Volunteer-powered rural clinic attempts to fill ER gap
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When more than one-third of Manitoba’s emergency rooms stayed closed over the August long weekend, Dr. Jacobi Elliott’s clinic in Grandview remained open.
For the past month, shortly after the community’s ER shut down for evenings and weekends this summer because of nursing shortages, Elliot has been running the private clinic seven days a week, with the help of 45 volunteers on weekends.
“We decided we had to do something,” Elliott said Wednesday.
With administrative help from community residents — answering phones, doing check-ins and cleaning rooms — and one doctor at a time, the clinic is open every day.
The local ER operated with one doctor on duty, pulling from the same small pool of physicians and locum physicians in the area. For months, it had been operating only sporadically, before the Prairie Mountain Health Region announced further suspension of service in late June.
Grandview is about 45 kilometres west of Dauphin, and residents can go to the next-closest ERs in Dauphin or Roblin. However, Elliott said the nurses, lab techs, pharmacists and doctors in Grandview are trying to provide the kind of stable care people can only get at home.
“The patients know us, they trust us,” she said. “We really know what’s going on with our patients. And when they’re really sick, when they’re in a pain crisis or they have a mental health crisis or there’s a death in the family, those are the times when I really want to be able to help them, and those things often happen after-hours.
“If there is a clinic, then at least you are around for people in crisis.”
The private facility, which Elliott owns with subsidies from the town, has been open 8 a.m. to 4 p.m. Saturdays and Sundays, in addition to its usual Monday to Friday hours since early July.
However, it won’t be able to keep operating every day without additional physicians; Elliott’s practice is down two physicians already. They wouldn’t be able to make this happen without volunteers and locum doctors being willing to give up their summer weekends, she said — and doesn’t know how long it will last.
“We have to be innovative right now. We’re in a dire situation I think, and so we have to think a little bit outside the box,” Elliott said. “There’s so many things I can’t change, so if there is something in my power to do, then why wouldn’t I try it?”
ERs are usually busier on summer long weekends, but more than 30 per cent of rural ERs are currently shut down; 22 of 67 are closed and another 22 are operating on reduced hours, Doctors Manitoba said last week.
Manitoba’s largest ER was also busier than normal over the August long weekend, with wait times slightly higher than the five-year average at Health Sciences Centre’s adult and children’s emergency departments in Winnipeg.
In the adult ER, the median wait time was around two hours between July 29 and Aug. 1, according to figures provided by Shared Health. (Median measures the mid-point, meaning half of patients waited longer and half of patients waited less time.) Over the past five years, the average median wait in the HSC adult ER was 1.93 hours, and 1.18 hours in the children’s ER.
Over the course of last weekend, 621 adults were triaged at HSC, and a high rate of them were seriously ill. Almost 19 per cent (115 people) needed to be admitted to hospital.
In a statement Wednesday, Shared Health thanked staff who worked over the weekend.
“Long weekends are historically high-visit periods, as Manitobans take to the highways and waterways across our province for recreation and other activities, which can lead to increased presentations for injury, trauma and illness.”
In rural parts of the province though, small emergency departments often serve a different purpose. They’re the only place people can get medical attention outside of usual 9-to-5 business hours, Elliott said.
“If you’re not going to have an ER, you’re not going to have primary care. The two things can’t be separated.”
There are solutions to this crisis, Elliott said. She suggested decision makers should consistently allow nurses to self-schedule, the way doctors do, cut top-heavy, bureaucratic health-care management, and actually listen to front-line staff.
Running private clinics daily is not a long-term answer, Elliott said.
“I can do it for a short while, but I can’t do it forever. You definitely need more bodies if you want to make this kind of thing work.”
Katie May is a general-assignment reporter for the Free Press.