Early in his medical career, Dr. Peter Newbery realized that to be an effective family physician he’d have to commit to his community. Today, 34 years after moving to Hazelton, the Order of Canada winner says a long-term attachment to community is crucial if family physicians are to understand all of the contexts in which their patients live.

“I learned the importance of a family doc who was prepared to stay and be consistent in a community. My theory all along has been that the willingness of a physician to stay in a community has something to do with the way that community thinks about itself. Medicine becomes a centrally important way of contributing to the life of small communities.”

Haida Gwaii’s Tracy Morton echoes that commitment. The doctor-patient relationship is based on trust, he says, and that isn’t going to happen if you leave after the first rainy season.

Stephen Ashwell, a family physician in Dawson Creek, says it differently but makes the same point. “I don’t need to be heroic. I can just be constant for people. They appreciate that. Staying here and being constant, not glamorous. People don’t need excitement; people need loyalty and constancy.”

Cultivating pride
All three doctors are featured in a new book, Front Lines: Portraits of Caregivers in Northern British Columbia. The book, written by CBC literary award-winner Sarah de Leeuw and co-published by the University of Northern BC and Creekstone Press in Smithers, focuses on 44 innovative and dedicated caregivers from northern BC who, collectively, reveal the essence of effective health care in the North’s more remote and sometimes marginalized communities.

For First Nations caregivers, cultivating pride in identity is key to effective health care. Residential schools, Indian hospitals, reserves, oppressive legislation and stereotyping have all served to engender Aboriginal mistrust of the healthcare system and also to distance Aboriginal people from their rich cultural traditions.

“I work with an amazing team,” says Lisa Sam, a nurse with the Nak’azdli band in Fort St. James. “The core [of our work] is making people feel stronger about who they are. Giving them knowledge and watching them stand on their own two feet. All our programming is about building people’s strengths.”

Barbie Everett, a social worker from Sai’kuz First Nation south of Vanderhoof, recalls a day long ago when the Elders of the community came to her school. “I put on my regalia for the first time in public and we all danced, the Stoney Creek Dancers. I had people come up to me and say you’re so lucky to be Native. I felt so proud. I do have an amazing culture. I have a wonderful culture. It’s so full. It’s so beautiful.”

Given that BC’s Aboriginal population is growing at three times the rate of the non-Aboriginal population and that 15 percent or 45,000 of them live in northern BC, it is essential that caregivers incorporate “another way of knowing” into their health care practices.

“I don’t want to generalize,” says Morton, “but the Haida have a very different idea about things. A medical condition might be because you’re in a bad relationship. Because the spirits are making you sick, or there’s something wrong with your family and you’re worried.

“So much of Haida culture is derived from the relationship to land…a disconnection with the land could manifest to a disconnection with culture and therefore illness.”
Being able to “walk in two worlds” is also important to Prince George social worker Louise Creyke, a Vuntut Gwit’chin woman originally from the Yukon.

“Your way isn’t the only way,” she says, referring to Western bio-medical models of health care. “When we learn to work together, when we better understand grassroots communities and start listening to what aboriginal people say will work for them and their communities, then healing will begin.”

Shared journey
Nurse Debbie Sullivan from the Hazelton area says that while it is crucial to understand the kinship structure of the Gitxsan people she works with, it is just as important to look inward, to be aware of your own culture, your own privileges and idiosyncratic ways of orienting to the world.

“What do you bring to this situation?” she asks. “Do you value connectivity? If you are not interested in who you are, and who another person is, they will very quickly lose interest in what you’re doing.”

On the wall of her cancer clinic in Prince Rupert, nurse Judy Rea provides another clue to effective care giving in the North. It’s in the form of a poem called “Shared Journey” that speaks, metaphorically, to the mutuality of caregiver and patient.

Together, nurse and patient…
take turns carrying one another
for they know that neither can make it alone.
It’s just as true for the physician-patient relationship, says Newbery. “When patients come to see a family doctor, they are placed in an extremely vulnerable position. Part of what makes the relationship work, I think, is for the physician to be vulnerable as well. We share the issue. Together.”

Prince George physician Tammy Attia says much the same thing when trying to define healing. “Healing takes building a relationship, building a bond. And what makes a bond tick? I suspect the basis is mutual trust and respect. This is probably way more important than any knowledge about something organic, or anything pathological or pharmacological or biochemical.”

Actively connecting with the natural world around us, finding a balanced way to inhabit and learn from that world, is another recurrent theme put forward by the northern caregivers. For Newbery, the avalanches and rock-slides along a sometimes flooding Skeena River remind him of the need to be vigilant, of the vulnerability he shares with his patients.

For physician Charles Helm in Tumbler Ridge it’s often as simple as fresh air and exercise. “In the Peace we have these beautiful clear skies in the winter,” he says, “yet people get seasonal affective disorder (SAD) and the winter blues. They buy these SAD lamps [but] you could just go outside and, for free, enjoy the sunlight.”

Rugged terrain and isolated communities
Commitment to place, recognizing the healing power of cultural pride, an openness to other world views, self-awareness, a sense of shared vulnerability, and a therapeutic connection with nature… these, according to northern caregivers, are key components of effective health care in a territory characterized by vast distances, rugged terrain, and isolated communities.

According to Dr. Dave Snadden, head of the Northern Medical Program at UNBC, northern healthcare practitioners deal with serious illness and major trauma with minimal resources in the middle of nowhere, and in weather sometimes too extreme to evacuate patients.

“[Their stories] are about triumph and tragedy, about lives saved, lives altered and lives lost,” he says. “ [They are] a unique collection of individuals whose motivations and passions not only reflect the character and spirit of northern caregiving but entice others to accept its challenges.”