Chartering the right to healthcare
Weeneebayko Program has provided medical services for Moose Factory region since 1960s
It was in August, 1965, when four doctors from Queen’s department of pediatrics made their first visit to a small hospital in Moose Factory, Ontario. One of those men—Dr. Don Delahaye, a Queen’s alumnus who joined the department in 1955—kept a diary of his travels.
“At the end, the old Chief came specially to thank me with tears in his eyes—I had a few tears in my eyes too, mainly due to shame that he should have to thank me for a minute fraction of the Medical Care that most other Canadians would consider their Birth-Right,” Delahaye wrote of a visit to a small community in the James Bay area.
That year, Queen’s began providing medical service and education to Moose Factory and the surrounding region. Before his retirement in 1990, Delahaye traveled there more than 60 times and worked in the hospital as a full-time pediatrician for four years.
Weeneebayko General Hospital—known first as Moose Factory Indian Hospital and later as Moose Factory General Hospital—was built as a sanitarium for tuberculosis patients in 1949. Moose Factory, on an island in James Bay, was chosen as the setting for the $3 million project in order to isolate the disease.
Medical Education Vice-Dean Lewis Tomalty said the University of Toronto and the Northern Ontario School of Medicine are also involved at Weeneebayko—a Cree word meaning “of the two bays.” Because of its history, though, Queen’s has the strongest involvement with the hospital, he said.
Along with medical students, nursing students and residents, Queen’s sends a surgeon and a number of family physicians on contract to Moose Factory. Usually the contracts last for about three years, Tomalty said.
The University also sends specialists to visit the hospital on a regular basis.
“It’s more cost-efficient … for somebody to go up and spend a day seeing 20 patients than it is to bring 20 patients down here,” Tomalty said.
Today, the hospital has an emergency services department and a renal dialysis clinic. In the case of a major trauma or a severe illness, though, patients are sent elsewhere by Medivac—often to Kingston General Hospital.
Weeneebayko Patient Services, which is run out of Hotel Dieu Hospital, provides a temporary residence for patients in a house called Geaganano, which means “our home” in Cree.
Sarah Butler, Weeneebayko Patient Services administrative assistant, said patients come to stay from Moose Factory and Moosonee, as well as the surrounding communities Fort Albany, Peawanuck, Kashechewan and Attawpiskat.
Geaganano can house 18 visitors and, if it’s full, staff book hotel rooms for patients. They also co-ordinate appointments and transportation and provide translators for patients who don’t speak English.
The geography of the Moose Factory area is one thing that makes the hospital and its medical program unique, Tomalty said. To get to Moose Factory, most visitors fly to Moosonee, Ontario, a nearby town of about 3,000 people. From there, the journey is determined by the season.
“In the summer you go across by boat and in the winter you go across by skidoo and when the ice floes are going you go across by helicopter,” he said.
“They’re completely isolated on an island in James Bay … so the physicians who are working there have to be very well-rounded physicians who can handle all aspects of medicine. It’s a very interesting training site—you don’t know what’s coming in the door.”
Although there’s currently a full slate of physicians at Weeneebayko, it can be difficult to attract people willing to stay in northern regions, Tomalty said.
“It is very isolated,” he said. “I have been quite a number of times and I tell you … you go out for a run at night and you’re kind of making sure there’s not a bear chasing you.”
Tomalty said incentives for doctors considering a move to the Moose Factory area include extensive vacations, much higher pay and continuing education.
“Most people would not do this for a lifetime,” he said. “They tend to do it for a few years. There is a turnover.”
The Weeneebayko Program gives students and physicians a different perspective, Tomalty said.
“There are healing ceremonies, there are traditional medicines, and we want our learners to understand those and to respect them,” he said, adding that there’s also a need to understand particular health care issues within the aboriginal population.
Ruth Wilson, a professor of medicine and family physician who has done extensive research on health issues in aboriginal populations, moved to Kingston from Sioux Lookout to co-ordinate the Weeneebayko Program in 1989.
Wilson said poverty in aboriginal communities doesn’t necessarily explain the health issues that people living there face, which are more extreme than those within non-aboriginal communities living in poverty. The health status of aboriginal peoples in Canada is far worse than that of the population as a whole, she said.
Along with lower life expectancies and higher infant mortality rates, a number of people suffer from infectious disease such as cholera, malaria, typhus, measles, diphtheria, polio and tuberculosis. The rate of infectious disease is especially high because of poor housing, sanitation and water, Wilson said.
First Nations communities also have high rates of chronic diseases including diabetes, heart disease and kidney failure.
“One of the chief culprits is the tremendous change in lifestyle that they’ve undergone,” Wilson said. “These are people that were genetically selected to be hunter-gatherers.”
Aboriginal populations have what Wilson calls the “thrifty gene,” a genetic predisposition to store fat easily in times of plenty and give it up sparingly in times of famine.
When the population moves into settled communities with easy access to food and transportation, the results are obesity and high rates of diabetes, leading to heart disease and kidney failure, she said.
First Nations communities also tend to have higher rates of suicide, homicide and sexual and physical abuse.
“I think it’s the number one health issue facing our country, and so would anybody from outside Canada,” Wilson said.
When she arrived at Queen’s in 1989, the Weeneebayko General Hospital was funded by both the provincial government and the federal government and administered through the University. One of her projects was moving the program’s governance from Queen’s to the Mushkegowuk Tribal Council.
“The solutions in the long run have to come from the communities themselves, and our job is to stand with them and assist them,” Wilson said. “For us to direct the services just contributes to the long history of colonialism and wasn’t in the long term going to lead to the right governance.”
Pat Chilton, CEO for Weeneebayko Health Ahtuskaywin and a member of the Kashechewan First Nation, said recently there has been a demand for access to traditional healers in the Moose Factory area. In August, a Cree physician from northern Manitoba with an interest in healing started working at Weeneebayko, Chilton said.
“How to bring those together, in a health care system, is a real challenge, but at the same time very rewarding, I think, to see a lot of people finally accessing the type of care that they wanted to get,” he said.
Chilton, who lives in Moose Factory but spoke with the Journal over the phone from Toronto, said there are similar programs that blend traditional healing with western health care in Sioux Lookout and Toronto.
“Our goal in Weeneebayko is to try to formalize that,” he said. “We’re even considering going through an accreditation process … so that we have our own method for allowing these healers to come into our system.”
Although Chilton took over for Wilson as co-ordinator in 1992, he left the hospital a few years later. In 2002 he returned to work on a new initiative.
“What we’ve been doing there since then is trying to realize the vision that our leaders had back in 1984, ’85, that was to create one regional First Nations-governed health care system,” he said.
The system should be fully operational by April this year. Although affiliations with universities will remain in place, the agreement will create one integrated health care system for the area, which will include physician services, dental services and land ambulance programs, among other things.
Chilton said Weeneebayko’s relationship with Queen’s is very strong.
“The relationship we have is so ingrained right now in the way that we provide care that changing it now to start sending our patients to Sudbury or to Timmins, I don’t think it would go over too well with our leadership or our clients.”
Although patients travel to Timmins for some procedures, he said, the hospital values the care its patients receive in Kingston.
Chilton said the Weeneebayko Program also helps residents and physicians get an idea of what issues are present in the First Nations community.
“They might read about it and hear about it in the news or see some people coming down to Kingston for their treatment. But I think it’s good for them to see what the lifestyle is up there,” he said.
Willa Henry, program director of the Family Medicine Program at Queen’s, said the program is mandated to prepare doctors for rural practice: “Train here, work anywhere,” she said. Residents are sent throughout Ontario, and some do electives overseas.
“Moose Factory is one of the best sites for preparing our residents to handle any situation that might present itself in that remote setting,” Henry said.
She said the University sends between six and eight residents to Weeneebayko every year for periods of eight to 12 weeks.
“They do obstetrics, they man the emergency room and, most exciting, they get to fly up the coast to smaller communities and provide medical care.”
Specialized health care
Dr. Karen Yeates runs the kidney dialysis program in Moose Factory, and travels there monthly. A chartered plane makes flights between Kingston and Moosonsee three times weekly—on Mondays, Wednesdays and Fridays.
Yeates, who cares for 12 patients in Moose Factory, was supposed to fly there for the day on Wednesday, but bad weather kept her in Kingston. Instead, she did a telemedicine clinic with patients at Weeneebayko.
For the past year, Yeates has been working on a documentary which follows two patients preparing for kidney transplants. Research shows that aboriginal patients get transplants at about half the rate of non-aboriginals—not just in Canada, but in other countries, she said. The reasons for the disparity are unclear.
“Our documentary … it’s looking at the difficulties with this process from the perspective of the patients,” she said.
“My struggle as a physician … is trying to be aware and cognizant of the need to not just impose my own western medicine beliefs on the patients up there.”
As a researcher, Yeates—who also works in Africa, often in Tanzania—said she looks for ways to make people understand there’s unequal access for care among aboriginal populations.
“I really feel that aboriginal people are almost, in some ways, getting third world health care in Canada,” she said. “I find similarities with what I see up the coast and what I deal with in Tanzania.”
But she said the Weeneebayko program is a platform for change.
“The program itself allows people to be exposed to what happens up there and the program allows specialists like myself to go up there,” Yeates said. “I think that that’s a really important thing.”