Surprise! There's a child on my back!

There's a lot you don't expect when practicing paediatrics up north, especially in the first few days. This was represented beautifully when I walked from my office to the waiting room to get my second clinic patient on my first day. All I saw was a woman wearing what looked like a colourful jacket-vest with an oversized hood. And then her shoulderblades started to cry, which I admit I found odd until she turned a bit and revealed the source: the baby riding in her giant hood on her back.

I admit that I am dramatizing this a bit. I was in fact previously aware from exposure to Inuit art (like that piece to the left) that Inuk mothers wear their babies on their backs. I think I just forgot about it and also kind of thought that it was a historical thing. Wrong. It's actually pretty cool that this piece of culture has been preserved. Also, it's poetic because the mothers are showing up to my clinic literally carrying their problems on their backs.
Not that their babies are a problem, it's that their babies have problems.
That's why they're coming to see me, obviously.
Don't get up in arms so quickly!

And problems they indeed have. And then I get to play the "surprise" game back with the mothers where I "surprise" them by telling them that they are going to go on a much longer trip than they expected. I will explain how that works... now.

Several patients have come in with recurrent urinary tract infections with fevers. In infants, this is a concerning presentation because it could be indicative of something called vesicoureteral reflux (VUR) - a condition where the valves between the ureters and the bladder are incompetent and allow urine from the bladder to reflux back up to the ureter and kidney. When said bladder is infected, this refluxing urine can spread the infection to the kidneys where it can cause scarring and, eventually, bad things like high blood pressure.

So how do you test for VUR? With another acronym - a VCUG (voiding cystourethrogram). In this test, a catheter is inserted into the bladder (don't squirm... buck up and keep reading) and a dye is inserted in the bladder and xrays are taken. A normal exam would show all the dye staying in the bladder. VUR would look like this -->

Of course, as the picture helpfully points out, this is not a procedure that we can do in Iqaluit. Surprisingly (surprise!), in fact, because there used to be a fluoroscopy machine here (the special kind of xray used for this test). It hasn't worked for quite a while though. As always, it's a resource allocation issue.

So I get to wonderfully surprise parents by telling them that their child may have to go down to Ottawa to have the test done.

That's a long flight from Iqaluit but it's even longer from places like Arctic Bay or Pond Inlet (see if you can find them). These children have to fly up to 7 hours one way to get a test that children in "The South" take a couple hours out of daycare for. That was definitely a surprise to me. The government pays for the transport but gee golly it sure seems like a convoluted way to get what we generally consider a simple test. Also, arranging the whole process can take up to an hour in paperwork and phonecalls. I promise you, Sick Kids, I will never complain about your procedures again!