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Hurricanes, wildfires and the Opioid crisis: How one NOSM Resident won a national award for social accountability

Dr. Lloyd Douglas was involved in public health before he was even old enough to realize it.

“In Jamaica—when I was just a teenager—when a hurricane came my way I was the guy running around bringing people out of the way.”

What started as volunteer work, became real public health experience. At a young age, Dr. Douglas was assisting with emergency planning and response to Jamaica’s hurricane season. The experience would lead him onto his path of becoming a doctor.

“That passion was always inside of me and I’ve always really wanted to help.”

Fast forward to April 2019,and Dr. Douglas was the only medical resident in Canada to receive the Dr. Ian Bowman Award for Leadership in Social Accountability, presented on behalf of the Medical Council of Canada—an honour he earned along the way.

Dr. Douglas is an international medical graduate from Jamaica. In 2010, he immigrated to Ottawa with his wife and two young children. The plan was for Dr. Douglas to do his medical residency in Canada. He says he almost gave up trying to get into a program when a personal mentor convinced him to apply to the Northern Ontario School of Medicine; a School designed with the intent to help the underserviced North.

“I realized I could help fill the gaps in the North, so I came to NOSM and to the North with the clear intention to work with First Nation communities,” he says. “I completed my residency in 2014, and I’ve postponed my last one-month residency rotation with NOSM’s permission so that I can help with the wildfire evacuees right now.”

And in this spirit, Douglas continues to work out of Sioux Lookout. When he first became a resident at NOSM, he specifically requested to go to Sioux Lookout to complete his rural placement. The community is located nearly 400 kilometers northwest of Thunder Bay and is considered a hub to the far North. Sioux Lookout services up to 33 First Nations communities. Nine years after coming to Canada, Dr. Douglas now calls Sioux Lookout—and Canada—home and says he intends to stay.

“When we moved to Sioux Lookout I called the Meno Ya Win Health Centre, and within a 24-hour period they told me they needed me there. My wife is a nurse and she was offered a temporary part-time job, there so she took it. There was no job security in coming to the North, but I would’ve come even if it was only to volunteer,” Dr. Douglas recalls.

“I want to go where I’m needed,” he says. “It’s not about me; it’s about being part of the solution to re-empower Indigenous communities. I only play a supporting role,” Dr. Douglas explains metaphorically, “I hold the mic while they speak.”

And Dr. Douglas has been playing that supporting role since childhood. He says his personal passion for helping people developed when he witnessed his grandfather recover from severe alcohol use, and his father from a gambling addiction. He credits his volunteer work with the church in Jamaica for instilling his dedication to public health.

The experience has led to his work today, helping address the regional opioid crisis. He was the first physician in the region to use the depot-naltrexone for severe alcohol use disorder through Health Canada’s Special Access to Drugs and Health Products program.

In Cat Lake First Nation and Bearskin Lake First Nation, Dr. Douglas developed working relationships with Chiefs, Councils, and health directors, at their request to help make the case for a treatment centre, and find agency sponsorships for diabetes workshops.  He also worked with the nursing staff at the Meno Ya Win Health Centre’s Outpatient Withdrawl Service to reinitiate an addictions medicine physician service that had previously lost dedicated physician support,  including offering naloxone treatments for substance use disorders for remote Indigenous communities and in Sioux Lookout.

Dr. Douglas has made personal connections to the community, and he affectionately refers to his friends and neighbours as his “Indigenous brothers and sisters” He says his Jamaican faith also offers a unique connection to the community. “I, too, believe in the creator and the higher power, and I don’t believe I’m here by chance. I believe there’s a reason as to why I ended up here.”

He encourages others, including medical students, to think about how they too, can contribute to purposeful, meaningful change.

“I’d like to see people think outside of the box and get out there. It’s all about relationship building, decolonization, re-empowering people, reconciliation, and listening to people in a meaningful way. The only way it’s going to work is when medical residents come and spend time in communities and takes time to listen to the people. We really need to get out there and get involved, and move away from the individual-ness of it all. Let it be about helping and lifting up someone else.”

 

About the Dr. Ian Bowmer Award for Leadership in Social Accountability

This national award is presented by the Medical Council of Canada. It is awarded to only one medical student and one resident in Canada who have demonstrated leadership in social accountability within the schools of medicine in Canada. The focus is on leaders who have conceived new approaches and inspired teams to respond to a community or population need by consultatively and collaboratively developing a relevant approach and vision in partnership with communities.

Dr. Douglas is a post-graduate fifth-year medical resident in the School’s Public Health and Preventive Medicine (PHPM) Program who demonstrates an ongoing commitment to social accountability and the underserviced populations of Northern Ontario. Specifically, he has helped improve access to care for Indigenous peoples from his home-base in Sioux Lookout.

 

How education and work reconnected a NOSM Francophone employee to her culture

Debbie Popien is best described as the person who is always smiling and goes out of her way to see how others are doing.  She’s a Francophone Student Records and Electives Officer at NOSM at Lakehead University.

She speaks English with such clarity and ease that you’d never know her first language is French. Born in Timmins, her mom is from a small town in Quebec and her dad is from a small community outside of Kapuskasing called Moonbeam.

“When I was a year old, we moved to Thunder Bay for my dad’s business in the forestry industry, and I spoke only French until I was about four. Then I had to start school,” she recalls.

At the time, there were no French schools in Thunder Bay. Debbie recalls befriending another little girl who only spoke Italian. It was not until years later that a fully French elementary school would open in Thunder Bay called École Catholique Franco-Superieur, and high school École Secondaire Catholique De La Verendrye.

“I think it was more difficult for me back then. Now there are way more accessible services in French.”

She says for a long time she didn’t use her French aside from visiting with family in Thunder Bay. It wasn’t until she had her daughter and was encouraged to enroll her into the French school system in Thunder Bay that she reconnected with the Francophone community.

“I fell away from my culture for many years. I really didn’t have the Francophone influences in my life and I found that I missed it. I missed the traditions, it’s hard to explain culture.”

When her daughter started grade one, she debated whether to enroll her into French school. It was friends at a Francophone playgroup who convinced her to try it.  I thought, she’s not getting the Francophone experience anywhere else, and I want her to have the same Francophone experience that I had. She didn’t speak French when I enrolled her and by the end of the year she was bilingual. That’s when I started to reconnect.”

Debbie says she now uses her French all the time in her work at NOSM. She says the Francophone medical students appreciate having a Francophone to communicate with.

“You know, the French-lived experience is a big part of NOSM and the fact that we have French staff who can relate to the French students really matters because it’s more comfortable for them to have service in their preferred language. I’m able to provide them with Active Offer in French,” she says.

For Popien, it’s been personally rewarding to work with fellow Francophones.

“I feel like I’m re-immersed in the Francophone culture, rediscovering and reconnecting. I enjoy communicating with the Francophone Affairs staff at NOSM. Also, I help our French students feel connected and there’s a degree of comfort with that. It reduces a little bit of their stress.”

She says she values the Francophone inclusiveness within the social accountability mandate at NOSM; reflecting the diversity of the region and Francophone communities that NOSM serves.

“Encouraging Active Offer in French and having Francophone physicians is huge. In my own experience, when my mother was unwell and trying to explain her symptoms to the physician, I remember the difficulty she was having. She couldn’t express it in her own language.”

“It is so important for people to be able to speak to their physicians in their preferred language. That is when the barriers drop and there is a comfort level. And, there’s a huge Francophone community here; it just makes it all the more relatable.”

 

The Art of Treating Patients in French

“When I hurt, I hurt in French.”

It is hard to imagine receiving health-care services in a foreign language. Dr. Crystal Boulianne, Northern Ontario School of Medicine (NOSM) alumna, is committed to eliminating linguistic barriers that affect the quality of health care for the Francophone population of Kapuskasing. Her efforts are so formidable, that she was awarded the 2019 Family Medicine Resident Award for the Study of Communities Impacted by Health Disparities granted by the College of Family Physicians of Canada (CFPC) through the Foundation for Advancing Family Medicine. Boulianne will receive the award in November, during the CFPC’s 2019 Family Medicine Forum in Vancouver.

Born in Kapuskasing, Boulianne was raised in an Anglophone household and attended elementary and high school in the French immersion program. At a young age, she recognized the value of bilingualism in her community. While living and working in the region, she was inspired to learn more about the French language. Driven to grasp the vocabulary, she quickly mastered the language.

For Boulianne, speaking French gives her another outlet to express herself⁠—through the art of communication. To her, the language is both personal and professional.

In fact, Boulianne got so comfortable with the language that during her third year at NOSM, she chose to complete her entire eight-month Comprehensive Community Clerkship (CCC) placement in the town of Hearst, a predominantly Francophone community. While there, Boulianne undertook a research project focused on the health-care services for Francophones who are transferred to larger, predominantly Anglophone center, for specialized treatment. The results highlighted a significant obstacle.

“I heard horror stories of elderly patients being redirected to cities like Sudbury for health care, that arrive by ambulance, and are unable to communicate in their own language,” explains Boulianne. “They would come back to Kapuskasing without an understanding of the instructions they had received. Are the services considered available, really available,” questions Boulianne. She noted that when follow-up appointments are required, and the patient is steered towards a larger urban centre⁠—like Sudbury, Timmins or Thunder Bay⁠—there is no guarantee that the service the patient will receive will actually be available in French.

Boulianne, who hopes to establish her medical practice following the summer of 2019, remains passionate in her efforts to offer equal medical services for all her patients. Her ultimate goal is to change the way the physicians in smaller Francophone communities transfer their patients to larger medical centers. She says she hopes that someday patients will have the right to demand access to Francophone specialists. To Boulianne, “Active Offer” means ensuring that services in French are obvious, easily available, and accessible for all her patients.

According to the French Language Services Commissioner’s Office (now part of the Office of the Ombudsman of Ontario), Active Offer is “the guarantee of the quality of government services offered to the public. For the patients navigating the health care system, active offer is synonymous with safety.”

“My husband and I, and even my supervisors, find it funny that I am an Anglophone, and it is me who is fighting to ensure the rights for Francophones,” says Boulianne.

From her perspective, Boulianne feels that the nuances of medical care for Francophones do not differ widely from Anglophone care. However, what does differ is how care is planned. By providing Francophone patients with access to Francophone health-care professionals, the linguistic barrier is eliminated.

Boulianne says that although it is difficult to find a concrete solution to ensure equal access to health care, the first step is to normalize the concept of the Active Offer for physicians⁠—to make it commonplace. In order to ensure equal and safe medical services, Boulianne believes Francophones should be informed of their right to receive health care in French and feel empowered to request care in their preferred language.

In the meantime, Boulianne says she is dedicated to blazing the trail.

 

NOSM University