In this section, we feature submitted snapshots and videos of BC rural healthcare practitioners at work and at play.
Want to submit a pic for this section? Email Sharon Mah, Communications Manager at firstname.lastname@example.org for more information.
Summer 2019 – Takla Landing healthcare team
The Takla Landing healthcare team celebrated a five year milestone this summer: the first successful cardioversion of a patient in a rural and remote community via telehealth.
Story by Dr. John Pawlovich
“Five years ago Al (patient) presented to the Takla Health Center very ill. Two very brave nurses helped two docs, over a lumpy satellite telehealth connection, cardiovert Al. It was a life saving effort. It was, as far as I am aware, [this is] the first cardioversion over telehealth where a physician was not present in the community in BC and probably western Canada and beyond. It was an important day on many levels.
“I had breakfast with Al and his wife Julie this [morning] in their home in Takla. They gave me permission to share these pics and this story. Telehealth saves lives. As we all move forward with a variety of virtual health initiatives in this province please keep Al and these two amazing nurses in your thoughts.”
June 2019 – Dr. Daphne Hart
Dr. Daphne Hart is one of four recipients for RCCbc’s 2019 Awards of Excellence in Rural Medicine, Lifetime Achievement.
Dr. Hart has practiced rural medicine for 42 years – 4 years in the high Arctic and 38 years in the Bulkley Valley. Like many rural physicians, Dr. Hart is dedicated to her community and her patients, leading her to expand her scope of practice to bring urgently needed knowledge and skills closer-to-home. Up until her retirement earlier this year, she continued to advise, support and shape healthcare service delivery to best serve Bulkley Valley residents.
The Smithers Interior News interviewed Dr. Hart after she returned home from the awards ceremony in Nanaimo. You can read that story here.
May 2019 – Dr. Bryn Fell – “Doing something momentous”
Excerpts from The Prince George Citizen
Dr. Bryn Fell is among the latest crop of students to graduate from the Northern Medical Program.
“This legacy is for him,” Fell said Friday just prior to a celebration at the University of Northern British Columbia. He is referring to his infant son, Shea, who was born Dec 2013 with a rare and painful skin condition – “butterfly syndrome” that claimed his life a scant eight months later. In the aftermath, Shea’s father, had a choice to make: either “crawl into a dark hole or do something momentous.”
He chose to once again attempt entry into the Northern Medical Program – his fourth attempt.
March 2019 – Mike Gojevic and Dr. Paul Dhillon
Excerpted and condensed from The Local Weekly
They are a committee of two that organized an organ donor registration drive on the Coast, lung transplant recipient Mike Gojevic, left, and Dr. Paul Dhillon. They made it a contest between medical clinics and signed up more than 200 potential donors in a month.
This first ever challenge project was supported by a grant from the Rural Coordination Centre of BC. Now the details will be reviewed and improvements made with a view to making it an annual event, and possible expansion across the province.
“This was a great chance to engage the communities of physicians and medical office staff along with their patients all along the Coast,” said Dr. Dhillon. “I was so happy to have all the clinics jump on board and participate in the program. We know that some people also signed up and made their wishes known online so the ripple effect from this challenge will hopefully save a few lives down the road.”
If people missed the challenge this year and want to update their status, they can do so at https://register.transplant.bc.ca/.
January 2019 – Longtime rural physician Dr. David Shaw retires
Excerpted from In the Loop
Dr. David Shaw is putting away the stethoscope after 35 years of rural generalist service in the BC communities of Logan Lake and Oliver.
His medical practice partner, Dr. Alan Ruddiman, described Dr. Shaw as an excellent teacher to many medical students and residents, a stellar mentor, and a wonderful friend.
Interior Health’s VP, Medicine and Quality, Dr. Mike Ertel, concurred.
“Dr. Shaw is one of the best clinicians that I’ve ever worked with and I have a deep respect for him as a physician, a leader and as a person. I always left a discussion or meeting with David feeling that I had learned something.
“I will miss him very much and wish him, his wife and his family a long and joyful retirement.”
November 2018 – Dr. Don Burke receives Joule Innovation Grant for work on CODI app
Dr. Don Burke is the recipient of Joule’s $25,000 Early Innovation Grant for his work on co-creating the CODI (Critical Outreach and Diagnostic Intervention) app. Read the full announcement from Joule here.
To learn more about the CODI app and how it can support rural physicians in small community emergency departments, click here.
October 2018 – BC Rural Health Network
This grassroots organization may be young (it started up in December 2017) but has much wisdom to share.
The BC Rural Health Network is a collective of small communities working collaboratively to advocate for improved health service delivery in rural BC. The idea to create this group came after a presentation by the Princeton-based Support Our Health Care (SOHC) group at the BC Health Coalition Conference in 2017. SOHC presented a “how-to” workshop on organizing a Community Consultation on Health Care. The response to the presentation was overwhelmingly positive, and SOHC found itself being approached afterwards by other organizations who either had similar expertise to lend, or who wanted to draw on the hard-earned wisdom of SOHC and other seasoned rural BC community health care advocacy groups. A few weeks later, the BC Rural Health Network was formed with members from the communities of Ashcroft, Nelson, Sicamous, South Shuswap, Trail, and Princeton taking part.
Although the network is still establishing itself in a formal sense – terms of reference for the organization are in the process of being finalized – it has hit the ground running, organizing meetings with key stakeholders (including the Ministry of Health), connecting with other rural communities and adding to its membership, hosting conversations with rural physicians through the Divisions of Family Practice, and planning next steps. If your BC rural community is looking for information, support, or ideas about how to improve and sustain health care services, check out the BC Rural Health Network online or on Facebook. We’re all in this together.
Summer 2018 – Village of Queen Charlotte raises first “monumental” pole in 200 years for Hospital Day
Story by CHEK News
A “monumental” totem pole was raised in the Village of Queen Charlotte in Haida Gwaii Saturday, the village’s first in over 200 years.
The event was said to mark the major work done between the communities of Queen Charlotte and Skidegate in crafting a unique health care centre.
June 2018 – Bella Bella’s A Night of 1,000 Lights gala fundraiser
The medical community of Bella Bella recently hosted “A Night of 1,000 Lights,” a gala that aims to raise funds to support the purchase of medical equipment for the community. This year, the group set a target of $20,000, with an eye to using the monies to purchase of a LUCAS device – a mechanized CPR pump that is very useful in resuscitation.
Dr. Lauri-Ann Shearer reported that the gala attendees far exceeded their fundraising goal, generating $41,000 in donations! In addition to the LUCAS device, the organizers were also able to purchase two AEDs for use in the community, and secure some other equipment as well.
Congratulations and thanks to all who contributed to the acquisition of these great community resources! Rural medicine is a team effort – that includes patients and their loved ones, along with neighbours who do what they can to support quality health service provision.
May 2018 – Rural Pre-Medicine grads – Svetlana Hadikin and Adib Malas – accepted into UBC Medicine!
Selkirk College’s Rural Pre-Medicine (RPM) program achieved a significant milestone this month when Class of 2018 graduates Svetlana Hadikin and Adib Malas were offered admission into UBC Medicine’s MD undergraduate program. Hadikin and Malas are the first two RPM graduates to be offered seats in a medical school.
The Rural Pre-Medicine program opened its doors to learners in 2014, aiming to provide rural students with a strong grounding in health sciences in preparation for careers in medicine. The three year offering provides students with a strong grounding in sciences but also teaches learners about Indigenous approaches to healing, psychology, and small business management to prepare them for the multiple demands of professional health care service delivery.
The RPM enables rural students to engage in and prepare for a career in medicine closer to home. Studies have shown that rural learners who train in medicine are more likely to practice in a rural setting upon completion of their studies.
To learn more about Hadikin and Malas, check out the Castlegar Source’s profile of the two students.
The Joint Standing Committee on Rural Issues (JSC) is a proud supporter of the Rural Pre-Medicine program.
April 2018 – Hijinx at the SRPC Rural and Remote Medical Course in Newfoundland
The Society of Rural Physicians of Canada (SRPC) hosted an amazing 2018 Rural and Remote Medical Course in St. John’s Newfoundland April 12-14, and welcomed rural physicians and nurses from every corner of the country. As always, there were great discussions about rural medical practice, and inspiring presentations from thoughtful plenary speakers. There was also the induction of the SRPC Executive and select staff as honorary Newfoundlanders: here we see outgoing president, Dr. Tom Smith Windsor reciting the required phrase, kissing the cod, eating baloney and shooting screech.
Thanks again to the SRPC for a great opportunity to meet with colleagues from across the country, and for a fun time in St. John’s!
Feb 2018 – Dr. Mallory Quinn returns to Smithers to open a rural medical practice
As rural communities across the province struggle with doctor shortages, a new practice in the northwestern B.C. community of Smithers may point to a way out of the problem.
The new clinic is being led by Dr. Mallory Quinn, who recently returned to her hometown after graduating from the University of British Columbia’s Northern Medical Program in Prince George.
Listen to Daybreak North’s interview with Dr. Quinn (starts at 26:30)
Jan 2018 – Mitchell Mammel and Tec McMillan, Northern Medical Program Year 1 students
Submitted by Mitchell Mammel
Myself and Tec McMillan are both in our first year in the Northern Medical Program. We both have an interest in rural medicine learning opportunities, part of what brought us to the NMP. We were luckily given a spur-of-the-moment chance to visit Takla with Dr. John Pawlovich for two days, and jumped at the opportunity. Half an hour later, we were both on the way to Takla, hearing about not only remote medical practice, but the importance of 10-ply tires, SPOT-locators and satellite phones from Dr. Pawlovich (things you need so that you can actually arrive to where you are going to be practicing).
Our time at Takla was a wonderful learning experience – we were able to learn from Dr. Pawlovich, the staff at the Takla health centre, and the community members we interacted with while working there. The community-centered model of health care in Takla was particularly rewarding for the two of us, and we’ll both be looking for more opportunities to work with and learn from the community and Dr. Pawlovich in the future.
Nov 2017 – Valemount Healthcare Team
The healthcare team in Valemount, BC works interprofessionally, and is serious about building strong relationships with their patients and each other. This photo documents one of their regular Friday team building exercises: push ups! Healthcare isn’t just about helping patients get good care, it’s also about role modelling healthy behaviours for the community.
Oct 2017 – Rural hospital auxiliaries
Several small hospitals in rural BC are supported in part through hospital auxiliaries – community groups that support their local hospitals through fundraising, advocacy, and creative problem solving. Many of these community groups gather together to operate gift shops, thrift stores, cafes, or run community events to raise money to fund special projects or purchase new equipment.
Some rural hospital auxiliaries have gone beyond fundraising and have worked with local healthcare providers to support recruitment efforts. Nakusp’s Arrow Lakes Hospital Auxiliary came up with the idea to purchase a home to offer as an incentive to attract a physician (and his/her family) to the community. (It worked – they signed a doctor shortly after the acquisition.) Princeton’s Support Our Health Care (SOHC) community group formed to take action over the shutdown of its ER for four nights a week in 2012 — since then, it has worked with the health authority and healthcare providers to attract practitioners to the community, and has established a visiting specialists clinic. Fort St. James’ local committee was approached to help attract physicians to the community of 1,700. The group – which had taken over operation of a local ski hill to keep this resource in the community – lent its innovation and ingenuity to the problem and worked with Northern Health to create a new model of clinic operation in the north that brought several doctors into the community.
Rural auxiliaries and community healthcare groups are key contributors to the success of healthcare delivery in rural and remote communities. Whether you’re operating a stethoscope or a set of knitting needles, each contribution of service helps move rural healthcare forward.
Sept 2017 – Stellat’en Health and Wellness Centre
The rural BC community of Stellat’en officially opened a new Health and Wellness Centre on August 31, 2017. The Stellat’en First Nation was proud to welcome members, physicians, and dignitaries to the event, including REAP, RCCbc, and UBC physicians Dr. John Pawlovich, Dr. Ray Markham, and Dr. Terri Aldred. Fraser Lake healthcare staff, including Dr. Midori Yamamoto and Nurse Practitioner Laura Lee Pechako, were also at the event, along with First Nations Health Authority Chief Operating Officer, Richard Jock, and FNHA Northern Regional Director Nicole Cross.
The centre is part of a healthcare vision by Community Health Representative Cynthia Munger, who advocated for the facility over a seven year period. She and her community brought together funding from diverse sources – Stellat’en First Nation, community members, Carrier Sekani Family Services, health authorities, and local industries – to build the centre. Munger says she will continue to work with stakeholders to find ways to expand and facilitate ‘closer to home’ health and wellness delivery to her community.
A video segment of the opening by CKPG is available online.
Aug 2017 – BCEHS
BC Emergency Health Services operates an air ambulance service that transports critical care patients to nearby care centres with the capacity to treat serious injuries and/or conditions.
In this photo, the air ambulance has brought a patient to Vancouver General Hospital, BC’s primary trauma centre. The cityscape is hazy with smoke from the wildfires raging in rural BC. These are just two of the ways that urban and rural are intertwined in this province.
July 2017 – Dr. Nathan Teegee
Dr. Nathan Teegee, a second year UBC Dermatology resident, recently returned to his traditional territory with the Carrier Sekani Family Services (CSFS) Primary Care Team. One of his stops included his home community of Takla.
The week-long visit was a full circle moment for Teegee in more ways than one. Teegee, a former CSFS employee, accompanied the Primary Care Team as part of his dermatology training, bringing in-person specialist services to his people. The visit provided valuable community practice experience for Teegee, and supported Carrier Sekani Family Services provision of specialist services to its rural and remote patients.
For more on Teegee’s visit, read the full article (with more photos!) in the CSFS newsletter.
June 2017 – Elizabeth Lund, PhD
Elizabeth Lund is the program coordinator of Selkirk College’s Rural Pre-Medicine Program. From the early days when the Rural Pre-Medicine Program was only a concept on paper, Lund has worked tirelessly to advocate for this innovative, rurally-located program. The first cohort of the Rural Pre-Medicine Program will graduate this year, and there are plans to enhance the program further, and also deepen the relationship with the University of Calgary’s Faculty of Medicine.
Lund, Kootenay born and bred, holds a PhD in Synthetic Organic Chemistry and has worked on several projects linked to medicine. In 1996, she left the lab benches at UBC for the jungles of Thailand where she studied and lived as a Bhuddist nun for ten years. She returned to the Kootenays in 2006 and continues to be an educational leader, working with Selkirk College and the Mir Centre for Peace, and providing local outreach through science activities and events.
May 2017 – Dr. Fishy Band
Dr. Greg Linton, Site Director at UBC Family Medicine’s Terrace Residency Site, along with James Powell, are the co-founders of the Dr. Fishy Band. When Linton isn’t teaching medical learners or looking after patients, he is playing, singing and writing some of the tunes for Dr. Fishy.
This five piece ensemble plays a combination of folk, rock, jazz and blue grass, and are North West BC festival favorites. This clip was filmed at a private concert hosted during a social dinner at RCCbc‘s 2017 BC Rural Health Conference in Prince George on May 12, 2017.
April 2017 – UBC Dermatology
Dr. Neil Kitson of UBC Dermatology, and his resident, Dr. Bez Toosi, joined Dr. John Pawlovich on his monthly visit to see patients in Fort Babine. The road into the community is mostly unpaved and involves pulling over frequently to allow massive logging trucks free passage. Vehicles don’t stay clean for very long, but it provided the good doctors a cheap billboard for free advertising! (Kudos to Dr. Toosi for his rendition of the UBC logo.)
Kitson and Toosi are just some of the physicians collaborating with Pawlovich and other health services providers to bring specialist services to rural and remote populations. Hosting local, closer to home specialist services clinics helps build patient-practitioner relationships, provides learning opportunities for local health service providers as well as medical learners, and saves the patient and the health care system both time and money by making effective use of physician time and resources.
March 2017 – Support Our Health Care (SOHC)
In 2012, the community of Princeton was in crisis. There was only one physician on-call for the community of nearly 3,000 people, the ER was closed for four nights a week, and there was a shortage of nurses, medical office assistants, and laboratory staff. Through the combined efforts of the Support Our Health Care (SOHC) group, the Cascade Medical Centre, the Princeton General Hospital, and allied health care workers, the community was able to recruit and retain additional health care staff and work with several stakeholders to restore existing services, and even introduce new specialist clinics to the community.
Princeton locals Ed Staples and Nienke Klaver, are two of the founding members of SOHC who have worked tirelessly to advocate, coordinate network, and support the community’s health care professionals. In a conversation with RCCbc last year, Nienke mentioned tongue-in-cheek that the SOHC has become a retirement project for her and Ed! We salute the efforts of the SOHC in enabling the transformation of Princeton from a community in crisis to one that is now stable, and look forward to seeing what innovative programs the community will put forth over the next few years.
Photo by Sharon Mah
February 2017 – Dr. Shannon Douglas
Dr. Shannon Douglas (left, skijoring) and her mother, Ms. Ann Watney (right, dog sledding), recently dusted off their dogs and participated in the annual Gold Rush Trail Sled Dog Mail Run. The race takes participants through three stages over three days from Quesnel to Wells to Barkerville, primarily using sled dogs, although skijorers, cross country skiiers, and snowshoers are also invited to participate. Mail is still transported as part of this race (you can order envelopes specifically labelled “Carried by dog team”) and can be ordered ahead of the event .
To learn more about the rich history of this event, visit the race web site.
Photo by Dr. John Pawlovich
January 2017 – Drs. Bob Bluman and Kirk McCarroll
Dr. Bob Bluman is the Executive Medical Director of UBC Continuing Professional Development, and a rural locum family physician. He and FP Anesthetist, Dr. Kirk McCarroll are currently collaborating on the development of a Clinical Coaching pilot program to support Family Practice Anesthetists practicing in rural communities. Details about this innovative program will be featured in a future issue of BC Rural Update.
November 2016 – Dr. Sarah Newbery
Reprinted with permission from HealthyDebates.ca
The daughter of a rural physician, Dr. Sarah Newbery always wanted to practise medicine in a small community. She talks about the joys and challenges she has experienced during her 20 years in rural medicine.
“I grew up in Hazelton, British Columbia, which is the northern-most point on what we now call the Highway of Tears. My father was a family physician there. Almost all of the physicians and dentists and many of the nurses lived on the hospital grounds. We spent a lot of time as we were growing up, in the hospital for volunteer work, and for social things too. There was an old pump organ at the nursing station, which is where we would spend Christmas morning singing and visiting with patients and each other.”
September 2016 – Rural Pre-Medicine Program, Selkirk College
The third cohort of the Rural Pre-Medicine Program at Selkirk College started this September. This successful small rural pre-medical training program, located in Castlegar, is supported in part by funding from the Joint Standing Committee on Rural Issues (JSC). It was recently endorsed by the medical school at the University of Calgary.
“Selkirk College’s Rural Pre-Medicine Program is an exciting new program that connects a health care system in need of rural doctors with students coming from rural backgrounds. Selkirk College offers students a chance to complete the first three years needed to enter medical school here in a rural setting, receiving state-of-the-art instruction in an intimate classroom setting. From MCAT preparation to mindfulness training, the curriculum provides a strong foundation.”
For more information: selkirk.ca/program/rural-pre-medicine
August 2016 – Dr. Granger Avery
Dr. Granger Avery was inaugurated as the President of the Canadian Medical Association on August 24, 2016 during the CMA General Council. (Read his inspiring inauguration speech now.) There are many things that we could say about Granger, former executive director of RCCbc and former co-chair of the Joint Standing Committee on Rural Issues. However, we direct you instead to the CMAJ profile of Granger which begins “Dr. Granger Avery’s luxuriant mustache merges seamlessly into his mutton-chop whiskers, making him look less like a country doctor than a Victorian-era sergeant major.”
We look forward to seeing how Granger will direct the CMA in the upcoming year.
July 2016 – Murry Coughtrey
Murray Coughtrey (right) has been a rural nurse for 20 years. He prefers working on the front lines – so much so that he returned to rural nursing on the North Island after spending several years in management. In rural environments, he explains, “you discover what needs to be done and then do it.”
Coughtrey has worked as a nursing faculty member of The CARE Course for several years, bringing his wisdom and expertise to the popular rural emergency training course. In one of the high fidelity simulations, Coughtrey is occasionally tapped to play the role of a labouring woman entering the rural ER ready to deliver. He always gets laughs when he – a bearded man – waddles in wearing a “Mama Natalie” pregnancy simulator, but several participants have commented that Coughtrey’s dialogue is spot on, that many of their patients have made the exact comments that he uses in the scene. “I’ve heard lots of surprising comments from labouring women,” says Coughtrey, “and I save them up and use them when I’m teaching.”
The Mama Natalie simulator is essentially a fabric ‘frontpack’ that comes with a plastic baby (that can be filled with sand or water to simulate the weight and ‘floppiness’ of a newborn), a detachable umbilical cord, and a fabric placenta attached via velcro to the “uterine” wall. The pack has two openings for the wearer’s hands, allowing instructors to manipulate the various components. Coughtrey notes that the tool adds a dimension of realism to the training. “I can control the descent of the baby, and be more responsive to the skill set of the participants. If the learner seems nervous, you can simulate a normal birth to help him/her become more comfortable with the basic skills. If the learner is confident, you can add interesting challenges to test his or her knowledge.”
Coughtrey is shown here with Dr. John Soles during The CARE Course delivered in Clearwater, BC.
June 2016 – Dr. Sarah Pawlovich
Dr. Sarah Pawlovich, along with her husband, Dr. John Pawlovich, worked in Fraser Lake, BC for more than a decade before their move to Abbotsford. During their time in this small northern BC community, they hosted several fun sessions for local children to experience “hands on” rural medicine.
There are several studies which have demonstrated that medical students from rural communities tend to practice in rural communities after completing their training. Programs such as the UNBC Healthcare Traveling Road Show, Selkirk College’s Rural Pre-Medicine program, and REAP’s upcoming expansion of the Aboriginal eMentoring program in Trail, BC strongly encourage and support young rural learners to pursue their dreams of becoming healthcare workers.
April 2016 – Dr. Trina Larsen Soles
Dr. Trina Larsen Soles, an avid gardener, is shown picking the elusive wild huckleberries, a bounty which is only available in the mountains during the summer. Says Larsen Soles, “if [the pail was from] my garden, it would be full of black currants, raspberries or apples, of which we grow far too many!”
A long-time resident of Golden, BC, Larsen Soles is a rural health leader and advocate at the local, provincial and national levels. She is a clinic lead within the community’s GP-led practice and, together with her team of 13 physicians, has successfully leveraged local clinical teaching as a recruitment tool. Provincially, she has supported the work of Doctors of BC, the Joint Standing Committee on Rural Issues (JSC) and RCCbc for more than two decades. She is a co-chair for the College of Family Physicians of Canada’s (CFPC) Canadian collaborative task force “Advancing Rural Family Medicine.” Larsen Soles is a Fellow of Rural and Remote Medicine (FRRM) with the national Society of Rural Physicians of Canada (SRPC) and served as its President from 2004-2006.
You can follow Larsen Soles on Twitter – @DrLarsenSoles.
March 2016 – Dr. Ray Markham
Dr. Ray Markham participates annually in a bi-lateral global health project involving practitioners and volunteers from Zimbabwe and Canada. Markham, originally from Zimbabwe, has spent his month-long stay seeing patients, learning medical procedures from Zimbabwean physicians, lecturing to medical students and residents, and coordinating Skype-enabled rural rounds between practitioners in both countries. He structures his projects to help build capacity for rural practitioners in both Canada and Zimbabwe. (See Markham’s Twitter feed for more photos.)
The photo shows Australian, Canadian and Zimbabwean physicians at a CME session based on UBC Rural CPD’s Hands On Ultrasound Education (HOUSE) program, a modular course that teaches rural physicians how to utilize ultrasound for multiple applications, including diagnosing abdominal pain and trauma, or visualizing central line placement. (Markham is not shown in this photo.)
January 2016 – Dr. Alan Ruddiman
Dr. Alan Ruddiman, rural physician and president-elect of Doctors of BC, enjoys hiking through the hills surrounding his home community of Oliver, BC. He also enjoys lake activities, including sailing and kiteboarding.
Ruddiman, originally from South Africa, came to Canada in 1991 to travel and gain some experience with international medicine. It was while he was working at his first placement in Moosejaw, SK – where he saw patients mostly on a walk-in basis – that he discovered that he wanted to practice in a way that would facilitate continuity of care for his patients. Ruddiman stepped gladly into rural family medical practice and has never looked back.
December 2015 – Ms. Cynthia Kong
Cynthia Kong is a third year MD student. Her article, “The price of living rurally,” is excerpted here from the BC Medical Journal, with permissions:
“Family medicine, particularly in small communities, has a charm that I haven’t experienced elsewhere. There is an incredible depth and history to the doctor-patient relationship when all the members of a family can see the same physician throughout their lives. During my time in a small community I, too, had the chance to see patients over a series of follow-ups, and I was drawn by the relationships that transpired: chatting excitedly with the bright but shy teenager—who had barely said a word a few weeks earlier—about her university plans and aspirations; understanding a vulnerable mom’s hectic schedule at each weekly prenatal checkup; listening to a gruff elderly man with chronic pain share stories of the beautiful garden he pours his heart into since his wife passed away. At times I was even able to relate to the challenges that their health conditions presented in their school or workplace—after all, there was only one local grocery store, brewery, and pastry shop in this small town of 1000.
Having worked in some of the biggest centres in the province, however, I had to rewire my brain to fit the small town clinical setting. At 5:30 a.m. on my first call shift, a patient presented with classic signs of gallstone disease. But was it biliary colic, choledolithiasis, or gallstone pancreatitis? I presented the case to the attending physician and rattled off investigations. “I would order a CBC with diff, electrolytes, liver enzymes, serum lipase…” My supervisor stopped me in my tracks. First, the lab didn’t open until 8 a.m. on Saturdays, unless we wanted stat bloodwork. Second, the clinic couldn’t do stat liver enzymes and certainly not lipase. It would take days for them to be sent to Prince George, analyzed, and results reported.
The case was ultimately straightforward—biliary colic, which responded well to symptom control. No bloodwork, no imaging, happily home with return-to-care instructions. I was shocked! When I relayed the story to my preceptors in the morning, they simply laughed. “Welcome to rural medicine!” they said.
A classic example of rural pet therapy. As part of a program provided for patients in extended care, this man had the opportunity to be re-united with the horse world, resulting in this wonderful photo (taken with the patient’s consent) by Dr. Stuart Johnston.
October 2015 – Dr. Alia Dharamsi
Before rural, I had never seen a pilot land a helicopter onto a dock, in a rainstorm, into small, remote community accessible only by boat or by aircraft. Come to think of it, before rural I hadn’t been in a helicopter before. Through my placement in Port McNeill I not only got to fly over the beautiful waters, glaciers, mountains and islands of the BC Coast/Vancouver Island, I got to land in the heart of communities to be a part of the most interesting medicine and culture I have seen yet. Port McNeill is a small town, around 3,000 people, but the medicine is far reaching, not limited by roads or water, phone lines or internet, and together we are the team that provides physical, emotional, and psychological support to everyone here. And by we, I mean the team of doctors, nurses, social workers, mental health workers, physiotherapists…and us, the medical students, who are fortunate enough to play a small part in these care providers’ efforts to bring medicine to British Columbians.
Being here allows me to absorb the sights and stories of remote communities like Kingcome Inlet, Gilford, Woss, Sointula, and Rivers Inlet…each community with its own flavor, and each with its unique story. Everything from prescription refills, to X-rays, to colonoscopies—what would be a routine referral in “the big city” can sometimes turn out to be an exercise in transportation logistics, and patience. Yet, everywhere I travelled this month, there was someone offering a story, an artist patiently describing the meaning of their work, a recovering addict inviting us into her home during a house call to show us how far she has come in her recovery. All these people, our patients and their families, welcomed me into their lives both inside and outside the exam room, eager to not only help me advance my medical knowledge, but also to give me a better understanding of their lives and the place they call home. And as I close the door of the exam room behind me, the nursing staff, the X-ray technicians and the lab staff invite me to join them for a coffee and a chat, imparting their wisdom from the years of experience they have working in the McNeill hospital. It didn’t take me long to appreciate that rural medicine is as much about the people, as it is the procedures.
This has been a month of firsts—first IVs, first phlebotomies, first ECGs, first casts, first ambulance transfer, first helicopter ride, first time catching/cooking crabs. Also, my first time comforting a grieving wife, first time partnering with a mental health worker, first time reassuring a worried mother. We explored the beautiful waters and mountains of the surrounding areas, watched whales play, kayaked in Telegraph Cove, and watched the sun set from the beach. We even got up close and personal with the Stanley Cup, when Willie Mitchell brought it back to his home in Port McNeill! Although I felt unsure of myself in so many ways, (usually fumbling with pharmacology, forgetting anatomy names, dropping things), I have realized that what I can do best is listen openly, comfort families, watch attentively, and smile. I truly hope to one day be able to emulate the skills, patience, kindness, and resourcefulness that my preceptors have demonstrated over the past month, and will carry their “golden rules” with me as I continue my training in medicine: the history is the most important part of the diagnosis; take time to listen to your patients; and learn, learn learn.
Alia Dharamsi is currently completing her second year of residency in the Emergency Medicine program at the University of Toronto. She worked with the Port McNeill healthcare team during her third year of undergraduate medicine at UBC. Alia grew up in the “big city” of Vancouver, but has fallen in love with the pace of rural communities and plans to continue to experience rural life every opportunity she can.
Photo submitted by Alia Dharamsi
September 2015 – Drs. John Pawlovich and Alyson McCabe
Not your average commute, Dr. John Pawlovich and UBC family medicine resident Dr. Alyson McCabe take off for a week-long trip to five rural and remote Carrier First Nations communities in northern BC: Fort Babine, Tachet, Stellaquo, Yekooche, and Takla. Dr. Pawlovich regularly delivers family medicine care to these communities through an innovative combination of local visits and telehealth.
On the day this photo was taken, Drs. Pawlovich and McCabe attended to clinical work, performed house calls, and celebrated BC Rivers Day with the community by partaking in early morning fishing on the river and a lunch barbecue at the Fort Babine Salmon Interpretive and Natural Resources Centre.
Photo submitted by John Pawlovich