Written by the Division of Social Accountability

Guest blog on “Preston’s Page” (Dean of Medicine, U of S)

Social accountability is not a new concept here at the College of Medicine. It continues to be a principle and lens that guides our actions. It permeates discourse in medical schools both nationally and internationally. Much has changed in the past year in terms of social accountability within our college.

Every student, every faculty and staff can support social accountability in the college. We are doing a great deal already.  Among our national and international colleagues working in this area, our college is looked upon as a leader in the area of social accountability, and we aspire to continue to measure up to our reputation. At the same time, we recognize that there is still much more to do. The division continues to collaborate and support college-wide strategies for building a culture of engagement and social accountability, working in partnership with our internal and external stakeholders towards integrating social accountability into the four areas of CARE. An overview of activities supported by the Social Accountability Committee was shared at the college’s May 2017 Faculty Council meeting.

Much work has been put into assisting the college through the accreditation process, particularly in light of the new CACMS accreditation element 1.1.1. Social Accountability. We have been working closely with the accreditation team to identify sources of information and outline processes for 1.1.1. (as well as other accreditation elements with social accountability components) and began the process of drafting measures of social accountability to capture progress to date and long-term impact. We look forward to sharing progress on those measures at the upcoming September 2017 Faculty Council meeting.

This past year, the team has been working closely with various internal units in the College of Medicine to advance social accountability. We were excited to see the college approve implementation of a Diversity and Social Accountability Admissions Program, put forward by the Admissions Committee after consultation with the division and the Social Accountability Committee. We received valuable feedback at the pilot of the Social Accountability Lens at the December Curriculum Retreat and continue to work with the UGME Curriculum Committee and its subcommittees to build social accountability into the foundation of the curriculum. We drafted an annual communique identifying priority health needs rooted in social issues, which was distributed to course chairs for integration into curriculum planned. A masters of public health practicum research project that began last summer is continuing into phase 2 this year with an appreciative inquiry of how Canadian medical schools are putting social accountability into action. The division continues to engage internally to expand capacity and understanding of social accountability in theory and in practice, co-presenting at grand rounds with various departments. Further, the division was fully engaged on many of the working groups and full-day sessions for CoM strategic planning and was enthused to hear such a strong emphasis on social accountability from numerous attendees.

Other areas of focus and activity have included global and Indigenous health opportunities in partnership with the Global Health Committee and the Indigenous Health Committee. We continue to manage the Making the Links global health certificate program with fifteen positions for first-year medical students each year. The two-year program was recently expanded to support students interested in an Indigenous Health Stream. With the help of the college’s Aboriginal Admissions Coordinator, Val Arnault-Pelletier, we expanded our community partnerships last year to include Kawacatoose First Nation in southeast Saskatchewan and rural and remote Indigenous communities in Townsville, Australia. We also partnered with various internal and external committees to put on numerous global health events this year, including our fifth annual student-led Global Health Conference: Sustain the Gains, a documentary screening of On the Bride’s Side, and community and on-campus conversations with speakers Dr. Ted Schreker and Dr. Eric Lachance. The Global Health Travel Awards Subcommittee updated the award program this year to better align with learner, faculty and college needs and now runs two award cycles per year. We have also been working to identify opportunities for mutually beneficial community-university partnerships and collaborations (e.g., SPRP/Health Region Poverty Reduction Strategy Consultation; YXE Connects).

On the people side of the division, in December, we welcomed back Carlyn Seguin, who had previously been away on maternity leave. We said goodbye to division head, Dr. Ryan Meili, and welcomed Dr. Eddie Rooke as acting director.  Erin Wolfson, Lisa Yeo and Joanna Winichuk all celebrated their one-year anniversaries with the division.

We continue to build a greater understanding of the ever-changing needs of the college and the larger community it serves. Reflecting our commitment to being responsive, relevant and accountable to our communities locally and globally, we expanded the roles within the Division of Social Accountability. This will allow the college to build on its existing strengths, programs and commitment to meaningful engagement, locally and globally. Some of the DSA staff roles and responsibilities have changed to reflect this commitment, and we share our staff information here to ensure you can connect effectively with us (contact information):

• Carlyn Seguin continues to lead the management of the Making the Links – Certificate in Global Health (MTL-CGH) Program amongst various global health activities, in the position of Global Health Manager.
• Lisa Yeo continues to provide strategic leadership, planning and project support in the Social Accountability Strategist position, serving as a resource to many areas of the college with a keen focus on measurement and evaluation.
• Erin Wolfson has recently moved into the role of Community Engagement Specialist, expanding the college’s capacity and commitment to ethical collaboration and authentic engagement with communities. This involves enhancing and building community-university relationships and interdisciplinary collaborations that build health equity and respond to priority health concerns of partners and communities.
• Joanna Winichuk, as Clerical Assistant, continues to provide invaluable administrative support to the team and to the MTL-CGH program, with an expanded focus on communications in the upcoming year.
• Eddie Rooke has taken on the role of Acting Director, promoting and expanding capacity in social accountability throughout the college, teaching undergraduate and postgraduate students, and liaising with internal and external partners to advance the vision of health equity.

Our division was established in 2011 to promote and support the college’s social accountability promise – a promise to direct its Clinical, Advocacy, Research and Education (CARE Model) activities towards the priority health needs of the communities we serve. We see this promise reflected in the 2017-2022 College of Medicine Strategic Plan and mission statement of our college. It’s a promise to address community health needs, but it’s also much more than that.

There is still much more to be done. With a focus on accreditation in preparation for our college’s full accreditation visit in the fall, the team continues to respond to incoming requests. We continue to engage with our partners internationally and some of the team recently attended the Social Accountability World Summit (check out the social accountability blog page in the coming weeks for learnings and invaluable resources from the summit).

We are excited for all that is to come and look forward to continuing to support the CoM in meeting the needs of the people of Saskatchewan and achieving health equity. We thank Dr. Ryan Meili, our former division head, who helped advance social accountability here for more than 10 years.

For more on the division, visit our webpage!

Closing the Gap in Australia and Canada: Reflections from an international practicum placement in Saskatchewan

By Lily Aboud + Kimberley Hardwick 3^rd Year MMBS, James Cook University, Townsville Australia

Thinking of travelling down under? There’s something a lot scarier than plate-sized spiders and crocs lurking beneath the surface. In a report published by the United Nations (2009) regarding The State of the World’s Indigenous Peoples, it was indicated that the world’s highest life expectancy gaps between Indigenous and non-Indigenous peoples existed in Nepal, a third world country, and Australia. In this land of supposed equal opportunity, Australian Aboriginal and Torres Strait Islander peoples can expect to live between 10-17 years less than non-Indigenous Australians. With many mainstream health services lacking cultural sensitivity, they fail to address the root causes of social, economic, and health inequity. There are clear similarities between Australian and Canadian colonial history, with a historic trend of dispossession and discrimination. The Stolen Generations are part of Australia’s history, in which the forceful removal of Aboriginal children from their families, land and communities scarred the emotional and spiritual wellbeing of generations. As a result of this trauma, Indigenous Australians have some of the lowest education and employment levels, poorest living standards, a deep rooted mistrust in the health system and the worst health outcomes in Australia. The Closing the Gap initiative is an agreed national priority which aims to set concrete targets to close the gap in literacy, numeracy, incarceration rates, employment, infant mortality, and life expectancy. For this to continue in its success, a mutual partnership must continue between Indigenous and non-Indigenous Australians. In the healthcare system, cultural safety and the recognition of traditional medicines and healing practices need to be integrated. In efforts to move toward this goal, Aboriginal Community Controlled Health Clinics support community self-determination in providing quality and culturally safe healthcare. However, there is still much more work to be done in addressing the social determinants of health and employing principles of equity if this gap is to be closed both in here at home in Australia and abroad.

I realised what was so rewarding about this entire experience was how I could compare everything to back home and easily think of ways that I could integrate the skills and knowledge learned here in Saskatchewan to my life at home. While as a second year student my clinical knowledge is limited, I really enjoyed the amount of community based activities we were able to involve ourselves in. I definitely wouldn’t have learned as much from the experience if we were purely doing clinical/ hospital work the entire time. I liked the mix of city and rural/remote locations as each came with their own unique challenges and strengths. What was interesting about this trip was that coming in rather blindly to Canadian Indigenous culture and issues, I had no preconceived notions or prejudices. I was happy to listen to all perspectives and above all, just wanted to learn as much as I could. Accepting my ignorance and taking the steps needed to enhance my knowledge and cultural sensitivity was easy to do in Canada. What potentially will be harder to do (yet completely enriching to my studies, life, and future career), will be to bring that back to the rural and Indigenous communities in Australia. Realising my own prejudices, acknowledging them, and trying to learn and move forward from them is what I have learned from this experience. Showing a willingness to learn, participate, and go beyond what is expected truly goes a long way. I have enhanced my abilities to be open minded, to seek support when confronted, to not blindly accept but question, and to try and understand the complexities and power of a culture so different to my own with the respect it deserves. I can’t wait to share what I’ve learnt about First Nations and Métis culture with my peers and educators.

Lily and Kimberley, third year undergraduate medical students, participated in an international practicum placement, as part of an international exchange partnership between the College of Medicine and Dentistry, James Cook University, Australia and the College of Medicine, University of Saskatchewan. Tom Smith-Windsor and Val Arnault-Pelletier were instrumental in supporting the exchange, among others. The students arrived in Canada on November 20th, 2016 and spent four weeks in Saskatchewan learning from the knowledge and experience of First Nations and Métis Elders, and community members and community partners from across the province. The program’s emphasis on community-engaged, experiential learning allowed the students to explore the area of Indigenous health more in-depth, learning about Indigenous health and social issues, including their historical and social context. Some of the places Lily and Kimberly visited include, the College of Medicine, University of Saskatchewan; Station 20 West, St. Mary’s Wellness and Education Centre, and SWITCH in Saskatoon; All Nations Healing Hospital, Fort Qu’Appelle; Access Place Needle Exchange and Sexual Health Clinic, Prince Albert; Sturgeon Lake Reserve Health Centre; and Île-à-la-Crosse, Patuanak, and Dillon.

By Brendan Groat MED II

Last summer, through the University of Saskatchewan Making the Links (MTL)Global Health Certificate Program, I had the exceptional experience of living in Île-à-la-Crosse for six weeks and visiting other northern communities, including Dillon, Pinehouse, and Buffalo River Dene Nation (Dillon). I learned about life in the north and the health experiences of northern peoples, both through clinic hours but, moreso, community involvement.  

Among presentations, work with schools and community centres, and Water Safety and other community days, a Bike Day was a bright spot of the summer. Activities & games, health & safety education, as well as bike tune-ups were eagerly enjoyed despite few tools and zero replacement parts. Through this, and further conversations with and, importantly, listening to community members, I learned northern communities very much want to support bicycling.

I heard that northern peoples see bicycling as a health solution for their communities; They are aware of the improved physical health provided in exercise and increased access to nutritious–including traditional–food. They care that mental health, especially of their youth, is improved through the empowerment and joy of maintaining and riding a bike. Access to social connections, a root aspect of social health–especially in Indigenous culture–is increased by way of bicycles. Closer connection to land and environment supports spiritual health through traditional values. These are their feelings and ideas related the functioning of their communities, and hopes for improving health.

Because advocacy is first about hearing the help asked for, then acting to create relevant supports, and that ‘those that are able, ought’–I was compelled to give materials and knowledge, so I took steps towards the Bicycling North project. In addition to  efforts to increase access to healthcare, supporting bicycling in these communities is responsive to the autonomy and aspirations of these communities. Through the project, which will take place the summer 2017 (May 15 – June 30), I will be visiting each community (Île-à-la-Crosse, Dillon, Buffalo Narrows, La Loche, Beauval, and Patuanak), by bicycle, and conducting a fun Bike Day (of games, bike tune-ups, and health & safety education), and another Workshop Day of basic bike mechanic skills, providing knowledge, parts and a tool set, to be sustainably championed by respective community centres. I will also be completing clinic hours, representing an important connection of community initiatives to healthcare.

On March 4th we held the RYDE YXE Fundraiser, successfully raising nearly $200 to support this project! I encourage you to get involved in the project donating to gofundme.com/bicyclingnorth, or promotion through word-of-mouth or @BicyclingNorth on social media! All contributions will be directed towards purchase of tools and parts for northern communities. For more information please visit the project Facebook page– www.facebook.com/bicyclingnorth or contact me at bjg038@mail.usask.ca. ​

Working with and advocating for the needs of those living with disability. Reflections from and opportunities for USask medical students.

By Alicia Thatcher, MED II

I entered medical school in August 2015 with six years of experience (in both employment and volunteer capacities) working with individuals of all ages with intellectual and physical disabilities. A three-week volunteer experience at Camp Easter Seal at Manitou Beach developed into a passion for working with this diverse population, full of rich personalities and unique abilities for building relationships and connecting with the world. That experience led me to active and continued involvement with Camp Easter Seal, Best Buddies, Special Olympics, Autism Centre, Cosmopolitan Industries, and Next Chapter Book Club, and the medical student interest group Advocates for Bringing Light to and Education on Disabilities (ABLED). In the years directly leading up to medical school, I personally committed to lifelong work in this field. I have been privileged to be involved with this community through a number of different projects and hope that my work will contribute to removing some of the societal barriers that have become the norm for many within the community.

Throughout my last two years of high school, my pre-med studies at U of R and U of S, and my first year of medicine, I was involved with the Best Buddies program, both as a member or chapter president. Best Buddies is an international not-for-profit organization that matches adults and students who have intellectual disabilities with student volunteers to break down barriers and facilitate one-to-one friendships. Student volunteers pledge to spend time with their buddy twice a month and telephone, email, text message or write a note once a week. Over my 7 years of participation, and during my tenures as president of various chapters, the participation of student volunteers grew significantly, and the program helped to establish friendships that continue to flourish.

In 2015, in Saskatoon, I joined a committee working with an affordable housing developer on a project to build an “intentional community” apartment; a new inclusive and accessible housing option for people with and without intellectual disabilities. There will be approximately 30 suites, with 1/3 going to university students, and 2/3 going to adults with intellectual disabilities. This apartment building will be downtown and will hopefully include study space, exercise equipment and a yoga studio, a community kitchen, green space, and a bike share program. This opportunity became available through my active involvement with the Saskatchewan Association for Community Living (SACL) and as a direct result of involvement with the agencies listed above.

Last year I formed Saskatoon’s first “Next Chapter Book Club” – a fully accessible book club for adults with and without intellectual disabilities. Myself and two other volunteer facilitators met weekly at a local café with 5 regular book club members. Many people wrongly assume individuals with intellectual disabilities are unable to read. Although literacy skills are enhanced, the philosophy of the book club is to focus on “reading to learn” rather than “learning to read”. Members are encouraged to read for enjoyment rather than for accuracy and includes group reading, shared or adapted reading, and discussion of what was read. Members are provided meaningful opportunities for lifelong learning, building social connections, community inclusion, and learning life skills like budgeting and problem solving. As I have moved to Regina this year, I have yet to get involved with a new book club. Individuals in Saskatoon interested in volunteering with or starting their own book club should contact SACL.

The day I was accepted into the College of Medicine, I started to plan my trip to Louisville, Kentucky, where I shadowed at the Lee Specialty Clinic – an interdisciplinary clinic for patients aged 16+ with intellectual and developmental disabilities. In my years leading to medicine, I had researched a number of organizations and initiatives that support people with intellectual and developmental disabilities and committed to learning all that I could to contribute to the community. The experience was very informative and inspiring and provided insight into the startling overmedication of this population contributing to significant weight gain, challenging behaviours and significant problems with both physical and mental health. I learned about some of the ins and outs of managing pain and other symptoms in patients are who non-verbal or have difficulty communicating, and about working with a behaviour analyst and a variety of specialties to get to the bottom of the cause of challenging behaviours such as aggression. Many common health problems as simple as ear infections can go undiagnosed. I learned some of the most important and most common problems and investigations to never miss in this population. I plan to connect some of the Lee Specialty Clinic staff with my classmates through my involvement with the Advocates for Bringing Light to and Education about Disabilities (ABLED student interest group).

Following my experience at the Lee Specialty Clinic, I travelled to Chicago to attend the annual conference for the American Academy of Developmental Medicine and Dentistry (AADMD). I am currently working on connecting Canadian health care professionals working in this field to create a committee which can discuss the issues unique to the Canadian health care system while collaborating with the AADMD to strive for similar goals. This project is only in its infancy, so if anyone is interested in working with me on establishing this I would happily welcome any support. While developmental pediatrics is established in Canada, there is no developmental medicine specialty for these patients after they turn 18 years of age. It is my desire to open a clinic, similar to the Lee Specialty Clinic, in Saskatchewan in the future.

Last, but certainly not least, my experiences in this area led me to attend an American Sign Language immersion camp in Calgary where I continued to improve my skills in communicating with individuals who are deaf and hard of hearing. I have had a number of opportunities to use these skills while volunteering and I intend to use this skill in future interactions with patients. I would encourage anyone interested to take ASL classes from Saskatchewan Deaf and Hard of Hearing Services (SDHHS) in either Saskatoon or Regina.

These experiences have shaped my future as a physician and the individuals I have been privileged to meet have changed my world for the better. I am excited to act as vice-president of the ABLED student interest group this year and to use this platform to share my passion for working with this population with my classmates and community. I hope to be able to contribute as much to their future as they have to mine.

For more opportunities, follow us on the Social Medicine Network – SK Facebook page   www.facebook.com/socialmedicinesk