In the summer of 2023, as forest fires ravaged northern Quebec, a team of McGill nephrologists and healthcare workers faced an unprecedented challenge: how to save lives of the dialysis patients of Eeyou Istchee (Cree nation) while keeping communities together. We spoke to the doctors who led the charge and created a robust emergency dialysis strategy out of the crisis 

 

This year Quebec was fortunate to experience a less destructive forest fire season than other parts of Canada. Not so in the summer of 2023, when devastating wildfires threatened large swaths of the province, including the Cree communities of Mistissini and Chibougamau. Evacuating these remote areas was especially challenging for dialysis patients who require regular, life-sustaining treatments. 

 

Disasters disrupt lives universally, but for those reliant on continuous medical care, such as dialysis, the stakes are critically higher. 

 

Faced with this crisis, a dedicated team from the McGill University Health Centre (MUHC) and the Cree Health Board (CHB) sprang into action. Leading the charge were Laura Horowitz, MD, Assistant Professor, Department of Medicine and nephrologist at MUHC and Director of the Northern Renal Program; Catherine Weber, MD, Associate Professor, Department of Medicine and Director of the Montreal General Hospital (MGH) Hemodialysis Unit; and Rita Suri, MD, Associate Professor, Department of Medicine and Director of the Division of Nephrology at the MUHC and McGill. Their task was daunting: coordinate the evacuation and ensure that the displaced patients received uninterrupted care. 

 

“Most people don’t realize how resource intensive dialysis is,” says Dr. Suri. “The media covers very well how serious these tragedies are for communities, but they are all that much more grave for somebody whose life depends on being able to reach the hospital for life saving treatment with high technological and personnel demands.”  

 

Lifesaving – and culturally safe – collaboration

When the fires threatened the Cree communities, the team immediately focused on transferring patients more than 700 km south to Montreal, where they could continue their treatments without interruption. The logistics were complex, involving not only the physical transport of patients but also finding available dialysis spots at the MGH and other McGill hemodialysis units, where capacity was already stretched thin. 

 

We were asking some of our own patients who dialyzed locally to move to other centres in Montreal so that we could accommodate evacuees,” explains Dr. Suri.Those patients are to be thanked and commended for their willingness and generosity to disrupt their lives to go to a different centre. 

 

The successful emergency response was the result of a coordinated effort across multiple teams and individuals. “It was a great collaboration at so many levels,” says Dr. Weber . Key contributors included the leadership team, physicians, head nurse Nancy Filteau, pharmacists such as Vlad Alexandru Rosu, unit nurses, and community nurses and social workers from both the MUHC and the affected communities. The Centre de coordination des mesures d’urgence also played a crucial role. On the CHB side, François Prévost, director of medical affairs and services, Kaviraj Gosal, MD, director of medical emergency preparedness/risk management and Assistant Professor, Department of Family Medicine, Jason Coonishish, coordinator for emergency measures and Nii Helen Bélanger, director of Wiichihiituwin, an organization that coordinates medical travel for Indigenous patients, were instrumental in the efforts. 

 

Partnering with the local healthcare community made all the difference, notes Dr. Horowitz. “To see these already very sick, burdened patients have their whole team supporting them during this horrible, traumatic situation….,” she says. “It was a beautiful moment.” 

 

Lessons learned and future preparedness

The emergency prompted thorough reviews of the team’s response and the issue at hand, as well as crucial updates to the team’s preparedness plans. “So many lessons were learned about how we could better prepare for the next emergency, and we started to implement these changes right away in our other communities,” notes Dr. Horowitz. 

 

Problems identified included patients evacuating without enough medication or up-to-date charts, and gaps in organization and communication between teams. In response, improvements have been made in all these areas and point people have been designated to coordinate emergency efforts and communication. Dr. Weber is focusing on MGH protocols, while Dr. Horowitz is adapting these strategies for northern patients. 

 

That experience is now our springboard for our emergency preparedness protocols and how we’re going to approach it next time and with more efficiency, more confidence, and again, always focusing on the patient,” says Dr. Weber. 

 

Preserving community and culture 

Throughout the evacuation, the team prioritized maintaining a sense of community and continuity for the displaced patients. Recognizing the importance of cultural and social ties, they made every effort to keep patients with their usual care teams and, when possible, with each other. 

 

Dr. Horowitz shared a particularly touching moment: “I was actually in the room with one of the displaced patients when their nurse walked in to start treatment,” she recalls. “The patient’s face lit up when they realized that even though they’re in a different institution, doing treatment during a crazy time, that it was their own nurse from their own community who knows them and always treats them. 

 

Beyond medical care, the CBH even organized outings in Montreal to traditional spaces, helping patients stay connected to their culture during a time of upheaval. 

 

We really wanted to avoid inflicting further trauma,” explains Dr. Suri. “Our goal was to keep families together and ensure that no one felt isolated or disconnected from their community. 

 

A year after the crisis, the dialysis patients have long since returned to their communities and continue to rebuild after the fires. “The people were so resilient,” says Dr. Suri. “They somehow trusted and had faith in the hospital and in their care team members that they would be taken care of.” Although the crisis left scars on the affected communities, the experience resulted in improved processes such that in the event of a future crisis, dialysis patients in remote communities are in a better place than ever before.

 

Eeyou Itstchee sky during wildfires (Credit: Cree Health Board)
Eeyou Itstchee sky during wildfires (Credit: Cree Health Board)