Aboriginal transplant rates show 'two tiers' to health-care system: experts
By Margaret Munro , Canwest News Service
November 8, 2009 2:02 PM
http://www.vancouversun.com/health/Aboriginal+transplant+rates+show+tiers+health\
+care+system+experts/2199807/story.html



Peter Nakogee, former mayor of a small Cree community on James Bay, has finally
made it onto the wait list for a kidney transplant. He hopes to soon be
liberated from dialysis machines, shown here, that now clean his blood three
times a week.
Photograph by: Margaret Munro, Canwest News Service
MOOSE FACTORY, Ont. - Peter Nakogee knows the chances are not good for
aboriginals seeking transplants in Canada, but the gregarious father of four has
reason to celebrate.

The former mayor of a small Cree community on James Bay has finally made it onto
a national waiting list. As of this week, Nakogee is in line for a new kidney
that could not only transform his life, but show it's possible to overcome what
some consider a racial divide in Canada's health-care system.

The disparities in the medical treatment received by First Nations people
compared to other Canadians have attracted growing national and international
attention. The latest study says aboriginal people are only one-third as likely
to get a kidney transplant as Caucasian Canadians, even though they have more
than twice the rate of kidney failure.

"If you're a poorly educated person on dialysis, it doesn't matter if you're
here in Moose Factory or living in downtown Winnipeg, you don't get the same
level of access," says Dr. Karen Yeates of Queen's University in Kingston, Ont.,
on one of her frequent trips to James Bay, where she oversees the dialysis unit
in Moose Factory, roughly 900 kilometres north of Toronto.

She's the lead author of a new study, done with colleagues from Harvard Medical
School and several other universities, that suggests aboriginals get transplants
at just 34 per cent the rate of Caucasian Canadians.

Geography, poverty, culture and "institutionalized bias and racism" all come in
to play, making it extraordinarily difficult for First Nations people to get
transplants, says Yeates. They are also much less likely to get specialized
medical care that might prevent their kidneys from failing in the first place.

Canada's Cree people have some of the highest rates of kidney disease and
failure in the world, much of it linked to diabetes, obesity and poor preventive
care. Transplants are seldom considered as an option when their kidneys fail,
though that's beginning to change.

Nakogee, who has made dozens of trips to Kingston during the past two years for
the tests needed to be considered for a transplant, completed the battery of
medical checks last week and has just been wait-listed. He will be rushed by air
to Kingston's medical centre when a donor kidney becomes available.

He dreams of taking his wife to New York City when he is no longer tethered to
dialysis machines. "After that, a cruise to Alaska," he quips.

Nakogee's medical odyssey began with a diagnosis of diabetes when he was just
28, the first in his family to get the disease that later hit his father and
several siblings.

"I thought I was doomed," recalls Nakogee, now 53. He learned to inject insulin
to control his blood sugar, and gave up "luxury foods like goose and moose fat"
along with chocolate, chips and pop.

Then in 2005 a foot injury on a hunting trip got so badly infected after a
hospital visit that it led to kidney failure.

Dialysis three times a week now keeps him alive, but the long-term prospects are
not good. Thirty to 50 per cent of diabetics on dialysis die within five years,
says Yeates.

Kidney transplants typically add 10 years or more to the lives of people who
qualify to get them. But organs are in such short supply there are more than
3,000 Canadians wait-listed for the 1,000 kidneys available for transplant each
year.

And aboriginal Canadians are much less likely to get them, Yeates and her
colleagues report in the journal Kidney International.

Transplant rates in Canada, the United States, New Zealand and Australia show
that in all four countries indigenous people are less than half as likely to get
a kidney transplant as white patients, the doctors report.

Of the 17,986 Canadians on dialysis between 1994 and 2005, Caucasians were three
times more likely to get a new kidney than aboriginals - almost 12 per cent of
Caucasians received transplants compared to just less than four per cent of
aboriginals.



A team led by Dr. Marcello Tonelli at the University of Alberta, turned up
similar results when it reviewed transplant rates in the Prairie provinces in
2004. "Despite universal access to health Canada, Aboriginal people had a
significantly lower rate of renal transplantation," his team reported.

Recent research shows the disparities begin long before people's kidneys fail.
Aboriginal people are admitted to Canadian hospitals with severe kidney problems
at almost twice the rate of non-aboriginals, many of them never having received
specialized care that might have helped save their kidneys in the first place.

Yeates says similar disparities exist for many types of advanced medical care
such as cardiac surgery and cancer care. "We have two tiers but we don't admit
it," she says, noting that more affluent, educated Canadians get more advanced
care.

"Our poor people and our minorities and aboriginal people don't have the same
access."

Yeates is helping several of her Cree patients in James Bay navigate through the
medical system so they can be considered for transplants. There is also a
documentary by Mushkeg Media in the works, which Yeates intends to show to
"every" kidney specialist in Canada.

Nakogee says he is tickled to be one of the "movie stars" in the documentary,
following his daunting and at times depressing medical journey.

Nakogee, who was born in a goose-hunting camp on the James Bay Coast and later
became mayor of Moosonee, was flown to Kingston medical centre and started on
dialysis when his kidneys failed four years ago. Nakogee's father had been in
the same situation years earlier, relocating from Fort Albany, on the James Bay
coast, to Kingston for dialysis and later dying there.

Nakogee says at one low point he was ready to give up on dialysis. "I was
homesick so terrible," he says. But the staff at the native residence where he
stayed in Kingston hid his belongings so he couldn't leave.

When a dialysis unit opened in Moose Factory six months after he'd been sent to
Kingston, he moved home to nearby Moosonee, and his family, friends and fishing.

But he longs to return to his old camp up the coast where huge flocks of snow
geese fill the sky so he can start hunting again.

"I'll be doing that when I have a new kidney," says Nakogee.


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