Manitoba restores medical services for critically ill children from central Nunavut

Manitoba's health agency is now allowing critically ill children from central Nunavut to be admitted to pediatric intensive care two months after it issued a directive to send them elsewhere due to "unprecedented patient volumes."

A spokesperson said in an email on Tuesday that Shared Health is now accepting patients who will likely need to access the pediatric ICU from the territory's Kivalliq Region as well as northwestern Ontario after pausing the program at the end of August.

When Nunavut's chief of staff for physician services, Dr. Francois De Vet, says he couldn't stop smiling when he heard the news..

"My main goal … is to make sure that we provide the best care that we can … as expeditiously as we can. Now that we are going back to that same level of care is just an absolute relief," he said.

The last two months have been fraught with challenges, De Vet says, because unlike northwestern Ontario, Nunavut doesn't have any intensive care units to treat the high number of young children who struggle with respiratory illnesses, which are often due to cramped housing and poverty.

"We don't have capacity in the territory to look after these children, so it's problematic because if you tell us we can't take your child and you need to find another space for them, it's very difficult for us to do that because we literally have to start phoning around to different [pediatric ICUs] to find support," he said.

During those two months, at least 14 patients under the age of 15 were flown out of Kivalliq, according to information from the government.

Some of the hospitals where they have found support are hundreds of kilometres away in London and Kingston, Ont., or Edmonton, Alta., De Wet says, but that poses another problem for the territory that relies heavily on air ambulances to transfer patients.

"Typically, if we send a plane to Winnipeg they could potentially crew that plane, send it back to the territory and it's a minimal delay in using that plane again for other patients," he said.

The doctor says sometimes the flights to bring patients to the children's hospital in Ottawa are unavailable for up to three days because of Transport Canada guidelines that require pilots and staff to rest between flights.

Data from Nunavut indicates there were 1,043 pediatric respiratory medevacs between January 2019 and October 2022.

Of those, 398 took place in 2022, nearly four times as many as there were in all of 2021.

In Manitoba, pediatric patient volumes have been so high Shared Health made the decision to restrict access to the pediatric ICU to preserve space for local patients, the spokesperson says.

In a written statement on Tuesday, the health agency says patient volumes at Health Sciences Centre Children's emergency department have "risen significantly" since the end of October, with respiratory illnesses and influenza believed to be driving the spike.

So far in November, a daily average of 180.5 patients have visited the children's emergency department, up nearly 24 per cent from October when the daily average of patient visits was 145.8.

It is also up nearly 46 per cent year-over-year: the daily average in November 2021 was 124 patients.

Despite how busy the emergency department and ICU have been, Shared Health says it still accepted patients from Nunavut who were unlikely to enter the pediatric ICU, who were referred or transferred to the neonatal ICU and those who faced an immediate threat to life and limb.

Supports for Inuit patients in Manitoba

Another barrier for Nunavut children needing care is the lack of language support for those who only speak Inuktitut, De Wet says.

That support does exist at the Winnipeg children's hospital, he says, as well as other resources at local Inuit organizations.

Maxine Angoo, the Child First initiative manager at Tungasugit Inuit Resource Centre in Winnipeg, says the break in services in the territory points to a need for better health-care access in Nunavut.

"It's critical, right? It's a life or death situation," Angoo said. "We should have access to [health care.] We are the first peoples of this country. They should have the same access all across the board."

Premier Heather Stefanson says the government's health ministry will be announcing a human resources strategy to address staffing problems at Manitoba hospitals.

"We don't want to turn anyone away for health care in our province. We know there's a significant challenge when it comes to human resources … we'll continue to do what we can," she told reporters on Tuesday.