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- Page navigation anchor for RE: Surgical and obstetrical services for rural and Indigenous CanadiansRE: Surgical and obstetrical services for rural and Indigenous Canadians
Two recent articles highlight health care inequities for Indigenous Peoples in Canada. Relative to the non-Indigenous population, these groups had a 30% higher rate of death after surgery, limited access to certain surgeries and higher complication rates.(1) They also experienced reduced access to birth care close to home.(2) Anesthesia care represents an essential foundation for both surgical and obstetric services, and limited availability of anesthesia care providers may have contributed to these inequities.
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Provincial governments need to respond to the national shortage of anesthesiologists by expanding the number of training positions for specialist anesthesiologists, as well as for family practice anesthetists, who serve rural communities.(3) A recent report on rural anesthesia care identified additional strategies.(4) These include addressing the maldistribution of physicians, by providing access to suitable training, continuing professional education and mentorship for generalist family physicians with anesthesia skills. Medical schools must become more socially accountable, training anesthesiologists to meet population needs. Health policies must support small rural hospitals, recognizing the interdependence of surgery, obstetrics and anesthesia and promoting the networks of care with tertiary centres on which these hospitals rely.
The impact of the shortage of anesthesia care providers in rural Canada is unknown because relevant human workforce data a...Competing Interests: None declared.References
- Jason A. McVicar, Alana Poon, Nadine R. Caron, et al. Postoperative outcomes for Indigenous Peoples in Canada: a systematic review. CMAJ 2021;193:E713-E722.
- Smylie J, O’Brien K, Beaudoin E, et al. Long-distance travel for birthing among Indigenous and non-Indigenous pregnant people in Canada. CMAJ 2021;193:E948-55.
- Orser BA, Wilson CR. Canada needs a national strategy for anesthesia services in rural and remote regions. CMAJ 2020;192:E861-3.
- Orser BA, Wilson CR, co-chairs. Symposium on anesthesia care and pain medicine in rural and remote regions of Canada; 2020 Nov 20–21. Toronto: University of Toronto, Temerty Faculty of Medicine, Department of Anesthesiology and Pain Medicine; 2021. Availa
- Page navigation anchor for RE: Postoperative outcomes for Indigenous Peoples in Canada: a systematic reviewRE: Postoperative outcomes for Indigenous Peoples in Canada: a systematic review
I suspect that reference 11 is erroneous. It is given to support the statement in the introduction that "These health inequities are direct impacts of the social determinants of health, which are in turn effects of colonialism and government policies, including the Indian residential school system".
The cited reference, about type 2 diabetes, does indeed address some determinants of health such as diet and physical activity (in addition to genetics and metabolic factors), but it does not address racial inequality, and makes no mention of either colonialism or residential schools.
Was a different reference intended?
Competing Interests: None declared.References
- Jason A. McVicar, Alana Poon, Nadine R. Caron, et al. Postoperative outcomes for Indigenous Peoples in Canada: a systematic review. CMAJ 2021;193:E713-E722.
- Young TK, Reading J, Elias B, et al. Type 2 diabetes mellitus in Canada’s first nations: status of an epidemic in progress. [published erratum in CMAJ 2000; 163:1132]. CMAJ 2000;163:561-6.
- Page navigation anchor for RE: Post op outcomesRE: Post op outcomes
A. time to presentation? not mentioned
B. the raw data, and the interpreted data do not seem to match. As a non-statistician, the discordance does not make sense to me.
C. Nutritional status, smoking status pre op not stratified. Supplements, pre-op CV status not mentioned.
My observation is that some people present late for their disease states. I have observed Indigenous people present later in their course of disease, and with more severe disease, which makes surgery of increased risk. I have observed this not only in Canada. The pre-op risk scores not mentioned in the article either. If the pre-op risk scores correlate with post-op outcome, the difference in ethnicity would be a more powerful statement, for the same pre-op risk score, and different post-op outcomes.
I get the sense that the paper intended to show a difference and was not as diligent in following the details as the authors may have been, to identify contributory factors other than ethnicity.
For anyone with learned helplessness, their outcome is probably worse than those who aggressively pursue favorable health outcomes. Anyone with PTSD, childhood abuse, etc, regardless of race is at increased risk to other health determinants in my practice. The most vulnerable may benefit from more attention, at the very least to identify them as at increased risk for complications, if nothing more.Another study, including more variables would be welcome.
Competing Interests: None declared.References
- Jason A. McVicar, Alana Poon, Nadine R. Caron, et al. Postoperative outcomes for Indigenous Peoples in Canada: a systematic review. CMAJ 2021;193:E713-E722.