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Nursing North of 60º

Taloyoak, Nunavut - July 2012
Sea Ice breaks up in early July in the Arctic, but makes its return in mid-August.

From the air, the vast expanse of the Arctic Ocean is turquoise, and looks deceivingly tropical and inviting.  It’s not until the plane nears its approach to the gravel airstrip in Taloyoak, Nunavut that I realize the turquoise is a reflection of pack ice in the 24-hour sun.

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It’s early July, and I am setting off on my next great adventure: Nursing in Canada’s High Arctic.  I land in an eerie, moon-like landscape, where the tallest shrubs and bushes are only a few inches off the ground.  Rocks and boulders scatter across the landscape as far as the eye can see, and I spot patches of bright purple and yellow wildflowers blowing in the stiff wind.

Having worked on isolated reserves in Northern Ontario for many years, I was prepared for the challenge of working independently, making treatment decisions using government issued guidelines, and coming up with creative solutions to problems which anywhere else would not be as big an issue.  What I wasn’t prepared for were the ravenous mosquitos.

Summer in Nunavut lasts only two to three short weeks, and at 4am, when the sun is as high in the sky as it would be at midday, there are kids playing baseball at the diamond outside my bedroom window. The clinic, generally staffed by four registered nurses, sees about 20 to 30 patients a day, ranging from prenatal patients, to elders. Nurses rotate emergency on-call shifts, in order to provide 24-hour access to care. Most patients come in for common primary care complaints:  UTI, Ear Infections, coughs and colds, etc.  Kids get their vaccinations at the clinic, expectant mothers have their bi-weekly prenatal visits with the nurse, and elders have their chronic disease follow up.  There is a portable x-ray machine in each clinic, and the nurses local support staff are trained to take x-rays, which are then sent to Yellowknife to be read. Once every 3-4 months, an ultrasound technician visits with a portable ultrasound machine, providing accessible diagnostic imaging for patients in their home community.

The physician visits the community for one week each month, but is otherwise accessible for consultation by telephone. The nurses are the eyes, ears and hands providing all the care in the community.  The Community Health Representative – a local worker trained in the technology, manages Telehealth conferences.  These videoconferences allow patients to remain in their own community while being assessed by specialists as far afield as Yellowknife, Edmonton and Toronto.

In the perpetual daylight hours of the arctic summer, its not unusual to be woken by the sound of a baseball game at 4am. 24 hours of daylight makes for a lot of activity at all hours.

Working in such an isolated setting is not without its challenges. I received a phone call from the nurse who was first on call early one Friday evening. “I’m in the clinic, and have a baby seizing. Can you come help?”

It was just after the regular clinic day ended, and the other nurse had taken the vehicle to the grocery store, so I grabbed my coat and ran out the door.  I flagged down the first 4-wheel ATV that passed by. “There is an emergency at the clinic!! Can you please give me a ride?”  The driver didn’t speak much English, but he understood enough, and drove as quickly as he could.

Running into the trauma room, I see the 6-month-old baby girl seizing, and my colleague was applying oxygen with the ambu-bag.  I got the physician on speakerphone, then quickly got some lorazepam out of the fridge, and attempted to start an IV in her tiny wrist.  After two attempts, I still had no success; the third went in and went interstitial. We had no choice but to attempt an intraosseous.  With many drugs on board, the little one finally stopped seizing, and we were able to arrange a medevac by plane to Edmonton, though the plane wouldn’t arrive for another 4 or 5 hours. About half an hour later, we got another phone call that a teenager had fallen off a moving ATV, and likely broke his arm.  After a quick assessment, some pain meds and an x-ray, a compound radial-ulnar fracture was confirmed, and we arranged for a medevac to Yellowknife – the second that evening.  All in a northern nurses’ day’s work!

Nursing in Canada’s north is not for the faint of heart.  You need to be confident in your assessment skills, and creative in your problem-solving abilities. In Nunavut nurses have a significant and positive impact on the community’s health and patient care every day.