Indigenous skin health challenges in northern Manitoba identified
Survey of Nisichawayasihk Cree Nation in Nelson House, Man. reveals barriers to medical access, burden of disease, and self-medication practices (Issue #242, 8 minutes, 1,761 words)
Jonah Perlmutter and Sierra Fremont reported during a presentation at the fourth annual Indigenous Skin Spectrum Summit on Oct. 4, 2024, in Toronto, that a survey conducted in a remote community in northern Manitoba found a lack of access to healthcare and significant impairments to quality of life for Indigenous patients with skin conditions. The study also showed the need for increased cultural competence among healthcare providers working in the community.
Perlmutter is a medical student in the Temerty Faculty of Medicine at the University of Toronto. He has worked with Elders and knowledge keepers of the Nisichawayasihk Cree Nation to synthesize and distribute natural medicines to Northern communities.
Fremont graduated from Western University in London, Ont, in 2024 with an honours bachelor's degree in medical sciences, specializing in interdisciplinary medical sciences. Her primary interest in medicine lies in addressing the needs of marginalized communities, and she is currently engaged in research examining the barriers faced by members of the Nisichawayasihk Cree Nation in accessing healthcare.
Perlmutter and Fremont were co-investigators of a qualitative study on a reserve in northern Manitoba. Researchers collaborated with the Elders and medicine people of the Nisichawayasihk Cree Nation in Nelson House, Manitoba, who approved the study's design.
Nelson House is a community of 5,000 people located 850 km north of Winnipeg. It has no full-time access to a physician, so care is provided virtually, said Perlmutter.
The study aimed to understand and address the experiences of patients living with chronic skin conditions, to promote holistic care, and to improve health outcomes within Indigenous communities.
According to Perlmutter, investigators held a general dermatology clinic in the community with a dermatologist from Manitoba. This clinic was used to recruit participants.
The most commonly mentioned themes from participants were lack of access to healthcare and significant quality of life detriments, as patients often presented in advanced stages of their condition, said Perlmutter. Many patients also discussed their use of traditional medicine but didn't feel comfortable discussing it with their primary care physicians or dermatologists. Many patients also reported a lack of education from their healthcare providers on managing their skin conditions and even on the name of the condition they had been diagnosed with. Many also reported facing discrimination in the healthcare system based on their Indigenous identity.
Among patients with psoriasis, 72% mentioned being in an advanced stage, said Fremont. Patients said they largely self-medicated to manage their condition. Interviews with patients highlighted the severe symptoms and the lack of access to early treatment.
Among patients with AD, 91% said they had learned to accommodate their symptoms independently, said Fremont. Patients also shared experiences with cultural barriers when accessing healthcare and psychological impacts.
Data on patients with acne and rosacea showed 86% said the condition had an impact on their mental health, said Fremont. The condition impacted their confidence and daily life, resulting, in some cases, in having to miss work for up to two weeks.
Among patients with diabetes and chronic vascular conditions, 57% mentioned a lack of guidance when it came to wound care, said Fremont. Many patients had to treat wounds on their own.
Interviews with patients showed the need for increased cultural competence among healthcare providers working in the community to target patients' specific needs.
According to Perlmutter, those living in the community have the most valuable insights into what solutions might be to these issues. Community members referred to the Call to Action of the Truth and Reconciliation Commission and the need for greater integration of traditional Indigenous medicine into Western healthcare practices. Community members also called for greater resources to be allocated to First Nations communities, more research into health disparities, better virtual care and more specialist visits, and more healthcare practitioners and transportation options on a local level.
Bottom Line: A study conducted in a remote northern Manitoba Indigenous community found that the most commonly mentioned themes from patients were lack of access to healthcare and significant quality of life detriments from skin disease, as patients often presented in advanced stages of their condition. Many patients also used traditional medicine but didn't feel comfortable discussing that use with their physicians. Many patients reported a lack of education from their healthcare providers on managing their skin conditions and even on the name of the condition they had been diagnosed with. Patients felt they had to self-medicate and care for their conditions themselves. Many patients said they faced discrimination in the healthcare system based on their Indigenous identity.
From the literature on remote and Indigenous dermatology
Multi-strain carriage and intrahost diversity of Staphylococcus aureus among Indigenous adults in the USA
For this study, researchers investigated Staphylococcus aureus SA co-carriage and intrahost evolution by sampling several colonies from multiple anatomical sites and whole-genome sequencing (WGS) on 310 SA isolates collected from 60 Indigenous adults participating in a cross-sectional carriage study.
Investigators assessed the richness and diversity of SA isolates based on differences in multilocus sequence type, core-genome SNPs, and genome content.
Using WGS data, they identified 95 distinct SA intra-subject lineages (ISLs) among the participants. They detected co-carriage in 42% (25/60). Notably, two participants each carried four distinct SA ISLs. Researchers identified variation in antibiotic resistance determinants among carried strains among 42% (25/60) of participants. Lastly, the authors found an unequal distribution of clonal complex by body site, suggesting that certain lineages may be adapted to specific anatomical sites.
Their findings suggest that co-carriage may occur more frequently than previously appreciated and that further understanding of SA intrahost diversity during carriage has implications for surveillance activities and epidemiological investigations.
Outcomes of a fledgling public dermatology clinic in rural Australia
To address the shortage of information regarding the epidemiological characteristics of patients attending dermatology outpatient services in rural Australia, researchers performed a retrospective cohort study of patients attending a public dermatology clinic established at Dubbo Base Hospital in rural New South Wales.
Researchers examined data on 190 dermatology appointments, including 112 new episodes of care and 78 follow‐up appointments (66 in‐person reviews and 12 episodes of telehealth). Some 58% and 42% of patients resided in rural and remote communities, respectively, with the patient who travelled the furthest living 466 km away. Most referrals were from general practitioners (n=89, 79.5%), followed by pediatrics (n=8, 7.1%), medical oncology (n=5, 4.5%) and obstetrics and gynecology (n=4, 3.6%). While First Nations Australians represent 15% of the total population serviced by the Dubbo Health Service 4, they accounted for 24.1% of the patients seen in this outpatient dermatology service.
Researchers observed the most common presentations as psoriasis (16.1%), eczema (12.5%), lupus (6.3%), infantile hemangioma (6.3%), lichen sclerosis (3.6%), acne (3.6%), congenital melanocytic naevus (3.6%), and hidradenitis suppurativa (3.6%).
The broad range of dermatological presentations and the brisk uptake of remote patient services highlight the ongoing need for specialist dermatology services in underserved rural communities.
Clocking injustice: Racial disparities in specialty wait times
In this nationwide U.S. analysis, researchers quantified specialty care waits by race and ethnicity and identified potential drivers of observed disparities.
Investigators used administrative data from the U.S. Veterans Health Administration (VHA) to identify patients referred to either VHA or community specialists from 2018 to 2022 for the 10 highest-volume specialties: cardiology, dermatology, otorhinolaryngology, gastrointestinal endoscopy/gastroenterology, mental health, ophthalmology, orthopedics, podiatry, physical therapy, and urology. The sample included 6,619,517 referrals to VHA specialists and 3,753,657 referrals to community care.
They found Black patients had the longest mean waits for VHA care (40.0 days, standard deviation (SD)=40.3) followed by American Indian/Alaska Native (38.6 days, SD=40.0), Hispanic (38.4 days, SD=38.4), Asian/Pacific Islander (38.1 days, SD=38.0), and White patients (37.1 days, SD=39.5).
For community care, Black patients had the longest mean waits (52.9 days, SD=49.3), followed by Asian/Pacific Islander (46.8 days, SD=43.1), American Indian/Alaska Native (46.5 days, SD=42.1), White (45.1 days, SD=41.7), and Hispanic patients (42.0 days, SD=37.6). The disparities were primarily attributable to group-level differences in the distribution of facilities from which patients were referred and specialty mix.
VIDEO: Aboriginal health and wellbeing—Healthy skin in disease prevention
In this presentation from the Western New South Wales Primary Health Network in Australia, Clinical Nurse Consultant Public Health Cathie Hallahan, Registered Nurse David Orozco, and Senior Environmental Health Officer David Ferrall discuss tips on how healthcare professionals can help Aboriginal patients keep their skin healthy and what can go wrong if it is not looked after.
At the intersection of skin and society
CBC News reports that a report from the Assembly of First Nations suggests that First Nations voters could shape federal election results in 36 ridings across Canada.
Using census data on population and Elections Canada 2021 voting results, the AFN identified ridings where the percentage of First Nations voters is higher than 2021's margin of victory (between the winning candidate and runner-up) or where First Nations people make up 10% or more of all eligible voters.
The AFN also pointed out ridings where new boundaries have resulted in increased percentages of First Nations voters, such as Sudbury East—Manitoulin—Nickel Belt, Kapuskasing—Timmins—Mushkegowuk, Dauphin—Swan River—Neepawa and Battlefords—Lloydminster—Meadow Lake.
Cara Currie Hall, a Cree from Montana First Nation in Alberta and one of the co-founders of 2015's Rock the Indigenous Vote campaign, said voting in elections does not violate Indigenous rights but rather presents an opportunity to make requests.
Others disagree. Kaity Adams, who is Onondaga, Deer Clan, from Six Nations, told the news outlet she is a citizen of the Haudenosaunee and Onondaga Nation, not Canadian, and has never voted in provincial or federal elections.
She said declaring herself a Canadian citizen by voting in the federal election will continue the assimilation of Indigenous peoples “until there's no more left.”
Marc Merilainen, a member of the Chippewas of Nawash Unceded First Nation, hasn't voted since 2015 but is considering doing so in this federal election.
He said the Canadian government needs increased Indigenous representation, and he doesn't think it's an “either/or” situation between choosing sovereignty and voting in Canada's political system.
He said he thinks a lot of people underestimate the power of the Indigenous vote.
The AFN has released its election priorities and is seeking commitments from party leaders on economic reconciliation, Canada-U.S. trade and border mobility, the Calls to Action from the Truth and Reconciliation Commission of Canada and the Calls for Justice from the National Inquiry into Murdered and Missing Indigenous Women and Girls.
This week
April 14 is Pan American Day
April 16 is Advance Care Planning Day
April 17 to 23 is National Feet Week in the U.K.
Something to think about in the week ahead . . .
—Millicent Carey McIntosh, (1898 – 2001), U.S. educator
Next week
As part of a presentation at the inaugural Indigenous Skin Spectrum Global Summit on April 5, 2025, in Montreal, Dr. Monique Mackenzie (Ngāti Tūwharetoa) describes the state of skin cancer among the Maori people of New Zealand. Dr. Mackenzie is a Consultant Dermatologist at Skin Centre, New Zealand.
Save the date for the 2025 Summit on Atopic Dermatitis
The 2025 edition of the Summit on Atopic Dermatitis virtual conference will be held on May 10 from 10:00 a.m. to 1:00 p.m. Eastern Time.
Chaired by Dr. Marissa Joseph (Toronto), the Summit on Atopic Dermatitis will address the unmet need for education among healthcare providers on the incidence of and latest therapies for AD.
Join us for an in-depth discussion on the diagnosis, treatment, and latest therapies for atopic dermatitis in Canada.
The 2025 program will be held virtually and will be available to attend at no charge to delegates.
Register for the webinar using the link below, and watch this space for further details.
If you enjoy Skin Spectrum Weekly, why not check out the Chronicle’s other publications, podcasts, and portals?
Established in 1995, The Chronicle of Skin & Allergy is a scientific newspaper providing news and information on practical therapeutics and clinical progress in dermatologic medicine. The latest issue features:
Dr. Ruth Ann Vleugels (Boston) describes emerging treatments for dermatomyositis associated with lupus.
Drs. Charles Lynde (Markham, Ont.), Fiona Lovegrove (London, Ont.), Julien Ringuet (Quebec), and Kerri Purdy (Halifax) review new dermatologic therapies to watch in 2025.
Dr. Susan Poelman (Calgary) summarizes current research into treatments for hidradenitis suppurativa and discusses why physicians should be optimistic about the future of managing this disease.
Plus regular features, including the popular column “Vender on Psoriasis” by dermatologist Dr. Ron Vender.
You can read a recent digital edition of The Chronicle of Skin & Allergy here. To apply for a complimentary subscription or to request a sample copy, please email health@chronicle.org with your contact information.
The Women in Dermatology e-newsletter updates readers with new findings concerning dermatologic issues affecting women and the female dermatologists who care for them. Read the current issue here.
Season three of the Vender on Psoriasis podcast with Dr. Ron Vender has begun. Listen to the new season here. In episode five, Dr. Vender discusses whether vitamin D influences psoriasis severity, sex differences in psoriatic inflammation itch, and the risk of psychiatric disorders associated with acitretin.
And if you’re looking for a web destination for all things derm, visit derm.city, “Where Dermatology Lives.” Please like, rate, review, and share it with your colleagues.
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