Nunavut’s health system still on life support

IQALUIT — If you wake up with a headache in Arviat and decide that you need to see a nurse, you may be out of luck.

As in many Nunavut communities, overworked nurses at Arviat’s nursing station are only able to see emergency cases, so they may suggest that you stay at home, take a painkiller, and come to the clinic only if you continue to feel sick.

This increasingly common scenario is being played out in several Nunavut communities, where health clinics are forced to operate with half the required number of nurses.

Throughout most of the past summer, only two nurses juggled health services for Gjoa Haven’s 1000 residents, while in Arviat, population 1800, three nurses have had to reduce their public health education work and treat patients on an emergency-only basis.

“It’s kind of miserable.”

“It’s kind of miserable,” said a nurse from an understaffed clinic in one of Nunavut’s fast-growing communities

After spending several years in that community, the nurse, who has requeted anonymity, packing her bags this week to leave permanently for the South.

This nurse said doesn’t want her name to appear in the newspaper because she feels guilty and worried about her imminent departure.

She says decided to resign because she’s exhausted from long days at work to often followed by nights on call. She’s also tired of dealing with the additional financial stress of having to pay thousands of dollars for staff housing and occasional holidays out of Nunavut.

And she’s embittered by the fact that casual fill-in nurses who come to Nunavut for shorter periods of time receive more generous benefit packages. These include subsidized housing and round-trip airfares home.

“It’s terrible,” this nurse said. “It’s a rip-off of the permanent staff. You’re better off if you’re casual, so people are quitting and going casual.”

She said that, in addition to the perks given to non-permanent staff, temporary nurses and doctors also cost health boards more money because their time spent at work is less cost-efficient. They have to spend additional time orienting themselves in each new community, and redoing medical case histories for each patient.

Lower quality care

She said patients also end up with lower-quality care. “I’m the one that the people in this community come to and the other local health staff consult when there’s something going on,” said the departing nurse.

But residents of this nurse’s former community will have to get to know a new person, one that will probably not stay for more than a few weeks.

The Keewatin health board has what administrator Dave Barnett termed a “sizeable” turnover in its medical personnel, as well as many interested doctors and nurses who simply back off when they learn about Nunavut’s poor vacation travel and housing benefits.

“It’s a continuing battle,” Barnett said, referring to his board’s recruitment efforts.

Alice Isnor of the Kitikmeot health board, says her organization faces a similar challenge in recruit new staff for the five communities in her region.

She says her board is now advertising “everywhere” to find medical professionals who want to have an “adventure of a lifetime” serving the people of the Kitikmeot.

The Baffin Regional Health and Social Services Board recently went as far afield as Australia to hire new nurses.

Eleven nurses from Australia, some with experience working in aboriginal communities there, have just started two-year contracts in the Baffin region.

Baffin still understaffed

But even with the arrival of one Australian nurse in Pangnirtung, this community still has only three of the six nurses that it’s supposed to have.

In fact, only three or four of Baffin’s health facilitiies are fully staffed. The 34-bed hospital in Iqaluit continues to operate at a reduced capacity of 18 beds.

But Jarvis Hoult, director of the Baffin Regional Health Board, said that, compared to other regions in Nunavut, the Baffin region is relatively well-off and “quite stable”, in regardsto medical staffing, thanks to the draw of its hospital and other services available in Iqaluit.

Those who leave tell Hoult that they’re discouraged by the high cost of housing, food and airfares, as well as difficulties in continuing their professional education.

“It’s hard to do it up here,” said Hoult. “And when you do it, it’s very expensive.”

Health Minister Ed Picco said that he’s aware that many Nunavut health clinics are chronically understaffed.

“It’s not acceptable to have personnel working 24 hours a day, seven days a week,” said Picco.

And he also recognizes that Nunavut’s health boards are having serious difficulties recruiting replacements.

But this problem, says Picco, is not unique to Nunavut.

And he doesn’t believe that the hard times that boards are experiencing to find and keep staff are due solely to Nunavut’s relative isolation and high cost of living.

He attributes this to the lack of medical professionals everywhere in Canada, and problems that Nunavut has inherited from the GNWT.

Preventative health care

Picco remains convinced that Nunavut will eventually have a health care system “second to none” in Canada.

To achieve this, the government intends to promote a community-based and locally-staffed health care system. Over the long run, this would also help save millions of dollars spent on patient travel and salaries for nurses and doctors from the South.

“As a government, we’re trying to move towards a primary health care model and to look at the prevention of… diseases and problems before they happen,” Picco said. “But to be able to get that kind of delivery system in place and to shift our resources towards a primary health care model, we have to have capacity at the local level.”

This means training qualified personnel through such programs as Arctic College’s first nursing course, due to start on October 4.

Picco said that the Nunavut government plans to look at the “recruitment and retention issue, very strongly, very forcefully.”

An internal working committee is also looking at how to alleviate what Picco called “the two r’s.” Possibilities include the hiring new staff, such as community health representatives.

Picco expected that after the territory’s three boards amalgamate on April 1, 2000, recruitment will be easier.

The boards’ unification will also save at least $3 million a year, which can be plowed back into human resources.

Picco said that new money won’t be found through scrimping on services to patients.

“We are trying to move aggressively as a government to solve some of these issues,” Picco promised. “[But]I don’t have a magic wand that will them fix them overnight.”