I have enjoyed the MHST 601 course and have appreciated that this course allowed me to focus and reflect on health care issues that have a direct impact on my midwifery practice. As a frontline health care worker, often there is not the time to reflect on the root causes of the clinical picture that is unfolding in front of you. The MHST 601 course gave me that theoretical space to explore the “bigger picture” of what we are trying to achieve in health care. Namely, professionalism and the effective provision of care in a digital age, social determinants of health including racism in health care, multi-level approaches to improving health outcomes and disease prevalence and prevention.
Professionalism in a Digital Age
Midwifery as a profession is under constant scrutiny by the medical community. This adds an extra layer of importance for a midwife to maintain a professional presence in the world both in person and on line. Being a professional while utilizing social media can at times be difficult to navigate.
Until I undertook the MHST 601 course, it had been my preference to maintain a low profile online to avoid the many pitfalls associated with social media. However, this course has given me more confidence in how to maintain a professional online presence. I am planning on maintaining the eportfolio that I created for this course towards the goal of maintaining a professional online image.
Near the very beginning of this course, I also started an Instagram page for my midwifery practice (@bornnaturally_vernon) to continue to expand my online presence and reach a broader (and younger) audience.
I plan to continue to use my professional and personal social media accounts to promote midwifery in a positive way and to ensure that I am posting evidence- based content.
Social Determinants of Health
As a midwife from Manitoba I am all too familiar with the social determinants of health and the disparities and barriers Canadians from different walks of life face in achieving and maintaining good health and gaining access to quality health care. As Bryant T, et al. discuss, there is direct correlation between income and health in Canada which has “increasingly led to a “privatization of security” whereby security is (financially) guaranteed for the wealthy and rather less so for the poor and disadvantaged [135]”. The research is clear, the more socioeconomically disadvantaged one is, the more likely an individual is to suffer from poorer health over their lifetime.
I would argue that Canada’s First Nation’s population is the hardest hit by this truth. Living on reserve, racism, poverty, lack of cultural competency by the primarily white health care system have all contributed to the Aboriginal population carrying a disproportionate percentage of the disease burden in Canada. All of these truths were evident in my blog post about the tragic death of Brian Sinclair
On Sept. 19, 2008, Brian Sinclair, a double amputee who lost both his legs to frostbite, presented to a busy Winnipeg hospital emergency department after being seen at a community clinic. The attending physician at the clinic felt that Brian Sinclair was in the early stages of a bladder infection that might lead to sepsis if untreated. As the clinic was not equipped to manage Brian Sinclair’s needs the community physician organized a ride and gave him a letter to give to staff upon arrival in emergency so that he would be seen promptly. Brian Sinclair would spend approximately 34 hours in the emergency department waiting room where he would later die from sepsis from an untreated urinary tract infection without ever having been examined by medical staff. There are 34 hours of security footage demonstrating Mr. Sinclair’s presence and lack of treatment. It was not until the morning of September 21, 2008, that Brian Sinclair was finally attended to by a nurse and found dead. This nurse was asked to check on Sinclair earlier in her shift but stated that it “didn’t seem urgent” so chose to finish charting and paperwork before checking on Sinclair. When this nurse finally did check on Mr. Sinclair, rigor mortis had already begun to set in and Brian Sinclair was officially pronounced dead at 12:51 on September 21, 2008 (Gerster, 2018).
This tragic story demonstrates how someone with various challenges and barriers to accessing culturally safe and competent health care can have a very different and negative experience while navigating our health care system. Brian Sinclair was an indigenous, drug addicted double amputee living in poverty. None of these facts about Mr. Sinclair should have impacted his ability to access timely health care but ultimately lead to him dying without ever being assessed by a health care provider prior to his demise.
Working in health care means trying improve health and health outcomes for ALL. To me this means treating each patient I meet with compassion and respect while helping them figure out how to navigate our health care system to meet their own individual and unique needs.
Multi-Level Approaches to Improving Health Outcomes
I explored the social determinants of health even further through my assignment on how a multi-level approach to health care could lead to improved health outcomes beginning right from the time of conception. Ramey et al. explored the multi-level influences that lead to health disparities across diverse populations and developed The Preconception Stress and Resiliency Pathways Model (PSRP) to explore the diverse and complex ways our genetics, environment, community, physical and mental health weave together to contribute positively or negatively to the health of an individual beginning with the health of the mother prior to conception. The PSRP model is quite complex and attempts to investigate health determinants through a holistic and thorough lens including pre-conception health, the role of the father, maternal stress as well as community influences such as income, employment, and housing (Ramey et al., 2015).
This assignment got me excited to imagine a model of health care where every woman contemplating pregnancy had access to a health care provider knowledgeable in pre-conception health with individualized recommendations for health promotion, access to community programming targeting ways to improve pregnancy outcomes, education and funding on how to purchase and prepare healthy meals, community lead activities promoting exercise and stress reduction as well as education for fathers and family members to encourage healthy pregnancy behaviours and positive parenting approaches.
Disease Prevention and Prevalence
While there are many different chronic diseases affecting the population I work with, diabetes and its close cousin gestational diabetes are chronic illnesses that a midwife will diagnose and treat on a regular basis.
Learning that BC had the highest rates of gestational diabetes in the country initially surprised me. British Columbia has a reputation for being somewhat health conscious however, it is also a province with a high Indigenous and Asian population which suggests that this increase may be caused at least in part due to genetic factors. Diabetes is more prevalent in individuals of Arab, Asian, Hispanic, South Asian and Indigenous descent in addition to being more prevalent among those from lower socioeconomic backgrounds (Maternal Diabetes in Canada). Yet, it is not surprising to find rates of type 2 and gestational diabetes are climbing and certainly this matches my anecdotal experience as a clinician. Age and weight are two significant contributing risk factors to the development of both type 2 and gestational diabetes and with a significant percentage of the population being either overweight or obese and with many women delaying pregnancy until later in life, it appears that gestational diabetes rates will continue to climb for the foreseeable future (Berger et. Al, 2016).
In summary, chronic diseases are here to stay and rates of diabetes and many other chronic illnesses are going to continue to rise if current health trends persist. All health care disciplines are faced with preventing and treating disease. It is my hope that as more research demonstrates the significant impact that the social determinants of health have on an individual’s risk of chronic illness and overall quality of life, that more funding will be made available to work towards closing the disparities that exist in our health care system while improving the overall health of our society. While this is a challenging goal to achieve due to vast amount of inequities in health across a diverse population, it is my hope that health care providers in Canada will continue to work towards adopting a system that will go well beyond simply treating physical illnesses. I am optimistic that we can slowly grow to incorporate a multi-level approach which includes more emphasis on disease prevention while addressing the social determinants that contribute to our most vulnerable populations carrying a disproportionate amount of the disease burden.
Resources:
Bryant T, et al. Canada: A land of missed opportunity for addressing the social deter-minants of health. Health Policy (2010), doi:10.1016/j.healthpol.2010.08.022
Berger, H., Gagnon, R., & Sermer, M. (2016). Diabetes in Pregnancy. Journal of Obstetrics and Gynaecology Canada, 38(7), 667-679.
Cultural Diversity and Ethnic Minority Psychology, Vol 25(1), Jan, 2019. Special Issue: Understanding, Unpacking and Eliminating Health Disparities: A Prescription for Health Equity Promotion Through Behavioral and Psychological Research. pp. 1-5
Geary, A. (2017, September 19). Ignored to death: Brian Sinclair's death caused by racism, inadequate inquest, group says. Retrieved from https://www.cbc.ca/news/canada/manitoba/winnipeg-brian-sinclair-report-1.4295996
Gerster, J. (2018, September 21). Brian Sinclair. A man was ignored to death in the ER ten years ago. It could happen again. Retrieved from https://globalnews.ca/news/4445582/brian-sinclair-health-care-racism/
Lavallee, L. F., & Pool, J. M. (2010). Beyond Recovery: Colonization, Health and Healing for Indigenous People in Canada. International Journal of Mental Health and Addiction, 8(2), 271-281.
Living with Gestational Diabetes. (n.d.). Retrieved from https://www.diabetes.ca/diabetes-and-you/living-with-gestational-diabetes
Maternal Diabetes in Canada. (2014, October 09). Retrieved from https://www.canada.ca/en/public-health/services/publications/healthy-living/maternal-diabetes-canada.html
Ramey, S.L., Schafer, P., DeClerque, J.L. et al. Maternal Child Health J (2015) 19: 707.https://0-doi-org.aupac.lib.athabascau.ca/10.1007/s10995-014-1581-1
Reading, C.L. & Wien, F. (2009). Health Inequalities and Social Determinants of Aboriginal Peoples’ Health. Prince George, BC: National Collaborating Centre for Aboriginal Health.
Reproductive Health - Diabetes in Pregnancy. (2018, June 12). Retrieved from https://www.cdc.gov/reproductivehealth/maternalinfanthealth/diabetes-during-pregnancy.htm
Strutz, K. L., Hogan, V. K., Siega-Riz, A. M., Suchindran, C. M., Halpern, C. T., & Hussey, J. M. (2014). Preconception stress, birth weight, and birth weight disparities among US women. American journal of public health, 104(8), e125-32.
What is Gestational Diabetes. (n.d.). Retrieved from www.diabetes-pregnancy.ca/gdm/overview/
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