Service interruptions will increase, says Shawville surgeon

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Added: Wed, 03/27/2019 - 12:53pm
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Allyson Beauregard

SHAWVILLE – From 8 am until 6 pm on March 3, the Pontiac Community Hospital (PCH) experienced an interruption of service when a general surgeon wasn't available for on-call duty. Emergencies were directed to Gatineau or Hull.
While the PCH has only had two short surgery interruptions since August 2018,
Dr. Freydoun Homayounfar (Dr. Fred), one of the PCH's two on-call general surgeons, warns the problem will worsen if something isn't done soon.
Dr. Homayounfar and Dr. Nicholas Sperduto work alternating shifts at the PCH with a rotation of seven days on, seven days off. This means each of them is on call fourteen days a month while surgeons in the city generally don't
work more than five, because of additional personnel. Dr. Homayounfar said this schedule is demanding, mentally and physically taxing, and reduces their ability to cover each other's shifts due to burnout and legal requirements. 
Despite the seriousness of the problem, the Centre intégré de santé et de services sociaux de l’Outaouais (CISSSO) hasn't developed permanent solutions. “When one of us is absent and the other is unavailable to cover the shift, the only solution we're offered is an interruption of service. We're both getting older so the
interruptions will only get worse [unless better solutions are found],” said Dr. Homayounfar.
A lack of replacements with the training required to serve the PCH is a major contributor to the problem. The PCH is the only rural hospital in the Outaouais offering obstetric care. In other regions, pregnant women are directed to Gatineau or Hull. While the PCH's obstetric unit allows patients to receive care closer to home, its presence means on-call surgeons must be able to perform caesarean sections, a skill many general surgeons are not equipped with. “About 80% of emergency surgical interventions at the PCH are c-sections,” said Shawville's Dr. O'Neill, who is also headof Anesthesiology.
The solution is not complicated, noted both Dr. Homayounfar and Dr. O'Neill; other regional general surgeons could complete the short training required to perform c-sections and then offer their services to the PCH or new doctors could be hired who have or are willing to take the training. However, this would require
concerted effort on behalf of all parties: the province, CISSSO, the community (to make new doctors feel welcome), and other general surgeons in the region.   
Dr. Homayounfar said as little as thirteen weeks (a quarter of the year) of relief per year would drastically improve the current situation at the PCH including his and his colleague’s quality of life. “Right now, it's difficult to even get one day,” he concluded.  
Maniwaki's hospital is plagued by frequent and long duration failures given that they only have one anesthesiologist and most of their surgeons do not live locally. They experienced a nine-day closure in December.
Emergency caesarean required  
Although no transfers were needed at the PCH on March 3, a local mother was
transported to the Gatineau hospital for an emergency caesarean about eight hours prior to the planned interruption. Renée Lance arrived at the PCH before midnight on March 2, three days before her scheduled caesarean, with severe abdominal pains and contractions. She said she was told the on-call surgeon was unable to respond, but CISSSO maintains the transfer was due to her condition. 
Lance found out the reason for the severe abdominal pain in Gatineau; she had suffered a uterine rupture and the baby had moved into her abdomen. A uterine rupture is a rare, serious and sometimes life-threatening condition where the uterus tears. Rapid response reduces the risk of serious consequences.
“The surgeon kept telling me how lucky I was that we were both okay,” said Lance,
who was discharged 36 hours later with her healthy baby boy. “The lack of services I experienced was unacceptable. I needed an emergency c-section usually performed in Shawville, but didn’t receive care because of a breakdown in services,” she concluded.