Health system neglects northern patients by design: Doctor

Canadians like to thinktheyhave one of the best health care systems in the world and that it's there for everybody, no matter what.But Dr. MikeKirlew, a family physician based in Sioux Lookout, Ont., and one of the few doctors who works in the remote Indigenous communities in the northernmost part of the province, says that's not true.

"My patients do not receive anywhere close to a comparable level of care that other Canadians would enjoy. They just don't," Dr. Kirlew says."That's the height of un-Canadianness."

Originally from Ottawa, Dr. Kirlew moved to Sioux Lookout, Ont., after medical school. He only expected to stay a few months 10 years later he's fallen in love with the North.

Hesays health care in Canada issupposed to be based on equality and fairness,but these days he wonders if that's just something Canadians like to tell themselves.

"The system isn't broken, the system is doing what it was originally designed to do," says Dr. Kirlew. "It was never meant to provide care. It was meant to deny care."

CBC's The National sent NickPurdonand LeonardoPallejato follow Dr.Kirlewon the job and find out how people inOntario's far North are being served by the health care system.

Canada's struggle to provide health care to northern communities

7 years ago

Duration 13:54

Canada is struggling to provide health care to northern communities, according to one doctor who travels monthly to provide his services. Dr. Mike Kirlew says that the level of care his patients in northern communities have access to is not even close to what is available to other Canadians

Sioux Lookout

If you want to understand health care in northern Ontario, it's best to start in Sioux Lookout.

The town of about 5,000 is a medical hub for many of the 49 Indigenous communities spread out across a swath of northern Ontario roughly the size of France.

Known collectively as theNishnawbeAskiNation (NAN), most of the communities are so remote theydon't have road access.

For the45,000 people who livein the territory,the only way to get comprehensive medical care is toflyto a centrelike Sioux Lookout.

After years of waiting, 36-year-oldBerniceBoyce did just thatthis past September.

She left her home inWapekeka, Ont.,and moved 500 kilometres south to Sioux Lookout so her 14-year-old son Joshua could get the help he needs.

"We don't have anything back home," BerniceBoycesays."And that's why we are here."

JoshuaBoyceis developmentally delayed and suffers from severe asthma.He's Dr.Kirlew'sfirst patient of the day at theMenoYa Win Health Centre's northern clinic.

The doctor high-fives Joshua and asks Bernice if heis still using his puffer.

Dr.Kirlewsays Joshua was unable to get regular access to occupationaltherapy inWapekeka,and he struggled at school and at home.

"Can you imagine having to leave your home to be able to access basic services?," says Dr. Kirlew."Can you imagine making that decision?"

A hostel unlike any other

It's not just Bernice and JoshuaBoycewho had to leave their communitiesto get health care. For many northern Canadians amulti-day trip is a fact of life for even a simple medical procedure or therapy session.

TheJeremiahMcKayKabayshewekamikhostel isa100-bed facility attached to the medical centre in Sioux Lookout where patients from far northern Ontario communities stay while they are in town.

Last year a total of 36,394 clients and escorts stayed at the hostel,whichhas an operating budgetof more than$6 million a year.Another 15,443 people were booked into local hotels when the hostel was full.

In late January when The National visited Sioux Lookout, there were 95 patients staying at the hostel. Another153were being housed in hotels in town.

Here are a few of the patients we met that day:

Jordan Strang, 25, from Poplar Hill First Nation, holds his 2-year-old daughter Jordja. He's at the hostel awaiting the birth of his fourth child a baby boy.

Christian Sakakeesic, 19, from Cat Lake, waits to see a counselor.

"I try hard to cope," Sakakeesic says. "I tried hard to talk about my feelings back in my reserve, but nobody is there to listen."

Ivy also flew in from Cat Lake, with her mom Verna Wesley.

"It's hard to travel out here just to see a doctor,"Verna says. "I am missing a lot of work at home right now, which is going to be hard on my payday."

Grady Kakekagamick, 37, is from Deer Lake. He's at the hostelfor the birth of his daughter.

Life at the hostel

Not all of the hostel's guests are there for a short-term stay. Stephan Fiddler has lived alone inroom No. 233 for 18 months.

He left his home in Bearskin Lakebecause of diabetes and kidney failure. Fiddler needs dialysis three times a week and there isn't a dialysis machinein his community.

"I am going blind, so I need some help while I am here," Fiddler says.

"I left my family in Bearskin, which is very hard to do. It's very lonely here. I miss family. And the things I used to do."

Stephan Fiddler's forced exile

7 years ago

Duration 1:30

Stephan Fiddler has been forced to live alone in in room No. 233 at The Jeremiah McKay Kabayshewekamik hostel in Sioux Lookout for 18 months because he needs regular dialysis and can't get it in his own community. He talks about what it's like to have to leave everyone he loves behind to get the treatment he needs to stay alive

Fiddler is in an impossible situation. If he ever decidesto returnhome to his family in Bearskin Lake and stopsgetting dialysis, he'lldie.

"This is Canada. I think all Canadians should get the same services as people who live down south," he says.

"Wouldn't it make more sense," says Dr. Kirlew, "to put the infrastructure the dialysis machine in the community? Wouldn't that be cheaper, too?"

And Dr.Kirlewpoints out that the people who fly toSioux Lookout for their medical needsareactually the lucky ones, because not everyone makes it to town. He requests coverage for his patients to traveland the federal government decides who is eligible and who isn't.

"By controlling transportation," the doctor says, "you are controlling care.

"There are times when a patient might pass away, or you witness several patients passing away because of lack of access to certain services,and it makes you want to give up," he says.

On the ground inWapekeka

Once a month, Dr.Kirlewflies north from Sioux Lookout toWapekeka, Ont., where he has been the community's doctor for the past 10years.

"I love going up there," Dr. Kirlew says.

"It has experienced significant tragedy in the past because of a number of suicides," he adds."But I also see hope and a desire for change and a desire to transform the system."

There are threefull-time nurses who serve the 400 or so people inWapekeka.

But they have limited facilities to provide care. There'sno X-ray machine orultrasound.

There's no ambulance, either. The only medical transportation in the community is a regularSUV, and thedriver has only basic first aid training.

Since there's only a doctor in town for about a week every month, there's a long listof people who want to see Dr.Kirlewwhen he arrives.

Three-year-old Chase is hisfirst patient of the day.

Chase has a bad rash on his face, but what his dad Jason Baxter, 42, is more worried about is the boy's recent allergy attack.

"He almost died in Thunder Bay.Lucky thing he was actually in town when it happened and not up here," says Baxter.

InWapekeka,a simple peanut allergy is a big deal.

Dr.Kirlewsays they'verun out of basic medicationsuch asVentolinto treat an anaphylactic reaction before.And if there are complications, there's no guarantee medical help will arrive in time.

"We don't let him go anywhere or visit anybody else's home, because of all the time it takes for medical help to get here," Baxter says. "He stays at home.We don't want to take that chance."

Tracy Winter, 36, sees the doctorabout her daughterJayla, who is seven.Jayla'shaving troubleforming some of her words and she's falling behind at school.

Winter saysshe's beenwaiting for years to get speech therapy for her daughter inWapekeka.

"That's a real problem in our region getting kids accesstothose services," Dr. Kirlewsays. "And even when we do,sometimes we can only get them once it's very difficult to get things on an ongoing basis."

Dr.Kirlewhas already written two letters to thefederal government trying to getJaylaaccess to speech therapy.

He promises the family he'll write another.

"We have a system that's fairly efficient at denying children care," hesays."How can we have that in a country like this?"

Hope for change

One of the realities of life for a northern doctor is that you work, sleep and cook at the nursing station.

On this morning, Dr.Kirlewhas breakfast with SolMamakwa, ahealth adviser with theNishnawbeAskiNation. Mamakwa, 47, is inWapekekato learn more aboutthe situation on the ground so he canimprove the health care for his people.

Over breakfast they talk about some of the simple things they think should be done.

"We seeso many parents bring in their children, looking toaccessdevelopmental services," says Dr. Kirlew. "These services could fly into the community."

Mamakwa, who grew up in Kingfisher Lake,about 60 kilometresto thesouth ofWapekeka, says it wouldn't just be cheaper for health care professionals to fly into communities to see groups of kids, rather than the kids flying out. It would also be less disruptive.

"Iheara lot of the health care is broken," he says."But when you actually think about it,it's not broken. Itis in fact doing exactly what it has been designed to do: To diminish the rights of our people, the health of our people," he says.

"Sometimes I would even go as far as saying that the system is killing our people."

Mamakwapoints to the three young girls from Wapekekawho committed suicide last year.

He says that six months before the tragedy, thecommunity had asked the federal government for mental health support. The request wasdenied.

"When you hear of a younggirl orboy, 11 or12 years old, dying by suicide, itjust pushes you to make more change. To bring change for our people," he says.

"We cannot give up. We cannot."

Health Canada has since pledged $380,000 for suicideprevention strategies in Wapekeka.

But Mamakwasays the real solution isn't for governments to give communities more money.

"We need to dismantle the system and rebuild it up, from the community up," he says.

This past summer the provincial and federal governments, along with NAN's grand chief Alvin Fiddler, took a step toward self-government when they signed an agreement in principle to give health care in the territory over to Indigenous control.

'You forget what normal is'

After a long day seeing patients at the nursing station, Dr.Kirlewmakes a house call and the reality on the ground hits again.

Donnie Brown had a stroke four years ago from a ruptured aneurysm. Much of theright side of his body is numb.

"He can't feel," says Elsie, his wife of 40 years who takes care of her husband by herself. "Especially on his foot he gets cold, too."

In the four years since his stroke, Donnie Brown has only had asingle rehab appointment. These days he has a hard time communicating.

"We end up shouting because we can't understand each other sometimes,"Elsiesays. "It's hard. It's been four years the way he is."

On the living room couch Dr.Kirlewlistens to Donnie's breathing but there isn't much else he can do.

"I wish I could provide somehome care,because that would be something people would get down south," hesays. "But we don't have access to that kind of service."

Kirlew packs his stethoscope and on thedrive back to the nursing station he reflects on a long day of seeing patients.

"You forget what normal is," he says. "You have to remind yourself of what normal is. That's part of the fight.

"They have this phrase in medicine called the HippocraticOath," he continues. "We take it when we graduate from medical school. It means 'to do no harm.' Sometimes I see my role as a physician is to minimize the harm that the system is already doing to them."

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