Thank you.
Monsieur Malo, please.
Evidence of meeting #36 for Health in the 40th Parliament, 2nd Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was supplies.
A recording is available from Parliament.
Evidence of meeting #36 for Health in the 40th Parliament, 2nd Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was supplies.
A recording is available from Parliament.
3:50 p.m.
Bloc
Luc Malo Bloc Verchères—Les Patriotes, QC
Thank you very much, Madam Chair.
Thank you for coming here today.
You concluded that Health Canada should be instituting stricter centralized controls within the procurement process for body bags. You said that you realized that the members of the nursing staff on the ground are the most qualified to assess the general needs.
Does that mean that, at present, there is no regular communication between the individual who places the order and the individual who ships the order? In your conclusion, you discuss body bags only. Wouldn't it be a good idea to have a more regular, ongoing communication for all supplies? I have the impression that this was what was missing in this case.
3:50 p.m.
Deputy Minister, Department of Health
Thank you for this question, which is very pertinent.
I think that a distinction has to be made. We have a principle which, generally speaking, is good and should remain. For most medical supplies, the nurse working in the field is in the best position to use her judgment when placing orders. There are certain exceptions. Drugs, narcotics, for example, are an exception and we already monitor such items very closely.
Up until now, the body bags have not been an exception. This was not an item that we ordered on a regular basis, because there was very little requirement for it. In some instances, there are other resources available, such as the RCMP. If the reserve is quite close to one of these detachments, the RCMP may have these items.
I personally learned something from this investigation: for cultural reasons, this order raised the alarm in the community. We respect that. We need to add a new exception to this principle where we leave it up to the nurses to decide when this type of product should be ordered.
You mentioned something else. There appears to be a lack of control. I agree with you, that is another aspect. And perhaps there is a certain lack of communication. Once again, there is no ill-will involved. As for products such as controlled drugs, there is communication, control and stringent restrictions.
We need to have a system, and we are in the process of implementing one, although it has yet to be completed. I have made this recommendation in the report. We are going to be doing this to avoid a repetition of this incident, and that will involve the nurses, the employees at the regional head office in Winnipeg, and others if necessary.
We learned another thing. Not only do we probably need better communication between the employees of Health Canada who are in the first nations communities and the Health Canada employees in Winnipeg, but we also have to think about the need to involve the first nations.
3:50 p.m.
Bloc
Luc Malo Bloc Verchères—Les Patriotes, QC
Indeed, they are the ones who are most affected by the situation and should be the first ones to be consulted in establishing this list of sensitive material.
Since today's meeting is to some extent a replacement for our weekly more general update meeting on the flu situation, could you tell us—because I know that you went to Mexico as part of a meeting between the United States and Mexico—what conclusions you were able to draw from this visit?
3:55 p.m.
Deputy Minister, Department of Health
Yes, thank you.
I was in Winnipeg on Friday, I went to Mexico Sunday morning and I came back Monday evening. We had a brief but useful meeting with the Americans.
The Under Secretary of the Department of Homeland Security—in the United States, this is the department that coordinates these matters, along with officials from other departments, such as the U.S. Health Department—his Mexican counterparts and we currently have a North American pandemic plan that dates back to 2007. At that time we were preparing for avian flu rather than H1N1.
The purpose of the meeting was to reconfirm or even modify certain coordination mechanisms between the three North American partners—mechanisms pertaining to such things as animal health, access to laboratories, coordination and communication.
We concluded as a result of this meeting that we needed to re-establish and perhaps change somewhat the composition of certain coordination groups, to have meetings more frequently to exchange information and work better together, because the pandemic knows no borders.
3:55 p.m.
Conservative
The Chair Conservative Joy Smith
Thank you very much. I think we'll have to stop there.
Ms. Wasylycia-Leis.
3:55 p.m.
NDP
Judy Wasylycia-Leis NDP Winnipeg North, MB
Thank you, Madam Chairperson, and thanks to both of you for being here today. The primary reason we've gathered is to discuss the important incident that happened on September 16. You brought us a report today. I think the whole way in which this issue was handled gets at the deeper problem and the reason this became such a headline in the first place, and that is poor communication and the need to build relationships between Health Canada, the Public Health Agency, and first nations, Inuit, and Métis people across the land.
This is a report today on October 7, which is more than three weeks after the incident happened, more than two weeks after we got a letter of explanation from Jim Wolfe in Manitoba and an apology, and more than several weeks since first nations people said this is about the lack of regard the federal government has had with respect to their needs and concerns about preparing for a pandemic.
I don't think this incident would ever have happened if there were better relations. It wouldn't happen with friends or familiar partners. I think it happens when people are strangers, when I think Health Canada was treating first nations as strangers, and the report you've delivered today doesn't even get at the root of the problem, which is that communication, that building of a relationship. So it's going to cause anger among the community. Already Chief Knott from Wasagamack has said he's upset with the report. We've got Chief David Harper from MKO saying this is not good enough. They're both calling for an independent investigation. That's unfortunate.
Why couldn't we have found a way to handle this issue in a way that got to the root issues at hand and dealt with it on the spot? There was no need for us to wait for three weeks for this kind of a report that simply says there was an overestimation of the number of body bags required and we're sorry and we're going to put in place ordering procedures and procurement procedures to fix this problem, and not really a word about the fact that this was an affront because these were first nations communities trying to get the attention of government to get some help. They wanted some help preparing flu kits, and ironically this report comes out today, the very day the first nations community, in cooperation with the Manitoba government, has finally been able to send flu kits into all their communities, so they feel some sense of comfort and preparedness in the event this pandemic starts to spread.
So I think the real question to you today is, where is your response to that root cause of the problem? You acknowledged it by signing a protocol three days after the body bag issue. You did that because you knew there were problems, and this protocol promises comprehensive, well-coordinated communication. So you knew that was a problem. It promises enhanced understanding of the unique challenges facing first nations. It promises joint development of culturally appropriate H1N1 public health information. It promises consistent message and information. Today this report disregards all of that; it only hurts and it keeps the wound wide open.
So I think the real question is, what are you going to do to repair the damage and address the real concerns around working together in terms of flu supplies, protective devices, staff on reserves, and how it's going to be paid for? I think they're still all grappling with the fact that they believe priorities will be revised to take money from existing programs in their communities if it's needed in terms of an influenza outbreak. In fact when folks showed us the Jim Wolfe apology letter of September 21, they also showed us his letter of June 17 talking about how there will be flexibility within the funding that goes to first nations communities to divert funds from there in the event of a pandemic. That worries them.
Are there any additional resources? Is there a plan? What has happened with respect to this protocol? What can you point to, and are you prepared to address the negative reaction to the report you've tabled today?
4 p.m.
Deputy Minister, Department of Health
Thank you for your question. Let me try to respond.
There are a number of things that have occurred since this unfortunate incident, I would say, starting with better communication. I'm not going to defend the situation as being optimal. I think everyone recognizes that we have work to do. That's been the case for a long time, and we are doing it.
A number of things have happened since then. The minister was in Manitoba on a couple of occasions. She did meet with Grand Chief Evans and Grand Chief Harper. As I mentioned, I was in Manitoba last Friday for the express purpose of talking to them about the report and asking them whether they thought the report was a fair summary. I don't pretend that the report is a comprehensive treatise on all of the underlying social conditions in first nations, nor do I deny that those are things that governments in Canada need to work on, and we are working on them. In my discussion with the two grand chiefs—and we agreed, we did talk about these issues—we did talk about the desirability and the need for better communication and consultation. We did talk about needing to develop a process that will deal with some of these broader questions, but we also acknowledged that over the course of the immediate future, in terms of the hierarchy of needs, the priority was to focus on preparation for the fall and the possibility of a second wave in northern Manitoba. Those are some of the things we've done.
The other thing we've done, and quite importantly.... The gentleman sitting next to me, Paul Gully, who you know, has been here a number of times since he's been back from Geneva. He is a very well-known and credible Canadian public health official who has spent a number of years at the World Health Organization working on pandemic preparedness. We brought him back to quarterback our efforts with respect to first nations across the country, and I would say that probably he has spent a significant amount of his time in Manitoba and dealing with preparedness in Manitoba.
I'd also say that the minister has reached out—and I give credit to the minister and to the new national chief, Shawn Atleo, who had a number of discussions on the day this broke and subsequently. That led to the signing of the communications protocol. I think that protocol, which is really a little over two weeks old, is something we intend to put into effect. One of the issues—I think Dr. Gully mentioned this last week—was the idea of a virtual summit, an Internet-based summit that would enable preoccupations of first nations broadly around pandemics to be addressed, so that there would be opportunities jointly between ourselves and first nations leadership to answer questions.
So I would say there have been a number of significant steps taken. Is that all? No. Could we do better? Yes, we can always do better. Do we learn from some of our mistakes? Absolutely. It's with that spirit that I try to do my work and that we're going to move on in the future.
4:05 p.m.
Conservative
4:05 p.m.
Conservative
Patricia Davidson Conservative Sarnia—Lambton, ON
Accepted.
Dr. Gully, Mr. Rosenberg, thank you very much for being here with us again today. Dr. Gully, I know we've seen a fair amount of you in the last month or so, and that's good. It's nice to see you here, too, again, Mr. Rosenberg.
I thank you for the presentation you've given us today. Certainly it puts the situation as it occurred in a better perspective. I think that was something that we all needed to understand. We do know from your report that the order was given, that there were a lot of supplies ordered, and perhaps there was an overextension on a fair number of different items in that supply order. I can understand that because I think we're working in extraordinary circumstances. I think everybody is doing the very best they can to try to deal with a situation that they hear on a day-to-day basis can be extremely life-threatening and can increase very rapidly at a minute's notice. So I think the people on the ground are doing the best they can to deal with that.
Ordering in extra supplies when sometimes, as your report says, it takes three or four helicopter flights to get one shipment of supplies into the community would be in my mind a natural thing to do. The last thing you would want with fall and winter coming on would be to be left with no supplies and caught in that situation.
We've heard testimony from different people here today about the nursing staff and what a terrific job they're doing. I think they are, and you certainly have corroborated that. I think they're doing an extraordinary job in these extremely trying times.
You've talked a bit about your meeting with Chief Adams and the Assembly of Manitoba Chiefs and Chief Atleo. You have said they have been good meetings. One thing I would like you to do is talk a bit more about that and the virtual summit that you just mentioned, if you could.
The other thing I want to say is that you feel this was an isolated case but you are reviewing the procedures, and I think that's excellent. I think that's what pandemic planning or any type of emergency planning is all about. There will always be various external forces that nobody expects, and that's why they are emergencies or pandemics. I think that to be able to review this, to review the situation and the policies and procedures that are in place to make the proper changes and address those issues as they happen is good planning. I just wanted to make that statement.
Maybe you could tell us a little bit more about your dealings with the various chiefs and this virtual summit.
4:05 p.m.
Deputy Minister, Department of Health
There were a number of meetings. I don't have them itemized here. The minister met and spoke with Grand Chief Evans and Grand Chief Harper on a number of occasions.
My purpose in going to Winnipeg last week was simply to provide an opportunity, really out of a sense of respect for everybody involved, to look at the report and make comments. On both sides there were some comments. In fact, the comment about the God's River community came from our meeting with the chiefs. They had heard there were a larger number of body bags in God's River. We hadn't and we rechecked.
What is in the report is what I believe to be true, having done due diligence and checked everything as thoroughly as possible. That's all I could really do—do my best and perform due diligence. And we did that.
The conversation dealt not just with the immediate incident but also with some of the surrounding context—the social determinants, the need for better communication, and the desire on all sides to work towards that end. The chiefs showed considerable respect for the work the nurses are doing, which respect I very much share. I took it as a positive meeting and a place from which we can continue to build over the coming weeks as we deal with the event at hand. There is an order of priority to this stuff. We are dealing with a pandemic, but there are also some longer-term issues we need to address.
On the virtual summit, we had a good meeting with National Chief Atleo shortly after he became national chief, together with the minister and other officials from the AFN. We were looking at ways to improve our pandemic planning, and that idea came up. We're all committed to it, and it is now at the design stage.
Paul has been involved in this, and I will ask him to say a few words.
4:10 p.m.
Senior Medical Advisor, Department of Health
I look at the virtual summit as one part of our effort to communicate at all different levels. This was something that the AFN thought would be worth promoting as a means to ensure access to information about pandemic preparedness, about response, and particularly about immunization. We would need to roll this out at the end of October or the beginning of November.
The form is being developed in collaboration with the AFN. There were AFN and Health Canada meetings yesterday, and there will be other meetings tomorrow. There are working groups assigned to this to make sure it happens at that time. It is designed to meet the needs of the first nations, and then to complement communications on pandemic preparedness and prevention. These communications will complement those you will see in the media for Canadians as a whole. We are looking forward to it. The format has yet to be pinned down, but it will be done with the AFN.
4:10 p.m.
Liberal
Joyce Murray Liberal Vancouver Quadra, BC
Thank you, and my thanks to the witnesses for being here.
I have quite a different line of questioning. In your work with the aboriginal communities, is there any financial support for making accessible the traditional prevention and treatment methods for H1N1 that the aboriginal communities have used in the past?
4:10 p.m.
Senior Medical Advisor, Department of Health
I don't believe we've actually put resources towards that. However, I am aware that some communities are incorporating traditional methods of healing into their pandemic preparedness plans. I know that communications have gone on between the regional office in Manitoba and first nations. There are communities that wish to do that.
We're not saying that pandemic preparedness plans have to adhere to a particular template. We recognize that. It is also recognized in the annex of the Canadian pandemic influenza plan that the wishes of first nations communities in this respect should be taken into account. In fact, there will be some reference to traditional healing in future guidelines, which are in preparation right now.
4:15 p.m.
Liberal
Joyce Murray Liberal Vancouver Quadra, BC
Thank you.
The other part that I just wanted to mention is this. I just came back from China with the legislative association, and I heard on the news there that the City of Beijing, which has more than half the population of Canada, has reserved millions of traditional Chinese medicine doses to fight against the flu. So the Beijing municipal government is doing that.
When looking up why they are doing that, I found that traditional Chinese medicine is being widely used to treat H1N1 flu patients in China, according to a senior health official. China so far is the only country worldwide to introduce traditional medicine, TCM, as practised for thousands of years in China. The ministry of health recently released guidelines for treating H1N1 with a combination of western and TCM medicine for primary courses of treatment, and on and on.
Studies and symposia cited in The Lancet, by the WHO, and the ministry of health in China have indicated that a trial and experimental studies of traditional Chinese medicine have achieved a major breakthrough against H1N1.
So I guess my question is that in negotiating with the provinces for cost-sharing and working towards having enough doses of TAMIFLU, of which there may be some shortages, has the health ministry done research on traditional alternatives like TCM to partner with the provinces to help them make these alternatives available to people who can't or won't use some of the conventional treatments for H1N1?
4:15 p.m.
Senior Medical Advisor, Department of Health
Thank you for the question.
In terms of supplies of western medicine being available—antivirals, for example—we feel there are sufficient supplies available, and these have in fact been pre-positioned in the communities that need them. Estimates have been made to determine the amounts that should be pre-positioned given what we know about H1N1 right now.
That's not to say one would not want to take into account utilization of traditional medicine. I would suggest that the traditional medicine first nations may wish to use may be quite different from that available in China. We'd want to ensure there were practitioners, presumably in China, who would know the particular circumstances in which to use Chinese traditional medicine. So I think we would be very open to assist if communities wished to use those. I think we would want to make sure there wasn't an interaction between traditional medicines...because there have been instances in the past of western medicine in fact interfering with traditional medicine, or the other way around.
The challenge is actually to do clinical trials for those kinds of medicines. In fact one needs large numbers of people in a very controlled clinical trial, and that's not something one can do in the short term considering the number of cases of H1N1 we have. Maybe China has large numbers of cases on which it could actually do research, but in the short term, we're promoting and trying to combine as much as possible the utilization of traditional medicine—if in fact there are practitioners available in the community. People have to be fully informed as to what is available.
4:15 p.m.
Senior Medical Advisor, Department of Health
I was talking about first nations in particular.
4:15 p.m.
Conservative
