Dialysis units first victory for the North

Page 27

Six dialysis chairs are heading more than 600 kilometres northeast of Winnipeg to the Island Lake First Nations Renal Care and Dialysis Centre.

The four First Nation communities in the Island Lake region- Garden Hill, Red Sucker Lake, St. Theresa Point and Wasagamack-are accessible only by water, air or a less than reliable winter road.

Island Lake has the highest rate of diabetes in Manitoba, many times the provincial average.

"There is a growing number of people who are already receiving treatment or will soon need the service," said Mike Nadwidny, project co-ordinator of the Joint Health Governance Working Group at the dialysis centre.

"Our first objective was to develop effective ways to bring dialysis services to the community rather than have the patients go to the service. We should be up and running by early 2004. The interim dialysis unit will be initially located at the Garden Hill nursing station because there is no hospital to set up in. It can be moved when the much needed primary health centre is built, hopefully in three to five years at the most."

Nadwidny said there has never been a dialysis unit outside a hospital in Canada, never mind in a nursing station, never mind on a First Nation, never mind involving mixed funding from federal and provincial sources.

"We actually developed a way for agencies to work together," he said. The members of the Joint Health Governance Working Group responsible for the project include the Four Arrows Regional Health Authority, Health Canada, Manitoba Health, Manitoba Aboriginal and Northern Affairs and Indian and Northern Affairs Canada.

"That maybe doesn't sound unique but we actually went into each organization and re-worked the way they did business internally and with each other. It has never been done before in this country. That is a real success story in and above everything else. The dialysis unit will have its own merits but the multi-jurisdictional think tank really makes this project unique. You will hear a lot more about this in the next few years because we want this idea to be able to spread."

The goal of providing renal care in such a remote location is to be able to repatriate some dialysis patients, allowing as many as possible to come home to get treatment. The hope is that the local service will also slow the exodus of people leaving in the first place.

"What happens is people have two choices, go on dialysis or suffer and possibly die," Nadwidny said. "If they decide to live they have to move away to the city with only fragments of their families. The question becomes who is going to go to the city to live with grandma or grandpa and who is going to stay? Without a local hospital, we can't bring back everyone. Although there will be local dialysis and renal care service, the region lacks the other health services and infrastructure for many of those suffering from the effects of diabetes and other illnesses to live here safely. With a regional hospital, more can come home and more can stay. When they leave here, they often become instant welfare clients and they don't know the system. It is an alien environment. Many do not want to leave home, never mind live in the big city. Such large urban centres are not known for promoting Aboriginal culture and traditional values. But to stay in the communities without dialysis treatment can be a death sentence. It is a sad, sad deal of the hand. Not only are you in final stage renal failure but now you have to move away to a strange environment and live on often-sporadic handouts from the government."

Nadwidny said one of the biggest challenges is getting the human resources to the area.

"Most care is provided by nurse practitioners and local health care staff, supported by weekly visits from Winnipeg-based physicians and weekend telephone consultations. Doctors do fly in to work in the region, to provide varied coverage depending on the community. One of the communities is fortunate t have a doctor who has chosen to live in St. Theresa Point, but after-hours and weekend medical attention is virtually non-existent in the majority. There is also a heavy reliance on nurse practitioners. We need a stronger health care presence in the region, available 24/7. We would prefer to see more local Oji-Cree people recruited and trained in health professions and we are working towards that goal."

Not having a hospital is a major issue for Island Lake, particularly when the area has one of the highest hospitalization rates in Manitoba.

"There is a very unique triad of genetics, socio-economic factors and lifestyle that causes the high diabetes rate," Nadwidny said. "One of the most alarming global statistics is that Island Lake is where juvenile diabetes was first found. All we have are nursing stations. That is not a hospital. That frequency of contact with the patient is not there. There have been cases wherein a patient does not come in until something is really bad and then-wow-the next day they are put on dialysis and they didn't even know they were diabetic the day before."

The next step is to continue to lobby the federal and provincial governments for the regional primary health care centre. This is essentially a hospital to serve a collective population that will soon top 10,000.

"If the same health stats were seen in a non-Aboriginal rural community, it would not be long until a primary health care centre was established. Why should it be any different here?"

In addition to dialysis, there are many other aspects of treatment, which must be considered for providing health care services to an area of such high incidence of diabetes.

The regional primary health care centre would treat a wider range of conditions, allow for faster stabilization of patients, faster diagnosis and treatment and less need for travel outside the community. That would keep families together, lower stress and provide a quicker return of the recovering patient to his r her home.

The increased contact with health care professionals means earlier diagnosis and intervention of ongoing health conditions.

Mike Nadwidny warns that even though the evidence supports the development of this highly needed facility, it is an up-hill battle with no guarantees.

"The federal government says they are not in the business of building hospitals, and the province is not too anxious to do so either," he said. "The task is to again find new ways to work together and develop a plan that will do the right thing and get everyone pulling in the same direction. I hope that in five years' time we see a regional hospital and are not just looking at a stand-alone dialysis unit running out of a nursing station. If that occurs, we must realize that we set the bar too low and that we have not done our job.

"These people here are just as important as those in any other part of country. In fact, their health needs are even greater. This merits health services and infrastructure at least equal to the rest of the population.

"Although acquiring local dialysis and renal care service is a victory, it is only a victory in one of the many battles in the war to improve the health and wellness of the Aboriginal people of rural and northern regions. We must press on."