•MEMORIA L U NIVERSITY OF N EWFOUNDLAND

St.John' "Newfou, Jl, nd, C,n .d. ~< -r-...{~

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Nr . Dona l d S . Ri cke rdPresidentDonner Can adian Fo undationP.O . Box 122Toronto -Do mi n i o n CentreToro nto , Ont ario M5 KIHl

Iam pleas e d t o r e ply i n respons e t o )'our re ques tforour a ppl i c a t i o n for support of our Nor t he r n Med ic i neapo logize for the del a y in my letter du e t o he avyse veral weeks and in particular an i mporta nt se r iesvery r ec ent o pe n i ng o f our Health Sci en c e s Centre.

Fo l lowing j oint di s cu s sion s an d plan ni ng by th e Hemorial Universi ty (r'WN)an d t he I n ternational Grenfell Association ( I GA) a Conference was he ldin Co rn er Br oo k i n J un e, 1977, at tended by del e ga t e s of th e t woin stitution s, t oge th er wi t h nati onally recognized e xpert adv lsersineducat io n , r e s earch, and health care sys tems o r gani zat i o n and f unction .

1: Th e Con f e r e n c e r e v iewed th e major hea l t h problems of o ur Northe rnarea t-lh i chwereclassif ie d broadlyas follows :

( i) Dlso r de rsof lifes ty leandbehaviourofwhichalcoholismcl earlyi s th e most impor ta n t

Nr.DonaldS.Ricker .Nov e mb er 21 . 1978Pa ge 2

•Hygi e ne inclus i ve of sa nLt a t f on , s ewc r age , r:lean,...atersupp 1y

Disorde rs of high incidence suc h as perinatal morbidi t y andmor tality, h yp ertension and cardiovascul a r di s e a s e, and canee r .

2. AffiliationisbeingdiseussedbetHeentheUniver sityandtheCaptainHilliamJackmanHemorialHospitallocatcdinLabrado r Ci t y.

~:~e~~:;I~I~ · l~~~ke r.Pa ge 3 •3. The Und e r g r a d ua t e e l ect ive p rogram for medical students i s acecnt.Lng

th e o pportun i ty for e xperience in the hospitals and nursingsta t i on sof th e N:ort he r n area ;simulta ne o usly , an in c r e a s e d o pp o rtunityforinterns a nrl r e s idents t o ob t a in a portion o f th e i r t r ain in g i n ano r the rn set ting is b e in g de ve l o pe d. Al ready t he internship and t her e s i dency in su rgery include r o t a t i ons t o St . Anthony . Al l of thesep r og r ams a re orienta t e d t oward p ro v i s ion of expe r ienc e i n t h e no r t hern

::~~~:si:u~~e~:a~r:a;~aduate wi l l b e capab le of a nd r e c e pt i ve to

4 . The Co n t i nui ng Ned ical Edu cat i o n Progr am of t h e Facul ty of Hedic i neis d Lre c t In g incr e a s ed a t t en tion t o th e nee ds o f physicians inth enorthemare a- mosteffectivehav ebeenthe vis itation sofFa cultymembe r sin consul tan t c a pa c i tyas sociatingclinicalservicewi t ht e a ching sess io ns on topics o f s pe c i a l i n t erest t o t he r e s id e n tphys i c i a n s ( e. g . Lab r'ad o r Ztra bus h ) ,

5 . Si nc e 19 72 t heFac ul t y ha s develo pe dan increasing i n te r es tin t herole ·that t eleco mmuni cations mig h t play ina vari etyofhealth c a rea ctivities, part icularly a s th e y r elate to th e Fa culty' s man da tetomake its resour ce s available to th e whole Pro vince . The problems oftran sportation and communication arc particularly s ig n i fica n t t othemor e northerly a n d isolated port i on s of th e I sland a nd of Labrad o r .

For l 2 weeks in the Spring of 19 77 th e Fa culty of Me d i c i ne an d th e

~:~~e~~i~~:U:u~~~~~~~~:a: ~1;~v~:~~~1~~:t~:~::dt~h~o~:~~~a; ~:~~:~-of "e xp e r i me n t a l programs in th e continuing e d uca t i on of healthpro ­f e s sionals ,patientconsul tationsandthetran s mi s sionofX-raysbys l ow scan equ i pment , and co mmuni ty h ealth edu c a t i on f o r se lec t e dco mmuni ty group s. These exp eriments were f unded in full from f ed er alsources • Th e pr o grams involved ho sp ital s in Stephenville , St . An t hony,Labrador City a n d Goos e Bay, a s well as St. J ohn ' s. There s ul t s ofthis trial we r e so e nc o uragi ng th at th e Fac u l ty and ETV a re nowinitiating,in c o- op eration withthe Newf o undl a nd Tele ph on eCompa nyLi mited, a ded i c ated t e Leph o ne con f erence sys tem l i nk i ng a n umber ofhosp itals ac ross th e I sland, with b ridge f in a nc in g provided by t hefe dera l Department of Supply a nd Se rv ic es . Fr om t he ou t se t , howev e r,u s er o rg a n izations wi l l con tri but e t owa r d t he c os t s , and i t i s h op ed

~~:; ~::s~asic sys te c wi l l become s e lf s uppo r t i ng by 1980 t h r o ugh

I n add ition t o s tar t ing th e t ele c o n f e r e nc e sy s te m, th e Faculty ofMe d i cine i s ac t ive l y dis cu s s i ng t he po s sibility of u s i ng t he Ani k Es a tel l i te i n 1 98 0 . If curren t p l a ns a reimpl e me n t e d, Anik B wil lpr ov id e Hemo r La I Uni ve rsi ty wf t h a on e way v Lde c -rt wc wa y au dio l i n kt o Lab r ad or . Such a f a cil i t y ,.,i ll p l a y a n i mpo r ta n t r ole i n th eUnivers ity ' s I ns t itute of Northern and Labrador Studie s an d i n th eFacul ty of Ned Lc Lne l s Nor t hern He alth a nd Nedicinc Progr a m. Aga i nma jo r f e de r al fu nding f or th i s pr oj ect i s a n t ic ipa ted .

HL Dona ldS. Ricke.November 21, 19 78Page 4

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Hr . Do na l dS . Ric ke eNo ve mber 21 , 1978Pa ge S •

Dr . Ge or ge Fodor our Pr of e s s o r o f Epid emiolog y i s heavi lyi nvolve d in t he study of t he Epidenio logyand t r ea tment;of ess e nt i al hyperten s i o n . Of par ticular relev a nce: ha sbeen his s t ud i e s r elating t o t he increased i ncide nc e o fhypertens ion in t h e Province of Newf ound Land a n d Labrador ,including increased consumpt i on of sa l t .

Dz , Gord on Johnson , As so c i ate Profe s s or of Ophthalmology,s e rv ed fo r three years as o ph t ha l mo l ogic co ns ul t ant t oth e Inte rn ati on al Gr enfell As socia tion ba s e d a t St. Anthony.During th at time h i s s t udies l e d t o carefu l doc umen tation o fey e dis o rd e r s in th e northern se t t i ng and in particularoriginal de s criptive materi al r elating to th e unu su al d i s­order , Labrador Kera topathy.

~~~e~~i~:r~~:i~it~~~f:~:~~e:fo~~~:o~~~~;r~~~eu:~e~~::~:deficienc y an d an incre a se d i ncidence o f l ymph o ma i n i s o l at edc ommunitie sonthenorthwe st c oa stof Neuf ou nd l a ndO·lltC fu n ded) .

Dr . Mar y Lob ban, Profes sor of Phy s i ol ogy, ha s jus t t a ke n up~ appointment 'vi th the Fa cu l ty of eredt c t ne , Dr . Lobb a n ha sextensive ex pe r ien c e in northe rn c Lr cums t a nc e s , particul a rlyin Nar rh ern Norwa y and in th e Nor th we at; and Yuko n Te r r ito rie s.Her particular area o f inve st i gat i on is th at of circadi a nrh ythms a s r e l ated pa r ticul arly t o th e p ro l on ged period s o fda y or o f n i ght in no rthern l at i t ude s 0 -1RC f und i n g b eing s o ug h t ) .

The HealthCa r e Systemis ares po n s i b ility ofth e Boa r d o f th e l n t er­na t iona l Gr enfell Associa t i on al th ough f und Lng mc w i s derive d a lmos tt otally from t he Department of He a l t h o f th e Provinc e of Newf o u nd l anda nd Labrad or. The maj ority of th e phys i c i a n staf f o f t he In t e r na tio nal6renf ellAs so cia t ionhold cros s - a ppo intme n t s'viththc Fa cu lty of Hedic in eat He mor ial Uni v er s ity . Additio nally, full - t i me Fa cu l tymp.mbers f r omHemoria l Un i versi tY \-li l l pa r ticipat e i nclinical s e rvicesofthe I n t e r ­

~:~;:~:;n~:~nfell Associa tion , partic ul ar l y t h r o ug h t heir fu nct ion a s

}Ir. Don alu S. Ricke eNovembe r 21 . 1 97 8Page 6 •

The Dean of Medi c ine . a s a member of th e Boa r d of th e In ternationa1Grenfel1 Associ ation . ha s be en a sk ed to Cha ir a Commit t e e s t u dy i ngth e transfer of re sponsibility for t he Health Care Sys te m f ro m t heInternationa1Gren f ell Association Board to Re g i ona l andCommunityBoards. The Committee un dertaking the s t udywi 1l in clude t he Dire ctorof Northern Hed i cine a nd Health, ce rtain physicians from th e I n t er­

:~t~~:a;r;::n~:~e~~Sociation , a nd r e p r e s ent at i ve s f r om- the communi ties

Since s ubmi s s i on of our pr op o sal t o t he Fou nda tion in August , 19 7a, wehav e moved to join t University/IGA appointme n t of a Di rec to r of th eProgramofNorthernHedicine a nd Health.followin g ,nninte rn atio na lse a r ch . Hi s curriculum vitae was pr ev i ou sly s ubrni t te dbut , for co n­v enience,.isappend edtogether withtheTe nn s o f Re f er en ce.

Criteria included within th e con sid er a tion of th e Search Commit t e ewere the followin g:

A physicia n wi t h p re vious c linical experience in the North ,with both academic and r e s e a r ch capability a nd understanding .

Pr oven l e a ders h ip ability and the ability to co -ordinate

:~~i:~~~~e~cross a diverse spectrum of r e s e a r ch. educa tion

~r::~~ity t o communica te effectively in wri t ten and v er ba l

•

c.~

The Ned ic al Sch oo l and the Internat i on al Gr en f ell As s ociation a reproviding off i c e f acilitie s for th e Directo r of thePrograminS t ,

John ' s, in St. Anthony, and in Goos e Ba y . In itial pr ovisionha s b eenmade for trav el ancl s ubsis t e nce cos ts r elated to th e nec e s s ary v i sitsto the no rthern area by the Di r ector in es tablishmen t o f th a Pr og ra m.

seeking funding from t h e Foundation for t he s uppo r ting se c re ta ryr e s e a r c h a s so ciate, for a portion of th e sa la r y o f th e Director a nda portion of th e s a l a r y of th e Nursing In struct or to be po sted a t

~~:h~~~~ct~~ . ha ve also r e qu e ste d s uppor t for tra vel a nd s ubs iste nc e

Operation aland capital equ i pment costsof sp e c i f i cre s earch proj e ct swill be borne by a pp r o pr ia t e fun ding age ncies incl usive of Nat i ona lHea lth and u eL f a r c , MedicalLtes earchCou nc il,HeartFound a tio U, Cance rIn s t i t ut e and others . Failure to ac h i eve funding i n on e or t wo oftheseprojectswithintheProgr am <t-1illnotlimitprogr e s s in othera r e a s par ticularly in vi ew of t he f a ct th a t th e Pr og rara i nc ludesEducation, Health Care Se rv ices , 3 5 well as Rese arch c ompon ent s ,

I trust th at this r e sp on se provide s th e info nnation you require.t o y~ur favourable r esponse .

•it:MEMORIAL UNIVE RSIT Y OF NEWFOUNDLAN D

SL John 's, Newfoundl and, Canada AIC 5S7

Of!iceo[ the Vice.President(HealthSciellces) TeIex :OI6-4101

l 'ek phon" (709) 7SJ-1200

Th is wi l l confirm t he a ppr ova l by Memori al Universi ty of Newfo und la ndo f th e terms of r e f eren ce f or t he Pr ogr am of Nor ther n l-ledicine a nd He alth,a s al ready a pp roved by the Board of t he International Gren f e l l Association .

It is un de rstood that it i s th e wish of Memor ia l UnIversi ty tha t t her esh o ul d be no du plicat i on o r con f us i on wi th th e Advisory Committe e oftheLab rador I nstitut e of Nor t he rn Stud i e s. It i s hope d th at the AdvisoryCommi t t e e t o th e In s t Itut e- or its i nd i vidualmembers -may be use d asas ourc e of advice whe rever f e a sib l e . In o ther i ns t a nc e s , th e a dv i c e o fparticular i ndividua l r eside nt s of mr ther n communities may mee t th e ne ed s~:f:~:n:~~thern Med i c in e and Health Pro gr am, as indic at ed in the Terms of

Th i s memor an dum also con firms th at t he five a ppo i n tees from Memor 1a lUni ver sIty fo r an i ni tial t erm as members of t he J oint CommItte e wi ll be:

Dr.A.R. Cox , De an of Medici neMis s M. McLean , Di re c to r ,MUN SchoolofNurs 1ngDr. A.M. Ho use , As s oc i ate Dea n f or Cl i n i cal Af f airsDr . J . G. Fod or, Profe s s or o f Ep idemiologyMr. DavidGren ville, C- CORE.

l AN E. RUSTED.M .D . •F . R . C.P. (C)c .c .E:x.e c utiveDirec to r , I n te rna tiona lGrenfe l lAssocia t lo n

Jfbi ~ !TeIJx:016-4101Tel.: (709) 737-M02

Afterasubstantialperiodof in te rna l rev iewand discussion ,the JointCommit tee of th e Pr o gr am of Northern Med i c i ne and Health (c ompr i se d o fUniv er s ity, Gre n fe l l Reglona l Hea l t hSer i vces Boar d ,an d t he I nt er nat i on alGrenfell Association r epres ent ation) co nc l uded un anim ously a t i ts mee tingon Augus t 11, 19 84, th at th e Pr ogr am s ho u l d bedi s cont lnued e ffectiveDe cember 31, 19 84. Thi s r e comme ndation is go ln gforw ar d t o th e Gre n fe l lRe g i on al Health Services Board a t th e e n d of September.

The Pro gra rn,ajoint end e avour oftheIGA and MUN, was e st ablish ed i01978withaviewtofost er ingimprov edhealth c ar e,health edu c at i on and r e s earchin Labrador and Northern Newfoundland . At th at tim e the biggest problemsidentified by th e people of the North were clean and availablewater ,sewage ,isolation,transportationandcommunicat ions . Amongst th e nat ive peopleproblems ofunempl oyment,culturalpre s er vat ionand al cohol i smw er enot e d.

Supportedbyagrant from th e IGAandmatchingmon eyfromtheMedic a l Schoo l ,to gether with a gr ant durin g th e f irst three yea rs fr om th e Donn erFoundat i on,th e Program was in itiatedw1th the staff in cluding a part-time Di re ctor(Dr . JohnMartin), a secretaryand ares e archassistant.

A number o f s ubs tan tial s uccesses wer e ac hieved in cludin g th e f ol lo wings t udies an d pr oj ect s :

-Pattern o f Patient Ref errals in th e GRHS-Profile of Na in-Parasitofaunaof South ernLabrador-Maternal and Neonatal Morbidity & Mortality Study-Melville Hospi t al

The Program pa rticipa te d e f fec tive ly in th e Lab ra do r Dus t St ud yandfosteredNut r iti on Stud ies in Labrad or. Pa rt i c ip ant s i n th e Pro gr am hav e co n t ribu te dsubs ta ntial ly t o th e biannual i nterna tional symposia on Circumpola rHealth.

VIc e-PresIdent (Health ScI en ce s & ProfessIonal Schools)September18,1984Pa ge 2

TheJointCommitteelsunanim ousinitsviewthatthe s ituationhassor adIcally cha nge d ove r th e past 10 year s (s in c e th e Pr ogram wa s c once ived)th atnew,mor e streaml i ned,andle s s costlymean s o f contr ibut in gmu s tbef ound . Amongs t th e cha nges a re th e f ollowin g :

ex tensive and exce l le n t co mmun ica tions by r ad i o a nd byte lecon fe rencing

much impr oved transportatIon and mob ilIty o f r esident so f f ormerly i s ol ated a re as

tran s f e r of r e s p on s i b I l i t y fo r hea l t h ca re t o a lo cal board(GRHS) from th e I GAwh i ch ha s di vested Its extensive physicalholdings an d r e s pon s i bil i t i e s

t he I GAha sbe come alimite d and modlf i ed f oun da t Lon supportinghea lth or Len t ed projects in Northern Newfoundland and La b r-ado r

th e UnLve r s f t y ha s es tablishe d LINS with phys Lca I r e s our ce s a n ds ta ff ba s ed i n Goose Ba y wf t h a mandat e ov erlapp in g

The Grenfell Regional Health Se r v I c e s ha s intent t o es ta b lish an internalHea l t h Stu d I e s Division r e s pons i bl e f or dat a collection and as sembly .The J oint CommIt te e of th e Pr og ra m Is con fi den t th a t th e close r e I a t Io na hdpv dt h th e Grenfel l Regiona l Heal th Servi ce s , a nd t he HospI ta l InSt. Anth on ywill co n t t nue t hr oug h th e aeg Ls of t he exfs t fng Aff i l I at I on Agre ement be tween

~~~~:~:lo~n~~:r~;~~a::~ ~~:t~~~~~So~e:~;~~;r~o;i~~~;sa:~ ~~~~~g~e~~:l~~o~asbe come an I nc reas I n gly In te gra l part.

Concurrence of the UnIversIty with th e strong r ec ommendation o f t h e J oIntCommIttee to dI scontinue th e Program of Northern MedIcIne and Hea lth effe ctiveDec ember 31, 19 84, Is sought.

Yours;.~.nce lY

~~COX'M.~.'F.R.C .P.(C)Letter from Board of Regents, March26, 1982Revised Terms of Reference , Feb r ua ry 16 , 1982