Healing northern nursing stations

NISICHAWAYASIHK CREE NATION — On a recent snowy April morning, Wanda and James Bunn packed up their ice-fishing gear and hit the road, never suspecting how much their lives would change within the next 48 hours.

James was experiencing chest pain before they departed, but the couple — born and raised on the northern Manitoba First Nation, high-school sweethearts and now in their 40s and married for 19 years — dismissed it as heartburn.

As the afternoon passed on the windswept ice of Footprint Lake, the frigid breeze did little to ease the pain.

“James wasn’t fishing, so I should’ve known something was wrong then,” Wanda said in a recent interview.

Worried about his health, she called Nisichawayasihk’s nursing station to tell staff the couple were on their way in.

At the health-care centre, nurses hooked James up to an EKG and consulted with a doctor over the phone. The diagnosis: a pulled muscle. Nurses gave him an anti-inflammatory shot before sending him away.

Wanda wasn’t convinced. Three years earlier, her mother went through a similar situation — despite experiencing chest pain, she was improperly assessed and sent home, Wanda said. Her mother later returned to the nursing station with chest pains, which, was diagnosed as a second heart attack.

Unlike many residents in Nisichawayasihk (also known as Nelson House), the Bunns had a vehicle. They drove an hour east to the emergency department at Thompson General Hospital to get a second assessment.

After a series of tests and blood work, doctors confirmed James had suffered a heart attack.

He was airlifted the next day to St. Boniface Hospital in Winnipeg, where a stent was inserted. Doctors told Wanda if James hadn’t received treatment when he did, he likely would have suffered a fatal heart attack.

“The doctor told him that artery is called a ‘widow-maker.’ So, I would have been the widow,” Wanda said.

The Bunns’ story is common among northern First Nations. Throughout the North, health care is delivered primarily through community nursing stations — mostly small facilities with limited examination space and basic, often outdated equipment.

“The doctor told him that artery is called a ‘widow-maker.’ So, I would have been the widow.”–Wanda Bunn

Additional challenges, such as staffing shortages, inadequate housing for fly-in nurses and even a reliance on outdated paper medical charts can result in a substandard level of care.

In Nisichawayasihk, two to four nurses are often on call at a time. When James Bunn sought treatment, three were on rotation. Residents have access to primary and emergency care, but the station lacks critical diagnostic equipment.

While critics may argue over who is ultimately responsible for the crisis, they agree more must be done.

“If the government can’t treat the First Nations people the way that they need to be treated, certainly, the staff and the nursing that goes in there is at a disadvantage already,” said Lorena Clace, co-president of consultation for Indigenous Services Canada, the federal department responsible for operating nursing stations in First Nations, Inuit and Métis communities.

Clace, an Indigenous nurse and member of Ontario’s Lac Seul First Nation, has spent more than 20 years with the department. She has worked in multiple First Nations in Northern Ontario.

Niki Ashton, longtime New Democrat MP for Manitoba’s Churchill—Keewatinook Aski riding, argues Indigenous Services is part of the problem — a product of chronic underfunding.

“The reality is that a lot of these nursing stations are staffed directly by Indigenous Services Canada, and Indigenous Services Canada is failing First Nations when it comes to making sure that there’s enough nurses and health-care staff to run the nursing stations,” she said.

Ashton, who represented the riding from 2008 before losing the seat to Liberal candidate Rebecca Chartrand this week, is familiar with stories like the Bunns’.

“People say they don’t go (to nursing stations) even if they’re sick, because they feel that they’re not sick enough. Or there are people that go and there’s concern that they’re not always getting the attention that they deserve,” Ashton said.

Pam Spence, a longtime resident of Nisichawayasihk, said her husband waited for hours April 18 with symptoms of pneumonia before leaving the station due to lack of care. Though he is now OK, she wondered what would have happened if the situation was more dire.

Spence, 54, and husband Morley, 68, grew up on the First Nation. They have faced these issues with the nursing station for years.

“The rule is you’ve got to call and make an appointment before anyone will see you, unless you’re dying, bleeding out — whatever emergency,” Spence said.

Spence doesn’t drive, which means she doesn’t have the option of taking her husband to Thompson for care.

“They always say ‘elders first, children first,’” she said. “It’s just kind of concerning that the people that don’t have resources get declined for basic health care.”

Despite the limited capacity of the nursing station, Spence and the 2,400 residents of Nisichawayasihk have no other reliable alternative. The resulting high demand makes staff burnout inevitable.

Nurses are often flown in to work on rotation in the North. Once they arrive, they face their own set of challenges. Nurses are housed in staff accommodations while working in the community, but Clace said the conditions are sometimes inadequate.

“The housing for the nurses is terrible,” she said. “There’s just no R&R for you, there’s no respite from work.”

Clace said nurses often have to share homes with their colleagues. Even with separate bedrooms, the tight quarters leave little room for privacy and no opportunity to disconnect after a long day of work.

“What we’re most worried about with this crisis situation being ignored is that the two or three nurses that we have on a day-to-day basis are going to walk out.”–Chief Angela Levasseur

At a news conference in Winnipeg in July 2024, Nisichawayasihk Chief Angela Levasseur criticized the federal government’s response to the community’s health-care crisis.

“What we’re most worried about with this crisis situation being ignored is that the two or three nurses that we have on a day-to-day basis are going to walk out,” she said.

With inconsistent wait times and a rotating staff of nurses, residents like the Bunns who have access to a vehicle choose to travel for medical care. Either an hour east to Thompson or an eight-hour drive south to Winnipeg.

Elders with limited mobility and no access to transportation have nowhere else to turn. They rely on community support to get them where they need to be, advocates said.

Joel Spence, who works with the nursing station providing transport for patients to Thompson, manages multiple trips a day for dialysis patients.

The day begins at 5 a.m., with the first group of patients. Their treatment takes four hours. After a short rest, he picks up a second, wheelchair-bound group at 10 a.m., takes them to lunch, then to dialysis. He brings the first group home, rests again, then goes back to take the afternoon group out for supper around 6 p.m.

They return home between 7 and 9 p.m., depending on how busy the restaurant is. The driver may be off as late as 10 p.m. by the time each patient has been dropped off.

“Seventeen-hour shift,” he said with a chuckle.

The time commitment is still the same even when patients need to travel for only brief, routine appointments.

“Telehealth would probably suffice,” Spence said, referring to appointments conducted over the phone. “It would probably be a big help, rather than the patients just going for a five-minute appointment where the doctor doesn’t need to physically touch them or assess them.”

When it comes to infrastructure, there are signs of progress.

In August 2024, a $157.9-million health centre opened in Norway House, complete with emergency, in-patient and palliative care and dialysis.

A similar facility is slated for construction in Nisichawayasihk by 2028. The new NCN Health Centre aims to alleviate the burden on the nursing station and will include the same technologies as Norway House.

Potentially, it could include electronic health-record systems.

The nursing station still relies on paper records, which, according to Clace, is typical in northern First Nations. “We just had a situation in Ontario where the nursing station burnt down to the ground. When that happens, you’ve just lost all your patient records.”

Lost charts mean lost medical histories. When patients are often seeing a different nurse each visit, access to these charts are crucial for providing continuity of care.

“We just had a situation in Ontario where the nursing station burnt down to the ground. When that happens, you’ve just lost all your patient records.”–Lorena Clace

The system is so outdated that when nurses come from larger centres, they are completely unfamiliar with paper-based charting. Clace said that puts nurses at a disadvantage in an already high-pressure environment.

Due to the ongoing nursing shortage, ISC is sometimes forced to hire staff from non-emergency backgrounds. Many become overwhelmed with the demands and leave, observers said.

Marcel Moody, deputy chief of Nisichawayasihk Cree Nation, said the community needs to address the problem by training nurses locally.

“The demands, they’re getting greater. So we need to train more people that want to stay up north. Doctors typically don’t want to travel all the way to northern Manitoba or live in northern Manitoba,” Moody said. “We need to maybe train our own people to fill those positions right now.”

Changes are underway to address those concerns.

In fall 2023, the NCN Family & Community Wellness Centre — a facility focused on improving community health — partnered with Brandon’s Assiniboine Community College to launch a practical nursing diploma program. Currently, 27 local students are enrolled.

The goal is to train young residents to become nurses, with the understanding they will return to contribute to the community.

Though they may disagree on where blame rests, both Ashton and Clace maintain the nurses themselves are not at fault.

“(Nurses need to be respected, and they need to be valued for what they do.”–Lorena Clace

“Nurses that are working in communities across the region are doing their best,” Ashton said. “What we’ve been pushing is for Indigenous Services Canada to live up to its obligations. It runs nursing stations across our region. It has contracts to provide nurses and they’re not living up to those contracts.”

Clace does not dispute that more needs to be done and emphasized how important the nurses are to the communities.

“(The government needs) need to understand what a valuable service that the northern nurses provide, how different it is from many of the other nursing jobs that are out there. Nurses need to be respected, and they need to be valued for what they do,” she said.

Ultimately, it’s the people in these communities who are left to pick up the pieces — to bear the weight of a system that doesn’t always work.

“In the North, I think that it’s basically the luck of the draw what kind of care provider you get and how fast you can be assessed,” Wanda Bunn said. “I’m just glad my husband’s alive today.”

fpcity@freepress.mb.ca