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“Sometimes you have to break your own trail”

the front cover of a crosscurrents magazine- the main image is a vase with bold coloured flowers

Unique program prepares students for practice in remote communities

By Helen Buttery

Summer 2005, Vol 8 No 4


As a social work student at the University of British Columbia (UBC), Krista Sigurdson was working in Port McNeill on North Vancouver Island with an Aboriginal client in an alcohol withdrawal program. A few weeks later, Sigurdson visited Rivers Inlet, a small coastal Aboriginal community, where she watched the same woman enthusiastically smoking salmon for her family and friends. The experience was like seeing one of her textbook pages come to life: “In social work we talk about the importance of Aboriginal people reconnecting with their culture, but it’s one thing to learn about it in the city and quite another to see it firsthand,” says Sigurdson.

She gained the experience through the Interprofessional Rural Program of B.C. (IRPBC), which places students for up to three months in remote or small communities as part of their practicum. Since its launch in 2003, the provincial program has placed 62 students (plus 29 this summer) from 11 health fields, including nursing, social work and occupational therapy, in communities like Bella Coola, population 2,500, and Port McNeill, population 3,000.

“There is a shortage of health care workers in rural communities because students from urban centres don't think about practising in rural communities,” says Grant Charles, a social work professor and a program lead with IRPBC. “We hope that as we expose students to rural communities they will develop a passion for working there.”

This logic is starting to work in the field of medicine, which faces a critical shortage of physicians in remote areas. To deal with this shortage, two new medical schools have recently opened in rural Ontario and B.C. “If it’s working for doctors, why don’t we try it with other health professions?” asks Grant, citing a project in New Mexico which found that working in rural settings influenced nurse practitioners’ choice of practice location.

Adapting the New Mexico model for the Canadian context, IRPBC trains students from various health care disciplines; even more important, it emphasizes collaboration. “Interprofessionalism means learning about and learning to work with and appreciate the skills of other professions,” says Grant. One component of the program involves shadowing; for example, a social work student may accompany a nurse on an overnight hospital shift. The ultimate goal is to improve how health care professionals work together. Such interdisciplinary work is crucial to remote communities, where resources are scarce and health care professionals must rely heavily on one another.

Indeed, students in the IRPBC program support one another in what is, for most students, a foreign environment. The uniqueness of a rural setting can bring a sense of isolation. “It’s a long way to the next biggest town,” says Carole Clark, mental health programs manager at Bella Coola General Hospital, which has participated in IRPBC since its inception. “There are all sorts of recreational opportunities here, but you have to do them yourself – sometimes you have to break your own trail.”

Adjusting to isolation is one challenge; coping with the widespread problems in rural communities is another. Bella Coola, for example, has been hard hit by the economic decline in resources, namely logging and fishing. Clark estimates an 80 per cent unemployment rate. “The economies bottoming out has led to increased stress and all that comes with that – depression, other mental illness, violence and substance abuse,” she says.

But students aren’t the only ones learning from the experience. For Clark, who supervises the IRPBC’s social work students, the experience made her re-evaluate her own perceptions. “Being in a remote place in the middle of winter gets depressing,” she says. “Come February, there’s a lot of suicidal ideation here; it doesn’t surprise those of us who live here, but one of my students was really taken aback, which made me wonder, ‘Perhaps I should be taken aback more, too?’”

IRPBC students come armed with new knowledge and they’re keen and energetic. “The whole town looks forward to their arrival,” says Clark. The students take some of the workload off local healthcare providers, shortening waiting lists and often getting programs off the ground that would otherwise be put on the backburner. Sigurdson, for example, put together a withdrawal wellness package. “I saw a lot of clients who would go to the hospital and stay there for a day or a week with nothing to do, so they’d become depressed,” says Sigurdson. “With my supervisor’s help, I put together a package of various activities that a person can do while in detox.”

So will Sigurdson end up working in a rural community? “I would definitely work in a rural community for a year or even a few years, but I can’t see myself settling there permanently,” she says. A lot of it comes down to lifestyle. Sigurdson describes herself as a “city person through and through.” You can’t win them all, but two IRPBC graduates have already returned to work in rural communities and others have expressed interest in doing so.