Natalie Mezey – NV Director of External Affairs and Queen’s MD Candidate
Qikiqtani General Hospital
Dr. Jim Denstedt is a PGY-4 Ophthalmology resident at the University of Ottawa whom I first met when I attended the Sally Letson Symposium in Ottawa in the fall of 2022. This year I was delighted to return and hear his fascinating presentation on his experiences on elective in Baffin Island.
This topic was of particular interest to me as I have been involved in several initiatives related to increasing access to care in rural and Indigenous communities. I spent part of my summer volunteering with Orgne air helicopter service in NW Ontario, where I had the opportunity to witness directly what it was like to deliver care in remote regions and Indigenous Communities which had not easy access to physicians. I also had the opportunity to volunteer with the Vision Loss and Rehabilitation Eye Van, which provides life-saving eye care travelling through remote communities in Ontario on an annual basis. Both these experiences further solidified my passion for access to care and made me especially eager to hear about Jim’s experiences in Iqaluit. Here is what Jim had to say:
- What motivated you to go to Baffin Island in the first place?
Every resident has the opportunity to go up North here in our Ottawa program. It was one part of the program that I found appealing, and I definitely looked forward to the time I was able to go up and enjoyed my experience while I was there. It offers a unique experience for residents from the standpoint of training, seeing a diverse population and managing a variety of serious ocular conditions in a much different environment than we are accustomed to in Ottawa.
- Is the Baffin Island elective rotation offered to residents at U Ottawa every year? How is it structured?
We were in Iqaluit for one week. Our clinic is in the Qikiqtani General Hospital in Iqaluit. The clinic space is shared with other specialties who head up North on a rotating basis. Specifically, we go up twice per year, once in the summer and once in the winter.
- What is the catchment area for this program and the patient population you serve?
Our program serves all of Baffin island, including the variety of small communities located across this area. I found that there were many patients who were in fact far from Iqaluit traveling in to see us in our clinic. We had many patients who would fly in in order to see us even when we were located in Iqaluit. This was a little different than I initially anticipated and spoke to the broad geographic area that Baffin Island covers.
- What does a typical week look like for residents on this rotation?
On a typical week, we can expect to have a busy, fast-paced clinic where we try to care for many patients who need our care. We manage acute and chronic ocular diseases, perform many laser procedures and injections of medications throughout the day, and typically we have at least one OR day where we do surgical procedures, mainly eyelid surgery and strabismus surgery. On most days at the end of clinic, we would have at least one minor procedure book such as an eyelid procedure or chalazion excision.
- What was the biggest challenge of offering comprehensive ophthalmological care in the region?
Certainly, the nature of providing care in such a remote region introduces certain challenges. Specifically, in ophthalmology, there are some conditions which require more frequent care such as those receiving ongoing injections, and it can be challenging to provide this type of regular care given these constraints. Thankfully, we also have the ability to see patients in Ottawa should this be needed.
As I mentioned earlier, it was interesting to see the proportion of patients who live even further from Iqaluit and required flights to see us while we were up North. This speaks to the broad and diverse communities that exist up North all across Baffin Island and shows that even more consideration needs to be made with respect to geographic constraints.
- What are some creative solutions that you or the team came up with to face this/these challenge(s)?
We brought up our own medication for injection which I did have to store in my fridge apartment before flying up North. We also made sure to maximize the space that was available to us. For example, most patients who receive an injection require a form of imaging of the eye called an OCT just before the injection to confirm that this is indicated. We repurposed one of the clinic rooms to have the OCT machine and the injection equipment in one room. The resident would do the OCT themselves, discuss the results with the patient, and then proceed with doing the injection right in that room.
OCT/Injection Room
- What are some of the most common pathologies encountered?
Generally speaking, common eye issues were also common up North. This would include diabetic retinopathy, primary open angle glaucoma, cataracts, strabismus, etc. Certainly, we saw a lot of acute and chronic angle closure glaucoma which is known to be of higher prevalence in this population. Therefore, laser peripheral iridotomy was a very common procedure for us, doing many of them throughout the day on each clinic day.
- What are some of the procedures offered during this rotation?
As I briefly mentioned above common procedures for us were laser iridotomy, laser capsuotomy, laser retinopexy, chalazion excision, lateral tarsal strip procedures, other basic eyelid procedures such as epiblepharon repair, and strabismus surgery. We also did many intravitreal injections throughout the day on most clinic days. We do not have an operating microscope up North, so any intraocular surgery such as cataract surgery is done down in Ottawa.
- What future opportunities do you see for delivering care in remote regions? Do you see teleophthalmology playing a greater role for screening and diagnoses?
We have recently been discussing the possibility of having fundus cameras brought up North to facilitate remote screening for diseases such as diabetic retinopathy. We already have a similar setup here in Ottawa in our new downtown clinic in a community health center. We are hoping to implement a similar system up North as well although this is currently in its early stages. This would be a massive benefit to patients limiting the travel time required for these regular screenings which can be quite lengthy even within Baffin Island. Better access to screening in cases such as diabetic retinopathy can be invaluable in the prevention of blinding complications of the disease.
- How might residency programs and practicing ophthalmologists help to alleviate some of the challenges of delivering care in Baffin Island and are there opportunities for more involvement?
I think that just being able to travel up to Baffin Island as a resident has a very beneficial effect on each of us in terms of increasing our knowledge of what is available up North. There are in fact more resources than a resident might realize, including more regular care provided by optometrists who can also travel to the other remote communities on Baffin Island. Making the knowledge of this landscape more disseminated amongst residents would be helpful when dealing with cases on call or establishing follow-up for these patients. This was what motivated me to give a talk on this topic at the Sally Letson Symposium to describe the available resources to some of the team down here.
- Do you have any advice or tips for aspiring ophthalmologists who wish to make rural and remote medicine and other global health initiatives part of their practice?
In these settings, you will be tasked with providing very comprehensive care to the population as there is limited access to various subspecialists. So, one would expect to see a variety of conditions including pediatric ophthalmology and strabismus, retinal problems, corneal disease, and other conditions that might not typically come through a comprehensive practice in a larger city. Personally, I find this scope of practice very appealing, and I like having the ability to apply a broader set of skills that I gained during my residency.
Thank you to Dr. Jim Denstedt for sharing his experiences.
Laser Room