Canadian Medical Association Journal 1996; 155: 1609-1611
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© 1996 David Square
St. Therese Point is one of four First Nations communities on Island Lake, an archipelago of thousands of islands about 480 km northeast of Winnipeg. St. Therese Point, Red Sucker Lake, Garden Hill and Wasagamack have a combined population of nearly 4000, and each has a primary care nursing station staffed by nurse practitioners and local health care workers employed by Health Canada and the community. Two physicians visit Island Lake from Monday to Thursday, and provide phone consultation from Winnipeg on weekends.
The Island Lake communities are part of the J.A. Hildes Northern Medical Unit (NMU) at the University of Manitoba, a network of nursing stations in northern Manitoba and the Northwest Territories operated by either Health Canada's Medical Services Branch, the Manitoba government or the NWT government through the Keewatin Regional Health Board.
Ideally, such remote communities would have their own aboriginal physicians as well, but this is a long-term goal. Although some agencies and associations, including the CMA, are now providing financial support to aboriginal students who want to become health care professionals, for now northern and remote communities must rely on nonaboriginal physicians and nurse practitioners for most of their medical care.
Cronin, who is on the NMU's teaching staff, is no stranger to the North. He spent 13 years practising family medicine in the NWT before relocating to Manitoba in l994. "I love the North and the people," says Cronin, who enjoys the challenge of practising very fundamental medicine. "I have to be innovative and rely on past experience when I treat a patient or make a diagnosis because it costs a lot of money to medevac a patient to Thompson or Winnipeg." If there is any doubt about a patient's condition, Cronin telephones specialists in Winnipeg to confirm a diagnosis or help make a decision about evacuation.
Dr. Wendy Smith, who practises family medicine at the Garden Hill Nursing Station at Island Lake, has made a career of working for the NMU. "I grew up in New Brunswick, graduated from medical school at the Memorial University of Newfoundland and interned at the Health Sciences Centre in Winnipeg," says Smith, who joined the NMU after receiving her medical degree. "I attended a recruitment seminar and was immediately sold on the idea." Eight years later, Smith has worked in Norway House and Churchill as well as Island Lake.
The NMU was established in l970 by the late Dr. Jack Hildes, a longtime advocate of improved health for aboriginal people in Canada's North. Dr. Sharon Macdonald, the current director, says the original NMU served the Hudson's Bay seaport town of Churchill; 26 years later, it has expanded to include Indian and Inuit communities as far north as Repulse Bay, NWT.
The NMU now provides in-service education for nurse practitioners and physicians by arranging visits by specialists in a variety of disciplines. It also accepts medical school students for elective experience in community hospitals. "We have summer programs that employ medical students to live and work in the federal nursing stations, as well as a primary care clerkship for final-year medical students who spend 6 weeks in clinical and community practice under a family physician," explains Macdonald. Residents in specialities are also encouraged to accompany consultants into the communities.
Graduate students can take a master's degree or residency leading to certification in community medicine through the NMU. "We also administer programs in dentistry, dental hygiene, social work, nursing and primary care training."
Working in conjunction with the NMU, the program also offers personal and career counselling for students and their families as well as assistance with housing, child care, personal development and urban relocation.
"We encourage our students to explore all outside funding options," says Stephens. "The Manitoba government recently cut 38% from the budget of the ACCESS program, which provided over 500 aboriginal students a year with funding." Many leaders of Manitoba's aboriginal community, including Assembly of First Nations Grand Chief Ovide Mercredi, got their start through ACCESS.
Inadequate funding can be the most difficult problem facing aboriginal students, many of whom come from underprivileged backgrounds and are less prepared academically and financially for the long course of medical study. The need to support aspiring physicians from native communities was recognized several years ago by the CMA, which established a bursary program for undergraduate aboriginal medical students. According to Dr. Vincent Tookenay, president of the Native Physicians Association in Canada (NPAC) and administrator of the CMA's Special Bursary Program for Aboriginal Medical Students, the CMA provides up to $4000 per academic year to each successful applicant. Recipients also receive memberships in the CMA, the relevant provincial/territorial division and NPAC. The CMA, which recently renewed its commitment to the bursary program for 4 years, this year will award $40 000 to assist aboriginal medical students.
In spite of this support, CMA data indicate the ratio of aboriginal physicians to the native population is about 1:33 333, which stands in stark contrast to the 1:542 physicianpatient ratio in the general population. However, progress is slowly being made to redress the imbalance.
Jamie Irvine, a third-year medical student at the University of Manitoba, knows that special programs and bursaries can mean the difference between success and failure for aboriginal students. He plans to apply for assistance to help finance his final year. "A CMA bursary will be a godsend to me," he says, "especially since the ACCESS program was cut back." Irvine, who grew up in Rivers, Man., said the CMA's continued commitment to aboriginal medical students is appreciated because of cuts in most government-sponsored financial-incentive programs.
Dr. Catherine Cook, associate director of the NMU, also owes some of her success to the support of special programs. She spent most of her early life on Matheson Island, a small Métis community on Lake Winnipeg that is accessible only by plane or ferry. When she enrolled in the pre-med program at the University of Manitoba she was married with one child and had been out of school ll years. Cook worked her way through university with help from the special studies program and the NMU, spending the first 5 years of family practice in nursing stations. Last year she was the medical officer for health for Manitoba's Norman region, and this year she is working on a master's degree in community health sciences.
Dr. Judith Bartlett, who is currently on education leave from her position as director of health programs for Health Canada's education services, says she would never have enrolled in medical school without the financial, educational and emotional support offered by the special studies program and the NMU. "When I returned to university, I didn't have a complete Grade 10. In 1 year the SPSP professors gave me a solid grounding in high-school physics and chemistry," recalls Bartlett, who spent her early years in an abandoned gold-mining town that was accessible only by water. "At age 27 I was a single parent with two children. The special aboriginal programs offered at the University of Manitoba made it possible to attend classes, put my kids in daycare and eventually graduate from medical school," says Bartlett, who is also working on her master's thesis in community health sciences."I'll be forever grateful."
Macdonald feels the NMU can be justifiably proud of its achievements since l970, but hopes more aboriginal physicians and health care professionals will return to live and work in native communities. The NMU still recruits mainly nonaboriginal physicians to work in the North because of the shortage of native doctors. This causes its own set of problems, explains Macdonald. "An interpreter is often required to help the nonaboriginal physicians make a diagnosis, and it costs a lot of money to fly the doctors in and out each week." Moreover, a telephone diagnosis is never as easy as one performed in person.
The overall outlook is bright, however. This year 20 aboriginal students from Manitoba and one from the NWT are enrolled in the special studies program. Even though governments are cutting back programs like ACCESS, other organizations such as the CMA continue to fund special initiatives. In the future, the weekly flights ferrying nonaboriginal doctors to and from destinations like St. Therese Point may be a thing of the past.