Why northern Canadians get a raw deal when it comes to healthcare: Commentary

How does a country provide adequate healthcare to around 150,000 people spread across an area that’s twice the size of Western Europe?

That is the logistical challenge facing Canada, where just 1% of the population live north of the 60th parallel. This group occupies around 40% of the country’s land mass – much of it in the Arctic region.

The vast distances involved mean that people living in northern Canada rely on air travel in the same way that those in Vancouver rely on an ambulance to rush them to ER, or their car to take them to a doctor’s appointment.

In Nunavut, for example, there are no roads that connect the territory to the rest of Canada – or even one community to another. That’s why the 8,300 Inuit that call its Kivalliq region home make a total of 16,000 medical trips to Winnipeg each year. Without a viable alternative, the relationship with air travel is fundamentally different in the north.

Even Canadians with road access often rely on air travel to get treated by a specialist. Take the town of Fort McPherson in Yukon. If someone needs specialist care that isn’t offered at the regional hospital in Whitehorse, that person would have to travel to Vancouver. That’s a two-day drive on a road that can be treacherous in winter.

It’s no wonder that 9,000 Yukoners (roughly 20% of the territory’s population) travel to Vancouver each year for medical appointments.

Unfortunately, the current northern healthcare model is fraught with risks when it comes to medical evacuations.

Puvirnituq is the medical hub for seven remote Nunavik communities that are only accessible by air. The Innuit village’s medical center can stabilize patients, but it must fly them more than 1,600 km south to Montreal for emergency and specialist care. It’s a system that is typical of northern Canada.

Unfortunately, the network that takes patients to major southern hospitals is patchy, slow and unreliable, and in emergency situations it can costs lives.

On the morning of Aug. 11, 2022, 61-year-old Kitty Kumakaluk was admitted to Salluit health center in Nunavik after coughing and vomiting blood. An emergency flight to Puvirnituq was then arranged for her. But following a six-hour delay, she fell into cardiac arrest mid-flight and was declared dead two hours after boarding the plane. The delay was highlighted as a major factor in the coroner’s report.

In Vancouver or Calgary, an ambulance that rapidly takes a patient into ER may be able to resuscitate that person or successfully stabilize them. However, the chances of survival decrease when it takes longer to access the specialised emergency care found in larger hospitals.

One medical study covering 630 adults transported by air ambulances in Manitoba found a 34% higher mortality rate for patients with a travel delay of five hours compared to those without one.

Unavoidable Risks

Time matters and some of this risk is unavoidable because the distances between major hospitals and remote communities are immense. However, delays are foreseeable and an avoidable part of an equation that determines life and death.

In Puvirnituq health center, there is only one day and night team that handles medevacs. So when two patients – one a premature baby and the other suffering from an abdominal haemorrhage – required urgent medevacs on the same night in July of this year, there weren’t enough aircrafts available. On another night a baby in critical respiratory distress had a three-to-four hour medevac delay because a pilot wasn’t immediately available.

Local health centers need to be flexible enough to handle multiple patients at the same time. If that’s not the case, the system can become overwhelmed. This flexibility requires more pilot hours, more aircrafts and more medevac teams.

With a nationwide pilot shortage, medevacs should be exempt from a federal law that requires pilots who have flown eight hours in a single day to be grounded. That begs the question: Is the risk to life greater if the pilot exceeds that eight-hour threshold or if the patient’s emergency care is delayed? Or is it fair that the medical staff in regional health centers may be forced to work near 24-hour emergency shifts to stabilize patients with insufficient equipment, so that the federal flight-hour requirements are met?

Prohibitive Costs

There is also the challenge of covering medical costs in the north.

In Labrador, residents requiring specialist or emergency medical support such as cancer treatments, cardiac care, children’s hospitals and even dental specialists must travel to Newfoundland to receive it. However, the cost of getting to the island portion of the province is excessive. Rex Goudie, the chief executive officer of Goose Bay Airport, points out that the average airfare from Nain to St John’s – where most of the provinces medical service are provided – is $3,742.

Even in Goose Bay, the relatively well-connected capital of Labrador, seniors and others with limited incomes may not be able to afford to travel for appointments with specialists. Many have been forced to raise money to cover their travel expenses.

The status quo is akin to a healthcare tax levied on the most vulnerable and isolated communities in Canada. If such extensive delays and bills are deemed unacceptable for those in Vancouver or Montreal, the same should apply to northern Canadians.

Olli McIntyre holds an MSc in History of International Relations from the London School of Economics and is Head of Daily Operations at The Plakhov Group.