Rheumatic fever rates in some Ontario First Nations 75 times higher than rest of Canada

People living in remote First Nations north of Sioux Lookout, Ont., are experiencing acute rheumatic fever at a rate that is among the highest in the world, according to new research from the College of Family Physicians of Canada.

Researchers identified 8 cases of acute rheumatic fever among 25,000 patients in the region during a recent 18-month period ending in March 1, 2015. That marks an incidence rate of 21.3 per 100,000 or 75 times greater than the overall rate in Canada.

Two four-year-olds in the region died of acute rheumatic fever during the time period that was studied.

The report's authors say the incidence rate among First Nations in northwestern Ontario is related to late diagnosis, overcrowded housing and inadequate public health response.

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"The health care system that exists treats us as second class citizens," said Sol Mamakwa, the health director with Shibogama First Nations Health Authority. "The system is built like this: if you're First Nations, if you live on reserve, you don't matter."

A recent report by the Auditor General of Canada highlighted problems with the care Health Canada provides in remote First Nations where there are no resident doctors. It noted that only one in 45 nurses surveyed for the report had completed all of their mandatory training.

"We get lots of complaints where children and moms are sent back home [from the nursing station] with Tylenol even though they know there's something more to that," said Mamakwa.

"Even if they want a second opinion, or to go to another nurse, that's not an option," he said. "I think it's very difficult because you're limited to whoever is working at the nursing station."

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A coordinated effort to educate health care providers about acute rheumatic fever and the importance of early diagnosis was hampered by the lack of continuity in nursing staff, according to the research.

There was an average delay in diagnosis of 88 days, the report said.

It also calls for a surveillance system for acute rheumatic fever, making it a reportable disease to Canada's Chief Public Health Officer.

Dr. John Guilfoyle, who was involved in the research, supports that recommendation but adds, "you can report this disease all you like but if you do not change the very conditions that generate it in the first place, it will not make a significant impact."  

Those conditions, according to the research, are social determinants of health such as the inadequate and crowded housing in First Nations communities.

"Deficient and overcrowded housing is not a benign social condition," the authors write in their conclusion.

"For Canadians, it is a canary in the coal mine — bellwether for problems and serious deficiencies in our health care systems," Guilfoyle wrote in a commentary published this month in the Canadian Family Physician.

"It has eerie echoes of the report of Canada's first Chief Medical Officer, Dr Peter H. Bryce, who, as early as 1907, pointed out the adverse effects on the health of children who attended residential schools," Guilfoyle said.

Implementing the recommendations of the Truth and Reconciliation Commission would help reduce the widening gap between the health status of First Nations people and the rest of Canada, he said.