Closure of Mature Women's Centre an unprecedented assault on women's health

On July 10, the Winnipeg Regional Health Authority announced a catastrophic blow to the provision of innovative health care for the women of Manitoba.

A news release about budget cuts announced the health authority will be "redirecting many services provided by the Mature Women's Centre at Victoria Hospital by Oct. 1, 2017."

We were informed that "general OB/GYN physicians will be able to care for the majority of patients. Those requiring care by subspecialists will be accommodated at HSC [Health Sciences Centre] through a redirection of existing resources."

The main reason given for this destructive decision is "cost savings."

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Contrary to what is being touted by leadership to the public, there are no specific plans regarding the continuing clinical care of our patients.

'Cost-saving program'

This is not a program shift but a deliberate dismantling of a successful and beneficial cost-saving program.

Many patients tell us how relieved they are to have found our centre. Some have struggled for years before finding us.

There will be an abrupt termination of our innovative and professional interdisciplinary staff, which includes menopause nurse clinicians, a pharmacist, a kinesiologist and a dietician.

I would like to highlight some of the statements from previous communications sent by the Winnipeg Regional Health Authority:"WRHAchanges will provide better care delivered more effectively," they said, and "consolidation of health centresbuilds onexcellence."

This action does the opposite.

It dismantles a consolidated, cost-saving program that provides unique services.

There will no longer be a consolidated centre of excellence in menopause medicine. Women will not be empowered to make choices regarding their options by working with a multidisciplinary team of specially trained professionals.

The menopause program is interdisciplinary and nurse-managed. It provides a platform to use the latest evidence-based menopause medical care for both low- and high-risk women as they navigate through the peri- and post-menopausal transition.

Many of these women are young cancer survivors, have premature ovarian failure and numerous medical conditions that place them in high-risk categories that require individualized assessment, interventions and followup.

Other, lower-risk women struggling to navigate through the menopause transition have sought information and care unsuccessfully throughout the medical system. Many were finally referred to the program by their health-care providers for consolidated care.

Our objectives are to ensure that we deliver quality care and provide services that maintain health, prevent disease and improve physical, psychological and sexual well-being.

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This move will also terminate the HAlt program and procedure room, which is a centre of excellence for the investigation and management of abnormal uterine bleeding as well as uterine fibroids.

We must be advocates for women of all ages tohave full control and say over their own bodies as well as where they have access to quality health education and care serviced by a consolidated collective of health professionals, strong, powerful and heard no exceptions.

The Hysterectomy Alternative program (HAlt) and procedure room has been established to use a new paradigm in the diagnosis and management of abnormal uterine bleeding and uterine fibroids in pre- and perimenopausal women.

This innovative approach allows for a one-stop assessment, diagnosis and management plan, using diagnostic hysteroscopy and endometrial biopsy in our procedure room. The patient is able to visualize the problem and an immediate discussion about management takes place.

Direct visualization of the uterine cavity with a hysteroscope allows us to make an immediate diagnosis using a new classification, which determines the actual cause of the bleeding rather than depend on symptoms alone or imaging (ultrasound, CT scans or MRI). This process is very accurate and safe. It is efficient, cost-effective and well accepted by our patients.

Documented testimonial evidence and data demonstrate that these women are immediately empowered to make choices regarding various conservative, medical or minimally invasive surgical procedures, which can be very successful alternatives to myomectomy and/or hysterectomy.

The traditional model, where the diagnosis is symptom-based, may involve more investigation and imaging, several subsequent visits and trials of various interventions, which increases costs.

'Significant step backwards'

The closure of our procedure room is a significant step backwards and forces women to have their surgery in the main operating room, which is less cost-effective and adds more stress with greater intervention.

Many patients tell us how relieved they are to have found our centre. Some have struggled for years before finding us. This type of care is special and is not provided consistently by family physicians or the general ob/gyn population.

It is apparent that the services provided by the Mature Women's Centre are poorly understood, and there is little appreciation thatthis move:

• Will not necessarily "provide better care more effectively."
• In fact destroys consolidation andleads to dispersionof services.
• Will most likely drive up costs.
• Is not just a matter of redirecting care; it is an issue of deprioritizing women's health.

We must be advocates for women of all ages to have full control and say over their own bodies as well as where they have access to quality health education and care serviced by a consolidated collective of health professionals, strong, powerful and heard no exceptions.

R. S. Boroditsky, MD, FRCSC, FACOG, FSOGCis themedical director of the Mature Women's Centre.

This column is part ofCBC'sOpinion section.For more information about this section, please read thiseditor'sblogandourFAQ.

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