ObjectivesThis paper explores patient experiences and identifies barriers and opportunities for improving access to healthcare for patients from the Canadian north who travel to receive medical care in a Southern province.DesignA mixed-methods, cross-sectional study involved one-on-one interviews, focus group discussions and key informant interviews.Participants52 one-on-one interviews with Northwest Territories (NWT) patients and patient escorts and two focus group discussions (n=10). Fourteen key informant interviews were conducted with health workers, programme managers and staff of community organisations providing services for out-of-province patients. A Community Advisory Board guided the development of the questionnaires and interpretation of results.ResultsRespondents were satisfied with the care received overall, but described unnecessary burdens and bureaucratic challenges throughout the travel process. Themes relating to access to healthcare included: plans and logistics for travel; level of communication between services; clarity around jurisdiction and responsibility for care; indirect costs of travel and direct costs of uninsured services; and having a patient escort or advocate available to assist with appointments and navigate the system. Three themes related to healthcare experiences included: cultural awareness, respect and caring, and medical translation. Respondents provided suggestions to improve access to care.ConclusionsPatients from NWT need more information and support before and during travel. Ensuring that medical travellers and escorts are prepared before departing, that healthcare providers engage in culturally appropriate communication and connecting travellers to support services on arrival have the potential to improve medical travel experiences.
Since the 1960s, scientists have been aware that human activity has resulted in a warming climate. Th is reality has and will continue to result in changes to the way we live.Th e Arctic and Subarctic have held prominent places in discussions on climate change, in part because impacts here are so stark and clearly connected to the eff ects of changes in temperature. In popular discourse internationally, media narratives often focus on "charismatic megafauna": polar bears starving, venturing into towns, disoriented, hungry, drowning. 1 In Canada, Indigenous and ally activism on climate change make the link with food security, personal safety, and cultural survival, employing stories of Indigenous hunters no longer able to reliably read the signs of the land due to "strange weather." 2 Indigenous Peoples provide critical insights into how climate change results in immediate and important implications for humans. 3 However, using Indigenous experiences as evidence for climate change is often where the conversation stops-it should instead be a starting point. Th e conversation needs to turn to how Indigenous
The Arctic Environmental Responsibility Index (AERI) covers 120 oil, gas, and mining companies involved in resource extraction north of the Arctic Circle in Alaska,
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