We the North
Posted on Monday, February 1, 2021
By Michelle Read
Imagine travelling to southern Mexico for surgery, the pre-operation anxiety compounded by language barriers, cultural differences, absence from family and hours on a plane.
Similar scenarios often occur for patients living in Canada’s rural and remote areas, who must travel long distances to tertiary centres like The Ottawa Hospital for essential procedures and specialized care.
“The disruption for patients and their families can be mitigated,” says Dr. Jason McVicar, assistant professor at the Faculty of Medicine Department of Anesthesia and Pain Medicine and director of its Global Health program. Providing care in-territory where possible, he says, controls costs, reduces cultural and language barriers and eases stress on families.
Keeping care in the communities
For four years, the Global Health program has supported the medical team in Iqaluit, Nunavut in keeping patients in the community for medical care by improving perioperative care processes in-territory. This includes ongoing support by Ottawa physicians of the continuing education and professional development of family practice anesthesia colleagues at the Qikiqtani General Hospital.
“Sometimes it may be more practical for the professional, rather than the patient, to be the one to travel between communities—not only is it easier on costs and the patient, but it aids in skill sharing and expanding the medical repertoire of the physicians,” says Dr. McVicar, an anesthesiologist at The Ottawa Hospital.
In some cases, Ottawa physicians travel to remote communities to support medical procedures and patient care; while there, they may also give presentations for the physicians’ professional development. Conversely, physicians may come to work in Ottawa for learning opportunities while providing clinical care.
“They can learn things we do on a daily basis that they may only do on occasion,” says Dr. McVicar.
At Qikiqtani Hospital, three family physician anesthetists, each with a broad range of skills, provide many of the medical services. Ottawa’s physicians work to support them in patient care as needed and to share ongoing training.
“When the care stays in the territory, those physicians know the nuances and needs of their patients and are much better suited to provide culturally appropriate care,” says Dr. McVicar.
Honing skills through strong connections
Dr. Chelsey Sheffield is the chief of anesthesia in Nunavut; she practices anesthesia at the Qikiqtani General Hospital, along with obstetrics, family medicine and emergency medicine. Dr. Sheffield has taken advantage of opportunities to travel to The Ottawa Hospital to brush up on skills for procedures with which she must be familiar but does not have the opportunity to perform often in Nunavut, like awake intubations and epidurals.
“We consider ourselves very fortunate to have such a close relationship with The Ottawa Hospital’s anesthesia department,” Dr. Sheffield says. “They have provided us with information and support for everything from virtual grand rounds presentations, locum coverage, clinical questions, continuing education and research, hospital policies, and the COVID-19 response.”
The partnership helps bridge the knowledge from the specialists at The Ottawa Hospital back to Qikiqtani, where most physicians are generalists.
“The ongoing support that Dr McVicar and his team have provided has had a lasting impact on my personal practice, as well as that of our anesthesia group,” says Dr. Sheffield.
Sharing support with physicians and beyond
When a physician introduces a new procedure to their hospital, it is essential that nurses be supported to ensure patients receive optimal care throughout their hospital stay. Dr. McVicar says his team is in contact with nurse educators at partner hospitals to share policies in areas such as acute pain.
“A team will likely choose to do a procedure where the expertise is embedded in the culture,” he says. “You might be able to technically do the surgery in territory, but you must also ensure the level of nursing support through the recovery phase.”
As part of the Global Health program, Dr. McVicar is conducting Indigenous perioperative health care outcomes research. The current literature is scant, he says, but he is communicating with organizations like Nunavut Tunngavik Incorporated to frame the necessary research questions.
“Inuit leadership has many priorities to address with their resources,” he says, explaining that his team is examining how differences in access to surgery impact Indigenous patients in terms of mortality, length of stay and complications.
Dr. McVicar stresses that we must remind ourselves of just how foreign an environment Ottawa can be for Canadians in the North as we seek to provide the best care for patients.
“It is important that academic centres are available to support colleagues in communities, no matter how far away they may be, so that all Canadians have access to the best possible care.”
Main photo: Qikiqtani General Hospital in Iqaluit, Nunavut. Credit: Thomas Rohner/Nunatsiaq News
Remaining photo credits: Dr. Jason McVicar