In this episode, I'll be discussing a case of eye pain/decreased vision that presented here and the difficulties we have in certain places trying to sort out and manage ophthalmic conditions without proper equipment and sometimes abilities to get people out.

Intro - I'd like to start off by apologizing for taking so long to get back out here. Thanks to everyone that listened to my first episode, I hope you come back now that I've got this new one out. Special shout out to the listener from Samoa that made this the #1 Health Podcast in their region for a few days!! Land Acknowledgement - I recorded this on Treaty 6 Land, homeland of the Oji-Cree, Ojibway, Cree, Dene and Inuit peoples and the place where I'm employed to help care for some of these people. Topics - Remoteness, Patients, Health Issues/Social Determinants, Administrative issues. I work in a fly in community in Northeastern Manitoba, roughly 600km from WInnipeg, which is the main health care referral centre for us. There is an ice road here in the winter, but for the most part things are flown in, including health care providers. Unfortunately, this also means patients often need to be flown out. Patients are often complex - it's a rarity when something is straight forward. They're also often difficult to contact, sometimes reluctant to come in. They're also sometimes quite reluctant to be sent out, even if they really need it, as they're concerned about family separation, especially if people are critically ill. There are a lot of health issues here that revolve around diabetes and hypertension and the downstream effects from those. There is a dialysis unit here due the kidney disease burden here. There are a wide variety of infectious diseases here - MRSA skin infections, TB, syphilis and other STI's. There are some issues with substance use/abuse as well. Housing is an issue here - there is often a lot of crowding within homes, water comes from holding tanks or cisterns. Food is expensive here, particularly fruits and vegetables. There are many admin challenges here - paper charting, formulary issues, patient movement and transport, who's going to pay for things people need. An often tiring issue is finding a hospital/ED to accept patients, since most of them are getting hammered due to bed blockages. Despite all this, the work is very interesting and rewarding. Take care and see you next time :-)