Frontlines

“Okay, let’s get started with the medical staff meeting. I think the administrator should be here in a minute.”

It was George’s turn to be the chief of staff of the hospital and it gave him the chance to set the agenda. He was determined to explore the idea of data and specifically, what data they needed to manage the health services for the people of Cedar Grove, as well as begin to think about how to increase awareness of climate change. He expected to get some push back from one of the other doctors, Toby Arc, and the administrator Ned. But maybe there would be some support from the other two younger doctors, Jennifer and Casey. Ever since he and Carmen had started the Cedar Grove climate committee, the path forward seemed a bit clearer. George was a more determined to make the changes that were needed. As Ned pulled up his chair to the table George called the meeting to order.

“We have a couple of new items on the agenda and I think we should talk about those first. The first item is data. Now I know we have a lot of data but it is not very useful. It is more about what we did two years ago. I’ve been reading about a way of reorganizing our approach to the data we need to run our local clinic and hospital and I would like to explore some of the ideas with you. These are some of the questions I think we should try and answer:

1. How many people actually live in the service area of the Cedar Grove hospital and clinic and how stable is the population? Can we estimate the needs of the population for health services?
2. Are the health services we currently provide appropriate and sustainable for our population. How do we compare to other similar sized communities?.
3. What are the outcomes for our population? How do they compare to other populations?
4. What are the patterns of access to services for our population? Do local people come to local services or are people traveling away to access basic services elsewhere? Are some people not able to access services at all?
5. How could we do better in trying to meet the needs of the people who live here? If we start a new program how can we measure the effect?
6. The COVID-19 pandemic has really thrown a wrench in our system. COVID is only one example of a myriad of challenges we are going to have with ecosystem disruption related to climate change. What preparations should we make and what data do we need to inform those preparations.”

Not surprisingly the push back from Ned and Toby came right away.

“Why are we not satisfied with what we have now?” Ned asked. “It seems to work for everyone else.”

“If it ain’t broke don’t fix it,” he added. “And who’s going to pay for it anyway?”

Toby chimed in, “My schedule is already packed seeing patients, where am I going to find the time to reorganize data? My patients are satisfied with my care, that’s all that matters”

It seemed to George that Ned and Toby, as always, were guardians of tradition. Every time something new or innovative was suggested, their first response was that It wouldn’t work and why were we bothering anyway.

The old way was regionalization with regional control of small community services, and the solution for almost any ecosystem disruption was evacuating to the closest regional centre. That just hasn’t worked. The assumptions are that, one, we can actually get there and two, that the regional centre isn’t already overwhelmed.

The huge caveat is that when people abandon their homes to stay in a gymnasium in a larger community during a crisis, that their home will actually still be there when they get back. It seemed to George that it made a lot more sense to try and stay at home, if at all possible, and mitigate local harm as much as possible. To do that they needed data about the local community and a larger local strategic plan. Most importantly, they need to prepare before the event.

George’s musings were interrupted by Toby whose phone went off loud and insistent.

“Time is wasting and time is money,” he said, getting up and leaving the room to take the call.

George brought the meeting back to order: “Listen everyone, 25% of the patients who live here don’t have a family doctor for starters, and a lot of them end up lined up in the emergency waiting room just to get a prescription filled or access basic care. I think one of the advantages of revamping our data systems would be to try and actually take charge of the system that is driving us before it overwhelms us completely. I think we are all feeling like we are burning out.”

The two younger doctors Jennifer and Casey nodded their heads in agreement. They had been listening quietly and seemed open to new directions.

“So how do we move this forward?” Casey asked.

“I think we need to write up a one page proposal for the idea and I’m willing to take that on,” responded George. “Then maybe we can figure out how to get this done. If we can make what is currently happening more visible we might be able to organize some upstream strategies to mitigate the spiral we are in. We also need to develop some local plans for emergency preparedness related to environmental threats like fires, heat domes, and heavy rain. While we are at it we should think about what community assets we have that might support us. Food security should be a part of our thinking as well.”

George jotted down some important questions came out of the discussion:

1. What are our risks of fires, heat dome events and floods based on past experience and similar rural communities? What mitigating strategies can we put in place?
2. Who are our vulnerable people and how are we going to protect them in the event of future environmental hazards?
3. How can we strengthen our food security? Can we grow more food locally?
4. What emergency medications do we need to add to our existing formulary based on the threats we are considering?
5. We need a community team to respond to these threats. Who should be on the team and how do we get this going?

Overall, George was pretty satisfied with the meeting, they had covered a lot of ground. It was time to wrap up and it was pretty clear that he was going to have to do the work to get this rolling but it looked like it was rolling in the right direction for change. He was looking forward to sharing some of this progress with the climate committee, and with Carmen.