Diabetic Retinal Ian Whetter Screening Pro- receives Jack

the
caribou heard
2nd Quarter 2005
In this Issue
NPs in Action: Profile
of Shirley Hiebert......2
How a whole
Community can deliver
a Baby.......................4
Announcements.........6
Comings & Goings....6
Photo Ops.................7
More Photo Ops........8
Recipe........................9
Word Search............10
Cryptogram.............10
Your link to and from the North
Volume 3, No. 2
Diabetic Retinal
Screening Programme begins
Ian Whetter
receives Jack
Hildes Award
by Julie Creasey
by Julie Creasey
D
iabetic Retinopathy is the leading cause
of adult onset legal blindness in North
America.
Without proper retinal screening of Diabetics
this statistic will not change. Unfortunately,
there are usually no symptoms associated with
retinopathy until vision loss has occurred.
The Retinal Screening Programme will provide
access to retinal screening for First Nations
people within their own community along with
appropriate referrals to specialists and followup screening. Through diabetes education the
Diabetic Retinal Screening Programme will
create more awareness of diabetic retinopathy
and what steps need to be taken to prevent
blindness.
Linda Taitley, Diabetic Retinal Screening
Nurse Clinician, began visiting some of our
Communities in June providing diagnostic
screening for diabetic retinopathy. All diabetics
within these communities will be encouraged
to be screened. The Nurse Clinician will also
provide diabetes education for all individuals
being screened.
Retinal photographs will be taken and via teleophthamology, the photographs will be read
by Ophthalmologists at the Royal Alexandria
Hospital in Edmonton, Alberta. After the
photos are interpreted, appropriate referrals
and follow-ups can be arranged for the clients
involved. s
The Jack Hildes Award is
presented to a member of the
graduating class who most
exemplifies those qualities of
humanity, personal discipline,
keen curiosity, scientific inquiry,
social responsibility, and good
citizenship which enhance career
in medicine and advance health
in the community. The award is
$2,000 for advancing the winner's
appreciation of health care needs
in developing areas of the world.
Members of the graduating
class nominate other classmates
and the Jack Hildes Awards
Committee makes the final
selection.
T
he 2005 Award was presented
to Ian Whetter. In addition
to his studies Whetter, along with
Dr. Sarah Bowen of Community
Health Sciences, started the
Health Advocates Program
to facilitate better health care
access for refugees in Winnipeg
and encourage awareness of
international health issues on
campus. He also tried to foster
an interest in learning and provide
a safe space for the children who
live around HSC by volunteering
at the Jacob Penner Park Drop-In
Centre.
...continued on page 3
Faculty of Medicine, University of Manitoba
J.A. Hildes Northern Medical Unit Publication
the caribou heard
2nd Quarter 2005 Volume 3, No. 2
NPs in Action: Profile of Shirley Hiebert
reprinted with permission from Canadian Nurse
Practitioner Initiative (CNPI)
website: http://www.cnpi.ca/np_profiles/index.
W
hen most people think of the northern
community of Churchill, Manitoba, one of the
first things that comes to mind are polar bears. But
while the world-renowned bears bring in valuable
tourist dollars there’s another aspect of Churchill
that’s equally vital to this remote community — the
Northern Medical Unit run by the University of
Manitoba’s outreach program.
Shirley Hiebert knows first-hand the diverse healthcare needs of population in rural and remote
communities. She began working in 1988 as a
northern nurse in some of Manitoba’s most isolated
First Nations communities, some of them only
accessible by bush plane.
“
Nurse practitioners (NPs)
can play a valuable role in
Canada’s primary health-care
system. Besides providing
quality treatment for common
illnesses and injuries, NPs
place a major emphasis on
health promotion and illness
prevention. You could say
that our focus is on keeping
Canadians healthy.
”
Shirley says she became a nurse practitioner (NP)
because she wanted more challenge — a chance to
practice more in-depth nursing. “I felt I would be able
to assist patients in addressing health issues more
fully if my nursing scope was broader,” she says.
Since Manitoba was without a master’s level NP
program in 1995, Shirley elected to enrol in the
University of North Dakota’s Master of Science Family
Nurse Practitioner Program. “I believed the strong
science content of the program was necessary for
the type of NP duties I would encounter as a northern
nurse in isolated settings” she explains.
The NP profession has evolved in Manitoba since
that time. To date, a commitment was made by the
Provincial Health Minister for cabinet approval and
Page 2
Shirley Hiebert
proclamation of the Registered Nurse Extended
Practice regulation on 1 April 2005. The next step
in terms of licensure is for applications to be made
available for qualified registered nurses (RNs) to take
a national NP exam.
Shirley currently practices with Churchill’s Northern
Medical Unit, a setting that includes a Level 1
hospital, a pharmacy, lab and x-ray, plus a long-term
care facility, and a team of health and social service
providers as well as visiting specialists.
In her capacity as a clinician, Shirley seeks to meet
the needs of patients who come to the clinic for health
care. This may include carrying out diagnosing health
and wellness problems and writing prescriptions
collaboratively.
A typical day for Shirley involves seeing patients
through all life’s stages with various common and
not-so-common ailments, including pregnant women,
newborns, children, teenagers, adults, and the elderly
from First Nations, Métis, Inuit, as well as nonAboriginal population.
“I collaborate with physicians and other health-care
team members on less common problems or ways to
address health issues that require a broader focus,”
she says.
“As our clinic is part of a university teaching program
there are many opportunities to collaborate with
family practice physicians, visiting specialists, mental
health and social services professionals, plus the
dietician, physiotherapist, pharmacist, audiologist,
dentist and so on,” says Shirley.
NPs like Shirley also take after-hours calls to see
emergency patients, as well as attend hospital rounds
...continued on next page
Faculty of Medicine, University of Manitoba
J.A. Hildes Northern Medical Unit Publication
2nd Quarter 2005 Volume 3, No. 2
Hiebert
continued from page 2
with physicians and other health-care team members.
“An RN functions in a more structured role and
setting, whereas an NP works collaboratively within
a broader scope of practice,” explains Shirley. “Both
an NP and an RN seek to optimise a patient’s ability
to meet their health and illness needs by providing
holistic care.”
the caribou heard
Change your Bookmarks
Revised NMU Website
Although our website pretty much has the
same basic look, major changes have been
made.
I re-did quite a bit of the back-end
programming but that is not something you as
a visitor to the site would observe.
”Shirley finds it particularly rewarding to see patients
actively involved in achieving improved health for
themselves. “I see myself as a facilitator in this
process by helping patients understand their health
and illness needs and ways to better meet them.”
The most noticable changes you will note
are a consistent look across all pages, the
search functions work, information has been
re-organised, and the menu tree is slightly
different.
In addition to her clinical duties, Shirley’s doctorate
research experience in northern First Nations
communities around childbearing, as well as NP and
community health issues, has provided her with a
broad insight into health and illness needs as they
impact both individuals and populations as a whole.
Forms and Guidelines for Staff are in the
"For Staff" area.
Shirley continues to pursue her research interests
and makes herself available as a community health
consultant. “Based on over 25 years of experience
in the health-care field it’s obvious to me how well
NPs can meet the needs of patients in a wide array of
settings,” she says. s
Ian Whetter
continued from page 1
For Whetter “the pursuit of medicine as a career
is about being a force for positive, social change,
but it is difficult, at times, to be sure that is in fact
what we are". He notes that “we only have to look
back to Saskatchewan 1962 when doctors went
on strike at the suggestion that medical care would
be universally funded to see that we may not be
the paragons of social change.” This serves as a
reminder to Whetter “that being a force for positive,
social change does not end with earning a title or a
degree, but is an ongoing struggle.”
Whetter is now headed to Newfoundland's Memorial
University for two years to complete their rural and
northern family medicine residency program.
Over time we will be updating the content and
perhaps adding more on-line forms.
If you have any questions or comments please
contact me: Julie Creasey 204-987-3510 or
[email protected]
(FYI: I studied backend programming for the
Internet at the University of Winnipeg as well
as other topics related to web development, plus
graphic arts, database administration, writing, and
communications. — Julie Creasey)
Recommended Readings
Occult hepatitis B virus infection in a North
American community-based population,
Objective: document the prevalence of
occult HBV in an isolated North American
Inuit community. Authors: Gerald Y. Minuk,
Dong-feng Sun, Julia Uhanova, Manna
Zhang, Shauna Caouette, Lindsay E. Nicolle,
Adam Gutkin, Karen Doucette, Bruce
Martin, Antonion Giulivi. Elsevier, European
Association for the Study of the Liver, Journal
of Hepatology, 42 (2005) 480-485
Once he finishes his residency he will return to work
in rural in Manitoba. We wish him all the best. s
Faculty of Medicine, University of Manitoba
J.A. Hildes Northern Medical Unit Publication
Page 3
the caribou heard
2nd Quarter 2005 Volume 3, No. 2
How a whole Community can deliver a Baby
by Locum Physician, Dr. Christine Dechert
I
was having a lazy sleepy
morning on a Saturday in
April 2005. I wasn’t working
the clinic but was on call. I did
some errands, which in northern
towns doesn’t take you too far
from home or too much time to
complete: to the grocery store,
then kitty corner to the pharmacy,
then across the street to the bank
all done within 15 minutes. Later
on in the afternoon, braving the
-26 temperature I took a long
walk and then wandered over to
the clinic.
“
I figured I’d pop
over, do a quick
easy delivery
and be back in a
couple of hours
to enjoy the rest
of my lazy day.
”
Once there I found a
message asking me to fly to a
neighbouring town to assess a
patient. A patient was either term
or preterm, in active labour or not
in active labour, 3 cm dilated or 7
cm dilated. The location is only
a 15 minute flight, so assuming
the best case scenario, I figured
I’d pop over, do a quick easy
delivery and be back in a couple
of hours to enjoy the rest of my
lazy day.
I rushed to the airport stopping
to grab one or two things from
home. The medivac plane was
fairly small, the eight seater plane
used for local flights. Physical
movement was limited because
of all the gear, stretcher, and
incubator. The flight nurse,
Tracy was extremely efficient
as she readied everything in the
confines of the plane.
Page 4
We arrived
uneventfully
with no
vehicles
in sight
to pick us
up. At the
unattended
terminal we
called the
health clinic.
They told
us that the
clinic’s SUV
should have arrived for us 10
minutes ago.
This town’s airport is a 15 minute
drive outside of town — 6.2
miles over open tundra. Waiting
5 minutes — and still no SUV
— I called back. The clinic then
called the RCMP who dispatched
some officers to come pick us
up.
Fifteen minutes passed without
the SUV or the RCMP arriving. I
then called the RCMP and spoke
with an acquaintance, Kristie.
She told me both vehicles had
been stuck and had to wait for a
road-clearing front end loader;
which they were now following
out. As backup additional RCMP
in snowmobiles had also been
sent.
While waiting I learned the
patient was only 34 weeks along
(always a good outcome in a city
with a neonatal ICU unit, but not
here where there is little support)
and that there was dark-coloured
amniotic fluid (which can be lifethreatening). As well, the patient
had a still-born baby with her last
delivery. Things were going from
bad to worse and we weren’t
even out of the airport yet.
Finally the SUV arrived. Passing
the RCMP snowmobiles we
arrived in town after breasting
only a few drifts. At the clinic a
quick assessment showed the
patient’s contractions were every
10 minutes and she was half-way
dilated.
I made the decision to transport
her to Winnipeg hoping to get at
least part way before delivery —
even if we had to land in Churchill
or Thompson to stabilize the
new-born. Though I knew it was
unlikely, I prayed we’d make it
all the way to Winnipeg without
incident.
Delivering in the plane didn’t
worry me too much although
the cramped quarters would be
difficult. My biggest worry was
stabilizing the baby and the
possibility of having to bag it for a
prolonged period of time.
In less than an hour we had
the patient on a stretcher in a
sleeping bag and headed back to
the terminal.
The front end loader had been
going back and forth to clear the
road but the snow had drifted
again and the blowing snow
obliterated the vision of the road
in many places.
Alan, the driver couldn’t see.
Faculty of Medicine, University of Manitoba
J.A. Hildes Northern Medical Unit Publication
2nd Quarter 2005 The wiper blades were freezing
and not clearing the windshield.
I had to help navigate, saying
“your way, my way, straight,
etc.” sticking my head out the
window trying to see the road.
“
the caribou heard
Volume 3, No. 2
to us were stuck. They were
sending out more snow machines
with a kamotiq (an Inuit sled used
behind a snow machines).
Alan ploughed
off the road into
a five foot drift.
We crawled along with minimal
visibility, sometimes navigating
by intuition alone. The airplane
came into sight about a mile
away as we breasted the last
rise. Clear road after that —
then Alan ploughed off the road
into a five foot drift.
We tried to push the SUV out but
it was caught up on the engine
block. Although all four wheels
were free, they just spun. No
shovel, no radio.
We sent the patient’s husband
running to the terminal a mile or
so away to call the RCMP and
bring a shovel. While waiting I
dug out a fair amount of snow
with my hands with no success.
The people came back from the
terminal — no shovel — only
a board with nails sticking out
of it and the tops of two storage
containers.
More efforts while we waited for
the front-end loader failed. At
one point Ken was lying on the
snow in front of the SUV using
the board to chip away the ice
frozen under the engine block.
Visibility diminished and we
couldn’t see the airport anymore.
We asked Ken several times
if he’d still be able to take off.
Finally he pointed to a sign about
50 metres away and said “When
we can’t see that sign any more I
won’t be able to take off.”
After an endless hour Kristie
showed up on a snow machine.
The front end loader and all other
vehicles trying to get through
The sign 50 metres away was
starting to get fuzzy and if we
didn’t take off soon we wouldn’t
be able to leave. Just as we
seriously thought of carrying the
patient the last mile the snow
machines finally arrived.
“
Every 30 seconds
or so I yelled 'Are
you alright' and
would hear a faint
'yes'.
”
Four people hopped over the drift
at the side of the road to bring
over the kamotiq. We hooked it
up behind another snow machine
and transferred the patient, who
was completely zipped up in her
sleeping bag and covered by a
tarp. I jumped on the kamotiq
kneeling practically on top of her.
I couldn’t see any part of her and
could barely hear her, so every
30 seconds or so I yelled, “Are
you alright”, and would hear a
faint “yes”. Luckily she had some
Gravol and was quite calm and
comfortable through all this.
We got to the plane in only three
or four minutes. My hands were
freezing. I could barely feel my
fingers and I needed help to get
out of the kamotiq. In our frozen
state it took six of us to lift her
onto the plane.
to take off — just by following
the runway lights. I didn’t watch
— just prayed. My hands thawed
quickly but I was still shaking
with cold an hour later. The
patient’s contractions settled
down to every 10 minutes but
it was still high high stress — I
was making plans in my mind in
case she delivered.
We flew past Churchill and
I examined the patient just
before Thompson. We decided
to make the push for Winnipeg.
About 45 minutes before
arriving her contractions picked
up in frequency and intensity.
On arrival in Winnipeg we
transferred to the waiting
ambulance and made a leisurely
journey to the hospital.
Unbelievably we made it to the
delivery suite just as the patient
was about to deliver!
At this point her care was handed
off to the nurses and at the
hospital.
Feeling a sense of relief and
elation we headed back to the
airport confident in the outcome.
On the flight back my thoughts
centred around how the
contributions of all the people
involved — nurses, doctors,
pilots, police —were absolutely
essential.
The whole undertaking would
have failed if all involved hadn’t
been skilled and resourceful at
doing their job. Sometimes it
does take a whole community to
deliver a baby. s
I later learned that in an unheard
of medical twist, although the
patient was ready to deliver when
we got to the hospital, her labour
stopped just after we left the
hospital and she delivered two
days later! I’ve never seen that
before in 15 years of experience.
Unbelievably the pilots were able
Faculty of Medicine, University of Manitoba
J.A. Hildes Northern Medical Unit Publication
Page 5
the caribou heard
2nd Quarter 2005 Volume 3, No. 2
I think we have encountered our first problem!
As seen in ‘The Lighter Side of Dialysis’. Used with the permission of Peter Quaife and Jazz Communications
Announcements
Dr. Bruce Martin - Received the well
deserved 2005 MMA Administrative
Award for contribution to policy and
administration of health care. He was
honoured by the MMA at its Annual
General Business Meeting on 11 May
2005. Congratulations Bruce.
Comings and Goings
J
acquie Thiessen started with the NMU in April
as Wendy Whalley's (Renal Health Programme
Manager) Administrative Assistant. Jacquie spent
16 years in Medical Microbiology here at the U of
M; 10 years in Infectious Diseases and six in Adult
Leukemia Research. Welcome Jacquie :-)
Linda Taitley is our new Diabetic Retinal
Screening Nurse Clinician. Linda began visiting our
communities in early June. See story page 1
Dr. Elmo VanWyk left us at the end of May.
A new midwife/nurse practitioner for Churchill, Martha
Aitkin will be starting in August 2005.
Michelle Vandenbroeck - is a first time
grandmother!! Michelle's daughter gave birth to a
healthy and happy baby girl on 16 April 2005.
On 22 April 2005, Minister Levinia Brown honoured
Rose Brown with a Long Term Service Award (25
years) at the Kivalliq Health Centre.
Renier Loots Joubert was born Sunday, June 5th
2005 at 12:45 p.m. at St. Boniface Hospital. He
weighted 8 lbs and 11 ozs. Parents are Renier and
Annalize Joubert of Hodgson.
and then in Hodgson) Dr. Freddie and Karen Meyer
are leaving for BC. The staff at Percy Moore put on
a wonderful barbeque for them on 1 June 2005 at
the hospital. It was apparent they had become a part
of the community and will be sadly missed. We wish
them all the best.
By mid-summer we will have three new docs at Percy
Moore in Hodgson. Dr. Tina Wasicuma will start in
mid-July and Drs. Khaled Alnhisi and Mohamed
Albrar will be available once they have completed the
immigration process.
Physician, Dr. Danielle Froese, MD, CCFP, will be
starting full time on July 4th in the Kivalliq Region
of Nunavut along with her partner Rick Smith,
Physiotherapist. Danielle is originally from Ontario
and Rick is from the Vancouver area.
After 4 years with the NMU (first in Norway House
Page 6
Faculty of Medicine, University of Manitoba
J.A. Hildes Northern Medical Unit Publication
2nd Quarter 2005 the caribou heard
Volume 3, No. 2
Photo Ops
Dr. Martin Receives MMA Award
Plaque Commemorating Dr. Christine Egan
Dr. Martin (middle) holding the MMA's 2005
Administrative Award presented to him at the MMA's 2005
Awards Dinner and Installation Ceremony. He is joined
by Dr. Alec Macaulay, Dr. Anne Durcan, and Dr. Nichole
Reise.
Visits to NMU
Dr. Sharon Macdonald, VP, Community Care, WRHA; Dr.
˝ Szathmáry, President, University of Manitoba;
Emoke
and Dr. Ellen Judd, Professor Anthropology, University of
Manitoba honour their friend and colleague, Dr. Christine
Egan in a plaque unveiling ceremony.
Newlyweds, Perry and Batya Gall visit a few days
after their Toronto wedding
Plaque can be viewed in the J.A. Hildes Memorial Court
at the Basic Medical Sciences Building at the Bannatyne
Campus.
Faculty of Medicine, University of Manitoba
J.A. Hildes Northern Medical Unit Publication
Much to the delight of our staff, Mike Patterson stops
by with his baby Rohnan.
Page 7
the caribou heard
2nd Quarter 2005 Volume 3, No. 2
More Photo Ops
Farewell
Freddie and Karen Meyer at their Farewell Barbeque
put on by the staff at Percy Moore.
Showing off the cake
Teddy Bear Picnic Photos
Alec Macaulay and Anne Durcan with their children,
Maura, Helen, and Patrick
Peds resident and former NMU summer student
programme participant, Scott Sawyer and family
Island Lake area physician, Wendy Smith and son,
Nunavut, Department of Health and Social Services,
Kivalliq Region Tent
Page 8
Faculty of Medicine, University of Manitoba
J.A. Hildes Northern Medical Unit Publication
2nd Quarter 2005 Volume 3, No. 2
Do you have a story?
If you have a story you would like
to share with everyone please send
it to:
Julie Creasey
the caribou heard
Winter Issue
Cryptoquote Solution
"Peace, food, and sanitation is far
more important than medical care in
the big picture." Dr. K. Jansen
[email protected]
Recipe
Old Fashioned Baked Beans
4 to 6 servings
12 hours prep time
yellow eyed beans
1 teaspoon
baking soda
1 medium
onion
1/2 lb
salt pork
1/4 cup
brown sugar
1/2 cup
molasses
2 teaspoons
dry mustard
1/2 teaspoon
salt
Soak beans overnight well covered with cold water.
Pour off soaking water and pick over beans to
remove any bad ones or debris.
Put beans in a pot.
Cover with fresh cold water and add 1 tsp. baking
soda.
Bring to a boil and cook until skins of beans crack
when you take one out on a spoon and blow on it.
Cut onion in quarters and put in bottom of a bean
crock or large casserole.
Add the partially cooked beans.
Put cut up salt pork on top.
Faculty of Medicine, University of Manitoba
J.A. Hildes Northern Medical Unit Publication
Combine brown sugar, molasses, mustard, and salt
with 1 1/2 cups boiling water.
Pour over the beans.
Add more boiling water if needed to come just to the
top of the beans.
Also, if needed during baking time add more boiling
water.
Bake, covered, at 300 degrees F for 6 hours or until
beans are tender.
"Why did the cross-eyed teacher lose her job?"
Answer: She couldn't control her pupils.
2 lbs
Page 9
the caribou heard
2nd Quarter 2005 Word Search
(solutions to puzzles in next newsletter)
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Volume 3, No. 2
BEAR
SAGE
BUFFALO
SEAL
CARIBOU
SWEETGRASS
CEDAR
TOBACCO
EAGLE
WALRUS
LICHEN
WOLF
MOUSE
PEREGRINE
RAVEN
Cryptogram
NMU Website
Have you visited the Northern Medical Unit
website? We are located at:
http://www.umanitoba.ca/faculties/medicine/units/
northern_medical_unit/index.php
The website has information about Northern
Medical Unit programs, areas served, job
postings, links to current and archived
newsletters, forms, and practice guidelines.
the
caribou heard
The Caribou Heard is published quarterly by the J.
A. Hildes Northern Medical Unit, A Division of the
Department of Community Health Sciences at the
University of Manitoba
Submissions can be made to Julie Creasey at T162770 Bannatyne Avenue, Winnipeg MB, R3E 0W3,
[email protected]
Phone: 204-789-3425
Fax: 204-774-8919
Opinions expressed on these pages may or may not be
the opinions of the Editors.
Page 10
Faculty of Medicine, University of Manitoba
J.A. Hildes Northern Medical Unit Publication