COVID-in-the-North

Dr. Sara GouletDr. Sara Goulet is helping keep an isolated northern Manitoba community safe during a pandemic

by Sherry Kaniuga

Standing outside the hospital room of a suspected COVID-19 patient at the Health Sciences Centre this past May, Dr. Sara Goulet had a sudden realization.

One of her many roles involves practicing alongside nurses in Nunavut and remote communities in Northern Manitoba, including her latest posting in Garden Hill First Nation. The reality hit her that just being inside a hospital in Winnipeg posed a risk to both the northern community and her position there.

“I was thinking, if I get COVID-19, either I’m not going to be able to go to work in Garden Hill next week, or I’m not even going to know I have it and I’ll be the person who brings it up north. I don’t think I could live with myself if I was the one who brought the virus in,” she recalls.

A plan was quickly put into place for Dr. Goulet’s hospital work to be covered by other physicians who were keen to fill in. With that, she became dedicated to balancing treating the 4,500 or so residents of Garden Hill and keeping them safe from the deadly virus.

Dr. Goulet’s roles also include Associate Dean of Admissions for the University of Manitoba’s Max Rady College of Medicine and the senior lead coordinating the Fly-In Program with Ongomiizwin Health Services, which serves rural and remote northern areas with largely First Nations and Inuit populations.

In response to the pandemic, her stays in Garden Hill have been extended from 4 or 5 days to 12 days, reducing the frequency of the back-and- forth between the three physicians who serve the community. She then flies back to Winnipeg for about 10 days – where she rests after her exhausting work up north, and manages her other roles from home – before heading back to Garden Hill.

She’s used to taking to the skies – her own father became a bush pilot after fighting in WWII, flying up to remote parts of Nunavut and northern Manitoba transporting cargo and tuberculosis patients.

“When I was young, he would take me with him all the time, showing me how beautiful the First Nations and Inuit communities were, and how they are worth protecting,” she says.

Those memories stuck with her – including the vast need for medical support services in the north.

Northern communities like Garden Hill are particularly vulnerable to COVID-19, due in part to limited capacity and equipment in nursing stations, low ability to transport people out of the community quickly by air, large inter-generational families residing together, and a higher rate of chronic diseases like diabetes. In addition to provincial restrictions on travelling to them, these communities have had to come up with creative ways to keep COVID-19 away – and help people understand public health orders in a way that makes sense to them.

Early on, Garden Hill and the nearby Island Lakes communities established COVID Response Teams, which support community members who need to isolate and monitor people going in and out of the community. They meet people at the airport, to help screen for possible exposure to the virus, along with a handful of Four Arrows Regional Health Authority nurses who normally work in local community health programs which have slowed down. COVID-19 is affecting First Nations people disproportionately, so the Garden Hill community remains vigilant against the virus.

While there’s “a lot of fear around going to Winnipeg,” during the pandemic, every day about 25 people from Garden Hill fly out for medical appointments. Meanwhile, Dr. Goulet and her colleagues have found ways to limit how many people need to come to the nursing station in person, including through the use of virtual care.

“Our Indigenous communities are resilient, and they have strong family connections. So it’s challenging for them to think about not seeing their family members for 14 days because they’ve returned from a medical appointment in Winnipeg and need to self-isolate,” Dr. Goulet explains.

“I’ve been so impressed with how the Chief and council here are rethinking and amending public health guidelines to interpret them for the community. For someone to self-isolate in a home that might have 8 or 10 people, two or three bedrooms and one bathroom is not going to be possible, so they talk about staying in your own ‘family bubble,’ to help reduce the risk of exposure. They’ve been really creative and innovative, and it’s very powerful.”

Dr. Goulet says it’s been “an honour” to work on that piece of the puzzle – to see communities stand up and say, ‘we want to protect ourselves and this is how you can support us.’

“Some days are hard, but I think the gift of COVID-19 is that everything has changed, and we have to think about working differently. There has been some really great teamwork, and our partnership and relationship with the First Nations has been strengthened as we’ve worked together through this process.”