Physician Assistant Role in Indigenous Health

There has been difficulty providing health care access to Indigenous Communities in Manitoba for several reasons:

• Lack of health care facilities in rural and remote communities: For example, some communities are 200 km away from the nearest Emergency. There is a large reliance on ambulances.
• Physician Retention in Manitoba: There has been difficulty recruiting physicians to work in remote communities, within 100 km of Winnipeg, there has been a large reliance on ambulances.

We have to recognize the resilience and strengths of diverse communities, that is, recognize and respect their indigenous knowledge, medicines, knowledge of the land, honouring of elders and indigenous leadership.

First Nations are at higher risk of chronic and communicable diseases: 

• 1 in 4 children in First Nation communities live in poverty – double the knowledge
• Suicide rates amount First Nations 5-7 x higher than other non-Aboriginal Canadians
• Life expectancy is 5-7 years less than other Aboriginal Canadians, infant morality rates are 1.5 times higher
• Tuberculosis rates among First Nation citizens living on reserves are 31 times the national average
• First nation youth is more likely to end up in jail than graduate high school.
• First National children on average receive 22% less funding for child welfare services than other children.
• There are almost 600 unresolved cases of missing and murdered Aboriginal women in Canada
• 1 in 5 First Nations lives with diabetes – 3-5 times national average
• About 25% on reserve water treatment systems pose a high health risk. In fact, 12% of First Nations to boil their drinking water. 

From: Assembly of First Nations, Facts on Quality of Life of First Nations, June 2011.

There is an opportunity for Physician Assistants as well as Nurse Practitioners to serve indigenous and remote communities. There is a high turnover of physicians in Manitoba.

PAs can make a difference in areas such as:

• Management of diabetes
• Prevention of diabetes related amputations
• Diagnosing and treating communicable diseases
• Communicate with community
• Responding to the needs of youth

In the United States:

The Indian Health Services there are 250+ PAs meeting health care needs of American Natives and Alaska Natives. These PAs are credentialed in Emergency and Family Medicine. This program has been successful and a model worth examining when implementing PAs to serve rural, and remote communities.

Manitoba Research

Early findings suggest that PAs could have significant impact on:

• Ability of primary care practices to accept new patients
• Patient access, serving remove communities where there is low retention/ high turnover of physicians.

There is potential for PAs to work in remote communities, with physician supervision available by phone. 

If PAs wish to work in underserviced areas, they must learn and respect:

• Strengths of the indigeneous community
• How to practice cultural safety
• How living conditions determine health
• The effects of colonizaiton
• Commit to the 94 actions proposed by the truth and reconcillation comission:

“We call upon the federal government, in consultation with Aboriginal peoples, to establish measurable goals to identify and close the gaps in health outcomes between Aboriginal and non-Aboriginal communities, and to publish annual progress reports and assess longterm trends. Such efforts would focus on indicators such as: infant mortality, maternal health, suicide, mental health, addictions, life expectancy, birth rates, infant and child health issues, chronic diseases, illness and injury incidence, and the availability of appropriate health services.”

Resources

• The Community Well-Being Index: Report on Trends in First Nations Communities, 1981-2011
• Indian Health Services: Physician Assistants