Resilience and Recovery

How a community-led mobilization of local and provincial health services helped La Loche beat back COVID-19

By Girard Hengen | Photo credit Hilary Aadland

When the remote northern village of La Loche overcame an outbreak of COVID-19 early in 2020, the massive effort to squelch the virus was lauded as a success. But for physicians looking back more than a year later, that success is hard to define.

“It is a success story in terms of how the outbreak was managed, how everything came together and the ultimate outcome – because it could have been worse – but the fact that people still lost their lives was still pretty difficult to deal with,” said Dr. Moliehi Khaketla, Medical Health Officer with the Northern Saskatchewan Population Health Unit based in La Ronge.

Dr. Moliehi Khaketla, Medical Health Officer with the Northern Saskatchewan Population Health Unit

“The fear and anxiety that people had was understandable, particularly when northern communities including La Loche started losing residents as a result of COVID-19,” she said. “Communities had to adjust to grieving and paying respects to loved ones in a different way – that presented an additional layer of complexity to a very challenging situation.”

The first case of COVID-19 in La Loche appeared in early April 2020. A public health investigation determined the infection was linked to travel from northern Alberta. By mid-April, an outbreak of COVID-19 was declared at the local long-term care facility. Subsequent community transmission resulted in more than 250 people being confirmed positive, dozens hospitalized, and several deaths by the end of May 2020.

Health resources at local and provincial levels were mobilized to deal with what at the time was the largest outbreak in Saskatchewan and the first in a remote Indigenous community in Canada. This, in combination with travel restrictions and door-to-door testing, ultimately helped disrupt the spread of disease within the communities of La Loche and neighbouring Clearwater River Dene Nation.

Dr. Khaketla had just returned from maternity leave when the World Health Organization declared COVID-19 a pandemic on March 11, 2020. Shortly thereafter, she and her northern public health team were faced with an unprecedented pandemic crisis that significantly increased their workload. Fortunately, her mother was able to assist her and her husband with much needed child care.

“The experience did take its toll because there was so much uncertainty around how things would evolve. Evidence was changing rapidly, and there were various demands for information, in addition to case investigation, contact tracing, data analysis and reporting, monitoring of cases, and dealing with issues related to enforcement.”

On the ground working in La Loche, Dr. Laura Remarck was energized by a community that amazed and inspired her.

“We received so much energy and inspiration from a community that continued to shine in terms of their strength, their resilience, their capacity for hope, their capacity for generosity and hospitality,” she said. “We were so profoundly touched, humbled, and amazed by this beloved community, and that seemed to help us stay strong and committed.”

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Dr. Remarck had spent her career in community health and was practising in the United States before coming to La Loche. When the first cases of COVID-19 appeared, “we took it by the horns, essentially,” she said.

An emergency operations centre was established with village and reserve leadership, while the Saskatchewan Health Authority and the Northern Inter-Tribal Health Authority (NITHA) provided support. Nurses and staff were brought in from the south. With help from community residents, they knocked on every door to test for the virus, diagnose and self-isolate cases, and gain the trust of a population whose wariness of the health-care system was rooted in generations of trauma and an inherent mistrust of anything public health or health related.

“It was extremely important that our effort be very culturally humble, very culturally sensitive, and very engaging with the community.”

The door-to-door campaign screened 813 houses in La Loche and the nearby communities of Garson Lake, Black Point, and Descharme Lake, as well as 220 houses on the Clearwater River Dene Nation. Test swabs were shipped to the provincial lab in the south, delaying results until the community secured a portable GeneXpert machine for onsite testing.

WE RECEIVED SO MUCH ENERGY AND INSPIRATION FROM A COMMUNITY THAT CONTINUED TO SHINE IN TERMS OF THEIR STRENGTH, THEIR RESILIENCE, THEIR CAPACITY FOR HOPE.

A COVID assessment centre was opened in one wing of the La Loche Community Health Centre, while another wing became a treatment centre. Camper trailers were used to house COVID-positive patients who could not isolate at home, while high-acuity cases were transferred out. A shelter was created with camper trailers for about 32 chronically ill people who needed addictions and alcohol support through a managed alcohol program.

“We were able to do quite a bit to help communities at different levels and with different levels of need,” said Dr. Remarck, “but we couldn’t have done it without our community leaders, the elders, who championed the effort. They led the effort, so we humbly walked behind them as they helped open the doors of trust and allowed for as much coopting as possible.”

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Before specializing in public health and preventive medicine at the University of British Columbia, Dr. Khaketla started her career as a family physician. Having practised in South Africa, New Zealand, and Canada, she is passionate about the intersection of health policy and politics, prevention and control of communicable diseases, and efforts to address structural inequities and racism globally in health care. She was drawn to population and public health, and as part of her post-graduate training completed an internship at the World Health Organization in Geneva. She found the experience and exposure to that level of coordination and expertise helped put the local pandemic response in a context beyond what was happening in Canada in the spring of 2020.

“For public health and preventative medicine specialists, this once-in-a-lifetime event is what we were trained for,” she said. “Community leaders collaborated effectively with the health authorities, with other stakeholders like the Public Safety Agency, local physicians, other community stake holders and organizations to achieve a common goal. That is what public health is about.”

She emphasized that communication was key to managing the outbreak. People waited for daily radio broadcasts that were translated into Dene. “Sometimes we take the value of communication for granted. Early on there was this need for a coordinated and effective communications process. It was important because so many people were involved in this outbreak. It was quite challenging in the early phase, but definitely improved over time.”

She said thankfully, crucial working relationships had been established through years of work in the community with local leaders, the Northern Saskatchewan Population Health Unit, and NITHA. “I am very grateful to work with a remarkable team of public health nurses, community outreach and education workers, public health inspectors, an epidemiologist, administrative support staff, and many others who do not always get recognition. I couldn’t have picked a more rewarding specialty and area of practice as a physician; it is an incredible honor and privilege to be able to make a difference at a population level.”

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More than a year later, long after the outbreak in La Loche was declared over in late summer of 2020, physicians remain vigilant, watching the spread of COVID-19 and its variants of concern. For Dr. Remarck, spring of 2021 in La Loche brought the return of a warming sun, the chirping of birds, and a people once again reborn after tragedy.

“The community is amazing. It went through yet another trauma and here it is thriving…. The community has also been coming back from a year of isolation. That was very difficult for a community that is very family oriented, very hospitable and warm toward each other.’

Dr. Khaketla, too, finds the resilience of the community remarkable, considering its people have endured tragedies and despair. “The pandemic, including the outbreak in La Loche, really highlighted things we already knew existed in the north in terms of inequities,” she said. “This is part of the work that physicians like myself and medical health officer colleagues across Canada do in trying to address these inequities and advocate for adequate investments and resources in public health.

“Lower income, higher unemployment rates, houses that are not in the best shape, overcrowding, food insecurity – all these things have been highlighted and amplified in the context of the pandemic,” she said. “I’m hopeful that some of the work that’s being done around COVID-19 and the pandemic response can help to find longer-term solutions for challenges that people in the north have been living with for decades.

“I’m hopeful that the pandemic presents an opportunity for improvement of the health of northern people.” ◆