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First Nations diabetes care hits the road

By Lisa Hale

Nurse Sue Falconer performs an A1C hemoglobin test on Rochelle Raphael.

The diabetes epidemic takes the eyesight, limbs and lives of many in Canada’s First Nations communities. 

But a team of nurses and a vision technician based out of Seabird Island First Nation are bringing free diabetes testing and care to people affected by the disease where it matters most — on reserve. 

A welcoming approach

Routine testing for her pregnancy revealed that Rochelle Raphael had gestational diabetes but she wasn’t satisfied with the explanation she got from the hospital clinic she visited.

“It was really difficult because the information available wasn’t sufficient,” she says.

Raphael, who is non-Aboriginal, and her husband Steve, who is Nlaka’pamux, decided to come here, to the Mobile Diabetes Clinic, while it’s at Sto:lo Nation Health Services for the day.

Nurse Sue Falconer welcomes the young family and starts by asking about Raphael’s medical history.  Gestational diabetes is a temporary elevation of blood sugar in pregnant women who did not previously have the disease.  While the condition usually goes away after pregnancy, it can lead to the development of type 2 diabetes in offspring and can cause women to become diabetic after giving birth.

Laughter fills the room as Raphael and the nurse chat about the changes her family have gone through since the diabetes diagnosis.  Her toddler plays with toys spread nearby while Falconer pricks the young mother’s finger to test her blood sugar levels over the past three months.

Raphael says that she appreciates the staff at the mobile clinic allowing her to bring her daughter to the appointment. This was not permitted at the hospital.

“I’m not getting a babysitter to go and have someone tell me I can’t drink Coca-Cola and eat white bread,” she says. “I kinda already knew that, it’s kind of a waste.”

Taking diabetes care where it’s needed

The Mobile Diabetes Clinic is run out of Seabird Island First Nation in the Fraser Valley

Since 2009, the Mobile Diabetes Clinic has been contracted by Health Canada’s Aboriginal Diabetes Initiative to visit all Aboriginal diabetics who live on-reserve in Southern British Columbia. This means traveling as far east as the Alberta border and toward Williams Lake.  The clinic also visits Bella Bella, Bella Coola, Hartley Bay and Klemtu on the north coast. Many of the communities it visits are remote and some can only be reached by plane or boat. 

Carrier Sekani Family Services provides a similar traveling clinic that covers the north of the province.

Aboriginal people living on-reserve have the highest rates of diabetes (17.2 per cent) of any group in Canada. This, compared to a rate of 10.3 per cent amongst Aboriginal people living off-reserve and only five per cent among the wider non-Aboriginal population, according to a 2011 report by the Public Health Agency of Canada. 

The report also highlights the fact that Aboriginal people are more likely to suffer from complications from the disease than other Canadians.

The Mobile Diabetes Clinic is part of an initiative to administer early screening for complications of diabetes in First Nations communities. It’s also an attempt to address disparities in health status between Aboriginal and non-Aboriginal Canadians, as well as the increasing prevalence of diabetes in Aboriginal populations, says Heather McDonald, a health policy and quality officer with Seabird Health.

McDonald says that the Mobile Diabetes Clinic improves conditions for people living with the disease, and in some cases, saves lives.  In one instance, the team found someone with serious complications and helped them get emergency treatment, without which the community member would likely have died.  Generally, it’s not so dramatic, Falconer says.  While a once-a-year appointment cannot replace other health care services, the clinic’s screening, A1C tests, nutrition counseling, foot care and wound and eye checks allow people on-reserve to reduce health complications and make choices about how best to manage their disease.

Listen: the Mobile Diabetes Clinic visits Sto:lo 

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Coping with diabetes on reserve

Robyn Cobon knows the high cost of the illness.  The mother of three, from Cheam First Nation, lost an uncle to diabetes. She also has a diabetic father and her mother has the precursors of the condition.

“My grandparents had it, my uncles had it, it was something you had to worry about, that’s all I knew…but I never really thought about how it would affect my life personally,” Cobon says.

That changed the day she “died” on the operating table during elective surgery six years ago. Doctors resuscitated her, but her pancreas never worked again.  She found out her body wasn’t regulating insulin.  Blood tests revealed that diabetes was raging unchecked in her system.

Finger prick

Falconer takes a drop of blood for the A1C test.

Cobon has since changed her diet and started medication that stabilizes her condition.  She had her first appointment with the Mobile Diabetes Clinic when it visited Cheam in January.  She also visits Seabird Island First Nation for regular testing and diabetes care.

Unlike many users of the mobile clinic, Cobon lives only a five-minute drive away from health services in nearby Agassiz.  However, she feels that the mobile clinic offers more informative services than others she has used in the past. 

Cobon says that her appointment with the clinic in January, and her visits to Seabird Island’s Health Centre, as well as changes to her diet and lifestyle, are all part of her strategy for keeping her condition under control. 

Visiting the clinic

The mobile clinic team is made up of two registered nurses, Falconer and Dann Swann; a vision technician named Andrew Duerksen; and Bonnie Nickel, a licensed practical nurse and coordinator of the program. Both Nickel and Swann are Aboriginal, members of Squamish Nation and Peguis Band respectively. Not all members of the team go to every clinic they hold, so they split up the travel amongst each other.

When the Mobile Diabetes Clinic sets up in a community, it generally sees about eight people per day.  The team spends between one day to a week in the communities it serves, depending on size of the First Nation and the number of people wanting to be seen.

An appointment can take up to an hour and involves a hemoglobin A1C test, cholesterol testing, as well as health and nutrition counseling.  Nurses check wounds and feet, and the vision technician does an eye exam.

Challenging work

Licensed practical nurse Bonnie Nickel says that the reception the team receives in the communities has been positive.

“The people are quite surprised at what the team is able to do, I think. That they don’t have to go to a lab and have all these other tests done. We bring it all to them. They always want us to come back.”

Traveling thousands of kilometres to visit most of the reserves in southern B.C., and a few on the north coast, can be extremely challenging and travel to remote communities is highly weather dependent.  The difficulty in reaching some of the reserves highlights the importance of this service – if it’s hard for the team to get in to provide medical services, there’s no doubt it’s a struggle for individuals to get out and access health care. 

There are also logistical considerations when trying to get 500 pounds of medical equipment to communities that are only accessible by boat or float plane.

Entrance to the Mobile Diabetes Clinic offices at Seabird Island First Nation.

For visits to road-accessible communities, the team members load hundreds of pounds of gear into a white SUV that sports their logo: an eye with a brightly coloured medicine wheel in the iris.  They start early in the morning and spend long days driving into the south of the province.

The team face a bigger challenges than logistics, however. Falconer describes the complexity of working in places where there is little access to affordable, healthy food, since one of the keys to successfully managing diabetes is controlling blood sugar and eating healthily.   Falconer emphasizes the difficulty in counseling people about food choices in places where they may not have the resources to afford higher quality, and therefore more expensive, items. 

“(Some diabetes) drugs are free, food is not,” she says. 

For that reason, the nurses work with people to identify strategies for preparing healthier meals.  Falconer says she uses the example of how ramen noodles can be made healthier, by simply adding some frozen veggies – the extra fiber prevents blood sugar from spiking after eating. 

The nurses also recommend bringing more traditional foods, like salmon, into the diet, something many of their clients are interested in or are already doing.

Explore: see where the Mobile Diabetes Clinic travels throughout the year

View Reserves in a larger map

Giving diabetics a choice

Aboriginal people in remote communities often face long hours of travel to access health care services.  Falconer describes one community where the closest pharmacy was a two-hour drive away.  Some of the people the team sees do not have regular contact with doctors and specialists.

“Many times we are the only person they’ve seen that would be considered a health care professional for some time,” says Falconer.

The nurse, who has a friendly, approachable manner with clients, says the key to the work of the Mobile Diabetes Clinic is to give people the information they need so that they can decide how they want to manage the condition.

“You like to encourage people and give them the education so that they can control their diabetes or choose not to,” she says. “The idea is to give them enough information that they can make the choices they want.”

Getting back on the road

At the end of their day at Sto:lo Nation, the mobile clinic team members make quick work of packing up the medical equipment and loading in into their SUV.  Once ready, the crew get on board and the GMC Yukon drives down the road to join the flow of traffic heading towards the highway. Next stop: a return landing at Seabird Island First Nation. 

Today’s clinic is just one of the many short trips that the team will do to neighbouring areas.  But as the weather improves, the vehicle’s odometer is set to climb swiftly. The Mobile Diabetes Clinic team is gearing up for another travel-filled season to the some of the farthest reaches of B.C.

Lisa Hale is a freelance journalist and broadcaster based in Coast Salish territory. You can follow her on Twitter @lisa_hale

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1 Comment

  1. Suzanne says:

    enlightening! bringing the treatment to the user makes so much sense. Thank you, Lisa

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