Geriatricians get taste of health-care challenges in coastal communities

North East LHIN CEO Louise Paquette led a delegation of three gerontologists – Dr. Samir Sinha, Dr. Janet McElhaney, and Dr. Jo-Anne Clarke – to several communities along the James Bay coast in February. Also along for the tour were North East LHIN primary health-care lead Dr. Alan McLean, Bernie Schmidt, CEO of the Weeneebayko Area Health Authority and chief of staff Dr. John Waddell.

Following a fire that destroyed the Weeneebayko General Hospital site in Moosonee, a temporary clinic was set up in the town’s curling club. Foam-core tents used for clinical rooms lack privacy and medical records are in boxes in an open area.

In Kashechewan, there’s an X-ray machine that hasn’t been used for three or more years because there are no qualified staff to operate it.

In Peawanuck, a seniors residence was built, but no one was consulted and the seniors don’t want to live there, so the building is being used as the band office.

These are just a few of the most glaring examples of the health-care challenges witnessed by North East LHIN CEO Louise Paquette and three gerontologists earlier this year during a visit to First Nation communities along the James Bay coast.

The list goes on and on: sparse to nonexistent home care, mental health services and diabetic foot care. No consistency in the maintenance of medical records.

Ambulances, but no paid drivers to operate them. The lone wheelchair in the Peawanuck Health Centre ripped, broken and unusable.

Eye opener

The two-day coastal visit to Moose Factory, Moosonee, Peawanuck, Kashechewan and Fort Albany was an eye opener for gerontologists Dr. Samir Sinha, Dr. Janet McElhaney and Dr. Jo-Anne Clarke. Sinha is a gerontologist at Mt. Sinai Hospital in Toronto and provincial lead for Ontario’s seniors strategy, Clarke is clinical lead with the North East Specialized Geriatric Services in Sudbury and McElhaney is Geriatrics Research Chair at Health Sciences North.

Also along for the tour were North East LHIN primary health-care lead Dr. Alan McLean, Bernie Schmidt, CEO of the Weeneebayko Area Health Authority and chief of staff Dr. John Waddell.

Paquette suggested the coastal visit when Sinha was in northeastern Ontario last September as part of a province-wide fact-finding tour.

“The challenges faced by the 11,000 people in our coastal communities in terms of access are unique,” said Paquette. “I wanted to expose Dr. Sinha and our gerontologists to the people, to the infrastructure challenges and what we have in terms of facilities.”

Any understanding of the status of seniors care in Ontario without visiting the remote First Nation communities in Northern Ontario, she thought, would be incomplete.

Through meetings with elders, community leaders and health-care workers along the coast, the four visiting physicians learned about the high prevalence of diabetes and other chronic diseases, the scarcity of home-care services, the high incidence of substance abuse and the high rate of early pregnancies and very large babies.

Some of the issues brought to the attention of the delegation received prompt attention.

“A good example was in Peawanuck, where one gentleman took me by the hand and said, ‘Look, Louise, this is what I’m talking about.’ It was a wheelchair, but you couldn’t use it because the seat was torn and the arm was broken off. It was the only one in their health centre.”

Returning to her office, Paquette immediately ordered a new wheelchair and had it shipped up. Another example of a quick fix resulted from a discussion with a personal support worker in Fort Albany, who asked about training so she could provide foot care to some of her clients. Paquette said “absolutely,” and sent out foot care training packages without delay.

“Some of the things requiring action don’t have to cost a lot of money,” she remarked. “It just requires some attention and people to connect the dots.”

Challenges

The larger issues will be much more difficult to resolve and will take time. Health-care challenges resulting from poverty, isolation and social dysfunction are hard enough to overcome when there is one responsible authority.

However, with the coastal communities and all First Nation communities in Northern Ontario, the provincial government is responsible for some aspects of health-care and the federal government is responsible for others.

“We work closely with the federal government to ensure alignment of priorities and services, but it isn’t always easy,” said Paquette.

The reliance by the coastal communities on Kingston General Hospital as the referral site for tertiary care is one of the issues the North East LHIN has identified for further study.

“We need to look at the arrangement with Kingston, why it works well, if there are shortcomings, what people want and what role hospitals in Sudbury and Timmins can play,” said Paquette. “The agreement with Kingston goes way back, but health care has progressed in Northern Ontario. We have infrastructure much closer to the coast. We have telemedicine and we want shorter stays in hospital.”

The LHIN has produced a summary report and health-care action plan to deal with the many challenges and issues the delegation encountered, but given their complexity, the province’s fiscal challenges and the shared responsibility of the federal and provincial governments, no one expects improved health- are in the coastal communities to occur overnight.

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