Grace Egeland knew she was embarking on a delicate mission. The last time a ship had criss-crossed the Canadian Arctic to conduct health surveys, hundreds of Inuit had been taken away from their families, never to return. It was the 1950s, at the height of a tuberculosis epidemic that killed more than 250 Inuit. The federal government dispatched the C. D. Howe, a Canadian Coast Guard vessel converted into a roving medical clinic, to screen the sick. Thousands were moved to sanatoriums in Hamilton, Montréal, Québec and other cities, without being given a chance to say goodbye. To this day, many of their families don’t know where they were taken, whether they subsequently died and, if so, where they were buried.
Egeland, a professor at the School of Dietetics and Human Nutrition at McGill University in Montréal, vowed that her International Polar Year (IPY) Inuit Health Survey would be radically different from the C. D. Howe’s assignment. Under her leadership, the CCGS Amundsen, a retrofitted icebreaker, travelled to 36 communities in Nunavut, the Inuvialuit Settlement Region of the Northwest Territories and Nunatsiavut (northern Labrador) in the summers of 2007 and 2008. With the help of community research assistants, a team of 40 doctors, nurses and scientists embarked on a mass checkup to assess the health status of the Inuit population. “We worked with and for Inuit,” says Egeland.
Relatively recent health concerns, such as obesity, diabetes and heart disease, are having devastating effects among northerners. Yet Egeland, who is also a researcher with McGill’s Centre for Indigenous Peoples’ Nutrition and Environment, says there is still time to make a difference. “With this survey,” she says, “we wanted to discover the factors that contribute to these new health problems and to learn how they can be prevented.”
Map: Steven Fick/Canadian Geographic
The concept isn’t new. In 2004, the Amundsen toured the 14 villages of Nunavik (northern Quebec) for a similar research project. Éric Dewailly, a professor and epidemiologist at Université Laval in Québec and a co-director of the Nasivvik Centre for Inuit Health and Changing Environments, led that survey, simply titled Qanuippitaa? How are we? The last time data had been collected on the health of Inuit communities in Nunavik was in 1992.
Egeland launched Qanuqitpit? Qanuippitali? Kanuivit? How about us? How are we? (in three Inuktitut dialects) to study communities in the rest of the Canadian Arctic, for which no specific Inuit health data had ever been compiled.
Paul Onalik still proudly wears a vest sporting the healthsurvey logo when I meet him in September 2009 on the edge of the bay in Kimmirut, a hamlet of 411 planted in the tundra on southern Baffin Island. Egeland’s team had left the Arctic nearly a year ago and was still collating the survey results, which will be released later this year. But the survey participants had already received their personal health assessments and were following up, if necessary, with their local medical clinics.
Onalik works at the Kimmirut airport, a small corrugatedsteel building barely bigger than a bungalow. He radioes weather information to the pilots of Kenn Borek Air, who come in from Iqaluit four times a week, landing their Twin Otters on the gravelly airstrip. For two summers, however, Onalik took a break from his airport duties to board the Amundsen and work with Egeland as an interviewer, asking fellow Inuit from one end of the Arctic to the other about their eating habits and way of life.
He thought twice before joining the research team. The C. D. Howe experience left deep scars in the collective memory that have yet to heal. “I wasn’t born at the time, but I have witnessed the devastation caused by the disappearances,” says the 49-year-old. “I was immediately assured, however, that this health survey would be different.”
Egeland visited several communities to explain her project in person, and Inuit supported it in droves. About 2,500 participants visited the Amundsen’s floating research clinic in 2007 and 2008 to have a complete physical exam, including blood tests and, for some, bone-density scans and cardiac ultrasounds. They then spent nearly two hours answering questions from interviewers like Onalik, who, as a group, spoke all three of the region’s Inuktitut dialects.
“It was a golden opportunity,” says Iqaluit Mayor, Elisapee Sheutiapik, in her city hall office. “Community clinics are modestly equipped; the arrival of the ship gave us the opportunity to undergo tests that are not normally available here.”
Sheutiapik says she was sold on the project as soon as she heard about the earlier study in Nunavik. As president of the Nunavut Association of Municipalities, she convinced her counterparts of the importance of contributing to Egeland’s survey. In 2007, Sheutiapik travelled to Sanikiluaq to join the field team that visited each community before the ship’s arrival. They explained the project to residents and invited families, whose names had been chosen at random, to participate.
“From the first village, in Sanikiluaq, when the time came to gather people on the beach and bring them to the Amundsen, we ended up with more people than we had on our lists,” she says in a burst of laughter. “Everyone wanted to be on board.”
In each community, the team aimed for and obtained a participation rate of 10 percent of the population. “Sometimes we went into homes to explain the project and were refused,” says Diane McGlade, a nurse in Iqaluit who was a member of the field crew. “But when the boat arrived and a few people had undergone their exam on board, families came over to tell us that they had changed their mind.”
Born in Ontario, McGlade began her career at the hospital in Iqaluit 27 years ago. She works there still, organizing clinics with specialists — ears, nose and throat doctors, gynecologists and cardiologists — who see their Inuit patients only occasionally. “When I started here, we never saw an Inuk suffering from diabetes or cardiovascular disease,” she recalls. “Things began to change a few years after my arrival.”
By choosing southern food over food off the land and gradually abandoning hunting expeditions for a more sedentary lifestyle, Inuit have become susceptible to illnesses that until recently rarely affected them. Traditional Inuit food is full of “healthy fats,” while southern fare is replete with saturated fats. Caribou, seal and polar bear meat and fish are rich sources of unsaturated fatty acids, such as omega-3, with proven benefits for maintaining a healthy heart. “Hunting and fishing are also excellent forms of exercise,” says McGlade, an avid caribou hunter who routinely gives meat to elders who can no longer travel on the land to provide for themselves.
The results of the Nunavik survey show that in 2004, six out of 10 adults were overweight (30 percent) or obese (28 percent). That’s a jump from 1992, when 41 percent of the adult population carried extra weight and 19 percent was obese. The proportion of Inuit with high blood pressure also rose, from 6 percent in 1992 to 12 percent in 2004. These figures concern Laval’s Dewailly. “Combined with other factors, such as smoking,” he says, “it is clear that Inuit are facing serious problems.”
Nevertheless, in 2004 nearly half of Nunavik’s Inuit residents said they hunted at least once a week over the course of two seasons. Not surprisingly, older survey respondents were more interested in the hunt than younger participants.
As a mother of two young children, Laakkuluk Williamson Bathory insists on feeding her family caribou, char and ptarmigan. The daughter of an English anthropologist who spent much of his life in the Arctic and an Inuit immigrant from Greenland, Bathory is firmly attached to her roots. “Hunting is a lot more difficult than it used to be,” she says, while keeping an eye on her youngest child in their home in Iqaluit. “Most of us work nine to five. That leaves weekends for hunting and fishing. We have to go farther and farther to hunt. The city has grown; there are more vehicles and snowmobiles. That chases the animals away.”
Luckily, Bathory can count on a dependable network for traditional food. A friend gave her the beluga steaks that are on tonight’s menu. Sharing food is solidly entrenched in Inuit culture. Most villages still have community freezers, where hunters store their surplus meat for others.
Aficionados of fish and game can also stock up at Jim Currie’s shop in Iqaluit — if they can afford it. A piece of smoked Arctic char sells for up to $20. Yet despite the steep prices, Currie easily sells out of his stock, and his freezers are often empty. “There were fewer hunters last year,” he says. “Many were discouraged by the price of gas. Filling up a snowmobile or motorboat has become unaffordable for many of them.”
Aside from work schedules and the price of gas, many Inuit have given up regular hunting and fishing since the 1980s because of the widespread news of the contamination of marine mammals by heavy metals such as mercury or persistent organic pollutants (POPs) such as polychlorinated biphenyls. But the concentration of POPs in the Arctic has recently declined, and small fish, including the prized Arctic char, are virtually mercury-free.
“From a health perspective, there is absolutely no reason to drop traditional foods,” stresses Isaac Sobol, who worked as the manager of a rock band in San Francisco and as a wildanimal caretaker in European safari parks before becoming a doctor at 41 and practising medicine in aboriginal communities in Canada. He is now Nunavut’s chief medical officer of health. “The benefits of Inuit food easily outweigh any disadvantages,” he says, “especially when we compare it with food from the South.”
Sobol’s department is working with the territory’s grocery stores to help customers understand which foods are safe, neutral or detrimental to their health. “We are a trusting people,” says Mayor Sheutiapik of Iqaluit. “Elders who speak only Inuktitut cannot read the labels and take it for granted that what you find on supermarket shelves is, by definition, good for your health.”
Public health messages are starting to gain ground. In her 71 years in Kimmirut, Annie Ikkidluak has seen the lives of her people completely transformed: increasing contact with southerners and sedentariness in the villages, the arrival of the telephone and the internet. But she has never lost her taste for seal or caribou meat or Arctic char. “It’s better for your health,” translates Ikkidluak’s niece Leevee Temela.
Ikkidluak supplements her diet with food bought at the local co-operative. She makes the best bannock in town, and children flock to her kitchen table for a nibble. A little bit of flour, powdered milk, a pinch of salt and, acknowledging my interest in health issues, she glances over as she picks up Crisco to add to the mix. “I cook everything else with margarine that has no cholesterol,” she assures me.
To address the current state of Inuit health, public health authorities will have to do more than encourage people to eat well and exercise. Smoking, alcoholism and drug abuse are rife in most communities. The 2004 Qanuippitaa? survey revealed that 77 percent of Inuit in Nunavik smoked. That percentage soared to nearly 90 percent among young adults between 18 and 29 years of age.
Seventy-seven percent of the adult population drank alcohol occasionally or regularly, a lower proportion than in the rest of Canada (81 percent). However, nearly a quarter of those respondents admitted to abusing alcohol at least once a week over the course of the previous year. From 1992 to 2004, the proportion of adults using cannabis rose from 38 to 60 percent.
In a “big” town like Kuujjuaq, signs of alcoholism and violence are apparent everywhere. “Sometimes we feel as if we’ve tried everything,” sighs Elena Labranche, assistant to the director of Nunavik’s public health department. Determined to improve conditions in her community, the young Inuit manager worked relentlessly with Éric Dewailly to launch Qanuippitaa? “The results of the survey confirm what we already knew,” she says. “They help to bolster our claims to the government and to develop health-promotion programs, but it won’t be easy.”
Shirley White-Dupuis, one of only three Inuit nurses in Nunavik, faces similar moments of disheartenment. Now 51, she beat alcoholism in her early thirties. “I still attend Alcoholics Anonymous meetings, here in Kuujjuaq,” she says. “We regularly welcome new members, but most drop out.”
White-Dupuis wishes there were more health professionals like her in Kuujjuaq — Inuit helping Inuit, instead of southerners who take care of the sick for a while before heading back home. Over the past few years, Iqaluit’s Nunavut Arctic College, in partnership with Dalhousie University, in Halifax, has offered a bachelor of science in nursing. But the program remains unpopular among Inuit. In Nunavik, aspiring nurses must train in southern Quebec.
“We’re in a better position to understand the needs of the population,” says White-Dupuis. “Our people are still bearing the scars of past traumas, whether that might be the events of the C. D. Howe or a sedentary lifestyle in villages. Many youth turn all this anger onto themselves. They must realize that they don’t have to relive the past. You don’t have to make every little mistake that your parents or grandparents did.”
Sobol shares White-Dupuis’ vision. The best cure for what ails Inuit, says Nunavut’s chief medical officer, lies in learning Inuktitut and being proud of one’s origins and respectful of tradition. It’s more difficult than it seems. “I’ve spent my whole medical career working with aboriginal people,” says Sobol. “They’ve repeatedly been told that they must have one foot in traditional culture and the other in the modern world. It isn’t easy.”
Paul Onalik fully understands this predicament. The topic frequently came up for discussion during the weeks he spent on board the Amundsen. “We often hear Inuit say that things would be better if we could return to the land, to our nomadic way of life,” he says. “But it’s too late. We have to find other ways of expressing our pride. We have to move forward.”
Over the course of the Amundsen’s journey, elders took advantage of the ship’s passage to remember the C. D. Howe years. They took to the airwaves on community radio and organized ceremonies in honour of those who disappeared. “There’s never been any closure,” says Egeland.
In Pond Inlet, members of the community gathered in a circle on the beach as the Amundsen sailed away. They asked the ship’s captain to blow the horn three times, in memory of those who never came back.
Egeland hopes that in the future, when Inuit recall the big ship that came to the Arctic to run health surveys, the image of the Amundsen, rather than the C. D. Howe, will come to mind. “The only way to honour the past and heal wounds,” she says, “is by doing our work in a better way now.”