Looking for a Health-care Jewel in Cape Breton

ABORIGINAL AFFAIRS--Looking for a Health-care Jewel in Cape Breton

Premier John Hamm mentioned its success in a recent speech. So did Prime Minister Paul Martin. And it was modeled after another program that earned accolades in the Romanow Report on Health Care. The Tui'kn (pronounced "dweegan") Initiative may be built around the health-care needs of the five First Nations' communities in Cape Breton, but its success could have implications well beyond the region's borders.

"It's a potential jewel in the health-care crown of Canada," says project advisor Mary Jane Hampton. "It can be a model for the type of health care that every Canadian should expect."

Tui'kn (the Mi'kmaq word for passage) is designed to help people pass through barriers in the health-care system. The initiative builds upon the most successful elements of an earlier pilot program -- the Eskasoni Primary Care Project (1998-2000).

Rather than simply deal with symptoms, the Eskasoni project sought to prevent health-care problems by educating -- both the patient and the patient's family -- and by encouraging changes in risky lifestyles. Studies showed that 89 per cent of Eskasoni residents felt that the quality of health-care services in their community improved during the program. There was also a significant decrease in the number of times area residents visited the doctor or went to the emergency room.

That program's success was cited in the Romanow Report on Health Care as a worthy model for future improvements. And so, in January 2004, the Tui'kn Initiative was begun.

Health-care teams established through Tui'kn generally consist of a doctor, a dietician, a pharmacist, a nurse and a health educator. Team members are paid a salary rather than a per- patient fee.

"Not everyone who comes in, needs to see the doctor," says Ms. Hampton. Patients are connected to the team member who can best address their problems, allowing the doctors to spend more time with the patients who need them the most.

Although it is too early to measure results, Sharon Rudderham, health administrator for Eskasoni, is pleased with how the initiative is already creating partnerships. "Health directors in the communities have always worked together in the past," she says, "but now, with the support of the chiefs and the band councils, we have more formal recognition."

David Gass, director of primary health care for the Nova Scotia Department of Health agrees. "It's exciting to see the commitment that the five communities have to working together," he says.

It is obvious this kind of team approach can work right across Canada. Importantly, however, Tui'kn also addresses some special considerations to provide "culturally appropriate" health care.

For example, it acknowledges that aboriginals generally see the care of the elderly as a family responsibility and are less willing to move parents into long-term care facilities.

It also takes into consideration more subtle differences that can affect health-care services. While non-aboriginal cultures see direct eye contact as a sign of truthfulness, for example, in most First Nations' cultures it is considered impolite. Such opposing signals can impair the relationship between non- aboriginal health-care workers and their clients.

Indeed, that leads to another major challenge for the Tui'kn Initiative: to attract and keep doctors in the various communities. The program is currently paying for the training of three family doctors who have agreed to a four-year service period in Tui'kn communities once their training is complete.

While this short-term measure is a good start, Ms. Hampton says one of the goals of the initiative is to attract doctors "who will stay until they retire." To do this, the system must pay doctors a competitive salary and emphasize the benefits of this new health-care model. Such a system allows doctors to lead a professional life in which they know their hours in advance, have a guaranteed vacation, and work as part of a team.

Ms. Hampton estimates that of the 60,000 doctors practising in Canada, less than 50 are from First Nations. Efforts are also therefore planned to encourage more First Nations' students to move into health-care fields, particularly as doctors. Innovative teaching materials -- such as a science program now offered at the University College of Cape Breton that combines traditional and modern science -- will help.

Tryna Booth, policy advisor for First Nations and Inuit Health Branch with Health Canada, says the Tui'kn Initiative is a great project. "It's something we're holding up as an example of primary health-care across the country," she says.

If the Tui'kn Initiative can achieve the same concrete results as the Eskasoni project, Cape Breton First Nations may be helping Canada develop a health-care system that is both efficient and flexible.