By: Mike Hagino, Toronto, Canada
2006 Travel and Transitions travel story contest participant
I am a 52 year old Japanese Canadian dentist who,
in 1997, ditched my Toronto practice in favor of weekend emergency
clinic work. In the fall of 1997, I became part of the Sioux Lookout
Dental Program, providing dental services to the Indian reservations
in the western sector of Northern Ontario - bordered by Thunder
Bay to the south, Hudson' s Bay to the north, and the border
of Manitoba to the west. There are about 24 communities in the Sioux
Lookout zone, with between 200 and 2500 people in each community.
In all, there are probably less than 30,000 people living in an
area the size of France. There is no road or rail access. Each community
has a makeshift airport. Each of my trips are for about two weeks,
taking seven trips in a calendar year.
My first trip to the north was in November of 1997.
I received airline tickets taking me as far as Sioux Lookout (via
Thunder Bay). The orientation was at the zone dental office in Sioux
Lookout, on a Monday. I had arrived the previous night via Bearskin
Airlines and Air Canada from Thunder Bay and Toronto respectively.
We were briefed on native life, customs and treatment philosophies,
then sent back to the hotel - to be flown to the community
the following morning.
That first trip was to a community called Fort Hope,
which had a population of about 1500 at the time. The plane
from Sioux Lookout was a twin engine propellor-driven “toothpaste
tube” run by Bearskin Airlines. The northern Ontario routes
are now run by Wasaya Airlines, a First Nations outfit.
On the morning of my departure to Fort Hope, I was
expected to drop by the hospital kitchen to pick up my grocery boxes
on the way to the Sioux Lookout Airport. It was expected to last
for the first week. A second shipment of groceries were to be flown
up on the Friday for the second week. I was also expected to carry
up the dental supply box, which contained some drugs, record books
and log sheets.
Although only November, the lakes were starting
to freeze over, and snow had been on the ground since Halloween.
Fort Hope, like most of the communities, was a collection of shacks
and prefab houses arranged along “streets”, with a school
(going to grade 8 only), a store, a nursing station, and a band
office - and also small shacks for a pumping station and water treatment,
a power plant, and a leeching bed for waste treatment … and
On arrival, I dragged my gear to the shack designated
as the airport terminal. Waiting for me was a driver from the nursing
station, who helped me load my bags onto the vehicle. At the nursing
station, I was directed to the visitors' apartment in the residence
wing of the station. The visitors' apartment or “transient
apartment” as it is referred to in the north, was quite nice
and well appointed. It had three bedrooms and one and a half bathrooms.
All visitors were expected to share the apartment, so the nursing
staff were careful not to overbook the accommodations. Although
all of the apartments have satellite television service now, the
television in the transient apartment at Fort Hope in 1997 could
only get one channel - CBC North.
After unpacking my bags and stocking the refrigerator,
I went to find the dental office. It was located in the basement,
with a separate entrance from the outside. I was essentially isolated
from the rest of the clinic and staff. I was greeted by my native
assistant, who had only a rudimentary knowledge of dental assisting,
but was invaluable as a translator of the Ojibway-Cree language.
Most of the community will speak English, but many of the elders
hold on to the old ways. Some of the basic dental equipment was
old and worn, such as the chair, light, and compressor. The handpieces,
instruments and materials were current, and I was capable of much
the same level of treatment that I could provide in Toronto. I was
a little nervous that first afternoon, but I soon found my rhythm.
The people were quite courteous, although fairly quiet - especially
The teenagers try to keep up with the style of their
Toronto counterparts. When a dentist comes into town, parents send
in their children first. If the reports aren' t too unfavourable,
then the adults will come in. It is not uncommon for a visiting
dentist to find that he has no patients for the second week, if
the word is spread that he/she is painful and/or deemed incompetent.
If a major faux pas is committed, the Chief and Council may decide
to send the dentist home that very day.
The vast majority of the dental work involves extractions.
Over the nine years that I have been visiting these communities,
I think that the state of the peoples' teeth has generally improved,
although government cutbacks have reduced the number of dental visits,
especially to the large communities such as Pikangikum and Sandy
Lake. Attitudes still have to change. One day, a beautiful teenage
girl came to the clinic, with pain in a maxillary anterior incisor
- a front tooth. It was abcessed. In Toronto, a root canal procedure
to save the tooth would be chosen in 100% of the cases. This girl
asked, ”how long will the root canal take ”and “which
procedure will hurt less. After a minute of consideration, she said
“just pull it out”. This disturbed me. However, her
parents and boyfriend were probably missing these teeth, as well
a great deal of her friends - so why SHOULD she care?
The kids are funny. It seems that parents make an
effort not to duplicate first names within a given surname. If there
is a Bob Roundhead in the community, then the other Roundhead families
won' t use the name “Bob” for new family members. Coming
through the clinic were kids with names like “Thor, Jethro,
Lance, Helmut, etc. An Indian kid with the name of “Bjorn”
is almost surreal.
Nursing bottle caries” runs rampant in the
north. This means that the front four or six teeth have to be extracted
from most two to four year olds. In the city, most of these cases
would be referred to a paedodontist. In the north, the visiting
dentist is expected to deal with this problem, so we are allowed
to administer a sedative, Midazolam, or VERSED (trade name). It
is usually injected, but a 5ml vial mixed with some juice can be
administered by mouth. Parents find it hilarious to watch their
kids drunkenly crash to the floor, 20 minutes after administration.
This would never wash in Toronto.
After a few days in the north, there is the realization
that the supplied groceries are rather bland. The boxes are filled
with chicken breasts, hamburger, a couple of tiny steaks, dried
pasta, rice, fruits, vegetables, cans of soup, milk, bread, apple
and orange juice, and some condiments (packaged ketchup, relish,
salad dressing, mustard, salt and pepper). It was time to visit
the local store. The chain of stores in the north is called the
“Northern. Everything is flown in, so the prices are outrageous.
Snacks, which have a tremendous shelf life and are compact, are
reasonably priced. However, four litres of milk costs $12.00. A
two litre bottle of pop costs $6.00?!!*&%$%. Forget fresh fruits
and vegetables. I limited my purchases to a few snacks and a frozen
The northern Ontario landscape is unfortunately
fairly flat, but dotted with lakes. A winter walk is still beautiful,
especially at dusk. The towns are literally carved out of the bush,
with roads leading out of town to the airport and the dump - and
that' s it. The ice on the lakes will become about three feet thick
by January, which is strong enough for transport trucks. Because
of this, “winter roads are ploughed through the bush and over
the lake systems in January to connect many of the small communities
to the southern highway system. Walking over the frozen lakes makes
for a nice evening walk, especially if the Aurora Borealis is active.
Northern Ontario is still far below the Arctic Circle,
so on the darkest day in December there is still light, but it may
last from about 9:00 a.m. to about 3:30 p.m. In June, the sun may
come up at 4:00 a.m., and not set until 11:00 p.m. Apparently, the
flies in the summer months are almost unbearable, but luckily the
dental program is run during the school months (September to June).
The temperatures in the winter months can reach below minus 40 degrees
Celcius. I don' t believe that a lot of snow falls during the
winter, but all of the snow that falls from the end of October stays
until the end of April.
All of the communities are different. Some are more
dysfunctional than others. Northern Ontario has one of the highest
suicide rates in the world. Despite the fact that all of the northern
communities are supposed to be dry, alcohol and gas sniffing seems
to be cause of most of the problems in the north. Vandalism, assaults,
suicides, family violence and abuse seem to often be related to
some form of substance abuse. Alcohol is often smuggled in over
the winter roads. There are also numerous illegal stills set up
in these communities. People are drinking all sorts of solvents
(antifreeze, hair spray, etc.) and dying or going blind in the process.
However, these problems never seem to present themselves to me during
my stay. The nursing staff deals with these problems while on call
during the evenings.
Along with the varying degrees of dysfunction, are
the degrees of maintenance and community pride. Pikangikum is one
of the most dysfunctional towns in the north, and it resembles a
third world slum in many areas. On the other hand, Summer Beaver
has neat rows of log cabins, with very little garbage in sight.
In all, my experiences in the north have been quite
positive. I think that the native population has a tough time trying
to figure me out. I don' t look like a white man, but I don' t
look quite like them either. One of my assistants pegged me as a
I will continue to travel the north for some time
to come. I have applied for a Nunavut dental license, so I may be
reporting from beyond the Arctic Circle in the near future.