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Point of View: Veterinary Service in Nunavik
Chinook Project: Summer 2011 Report
Unikkausivut: Sharing Our Stories
Making a Mitten Harness
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Dogs in Kuujjuaq Photo: J. Ducrocq
Point of View: Veterinary Service in Nunavik
A conversation with veterinarian Dr. Julie Ducrocq on August 12, 2011.
SH: In his apology speech Quebec Premier Jean Charest said "never again" and this is one of the reasons I wanted to talk to you because I think it is happening again and again since so many dogs are still dying because of lack of vaccinations and veterinary care.
I'd like to hear your feelings on the dogs of the North and learn about some of the things you've been doing.
JD: As for historical events, even if we do not have any historical medical records for these animals, it is suspected that northern dog populations have been exposed to "old world" diseases when Europeans came into contact with the Inuit. Infectious diseases were probably present in the Arctic but maybe limited by natural selection, the harsh environment and the low density of dogs on the arctic territory. Again those are my personal speculations. The introduction of the skidoo and the decline of the number of arctic dogs have had a profound impact on the Inuit culture and consequently on dog populations and genetics. Everything is intertwined in the North and one must try to understand all these issues before making a judgment on what is right or wrong to do in regards to animal ethics.
From 2003-2006 I was working for the Ministry of Agriculture (MAPAQ) in Quebec City and I participated in the rabies vaccination campaign of dogs in the North. It was the first time I went up north by myself. The MAPAQ organizes vaccination clinics because rabies is a zoonotic disease, hence dangerous to humans, but distemper vaccination was also added because it was a problem in local dog populations. Even if the main goal is vaccinations you can still do examinations, basic prevention and treat dogs for parasites or other problems.
The MAPAQ continues to send a veterinarian up once or twice year depending on the response of the Nunavik communities. I don't believe vaccinating dogs is one of the legal mandates of the MAPAQ (e.g. they are more responsible for agricultural animals - cows, horses and all the diseases of those animals) but the government keeps doing it for combined human and animal health issues. The responsibility for dog health up north is very hard to determine. Because down south if you have dogs you are yourself responsible for them. You have to get your animal vaccinated and sterilized. But the big question is who would be responsible for getting a minimum of veterinary service up north? I know that Makivik has been thinking about hiring a vet for a number of years. They did in the past have a vet come in for a couple of years but very often these people moved down south again.
There are many cultural differences between the North and the South and because the majority of professionals such as doctors, nurse or vets are still non-Inuit, it is quite rare that they will establish themselves for a long period of time in Nunavik. Presently, the health system functions in Nunavik because professionals do shifts up north by flying in and out. You could probably find a veterinarian who loves the Inuit culture and the North who would really do that (commute) and it would be great. Personally, because my apartment, my family and my friends are in Quebec City, I wouldn't be happy living up north for long periods of time. However I wouldn't mind going up north for small periods of time. I have approached Makivik to ask if they would be interested in having a rotational system for veterinarians but I'm still waiting for their response, which will depend on their budget constraints and priorities.
SH: Isn't that kind of hard to have rotations because sometimes it takes a while for the community to build up trust?
JD: I'm aware of that but I sometimes think is it better to start with this idea rather than having no service at all for the rest of the year. I also think the objective should be to have a veterinary service durable in time. Manon Simard of the Nunavik Research Center has informed me that she has an Inuit student interested in studying to be a veterinarian. Having an Inuktituk speaking veterinarian would be the most interesting and durable option for the future in Nunavik. Even getting a couple of students from the villages interested to study an animal health program would be a great step ahead. However, even if this is possible there is still a need to set up an animal health plan.
SH: I understand that something like that goes on in Greenland. There are five veterinarians that service most of the island except for parts of East Greenland. Since they can't be in every place all the time, they have "lay people", like human physicians assistants only veterinary assistants, that are in each community and they communicate with the veterinarian so they (the technicians) can be responsible for vaccinations and minor procedures.
JD: Well this is actually what is going on in the majority of Inuit villages in Quebec. Laypersons or human nurses or technicians have been trained to vaccinate dogs and keep track of the information for the MAPAQ, between vaccination clinics. This is based on the human health system in Nunavik where there are not necessarily doctors in every village (e.g. nurses are the main health responder). Hence, for dog vaccination up north, there is a little bit more "legal" flexibility for things trained laypersons (Inuit or non-Inuit) can do compared to the South. Please note that these persons have only been shown how to vaccinate and take note of delayed reactions to vaccines. They are not able to perform minor procedures in the name of the MAPAQ or perform any other veterinarian act.
You were asking me if this is legislated. In Québec, it is not the government but the provincial veterinary medical association (e.g. OMVQ in Québec) that is responsible for veterinarian acts. So unless you are a veterinarian member of this association, nobody else has the right to do veterinary acts in Nunavik. But like I said before, there is presently a little bit of latitude from the OMVQ in the absence of veterinarian service up north and only for administering vaccinations outside the MAPAQ's yearly clinics.
SH: What vaccines are you talking about?
Dogs in Kuujjuaq Photo: J. Ducrocq
JD: The MAPAQ usually gives two separate vaccines, one for rabies and another for common dog diseases amongst which is the canine distemper virus. Canine adenovirus, coronavirus, parainfluenza and parvovirus are often included in the second vaccine but it really depends on the brand that is used.
SH: That seems to be the big issue, the availability of distemper and parvovirus vaccines has not been good I understand in both Nunavik and Nunavut because of the laws.
JD: I can't talk about Nunavut but in Nunavik I know that there should be vaccines in every village and there is somebody trained to vaccinate. However, if the trained person does not notify the MAPAQ of a lack of vaccines then it is hard for them (MAPAQ) to know. Mushers are also usually trained to vaccinate their dogs for booster shots or for new puppies.
SH: I just recently heard of an incident where a dog team owner in Kuujjuaq wanted his puppy vaccinated by a team that went there from the University of Montreal. He was told they didn't have anymore distemper-parvo vaccines, that they only had rabies. So the pup didn't get vaccinated and it died.
JD: The first thing that comes to mind is that it doesn't necessarily mean that it died of distemper or parvo. I'm not aware about that [incident] but usually the MAPAQ teams leave the vaccines in every village they visit. However, if a village has not responded to the MAPAQ to have a vaccination clinic, then it is possible that no vaccines are left in the village from previous clinics. I'm aware that the University of Montreal has occasionally sent veterinary students or personnel up north in the past but I'm pretty sure it was more for other kinds of projects. So it was hard for the person that was asked to vaccinate if she did not have access to distemper vaccines in the village. This is a good example of the possible lack of coordination between villages, Makivik, the MAPAQ and veterinarians going up north.
There is also a problem because the MAPAQ is presently offering the vaccination clinics for free and therefore the population is expecting any trained person to vaccinate or treat animals when possible. So, if there is eventually a veterinarian working up north, my big question is "who is going to pay for vet services beyond basic rabies or distemper/parvovirus vaccinations?"
SH: Why couldn't the animals' owners pay? Do you think they wouldn't vaccinate or ask for other services if they had to pay?
Dogs in Kuujjuaq Photo: J. Ducrocq
JD: Well I don't know. It's a lot like international development when a population gets used to getting things for free, they're kind of surprised when they have to pay for it. I honestly think that local Inuit government levels (e.g. Makivik and villages) need to address these problems. I mean it's one thing for the MAPAQ to vaccinate for rabies but another challenge to start educating people about basic dog care and ownership. Based on my personal experiences, I think the local, provincial and federal governments should put some money and start organizing veterinary service up north. Again, I'm of the opinion that people have to organize themselves and decide that they need veterinary service. I have observed that grassroots solutions are usually more easily accepted than imposed solutions. This is what happened with the Ivakkak race. I had heard that last year they did have some problems with the animals. According to the description by one musher, there were a lot of sick dogs so it might have been an infectious disease epidemic of some sort (distemper or parvovirus as an example). I'm not sure because no diagnostics were done on the sick animals.
Following that episode, an influential musher in Kuujjuaq highly suggested of having a vet at the next Ivakkak. This particular musher is very educated about dog care and uses the MAPAQ's veterinary services every time they're available. He's very aware of the spectrum of veterinary services we could offer. I vaccinated and examined his dogs when I was visiting Kuujjuaq for a caribou project. So because the Inuit people described their needs to their authorities, they asked for a veterinarian to join the team for the 2011 Ivakkak. When I saw the advertisement, I immediately applied. I had previously proposed my services over the past six or seven years but they had never felt the need to have a vet for the race. I've kind of aligned myself with the Inuit culture in that they have to progress on their own and when they feel the need then they go out and ask for it. This is just a personal belief.
SH: Were you well received attending the race? That was a new concept for folks up there.
JD: Yes it was. I was well received because I had met at least half of the mushers while vaccinating their dogs with the MAPAQ's rabies program or during hunter-based training for a caribou parasite project up north. So a lot of them recognized me from earlier veterinary work I had done in Nunavik. Even if I was well received, there was some skepticism at first because I was prescribing some non-steroid anti-inflammatory for some limping dogs and the mushers thought that those animals were doped (with steroids). But they also saw what kind of treatments and solutions to problems I could offer for sled dogs and I showed them a little bit of sled dog care at the same time like clipping toe nails and trimming hair under the foot.
I'm a very careful person when immerged in another culture even when doing the professional work I was trained for. I was on the side at first, just doing my stuff and letting the mushers do what they were trained to do. If I had comments on some dogs I would first ask them what they thought, to get their impressions, and then I would suggest some treatment or other options. So the trust was built up during the week mainly from seeing other mushers use my services. Overall, I felt it was positive to have a veterinarian attending the race. I had ordered all sorts of things for basic dog care and made sure that everyone got some access to some material at the end of the race.
SH: That's really good. I've heard similar stories from my contacts at the Chinook Project on Prince Edward Island and the Canadian Animal Assistance Team. Both groups go north into communities only when they're asked. They experienced a lot of skepticism at first and then trust is built and in the end the communities are very happy to have them visit. But that's only once a year for maybe two weeks. Not nearly enough.
JD: I understand. I do think there is a bigger need for dog health care. But when you start doing this for free then it's hard to change it in the future. I've been really pushing the Makivik government to hire somebody to start working with the needs of their people. In the past years, I've felt that solutions or services are mainly coming from people down south. There are cultural differences between Inuit and non-Inuit and solutions that come from we non-Inuit are not necessarily the best. I mean, it would be a good idea to have sterilization clinics up north but I think it would be important to see if the animals' owners would use and pay for this service. I know that mushers would like to have their females sterilized, but not their males. But even if it's free, I don't know if, besides mushers, people would sterilize their animals. There are presently studies on alternatives to taking the testicles out of males and the ovaries and uterus out of females but I'm not aware if these procedures have been approved in Canada yet. Another example of a problem up north is how do we identify previously vaccinated dogs? Animals in villages are often loose and the perception of ownership is very different from ours, down south. So how do we deal with those issues?
SH: What happened to that plan the University of Montreal had? There was a multi-year plan/feasibility study with a goal of establishing a clinic in Kuujjuaq. What happened to that?
JD: When I was at the MAPAQ, I had written a multi-stakeholder project proposal for dealing with animal health and zoonotic diseases. When I left the MAPAQ, this proposal was later transferred to a group of veterinarians at the University of Montreal that is now heading a meeting group including the MAPAQ. Multiple other professionals have improved this project but its study is still based on volunteering, on personal spare time. The problem is that nobody is paid to handle and lead this initiative at the University of Montreal. I feel many people, just like me, are aware of the needs of Nunavik in regards to veterinary service but there is presently many time and financial constraints to explore and implement durable strategies.
SH: I do understand "arctic time". Things move slowly. My husband and I were in Kuujjuaq when there was to be a meeting of all the community leaders and one of the topics of discussion was supposed to be veterinary service. So while I was there I scrambled like mad to get a letter of support from the folks at the University of Prince Edward Island Atlantic Veterinary College's Chinook Project so the letter could be taken to this meeting. The letter was sent but nothing came of it and that was back in 2007.
JD: Yes…It's a very long process. I think that if Makivik, the local government, initiates a program, strategies or solutions will be more applied to the local problems and more durable in time. It could also decide if it wants to offer free of charge veterinary services to its population. Makivik, could also ask for the collaboration of many organizations and many government levels, including Nunavik's communities. Because everything is intertwined, a broad animal health project would be essential. You have many non-identified roaming dogs in communities and these dog control activities also need to be addressed. And now, the MAPAQ is writing new regulations about animal care ethics and the impact of these rules might have an impact on how dogs can be cared for in the North and by mushers. It might change but the last time I saw the draft, it will not be legal to tie a dog for more than 12 hours.
SH: Yes, I heard! But I didn't know if that was going to apply to Nunavik.
Dogs in Kuujjuaq Photo: J. Ducrocq
JD: Pita Aatami of Makivik just wrote to me saying that he spoke directly with Premier Charest of Québec about that subject and was suggesting an exception for the North because Nunavik communities are trying to ask their citizens to tie their dogs in order to control roaming dogs, which is a common and big problem up north when trying to vaccinate animals. Even non-Inuit mushers all over the province are disputing issues regarding these proposed rules for the management of their sled dog teams.
SH: When speaking about a grass roots effort for veterinary service in particular I can understand where dog people/mushers wouldn't know where to start. And so it takes a little bit of leadership from government, agencies like Makivik to take the lead and get things going. And I don't know…does Makivik have the will?
JD: Yes, I think Makivik has the will to get some sort of veterinary service up north, especially if mushers are asking for it. I have proposed a couple of solutions to the North in the past but it doesn't necessarily mean they're ready for them. They do have human health and social issues far more of a priority than dog health right now. Things have to be seen in perspective. Again, we look at these situations with our southerner's point of view and culture. The northern culture is still adjusting to new realities and any implementation of veterinary services up north needs to take that into account.
I would be so glad if something can be done. I've put so much energy and time on implementing a veterinary service in Nunavik. I'm more patient now. They know I'm out there and if they need something they know how to communicate with me.
SH: I would like to thank you very much for that attitude and that offer and hopefully someone will take you up on it. And that's just Nunavik. Then there's all of Nunavut as well with similar issues. It's a very complex problem and I guess very frustrating for people like you and me to see dogs dying in the mean time.
JD: I get really sad when it happens but it does remind me that in the North relationships with animals are very different from what we have here in the South where we treat them almost like family members.
SH: Well, you really can't do that with working Inuit Dogs. They have to have their own society amongst the dogs themselves. Of course there has to be human intervention and socialization but I do understand that difference in relationships. However I do think from the reports I've heard from the Canadian Animal Assistance Team and the Chinook Project people that there is a real appreciation for the veterinary care and the enlightenment of what that sort of activity can do for their dogs. Once they get a grasp of that I really think it would be embraced.
JD: Yes, you are right and I'm pretty sure they will want a vet next year for Ivakkak. The situation is slowly changing but moving in a really good direction. We need to be patient and not to be discouraged. As for me, I'm in contact with Makivik through Pita Aatami and Allen Gordon and I have proposed my services on a rotational basis to the Nunavik local government. I know there is a big need for this and I would be very happy to work with them. And if not me, any other veterinarian with experience with the North would be happily received. It would be easier for a veterinarian as a Makivik representative to approach all the governmental levels and groups already working up north (e.g. agriculture, education, human and animal health, etc.) and say, "Hey let's do something together. Let's get some money for a multidisciplinary animal health program. This program would include educational program, vaccinations and sterilization clinics, dog control strategies and studies, etc".. Makivik could then decide what approach to take for a durable animal health services (e.g. if it is going to be free or not and if not who's paying) in the present context. Ownership is so different from down south. In many villages, dogs are not even used to having collars. They're presently having a hard time just to get the rabies vaccination tags on those dogs which would help knowing if a dog was vaccinated or not when humans are bitten. It is easier for human doctors to know the vaccination history of animals wearing rabies vaccination tags in order to make prompt decisions in giving rabies prophylaxis or not. So how do you try to identify vaccinated dogs from others?
SH: I thank you for your time. It's been an enlightening conversation. I'm very glad to have heard your insider's pragmatic point of view of what's going on.
JD: You know, a couple of years ago I had this "I can change the world approach." But I guess I'm getting a little older and wiser. As much as I want to help, I have to respect the speed at which people are able to cope with change.