The patient referral pathway from Qikiqtani-Qikiqtaaluk Region to Ottawa. (Image courtesy of CMAJ Open)

Nunavut Inuit more likely to experience serious complications after surgery: study

Researchers think this may be due to barriers in accessing timely and culturally appropriate health care

By Meral Jamal

Inuit from Nunavut are 25 per cent more likely than non-Inuit to experience complications in the first month after surgery, new research has revealed. 

The study, published May 3 in the Canadian Medical Association Journal, used information from 2011 to 2018 to compare Nunavut Inuit with non-Inuit patients who had similar surgeries, age, and medical conditions. 

Dr. Jason McVicar, lead author of the study, said this research shows the need to provide care closer to home whenever possible. (Photo by Peter Duffy)

The study relied on data from the Ottawa Hospital, which provides care for Inuit from the Qikiqtani and Qikiqtaaluk regions of Nunavut.

Not including obstetric or cardiac surgeries, Nunavut Inuit patients made up 928 of the 98,701 surgeries during that time.   

For the study, researchers identified Inuit from Nunavut through a code in their Nunavut health card number that indicates they are an Inuit land claim beneficiary.

Inuit patients who had elective surgeries and cancer surgeries were 58 per cent and 63 per cent more likely to have complications compared to non-Inuit patients respectively.

The study also found Nunavut Inuit arrive at surgery in a more advanced state of illness, increasing their risk of complications.

Compared to non-Inuit patients, Nunavut Inuit had higher rates of hospital readmission, greater lengths of stay, higher costs of hospital care, and greater chances of being sent to long-term care or other assisted-living facilities rather tan going home after surgery.

One of the big challenges Nunavut Inuit face is having to travel outside the territory to receive their care, said lead study author Dr. Jason McVicar. 

“Our [health-care] system has complicated access to resources for Inuit,” said McVicar, a Métis anesthesiologist at the Ottawa Hospital and assistant professor at the University of Ottawa.

“From some communities, Inuit have to travel more than 1,000 kilometres just to get to Iqaluit. From there, it’s another 2,000 kilometres to get further south into Ottawa. By that time, they’ve actually crossed several jurisdictions and health-care systems.” 

The team also found Nunavut Inuit are likelier to face these complications due to barriers in accessing timely and culturally appropriate health care.

For McVicar, this research shows the need to provide care closer to home when possible. 

Dr. Donna May Kimmaliardjuk, one of the co-authors of the study, said ensuring that Inuit are able to access health care in Inuktitut and have escorts come with them for support is critical in improving their experience with surgery. (Photo courtesy of Dr. Donna May Kimmaliardjuk)

Dr. Donna May Kimmaliardjuk, the first Inuk heart surgeon in Canada and a study co-author, said language barriers play a significant role in the way Inuit receive care as well. 

She said ensuring Inuit are able to access health care in Inuktitut and having escorts come with them for support is critical in improving their experience with surgery. 

“Providing care in a language that the person understands is a very basic step and a very tangible one, because there are going to be elders or other Inuit who come down south for care and don’t speak a lot of English or might not understand medical jargon,” Kimmaliardjuk said.

“Health-care providers need to understand how to communicate with their patients, and how their patients are communicating with them.”

The team’s next step is to use Nunavut health data to look at outcomes for Inuit one year after surgery. 

The work is part of a larger research program at the Ottawa Hospital and University of Ottawa to better understand Indigenous Peoples’ experience of surgery in Canada. 

The research team is also looking at the possibility of expanding the kinds of surgeries that can be done in Nunavut, so patients can receive care closer to home.

Correction: A quote in this story was changed to correctly identify the route some Inuit must travel receive health care in Ottawa.

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(36) Comments:

  1. Posted by Observer on

    “From some communities, Inuit have to travel more than 1,000 kilometres just to get to Calgary. From there, it’s another 2,000 kilometres to get further south into Ottawa.”

    Did McVicar seriously confuse Calgary and Iqaluit’s names?

    That aside, last time I checked, there were two other regions in the territory, and they don’t use Ottawa as a surgical center, so the question obviously is, does this hold true in the Kivalliq or Kitikmeot as well? That answer will suggest different solutions.

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    • Posted by anon on

      My guess is that the confusion was between Winnipeg and Calgary, as Winnipeg is where flights south from Sanikiluaq go.

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  2. Posted by Nunavummiut on

    I also think that we lack basic family doctors. Most people in the South have a family doctor they see. This would be where they get the bulk of their primary health care education and they form relationships with their clients. In Nunavut, there is a lack of a relationship with the health care providers. The majority of the health care providers are transient workers, who come and go. This causes breaks in relationships.

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    • Posted by Dave on

      Most people in the South have a family doctor they see
      —————-
      While that is true, most people in the north do not have a family doctor. By north I mean, an hour north of a major centre, in one of the provinces. Even in wealthy northern locales with strong resource economies, virtually nobody has a family doctor and transient doctors are the norm for everyone.

      I hear what you are saying, but this is a huge problem in Canada right now. And not a problem that will be easy to deal with. I read an article recently saying it’s a big problem across Canada for towns under 10 000 people.

      Because the demand for family doctors is so high, doctors can go anywhere they want, and that doesn’t help northern residents at all. Expect this problem to get worse, not better. That’s what I think anyway.

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      • Posted by Lol look east on

        Look at Halifax. No one has a family doctor. Wait times for an ambulance over an hour. Oh, and the transportation to the hospital isn’t free like it is for Inuit as they receive NIHB. People often travel the equivalent in time in transit as Inuit who travel from up island. The point is that healthcare is falling apart for everyone, not just Inuit. It is what decades of easy policy decisions by all governments resulted in and now we are paying the piper for more and receiving less. If covid didn’t add many beds to your local hospital the only force powerful enough to do this is an aging baby boomer population.

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    • Posted by I Wish What You Said Was Correct! on

      You’re statement may have been true in distant past – it certainly isn’t now.

      Many many people don’t have family doctors, and the waiting list to get one is years long. I changed provinces five years and 7 months. I couldn’t get a family doctor in the province that I left, and I’ve been on the waiting list in my new province since I got here.

      It is walk-in clinics or nothing. Time to update your vision of the ‘south’.

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    • Posted by Northern Guy on

      NOPE! The majority of Canadians no longer have access to a family doctor, especially if they happen to live in rural areas and/or smaller cities.

  3. Posted by concern on

    I agree with parts of the article, but if you live with Inuit like me since 25 years you know another parts of the problem, first when they go to nursing and come back home “ that nurse don’t not thing she just give me pills and most of the time they go to garbage, they expecting seen a wizard and be ok instantly if its a prescription most don’t even go pick it up when arrive, last fall our brother in law medevac diagnosis lung cancer he is TRANSLATOR for our hamlet, doctor said to them him and is 2 escort good thing you here now we will start treatment because you could be dead and 2 or 3 months, When we have the call at home is wife crying away said my husband gone be dead in 2 months it was not language problem, about 6 years ago I was at hospital another brother in law have a heart attack when the doctor give instructions to is wife and 2 daughters they go don’t bother if he need some thing we will call nursing at home, so the biggest problem is medical are not part of their culture and of course they didn’t learn from grand. parents.

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    • Posted by This is a fact on

      There is a pandemic of ignorance in our territory, and it is killing people.

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  4. Posted by Biggest missing piece! on

    How come the article doesn’t mention Inuit Qaujimajatuqangit? The doctors in the south should have to take a course in IQ too.

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    • Posted by Yes, As Far As It Goes on

      That would be ideal, yes.

      Equally ideal would be if Inuit also received cultural training so that they can understand the people around them when they are guests in the south. We don’t provide this training to our people travelling south, and we really should.

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    • Posted by Traditional healers on

      I agree there should be more traditional healers hired at the health department then we wouldn’t need to send people down south in the first place.

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      • Posted by Brucie the Friendly Northern Store Panhandler on

        Where do we find these traditional healers? There are dire shortages of Inuit nurses, doctors, teachers, translators, midwives, tradespeople… basically every position imaginable. There are only so many people available who want jobs.

      • Posted by Northern Guy on

        When I require medical attention, the last person I want to see walking toward me is a “traditional healer”. I would demand to be seen by a qualified medical practitioner with the education and experience necessary to diagnose and treat my ailment.

      • Posted by Crystal Clarity on

        I have yet to see anyone healed by a “traditional healer”, whatever that is. I haven’t seen anyone using certain plants or animal parts etc to heal people of anything, not even talk about it. In more southern locations where flora is more plentiful and diverse there are many plants used by indigenous people for healing but in the Arctic it is minimal at best. I’m sure there are a few that might have medicinal value but not much. Someone who is seriously ill would likely die waiting for one of these traditional remedies to work. And lets not talk about Shamans…..more like charlatans holding people in fear at what they claim they can do.

    • Posted by Observer on

      And given they’d also need the equivalent training for the multiple First Nations in the south, Chinese, Sikhs, Tamils, Filipinos, Americans, Norwegians, Ukrainians, Russians, Koreans, Chileans (continue inserting whatever nationalities and ethnic groups you want representing the people said doctors also treat), at what point were you thinking they’d actually get to practice medicine?

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  5. Posted by Jim Bouche on

    Am I reading this correctly? If inuit suffer a 25% higher increase in higher complications then does that mean non-inuit living in Nunavut that require medical care in the south also can expect a higher rate of complications?

    • Posted by Crystal Clarity on

      Yes. Anyone living in Nunavut will be diagnosed later, treated later, have more complications etc…,… unless they go south on their own dollar and initiative.

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  6. Posted by Brucie the Friendly Northern Store Panhandler on

    Latest figures show that 70%+ of Inuit smoke or use tobacco. The WHO has stated that smoking is proven to cause post-surgical complications such as infections and longer healing times. These 2 facts cannot be unrelated, as much as Nunavummiut love to blame every problem on someone else.

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    • Posted by Gus the Polar Bear on

      An interesting point that can’t be ignored. Yet there is no mention of it in the article. Does anyone wonder why that is?

      My guess, it doesn’t fit the underlying tone, which is to present Inuit in a state of perpetual marginalization.

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      • Posted by Through a fog on

        I went to the web page for the Canadian Medical Association Journal, searched the index for the current publication (May 2, 2022 Vol 194 Issue 17), even did a specific search on Dr. Vicar, but unfortunately could not find anything related to this research.
        https://www.cmaj.ca/content/194/17

        Maybe someone who knows can provide a link to this study?

        My curiosity is piqued as to whether smoking factors appear in the research. They may be there, and where ignored by the author of this article. Or they weren’t there at all. It would be interesting to know.

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        • Posted by Brucie the Friendly Northern Store Panhandler on

          It’s unfathomable that smoking was not considered. Smoking rates are much higher in the north and the impacts on all aspects of health are well known and severe. It is at the point now that the first thing a doctor will ask is “Do you smoke?” If smoking was not included as a variable, this study isn’t worth the time it takes to read it.

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          • Posted by Brucie the Friendly Northern Store Panhandler on

            Predictably, the study makes no mention of tobacco or smoking. It only considers the outcomes of the patients and completely ignores patient behaviors such as smoking, adherence to post-op instructions, attending follow-up appointments etc. We can have easy access to the best healthcare in the world provided by completely non-racist staff, but if we keep smoking, ignore doctor’s orders and fail to show up for follow-up appointments, we’re going to have worse outcomes.

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            • Posted by Disgraceful on

              It is inexcusable that a heart surgeon could intentionally ignore these variables.

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    • Posted by Northern Guy on

      Add significantly higher levels of substance and alcohol abuse and now you have three significant confounding factors that probably never even crossed the author’s minds let alone applied to the the data they were using.

  7. Posted by Qavvigarjuk on

    It is not just Inuit that are having more complications after surgery. It is all Nunavut residents ( Inuit and non Inuit) who suffer from the worse health care system in the country.

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    • Posted by Brucie the Friendly Northern Store Panhandler on

      On what do you base this claim? The study in question only considers Indigenous.

      • Posted by Qavvigarjuk on

        My point is that we all suffer proper medical care in Nunavut as through preventative medicine screening , As an example, we do not even have mammograph machine in Nunavut and women are not routinly scanned for breast cancer. . The GN does not specifically send you out for mammograms. This is but one example.

  8. Posted by Inu on

    had stint put in my heart after surgery just a month ago , taking meds for it but ran out of meds and now fighting with GN just to get my meds and had nurse yell at me for not taking meds that I’m still waiting for . GN threaten to charge me because I had heart attack while working .

  9. Posted by Karl Popper on

    Google ‘agenda driven science’ and you will get an idea of what is going on here.

    There is a lot of debate around this today in the research community and it is important you can discern when you are seeing it. A useful guiding principle is that science starts with a question (a hypothesis), agendas start with a conclusion.

    The agenda in this case can be found in the conclusion to the study:

    That indigenous communities “direct Indigenous population health research and policy.”
    https://www.cmaj.ca/content/cmaj/193/20/E713.full.pdf

    Not terribly controversial and you may agree with it. Still, it only superficially connects to the research, if at all, which—critically—is not meant to make a scientific point, but a moral one.

    In addressing disparities in post-operative outcomes between indigenous and non-indigenous populations the research addresses selective points, omits controversial or less favourable evidence and relies heavily on evocative language around colonialism and anti-indigenous racism (considered self-evident).

    Again, you may agree with all this. But let’s be clear about what it is; a politically driven moral discourse wrapped in a visually stunning, yet superficially thin scientific cloth.

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    • Posted by No Moniker on

      Another thin veneer worth looking beyond is that between the writer of the article, or, the journalist, and the ones who respond in the informal format of the comments. We automatically assign authority to the former, while the latter starts with a disadvantage and on a lower playing field. None of this truly reflects the quality of what has been said by either, and that is worth noting.

    • Posted by Dave on

      Very good points to make.

      When I read the original study I was thinking the exact same thing. How do legitimate scientists use such charged language in a study?

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      • Posted by Northern Guy on

        Not scientists, merely medical practitioners who think they are scientists. Most research and science-based journals wouldn’t touch these types of flawed and questionable studies with a ten foot barge pole.

  10. Posted by What does media do? on

    Is it not the mission of our local media to analyze the information it floats into our information ecosphere? Or does it content itself on merely paraphrasing Canadian Press releases? Why is it that the only push back to shoddy research comes from the comments section, but rarely if ever from our journalists?

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