Highs and lows of rural practice in the midst of COVID-19

By Greg Basky | Photo by Laura Miller

Two images will stick with La Ronge family physician Dr. Michael Bayda after the pandemic subsides. One is from spring 2020, when a number of surrounding communities saw major spikes in case numbers.

“When those patients first presented through our emergency department, it was a really steep learning curve, because a lot of the protocols were still being developed or rolled out,” recalls Dr. Bayda. “That stands out as a time when everyone had to come together and work as a team and make sure that everyone felt comfortable and safe, and understood the different considerations for COVID.”

The other lasting impression, he says, is of the impact the pandemic has had on patients and families – in particular people who had to be transferred to a hospital in a different community or to an assisted isolation site.

“It’s scary for people to find out that they’ve tested positive, and then you follow up that news by telling them, ‘You have to leave, and you don’t get any visitors, and it could be a couple of days, or it could be a couple of weeks,’ ” says Dr. Bayda. “That’s a difficult conversation to have, and I think it’s really hard for patients. They’re trying to notify their family. They’re concerned about themselves. And they have to leave town. It was really hard, trying to help people navigate all of that.”

Dr. Michael Bayda, family physician, La Ronge

Challenges of rural, remote practice during pandemic

According to Dr. Bayda, COVID-19 brought some unique challenges for physicians working in rural and remote locations. While having a smaller health-care team made it easier to keep everyone informed of the latest updates from the Saskatchewan Health Authority, being short by even just one member would throw a wrench into staffing. “If there’s any dip into that pool – people needing to isolate, people not being able to work for whatever reason – then it instantly affects your numbers quickly.” Dr. Bayda says their physician group has had to be flexible in how they do their scheduling.

AS A RURAL PHYSICIAN, YOU’RE WEARING ALL OF THOSE HATS AND YOU’RE SPREAD VERY THIN ALREADY. THAT’S PART OF THE NATURE OF THE PRACTICE THAT EVERYONE LIKES. THAT’S WHY YOU DO IT. BUT ALL OF THOSE THINGS WERE MAGNIFIED (BY THE PANDEMIC) AND YOU’RE SPREAD EVEN THINNER.

With their limited bench strength, Dr. Bayda says it was often tough finding time to provide support to patients who were in assisted isolation. While numbers in La Ronge were lower than in many other centres, this additional service added to an already overflowing plate. Dr. Bayda and his colleagues were still doing deliveries, taking shifts in emergency, and supporting the outpost communities – while at the same time trying to stay on top of ongoing regular health checks and clinic follow-up that needs to happen for people’s wellbeing.

“As a rural physician, you’re wearing all of those hats and you’re spread very thin already,” he said. “That’s part of the nature of the practice that everyone likes. That’s why you do it. But all of those things were magnified (by the pandemic) and you’re spread even thinner.”

Saskatchewan Air Ambulance, STARS transport critical patients to tertiary centres

While the La Ronge area did not see as many critical cases come through emergency as neighboring regions to the east and west, Dr. Bayda says there were times – particularly during peaks in case numbers – when they relied heavily on ground EMS, Saskatchewan Air Ambulance (SAA), and STARS (Shock Trauma Air Rescue Service) to transport patients to the province’s larger centres. Over the past 19 months, Saskatchewan’s fixed wing and rotary wing air ambulances have transported intubated COVID-19 patients who were some of the most fragile and difficult patients to ventilate that either organization has ever transported.

It was in fact a resident of northern Saskatchewan that presented the SAA team with its first chance to put into practice newly developed COVID processes and protocols – just two weeks into the pandemic. David Mandzuk, manager of SAA, says transporting that first COVID-19 positive patient set the tone for all that followed.

David Mandzuk, manager, Sask. Air Ambulance

“What struck me most was that it was really just a normal, everyday transport that we do hundreds of times a year,” says Mandzuk. “We did our job, just like every other day. We approach each trip so that we minimize risk to the patient and to our staff. We’re here to transport patients safely and efficiently to where they need to go.”

Between March 2020 and March 2021, SAA’s King Air 200 fixed wing airplane transported 93 COVID-positive patients from smaller centres such as La Ronge, while Rise Air (previously Transwest Air) – which serves the province’s Northern Medivac Program – flew another 48. To put those figures in perspective, SAA’s “flying ICU” averages around 110-120 patient transports per month or around 1,350 per year. Mandzuk and his team saw peaks in requests for transports correspond with COVID-19’s first wave in fall 2020 and second wave in spring 2021. While most transports come out of the north, the SAA serves the four corners of the province.

Saskatchewan Air Ambulance

The transport physicians with STARS provide online medical consultation to local doctors for every critical call – whether it ultimately results in a SAA or STARS mission. During the pandemic, they have coordinated care with sending and receiving physicians, first responders, and ground EMS.

Although STARS has not collected figures on confirmed or suspected COVID patients specifically for Saskatchewan, the fact that their numbers doubled for critical care and transport of patients with influenza-like illness illustrate the significant uptick in demand they’ve seen through the pandemic.

Many of the patients coming from rural areas and the north had comorbid illnesses such as diabetes and high blood pressure, so they’re more fragile and they require extra care. During peak times, the STARS team was caring for confirmed or suspected COVID-positive patients on virtually every shift. When called upon – often on short notice – STARS staff also supported ground transport teams in rural and regional sites.

Dr. Jon Witt, STARS transport physician

Dr. Jon Witt, a transport physician with STARS, says a silver lining is the way health-care professionals across the system continue to pull together as a team under adverse conditions. “We see people working hard to support patients in their home community, and support the urban centres by managing sicker patients,” says Dr. Witt. “Then STARS and Air Ambulance (SAA), and all the other providers across the province in turn supporting them, and everybody just working together and collaborating through really the most challenging health-care crisis the world has seen in over a hundred years. That’s what makes this such a great place to live and work.”

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While the past 19 months have been challenging, La Ronge’s Dr. Bayda says the positives of practising in a remote location outweigh the struggles he and his colleagues have faced during the pandemic.

“It did just really highlight the flexibility and the variety that comes with rural medicine,” says Dr. Bayda. “That’s something that everyone (who practises in rural and remote areas) embraces – being part of a community and flexing and adapting to whatever the community needs are. The pandemic really highlighted what’s special about that.” ◆