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The challenge of bringing health care services to remote First Nations communities




The Challenge When Laurie Ducharme took over as director of operations at the Four Arrows Regional Health Authority in 2005, she had a vision to change health care in the First Nations Island Lake communities of Garden Hill, Wasagamack, Red Sucker Lake and St. Theresa Point in northern Manitoba that are collectively known as Four Arrows.

In 2011, health officials were unable to categorize nearly 52 per cent of deaths in the Island Lake community because of a lack of facilities to document them. Statistics from 2012 indicate that premature deaths, digestive disorders, respiratory infection, teenage pregnancy and mortality rates were higher for Island Lake people than Manitobans in general.

Ms. Ducharme said she knew the community needed a primary-care centre, a 21st century nursing station and public health projects from diabetes care to immunization.

The Background Ms. Ducharme was born in Sioux Lookout, Ont., and is a member of the St. Theresa Point First Nation. She says she learned leadership skills from her mentor, friend and father, Ed Wood, who managed infrastructure programs for First Nations. She watched how he bridged the corporate world and First Nation communities, and from him learned the benefits of active listening, creating flattened hierarchies, promoting strong inter-cultural teamwork and using passion to drive work.

She said his example taught her the importance of strong stakeholder engagement, and that if important changes were to occur, she must work closely with members of the community.

“Management by grassroots connections really helps you be more visible, connect with employees, share ideas and invite suggestions for doing things better,” Ms. Ducharme said.

She manages a health-care team of 16 in Winnipeg that is responsible for health care in Island Lake. Ms. Ducharme said her goal was to establish accessible health programs and services, allocate funds according to the priorities of community members and ensure public health and safety was maintained through mandatory health programs.

The Solution Ms. Ducharme said she knew she needed to get partners and key stakeholders in the community to have common goals. She chose to do this through a memorandum of understanding (MOU).

Partners and key stakeholders in the MOU included the Four Island Lake communities’ chiefs, council and health directors, the board of the Four Arrows Regional Health Authority, provincial health agencies, the Assembly of First Nations, First Nation and Inuit Health (Manitoba and National), and the Assembly of Manitoba Chiefs.

Ms. Ducharme said she encountered resistance or ambivalence and goals that competed with those of the project, but met with the stakeholders separately and in groups and prepared responses to their concerns.

The memorandum states shared goals to co-operate on strategies to achieve improvements, and to identify the communities’ needs. It became the first step towards improving health care conditions collectively and establishing programs and projects for long-term sustainability of access to health care services.

The Results The MOU was key to the development of four health initiatives lead by Ms. Ducharme.

Island Lake Regional Primary Care Centre Hospital Four Arrows developed a joint health governance group comprised of representatives of the four communities, Manitoba Health, and First Nation and Inuit Health to develop a master plan. A site for the hospital has been approved and funding is being sought through public private partnerships.

Manitoba First Nation Public Health Improvement Pilot Project The Four Arrows is participating in a five-year pilot project funded at the national level by Health Canada to develop strategies for improving public-health services to First Nations. One strategy in Island Lake was an immunization program. The immunization rate has increased by 20 per cent since 2006 and has increased immunities to infectious diseases over the past five years.

Diabetes Integration Project The Integrated Diabetes Health Care Service Delivery is a mobile diabetes care and treatment services model. In the Island Lake communities, its goals are kidney-disease prevention and early diabetes detection in individuals, a sustainable platform for comprehensive kidney care unique to First Nations people, and reducing the need for dialysis in Manitoba.

A 21st-century digital nursing station The digital nursing station will be connected to the provincial and federal health care systems and it will mean faster and accurate patient care information for doctors and nurses. This turns into faster care and referrals for the patient. It can also identify and monitor patients and therefore improve the overall quality of care for patients in the community.

Ms. Ducharme is continuing to work with stakeholders on developing the hospital, which would include facilities for dialysis, lab and x-rays, a birthing centre and provide medical treatment 24 hours a day, seven days a week.

Sharaz Khan is an Instructor of Business Technologies at the Haskayne School of Business.

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