Fly-in DocsBringing the Western medical model to Saskatchewan’s north is a complicated job. Without the nurse, the pilot, and the doctor the system would stall.
The late dawn of a mid-November morning holds the promise of a great day for flying as Dr. Sean Groves pulls off Highway 102 near La Ronge and into the parking lot of (James) Barber Field Airport. The squat brick building is named after a local WWII bomber pilot well known in the area both as a skilled bush pilot and as one of the original few who were counted upon to transport nurses and their patients to and from remote reserves. The few passengers sitting in the lounge are still half asleep, and pay no attention to Groves who chats with a pilot as he signs the flight manifest and walks out onto the tarmac to board the twin engine Navajo chartered especially for this trip to the settlement of Wollaston Lake. Joining him on the flight are a teenaged boy and a young woman with a baby, members of the Lac La Hache Indian Band returning from medical appointments.
For all the medical advances that have taken place in the last fifty years, not much has changed in the world of bush aviation. Although they have an excellent safety record, doctors and nurses who spend time in these small planes operating in adverse weather conditions inevitably accumulate some hair-raising stories; in-flight engine fires, skis snapping upon landing, IV lines freezing up after the cabin heater quits working on a –40 night. Doctors—and by extension, their patients—must constantly put their lives in the hands of the pilots and mechanics.
Remarkably, the baby sleeps soundly through the one-hour flight, unperturbed by the loud engines or the turbulence that comes up when the weather nearer to Wollaston Lake turns cold and it begins to snow. The plane touches down with a gentle bump and Dr. Groves gathers his bag as the other passengers hop down from the cabin. Healthy and happy to be home, their long journey is complete.
In order to achieve a level of healthcare in the northern reserves that is somewhat equal to the care experienced in the rest of the province, the federal government (responsible for funding First Nations healthcare) spends a large portion of the allocated budget on transporting doctors and patients between larger centres and the small reserves. In a single year the La Ronge doctors will make slightly fewer than 400 flights to serve the remote communities on the circuit. Each of these flights is chartered and costs roughly $3000 for a round trip. Also, as chronic diseases such as diabetes continue to spread across the North, more flights are required to take patients from the reserve to specialist appointments in a larger centre. The complicated logistics of organizing and funding such travel has led to the creation of over a dozen transportation coordinator jobs, described as one of the most difficult jobs in the healthcare provision system.
Dr. Groves walks through the small corrugated iron prefab that serves as the airline’s office and exits the building on the other side of the air-strip fence that is adorned with a sign warning that “Unrestrained Dogs will be Shot.” Waiting for him in an idling SUV, is one of the few nurses who works in this settlement of about 1,400 people. As she drives the short distance to the clinic, she tells Dr. Groves that the day’s workload should be light, but they both know from experience that the final tally of patients he will see—anywhere from 8 to 18—will likely include some who haven’t booked appointments. Groves glances up as a raven soars by, takes a last breath of the bracing northern air, and enters the warmth and bustle of a reserve clinic on “Doctor Day.”
The History of the Medicine Chest
When Chiefs Mistawasis, Ahtahkakoop and Poundmaker negotiated with the Crown what would become known as Treaty 6 in 1876, they were doing so on behalf of an exhausted, starving people. Though it is debatable whether the native signatories fully understood the consequences of their dealings with Queen Victoria, they were miserably aware of the circumstances that led them to demand a unique clause that would ensure that “if overtaken by any pestilence, or by a general famine, the Queen, on being satisfied and certified thereof by Her Indian Agent... will grant to the Indians assistance... sufficient to relieve the Indians from the calamity that shall have befallen them.”
Significantly, a short clause was also included, pronouncing “that a medicine chest shall be kept at the house of each Indian Agent for the use and benefit of the Indians.” From this, courts have upheld that all medicine, drugs, or medical supplies are to be provided free of charge to First Nations people.
Not surprisingly, not all of the wonders of modern medicine of the day were immediately made available to the residents of the North. This did mean, however, that for better or worse, under the Indian Act, Natives in the northern regions would now have their health needs administered to by the federal government in far off Ottawa.
By 1946, Premier Tommy Douglas was tinkering with the first incarnations of socialized medicine. That year, the province also introduced the world’s first air ambulance service.
By 1960, the village of La Ronge, previously only served by a small complement of nurses, had a brand new hospital and at least one doctor to staff it. In 1975, the hospital’s four physicians simultaneously departed, leaving vacancies that were filled by Dr. Betty Spooner and three of her classmates, all arriving with the ink still wet on their University of Saskatchewan diplomas. While the exiting doctors left the new recruits to learn the realities of northern medicine for themselves, they also left the beginnings of an ambitious plan to greatly increase the level of care found in the area’s remote reserves.
Stanley Mission, South End, Pinehouse, and Wollaston Lake were beyond the reach of existing roads, and radio reception was patchy at best. Someone who fell ill or was injured had to rely on the under-equipped settlement nurse or risk travel on the trails and waterways that led to La Ronge. Now, arriving by bush planes configured with floats during summer and skis when the lakes froze, the doctor would come to the patient. A new era of medicine in the North had begun.