Guest author: JJ travels to Kimmirut!

First off--WE MADE IT ONTO GOOGLE!  You need to google search specifically for "Iqaluit blog Captain Jack Sparrow", and the only hit was from JJ searching out of curiosity one night, but still!  Its THERE! We're in the big leagues now y'all.

As all of you loyal readers know, JJ went to Kimmirut in his capacity as pediatrician a couple of weeks ago.  Since everyone loved the first post he did on "medicine in the north", he agreed to do another guest-spot on the blog about his travels. Yay! He was only gone for a few days (a day shorter than he was supposed to be as his first flight was cancelled due to poor weather), but he came back with great stories and had a fantastic time.  Take it away, JJ!

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It's now been 4 months since I started working here in Iqaluit. Among the many enjoyable professional experiences I've had so far, one of my favorite has been the community work. As I described in my previous post, we're responsible for about ten other fly-in communities scattered throughout the Baffin region. These communities range in size from ~400 (Kimmirut) to ~1800 (Pond Inlet, Igloolik). All are located on the coast and all have an airstrip so are accessible by sea and air -- none are accessible by road. Hall Beach and Igloolik are the two communities located closest together, separated by a distance of ~70km. Inuit will occasionally travel between these two communities via snowmobile. Not without risk. Here is an article from a couple of weeks ago of a father and teenage son who survived 4 days on the land after a blizzard wiped them out trying to get between these two communities.

Find the article here.

 I've been assigned the community of Kimmirut. This is the smallest community (population: 389) in the Baffin region and also the one closest to Iqaluit (~120km away). When you stand on the waterfront in Iqaluit, you look across Koojesse Inlet and Frobisher Bay to the hills of the Meta Incognita Peninsula. On the far side of those hills, located on the shore of an inlet of Hudson Strait, is, absurdly, a tiny cluster of homes, three abandoned Hudson Bay Company warehouses (c.1930s), an Anglican church (c.1909), an airstrip and a nursing station. Welcome to Kimmirut! 

Halifax-Dartmouth just 1270km that way!

Kimmirut translates to "the heel", a reference to the large grey rock face that faces the hamlet on the left side of the photo. 

Just getting to Kimmirut is an experience. If you have the time, energy and expertise, you can try the Itijjagiaq Trail, the traditional overland route connecting Kimmirut and Iqaluit. Buttercup discussed it in detail in a previous blog post here. While I would have loved to have been the pediatrician that arrived in Kimmirut after days on the Itijjagiaq Trail via dogsled, the more likely outcome would have been me making it as far as the Iqaluit Dump and needing to be rescued by the RCMP..... 

But that's ok, even the flight to Kimmirut was interesting! For starters, no security! You check-in at the Iqaluit Airport (detailed here) and then proceed to Gate 5. Gates 4-6 are directly behind the check-in counter -- no security apparatus. No lines. No x-rays. No taking off your shoes. You can bring whatever liquids, weapons or wildlife you like when you travel up island!

Pay no attention to the "On Time" comment. The signs always
say "On Time" and bear no relation to what is actually happening
on the tarmac.  Its just as likely that the plane is "Days Late"...

Walking across the tarmac to the plane.

On board the aircraft.

 The plane is tiny. Basically, it's a converted transport aircraft (Kenn Borek Air -- Beechcraft King Air BE200) with 6 seats bolted to the floor in the back 1/2 of the plane. Your luggage is piled in the front of the plane "strapped" down (by which I mean a strap is laid loosely over whatever suitcase is in the middle of the pile). While your boarding pass will have a seat assignment written on it (like seat "3A"), this is obviously a joke. You grab whatever seat is available, fasten your seatbelt and enjoy the in-flight entertainment (watching the pilot's GPS.) The flight to Kimmirut takes 25 minutes.

After landing in Kimmirut, your luggage is brought by van to the side of the airstrip.

My arrival in Kimmirut was delayed by a day and a half because of weather. There is no cell service in Kimmirut nor was there anyone to meet me at the airport. I borrowed the phone at the check-in counter and was able to reach the Co-op. They sent a truck to pick me up (most of the vehicles in town are snow machines or ATVs) and brought me to the check-in desk where I was greeted by the very pleasant Annie (recently arrived from Resolute). Annie prepared my room, my meals, cleaned the dishes and did everything to make sure I was comfortable during my stay.

The Kimik Co-op. The main floor is the department/grocery store
for the hamlet. Upstairs is the sleeping area with 8 beds,
shared bathroom facilities and a common eating area.

My home away from home. Clean and comfortable. But you can't
plug-in the microwave and the fridge at the same time. You need
to pick one or the other.

The common dining area of the Co-op.

Prices in Kimmirut (and Nunavut in general)
are extortionate. That's $15 for 6 rolls of paper towel.

The Kimmirut Health Centre at 3:30 in the afternoon in December.
(You can see some kids playing on the entrance ramp--they are climbing
on top of the railing and jumping into the snowbank below. Looks
like I'm going to have work here!)

The waiting area of the Health Centre.  There are, astonishingly, many cases of active pulmonary tuberculosis involving children in the Baffin region, including in Kimmirut. The reasons for this are complex, multi-factorial, and related to the endemic poverty and the third-world housing conditions.  

Despite my late arrival to the community, I was able to see all the kids that were scheduled to see me. It was great. The key player wasn't me, but the dedicated team of health professionals that work at the Health Centre and who have lived in the community for months and, sometimes, for years at a stretch. They know the families, they know their stories and they know, specifically, how the visiting physician can best help them. I am amazed at the level of care they are able to provide. Probably the best thing that came out the visit was putting faces to names and inviting the staff to phone/e-mail me if they have concerns about the kids in between my visits. I was also able to arrange for a few of the sicker or more complex kids to be "schedi-vacced" to see me in Iqaluit where I can arrange for the testing (blood work, imaging) that needed to be done. All of the test results and my notes can be easily accessed by the nurses in Kimmirut as they share the same EMR (electronic medical record) system that we use in Iqaluit. Soon, *all* of the communities in the Baffin region will be linked by the same electronic record system, facilitating communication between the individual Health Centres and the doctors in Iqaluit.

 My time in Kimmirut was too brief, only a few days. I had a chance to walk around the hamlet and take a few pictures:

The "Northern". The second place in town you can buy food/supplies.
Also the home of the Kimmirut Post Office.

St. Paul's Mission and Anglican Church. The building
is over 100 years old and still in active use.

Qaqqalik School. Students attend from Grade 1 through to Grade 12. Kids
here are able to complete their high school education without having to leave
home--absolutely astonishing for a community of less than 400 people,
(although not without its own issues).

Kimmirut was known as "Lake Harbour" until 1996.
The name was changed in anticipation of the creation
of the territory of Nunavut in 1999.

One of the three abandoned Hudson Bay Company warehouses in Kimmirut.

A view of the community. The large building halfway up the hill is the
local RCMP detachment and staff housing.

Sometimes hard to believe you are still in Canada
here and that you don't have to show a passport when you
land at the airport.....

Kimmirut. A long way from anywhere!

Love this.  A sealift crate that's been converted into a shed with a proper door fit into the wood.

Panoramic view of Kimmirut. The Kimmik Co-op is the large grey building
 located on the water on the right.

A final point: All of the nurses and physicians (and dieticians and social workers and respiratory therapists and administration) in Nunavut are either employees of or contractors to the Government of Nunavut (GN). All are entitled to *secure* GN e-mail accounts and all of these e-mail accounts are easily accessible and searchable internally (just as if you worked for any major corporation with an internal e-mail system). This secure email access linking all GN workers *greatly* facilitates communication between the hospital and the region it serves. I routinely receive e-mails from the community Health Centres with questions regarding pediatric patient care. Additionally, immediately upon my arrival in Iqaluit, I was given a list of the contact names and email addresses of the nurses-in-charge at each of the fly-in communities. 

This is in contrast to my practice in northwestern Ontario. There, the e-mail system is limited to the hospital only. There is no secure way to e-mail the nursing stations of the fly-in communities. There is no central registry of who the nurse-in-charge is at these nursing stations. Most critically, there is no pediatric "ownership" of the individual communities.  I think this is a key (but not only) reason why we are in constant "crisis management" mode and dealing with the most acute issues while we are on-call. I would love to talk to my colleagues about this care model and whether it could be applied to the similar challenges (both geographic and socioeconomic) we face in northwestern Ontario.

Thanks for posting, JJ!  If anyone has any questions for JJ contact me or leave a comment below. Up next: a look at religion in Iqaluit.