pay i t f o r w a r d
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A long, cold winter
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n the Saskatchewan reserves where Dr. Bonnie Richardson delivers healthcare, upwards of 10 or more people—grandparents, grandkids, parents and foster children— share three or four bedrooms in a 1,000-square-foot residence. In such homes, the parents might be absent, with a single grandmother raising a half dozen kids on her own. Such physical and economic stresses are exacerbated
commands the fight to control and treat the coronavirus on a variety of fronts: acute medicine, critical care surgery, emergencies, field hospitals and setting new COVID-19 protocols, among other responsibilities. It also means that Richardson is putting in 12-hour-days (or more) seven days a week—and has been since the virus hit the province early last year. The litany of daily tasks and decision making doesn’t describe the emotional side of the job, and Richardson is deeply frustrated about being unable to deliver the same level of care to Indigenous patients as her urban patients receive. On Indigenous reserves, says Richardson, the medical care is, “unfortunately, equal to a third world country.” Before the pandemic added layers of frustration, work and challenges to her practice, Richardson and her colleague, Dr. Stuart Skinner, would travel the highways and back roads of Saskatchewan (much like the frontier doctors of long ago) to care for sick and isolated patients, as well as set up basic healthcare systems. Richardson and Skinner called the initiative the Wellness Wagon. Eventually, the program had 19 team members dealing with the epidemic of Type 2 diabetes, kidney disease, hepatitis C and HIV found on many re“Everyone’s serves. The Aboriginal populajust tired—tired of tion in Saskatchewan is about the whole thing,” 175,000 people, or 16% of a says Dr. Bonnie by the strain of COVID-19 populace of 1.18 million. The Richardson protocols. One such statistics are grim: the average woman recently called age of onset for kidney disease Richardson, who is a specialist among Saskatchewan Aboriginals in the nephrology unit at Regina’s is 56.4 years, with 33% developing the Saskatchewan Health Authority, overseecondition. Type 2 diabetes affects more ing the care of thousands of patients with than 17% of Aboriginals, a rate three times kidney disease who need dialysis. “You higher than the general population. HIV gotta help me doctor,” the woman begged infection rates are 3.5 times higher than Richardson. “I have my dialysis today but the non-Aboriginal population, at 35.8 per I’ve got seven grandkids here and they’re 100,000. And Hepatitis C is 2.4 times higher all home from school. I can’t be gone; among Aboriginals. Substance abuse, prithere’s no one here to look after them.” marily crystal meth and fentanyl, compli“That breaks your heart, you know?” cates efforts to tackle these ailments. says Richardson, who is also the defence Poverty, says Richardson, is largely chief for COVID-19 in the southern to blame. Often, reserves only have one half of the province. This means she small store serving mainly chips and pop,
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and people will consume two to four litres of fizzy drink a day. A diet gleaned from hunting and gathering is much healthier, and Richardson works with Aboriginal elders, blending Western medicine with traditional knowledge, to try to improve diet and thus health outcomes. There has been progress thanks to Richardson’s efforts, with health directors and nurses now stationed on many reserves. Such localized medicine is crucial as these “marginalized populations” often feel the sting of prejudice and disrespect in urban health centres and hospitals, says Richardson. It’s also difficult, when living on rural reserves that are hundreds of kilometres from urban centres, for patients to travel. This winter, temperatures in Saskatchewan plunged to -50˚C due to a polar vortex, shutting down roads. Patients couldn’t navigate the deadly cold and roads to come in for things like dialysis. Solutions are possible, like implementing home dialysis for those with kidney disease, but many reserves don’t have an appropriate water supply or clean environments for such measures. “They are poor people living in an environment without appropriate resources,” Richardson says. COVID-19 has exacerbated these problems. There have been cases where all the household members contracted the virus due to overcrowding. This has forced practitioners to provide care virtually rather than in-person, increasing the anxiety and uncertainty already gripping communities. Further adding to the burden of care in Saskatchewan is a growing backlog of patients. Last year, many patients were reluctant to visit hospitals or clinics for fear of contracting the virus. Their conditions have now progressed to a point where they are significantly sicker than if they would have received regular care, Richardson says. As much as Richardson and her colleagues maintain a brave face, the grind of COVID-19 means that “we’re all working harder. Everybody’s feeling stressed. I mean, it’s -50˚C and everyone wants a holiday. Everyone’s just tired—tired of the whole thing.”
courtesy of dr. richardson
Bringing much-needed medical care to the rural, prairie fringes of Saskatchewan
