Health Committee on Oct. 28th, 2009

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

Thank you.

We've heard from Dr. Wootton, and he indicated he brought a student who might have fresh eyes and thinking.

Would she feel comfortable sharing how it has been for her, or what she's seeing?

[Cecelia Li, Medical Student, McGill University, Society of Rural Physicians of Canada]

I'm unfamiliar with the situations in Manitoba and first nations communities. Being a McGill medical student and coming from downtown Montreal to Shawville--and I've been here for about a week now--I agree with what Dr. Wootton said previously.

One of the things I see, for sure, is that in terms of the resources, I don't see a lack of supply in, say, the number of masks or the number of hand sanitizers available. It's mainly about staff. I think there's definitely a shortage of staff relative to the number of patients we need to serve. In case of a serious pandemic occurring in the hospital, that would be a major problem.

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

I guess my next question is, in this extraordinary time, do we have medical students jumping into clinics en masse? Are we really seeing a mobilization of some of our resources that perhaps wouldn't typically be used?

Dr. Wootton.

[John Wootton]

Mostly we're trying to pull all the retired nurses back into the fray.

Already in rural Canada, when we have residents and students, we give them a lot of responsibility, so they certainly take some of the load that is appropriate to their level of training. The Society of Rural Physicians really tries to take the long view on all of this. This is a crisis this fall, but what's really important is what happens over the next 10 years in rural communities with respect to their health human resources. This isn't the first and won't be the last type of crisis that stretches the human resources on the ground, and if those are very marginal to begin with, it will be a matter of lurching from crisis to crisis.

The society really has an interest in developing strategies to increase the interest in rural Canada, to increase the level of training that occurs in rural Canada. I must say, actually, we've been fairly successful over the last 10 years in promoting things like the new medical school in Sudbury and Thunder Bay. Those are the things that are going to pay off in the long run, and we have to keep our eye on the ball and make sure we do more of that.

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

I do know that we have embarked on a health human resource study, and I think we will perhaps be able to take some of the lessons learned from this particular pandemic crisis that will also help inform the work of our health human resources, for sure. I appreciate your comments about the longer term.

Do I have time left?

[The Chair, Conservative, Joy Smith]

You barely have time. I'm going to cut you off very shortly, Ms. McLeod. You have about 15 seconds.

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

Okay.

[The Chair, Conservative, Joy Smith]

Thank you.

We'll now go to Dr. Bennett.

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

I only want to repeat what Rob Oliphant said, that granted we really did believe we were repeating what had been said to us from your communities when we were in Manitoba in June, and then at the AFN in Calgary in July, in their request for flu kits and request for real resources, again kitimâkan, which I think is Cree for “I'm sorry”. We would never do anything to offend.

We did believe that raising attention for the really dire needs that we saw when we were there was uppermost in our minds. You need resources. It's inexcusable in terms of the overcrowding, the lack of water, the things that we know, and the fact that you've been told to wash your hands or take a bar of soap.... I mean, I think we felt that we were repeating what had been said by your people. If that is not the case, then that shouldn't have happened.

What I really want to know is this. From the time we met in Calgary at the AFN not only did you have some very serious concerns about resources, but I think Mr. Sanderson had some concerns about the scope of practice of the nurses in the various nursing units and health centres. Has that been rectified?

[Grand Chief Ron Evans]

May I respond first, please?

Yes, the last time I was here I did express our disappointment with the way the federal government was responding at the time. They didn't know what was in the flu kits, and I believe that's on record.

I do thank all those who made a contribution towards raising the issue of the need to look at making the first nations, the aboriginal people, a priority when it comes dealing with the H1N1 pandemic. We certainly want to thank all those who did that for us. The only concern...and I do thank you for doing what you did. It just didn't sit well, the way it was done, and I had to express that on behalf of our people who took offence to it. That's merely what I'm doing here.

Also, as I mentioned, some of the information was not correct. The flu kits were something the AMC did. I didn't think we would want to give credit to the federal government for something that we did, right?

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

Grand Chief, that's what we were hoping for, that the federal government would have done that in July. That's what we were asking.

[Grand Chief Ron Evans]

In the information, you should use as much fact as you can. The body bag issue was dealt with, and I think we accepted the report. We understood what happened there.

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

I promise you that this went out before the results of the report.

[Grand Chief Ron Evans]

Well, we didn't know that. We don't know that. That's why we brought it to the attention--

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

That's fine.

[Grand Chief Ron Evans]

Glen, is there anything you want to add?

[Glen Sanderson, Senior Policy Analyst, Assembly of Manitoba Chiefs]

In terms of your question regarding the skilful work, there still is an issue and it will likely be an issue for quite some time. The grand chief alluded to it in his comments earlier. There are 37 health centres in Manitoba that do not provide primary care. The only primary care that you have access to is usually an hour or an hour and a half drive away. Now, if you have no access to a vehicle in terms of an emergency.... The health centre is open from 8 a.m. until 5 p.m., and after it's closed, there is no access to primary care at all. If you have no vehicle, you can't get out. And we deal with a lot of poverty in our communities.

Is it okay if I answer some of Carol Hughes' questions?

We received a letter in the early part of June from Jim Wolfe in the regional office of the first nations and Inuit health branch. He directed our first nations to move their health dollars from what we have--a native alcohol drug abuse program and Brighter Futures--into pandemic planning and pandemic resources. But what it does is leave a gap in service--a huge gap. This is why we were continuously looking for more moneys for pandemic planners.

In terms of that, we submitted a proposal to the first nations and Inuit health branch. We have a preliminary response from them to employ 19 pandemic coordinators. What they would do is primarily finish writing the plans in the communities. There is not a lot of capacity in the community to do a lot of these plans, so we want to make sure we provide that resource to them as well.

In terms of medical services and supplies to the communities, the algorithms that are provided to us by the provinces.... We have supplies in the community. If we run out of supplies, they are immediately restocked by the province if we need them. So we have all those agreements in place in terms of supplies for H1N1 masks, and for whatever else we need--gowns and everything else that would be required in a nursing station for primary care. Those supplies are available to us probably within 24 hours. It's one phone call, and within 24 hours they should be in our communities. So all of those systems are in place.

We've been involved within the tripartite committee in Manitoba since the early part of the spring. As soon as the outbreak started, we were involved in the tripartite committee, where the first nations and Inuit health branch sits, INAC, the southern chiefs' organizations, as well as the Manitoba northern chiefs. And we voice our concerns. We advocate for the needs of our communities.

Many of them are being addressed in terms of the medevacs. We supported the move to a central dispatch service. Generally how it happened in the communities is the nurses themselves would make a phone call to several carriers, several service providers, and they would have one of them come in, the one that would come in the quickest. But what we've done is take that extra duty away from the nurses. We've agreed to make sure that it was centrally dispatched out of Brandon, Manitoba. All the nurses do is make one call to the dispatch centre, and then they take care of the rest. And they can continue to do their primary care in the community. So those kinds of things have been put in place.

In terms of the staffing in some of our communities, I can give you an example. There should be a contingent of about eight nurses in that community, based on the population, the need, and the service that is being provided there. They would only have maybe eight. I mean, we require eight; they're usually staffed with six. We're always understaffed. That's not a question. We are always understaffed.

As for the call from the northern medical unit in Manitoba, it's a provincial initiative. They made the call. If we need nurses on the ground, they will find the nurses for us fairly quickly. Usually within 24 hours, we should have a response and have people out there fairly quickly, both nurses and doctors.

In terms of the kits, we did a lot of fundraising for those kits, and they were designed to be the first line of defence right in the home. We finished delivering all of them last week to every single household in Manitoba. And we're very, very proud of that.

[The Chair, Conservative, Joy Smith]

Thank you so much, Mr. Sanderson. This is some very good news.

Now, Dr. Carrie.

[Colin Carrie, Conservative, Oshawa, ON]

Thank you very much, Madam Chair.

I want to thank the witnesses for being here, particularly Grand Chief Evans, although I do want to disagree with you, sir, on one statement you made. You said you're just a first nations leader. Well, I think you're an excellent example of a leader, and I think all of us around the table could learn from you.

When you came before us in August, you brought forward your community's interests and you brought them forward very articulately. I think the governments involved have done their best to respond, and I want to commend you for working together and throwing yourself out there in front of the nation for your people. I know that's not an easy thing to do.

I know you've worked very hard to get proper information out to your people, and that's why I must say I share your disgust and I'm very upset with the document that you showed the committee today. I want to ask the chair to make copies available to all committee members.

I feel the committee is supposed to be working in a non-partisan way, especially with something like this. Dr. Bennett, I do hope you apologize to the committee members for this, because I feel this is disgusting. I think the Liberal Party leader should apologize publicly in the House and let us know where these documents were sent. Because if there is any information in there that is misinformation, I think everyone on this committee would like to have that brought forward.

I know the minister is working very hard with all communities and with this challenge we've had of the information changes. As the science changes, we do have difficulty communicating with different communities, particularly first nations and remote communities. As the science has changed, the minister has been very adamant about trying to get the information out as quickly as possible.

I was wondering, sir, at this time if there are any more recommendations you could make to Health Canada in regard to communicating better with the first nations community. Now that we're into the second wave, are there things we could do better at the community level?

[Grand Chief Ron Evans]

Thank you, first of all, for your encouraging comments. I take them to heart and I want to thank you for that.

As to what could be done further, because of our appearance here the first time and the things that have happened, a lot of things have improved in terms of communication, in terms of awareness of the H1N1 virus and the seriousness of it and the need to address those issues.

We're going into the second wave. As I've reported in my presentation of the things we have done, but more so because of the 19 pandemic coordinators Glen has mentioned, we're going to be able to really have the plans in place to be very effective in preparing for other pandemics.

This is a wake-up call for all of us, but more so for the first nations, about the need to prepare. We had talked about pandemic preparedness before the H1N1 outbreak, and I don't know many people really believed there'd be such a thing as a pandemic outbreak, but now we're going through that experience.

In terms of the future, what we're learning from all this is the need to deal with those issues that make us vulnerable. I hope those things are not lost once we all come through this pandemic outbreak, through the second wave. Once we're out of it, I hope we can continue to focus on the need to deal with those issues that make us the most vulnerable when it comes to pandemic outbreaks. But not only that, we need to have the federal government and the governments work with first nations in the way we're actually working with governments at this time with this H1N1 outbreak. If we keep that kind of cooperative working relationship, I think we can deal with those issues.

[Colin Carrie, Conservative, Oshawa, ON]

When you were here last, we heard from Health Canada that 90% of first nations had a pandemic plan, and I was wondering—

[The Chair, Conservative, Joy Smith]

I'm so sorry, Dr. Carrie, I have to be fair. Your time is up.

Monsieur Malo.

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

Thank you very much, Madam Chair.

I want to thank the witnesses for being here this afternoon.

Ms. Anderson, could you tell us how many members your association has, and whether all of them plan to get the H1N1 flu shot?

[Dr. Marcia Anderson]

I can answer part of that question. We have--

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

You can give me their names, but you cannot answer my second question?