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Elective in Canada's North: Rural family medicine in Iqaluit
“Brrrrrr!” I thought to myself as I ran from the front steps of my home to my pre-warmed car in the driveway, six metres away.
It was a cold week in New Brunswick with temperatures reading in the – 30°C range. “How are you going to survive in Iqaluit if you’re cold here?” my friends and family kept asking as I complained. But the tickets were booked, and housing arrangements made. I was travelling to Northern Canada in January, undoubtedly one of the coldest months of the year.
How then, you ask, did this opportunity come about? One I most likely wouldn't have pursued on my own?
Well, as a student in the Longitudinal Integrated Clerkship at Dalhousie Medicine New Brunswick, I was paired with Dr. Clay Marco, one of my preceptors. He's a family doctor working in Florenceville-Bristol, a small town in western New Brunswick, and home of McCain Foods' Corporate Headquarters.
Aside from his passion for establishing point-of-care ultrasound as an everyday clinical tool in his practice, he also enjoys traveling to Iqaluit to provide care. Recognizing Canada’s North as an invaluable experience for any practitioner, he graciously invited me and my classmate and friend, Shannon Rasmussen, along.
To prepare for my trip I dutifully researched the territory, Iqaluit, and the Inuit culture. I joined local groups on social media. I asked friends and mentors about their experiences. Much of the advice I received in preparation for my trip was to pack food, as even the essentials can be expensive in the North. Although I was a little timid as my trip approached, I quickly became captivated by the opportunities I encountered upon my arrival.
Arrival in Iqaluit
After a two-day weather delay in Ottawa, we finally arrived in the Great North. I was excited to get settled, explore, and start work at the hospital. Luckily, the locals indicated a mild temperature forecast for the upcoming week at around – 25°C. Mild isn't the first word that came to mind.
Each morning, donned in full winter attire, I walked the 10 minutes from my temporary dwelling to the Qikiqtani General Hospital. It was under this roof that I learned the most about medicine in Canada’s North.
Shannon Rasmussen and Laura Faulkner at Qikiqtani General Hospital
Medicine in Canada's North
Working with a mostly Inuit population, I learned many of the health issues faced by this group start with the social determinants of health. What I found to be most impactful was the state of living conditions and food security. Overcrowding is a major issue within Iqaluit and among other rural communities in Nunavut. I quickly learned to incorporate questions such as, “How many people are you living with?” and “Are you getting enough to eat?” in my history taking.
Some families have up to 10 people living in a two-bedroom apartment, where they take shifts sleeping due to a lack of space. These conditions have contributed to a high incidence of tuberculosis, a rate that's comparable to the incidence in some third-world countries.
Another social determinant of health affecting the northern population is gender, specifically in relation to women’s health. Prior to this experience, I had never heard the term “Grand-Multip”, short for Grand-multiparity, which describes a woman who has given birth to five or more children; most women I met in prenatal clinic fit this definition.
The age of many women’s first pregnancies, often around age 16, was also quite surprising. Access to birth control is often discouraged by male partners.
Given the high birth rate, it was empowering to see Inuit women supporting each other despite their circumstances. Culturally it's acceptable to adopt children within the family. Young mothers often adopt a child to their older sister or cousin who wants a baby. This truly embraces the adage “It takes a village to raise a child.”
Access to care in Iqaluit is also a major barrier for the population. As previously mentioned, there are very few specialists in the area. Luckily, specialists do travel to Iqaluit to offer clinics and perform procedures and treatments otherwise unavailable in the region. However, without certain equipment and teams available, many patients must travel to Ottawa to receive appropriate care. Even with the services that are available in Iqaluit, much of the population still must travel from afar.
For the smaller, more rural communities in Nunavut, Iqaluit is the health-care hub. Travelling in and out of these communities is done solely by plane unless you own a snowmobile or dogsled team. When patients from these communities have appointments in specialty clinics, such as surgery or pediatrics, they stay in a boarding house adjacent to the hospital while investigations for their care are completed. Access to care is thus a challenge to organize both for medical administration as well as for patients and their families.
This is just a sample of the struggles faced by the Inuit people. Despite the disparity, it was reassuring to recognize basic Canadian values are true even in our most northern regions. That is, to do your best to get by, to be kind, and to provide for your family. The natural beauty of the barren tundra can appear desolate from afar, but with a closer look you will see Iqaluit’s people cultivate a warmth of grace and kindness.
Though many of my medical encounters at the Qikiqtani General Hospital taught me about unique disease presentations, the greatest skills I gained are those of a humanistic quality. Having compassion, listening to patient narratives, and attempting to understand from a perspective other than your own, are practices often lost throughout one’s medical education.
The people of Nunavut have revitalized my sense of altruism. I'm reminded of a vital line in the Hippocratic Oath: “I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being.” I hope to someday return to the North, equipped with additional skills necessary to provide excellent care.
Shannon and I would like to thank Dr. Marco, clinician extraordinare, for his guidance, and Dr. Rob Boulay, assistant dean of DMNB Clinical Education and essentially the father of the longitudinal integrated clerkship (LIC) program, for supporting a broad definition of the LIC program.
We would also like to thank Dr. Jennifer Hall, dean of DMNB, for backing us as well as the folks at the Global Health Office and their generous donors who provided us with a bursary to help cover costs.
And lastly, we’d like to thank the people of Iqaluit, community members, hospital staff, physicians, and patients, for welcoming us and teaching us.
This story was originally published in the Spring 2018 edition of VOXMeDAL.
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