You asked, you begged, you pleaded....well, some of you said "I miss those blog posts!" Now, back by popular demand, it is time for one final encore presentation of "The Blog"!!! Yaaaaay!
After we arrived in Thunder Bay, JJ and I left again. My mother volunteered to stay home with the kids, and we spent three days in Duluth, Minnesota.
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| The downtown area of Duluth, Minnesota. (source) |
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| We stayed at the South Pier Inn. You can watch lakers pass under the lift bridge. (source) |
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| source |
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| source |
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| Or like those lounge chairs from Wall-E. (Does anyone else find the similarity frightening?) source |
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| JJ Tribbiani |
After we ordered food we received a buzzer to let us know when our mozzarella sticks would be ready. The mozzarella sticks were the size of baseball bats. Maybe I'm exaggerating slightly, but they were enormous. So was the popcorn, and the drink was so heavy I had to hold it with two hands. After the tea in a mug and little snacks from the Astro (and everyone using the same roll of brown paper towel), everything at this movie theatre seemed....a little excessive.
We also, of course, ate out the whole time we stayed in Duluth. Every time we got a bill for our meal, we felt like we were getting away with something........it was all so cheap! Tex-mex for two, meals plus drinks for $50? Are you kidding? We almost felt a little guilty, paying so little for food.
After our lovely getaway it was time to finally begin the process of settling into our house. Temperatures have swelled into the mid to high 30's here in Thunder Bay, and the kids enjoyed a wonderful day at the beach. A friend of ours has a cute little camp on the shores of Lake Superior. (For all of you not from Thunder Bay, let me explain. Everyone else in the world would refer to my friend's seasonal dwelling on the shore as a "cottage" or a "cabin". Here though, it is referred to as a "camp". If you say you are "going to camp" for the weekend, it is implied you are heading to your cottage. If you say you are going "camping", there is more uncertainty. No one knows if you really mean going to a cottage or pitching a canvas tent somewhere in the wilderness.)
Also, our boxes have arrived from Nunavut. Unlike our other move, this time, no boxes were missing! Bizarrely though, we somehow managed to pick up a box along the way. The moving company was instructed to deliver 62 boxes to our home. JJ tallied everything as it was dropped off, and the final count was 63. We were concerned. Is this what happened to our missing 3 boxes from last summer? Do we now have personal items belonging to some other poor sap who is wondering where his things are? The movers assured us that no, that was simply impossible. More likely, the initial moving company (in Nunavut) failed to count properly. Hmmmmm. As we open our boxes we are making sure everything inside is, in fact, ours. Surprisingly, none of our boxes were crushed, or eaten by ravens, or peed on by rodents, so unpacking is a little less interesting this time around.
After living out of suitcases for over 3 weeks, the kids were quite excited to have their clothing unpacked, as well as toys, art supplies, etc. Captain Jack, however, was a little confused. As I was out shopping with Coraline (yes, we hadn't unpacked everything yet, but she absolutely NEEDED a clothes hamper to match her new bedroom decor, and I had to get away from boxes), the Captain was helping JJ unpack. In our front entrance area are two closets: one for the kids and one for the adults. JJ and CJS had gotten to a box labeled "boots and coats", and were hanging things up on hangers in the adult closet. "Daddy", Jack said, with a concerned voice, "Do girls always get to have more coats than boys?" JJ looked at the closet. On the left were the 5 hangers belonging to him. On them were a raincoat, fall jacket, wool peacoat for work, winter parka, and ski jacket. On the right....... quite the selection of parkas, vintage and modern trench coats, bomber jackets, vests, cotton jackets, denim jackets, a denim trench coat, a snow skirt, a courderoy jacket, etc. JJ wasn't quite sure how to answer this other than to laugh. Captain Jack, still concerned, asked him if he needed some more coats. "Buddy," replied JJ, "I have as many coats as I need."
In my defence, when JJ and I first started dating I was living in Florida. I had initially moved to Florida specifically because I am not a fan of cold weather. In order to be with the love of my life, I had to sacrifice living in a tropical climate and move back to Canada. I vowed to make lemonade out of that particular lemon. Cold weather is my excuse to own nice, fun coats and jackets. Cold isn't miserable anymore, cold means shopping!
Also, since we've been back, this happened:
We missed the trees, but have realized a benefit to living in the tundra: no trees means no tree problems. Not to worry though, our neighbor loves any excuse to use a chainsaw. He had the tree chopped up and off my garden within 24 hours. He also constructed a temporary fence panel for us so Buffy could still play in the yard. A family friend replaced the temporary fence the next day, so within 48 hours, aside from a couple of slightly squashed hostas, the garden looked as good as new.
Do you remember that awhile ago I had asked JJ to write a second post about his adventures in medicine? It took a few months, but he has finally done it! Take a look below.
******
Buttercup asked me to put some thoughts together on a couple of topics--one, the trip to Arctic Bay from a medical perspective, and two, my time as Acting Territorial Chief of Staff. I would also like a add a couple of comments on the trip as a whole....
I outlined how the territory is divided into three regions and how the pediatricians and family physicians cover the various fly-in communities (link) in my previous post about my trip to Kimmirut in November. I won't belabour the point here. Suffice to say that Arctic Bay is one of the fly-in communities on the northern coast of Baffin Island. (Technically, it is located on the body of water, Arctic Bay, which opens into Adam Sound, which is connected to Admiralty Inlet and, thence, to Lancaster Sound--wait, Buttercup is telling that no one cares......but I do! Here is a map of the local region:
You can see Nanisivik, an abandoned mining community, on the map. It is located about 20km east of Arctic Bay. It was closed in 2006 and the site is slowly being converted into an Arctic refuelling station and depot (which was supposed to happen by 2012, but well, things move slowly in the north....)
Arctic Bay is located just over 73 degrees N latitude and is the northernmost community on Baffin Island. The only communities further north in Nunavut are Resolute Bay (located on Cornwallis Island at 74 degrees N, pop: 230) and Grise Fiord (Ellesmere Island, 76 degrees N latitude, pop: 130). I would have loved to have made it to either of those two communities but it was not to be. My pediatric colleague, Dr. M, visited both Resolute and Grise Fiord a few weeks prior to my visit to Arctic Bay--it was the first pediatric visit to either of those two communities in over 10 years (!)
The population of Arctic Bay is roughly 850. It typically receives 1-2 visits per year from a visiting pediatrician. It has a brand new Health Centre that opened in September 2017, and it is gorgeous:
The photo below is of Gail R, nurse extraordinaire. Gail has spent 30 years living in Arctic Bay and providing health care to the children and families there. She is a remarkable woman and an
institution in her own right.
I spent most of my daytime hours seeing kids in the clinic. There is access to Meditech, the same EMR (Electronic medical record) that exists in Iqaluit, so I could review test results, imaging reports and consultation notes from previous speciality visits. I could also order tests electronically. Simple tests (urine dip, electrolytes, blood glucose, blood gas, etc.) can be done on-site using rudimentary equipment or an i-stat device. Most blood work, however, needs to be sent down to Iqaluit for processing. This is usually batched and sent twice a week, although in a pinch, you can arrange for "someone" (a random passenger) to bring the blood work down on the daily passenger First Air flight that leaves in the morning.
There is also an X-ray machine and the nurses are trained on how to operate it. Getting radiographs done on pediatric patients in the community isn't straightforward. There is a skill in having kids stay in the proper position long enough to get the correct exposure of the area you are interested in.
A common reason to order an x-ray in Nunavut is to either diagnose or track progression/improvement of treatment for tuberculosis. Tuberculosis chest x-ray findings can be subtle and it is always a struggle to decide whether to do it in the community (and save the family the inconvenience of the 3.5 hour (one way) flight to Iqaluit and the hassle of having to stay overnight in the capital -- and the corresponding cost to the health care system!) but risk having an inadequate film that just has to be redone anyway -- resulting in an unnecessary radiation exposure to the child.
One of the nice things about the clinic work in Arctic Bay was there were very few "no-shows" for appointments. Most families are happy to walk across "town" to the Health Centre and see the specialist. In the few cases where kids didn't show up --Gail arranged for the medical van to drive the home, knock on the door, and bring them in directly. I loved it.....
There is a "5-plex" adjacent to the Health Centre where most of the nurses (2-4 at any given time on the ground) stay. They share the on-call responsibilities for the community. A nurse is available 24/7 to see patients, triage, diagnose and treat with phone back-up available from the family physician covering the Emergency Department in Iqaluit.
By chance, a young woman presented to the Health Centre with threatened preterm labour one evening while I was there. The baby was about 32 weeks gestation, or about 2 months early. Happily, there was a family doctor in town and a pediatrician! Even more happily, we were able to send the mother down to Iqaluit via Medivac without the baby delivering in Arctic Bay. It was a good exercise, however, for me and the nurse to pull out the neonatal warmer and the resuscitation equipment and review what the "plan of care" was going to be should the baby deliver. It was an excellent ad hoc review of the 2016 NRP Guidelines for everyone....and an great reminder to me of how the nurses that choose to live and work in these remote northern communities truly need to be ready for anything....a premature baby one minute, a cardiac arrest the next, a gunshot wound the following shift....I am so impressed by the work they do!
My time in Arctic Bay was too short. The extracurricular stuff that my wife and I got to experience was detailed in Buttercup's post "here".
I found the community visits to be absolute highlights of my time in Nunavut and I would love to find a way to stay involved with them, if possible, even from Thunder Bay. Communication is the key to delivering effective health care to these remote regions. Safe, confidential communication between (ideally) long-standing nurses on the ground and physicians dedicated and committed to serving the same community over time. The communities that have the luxury of long-term dedicated health care providers fare much better than communities plagued by continuous staff turnover. Physician/nursing recruitment to the North is a (relatively) easy problem to address, it is the "retention" of health care professionals that is key. (The "obvious-to-see but very difficult to implement" solution is to have the community health centres staffed by locally educated and trained Inuit. This must continue to be the long-term goal for health care delivery in Nunavut.....)
An unexpected professional opportunity arose during the final few months of my time in Iqaluit. I was asked to cover as Acting Territorial Chief of Staff (CoS) from the end of April until the beginning of June while the search committee continued its efforts to find a permanent replacement for the outgoing Chief.
Typically, The Chief of Staff's mandate concerns "quality of care", and this takes two forms. The first is a reactive approach, aka, the "complaints department" wherein someone (a patient, family member, staff, physician, etc.) approaches you about a concern regarding the quality of care someone is/isn't receiving. The second is a proactive approach where you try to initiate and implement "change" at a department/hospital/policy level in a team-based effort to improve the quality of care your hospital/department is providing in some quantitative way. The CoS chairs the Medical Advisory Committee (MAC) of the hospital and, in a traditional hospital governance structure, presents the recommendations of the MAC to the Hospital Board for final approval.
Nunavut and the Qikiqtani General Hospital (QGH) do not have a traditional governance structure in two important ways. The first is that there is no arms-length Board of Directors at the top of the organizational chart. The hospital is directly owned and operated by the Department of Health. The second is that the CoS has jurisdiction over the entirety of the territory--not just the Baffin region--but all of Nunavut, the 25 communities, their respective health centres as well as Iqaluit and QGH.
(Buttercup is telling me that the readers' eyes are now glazing over and nobody shares my interest in territorial/provincial/hospital governance structure.....)
In any event, it was an intimidating and fascinating job to take on--even in a limited "acting" role for 6 weeks.
I found one of the most interesting challenges as CoS was sorting out transport logistics. As outlined elsewhere in this blog, any of the nurses manning the community health centres have access 24/7 to the family physician covering the QGH Emergency Department (ED). Many of those calls end with arranging of a medivac of the patient from elsewhere in the territory to Iqaluit. There are only two (!) transport planes available. The first is a KingAir jet and the second is the Lehr jet. They have different transport capabilities, the most important of which is range, or how far they can fly on a tank of fuel. Other important considerations include when the flight crew (pilot, flight paramedic, respiratory therapist) "time out"--that is, when the crew must be released from duty after so many hours of service. When a crew is "timed out", that plane is now grounded until the mandatory duty rest is completed or until another complete flight crew becomes available. On a busy night, it is not uncommon for there to be 5-10 active and pending transports listed on the white board in the ED. Most of the time the physician working the ED makes the necessary triage decisions independently in terms of where the planes are directed in what order of priority, but sometimes, the acuity and volume is judged to be so high that they are considering hiring a "third party" plane. That is when the CoS gets involved.
It is a humbling phone call to get in the middle of the night. I receive a list of the patients requiring transport and from which communities--the 55 year old woman in Pangnirtung who sounds like she is having a stroke, the 22 year old woman in Pond Inlet with new onset psychosis, the two young males in Qikiqtarjuag who were involved in an ATV accident and have sustained significant head injuries (no one is wearing helmets, natch) and the 18 month old baby from Cape Dorset in status epilepticus. I get a weather and flight status update from Keewatin Air and look at the map and then I (with in put from the ED doc and the nurse and the flight team) make my best decision about how best to direct resources. Then I authorize Keewatin to go ahead and try and find another transport plane and team from one of the southern provincial medical transport services--anywhere from Quebec to British Columbia--and hope that one of them has the capacity in their already-strained transport services to lend to us to 12-24 hours.
Happily, I worked with an excellent group of nurses and never felt "alone" with the responsibility. Other tasks included chairing the monthly medical advisory meeting, attending weekly hospital "pager" rounds with nurse management and senior hospital administration, and attending weekly JEC meetings with the deputy minister of health and her team. Then there was the daily "put out the fire" aspect of the job--most often revolving around last minute changes to the physician schedule. A doc might be needed to go on a transport to a community for a particularly sick individual and now a second physician needs to cover the ED while the first one is out. Or the surgeon may need a physician as a "surgical assist" in the OR to help with a particularly complex case. These phone calls can come any time during the day or night.
A last anecdote about my time as CoS--I received a phone call one Sunday morning from someone representing the "U.S. Navy". A soldier was injured (a broken humerus--arm bone) during a military exercise occurring off the coast of Greenland. They were sending a medical transport to medi-vac the soldier back to Washington, D.C. The military transport plane would need to land and refuel in Iqaluit and "could I authorize the release of one of the Iqaluit physicians to board the transport, travel to Greenland, attend to the patient and accompany him to Washington?" After which, the doc would board a commercial flight to get back to Iqaluit. This sounded to my ears like a very odd request--surely the US navy has better access to physicians than pawning one from a remote Arctic community. Agreeing to this request would mean removing one of our docs from our roster for 24-48 hours and then scrambling to cover the holes left in the schedule. I told the flight sergeant that I would "need to get back to him", hung up, and phoned one of the long-standing docs in town to review the whole scenario. His response was laughably terse:
"F*ck'em"
So I phoned back and presented a slightly-more-politically-correct response that conveyed the same message. No dice. We were strapped for docs as it was and the community couldn't afford to release one at the last minute like this. (Also, do you really need to have a physician on board to escort a soldier with a broken arm back to the US?) I spent the rest of the day afraid some American 5-Star general was going to track me down and chew me out over the phone for my lack of "team play"......(It never happened.....)
And well, because I don't have any good "Chief of Staff" photos, I'm going to post a few random favourite photos from the past year. Apologies if they are repeats!
Well, that's that. My next plan is to present some of the interesting medical cases wrapped around a bit of a travelogue at an upcoming Grand Rounds at the Thunder Bay Regional health Sciences Centre later this fall. If anyone is in town and interested in attending, feel free to reach out to me.
It was an amazing year. My thanks to Buttercup for making this year happen for the family and doing such an excellent job maintaining this blog. I agree with the readers--she needs to find some outlet to keep writing now that we are back home. (Somehow, "The Jaggers Live in Thunder Bay", doesn't have the same ring.....)
Thanks, finally, to you the readers for sharing this journey with us! 8000+ hits on this blog! Incredible! Until next time........
After our lovely getaway it was time to finally begin the process of settling into our house. Temperatures have swelled into the mid to high 30's here in Thunder Bay, and the kids enjoyed a wonderful day at the beach. A friend of ours has a cute little camp on the shores of Lake Superior. (For all of you not from Thunder Bay, let me explain. Everyone else in the world would refer to my friend's seasonal dwelling on the shore as a "cottage" or a "cabin". Here though, it is referred to as a "camp". If you say you are "going to camp" for the weekend, it is implied you are heading to your cottage. If you say you are going "camping", there is more uncertainty. No one knows if you really mean going to a cottage or pitching a canvas tent somewhere in the wilderness.)
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| Captain Jack Sparrow gives paddle boarding a try. |
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| Building sandcastles. |
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| Coraline on the water. |
Also, our boxes have arrived from Nunavut. Unlike our other move, this time, no boxes were missing! Bizarrely though, we somehow managed to pick up a box along the way. The moving company was instructed to deliver 62 boxes to our home. JJ tallied everything as it was dropped off, and the final count was 63. We were concerned. Is this what happened to our missing 3 boxes from last summer? Do we now have personal items belonging to some other poor sap who is wondering where his things are? The movers assured us that no, that was simply impossible. More likely, the initial moving company (in Nunavut) failed to count properly. Hmmmmm. As we open our boxes we are making sure everything inside is, in fact, ours. Surprisingly, none of our boxes were crushed, or eaten by ravens, or peed on by rodents, so unpacking is a little less interesting this time around.
 |
| Boring old boxes. |
After living out of suitcases for over 3 weeks, the kids were quite excited to have their clothing unpacked, as well as toys, art supplies, etc. Captain Jack, however, was a little confused. As I was out shopping with Coraline (yes, we hadn't unpacked everything yet, but she absolutely NEEDED a clothes hamper to match her new bedroom decor, and I had to get away from boxes), the Captain was helping JJ unpack. In our front entrance area are two closets: one for the kids and one for the adults. JJ and CJS had gotten to a box labeled "boots and coats", and were hanging things up on hangers in the adult closet. "Daddy", Jack said, with a concerned voice, "Do girls always get to have more coats than boys?" JJ looked at the closet. On the left were the 5 hangers belonging to him. On them were a raincoat, fall jacket, wool peacoat for work, winter parka, and ski jacket. On the right....... quite the selection of parkas, vintage and modern trench coats, bomber jackets, vests, cotton jackets, denim jackets, a denim trench coat, a snow skirt, a courderoy jacket, etc. JJ wasn't quite sure how to answer this other than to laugh. Captain Jack, still concerned, asked him if he needed some more coats. "Buddy," replied JJ, "I have as many coats as I need."
In my defence, when JJ and I first started dating I was living in Florida. I had initially moved to Florida specifically because I am not a fan of cold weather. In order to be with the love of my life, I had to sacrifice living in a tropical climate and move back to Canada. I vowed to make lemonade out of that particular lemon. Cold weather is my excuse to own nice, fun coats and jackets. Cold isn't miserable anymore, cold means shopping!
Also, since we've been back, this happened:
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| This tree fell down and smashed a part of our fence. |
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| My poor innocent garden!! |
We missed the trees, but have realized a benefit to living in the tundra: no trees means no tree problems. Not to worry though, our neighbor loves any excuse to use a chainsaw. He had the tree chopped up and off my garden within 24 hours. He also constructed a temporary fence panel for us so Buffy could still play in the yard. A family friend replaced the temporary fence the next day, so within 48 hours, aside from a couple of slightly squashed hostas, the garden looked as good as new.
Do you remember that awhile ago I had asked JJ to write a second post about his adventures in medicine? It took a few months, but he has finally done it! Take a look below.
******
Buttercup asked me to put some thoughts together on a couple of topics--one, the trip to Arctic Bay from a medical perspective, and two, my time as Acting Territorial Chief of Staff. I would also like a add a couple of comments on the trip as a whole....
Arctic Bay ("Ikpiarjuk" in Inuktitut)
I outlined how the territory is divided into three regions and how the pediatricians and family physicians cover the various fly-in communities (link) in my previous post about my trip to Kimmirut in November. I won't belabour the point here. Suffice to say that Arctic Bay is one of the fly-in communities on the northern coast of Baffin Island. (Technically, it is located on the body of water, Arctic Bay, which opens into Adam Sound, which is connected to Admiralty Inlet and, thence, to Lancaster Sound--wait, Buttercup is telling that no one cares......but I do! Here is a map of the local region:
You can see Nanisivik, an abandoned mining community, on the map. It is located about 20km east of Arctic Bay. It was closed in 2006 and the site is slowly being converted into an Arctic refuelling station and depot (which was supposed to happen by 2012, but well, things move slowly in the north....)
Arctic Bay is located just over 73 degrees N latitude and is the northernmost community on Baffin Island. The only communities further north in Nunavut are Resolute Bay (located on Cornwallis Island at 74 degrees N, pop: 230) and Grise Fiord (Ellesmere Island, 76 degrees N latitude, pop: 130). I would have loved to have made it to either of those two communities but it was not to be. My pediatric colleague, Dr. M, visited both Resolute and Grise Fiord a few weeks prior to my visit to Arctic Bay--it was the first pediatric visit to either of those two communities in over 10 years (!)
The population of Arctic Bay is roughly 850. It typically receives 1-2 visits per year from a visiting pediatrician. It has a brand new Health Centre that opened in September 2017, and it is gorgeous:
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| My office and examining room. |
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| The waiting area at the Health Centre. |
The photo below is of Gail R, nurse extraordinaire. Gail has spent 30 years living in Arctic Bay and providing health care to the children and families there. She is a remarkable woman and an
institution in her own right.
 |
| The view out my clinic window of the still-frozen eponymous bay and the King George V Mountains across the water, a popular day-hike from the hamlet. |
I spent most of my daytime hours seeing kids in the clinic. There is access to Meditech, the same EMR (Electronic medical record) that exists in Iqaluit, so I could review test results, imaging reports and consultation notes from previous speciality visits. I could also order tests electronically. Simple tests (urine dip, electrolytes, blood glucose, blood gas, etc.) can be done on-site using rudimentary equipment or an i-stat device. Most blood work, however, needs to be sent down to Iqaluit for processing. This is usually batched and sent twice a week, although in a pinch, you can arrange for "someone" (a random passenger) to bring the blood work down on the daily passenger First Air flight that leaves in the morning.
There is also an X-ray machine and the nurses are trained on how to operate it. Getting radiographs done on pediatric patients in the community isn't straightforward. There is a skill in having kids stay in the proper position long enough to get the correct exposure of the area you are interested in.
A common reason to order an x-ray in Nunavut is to either diagnose or track progression/improvement of treatment for tuberculosis. Tuberculosis chest x-ray findings can be subtle and it is always a struggle to decide whether to do it in the community (and save the family the inconvenience of the 3.5 hour (one way) flight to Iqaluit and the hassle of having to stay overnight in the capital -- and the corresponding cost to the health care system!) but risk having an inadequate film that just has to be redone anyway -- resulting in an unnecessary radiation exposure to the child.
One of the nice things about the clinic work in Arctic Bay was there were very few "no-shows" for appointments. Most families are happy to walk across "town" to the Health Centre and see the specialist. In the few cases where kids didn't show up --Gail arranged for the medical van to drive the home, knock on the door, and bring them in directly. I loved it.....
There is a "5-plex" adjacent to the Health Centre where most of the nurses (2-4 at any given time on the ground) stay. They share the on-call responsibilities for the community. A nurse is available 24/7 to see patients, triage, diagnose and treat with phone back-up available from the family physician covering the Emergency Department in Iqaluit.
By chance, a young woman presented to the Health Centre with threatened preterm labour one evening while I was there. The baby was about 32 weeks gestation, or about 2 months early. Happily, there was a family doctor in town and a pediatrician! Even more happily, we were able to send the mother down to Iqaluit via Medivac without the baby delivering in Arctic Bay. It was a good exercise, however, for me and the nurse to pull out the neonatal warmer and the resuscitation equipment and review what the "plan of care" was going to be should the baby deliver. It was an excellent ad hoc review of the 2016 NRP Guidelines for everyone....and an great reminder to me of how the nurses that choose to live and work in these remote northern communities truly need to be ready for anything....a premature baby one minute, a cardiac arrest the next, a gunshot wound the following shift....I am so impressed by the work they do!
 |
| Not a photo taken by JJ, but there is way too much text here. I need to break it up. -Buttercup source |
My time in Arctic Bay was too short. The extracurricular stuff that my wife and I got to experience was detailed in Buttercup's post "here".
I found the community visits to be absolute highlights of my time in Nunavut and I would love to find a way to stay involved with them, if possible, even from Thunder Bay. Communication is the key to delivering effective health care to these remote regions. Safe, confidential communication between (ideally) long-standing nurses on the ground and physicians dedicated and committed to serving the same community over time. The communities that have the luxury of long-term dedicated health care providers fare much better than communities plagued by continuous staff turnover. Physician/nursing recruitment to the North is a (relatively) easy problem to address, it is the "retention" of health care professionals that is key. (The "obvious-to-see but very difficult to implement" solution is to have the community health centres staffed by locally educated and trained Inuit. This must continue to be the long-term goal for health care delivery in Nunavut.....)
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| Boarding the plane Friday morning. First Air flight 883 from Arctic Bay to Iqaluit via Pond Inlet. |
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| The approach on landing in Pond Inlet. The mountains of Bylot Island across the Eclipse Sound. |
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| Eating Arctic char that night with the family, a gift from Gail and her partner! |
Territorial Chief of Staff
An unexpected professional opportunity arose during the final few months of my time in Iqaluit. I was asked to cover as Acting Territorial Chief of Staff (CoS) from the end of April until the beginning of June while the search committee continued its efforts to find a permanent replacement for the outgoing Chief.
Typically, The Chief of Staff's mandate concerns "quality of care", and this takes two forms. The first is a reactive approach, aka, the "complaints department" wherein someone (a patient, family member, staff, physician, etc.) approaches you about a concern regarding the quality of care someone is/isn't receiving. The second is a proactive approach where you try to initiate and implement "change" at a department/hospital/policy level in a team-based effort to improve the quality of care your hospital/department is providing in some quantitative way. The CoS chairs the Medical Advisory Committee (MAC) of the hospital and, in a traditional hospital governance structure, presents the recommendations of the MAC to the Hospital Board for final approval.
 |
| source |
Nunavut and the Qikiqtani General Hospital (QGH) do not have a traditional governance structure in two important ways. The first is that there is no arms-length Board of Directors at the top of the organizational chart. The hospital is directly owned and operated by the Department of Health. The second is that the CoS has jurisdiction over the entirety of the territory--not just the Baffin region--but all of Nunavut, the 25 communities, their respective health centres as well as Iqaluit and QGH.
(Buttercup is telling me that the readers' eyes are now glazing over and nobody shares my interest in territorial/provincial/hospital governance structure.....)
In any event, it was an intimidating and fascinating job to take on--even in a limited "acting" role for 6 weeks.
I found one of the most interesting challenges as CoS was sorting out transport logistics. As outlined elsewhere in this blog, any of the nurses manning the community health centres have access 24/7 to the family physician covering the QGH Emergency Department (ED). Many of those calls end with arranging of a medivac of the patient from elsewhere in the territory to Iqaluit. There are only two (!) transport planes available. The first is a KingAir jet and the second is the Lehr jet. They have different transport capabilities, the most important of which is range, or how far they can fly on a tank of fuel. Other important considerations include when the flight crew (pilot, flight paramedic, respiratory therapist) "time out"--that is, when the crew must be released from duty after so many hours of service. When a crew is "timed out", that plane is now grounded until the mandatory duty rest is completed or until another complete flight crew becomes available. On a busy night, it is not uncommon for there to be 5-10 active and pending transports listed on the white board in the ED. Most of the time the physician working the ED makes the necessary triage decisions independently in terms of where the planes are directed in what order of priority, but sometimes, the acuity and volume is judged to be so high that they are considering hiring a "third party" plane. That is when the CoS gets involved.
It is a humbling phone call to get in the middle of the night. I receive a list of the patients requiring transport and from which communities--the 55 year old woman in Pangnirtung who sounds like she is having a stroke, the 22 year old woman in Pond Inlet with new onset psychosis, the two young males in Qikiqtarjuag who were involved in an ATV accident and have sustained significant head injuries (no one is wearing helmets, natch) and the 18 month old baby from Cape Dorset in status epilepticus. I get a weather and flight status update from Keewatin Air and look at the map and then I (with in put from the ED doc and the nurse and the flight team) make my best decision about how best to direct resources. Then I authorize Keewatin to go ahead and try and find another transport plane and team from one of the southern provincial medical transport services--anywhere from Quebec to British Columbia--and hope that one of them has the capacity in their already-strained transport services to lend to us to 12-24 hours.
Happily, I worked with an excellent group of nurses and never felt "alone" with the responsibility. Other tasks included chairing the monthly medical advisory meeting, attending weekly hospital "pager" rounds with nurse management and senior hospital administration, and attending weekly JEC meetings with the deputy minister of health and her team. Then there was the daily "put out the fire" aspect of the job--most often revolving around last minute changes to the physician schedule. A doc might be needed to go on a transport to a community for a particularly sick individual and now a second physician needs to cover the ED while the first one is out. Or the surgeon may need a physician as a "surgical assist" in the OR to help with a particularly complex case. These phone calls can come any time during the day or night.
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| source |
A last anecdote about my time as CoS--I received a phone call one Sunday morning from someone representing the "U.S. Navy". A soldier was injured (a broken humerus--arm bone) during a military exercise occurring off the coast of Greenland. They were sending a medical transport to medi-vac the soldier back to Washington, D.C. The military transport plane would need to land and refuel in Iqaluit and "could I authorize the release of one of the Iqaluit physicians to board the transport, travel to Greenland, attend to the patient and accompany him to Washington?" After which, the doc would board a commercial flight to get back to Iqaluit. This sounded to my ears like a very odd request--surely the US navy has better access to physicians than pawning one from a remote Arctic community. Agreeing to this request would mean removing one of our docs from our roster for 24-48 hours and then scrambling to cover the holes left in the schedule. I told the flight sergeant that I would "need to get back to him", hung up, and phoned one of the long-standing docs in town to review the whole scenario. His response was laughably terse:
"F*ck'em"
So I phoned back and presented a slightly-more-politically-correct response that conveyed the same message. No dice. We were strapped for docs as it was and the community couldn't afford to release one at the last minute like this. (Also, do you really need to have a physician on board to escort a soldier with a broken arm back to the US?) I spent the rest of the day afraid some American 5-Star general was going to track me down and chew me out over the phone for my lack of "team play"......(It never happened.....)
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| (What JJ was afraid might happen......) source |
And well, because I don't have any good "Chief of Staff" photos, I'm going to post a few random favourite photos from the past year. Apologies if they are repeats!
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| Waiting for the plane to take us from Arctic Bay. |
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| Getting ready to go dogsledding with the family in January. (It was COLD! Can you tell?) |
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| Dogsledding in the spring with the family and the visiting Dr. S. (Much more civilized.) |
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| Buffy, the kids and I in the tundra in our backyard. |
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| The family with their stylin' NorthMart toques. |
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| Igloo buildings in Sylvia Grinnell Park. (I didn't build any igloos.) |
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| At the breakwater across Koojesse Inlet from town. |
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| I'll miss my time at the Frobisher Racquet Club. You are looking at the "B" pool (Regulation Round) Semi-Finalist! |
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| Me, Buttercup, and my folks--I can't believe they came all the way from Fall River, NS, to visit! |
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| Making music with the kids in our living room. Our Baffin home away from home. |
Well, that's that. My next plan is to present some of the interesting medical cases wrapped around a bit of a travelogue at an upcoming Grand Rounds at the Thunder Bay Regional health Sciences Centre later this fall. If anyone is in town and interested in attending, feel free to reach out to me.
It was an amazing year. My thanks to Buttercup for making this year happen for the family and doing such an excellent job maintaining this blog. I agree with the readers--she needs to find some outlet to keep writing now that we are back home. (Somehow, "The Jaggers Live in Thunder Bay", doesn't have the same ring.....)
Thanks, finally, to you the readers for sharing this journey with us! 8000+ hits on this blog! Incredible! Until next time........
