It's a complex question with complex solutions. I used to work in a first nations and Inuit health branch as a university student, so sometimes I walked by the NIHB employees and staff and had a listen to the conversations that they were having with our people. Some of them were around medical transportation, which was mentioned previously, and they would ask, “Why can't you just walk to the health centre?” There's no public transportation on reserves, as people know.
What I find is that the bureaucrats who work under the program are completely out of touch with the reality of the lived experiences of people on the reserve and the communities that they're supposed to provide care for. They act as an extreme barrier to the provision of basic, standard care. They don't have any training about indigenous peoples, about indigenous peoples' health, about our treaty promise to health and the provision of health care, medical services and supplies. That is a huge issue.
You mentioned a second piece, which is the tremendous advocacy that physicians or health providers have to do to navigate and get items covered under that program. As indigenous physicians, other indigenous colleagues and I, who work with our own people, routinely have to get people's names and supervisors and document them in the medical chart. We literally say, “You will cause the death of this patient. I'm documenting this and your name will be on the death record as, potentially, one of the contributing causes.” Only then are items covered under this program.
It shouldn't take that level of advocacy. Most health professionals don't even know how to navigate through this system, because they're not taught about it within their professional schools, whether that's in medicine or pharmacy. It's only when we are forced to work within this system that we have to figure out which buttons to press to ensure that something is covered.
When we compare that to any other extended health benefits, whether that's Blue Cross, Manulife or any of the other ones in this country, providers routinely say that the NIHB program is the most difficult and causes the most harm to patients when they want to access it. It is also the most humiliating for patients to access, when they're at the provider's, looking to have their pharmaceutical or their medical equipment covered and having to stand there and advocate for themselves to great lengths to ensure that they receive proper care.