"Nice to meet you; when are you leaving?"
Even if they don't say it out loud, it's a fair bet that that's what residents of Northern Ontario's more remote communities are thinking when they meet a new healthcare practitioner.
"We know that people aren't really here to stay," says Valerie Beaudin, a registered practical nurse and diabetes worker in her First Nations community of M'Chigeeng, on Lake Huron's Manitoulin Island. "We get used to somebody, we get comfortable with them, and then they're gone."
Zsolt Toth, however, is an exception. The diabetes dietitian educator has worked for the past six years at the Noojmowin Teg Health Centre on Manitoulin, and he has no plans to leave any time soon. It's great news for his clients, the members of seven First Nations communities on the island who rely on his expertise and support as they manage a chronic disease that disproportionately affects Canada's Aboriginal communities.
"I look back at my MPH and I think, 'Wow'," Toth says. "Lakehead University really allowed me to do things I didn't actually believe I could do."
A native of Serbia (then part of Yugoslavia), Toth, 33, grew up in Nova Scotia, where he earned two Bachelor of Science degrees: the first in kinesiology from Dalhousie University, and the second in dietetics from Mount St. Vincent University. This year, Toth added another degree under his belt when he completed a Master of Public Health (MPH) at Lakehead — completed entirely through distance education. For his thesis project, he studied the impact of Aboriginal cultural beliefs on the acceptance of dietary recommendations for type 2 diabetes. He chose the topic, he says, in the face of some of the communication barriers between him and his clients.
This series of posters promoting the Diabetes Wellness Team reinforces the Medicine Wheel, which represents among other things physical, emotional, mental, and spiritual well-being
"I think a lot of Aboriginal and non-Aboriginal health professionals go into communities with this belief that we have this expertise, we have this information, and that if we can just tell people about it, they'll listen," he says. And yet, he notes, so often that information isn't acted upon. "I had this inkling that there was some kind of cultural component to this, some kind of community-wide belief or attitude. And so I decided to explore those cultural beliefs and attitudes."
Toth has learned, for example, about the importance of family and community to his clients' ability to manage diabetes. For example, the standard, westernized model of one-on-one sessions between healthcare provider and client doesn’t necessarily map well onto Aboriginal communities, where family or even community-wide meetings may well have more impact. Respect for family and Elders is also key to his clients' success. Toth learned the hard way that he couldn't simply tell a woman with diabetes to refuse her mother's constant offers of cake. "It's actually insulting to say no in that situation. It's going against cultural norms, so of course what I'm telling her is not going to work. That was an 'a-ha' moment."
Toth credits the MPH program with simultaneously opening doors for him while allowing him to deepen his roots on Manitoulin
These kinds of "a-ha" insights have informed Toth's research and allowed him to work with his clients in what he terms "culturally safe" ways: being aware of and giving advice that works within cultural perspectives, and finding ways to reach community members where they're coming from. For example, his research suggested that diabetes education teaching at pow wows — which can tempt participants with a wide array of potentially diabetes-unfriendly foods — would be welcome. With the help of a Northern Ontario Aboriginal Diabetes Initiative Grant of about $26,000, Toth set up interactive Diabetes Wellness Interactive Health Information tents at pow wows on Manitoulin in the summer of 2011.
His approach has earned his clients' trust. "Zsolt has been taken into and embraced by the community, which is a tough thing to do," says Valerie Beaudin. "It seems that [his clients] are really able to embrace him and what he's saying. He's a huge asset to our community."
That emphasis on community played a large role in Toth's decision to study at Lakehead through distance education. A Northern Ontario university, he figured, "would understand the context in which I worked." Crucially, the program allowed him to stay in his community, continue to work, and provide continuous care for his clients while maintaining their trust. In this sense, the distance education model is a huge boon not only to students, but to the region.
"There is a noted shortage of health professionals in Northwestern Ontario but more explicitly in some of these remote areas," says Lori Livingston, dean of health and behavioural sciences. "So the fact that Lakehead can allow people in this program to go to school while staying at home, maintaining family ties, and still serving their communities is a tremendous asset. Because those communities cannot afford for those professionals to be away."
Of course, distance education offers its own challenges: students must be comfortable with little direct contact with professors and campus. "Zsolt had to be more self-disciplined than a typical grad student, especially with a full-time job," says Professor Ian Newhouse, one of Toth's thesis supervisors (the two met in person only upon Toth's graduation). "He really had to be highly motivated. But he was. And one key to his motivation is that he could see the direct application of his thesis project in his regular job."
Toth credits the MPH program with simultaneously opening doors for him while allowing him to deepen his roots on Manitoulin. Getting his MPH through distance education at Lakehead, he says, gave him new experience and grounding in research, presentation, and communication skills, and taught him about writing proposals and grant applications. Partly as a result, he has no intention of taking the "hello-I-must-be-going" approach to healthcare so common to the region. With a job he loves, opportunities for research, and skills developed at Lakehead — not to mention a partner and extended family on Manitoulin — he's in it for the long haul.
"I look back at my MPH and I think, 'Wow'," he says. "Lakehead University really allowed me to do things I didn't actually believe I could do."
"I think a lot of health professionals go into communities with this belief that we have this expertise, and that if we can just tell people about it, they'll listen," Zsolt Toth says. Often though, that information isn't acted upon.