Nunavut

Researchers shed light on the experiences of caregivers in Nunavut's family service system

Christopher.Sorensen — Thu, 14 Nov 2024 18:22:13 +0000

Researchers shed light on the experiences of caregivers in Nunavut's family service system

Christopher.Sorensen Thu, 11/14/2024 - 13:22

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Researchers at OISE and the Umingmak Centre have released a report that provides insights into the experiences of caregivers of children involved in Family Services in Iqaluit, Nunavut (photo by Saffron Blaze)

Marianne Lau

Topic

Breaking Research

Nunavut

Ontario Institute for Studies in Education

Research & Innovation

Subheadline

Nunavut's Umingmak Centre partnered with the Critical Health and Social Action Lab at OISE to better understand the needs of caregivers and enhance child advocacy in the territory

Researchers at the Umingmak Centre, a child advocacy centre in Nunavut, and the 91�Թ�’s Ontario Institute for Studies in Education (OISE) have released a study that identifies systemic challenges in Nunavut’s child welfare system – and recommends strategies to strengthen caregiver support.

Available in Inuktitut and English, the study is one of the first to directly engage caregivers in Nunavut and emphasizes the importance of understanding of Inuit culture. It found that difficulties in information sharing, resource insecurities, caregiver exploitation and institutional harm are critical issues impacting caregivers’ experiences within Family Services.

The study noted that respondents talked about these challenges differently depending on their backgrounds, including race and socioeconomic status. Unlike their settler counterparts, few Inuit caregivers said they felt burnt out or expressed a need for psychological supports – a phenomenon researchers attributed to a profound and deeply personal sense of exhaustion that has cut across generations.

The report’s authors say the findings underscore a critical need for significant reforms in child welfare, including culturally safe support mechanisms for caregivers following disclosures of child maltreatment and abuse.

“Improving caregiver relationships with services could lead to more community members offering to become caregivers, reducing the number of children leaving the territory into the foster care system,” says study co-lead Romani Makkik, a senior researcher at the Umingmak Centre who is Inuk.

The researchers also highlight the importance of respectful engagement with Inuit communities and the equitable provision of resources that acknowledge and address historical and ongoing systemic injustices.

“Families thrive when they receive meaningful information in a culturally safe, timely, and respectful manner," says Jeffrey Ansloos, an associate professor of Indigenous health and social policy at OISE who is Cree and English, and a citizen of Fisher River Cree Nation. “Achieving this requires a fundamental shift in power dynamics and a focus on relational accountability in service delivery, leadership, and research.

“While much work remains to improve child advocacy in Nunavut, Inuit leadership and strong support for Inuit families must be central. This is why Umingmak’s work is so important.”

Caregivers involved in Family Services have long faced unique challenges and a lack of support while navigating child protection processes in Nunavut. For Inuit caregivers, this is exacerbated by the experience of intergenerational trauma, anti-Inuit racism, and the complex history of Family Services and law enforcement complicity in settler colonization across Inuit Nunangat (the Inuit homeland).

In response, the Umingmak Centre opened in Iqaluit in 2019 to provide trauma-informed, culturally safe care for children and families involved in Family Services due to abuse. A critical gap soon emerged: while caregivers sought services for children, they rarely sought support for themselves, despite the distress that child welfare processes may cause – especially for those facing intergenerational trauma, racism or a lack of cultural safety.

To better understand the needs of caregivers and enhance child advocacy, the Umingmak Centre partnered with the Critical Health and Social Action Lab (CHSA Lab) at OISE, an Indigenous-led research centre led by Ansloos that focuses on advancing health justice through community partnerships.

Between October 2022 and July 2023, the research team conducted 30 interviews with Inuit and settler caregivers who had interacted with the Umingmak Centre, as well as Inuit and settler service providers.

Challenging power dynamics in research

One challenging aspect of the project was ensuring the researchers did not replicate the institutional harms they were studying through their own methods, says Cara Samuel, a doctoral candidate at OISE who acted as project co-ordinator for the study.

The team used a collaborative story analysis method for interpreting the interviews. Guided by the principles of Unikkaaqatigiinniq (storytelling) and Iqqaumaqatigiinniq (all knowledge coming into one), the team analyzed interviews in their entirety to preserve the integrity of each individual’s story.

“Often, how we approach research inadvertently reinforces inequitable power dynamics that prioritize Western or Southern knowledge,” says Samuel. “We wanted to elevate Inuit Qauijimajatuqangit (Inuit knowledge) and cultural resources in our research paradigm and centre lived experience.”

Community leadership and partnership

The CHSA Lab’s emphasis on community partnership ensured genuine collaboration and shared decision-making at every stage of the project.

“We were partners, which means equity in leadership and shared responsibilities for the work and its outcomes,” says Samuel.

“Research is only powerful when led by the community it serves, and we were fortunate to work with dedicated partners in Nunavut committed to justice for Inuit families,” adds Ansloos, who is the Canada Research Chair in Indigenous Studies in Health, Suicide Studies, and Environmental Justice. “Our team worked hard to engage a wide range of people, but Umingmak's research leadership, Romani Makkik, and her long-standing relationships and trusted work in the community made our deeper engagement with Inuit caregivers possible.”

Makkik says that the report will play a crucial role in improving Umingmak’s services and shaping future programs – and that the Umingmak Centre hopes to strengthen its partnerships with government services and community organizations to improve services for children and caregivers across Nunavut more broadly.

Virginia Isaac, a 91�Թ� Social Work grad, is helping Nunavut residents quarantine during COVID-19

Christopher.Sorensen — Tue, 17 Nov 2020 14:31:58 +0000

Virginia Isaac, a 91�Թ� Social Work grad, is helping Nunavut residents quarantine during COVID-19

Christopher.Sorensen Tue, 11/17/2020 - 09:31

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Virginia Isaac, who is graduating with a master's degree in social work, is currently supporting Nunavut residents who must quarantine at an isolation centre in Ottawa before returning to the territory (photo by Dale Duncan)

Topic

Factor-Inwentash Faculty of Social Work

Nunavut

Virginia Isaac, a community social worker with the Government of Nunavut, is working out of Ottawa these days as she supports returning residents who must complete a 14-day quarantine in the territory’s isolation hubs.

The isolation hubs, which also exist in Winnipeg, Edmonton and Yellowknife, serve as entry points to Nunavut and have played a key role in helping it avoid the first wave of COVID-19.

Yet, while the strategy has been successful – the territory’s first case was identified Nov. 6 – Isaac says the experience can take its toll on residents.

“My job is to welcome new guests to the hubs, help them with their adjustment to quarantine, and do whatever I can to ease their stress during their stay,” Isaac says. “Isolation can be difficult, whether you’re travelling alone or managing the pressures of having your spouse and children living together in one room.”

Isaac, who is graduating this fall from the 91�Թ�’s master of social work program in the Factor-Inwentash Faculty of Social Work, does daily check-ins to monitor guests’ needs, which include meals that cater to their cultural and dietary requirements, safety, support and mental health services. Guests at the isolation hubs are reminded to adhere to public heath regulations, which include wearing a mask, practising social distancing, staying in their bubble and washing their hands frequently.

“When people are struggling with the demands of quarantine, I remind them that they’re making a positive contribution to preventing the spread of the virus,” Isaac says. “Remembering the broader value and purpose of their sacrifice often helps.”

As for her own safety, Isaac also takes a big-picture perspective.

“I’m very proud to be among those making a difference in people’s lives during the pandemic,” she says.

Isaac says her education and experience have served her well in her current role. As an advanced standing student, she pursued the faculty’s social justice and diversity field of study.

“A central emphasis in the program is recognizing clients’ unique life experiences and treating them as equal partners,” she says. “This is the way I approach my relationship with every new guest at the hub.”

Isaac was a social worker with the Government of Nunavut for more than six years before studying for her master’s degree at 91�Թ�. When she arrived in the territory in 2012, it was her first time in Canada’s Arctic. “It was a bit shocking at first in terms of the vast and untamed landscape,” she says. “But I took the time to get to know the culture and traditions of the Inuit, and their close relationship to the land.”

She says she soon saw similarities with her own childhood on the Caribbean island of Saint Lucia, where people in her rural village also have strong ties to their surroundings.

Isaac was a teenager when she immigrated to Toronto, which she now considers home. But she spent several years in British Columbia studying, working and vounteering with an intercultural and immigrant aid society – work that inspired her to becoming a social worker. There, she forged strong connections with local Indigenous communities. Before moving to British Columbia, Isaac worked for several years in health care in Toronto.

“I’ve always had a strong interest in learning about and working with Indigenous Peoples in Canada,” she says. “My own experience as a Black woman and that of my ancestors is very parallel in terms of marginalization, poverty, discrimination and stigma.”

For her master of social work practicum, Isaac worked at a community organization serving the Black community in Toronto, where many of the clients were coping with such issues.

Isaac is not sure what she’ll do once the isolation hubs are no longer needed. But she says the uncertainty doesn’t bother her.

“My ambitions are many, but wherever I am and whoever I’m working with, I approach things with an open mind and a passion for helping people.”

Food insecurity in Nunavut increased despite federal subsidy program: 91�Թ� study

Christopher.Sorensen — Tue, 21 May 2019 18:55:26 +0000

Food insecurity in Nunavut increased despite federal subsidy program: 91�Թ� study

Christopher.Sorensen Tue, 05/21/2019 - 14:55

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A study by 91�Թ� researchers found that 46 per cent of Nunavut households suffered from food insecurity in 2014, up from 33 per cent in 2010 (photo by Pierre Dunnigan/500px via Getty Images)

Jim Oldfield

Topic

Breaking Research

Dalla Lana School of Public Health

Research & Innovation

Researchers at the 91�Թ� have charted a spike in food insecurity since the introduction of Nutrition North Canada in 2011, calling into question the federal program’s approach and claims that it has been successful.

Food insecurity is the insecure or inadequate access to food due to a lack of money. In 2010, it affected 33 per cent of households in Nunavut – almost three times the national average. But the 91�Թ� study showed that by 2014, when Nutrition North was fully implemented, food insecurity had increased to 46 per cent of households.

The increase in food insecurity remained even after the researchers accounted for macroeconomic trends and changes in household characteristics over time. The findings were published today in Canadian Medical Association Journal.

“These results are shockingly bad,” says Valerie Tarasuk, the paper’s senior author and a professor in 91�Թ�’s department of nutritional sciences.

“They really call out for a re-think of this program based on the daily experience of people in the North, rather than on metrics such as the price of food and shipments of goods.”

Nutrition North provides subsidies to retailers and suppliers, which are expected to pass on lower prices to consumers in remote areas. The program offered $69 million in subsidies in 2017 and last year the federal government announced an additional $62 million in funding over five years.

The program emphasizes perishables such as fruits and vegetables, and provides funding for education on healthy eating. The Nutrition North website claims the program has lowered the cost of the Revised Northern Food Basket (typical food consumption for a family of four) by almost $100 a month, and that the average volume of eligible items shipped to the North has increased by about 25 per cent.

“Price and volume of shipments are distant measures of whether people can afford and access food,” says Andrée-Anne Fafard St-Germain, lead author on the study and a doctoral student who works with Tarasuk.

“Our results suggest that a lot of people aren’t able to afford the foods in the stores despite the presence of Nutrition North. We think the federal government should be concerned by the disconnect between our findings and their reports.”

The researchers used data from over 3,200 households, based on 18 questions about different food access problems caused by financial constraints in the annual Canadian Community Health Survey. These metrics provide a picture of food insecurity over time, say the researchers.

Food insecurity in Nunavut breached 50 per cent in 2016, the researchers also found. They added that the figures are likely conservative because they are based only on data from the 10 largest communities in Nunavut.

The study results do not provide an explanation for why food insecurity has grown in Nunavut. But the researchers hypothesize that perhaps wealthier households that were already more food-secure benefited the most from the reduced prices.

“We can’t validate whether this is true, but it might help explain how food insecurity has grown while more food is being shipped since this program began,” says Fafard St-Germain.

The researchers acknowledge that their data does not include all aspects of food security that affect the Inuit, including access to traditional foods. But they note that broader measurement could show even more food insecurity, and that the survey data they used is well-suited to measuring the impact of Nutrition North’s retail and subsidy components.

“The bottom line is that this program was never really evaluated against the lived experience of food access,” says Tarasuk, who is also a scientist in the Joannah & Brian Lawson Centre for Child Nutrition and 91�Թ�’s Dalla Lana School of Public Health.

“We can see that food insecurity has worsened, and think that any solution should come with more meaningful input from the people of Nunavut.”

The study was supported by the Canadian Institutes of Health Research.

91�Թ�'s Dr. Barry Pakes reflects on first year as Nunavut’s deputy chief medical officer of health

ullahnor — Fri, 27 Jan 2017 17:18:11 +0000

91�Թ�'s Dr. Barry Pakes reflects on first year as Nunavut’s deputy chief medical officer of health

ullahnor Fri, 01/27/2017 - 12:18

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Professor Barry Pakes in Arctic Bay (photo courtesy of Barry Pakes)

Jim Oldfield

Author legacy

Jim Oldfield

Topic

Dalla Lana School of Public Health

Global

Inuit

91�Թ�'s Dr. Barry Pakes has been Nunavut’s deputy chief medical officer of health for almost a year.

“It's hard to create comprehensive solutions to complex health problems when you're constantly putting out fires,” says Pakes, an assistant professor at the Dalla Lana School of Public Health.

One of those fires is whooping cough, which this year has sickened more than 130 people and sent several infants to intensive care in Ottawa. Another is a common but serious condition called respiratory syncytial virus. Health officials have recorded 88 new cases since September.

“Nunavut has 37,000 people living in 25 communities on land half the size of Western Europe,” says Pakes, the director of the Global Health Education Initiative and the Public Health and Preventive Medicine (PHPM) residency program at 91�Թ�. “The health issues here stem from a complex interplay of cultural, social and historical factors, extreme remoteness and harsh environment, and the dual burden of infectious and chronic diseases in addition to mental health issues.”

Pakes and Dr. Kim Barker, Nunavut’s chief medical officer of health who is also a graduate of the University’s PHPM program, are trying to develop long-term prevention plans for several diseases. The plan for respiratory disease includes widespread vaccination but also better communication among public health workers, hospital staff and primary-care providers.

“One of the first things I did here was start a small brainstorming group of public health and clinical health care professionals,” he says. “The hospital and the Department of Health headquarters were just down the street from each other, but we weren’t problem-solving together like we could have been.”

As Nunavut's deputy chief medical officer of health, Professor Barry Pakes did a radio show on tobacco. Mostly elders called in to ask questions and to describe their personal experiences with quitting (photo courtesy of Barry Pakes)

Pakes says a lot of good has come from the meetings, including new ideas about how to reduce Nunavut’s high number of medical evacuations, which cost tens of thousands of dollars each.

“With more communication, we can better think about how to organize health services and create a web of prevention that saves lives and resources.”

Good communication among the many players in a health system is one lesson Pakes has taken from his years as a global health practitioner and educator. He has been a senior ethics fellow at the World Health Organization and worked in Ethiopia, Zimbabwe and India. He still practices emergency medicine in Northern Ontario and primary care in Barrie.

Pakes’s many roles at 91�Թ� – and the five children he has with his wife, who is also physician – now keep in him in Toronto most days. But he spends at least one week a month in Nunavut. He says that being based in Toronto is at times a drawback, but that it also lets him act as a conduit between South and North.

“The frameworks we teach to PHPM residents in Toronto are exactly those necessary to address the complex issues in Nunavut so it’s very rewarding to bring those perspectives – along with the collective knowledge and overwhelming goodwill of public and allied health experts in Toronto,” says Pakes. “At the same time, it’s great to share lessons learned in Nunavut with my colleagues in Toronto and in training the next generation of Canadian public health leaders.”

Pakes is sensitive to the optics around his background and where he spends his time. He says that Nunavummiut generally don’t want to be told how to deal with their problems by people from the South.

“And health issues here are unique,” he adds. “Some paradigms of global health overlap with Indigenous health, but there are important differences.”

Professor Barry Pakes outside the Arctic Bay Health Centre (photo courtesy of Barry Pakes)

Nunavut's high rates of respiratory disease, relative to the rest of the world, stem in part from overcrowding and smoking in homes. And the mental health issues many residents face – suicide rates in Nunavut are 10 times higher than in the rest of Canada – likely have some roots in Canada's residential school system and the forced displacement of communities, which separated families and pushed many Inuit off their land.

Emma Mew is a master's student in epidemiology at the Dalla Lana School of Public Health. Last summer she worked as a public health consultant in Nunavut, helping the territorial government start to develop a mental health monitoring system to identify at-risk youth and prevent suicide, which in Nunavut often happens in clusters.

“I don’t want to speak on behalf of Inuit, but I gather their experience of colonization has been different from other populations,” says Mew. “Inuit identity is closely tied to the land so forced relocation together with complex social factors likely affect Inuit mental health and wellness profoundly.”

Mew has worked in Tanzania and interned at the World Health Organization, but she says getting things done in Nunavut was harder than anywhere she has worked.

“My department was very cross-cultural, and I feel privileged to have learned so much about Inuit culture from my co-workers. But across the territory, the health workforce is transient – six months is considered long-term – and my impression is that this can exacerbate the divide between Inuit and non-Inuit."

Pakes says that even after ten years of research and a PhD in public health ethics, the ethical dilemmas in Nunavut are some of the most challenging he has faced.

“Inuit culture and self-governance are critically important to every health issue. For example, ‘country food’ and the connection to the land are paramount. So solutions for food insecurity and poor housing that make sense in urban and warmer areas don’t work in the Far North.”

He had a cross-cultural ‘aha’ moment recently while exchanging photos with an Inuit colleague. He proudly showed her a photo of his children, and she responded in kind with a picture of her grandchildren at a feast – two smiling toddlers with their faces covered in seal blood.

And then there is Nunavut’s physical remoteness. It often limits access to health services and online mobile technologies that are improving health globally because satellite Internet access is spotty and slow.

But Pakes says Nunavut's cultural vibrancy and diversity make up for many of its geographical and technological challenges. He says people are surprised when he tells them that Nunavut is probably the most ‘uniquely Canadian’ place he has worked. Iqaluit is home to a flourishing Inuit culture but also a new mosque and many recent immigrants including Cameroonians and a sponsored Syrian family.

"Most days – and daylight can last 18 hours – I feel I can make a real difference,” says Pakes. “And not just for one person but for entire communities. That’s the incredibly rewarding thing about public health.”