One of the most interesting things about working in the hospital in Yellowknife is meeting people from all over the north. Most of the residents across the Northwest Territories, as well as the western half of Nunavut, come to Yellowknife for hospital or specialist care. Each of the small communities across this far flung region has a health centre, staffed by nurses, where residents get medical care. Part of my job as a Yellowknife emergency doctor is to provide telephone support and advice to the nurses. So every day at work I speak to nurses across the land, and decide what care a patient requires – ranging from reassurance that the nurse is doing all that is needed, to giving treatment advice, reviewing an XRay, or arranging a patient transfer to Yellowknife. To call out a plane for an urgent transfer costs roughly $10,000. If the patient can wait a day and get on a scheduled flight, its more like $1000. As you can imagine, the medical travel budget for the North is enormous.
The nurses in the nursing stations have an unenviable job. They are providing comprehensive primary care 24 hours a day, and have to deal with every emergency that comes their way – whether or not the health centre is equipped to deal with it. They have no ability to hospitalize patients, so if someone needs to stay overnight, it means the nurse has to sleep at the patient’s bedside. The rates of certain medical conditions, as well as trauma, are very high in the north, and so the health centre staff are nearly guaranteed to see very sick people at times.
I love my contact with the patients I meet from the high Arctic communities. They are mainly Inuit people, although there are several different cultural groups and languages through this large region, (of which I am entirely ignorant, alas.) It feels sometimes like meeting people from a different time and a different country. They come to the ER in their traditional clothing, and with traditional foods, like char, (my favorite fish), muktuk, (which is whale blubber), or caribou. (I recently had some caribou heart – a delicacy, and it was amazingly tender and delicious, to my surprise.) This can lead to some interesting notes on patient charts, like this allergy alert form.
At the risk of cultural stereotyping, I will say that I find the Inuit people to be, in general, quiet, slow to speak, very pleasant, and very accepting. Decidedly not demanding. Sometimes they communicate with unusual facial gestures, like eyebrow movements to indicate yes and no. They look me in the eye, and smile with both face and eyes. I really feel like I’ve been seen. And welcomed. The elders are especially full of character. I will never forget one hunter I met, an 80 year old fellow who was raised in an igloo and on the land. We did not have a common language, yet it was clear to me that this man with his aged, finely etched face, so angular and sunbeaten, so full of character, was a wise being. This man had a presence and an energy that I’ve rarely encountered. So full of serenity, of knowing, of wisdom, of gentle acceptance.
Naturally I find the life and culture of the Inuit fascinating. I’ve heard some stories of life in the communities, the remote places these traditionally nomadic people have settled in, yet its hard to imagine what life is like there. My best guess is that it might be more like a foreign country than other foreign countries I’ve visited, as it must be so different from the rest of Canada I know.
It took a while, but eventually I navigated the mysterious paths of bureaucracy and obtained the necessary medical license to go work in a community myself. I was asked by a Yellowknife colleague to share the monthly community visits to Gjoa Haven, in Nunavut, and I was thrilled at the change to see this remote part of Canada for myself, in a way that a tourist can not.
Gjoa Haven is a community of about 1400 people, on Victoria island in the Arctic Ocean, just north of the mainland. The name comes from the Norweigian ship Gjoa, which Roald Ammundsen used to find the Northwest Passage. He found safe anchorage in the harbor and spent two years there, just 110 years ago, in 1903. At the time there were about 70 people based there, although as nomads I am sure they moved around with the seasons and the movement of the caribou. Because of Ammundsen and his men, we know something what the community looked like to outsiders at the time, a rare opportunity to understand something of the local culture before there was significant contact with the outside world.
I was lucky enough to go there in August and while I was there the weather was unseasonably warm. The temperature was 20 degrees, the sea was like glass and the sky a clear blue. The locals were all perspiring in the unusual heat, although to my surprise they seemed quite overdressed in long sleeves, fleece and coats, and even toques. I suspect they may not own anything more fitting for warm weather, having such little need for it.
The town is a surprisingly small collection of houses, (meaning there aren’t enough houses for everyone, I’d guess, and multiple generations share a home) right on the water. The surrounding tundra is flat in all directions, the vegetation about 1 cm high and brown when I was there. The ground is soft and spongy, and there are lots of small lakes and streams. The area around the town is littered with snowmobiles and komatiks, the tough sleds used for hauling stuff in the winter. There are also assorted shacks doting the landscape, for storage or summer camps I suppose. There are lots of boats too, in the bay.
Scattered here and there are sled dogs chained up to a dog house, some with puppies roaming around, and to my surprise, all very friendly. Under that 1 cm of vegetation is sand and big rocks, so that is what all the “roads” in town are made of. They aren’t roads per say, just areas that have been traveled enough to pack down. There are probably no more than 5 km of road in the area, so few automobiles. People mainly get around on ATVs, in summer, and skidoos in winter. (The absence of the car also means that its incredibly quiet in town – at 10 pm under the blazing sun, or 7 am, its so quiet in town you can hear a pin drop.) The absence of graded roads means the terrain is rough – difficult to walk on, and impossible if you have a walker or a stroller. No wonder the tradition of carrying babies and small children in a large hood on mom’s back survives. (This is called an amati). I suspect for the infirm elderly, this means a life indoors.
The town consists of long rows of houses in rough blocks, near the bay, and a few public institutions – the health centre, the school, the police, a new heritage centre, some churches, the airport, and two private enterprises – The Coop Grocery Store and The Northern Store, both with food and basic items like clothing and household items. And that’s about it. No video store, no corner store, no liquor store, no restaurant or coffee shop. No park, no town square, not one bench or tree, no movie theatre, dress or shoe shop, hardware store, bakery, or drug store.
There are an amazing number of kids in town – something like 800 of the 1400 people are kids, and there are about 100 kids under two. (Imagine the difficulites of planning for this kind of population growth, where houses have to be brought in on the ships that come once a year, or by air. The cost must be enormous.) The kids are incredibly friendly – happy, welcoming, playful, curious. Everywhere smiling and laughing kids.
Lots of people come by the medical residence to sell their local crafts. (There is really very little opportunity for them to market their work, or find employment.) I was very lucky to be able to buy some gorgeous sealskin mitts, from Linda, the lovely lady who made them. He husband hunted the seal, and she tanned the hide.
I very much enjoyed my time in Gjoa Haven. The best part was meeting the locals, and hearing stories about life now, and in the past. People were friendly and welcoming. I never once heard anyone raise their voice, or yell. I didn’t hear any arguing at all, but lots of children laughing as they played. Life is certainly different in Gjoa Haven. I get the sense that it is mostly an interior life, although people really love to get out on the land as well. More than Canada, it reminded me most of my time in the Everest region of Nepal. Friendly down to earth people with enough money for food and clothes but not necessarily more than that. Rough dirt trails, no roads, spectacular wild scenery, animals that work for their food. Curious happy children, and wise, weather beaten elders.