On any given day in Sachigo Lake First Nation, there are often only two nurses at the local nursing station, says Ben Langer, a resident doctor who visits for a week each month. One registered nurse provides all primary care to the roughly 400 community members — treating acute injuries, providing bedside care for those too sick to leave their homes, conducting contract tracing for sexually transmitted diseases, and counselling patients on how to use medication. “All the aspects of the health-care system,” says Langer, “just under one roof.”
The nurse-in-charge does all the administration: processing paperwork, sending and receiving lab tests and results, explaining those results to patients, booking appointments, and liaising with band leadership. “When I'm there, it creates more work,” says Langer. “I'm seeing 20 patients a day and asking for bloodwork, vitals, and follow-ups.”
Local physicians say the system has always been underfunded and overwhelmed and that the pandemic is making an untenable situation even worse. On January 29, a group of 47 Sioux Lookout-area doctors sent a letter to Indigenous Services Minister Marc Miller calling for immediate additional support. “Funding for more nurses, along with the necessary community-based administrative staff and housing infrastructure to support their work, must be provided to meet the urgent and immediate needs of these communities now,” the letter reads.
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Nursing stations are the first point of contact for any health-care matter in remote communities. As hospitals, clinics, and specialists may be a several-hundred-kilometre flight away, nursing stations are an essential community service. Depending on the size of the community, they are run by between two and nine nurses; doctors and other specialists fly in for a week or two each month to provide more specialized care. First Nations’ health care is federally funded; there are 79 nursing stations in Canada, 21 of them in Ontario.
According to Janet Gordon, who serves as the chief operating officer for the Sioux Lookout First Nations Health Authority and previously worked as nurse in the north, “nursing is not a new issue. It's a long-standing issue.” A 2015 auditor general’s report indicates that, when Health Canada was responsible for nursing stations, prior to 2017, there were issues related to chronic understaffing and a lack of mandatory training and that staffing and funding were “based on what had been allocated in the past plus increments, rather than on the basis of current needs.” With stations now under the auspices of Indigenous Services Canada, “nurse recruitment and retention continues to be a challenge for health delivery in northern Ontario,” an ISC spokesperson tells TVO.org via email. (TVO.org reached out to the Canadian Nurses Association but did not receive comment by publication time.)
Staffing nursing stations is a challenge: the job often requires working far from home and taking on a wide range of responsibilities. “We’re watching our nursing colleagues burn out with the stresses of being asked to do more than they really are able to do in any given 24-hour period,” Langer says. To address chronic shortages, ISC says it’s implemented a student-outreach program, an onboarding program to “orient and familiarize nursing candidates,” and programs for nursing development and recruitment. In response to the pandemic, ISC says, it has expanded existing contracts and entered new contracts for “for additional nursing resources in First Nations communities.”
But shortages persist, and, coupled with the pandemic, they are burdening an already overwhelmed system, according to Claudette Chase, a doctor who visits Eabametoong First Nation. “It's not like we're catching up on childhood immunizations or PAP smears or screening people for cancer,” says Chase, who herself worked as a nurse for 14 years. “The nurses are working hard to deal with the acute care.” And mental-health issues among patients are a growing concern: “The crisis has been happening since I started here in the ’80s. And it's worse now — it's just worse. The people who were already struggling with mental illness are more ill.” Langer concurs: “I’ve been seeing a lot of tragedy, to be honest. It can be quite overwhelming to fathom.”
The immediate solution, the doctors say, is to increase staff and create the infrastructure necessary to house them. Even if they had adequate staffing, Chase says, “there would be no place to put them.” ISC says it is “aware” of these needs and is “working with [northern Ontario communities] to develop a plan to respond, not only for vaccine deployment but to continue to manage the pandemic.” The spokesperson adds that ISC has invested $785 million since March 1, 2020, in First Nations and Indigenous organizations in Ontario, and provides supports for families that “include, but are not limited to health human resources, equipment, supplies and infrastructure.”
While funding is vital, Gordon says, health care should be managed and operated by those most invested in the community’s well-being — its members: “The ideal situation would be to have community people be those nurses and be that doctor.”
Gordon says the health-care system in remote communities must evolve in the long-term: “The nursing-station model doesn't meet the needs of our communities today. Funders need to take that seriously. [Funding is] based on what's allocated at the government level. It's never based on the needs of the community.” And improving infrastructure and access to everything from education to housing and water — factors in the social determinants of health — can lessen the need for acute care and ease the burden on nursing stations. “[Funding shortages are] further highlighted by things like poor housing, poor water, not having adequate electricity,” Gordon says.
Chase’s recent return to Sioux Lookout from Eabametoong was held back by flight delays, which coincided with the water going out. “It was a classic northern trip,” she says, reflecting on how such issues factor into the overall well-being of the community she serves. “They’re all interrelated.”
This is one in a series of stories about issues affecting northeastern Ontario. It's brought to you with the assistance of Laurentian University.
Ontario Hubs are made possible by the Barry and Laurie Green Family Charitable Trust & Goldie Feldman.