Vol. 12 No. 2 - 2014

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2014, June Your link to and from the North Volume 12, no. 2

University of Manitoba, Faculty of Health Sciences, College of MedicineSection of First Nations, Métis and Inuit Health, J.A. Hildes Northern Medical Unit Publication

A copy of this and past Newsletters are on our website at the following URL:

http://tiny.cc/nmu_news/

Google: J.A. Hildes Northern Medical Unit

In this Issue

5 NMU Programs �� 3

Announcements �� 5

Rural Week �� 6

National Aboriginal Day �� 8

Library Services �� 10

...more photos inside

Raising Diabetes Awareness Among Poplar River's Youth

The cold drizzly weather on the 11th of June didn't deter the

students of Poplar River Elementary School from walking 3 km from the bridge to the Nursing Station. Nor did it dampen the enthusiasm of the volunteers and the organisers in making the Annual Walk a success.

Even though youth see first hand what some family members with diabetes go through, not all youth know about the causes of diabetes; that it can be prevented or delayed; and, because of the increase in Type 2 Diabetes amongst the young, they too are at risk. Engaging in events such as this, along with other community initiatives, helps to raise the awareness that simple things like getting regular exercise and eating healthy food lower that risk.

Congratulations everyone on a successful event.

A Community event organised by the Northern Store's, Richard Martel; the Nursing Station's NIC, Edith Martel; ADI/CHR worker, Rosalie Franklin; CHR, Rose Klippenstein; and a number of volunteers and speakers.

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2014, June Volume 12, no. 2

The J. A. Hildes Northern Medical Unit provides several services to some of the

Northern First Nations Communities to prevent and treat complications from diabetes. Most of these services have been covered in the Caribou Herd:

1. Diabetic Foot Care Program: Two Nurses provide foot care prevention and treatment to 14 communities. The main activities are: educate, examine feet regularly, treat common problems like nail deformities or

calluses; refer problem cases to the Diabetic Foot Clinic at the Health Sciences Centre to prevent further major complications; and prescribe insoles and shoes for Orthotics.

2. Retinal Screening: Two Nurses photograph the retina as seen through the ocular microscope and an ophthalmologist in Winnipeg checks these photographs and decides on further action to be taken.

3. The Island Lake Regional Renal Health Unit in Garden Hill: This Dialysis Unit serves

Vince Choy, Registered Orthopaedic Technologist in the Cast Room, HSC

Photo by Dr Mario Dascal, Diabetic Foot Surgeon

by Dr� Frank Duerksen

Dr. Frank Duerksen is a retired orthopaedic surgeon. Dr. Duerksen's first trip for the NMU was in 1975 and his last in 2008 when he retired. He worked in Churchill, Rankin Inlet, and later in Norway House. He initiated the Diabetic Foot Clinic at HSC, was Medical Director of Rehab Engineering, and initiated the visits of two orthotists to First Nation Communities. Together with Dr. John Embil they initiated the Diabetic Foot Care Program in 2002. He also started the Cast Technician Program in Norway House. In addition to his work in Northern Canada and Winnipeg, Dr. Duerksen is an expert in leprosy reconstructive surgery in South America and Africa. Throughout his career he would travel between Paraguay (his birth country), Winnipeg, Northern Manitoba, and Nunavut.

5 NMU Programs for the Prevention and Treatment of Diabetes Complications



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5 NMU Programscontinued

four communities. In the past the patient on dialysis had to move to Winnipeg, usually an elderly person, separated for good from their family and community.

Two which have not having been covered are:

4. Orthotic Service: Two orthotists provide custom made insoles and shoes to four communities. This saves many trips to Winnipeg.

5. Total Contact Casting (TCC) in Norway House: (Vince Choy) The standard treatment for a plantar foot ulcer (wound) and for broken bones in diabetic feet is the total contact cast (TCC). The TCC is a special cast with very little padding. The cast distributes the weight bearing over the whole lower leg and foot. It takes off about 60% of the weight. It speeds up the healing of the ulcer and prevents further fractures of the bones in the foot (Charcot foot) that would eventually lead to total destruction and amputation of the foot. It

usually takes 10-12 weeks in a TCC to heal a foot ulcer. The TCC for bone fractures is used usually for 6-8 months. It takes twice as much time to heal bone fractures in diabetic patients. The normal sequence for the first cast to be changed is at one week, then at two weeks, then at three or four weeks, and from there on every four to six weeks.

Special training and care is necessary for the application of the TCC. Vince Choy is a Registered Orthopaedic Technologist Advanced Standing. He is very well trained and experienced in applying TCC’s and he spends two days, twice per month in Norway House. He changes the TCC’s that are needed, saving many air trips for patients and their escorts to Winnipeg. He also helps the local staff by applying casts on patients with fractures.

These are unique programs that benefit a number of First Nations Communities. Community members do not have to leave their homes for treatments or assessments resulting in significant cost savings by reducing travel. s

Garden Hill, Renal Health Unit Staff and children, Jennifer Esau, Nancy Mentuck, Kevin Esau, Chester Miller (on the table), Grant McDougall-Beardy, Natasha McDougall-Beardy, Deanna Miller, Phoenix Mentuck, Tamara Mentuck her baby, Brianna�



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Poplar River Walk for Diabetes Photos

Food Prep Crew: (L to R) Linda Bittern, Virginia Bathenchuk, and Joan Nugent, RN�

3 BBQ's were fired up for hotdogs and hamburgers (food provided by the Northern Store) to feed the hungry group after the long walk�

Community Member, Edith Hammond helping out with the hotdog stand�

Smiling faces all around, good exercise, good food, and good fun

Along with the hotdogs & hamburgers there was lots of fruit and veggies

CHR, Rose Klippenstein holding Banner for the Walk�



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Reluctantly we said good-bye to our financial assistant of two years, Kathy Cao. Kathy

was offered a position at Fort Garry in Extended Education as a budget Budget Analyst. This is a fantastic career move for Kathy but we will miss her laughter, friendship, and Joie de vivre. Kathy, we wish you everything good life has to offer.

A new psychiatrist, Dr. Polina (Lina) Anang will begin travelling in August to Repulse Bay. Dr. Anang is filling the shoes of long time NMU psychiatrist, Dr. Keith Hildahl.

Dr. Hildahl recently retired after traveling to the Kivalliq since February of 1989. At the time, the Kivalliq was the Keewatin District of the NWT. We wish Dr. Hildahl a happy retirement and thank him for his committment to northern health over these last 25 years.

We also said good-bye to Dr. Martin Nguetsop who is going into the Radiology Residency Program. Dr. Nguetsop came from the N/R Residency Program to us in August of 2011 and worked in Norway House and Hodgson. We wish him all the best in the next phase of his medical career.

Welcome to Dr. Christina Katopodis who has joined Dr. Gerry McCarthy's practice. Christina travelled with Dr. McCarthy quite a bit during her residency and will be alternating trips with Dr. McCarthy.

Drs. Cal Bergen, Nadin Gilroy, and Adrienne Morrow, who all come from the N/R Residency Program, will all be starting in Norway House this summer. In addiition, Dr. Morrow just completed her Public Health Residency with Community Health Sciences. Congratulations Dr. Morrow.

The Northern Medical Unit Specialist Program is expanding into other communities and regions in the province. In response to these changes, Lori Thiessen's role will slowly transition to support ongoing program development and supervision of the day to day co-ordination of the Specialist Program.

Announcements

Kathy Cao

Dr. Keith Hildahl

Dr. Moffatt will continue as our Specialist Program Advisor in his role as Senior Medical Consultant.

Amanda Abele (Hospital Based) and Mary Carey (Kivalliq & Kitikmeot) will be assisting Lori with co-ordination activities for the Specialist Programs.

Doing cartwheels around the office are our Retinal Screening Nurses, Amy Dytnerski and Gitane Ouelet who just learned they obtained their Canadian Diabetes Educator Certification. Congratulations!!!!



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Rural Week is a one week learning experience for all

first year medical students. It provides an opportunity for the students to get first-hand experience and exposure to not just rural and northern medicine but rural and northern life. It is also an opportunity for participating communities to showcase themselves and promote the opportunities and benefits of rural and northern medicine.

It takes the efforts of numerous preceptors, health care professionals, and countless community volunteers to provide students with rural medicine and community experiences. Dr. Anne Durcan (NMU, Director Inuit Heath) in her other role as Education Co-ordinator, Undergraduate Rural Medical Education successfully co-ordinates the week in conjunction with the Office of Rural and Northern Health. And helping

to contribute to that success is the NMU's Kathy Risk who co-ordinates the student's travel to some of the northern and Inuit communities participating in the Week.

The feedback from students was wonderfully positive with respect to their

preceptors. Most were happy with the teaching, guidance, patience, and assisting in a variety of settings. Although, at times in some communities, clinics were so busy there was very little time for teaching.

High praise was given for all the health care staff from nurses to medical drivers. Many commented how everyone was incredibly supportative and

Another Successful Rural Week

Med I's Kiilmeny Melnick and Out on the land in Sanikiluaq, fishing mussels, and making bannock & smores

The instructor I had made my rural week. He was a very dedicated teacher and was giving me lessons I hope to reflect on as I continue both my education and eventually my career in medicine.

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most helpful and happy teaching and answers the student's questions.

Most were able to participate in community events, such as High School Presentations, tours of the communities, hunting for mussels and sea urchins, smudge and pipe ceremony. And most would have liked to have experienced more community events, culture, and way of life.

One student reflected the others in the "Most Liked" question on the feedback form:

"I really enjoyed getting to live on a reserve and see first hand what life on a reserve is like. I think this is an integral experience for physicians, even those practicing in urban centres, as you will still have to see these patients. I really enjoyed being in a rural setting where I could fish. I thoroughly enjoyed speaking with the locals and learning from the nursing staff." s

Other support staff and community members made the experience very enjoyable. Everyone was extremely kind, welcoming, and helpful.

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Start: 09/19/2014End: 09/21/2014Timezone: Canada/Pacific

TheTłıchoGovernment,theGovernmentoftheNorthwestTerritories and Canadian Polar Commissi,on are co-hosting a multi-event symposium to advance the use of Traditional Knowledge.Overview

The symposium will comprise four companion events Friday though Sunday:

• Akick-offeventinBehchokoinhonour of Aboriginal elders, with invitations to leaders, symposium VIPs, major sponsors, and key presenters

• One-dayscholarlysymposiumattheExplorerHotel

• “TEDxTłıcho”:aone-dayTEDxpodium event at the Explorer Hotel

• AcompanionTraditionalKnowledgeFestival incorporating booth displays, cultural demonstrations, and a book fair

For More Information:http://nativemaps.org/node/3905

ITA YATAI: A Symposium on Traditional Knowledge

Yellowknife, NWT

INIHKD & Manitoba NEAHR Conference 20145 - 10 October 2014

This conference builds on the INIKHD’s international gathering held every two years that is dedicated to improving the lives of Indigenous peoples globally through Indigenous and community-led research, health services, and workforce development. This year’s conference will include a focus on Indigenous health research in true collaboration and mentoring new investigators and graduate students.

In October 2014 this gathering will be taking place in Winnipeg, Manitoba, Canada. An estimated 600 people including health service providers, Indigenous community members, researchers, and policy formulator attendees will share in the showcasing and honouring of Indigenous-led knowledge development in research, education & training, and health service models.

http://inihkd2014-neahr2014.com



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National Aboriginal Day 21 June 2014Held on Friday, the 20th of June at the U of M/HSC Complex

Once again The Section of First Nations, Métis, and Inuit Health along with the University's Aboriginal Health Library, Aboriginal Services at HSC, and CancerCareManitoba, First Nations,

Métis, & Inuit Cancer Control did a bang up job putting on the day's festivities.

This year there was a Ceremonial Blessing of the soon to be Medicine Wheel Garden of Indigenous Learning. The Garden will be located in the green space off Bannatyne right across from the Old Basic Medical Entrance. The arrangments for this portion of Aboriginal Day were made by Ft. Garry's, Indigenous Achievement.

New this year were booths showcasing aboriginal health programs at the University, HSC, and CancerCare. Congratulations to the Committee Members for providing a wonderful day for all who attended. It gets better every year!! s

Sylvia Boudreau of HSC's Aboriginal Health Services Amy Dytnerski, Diabetic Retinal Screeing Nurse & Ava Halpin, Diabetic Foot Nurse

Craft Vendors in Brodie Centre Medicine Wheel Garden Blessing



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Submitted by: Janice LintonAboriginal Health Librarian and Liaison Librarian for Community Health Sciences

Library Services to the Kivalliq Region & Sanikiluaq

As they are published, new books are being shipped in June and late summer to Kivalliq Health Centres and Medical Rehabilitation Services in Rankin Inlet.

Don’t forget that library services are available all year round for health care providers working in the Kivalliq communities and Sanikiluaq

Library & Information Services Include:

Literature Searches to find the information you need for patient care, program development and evaluation, continuing education, and professional development.

Document Delivery Sending you journal articles, reports and information wherever and whenever you need it.

Contact Janice Linton, Aboriginal Health Librarian & Liaison Librarian for Community Health Sciences, for information on Kivalliq Library Services [email protected]

A selection of new articles relevant to patient care in Canada and Nunavut

(1) Athwal L, Marchuk B, Laforêt-Fliesser Y, Castanza J, Davis L, Lasalle M. Adaptation of a Best Practice Guideline to Strengthen Client-Centered Care in Public Health. Public Health Nursing 2014;31(2):134-143.

(2) Do MT, Fréchette M, McFaull S, Denning B, (2) Bains A, Pakseresht M, Roache C, Beck L, Sheehy T, Gittelsohn J, et al. Healthy Foods North improves diet among Inuit and Inuvialuit women of childbearing age in Arctic Canada. Journal of Human Nutrition and Dietetics 2014;27(SUPPL2):175-185.

(3) Cheung J, Goodman KJ, Girgis S, Bailey R, Morse J, Fedorak RN, et al. Disease manifestations of Helicobacter

pylori infection in Arctic Canada: Using epidemiology to address community concerns. BMJ Open 2014;4(1).

(4) Findlay L, Kohen D, Miller A. Developmental milestones among aboriginal children in Canada. Paediatrics and Child Health (Canada) 2014;19(5):241-246.

(5) Ford JD, Willox AC, Chatwood S, Furgal C, Harper S, Mauro I, et al. Adapting to the effects of climate change on Inuit health. Am J Public Health 2014;104(SUPPL. 3):e9-e17.

(6) Freeman T, Jolley G, Baum F, Lawless A, Javanparast S, Labonté R. Community assessment workshops: A group method for gathering client experiences of health services. Health and Social Care in the Community 2014;22(1):47-56.

(7) Kaplan A. Canadian guidelines for acute bacterial rhinosinusitis. Canadian Family Physician 2014;60(3):227-234+e149e156.

(8) Magee LA, Pels A, Helewa M, Rey E, Von Dadelszen P. Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy. Pregnancy Hypertension 2014;4(2):105-145.

(9) McIsaac KE, Lou W, Sellen D, Young TK. Exclusive breastfeeding among Canadian Inuit: Results from the Nunavut Inuit Child Health Survey. Journal of Human Lactation 2014;30(2):229-241.

(10) Pakseresht M, Lang R, Rittmueller S, Roache C, Sheehy T, Batal M, et al. Food expenditure patterns in the Canadian Arctic show cause for concern for obesity and chronic disease. International Journal of Behavioral Nutrition and Physical Activity 2014;11(1).



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(11) Statham S, Ford J, Berrang-Ford L, Lardeau M-,Gough W, Siewierski R. Anomalous climatic conditions during winter 2010-2011 and vulnerability of the traditional Inuit food system in Iqaluit, Nunavut. Polar Rec 2014.

(12) Valery PC, Moore SP, Meiklejohn J, Bray F. International variations in childhood cancer in indigenous populations: A systematic review. The Lancet Oncology 2014;15(2):e90-103.

16th International Congress on Circumpolar Health

Oulu, Finland8 - 12 June 2015

The congress will focus on human health and well-being in the Arctic and northern areas. It is open for everyone interested in Arctic issues, especially scientists, researchers, health care professionals, policy analysts, government agency representatives, and community leaders.

The congress is organised by the Thule Institute, University of Oulu in collaboration with the International Union of Circumpolar Health (IUCH), the Nordic Society for Circumpolar Health, the Society of Arctic Health and Biology, and the Rokua Health & Spa.

The InternationaI Congress on Circumpolar Health (ICCH) series are arranged every three years in Arctic countries or countries related to Arctic issues. First congress of the series was arranged in 1967, and it was previously hosted by Oulu in 1971.

For more information: http://icch16.oulu.fiFacebook: https://www.facebook.com/icch16

We are on Facebook

Just a reminder that we are on Facewbook.

Please view our page and "like" us. If you do not have a facebook account you can still "view" our page - you just won't be able to make comments or receive our updates.

The facebook page is a place for us to share news, announce upcoming events and courses, and share photos with you. We encourage past and present employees and friends to share their stories, post photos and videos, and share events happening in the communities where they work.

You can view our page at:

https://www.facebook.com/pages/JA-Hildes-Northern-Medical-Unit/100114110078688?ref=ts&fref=ts

or do a search for:

facebook j.a. hildes northern medical unit



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Advanced Trauma Life Support® Course for Doctors

This Course fills up Fast - Register EarlyThe Advanced Trauma Life Support® Course is publshed by the American College of Surgeons and provides a framework for the management of the injured patient. It is intended to allow the single doctor in a rural hospital to effectively assess and manage multiple trauma.

The Course 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.

The next advanced Trauma Life Support® Provider/Refresher Courses will be held:

2014

- September 12-13 and 13-14- November 14-15 and 15-16

Please contact ATLS Department of Surgery:AE402 - 840 Sherbrook StreetWinnipeg MB R3A 1S1Phone: 787-2394Fax: 787-4618Email: [email protected]

Please send us your announcements: accomplishments, births, marriages, engagements, and community events

Photos of staff (administrative and health care providers) for the newsletter would be greatly appreciated as well as photos of the communities you work.

Also, if you have a story or experience you would like to share in the Newsletter please send it in.

When you submit a photo it is with the understanding it might be put in the newsletter and we do not require written permission to use it� If we would like to use it for promotional materials (eg: brochures) a photo release form must be signed� Photos of patients in a medical context and children are not used without the subject/guardian(s) written permission.

Julie Creasey: [email protected]

Send us Your Announcements, Photos, and Stories

t h ec a r i b o u h e a r dThe Caribou Heard is published by the J. A. Hildes Northern Medical Unit, Section of First Nations, Métis, and Inuit Health of the Department of Community Health Sciences at the University of Manitoba.

Submissions can be made to Julie Creasey at T162-770 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.

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Vol. 12 No. 2 - 2014