The effect of the Northern Ontario School of Medicine on access to quality health care goes beyond doctors.

Since its creation in 2007, 135 registered dietitians have graduated from NOSM’s Northern Ontario Dietetic Internship Program (NODIP). Two of those graduates, Kelsey MacKinnon and Jasmine Connelly, are now practising in the Kirkland Lake area.

MacKinnon, a registered dietitian with the Timiskaming Diabetes Program North at Kirkland & District Hospital, grew up in Cambridge. Her family is from Kirkland Lake, and her parents returned to the community while she was in university. “I had never lived in Northern Ontario full-time before I started my internship, I had just come to visit,” she says. “Through my placements, I got more exposure to the communities and the way of life in Northern Ontario, and decided to try it out and take a job here when I graduated. That was five years ago, and I couldn’t be happier.”

She says the sense of community is one of the main reasons she decided to stay.

“Someone who’s your client may also be your neighbour and you see them at the grocery store, so you’re treated more like a friend or family,” she says. “When a client comes to see you, the interactions we have are very warm and friendly, and I really like that.”

Connelly, a registered dietitian with the Kirkland District Family Health Team, grew up in the Kirkland Lake area, and it was while she was studying in Southern Ontario that she knew she wanted to return to and work in the North.

She says NODIP allowed her to do placements in areas in and around Kirkland Lake because of her expressed interest in eventually returning to live there.

“The client population is different than in Southern Ontario, as are the resources available, and I wanted to experience that setting as an intern,” she said. “NODIP allowed me to do that, and it’s because of the program that I felt fully prepared me for the work I do now.”

MacKinnon, who is now a preceptor with the program and facilitated one of Connelly’s placements last year, adds that the program shows  interns the day-to-day variety of rural practice, something she says is one of the big attractions of working in the North. “When you’re the only providers in the diabetes program, you’re covering a lot of different settings,” she says. “It’s very multifaceted, and I feel very lucky to be able to expose the interns to things like this that they may not know about practising in Northern Ontario.”

She says that above all, her clients are grateful when they realize they can see a dietitian in their home community, and are often excited to see interns that are returning to the area.

“When you’re in an appointment and an intern introduces themselves, you can see the clients light up,” says MacKinnon. “They say things like, ‘Oh wow, you’re coming back home,’ or ‘You’re giving back to your community,’ and they’re just very happy.”

Read more in the latest issue of Northern Passages.

Dr. Bryan MacLeod has seen first hand how the shortage of doctors in Northern Ontario effects both patients and clinicians in the region.

That’s why when he heard the Ministry of Health and Long-term Care was looking to establish an ECHO Hub focused on chronic pain in Ontario, he knew he wanted to be a part of it.

“Chronic pain is such a common and debilitating condition, and there’s very few specialists or experts, so this is one way of providing care that hasn’t traditionally been available in rural communities,” says MacLeod, Medical Director of the Chronic Pain Management Program at St. Joseph’s Care Group in Thunder Bay and Associate Professor at the Northern Ontario School of Medicine (NOSM).

Project ECHO, which stands for Extension for Community Health Outcomes, uses a “hub and spoke” model. The ECHO SJCG Chronic Pain & Opioid Stewardship Hub connects primary care sites in Northern Ontario and across the province (the “spokes”) to chronic pain specialists at St. Joseph’s Care Group and the Ottawa Hospital (the “hub”) via teleconferencing. In weekly sessions, members bring forward patient cases that the group then reviews together. There is also time built in for teaching on topics relevant to chronic pain and opioid stewardship. Participants come from communities across the province with a focus on Northern Ontario, and include a range of health professions including physicians, nurses, physiotherapists, occupational therapists, social workers and more. They work in a number of different primary care settings, and bring learnings from ECHO back to their teams.

“Our pain management team at St. Joseph’s is a highly interprofessional primary care environment,” says MacLeod. “In smaller communities, people might not have access to a dietitian who specializes in pain-related issues. So this is a way we can share that expertise with a wider group of clinicians, and in turn a wider group of patients.”

ECHO also allows for relationship building, breaking down the professional isolation that often affects clinicians in the North, says Katrina Radassao, a physiotherapist at Nipigon District Memorial Hospital.

“Being a new grad in a small, rural hospital, it’s great to have that sense of community,” she says. “When you have a difficult case, it’s so valuable to have this ‘expert panel’ who all have different opinions and backgrounds, and can support you in making sure your patient gets the care they need.”

MacLeod and his co-chairs are also working to expand the hub’s offerings beyond participation in the weekly ECHO sessions, including hosting a series of NOSM-accredited evening sessions on opioid management for doctors, nurse practitioners and other opioid prescribers in the region.