In some ways Jackie was a typical teenager in Kuujjuak. She was smart and a natural leader. Younger kids saw her as a role model.

But she was also very withdrawn and her head swam with troubled thoughts. In 1998, Jackie (not her real name) was admitted to the group home for distressed youths in Kuujjuak. The staff there knew the Inuit 15-year-old was suicidal and kept her under close supervision.

After many months, Jackie started opening up about her problems. Then, one day in March 1999, her life was cut tragically short. She committed suicide in the very group home that was supposed to help her and protect her from herself.

It’s still not completely clear what happened that day. The coroner and Quebec Human Rights Commission launched separate investigations, which are both still ongoing. The Nunavik Health Board refuses to comment.

But former Nunavik health and social-services workers say the suicide didn’t need to happen and that Jackie wasn’t given adequate supervision. And they say the suicide is just one sign of the inadequate social services and health care in the Inuit communities.

Twenty-five years after the signing of the James Bay and Northern Quebec Agreement – Canada’s first modern treaty – many Inuit say the promises of the agreement haven’t been fulfilled. They say the 14 Inuit communities are plagued by substandard, poorly funded health and social services controlled by outsiders who are insensitive to local needs. Few Inuit work in the health network as professionals or managers.

This complaint is shared by some of the health network’s most senior officials. “In other organizations, we have trained Inuit people to become teachers, navigators on shrimp boats, airline pilots. We don’t seem to have the will to train Inuit people to become nurses and doctors,” said Eli Weetaluktuk, executive director of the hospital in Puvirnituq, which serves the western half of Nunavik (see sidebar).

“We as Inuit people are allowing ourselves to be manipulated by non-Inuit who come here and, instead of working for the people, end up working for themselves,” he said.

What is clear to all is that the Inuit people’s physical and mental health is not in good shape. An alarming 1995 study showed that Inuit life expectancy has fallen from 65 years in 1975 to 60 years, which made it lower than South Africa’s and equal to that of India. The average Canadian life expectancy was 77 years.

A big reason was that the Inuit of Quebec have one of the highest suicide rates in the world. Inuit in their late teens are 25 times more likely to take their lives than the Quebec average.

The complaints about inadequate health and social services are familiar to many Crees. Last year, Crees held a special assembly on health and looked at reforms. Out of that assembly emerged a campaign to wrench more health funding out of the Quebec government.

The Inuit have yet to hold such an assembly or implement major changes. Some Inuit say that’s because their people are simply grateful for all the southerners who’ve come north to work in their health system.

“They have all these people coming from the south. They didn’t have that before, and so, in appreciation, they don’t say anything,” said Lizzie York, an Inuk who was executive director of the Nunavik Health Board for 15 years.

“There is a lot of insecurity among our people. They’re afraid to speak,” she said.

But people are started speaking out. A petition has circulated in the Inuit communities calling for changes to the health network. Eighty-five people have signed so far. At a health board assembly last summer, Weetaluktuk, one of the top three officials in the Nunavik health network, criticized the health system’s insensitivity to Inuit culture and the lack of Inuit staff.

Lizzie York went through her own awakening in 1997. She came back to her job as executive director rejuvenated after three months’ leave and full of ideas for changing the system. She wanted to take back control of the health board and make it more accountable to the people. She started with little changes.

For example, she said, “I decided not to put up with racism any more. If I saw someone being put down, I started standing up for them if they didn’t stand up for themselves. I really started putting my foot down. No more horsing around.

“For all those years, I was just doing what I had to do. I had seen people forced out because they were becoming too close to the Inuit people. The best people were forced out or were so disgusted they left.”

York said the racism included jokes and put-downs directed at both Inuit staff and clients – “that our people don’t know how to bring up children, that they are drunks.” York said she quickly met with resistance to her changes. Key managerial positions in the health board were controlled by non-Inuit, who felt threatened by her newfound assertiveness, she said.

Then, on March 13, 1999, Jackie committed suicide. The girl had been a good friend of York’s daughter. The day before the suicide, Jackie and York’s daughter had both stopped a boy from the community who had tried to commit suicide. After this, Jackie herself started talking again about suicide. York’s daughter warned the staff at the group home about Jackie’s precarious state of mind – “so they were quite aware of (Jackie’s) intent,” said York.

The next day, around dinner-time, Jackie was left alone in her room, according to former health staff. She went to another room where she barricaded herself in and then hung herself with a pair of pants, said the former staff.

“If she was that suicidal, she should not have been by herself. She should have had someone with her all the time until she had calmed down,” said York. “I thought it was handled badly.”

Another former Inuit health worker who is familiar with the incident agreed: “They left a child unattended. That’s why she was brought to the group home – because she was suicidal.”

The group home’s coordinator didn’t return our phone call.

After the suicide, York called in the Quebec Human Rights Commission to investigate. A month later, her contract wasn’t renewed. She was told she wasn’t a team player, had worked there too long and was absent a lot from work – allegations she denies.

Minnie Grey, the Nunavik Health Board’s new executive director, refused to comment on the suicide because the human-rights commission’s investigation is still not finished. She did say, however, that the high Inuit suicide rate “is not something to be proud of.”

As for York, Grey would not comment directly on her complaints or employment situation.

Grey acknowledged, however, that the Nunavik health network lacks trained Inuit staff and that this affects services to the communities. Out of 50 or 60 nurses in Nunavik, only three are Inuit, she said.

“That’s not to say that people aren’t doing a good job. (But) there is always a gap between the community and the regional (health) board. Most of the professionals are not Inuit,” said Grey.

One big problem is non-Inuit staff often don’t stay in their jobs very long. “The turn-over in (non-Inuit) professionals who come here to work is a problem, and we do have problems replacing people. That directly affects ongoing files,” she said.

“If we had trained Inuit, we wouldn’t have that problem.”

Grey is, however, positive about the future. Earlier this month, the provincial Minister Delegated for Health, Social Services and Youth, Gilles Baril, was in Nunavik to announce $1.8 million in new funds this year for youth programs, including job training and suicide prevention. Quebec will give $3.3 million in annual funding for youth projects in subsequent years.

“Never in our history have we seen this amount of money coming in to deal with these issues,” said Grey. “We have only been funded on a piecemeal basis.” But others say money isn’t enough to solve the problems in the Nunavik health network, and that big changes are needed.

Inuit health at a glance

Suicide rate in Nunavik: 101.8 per

100.000 inhabitants

Suicide rate in Quebec: 18.1 per

100.000 inhabitants

Suicide rate in Nunavik for 15 to 19-year-olds: 480 per 100,000 inhabitants Nunavik infant mortality rate: four times Canadian average Rate of trauma death in Nunavik: seven times Quebec average