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Clinical fellow explores how geography shapes maternal care
By Evelyn Jones
Dr. Charlotte Roy is studying the impact of relocation on patients with high-risk pregnancies
By Evelyn Jones
Dr. Charlotte Roy has seen patients drive more than four hours to a medical appointment, then four hours home before heading to work.
Experiences like these have shaped how the maternal-fetal medicine fellow thinks about geography, access and patient care.
“I’ve seen how geography is a key determinant of health,” Roy said. “Access to health services can be a barrier to equitable care."
Growing up in Sudbury, Ont., Roy experienced northern Ontario as both home and, eventually, the setting for her medical education.
After completing an undergraduate degree in life sciences at Queen’s University with a minor in French, she returned north to study medicine at the Northern Ontario School of Medicine.
“Part of the appeal for me was going back to my home, going back to my roots,” she said.
She did rotations in rural Australia, and later completed her obstetrics and gynecology residency at Memorial University in Newfoundland, where caring for patients from rural and remote communities remained central to her practice.
Those experiences showed Roy that accessing health care can require much more from patients than attending an appointment.
“They may already be going through a stressful time in their lives, and now they’re adding on the time and cost of travel, as well as losing work or being away from their family, all while in a new or unfamiliar city," she said.
Today, that perspective informs her research at Schulich School of Medicine & Dentistry, where Roy is studying the impact of relocation on pregnant patients admitted to hospital before giving birth.
Patients experiencing complex, high-risk pregnancies may need access to specialized services available only at larger centres. When hospitalization occurs early in pregnancy, patients can spend weeks away from family and cultural supports.
By better understanding the impact of relocation, Roy hopes her research can identify ways to support patients from rural and remote communities.
“There’s not a lot of data about the impact of antepartum relocation for weeks at a time,” she said. “Hopefully, we can learn how to use innovative approaches to support more care at home, while thoughtfully considering the patient-centred and culturally sensitive care we offer for those who remain admitted.”
Long before entering medicine, Roy spent more than a decade volunteering with Girl Guides of Canada, working as a leader and role model for young women. Her leadership experiences reinforced the importance of ensuring women have the knowledge and support to make decisions about their health.
“I believe in and will always stand for women’s autonomy,” she said.
Roy also grew up surrounded by strong female role models. One story from her family has stayed with her throughout her medical career.
During the Second World War, her great-aunt worked as a physician in England. Roy recalls hearing that her great-aunt was once stopped by police while driving during wartime petrol rationing because authorities did not believe a woman could be a doctor (doctors qualified for extra fuel allowances).
“I always have her in the back of my mind, this woman who created a space for herself,” Roy said. “I think there’s a little bit of her in me.”
For Roy, maternal-fetal medicine allows her to combine detailed clinical problem-solving, procedural and surgical skills, and meaningful relationships with patients and their families.
It also places her alongside families during some of the most difficult moments of their lives.
Whether helping patients navigate a complex diagnosis or decisions about their pregnancy, Roy sees her role as providing clear information while recognizing that every patient brings different values and experiences to their decisions.
"My role is to support families by making sure patients have the information they need to make the decision that is right for them, and to support them in that decision and that journey."
Even when medicine cannot change an outcome, Roy believes there is still an opportunity to change how a patient experiences it.
“It is a privilege to sit with families in these vulnerable times," she said. "If we can give patients compassion and dignity through these experiences, then I think we’ve done our job.”