By Rebecca Connop Price

With fewer than 500 residents and sitting on a 137-kilometer-long lake surrounded by mountains in the far northwestern reaches of British Columbia (BC), Atlin is one of Canada’s most scenic small communities.

However, getting to and from the community can be a challenge.

“The nearest big centre is Whitehorse, Yukon, and that is two hours’ drive away, on a good day,” says Jen Stronge, one of only two nurses who work at Atlin’s Primary Care Centre.

There are no physicians in the community, so when there is an urgent or critical case, it’s down to the nurse on call to figure out what to do next, even if it’s to navigate a way to transfer the patient to a larger centre.

But in December of 2020, the nurses got a phone call that would change their lives.

It was Dr. John Pawlovich, the virtual health lead at the Rural Coordination Centre of BC (RCCbc). He wondered if they’d heard of Real-Time Virtual Support (RTVS), a province-wide program, launched in April 2020, to support healthcare providers in rural, remote, and Indigenous communities in BC.

The service, which operates 24/7, would give Stronge and her nursing colleague, Rosie O’Reilly, immediate help with any cases that walked through their door.

“At first we were kind of skeptical… we were like, ‘What’s the catch?’ But there hasn’t been a catch.

“Instead, it’s just been a huge game-changer … enhancing our practice and enhancing the lives of our community just on a daily basis, pretty much,” says Stronge.

There are four 24/7 RTVS pathways and they cover a variety of situations, including Emergency (RUDi), Critical Care (ROSe), Pediatrics (CHARLiE), and Maternity and Newborn (MaBAL)—all designed to enhance health equity in rural, remote, and Indigenous communities across BC. They do this by connecting rural healthcare providers and patients to RTVS virtual physicians via Zoom or telephone.

The pathways provide free, friendly, and culturally safe support for case consultations, second opinions, ongoing patient support, patient transport coordination, point-of-care ultrasound, and simulations.

In addition, several Quick Reply pathways—Dermatology, Hematology, Myofascial Pain, Post-COVID-19 Recovery Clinic Referral, Rheumatology, Thrombosis—are also available weekdays during regular business hours.

Dr. Pawlovich, who, in addition to his role with RCCbc, is the UBC Rural Doctors’ Chair, says he was pleased to see the impact RTVS was having, especially in the most vulnerable communities, including Atlin.

“What we are seeing is technology is allowing us to reach rural, remote, and Indigenous communities and provide tangible support to the healthcare providers and their patients in these settings.

“With RTVS, providers feel like they have someone who will help, who will understand their challenges, and who will not try to pass them on to someone else. It is a huge step and it has been welcomed with open arms.”

Stronge agrees. She says the service had changed the way they handle emergencies and provided much-needed peace of mind.

“It makes our jobs easier. I mean it’s still not easy… it’s always a challenge, but it just helps relieve some of that burden of everything, every decision, being on one person,” she says.

Before RTVS, Stronge would have called into the Emergency Room in Whitehorse for help. “It’s cumbersome, to say the least. The doctors there are wonderful and the staff there are wonderful, but they’re very, very busy, so we would get put into their triage queue and we could wait. A normal wait would be two hours before a doctor could get back to us, sometimes longer.”

With RTVS it’s instant. “We get somebody right away, and they have the time just for us in our situation and can talk things through. They’ve always been so wonderful about answering questions and helping us work through problems. It’s just a game-changer. Makes my job so much easier, I feel safer, I feel supported.”

Dr. Matt Petrie, who is one of the doctors in the RUDi Emergency pathway, says all the RTVS virtual physicians have experience with, or understand, the rural context.

“The geography and topography of BC is incredibly complex from a patient transport standpoint. So there’s a whole knowledge-base and understanding that we all have that goes into these services to really help coordinate care for people so that we can be supportive of on-the-ground practitioners. It’s hard to wrap your head around that if you’re used to working in downtown Vancouver.”

The RTVS program is still only 16 months old, but it’s hoped that it will have an impact on the recruitment and retention of rural providers in BC.

Petrie added: “It’s tough to recruit and retain nurses and physicians in rural places. Healthcare in rural communities, it’s tough work; medically, socially, and psychologically, in a place where you may be the sole provider. So whether it’s a new grad that we can help support through uncertain times or a particularly difficult case – it’s going to really help prevent burnout and increase retention.”

Stronge says there was one other spin-off benefit of the program. “We are also finding that the education side is really useful. The information that we take away from every phone call or Zoom call we share that with the other nurses and that makes us all better, it makes us all able to provide better care to our community, and I think that’s really what we’re all striving for.”

Rebecca Connop Price is a Communications Officer, Real-Time Virtual Support (RTVS), Rural Coordination Centre of BC (RCCbc).