Stress, trauma, and recovery

This past weekend I was able to attend a community workshop called "Pathways to Healing". The workshop brought speakers, from a variety of backgrounds, both from Canada and the U.S, to Moose Factory. The workshop is held annually and is intended to help the community overcome past struggles and increase its resiliency.

I was fortunate enough to hear Darryl Tonemah speak. Darryl is an aboriginal health psychologist from the Tucarosa reserve in New York. Along with three undergraduate degrees, he has a master's in community counseling, and a Ph.D in counselling Psychology and cultural studies.

What grabbed my attention immediately about Darryl was his incredible story telling ability. I've only experienced a few times in my life someone who is able to engage you so deep in story that you find your palms sweating, and you are ready to jump out of your seat. Darryl was one of those story tellers.

Darryl's talk focused on stress and trauma, and its impact through the life cycle.

He presented stress as something that forces you to act, it is not necessarily a negative, but it just means you can't do nothing. Looking at stress in this way, it can actually be viewed as a very positive thing. You can't grow, learn, or love without it!

He then defined trauma as an event that overwhelms our ability to act. It is an event where we have no control over the situation, and is so difficult to process that the brain and body protects itself by shutting down. The problem with this response is you don't always return to normal afterwards.

Darryl began his discussion of trauma looking at its impact on pregnant mothers. He talked about a study that followed the children of mothers who were pregnant in the New York City area during the Sept. 11, 2011 terrorist attacks. The study followed the children 10 years  following the event and found they experienced worse physical and emotional health outcomes, than children who weren't in utero during the attacks. The trauma felt by the mother is turn felt by the fetus, through the various chemical changes that occur. The mind-body relationship is an amazing thing.

What I learned most from Darryl's talk was how difficult it is to recover from a traumatic event, and when you don't have adequate support to help you process, then trauma can last a lifetime.

If trauma can perpetuate from one generation to the next, how do you try to recover as a community?

It is certainly not something that will fade in time. That is what Pathways to Healing is trying to address, and I feel very grateful to have had the opportunity to attend Darryl's presentation.

 JK

 





 

Nutrition North and the high cost of food

One issue I wanted to explore during my time in Moose Factory, was the high price of food in remote communities. Moose Factory itself is not included in the Nutrition North subsidy program, although food in Moose Factory/Moosonee is significantly higher than down South. However, many other communities in the health district do partake in the subsidy program.

A little on the Nutrition North program...   

The Nutrition North subsidy is a federal program that provides retailers and food processors located in Northern communities, with no year round surface transportation ( no permanent road, rail, or marine access), subsidies on perishable foods (fruits, vegetables, eggs, meat, milk, and cheese). The program is a market driven model, so retailers apply to the program, and if accepted the subsidy is transferred directly to the store. Businesses are then accountable to pass on the subsidy to the consumer. Restaurants and social institutions, such as day cares or schools, are also eligible for this subsidy.  

Fruits, vegetables, meat, milk, and eggs are eligible for a higher subsidy rate than combination foods such as pizza or lasagna.

The main question, which has drawn criticism of the program, is how much of the subsidy finds its way to the citizens of these communities? A “market driven model” such as the Nutrition North program, encourages business growth in these communities by making them more profitable. It does not guarantee nutritious and affordable food will be available in Northern communities. This is not to say that business is bad, and that the government should fully control the food entering these communities. It is just to say that without proper oversight and transparency, these businesses providing the service could profit at the expense of the communities. It comes as no surprise then that the most successful initiatives for providing food to remote communities have been generated from within.

As the Wawatay news reported in September 2011, Fort Albany is a good example of a community who organized to fill a hole in the subsidy program. The community started up a food security committee in January 2011, with concern of affordable nutritious food as its focal point. The community partnered with Nishnawbe Aski Nation’s True North Community Cooperative, which provides remote communities with nutritious food boxes, subsidized through Nutrition North Canada. The program is like a bulk buying club for the community, which cuts out the retailer, and most of the food comes from stores in Cochrane or Timmins. The food is then sold, in the style of a farmer’s market, at cost to the community. 

It is creative ideas such as this that are needed to provide remote communities with accessible nutritious food. The community took advantage of the subsidy to better fulfill the needs of its people, instead of going through a retailer like the Northern store.   

A discussion thread for anyone interested in learning more about how Northern Nutrition Canada has impacted communities can be found here: 
https://groups.google.com/forum/?fromgroups#!topic/northern_food/Pdkgrd-xYXg  

It's cold and there are dogs.

So I've been told by several people this week that they haven't remembered the last time it was this cold for this long. It hasn't really dipped above -30 Celcius wind chill for about a week, and it doesn't look like it will until the weekend. And I must say it makes getting anywhere challenging.

I certainly would not be leaving the house very often if it weren't for work, and so I have not been suprised on the -45 days that we've had many canceled appointments. I'm not sure whether the problem lies in lacking the motivation to brave the cold (a category I would fall into), or if people simply have not been able to get their vehicles to start (which happened to us with one of the hospital trucks despite it being plugged in).

So although I blame the cold for the fact that the only place I've walked to this week is work, about a 5 minute walk, there is also one other reason.

Dogs. There are lots of dogs. It's not that I'm not a dog person, because I definitely am, and besides most of them are really friendly. I've had no real problems, but I must say walking on the street and seeing three large dogs barreling down at you does make your fight or flight reaction swing into gear.

It was interesting that the first thing my roomate, who is from Moose Factory, asked me was whether or not I am afraid of dogs. When I answered "maybe a little nervous", it was nice of him to reassure me with "you shouldn't have any problems just avoid them during mating season, what you really have to watch out for are wolves, they come over sometimes when the water freezes".

This place really does force you to get comfortable in a hurry.

It was also interesting hearing from one client that the reason she stopped walking outdoors for her exercise was that there was a dog that had chased her up onto a snowbank. Another worker mentioned that she talked about the dog problem to a police officer friend, who told her to carry a baseball bat with her.

It is reasurring to know that at least some people are helping solve the problem. Apparently one of the family doctors spayed one of the street dogs, who seemed to be particularly efficient. So in a few weeks when it warms up, and I no longer have the excuse of it being too cold to walk to the grocery store, I'll simply have to bring my baseball bat and keep my head on a swivel looking for wolves.

No problem.

Cree language in the James Bay region

I was surprised to hear during my orientation this week that counselling sessions sometimes have to be done through a translator. Not for French but for Cree. The health region is 95%+ Cree, and the Cree language is still spoken by many in the area. Most of the population can speak english, but for people over the age of 60, Cree was almost certainly their first language.

This makes providing health services even more complex, as plain language becomes even more important. You not only have to adapt for education level but also for language. Cree language services are not widely available, unlike french since it is an official language.

Complicating matters is that Cree is spoken in 3 different dialects in the James Bay area (see map). There dialects are categorized as n,l, or y based on the Cree spelling of the word "no". In the Attawpiskat area the word no is "mona", in the Moosonee/Moose Factory area it is "mola", and in the quebec area it is "moya".

For people with limited English then you not only need someone who can translate Cree but also in the proper dialect. Often times it will be a relative who is asked to translate, but if this isn't available it makes communication quite difficult. The other issue with having a relative translate is there may be a breach of confidentiality as the patient does not feel comfortable with their relative in the room. If anyone has attempted to speak through a translator it is not so simple. Some words are difficult if not impossible to translate.

If a relative is not able to translate, and neither is anyone on staff it can cause significant complications. For myself as a dietitian it isn't so much life or death, but it does add another dimension to communication. When speaking in your second language everything takes a second longer to process (as I know from speaking mediocre french). It is also easy to misunderstand, or not pick up on key words. It is important to double check, and ensure that messaging is clearly understood in this context.



JK    

Weeneebayko health region

Today was my first day interning at the hospital. It was interesting talking to my supervisor Beth about the hospital and health region structure.

The Weeneebayko general hospital in Moose Factory (Pop. ~2500) is the main hospital in the health region, though there are smaller "hospitals" in Moosonee (~3000), Attawpiskat (~2000), and Fort Albany(~1000), however these are staffed permanently only by nurses and have only a handful of beds. Other communities in the area include Kashechewan (~1500), and Peawanuck (~300) a 3+ hour flight NorthWest from Moosonee.

The remoteness of some communities make healthcare challenging. Physician and other healthcare team members do make the trip up the coast for appointments when they can, while tele health is also used to cut down on travel needs.

The community of Attawpiskat is especially underserved compared to the others in the region. Health services are stretched thin with the current housing crisis and other social issues, such as addiction, in the community.

It was interesting to hear that the community of Peawanuck actually has much better health outcomes, including lower rates of diabetes, than other communties in the region. No studies have been done to figure out why health indicators are better in Peawanuck, but Beth mentioned that it is a model community for the region. Peawanuck is the most remote community, and the people of Paewanuck lead a more traditional lifestyle in terms of diet and economy. They have also had less contact historically with European settlers and later with the Canadian government.

JK

First weekend in Moose Factory

After two days of travel I finally arrived in Moose Factory. After 3 flights, a 2 hour bus ride, and a 6 hour train ride, I finally arrived in Moosonee where I was picked up for the short drive across the ice road, over the Moose River, to Moose Factory located on an island.

I was picked up by one of the dietitians and her boyfriend, who took me to the grocery store to stock up before giving me a tour of both Moosonee and Moose Factory. Prior to coming all I knew of the area was from wikipedia and through Joseph Boyden's novel "Through Black Spruce".

The community of Moose Factory is divided up into three sections that come under different jurisdiction. There is federal land where the hospital is located, a small area under provincial designation, and a larger area of reserve land. One can only imagine how this complicates infrastructure projects.

The place I'm staying in is temporary housing for "locums", which are nurses and other health care workers that sign contracts for set periods of time in Moose Factory, while residing in Southern Ontario. Locums fill the gaps in permanent workers, and although many locums sign contracts regularly it still creates issues for continuity of care.

Patients suffering from chronic conditions may have to see a new healthcare provider on each visit. Making it difficult to build trust and rapport with patients. This may also act as a barrier for some people to come in and receive the care they need.

Even with the turnover among health care workers, they make up an interesting and tight knit community in Moose Factory. I've only met a few people so far, since the freezing rain kept me mostly indoors, but I'm looking forward to an interesting 3 months in Moose Factory.

JK

Intro

Hi Everyone,

I've decided to start this blog to keep everyone updated on my experiences while in Moose Factory. It will focus, but not be limited to, food related matters. I will also try to include photos whenever possible, and any interesting links or articles I come across.

Anyways I hope everyone enjoys this blog!

Josh