Camp stove tragedy sparks Nunavik health debate

Quebec Inuit were promised a gold-plated treaty in the 1975 James Bay Agreement. So why do they have one of the world's highest suicide rates, a plummeting life expectancy and a poorly funded health care system run by outsiders?

Page 9

Sarah Ningiuruvik Paulusi was 79 when a tragic accident at her camp in northern Quebec took her life last year. The Inuit Elder had poor vision and mistakenly filled a camp stove with gasoline, instead of kerosene. As she lit the stove at around 6 p.m., it exploded.

Her son, outside chopping wood, looked up to see his mom's face and clothes on fire through the cabin window. Only her feet weren't burning.

He put out the flames with help from three other women, then jumped on a snowmobile to get help in the Inuit village of Kangiqsujuaq, 25 kilometres away. What happened next has sent shock waves through the 14 Inuit communities and sparked a debate on the failings of the Inuit-run health-care system set up under the 1975 James Bay and Northern Quebec Agreement, Canada's first modern treaty.

Paulusi's son rushed into Kangiqsujuaq at 9:30 p.m., and immediately sought out the community's two nurses. But citing internal regulations, the nurses refused to go to the camp to help.

The Elder couldn't be airlifted out, either, because all available pilots said they'd already flown their legally allotted hours for that day; there was no provision for emergencies.

Finally, a convoy of Canadian Rangers and a police officer took off for the camp at 11 p.m. On arrival - after midnight - the officer applied his limited knowledge of first aid and then radioed the village. He informed the clinic the Elder would need to be flown to the hospital in nearby Kuujjuak as soon as she was brought into Kangiqsujuaq.

The group left the camp at 12:45 p.m., but on arriving in the village no plane had been called because of another regulation that requires nurses to visually check patients before ordering a medevac. It was 3 a.m. - seven hours after the explosion.

It wasn't until 9:30 a.m. that Paulusi was finally taken to the airport. She arrived in Kuujjuak at noon, when she finally got hospital treatment 18 hours after the accident. But the Elder's injuries were so serious it was determined she should be sent to a hospital burn unit in Quebec City. At 7 p.m., she was again put on a plane, arriving at 11:35 p.m. - nearly 30 hours after the explosion. Paulusi passed away in Quebec City at 3:10 a.m., the morning of June 3.

Paulusi's story has sparked frustration and anger about the health-care system in northern Quebec. In a report last April, the Quebec coroner's office slammed the Inuit-run Nunavik Health Board for lacking "good sense" and "compassion" in handling the incident.

Some Inuit say the tragedy is just part of a bigger problem. Twenty-five years after the signing of the James Bay Agreement - in which the Inuit and Crees agreed to end their opposition to Quebec's massive James Bay hydro-electric project - many Inuit say they're still waiting for the promises in the agreement to be fulfilled.

They say the 14 Inuit communities are plagued by substandard, poorly funded health and social services that are controlled behind-the-scenes by non-Inuit managers who are insensitive to local needs. Few Inuit work in the health network as caregivers or managers. Out of 50 or 60 nurses, only three are Inuit.

At the same time, Inuit people's physical and mental health has deteriorated dramatically since the James Bay Agreement was signed in 1975. The agreement brought abrupt changes in the Inuit world with the hunting and fishing way of life abandoned by many.

An alarming 1995 study showed that Inuit life expectancy has dropped to 60 years from 65 years in 1975. This makes it lower than South Africa's and equal to that of India's life expectancy. The average Canadian life expectancy is 77 years.

One reason for the plummeting life expectancy is that Quebec Inuit have one of the highest suicide rates in the word. Inuit in their late teens are 25 times more likely to take their lives than that age group in the general Quebec population, according to the 1995 study.

The same problems - inadequate health care, poor health - have hit the Quebec Crees, too. They now have one of the world's highest rates of diabetes, an illness linked to abrupt changes in their lifestyle. Complaints have also surfaced about the Cree Health and Social Services Board. Last year, Crees held a special assembly on health and social services to air the concerns. The Cree health board vowed to make reforms.

But the Inuit communities are just now waking up to the need for change in their health network. There have been no special assemblies. Reform has been slower in coming, and those who speak out have often faced ostracism or reprisals.

"There is a lot of insecurity among our people. They're afraid to speak," said Lizzie York, an Inuk who was executive director of the Nunavik Health Board for 15 years.

York experienced what happens when someone voices criticisms. For years, she said she silently put up with racist or stereotypical remarks about Inuit staff and clients from the health board's own non-Inuit employees. Then she decided she'd had enough.

"I decided not to put up with racism any more," she said. "If I saw someone being put down, I started standing up for them, if they didn't stand up for themselves. I really started putting my foot down. No more horsing around.

"For all those years, I was just doing what I had to do. I had seen people forced out because they were becoming too close to the Inuit people. The best people were forced out, or were so disgusted they left."

York's change in attitude didn't go over well. Last year her contract wasn't renewed. She is now out of a job.

One of the final straws came in March 1999 after a good friend of York's daughter committed suicide in a group home for troubled kids in Kuujjuak. Jackie (not her real name) was left alone in her room around dnner-time, even though group home staff were informed she had expressed suicidal thoughts, according to York and other former health staff. Normally, the staff is not supposed to leave suicidal kids unattended.

"If she was that suicidal, she should not have been by herself. She should have had someone with her all the time until she had calmed down," said York. Another former Inuit health worker familiar with the incident agreed: "They left a child unattended. That's why she was brought to the group home - because she was suicidal."

One veteran social worker said she quit the health board not long after this incident.

"I was disgusted by the health board," she said.

The group home's coordinator didn't return our phone call.

After the suicide, York called in the Quebec Human Rights Commission to investigate. It was a month later that her contract wasn't renewed.

Minnie Grey, an Inuk who replaced York as the health board's executive director, refused to comment on Jackie's suicide, and dismissed criticisms of the health system.

"They have no validity whatsoever. It's disgruntled employees."

If there's anything good to be found in Jackie's suicide or Paulusi's death, it may be that the tragedies helped galvanize Inuit people's resolve to take action. A petition has circulated calling for changes to the health network, and 85 people have signed so far.

Other top health officials have joined in the criticisms, too.

"We as Inuit people are allowing ourselves to be manipulated by non-Inuit who come here and, instead of working for the people, end up working for themselves," said Eli Weetaluktuk, executive director of one of the two Quebec Inuit hospitals.

"In other organizations, we have trained Inuit people to become teachers, navigators on shrimp boats, airline pilots. We don't seem to have the will to train Inuit people to become nurses and doctors," he said.

In a dramatic development in June, health board chairman Jean Dupuis took many by surprise and resiged from his position. The move came after a series of articles in The Nation, a Cree magazine, about Paulusi's death and other problems at the health board.

The Nunavik Health Board's board of directors elected the reform-minded Weetaluktuk as its new chair in a vote of nine to four.

That has York feeling cautiously optimistic. She said Weetaluktuk doesn't have time to make any real reforms before his term is up in December, but she added that at least his appointment shows people want change.