Indigenous and Northern Affairs Committee on Dec. 1st, 2020

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

Ms. Agrell, you mentioned that you needed support on the construction side and with water advisories. There are priorities that need to be respected.

Do you have anything else to add on this subject?

[Kirsten Agrell]

We've certainly been keeping an eye on the work and the progress of work that's been going on. We're certainly encouraged that some local businesses are being formed and doing that work. Obviously, there's more to be done. We just want to make sure it continues and that, to the extent possible, using indigenous workers and ideally our workforce, our members do the work.

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

You also said that you were having problems with training. You want to keep people from getting the virus.

What solutions do you think would help to better train people?

[Kirsten Agrell]

Certainly, as I think I said, keeping training or making communities more self-sufficient with more access to resources closer to where they're at, ideally in the north or in remote communities, helps to reduce movement between communities and keeps the knowledge local. They are able to rely on themselves without having to move long distances, which is disruptive to young community members even outside of the time of a pandemic.

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

Mr. Vodden, it was said earlier that air transportation is essential to every aspect of northern and indigenous society.

Would it be preferable to consult much more broadly with all stakeholders who depend on air travel?

[Nick Vodden]

Yes. Absolutely. I think that would be important. I think that process has started at a very micro level. We're working with each community and with provincial governments to get that program going right now.

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

In a brief submitted to our committee, the Northern Air Transportation Association, or NATA, supports the expansion of the airport capital assistance program to upgrade infrastructure and runways.

Where do you think the money from this program should be spent as a priority?

[The Chair, Liberal, Bob Bratina]

Go ahead, but please be brief.

[Nick Vodden]

You know, as we progress through the pandemic, I think the landing strips are important, as is the infrastructure at the airports, but currently any infrastructure we can provide—rapid testing, vaccination program, supplies to these communities—is vital.

[The Chair, Liberal, Bob Bratina]

Thank you very much. Thanks, Madame Bérubé.

Ms. Blaney, you have six minutes. Go ahead.

[Rachel Blaney, NDP, North Island—Powell River, BC]

Thank you, Mr. Chair.

I also want to thank all of the witnesses here today for your testimony. It has been extremely informative.

I will start with you, Mr. Smith. You talked earlier in your testimony about your concerns around burnout among health care folks, the incredible work they are having to do during this time, and the fact that so many in your region don't have a lot of health professionals. You also mentioned very briefly the psychological support that has been available for people.

Could you talk a little about the concerns you have around burnout? I want to recognize that so many community members and everyday people are also struggling during COVID. You have two levels of burnout. There are the everyday folks and then there are the professionals trying to care for them. I'm wondering about the resources available and how you're working collaboratively to manage that burnout.

[Duane Smith]

Thank you for the question.

We're our own indigenous government, so we do provide these types of additional services to try to alleviate the demand on the health system within the region and the territory.

A lot of the medical staff here are transient. They will come up from one of the provinces. A doctor and even some nurses will come in on rotation for say eight weeks at a time, but when they go back to wherever they come from, they are continuing to work. Those demands and pressures are still on them on a daily basis. We're trying to provide other services, such as home care workers who can go into the households to check on the elderly or those who are in need of that type of service. We are able to provide that as well.

I also mentioned the counselling services. We have done that in the past and we have a lot of experience with providing that due to residential school issues. That's where we provided those supports.

We're looking at any and all means. Like I said, we're providing medical kits to the households as well—rubber gloves, masks, first aid kits, hand sanitizer. These are a part of these kits that we're trying to get into the households so that they are readily available to them as well. It is difficult at times to find some of this material, but we're trying to get as much as we can into each household.

[Rachel Blaney, NDP, North Island—Powell River, BC]

Thank you.

You spoke earlier about the incredible work you're doing around providing kits for sanitization. Of course, one of the challenges you talked about, Mr. Smith, was overcrowding and lack of housing.

Could you talk about what you're doing to help households stay as clean as possible? If you do have someone who is diagnosed with COVID, are you able to isolate them or is the overcrowding a significant challenge?

[Duane Smith]

When people return from outside of the territory, they are expected to isolate for 14 days in a major centre such as this community. They are allowed to go home after that. Hopefully, they don't contract COVID and then bring it back into the household. That's why there's such a long length of isolation time required.

Initially, we did provide cleaning materials such as hand soap, J-cloths, Clorox, bleach and Mr. Clean, as examples. These were part of the cleaning kits we provided to the elders' households. We saw the interest from others so we were able to start putting together the second approach for these kits.

If there is an outbreak in any of the outlying communities, and in this community as well, the infrastructure will not be able to manage it. That's why I was pointing out the mobile camps and our interest in knowing how ready the territorial or federal government or the military would be to go into one of these communities in a timely manner, isolate the issue and start to address it as soon as possible.

[Rachel Blaney, NDP, North Island—Powell River, BC]

Thank you.

My last question to you, Mr. Smith, is around what you said about dealing with the dark time. Of course, you had some solutions that put people out on the land, doing all that amazing work. Now you're having to face this other challenge of people having to stay home in these isolated houses or in houses that may not be sufficient for their needs.

How are you preparing for that period of time, and what are your biggest concerns?

[Duane Smith]

Again, thanks for the question.

We're trying to look at kits again for the youth. The education system only restarted physical fitness again just this week. That was a concern being raised by the communities in regard to the lack of opportunity for children to be active and exercising, not only physically but mentally as well.

We're looking at putting kits together again that we could provide to as many youth as we can, as well as other things, like I pointed out earlier the sewing kits for those who want to do that. It's little things like even puzzles. We can purchase puzzles to get into the households. It's a way of keeping people occupied and hopefully families of all ages will be taking part in that so it's building life skills and family bonding at the same time. Those are the sorts of things we're looking at.

[The Chair, Liberal, Bob Bratina]

Thank you very much for that.

Thanks to all of our panellists. Unfortunately, we were shortened due to technical issues but the testimony's remarkable. As much as we have technical issues, I think it's just great that we're able to speak to people across this great distant country of ours. Your technology worked just fine on the Alaskan border. Ours didn't work so well here in the House. Once again, thank you to all.

We're going to suspend just briefly while we set up our next panel and then we'll be back. Thank you.

[The Chair, Liberal, Bob Bratina]

Members of the committee, we're now able to resume our meeting with the second panel.

I call this meeting back to order.

With us by video conference for the second hour are the following witnesses: Mickel Robertson and Marjolaine Siouï, executive directors from two commissions of the Assembly of First Nations Quebec-Labrador; Dr. Nel Wieman, president of the Indigenous Physicians Association of Canada; and Christopher Sheppard, president, and Jocelyn Formsma, executive director, of the National Association of Friendship Centres.

Welcome to all. We now have six minutes for each of the witnesses' opening statements, beginning with the Assembly of First Nations Quebec-Labrador.

Please, go ahead.

[Marjolaine Siouï, Executive Director, Health and Social Services Commission, Assembly of First Nations Quebec-Labrador]

Thank you.

[Witness spoke in Wendat and provided the following text:]

Kwe, Eskenonhnia ichies’, Marjolaine Siouï Wendat endi’.

[Witness provided a French version, translated as follows:]

Good afternoon, I hope you're all doing well. My name is Marjolaine Siouï, and I am Wendat.

[Translation]

We would like to thank you for your invitation. We wish to acknowledge the unceded territory of the Algonquin Nation and the nations where we are.

I join you from my community of Wendake. I will share our presentation with my colleague, Mickel Robertson.

We will present some of the issues that are opportunities that we are collectively seizing to revive the economy and contribute to improving the health of our populations.

The examples we're going to present today are drawn from a report card that was produced by the Assembly of First Nations Quebec-Labrador.

When the First Nations population across the country is faced with major health issues, consistency is essential. Despite the investments made to support communities and businesses since the beginning of the pandemic, it is extremely difficult for many of them to be part of an economic recovery without the support and formal commitment of the provinces and the federal government, an essential condition for any progress in relations with First Nations.

As you know, an individual's health status is influenced by determinants and their environment. We note an urgent need to obtain telemedecine services from health and social services professionals and to access teaching staff in order to keep in touch and break the isolation and distress experienced by many of them.

Providing quality care and services also requires investment in the development, support and implementation of digital and information strategies for First Nations. The current situation demonstrates with certainty that laws and policies do not allow for adequate monitoring of information or surveillance of the health status of these determinants for our populations.

We need to strengthen our governance and capacity to ensure greater control and better management of our information. We cannot ignore overcrowding, lack of housing and infrastructure. For example, we also need to increase the number of seniors' residences in communities to protect our custodians of our traditional knowledge and cultures. This phenomenon has been mentioned many times, not to mention the shortage of staff, training needs and low salaries.

Despite the efforts and investments, we continue to face several constraints and difficulties in accessing PPE. A greater involvement of First Nations in decision-making processes is essential when developing strategies for the supply of equipment, testing—this was discussed earlier—and also vaccination, which is eagerly awaited.

Although the federal government has recommended that provincial and territorial governments work with First Nations, much more adapted communication strategies must be developed to inform and sensitize our populations about the benefits and also the disadvantages that the arrival of new vaccines could represent.

Finally, several essential workers spoke about both the vulnerability they felt working on the front lines and the vulnerability of the weakening health care system. Succession planning is needed. It is necessary to ensure that external personnel are trained and sensitized to the concept of cultural safety. The issues presented can all be resolved and seen as opportunities for economic development. However, this willingness and vision must also be shared by all.

I'll now turn things over to Mr. Robertson.

[Mickel Robertson, Executive Director, Economic Development Commission, Assembly of First Nations Quebec-Labrador]

Good afternoon.

The lack of housing among First Nations and the resulting overcrowding are long-standing problems. The crisis was there before the pandemic, and the last few months have confirmed once again the urgent need for action.

A study done by the Assembly of First Nations Quebec-Labrador reveals a need for more than 10,000 new housing units in Quebec communities, nearly 9,500 lots to be serviced and nearly 7,500 units to be renovated. This catch-up project represents a major economic development opportunity for all.

However, at the last meeting of the Regional Tripartite Housing Committee, the regional office of CMHC, the Canada Mortgage and Housing Corporation, informed us of a reduction in the budget for the Section 95 social housing program. This 8% reduction will take effect next year. In Quebec, this translates into a decrease of nearly $1 million, which means that fewer housing units will be built.

In addition, we have seen an increase in construction costs in recent months. The number of housing units that will be built next year will decrease because of the combination of these two realities. This reduction is difficult to justify in the context of a pandemic. The housing crisis places First Nations in a situation of vulnerability exacerbated by the pandemic.

Rather, all avenues must be explored to increase First Nations housing capacity. Funds dedicated to temporary infrastructures, which could serve as places of isolation in times of pandemic and as shelters for the homeless in normal times, would be welcome. Hidden homelessness isn't only an urban phenomenon, it's a phenomenon that has also been revealed in our communities by the pandemic. The rapid housing initiative could be useful, but we feel that it isn't enough. The $500 million envelope for which we will be able to submit applications will be open as much to the 630 indigenous communities as to other communities that are not major cities. An envelope specifically dedicated to the problems of homelessness on reserves is necessary, especially since our communities do not have access to the federal funds for homelessness transferred to the Province of Quebec.

We also recommend that the government emulate Quebec's strategy contained in Bill 66 to accelerate the construction of seniors' homes. Yesterday's announcement is an encouraging first step. Building seniors' residences in our communities would make it possible to house and protect our seniors while freeing up residences for all those on our long waiting lists.

We also need to accelerate the deployment of high-speed Internet access for all our communities. The health of our people depends on it, and future economic development will be facilitated.

Furthermore, in order to include us in the recovery, the government must make its current Procurement Strategy for Aboriginal Business mandatory—

[The Chair, Liberal, Bob Bratina]

I'm sorry. We are way past time. We'll pick up any points later on through the conversation.

For all of our witnesses, if we're not able to—

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

Excuse me, there's no interpretation.

[The Chair, Liberal, Bob Bratina]

Is the translation okay now?

Okay.

Any points that are missed in the conversation can certainly be submitted in writing.

Now I'm going to offer six minutes to the president of the Indigenous Physicians Association, Dr. Wieman.

Please go ahead, for six minutes.

[Dr. Cornelia Wieman, President, Indigenous Physicians Association of Canada]

Boozhoo. Aahni.

I'd like to thank the chair, vice-chairs and members of the standing committee for the invitation to appear before you. My name is Dr. Nel Wieman and I am originally from Little Grand Rapids First Nation in Manitoba. I'm a psychiatrist by training, and the current president of the Indigenous Physicians Association of Canada, also known as IPAC.

I also work as the acting deputy chief medical officer at the First Nations Health Authority in British Columbia. I am joining you from the traditional ancestral and unceded territory of the Coast Salish peoples—the Musqueam, the Squamish and the Tsleil Waututh.

These are some of the key messages IPAC would like to convey, organized around various themes, regarding support for indigenous communities and individuals as we are going through the second wave of COVID.

Regarding IPAC, the Indigenous Physicians Association of Canada is the national representative organization of indigenous physicians, residents and medical students. We have approximately 250 members who are studying, training, living and working across this country from coast to coast to coast. We also know there are other indigenous physicians and medical learners out there.

IPAC members have a collective intent to collaboratively use our skills, abilities and experiences to improve the health and wellness of indigenous peoples across the country. This includes advocating for individuals, families and communities who have experienced COVID-19 infection and outbreaks, those who remain at risk of infection and those who are at high risk of experiencing severe courses and outcomes related to COVID-19 illness, including death.

However, IPAC cannot represent the many diverse views of all indigenous people across Canada, in this instance regarding the supports needed as part of the response to COVID-19.

During the COVID-19 pandemic, indigenous physicians have participated in the response in a variety of ways: as primary care providers on the front lines in indigenous urban, rural and remote communities, either in person or virtually; as specialists working in communities or in hospitals, including academic teaching hospitals; as public health physicians contributing to the COVID-19 response in cities and health authorities; as administrative and medical education leadership in health organizations and universities; and also in governments at the local, regional, provincial and federal levels.

We have also created a series of public service announcements—five altogether—which feature eight to 10 indigenous physicians from across the country. The PSAs convey culturally safe and relevant information on themes important to our communities and nations during COVID and highlight our indigenous strengths and resilience.

IPAC members have also served during the pandemic on various committees and advisory groups, including the Public Health Agency of Canada's health professionals forum and on more focused initiatives such as providing review and input into developing Canada's COVID-19 immunization plan.

We respect all indigenous peoples' right to self determination. Support for first nations communities should recognize and reinforce first nations' self-determination and systems of self-government. One example is the ability of communities to declare closures and/or limit access during the pandemic. Communities also express self-determination and the capacity to assess or declare their need for funding for emergency measures. Such a decision should only need to come from the community itself and there should not be an additional layer of verification required from an external body.

IPAC continues to be concerned about the health and wellness of indigenous people across the country during COVID. We are especially concerned about the mental health and wellness aspects, and note the particular challenges when there is concurrent substance use.

In B.C., we are dealing with dual public health emergencies: COVID-19 and the opioid crisis. We are seeing that the significant rise in overdose events and deaths are particularly tragic, unintended consequences of the imposed public health measures to reduce the spread of COVID-19. Indigenous people are unfortunately overrepresented in the overdose crisis. We are supportive of increased funding for harm-reduction services, treatment programs and building up capacity for establishing a safe supply in order to separate people who use drugs from the toxic street supply.

IPAC draws particular attention to the capacity of indigenous communities to access health services, including primary care, virtual services and timely COVID testing, which has been mentioned already. There are long-term investment needs including medical transportation and infrastructure, Internet access to telehealth, necessary medical equipment, technology and supplies. The pandemic has only highlighted the disparities in health services to indigenous people.

There is also a need for sustainable, healthy homes. COVID-19 thrives in inequity. During the pandemic the overcrowding and poor conditions of some homes mean that self-isolation is impossible, and the spread of the virus within a family group is inevitable. Given the past harms and devastating experiences of indigenous people during pandemics, historically and in more contemporary times, it is important to clearly articulate messaging around COVID-19 and the public health response.

For example, we are concerned about vaccine hesitancy when one becomes available, in part, because of indigenous peoples' past experiences with medical experimentation and poor treatment. We do advocate for indigenous people to be a high priority when vaccines become available, given their health and exposure vulnerabilities.

Indigenous people want access to their own health systems, including funding for elders, traditional medicine people and healers. Many of us see this as vital to our own health and well-being.

Finally, yesterday's release of the B.C. provincial inquiry report into anti-indigenous racism in the health system, in plain sight, reminds us that we have a long way to go to create a health system for indigenous people that is safe to access during the COVID-19 pandemic and beyond.

Meegwetch.

[The Chair, Liberal, Bob Bratina]

Thanks very much, Dr. Wieman.

We'll now go to Christopher Sheppard and Jocelyn Formsma from the National Association of Friendship Centres.

You have six minutes. Please, go ahead.