The coronavirus crisis of 2020 has exposed the strengths and weaknesses of the Canadian health care system. This is particularly true in Canada’s North, where isolated Indigenous communities face the prospects of widespread infection with great anxiety. The remoteness of Northern settlements—coupled with serious housing shortages, overcrowded homes, and limited health care services—heighten the dangers of the pandemic.
In the midst of the crisis, Northerners and health care professionals wonder aloud about the availability and usefulness of new ways to deliver health care—particularly those that do not rely on face-to-face contact between patients and health care professionals from other regions. Northern health systems have been working with telehealth for many years. Various phone, video, and Internet systems allow patients to receive psychological services, specialist consultations, test results, and interviews with doctors.
Rosie the Robot, for instance, has ensured timely access to medical care for the residents of Nain, a remote community in Labrador. Rosie is a remote presence robot that connects patients to physicians and health care experts located in an urban centre 350 kilometres away. It has been used to perform a variety of tasks, including patient consultations, diagnostics, and ultrasound readings. In Saskatchewan, several other initiatives to deliver remote health care are underway. Between 2016 and 2017, eHealth technology saved roughly 6 million kilometres of health-related travel for patients from rural and remote communities.
Northerners appreciate that the region lacks much of the infrastructure needed for remote medical care. Internet coverage is improving slowly, but falls well short of Southern Canadian standards. Many Northern homes lack ready access to computers, tablets, and video screens. Most communities do not have enough technical personnel to maintain equipment and ensure connections are reliable. Quite simply, it is difficult to provide quality remote health care without the right combination of Internet service, devices, technical support, and community familiarity.
Even as the North seeks to realize the potential of telehealth and its role in improving diagnostics and access to physician expertise, it is important to consider future technologies that could address other long-standing medical challenges. One of the more thought-provoking technologies lies with remote surgery.
Remote surgery is already being used in Canada, mostly at major research hospitals. The technology allows a specialist in one site to perform complex procedures at another site that can be several hundred kilometres away. Advanced machinery at both ends allows the lead physician to complete technical procedures on a patient.
The process requires a reliable high-speed Internet connection. At present, it also requires a surgeon and/or other specialist to be present with the patient, in case emergency intervention is required. Remote surgery is equipment-intensive and involves multiple senior medical professionals on a single case. As a consequence, it is expensive and generally used only in specific circumstances. But, in the right environments and with all the appropriate systems in place, these procedures have proven to be safe and dependable. One highly skilled physician can perform specialized procedures in multiple locations without travelling.
The situation in the Far North is certainly challenging. Communities and professionals have made impressive adaptations to telehealth, and they understand the potential of distance-delivered health care. But the region suffers from low-quality and unreliable Internet service, well below the requirements for remote surgery. And there are a host of questions and uncertainties about how the technology would be received and implemented in Northern and remote regions. It would be wrong for the Canadian North to leap too rapidly into the world of remote surgery. That said, it is important for those involved in Northern health care systems—related training programs, technological installations, medical research—to add remote surgery to the list of medical options to consider.