Thompson desperately needs foot care services after nursing positions left vacant, seniors group says
Lack of preventive foot care in northern Manitoba city could lead to serious health issues, say advocates
WARNING: This story contains a graphic image of an infection.
Northern Manitobans are calling on the province to restore preventive foot care nursing at a clinic in Thompson, saying the loss of those services is causing suffering and hardship.
Thousands have signed a petition saying the number of seniors and people with diabetes is growing in the northern city, with many unable to afford the vital ongoing foot care they need.
Retiree Cliff Duchesne, who lives with diabetes, spent much of the past year in and out of hospital after an infection started in his foot.
He was put on an air ambulance in the fall of 2021 to Winnipeg after his toe turned black overnight, which eventually led to an amputation.
"I had two toes taken off — the big one and the one next to it," said Duchesne.
Duchesne believes that could have been prevented had the province not cut the foot care services he depended on.
"I tried to get foot care" prior to his amputation, he said. "I asked lots of times, but they said, 'Well, maybe … [the foot care services are] coming back.' That's all I'd get told. But no, never, nothing."
Duchesne said he'd asked staff at the Thompson Clinic for help with his foot infection months before the operation, but wasn't referred for more advanced treatment until it was too late.
"I started going back and they told me to just watch it," he said. "They gave me some cream, but it just kept getting worse."
A few months after his first amputation, he was flown south again for more.
"My other toe turned black," Duchesne said. "So they took that. And then my finger."
Because of diabetes, Duchesne has to be careful with his feet, but he's unable to use nail clippers due to issues with his hands and wrists.
"I nicked my big toe when I filed my nails," said the senior, who once ran Cliff's Taxi company in Thompson.
"I filed away part of my skin and that's where [the infection] started."
According to Diabetes Canada, adults with diabetes are about 20 times more likely to have a lower limb amputated than other Canadians, and 85 per cent of those procedures are preceded by a foot ulcer, which can become infected and lead to amputations.
Loss of foot care nurses at clinic
There used to be two foot care nurses who offered preventive services at the Thompson Clinic on Selkirk Avenue until 2019.
"When these nurses retired, they were not replaced," the Northern Regional Health Authority said in a statement.
That "corrected a situation that should not have existed in the first place," the health authority said, since treatments requiring specialized nursing skills, such as cutting thickened nails and comprehensive assessment of legs and feet, "are not to be taxpayer funded."
The health authority now only covers foot care nursing for patients who need medically indicated skin and wound care.
People in hospital or long-term care are given basic nail care, as are home-care clients.
Lydia Penner, 69, is dismayed by that position.
"They don't care," she said. "It's very sad to say, that's the message I get."
Penner also lives with diabetes and had a kidney transplant several years ago. She worries what happened to Duchesne might happen to her.
"I have to be very careful and make sure there's no blisters or open sores, because an infection could cause amputation."
Penner said she experiences pain and numbness in her feet daily, and the foot care nurses who used to work at the clinic are sorely missed.
"It's hard because you don't know what you're looking for, or where to look" when you check your own feet, she said.
Petition launched
Both Penner and Duchesne are connected with a group petitioning the province to bring foot care services back to the clinic in Thompson.
The Thompson Seniors Community Resource Council recently set up tables in local malls, collecting roughly 2,500 signatures and a slew of comments from community members.
They heard from "people saying, 'my mom really needs this,' or telling horror stories about people they knew that were suffering," said Barbara Henderson, a member of the council's ad hoc committee on foot care.
The seniors group hired researchers who discovered the Winnipeg Regional Health Authority provides foot care nursing to people without insurance coverage at several different sites, free of charge.
"It's so upsetting," said Henderson. "There is such a discrepancy in what we're provided with up here."
That's despite the Northern health region having the highest rates of diabetes in Manitoba, a province with some of the highest rates in Canada.
Provincial response
On a recent trip to Thompson, Manitoba Premier Heather Stefanson said the health minister is aware of the seniors' petition.
"We're going to look into the matter and make sure that we can deliver those services to those who need it," Stefanson said on Oct. 14.
But Henderson said her group hasn't seen any action from the province.
"[They] refused to answer letters or phone calls," she said. "They cancelled a meeting. They won't reschedule. The minister of health didn't respond."
In an email to CBC, Health Minister Audrey Gordon's office echoed the Northern health authority's statement that publicly funded foot care is available in Thompson, if it's medically indicated.
The health authority also said foot care services were not affected by the COVID-19 pandemic.
"Foot care is within the scope of practice for all nurses," read the health authority's statement, "and there are hundreds of nurses in Thompson."
But the Manitoba Association of Foot Care Nurses said that's not completely accurate.
"All nurses can use a nail clipper and an ordinary emery board-type nail file," said Pat MacDonald, a member of the association's executive committee.
But she said regular nurses aren't qualified to do more complicated treatments, like dealing with ingrown toenails and monitoring diabetic neuropathy.
"That's well beyond their scope of practice," MacDonald said. "You can't manage those [conditions] unless you have additional training and the proper instruments."
The Northern health authority also compared diabetic foot care nursing to basic grooming, saying in its statement that "pedicures are available through estheticians at the client's expense."
That drew the ire of the seniors council committee.
"It's very nice to be able to go get a pedicure," said Henderson, who also has diabetes, "but that's not what medical foot care is about.
"We've not found anybody that's receiving [preventive] foot care in Thompson, and that's after asking thousands of people."
Quality of life
A former public health diabetes co-ordinator for the north says the province's decision not to replace the foot care nurses in Thompson doesn't add up.
"That need hasn't gone away," said Anita Crate, who's now the tribal nursing officer for the Keewatin Tribal Council.
"It would be more cost beneficial for people to receive that care rather than waiting till they need an amputation," said Crate, citing the high costs of hospitalization, surgery and rehab.
"But I think the most important thing is the quality of life for that person.… If this is something that we can prevent, why wouldn't we?"
In its recommendations for Manitoba, Diabetes Canada calls on the province to "implement health policies that support the prevention and management of diabetes foot complications and reduce the risk of lower limb amputations."
The Thompson Seniors Community Resource Council said it will keep taking steps to get the province's attention.
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