Health Committee on Dec. 6th, 2012

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.

On the agenda

Technological Innovation

Committee Business

MPs speaking

Also speaking

Ivar Mendez Professor of Neurosurgery, Anatomy and Neurobiology, Dalhousie University

Michael Jong Professor, Memorial University, As an Individual

Gail Turner Consultant, Department of Health and Social Development, Nunatsiavut Government

Clerk of the Committee Ms. Julie Pelletier

11:55 a.m.

Professor of Neurosurgery, Anatomy and Neurobiology, Dalhousie University

Dr. Ivar Mendez

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.

December 6th, 2012 / 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.