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TRANSCRIPT
Discussion Panel
Brian QuinnNurse Senior
EpidemiologistNorthern Population
Health Unit
Teddy ClarkeChief of Clearwater River
Dene Nation
Dr. James IrvineConsultant Medical
Health Officer, Northern Population
Health Unit
Jennifer AhenakewExecutive Director of
Primary Health Care, NNW,
SHA
Leonard MontgrandMétis Nation of
Saskatchewan, Area Director
Dr Moliehi KhaketlaMedical Health OfficerNorthern Population
Health Unit
Dr. Nnamdi NdubukaMedical Health OfficerNorthern Inter-Tribal
Health Authority
Dr. Rim ZayedMedical Health OfficerNorthern Population
Health Unit
Robert St. PierreMayor of La Loche
Jennifer ZelmerCEO, Canadian Foundation for
Healthcare Improvement
Saskatchewan Northwest North Outbreak - Lessons
Learned
June 29, 2020
COVID-19
saskatchewan.ca/COVID19
saskatchewan.ca/COVID19
VISION
Healthy People, Healthy Saskatchewan
MISSION
We work together to improve health and well-being. Every day. For everyone.
VALUES
• SAFETY: Be aware. Commit to physical, psychological, social, cultural and environmental safety. Every day. For everyone.
• ACCOUNTABILITY: Be responsible. Own each action and decision. Be transparent and have courage to speak up.
• RESPECT: Be kind. Honour diversity with dignity and empathy. Value each person as an individual.
• COLLABORATION: Be better together. Include and acknowledge the contributions of employees, physicians, patients, families and partners.
• COMPASSION: Be caring. Practice empathy. Listen actively to understand each other’s experiences.
PHILOSOPHY OF CARE: Our commitment to a philosophy of Patient and Family Centred Care is at the heart of everything we do and provides the foundation of our values.
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Northern Saskatchewan Administrative District
850 kilometers north of Regina
Northern Village of LaLoche – Dene / Métis population of about 3200
Clearwater River Dene First Nation - population 1039 – 10 km from La Loche
Denesuline language spoken by 89% of residents
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• La Loche, Sask, was incorporated as a northern village in 1983, with a population of around 2600 people.
• The Northern Village of La Loche lies on the eastern shore of Lac La Loche in northwestern Saskatchewan near the Saskatchewan-Alberta border.
• The settlement of La Loche dates back to at least the fur trade and Peter Pond’s "discovery" in 1778 of the Portage La Loche or Methye Portage, which crosses the height of land between the Hudson Bay and Arctic Ocean drainage basins. The MethyePortage played a significant role in the Canadian Economy.
• As a result of this, the people of La Loche have experienced a long history of colonization that resulted in intergenerational trauma which is still felt today and exhibited in the high rates of mental health and substance use in the community.
La Loche
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Clearwater River Dene Nation
• Bordering La Loche to the north and reached via Highway 955 is the Clearwater River Dene Nation (CRDN) with a population of 1039 people (on-reserve).
• The La Loche/CRDN population centre with about 4,000 people represents about 30 percent of the Denesuline speakers of Canada. The Denesulinelanguage is spoken by 89% of the residents.
• Originally from Fort McMurray area people and our treaty was signed in Fort McMurray in 1899. Back then people migrated along the Clearwater River, Christina River to Garson lake and to La Loche. CRDN didn’t receive it’s land until 1970. It’s was known as Portage La Loche Band later the name was changed to the Big C Band after years of negotiations to do a land transfer to be closer to modern amenities.
• In the early 1990s the bands name was changed to Clearwater River Dene Nation which really represented our history.
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The La Loche Health Centre has 9 beds in Acute Care, 5 Long Term Care beds and 2 Alternate Level of Care beds.
The Emergency Room runs 24/7, with Emergency Medical Services and Emergency Air Medivac and ground transport.
Northern Medical Services contracts 9 Physicians covering 3.5FTE (4.0 during COVID-19 pandemic) and coordinates the delivery of specialist services (Psychiatry, Orthopedics, ENT, GI, etc.) through remote and in person consultations.
La Loche Health Centre
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IHICC -Commander
TBC
Logistics Chief
TBC
Supply Chain
TBC
Digital Health
TBC
Planning Chief
TBC
HR
TBC
Provincial Program/IIS
Directors
Finance Chief
TBC
Operations Chief
TBC
HR
TBC
PHC
Acute Services
Continuing Care
IIS
Directors
Physician Services
ACOS leads
Provincial Programs
Directors
Liaison Officer
TBC
Communications Officer
TBC
Documentation Aide
TBC
EOC Manager
TBC
Safety Officer
TBC
Medical Health Officer
TBC
IHICC -Commander
TBC
Logistics Chief
TBC
Supply Chain
TBC
Digital Health
TBC
Planning Chief
TBC
HR
TBC
Provincial Program/IIS
Directors
Finance Chief
TBC
Operations Chief
TBC
HR
TBC
PHC
Acute Services
Continuing Care
IIS
Directors
Physician Services
ACOS leads
Provincial Programs
Directors
Liaison Officer
TBC
Communications Officer
TBC
Documentation Aide
TBC
EOC Manager
TBC
Safety Officer
TBC
Medical Health Officer
TBC
EOC Commande
r
Derek Miller
Logistics Chief
Shane MerrimanSupply
Chain
Colin KarstDigital Health
Chad Freeman
Planning Chief
Brent KitchenHR
Kevin Zimmerma
n
Pandemic Plan Annex
Leads
Provincial Program/II
S
EDs
Finance Chief
Ken Unger
Operations Chief
John Ash
HR
Blake McMullen
IHICC –Saskatoon
Suzanne MahaffeyIHICC –
Regina
Sheila Anderson
IHICC –North
Pam McKay or
Jennifer Ahenakew
IHICC –Rural
Jeannie Munro or
Jacquie Holzmann
811 Healthline
Rod McKenzie
Physician Services
Rob Gentes
ACOS lead
Liaison Officer
Jocelyn Bishoff
Communications Officer
Kim McKechne
y
Documentation Aide
Tamara Bond
EOC Manager
Luiza Kent-SmithSafety
Officer
Cynthia Leschyshyn
Medical Health Officer
Dr Julie Kryzanows
ki Provincial EOC (Government wide)
Health EOC (Ministry of Health)
EOC Command
er
Derek Miller
Logistics Chief
Shane MerrimanSupply
Chain
Colin KarstDigital Health
Chad Freeman
Planning Chief
Brent KitchenHR
Kevin Zimmerma
n
Pandemic Plan Annex
Leads
Provincial Program/II
S
EDs
Finance Chief
Ken Unger
Operations Chief
John Ash
HR
Blake McMullen
IHICC –Saskatoon
Suzanne MahaffeyIHICC –
Regina
Sheila Anderson
IHICC –North
Pam McKay or
Jennifer Ahenakew
IHICC –Rural
Jeannie Munro or
Jacquie Holzmann
811 Healthline
Rod McKenzie
Physician Services
Rob Gentes
ACOS lead
Liaison Officer
Jocelyn Bishoff
Communications Officer
Kim McKechne
y
Documentation Aide
Tamara Bond
EOC Manager
Luiza Kent-SmithSafety
Officer
Cynthia Leschyshyn
Medical Health Officer
Dr Julie Kryzanows
ki
IHICC -Commander
TBC
Logistics Chief
TBC
Supply Chain
TBC
Digital Health
TBC
Planning Chief
TBC
HR
TBC
Provincial Program/IIS
Directors
Finance Chief
TBC
Operations Chief
TBC
HR
TBC
PHC
Acute Services
Continuing Care
IIS
Directors
Physician Services
ACOS leads
Provincial Programs
Directors
Liaison Officer
TBC
Communications Officer
TBC
Documentation Aide
TBC
EOC Manager
TBC
Safety Officer
TBC
Medical Health Officer
TBC
IHICC - Regina
IHICC -Commander
TBC
Logistics Chief
TBC
Supply Chain
TBC
Digital Health
TBC
Planning Chief
TBC
HR
TBC
Provincial Program/IIS
Directors
Finance Chief
TBC
Operations Chief
TBC
HR
TBC
PHC
Acute Services
Continuing Care
IIS
Directors
Physician Services
ACOS leads
Provincial Programs
Directors
Liaison Officer
TBC
Communications Officer
TBC
Documentation Aide
TBC
EOC Manager
TBC
Safety Officer
TBC
Medical Health Officer
TBC
IHICC - Saskatoon IHICC - North IHICC - Rural
Integrated Health Incident Command
Centres
Cascading Command Structure– COVID -19
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• Unique collaborative initiative in Saskatchewan - established in 1998• Efficient delivery of population health services across geographic
northern half of province• Provides support, expertise & specialized programming across the north
• Population health promotion • Health protection and disease control • Health surveillance • Emergency preparedness & response• Program planning and evaluation • Research etc.
• Team includes: Medical Health Officers, Epidemiologist, Public Health Nurse Specialists, Public Health Inspectors, Env. Health Protection Coordinator, Public Health Nutritionist, Dental Health Educator, Infection Prevention & Control Practitioner, Population Health Promotion Coordinator and others.
• Work closely with communities, leadership and First Nations partners
Northern SK Population Health Unithttps://populationhealthunit.ca/
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NITHA
33 First Nation Communities
37, 441 on-reserve pop
(INAC 2019)47.5% of SK on-
reserve pop; 3% SK total pop.
saskatchewan.ca/COVID19
• The first case was confirmed on April 15, 2020, with contact tracing
demonstrating the case was related to an outbreak in Kearle Lake Oil
Sands, north of Fort McMurray
• MHO of the Northern Saskatchewan Population Health Unit led a CD team
to promptly initiate the case investigation
• The index case was a health care worker linked to a Kearle lake case
• Subsequent transmission in the long term care facility and community
First Case
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Long Term Care• The index patient was a health
care worker
• There were 6 LTC patients and 2 respite patients
• 21 HCW were identified as close contacts and were required to isolate for 14 days in addition to being tested for COVID-19.
• The outbreak was declared in LTC on April 17, 2020.
Long Term Care Outbreak
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Precautionary Travel Advisory
Long Term Care Facility Outbreak Declaration GeneXpert in
La Loche Operational Surge
Door-to-Door Active Case Finding
Apr. 18 Apr. 22 Apr 29 May 10-20Apr. 17
Public Health Measures - Milestones
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• Screening of 813 houses in La Loche, Garson Lake, Black Point and Descharme Lake
• The use of GeneXpert was helpful to guide the active case finding
• Household health risk assessment to support vulnerable population
• Working with the community EOC was key to support the isolation requirements
Door to Door Active Case Finding
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Door-to-Door Active Case Finding
Clear Water Dene Nation – NITHA
Number %
Number of homes in community 220 -
Number of home visited 213 97%
Individuals offered testing 288 -
Accepted request for testing 141 48.7%
Declined 138 47.9%
Previously tested 5 1.7%
Will get tested 4 1.4%
Tested at home 85 60.3%
Tested at the clinic 56 39.7%
Tested Positive 2 1.4%
Tested Negative 139 98.6%
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What Worked well
• Strong collaborative partnerships with the SHA, Community Leadership, Medical Health Officers and local Emergency Operations Centre with additional support from:• Northern Intertribal Health Authority;• Saskatchewan Government Relations;• Saskatchewan Public Safety Agency;• Northwest Regional Emergency Operations Centre• Indigenous Services Canada
• Public Health Interventions: Public Health Orders, community engagement and ongoing communication, assisted self-isolation, enhanced testing, contact tracing and case finding in collaboration with NITHA. Implementation of door to door screening and testing.
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What Worked Well
• Deployment of voluntary staff from across Saskatchewan Health Authority Labour
Pool and Supplementary Workforce.
• Coordinated ongoing communication and education for community members in
English and Dene.
• Implementation of the Managed Alcohol Program in response to COVID-19
outbreak management, in a very short time frame
• Quick mobilization of operations and logistics with strong leadership to monitor
the operations on a daily basis
• Use of Modelling to guide strategic directions and allocation of resources
• Flow of information between different stakeholders
• Financial support from the Metis Nation - Saskatchewan
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What Worked Well
• Check points
• Curfew
• Closure of liquor sales
• Community engagement
• Strong community leadership
• No “cookie-cutter” approach to pandemic response
• Multi-jurisdictional approach
• Communication
• Culturally grounded, strength-based approach to public health measures
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Better If
• Support for Vulnerable Populations and Assisted Self-Isolation was lacking at the
outset
• Lack of PPE, hand sanitizer and disinfectants for community members was an
ongoing challenge.
• Initial communication gaps because of multiple agency involvement caused
challenges in the beginning - this improved throughout experience
• Little known about COVID-19 at the outset and created a lot of fear and anxiety in
the community
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Better If
• Invest in local capacity building to overcome the challenge of limited human
resources
• Develop innovative solutions to chronic problems
• Addressing stigma associated with COVID-19
• Lack of local infrastructure impacted on the ability to respond. i.e. no hotel for
deployed staff in La Loche
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Challenges
• Stigma and discrimination
• Fear and anxiety
• Social determinants of Indigenous Health had major impact on pandemic
response
• Contact tracing and compliance with mandatory isolation
• Sustaining public health measures
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Next Steps
• Develop a multi-stakeholder taskforce driven by the community.
• Work on challenging community needs for long term objectives across the life span
• Preparing for potential second wave of COVID-19.
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Discussion Panel
Brian QuinnNurse Senior
EpidemiologistNorthern Population
Health Unit
Teddy ClarkeChief of Clearwater River
Dene Nation
Dr. James IrvineConsultant Medical
Health Officer, Northern Population
Health Unit
Jennifer AhenakewExecutive Director of
Primary Health Care, NNW,
SHA
Leonard MontgrandMétis Nation of
Saskatchewan, Area Director
Dr Moliehi KhaketlaMedical Health OfficerNorthern Population
Health Unit
Dr. Nnamdi NdubukaMedical Health OfficerNorthern Inter-Tribal
Health Authority
Dr. Rim ZayedMedical Health OfficerNorthern Population
Health Unit
Robert St. PierreMayor of La
Loche
Christine QuinnDirector, Canadian
Foundation for Healthcare Improvement