The First Mile

Supported by the SSHRC-funded First Nations Innovation Project

In spring of 2009, the H1N1 influenza epidemic was a significant health threat in communities across the country. Since people have no natural immunity against the virus, it resulted in hundreds of deaths in Canada. To help combat the disease in Ontario communities, Keewaytinook Okimakanak Telemedicine (KOTM) organized in-person workshops for community leaders and healthcare workers.

KOTM is recognized as the only First Nations operated telemedicine network in Canada and the world. They provide telehealth services to on-reserve populations in isolated communities, and receive funding and support from Health Canada to carry out their operations.

KOTM coordinated the in-person workshops on H1N1 Prevention and Awareness to include public health nurses, tribal councils, home and community care nurses, and NAN Health representatives as hosts. Unfortunately, turnout for the workshops was low, and tended to involve the same audience. KOTM noticed that even though First Nations leaders were invited, they were often too busy to attend. Instead, they sent their Health Directors and front-line workers to participate.

One of the chiefs from the area, Chief Connie Gray McKay, expressed a desire to have Chiefs talk to each other about H1N1. She was concerned that the leaders were not guiding their staff to work on Strategic Pandemic Planning. This is when KOTM developed a “Chief’s Forum” videoconference for Northwestern Ontario Chiefs. This online forum allowed leaders to discuss the way that H1N1 affected their communities. It also allowed them to share information and ideas on how to manage the disease in their communities.

All the chiefs in the Sioux Lookout District had the ability to access the videoconferencing system. This was made possible by KO-K-Net’s dynamic management of the limited pool of available bandwidth.

The call was supported by the use of K-Net’s videoconferencing bridge. The bridge can connect to both ISDN and IP-based videoconferencing units, and to the telephone network. Connections in the communities took place through KOTM / Ontario Telemedicine Network (OTN) partner Telemedicine Suites.

The OTN is one of the largest telemedicine networks in the world. It uses live, two-way videoconferencing to provide telemedicine services to more than 3000 health care professionals in more than 1175 sites across the province.

Thanks to the regional networking made possible through this videoconferencing system, the Chiefs invited community leaders from Manitoba to participate as well. The Manitoba Chiefs were glad to join and exchange different methods of pandemic planning. Each of the H1N1 videoconference calls had as many as 45 communities participating from across Ontario and Manitoba.

During the online videoconference event, three Chiefs, considered champions in managing H1N1 in their own communities, facilitated the discussion. These three Chiefs were: Don Morris (Big Trout Lake First Nation), Connie Gray McKay (Mishkeegogamang First Nation), and Adam Fiddler (Sandy Lake First Nation).

“The Chiefs took complete ownership of the forum. They were the ones to decide who their next guests would be and what would be discussed. They were able to exchange ideas in their own language. At times, when things sounded very dismal, someone would tell a funny story and get everyone laughing. This is very typical in native culture: laughter is good medicine for the soul. This made the meeting of leaders from the two provinces very effective,” said Tina Kakepetum Schultz of KOTM.

Over a series of five sessions, the Chiefs shared what they had done in their own communities to combat the disease, and discussed possibilities with other community leaders. The Chiefs shared numerous strategies throughout the series of five videoconferences.

The conference calls were funded by Health Canada, and also included Health Canada managers from Toronto, Ottawa, Thunder Bay and Sioux Lookout.

“I was telling the Regional Director of Health Canada about one of the Chiefs requesting to use videoconference to meet other Chiefs to discuss the H1N1. We were also interested in finding out what prevention plans they had in place. The Regional Director asked me to let her know when dates of the meetings were set, and she would get her staff involved!’’ said Tina.

The Health Canada managers were available to answer any of the Chiefs’ questions. This gave the community leaders access to experienced health care professionals that might not have otherwise been available.

The success of the Chief’s Forum on H1N1 demonstrated how the videoconference network can be used to discuss pressing health issues. This encouraged KOTM to continue to work on providing a program for the Chiefs to access to regular videoconferencing sessions. This new initiative will be called "The Chiefs Meeting Place".

“The Chiefs’ Meeting Place will be only for the Chiefs and their Band Council, if they wish to invite them. They will facilitate the meeting, and we will not attend or facilitate unless invited. We will just provide them with the connection and book the communities that want to attend.” said Tina.

One recent videoconference discussion focused on prescription drug abuse, which is a major issue in communities across Ontario. Over the videoconference sessions on prescription drug abuse, community leaders were able to discuss the issue with doctors, pharmacists, treatment centre staff, judges, and police.

These videoconference sessions are a useful resource for community leaders, and Tina hopes they will become a way of life.