Indigenous and Northern Affairs Committee on May 10th, 2022

[Jaime Battiste, Liberal, Sydney—Victoria, NS]

I know I don't have a lot of time left, but I want to ask all three participants—

[The Chair, Liberal, Marc Garneau]

You have 50 seconds, Mr. Battiste.

[Jaime Battiste, Liberal, Sydney—Victoria, NS]

—the following question.

If we were to invest money in a certain area of indigenous health that needs more capacity for indigenous health care workers, where do you think we would best make those investments? Answer quickly, please, all three participants.

[Angela Grier]

It's mental health.

[Rudy Malak]

It's mental health, absolutely, and addiction.

[Jaime Battiste, Liberal, Sydney—Victoria, NS]

Can you be specific in terms of mental health supports? There are case workers out there. What do we need?

[Angela Grier]

We need CCCs.

[Rudy Malak]

We need follow-ups. People get diagnosed, and then they don't get the follow-ups, counselling, the cognitive behavioural therapy and the psychotherapy. It's not just medication. They need counselling and follow-ups constantly.

[The Chair, Liberal, Marc Garneau]

Thank you very much.

Go ahead, Mrs. Gill. You have six minutes.

[Marilène Gill, Bloc, Manicouagan, QC]

Thank you, Mr. Chair.

I would like to thank Ms. Grier, Mr. Malak and Ms. Tshernish for being with us today. Their experience on the ground will no doubt inform our work.

I have some questions for Ms. Tshernish, the director of the total health and wellness sector for the ITUM.

Ms. Tshernish, I'd like to hear more about your experience on the ground.

Do you have recommendations to share with us? The committee doesn't have a lot of time to do its work.

Tshinashkumitin.

[Marceline Tshernish]

Thank you for your question.

I would come back to mental health. One of Uashat Mak Mani‑Utenam's priorities would be to invest in mental health programming for youth. Those programs do not exist in our community right now, and I don't think the provincial landscape is much better. We are really in need of those services because we are seeing children in psychological distress at a very early age, even at the elementary school level. Substance abuse is another major problem in the community.

Care and services related to chronic illnesses would be another priority, including promotion, prevention and even healing. Another concern is access to medical supplies and equipment, as well as pharmaceuticals, because the application and approval processes should be streamlined, and that is true for all benefit claims.

Memorandum of understanding should be established with the various care providers, whether dental care providers or private clinics, to streamline the process and ease the burden on patients. It is also important to ensure that culturally safe health care services are available. We need funding to ensure that our own expertise in healing is recognized, particularly for services provided in the community, and we should be allowed to develop our own eligibility criteria in that regard.

Those are the issues I would flag at this time.

[Marilène Gill, Bloc, Manicouagan, QC]

Thank you, Ms. Tshernish.

You can send us the portion of your opening statement that you didn't have time to get to. That will ensure the committee can take your comments into account.

Throughout today's meeting, people have frequently referred to the land and the community, whether it be Nutshimit or Nitassinan.

Can you talk more about that?

I would like to know how that aspect could be integrated. As I understand it, the connection to the land is not recognized, but it is part of the healing process.

What would you recommend to the committee on that front?

The question is for all three witnesses. Perhaps you can go first, Ms. Tshernish.

[Marceline Tshernish]

For us, health is a whole. First nations have a holistic view of the health care system. A person's well-being stems from the well-being of their family, the people around them and the environment in which they live. Given the history of families being expelled from Nitassinan land to indigenous communities, we firmly believe in the importance of reclaiming our knowledge.

Right now, we are looking at how we can take full advantage of our healing approaches on the land. We hold information sessions for client groups of various ages to make sure that they can choose between so-called traditional medicine and the medicine that represents us, as first nations. Members of the community are clearly interested, and we are already seeing the effects of Nitassinan- or land-based healing on people's well-being.

I would be remiss if I did not mention the loss of language. Earlier, the discussion focused on the importance of providing care to first nations members in their language. That is a problem when it comes to the care and services we provide.

[The Chair, Liberal, Marc Garneau]

Thank you, Madame Gill.

Madam Idlout, you have six minutes.

[Lori Idlout, NDP, Nunavut, NU]

[Member spoke in Inuktitut as follows:]

ᖁᔭᓐᓇᒦᒃ ᓯᕗᓪᓕᕐᖕᒥᒃ ᑖᒃᑯᐊ Angela-ᑯᑦ Machelen-ᑯᑦ ᖁᔭᓐᓇᒦᕈᒪᕙᒃᑲ ᐅᖃᐅᓯᕆᔭᓯ ᑐᓴᕐᖕᓂᖅᑐᐃᓐᓇᐅᓵᕐᖕᒪᑕ ᐱᒻᒪᕆᐅᓪᓗᑎᒡᓗ ᐋ ᐊᒥᓱᓂᒃ ᐊᓪᓚᓂᒃ ᐊᓪᓚᖓᔪᓂᒃ ᐃᓄᖕᓂᒃ ᐊᑦᔨᐸᓗᖏᓐᓂᒃ ᑐᓴᖅᓯᒪᒐᑦᑕ ᐊᐃᑦᑖᖑᒐᓗᐊᖅ ᑐᑭᓯᓇᑦᑎᐊᖅᑐᓂᒃ ᐅᓂᒃᑳᓵᕋᑦᓯ ᖁᔭᒋᕙᑦᓯ Rudy-ᒧᑦ ᐊᐱᖅᓱᓪᓗᐊᑕᕐᖕᓂᐊᕋᒪ ᑖᓐᓇ ᑐᑭᓯᕝᕕᒋᔪᒪᒐᒃᑯᐃᓛᒃ ᐄᔭᒐᖅᑐᓕᕆᓂᐅᑉ ᒥᒃᓵᓄᑦ ᖃᐅᔨᒪᑦᑎᐊᖅᐸᓚᑦᑎᖕᒪᑦ. ᐊᐱᕆᔪᒪᕙᒋᑦ Rudy ᖃᓄᖅ ᐊᑯᓂᐅᑎᒋᔪᖅ ᐊᑭᓕᖅᓱᖅᑕᐅᒐᓱᖃᑦᑕᖅᐲᑦ? ᑖᒃᑯᓄᖓ ᓄᓇᖃᖅᑳᖅᓯᒪᔪᓄᑦ ᐋᓐᓂᐊᖃᕐᖕᓇᖏᑦᑐᓕᕆᓂᕐᖕᒧᑦ ᓇᓪᓕᐅᒃᑯᒫᖃᖏᑦᑐᓄᑦ ᐃᑲᔫᓯᐊᒃᑯᓐᓄᑦ ᐊᑭᓕᒐᒃᓴᓂᒃ ᑐᓂᐊᓂᒃᑳᖓᕕᒋᑦ, ᖃᓄᖅ ᐊᑯᓂᐅᑎᒋᔪᖅ ᐊᑭᓕᖅᑕᐅᓇᓱᖃᑦᑕᖅᐲᑦ ᑖᒃᑯᓄᖓ?

[Inuktitut text interpreted as follows:]

Thank you.

I want to thank Angela and the other people for their presentations. These are very informative and very important issues that you've raised. It is clear that the Métis have been treated differently than the Inuit and first nations have.

I have a question for Rudy Malak.

I want to understand this better. When you're a pharmacist, you are well informed—it's your business. How long does it take for you to get paid by the NIHB after you have billed them? What is the waiting time?

[English]

[Rudy Malak]

I believe it's two weeks.

[Lori Idlout, NDP, Nunavut, NU]

[Member spoke in Inuktitut as follows:]

ᐄ ᖁᔭᓐᓇᒦᒃ ᐊᑭᓕᖅᓱᖅᑕᐅᖏᑦᓲᔭᖃᑦᑕᕐᖕᓂᐅᑉ ᒥᒃᓵᓄᑦ ᑖᓐᓇ ᐃᓱᒫᓘᑎᐅᖕᒪᖔᑦ ᐅᓂᒃᑲᐅᑎᒋᔪᓐᓇᖅᐱᐅᒃ?

[Inuktitut text interpreted as follows:]

Thank you.

I know that as a business person I would be worried if I wasn't getting paid on time, because it would put my business at risk. Has that ever happened to you?

[English]

[Rudy Malak]

It definitely has, but what has happened is that it's not the delay. It's the decline or the nonpayment.

If I can, I'll give a quick example. A patient has an ostomy. An ostomy is an opening in their abdomen. They've had cancer and the removal of part of their colon, let's say, and this is their only way to excrete waste out of the body. They need pouches, they need flanges and they need tens of different items to be able to excrete that waste out of their body.

We've applied once and twice and three times, let's say, and months and months have passed. When the patient comes in, what am I going to do? Tell him that I cannot give it to them? I've given them multiple supplies, and because I haven't received approvals or the doctor hasn't filled out the document or...or...or...it has been months and months and months.

Sometimes, yes, the lack of approvals sometimes may not.... We don't refuse care, but sometimes we ask the patient if they can pay for it or if they can go to their health centre so that they can also advocate on their behalf there, because the process is very tedious, very difficult and very time-consuming. Yes, we sometimes cannot get paid if things are not done correctly and on time.

[Lori Idlout, NDP, Nunavut, NU]

[Member spoke in Inuktitut as follows:]

ᐋᒻ ᐊᐱᕆᒃᑲᓐᓂᖅᓗᑎᖅᑲᐃ ᐋ ᓇᖕᒥᓂᖅ ᐃᒃᐱᐊᕐᔪᖕᓂᓐᖔᖅᑐᒥᒃ ᐊᑭᓕᖅᓯᖃᑦᑕᕆᐊᖃᓕᖅᓯᒪᓂᑰᕖᑦ? ᑕᒪᒃᑯᐊ ᐋᒻ ᑖᒃᑯᐊ ᐃᑲᔫᓯᐊᒥᓐᖔᖅᑐᓂᒃ ᐸᐃᑉᐹᓂᒃ ᑕᑕᖅᓴᐃᓯᒪᑦᑎᐊᖏᑉᐸᑕᓘᓐᓃᑦ ᐅᕝᕙᓘᓐᓃᑦ ᖃᓄᑐᐃᓐᓇᖅ ᑐᑭᓯᕕᒋᔪᒪᓪᓚᕆᒃᑲᒃᑭᑦ ᐃᕝᕕᑑᖏᑦᑐᒃᓴᐅᒐᕕᑦ ᐄᔭᒐᖅᑐᓕᕆᔨᐅᓪᓗᑎᑦ ᐊᒥᓲᖕᒪᑕ ᑲᓇᑕᒥ ᐋᒻ ᑖᒃᑯᐊ ᓄᓇᖃᖅᑳᖅᓯᒪᔪᓂᑦ ᐋᒻ ᐃᓄᖕᓂᑦ ᐃᑲᔫᓯᐊᕐᖕᓂᒃ ᐄᔭᒐᖅᑖᕈᑎᓂᒃ ᐃᑲᔪᕆᐊᖃᖅᑑᒐᓗᐊᑦ ᑐᓴᐅᒪᐅᔭᐃᓐᓇᕋᒪ ᐋᒻ ᐃᓅᖃᑎᓐᓂᑦ ᑖᒃᑯᐊᒎᖅ ᑐᓂᔭᐅᑦᔮᖏᑦᑐᑦ ᐊᑭᖃᕐᖕᓂᐊᕐᖕᓂᖏᓐᓄᑦ ᐅᖃᐅᑦᔭᐅᕙᒃᓗᑎᒃ ᑖᒃᑯᐊᒎᖅ ᐄᔭᒐᖅᑖᖅᕖᑦ ᐋᒻ ᐋᒃᑳᖅᓯᖃᑦᑕᕐᖕᒪᑕ ᐊᑭᓕᖅᑕᐅᑦᔮᖏᓐᓇᒥᒎᖅ ᑖᓐᓇ ᑐᑭᓯᒋᐊᒃᑳᓐᓂᕋᓱᑐᐃᓐᓇᖅᐸᕋ.

[Inuktitut text interpreted as follows:]

As another final question to you, are you often paying out of your own pocket when these situations arise because the paperwork is not done, because the approval hasn't been done or because it's not covered by NIHB? I think you would not be the only one in the pharmacy who is sometimes paying out of your own pocket when you serve indigenous people, supposedly under the NIHB.

I have heard that some Inuit have been told, “We cannot pay. These are to be paid out of your pocket.” Then the pharmacist has refused to give us our medication because it wasn't approved.

[English]

[Rudy Malak]

Sometimes that does happen. Yes, that is correct.

[Lori Idlout, NDP, Nunavut, NU]

[Member spoke in Inuktitut as follows:]

ᐋᒻ ᑕᐃᒪᓐᓇᐃᒃᑳᖓᒥᒃ ᖃᓄᑎᒋ ᑐᑭᓯᑎᒃᑲᓐᓂᖅᐹᓪᓕᕈᓐᓇᖅᐱᑎᒎᑦ? ᖃᓄᑎᒋ ᐊᖏᑎᒋᖕᒪᖔᑦ ᑖᓐᓇ ᐃᓱᒫᓘᑎᒻᒪᕆᐅᖕᒪᖔᑦ ᐅᖃᐅᓯᒃᑯᑦ ᐅᓂᒃᑲᐅᑎᔪᓐᓇᖅᐱᑎᒎᑦ?

[Inuktitut text interpreted as follows:]

When that happens, can you illustrate to us how damaging that could be to your own business and how much you are paying out of pocket when those situations arise?

[English]

[Rudy Malak]

It's very damaging to the patient, first off, because they leave. They can be frustrated. Some people can fight on their behalf and go speak to the doctor or go to the health centre, but some other patients are vulnerable. If they have a mental health issue or if they have, let's say, schizophrenia or something of significance, so that they cannot fight on their behalf, they just leave. They don't get the care, and they end up in the hospital somewhere because they can't fight for themselves.

For some people who have come again and again, we ask them to also help us. We ask them to call the doctor, call the office, call NIHB and call the health centre. That's the only way to get things moving.

[The Chair, Liberal, Marc Garneau]

Thank you, Ms. Idlout.

We're going to proceed very quickly to a second round. I believe Mr. Schmale is up.

Mr. Schmale, you have five minutes.

[Jamie Schmale, Conservative, Haliburton—Kawartha Lakes—Brock, ON]

I'll start with Mr. Malak.

I don't think anyone has brought this back up, but at the beginning, did you say, “Faxes get lost”?

[Rudy Malak]

Absolutely.