Spring 2014 (Volume 24, Number 1)

News of Newfoundland & Labrador

By Paul Dancey, MD, FRCPC

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My last regional update for the CRAJ was almost 10 years ago. I was still in the early stages of working at the Janeway Children’s Hospital and Memorial University as a pediatric rheumatologist. I can recall leaving the hospital every day with a stack of charts to review in the evening in preparation for the next clinic. With current privacy laws I would probably be arrested before reaching my car if I tried to do that again. While it is interesting to meet new patients, I have also come to appreciate getting to know patients over the longer term. While that stops at age 18 (not really long term!), patients still drop in to let me know how they are doing. I received my first consult request recently for the child of a former patient. Yet another mark in the passage of time.

Our new medical school building in lovely St. John’s.

In the last update I was hoping that a subspecialty nurse would be added to the team. For the last several years, Betty Sheppard has taken on this role, dividing her time between rheumatology and gastroenterology. Her presence has made a huge difference to improving patient care. The diagnosis and treatment plan is relatively straightforward, compared to figuring out how to start methotrexate (MTX) or biologic injections for a patient living in rural parts of Newfoundland or isolated areas of Labrador. Betty seems to have a direct line to everyone and can get things done quickly.

The number of patients coming through the adult rheumatology program continues to be almost overwhelming for the small but outstanding group of rheumatologists in the province. Dr. Nayef Al-Ghanin came aboard in August of last year, joining Dr. Sean Hamilton, Dr. Proton Rahman,
Dr. Majed Khraishi, and Dr. Ramin Yazdani. Given their research and teaching responsibilities their numbers fall well short of the seven full-time-equivalent rheumatologists needed to serve the province. Despite the challenges there has been a significant improvement in access to rheumatology care with the assistance of a team of allied health professionals. A rheumatology nurse practitioner helps triage standardized referral forms, and can direct patients into a rheumatology health program that includes the services of a physiotherapist, occupational therapist, pharmacy, as well as the rheumatologist. Patients with inflammatory disease thus have early access to an effective multidisciplinary team.

Newfoundland and Labrador is on the eastern edge of the country and the leading edge of research and technology development. Dr. Khraishi and software engineers at Newfoundland and Labrador Research Technologies (www.nlrt.ca) have developed several apps for both screening and monitoring arthritic disease; these are available on iTunes. Genetic research is one of our strengths, which will be further facilitated with the opening of a new genetic research facility at Memorial University. The medical school class size has now expanded from approximately
60 to 80 students. The new medical school building opening later this year will provide state of the art classroom technologies and an advanced patient simulator. So despite the rumors of fog, the sun is always shining out this way. Come and visit and you might just choose to stay.

Paul Dancey, MD, FRCPC
Associate Professor of Medicine,
Pediatric Rheumatologist,
Janeway Children’s Hospital and Rehabilitation Centre
St. John’s, Newfoundland