Indigenous and Northern Affairs Committee on April 29th, 2022

[Vice-Chief David Pratt]

Thank you for the question.

First of all, of course, first nations had our own health care system prior to contact. We relied on a lot of our spiritual and traditional healers, and we still do. A lot of our first nations people utilize both systems of care. If they are being treated for cancer, they also take our traditional medicines and healers and it has worked for a number of them.

Our position here in Saskatchewan, as well as in many of the other regions, is that our healers and our elders have to be part of the system. They bring such knowledge and I know they've helped a number of our people. One thing we know for sure, with all due respect to our European brothers and sisters, is that the western system of treatment, whether for addictions or mental health services, does not work. First nations have to drive it. It has to be holistic, and it has to be based not only on the spiritual connection but the mental and emotional connection. Even the connection to the land is so important.

There are some great things happening on the ground here with a lot of our traditional healers and their being incorporated, but non-insured health benefits have to properly respect them and give them that same level as a person with a medical degree or a person with a Ph.D. in psychology. That's key and that's critical as part of this long-term reform that we're talking about today.

I hope that answers your question.

[Jenica Atwin, Liberal, Fredericton, NB]

Thank you very much.

You also mentioned Joyce Echaquan and the need for Joyce's principle in particular to be implemented across health care for indigenous peoples.

Can you speak more about that and some about systemic racism and how that impacts health care delivery for your communities?

[Vice-Chief David Pratt]

Oh, my goodness. At the FSIN, and I'm sure at the other regions, we have literally stacks of reports. Recently, the federal government committed to a first nations health ombudsperson and that work is starting.

There is encouraging news in Saskatchewan, in that over 70% of the health care professionals in a survey by Saskatchewan Health Authority recognize the need to do more for first nations' health. They recognize that we have to implement the TRC recommendations specifically for health care. There's 30% that hold the systemic and institutional racism that's impacting our people's health. We're dealing with cases right now, but there's a lot that has to happen.

As we move forward on this transformative work on NIHB, it can address some of those inequities and those discriminatory practices and hold the system accountable to our people when they walk through the doors of those emergency rooms and clinics.

[The Chair, Liberal, Marc Garneau]

Thank you very much.

Mrs. Gill, you have the floor now for six minutes.

[Marilène Gill, Bloc, Manicouagan, QC]

Thank you, Mr. Chair.

I'd like to thank all the witnesses for being with us today. What they are telling us about non‑insurance health benefits is obviously very important.

Mr. Pratt, as you mentioned in your opening remarks, you were involved in the joint review of the NIHB program from 2015 to 2017. The Assembly of First Nations, or AFN, was there.

Since then—it'll be five years this year—what improvements do you think have been made? You can put it in many ways, depending on your priorities.

I'd also like to have your assessment of what remains to be done, in order of priority.

[Vice-Chief David Pratt]

Thank you for the question.

First of all, I just want to say that the work is continuing and is ongoing right now. It's a work in progress. There was some movement on that, but of course the pandemic put the brakes on everything when it came to the very important work that we're conducting right now.

I know that in terms of changes there are a lot of good conversations that have happened with Canada, where they were hearing the concerns from each of the regions. In terms of the implementation, I think we still have a lot of work to do, so that joint task force has to continue its work. That will be a priority at the AFN as we're moving forward. Especially now that we're coming out of the pandemic, we want to be able to continue to make sure that all the issues are being heard from all the 10 regions in Canada so that very important transformative work can happen.

I want to acknowledge our health navigators in each of the regions, because they do tremendous work. I speak not only on behalf of the FSIN but the other regions as well. When there's an issue and I bring it up, they elevate it and deal with the NIHB. Denials are reversed many times and, in a lot of cases, particularly with elders.

As I said in our statement, we had one elder who had to choose between paying her rent and paying for her dentures, because the NIHB pays for dentures only every five years. We got some advocacy going, she paid for her dentures—because she couldn't eat without them, obviously—they reimbursed her and she was able to make the rent.

Those are just some of the prime examples. A lot of first nations people rely on this program. We have to make sure that's it sustainable. Number one, we have a booming population, and number two, we have to make sure that it meets all the needs that the Crown agreed to when we signed the treaty, particularly the medicine chest clause of Treaty No. 6.

Meegwetch.

[Marilène Gill, Bloc, Manicouagan, QC]

Thank you, Mr. Pratt.

In short, following the review, there were consultations, but the implementation of the recommendations—in other words, the concrete actions—are still pending. The COVID‑19 pandemic must be taken into account, but I would point out that from 2017 to 2020, three years have passed, and I hope that progress has been made during that period.

I would also have liked to hear from all of the witnesses on one part of the motion before us, which concerns call to action 22. My colleague Ms. Atwin mentioned this a little earlier, and it's about traditional first nations counsellors.

I have, of course, followed the work of the commission, but I wasn't involved in all the conversations. I would like you to tell us about the role of traditional counsellors. There are certainly elements that vary according to the different communities and the different peoples.

Could you explain what the traditional counsellors do? How do they work with individuals in the communities?

The motion and the Truth and Reconciliation Commission of Canada talk about recognition. How could their work be recognized?

I'd ask you to make your answer brief because I don't have much time left.

[Vice-Chief David Pratt]

How much time do I have, Mr. Chair?

[The Chair, Liberal, Marc Garneau]

You have two minutes.

[Vice-Chief David Pratt]

Okay. I'll try to get it under 45 seconds.

First of all, thank you for that question.

I do want to say that the traditional healers, the elders in our first nations communities, do a lot of great work that's recognized. I know that they've done some excellent work in terms of healing.

I don't want to share too many stories here because of the time factor—and there's not enough time—but there are numerous occasions when there are no healers, and the elders—

[Marilène Gill, Bloc, Manicouagan, QC]

I'm sorry for interrupting you, Mr. Pratt.

It’s true that we don't have a lot of time and that's very limiting, but you could send the committee additional information, if you wish. That might complement what you were going to say.

Thank you.

[Vice-Chief David Pratt]

I'd be happy to. The AFN will prepare a brief note for the committee, and we'll forward more information on them. I really appreciate that you're interested in that. It shows that there's some interest in terms of our traditional medicines, our traditional ways and our elders.

We'd be happy to provide that to you as a follow-up to this committee.

Thank you, Mr. Chair.

[The Chair, Liberal, Marc Garneau]

You're welcome.

Go ahead, Ms. Idlout. You now have the floor for six minutes.

[Lori Idlout, NDP, Nunavut, NU]

[Member spoke in Inuktitut, interpreted as follows:]

We know that many aboriginal people volunteer as medical escorts when people have to travel south. The medical escorts usually are volunteers without pay. They volunteer. They leave their families and children behind. Sometimes they may be away from their family for up to a month.

Cassidy, I'll ask you first, and then Natan and David.

The medical escorts make a big difference to the patient. They are volunteers. I would like to see them paid as medical escorts.

Can you answer my first question?

[Cassidy Caron]

Thank you. It's great to see you again.

Specifically for medical transport, once again, Métis people don't have access to NIHB. We have been developing medical transport systems on our own, with each of our governing members, for quite some time now. It's based on various contribution agreements that we get through federal, provincial and territorial governments, and sometimes even just by applying for grants through not-for-profit organizations.

As a specific example, Métis Nation Saskatchewan has set up their own medical transportation system from northern communities to the south. I don't have the actual stats on that and if they pay their support people who travel. That is something I'll have to look into.

You're absolutely right. The family members who travel with our community members down south to access health services have to put their lives on pause to be able to support their family member or friend who needs to access health services. If we can honour their time in ways they're not being honoured right now, I think it would be very beneficial.

[Natan Obed]

From the Inuit Tapiriit Kanatami perspective, this dovetails into official language rights and official language status. Inuktut has no federal status as an official language and doesn't have status even as an official language in Inuit Nunangat by the federal government. It has official language status within three of the four Inuit jurisdictions. Therefore, services that are provided by provincial or territorial governments sometimes can be delivered as a right in Inuktut.

Largely, medical escorts are also providing interpretation services. We need greater recognition of Inuktut within the way the federal government provides service delivery to Canadians to ensure that these services are not given by family members or people who have no training within the medical field, but that they are providing services on behalf of a health system and patients.

I think that some of the roles that escorts play are medical system roles. When those roles are provided, there should be a real clear understanding and focus by health systems about the compensation necessary in the provision of health services.

[Vice-Chief David Pratt]

Hello. Thank you for that question.

First of all, I want to acknowledge that medical transportation does present a lot of challenges, even in Saskatchewan. A number of our people have come forward, of course, with the rising costs of gasoline now. The mileage is inadequate for them to be able to get somewhere to meet the needs of our people, particularly when they're transporting our people, for example, to a dialysis treatment. Of course, diabetes is very prevalent amongst first nations people. We're not built for this western diet of Big Macs and fast food and processed foods that are sold at the Northern Store. We're off that diet now. It's impacting the health and welfare of our people. Medical transportation is a big issue.

You talked about the language, I believe, in terms of the challenges. The language barrier is huge, particularly for our northern and remote communities. For example, in the Dene community, we had an elder who was sick in one of our hospitals, the Victoria Hospital in Prince Albert, and they could not communicate with the doctors and the nurses. It was as simple as them reaching out to the local tribal council and saying, “Hey, we need a Dene speaker here.” It was a Dene nurse who was working on call on a shift who said this elder needs this, this and this. He finally started getting the treatment that he got.

In terms of the families being there to be able to provide those supports, yes, it's inadequate. I do want to acknowledge NIHB, but they need to bring up their hotel rates. Some of the hotels they keep the families in are inadequate. I would not stay there. I would not keep my family there, but because of the ceiling cap on paying for the hotels, they're putting them in hotels that they shouldn't be staying at, particularly when we did sign treaties and agreed to share the wealth of this land. When our people are sick and they're suffering and they need supports, they shouldn't be staying at a run-down hotel and barely getting the gas they need to support their family member.

There are lots of issues. We need major investments and we need sustainability.

Thank you.

[The Chair, Liberal, Marc Garneau]

Thank you very much. That will bring the first round to an end. We have time for a short second round, if everybody is disciplined.

We'll start with Mr. Vidal.

You have five minutes.

[Gary Vidal, Conservative, Desnethé—Missinippi—Churchill River, SK]

Thank you, Mr. Chair.

Thank you to all of the witnesses for being here today.

I have to admit that I'm a little bit surprised at how much discussion we've had about medical transportation today. I thought that would be a more peripheral topic today, and I want to focus a couple of my questions for Vice-Chief Pratt on exactly that topic. He's very familiar, obviously, with my riding in northern Saskatchewan as he just referred to some of the rising costs and the challenges.

I'm going to change it up a little bit to drill into some comments that he made. He talked about the review of the NIHB program and some of that going on. The vice-chief also talked about service providers dropping out at rapid rates, and I know he referred to dental and optometry, but I want to tie that back to travel for a second. Before all of this study began, I actually had some people reaching out to my office about their concerns with trying to survive in the medical taxi business from northern Saskatchewan

In the context of the review, you referred to the high cost, the cost of fuel, etc. In that review, was there any discussion going on about how we ensure that we don't lose those service providers who are providing some of the transport, as well, or is that becoming an issue in Saskatchewan that you are aware of?

[Vice-Chief David Pratt]

Thank you, Gary.

First of all, it's good to see you virtually. We haven't connected in person for a while, obviously, due to the pandemic. I appreciate that question.

Yes, there are issues around the medical transportation particularly for the north. Dialysis treatment is a prime example, Gary. In your riding, you know well the highways and the distance from first nations communities. They have to drive sometimes five hours one way to receive the dialysis treatment in Prince Albert and Saskatoon. It's five to seven hours one way, and of course when they come off of the treatment, they're weak and they're not well. Then they have to drive back five to seven hours again. It takes a lot out of our elders, so it's important to have access to those treatment facilities closer.

Yes, there is an issue with medical transportation, Gary. That's a huge flag in terms of providing and meeting the needs and challenges, particularly for our region.

I can't remember your second point, Gary.

[Gary Vidal, Conservative, Desnethé—Missinippi—Churchill River, SK]

That's fine. Just because we're so limited on time, I'm going to move on to another one. I'll give you a pass on that one.

The other thing I want to talk about a little bit today is mental health and some of the stuff around that. You and I have had conversations in the past about this, and I want to drill into a couple of things.

As you're well aware, one of my first experiences as a member of Parliament back in 2019 was experiencing the declaration of a state of emergency in one of the first nations in my riding. Shortly after that, there was an announcement of some funding, and I was actually privileged enough to be present in Saskatoon when that was.... You and I were there together. There's little information I'm able to find on how the department measures or evaluates the performance of these kinds of.... I don't know if “ad hoc investment” is right, but it was something that was a reaction to a situation at the time.

I'm curious as to whether you can shed any light on the impact that funding over two years ago had, how it gets measured, how the money got spent and how many first nations in Saskatchewan were impacted by that announcement from December 2019, if I'm not mistaken. I think you'd be very familiar with that.

[Vice-Chief David Pratt]

Thanks, Gary.

I'll be real quick with my remarks. I'm getting feedback here.

Definitely, that $2.5 million was a result of Chief Margaret Bear of Ochapowace first nation and Chief Ronald Mitsuing in Makwa Sahgaiehcan—which is in your riding, Gary—declaring states of emergency. That happened right during the AGA that year in December. They had a number of suicides. These weren't just young people; these were also older men.

Committee members, right now in Saskatchewan region we are in a full-blown mental health crisis with addictions to crystal meth and fentanyl overdoses. It's really bad out here, as I'm sure it is in all the other regions. You're hearing reports of overdoses. There's an overdose every day. Maybe two or three times every day somebody is dying in Saskatchewan with an overdose of fentanyl or crystal meth. You have that exacerbated by the pandemic and isolation for two years. Addictions have risen and mental health issues have risen.

Gary, of that $2.5 million, $2 million flowed directly. We knew that $2 million wasn't enough. It was a drop in the bucket for what we needed in Saskatchewan. We didn't want to be the judge and jury like Solomon, dividing where which part should go or who should have it. We just decided to break it up. We have our funding formula that we use for SIGA. We busted it all up by population and got the money out the door. Some good work came out of that.

I'll give you an example. Peter Ballantyne, which is one of our largest bands—it is in your riding—put on an event for three or four days for their young people because they were experiencing a crisis. A 10-year-old girl killed herself in Southend, and it kind of spurred the chief and council of the first nation to bring their youth together. They were able to take $150,000, which was their allocation out of the $2 million, to put on a four-day event and bring their youth to Saskatoon to build them up and teach them coping mechanisms. They did the ASIST training. They were able to talk to one another on how to prevent people from taking their own lives.

Some good outcomes came out of that, but, Gary and committee members, we need more and not just in Saskatchewan. We have a comprehensive life promotion program ready to go, but we just need the funding. I can probably say the same for all the regions. We are in a full-blown mental health crisis. We need those investments and those resources across the board.

I'll keep it at that. Thank you very much.

[The Chair, Liberal, Marc Garneau]

Thank you, Mr. Pratt.

Mr. Powlowski, you have five minutes.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

Following on that, Chief Pratt, I worked for quite a few years as a doctor, including a couple of years in Norway House. I totally agree with you that the European health care system has totally failed in mental health and addiction. The implementation or the approach really has not worked well in indigenous communities.

I'd also suggest that our present system isn't very cost-efficient. When you have to fly somebody out of the community after they've overdosed, you have to pay $30,000 or something. That $30,000 would be much better spent on providing the services in the communities.

I agree with you that we should be doing way more in terms of funding indigenous healers within the communities. These are people who are far more likely to be successful than people with a purely western, European approach to mental health problems.

Are we doing enough in terms of mental health services in the communities? It sounds like you're from an area where there are a lot of isolated communities. Do most of those isolated communities have any mental health services on an ongoing basis, especially with a traditional component?

[Vice-Chief David Pratt]

Thank you for that question.

The sad part about it is the western way, like you said. When there's a crisis in a community and the community declares a state of emergency over a mental health issue, whether it's a string of suicides by youth or overdoses, they bring in the community supports. Canada or ISC or FNIHB will bring in those counsellors and therapists to provide the wraparound supports for three or five days. Maybe they're in there for two weeks, but then it starts taking a toll on them. When Makwa Sahgaiehcan declared a state of emergency, they had to replace the mental health workers because they were burning out from carrying all the burdens of the community and the people.

In terms of traditional ways of knowing, I think that's where it's at. We could look at what NAN is doing with the choose life program in their northern nations in Ontario. That program is working. It's all land-based and connected to the land.

I think we need to look at that same approach here in Saskatchewan. A lot of people are going back to the land and realizing that there is healing in nature and in rebuilding that connection first nations people have had for thousands of years here on Turtle Island. I think we need to restore that and look at those.

The western model is not working. Let's try the first nations' way and see if that helps. If the current system is failing, let's try something new. That's my recommendation.

Meegwetch.