Dawn Ostrem
Northern News Services

Yellowknife (Jan 07/02) - Andre Corriveau, the NWT's chief medical officer, grew up in Montreal. But it seems this former city dweller is meant to work in the North.

How is the NWT regarded by other health officials you meet at national conferences?

Andre Corriveau: I think because we are at the forefront of many issues and work with limited resources, people often look at us for innovative ways or novel ways to deal with issues. We contribute quite a bit to discussions about medicare, the role of nurse practitioners and health-care providers.

Some people look at us with some envy and others wonder why would you want to work up there all by yourself. The issues are different but everybody struggles with limited resources and the challenges of health care as it evolves in Canada right now.

You seem to have been travelling a lot lately. Is your job as NWT chief medical officer always like that?

AC: I have a role in terms of my leadership in the public health system. It is important that the people don't just see my writings or letters, but they see who the person is. So, I like to make myself available.

The other reason I travel a lot is because I get to represent the NWT at a lot of national forums. I am the only public health specialist in the Northwest Territories, so those connections are the very important.

When a health issue becomes a concern what is your next step as chief medical health officer?

AC: The first step is to create awareness. Earlier this spring we published the smoke alarm report. We found, through survey work, that a lot of people don't really see smoking as a health problem. So, we need to create awareness and right now we are obviously not doing a good enough job with youth, especially aboriginal youth. It has been getting worse over the last decade.

The next step, once they have a desire to quit, is to facilitate the tools like smoking cessation programs or banning smoking in public places.

What are the issues facing the North right now?

AC: There are issues around the health-care system and then there are the health issues that affect people. Those two must connect at some point but they are not totally identical.

If I look at a population health perspective, one of the big issues in the North is a lot of premature mortality. And people are sick from preventable conditions, whether it is related to smoking, injuries, drinking, engaging in risky behaviour, drug use, issues with family violence and high rates of sexually transmitted diseases.

There is often a disconnect between the perceived risk versus what the real issues are. Having a dialogue with the community is very important.

For example, when I travel there is a lot of concern about cancer everywhere I go in the North. Cancer is very visible in the North. If somebody has cancer down south their relatives might know but here, in most cases, the whole community knows very quickly. They have noticed a real increase in cancer in the North and their first temptation is to look around and try to point to an external cause -- an old mine that was there or the quality of drinking water.

It is important to explain why rates are going up. The rates of cancer increase in the older population. People live longer than they used to and we have more elders. The other part is going back to those preventable conditions. We have the highest rates of smoking and a lot of diets have changed dramatically from traditional foods that were probably very protective against some kinds of cancer.

Are many people's fears of an outside source unfounded?

AC: I would not want to use the word 'unfounded' because obviously we had an issue a few years ago that came to the forefront. Trihalomethanes (THM) is a product that is produced when you mix chlorine with organic material. We use chlorine to disinfect water, and if the water has a lot of organic material like plant debris or mud, you produce that class of compounds.

Some studies came out of the U.S. saying over a lifetime if you drank water with high levels of trihalomethanes you could increase your risk of cancer by maybe 15 per cent over your lifetime. It is a very small amount. If you compare that to smoking, your risk of lung cancer is seven to 14 times above your baseline risk of developing cancer.

What about sexually transmitted diseases (STDs) in the North?

AC: It is a big concern because it is a marker for high risk of HIV spread, which we have not had, but I think it has been pure luck over any kind of strategy we had.

One of the concerns I have, which is not being spoken of very openly, is sexual abuse and how that contributes to high levels of STDs in young people.

I think there is a lot of forced sexual activity that is going on with older boys and younger girls, and I don't think this issue has been explored or even discussed sufficiently at this point. I think we will have to find a way to connect this. If you are being forced into a sexual act, even if you know you should be using a condom, it is not going to help.

We have the tools to treat STDs and there really is no reason why our rates should continue to be so high. In most parts of Canada the rates of STDs have been going down over the last decade.

What is NWT average compared to the national average?

AC: Well, ours are seven to eight times higher. It is of concern.

What about the health-care system?

AC: It is a big challenge right now. Recruitment is already very difficult, and in Canada we already have a shortage of doctors and nurses and other professionals. Our ability to compete with higher wages and benefits is not infinite. Our system has always been somewhat fragile and it has been a bit compounded in the last few years. We also have the challenges of long distances and working in isolation.

Do you think that would be remedied by changing the system by which the boards currently operate?

AC: Well, I am not going to comment directly on your question. But what I would like to say is that it is a challenge to get the right resources in the right places in the North. Obviously, it is easier to recruit out of Yellowknife than it is in smaller communities, so the problem is compounded. There is a lot of effort that is being done.

There has been work done on the recruitment and retention services with the boards and initiatives for joint-recruiting but it still remains a challenge. We need to develop more Northern resources. We already have our own nursing program. We need to find some flexibility in redesigning our system.

How prepared should we be? Is it going to get worse before it gets better?

AC: I don't think it is going to get worse, but I think we are going to be in a very fragile state for several years. If we have midwives who cannot work as midwives because they are missing legislation, well, let's change the legislation.

What kind of legislation do we have in place for that right now?

AC: There is none. I am using that as an example because it is a commitment our previous minister already made. We have to be sure our system can support the best quality care.

There is a formal commitment we will introduce at some point in the near future to define the scope of practice, the type of role we want to play in the North. It is not illegal to practice midwifery in the North but without the legal framework it makes other practitioners reluctant to engage or partner to guide them.

How have the events of Sept. 11 changed health priorities?

AC: People attended meetings in Ottawa last month on these issues.

The meetings were to map the situation in Canada right now and the gaps that may be here in terms of lab network or training issues, and provide an inventory on what we can do to increase our capacity to respond to real or threatened terrorism.