In the fall of 2015, St. Paul’s Diabetes Health Centre was approached by the First Nations Health Authority (FNHA) to partner and provide diabetes education and treatment to clients in remote communities using telehealth, the provision of healthcare remotely by means of telecommunications technology.
The Diabetes Health Centre team was quickly onboard and connected with Dr. John Pawlovich (or “Dr. John” to his clients), the catalyst for this initiative and medical director for the Carrier Sekani Family Services (CSFS). Dr. John visits the Carrier Nation communities on a monthly basis; supplementing those in-person visits with telehealth conferencing.
While facilitating telehealth might seem as easy as flipping on a computer and opening up Skype, there are a number of details—from being trained on the conferencing technology, to taking PHC’s Indigenous Cultural Competency training, to painting the room the Diabetes Health team would use for conferencing—that needed to come together prior to launch.
And then of course, there is the interpersonal side of things, which is how dietitian Stephanie Chung and registered nurse Daphne Wright found themselves buckled into a twin-engine Dash 8 on November 13, 2016, en route to Smithers with Dr. John and his two residents.
Meeting patients where they’re at
Over the six days that followed, the group visited the Carrier Nation communities of Fort Babine, Tachet, Stellaquo, Yekooche and Takla.
And at each community, the clinical team was met with hospitality and generosity: meals were shared (including delicacies such as white fish caught that very morning from Lake Takla), doors were opened (at a substance-use disorder meeting at Stellaquo, Stephanie and Daphne were given the honour of being allowed to smudge with the group), gifts were given (bear grease from Fort Babine travelled on ice with Stephanie and Daphne until the precious cargo landed safely back in Vancouver), laughs were shared and, above all, a connection was formed.
“We now understand the challenges faced by these communities as they make their way into town for staples; the travel between each community is long, often bumpy and, at times, dangerous. And when people do get to the grocery store, costs are high and choice is limited.”
“Visiting each community and learning about their way of life and the challenges they face went a long way in helping us better understand where our telehealth clients are coming from,” says Daphne.
The team also got insight into the lengths patients have to go to to simply be seen by a doctor. For example, in Takla, access to services can mean a three and a half-hour trip down an isolated, icy, bumpy, unpaved logging road, followed by an additional two-hour trip on paved highway before making it to Prince George.
“The distances between each community and the nearest town can be long. It’s understandable why people are not able to attend appointments or get blood work completed. Anyone of us would find these challenges daunting,” said Daphne.
The Diabetes Health team saw their first telehealth client in December 2016 and are still going strong.