INUVIK - After 20 years of serving Inuvik and the Beaufort Delta, Braam de Klerk received the highest civilian honour in Canada for his dedication as a physician, teacher and advocate of health care in Canada's North and in rural communities.

Braam de Klerk, left, receives the Order of Canada from Governor General David Johnston on May 27 at Rideau Hall in Ottawa. De Klerk received the honour for his contributions to health care as a physician, teacher and administrator, and for his continued advocacy for the needs of rural and remote populations in Canada's North. - photo courtesy of Sgt. Serge Gouin, Rideau Hall, OSGG

On May 27 de Klerk received the Order of Canada, which recognizes a lifetime of outstanding achievement, dedication to a community and service to the country. Governor General David Johnston recognized him for his commitment to teaching and training medical students and residents from Canada and around the world.

He is also the founding member of the Society of Rural Physicians and has helped promote sustainable and equitable health care for remote populations. De Klerk worked for 20 years as one of Inuvik's longest-serving doctors before retiring to a locum position last June.

Despite all his accomplishments, he remains humble in his receipt of the award.

"Michael J. Fox, one of the other recipients, said he had a bad case of imposter-itis and wondered why he was here with the other people," de Klerk said. "I just did my job for 20 years and other people did cardiac research or preserved buildings. I just worked in the North in a rinky-dinky town. The important thing is that someone thought we should be recognized."

Since de Klerk and his family moved to Inuvik in June of 1990, he has striven to keep the quality of care equal to that in Yellowknife and the rest of Canada. He has lobbied for extra doctors and specialist visits for the Inuvik region and advocated for the continuation of community-based medicine in Inuvik.

While other regions in the NWT have reduced services or changed from hospitals to health centres, de Klerk has fought against the closure of the operating room at the Inuvik Hospital and against proposals to move obstetric care to Yellowknife. As a result, Inuvik has a high-quality hospital that serves the Beaufort Delta communities, too, with top services available.

"It's not something I did alone. There are great doctors, nurses here and administration, Nellie (Cournoyea) and Fred Carmichael," de Klerk said. "I have worked with a lot of people in the health board and the other guys – Floyd (Roland) and others have made things happen for this town."

De Klerk is also the medical director of the Inuvik training centre for the University of British Columbia rural postgraduate program. Over the past 20 years, 360 student physicians have trained there from all over Canada and the world, including Argentina and Australia.

Statistics from UBC show nearly 70 per cent of residents who completed the program went on to provide rural service. Unfortunately, those numbers have not translated well for Inuvik. In 2004/2005, Inuvik had 11 full-time doctors. Now the hospital has only one.

"We have not had such a big success. Inuvik has an exotic flavour and all Canadians have a taste for the North," de Klerk said. "They come for a longer or shorter time, but once their children reach a certain age, they move south."

Inuvik does have a pool of locum doctors who return many times, but few who settle in the community permanently. With a shortage of doctors across Canada, Inuvik is competing with many other communities and countries to woo new doctors.

"Inuvik gets doctors because it's well-known for its work environment. It's friendly, has a lot of support. We've built a good environment here," de Klerk said. "But it doesn't make people move here forever. Doctors are mobile and can work in Vancouver or Australia. They choose to settle in the south."

Only a certain type of doctor would choose to stay in Inuvik; one who enjoys a variety of practices from surgical to emergency to obstetrics and general practice. They also have to have confidence to make a final decision since no specialist will be around, unlike in places such as Yellowknife to help if a situation turns desperate.

Recruitment

Yellowknife has had a successful recruitment campaign, with 26 doctors for 27 positions with the Yellowknife Health and Social Services Authority and 12 doctors for 21 positions at Stanton Territorial Hospital. It's the other communities, such as Inuvik, that have the trouble. None of them have permanent doctors and that should change, de Klerk said.

"If you have one kid who is a slow reader, you have to help him every evening. You don't have to help the fast reader as much," de Klerk said. "Maybe the GNWT should say 'Next year, let's focus on the smaller communities because what's really doing good in Yellowknife isn't working for the other communities.'"

De Klerk thinks the solution sits with other Northern jurisdictions, in Nunavut, Yukon and northern Ontario, Manitoba, Saskatchewan and British Columbia, to find out what they're doing and then come up with a plan to compete with those areas.

"Do what other places are doing. If they're offering four months of holiday or every other weekend off, do that," de Klerk said. "Money is not the answer, because you don't want money-grabbers, but stop staying dependant on locums."

According to de Klerk, studies have shown that when patients have continuous care from a family doctor, they will cost the health care system less money. Patients will have constant access to physicians and be treated before symptoms turn into serious complications.

"If we really want doctors, we have to look at other jurisdictions," de Klerk said. "We want to finish our own vision, but let's look at other jurisdictions and stop reinventing the wheel. What's working for Yellowknife isn't working for Fort Smith, Hay River, Fort Simpson who don't have permanent doctors."

De Klerk stopped working as a permanent physician in Inuvik last June. When he's not testing out the waters of retirement in Victoria, BC., he returns for six-week stints as a locum.

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