Adele, First Nations community care nurse

"Nurses were constantly moving around because they were not happy anymore — and I guess I was one of them"

Adele’s story

My name’s Adele. I’m a registered nurse here at First Nations Health and Social Secretariat of Manitoba. We are an intensive home visiting program. 

Empowering families, working in partnership with our communities, is what I love most about my job.

I’m First Nations. We work in First Nations communities, and we’re able to watch families grow. We need to break that cycle of the attachment and bonding that we’ve lost. And this program, we find it’s based on research that works. 

Being from northern Manitoba, where communities are so dispersed — and from my own personal experiences as a young mother in a small town — I wanted to give back and care for our communities.

Manitoba is unique in geography. We have 63 First Nations throughout the province, seven tribal councils — and programs are not in every community. 

Some of our reserves are close to the bigger centres. When you go up north, it’s fly-in. At our nursing stations, you have the nurses start at 8:30; acute care, 8:30 to 4:30 or 8:30 to 5:00.

Doctors fly in and fly out. Some stay, some don’t based on their contracts. Emergency care is basically done on a nurse-in-the-middle-of-the-night basis. Doctors won’t be there, and it’s MedEvac. 

With a shortage of nurses… public health gets put on the wayside. Yes, our immunizations get done, but there’s so much involved in an immunization clinic for a public health nurse.

I don’t think the access to care is there. Then if you’re status or non-status, there are issues around medical-service coverage.

On March 17th, [2020], the worldwide pandemic was announced and we were all sent home. We packed ‘er up that day and went home. 

Our organization worked very quickly on communication. As nurses at FNHSSM, we’ve got to call our partners. What are we doing? What’s going on?

We tried to talk to the nurses up in Shamattawa, Tadoule Lake, but we were losing connection on our phones — and this is our healthcare system. This is how we operate, through phones and emails and faxes. We couldn’t get through because of connectivity. Like, this is ridiculous. We can’t have a great meeting, a conversation of what we’re doing as healthcare providers.

I would say it was 18 months to two years that it was all hands on deck, focusing on COVID-19. Basically, we acted as a band-aid to our healthcare system, in helping our communities protect themselves from COVID-19.

Tests were sent to the community to test for COVID-19. We needed two nurses to work the lab. We’d gather the samples and then we’d test them all day. 

You’d take a break in the afternoon, then you’d be the swabber. This alternated every day or however you were comfortable. 

We even went out in full PPE, from door to door. We were doing swabs through the doors and taking them back to the lab. 

One community, we were with the military, and we followed the military nurse around and helped. We were going in and doing mass testing, and bringing people with positive results out to Winnipeg for isolation.

This was how we were dealing with our 63 communities. But the pool was getting smaller. Nurses were getting burnt out. 

In our communities, we have a lot of families that either live with 10 or more people — you know, three or four families within a small house. If one family member contracted COVID-19, then we needed to bring that family out to isolate. There’s nowhere in the community for them to isolate. 

The province started the AIA — Alternative Isolation Accommodations — program. They got hotel rooms in the city for us to bring people out for isolation. 

Alternative Isolation Accommodations was a huge project for our families. We operated in a more culturally sensitive way. It almost brought back the residential school feeling for a lot of the families: being taken from the community, placed in a room, and given food at the door for breakfast, lunch, and dinner.

Our nurses worked tirelessly to provide comfort and care traditionally and holistically. They were able to set them up in teams to do ceremonies, like funerals. It’s our culture to have mass gatherings for funerals. There was a lot of coordination about how to set that up for families to grieve.

Diabetes is a pandemic, and an epidemic in our communities in Manitoba. The province has the highest rates of diabetes in its First Nations people.

Within our organization, we have the Diabetes Integration Project. There’s three teams that travel to the community and do [estimated glomerular filtration rate] kidney testing. 

The Diabetes Integration Project needed a director like yesterday. So I started that role. 

It’s a huge project. And at the same time, there’s a pandemic.

Our health centres are busy with a multitude of chronic conditions, and we don’t have the diabetes programs that we should in our communities. So things were getting left untreated and misdiagnosed, and quality care was gone. You’re finding more and more amputations. Blood sugars are high. 

You want to delve into racism with our governments, because of the high numbers of diabetes in First Nations people. The amputations are triple [the rate of other diabetics in Canada]. It’s like we’re not being heard. 

It took a toll on me, being in that role. I thought I was ready. It’s a huge role. It’s an important role. I didn’t want to be the one to mess up such a great program. 

I was feeling a lack of confidence as a nurse. Maybe it was because of burnout that I felt vulnerable.

I made the decision to step down. I was busy with home, worried about home. My mom was getting over cancer, they live far away, we all went through — everyone goes through this in a different way. 

Stepping down, I felt like a failure, that I couldn’t do such a position. But the team said, “No, Dele, you did fine. You just didn’t have a chance. You didn’t get the chance to do it because of having to deal with the pandemic.” 

We were making sure our families were being taken care of, through our nurses that were employed here and in the program, and in our home life, and doing deployments and all the reports that were due, while being worried that the government’s going to take our funding back. Nurses were constantly moving around because they were not happy anymore — and I guess I was one of them.

Our workforce is in trouble. We have high turnaround, whether it be home visitors or nurses, doctors, and therapists. 

How are we preparing now? Us regionally, how do we prepare our nurses and our home visitors when they enter homes? What are they going to see? What are they going to find? What do we do? 

We’re doing a lot of strategic planning on our end about how to support that. It’s heartbreaking, but it’s reality.

I love this organization and what they stand for: making our communities better. And we’re a strong voice. 

So that’s what I am hopeful for in my career and where I work. We can get through to leadership, we can get through to the government, we can move forward for our people. We ran our own communities until before time and we just need to resurface that.

A special note of thanks from Healthcare Salute

Over the course of the COVID-19 pandemic, healthcare providers from across Canada have participated in our research on “COVID-19-Related Stress, Moral Injury and Minority Stress in Healthcare Workers and Public Safety Personnel in Canada.” Their struggles, heartbreak, courage, and resilience have inspired and moved us, and formed the bedrock of our research for this project. We are deeply grateful and committed to sharing their experiences.

We would also like to express our heartfelt thanks to our funders, the Public Health Agency of Canada, for giving us the opportunity and the autonomy to share our research with the larger Canadian audience without bias or restriction. This work would not have been possible without their generous and arms-length funding support. We also wish to thank our collaborators and supporters — McMaster University, St. Joseph’s Healthcare Hamilton, Homewood Health, and Homewood Research Institute.

After viewing, visit “Applying cultural competency in practice,” an education module for mental health providers and peer supporters.