Canada accused of failing women patients
BMJ 2004; 329 doi: https://doi.org/10.1136/bmj.329.7459.192-e (Published 22 July 2004) Cite this as: BMJ 2004;329:192All rapid responses
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There is no doubt that "Canada" can, should and must do better in
providing health care to women (and every citizen) in rural, remote and
northern communities.
That being acknowledged, this nation's purported failings should be
considered in several contexts. Enormous distances are involved, and
extremes of weather in our northern nation's north that one must
experience to comprehend. Envision providing services to a remote
community that is easier to reach in midwinter than midsummer, across an
enormous frozen lake into which one could fit all of Ireland. The
communities and their supporting beliefs, cultures and languages are
diverse, not just English and French but Inuit, Dené...Cree, Iroquois,
Mohawk...Germanic Hutterite and Mennonite ...immigrant "new Canadian".
Fifteen years ago, 20% of Manitoban aboriginal women age 15 and up were
diabetic and their is little doubt that the proportion now is higher. And
despite all of this Canada's health outcomes are remarkable in most
respects, significantly better than those of our nearest southern
neighbour in most measures,for example .
And there are noteworthy, even remarkable examples and exceptions to
the purported national failure to provide appropriate, culturally
sensitive service to remote and rural settings. One is the Manitoba
Obstetric Outreach Program, now in its 20th year. Our service sends
trained obstetric nurse sonographers under medical direction and immediate
online support support to nine rural communities throughout the province.
These include five communities served by air at a distance of 450-500 km
north of Winnipeg, and seven by land. Some of these involve access by boat
or in winter, by snowmobile. Over 1100 patient examinations are conducted
annually by the program.
While the program enables patients and providers of care to make
decisions as to whether delivery in their own communities is safe and
supportable, it also provides triage for pregnancies with issues that
warrant transfer to urban care in Winnipeg. Within two years of the
program's inception, perinatal mortality and morbidity rates in Manitoba's
rural and remote settings began to drop significantly, and even then
(1986) the program's PNMR of 8.9/1000 was lower than that of the province
overall (9.9/1000). In 2002, our program's perinatal mortality rate was
2.7 per 1000.
Philip F. Hall, MD BScMed FRCSC
Director, Manitoba Obstetric Outreach Program
Professor, Faculty of Medicine, University of Manitoba
Competing interests:
None declared
Competing interests: No competing interests
Re: All generalizations are wrong
In his rapid response Phipip F. Hall said:
"And despite all of this Canada's health outcomes are remarkable in
most respects, significantly better than those of our nearest southern
neighbour in most measures,for example."
My RR is merely an anecdote-based response to his. I grew up in a
remote Canadian community (not in Manitoba) which in my earliest youth had
no road access. As a young child I remember twice yearly axle-wrenching
journeys of over 300 miles one way on abysmal gravel roads twice a year
for elective eye examinations. All other care, including some very serious
illnesses was handled locally.
I have worked in remote fly-in communities in the Ontario north and
in the western Canadian arctic where roads out were closed for weeks
during break-up and freeze-up.
In all those places I found the quality of my general day-to-day
medical care, preventative services, interaction with carers, and the care
& cost required when I needed to fly out for surgery in one setting to
be much, much better than that available to me now in far less remote
areas of the United States. One of the biggest cultural shocks to me when
I made the transition was the discovery that the rural areas here have so
much less in this respect than those I lived in in Canada. I am tempted to
speculate that is is because so many of Canada's brightest and best do
stints early in their careers exploring the delights of remote areas, and
that the health system there makes such things possible, but that would be
more non-scientific speculation.
jan perkins
Competing interests:
None declared
Competing interests: No competing interests