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ADVOCATE: Medical Laboratory Professional Shortages in Remote First Nations Communities

By Lauren Hicks, Communications Administrator, MLPAO



“I have a story that I want to share with you about a young boy called Brodie Meekis. Brodie and his siblings came home from school in Sandy Lake with fevers and sore throats. The father took the children to the local nursing station and the boys were advised to take Tylenol and to rub their chests with Vicks. While the siblings slowly returned to health, Brodie did not and his health continued to worsen. There was no available appointment for at least two weeks. The 5-year-old later died of strep throat – a common bacterial infection that is easily cured with antibiotics when properly diagnosed,” explained Ovide Mercredi, the previous national Chief of the Assembly of First Nations. “This is an example of how important the services medical laboratory professionals provide to our communities are and how they can save lives.”


Mercredi is now the lead of the Nishnawbe Aski Nation’s (NAN) Health Transformation Initiative – a long term project that aims to bring the healthcare system in NAN territory under the authority of the First Nation itself. The initiative is in response to decades of systemic inequities and perpetual public health crises for NAN communities. However, these inequalities are not isolated to NAN territory. The majority of fly-in First Nations communities in northern Ontario face issues with resource allocation, equipment shortfalls and staffing. And the shortage of medical laboratory technologists and technicians felt across Ontario is only exacerbated in these isolated areas.


Nursing stations in northern Ontario’s remote First Nations communities are under the jurisdiction of Health Canada (Indigenous Services Canada) and are often understaffed, have no accreditation requirements and no official quality assurance protocol. As there are no medical laboratories near said stations, samples are flown to Sioux Lookout in order to run tests.


“There is always the possibility of losing a sample, samples becoming spoiled due to weather delays and slow communication between the lab and healthcare providers,” said Mercredi. “Ontario has one of the best healthcare systems in the world. That does not exist for First Nations communities. Equity of access is a big issue.”


The Sioux Lookout Meno Ya Win Health Centre (SLMHC) houses the lab that conducts tests for these fly-in communities. Founded as part of a four-party agreement between the federal and provincial governments, the town and NAN to amalgamate the segregated provincial and federally run hospitals, SLMHC opened its doors in 2010. The one-of-a-kind health center includes a ventilated smudging room, a traditional foods program and mandatory cultural awareness training for all new hires.


Currently, 65 to 70 per cent of the ISO Plus accredited laboratory’s total workload is allocated to running routine tests for nursing stations. The laboratory currently has a staff of 20 (six laboratory assistants and 14 technologists) trained in transfusion medicine, microbiology, chemistry and hematology.


The SLMHC also runs quality checks on point of care equipment for the northern nursing stations. Once a month, samples from glucose meters and HemoCues are run through the lab’s chemistry analyzer to ensure the results agreed within an acceptable percentage range.

Brenda Voth, the lab manager at SLMHC, says their laboratory only offers full time positions as individuals are unlikely to move to Sioux Lookout for a casual position. She went on to explain that they try to stay at the very top end of overstaffed to ensure vacation coverage and to avoid unnecessary overtime – but this is rarely the case for long.


“The biggest problem for us is turnover. We get adventurous people who come here for awhile to get experience but a lot of times want to go home once they can get a job there. We are constantly training new people all the time,” said Voth. “It would be ideal if we could have more homegrown talent who want to train, live and work here.”


Rhea Rice, an MLA with the SLMHC, was uncertified when she first made the transition from an admissions clerk 16 years ago. Since she took the MLPAO exam, all technicians at the center require certification upon hire. As Indigenous Services does not currently hire laboratory assistants, Rice runs a half-day training program in phlebotomy for nurses sent by Health Canada before their deployment to northern stations.


Over the last few years, Rice has also been asked to go to the northern communities and train laypeople to help reduce nurse workload.


“I usually go up for three days at a time and train community members who have shown interest in learning a new skill. The first day is the technical side of phlebotomy and paperwork then we work with a fake arm and then we bring in community members who are willing to offer up their arms who require blood work,” said Rice.


Rice explained that she has to be mindful of the vocabulary she uses during these exercises, as many of the trainees are not as familiar with medical and laboratory terminology as somebody who is formally educated in a medical field. Trainee retention is also an issue she faces.


“I have been to Sandy Lake [First Nation] three times and I believe only one person out of nine or ten that I have trained have stuck with doing lab work,” Rice explained. “The community members either move on or are given other responsibilities in the nursing station.”


For now, the SLMHC is participating in high school career fairs to raise awareness of the career and help pave the way for a more sustainable healthcare workforce in the north.

In the interim Andrea Auger, the reconciliation and research manager at the First Nations Child & Family Caring Society, believes medical laboratory workers who are interested in working in these communities need adequate support.


“It can be a big culture shock for those going into the fly-in communities. There is not a lot to do and it can be really hard for people. So just having those support programs in place where they are introduced to community members or being included in ceremonies and local events,” said Auger.


Mercredi believes that this health transformation will begin with breaking the tradition of prioritizing southern Ontario and by seeing the province as one collective place worthy of equal health services.


“I think medical laboratory workers need to hear that we need them. We welcome them to our communities,” said Mercredi. “The work they do is vital in ensuring that the health quality is improved in the north and that we prevent people from dying needlessly due to a lack of access to proper medical services that many in Ontario take for granted.”

This article appeared in our Summer 2019 issue of the ADVOCATE, "Optimizing Scope: MLA/Ts at Work." Members can access this and other articles through our App. Contact mlpao@mlpao.org for the password!

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