The first few days: a warm welcome

Adam and I arrived in Inuvik on October 27^th, a “warm” and sunny afternoon (it was only -3 C), after our plane required de-icing in a slushy Edmonton morning. Temperatures here the last few weeks have been 10-15 degrees C above the seasonal average! 

Snow in Edmonton before take-off

Re-fuelling in Yellowknife

We were driven to the hospital from the airport by taxi driven by a friendly gentleman, originally from West Africa, who moved to Inuvik from Calgary 7 years ago on the advice of a cousin “for the money.” Apparently there isn’t so much money in the town these last few years: less confidence in the natural gas industry and uncertainty about the future of the promised pipeline to the north has resulted in decreased growth of the population, less construction, and fewer jobs. However, even the "minimum wage" jobs here can pay upwards of $20/hr, so it's not so bad yet.

Inuvik is a town of about 3000 people in the Northwest Territories. It is located on the Beaufort Delta, where the Mackenzie River forms a mess of little rivers and lakes to pour into the Beaufort Seat (Arctic Ocean), which is about 100km to the north of us. Fun Fact: Inuvik is 10 degrees further west than Vancouver, but is in the (Alberta) Mountain Time Zone. Figure that one out.

Day 1 - I spent my first day in the hospital with the community public health officer, following up on some TB cases.  A good reminder right off the bat that a differential diagnosis here in the north has to be much wider than usual. Latent TB is incredibly common, and the BCG (TB vaccine) is still included in the regular schedule of childhood immunizations. Anyone with a cough requiring admission to hospital gets sputum for AFB… affectionately called “spits tests.” Rabies is also a real concern, quite common in the wild foxes that roam into town, and any animal bite needs to get reported and triaged for rabies risk.  Even more rare, there has also been a case of botulism recently in the Territory!  Botulism is a neuromuscular disease that weakens your muscles from the top down and so gives you blurry vision, difficulty swallowing and finally can cause respiratory failure. We usually worry about it coming from improperly canned foods, or in honey when fed to kids under 2 years old, but in the arctic it most commonly comes from “Muktuk” or whale blubber.  Really glad I didn’t know about this when I ate Muktuk in Repulse Bay…!

As we were about to head home from our first day in the hospital, a trauma case rolled into the ER and it was all hands on deck to stabilize him for a medevac (or 'medical evacuation' i.e. by plane or helicopter) out.  Just a taste of the decision-making challenges here: you have a guy with a head injury, your closest CT is in Yellowknife, 1100km away and about 3h by air, but there is no neurosurgery there if he needs an intervention. Edmonton is about a 6 hour flight and the medevac will cost approximately $25 000 as opposed to $14 000 to Yellowknife... so where do you send him?  (Follow-up note: he was sent to Yellowknife for a head CT which was normal, no bleed. Thankfully he did just fine!) 

And that was only Day 1...

Day 2 - I left to go on a community visit to the hamlet of Fort McPherson.  This is a town of about 900 people, mostly Gwich'in, located 182km southwest of Inuvik down the Dempster highway. Only Day 2 and I got to drive (at least a short way) on the famous Dempster!

The Dempster... it's pretty straight.

The nursing station in Fort McPherson is run by a fabulous Nurse Practitioner and a rotating group of temporary RNs whose scope of care in the north is well beyond that of their big-city colleagues. They really do an amazing job of handling all sorts of primary care (and occasionally emergent) medical issues.

Medical highlight: Saw some pretty regular stuff in the 2 days of clinic, a bunch of prenatals, some chronic disease. Picked up a classic tinea versicolor… which is apparently more common in warm, humid countries. Hmm.

Musing for the day: To get from Inuvik to McPherson, you need to cross the Mackenzie River, by ferry in the summer, or ice road in the winter. 

Taking the ferry across the Mackenzie River

During the 3-5 weeks each spring and fall when the river is in freeze-up or break-up, not much comes and goes from the community except by plane. Fort McPherson is a "controlled" alcohol community, meaning there is no alcohol sold in town, and you can bring in and possess only a limited amount at any one time, in an effort to reduce the problem of alcohol abuse in the town.  The general consensus is that this strategy fails quite miserably. But one of the nurses made an interesting observation: each year during freeze-up and break-up, the supply of booze in the town dries up after a few days, and for the next few weeks the health centre becomes dead quiet, families are spending time together, people are out walking, being active, and the whole town seems like a healthier place to be. 

Sunlight count: 7h 21min (Sunrise 10:56 Sunset 18:17)

Temperature: Warmer than in Calgary today.

Day 4 - On the way back from McPherson we passed through the little Hamlet of Tsiigehtchic (tsee-get-chick), a beautiful traditional Gwich'in fishing village located at the confluence of the Mackenzie and the Arctic Red Rivers. This hamlet of about 120 people doesn't have a permanent nurse, but has a health centre that visiting docs will run clinic from about once every 5 weeks. We held a short clinic, and had time in the light to look around the town and take some photos in the daylight: 

Beautiful place. But as Adam wondered aloud, will this tiny community continue to exist 50 years from now?