Evidence of meeting #69 for Health in the 41st Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was see.
A recording is available from Parliament.
11:55 a.m.
Professor of Neurosurgery, Anatomy and Neurobiology, Dalhousie University
Good to see you.
I'm going to stop the demonstration here and let Michael come. I will disconnect here, Theresa. Thank you very much.
You can see, we have been in Halifax. I talked to the nurses. I was able to see my patients. You can imagine the potential of this. Of course the potential is greatest in the places where people need the most and have the least. This is where Michael is going to come in and talk to you.
11:55 a.m.
Conservative
The Chair Conservative Joy Smith
I broke a few of the rules today because we're doing these robotics. I didn't want to interrupt this magnificent demonstration. Forgive me, committee.
Could you continue? Thanks.
Noon
Dr. Michael Jong Professor, Memorial University, As an Individual
Thanks a lot for this opportunity to talk to you. It's not very common that someone from Labrador can come here and speak to the committee, so I appreciate it very much. To those people behind the scenes who made it happen, this is very important for us.
I will talk about robotic medicine for remote communities. This is an innovation that Dr. Mendez started in Halifax. We're lucky enough that he's willing to share this with us in the north. He has great vision. There are parts of Canada where there is no access to service, so I think the best innovation is to make this all simple.
The biggest problem in Canada is the rural-urban divide. The death rate is much higher in rural Canada than it is in urban Canada. It's as much as 30% higher in rural areas. The further people live from an urban centre, you can actually see a linear increase in death rates. One of the reasons for this, of course, is access, but there are other reasons, too. Lifespan is shorter by three years if you live in rural Canada.
In our region Nunatsiavut Inuit is a big component of the population and if we look at Canadian Inuit, their lifespan is 12.6 years less than that of the general Canadian population. This is a big thing. If you want to address the backyard of Canada, this is where we need to address it. It affects the young population as well.
Of course, there is more than one solution, but one of the solutions is access through using this computer that you see right here. This is me in Goose Bay.
This is what Dr. Mendez tried to show you. People in Nain can have access to a physician by robot. There's the Nain emergency department where I would be able to see anyone who comes through the door. Any physician can see anyone who comes through the door.
What we've been able to do for the last four years is literally perform resuscitation remotely. In the past, when someone had no pulse and was not able to talk to you, you might as well assume the person was dead because by the time we went to pick them up, it was too late. Now it's possible to save lives. This is possible.
We can also do remote ultrasound, as you can see. This is what Dr. Mendez showed you. Basically, the nurses will do it for me and I will see it. It's so fast, and so easy. No guesswork is required. I can simply see what's happening.
There's a lot of mental health work being done, in terms of psychotherapy. Now there's also management of chronic conditions. In rural Canada there are high rates of diabetes, high blood pressure, and heart problems.
As we try to get more health providers into remote communities, what we have to try to do is train them in those remote communities, but now we can actually supervise them.
We have done an analysis of the impact. The patients are very satisfied. For the nurses who live and work in remote northern communities, it can be very stressful, and for a physician listening at the other end of the phone line, it can be equally stressful, not knowing what is actually happening. With this, our job is a lot easier and we're much more satisfied.
At the end of the one-year assessment, we were able to avoid medical transportation for half the patients who would otherwise have had to be transported somewhere else. Besides better patient care, it translates also into savings in health care costs.
As Dr. Mendez said, Rosie is now a member of the team. Even in Nain, I roam around, and it makes no difference. They know. They're so used to it. It basically provides citizens in remote communities with access to physician services 24 hours a day, 365 days a year. You can live in a remote community and have access to physician services; it's possible nowadays, if you have Internet access.
I think the road to success, as Dr. Mendez has said, is always under construction. We are always finding new things, new applications.
I think if Canada wants to be proud of what we are doing we can always innovate and be a leader, as Dr. Mendez said.
Before I finish, I want to acknowledge that I am very grateful for FNIHB and Health Canada to facilitate this process, to connect us with Dr. Mendez and bring this to Labrador
Without Debra Keys White, who is here in the audience, robotic telehealth would not have happened because she introduced the idea to me. For the Nunatsiavut government to allow me the privilege to do this in their communities and to allow me to help and be part of the community, I thank Gail Turner.
12:05 p.m.
Gail Turner Consultant, Department of Health and Social Development, Nunatsiavut Government
It is an honour to be here representing the Inuit land claim of Nunatsiavut, as an Inuk and as a former director of health for that region.
On the map you will see the Nunatsiavut land claim, the last of the four Inuit regions of Canada to be proclaimed, in relation to the rest of Labrador, and of course it is part of the province of Newfoundland and Labrador.
Nain is the most northerly community in the province of Newfoundland and Labrador. The population varies between 1,200 and 1,500. It is the administrative capital of the land claim. The word Nunatsiavut means beautiful land, and I think if you look at the photos you will see why.
Nain is nestled among many hills, and while that makes it picturesque, it creates very particular challenges for flying. It is the only community in Labrador where a medevac flight cannot go in after dark. This obviously increases the stress on the staff in the clinic and also the staff in Goose Bay when they are trying to manage patients.
Mount Sophie is in Nain. This is the view from the clinic. This is the weather vane. If the staff in Nain say they can see Mount Sophie, you can fly; If you can't see Mount Sophie, you can't fly.
This is the outside of the clinic in Nain, which is responsible through Labrador-Grenfell Health for delivering primary care both through this clinic and through the hospital or the health centre in Happy Valley-Goose Bay. The secondary level of care including diagnostic, surgery, obstetrics, and access to physicians comes from here. On a good day with fair weather we could be up to Nain and back within four hours, if we didn't need time to stabilize a patient in Nain.
We have a collaborative model of care. The community side of care, public health, home and community care, is delivered by the Nunatsiavut Department of Health and Social Development. Their staff is in Nain.
What was our role in this process? There were several committees at different levels, and I would like to acknowledge the deputy minister of health and social development, Michelle Kinney, who I am replacing here today, but who's been a very strong advocate for this project throughout its implementation. We're also responsible for endorsing it, meaning because we had a voice in what happened with this project, Inuit were much more readily open to it as part of change.
If the Inuit can be part of change, then obviously it increases our access to health care. We use data from non-insured health benefits as part of our data-sharing agreement. At the moment Nunatsiavut is the only aboriginal group in Canada which manages its own non-insured health benefits program. We were involved in the development of the evaluation and we were also champions among Inuit.
We used the fact that we were an Inuit land claim sitting at a table with our colleagues through Inuit Tapiriit Kanatami to promote this type of technology as a way forward for improving access to health care for Inuit in Canada.
As you've just seen, we had seen computer footage of Rosie in Cape Breton, but it was still hard for us to conceptualize how that would work for us in the clinic in Nain. We didn't know what Rosie could do. We didn't know how the community would accept her. We didn't know whether it would truly bring service closer to home, or what the outcomes would be.
What we did know was that people in Nain, as in most Inuit communities, do not always want to have to travel for medical service. They have to leave families and their homes and they are often gone for days or even weeks. We knew that supporting nurses, helping the nurses feel more confident in their decision-making, improves their retention, and if we improve their retention, we're more likely to have culturally safe care. We knew that Nain was ideal for this pilot because of the restrictions on flying. They have fairly stable staff, and they've worked for several years with the traditional telehealth system, so they would be much more comfortable with the technology.
We knew that as a government we would do everything we could to support this project. We knew that the philosophy Dr. Mendez brought to this project matched what we believe. We believe we have to do much more to bring care to the Inuit and not Inuit to the care.
What did we learn? Rosie very quickly became a member of the staff, and I think the nurses now would feel a loss of confidence if she were to leave the clinic and they lost that support piece they've had.
The community actually loved her. They called her that old robot doctor. She saved lives. She saved travel time. She became an integral part of health delivery in Nain, so much so that the Nunatsiavut government has recently purchased Rosie Two, which has even greater capacity for the community of Nain.
What about the future? We believe we have to do several things. We certainly have to continue with the excellent work being done. We think we need to expand the use to make sure we're using it in the best capacity we can. We have to explore some increased utilization with other peripherals. More importantly we need to continue to document the improved service delivery through all avenues, using presentations and opportunities such as today, through newsletters and professional journals, so we're sharing the story of what can be done with the rest of Canada.
12:10 p.m.
Conservative
The Chair Conservative Joy Smith
That was really interesting. My goodness. It was amazing. Thank you so much for coming today.
We're going to begin our questions and answers with Ms. Davies.
12:10 p.m.
NDP
Libby Davies NDP Vancouver East, BC
Thank you very much, Madam Chair.
Before I begin my comments and questions to the great witnesses we have here today, I would like to make a point.
I didn't want to interrupt the presentation because I know the meeting is shorter today, but this is the second meeting where we've had material up on the screens that hasn't been in both official languages. I do think we need to reinforce this with people who come before the committee. Usually there has to be a motion to approve it, but because of the short time I didn't want to interrupt. It's a note for the future. I don't think....
12:10 p.m.
NDP
Libby Davies NDP Vancouver East, BC
I just want to put it on notice that I don't think we'll allow it to happen again.
December 6th, 2012 / 12:10 p.m.
The Clerk of the Committee Ms. Julie Pelletier
My understanding of the motion is that statements don't need to be bilingual, but everything that is shown in PowerPoint needs to be bilingual. If I have a paper copy that is bilingual, it's sufficient to meet this requirement.
If you don't think it is, maybe that's something we can discuss at a committee meeting, but yes, we had the bilingual version of each document.
12:10 p.m.
NDP
Libby Davies NDP Vancouver East, BC
So you're saying if it's not displayed on the screens, that's acceptable. Anyway we can discuss it later. I just wanted to flag it because it's the second time, and I wasn't clear about it then.
12:10 p.m.
The Clerk
The last time it was different. There was a misunderstanding between me and the witness, and the witness never sent me his PowerPoint presentation so I didn't have time to translate it.
Yes, we didn't have the copy in front of us. That's why we asked for unanimous consent to allow the witness to make his presentation. It's two different....
12:10 p.m.
Conservative
The Chair Conservative Joy Smith
In other words the clerk was well within her.... She's an excellent clerk, and follows the rules.
12:10 p.m.
Conservative
12:10 p.m.
NDP
Libby Davies NDP Vancouver East, BC
I know. I wanted to flag it. I said I was flagging it. That's what I said.
12:10 p.m.
Conservative
The Chair Conservative Joy Smith
I'm flagging it to say the clerk did everything correctly. Thank you. Go ahead.
12:10 p.m.
NDP
Libby Davies NDP Vancouver East, BC
To the witnesses, again I'm sorry I had to make that intervention, but I felt it was important to do.
I want to thank you for being here today, especially coming from so far away. I think your presentations have opened up a new horizon for us to think about as we do this study on technological innovation.
Some of my questions have to do with whether there are any risks associated with robotic medicine.
It seemed to me, Dr. Mendez, that you must be very practised now at how you manoeuvre Rosie in tight corridors, in and out of rooms, and so on. Is there a lot of training required so mistakes don't happen? Is there any study or monitoring to look at the risks in terms of mistakes that could be made because you are using a remote technology?
I'll begin with that question.
12:15 p.m.
Professor of Neurosurgery, Anatomy and Neurobiology, Dalhousie University
That's a very important question.
The first thing I should tell you is that the robot is the size of a human being. It is roughly the same shape, width, and height of a human being. That allows the operator to know intuitively where the robot can or cannot go. The controls are so intuitive that anybody can learn to drive the robot in 10 minutes. We probably have the most experience in the world with this. We've never had an accident with, for example, the robot bumping into something or anything like that.
The key issue is—and this is at the heart of this technology—when you're faced with a life-and-death situation, when somebody has a pneumothorax—air in the lungs that is compressing the lungs and the heart—the ability for Dr. Michael Jong to direct a nurse and save somebody's life when they would otherwise certainly die is what makes the difference. The crux of the matter is that—and this is where my philosophy comes in—we pride ourselves on the idea that all Canadians have the same access to health care, but you know that's not true. If you're here in Ottawa and you have a problem you can be taken to the Ottawa Hospital. If you live in Nain, there's really no alternative. I think this technology will allow us to narrow the gap of that inequality. That is the basic issue. Practically speaking, there have been no mishaps with the robots in all the years we've been using them.
12:15 p.m.
NDP
Libby Davies NDP Vancouver East, BC
So far, this program is happening only from Nova Scotia. I know it's in other communities, but you make it sound as though the program you're engaged in is based in Halifax. Are there many other communities that are using the same robot?
12:15 p.m.
Professor of Neurosurgery, Anatomy and Neurobiology, Dalhousie University
There are two programs in the country.
The first is the network of robots we have in Nova Scotia. They're used for specialized care in brain surgery. Then there is the primary care system in Labrador where the hospital in Happy Valley-Goose Bay takes care of the remote community of Nain. That shows you the ability of the system to work in a reasonably well-urbanized territory like Nova Scotia with different regional hospitals as well as in truly remote communities where the only access is by air.
12:15 p.m.
NDP
Libby Davies NDP Vancouver East, BC
One of the issues we're facing is how we can make sure that the health system is equitable and that there aren't those kinds of disparities. It's fascinating to see that we have these locations that are now accessible, but it raises the question of how we can ensure that this happens across the country.
Do you have any suggestions or recommendations about what you think the federal government should be doing to ensure that this kind of advanced technology is available elsewhere?
12:15 p.m.
Conservative
The Chair Conservative Joy Smith
I'm sorry, Dr. Mendez, but Ms. Davies has used up her time.
Perhaps Dr. Carrie has his own question or something he wants to pick up from Ms. Davies' comments.
12:15 p.m.
Conservative
Colin Carrie Conservative Oshawa, ON
Thank you, Madam Chair.
I'd like to split my time with you.
I'd like to direct my question to Ms. Turner. I'd like to hear about the residence and what kind of things you've heard over the years about the challenges with access to health care. How has Rosie changed that? I liked what you put up about the philosophical part of it too.