Senior health executives of my vintage would tell you “this is not my first rodeo”! We have seen major outbreaks of highly infectious diseases for as long as I have been alive which is 75 years! Polio was alive and not well when I was a kid with iron lungs as the way to save lives of thousands of people. Then Jonas Salk invented a vaccine which we, as school kids, took without any choice. Our family knew only one thing: with the vaccine the likelihood of tragic illness was all but eliminated; avoiding it left us with a great chance of getting a dreaded disease. So Rotary Club and Bill Gates Foundation have now made strides in the near elimination of polio worldwide.
Then measles, chicken pox, and influenza. Now, at our age and for good reason, we are doing the Shingles Vaccine because it is such an awful disease; vaccine is not a guarantee but lowers the risk enough to make it worth the $400 we pay!
SARS was the big one of this century taking the world by storm in 2004. In Canada it started innocently enough but spread in the population centres very rapidly and was, again, lethal with the frail elderly population. The health system was ill-prepared for it so there was much scrambling for gowns, masks, gloves, and sanitizer. After about 6 months the country was back to its old ways and some provinces used the experiences to chart some different courses in health care.
In New Brunswick, with the calm leadership of the Pandemic team, we are seeing things happen that had been debated for decades. Suddenly it was possible to get the Alternate Level of Care patients, all frail seniors, out of expensive hospital beds and into long term care. How did that happen so quickly especially since it had been debated for decades?
Suddenly virtual medical consultations have become acceptable with patients receiving the counsel they need either via Skype or on the phone. And suddenly the Departments of Health and Social Development are working feverishly together to provide support to distressed health service providers, conversations that have not apparently taken place for years.
And suddenly the system is recognizing that long term care is more than nursing homes but involves vibrant home care and special care or Adult Residential Facilities. That is a level of new understanding missing for a long time.
Suddenly a serious focus has been placed on basic hygiene; not only health care workers but the public is washing hands like never before. These basic personal hygiene practices, if the truth were known, are central to the annual spread of influenza, colds, and other infectious diseases that jam up Emergency Departments and After Hours Clinics. Yet the general public and many centres of business, prior to Covid-19, seemed blissfully unaware.
For well over a decade, informed and caring people have been champions of reform of our health care systems in New Brunswick. Yet essential reforms, things that would have made huge improvements in public service, have not been made and it is essential that we answer this one central question: if we can achieve incredible change in the system in a couple of weeks during a pandemic, why can we not get all the other things that are real issues in our health system dealt within a reasonable time?
Consider, for instance, the Dementia Strategy that has been discussed for a decade and, indeed, introduced in other provinces. Dementia is a collection of diseases of the brain that cause enormous upset to families, marriages, financial well being, and death. The numbers of persons afflicted, thus affecting many more families, is growing exponentially yet it is managed sometimes very well, often times very poorly. And who suffers? Patients and the entire family unit! If the will to change were present, the province could have a superb strategy in a month not a decade!
There will, in fact, be way more deaths this year in New Brunswick from Dementia-related diseases than Covid-19! Let that register. While it is not contagious, it is no respecter of persons whether economic well being, social status, good looks or more!
Primary Care is another, the inefficiency of which has been well documented and tragic stories of lack of access abounding for well over a decade. Indeed, for almost two decades the province has invested hundreds of thousands of dollars each year in staff costs associated with Primary Care Reform. The problem: where is the reform? It is 2020!
Access to specialty care is yet another major issue. The good news is that New Brunswick has some incredible medical specialists and they perform miracles every day on behalf of people. So if you have a bad hip, bad heart, cancer, diabetes, kidney failure, diseases of the eyes and others you are going to get wonderful clinical care…..when you can get to the specialist and when the specialist can get Operating Room time.
So getting to the specialist, that is, working through the maze of primary care, wait time to get an appointment is often not easy. Then when diagnostic work has been done and a definitive diagnosis and treatment plan is concluded, the surgeon tackles the problem of OR time. And heaven help you if it is summer or Christmas or other preferred times of the year.
Perhaps your symptoms are a bit obscure and do not lend themselves to the typical diagnostic process. Suppose yours is such that you really need to get to a sub-specialist such as the provincial expert in Crohns or Inflammatory bowel disease. How do you manage through the maze to get to person with superior training and expertise? The answer is you don’t and an increasing number of anecdotes can be heard of people who have taken it upon themselves to self-refer to centres outside the province.
Horizon Health Network had a proposal several years ago that would lead to a re-structuring of specialty services on a provincial basis much as has already been done with the Cardiac sub-specialties. Where is that plan and why has it not been acted upon?
People act based on several motivators. The first obvious motivator is money; health professionals have to earn a living like all of us and if the fee schedule dictates a certain mode of practice, that is what you get. The second major motivator is professional pride which is where the call for a vision of Excellence comes into play. The third motivator, as we have seen with the pandemic, is fear; if I do not do thus and so, lives in my family or community may be at risk.
And so when government and its agents issue directives when the public is locked down in fear, they can get the public and professional staff to do mostly anything, even those things that may have been sources of objection previously. If the threat is significant, as it has been, we become like sheep and fall into line.
So the question after the pandemic must be: how do we get these same people and organizations to understand that the well being of the public is threatened by the absence of a Dementia Strategy, a totally integrated Primary Care System, a serious provincial organization of clinical specialty services, and more. To me the threat to the public of not having those things fixed is every bit as high as the threat of major infectious disease. Don Cherry would say: “just shoot the puck!”
Ken McGeorge is a retired CEO in major teaching hospitals and long-term-care facilities. He was co-chair of the New Brunswick Council on Aging and is a columnist with Brunswick News. His email address is firstname.lastname@example.org.
Ken McGeorge, BS,DHA,CHE is a career health care executive based in Fredericton, NB, Canada.