A Blog for STUDENTS OF RURAL and REMOTE MEDICINE in CANADA

Stories and reflections of our journeys on medical electives in rural and remote Canada

The SRPC Student Committee is comprised of medical students from across Canada
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This blog is designed for Canadian medical learners to reflect on their rural and remote experiences, share stories with others, and learn about the ways that the our national network of peers are engaging with rural medical practice and community.

This blog is brought to you by the Society of Rural Physicians of Canada (SRPC) Student Committee, your national voice in rural medicine.

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  • 09-Nov-2022 10:00 AM | Anonymous
    As our 10-passenger plane whirled into the air, its engine spluttered in the winds. I marveled at the tributaries like veins weaving through the lush greenery and watched the homes becoming mere specks. I imagined the wildlife that lived down there, appearing seemingly untouched by man, no semblance of concrete and glass I am so used to. Just soil, water and trees in its natural opulence. We were on our way to Kashechewan.

     

    Keeshechewan, meaning “where the water flows fast” in Cree, is a Cree First Nation community located near James Bay. The community lies in a flood-prone area which becomes swallowed by the Albany River every spring. They are part of Treaty 9, an agreement first signed in 1905-1906 between Anishinaabe and Mushkegowuk Cree communities and the Crown. However, the circumstances around the treaty are still in question, promises left unfilled.

     

    We were met by friendly faces on the tarmac. It was a herculean effort as we climbed on top the back of the pickup trucks, destined for the nearby nursing station. The back littered with empty water bottles, we packed ourselves like sardines. The unpaved roads tumbled our bodies around like ragdolls. The cold, crisp air made my cheeks burn; our hair whipped defeatedly in the wind. We shot each other looks of disbelief and childish amusement, the type of look when you are unsure if you are having fun or on the cusp of danger.

     

    I never would have imagined myself in a small Indigenous community on the James Bay Coast – another unique opportunity that my medical training has afforded me. I was sent as part of a team from Weeneebayko Area Health Authority to provide support in the midst of a serious COVID-19 outbreak. The virus was spreading quickly through the intergenerational homes and patients left vulnerable by chronic disease and effects of colonization. As we tried to find calm in the chaos, I was assigned to see patients that were not query COVID.

     

    C.W. came into the nursing station because his cast was too loose. A relatively benign, low acuity complaint – however, one that excites a medical learner enthusiastic to be hands-on at any given moment. I was eager to help wherever I could. As I awkwardly set up our supplies to recast his arm, he graciously offered me small talk.

     

    He asked what year I am in and what I’m training to be. He says, “you must be really smart”, in a way that felt intimidating to me. I briefly held the weight of his words. Reflexively, I asked him what he does. He told me he is good with his hands, worked in carpentry, but that is how he hurt his arm. He grew up here in Keeshechewan, but went to school in a bigger city, an opportunity he acknowledged that not everyone has access to around here. He also tells me for a while he lost his language, but he was lucky to get it back after he returned to the community.

     

    He spoke excitedly about his youth, his love for hockey and his achievements as a goalie. However, his love also led to a herniated disc that left him in chronic pain. And now with his hand in a cast, he could not do his other love, which was to write. He beamed with pride speaking about his beautiful cursive, the way he could string together letters in a fluid entanglement. He was even paid by friends to help write letters for their families, but he spoke about this in a trembling despair.

     

    He was extremely polite – grateful – for what we did for him. He then tells me he remembers my preceptor, when he had first broken his arm in a work-related accident. He was extremely flustered, his father on the brink of death because of COVID-19 and may have acted inappropriately with the staff in Moose Factory. He told me he was thankful that they crossed paths again, because he sincerely wanted to apologize. I told him that I think she would really appreciate that. His eyes were filled with regret and his voice was soft. And I ponder what it means to hurt and be hurt. What it means to acknowledge our flaws and to right our wrongs. How insightful for him to see the harm he caused in light of his own suffering.

     

    I cleaned up the plaster between his fingers meticulously and was proud of my work.

     

    And then he wished me luck with my studies, and I wished him luck too. My work here was done. My brief interaction with him, also marked my brief time in Keeshechewan. I knew that I likely would not be back to see him again like two lines on diverging paths.

     

    As my day ended, we were sent back on our charter plane to Moosonee. Another bumpy ride in the back of a pick-up truck, it was becoming routine. However, on our car ride back towards the airport I noticed something. The worn-down houses, that resembled portables more than homes, were splattered with signage saying…

     

    “No Visitors.”

     

    As the wind began to catch under the wings of our little plane and the sun fell towards the horizon, I contemplated the weight of those words.

     

     ---------------------------------

    A sincere thanks to all of the patients, preceptors, and locals who welcomed me to their community. Who trusted me with their care. Who shared time with me. Who allowed me to see a world, so different than my own.

     

    And I hope we continue to reflect on our responsibility to Indigenous peoples that have been harmed; what are we but our words and commitment to each other? That we continue to reflect on how we are visitors to this land, and sometimes to our patient’s lives… in cross-section. And that we will never understand the harms and experiences in totality, we nonetheless have a commitment to work together and live in balance and harmony.

     

     

    By Andrew Lee
    Queen’s University – Class of 2022
    alee@qmed.ca

    Word count: 990

    Winner of the SRPC Student Essay contest 2022
  • 14-Jun-2021 12:08 PM | Anonymous

    My first two years of medical school were a whirlwind of new experiences and learning, as I began to envision what my future as a physician could look like. I entered medical school with an interest in family medicine, but with a limited understanding of the breadth of what the specialty really encompasses–especially in a rural setting. It was a weeklong experience at the end of first year that was the spark that lit the match in my decision to pursue a career and life as a rural family doctor. I really believe that every medical student should be exposed to such an enlightening experience in rural medicine early on in their training.

    Community Week is a particularly unique opportunity that Queen’s provides where students are placed in a small community in Ontario to explore rural medicine. I was placed in Barry’s Bay, Ontario, and worked with an incredibly passionate community leader, Dr. Jason Malinowski. I saw and experienced firsthand how diverse and vital the role of community generalists are. Dr. Malinowski practices all types of medicine, is a key community advocate and leader, and most importantly, is committed to and deeply loves his community. The positive experiences I had in Barry’s Bay motivated me to pursue a rural medicine clerkship experience two years later.

    At Queen’s, clerks are offered the opportunity to participate in a longitudinal integrated clerkship experience, where we complete Family Medicine, Pediatrics, and Psychiatry in a rural community over 12 weeks. Because of my experiences in Barry’s Bay, I knew that I wanted the ability to work with preceptors at length, to create space and opportunity to build meaningful professional relationships. I won the clerkship lottery when I was placed in Perth, Ontario, with three phenomenal preceptors: Dr. Anil Kuchinad, Dr. Dan Kruszelnicki and Dr. Bob Van Noppen.

    Each of these physicians wear many different hats in Perth and practice a wide variety of clinical medicine. Over the 12 weeks, I gained exposure to a broad scope of clinical work, including office-based family medicine, inpatient hospitalist, obstetrics, emergency medicine, surgical assist and palliative care. Working in Perth and Barry’s Bay shone a light onto how diverse and rewarding rural family medicine can be, and the flexibility there is in molding your practice to fit your passions and interests. 

    My preceptors invested the time in fostering confidence in my clinical knowledge and skills and encouraged me to take ownership of my patient’s management plans and follow up. One of my favourite parts about being in Perth over those three months, was that I had the ability to follow up on my patients’ admissions or visits to the Emergency Department, allowing for extended continuity of care. Working in a rural setting is unique in that it is not uncommon that you are the person to see the patient in the ED, admit them, round on them, discharge them, and even follow up with them in clinic days later. I learned an incredible amount from my preceptors, but also from patients who I grew to know well because of this continuity.

    In Canada, we are sparsely populated geographically and there are major barriers to healthcare access that exist because of this. It is absolutely vital that undergraduate medical curricula engage their trainees in the importance of serving rural communities as a way to fulsomely serve all Canadian patients, ensuring access and equity. My exposure to rural medicine in Perth and Barry’s Bay was invaluable in demonstrating the reciprocal value in practicing in small underserved communities and was an absolute privilege to be a part of.

    Marika Moskalyk 

    MD Candidate | Class of 2022 

    Queen’s University School of Medicine

     
  • 26-Apr-2021 12:11 PM | Anonymous

    Living the majority of my life in northern small towns with limited access to health services motivated me to attend medical school with the hopes of becoming a family doctor. For my first clerkship elective in February 2021, I had the opportunity to do two weeks of rural family medicine in Fergus and Elora, Ontario. The roles of rural family physicians are diverse, during this elective I experienced a broad scope of family practice by doing inpatient rounding in the hospital every morning followed by clinic in a primary care office. I also worked at the local hospital doing ER shifts, and assisted in the operating room. We delivered virtual and in person care, performed physical exams, investigated symptoms and discussed management plans. My main objectives for this elective were to help patients manage chronic diseases and to develop an approach to common dermatological complaints. These two objectives are important in rural family medicine because specialist services are not readily available. I was able to do skin biopsy, sutures and see various rashes in children and adults. Being a family doctor with the skills to interpret rashes and discern a concerning skin growth from a benign lesion is essential in rural settings. 

    Overall, I had an amazing experience in these charming towns and was impressed by the broad scope of medicine practiced by my excellent preceptors. In May, I will be doing a second rural family medicine elective in Grand Erie Six Nations region. The work of rural family physicians is both rewarding and inspiring, there is a familiarity between patients and their physicians unique to rural settings. This allows physicians to support patients on an individual level while also helping to improve community health as a whole. 

    Elisabeth Fortier, Class of 2022, McMaster MD program

  • 13-Apr-2021 1:33 PM | Anonymous

    I completed an 8-week rural family core clerkship rotation in Labrador as a third-year medical student. This was my first time visiting “The Big Land” and I was immediately drawn in by the breathtaking landscape. Early into day one, I joined a friend for a 12km trail snowshoe with the local Birch Brook ski club – getting a chance to meet new people, experience the tail end of the Labrador winter, and take in the beauty of the Mealy Mountains. I immediately felt at peace, knowing I had begun an experience I would never forget. 

    The schedule for my first four weeks was filled with outpatient clinics, emergency room shifts, a week of inpatient care and a few OR assist shifts. My second month included a coastal visit to Hopedale and another to Rigolet – two excursions I was very much looking forward to. I was eager to meet the staff, the residents, the patients, and community members I had heard such good things about from learners before me. 

    During a day in outpatient clinic, I saw an elderly man who had come for a checkup, accompanied by his wife. At the end of the visit, she explained how anxious her husband was about coming to the hospital and thanked me for making it such a comfortable and pleasant experience. This is just one of the many experiences that touched my heart and made me feel so welcomed and appreciated in Labrador. 

    While my rotation was filled with inspiring and positive experiences, I was surprised by the continued lack of access and its association with communication or health literacy barriers. In particular, I recall one patient who had travelled from the coast to be seen in the ER for an infection, which may have been avoided or mitigated if not for the systemic limitations. The patient spoke little English yet nodded in agreement throughout our conversation. It was apparent that she was not entirely understanding of the minor procedure she had undergone just a few months prior and the follow-up care that was required as a result. Despite the communication, geographical, and cultural, and financial barriers faced, she remained polite and appreciative throughout the assessment. 

    With each day, I was inspired by the gratuitous patients, welcoming healthcare team, encouraging mentors and incredible scenery. The connections that exist between staff and their associated coastal communities were like no other. My experience in Labrador showed me the value of emotional connections, the impact they have on people and places and, the reciprocal fulfilment they can provide. It reaffirmed my aptness for rural medicine and gave me a desire to return.

    During my fourth, and final, year of medical school, I had the opportunity to return to Labrador for Memorial Universities Progression to Postgraduate (P2P) program – accounting for twelve weeks of selective clinical placements in a variety of fields, including hospitalist medicine, emergency medicine, general surgery, obstetrics, outpatient clinics, and indigenous health. After having spent a total in 5 months in Labrador, a vast part of my home province that I had previously never seen, I reflected on my unique experience.

    With my phone to the window, I’m attempting to capture the beauty the is The Big Land. It was my first month in Labrador and I had the privilege of tagging along on a MedEvac to Hopedale to retrieve a child with suspected impetigo. We left the airstrip in Goose Bay just before sundown to incredible views of the Mealy Mountains. During my second trip to Labrador, I was fortunate enough to spend a week in Nain, the northernmost settlement in Labrador. Nain is serviced by a small runway which lacks lighting, thereby limiting the window through which planes can land – in addition to the occasional low ceilings and obscured visibility. Luckily, for my flight from Goose Bay to Nain the skies were clear, showcasing the spectacular land, so vast and untouched. At that point, I realized no picture could ever really capture the beauty of this land.

    While in Nain a terminally ill patient presented to the clinic with a new GI bleed. The staff did an incredible job of managing him for several days while the weather was down – despite the clinic not being equipped for inpatients. Family and community members took turns visiting at all hours and even brought hot stew for the staff. This was truly an example of a community coming together, demonstrating how isolated and resource-limited settlements continue to thrive.  

    On my last day in Labrador I shed tears knowing what I was leaving behind: an amazing three months of medical, cultural, and personal experience; incredible friendships; amazing mentors; and, so much more. As I drove away from town into what are arguably the most beautiful sunsets, upon a backdrop of the Mealy Mountains, I knew that this would not be my last visit to The Big Land.

    Patricia Howse, M.D.

    PGY1 Family Medicine

    Queens University, Belleville, ON

    For information on how you can experience Labrador during electives – check our MUN Family Medicine on the AFPC Portal or email ugme.electives@med.mun.ca for additional information.

  • 13-Apr-2021 1:33 PM | Anonymous

    We walk into the hospice. My Family Medicine preceptor invites me to meet a patient with a soft voice and lovely eyes. I can feel the bones in her hands when she reaches out to greet me. With her daughter beside her, she timidly voices her fears about dying: what she might miss, that she will be forgotten, and the pain she will leave behind with the people she loves. I marvel as my preceptor conjures words of kindness and listens patiently to her story, which at this moment I imagine offer equal comfort to the medical measures we are providing. One year later, I walk into the same rural hospice. This time, a familiar face occupies the space in that bed. The lady with the soft voice has gone, replaced with the lady who shaped my partner’s childhood; his grandmother. A different physician who joined her care in the hospital guides the family through a similar process of loss, but my role has shifted now. I not only hear the words that the physician says, but I feel their impact this time. When abstract experiences become firsthand immersions, and when emotion is added to education, that is when learning becomes understanding. This juxtaposition of patient illness experiences opened a window of insight for me, and influenced me to realize how physicians’ words and actions can impact patient and family care. I want to be a part of this frontline care, working across settings in the realm of stories, relationships, and community. I want to be a rural family doctor. 

    Jodie Hooker

    PGY-1, Rural Family Medicine

    Collingwood Site, McMaster University

    Collingwood, Ontario
  • 13-Apr-2021 1:32 PM | Anonymous

    The gifts of learning in a rural medicine setting are plentiful and rewarding. As a pre-clerkship one-month placement facilitated through ROMP as a NOSM learner in Owen Sound, I had my hands busy, mind full, and heart proud. I was granted opportunities to learn in various settings including family medicine, obstetrics, emergency medicine, and palliative care. I was typically the only learner alongside the preceptor – no long chain of command or “fighting” to perform a procedure (such as stitches, for example). As the primary learner in most settings, I feel like I was fully immersed in a learning environment and confident in my advancement in my medical training, which most of you know is often challenging and overwhelming. Outside of academia, this rural are offered many opportunities for community involvement and events such as farmer’s markets, local fundraisers, and a Saturday morning run club. Notably, it is important for me to have access to running and hiking trails, a view of the water (fortunately here it is the beautiful Georgian Bay!), and parks to wander with friends. It was easy to balance medical training and my personal life during my placement here because of the sense of community that is bonded together through the love of water, outdoors, and community engagement.

    Anonymous

    NOSM Learner

  • 22-Mar-2019 1:36 PM | Anonymous

    Hi my name is Caitlyn, a third year medical student from the University of Saskatchewan! I was fortunate enough to spend my 4-week rural family medicine rotation in La Ronge, SK

    During this rotation I spent some…

    • mornings rounding on inpatients
    • afternoons in the clinic
    • days flying to remote communities
    • nights in the emergency room

    Northern Saskatchewan really has it all! It is an experience you will not find just anywhere. I can honestly say, there is no neater way to go to work than in a helicopter!

    La Ronge 5

    Traveling from La Ronge to Stanley Mission, SK

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