In 1944, the Government of Saskatchewan created the Northern Administrative District (NAD), which established Northern Saskatchewan as a spatial entity within the provincial milieu. Attention was focused on modernizing the region, and public health nursing became one of the first state-sponsored institutions to be introduced by the provincial government. By examining the day-to-day activities of nurses who worked at remote nursing outposts in Northern Saskatchewan between 1944 and 1957 and beyond, this research examines the complex internal factors involved in region-making. Nurses lived and worked amongst their patients in small remote communities, thus making them effective vehicles for promoting modernization principles through preventative and educations programs. Despite the governments intention to modernize Northern Saskatchewan, a colonial relationship emerged between the region and the rest of the province. This situation left nurses in a confusing and often difficult position, because the institution behind initiatives to modernize the region was also their employer to whom they had certain obligations. Furthermore, the colonial attitude towards the region also extended to the nursing stations and the nurses, which often frustrated their attempts to provide medical care. As such, the small cadre of nurses played an ambiguous role, both as agents of modernization, but also opponents of its egregious effects.<p> The research examines the role of nursing in region-making through two types of geography: A geography of region-making where the literature focuses on the formal process of institutionalization, and a geography of social life, where the emerging literature on the geography of nursing provides an entry point. This two-part approach provides an opportunity to use different lenses to view the processes involved in shaping Northern Saskatchewan as it emerged as a distinct northern place within Canada.

In 1944, the Government of Saskatchewan created the Northern Administrative District (NAD), which established Northern Saskatchewan as a spatial entity within the provincial milieu. Attention was focused on modernizing the region, and public health nursing became one of the first state-sponsored institutions to be introduced by the provincial government. By examining the day-to-day activities of nurses who worked at remote nursing outposts in Northern Saskatchewan between 1944 and 1957 and beyond, this research examines the complex internal factors involved in region-making. Nurses lived and worked amongst their patients in small remote communities, thus making them effective vehicles for promoting modernization principles through preventative and educations programs. Despite the governments intention to modernize Northern Saskatchewan, a colonial relationship emerged between the region and the rest of the province. This situation left nurses in a confusing and often difficult position, because the institution behind initiatives to modernize the region was also their employer to whom they had certain obligations. Furthermore, the colonial attitude towards the region also extended to the nursing stations and the nurses, which often frustrated their attempts to provide medical care. As such, the small cadre of nurses played an ambiguous role, both as agents of modernization, but also opponents of its egregious effects.<p> The research examines the role of nursing in region-making through two types of geography: A geography of region-making where the literature focuses on the formal process of institutionalization, and a geography of social life, where the emerging literature on the geography of nursing provides an entry point. This two-part approach provides an opportunity to use different lenses to view the processes involved in shaping Northern Saskatchewan as it emerged as a distinct northern place within Canada.

Methicillin-resistant Staphylococcus aureus (MRSA) is a growing concern in Canada especially in Aboriginal communities in remote regions. The northern and remote communities possess some or many of the risk factors that are identified in previous research to be associated with Community-Associated Methicillin-resistant Staphylococcus aureus (CA-MRSA) infections such as overcrowding, challenges in maintaining personal hygiene and limited access to healthcare. CA-MRSA spreads rapidly in the communities. It is known to not only affect young and healthy individuals, but it is also associated with high morbidity and mortality rates. Furthermore, antibiotic resistance in CA-MRSA is increasing in Canada. It is known that inappropriate and greater use of antibiotics is associated with increased antibiotic resistance. Resistant CA-MRSA infections are more difficult to treat. To reduce and to control the antibiotic resistance, monitoring the prevalence of CA-MRSA and the changing antibiotic susceptibility profiles at the population level, especially in highly affected communities, is crucial. By monitoring this trend, it will enable healthcare practitioners to provide more adequate and appropriate treatment. To our knowledge, there was no community-based study that examined the epidemiology of CA-MRSA skin and soft-tissue infections (SSTIs) in First Nations communities in Canada at large scale, and the knowledge on the risk factors, outcomes and antibiotic susceptibility profiles is still very limited. This study aimed to describe the local epidemiology of SSTIs at the community level in selected First Nations communities as well as to describe the antibiotic use to treat SSTIs and the antibiotic susceptibility patterns of CA-MRSA. A retrospective chart review was conducted in 12 nursing stations in the First Nations communities across 5 provinces in Canada. The charts of individuals over 18 years of age who had received service at the nursing station in the previous 12 months, starting retrospectively from the date of collection, were reviewed in this study. Each antibiotic prescription that was noted in the chart in this period prior to chart review was recorded in the antibiotic tracking case report form. Data collected included demographics, indication for antibiotic use, antibiotic prescription parameters and patient outcomes. In total, of 372 patient charts reviewed, 224 patient charts contained at least one case (an encounter that resulted in an antibiotic prescription during the study period). Of those 224 charts, 459 cases were recorded and, of those, 137 cases had a diagnosis of an SSTI. In the 65 patients accounting for all cases of SSTI patients, more than 80% of the study population were under the age of 50. The prevalence of impaired renal function was low, diabetes was present in 20% of cases, cardiac disease was present in 15% of cases, and reported alcohol misuse was present in 30% of cases. The presence of indwelling devices was very rare. There were 137 cases of SSTIs over 372 charts reviewed in total. The prevalence of SSTI among the selected First Nations communities in 2012-2013 was estimated at almost 37% (137 cases of SSTIs / 372 charts reviewed). In the 137 SSTI cases, 55 cases were identified as MRSA infections either by laboratory test such as wound culture or by history of colonization documented in the chart. The overall prevalence of MRSA in all SSTI cases was estimated at 40.1% (55 confirmed MRSA positive cases / 137 cases of SSTIs). The majority of SSTIs were purulent infections and wounds. We also found that a wound culture and susceptibility test were performed only in 29% of all SSTI cases. An orally administered antibiotic was most frequently used (in 71.5% of treatments). Topical antibiotics were used in 18.3% and IV antibiotics were used in 8.8%. Other than the antibiotic treatment, wound care was performed in 49% of the SSTI cases and incision and drainage (I&D) procedure in 9%. The majority of MRSA isolates in this study were susceptible to clindamycin and co-trimoxazole (90.5% and 95.2%), but only 29% were susceptible to erythromycin. In general, higher rates of SSTIs were seen in communities where overcrowding and poor access to running water are more prevalent. In this study, we found that the diagnostic tests such as wound culture and sensitivity test was not ordered very often and there was also lack of follow-up or lack of documentation of the follow-up. More research is needed to better understand some of the challenges and risk factors associated with CA-MRSA infections in remote communities. Developing a national-level surveillance system that can help with monitoring the epidemiology of SSTIs and the antibiotic susceptibility test results of CA-MRSA at community level would be essential for better prevention, control, and management. Furthermore, adopting other initiatives such as antibiotic stewardship programs at community and healthcare settings as well as addressing the socio-environmental factors such as housing and access to water would be all very important in the steps to curb antibiotic resistance.

Most of the blood transfusion facilities had adequate space, but lacked some of the basic equipment. Blood collected in these facilities was not adequate to meet the blood needs of the regions. These facilities lacked specialised personnel and some of those practicing blood transfusion were not conversant with blood groups, transfusion reactions and the measures to be taken if a reaction occurs. The findings of this study will be used to strengthen blood transfusion services in these hard to reach regions.

Most of the blood transfusion facilities had adequate space, but lacked some of the basic equipment. Blood collected in these facilities was not adequate to meet the blood needs of the regions. These facilities lacked specialised personnel and some of those practicing blood transfusion were not conversant with blood groups, transfusion reactions and the measures to be taken if a reaction occurs. The findings of this study will be used to strengthen blood transfusion services in these hard to reach regions.

Magister Public Health - MPH / Most of the blood transfusion facilities had adequate space, but lacked some of the basic equipment. Blood collected in these facilities was not adequate to meet the blood needs of the regions. These facilities lacked specialised personnel and some of those practicing blood transfusion were not conversant with blood groups, transfusion reactions and the measures to be taken if a reaction occurs. The findings of this study will be used to strengthen blood transfusion services in these hard to reach regions. / South Africa

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