Weather disasters prevent rural health workers from providing care. Here’s how they adapt

Our planet is changing. It’s our journalism too. This story is part of a CBC News initiative titled Our changing planet to show and explain the effects of climate change and what is being done about them.

Dr. Stefan Patrascu was the only doctor working at Fraser Canyon Hospital in Hope, BC, nearly three weeks ago, when floods and mudslides swept through the region, leading to a Code Orange.

The code – called when there is an external event, such as a mass accident or environmental disaster – came when society was also hit by a power outage.

Patrascu expected that an influx of people injured by the mudslides would arrive at the small, rural hospital at some point, while he hoped colleagues would be able to come in to help.

He called it the most stressful shift of his career.

“I managed to get a 90-minute nap in the middle of the night, but it was a long 26-hour stretch,” he said.

All the roads into Hope were cut off by the mudslides when Patrascu found out that helicopters would not be able to land in the community due to strong winds.

“I relied on that opportunity – not only to transfer patients out, but also, you know, to bring in some relief; not only in terms of doctors, but also in terms of my nursing colleagues,” he said. White coat, black art host Dr. Brian Goldman.

In mid-November, a mudslide closed Highway 1 between Popkum and Hope, BC, east of Chilliwack. (BC Ministry of Transport and Security)

As climate change increases the likelihood and frequency of severe weather events, doctors in rural hospitals are likely to face growing challenges in the provision of care and may need to plan to lose resources such as electricity and roads.

Building resilience into health care systems to deal with climate change is a multifaceted problem, according to Linda Varangu, a senior climate adviser to the Canadian Coalition for Green Health Care.

“It’s not just infrastructure, [it] include leadership and human resources and early warning systems and make sure your supply chain is uninterrupted, “she said.

“This means that the hospital… has identified what climate changes or extreme weather events may occur in their area [and] have prepared for it so that when these events occur, they can continue to function. “

At the recent COP26 conference in Glasgow, Canada formally committed itself to developing climate-resistant, low-carbon, sustainable health systems along with dozens of other countries.

But one of the first – and most difficult – challenges to overcome is changing the mindset of hospital leaders, Varangu said.

Doctors who helped with mudslides and floods are shown outside Fraser Canyon Hospital in Hope, BC From left to right: Dr. Rebecca Adams, Dr. Ben Love, Dr. Stefan Patrascu, Dr. Aseem Grover, Dr. Josh Greggain, Dr. Danica Whalley and Dr. Jeff Schulz. (Mike Bradley)

“Health care is basically crisis management, and something always pops up that … gets your attention faster. Resiliency planning is long-term planning,” she said. “It’s like preventative health care … We know the right things to do, but we actually do not eat right, we do not often do the right exercises. It just requires constant vigilance to do this.”

Making health systems more sustainable also comes with an economic benefit, Varangu said, pointing out how some hospitals have relied on recyclable personal protective equipment during the COVID-19 pandemic.

“It actually saves you money and it ensures you have that product when the supply chain is disconnected,” she said.

‘Resourceful, adaptable, fast’

In the midst of his unfolding challenge in Hope, Patrascu was particularly concerned about a 14-year-old who had suffered a serious head injury when his family’s minivan was hit by a mudslide that rolled twice as it slid downhill.

Patrascus Hospital did not have a CT scanner and the teenager eventually had to be moved to a facility with an intensive care unit (ICU).

Eventually, about 24 hours into Patrascus’ shift, a doctor from Squamish, BC, who happened to be stranded in Hope, came to the hospital. But because Dr. Jeanette Evans was from another health authority, it took several hours to get emergency permission to give her hospital privileges to work in Hope.

Eventually, a team of doctors from Surrey, BC, were also able to make it through with a train carriage, and later the 14-year-old boy aired to BC Children’s Hospital in Vancouver, thanks to a break in the air. He is expected to recover completely.

Patrascu credits his own resilience in this matter to the support of his colleagues, his education, and his work as an emergency physician.

“We are used to being resourceful, adaptable, quick to respond to emergencies and … I believe perhaps more in a rural hospital, to being creative with our solutions,” he said. “We do not always have, you know, access to CT scanners or, you know, neurosurgeons or cardiologists on site. But we certainly do.”

An emergency team of health workers was flown to Hope from Chilliwack, BC because the roads were closed. From left: Christine Tucciarone, ward assistant at a long-term care facility; Sandra Smith, a health assistant at a long-term care facility; Nurse Alana Eberts and Dr. Jeff Schulz, Head of Family Practice at Fraser Canyon Hospital. . (Christine Tucciarone)

Despite the teenager’s airlift and the relief that eventually came, the hospital’s struggles were not quite over, as Hope was essentially cut off from the rest of the province for about four days.

“We have disaster planning in place; it’s just really hard to plan for details and for this degree of isolation,” Patrascu said

During the following days, air transport was the only way to get staff, medicine and laboratory samples and results to and from the facility, said Dr. Josh Greggain, the former medical director of Fraser Canyon Hospital, who is now president of doctors. of BC.

On an average day, the facility transfers between three to five patients to major hospitals in Abbotsford and Chilliwack, Greggain said. They were initially unable to transfer any patients after the closures, and then only had to rely on helicopter air transport in the days that followed.

“Rural areas and rural providers – and specifically rural doctors – continue to be innovative. They solve problems they did not know they wanted, like how to get a helicopter up to the Boston Bar in a storm?” said Greggain, referring to a small community located about 60 miles north of Hope.

Recent events also marked the fourth Code Orange that the hospital has been dealing with for the past 10 years, noted Greggain, who remembered something a colleague once told him.

“When you look at how hardy and resilient people are in rural areas, you do not quite understand how much that is true until you remove their power, their medicine, their roads.”

Supplies, including drugs, laboratory samples and COVID-19 vaccines, are loaded onto helicopters at Chilliwack Airport. (Aseem Grover)

The main road is cut off in Cape Breton

It’s a feeling that agrees with Ken Murray.

The family doctor in Neils Harbor, NS, says he was on half board, but he has recently increased his workload to fill medical gaps in his community in northern Cape Breton.

Early last week, a storm brought heavy rain and strong winds to the area, with some parts seeing more than 260 millimeters of rain, leaching roads and bridges.

Dr. Ken Murray is a family physician in Neils Harbor, NS, in northern Cape Breton. (Posted by Ken Murray)

A major weather event in the fall or winter is not unusual, Murray said, but “we have never had one that caused so much road damage and disruption to normal transportation.”

Part of the Cabot Trail, which leads to Neils Harbor from Ingonish, NS, was cut off, stranding some hospital staff. The alternative route – going west on the bumpy, 285-kilometer-long highway loop – would add significant travel time, so many health professionals chose to board with members of the community instead, Murray said.

“In some cases, they just slept in the hospital, even slept in empty patient rooms.”

SE | Drone footage shows damage to Cabot Trail:

Drone footage of the Cabot Trail shows the extent of storm damage

A tour of Nova Scotia’s Cabot Trail, north of Ingonish, shows the extent of damage from a punishing rainstorm. (Steve Lawrence / CBC) 0:48

The road closure also affected food and medicine supplies to the region, as trucks and ambulances also had to travel the long way around. So a local pharmacist got creative and turned to boats to deliver medicine.

“There’s no ordinary boat to do this, so our local fishing cooperative has actually gone up … And there’s a fisherman who runs twice a day when the weather allows it,” Murray said.

But the experience of that storm ultimately raised some “big questions” about what society will have to plan for in the future, Murray said.

In the long run, he believes it will be important to protect and preserve infrastructure, such as roads, bridges and highways, to ensure residents are not isolated.

In the short term, though, it means being creative.

“I think there is a lot of improvisation going on, both at [the] emergency level and in the community, “he said.

Written by Andrea Bellemare, produced by Colleen Ross and Amina Zafar.

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