Nova Scotia·THE SEARCH

Helped along by dried fish, a rural community found its way on health care

When the Municipality of Clare was confronted with a doctor crisis in 2003, it took charge of its own destiny. The community financed a new medical clinic and took a hyper-local approach to cultivating future doctors.

The Municipality of Clare faced a doctor crisis in 2003 and took charge of its own destiny

Dr. Michelle Dow stands in the waiting area of the Clare Health Centre. (CBC)

Never underestimate a community that understands its health-care needs — or the power of dulse and dried fish.

Like so many rural communities in Nova Scotia, the Municipality of Clare has watched its fair share of doctors come and go. It reached a boiling point in 2003 when the two family doctors in the area gave municipal council a stark warning: They were overworked and would leave if they didn't get help.

Ronnie LeBlanc remembers that meeting well.

Today he's the municipality's warden, but back then he was a newly elected councillor. Council quickly established a committee with people in the health-care field to focus on two things: infrastructure and recruitment.

Theirs was a challenge many communities are grappling with right now, something CBC Nova Scotia is focusing on this month as part of an in-depth look at the province's doctor shortage.

Ronnie LeBlanc is warden of the Municipality of Clare. (CBC)

"We knew we needed a modern health centre," LeBlanc said in a recent interview.

Emboldened by support from the community, council started raising the money it would need to build one. Residents of the Acadian community were more than willing to shoulder a property tax increase to foot the bill, and also finance $100,000-bonuses for doctors willing to sign on for five years, he said.

"It was just after an election, and we were speaking to a lot of residents who were sick, who didn't have family physicians, and were basically worried about their future."

In 2008, the $4-million Clare Health Centre — financed entirely by the community — was ready to open in the village of Meteghan Centre, right in the heart of the municipality.

But how to fill the space?

Recruiting to the area is "not an easy task," said Dr. Michelle Dow, who started working in the community 30 years ago. From the time she started, Dow said she was trying to recruit other people to Clare.

It grew progressively more difficult through the years until 2003 when council received the warning.

Dr. Michelle Dow is one of six family doctors at the Clare Health Centre and has worked in the community for 30 years. (CBC)

While there were doctors attracted to the area, they would eventually leave, said LeBlanc. Council, Dow and others decided their focus must become hyper-local.

"It was clear to us that to have a long-term strategy we had to really build those relationships with young people from the area or who have an attachment to the area," said LeBlanc.

That local focus means anyone from the community accepted into medical school receives a congratulatory letter from council.

"Basically, we tell them that we're proud of what they accomplished, that they're the future leaders of their community and, if they want to, they're welcome here — the community wants them here," said LeBlanc.

Then there are the pre-exam care packages. No matter where a student may be studying medicine, if they are from Clare or have ties to the area, a package arrives just before exams with small tokens, including dulse and dried fish, to remind them of home.

"It means something to them, I believe, because we often get those little thank-you notes and you can tell they appreciate it," said LeBlanc.

Construction of the Clare Health Centre was fully financed through taxes paid by people in the Municipality of Clare. The site now serves as a major recruiting tool. (CBC)

This long-term courtship, which includes annual Christmas dinners with municipal leaders, members of the medical community and other residents, is vital to recruitment. LeBlanc said waiting until a student is almost through their training to begin the effort is likely too late.

"You've got to tell them that they're wanted here, they're needed here, and people will appreciate that. It goes a long way."

Those efforts have paid off. Today the health centre hosts six family doctors, all with ties to the community, and a nurse practitioner from Wedgeport, just south of Yarmouth.

The Clare Health Centre includes a twice-a-week blood collection service, which saves patients from having to travel to Yarmouth or Digby. (CBC)

Together they work in a place that embodies the collaborative-care model most new doctors want and, in just about every sense, has a setup that would be the envy of any community.

Besides seeing their own patients, doctors at the health clinic in Meteghan Centre take turns staffing a walk-in clinic for people without a doctor or who need to see someone sooner than an appointment might be available.

The building houses continuing care, public health, mental health and addiction services offices, along with blood collection twice a week, saving patients a trip to the nearest hospitals in Yarmouth or Digby.

The Clare Health Centre has a variety of services, including a small emergency room for minor procedures and work. (CBC)

There's a cardiovascular clinic that visits regularly, as does a dietitian, podiatrist and orthotics expert. The site is also fully equipped for telehealth, a video-conference system, which means people don't always have to travel three hours to Halifax for an appointment with a specialist.

Even with all of these services, Dow said there is still room for more. There's a waitlist of about 1,000 people for a doctor, and the site could use a physiotherapist and more mental-health services, she said.

"It's basically looking at what the needs of the community are."

Determining those needs, and ways to meet them, was the key to success, said LeBlanc. Theirs has been a long-term strategy, and he advises other communities to approach it the same way.

"There will be a struggle, no question."

Dr. Michelle Dow, medical director at the Clare Health Centre, speaks with the site's nurse practitioner, Terrilee O'Connell. (CBC)

Despite the community's successes, LeBlanc would like to see more collaboration with the provincial government on recruiting, where the municipalities can build relationships with potential doctors while the province helps with resources.

Still, the people of Clare weren't prepared to wait around for help when things were at their most dire. Those who live in rural communities know what happens when there's a problem and no one acts. And in a rural community, LeBlanc said, nothing is more important than health care.

"Without health care, communities are in trouble and they'll eventually die off."

It's a prognosis that seems a ways off in Clare.


Michael Gorman is a reporter in Nova Scotia whose coverage areas include Province House, rural communities, and health care. Contact him with story ideas at