Salgirah Mubarak from the Aga Khan Health Board for Canada
Dear Brothers and Sisters and fellow healthcare professionals,
On behalf of the Aga Khan Health Board for Canada, we wanted to wish each one of you, your families and your Jamats a very warm Salgirah Mubarak. On the occasion of our beloved Mawlana Hazar Imam’s birthday we pray for good health, safety, security and baraka for the global Jamat.
The last few months have been a challenge for many, but as with other crises, the Jamat has come together and has been so generous with their knowledge, time, spirit and talent. Together we have been able to support one another and extend help to our sisters and brothers that need it the most. Inspiration and hope has also emerged through these difficult times due to the many murids, healthcare workers, from different disciplines who have gone above and beyond their professional and personal obligations to serve the Imam and the Jamat.
While the near future is blurry, we are excited to work with all of you on key projects to advance the health of the Jamat so that we emerge stronger together. Our monthly newsletters are a way to provide key updates and opportunities to our community of over 2,000 Ismaili healthcare professionals. Please keep your eyes and ears open for some exciting initiatives which will be disseminated via this newsletter but also on our webpage as well as our social media platforms.
We wish you success in all that you do, and offer our humble gratitude for your support and collaboration.
With respect and admiration,
Drugs, Alcohol and Other Substances
Decriminalization. Rising rates of experimentation. Misuse and abuse coupled with the ‘double pandemic’ which includes the longstanding opioid crisis. As Ismaili Healthcare Professionals it behooves us to reflect on our own competency and comfort in considering if/how substance use plays a role in the wellness of those whom we strive to serve.
The statistics can be surprising – and unsettling. One in five Canadians aged 12 or older drinks in excess of the daily or weekly limit (1). Of those 15 years or older who do drink, 18% of them will have a diagnosis of “alcohol use disorder” (AUD) during their lifetime. Interestingly, twin studies indicate that the propensity to develop AUD is 50% genetically influenced; this new insight can inform care plans tailored to individuals, but may also be a consideration as a life choice with the potential to impact future generations. In terms of cost, alcohol contributes to 8% of Canadian deaths. Furthermore, the economic implications of substance use in Canada is approximately $40 billion dollars per year ($14.6 billion from alcohol, $12 billion due to smoking and $11.8 billion from others) (2, 3, 4).
Research estimates that up to half of current users will die of a tobacco-related disease (6, 7). With the advent of alternative options, there is a mounting “gateway concern”. That is, young people who would not otherwise try cigarettes, start using e-cigarettes (the ‘gateway’ [substance]), thereafter, becoming smokers. The literature showed a 900% increase in Canada, from 1.5% in 2011 to 16% in 2015 among high schoolers who began using e-cigarettes. While media and mates may minimize the sequalae of e-cigarettes, firm evidence on the types and concentrations of potentially harmful chemicals within e-cigarettes remains lacking, as does data on long-term safety. Some associations however, continue to be verified. A recent review concluded that “the early initiation of cannabis use was associated with an increased risk of early onset psychotic disorder, especially for those with a pre-existing vulnerability and those who use cannabis daily” (9).
Sometimes, a person’s drug of choice could be a stimulant (cocaine, ecstasy, amphetamines, etc.) or an opioid (morphine, heroin, fentanyl/carfentanyl etc.). According to a survey by Health Canada, 22% of Canadians 15 years or older had used a psychoactive agent (10). Often, substances are used together. Given the multifactorial impact, coupled with the rise in accidental injury and fatalities, public health, inner city and primary care responses – particularly in regions such as Vancouver’s downtown eastside (DTES) – are augmenting efforts to mitigate the current opioid crisis. Opioids have surpassed motor vehicle accidents, and are now the leading cause of injury in North America. Ancillary impact also occurs with high risk behaviours, such as sharing of needles, which leads to increase risk of transmitting and acquiring blood-borne viruses including hepatitis and HIV.
The impact of substance use can compound easily. For example, anxiety frequently co-occurs with substance use disorders (11). Compared to the general population in which 16% are affected, 30% of those with substance use disorders have an anxiety disorder (12). Furthermore, the presence of a substance use disorder increases the risk for anxiety disorders by 1.7-2.8 times. Other critical factors, such as social determinants of health (poverty, housing, access to food, resiliency … a global pandemic) can add other barriers. Layered upon this is taboo, tradition, today’s times, Tariqah, and ultimately, our openness to open the conversation.
What’s out there?
The longstanding advocacy for primary care and improved access to it, seems to be garnering local and national support, albeit in varying degrees. In some areas of the country, creative models aim to accelerate improvement, both on a person/family level but also on a systems level. Examples include rapid access to opioid agonist therapy such as the Rapid Access Addiction Clinic (RAAC) in BC, Rapid Access Addiction Medicine (RAAM) in Hamilton, Addiction Recovery and Community Health Clinic (ARCH) in Edmonton. Other models include offering team-based care which can provide much needed allied health supports (for example, in social work and trauma informed counselling), and may include ‘wrap around care’ and case management. Still others may ‘outreach’ – physically going to the person, whether they are living at home, or on the streets. In tandem, public-private partnerships often enable community resources which aspire to be nimble to the needs of those requiring additional supports.
What can we do?
As more and more primary care clinicians and specialists at nearly all levels are exposed to the implications of substance use, for those who care for the health of peoples and communities, how can we be better equipped? Adopting a harm reduction perspective and being mindful of the following points may add value in our capacity to care for people and their loved ones – particularly at a time when relapse or struggle may be the presenting state.
Be open to discussions regarding substance use, adopt a safe and non-judgmental approach to enabling others to make informed decisions while taking active responsibility for their wellness.
Examine our own beliefs and biases while using best practice and up to date evidence. The principles within our Tariqah offer perspectives so we may be better suited to support others holistically.
Meet people and their loved ones “where they are at”.
Be liberal with compassion and commitment to improving the quality of life of those we strive to serve, physically, mentally, emotionally and spiritually.
Alwaeza Dr. Ashnoor Nagji is a Family Physician with a certified added competency in Addiction Medicine. Her work focuses on marginalized populations in Vancouver’s DTES and includes outreach, maternity care and teaching.
References 1. Canada's Low-Risk Alcohol Drinking Guidelines – Recommendations are: no more than two drinks a day, 10 per week for women, and three drinks a day, 15 per week for men, with an extra drink allowed on special occasions. Website. 2. UBC CPD elearning Alcohol Use Disorder Module. Addiction Care and Treatment Online Certificate Program 3. Canadian Centre on Substance Use and Addiction. Canadian Substance Use Costs and Harms in Provinces and Territories (2007-2014). 4. Litten, R. Z., Ryan, M. L., Falk, D. E., Reilly, M., Fertig, J. B. and Koob, G.F. (2015) Herterogeneity of Alcohol Use Disoder: Understanding Mechanisms to Advance Personalized Treatment. Alcohol Clin Exp Res, 39: 579-584. 5. Statistics Canada. Health Fact Sheets: Smoking (cat. no.82-625-X). Website. Published 2017. Accessed August 27, 2018. 6. Ng M, Freeman MK, Fleming TD, et al. Smoking prevalence and cigarette consumption in 187 Countries, 1980-2012. JAMA. 2014: 311(2). 7. World Health Organization. WHO Report on Global Tobacco Epidemic, 2013. Enforcing bans on tobacco advertising, promotion and sponsorship. Website. Published 2013. Accessed. Accessed January 11 2019. 8. Glantz SA, Bareham DW. E-Cigarettes: Use, Effects on Smoking, Risks, and Policy Implications. Annu Rev Public Health. 2018;39(1):215-235. 9. Bagot KS, Milin R, Kaminer Y. Adolescent initiation of cannabis use and early-onset psychosis. Subst Abuse. 2015; 36: 524-33. 10. Canadian Tobacco Alcohol and Drugs (CTADS): 2015 summary. Government of Canada. Website. Updated June, 2017. Accessed Janar 24, 2019. 11. Ries R, Miller SC, Saitz R, Fiellin DA, Ebooks Corporation. The ASAM Principles of Addiction Medicine. Fifth ed. Philadelphia: Wolters Kluwer Health; 2014. 12. Wolitzky-Taylor K, Operskalski JT, Ries R, Craske MG, Roy-Byrne P. Understanding and treating comorbid anxiety disorders in substance users: review and future directions. J Addict Med. 2011;5(4):233-247
Ismaili Healthcare Professional Registration Drive
Our bi-annual Ismaili Healthcare Professional Registration Drive will take place December 10th to 13th. Click any of the below buttons to share the registration link with other Ismaili Healthcare Professionals.
2021 Ismaili Health Professional Conference
This conference, originally scheduled for June 2020, has been rescheduled to May 2021. This exciting event will be virtual and have an international flair. We look forward to providing updates in upcoming newsletters and social media platforms. If you are interested in getting involved please contact us via email.
Nominate a Healthcare Hero
Throughout Canada, Healthcare workers are showing extraordinary care and commitment during the current pandemic. The Healthcare Heroes initiative celebrates these heroes. We want to honor them for their efforts and for the sacrifices they make every day.
Administrative Coordinator - Child and Women’s Health
National Child and Women’s Health portfolio is looking for an Administrative Coordinator to keep meetings, deliverables, and action items organized for the portfolio. This position will be supporting various members and projects. These are new and exciting projects with the opportunity to significantly impact the quality of life and health of the members of the Jamat.
Administrative Coordinator - Chronic Disease and Elder Care
The Chronic Disease and Elder Care portfolios is looking for an Administrative Coordinator to keep meetings, deliverables, and action items organized for the team. This position will be supporting various initiatives including Aging Gracefully and Chronic Disease Prevention strategies. These are new and exciting portfolios with the opportunity to significantly impact the quality of life and health of the members of the Jamat.
Already Licensed Mental Health First Aid (MHFA) Facilitators
The Aga Khan Health Board Canada is looking for MHFA Facilitators who are interested in facilitating MHFA sessions for our Mukhis, Kamadias, Mukhianis and Kamadianis and other Jamati leaders, staff and volunteers. Facilitators must have valid licence to facilitate MHFA sessions and have completed the Mental Health Commission of Canada (MHCC) upskill training to be qualified to facilitate virtual MHFA sessions.
Baby2B Regional Data and Evaluation Manager - Ontario
The Baby2B Regional Data and Evaluation Manager role is to ensure that the specifics of data management collection, data entry and management, and evaluation are carried out for the sessions. Required skills: background and/or experience in data management and health research, proficient in general computer applications, demonstrates a high level of confidentiality.
The Baby2B program is a 6-week national program that is coordinated by the Aga Khan Health Board for Canada (AKHBC). AKHBC is looking for Facilitators to support, and facilitate weekly sessions. The Baby2B program aims to drive a strengths-based approach with a focus on empowerment, healthy and mindful approaches to decision making and creating community-based support. Note: At this time sessions will be conducted virtually due to pandemic.
Human Resources Coordinator, Mental Health & Addictions (MH&A) - Ontario
The HR Coordinator will contribute to the success of the MH&A Portfolio by managing the recruitment and onboarding for all program members, coordinate interviews, maintain ongoing engagement with team members, scheduling and manage postings.
Living Life to the Full (LLTTF)
The Mental Health and Addiction (MH&A) portfolio is seeking LLTTF Facilitators. LLTTF program is a CBT (cognitive behavioural therapy) based program offered over 8 sessions, 1.5 hours each. The course teaches individuals stress management skills and basic tools to deal with daily worries and to enhance mental health. The cost of training for you to become a facilitator will be covered. The portfolio expects that each facilitator offers at least 2 in-person (3 virtual sessions) per calendar year. Note: At this time all sessions will be conducted virtually due to pandemic.
Mental Health First Aid (MHFA) Facilitator
MHFA is a standardized course aimed to teach participants common mental health conditions and crises and first aid measures when helping individuals who might be facing these conditions. The Mental Health and Addiction (MH&A) portfolio is seeking Facilitators who have a: 2 years background clinical mental health experience, teaching skills, previous facilitation skills. The cost of training for selected candidate to become a Facilitator will be covered.
Note: At this time all sessions will be conducted virtually due to pandemic.
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