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Confusion reigns over Baffin health care

Right now, Baffin region patients don't know when they'll be able to get appointments with medical specialists

ANNETTE BOURGEOIS
Nunatsiaq News

IQALUIT ­ The chair of the Baffin Regional Health Board says no decision has been made to sever ties with McGill for medical specialist services, but a letter written by the board's chief executive officer states the opposite.

A six-month contract with Montreal-based McGill to provide specialist services in the Baffin region ends September 30 and, according to chair Ann Hanson, the board hasn't made any decisions about where specialists will come from after that date.

No specialist care?

That means anyone who needs to see a specialist, but who's case isn't urgent enough to require treatment in the South, doesn't know when, or if, they'll be able to get that service.

Hanson said the board will meet at the end of the month to decide whether or not to switch to Ottawa. Senior management has been negotiating with officials at the Ottawa Heart Institute about contracting specialist services.

But in a letter dated September 1 from Pat Kermeen, the board's chief executive officer, to Dr Gary Pekeles, director of the McGill-Baffin Program, Kermeen states the board has already made its decision.

"The Baffin Regional Health and Social Services Board will not be renewing our specialist physician contract with McGill," Kermeen states. "The board has decided to enter into a contract with the Ottawa Heart Institute to develop these services for us."

For about 30 years McGill has been providing medical, surgical and rehabiliation services to the Baffin region. In the 1996-97 year, McGill provided 36 different specialist services in Iqaluit and outlying communities to 4,700 patients.

But for the past several years, the board has been reviewing this relationship.

Problems with Montreal

Hanson cited complaints about the French language barrier for unilingual Inuit patients as one impetus for beginning the review.

"Some (patients) report that some nurses and doctors have refused to speak English," Hanson said. "Patients who are bilingual end up interpreting. These are non-medical problems, but they're very connected to health services."

She added Inuit organizations, such as Pauktuutit and Nunavut Tunngavik Inc, are located in Ottawa, where there's an Inuit population of about 400.

This, combined with only two hospitals in Ottawa compared to Montreal's nine, should make it easier for Inuit travelling south for medical treatment. She said moving from Montreal to Ottawa would not reduce the quality of service to Baffin patients.

Board wants move to Ottawa

Doug Sage, regional superintendent for health and social services in the Baffin region, said negotiations with Ottawa started because of a board directive.

"Our marching orders are to get ready to move to Ottawa," Sage said.

He said if the board decides to contract specialist service from Ottawa, an itinerary for specialist visits to the region can be in place in early October.

"It's the not knowing that has people worried and they're wondering are they even going to get a service," Sage said. "It's not about will we still have specialists coming here or not. Of course we will."

Sage added that because of the long-term relationship with McGill, a number of practices, which are needlessly costing the board money, have gone unchecked.

"In some respects we think there are practices going on that shouldn't be, that people are going South that don't need to," he said. "Now that we've examined these things, we can provide a lot of the services that have been provided in Montreal here much more effectively and cheaply."

High cost of administration?

Sage said it should be no surprise to the director of the program in McGill that the board isn't happy with the relationship.

"We've been talking to McGill for years about our concerns and they've only paid lip service to them, especially the high cost of administration. The McGill physicians are the best. We don't have any problem with the services they provide, but the administration is unwilling to make the changes we need to make."

For his part, Dr. Pekeles said the long-term relationship between Baffin and McGill has provided stability and understanding between doctors and patients.

"It enhances the care of patients when they come south because we have a critical mass of doctors either as staff or when they were residents who worked in the Baffin region and have some idea of what the context is," he said from his Montreal office.

Phone calls ignored?

Dr Pekeles said he's responded to a number of board concerns, which he says have been virtually ignored along with several phone calls he's made to Iqaluit.

He suggests there are about 1,000 patients who will need to see specialists during the next several months.

"Some who would have been seen near their homes may have to come south," he states in a letter to Nunatsiaq News. "Others will have to wait longer until the BRHSSB managers have made arrangements for replacement consultants."

The board will meet in Iqaluit September 24-26. That meeting is open to the public.

Lucien Bouchard to visit Nunavik

JANE GEORGE
Nunatsiaq News

QUEBEC ­ When Quebec Premier Lucien Bouchard sits down with Nunavik leaders next Tuesday in Kangiqsualujjuaq, he will become the first Quebec premier to visit the region.

This visit follows a recent uproar over the Bouchard government's decision to assign new French names to islands in Northern Quebec.

Barring an unexpected crisis in the South, the Premier will fly direct to Kangiqsualujjaq.

There, he will spend several hours meeting with the regional council of the Kativik Regional Government (KRG) before heading on to Radisson in the James Bay region.

KRG councilors hope their meeting with the premier will be more than just a boost to Quebec's flagging profile on native concerns.

"I hope if he's coming all the way up here, it won't be just to shake our hands," says Kuujjuaq Mayor Johnny Adams, a member of the KRG council's executive.

The KRG council is made up of 16 regional councilors, including mayors and one chief from communities in the Kativik region.

"We hope to discuss regional concerns," says Adams. "Like housing and municipal programs."

A discussion of self-government may also be on the final agenda, which had not yet been fixed, as of Nunatsiaq News' press-time.

Union wins pay equity battle with GNWT

Human rights law applies in the NWT, too, Supreme Court tells GNWT

Nunatsiaq News

IQALUIT ­ The Supreme Court of Canada has dismissed a request by the Government of the Northwest Territories to appeal a lower court decision in its longstanding pay-equity dispute with the Union of Northern Workers.

The GNWT, which argued for 10 years that employment practices in the Northwest Territories are not subject to the Canadian Human Rights Act, has no further avenue of appeal.

"This is a big win for the union and the workers," UNW president Jackie Simpson said in a news release.

"It is now beyond dispute that northern public employees are Canadians who enjoy the protections of the Canadian Human Rights Act. It is also now beyond dispute that the GNWT pay plan is dicriminatory."

The Canadian Human Rights Commission had previously upheld a complaint by the UNW that the GNWT discriminates against female employees when it comes to pay.

Observers believe the government is now liable for tens of millions of dollars in back pay to affected employees.

"The decision is disappointing," GNWT Finance Minister John Todd said in a news release. "We disagree that the NWT does not have provincial-type jurisdiction in this area."

In quashing the GNWT's appeal Aug. 28, the Supreme Court also awarded court costs to the Public Service Alliance of Canada, which has represented workers throughout the pay-equity dispute.

Last February, the Federal Court of Appeal decided in favor of PSAC when it found no bias in the wage-gap analysis conducted by the Human Rights Commission.

"Each and every pay day many union members who work for the GNWT are being paid illegally, some of them much less that what the law of the land says they should be getting," Simpson said.

"With this most recent decsion against them we can only hope the government will face up to its obligations and start to remedy a completely unfair situation."

The GNWT has been trying to introduce a new job-evaluation system to address concerns over pay equity, but has so far failed in its negotiations with the UNW.

"We are committed to implement a job evaluation systen that resolves any issues over pay equity once and for all, but we must meet this commitment in a manner that is affordable and fair to all NWT residents," Todd said in a release.

ID cards for beneficiaries approved

Nunatsiaq News

IQALUIT ­ Nunavut Tunngavik Inc. will issue official identification cards for all land-claim beneficiaries over the age of 16.

NTI's board of directors approved the plan for the production of ID cards during a meeting in Arviat last week. Because of the expense associated with obtaining photographs, the board of directors agreed that the ID cards should contain text only, and NTI's logo.

"The logistics would have been difficult, too, since appropriate photo ID equipment just isn't available in many of our communtiies at this time," Solomon Awa, project manager, said in a press release.

The ID cards are expected to be of particular value to beneficiaries who live in the South and must prove their Inuit status from time to time to government agencies, educational institutions and health authorities.

Quebec firm eyes Baffin's food-freight trade

Direct flights from La Grande would be cheaper for retailers and consumers, company vows

DWANE WILKIN
Nunatsiaq News

IQALUIT ­ A Cree-owned food wholesaler is cooking up a plan to compete directly with First Air for a large segment of its commercial freight trade in Nunavut.

If the plan goes ahead, consumers in the Baffin could be spared the worst effects of rate increases expected as a result of proposed new fees for air navigation services in the North.

It might even improve the quality of fruit and vegetables.

Servinor Inc., based in Val d'Or, says it could trim travel time and cut costs significantly by shipping food directly from its warehouse in northern Quebec.

"We're a food wholesaler and what we're looking at is providing a better service for our clients," Joe Petruska, Servinor's director of sales told Nunatsiaq News last week.

The Servinor idea is straightforward the company proposes to fly its own food to Baffin communities from an airstrip at La Grande, site of Hydro-Quebec's LG-2 hydroelectric power dam. The airstrip can be reached by road.

Since Val d'Or is already a designated staging point for the government-subsidized food-mail program, Servinor believes it could pass on substantial cost savings to Baffin clients.

Nav Canada's decision to charge airlines new user fees for navigational services triggered Servinor's interest in Baffin's food-supply route.

If the new fee structure is implemented this fall, as has been reported, airline customers will likely be hit with another round of freight-rate increases.

But Petruska said there are obvious gaps in the service currently offered by First Air which are, quite literally, large enough to fly a plane through.

"They're giving the people of Baffin Island a terrible service when it comes to food," Petruska said.

For starters, in order to qualify for the subsidy under the Northern Air Stage Program, food destined for the Baffin must be trucked to Val d'Or.

"The problem is First Air wanting everything to fly out of Ottawa and Montreal," Petruska said. "What's been happening is that First Air's been trucking it back to Ottawa to fill in their flights.

"That really deteriorates the quality of the food, whether it's fresh of frozen. It's just more handling."

Petruska recently met with the Baffin Region Chamber of Commerce in Iqaluit to gauge support for the Servinor proposal from the local business community.

Petruska said that the company's market research shows that flying directly from La Grande could bring freight rates down by as much as 50 per cent in some cases.

QIA takes Nunavut water board to court

The Qikiqtaani Inuit Association isn't happy with the Nunavut Water Board's decision to give Nanisivik Mines a new water licence.

Nunatsiaq News

IQALUIT ­ The Qikiqtani Inuit Association will ask the Federal Court of Canada to block a decision by the Nunavut Water Board to renew a permit for mining operations in Nanisivik.

The water board renewed a water license for Nanisivik Mines Ltd.'s on July 31, over QIA's objections about local environmental practices.

"We didn't feel the board considered everything they needed to consider, or the process was slightly flawed," Lazarus Arreak, president of QIA said.

Among other complaints, the Inuit organization believes that in renewing the water licence, the water board failed to clearly identify ways by which Nanisivik Mines Ltd. cold eliminate wind-blown mine tailings.

In its application for judicial review before Federal Court, the QIA has also pointed out that the water board issued the water license without requiring the mining company to repair and maintain its sewage treatment plant.

According to the QIA, the water filtration system at the plant hasn't been operating properly since the spring of 1995, causing an overflow into a creek that empties into Strathcona Sound.

Last April, the GNWT's Department of Resources, Wildlife and Economic Development launched an formal environmental review of the lead-and-zinc mine's operation, and its affect on residents in nearby Arctic Bay.

Complaints of unsafe environmental practices at the mine were first brought to QIA's attention by two land-claims beneficiaries who cited high dust levels and contaminants spillage, especially when ore is loaded onto ships.

Arreak said that taking legal action to block the granting of the water license "is not a step we take lightly," but is in the best interests of beneficiaries and the environment.

"We'll present our evidence as we see fit and as we deem necessary to win," Arreak said.

Opinion

PETER WILLIAMSON
Special to Nunatsiaq News

Inuit have suffered more from the activities of animal rights extremists than any other people. They don't care about Inuit, although some of them pretend they do, traveling to the Arctic on the pretense that they are tourists visiting our beautiful land.

They are dangerous, cannot be trusted, and our hunters and trappers associations need to take steps at the community and regional level to protect the Inuit way of life.

For the animal rights extremist, it is not good enough that they destroyed the Inuit sealing industry, which was the only means for many Inuit families to continue their traditional way of life. Mothers and fathers, sons and daughters, aunts and uncles, and grandparents and grandchildren used to go on seal hunting camps for two months during the spring, only returning to the community to purchase supplies.

After the 1983 European seal ban, Inuit no longer had the cash derived from the seal hunt and many families could no longer support their other hunting activities during rest of the year.

It also halted our elders from passing on their traditional skills and knowledge to the younger generation, too many of whom cannot afford to buy ski-doos and boats, and many are more or less restricted to unemployment in the community.

U.S. president opposed to bowhead hunt

There are powerful animal rights extremists at work in the United States too. So much so that the President of the United States issued a statement to the US Congress this year, condemning Canadian Inuit for hunting bowhead whales.

To punish us, the President instructed his administration to not even discuss the possibility of opening the U.S. market for marine mammals and marine mammal products.

This is in no way the fault of those involved in hunting bowhead whales, it was just another opportunity for animal rights extremists to attack Inuit. These matters can best be addressed by the Inuit Tapirisat of Canada, provided they have the funding, expertise and political backing to take on the United States government.

But there is important work that needs to be done by our community hunters and trappers associations and regional wildlife organizations too. With increased access to the North, there is increased tourism, and now there are animal rights extremists visiting the North, posing as tourists.

Tourism isn't bad

Tourism is not bad in itself ­ it provides economic opportunities and much-needed jobs. 400,000 Germans visit Canada every year, they are rich, and over the years more and more are going to take their holidays in the North. There are significant business opportunities that Inuit should take advantage of, instead of leaving it to non-Inuit, because it will definitely happen.

The Inuit culture and people are known around the world as incredible survivors who have withstood the harsh Arctic environment for thousands of years, and are capable hunters of dangerous animals, like the polar bear and walrus.

To the world tourist, the Canadian Arctic is an exotic place. Some will want to go canoeing for days or weeks without seeing another soul, and others will want to go on hunting expeditions.

Animal rights extremists visted Baffin

There are at least two known animal rights extremists that visited Baffin Island in the last year, posing as tourists. The first flew in a helicopter and saw a number beluga whale carcasses along the beach that had been hunted for their muktuk, and wrote a negative story about it in the Financial Times, an influential British newspaper.

These types of stories raise a lot of money for organizations like the International Fund for Animal Welfare, which destroyed the Inuit sealing industry, and made a $2 million contribution to the Labour Party that won the British election this year.

The second hired a hunter to take him out to see a polar bear, then urged him to follow the bear by ski-doo. Once the extremist, posing as a tourist, got back to Europe he complained that the Inuk hunter was cruel to the bear, running it down to exhaustion, and asked the German government to ban German citizens from polar bear hunting in the Canadian Arctic.

Learning programs for tourists

What proactive steps could Inuit take to minimize the damage caused by these extremists, posing as tourists?

* Regional wildlife organizations could develop cultural awareness programs for community hunters and trappers associations to deliver when tourists visit the communities.

This could include information on the wildlife in the area, the population status of the different species, the responsible management of the environment and wildlife, and hunting techniques. People who donate money to animal-rights organizations only have one side of the story, and after they've heard the other side many may change their opinion.

Community hunters and trappers organizations, with the coordinated assistance of the regional wildlife organizations, could develop training programs so guides can spot animal rights extremists who are asking suspicious questions, and how to best answer them.

Once a situation has occurred that has not been properly addressed the damage is done. What might be normal, like a whale sinking to the bottom once it has been shot, may seem like a reason to complain to the animal rights supporter.

But if the tourist was told that some whales just sink, and that the populations are properly managed, the tourist may understand that this is just a normal fact of life in the Arctic.

* Makivik Corporation, and possible Nunavut Tunngavik Inc. and the Inuvialuit Regional Corporation, may want to think about First Air and NWT Air ­ in partnership with Air Canada ­ offer holiday packages to Germans.

Holiday packages could included sea kayaking in Nunavik, hiking in Nunavut, white water rafting in the Inuvialuit region, and learning about the Arctic environment, wildlife management, and specifically about the Inuit hunting culture.

In any case, more Inuit ownership is essential to maximize the economic benefits provided by the tourism industry, and more Inuit control will needed at the community and regional level, to protect the Inuit way of life from animal-rights extremists, posing as tourists.

My Little Corner of Canada

Abe

by JOHN AMAGOALIK

If there was ever a farther figure for those of us who worked in land claims and northern politics, it was Abraham Okpik. Not only because he was older than us, but because he was involved in all aspects of northern life and had been at the forefront of Inuit politics when most of us were little kids.

I first heard of Abe when he was the Area Administrator in Taluqjuaq in the early 1960's.

In those days, an area administrator had a lot of power and I was impressed that an Inuk was holding such a position. I next heard of him when he was the first Inuk to be appointed to the Northwest Territorial Council.

Abe was opening doors for many of us to follow. He was uniquely positioned to bridge the gap. He spent most of his life standing between the two cultures and working to bring them closer together.

Most people will refer to Project Surname when they talk about Abe Okpik. But Abe should be remembered for more than that. He should be remembered as a pioneer, an elder, a statesman, and a concerned and loving father.

Dion gets tough with separatists

The summer has seen a flurry of letters flying back and forth between Stephane Dion and the separatist leadership in Quebec.

The Canadian government is finally getting tough with Bouchard and his gang. Most people think that the Canadian government's "Plan B" is something new being cooked up in Mr. Dion's office.

But if one was to examine the government's new position on Quebec independence, one would find it almost identical to the position that the Inuit have taken on the issue for many years.

Plan B seems to be having the desired effect. The separatists have responded with a lot of incoherent blithering.

Letters to the Editor

An open letter to the people of the Baffin region

It seems that, after 30 years of service in the Baffin region, the medical, surgical, and rehabilitation specialists from the McGill hospitals will no longer be coming up to the Baffin Region.

I say "it seems" because no manager from the health board has replied to the telephone calls and letters to them since the middle of June.

It is of course, the prerogative of the Baffin region health and social services board to arrange its specialist services as it sees fit. An evaluation of those services was sent to us in early June. In late June, we responded with a detailed set of suggestions about ways to improve the service at a lower cost. We have received no follow- up.

As I write this, there are no consultation visits scheduled beyond September 30. Some of our consultants have been visiting Iqaluit, and the other communities for over 20 years, most over 10 years.

Particularly during times of rapid turnover of family physicians and nurses in the Baffin region, these consultants have provided some continuity for patients with more complicated chronic diseases.

Last year, there were about 5,000 clinical visits with McGill specialists in the Baffin Region. The cost of the program was 17 per cent less than in the previous year, and lower than any year since 1991. There is no remote rural area in Canada that enjoys an equivalent access to such an array of specialist services as the Baffin region.

Our consultants have enjoyed their work in the Baffin region, and the privilege of access to the Inuit culture of the Eastern Arctic. Many have wanted to continue to work beyond their retirement in the south. On behalf of all of them, I would like to thank you for the hospitality and warmth that you have shown in the past.

It is not clear that there has been a broader discussion within the Baffin region about the pros and cons of changing the southern base of the operation. We believe that the broad proposals we sent to the senior managers of the Baffin regional health and social services board in June would provide an excellent basis for improved services for the next few years during the establishment of Nunavut.

It appears that these proposals have not circulated beyond a few desks.

Change is always exciting. In seeking to make improvement one must be careful no to endanger those activities that are working well. Those of us who are obliged to make such decisions must stay humble about our ability to predict changing needs and to anticipate all the effects, good and bad, of changes that we make.

We are very concerned that there will be a hiatus of specialist services. We know that arrangements have not yet been made to replace the consultants who have been going up.

As I write this, there is a list of about 1,000 patients who would have seen these consultants in the next four or five months. Some who would have seen near their homes may have to come south.

Others will have to wait longer until the board's managers have made arrangements for replacement consultants. We know from our colleagues in Ottawa, that for the most part, this has not yet occured.

Again, we have been privileged to enjoy the relationship with you. We feel that we have provided high quality services at a low cost, that we have responded to the needs that the health board, its administration, and the physicians and nurses have expressed in the past.

We are very willing to provide them in the future. We urge you to ask your board representatives about the decision they are making on your behalf about specialized health care in the Baffin region for the future.

Gary Pekeles, MD, MSc., FRCP(c)
Director, McGill Baffin Program

Editor

Does anyone care about health?

Is the quality of our health care system falling below national standards?

Based on what we've been able to observe recently ­ especially in the Keewatin and Baffin regions ­ the answer to that question looks like a resounding "yes."

As you read this, most people in the Baffin region who need to see medical specialists don't know ­ at this moment anyway ­ when or how they can have those appointments made.

That's because the Baffin regional health and social services board has ended its longstanding contract with McGill University as of September 30. Under that arrangement, numerous medical specialists have for many years regularly visited the region to provide specialist care and advice.

As well as being able to see those touring medical specialists, some Baffin residents have been able to fly to Montreal to visit specialists who don't normally make scheduled visits.

But now, all is confused. As of our press-time this week, no one in authority at either the Baffin health board or the GNWT was able to tell us exactly how and when they will replace the McGill-Baffin program.

All they can say is that some time soon, McGill-Baffin specialists will ­ perhaps a week or two after September 30 ­ be replaced by new specialists based in Ottawa, but that some patients will continue to fly to Montreal to see specialists, or to get other types of treatment.

Meanwhile, doctors and nurses are now telling Baffin region patients who need to see specialists that they can't make appointments for them beyond September 30.

There are good reasons why the Baffin board should be reconsidering its relationship with McGill University and looking at institutions in Ottawa. One is the continued uncertainty over Quebec's place in Canada, increasing difficulties with getting service in English in Montreal, and the possibility that Ottawa may be less expensive.

But specialist care is now an integral part of modern medicine. Without it, many people cannot get the treatment they need. And until Baffin health officials can say otherwise, we are now without it.

That's the kind of health care situation you'd expect to find in impoverished Thirld World nations like Bangladesh or Rwanda ­ not Canada.

As well, there are lingering questions about who is really making the decisions. Is it the Inuit members of the Baffin board? Or is it GNWT officials and board staff people who make de facto decisions that the health board is then asked to rubber stamp?

In the Keewatin, residents are facing a similarily worrisome situation. There, not only does no one know how or when specialists will visit the region after September 30, no one knows how or when Keewatin residents will even get to see general practitioners after that date.

That's because Elizabeth Palfrey, the chair of the Keewatin board, abruptly broke off negotiations with the University of Manitoba's northern medical unit earlier this year.

That, and other questionable decisions by the Keewatin board, has prompted Kivallivik MLA Kevin O'Brien to demand a public inquiry. Three hamlets now say they want to leave the Keewatin board, and numerous others are demanding Palfrey's resignation.

In addition to these new sources of concern, of course, the health care system continues to deteriorate in other ways.

For example, there's a growing shortage of doctors and nurses. In the Baffin region, doctor turnover is so high, some patients rarely get to see the same doctor twice.

As for nurses and other health care workers, those who choose to remain face crushing work loads that only promise to get heavier ­ and because of the GNWT's recent collective agreement with the UNW, are paid less than ever before.

And because of the GNWT's longstanding practice of violating its employees' right to free speech, those who know the issue best ­ the NWT's health workers ­ are too frightened to speak out about what they see. Those who do are usually fired or disciplined.

By the time the GNWT builds its new hospitals in Iqaluit, Rankin Inlet and Cambridge Bay, the GNWT's reputation as a lousy employer may have sunk so low that no health worker in Canada will want to work here.

Meanwhile, Health Minister Kelvin Ng continues to act as if the NWT's health care system is nothing more than a plaything for various private businesses who want to do business with health boards and the GNWT.

But instead of putting his energies into defending the integrity of the Keewatin health board's questionable practices, he must begin to defend the integrity of the health system itself.

It's mostly Ottawa's money that the GNWT gets to play with. If Ng and his buddies in the territorial cabinet don't wake up, NWT residents ­ including aboriginal organizations with an interest in protecting aboriginal rights to health care ­ should start putting direct pressure on the federal government.

And if Ottawa doesn't keep closer tabs on what Yellowknife officials and they're colleagues in the regions are doing with its money, they could be well on their way towards an embarrassing health care disaster that they won't want to have to explain to the rest of the world. JB

These materials are Copyright (C) 1997 Nortext Publishing Corporation (Iqaluit), and may be freely distributed throughout the Internet, or other electronic computer networks or bulletin boards, as long as this notice remains intact and the articles are reproduced in their entirety. These materials may not be reprinted for commercial publication in print or other media without the permission of the publisher.