← How to Be Anything
How to Be Anything
9. How to Be a Doctor in the Arctic Circle
00:23:06
A conversation with remote physician Dr. Jen Pond
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- [00:02]
Acast Announcer
ACAST powers the world's best podcasts. Here's a show that we recommend.
- [00:11]
Zibby Owens
Hi, this is Zibby Owens, host of Totally Booked with Zibby, formerly Moms don't have Time to Read Books in my daily show, I interview today's latest best selling, buzziest or underrated authors and story creators whose work I think is worth your time. As a bookstore owner, publisher, author and obviously podcaster. I get a comprehensive look at that's coming out and spend my time curating the best books so you don't have to stay in the know. Get insider insights and connect with guests like Grammy Award winning singer Alicia Keys, critically acclaimed author Judy Blume, and Academy Award winning screenwriter John Irving every single day. With Totally Booked, you aren't just listening, you're part of the story. So don't miss out. Follow Totally Booked with Zibby on Apple Podcasts, Spotify or wherever you're listening now.
- [01:05]
Acast Announcer
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- [01:17]
Dr. Jen Pond
I think there's a difference between being able to make a career and being able to make a living. I'm not sure I ever actually realized I could make a career out of it. I think I I finished my postgraduate training in family medicine and I was in my late 20s and sat in a general practice office. A lot of my friends at that point were getting married and having babies and buying bigger houses and I just remember seeing the next 40 years spread ahead of me and thinking, is that it? And it terrified me and I thought, oh, I'm not sure I'm ready for that. So I started actively looking for where I could use that skill and in environments that interested me. And of course, like a lot of people's careers, you do one job, you meet people that opens doors for another job, and suddenly it kind of snowballs and before you know it, you've had these phenomenal opportunities and these phenomenal experiences.
- [02:15]
Emily McCrary
This is how to Be anything. The Podcast about People with Unusual jobs I'm Emily McCrary. Jen Pond is a remote physician practicing in the far north of the Canadian Arctic in a region called Nunavut. It's sparsely populated, only one person for every 25 square miles or so, and it's accessible only by air or by sea or dog sled, if you're up for it.
- [02:42]
Dr. Jen Pond
Remote medicine is an umbrella term for those of us who practice medicine in remote, rural, austere environments, often in very low income settings and certainly very low resource settings. You may well have a health infrastructure in place for example, my work is within the structure of the Canadian healthcare system, but logistically, you are a long way from higher levels of care, and you have very few resources to optimize your treatment, so you're practicing it at the very extremes of medicine.
- [03:21]
Emily McCrary
Extreme is right. If the weather cooperates. It takes her two days to commute from her home in Fernie, a small town in British Columbia just north of the US border, to the village of Tuloyoak, population 1,042. First she flies to Vancouver, then to a small city called Yellowknife, where she stays overnight. In the morning, Dr. Pon gets on a puddle jumper that makes stops among the communities in Nunavut.
- [03:49]
Dr. Jen Pond
Takes about five hours from Yellowknife to get to my town. On that milk run, you've gotta be reasonably well prepared. It's cold, there's a lot of wildlife, including polar bears.
- [04:00]
Emily McCrary
When Dr. Pon arrives in Toloiuak, she buys her groceries, then settles into the health center where she lives. Upstairs, it looks like a clinic with consulting and observation rooms, though the medical setup is austere. There's an X ray machine that can handle limbs and chests, but that's about it. There's no lab, though. She can run some basic blood work in an emergency situation. Otherwise, labs have to be flown out, meaning results can take days. If the weather is bad, Dr. Pond is there for a couple of weeks at a time, trading off with another physician every other month. But besides a few nurses and paramedics who are there all the time, she and her counterpart are the only physicians in town. Tuloju' AK isn't the most austere environment Dr. Pond has worked in. Back when she quit that first job in family medicine and decided normal medical practice wasn't for her, she took an unpaid job in the mountains of rural.
- [04:58]
Dr. Jen Pond
India, pretty much lived in a mud hut for a year, attempted to practice medicine. I was very early on in my career. It was very humbling. There were no local doctors. There was a hospital with a gentleman who was a lab tech, stroke nurse, I think, who essentially did everything for that community. There were no real sports and there was no Internet to access any of those wonderful sports, just old school textbooks and trying to work it out. But walk three hours to get to the nearest village to try and provide health care for the communities. And the women generally had to get permission from their husbands to be able to attend. You would see the extremes of poverty. The caste system where we were was well and truly alive, and there were people who worked for scraps of food. And I'd never been exposed to anything like that. A lot of our work there was trying to create prenatal care. I didn't want to be somewhere where you go in and do something and then when you leave, that is no longer there. It's no longer a service that's provided. There was a lot of kind of prenatal care that some of the local villagers were able to train up to. How to take a blood pressure, at what point a blood pressure in a pregnant woman would be a concern, how to dip the urine. The local knowledge is phenomenal. I learned how to make dal. I learned how to milk the next door cow. I learned how to create butter and yogurt from that milk that we got, you know, learned how to speak very bad Hindi. I'm not sure how much medicine I learned in that particular job. You really need those peers to tell you what you're doing wrong to help kind of find your way through medicine.
- [06:47]
Emily McCrary
So she went looking for more experience, this time in the mountains of Nepal.
- [06:52]
Dr. Jen Pond
My next stop was the Himalayan Rescue association in Periche.
- [06:55]
Emily McCrary
Farachay is a small town on the route up to Mount Everest Base Camp, and it's one of the stopovers for Western trekkers heading to the peak.
- [07:03]
Dr. Jen Pond
We went for three or four months and ran a clinic in the post monsoon trekking season. And the Western trekkers, which pay for the consult and the medicines, and with that money, the local Nepalese or the porters or the Sherpas coming through, were able to be seen at a very low cost. I spent a season there.
- [07:24]
Emily McCrary
This is where she met Dr. Luanne Freer.
- [07:27]
Dr. Jen Pond
Luann Freer is a phenomenal woman and friend and physician who is incredibly inspirational. She's a lady who in the early 2000s, saw kind of what was happening at Everest Base Camp, where porters were coming up and becoming unwell, trying to deliver things, tents and food and supplies for expedition companies. And she realized that there was no one there to help them. And she set up this not for profit, that was affiliated with the Himalayan Rescue association, where she could set up this tent at Everest and charge the Western climbers if they needed to be seen or for their medicine. And with that money, all the locals could be seen free of charge or at very low cost.
- [08:12]
Emily McCrary
Meeting Dr. Freer in Farah Shea opened new doors, this time at Everest ER, which at more than 17,000ft or 5,300 meters, is the highest emergency room in the world.
- [08:25]
Dr. Jen Pond
I love the mountains. I love the solitude of the mountains. I love how Mother Nature really puts you in your place. You know, you are at her mercy with the Himalayas, those huge mountains. You are just a dot on her horizon. And I love how humbling that is, how you realize that you're really not important at all, you know, in the scale of it. And I love being put in my place that way.
- [08:52]
Emily McCrary
Medical teams arrive at Everest, er, in late February, just before the climbing season begins, and stay through early June. They live right there on the glacier and practice medicine in heavy duty tents.
- [09:04]
Dr. Jen Pond
I mean, it's a phenomenal logistical setup when you realize that during the climbing season, the best part of 1,000 people are at Base Camp. And half of those people will at some point be on the mountain. But half of us stay at Base Camp. You've got the Base Camp managers, you've got the cooks, you've got the porters, you've got the docs.
- [09:24]
Emily McCrary
The doctors stay at Base Camp and the injured are brought down to them or guides on the mountain radio down for consults. On Everest, there are some predictable ailments. Unless you were born and raised at high altitude, and I mean really high altitude, these are the Himalayas. Your body is going to be seriously taxed. Most common is high altitude pulmonary edema and high altitude cerebral edema, which is just when fluid collects in your lungs or your brain due to the crazy altitude. But that can be really deadly. Climbers get frostbite, they break bones. There are coughs and colds and GI bugs, which, by the way, travel really quickly since everyone is more or less eating the same food.
- [10:06]
Dr. Jen Pond
And then there's a lot of psychological consults. And a lot of people have paid a lot of money to fulfil this dream of climbing Everest. And they've normally drummed up a huge amount of support back home and feel an immense amount of pressure. And I think some people find the altitude hard, get through the icefall and find the ladders hard, maybe realize it's not for whatever reason, whatever is going on in your mind, you'll have a lot of physical presentations of psychological problems.
- [10:39]
Emily McCrary
How often have you told someone or have you told someone you don't need to continue climbing?
- [10:45]
Dr. Jen Pond
You should staff now fairly regularly. There's people who need to stop because not only are they putting their own life at risk, but they're putting other people's lives at risk. On a mountain, a rescue is a significant event that puts a lot of other people at risk. So there's the very black and white kind of issues, and then there's the gray where you're Helping someone work out whether it's the right path for them, whether they want to keep trying, whether they need you as the excuse. The doctor said I couldn't carry on, but really it's that relief that the pressures gone. So a lot of the time you're trying to help guide someone so that they can work out what the best decision is for them, provided you're not making a decision that endangers everyone else on the mountain.
- [11:31]
Emily McCrary
How much of remote medicine and the unusual environments you practice in, how much of remote medicine is mental health care?
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Dr. Jen Pond
A huge amount of it, I'd say in expedition medicine, the majority of people who take on extreme expeditions already have certain personality traits that allow that resiliency and that strength. It's a huge part of everything we do, isn't it? The things we're not expecting, how we deal with that, how we deal with finding something harder than we thought we would, how we deal with adversity. In the environments I work in now say in Nunavut, for different reasons. Mental health is a huge issue within marginalized communities who live in poverty. They are, to the most part, Inuit. There are a few non Inuit, generally teachers or healthcare professionals. And we have fairly young communities, lots of kids. I have a number of elders in my community and many of the elders are unilingual and will only speak in Uttatuq, so you'll often need a translator. But the majority of people are bilingual and speak English and Anuktu Tuk and people still live fairly traditional lives. So although not quite as nomadic as the Inuit would have been many years ago, hunting and fishing is, is how people feed themselves and how people live their life. The land is incredibly important to them. You do see a lot of trauma and fallout from the residential school years. And my community is they're poor, very poor. Live in overcrowded, poor quality housing, poor ventilation. I'd say the majority of people are malnourished. Sometimes I find it difficult to work out what my cultural norms are that I'm imposing and what's right and wrong.
- [13:37]
Emily McCrary
Beginning in the 1830s, Indigenous children in Canada were forcibly taken from their families and placed in residential schools run first by churches and later by the Canadian government. These institutions were designed to erase Indigenous languages, traditions and identities. By the 1920s, attendance for Indigenous children was mandatory. And over 150 years, more than 150,000 children passed through their doors. They received little real education, were punished for speaking their own languages, and many suffered neglect and abuse. The last residential school didn't close until 1996. This is a system the Canadian Truth and Reconciliation Commission has rightly deemed cultural genocide. The effects of the residential school system are far reaching and long lasting.
- [14:32]
Dr. Jen Pond
Then you have conditions like TB which are hardly heard of in high income countries. So the Canadian average is around. The incidence of TB in Canada is stated to be 4.8 cases per 100,000 population. If you actually kind of look at that in more detail, the number of non indigenous Canadians who have TB is less than 1 per 100,000 population. And then when you go to Nunavut, the incidence is 191.4 per 100,000 population. And TB, some would call it a social disease with medical consequences.
- [15:12]
Emily McCrary
What does that mean?
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Dr. Jen Pond
That the best ways to to not have TB outbreaks within your community is to prevent it. And to prevent it you need to improve those social demographics of health. People need to live in well ventilated, good quality housing. They need to not be malnourished.
- [15:32]
Emily McCrary
Social demographics of health, sometimes called social determinants of health are those external factors like where you're born and where you live and what race you are that have a significant influence on your health. The residential school system did serious damage to cultural and social supports and indigenous communities across Canada still feel these effects.
- [15:54]
Dr. Jen Pond
There's a lot of mental health, drug and alcohol misuse. Unfortunately, suicide is about seven times more common in Nunavut than the rest of Canada. We see a lot of late times diagnoses of cancer. Some of that is logistics. You know, you suspect, well, you've only got a physician in community one week of the month for a start. So if someone has to wait a month to see you and then you need to organize often imaging, say a CT scan, a CAT scan, and we don't have access to those where we are. So someone would have to fly to southern Canada to have that. The life expectancy of someone who lives in Nunavut is 10 years less than that in southern Canada. It's around 80 years for someone in southern Canada and it's 70.8 years for someone in Nunavut, which is a huge discrepancy and disparity and it shows the inequities that are within our health system. A 10 year difference in life expectancy within the same country, it's massive. It's hu. Yeah, it's huge.
- [16:59]
Emily McCrary
How do you think you're viewed in the community, by the way, Dr. Pond is white.
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Dr. Jen Pond
I've been going to Nunavut since 2021. I feel like it takes time for want of a better Term the white man has certainly done significant amounts of damage to indigenous populations in Canada. And the last residential school only closed in 1996. So it's not in the distant past. People are still dealing with that trauma. And some of the impact of that is a lack of trust in Western culture and Western cultural beliefs. And Inuit have their own health care beliefs. They have their own traditional medicines. So we rock in and say, no, we should be doing it this way. You know, it takes time to build relationships, and it takes time to build trust. I would like to think that people now trust me to advocate for them. I feel like the more I go, the more stories patients are starting to tell me, the more can I hear about their childhood or their experiences.
- [18:11]
Emily McCrary
Why do you think you seek out such extreme environments to practice in?
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Dr. Jen Pond
I like to take myself out of a comfort zone. I think that's how I stay interested, because I don't want to be in my comfort zone. I want to be challenged. I don't like to be overwhelmed, but I think we all thrive on a little bit of stress.
- [18:32]
Emily McCrary
What is your relationship to your job? How has that changed as you've been a practicing physician?
- [18:39]
Dr. Jen Pond
Well, medicine is a vocation and not a job. It's definitely a part of you, and it's a part of your life, and it's a way of life. There certainly are specialties where you can clock in at 9 and leave at 5. But I feel for me and for the role I take, you're so much more involved than that. There's the science, the black and white science of medicine, how you elicit a history, how you ask the right questions to get the correct information, how you understand what their ideas and concerns are, why they're actually sat in the seat opposite you, and why it's important to address those as well as address your own concerns about what might be happening. And because it's a way you interact with people, it inevitably becomes a part of your makeup and your fabric wherever you go, in a sense. So you're forever tied to your job and your career. There are days where you feel you're really good at your job, and there are days where you feel you're just good enough. And there are days where you think, I wish I did that differently. I think what makes a physician good at their job is when they constantly question their decisions. How could I have done it differently? And when you stop doing that and you stop caring about that, I would no longer be doing my job well. And honestly, I thought in my early 20s, I thought I was going to get married and have children and kind of be a part time GP and a part time mom, and there's absolutely nothing wrong with that. But I was young and over the course of the next 10 to 15 years, my life aspirations changed.
- [20:18]
Emily McCrary
Dr. Pon does have a family now with her partner Bruce, whom she met at Everest. She was a doctor, he was a guide, you know. Though she's slightly more settled than she was in her late 20s, she still gets to work in exciting places. Ultimately, she found a way to do.
- [20:34]
Dr. Jen Pond
Both with time and experience. I eventually found that I could work in Nunavut in the Canadian Arctic and have the joy of working in similarly remote settings, but I could actually feed my children at the same time, which is always a bonus.
- [20:53]
Emily McCrary
Working in Nunavut has been really good for Dr. Pond for a lot of.
- [20:57]
Dr. Jen Pond
Reasons, and I learned from that, that I am terrible at putting my boundaries in. The toll it took not just on me, but on my family and my relationships. I was never present at home, even if I was physically at home. My mind was still at work. I needed to find a way to be able to go and do my job and only have to do my job and then come away from it and be off. That's what Nunavut brings to me. I go, I put my head down, I'm there for three weeks. I have nothing else to do. I'm not on school dinners or picking the kids up from swimming. I can just go and research whatever I need to research, phone the specialists I need to phone, and then I can come home and I'm no longer at work and I'm at home and I'm mum and partner. For us as a family, it seems to work really well. And I think they get more of me and better quality me this way.
- [21:56]
Emily McCrary
By now, Dr. Pond has worked on every continent, including at Vinson Base Camp in Antarctica. Yet it's not the places that she values most.
- [22:07]
Dr. Jen Pond
I think people are often the most influential. You see your peers and your superiors. Like when you see someone who you think is good at their job, master that art form of medicine, you think, I want to be able to do it like that? I think it's really important to know that you can never stop learning from your patients, from, from your peers, from your colleagues. And that's not just physicians, you know, your ACPs, your nurses. I think the most influential parts in medicine are when you get it wrong, because you learn how you don't want to feel and you learn how to do it better to stop that happening. They're really hard lessons to learn, and I think you have to have an element of resiliency and you have to be humble enough to say, okay, not good enough. How do I make myself good enough?
- [22:55]
Emily McCrary
What do you hope you'll be able to say about your career by the time you retire, which is a long way off?
- [23:01]
Dr. Jen Pond
You know, if I turned up at someone's doorstep and said, hi, it's Dr. Pond, I just want to do a home visit, they'd let me into their house, they'd tell me their deepest, darkest secrets. They tell me their fears and what they're scared of, and they don't know me. And to have someone trust you without knowing you and open up to you that way is phenomenal. I hope that I get to look back and know that I never stopped learning and that I always try to do my job to the best of my ability. I think it's a beautiful career that never gets dull.
- [23:33]
Emily McCrary
How to Be Anything is created and written by me, Emily McCrary. Our producer is Lily I. Johnson and our editor is Kayden Boffman. Visual design is by Mika Semovic Fisher at La Boude. You can see pictures of Dr. Pon practicing medicine in her element at our substack howtobeanything.com or on Instagram. How to Be Anything we also publish outtakes from interviews and behind the scenes looks at how the show is made. We are an indie podcast so show us your support by rating and reviewing the show wherever you listen. And if you like how to Be Anything, please text it to a friend.
- [24:25]
Acast Announcer
Acast Powers the World's Best Podcasts Here's a show that we recommend.
- [24:34]
Zibby Owens
Hi, this is Zibby Owens, host of Totally Booked with Zibby, formerly Moms don't have Time to Read Books. In my daily show I interview today's latest best selling, buzziest or underrated authors and story creators whose work I think is worth your time. As a bookstore owner, publisher, author and obviously podcaster, I get a comprehensive look at everything that's coming out and spend my time curating the best books so you don't have to stay in the know. Get insider insights and connect with guests like Grammy Award winning singer Alicia Keys, critically acclaimed author Judy Blume, and Academy Award winning screenwriter John Irving every single day. With Totally Booked, you aren't just listening, you're part of the story, so don't miss out. Follow Totally Booked with Zibby on Apple Podcasts, Spotify or wherever you're listening now.
- [25:28]
Acast Announcer
Acast helps creators launch grow and monetize their podcasts everywhere. Acast.com.