Thank you, Mr. Chair.
I'm very honoured to be here to speak on behalf of the Aboriginal Nutrition Network.
I'm a member of the Abenaki First Nation in Quebec and one of seventeen aboriginal registered dieticians in Canada.
I brought a copy of the role paper for the Aboriginal Nutrition Network, but unfortunately we didn't have funding to have it translated. Carmen has a copy.
I know you've heard much information from many different parties. Being invited to speak at a grassroots level, I would like to give you an idea of what a dietician faces in the community. I'm speaking to you on behalf of my experience in the near north on a reserve community, as well as in an urban population.
I'll come to my first day at work.
I'm the only RD servicing an aboriginal population of about 5,000 people living on and near the area's seven reserves. The nearest large urban centre is 350 kilometres away. Travelling distance between communities is up to 250 kilometres, often on gravel roads.
On my drive in to work, I'm thinking about how busy it has been since my colleague left six months ago. She was the third person in that position in a two-year period. We are lucky to be funded for two FTEs, but the position has been vacant since she left. We are at risk of losing funding for that second position because of the vacancy.
I arrive at my office to find a community health representative, or CHR, waiting at my door. She needs some nutrition information ASAP for an 18-year-old girl who has just found out she is pregnant. The girl is enrolled in the Canada prenatal nutrition program, but the CHR has no formal training in nutrition. She calls on me often. The girl is leaving soon to go down south to school, so she needs the information right away.
My agenda for the day, then, includes three individual counselling appointments and an afternoon workshop. Meet my clients.
The first is a 54-year-old woman who has just been diagnosed with diabetes. She's taking care of her daughter, son-in-law, and three of her grandchildren. They're all staying in her three-bedroom home because of the mould in their own home, and they're having breathing problems as a result.
We start with basic diabetes education and a few small changes she could make to her eating habits, with some discussion on physical activity. We also go over some ideas for her to feed her grandchildren, although she doesn't like to interfere with their care. I'm amazed that in spite of the chaos in her home, she even came for her appointment. I hope she comes back for follow-up.
The next one is a single mother of four young children, including a two-month-old infant. The CPNP worker has asked me to see her about her own nutrition while breast-feeding her young infant. She doesn't show up for her appointment. When I call her, she tells me one of her children is sick, she has no babysitter, and she has no transportation to the clinic. I arrange to do a home visit the next day.
It's only the third week of the month, but her family food budget of $400 has been spent. The local store is expensive and the selection of fresh produce is slim. I will bring her a food voucher from the CPNP, but some clients have reported that their Ontario Works allowance has been reduced by the amount they receive from CPNP vouchers.
Next, I see a 40-year-old man who has been referred for high cholesterol and triglycerides. He has been on my waiting list for two months. We talk about his diet, and I ask if he is able to use any traditional food. Although he used to go hunting and fishing with his dad as a child, no more. He works full-time and can't take the time off to go. He doesn't have money for a boat or a trailer, and the cost of butchering a deer or a moose is too high, at $125 to $200. Besides, his doctor told him wild meat wasn't good for him because it has too many contaminants and is high in fat.
We talk about how our traditional foods are actually what kept us alive, and how they are in fact much healthier and lower in fat than most market foods. The benefits far outweigh the risk of any contamination in this region, which is actually low. His wife was unable to attend with him, since she works also, but we go over some sample food labels of the convenience foods she has been cooking for the family. He's shocked to realize how much sugar and fat is in the pop and chips he has at night with his children.
I answer a few phone calls. The first is a call from a teacher at the elementary school who wants to start a class for overweight children—a fat class, in effect. I suggest that isolating children who are overweight for diet and exercise might not really be the best approach. I tell him I'll be happy to come and do some healthy lifestyle programming with all of the kids, and we agree to talk about it the next time I'm in the community.
Next, one of the parent volunteers with the breakfast program needs help with menu planning. We talk about potential donations, since the budget from the Canadian Living Foundation's Breakfast for Learning is limited.
Lastly, I get a call from a nurse in one of the other seven communities, 150 kilometres away. I'm not scheduled there for another two weeks. She has a client whose 8-year-old has just been diagnosed with type 2 diabetes. The child is overweight and they live in a remote area with few recreational activities, so they watch TV and play computer games. I fax her some information until I can get out to the community and speak with the family. I also tell her about a new program on APTN that now includes an aboriginal dietician.
My afternoon class goes well. We're learning about canning the first harvest from a community garden. It was a challenge getting it going and to keep vandals, dogs, and wildlife from ruining the garden, but it worked.
The maternal child health program here provides child care so moms can attend the class. A few of the people who had signed up for class didn't come. They are most likely attending the funeral of a young member who committed suicide. The day ends with completing paperwork and trying to prepare for the next class the following week.
On my day as an urban dietician, I work in a program funded by the Métis, the off-reserve aboriginal and urban Inuit prevention and promotion program from ADI, and I'm challenged with the task of diabetes prevention with funding that is limited to short-term projects, not ongoing programs. Our diabetes prevention program has, for the last two years, depended on last-minute annual extensions. Most recently, we got a six-month extension, and just yesterday we received notice that we have had approved a new program to start on December 1, in three weeks.
The N'Amerind Friendship Centre in London is our best partner. We partner with them often to gather and to reach the children and youths in the community, although their youth program has been cut and they have no funding for our youth program in London. There are over forty schools in the city of London, with a few aboriginal children in each school. If I go to the ones with the highest concentration of those children, I'm told that since many of those children come from on-reserve nearby communities, they're not my mandate under the off-reserve ADI program. Nutrition services are not considered core services for provincial aboriginal health access centres.
Now that you have a grassroots idea of what some of our challenges are, how can you support aboriginal people and their registered dieticians and health workers in their communities to do the work that needs to be done?
We need human resource capacity-building and improvement and access to dietician services. We need support for recruitment and retention of aboriginal people in careers such as nutrition, physical activity, and health promotion. They need to leave their communities to do these programs, so we need enhanced distance education opportunities and internships closer to home that include cross-cultural training and initiatives such as the career promotion tool kit developed by the Aboriginal Nutrition Network.
We need mandatory core funding for registered dieticians in primary care and prevention programs. The breadth and quality of nutrition education could be greatly improved by measures ensuring that a registered dietician is mandatory staff, or at least a resource person for programs such as ADI, CPNP, and maternal child health; and that health workers such as CHRs and pure educators in the community are supported and trained in nutrition.
We need reimbursement for transportation, not only to medical appointments but also physical activity opportunities on and off reserve.
We need a specific research agenda for both on- and off-reserve populations, one that will yield useful and accurate data to direct programming efforts. Incidence of on- and off-reserve diabetes and other chronic disease rates are not known. We need information on food consumption patterns, activity patterns, and preferences. We need qualitative research to explore aboriginal peoples' perceptions, values, and beliefs around health, weight, activity, and the effects of residential schools on parenting, eating, and feeding behaviours. We need clinical research related to diet composition—carbohydrates, protein, and fat—and the effect on insulin resistance and diabetes and cardiovascular disease specifically within aboriginal populations.
We need support for educational activities in developing culturally appropriate teaching materials that encourage traditional food use and activities, in print as well as in audiovisual tools such as video, music, and theatre, and using technology that appeals to children and youth, with translation into English and French as well as aboriginal languages.
We also need a clearing house of program funding and resources available to improve the dissemination and communication of the resources available.
Lastly, we need to improve access to traditional foods and activities, and to improve support for community traditional food use and sharing programs such as community gardens, freezers, and institutional policies that are respectful of the spiritual and cultural significance of food for use in health and in ceremonies.
Environmental protection of traditional food supplies goes without saying. Support hunting and fishing programs both in the north and in southern and urban aboriginal areas.
Aboriginal school curricula and after school programs such as those funded by friendship centres should include mandatory nutrition and physical activity components.
Finally, this funding needs to be flexible enough to eliminate the disconnect between on- and off-reserve funding and improve coordination between provincial and federal funding. It must be a long-term commitment and use outcome measures that reflect more qualitative results than just BMI.
Thank you.