“If you don’t know where you are, you don’t know who you are” –Wendell Berry.
To me, this quote rings true and is relevant to our current health care crisis in Tumbler Ridge.
Why does this quote matter? It matters because we live in a bowl in the foothills of the Rockies in our province’s northeast. It matters because we live in a place where the major employer operates a heavy-industry coal mine. Because to get from here to our nearest communities we have to travel up and over the hills, gaining and losing a lot of elevation. Because we live in the north, so our winters are long and unpredictable. Because driving times to these communities are an hour and a half if we follow the speed limit, but we can be cut off from those communities during winter storms, and then air transportation will probably be impossible too. It matters because we have wonderful scenery and natural attractions, so that we live where tourists want to come and play.
To understand all this, and therefore to know who we are, we need to live here. It is not something that outsiders necessarily ‘get’ easily. So, when decisions are made that really impact who we are, but don’t take into account where we are, that is a problem. And I have a concern, that when the Northern Health leadership announced that after-hours ER services in Tumbler Ridge would end, insufficient attention was given to our local perspective and where we are.
To provide one simple example: the elevation change involved in driving to Chetwynd or Dawson Creek has predictable medical effects. It means that for anyone with a collapsed lung (pneomothorax), inserting a chest tube is an essential precaution before transportation begins. I wonder who is going to insert those chest tubes when our ER is closed. Or maybe a collapsed lung is another of those conditions, like heart attacks, that we should preferably not suffer after-hours or on weekends.
A couple of things are clear as a way ahead. Firstly, I think the initiative has to come from our community, rather than wait for Northern Health leadership to come up with a solution. Secondly, I suggest that mediation/facilitation is urgently needed. A mutually acceptable facilitator would need to be appointed and funded. This would enable all concerned to establish what the respective non-negotiables are, as well as the areas where common ground exists and a potential solution could be sought.
Why does this need to happen urgently? Clearly, every day that our ER remains closed after-hours puts all our lives unnecessarily at risk. (As an example, what happened to Mayor Krakowka recently is enough to make residents worry that they could be next.) That alone makes this situation extremely urgent. But there is another consequence: what if a ‘spiraling out of control’ situation unfolds? Already one provider has indicated that if 24/7 ER coverage is not reinstated, they will be leaving. Already one of our allied health professionals has indicated on Facebook that they may have to leave as a result of the changes. And locums (on whom we so desperately depend) will be reimbursed substantially less if they come here compared to communities that offer 24/7 ER care – in other words, our locums are being de-incentivised from working here. I look at the future if this trend continues, and I see the potential collapse of the health care that we hold dear and assume is our right in Canada. And what happens to our community’s economy and livelihood when people leave or choose not to come here because of the state of our ER care? We therefore need to find the brake of this runaway train and reverse things before it becomes too late. These are inconvenient truths, but they need to be heard.
We need to respect the challenges that Northern Health experiences in having to provide health care for a huge area in very tough times. The ideal way forward is for Northern Health leadership to listen, heed our community’s concerns, commit to reinstating after-hours ER care as soon as possible, and then for us to support our health authority in any way that is feasible. We already do this through things like the Tumbler Ridge Medical Conference (perhaps the most recruiting tool that we have), the Type 2 diabetes remission project and the Tumbler Ridge Health Fair, as well as supporting recruitment of physicians, nurse practitioners and locums. And our mayor and council are going to extraordinary lengths to make physicians, locums and nurses feel welcome here.
It is unfair for Northern Health leadership to use the current shortage of physicians in Tumbler Ridge as a reason to shut down after hours ER care in Tumbler Ridge, and then make us feel that there is no hope of our community ever regaining that service. We expect, and deserve, better. In this sense, I think of Tumbler Ridge as being similar to, say, Fort Nelson, McBride, Valemount or Dease Lake: these commnunities are all small and remote, where removal of after-hours ER care is not a viable option. We can legitimately ask why Tumbler Ridge seems to have been singled out for this treatment.
Another aspect of what Northern Health has not done involves the virtual ER support (VERRa) option. This stands in contrast to what an adjoining health authority (Interior Health) is doing for its small remote communities – actually trying to keep them open through virtual ER support. We should be careful not to claim that VERRa is perfect, as an in-person ER physician who will come in after-hours to attend to emergencies is the ideal. However, in my view VERRa is superior to what is currently on offer after hours, and my understanding is that VERRa leadership thinks that we in Tumbler Ridge are an ideal case for virtual support. First, however, a green light from Northern Health is needed.
I recall how, back in the “good ol’ days” of the nineties, there was a Tumbler Ridge Health Centre Board of Directors and a local administrator. Those people understood what it meant to live in Tumbler Ridge. Closure of our ER after-hours would have been unthinkable to them. In a sense, then, what we are seeing now is the result of centralisation. And when decisions that profoundly affect our community are enforced on us from a distance, we are forced into damage-control mode.
What does all this mean? More than any other community that I am aware of, in Tumbler Ridge we know WHO we are, because we know WHERE we are. And, as we move towards mediation, that allows us to articulate our position clearly to Northern Health and expect to be heard.
I am immensely grateful to MLA Larry Neufeld and Mayor Krakowka and council and so many good citizens of Tumbler Ridge for keeping the community’s flag flying high. You have all spoken truth to power and provided us with a beacon of hope.
