The Northern Ontario School of Medicine's new associate dean of community enagagement is looking forward to advancing the school's social responsibility mandate and working with the region's Aboriginal communities.
Dr. David Marsh, a Newfoundlander with Mi'kmaq ancestry, assumed his new duties at the school's Sudbury campus on July 1. A graduate of Memorial University, Marsh completed four years of graduate studies in neuroscinece and pharmacology and spent 12 years practicing addiction medicine at the Addiction Research Foundation and the Centre for Addiction Health and Medicine in Toronto.
More recently, he served in a dual role as medical director, addiction, HIV/AIDS and Aboriginal health with Vancouver Coastal Health and physician leader, addictions medicine, with Providence Healthcare, a Catholic health care organization serving Vancouver.
Marsh will devote one day per week to clinical practice, but will focus primarily on his community engagement portfolio, overseeing the school's Francophone Affairs and Aboriginal Affairs units and ensuring that communities across Northern Ontario are actively engaged in welcoming and supporting medical students during their off-campus placements.
"I was very attracted by the role here, and by the possibility of working at the first new medical school in Canada in 30 years," said Marsh. "Having grown up in a relatively small community in Newfoundland, I could understand the need to train physicians to work in rural and remote environments.
Social accountability mandate
"Also appealing to me was the social accountability mandate of the medical school because a lot of my work in addiction medicine focused on engaging socially marginalized communities. I saw the role here as an opportunity to further expand my experience working with Aboriginal communities."
Marsh was intrigued by the concept of a medical school committed not only to teaching, but also to improving the overall health of people in Northern Ontario. In contrast with the ivory tower mindset of many medical schools, NOSM prides itself on reaching out and connecting with the communities it serves, he said.
A star recruit, Marsh was in the national spotlight for six and a half years as medical director of Vancouver Coastal Health's controversial Supervised Injection Site in the city's Downtown Eastside, an area known for its high incidence of poverty, drug use and crime.
The only site of its kind in North America, the Vancouver Supervised Injection Site serves between 600 and 800 people a day who would otherwise be injecting drugs on streets, in back alleys and in abandoned buildings.
According to Marsh, research published in the Lancet and the New England Journal of Medicine clearly confirms that the Vancouver Supervised Injection Site reduces HIV risk behaviour, prevents drug overdoses, saves the health-care system money and increases the rate at which people enter addiction treatment programs.
The site has been the subject of a long simmering legal dispute with the federal government that is now headed to the Supreme Court of Canada.
Marsh also oversaw a heroin prescription trial in Vancouver that researched the effectiveness of heroin-assisted therapy for people suffering from chronic opiate addictions.
Opiate Medication Initiative
Part of the North American Opiate Medication Initiative funded by the Canadian Institutes of Health Research, the trial showed substantial benefits, according to results published in the New England Journal of Medicine.
"Using illegal heroin, the participants in the trial would be getting irregular doses and all kinds of impurities," said Marsh. "They'd be more likely to die of overdose, get infections like HIV and engage in criminal activity."
Heroin assisted treatment programs have been tested in several European countries and are now a regular part of the treatment system in Switzerland, Germany and the Netherlands.
Treating addiction doesn't necessarily equate with complete abstinence, said Marsh.
"I think there is a misconception that treatment for addiction means making sure someone is completely abstinent of mind-altering drugs for the rest of their lives. If there's a medication they can take in a controlled way like methadone, for example, and they are able to function much better than they did when they were using drugs in an uncontrolled way and their health improves, then the treatment has merit.
"If someone has schizophrenia and is taking a medication that makes their hallucinations go away, we wouldn't say they're not a treatment success. It's the same with addiction treatment. Some people with addictions are able to stop using drugs and do very well with appropriate counselling and other interventions. Others need medications to help them function well."
According to Marsh, "alcohol and tobacco do much more harm in Canada than any illegal drugs."
Aboriginal community
Marsh's knowledge of addiction medicine is sure to be tapped in his new role at NOSM, but it will be overshadowed by his primary goal of building on the strengths of the school's already impressive track record for community engagement, especially with Northern Ontario's Aboriginal community.
"It's well known that Aboriginal communities have greater health needs than other communities in Canada and are more poorly served by the current health-care system," he noted. "One way of addressing that is to have more Aboriginal people become physicians.
"In 2005, when NOSM admitted its first class, there were six Aboriginal students in medical schools across Ontario and they were all here at NOSM. None of the other medical schools in Ontario that year had any Aboriginal students."
Since then - and largely because of NOSM's example -medical schools across Canada have developed programs to recruit Aboriginal students. In 2009, said Marsh, there were 23 Aboriginal students beginning first year medical school in Ontario and only three of them were enrolled at NOSM.
The process of recruiting Aboriginal students to medical school needs to start as early as possible, he said.
"We have to give young Aboriginal people a sense of optimism and hope that they can finish high school and go on to higher education."
Currently, only 20 to 30 per cent of Aboriginal children in remote communities finish high school, he said.
"It's not because they aren't intelligent. It's because of structural barriers. Imagine if you were a 12-year-old and had to leave your family and your home community to go elsewhere to attend high school."
Education and the employment opportunities that go with it are the keys to improved health and economic development in Aboriginal communities, said Marsh.
