Canada, US Struggle to Provide
Health Care to Those Who Need It Most

By Harmony Huskinson
Cronkite Borderlands Initiative

NIAGARA FALLS, N.Y. — Tourists travel here from around the world to see the famous falls, to feel the mist brush against their cheeks and to gaze upon the cascading white water along the border between Ontario and New York.

But the natural wonder of the falls belies a sobering fact. The twin cities of Niagara Falls, Ontario, and Niagara Falls, N.Y., host a large population of elderly and poor citizens with chronic diseases like diabetes, heart disease and obesity. Making things worse is that many of those most in need do not understand how to access the health care systems for treatment, must endure long waiting periods, and are too poor to afford health care.

“We have very good people working in some very broken systems," said nurse Karen Franco about the Canadian Healthcare System.  "We have excellent physicians and excellent nurses and excellent health care, but the system is cumbersome.”

Franco works at Niagara Falls Memorial Medical Center in New York, but lives on the Canadian side of the border.

Nurse Karen Franco in her home in Ridgeway, Ontario. Franco works as a nurse at Niagara Falls Memorial Medical Center in New York and crosses the border to go to work. Photo by Lillian Reid.

Some of those in medical need in Canada must wait months for a surgery, while others in the U.S. simply can’t afford it.

“This community is old and poor. It’s had a stagnant population for 30 years. We didn’t have the bust, because we never had the boom,” said Fred Caso, vice president of community relations at Mount Saint Mary’s Hospital in Niagara Falls, N.Y.

Around 12 percent of Niagara County, N.Y. adults did not have health insurance, according to a 2008 Community Health Assessment — in many cases because it was too expensive, Caso said.

The poor in Niagara Falls, Ontario, also have trouble accessing care. Although the Canadian system pays for their health care, they get lost in a complicated network of specialists, tests and privatized services.

“Poverty is hidden in our community,” said Diane Corkum, operations director for Project Share, a community food bank in Niagara Falls, Ontario.

Hospitals on both sides of the border struggle with high costs associated with those who use the emergency room for primary care services.

“A lot of people tend to use the emergency room as a physician’s office, and the emergency room is set up as the emergency room," said Vicki Landes, administrative director of the Niagara Health Home. "That’s what it means — an emergency."

Landes said patients have gone to emergency rooms seeking care for toothaches and similar ailments.

Landes's program seeks to steer these kinds of patients away from the emergency room and into appropriate places for care.

“A lot of people just don’t take the time and really listen to them and help them," Landes said. "And that’s what our goal is, to take the time, figure what’s going on and help them get the services they need."

Brady Wood, chief communications and external relations officer of the Niagara Health System in Ontario, said the Canadian health system also struggles with emergency room over-users.

Wood said the Niagara Health System is working to find a strategy to help these "frequent fliers."

The hospital identified someone who was using the emergency room nearly every day, Wood said. Hospital costs associated with that person quickly built up.

“It’s not an easy situation … but there are a lot of supports for the poor in the system, and we’re getting to have more,” Wood said. “I don’t think people really realized necessarily that that was going on.”

But in Canada, even those who go to the right place for care often have to wait for it.

Heather Thiffault, a resident of Niagara Falls, Ontario, was on her way to receive knee replacement surgery at the Greater Niagara General Hospital Site on March 13, 2013, after injuring herself on Oct. 31, 2012.

Thiffault, a middle-aged woman with short red hair, said she felt great relief that she would be finally rid of her pain on the day of her surgery.

On the outskirts of the hospital, she limped to a parking meter, cane in hand, to pay for the several hours her surgery would require.

“I haven’t been able to stand or do any extensive walking since the end of October,” Thiffault said. “Pain changes your personality. When you’re trying to cope with not being able to do things and hurting all the time, you don’t want to different than you, but it’s pretty difficult not to be.”

After some initial tests, Thiffault waited six weeks for an MRI, a week and a half for the results, and then another six weeks to see an orthopedic surgeon.

At first she was told she was too young to receive a knee replacement, but her pain persisted and so did she.

Heather Thiffault about to enter the hospital for knee replacement surgery. She waited six weeks for an MRI in the Canadian medical system. Wait time is the top complaint from patients in Canada's government supported healthcare plans. Photo by Lillian Reid.

“If I’d had the MRI right away, I probably could have seen the surgeon much sooner and the whole process could have happened faster,” Thiffault said.

According to a wait time calculator for the Ontario Ministry of Health and Long Term Care, the typical wait for a knee replacement surgery in the Niagara Health System is 244 days.

But Thiffault got lucky, she said, because she was on a cancellation list that allowed her to replace someone who rescheduled or cancelled a scheduled surgery.

After seeing the orthopedic surgeon, Thiffault only waited two weeks to get her surgery.

She walked into the hospital, clutching her cane with a look of mild pain and much determination.

“They have to do a better job of figuring out who needs to get it done faster,” Thiffault said.

Michael Carter, a professor in the Department of Mechanical and Industrial Engineering at the University of Toronto, worked with the Canadian Ministry of Health to develop the wait time calculator.

“I believe that engineers have an opportunity to make the health care system better,” Carter said. “Every time I go into a hospital I’m just shocked at the waste.”

As a director of the Centre for Research in Healthcare Engineering, Carter works with hospitals to reduce patient wait times and increase efficiency. He teaches a class in which engineering students learn about applying the connections and organization of engineering to the health care industry.  

Numerous problems combine to confound a fragmented system, including over-specialization, lack of preventative care, miscommunication and failure to look at the flow of patients, Carter said.

“There was no wait list, you’d go into your doc and he would say ‘I’ll put you on the wait list,’ secretary writes it down on a piece of paper, and you’re on the wait list. But there’s no national, provincial wait list,” Carter said.

That was in 2006, and since then Carter has worked with the ministry to develop a calculator, and wait times have decreased to an average of two months for a surgery in Ontario.

Instead of waiting to access free care, some Canadians simply pay extra for instant health care south of the border.

“We have two-tier medicine, it’s called the United States,” Carter said. “So if you want to have it tomorrow, you go to Buffalo.”

But some health issues in the twin cities of Niagara Falls aren’t fixed so easily.

Both municipalities are burdened with citizens suffering from chronic illnesses like diabetes and heart disease. Around 62 percent of adults in Niagara Falls County, N.Y. were overweight or obese, according to a 2009 study from the Niagara County Department of Public Health.

In the Niagara Falls region of Ontario, 52 percent of adults were overweight or obese, according to the Niagara Region.

Community hospitals play a huge role in fighting these challenges and others, said Ann Marie Tucker, vice president of community relations at Niagara Falls Memorial Medical Center.  

“People should have access to high-quality care in their own communities, even if it’s just a half hour away," Tucker said.  "But the half-hour can make a big difference."

Caso said that the more affluent have fled the cities for the suburbs, leaving behind an impoverished population with more health problems — and who struggle with transportation to appointments or who simply don't want to leave their community to seek care.

“We have people who would almost rather be amputees than cross the bridge,” Caso said.

Systems on both sides of the border are intensively working to recruit more doctors to their communities and thereby provide more health care options.

The U.S. Department of Health and Human Services designated much of Niagara Falls, N.Y. as a Health Professional Shortage Area and a Medically Underserved Area.

A Health Professional Shortage Area is defined by the USDHHS as an area that has shortages of primary medical care, while a Medically Underserved Area has too few primary care providers, high infant mortality, high poverty or a high elderly population. 

Caso said Mount Saint Mary’s works proactively to recruit physicians. He added that some doctors avoid the area because they will not make as much money.

But his recruiting pitch to young doctors is simple and practical — Mount Saint Mary's will handle all of their logistical and administrative needs.

“They want to practice medicine, they don’t want to run businesses, they don’t want to hire receptionists, and put in computer systems and all the rest of it," Caso said. "They want to treat patients." 

Family doctors and specialists are also in short supply in Niagara Falls, Ontario — partly because of a national "Brain Drain" to the U.S.
 
Often Canadian doctors will receive their medical education north of the border and then move to the U.S. to make more money in a privately funded system.

Health care officials say nurse practitioners can replace some of the care provided by doctors, and people can access top-quality specialists in concentrated areas, regardless of the country in which the service resides.

Nonetheless, residents of the Niagara Falls, Ontario region are worried that new changes in the Niagara Health System will affect their access to care.

Siemens SOMATOM Definition AS Open CT machine in the new St. Catharines Hospital, which is replacing the aging facilities of St. Catharines General Hospital and the Ontario Street Hospital. Photo by Lillian Reid.

The Niagara Health System, the multi-site hospital amalgamation in Niagara Falls, has been under scrutiny for and centralizing care in a new hospital in St. Catharines, which is at least a 20-minute drive from Niagara Falls.

Thiffault, the patient waiting for knee surgery, said while there are benefits to a new facility, the location is a drawback. “I’m sure it’s a beautiful facility, I don’t want to deny that, but I think the location of it is bad.”

For example, the maternity ward and in-patient mental health treatment have moved from the Greater Niagara General site to the new St. Catharines hospital.

Laura Blundell, health promotions coordinator at Niagara Falls Community Health Centre, said many of her patients depend on nearby in-patient services. They will be affected by the move to a better-equipped, but farther-away hospital.

“That’s going to be an enormous change for our client population, not only trying to figure out how they’re going to get themselves there if they need to be hospitalized, but how they’re going to get home,” Blundell said.

However, she said the health centre has been working with the Niagara Health System to set up a shuttle system for those who need in-patient services.

On the other hand, Arlene White, director of the Binational Alliance in Buffalo, N.Y. and a resident of the Niagara region in Ontario, said the new hospital and movement of its services are beneficial to a system that needs consolidation.

“It’s the same philosophy of a school in every neighborhood, a church in every neighborhood, a shopping mall in every neighborhood," White said. "It’s not like that any more. And realistically it never was."

White said best care arises from concentrated areas that provide core services in one area but services other needs through clinics and auxiliary services.  

However, she said she understands why many Ontario residents might feel anger or dismay.

The older generations of Niagara communities remember putting their money into building a nearby hospital. The buildings become symbols of the community and an attachment grows.

“It becomes a very emotional issue, and it becomes a real estate issue rather than a servicing issue,” White said.

The new hospital will update and add much needed services like dialysis, angiograms to detect blood flow in the arteries, other cardiac services, and radiation therapy for tumors.

Regardless of the multitude of health care issues facing the public and providers in the Niagara border region, health care officials say they must carry on.

“You have to reach out to your community,” nurse Karen Franco said. “It’s back into the community and serving the population and the diseases that are in your community, and trying to make your community the healthiest it can be.”