When is a Crisis Really a Crisis?

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The crow wished everything was black,
The owl that everything was white.
William Blake

Canada is consistently rated the best country in the world in which to live, but a close look at the tension and acrimony in the health-care system here would lead one to believe that the wheels are about to fall off the chariot of health care provision.

Have we reached a historical crossroads at which point we need to evaluate how health care is provided and prioritized, and does the focus need to shift the way we think about health care, or will we line up with the doom and gloom naysayers and allow our system to end up on the scrap heap?

We have placed disproportionate emphasis on a Curative Model that is further gelled into the psyche of the television-viewing public by dramatic high tech procedures and technology that certainly dazzle, but are they really all necessary? Why does prevention consistently lag behind cure – why do we rush around in high adrenaline mode for the “sudden” heart attack, and yet ignore obesity, social ills, poverty and childhood neglect, all of which are critical factors that eventually cost the curative system billions of dollars?

Do we have the courage to take a serious look at these issues without the all-too-powerful lobby groups and the all-too-fickle politicians continuing to call the shots?

The new millennium is indeed a time that is ripe for the population of our geographically diverse and culturally rich province to ask penetrating questions about our Health Care.

Statistics clearly show a rise in cardiovascular disease, chronic obstructive lung disease and malignancies – an informed public with ready access to educational and preventive programs should allow us some latitude to devise a plan that emphasizes prevention and embraces beneficial emerging technologies, such as genetic research.

An aging population with the attendant health burden should force us into thinking about dementia, home supports, creative means of supportive community living, and caregiver stress issues, but the ever present “crises” continue to demand the lion’s share of resources as we chase waiting lists for cardiac bypass procedures.

Can we take the giant leap forward and allow some debate on how the system should and could be sustained, if only the emphasis on our true needs as health care consumers is to be met? The path of least resistance would appear to be yet another Royal Commission that will fill more space in our National Archives gathering mold and dust!

An idea can only become a reality if the population of our democratic nation is willing to become informed about alternative ways of delivering health care. This population must be given an opportunity to visualize a realistic and attainable goal. The ever-present negativity which currently consumes health-care provision is an infectious modality that ultimately will become a self-fulfilling prophecy – the system will “collapse”.

We are constantly bombarded by large numbers of studies, papers, analysis and discussion groups that focus on measure of health care and outcomes based on arbitrary factors, such as percentage of GDP spent on health, numbers of MRIs per one thousand of the population, or access to tertiary care.

In focusing on cure, we repeatedly are blinded to the reality that prevention and promotion of wellness could make on our global health status.

The overwhelming acuity of our health pressures is borne out of disease processes that can be directly attributable to smoking, obesity, sedentary lifestyle, childhood poverty and neglect, and accidents. Burgeoning costs have finally forced bureaucrats and politicians to begin to fund programs that look at alternative methods of delivering health care. One such program is the Primary Health Care Project that has established itself in this province at three Pilot Project Sites (Goose Bay, Port aux Basques, and Twillingate).

Not another pilot project, they say; we have had enough of these projects. Maintain the status quo – money, more money, lots more money is what will get this rusty old Cadillac back on the road…

Is that familiar gut-wrenching aura of doom and gloom consuming your consciousness? There is hope – come and visit historic and beautiful Twillingate where a new model and partnership in Health Care Provision is perhaps but one way in which we look at the future.

Twillingate is an island community that juts out into the fierce North Atlantic, and over the years its people have attained a culture of pride and independence: an island people with compassion, caring and altruism. These same people have seen and faced adversity and tragedy as their livelihood has centered on the abundance of the ocean.

A key cultural component of this island psyche has been the health care of its inhabitants. From the early pioneering and inspirational foresight of visionaries such as Olds, Parsons, Woods, and, more recently, Dennison, Woodruff, Sheldon, and the like, the social focus and endearing psychological cushion in the minds of most citizens comes from the pride of the island – a Memorial Hospital. Originally built in memory of the huge emotional and personal losses of the Great War, this institution, in its more modern guise, reigns supreme over the community – a Goliath of modern architecture that commands an almost mystical presence above a rich mosaic of pristine homes and rugged rocks that pose a fairytale vision to the virgin eye.

This is a community ravaged by mismanagement in the Fishery, out-migration of almost an entire generation, and loss of surgical services in an institution which once stood as the capital of the North. Those in need (with suitcases packed) arrived from all parts of Newfoundland and Labrador where the work of the pioneering physicians saved so many lives – their stature grew as they became legends in their own time.

The hated concept of regionalization took surgery away from this institution in the mid-90’s, and with its loss the citizenry felt a profound loss – “there’s nothing left up there”, they cried, and an almost hopeless sense of grief descended upon these people – a people not unfamiliar with adversity, but with a sense of helplessness as the inevitable “path to progress” meant yet another nail in the rich and historic tradition of the heart and soul of this proud community.

A diagonal shift in the thinking of federal bureaucrats has now created a window of opportunity, which, if grasped, could re-establish this proud community as a leading light in the provision of health care.

Primary health care (perhaps a buzzword to some) is visualized as a model of partnership between community and health-care providers to focus on community wellness. A cornerstone of this program (funded and supported by Federal financial incentives) is for a community in concert with its health care professionals to foster a relationship which identifies the medial needs of a community and allows a blended partnership of multiple disciplines where teams of individuals focus on these needs and act in a concrete long term plan to improve wellness.

The community today sits on a threshold of rich possibilities – an integrated health-care model which grows with its community as a partner. Critical needs can all be addressed by a team of individuals where hierarchical boundaries have broken down, and where prevention, research, teaching, and empathy become the platforms from which ideas germinate and grow.

The cynics look at this model and apathetically brush it off as yet another illegitimate child of a crazy Ottawa plan hatched by pencil pushers. Those who see the potential, however, encourage the community and its partners to look at the model, and come together to foster and nurture its possibilities.

What are the alternatives? Can any nation continue to forever support the burgeoning cost of a health care monster that is out of control?

“An idea can become an ideal
A light transforms to a rich beacon.”

Grasp this little seed of prevention, partnership and possibility. Nurture it and watch it blossom – the results may surprise us all.