Salamonie Arnaquq is playing the waiting game. The slim elderly man with a thin moustache has been having trouble with the medication for his leukemia. The pills he’s been prescribed haven’t been working, and so he needs to see a specialist.
But it isn’t all that simple. Arnaquq lives in Iqaluit, Nunavut. His hometown, the capital of the territory, has a hospital, 16 full-time family physicians, two surgeons and some specialists — but no oncologist. The closest is a three-hour flight south in Ottawa. Because he is an elder, the government says he can have an escort to travel there with him. And because he needs to see the doctor a number of times, he needs a place to stay.
That’s what has brought him here to Larga Baffin (“Larga” refers to a spotted seal; “Baffin” refers to Baffin Island, the massive Nunavut island that is home to Iqaluit and other communities). From Richmond Road in Ottawa’s suburban west end, Larga Baffin resembles the three-storey motel it once was. Now, it is a residence for Inuit from 12 of the communities in Qikiqtaaluk, the eastern region of Nunavut, sent south for any sort of medical attention they can’t get in the north — everything from a specialist appointment to cancer treatments to orthopedic surgery.
More and more people make the trip from Nunavut to Ottawa each year for medical help; 2,900 visits were made in 2015 and 2016. Many of the medical travellers end up at Larga Baffin. A few find themselves farther down the street at Embassy West Senior Living, for Alzheimer’s and dementia patients, or at the Mamisarvik Healing Centre, a treatment centre for trauma and addictions. Then they settle into the role of patient, waiting for their next treatment or appointment. Some stay a few days; some much longer. Some never go home at all.
Hospital stays can be trying at the best of times. For Inuit who have never ventured far from their homes in the North, the journey thousands of kilometres south for medical attention is a lonely, frightening experience. Specially purposed residences like Larga Baffin try to alleviate the dislocation and culture shock, but the only real remedy is successful treatment and an airplane ticket home.
“This is one of the more common rooms,” says Lynn Kilabuk, president of Larga Baffin, as she shows me around the residence. The double room is airy and bright, if a little stark — white walls, light-coloured furniture and a laminated wooden floor. Durability is key. “When you have 44,000 bed nights,” — that’s the total number of occupied beds they have in the course of a year — “you want it to be able to withstand a lot.”
Founded in 2001 with just seven beds, Larga Baffin has grown every year since. Today, the facility has 129 beds and 80 staff members, and at any given time the residence is 70 to 80 percent full. They moved into their current facility in December 2015. “We have gone over capacity twice recently,” Kilabuk says. “We didn’t expect to hit capacity for a few years yet.”
The residence, privately owned by two holding companies headquartered in Nunavut, provides these services to the government of Nunavut under contract. There are similar facilities in a number of other Canadian cities — Winnipeg, Edmonton, Yellowknife — that provide Canada’s Inuit population from other regions of the North with the health care they cannot get at home.
Spending just part of an afternoon hanging out in the lobby, the TV and computer lounge, and outside near the corrugated plastic smoking shack, I quickly meet a wide range of the people who use Larga Baffin. Darryl Ukalik is there with his little boy Jude Siakuluk, who is just four. Jude has had his tonsils out. They flew south directly from Hall Beach, which is part of the Qikiqtaaluk region, on the mainland. They’ve been here for a couple of weeks and will be heading home in another week or so. Batiste Tootoo is here to be treated for throat cancer. He’s due to go home fairly soon as well. Joseph Auksaq came south as the escort for a nephew who had been stabbed in the head with a screwdriver — five months ago.
Larga Baffin has its own fleet of white vans bearing its distinctive logo to ferry passengers to the Ottawa Hospital, the Children’s Hospital of Eastern Ontario and various doctors around the city. A large TV screen mounted over the reception desk lists the times for the day’s runs. For much of the day, however, the patients and escorts stick close to the residence.
All the patients and escorts I encountered spoke well of Larga Baffin and the health care they received, but spending weeks or months here, far from home, wears on a person. Accounts of the North play up its stark quality, but Ottawa’s Richmond Road in February has its own bleakness. This is an environment designed with the car in mind, and inhospitable for anyone on foot — especially if you are using a walker or crutches. The mounds of dirty late-winter snow piled up and lining the big road add to the glum feeling.
“It can be a bit isolating,” says Kilabuk. And stressful. Larga Baffin employs a full-time social worker, Lorne MacLeod, to help its patients and their escorts make the adjustment. MacLeod has been at Larga Baffin for six years; before that, he spent a decade working in the North.
“People are extremely homesick,” he says. “They just want to go home.” For many Inuit, the south is an entirely new experience, especially “for elders, who haven’t really experienced this world — the traffic, the trees. And then to be going to a hospital.”
The dislocation is understandable. Carolyn Roberts is the Aboriginal patient nurse navigator at the Ottawa Hospital tasked with helping Indigenous cancer patients, many of whom are Inuit staying at Larga Baffin. “How would we do if you put us up north on a trapline and expected us to get from A to B?” she asks. “We can’t expect them to just come here and take a bus.” A lot of Inuit, she also points out, come south without much money.
Larga Baffin does its best to help them settle in. “We try to do an outing at least once or twice a week,” says Kilabuk. “Sometimes it’s a drive to see some nature.” Larga Baffin also features a sewing room, and the residence’s walls are covered with Inuit art, some of it created by former patients and escorts.
As I learn when MacLeod takes me to lunch, Larga Baffin makes sure its residents can eat the foods they are used to. Off to one side in the modern cafeteria stands a table where five women are working with ulus, the traditional rounded, general-purpose Inuit knife. One offers me muktuk, whale skin and blubber, on the edge of her knife. It’s tasty, if chewy — nothing about it to faze the urban sushi eater. The Inuit refer to this and other foods such as seal, caribou and Arctic char as “country food.” For many people here, the older ones particularly, it is what they still eat a lot of at home. Kilabuk says they purchase some of it from hunters, and sometimes residents bring it with them. “We provide a space and a freezer,” she says.
The outings, the food, the kind people to talk to — it all helps to break up the days and weeks, but in the end, it’s still a waiting game.
“There is no place like home,” says Arnaquq.
Peter Irniq bangs the large flat drum over his head while doing moves he earlier likened to Chubby Checker’s classic twist. In a conference room on the lower level of Embassy West Senior Living, about five kilometres east of Larga Baffin along Carling Avenue, the audience watches, delighted.
Irniq has been a politician and public official, serving as a member of the legislative assembly in the Northwest Territories and as Nunavut’s second-ever commissioner, its highest non-elected post. Today, he is here in another of his roles — that of a cultural teacher.
Like Larga Baffin, Embassy West started life as a hotel. The lobby retains the feeling of a fairly upscale establishment: leather sofas; a grand piano; a smiling, crisply dressed young woman at a reception desk. But Embassy West specializes in providing a comfortable residence for people suffering from dementia and Alzheimer’s.
Irniq is here today to help the staff understand one particular group of patients they work with: elderly Inuit in various stages of dementia who need constant care. Like the residents at Larga Baffin, these patients have been brought south for medical reasons; unlike the people at Larga Baffin, they will probably never go home.
The numbers change, but there are currently 21 Inuit elders residing at Embassy West. Many speak only Inuktitut. For most of their lives, they have eaten country food.
“The Inuit have gone from igloos to microwaves in 50 years,” Irniq says. These elderly people lived through that often-traumatic transition. They were the generation who attended residential schools, underwent forced resettlement in the 1950s and saw their sled dogs slaughtered. Now they are living the last days of their lives far from their families. The Government of Nunavut pays for one or two family members to travel south as escorts for patients who need support during medical treatment, but those who want to visit relatives living in faraway long-term care facilities are on their own. For most, it is too expensive — usually more than $2,000 for the round trip.
This past January, Nunatsiaq News reported on a complaint made to the Nunavut language commissioner’s office by Manitok Thompson, a former Northwest Territories and Nunavut MLA currently living just outside Ottawa. Elders living at the Embassy West seniors’ residence, through a contract with the Government of Nunavut, were not being offered services in Inuktitut. Although translators were available to help them with medical appointments, the rest of the time they were cared for by non-Inuktitut-speaking attendants and personal care workers. In theory, the Government of Nunavut requires all services provided for its residents to be available in Inuktitut, but as yet the law does not cover privately owned businesses.
In March 2016, CBC News Ottawa reported that one elderly Inuk, suffering from Alzheimer’s and believed to be dead by his family in northern Quebec, was in fact living at the residence. All contact had been lost.
A well-regarded home, Embassy West does what it can. Inuktitut-speaking staff have already been hired; the goal is to always have a translator available during residents’ waking hours. Irniq and other members of Ottawa’s 3,300-person Inuit population frequently visit to try to fill in the gaps. Irniq brings residents country food and gives them a chance to speak their own language. “I keep in touch with their relatives,” he says. “It’s comforting for people to know that they have someone like me coming here on a regular basis.” His visits also have a personal angle; his uncle is here. “I call his kids and tell them he’s okay.”
Qikiqtaaluk is the most populated of Nunavut’s three regions, but “populated” here is a relative term. In the 2016 census, 19,654 people called it home. Iqaluit, the capital, is way out in front with 7,590 residents. Of the region’s other communities, spread out over 990,000 square kilometres, only five have a population of more than 1,000.
These two factors, geography and human numbers, are the major barriers to giving people in the region the health care they need locally. Only Iqaluit has the population to support a hospital. Of the regional health clinics scattered across the district, Rankin Inlet has three full-time doctors and Cambridge Bay, one; the rest make do with a nurse and occasional visits from MDs.
These obstacles can never be completely overcome. As Dr. Sandy Macdonald, the Nunavut health department’s territorial chief of staff, says, “We are never going to be able to do neuro- or open-heart surgery here.”
However, he adds, “there are things that we could do.” One idea, which his department has put in place over the last three years, is improving high-speed Internet access so doctors in Iqaluit can share their patients’ x-rays, ultrasounds and scans with specialists in Ottawa, who can interpret the results. Macdonald would also like to make greater use of telehealth, so doctors in Iqaluit or nurses working in remote locations could have a patient looked at by a specialist in the south. For the moment, however, the Internet in Nunavut is simply not up to the task.
For many Inuit, the south is an entirely new experience, especially ‘for elders, who haven’t really experienced this world — the traffic, the trees. And then to be going to a hospital.’
In terms of preventive medicine, Nunavut launched an ambitious program in 2012 called Tobacco Has No Place Here. It should ultimately cut down the territory’s lung cancer rates, said to be among the highest in the world. As well, plans are afoot to bring some of the chemotherapy done in Ottawa to the North. “We have the hardware, a new pharmacy, and we’re going to hire some nurses and a doctor to oversee it,” says Macdonald.
It’s a bit too early to call it a certainty, but the region may also get its own residence for elders in need of 24-hour care. Pat Angnakak, an MLA, and others have been working to create a 72-bed facility that they hope will open in about two years. It would provide a hospice for those in prolonged or palliative care, spaces for people in assisted living and at least 24 beds exclusively for those with dementia. Since Angnakak began work on the project, her own mother has been diagnosed with dementia and sent south to Embassy West. “It’s touched me in a much more personal way than I ever thought it would,” she says. The centre would require between 80 and 100 employees, many of them local hires, such as graduates of the nursing program at Nunavut Arctic College.
That’s key. Providing better health care is largely a question of finding trained people. Not just attracting doctors and nurses from the south, but equipping local people with the required knowledge and skills. “The longer-term strategy,” says Macdonald, “is to encourage kids from Nunavut to go and get training as physicians or nurses, pharmacists or dentists — you name it.” To that end, his department has been sending Nunavut students to science camps in Newfoundland and to the new Northern Ontario School of Medicine (NOSM), with campuses in Thunder Bay and Sudbury, Ont. The school has a strong focus on working with Indigenous communities, Macdonald says. “This summer, with some funding from the federal government, NOSM is going to run a science camp for kids here in Iqaluit.”
It’s unlikely that the residents of Qikiqtaaluk will ever get the local medical services that those living in Canada’s big cities take for granted. But then, neither do smaller towns in the south. When they need health care, the Inuit will still play the waiting game — but not for as long and a whole lot closer to home.
This story first appeared in The Observer’s June 2017 issue with the title “Southern exposure.”