Reflecting on it, after a thankfully cool and rainy spring in June, 2022, Dr. Merritt wrote this piece to his colleagues at Kootenay Lake Hospital:
"Last year at this time, we saw an unprecedented number of patients presenting symptoms of acute and subacute heat stress in the KLH emergency department. This trend was attributed to the heat dome that we experienced in Nelson during late June to early July. This high-pressure system trapped hot air in our atmosphere for several days, with temperatures remaining stagnant throughout the evening and nighttime hours. In years prior, temperatures would normally drop off overnight, providing more opportunity for people to cool down.
This unusual weather event presented challenges in emergency departments across the Kootenay Boundary. The effects of climate change and the accompanying impacts on community health proved to be unpredictable and unlike anything we had seen before. We had to quickly adapt to the high number of patients that required treatment for heat-related illnesses. In the event that we are faced with a similar event this year, I have included a list of helpful resources at the bottom of this article so that we can be better prepared to handle it.
The effects of the heat dome are particularly concerning for seniors and people who are living with mental illness and chronic illness. Medical frailty and social isolation can prevent people from seeking help and being able to cool themselves appropriately. According to the BC Coroners Service, 619 deaths were identified as heat-related between June 25 and July 1, 2021 and were comprised of mostly older adults with existing health concerns who lived alone. Ninety-eight percent of these deaths occurred indoors.
The Coroner’s report calls our attention to the number of people in our communities who are isolated and our need as a community to adapt to the extreme weather events we are seeing as a result of climate change. While it is important for us as physicians to address the effects of climate change in relation to health, I would also like to stress that these preventable deaths are a public concern. I hope that these statistics will open the door for more dialogue about heat-related deaths and illness to encourage our community to implement strategies that will keep our most vulnerable members safe during times of extreme heat."
Have questions or feedback? Let us know.
Dr. Nattana Dixon-Warren wears many hats including KBRH Senior Medical Director, Primary Care Physician in Salmo, and KBRH hospitalist. She shares her experiences while keeping an eye on the weather and the snow conditions at Red Mountain in Rossland, where she lives with her family. She wanted a balanced lifestyle and she got it.
Although Dr. Dixon-Warren didn’t get into medicine on her first try, she continued her studies in premedical training, biochemistry, environmental toxicology and English literature, later graduating from UBC medical school. She and her husband, ready for a move, put a list of career options on their fridge in their Ontario home. They chose KB over places like Churchill, Manitoba.
Dr Dixon-Warren and a colleague set up their family practice at the Salmo Wellness Centre, established with help from the town, the regional government, and the Health Authority, filling a long-time community void.
“I’ve always enjoyed the variety of longitudinal care. It is unbelievably satisfying,” said Dr. Dixon-Warren about her role as a family doctor.
The longer she stayed, the more roles she took on.
'Nimbleness’ needed for today’s services
She describes the four bundles of family medicine as running a clinic, delivering babies, helping out with hospital/facility services, and using special skills in the community. It’s not as simple as it used to be, but KB’s collaborative and collective teamwork across a complex system and service delivery impressed her. The model is one of its biggest strengths and played a major role in Dr. Dixon-Warren coming, staying, and expanding her roles.
“There has to be a nimbleness to the way services are developed,” she adds, using the COVID crisis as an example. “A respiratory assessment clinic was needed here, which involved setting up, running, staffing and planning.”
They did just that; another example of KB medical services in motion.
Blending family and work
Having grown up in a large family with professional parents, one being a doctor, she learned first-hand about the accommodation required by family to make a medical professional’s work life possible. It asks everyone to be flexible, so the community benefits. Her family, including four children, accepted this lifestyle and she looks back at a busy 20 years as ‘fun and happy’. They took advantage of all KB offers: sports, arts, fitness, outdoors, and nearby urban culture. Her husband, a teacher at the time of their move, later switched to ski instructing, running a guest cabin, and domestic roles. They wanted to move to be closer to my family, who live at the coast, and have access to skiing. The work-life balance was struck.
“KB is quite family oriented,” she adds “What’s important to me is that family life is supported throughout this journey.”
In true Kootenay style she blends activities into her daily routine, doing a 1950s military fitness program, yoga with her daughter via Zoom, and walk and talk meetings, to take indoor tasks outdoors.
“I’m happy the offerings here make for a sustainable lifestyle.”
Taking the lead
Not only is Dr. Dixon-Warren KB's Senior Medical Director, a family doctor to the residents of Salmo, and a KBRH hospitalist, she's also Assistant Clinical professor for UBC medical program and serves as admin lead for distributed post graduate medical education. She is instrumental in helping drive the region’s medical education programs.
In her role as KB’s Senior Medical Director, Dr. Dixon-Warren strives to ensure resources are planned for and distributed as needed throughout the region. She describes the job as a resource for chiefs of staff across the region, working to plan and recruit the resources needed to ensure nodes of acute care are functioning, supporting community service delivery, and that the region's specialty care centre is strong enough to do its job. It’s about keeping it all working smoothly and efficiently.
“The discipline needs to keep an eye on the ball and ensure everyone is cared for. It’s our social contract.”
Her reach is broad, her jobs varied, her vision expansive, but that’s how she likes it!
Dr Nattana Dixon-Warren
BSc, PBDip, MD, FCCFP
KB Senior Medical Director
Primary Care Physician- Salmo Wellness Centre
Member of KBRH Hospitalist Group
If you want to learn more about living and working as a physician in Kootenay Boundary, please get in touch with Sylvain Turgeon, Head of the KB Doctors Recruitment Team.
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Video Health Choices - Dr. Nattana Dixon-Warren
Even established medical practices like dialysis can benefit from new approaches. A Kootenay Boundary Regional Hospital team pooled their skills to search for a safe way to remove lung fluids during dialysis treatment. The team followed their hypothesis and analyzed the side effects of fluid retention on hemodialysis patients. Their goal was to see what benefits lung ultrasounds could provide for patients experiencing hypertension during treatment.
The Lung Ultrasonographic Assessment of Volume Status in Hemodialysis team was keen to test Point of Care Ultrasound (POCUS) to identify extravascular lung water volume overload. It requires care and accuracy before taking action.
“If you remove fluid too excessively, it can precipitate low blood pressure, loss of consciousness, heart attacks,” said DharmaPaul L. Raju MD (Nephrologist and Project Coordinator). “It can be quite dangerous.”
Results give new insights and options
The team members represented the variety of service providers a dialysis patient might come in touch with during treatment. This Physician Quality Improvement project was conducted by Justin Dragoman (Medical student), Chi Zhang MD (Chief of Nephrology and the Department of Medicine), Marlene Johnson RN (Dialysis Nurse), and Dharma Paul L. Raju MD (Nephrologist and Project Coordinator) at KBRH.
The lung ultrasound results demonstrated a statistical decrease in the overall time patients were hypertensive while on dialysis. Also, the ultrasound allowed the researchers to identify patients with sub-clinical congestive heart failure (those without signs or symptoms of heart failure) who benefited from additional fluid removal. Most of the test patients were asymptomatic, leading to improved targeted ultrafiltration (UF) for patients with subclinical volume overload.
UBC Medical student Justin Dragoman explained how the first step was to assess how often patients were becoming hypotensive during treatment. “We determined patients spent about 40 percent of their time in hypotension when they are undergoing a dialysis session.”
Using lung ultrasound technology helped reduce the patient’s time in hypotension by 12 percent and deal with low blood pressure issues.
Looking to the future
“As physicians, we want to make sure we improve patient outcomes,” said Chi Zhang MD, Chief of Nephrology and the Department of Medicine. “But also we want to improve their physical well-being and experience with dialysis.”
Lung ultrasonography has already been utilized by ICU and Emergency Room physicians. The project plans to expand throughout Interior Health and engage students and nurses throughout the region. Using this simple invaluable bedside tool can enhance patient safety in rural areas without easy access to hospital services.
Review this project report here
If you want to learn more about this initiative or anything else about living and working as a physician in Kootenay Boundary, please get in touch with Sylvain Turgeon, Head of the KB Doctors Recruitment Team.
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Kootenay Boundary Regional Hospital (KBRH) Project Spotlight
One thing that was a standard normal for our profession and services became a new normal for our patients in 2020. Masks. But, while many of us are comfortable with masks, and find them necessary and often preferable, for others it is uncomfortable and un-welcome. Wearing masks for safety may have grown in acceptance and practice but at the same time so did an increased desire to see people’s faces. Patients want to see their doctors’ faces. The solution: the Kootenay Boundary Physicians Association (KBPA) Face Button Project.
KBPA’s goal is to supply all physicians, nurses, admin staff—anyone working at KBRHs—with their own smiling face button to wear for the public, patients, and colleagues. We are committed to this ‘face time’ project and participation is growing.
It's a simple solution to the complex COVID protection protocols. The US National Centre for Biotechnology Information (NCBI) recently reported on the severe affects and challenges wearing face coverings are producing during the pandemic. They explore how “…the face mask can hinder interpersonal communication…”, an important component of our services.
A key side-effect of masks is blocking facial expressions critical in comprehension. The facial muscles that create expressions, predominantly moving our nose and mouth, are important when conveying emotions and information. As communication is a two-way street, we are experiencing even more congestion as both parties communicating are wearing masks. The smooth flow of information is prone to being blocked.
The KBPA are supporting the #KBRHSmiles to provide a face button with a head and shoulders photo so everyone can see the smile behind your mask. Dr. Sue Babensee, KBRH physician and Project Lead, wears hers with pride, loving the positive response she gets when others see her happy face.
We’ve made it easy for KBRH IH Staff and physicians to join in. Take a selfie or chose a photo and contact your department head or our Project Co-Ordinator: firstname.lastname@example.org. The rest is up to us. We’ll send your button and you can join the growing number of project supporters.
Get your smile out from behind your mask. Let’s face it. Putting our real face forward is a prescription for better connections, so important at this time.
Date: January 2021