Health Committee on March 25th, 2010

[Carol Hughes, NDP, Algoma—Manitoulin—Kapuskasing, ON]

I wanted to give an opportunity as well to Dr. Anderson, because I'm sure that within five minutes--I believe it was five minutes--you didn't have a chance to really put out as much information as you would have liked. So you have the opportunity right now to add something to what we need to do or need to consider.

[Dr. Marcia Anderson]

Thank you for that opportunity.

Now you're putting me on the spot. Of course, my mind just went totally blank.

I think I would just take the opportunity to really enforce how successful our organizations have been, even in these difficult climates. One concern I would raise again that I haven't dealt with too much is the physician retention and physician support issue. We've mainly focused and often focus on student recruitment and retention. We have not focused as much on physician retention, and I mean physician retention in remote, rural, and underserviced urban indigenous communities.

You mentioned one issue, which is the inability to pay market rates. Our students are graduating with among the highest debt loads because of our higher likelihood of living in poverty. It's an absolute myth that all of us have access to band funding, especially for the duration of medical training. We have new physicians with higher debt loads and generally higher family responsibilities, so asking them to go work in lower-paying jobs under those financial pressures is unrealistic. I think that is a key issue why we may not achieve one of our goals, which is to increase the number of indigenous doctors working in areas where there is a high proportion of indigenous patients.

Further, although we don't have definite studies, I can tell you anecdotally from my personal relationships across the country and in my term as president, we have a very high rate of burnout among our physicians. I think it is because of the very stressful and emotional nature of our type of work. We work in advocacy roles, in addition to providing just straight health care, advocating for not only our communities, but often for our family members, in a system that is extremely unfriendly to us.

We need to do more to support our physicians.

[The Chair, Conservative, Joy Smith]

Thank you, Dr. Anderson.

We'll now go to Ms. McLeod.

[Cathy McLeod, Conservative, Kamloops—Thompson—Cariboo, BC]

Thank you, Madam Chair.

I'd like to thank all the witnesses here. We've had very important discussions and presentations this morning.

I'll also reiterate what my colleague started off with, which is on the absolutely unacceptable disparities in terms of health status. I'd also like to acknowledge the work that the CHRs do across this country. I think they are perhaps one of our lesser known paraprofessional groups, not only in the work they provide in rural and remote communities but in the support they give for non-aboriginal physicians and nurses, as they enter into those communities, in terms of supporting them to be successful. Certainly it's important work.

For my clarification, I just want to understand something. Let's say there's a vacancy in a community for a community health representative. To qualify for that position, can anyone be hired and then get the courses as they go? Is there any work towards having those courses perhaps qualify for laddering in terms of credits? Could you maybe just share a little bit more about how that's working these days?

[Debbie Dedam-Montour]

The training of CHRs is not a standardized process. If you wanted to be a CHR tomorrow, you could probably get hired. You have no training, you've never done any presentations, you may not have a computer, you just have a telephone and a fax, and you're supposed to provide services to the community. That is some of the reality faced by many new CHRs.

In the past, before the health transfers, CHR training was under the mandate of the medical services branch, or Health Canada, or any of the different names it has had over the years. Once the health transfers came in, much became decentralized, so training in one region might be happening, while in another it isn't. So unfortunately that's what we're seeing.

Last year I was speaking to a CHR. She was a young person, in her mid-twenties, and she'd been a CHR for two years. I asked her, “What was your training?” She said, “Well, I followed her around.” She followed the other CHR around, so basically it's on-the-job training. They do take some courses that may give them some skills, and those courses may not have an ability for accreditation, for laddering, etc. That's some of the work we're trying to get done in our road to competency for the CHRs. Our work had originally looked at including all the paraprofessionals in the community, but we weren't able to move it as far forward as we would have liked, so we had to refocus just to do the work for CHRs. That is one of the things we want to see: accredited training in every region. We want to see CHRs giving that proper support so they can do their job better, because they have very important roles in the community, not only for the community members, but, as you mentioned, for the health professionals.

[Cathy McLeod, Conservative, Kamloops—Thompson—Cariboo, BC]

Thank you.

I'd like to go over now to Ms. Goodtrack. When the nursing associations or the colleges went from two-year access to four-year, one thing I always wondered about was whether that had a profound impact in terms of aboriginal nurses entering the field or being supported? Did that change make a difference?

[Rhonda Goodtrack]

Thank you very much.

The two-year programs are for diploma nurses, you could say, and the four-year programs are degree preparations. When we do health careers in the schools and talk about how many years it takes to be an RN or a physician or whatever, they are just astounded at the number of years. Certainly the funding and the time away from their communities and families all come into play when they decide whether they're going to venture into health careers and take the challenge, so that's definitely a factor. When I talk to them, when I see their eyes in shock, I tell them to figure out what they want to do, because when they put the work in at the front end it pays off when they take on their careers. As for the length of time in the school, invest in that education, because your life and the future of your family and your community will be greatly impacted by it.

However, you have to address the funding and the social supports for these individuals. In terms of recruitment or retention in the remote and rural communities, you'll see greater retention if you educate those individuals from those communities. They're invested in those communities. They have community ties and kinship there. It's important to educate.

My colleague down there was right: secondary is critical. They come to us underprepared in the maths and sciences, and that's where they struggle. That's where they fail. They'll take those classes over and over and over again, and at some point they just give up. Others who want to succeed will stay in there, but the supports have to be in place, and the secondary education is critical.

[Cathy McLeod, Conservative, Kamloops—Thompson—Cariboo, BC]

We've heard a great deal about Saskatchewan's success--

[Rhonda Goodtrack]

Sorry; I apologize for that.

[Cathy McLeod, Conservative, Kamloops—Thompson—Cariboo, BC]

No, no. I think it's very important for us to hear about success, because I think we need to learn throughout the country. Do you know of any other examples of places in this country where they seem to be making really good progress?

[Rhonda Goodtrack]

On Monday, when I was at a summit on post-secondary education for aboriginal people in Saskatchewan that was held by the Public Policy Forum, there was a presentation on best practices from Manitoba and Alberta. Manitoba has great success in recruiting aboriginal people into their post-secondary programs, and it's because of the supports that are in place in those institutions. Those supports include student advisers, as I mentioned, who provide a space where students can go and have that sense of community and relate to someone who is facing the same issues. Many themes came out from that summit, but that was a common thread across the country.

Other provinces definitely include Manitoba, and Alberta as well. There aren't any institutions in B.C. I'm sorry about that; I apologize.

[The Chair, Conservative, Joy Smith]

Thank you so much.

Did you want to make a quick comment?

[Audrey-Claire Lawrence]

I wanted to address the issue around the two-year and four-year programs. The level of complexity of care that is required, particularly for nurses in rural and remote areas, really requires that four-year program. Like the physicians' association, we recently established the cultural competencies, and it's much easier to integrate that aspect into the four-year program. They can modify it and have a better understanding and understand the relationships of working with the clients.

As to the whole issue of scope of practice, as Debbie pointed out, the lack of consistency in scope of practice in the CHRs means that the nurses cannot count on the scope of practice in the CHR he or she is working with in a community. It's the same thing; the level of demands placed on nurses in rural and remote communities, and in urban centres, is so high that they really need to be RN-based.

There are also issues of lack of nursing oversight in some communities. We're working with Health Canada to try to address that issue.

Thank you for your question.

[The Chair, Conservative, Joy Smith]

And thank you for your comments.

We're going to go into the second round. It's a five-minute round, for questions and answers.

I need to make you aware that at about 10:30 Ms. Murray will be taking the chair; I have another event I need to be at.

We will continue with the five-minute rounds, beginning with Ms. Murray now, please.

[Joyce Murray, Liberal, Vancouver Quadra, BC]

Thanks for your presentations.

I just had the privilege of being in Vancouver and Whistler throughout the 2010 Paralympic and Olympic Games. I went to a number of receptions hosted by the four host first nations. The empowerment of aboriginal peoples that came out of that initiative, as communicated by the aboriginal peoples there, was unbelievable from my perspective as an observer and participant. To me it's inspiring to see how equality, lifting up, and being completely part of the leadership of an initiative must happen with first nations in all other important areas, as it worked so well with the 2010 games.

With that vision of possibility that was expressed in Vancouver and Whistler, I have a question about two things that I have heard today. Essentially, at the risk of oversimplifying it seems to me that everything we're talking about boils down to “attract, train, and retain” in any of the different areas. Dr. Anderson made the comment about teaching our kids to dream big; that's part of the “attract”. I saw that happen with the 2010 games, in the dreams of aboriginal kids to get into sport and to be on the podium and win the gold medals.

One question is, what would be something that would be comparable to attracting, to dreaming big, in health human resources?

[The Chair, Conservative, Joy Smith]

Who would like to take that? Ms. Goodtrack or Ms. Lawrence?

[Audrey-Claire Lawrence]

I think it was mentioned in various comments that if the students get a taste of what is actually involved, that's when they realize that they can do it too. That's when the support for camps, whereby they come in to universities and get to connect, or get the experience of even having access to professors coming in, or of remote tele-health conferences in the north, in which they actually see what science is involved... It's exciting. The provinces are working to support education, but they need to get the sciences earlier; they need to get a taste for it and get better science and math training and possibilities, if they are to see that they can be in those roles.

In particular, we're really trying to emphasize that of the 75% of aboriginal students who drop out of high school, 80% are males. We are really concerned in nursing, because nursing is a community role in which they can have a good-paying job, about trying to recruit more aboriginal males into nursing. We want to get them to feel that they can have the confidence to see themselves in that function, in addition to other health science careers as well. Those efforts pay off in the long run.

Then there's the ability of organizations to stay in touch with them. You see a kid in grade eight and you send them an e-mail every year. You talk to them and ask whether they are still continuing, how they are doing with their math, and whether they need a tutor—that kind of thing. We're looking at doing more cyber-mentoring with our students across the country, just so that they turn to someone, rather than just quit because they think they can't do it.

[Joyce Murray, Liberal, Vancouver Quadra, BC]

So it's a question of nurturing the dreams they have. I would like to get my second question in, Rhonda, but I am interested in your comments as well.

[Rhonda Goodtrack]

There is also a program called the Pre-Health Professions Club. It links up high school students who have identified that they are curious about a health career with a mentor in either medicine, nursing, or pharmacy at this point, and there are other health groups that we'll be exploring. It gives them an opportunity to job-shadow that individual for eight hours.

It's a great opportunity, because they get to see whether that's the profession for them. And they stay connected with the students.

[Joyce Murray, Liberal, Vancouver Quadra, BC]

That question was around “attract”. Another one is around “train”.

The systemic lack of stable funding is very worrisome and unacceptable, especially when comparable organizations I'm hearing about that are non-aboriginal get that kind of funding. There are jurisdictional problems leading to this.

Again, my touchstone for comparison is the 2010 games. Early on—in 1998, 1999, 2000—the leadership for those games set that vision of absolute equality for first nations as hosts and completely part of the leadership and drivers.

Something like that has to happen here for your organizations' and first nations' success and training.

Whose responsibility is this? Is it a federal responsibility to ensure that this kind of interjurisdictional squabble is not leading to a lack of nurturing or support?

[Dr. Marcia Anderson]

I think we need to recognize that it's the responsibility of all of us. Half of our population is urban, so it is not exclusively a federal responsibility; we all have to step up and play our roles.

When I was in St. Theresa Point about a month ago now, we had a forum on public health and improving the public health system. One of the things we talked about was public health human resources. A community member there asked why health is not working with education to build something like a feeder education system. We have specialized schools in which they say they want to train more engineers, or they have an excellent basketball program and everything in the curriculum is geared to that. Why are we not doing this with our education systems, whether in a first nations school that's directed by a first nation, in Inuit communities, or in urban schools where there are high proportions of aboriginal peoples? Why do we not work with our education colleagues?

I think the four host first nations provide an excellent example. They identified who the relevant stakeholders were—it was the four first nations—and identified their common goal, which is to empower their communities to ensure that they got part of the benefits from hosting and to ensure that there was meaningful education and participation for everyone who came there.

Why can't we work with all of the relevant partners, including those around the table here today—our organizations—and the provincial education, the federal, and the first nations education holders, to make this happen in a systemic and sustained way?

[The Chair, Conservative, Joy Smith]

Thank you, Dr. Anderson.

I'm sorry, Ms. Murray; we'll now have to go to Ms. Davidson.

[Patricia Davidson, Conservative, Sarnia—Lambton, ON]

Thank you, Madam Chair.

Thanks very much to each and every one of you for being here this morning. We certainly heard some very interesting testimony. I applaud you for the roles you have taken with your organizations in moving things forward in the way that you have.

My first question is going to be for Ms. Goodtrack. I'm referring to the testimony you gave us earlier. I'll ask two or three things about it, and you can continue then.

Could you enlarge a little on your transition program, which you were speaking about?

You also talked a bit about the discrepancy involved in the definition of a full-time student. To me that is something that should be simple to fix. How does it get fixed? Maybe the things that should be the simplest are often the most worrisome to get to the bottom of.

You talked a bit about space dedicated to aboriginal students.

Could you elaborate a little more on those three items, please?

[Rhonda Goodtrack]

Thank you very much.

On the transitional programs, we have a program called the aboriginal first year experience program as well as the math and science enrichment program at the University of Saskatchewan. Both programs are meant to give students the basic arts and science classes. It is the stuff they would take no matter which discipline, which college, they go to.

The classes are a lot smaller. They build a sense of community among the students, because they're used to a smaller classroom. Whether they're in their community in high school or are from a rural setting, it's a smaller classroom. They're not overwhelmed by taking biology with 120 to 200 other students. Also, it's easier to ask questions. If they don't know anything, then everybody else looks like that. They understand the content.

There are extra tutorials set aside so that the students can better absorb the content. As well, in our programming we provide monies for extra tutoring outside those tutorials, in case they can't make it, for whatever reason.

There is an English class offered over the summer. What they do is apply, and then they take the class. They get the reading and writing skills, which are critical for being able to do any other papers. It's a slower pace, a more relaxed pace, and they're meeting other individuals who will be taking university classes. So they're already building that community before university starts, before the September rush.

You asked about the discrepancy between the definitions of “full-time student”. I think the reason for that difference is that it's now a competition for funding dollars. When I went to school, there was just me. In that nursing class, there was just me. I was the only Indian in that class. Now there are 32 in Saskatoon, 32 in Regina, and 40 in Prince Albert. That's a lot. That's a lot of competition for those dollars, and I think that's part of the reason. A lot of people are falling through the cracks. There's no question there.

In regard to the space, we have dedicated student lounges for our aboriginal nursing students. It gives them an opportunity to just unwind and come together.

It is an intensive group, and they break them up into smaller groups and they're not all together. It's a smaller group, so that's good, but sometimes someone is the only aboriginal in a smaller group. The lounge gives them an opportunity to come together, talk to each other, and debrief. They can articulate the common problems they're having, or better yet, they can help each other out. They'll share notes and share assignments. The second-year students will help the first-year students navigate their way through, as well, when we're not there. It gives them a sense of belonging. They build a nice community, and that carries them through the four years.

I just had a conversation with one of my students. She was confronted by a non-aboriginal nursing student who said that there was a controversy going on about the aboriginal students. She said that they had heard that the aboriginal students have their own space and that none of the non-aboriginal students are allowed to enter. I'm not sure where that information got circulated. They had also heard that the aboriginal students have special luncheons, and the information that's shared they're not allowed to share with the rest of the students. That's completely false. All we're doing at those luncheons is having a third-year student come in to talk to the second-year students to tell them how to ease the transition into third year.

Right now, how it is in Saskatchewan is that you take first and second year at one campus, and you take third and fourth year at another campus. So there's fragmentation. When you transition into third year, that student said, this is the best way to do it. They can tell you that when your teachers say to read the cardiology and neurology notes before September starts, do it, because they expect you to have read them by September; it's common knowledge.

[The Chair, Conservative, Joy Smith]

Thank you very much for your very insightful comments. They're very useful to this committee.

I now go to Monsieur Dufour.