Dr. Bonnie richardson

a long, cold winter

Bringing much-needed medical care to the rural, prairie fringes of Saskatchewan

on 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

by the strain of cOViD-19 protocols. One such woman recently called richardson, who is a specialist in the nephrology unit at regina’s Saskatchewan health authority, overseeing the care of thousands of patients with kidney disease who need dialysis. “You gotta help me doctor,” the woman begged richardson. “i have my dialysis today but i’ve got seven grandkids here and they’re all home from school. i can’t be gone; there’s no one here to look after them.”

“That breaks your heart, you know?” says richardson, who is also the defence chief for cOViD-19 in the southern half of the province. This means she 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 reserves. The aboriginal population in Saskatchewan is about 175,000 people, or 16% of a populace of 1.18 million. The statistics are grim: the average age of onset for kidney disease among Saskatchewan aboriginals is 56.4 years, with 33% developing the condition. Type 2 diabetes affects more than 17% of aboriginals, a rate three times higher than the general population. hiV infection rates are 3.5 times higher than the non-aboriginal population, at 35.8 per 100,000. and hepatitis c is 2.4 times higher among aboriginals. Substance abuse, primarily crystal meth and fentanyl, complicates efforts to tackle these ailments. poverty, says richardson, is largely to blame. Often, reserves only have one small store serving mainly chips and pop, 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.”

“Everyone’s just tired—tired of the whole thing,” says Dr. Bonnie Richardson