A blueprint for First Nations health service delivery

The last time Manitoba’s First Nations communities saw widespread flu-like symptoms among their people, the outcome was grim. In 2009, the H1N1 influenza pandemic disproportionally affected Indigenous peoples, with higher rates of infection and over-representation among those needing hospitalization.

Tackling COVID-19 in these communities poses unique challenges, as generations of social, cultural and economic inequities have created obstacles to good health. So when COVID-19 arrived in Canada earlier this year, it was clear something different needed to be done to avoid another health crisis.

Rapid Response Teams is a concept designed and led by the Manitoba First Nations Pandemic Response Coordination Team (a partnership between the Assembly of Manitoba Chiefs, Manitoba Keewatinowi Okimakinak, First Nations Health and Social Secretariat of Manitoba, and Keewatinohk Inniniw Minoayawin). It is coordinated by the University of Manitoba’s Ongomiizwin Health Services.

These inter-disciplinary teams of up to seven people are chosen from a network of health-care professionals – including doctors, nurses, rehab specialists – that Ongomiizwin identified early on in the pandemic as being willing to respond to urgent needs in the community.

When the number of COVID-19 cases in a First Nations community exceeds or is anticipated to exceed what the local health workforce can manage, a rapid response team (RRT) is quickly deployed – often within 48 hours.

“They do so knowing they are putting themselves in to a riskier situation in service of our communities,” explains Melanie MacKinnon, Executive Director of Ongomiizwin Indigenous Institute of Health and Healing. “They are the first people to really get a sense of how serious the situation is, and being on the ground they have to identify and troubleshoot any challenges that are often not as apparent to those of us who support them from Winnipeg. This is a significant weight that they carry.”

Each team works in support of the local health workforce and with community leadership. In addition to supporting contact tracing, assistance with isolation planning, and communications, they also bring rapid point of care testing, set up testing sites, and schedule community members for testing which has helped contain clusters quickly.

Along with helping to deliver prompt, efficient care, the collaborative nature of RRT has also brought renewed confidence to First Nations communities.

“First Nations leadership for the RRT is critical because it capitalizes on the health expertise, systems and community contextual knowledge, and relationships that First Nations leaders bring. It engenders a level of trust that results in teams being able to hit the ground running and deliver excellent, culturally safe care,” says Dr. Marcia Anderson, Executive Director, Indigenous Academic Affairs at Ongomiizwin Indigenous Institute of Health and Healing and Vice-Dean, Indigenous Health in the Rady Faculty of Health Sciences.

She adds: “We have had really unprecedented collaborations in ensuring that we had this resource available to support communities. The National Microbiology Laboratory prioritized distribution of rapid point of care testing devices to remote First Nations communities, and the Public Health Agency of Canada has supplied field epidemiologists to assist us in assessing the larger outbreaks. We have had excellent support and collaboration with provincial Medical Officers of Health, Epidemiologists, and Regional Health Authorities. The way we have been able to leverage and access resources from others to support this First Nations led response is a blueprint for all First Nations health service delivery in the future.”

At publication time, 12 RRT have been deployed to communities as cases continue to rise. While First Nations people comprise 10.5 per cent of Manitoba’s population, they currently represent 19 per cent of active COVID-19 cases and 13 per cent of all deaths from the disease in the province.

Heather Olynick