AUDREY MANNING
The Beacon

     The evidence is overwhelming that there is systemic disorganization in healthcare. When are we going to have faith in ourselves and find a local solution to local problems? And the word is problems, not challenges.
     Let’s call a spade a spade! It’s a problem when a Lumsden with a family history of breast cancer, cannot get a mammogram. Should she be faced with the challenge of having to battle the system in order to obtain a basic procedure?
    Newfoundland and Labrador is unique. Many of the people in urban centers have no idea of the distances patients have to travel to receive health care. Yet we take it in stride, until those basic services become unavailable. When that happens, there’s no option but to protest.
     Health Minister Jerome Kennedy was an impressive figure before he was elected to government. Is Mr. Kennedy the man who can take a step back and look at the bigger picture? Is Jeanie’s inability to get a mammogram a cost cutting measure, or is it evidence-based?
     How can anyone believe that a healthcare model, designed for densely populated urban centers, can be transposed to a rural province where the population is spread over hundreds of kilometers of rugged coastline, subject to all winds and weathers?
    This begs the question: what is going to happen to the ambulance services in the province. The unfolding of the future of ambulance services may be the key to understanding whether healthcare will stay the course, or if Minister Kennedy is a captain who can steer the ship away from the reefs.
    Apparently, there are three types of ambulances services in Newfoundland and Labrador. Some hospitals have an in-house service, while some communities have a not-for-profit service. As well, there are private for-profit companies, which operate the majority of the ambulances.
    The problem with this setup is the hospital ambulance workers are paid more that the other two groups, which are subsidized by government. There is obviously something wrong if the person who is responsible for transporting people to hospital in an emergency is not valued because s/he works outside a healthcare corporation.
    This situation is disturbing for many reasons. One glaring reason is Minister Ross Wiseman’s response to the concerns of the operators. According to an article in the Gulf News, June 1, 2009, Mr. Wiseman compared the ambulance service to hardware stores… some are more profitable than others.
     Does Mr. Wiseman see healthcare as a commodity? How can first responders be compared to hardware? Yet, as unbelievable as it seems, when corporations run healthcare, it becomes just another commodity, like hardware. Patients become clients/customers!
    Do we have to remind the government that health services are not products that are purchased on a whim? First responders may be the difference between life and death for people with medical needs.
     It is not surprising people are concerned that ambulance operation, as we know it, may be coming to an end. Government is giving the management of ambulance services to the healthcare boards. Unless stopped, boards will more than likely travel down the well-worn path to privatization. Boards have no power to stop the train!
      That leaves open the possibility that a company from outside the province will operate ambulances for profit. Currently, even though we have private operators, they seem community grounded.
In 2002, the government released its strategic plan for healthcare, Healthier Together. The vision of this plan: “For all Newfoundlanders and Labradorians to enjoy the best possible health and well-being.” Its Mission: “To provide quality health and community services to improve the health and well being of individuals, families and communities.” The timeline for implementation was 2007.
 The guiding principles for decision-making in this report were the words: People-centered, accessibility, accountability, equity, evidence-based, and sustainability. What has happened to healthcare since 2002?
Did Minister Wiseman have people-centered in mind when he compared ambulance services to hardware stores? Would the lady in Lumsden agree that healthcare is more accessible? Will the patients with botched hormone receptor tests think the system is accountable to those it serves?
 Will the people of the rural areas who see services, such as lab and x-ray, in jeopardy agree that the system is equitable? Will the people who have gone through the H1N1 muddle think that decisions are evidence-based?
Then there is that buzzword sustainability — a word which rolls off the tongue but has about as much meaning as “meeting the needs of the people,” as it relates to the visions of multinational corporations. Will the people who have to travel long distances for services say the system is being sustained in their communities since 2002?
Evidence-based is a tricky matter. Lessons learned could work for future vaccinations. However, transposing lessons learned about delivery of health care, in highly populated areas, to the rural areas of Newfoundland and Labrador is setting up a system for frustration and failure.
Mr. Kennedy, you know that our province is unique. We have workers in the system, second to none, who can offer advice on how to make rural health people-centered, accessible, accountable, and sustainable, but maybe not evidence-based.