Leader 2a | Really, I'm supposed to tell you that we're still a close-knit community. That we all know each other, but I can tell, if you go to Alberts Lake, the one neighbor may know their neighbors name, but asked them what they did yesterday afternoon; they all can't tell you. It's really small, but like a big city with big city problems. |
Leader 3a | "It was all bush. There were no roads" |
Leader 6a | "I know, a few of my friends. They were so addicted, they had about 6 cokes or pepsi a day, eventually they went on dialysis". |
Leader 4a | “There's a bit of an economic change over the years, too much, too fast. It's like cultural shock. It's different kind of shock, so we are adapting to that change gracefully. That's running and hopping into our trucks and drive 200 yards away. I don’t walk. It’s crazy...We have to change that and go back to promoting a healthy lifestyle.” |
Leader 5a | "The young ones, when they get up in the morning, the first thing they want to watch is Sesame Street. They pick up the language from there. There's an elder here where that made her sad. All her little grandchildren, she wasn't able to talk English or understanding English". |
Leader 2b | "At the corner of this building is the orange tubes that are sticking out. Well, that’s fiber Optic. It’s getting ready to be brought into the community and it will get hooked up here first, right, and then disseminated through the community thereafter. Well, what will that do? Right? If you were to take a survey of the community, there are about 1000 houses plus in the community, out of the 1000 you'll be hard pressed to find 50 ergonomic chairs. For all the gaming and all the videoing we are going to do. You see it on Facebook all the time. I came to visit my relatives, and here's how we visit. Five of them, and they're all in various inappropriate positions. All of that is new and in terms of the course of history... We went from a very mobile community and mobile people, nomadic, self-sufficient, to absolute dependence on technology and other things". |
Leader 2c | "We would make time for that back in the day. You simply lived it. You had silence. You’d make time for silence during the day. Consciously or unconsciously. Its when you have silence that’s when you connect yourself to your spirit. What do VLTs do? They take us away from reality for however long". |
"The VLT example. That desire to be somewhere but no where. I think that is our way of filling the void with what used to be out spiritual experience". |
Leader 3b | "People are scared to do culture things here. We've been told all our lives how to live, how to do things, what to do, how to dress; How to look; How to do things? People are very skeptical about those things." |
Leader 9a | "Well, there's some traditional dancers here. I guess that's traditional too, like trappers go square dancing. When I moved here, I kind of fall in the traditional area, I was shocked that nobody wanted to be out in the open about, like “sweating”, or God forbid “sun dancing”. One of (name) old friends, I would pick her up and we'd sneak away to a sweat and stuff. It's changed a lot. It's a lot more open now, but there's still really strong religious, I guess, spiritual. The man who taught a lot of the people to do sweats and stuff, he was traditional. He was teacher, and had learned that from his. But, he also read a page from the Bible every day. It's funny because everybody really respected him like, “Oh no, he doesn't do that anymore.” So, it's gotten better. I was shocked at how close-minded people were here. Now even the chief and people will be open about it, and be at the ceremonies, and still go to their church. Even at our family camp, we bring in Square dancers and we bring in some of the powwow dancers". |
Leader 4b | Canada is supposed to have health services. They're supposed to be universal. They're supposed to be affordable and accessible. Healthcare is not universal. It's not the same in Winnipeg as in Cross Lake. North or South Province. They are lacking” |
Leader 3c | "It's not community based and it's not accessible. Most of it's not portable. So, it really affects their lifestyle. I'm glad you said that, because that's the biggest thing. Our people want to get better, but everything's out there. Not here. It's always about the medicine You have to get pills or something like that." |
Clinician 1a | "In terms of management, it can be difficult sometimes to prescribe the appropriate non-pharmacological measures." |
Leader 4c | "Here, way down at the bottom of the list. You won’t get the medical attention. A lot of people just quit on that because they can't wait and they just say, “oh, what the hell with it, I'll just go on like this forever”. It's happening all the time, constantly." |
Leader 8a | "Yeah, this for us, we're through the Health Canada, First Nations, Inuit health branch. Anything we do is always federal. I know we are part of the 1964 agreement, which means provincial, but we don't have any provincial here other than some physician services. Majority of our facility is Health Canada". |
Leader 2d | "The mission is to ensure that our residents, within our community boundaries, are kept healthy and their needs are met in regards to clean drinking water, well water and sewer, garbage pickup. Any kind of programs that we can have, that we apply for and implement in the community". |
Leader 5b | "We were more or less neglected out in the bush. Gradually, we go out to the system to be able to face people's oversight. Telling our stories, even telling our stories. Some of those people out in the South, they didn't really trust or believe us. They didn't believe till they actually came to see what was happening." |
Leader 4d | "I think we're looking at the health complex, not just a hospital looking at treatment of illness. It's holistically everything should be covered, and that's what our health centers like. Traditional medicine man there, tradition community Wellness plan, and we have chiropractic care that's going to be there, eye care, and all that stuff. You want to make sure that we have part of this." |
Clinician 2a | "Typically we talk. A lot of it's talking, trying to figure out the source, try to name what the feelings are. That's usually a really big one, and to release some of the emotions. Very often it's tears, so that usually needs to come out. I've recommended and I've sent some folks to the massage therapist that's here. I think that that's been a big help, you know, because muscles store memories and all that. I think some folks have found that helpful." |
Leader 3d | "two things that are relatively new, but right now are almost irrelevant. Probably deemed to be relevant, but very irrelevant to everything you've just said. One is, so my reference point to it is 215. The discovery of those bodies, those unmarked graves. What that has done to the psyche, to the mind and the spirit of the people and its correlation to the body and what has happened. Everything then after gets exacerbated, by pain". |
Clinician 5a | "Do they have access to certain things, you know, that's non pharmacological? In most cases, because it's Cross lakes, they don't, which is an issue. Back pain isn’t just treated with medical therapy" |
Leader 8b | "I was in so much pain, and I went to an Emerge facility. It was terrible what happened there. I was in pain, and the physician that was on call did not believe that I was there for pain. I know I was labeled. I laughed like absolute embarrassment, and my sister said, “do you want to go try acupuncture”? I was at that point, because I did not want to do anything. I did an hour of acupuncture, and I came home and I could do hours of cartwheels. That's where it started. Doing chiro, massage, acupuncture and not having to take medication. It makes the world of difference." |
Clinician 2b | "Anxiety is huge up here. Lots of Marijuana use to try to cope with that, and it's not helpful at all. [...] It's always odd when I find out that someone hasn't been drinking for like a year or more, or that someone isn't using marijuana because marijuana is a be all end all. We find all these young men, they have cannabis induced psychosis, and we see that a lot as well. I think just trying to educate too and just say “Pot is not healthy. No matter what they've been told. This is not going to be the solution to your anxiety and to your emotional difficulties”. |
"Cocaine, for sure. I know crystal meth was bigger up here, but I’m shocked at how much cocaine there is up here. There's a lot of cocaine, marijuana, alcohol, whether it's beer or home brew. But, that was huge during COVID. I don't know if that's kind of settled down a little bit. Maybe it has." |
Leader 5c | “People don’t want to go there [alcoholic anonymous] because you see a person go in there[Nursing Station] after 7:30 in the evening, then that’s an alcoholic. So they are labeled”. |
Clinician 5b | "I typically use the old cards format. So, you know, onset, location, duration and exacerbating bleeding factors. Any of the red flags that can pop up with back pain or spine pain. History wise, that's pretty much how I attack it." |
Clinician 1b | "[...], back pain is so common that I don't think everybody is referring to a clinical practice guideline every day. It just becomes something that's ingrained and it's up to the individual clinician/practitioner to subscribe to anything that could give them updates and if there's something that comes up." |
Clinician 2c | Typically we talk. A lot of it's talking, trying to figure out the source, try to name what the feelings are. That's usually a really big one, and to release some of the emotions. Very often it's tears, so that usually needs to come out. I've recommended and I've sent some folks to the massage therapist that's here. I think that that's been a big help, you know, because muscles store memories and all that. I think some folks have found that helpful. |
Clinician 5c | "A good chunk of my encounters are spent talking about what we can realistically do to tackle it, but I find I've had that issue up north as well as when I was in residency here. I don't know if that part is very cultural, but I do think that the way that they experience it is very different. Psychosocially, pain can present from things like PTSD. By and large things are all related to a lot of mental health conditions. So, I think the experience of “being” is very different up there than it is down here." |
Clinician 1c | "And of course with the last few years, the Canadian Medical Association, and other bodies are recommending against narcotizing patients. We understand that now. Although, maybe some 20 years ago, physicians were told they weren't treating pain adequately or appropriately, and we first used quite a bit of opioids. We know now that probably doesn't help long term and actually creates more issues than we would like to see." |
Clinician 11a | "You know, when people are coming to you and they have real issues and they're suffering, It's a really uncomfortable feeling to feel like you're not sure about what's going on with them or how you can help them." |
“if we focus on this, maybe your back pain will also improve”? In my mind when I say that even though I believe it, I sometimes I worry that this is a desperate move because I'm just not sure what's going on. I want to believe so much that by, affecting their depression, that I'm also contributing to improvement of their back issue." |
Clinician 6a | "..., a lot of the problem is that the source of the mental health problems is not necessarily a problem that could be solved on the medical side of things, right? It is social determinants that affects a lot of it, and we can just provide support. Sometimes you feel you can't fix the problem because it's too over whelming." |
Clinician 6b | "We've been teaching ourselves how to teach some physical activity for patients, but it's very sub-optimal in terms of non-medical care." |
Clinician 6c | "They're more likely to do it, if you go and perform it in front of them. Sometimes we don't have the time to, and, sometimes, that's an important part that patient needs to start moving right away." |
Clinician 6d | "They just end up getting stuck on medication and they develop pain behavior. The patient is now believing that they're very sick because of their back problem. It's hard to make a patient get out of that mindset once it's been established; Especially once you pass that Six month mark." |
Clinician 6e | "[...] but we still don't have a specialist for care like a chiropractor, a physiotherapist, or kinesiologist. Somebody that can give more focused attention to those problems." |
Clinician 1d | “A physician wants to feel good about the (doctor patient) interaction, but also to feel like they’ve helped. There’s nothing worse than listening to an issue and not being able to help your patient, not having a real good option, or at least a reasonable option”. |
Clinician 5d | "It is pretty hard to start that conversation if you've met that patient for the first time that day, because then you start to get some miscommunication. When you mention “mental health” and “pain” it kind of goes to (the patient) “oh, then it's all in my head”, which is not the case. So, I typically will not bring up that initial point until our second time meeting. Again, it is a bit difficult up there to have that continuity of care because our clinic is set up in a way that people see patients first come first serve. So, you're not guaranteed to actually see the patient that you've seen in a couple of weeks." |
Clinician 1e | "You really need to have good rapport, a good relationship, with your patients to be able to even make an impact. What I tell my patients is, I prime them and I say “I probably won't be able to take your pain away completely”." |
Clinician 5e | "Yeah, because we don't typically ever actually get any reports from other healthcare professionals. You know PT, chiro, acupuncture. We don't get those reports. I think it's just because we're assuming that we're not in the same loop, but It would be nice”. |
Clinician 1f | "Neurosurgery and spine surgery services in this province, to put it nicely, are extremely unhelpful and somewhat obstructive. And honestly, you will hear this example, it's going to be recurrent. They don't want to talk to you, unless you have an MRI. They really don't. You could have someone with what sounds like cauda equina and many physicians that I've spoken with have been through that or have had an almost identical experience." |
Clinician 8a + 7a | Clinician 8 “Thompson and Winnipeg, they get the referral and then they notify the patients about the appointments”. Clinician 7 “The patients gets them in the mail. Sometimes the referral clerks here don't get the appointment notices. Most of the time, they mail them to the patient, and then the patients responsibility to bring them here and say, “here's my paper, my appointments coming up”, so that travel can be set up ahead of time”. |
Clinician 9a | “It always seems like it's bad. I think normally they're supposed to have 13 nurses over on that side, and there's maybe 3 or 4 right now. That's kind of been the standard”. |
Clinician 6f | "With the nursing staff it is hard because they keep coming and going. I won't put a lot of resources there and tell all the nurses because they are here today. The problem is they are there for like six months or four months, so there's a lot of inconsistency. They move around a lot ." |
Leader 5d | "This has been our general dream. To get on our own. Get our own, nurses and everything. We have a few nurses already, but what we do is we put them in managerial positions, in some offices. They should be in a nursing station". |
Clinician 2d | "I think if there's more time, more ability, if there's more education, I think that that would make a difference" |
Clinician 11b | “I can't wait for the day where we have (electronic medical records [EMR]) in Cross Lake... It would solve a lot of problems. We'll streamline a lot of things. If one of the implementations of EMR would be to allow us to score and make clinical decisions and access and allow us to have a systematic approach for this population of patient, I think that would be very welcome to everybody.” |
Clinicin 1d | "Basically, you have an image and you point to where the back pain is and then on the same questionnaire one side the patient could fill out their symptoms and symptom frequency and all that. On the other side is a physician assessment [...] So, if they have a “my care map” and then at the bottom there is a Check box for massage therapy, referred to chiropractor, or pharmaceuticals XYZ underneath and that’s it. Then you have that and you can use that form again at the next visit, whether it's 2 or 4 weeks from that first visit" |
Clinician 6g | "I find patients are much more willing to, if they have visuals. Especially if there's more pictures in it than if you just give them a bunch of written exercises that they can do. They're not going to read through it. They're more likely to do it, if you go and perform it in front of them. Sometimes we don't have the time to, and, sometimes, that's an important part that patient needs to start moving right away." |
Clinician 10a | "The other option would be is if it can be set up somewhere on a computer so that it's there all the time, and then if you’re a new nurse coming into the community you can say “Hey, take 20 minutes, 30 minutes, or however long it is. I need you to watch this video. This is important in terms of what we're doing here in this community, and it will help guide if you're dealing with clients with spinal problems, etc.” |
Clinician 11c | "desperate move because [they’re] not sure what is going on" |
Leader 5e | "This has been our general dream. To get on our own. Get our own, nurses and everything. " |
Clinician 4a | “It's just, I guess, education. Like the older people, like the elders, like they need to understand, but they don't. They can't. They don't really understand English that well, so they won't be able to understand what a chiropractor is. Maybe if somebody would explain on the air, like we have a local TV station that people use as bingo. If somebody is out there. If they would put it on the air people, then yeah, they would listen. Somebody would have to interpret for that.” |
Leader 9b | "There was a lot of people that he was working with that have been on lots of pain meds that got off the pain meds. Unfortunately, the women wanted their trailer back to do stuff with it, so he didn’t have a space to do it." |
Leader 1a | "It used to be a college, but not anymore. There used to be a exercise area there, and then close it down. Many people attended that that exercise program. I think we need to go back to exercising. " |
Clinician 6h | "You would think that, if you take the specialist away from the tertiary centre and bring them to a remote area that you would have a good uptake. It doesn't necessarily always happen. I think if you have good logistical support that can ensure that patients are notified and that their mode of transportation can be confirmed, then you'll have a much better ability to see client." |
Leader 1b | "Right now I think it's convenient, because there's the transportation and most of the people have their own vehicles. There is no excuses" |
Leader 8c | "I was under the opinion that you can't see a chiropractor because they're going to snap your neck. Where did that come from? I don't remember, but I do remember being very firm like that was a belief to my core. In Indigenous communities, there's some of these beliefs. They’re myths but turn into beliefs and we hold them dearly.” |
Clinician 11d | "[...], I've never really thought about referring people to chiropractors. You know there is stigma, perhaps. In your first years of medicine, you hear, “oh, there are evidence that chiropractors can cause harm”, so I think it's instilled by training to be a little bit fearful and doubtful" |
Leader 7a | "That might have the greatest pull to have some effect on change, because that would be the right people at the table. You know the one saying “yes, our people need this”, This one saying “these are the benefits here”. They can't argue it because they know they did it before." |
Clinician 3a | “I think every sickness, every chronic-like sicknesses, people have aches and pains, muscle pains, or you know they can't move around, to encourage them to be physical. To have that physical activity, so they'll feel much better if they do these exercises. That way, I think, that they will know the difference. That exercise is important for everybody, even young, old, you know, different age groups and people with disability. We need to reach out to these people, because I hear them say, “oh, there's nothing for us”. They give up, you hear them say “They don't do anything for us”. We have no resources, not much resources that are available even with the equipment myself. I can't have any equipment to do warm-ups. I promote that warm-up exercises. Go out in nature, walk. Go for a walk in the community” |
Clinician 1e | "In terms of management, it can be difficult sometimes to prescribe the appropriate non-pharmacological measures. Recently, with many of these remote northern communities having access to the Internet, It's actually been interesting because I've prescribed physiotherapy by YouTube. There are a couple therapist that I like on YouTube; Brad and Bob I think. They do a good job. They're licensed. I like their approaches. They seem quite reasonable, and it's free of charge, their advice. So, I've used that, and patients who are actually willing to explore have sometimes found this helpful". |
Leader 8d | "Lack of motivation, because we've done some and that's my concern. I said, “how are we going to Prevent that. How do we prevent that?” Because we've done yoga classes, spin classes. We've had nurses who will teach these things, and RCMP. People first come 1, 2, 3, 4, and then they say, “oh, I can't make it tonight. They won't be there tonight. They have this tonight,” and then they all become ghosts, right?" |