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PROTECTING PUBLIC HEALTH: ONE FAMILY’S JOURNEY

What was to be a short visit from her home country to Fredericton to be with her son, daughter-in-law and new grandchild, became an unexpected situation involving multiple local, federal and international government agencies as she fell ill with a rare and contagious illness.

For patient privacy, the names of the patient and family members have been changed. At the patient's request, Horizon is not identifying the patient's home country and the specific disease in this article.

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Last May, as Eileen Smith boarded a plane at one of the large international airports in her native country, happy thoughts of seeing her son and his family in Canada filled her mind. As she settled in for the long flight, her son's family in Fredericton was preparing to welcome Eileen to the city and eagerly anticipated their one-year-old daughter's first encounter with her grandmother.

During Mrs. Smith's six-month stay, Andrew and Sally Jones were ready to showcase the city they've called home for the past decade. Sally, educated in New Brunswick, fell in love with Fredericton and its people as she awaited her husband's paperwork to wend its way through the immigration system so he could join her.

Throughout the spring and summer, the Jones' enjoyed many outings with their visiting mom, taking advantage of the warm weather.

SURPRISED BY ILLNESS

But as summer waned, Eileen suddenly fell ill.

"This was a big surprise," said Sally, noting her mother-in-law had a complete physical before arriving in Canada and other than high blood pressure, she was given a clean bill of health.

But early in September, her symptoms were serious enough that the family took her to a walk-in clinic where she was tested, given antibiotics and sent for a chest X-ray at Horizon's Dr. Everett Chalmers Regional Hospital (DECRH).

Nine days later, the family visited the walk-in clinic for the results. The physician detected an anomaly and scheduled a CT scan in a month. This was cause for concern, since Eileen's six-month visitor's visa was set to expire and her flight home was already booked for late October.

While awaiting her appointment, her symptoms worsened. The family rushed her to the Emergency Room at the DECRH where she underwent testing and another X-ray. The doctor determined the size of the anomaly had increased and scheduled a CT scan.

At first, cancer was suspected but it turned out to be a rare strain of an infectious disease requiring isolation.

"About two days before the flight we got a call from the Public Health nurse who said we should stay at home and cancel our flight," said Sally. "That's when we felt worried."

ISOLATION AND CHALLENGES

Ruth Amos is the Public Health Nurse who was on duty when the lab results came back in mid-October. She promptly notified the proper officials and contacted the family about the need for Eileen to stay, both for Eileen's and the public's protection. Suddenly, what was to have been a relaxing family visit had turned into an ordeal.

Overwhelm and uncertainty occupied their thoughts. Would Eileen's insurance cover the medical fees? Unable to speak English, how would she communicate with her care providers? What about their baby…had she been exposed? Would they be able to arrange a visa extension for their visiting relative?

Fortunately, her mother-in-law had insurance to cover her initial medical care. Tests indicated that those in close contact had not become infected. They also managed to get her visa extended.

Ruth's bedside manner and assuring words comforted the family.

"Ruth told us if she didn't get diagnosed before her flight (home) it could have been very difficult for her," said Sally. "She would suffer more from this if she flew back and possibly affect more people so if you look at it another way, it's a good thing they found this before."

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BROAD DRUG RESISTANCE

Dr. Duncan Webster is an infectious diseases doctor and a medical microbiologist at Horizon's Saint John Regional Hospital. When a smear tests positive for an infectious disease, he is the first to know.

He knew immediately it was a rare form of infectious disease, resistant to most of the typical drugs used to combat it.

"With such a broad resistance, we had to put together a very complicated regimen," said Dr. Webster.

This was only one of many challenges to be faced.

The extremely rare and drug-resistant strain also meant some of the necessary drugs for treatment were not available in Canada. Special access medications needed to be ordered overseas for Eileen.

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PROTECTING PUBLIC HEALTH

Dr. Na-Koshi Lamptey, Regional Medical Officer of Health, is charged with protecting the health of the community in central region New Brunswick. Among her roles is to identify risks that could harm public health.

"This situation has been a learning opportunity on several fronts because the illness was unusual in terms of it not being very common in Canada," she said.

"The other component was of course making sure that we were being client-centered as Horizon and the Department of Health always tries to be," she added, noting the complexities of dealing with a family of another culture and language.

Sally admits her mother-in-law was becoming depressed being isolated in the hospital, especially because she could not understand or be understood.

"She asked to be isolated at home," said Sally. "Public Health, the hospital, the Extra-Mural program and the Department of Health had a meeting to discuss this and it was decided to make all the arrangements so she could be isolated at home. She was very happy about that."

Andrew and Sally still wondered if having her in isolation at home would have health implications for her daughter.

"Public Health took care of that," said Sally. "They gave preventative medication to my daughter to protect her--that's a big relief for us."

Eileen has been off isolation since late January but continues on what's known as Directly Observed Therapy, meaning a Public Health official must observe her taking her pills to ensure her and the public's health is not compromised.

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SOME HURDLES REMAIN

Despite the successes, a few hurdles remain. Dr. Webster notes Eileen will continue a tough and lengthy regimen of five drugs for at least 20 months due to the drug-resistant strain of the disease.

"When she goes back home she would of course want to continue her treatment," said Dr. Webster, who is working with health care providers in her country to ensure "she can receive the care that she needs to get that cure that is such a possibility with infections."

Drs. Webster, Lamptey and others are working with the Public Health Agency of Canada (PHAC) to try to identify a receiving physician in the patient's home country, a logistical challenge due to the language barrier and the mismatched time zones. Another concern is ensuring the special access medications she needs are available to her when she returns home.

Sally hadn't expected such caring efforts for her mother-in-law.

"I think the system here is very responsible for the patient," she said. "That's really appreciated."

"When we look back now we had nothing to be worried about because we had all the help," said Sally.

CANADA, A CARING COUNTRY

Sally acknowledges they need another visa extension for Eileen while preparations for travel are arranged. Despite this, Sally is glad the events unfolded in Canada, because it's such a caring country.

"We feel safe and secure here," said Sally. "That's why we love Canada and we tried to settle here," she said, recalling that one doesn't have to worry when a surprise happens.

"We always can get help from people or institutes that get involved and they are very caring and things will be sorted out eventually," she said.

EXCEPTIONAL CARE

Sally says her mother-in-law received exceptional care, citing nurses and doctors at the DECRH translating English into Eileen's language so she could understand some of her issues. Hospital staff kept the family in the loop, making communication as smooth as possible.

It seemed to the family that the medical professionals involved went the extra mile. With no infectious diseases doctor in Fredericton, Dr. Webster drove to meet with them at their home. All in a day's work to him.

"If you look back at how things were, these house calls were the norm," said Dr. Webster, noting this was a really special case. "I was happy to do it and see it as part of my job."

"I think it's important to have that opportunity to meet someone face to face and to ask questions," he said. "It's important to have a connection, to feel supported and to feel confident in the people involved in your care."

TECHNOLOGY HELPED IN PATIENT CARE

When he couldn't be there in person, he made use of technology that is today's version of 'the next best thing to being there'.

"I had an opportunity to meet with them by TeleHealth," said Dr. Webster. "That's another thing through Extra-Mural and the Tele-Health support, we can basically Skype and have healthy conversation that way, making things efficient in terms of providing good care."

Seeing a positive outcome is rewarding to Dr. Webster. Dr. Lamptey agrees.

"To see the entire team of health care providers and health service providers come together and identify and meet unexpected challenges was really gratifying," said Dr. Lamptey. "It was a situation where we could never really rest because as soon as we dealt with one issue, another one would come up and people just had a really positive approach to doing what was right for the patient and the community."

"We are really deeply appreciative of all the help, because they were here when we needed them." said Sally. "They have just been so caring about us."

Eileen's health continues to improve and she is happy, a huge relief to her family as she awaits the signal to safely return home.

 

 


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