80 HEALTH CARE IN NORTHERN CANADA - AN HISTORICAL PERSPECTIVE J.D. Martin Health and Welfare, Yellowknife, Northwest Territories, Canada A brief histofY of health care development in Territories. Starting with their ro1ss1on at Fort northern Cal")8da Providence in 1867, they followed by providing Contact between the native people of northern the same services at Fort Resotvtion in 1903, Canada and f:uropeans occurred in the 1700's and hospital services were added at Fort Smith in 1800's and ttie whalers were of particular import­ 1914, Fort Simpson in 1916, Aldavik in 1925, ance. Althoygh thev did not set up anv permanent Chesterfield Inlet in \930, fon Re"OO\ution in settlements, they markedly influenced the health 1939 and Fort Rae in 1940. of the local iohabitants. The introduction of many The first hospital established in the Eastern communicable diseases, some of which were pre­ Arctic was St. Luke's, built by the Anglicans in viously unknown, in many cases, almost totally 1930 at Pangnirtung. Recruitment of federal eliminated the native peoples. Epidemics of small government physicians began in 19:Z2 as a result of pox, influenza and tuberculosis were not un­ firm and consistent representation by the church common. to Ottawa for staffing the growing number of Reverend Peck, an Anglican missionary. es­ mission hospitals ( 1 ). Dr. Livingstone, the first tablished a hut for the sick at Black Lead Island in government re$ident physician to the Inuit, was Cumberland Sound in the Eastern Arctic in the the first doct<1r at St. Luke's and as the only 1890's. In llcldition, he adopted syllabics for use doctor in the Eastern Arctic at that time, regularly by the Inuit and wrote the first definitive grammar travelled by dog team to isolated hunting camps used in the Eastern Arctic. on Baffin Island, an area o1 \9\,t\00 square miles A pioneering doctor from Alberta, Dr. W. N. and surely one of the largest medical practices in Mackay. was the first resident physician of the area in the world (2). North, when in 1867 he joined with the Hudson's In the Yukon, during the Gold Rush of 1898, Bay ComP8rty as a surgeon and set up practice and a number of private practitioners followed the Bay trading ;rt York Factory. Or. Mackay moved gold seekers to Dawson Qty and established the next year to Fort Simpson, some thousand practices there. Father Judge, a Roman Catholic miles west and from there to f:ort Rae where for missionary built the first hospital in Dawson City. nine months of 1866 he actively practised medicine This hospital was used until just tecently when a while still employed by the Hudson's Bay Com­ cottage hospital replaced it. Traditionally, private pany. Dr. Mackay frequently changed his location medical practice has been the pattern in the so as to afford a greater number of the native Yukon. people the breadth of his ministrations. The military has been involYed in the develop­ Coinciding with Dr. Mackay's arrival in the ment of healt!\ care facilities in ttle North until North was the establishment of the first nursing recently. An army hospital was built in White· station by the Roman Catholii:::s at Fort Providen<l! horse, Yukon. In Frobisher Bay, the settlement in 1867. "typical of these pioneering nursing itself was developed by the militarv during the sisters they served not only the sick and suffering second World War, and medical facilities were pro­ but also offered continuing care for the crippled, vided by the Armed Forces. In many cases, devel· blind and the paralyzed. opment was initiated by the United States Armed In any account of the de~loPment of health forces with later 11ansfe1 to 1he C;,nadian Govern­ service in the North, special mention must be ment. made of the commitments and dedication of the In the Eastern Arctic, the ~ Arctic order of the Grey Nuns, who served so faithfully patrol was the once-a-year contact with tradi­ for over <>nil hundred years in the establishment tional southern medicine. Til8Sle patrols were and operation of health servi°" to the Northwest initially a pert of the resupply of Hudson Bay I 81 Company posts, and a physician usually travelled lnuvik General, the Rae-Edzo Cottage Hospital, with the ship. In 1950, the Canadian Government the Fort Simpson Cottage Hospital and in addition built the Canadian Coast Guard Vessel C.D. thirty-fline nursing stations, eight health centers Howe. This ship was designed as a medical and and a number of health stations. The federal cargo vessel and had an ice reinforced hull. Faci­ health service provides public health services to all lities on board included an operating room and communities in the Yukon and Northwest Terri­ clinical area staffed by two dentists, an eye spe­ tories. The two Territorial Health Departments are cialist, a radiologist, nurses and two or three rapidly taking greater responsibility for healttlf:ilf"e general practitioners. This ship would sail annually and will eventually assume full control of health from Quebec City and the medical team on board service. would examine almost the entire population of In the Yukon, the 125-bed Whitehorse Gener­ the Eastern Arctic. Each person would receive al Hospital was opened in 1958. In addition, there a complete physical examination, laboratory is the Old Crow Nursing Station 'in the northern work, a chest x-ray, dental examination and eye Yukon, the Father Judge Memorial Cottage Hos­ examination. It was not unusual for an Inuit per­ Pital in Dawson City, the Mayo General Hospital, son to be evacuated immediately on board this the Watson Lake Cottage Hospital and several vessel and spend from one to two years in south­ health centres in smaller communities. ern sanatoria for the treatment of tuberculosis. In the Northwest Territories, the 35-bed The C.D. Howe was taken out of service in 1968 l=robisher Bay General Hospital serves as a regional when other means of servicing the eastern arctic hospital for the Eastern Arctic and the twelve Inuit were found to be more effcient and prac­ l"tursing stations in that area serving a population tical. of approximately 7500. The 55-bed lnuvik Gene­ ral Hospital in the Western Arctc serves a much Organization of health care services and facilities smaller area geographically, but has approximately in the North the same number of nursing stations and health Ultil 1967, healt serviC8$ in the Northwest Terri­ centres. tories were provided by Regional Offices of The 75-bed Stanton Yellowknife Hospital Medical Services Branch of the Federal Depart­ operated by the Government of the Northwest ment of National Health and Welfare situtated in Territories provides services to Yellowknife and southern centm namely. Edmonton, Winnipeg the Great Slave Lake area and admits referrals and Ottawa and responsible for Indian health from the Mackenzie and Central Arctic. Two services in the provinces a well as north of 60°. $1'Tlaller hospitals in Hay River and Fort Smith are In 1967, Northern Region was created with head­ operated by the Northwest Territories Govern­ quarters in Edmonton and responsibility solely for ment. the Yukon and Northwest Territories. In 1974, The nursing stations are staffed with from one Yukon Region was established in Whitehorse and to four nurses depending on the size of popu­ in 1980, Northwest Territories Region was moved lation. The nurses are well trained in treatment, from Edmonton to Yellowknife. mid-wifery and public health. At the present time, the responsibility for Health stations are smaller facilities which health care is shared with the two territorial provide overnight accommodation for visiting departments of health. In the Northwest Terri­ nurses and doctors in those communities too small tories, the Department of Health, Government of to warrant a nursing station on the basis of popu­ the Northwest Territories is responsible for three lation. hospitals, the Stanton Yellowknife Hospital. the Hay River Hospital and Fort Smith Health Centre. Northern health care professionals In addition, that Government maiages the hos­ From the experience gained in providing service to pital insunn:e and health care plan and supple­ native people across Canada, the federal health de­ nwttary health care benefits. including a phsma­ partment has developed three new health care care program to residents 65 years of age and over. workers who have found a unique place in the The Federal Health Department manages four hos­ Canadian health care system, the dental therapist, piUlls including the Frobisher Bay General, the the nurse practitioner, and the conmunity health 82 representative. Arctic by providing consultant and resident staff The School of Dental Therapy began in 1971 from Montreal. This has developed over the years at Fort Smith in the Northwest Territories to and now there is a very active affiliation with train dental therapists in a two-year training McGill. At the Frobisher Bay General Hospital, program. On graduation the dental therapis there is, in addition to five staff physicians, a resi­ lives in northern communities and provides treat· dent in pediatrics on rotation from the specialty ment and preventive dental programs to the school training program in pediatrics at the University. age population. In addition, the therapist pro­ In addition, there is usually one medicafstuclent vides emergency dental treatment to adults. This spending eight weeks of an elective progrant in is carried out under the direction of a dentist who Frobisher Bay. Specialists representing the various visits the therapist in the field at regular inter· medical sub-specialties spend two to four days vals prescribing treatment which is then carried each month in Frobisher Bay. Regular surveys are out by the therapist.