Wakaw Primary Health Centre and CEC Carol Baldwin, Local Journalism Initiative Reporter

In the Saskatchewan Health Authority’s recent summer newsletter shared through the Primary Health Care North East 6 network (North East 6 includes the towns of Wakaw, Alvena, Cudworth, St Louis, Duck Lake, Laird, Waldheim, Hepburn, Hague, and Rosthern and the surrounding RMs of Hoodoo, Fish Creek, St. Louis, Rosthern, Laird, and Duck Lake, as well as the One Arrow First Nation and Beardy’s Okemasis First Nation), Dr. Mohammad Khan, Medical Health Officer, identified some examples of what the determinants of health are. The World Health Organization defines health as “a complete state of physical, mental, and social well-being, and not merely the absence of disease or infirmity.” The perspective of First Nations is that health or well-being involves a balance of four elements: physical, emotional, mental, and spiritual, and this is often represented through the image of the medicine wheel.

What our society sees as health concerns or problems Khan says, are really the end result or byproduct of issues that start farther back. Some issues start as far back as our genetic makeup, and possibly even that of our parents and their parents before them. The study of epigenetics is a fascinating new field of study that looks at how genetic markers or ‘switches’ can be turned on in one generation and impact the next. It looks at how things like diet, physical activity, and stress levels can impact not only our own health, but the health of our children, grandchildren, and other descendants. Epigenetics is an emerging area of scientific research that shows how environmental influences, the things people experience, actually affect the expression of their genes. This means the old idea that genes are “set in stone” has been disproven. According to epigenetics, it’s not a question of nature or nurture, it’s nearly always both! Epigenetics explains how early experiences can have lifelong impacts. Experiences very early in life, when the brain is developing the most rapidly, cause adaptations that influence how, when, or even if certain genes will release their instructions for the future building of health, skills, and resilience. Both positive and negative experiences leave unique ‘signatures’ on genes which may be temporary or permanent. Epigenetics also change as people age. Changes can be ‘switched’ on or off both through normal development and aging and through response to behaviours, experiences, and environment.

Experiences like malnutrition, exposure to drugs and chemical toxins, and even toxic stress in the prenatal period and in early childhood become built into the architecture of the developing brain. These “biological memories” that are associated with these epigenetic changes can affect multiple systems and increase the risk not only of poor physical and mental health outcomes but also of impingements on future learning capacity and behaviour. Recent research shows that there may be ways of reversing some negative changes, but as the saying goes, the best defense is a good offense. The best strategy is to build strong brains and healthy organ systems by providing high-quality health care for all pregnant women, infants, and toddlers and continue that through the life cycle. Support for new parents and caregivers can quite literally, affect the chemistry around children’s genes and therefore the generations yet to come. (https://developingchild.harvard.edu/resources/what-is-epigenetics-and-how-does-it-relate-to-child-development/) Wouldn’t it be amazing if through high-quality healthcare that is accessible to all, some of the chronic illnesses people suffer from, could be diminished?

It is this new research-based knowledge that makes it clear that it is even more vitally important to have a family doctor, something more and more people in Canada and Saskatchewan are having to live without. Even having a family doctor does not guarantee timely appointments. In Rosthern for example, an individual who has one of the physicians there as a family doctor called for a non-urgent appointment, and the earliest time available was a two-month wait. Many things can change in two months and what may have appeared as non-urgent could easily progress to something much more problematic in that time frame and there are many people who would not consider trying to call and get an earlier appointment, especially the elderly. Wakaw too, in the past, has struggled to have a full contingent of doctors to meet the needs of the Collaborative Emergency Centre (CEC)4q and all of North East 6 east of the South Saskatchewan River. Currently, Wakaw has three physicians and one registered nurse who see patients from a large rural area and Rosthern has seven, aside from Dr. Melle who is leaving next month. The physicians in Rosthern also work shifts at the hospital which functions as an emergency hub between Saskatoon and Prince Albert.

As noted previously in an earlier edition, there is a shortage of doctors in many different areas of medical practice, but probably the most profound shortage is in the area of family medicine. Family doctors have already identified a part of the problem with attracting and retaining family physicians and that is the payment structure. Being organized on a format of quantity not quality results in a factory-line approach to medicine which runs counter to the very premise of family medicine which is best served by being able to spend time with patients to get to know them and know their needs. Family practitioners are the front line of medicine and sometimes must play detective to uncover what lies at the base of a patient’s problems. Individuals who only have access to walk-in urgent care physicians do not get the continuum of care they would from a family physician. But family physicians find themselves juggling many responsibilities and feeling like they are constantly having to add even more to their already overloaded routine of administrative paperwork, seeing patients, investigating symptoms, completing reports and following up on test results, and even recruiting additional or replacement physicians to join their practice.

We all know the vital role family physicians play in our day-to-day health; the science of epigenetics shows us their importance in determining future health outcomes for those who come after us. Another factor that undoubtedly plays a role in doctor burnout and high patient lists is the very nature of what makes individuals good family doctors in the first place…compassion. They see that someone needs to have a family doctor to monitor an ongoing condition and they take them on as a patient so that there is someone monitoring that condition. These one-at-a-time additions to a doctor’s patient list can add up quickly, especially since chronic conditions often require more than just once-a-year visits and suddenly that list of patients requiring follow-up care burgeons and appointment wait times grow. 

Finding a solution to family doctor and primary care provider shortages will not happen overnight and it won’t happen by increasing seats in medical schools by four per year. The answer will be complex and will come through many different avenues, but it is vital not only for those in the current and near future, but as the science of epigenetics is discovering, but also for those yet to come.

By Carol Baldwin, Local Journalism Initiative Reporter

Original Published on Jul 06, 2023 at 21:26

This item reprinted with permission from   Wakaw Recorder   Wakaw, Saskatchewan
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