
                              THE RURAL ROUTE

                               By MARTA GOLD
                              Edmonton Journal

     CEREAL, Alta. - Wanted: Doctor for solo practice in community of
     450 people, two-and-a-half hours from the nearest large centre.
     Must be on call seven days a week.

     That job description hasn't attracted many doctors to this village
     nearly 200 kilometres east of Calgary.

     In fact, the village been without a physician now for more than
     five years, despite what observers say is a glut of doctors
     elsewhere in the country.

     ``Every so often, someone comes and takes a look around, and then
     we never hear anything more about it,'' says Cereal Mayor Elaine
     Michaels. ``I think we're probably just too small and too far away
     from everything.''

     The amenities of Cereal are much the same as those of any other
     small Canadian comunity: a hotel, hardware store, grocery, bank and
     gas station, along with a few small businesses and a nine-bed
     hospital operating at about half-capacity.

     Its problem in attracting a doctor is shared by rural centres
     across the country that, like Cereal, are too small to support more
     than one or two physicians.

     ``There isn't one province that can say it doesn't have a problem''
     finding physicians willing to practise in rural communities, said
     Lucien Blair of the Canadian Medical Association.

     Manitoba, for example, has about 40 openings for rural physicians
     around the province at any given time, said John Laplume, executive
     director of the Manitoba Medical Association.

     Doctors come to Cereal from nearby communities three days a week.
     ``If you happen to get sick on a Wednesday and the doctor doesn't
     come until Thursday, you either suffer or drive (to another
     town),'' she said.

     In Forestburg, Galahad and Alliance, a trio of communities about
     200 kilometres north of Cereal, patients regularly drive between
     the villages to see the area's lone doctor. The doctor, Stanley
     Kumar, does a fair bit of driving himself.

     From daily rounds and appointments at the area's 40-bed hospital in
     Galahad, Kumar drives the 16 kilometres to Forestburg to hold
     afternoon and evening office hours.

     In between, he handles house calls at the seniors home, emergencies
     that arise at nearby farms and industries, vehicle accidents and
     any deaths.

        See <16health> for discussion of typical family doctor
        See <19health> for discussion of nurses' jobs

     Kumar's patients in nearby Alliance must catch him at his
     Forestburg office or at the Galahad hospital. Doris Kuefler, who
     uses a wheelchair because of her emphysema, must travel from her
     Alliance home to Galahad every time she suffers an attack.

     ``It's a little inconvenient, me being in a wheelchair,'' she said.

     In the 23 years he's lived in Forestburg and served the area's
     3,000 residents, Kumar has seen 17 doctors come and go. Some stayed
     a year or two, others lasted only a few weeks.

     Less than 10 per cent of doctors in Canada are currently practising
     in rural areas, according to figures compiled by Southam Direct
     Marketing Services. About 30 per cent of rural doctors are
     specialists, compared to almost 64 per cent of physicians in urban
     areas.

     ``Rural doctors are a unique species,'' said Kumar. ``He or she
     must be prepared to give up a lot.''

     The demands of his work caused him to miss much of the day-to-day
     lives of his children growing up. Medical emergencies pulled him
     away from one daughter's wedding and the high-school graduations of
     most of his kids.

     ``There isn't really an idyllic life of a country doctor,'' he
     added. But Kumar still cites the virtues of rural practice over the
     drawbacks.

     A stroll through the senior citizens complex in Forestburg quickly
     restores the smile to his face, as he stops to offer advice and
     encouragement to the patients he's known for more than two decades.

        See <30health> for a discussion of elderly care

     Dr. Thakor Amin retired last month after 25 years as, at times, the
     only doctor in the town of Killam, Alta.

     ``It's too much responsibility (for young doctors),'' said the 59-
     year-old physician who routinely delivers babies, removes
     appendixes and sets broken bones.

     ``Some people feel very inadequate coming out here,'' agrees Dr.
     Bev Brilz, who has been a physician in Wainwright, Alta. for eight
     years. Rural doctors must be more self-reliant and have more
     general skills than physicians in urban areas with access to a
     range of specialists, she added.

     Dr. Hedy Fry, president of the British Columbia Medical
     Association, said general practitioners in rural areas need some
     specialized training in such things as surgery, anesthesia and
     obstetrics.

     Attempts to force doctors to practise in rural areas have proved
     unsuccessful.

        See <29health> for a discussion of northern medicine

     Three years ago, B.C. denied doctors a billing number unless they
     agreed to practise outside urban areas. The B.C. Medical
     Association took the province to court, arguing the move violated
     the Charter of Rights and Freedoms. The B.C. Court of Appeal
     agreed.

     Medical schools, like the one at the University of Alberta, are
     trying a different approach, putting a new emphasis on rural
     medicine in an attempt to encourage students to consider the move
     to smaller communities.

     Half the 120 undergraduate medical students at the U of A last year
     completed a mandatory four-week stint in rural Alberta. This year,
     about 60 per cent of the students are interested in the rural
     component, said Dr. David Moores, the university's new chair of
     family medicine.

     Residents in family medicine at the university currently spend
     between two and four months in a rural practice. Moores said the U
     of A's program borrowed the idea from Memorial University in
     Newfoundland, where he was associate dean of continuing medical
     education before moving to Edmonton last year.

     A $2-million program introduced April 8 by the Alberta government
     offers students who agree to practise in rural areas extra bursary
     money and extended time to pay back student loans. New doctors
     willing to spend two years in rural communities will get up to
     $10,000 in benefits.

     In Saskatchewan, similar strategies are being looked at to
     encourage students to practise in rural areas, said Dr. Ernie
     Baergen, executive director of the Saskatchewan Medical
     Association.

     In New Brunswick, doctors willing to practise in rural areas are
     guaranteed a minimum income level by the provincial government and
     receive 110 per cent of the fee schedule. But financial incentives
     alone aren't the answer, many doctors agree.

     ``No amount of compensation will keep someone happy who virtually
     has to be a slave to the community,'' said Laplume of the Manitoba
     Medical Association.

     Dr. Joe Askin, a resident in family medicine at the University of
     Alberta, said the slower pace and unique philosophy of rural
     doctors encouraged him to join the four-physician practice in the
     town of Three Hills after spending two months training there last
     year. He sees rural practice as a return to the traditional role of
     a family physician.

     ``That overall care that doctors once provided is being lost in the
     city,'' he said. Surrounded in urban areas by so many specialists,
     a family doctor becomes ``like a signalman where they just point
     the patient in the direction of the next specialist.''
