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Nurse educator helps bring expert, culturally competent diabetes care to First Nations communities

Kari Meneen joins project to improve capacity of First Nations health workers

By Laura Eggertson
July 17, 2023
Evan Noble
Kari Meneen became a nurse specifically to care for people with diabetes, after learning about the inequitable health status of Indigenous people in regard to the chronic disease. She is proud of her work to improve and provide culturally safe diabetes care and education for First Nations people, and to train Indigenous health professionals to support their communities.

When the researchers leading a project to improve diabetes outcomes in six Alberta First Nations communities approached Kari Meneen to help, they weren’t certain their project would succeed.

“They thought there were going to be too many challenges to overcome to see any positive patient impact,” Meneen remembers.

They hadn’t reckoned with the passion and determination of the Cree nurse, who is a certified diabetes educator.

“That challenge alone made me want to make it successful,” says Meneen.

The project, called RADAR (Reorganizing the Approach to Diabetes through the Application of Registries) was a community diabetes intervention aimed at improving the capacity of First Nations community health workers to deliver the best possible care, based on clinical practice guidelines for treating and managing diabetes.

Inspired by inequity

Meneen, 41, began work in 2015 as the remote diabetes care coordinator. Her job is to assist the communities in adopting electronic medical records and populating an electronic diabetes registry developed specifically for First Nations communities. She also supports existing health-care providers in each community, through virtual case conferences and meetings to manage patient care.

As a member of the Tallcree First Nation, located in Treaty 8 territory, Meneen has a longstanding interest in diabetes, making her the ideal person for the job. She became a nurse specifically to care for people with diabetes, after learning about the inequitable health status of Indigenous people in regard to the chronic disease.

First Nations people are three to five times more likely to have type 2 diabetes than the general Canadian population.

In the remote communities that the RADAR project served, residents are also less likely to have access to regular blood work, retinal scanning, foot care, support from dietitians, and access to good primary health care: all services they need to manage diabetes.

Those realities first struck Meneen when she was 21, working as a research assistant for Alberta Health Services. As part of a project reporting on Indigenous health, Meneen collected and entered diabetes data and compared the information to that of the general Canadian population.

Screened for diabetes

The incidence rates of every diabetes-related complication, including kidney disease and amputations, were dramatically elevated in First Nations communities.

“Every diabetes statistic I was pulling was an eye-opener for me,” she says.

Meneen became determined to bring those numbers down. After earning a bachelor of arts degree in psychology, she planned to pursue a public health career.

Her first foray into that field was as a retinal photographer with the province’s mobile diabetes team. The team travelled through rural Alberta’s underserved Métis settlements and First Nations communities to screen for diabetes, in part by photographing people’s eyes to check for changes to the small blood vessels in the back of the eye that can signal diabetes complications.

Meneen and her colleagues sent the images they took back to ophthalmologists who checked the images.

The goal of the screening program was to prevent people with diabetes from developing complications that could affect their eyesight.

Although Meneen enjoyed screening patients, the two nurses she worked with encouraged her to do more. One of them, Gloria Fraser, shared her experiences as a northern nurse. Fraser, now the health director for the Bigstone Cree Nation, also opened Meneen’s eyes to the health promotion aspects of nursing. She became Meneen’s mentor.

“Listening to her experiences motivated me to apply to nursing,” Meneen says.

Once in nursing school, Meneen quickly overcame her initial aversion to blood and pursued opportunities in health promotion. After graduating from the University of Alberta’s Faculty of Nursing, she spent the next two years as a home care and diabetes nurse for the Kee Tas Kee Now Tribal Council’s health administration, about 400 kilometres north of Edmonton.

Annual foot exams, blood work, retinal eye exams, and access to a diabetes educator were inaccessible to many of her patients because of numerous barriers including cost, location, and the time required to travel to larger centres for those services.

Built trust

Many of Meneen’s patients were also reluctant to see specialists because of negative experiences in the health-care system, as one community Elder told her.

After cancelling appointments multiple times, the Elder finally allowed Meneen to care for her feet. That process was the beginning of building trust.

“Once she was in my chair and she felt comfortable with me providing foot care, she started talking, and I started asking questions,” Meneen says.

The Elder, a residential school survivor, had been rushed through appointments with health-care providers who brushed off her concerns, questioned her sobriety, and made other stereotypically racist assumptions about her.

“You add all these barriers to accessing care, and then you add systemic racism on top of it — it broke my heart that the Elder, who is the sweetest lady in the world, chose not to access care in our health system because of how they made her feel,” Meneen says.

Meneen and the Elder became partners in improving the Elder’s care. The Elder became confident enough to go to Grande Prairie for an eye exam and blood work.

“It reassured her that not every nurse or health-care provider is racist or is going to treat her badly,” Meneen says.

Improved outcomes

Meneen’s work as a diabetes educator led her directly to the position with the RADAR project, and her experience and determination to have the project succeed paid off.

After two years, 91 per cent of patients achieved a 10 per cent improvement in key metrics such as blood sugar, cholesterol levels, and blood pressure, or stabilized in these metrics.

While working with Bigstone Cree First Nation, for example, one of the grant’s founding partners, Meneen helped a dietitian, retinal photographer, and health-care aide register clients in an electronic database and manage their care. She also fostered a relationship with primary care providers working nearby.

“It helped improve the diabetes outcomes for Bigstone patients,” she says.

Although the RADAR project is slated to wrap up this June, several participating communities have opted to carry on the work.

Today, in addition to finishing her role with RADAR, Meneen also works for a health services and informatics social enterprise called Okaki Health Intelligence. She leads the OKAKI diabetes virtual care team that grew out of the research project. She and her team, consisting of an endocrinologist, nurse and dietitian, train certified diabetes educators and provide access to culturally safe diabetes care and education for Indigenous people living with diabetes.

One day a week, Meneen also works as a diabetes nurse educator at the Royal Alexandra Hospital’s Indigenous Wellness Clinic, keeping her clinical skills sharp.

She balances her busy career with her role as mother to her young daughter, Eliana, and partner to her husband, Jeff. When she’s not getting outside with them and her Wheaton Terrier/poodle mix, she plays hockey with a league that she has belonged to for more than 10 years.

“That’s my release from a very busy week,” Meneen says, laughing.

She is proud of her work to improve and provide culturally safe diabetes care and education for First Nations people, and to train Indigenous health professionals to support their communities.

“That was always the goal, to build capacity with First Nations community health workers so they could take this on themselves and deliver diabetes care that meets their community needs,” she says.

Laura Eggertson is a freelance journalist based in Wolfville, N.S.