Past experiences enhance the future. Health care providers gaining expertise in creative thinking, traditional medicine, spirituality, and cultural sensitivity is an essential requirement for 21st century health care. We must stay mindful that poverty, isolation, and rural living may create new forms of social exclusion because of lack of communication and rapidly changing technology. Conversely, sensory overload resulting from a faster paced lifestyle and rapid enhancements in technology may cause increased tension and stress. This article reviews successes that may offer the reader ideas on coping with the provision of health care services in such a volatile changing environment, while honoring tradition and cultural competency.
To retrospectively examine the barriers faced and opportunities for improvement during the 2009 H1N1 pandemic response experienced by participants responsible for the delivery of health care services in 3 remote and isolated Subarctic First Nation communities of northern Ontario, Canada.
A qualitative community-based participatory approach.
Semi-directed interviews were conducted with adult key informants (n=13) using purposive sampling of participants representing the 3 main sectors responsible for health care services (i.e., federal health centres, provincial hospitals and Band Councils). Data were manually transcribed and coded using deductive and inductive thematic analysis.
Primary barriers reported were issues with overcrowding in houses, insufficient human resources and inadequate community awareness. Main areas for improvement included increasing human resources (i.e., nurses and trained health care professionals), funding for supplies and general community awareness regarding disease processes and prevention.
Government bodies should consider focusing efforts to provide more support in terms of human resources, monies and education. In addition, various government organizations should collaborate to improve housing conditions and timely access to resources. These recommendations should be addressed in future pandemic plans, so that remote western James Bay First Nation communities of Subarctic Ontario and other similar communities can be better prepared for the next public health emergency.
Significant health problems encountered in adulthood often have their roots in health behaviours initiated during adolescence. In order to reverse this trend, school and health personnel, as well as parents and other community members working with high school students, need to be aware of the health-related beliefs and choices that guide the behaviours of teenagers. Although a wide variety of research has been conducted on this topic among urban adolescents, less is known about the health beliefs and behaviors of adolescents residing in rural areas, particularly in Canada. In general, rural Canadians are less healthy than their urban counterparts. Building on the knowledge and understanding of their own community, key stakeholders were invited to engage in the design and implementation of a participatory action research project aimed at understanding and improving the health of rural adolescents.
A group of parents, teachers, students, school administrators and public health nurses engaged in a participatory action research project to better understand determinants of the health of rural adolescents at a high school in Western Canada. Group members developed and administered a health survey to 288 students from a small rural high school, in an effort to identify areas of concern and interest regarding health practices and beliefs of rural adolescents, and to take action on these identified concerns.
Results indicated some interesting but potentially worrying trends in this population. For example, while frequent involvement in a physical activity was noted by 75.9% of participants, close to half of the females (48%) described their body image as 'a little overweight' or 'definitely overweight', and approximately 25.8% of respondents noted that they skipped meals most of the time. Differences between the genders were apparent in several categories. For example, more girls smoked (16.2%) than boys (12.3%), and more males (55.0%) than females (41%) had tried illegal drugs. Participants indicated awareness of other health-compromising behaviours, including unsafe driving habits and high stress levels, and acknowledged several steps they wanted to take to improve their health, as well as the barriers to taking those steps. Students identified improved nutrition, stress reduction, and increased levels of physical activity as particular important health goals. Students also recommended ways in which information and support could be provided within the school environment to enable them to achieve their health-related goals. Several activities developed in collaboration with students have incorporated the recommendations, and have spawned other activities in response to the ongoing identification of new concerns.
The process of including the rural community in the identification of health assets and needs from the perspective of students -- as well as the planning and implementation of appropriate strategies to address those needs -- demonstrates the strengths inherent within a small rural population. Community members' awareness of the need to create a healthy environment for youth is reflected in their willingness to participate in activities leading to improved health. Greater awareness of the health needs of rural adolescents, and of the influence of gender in some aspects of health behaviors, will help researchers to explore ways in which the unique culture of rural communities can be harnessed to help shape health-focused interventions.
Community-health nursing practice is a pivotal aspect of present-day health reforms. In Quebec, Canada, the recent introduction of a population-based approach has entailed increasing the resources allocated to health promotion and disease prevention. Semistructured interviews were conducted with nurses and managers (N = 69) in an effort to understand how these new resources are reflected in nursing practice. Three classes of factors emerged as key conditions for change: contextual and historical, training and professional-development, and work-organization factors. The authors propose courses of action respecting these conditions to provide support for community-health nursing practices that incorporate a contemporary population-based approach.
Initial efforts to increase the availability of training positions, standardise training, and obtain national recognition for family physicians who wished to practise anaesthesia had stalled.
To describe the work undertaken to create and sustain family medicine anaesthesiology capacity in Canada.
In our review, we examined the critical aspects of successful intersectoral work, namely, involvement by key stakeholders; the development of decision-making mechanisms; clearly defined objectives, roles and responsibilities; official support and legitimisation from participating organisations and adequate resources for partnership building.
Canadian rural family medicine anaesthesiology practice.
A small steering committee obtained funding for a national meeting of stakeholders and subsequent committee work over an 18-month period. The national meeting brought together the necessary stakeholders to review and discuss the issues and agree on a group-determined agenda, determine a work plan, identify priority areas and allow the College of Family Physicians of Canada to be the lead organisation in moving the work ahead. Within 18 months, the boards of the key organisations had accepted a common set of standards for training and a national curriculum. Work remains in the longer term to identify sustainable funding for training of family physician as well as the provision of continuing medical education for those trained.
Appropriate attention to the key components of successful intersectoral work may enable previously stalled and complex work to move ahead despite opposition.
Approximately 24,000 Ontarians live in remote Indigenous communities with no road access. These communities are a subset of Nishnawbe Aski Nation (NAN), a political grouping of 49 First Nations communities in Northern Ontario, Canada. Limited information is available regarding the status of emergency care in these communities.
We aimed to understand emergency response systems, services, and training in remote NAN communities.
We used an environmental scan approach to compile information from multiple sources including community-based participatory research. This included the analysis of data collected from key informant interviews (n=10) with First Nations community health leaders and a multi-stakeholder roundtable meeting (n=33) in October 2013.
Qualitative analysis of the interview data revealed four issues related to emergency response systems and training: (1) inequity in response capacity and services, (2) lack of formalised dispatch systems, (3) turnover and burnout in volunteer emergency services, and (4) challenges related to first aid training. Roundtable stakeholders supported the development of a community-based emergency care system to address gaps.
Existing first response, paramedical, and ambulance service models do not meet the unique geographical, epidemiological and cultural needs in most NAN communities. Sustainable, context-appropriate, and culturally relevant emergency care systems are needed.
Cites: Can Fam Physician. 2008 Jul;54(7):1022-3 PMID 18625830
Health care in Canada's north and circumpolar regions faces considerable challenges with the remote and widely dispersed population, harsh environmental conditions, and human resource challenges. Despite per capita expenditures that are among the highest in the world, health outcomes continue to lag behind the rest of Canada, and health disparities between the Indigenous and non-Indigenous populations within the north persist. While improving the health of northerners requires addressing underlying social determinants, transforming the health care system holds promise for health improvements in the short- and medium-term . The evidence required to inform a northern-focused and relevant transformation of health care systems remains to be generated and applied. This seminar set out to identify priority areas for a research initiative that will address systems challenges and engage decision-makers in these jurisdictions. The overarching objectives of the seminar were to explore the priority areas for health systems research in circumpolar regions, and to propose how we might best maximize our current resources, and facilitate partnerships for the advancement of a common agenda.