In Nunavut’s remote corners, nurses form the backbone of health care

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This is part of The North, a Globe investigation into the unprecedented change to the climate, culture and politics of Canada's last frontier. Join the conversation with #GlobeNorth.

In any given week, Cathy Rose might suture a wound, set a broken bone, prescribe medicine or take an X-ray in the high Arctic hamlet of Resolute Bay (population 214).

Occasionally, she'll be called upon to treat unlucky soldiers or polar explorers and, in rare circumstances, sew up an injured sled dog in Canada's second-most-northerly community – about 600 kilometres north of the Arctic Circle. Ms. Rose is a nurse, not a physician, but like many in her profession across Nunavut, the northernmost of Canada's three territories, she is frequently called upon to provide health care that can't wait until patients see a doctor.

Physicians are based in only a few of Nunavut's 25 communities, so in most towns and hamlets, the largely Inuit population turn first to nurses for medical attention. This includes basic blood work and delivering babies that come early, before mothers can make it to the capital, Iqaluit.

Nursing is a demanding calling anywhere in Canada, but it's especially trying in remote Arctic communities with harsh climates, where the sun disappears below the horizon for months at a time each winter. "This is not a place to come if you're suffering from seasonal affective disorder," says Joanne van Bommel, a nurse working in Arctic Bay, a northern Baffin Island hamlet of about 820.

Still, nurses such as Gail Redpath – in charge in Arctic Bay – thrive on the challenge. Ms. Redpath, who has practised in the North for decades, says her Arctic career is markedly different from her earlier service at a Peterborough, Ont., hospital. "What I did there is probably one-one hundredth of the job I do here," she says. "I can't imagine leaving this now."

The job carries a cost. Personal and work life blur together in small communities where residents approach nurses for health advice at the grocery store and an emergency can interrupt the small staff's private lives at a moment's notice. Doctors and medical specialists make regular tours of the communities – and are always a phone call, or teleconference, away – but the day-to-day pressures of running a health centre fall on nurses, the backbone of Nunavut's health-care system.

When an emergency arises in Resolute Bay, Ms. Rose, in charge at the Cornwallis Island hamlet's health centre, says she instinctively checks the weather and develops a backup plan in case flights aren't an option.

On good days, a medevac from Iqaluit, 1,575 kilometres to the south, can arrive in Resolute about six hours after it's summoned to rush urgent-care cases to surgery. On rough days, the time it takes to fly a patient to Iqaluit, or farther south, is anybody's guess.

"Sometimes it's heartbreaking, and sometimes the weather is bad, the plane can't come, and it doesn't always have a happy ending. Mostly it does, but sometimes it can be quite heartbreaking," Ms. Rose says.

She refers to herself as an "outpost nurse." The closest equivalent to Arctic nurses in southern communities might be nurse practitioners, health-care professionals with advanced education who carry out some tasks performed by family doctors.

Arctic nurses, though, also develop skills in the most unlikely areas – from troubleshooting the health-centre generator to fixing computers. In late November, for instance, Ms. Rose had to clamber up a boiler room ladder to reboot a malfunctioning telephone system. "I just kind of laughed because they don't teach you this in nursing school," she says.

Health-care providers in the Arctic face some of the toughest challenges in Canada, including high rates of infant mortality, of suicide among young people, of sexually transmitted disease and smoking. However, nurses say the small communities can also make the job more rewarding. They can track the difference they make in their charges' lives. They see a baby and then the next patient might be the child's grandmother.

"You've got the whole spectrum of life in front of you and you can be involved in it and influence it," Ms. Redpath says. "There's nothing nicer than hearing, 'I quit smoking because you told me to.'… It's like you might have saved somebody's life in the long run."

Remote living also offers nurses a front-row seat on the marvel of Arctic wilderness. Ms. Rose talks of her stint in Grise Fiord, Canada's northernmost community, when people banded together to keep polar bears from raiding a pod of beluga whales trapped by the sea ice – a situation that had turned into a "24-hour all-you-can-eat" for the predators.

"People went out and [chased] the bears away and used chainsaws and actually made more breathing holes," she recalled. "They culled the most seriously injured of the belugas to make more room for the ones that weren't injured, and we camped there for a few nights. And the men took turns sitting up to watch for the bears in case they came back."

Of the more than 265 nurses serving across Nunavut, few were born or raised here. Nunavut's government says 97 per cent came from southern Canada or abroad. The hope is this will change. For more than 13 years, Nunavut Arctic College has offered a nursing program that has so far graduated 37 people – more than half of whom are working in the territory today.

"We're the past," Ms. Rose says, referring to herself, originally from Kitchener, Ont., and her Resolute Bay nursing colleague, who hails from Ireland. Of the new homegrown graduates, she says, "They're the future."