Royal Alexandra Hospital Foundation

HELPING WHERE IT’S NEEDED MOST

February is Heart Month, a month dedicated to calling attention to the importance of cardiovascular health.

For many, ‘Heart Month’ can slip by unnoticed. But for those who have experienced heart disease—or have family members who have—it hits very close to home.

For others, it can even hit harder, especially if there is limited access to cardiovascular health services in one’s community. An overly lengthy ambulance ride can be just as dangerous as the inability to spot a warning sign or address a risk factor.

The fact is, cardiovascular disease has reigned as one of the top killers of Canadians for roughly a century. A lesser known tragedy is that it is also one of the most preventable. 

With this knowledge in mind, the CK Hui Heart Centre has been working around the clock and behind the scenes to bring heart health education and services to the communities in Alberta that need it most. 

STRIKING AT THE HEART OF THE ISSUE

The Multicultural Heart Health Program (MHHP) has been operating since 2011, one of the CK Hui’s earliest initiatives. Funded by the Royal Alexandra Hospital Foundation, the program identifies cultural and ethnic groups throughout Alberta that may be most at-risk for cardiovascular health issues and aims to provide heart health services and education.

The most recent few years have seen focus directed toward several different Indigenous communities via the Indigenous Heart Health Initiative (IHHI), an offshoot of the MHHP.

The program has been spearheaded by two cardiologists in particular: Dr. Po Kee Cheung and Dr. Ben Tyrrell.

Dr. Po Kee Cheung is an interventional cardiologist at the CK Hui Heart Centre. While he holds an impressive list of titles, accomplishments, and responsibilities, he is well-known for his modesty, quiet confidence, and genuine consideration for his patients and fellows. His peers and students describe him as someone who is constantly volunteering his time to train the next generation of cardiologists (and sometimes travelling as far as Nairobi or China to do so).

Dr. Ben Tyrrell is also an interventional cardiologist at the CK Hui, and similarly has his own fair share of hats to wear at the hospital and beyond. Like Dr. Cheung, he shares a passion for teaching and passing on his knowledge to his students, residents, and fellows, which he has described as one of the best parts of his job. When it comes to the IHHI, “I’m really more like Po Kee’s assistant,” he said, and credits the many nurses at the Royal Alex who also support the program.

The goal of the program itself is rather simple: 

“Canada is a multicultural society. Heart disease prevention will be more successful if we can assist the individual high-risk cultural groups to take ownership in helping their members fight heart disease.” - Dr. Cheung

And that also sums up the main strategy of the IHHI.

THE PROGRAM’S FIRST BEATS

Back in 2016, members from the Enoch Cree Nation reached out to Dr. Cheung, Dr. Tyrrell and a handful of others. The Enoch Health Centre had set up a successful diabetes clinic to address the community’s high prevalence of the disease—First Nations people can be three to five times more likely to develop type 2 diabetes than the average Canadian. They wished to inquire about setting up a cardiology clinic, given the large overlap in care.

The heart specialists from the CK Hui quickly recognized the importance of the need, the community’s challenges, and the effect their help could provide. 

With help from the Royal Alexandra Hospital Foundation, they soon set to work raising funds for an ECG machine that would eventually be donated to the Enoch Health Centre, which would be a crucial addition to the centre for on-site assessments. Members from the Enoch Health Centre also discussed holding educational lectures and Q&A sessions for the communities, starting with their upcoming diabetes conference.

“When they invited us to speak, it really cemented the importance of setting up a cardiology clinic. We’ve come every year for the past three years now, with the unfortunate exception of 2020, due to the pandemic,” said Dr. Tyrrell. 

DETECTING EARLY SUCCESS

The diabetes clinic was the first step on the path toward improved cardiovascular health for the Enoch Cree Nation community.

“There just weren’t a lot of resources in the community, and it got to the point where families started to have children, nieces and nephews diagnosed with diabetes. We were getting a lot of feedback from our clients and felt we had to start a diabetes program to help,” said Susan McGillis, a registered nurse who has been with the Enoch Health Centre since 2008. 

“It’s good fortune that we’ve had a number of specialists from outside the community say ‘We want to work with you’ and to start coming out,” she continued, speaking first of Dr. Jeff Winterstein who was instrumental in setting up the diabetes clinic, and later Dr. Cheung and Dr. Tyrrell with the Enoch Health Centre’s cardiology clinic.

The diabetes conference has grown from a one-day to a two-day conference, garnering ~350 attendees from across Alberta, BC and Saskatchewan, and has served as the launch point for the surprisingly well-received cardiology clinic.

“There was a lot of apprehension in the community, and maybe a bit of fear. Even at the clinic we were worried about attendance, but the cardiologists who came out were so easy to talk to, so enthusiastic and so accommodating, they made everyone feel really comfortable,” said Holly Calliou, a nurse who started at the Enoch Health Centre in 2015, who also described it as a “great fit.”

The education was not just for the community members, but the medical staff as well. Dr. Cheung and Dr. Tyrrell brought nurses like McGillis and Calliou to be trained to use the donated ECG machine to perform assessments and take readings on-site that could be easily sent to the CK Hui for closer analysis.

“Many people have seen others with major heart issues and sometimes don’t want to know if it could be their reality too. Giving the presentations in the community makes it a lot less scary, and makes access much easier and better.” - Susan McGillis, Enoch Health Services registered nurse

And that point of access is a major benefit across all communities where the CK Hui has assisted in opening a cardiology clinic, which now proudly includes the Maskwacis community and most recently the Frog Lake First Nations community.

BRANCHING OUT

Similar to the Enoch Cree Nation, the cardiology clinics at Maskwacis and Frog Lake were focused around giving people access to services they simply could not receive from the local area.

“It’s all about the community, and [cardiovascular care] is so needed in the community.” - Cheryl Brookman, nurse practitioner with Maskwacis Health Services

“There are transportation issues, language barriers, and other roadblocks in the way of people being able to access those services, that just for people to be able to be screened and scheduled for follow-up right in their community is very helpful,” Brookman continued.

The access to the two top-level cardiologists is what she declared was “the best of the best.”  The reason being, if as a nurse you have a patient and are not sure if they need to see a cardiologist, you have a direct connection to one, who also happens to be familiar with the community and understands the struggles its people go through.

As Brookman described, having the clinic right in the community has facilitated the ability to get much-needed information, especially for people who don’t have a car or reliable transportation. 

If all they need is an assessment, it’s a quick in and out as opposed to the alternative—first finding and scheduling a time that works for them, then driving over an hour into town, waiting, having the assessment done, then driving over an hour to get back. People often have to leave home at 6:30 AM in the morning, turning a relatively quick check-up into an all-day affair, and that’s if they have or can get access to a car.

While Maskwacis Health Services does have transportation to take people to appointments, many of Brookman’s patients were excited that they wouldn’t have to travel as much, which can be very difficult in the winter or when the roads aren’t the safest.

Maria Brousseau and Wanda Henderson from Frog Lake’s Morning Sky Health and Wellness Society seconded those thoughts.

“Before we’d have to get an order from the doctor for an ECG, then send the patient to a nearby town where there’s a lab that could do the ECG. That’s at least a 40-minute drive, and some people don’t have reliable transportation,” said Brousseau, an LPN. “Now we can do it right here in Frog Lake, and send a really nice updated exam over to the cardiologists at CK Hui, who are there to answer questions, able to call in and ask more about the patients, receive our referrals, and more.”

The equipment also makes a huge difference. 

“One challenge we recognized here is that within many First Nations communities is a lack of equipment,” said Dale Steinhauer a health advisor and liaison for the Treaty Six area from Tribal Chief Ventures Inc., an organization that has been instrumental in inviting the speakers and facilitating collaboration.

“In looking at the maintenance and prevention of diabetes, which includes all the co-morbidities and all the correct equipment, we were not able to source the equipment we needed through our regular support system," he said. "Thankfully, through the generosity of sponsors and donors, the CK Hui was able to assist with the procurement of the ECG equipment.”

And while many ECG machines are a regular 4-lead ECG system, the donated ECG used at Frog Lake is a more sophisticated 12-lead machine. Like Brookman, Brousseau and Henderson also received training on the portable ECG machine.

A PANDEMIC HIDING A SILENT EPIDEMIC 

Unfortunately, all three cardiology clinics have had to pause operations to redirect resources toward dealing with the pandemic but are eager to get operations back up and working harder than ever once the situation has calmed.

“The implications of COVID have dampened our efforts and caused an issue everywhere, with many health services taking a backseat to the virus,” said Brookman. 

Her concern is that primary care, like cardiovascular health appointments, are still very much needed in order to address the ongoing health concerns that are not related to COVID.

“The goal is a healthy community, and to have a healthy community you need to address any cardiovascular issues. The more awareness that we can spread among people in the community about the importance of heart health to improve health and health outcomes, that’s what it’s all about.”

This is one of the reasons that Heart Month is so crucial...

“There are so many people close to us who touch our lives every day who have silent heart diseases that one day won’t be silent anymore. So we need to have them in the healthiest state they can be in to avoid that position.” - Cheryl Brookman

A HEALTHCARE MODEL BUILT ON TRUST

Despite the challenges presented by COVID, the various groups of healthcare providers are optimistic about the future of the cardiology clinics, and their ability to improve health outcomes for their respective communities.

First and foremost, the clinics are built on trust and mutual respect. And according to the nurses and clinic workers, if the community is supportive, the program will do really well. Central to that belief is the importance of honouring the Indigenous way, the medicines and way of life. 

“With any program, it’s important to make sure it’s something the community wants, that it’s not something done to the community but for the community,” said Brookman. In her eyes, the best approach as healthcare providers is to offer the programs to the community and give individuals the power of choice to use them if they so decide.

When it comes to the educational visits and training, the cardiologists “try to make it very hands-on,” said Dr. Tyrrell. “We bring coronary scans, catheters, pacemakers, stents, balloons, and models, so everyone can see them up close and handle them.”

The goal here is to help community members gain a better understanding of various coronary procedures, tools and devices, and ask questions of experts who are ‘very welcoming, and very eager to be able to offer their cardiology services.’ And while programs like these always take time, it seems to be helping. 

“People are actually going to their appointments, going to see their specialists, and even driving over to the CK Hui for their follow-ups. That’s how you know it’s effective.” - Holly Calliou, Enoch Health Centre nurse

GAINING MOMENTUM

Dale Steinhauer has also noticed several positive heart health trends in the Frog Lake First Nations community, one of several with whom he works closely in his role as health advisor.

The main trends he’s observed, along with members of the Morning Sky Health and Wellness Society, are more people walking (young and old), more people feeling good about the management of their diabetes and wanting to get their sugars down, and more awareness around healthy eating.

And, of course, more trust. 

Dale credits the success of the diabetes programs that have been “very well-received” and have been attracting support and attention from other key players in the healthcare world. 

For example, the Lakeland Primary Care Network (the local PCN) sent out dieticians to complement Frog Lake’s diabetic programming. 

In Dale’s words, “It’s something that grew organically, and the momentum and the doors that have been opened have been unreal.”

The model also works well for all involved parties. At Morning Sky, the centre handles the appointment bookings for the specialists, with trust being placed in the clinicians’ ability to refer individuals they feel would benefit from a cardiologist consultation. 

And to make appointments as seamless as possible, the centre is continually spreading word within the Nation about when they have a cardiologist visiting or available via telehealth (with telehealth being one area—along with remote monitoring—where doctors like Dr. Cheung have observed plenty of innovation, which is sure to further improve medical access).

Dale stated he would love to expand this to other First Nation communities when everything starts to return to normal. His plan would be to use the same model around follow-ups and how the appointments are structured to see if it translates successfully across communities. 

So far, it has.

LOCALIZED INNOVATION

The nurses and clinicians have also been generating plenty of ideas of how to continue to spread awareness and improve heart health knowledge, as their communities progress past COVID.

At Maskwacis, they have multiple avenues for sharing health info, such a billboard on which to advertise key health info, a Communications Officer who goes on the local talk radio station to promote different programs in the community, and a regular newsletter.

At the Enoch Cree Nation, McGillis and Calliou pointed out that Enoch built a new K-12 school just prior to COVID and, while many of the youth had been going to Edmonton for schooling, many have since returned. “So we’ve been thinking about collaborating with the school to work on addressing all the chronic health conditions, and focus on preventing or at least delaying those conditions.” Some initial ideas would be around risk factors such as vaping or the usage of tobacco.

It’s also possible Dr. Tyrrell may hold brief consultations with potential patients out on the rink. Rumour has it that Dr. Tyrrell has often been seen at Enoch’s arena playing hockey, which may be how he knows so many people around his age in the area. 

THE NEXT GENERATION 

The team at the CK Hui have been thinking about how to further improve the IHHI.

“Going forward, we’d like to concentrate on educating the younger generation,” Dr. Cheung and Dr. Tyrrell agreed.

Team members have noticed that the younger generations can be very helpful in the conferences. While some can seem shy initially, they often ask lots of great questions, and make the sessions very interactive as more trust is established.

The doctors describe it as a mutual sharing of experiences. “They want to tell their stories, what their experience with the healthcare system has been like—such as a family member having a hard experience, or if they personally ended up getting treated and what happened,” said Dr. Tyrrell.

“We learn about the community and they learn a lot about us, too,” said Dr. Cheung.

We trust this mutual learning is sure to continue for many years, and will help improve the health of many of Alberta’s First Nations peoples and communities.

Thank you to the doctors, nurses and medical staff who support this program, and of course all those who have been instrumental in their communities in spreading heart health knowledge, running the clinics and helping the programs be successful. 

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