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FOR THE RECORD
September 19, 2003 Repairing the repair businessExcerpt from a speech by Aqqaluk Lynge, vice-president of the Inuit Circumpolar Conference, at the International Congress on Circumpolar Health in Nuuk I want to talk to you today about the principles of community health. And the field of preventive medicine, or the practice of public health. We need to focus on healthy lifestyles, rather than on curing the disease that follows unhealthy ones. We need to focus less on bringing expensive repairmen - or doctors - to Greenland, for example, and more on developing cost-effective local human resources that promote health and prevent illness. Communicators, educators, and media people may be more instrumental in dealing with our health challenges in Greenland than doctors, expensive diagnostic equipment, and hospital beds. The principles of community health and preventive medicine are not new. They go back a long way in most Arctic countries and, indeed, the world over. Lip-service is often paid to prevention and public health, but it is just not as interesting as, say, studying an obscure chemotherapy for an equally obscure cancer. Or not as easy as simply putting more money into hiring more repairmen to fix what is wrong. Community health principles are well known. It is time we turn back to these principles. They include things such as equitable distribution. In Greenland, and across the Arctic especially, this is a major challenge. For Greenland, our best health - or rather illness - facilities are here in Nuuk. The best diagnostic equipment is here. Some would argue, the best doctors. The principle of equitable distribution means that we must not neglect small communities and small municipalities. Another principle stresses community involvement. This means that there needs to be active participation by members of the local community in their own health decisions. Again, using Greenland as an example, this means that within certain parameters, community members in Qaanaaq, say, should have a say on how the health-care kroners are spent on them. They should be given resources so that they can be decision-makers and take responsibility for their own health. A further underlying principle is using appropriate technology. That is, the technology should be acceptable and relevant to society. This does not mean we need no new technology, or no new approaches to healing those who are sick. But we need cost-effective technology that responds to local needs. I am not quite sure if we need bio-artificial livers, for example. A final principle I want to raise is the necessity of a multi-sectoral approach to health care. This is perhaps one of the most important principles. Treating the sick must be seen as only one segment of the big picture of health. We need to stress nutrition, education, clean drinking water, and appropriate and safe housing. These are all part of health and well-being. If we move in this new direction, are we going to hear more about the woeful lack of doctors? This is a common complaint in many parts of Greenland society, and, I am sure, across the Arctic. Doctors, I believe, are primarily acting as repairmen, and the new approach may actually call for fewer, not more, repairmen. Doctors cannot look after our preventive maintenance, in my opinion, because the structure of their practices is set up to encourage them seeing a patient in a few minutes, prescribing a medication, and shoving them out the door. We cannot expect doctors to make our decisions for us, but we must find a better way, in my opinion, to use their time. They cannot make decisions for us on how much to smoke. They are not the ones who decide whether we will consume alcohol and how much. They won't knock on our door every night to get us out to exercise. They won't stock our refrigerators with nutritious foods. They won't stop environmental contaminants from entering our fragile Arctic environment. Doctors won't make us healthy. It is not time, in my opinion, to throw out all of our repairmen, but it is time to admit that the repair business is itself in need of repair. Perhaps we are asking too much of our doctors. And they cannot deliver. Suicides, depression, alcohol-related diseases, cancer from smoking, and other ills are directly related to our society and individuals not focusing on life. In order to build this new paradigm of cooperation, new research, and sustained political will, what do we have to do? Well, we have to first understand that life is essentially fragile and here in the Arctic it is especially so. Our individual life spans are short. And only a revolution of community life will help us turn it around. What are we to teach our youth? Simple. Look at the data. We need to teach them not to smoke. We need to teach them to use alcohol wisely or not at all. We need to continually remind them of the nutritious and tasty foods we have in our seas and on our lands. We need to get them to reduce their junk food intake. Children need to learn from their families to stay in the kitchen, that good food, taken from the large Arctic cupboard, is made there. Children need to be taught good eating habits. We can, with a new focus on health, rather than on sickness, create an environment that is life-giving for all. Our communities and nations need strong leaders. When there is a leadership crisis, the whole nation feels it. Its members start to feel insecure, lethargic and, eventually sick. Strong leaders in both the scientific and political spheres are needed to make
the necessary changes. We need to work together with the researchers gathered
here to forge a new path. Towards healthier individuals. Towards a healthier
society. COMMENTARY September 12, 2003 Remembering Sept. 11 in New York CityKindness and collective love in the midst of disaster JIM SHIRLEY
It was a little after eight in the morning. I was sitting at the table at my friend Rudy's house trying to put together a breakfast. I've known Rudy since the 1960s, when both he and I were young men involved in the political synergy of the time. He lives in faculty housing at the Pratt Institute in Brooklyn, just across the East River from downtown Manhattan. It was one of those rare magnificent days in New York. The sun was bright, suspended in a deep, rich, blue sky — not that much different than many of the beautiful days I've experienced in my two decades in the Kivalliq. Then, suddenly, there was an unusually large booming sound. It seemed as if it came from a great distance. I could feel, for a moment, a shaking in the foundation of the building. I had never heard and felt anything quite like it. The moment faded, and I decided to go down to the store around the corner from the park where young Black men play basketball every day — a ritual I take some comfort in watching since it is part of my past. As I was making my way past the park, I noticed a group of young Hispanic men and women standing at the corner. There was an intense but subdued conversation going on between them and a man who was in the parking lot, which is also at the corner. I heard him say, "I saw the plane when it crashed into it. It looked like it was intentional." Then I looked up myself. The Twin Towers are very visible from across the East River. The one on the right was on fire, smoke billowing out of it, not far from the top of the building. Like many who had taken notice at the time, I could not really comprehend what was happening. I had become jaded, like all of the other folks on the street, by movies, special effects, illusions of devastation that are coming at us all of the time. A plane crashing into the Twin Towers — it was like a theme from some B movie. I didn't believe what I was seeing, even though it was right there before my eyes. I went on about my business, bought my milk, newspaper and coffee-to-go, and made my way back to Rudy's house. When I walked through the door, the TV was on. It was a horror beyond all description, beyond anything that could be conjured up in a Hollywood imagination. I used to go down to that area when I was a kid, before the towers were even considered, a time when the area was populated by small shops that had been there since the middle of the 19th century. I knew the Twin Tower buildings well. I'd been in them. Just about every summer, I used to jog past them daily along the pathways and small parks on the coast of the Hudson River running past the Twin Towers, down to the Staten Island Ferry at the end of Manhattan. I will never forget the sight of these great symbols of the arrogance of Western domination and economic power crumbling to dust in a matter of seconds. I was amazed at how vulnerable, how much of an illusion it all was. In an instant, everything that everyone had ever known was changed forever. Like everyone else, I was fascinated by the images of terror and chaos on the TV — people dazed, staggering through streets I had known since I was a child. Very briefly, a new race was created, comprised of people from all walks of life, covered in grey dust from head to toe, bound together in a recognition of their most basic urge to survive. It was a time of an encounter with the very basics of human existence — fate and certainty, life and death — all of it transformed into media moments, fragments of personal and collective destiny brought to you in real time, around the world. The ashes and the smoke from the devastation drifted through the air throughout the city for days after the tragic event. I spent some time just about every day not far from the site. Ominous smells would rise up and filter through the streets from time to time, only to be replaced by others. In spite of brutal realities, there was a stubborn strength, a commitment to the rituals and services that keep the city alive. The firemen, policemen and health service officials were the most visible heroes of the moment. There were countless other heroes who were less visible. I made my way across the Brooklyn Bridge which, at the time, was the only way into the city from Brooklyn. I walked around downtown Manhattan, in Soho and below Canal Street. I saw fences along the park, walls, fire stations, police stations covered with flowers, candles, pictures of loved ones who were missing or lost. Kindness and collective love were everywhere. There was scene after scene that honored the human ability of New Yorkers to be compassionate to each other. Even though I now live in another part of the world, I was proud to be one of them. One of the most powerful things that I saw was the strength and grace of our humanness. In New York, for one moment, we had to worry about something more important than whether we had the cash to make it through the day. Maybe, without needing a great tragedy to provoke it, we should be dipping into our abundant social reserves of compassion and selflessness on a more extended basis, right here in the North. On the radio the other day I was saddened to hear someone offering to sell berries they had picked. I know that it was because the person making the offer was broke and needed the money. I couldn't help but feel that with all of the wealth that streams through our northern economies, we could do better than we are doing in dealing with people's needs. It isn't simply a matter of money. The foundations of our lives aren't based on our wealth, but on the social principles we live by: our concern for each other, our awareness and respect for one another. We should try more often to put to the forefront the kinds of things that make us self-sufficient and confident — all of us. We have a distinct environmental advantage over the people of New York. We've got nature on our side, and nature is a better friend and a more considerate adversary than the ones New Yorkers faced in the Twin Towers crisis. Some of the elders I spoke with many years ago said that the struggles people face within themselves in modern life are more dangerous than the ones faced by people exposed to nature in traditional times. The Twin Towers tragedy confirms this on a broader scale. Jim Shirley, an artist who has lived in Rankin Inlet for 20 years, grew up in New York City. FOR THE RECORD September 12, 2003 Little funding for FASD in Inuit communitiesExcerpts from a speech by Veronica Dewar, president of Pauktuutit I have serious concerns about federal government commitment to fetal alcohol spectrum disorder — as evidenced by funding levels of programming for Inuit. Two weeks ago, Pauktuutit participated in a workshop sponsored by the First Nations and Inuit Health Branch of Health Canada to assist in the development of national program guidelines regarding FASD. To give you some context, you need to know that we suspect that many, many children, youth and adults in our communities are FASD-affected, but there are virtually no health professionals practising in Inuit communities who can even diagnose FASD. Rarely are any such assessments conducted by sending individuals south, and so we have no hard figures to offer. The Nunavut government representative at the workshop reported that even though they now have a workplan for addressing FASD issues, there are no plans yet for diagnosis, because they don't want to raise expectations for services and programs that cannot be met by the current or anticipated level of resources. A representative from an Inuit community in Labrador reported that a social worker in her community suspected that a number of children she was in contact with through her work had FASD. She established a partnership with other agencies and was able to fundraise enough to bring in a doctor to assess approximately 33 children from that community. Twenty-seven of these children received an FASD diagnosis! There were more children on the list to be assessed, but there wasn't sufficient time. The majority of these children are now in the school system and experiencing major difficulties. When you consider that this community has a population of only 620, this is a huge proportion of the children in their age group. And that is only the beginning. The representative said that there were many more children not in the social service system that they felt should be assessed as well. Although the doctor is willing to return, no funding has yet been identified. As you can well imagine, the representative stressed that there was a critical need for training, program development and delivery of services to these children. Informally, Inuit representatives at the workshop determined that of the million-dollar enhancement fund recently announced by the Honourable Ethel Blondin Andrew, less than half would go to Inuit. If the numbers of FASD-affected children (not including adults) is anywhere close to what the reality is in the one community I have just mentioned, funding for support for these children and their families is unlikely to come from the dollars that are soon to flow. This is nothing short of a huge tragedy, unaddressed for decades, and seemingly very little to hope for in the near future. While Pauktuutit continues to work on resources and training to increase awareness of FASD and improve prevention and support efforts, the issue requires the urgent attention of many agencies at all levels and a huge influx of financial resources to Inuit. Veronica Dewar, the president of Pauktuutit, delivered this address to a
federal-provincial-territorial meeting of ministers responsible for social services
in Yellowknife on Aug. 25. This week, Pauktuutit held a workshop on FASD in
Iqaluit.
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