Hey, this Arctic blog post is just like a regular blog post

I guess what’s most striking about medicine in Inuvik so far isn’t how different it is from “down South”, but how it’s pretty much the same in the day-to-day. Sure, you worry about things like botulism after people eat bad muktuk (fermented whale oil), the tuberculosis rate is ten times the national average, and you get more pedestrians frozen to death than killed by cars, but for the most part, Arctic medicine runs like “regular” medicine. An Arctic pneumonia is still a pneumonia, an Arctic heart attack is still a heart attack (or maybe it’s Takotsubo cardiomyopathy, like last week), an Arctic broken hip… etc.

Some of the cases so far could’ve happened just as easily back at St Paul’s or at Toronto General: a 96-year-old grandmother recovering from a hip replacement, with worried family needing encouragement to keep her moving; a 40-year-old first time mum with a labour that isn’t progressing well; an 11-year-old boy anxious about bullying; a 4-month-old wheezing and too sick to cry; a 16-year-old on a Saturday night needing a medical ‘ok’ to sober up in the RCMP drunk tank; an 83-year-old with deepening dementia I needed an interpreter to figure out. It was a Siglitun interpreter instead of, say, Cantonese or Polish, but again, dementia is dementia wherever you are.

It’s a pretty impressive setup if you’re used to medicine in the rest of Canada. There’s often a sharp distinction between (usually rural) limited-service community hospitals, and (usually urban) referral centres. When you train in the city’s specialised, academic teaching hospitals, ones proudly Achieving Global Impact with The Best Medicine, it’s almost ingrained to see the smaller, community hospitals that send your way as something, well, less than “The Best Medicine”. They’re sending you patients because they can’t handle them – pfft, wimps.

So when you come to a town of a mere 3 000 – towns that size don’t even have hospitals down South – and you’re the one taking patients and fielding calls from the towns around you, it’s a bit of a change. They opened this hospital just three or four years ago, and with construction costs expensive as you’d expect having to ship or fly everything up to build, you can be sure they would’ve pared it down to the bare essentials. So when you look around and see everything – a full operating room suite, labour and delivery rooms, laboratory, long-term care ward, transition hostel and chapel – you know they’re not frills or luxuries in a proper regional hospital.

Dr D explained the case. Yes, keeping the place running with “frills” like Obstetrics and Surgery costs money, because you have to have a surgeon, an anaesthetist, OR staff, equipment and post-op wards. Say $3M a year in Inuvik – about the same as the hospital’s funding deficit, apparently. Vs cutting the surgery and anaesthesia service, and just aerovacing everyone, every case, to Yellowknife. But that also means sending every surgery away, and every labour and delivery too (since there’s no surgery or anaesthesia). Cost? Turns out, about $2.8M – but that doesn’t include the increased workload on the surgeons and OR in city hospitals.

But it’s more than that. What price can you put on feeling safe in your own home, knowing the care you need is available nearby? Especially among traditional First Nations families, what price on having your loved ones nearby when you’re sick? Keeping elders near their children and grandchildren, passing on traditions and languages that don’t have cultural centres or schools to protect them? Or having nonna in the delivery room at granddaughter’s birth? Healthy communities need full medical – and surgical – care.

There’s an established pattern: first the surgeon leaves, because there aren’t big exciting cases to do. Then the anaesthetist leaves, because if there isn’t surgery, why are they there? Then you can’t have Obstetrics anymore, without an anaesthetist. Then GPs withdraw emergency and on-call service, because if something happens when they’re on-call and there’s no emergency surgery or C-section capacity, there’s little you can do. And when a community can’t offer people emergency medical service in town, it scares off potential new residents, and locals – especially young families – move away.

You read so much about medicine being about the doctor-patient relationship, the privilege of being part of individual lives, stories; but doctors as a part of community sustainability, the lynchpin keeping entire towns and cities alive – that’s a pretty cool privilege too.