Friday, December 10, 2010

What Jack Taught Us

Professor Arnold Naimark has referred to Jack Hildes' definition of the silent language of medicine as the non-verbal means by which values and standards find their way to those places in our hearts that words alone cannot reach. Most of Jack Hildes’ lessons were of this non-verbal variety.

Jack was the kind of fellow you watched carefully, attempting to determine how he made it all come together. I went to Churchill with the Northern Medical Unit as a student first in 1972 when Wally Temple, John Russell and Mike Gonzales were doing burr holes for subdurals and emergency abdominal operations. I saw Churchill and the kind of supportive supervision one could get from the university connection and visiting specialists as a good way to prepare myself to return to Africa. I was so green, I d
id not realize you were in trouble when flames started to leap out of one of the engines in a Twin Otter. I would probably still be there in Arviat except for a curious Inuk who came by on skidoo to see why we had landed so far from the air strip! I travelled on to Chesterfield Inlet with Jack, fell asleep while he played bridge with Sister Isabel until the wee hours of the morning. I was astounded when he started his clinic at 7 the next morning. I felt that I would need to train as SuperDoc to work in the North.

So when Sharon Macdonald, Eddie Berinstein and I went to Churchill to practice as the first group of U of M graduates in 1974, we were in the beginning, all very clinically focused. We had to be. We took turns doing surgery and anaesthesia. Bill Sutherland, who later went to practice in Rankin Inlet, helped to ease us in to our new roles. Jack would come up to Churchill 4 or 5 times a year to wrestle the hospital board into shape; getting them to agree to having an Inuit representative, Ollie Ittinuar, by offering to prov
ide an interpreter; forging a strong connection with Keewatin Medical Services with visits to the Inuit hamlets and teaching nurse practitioners for us; and making links with the province with regular visits to the Cree communities down the Bayline and to the Tadoule Lake Chipewyan community. In short, he was transforming, bit by bit, what had been a white hospital enclave at the old army base in Fort Churchill into an flourishing aboriginal Community Health Center.

At the end of our first year, Sharon, Eddie and I were invited by Jack to negotiate for our second year. He was surprised we didn’t ask for more money and increased our salaries anyway. But by then we had started to get a broader picture of aboriginal health. So we said we wanted to get more involved in northern health, attend conferences, do research and assist with the community health center. Jack readily agreed.

" Whoa", we countered, "we don’t even know where to start or what to do. We need your help. "

We were asking even at that early date to be mentored.

Around about then, Lorna Medd came on board as co-director of the NMU, although she used to joke that she was the only co-
director, Jack always remained the director! But we began to get more creative. We held several of our own health conferences in Churchill. The first conference was broadcast over CBC North. Soon CBC was swamped with phone-in calls from the Keewatin communities and Josie Kusugak was invited down as their spokesman. We approached Jackson Beardy about using his art as a basis for a cross cultural sensitivity workshop for medical students who were spending the summer on northern reserves. When we first asked him, Jackson said You might be barking up the wrong Cree.”

But he agreed and it was a rousing success. The family medicine residents asked us to do one for them as well. Social scientists such as Mary Morison were doing research on the relationships between the GPs and the specialists, social
workers and dentists were engaged and along with a wonderful group of itinerant specialists whom we referred affectionately to as Uncle Jack’s Old Boys Network, a functional health team was being shaped.

Two of Jack’s tips have followed me in my career. The first is: Start with what you have. I had started to track the high number of meningitis cases we were seeing in Churchill but before long I was ready to toss in the towel. The laboratory was a hodge podge of antiquated laboratory tests such as Pandy’s test and medical records were a dysfunctional labyrinth you could enter but might never emerge from. Jack was adamant that we had to start with what we had. Only then would the lab and medical records improve, he claimed. Start with what you have has travelled with me thru mental health issues in Labrador to motor vehicle accidents in Africa.

The second tip from Jack that I continue to use frequently is she who writes the minutes controls the meeting. The early Northern Medical Unit days were peppered with meetings: meetings with the province, with medical services, with communities and with doctors. Jack always went in with a clear idea of what he wanted out of each meeting. He would brief us in advance and debrief with us afterward. He often had one of us take minutes but he always edited them carefully. He wasn’t interested in what he called purple prose, but he tracked forward progress. His approach to meetings made him an effective negotiator.

He was also known to occasionally fall asleep in the middle of a meeting. One could actually hear the Zizzes. But he would come to quickly and leap right back into the fray. I think it was Jack’s way of signaling that he was bored by posturing and rh

She who writes the minutes controls the meeting
has been extremely useful to me. I can point to a number of times when concise minute taking has made a real difference in not only meetings but in forward progress in projects and steering committees.

Jack not only established community medicine training at the University of Manitoba but was a true founder of community medicine in Canada. There are many wonderful stories of how he related to and interacted with communities, but
my favourite occurred during a visit to introduce the Northern Medical Unit to the communities on the East side of Lake Winnipeg. A group of us had dropped in with Jack to Berens River, Popular River and Paugaussi in a single engine Cesna one fine summer day to talk about what a link with the university might mean to these isolated reserves. This, as you can imagine, was not an easy idea to put into words, never mind to sell to remote reserves. No sooner had the community gathered in Little Grand Rapids than we realized we had walked into an active hornet’s nest. The nurse was threatening the chief and councilors. Everyone was hurling abuse at the nurse. Accusations and intimidation filled the air. And in the middle of the controversy was a sick, disabled child.

This was not the time to point out that the NMU had played no role in this particular fiasco, nor to point out that the university and Medical Services were completely different organizations. Most of us with him thought that Jack could walk on water but we figured he was about to meet his Armageddon in Little Grand Rapids that day.

As the shouting escalated, the rest of us physically and mentally backed off.
In contrast, Jack became totally engaged. He listened carefully, teasing out what had happened. He probed skillfully and rephrased appropriately until the sequence of events was clear. It wasn’t a pretty situation or even a defensible one. But finally when tempers had cooled, Jack got everyone to agree that mistakes had been made; that pressures on everyone had been excessive and that humans are fallible. A meeting about what the addition of the university could add to the current health mix in Little Grand Rapids was no longer necessary. Jack had provided the best possible demonstration.

He could certainly dance and dance he did that day as the rest of us watched spell bound. I think now what made Jack so effective in so many similar high pressure situations was his strong belief in our human connectedness and our fallibility.

Jack loved details and he was a big picture thinker. It was this paradoxical mix that made him so influential. He influenced those of us who mentored under him not just to address the ill health of people but to notice and appreciate what kept them whole, vibrant and unique. He might have been measuring the temperature in the leg veins of arctic shore birds when he first went to the Arctic as a physiologist but what captured the places in his heart that words alone can not reach was how, despite the adversity, the scarcity of resources, the poverty and the attempts at assimilation, northern aboriginal people not only had managed to survive but did so with so much of their culture and center intact. His legacy to all of us has been a NMU that could address with sensitivity not just the ill health of aboriginal people but could celebrate with them their culture, strength and aliveness.

Photos: Jack on Jackhead dock; Charlie Ferguson at Rankin Inlet; HBC at Repulse Bay; John Crispin at Norway House; aerial view of Norway House by George Hunter & Norway House Baby Contest, 1977.



Anonymous Stefanie Bill said...

I'm happy to hear hat there are still people like Jack that his legacy for all of us has been a NMU that could address with sensitivity not just to the ill people but could also join their culture, strength and aliveness.

10:44 PM  

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