Hope physician Dr. Joshua Greggain is a 2020 recipient of the rural service award from the Society of Rural Physicians of Canada. Submitted photo

Hope doctor receives rural service award, after 16 years in Hope

Doctor Joshua Greggain said a network of services extending from Hope up the Canyon to provide care

A Hope doctor is a 2020 recipient of a rural service award from the Society of Rural Physicians of Canada.

Dr. Joshua Greggain is one of 13 rural doctors who have spent over a decade serving rural communities from Tofino to Happy Valley-Goose Bay. In Greggain’s case it has been just under 16 years since he first stepped foot in Hope.

Doing his rural residency in Hope in the fall of 2004, Greggain remembers there being three clinics in Hope which operated in their respective silos. A year later he returned to work as a locum on weekends and in 2007 he took on a full-time practice here.

Greggain said it isn’t anything ‘miraculous’ that he’s done, rather his working in the community for these years has provided a sense of ‘leadership’ and ‘stability’ in the community, something he’s honoured to be recognized for. Working rurally, Greggain said, allows a doctor to wear multiple hats and see people through the various parts of the local medical system, resulting in ‘true integration and collaboration.’

Greggain’s ‘hats’ include being medical director of Hope’s two clinics (the Hope Medical Centre and the Fraser Canyon Clinic), site medical director for the Fraser Canyon Hospital and chairperson of the Chilliwack division of family practice which covers primary care practitioners from Chilliwack to Boston Bar.

Sixteen years since he arrived here, what exists is a ‘network of clinics’ and services in place to tackle difficult local health-related issues from Hope extending up to Boothroyd, Greggain said. As an example, he said he can pair a person who might need to see Sue Lawrence, a nurse practitioner providing care to vulnerable populations, with Dr. Aseem Grover who is running an opioid agonist program (prescribing methadone and suboxone, treatments that prevent withdrawal and reduce cravings for people who are addicted to opioids), with the Hope and Area Transition Society and Fraser Health’s addictions services.

“Suddenly there’s a network of services being provided for a challenging situation which is usually addictions or mental health,” he said.

Greggain has also been working hard on how to retain doctors in the community. Since 2013, when three medical clinics closed down within a span of two years and Greggain declared Hope in crisis, the community has avoided what other rural communities are dealing with as doctors retire early without anyone to take their place. It’s a luxury, Greggain said, to have doctors who want to stay and invest in the community, including physicians he sees as ‘emerging leaders.’

“You don’t lead on your own, right, you lead with a team of people who are providing the service and the care in a manner that makes sense,” he said.

“I hope that what I’ve done, more than anything else, is create a culture of care for people and that includes people being looked after in the community but also then laid an expectation that the physicians and nurse practitioners genuinely care about who they’re looking after, and they can walk alongside their their patients and their clients.”

Read more: How Hope is avoiding the rural doctor shortage

Last year, the Anderson Creek Health Clinic in Boston Bar celebrated its 10 year anniversary. This clinic, on-reserve and Indigenous-led, “really changed the landscape of the Canyon” Greggain said. He was one of the first physicians practising at the clinic.

Working with Indigenous clients is humbling, Greggain said, many of whom have had challenges accessing and navigating healthcare.

“You have the privilege to work alongside people who have walked a very different path than I have,” he said.

With the worldwide protest movement decrying systemic racism against black and Indigenous people, Greggain said he has been reflecting on being a “middle-aged, white physician” and his role in the Indigenous communities in which he works.

“I’ll never pretend to know anything more than what the community says about their experience,” he said. “The hope is that we get to work alongside those communities to help get the service that they want, not the service that I think they need. Because I’ve not walked a day in anyone’s shoes who lives on reserve, I’ve only been given the privilege to be there.”

The rural service award is one of 14 awards the society gives out each year, honouring the work of doctors, residents, students and leaders in rural communities across Canada. The criteria for the award include having lived and worked in rural and remote Canada for 10 years.

This is not the first nod to Greggain’s efforts in the community. In 2016 he was named a health care hero for Fraser Health at the BC Health Care Awards, as well as receiving Fraser Health’s 2015 Above and Beyond Award.

Last year the community of Hope itself was recognized for its efforts in rural healthcare with the society’s Rural BC Community Award.

 Healthcare practitioners from other parts of B.C. praised Hope’s model at a December celebration, with Dr. Stuart Johnston saying Hope is the only community doing the ‘bottom-up or grassroots’ model of healthcare.

Read more: Hope received 2019 Rural BC Community Award

Celebrating his latest award, however, will have to wait as celebrations set for April were cancelled amid the pandemic. Dr. Greggain is being invited to next year’s awards in April 2021.

Pandemic a ‘great amplifier’

Greggain said the pandemic has brought on ‘dramatic’ changes in medicine over the past three months and has highlighted work that is needed locally.

While the community of Hope, as well as the more rural Fraser Canyon and communities along Highway 3, have been relatively spared from the virus thus far, work is needed to prepare for the second wave Greggain said.

Critical for the area is transportation, in order to improve access to testing for COVID-19, patient transfers and other needs should the virus arrive in these communities.

Read more: B.C. adds 55 ambulances, air support for remote health care

The pandemic is also showing, ‘amplifying’ in Greggain’s words, what people value. For himself, he has valued the time with family, as well as the time connecting with patients which has largely happened over the phone and videoconferencing. And the value of family physicians, who have always checked in on their elderly patients and are doing so during COVID-19 times, is being valued by the province as doctors are now getting paid to do so he said.

Some services, such as mental health and nephrology (kidney care) have gone nearly completely virtual during the pandemic. This has resulted, for example, in a zero per cent no show rate for mental health appointments Greggain said, as obstacles such as transportation are removed.

“I’ve been on the virtual care bandwagon for some time,” he said. “Across Fraser Health…we really need to have a more robust virtual care strategy.”

Read more: Virtual mental health supports in B.C. during COVID-19

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