By Leah Geller
Della Magnusson’s one-stop shop
At an inner-city clinic in Saskatoon, this nurse practitioner is supporting HIV-positive pregnant women and their goals
During the last eight years, Della Magnusson has worked with about 80 HIV-positive pregnant women. None have had HIV-positive babies, a testament to the comprehensive care they receive at Westside Clinic, part of the Saskatoon Community Clinic.
“We put all the pieces together to ensure these women have healthy babies,” says Magnusson, the clinic’s nurse practitioner, who specializes in women’s health and prenatal care. “It’s like conducting an orchestra.”
The clinic serves a predominantly aboriginal population. Many who access care live in poverty. The team offers a range of social and health services and includes physicians, nurses, aboriginal outreach workers, aboriginal counsellors and a nutritionist.
“Westside Clinic has a relaxed and informal environment with very little hierarchy,” Magnusson says. “My patients call me by my first name. On a regular day, I wear jeans and a nice shirt; there are no white coats here. A lot of our staff and most of our patients are aboriginal. And the work is varied and always challenging. It really has the feel of a northern setting.”
Magnusson, who obtained her nursing diploma in 1985, decided to become an NP after working for several years in advanced practice roles in Nunavut and northern Alberta and Saskatchewan. After moving south, she wanted to maintain the broad scope of practice she had enjoyed in remote communities. She went back to school, in her home province of Saskatchewan, for a primary care nurse practitioner advanced certificate and a bachelor of science in nursing degree. “I kind of did my education backwards,” she laughs.
Saskatchewan’s HIV rates are the highest in the country, with rates among aboriginal people making national headlines. “Here in Saskatoon, injection drug use of cocaine, crystal meth and morphine is driving the HIV epidemic.” Some of her HIV-positive prenatal patients have a history of addiction and homelessness.
If an HIV-positive pregnant woman is treated with an antiretroviral, the likelihood of her having an HIV-positive baby is less than one per cent. That’s why Magnusson tries to see these women as early in their pregnancy as possible. Word of mouth and the fact that the clinic is well established in the community help bring people in the door.
“I’ve geared myself up to be a one-stop shop,” she says. “I sit down with the patient initially and ask about her goals for the pregnancy. If she wants treatment to get off drugs, we can get our physicians to prescribe methadone as appropriate. Later, we start them on the antiretroviral medication.” She has strong support from a visiting obstetrician, infectious disease physicians and outreach workers, who help her manage these complex cases.
“Pregnancy is a huge motivator for these women to make positive changes in their lives,” she adds. “We work opportunistically — setting them up for success and doing as much as we can right off the bat by drawing on all our resources.”
Magnusson does a postpartum checkup six weeks after a birth and counsels the woman about birth control. For someone whose life is too chaotic to manage daily birth control, she’ll fit an IUD. “The medical costs for a child born with HIV could amount to more than a million dollars. More importantly, imagine the hardship for the child dealing with HIV for a lifetime.”
She estimates that about a third of the mothers she’s seen have successfully kept and cared for their babies. “It’s so important for the mom to make the decision and be supported. If she wants, we can arrange to have family members take care of the baby or have it adopted out. If she wants to parent, we’ll find ways to do that, too, including 24-hour supportive living. Years ago, social services were seen as the people who take away babies. Now they’re part of the prenatal team — on board and willing to work toward the woman’s goals.”
In her office, Magnusson has a corkboard with pictures of all the babies along with obituaries of some of her former patients. Pictures of her two daughters are also on display. “I think those personal touches allow my patients to see me as a mom, too.”
Magnusson’s heart is in the North and she says she’ll probably return once her daughters have grown up. For now, she’s loving her work. “I get to spend the time I need for each appointment, handling all the assessment and care from start to finish — from weighing the mother and taking her blood pressure to interpreting lab results. That hands-on time, having those conversations really helps build their trust and confidence in me. That pays off in the end.”
10 questions with Della Magnusson
What is one word you would use to describe yourself?
If you could change anything about yourself, what would it be?
To say no without feeling guilty
What are you most proud of having accomplished?
Raising two beautiful teens who are strong, increasingly independent and not afraid to be their true selves
What is one thing about you that people would be surprised to learn?
I have a nursing licence from New Zealand
“If I had more free time, I would...”
Learn to practise meditation and try to use it
Name one place in the world you’d most like to visit.
Iceland, where my father’s side of the family is from
What is your biggest regret?
Not having learned a second language
What was the last good book you read?
Wild by Cheryl Strayed
What was the best piece of career advice you’ve received?
At the end of the workday, always thank staff and colleagues (I do this all the time!)
What do you like most about being a nurse?
The world is your oyster! You can work almost anywhere