Canada’s best medical care for women

Source: Best Health Magazine, May 2009

More and more, researchers and medical practitioners here and abroad are recognizing the need for a ‘gender lens’ in delivering health care, because the way a medical condition affects women is often different from the way it affects men. But some Canadian institutions have been delivering female-focused care for years, and are setting a good example for our healthcare system nationwide. We zeroed in on four such women’s healthcare facilities, and one that will open in 2009.

Women’s College Hospital, Toronto

History: Traces its origins to the 1880s, when Women’s Medical College was established in response to the refusal of medical schools in Toronto to admit female med students. The name was officially changed to Women’s College Hospital in 1924, and in 1935 the hospital moved to its present location, a 10-storey, 140-bed facility. Staff members have pioneered numerous improvements in women’s health, including the use of the Pap test and the opening of the first cancer detection clinic in Ontario. Women’s College was the first hospital in Ontario to use mammography and the first in Canada to have a perinatal intensive care unit.

How they help: Covered by provincial health insurance and available on a self-referral basis, the Women Recovering from Abuse Program (WRAP) at Women’s College Hospital is the only childhood abuse program for adult victims of child abuse in Canada. It’s also uniquely situated inside a large urban hospital, and Eva-Marie Stern, a psychotherapist and art therapist who helped start the program, says the connection dovetails well with WCH’s philosophy of women’s health. ‘At Women’s College, we believe mental health affects physical health,’ she explains, noting that conditions such as fibromyalgia have been linked to childhood maltreatment. Indeed, many of the women who have gone through the WRAP counselling sessions were referred by physicians at WCH’s Family Practice Health Centre.

For four half-days a week over a span of two months, a group of eight women gathers with WRAP’s team of professional facilitators to begin the hard work of repairing the many effects of childhood trauma, including their capacity to forge relationships. The facilitators help the women to explore their experience, express themselves candidly and take risks in relating to the others.

Stern notes that part of the process involves art therapy, which allows survivors to express feelings they can’t articulate in words, sometimes because their abusers had threatened revenge if they ever spoke about their experiences.

In the 10 years of its existence, about 350 women have gone through the program, and there’s always a waiting list, says Stern. She adds that a qualitative assessment of the program showed that graduates reported better relationships, a greater sense of security and improved self-esteem.

Women’s Health Clinic, Winnipeg

History: Opened in downtown Winnipeg in 1981, and remains the only women’s health clinic in Canada with a community board. Funded by the Winnipeg Regional Health Authority and the United Way. With physicians, nurse practitioners, mental health counsellors, a dietitian, midwives and several volunteer programs, the clinic serves women of all ages and backgrounds with reproductive health needs, mental health issues or complex women’s health concerns.

How they help: When a ‘client’ books an appointment at the Women’s Health Clinic, she can always expect to spend a comfortable 20 to 40 minutes with one of the facility’s healthcare practitioners. ‘We try to address all of her health issues during her visit,’ says medical director and family physician Dr. Carol Scurfield.

The clinic was founded by a group of women in the community who felt that women weren’t being well served by the mainstream healthcare system. Accountable to a community board, it has adhered to a philosophy of care that is both holistic and realistic. As Scurfield points out, health concerns are actually inextricably connected to the individual’s lifestyle and socio-economic circumstances. The clinic’s practitioners feel that in order to offer meaningful and collaborative advice, they need to know what else is going on in their clients’ lives. The basic belief, she says, ‘is that women are experts on their own bodies.’

The clinic has steadily expanded its services and now offers consultations and outreach programs on unplanned pregnancy, sexually transmitted infections, birth control, mental health, menopause, adolescent health issues, mothering issues, services for immigrant women and political advocacy on public health policy.

The clinic also believes in the importance of promoting population health and a gender analysis of health care and public policy. That involves community education and the operation of several volunteer programs with preventive health practices for women and children.

BC Women’s Hospital & Health Centre, Vancouver

History: Founded by The Salvation Army in 1927 as the Grace Hospital. The only facility in British Columbia that is devoted primarily to the health of women, newborns and families. With 7,500 deliveries annually, BC Women’s is Canada’s busiest maternity centre. It also provides provincial leadership in developing, maintaining and participating in effective networks of partners who share the goal of better health for women and their families. As an academic health centre, BC Women’s is affiliated with the University of British Columbia, Simon Fraser University and Women’s Health Research Institute.

How they help: In 2005, hospital obstetricians began scrutinizing delivery data and discovered that the province had a noticeably higher rate of C-section births than the rest of the country. They concluded that geography played a role: In remote communities it was often easier to transfer an expectant mother to a larger centre and perform a scheduled C-section, explains obstetrician/gynecologist Dr. Jan Christilaw, vice-president of medical affairs at BC Women’s. But the goal now is to find ways to allow women to deliver in their own communities, where they are close to family and support networks.

Given its mandate, BC Women’s has launched several outreach initiatives in the past decade to reduce the provincial C-section rate. These include Friday morning telehealth ’rounds,’ during which physicians from anywhere in the province can tune in to live two-way videoconferences by BC Women’s specialists. The hospital’s obstetricians have taken advantage of virtual communications to train dozens of small-town GPs to perform certain types of general procedures, such as C-sections. And physicians in remote communities can upload ultrasounds to the Internet for ‘a consult if they spot something troubling.

IWK Health Centre, Halifax

History: Formed in 1996 with the merger of Halifax’s Grace Maternity Hospital and the Izaak Walton Killam Hospital for Children (though its history dates back 100 years). Has the greatest number of births among maternity wards in Atlantic Canada. Specializes in health care for women, children, youth and families. IWK includes many outpatient clinics both on- and off-site.

How they help: About three years ago, Dr. Scott Farrell, an IWK uro-gynecologist, decided to launch a clinical trial to follow up a hunch he had about the way women seek treatment for urinary incontinence, a problem he says affects one in three women age 30 to 65.

Farrell had observed that many physicians in his field tended to offer women surgery rather than ‘conservative’ options, such as exercises and the use of a pessary’a device made of medical-grade rubber that is placed in the vagina to stop bladder leakage.

His team of three uro-gynecologists and four nurses compared patients who had referred themselves to a clinic staffed by a continence educator and nurses with patients who had been seen by gynecologists. The former group tended to receive the more conservative treatment options. The trial confirmed Farrell’s expectations: that such non-invasive approaches produce results that are as good as surgery’and sometimes better. That’s partly because the continence educator was able to spend the amount of time needed to better educate patients on how to deal with this benign but stressful condition.

In 2005, led by nurse continence advisor Linda Irving, a self-referral continence clinic at the IWK was established. It’s the first of its kind in Atlantic Canada.

Incontinence becomes more common in older age groups. Farrell predicts more strain on healthcare resources as well as gynecologists as baby boomers grow older.

At the same time, it is also a frequently untreated condition. Farrell notes that between 50 and 80 percent of sufferers don’t seek medical help, sometimes because they’re intimidated by physicians or feel ashamed. In addition to the self-referral clinic, which focuses on long-term management and education rather than on surgical intervention, Farrell recently set up a company that developed an over-the-counter self-inserted pessary, known as Uresta, which is available in Atlantic Canada and will be distributed this year to drugstores across Canada.

Lois Hole Hospital for Women, Edmonton

The plan: A six-storey, 160-bed facility being built on the Royal Alexandra Hospital campus, and part of Alberta Health Services. Construction began in 2005; expected to open in 2009. Will focus on high-risk births, specialized clinics and in-patient gynecology, telehealth services to patients in distant communities, women’s health research and training of professionals in women’s health. Mandate to serve patients throughout Alberta and northern Canada.

How they will help: ‘Down to earth and so sincere.’ That’s how Joanna Pawlyshyn, vice-president of Edmonton’s Royal Alexandra Hospital, describes the much-beloved former Alberta lieutenant-governor Lois Hole, whose name will adorn Edmonton’s newest hospital-within-a-hospital. The trick, she adds, was building a facility that embodies what Hole meant to Albertans.

When Pawlyshyn and her development team began cobbling together a vision, they decided to embrace the obvious elements’such as state-of-the-art operating room technology’as well as design details that will distinguish Lois Hole Hospital for Women as a hospital designed with women in mind.

Instead of treating women’s conditions such as pregnancy as illnesses, the hospital opted for a ‘wellness’ model for the birthing rooms, so spouses, children and families could be accommodated. The designers consciously opted for a spa-like ambience, with soothing colours and finishes, natural light-filled common areas and lots of art instead of the clutter of signs that typifies most hospital corridors. The in-patient rooms, two-thirds of which will be private, are set up to have the look and feel of hotel suites, complete with makeup mirrors, adjustable shower heads and high-end fixtures.

Those décor details complement a layout that is tailored to the hospital’s proposed specialties, including high-risk multiple births. Two operating rooms just for C-sections will be situated across the hall from the labour delivery rooms. All rooms are on the same floor as the neonatal care unit, to reduce transfer time and delays.

This article was originally titled "Leading the Way for Canadian Women," in the May 2009 issue of Best Health. Subscribe today to get the full Best Health experience’and never miss an issue!’and make sure to check out what’s new in the latest issue of Best Health.