Sailing from Nunavut to Labrador (SOI Arctic Expedition 2016)

Hi friends!

I'm fresh from an expedition to the Torngat Mountains and western Greenland, working as an expedition physician with Students On Ice. I've shared the last three weeks with the most amazing family I've ever worked with - some 120 students from across the North and the world, and a team of 80 educators, including glaciologists, climatologists, botanists, ichthyologists, anthropologists, diplomats, Inuit elders and youth, and some of the world's most brilliant explorers.

Below, I'm sharing daily excerpts from my journals: memories of exploring fjords, calving glaciers, and Inuit communities; watching polar bears, walrus, seals, fish, microscopic critters and humpback whales; participating in the launch of the the National Inuit Suicide Prevention Strategy in Hebron, Labrador; paddling handmade Inuit qajaq's in corners of northern Labrador where they haven't been seen in 150 years, and finding qajaq's old and new in Greenland, home to an awesome resurgence in Inuit qajaq traditions. 

Join me on a remarkable adventure across our Arctic home, with videos, photos, and stories below.

In the expedition spirit, 

Andrew

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Day 1: Ottawa, Canada. 

It's not everyday the Prime Minister of Canada, Justin Trudeau, drops by to wish you well on your Arctic Expedition. An auspicious start! 

Over the next few weeks, I'll be sharing some of my favourite stories and photos from our Students on Ice expedition to the Torngat Mountains, Baffin, and Greenland. What better way to start then on International Youth Day? 

Expedition Leader Geoff Green is one of the greatest champions for youth I've ever met. The organization he founded, Students on Ice, connects northern youth from across Inuit Nunangat with youth from southern Canada and around the world, creating the most profound opportunities for connection, reconciliation, and change I've ever seen. 

It's one thing for a young person to hear about climate change, Inuit relocations, or suicide in Northern communities. It's another thing entirely for a young person to sit beside another youth in Hebron, and hear how their grandparents were forcefully relocated from that same spot just 50 years earlier, to accompany them and wipe tears away during the launch of the National Inuit Suicide Prevention Strategy in that same spot, or to stand at the edge of the greatest glacier in the Northern hemisphere, and watch as it calves icebergs into the North Atlantic, the slow motion of it's retreat suddenly speeding into reality. This is a whole other way of knowing; you feel it in your bones, in your heart and soul; it changes you. What better classroom? What better way to learn?

Summer love. aujaq nalligusuk ᐊᐅᔭᖅ ᓇᓪᓕᒐᓱᒃ We made so much music together on our expedition. This unforgettably fun and beautiful piece was written by Natashia Allakariallak of Iqaluit and Katya Potapov of Toronto, with our wonderful expedition musicians Tim Baker and Ian Tamblyn‪#‎nijjausijaquvagut‬ ‪#‎ᓂᔾᔭᐅᓯᔭᖁᕙᒍᑦ‬ ‪#‎wemakemusic‬

Day 3: Iqaluit, Nunavut

I can still taste the salt sea on my lips from our zodiac race to the ship; Kate and I just unpacked the medical kits and set up the infirmary; my bum's wet; and oh man was it cold out on Frobisher Bay, but we're here!

After a day of twists and turns, dramatic weather in Iqaluit, and a slightly too exciting low level arc below the 380ft cloud ceiling over the tundra, we're here - at sea, aboard the Ocean Endeavour.

It's already hard to imagine the heat we left behind at the University of Ottawa and the Museum of Nature. We filled the day playing icebreakers, connecting, learning Inuktitut, climbing trees (I'm a bad influence!), and then, a last minute race to the airport, uncertainty right until we stood on the edge of the ocean, hearing that our second flight had landed. Every part of being where we are tastes a little sweeter knowing we were so close to having it not happen.

We're so lucky to be here, and we know it.

Now, we're outward bound from Baffin Island, heading to the Torngats and north to Greenland. From this point on I'm a physician at sea, helping to keep a wildly inspiring team of 200 students, staff, and sailors safe in our beautiful and unforgiving Arctic home. 
Atii, anijuq, ilaujunnaqtugut; ᐊᑏ ᐊᓂᔪᖅ, ᐃᓚᐅᔪᓐᓇᖅᑐᒍᑦ!

Day 4: Frobisher Bay, Nunavut

Our first day at sea, and already we woke up to a large herd of walrus swimming alongside the ship, seals popping up around us, and, playing in the flow edge that had altered our course, nine polar bears hunting seals amongst the ice.  Just as beautiful - seeing people discovering these powerful animals for the first time. ‪#‎nanuq‬ 

Day 5: Eclipse Channel, Nunatsiavut

This morning we sailed into Eclipse Channel, in the far northern reaches of the Torngat Mountains. 

After exploring a nearby river, we made our first landing and started workshops out on the land - with plant dude Roger teaching tundra botany, Annie Petaulassie teaching sewing, explorer Dr. Fred Roots investigating our surrounding geology, young Fletcher fishing for arctic char, and Eric Mcnair-Landry and Genevieve Cote launching traditional, handmade Inuit qajaqs. Seeing Nunatsiavimmiut youth paddle Eclipse Channel in handmade Inuit qajaqs was one of the most moving experiences of my life. 

Here's why: 

This spot, North Aulatsivik Island and Eclipse Channel to its west, was one of the last documented camps of what Moravian missionaries called "heathen Inuit", people who resisted settlement and continued to practice a sovereign, Inuit way of life into the late 19th century. I think our Expedition may have been the very first to bring traditional Inuit qajaqs back to Eclipse Channel and North Autlatsivik Island in the 150 years since sovereign Inuit last paddled here. 

 Inuit and qalunaat youth get ready to explore Eclipse Channel in handmade Inuit qajaqs. I think this might be the first time in 150 years that Inuit have paddled handmade Inuit qajaqs in the northern reaches of the Torngat Mountains.  ‪#‎ᖅᔭᖅ‬   ‪#‎qajaq‬   ‪#‎qisforqajaq‬   ‪#‎makinghistory‬   Students on Ice

Inuit and qalunaat youth get ready to explore Eclipse Channel in handmade Inuit qajaqs. I think this might be the first time in 150 years that Inuit have paddled handmade Inuit qajaqs in the northern reaches of the Torngat Mountains. ‪#‎ᖅᔭᖅ‬ ‪#‎qajaq‬ ‪#‎qisforqajaq‬ ‪#‎makinghistory‬ Students on Ice

Amazingly, I think we also may have launched them from the very spot where Inuit qajaqs were last launched. The southern tip of Eclipse Channel is home to the remains of seven sod homes, but it was "westward to the mouth of a bold snow creek which dashed rapidly into the salt water inlet" where on 20 July 1860, almost 155 years ago to the day, the US Eclipse Expedition (after whom the Channel is named) documented an Inuit winter camp on what I think might be the very spot where we landed on our 2016 Students on Ice Arctic Expedition: 

"we sailed westward to the mouth of a bold snow creek which dashed rapidly into the salt water inlet. Here we landed. The first thing we saw on the beach was what appeared to be a dead young seal. Kicking it over, we saw that it was something sewed up. One of the sailors split it open with his knife, which its contents were discovered to be an Esquimaux sealskin shirt and a well worn very short pair of trousers of the same material. Not far off was seen one of the stone huts they build for killing seal, and while we were yet speculating on the fate of the owner of the bundle which was evidently washed up, we came upon an Esquimaux hut, the first we have seen" (Lieber, n.d., in Loring, 1980).

What a perfect accent to a genuinely historic moment: the return of Inuit qajaqs to the northern reaches of the Torngats!

  Annie Petaulassie  teaches Inuit and qaluunaat youth how to make crafts from the land, at Eclipse Channel in the northern Torngats: "I was brought up in a camp until I had to go to school, I have some knowledge of traditional life. I like to pass on our Inuktitut language, traditional songs, and our history to younger generations."  With 33 years experience in teaching, Annie integrates Inuktitut in all subjects, from kindergarten to the  Nunavut Sivuniksavut  program. She's celebrated for her skills in sewing, beading, quilting, crocheting, embroidery, and making mittens, slippers, bags, hangings, parkas, and other useful and beautiful things.  ‪#‎teacher‬   ‪#‎ilisaiji‬   ‪#‎ᐃᓕᓴᐃᔨ‬

Annie Petaulassie teaches Inuit and qaluunaat youth how to make crafts from the land, at Eclipse Channel in the northern Torngats: "I was brought up in a camp until I had to go to school, I have some knowledge of traditional life. I like to pass on our Inuktitut language, traditional songs, and our history to younger generations."

With 33 years experience in teaching, Annie integrates Inuktitut in all subjects, from kindergarten to the Nunavut Sivuniksavut program. She's celebrated for her skills in sewing, beading, quilting, crocheting, embroidery, and making mittens, slippers, bags, hangings, parkas, and other useful and beautiful things. ‪#‎teacher‬ ‪#‎ilisaiji‬ ‪#‎ᐃᓕᓴᐃᔨ‬

Day 6: Ramah Bay/Nullatatok + Nachvak Fjord, Nunatsiavut. 

This morning we sailed into a place I've heard about my whole life, pulling qajaqs and zodiacs ashore to explore one of the most remarkable archeologic sites in the circumpolar world.

People have lived here for a long time. In August 1868, Moravian missionaries described a funny episode that contrasts the fitness of sailing and qajaqing on this wild coast: “Some Eskimoes whom we had met at Saeglek came to see us, as we slowly continued our voyage up the coast; near Nullatatok we could discern the smoke of their huts and their skin-boat…In spite of favourable wind our progress was very slow, owing to the strong current in a southerly direction, and we had to tow our little craft, assisted by some natives, who came on board with their kayaks."

The beach is full of smooth stones, including ramah chert: a semi-translucent, and fiercely sharp stone used as early as 7,500 years ago to make precision tools traded as far north as Greenland and south to New England. The only known source of this rare stone starts just over that first mountain, rising 600 ft from the sea, a distinct vein running some 30km between Nachvak and Saglek Fjords. 

Just meters from the water is a line of green, grassy mounds - the well-preserved remains of Inuit sod homes, and the stone foundations of the house the Moravians built alongside the Inuit: "As Eskimos are by far the larger portion of the year o n the coast, it is very desirable that the new station should be at no great distance from the shore…all the information I could obtain points to Nullatatok Bay as a site for a station, preferably to the spot where our house now stands.” Exploring the shoreline, we could found the remains from the settlement - tools, the door of an old wood stove, and old graves. 

Just being in this place is incredibly moving. It’s beautiful to share some of this knowledge with youth exploring it for the first time, to trade eyes for a few moments and catch each others wonder. 

Along the shore, near a waterfall, we found a natural amphitheatre made of stone. I brought my cello up here and joined David Serkoak from Arviat, Miki Jacobsen from Sisimiut/Nuuk, and Tim Baker from St. John's, who played a song he calls "Spirits." Our friends told us we looked and sounded great, but there's no way their view was better than ours: an incredible group of people, young and old, from every corner of the north and beyond, and the sea and a wall of cloud perfectly surfing up the mountain on the other side of the bay. What a dream.

 As we sailed into Nachvak Fjord, I stood on deck with Boonie and Eli Merkuratsuk, friends I've shared seasons and stories with in Goose Bay, Nain, and the Torngats.   Boonie and Eli were glowing, pointing out places where they'd camped, fished, and hunted with their family growing up. For the Merkuratsuks, this is home. Seeing Nachvak Fjord through their eyes is to discover intimately human stories in one of the wildest places on earth.   Ilinniajuk takunnagiamik. ᐃᓕᓐᓂᐊᔪᒃ ᑕᑯᓐᓇᒋᐊᒥᒃ.  ‪#‎learningtosee‬

As we sailed into Nachvak Fjord, I stood on deck with Boonie and Eli Merkuratsuk, friends I've shared seasons and stories with in Goose Bay, Nain, and the Torngats. 

Boonie and Eli were glowing, pointing out places where they'd camped, fished, and hunted with their family growing up. For the Merkuratsuks, this is home. Seeing Nachvak Fjord through their eyes is to discover intimately human stories in one of the wildest places on earth. 

Ilinniajuk takunnagiamik. ᐃᓕᓐᓂᐊᔪᒃ ᑕᑯᓐᓇᒋᐊᒥᒃ. ‪#‎learningtosee‬

Day 7: Hebron, Nunatsiavut

This morning we sailed into Hebron for the launch of the National Inuit Suicide Prevention Strategy (NISPS).

For Labrador Inuit, Hebron is sacred ground. When we learned the sea ice would alter our course south to the Torngats and Hebron, I was sitting with my young friends from Nain, Makkovik, and Rigolet (Shawna Dicker, Kirsten Dicker, Katrina Ford, Charlie Mae Dyson, Jessica Winters, Michaela Palliser, Robert Jacque) sharing eye contact, feeling the mix of excitement, sadness, and joy that speaks to the importance of this place in our lives.

Beyond the icebergs and islands, the rolling windswept rock hills and valleys are dotted with inuksuit and stone grave sites that speak to hundreds of years of Inuit habitation. The iconic Moravian mission house, crafted with timbers shipped from Germany in 1831 to sedentarize and Christianize the Inuit, still stands here, though it’s now taking on a very different meaning. In 1959, the provincial government declared the community economically unviable, and gathered families into the mission house to tell them that they would be relocated to Makkovik, Nain, and Killinik. They chose the mission house because they knew this was a place where Inuit would not speak back.

 Maatalii Okalik, President of the National Inuit Youth Council, speaks to students in Hebron, Nunatsiavut. Mutely shared a message from Natan Obed, president of Inuit Tapirriit Kanatami. 

Maatalii Okalik, President of the National Inuit Youth Council, speaks to students in Hebron, Nunatsiavut. Mutely shared a message from Natan Obed, president of Inuit Tapirriit Kanatami. 

Looking upstream from suicide takes us to places like Hebron, and moments like 1959. Hopelessness, isolation, intoxication, recent loss - these acute crises can feel messy, complicated by mental distress that too often has its aetiology in a combination of acute or toxic stresses in utero and early childhood, themselves informed by intergenerational trauma and the community distress of social inequities like crowded housing, food insecurity, and poor access to services.

All of this is intimately human. My hometown, Makkovik, still has a neighbourhood called “Hebron”, where refugees from the relocation were settled in 1959 along with others like my grandma Nellie, relocated from Nutak, and left to make a new life in an unknown territory, negotiating access to fishing, hunting, and trapping spots in communities where these had already been claimed for generations. I see the acute manifestations of this upstream story every time I see patients in crisis in my emergency room at the Labrador Health Centre.

Walking in Hebron with my dear friend Gary Baikie, we found the beautiful ruins of his family's old house. “Come here,” he gestured to a black and white photo, handing it to me from the wall, “this is my grandmother. This is her house.” The floor is covered in old paint chips, a brush, an axe handle, the debris of everyday life. His daughter, her great granddaughter Caitlyn Baikie walks through the grass beside me to the window, and we go inside.

 Caitlyn Baikie, from Nain, stands in her great-grandmothers house in Hebron, Nunatsiavut. 

Caitlyn Baikie, from Nain, stands in her great-grandmothers house in Hebron, Nunatsiavut. 

Caitlyn's from Nain, the Arctic Youth and Partnerships manager for Students On Ice. She’s the future. “Whenever I return here I can’t help but think what kind of lifestyle my family and I would have had if we still lived here,” she shares. “We are ready to reconcile with the government, with each other, and with families to move forward to build stronger communities and rebuild aspects of Inuit culture that we once lost."

Gary’s helped build this future. He’s the first Inuit Superintendent of Torngat Mountains National Park, worked on archeological digs in the northern reaches of the park in the 80s, and led the Inuit purchase of the Moravian Mission house. The Moravians initially asked for $1 million, and Gary talked them down to $1. They stipulated that Inuit throat singing and drum dancing never take place in the Mission house - a bizarre request that shows how deep colonial attitudes still run in some circles. Courageously, the first thing Gary and friends did after Inuit reclaimed Hebron was to hold a celebration in the Mission house with Inuit drum dancing and throat singing, welcoming Inuit home.

Wild Labrador weather meant the official launch had to be relocated to to Kuujjuaq ᑰᔾᔪᐊᖅ, Nunavik, and that some of the friends and dignitaries we were expecting were unable to join us, including ITK President Natan Obed, US Ambassador Bruce Heyman, Canada’s Minister of Health Jane Philpott, and from Circumpolar Ambassador and ITK president Mary Simon. But this didn’t stop us from continuing with our own special events to recognize the launch of the NISPS, and I think, allowed for an even more intimate experience for all of us.

Our celebration today really felt like part of this reclamation. Alassua Hanson and Natashia Allakariallak (Iqaluit, NU) throat sang together. David Serkoak (Arviat, NU) and Jonathan Pitseolak (Pond Inlet, NU) drum danced. We again paddled the handmade Inuit qajaqs Eric Mcnair-Landry built, exploring the islands around the community. Maatalii Aneraq Okalik read Natan’s statement from Kuujjuaq, while a gorgeous Inuit sled dog walked freely between the outside and the mission house.

We shared company with Inuit staff from the Nunatsiavut Government and Parks Canada, employed to restore and redefine this as a place of cultural continuity, strongly grounded in Inuit language, culture, and history; a place that supports community cohesion, with all it’s downstream effects, including healthy families and nurturing environments that raise resilient, healthy youth.

A beautiful moment - today, I played cello with Tim Baker in the Mission house, for our expedition family, for survivors of the relocation, for this place. Afterwards, as we watched youth pulling up qajaqs, getting ready to set out again, Jacko D Merkuratsuk smiled and told me the cello had sent shivers down his spine. This meant the world to me - he’s a a bit of a hero to me, like most of the people gathered at Hebron today. Each note was inspired by the most important people in my life, survivors and a new generation building a future I’m so thankful to be a part of.

 Playing cello with Hey Rosetta's Tim Baker in the Hebron mission house, to mark the launch of the National Inuit Suicide Prevention Strategy. 

Playing cello with Hey Rosetta's Tim Baker in the Hebron mission house, to mark the launch of the National Inuit Suicide Prevention Strategy. 

Day 8: Saglek Fjord, Nunatsiavut

Today, making house calls meant joining Inuit youth at sea on Saglek Fjord. This was my first time back since Exercise Piulitsinik, our search and rescue exercise with Parks Canada and Joint Task Force Atlantic in the Torngat Mountains last Fall. This time, we surfed stormy waves under dramatic clouds, zipping along the fjord in our zodiacs. A favourite moment: singing Stan Roger's "Northwest Passage" with James Raffan and friends, giving my cello a salt water baptism on the devil's dance floor. There are lots of beautiful moments in medicine, and lots of beautiful ones too.

We spent the day studying tundra botany and archeology, and getting ready to say farewell to Labrador - for me thankfully a very short farewell, until I come back home to Nunatsiavut in the fall. Tonight, we sail north from the Torngats, back across the Hudson Straight and along the eastern edge of Baffin Island towards Greenland.

 Group photos are always better with wolf-huskies in them. Students on Ice in Hebron, Nunatsiavut. Qimmiq ᕿᒻᒥᖅ sled dog. Isuraqtujuq ᐃᓱᕋᖅᑐᔪᖅ lead dog in a sled team. Ilagiit ᐃᓚᒌᑦ family. Ilajaakka ᐃᓚᔮᒃᑲ my extended family.

Group photos are always better with wolf-huskies in them. Students on Ice in Hebron, Nunatsiavut. Qimmiq ᕿᒻᒥᖅ sled dog. Isuraqtujuq ᐃᓱᕋᖅᑐᔪᖅ lead dog in a sled team. Ilagiit ᐃᓚᒌᑦ family. Ilajaakka ᐃᓚᔮᒃᑲ my extended family.

Learning to see: ilinniajuk takunnâgiamik

"Il a trouvé le beau et l’a partagé avec nous tous."

I'm fresh from an expedition to the Torngat Mountains and western Greenland, and am catching up on some writing - including notes on a separate and remarkable 1700km expedition by sled and ski, up the coast of Labrador from Goose Bay to Tikkoatokak (more on this soon!). Shortly after getting back from this trip, I returned to my clinic in Nain, Nunatsiavut, and shared a lovely visit with my dear friends Harry and Sophie, and their kids Leon and Nellie. 

Like so many loved ones in Labrador, Harry Borlase is a second generation friend - our parents worked together as teachers on the north coast in the '80s, and Harry and I have been fast friends ever since we first ran into each other in Yukon some seven years ago. Sophie and Harry fell in love a few years ago, and I've had the great joy of growing closer with them during my regular trips up the coast for clinic and exploration.  Sophie sees beautifully, and writes what she sees. After my last trip to Nain earlier this summer, she wrote a post that helped me see the world a bit differently, about how I'd helped her see her world a bit differently. How nice is that? 

"Dans la vie, tout (ou presque!) est question de perspective. Certains ont une facilité déconcertante à voir le beau et d’autre ont plutôt tendance à mettre l’accent sur les petits et grands défauts, sur ce qui pourrait être mieux.

L’inspiration pour mes billets me surprend parfois. Aujourd’hui, j’ai essayé mes vêtements d’été en prévision d’un voyage-éclair au Nouveau-Brunswick plus tard cette semaine. Rien ne fait. Je suis incapable d’enfiler mes pantalons et mes blouses habituellement amples me collent au corps et m’empêchent de bouger. J’ai failli paniquer, mais j’ai plutôt décidé de prendre Nellie dans mes bras et de me laisser bercer par ses petits ronflements. Mon corps a porté Léon et Nellie. Je t’aime mon corps!

Andrew

Notre ami Andrew était en visite la semaine dernière. Il est médecin et vient régulièrement faire son tour à Nain. Andrew lui voit le beau partout, il le crée même parfois! C’est lui qui a pris la magnifique photo de couverture.

J’étais passé devant la même peau d’ours et me disant que c’était dommage que la fourrure soit cachée et que ça ne valait probablement pas la peine de prendre une photo. Andrew lui s’est faufilé entre le cadre de bois et la maison pour prendre sa photo. Il a trouvé le beau et l’a partagé avec nous tous. Merci à Andrew et à toute les personnes qui nous rappellent que malgré les mauvaises nouvelles et les tracas de la vie, il est encore possible de s’émerveiller.

 

 Harry, Léon, Andrew et Nellie en route vers l’école pour le spectacle de fin d’année des élèves

Harry, Léon, Andrew et Nellie en route vers l’école pour le spectacle de fin d’année des élèves

Harry, Léon, Andrew et Nellie en route vers l’école pour le spectacle de fin d’année des élèves.

Dans les yeux de Léon

En écrivant ce billet, j’ai aussi pensé à Léon qui voit la vie et le monde du haut de ses 3 ans. Notre grand garçon sait maintenant épeler son nom, se pratique à l’écrire, il sait lire une dizaine de mots, il aime prendre soin de sa petite soeur, nous aider à préparer le repas et même à faire le lavage. Il aime créer des villages avec ses blocs et il s’invente toutes sortes d’histoires et de jeux. Il nous ramène en enfance et nous donne l’occasion de jouer nous aussi. Je l’aime mon grand!

Il y a quelques jours, il m’a demandé s’il pouvait prendre des photos avec mon téléphone. Après avoir effacé quelques centaines de photos très floues, j’ai trouvé des petits trésors.

 Tendre moment pris en photo par Léon alors que nous étions tous les 3 dans son lit après la sieste

Tendre moment pris en photo par Léon alors que nous étions tous les 3 dans son lit après la sieste

Tendre moment pris en photo par Léon alors que nous étions tous les 3 dans son lit après la sieste.

La même journée, Léon a réussi à capturer sur vidéo l’un des premiers vrais sourires de sa petite soeur. Un souvenir que nous chérirons pour toujours!"

Read more of Sophie's beautiful writing on her website, iniKunattutk

Friluftsliv and winter medicine

In early February my friends and I surfed the friendly edge of a rather unfriendly winter storm, racing across the island of Newfoundland to catch the ferry across the Straights of Belle Isle to the Labrador coast. 

Since the summer, we’ve been building a newly close relationship between our medical team and the search and rescue (SAR) team serving Labrador's north coast. This winter was the first time our annual winter camp included SAR exercises alongside our training in winter medicine, and time out in the open air.

 Field testing my new Hilleberg Keron III GT during our SAR/wildmed exercise

Field testing my new Hilleberg Keron III GT during our SAR/wildmed exercise

Battered by high winds and thick ice (and escorted by Canadian Coast Guard icebreaker) ours was the first ship in three days to make it across the straights, and incredibly, into beautiful sunny weather on the south coast. From Blanc Sablon in northern Quebec, we drove 600km+ though the Labrador wilds, navigating freak whiteouts and the beauty of the wide, open country to get home to Goose Bay, arriving just in time to catch up with friends, pack our gear, and hop on our sleds the next morning for winter camp.

Following trails through town and woods to the open ice, we made our way up the inlet that leads from Goose Bay to the open ocean, finding a sheltered spot along the shore to set up camp. At our basecamp, we set up a large Innu tent and stove, cutting spruce boughs to make a soft, insulated floor. 

Building a dwelling together is a powerful way to build community, too, and our tent really became an ideal home – warm, roomy, and cozy all at once, a place to cook, dry gear, warm up and snuggle, to share stories and dream new ones. 

Gathering the ingredients of home from the world around us reflects the Nordic philosophy of outdoor living, Friluftsliv ("free air life") - a recognition that being in nature is returning home. Sitting in our warm tent, on a bed of fragrant spruce and balsam fur boughs, I found myself thinking quite a lot about the people in my life who've embodied this ethic - mentors like Norwegian-Canadian outdoor educator Mike Elrick, Arctic explorer Matty NcNair, my mom and dad, and so many others I've been lucky to share time with. 

Mike, Matty, and my parents were part of a generation of outdoor educators who trained with Bob Pieh at Queen's University and the Canadian Outward Bound Wilderness school in the '70s. The simple idea that "there's more in you than you think" was central to their ethic of impelling young people into experience - that by being exposed to our world we're changed by it, better equipped to navigate it with resilience, compassion, and creativity. 

For a taste of some old school OB, check out this film on Outward Bound Canada from 1975 - the outdoor fashion is fabulous, and really reminds me of the worn gear my parents used with us growing up. It's also full of OB wisdom, like this familiar gem from German educator and OB founder Kurt Hahn - “I regard it as the foremost task of education to insure the survival of these qualities: an enterprising curiosity, an undefeatable spirit, tenacity in pursuit, readiness for sensible self denial, and above all, compassion.”

Outward Bound wisdom was familiar stuff in my house growing up, and I think was very on on Mike Elrick's mind when designed the Community Environmental Leadership Program (CELP), a 6-month outdoor and experiential education program that my siblings, cousins and I experienced during high school. At CELP, we learned the biochemical equation for photosynthesis while tapping trees to make maple syrup (as close as you can get to drinking sunlight). We learned the krebs cycle after sweating it out on ropes courses. And we learned to think beyond "away", extending the tap and the drain by bicycle to our city's local water and sewage treatment plants, along the way growing an intimate sense of our own ecology and urban design - the often invisible systems and relationships we depend on every day. 

Our camp under the big dipper, on the edge of the ice leading out to the Labrador sea. 

This is what good outdoor and experiential education is all about, for young people and new doctors alike. For students at Outward Bound, it means learning to function as a team while stretching our sinews on rivers and rock; for young people at CELP, it means discovering the connections that make everyday life possible. And in medicine, it means listening to patients stories, learning to follow each clinical story upstream to it's source. Every clinical story has a social story. Learning to see these stories is essential to being a good physician. Because it's these stories, after all, that hint at the broader patterns of inequality we need to tackle if we're to win in our efforts to build a more healthy society. 

Northern winters inspire an indelible ingenuity - unforgiving cold, wild seas, changing ice, and big mammal ecologies inspire a sense of wonder, and have created across Labrador a culture of looking out for each other. In a place where every family has stories of running into trouble at some point, a commitment to good search and rescue and universal health coverage is second nature. As northerners, we find or invent what we need to look out for each other, whatever it takes. 

Our remoteness demands the same creativity that helps us build a home from our surroundings. In our emergency department, we gather sutures and blood products like spruce bows and fresh water. We learn to invent what we need to help each other survive and thrive. The skills we learn for winter medicine are the skills we need to be good rural generalists - the same resilience, compassion, and creativity that helps young people thrive, and makes good human beings. 

  

Piulitsinik: Search and Rescue in the Torngat Mountains

This week I joined Joint Task Force Atlantic for Exercise Piulitsinik, a land, air, and sea search and rescue exercise in Torngat Mountains Mountains National Park, on the northern tip of Nunatsiavut. 

The Torngats are the most beautiful place I’ve seen - an arctic alpine tundra shaped by wild seas and deep fjords, full of whales, seals, caribou, barren ground black bears, and polar bears. 

The exercise was the first of it’s kind in Labrador - a unique chance to test our emergency response abilities in this remote part of the Inuit homeland. It’s name, piulitsinik, comes from the Labrador dialect of Inuktitut, and means rescue

During the exercise, we did a number of high fidelity simulations including a mass casualty scenario involving a zodiac flip and polar bear attack; water rescues; and a land and air search for a lost group of paddlers deep in the Torngat Mountains. As physician on the exercise, my job was to test our emergency response systems, offering high order medical insights during the search and rescue scenarios.

The exercise included members of the Army, Navy, and Air Force, including 444 Squadron’s Griffin search and rescue (SAR) helicopter out of Goose Bay, and 103 Squadron’s Cormorant SAR helicopter out of Gander, as well as staff from Parks Canada and Torngats Mountains Base Camp and Research Station. The exercise was filmed by members of the Okalakatiget Society for a documentary in English and Inuktitut to be broadcast on APTN in 2016. 

Just getting these people in the same room - let alone together for a remote field exercise - was an incredible achievement, with an astonishing back story. In the summer of 2013, a polar bear attack in Labrador's Nachvak Fjord gave the Park an urgent sense of the need to optimize SAR capacity. By coincidence, I was on call the night of the attack as a medical student in Goose Bay's ER, and closely followed the survivor's story. The sheer number of bears we saw flying over the park by helicopter and exploring its islands and fjords by zodiac made me appreciate his unlikely survival even more.

Nanook (polar bear) chasing ukalik (arctic hare) on Jens Haven Island, Nunatsiavut (Andrew Bresnahan 2015)

Parks Canada carried this interest in rural and remote SAR with them to the high Arctic, where the discovery of a ship from the Franklin Expedition last fall brought their underwater archeologists into close contact with dive teams from the Royal Canadian Navy. This spring, Rear-Admiral John Newton and Parks Canada's Eastern Director Carol Sheedy met while visiting the ship and conceived the exercise, which came to life in just four months - a demonstration of their commitment to improving SAR capacity in the North. 

The spirit of piulitsinik runs deep on the Labrador coast, where people live in intimate proximity to the land and sea. For most of us, the importance of optimizing search and rescue capacity on the coast hits very close to home. I was born in Makkovik, an Inuit community of 360 people on the north coast of Labrador. In February 2012, friends and family in my hometown desperately searched for Burton Winters, a young boy who'd become lost on the sea ice during a blizzard. The day I was invited to interview for a spot at med school was the same day my friends found his skidoo, stuck between blocks of jagged ice. For me, these experiences were inseparable; the relief of finding a path to medicine, and the heartbreak of my community mourning an unbearably preventable loss, became tributaries of the same river.  

Search and rescue capacity is expensive. Compared to vaccines, or seatbelts, or oral rehydration salts, TB drugs, or lifesaving antibiotics, it's not the most cost-effective way to save lives.  But it, too, matters. It's about a commitment to help, and not abandon people who are in trouble. It's about the kind of society and community we want to be - one that's ready to find and save, to look out for each other. It's about moral community. 

Matt Damon's character articulates this idea in the film The Martian, suggesting "every human being has a basic instinct to help each other out. If a hiker gets lost in the mountains, people coordinate a search. If an earthquake levels a city, people all over the world send emergency supplies. This instinct is found in every culture, without exception." The film follows his character and team as they take this instinct, and "science the shit" out of it.

What are the boundaries of our moral community? Just as our readiness to pour resources into saving a lost hiker (or astronaut) speaks to the better angels of our nature, it also uncomfortably reveals the contradictions implicit in ignoring the suffering of far-away others. If we're ready to supply a Cormorant SAR helicopter to rescue sailors in the north Atlantic or paddlers in the Torngats, are we also ready to supply methotrexate for women with post-partum haemorrhage in Papua New Guinea, nutritional supplements for malnourished kids in the Sahel, mosquito nets and anti-malarials in Malawi, and clean drinking water in Attawapiskat? 

In 2008, I met Dr. Paul Farmer, a physician and anthropologist who founded the group Partners in Health with fellow physician anthropologist Jim Kim (now president of the World Bank), and humanitarian Ophilia Dahl (niece of this other Dahl). When it came time to describe their mission, they put it this way: When our patients are ill and have no access to care, our team of health professionals, scholars, and activists will do whatever it takes to make them well—just as we would do if a member of our own families or we ourselves were ill.

This mission inspires my work as a medical doctor and anthropologist. It inspires the public ethics of search and rescue. It inspires public action in moments of global crisis. And it inspires the work of so many who accompany those who suffer close to home and in far away places while so much of the world looks elsewhere. It inspires us to think about what kind of society we want to be, what kind of people we want to be. 

 

Piliriqatigiingniq: Working Together to Stop TB in Northern Canada

Every clinical story has a social story. Learning these stories is more than the heart of medicine - it's the key to building a more healthy society. 

This week I start my Northern Family Medicine residency in Labrador, serving my hometown and a vibrant population of Inuit, Innu, and settlers spread along the coast north of Quebec and south of Greenland. As I write, the people of northern Labrador are experiencing their fourth TB outbreak of the decade, revealing a pattern of prevalence that can teach us a lot about the conditions of everyday life in the North. 

Globally, over 2 billion people - fully one third of humanity - are infected with Mycobacterium tuberculosis, the bacterium that causes TB. While anyone can be exposed to TB, our risk of infection, disease, and bad clinical outcomes is intimately shaped by our conditions of everyday life. Just as TB can teach us how housing, nutrition, and income are embodied as disease, it can help us learn to think upstream, and work together to build a more just and healthy society.

Upstream thinking draws on a helpful metaphor – instead of only waiting downstream to help all those drowning in a river, why not head upstream to learn why people fall in, solving problems at their source? In Canada, Inuit are not only the most affected by TB - they're leading the way in designing upstream solutions to improve northern health. To learn more, check out my new article Piliriqatigiingniq: Working Together to Stop Tuberculosis in Northern Canada.

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