Health Committee on Aug. 28th, 2009

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

Again, I would ask, how do you report to First Nations and Inuit Health Branch on preparedness? Is that by e-mail? Is it by teleconference, where somebody says, do all of you have your plans? Is that what's happening? Or how is this working, that these numbers can be so different from Shelagh Jane Woods' numbers, that 90% of first nations communities across Canada have a plan?

[The Chair, Conservative, Joy Smith]

Who would like to answer that?

Grand Chief.

[Grand Chief Ron Evans]

Actually, I share with the other presenter, Ms. Turner, how appalled she is about the lack of knowledge the minister has, how the minister's office and those working under her authority fail to inform her of the state of first nations and aboriginal communities.

She asked about what's in the flu kits, but we have met with her regional office to share with her—and it has been in the media—what's in the kits, what they cost, and what they're for. To say to the communities that all they need is a bar of soap and everything is going to be fine is not acceptable. We're going to need more than that.

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

You're going to need water.

[Grand Chief Ron Evans]

In order for that to happen....

When I say there's lack of knowledge, many of our communities also have high unemployment rates and poor and overcrowded housing. It's not only overcrowded housing, but those houses are also in a state of disrepair, so it's going to become—

[The Chair, Conservative, Joy Smith]

Thank you, Grand Chief. I'm sorry, but I'm going to be really tough on time.

I'm going now to Monsieur Malo.

[Luc Malo, Bloc, Verchères—Les Patriotes, QC]

Thank you, Madam Chair.

As I was listening to all the presentations, I had the very definite impression that we are dealing here with a persistent and ongoing problem. Today we are talking about the H1N1 flu virus, because that is the greatest risk facing the communities this fall.

However, as Chief Evans was explaining, living conditions in your communities are such that they run the risk of being seriously affected by this disease, as well as others. There is reason to wonder today why action has not been taken to improve those living conditions over time. That would have meant that, in dealing with a possible H1N1 pandemic, the communities would have been better equipped at the grassroots level to deal with the situation.

A littler earlier, my colleague was asking officials what the current situation is with respect to access to water. At this time, it is expected that tanks will be delivered to certain communities that do not have access to water. That resolves one issue at a very specific moment in time, but it does not solve the long-term problem. And, it is a problem that can become critical when we are talking about a disease that is likely to affect the community.

Ms. Turner said that, in the short term, the only tool available to them to deal with the H1N1 virus is the vaccine. As for the other issues, unfortunately, it is too late to deal with them before the fall. Is it your sense that, right now, the real priority is to ensure that everyone has access to the vaccine?

[The Chair, Conservative, Joy Smith]

Who would like to answer that? We only have two minutes left.

Grand Chief Ron Evans.

[Grand Chief Ron Evans]

Yes, I would agree that we do need vaccines, but more importantly, we need to ensure that the plans can be tested. We don't have a plan that has been tested. We don't know what to do with transportation if there are no supplies and weather is poor. What happens if we need additional space because of the lack of infrastructure? What do we do if we need more nurses or more physicians? We have not tested any of these plans simply because we don't have the resources to do so.

[The Chair, Conservative, Joy Smith]

National Chief Atleo.

[Chief Shawn Atleo]

I think this is a really critical point. It's about not always looking just at treating the symptoms when the underlying causes are being avoided. It's that notion that wealthy is equal to healthy, more generally. And building on the grand chief's comments once again, it's also important to recognize that we would be having a similar conversation, I would expect--I would be looking to the experts to confirm--if we were talking about third world countries. Well, this is in Canada, and that's the reason I so strongly support all of the sentiments that have been expressed.

Also, Vice Chief Deranger talked about the PA grand council, which has been putting plans and efforts in place. What's required is to recognize that this is where good health planning can and should occur, to recognize the treaty jurisdiction, and to make sure those efforts are recognized and supported.

[The Chair, Conservative, Joy Smith]

Thank you very much, Monsieur Malo.

We'll now go to Ms. Wasylycia-Leis.

[Judy Wasylycia-Leis, NDP, Winnipeg North, MB]

Thank you, Madam Chair.

Clearly, we're talking about some long-term issues as well as short-term band-aid solutions to a possible pandemic this fall.

Let me start with you, Dr. Kettner. You said you thought things were progressing in terms of preparations for the possible pandemic, but that the best way to prevent the spread of this H1N1 is good health. What do you suggest we do with that, as a committee, in terms of the big issues that you and others have raised here today?

[Dr. Joel Kettner]

If we're talking about the pandemic H1N1 influenza, just to be clear, there is a whole set of strategies and actions that are needed to reduce the morbidity and mortality that we may anticipate from the next wave of this. Good health, being as healthy as you can, having your chronic medical conditions well looked after, knowing about measures to reduce the spread of disease, all of these things are important. And it's useful to divide them into two categories.

One is reducing the probability of getting exposed to the virus, and that has to do with crowded housing, handwashing, knowing how to conduct yourself in social settings to reduce the risk of exposing others to the virus. So there's that whole category.

But it's a different question from the question of, if you do get the flu--and we have to expect that many of us, no matter where we live, are going to be exposed to the flu; it's a very difficult virus to contain--who's more likely to have severe disease and need intensive care and die? It's a really important question. That has more to do with chronic health conditions—we've talked about that already—it has to do with getting appropriate and timely care if you are in that very small percentage of people who go on to get pneumonia or severe complications. For those people who we think we can help with early use of antivirals when they first get even mild symptoms, if they have those risk conditions, it means having access to that. And it means, on both sides of the table, an educated, enlightened public who know when to access health services and a ready health system that's there to receive them and give them appropriate care.

I could speak more about what some of those dimensions are, but I wouldn't want to oversimplify the issue to be either one of prevention or one of treatment. It's really a combination of both.

[Judy Wasylycia-Leis, NDP, Winnipeg North, MB]

Thank you. And I think that's what Gail Turner was saying as well, that it might be too late in terms of dealing with the long-term systemic issues for this possible pandemic, but we'd sure better use our heads and start planning in the future.

[Gail Turner]

Can I comment?

[The Chair, Conservative, Joy Smith]

Yes, please, Ms. Turner.

[Gail Turner]

I think it varies across Inuit regions as well. I live at the top of the province of Newfoundland and Labrador, and on a good day, without H1N1, we have no capacity. We have no hospital beds; we have one anesthetist, so additional ventilators won't really help us; and of course we always have the challenge of geography and weather. We don't know yet how we are going to immunize in our communities. Because we're an Inuit land claim within a province, we don't fall under the same umbrella of service of Health Canada as many other places do. They won't be looking to send us additional resources, and so we will have to work ourselves and try to ensure that it is delivered.

[Judy Wasylycia-Leis, NDP, Winnipeg North, MB]

Could I ask National Chief Atleo a question?

First of all, congratulations on your election.

The AFN has recommended funding for a task force to implement annex B, investing, as we just talked about, in first nations communities. On a short-term basis, what do you think about the idea that is now implemented in Manitoba of having a special aboriginal expert coordinating on the pandemic? The person in Manitoba is Dr. Cathy Cook, who's well respected—I'm sure that Grand Chief Ron Evans will comment on this as well—and I'm wondering about that as a national issue and a possibility. Should we do that nationally or should we coordinate with what's happening in Manitoba and Cathy Cook?

[Chief Shawn Atleo]

Actually, because you're talking about Manitoba, I'd like to defer to Grand Chief Evans, and if there is a moment I'll have a quick comment after.

[The Chair, Conservative, Joy Smith]

Actually, we're running out of time right now, so I'd ask, Grand Chief, if you would mind commenting on that for Ms. Wasylycia-Leis.

Thank you, National Chief.

[Grand Chief Ron Evans]

First of all, I want to thank Manitoba for doing what they're doing in terms of working with our communities. But what is needed, in the absence of implementing and working towards the long-term solutions, is to provide the communities the resources to start training whoever will be needed, whether it's the nurses or whether it's the caregivers, and the resources for putting their plans in place for the additional space they're going to need. Preparing for the worst case, that's what we need to do. We have to test those plans in terms of the transportation and how we get more vaccines and who gets vaccinated. How soon we can do all those things, that's what we need to do right now.

Thank you.

[The Chair, Conservative, Joy Smith]

Thank you, Grand Chief.

We'll now go to Dr. Carrie, who will share his time with Mr. Clarke.

[Colin Carrie, Conservative, Oshawa, ON]

Given the time, I think maybe Mr. Clarke may not have time with this, but if he does....

I want to say that I agree with the grand chief. I think it's very important that everyone works together and that, as these plans move forward, we do have the opportunity to make sure they're tested.

I do have a question, Dr. Kettner, because I understand the Government of Canada and the Province of Manitoba have been working very closely together on the pandemic preparedness for Manitoba first nations communities. I know that Minister Aglukkaq has had many teleconferences with her colleague Minister Oswald. During the first wave we worked together, and we monitored and were able to relocate human health resources such as nursing staff and physicians to those communities most in need. We also coordinated our efforts through tripartite planning tables with the Province of Manitoba and first nations.

I was wondering, would you agree that we do have an effective, collaborative relationship?

[Dr. Joel Kettner]

I love general questions like that.

More so than before.