Health Committee on Oct. 28th, 2009

[Nicolas Dufour, Bloc, Repentigny, QC]

At our last meeting in August, we talked about the H1N1 crisis and first nations communities. Obviously, there was a deep-seated problem well before the crisis: the level of poverty, which is sometimes extreme. I was not trying to be radical, but I even likened it to the third world. When you see the sheer scope of the problem—the ability of communities to access clean drinking water and the state of certain buildings, for example—one might compare it to the third world, unfortunate as that may be.

I fully agree: the problem goes much deeper and has to do with access to drinking water. Without clean drinking water, a necessity of life, it will be extremely difficult to combat H1N1.

Mr. Evans, I do not mean to rub salt in the wounds, but I admit that I was very surprised by the document you showed us. Unfortunately, the rules of the House prohibit us from handing it out to the other committee members because it has to be translated first. You referred to the document a little bit.

[The Chair, Conservative, Joy Smith]

Monsieur Dufour, can I intercede? We can send it to your office, so we'll do that.

[Nicolas Dufour, Bloc, Repentigny, QC]

Thank you, Madam Chair.

[The Chair, Conservative, Joy Smith]

Thank you.

[Nicolas Dufour, Bloc, Repentigny, QC]

We heard about how the problem was made into a political issue. I am shocked by the information you gave us. Where did it come from, and what is in the document?

[Grand Chief Ron Evans]

Thank you very much for that.

This was brought to our attention by, obviously, those who received it somehow. I guess it's mailed. Of course, I'm not with government; I don't quite understand how these things work. I don't know how your system works, whether it's in two weeks or a month that you may get these things out. Nevertheless, it was brought to our attention. Every time something happens out there that disturbs our people, they bring it to our attention. So that's how we receive information, and then we have to find ways to deal with it.

So we received this just the other day, and then we questioned when it actually happened. The reason we bring it at this time is that our flu kits went out just within the last couple of weeks. On the investigation that was done for the body bags, actually the report came out way before we were sent the flu kits. So we assumed that this came out not too long ago. That's information that is not used for the right purposes, we thought, and so we needed to at least bring to the attention of those who are sending this kind of information out that it's really not acceptable for information to be used for those purposes.

It's a serious issue out there. It really deals with the health of people. It should be about the people first, and politics should not even factor into it. We have a relationship with the provincial government where they helped us with getting the flu kits into the communities. We did it, and then we worked out the logistics after that, and that's the way it should be.

[Nicolas Dufour, Bloc, Repentigny, QC]

Indeed, both opposition parties and the government side are trying to send a clear message that we need to encourage people to get vaccinated and to work together, all politics aside. Unfortunately, however, what you showed us is very counterproductive.

I want to come back to vaccination. According to a number of polls across Canada, a high percentage of Canadians are worried about getting the shot.

Do you have any poll results, statistics or other indications to show where first nations people stand on that? Ms. Anderson touched on it a little earlier, but, in your opinion, do a large percentage of first nations people fear getting vaccinated?

[Grand Chief Ron Evans]

Thank you for that question.

There was a concern initially, but as leaders, the other day in our province the president of Manitoba Metis Federation, David Chartrand; as well as Dr. Kettner, our public health officer in Manitoba; Dr. Postal; I myself; and another health professional took the flu shots. I believe that at least it gave people some confidence in the vaccine themselves. Therefore, the numbers have actually increased in the last few days.

As I've stated, in the community of Cross Lake there were 2,000 vaccinated yesterday. Cross Lake is a population of, I think, 6,000 people, so they're probably just about done today or, if not, in the next few days.

In the communities where this took place, it has really increased in terms of the people coming out to get vaccinated. So we're encouraged by the response and the turnout in the last 24 hours. We're very grateful and pleased to see the turnout in the communities in Manitoba.

[The Chair, Conservative, Joy Smith]

Thank you.

[Nicolas Dufour, Bloc, Repentigny, QC]

I understand. Are there still communities that are unprepared or ill-prepared for vaccination?

[Grand Chief Ron Evans]

No, we've worked very well with the province and the region, with the first nations and Inuit health branch. We have regular meetings, almost daily, just to make sure we're working together cooperatively, to make sure there's a schedule and that we're actually meeting the expectations of the communities as well as ourselves as leadership.

So I certainly feel at this time that what could be done is being done. And we're also beyond that. I think we're going to be able to start moving beyond that to make sure that in the future our communities are much more prepared than they were this past spring.

[The Chair, Conservative, Joy Smith]

Thank you very much, Grand Chief.

We'll now go to Ms. Hughes.

[Carol Hughes, NDP, Algoma—Manitoulin—Kapuskasing, ON]

Hello, and thank you very much for being here. I think it's really important that we hear from you.

Some of your feedback has been quite interesting to me, and you've indicated some of the resources that you need. My riding itself is made up of 17 first nations and very many rural communities, and I understand some of the concerns that are being experienced in the area.

My first question is to you, Chief Ron Evans.

Previously, questions were raised by first nations as to whether health funding arrangements were flexible enough to allow communities to direct program resources in order to address the influenza outbreaks. From talking with some of my first nations communities, I know they've indicated that they have very few resources to redirect and they had difficulty even to have someone as the main key person to deal with H1N1 without additional funding from the federal government.

Given that this would actually be an extraordinary cost to first nations, I'm wondering how it has impacted. Have you been able to get additional dollars from the federal government to deal with this situation instead of dipping into your own resources, whether it is for communications or whether it is to ensure preparedness within the community? Could you elaborate on that aspect?

[Grand Chief Ron Evans]

Thank you for that question.

As chiefs, we've had meetings with INAC officials in the region and we've also had discussions with some of the school divisions, even the band-operated schools, to work out those kinds of details. It's pretty complicated, but we were able to work out solutions at this time. Discussions are being held at this time.

In terms of getting some additional help with funding, we were able to get the support we need to get some coordinators in the communities for each particular region. I think we're getting about 10. It almost touches on what Dr. Anderson said about people focusing all their energies on pandemic preparedness, on planning, and on getting the communities ready so that the information then comes to us. That way we know what we have to bring to the attention of the federal government in terms of what they need to do to fulfill their responsibilities.

[Carol Hughes, NDP, Algoma—Manitoulin—Kapuskasing, ON]

Again, my question is whether you have received a commitment from the federal government that they would be prepared to put additional resources in there for you. Have you?

[Grand Chief Ron Evans]

Yes. We're able to access the resources that we need to begin to do that.

[Carol Hughes, NDP, Algoma—Manitoulin—Kapuskasing, ON]

Okay.

Marcia, did you want to add anything?

[Dr. Marcia Anderson]

One of the organizations that responded to me mentioned that they had put in a $10 million proposal for additional resources to set up their incident command systems and to do the appropriate training, and the only commitment they've had thus far is that they'll have a response soon. That's as much as I know.

[Carol Hughes, NDP, Algoma—Manitoulin—Kapuskasing, ON]

For this response demand, are we talking about medevacs? Are we talking about additional nurses, access to hospitals? I'm trying to get some sense as to whether first nations communities, especially remote first nations communities, actually have additional human resources now to deal with the issues that may come up with regard to their medical needs.

[Dr. Marcia Anderson]

That specific proposal was for four incident command system-related personnel in each community. That would roll up to the regional and provincial level. It didn't address the direct health service delivery needs of those communities.

I do know that the provincial government and the federal government have been talking with the first nations representatives about, for example, the medevacs, which is quite a concerning aspect as we head into winter and freeze-up, but I don't know any more details about that.

[Carol Hughes, NDP, Algoma—Manitoulin—Kapuskasing, ON]

Are there more concerns with regard to rural communities? Both for first nations and for rural communities, has there been an issue with getting the N95 respiratory masks? Are there more barriers there that you feel that we need to look at?

[Dr. John Wootton]

I don't think it's an issue of supplies; it's mostly an issue of manpower. In most rural communities the essential services are covered by people who are working flat out already. If 30% of them are sick, then there will be difficulty covering emergency departments.

I had one note from Golden, which is in the Rockies and gets a lot of accidents off the highway. They have an anesthetist who had to go with a patient on a transfer, and the community had no anesthetist for the time it took to go and come back.

If the pandemic is mostly volume, rural communities will cope better than if the pandemic produces a lot of very ill people. That is where the rubber is going to hit the road. If there are very ill people, and the people looking after them are ill, they're going to run short and have to stop doing other things that are critical. That's the scenario that is most worrisome.

To give a personal observation from my rural community so far, Cecelia Li and I ran a flu clinic this morning to keep people away from the emergency department. Most of what we saw was anxiety, not H1N1. There's a great deal of reassurance that's required.

If people do the self-help and stay home unless they're critically ill, the volume should be manageable. However, if people get very sick, they're going to come to the facilities. It's the coping capacity of those facilities that will be stretched, and I have not heard of their getting any extra resources to do it. In fact, they're probably getting more work added to existing resources.

[The Chair, Conservative, Joy Smith]

Thank you, Dr. Wootton.

We'll now go to Mrs. McLeod.

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

Thank you, Madam Chair.

I'd like to thank all the speakers.

The rural, aboriginal...how things are happening in terms of dealing with H1N1 is extremely important to us, as a health committee.

I'm a new member of Parliament. I've been here for one year now. I know that politics has some rough and tumble to it, but I always thought there was a boundary of what is appropriate. What you indicated today is quite nauseating to me. I feel quite sickened for us, as parliamentarians. Not only is an apology in order for the House, but I think it's more important for first nations communities in Canada. For me it is a very shocking and sickening exhibition of what politicians do.

Having said that, I think we should head into more informed kinds of questions.

My first question is to Dr. Anderson. We talked earlier about the different provincial and federal government responsibilities, and off-reserve first nations typically fall under the jurisdiction of the province. I know in my province they're working very hard to reach out to that group. I'm wondering if your organization is supporting the provinces in any way with that off-reserve work.

That would be my first question.

[Dr. Marcia Anderson]

We have not, to date, played that role. We have encouraged representative organizations, for example, the northern and southern chiefs in Manitoba, who have played that role quite well. We would be willing to have an enhanced role in the H1N1 response, and we have offered to work particularly with the Government of Manitoba, since that's where I'm located, in this and other ways as well. I do think that professional organizations like our own, and the Aboriginal Nurses Association of Canada, for example, could have a strong role to play there, but we have not done so to date.