‘Rural’ doesn’t have to mean ‘cultutally backward’ and an innovative program launched by a doctor in Prince Rupert demonstrates the opportunities smaller communities provide to improve health standards.
Gynecologist Dr. Marius Pienaar is testing a program to prevent cardiovascular disease in women. The doctor, based out of the Prince Rupert Regional Hospital, explained the program and the North Coast Maternal Health Clinic in plain language last week.
Pregnancy is a stress test for a woman’s body. If a woman gets gestational diabetes during pregnancy it’s a signifier that the pancreas is faltering and diabetes is most likely to return later in life. Six weeks to six months after giving birth, the woman is supposed to get diabetes screening. Dr. Pienaar is using a related method for cardiovascular disease.
“For the past 10 years or so we’ve known that there is a similar thing where pregnancy is a stressor or a stress test to see if you’re going to get a heart attack at an early age as a woman,” Dr. Pienaar said.
A woman fails the heart “stress test” if she has one or more of these five risk factors: eclampsia (convulsions during pregnancy due to high blood pressure), gestational diabetes, preterm birth, abruptio (when the placenta separates too early from the wall of the uterus) and intrauterine growth restriction (if the baby is not growing at a normal rate in the womb).
“In pregnancy we collect a lot of data on a woman,” Dr. Pienaar said. “We have this amazing collection of data yet we do nothing with it. That data is filed and nothing happens.”
There are only approximately 200 deliveries a year in Prince Rupert so the program could never be more than a proof-of-concept pilot, but if it works it has the potential to be tested in bigger city centres.
This is how it works: a woman who has one or more of the risk factors goes into a software program that Dr. Pienaar’s wife, Erica — a former computer programmer — created. The software sends a letter to the secretary of the North Coast Maternal Health Clinic three-months after the woman gave birth.
The secretary then sends a letter to the woman informing her of the potential risk of having a heart attack later in life and provides some basic information on why she needs to be screened. The secretary sets up an appointment with the woman to visit the clinic six months post-partum.
Before coming to the clinic, the woman gets some blood tests done. At the clinic a physician weighs her, takes her blood pressure, checks waist circumference and collects her personal and family history.
All the data is punched into the software program, which calculates the woman’s risk of having a heart attack in the next 30 years.
Dr. Pienaar then sees the woman 10 minutes later and explains why the woman has (for example) a 29 per cent chance of a heart attack later in life.
“But the most important thing I can say to Mrs. Smith is, ‘Look here on the screen. If we click on remove smoking the risk drops to 22 per cent. If you’re able to lose weight the risk drops. If you get your cholesterol under control, this is what happens.’ It gets their attention,” Dr. Pienaar said.
The woman is then sent to a smoking cessation counselor, a diabetic nurse or a dietitian to learn how they can improve their health. From here, Dr. Pienaar no longer continues with the patient.
The software program then sends a letter, with all the woman’s data and calculated risk, to her primary caregiver or nurse practitioner on Haida Gwaii, Kincolith or wherever she lives.
“Our purpose is to identify the women, bring them in, test them and give them an opportunity to do something for their lives to decrease their chances of getting a heart attack,” he said. The family doctor or primary caregiver takes it further with his or her patient.
The program is low-cost and simple with minimal time commitments but it would be difficult to get a program like this going in the bigger city centers, such as Vancouver, where there are committees and several colleagues Dr. Pienaar would have to consult to get the program running.
In Prince Rupert there is more flexibility. With some determination and energy, he can be innovative, test drive a new program that could potentially affect the lives of women across the country.
The doctor has already shared his program with a physician in Kingston, Ontario and a gynecologist in Prince George is considering using the program at his office as well.
“It’s a golden opportunity to have an effect on their lives and prevent a heart attack,” he said. He plans to make his program available free of charge to other maternity units.