Sunday July 17, 2022
I have a soft spot in my heart for the community of Clearwater, about 125 km north of Kamloops on the North Thompson River. The Clearwater River runs deep and clear (of course) out of Wells Gray Provincial Park – one of the best fly-fishing rivers in British Columbia.
The town of Clearwater is postcard pretty.
Sadly, though, Clearwater has become a poster child for emergency ward closures.
The Dr. Helmcken Memorial Hospital is as pretty as the town itself. A low, wooden building surrounded by manicured gardens, it contains a four-bed emergency room, a trauma bay, and a six-bed acute inpatient care unit.
The hospital is supposed to have eight full-time nurses on staff. It currently has four.
"They're coming in on overtime, staying late, coming in early to keep us open as much as we can,” Dr. Kara Perdue told a CBC reporter. “Sometimes it's quite amazing that we're only closed one to two nights a week, given how short-staffed we are.
"At this point, if even one person calls in sick, that's enough to shut us down."
Every night, the local news reports on emergency ward closures. Not just in Clearwater. Also in Merritt, Chetwynd, and/or Port McNeill. And other places. The smaller, rural communities bear the brunt of these closures.
When Clearwater’s emergency ward is closed, urgent cases must be ambulanced to Kamloops, more than an hour away. A little less, with the siren going. Longer, if there’s a highway accident.
But Royal Inland Hospital in Kamloops also struggles with staff shortages. One unofficial report spoke of 50% staffing levels. Official figures run closer to 75%.
Which raises the issue of triage.
Triage – that’s the system of sorting incoming patients into three groups, according to their need for medical intervention.
Those who will survive, even without treatment.
Those who need urgent treatment, to save their lives or to relieve intolerable pain.
And those who won’t make it, regardless.
We’ve all seen those reruns of M*A*S*H, where Hawkeye Pierce bends over the incoming wounded, and makes instant life-or-death decisions.
I don’t recall him telling head nurse Hotlips Houlihan to ignore a hopeless case. The hopeless cases typically died on their own, sparing him from making a seemingly callous decision.
Hollywood doesn’t like unhappy endings.
Every emergency department, at every hospital, has some kind of triage admission process. To some extent, you get treated by your order of arrival – first come, first served. But if you’ve got a bad bruise, the victim of a highway crash will take priority.
Closures of emergency wards, however, impose their own kind of triage.
Residents of Blue River needing emergency care for, say, a heart attack, a stroke, a ruptured aneurysm, would normally be rushed to Dr. Helmeken hospital in Clearwater, an hour away.
But if Clearwater is closed…
B.C.’s ambulance system has an information network that notifies drivers of the nearest available emergency ward. But a two- to three-hour drive may be too long for critically ill patients.
At such times, emergency ward closures are more than a temporary inconvenience. They can be a death sentence.
Money is not the answer
This week, the provincial and territorial premiers gathered in Victoria. They demanded that the federal government increase its funding for health care.
Some people, the saying goes, “don’t do windows.” I don’t do budgets. Big numbers make my head spin. So I can’t comment on the figures being touted by both provincial and federal representatives.
But throwing money at this problem is not, and cannot be, the answer. Because if you ain’t got the personnel, pasting paper money onto open wounds won’t heal anything.
B.C. tried to entice new doctors into family practice by promising a $25,000 signing bonus, a $300,000 starting salary, and $150,000 loan forgiveness.
Not one doctor signed up.
UBC is the only medical school in this province. It looks to me as though it graduates about 250 doctors each year. About 1400 nurses also graduate each year, but the actual number of nurses in practice has been declining by about 1.5% a year.
At the personnel level, incoming doesn’t balance outgoing.
The only real solution to the closures of emergency wards, it seems to me, is more slippers on the floor. More people trained. More staff on the job.
And that will take several years. At least.
Until then, good luck if you have a medical emergency outside a major centre.
Copyright © 2022 by Jim Taylor. Non-profit use in congregations and study groups encouraged; links from other blogs welcomed; all other rights reserved.
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I got a variety of letters about the failure of my mailing list program to deliver about two weeks’ worth of columns. Three people wrote to ask if I was all right; my thanks to them for caring. Their letters prompted me to contact my techies, to find out what had gone wrong, and to get the mailings going again.
Several other writers let me know which columns they had received.
Randy Hall suggested, “perhaps your mailing list fell off Seneca’s cliff!”
Don Gunning looked back over the five generations we have shared, and thought about the Hell in a Hand Basket warnings from our parents “remains etched in my mind.
“We have survived at least three near calamitous periods -- with the hope, in each case, that lasting peace and prosperity were finally at hand! Your iteration of present day ‘open sores’ hardly bears thinking about.
“In the midst of all this, of course, are the untold acts and undertakings of kindness and support that surround us -- and so impress and encourage us.
However! In his compelling book Sapiens, Yuval Noah Harari concludes that upon the demise of hunter-gatherer Neanderthals by the ‘organized’ Homo Sapiens, it's been downhill ever since !”
Isabel Gibson endorsed the “Seneca’s cliff” concept: “Yes, institutions and norms that take decades or even centuries to build can be destroyed in a few years, it seems. Something about inertia, perhaps.
“We'll hope for better on the other side of what sure looks like an impending collapse.”
So did Heather Sandilands: “My experience is that it takes half a decade to build truly trusting relationships & community and one thoughtless comment to blow a hole in it.
“But as I reflect more, I consider that while new ideas and ways of being can topple empires, the backlash to those new ideas can be more brutal. Roe v. Wade being assassinated. The TRC Call to Territorial Acknowledgement raising more resistance and backlash (in my experience) from white people than tears at unmarked graves & the residential schools system.
“So I wonder if Seneca's cliff is more noticeable when good things are destroyed and regressive policies hold sway, than when good & justice is being built up and inhuman, archaic ideas shaved down?”
About that Hell in a Handbasket metaphor, Ted Spencer wrote, “Haven’t old geezers (like myself) been saying that for millennia? I bet they have. I’d also bet that we’ve got tools for making the precipitous plunge much more interesting and spectacular than ever before.
“I see little likelihood of a collective change of heart that will turn us into rational races. What a dreadful condemnation of society that is.”
Vera Gottlieb: “As I see it, the white ‘cultured/civilized/educated’ race that has been disturbing the shit all over the globe for a long time already. We like to humiliate others of different race/social standing but we certainly don’t mind exploiting their natural resources to benefit us. And now we are surprised when the fan is sending the shit right back in our faces. We are reaping what we have, for so long, sowed.”
Steve Roney: “Your latest Sharp Edges seems to envision only two possibilities for our collective future: either democracy collapses suddenly, or it fades slowly.
“I think instead that the arc of history, and technology, favours the growth of democracy. It has to do with the advance of communications technology. Before the invention of printing, and in general poverty, the scarcity of information necessitated government by the few who were educated and therefore in a position to understand the issues and options. There were small democracies long ago, in Greece, Mesopotamia, and the Nordic countries, but these tended to rely on the institution of slavery. Free men were an idle minority of the true overall population.
“With printing, information became more plentiful, and representative democracy become more plausible. The common man was now at least informed enough to be capable of choosing his preferred experts. This evolved over centuries, because it took the printing press centuries to generate a large enough corpus of information. And, of course, printing technology improved over this time. The Industrial Revolution, in turn, gave more people the leisure to read.
“With the Internet, in principle, information is now rapidly become exponentially more readily available. The inevitable upshot over time will be something closer to direct democracy.”
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