A Rural Return

2014
Wasko, Kevin

Eastend, Saskatchewan, a quaint and idyllic community nestled in a valley of rolling hills at the east end of the Cypress Hills of Southwest Saskatchewan, is my home.  My roots in that community extend for generations. 

In the sixth grade I decided unwaveringly that I was going to become a doctor one day and treat the people of Eastend.  While my initial goal of treating and caring for the people Eastend was steadfastly absolute in the sixth grade, my resolution seemed to wane with the more education I accumulated.  There were certainly times that I was convinced I would never become a physician at all.  Once that goal was all but assured upon admission to medical school, the thought of returning to Eastend to work was not even on my radar.  It wasn’t until I neared completion of residency that I pondered providing an itinerant clinic in Eastend. 

When I was growing up, there was a solo general practitioner who worked in Eastend.  He was a loud and, at times, brash South African doctor who was larger than life but cared for that community wholeheartedly.  He was one of the last holdouts of the era when solo country doctors cared for communities on a 24/7 basis and practiced full scope family medicine and then some.  Indeed, he was what I grew up thinking a doctor was and should be.  When he passed away after 22 years in the community, the people of Eastend found themselves without a primary care provider. 

A solo GP from South Africa was recruited and left within a year of coming.  Eventually a primary health care model was introduced at the health centre in town.  Clinics were set up with nurse practitioners and visiting family physicians based out of Maple Creek, located one hour northwest of Eastend.

Because I still have strong links to the community, I knew there was dissatisfaction with the care people were receiving.  There were often inconsistencies with care providers and ultimately care plans.  This was not the fault of the providers but inevitable given the set up.  The larger issue seemed to be a mistrust of the system and I could see that people longed to trust a care provider like they had once trusted that venerable physician who cared for them for over two decades. 

One month out of residency I realized my sixth grade ambition when I held my first clinic in Eastend. I joined the primary health care team there and committed to commute the one and a half hour drive from Swift Current, where I had established my permanent practice, to Eastend each Wednesday. 

The first day in clinic in Eastend seemed somewhat surreal.  It was hard to believe that my long and arduous road to becoming a physician had brought me right back to where I had started.  I knew all the staff and although there was comfort in familiarity, it also evoked nervousness about how they would approach my role as a leader of the health care team.  

As I looked over my patient list for the day I was reassured that all slots had completely filled.  Although I thought most people would likely be fine with seeing me as a physician, there had been a nagging in the back of my mind that people might rather see someone with whom they are less personally familiar.  I worried that they might not take me seriously as a new physician. 

As time has passed, I have quickly become accustomed to providing medical care to people I have known my entire life; this is something that most physicians don’t experience.  I appreciate that I know the patient’s “context” without having to ask.  I know their marital situation, if they have just recently lost a spouse or parent, where they work, their children, and their financial means.  I care for multiple generations of patients within the same families.  Every face is familiar and for many people that puts us both at ease.

I have realized the major impact that my new role holds in the lives of these people.  In my short time of practice I have picked up a new onset of unstable angina and my prompt referral resulted in an urgent coronary bypass surgery.  By picking up a colon cancer in its early stages another patient underwent bowel resection surgery before it became metastatic.  These catches were gratifying and perhaps more so because of the preceding personal connection with the patients.  At the same time, the realization that I could very well be missing major diagnoses in these people was equally impactful.  It has perhaps made me a more prudent physician.  

All the while, I have also had to become accustomed to practicing in such a rural and remote part of the country.  As a physician practicing several hours away from the tertiary centre, one is faced with different challenges and obstacles.  Geography, the finances of the patient, and ease of travel factor into decision-making processes.  Tertiary care is nearly four hours away in Regina and it is nearly five hours to Saskatoon.  I am the only physician working in the clinic at any time and acute care services are twenty minutes down the road in Shaunavon.  This contrasts with my experience in Swift Current where I practice in a clinic with eight other physicians in a community with a regional hospital staffed by core specialists.  Tertiary care in Regina is two hours away on a divided highway. 

Rural physicians must comfortably practice to their full scope so that patients can, where possible, receive care in their home communities.  I find that during my days in Eastend I am more likely to solve the problem myself and prescribe medications that I am fairly confident my specialist colleagues would start if I referred them on.  Indeed, for the patient from Eastend a four-hour drive to Regina for a ten-minute consult is a greater ordeal, especially during winter in Saskatchewan. 

It is for the reason of understanding the rural context that I have incorporated learners into my clinic in Eastend every week.  The time that medical learners spend in Eastend will expose them to what rural medicine really looks like.  It is the hope that this exposure might inspire them to serve rural communities in the future.  Even if they ultimately end up practicing as a specialist in an urban centre, they will have a better understanding of where these patients come from and the burden they have assumed to travel vast distances to access medical care.

Few people can truly say they grew up to fulfill their sixth grade aspiration.  Not only have I done that, but I also couldn’t be happier about the choices that I have led me back to where I started. 

Robert C. Bowman said, “Physicians who are drawn to rural practice want to make a difference in peoples’ lives and want to have a respected position where you care for a town and the town cares for you.”  This statement summarizes the major reasons why I chose to become a physician in the first place and I feel humbled that I am able to live that goal now.  

 

Theme: Community | Communauté
Theme: Health Care Delivery | Prestation des soins de santé
Theme: History | Histoire
Theme: Patients | Patients
Theme: Relationships | Relations

Stories in Family Medicine | Récits en médecine familiale [Internet] Mississauga ON: College of Family Physicians of Canada. 2008 --.

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