The Manitoban primary care system is at risk. The list of issues seems insurmountable. People don’t have doctors; they aren’t being diagnosed as soon as they should be; there’s no continuity of care; emergency departments are clogged; the majority of staff is burned out, meaning there’s not enough staff to care for everyone. The whole system feels like it’s falling apart.
That’s where we are now. And that’s what participants in Manitoba’s OurCare Priority Panel – one of five provincial panels created by Tara Kiran and MASS LBP in British Columbia, Nova Scotia, Ontario, Quebec and Manitoba – came to discuss and search for ways forward.
Our 30 participants came from all parts of the province – remote and rural communities; fly-in communities; suburbs; and city downtowns. We are Black and White and other People of Colour. We come from many ethnic and racial backgrounds; born in Canada and new immigrants; Indigenous and colonizers; members of the LGBTQA2S+ communities. We are of many religious and financial backgrounds, able bodied and disabled, with different experiences with the health-care system. We are formally educated and not; men, women and nonbinary people; liberal and conservative, and everything in between.
And here’s the thing – despite our difference, we all agreed on one thing – Manitoba’s primary system is falling apart and badly needs reformation. I don’t mean to say that none of us have had excellent care – I personally have an excellent family doctor – but we can all see strains in the system.
Our panel had two virtual meetings during which we learned the background of our health-care system, and then an intensive, in-person weekend session. Combined, we had 30 hours of education about the system.
Over the course of the weekend, we were grouped based on our interests and areas of concern to come up with recommendations on how to reinforce health care. The entire process was well coordinated and managed to get us from important but vague qualities that a health-care service should have, like accountability, to specific recommendations.
As we discussed our experiences with primary health care or the lack thereof, it was eye-opening to see just how rough the system is for so many people. It’s hard to fathom that people living 30-45 minutes away from Winnipeg face significant difficulties in getting proper medical care and that even getting virtual care can be hard to access because of poor Internet connections. It doesn’t get better closer to the population centre – Winnipeg alone has nearly 20,000 health-care job vacancies.
Seeing the reality of our health-care system, I’m ashamed as a Canadian that we’ve let it slip so far. While many have had terrible relationships with our (white) system of health care, for many, our Medicare system is a source of national pride. Hockey, Tim’s doughnuts and free health care are cultural touchstones, despite questions about how materialistic and corporate these may be. It feels like a national failure that our health-care system is so strained.
Seeing the reality of our health-care system, I’m ashamed as a Canadian that we’ve let it slip so far.
I’m not saying that the system is entirely broken, or that no one has access to care. Many people do, including me. But there is a glut of issues that need to be addressed, and some signs warning of deterioration – even those of us fortunate enough to have better access now experience longer and longer wait times for specialists or in emergency departments. Ambulances too are impacted – in 2021 alone, there were 17,000 hours during which ambulances couldn’t be staffed.
Family doctors are retiring (or moving away) and there’s nothing to do but wait as the list of patients who need primary care grows. Nearly 300,000 Manitobans may be without primary care. Right now, Manitoba has the lowest number of family physicians in Canada, the third lowest of specialists and is the second lowest for all doctors, period. We need nearly 450 new doctors just to reach the national average.
We cannot just stand to the side watching as issues mount. We need change now, while we can still turn things around. We produced almost 40 recommendations to improve primary care. Social determinants of health featured prominently as did issues around accountability, transparency, structural inequalities and intersectional identities.
Given Manitoba’s population, Indigenous health care featured prominently, from First Nations’, Inuit and Metis’ historical relationship with health care to having to fly south for advanced care; from the ability to bring a caregiver with you on these enforced trips to access to Elders. Consider the need to fly south for treatment – one panel member told of having to fly for an appointment at the start of the week, return home for a few days and then fly back for another appointment a few days later. A ridiculous expense for a patient with a serious health problem, not to mention the stress it creates. This is the kind of utter absurdity that has somehow become baked into our system.
To start to improve things, more cultural safety, trauma-informed care, people-centered health care, introduction to Indigenous cultures and practices and continuing education must be provided by all employees. And not only for staff involved in direct patient care. The experience of accessing health care is deeply influenced by everything patients, caregivers and even visitors are exposed to. Even security guards can play an outsized role if they are not sufficiently trained to deal with cultural practices.
Our panel recommended creating and promoting an Indigenous Health Department within the provincial government to ensure Indigenous health becomes a funded priority. Scaling existing Indigenous health programs, creating a Traditional Wellness Clinic at the Health Sciences Centre and supporting various forms of education for health-care students and professionals would all be significant steps forward.
Despite hearing many heartbreaking stories, we still have confidence in our system and more importantly, in our population and our desire for change. But it did feel like we had a lot more confidence in each other than in the system itself.
What hope there is rests on our new NDP government. We believe that the government has the tools to turn things around. Wab Kinew, Manitoba’s first First Nations premier, has experienced the structural racism that is part of our medical system his whole life. His wife is a First Nations doctor who’s practiced in an inner-city clinic. Health care was a big part of his campaign; we must have to hope that there will be improvements.
What shone through the gloom of systemic failure during our sessions was the common goals we have. We created a community for the weekend, learning about what everyone needs and wants. We felt that we had, if not the ability to fix it, at least a road map for our province to improve. There are many frustrations and disappointments with the system, but there are also many potential ways forward. Here are 37 possible solutions. Take them into account.
Don’t let our work be for nothing. Don’t let Manitobans continue to suffer without access to a healthy primary care system.