CALEB NICKERSON
SHAWVILLE Oct. 21, 2020
Note: This is the fourth installment of a series on the crisis in rural health care that attempts to discuss as many facets of the issue as possible. If you haven’t read the previous portions, check out page two of our issues on Sept. 2, Sept. 9 and Sept. 23. This article will examine problems caused by staffing shortages in two areas of the Pontiac Community Hospital (PCH), physiotherapy and the microbiology lab. If you have a story or perspective you want to add to the conversation, send an email to editor@theequity.ca or call 819-647-2204.
The loss of the obstetrics unit at PCH garnered a huge amount of attention earlier in the year, and for good reason. Many residents were outraged that such pillar of local health care services would be lost, and were justifiably skeptical of the regional health authority CISSSO’s claim that that the closure would only be temporary. Here we are more than a month after the promised re-opening date and the problem not only remains unsolved, but the situation hasn’t improved significantly since the start of the year.
Even with the havoc and uncertainty unleashed by COVID-19, there are some recent changes that cannot be blamed on the strain of a global pandemic.
THE EQUITY reported on Oct. 7 that physiotherapy at the PCH has been interrupted in recent weeks, due to both physiotherapists being . . .
away on sick leave. While there is a tech on site available to conduct therapy, replacement therapists have been brought in from the city, explained PCH coordinator Gilbert Daoust. However, these therapists are not always available.
“Twice a week I have physiotherapists from Gatineau that come and do assessments on the patients, and I have a tech in rehabilitation that does the intervention,” he said. “She’s not allowed to … evaluate but she can treat. A physiotherapist has to evaluate. We had two weeks where we had a breakage, because it’s on a volunteer basis from physiotherapists that work in Hull.”
He added that in certain cases, such as strokes where a patient receives thrombolysis (a procedure where a blood clot is broken down with medication, known informally as a ‘clotbuster’), the patient will now be sent to the city for an evaluation, as it is ideally performed within a timeframe of about 72 hours.
A local health care worker with extensive knowledge of the situation said that transferring patients is just the start of more services being moved to the city, and questioned why only certain patients qualified. The source spoke to THE EQUITY under the condition of anonymity, as they are not authorized to speak to media and were worried about repercussions from managers at the CISSSO.
“It’s exactly the same thing as the obstetrics, that’s what’s hurting us so much,” the source said, referring to a lack of resources in the Pontiac being used as an excuse to move services to facilities in the city. “It’s the same thing and nobody thinks obstetrics is going to open, no-bo-dy. So I think physio’s the same thing. Why is it that … stroke patients will only be transferred if they recieved the clotbuster? … How is it that nobody in the Pontiac [was] consulted about this? … We don’t have the resources so they take away the service. There are resources, but they’re in the city. It’s not like the people don’t need it. They’re admitting full out that the patients need the service because they’re transferring them out of the Pontiac. We have an orange zone and Gatineau’s red. Who wants to go there?”
They went on to explain that thrombolysis is only available to patients that manage to get medical treatment quickly.
“We’re like, ‘OK, what about the patients that don’t get the clotbuster?’” the source said. “They don’t qualify for it, so they don’t qualify for physio? They get to stay in a bed in Shawville for two weeks or more while they wait around because for some reason of nature and happenstance, they didn’t get the clotbuster?
“The distinction doesn’t make any sense,” they continued. “‘Oh you got your knee replaced? Now you can no longer come to Shawville for physiotherapy.’ Why is that different than a stroke? Or if you had a major heart attack or you just had your gallbladder removed and things went wrong and now you need physio? It’s a slippery slope and the CISSS isn’t being straight with anybody about this file at all, they’re doing it all in the background.”
Daoust explained to THE EQUITY that the decisions about where to send patients were made by a CISSSO committee, and added that they are checking in often with the two therapists on sick leave. He said they have no indication when they will return, but will be forced to make alternate plans for the time being. In the meantime, all physio appointments for those not staying at PCH will have to take place in the city.
“For people that are external, they have to be evaluated in the city, because we have a breakage of service right now because of the [absence] of our two physiotherapists,” he said. “In the long and medium run [the physiotherapists] are evaluated every month to see if they are able to come back, and since now they’re not, our plan B is to get physio from the city twice a week.”
He highlighted the difficulties of finding employees willing to work in a rural area.
“We’re trying to recruit, we’re asking for replacements in the medium/long term basis, but we have no candidate that applied to the CISSSO that wants to come in a rural area. It’s very hard to get employees in a rural area,” he said. “They’re not all keen, especially winter-wise when they have to travel. We’re not their first pick, unless we have a local graduate and then it’s easier to get them, but other than that, it’s harder.”
“Management says they’re working hard on it and everything like that, and I’m not even going to doubt that, but the CISSS has a responsibility,” the source said. “We’re just snuffing out one candle at a time.”
RELATED: Crisis in rural health care part 2.5
The source pointed out another service at the hospital that is being lost to the city due to a staff shortage: the microbiology section of PCH’s laboratory. Microbiology deals with growing bacterial cultures from things like urine samples for example.
“We do not know what’s going on,” they said. “If you have a urinary tract infection … that’s super common, it’s something that gets done absolutely every day, so why can’t we do something like that in Shawville? It’s ordinary stuff. Sometimes if you’re running a fever and you’ve got cancer or something like that, patients need a blood culture. What they’re suggesting with this move, is that everybody is going to wait a day or two extra. Every day counts when you’re having an infection, because what they’ve proposed is, anything that you do during the day is going to be brought down to the city the next day. They can’t give us the results in the same amount of time.”
In an email sent on Oct. 13, CISSSO media relations agent Patricia Rhéaume said that the situation was temporary and even suggested that wait times would be improved.
“Regarding your question on microbiology at the Pontiac Hospital, only part of the microbiology is transferred due to a lack of personnel,” she said. “Once the situation is restored, the specimens can be transferred back to Pontiac. Rest assured that quality will be maintained and response times will be improved as the Gatineau laboratory is open 16 hours a day.”
THE EQUITY requested more details and an interview with someone who has direct knowledge of the situation. Rhéaume responded that she would attempt to set up an interview, but didn’t follow through in time for this week’s edition.
Daoust declined to go into detail about microbiology, as the laboratory isn’t his specialty, but did state that centralizing lab tests has been an initiative that local health authorities have been working on for some time.
“I know it’s a system that they want to put in place, it’s been years and years, even two governments prior to this one,” he explained. “They call it an Optilab, it’s a centralized service that doesn’t have to be done in small hospitals if we concentrate in the bigger hospitals. An Optilab, they have more people to analyze, more machines to do so …”
The source expressed serious doubts about any reduction in the cost or the speed of testing, as samples have to be sent down to the city via taxi, a considerable expense.
“If they said look, you’re going to get your result at the exact same time and there’s not going to be any difference between the doctor and the patients, that is just completely untrue,” the source said. “Gatineau can’t help us, those poor people, they get the samples, they can’t make it grow any faster. They’ve been talking about Optilab for years and years and you can never get a straight answer but at the end of the day, that’s another service gone for the Pontiac.”
They questioned why local employees hadn’t been consulted on the move, adding that Pontiacers will be “second-class citizens” without these resources.
“Why are we always the last to know what’s going on? Does anyone really know what’s going on in the Pontiac?”
