NOSM and the future of medicine in remote places
In 2020, amid the pandemic, the Northern Ontario School of Medicine (NOSM) recruited NetGain to help establish a new center for social accountability, leveraging our ability to capture diverse perspectives and secure funding for the unique healthcare needs of remote northern communities. This contributed to the School’s credibility which ultimately led to NOSM becoming Canada's first stand-alone medical university.
In 2020, at the height of the pandemic, what could be more appealing than a remote assignment with the Northern Ontario School of Medicine, headquartered in Sudbury with a second campus in Thunder Bay? Operating under the aegis of Laurentian University, the school had a new Dean, Sarita Verma, whose international work in public health brought a radical new perspective to the delivery of care over vast distances to remote communities.
It might be reasonable to wonder why on earth NetGain would be recruited to work on this. We worked in the 90s on medical issues (launch of MedMira Laboratories’ rapid self-test HIV kits, donor research for Orbis Canada, and planning for an ophthalmology clinic in Tanzania for the International Trachoma Institute), but were in no way qualified as subject experts on the NOSM assignment.
But that’s not what they wanted. Their development director had worked with NetGain years previously on a succession of projects for Centennial College. Capturing multiple perspectives in a cogently stated project description, and providing a compelling, unified rationale for support, had resulted in 10’s millions of dollars in government funding for a rebuild of the College’s campus and for conversion of the historic De Haviland plant into an aeronautics school at Downsview Park. It was that capture and distillation of perspectives that was needed to align faculty and administrators for the establishment of a new center for social accountability, in keeping with the incoming Dean’s priorities.
Some consultants are know-it-alls, but that’s not what was required here. Experts come with formed opinions and perspectives whereas NOSM needed a “learn-it-all,” someone willing to listen, sift, weigh, and articulate complex issues on behalf of a group. What we learned quickly made us advocates for NOSM, its new center for social accountability, and the shared vision of its leadership group.
They were focused on social accountability because there was a clear gap between the function of provincial healthcare delivery in northern Ontario and the unique needs of the communities scattered from the Muskokas west to the Manitoba border, and from the Great Lakes’ north shores up to James Bay and Hudson Bay to the north and east to the Quebec border. Much of the planning and policy work underpinning that array of healthcare services emanated from the Ministry of Health, headquartered at Queens Park in Toronto. Accountability for its shortcomings was difficult for northern residents to establish. As a prime actor in the region, as a recruiter, trainer, and educator of medical professionals, NOSM was implicated.
A fresh perspective was needed and, at the risk of annoying its government masters and institutional partners (regional hospitals and universities), NOSM wanted to provide that perspective. Residents of northern communities suffer a much higher rate of premature and avoidable death than their southern counterparts and on average die seven years earlier. Many in remote places never get the preventative and diagnostic services taken for granted in Southern Ontario. Early cancer detection, for instance, is much less likely for a Northerner, and emergency responses take many times longer than in the South. Although there is a capable air ambulance system, even these are much less swift and reliable than for southern residents living in close proximity of ERs to residents in the south.
While professing no deep expertise in these matters, it was evident that the southern model of giant factory or fortress hospitals wasn’t addressing the chronic needs of remote populations, especially among ethnic and linguistic minorities. Well-intentioned planning and policy work was going into adaptations of the system to improve outcomes, but therewas no substitute for the direct experience that NOSM and its graduates could bring to the difficult work of adapting an urban model to huge catchment areas and harsh climate, under hard financial constraints.
The value of this direction from the School appears to have been appreciated by the Ministries of Health and Education, under which it operated. Later that year, when the extent of Laurentian University announced its insolvency, and over the next year while the consequences of that calamity were being decided, NOSM was preserved intact and elevated to independent degree-granting status. Where formerly it had been under the governance of the University’s board of regents, the Government of Ontario passed legislation making it the first stand-alone medical university in Canada.