Ornge Pulse Podcast

Operation Remote Immunity 2

PULSE: EPISODE 3

May 8, 2021

8 May, 2021

|

Ontario

| By: Par:

Ornge Media

In this episode, we meet Team 6, who detail their journey to deliver vaccinations to the community members of Kashechewan. We also talk to Patrick Auger, Incident Commander for Operation Remote Immunity and Rob Taranishi, Logistics Section Chief for Operation Remote Immunity.


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See episode transcript below:

… Various news clips

Rachel Scott:
If you live in Ontario, you've probably heard of Operation Remote Immunity, or as we call it, ORI. Launched on February 1st, 2021, ORI offers residents in remote indigenous communities access to the Moderna vaccine. Recognizing the critical importance of engaging indigenous leadership and how vaccines are offered to their communities, ORI was co-developed in partnership with the Nishnawbe Aski Nation. Between January and April 2021 vaccination teams under the direction of Ornge traveled to 31 northern remote NAN communities and Moosonee to administer the vaccine to residents who wish to receive it. More than 25,000 doses were delivered. During this episode, we're going to give you an in-depth look at Operation Remote Immunity by talking to team six. You'll hear as they recount their visit to the Saskatchewan First Nation community located near James Bay in northern Ontario. My name is Rachel Scott. Welcome to Ornge Pulse.

Steve Darling:
Our first night in was the adventure.

Dr Laurie Mazurik:
On that day, because we had gone through a bit of an adventure.

Dr Karen Devon:
I'm not sure how much you heard of the adventure from others, but I think if anything could go wrong, it went wrong on that day one.

Patrick Auger:
What's interesting is, on this operation, we're trying not to put our crews into a situation where they overnight, but it's interesting, on day one, week one, of our operation we had one of our teams overnight.

Rob Taranishi:
Their situation in the first week became quite unique because they had to use those kits the first day of ORI. The very first day I'm going, oh boy. Plus the team got separated, so there were some interesting challenges.

Rachel Scott:
February 1st, 2021, marked the launch of Operation Remote Immunity. Weeks of planning was finally put into motion as half a dozen teams embarked from one of three staging areas in preparation for five days of community vaccinations. Team six was no different from the other task force teams. They had a seasoned paramedic as their team lead, as well as doctors and nurses who performed vaccinations, an immense staff who kept them organized, and a site coordinator. Norm Wesley was the site coordinator for team six. Every site coordinator was specifically identified by the Nishnawbe Aski Nation as someone who was familiar with the community and able to support on the ground activities. This is Norm. He is a teacher.

Norm Wesley:
Teaching is my career, my profession. Elementary school, high school, secondary school. I'm a former chief of the Moose Cree First Nation and chairman of the Muskegog Tribal Council. Yes, it's called Band Chief these days, and I've done an awful lot of things.

Rachel Scott:
So where do you live? Where are you from?

Norm Wesley:
I live in Moose Factory, Ontario, it's a community that's about, oh, I think there's about 4,000 people here, give or take. I never actually did a count but it's a small community compared to Toronto. It's called the oldest English speaking settlement in Moose Factory, along with Kingston, Ontario, I think. But well over 300 years, I believe it is, or something like that.

Rachel Scott:
According to Parks Canada, it was founded in 1673 and established as a fur trading post called Moose Fort by the Hudson's Bay Company. That makes it just under 350 years old. So, Norm, how did you get involved with Operation Remote Immunity?

Norm Wesley:
I am the community relations consultant with the Weeneebayko Health Authority in James Bay here and I have been called in to accompany the vaccinations team into the communities along James Bay with the WAHA, as it's called. And we usually depart from Moose Factory. I do anyhow, I get up early in the morning and I have a very quick breakfast, I head over to the airport at Moosonee and we jump on the plane, the Ornge charter, to take us to these communities north of here, in this case it was Kashechewan.

Rachel Scott:
So Norm's in Moosonee waiting for team six to fly in from Timmins. The plan is to pick them up as well as an additional group of vaccinators provided by the Weeneebayko Health Authority, WAHA, and then the entire group will set off to Kashechewan. Before I introduce you to the rest of the team six, I want you to meet Pat Auger. He's a critical care paramedic with Ornge, but he's currently the incident manager for Operation Remote Immunity. Hey, Pat. Do you mind discussion a bit about the remote communities that have been identified?

Patrick Auger:
Fly-in communities. We've actually identified 36 sites that we'll be supporting and some of those supports are certainly human resources, some of them are medical consumables, delivery of vaccine and we're also providing some supports around technical advice related to assisting the communities in roles and responsibilities and helping them get the vaccine clinics up and running.

Rachel Scott:
So prior to COVID, Ornge was regularly involved with transporting patients from these communities, can you give a bit of insight into that or maybe touch on some of the considerations looked into for ORI?

Patrick Auger:
Within the healthcare system itself there are issues around health equity in that many of these communities while they might have a nursing station they don't necessarily have a dedicated family medicine clinic or a hospital that you can go to. Ornge in many cases for these communities provides that linkage to not only acute care but primary care support in terms of moving people in and out of communities. And so our site coordinators in the community, this is very much a cooperative working relationship in we have to recognize that we are dealing with 31 independent communities.

Patrick Auger:
All of the communities have challenges related to infrastructure support, healthcare resources, et cetera. And so what the NAN did was they established a framework at the community level to provide site coordinators and the site coordinators are absolutely essential to the success of this operation because they know their communities, they know the culture of the communities. In many cases, as an example, depending on the community that we go to, before we start vaccinations there may be a prayer, there might be a ceremony, in some cases the vaccine itself is blessed and these are all important considerations when we're trying to get by and in community support.

Rachel Scott:
It's great to hear about collaboration within each community. Do you mind talking a bit about how you plan an operation as complex as this?

Patrick Auger:
To put it into context, some of the aircraft are flying the equivalent of Toronto down to Florida and back or the Gulf of Mexico and back. And we are moving human resources, medical consumables and vaccines following a very strict call chain protocol related to that. And what I would see in terms of the complexities around it, to start, it really required implementing what's called an IMS framework or Incident Management System framework that covers off everything from medical direction, where we have a specific medical director for Operation Remote Immunity, liaison officers for community engagement and recce, we have a planning section that just focuses on incident management documentation and planning an operational cycle. And there's a tremendous amount of planning that goes in place because we are dealing with a multitude of organizations and various levels of government.

Rachel Scott:
So I did read the incident action plan as well as the introduction package, it's about 250 plus pages of clearly laid out planning, it included day-to-day tactical operations, key positions, logistics, scope, objectives, flight operations. It had team members, job action sheets, schedules, safety documentation. It even had floor plans, layouts, locations, check-lists, protocols and everything in-between. But the one part that really just jumped out to me was the first page. There was a big black box highlighting the 12 guiding principles laid out by NAN that Operation Remote Immunity would work within. These guidelines were imperative and it was clear that they were established to ensure that this operation was a success. It included guidelines like vaccination teams must be vaccinated, ORI must implement a phased approach by region, translation and translators must be provided at the clinic. Not only was this project well planned, but it was a collaborative effort made with intention. Anyways, I guess it's time you meet team six. Here's Steve Darling. He was the team lead.

Steve Darling:
Steve Darling, I'm the critical care paramedic at the GTE base. I have had the opportunity to be team lead for Operation Remote Immunity for team six which was based out of Timmins and services the James Bay and Hudson Bay coast.

Rachel Scott:
So how long have you been working with Ornge?

Steve Darling:
I've been involved with air ambulance since '88 and paramedic since '83. Our base of operations was out of Timmins. From that location I guess it was pretty strategic. We were able to service the James Bay, Hudson Bay coast communities and then be able to return to Timmins for resupplying, reorganization, et cetera.

Rachel Scott:
Can you tell me a bit about your team?

Speaker 5:
I had Dr. Laurie Mazurik as the 2ic as it's called, the second in command. And we've worked together for at least 25 years, so we sort of know each other. We hadn't work that closely together, but that was great.

Dr Laurie Mazurik:
Hi, my name is Laurie Mazurik. I am a transport physician with Ornge, Sunnybrook staff emergency physician for probably at least 25 years or so.

Steve Darling:
Then I had an interesting group. I had a EMERGE physician from UHN, I had a vascular surgeon from William Osler and I had a general surgeon from UHN.

Dr Karen Devon:
I'm Karen Devon, I'm an endocrine surgeon and surgical ethicist at Women's College Hospital and UHN in Toronto.

Rachel Scott:
Okay, so I just have to interject for one moment. Dr. Karen Devon was about 30 seconds late for our Zoom meeting. She had just successfully completed an operation and took a moment to have a chat with me.

Dr Karen Devon:
Oh, I was doing a parathyroidectomy, an operation to remove the parathyroid glands in a patient who needs them removed. And there's always something unexpected so it took a little bit longer than anticipated.

Rachel Scott:
She's also an ethicist and had some really interesting side thoughts.

Dr Karen Devon:
Every decision we make is an ethics issue, who to give the vaccine to first is an ethics issue, whether to emit the carbon dioxide it requires to fly to all these places is an ethics issue. Literally everything we do is ethics, but we don't spend as much time necessarily thinking about those things until they come to the forefront like they have with COVID, all of a sudden ethicist are in high demand.

Rachel Scott:
Anyways, back to Steve.

Steve Darling:
This group as well, they're pretty motivated with remote medicine. Dr. Mazurik, she's doing locums up and down the James Bay Coast as well at this time, so she's very familiar.

Dr Laurie Mazurik:
I have another kind of sort of informal role with Ornge and that's as a liaison for a project I started called Stronger, which I've taken a year off of Sunnybrook and I'm working exclusively in the north so in predominantly First Nations communities as a way to find out better ways we can work with stakeholders in those regions, et cetera.

Steve Darling:
And it worked out really well because our first flight in was the adventure.

Dr Karen Devon:
As we had gone through this sort of a bit of an adventure we all really bonded and so it was like a great team from there on in.

Dr Laurie Mazurik:
Yeah, that was an adventure, so I'm not sure how much you heard of the adventure from others but I think if anything could go wrong it went wrong on that day one. But the result of it was an amazing bonding between us and the WAHA team.

Rachel Scott:
Okay, so before we get into the adventure, can you tell me a bit about Kashechewan, have you been there before?

Steve Darling:
So I'd been up there for five days already just doing site visits. So I had been to Kash once and I've had limited experience, but I'd been into the communities up there so I sort of knew what to expect.

Rachel Scott:
So Dr. Devon, can you tell me a bit about what you did to prepare?

Dr Karen Devon:
Well, first of all, we had some cultural sensitivity training and when you get the link for online training, it's not always that exciting a prospect, this training was phenomenal. The training in indigenous issues was just extremely educational and engaging. It takes at least eight hours but you can spend many more than that and there's still an ongoing discussion in my group on that training module. So it was absolutely super, super worthwhile. And then the next morning was go time and so...

Steve Darling:
It was a Monday morning, we'd already done our training the day before. We met out at the airport and we'd gotten our vaccine. We left Timmins and we stopped in Moosonee to pick up a WAHA group of paramedics and nurses and then up to Kash. And so as luck would have it, the weather came in and we missed the approach.

Dr Karen Devon:
We did this thing where we actually started doing the landing approach and I guess there's a certain altitude at which at that point the pilots have to be able to see the runway and otherwise you sort of go back up, so that's what we did. We sort of went down, and down, and down, and it was foggy and up we went. So those of us who don't do this often were like, that was interesting.

Steve Darling:
So we couldn't get into Kash immediately so we returned to Moosonee to wait out the weather.

Dr Laurie Mazurik:
So as we get off the aircraft we find out that we're weathered in, we cannot get into Kashechewan. In fact, I think we had tried to get in, we missed and ended up in Moosonee. And so there we are faced with the dilemma of how do we get to Kashechewan because we can't fly, there's ice fog and the visibility isn't such. This is around 10:00 in the morning so it might be clear at about 13:00, but then that gives us two or three hours to vaccinate and then they'd booked 150 people.

Steve Darling:
Because the weather to the south of Moosonee was fine, I'd talked to Mr. Auger back at the command, so because of the weather that's so unpredictable at the coast I told him to plan for two days in community.

Dr Laurie Mazurik:
To ensure people come out. We cannot fail to get there on this day. So we sort of huddled as a team and immediately the team said, well, can we go there by ice road? We have survival gear, we can just break it out and sleep on the floor in the school like we don't care. We're with you on this. We support you. We're here to help. We don't care if we don't have accomodation, we're going and this is why we're here and we're with you on this. We were completely willing to do whatever to make this happen and I think all of us coming from the south who know people we would like to see immunized knew the value of the immunization and felt that this is important to do.

Dr Karen Devon:
And we were delayed by about five hours and we decided as a team, team six, that if we every did get to our destinations, because we were supposed to be vaccinating people all day already, we were supposed to start at 9:00 AM and we were worried that people would have come and then not get and then that's obviously not a great start. So we decided as a group that if we could, we would stay in the community that evening so that we could have a late clinic and an early start. And so it was an adventure.

Rachel Scott:
Okay. So quick recap. Team six is ready to go but on their way to Kashechewan it turns out the weather's preventing them from flying in. So there seems to be quite a lot of logistics at play here. To talk a bit about some of the logistics involved, I spoke to Rob Taranishi.

Rob Taranishi:
My name is Rob Taranishi, I'm a critical care paramedic with Ornge, currently I'm also in the position of standards paramedic with Ornge and my position with Operation Remote Immunity is logistics section chief.

Rachel Scott:
So as logistics section chief, what are some of the responsibilities for your role?

Rob Taranishi:
My job as logistics section chief is to make sure that all the equipment, vaccine especially is handled correctly, and the inventory is up to date, and basically trying to get everything that the operation requires.

Rachel Scott:
Can you tell me a bit about some of the logistical challenges or new technology that came with this project?

Rob Taranishi:
We needed to find a mechanism to transport the vaccine. The vaccine is Moderna and it needs to be frozen for us to travel by air, or really by any means it need to be in a frozen state, which logistically brings up some challenges because it has to be maintained between -15 degrees Celsius to -25 degrees Celsius. So it can't just be put into any sort of cooler. So we had to actually find a cooler that was able to maintain a temperature of about -20 for long periods of time because if any weather issues came up or any sort of mechanical issues with the aircraft the teams would be staying in the communities perhaps 48 hours, maybe 72.

Rob Taranishi:
So we went with what's called the Credo Cube, which is new to our system. We obviously don't need to use it for anything else other than the vaccine. And with that also we needed a device to be able to monitor the temperature. We went with an organization called Blue Rover and their device actually uses cell coverage and provides us constant monitoring of the temperature inside the cube where the vaccine is being held, so that was kind of new technology for us to get familiar with as well.

Rachel Scott:
I also see that there is an overnight kit for teams.

Rob Taranishi:
During the planning process, one of the big things for safety was to have overnight kits. So we had to come up with kits that would accommodate in case they can't get back home. Some communities will have places, others will have say, a community center and maybe the team can stay in there. So what we developed are kits that would have a sleeping bag, a cot, some food in case they were unable to get any food, but these kits would have to be carried with them every day on the plane. So we had to come up with something that was relatively small enough to get into a plane but still had enough to accommodate each team member. So having the cardiac monitor and having all these things was on the list that we worked towards and then we had to find it. We had to get it and make sure that it was all at the hubs so that they can all operationalize that.

Rachel Scott:
So when Rob refers to a hub, he's talking about one of three staging areas. Thunder Bay, Timmins and Sioux Lookout were identified as the best launching points to fly into the 31 remote communities. Each of these locations are in close proximity to an Ornge base, this means it's a bit easier to book hotel accommodations and conference rooms for storing of equipment and supplies.

Rob Taranishi:
So sometime the challenge is we don't get too much notice, so having to kind of really think on our toes. And some places like Timmins and Thunder Bay we can get most of the equipment shipped relatively quickly, in some case probably the next day. Sioux Lookout is a little bit different, it takes us probably up to four days to get anything couriered up there. So the challenge is trying to get the equipment there, trying to get a Credo Cube, sometimes there's a bit of a lead time to get that from the manufacturer. So it's been very interesting, and hectic, and fun I guess all at the same time. It's quite a challenge sometimes, we might only get a couple of days notice that we're going to expand a team or we're going to send a team to a different location and they need to bring vaccine with them as well.

Rachel Scott:
So as a paramedic, have you had any experience working with patients in these northern communities? Have you gone on a recce or reconnaissance mission for ORI?

Rob Taranishi:
I have not gone on any recce missions. I had the privilege on Monday to escort Grand Chief Alvin Fiddler, grand chief of NAN. He was traveling to Sandy Lake to get his vaccination, so I was very fortunate to accompany him and spent the day with him and he was very, very complimentary of Ornge and was able to kind of meet the community members and the chief of Sandy Lake. It was very rewarding to meet that way of getting to see different kind of... We're there for different reasons. We're not there to transport, we're there to provided vaccinations, we're there in a different capacity. So for me, it's been, like I said, very rewarding and I was very fortunate of getting to listen to some stories. It was pretty amazing for me. I'm very lucky that way. So in my career, it's definitely a highlight of my career.

Rachel Scott:
Okay. So we heard about logistics, we heard about the plan and now we're going back to team six to hear about the rest of their adventure.

Steve Darling:
So the weather cleared, so we strategized and sent the plane up with all of our team, team six, and all of the WAHA staff to open clinic. It would have been about two and half hours late, but it was still open.

Dr Laurie Mazurik:
When the weather lifted, all of us except Steve were then able to fly into Kashechewan in order to... We took the vaccines we have so we could start. We could fly into Kashechewan, and set up, and deliver those initial 60 while Steve and Norm would drive by the ice road to bring the vaccine up. The aircraft then had to leave and we all knew that was going to happen and we knew we were going to sleep wherever and we didn't care.

Dr Karen Devon:
Actually, when we got off the airplane and we're greeted by sort of the rangers there was a lot of cheering, which was really nice to arrive to cheers. And then they piled us into five pick-up trucks with all our stuff and we just got going. So it started out, it was great. I think at least the first group of people that were there were obviously the most motivated to get the vaccine and the people with the least apprehension. And so the first few hours were sort of quite smooth, great team work and we decided as a team, team six, that if we could, we would stay in the community that evening so that we could have a late clinic and an early start.

Dr Laurie Mazurik:
We just wanted to deliver the vaccine, so we started I think at about 15:30, it was amazing. Seriously, it was amazing. I think most of us thought it could have really gone bad but it turned out to be amazing and it's a tribute to the people that were there who decided to work together.

Steve Darling:
And then once the plane came back from Timmins with more vaccine and then Norm Wesley and myself drove up on the ice road.

Norm Wesley:
In Kashechewan we had ice crystals and we had to delay the flight. The flight was delayed until 13:30 in the afternoon And the team went up. And Steve Darling and I stayed back to wait for the balance of the vaccine to arrive and then we drove up the winter road for two and a half hours to catch up with the team with all the products.

Steve Darling:
So that was two and a half hours with an elder to share all his experiences growing up with residential schools and then the verbal history stories were just incredible about Hudson Bay Company back in the 1600, 1700s.

Norm Wesley:
I'm 71 years old. Well, not quite. I'm going to be 71 in June. And I guess that make me an older person and you were asking me, what elders are? Elders are people that listen, elders are people that care, elders are people who love their people, who love humanity and want to do the right thing. And if any of that is within me then I guess that makes me an elder. Am I perfect? No. Do I make mistakes? Yes. Do I love my people? Yes. So some people say I am an elder and I feel very humbled in being called that. At times when I do make some mistakes, which is usually every day, I feel lesser then. But that's who elders are. It's not who you think you are, it's how people see you and if people see you as an elder then indeed you are an elder.

Steve Darling:
So up the ice road we went. The scenery was absolutely gorgeous. So we arrived in Kash at approximately 13:00, I can't remember the exact time. But the more significant thing was we arrived just as they were giving the last of the vaccine that they had. So with a little delay just to prepare more vials of the vaccine, away we went and we had enough supplies so we extended the clinic until about 21:00 at night. We were supposed to be finished at 17:00. So absolutely nobody blinked an eye at it and everybody seemed happy so we served the community.

Norm Wesley:
And the vaccination went from, oh, I think it was 15:00 to about near 22:00 at night. And we covered alot of ground.

Dr Laurie Mazurik:
And at the end of it we had enough vehicles, Steve had enough vaccine, we were committed to stay in community, we shift the time from whenever we got there till nobody was willing to come, so we though we'd cut off at 21:30 at night. At the end of that day, I would say, every single on of us thought, man, that was singularly amazing that we could start off in such difficult challenges, it's not like a bomb blew up, don't get me wrong, but with such difficult challenges which it could have gone very badly that went incredibly well. And I think that solidified the subsequent success.

Steve Darling:
First night in was the adventure, so we spent the night in community.

Dr Laurie Mazurik:
The community brought us food, they found accommodation for everybody because WAHA had to stay too as well.

Steve Darling:
And then we spent overnight.

Dr Laurie Mazurik:
So we all slept in different places in the community. I think our Ornge team of six, they somehow got us into a bed and breakfast. Steve and I gave the four beds to the vaccinators and Jennifer.

Steve Darling:
They found us a bed and breakfast and we got in there, it was basically two construction trailers put together, there was enough beds and couches for everybody but me, so I pulled up a piece of hardwood floor and spent the night.

Dr Laurie Mazurik:
Steve, God bless his soul, he took the floor and I got the couch and it's interesting, a lot of people said, that was the best sleep for my whole week. So I think it's probably just because we were all tired.

Steve Darling:
But everybody was in really good spirits and I think that was really key to it and the community were appreciative of that because we didn't miss a vaccination day. Fortunately, concession one is the only Tim Hortons up the coast, so I was able to supply them coffee in the morning and they were happy.

Norm Wesley:
We got up in the morning and started vaccinating people again at 10:00.

Rachel Scott:
Okay, so can we talk a bit about the building it was in and how it was organized?

Steve Darling:
I would say, a typical school, nice gym and your typical double basketball court type of gym. They had organized it with a sort of floor plan, so they had a nice flow.

Dr Karen Devon:
So we got to the gymnasium of the school and it was already extremely organized. It was really no different than the clinic I had attended for my own vaccination in Toronto. There were tons of people out to help in terms of the logistics, the forms, et cetera.

Norm Wesley:
Very well organized and the layout, the vaccination clinic area worked quite well, very professionally.

Steve Darling:
People could come in and register, write in, into a waiting area and then they'd go to 1 of 10 vaccination stations, a little waiting area, and then they were on their way.

Dr Laurie Mazurik:
WAHA was extremely well prepared. They had three medics, they had a couple of docs, they had their gear, they had all done this before. In Kashechewan the nursing stations had already committed at least three nurses to come and assist as well. Who had previously, they usually do the flu vaccinations so they're skilled immunizers and in addition they had I think at least 10 and possibly a dozen people, screeners at the door who did the paperwork. So they really created a highly efficient system where we could literally fly through immunizations.

Steve Darling:
So my sort of role was support completely. So Jennifer Young and I sort of stayed at the back of the room and she was the documentation person. And Laurie Mazurik sort of ran the floor. So the vaccinators were WAHA people and our staff as well. It was a mix and some FNIHB  nurses as well. So I would sort of stay at the back and the key to it is because the processing time is very stringent, I just sort of sat there and watched the amount of people that were coming in, and Jennifer would give me feedback as far as how many pieces of documentation are in, so that's how many people have been vaccinated. And then I would try to stay about 20 vaccinations ahead, so I would just draw them up and I'd lay them on the table. So I never left that position and Laurie would run the floor and she would bring the new vaccination loaded needles out to the staff. So there was walking around or minimized walking around anyway.

Dr Laurie Mazurik:
We had to, what I would call, thaw and draw as fast as we could to get as many vaccines out as possible because they were literally just flying off the shelf. So I became a goffer with a certain natural evolution to things that fit my skills and Steve took over a natural evolution that took his skills. And I think it worked extremely well. And then from there it was a really solid unified kind of team approach. We had people faint, we had people that seemed to have allergic reactions, we had just about everything on that first day. So we learnt very rapidly how to draw up vaccines super fast, how to anticipate who might faint, and where to put them, and how to manage them and things like that.

Dr Laurie Mazurik:
That day was probably the biggest learning experience for any of us, because I'm a physician and Steve is a medic, so Steve being more familiar with the logistics, the vaccines and the incident command part of things, he basically did that aspect. All logistics, all reporting, all sort of organization of meals, flights, anything else that we need he would look after it. He's also had to be the listener to all. Physicians tend to air their ideas whether they are welcomed or not, he had to listen to many ideas and try to ensure that all were heard and that we came to consensus, so that would his role.

Dr Laurie Mazurik:
I think my role evolved to being kind of the medical consultant. In other words, I was the... I like restaurant wars and all these sort of like top chef, the expediter at the pass, which means, I would check the processes from the start to the finish. So I checked to make sure the screeners are ready, that they knew what had to do and Jennifer Young did that as well. As people came in and sit down, I would try my best, but we had crowds, to direct them to open spots. And for the vaccinators, if the vaccinators had questions that they couldn't answer with regards to indication, contrary indications or any kinds of special measures we needed to take with a patient, I would answer those questions. If patients wanted a physician and a physician wasn't available, I would provide the physician consult to a paramedic or a nurse vaccinator on behalf of that patient.

Steve Darling:
At the same time there was a volunteer who watched the staff after they had been vaccinated for the 15 minutes or if they were at risk for 30 minutes. And then if there were any incidents at all, I would excuse myself from where I was and Laurie would come over and we'd do some care for the patients.

Rachel Scott:
So what was the promotion like, how did you get more members of the community to show up and participate?

Dr Laurie Mazurik:
To get people to come, Norm, Lynn, the chief, all got on the radio, they all did live face time streaming and got people to come and this was a pattern that continued every single day after that.

Dr Karen Devon:
I was asked by the CEO of the Weeneebayko Health Authority if I would come with her and be the doc on the local radio. So we went into sort of a trailer which was the radio host trailer and we were on. So we basically were just speaking directly to the community, I think talking about the importance of the vaccine and everything was translated into Cree or Cree Ojibwe.

Norm Wesley:
We did a lot of reaching out to people to encourage them and I would go on the radio, the local radio, to talk to people about the importance of being vaccinated, and what herd immunity is all about, and other things about protecting not only yourself but your children, or your grand children, your grand parents, that kind of stuff.

Dr Karen Devon:
We talked about information around the vaccine, we tried to dispel some myths about the vaccine, for example, who's contraindicated.

Norm Wesley:
People are hesitant, there's of course a lot of people who are on Facebook, there's a lot of misinformation.

Dr Karen Devon:
We invited people to come and talk to us even if they didn't think they wanted to get the vaccine because the conversation was free. And that I think was on day two and it made quite a difference, there was quite a rush kind of after that announcement, so that was sort of unexpected and fun.

Norm Wesley:
We had a very good turnout towards the end of the day. We had a lot of younger people showing up and that was very encouraging. And I was talking to one young lady there and she was very, very nervous about being vaccinated and stuff. And then she mustered up all the courage she could to come there and she came there with her sister and she was very, very nervous and stuff but she dit it and it was absolutely awesome.

Dr Karen Devon:
There were people who were very motivated, there people who were I think quite apprehensive but willing and there was the people in between.

Norm Wesley:
In one case we had one gentleman come in and he had a long chat with one of the Ornge doctors, and along with our president from WAHA, and kind of found out about this vaccine and he wasn't sure because of what he's heard. And it turned out that he was very pleased with what he heard and he went home and brought his family in to be vaccinated, so it was all good.

Dr Karen Devon:
Certainly having access, the easy, was a major driver of that happening. I think for some if they had to make a significant effort to get to us it would have been different. We also did a few home visits for people who literally could not leave the home.

Rachel Scott:
Team six and this mission seem like a success. On February 3rd, Chief Leo Friday announced that the vaccination drive was successful with 73% of individuals over the age of 18 who were able to take the vaccine were vaccinated. Did you have any final thoughts, or any experiences, or any insights from your journey?

Dr Karen Devon:
This trip was almost career changing for me, I think. I mean, we'll see where I go, but I think that was totally unexpected. I knew I was going to do some good, and probably enjoy parts of it, and seeing that part of our country, but I don't think I knew that it was going to have such an impact personally. I most certainly plan to go back, probably both as a visitor potentially with my family, but I have been thinking of ways to connect in particular with some of the people that I met there and see what kind of things we can collaborate on and what kind of services I might be able to provide or help develop from the inside out. So there's no doubt that there will be further future visits from me.

Steve Darling:
I'm pretty well a southern boy. I haven't had much experience up north. I have had experience enough to sort of know how to conduct myself and nothing's a surprise up there but most of my experience up here was just teaching, come up and preach up here and then leave again. When we're up here with the air ambulance it's sort of we're up here for a reason and it's sort of rush, rush and we're sort of focused on the patient at hand and you can't really interact with the people.

But there's lots of opportunity to look after the people, not in Kash specifically but we ate bannock, we had moose, we had lots of different things. We participated in a closing ceremony at one location, I think it was Fort Albany, as well, so that was quite special, quite amazing. I really want to stress that this is not an Ornge project, we are not the lead on this project, we are not the feet on the ground, we are there to assist WAHA with the logistics. They are the face of the community when Ornge leaves so I think it's important that we work in partnership. I think Ornge just has to come in just being very humble and very appreciative that we had the opportunity to participate, not do.

Dr Laurie Mazurik:
I think with their desire, the communities desire to have the vaccine, thank goodness because I can tell you that initially there was a lot of concerns about the vaccine. But anyway, cooler kids came to bear. It's probably the number one difference to the First Nations community with regards to COVID and COVID's impact, I think we will see, I'm hoping because there are variants, but as long as this vaccine does what it's supposed to do it will I think be life saving in many instances regardless of who gets it and certainly that's a big difference to small communities with minimal resources.

Dr Karen Devon:
Sometimes the reasons why we do things are nuanced, but I have absolutely not doubt that prioritizing these communities with respect to the COVID vaccine is the only right thing to do. There's not doubt in my mind that is the case based on both the health services that are normally available there and the devastation that an outbreak would cause, I have absolutely no doubt.

Rachel Scott:
Was there anything else, do you have any other highlights?

Dr Karen Devon:
The unexpected bonus for me was getting to know some of the indigenous health care workers and a community elder who travels along with us, Norm Wesley, that was definitely a highlight.

Rachel Scott:
We had a brief chat and I thought it was only right to close off this episode with some insight from a community elder like Norm Wesley.

Norm Wesley:
Well, when we were in one of the communities I was thinking how am I going to relate to people in terms of trying to convince them on what is this that you're doing when you get this vaccine and why it's important that we get as many people to come out and get vaccinated. And this image kind of came to my mind where we have this musk ox in the far Arctic that you find in the barren tundra and very little protection I guess you can say, just ice, and rock, and snow, and stuff. And they survive the harshest of climates and because of their size they're not at the top of the food chain, the wolves are and the wolves will chase down these huge musk ox's, and if you're alone then you're food for the wolf, so if you're in a herd then you can run as a herd and then when you get tired you're pursued by a whole bunch of wolves, then the musk ox will stop and they will turn and they will form a circle, each of them will start facing outward and the younger and the weaker will be in the middle and they challenge and take on the wolves.
In the case of COVID-19, the virus, they're the wolves, the musk ox, that's us. The vaccinated are the ones standing around in the circle protecting themselves, and protecting each other, and protecting those people who cannot be vaccinated or who chose not to be vaccinated and the young people, so that's the image I have of what we do when we personally are vaccinated and what we do when we are vaccinated in large numbers. And of course we talk about herd immunity and we try to strive for this magical number of 75% of the total population to protect ourselves as best we can. Is there a guarantee that we will not get COVID-19? No, there is no guarantee. Is there a guarantee that all the musk ox will survive when they make the circle? No, there's no guarantee. But we do what we can to protect ourselves.

Rachel Scott:
I think it's important to remember that this is just one story, one mission, one community. There are so many stories and experiences out there, but thank you for coming along on this journey. I'm Rachel Scott and this is Ornge Pulse. This podcast could not have been completed without help from staff on team Ornge. More importantly Operation Remote Immunity was only possible due to the collaboration from a number of partners, the Weeneebayko Area Health Authority, the Sioux Lookout First Nations Health Authority, Indigenous Services Canada, the Northern Ontario School of Medicine, Queens University, the University of Toronto, Northern Paramedic Services, the Porcupine Health Unit, the Thunder Bay District Health Unit, the North Western Health Unit, the Ministry of Natural Resources and Forestry, the Canadian Red Cross, the rangers and many more.

Note: Members from Team 6 interviewed for this episode include: Steve Darling CCP (Team Lead), Dr Laurie Mazurik (2IC), Dr Karen Devon (Vaccinator), and Norm Wesley (Community Coordinator).
 
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Ornge is the largest provider of air and land ambulance services in Canada. We perform more than 20,000 patient-related transports per year. This podcast will give you insight to the inner workings of our organization.

From coordinating and dispatching calls, triaging patients across the province, and the logistics that come with operating a fleet a helicopters, planes and land ambulances. We will tell you what it takes to deliver life saving care in an ever changing environment. Download PULSE on your favourite podcast app, or visit www.ornge.ca/pulse for the latest episode.

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