Background Content

Call to Action # 19: Health (18-24)

For fly-in doctors of Manitoba, work is far from home but close to the action

September 27, 2023

Remote nursing stations are a lifeline for First Nations and rural communities, and a fulfilling challenge for the physicians who choose the demanding line of work

At the Cross Lake Nursing Station, Dr. Praveena Senthoor demonstrates wrist movements to Kenton McKay, who will have to travel to Winnipeg – more than 600 kilometres away – to get surgery for his broken hand.PHOTOGRAPHY BY SHANNON VANRAES/THE GLOBE AND MAIL

Special to the Globe and Mail: UPDATED YESTERDAY

Dr. Praveena Senthoor leans over a patient’s left arm on a warm July evening. She inspects a jagged stab wound, then turns to Dr. Anna Schwartz to confer about the number of sutures required to close the laceration.

It’s the type of injury a plastic surgeon might handle “down south” at an urban hospital, but nearly 600 kilometres north of Winnipeg, at the Cross Lake Nursing Station, physicians and nurses have to be prepared to handle whatever comes their way – be it a nasty virus, broken bones, chronic illness, addiction, stroke, dental abscess or, as in this case, the victim of a knife attack.

For Dr. Senthoor, a second-year resident with the University of Manitoba’s Northern Remote Family Medicine Program, that diversity of practice was part of the draw. “I chose Northern Remote because I wanted to be an autonomous practitioner,” she says. “I wanted to be able to do something for every patient that I see and feel comfortable doing that on my own.”

Dr. Senthoor numbs the stab-wound patient’s arm with lidocaine as she and Dr. Anna Schwartz discuss the best way to suture his injury.

The Ontario-born, Irish-trained doctor had landed in the Cree community of Pimicikamak Okimawin, also known as Cross Lake First Nation, only a few days earlier. Like all residents pursuing remote rotations through the University of Manitoba’s Max Rady College of Medicine, Dr. Senthoor will fly into Indigenous communities in Northern Manitoba, working under the guidance of experienced clinicians and living in the community as part of her training. Serving a population of about 8,500, the Cross Lake Nursing Station is the largest in Canada.

Doctor shortages have long presented a barrier to health care in remote First Nations, which lack amenities and are unable to offer recruitment incentives to an already diminished pool of family physicians in Canada. It’s also an area of medicine that comes with significant challenges, but in many ways, it’s the challenges that make remote medicine such an engaging field of practice for those who choose it.

Dr. Schwartz – who agrees the stab wound needs four sutures – pivoted to remote medicine one year after finishing her own residency, and was also attracted to the field by the diversity of care doctors provide in northern communities, and the opportunity to develop new skills. “But in terms of your work-life balance, it’s important to also keep your sanity when you’re up there, because it’s just so different it can feel isolated,” she says, adding that new doctors need mentorship that goes beyond clinical concerns.

It is overcast and 13 degrees outside on the July day when Dr. Senthoor arrives at the Cross Lake Airport, which serves both the local First Nation and the incorporated community of Cross Lake.
Dr. Senthoor arrives at the residence.
Dr. Senthoor and Dr. Schwartz walk around a small wooded area between the nursing station and residence. Long-term staff are wary of going beyond this area because of the many dogs that wander loose. Bears sometimes forage around the dump, known affectionately as the ‘Cross Lake Zoo.’

Cross Lake is Dr. Senthoor’s first fly-in rotation, but the 32-year-old says finding a way to balance remote medicine with her desire for partnership and a close-knit family is “definitely a source of anxiety.” Some medical staff fly into Manitoba from the East Coast while others travel from Ottawa and stay for two weeks at a time. A few have their spouses join – the husband of one Cross Lake nurse works at the local North Mart – while doctors with kids at home might choose to work less than full-time, or fly into a community for three nights each week.

Fly-in veterans say one of the benefits of remote work is that “when you’re home, you’re home.” Yes, there might be long hours and some very late nights during your rotation, but no one is asking you to pop back into the office once you fly out.

Just 7.6 per cent of all Canadian physicians practise rural medicine, and the subset that fall into the remote category is even smaller. Dr. Senthoor shifted her focus toward remote medicine later in her studies, in part owing to the limited number of residency opportunities available to international medical graduates. Only 13 per cent of Canada’s 3,295 residency openings were open to foreign-educated doctors in 2022.

One year into her residency, Dr. Senthoor is grateful to be in the Northern Remote program. “It’s opened my eyes to so much – especially coming from Toronto,” she says. “I didn’t fully understand all the Indigenous struggles in Manitoba, or Canada, and now it’s front and centre.”

A three-year-old girl looks out from the nursing station, a building believed to have been built in the 1960s before its expansion and redesign.
The station’s main hallway is a busy place. A white board lists the weekly schedule of clinics and procedures.
Ivanna Turner, 8, grimaces as a nurse applies ear drops. Staff at Cross Lake, which serves about 8,500 people, have to be ready to treat a wide range of ailments.

Community leaders in Pimicikamak have fought hard for improved health services, and a new $55-million health care complex was announced in 2016 amid a suicide crisis and ensuing state of emergency. Donnie McKay, the community band councillor responsible for health and social services, says breaking ground on the complex required “intense” negotiations with Ottawa; the First Nation is still pushing the Manitoba government to contribute to the project.

The 60,000-square-foot facility is expected to open later this year. Community members, as well as medical staff, are excited by the prospect, but note it won’t erase health inequities faced by remote Indigenous communities like theirs – particularly because it doesn’t include a dialysis unit or a birth centre, meaning many people will still have to travel to Winnipeg or Thompson for routine care.

Mr. McKay says some community members, including his own sister, have declined medical care rather than leave the community. “They are giving up their lives to be with their families,” he says. “That doesn’t need to happen in our country.”

There are also concerns about staffing the new health complex; the existing nursing station rarely operates with a full complement of staff.

Cross Lake’s new health centre is expected to open later this year.

Dr. Barry Lavallee, chief executive officer of Keewatinohk Inniniw Minoayawin, says multiple factors contribute to persistent health disparities for Indigenous peoples. “Our systems, including the federal and provincial systems, work at deficits continuously, despite the evidence saying that we need an equitable amount of physicians, surgeons and facilities in communities so we can deliver care closer to home,” he says.

His organization, which supports health and wellness services for 23 First Nations in Northern Manitoba, is working toward systemic change and aims to become a health service provider in the future. He wants Indigenous peoples to have more autonomy when it comes to who provides health care in their communities, but says fly-in physicians will always have a place in remote medicine.

“First Nations communities are really dedicated to their nurses and physicians,” Dr. Lavallee says. “We have love and we have kindness and we want to share what we have.”

Dr. Senthoor calls a specialist in Winnipeg to discuss a case.

Dr. Senthoor is just wrapping up her first week at the nursing station when the skies clear and the emergency room finally empties out. With the prospect of a couple free hours, the station’s doctors and nurses pile into a minivan and head to the Annual Family Campout on Sand Bay. Organized by the Incorporated Community of Cross Lake – which is independent from, yet deeply tied to, Pimicikamak – the event sees hundreds of families from both communities gather for meals, music and more.

Still in her scrubs, Dr. Senthoor picks wild raspberries with her colleagues, then heads to the main stage where a country artist is performing. The week has left her physically tired but emotionally energized. “I know it sounds super cheesy, but I was just one of those kids that always said ‘I want to be a doctor when I grow up,’” she says. “And I could see myself working somewhere like Cross Lake, especially with all the really great people who are here.”

Dr. Senthoor checks in with her far-away family during a coffee break.