Gloria Stoney waited five days in October to be medevaced to Toronto from her home in Peawanuck, Ont. – a Cree community near the shore of Hudson Bay – after she began experiencing serious cardiac symptoms.
“I didn’t feel so comfortable, but my family was there to take care of me and make sure I wasn’t alone,” she says.
Upon arriving at Toronto General Hospital, she was admitted immediately for further work-up and was able to return home to Peawanuck while she was monitored remotely. A short time later, she was flown out to Kingston, Ont., for more testing and returned home at the end of November.
Gloria’s experience criss-crossing the province could soon become less common for local residents thanks to efforts by the Weeneebayko Area Health Authority (WAHA) that are being supported by physicians at the Peter Munk Cardiac Centre, University Health Network (UHN).
Building on an existing 2017 partnership, WAHA and UHN have signed a five-year memorandum of understanding that would support the cardiovascular needs of James Bay and Hudson Bay communities with a focus on direct care and remote management. That includes building local capacity and making use of remote technologies and other digital tools to bring diagnostics and treatment closer to where patients live.
“Signing the MOU emphasizes WAHA and UHN’s joint dedication to enhancing cardiac care in the James and Hudson Bay region,” says Lynne Innes, WAHA’s president and CEO. “Together, we’re working to improve cardiac care delivery, making it more accessible while enhancing quality of life.
“This partnership is a significant example of how health equity can be advanced in Indigenous communities.”
Using both Indigenous and western strategies, WAHA provides health care to six communities throughout the James Bay and Hudson Bay region, including Peawanuck.
Innes notes there is currently limited access to specialized cardiac care in the region, requiring patients such as Gloria to use a combination of boat, train, plane and car to travel more than 1,300 kilometres to the south.
“Leaving home for medical care is tough,” she says. “It requires the co-ordination of many people and organizations, and for our clients, it can mean a lot of anxiety from having to navigate a different city and hospital, all while missing the comfort of home. It’s a journey of healing mixed with the struggle of being far away from what’s familiar.”
Under the arrangement, co-ordinated clinical care would involve regular in-person visits by UHN staff to WAHA’s six communities and use of the Medly Program – a remote patient monitoring system for heart failure management that already counts more than 30 WAHA community members, including Gloria, as users.
There would also be opportunities for researchers and trainees to engage with WAHA and community members through Transform HF, a U of T institutional strategic initiative focused on digital innovation for heart failure care that brings together the university and the Ted Rogers Centre for Heart Research – itself a partnership between the University of Toronto, UHN and the Hospital for Sick Children.
Heather Ross, head of the cardiology division at the Peter Munk Cardiac Centre at UHN and a professor in U of T’s Temerty Faculty of Medicine, says improving access to culturally safe cardiovascular care in WAHA’s communities could drastically improve patient care and outcomes in the region.
“Digital innovation is the key,” says Ross, who is also co-lead of Transform HF. “It can provide access to health-care services not historically offered in the region and that require clients to travel out of community.”
A recent community-based study in Moosonee, Ont., found that community members are receptive to digital health tools, though they must be designed in a way that reflects their values and integrates western and Indigenous approaches.
Gloria, for one, says digital tools such as Medly have made a difference in her life.
“Medly has been helpful,” she says. “It saves me running to the clinic every time something happens. You get a response right away, and someone reaches out to you when something is up.”
Gloria says she also appreciates that her results are available through the app, so when she needs to receive care outside of her community, there’s no need to re-explain her symptoms and management.
“I’m not the only one in Peawanuck with a heart issue,” Gloria says. “Medly benefits a lot of people here.”
The partners are also initiating a screening program for earlier detection and primary prevention of heart failure.
Additionally, the partnership will support ongoing community-based qualitative and quantitative research with a focus on field testing digital devices, point-of-care testing and other innovations in community and on the land.
WAHA and UHN will also work together to build capacity in the community. Mentorship programs will facilitate exposure to clinical and research environments for the next generation of WAHA-based health-care providers, and opportunities will be created for Toronto cardiology residents and fellows to participate in this collaboration through observerships.
“Working in community, with community, is so important – this MOU supports that,” Ross says. “When you add in the layer of digital health and remote monitoring, I think we can support WAHA in keeping their community members healthy at home.”