This report was written by a New Zealand resident who did a 3 month rotation in Inuvik. He says about the report: 'While it is based on truth I seem to remember to applying an element of literary licence!'
Abstract
My medical elective was spent working in the Canadian western arctic. I was based at the Inuvik Regional Hospital on the banks of the Mackenzie River, 400km north of the Arctic Circle. The hospital services a population of approximately 10,000 people, 2300 from Inuvik and the remainder from small Inuvialuit (Inuit) and Gwich’in communities on the mainland and arctic islands.
I worked in the emergency room (ER), operating theatre, hospital and family practice clinics. In addition to my regular rostered work I helped to provide medical care on the frequent medical air evacuations to and from Inuvik. One to 3 times a week I was on-call. This involved being responsible for the ER and taking calls from outlying health centres. The aims of my elective were to work in a position where I could take on a greater level of responsibility than I had previously and implement my learning of the previous five years. Both these objectives were certainly achieved. Throughout my time in Inuvik I was privileged to work with some inspirational doctors, was given considerable responsibility for my patients and was exposed to a wide variety of medical conditions. These experiences have given me a level of skills and confidence that I look forward to taking to my first year House Surgeon position in 8 weeks. I would highly recommend a placement at Inuvik Regional Hospital for anyone prepared to take on a high level of responsibility and a heavy work load in a culturally and environmentally fascinating location.
Elective choice
If the world was my oyster, on which part of this great crustacean was I going to choose to spend my medical elective? I had spent enough time in the entrails of Delhi and the heady heights of the Himalaya in the past. What I wanted was an elective that would be culturally and geographically fascinating, one that would expose me to a wide diversity of medical situations and allow me to roll my sleeves, dive in the deep end and practice what I had been taught.
There where other people to consider in the decision. Barb, my wife, who has dutifully supported me through the riggers of my medical training, also had ideas as to where she would like to travel and work. Being Canadian she was keen to spend some time in her homeland. A friend of mine had worked with some Canadian doctors who, by virtue of their geographical location, were required to have a diverse range of skills and the confidence to use them. The decision was made. We would head to the very rim of the oyster shell, to the small Inuit community of Inuvik, well above the Arctic Circle on the northern coast of Canada.
Experience one
Hi all,
It’s been a big week over here. With one-week left on my elective the tempo has been wound up a click. I'm now on my 3rd 32-hour shift in the week and yes, I am tired.
What did not help was the phone call I got the other night. Apparently there had been a motor vehicle accident 250km down the only road that comes into Inuvik. This 750km long mud and dirt road is renowned for having nasty accidents. Twenty minutes later I was skimming across the Mackenzie River delta in a helicopter. Slowly updates got relayed to the Paramedic and I. Twenty meter high bluff, 6 in the car, 4 dead, 1 under vehicle alive, a head injury. We flew at low altitude, following the road looking for the accident. In places the road cut through deep gorges forcing us to fly high above it or in other places nipping between the narrow rock walls. As we approached the high mountain pass that divided the Northwest Territories and the Yukon I spotted flashing lights. Three hundred meters past the border lay an overturned vehicle. Surrounding it were some firemen and bodies. As we came closer I noticed someone doing CPR on the pale outline of a person. We landed, grabbed our gear, and scrambled down the bank. Seeing our arrival the fire crew pulled back and let the paramedic and I take over the CPR. The man was already connected to an automatic defibrillator device droaning out instructions in a thick American accent. Despite the patient’s Indian origin he looked pasty pale. His large black dinner-plate pupils gazed upward. Compressing his chest was almost identical to that of the plastic CPR manikins, the only difference being the warmth of his skin. As we work we were told that this man had been the one crushed under the overturned vehicle. For 2 hours he had talked with the people first on the scene about where he was from, his two-month baby and where they had been heading. Once the fire crew arrived they managed to roll the vehicle enough to pull him out. He immediately went into cardiac arrest. That was 20 minutes ago. We persisted for another 10 minutes before getting a proper ECG tracing from the Lifepac we had brought. The line was flat. We moved on and assessed the four other victims. Two had been thrown free and lay in the contorted positions they landed. The warmth of their skin disconcerting, I felt for carotid pulses at multiple points on the neck with the hope that I would detect a slight throb. I listened intently above the noise of the wind for breath or heart sounds and gazed into the fixed and dilated pupils. The other two were still in the vehicle. The first clearly dead due to a major head injury, grey matter splattered the surrounding rocks. The second was curled up on the overturned car roof. I lifted his face to find him floating in a pool of blood.
The fire crew directed me to the only survivor. Lying up on the road to which he had managed to scramble for help he lay where he had collapsed. I crawled under the green tarpaulin that he had been covered with. After introducing myself I quizzed him on what had happened and where we were. He responded very appropriately. After examining him I ascertained that he had an injured right shoulder and hip otherwise he was stable.
The paramedic and I spoke to one another for the first time since arriving. She had been doing similar checks on the dead. Despite that, we decided to check one more time. My main concern was that we would declare someone dead when they weren't and commit them to a slow death in a wrecked car high on the alpine pass. All five ECG tracings were flat; there was only one survivor. As I walked up the bank for the last time a man approached me. He explained that he had held the crushed man’s hand, and spoken to him for the two hours before he died. He felt an obligation to tell the survivor the sad news. Him and I crawled back under the tarpaulin and in the surreal filtered green light he broke the news. After several minutes, as the survivor composed himself, the man left. The injured survivor then turned to me and inquired as to the injuries of his other 4 friends. While not being the best place to break news like this I had to explain to him that none of them had survived.
Dark clouds occluded the midnight sun putting pressure for us to get airborne. Without wasting a minute we loaded our survivor and roared off into the oncoming weather. The pass was now clouded out so we flew along the spine of the Richardson Mountains before attempting to fly over the cloud layer. It turned out being too high so instead we searched for a low pass, finally found one, and nipped back through to the Inuvik side of the mountains. The hour flight back across the wide Mackenzie delta was both beautiful and terrible all at once. The meandering river channels shone copper in the low sun. Our patient lay flat on his back, neck brace on, sobbing. Had he been able to see the view I'm sure that he would have appreciated it far more that we could.
Without any other medical help I spent the rest of the night scaring myself. His first chest X-ray showed a widened mediastinum, could he have a major aortic injury? It turned out to be the angle of the X-ray; his aorta was fine. I then found a crack in his odontoid peg, one of the vertebrae in his neck, after multiple repeat x-rays and waking a radiologist in Edmonton, 1000km south, it turned out to be normal.
Yesterday, five days after the accident, I discharged him. It was with great relief that I shook his hand at the hospital doors. Being a devout Muslim he explained, as he and his friends were on a religious trip to Inuvik when the accident happened, they died as martyrs, for that he was happy for them. His terrible feelings of guilt and regret were for the families and children of his friends. It is for them that he believes he was spared, from here on his intention was to act as their servant.
I trust you are all enjoying yourselves on the beaches!
Kynan
Planning
Planning for my elective began over a year prior to my departure. The power of the Internet enabled me to make contact with the Inuvik Regional Hospital. After forwarding them my CV I was quickly informed that I had been accepted for the full 3-month period. Later I was to find out that the Hospital receives many requests for elective placements. I can only think that New Zealand’s exotic reputation pushed the decision in my favour and secured the placement. With a supervisor organised I was then required to become affiliated with a Canadian University, gain a student practice license for the Northwest Territories, obtain health insurance, indemnity insurance, be entered on the education register for the Canadian College of Physicians and Surgeons, obtain a study visa and book my flights. All went smoothly until I received the fee assessment from the University of Alberta - NZ$2400. I managed to convince myself to push on with the plan by offsetting the cost of the fees with the fact that my accommodation and food in the arctic was going to be free. After handing over several hundred dollars for a medical my Canadian visa was issued. My second shock came when I was told that as I was going to be in North America for longer than 90 days, and was transiting through LA, I would also require a US visa. Obtaining one of these visas is no simple task, I was required to fly to Auckland, have a 2-minute interview and empty my pockets of its remaining coins before it would be issued. Anyone would have thought that a silent invasion of Canada had taken place, and perhaps it has.
I was allocated the third quarter for my elective that fitted in well with my wife. It also placed us in the Arctic for the summer, saving us from the -50C temperatures and perpetual nights yet exposing us to the peak of the North American mosquito population and 24-hour daylight.
Inuvik
Inuvik is a small town located at the end of a 750km long mud and gravel road. The town is located on the banks of the enormous McKenzie River, the 2nd largest river in North America. Prior to spilling into the Beaufort Sea the river widens into a delta approximately 80km wide. It is one side of this enormous delta that Inuvik is placed. With a population of approximately 2300 Inuvik is the largest town in the eastern arctic. The hospital serves both the Inuvik community and the outlying communities, some of which lie over 500km away and consist of a small collection of houses on a corner of one of the arctic islands. Ethnically Inuvik is comprised on 1/3 Inuvialuit (Inuit), 1/3 Gwich’in and 1/3 European Canadian. Many of the population work in local government or oil and gas exploration. In the last couple of years considerable amounts of money have been poured into the town in preparation for the construction of a gas pipeline that is planned to run south to Alberta.
When driving into town the first significant building one comes across is the newly built Inuvik Regional Hospital, completed on 2003. Perched above Boot Lake the hospital is on a refrigerated concrete to guard against the unstable permafrost. The hospital has 15 acute care beds, a long stay unit of 25 beds, an emergency room, three bed ICU, two operating theatres, specialist clinics and general clinics, a physiotherapy department, radiology department consisting of X-ray and ultrasound and a pharmacy. Six full time GPs staff the hospital and are usually assisted by 1 Resident and a rotating roster of surgical specialists and Anaesthetists. Medical specialists visit the hospital on a rotation basis. In addition to the clinics run at the hospital there is also a community clinic based in the centre of town.
Experience two
The call came through at 9am. Stab injury at Colville Lake. I had heard that Colville Lake was an interesting community. In 1962 a Roman Catholic minister convinced his congregation of the Slavey tribes people to travel over the winter ice on foot from Fort Good Hope to the Great Bear Lake. On the banks of the Great Bear Lake they established a camp that over the years became a village. Living off caribou and a plentiful trout supply the community began to grow. With no road access the only way out was several days on a snowmobile in winter or by air year round. Up until recently no scheduled flights serviced Colville Lake. The controlling minister who established the town owned the only plane. The community of about 75 people was alcohol free and had little contact with the outside world. The village consisted of a series of traditional log cabins, a log schoolhouse, church and a short gravel runway. A significant change occurred when the Minister was defeated in the mayoralty election approximately ten years ago. With a change in governance came a scheduled air service and alcohol. Piggybacking these changes came domestic violence and the ills of an increasingly dysfunctional society. Approximately 8 years ago a TB epidemic swept through the community. The Territory government acted by establishing a health centre at Colville Lake, staffing it with a nurse and dosing the population with anti TB treatments.
The stabbing we were soon on route to was yet another assault in a self-destructing community. Due to the length of the runway we were unable to fly the regular King air 200 aircraft. Instead we flew in the larger but slower Twin Otter. As the Twin Otter was not pressurised we flew low over the vast baron expanse of the north. Below convoluted rivers and oxbow lakes passed. Shimmering lakes of a myriad of colours contrasted the baron tundra. Enormous parallel scratch marks stretched into the distance, the footprint of the last ice age’s northern ice cap.
Looking down on the village it could be easy to mistake it for an idyllic miniature model. The log cabins were positioned between trees skirting a wide shimmering blue bay. Colourful boats were pulled up on the beach. The grass was almost an artificial green. Dodging the swarms of mosquitoes we reached the health centre. He lay on a stretcher. Directly over his heart was a dressing under which was a 2cm stab wound and considerable swelling. Thankfully his vitals were stable. The story came out that there had been a party the night before. Like many of the parties, they occur when alcohol comes to town. The favoured form of alcohol is a cheep Vodka. The proprietor in the only liquor store in Inuvik had informed me that the number one selling item in his shop was a box of 12 x 750ml bottles of vodka. As the party got out of hand people became argumentative. In the end one of the women became so angry she seized a carving knife and plunged it into his chest. From my experiences in New Zealand, when two people want to hurt one another they biff each other in the jaw or give each other a black eye. In the arctic they appeared to take assault to another level. Whale harpoons had been known to be driven into a rival’s chest. Machetes frequently left large gashes. Gunshots were not uncommon. Further questioning revealed that the stabber was in fact the sister of the stabbed. We strapped him to the stretcher before sending him off to be loaded onto the aircraft.
Walking through the beautiful buildings next to the pristine lapping lake shore the beauty of the place was a stark contrast to the activities here the previous night. I reflected on the dynamics that push a sister to stab her brother in a drunken rage, the changes the Slavey people have experienced in the last 100 years, the forced introduction of the western culture and the social pressures of living in a small and isolated community.
Career needs
Since deciding on a career in medicine my intention has always been to work in general practice. While I found other disciplines of medicine fascinating, none appeared to provide quite the diversity and opportunities that were possible in general practice. Through my observations it appeared to be the rural General Practitioners that were required to have not only the most diverse set of skills but also the confidence to use them. What I was seeking was a placement that would expose me to the reality of delivering primary health care in an isolated location where outside support was not easy to access.
An observation I had made of House Officers was that there was a very steep learning curve at the beginning of their first year of practice. I hoped that my elective would give me some additional confidence and applied practice so as to ease me through the transition from being a student to that of a junior doctor. The only way for that to be done was to be put in a position where I held some level of responsibility. My greatest concern was that I would arrive at my elective placement to find that I was there to observe rather than take on my own patients and the responsibility that comes with them, as I was soon to find out my concern was completely unwarranted.
My Role
The Canadian and New Zealand medical training programs vary considerably. This became evident on my first day in Inuvik when my supervisor attempted to assign me a role in the hospital. The Canadian 3-4 year postgraduate programs would have me as a senior resident (Registrar) however according to me I was a final year student. After some discussion it was decided that I should work as a ‘Resident’. Without a true understanding of what this position entailed I cautiously accepted, making clear that I was happy for a demotion if I was not meeting their expectations. As a Resident I was under the supervision of one of the doctors. While I was expected to make clinical decisions, admit patients, write medication orders and discharge patients all my orders were counter signed at some point. From the start it was made clear that contacting my supervising doctors was the last step. Prior to making the call I was to have undertaken all examinations, completed necessary tests and put a plan in place. The only exception to this was when someone’s life was in danger.
The first week of my placement I spent in the Emergency Room (ER). I was then rotated through ER, the operating theatre, hospital clinics and the family practice clinics. Once to 3 times a week I was on-call. In addition I was to go along on any medical air evacuations (medivacs) that were required.
While ER operated similarly to the DPH Emergency Department it was on a much smaller scale. During the day 2 nurses and I staffed it with one doctor available as back up. In the evening the same applied however there was only 1 nurse on. Numbers through the ER varied from 10-35 patients a day. ER consisted of a well-equipped trauma room, 2 examination rooms and a 4-bed ICU area.
Surgery occurred in the morning or when it was required. I would either assist the anaesthetist or the surgeon. After the first few cases I was responsible for doing most of the intubations and anesthetic care with the doctor watching over my shoulder. Surgery consisted mainly of appendectomies, tonsillectomies, D&Cs, pregnancy terminations, open cholecystectomies and dental procedures. This varied depending on the locum surgeon in town at the time.
Hospital clinics operated much like a normal GP clinic however catered to those from out of town and patients who didn’t have a regular GP. In these clinics I would see my own patients and have the doctors’ sign off any scripts as necessary. During my elective I travelled with one of the other doctors to two of the small communities to run 2 to 4 day clinics. These trips gave me a good opportunity to gain an insight into the Inuvialuit culture, communities and environment in which these people live.
On-call involved being the first called over a 24-hour period for ER. This covered both walk-in patients and phone calls from the isolated communities. After the 24-hour period I was expected to work the rest of the day sorting out patients that had been admitted. This was frequently a 32-hour stretch often with no sleep. After completing a week with three of these 32-hour shifts plus another 24 hours of regular hours I now know why we have an RDA.
As Inuvik Regional Hospital services the entire Canadian western arctic there are frequent medivacs to the small communities. Fixed-wing aircraft (King-air 200’s, Twin Otters) were most often used however where there was no runway helicopters were employed. Medivac staff included 1-2 pilots, 1 paramedic and me. Communities were up to 2 hours flight away. Medivacs also took patients from Inuvik to Yellowknife, the closest larger hospital. While on some of the medivacs my role was purely to assist the paramedic if the patient deteriorated, on others I was called upon to stabilise the patient prior to flying them out.
Experience three
One of the specialists visiting Inuvik was Dr Frances Wren, a very capable, dynamic and eccentric Gynaecologist. Frances had a very pragmatic approach to medicine that rubbed off in her teaching of students. There was no possibility of standing back and watching, Frances would have me up to my armpits in any number of gynaecological procedures that she could find a patient for.
When a call came in from Tuktoyuktok to say that a woman, who had had a cone biopsy 10 days earlier, had just presented bleeding profusely PV I was the first one she called. The nurses described approximately 2 litres of blood loss and the woman’s BP to be dropping. "Go and get her, pack her hard, and bring her back alive" were my orders. Before boarding the medivac plane I threw some IV fluids, IV lines, vaginal packs, a speculum, gloves and a pair of ring-ended forceps into my pack. After a quick 25-minute flight across the tundra we banked sharply over the sea ice of the Beaufort Sea before landing in a great cloud of dust on the mud runway. A clapped out old van ferried us to the Health Centre nestled in the middle of a collection of rough houses.
As I entered the room it was clear that there was considerable blood loss. Large blood soaked dressings covered the floor and there lay an extremely obese lady smeared with blood. Picking my way through the bloodied dressings I introduced myself to the patient and the nurses. Thankfully one of the nurses had gained IV access so we hung the first bag of fluids. I then busied myself in preparing to pack the patient’s vagina. As one of the nurses was helping me to get the gear ready I quietly asked her whether she had done much of this herself. She responded that she had never done it, I quietly muttered to her that neither had I.
After figuring out how the light attached to the plastic speculum I then managed to insert it upside down (not that I knew at the time). I then cleared away clots to expose a bleeding cervix. Relief, I was in the right place. With my forceps I fed in packing material remembering Frances's instructions to "pack it hard". The tricky part of the procedure was to remove the speculum without removing the packing. After some careful juggling we got the speculum out. Sweat pearled down my brow.
From bed to stretcher to van to plane to ambulance the woman was transferred, all the time receiving IV fluids. Once we got her into Inuvik hospital not only had she stopped bleeding but her blood pressure had stabilised. I had followed my orders, she had been retrieved, bleeding had been stopped and she was alive. After 6 years of medical training it is often easy to feel incompetent at many procedures and master of none. I find it particularly satisfying when I manage to successfully complete a task that results in a good outcome.
Values and limitations
My elective was nothing short of invaluable. As I mentioned, I was seeking an experience that would allow me to put theory into practice and be given a degree of responsibility so as to bridge me between my TI year and the responsibilities that come with being a first year House Surgeon. These goals were certainly met. Over the first couple of weeks I felt that the medical staff were assessing my competence. I seamed to win their trust and as a result was left to practice more independently. Taking on a higher responsibility didn’t always come easily, I was frequently deliberating what medication to start, what doses were normal and debating whether to call my supervisor in the middle of the night.
Some of my skills seemed to be higher than that expected of me, for example inserting IV lines, something that tends to be done purely by nurses in Canada. In other areas I felt quite ignorant. A number of the Canadian medical students in Inuvik humbled me by listing rheumatology blood tests that should be considered for a certain patients, most of which I hadn’t heard of. Certainly many of them equalled, if not exceeded, my knowledge of detail. When it came to the overall management of a patient however I felt quite comfortable with prioritizing investigations and addressing the patients concerns from a number of angles.
One of my major challenges was coming to terms with medication names. Even commonly used medications had different names than where used in New Zealand. A concise formulary such as MIMS does not exist in Canada; instead I waded through a 10cm thick tome every time I wished to confirm doses and interactions.
As my elective progressed I identified a number of areas in which I felt particularly weak, I then put myself in situations where I could pick up these skills. One area in particularly was that of delivering babies. Unfortunately due to the current relationship between midwives and doctors in New Zealand rare opportunities exist for medical students to observe or assist with births. Because of this I maximized my opportunity for delivering babies in Inuvik. Over the three months I attended approximately 10 births and developed a level of confidence to be able to deliver a baby if it was necessary.
The one area that I was not able to gain enough experience to ensure competence was that of completing PAP smears. While I know that this is a skill I will require as a GP, at this stage of my training the nursing staff, female doctors and clinic booking staff seamed to steer women requesting a PAP away from the inexperienced male medical student. While I find this quite understandable it does still leaves me fumbling with the speculum and spilling the fixative.
Experience four
The tall man leaned threateningly over the ER counter. Below him I sat listening. The message I was hearing was that his employee had put his finger through a grinder, he had lost so much blood that he had collapsed, and he required an immediate medivac. All the information on the accident he had received via satellite radio as his employee was with a work crew doing maintenance on a DEW line station. DEW line stations are relics of the cold war. They were a joint US/Canadian initiative to identify and track nuclear missiles launched from the USSR. Each station consists of a large white dome housing a radar arm and support buildings. Originally all the stations were staffed however now most have been automated. Cape Parry DEW is one of those that have been automated. The work crew were supposedly at the station for its annual maintenance.
On questioning the boss I was told the ring finger had a proximal transverse laceration across its dorsal aspect, that there was no sensation in the tip and that he could not move it. From this I interpreted that the extensor tendon, blood and nerve supply and was severed. It seamed that he should be flown in. Much to the bosses despair I told him that I wanted to call the DEW line base and talk with the mans on-site boss before approving the medivac. Huffing and puffing he stormed off.
On the phone the boss gave me a vague story. Apparently there was lots of blood however he hadn’t collapsed. He couldn’t be sure if he had lost sensation or not.
What to do? Cape Parry was at the end of a long isolated peninsular of land jutting out into the Armundson Strait – a flight out there was going to cost about $10,000. With the information we had been told and no other way for the patient to get to hospital we agreed to medivac him.
The flight was stunning as we skimmed across the great slabs of sea ice. After a flight of about 90 minutes we spotted the small gravel runway spanning the width of the peninsular next to the white domes of the DEW station.
The landing was rough, spraying gravel up onto the underbelly of the fuselage. We shuddered to a stop at the end of the runway. Next to a parked truck were two men. We disembarked and walked over to them, expecting a lift up to the station to meet the patient. Instead one of the men pulled his hand out of his jacket pocket exposing bandages. Far from having collapsed our patient stood on the runway commenting that it was really quite a small cut and how sorry he was that we had needed to come all this distance for him. We unwrapped the hand to reveal a minor laceration to the end of his finger. No nerve, blood vessel, ligament involvement. He really could have got away with a band-aid.
Clearly it was his superiors who had over reacted. Chinese whispers amplified the story and before we knew it we had just spent $10,000 to apply a band-aid. To our relief we ascertained that he was not up to date for his tetanus so used that to justify the flight. We wrapped up his finger belted him in and flew him back to Inuvik. Not only did he get a tetanus jab but was given two stitches for good measure. Where the stitches indicated? Possibly not, other than to help alleviate our feeling of having wasted such a large amount of money.
Comments
It’s difficult to see how any medical student would not come away from an elective in Inuvik a changed person. The diversity of cases, responsibility and workload may have left me scarred for life however I loved every minute of it. Inuvik may not however be for everyone. It certainly is not a relaxed holiday. It shouldn’t be seen as a way to see the Canadian Arctic - medical tourism is strongly discouraged by the Medical Director. Students taking an elective placement in Inuvik need to be ready to take on a high level of responsibility and be prepared to work very hard. Because of the workload I would not advise bringing along a partner – the town is fairly quiet and the hours are long.
When comparing the hospital experience in New Zealand and Canada I found that in many ways they operated similarly. One of my biggest challenges was to learn the North American drug names. A small booklet or PDA file to assist with these would have been helpful. In some areas there are local preferences for medications. Where Maxalon is used frequently in the New Zealand in Canada Gravol seams to be the preferred first-line antiemetic. The Inuvik Regional Hospital record keeping system varied to the New Zealand system in that notes were not integrated. Nursing notes were in one file while “Doctors Orders” were in another. I believe the New Zealand system to be more integrated resulting in better multidisciplinary communication. Another difference that I noted was the legislation relating to domestic violence. Where in NZ the police would have been notified about victims of domestic violence presenting to the ER in Canada the victim was the one that needed to initiate the police contact, unfortunately this rarely happened.
The reason I learnt so much on my placement was that I was made responsible. This was in stark contrast too much of the time spent in Dunedin Public Hospital. While exceptions do exist a considerable amount of time in the 4th, 5th and TI are spent floating along on ward rounds being expected to learn through being present or random questioning. While my daydreaming skills were honed my medical knowledge was slow to develop. When responsibility is handed to a student, whether it to actual responsibility of perceived responsibility, I believe strongly that in the majority of cases they will step up and perform to their best ability. While they wont be perfect in all they do they will better retain what they learn as they go along and feel a valued member of the medical team. While feeling very fortunate to have been given these opportunities on my elective it leaves me wondering why I could not have had such experiences in Dunedin.
Undertaking my elective in Canada enabled me to gauge the quality of my medical training. While in Inuvik I worked alongside a number of other residents and medical students. Consistently I was impressed at the level of medical knowledge held by the students. My level of understanding appeared shallow in contrast. There were however areas of my skills that did however seam to be stronger. What I attributed to common sense decision-making appeared to be difficult for some of the Canadian students and residents. I was also far more practiced at practical skills such as inserting IV lines and taking ABGs.
I spent the spring and summer in Inuvik. During this time I got to experience the break up of the river ice, the flowering of the arctic plants, the 24-hours of sunlight and the mosquitoes. While I am sure that each season brings different opportunities from what I understand the time to avoid being in Inuvik would be in the autumn and early winter. With 24-hour dark and -40C there would be little to see. Having experienced the summer I would love to have the opportunity to return to Inuvik in the late winter and early spring when skiing, snow-mobiling and northern lights are at their best.
Acknowledgements
Nina Stupples was to blame for telling me about the great experiences she had in Inuvik nearly ten years ago. Stories over freshly baked cookies motivated me to apply for my elective at the Inuvik Regional Hospital. Thank you Nina for both the cookies and the inspiration.
My sincere thanks go to Braam de Klerk, the Medical Director at the Inuvik Regional Hospital, who began as my supervisor and became a friend. Braam’s commitment to his patients, skills and approach to medicine were inspirational and will help shape me into the doctor I become. I look forward to more trips into the mountains in the future. My gratitude also goes to Chuck MacNeil, one of the GPs in Inuvik, who made a particular effort to get me out to stunning village of Ulukhaktok (Holman). Chucks relationship with his patients, eagerness to advocate for them and sound values made him a valuable role model.
Ellen Hendry at the Dunedin School of Medicine fought long and hard for an exchange with the University of Alberta so as to minimize my fees. While the battle was eventually lost I appreciate Ellen’s hard work both for my elective and the assistance she has provided throughout my medical training.
Thank you to Dan Allen who successfully held the fort and home while I was off travelling the tundra. While the pot plants barely survived his presence is as always appreciated.
Barb, my wife, who is lucky enough to come from the beautiful country of Canada, was instrumental in helping with the decision to undertake my elective there. For her encouragement and support for both my elective and medical training I am forever grateful.
Kynan Bazley, 3 September 2006
