Guest author!

Before I start this post I just need to share this with you all:  Last week JJ brought home a letter from work.  The main paragraph said this:

"Informatics Planing and Services wish to remind all users that sun transits are upon us again and will affect satellite communications for a short period each day over the next two weeks beginning with a few seconds each afternoon but increasing to as much as fifteen minutes each day.  Television and cell phone service will lose their connections temporarily and this should begin on Monday, October 9th, and continue through to Tuesday, October 17th."

A chart then follows with blackout times for each day for the next couple of weeks.  Yup, we will be losing our internet, cell phones, and television service because THE RADIATION FROM THE SUN DIRECTLY BEHIND THE SATELLITE WILL COMPLETELY OBLITERATE THE SIGNAL TO EARTH. How's that for weird? 

Now back to your regularly scheduled blog post:

The hospital where JJ works.

Some people are wondering what exactly we are doing up here. Long story made short: JJ is a pediatrician.  Many years ago during his residency training, he worked up here on Baffin Island for one month. He fell in love with the place, and had always wanted to come back.  At the time he completed residency training, there was no full time pediatrician "In the North".  A young, fresh grad, JJ didn't feel comfortable starting his career in such an isolated location working as the sole pediatrician. (It would also have meant being available to patients 24/7.)  So, we moved to the booming metropolis of Thunder Bay, where there were five other pediciatricians to keep him company, share on-call shifts, and cover in-patient hospital services.

Fast-forward 8 years, and we're back!  As a special treat today I am turning the blog over to my hubby, JJ.  Enjoy!

JJ here.......

My wife, Buttercup, has had a few good lines over the past year about our "Northern Adventure".  When I first broached this with her shortly before attending the Canadian Paediatric Society conference last summer, I said something to the effect of "I would like to take the family 'up north' and work for a year".

Pregnant pause.

Then:

"I thought Thunder Bay *was* north....."

My wife trained as an orthotist (bracing) and as a prosthetist (manufacture and fitting of artificial limbs).  She specifically chose to complete her residency training in Florida because it was as far away from Canadian winters as she could get.  She subsequently moved *back* to Canada to Kingston where I completed my paediatrics residency and then to northern Ontario where I started my career as a paediatrician and we started our family with Coraline and Captain Jack Sparrow.  Moving to Iqaluit is about as far away from the beaches of Florida as it is possible to get.....

This is one of the clinics Butter worked at...........
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...and the Hollywood Beach boardwalk that was literally around the corner from her house.
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Still, she has been a very good sport about the whole thing.  She is largely responsible for all the logistics of the move that you have been reading about and she is the ever-present rock of the kids' lives.  Mountains have been moved to ensure that Coraline's and CJS's day-to-day routine here is predictable and that they are well-connected with their schools and extracurricular activities.

I've been referring to this year as a "sabbatical" (Buttercup has been referring to it as "my mid-life crisis").  I am, however, working as a full-time paediatrician for the eastern Arctic.  

Nunavut is divided into three regions, Kitikmeot (in the west, the orange area of the map below), Kivalliq (formally, Keewatin, in yellow) and Qikiqtaaluk (Baffin Region, in green):

I (along with 2 other paediatricians) am responsible for the medical care of the babies and children less than 18 years old who live in the Qikiqtaaluk region.  The total population is ~19,000 of whom 7,700 live here in the territorial capital, Iqaluit.  The other 11,000 live scattered among ~10 other communities located on Baffin Island (Kimmirut, Cape Dorset, Clyde River, Pangnirtung, Qikiqtarjuak, Pond Inlet, and Arctic Bay) as well as scattered on the mainland of Canada (Hall Beach) and other islands in the Arctic archipelago (Igloolik, Resolute, Grise Fiord).  The communities range from small (~2,000) to tiny (a few hundred).  None are connected by road to each other nor are they connected to Iqaluit.  The total area is just under 1 million square kilometres.

Nursing station at Qikitani General Hospital.
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By comparison, the Thunder Bay Regional Health Sciences Centre (where I spent the last 8 years working) services northwestern Ontario (LHIN 14), covering a catchment area ~650,000 square kilometres ("An area greater than the size of France" as the promotional brochure exclaims...) containing a population of ~250,000 people.  If we're going to use "European countries" as the unit of measurement, then the Qikiqtaaluk Region is a touch smaller than the combined size of France and Spain containing a population smaller than Brockville, Ontario (or Bedford, Nova Scotia for our Maritime audience!)

Each of the communities has a "Health Centre" staffed by a nurse (or two).  These nurses do an amazing job delivering primary care to the people who live in these communities. They are also the front line care providers for any and every acute medical emergency that shows up on their doorstep.  Phone advice may be provided by a family physician carrying the "Community Pager" back in Iqaluit.  If it's a pediatric case, the pediatrician on-call may be asked to review the management plan with the "Community Pager" doc, or we may be asked to liaise directly with the Health Centre and provide advice and orders.  

Kimmirut Health Centre
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Managing pediatric medical emergencies remotely is easily one of the most challenging parts of my job here.  You are making decisions based on a limited amount of information and there are very few resources in the communities.  (Blood work can be drawn but can't be processed locally, a few centres have x-rays available but the quality of the images are...."variable".... at best.)  IVs can (usually, hopefully) be started on-site and broad spectrum antibiotics can be administered (ceftriaxone, etc.)  There is a low threshold to just "culture and cover" (this means "give antibiotics just in case") and arrange for transport down to Iqaluit for further assessment and management.

Poor weather and immense distances are two constant realities and there are usually only two planes potentially available for "Medivacs".  (If a patient is felt to be stable, they can usually be flown down on a commercial flight in a day or two -- a "Schedi-vac")  Flight times range from 30 minutes (Kimmirut) to 3+ hours (Pond Inlet, Grise Fiord, Resolute) one way.  You need to mobilize a team (paramedic, respiratory therapist, pilot +/- a physician) knowing that whoever you send -- that plane, equipment and expert personnel -- are no longer available locally or for the next community emergency until they return.  And that timeline assumes the weather cooperates, a sketchy bet at the best of times!

The King Jet.  (This is the "big plane".)

Add to the mix a patient population that suffers from a panoply of socioeconomic challenges including a lack of adequate housing (north of 60°!), food insecurity (did you see Buttercup's post on the cost of a carton of milk?), mental health issues, substance abuse and a raging tuberculosis epidemic unlike anywhere else in North America and I don't know why I'm surprised at just how sick many of these kids are when they arrive in the hospital here.....

But enough of the big picture stuff.  Buttercup tells me it's photos that sell the blog.....!

Below are a few pictures from a transport I did a few weeks ago to Pond Inlet.  The patient was a baby with respiratory distress.  

To my left sitting on the bench inside the King Jet.  A paramedic
 and respiratory therapist get prepared for the transport.

To my right.  Piles of medical equipment.

At my feet.  A bucket containing 100+ bars of instant snack food. 
Who knows when the next proper meal will be?

View of Bylot Island on approach to Pond Inlet.  On the north
 side of this island is Lancaster Sound, the historic ingress
 from Baffin Bay in to the Northwest Passage

On final approach to Pond Inlet

The Health Centre at Pond Inlet

And en route back to Iqaluit.  Baby is stable (although it turns out he will need
 two chest tubes for his bilateral pleural effusions.....(!))

Overall, I'm very much enjoying things here.  I work with two excellent paediatricians -- one who has been practicing here for 8+ years (!) and the other is a recent grad full of enthusiasm for northern paediatric practice.  Dr. S and I both work as 1.0 FTEs (full-time equivalents) and Dr. M. is currently working as a 0.5 FTE.  We also have locum support so, on balance, I'm working 1:3 to 1:4 call. (Editor's note: that means averaging one call shift every 3 to 4 days.   A "call" means being available to the hospital and communities for emergencies, as well as being responsible for all the patients currently in hospital. It lasts 24 hours).  Dr. M. is also the Chief of Pediatrics here so all of the administrative responsibilities land on her desk (!).

JJ's desk is on the right.

Patient exam room.

The call volume is quite variable.  Some stretches are calm and other times are......a bit nutty.  If I'm not on-call, there are outpatient clinics that I run at the hospital.  1-2 paediatric residents from CHEO (Children's Hospital of Eastern Ontario) are on-site most of the time so there is usually an extra set of hands to help out and I get to keep up my teaching.

As much as I'm enjoying this opportunity here in Nunavut, I know I'll be looking forward to returning back "home" to Thunder Bay in 2018.....!  

If these medical posts are interesting, let me know, and I will share other stories over the course of the year.....

Up next: where to find the best animal furs in town.