Some RSV-related reading

My WordPress blog stats tool informs me that my most recent post produced a dramatic spike in page views today, orders of magnitude greater than the meagre numbers that it usually attracts.

Given this level of interest, I thought some people might be interested in more context.

Below you’ll find five different studies done on lower respiratory infections among Baffin Inuit infants since 2001, a press release related to Banerji’s work and a couple of news stories on the issue published about a year ago:

• Study on lower respiratory infection rates in the Baffin region (June, 2001) (188 KB)
• Study on costs to goverment from infant bronchiolitis in Baffin (August, 2004) (172 KB)
• Study on poor indoor air quality and LRTI in Baffin (December, 2005 (196 KB)
• Study on risk factors associated with Inuit infant LRTI hospitalization (August, 2009) (212 KB)
• Comparison between cost of hospitalization for RSV and cost of palivizumab (August, 2009) (212 KB)
• St. Michael’s Hospital press release on RSV work done by Banerji’s team (May, 2009) (136 KB)
• Nunatsiaq News, Jan. 9, 2009: “RSV study not needed in Nunavut: GN,” by John Bird
• Nunatsiaq News, Dec. 12, 2008: “Should Nunavut turn down free medical help?,” by John Bird

A blistering attack on the Government of Nunavut

Dr. Anna Banerji: 'The biggest barriers I have encountered have been complacency and inertia.' (PHOTO COURTESY OF NUNATSIAQ NEWS)

In an article published in a recent issue of the Canadian Polar Commission’s Meridian newsletter, Dr. Anna Banerji, a well-known disease expert, unloads on the Government of Nunavut, the Government of Canada and the pediatric research community for ignoring the appalling rates of respiratory infection among Inuit infants in Arctic communities, especially Nunavut.

A nasty little bug called RSV, or respiratory synctial virus is responsible for most of these serious infections: infections that require sick infants to be flown on highly expensive medevac flights to southern hospitals, where they receive equally expensive treatments to help their bodies recover. Much of what we now know about RSV, including its prevalence and its costs, is due to the work of Banerji and other researchers with whom she has worked.

RSV has blighted the lives of numerous Inuit children and their families. Inuit children suffer the highest rates of LRTI, or lower respiratory tract infection, in the world.

Banerji believes that health care providers can limit the damage by administering an agent called palivizumab. It’s manufactured by Abbot Laboratories and it costs a lot of money. Banerji, pointing to her research, asserts that palivizumab would help 80 per cent of infected children fight off the disease without their having to be hospitalized.

The Canadian Pediatric Society shares this view. But not the GN. The territorial government’s policy, even now, is to administer palivizumab only to premature infants or those who are at risk for other reasons.

The Canadian Press published a damn good story, by Bob Weber, about this dispute today. Your humble content provider is eager to see whether anyone in Nunavut pays attention to it.

Here are some salient quotes from Banerji’s Meridian article:

Working in the Arctic has been one of the most positive experiences in my life, but at times it has been very challenging. The biggest barriers I have encountered have been complacency and inertia. I have met many committed, dedicated people in the north. I have also met individuals so used to the high rates of LRTI, endemic diseases, poverty, overcrowding, and sub-standard housing that they have little motivation to lobby for change.

[Nunavut Tunngavik Inc.s] 2007–2008 Annual Report on the State of Inuit Culture and Society states that the Nunavut and federal governments “must communicate with and involve Inuit in the design and delivery of health care” as a legal requirement under the Nunavut Land Claims Agreement Article 32.

We have experienced situations when our research, though endorsed by the numerous Inuit organizations that we consulted for input and advice, and approved by the Nunavut Research Institute, has nonetheless encountered obstacles from the territorial government. We are still trying to to negotiate and overcome these difficulties.

And this is part of what she has to say about the complacency of the pediatric research community:

Although Canadian Inuit children have the highest rates of LRTI in the world, our study is the first (and only) case-controlled study of its kind published – and we submitted the papers five times before they were accepted for publication.

One reviewer from a major pediatric journal actually wrote that, “remote arctic communities are not of interest to the general reader.” To ameliorate the situation, Canadian journals should make it a part of their mission to include papers on aboriginal health and underrepresented populations, especially because very little data exists.

You can download Banerji’s entire article here: Meridian, Fall-Winter 2009, (PDF, 712 kb) The article runs from pages 1 to 3.

If you’re in Ottawa, check this out

The play Night, starring 16-year-old Abigail Ootova of Pond Inlet and developed by the Human Cargo theatre group of Toronto over the past few years, is showing Jan. 4 to Jan. 16 at the National Arts Centre in Ottawa.

Today is pay-what-you-can. Tickets for the Jan. 5 and Jan. 6 preview performances are $23. From Jan. 7 to Jan. 16, tickets are $35.

Sixteen-year-old Abbie Ootova of Pond Inlet cradles the head of Linnea Swan of Toronto, as the two rehearse the play Night in Pond Inlet this past February. Her director, Christopher Morris, says Ootova is the most talented person her age he's ever met. (PHOTO COURTESY OF CHRISTOPHER MORRIS)

When newspapers were not pitied

From Deadline—U.S.A., 1952, starring Humphrey Bogart, Ethel Barrymore and Kim Hunter, directed by Richard Brooks.

“A paradox of development”

It’s no surprise that circumpolar Inuit leaders who attended last month’s United Nations climate change conference in Copenhagen last month, known as COP15 for short, are divided over resource development in the Arctic.

One one side, you have leaders such as Aqqaluk Lynge of the Inuit Circumpolar Council’s Greenland section, who said this last November: “When I’m lying awake at night, I pray we don’t find oil.” Or Sheila Watt-Cloutier, who frames the issue in moral terms.

On the other side you have political leaders like Greenland’s nationalist premier, Kuupik Kleist, for whom the prospect of future CO² reduction measures comes at a most awkward moment in his country’s history. Greenland’s new self-rule arrangement with Denmark, marked with a lavish ceremony this past June 21, would, in time, give the country full independence.

But that’s only if, under a complex formula, Greenland’s oil and gas revenues rise to a level that is double the size of the block grant it receives from Denmark each year. Right now, Denmark gives the Greenland government about US $633 million each year, or about $11,000 for every man, woman and child living on the island. (This, incidentally, amounts, in per capita terms, to less than a third of what the Government of Canada gives the Government of Nunavut each year.)

The fate of Greenland’s nationalist project depends not only on the extraction of fossil fuels. Its fate also depends on a rapid and substantial rise in greenhouse gas emissions, from 639,000 tonnes a year now to 8.3 million tonnes a year by 2017. If the Greenland home rule government is forced reach into its own coffers to pay carbon offset charges on all that economic development, their day of independence could be long delayed. This explains why Aqqaluk Lynge said in Copenhagen that Inuit face “a paradox of development.”

Then, of course, there are leaders like Jimmy Stotts, the president of the Inuit Circumpolar Council. His home region, the North Slope of Alaska, depends on resource extraction. That’s their economic base. For the Inupiat of that region, resource extraction represents liberation from poverty and dependence.

Nunavut, with at least four or five energy-guzzling open-pit mining projects now at various stages of development, finds itself in a similar position. Those future mines, and the territory’s utter dependence on fossil fuel products, explains why, in 2008, most of its elected leaders firmly resisted the idea of a national carbon tax.

In this video interview posted below, Stotts mostly sticks to ICC’s six-point position statement. But at around the 7:20 mark, he asserts the right of Inuit to develop oil and gas reserves on their own lands…

…all of which means that on these issues, the people of the Arctic are not unique. We don’t like climate change and we fear for the future. But when asked to do something about it, we want someone else to pay. This is the paradox that has paralyzed Canadian governments, Liberal and Tory alike, since 1997. It’s a paradox that dogs all governments, especially those that are democratically accountable to impatient voters.

For the record, here’s a standard Inuit interpretation of the issue from Mary Simon, president of Inuit Tapiriit Kanatami:

And here’s Aqqaluk Lynge in Copenhagen. Most of this is in Greenlandic, but the juxtaposition of visual images conveys at least half the message:

Congratulations to Murray Angus

Murray Angus, in the centre at the far end of the table, with a group of Nunavut Sivuniksavut students and staff members. (PHOTO COURTESY OF NUNAVUT SIVUNIKSAVUT)

I know, it’s been two months since my last post. All I can say is work, life and other diversions, such as words printed on paper, have kept your humble content provider away from his blog hobby.

But I can’t think of a better way to start off again than to offer congratulations to Murray Angus, who helped found and run the Nunavut Sivuniksavut program in Ottawa.

On Dec. 30, Governor General Michaëlle Jean appointed him to the Order of Canada, as a member, in the education category.

Congratulations, Murray. You deserve it.

Make the words plain

Open communication: a trendy phrase coming soon to a press conference near you, if you live in Nunavut, that is.

The Nunavut premier and most other MLAs just signed on to a to-do list that commits them to better communications with the public and among themselves.

I do not doubt their sincerity. Hardly anyone inside the Nunavut government knows how to communicate and their long-suffering clients know this.

But before they get too far into this new-found commitment to communication, I would suggest they also commit to this: plain language.

Here’s a definition:

Plain English is clear, straightforward expression, using only as many words as are necessary. It is language that avoids obscurity, inflated vocabulary and convoluted sentence construction. It is not baby talk, nor is it a simplified version of the English language. Writers of plain English let their audience concentrate on the message instead of being distracted by complicated language. They make sure that their audience understands the message easily.

Plain English, in other words, means good English. Good English uses concrete words, short sentences and commonly-accepted grammar and punctuation. It’s not about multi-syllabic abstractions and dense periodic sentences.

Well-educated people do not need to use big words and convoluted sentences to communicate. In truth, big words and convoluted sentences signify illiteracy.

Jim’s four-point guide to plain language relies on the following:

1. Reduce your use of the passive voice. (If you can’t recognize the passive voice in a sentence, then get a grammar text and learn how.)

2. Reduce your use of adverbs that end in -ly, especially weak intensifiers like “very.” (Remember how Paul Martin sounded whenever he listed his “very, very important” priorities?)

3. Reduce your use of the verbs “to be” and “to have.” (Yes, this is hard, because in English, forms of these verbs are used as auxiliaries with other verbs. Do it anyway.)

4. Reduce your use of abstractions.

But I’m just an amateur.

If the Nunavut government wanted to, they could learn from the pros. The British plain language campaign has been at it since 1979. And the U.S. government also gives the principle some attention.

In Nunavut, the only government agency to embrace plain language is Elections Nunavut. The materials that Sandy Kusugak, the chief electoral officer, prepared for the 2008 territorial election are models of plain language.

In Canada, the Office of the Auditor General embraces the use of plain language for all of the auditor general’s reports. Download and read any of her recent reports to see plain language in action.

Notwithstanding the Official Languages Act, all Nunavut government documents appear first in English, then get translated into Inuktitut and French. A commitment to plain English would make life much easier for the dozens of translators who toil for the GN.

By the way, how’s your English grammar?  Try this quiz and find out.

 

Here’s what all the fuss was about

Thanks to the thoughtful generosity of Nunavut’s unofficial archivist, Jack Hicks, I now have the full text of the 1998 Jeffrey Simpson column that I mentioned Oct. 25.

Since the column doesn’t appear any more on their website, I’m sure the Globe’s legalists will overlook the copyright violation. After all, it’s an eleven-and-a-half-year-old piece that’s of interest only to obsessive compulsive geeks like me and the handful of people who suffer their way through this little blog.

It’s worth noting that some things have changed since 1998, mostly for the worse. The sexual assault rate is now about 12 times the national average and the overall rate of violent crime, including all forms of homicide, is higher too. So too, has the suicide rate increased, though there is some variation from year to year.

The abuse of solvents and aerosols as intoxicants appears to be in decline (I’m just guessing on that one,) but cannabis use is likely at 60 to 80 per cent, depending on the community. And we now see increasing use of crack cocaine, crystal meth and various forms of hillbilly heroin, such as oxycontin.

Fuel and power costs are much higher, creating a mounting fiscal burden for the territorial government. So has the cost of retail food and air cargo.

The $600-million budget for 1999-2000 that Simpson refers to was not enough to even maintain the status quo. That figure has now risen to about $1.1 billion annually. This year, the Nunavut government will likely spend more than $300 million on capital projects, compared with only $50 million in 1999-2000.

And, as I said in the post below, a small rising class of middle-class Inuit is now emerging, mostly in the larger communities. I expect that, motivated by self-interest, they will continue to press for more of what got them there in the first place: government spending on new schemes that will create jobs for themselves and others like them, and the preferential hiring of Inuit under Article 23.

But what I don’t see enough of is the political will to help Nunavut’s growing underclass, who need nutrition, mental health services and adult education. Under-nourished stoners don’t make very good trainees or workers.

Tough times lie ahead for the new territory of Nunavut

by Jeffrey Simpson
The Globe and Mail
1998 June 5
(Reprinted without permission.)

Want a challenge? Try this one on for size: Improve the “life chances”
for Canada’s 25,000 residents, mostly Inuit, of the new territory of Nunavut.

On April 1, 1999, Nunavut — or the so-called Eastern Arctic — will be officially hived off from the Northwest Territories. Canada will have a new territory 2,000 kilometres wide and 1,800 kilometres deep.

In that vast and forbidding terrain, only 25,000 people will live. Eighty-four per cent of those are Inuit.

No one yet knows precisely the price tag for the new government and the delivery of services to those widely dispersed people, fewer than a third of whom will live in towns. Around Ottawa the figure most bandied about is $600-million — or about $80 for every Canadian family of four. That $600-million represents roughly what it will cost just to maintain the status quo.

The status quo, however, isn’t good enough, given the staggering social and economic problems faced by the Inuit. Nunavut, after all, will be poorer than the rest of the Northwest Territories, of which it was part until Inuit voted to separate.

Start with population. Almost half the Inuit are under 20 years of age. The comparable figure is 27 per cent nationally. Nunavut’s population is growing at three times the national average. Families are one-third larger than the national average. Where, oh where, are the jobs going to materialize for this burgeoning population?

Some will be created by the new bureaucracies of Nunavut. Training Inuit for those jobs is proceeding, but much more will be required in everything from accounting to the law, financial administration to health care. After all, there’s no sense creating an essentially Inuit territory run by southerners. Outside the new bureaucracies, however, jobs will continue to be scarce.

A fifth of households have six or more persons. The vast majority of the housing is government-supplied. A third of the population in 1996 depended on welfare. The teenaged pregnancy rate is three times the national rate, the infant mortality rate twice, the incarceration rate three times, the suicide rate six times.

Want more depressing socioeconomic indicators? Try these. Smoking is more than twice the national average, heavy drinking three times, cocaine three times, abuse of aerosols and solvents 26 times the national rate. Sexual assault rates are seven times the national average, homicides three times, violent crimes five times.

Every study without exception points to the link between education levels and incomes, and even jobs. Bear that in mind, then try these indicators on for size. School dropout rates are mercifully declining, but in 1991 two-thirds of the territory’s 15- to 24-year-olds were not attending school. The youth unemployment rate, not surprisingly, was almost double the national average.

Want to live in Nunavut? Get ready for higher costs, even higher than in other parts of the Canadian North. Some estimates put living costs 65 per cent higher than in southern Canada. Food, apart from traditional Inuit fare, costs far more than down south. Energy costs are exorbitant: Electricity rates, already subsidized, are five times the national average. In a bitterly cold climate, high fuel-oil heating costs take a big bite from incomes.

No wonder, given all this, that Nunavut’s per-capita income will be 30 per cent lower than Newfoundland’s, Canada’s poorest province. And Nunavut will be much more heavily assisted than Newfoundland through transfers from the rest of Canada.

The Inuit wanted their own territory and voted in a referendum to get one. Parliament agreed, overcoming whatever qualms a few members had about creating territories organized politically around ethnicity. It was, if you like, a vote for partition, a loaded word in a very different southern Canadian political context.

Inuit leaders, and they have some exceedingly good ones, obviously want to maximize federal transfers. No other part of Canada has been so dependent upon them. That dependency shows no signs of diminishing, at least not for a long while.

In strict economic and fiscal terms, the Inuit would have been better off to stay within the Northwest Territories. They chose a different route for a welter of reasons including the classic group-identity one of wanting something to call their own. The challenge of making Nunavut work — that is, by making life better for citizens — will be a formidable one indeed.

No reason for complacency

If the people who run intensive care units are worried, so should you:

• ICU docs who rode H1N1’s first wave warn colleagues of what’s coming
• Ontario teen dies from H1N1

Okay — but how do you make money out of it?

Bill Doskoch posts some links to articles that find news websites boosting visitor traffic by building a presence on Facebook.

Yes, even for the tiny newspaper that I work for, this appears to be the case.

But how do you make money out of it? The quest for an answer continues…