Thank you for this very useful thread.  I have subscribed to click4hp but
only seem to receive introductory messages from a lot of neat people. I have
not previously seen any of this discussion flashing by!  Anyone know why?

I have worked with numerous communities who were interested in "defensive"
strategies to avoid or mitigate the loss of their acute hospital.  Even some
"rural" locations who were only 20-30 minutes surface travel from not only
another hospital but sometimes a large facility.

Balancing "needed health services" against "protecting the local economy"
(ie. peoples'  jobs and potential to attract people to an area) is a serious
issue in times of increasing pressure on the health dollar.  We have, on
occasion, worked with local community economic development offices to
identify the business activities that were planned for development and have
talked with managers and unions about re-training.  This works more for
support staff than for the health professionals.

In some cases it has been wiser to concentrate on improving transportation
than on developing a survival strategy for the hospital.  In other cases it
has been beneficial to think of the hospital as simply walls and a roof that
could house a wider range of health or health-related services.  This has
sometimes allowed a level of primary acute care to continue (perhaps even
with visiting specialists) because the overhead and infrastructure costs can
be spread among multiple services (eg. shared reception, switchboard,
secretarial, maintenance etc.)

The definition of health is very broad and certainly extends beyond health
care.  Our government structures have often impeded the true integration of
a variety of community services.

One of my colleagues has worked with a number of groups to provide joint
"traditional" and "scientific" health services.  Sometimes these have been
on reserves or on the boundary of the reserve and non-reserve land.

I really believe that we often get stuck in our own history.  Our health
system developed a certain way and it is difficult for some to visualize
that other models could be as good or better.

I really appreciate the benefit of some of these insights and hope we can
keep the discussion going.

Geoff Rowlands



At 11:24 13/05/96 -0400, you wrote:
>This long posting may be of interest.  It comes from the Community Economic
>Development Network listserv at Simon Fraser U in BC, and was a message
>posted by the Rural & Small Town Programme in Sackville New Brunswick, with
>a copy of a message / response from Manitoba - so a great example of a
>national and international brainstorming on a shared issue of health reform
>and economic development.
>I am copying the  original message first,
>then the Manitoba message and finally
>the list presented to a group of residents and others who used it to develop
>actions.
>It is a great example of using Computer-Mediated Communications for
>community health work!
>
>By the way, take a look at who the final message went to - 12 Canadian
>list-servs and electronic discussion groups/mailing lists - a very broad
>network!
>
>Alison Stirling <[log in to unmask]>
>_____________________________
>From: owner-ced-net
>To: ced-net
>Cc: localgov; crrf-l; ruraldev; rural; maritgr; geoatlantic-l; rural;
>non-met-dev; rurcan; arktel; cap-atlantic-network
>
>Friends:
>
>We are generating a list of ideas (one-liners) and case studies (paragraph
>or two) of how small town hospitals which have been downsized (beds closed,
>services reduced) have taken on new activities to keep people employed and
>still provide health services to the residents.
>
>This 55-bed hospital in Sackville, New Brunswick Canada has been downsized
>over the past few years to the point of having only about 33 beds
>operational.  There eight family doctors in town.  There are two large
>hospitals 45 minutes away in Moncton.  Some of the doctors in Moncton travel
>to Sackville once a week to offer special clinics (dermatology, for example)
>not provided by family doctors, but this may be reduced or ended as the
>Health Care Corporation and the doctors themselves do not seem interested in
>supporting it.  There is also a two-bed obstetrics facility in the hospital,
>but fewer family doctors seem willing to perform births there, preferring to
>send their patients to the larger hospials in Moncton.
>
>Do you have examples of how hospital facilities can or have been used for
>medical-related or non-medical-related activities that can meet population
>demand and provide employment?  Please e-mail directly to [log in to unmask]
>
>David Bruce, Research Associate
>Rural and Small Town Programme
>Mount Allison University
>Sackville  NB  E0A 3C0
>506-364-2395  506-364-2601 (fax)
>[log in to unmask]
>
>Visit our WEB SITE at http://www.mta.ca/rstp
>
> ----------
>Re: > Do you have examples of how hospital facilities can or have been used
>for medical-related or non-medical-related activities that can meet
> population
> demand and provide employment?
>
>I think this is an issue that is being faced by a lot of small, rural
>communities. I would appreciate seeing some of this information posted
>directly to the list. In our area we have a 150 bed hospital surrounded
>by 4 smaller (20-30 bed) facilities. With the rationalization taking
>place in the Manitoba health sector, it doesn't take a rocket scientist
>to predict that one or more of these facilities will be closed or have
>to change function. So, the quest is on...
>
>Ken Arundell                                      <[log in to unmask]>
>Assistant Manager                       <http://www.cpnet.net/cp>
>Central Plains Inc. - A Manitoba Regional Development Corporation
>___________________________
>
>To: ced-net
>Cc: localgov; crrf-l; ruraldev; rural; maritgr; geoatlantic-l; rural;
>non-met-dev; rurcan; arktel; cap-atlantic-network
>Subject: Responses to Alternative Uses for Community Hospital
>Date: Monday, May 13, 1996 10:12AM
>
>Thanks to everyone who contributed ideas for our list of alternative uses
>for a small community hospital.  We presented the list below to a large
>group of residents and others who worked in small groups to flesh out
>priorities, possible actions, etc.  I have also attached two ideas that came
>in late after the list was used by the group.
>
>
> --=====================
>
>
>          Ideas List of Alternative Uses for Hospital Facilities
>                       (From experiences elsewhere)
>
>I.   Specialized Medical Services
>     Physiotheraphy/Occupational therapy
>     Pathology
>     Chronic care - Parkinson's; Arthritis; Alzheimer's
>     Acute care/Trauma Centre
>     Palliative care - AIDS
>     Paediatrics
>     Geriatrics
>
>II.  Clinics
>     Nutrition                Incontinence
>     Maternity                Teenage sexuality
>     Wellness
>
>III. Centres
>     Rehab Centre - Industrial injuries such as agricultural,
>     fishing, mining; other workplace injuries Research Centre,
>     e.g. environmentally sensitive research; epidemiology, etc.
>
>IV.  Training
>     Birthing Centres, e.g. midwife training
>     Nurse Practitioners
>     Satellite campus for medical schools/research institutes, e.g.
>    Dalhousie University
>
>V.   Community Health Centre
>     "One stop shop" - combine all health and human services under
>      one roof, including Public Health, Red Cross, VON, Extra
>      Mural, Mental Health, Social Services, etc.
>
>VI.  Others
>     Community College
>     Retail outlets
>     Child care centre
>     Community education and awareness building, ex. preventive
>     medicine
>
>NOTE: Any of the items on this list may be further broken into
>delivery; care; treatment; training.  Many also have research
>centre potential.
>
>
>Two late additions:
>
>I have no direct experience, but have always visualized a community
>healing centre which would combine traditional medical care with
>space for businesses related to health, including nutritionist,
>massage therapists, family counselling, daycare, a small gym or
>exercise facility, perhaps midwives, lactation consultants,
>etc...plus space for workshops adn community meetings on
>meditation, various healing practices, herbal remedies,
>cooking/food preparation courses, etc.
>
>MOst community colleges are cutting back on these "general
>interest" types of programs, but we are very much a part of a
>learning society.  Could also include a seniors centre, library or
>resources, ACCESS TO THE INTERNET, distance education centre,
>up-grading or adult ed centre...
>
>Combining government funded services with private business and
>entrepreneurs can be to everyone's benefit.  Of course, it depends
>partly on the population of the surrounding area to determine
>whether there is enough potential business to support it.  However,
>you may find that there are lots of home-based business people
>locally who would be interested in having access to a facilty
>part-time, or an outlet for their products.
>
>_______
>
>Apart from my work at the above address (Uni of Tasmania), I work
>at the Westbury Community Health Centre.
>
>Originally this was Westbury Hospital and later became a nursing
>home catering for 9 residential patients. This was closed down and
>the patients were relocated to other nursing homes. The main
>hopspital being 30 minutes away. There are only 2 family doctors at
>the local clinic.
>
>In its place there is the Westbury Community Health Centre which is
>staffed by:
>
>1 Diversional Therapist (part-time), who provides day centre and
>community services for the frail aged and disabled members of the
>municipality
>
>1 Community Nurse (full-time), who works with frail aged and
>disabled members of the community, often making house visits and
>giving follow-up treatment to patients who have been released from
>institutional care. She has several home maintenance and home
>carers working under her program as needed.
>
>1 Social Worker (full-time), who provides counselling and other
>services which aim to improve the well being of residents of the
>Municipality.
>
>1 Family & Child Health Nurse (full-time), who provides advice and
>aid to parents with children up to highschool age.
>
>1 Youth Worker (part-time), who works with youth from 14 to 22
>years old in providing them with activities and services (including
>education).
>
>1 Centre Manager (full-time), who apart from ensuring the efficient
>operation of the Community Health Centre, is instrumental in health
>promotion activities (not just physical but emotional and spiritual
>as well). This often means giving direction to community groups who
>come together with a common aim  so that they can reach their aim
>(Many people have ideas but do not have the skills to implement
>those ideas). She is also responsible for recruiting and training
>of volunteers which make so much of the work done by the Centre
>possible.
>
>For any other information, please feel free to contact me on the
>above e-mail or write to:
>
>                Centre Manager, Annette Barrett
>                89 Bass Highway
>                Westbury TAS 7303
>                Australia
>                Tel: 003-931222
>                Fax: 003-931872
>
> --=====================_832007484==_--
>
>
Geoff Rowlands
Partner
Health Management Resource Group
Vancouver, British Columbia
Voice (604) 730 0121   Fax (604) 730 0120