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Alumni Stories, In the Spotlight

Striving for Inclusion

As the active anti-racism movement continues to ripple across multiple professions and communities in Canada, medical schools are among those taking a closer look at their institutional systemic practices to make active improvements in diversity and inclusion.

Joby Quiambao is a Registered Dietitian, alumna of the Northern Ontario Dietetic Internship Program (NODIP) at NOSM, and works full-time with the Maamwesying North Shore Community Health Service. She’s also a member of the inaugural Canadian chapter of Diversify Dietetics— a group working to increase ethnic and racial diversity in the dietetic profession.

“With the amplified awareness of racial injustice in the news and the ongoing anti-racism protests, it has given voice to the lack of diversity in many professions. Westernized and colonial roots are being revealed and confronted,” Quiambao says.

“Early in my undergraduate university experience I didn’t realize how important knowing my own native language and cultural history was at first. It provides me an enriched perspective and understanding of the work that I do today as a dietitian. I believe a large part is due to the fact that it is instilled in our systemic and institutionalized societies to think in a standardized way.”

Quiambao emphasizes that “racism is present in Canada and continues to stem from colonial roots, from defining what food we should eat, to who gets to become part of the dietetic profession.”

However, change is happening in communities and there is a growing, diverse population across Northern Ontario. Quiambao sees it and says she feels part of it, “I am very grateful I got into NODIP and that I secured my career in the North.”

“However, throughout my journey toward becoming a dietitian, there was a blatant lack of racial diversity both during my undergrad at Western University and later at NOSM’s Northern Ontario Dietetic Internship Program-I was the only person of colour within my NODIP cohort.”

She says she would like to see more diversity across all nutrition and dietetics education programs, where learning institutions provide sustainable opportunities that are inclusive and accessible for underrepresented applicants of various cultures, ethnicities, and socioeconomic status.

Currently, Quiambao is working on a project that looks at the demographic data of applicants to nutrition and dietetic programs. She hopes the project will offer valuable evidence to improve the intake process and contribute to diversifying the profession. She describes this work as “a start.”

Much of Quiambao’s self-identity and self-exploration began while working with and among Indigenous communities both in Toronto, and in the North. It was advice from her former colleague, traditional healer, Kenn Pitawanakwat from Wikwemikong Unceded First Nation, who encouraged her to explore her own culture and its connection to her own career path and wellness.

“I’ve learned that traditional teaching is cultural sharing. Also, that nutrition, Indigenous health and the environment all intersect and are interconnected, and I see that clearly as a dietitian.”

Quiambao says it would’ve been powerful to see someone else, like herself, a person of colour, in the program or represented in the promotion of dietetics education.

“It brings a lot of hope when you see someone relatable being represented in roles you aspire to fulfil. It adds a whole new perspective on whether one can hope to be, or strive to become, part of that profession.

“Seeing someone like you in a career you hope to have someday sends the message that there are opportunities for you that are available and accessible.”

Resources and further reading on this topic: 

NODIP’s related research work:

The Scope, page 12
Published paper in Canadian Journal of Dietetic Practice and Research

Other dietetic health promotion work of interest:

Diversify Dietetics
Towards Decolonizing Canadian Dietetic Practice

Alumni Stories, In the Spotlight

New NOSM Graduate Receives CMA Advocacy Award 

Dr. Niharika Shahi (MD Class of 2020) received the Canadian Medical Award (CMA) for Young Leaders (Student) for her outstanding advocacy efforts on unique Northern Health issues including, Indigenous youth mental health support in high school, public education around opioid overdose  and Naloxone administration, and raising awareness about the signs of local human trafficking.

The award honours one student “in recognition of their exemplary creativity, initiative and commitment to making a difference at the local, provincial and national level.

Dr. Shahi was surprised to that she was the recipient of the award, and she doesn’t know who nominated her.

“I was in my fourth year of medical school and it was a very big surprise,” says Dr. Shahi. “It’s not only a success for me, but also for the teams I worked with on these projects. In the North, work is often being done on a smaller scale and when a national award happens, suddenly these important health-care initiatives start to be talked about across the country. On Twitter, I see physicians from Ottawa becoming interested and discussing these projects in Northern Ontario. To me, that is the biggest success,” she says.

She credits the NOSM social accountability mandate for fueling her interest in unique Northern health initiatives that go beyond the mandatory MD curriculum.

“I was always interested in providing better health care to Northern communities and that was a big reason why I chose to attend medical school in the North. I have a responsibility as a future health-care provider, so I took it upon myself to recognize the different issues being faced by our communities,” says Dr. Shahi.

During a NOSM rural placement in Kenora, she spent time talking to youth and visiting nearby First Nations communities. Indigenous youth shared challenges of travelling to attend high school in Thunder Bay. She recalls recognizing the mental health challenges associated with an entire population of teenagers who are separated from their families to gain higher education, and in many cases only visiting home twice a year.

“I was able to partner with local psychiatrists through Compass North (NOSM’s student-led outreach clinic) and we structured workshops for high-school staff who are working with Indigenous youth to provide them with the resources needed to support better mental health for their students,” says Dr. Shahi.

She also reached out to a local needle exchange program she recognized the prevalent opioid crisis in the North and lack of training in opioid overdose management She started working with the program to offer training around the safe and recommended ways to administer Naloxone. The workshop was initially only offered to medical students, however with Compass North’s advocacy, is now widely attended as a public workshop.

In her first year of medical school, Dr. Shahi joined a new volunteer group called Canadian Association of Medical Students Against Human Trafficking.

“It was an inaugural year for this group. They were looking for a representative from each medical school. I realized this is something that is happening in Northern Ontario that is not talked about in our medical school curriculum, nor even mentioned,” says Dr. Shahi. “So I took on the role of campus representative. I got in touch with the local police and asked them if they would provide some information to NOSM medical students through a workshop.”

The topic was added to the agenda of a women and children’s health night at NOSM. The workshop included advice on how physicians can recognize the signs of human trafficking and how to differentiate treatments for victims.

“It was an eye opener for everyone who attended because it’s an issue that is not openly discussed , for example, we talked about what to do if a patient comes in who is a victim of human trafficking,” she says.

She continued to work with Compass North throughout her medical education and later became the Director of the Clinical and Social Service Committee of the clinic.

“Compass North was initially set up to offer health care services outside of clinic hours to improve access to care for the public. The clinic would offer limited basic services like health promotion workshops and flu vaccines,” says Dr. Shahi. “It was a great learning experience, because as early as my first  year of medical education I was able to interact with patients, and I was able ask for consent and and gain clinical skills before moving into clerkship.”

“Experiences like Compass North, and partnering with different organizations locally, provided me an opportunity to work with different teams and learn to provide better health care in the North. That was the biggest driver for me, and I would love to continue working on some of these projects with NOSM students, and help them gain better education.”

Dr. Shahi recently started a radiology residency at McMaster University in Hamilton. She plans to return to Thunder Bay to provide care to her home community in future.

Northern Routes

Evolution – Should we rename the Social Determinants of Health to be the Social Determinants of Equity?

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Hello, Aaanin, Boozhoo, Bonjour!

Equity is making headlines now more than ever. At NOSM improving health equity in Northern Ontario has been a priority since the School’s inception; this continues to be a focus in our next strategic plan. We are committed to leading the way with our values of social accountability and inclusiveness and with a culture of respect.

It’s important to note that the root causes of worsening health in entire populations is linked to inequity. Camara Phyllis Jones is research director on social determinants of health and equity in the Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion in Atlanta, Georgia. Dr. Jones is a family physician and epidemiologist whose work focuses on the impact of racism on health and wellbeing. In the US, her work advocates for universal access to high quality health care, but also raises attention to the clear links between the social determinants of health (including poverty) and the social determinants of equity (including racism). I think all physicians would benefit from watching her presentation.

People in highly inequitable circumstances have little choice but to resort to using the health system when they “fall off the cliff.” Usually, in those emergencies, a system kicks in to offer them care. But what about those who have very little access, or no access at all?

In Northern Ontario, accessible health care is a huge problem. We know this. It is why a transformation of health human resources (HHR) planning is the top priority of our 2021-2025 Strategic Plan; a plan that will challenge us in all that we do.

One of the key areas is linking health human resources to Northern Ontario’s needs. NOSM seeks to build a flourishing physician workforce for Northern Ontario; one that is locally integrated within the system, with a strong regional network. Primary care at the foundation, supported by robust, accessible specialist services across the North.

Clinical education must be considered an integral component of a sustainable health-care system. The physician resources required to enable high quality, accessible care must also be considered in the context of teaching and learning. Education must be built into the health-care system; this means learners are trained by the same physicians presently working in the region. By sharing skills and methods through the Northern lens of care we ensure that future physicians are capable of providing the same level of innovative, high-quality care.

The concept of an integrated teaching and clinical service workforce has not been realized in Northern Ontario, but it is the key to the future success of sustainable health-care delivery for the region—a region of complex geography, diminished access to care and higher than average rates of chronic disease, morbidity and mortality.

Despite NOSM’s 12 graduating classes of students, and a total of 714 MD graduates, the needs of Northern Ontario remain high. Rural, remote, Indigenous and Francophone communities still lack family physicians and several communities across Northern Ontario are in crisis. This situation impacts not only clinical care but also NOSM’s ability to sustain the distributed medical education model intended to ensure a future workforce.

Addressing the social determinants of health requires action and effort to reduce health and socioeconomic inequalities. Objections to taking action on the social determinants of health are often intensely political. In response to my statement against racism, some say it is not our responsibility to enforce behaviour. I implore you to consider the facts. Poverty, rising inequality in income and assets, and social exclusion all drive the widening and deepening health inequalities in Northern Ontario.

The Public Health Agency of Canada lists examples of determinants of health from income and social status, race, to gender and culture. The list is extensive and we know the health of any individual is a complex summation of these factors.

NOSM’s new strategic directions will address inequity and the necessary system transformation to align with Ontario Health Teams, supporting seamless, integrated care, better patient outcomes, and better value for funders with more integrated, more cost-effective care. To achieve this, we need adequate local physician resources in communities to decrease system fragility and locum dependence. Ensuring adequate physician resources will be an investment in higher value care in the future.

The system relies on effective recruitment and retention of comprehensive family physician generalists who can work across communities in hospital, long-term care, home care, and primary care in urban and rural environments alike.

Building primary care as the foundation of the health-care system is critical now, as we anticipate another wave of acute COVID-19 cases, and as we anticipate the emergent waves of chronic disease both from COVID-19 and from other complex conditions including increasing mental health and addictions.

The Northern Ontario Health Equity Strategy states that equitable access to physician services is key considering that health outcomes across Northern Ontario are significantly worse than the rest of the province.

As for the social determinants of equity—they are key to revitalizing NOSM’s social accountability mandate. NOSM remains devoted to addressing the needs of vulnerable populations. Our health-care services must address the wider growing crisis by building increased clinical capacity and socially accountable research with findings that will help us formulate realistic solutions. NOSM is prepared to face these challenges.

A new NOSM initiative, led by Dr. Barbara Zelek, NOSM’s new Division Head of Clinical Sciences, will help us understand priorities that matter to Northern Ontario patients, primary health-care professionals, and communities through collaborative research. A Practice-Based Research Network (PBRN) called NORTHH (NOSM Research Toward Health Hub) was developed to workat the intersection of quality improvement and research, to address these critical priorities. Dr. Zelek tells us more about this important initiative in this video. Thank you Dr. Zelek for your passion, dedication and work in addressing the social determinants of health in our region.

Miigwetch, thank you, merci, for individually committing to health equity in Northern Ontario.

Dr. Verma

Please continue to follow my journey on Twitter @ddsv3 using #WhereisDrVerma

I welcome input on this blog and other issues you want to bring to my attention by email to dean@nosm.ca.

Orange Shirt Day is September 30
Orange Shirt Day encourages Canadians to work together towards reconciliation and to hear the truth telling that comes from residential school survivors who have shared their stories. Join me on September 30 at 1:30 p.m. to hear from residential school survivors Donna Debassige and Edmund Metatawabin.

Orange Shirt Day tees are back! Buy yours at the NOSM store. Survived, still here artwork by Isaac Murdoch.

For more details or to donate to the Indigenous Educational Initiatives and the Indigenous Bursary Fund, visit nosm.ca/orangeshirtday.

→ Email a selfie of you wearing your Orange Shirt to communications@nosm.ca and we will share it on NOSM’s social media!

15th Annual Northern Health Research Conference
This year’s NHRC is going virtual! Join us on Friday, October 2 at 9:00 a.m. with keynote speaker, Dr. Erin Cameron. Learn more at nosm.ca/nhrc.

NOSM University