Nunavik man goes with traditional ways to initially treat frozen feet
Sara Frizzell | CBC News | Posted: March 11, 2018 10:00 AM | Last Updated: March 11, 2018
Billy Augiak says feet are healed after an ordeal on the land, but doctors don't recommend his method
Billy Augiak put his trust in Inuit traditional knowledge to initially treat his frozen feet.
At the end of January, about 50 kilometres from Aupalak, Que., Augiak and a friend got his snowmobile stuck in slush as river water rose while they were putting out fishing nets.
Standing in the slush, they tried to push their machines out, but they wouldn't budge. Eventually Augiak and his friend, Etuak Iggiyuk, started to walk back to town.
Iggiyuk had taken off his wet socks and fashioned new ones out of an extra sweater he'd brought along, but Augiak trudged along.
After about an hour, Augiak said he was too cold and wet to continue so Iggiyuk left him with a thermos of hot water and continued on the remaining nine-hour hike to the village. It was around –40 C, Augiak said.
"He couldn't walk nicely anymore ... he barely made it to the town, to tell the people I'm still [on] the land," Augiak said.
Mayor to the rescue
Aupalak Mayor Johnny Akpahatak was alerted when Iggiyuk made it back to town. Akpahatak took his snowmobile out to pick up Augiak, and brought him back to his house to treat him according to the traditional methods of the region.
"I told him that your feet will be amputated if you go to the health centre and I told him that I will help thaw his feet," Akpahatak said in Inuktitut.
After two hours of wrestling with his frozen boots, they finally resorted to cutting them off with an axe. He then packed Augiak's feet with snow in a plastic bag.
"It was very painful just for a moment, if they put me in hot water it would be very much more painful," Augiak said.
"The RCMP and the nurse came and they wanted him at the health centre and I said no. I was arguing with them, but they insisted he should be monitored, so I told them I will let him go if I could keep his feet in snow," Akpahatak said.
His feet remained packed in snow for three hours before he was medevaced to the hospital in Kuujjuaq, Nunavik.
There, he spent two weeks recovering, with nurses changing the dressings on his swollen feet every day.
When Augiak was released he was on crutches as his heels were still painful to walk on. He says he is now completely recovered because of the traditional approach.
Traditional medicine and modern science
The Nunavik Regional Health Board acknowledged Akpahatak's treatment, but said the current practice is to "warm up the frostbitten area."
Nunavut's deputy chief medical of health, Dr. Michael Patterson, says rates of frostbite are higher in many southern areas than they are in the Arctic because there is a greater understanding of the cold in the North.
"We can all agree ... traditional knowledge in terms of survival skills, reading the ice, being able to build temporary shelters and right down to things like making proper clothing that's often as good or better than what's commercially available goes a long way toward preventing frostbite, which is probably the most important part," Patterson said.
However, he says "rapid rewarming" is the accepted practice for treating frostbite in hospitals, as the goal is to return blood flow to the affected tissue as quickly as possible.
The only case in which he would not recommend immediate thawing is when someone is still out on the land and has a journey to get back to town.
"Having frostbite, thawing it and having it refreeze in a short period of time is probably the biggest predictor for a bad outcome," Patterson said.
That said, he says it often takes quite a while to determine whether a digit or limb will need to be amputated.
"It's not quite true, but a line in surgery used to be 'freeze in January and amputate in June.' We often give it a long time for the injuries to really declare themselves as to whether the digit is really dead."
A history of 'cooling' frostbite
Gordon Giesbrecht, a frostbite expert with the University of Manitoba, says a line will clearly appear dividing dead flesh from flesh that will recover. Most of the time amputation is not necessary, the dead flesh can just be pulled off.
He does not endorse the traditional method of treating frostbite with snow.
"From a medical perspective, it doesn't make any sense because you're just continuing the insult," he said.
"The reason the person is frozen is essentially because their feet have had the equivalent of being packed in snow. It's only going to make the damage worse."
He said the practice of "cooling" frostbite was common around the world until the 1950s.
He says Napoleon's personal physician noted those who warmed their frozen hands by the fire burned their hands, so he deduced heat was ineffective and suggested cooling frostbite.
Frozen flesh is less responsive, so uncontrolled heat sources were a danger in the past, but Giesbrecht says research shows warm — not hot — water is the best treatment.
He said he's unaware of any direct comparison studies between snow and warm water.