Renal outreach

Leonora Spring Chief wasn’t too impressed with what the nurse practitioner told her the first time they met.

Ellen Novak had just started a weekly outreach prevention clinic on the Siksika reserve near Calgary to help people at high risk of developing chronic kidney disease.

“I wasn’t really interested in talking to her,” recalls Spring Chief, 59. 

“But on my second visit, she told me I had this cholesterol and protein and other things in my body and she explained a lot of things to me about what I should do and shouldn’t eat.”

Now, three years later, the diabetic has modified her diet, started exercising and lost weight.

“I feel better,” she says.
 
Spring Chief is one of about 100 patients Novak follows regularly on the reserve, located 95 km east of Calgary. 

The community of Siksika has the highest prevalence of diabetes in Alberta, at 15.1 per cent -- three times the provincial rate. Diabetes is one of the most common causes of kidney disease.

The clinic, developed by the Southern Alberta Renal Program (SARP) and spearheaded by Novak and nephrologist Dr. Brenda Hemmelgarn, targets high-risk patients: people with diabetes, high blood pressure, high cholesterol and/or protein in their urine.

Novak holds the clinic every Tuesday at the Siksika Health and Wellness Centre. (Hemmelgarn joins her three or four times a year).

Health care on the reserve is under federal jurisdiction; however, AHS received permission from Tyler White, Health Director of Siksika First Nations, to run the clinic, which complements other services at the health centre.

“We want to bring services available to people in the city to people in rural areas; specifically, the First Nations community of Siksika,” Novak says.

“During the initial visit, I do a complete history and physical examination and get a urine sample and blood work. If there is a particular amount of protein in the urine, it shows the kidney is being affected.

“I always say to patients: ‘We can’t change the current damage that’s been done to your kidneys to this point but we can hopefully prevent further progression.’ ”

Novak hopes her patients’ improved health will bring others to her clinic. 

“It’s a matter of being patient, encouraging, respectful and culturally sensitive,” she says. 

“There are always challenges inherent in the lives of First Nations people. Most of my patients have complex family and medical histories and I think their own health is often put on the backburner, so I try to educate and empower my patients to advocate for themselves and to ultimately be the master of their own health.”

Novak counsels her patients to eat less salt, sugar and fat and she manages their blood pressure, glycemic control and lipid control with medications.

Her work is paying off. Since she started visiting the reserve, the average blood pressure of her patients has been reduced by 12 percent to recommended, safe levels. Controlled blood pressure helps prevent the onset on chronic kidney disease.

Spring Chief just knows she feels better than ever and has sent her brother and sister and a lot of her friends to Novak’s clinic.

“Some of the elders have been going there, too, and they’re really glad that Ellen is around,” says Spring Chief. “She’s helped a lot of people on the reserve.”

The Northern Alberta Renal Program (NARP) runs similar clinics in towns across northern Alberta, although none is targeted specifically to First Nations communities.