Health Committee on Aug. 28th, 2009

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

Thank you, Madam Chair.

Thanks very much, Minister, for coming back and speaking with us again on this very important issue. I know that the whole committee, as well as all Canadians, are certainly concerned about it. I'm glad to see that we are progressing as quickly as we are and as successfully as we are.

One of the things that I was really pleased to hear you say in your opening remarks, Minister, was your step-by-step rationale for going through what's happening to address the issue of the H1N1. You talked about understanding how it spreads, who are the most vulnerable, recognizing those things, and making sure there is a plan in place and recognizing what that plan is: communicating to the public, collaborating with the territories and provinces, and the international aspect of the whole thing. I think all of those things are very good, and I think they are what is going to make this H1N1 issue manageable for this country.

I certainly don't have experience in pandemic planning, but as a municipal mayor for many years, I've had many courses on emergency planning and the role of the different levels of government. I think it's critical that we are able to collaborate and that everybody understands what their role is, because this isn't a federal problem, this is a problem at every level of government. Whether it is the municipal, provincial, or federal level, I think it's something wherein everybody has to understand what their role is and they have to clearly be able to implement their role. So I think it's good that we're talking today and we're talking in particular on first nations issues and the issues as they may apply specifically to those areas.

One thing you talked about was communication with the public. Although I didn't jot it down, I thought I heard you say in your remarks that you were doing some first nations publications. If I did, could you elaborate on that and tell me a little bit more about how that's happening, and how they're being distributed, who it goes to, and how the people in the first nations areas can access those publications?

[Leona Aglukkaq, Conservative, Nunavut, NU]

Thank you for that.

I'll start off and then I'll pass it on to my officials.

First of all, in terms of communications since April, early on there was daily communication with the Canadian population in terms of what we were learning about H1N1. The information I had is what I had shared with Canadians on a daily basis as we were dealing with H1N1 from April on. As we learned more about it, that changed to a weekly national media release to get that type of information out.

What was key in getting the information to communities was understanding what H1N1 was. How is it spread? How can you prevent it? That information was essential in terms of developing our communication strategy as we went forward to prevent the spread of it. As we're dealing with the fall, the information that we're going to gather in Winnipeg this week in terms of studying the cases that we have seen in this country, the more severe cases, the deaths, and what some of the underlying conditions were, that will further shape how we communicate to Canadians in the fall about who should be vaccinated and, if you're in one of these risk groups, to encourage you to get the vaccination. That information is essential for the fall, in addition to the prevention piece.

The other piece is to get vaccinated. That is key in managing this process in the fall. That will play into this, and we'll be communicating it to communities through the radio stations, through APTN, as an example, and aboriginal papers.

The other thing I said to my staff is that it has to be in the aboriginal languages. We have to get the information out in a language people can read. In Nunavut it's Inuktitut Inuinnaqtun, in the Northwest Territories it's Inuvialuktun, and there are the first nations communities as well. That will be key as we go forward in the fall in developing and managing the pandemic.

Perhaps you want to elaborate in terms of which organizations receive the information on that.

[Shelagh Jane Woods]

I'll give you the perspective from the officials' point of view. The preoccupation of our regional offices is always to make sure that our nursing stations and the staff at the stations, whether these are run by Health Canada or first nations, have the most up-to-date information from the provinces, because we operate as though we're under provincial jurisdiction. Of course, nurses and doctors are licensed in the jurisdiction where they're working. So we make sure we're passing along or facilitating the flow of all of the guidelines and those kinds of things from provincial authorities that are absolutely critical for the medical staff to have.

In addition, at the very beginning we did a large mail-out from headquarters to first nations communities to help build awareness so they knew what was going on. Of course, we work very, very closely with the Public Health Agency in all of these endeavours. We know how important these are. And of course, we've also made first nations aware of the website, fightflu.ca, for those who can gain access.

Our regional offices take this very seriously. Their perspective, which we share, is that you cannot over-communicate, so it's much better to bombard people with legible, understandable materials than to risk missing somebody. So that's the approach we've taken.

[The Chair, Conservative, Joy Smith]

Thank you.

Now we'll go to Monsieur Dufour.

[Nicolas Dufour, Bloc, Repentigny, QC]

Thank you very much, Madam Chair. I would like to thank our witnesses, as well as the Minister, for being with us today.

In terms of the relationship between First Nations and the H1N1 virus, I believe the problem goes much deeper than that. Right at the outset, you indicated that there is an issue in terms of the social groups that were most affected. We are talking about people between the age of 16 and 25—the Aboriginal population is younger, on average, than the rest of the Canadian population—pregnant women and people with chronic diseases.

You mentioned something several times that caught my attention: access to water and basic sanitation in First Nations communities. Some communities—for instance, some north of the Abitibi region, in Quebec—live in third world conditions. They have an issue with access to drinking water. So, it is all well and good to engage in extensive awareness campaigns to try and prevent problems, but there is a serious lack of facilities in these communities. They do not have the basic things that would allow them to adequately protect themselves against H1N1 flu. It's fine to tell them what they have to do in terms of prevention and how to prepare themselves, but if they don't have access to those basic things, it will not amount to much.

I would like to know whether the federal government intends to do something in that area.

[Leona Aglukkaq, Conservative, Nunavut, NU]

I'll start off.

In terms of the drinking water, the Department of Indian and Northern Affairs has provided water to some first nations communities, and we can elaborate a bit more on that. But there are some functions that fall within another ministry, whether they be housing or roads or water. So I will have my staff respond on how we are working with Indian and Northern Affairs Canada in responding to those challenges in remote communities.

[Dr. David Butler-Jones]

Shelagh, go ahead.

[Shelagh Jane Woods]

Well, not to wear you down with all of the bureaucratic details, we are working very, very closely with the Department of Indian and Northern Affairs. We have identified some of the water issues to them and are providing our best public health advice. They make a distinction between access to drinking water and access to water; you can wash your hands in boiled water, if you have to, and that kind of thing.

They're critically aware of it. They have a plan with us to make sure that all communities will have access to the water they need before the flu season starts.

[Nicolas Dufour, Bloc, Repentigny, QC]

Dr. Butler-Jones, would you like to comment?

[Dr. David Butler-Jones]

We know that some communities are facing major challenges. However, the government has invested in housing construction, which is a long-term solution.

As Ms. Woods was saying, access to water in the communities falls within the purview of the Department of Indian and Northern Affairs. That is another factor in the context of this pandemic. The long-term solutions are a major challenge for everyone.

[Nicolas Dufour, Bloc, Repentigny, QC]

Madam Chair--

[Shelagh Jane Woods]

Could I just add something?

The Department of Indian and Northern Affairs uses cisterns, or mini cisterns, when the situation is urgent. That is a significant part of our plan.

[Nicolas Dufour, Bloc, Repentigny, QC]

Do I still have a few seconds?

[The Chair, Conservative, Joy Smith]

I'm sorry, you only have 30 seconds left. If you can do that in 30 seconds, Monsieur Dufour, go ahead.

[Nicolas Dufour, Bloc, Repentigny, QC]

Will there be enough nurses to deal with the pandemic, if it comes to be?

[Shelagh Jane Woods]

It's a very difficult question to answer. We will do our best.

If I understood your question well on whether we will have enough nurses, we will do everything we can. We talked about the urgent need sometimes to reallocate. We are also trying to identify and work with as many partners as possible to see if we can even use retired nurses in limited circumstances, and any help we can get, as long as we are respectful of nursing qualifications.

[The Chair, Conservative, Joy Smith]

Thank you, Ms. Woods.

We'll now go to Ms. McLeod.

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

Thank you, Madam Chair.

Thank you for coming today.

First of all, I think we were really lucky to have had SARS and to have created the plan, which is being implemented. Of course, there's always room.... And we're fortunate to have a little bit of time to be looking at our plan and making sure things are in order.

I have a few thoughts and questions, but I think we are underestimating what's already been done. For example, in my local newspaper there were articles every day this week saying that the school board was prepared, that the university was prepared, etc. My background is in health care, and we have worked with our aboriginal communities over the last three or four years in creating pandemic plans. So we have some details, but I think we are really making great, great strides.

I have a couple of more technical questions, whether for Ms. Woods or the minister.

You alluded to transferred bands and a number of different models. Of course, some bands are completely transferred. We look in British Columbia, where within our regional health authority we have a very, very strong connection between all of our aboriginal communities and our public health system. So it would be interesting to hear if there is any difference in how Health Canada deals with the different bands, depending on the relationship. It would be nice to understand a bit more in terms of whether it depends on the on-reserve structure.

[Shelagh Jane Woods]

Sure, I'd be happy to try to answer that one.

We make no distinction in the case of an emergency. So when we ordered pandemic supplies, it wasn't as if we ordered pandemic supplies only for the communities where the nursing stations were operated by Health Canada. There is no distinction when it comes to that level. An emergency is an emergency, and everyone has to be well supplied. We work very closely with the transferred communities.

I think one of the things I failed to mention this afternoon is how important it is to make sure the first nations and the provinces are working together. You referenced B.C., but I know of lots of cases in all of the regions. I know Dr. Kettner is here, and we've done a lot of work with Dr. Kettner and Manitoba Health and Healthy Living with the first nations to make sure we're all in the same circle.

So the short answer—and I've never given a short answer in my life—is no, we don't treat them differently.

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

So it would actually be an interesting experiment at the end to see, in the provinces that had a more direct relationship, how the planning went. But that's for later.

I'm a nurse by background. We're talking about capacity of nurses and we talked about training home care nurses. In terms of giving a vaccine, are there not other people we can train to be immunizing, with nurses in charge of clinics?

[Shelagh Jane Woods]

Well, home care nurses are nurses. We're just making--

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

No, others.

[Shelagh Jane Woods]

Oh, others. Yes, certainly. We're combing every inventory to try to find other people, but also to find other people who can support the nurses, so that they can take some of the workload away from the nurses. Also, on the vaccine side, if you're particularly interested in the vaccination, at headquarters we're trying to form a couple of special teams from the medical personnel who happen to work with us, so that they would be able to go out to communities and help to blitz immunization clinics.

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

Obviously you use the expertise of the nurses, but many, many people can technically give a needle. So I think we have ways to build capacity.

[Dr. David Butler-Jones]

Certainly when you look across the country, each jurisdiction is a little bit different. For example, in Ontario I used to use licensed practical nurses, under the supervision of RNs and PHNs, to deliver the routine vaccine programs, and they can be mobilized.

I just got a letter from the Canadian Veterinary Medical Association. They give immunizations all the time, to a different species from us, but again, they have the skill, and with the right information, as Shelagh Jane is referencing, we have other supports there. We actually have a lot of experience with large mass clinics in different settings and having the supports there, so that the nurses can focus on what they need to do, answering questions, getting the immunizations done. There are nursing students, medical students, a whole range of people who are being looked at, and as I've heard, pharmacists included. All the jurisdictions are actually working together on how we can maximize our ability to immunize quickly, no matter where people are in the country—and clearly, isolated northern communities and others that are going to be a very high priority in terms of getting that done.