In 2019, we interviewed Andrea Prince, MD, who was completing her internship in the Inuit village of Puvirnituq, a town of 2000 more people located in Nunavik, in Canada’s far north. Five years later, still in your position, how do you see?Have the difficult situations of practicing medicine in a remote domain within the Inuit network affected your calling?Would you propose this experience to young doctors?Maintenance.
Medscape: What position do you hold lately?
Andrea Prince: I’m a full-time general practitioner at Puvirnituq Hospital. My day-to-day jobs range from inpatient follow-up to outpatient care for chronic conditions. As part of our medical team, I see patients in the emergency room (day and night shifts) and I see the small dispensaries nearby, especially in the village of Akulivik. So, it’s quite a varied practice.
More recently, I have been involved in distance medical teaching projects in collaboration with Montreal-based specialists. In this context, we are increasingly seeking to collaborate with doctors from other indigenous communities, such as the Great Council of the Crees, because our practices are similar.
Medscape: How many patients do you see?
We see between 20 and 30 patients a day at the clinic, plus a dozen by appointment and dozens of calls from the clinics, in addition to the patients transferred from the villages. There are 4 day doctors (one night shift) and about fifteen full-time doctors. nurses at Puvirnituq Hospital.
Our practice relies heavily on collaboration with the nursing team, who have a broader role: they can treat certain patients according to the treatment plan set by the doctor and prescribe medications (e. g. , antibiotics for undeniable ear infections).
Medscape: Access to care in those remote spaces is difficult. Have you noticed an improvement in the scenario in the last five years?What about the new curtains and human resources?
For a year we have had a Starlink web connection in the hospital, which facilitates telemedicine exchanges with specialists; We can now send medical knowledge and photographs to Montreal to gain experience much more easily. Before, everything was done over the phone or with significant delays. We don’t have a cellular network yet and lately all records are in paper format.
But difficult situations remain. Progress is very slow. As across the country, we are experiencing staffing shortages, adding an inadequate number of nurses. But the effect is even more dramatic in those remote territories. We have had to close clinics on the coast due to the shortage. and will only provide emergency services. However, patients have no other options; They can’t drive to any other hospital. In Nunavik, the road network is almost non-existent and travel to other regions is done by air (about 2. 5 hours of medical evacuation).
Therefore, patients do not receive treatment in time and, when we see them in spite of everything, unfortunately the challenge can be quite advanced.
Medscape: What are the most urgent logistical needs?
We don’t have a scanner in the far north yet. This has a significant effect on mortality, especially in the case of injuries and injuries, which are not unusual in those regions. ” The citizens of Nunavik are 4 times more likely to suffer trauma than the rest of Quebec’s population and 40 times more likely to die from it,” as La Presse recently reported.
There has also been a lot of discussion about cancer mortality, with approximately a 70% increased risk of death after a lung cancer diagnosis (reported via Medscape Medical News). We don’t have a mammogram device to diagnose breast cancer. Prior to COVID-19, the diagnostic groups provided would travel around the region, but this is no longer the case. Today, a patient who needs a mammogram will have to travel to Montreal. The same goes for colonoscopies, but visits are becoming less frequent. . As a result, screening campaigns for some non-unusual cancers are virtually non-existent.
As for urgent surgeries (appendicitis, caesarean section, trauma, etc. ), patients will have to be transferred to Montreal by medical evacuation. We have a surgeon who visits us twice a year.
Medscape: What methods do you foresee to improve despite the lack of resources?
The saying “prevention is better than cure” makes much more sense in such remote spaces and in excessive situations (a medical evacuation is highly unlikely to take place when it’s too windy or during a snowstorm!). Prevention deserves to be the most sensible priority in physical care. It may seem obvious, but nothing is undeniable in the Far North.
Medscape: Where do you think prevention campaigns should be prioritized?
One example is dressed in helmets. In the Far North, virtually no one wears this kind of protection. They use all-terrain vehicles that are harmful and for which it is essential to wear a helmet. But you can’t get them in stores. That’s why communication is difficult: others tell people, “You want a helmet for mountain biking, another for cycling, for snowmobiling, for playing hockey, etc. , when it’s hard to get one. “We were commissioned to create multifunctional helmets for young people with orthopedic surgeons in Montreal. – to protect them but also to spread a culture of wearing helmets, which is not an unusual practice on the Internet; However, those are time-consuming tasks that are more complex than they seem.
The villages still don’t have running water. This makes it difficult to give recommendations to patients as they live in unprecedented fitness situations in Canada. Without blank water, we cannot guarantee that wound care will be done correctly. Not to mention the emergence of hepatitis A epidemics, like the one we’ve had to deal with.
Residents also struggle with significant problems with alcohol and smoking, but there is no detox center or counseling on-site. To go through a detox program, patients would have to leave, away from their families, and that can be very unsettling psychologically. In my practice, I try to communicate with my patients, especially pregnant women, because many continue to smoke or drink during pregnancy, but we want more resources.
Medscape: What about women in this region?
We are fortunate to have a team of midwives, many of whom are Inuit, who are very helpful in accessing contraceptives, cervical cancer screenings, etc. But some high-risk pregnant women who are transferred to Montreal refuse to give birth outside their families. Again, if we had the means to allow high-risk women, or those for whom ongoing follow-up or a C-section would possibly be necessary, to give birth here safely, that would be a huge step forward. Abortion is feasible but remains a very taboo subject in the community.
On violence against women, I have not seen any particularly encouraging progress over the past five years, but we recently met with the Mayor on this issue, in the hope that concrete steps will be taken to help those who experience violence.
Medscape: What is the main feeling in your day-to-day life in a scenario that is slow to change?
I still have hope for my patients. We have to keep fighting!Initiatives will also have to come from the communities themselves; They want to worry about finding solutions. Because patients want hope, too. They have the right to be treated like other people in Canada.
For my part, I try to find a balance between feeling smart in my task as a caregiver and not burnout. But burnout is a topic that concerns many doctors around the world and is being talked about more and more. We all deserve to receive mental advantages when we enter medicine!
Medscape: Would your colleagues want to come and paint in the Far North?What would you say to them?
I would tell them they won’t regret it! Yes, it is difficult, but it is an exclusive type of practice and very enriching on a human level.
Professionally, it is a very widespread practice that is no longer seen in the town. The spectrum is very broad, ranging from neonatology to geriatrics, from the simplest to the most complex. It’s very exciting. From a diagnostic point of view, the practice is also very different from that in mainland France. Without a CT scan, you have to ask and investigate whether a patient deserves to be evacuated by plane to Montreal or not. This is not trivial. . Decisions must be made prudently and quickly.
The human experience is also unique. Inuit communities are not well known and the facets reported in the media are negative due to their increased risk of addiction. However, they are cheerful and very warm people, with an ordinary culture. I learned a lot from them, adding that I reconsidered the perception of time, reviewing my priorities and taking life one day at a time.
I am very grateful to them for accepting me. Sometimes they even greet me with a “Welcome home!”When I come back from vacation. . . To think that I am also “at home” at Nunavik moves me enormously. I’ve noticed that young people grow up, teenagers become adults. A bond of acceptance as true has developed.
Of course, all of this comes with sacrifices, such as being away from family and loved ones. We miss birthdays, weddings, etc. But without hesitation, it’s worth it!
Medscape: What are the next steps in your career at Nunavik?Are you going to do it for a long time?
I’m taking it day by day, especially since I’m about to take maternity leave very soon. But if going back to Nunavik full-time is complicated with a newborn, I know that Nunavummiut [Nunavik residents] will be a component. of my life and my practice.
I need to continue to care about those communities, either on-site (practicing there a few months a year) or in Montreal, where many patients are transferred. Coming to a big city (Montreal, 1. 7 million inhabitants), in very large hospitals, can be very stressful for them. They express themselves much less verbally than Westerners, so you have to know how to pay attention to them, dedicate the obligatory time to them, to their culture and beliefs. I’d like to be the familiar face they encounter when they’re cared for away from home. It’s a connection I need to preserve.
This story was translated from Medscape France with various editorial tools, adding artificial intelligence as a component of the process. This content was reviewed by human editors prior to publication.
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