'It was too late for us': Nunavut mother says son's pneumonia death preventable

A mother from Igloolik, Nunavut, says her four-year-old son's death could have been prevented if he had been medevaced for care sooner instead of being sent home multiple times during what she says was a shortage of nurses at the local health centre.

Paula Alorut's son Noah had pneumonia in both lungs, but she says by the time they found that out at the hospital he was sent to in Iqaluit, his health had deteriorated to the point where she thinks he knew he was dying. 

Mommy, is it time?- Noah Alorut, 4

"It was too late for us," Alorut told CBC News. 

Alorut sat behind Noah's back as he lay in his hospital bed hooked up to medical equipment all around him. 

Between falling asleep and waking up, her little boy kept asking her, "Is it time?"

She thought Noah was asking if it was time to take off his mask that was helping him breathe.

But on March 5, the day Noah died, he asked that question one last time.

"Mommy, is it time?," Alorut recalls. "That's when it clicked: I knew that he was trying to be taken by his guardian angel. I said, 'It is time. You will be going home soon, it is time.'

"He gave me his last thumbs up as a sign. So, I gave my thumbs up to him. He went to sleep and never got up again."

Noah died a day after being medevaced to Iqaluit. Doctors couldn't stabilize his breathing in time to fly him to the Children's Hospital of Eastern Ontario in Ottawa, according to his mother. 

9 infant deaths this year

CBC News has learned that Noah is one of nine children under the age of five who have died in Nunavut so far in 2018.

Five children in the same age range died in 2017.

Deputy chief coroner Khen Sagadraca won't say if there are any connections between the cases because it's too early in the investigations.

Arctic Bay, Pond Inlet and Kugaaruk all lost children in their community this year. Iqaluit and Arviat had three children die in each community. 

Arviat's mayor, Bob Leonard, has gone to all the children's funerals in his community and says the details of the deaths are only being talked about privately among family members. 

Autopsies are underway to determine causes of death, a process that can take up to 10 months depending on the complexity of the case, said Sagadraca. His office does preliminary investigations into all deaths of people under five. 

In the meantime, Alorut and the mayor of Igloolik have questions about Noah's case, specifically, whether a staff shortage at the community's health centre affected how quickly he received care.

No doctors at health centre

Alorut says her son was an outgoing, lovable, "mommy's boy." She called him "Mikitulaa," an Inuktitut term that translates to "the smallest one." 

Noah was the youngest of three boys and was born premature with a large heart murmur. He got sick easily. 

On Feb. 27, Alorut brought Noah to the Igloolik Health Centre — which has nurses but no doctors — after he came down with a fever and flu-like symptoms. 

Alorut says the nurses did a basic exam of Noah's eyes, ears, and throat, then determined it was a sinus cold and sent him home. She says they told her to humidify Noah's room.  

Alorut returned to the centre twice in the days that followed saying it must be more than a sinus cold but was told to come back in two days if he wasn't better.

"He was so dehydrated. He just wanted to sleep. He didn't want to eat or do anything," said Alorut.

Pneumonia could have been treated

By the time Noah was transferred to Qikiqtani General Hospital in Iqaluit to see a doctor for the first time, five days had passed since Alorut's first visit to the health centre in Igloolik. 

An X-ray revealed Noah had pneumonia in both of his lungs, said Alorut. She's convinced that had staff at the Igloolik health centre recognized her son's symptoms as pneumonia and had him transported to Iqaluit or Ottawa, he could have been treated and survived, she said.

"The coroner I spoke with in Iqaluit said that it would have been preventable if they would have sent us out on March 1," said Alorut.

Alorut says she doesn't want to point any fingers, but is now haunted by one question: is the reason her son wasn't medevaced earlier because of a staff shortage?

Alorut has insight into Igloolik's health centre because she's an employee there.

For the past year and a half, Alorut has been doing patients' paperwork for their medical travel. She says nurses need approval from a doctor for a patient to be medevaced elsewhere for care. 

The week she brought Noah into the health centre, they were short on nurses and medical travel workers, she says. The centre was also inundated with flu cases, she said.

'Understaffed and overworked'

Igloolik's mayor, Celestino Uyarak, says patients' cases are not being "handled properly" at his community's health centre because of a staff shortage.

"They are understaffed and overworked," said Uyarak. "It's a problem across Nunavut."

He witnessed the problem firsthand when his two granddaughters were medevaced to Iqaluit and Ottawa this past winter.

It's an alarming concern.- Celestino Uyarak, Mayor of Igloolik

"Patients are being sent home, not being dealt [with] properly," said Uyarak. "That's because we don't have doctors. It's an alarming concern, when a patient — especially a child — is sent home."

Other communities also raised concerns about the issue at a Baffin mayor's meeting in early March. 

This week, Uyarak asked his area's member of legislative assembly, Paul Quassa — who is also Nunavut's premier — for help. 

He wants the government to send more doctors to northern communities in Nunavut, especially when there are outbreaks. 

Quassa's office said he was not available for an interview with CBC News. 

Mother wants nurses to call doctors

As for Alorut, she wants to make it mandatory for nurses to do more than a basic exam on children. 

"Don't just do the vital signs, call the doctor," said Alorut. "Ask for X-ray report or something."

Her family is still grieving the loss of Noah. They're trying to manage and come up with new routines, but Alorut hasn't returned to work since her son's death because she has flashbacks when she walks into the health centre. 

"It's still hard right now," she said.

The Health Department of Nunavut, which fields media questions about the territory's health centres, did not respond to CBC's questions.

The territory's Minister of Health was not available for an interview.