Island Doctor

July 1, 2008

A diminutive, wiry man, Dr. Jesus Dapena moves around his small hospital on Grand Manan island with the purposefulness and ease born of almost four decades of service. He is immaculately dressed with the flare of a toreador: maroon pants, elegant leather shoes and colourful tie offsetting his white shirt and a subdued tweed jacket.

“It’s nothing,” he assures one of his patients who complains of pain in her wrist. “It’s a sprained wrist. You did not break anything. Take it easy,” he orders brusquely. The lady he is talking to is well over 70. She says she did not do much of anything except lift baskets of wet laundry.

Another patient complains of a sore throat. A swab is clear. “It’s a virus. Stay home and it will go away. There is nothing I can give you. Antibiotics don’t help here. You can’t kill a virus,” he tells her. She explains that they are short staffed and that she has to go back to work. He looks at her sternly: “And I am telling you to stay home. Be kind to yourself and to those around you. Do what you must.” She asks if it is contagious and he waves his hand. “Of course it’s contagious.”

Dr. Dapena is the only physician on Grand Manan, an island off the coast of New Brunswick. That for 36 years this 74-year-old Spaniard has alone served the island’s 2700 residents is a reflection of the almost impossible task remote and rural communities face: finding and keeping family physicians.

For 36 years islanders of Grand Manan have been able to count on Dr. Dapena to treat their ills and listen to their complaints. But retirement is looming. At the very least, Dr. Dapena would like to work fewer hours. But how to find a replacement?

That few of today’s family physicians are willing to work the demanding hours of old-style physicians like Dr. Dapena is readily acknowledged by the Dean of Medicine at Memorial University in St. John’s, Newfoundland, Dr. James Rourke.

“[In a rural setting] you get into a lot more involved medicine. It’s very dynamic and very challenging,” he said.

For that reason there aren’t many medical students graduating today who plan to work in rural areas.
Forty years ago Dr. Dapena certainly had no plans of staying on Grand Manan for the rest of his life. “I planned to stay for one year,” he recalls with a chuckle.

Dr. Dapena arrived in North America in the sixties as a young medical doctor. He opened his practice in New York, but in 1967 he accepted an offer to work in Fredericton. After two years he obtained his Canadian license. Almost immediately, he was asked to practice on Grand Manan for a year.

“Then I met my future wife on Grand Manan. I got married and from then on…”

The islanders, who pronounce his name with a long e (Da-peen-a) instead of the open Spanish version (Da-pen-a), speak with affection of their only doctor for almost forty years. But the relationship between islanders and their only doctor can sometimes be ambivalent. “He might not be my favourite doctor, but he is loyal to the island and that is a lot,” says Burt Green, lobster fisherman and patient.

The line that separates a doctor’s work and his personal life in a remote area is thin: Dr. Dapena rarely leaves the island for longer than a day at a time; he can recall the medical history of virtually every person who lives on the island.

“I know everybody here. As a matter of fact, I have all sorts of charts on every person, but I think I have everyone in my mind,” he says. “You see everything here. Everything that you would see in a big city. All kinds of traumas, accidents, everything.” He is thoughtful for a moment and than he adds: “In a big city, let us say New York – when I saw somebody in New York, I never met the man or the woman, never met them before. I saw they were sick, but it did not mean anything. Here you know everybody. You know their families. It’s always… It’s trauma. My goodness. It’s really hard.”

There was the day Dr. Dapena left. His son’s best friend, Julian, had an accident, leaving one of his wrists slashed wide open. Debbie Charters, Dr. Dapena’s secretary of 18 years recalls the day vividly; Julian is her son.

“He [Dr. Dapena] was away that day. He never goes away for more than a day, because there is nobody else here. His son Desmond, [and Julian] were playmates, they played together. Desmond was absolutely horrified that his father wasn’t here to stitch [his friend] up,” she recalls. “Six hours had not transpired, so he did stitch him up, but his son Desmond was very upset that his father was not here to help [his friend] at the time.”

Stories such as this one illustrate why it is so difficult to find doctors to serve in remote places such as Grand Manan.

But, says Dr. Rourke: “Some of the good things about practicing in a small community are also the difficult things. The good part is that you get to work in a place where people go to vacation. But then, knowing everybody, you still have to be able to do things you need to do as a doctor and be friends with some of the people you are treating. You have to be what I call an omnipractitioner. You have to be an expert in a variety of areas. You get to use so much of what you learned in the medical school.”

The Faculty of Medicine at the Memorial University has the highest percentage of graduates in Canada who decide to work in a rural setting. As much as 40 percent of family medicine program graduates end up working outside of major urban centres, mostly in Atlantic Canada. Dr. Rourke believes that reflects the composition of their students as well as the school’s focus on serving the communities of the Atlantic provinces.

Replacing a doctor in a more remote area like Grand Manan is difficult, he concedes. There are, he says, legitimate reasons for young graduates to stay away from rural practice.

“Medicine has advanced so much so the amount of knowledge is increasingly complex and it is increasingly difficult to be a jack of many trades,” he says.

Adding to that pressure is a patient population that is more knowledgeable than ever about health issues, a population that expects to receive the same treatment wherever they happen to live.

That can be difficult to offer in a small community.

Dr. Dapena works out of a small hospital with ten beds. He is also in charge of a 30 bed nursing home facility, which he claims is too small for the island’s needs. The hospital, however, is as good as it’s going to get, he says.

The changes witnessed during his career are staggering. He no longer has to transport patients in the back of a station wagon borrowed from a fellow islander; today he can have a patient airlifted and has access to digitized x-rays which can be instantly interpreted by a skilled specialist in Saint John. He used to hire taxis almost daily to run blood samples to Saint John on a ferry and return with the previous day’s results. Today, he can perform basic blood tests at the facility on Grand Manan and the detailed reports are available three times a week through a specialized team that visits the island on Mondays, Wednesdays and Thursdays.

“What they have now is almost perfect. It’s ideal. I don’t think that in Saint John and here you get any different quality of medical care. If you live in Saint John it might take you half an hour or 15 minutes to get to the hospital. I can put you in there in an hour. That’s not bad either. And in that time we are already beginning the care,” he says.

He loves his work. But, at 74, he would like to work less. Not retire, but work less.

“What would you do if you had nothing to do? It’s too much or nothing. You don’t have choice of something in between. I want something in the middle. It’s too much work or no work at all. I mean, that is no good at all,” he says.

That a new doctor will come to the island late this summer on a two-year-contract is a victory not only for his semi-retirement plans, but for the islanders, who feared that they could find themselves without a family physician.

Yet the change will be a difficult one, says Dr. Dapena’s secretary.

“I think that there may be a sense that the place is his. But, obviously it isn’t. Of course it’s not. When you have that long attachment to the place it is a matter of having to let go and, I am assuming, that is not so easy, but it’s obviously something that has to be done. He loves his work. He loves his work and it is his life,” says Ms. Charters.

It will take time for a small community to adjust to the new doctor. Yet, there are no guarantees that Dr. Dapena’s new colleague will decide to stay on the island long term.

“Rural practice can be isolating. Most physicians want to work hard, but want some balance with their family life,” explains Dr. Rourke. The practice on Grand Manan is very much a 24/7 cycle with annual five weeks of vacation.

Dr. Rourke believes that there are four ingredients necessary to build solid rural medicine practice in Canada. He insists that we need more students with rural backgrounds in medical schools because they already understand and love the lifestyle and the environment they will be working in in the future. The second component, according to Dr. Rourke, that will attract more physicians to the rural practice are adequate facilities, probably along the lines of community health clinics that are collaborative and team oriented in their nature. Teamwork is the third ingredient in the mix.

“Everyone wants to work as a part of a team. We need colleagues to share challenges, joy, difficulties. We all need a supportive team,” he says.

The fourth ingredient is most often talked about – financial compensation. “There needs to be additional compensation for extra night and weekend work and to make it possible to keep up to date with the developments in medicine,” says Dr. Rourke. He adds that there should also be financial compensation for those working in geographically isolated areas. He is careful to emphasize that not all rural places should be classified as isolated because many of them have excellent access to major urban centres.

There are other countries that have made a conscious decision to invest in rural medicine, Australia, for example. Canada should do the same, says Dr. Rourke. He is encouraged by the developments in rural practice in Ontario where he and his wife worked as physicians for 25 years.

“Rural health is all about access. We can and should do better,” he says.

Dr. Rourke does admit (with a laugh) that there is another thing that has proved the most effective way of keeping a physician in a rural setting. “When they buy a house and meet a spouse you know you have them.”

For that very reason, what should have been a one-year detour turned into a lifetime commitment for Dr. Dapena. He would not change a thing. “I am very satisfied. I don’t regret staying here. If you look for money, the bigger the place, the more money. There is no question about that,” he says. “But there are rewards. I love the people here.”

One Response to “Island Doctor”

  1. Caroyl Losier Says:

    Dr. Dapena was definitely an amazing person and his dedication spoke volumes to our Island we call home. He will be sadly missed but his memory will be forever etched into the memories of our hearts . R.I.P. SWEET MAN.

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