LITTLE CURRENT—The high incidence of hypertension found in First Nations communities has been a concern for many years and an “education event” on hypertension management was held at the Manitoulin Island Hotel and Conference Centre recently in order to help reduce the rate of hypertension in those communities.
Hypertension, often called ‘high blood pressure,’ is a chronic medical condition where the blood pressure in the arteries is persistently high. While high blood pressure does not cause immediate problems for the sufferer, over time it can lead to heart disease, coronary artery disease, stroke, aortic aneurysm, peripheral heart disease and chronic kidney disease. It is a very serious condition.
While treatment through medication does increase life expectancy, lifestyle changes among those at risk can make an important difference and, because the impact of hypertension accumulates over time, early detection and treatment is also key.
“We invited a small group of 20 staff from the local communities who have worked with patients to help manage hypertension,” noted Sarah Winterton, registered dietician with the Ontario Stroke Network, about the workshop. She explained that the event was part of a project that has grown out of a pilot first implemented by Noojmowin Teg Health Centre in 2007 to promote local healthcare and support First Nations communities with resources and tools for hypertension management.
Some patients joined the workshop at lunchtime to provide a local connection to the impact of strategies dealing with hypertension management.
Two staff from the Ontario Stroke Network, Pauline Therrien RN and Ms. Winterton RD herself, both clinical specialists, were making their annual visit to the Island.
“The Aboriginal Hypertension Management Program offers e-web-based resources and a repository to hold and manage data to provide tools for primary healthcare to provide optimal best practice in line with Ontario’s Chronic Disease Management Framework,” said Ms. Winterton. “Staff undertake special courses to improve motivational interviewing skills so that patients become the focus of care and they decide which lifestyle goals they would like to work on to improve their health.”
Those improvements have been taking hold and showing some signs of success, an important consideration when one recognizes that the incidence of hypertension in the regular population is in the neighbourhood of 30 percent, while in First Nations communities that rate soars to over 50 percent.
“Some patients choose to become more physically active and take up walking or fitness class, some patients attend local community kitchens and prepare and eat healthy meals that are low in sodium and rich in vegetables fruits and fibre,” said Ms. Winterton. “Herbs and spices can be used to flavour food instead of the salt shaker, while lean proteins such as local fish and chicken, beans and pulses can become a major food choice to replace fatty processed meats and convenience meals.”
“We have been partnering with that group since they were with the Heart and Stroke Foundation,” noted Noojmowin Teg Health Centre Executive Director Pam Williamson. “The project was a partnership between Whitefish River First Nation and Aundeck Omni Kaning First Nation.
Anishinabek Nation (Union of Ontario Indians) Regional Chief Patrick Madahbee was a fervent early supporter of the project when he was chief of Aundeck Omni Kaning and by all accounts at the time, he was considered the “star pupil” of the management program, having reduced his own blood pressure to manageable levels.
Ms. Winterton explained that local registered dietitians aid in sharing recipes and ideas to how to manage a healthy diet on a budget. “Some patients are prompted to consider smoking cessation especially if a family member has respiratory health problems such as asthma or COPD,” she said. “It can support better home environment for everyone in the family.
To aid in that lifestyle choice, local support is available to provide information about nicotine replacement products and how to use hobbies to distract from picking up a cigarette. “In this way tobacco is only used in a good traditional as per the ancestors,” noted Ms. Winterton. “Better food choices and taking up physical activity can contribute to weight loss goals that people set for themselves. Drinking water instead of pop and juices removes a lot of sugars in the diet. People in the community can ask about Ontario Stroke Network’s AHMP (Aboriginal Hypertension Management Program) and staff are able to assist in offering appointments to measure blood pressure (BP).
“We are looking to give as much support to the community,” said Ms. Williamson. The other goal is to make the program self sustaining. Ms. Winterton noted in her presentation that among the program’s challenges are: “staff turnover and the heavy burden on individual team players such as CHRs. “There are calls for local leadership of the program and increased shared responsibilities,” she said in her presentation during her hypertension management session.
She reported that among the feedback that staff has seen are improved motivation, lifestyle Choices, and overall health of patients and see opportunities to share community success at annual feast and socials.
Feasts, socials and other traditional gatherings help provide an ideal opportunity to assist patients in dealing with the stress of chronic disease and go a long way toward reducing feelings of isolation.
The program in intended for adults, noted Ms. Winterton. “Many people do not know that they have high blood pressure so it is important to have BP checked and receive help if levels are above target. Sometimes if a family member has had a stroke or heart problems other family members may be at risk so adult siblings and offspring should be checked. In this case people should make appointment with doctor or nurse at primary healthcare office. There are many ways we can take charge of our own health and knowing numbers such as BP, weight and BMI (Body Mass Index—a measure based upon height and weight) that can provide useful information and, if above ideal range, can be used to monitor health success by regular monitoring.
“Social groups, friends and family can help behavioural change when someone is trying to make better choices about food, smoking or physical activity,” noted Ms. Winterton. “It helps not to feel isolated when managing a chronic condition such as obesity, diabetes, heart and lung problems. Healthcare locations can support people who feel stressed or depressed and traditional practices and ceremonies can help reduce anxiety and loneliness.”
The data collected by the program is available as a web-based support, but Ms. Williamson noted that a more ideal solution would be to incorporate that data into the existing electronic health records of the clinic. “It would be very helpful to not have to access a wide variety of databases for that information,” she said.
There are seven First Nation clinic sites in the region where people can find assistance in hypertension management, located at the local First Nation health clinics in the community.
