Indigenous and Northern Affairs Committee on May 22nd, 2020

[The Chair, Liberal, Bob Bratina]

I'm sorry to interrupt, but we're well past time.

We have to suspend our meeting now in order to prepare for the next panel. I also need to get these musical instruments out of my headset.

To all our witnesses, thank you so much for the testimony that you brought. It was captured by our analysts and will appear in our report.

Without my gavel, I'll temporarily suspend this meeting to prepare for the next round.

Thank you.

[The Chair, Liberal, Bob Bratina]

Okay, folks. My very strange audio problem seems to have been resolved.

We can now turn to our guests. From the First Nations Health Authority, the speakers will be Richard Jock, the interim chief executive officer, and Dr. Shannon McDonald, the acting deputy chief medical officer. From the First Nations Health Council, Chief Charlene Belleau will join us.

Mr. Jock or Dr. McDonald, please go ahead with your five-minute presentation.

[Richard Jock, Interim Chief Executive Officer, First Nations Health Authority]

Thank you for the opportunity to speak to you today.

We will provide a brief summary of the document we have provided which will give you greater context. We are, of course, very interested in questions.

One of the things I want to focus on is that our response to the pandemic is characterized by our partnership with both the federal government and provincial government. Further, there are additional partnerships that exist with each of the five regional health authorities within the province of B.C. This, I would say, is a unique situation in Canada for first nations, and our response and our ability to respond have benefited from those partnerships and relationships.

One of the things I would use as an illustration is that as we have moved into the COVID response, one of the innovations that has been developed is the first nations virtual doctor of the day. This was done by working with the rural and remote coordinating committee, which is a subcommittee of physicians in B.C., with our First Nations Health Authority staff in partnership, and then working with the Ministry of Health in terms of using primary care resources to carry out this important innovation.

This has enabled us to provide primary care services in contexts where no longer have physicians been able to travel into rural and remote communities. This is an example of how we've pivoted our services in the midst of COVID response. Similarly, we are doing mental health services, even including traditional healers and other cultural supports through this mechanism.

I would use as a further example that we have developed partnerships with groups, like the Red Cross, which are also part of our readiness and ability to deploy resources such as volunteers to meet our anticipated surges.

These are some of our partners.

One of the challenges we have worked through in our tripartite approach are the PPE issues. Obviously, this is a global issue, but we've been able to address and develop mechanisms for distribution so that we are covering some of the basic needs. However, I would say that there is much to do on that.

There is point-of-care testing, which is evolving under the first nations context, again to make sure we're covering the gaps.

There are also discussions with emergency management. Our response is based also on the relationship to overall emergency management, with a specialization in pandemic response on our part.

I just wanted to make some of those general comments and then pass it over to Shannon to talk about our circumstances and our data.

[Dr. Shannon McDonald, Acting Deputy Chief Medical Officer, First Nations Health Authority]

Thanks, Richard.

We've been really lucky in our relationship with the provincial health officer in being a full participant in the B.C. response to COVID. Our province is sitting at 2,467 cases, as of yesterday, and 149 deaths.

For first nations in B.C., the story is actually better. So far we have had a total of 81 first nations cases in the province. Of those cases, 41 are residents on reserve, and a significant number of those 41 have occurred in two cases of wide community transmission. We have had only nine of over 200 first nations communities that have had a positive case of COVID in the community.

We are also able to monitor the non-resident first nations people through a first nations client file. The first nations client file was created initially in 2010 and allows us to combine the Indian registry plus the provincial registration and premium billing system so that we have a dataset that identifies all resident first nations people in B.C. and links them to their provincial health number. We can use that dataset to link to a number of provincial datasets that we have. However, in this case, we were able to link to the dataset from the Provincial Health Services Authority that registers all the positive COVID cases in the province.

[The Chair, Liberal, Bob Bratina]

Dr. McDonald, we're at time right there. Please keep those further thoughts on hand, and I'm sure we'll come back to them.

We have, from the First Nations Health Council, Chief Charlene Belleau.

Please go ahead for five minutes.

[Chief Charlene Belleau, Chair, First Nations Health Council]

Thank you.

My name is Charlene Belleau. I'm chair of the First Nations Health Council. The Health Council is a representative body with 15 appointed members from the five health regions throughout the province. Our mandate is to advocate on behalf of B.C. first nations in the area of health and to make progress on the social determinants of health.

The First Nations Health Council supports the first nations health authority in this work through advocacy with partners. We've established tables with federal and provincial deputy ministers. As chair, I advocate through direct phone calls and meetings with the Premier of B.C., various ministers, and the regional director general of Indigenous Services Canada. We also have coordinated our respective COVID-19 efforts with the First Nations Leadership Council in B.C.

Through our advocacy work, we've elevated several issues to the attention of B.C. and Canada. These include the following challenges that leaders identified.

There were challenges around engaging and informing chiefs of positive cases in their community so that they could mitigate and manage further spread of COVID-19 impacting elders and citizens. One example of this is that of a federal inmate who was released, tested positive and made contact with families and communities.

As the First Nations Health Council representatives and chair, we successfully advocated for the First Nations Health Authority to work with key provincial partners, such as the provincial health officer Dr. Bonnie Henry, for changes relating to COVID-19 processes of notification to include chief health director and regional First Nations Health Authority officials. The First Nations Health Authority, Correctional Services Canada and the Province of B.C. developed a notification pathway after this incident. We need to ensure that first nations' interests are addressed in the development of these agreements.

First nations and their communities do not have access to adequate Indigenous Services Canada financial resources for security costs associated with mitigating the spread of COVID-19. First nations have been referred back and forth between ISC and Emergency Management BC. It hasn't been clear who is responsible for these additional costs. ISC cannot rely on first nations to use their own resource revenue as a means of protecting their communities. The federal and provincial governments need to address issues and concerns identified following the 2017 wildfires and previous flooding incidents so that we are not constantly responding from a position of crisis.

During the pandemic, when communication and connection are so critical, many of our first nations do not have connectivity. This issue must be addressed as a priority.

A key principle is that no one is left behind, especially during this time of crisis. We have been strong advocates for our family members living off reserve. We have advocated that any available off-reserve resources be provided directly to our nations. We know where our members are and can support them.

The Health Council made a presentation to the National Inquiry Into Missing and Murdered Indigenous Women and Girls and provided recommendations that would greatly assist during this pandemic. Violence against indigenous women is on the rise, and women continue to go missing during the pandemic. Our communities already suffer from a lack of resources for those fleeing violence and we need infrastructure to provide support. We especially need second-stage transition houses near our communities where women can stay for as long as they need to in a safe and permanent place. Transition housing will save lives.

Our indigenous children and youth are impacted by COVID-19. Timely and definite access to funding under Jordan's principle is critical.

COVID-19 has had devastating impacts on the mental health of our youth, families and communities. We have initiated and provided culturally appropriate funeral protocols, traditional wellness and many return-to-the-land activities to address these mental health needs. It's crucial to have adequate supports in place in the event of a second wave.

In 2018, the Health Council signed a tripartite MOU on mental health. The MOU pilots a new community-driven nation-based model of funding mental health services. It supports a broad range of measures to improve mental health and clinical support. The MOU on mental health and the social determinants of health focuses on more than short-term improvements. It commits Canada and B.C. to develop a 10-year strategy on the social determinants of health. It also sets the foundation for a more transformative conversation on nation building and empowering B.C. first nations to design and deliver services that work for them.

Throughout our work, we have noted that self-determination is a critical determinant of the overall health of our people. When our people have their authority and autonomy recognized and supported with adequate resources by Canada and B.C., our health improves.

The knowledge exists within our communities. Supporting nation-based health governance will improve the resilience of B.C. first nations, support an empowered response to COVID-19 and better health outcomes for all.

Thank you again for the opportunity to speak today. I am happy to answer any questions.

[The Chair, Liberal, Bob Bratina]

Thank you very much, Chief.

Now we will go to a six-minute round, starting with Mr. Zimmer.

[Bob Zimmer, Conservative, Prince George—Peace River—Northern Rockies, BC]

Thank you, Chair.

Thank you, everybody, for coming on the call today.

Chief Belleau, I was through your community just this week. I drove to Vancouver. I had some very important meetings down there. I always like going through Williams Lake. I have family there still. It's a great city.

My role is critic, or shadow minister, for northern affairs and the Canadian Northern Economic Development Agency, so my questions are going to be posed around the economic side of where we are with COVID and the situation we're in.

Many have asked—and I'll even speak to my local community here where the Blueberry River First Nations are. They were struck with a few cases of COVID with a huge lack of PPE during that crisis. They were left scrambling to places like Walmart to find hand sanitizer, masks and all kinds of supplies to address those cases in their community. It goes against what has been said about the availability of PPE for our indigenous communities.

Chief Belleau, has PPE been readily available for your communities, broadly speaking, in the Williams Lake area and in the indigenous communities that you know of?

[Chief Charlene Belleau]

I know that PPE is an issue for sure, whether it's within our own region here in Williams Lake but throughout the province as well, but we also recognize the limitations across the country.

We are constantly advocating for PPE not only for our health care providers but also for our people who are providing security on the lines or band offices.

[Bob Zimmer, Conservative, Prince George—Peace River—Northern Rockies, BC]

Chief Belleau, you were saying there are issues for PPE for your front-line workers especially and other members of the community who are part of the infrastructure. These are folks who have to deal with the public and also are lacking PPE.

We've heard from members in this very committee who have said that all PPE is readily available to indigenous communities. We have seen the opposite.

Chief, we had also heard concerns from the previous panel about what this is going to look like in the future. Until today, we have had what's behind us, and we can only correct what's in front of us.

As I stated, my concern is about the economic effects and how we can come out of this whereby communities are getting back to work but doing it safely. For community members who are working at the administrative building and band council workers and all the community members who need this PPE, how does that look going forward? How can we get to where we need to be?

Where do you think we need to be to get our economy going again?

[Chief Charlene Belleau]

I think there are several things that we can do where I feel that our communities may be more prepared. I

am grateful that in the province of B.C. we have at least 145 band offices that were closed during the pandemic and there are 90 first nations emergency operations centres operating. We have 53 local states of emergency. We have 87 communities that self-isolated and went into lockdown. To me, the communities are well aware of what COVID-19 is and how it could impact our communities. It hasn't, thank goodness, and Dr. McDonald's report helps us to prepare for the next round, I think, through lifting it to open to help the economy.

Of course, we're a little afraid for the safety and wellness of our communities, but again, I think the First Nations Health Authority has done what it needs to do to make sure that we have the PPE, that equipment, available to our communities.

[Bob Zimmer, Conservative, Prince George—Peace River—Northern Rockies, BC]

Great. Thank you for that, Chief.

I'd like to go to Mr. Jock from the First Nations Health Authority.

I have a question that is similar to what I asked the chief about the PPE and the access to it. Are you seeing access to the needed and available PPE? We hear about this provincial-federal jurisdiction and who's in charge of what. It's a federal responsibility to provide PPE to the indigenous communities. It was supposed to be established that way. We're seeing and hearing of shortages across the board across Canada.

Have you seen that shortage? We don't need to get into the politics of it, I guess, but if there is one, what needs to be done to re-establish this? I think there's a national emergency strategic stockpile that's supposed to provide access to this equipment across Canada. What needs to be done in the future to make that accessibility to the PPE better?

[The Chair, Liberal, Bob Bratina]

You have 30 seconds. Go ahead, please.

[Richard Jock]

Thank you for your question. I would say two things.

One, as Charlene has said, is that we have made sure there's a few weeks' supply of PPE. What we've done is develop a system of distribution and we make sure that we can replenish those supplies, but I would not want to say that there's a stockpile or an accumulated surplus. I think part of what does need to happen is that each region needs to stockpile.

In our case, what we're saying is that each of our sub-regions within B.C. also has to have its stockpiles and, as you pointed out, that it is available to provide supplies to schools, commercial ventures and other aspects of the everyday operation of communities. We are developing that, but I think there's a long way to go, no question.

[The Chair, Liberal, Bob Bratina]

Thank you very much.

We move to Mr. van Koeverden now for six minutes .

[Adam van Koeverden, Liberal, Milton, ON]

Hi, everybody. Thank you so much for your testimony, your words of wisdom and your contributions today. We really appreciate it. It enables us to do our work so much better.

I have a general question, and I'll allow you, Mr. Jock, Dr. McDonald and Chief Belleau, to answer as you see fit.

Chief Belleau, you've already touched on the subject a bit, so if you'd like to elaborate a bit, that's fine. Perhaps your colleagues will go first so that you can hear their take on it as well.

My question is specific to women, children and mental health. I'm hoping that you can identify specifically what factors are negatively impacting women and kids and putting them in an incrementally vulnerable position.

I applaud and support your advocacy for nation-based health and education, governance and self-determination. I think the evidence is very clear that we get better results from the delivery of these programs. I'd like to hear more about culturally appropriate delivery and maybe identify some partnerships. I know about the indigenous guardians program. I've seen what they do, and I think they do an incredible job of ensuring that our relationship with the land is strong.

Basically, what can we do better for these vulnerable populations? How can we mitigate the impacts specifically on women and kids in the context of mental health, but certainly in terms of any other health, economic or sociological concern that your communities or any communities within your jurisdictions might have?

I'll ask Mr. Jock to start.

[Richard Jock]

Thank you.

One of the things we observed and identified early on was that there was an important gap, particularly in terms of youth. I would say that as we look at adolescents and young adults, there's a real area of challenge, especially in a context where social distancing is important. We've observed that this is a really challenging group within our target audience and we've heard that from communities.

What we have done is pivot our mental health programs into virtual approaches. We have cultural supports and other kinds of supports that are provided now over Zoom and telephone platforms, but there is much more to do. Part of what our physician group has been focused on has been tips and comments on parenting and some guidance on how to work with children while they're being home-schooled. We have done a lot of social marketing, but I'll turn to Shannon for some additional comment.

[Dr. Shannon McDonald]

Thank you, Richard.

I think what we have to recognize in any discussion about issues with women and children and family violence is that these didn't start with COVID-19. Many of the circumstances, the social determinants of health—issues of poverty, problematic substance use, lack of opportunity—have all gathered together, and just as the rest of the country is coming to the point of experiencing things like isolation and lack of services and financial challenges, those are situations that our communities have been experiencing for a long time. When the stress of COVID-19 is added on top of those, it's not surprising—it's sad but not surprising—that some of those behaviours have come to the fore.

It's very challenging, of course, in this circumstance to have staff travel to communities to provide supports. The virtual supports that are made available have had a really positive response from community. We also encourage communities to do the work themselves and to use their time on the land and their traditional practices to support individuals, families and the community in moving forward in a time of crisis.

[Adam van Koeverden, Liberal, Milton, ON]

Thank you, Dr. McDonald.

Chief Belleau, can I ask if you have any partnerships that we could consider? I'm the parliamentary secretary for youth, among other things, so I get to sit with the Prime Minister's Youth Council often. We hear from indigenous youth across the country on that council, but I'd like to hear from you on potential partnerships that we could be fostering to provide better services.

[The Chair, Liberal, Bob Bratina]

Chief, before you answer, we're still struggling with some technical things. The translation's not getting through. IT has asked if you'd let the microphone go on your headset and then just speak like that and see if that solves the problem. There was an issue with translation.

Go ahead with your answer to Mr. van Koeverden.

[Chief Charlene Belleau]

Thank you.

I think there are several partnerships we can consider. Within the province we're able to do various activities with interior health. With the Province of B.C., we have a memorandum of understanding whereby we work with the province on various programs and services. The ones we find a lot of success with are the ones that provide resources for on-the-land programming and services to our youth.

Some of the positive things that have come out of COVID, if they could be positive, are that we've been able to strengthen our families and our communities by returning to gardening and returning to drumming and our ceremonies as well as bringing our families back together and keeping them at home, away from the addictions and the challenges with drugs. We've been able to partner.

[The Chair, Liberal, Bob Bratina]

Chief, that worked.

[Chief Charlene Belleau]

Good. Thank you.

[The Chair, Liberal, Bob Bratina]

You can use the same solution next time.

We have either Ms. Bérubé or Ms. Gill next. I'm not sure who's speaking for the Bloc.

[Sylvie Bérubé, Bloc, Abitibi—Baie-James—Nunavik—Eeyou, QC]

I'll speak, Mr. Chair.