Healthcare team brings harmonized care to First Nations communities

For most Canadians, seeing a doctor is a simple matter of making an appointment and showing up at the clinic at the scheduled time. What seems like a straightforward process is anything but for many First Nations people living on reserve. Access to healthcare is limited either due to inadequate transportation to urban centres or a lack of healthcare expertise within the First Nations communities.

For the last decade, Saskatchewan has consistently had the highest rate of HIV in Canada (more than twice the national rate[1]) and has one of the country’s highest provincial rates of Hepatitis C, with Indigenous Peoples disproportionately affected[2]. Efforts to curb infection rates and to care for persons living with HIV have not been as successful as hoped.

Current mainstream health programs are not effectively meeting the unique psychosocial and spiritual needs of Indigenous Peoples. A unique model of care incorporating culturally based healing programs – rooted in the land and traditional knowledge, spiritual values, and ceremonial practices that include Elders and Knowledge Keepers is needed to improve First Nations health status.

Wellness Wheel, founded in 2016 by Drs. Bonnie Richardson and Stuart Skinner, is developed in collaboration with First Nations community members, leaders, healthcare providers and researchers committed to providing Indigenous Peoples living in First Nations communities with equitable access to care through harmonized cultural and western approaches.

“Canada’s clinic-centric healthcare model relies on patients to make their own appointments and to be able to come to us,” says Dr. Skinner. “That doesn’t work for many First Nations. They are expected to navigate a system that is complex and confusing to them, often resulting in individuals choosing not to seek care at all. Wellness Wheel engages patients and families in their own care by bringing healthcare directly into their communities.”

The Wellness Wheel team brings their own equipment and supplies to the clinics to maintain a small footprint in the health centres and minimize the amount of additional work for the local health teams.

An innovative “hub and spoke” model of integrated care.

The Wellness Wheel network is an integrated, multi-disciplinary team of healthcare professionals focused on providing services and programming to First Nations in First Nations communities, providing clinical support as required by First Nations community partners.

The first Wellness Wheel clinics in southern Saskatchewan were the result of advocacy by people living on-reserve who wanted to be able to access care within their own communities. A collaborative partnership began, which was grounded in traditional ceremony with community leaders and Wellness Wheel team members.

The administrative hub of Wellness Wheel is located within the Infectious Diseases Clinic at the Regina General Hospital. The clinic provides primary and specialist care to patients who live in the city, and to those who are able to travel to the clinic.

Spokes of the Wellness Wheel extend to the First Nations partner communities outside of Regina. Every month, a team of physicians and healthcare practitioners spend a full day working with local health teams on each community tending to patient needs. The programs and services provided vary according to the unique requirements of each.

At File Hills Community Health Services, which serves the Okanese, Star Blanket and Little Black Bear First Nations, Wellness Wheel has greatly improved access to healthcare for the area’s high number of diabetic patients.

Lois Dixon, a nurse and homecare coordinator at File Hills, says before Wellness Wheel the patients were not receiving adequate care. “Many didn’t even know they had diabetes – most just fell through the cracks.”

Two years ago, on Lois’ urging, Drs. Richardson and Skinner and other Wellness Wheel practitioners began working with File Hills patients. “The doctors are personable and well-received by our patients,” Lois says. “Thanks to them, we have made tremendous in-roads. It’s so much easier for our people to receive good healthcare and follow-up.”

Today, the team hosts regular Liver Health Days, conducts liver scans and provides on-site testing for Hepatitis C and HIV. File Hills now has a nurse practitioner on staff, and a visiting pediatrician who comes in three times a week.

Working together to create patient-focused, culturally responsive healthcare.

Understanding that healthcare success for First Nations peoples relies on First Nations health and wellness systems, Wellness Wheel works in collaboration with First Nations medicinal peoples and Knowledge Keepers.

Dr. JoLee Sasakamoose, Research Director of Wellness Wheel, says, “First Nations peoples have their own ways of healing and wellness. Medicinal peoples and Knowledge Keepers provide traditional medicines and ceremonies for additional protective factors that harmonize with western medicine approaches.”

Building First Nations health capacity and resiliency.

L to R: Dutch Lerat, FSIN; Elder Irvin Buffalo, Day Star First Nation; Elder Dexter Asapace, Kawacatoose First Nation; Chief Reginald Bellerose, Muskowekwan First Nation;
Dr. Jarol Boan, Wellness Wheel; Chief Dennis Dustyhorn, Kawacatoose First Nation; Dr. Stuart Skinner, Wellness Wheel; Susanne Nicolay, RN, Clinic and Projects Coordinator for Wellness Wheel. Photo taken at the Touchwood Agency Tribal Council Powwow, George Gordon First Nations, Punnichy, Saskatchewan.

A key aspect of Wellness Wheel is community empowerment beginning with creating a safe, culturally appropriate healthcare environment.

Josh Needham, a Wellness Wheel consultant, says, “each First Nations community has its own unique challenges. We establish relationships with First Nations chiefs and health directors, and we work together to identify strengths, address gaps in capacity and make decisions based on what is right for each community.”

Wellness Wheel supports the clinics in transition, equipping health centres with supplies ranging from tongue depressors to medical equipment. Supplies are transported to each community by visiting healthcare teams.

To facilitate care continuity and collaboration between care providers, Josh adds a web-based Med Access EMR, which enables access to patient files from anywhere while protecting patient privacy. “The internet is often very slow in First Nations communities. Fortunately, the EMRs work with low bandwidth,” says Josh. Med Access also allows for easy extraction of clinical data and trends, which are owned and shared with the individual First Nations health centres.

Finding a better way.

The Wellness Wheel team of healthcare providers deliver multi-disciplinary and integrated care for chronic and complex disease that is high quality, culturally responsive and safe. The health of Indigenous Peoples is being improved by supporting First Nations in taking the lead in healthcare delivery in their communities.

Wellness Wheel operates on funding from federal and provincial governments, Saskatchewan health authorities, grants and private contributions. The Wheel is also supplemented by the compassion of its team because, as Dr. Skinner says, “it’s the right thing to do.”

Since its inception, the Wellness Wheel team of 19 healthcare providers has traveled 80,000 km, served 11 communities and made in-kind contributions valued at $223,000.

[1] https://skhiv.ca/wp-content/uploads/2020/01/GovSK-HIV-AIDS-in-SK-Infographic-2018.pdf
[2] https://www.sac-isc.gc.ca/eng/1569955684724/1569958287940