It is an honour and a privilege to be here today to present to the standing committee on long-term care on reserve.
My name is Gwen Traverse. I'm the director of health for Pinaymootang First Nation, which is located in Manitoba's Interlake region. I have been a director of health in my community for almost 12 years. Prior to that I was away from my community for 17 years in order to get an education and work experience.
Upon my return and once I had been hired to look after health, one of the first things I noticed was how far back the first nation was in terms of meeting health care needs and how much jurisdiction has played a factor in creating division within health care for first nations. Today I have seen how community-based approaches have positively impacted our community by having services closer to home.
Pinaymootang is a thriving community, especially in the area of health. The community has an overall population of 1,700 on-reserve residents. Pinaymootang Health Centre is a health facility accredited by Accreditation Canada. Pinaymootang is under a five-year block transfer agreement under which transfer was first signed in 1998. Pinaymootang Health provides a variety of health and wellness services to support members of the community as well as surrounding neighbouring communities. Our goal is to operate an on-reserve continuing care facility that meets the needs of our first nations people in the areas of primary care and long-term care. This will allow our first nation members to receive care in a location convenient to their communities and their families, with services delivered in a culturally safe and respectful manner.
Pinaymootang does not have a long-term care facility in the community but is working on a continuum of care to address the range of holistic, medical and social services for those who do not have or who have lost some capacity for self-care.
In 2011, Pinaymootang First Nation, along with the three neighbouring first nation communities of Little Saskatchewan, Dauphin River and Lake St. Martin, were devastated by flood waters. This created many negative impacts for our first nation people physically, emotionally, mentally and spiritually, almost similar to the residual effects of residential schools, of being displaced. We are now slowly seeing repatriation happen after seven long years.
In late 2017, the first nation met with the provincial government on the repatriation priorities and impacts of long-term care. The first nation took the lead in the development of a comprehensive quality health service plan, with feedback from surrounding first nations within the Interlake region to ensure that a common position is identified in priority areas of health care services. Recommendations were provided and we have yet to see action being taken.
As part of repatriation, it has to be recognized that services in the Interlake have changed drastically. Some of the recommendations have included providing culturally safe and respectful services, ensuring retention of health care providers, improving access to comprehensive mental health and addiction services, improving access to emergency care, broadening the scope and mandate of health centres in first nations, and improving access to dialysis services.
Dialysis services in our area were once operational at full capacity, but since the flooding impacts and provincial budget cuts, we are now seeing many of our people accessing services further out, which causes financial impacts on our first nations.
We have faced many challenges when it comes to long-term care. Through the home and community care program, the palliative care component is now being funded and developed in our region. The communities have been providing palliative care with limited capacity. Respite services are very limited on reserve due to human resource capacity, lack of facilities in order to meet the need, and funding disparities in comparison with provincial systems, which then places the burden of financial care on families who live with limited resources.
There are non-indigenized care facilities near our community, and many times provincial policies dictate a first-bed policy, which can place our first nation's people in facilities that are a greater distance away from their home community and their families.
The home and community care program is a FNIHP-based program that was designed to meet the needs of short-term care nursing care. However, it is now functioning more as chronic care management for diseases and conditions related to issues such as diabetes, cancers and cardiac issues.
The first nations population is also prone to comorbidities. It is very common to have multiple disease conditions within the same person. For example, a person can be living with diabetes, depression, mental illness and cardiac issues. We also recognize that the disease process occurs earlier in our population.
In recent months, Pinaymootang has partnered with a private health firm to provide physician care services in the community. Since the beginning of this fiscal year, we have estimated that a total of 800-plus clients have been seen, and that is only increasing to the point where our human capacity cannot hold up much longer.
Pinaymootang Health Centre provides more of a primary health care service than what we are intended to provide. We recommend that health centres be evaluated based on the primary health care services they provide. We are providing services that are equivalent to a nursing station, yet we are designated and funded as a health centre.
Pinaymootang is filling an obligation to first nations in our area to bring services closer to home. In Pinaymootang we're also leaders in the Jordan's principle approach for the Manitoba region. Prior to the announced funding of Jordan's principle, we were funded under the health service integration fund as a pilot.
Pinaymootang developed a community-based approach program to assist families and children with disabilities. This program was successful in meeting the needs and was recognized as a best practice model with the Canadian Home Care Association. The first nation developed a tool kit guide in a 10-week period for Manitoba region to assist other first nations in developing and implementing their Jordan's principle programs. We have provided service coordination to half of Manitoba's first nations as well as to other regions.
There were also research projects developed in July 2017 by McGill University on the challenges of our first nation members faced in accessing services. To date we still see gaps in service such as the capital to properly facilitate care and the age out process. There is a high expectation that once age out occurs, those under Jordan's principle should transition into home and community care when, in fact, this expectation is unrealistic, given the human resource capacity in first nations and the complex needs of those affected who require long-term supports.
Many families want to take care of their own, and by saying this, we recognize that these initiatives should be grassroots-driven and that expertise should be acknowledged within first nation communities.
In closing, I want to say that Pinaymootang has worked really hard to improve systems in health care and the challenges we face to restore the dignity and pride that is lost. We foresee greater needs and greater demands for service, and we have an obligation to ensure that our most vulnerable are well cared for.
Meegwetch.