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Community-based doctor service

Thursday November 29, 2007

Doctor Anthon Meyer is not your run-of-the-mill physician.

November 29, 2007: Volume 34 #24

He has created a community-based program that is unique in its approach to health-care delivery in remote communities.

Born in South Africa, Meyer came to Canada in 2000. He qualified as a family physician in South Africa and worked to obtain his Canadian certification, which he earned in 2002. Initially he worked as an emergency medical physician in Thompson, Manitoba. He has always worked in what he terms “rural, under-serviced areas.”

The program he created is called Anthon Meyer Doctor Service, or AMDOCS for short. He currently delivers the program in the First Nations of Pikangikum, Kitchenuhmaykoosib and Muskrat Dam.

In the past, physician services to communities such as these were simply outreach programs, with a family physician visiting perhaps once a month or week from a place such as Sioux Lookout.

Not so in his case. Meyer prefers to treat his patients right in their home community on a regular basis.

“For me, it’s about the principle where I believe the best health care a community member can receive ... is in his or her home or town,” Meyer says. “My program’s experience has taught me that it’s one of the best ways I can change the outcome of disease profiles.

“Remote isolated communities have been neglected so many years in the past by not receiving adequate care in terms of resources, in terms of expertise, in terms of comprehensive physician services.”

Meyer explains that when a doctor arrives at a remote community such as Pikangikum, it can be an overwhelming experience for the unprepared.

“You are confronted with complexity of disease, with acuity levels based on what I call ‘acute exasperation’ of chronic disease,” Meyer says.

This method of health-care delivery created a shortcoming, according to Meyer, in that a patient could not receive detailed, comprehensive health care. It also led to doctors’ inability to focus on individuals and instead focus on a patient’s one ailment, he says.

For example, a doctor may focus just on a patient’s hypertension “because there are so many people (who are) waiting to see the doctor, the waiting list is so long.”

Billy Joe Strang, chairman of a health committee in Pikangikum, says doctor time with patients has improved since Dr. Meyer arrived with his program.

“The doctor spends more time with the patients – 30 to 40 minutes at a time (as opposed to) 15 minutes previously,” Strang says.

“I think access to physicians is really one of the major improvements,” he adds.

For example, patients in the past would typically be referred to a general practitioner (GP) in Sioux Lookout, who would then refer them to another GP, who would then refer the patient to a specialist, and the process could take months, Strang says.

With Dr. Meyer, a patient can be referred to a specialist directly.

Making the patient a partner in the management plan is also part of Meyer’s approach.

“It is about spending time with you,” Meyer explains.

“Now, all physicians in my experience want to have such a rapport and such a consultation with a patient but in the isolated rural areas where you are confronted with multiple patients, with a backlog that is severe, I’ve found that’s where many things fall through the cracks.

“Therefore the (community-based) program focuses mainly on chronic disease management on the neglected patient in a comprehensive way of dealing with patient care ... to succeed in getting the patient’s partnership in compliance.”

Meyer says he has seen success over and over with this treatment model in rural, under-serviced areas.

“I’ve been involved in 13 different remote communities in northern Manitoba over the past seven years using this model. I have witnessed the difference we are making.”

For Meyer, dealing with backlogs of patients also involves capacity building – creating an effective infrastructure of administrative and support staff.

“It is like 30 ants in a little building running around trying to settle things down,” Meyer says. “In that process the people working there, whether they are the professional people or the administrative staff, suffer grossly from the inadequate resources available to them and they do not have the opportunity to grow as workers.”

Strang confirmed that capacity building was one of the areas Dr. Meyer worked at improving when he first arrived in Pikangikum, and now health staff do not require as much supervision.

After successful capacity-building efforts, Meyer can focus on chronic disease management.

Meyer says all waiting lists in the three northwestern Ontario communities he now serves were cleared within six months of introducing his new approach to the region in September 2006.

Those lists, he adds, previously seldom numbered less than 200.

In Kitchenuhmaykoosib, waiting lists were long and medevacs were common – as many as 30 a month, according to a health service provider in the community who did not want to be named.

Since the arrival of AMDOCS, the number of medevacs has been cut back to an average of about five per month and there is no longer a backlog of patients waiting to be seen.

The First Nation Family Physician Health Services branch of the Independent First Nations Alliance (IFNA) contracted AMDOCS for three years.

“I do not accept contracts that are less than two years ... because it is not something that can happen overnight,” Meyer says.

Meyer sees the changes when the patients in the community start referring to the doctors as “our” doctors instead of the government doctors, and take ownership of their own health-care system.

“We already see that in the three communities which are serviced, which is great actually,” Meyer says.

Success is also measured through questionnaire leaflets given to patients who fill out the leaflets anonymously and through feedback from the First Nation Family Physician Health Services board of directors.

Strang says his office receives calls from patients who express happiness with the current physician services.

Meyer notes that the “show rate” for his patients – the percentage of people who show up for their appointments – “is close to 90 per cent, which is unheard of.”

And the smiles he sees on the faces of his patients would only be there “if there is trust in the relationship,” Meyer adds.

He also measures the success of his program through the feeling he gets from the community.

“I feel at home … when I go into my office. When you first arrive you are the outsider; people look at you as the ‘big doctor.’

“That is an artificial relationship.”

When people such as the woman filing the medical charts ask Meyer personal questions such as “How’s your wife?” he knows he has arrived.

“Then I know they have invited me into their community.”

Grant Keesic — Special to Wawatay News

Healing families a key to good health

Dr. Anthon Meyer recommends the prerequisite healthy diet and exercise for patients to prevent disease and to adjust lifestyles of patients. 

“I would prescribe exercise like I would prescribe an aspirin,” Meyer says. “That means, 150 minutes per week you do active exercise and you spread that over the seven days of the week.”

Also recommended are the breaking of bad smoking habits and the avoidance of alcohol.

But Meyer also believes sincerely in the mending of familial relationships as a pathway to good health.

“(It is) something which is very, very dear to my heart,” Meyer says. “It is going back to traditional family roots.

“My eyes have seen so many things in communities such as the ones that I work in which want to make my cry – when I look at the family relationships (and) the serious breakdown and generation gaps that we have. If we can recover the family as a unit, if we can recover the traditional values, if we can recover the discipline in the relationship between parents and children, if we can fix that alone and we can heal the pain and the hurt and suffering of the emotional aspect within the family unit, it would take at least half of the sicknesses in the community away.” 

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