Researchers Under the Scope

Dr. Stu Skinner & Mobile Medicine: Halting Syphilis & HIVStuart Skinner (MD) knew something was wrong three years ago, when patients started coming to him with vision loss, fever, rashes, and meningitis. Almost every case could be traced back to untreated syphilis — a sexually transmitted infection with caseloads exploding 1,200 per cent from 2017. Saskatchewan saw this spike just as Covid-19 entered the picture. "With the pandemic, testing dropped dramatically," Skinner said, noting this wave of syphilis entered north-western Saskatchewan from Alberta, often travelling alongside HIV. Syphilis often spreads through sores, and can remain unnoticed for months or years on end, making early detection difficult. "If you don't see it, you won't be seeking care for it." When the infectious diseases physician and the Wellness Wheel team began treating mothers with severely ill newborns, stillbirths and birth defects, Skinner knew he had to act. Treating syphilis usually means a series of clinic and laboratory appointments, followed by intramuscular Bicillin injections, and intense contact tracing. Instead, Skinner, Dr. Sean Rourke, Cara Spence and their teams pared that down to a one-hour stop. They approached tribal councils and Indigenous-led health organizations, asking for help setting up mobile locations where anyone could be tested, diagnosed, and offered treatment. Nursing teams drove vans to powwows, festivals, even pharmacies, offering quick, confidential finger-prick tests and results. "The whole concept was to be flexible and mobile and adaptable . . . . so that we weren't the barrier," said Skinner. "It wasn't easy for the nurses to set up and read the results or draw the blood in a less comfortable environment, but they did an amazing job." In Saskatchewan, a total of 1,797 people agreed to be tested, uptake Skinner calls 'phenomenal'. Roughly three per cent were infected with HIV; 16% had syphilis. "The majority were willing to get treated right then and there," Skinner said. Those teams have now visited more than 50 locations across the prairies, through a $4M national partnership called the 'Ayaangwaamiziwin' Centre — which translates to 'be careful, be prepared' in Anishinaabe. Health officials and private donors recently extended those grants for an additional year. Skinner's colleagues keep fielding requests for the point-of-care service, which in turn has created a network of trusted Indigenous health leaders. This web, he said, could create the backbone of targeted outreach and screening for other diseases, such as diabetes or cancer. But it only works with mutual respect, he warned. "This isn't going to First Nations just to help them," Skinner said. "I've learned so much from the cultural values that are built on what happens in First Nations. We have a lot to learn." Skinner said mutual respect also means predictable paycheques — not just the odd grant. He said health budgets need to pay for health promotion workers employed at Indigenous-run organizations and non-profits, the ones who stick around after the testing van leaves. Patients are more likely to stay in touch with familiar faces and staff, he said. "It's about respect, kindness, and building trust," he said. "That is really critical."

31min

Exercise Your Right to Breathe: Dr. Brianne Philipenko & AsthmaBrianne Philipenko (MD) was midway through her respirology fellowship in Calgary when the Covid-19 pandemic shut down the city. She started interval workouts at home using Nike's fitness app — when inspiration struck. "Coming up with a creative, innovative way to allow people to access an exercise program outside of the typical organized pulmonary rehabilitation in a gym setting was something that I became really interested in," said Philipenko.. As a respirologist, Philipenko was already frustrated by the lack of 'mainstay' guidelines on incorporating exercise into severe asthma treatment. "I think that's a big disservice for our patients," she said. "We're giving them these fancy medications that improve their asthma, but we're not going after the low-hanging fruit such as physical activity." "It's something cheap, accessible, that everyone can do, and it's something that I think is very much underutilized." Even before the pandemic, access to pulmonary rehabilitation programs was severely limited, as most also serve with people suffering from Chronic Obstructive Pulmonary Disease (COPD). Philipenko's asthma patients were often leery of exercise, for fear of triggering an attack. "You don't exercise, so then you get out of shape and that makes you more short of breath when you exercise," she said. "It becomes a vicious cycle of deconditioning and fear." Philipenko teamed up with a physiotherapist and a kinesiologist to develop an at-home rehabilitation program for people with pulmonary hypertension. Patients download an app, then follow the program for eight to 12 weeks, incorporating pacing strategies and breathing exercises to ease their way back into fitness. "We're still in the middle of recruitment," said Philipenko. "We have people that are extremely fit exercising every day, to people that never exercise ever, with asthma participating in the study," she said. "It's promising." By 2021, Erika Penz (MD) and Donald Cockcroft (MD) -- colleagues Philipenko met during internal medicine training — helped convince her to return to her hometown, taking on her current role as a respirologist and an Assistant Professor of Respirology, Critical Care and Sleep Medicine at the University of Saskatchewan's College of Medicine. "They have been giants in the space of asthma, and they really inspired me. They brought me back and made it exciting to participate in the research scene here in Saskatoon," Philipenko said. She's working with the Asthma Research Lab team, where her patients can now take part in bronchoprovocation studies and pharmaceutical clinical trials. "As much as I love my clinical practice, it's really nice to have something else going on that shakes things up. And for me, that was research," said Philipenko. She hopes to see a shift in the way exercise is perceived, pushing for recognition of its critical role alongside pharmaceuticals. "That's the wonderful thing about asthma, is that if it's controlled, you should be completely asymptomatic. It's not a progressive disease. And we have some medications that can achieve that for people now. So it's a pretty exciting time to be working in this field."

18min

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