Health Committee on Aug. 28th, 2009

[Chief Shawn Atleo, National Chief, Assembly of First Nations]

Thank you, Madam Chair.

To members of the committee, thank you for the privilege of appearing here. I appreciate the vigorous focus on something so important. As has already been articulated here today, we're talking about the lives of people.

Grand Chief, I echo the sentiments; please pass them on to the chief. Our prayers are with the chief and his family.

I want to begin by recognizing, respecting, and supporting the grand chief's comments, in particular as he finished off, with an acknowledgment of the importance of the treaties. They were always about mutual recognition and respect, about living in harmony with one another. This issue, H1N1, is bringing light to, as the grand chief said, the opportunity for us to rethink how it is we view one another and work together.

In support of what the grand chief has said, perhaps I'll add some comments on the part of the Assembly of First Nations.

I very much see it as our role, the role of the office of national chief, to support the chiefs in their efforts and to recognize that they are the ones whose ancestors signed treaties. They're the ones who hold title and rights.

Grand Chief Garrioch, when I travelled up to see you in northern Manitoba, the first thing the chiefs talked about at the meeting you were hosting was H1N1. They were deeply concerned about the health and well-being of their families and their communities.

Really, this is a conversation about how we can bring sharp focus and attention to the health and well-being of our people in our communities and to make sure there is a timely response to the issue of H1N1, which, as we head into the fall, will be increasingly important. This is why I'm appreciative of the committee bringing us all here together.

I had expressed my concerns, reflecting much of what the grand chief has expressed to the minister, and asked that we do meet. I was pleased that we did have a fulsome discussion with the minister this morning. We were talking about a number of issues, principally around the recognition of jurisdiction of first nations to care for their people, much of what the grand chief has described.

We know there are other examples out there, including that of tripartite arrangements, where the various jurisdictions, first nations and other levels of government, have the opportunity to work together to respond to the issues, as opposed to just having unilateral decisions being taken or solutions being brought in.

I think the principal message that I want to share with the committee is the idea of jointly responding to these issues, the idea of joint policy analysis, jointly arriving at the data and the information, particularly as it pertains to recognizing first nations as a priority. I think if there's one strong message that I want to bring forward--this comes from the chiefs I just met with yesterday, and it's shared by chiefs across the country--it's that we firmly feel that while we are addressing issues of the scientific analysis, importantly, we need to look at this through the full lens here of the social indicators of health. That includes first nations issues like the ones I heard being talked about, water and other factors. This is going to require full partnership and recognition of the jurisdiction of first nations, that we have treaties.

We have some examples. In the B.C. tripartite situation, there was joint communication occurring. Perhaps these sorts of examples need to be contemplated as far as how we work together. Clearly the resources need to be there as well for this sort of work to occur.

The joint development of national guidelines is something that I want to table to the committee as being important and needed.

These are all points, by the way, that I also tabled with the minister. I suggested very strongly that first nations jurisdictions need to be recognized. The issue of the high rates of pregnancy, the particular vulnerability that the grand chief alluded to--these are elements that this country, this committee, needs to pay particular attention to. We're talking about the lives of individuals here, and extremely vulnerable people within our society and within our community. There's a need for full collaboration and transparency in this effort.

When I spoke to the grand chiefs when we were meeting, I heard disparities in information. Disparity in information about what is actually happening on the ground is not helpful. It raises fear, it raises anxiety, and it puts mistrust between people in the relationship. I believe our people require us to be demonstrating much better leadership than that. I believe we received the commitment from the minister to follow up and work much more closely, and this is something that grand chiefs need to talk further about as to exactly how we would execute that.

Last, the idea we tabled was that we have a national exercise of some kind rather quickly to make sure that we bring focus and attention to this. To conclude, what the grand chiefs said was that while absolutely this is a crisis—it's in front of all of us, and you heard the call for declaring a state of emergency—we need to turn this crisis into an opportunity to talk about what's not working in the system more broadly, to make sure that we talk about the link to the broader social determinants of health, which include water and the need for proper education and educational facilities, and most importantly, the recognition of first nation jurisdiction and of the sacred treaty relationship.

I'm very pleased that Dr. Barker is here today. We've asked the minister to make sure that the H1N1 first nation adviser who has been put in place work very closely with our Assembly of First Nations health adviser, and there has been a commitment to that process as well. So Dr. Barker is here also to offer any thoughts as this conversation ensues.

Thank you once again.

[The Chair, Conservative, Joy Smith]

Thank you very much, National Chief Atleo. It's an honour to have you here, and the grand chief as well, and all the representations from the aboriginal community.

This committee is here to listen and to ask you questions.

We're going to go on to the Prince Albert Grand Council, represented by Vice-Chief Don Deranger and Chief Bart Tannsie. Welcome.

As well, we have Mr. Sanderson. Welcome.

Who is going to be presenting?

Thank you, Vice-Chief Deranger.

[Chief Don Deranger, Vice Chief, Prince Albert Grand Council]

I have with me Chief Bart Tannsie, from the Hatchet Lake Denesuline First Nation. I guess I'll be speaking.

I want to say good afternoon to you, Madam Chair and members of the committee. I'm Don Deranger, vice-chief of the Prince Albert Grand Council.

I want to thank you for giving me the invitation to appear before you to address the concerns, preparedness, and response plans for first nations of the Prince Albert Grand Council on the H1N1. I just want to brief you a little bit about who we are.

The Prince Albert Grand Council consists of 12 first nations, representing approximately 35,000 members and 24 communities. The 12 first nations are divided into two and four sectors: the first sector, the one far north, the Athabasca Denesuline sector, the Swampy Cree, the Plains Cree and Dakota nations, and the Woodland Cree.

The Prince Albert Grand Council also occupies four treaty areas, Treaties 5, 6, 8 and 10. The land base of Prince Albert Grand Council area is approximately 100,000 square kilometres. This area is located in the greater part of central and northeastern Saskatchewan. The Prince Albert Grand Council is one of the largest tribal councils in western Canada, and we have isolated communities in our jurisdiction as well.

Since the arrival of the H1N1 flu virus, the Prince Alberta Grand Council and its communities have been busy dealing with the challenges associated with this. We have been quite fortunate thus far as we have had no fatal cases in our PAGC communities. With the flu season upon us and the medical experts predicting the next wave of the H1N1 to be this fall, we at the Prince Albert Grand Council are doing our best to prepare our communities with the best possible pandemic plans; however, to assist our communities and to ensure the plans developed are effective, there are a number of issues we need to reflect to ensure that our communities can sustain themselves during the outbreak of the H1N1. These issues include, one, the lack of additional financial support; two, nurse recruitment and retention; and three, the sustainability of programs and services.

The lack of financial resources. The population in each of the Prince Alberta Grand Council communities increases significantly on an annual basis without being reflected in the administration funds. Population and financial increments are lagging, which puts many of our communities at a disadvantage right from the start.

The meagre annual 3% increase does not even begin to address the health issues and the demands that our communities face each year. The Prince Albert Grand Council is expected to prepare for the H1N1 with these limited funds and carry out the day-to-day administrative programs and services, purchase expensive medical emergency supplies and stockpiles of essentials, retain health professionals, etc. Over the past six years, the Prince Albert Grand Council communities have been preparing, with the assistance of NITHA , the third-level service provider, pandemic plans that would assist communities in being prepared for the H1N1 flu outbreak. In that sense, we are fortunate; however, there is still the underlying fear of running our already financially exhausted budgets to a stage where financial recovery will be a burden long after the H1N1 virus has made its mark.

The federal government needs to acknowledge the fact that this issue is long-standing and needs to be addressed before we can expect our communities to have adequate and effective plans in our communities.

Nursing recruitment and retention. The Prince Albert Grand Council communities continue to struggle with the retention and recruitment of our nurses in our communities. Nurses working in first nations communities are not treated fairly when it comes to financial compensation. Nurses working for the provincial system receive substantial increases and incentives that draw them out of our communities because we cannot compete with the provincial pay scales. The federal government has not recognized the fact that we do not receive any additional resources to compensate nurses working our communities.

The lives of our members will be jeopardized because we will not have the medical professionals in our communities to assist when the H1N1 outbreak arrives in full force. The lack of nurses is a major issue that needs to be addressed because of how it affects how well we are prepared to take care of our people during the outbreak. It is a critical issue that needs to be acknowledged and can no longer be ignored. We need to address this issue before the outbreak is upon us.

An example of the nursing crisis we face in some of our communities is that there are service contracts being set up with emergency medical service providers. They contract nursing personnel from far and wide just to have the coverage in a community for the weekend. Nurses are becoming stressed out and end up going to work for the province because we cannot compete with the provincial nursing pay scale.

The final issue I want to bring forward is the sustainability of programs and services. The expectation that the Prince Albert Grand Council communities must continue to operate, develop, and plan for the H1N1 flu outbreak on the existing budgets and resources is no longer acceptable. Additional resources are needed to be able to sustain the existing programs and services in our communities. The Prince Albert Grand Council has developed its own contingency plan for where areas of critical response may be required and how we will respond to the communities that will experience cases of the H1N1. Due to provisions of additional second levels in nursing, training, education, and prevention, assistance in the development of pandemic plans has been extremely beneficial and rewarding in terms of keeping the spread at a very low rate. Pandemic planning in our communities has been ongoing for the past six years or more and continues to be a priority with the Prince Albert Grand Council.

In all, with the exception of the three areas identified, the Prince Albert Grand Council has taken a very keen interest in making sure that our communities are prepared for the H1N1 flu season. It is hoped that there will be positive response from the federal government to recognize our needs.

[The Chair, Conservative, Joy Smith]

Thank you so much, Vice Chief. I appreciate your comments.

Now we'll go to Sydney Garrioch, the Grand Chief of the Manitoba Keewatinowi Okimakanak.

[Grand Chief Sydney Garrioch, Grand Chief, Manitoba Keewatinowi Okimakanak]

Good afternoon.

On behalf of the 30 first nations and 62,000 citizens of northern Manitoba represented by MKO, I thank you for the opportunity to take part in your expert panel on H1N1 preparedness and response of aboriginal and Inuit communities to the H1N1 virus.

I wish to point out an alarming trend that occurred within our region during the first wave of the current H1N1 pandemic. According to the Public Health Agency of Canada, on July 15 there were 151 first nations laboratory-confirmed cases nationwide, and 139 first nations laboratory-confirmed cases were from Manitoba. According to Manitoba Health, on the same date, 125 first nations laboratory-confirmed cases were from northern Manitoba, or the MKO region. As of August 6, 2009, there were 133 laboratory-confirmed cases from our region of northern Manitoba, and there were two recorded deaths, with one questionable death involving the loss of a child to a pregnant mother who was confirmed with H1N1. The severity of the H1N1 impact in the MKO region is illustrated by known statistics.

The alarming trend in our region is in fact a “cluster”, as defined by the World Health Organization. This cluster should have alerted First Nations and Inuit Health Branch and Public Health Agency of Canada to the severity of our situation, and these organizations should have been prompted to respond according to the mandate of the National Office of Health Emergency Response Teams, whose goal is “to train and certify Health Emergency Response Teams across the country, and to ensure that they are ready to be deployed on a 24-hour basis to assist provincial, territorial or other local authorities”—our emphasis—“in providing emergency medical care during a major disaster.”

We are concerned that our first nations are being left out of the scope of the emergency response protocol of the Public Health Agency of Canada, since there has been no reaction from them to date in the MKO region, other than in the Island Lake region in response to political pressure, despite a similarly high incidence of H1N1 in other communities.

Funding and human resource response levels to date provided by First Nations and Inuit Health on pandemic preparedness have proven wholly inadequate, with unrealistic expectations. Since 2007, MKO has received $375,000 for consultation and training with our first nations in pandemic preparedness. The three tribal councils represented within our organization received a total of $72,000 for pandemic preparedness. Our first nations have received nothing.

When one considers the vast geographic area to be covered in the provision of consultation and, most recently, planning assistance to our first nations, the human resources that can be dedicated under such limited funding regimes leaves the coordination, planning, and implementation of community pandemic response plans and related training out of our grasp. The MKO region covers two-thirds of the province of Manitoba, with 16 of our first nations accessible by air only. In short, the federal government has not prepared to respond to the current pandemic as it concerns our citizens.

It is inconceivable to complete the first-nation-specific community pandemic response plans with no new local funding available and sporadic regional funding for tribal councils and MKO and the unrealistic timeframe of two months, as First Nations and Inuit Health publicly stated on May 29, 2009. In comparison, the Burntwood Regional Health Authority, funded by the Province of Manitoba, received in excess of $60 million per annum and continues to develop its pandemic plan.

To further highlight First Nations and Inuit Health's lack of preparation, the Manitoba regional director general issued a letter on June 17, 2009, advising first nations that an arrangement may be negotiated to divert program resources, as an interim measure, to address influenza outbreaks. This is ridiculous, as it asks first nations to defer desperately needed programs to support presently unfunded pandemic planning. There is no long-term strategy at this time. MKO had to divert its funding from the aboriginal health transitions fund adaptation envelope to help communities respond, through education, awareness, planning support, research, media analysis, and policy development.

MKO employees have met with the regional health authorities—the Burntwood, Nor-Man, and Parkland authorities—to determine their response to first nations' pandemic planning and preparedness needs. To date, only the Churchill Regional Health Authority has produced and shared a pandemic response plan with MKO. Others have done internal planning, but generally have not involved first nations directly, except when political pressure is applied. MKO trained incident managers from each of our 30 first nations on June 22 to June 25.

There are no first nations community pandemic plans that have been tested. Only two first nations out of the 30 have completed their community pandemic plans.

Several of the incident managers who were trained have quit functioning due to the complexity and magnitude of the tasks involved, with all of them citing the fact that the role of incident manager is a voluntary position, as funding is not available for it from existing programs and services.

A dedicated human resource response is required, where all of the agencies involved collaborate with first nations on a community-by-community basis. This, together with a long-term funding commitment for local health emergency planning and preparedness, is needed immediately to ensure that pandemic plans are not only completed but are also thorough and comprehensive. Right now, communities are overwhelmed and don't have the support they need to at least feel prepared.

MKO has submitted a modest proposal to the Minister of Health, geared to the planning and preparation for health emergencies. Separate contingency funds should exist to be released to cover the implementation costs of actually responding to health emergencies. The proposal to the Minister of Health is only for the immediate needs to combat H1N1, apart from the long-term needs for adequate housing, safe drinking water, and access to quality health programs and services.

This expected funding will allow first nations to develop comprehensive community pandemic and health emergency plans. MKO and the tribal councils will be able to assist community pandemic planning coordinators with research and policy analysis, as well as education and awareness, in developing their plans and preparing their communities for implementation. MKO will also have the capacity to create regional plans and conduct policy research and analysis on regional, provincial, and national levels. We maintain at MKO that health is a treaty right.

Clearly, a new and more in-depth approach is required, one that brings together all levels of government in full partnership with first nations governments to ensure that the health and well-being of our citizens is maintained and enhanced through proper planning and investment in the determinants of health, and readiness to respond to any and all threats to the lives of first nations people.

MKO, on behalf of the 30 first nations and the 62,000 citizens we represent, is requesting that the Standing Committee on Health use its influence in Parliament to ensure that first nations receive adequate funding, necessary supplies, and essential services that should be available during an international crisis of this magnitude. Given our social and health conditions, MKO first nations require the necessary resources to adequately prepare and respond to this immediate threat, as well as future threats.

Thank you.

[The Chair, Conservative, Joy Smith]

Thank you, Grand Chief.

We will now go to the Inuit Tapiriit Kanatami. Gail Turner is the chair of the National Inuit Committee on Health, and Elizabeth Ford is the director.

Who would like to make the presentation?

[Gail Turner, Chair, National Inuit Committee on Health, Inuit Tapiriit Kanatami]

I will be speaking.

[The Chair, Conservative, Joy Smith]

Thank you, Ms. Turner. Please proceed.

[Gail Turner]

[Witness speaks in Inuktitut]

Good afternoon. I wish to thank the Standing Committee on Health for the opportunity to speak today representing Inuit Tapiriit Kanatami and the Canadian Inuit on the issues of H1N1 and its impact on us.

I am an Inuk public health nurse currently working as director of health services in Nunatsiavut, northern Labrador, and the current chair. I speak from a place of knowing.

Inuit Nunangat, our Arctic homeland, comprises 40% of Canada's land mass and 50% of its coastal shoreline. We number only 50,000 people living in 53 remote and isolated communities across the north. Most of our communities have no roads or hospitals, doctors or pharmacies. We live with significant issues of overcrowding, which creates an environment for disease spread and challenges the ability to reduce the risk to others. We have very poor general health and a much lower life expectancy than other Canadians.

We have a huge generational divide, with 35% of our population under the age of 15, compared with 18% for non-aboriginal Canadians. Young people and pregnant women, two of the high-risk groups identified for the current circulating H1N1 virus, are highly represented among Inuit. For the pregnant Inuit women, the risks are increased by having to travel in their last few weeks before delivery away from family and familiar health care providers to larger centres where they may be in communal accommodations.

Inuit fear H1N1, a fear generated not by media attention but rather by the very real history of the impacts of previous pandemics on Inuit. In Okak, northern Labrador, where I live, the Spanish flu wiped out nearly the whole community in a matter of days. Inuit are aware as well of their vulnerabilities created by geography, weather, and co-morbidities. Not for us the comfort of knowing that access to health care is nearby. As wonderful as the nurses are in the clinics in our communities, should we fall ill and our condition worsen, there must be a plane to the next level of care, and that is totally dependent on the weather.

The Canadian pandemic plan does not specifically address the unique issues pertinent to pandemic planning in Inuit regions as it does for first nations on reserve. In fact, it does not give the attention warranted to remote and isolated communities in Canada where guidelines created do not fit and use a language that is full of false assumptions and hints of colonial bureaucracy. In June the board of directors of Inuit Tapiriit Kanatami met in Nain, Labrador, and passed a resolution calling for an Inuit-specific appendix to the Canadian pandemic plan. They consider that given the high risks for contracting H1N1 and other viruses, having a pan-Inuit strategy would be an important step in the prevention and management of current and future pandemics.

The challenges for planning for Inuit are further complicated by jurisdictional issues, with land claims in two territories and two provinces and the lack of clarity around the role of Health Canada and the Public Health Agency of Canada. The relationships between federal, territorial, and provincial governments reflect the changing nature of politics and require a more concentrated focus on the people they serve. We have heard back from Dr. Butler-Jones a willingness to begin discussions of such a plan, and we are aware that this will not be until the pandemic is over.

In the interim, we are working on a trilateral work plan for H1N1. The plan must be written by us and not for us. Inuit must be engaged so that what is written is culturally relevant, and we can take our realities and include what we have learned from our journey with H1N1 and our pandemic planning efforts to date and create a meaningful document that can guide us in the future to the level of preparedness that we deserve.

Our human health resources are a great concern. We have communities where there is only one nurse, and his or her priority will have to be the provision of primary care. The logistics are daunting. With both staff and supplies having to be flown in, and the vaccine itself protected against the extreme temperatures that we face in the Arctic, by the time this vaccine is ready, we cannot be efficient. Immunizing a community of 250, given our resources, could take several days once you factor in the flight schedule and the weather.

Consideration must be given to support access to the vaccine for Canadian Inuit. We cannot change the social determinants in our immediate future. Right now, vaccine is our only defence against spread. We have no capacity for alternate care sites and will have to use home isolation.

[The Chair, Conservative, Joy Smith]

I'm going to have to interrupt you. We are running out of time. I've given you overtime now. Could you please wrap it up so we have time for questions and answers?

[Gail Turner]

Thank you.

I beg your indulgence, but I would like to continue just for one more minute, if I could, please.

[The Chair, Conservative, Joy Smith]

For 30 seconds, because you're way over.

Thank you.

[Gail Turner]

I'll move on to speak to some of the challenges, and then I'm into what we're calling on this committee.

I'm appalled, on a daily basis, at the lack of knowledge by bureaucracy at all levels in this country on who Inuit are and where and how we live.

In closing, Inuit Tapiriit Kanatami and the Inuit of Canada call upon the Standing Committee on Health to support the creation of an Inuit-specific annex to the Canadian pandemic plan, support the mass immunization of the remote communities as high priorities once the H1N1 vaccine is available, and begin the very serious work of addressing the social determinants of health that keep Inuit in Canada on the bottom of the health status scale.

Food security and access to health care must be improved. There are significant issues of social injustice that must be addressed. Canada must set target dates for the reduction of the number of persons living in a household until it resembles that of the average Canadian. The life expectancy of the Inuit should be rising, not falling, as it continues to do so.

At the end of the day, Canada will be judged on what efforts are made to improve health for all, and in particular for Inuit.

Nakurmiik.

[The Chair, Conservative, Joy Smith]

Thank you so much, Ms. Turner.

I'm going to ask all of you to please submit your presentations, and we'll see that each member of the committee gets a copy of each of your presentations.

Now, last but not least, we're going to hear from Dr. Kettner.

Dr. Kettner, perhaps you would be so kind as to make it brief, because we want to get into the questions. I have been generous with the presentation times because I thought it was so important to listen to this.

Thank you.

[Dr. Joel Kettner, Chief Public Health Officer, Government of Manitoba]

Thank you.

I'd like, first of all, to thank you for inviting me to attend this meeting on this important topic.

I'm going to say three things. One is that I want to be clear what my role is here. That's the first thing I want to briefly talk about. Second, I want to talk--very high level--about what we've learned in Manitoba from the first wave of the pandemic. And third, I'll talk about what I think are the key things going forward.

First of all, just so it's clear, I'm the chief public health officer of Manitoba. I'm here to speak to this very specific question that's on the agenda. I'll do that on my own behalf, as the provincial public health officer. I'm not here speaking on behalf of my deputy minister, minister, or government. And I'll do the best I can to speak truthfully and clearly with facts and opinions, as I'm asked.

Regarding our experience in the first wave, it looks as if it's probably mostly over with in Manitoba. The first point is that overall the pandemic was not as bad as some people feared it would be; however, some groups in Manitoba were more severely affected than others, not the least of which were our first nations people and other aboriginal people. I could give a lot of statistics and numbers, but I won't do that. I think those are pretty much known.

It's important to point out that from our analysis so far, even when accounting for many other of the known risk factors, it still appears that being a first nations person or an aboriginal person is a marker of risk for severe disease. Of course there are lots of reasons for why that's true, and I'd be happy to entertain that discussion if there are questions and if there's time.

Moving on to the third part, is the next wave going to be worse? Many experts think it may be. We have to plan for that possibility as well as for other possibilities. In Manitoba there are three issues we need to be aware of and plan for. The first is to prioritize aboriginal people for early use of the vaccine when it's available--presuming it's effective and safe--as well as early use of antivirals and early treatment for people, simply because we know they're at high risk by being aboriginal, regardless of what all those reasons might be.

The second is that we need to strengthen and improve our public health and primary programs and services for aboriginal people, wherever they live in Manitoba. They need better coordination and they need better integration. And that work needs to continue and improve more quickly than it has, through collaboration of aboriginal people, federal government agencies and organizations, and the provincial health department and its regional health authorities.

The last point, but not the least important, is that although we're battling influenza in this conversation, the long-term effective strategies and actions for public health to address the public health issues and health outcomes for aboriginal people require addressing the underlying social determinants and many other long-standing reasons for the poorer health outcomes that we've observed in people of aboriginal descent, not only from infectious diseases but for practically any health outcome that we measure.

[The Chair, Conservative, Joy Smith]

Thank you very much, Doctor.

With the indulgence of the committee, I'm going to ask, with your approval, that we go to our first round, a five-minute question and answer, because we do have another panel. I was very generous with the presentations. I thought we all should hear these very important presentations.

Do I have the agreement of the committee that we go into a five-minute round?

[Some hon. members]

Agreed.

[The Chair, Conservative, Joy Smith]

Thank you very much.

We will begin with Dr. Bennett.

[Carolyn Bennett, Liberal, St. Paul's, ON]

Thanks very much, Madam Chair.

I thank all of you for your presentations. I do apologize.

I do think, Madam Chair, we could have started much earlier today. It would have been much better to have a longer time with this panel in particular. In the future, I hope we can do better for the people who have come all this way.

That being said, I think their presentations were pretty well self-explanatory--that this is a very dire situation.

First, I want to apologize to Ms. Turner that I didn't word my question to the minister properly. I can hear from you that you do not want the general pandemic plan translated into Inuktitut; you want a commitment from this government to work with you to make sure there is a separate Inuit annex.

I was wondering, with the indulgence of the committee, if we could have all-party consent to ask the minister to help with that right away, because I don't think the question was asked. You can sort out how we'll do that, but we want to help in whatever way we can to make that a priority.

The second question is for the national chief, and for anybody else here. Are you aware if the aboriginal leaders in Canada have been included in the federal-provincial-territorial health ministers meeting in September?

[The Chair, Conservative, Joy Smith]

Who would like to answer that?

[Chief Shawn Atleo]

I am not aware of an invitation. Not that I'm aware of.

[Carolyn Bennett, Liberal, St. Paul's, ON]

Do you think it would be a good idea if you were included?

[Chief Shawn Atleo]

Absolutely. It would be absolutely necessary.

As you say, some of these things speak for themselves, the inter-jurisdictional nature in particular, and the grand chief made reference to the issues in Manitoba and Ontario with resource planning. In my earlier remarks, I made reference to the tripartite notions as being a way of making sure these issues do not fall through the cracks. So I think if this committee can bring some focus and attention to encouraging jurisdictional efforts to be undertaken, I think that would be incredibly important.

[Carolyn Bennett, Liberal, St. Paul's, ON]

I guess one of the things that are very important to us as parliamentarians is when two witnesses say pretty well the opposite.

I would like Regional Chief Garrioch to explain how many of his communities have a pandemic plan that has been revised and brought up to date with this particular H1N1 outbreak and has been tested.

[Grand Chief Sydney Garrioch]

Only two communities in northern Manitoba can be classified as having completed plans, but none of these have been tested.