Social colonization: primary root cause of TB among aboriginal populations

Elaine Randell (Communicable Disease Consultant, Department of Health and Social Services, Government of Nunavut, Canadian Public Health Association) presented evidence at the Senate hearing on Health in April 2010. She argued that,

“To fully understand the pattern of TB in most aboriginal populations in Canada, it’s important for us to understand the history of TB among this group, where the epidemic came from, as well as the social determinants of health that significantly contribute to the continuing high rates of infection and disease.

Contact with European merchants and traders in Canada occurred in sequence, beginning with the Atlantic provinces in the 16th century, Ontario and Quebec in the 17th century, the Pacific provinces in the 18th century, the prairies in the 19th century, and the territories in the 20th century. Contact in the territories began in the west in Yukon, and to the east, which is now Nunavut. The subsequent wave of settlement that followed this changed the way that aboriginal populations lived, from small, isolated, mobile groups to large groups living in settlements and stationary.

This social colonization was what provided the vector for the spread of tuberculosis. The earlier the epidemic began, the sooner it reached its peak and began to fall, until the last 15 years or so, as we’ve heard, which is why we see the pattern of TB rates we have amongst aboriginal populations, the rates being lowest amongst the population where the social colonization occurred earliest and highest in areas such as Nunavut, where it occurred most recently.

Inadequacies in the social determinants of health are key in continuing the cycle of outbreaks and high rates of TB among aboriginal populations. Crowded and inadequately ventilated housing increases transmission. I’m aware of situations in which infectious cases have been recorded in houses with 13 people or more, including young children, who are especially vulnerable. The rate of transmission in these situations is very high. Those without housing move from home to home as guests, thus increasing the number of people who are exposed and infected. Long periods of cold weather and darkness in the north lead to longer periods of time spent indoors in crowded and inadequately ventilated housing. This leads to increased exposure and shared air space and subsequent increase in transmission. Poor nutritional status increases risk of progression from infection to disease. In many remote communities, selection of nutritious foods such as fresh vegetables and fruits is extremely limited and prohibitively expensive. Programs such as food mail that provide access to more nutritious foods are easily accessed by people who have credit cards, but many Inuit don’t have credit cards and don’t even have bank accounts.

Delayed diagnosis of infectious cases results in prolonged exposure time for contacts. Diagnosis is delayed when regions don’t have local diagnostic capabilities and expertise.

Some remote communities lack continuity of health care providers. A successful TB program is dependent on a relationship of trust between the residents in the community and their health care providers. This requires continuity of staff and health care workers who are experienced and trained in early detection of tuberculosis.

Social colonization is the primary root cause of TB among aboriginal populations. Issues related to the social determinants of health, which include crowded and inadequate housing, poor nutritional status, and lack of continuity of health care providers, are the root causes of continued high rates amongst Inuit. TB rates in Europe began to fall even before the introduction of the first medications, with improvements to standards of living. By addressing issues such as poverty, housing, and access to health care and nutritious food, we can expect the same to happen here.”

Who’s Who

Randell, Elaine. 2010-04-20. “Social Colonization.” Evidence. Standing Committee on Health. 40th Parliament, Government of Canada. 3rd Session. Paragraph 1903660.

Qualitative Researchers at risk to emotional harm

This research resonated with my own experience providing me with a body of literature, a lexicon and and lens through which something that left me speechless might someday be spoken. 

 

“The first thing to note is that the concept of ‘duty of care’ is spelled out from the outset. This includes a reference to a moral obligation on behalf of those working in the University: The University must exercise a “duty of care” to employees and to those under supervision and this duty is recognised in both criminal and civil law. There is also a moral duty that the teacher has towards the pupil. (University ‘A’ Occupational Safety, Health and Environment Unit 2004: 4) It is then explained that it is through a system of ‘line management’ that the University’s statutory requirements are expected to be met. In University ‘A’ formal responsibilities for issues of fieldworker safety are delegated to Heads of Departments. It is therefore for the Head of Department to ensure that the risk assessment for the fieldwork is made and to ensure that safe systems of work have been established for all staff and students. Frequently the Head of Department will delegate this duty to a particular member of staff as Departmental Safety Officer, or to different research managers – PhD supervisors and Principal Investigators (Bloor, Fincham and Sampson 2007-06).”

A number of authors have stated that researchers can be negatively affected emotionally and physically by research on sensitive issues (Alexander et al. 1989; Burr 1995; Cowles 1988; Dunn 1991; Gregory, Russell and Phillips 1997; Lee 1995; McCosker, Barnard and Gerber 2001). Some of the possible negative outcomes include gastrointestinal problems (Dunn 1991), insomnia and nightmares (Cowles 1988; Dunn 1991; Etherington 1996), headaches (Dunn 1991), exhaustion and depression (Ridge, Hee and Aroni 1999) and threats to physical safety (Langford 2000; Lee 1995). (Dickson-Swift et al. 2006: 857) (Bloor, Fincham and Sampson 2007-06).”

“There are two manifestations of resistance to researchers documented in the literature. One relates to unwillingness on the part of potential research participants to cooperate, and to be obstructive, and the other relates to unco-operativeness on the part of those connected with research participants – for example ‘gate keepers’. For anthropologists the separation of these two sites of resistance is often complicated, as in a study of a particular community there might be no distinction between a participant and a gate keeper (Bloor, Fincham and Sampson 2007-06:32).”

The process of ‘pain by proxy’ described by Moran-Ellis (Moran-Ellis 1997: 181) appears to have resonance for many researchers. The emotional strain of having to deal with distressing situations or narratives can be acute. It should be noted that there is also a literature concerned with the emotional impact of disturbing data on those not directly involved with the gathering of the data. Transcribers and PIs have been singled out as particularly vulnerable to this effect (McCosker et al. 2001). Hochschild’s description of ‘deep acting’ (Hochschild 1983: 42-3), may mask levels of upset or even trauma suffered by researchers who feel their professional integrity would be brought into question if such upset were acknowledged. However, increasingly there is recognition that the issue of emotional well-being is of great importance to researchers, research institutions and the integrity of qualitative research itself (Bloor, Fincham and Sampson 2007-06:34).

“With regard to PhD students, several contributions highlighted the ambiguous position of research students when it comes to the requirements of PhD research and risk to well-being. It is often the case that a precondition of PhD funding in the social sciences is that it is original research. In some instances this means that the specific research arena has not been previously entered. Therefore the potential risks in such research arenas are, to certain extent, untested. In these circumstances it is inevitable that PhD students become their own risk assessors and the least experienced in research can find themselves in the most exposed positions when it comes to potential harm (Bloor, Fincham and Sampson 2007-06:34).”

“There was discussion of what one contributor called ‘re-entry shock’. This was described in relation to both returning to a research site, but also adjusting back to a ‘normal’ life after extended periods of field research. One researcher reported the isolation they felt when trying to readjust to their life after particularly intense fieldwork. The final area of discussion in the emotional impact involved the possible damage done by the misrepresentation of results, particularly in popular media. Once again the need for specialist training and awareness programmes to be provided through institutions was highlighted (Bloor, Fincham and Sampson 2007-06:45).”

Sampson, Helen; Bloor, Michael; Fincham, Ben. “A Price Worth Paying? Considering the `Cost’ of Reflexive Research Methods and the Influence of Feminist Ways of `Doing.’ Sociology, 42:5:919-933 (2008) DOI: 10.1177/0038038508094570.

Abstract: “Drawing on analysis of relevant literature, focus groups, and web-based discussion board postings, assembled as part of an inquiry into risks to the well-being of qualitative researchers, it is argued that emotional harm is more prevalent than physical harm and may be particularly associated with reflexivity and the important influence of feminist research methods. The particular concern of feminist researchers with reflexivity, with research relationships and with the interests of research participants may make them especially vulnerable to emotional harm.”

Bloor, Michael; Fincham, Ben; Sampson, Helen. 2007-06. Qualiti (NCRM) Commissioned Inquiry into the Risk to Well-Being of Researchers in Qualitative Research.

Risk to emotional well-being of researchers involved in qualitative research, Role conflict, Anxiety, Isolation, Resistance, Unanticipated long term impact of research, Staying emotionally/psychologically safe

 

 

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Commissioned Inquiry. 2006-03. “Risk to well-being of researchers in qualitative research”

Original Call for Evidence: Submissions/evidence are invited as part of an inquiry into risks to the well-being of researchers in qualitative research. Those persons submitting evidence may wish to draw our attention to lessons to be learned from experience. We are interested in submissions based on the experiences of researchers, research supervisors, members of ethics committees and anyone else involved in any aspect of the conduct and management of qualitative research. Submissions may embrace practical, regulatory and/or ethical issues and risks may include threats to mental/emotional health as well as exposure to physical hazards. The Inquiry is being conducted as part of the activities being undertaken by ‘Qualiti’, the Cardiff Node of the UK Economic and Social Research Council’s National Research Methods Centre. The aim of the inquiry is to produce guidelines for good practice of value to researchers, supervisors and other parties.

Broad Overview: There are risks to researchers in undertaking fieldwork. Some of these are obvious, some less so. These risks may impact on the physical, emotional or social well-being of researchers. Whilst there has been a concentration of effort in ensuring research ‘subjects’ are protected from the potentially harmful consequences of research (through ‘informed consent’ for example), there has been much less thought about protection of researchers from potential harm. It is likely too that researchers undertaking qualitative fieldwork are exposed to particular forms of risks, which arise from the characteristic emphasis of qualitative approaches on conducting research in naturalistic settings.

Qualitative researchers may experience a range of risks. Some risks relate to the physical well-being of researchers and correspond to conventional health and safety considerations in employment of all kinds. It is not difficult to think of situations in which researchers may be at risk of violence or other physical danger. Equally, researchers may become emotionally threatened, where, for example, the data being collected are distressing or the settings emotionally taxing. These different types of risk reflect the objectives of the research, the settings in which it is conducted and the characteristics of the participants in the research, both ‘subjects’ and researchers.

Researcher risks are a matter of urgent interest to a range of parties, not just researchers, but also research supervisors, research funders, insurers, ethicists, occupational health and safety personnel and others. Evidence and opinions are invited from all interested parties.

There have been past occasions where qualitative researchers have entered the field without fully understanding the implications of the research setting on their well-being. This is a situation paralleling a failure of ‘informed consent’, researchers should be able to make judgements as to the suitability of a research context with regard to ‘acceptable’ and ‘unacceptable’ risk of harm to them. Clearly, it is desirable to develop ‘good practice’ guides and recommendations to reduce risks to qualitative researchers. However, practice guides should be such that they do not threaten the integrity of the research process itself. This is especially pertinent given that much qualitative research is carried out in naturalistic settings and, more specifically, is frequently dependent upon the quality of the relationships between ‘subjects’ and researchers.

It is recognised that researcher risk may vary by gender as well as by setting. Submissions are welcomed which document and explore this gender dimension.

This inquiry aims to collate and analyse accounts of qualitative research where issues of risk may have been present to locate these accounts in the existing research methods literature and to draw out practical recommendations.

Moderated Forum: Evidence for the inquiry will be gathered via a moderated web-based forum. On this forum contributors will be asked to submit evidence under one of four topic themes. This evidence will then be placed on the website in an appropriate topic stream. It is anticipated that aside from gathering evidence this will also generate online discussion around issues arising from evidence.

Screen Teens for Most Extreme Consequence of Psychiatric Illness: Suicide

The most extreme consequence of mental illness is suicide. Acute psychiatric emergency utterly changes people, especially youth, causing extreme social isolation. Yet in 2008 mental illness remained ” a public health crisis [. . .] shrouded in misconceptions and misunderstandings. [. . .] These illnesses are serious, disabling, sometimes crippling, and all too often fatal. They deserve to be treated with respect, and those who suffer from them should not experience prejudice,” says Dr. Milliken. “If we treat both the illness and the individual with respect, without fear and in a straightforward manner, then we will legitimately look at trying to provide a range of options to help those individuals recover and resume their place in our families, our friendships, and our society, just as we do for other medical conditions.”

• “In Ontario, an estimated 530,000 children and adolescents have treatable mental illnesses, but only 150,000 are getting care.
• The youth suicide rate — 18 deaths per 100,000 — actually understates the loss of life because many kids overdose on drugs or die in violence. It also masks the staggeringly high rate — 108 per 100,000 — among aboriginal youth.
• Children wait one third longer than adults for psychiatric care in Ontario. They wait seven times as long as patients needing MRI or CT scans.
• Canada produces just 10 child psychiatrists a year (Goar 2005-02-11).”

Timeline

1958 The Canadian federal government started funding hospitals but excluded asylums (Bacic 2008-08).

1970s Canadian Federal Policies of “deinstitutionalization forced patients out of [mental health] care with no investment in community supports for [mental health] sufferers (Bacic 2008-08). Dr. Donald Milliken, president of the Canadian Psychiatric Association and a practitioner with nearly 40 years of experience, recalls his experience as a medical resident in 1970: “They gave me the keys to a ward and said, ‘There are 100 patients in there. Discharge 50.’ G&M”

2005-02-11 Senator Michael Kirby, head of the committee examining Canada’s mental health system met with “30 child psychiatrists, medical researchers, mental health advocates and parents at a
roundtable on kids and mental health, organized by business leaders and hosted by Scotiabank. [. . . ] Canada has the “worst adolescent suicide rate among the world’s leading industrial powers. Every year, 300 kids between the ages of 10 and 19 kill themselves [C]anada is doing an abysmal job — worse than the United States, Japan, Israel, Bulgaria, Belarus or Ukraine — of addressing the root causes of teen suicide (Goar 2005-02-11).”

2006-05 Senators Michael Kirby and Wilbert Joseph Keon tabled the Canadian Standing Senate Committee on Social Affairs, Science and Technology report entitled “Out of the Shadows at Last: Transforming Mental Health, Mental Illness and Addiction Services in Canada.”

2006-12-28 “In the United States, suicide is the third-leading cause of death among persons 15 to 19 years of age. In 2005 alone, according to the Centers for Disease Control and Prevention, 16.9% of U.S. high school students seriously considered suicide, and 8.4% had attempted suicide at least once during the preceding year (Friedman 2006-12-28).”

2008 The Globe and Mail printed a week-long series entitled “Breakdown: Canada’s mental health crisis.” “Columnists André Picard, Dawn Walton and Elizabeth Renzetti examined critical aspects of Canada’s mental health crisis, including how one-third of general hospital beds are filled with mentally ill patients, how 70 per cent of people with severe mental illness are working despite their illness, and how jails and penitentiaries have become warehouses for the mentally ill [. . . ] “Canada still doesn’t have a coherent strategy for treating the mentally ill,” says Ed Greenspon, The Globe and Mail’s editor-in-chief.” (Bacic 2008-08)

Who’s Who

Jennifer Chambers, co-ordinator of the Empowerment Council, an advocacy group for Canadian Association of Mental Health patients.

Anita Szigeti, lawyer for the Empowerment Council, an advocacy group for Canadian Association of Mental Health patients.

Vahe Kehyayan, director of the Psychiatric Patient Advocacy Office.

Simon Davidson, chief of psychiatry at the Children’s Hospital of Eastern Ontario.

Senator Michael Kirby, heads of the committee examining Canada’s mental health system.

Donald Milliken, past-president of the Canadian Psychiatric Association.

Richard Guscott, a Hamilton psychiatrist who specializes in treating children with mood disorders.

Jean Wittenberg heads the infant psychiatry program at Toronto’s Hospital for Sick Children.

Peter Szatmari, a specialist in autism who heads the psychiatry division at McMaster University.

Nasreen Roberts, director of adolescent in-patient and emergency services at Queen’s University.

Webliography and Bibliography

Bacic, Jadranka. 2008-08. “Landmark series on Canada’s mental health crisis gets people talking.” Canadian Psychiatric Aujourd’hui.

CPA. 2008-10. “Youth and Mental Illness.” Canadian Psychiatric Association.

Goar, Carol. 2005-02-11. “Tackling the issue of teen suicide.” TheStar.com

Friedman, Richard A. 2006-12-28. “Uncovering an Epidemic — Screening for Mental Illness in Teens.” New England Journal of Medicine. 355:26:2717-1719

Kirby, Michael J. L.; Keon, Wilbert Joseph. 2006-05. “Out of the Shadows at Last: Transforming Mental Health, Mental Illness and Addiction Services in Canada.” The Standing Senate Committee on Social Affairs, Science and Technology.

Prevent PTSD: End War

I have always thought she took too many risks and someday she would pay the price. Her mother had gone missing in an Alberta town in the 80s and was never found. Whenever I am with her I feel her mother’s eyes trying to see her daughter through mine. In some contorted fashion I cannot help but admire the way she lets herself follow her crazy instincts that compel her to park her flashy red sports car, get out and just sit down on the curb beside one of the 4000+ homeless people in Calgary just because she felt his “aura.” Her language is situated in some vague space between spoken word poetry and folk physics. And when she drops by unexpectedly I just automatically put on the teapot and take out the china. There’s always a story and I never know what is fiction and what is real but it all seems to matter somehow. When she leaves I feel exhausted.

While she sat there alongside the others a woman stopped and tried to give her money too. She didn’t feel insulted. She just felt she was supposed to hear this man’s story. He was a veteran from the war in Iraq and he was suffering from PTSD [1]. It somehow made those stories we read about “out there” seem closer to “here and now” in Calgary.

Suicide prevention is a primary concern for Bostonian Jonathan Shay, M.D., Ph.D., staff psychiatrist for Veterans Affairs in Boston in his work with Viet Nam war veterans. The suicide statistics among Vietnam war veterans are higher than American soldiers who died in Vietnam (MHAT). While their names do not appear on the Memorial Wall, their faces are reflected on its surface.

The numbers of suicides among veteran-soldiers of the Irag OIF (Operation Iraqi Freedom) and Afghanistan theaters have reached epidemic proportions. In 2003 the US military engaged a team of mental health experts to investigate unprecedented numbers of psychiatric casualties.

“It is baffling, if not astonishing, that these military psychiatrists, supposed experts in combat-related stress, have so normalized war that it is overlooked as the source of the disease they have been sent to diagnose, that its horror can be thus discounted and its psychic effects rendered invisible (Shay 2006:2).”

Shay argues that wars have provided scientists and doctors with an ongoing supply of combat-traumatized soldiers including material to enhance understanding of the etiology of soldier-veteran suicides. He claims that war itself is a disease that kills and maims bodies, and ravages the minds of those who engage in it. In the 20th century US (and Canadian?) soldiers were at a much higher risk of becoming a psychiatric casualty (and death by their own hands) than death by enemy fire (Shay 2006:2). And the psychological ravages of war are not restricted to veteran-soldiers. The mental wounds are not restricted to those directly involved but also are inflicted upon civilians and society at large. In fact, Shay argues forcefully that Herman’s groundbreaking work on trauma and recovery (1992, 1997) can be applied to societies as well.

Shay claimed that the “structure, organization and fundamental culture” of 20th century US military ventures contributed to the trauma suffered by soldiers. He challenges distorted histories about why the Viet Nam war ended. He asked a question he cannot answer but felt compelled to raise:

“[Did] and in what ways, [US Vietnam War soldier’s] resistance or refusal in the face of moral outrage serve[…] to protect an individual psyche from the effects of an overwhelming traumatic experience[?] (Shay 2006:2).”

The human practice of war, a state-sponsored activity which causes lethal physical, emotional , spiritual and psychological trauma, can be ended. An end to war is an intergenerational project similar to ending the human practice of slavery. “It has been with us since time began.” “It is part of human nature.” “It is part of every culture and found in every part of the world (Shay 2006:xii).”

The end the human practice of war involves “creating trustworthy structures of collective security, within which citizens of every state would have a well-founded confidence in their security from attack by another country [or from within as in the case of genocide perpetrated on a targeted population within the borders of a nation-state]- backed up be reliable expectation of prompt, effective and massively multilateral armed intervention (Shay 2006:xii-xiii).”

Shay refers to Emmanuel Kant’s essay “Perpetual Peace: A Philosophical Sketch” [4] in which Kant argued that even in a peaceful world where ruinous wars have passed away, police-like soldiers, would be necessary. Shay is not calling for peace through war, but peace from ruinous wars (2006:xiii).

Notes

1. During the American Civil War the disorder was called “irritable heart;” in WWI it was called “shell shock,” in WWII it was “battle fatigue” and now it is called Post traumatic Stress Disorder (PTSD) (Shay 2006:2-3).

2. The suicide of her husband, a Vietnam veteran, provided the impetus for Penny Coleman to research the “why question” and the result is the book entitled Flashback.

3. Judith Herman (1992, 1997) described responses of intrusions or flashbacks as a reflex in which the mind attempts to integrate [explain, contextualize, make tolerable?] an intolerable memory. When the “intolerable memory” fails to be integrated, wounds remain open and healing cannot take place. This may provoke a contradictory reflex where the mind protects itself by numbing, “forgetting” or avoiding the intolerable memory. Intolerable memories can be triggered automatically and repeatedly. Defense mechanisms of avoidance and numbing create their own problems and make the sufferer even more vulnerable. Herman called this self-perpetuating cycle, an “oscillating rhythm” between two intolerable states of being (intrusion and constriction) where healing and equilibrium remain elusive, a dialectic of trauma.

“The conflict between the will to deny horrible events and the will to proclaim them aloud is the central dialectic of psychological trauma. People who have survived atrocities often tell their stories in a highly emotional, contradictory, and fragmented manner that undermines their credibility and thereby serves the twin imperatives of truth-telling and secrecy. When the truth is finally recognized, survivors can begin their recovery. But far too often secrecy prevails, and the story of the traumatic event surfaces not as a verbal narrative but as a symptom (Herman 1997:Introduction).”

4. Kant also included notions of “hospitality” providing all with the freedom to emigrate with an anticipation of hospitality from the nation-state to which they were immigrating. He imagined a world of nation-states governed by republican governments and a global body of governance, a league of nations. His ‘conversation’ on world peace is ongoing.

Meanwhile, convoluted arguments are offered by political science professor, Erik Gartzke, who warns of the “possible pitfalls of a capitalist peace” (Perpetuating Peace forthcoming). Gartzke has used the Fraser Institute Economic Freedom Index to argue that ensuring economic freedom (including the freedom of the military industries) is more effective than forms of governance in the reduction of violent conflict.

US military professionals themselves are not militarists. Militarists who argue against an end to war include U.S. military industries and their most enthusiastic allies in politics and the media, many of whom seem to imagine that war exists to provide them with an income and/or an adrenalin rush (Shay 2006:xi).

Webliography and Bibliography

Coleman, Penny. 2006. Flashback: Post traumatic Stress Disorder: Suicide and the Lessons of War. Boston: Beacon Press.

Durkheim, Emile. Suicide.

Herman, Judith Lewis. 1992 [1997]. Trauma and Recovery: the aftermath of violence- from domestic abuse to political terror. New York: Basic Books.

Hopper, Jim. Excerpts from Trauma and Recovery.

Shay, Jonathan. 2006. “Foreword.” in Coleman, Penny. 2006. Flashback: Post traumatic Stress Disorder: Suicide and the Lessons of War. Boston: Beacon Press.

Mental Health Assessment Team (MHAT)

Vicarious trauma among researchers working with at-risk populations

A substantial body of literature on epidemiological studies estimate that between 36 and 81 percent of the general population experience a traumatic event at some time in their lives which is far more often than previously believed (Cusack et al. 2004).

Flynn-Burhoe. 2003. A Fliction: Dawn among the Hummocks, Iqaluit, NU

A US study a team of researchers led by Karen J. Cusack, Ph.D. concluded that since Post Traumatic Stress Disorder (PTSD) is associated with some of the most serious psychosocial impairments and highest rates of mental health service use and costs than any other disorder, it is important to identify an individual’s lifetime trauma exposure history. Yet in publicly funded health services screening for and therefore treatment of trauma exposure is rare (Cusack et al. 2004).

Cusack’s team promoted an educational component directed at intake workers which included several reliable instruments for measuring trauma symptoms based on DSM-IV including a self-report PTSD Checklist.

Post Traumatic Stress Disorder (PTSD) occurs when one is traumatized directly (in harm’s way) (DSM IV APA, 1994 [1]). However parents, professional health care workers, teachers and others may be traumatized indirectly. Secondary Traumatic Stress, Vicarious Trauma, Compassion Fatigue are experienceed though different social pathways. According to Charles R. Figley, Ph.D. of the Florida State University Traumatology Institute, there are few reports of the incidence and prevalence of Secondary Traumatic Stress. He suggests that related concepts such as Burnout, countertransference and worker dissatisfaction may have masked this common problem (Figley 1995). See Figley (2004).

Vicarious traumatization, for example, refers to a transformation in the therapist’s (or other trauma worker’s) inner experience resulting from empathic engagement with clients’ trauma material. . .[and] vulnerable to the emotional and spiritual effects of vicarious traumatization. These effects are cumulative and permanent, and evident in both a therapist’s professional and personal life (Pearlman & Saakvitne, 1995, p. 151).

According to Figley (1997) Compassion Fatigue or Secondary Traumatic Stress Disorder, is nearly identical to PSTD, except it affects those emotionally affected by the trauma of another.

York University Professor Susan McGrath’s called attention to the growing concern

“by researchers and practitioners alike regarding the emotional impact of working with victims of trauma on those in the social services or so-called “helping professions”, as well as on those who decide the fate of these individuals, and it has been widely accepted that interaction with victims of traumatic exposure places people at high risk of secondary exposure (Stamm et al. 2003). Classical burnout theory such as work by Maslach (1982) defines burnout syndrome as a pattern of emotional overload and subsequent emotional exhaustion, characterized by depersonalization, and reduced personal accomplishment as a response to the chronic emotional strain of dealing extensively with other human beings, particularly when they are troubled or having problems.”

She noted that,

“The terms “compassion fatigue” (Figley,1995) and “secondary traumatic stress” (Figley, 1995; Stamm, 1999) have been used interchangeably to denote a syndrome of symptoms nearly identical to Post-Traumatic Stress Disorder except that exposure to a traumatizing event experienced by one person becomes a traumatizing event for the second person (Stamm, 1999). Finally, the majority of studies in this area have used the term vicarious trauma which has been defined as “the transformation that occurs in the inner experience of the therapist that comes about as a result of empathic engagements with clients’ trauma material” (Pearlman & Saakvitne, 1995, p.31).

York University offers special courses in Clinical Intervention for mental health professionals, including psychologists, social workers, mental health counsellors, family therapists, employee assistance professionals, clinical supervisors, and other practitioners who provide psychological treatment and therapeutic intervention for survivors of trauma. The certificate course provides participants will also develop an in-depth understanding of compassion fatigue and strategies for prevention and enhancement of practitioner resiliency, including how to effectively intervene with care providers who have become “compassion-fatigued” through their trauma response work (source).”

Notes:

1. DSM IV (APA, 1994) is the American Psychiatric Association’s diagnostic disorders manual which is updated every ten years.

Tourists and old timers

There are two kinds of people who come north from the south. There are the tourists who stay for one or two years. Then there are those like … who have been here for decades. Those like … recognise that the longer they are here, the less they know about the north. They realise there is always more to learn. (Underlying this is a longing to be recognised as a complex people whose reality cannot be grasped quickly by an in out visit.)

…
I could not connect with this group and after awhile I realized I didn’t even want to.

I thought X had a kindly, compassionate expression on his/her face. I was disconcerted by his/her questions on the First Nations Treaty issues: […] Was I wrong or was X uninformed of the First Nations and Inuit relationship of decades long negotiations of treaties that were not respected and demanded constant re visiting? My heart sank when I realised the mind, heart and spirit behind the promising smile were without interest to me. I guessed that X spent very little time trying to understand the First Nations and Inuit point of view. X returned to the workforce after retirement to take up lucrative contracts with the Nunavut government? The combined package of salaries and benefits seems obscenely high here. X’s rates as a consultant are even higher. How frightening that X plays a pivotal role in a decision making team here. Behind the congenial face, is the face of the bureaucracy here that keeps the status quo in place.

As I write I am torn and I feel physically affected by the awful truth. Iqaluit is filled with X’s. No wonder the money continues to enrich bureaucrats leaving the Inuit population here without substantial services and in over crowded conditions that are more like third world than a developed country. I knew this. I knew there was skimming.

Please let me be wrong. [I am hoping that my…] my own inadequacies have led me to misjudge. I need to remember that once a light has come on, and the picture of inequalities is clearly visible, I too have some small role to play in it. I can contribute to maintaining the social injustice or I can work towards greater social equalities. I have a strong feeling that I am more effective in the background until my degree is completed. I am more useful right now in helping those in the foreground perform their work more effectively. I just have to trust that slowly I will be led to like minded people. Prevent me from wasting any energy on judging others.

Working for the Government in the North

[They] began to compare employee benefits between the Nunavut government and the federal government.
Y works for Customs and Immigration as a Custom’s officer. Y inquired about working for a summer term here. (Y’s father worked here last year.) Y was offered a two year contract. The federal government was not interested in hiring anyone for a short term contract. Y’s employment package would include: an apartment, a car, 2 trips south a year with 6 weeks vacation each?, 2 trips south for business, a salary of upwards of 70,000 plus northern benefits. The total package sounds like it would be $120, 000 for a Custom’s officer in a town of 7000 people with an airport that does not have international flights. Y’swork would be fairly abstract to say the least!

I have heard people snickering about the limited enrollment of Nursing and Law students here in Iqaluit and the cost of these programs.

Few people snicker at these obscene government employees packages that drive up prices in Iqaluit and exaggerate the have and have not divide.

Sons and daughters of these employees reap the added benefits of well paid, prestigious summer jobs.

I have been trying to understand the phenomenon of so many Government people working on weekends and evenings. Z explained that it is considered to be a part of many jobs. Work is scheduled with an assumption that people will be willing to work overtime on weekends. These government workers have three month vacations! They are encouraged to travel on business trips often. No wonder they have to work overtime to catch up!

The language they use is closed jargon. Even the location of their offices is very confusing. They refer to their buildings by number not by name.

Z noted that for the last budget he recommended that the government not instate the use of vouchers to replace cheques for welfare. Z’s suggestions were not listened to. This is one of the Nunavut government’s … advisors?????

Aflicktion: The Wreck of Hope

Aflicktion: The Wreck of Hope

Originally uploaded by ocean.flynn.

Aflicktion: The Wreck of Hope

Flynn-Burhoe, Maureen. 2007. “Nanuq of the North II: Animal Rights vs Human Rights.” Speechless. Uploaded January 3, 2007.

The Bush administration took advantage of the way in which all eyes turn towards Santa’s North Pole, where big-eyed talking polar bears, reindeer and seals live in harmony, to announce that they would save these creatures from Nanook of the North. See story.
For a divergent point of view read Nunatsiak News article.
Nanook (nanuq Inuktitut for polar bear) was the name of the Eskimo hunter captured on film in the first documentary ever produced, Robert Flaherty’s (1922?) Nanook of the North, — still shown in film studies survey courses. Nanook the Stone Age-20the century hunter became an international legend as a lively, humourous and skillful hunter of polar bears, seals and white fox who tried to bite into the vinyl record Flaherty had brought with him. (The real “Nanook” died of tuberculosis as did countless Inuit from small communities ravaged by one of the worst epidemic’s of tuberculosis on the planet.)

On August 13, 1942 in Walt Disney studios’ canonical animated film Bambi it was revealed that many animals with cute eyes could actually talk and therefore shared human values. Nanook and his kind became the arch enemy of three generations of urban North Americans and Europeans. Hunters were bad. Cute-eyed animals that could talk were good. Today many animals’ lives have been saved from these allegedly cruel hunters by the billion dollar cute-eyed-talking-animals-industry.

The White House has once again come to the rescue of these vulnerable at-risk animals. (There was an entire West Wing episode in which a gift of moose meat was rejected by all staff since it came from a big-eyed-talking-animal. See Ejesiak and Flynn-Burhoe (2005) for more on how the urban debates pitting animal rights against human rights impacted on the Inuit.) Who would ever have suspected that the Bush administration cared so much about the environment that they would urge an end to the polar bear hunt, already a rare phenomenon to many Inuit since their own quotas protected them?

When I lived in the north the danger for polar bears did not reside in the hearts of hunters. Nanuq the polar bear who could not talk was starving. He hung out around hamlets like Churchill, Baker Lake or Iqaluit, looking for garbage since this natural habitat was unpredicatable as the climate changed. Some people even insisted that there was no danger from the polar bear who had wandered into town since he was ’skinny.’ That did not reassure me! I would have preferred to know that he was fat, fluffly and well-fed. Polar bears die from exhaustion trying to swim along their regular hunting routes as ice floes they used to be able to depend on melted into thin air literally. They die, not because there are not enough seals but because they need platform ice in the right seasons. That platform ice is disappearing. They die with ugly massive tumours in them developed from eating char, seals and other Arctic prey whose bodies are riddled with southern toxins that have invaded the pristine, vulnerable northern ecosystem. Nanuq is dying a slow painful death. Nanuq is drowning. Although he doesn’t sing he is a canary for us all.

Climate change and southern industrial toxins affect the fragile ecosystem of the Arctic first. The Inuit claimed in 2003,”Global warming is killing us too, say Inuit .”This is why Sheila Watt-Cloutier laid a law suit against the administration of the United States of America. Now the handful of Job-like Inuit who managed to survive the seal hunt fiasco of the 1980s and are still able hunt polar bear, will have yet another barrier put between them and the ecosystem they managed and protected for millennia. When I see Baroque art and read of the Enlightenment, I think Hudson’s Bay and the whalers in the north. It wasn’t the Inuit who caused the mighty leviathan to become endangered. Just how enlightened are we, the great grandchildren of the settlers today? Who is taking care of our Other grandparents?

Since the first wave of Inuit activists flooded the Canadian research landscape fueled by their frustrations with academic Fawlty Towers they morphed intergenerational keen observation of details, habits of memory, oral traditions and determination with astute use of artefacts and archives to produce focused and forceful research. When Sheila Watt-Cloutier representing the Inuit Circumpolar Conference (ICC) was acknowledged with two awards in one year for work done to protect the environment, I wondered how many cheered her on.

I don’t cheer so much anymore. I am too overwhelmed, too hopeless to speak. I myself feel toxic, perhaps another pollutant from the south — my name is despair. I don’t want to dampen the enthusiasm of those activists who still have courage to continue. For myself, I feel like the last light of the whale-oil-lit kudlik is Flicktering and there is a blizzard outside.

Footnotes:

From wikipedia entry Sheila Watt-Cloutier

In 2002, Watt-Cloutier was elected[1][4] International Chair of ICC, a position she would hold until 2006[1]. Most recently, her work has emphasized the human face of the impacts of global climate change in the Arctic. In addition to maintaining an active speaking and media outreach schedule, she has launched the world’s first international legal action on climate change. On December 7, 2005, based on the findings of the Arctic Climate Impact Assessment, which projects that Inuit hunting culture may not survive the loss of sea ice and other changes projected over the coming decades, she filed a petition, along with 62 Inuit Hunters and Elders from communities across Canada and Alaska, to the Inter-American Commission on Human Rights, alleging that unchecked emissions of greenhouse gases from the United States have violated Inuit cultural and environmental human rights as guaranteed by the 1948 American Declaration of the Rights and Duties of Man.[5]

Digitage elements:

Caspar David Friedrich’s (1824) The Sea of Ice
Tujjaat Resolution Island, abandoned, DEW line station DINA Northern Contaminated Sites Program (CSP) web site
My photo of ice floes in Charlottetown harbour, March 2000
A section of my acrylic painting entitled Nukara (2000)

Selected Bibliography

Eilperin, Juliet. (2006). “”U.S. Wants Polar Bears Listed as Threatened.” Washington Post Staff Writer. Wednesday, December 27, 2006; Page A01

Gertz, Emily. 2005. The Snow Must Go On. Inuit fight climate change with human-rights claim against U.S. Grist: Environmental News and Commentary. 26 Jul 2005.

The Guardian. 2003. “”Inuit to launch human rights case against the Bush Administration.”

DEW line contaminated sites in Nunavut.

http://www.guardian.co.uk/international/story/0,3604,1104241,00….

http://www.grist.org/news/maindish/2005/07/26/gertz-inuit/index….

This will be updated from EndNote. If you require a specific reference please leave a comment on this page.

Creative Commons Canadian Copyright 2.5 BY-NC-SA.

Christmas Char on First Air

Youth and suicide

We both arrived early at the airport. I had only met P briefly before. She and her husband were well-known and liked. When I ate my meals at the Frobisher Inn they would often be there. He would come over to greet people including myself.

So there we were in the hustle and bustle of a small airport terminal in the middle of a not so typical Christmas conversation.

They have a twenty year old adopted child who had d… when he was young. This left this child with some weaknesses that P likens to Foetal Alcohol Syndrome. This child had a very difficult time during his teen years in High School in Iqaluit. At one point he attempted suicide by overdosing. Fortunately he was saved but this has shaken P. P wondered what more they could have done!

When P was called into P’s son’s school for a crisis situation, P was told by one of the staff that they were dealing with about five crises concurrently. They were understaffed and the crises strained the already overworked staff.

Our conversation grew out of my expressions of strong feelings of being shaken by the multiple youth suicides around me. I commented that the elders could perhaps be available for consultations with the youth but also with anyone in the community who needs their listening ears and their lifetimes of wisdom born of experience. P cautioned that the elders were not perhaps the most well equipped to deal with youth issues. (P reminded my there were fiascos resulting from well intentioned elders offering unsound advice to women suffering from spousal abuse.) P was concerned that the elders were out of touch with contemporary issues. We both agreed however that Iqaluit was under serviced in terms of dealing with youth in crisis. There was really nowhere for troubled youth to turn. She suggested that maybe the new youth centre could have a 24 hour counseling service where youth could turn for help.

Anti-poverty meeting at the NAC

Thoughts after an anti poverty meeting at NAC

“I have not been here for a long time. It seems like what I have seen is more like a blink than an observation. In this room we have people who have more knowledge than I have about poverty in Nunavut. But there are images I cannot shake. Now I recognize that these are rumors not necessarily facts. In the many conversations, in class with my students, the nursing students and others, in which I have taken part over the last few months, I have been presented with images that I cannot shake. I have not had these images of poverty since I lived in the third world, in Pointe Noire, Congo in the 1980’s. Then I lived in a Congolese neighbourhood where it was typical for people to live on one meal a day. I have not heard of that in Canada until I came here to the North. Even in my travels to other First Nations communities, I have not heard this described in this way. Perhaps I wasn’t listening. I have images in my head now of empty cupboards and fridges. I have heard the contents described: a jar of mayonnaise, a bottle of Ketchup, salt and pepper. No food. I have heard rumours that a young person who committed suicide may have been hungry. I have heard rumours that the homeless shelter only provides coffee and tea in the evening. The homeless do not always have an evening meal. Sometimes hunters provide this. Sometimes others do. I have heard rumours that the Soup Kitchen is no longer operational. This means that there is no place in Iqaluit where the homeless can be sure of a meal.

Recently I had a very minor incident which brought me to the RCMP. I was enquiring whether a young man was potentially dangerous and if I should have concerns for my safety. When I learned of the reality of this young man’s life, there seemed to be something very wrong with the picture. The RCMP officer explained to me that this person was homeless. On the coldest nights the young man who is ill, not a criminal, would be put into a cell so he would not freeze to death. Many nights he slept in the foyer of the RCMP building.1 I admit that there are aspects of this story that I do not know. But there is still something very wrong with the picture.

It is not surprising that southern Canada would be concerned with the housing crises in the North. I may have the statistics wrong, but it is my understanding that in the north 25% of the population share a room, whereas in the rest of Canada the figure is 2%. With all of the research available today that reveals links between overcrowding and violence it is not surprising that this is a concern. It ties in to so many problems in the North. Even in terms of the education crises. How can children study when they are living in such overcrowded conditions?”

Maureen Doherty keeps her cool and explains things articulately. She appears to be speaking from experience. She has lived in the smaller hamlets. After I spoke with my face getting increasingly red, she spoke with icy cool tones. From her experience in the hamlets there is an unofficial way of dealing with homelessness and hunger. People help each other. She painted a rosy picture of community in which no one fell through the cracks. Seeing double. My name is quoted but the words are not mine. They are hers. I am uncomfortable when she speaks. I recognize what is happening. It is on this note that the meeting has really ended regardless of what will be said afterwards. Has she found the right words to sanitize my images, to place them into a narrow, unique context that is not wide spread? Has she found the words to say what everyone really wants to hear? Things aren’t so bad. These are growing pains.

In the back of my mind, I recall the admonitions of the United Nations, criticizing Canada for the way in which the poor among us are treated.