With a nursing shortage and no hospital, Island Lake First Nations communities face health-care struggle

CBC Indigenous: Maggie Harper stood on a hill overlooking Island Lake as a helicopter carrying her mother took off from the landing pad alongside the nursing station in Wasagamack First Nation. 

She watched on that October day as the chopper rose and veered south toward St. Theresa Point First Nation, 12 kilometres away.

Harper’s mother, Mona Harper, would be transferred to a medevac for the flight to the Health Sciences Centre in Winnipeg, nearly 500 kilometres to the southwest, where she’d likely face another wait in the emergency room.

Harper knew the day before that her mother — a dialysis patient — would need care. She was unwell, so Harper called the local nursing station. But it was a Sunday after hours, and Harper says staff told her to hold on until the next day, when her mom was scheduled for dialysis. 

“I didn’t like it. What are we supposed to do, just sit around and wait?” she asked.

What happens when a remote First Nation has a medical emergency?

• 4 days ago, 3:05

Click on the following link to view the video:

https://www.cbc.ca/newsinteractives/features/island-lake-hospital

The community of Wasagamack First Nation, in northeastern Manitoba, has no airport. The First Nation relies on helicopters and boats to get people in and out for urgent medical care.

When Harper took her mom to the nursing station on the Monday, her condition had worsened, and she was triaged as an emergency patient. That prompted the cancellation of the day’s community clinic, as staff prepared her to be medevaced. 

It was an ordeal her mother had been through at least three times before — like other residents of her community who depend on being seen by nursing station staff, stabilized, transported to an airport and flown out to Winnipeg when they’re in urgent need of care.

Asked what she thinks of the system, Harper’s assessment was blunt.

“It’s not working.”

‘A lengthy process to get help here’

Wasagamack is one of four First Nations communities that make up Island Lake, an area in northeastern Manitoba dotted with hundreds of small islands.

Island Lake has a population of at least 15,000, according to Scott Harper, the grand chief of Anisininew Okimawin, which represents the four communities. 

Despite having a population roughly the size of Thompson, and having diabetes and hospitalization rates well above provincial averages, Island Lake has no hospital of its own. The region is accessible only by air, boat and an unreliable winter road.

The nursing station in Wasagamack First Nation, which has about 2,300 people, according to federal government data, typically operates short-staffed, with only two or three of five registered nurses working on any given rotation and a fly-in doctor who comes weekly.

The sound of a helicopter seems to always be roaring overhead.

“We’re always, always busy,” said Ian Knott, the health director for Wasagamack First Nation with the Four Arrows Regional Health Authority, which oversees health care in the Island Lake region.

On average, one patient is medevaced out of Wasagamack each day, according to Knott.

Wasagamack doesn’t have an airport, so from May to October, non-urgent patients are ferried by boat across the lake to Garden Hill or St. Theresa Point First Nations, which do have airports. 

But choppy waters can make boating dangerous, and poor weather sometimes means patients are stranded until helicopters can safely land, said Knott.

In the winter months, people are taken by helicopter, and non-urgent patients are taken to an airport by ice road, but that can make the trip riskier, said Knott.

“It is a very lengthy process to get help here.”

Getting a patient to urgent medical care in Winnipeg takes about five hours on average, during which their condition might deteriorate, Knott said.

“They’re sick in the first place and they have to go through that. When they arrive there [in Winnipeg], they have to sit in the waiting room for hours and hours. It’s not good,” he said.

But “our team here tries their best to get patients out as soon as possible.”

Every week, about 100 people travel by boat to an airport to get to medical appointments in Winnipeg, but Knott said the funding for the boat’s gas is inadequate.

The community gets about $75,000 annually for gas, but that needs to double, given the high cost of fuel and growth in the community, said Knott.

He estimates the cost of each medevac at $8,000 to $10,000.

“We have no choice. If we had a hospital here, it would eliminate that cost…. There’s four communities that can use that.”

More health care support needed in Red Sucker Lake First Nation

Watch: 4 days ago, 2:19

The nursing station in Red Sucker Lake First Nation, in northeastern Manitoba, is short of nurses and struggling to meet the needs of the community, which faces chronic illness related to diabetes, mental health and addictions, community leaders say.

Click on the following link to view the video:

https://www.cbc.ca/newsinteractives/features/island-lake-hospital

Most of the community’s health issues are chronic and related to the high rates of diabetes, said Knott, but there’s also an urgent need for addictions services.

Wasagamack created its own detox stabilization unit at the nursing station, where patients can stay for a couple of days, as the wait to get patients out for addictions treatment is between three to four months. 

“It helps. We’re always struggling to help the addicts of opioids and all that,” Knott said.

Patients leaving the community for care also face barriers. Lloyd Harper, who used to be a band constable and heavy duty mechanic in Wasagamack, no longer wants to travel out of the area for the monthly followup care he needs after brain surgery two years ago.

He said staff at the Perimeter terminal in Winnipeg refused to allow him on a plane two years ago because of the way he was walking and his slurred speech due to his injury. 

He said a staff member asked him how much he had to drink and tore up his boarding pass, refusing him the trip home. 

“I was on the street for one week. I had no bus money. I had no taxi money. No hotel money. Nothing.”

He plans to pursue legal action against the airline, but still has to use it each month to get to his appointments in Winnipeg.

In a statement, a spokesperson for Perimeter Aviation said Harper was “regrettably denied” boarding on the flight by a third-party security staff member who mistook Harper’s condition for intoxication. 

The airline said upon learning what happened, it apologized, compensated Harper for the trouble and provided him with a medical letter for future travels. 

The incident sparked change in the type of boarding passes issued and resulted in more training for staff, according to the Perimeter spokesperson. 

“We extend a heartfelt public apology to Mr. Harper. We acknowledge our mistake and deeply regret the oversight,” wrote the spokesperson. 

‘There’s hardly any nurses’

The lack of nurses in Wasagamack First Nation limits the services offered to the community.

While the nursing station has a team of pharmacy workers, paramedics and community health workers, the shortage of nurses is its top issue, said Knott.

“It’s always bad when there’s an emergency. They can’t see other patients in the meantime,” he said, speaking to CBC on the same October day when Maggie Harper’s mother was sent out. 

Anna Harper, a community health representative who works at the nursing station, tried to help people who arrived for the clinic that had to be cancelled that day.

“We’re busy. We’re very busy. As you can see, there’s hardly any nurses,” she laughed, gesturing around the halls of the nursing station.
 

On that day, Anna Harper was responsible for the operation of the telehealth services, looking after patients with tuberculosis, collecting sputum from patients in the community, distribution of medications and pest control.

“Right now, we’re battling cockroaches and bedbugs.… I went on TV and did a little presentation on the bugs, the cockroaches and all that,” she said.

Harper speaks the Anisininew dialect of the region, but most health-care staff don’t, which can lead to issues when people have to explain their symptoms over the phone or understand instructions, she said.

She travels by quad to make several home visits every day to people in the community.

“We need more nurses, and we also need more CHRs [community health representatives] like me.”

In a statement, a spokesperson for Indigenous Services Canada said the national nursing shortage is affecting nursing stations across Manitoba.

While registered nurses are the primary health-care providers at federally funded facilities in First Nations, “they are part of a multidisciplinary, inter-jurisdictional team,” which includes nurse practitioners, psychiatric nurses, licensed practical nurses, doctors, dentists, paramedics and mental health therapists, the spokesperson wrote.

The federal government regularly meets with Four Arrows Health Authority to discuss concerns and future service improvements, according to the spokesperson, who said ISC has “long supported” the Four Arrows Regional Health Authority of the Island Lake Tribal Council communities in efforts with the province to expand health services in the Island Lake communities. 

As well, ISC funds a number of mental health and diabetes prevention programs in the Island Lake communities, the spokesperson said.

“We are working hard with communities to improve services, so they better address the needs of patients.”

Crumbling infrastructure

But in Red Sucker Lake First Nation — which is on a peninsula close to the Ontario border and is the most remote of the Island Lake communities — health-care services are strained and at the mercy of crumbling infrastructure.

Red Sucker Lake, with a population of about 1,200, is only accessible by air for most of the year.

With $13.5 million in funding from the federal government, the community got a new nursing station in 2019, which included an X-ray machine and two hemodialysis machines.

But the X-ray machine no longer works, and the dialysis machines only work when the building isn’t using too much water and the water lines aren’t frozen, as the reservoir is the nearby lake.

In addition to more nurses, Red Sucker Lake needs more space for dialysis, “because we are a community of maybe 50 per cent that have Type 1 and Type 2 diabetes,” said Greg Harper, the community’s health director with Four Arrows.

“We’re supposed to have four full-time nurses, and after the pandemic we’ve only had two at most.”Red Sucker Lake remains in a state of emergency due to a mental health and suicide crisis, prompting calls from leadership for equal access to health care.  

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If you or someone you know is struggling, here’s where to get help:

• Canada’s Suicide Crisis Helpline: Call or text 988.
• Kids Help Phone: 1-800-668-6868. Text 686868. Live chat counselling on the website.
• Canadian Association for Suicide Prevention: Find a 24-hour crisis centre.

This guide from the Centre for Addiction and Mental Health outlines how to talk about suicide with someone you’re worried about.

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In one of many instances, a 16-year-old was found dead in a playground in front of the school. 

More help is needed to address that crisis, said Greg Harper.

“We do have workers that do the work here, but we need more funding within the nursing station,” he said.

“Our expectations, they overweigh the problems we have here…. We’re supposed to have two full-time mental health therapists. There’s only one that comes around.”

He said medevacs can take up to 16 hours to get patients from the community out to Winnipeg, and sometimes people don’t survive the transport. 

“We do try to do what we can, because we are a health centre that provides the service, but most times we struggle from the lack of funding,” he said.

The chief of Red Sucker Lake First Nation said on top of the nursing shortage, the community gets only a single physician visit each month, which isn’t enough.

“Though we were promised to get a full-time physician, a doctor to come and stay with us, it never happened,” said Chief Sam Knott. 

“As I’ve mentioned time and again, we’re in a third-world living condition.”

He also said there’s an urgent need for mental-health support, especially given the remoteness of Red Sucker Lake First Nation. Chief Knott said he and others with the Four Arrows Regional Health Authority have lobbied various levels of government to get funding for a treatment centre. 

A feasibility study on a centre in Red Sucker Lake was completed in 2020, but so far there has been no action.

Knott, like many others in the region, is optimistic there will be changes under the now NDP provincial government, which was elected last October.

“Hopefully this new government will step in,” he said.

‘Committed to a hospital in the region’: premier

When asked about the issue last Friday, Premier Wab Kinew said his government is “committed to a hospital in the region.”

Although it did not include a specific dollar figure or timeline, a new airport for Wasagamack First Nation was promised in the budget his government released last week.

The province needs to be “fiscally responsible” to the public, said Kinew.

“We have to break it down into bite-sized steps. So we’re moving forward with the airport now, and then there’ll be future investments in the region.” 

Mona Harper says that hospital would make a difference for people like her.

After she was medevaced out in October, she spent about a week in a Winnipeg hospital with pneumonia.

The 56-year-old doesn’t have diabetes, but does have a hereditary condition that led to her kidney failure. 

Since that October hospitalization, she said she’s been back to Winnipeg many times for appointments and checkups related to her candidacy for a transplant. 

She said she’s grateful to still be able to live in her home community, unlike the many people from Island Lake on dialysis who are in Winnipeg, waiting for a spot to open up in Garden Hill’s dialysis unit. 

She hopes for better access to care for herself and others in the region.

“It’s a tiring process when you go back and forth between your home community, and especially when you’re on dialysis and waiting on a transplant.”

About the Author

Erin Brohman

Erin Brohman is a producer and journalist for CBC Manitoba. She previously worked as a reporter for CBC News in Yellowknife and as a pediatric nurse in Alberta and Nova Scotia. Email: erin.brohman@cbc.ca.