January 2012 Fourth First Week in Rankin Inlet

January 2012 Fourth First Week in Rankin Inlet


What an exceptional week this has been! So many people looked at me askew when I said I was coming to Rankin for January. Many knew I was crazy as I posted the December temperatures on facebook, or mentioned that the Arctic was a great place to be in January. These first few days have proven this is the place to be.

Getting here...late as usual. Vancouver to Winnipeg flight was late, for no noticeable reason. Winnipeg to Rankin was late, but we were all warned on check in that the flights might end up in Churchill or back in Winnipeg due to weather conditions in Rankin. All the flights the day before were cancelled. While we were waiting the Calm Air flight left. That seemed like a good omen. However, they then announced that our flight was going to be delayed by an hour. An hour later we were still sitting in the airport, and then they announced we were boarding. Good.

Winnipeg was cool. It was the first time they had cold temperatures and the first big snow came December 31st. Temperatures on Jan 2nd were below 0 but not by much. On the plane they were announcing the temperature in Rankin Inlet was -32. I began to feel a little antsy and wonder if I really was making the right decision!

Since arriving the temperatures have been quite normal, usually around -30 with a wind chill of -45 to -50. I thought that walking in -50 was wrong, but have found that actually it works quite well. Now, of course, I am on first call. That means I have a car. It also means not enough exercise to sleep, which is just totally annoying. Thought there might be some activities that would help, and there are, yoga in Tuesday and Thursday, Walk Tall is Tuesday and Thursday. I will be able to sleep, for sure, on Tuesday and Thursday!

Yesterday we had a really unusual day. The first time, ever, that the fire alarms went off at the Wellness Centre. I walked through and the director said, “It must be real”, so went back to the Maternity and told them it was for real. We all dressed into all our clothes and got out, as did everyone else. It was the first time I had seen the physios since arriving. It was great! Got pictures of all the staff standing outside, in their parkas, waiting for the building to be cleared. Lucikly for us, the fire hall is next door to the Wellness Centre. He walked over and checked the building and then called whoever turns off the alarms. They couldn’t do it, and had to call someone else, and eventually they did go off. The noise was phenomenal, so I just stood outside, with the smokers, who found the whole situation so stressful that they needed a smoke break!

We had a birth on Tuesday. I was the second. It was just on the edge of normal, so was interesting to watch. I have learned that as a second it is best to sit on the sidelines, until needed and then just, be a second. It means that really not doing anything until the mother is pushing. That is always interesting when things are normal, but not quite.

Right now I am sitting looking out the window at the beautiful clear sky with the sun coming up, in the middle of the horizon, not on the east, and a low line of cloud beginning to come up in the southwest. It is unbelievably bright, as there are no trees, and lots of ice. It means you can see forever and the sun seems to be brighter than anywhere else on earth.

It is truly stark and beautiful here, and I am so happy to be here in January.

This Week in Cambridge Bay

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I only have a week left in this village, and have been spending the day cleaning, and thinking of what to make with the food I have left over. All very exciting? Not really.
Went to the Northern store this morning and was surprised at how little what I needed cost, and also at what they had. I had tried to buy a small pack of SOS cleaning pads earlier in my stay, but there were only large packs. Today small ones were in, as well as very small packets of laundry soap. Also got red onions..still expensive though at about $6.00 a lb, alfalfa sprouts and good bread, which is $5.90 a loaf. That was all pretty amazing.
It is the end to a very challenging and fun week.
Last Sunday the ultrasound lady here was doing maternity ultrasounds for women from other villages. They were to have come here on Friday, but no planes were flying so they came on Saturday and she worked Sunday doing the ultrasounds. I was on first call, and was just taking my puppy, Kiska, out for a walk, when a call came in from her that one of the ultrasounds did not look good, and could I come in and talt to the mother. Of Course, since that is my job.
Went in, looked that the ultrasound and talked to the mother, and then tried to decide what needed to be done. Most referrals we do with Stanton Territorial hospital in Yellowknife, but for a detailed ultrasound this woman would need to go to Edmonton. Medical genetics and Maternal Fetal Medicine are also there. So women from villages here who have problem pregnancies go to Yellowknife (a two hour flight) to have their babies, or to see obstetricians. If there are any other types of problems they go to Edmonton, which is two or three flights, and four hours away. (It also has better shopping but most of the women here are pretty happy with what Wal Mart and other stores have in Yellowknife. And everyone brings back a big bow of Tim Hortons' donuts. Tim Horton's in Yellowknife is the most lucrative franchise in Canada!)
While they are out the Inuit women stay at Inuit boarding homes. Non Inuit women have to provide their own accomodation. Women who are government of Nunavut employees are put up in hotels. It is a very interesting system, that leads to lots of interesting differences. Women cannot take an escort (partner) with them unless they are under 17 years of age, or are having surgery. There are a few other reasons for them to take their partners, but those are the main two.
Just imagine going 4 hours away from your home, by plane, to have a baby, and doing it alone.



Cambridge Bay now has a birthing centre though, so residents of this town, who are low risk women can have their babies here. The birthing Centre is very nice, with lots of local art on the walls, and big rooms with lots of windows.
Spent time in the centre this week, trying to make the prenatal/emergency birth bag into a medevac bag. Was mostly successful. We need one more thing, in its own bag. That will probably come before I leave. We were also in the Birth Centre to have our pictures taken for the Nanatsiaq news, the Nunavut newspaper.
Monday I went to the office, and we had report, as always from 8:30-9:00. It is always useful, in this community, and often fun, as the people who work in the health centre are generally fun.
Then I started to make the referral to Maternal Fetal Medicine. In the south, usually, you fax a request with a consult letter, or often without even a consult letter. Not so here. You have to organize the appointment, the consult, the travel requesitions, the contacts where women stay. It took almost five hours to complete the process! Yes, most of the day on one thing! My learning curve went up dramatically on that day, but ended up feeling like it was an accomplishment.
Tues, Wed and Thurs afternoons we see clients. Actually here a lot of the women are high risk. Most smoke, although less than in other towns. Many are under 19, although may not be having their first babies. It makes the experience of being a midwife here very rich.
My favourite activity this week happened most days, and that was walking the puppy. It has been very wet here. Temperatures are not down to their usual -1 to -6 but have mostly been above 0. This means rain instead of snow. It also means mud. None of the roads are paved, and there is little grass except out on the tundra, and even there, we are far enough there, that there is mostly rock. Every time I take her out she needs a bath! It is a good thing she is very cute.

I had been given a crate to take her home, and thought I was all organized. This week I phoned Air Canada three times to organize her flight, with me from Edmonton to Vancouver. The first time Tuesday, I was on hold for 50 minutes and then had to hang up. The Second time, Wednesday I was on hold just over an hour, and had to hang up. Thursday was the exciting day when we had no communications, including internet, with the outside world because the satellite had turned away from Earth. Yesterday I finally got through, after only a few minutes, only to be told that the crate was too big to fit in the door of the airplane that was going from Edmonton to Vancouver.
So, last night I phoned Yellowknife and they are sending a crate, air freight, to me here. Puppy is going to be very expensive, just to get home.
The crate here will be left for another dog who needs to be rescued. There are lots, and many puppies. Actually discussed "Big Heart Rescue" with the women here who rescue a lot of dogs, as they might be able to start such a group in Yellowknife. Apparently the SPCA there can find homes for any Arctic puppies from the communities, but there is no way, yet, to send them to Yellowknife without paying. Big Heart has this part all sorted out in BC.
This week there were also two luncheons...one put on by the administration and catered and a potluck yesterday for Thanksgiving. It was fun yesterday with lots of food that even a vegetarian could eat! Monday was also fun, but not so much food for a vegetarian, or the three vegetarians here. In the three weeks so far, there have been three potlucks.
The other excitement this week was remembering that I had another season of "The Closer" here with me on dvd. Had been going to the library here which has a fair selection of dvd's, books, and Northern books, which I have been reading. Currently it is "Muskoxen of Polar Bear Pass", which is an old book, but very interesting, and yes, it is about Muskoxen. The library is a place a lot of this community really uses, especially perhaps because it is in the school.
Today there are two more things to do, unless I get called (on second call today). Go and walk Kiska and make vegetarian shepherd's pie! Have looked up the recipes on line, and now to make the mixture. Adzuki beans I brought with me, veggies bought, or were left here.
Friday will be an exciting day for Kiska, as she should be with me when we leave here, weather permitting, and arrive at her new home.

Coming Back to Cambridge Bay

I was so excited to be coming back to the Arctic. Was trying to think of all the last minute things that were needed, and, of course, forgot a few, but not too much major. Most important was probably a vest, or fleece to wear at the office. Brita filter was another, but you can get almost anything here, if you want to badly enough.
Sent myself a box of food several weeks before leaving, packed a suitcase and a small cooler, and set off for the airport. My son, who drove me was a little concerned, as was I, about my ability to travel, since I had arthoscopic knee surgery six days previously.
I sailed through check in and security, carrying my pack sack and computer bag (heavy computer bag) on a set of wheels. Was met through security by a cart that took me through the airport to the Edmonton gate. It was late afternoon, and today we, another Midwife from Vancouver, and myself were headed as far as Edmonton.
Vancouver was interesting. The gate next to ours was going to Winnipeg and was supposed to depart at least thirty minutes before us. They started announcing delays awhile before they were supposed to load. Then they started announcing delays for our plane. For a long time they did not say what the delays were, but finally they were announced. Our plane was delayed because the staff had not all showed up to check up in. The Winnipeg plane was delayed because someone had been sick on it on the flight in, and they said "Believe me, you want it cleaned before you get on!) I was glad not to be going to Winnipeg!!
We landed safely in Edmonton and went to the hotel, had dinner, splitting an order of veggie fajitas and a salad, and off to bed. We had asked about getting to the airport for our eight o'clock flight and been told we only needed to be there an hour ahead.
So, up at six fifteen, after getting to bed about midnight, to catch the shuttle at six forty, and be there about seven. We basically went through security and onto the plane. A lot tighter than we had thought, but still good timing. No time for the last Starbucks though. There is not one in Yellowknife, although they do have the most lucrative Tim Hortons in the country, or in Cambridge Bay.
Flight to Yellowknife was unremarkable, except that it was full, and of course, it went mechanical. In this case that meant the front seat was loose, so mechanics had to come on board to tighten the seat, and readjust seat belts, etc. So, yes we were late, and we had only about a thirty minute lay over in Yellowknife, so were not going to make our next plane.
The flight was beautiful though, with the fields of the prairies and then the lakes and trees of the North West Territories.
On arrival there were four planes on the ground waiting for our flight. They were all Canadian North flights, and they just waited until ours came in, to take people to various communities. That is one of the great advantages of northern travel...along with the free meals.
A hot breakfast was served on the flight to Yellowknife, and again on the way from Yellowknife to Kuglugtuk, then a bread package from Kuglugtuk to Cambridge Bay.
We got in at 13:00, to our apartments to drop off the bags, and then to work. We were told we would not usually work on the first day, which is strange because I cannot remember a time not working on the first day.
We were given a very short orientation and started. Turned out the one midwife here was leaving in three days to go to Kuglugtuk, and we would be operating on our own. The next day was clinic.
We were introduced to everyone at the health centre, and had an amazing arrival and welcome. It was great to be north again and it looked like this trip would be full of adventure.

A Day at the Office

Last Monday was anything but a typical day at the office, but that being as it was, it makes it a typical day.
I am working in Langley, BC right now, and for the next eighteen months. When there seemed to be a lack of northern contracts, I contacted two practices near Vancouver and asked them if I could work with them. Both responded yes. This one was closer to my home in Maple Ridge, and with the new Golden Ears bridge, it was only fifteen minutes from my home to the office in Walnut Grove. It seemed ideal!
For the last six months I have been part of this four midwife team.
Last week two Midwives were on vacation. Two was okay for covering the work, as we had fewer clients in August, knowing there would be vacations. Only, the second Midwife I was working with suddenly became very ill. It meant that I was alone, taking care of the women booked for four of us.
This had happened to me previously, when I was a lot less experienced and we were working in a group of three. Interestingly, at that time a Midwife from Manitoba had visited me while on vacation, and said, oh well, that means you are only taking care of what, forty-five or so women. We counted them. There were about ninety clients. She was quite shocked.
In this practice there are many more. We had few deliveries for August, having booked fewer, and having some go in July, but we did have three women overdue.
I did not have a delivery on Sunday evening and was very thankful. Went to the office on Monday and immediately things started going awry.
Messages on the phone had to be answered, as usual, but this day there were more than usual.
The second client in said to our receptionist, "you must have a mouse in that cupboard because there is a lot of squeaking and scratching going on".
Receptionist was very daring. She said, "in this cupboard?" and then she opened the door, and closed it just as quickly. She said "I can see it there". She was asked how big it was, and she showed us about four to five inches in length, with her fingers.
I said "It sounds too big for a mouse, I think it might be a rat". The fear of God was now within all of us!
Then she asked me what we should do. My suggestion was to call the property manager. Man, did she do it quickly.
The next two clients were overdue, and due the next day. They were standing in the office commiserating with each other, while I was answering another page, when the "bug men" got there.
The most hilarious thing was looking at the door of the cupboard and seeing that a piece of cardboard had been taped over the door, just in case there was enough room for the "mouse" to crawl out.
While the two clients were talking, and the receptionist and I were talking the "pest control guys" looked in the cupboard. They said it was a rat, and it was in the trap and banging it from side to side trying to get out.
I quickly took the next client into the consult room. No point in having to watch what was going to happen.
However, it always happens that there are lots of people around when things are going a little off. Another client arrived, and everyone is talking and casually watching what the exterminators are doing. They took various things into the cupboard, and then casually left. They did mention that they had reset the traps, and also said that the rat had to have come in from the roof, in order to get where he was.
There was no more scratching or banging.
Within a few hours though, the question became, "who was going to check these traps?".
We have electronic charting in our office, and one of the perks of the program is a message system. The messages started flying. The property manager was contacted again. She has arranged for the traps to be checked once a month. I am waiting for the stench of a dead rodent that has been left in the heat for a month!! Realistically though, the office would know if one had been there more than a couple of days. Pregnant women notice smells.
The rest of the day flew by. Lots of interesting "low risk" women, with lots of "high risk" problems.
It was a fun day, with no births, but lots of appointments, and lots of fun, with this "rat" incident.

CBC was excellent Yesterday

Yesterday I made the long drive from Maple Ridge, over the bridge to Surrey, then over the Patella to New Westminster and finally over the Pitt River bridge back to Maple Ridge. As I was switching through radio channels, realized that CBC had a piece of circumcision on. Started listening. Now, whenever there are educational programs, that are related to work, I listen, but this was particularly poignant.
The first speaker (I heard) was discussing how the Canadian Pediatric Association was considering changing its guidelines on circ due to some new studies in Africa, which showed that circumsized men were less likely to develop AIDS. Interesting, but then he went to to discuss the cultural differences between Africa and Canada, and how this could make a huge difference.
In 1991 we travelled to Zimbabwe and Zambia. We were told horrific statistics about the population that had AIDS. The Zambian government, concerned about its workers, had tested all the miners in their diamond mines. There was a 50% positive HIV rate. They tested the physicians and discovered a 100% HIV rate. Sex there was obviously used differently than in the western world. The other very sad statistic was that half of the babies were being born HIV positive.
On the weekend I went to a party. Lots of parents, grandparents and children attended. Eventually about six of us were left. One of the enebriated men, whose wife and six week old son were there, announced that it had been a really bad day for his son recently, when he was circumsized. Now some of you will understand when I say that this was a group of childbirth educators, midwives and others; that talking about circing your son did not go over very well. This man actually said that he did it because he thought that is what everybody did. Since I know they attended childbirth classes, and know it was covered, it was a bit bleak to hear him say this. It means that the men are also not picking up the information.
The next speaker on CBC continued on with an interesting conversation about pain in neonates. He pointed out that 50 years ago we paralyzed babies to do open heart surgery because we did not think they felt pain. As researchers have done more and more experiments they have realized just how exquisite pain is for neonates. (Neonates are babies under 28 days of age.) This speaker discussed how some practitioners now freeze baby boys before they are circumsized, and how he is sure it hurts, but that he thinks it might be like other surgeries and also hurt on day one and day two, and maybe day three, but these babies are not given pain medication then. He also pointed out that other research shows that babies who have been circumsized have a much more intense reaction to immunizations and other forms of pain. The last really interesting thing he discussed is how we now know that neonates actually experience all pain much more acutely than adults or older children.
What an eye opener.
I had now arrived at my friends home, and turned off the car and listened to the last speaker before going in.
This was a woman, whom I expected to be quite fanatical, since she runs an anti circ organization in the US, and has been its head for 26 years. She did have a number of interesting things to say, some of which were quite surprising.
This organization does not think that circs should be stopped for religious reasons (Jewish and Muslim boys) but that males should be left intact until the age of majority, when they can decide if they want the procedure done or not. Interestingly she said that the Americans are going against religious freedom laws by circumsizing babies, and not letting them self determine their religion.
She did point out that non circumsized men have fewer infections and are cleaner, however she then talked about sexual dysfunction and how this occurrs much MORE frequently in non circumsized men. It makes sense. The forskin allows the glans to stay very sensitive, and react to touch. When the boy is circumsized his penis is much less sensitive. (A good example of this is rubbing the inside of your fourth finger gently, and then rubbing the outside of your pointer finger gently. You will see immediately that the fourth finger is much more sensitive, because the skin has been protected much more than the "pointer" finger.
This was all really interesting, and gave me some new views to help parents decide of circumcision or not. Mostly, I would like to go and listen to the whole programm again. It was excellent.

A Great Day

Today was quite amazing, and very ordinary at the same time. I realized that my time in Inukjuak is more than half over, and am quite sad about that. Last time here that was not my feeling.
This day was a day of revelations and learning.
It is Thursday. It is supposed to be education day at the Maternity. If there is a southern midwife, then she does the education. They only have one student now, and she froze during a shoulder dystocia and asked me to go over it. We did that last week, so this week was going to review that and go on to breech.
The morning started, as usual, at 9:10 with only me in the office. That means that I answer the phones and say...no she is not here...no she is not here either...they might be here at 10...can I help you. The answer is taima (probably spelt the wrong way, but pronounced more of less like that) which literally translated, means the end. It is not rude. It is how the telephone conversations usually end, sort of like good bye for us.
This only went on today until about 9:45. By that time though there was one message, and someone, other than me, had to deal with it. It is basically an Inuit woman in Quebec City, instead of Montreal, really needs a translator. Her boyfriend is also there, and they speak English and no french and had a baby born early due to infection. I think the government here (Katavik, not Quebec) is trying to get them all moved to Montreal, but not really sure cause all the subsequent conversations were in Inutittut.
At the same time the co-ordinator was making calls trying to organize the maternities and a peer review meeting this afternoon with the maternity in Puvirnituq.
I did my usual. Once there, checked my e-mails, which believe it or not, takes about 45 minutes if there are 20 e-mails. Computers here are very slow at work. They are in Nunavut too. Answered the phone while I checked them, did the dishes, and cleaned up a little.
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Then there were some prenatals to do that did not get done yesterday, when only I was in the clinic because there was a home birth the night before. So, the prenatals got done, I supervised one, and went on to my other job, which is sorting out protocols.
Have had some trouble figuring out the blood work they do here for maternity patients because some things are a little unusual. They order a group and screen on everyone in the first and third trimesters. I asked why? They said that was my favourite question. Quickly said that if they explained it to me I would understand and not have trouble doing it.
Toxoplasmosis is another interesting disease here. Many Inuit have had it already, but if they have not and they are pregnant then they are tested every two months to make sure they do not serum convert. There is also special counselling because they eat so much raw meat. I read the original research about it and it said they thought it was to do with sea mammals, although fish did not pass it on. Now the protocol says it is safe to eat sea mammals, as well as fish, but all other meat needs to be completely frozen before it is eaten raw, and that it should not be handled when women are pregnant, and are negative for toxo.
So today I tackled the protocol on lab work during pregnancy. Finished it just after lunch, and faxed it to the other maternities to discuss, and realized there was nothing in it on gestational diabetes testing. Revised it and faxed it again. So, by then the education time of the day was over, and we were well into prenatals and post partums.
I had the joy of doing a postpartum with a woman who actually had some continuity with me, and seemed happy to see me. That was very nice. It was here sixth baby, but she had given this one up for adoption. I was at the birth, and at that time she was pretty upset, although she did have two very young children at home. Today she was very happy and up. It was lovely to see.
Then did a postpartum with a baby who has a heart murmur. I was involved when this baby was 3 days old,and was sent to Puvirnituq for a telehealth and ECG. Also saw the baby two days ago when resps were too high, but only about 64 in a sleeping baby, and went down a little later. The heart murmur was amazing though.
Today the babies resps were 70 when the baby was sleeping and the baby was shipped off to PUV again, and likely will go on to Montreal this time.
In the south heart murmurs are not common. I have heard one or two minor ones only. Here they are so common that they have a protocol on how they are handled. This one was so extreme that you could hear it when listening to the right lower side of the chest doing resps. It was quite amazing.
While we were taking the baby to the medevac plane another midwife was doing a labour check, and talking to the mother about possibly having a homebirth, as there is still not much heat in the maternity. She declined but also not likely in labour, so hopefully things will have turned around that way before she does go into labour. It turns out that when they built in the sink in the major birth room, they put it over the heaters, with no way to get to them. They also have the water in the heaters going the correct way only about three quarters of the time, so there needs to be constant bleeding and fixing. And there is one guy here who does it all, for all the apartments and health centre. He is a replacement and is only here for three weeks. I think he is working about 15 hours a day. (Today he asked me if it would be okay for him to paint one of the bathroom walls in the evening this week).

The medevac was early enough that there was still time to go to the co-op before it closed at 6. I had wanted to go and see if the walrus carving was still there. It Is. Tomorrow, I'm hoping that my hats for Puvirnituq and the money for them comes, and then will be heading back to pick up the walrus. Only there are two there now, the one that was there previously and another, a bit smaller, a bit smoother, but with a little less character. So, tomorrow, if we do not have a birth, or other time problem, will be the day to purchase my second carving here.
I also found out today that although I refuse to to oxytocin inductions here, which the midwives do by themselves anyway, they still want me to come back. And when I said that the woman who coordinates who comes had told me to give her months next year I was interested incoming and she would organize it, they were quite happy about that.
The other part of a good day is getting all the personal things done. The laundry is done, the dishes are done, the shopping is done, and there was cauliflower/brocoflower cheese for supper. What can be better?
So, today is the day I figured out the blood tests, was useful in the maternity, heard an interesting heart murmur, had a client happy to see me, and found out my walrus has not been sold. Generally a very successful, happy day.

January 31, 2011

Today I am SO glad to be back at my one bedroom apartment. It was SO cold at work today. Workers were wearing their parkas to work in, if they sat at all during the day. One of the docs wore his parka all day. We also have a lady in early labour, and although homebirths are the exception here, it was easy to talk to her about it, because the maternity is also cold. We had tried warming it up all day, with extra heaters and lights on. Did not work particularly well.
The mechanic who is working here right now started talking to me when he was checking the heating in the maternity. He said he wanted to ask me where I was from, that he had worked, in Victoria, with the navy for 17 years, and thought I must be from there. I asked if it was my accent, and he said yes, but also I looked like someone from Salt Spring, or Quadra Island, or Victoria. Was almost taken aback, and then thought, what the hay...that is where I am from. (Born and raised in Victoria, and other than travelling, did not leave until age 23. Attended University of Victoria, and was married there as well. It is probably the reason I now live outside Vancouver...as Island life is lovely, but getting there and back is tedious.)
Lots of interesting calls today as we were trying to sort out a lady who went into premature labour on the weekend. They took her to Puvirnituq, on her way to Montreal, but conditions were bad in Montreal, and she ended up in Quebec City. Her boyfriend, though, ended up in Montreal. The Midwives were trying to help get him to Quebec City, and answer her questions about what was going on. The hospitals in Montreal have Inutittut translators, but not so in Quebec City.
As I mentioned in my weekend blog, three men are missing from here in Inukjuak. Two went polar bear hunting last Wed and one went fishing on Friday. The fisherman was found by search and rescue, who are here looking for the polar bear hunters, yesterday. He is fine and well. Today, they found the skido of the polar bear hunters, but not in the direction they said they were going. They have not been found yet. Conditions were not good on the weekend, with the wind chill dropping to -48. Everybody is worried.
One of the interesting things here is how many people are related to one another. It is probably due to the isolation. Each town has different names of families within it. Here there are masses of Kasudluaks and Aculiaks and Weetatuluks. If you read the list of people in town there will be a hundred or more of each of these names, and then you have a few families with only four members, and they came from somewhere else. In Puvirnituq the names are totally different. This is also true in Nunavut (probably not Iqaluit), that there are different family names in each community.

It has not been snowing much recently, and everything is extremely slippy. The snow has blown off all the roads and paths. The centre of the roads is more clear than the sides because cars, trucks and atv's use the road, where the side is used by skidos and pedestrians. Since the road to my house was plowed late last week, it is now like a skating rink. Not many people used it but I slid a number of times trying to get up the "hill" this morning. It is quite flat here, so a "hill" is relative. The river has finally frozen over, and sea ice has been forming for a week now. Not sure how long, or if, it will get to its normal amount. Usually it starts to form in November, and this year it started last week.
I was also told on the weekend that polar bears are newcomers here. They only started coming to the area about two years ago. So, for sure, as the global warming trend changes, it also changes animal habitat, and this is a prime example of that.
I am now drinking tea, and feeling warmer. My water is boiling, for drinking for the next couple of days. Am waiting to see what instructions will come out for February. Every month water inspectors go to all the villages and test the water. Then the health centre posts whether it should be boiled that month or not. Right now the water is boiled for 20 minutes and then, when cool, it goes into the brita. Tastes fine, but when I was here in the summer, one of the pregnant woman was really sick, and needed iv antibiotics, due to problems with the water.
My thoughts and hopes are going this evening to the families and the polar bear hunters. I am hoping that they are found quickly. It is so hard on the families when people are missing.
Hope you all have a great evening.

This Week in Inukjuak

This has been a truly interesting and fun week in this little village. Have been meaning to write about it for the whole week and now it is Saturday. I am not on call, am able to have a glass of wine tonight, watch TV(there is cable now), use the modum (which only came this week), and knit socks as an envelope also arrived for me. What fun.
We are a little low on personel at the Maternity this week. One Midwife is on maternity (adoption) leave, one became very sick on Wednesday, and one student quit just after I arrived. That leaves one Inuit midwife, one student and me. It might be quite busy next week, although probably only the lab days, Monday and Tuesday.
There is no lab here, and the majority of labs, especially routine, are done on Monday and Tuesday and sent off to Puvirnituq. The lad there does all labs for the Innulitsivik area (Hudson's Bay coast).
The other days we have meetings and administration and pap clinics. Midwives do most of the paps for women of the community, along with std testing and hiv testing (if they want it). There is no HIV in this community.
It has finally gotten cold and most days this week the high was around -26 with a wind chill one or two days. It makes it really clear, cold and wonderful. The sun rises just before we leave for work and sets before we leave, so we can look out the windows, and also walk home at lunch in brilliant sunshine. It is so cold though that everyone leaves their cars, trucks, atv's and skido's on while they are in buildings. So there is a constant blue haze in parking areas. Also as you walk down the side of the road, you are passed by skidos that ooze out blue haze, and cars, trucks and atv's in the middle of the road doing the same.
As I walk to work I pass all the kids going to school. They are dropped off by skido's, suv's and school buses, and a few walk. The school is at my end (old end) of the town, and there are few houses. It is mostly working buildings.
When I arrived the driver told me that although it is a nice road in front of our building, and it is the only building on it, that it is no road when there is a blizzard. With the wind it became obvious what he meant. Walking was a bit of a challenge. Most days a high truck went through so I could walk in the wheel paths. On Wednesday a car got stuck, and really stuck trying to get down. (Really do not have any idea why a car would even try to come down here). They did manage to dig it out. (This is a more difficult feat than you can imagine. The car was here over lunch time, which means it was not plugged in, and would become cold. Then it becomes very dicey starting them again. Our midwifery student had her atv freeze this week, and so she has not transportation until spring, or summer, when it is warm enough to thaw out, and they can replace necessary parts.) So, on thursday our little road was plowed. What a difference to walking, except now it is very icy.
Yesterday was a worried day in this town. Two young men went polar bear hunting the day before and had not returned. Yesterday a number of people were out looking for them. The elders were on the radio telling people that they did not think these men had the skills to survive, and had to be found. Snow is not good for igloo making this year, and probably they did not know how to do it anyway. The radio here is totally in Inuktittut, except for bingo, where it is French, English and Inuktittut, so I could not understand any of the postings. The Inuit Midwife did tell me some of what was being said.
Also yesterday morning polar bears were spotted just outside of town. We went out to see if we could see them, but of course, not. The lack of wildlife has been one of my few disappointments with the north. But then again, any smart animal is going to stay away from town, and as this is a very poor community, they are unlikely to survive a sojourn here.
I have seen lots of bird life, right now only ravens, siksiks in Rankin, a seal last summer going up the river here, Arctic hares in Rankin and Narwhals in Repulse Bay. The Ravens and I seem to have a problem. I keep trying to photograph them, and having no luck whatever. Yesterday the midwife told me I should go out when they are smoking with them, as the Ravens are always there. I did. They were not there.
This next week, my concentrations will be on trying to photograph Ravens.
I hope you will all join me in saying prayers and lighting candles, or whatever your choice for the two young men who are missing. Have a wonderful weekend everyone.

A Saturday Afternoon Bike Ride

It is August 21st today, and we finally had a birth yesterday. I was on second call, so the “baby midwife” as the second midwife is called here. The woman was an young primip, who had developed slightly elevated blood pressure about five weeks ago. She also had proteinurea (for you non-medical types protein in her urine) at 28weeks. Nobody had thought it was significant. A student was taking care of her, which is the norm here, and a senior midwife did each visit with them. The senior midwives are largely southern,and do not speak Inutittut, which is the language that is used for maternity appointments.



Two weeks ago I was asked to help with a visit, which I did, but seeing the blood pressures, insisted on a consult. Blood tests were ordered before the consult, and the student figured out which tubes were needed, and took the blood. (Yes we do our own blood taking here.) So we began checking blood pressure twice a week. This last week however, the blood pressure was high enough to need another consult. We started a more normal, for me course of care...twice weekly blood pressure, once weekly blood tests, and twice weekly NST’s (non stress tests).

There is no fetal monitor here. Non Stress tests are done by using a Doppler and two people, one to count and one to write. The fetal heart is taken for six seconds and then announced, then there is a four second rest. This is repeated for twenty minutes. The writer takes down all the numbers and plots them. When the twenty minutes is up they are joined, and you can get a line that shows if there are accelerations or not.

We did this Thursday, but as her pressures were very labile, we consulted again. The docs said to take her blood pressure again at the end of the day, and if it was high to let them know. It was, so consultation again. The MD’s decided that she should be induced with cervadil that night, and hopefully would go into labour. She was to remain in hospital, but under the care of the nurses, not the midwives, although she was staying in maternity.

This always causes a bit of stress for the nurses. They are not OB nurses, and the hospital is largely chronic care. There are twenty beds, and really is largely extended care. The building provides care for the whole community, but where in some communities there are group homes for seniors, there is not here. The seniors that need help are in the hospital, and so are the handicapped, who cannot be cared for at home. There are also a few beds for the babies and children with lung problems, and others who need to be observed. There is usually no surgery, and when there is, as there was last week, it is very specific. Last week a dentist was here taking out children’s teeth. Apparently they do orthodontics under an anaesthetic as well. (I do not know this for sure but was told that by the Inuit Midwives.)

Anyway, the woman went into labour, and had an extremely precipitous PIH birth. Mainly she went from three centimetres to birth in less than two and a half hours. Of course there were decels, a shoulder dystocia and a PPH. Typical PIH birth and only a little fast for an Inuit primip. But all this was done with no heart monitor, or additional monitoring. (It worries me slightly because I am the senior midwife here in September, and it is not something that I will do. So, there may be some battles with the director or the physicians. Am hoping there is just no more PIH. This is the second case since I have been here, although the other lady was from another community).

When the client was not having so many contractions, first thing in the morning, the student who was working with her said...”maybe we need a little synto” to get her going. Quite cavalier really. Luckily she delivered without oxytocin.

After delivery and overnight a postpartum worker took care of her. Post partum workers are women who take care of the women and baby dyad. They work eight hour shifts, so probably three postpartum workers and one or two trainees took care of this couple.. And there are always numerous family and friends at the maternity as well.

At two this afternoon I went to the maternity to discharge the baby. The first call midwife was already there, having dealt with a miscarriage, and had said she would do the baby as well. She had a different student with her, who really did need more experience, so I decided to leave. Told the other midwife I was going out on the road to the Hudson’s Bay so she gave me the walkie talkie. Apparently the phones do not work out there. Mind you, no cell phones work here. There is talk of getting a company to get them working for the Bay and Ungava coast, but who knows if the rumors are true or not.

She also suggested that I take the bike and go out. What bike?? Turns out there is a bike in the apartment building (six apartments only) that does not belong to anyone, and everyone uses. It seemed like a good idea.
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Went to the co-op, and got an avocado then back to the apartment. Forgot my camera, but did pick up water and took the walkie talkie, which is large, and headed out. The bike is purple. It matched my hair. The sky was overcast, but it was warm, and thank goodness I only wore my bug shirt. It also saved my arms and back.

As I rode off the realization quickly came as to why this bike was “free”. The gears did not work. Instead of ten or twenty, there are perhaps two gears. Not great for going up and down hills on gravel roads, but better than nothing, and it could take me further than my feet.


I rode through town and out the other side, following the road to the Bay. Before the houses ended, the gravel started, and it is heavy gravel, so the going was a little rough. There were a few bugs, but on the bike they were not noticeable.

I went over the first hill, and then I started to see things. There were mushrooms everywhere. Now fresh picked mushrooms are lovely, usually, but there are some poisonous ones here, and they are red. So, finally I got off the bike, took my water out of the bag I was carrying and started to collect mushrooms. Like all wild mushrooms it is advisable not to take the really big ones, because they have worms and maggots in them. Worms is what are in them here, and in the south you can often find the maggots after the worms.



So I was carefully checking out the mushrooms, and suddenly noticed that the blueberries and blackberries were ripe, so also picked some of them. Now the blueberries and blackberries are the size of small huckleberries, but they grow very close to the ground. I got enough for some youghert, so was happy with that, and about five mushrooms, and four puffballs.

Back on the bike, and riding along, and I suddenly saw little orange aupicks. These are Arctic raspberries, and they are orange in colour when they are ripe. They grow one on a stalk, so at first I thought they were flowers. Each little one is about two inches high and the berry sticks up from the stalk. They are delicious.


Of course while I was picking the berries, the bugs picked me. I realized I was being bitten on the face, but afterwards realized I was bitten inside my ear. It is quite odd to feel yourself being bitten inside your ear canal, and scratching with your finger to find a fly under your nail. Then you know that you are in trouble. Hearing becomes different, and you get a little vertigo as your ear canal closes from swelling.


As I had been riding a number of quads had passed me. They rode down the road and then off on little trails, and the riders were also collecting berries. You could see the quad drive off, slow down and the riders looking for what looked liked good areas. Picking berries here requires only a small container. The size means you are unlikely to get anything close to a bucket, and a small jar of jam can take a whole afternoon of picking. Of course if it is the aupicks, a number go into your mouth as well.

I felt very lucky and turned around to go home. I had not made it as far as the Bay, but had mushrooms, puff balls, aupicks, blueberries and black berries. Then I also noticed the little red mushrooms that were everywhere. I am going to go back and take my camera. There were so many little things to make the camera useful.
Rode home, having a good ride, although not that far really, maybe two or three miles, and got the filthy bike into the building.


Got upstairs and opened my bag. One of the puffballs was past its best and the ride had opened it, and its slimy contents. It went in the garbage. The other two will be my breakfast, with a mushroom as well, sautéed, put on toast with a little cheese grilled on them. And if nobody takes the bike tomorrow, the walkie talkie and camera and I will be repeating this little trip. If the bike is busy, then will have to decide if we are busy enough for me not to go out, as I am still on call. Either way it will be a fun day.

Welcome to Puvirnituq

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Welcome to Puvirnituq
Well maybe, or maybe not. As I sit here, nursing my hot, itchy sore ear and cheek, covered in bug bites, am not sure about the welcome. Have been here a little over a week, and have been here been on call the whole time. Likely we will have a birth tonight or tomorrow, and since I am first on call, it will mean more busy times. At least here we do not have to be at work from 9 to 5 if we have been up all night.
Arriving here was lovely. My camera battery died just prior to getting near to PUV, as Puvirnituq is affectionately called, or POV short for something similar that used to be the town’s name. The amazing thing is all the water, as it seems to be all over the north. In PUV though, you add colour. The water has amazing colours, and as there are drop off s a few metres off all the Islands there are an amazing array of colours in the water.

I did a medevac to Umiujaq, one village below Inukjuak and about an hour, by plane, south of here, and was surprised to see trees. Well, honestly they are not trees as you and I know them, but they were four to six feet tall, and grew in little clusters here and there. Our driver said they had one really big one...about seven to eight feet tall. They were really proud of that tree. It was also very verdant and green in the village. Unfortunately it was also heaving rain, and we were in a rush, so could not take photos. A woman had given birth there, which is not supposed to happen, and I had to check out everything and make sure the 36 week baby was okay.


She was fine and dandy, and had already breastfed by the time we got there.
As we arrived though, we got a call saying we would be heading to Salluit, for another patient, not maternity. So, it was, can you do this as fast as possible please, but at the same time teach the nurses because they will be doing follow up on this Mum and baby, and they have not done it previously. Not surprising as Umiujaq is only 400 people. Their pregnant ladies usually leave at 36 weeks and go to PUV, or somewhere else, to deliver. Some go to Inukjuak as it is closer, and many have relatives living there. (I thought about suggesting we check out their Northern store to see if there was any bread, but since we were in a rush, decided it was not a good idea. Also the Northern was the size of a normal house, so thought their stock might not be so large.)
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We drove back to the airport and were then told that we were taking two more patients from there, as the sched (scheduled flight) had not been able to land there due to weather. Prior to leaving PUV we had also been told we might not be able to land due to weather, but if we did not make it we would go to Kuujjuarapik and get more fuel, then try again on the way back. Luckily we did not do that.
Just before we took off, with the two extra patients with us, the pilot told the nurse that we had to stop off at Inukjuak, for an emergency. Oh well, what is one more person. The weather there was great. Now remember that these villages are about 35 minutes flight time from one another, and PUV is another 35 minutes north of Inukjuak. The weather systems are all different. So, we got into the clouds, and it was amazing to me that instruments can tell you where you are, because the whole flight seemed the same...in the middle of fog. But we successfully took off and landed several times that day. Inukjuak was quite nice, once we were under the clouds, and we landed without incident, picked up a patient on a stretcher and their escort and were off to PUV. The nurse was also told that there was no way they could land at Salluit, due to weather.


Well, as I started to say, it is amazing the differences a few miles make to the plant life in this region. Inukjuak is a beautiful green colour. There are masses of berries and grasses, and everything is very green. They also have the beautiful colours of the waters there, and the village itself is between the Inukjuak river and the Hudson’s Bay. It is a town of approximately 1600, with the highest number of people per capita on welfare, in the whole Quebec, according to the Midwives there. And judging from the number of food coupons we gave out there compared to PUV, it is a statement I believe. (There is a food coupon program for pregnant women and nursing mothers up here. I am not sure if it is Quebec wide, but suspect now.)


This time landing in PUV, my camera was at the ready. I snapped pictures and got some beautiful shots of the islands and the water. Lots of reds in the rocks and water colour, but the land is not green as it is further south. Everything here is much browner, despite the rain that has been prevalent since I arrived. I was also told by one of the midwives that the bugs were not bad here because the caribou had been through already. She said that when the caribou herd goes through the area, the bugs follow it. Not my personal opinion, as I am wearing my bug shirt, even if everyone thinks it is “cute”.
My previous medevac had been to Salluit. It was in the middle of the night, so did not take my camera, which was quite silly. It is light here by five am, so there were lots of photos that could have been taken and Salluit is truly beautiful. It is on a fjord in between two hills, well, hills if you live in BC, but the people here have said mountains. It is all in your perspective. The sun was rising as we left and it really was beautiful. Only problem with Salluit is the weather, which is very iffy most of the time. Even in summer you can get stuck there for three or four days because of fog, clouds, or the plane just not being able to land.

PUV has two stores, the Northern and the Co-op. Anyone who has been reading my blogs or facebook notes will know that this is the norm here. The Northern is a chain which used to, and may still, belong to the Hudson’s Bay Company. The Co-op’s are stores belonging to the Inuit of each village. In some places they say the Northern is for the southerners and the Co-Op is for the Inuit. I have not found this to be particularly true. Everyone seems to shop in both, depending on what they want. And if you want snack food or pop they both have an amazing variety!



The hospital here is divided into three areas. It has Nursing, the Department, and the Maternity. Nursing is where you go for an appointment, or if you need to see a doctor, although you see a nurse really, and if you are seriously ill, or have some problem that you will need to go south for, you see a doctor. This seems to be similar to Rankin. The doctors are considered the specialists of the south and the nurses are considered the GP’s of the south. There is a lab, a pharmacy, X-rays and usually ultrasound department, and everyone from the whole Hudson’s Bay coast of Quebec comes to this hospital for these services. The Department is the in patient services. I believe they have 20 beds but many are chronic care, and they also have an emergency department. Maternity has three birthing rooms, each with a double bed and chest of drawers. A tray is brought in for a birth that has most of the necessary equipment on it. There is also a clinic room, bathroom, office, storage room and emergency room. There is no baby stuff set up in the birth rooms. If there is a problem you take the baby to the emergency room. They have no EFM’s.
Other villages have health centres that consist of two or more nurses, and doctors either full time or sometimes depending on the size of the community. They seem to handle emergencies, and general health very well. If there is an emergency a plane is sent from PUV to the community, to pick up the patient. They are then screened here, and if necessary, sent by jet to Montreal. There seem to be jets to Montreal every day, but I have been told this seems to be the case right now, but is not in reality true.
I was told by Midwives in Inukjuak that years ago Inukjuak was to have the Hudson’s Bay hospital, but some old men in town thought it was a bad idea. They said they were quite mad at those men because there were now no jobs in that town, and PUV had jobs. PUV is the same size as Inukjuak, but it seems to have more problems as well. Both towns are friendly, but there are more jobs and money here, and it seems, more alcohol, drugs and violence. It may be my perception, and certainly it is nothing like a large town in the south, but the demeanor here is different than in the other villages. Having said that, I am liking it here just as much as in Inukjuak. It has its own flavour and character, as do all the northern villages.



To finish the medevac story, the woman we picked up in Umiujaq was with us til about six thirty that evening, when a Challenger jet came to take her and another patient to Montreal. I got home about seven and was called again at one thirty in the morning to go back to Inukjuak for another patient. The flying isn’t exhausting, but everything around it is. Getting ready, getting equipment, knowing the general information about the patient you are going to get, but not really knowing what you will be doing, and generally flying by the seat of your pants (pun). It does make the work a little more exciting. I am sure that if we have any normal births, (no births so far) it will be even more fun to be here.
So, I am enjoying the wind and rain and sun, the plants and ocean, knowing that by a month from now the temperature will have dropped and we will be experiencing very different weather. The berries will be picked and mushrooms harvested, and everyone will be getting ready for winter. Until then I will just observe all the wonderful changes of the north.

Today was a beautiful day. It is July 17th and I decided that a walk to the “waterfall” would be good. I also went last weekend, but it was raining and horrible. My thought was that the bugs would not be there to bother me. Wrong again. This weekend the wind was blowing at 35-50 km an hour so the bugs were not too bad. They were so bad this week that yesterday I ordered the “original bug shirt” which I am hoping will come asap. It has screens so you can zip up a hood and not be bothered by bugs in your face. It also has screens in the sides so you have lots of air and mobility.
In the south we would call the “waterfall” rapids. They are beautiful and the walk is probably about 2-3 km, along the Inukjuak River. Going along the road from this house to the beach I followed the road to the airport. This is a friendly little town and everyone says hello, or waves from their atvs and cars. The road is paved, but has large potholes that everybody drives around, so you have to be careful when you are near these, and give vehicles a wide berth.
As soon as the houses end the flowers start. It is quite amazing how large they are in comparison to Rankin. Today I was thinking that some of these very large flowers looked like the Arctic Saxifrage in Rankin, but much bigger. As you approach the turnoff for the river and sandbank, where there were people fishing, there were many more flowers and bushes.
The walk itself is along the river, and you can either walk along the top of the bank or on the rocks by the water. I chose to walk along the rocks today, and last weekend walked part way along the rocks as well. Only problem last weekend was that they were quite slippery. Today, they were not, but you had to watch your two feet much of the time, to avoid them moving...same as on any river trail.
Of course, there was no shade today. There are no trees. This week I did a comparison of latitudes because I was interested in where villages were in relation to each other, on opposite sides of the Hudson’s Bay. Although Inukjuak has no trees, it is further south than Churchill, which does, they are only a few minutes of latitude apart. Puvirnituq is about 2 degrees north of here...about 140 miles and Rankin is about 4 ½ degrees north of here, so about 310 miles north of here. It is obvious that latitude is not the only factor in “no trees”. The breeze was beautiful and part way there I took off my jacket, and rolled up my short sleeves to try and get a tan.

From the time I turned off the road until I was back in the village birds were screaming at me. I think they nest in the small bushes or rocks. They were most annoyed with me travelling through their territory. I would have liked a photo, but they were not sitting still long enough for that. If they were bigger I think their tactic would have been dive bombing!!
As you get further along the river, there in one section where walking on the rocks is difficult. I did it today but last weekend did not. I chose to walk along the top of the embankment instead, where there were masses of small bushes, lichens, and berries. At first I thought I was walking on moss, and then looked more closely and realized that they were berries, which now I know to be cloudberries, and they make wonderful tea.
Today the walk was along the river itself, and sitting on some of the rocks just watching the world go by. Last weekend there was a man fishing, in the rain, on the other side of the river, by the falls. He got there by red kayak, and during the week, when discussing weekend activities, realized it was one of the docs who is here. He if permanent, more or less, going to a number of villages but living basically in Inukjuak, and has the comforts to make life fun here. He said he caught two fish, and there was a huge one that got away.
One can well imagine that large fish inhabit this river. It is deep in sections, and quite flat, as is the land here. There are seals that come and hunt/fish in this area, and I was very excited this week to see one while out, just fishing around the river. I suspect that is not a good activity for seals here, as they are hunted and eaten. However, hopefully, that one was not. I know it is not terribly exciting to see seals when you live on the east or west coast, however, as I had seen almost no wildlife in the Arctic, it was great to see...even a seal.

There are actually two rapids, not very far apart. They are quite pretty, and I expect would be fun to “run”. Today the whole area was green and verdant. It was surprising how much greener it can get with rain, only because it already seemed so green.
Both walks I came home by the top of the embankment. Last weekend was a mass of bugs. I had on a waterproof/windproof jacket with long sleeves, and spent my time trying to keep them away from my face. It was so bad that when I tried to take a picture, I had four mosquitoes on my hand. Quickly put my camera away and pulled hands back into my sleeves once the picture was taken. Today it did not seem to be too bad, but surprisingly, since there was so much wind, there were little flies up on the embankment. Luckily they were nothing like the mosquitoes last week.
I came home very happy to have gone both times, and enjoying the beautiful sunshine, today, and the lovely scenery.

THE FIRST WEEK IN INUKJUAK
First weeks in new communities and at new jobs can be challenging. Inukjuak was no exception. I arrived Friday afternoon, and later than expected, since I was not expected! Nobody met me at the airport, and there are no taxis here. The health centre has a driver who picks up and drops off, and in a pinch, so do nurses and other staff.
My first afternoon started at 16:00 and everyone left at 17:00. That seems to be the same all over the Northern areas. The midwives were still seeing some clients on Friday afternoon at this time, because they had three births last week, so we still doing post partums. And all visits were done in Inuktituk. It was interesting to watch, as the student midwives conducted part of each visit.
At 17:00 I was given directions back to my house...not too difficult as Inukjuak only has a population of 1700 so is quite small. I walked up the road from the health centre, past the co-op on the right, and the municipal office, also on the right, then the school was on my left and I turned right just by the church. There is only one school and only one church in this village, so that was easy. My building was the green one just down the hill from the church. It was easy. But I needed groceries, and was told that the Northern, just below (down the hill) from the Co-op had more produce and better prices. Prices were much better, on many things than Rankin Inlet. Of course I was not as far north. Transport prices depend on how far north you are, at least in Nunavik. That was not so noticeable in the Kivalliq, the region where Rankin, Coral Harbour, Repulse Bay and Arviat are located.
The weekend was a write off. I got settled, cleaned, went shopping and for a walk. I had no internet service and no TV so was a bit on my own. It worked out fine though. Read all the “Welcome to Inukjuak information and the orientation to the work here. Found out on Monday that it was almost all old and not relevant anymore!! It talked about the role of the “southern” midwife being to teach and supervise the students, plan education for the midwives and help out as necessary. By Tuesday it was very clear that I was here as a locum, and mainly to be a second midwife at births.
I was asked what my specialty was. The student who was here this week actually came and asked me to do something for her on routine lab work. The program here is totally apprenticeship, and although there is quite a lot written, doing a hand out on the routine lab work here was very useful to me. There are tests they do here routinely that I have not heard of previously. So, my computer came to work with me, and I prepared a handout of all the tests routinely done here, and why they are done.
The biggest insight for me was that the Midwives are not necessarily familiar with why they do tests, but just that they are protocols, they have been told to do them, and they do. So, the job entails being on call for births, doing the odd bit of education, and sitting on your thumbs, or doing whatever has not been done. There are three midwives here, two student midwives and they appear to do about 40 births a year.
The health centre staff work largely in French. (This is Quebec after all.) The nurses and doctors are bilingual, English and French. The Inuit are largely bilingual, English and Inuktituk. There are also clerk/translators who work the front desk and help as necessary with translation. The health centre is very friendly.
The town is small, and the Midwives said that Inukjuak has the largest population on social assistance in Nunavik. The houses all appear in relatively good condition. In this community there is no pumped water or sewage. The water and sewage trucks come to the houses every day but Sunday. (We do not do laundry on Saturday or Sunday because of this.) The water comes from up the Inukjuak River, and I am not sure how they get it here. When walking today I saw a building called the water building, and am wondering if water is actually pumped there and then delivered by the trucks. Sewage is taken daily, by small tanker truck, to the sewage lakes. It is allowed to settle there, and I understand that it goes from there to the ocean, eventually.
In orientation books it said that you need to boil the water before you drink it here. By Monday I asked the midwives if they did this for their families. No, they did not. They suggested that I might want to because my body might not be used to some bacteria they had here. I had boiled water before making tea and coffee, and had already started a routine of boiling a kettle in the evening, then moving it to the Brita in the fridge before I want to bed. That way I had boiled drinking water. What I did not realize is that the water is to be boiled for fifteen minutes before you drink it. There would be nothing left! I am now boiling water for tea and coffee, and at night boiling some for the brita. So far, I have no stomach bugs from the water.
Roads here are mostly paved. The people drive, mostly, ATV’s. These do not have to be licensed, and nobody wears helmets. There are some cars on the road, maybe one to every seven or eight ATV’s. The boats are bigger than they were in Nunavut. There are lots, and they use E-Z loaders and pull the smaller ones behind their ATV’s. Today, while walking, I watched a woman with a trailer behind her ATV, pulling camping gear and children. The average number of people on an ATV is probably 3. Although lots of people are sole drivers there are also lots with three and four people on them.
There are few dogs visible here. Apparently they all live out of town, where they will not bother anyone with their howling, and someone goes out and feeds them every day or two. I have seen no cats, and no wildlife, other than birds and bugs.
Although it can be windy here, it is nothing like the places I visited in Nunavut. There definitely are bugs, and I am using bug spray, which is not making a lot of difference. There are mosquitoes, same size as in the south, and black flies, and these tiny bugs that swarm you when you walk. It is annoying, but part of what I should have anticipated. Bugs bother the Inuit as much as they bother the southerners. Yesterday someone left the back door of the health centre open, because it was muggy. We closed all our doors, and still somehow we were swatting moszies all afternoon. Finally one of the Midwives declared that if there were two more we should close the door. It was closed about three minutes later!
The land here is beautiful. There is more definition that Rankin had. Inukjuak is on the end of a peninsula between the Inukjuak River and the Hudson’s Bay. There are Islands off the Bay side. It is not as cold as Rankin, being further south, and so has more flowers and bushes, and they grow larger. Today, while walking, I saw lupins and daisies. The daisies were 3-4 cm across, which is very large by northern standards. There was also Arctic cotton, but it was a good fifteen inches tall. The lupins were not huge, but were over a foot tall, with beautiful purple and pink colours. The only flowers that reminded me of Rankin were tiny white stars, and they are the same size, but taller. I suspect the height is due to less wind and less cold. There are also grasses, not to make a lawn, but marsh type grasses. When you look across the river you see grass green.
The weather is cool. It has been foggy for several days, rained twice and have needed my hoody and waterproof jacket two days. Two days it was also warm enough to not have on a hoody...except for the bugs. The teens and children swim in the river. One of the interesting things is an upside down sled, extended, and used as a pier. Watching some teens one day is when I realized they dislike the bugs as much as others. The swearing as they got out of the water and were trying to swat them was English. I had thought all the words myself!
I am understanding why the “southern” midwives say they use Inukjuak as a retreat. There is a hotel here, but no restaurant or coffee shop. There is no industry. The people fish, hunt and carve, or not. There are a few jobs in the Co-op, the Northern, the arena, pumping gas, sewage and water and for the municipality. There are a few jobs at the health centre and at the half way house for mental patients. Other than that, there is not much happening here, relating to work.
This village, like many Inuit villages, has a much smaller population in the summer, because the families are out on the land. Where exactly, I am not sure. Walking today, I did get to the outskirts of town, which is not far, and the roads turn to gravel and there were many ATV’s and some cars going along them. If I am lucky, maybe it will be a trip I take before I leave this little village. In the meantime I am enjoying what is here and the slow pace of the workload and friendly smiles and hellos of the people.

Flying used to be exciting. Sometimes it still is, but more in the destination than in the flying itself. The first three or four times I flew to Europe, there was adrenaline pumping just getting on the plane. It is not like that any more. Now it is getting organized, figuring out what I need on the plane, or what I have to take because of weight restrictions, and just doing it. Lots of waiting, in the check-in line, in the security line, at the gate, going to have ID checked, and finally, at the plane itself, waiting to get to my seat.

Still the idea of the new place is exciting, and coming to Inukjuak was no exception. Leaving Vancouver is always interesting. The mountains and ocean are beautiful, as long as you can see them before cloud cover. On this trip the cloud cover was quite low. So, it was sea, low levels of mountains, and then clouds. I had a good book, “Plain Truth” by Jodi Picoult, and was very glad. I had some snack food. Had planned to have sandwiches, but had managed to burn the cauliflower, while I was multitasking before leaving. Obviously my multitasking ability is disintegrating, or maybe it was just trying to get one too many things organized. I did have cherries.

Over the prairies the clouds dissipated somewhat, so patchy fields could be seen some of the time. Then we hit clouds again, so could see patchy lakes through northern Ontario, and haze over the Ottawa Valley. The allergy index there much have been really high on the first of July, as we could see the shimmer and colour of poor air quality. Then finally we arrived in Montreal.

The airport was much smaller than I remembered, but have only used it previously on international flights, and this was domestic. It took over half an hour for the luggage to begin to arrive, and about two thirds of it was off in another ten minutes. And then the rest of us waited. Finally it all came. However, the end zipper on my hockey bag had broken, so the whole end was open. Don’t think anything fell out, as it was wool and food, but probably will not know for sure until I realize that one specific thing is missing. Had thought that if it opened there might be wool unwinding all over the conveyor belt...now that would have been a sight.

Outside the terminal I asked somebody where the hotel shuttles came. They told me and I went to look for mine. There were two...one for the Hilton and one for another hotel. Finally I asked someone if he knew when the one to Quality Inn came by. He asked which Quality Inn? I got out my paperwork and he said that was his hotel. Turned out the sign for the Quality Inn was small and on the door of the shuttle to the Hilton. They are next door to one another. So, got my own personal shuttle to the hotel. The driver was great. He helped with the luggage, and after a tip he found me bags for the items in the pocket of the hockey bag.

I checked in, and pushed the airport style luggage carrier to my room. On the way there was a man carrying two “Coronas”. I asked where he got them, and he replied, “In the Bar of course”. Of Course. In Quebec you can carry your drinks to your room, and enjoy them there. I went to the bar, and enjoyed my corona there!!
It was now 23:30 Quebec time. I had a 05:45 wake up call as I was catching the shuttle back to the airport at 06:30. The driver had suggested that I could go at 06:00, which was appropriate for an 08:00 flight, but that if I did mind going quickly, the later shuttle would be fine. Problem was that in BC it was only 20:30. I read, watched TV and turned off the light about an hour later. And of course, nothing happened. So by 04:15 I gave up, got up and messed around in the room until the wake up call. Had morning coffee, decaf, in the room, and headed downstairs, having repacked my baggage, for 06:20.

The evening before had packed all the excess into plastic bags inside a big plastic bag. Realized in the early morning that Inuit air was not concerned about how much bags weighed. I did not have to worry about overweight the same way, and the overweight piece had been the hockey bag. I put bags of wool into my suitcase and managed to get it all in. My hockey bag looked a mess, but it was closed, and nothing would come out the middle part. (And it will be replaced before my next northern exploit).

I went to the airport, and checked in. The small misadventures occurred again. The quote I had of $6.15 per kg for overweight was to the first destination of the plane. There were four, and Inukjuak was last, so it was $13.00 per kg. Oh well. I had already decided that it was all coming. I only had 53kg, which was 23kg overweight. I did not mind. Luckily, they do not weight your carry on baggage!!
Went to the gate, and thought I would check out the one concession stand in this small part of the airport. They were very slow so did not get the yoghurt parfait, and was later very glad. Our flight was called. We walked to the plane, following the instructions to stay within the white lines. (For those of you who have not flown in small planes, they do not come to the regular gates. You go outside, rain, shine, or snow, and walk to them, and up the stairs. Usually they are also parked at the ends of the terminals, so you have to walk further to get to the gates they are at.) There was no seat designation, and I had two seats to myself the whole way to Inukjuak. I must have been giving off the “leave me alone” vibes really well.

And then the adventure began. Leaving Montreal was great, and there was lots to see as there is leaving any big city. However, clouds were probably at about 2000 feet, so once above them, it was time to read again. There is a magazine in the north called “Above and Beyond”. I think First Air actually publishes it, but they had it in Inuit Air flights. It was a particularly good issue, with an article about an elder who lived in various places in the North and about finding dinosaur bones in the Arctic.

Almost as soon as we left we were served breakfast. They offered hot or cold. The hot was eggs, so I chose the cold. It was vanilla yogurt with oranges, orange juice, a croissant with three kinds of cheese, fruit and cretons. A very nice breakfast, and was so glad that yoghurt parfait had not been purchased.
As we went over northern Quebec the cloud cover disappeared, and we could see the forest below, and many lakes. It was beautiful.

Our first stop was to be Kuujjuarapik, and it was a three hour flight there. As we were getting closer it was noticeable that there were still trees. Once we landed and could see them, they were Churchill type trees, but with greater girth. They were mostly 3-6 feet high, but quite round, as there was less wind there than in Churchill. There was also masses of water, but the rock underneath the surface was mostly red, so it was like looking down on these red lakes with tiny trees all around. When you fly in BC the trees do not seem individual, because there are so many. Flying into this village the trees all looked completely separate.

We had to refuel in Kuujjuarapik, and were told it would take 30 minutes. I got out my camera to take pictures of the trees. Went out of the terminal and put the camera on, and to my eyes to focus...battery empty. So, you will not see pictures of the little Christmas trees.

After about an hour we were to get back on the plane. I was surprised because in this airport they had security. There was nobody manning it, but there were lots of signs about what you could and could not take. Our plane only had 30 seats, so perhaps they have some larger planes and have security for those. This is the first northern town where I have seen anything about security.

We then had a thirty minute flight to Sanikilluaq. Sani, as it is affectionately known in Rankin Inlet, is actually part of Nunavut, rather than Nunavik (northern Quebec). It is on the Belcher Islands. Flying into the area was really interesting. There were small icebergs all over the area, and probably the sea ice was just breaking up. There were also patches of snow everywhere. (It was July 2nd so thought that might have all disappeared.) We did not get off the plane, and could not see much of the village from the airport.

Our third stop was thirty minutes away in Umiujaq. There were lots of snow patches going into the airport but no ice. Again we did not leave the plane.
And finally we were on to Inukjuak. I realized that I was getting excited. Lots of anticipation about what this village would be like, where I would be staying for a month. There were patches of snow, but no snow ice. The terminal was tiny and very crowded. They had a conveyor for the luggage but it was about 6 feet long so everything was taken off as it arrived. There were lots of people in this tiny space, and outside smoking. Turned out that this flight turned around and went back, and everyone had to change flights, to go further north.

My luggage finally came, but there was nobody from the health centre to pick me up. I sighed and asked at the desk, when they were less busy, for the number to the health centre. They said someone had been there, but had left. I tried to call. Kept getting the “please hang up immediately and try again later” message. Of course, it was said first in Inuktituk, then in French and thirdly in English. As the flights left, and there were only two or three of us left in the terminal I went and talked to the clerk again. I had not been calling the area code. This time I got through first time.

The health centre had been expecting me on Saturday, and not on Friday. They came to get me, dropped my luggage off at my apartment (a one bedroom, for me only), and drove me to the health centre.

Once again flying has taken me to another adventure, and another place and time. I am truly looking forward to this month in Inukjuak, with the midwives, the beautiful scenery, the lovely women, and just being North again.