
                               NORTHERN CARE

                             By LAURIE SARKADI
                              Edmonton Journal

     YELLOWKNIFE - ``And here's this morning's community service
     announcements. The doctor will be in Snowdrift April 16-19. To make
     an appointment, call 555-2132 as soon as possible as this is not a
     walk-in clinic . . .''

     All across the Northwest Territories and Yukon, people in remote
     settlements served only by nursing stations tune into their radios
     to find out when a doctor or dentist will next be flying in for a
     visit.

        See <19health> for discussion of nurses in northern medicine

     For southern Canadians accustomed to around-the-clock emergency
     wards and columns of physicians to choose from in the Yellow Pages,
     such limited access to hospitals and doctors might seem like a
     health hazard.

     Indeed, residents of the Northwest Territories have the most
     abysmal health record in Canada, ranking first or second in all
     leading causes of death except heart disease - not to mention their
     chronic battles with tuberculosis, meningitis and other inflictions
     more commonly associated with developing nations.

     Yet health officials say the costly ``fly-in, fly-out'' approach to
     patient care has little to do with the overall poor health of the
     region's 53,000 people, the majority of whom are Indians and Inuit
     who were systematically placed in communities less than 50 years
     ago.

     At that time, people welcomed the warmth and security of heated
     homes and grocery store conveniences, giving little thought to the
     price they would eventually pay for leaving their wholesome
     lifestyles on the land.

     ``It's only recently that we've been able to supply a fairly decent
     level of water and sewage,'' says Nellie Cournoyea, the territorial
     health minister who grew up on a trapline in the Mackenzie Delta.

     ``People have to adjust to living in communities - you're dealing
     with all kinds of new offences against your body. In the old days
     if a family got a virus they were so far away from others they
     would never see anyone else.''

     Today it is not unusual to have as many as 16 people living in one
     poorly ventilated, substandard home, making the chronic housing
     shortage a major obstacle to combating infectious diseases such as
     tuberculosis and respiratory infections.

     Cournoyea says an additional 2,000 housing units are needed to meet
     the current demand, never mind the nightmare of an anticipated
     population explosion which could see the vast region's population
     double within 30 years.

     ``Housing is the number one health priority in the NWT and the
     second priority is environmental health (in the homes),'' says Dr.
     Paul Cappon of McGill University, who studied disease among Baffin
     Island Inuit and recently completed a community health assessment
     for the Yukon government.

     Cappon says the Yukon's 30,000 people (only 19 per cent are status
     Indian) enjoy a standard of health comparable to southern Canadians
     largely because they have overcome their housing crunch.

     However, the Yukon suffers the highest suicide rate in the country
     and its ``macho, pioneering spirit,'' along with widespread alcohol
     abuse, has made accidents and injuries one of its leading causes of
     death.

     ``It's the people who don't wear seatbelts and don't have smoke
     detectors, or they play hockey then drink and drive and they don't
     wear condoms. These kinds of attitudes among the whites in the
     Yukon are prevalent and white men as well as Indian men don't seek
     help for their problems of mental health,'' Cappon says.

     In the Northwest Territories, health officials agree that
     overcrowding and epidemic cigarette smoking - particularly among
     aboriginal women - pose greater health threats to children and
     adults than the more publicized problems of AIDS or chemical
     contamination of the food chain.

     ``We can't be continually bombarding people with messages so we're
     hitting a few priority items right now and number one is smoking
     because it's the single most preventable cause of disease in the
     North,'' says Dr. David Kinloch, assistant deputy health minister.

     A 1986 survey showed an alarming 77 per cent of Inuit women and 65
     per cent of Dene and Metis women smoke, giving women in the
     territories a cancer rate four times higher than the rest of
     Canada.

     Overall, more than half the residents in the Northwest Territories
     and 40 per cent of Yukoners smoke, compared to one-third of the
     population nationally.

     The statistics are grim in all areas except heart disease - the
     leading cause of death in southern Canada, but the only area in
     which the territories ranked last.

     Gabriel Nirlingayuk, an Inuk community health representative from
     the Arctic coastline settlement of Pelly Bay, knows it is the
     traditional diet of sea mammals and fish which has helped ward off
     heart disease across the North, so he's encouraging his people to
     junk their junk food and eat more ``country foods.

     ``I try to use some elders, get their experience out to the
     community on radio talk shows and I think that's a very effective
     way to get the message out,'' Nirlingayuk says.

     By returning to more of their traditional ways - including the
     public rebirth of healers, or medicine people - aboriginal
     northerners hope to regain their once-hearty health status.

     The Yukon has taken bold new steps in this direction, including
     recognition of traditional healing methods under the first Yukon
     Health Act, passed by the legislative assembly last December.

     Within two years, the Yukon and Ottawa will complete the federal
     transfer of health services to the territorial government, making
     the time ripe for a progressive, holistic approach to health care
     focusing on prevention, says Gaye Hansen, deputy health minister.

     ``We have a lot of people in the Yukon that have alternative views
     of health and certainly in that group are the first nations, but we
     also have a lot of alternative lifestyle people who believe in a
     back-to-earth approach to health and health care,'' Hansen says.
