Telehealth and Telemedicine

There is something special and calming about seeing people that you care about when you are ill or going through a challenging time - it can help make you feel supported at just the right moment. However, when your loved ones are thousands of kilometres away – in a hospital, or going to high school in an urban area – it’s not always easy to jump on a plane no matter how much you would like to.

Until not long ago (the 1990s), community members in Fort Severn were limited to using the telephone to stay in touch with faraway loved ones. Fortunately, with the advent of videoconferencing for telehealth and the technical infrastructure that supports it, Fort Severn community members can communicate with people over a distance, face-to-face. This has real implications and benefits for family visits, elder visits, and the areas of health and wellness.

Keewaytinook Okimakanak Telemedicine (KOTM) provides telehealth services to Fort Severn. KOTM has a community-driven and community-led philosophy. To implement smooth service delivery, in each community serviced by KOTM there is a community telehealth coordinator (CTC) who supports all kinds of telehealth visits and activities. This set-up enables community residents to use telehealth technology (real-time and two-way video and audio) to communicate face-to-face with medical professionals, mental health professionals, and family members.

For several years now Fort Severn has been participating in Elder Visitations, a monthly event sponsored by KOTM. During Elder Visitations, Fort Severn elders are given the opportunity to come together with each other, and with other elders in First Nations communities across the Sioux Lookout zone. This special time offers participants the space to communicate with each other in their native languages, visit with old friends and family who might have moved away, and also receive health education and a meal.

Family visits are another excellent example of meaningful interactions that take place via telehealth. If a Fort Severn family would like to connect with someone who has taken ill and who has been medically evacuated from the community, they need only contact the CTC to arrange a family visit using telehealth. If a family member leaves for high school or is temporarily living with a foster family, telehealth can again be used to reconnect family for a visit.

Many health and mental health activities take place via telehealth in Fort Severn. For instance, KOTM regularly offers health and wellness educational sessions. KOTM also offers Telemental health services where an individual in Fort Severn can connect with their counsellor or group (e.g., quitting smoking group, etc.) for mental health activities.

In 2010, Fort Severn participated in community-based research that explored community members perspectives on Telemental health. Specifically, 40 community members were asked about their perspective on the usefulness and appropriateness of using videoconferencing for mental health activities (e.g., counselling, etc.). Interestingly, a wide range of opinions were shared: 47% of participants thought that telemental was a useful and good idea, however another 33% had concerns about it and did not think that it was a good idea for their community, and another 20% had not decided or were neutral about the idea. A research paper was written on this topic, fully exploring all of the concerns and advantages identified by community members (see publications and resources section).

A story from Heather Coulson, Keewaytinook Telemedicine, about technology in Fort Severn

Having had the opportunity to be in Fort Seven on many occasions both for my present position and in the past in a different capacity, I have seen how the community has changed over the years. Even though there are now full services (phones, cell phones, telemedicine, internet access, etc.) the community is still in the far north and uses a satellite for connection. When technology goes down for any one of the multitude of reasons, the community is patient and rarely distraught when things don’t go as planned, after all “it’s the north.” While they most often go with the flow, they are always innovative in ways in which they can get things done.

I had an opportunity to go into the community to do some support and training for our Community Telemedicine Coordinator (CTC) and the Home and Community Care (HCC) staff on a pilot project called telerehab. Telerehab uses a wireless remote camera that is about four times larger than the average digital camera. It provides one-way video (where the camera points is what the other ends sees) two-way audio and two-way telestration (drawing on the screen). The camera is taken into the home for a patient visit. The pilot project was a inspired by the physio referral wait list of 350 First Nations people living in remote communities in the Sioux Lookout Zone catchment area.

The onsite portable camera was purchased and a kit was developed so that it could be taken into the home of any client with Internet service in their home. A Fort Severn community member was identified who was in need of a home assessment and willing to receive the needed services in their home. A consult was set up with service providers. All was in order including consent, staff in place, Internet connection in the home, etc. We were ready.

I flew into the community on a cold and windy day on a 19 seat Veech 1900 “Northern Jet” plane, thinking I was prepared for everything. The CTC (Community Telemedicine Coordinator) was there waiting for me when I arrived as I had asked. I was relieved that someone was there to pick me up as the airport is about 10 km outside of the community. I soon find out that I didn’t specify that I needed a ride only that she was to meet me there, but being a small community in which everyone knows everyone, we soon got a ride to the nursing station and my hotel.

It was later in the day already and the long flight had been the milk-run, which means you stop at two communities before landing at the destination. We had a quick meeting with Home Care staff Mary Miles, myself, and CTC Roseanne Miles, to confirm the plan for the next day, which was to meet at the client’s home at 9:30 am, and we would do the set up and be ready for the consult at 11am. Plan in hand it was back out into the cold, wind ripping at my scarf and stinging my eyes. I was grateful for my hand knitted thick wool sweater and all the layers under it.

The next morning Roseanne, the CTC, and I pulled or dragged the case with the equipment the short two city block walk to the client’s home the next morning. The advertisement for this case showed a grizzly jumping on the case and it won’t break. I am hoping that goes for polar bears as well as I cast a glance every now and then over my shoulder looking for any movement in the empty streets. The residents say the polar bears walk through the community either coming or going back out to the Hudson Bay coast. The case weighed about 35 pounds and was about five feet long, two feet wide and 14 inches deep with a handle at one end and wheels at the other to make it easier to carry or pull.

Within 20 minutes of arriving at the home, we were set up and ready to make the test call. Using the client’s home phone and a calling card we called the camera tech support in Winnipeg for a test call. It didn’t work. We checked over all the connections and it still didn’t work. We had Internet connection, or did we? We didn’t. A half hour had lapsed and we were now aware that we had no Internet connection and there was no way we were going to get a cable guy within the hour. We sat there looking at each other and I said “What can we do?” “Perhaps next door has internet we can run the line to, the camera is wireless.”

Mary agreed and she ran across the street to find out if they did and if we could use if for an hour. I waited on the steps of the client’s home. Within minutes Mary appeared in the doorway of the prospective alternative connection point and had the thumbs up. Roseanne undid the cords and we carried armfuls of cords, cable modem, security router, wireless router all to the house next door.
Again within 15 minutes we were set up and ready to see if the camera would pick up the wireless router next door. It didn’t.I told Roseanne who yelled out the door to Mary “NO”.

I asked Roseanne to ask Mary to carry the wireless router out onto the step, to bring it closer to the client’s home. Mary did, still nothing, she came closer, to the bottom of the steps, still nothing she came as far as the cables would allow and YES I had a flash of an antenna on the camera telling me we had connection. But it kept flickering.

I asked Roseanne to ask Mary to hold the wireless router up over her head, which she did and YES! There it was a solid green antenna. Mary being about 5’ 9” was quite a sight standing in the middle of the snow packed street with her hands up in the air with more than 100 feet of cable strung out behind her. I very seriously asked if she thought she could stand there for the duration of the consult, she looked at me for a moment and looked up at the router and said “I could.” Then we all laughed.

We managed to get a chair out there and reposition the router ears and make the test call. We had a connection! We cheered “YES!!” and then Mary stepped back into her role as the Home Care Coordinator, Roseanne held the camera and the client and his home were seen by the physio people more than a thousand kilometers away. We were done within an hour, packed up, and I was headed home on the late afternoon flight.

The North is used to things not going as planned, weather, time, deaths, illness, breakdowns, it’s life, it happens. Things will work out. They find a way to get through life. I think the technologies, while everyone agrees they’re not perfect, add opportunity and possibility. Two weeks later, the report is back to Mary Miles with recommendations for her client’s wellbeing. Things that had been either put on hold or not seen as crucial were taken care of.

Of all the recommendations the one that had the most impact for the client was the raising the sofa cushions so that he could get up and down unassisted, which means he had mobility in his home. A quality of life he didn’t have before and it was assumed that he couldn’t because his body wasn’t strong enough; it was because the sofa was too low. Technology; innovation, it’s good if we use if for good.