Consumption (57 page)

Rankin Inlet possesses two parallel cultures that are steadily becoming one. The Kablunauks are here briefly as individuals—the Mounties, for three or four years, the nurses, for two, the teachers, maybe five or six. (The doctors: usually six months or a year.) Nevertheless, every year there are more of them and, ludicrously, more cars and trucks too—even though the town is less than a mile across and there are no roads to any other place. Recently, the school system had school buses brought in on the summer barge to carry the children to school in the winter.

Every southerner who has ever affected concern for the people here declares the Inuit to be damaged by their contact with the south. It is a little like city dwellers worrying about the last stands of old-growth forest after they’ve cut down an entire ecosystem to build their subdivisions. The indigenous peoples of the entire New World have been swept aside without a thought, and if they have had the misfortune to inhabit valuable land the sweeping away was completed generations ago. But when it comes to the Inuit, who live in a place no sane southerner would ever covet, we affect concern for our acculturating influence. As if they aren’t aware. As if they aren’t embracing their own self-abnegation with exactly the same rigid-jawed determination as we have.

Insulin resistance begins and ends with obesity; if there is no obesity, there is almost no type II diabetes. As insulin levels rise, the desire to eat is increased, and so the obesity and the insulin resistance and the insulin-induced overeating worsen. It is a dreadful sequence of problems.

Human beings will eat what is available. Obesity is a problem to some degree wherever famine is not, and it is not confined to those with the thrifty gene; Americans, who for the most part do not descend directly from hunter-gatherers, are the fattest people ever to have existed and the numbers of them with diabetes is unprecedented: eighteen million, at least. Obese humans of any genetic heritage are effectively unable to limit their own dietary intake; none of the myriad of diets advanced is effective over any length of time at maintaining weight loss because no one sticks to them. Wherever people stop working, stop sweating and gasping and running for their living, they grow fat. And then they start falling apart from within, and dying.

The Inuit are the last of the indigenous peoples of North America to come in off the land. When one speaks to a fifty-year-old such as Yvo Nautsiaq, who is still young and vital, one must recall that he was born in an iglu and grew up eating caribou and whale and walrus flesh. Farther south, the indigenous peoples of North America don’t know their own languages any more. Among the Pacific west coast tribes, teachers come from the universities to instruct the children in Haida, or Coast Salish, as a gesture of some sort. The indigenous languages of the Americas are dying faster than can be recorded—whole ways of thought, of seeing the world, vanishing with the last breaths of old men and women. But when you walk on the frozen beach of Coral Harbour, avoiding the children playing hockey on the sea ice, the cries are full of
qs
and
ks
that mean nothing at all to anyone from the land of cappuccino.

These peoples came here about the same time that the Vikings were settling Greenland. The Thule culture, with its lithe little sealskin boats and its elaborate technology revolving around sea-mammal hunting, spread in the course of a few generations from the Beaufort Sea to the east coast of Greenland, just in time to meet the hairy bellies of that era, in longships and waving steel swords. The Norse were gone within a few generations of climatic cooling, after the medieval warm period ended. We presume. The Inuit endured, supplanting the Dorset people who preceded them in the Arctic, either absorbing or slaughtering them. By the time Europeans were exploring the Arctic in the 1800s, only the Thule Inuit were found, the ones with the
beautiful skin boats and harpoons and lances sufficient to kill bowhead whales: forty tons and they killed them in thirty-pound boats armed with sticks tied to sharp rocks. They invented the iglu and developed the dogsled. Relentlessly nomadic, with these skills they made voyages thousands of miles long across the sea ice and they inhabited—in the qualified sense that any part of the Arctic allows itself to be inhabited—every place south of Ellesmere Island.

What the Inuit were was a miracle. They lived in a land without trees, in houses made of snow. When there was no driftwood to be had, they made sled runners out of frozen fish wrapped together. Their technologies—the qayak and the toggle-headed harpoon and the seal-fat lamps—were the most elegant solutions to the problems of living in this land, and the finest expression of their wit and sense of beauty. What the Inuit are is us. And what they achieved in the Arctic was the clearest expression of human ingenuity and tenacity. They—we—prospered in the hardest place there is, and achieved magnificence.

But no one lives there any more. From the edges of the little towns on the coast of Hudson Bay, you can look out on the tundra and guess at some of the difficulties involved in pulling a living from a land such as this. Rock and lichen, snowbound ten months a year: no wonder no one lives there any more.

Certainty, or Evidence-Based Medicine and Its Decline

The portion of the west coast of Hudson Bay that stretches north from Churchill past the Seal River to Arviat, the poorest of the communities in this part of the world, is where the Padleimiut lived. These were inland Inuit, the only such people in all of the Arctic from Alaska to Greenland. They lived along the banks of the Thelon and Kazan Rivers, and fished for Arctic char. Uniquely among the Inuit, the principle food of the Padleimiut was caribou rather than sea mammals.

The Padleimiut were, consequently, the Inuit who were most affected by the last great famine. In 1956 the caribou varied their usual path through the tundra. The hunters waited in vain for them to return through 1956, 1957, and 1958. In these three years, one quarter of the Padleimiut starved to death. On the land in this area, one still comes upon famine graves, desperately small piles of rock heaped ineffectually over a young or very old body, whitened bones scattered around by foxes and ravens.

The famine prompted the creation of the coastal community of Arviat, where the people were brought to hunt sea mammals, believed to be more reliable food sources than the caribou. Arviat is now eighteen hundred people, perhaps five times as many Padleimiut as survived the famine. Arviat still wears an air of desperation; more than any other community on the west coast of Hudson Bay, it lingers in the desperate time. When epidemics strike the Inuit, they are always the most lethal here. Tuberculosis breaks out regularly, bronchiolitis often kills children, and the two outbreaks of
E. coli
dysentery in Kivalliq in the last fifteen years both occurred here.

During the famine, the hunters waited patiently at all their old hiding spots. If the caribou still lived, they thought, this is where they would appear. But they did not, and everyone wondered what sort of catastrophe had befallen the deer that had appeared to have killed almost all of them in such a short time. The people died in great numbers, and were mourned, and the deer were mourned too.

But four years later the caribou reappeared at all their old river fords and calving sites, plentifully, and with the usual distribution of age. The deer had not died. They had varied their migratory path. The hunters, who knew the deer better than anyone now alive does, were defeated by their certainty. They ought to have sought the
tuktu
out. It is easy advice to give, in retrospect. But certainty is like that, it makes so much sense at the time. And leads astray so often.

Medicine has clung to a sense of hierarchy that is elsewhere being abandoned; teachers answer to parents, bankers solicit borrowers, and priests strive to be relevant. But in medicine, a chain of command has existed since the profession found its modern face—
doctor’s orders
—with the most senior and academic physician experts directing, through treatment recommendations, the decisions of specialists, family physicians, and ultimately the patients. In recent years, at the insistence of patients, the authority of physicians as a group has been diluted somewhat; within the profession, though, the obeisance to authority and self-certain grey-bearded experts remains devout.

The appeal of authority proceeds out of the way medicine understands its craft. The guiding principle remains stubbornly Aristotelian: an understanding of the disease—articulated by the relevant grey-beards—comes first, before experimentation. On the face of it, the approach isn’t outrageous: doctors try to understand the nature of the ailment they are addressing, and then they try to think of an intervention—an operation, or a pill, or a type of psychotherapy—that goes to the essence of the problem. And this method often works. When Banting and Best identified the role a deficiency of insulin
played in the development of juvenile diabetes, the treatment that suggested itself—replacing the insulin—turned out to be a huge success. Banting and Best’s discovery was a model of how medicine advanced through most of the twentieth century. Research was based on this simple, rational premise: understand the problem and its solution will become self-evident.

But people, doctors included, have a tendency to see what they expect to see. If it makes
sense
that a treatment will work, or if one stands to make money if a treatment works, then one will, with alarming and disheartening reliability, perceive that it does in fact work. Human nature. What is surprising is that a profession that dresses itself up in the garb of science has taken so long to acknowledge this principle, which every small-town carny understands well enough. And anyway, the idea that anyone understands anything about the body well enough to make confident, a priori predictions about how it will behave is simply folly. But doctors are not adverse to folly. Nor to overestimating their own understanding of the body.

Chesterfield Inlet is a small town on the coast of Hudson Bay, two hundred miles north of Arviat; in the course of my work in this part of the world, I have visited often. The old hospital here, l’Hôpital Sainte-Thérèse, was built by the Oblate fathers seventy years ago. Now it houses cognitively challenged children, but fifty years ago there was an operating room and an acute-care in-patient ward; hundreds of babies were born here in the forty years it functioned as the only hospital in this part of the world. Old men and women to this day tell me stories of dogsledding all day, that night and the next, to get their sick children to the hospital there.

Arctic Doctor
was written by Dr. Joseph P. Moody, who worked in Chesterfield Inlet for three years in the 1940s, fresh out of medical school and internship. Sam Aliyak is the janitor and repairer-of-all-things in the Rankin Inlet nursing station. One day he spoke about his father’s experiences as a young man. He had been a friend of Dr. Moody in those days, Sam told me, expecting me to recognize the name. I had never heard of Dr. Moody, but I
looked him up and ordered a copy of his book from a used-book dealer and it arrived a week later.

I started reading it immediately after I received it. Joseph P. Moody, it struck me, was a man with considerable gumption. An old-fashioned word for an old-fashioned quality, but it expresses the idea well. He brought his wife and newborn daughter to Chesterfield after travelling by train to Churchill and then by boat upcoast to the village. He describes the wooden house they lived in, with the upper storey a giant warehouse large enough for two years worth of food and stores. Within days of his arrival, he relates, the son of the Hudson’s Bay trader in a community hundreds of miles away fell ill. He arranged to speak to Dr. Moody over the radio, and in the course of their communication, Dr. Moody determined that the child had meningitis. He instructed the man to draw up a syringe full of antibiotic and inject directly into the child’s anterior fontanelle, through the soft spot on the top of his head.

The man was, quite legitimately, skeptical about the safety of such a manoeuvre, injecting a needle into the child’s cranium, but Moody was steadfast. “Get yourself together,” he tells the terrified man over the radio. “Go ahead, now. Do it.”