T NMU's Retinal and Foot Programs Expand

the
caribou heard
1st Quarter 2008
In this Issue
Dr. Nichole Riese Steps
Down............................. 2
CIRCLE Study............... 2
2008 Summer Students.. 3
Rural Elective Week...... 3
Announcements............. 3
Book Review: Cornwall
Cree Nation................... 3
Photo Ops..............4 & 5
CBC Reports on Retinal
Screening Program....... 6
My Big Fat Diet............ 6
Community Therapy
Assistant (CTA) Program.7
Rankin Therapy Services
Moves............................ 8
Recipes.......................... 9
Word Puzzle................. 10
Photo Contest.............. 10
Full Colour copy
of this and past
Newsletters are on
our website:
http://umanitoba.
ca/faculties/
medicine/units/
Your link to and from the North
Volume 6, No. 1
NMU's Retinal and Foot Programs
Expand
T
he NMU is expanding the
Diabetic Foot Nurse Clinician
Outreach and Retinal Screening
Programs.
On 9 June 2008 Diabetic Foot Nurse,
Myra Ibabao and Retinal Screening
Nurses, Ava Halpin and Eileen Koop
started with the NMU by attending an
Aboriginal Awareness Workshop on
the 9th and 10th.
With this addition of staff these
Retinal Nurses Eileen Koop and Ava Halpin
Programs can now expand into the
and Diabetic Foot Nurse Myra Ibabao
communities of Beren's River, Poplar
River, and Little Grand Rapids. Currently the Programs are in Norway House, Garden
Hill, Red Sucker Lake, St. Theresa Point, and Wasagamach.
The Foot Program provides continuity of care by means of regular, monthly diabetic
foot clinics for people with diabetic foot complications or those at imminent risk of
developing complications. By providing care the nurse is able to assist community
health care teams with the prevention of ulcerations, amputations, and other foot
complications that can be devastating. The nurse's scope of practice allows her to:
prescribe antibiotics similar to FNIHB guidelines, debride complicated wounds, perform
radical nail resections, bone debridement, vascular studies via Doppler (toe pressures),
initial interpretation of radiology films, ordering of laboratory investigations, and basic
emergent casting for unstable fractures.
Public presentations as needed to community and nursing station staff regarding limb
complications due to diabetes are also provided.
The Diabetic Retinal Screening Program provides eye examinations in accordance with
the Canadian Diabetes Association Guidelines.
The examinations conducted by the Retinal Screening Nurse are performed using
specialised photographic equipment. These photographs specifically look for diabetic
retinopathy as well as other eye problems that may or may not be related to diabetes:
cataracts, glaucoma, and macular degeneration.
The digital images are uploaded to a web-server where they are viewed and
interpreted by an ophthalmologist. The ophthalmologist is able to diagnose levels of
diabetic retinopathy as well as other ophthalmology concerns including cataracts and
glaucoma. s
Faculty of Medicine, University of Manitoba
J.A. Hildes Northern Medical Unit Publication
the caribou heard
1st Quarter 2008 Volume 6, No. 1
Dr. Nichole Riese Steps Down
By Dr. Bruce Martin
A
t the end of June 2008 Dr. Nichole Riese stepped down
as Associate Director of the NMU.
Nichole has had a long standing commitment to the health
care and health status of Canada's Aboriginal Peoples. This
commitment has spanned two full decades and has included
not only the populations served by the University of Manitoba
but also the Anishanaabe of Northwestern Ontario and the
James Bay Cree. Nichole joined us when she returned from
Ontario in 1993 to embark on and thereafter complete her
Masters in Community Health Sciences.
She has been tireless in her commitment to program
development, administration, and the daunting challenges of
health human resources that have evolved in the past decade.
She has routinely provided clinical care to all communities
served by the NMU and provided on-site mentorship for our
community physicians.
Nichole was always willing to provide locum support at a
moment's notice. She selflessly sacrificed personal time to
provide essential services in times of need and specifically when
and where others chose not to come forward.
To seek relief from the rigours of these activities she additionally
worked with MSF as a source of respite. She has been well
recognised by undergraduate students due to her creditability as a
clinician, role model, and educator. She has been similarly highly
regarded by consultants in all of our program areas.
Dr. Nichole Riese
I am pleased Nichole has chosen to continue her
relationship with the Department of Community Health
Sciences. She will be involved in sustaining research
activities in First Nations communities and will have an
ongoing commitment to teaching.
I trust my thanks to her for her relentless support will be
echoed by all invividuals with whom she has worked.s
CIRCLE Study in Garden Hill & Wasagamack
E
ven though Nichole is stepping down as our Associate
Director she will be working for the NMU as Site
Investigator for the project ‘Canadian First Nations
Diabetes Clinical Management Epidemiology Study’
(CIRCLE).
CIRCLE's purpose is to collect information to provide
an understanding of the current management of Type 2
diabetes in First Nations communities.
At the end of May the NMU's two new Research
Assistants, George Flett of Garden Hill and Joseph Harper
of Wasagamack spent two days training at the University
of Western Ontario in London, Ontario.
Both George and Joe will be auditing charts in Garden Hill
and Wasagamack. Fifty (50) charts from each community
will be audited. Nichole will be making trips to each
community to lend assistance with the audits.
The RA's will ask those 18 years of age or older with Type
Page 2
2 Diabetes for permission to audit their charts. No charts
will be looked at without a patient’s consent.
George and Joe will also invite healthcare staff to
complete a short questionnaire regarding the healthcare
services available in their communities and also the staffs’
experience of problems they face delivering diabetes care.
Other investigators are from the Universities of Alberta,
Saskatchewan, Western Ontario, Toronto; Queen's,
McGill, and Memorial Universities; Chisasibi First
Nation; Indigenous Physicians Association of Canada;
and Newfoundland and Labrador Centre for Health
Information. The information from the study will be used
to suggest ways to improve diabetes programs and health
care for First Nations Canadians with Type 2 Diabetes.
Nichole hopes this study will push health care funders to
provide computerised chronic disease management systems
in all communities. s
Faculty of Medicine, University of Manitoba
J.A. Hildes Northern Medical Unit Publication
1st Quarter 2008 the caribou heard
Volume 6, No. 1
Let Me Introduce to you
Rural Elective Week
...our 2008 Summer Students
NMU Placements
Baker Lake
- Sagar Choksey
Repulse Bay
- Aaron Webb
May, 20-23, 2008 - Rural Elective Week is
a mandatory part of the University's Med I
curriculum
Garden Hill
- Rajat Jayas
Sanikiluaq
- Laura Gilbert
- Shelley Mott
Red Sucker Lake/Wasagamach
- Anita Hegg
- Ashley Blais
Poplar River
- Karen Kwok
Rankin Inlet
- Aaron Guinn
- Dana Delapenha (Med Rehab Student PT1
Announcements
We are very happy to announce Dr, Perry Gall
and wife, Batya are the proud parents of a baby girl
Sarah.
Joy Langrell, is our new transcriptioinst. Joy also
works part time at the U of M, Department of Surgery,
Administrative Office at HSC.
Carolina Maniquis and Ann Lou Balbin left the
Island Lake Regional Renal Health Program in
January 2008. We wish them all the best.
Erick Chacon will be starting in Garden Hill at the
Island Lake Regional Renal Health Program on
July 28, 2008 as a Clinical Nurse Specialist after
he completes the Manitoba Nephrology Nursing
Course at the Health Sciences Centre. Erick comes
to us from Toronto but his career path has taken
him all across Canada. His ten years of Nephrology
experience will be an asset in providing care to
patients from diagnosis to renal replacement therapy.
We wish him al lthe best.
Dr. April Boyd, Vascular Surgeon made her first visit
to Norway House in May with Diabetic Foot Nurse,
Stephanie Piper.
Dr. William Miller, Psychiatry made his first visit to
Coral Harbour in June.
After more than a ten year absence Dr. Eric Stearns
will again be providing us with his services. He will
be going to Baker Lake, Arviat, Coral Harbour, and
Repulse Bay.
Faculty of Medicine, University of Manitoba
J.A. Hildes Northern Medical Unit Publication
Rankin Inlet
- Joanna Colledge
- Mark Vendramelli
Sanikiluaq
- Shelley Mott
- Jessica Spence
Cornwall Cree Nation
T
here really isn't a
Cornwall Cree Nation
— instead it is the title
of a book written by Dr.
Alan Davis of the UK.
Although fictional the
book was inspired by Dr.
Davis's experience with
the NMU in 2002.
Davis writes of Dr. Philip
Cormack, a GP from
Cornwall who is facing
burn-out and divorce.
Having fond memories of a charming town on
the prairies where he spent a student elective,
Cormack sets out on what he thinks will be a
sabbatical in Canada to the fictional Jackfish
Lake. No idyllic town this; instead Cormack
finds himself on an isolated reserve where
deprivation and despair abound. The people seem
unwelcoming, his medical skills are taxed to the
limit, and he fears he simply will not cope.
Witty, darkly comical, and populated with quirky
characters whom Cormack befriends this book is
very entertaining. A must read for those who have
worked in the north.
To order this book go to: http://www.amolibros.co.uk/
johnstonhope/page4.html
Page 3
the caribou heard
1st Quarter 2008 Volume 6, No. 1
Photo Ops
NMU Receptionist, Iryna Tsybukh at our NMU Staff
CPR Training Course. The course was taught by
Sylvia Sunstrum (HR) and attended by Julie Creasey,
Joy Langrell, Kathy Risk, and Iryna Tsybukh
Groove FM's Morning DJ, Dan Michaels and staff
bring us muffins, coffee, and coffee mugs for winning
their morning "Breakfast with Groove FM Contest".
Thanks to Michelle Vandenbroeck for entering us.
Plaque dedicated on 27 September 2007 at Churchill Hospital
JOHN A HILDES C.M. M.D.
(1918 - 1984)
Physician, Board Member, Director of the Northern Medical Unit, Member of the Order of Canada. A grateful community
honours a true champion of Northern Healthcare whose hard work made his vision a reality in the Churchill Health Centre.
Page 4
Faculty of Medicine, University of Manitoba
J.A. Hildes Northern Medical Unit Publication
1st Quarter 2008 Volume 6, No. 1
the caribou heard
Photo Ops
As a Key Note Speaker at a Nursing
Students conference, Susan Aglukark
expressed her desire to visit with
groups focused on the development of
Aboriginal Health Education. She is
seen here at the University's Centre
for Aboriginal Health Education with
Dr. Catherine Cook, Director of the
Centre and former Associate Director of
the NMU and Clara Kalit, Interpreter
at the Kivalliq Inuit Centre. At the
Centre Susan visited with some of
the University's students enrolled in
medicine, nursing, and med-rehab.
In January water problems in Garden
Hill resulted in the relocation of the
Renal Health Staff and patients to
Thompson for a week. Here the staff is
pictured with the Thompson Hospital
Dialysis Staff.
1st Row: Carolina Maniquis, Evelyn
Zaragosa
2nd Row: Gladys Wood, Marion Licera
3rd Row: Anne Lou Balbin, Hazel
(Thompson), Mirasol Salacup
4th Row: Adam, Mike (Thompson)
The NMU's two new Research
Assistants, George Flett of Garden Hill
and Joseph Harper of Wasagamack on
their way to training at the University of
Western Ontario in London, Ontario.
They are shown here in the Winnipeg
office where they met with Dr. Nichole
Riese (Site Investigator) before their
trip.
George and Joe will be RA's on
Canadian First Nations Diabetes
Clinical Management Epidemiology
Study (CIRCLE).
See article on Page 2.
Faculty of Medicine, University of Manitoba
J.A. Hildes Northern Medical Unit Publication
Page 5
the caribou heard
1st Quarter 2008 Volume 6, No. 1
CBC Reports on Retinal Screening Program
Reprinted from ww.cbc.ca/canada/manitoba/story/2007/12/07/eye-screening.html
D
iabetic patients in northern Manitoba no
longer have to leave their communities
for eye exams, thanks to a new, $3-million
eye-screening program.
Through the program, a nurse takes pictures
of a patient's eyes with a special type of
digital camera, then sends the pictures to a
specialist in Winnipeg for diagnosis.
The system should allow diabetic patients
to get an exam, diagnosis, and treatment
within two weeks, helping diagnose retinal
problems that, left untreated, could lead to
blindness.
"The nice thing from our side is that
this increases our efficiency," said Dr.
Ravi Dookeran, an eye surgeon at the
Misericordia Health Centre in Winnipeg.
Former Retinal Screening Nurse, Linda Taitley conducting an exam
"We have been able to reach out to a community that, quite frankly, it was just too difficult — to leave a busy
practice, take time out, fly up north, really not see as many patients as we would like to in the time given, and then
come back to return to an overflowing practice."
The system reduces the waiting time for diabetic patients from six months to two weeks, Dookeran said.
Northern nurse Linda Taitley said the program is already making a difference, pointing to the case of a 33-yearold diabetic man who had a serious eye problem detected and surgery within a week.
"At the point he was at, he still had a pretty decent level of visual acuity, but had it continued, it would have
progressed to blindness," she said.
So far, about 400 Manitobans with diabetes have had their eyes screened using the new technology. About a
quarter of them were referred to a specialist. s
My Big Fat Diet
Aired on CBC Newsworld, The Lens, 11 March 2008
Described as:
"Supersize Me meets Northern Exposure in My Big Fat Diet when the Namgis First Nation of Alert Bay
gives up sugar and junk food, returning to a traditional style of eating for a year to fight obesity and
diabetes."
"My Big Fat Diet chronicles how the Namgis First Nation goes cold turkey and gives up sugar and junk food
for a year in a diet study sponsored by Health Canada and the University of British Columbia. Through
the stories of six people, it documents a medical and cultural experiment that may be the first of its kind in
North America."
If you missed this documentary you can find out more information on the study at:
http://www.cbc.ca/thelens/bigfatdiet/
Page 6
Faculty of Medicine, University of Manitoba
J.A. Hildes Northern Medical Unit Publication
1st Quarter 2008 Volume 6, No. 1
the caribou heard
Community Therapy Assistant (CTA) Program
by Tracy Miller Mifflin, MScPT
Senior Instructor, Community Therapy Assistant Program Nunatta Campus, Nunavut Arctic College
O
n May 12, 2008 an exciting new diploma
program got off the ground after six years of
planning, preparation, and consultation.
The Community Therapy Assistant (CTA) program
was launched at Nunatta Campus in Iqaluit with a
class of eight students from across the territory.
The CTA program was created to train Nunavummiut
to assist in the delivery of rehabilitation services.
The rehabilitation disciplines are: Physiotherapy,
Occupational therapy, Speech-language pathology,
and Audiology
Rehabilitation professionals (sometimes collectively
called “therapists”) are typically located in the regional
centres of Iqaluit, Rankin Inlet, and Cambridge
Bay. However, they are responsible for clients
throughout the territory. Nunavut’s vast geographic
area, sparse population distribution, and high rate of
disability present challenges in meeting the territory’s
rehabilitation needs. While disability rates among
Inuit have been reported at nearly twice the national
average, the per capita rehabilitation staffing levels
in Nunavut remain significantly lower than the rest of
Canada.
Community Therapy Assistants will augment the
quality, quantity, and continuity of rehabilitation
services in Nunavut. These skilled paraprofessionals
will be qualified to carry out treatment programs as
directed by supervising health professional in the
regional centre. Remote supervision will be achieved
through a variety of technologies, including email, fax,
telephone, and Telehealth videoconferencing.
Examples of a Community Therapy Assistant’s duties
might include performing hearing screenings, leading
a children’s literacy group, performing wheelchair
repairs, and assisting an elder with a home exercise
program.
CTAs also have an important and highly respected
role to play as the community, culture, and language
experts on the rehabilitation team. Their knowledge
of their communities and culture will help to ensure
that treatment plans and assessment methods are
appropriate and relevant to clients. They will also
serve to improve the efficiency and cost-effectiveness
of rehabilitation professionals’ visits to the remote
communities, acting as dedicated assistants,
interpreters, and cultural links to the communities.
Faculty of Medicine, University of Manitoba
J.A. Hildes Northern Medical Unit Publication
The Community Therapy Assistant program will
be delivered over four semesters, interspersed
with five clinical placements. Students will gain
specific knowledge regarding the rehabilitation
disciplines of physiotherapy, occupational therapy,
speech-language pathology and audiology; and
the therapeutic skills required for assisting in the
delivery of rehabilitation programs in Nunavut. These
skills will be taught in classroom, lab, and clinical
placement settings.
Students will also learn about the broad concepts
of health, wellness, and rehabilitation, and gain
English and communication skills. They will receive
a foundation in human anatomy, physiology, and the
medical conditions encountered by the rehabilitation
disciplines in Nunavut, and become skilled at
interpreting these concepts in both English and
Inuktitut.
Students will acquire knowledge required to link Inuit
and southern Canadian health practices and beliefs
in order to most effectively present rehabilitation
concepts to community members. An ongoing focus
on ethical practice, professional behaviours, and
independent learning will equip students with the skills
necessary to succeed on their own in the workplace.
Entrance criteria were designed to obtain students
with a combination of maturity, caregiving experience,
and motivation to work in the field of rehabilitation.
Almost all our students bring previous experience
working in a health care setting to the program.
The successful commencement of the CTA program
represents the culmination of years of hard work,
planning, and collaboration from a wide variety of
individuals, institutions, and departments.
Contributions from three colleges (NAC, College
of the North Atlantic, and Yukon College), health
managers from the GN and the Northern Medical
Unit at the University of Manitoba, rehabilitation
professionals from across the country, community
members from Nunavut, and representatives from
NTI and other GN departments were all instrumental
in creating this high-calibre program. s
Page 7
the caribou heard
1st Quarter 2008 Volume 6, No. 1
Dr. Emoke
óó Szathmáry, 10th President and Vice-Chancellor of the University of Manitoba along with husband, Dr.
George Reilly are presented with a polar bear rug at a Presidential Farewell Event held at Bannatyne Campus.
The rug was specially prepared by the community of Sanikiluaq in honour of Dr. Szathmáry's retirement from the
University.
Rankin Inlet Therapy Services Moves
by Dana Delapenha, Med-Rehab 2008 Summer Student in Rankin Inlet
T
he long awaited move of Rankin Inlet's Therapy
Services into the newly renovated Wellness Centre
took place in June 2008. Currently there is an Occupational
Therapist (Sarah Browne), a Physiotherapist (Francine
Mach), and we are actively seeking a Speech-Language
Pathologist.
Therapy Services shares the Wellness Centre with Public
Health, Midwifery, and Home Care. The Public Health
Nurses see children and adults from the community for
vaccinations, education, communicable diseases etc. There
are about four to five Midwives who see women and
babies, one Home Care Nurse who generally sees five to six
clients per day in their homes or at the Health Centre. The
Wellness Centre also has Clerk Interpreters to support the
program areas.
Page 8
Gym Room at the new Wellness Centre
Faculty of Medicine, University of Manitoba
J.A. Hildes Northern Medical Unit Publication
1st Quarter 2008 Volume 6, No. 1
Recipes
Rhubarb Sauce
Don't know what to do with all that rhubarb this
summer? This sauce can be used as a base for
smoothies, strudels, compotes, pies, stirred into
vanilla yogurt, poured over ice-cream, and anything
else you can think of.
3/4 cup
sugar or sugar substitute (to taste)
1/4 cup
orange juice
4 cups
chopped fresh rhubarb
In a medium saucepan stir together sugar and
orange juice.
Stir in rhubarb and bring to a boil over medium high
heat.
Reduce heat to medium and simmer, stirring
occasionally until rhubarb is tender, 5 to 7 minutes.
Transfer to airtight container.
Cool, cover, and refrigerate for up to 1 week or put in
freezer.
Rhubarb Smoothie
1/2 cup
rhubarb sauce base
1/2 cup
frozen berries of your choice
1 scoop
vanilla frozen yogurt
Mix ingredients in a blender. This makes a thick
shake. If you want it a bit thinner add some milk or
soy milk.
the caribou heard
Advanced Trauma Life Support®
Course
This Course fills up Fast - Register
Early
The Advanced Trauma Life Support® Course for
physicians teaches a systematic approach for the
effective assessment and resuscitation of the severely
traumatised patient. The 2 day course consists of:
• pre-course test
• didactic and interactive core content
lectures
• practical skill stations
• surgical skill station
• triage scenarios
• initial assessment and management skill
station
• post-course test
Upon completion of the course physicians should feel
confident in the concepts and principles of primary
and secondary assessment, establishing management
priorities, initiating resuscitative measures and
demonstrating the practical skills used in the initial
assessment and management of patients with multiple
injuries.
A verification card is provided upon successful
completion of the course and is valid for 4 years from
the date of issue. a student refresher course must
then be taken to maintain ATLS® provider status.
October 7-18, 2008. All other courses have been
filled. 2009 courses have not yet been announced.
Please contact ATLS Department of Surgery, Children's
Hospital, 787-7374. We also have application forms in
the NMU office.
Sauteed Potatoes and Leeks
Trying to figure out how to use up all those potatoes and leeks from the garden this year? Try this recipe - almost
like potato leek soup but without all the calories.
2 tbl
Butter
2
Leeks, sliced
4 large
Potatoes cooked in skins
1/4 tsp
Celery seed
pinch
Parsely, chopped
salt and pepper to taste
Heat butter in frying pan. Add leeks and cover pan,
cook 8 to 10 minutes over low heat.
Peel potatoes and cut into thick slices, add to frying
pan
Season and sprinkle in celery seed, mix well and
cook uncovered 7 to 8 minutes over medium heat.
Sprinkle with chopped parsely and serve immediately.
Faculty of Medicine, University of Manitoba
J.A. Hildes Northern Medical Unit Publication
Page 9
the caribou heard
1st Quarter 2008 Volume 6, No. 1
Word Puzzle
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Christmas Card
Photo Contest
Many photos are submitted to the NMU by
staff, students, and physicians. In 2007 we
decided to choose one of these photos to put
on our Christmas Card.
Image Gallery on Website
The image gallery gives potential
health care providers and those with
the NMU an opportunity to see pictures
of all communities, facilities, and
accommodations. We need pictures of
accommodations and facilities in all the
communities we serve. If you have any
photos please send to: Julie at: [email protected]
cc.umanitoba.ca
Any other pictures would also be welcome.
In 2007 we featured a photo by Dr. John
Warnica of snow buntings in Nunavut.
The idea was well received so we thought
we would make a tradition of it.
If you would like to have your photo featured
on the 2008 card all you have to do is send
in a "holiday looking" photo to: [email protected]
cc.umanitoba.ca by 30 September 2008.
The only criteria is it must have been taken
in one of the communities we service.
We will contact the winner by e-mail and
announce the winner's name in our Winter
2008 Newsletter.
Page 10
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caribou heard
The Caribou Heard is published 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: 204-789-3510
Fax: 204-774-8919
Opinions expressed on these pages may or may not be
the opinions of the Editors.
Faculty of Medicine, University of Manitoba
J.A. Hildes Northern Medical Unit Publication