Gupta, Archna

Getting ready to board a small ten person plane, heading towards a remote community unlike anything I had seen before, I was filled with excitement and apprehension about what was in store. What would the healthcare system be like in an isolated Northern Aboriginal community? The plane took off. The view was breathtaking - a melody of yellow, orange and green treetops in their full fall transition. The land was interspersed with a complex network of lakes and rivers. While looking down at these small islands, separated by vast bodies of water, I wondered how any supplies could possibly reach these communities? Surely one could not transport vehicles, fuel, or lumber on these little planes! As it turns out, there is one golden period each year, in the dead of winter, when a winter “road" is created, to allow supplies to enter. Each community is responsible for ploughing and maintaining a portion of the road after the water has frozen over. Hundreds and hundreds of kilometres of temporary road over frozen lakes and rivers… what a concept! Apparently, the past year was not ideal, as the weather was too warm; the road was only usable for four weeks - yet another consequence of global warming I had never envisioned.

We landed in our community, home to 250 people. It was the middle of the afternoon; I headed to the local clinic which is usually run by two registered nurses who come live in the community for a month at a time. The doctors come to see patients for a few days a month, and are available the remainder of the time via phone to support nursing staff when issues arise that are outside of their scope of practice. Within the clinic was a "medication room", which essentially acts as the local pharmacy. If a medication wasn't stocked there, a prescription would be sent to the nearest town, which was a flight away, and then the medication would then be flown in. The things we take for granted.

My clinical experiences in this community were diverse - some enriching, while others somewhat troubling. For the prenatal care visits, most of the women I saw were quite young, less than 20 years old, and several of them already had two or three children, if not more. During medical school, I was always taught to ask about domestic violence during pregnancy, as its incidence increases during this time. It was here, unfortunately, that I finally became comfortable asking woman about domestic violence; nearly every woman I questioned had been physically abused at some point, many of them during their current pregnancy, as evidenced by the bruises visible on their arms and faces. When I asked them to elaborate on their experiences, their affect was flat; I began to understand that violence was a normal and expected part of their life story. I wondered about the role of women in this community, and was saddened by how their sense of self-worth was diminished.

When I went to get a glass of water from the tap for a patient, it was brown. Apparently the water had not been acceptable for drinking for some time now. The community members were advised to boil their water or drink bottled water. However, during my home visits, it was quite evident that many families were not adhering to this advice.

I took a walk around the island and stopped off at the local store, the only source of food for the entire community. It was essentially a convenience store. After scoping out the shelves, it was clear that no one could possibly be eating a well-balanced diet and getting the nutrients they require. There were scattered vegetables and some frozen meats; but, primarily the store stocked canned items, pastes, processed meals, and junk food. What I was shocked to learn, however, is that any food could be flown into the community, completely at the discretion of one store owner. Imagine, one store owner, having a monopoly on such a major determinant of health - the diet of the community. No community resident could eat anything else without first getting on a plane and flying somewhere else! Wouldn't it be great to engage the store owner in a discussion about health promotion and allow her to be a health advocate for the community - simply by stocking healthier options on the shelf?

As I continued my walk, I surveyed my surroundings; dirt roads and run down homes, often covered by tarps. Solitude. Endless blue water. It was hauntingly beautiful.

Reflecting on my experience, it’s hard to believe that I was still in Canada, one of the world’s most "developed" nations.

Theme: Community | Communauté
Theme: Health Care Delivery | Prestation des soins de santé

Stories in Family Medicine | Récits en médecine familiale [Internet] Mississauga ON: College of Family Physicians of Canada. 2008 --.




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