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Sea to Sky corridor's only abortion clinic quietly closes

Departure of obstetrician, shuttering of Greyhound service creates barrier for women accessing reproductive services, officials say

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In the 10 months it was open, the Alpenglow Women's Clinic in Squamish provided 156 abortions, primarily for women living in the Sea to Sky corridor, but also for those as far away as Lillooet and Kamloops.

In total, 120 medical and 36 surgical abortions were conducted at the small clinic. Around 59 of the patients also opted to take part in the Safe Methods Program, which offers free contraception (both IUDs and birth control pills) to eligible B.C. residents.

If you think those numbers are high, consider this: the clinic ran quietly without even some Whistler non-profit organizations knowing it existed. Instead, organizations unaware of it referred women to Vancouver clinics like the Elizabeth Bagshaw Women's Clinic.

Dr. Kim MacDonald, the Squamish Hospital's obstetrician-gynaecologist, along with a nurse and two other GP doctors, opened the clinic—which was not run by Vancouver Coastal Health (VCH)— in response to the needs of women earlier this year.

But in the wake of his complicated decision to move with his family to Victoria, the clinic has had to close, leaving what some say is a gap in services for women in the corridor.

MacDonald—who has served on various provincial and federal committees regarding maternity and women's health and works as an assistant professor at the University of British Columbia's Department of Obstetrics and Gynecology—was the only obstetrician-gynaecologist in the corridor.

"Maybe the way to look at it is it's a great proof of concept," he said.

"I think women really appreciated it, and deserve the timely access, local access. The privacy of being in the corridor, but nobody knows who you are or what's happening—there's definitely a need for that service."

While a VCH official said in an email that, "abortions are conducted in the corridor," they later said that "therapeutic abortions are provided to women in the Sea to Sky region. VCH provides these services."

A therapeutic abortion is when a pregnancy is terminated out of medical necessity for the safety of the mother or because the fetus has been deemed unviable.

The VCH official would not say that medical and surgical abortions are not provided in the corridor, but other sources said that they did not know of any local facilities that provide it. The spokesperson also declined to comment on the closure of the Alpenglow Women's Clinic because VCH did not run it. The official would not go into further detail about the closest locations for women in the corridor to access abortion services.

MacDonald said that he and others running the clinic discussed ways to keep it open after his departure, but there were several complications.

"The problem is the surgical services were only offered by me as an obstetrician. There's no one else with that skill set or access to the (operating room) in the community," he said. "The economic model to make it work, I had to be involved. We billed through MSP, but everything got shared. I didn't make much from it—it was about providing a service. And it's really hard to make that work if you don't have a specialist in the group."

His hope is that the region will see "some health authority leadership and funding to support and prioritize women's health—maternity services, sexual assault, abortion care, etc. Maybe then it could take off again."

It might not be a great distance for women from Squamish to access abortion services in the city, but for those as far out as Pemberton, Mount Currie and beyond, it can be complicated to arrange a ride down for multiple appointments, he said. Part of the clinic's appeal was that it offered an all-in-one service—including ultrasound, counselling and birth control to prevent second unwanted pregnancies—to cut down on travel.

"One of the areas I felt was important that we don't have services for in the corridor was reproductive choice," MacDonald said.

"That was feedback from patients. It was my experience from people having to be sent to the city, especially for Mount Currie and beyond. The First Nations communities ... it can be harder for them to access resources. What often happens is they have to travel somewhere for an ultrasound and then they have a separate appointment and they have to travel again for that. It's just like barrier after barrier."

Those challenges were compounded when Greyhound ended its bus service in the region last month. At the Howe Sound Women's Centre (HSWC), which primarily helps women fleeing abuse in the Sea to Sky corridor, workers have had to come up with creative solutions like providing gas cards for women to hire drivers.

"Transportation is such a key in providing services," said Laurie Hannah, community programs manager with the HSWC. "If you don't have services, I feel at the very least you should be providing transportation. It's one or the other. Right now, we're putting it in that crisis situation where there's neither. It just makes people more vulnerable. I hear that number 156 (abortions provided at the Alpenglow Women's Clinic) but then I wonder how many more went out of town."

For its part, Whistler Community Services Society refers women who reach out to them for help to the Elizabeth Bagshaw Women's Clinic in Vancouver. Abortion is a big enough issue in the community that the organization is looking at creating a support group for those who have gone through it.

"We received some feedback around creating a group to support people," said Jackie Dickinson, executive director of WCSS.

"(We're looking at) developing a program for people who have experienced abortion and are looking for grief support."

But transportation to help Whistlerites get to any type of medical appointment outside the corridor has also become increasingly challenging, she said.

"We no longer have a volunteer driving program that can transport people, but we receive quite a few calls," she said. "For people who have health needs and health concerns, sometimes a bus is not always an option. People going through chemo or people who have to be sedated, they can't hop on a bus without support ... We look at other options. Transportation continues to be a concern for all medical needs that can't be served locally."

But this issue is not unique to the Sea to Sky corridor, said Dr. David Snadden, the Rural Doctors' UBC Chair in Rural Health.

"Emergency transport is one issue, but a bigger issue is the transport to medical care for non-emergency situations," he said from Prince George, where he moved in 2003 to lead the development of the northern medical program.

"That's a huge challenge for many, many patients."

Decisions around which services are offered in which areas is up to each health authority, he added. There is no set formula to determine at what population an area would start to receive certain services.

"In health care, if you start looking at population stuff, it doesn't help the individual," he said.

"No matter what the number, if an individual has an issue, they need help."

Part of the problem for rural communities is that decisions around standards of care are made in urban centres.

"The protocol that comes out almost can't be applied in rural areas," he said. "Change often comes from a number of things coming together. That's often the medical professionals, the patients and others working together to raise voices."

Meanwhile, MacDonald believes the Sea to Sky—and Squamish in particular—is currently at a crossroads. For now, women in need of help accessing abortion services can reach out to non-profit organizations like WCSS to navigate the system in Vancouver.

"As the corridor has changed, the needs have changed," he said. "We need a bigger scope of services that are available and we need more expertise in certain areas."

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