Ontario’s only Inuit-specific clinic a model of patient-centred care

Connie Siedule, executive director of the Akausivik Inuit Family Health Team in Ottawa, says the goal of the clinic is to help Inuit understand their health issues and a complex healthcare system. (PHOTO BY LISA GREGOIRE)

OTTAWA — Connie Siedule, executive director of Ottawa’s Akausivik Inuit family health clinic, keeps track of what she calls “saves.”

Like the woman who visited the clinic just to register as a patient and leave. She was in the last trimester of her pregnancy, detoxing from addiction and she looked unwell.

When Akausivik doctors examined her, they discovered her baby was in severe distress.

“It wouldn’t have ended well,” Siedule said Feb. 12, sitting in a meeting room of the Vanier-area clinic. “We bypassed emergency and went right into maternity.”

Then there was the woman who had gone to a hospital emergency room in Ottawa with severe abdominal pain but couldn’t explain her symptoms well in English.

Emergency staff sent her home but her discomfort continued. She decided to go to Akausivik.

Akausivik doctors diagnosed her with an ectopic pregnancy — a fetus growing inside a fallopian tube. If left untreated, this can be a potentially life-threatening condition.

Akausivik doctors called the hospital emergency staff to let them know the woman was coming back and gave her a letter explaining the problem so she could hand that to the triage nurses on arrival.

“Had she not come in here, she would have died,” Siedule says plainly. “That was a total save.”

Before the Akausivik Inuit Family Health Team clinic started providing a one-stop shop for Inuit healthcare in Ottawa in 2011, most Inuit patients would just go straight to emergency if they had a problem.

But often, by the time they got there, small problems had bloomed into complex ones, leading to hospital admission and extensive care.

Now, when they register at Akausivik, a case manager-interpreter sits down with them, asks a lot of questions about their past and current life, and tries to unravel what is often a tangled mess of physical and mental issues.

And they can speak Inuktitut if they want.

The clinic, near enough to Montreal Road in Ottawa’s Vanier neighbourhood to be accessible for many Inuit who live there but discreetly distant from the bars and street life, is modern, welcoming and brimming with Inuit artwork.

Funded through the Ontario Ministry of Health Long Term Care program, Akausivik operates on an annual budget of about $1.4 million.

Doctors are paid a salary, not fee-for-service, so they can take as much time as they need with each patient. Sometimes a 15-minute appointment turns into an hour and a half.

Since the clinic opened nearly four years ago, Akausivik has logged more than 78,000 patient visits and currently maintains a registry of more than 3,232 patients.

Ontario is home to more than 200 of these holistic, family health clinics, five of which are Aboriginal-specific. This is the only Inuit one, Siedule said.

An estimated 1,800 Inuit now live in Ottawa, according to the Ottawa Inuit Children’s Centre.

In the beginning, the clinic was under the umbrella of Ottawa’s Tungasuvvingat Inuit community health centre but on Jan. 1, 2015, Akausivik celebrated a rebirth by becoming an independent body led by a five-member volunteer board of directors.

Those five directors include the original three — Sally Webster, Rhoda Innuksuk and Mary Simon — and two new additions: Looee Okalik and Richmond Green. They held their inaugural meeting Jan. 9.

For Innuksuk, that meeting was the culmination of more than a decade’s worth of perseverance, planning, struggle, hope, focus, grant-writing, setbacks and finally, success.

“I’m very proud of the work they do there. It’s an incredible team,” said Innuksuk, an oral history researcher with Nunavut’s culture and heritage department in Igloolik.

“I’m still in awe but looking forward to continuing to improve the health and treatment of Inuit.”

Simon was also buoyed by the clinic’s long-time-coming incorporation.

“I would like to congratulate the Inuit of Ottawa for this achievement,” texted Simon, who was on the road Feb. 12.

“As soon as people come in the door, they know they are in an Inuit health centre and are greeted in their own language: Inuktitut. I want to recognize the continued support of the Ontario government for Inuit to have their own healthcare centre.”

Siedule said in the years leading up to the 2011 Akausivik opening, they offered band-aid health care solutions for Inuit whenever possible.

In 2009 for example, during the flu pandemic, Siedule said they managed to convince Dr. Indu Gambhir— with only a promise of future payment — to set up a flu clinic for Inuit who, according to statistics, were 14 times more likely than average Canadians to suffer complications, or be hospitalized, because of influenza.

“We set up three lawn chairs in the basement of Tungasuvvingat Inuit, put up a bookshelf to provide a little privacy for patients,” said Siedule, laughing. “We had to borrow thermometers and other equipment.”

Akausivik now employs five part-time physicians, including Dr. Gambhir, registered nurses, and case managers who identify ways the clinic can help patients, or external services to which they can be referred.

They also have affiliated specialists — a pediatrician, a psychiatrist, and a dental hygienist, for instance — who come in when needed.

Siedule is trained in traditional Chinese medicine so she offers acupuncture treatments for stress, addictions, pain, depression and other problems.

The clinic also does outreach work. A nurse and case manager visit the city’s homeless shelters weekly, Siedule said, to try to meet the needs of at-risk patients.

Sometimes they meet patients who have been kicked out of the Larga Baffin patient home because of drinking or drugs. Sometimes they meet people straight off the plane from Iqaluit.

If anyone needs care right away, staff will accompany them back to Akausivik, or to hospital if necessary.

“We have a number of patients who are open about their addictions and they feel comfortable coming here,” said Dr. Anne Duggan, Akausivik’s acting senior physician. “When they’re ready to deal with it, we’re here to help them.”

It’s sad to think Inuit might be better served at the Akausivik clinic than at some community health stations in the North, Innuksuk said.

“We hope northern clinics might pattern their care after our model here in Ottawa,” Innuksuk said. “In the North, you can’t insist on anything to the nurses or you could get accused of being abusive or uncooperative.

“But Inuit have special needs,” she said. “We need to design programs in the North that are geared toward those special needs.”

Siedule said Akausivik staff make an effort to see the person behind the problem — the abuse they may have suffered, the untreated trauma, the depression.

“People say it feels like home here,” she said, “which is kind of strange for a clinic, when you think about it.”