By François Bellemare
Over the last five decades, Nunavik’s health care system has undeniably grown. But what of the health of the residents themselves? Have new preoccupations arisen? A report about two regional CLSCs, one in Aupaluk and one in Kangiqsualujjuaq, where those in charge fill us in.
Throughout the entire Nunavik region of Northern Quebec, there are two small regional hospitals, each serving one-half of the area’s 14 villages: that of Puvirnituq on Hudson’s Bay, and that of Kuujjuaq on Ungava Bay. This latter hospital supervises the work of seven localities along Ungava Bay, in the context of very strong demographic growth among local Inuits.
At the Kangiqsualujjuaq CLSC, assistant head nurse Miaela Madan, who sees 15 patients a day, describes the specifics of a village that has seen its population increase tenfold in 40 years to currently stand at 1,400 inhabitants.
Enlarged Role
Her ten years’ experience in obstetrics comes in very handy. She explains: “Since we don’t have a midwife permanently in place, we send young mothers to Kuujjuaq to give birth, and to Montreal if there are any complications. But since we can only travel by air, and many flights are cancelled due to bad weather, we still have two to three births in our village every year.”
She explains that her role here is sweeping, since she has been trained in treating a variety of pathologies. Without the status of a super-nurse, Miaela clearly has a much greater room for manoeuvre here than she would have in the South.
Nonetheless, as in all small localities, the range of local care options available is limited. “Preventative measures,” she says, “which by definition require less equipment and fewer specialized personnel, are very important here: pre-natal courses, accompaniment to get people to stop smoking, or Alcoholics Anonymous-type activities.”
For example, in terms of tuberculosis, of which the village has the most cases along Ungava Bay, the disease spreads in part because housing units are overcrowded. The lack of housing also affects CLSC personnel: “Even if we had the money to pay a third nurse, would we be able to find them a place to live?”
Challenges
Miaela enumerates many positive accomplishments over the years. “We have infant care, a good vaccination rate, two doctors, a social worker with twelve years’ experience in the North, and a second nurse dedicated to the elderly, who often live in intergenerational housing. One of the nurses regularly posts information on social media. Some resources are shared with other communities, like a nutritionist, or tuberculosis detection.”
But even if infant mortality has decreased and older people are living longer, there is still the social tragedy of numerous early deaths among youth, often by overdose or suicide.
“It’s the consequence of all the psychosocial ills: lack of self-esteem, addiction, depression… Cardiovascular ailments are on the increase, and diabetes too, thanks to malnutrition. There are other aspects that leave something to be desired, especially the enormous challenge of recruiting, which up here is much tougher than in the South. A lot of prevention initiatives unravel as soon as the professional who initiated them leaves. And with the generalized approach of agencies (in contrast with individual recruiting), the distance from patients increases. This is counter-productive. The preventative approach is really sorely needed!”
A New Method
The Kangiqsualujjuaq CLSC created a new service, installed in a separate building since the summer of 2024, called Saillivik (Inuktitut for a state of well-being). Armed with a degree in addiction studies and years of practice as a clinical nurse in downtown Montreal, François Leduc greets us in a décor as non-institutional as you can imagine: decorated walls, cushions on the floor used as seats, and, especially, an invitation for patients to show up without an appointment.
“We give first aid courses,” François says. “Residents are strongly encouraged to consult at the onset of symptoms, or even to encourage a loved one to take the first step, for example to reduce alcohol or tobacco consumption, or test for tuberculosis. In a little village where everyone knows everyone else, people are often embarrassed to go and declare their problem at the reception desk of a CLSC. But when they enter here, they benefit from confidentiality with a counselor. In health care, the preventative approach pays off!”
Another thing Saillivik does is intervene at school. They have created a boy’s club and a girl’s club, to facilitate dialogue. “We are better able to reach teenagers to talk about sexual health and contraception. In the context of many teenage pregnancies among Inuits, it’s really not a luxury!” Nonetheless, worries this nurse: “Despite improvements in intervention techniques to treat overdoses, drug addiction problems have increased with the proliferation of chemical drugs, which have spread with impunity in the community, particularly among young people.”
Aupaluk: A New CLSC
Inaugurated in the spring of 2024, this imposing 20,000 square foot building (15 times more spacious than their old offices) cost over $45 million to build. It’s a budget that some find disproportionately high given the modest population it serves: a village of 245 souls.
CLSC coordinator Louisa Grey – already a member of the board through the years of project planning – explains why it’s money well spent: “We know that demographic growth is going to go on for a long time, so we don’t want to find ourselves with a resource that is too limited just a few years after its inauguration. As well, the building is designed to act as a shelter in case of a natural disaster or other major emergency.”
Lacking Staff
In taking the tour – trauma room, physiotherapy, dentist’s offices, doctor, family space, etc. – the visitor is impressed. In the South of Quebec, many communities with ten times the population don’t have half the clinical space that Aupaluk has! As for the question of the human resources necessary for this array of services to be efficient, the coordinator says: “It’s true that there are only 11 people on staff, and that for example, our two dental rooms are often unoccupied. If we had at least one dental hygienist present, it would be a big step in terms of prevention; even more so if they were Inuit!”
Louisa Grey herself has lived a life like many in this region. “I was a teenager in high school when I got pregnant with my first child,” she says. “Then I started working in different jobs: as an interpreter (sometimes on legal matters), a janitor, etc. Over the years I developed a social consciousness very anchored in the community. I felt a desire to improve the well-being of children. In the village, the average number of kids per family approaches four or five. This baby boom poses some very special challenges!”
Change the Agreement?
How would Louisa Grey change 1975’s James Bay and Northern Quebec Agreement (JBNQA) if she had the chance?
“That’s a big question!” she says. “In a few words, we have to recognize that access to health care is constantly moving forward, with a CLSC in each village and two regional hospitals. It’s probably one reason for our population boom. But there is still so much to do!”
She gives an example: “Take the Youth Protection Department, which is responsible for children who are victims of dysfunctional families. For a long time these kids were sent to live with families in the South. They would quickly lose their language, to the point of assimilating culturally. Many never returned to the North again. Things have changed. Youth Protection really listens when it comes to considering alternate solutions, like temporarily giving the child over to another family in the village – which isn’t always easy, I well know. But there is still a communication gap, one which we have to work to overcome.”
Photo: The brand new CLSC in Aupaluk. Photo by François Bellemare.
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