By: Francis Campbell, Chronicle Herald
It’s just what the community and the doctor ordered.
Dr. Aruna Dhara and the collaborative medical team she is part of seem a perfect fit for the First Nations community of Indian Brook.
“I got a really good feel about this place, and I knew it was going to be awesome,” Dhara said of the community and its Sipekne’katik Health Centre, where she and fellow physician Tiffany Tingley and nurse practitioner Melissa Stoddart have recently added their medical skills to a host of other health providers.
Tracey Martin, a primary health-care administrator who formerly worked with Colchester East Hants health authority, played a key role in bringing the two part-time doctors and full-time nurse practitioner to the hardscrabble East Hants community of 1,200.
“They didn’t have a physician on site,” Martin said of the health centre. “They really had a limited amount of health services at the centre for years.”
Given the go-ahead to put a physician-nurse practitioner team in the centre, Martin said the authority launched a yearlong search to find the right people for the job and the community.
“We took a lot of time to find the right fit. It will take a very special physician who is willing to be patient and practise in that type of community in a different way than they would in a typical physician office.”
Bubbly, diminutive and six months’ pregnant with her second child, the 35-year-old Dhara hardly considers herself a model of patience, but she’s confident that she can be a good fit at the clinic.
“It’s been really amazing to watch,” said Dhara, who has since February been co-ordinating part-time schedules with Tingley to treat patients at the centre.
“Community members call up other community members and work together to help us build the trust that we need and to build the rapport that we need with our patients. It’s really exciting to be part of this new thing in this community, that everybody is really excited to have the whole team in place.”
Dhara, who lives in Halifax and works part-time as an in-patient physician at Dartmouth General Hospital, said there are peculiar challenges and rewards associated with working in a First Nations community.
“On some levels, all patients are the same. COPD (chronic obstructive pulmonary disease) looks like COPD. Diabetes is diabetes, and my job is to monitor for all of the complications for those things, to manage those things. From a purely medical perspective, there is often not that much difference in how you manage somebody who lives on a reserve and someone who doesn’t.”
But she said there are other factors at play, including the all-important trust issue.
“When people seek care, how they seek care is influenced by their prior experiences, the experiences of the community they live in, the experiences they’ve had with other health providers, the experiences they’ve had at a walk-in clinic, the experience that their mother had or their child had. Those issues are very important.
“The particular experiences that First Nations populations have had historically, you can’t ignore that.”
First Nations communities also share particular health problems.
“Chronic disease is a pretty big burden in most First Nations communities for lots of different reasons,” Dhara said.
“The social determinants of health have a big role to play in chronic disease management and, historically, we know that First Nations populations have been disadvantaged in that way and have undergone lots of discrimination in lots of different ways that have put them at higher risk. Things like diabetes, heart disease, kidney disease, COPD, your standard bag of chronic disease management that I went to family medicine residency and trained to manage, it’s right here.”
Chronic disease management is about much more than just pills.
“I can give you medication that will help lower your blood sugar, but diabetes management is as much about lifestyle modifications (diet and exercise) as it is about medications.”
She said the connected community of Indian Brook can help decide and devise ways in which its citizens can “take their own health in their hands.”
The clinic is open from 8 a.m. to 4 p.m. daily, and if neither of the physicians are available, Stoddart is left holding the medical bag.
Working full-time at the clinic since October, she has seen countless patients.
And when something that requires immediate physician consultation pops up, “phone a friend,” Stoddart said of the two doctors on her team.
Community leaders who have been lauded in getting the collaborative medical clinic operational are quick to share the credit and the satisfaction.
“It’s pretty much like a family practice,” said Loraine Etter, community health director. “We’re all excited about it.”
Chief Rufus Copage said it might mean that people don’t have to travel off-reserve to see a physician in Elmsdale, Truro or Shubenacadie.
“We have an actual doctor there,” Copage said. “It’s up and running.
“There are people who don’t have cars, and it’s hard to get to the doctor.”
Dhara described the medical team’s role in Indian Brook as complementary to area family doctors who serve the same residents.
“Lots of folks are already receiving amazing care from family doctors in the area, and our goal here is absolutely not to replace that care. If you live in the community, our goal is to be a resource so you can walk in and we’ll see you. We’ll send a letter to your family doctor.”
But several people in the community do not have a family doctor.
“Those are the folks we are taking on in the clinic as our patients,” Dhara said. “Many of them are complex patients. Many of them may be elderly and may have mobility issues. For folks like that, getting off the reserve is an extra challenge.”
The medical team sees walk-in patients in the mornings and sees people by appointment in the afternoons.
Dhara said that could change, along with the community’s future health needs.
“Our role here is not to impose upon the community whatever we’ve decided are priorities. We have to work with the community to figure out what are priorities in the community.”
Originally published is The Chronicle Herald. See at http://thechronicleherald.ca/novascotia/1282885-a-good-dose-of-medicine-for-indian-brook