Indigenous and Northern Affairs Committee on May 3rd, 2022

[The Chair, Liberal, Marc Garneau]

Thank you very much. It's an interesting analogy, Dr. Lafontaine.

Mrs. Gill, you may ask a question or yield the remaining time to Mr. Morrice.

[Marilène Gill, Bloc, Manicouagan, QC]

I'm sorry, I thought you were talking to Mr. Morrice.

Of course, Mr. Chair, I'll give the remaining time to him.

Thank you.

[The Chair, Liberal, Marc Garneau]

Thank you.

Mr. Morrice, you have time for one quick question.

[Mike Morrice, Green, Kitchener Centre, ON]

Thank you again, Mrs. Gill.

Thanks to all the witnesses who joined us this afternoon. I was particularly struck by the comments you shared, Dr. Makokis, including on the limitations and inadequacies of this very committee structure and the fact that I can only speak with you in English.

If there's anything you haven't had a chance to already share with this committee, I want to just offer you the time to share that now.

[Dr. James A. Makokis]

Thank you so much for that opportunity.

If I think of my own family's experience in interfacing with not only the Canadian health system but with NIHB, there is a tremendous number of years of loss of life. Again, when I reflect on what our relationship is supposed to be as a treaty descendant in Treaty No. 6, that's not what it is supposed to be.

In our lifetime we want to see the transformation for the betterment of our children, of our grandchildren and great-grandchildren to be able to live and thrive and be the best possible human beings, ayisiyiniw, that we are meant to be here together.

It shouldn't take the tremendous amount of advocacy and work to obtain the basic, most foundational provisions of providing care. What we often hear as indigenous physicians from Indigenous Services Canada is that this program is comparable to any other federal program, including the ones that MPs have access to. I would challenge you to switch your program from your extended benefits that you currently have to the one that people who are Inuit and first nations are forced to use, and you can see how quickly the things that you routinely take for granted for your health, for your family's health, are taken away and removed. When you go and access care, the basic humanity that we strive to provide all people, as is in the mission of Health Canada to improve the health of all people within this country, changes suddenly.

I think that when we look at health transformation from an indigenous perspective, we need to rebuild the indigenous health system. We've seen over the past two years with COVID what happens when there's a threat to a health system, how quickly it crumbles, how quickly many of the provincial and territorial health systems were on the verge of collapse, and that's only after two years, let alone from 1885 to 1951 when we couldn't even access our own health system because we couldn't leave the reserve due to the past system, for example.

When we think of things in that perspective, there's a lot of work that needs to be done to rebuild the indigenous health system and support indigenous health healers, medicine people and elders, who when we do this will actually start to see a change in the morbidity and mortality that we have become so used to when we talk about indigenous people and indigenous people's health and the deficits around these.

In my lifetime, that is something I would like to see as someone who is 40 years old, who is one of the non-fluent Cree speakers in our community. In the next 20 years, there's the potential loss of the Cree language. If that happens, we're going to see worse health outcomes than we already have.

I know Dr. Adams talked about upstream health determinants, and language is an important part of that. With upstream health determinants, traditions and culture is an important part of that, and that's what we need to focus our attention on, and that's really what reconciliation is.

[The Chair, Liberal, Marc Garneau]

Thank you, Doctor.

Ms. Idlout, would you like to finish with a question?

[Lori Idlout, NDP, Nunavut, NU]

[Member spoke in Inuktitut, interpreted as follows:]

Yes, very much, one question.

I have a question to Dr. Makokis.

I'd like to ask you as a physician, do you have the ability to prescribe and refer patients to traditional healers? If you do, how does that work?

[Dr. James A. Makokis]

Again, MP Idlout, I have spent a significant amount of time with our elders and medicine people, learning our own medicines and traditional medicine practice alongside my western medical journey. During medical school breaks, I would go home and spend the summers with elders. During weekends, I would go home and learn from them.

There are very few indigenous physicians who do this. There are a handful of us who do that. As part of our regular practice, we routinely refer to healers and medicine people and elders within our own community, because we know the network that exists there, and they trust us.

This is an important part of our health system, and, unfortunately, this is not compensated. What I do as a physician and what I've done in the past is that, working fee-for-service, I would do a home visit with an elder and the patient. I would bill the provincial health system for a home visit fee, and I would split that fee fifty-fifty, so that the elder or traditional medicine person was compensated equitably to what I was compensated. I did that myself.

This is not something that's sustainable. Most health professionals—most doctors, most nurses—would not donate 50% of their salary to someone. That's what we really need to talk about: how we are going to adequately compensate our medicine people and elders who are identified by our own people and who we use in the community. It's a very important part of our health system.

Yes, I do that. It's not compensated. It needs to be compensated. There needs to be more of that.

If we look at the Diné College in the Navajo Nation, they have a training system for indigenous traditional medicine people and for Navajo students to learn from their own elders within their communities. We need to have processes for doing that in this country, whether that's indigenous medical students, indigenous medical schools, where we're training alongside our elders and traditional medicine people and providing care in a culturally safe, appropriate way that is as equal and as valid as western medicine.

[The Chair, Liberal, Marc Garneau]

Thank you very much.

On behalf of all the committee, I would like to thank our witnesses today, Dr. Lafontaine, Dr. Adams and Dr. Makokis.

Thank you for your testimony. Thank you for your candour. I think you've provided very valuable input to this committee's work, and we very much appreciate it. Thank you.

Please, Mr. Badawey, go ahead.

[Vance Badawey, Liberal, Niagara Centre, ON]

Thank you, Mr. Chairman.

Just quickly, to all three doctors, my office will be reaching out to you to get some more time in and to discuss some of the things we talked about at today's meeting.

I want to thank you for your time today.

[The Chair, Liberal, Marc Garneau]

Thank you.

With that, this meeting is adjourned.