At the 29th meeting of the 2021/2022 Rotary Club of Picton Tuesday, local Rotarian member Dr. Andy Janikowski spoke to the group about his time in Nunavut and the trials and tribulations the people have there.
Dr. Janikowski has practiced medicine in Prince Edward County for over 30 years and started going to Nunavut in 2005 to assist in the medical field in Canada’s north.
“I started going up to Nunavut in 2005,” Dr. Janikowski stated. “Thinking I would do it for a few years and here it is 17 years later and I’m still very much a part of the Healthcare community. It really is a spectacular place. But not only spectacular, its a huge place and most people don’t appreciate the size of Nunavut. Most people don’t appreciate the size of the Northern territories, the Yukon, the Northwest Territories and Nunavut especially. Nunavut basically encompassed three time zones, Eastern time-zone, Central time-zone and Mountain time-zone.”
Nunavut is the newest, largest and most northerly territory of Canada and was carved out of the NWT in 1999. As of the 2016 consensus, Nunavut’s population was 35,944, which has only grown since.
“It’s a very fast growing indigenous community, probably the fastest growing in Canada,” said Dr. Janikowski. “Two dozen communities all the way from Resolute Bay with 200 people there, to Iqaluit, the capital with around 7,740 people.”
With the exception of Baker Lake, all towns are coastal towns and every community has a healthcare centre. Hospitals in Nunavut include a larger one with a dedicated emergency room, maternity ward and operating room located in Iqaluit and a smaller basic hospital in Rankin Inlet.
“Basically different communities, different medical models,” Dr. Janikowski said to Rotary members. “All communities have healthcare centres, they have nursing, mental health, some limited x-rays, they have visiting MD’s such as myself, larger centres will have one or several doctors on staff who are there all the time 24/7. We utilize flying consultants so, at times, there will be obstetricians, general surgeons, paediatricians coming in a number of times a year. In the larger communities, they will run clinics so anyone who has to have further treatment has to go down south and down south depends on which part of Nunavut your in. If you need laboratory, x-ray or ultrasound, with the exception of simple x-rays, most ultrasound, most laboratory has to go down to a larger centre. We do fortunately have some telemedicine so there is psychiatry, theres interim medicine some of that is done now by telemedicine.”
Emergencies can happen any time, any place, be traumatic or medical and require critical care. If medivac is needed there are limitations to effectively and timely medivac a patient.
“The interesting challenges start when you realize a person three hours off in the land where two skidoos collided or whatever happened to get a broken bone, all of a sudden you’re trying to get the people off the land and into a health care centre where they can receive better care,” stated Dr. Janikowski. “That can be a challenge because there are really no helicopters for the most part, fixed wings can’t land so the first difficulty is just loading the patient onto a sled or a skidoo and getting them to a healthcare centre.”If they need to be medivaced, first of all if you realize someone has to go down south you have to call Winnipeg or Yellowknife or whoever your calling and see whether they have a bed.”
Without highly specialized and expansive mental health departments, options for treating those types of patients can be an issue.
“Usually it works other than psychiatric issues and psychiatric beds are premium so getting people with psychiatric problems sometimes takes hours to find a bed, then of course there is plane availability, they have a pretty good medivac system but its often in use and if the weather goes down then you really don’t know when that plane is going to arrive,” Dr. Janikowski recalled. “They’re a challenge because if you’re with a psychiatric violent patient on an airplane it’s just not safe so you have to work it remotely at getting these people sedated, making them safe to travel and then finding a bed which can be a real problem for psychiatric beds.”
The successes of health care in Nunavut include accessible free health care for all residents including, basic health monitoring and interventions, mental health, long term care, chronic care, free medications, electronic health records and access to speciality care either through outreach visits, telemedicine or travel to southern centres.
“There is often a mental health worker attached to each community,” Dr. Janikowski said. “There is longterm care, a number of communities have nursing in elder homes, that would be under chronic care as well, and health promotions, certainly the nurses go out into the community a lot such as public health would here and tried to get the health perimeters improved. Sitting here in Picton covering the north, I can access x-rays, cardiograms, consultant notes from the north right from the computer here in Picton which has allowed us to do so much more.”
Some challenges of healthcare in Nunavut are cost of travel, increasing difficulty in recruiting appropriate staff, increasing workloads, increasing prevalence of chronic disease, social dysfunction, alcohol, drugs, violence, suicides, etc.
“Certainly there is a longer list of challenges then there is successes,” said Dr. Janikowski. “The cost distances are huge- a return ticket to a northern community is $2,500. If your looking at a medivac and anyone who has to go down south in a hurry, your looking at a medivac and that’s about $40,000 just to get the person there. The plane has to be sourced out of either Iqaluit, Rankin Inlet, Winnipeg even or Church Hill, has to fly up to the community and then all the way back down then return to base, your looking at about a $40,000 cost.”
When Dr. Janikowski has to travel to Nunavut he either stays in a dedicated apartment or a hotel if no dedicated apartment is available. He also brings his own box of food as the people up north have a greasier diet.
“They do have an interesting kitchen,” Dr. Janikowski declared. “The same way polar bears need their fat, the local people need their fat so the food is very few salads, lots of greasy hamburgers and that kind of stuff. So very often I’ll go there and bring my own box of food just to allow me to survive the 1-3 weeks I’m up there.”
Dr. Janikowski wishes more Canadians could have the opportunity to visit the north, meet the people and see the spectacular land and the creatures that inhabit it such as polar bears, muskox, narwhals, arctic foxes and humpback whales.
“All these creatures inhabit the great north and usually if your lucky enough you will pretty well see all those creatures up there,” expressed Dr. Janikowski. “Probably the most wonderful for me when I’m up there are the people. These are truly amazing, amazing people. They’re so friendly, so outgoing, they love showing off their culture, they love having you be part of their culture. They’re truly my favourite first nation people. They’re really something that makes you keeping going up there, just to be with them, they are wonderful people.”
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