medical services during non-clinic hours (that is, week nights and weekends)  We have received consistent funding for the clinic coverage, although VIHA has not always been successful in finding someone to fill those locum positions.  This is why there are some weeks when we don’t have a doctor on Galiano.  The money is there and attempts have been made to recruit one each week, but sometimes there simply isn’t an applicant for the position so it remains unfilled.  The issue of night and weekend emergency coverage has been much more problematic.  This is a very complex situation which will be discussed in detail at the meeting, but what it boils down to is that for many week nights and virtually all weekends we have no medical coverage, something we did have when Dr. Beaver was here.  We do have on-call nursing coverage on two weekends each month but have nothing beyond the level of first responders and/or ambulance attendants on the other two weekends each month.  This situation is, in the view of the GHCS board, completely unacceptable.  We have expressed our concerns to the Ministry of Health and VIHA but to date the situation remains unresolved.

Our third problem has been sustaining the financial viability of the GHCS.  The loss of the doctor has meant loss of income (in the form of rent) and increased costs (in the form of office staff salaries etc.) which have come on top of numerous other costs we face with a steadily aging facility (e.g., the need to replace the flooring, to earthquake-proof the treatment areas, etc.)  Through the efforts and support of many board members and residents we have raised more money this year than ever, but the gap still remains.

This brings us to the point of this letter, which is, what can we do, working together, to correct this situation?  We would ask you to do three things. 

  • First, please continue to use the clinic for your health care needs.  We have a variety of health services available in addition to the locum, including a dentist, dental hygienist, nurse practitioner and many others.  The more you use the services at the clinic the easier it is for us to assure that our health care needs on Galiano are recognized and met. 
  • Second, please attend our meeting at the Lion’s Hall on Sunday July 24th at 2:00 pm to learn more about the situation and what we can do about it.  The goal of the GHCS is to assure that accessible medical care is available for all residents of and visitors to Galiano and with your help we believe that we can restore our previous levels of health care. 
  • Third, please support our fund-raising activities as much as possible.  If you’re not already a member, please join the society.  Consider making donations or bequests.  And last but not least buy tickets for the quilt raffle and attend our upcoming dance and the annual wine festival.

 

Thank you in advance for your help,

Jim Schmidt

                                                President, GHCS

Congratulations to our Nurse Practitioner Leanne Rowand!

Our dear Leanne Rowand has been awarded the UVIC NP Preceptor of the Year Award. She was nominated by a student, and seconded by the entire NP Committee as exemplifying the best in preceptorship.She share this award with nurse practitioner Tracey Adams.

Each year as appropriate, the NP Program Subcommittee will recognize a preceptor to receive the NP Program Preceptor-of-the-Year Award to be presented at the Nursing Week Alumni Luncheon. Each person recognized will have made a consistent and substantial contribution to NP student learning during at least one preceding year of the nomination date. Contributions might include such things as:

  • going over and above expectations in promoting student learning and achievement
  • serving as an outstanding role model for NP practice
  • promoting the NP role among colleagues
  • demonstrating excellence in teaching/learning as a preceptor

If you go to the School of Nursing website (http://nursing.uvic.ca/), you can take a look at last year’s recipient.

This year, for the first time, UVIC is recognizing two preceptors for outstanding mentorship of NP students. It’s been a great year for student learning. As previously mentioned Leanne will share the award with her colleague, nurse practitioner Tracey Adams.

Goodbye to Kimberly/ Welcome back Alex!

We are saying goodbye to Medical Office Assistant Kimberly, who is leaving us this week for new frontiers.  We wish Kim the best of luck and it was wonderful to have you work for the Galiano Health Care Society.  Alex  is returning to us from maternity leave, and will be back at the front desk starting April 4th.  Lori and Jackie will also staff the desk, so please have a smile for these women who work very hard for all the patients at the clinic.