Working Up North in Nunavut: A Physiotherapy Career Highlight
by Jennifer Allen
In the fall of 2017, I worked for 10 weeks on a short-term physiotherapy contract, otherwise known within the Government of Nunavut (GN) as a casual staffing action (CSA) in the Qikiqtani Rehabilitation Services Department in Iqaluit, Nunavut, Canada. It was a wonderful experience and I would recommend it to all Canadian physiotherapists.
Iqaluit, September 2017
For those of you who have been “up north”, you understand the impact that being up north for the first time has on Canadians from “down south”. I hadn’t been north of northern Saskatchewan prior to flying to Nunavut. My friend and physiotherapist colleague working in Nunavut, Annabelle Esteban, had shared stories about the telehealth sessions she delivered for patients, her community visits and some of the challenges and successes she had experienced in the couple of years she had been working in Nunavut after moving there from Toronto. I was excited and wasn’t sure what to expect.
Due to an expedited process available for staff hired on through CSAs, I was able to connect with the manager of rehabilitation, have an interview, and get all of my paperwork and flights in order in a short time frame of a couple of weeks in August 2017. Housing can sometimes cause delays in bringing in new staff as there are limited housing options available in Iqaluit.
View of Iqaluit from Above (November 2017)
The day I flew up north from western Canada to Ottawa and onward over northern Quebec, the Hudson Strait and Frobisher Bay to Iqaluit, it was perfectly clear and I was able to fully take in the beauty of the north from above. I was in awe of the clear waters and the picturesque tundra landscape. Iqaluit, being a city of over 7700 inhabitants, stood out with the invitingly coloured houses and all of the beautiful buildings, such as the new hospital, recreation centre and airport.
When I reached the airport, I was welcomed by a warm, friendly physiotherapist, Pascale Baumann. I was immediately impressed by the tight knit community atmosphere at the baggage pickup area and how most people knew each other. Pascale quickly whisked me away to drop off my luggage and then took me on a whirlwind tour of the hospital and the rehabilitation clinic down the hill where the rehabilitation team, which was made up of physiotherapists, occupational therapists, speech language pathologists and audiologists, treated patients.
After some training and orientation on the electronic medical records system, I was off to the races booking in patients who had been on the waitlist based on a priority system for days to years. In Nunavut, the rates of disability and chronic disease are notably higher than Canadian national averages and hence rehabilitation services are very important. Furthermore, at the time that I was working for the GN, there were no private physiotherapy services available in Iqaluit, which resulted in an increased burden on the government to provide these services.
Qikiqtani General Hospital, Iqaluit, Nunavut
The rehabilitation team was very welcoming and helpful in answering all of my questions related to the GN health care system. They taught me some Inuktittut words and explained the culture to me. In Nunavut, there are four official languages: English, French, Inuktittut and Inuinnaqtun. There were various events that I was fortunate to attend, such as educational sessions, community feasts and concerts featuring local artists. I was in awe of the strength within the community and the connection community members had to their culture and history.
Arctic Survival Training Workshop
The Qikiqtani Rehabilitation Services team provides coverage to all twelve communities in the Qikiqtani Region, serving a population of over 15,000 people
With the Qikiqtani physiotherapy team fully staffed, there would have been four full-time physiotherapists working, and the caseloads of patients from the 11 communities would be divided up amongst the physiotherapists. When I was there, the physiotherapy department was short-staffed so the load on the physiotherapists was increased.
Qikiqtani Region of Nunavut
Given that the physiotherapy team was responsible for all of the patients who had physiotherapy referrals in the hospital in Iqaluit and the patients who had been referred to out-patient physiotherapy, both in Iqaluit and the other 11 communities, there was a lot to do when I arrived. My role encompassed working on clearing a portion of the backlog of patients in the lowest priority levels, some of whom had been waiting for physiotherapy for up to years. Most of the conditions that patients faced in these priority levels involved chronic neck and lower back pain with associated fear avoidance behaviours. The majority of the treatment that I delivered was focused on patient education and reassurance, targeted exercises and gradual return to regular physical activities.
In Iqaluit, there is a beautiful recreation centre with a gym, pool and sauna facilities. Group fitness classes are offered, along with sports leagues and other forms of exercise classes, such as yoga, are available within the community. I was impressed by the array of activity options individuals could choose from. There was also the opportunity to explore the tundra and surrounding hills. Instead of asking patients if they went for a walk, I sometimes asked if they had gone berry picking during berry season or clam digging during low tide.
City of Iqaluit Aquatic Centre
Tar Inlet Hike During Berry Season!
What started out as a 4-week contract quickly turned into a 10-week one, as I was eager to learn more about the region and contribute as much as I could within the time that I was there. Staying longer also meant that I would have the opportunity to go on a community visit to treat patients in one of the communities for 10 days. The community that I was assigned to was Igloolik, a town of over 1,500 people.
Flying over the north to Igloolik from Iqaluit allowed me to gain a true appreciation for northern Canada from above. The icebergs and turquoise waters, along with the whales seen through the crisp, clear water, were stunning to say the least. When I arrived in the community it was the middle of October and it was around -10 to -15 degrees Celsius. I was wearing my winter coat, however the locals were very comfortable wearing their puffer jackets. I had a lot of acclimatizing to do, but luckily the Igloolik Health Centre was a short walk from my accommodation. The view of the ocean from Igloolik was absolutely amazing with the sun reflecting an abundance of shades of orange and pink off the water at sunset.
Canadian North En Route from Hall Beach to Igloolik
Sunset in Igloolik
In Igloolik, the patients are fortunate to have their own Community Therapy Assistant, Sharon Irngaut. Sharon has an office in the Igloolik Health Centre and she sees patients independently for rehab between rehabilitation professional community visits. It was a unique opportunity to be able to spend time working with her and learning from her. She taught me about the local traditions including seal and walrus hunting and ice fishing.
Igloolik Health Centre
I was impressed by how well coordinated the staff were at the Igloolik Health Centre. They seemingly effortlessly booked patient's appointments and managed their files. Sharon and I spent 9 out of the 10 days that I was in Igloolik treating patients. Igloolik is allotted three ten-day community visits by GN physiotherapists per year. In between community visits, telehealth sessions are organized as needed and Sharon provides regular updates to the physiotherapists covering the Igloolik community regarding the patients she sees, which is very helpful in ensuring continuity of care.
It took me awhile to adapt to the slower pace of life up north. It wasn’t until I returned to Alberta in November 2017 that I really felt the effect that the hustle and bustle of city life had on me. I craved the wide-open view of Frobisher Bay and the ability to walk around the whole community or drive from one end to the other in minutes.
Of course being in a small northern community wasn’t without its challenges. I experienced a couple of “snow days”, which disrupted the flow and efficiency of patient care. Not surprisingly, community visits may be delayed or postponed at times due to weather. Food was in some instances two to ten times more expensive than down south. It was challenging to build relationships and gain trust from patients who had a history of being mistreated by authority figures, such as health care professionals, in the past. It took me a while to begin to learn about the Inuk culture. I remember asking my colleagues about the facial expressions of Inuk patients, later to find out that raising of the eyebrows means yes and scrunching of the nose means no. The patients were very open to sharing details of their culture and explaining how humility is highly valued by Inuk people and it’s important for leaders to remain humble in their interactions with other community members. I empathized with patients as they shared their struggles about waiting for medical care and the shortage of health care professionals in the north.
Traditional Carvings in Iqaluit
Overall, working in Nunavut was a very special experience for me and I feel privileged to have had the chance to spend 10 weeks there. For physiotherapists interested in learning about Inuk culture and looking to contribute in a northern remote community, I would highly recommend inquiring with the GN about CSAs and other opportunities. I came out of the experience with a newfound appreciation for the extensiveness and accessibility of the health care available in the south, as well as the beauty and relaxed pace of the north. The magic “up north” just might be one of Canada’s best kept secrets.
Jennifer Allen holds a Bachelor’s degree in Kinesiology and Health Studies and a Master’s of Science in Physical Therapy. She is originally from Saskatchewan, but settled in Edmonton, Alberta after finishing her schooling at the University of Alberta. Jen enjoys working in a private practice and acute care settings. Jen’s global health experience includes Gender Advocacy with the World University Service of Canada in 2008 in Ghana and she completed her final physiotherapy placement in Kenya with the Kenya Working Group in 2010. She also lived in Mexico for 18 months from 2013 to 2014 where she worked as an instructor in the Department of Rehabilitation Science at a private university, Universidad Popular Autónoma del Estado de Puebla (UPAEP). In 2016, Jen worked for the International Organization of Migration (IOM) as a Physiotherapist Trainer (seconded by AmeriCares) for four months in Sindupalchowk, Nepal, at a rehab centre for victims of the devastating 2015 earthquakes. Most recently in 2017, Jen worked as a Physiotherapist in northern Canada in Iqaluit, Nunavut.