Diabetes pilot shows promise for remote First Nations

A diabetes pilot program that relies on community health workers to provide support in four remote First Nation communities in northwestern Ontario is being proposed as a model of care for all 33 communities served by the Sioux Lookout First Nation Health Authority (SLFNHA).
The program, modeled on work carried out by Dignitas International to combat the HIV-AIDS epidemic in Malawi, is based on training community health workers to provide the continuity of care that itinerant doctors and nurses are unable to offer given their high turnover and the challenges associated with recruiting health-care professionals to serve in remote, fly-in communities.
“Recruiting physicians and nurses is very hard in our area,” said Janet Gordon, SLFNHA’s chief operating officer. “It’s hard for people to go to our communities and stay for long periods of time when they’re not from there, which is understandable, so we have a high turnover of nurses. We also have a hard time recruiting physicians. They have to like that kind of medicine. It requires travel and being away from home and family, and we have other challenges relating to work space and accommodations.
“The high turnover affects continuity of care, so training community health workers who live in the communities results in more timely care and better control of diabetes.”
The four communities hosting the pilot program are Kitchenuhmaykoosib Inninuwug, Kasabonika Lake, Kingfisher Lake and Slate Falls.
“We have learned a lot about the barriers and challenges affecting care, what’s working and not working for clients and what community health workers need to excel in work such as this,” said Gordon. “First Nation people have been struggling for a long time to try to move health-care issues along and we thought this would be an opportunity to improve health care in our communities. Diabetes is a huge issue in all of our communities and it’s compounded by the poverty level, the high cost of food, poor living conditions, the harsh climate and insufficient infrastructure.”
The prevalence of diabetes in the Sioux Lookout area is approximately 30 per cent and as high as 40 per cent in some communities, compared with 10.2 per cent in Ontario as a whole.
The pilot had its origins in a decision by Dignitas International, a Canadian-based NGO founded by Dr. James Orbinski and James Fraser, to bring its expertise to remote, underserviced communities in Canada.
Dr. Orbinski accepted the Nobel Peace Prize on behalf of Médecins Sans Frontiers in 1999 and Fraser, who hails from Sudbury, worked for Médecins Sans Frontiers in Zaire for six years.
“We do all this work overseas and we developed a lot of skills at mobilizing communities and working with remote and rural areas,” said Dr. Sumeet Sodhi-Helou, a Dignitas International scientist, staff physician at the Toronto Western Family Health Team and associate professor at the University of Toronto. “We knew there are also remote and rural areas in our own country, and we thought we had a moral and ethical obligation to reach out to them.”
The pilot was launched in 2014, and began with two years of extensive research.
The first year was spent learning about best practices from similar community-based programs in Alaska, Minnesota, Malawi, Zambia, Pakistan and Ethiopia.
“We took the learnings from these global community health worker programs and presented them back to community leaders in the Sioux Lookout area,” said Sodhi-Helou. “In the second year, we did an environmental scan and baseline study…then developed a curriculum and training program for the community health workers.”
The pilot relied on community health workers and community health representatives who were already in place in the four communities, so there was no need to hire and fund staff for the pilot.
That was important because hiring people for the short term to do work that requires a long-term commitment is unsustainable, said Sodhi-Helou.
The community health workers visit clients at home or see them in the community’s nursing station. They provide assistance in getting their blood pressure and glucose levels under control, advise them on diet, lifestyle and foot care, and help them navigate the health-care system.
One of the findings by Dignitas International was that of all the patients referred to specialist care outside their community, less than 25 per cent were able to make their appointments.
“That was really surprising and was a huge barrier to care,” said Sodhi-Helou, who pointed out that applying for travel grants, and making arrangements for escorts, childcare and time off work can be challenging.
The ultimate objective of the pilot program is prevention of the most traumatic complications of diabetes, including hypertension, amputations, kidney failure, heart attack and stroke.
“I think there’s a responsibility that our provincial and federal governments have to support this work,” said Sodhi-Helou. “Over time, we hope to show that it’s cost-effective and that we can achieve good clinical outcomes.”
Given the success of the pilot, Gordon said she would like to look at how the model can also be applied to other areas of the health-care system.

Filed in: First Nations, News

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