Nunavummiut can access a full range of optical and dental care wherever they live in Nunavut, but the ease of access remains a sticking point for some MLAs.
Iqaluit-Niaqunnguu MLA and former Health minister Pat Angnakak says there have been community concerns over the timing of getting an appointment to see the dentist.
"The dentist is usually in town for five days or so and many residents don’t get to see the dentist on a timely basis due to demand. I think that communities facing a long wait list should get their MLA or mayor to write to the minister to request for more dental days for their community," she said.
"It's the same for eye exams. There are wait lists and the service is limited in the community for such a service and so we see many Nunavummiut travelling to the regional centres to get such services. I think the concerns over this kind of travel mostly has to deal with the travel experience itself or the fact that parents have to leave their children and family members in order to get the service."
The wait list for pediatric dental services in hospital is also long.
"But to understand it, you have to know what that means. It's always about 600 kids. But the number of kids we can actually treat in the territory through our channels is probably half that. The others are all slated for service in the south and the way they're allocated is they're controlled by the southern facilities," said Ron Kelly, the Government of Nunavut's director of oral health.
Aggu MLA Paul Quassa notes the high cost involved with sending children out of territory.
"I do know that Health sends children down to Churchill, Manitoba, for dental care, where parents or guardians are escorts and this cost is huge. These costs could be diverted to our community health facilities," he said.
Rankin Inlet North-Chesterfield Inlet MLA Cathy Towtongie's concern stems from personal experience.
"I do know with dental care, Non-Insured Benefits very often does not cover badly-needed braces for children. Two of my grandsons have been refused a number of times," she said.
"My daughter takes very good care of their teeth, but the teeth are crowded. This is an issue. Too many children have their teeth taken out instead of getting braces."
What's on offer?
Regarding braces, Kelly notes the Non-Insured Health Benefits Program is a federal program, and the GN has no say in decisions. But, he says, the desire for braces often has to do with aesthetics versus need.
"Specialty services, for the most part, have to be accessed outside the territory, although we do provide, here, some hospital treatment for children. We also provide some orthodontic care and oral surgery care," said Kelly, adding those are only provided in the three regional hubs.
Each community is set up with a GN-owned dental clinic, which Kelly says have mostly all been significantly upgraded. Basic dental services – fillings, extractions, preventive services, root canals and dentures – are available in every community.
"It's all pretty new. That's been ongoing for two, three years. And we have a lot of new clinics, also," said Kelly.
The two dental contractors means there are 15 to 20 dentists making their rounds at any given time. One contractor services the Baffin and Kivalliq regions, while the second services the Kitikmeot.
Visits to communities are regular, with separate teams designated for adults and children. The number of visits per year depends on the community.
"The minimum number of trips (per community) is four a year. Some communities only go two or three weeks at a time without service," said Kelly.
Kelly says some wait lists for dental care can be long, as for oral surgery. Patients are prioritized.
"It's need and how long you've been on that list. If you start as relatively low need and you keep getting bumped by people who are more urgent, you're going to become urgent. So we try to take both into account," said Kelly.
Angnakak notes travel is often necessary for children.
"This is because these children have to be put to sleep in order to get the dental work needed done. I do know that the Department of Health has tried to address this problem by using their health representatives in each community, where children are provided with a toothbrush and shown how to brush their teeth."
She hopes this will help in the long run.
"If we can get more and better services in the community, it will help families stay home and not have to travel. It will be less expensive for the GN if they can find the expertise willing to spend the time in the community," Angnakak said.
"It's not easy but I hope that the GN will be thinking about the next five years and how they can provide more services at home for Nunavummiut."
Aside from two private practices in Iqaluit, and an office privately maintained in Rankin Inlet, dental care in Nunavut is delivered by two contractors chosen in a Government of Nunavut open-bidding process.
Optical care easier to access out of territory
Similarly, eye care is provided by one contractor, but not by way of the GN.
"Optometry services are not an insurable service, meaning they are not covered by the territorial health program. Some residents have private insurance which will cover a portion of needed optometry services. This is in line with most of the rest of Canada’s provincial insurance programs," stated executive director of Iqaluit Health Services Dennis Stavrou by email.
"Non-Insured Health Benefits covers approved optometry services for eligible clients, including vision testing, screening for eye disease and corrective eye wear prescriptions."
That program is federally-run, and Stanton is contracted by the feds.
Stavrou says anyone with emergency eye issues should present to the emergency room (at the Qikiqtani General Hospital) or local health centre for assessment.
"Routine eye care (i.e. eye exams) should be done when clients are travelling out of territory for other reasons. Those not travelling can add their names to the eye-team waitlist," he said.
Stavrou explains the eye team of certified ophthalmic medical technologists can provide full routine examinations, provide prescriptions for glasses, assess for all pathology, treat when possible and refer to an ophthalmologist when necessary. They also perform visual fields, diabetic screening, and all other medical screening required by the ophthalmologist.
"Each community has at least two visits per year scheduled. Some communities have more depending on population. I can only speak to the specifics for Iqaluit. Iqaluit has six visits per year," Stavrou said.
He said there is a wait list, though he didn't specify the number of people waiting for eye care.
"Referrals deemed medically necessary are first priority. Otherwise clients are called on a first-come first-serve basis," said Stavrou.