Bracing for COVID-19 in a northern health-care hub

Sioux Lookout has 5,200 residents, but its local health-care facilities treat thousands more — many of them from 33 remote First Nations. How is it preparing for the coronavirus?
By Jon Thompson - Published on Mar 19, 2020
Sioux Lookout, located about 350 kilometres northwest of Thunder Bay, acts as a health hub for the region. (Jon Thompson)

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SIOUX LOOKOUT — Sioux Lookout, a community of 5,200 located about 350 kilometres northwest of Thunder Bay, acts as an important health-and-services hub for the 30,000 who live in 33 fly-in First Nations to its north, none of which have hospitals. Last year alone, 161,000 passengers passed through the Sioux Lookout Airport, and 90,000 outpatients visited the 60-bed Meno Ya Win Hospital.

At publication time, there are no reported or suspected cases of COVID-19 in Sioux Lookout; the closest is in Fort Frances, 300 kilometres south. But the municipality’s regional significance — particularly for First Nations communities — has given rise to concerns about what would happen if the global pandemic reached Sioux Lookout, prompting local health-care providers and the town to introduce preventative measures.

An hour after Premier Doug Ford declared a provincewide state of emergency on Tuesday morning that mandated the closure of restaurants and bars, Sioux Lookout mayor Doug Lawrance announced the closure of all municipal buildings. “I felt like, for two months, we were watching a movie called Coronavirus, and then we were in the movie,” Lawrance says. “So we’d better act our part and listen to the experts.”

But, he adds, it’s not realistic to expect that travel to and from remote communities surrounding Sioux Lookout will stop: “At this time of year, as long as the ice roads are good, there’s truckload after truckload delivering food, delivering construction materials for health-care facilities, for schools. There are airplanes delivering food and supplies.” On-reserve nursing stations, he notes, depend on doctors and specialists from the cities of Kingston, Peterborough, and Toronto, as well as from the provinces of Manitoba and British Columbia. “Coronavirus isn't the exclusive health-care issue. Diabetes carries on, cancer carries on, incidents that require urgent surgery carry on, measles, whatever it is — health care continues.”

The Meno Ya Win Hospital
About 90,000 outpatients visited the 60-bed Meno Ya Win Hospital, in Sioux Lookout, last year. (Jon Thompson)

Nishnawbe Aski Nation, the political body that advocates for 49 First Nations across northern Ontario, struck a committee on Monday to monitor the pandemic, but it recognizes the autonomy and authority of its member communities to make decisions about isolation.

James Morris is the executive director of Sioux Lookout First Nations Health Authority, the federally funded body that manages the relationships between the hospital and nursing stations in the 33 remote First Nations whose members fly to Sioux Lookout for care. He’s considering a policy that would allow access only to medical professionals flying in from Sioux Lookout. “What I want is for chiefs to pass a blanket shutdown for all our communities,” Morris says. “But I doubt that’s going to happen.”

It’s unclear, though, how many medical professionals from Sioux Lookout will be available. On March 13, 42 physicians from the community signed a letter addressed to Minister of Indigenous Services Marc Miller citing a “critical shortage in nursing resources in remote northwestern Ontario” and stating that  “a grossly under-resourced nursing service in the north, which has existed over many years is going to be even more taxed, perhaps to the point of collapse.”

The Meno Ya Win hospital deployed its pandemic plan over the weekend. Each inpatient is now restricted to one visitor; only one entrance — at which visitors and staff are assessed for symptoms before entering — remains open. The moves came after the facility’s occupancy rate fell below surge capacity (the threshold that marks when hospitals have exceeded 100 per cent of their available operating capacity) for the first time in more than a year amid the suspension of elective surgeries (non-urgent procedures, such as joint replacements).

Hospital president Heather Lee says that the facility has only two medical ventilators — devices that have been crucial in treating COVID-19 cases around the world — on site. Outpatients and their family members generally stay in hostels while they’re in Sioux Lookout; the 120 beds available are full. Northwestern Ontario’s only tertiary-care centre, located in the Thunder Bay Regional Health Sciences Centre, had reached surge capacity, although a single positive case has yet to been confirmed in that district (it is no longer at surge capacity).

Starsky Fiddler, from Sandy Lake First Nation
Starsky Fiddler flew out of Sandy Lake First Nation for medical tests in Sioux Lookout last Thursday. (Jon Thompson)

Meno Ya Win chief nursing executive Samantha Brooks says that her staff has no choice but to be ready for a patient influx. “As a health-care organization, we can never be closed to people who are in need of care,” Brooks says. “Our workers are very good at prioritizing care requirements, and we’ve become very creative in the way we can deliver care, so we will always make sure we are able to accommodate, even in the most stressful situations, because we don’t have an option.”

At a March 12 press conference, Janet DeMille, Thunder Bay Health Unit’s medical officer of health, stated that “First Nations communities are a group that are at significant risk for this virus” and that she had been in contact with SLFNHA regarding efforts to contain it.

In a March 17 speech, Prime Minister Justin Trudeau said those living in remote First Nations face greater risks related to COVID-19: “We know there is a higher degree of vulnerability. There are already vulnerabilities because of difficult conditions in so many of those communities.”

Ian Gemmill, Northwestern Health Unit’s acting medical officer of health, suggests that it’s only a matter of time before the respiratory disease reaches remote First Nations communities. “It’s fair to say now that, while containment is a noble cause, what we’ve learned from China, Italy, and others is that we’re not going to stop this,” Gemmill says. “We all agree that this being a pandemic, it will affect a considerable amount of the population.”

As pandemic fears mounted last Thursday, Starsky Fiddler flew out of Sandy Lake First Nation for medical tests in Sioux Lookout, having been cleared by the local nursing station. He says he misses his children but feels that it’s important for him to seek medical attention — although some friends advised him not to come. “I don’t worry,” Fiddler says. “Just keep doing what they tell you to do: wash your hands and keep your distance and keep praying. I'm a God-fearing man, myself. I keep praying and just don't worry about it — it's going to pass.”

This is one in a series of stories about issues affecting northwestern Ontario. It's brought to you in partnership with Confederation College of Applied Arts and Technology. Views and opinions expressed in this article are not necessarily those of the college.

Ontario Hubs are made possible by the Barry and Laurie Green Family Charitable Trust & Goldie Feldman.

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