Barriers to medical care on remote reserves
Travel time and costs, lack of nearby labs significant hurdles for Indigenous communities (1,400 words, 7 minutes)
Patients on remote Indigenous reserves face barriers to accessing healthcare, including travel, lack of access to physicians and staff, lack of home care, and lack of lab services, Kristian Blind, RN, told the 3rd annual Indigenous Skin Spectrum Summit. Blind said that visiting teams of physicians, specialists, and nurses can help overcome some of those barriers, adding that education and collaboration with patients and local care teams are essential.
Blind is a registered nurse who has been working primarily as a Community Health Outreach nurse for home communities in southern Saskatchewan, in the Touchwood File Hills, under the Touchwood Agency Tribal Council.
While working on their George Gordon First Nation home reserve and with the Kawacatoose, Day Star, and Muskowekwan First Nations, Blind found Indigenous people face several barriers to accessing care. Blind said the most prevalent of these is the need to travel for care, often unavailable within the community. Many First Nations communities do not have on-site staff. Home care, too, is limited to only two nurses, and neither is full-time, in charge of home care for two reserves. Blind noted it is challenging for a staff of only one, two, or three people to address the healthcare needs of an entire community.
Blind also said there are limited lab services in the communities. The medical staff is at the mercy of whatever hours the lab sets. The tests may not get processed if the lab technicians are off work or sick that day. Patients often must be sent to the city for emergency cases to get bloodwork done.
Programs such as Wellness Wheel, a non-profit organization in Saskatchewan founded in 2016 by Dr. Stuart Skinner, can help provide better access to physicians and allied healthcare professionals, said Blind. Physicians need to collaborate with patients and local care teams and provide education. He said that education helped him feel comfortable providing safe and effective care for Indigenous clients as a nurse in a rural and remote setting.
Bottom Line: Patients on remote Indigenous reserves face barriers to accessing healthcare, including travel, lack of access to physicians and staff, lack of home care, and lack of lab services. Collaboration with patients and local care teams and education are crucial for providing care for Indigenous patients.
From the literature on remote and rural dermatology
The influence of rurality on melanoma diagnosis in Indiana: A retrospective cohort study
In this study, researchers examined how geographic location affects the stage of melanoma diagnosis in Indiana to identify and address rural health disparities and ultimately ensure equitable care.
The investigators compared the demographics and disease characteristics of patients diagnosed with melanoma at Indiana University Health from Jan. 2017 to Sept. 2022. They found patients from rural areas presented with more pathological stage T3 melanomas (15.0% vs. 3.5%, p<0.001) than their urban counterparts. Additionally, rural patients presented with fewer clinical stage I melanomas (80.8% vs. 89.3%) and more clinical stage II melanomas (19.2% vs. 8.1%), compared to urban patients with no stage III (p=0.028). Concerningly, a significantly higher percentage of the rural group (40.7%) had a personal history of basal cell carcinoma compared to the urban group (22.6%) (p=0.005) and fewer rural patients (78.0%) compared to urban patients (89.4%) received surgical treatment (p=0.016).
Solutions for addressing the dermatologist shortage in rural Canada: A review of the literature
Noting that there may be as few as 0.6 dermatologists per 100,000 population in rural Canada, the authors of this paper review some of the consequences of this ratio and plans that have been proposed to address the issue.
They write the low number of dermatologists in rural areas in Canada is concerning and has negative consequences for access to care for patients in rural areas, ultimately resulting in worse patient outcomes.
The review notes that one solution that has been proposed is to incentivize dermatologists to practice rurally. The paper discusses several solutions using the following themes: dermatology program-specific incentives, dermatology practice-specific incentives, and other indirect incentives.
The authors conclude that future research is needed to evaluate the impact of these initiatives and assess future access to dermatologic care.
Scabies in French Guiana: Quantitative and qualitative factors associated with therapeutic failure
The authors of this paper note traditional communities in French Guiana have non-Western conceptions of disease and health. This research explores knowledge, attitudes, and practices to identify potential factors associated with the failure of scabies treatment in these communities.
In this study, researchers included patients with a clinical diagnosis of scabies who were seen at either the Cayenne Hospital in Cayenne, French Guiana, or one of 13 health centres between April 1, 2021, and Aug. 31, 2021. Researchers followed up with participants six weeks after treatment to check for the persistence of lesions. Investigators examined factors associated with treatment failure both at inclusion and six weeks, and they conducted semi-structured interviews with a diversified subsample of the participants.
Researchers included 164 participants in the quantitative component and interviewed 21 in the qualitative component.
Declaring that the second treatment dose had been taken was associated with therapeutic success. Western treatments were not always affordable to the participants. Researchers observed better adherence to topical treatments than oral ivermectin, while permethrin monotherapy was associated with failure. Scabies-associated stigma was high among Amerindians and Haitians but absent in Ndjuka Maroons. Participants reported environmental disinfection as being very complex.
Store-and-forward (asynchronous) doctor-to-dermatologist non-skin cancer specific teledermatology services in Australia: A scoping review
This scoping review provides an overview of Australian store-and-forward teledermatology (SAFT) models. The authors identified 12 studies through web databases, grey literature sites, and reference lists of eligible articles. Eligibility criteria included studies evaluating doctor-to-dermatologist Australian SAFT services provided to Australians for all skin conditions but excluded studies solely focusing on skin cancers.
Investigators extracted data on study design, setting, population, SAFT model, referral characteristics, patient and general practitioner perspectives, diagnostic concordance, and measured outcomes such as follow-up, investigation, and waiting time.
They found that SAFT can be used for patients with any dermatological condition, provides more accurate diagnostics than cases without dermatologist input, may reduce waiting times for dermatological expertise, and users generally had positive experiences with SAFT. Although they say the results are positive, the authors note this review reveals a heterogeneous nature of the literature on SAFT in Australia and a need to establish a uniform approach to assessing the outcomes and impacts of such services.
VIDEO: Teledermatology impact on healthcare delivery in remote sites in Egypt
In this presentation from the 25th annual World Congress of Dermatology, Ahmed Sadek, PhD, MSc, Manager of the Cairo Hospital for Dermatology & Venereology (AlHaud AlMarsoud) discusses the experience of Egyptian dermatologists in implementing a teledermatology program and how that has impacted healthcare delivery in the country.
At the intersection of skin and society
A new cultural centre for Black communities across Canada is to be established in Montreal, reports Global News.
The news outlet quotes Montreal city councillor Ericka Alneus, who said, “It is such a great historical announcement.”
“There will be a space where, through arts and culture, we will be able to tell the stories of Afro-Canadians.”
Patricia Fourcand, president of the project board, says the site will be Canada’s version of the National Museum of African American History & Culture in the United States.
“I’ve seen families travel days to be able to visit and feel empowered by this space,” Fourcand explains, referring to the U.S. museum. “I really hope we'll be able to do the same thing here in Canada.”
Montreal’s Afro-Canadian Cultural Centre (MACC) will be housed in the former École des beaux-arts de Montréal building. The complex will include spaces for performing and visual arts, a museum, and a library.
According to the project’s website, the building will be redeveloped and gain two extensions. One, a new entrance, will ensure the facility is accessible. The second will add a large performance hall.
Work on the 45,000 sq. ft. project will start in late 2024, with the official inauguration scheduled for Spring 2026.
This week
May 27 is National Sunscreen Day in the U.S.
June is National Indigenous History Month in Canada
June is National Caribbean-American Heritage Month in the U.S.
Something to think about in the week ahead. . .
—Frederick Douglass, U.S. author (1818-1895)
Next week
Dermatologist Dr. Carsten Sauer Mikkelsen of Denmark describes the state of dermatologic care for the Indigenous Inuit and Sami peoples of Greenland from a presentation at the Indigenous Skin Spectrum Summit.
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