October 23, 2024
Logo by Mi’kmaw artist Dr. Gerald Gloade, Millbrook First Nation / Logo de l’artiste mi’kmaq Gerald Gloade, Première Nation de Millbrook. Santé pulmonaire des enfants autochtones du Canada atlantique
Australian physician, Dr. Dustin Mills, completed his 12-month Dalhousie University Fellowship with the Izaak Walton Killam Hospital for Children’s (IWK) department of respirology, at the end of May.
During his fellowship in Canada, Dr. Mills traveled to many Indigenous communities in the Atlantic region, including Natuashish in Newfoundland and Labrador, on the importance of lung health and management of chronic cough in children. He credits Jacquelyn MacDonald, eHealth Clinical Nurse Specialist with FNIHB Atlantic, for providing the connections and opportunities necessary for his outreach work to communities.
Chronic cough, defined in children less than 15 years of age as a cough every day for more than 4 weeks, is not uncommon, but needs appropriate assessment and management, as it could signify serious underlying lung disease.
A chronic wet/productive cough can lead to irreversible lung damage called bronchiectasis, where the breathing tubes become chronically infected with bacteria and scarring occurs.
Bronchiectasis is an often neglected, but not uncommon chronic lung disease in children, with the highest rates described in marginalized Indigenous communities. Importantly if chronic wet cough is diagnosed early and treated appropriately, bronchiectasis can be prevented, or even reversed in some children as their lungs continue to grow and heal.
Unfortunately, chronic cough in Indigenous communities is often very common, and so can be seen as normal, and the damage from chronic wet cough is often underdiagnosed or misdiagnosed as asthma, and these children can end up with an accelerated decline in their lung function and shortened life expectancy in their later adult years.
The key message is a cough, particularly a wet cough every day for more than four weeks needs to be assessed and managed appropriately as captured in this video for Indigenous Australian communities on chronic wet cough in children.
Dr. Mills’ experience in the Atlantic region
In my year working in Atlantic Canada, we have diagnosed many children, both Indigenous and non-Indigenous with bronchiectasis, with a CT scan of the chest. Most of these children had a wet cough every day for many years before receiving this diagnosis, and most are now cough free, sleeping better, exercising better, missing less school, and have the best chance of letting their lungs heal if possible so that they may lead a longer healthier life.
Indigenous spirometry training program was designed so that Indigenous health centers can perform quality spirometry within their own communities, to support the early diagnosis and optimal management of respiratory disease.
The training day was opened with a smudging ceremony by Courtney Pennell, a proud Mi’kmaq nurse and the IWK Indigenous health consultant. It is hoped that the Indigenous spirometry training course will be offered on an annual basis through the IWK Children’s hospital.
The inaugural course was attended by 12 Indigenous health care workers from Indigenous health care centers:
Initiatives
To support lung health and chronic cough awareness in Indigenous children in Canada, there are a number of initiatives developed at the IWK hospital in collaboration with Indigenous communities including printed, online, and digital resources, conversations on how to improve virtual care / telehealth options, and regional training.
IWK Respirology team welcomes any phone calls, e-mails or faxed referrals from Indigenous health care workers (nurses, nurse practitioners and doctors). Follow normal pathways for acute care but for children with chronic respiratory problems, contact on-call respirologist via the IWK switchboard (902) 470-8888, fax pediatric respirology referrals to (902) 470-7223, IWK respirology clinic email iwkrespirology@iw.nshealth.ca, respirology clinic phone (902) 470-8218.
Dr. Mills is hoping to send out all material to Indigenous health centers in Atlantic Canada in the coming months and would welcome any feedback or collaboration on these initiatives moving forward.
Contact dustin.mills@health.qld.gov.au.
Credit: First published in The Arch – external newsletter for Indigenous Services Canada Atlantic Region - summer edition 2024.
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