Young doctor plugs hole in Hope’s addiction services

Dr. Aseem Grover found innovative ways to help drug users in Hope until he could create a clinic that offers more services to rural patients.

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HOPE — When family physician Aseem Grover started his first job in this small city, he was pretty shocked to discover that his patients found it “easier to get high than get help.”

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Grover had not planned to become an addictions specialist, but knew from his residency at St. Paul’s Hospital that there were many services and treatments that could help substance users. They just weren’t readily available to the 10,000 people who live in Hope and its surrounding villages.

It was 2016 and B.C. had just declared a public health emergency over an increasing number of fatal overdoses caused by toxic drugs. That crisis continues today, after claiming the lives of 9,760 British Columbians in the past 5½ years.

The rookie doctor reached out to addictions specialists for mentoring and gathered support from his local colleagues, and then tried — as best he could — to bring urban medicine to this rural community.

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“That operational part was through trial and error because there’s no sort of handbook on that. Anyone who works in Vancouver or other bigger cities would struggle in the geographically vast area where Hope and the Fraser Canyon fall — lack of pharmacies, lack of transport, all those sort of services,” he said.

Dr. Aseem Grover at the Fraser Canyon Clinic in Hope.
Dr. Aseem Grover at the Fraser Canyon Clinic in Hope. Photo by Jason Payne /PNG

So, at just 29 years old, Grover took some gutsy and generous steps in an effort to improve drug treatment options.

How generous? He rented a yellow school bus with his own money to take hundreds of patients to a drug treatment clinic in Chilliwack for about two years, until he could offer similar services in Hope.

And how gutsy? He went door-to-door handing out naloxone to drug users, but also to the dealers — asking them to pass the kits along to their clients in an effort to reduce overdose deaths.

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“We started a program where we gave the drug dealers tons of naloxone kits, and for anything they sell, (the buyers) were given a naloxone kit. And it was highly successful,” Grover said.

Most of these drastic outreach measures have subsided, although not entirely gone away, since Grover and his colleagues rejigged the Fraser Canyon Clinic in Hope in 2018 to focus more on this population.

Now about 200 people come through each month to get help for a variety of needs that include addictions, physiotherapy, maternity, social work, mental health counselling, and assistance with housing.

”Dr. Grover was really instrumental in highlighting the need. There’s a much higher prevalence here than people think (of substance use challenges) and it was just underserved,” said Petra Pardy, Fraser Health’s executive director of community services in Chilliwack, Agassiz and Hope.

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Trying to offer a full spectrum of any type of medicine is a struggle for rural doctors, who consistently have far fewer services, equipment and colleagues than doctors in urban centres. Emergency rooms have closed in several small towns across B.C. over the past several months due to a shortage of staff.

“We’re hearing about rural emergency rooms that are having to cut back on the time they’re open, and this is a common thing in remote Indigenous communities,” said Dr. John Pawlovich, who is the Chair in rural health at the University of B.C.

“There’s also the challenge of access to specialized care to medical services that are only found in urban areas. Medications are often a challenge to get to these areas, laboratory tests, people have to drive to get imaging. … The list is endless, truthfully.”

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Rural family physicians must be generalists who can respond to all types of medical needs, so Grover can’t just focus on addictions. His duties each week also include seeing patients at Hope’s family medicine clinic, being medical director of the 10-bed Fraser Canyon Hospital, and working in the emergency room.

Every role is important, but it was for his addictions medicine that Grover recently received an award from Fraser Health for going “above and beyond” to help his patients.

Grover, though, insists it is a team effort involving the 10 rural family medicine doctors in Hope, local nurses and pharmacists, and various outreach workers.

So have their innovative efforts worked? The evidence is just anecdotal.

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Hope had the highest number of fatal overdoses in 2020 and 2021 of any B.C. community, when the coroner’s service adjusted the statistics for population.

In the first four months of 2022, however, the city had zero fatal overdoses. That trend was broken in May, but it was still a sign of improvement, Grover said.

“Our efforts are panning out, just like we hoped they would, but that doesn’t mean that we’re out of the woods. There’s still a lot of effort to go,” he added.

Lance Rempel outside the Fraser Canyon Clinic in Hope.
Lance Rempel outside the Fraser Canyon Clinic in Hope. Photo by Jason Payne /PNG

Lance Rempel believes the addictions treatments now available in Hope saved his life, saying “it was just a nightmare” to get help before Grover arrived.

“It was very hard to access services like this,” he said, standing outside the Fraser Canyon Clinic.

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Now, he can come into the clinic any weekday, he can more easily get his meds, and his health is continually tracked by clinic staff.

“I’m now in a position where I can see the future,” Rempel said.

‘Big gaps in care’

The “big gaps in care” Grover saw for patients like Rempel when he first came to Hope in 2016 were accentuated by the fact that he had just completed a two-year residency at St. Paul’s, the downtown Vancouver hospital that cares for so many people with mental health and addictions problems.

“I think sometimes we forget the luxury of having a lot of the tertiary care services under one building or just nearby,” said Grover, now 35. He was born in Abbotsford, where both his father and brother are family doctors.

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“When we come into a rural community, even though the (total) amount of people that struggle with addictions is much less, there’s a huge lack of resources to actually apply what we learned in residency.”

He understood that drug users would have better outcomes if they could attend a clinic where all their needs were addressed under one roof, but the closest place like that was in Chilliwack, 50 km away. Public transportation was spotty and many of his patients didn’t own cars, so he rented a bus to take local patients there.

“(I) paid for a bus once a week for the patients to be brought over to that area where they had mental health counselling, where they had good addiction services, and then also the care that they deserve, including social work and disability care,” he said.

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Also in those early years, Grover was handing out naloxone to drug dealers to try to keep their customers alive. Today, substance users can now get kits from local pharmacies, the hospital’s emergency department, and Grover’s clinic — where dealers also drop by to grab some.

“We’ve established a strong base here where a lot of people that do sell drugs would even come to our clinic to pick up supplies,” he said.

He will still deliver naloxone and other medication when the situation arises, such as when one of his patients was withdrawing in a motel room. A dealer kept leaving drugs on the patient’s doorstep, so Grover kept leaving Suboxone, a medication used to treat opioid addiction, at the door as well.

On the day before the provincial government issues monthly income-assistance cheques, Grover joins local non-profit staff to visit vulnerable people in shelters and other places to remind them to be cautious because overdoses always spike when this money arrives.

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“I think that it’s made a difference,” said Grover, who remains on-call 24/7 for urgent addictions matters.

Doctors and nurses in Hope also provide medical services to a vast area outside the city: 80 km north to Boothroyd, 35 km west to Agassiz, and 70 km east to Manning Park.

Dr. Aseem Grover (right) with fellow doctors Dr. Stefan Patrascu (left) and Dr. Benjamin Love (centre) in Hope.
Dr. Aseem Grover (right) with fellow doctors Dr. Stefan Patrascu (left) and Dr. Benjamin Love (centre) in Hope. Photo by Jason Payne /PNG

Grover is part of a rotation of doctors that drives north to Boston Bar once a week to provide primary care and deliver medication, sometimes taking patients back to Hope where they can detox in the hospital. He also created the Fraser Health Region Rural Addictions Network, through which everyone who provides services to remote communities now speaks with each other.

“If it weren’t for Dr. Grover, our community would be in a lot of trouble. … I don’t even know how this community ran before Dr. Grover took this role. Thankfully, he was here before I was,” said Dr. Benjamin Love, a fellow rural family physician in Hope.

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“I don’t know many doctors who drive their patients to appointments.”

Love said one of the benefits of working in a rural community is that doctors get to know their patients well and work closely with pharmacists, but making do with fewer resources is a daily challenge.

Hospitals in rural communities in B.C. have been plagued with problems recently. On the July 1 long weekend, there weren’t enough doctors in Squamish to deliver babies, so some expectant mothers had to drive long distances to deliver. On Monday and Tuesday, the Merritt hospital closed its emergency room due to a physician shortage. On the last weekend in May, emergency rooms in Clearwater, Port McNeill and Chetwynd closed for 12-hour periods because there wasn’t enough staff.

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This is not just a B.C. problem, but one affecting small communities across Canada.

Drones part of solution

Dr. John Pawlovich is medical director for Carrier Sekani Family Services and the UBC Chair in rural health.
Dr. John Pawlovich is medical director for Carrier Sekani Family Services and the UBC Chair in rural health. Photo by Michael Bednar /UBC

As part of his work as the UBC Chair in rural health, Pawlovich and his colleagues are searching for solutions to better support rural patients and doctors.

One involves a study looking at how drones could deliver medicines to remote communities.

Pawlovich also hopes to reduce the need for rural residents to drive long distances for medical imaging by exploring how doctors can use hand-held devices to generate scans and then transmit that information to an expert in an urban centre for interpretation.

Another possible solution is the expansion of virtual support programs, which allow doctors in rural communities to connect by video with experts who can give advice.

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“We can now take technology and build a virtual team around a group of health care providers in any community in this province, to lessen that feeling of isolation and make them feel empowered,” said Pawlovich, who is also medical director for Carrier Sekani Family Services, which provides medical care to several rural Indigenous communities.

Pawlovich added that it is important, as well, for B.C. to train more physicians to work in rural communities through UBC’s northern medical program.

Trevor Newton outside the Fraser Canyon Hospital.
Trevor Newton outside the Fraser Canyon Hospital. Photo by Jason Payne /PNG

Trevor Newton is someone who was saved by rural medicine.

An accident in 2014 left him partly quadriplegic. The former construction worker was prescribed fentanyl to manage his chronic pain but then “fell through the cracks” of an urban medical system and began self-medicating with street fentanyl.

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Last year, his mother tried to help him by moving him into the garage of her Hope home, which is not wheelchair accessible. When the cold weather arrived in December, Grover insisted Newton move into a hospital bed and then supported him to stay clean for the last six months.

“The reason for me ending up in this hospital is because, literally, it was the last stop in my road before hitting the streets permanently,” said Newton, who hopes to move out of the hospital soon.

“Dr. Grover has been the best doctor I’ve ever had in my entire life, since I’ve become a quadriplegic. He is caring, compassionate, he has foresight into my care program. And he’s just an absolute dream when it comes to having a personal physician.”

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