Remote reserves can't keep physicians

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A report in a medical journal reveals that there is a high turn-over rate among doctors who practice in remote communities in British Columbia.

Carole Dawson, family, children and health director for the Union of British Columbia Indian Chiefs, told Raven's Eye that her first-hand experience in such communities convinces her that the study is right on the money, but she said it doesn't tell the whole story.

The availability of good ski hills and other big city amenities is cited as a contributing factor to the troubling trend that is seeing First Nations struggle to attract and keep physicians. Other less palatable reasons why doctors don't stay on First Nations were hinted at in the report, authored by to two British Columbia medical researchers, that was released in late November.

The report appeared in the November edition of B.C. Medical Journal. Dr. Stefan Grzybowski, a researcher at the University of British Columbia medical school's family practice department, and Dr. Harvey Thommasen, a professor of community health at the University of Northern British Columbia, co-authored the report.

After studying data compiled in 78 British Columbia communities with populations of 30,000 or under over a 10 year period ending in 1999, they found that the size of the Aboriginal community was linked to the length of stay of physicians - the larger the Aboriginal population, the better the chance doctors would not stay on for a prolonged period of time.

In the article, the researchers were very careful not to invoke racism as a contributing factor to this situation. Dawson said that her experiences tell her that racial intolerance is a factor but not the main factor.

"Yes, there is an element of racism there. But I, myself, have lived in small communities. I know there have been some really good, dedicated doctors there. They are over-run particularly in communities where there's a high Aboriginal population. Our health indicators are poorer. Our morbidity rates are higher; our mortality rates are higher. But to say that's the reason they're leaving is not the entire thing," she said.

Physicians bring their spouses and children with them to remote communities. Pressure from family members who probably are not accustomed to small town or reserve life is another part of the story, Dawson said.

The way the federal government conducts business in reserve communities is another contributing factor, she added.

"There's doctors who do their empire building in these areas where there's a high Aboriginal population. And some of them are dedicated but, for some of them, the Aboriginal community and its high morbidity and mortality rates become a meal ticket for these doctors who make lots of money off contracts with Health Canada," she said.

She said some physicians own clinics, buying into airlines that provide medical transportation and generally have a vested interest in discouraging competition.

"The other side of the problem is the greed of some individual doctors who do not allow any new blood to come in. So new doctors who try to come in, who are dedicated, who are committed people who are really interested in working in the Aboriginal community are prevented from doing that," she said.

The damage done by the colonial process accounts for part of the challenge faced by doctors in areas of high Aboriginal population. It's not something the government has acknowledged for political reasons, Dawson said, and that leaves the doctors and their patients caught in the middle of a difficult situation that increases the frustration level.

"We know money isn't everything, even though poverty is attached to poor health. I think the other factor is the loss of our traditional diets. This is another nightmare that government doesn't seem to get and health care officials are starting to understand now," she said.

The federal government has an uneasy relationship with First Nations when it comes to health e.

First Nations claim a treaty right to free health care. Government resists that claim and tries to cap its expenditures on Native health care. The result has been significant and on-going cuts to non-insured health benefits that, Dawson said, create under-funded health care systems that frustrate and discourage doctors. She blames that, in part, on First Nation leaders.

"It's [an issue] I have been raising since 1996 and no one seems to hear me," she said. "The Assembly of First Nations has been co-opted by the feds because, as you know, they have many joint committees with government officials and they have counterparts from the vice-chiefs offices across the country. There was one specifically for non-insured health benefits. These erosions continue and I think they're a real detriment to our health."

And while provincial governments have been successful in lobbying Ottawa for restoration of health funding that was cut during the deficit cutting era of the mid-1990s, Dawson said First Nation leaders have not done their job in that area.

"Our leadership is not bringing pressure to bear on them about the losses, which are major losses. We know Health Canada keeps saying they're going to be getting out of the business. It's a dump and run. DIAND, Health Canada, I guess the whole Cabinet are looking at a dump and run approach," she said. "You've got a patchwork quilt of abuse and neglect across the country."

Dawson also criticized the provincial government, saying it has not done much to support or retain doctors who set up practice in remote areas. That's a problem she sees affecting all people in remote regions, not just Native people.

"Any communities where there's a high Aboriginal population, there's usually a small town near them. So, of course the non-Aboriginal communities suffer equally. The high turn-over rates of physicians becomes a problem for them, too," she said. "At one time, the Aboriginal community was the only target for poo n shoddy treatment. It's not the case anymore. Is it because doctors are over-worked, is it because they're less caring, is it because government isn't doing their share, is it because the federals have cut down on the health transfer payments? I think it's a combination of many factors."