Rural Round-up: little story of something that inspires me
This month's Rural Round-up is written by Declan Fox of Prince Edward Island, Canada.
You don’t have to be inspired to work here…..but it helps!
So here I am at age 60, resurrecting an old rural practice in the northern-most community in Prince Edward Island, Canada. When I left my old practice back home in Northern Ireland, in 1998, after getting burned out and depressed, I figured I would never work full-time again. Nor would I take any risks with my work. Nor would I try to run a practice. And never, ever again, would I stay anywhere long enough to attract a lot of patients who needed me. As Dylan maybe said - am I right, John Wynn-Jones? - “Don’t look back. Something might be gaining on you
I had 13 happy years of locums in Prince Edward Island (PEI) before I took the step which led to, among many other things, me writing this piece. From 2011 to 2013, I did locums in O’Leary, PEI, in a modern purpose-built health centre. O’Leary has a population of under 1000 in north-western PEI.
It was an exciting time of changes, with primary care being taken seriously by the powers that be, nurse practitioners coming in, registered nurses (RNs) taking on chronic disease management and licensed practical nurses (two year diploma-level course) taking on the chaos of an incredibly busy walk-in clinic which turned away no-one, regardless of how sick they seemed.
And then I started to see ways we could run things better. Taking nurse assessments more seriously. Getting secretaries more involved on the clinical side, directing patients to the most appropriate service or professional. And I found several nurses who were having similar thoughts. We met, we talked, we bitched to each other, we decided to light one candle. We got permission - cue your favourite quote from management books here! - to have a day trying out some of our ideas. Skunk works was what it felt like, trying to hide it from the manager and one of the senior doctors.
We saw, that day, how we could provide high quality care to 50% more patients in a timely manner. We felt the thrill of working with like-minded people in a very efficient way. We knew then that nothing would ever be the same again. When you’ve been to Paris, you can’t go back to the farm.
We floated our ideas for change in O’Leary Health Centre but it didn't work out. With a bit of encouragement from the medical director, we moved to an old health centre run by a community co-operative, Tignish Health Centre. There had been a very busy practice there until 2012, when the incumbent retired and they welcomed us with open arms.
I could not have done it without my two nurse colleagues, Abby and Tanya. I left an easier and better-paid job and they gave up their permanent pensionable jobs-with-benefits-and-security to take a chance on me and Tignish. We inspire each other with our attitude to patients and to getting the job done. We inspire each other to try things out and change them if they’re not working. We trust each other and learn from each other. We help each other to step back from the day to day hustle and really look at what we are doing and how we are doing it. We support each other when we have problems.
Best of all, we are seeing others starting to work the same way. Other health care professionals come along and volunteer to help us out, unpaid. We are learning that there are lots of good people out here in rural health care, people with ideas, just waiting for a few mavericks like us to come along and show it’s ok to be a bit crazy if it helps get the job done.
Howling at the moon in rural Prince Edward Island, this is Declan Fox signing off.