[Witness spoke in Cree]
I'm from the Saddle Lake Cree Nation and am a descendant of signatories of Treaty No. 6. I'm one of the few indigenous physicians who grew up with their people and who work with their own people. Presently I work on Kinokamasihk. I am testifying as a user of the current NIHB program and as a Nehiyawak physician who treats Nehiyawak, also users of the NIHB program, on a daily basis.
I greet you today in the language of my people, Nehiyawewin, which comes from these lands upon which your people now sit, welcomed by my ancestors nearly 500 years ago, a language imbued with sacred teachings of natural law that governs our people, with laws that roughly translate to kindness, love, honesty, sharing, respect, family, trust, reciprocity, fairness, equity, care, longevity and, above all, honour for our mother, the earth, and all of its inhabitants.
The same language was used to agree to a treaty that allowed for your ancestors to respectfully share these lands in exchange for peace and friendship, mutual understanding and the promise of health and health care, also know as the medicine chest clause, to be honoured for as long as the sun shines, the grass grows and the rivers flow and as long as there are native peoples. In English legalese, this would be represented by the phrase “in perpetuity throughout the universe”.
If the promises of the treaty had been truly honoured, I'd speak to you in my own language, and all of you would fully understand what I am saying. We'd sit around a fire, begin our conversation in ceremony with a prayer and the guidance of a pipe, the keeper of our laws. We would sit and discuss these matters until the matter at hand was resolved.
Yet, I sit here and speak to you in English, a foreign language, with much too short a time limit to articulate the shortcomings of a program that shouldn't even be an issue because everything I'm going to discuss was already promised to us over 150 years ago when your ancestors agreed to a treaty.
To discuss these matters as an indigenous physician is insulting because not only are our health and health care guaranteed by our treaty, which continues to be in full force and effect, but the Government of Canada ushered in the era of truth and reconciliation in an attempt to correct the reality of what is actually happening to our people, which is genocide. Yet I still have to sit here and point out the ways in which NIHB not only continues to fail to provide adequate health measures for our people in the most basic ways, for example by giving patients an insufficient number of catheters while NIHB bureaucrats instruct these same patients to wash and reuse their catheters, which goes against medical standards, but also does so in communities with boil water advisories, as was the case when I practised in my own nation, Saddle Lake, in 2013.
We wonder why indigenous peoples have higher rates of kidney disease and dialysis. We wonder why, when ISC nurses asked me to assess a 17-year-old Cree person from my community who had suffered a spinal cord injury, I found a stage 4 sacral ulcer. For those of you who don't know what that means, the ulcer was so deep I could press on her tail bone. Why did she have this? NIHB would provide her with a new wheelchair at only limited intervals, but children grow and she outgrew her wheelchair, causing these pressure ulcers. Jordan's principle was passed in an effort to address these issues, but still they persist.
This February, it took two months to get an appropriate nutritional formula for a four-month-old Cree baby at a time in their life when their brain was developing the most. We wonder why indigenous youth do not graduate from high school.
To get anything covered through NIHB requires extensive and exhaustive advocacy. I once required post-exposure prophylactic antiretroviral HIV drugs after I performed a procedure in my clinic. The ID specialist recommended I take two drugs within 72 hours of the incident. NIHB denied the claim. I then had to get on the phone myself and speak with the NIHB bureaucrat, who then directed me to the national pharmacist of the NIHB program. I had to tell the national NIHB pharmacist, “If you do not give me these anti-HIV medications, I will be at Canada Place on Monday morning with the Grand Chief of the Confederacy of Treaty Six stating that your policies have possibly caused one of the few indigenous physicians in this country to contract HIV, and it will be in the media. Is that what you want?” Only then was this medication provided. How would a regular person be expected to know how to navigate and advocate through this bureaucratic mess? And we wonder why indigenous peoples have the highest rates of HIV infections.
On April 25, our home care nurse stated that NIHB would not cover wound supplies for a 65-year-old Cree woman who was palliative, dying at home, with metastatic cancer. She required daily dressing changes and NIHB would only give one dressing every three days. I had to spend 60 minutes on the phone with the NIHB bureaucrats and speak with a supervisor to explain that if the patient died of sepsis, I would record how their actions contributed to her untimely death.
It is only when physicians make drastic statements that supplies, equipment and medication are covered. We should not have to do this. Family physicians, specialists and allied health professionals repeatedly state how difficult it is to work within this program and to attain appropriate coverage for indigenous peoples and they ask how this can be improved.
I recommend that the NIHB program be evaluated by indigenous scholars, allies and users of the program and then changed to create an inclusive, responsive and comprehensive program that actually meets the real health needs of indigenous peoples. The current NIHB system only further contributes to our early morbidity and mortality, and its use is a risk factor for our early death.