Evidence of meeting #20 for Indigenous and Northern Affairs in the 44th Parliament, 1st session. (The original version is on Parliament’s site, as are the minutes.) The winning word was system.
A video is available from Parliament.
Vice-President, Health Services, Nunasi Corporation
[Witness spoke in Inuktitut as follows:]
ᐊᐅᔭᐅᓯᒪᓕᖅᑎᓪᓗᒍ ᓯᑯᑦᓴᔭᒦᑎᓪᓗᒍ ᖃᐃᔪᓐᓇᑦᑎᐊᓛᖅᑕᕋ ᐅᓐᓂᑑᑎᒋᓗᒍ proposal−ᖑᑎᓪᓗᒍ ᐅᓐᓂᑑᑎᐅᑎᓪᓗᒍ, ᑕᐃᓐᓇ ᐃᔾᔭᕋᒃᓴᖅᑎᓪᓚᕆᐅᒻᒪᑦ ᓯᐊᒻᒪᒋᐊᖃᖅᓱᓂᓗ ᓄᓇᓕᒥᒫᓂ ᐱᐅᔪᓪᓚᕆᐅᔫᒻᒪᑦ ᐃᑲᔪᖅᓯᒪᓪᓗᓂᓗ ᓄᓇᖓᓂ ᑖᕙᓂ, ᖁᔭᓐᓇᒦᒃ.
[Inuktitut text interpreted as follows:]
Yes, I will write the report to you and explain the situation of what happened. It's a very good case study of how we can be more community-based when it comes to healing and assisting our people.
NDP
Lori Idlout NDP Nunavut, NU
[Member spoke in Inuktitut as follows:]
ᖁᔭᓐᓇᒦᒃ. ᐱᕕᖃᖅᐳᖓ ᓱᓕ?
[Inuktitut text interpreted as follows:]
Thank you.
Liberal
The Chair Liberal Marc Garneau
Ms. Idlout, you still have a minute. Is it okay if we proceed to the next?
NDP
Lori Idlout NDP Nunavut, NU
If I still have a minute, I'd like to ask Caroline Lidstone-Jones something.
[Member spoke in Inuktitut as follows:]
ᐊᐱᕆᔪᒪᕙᒋᑦ ᑖᓐᓇ ᓄᓇᖃᖅᑳᖅᓯᒪᔪᓂᑦ ᐃᑲᔪᖅᑎᐅᔪᑦ ᐃᓄᓕᕆᔩᑦ ᐅᖃᐅᓯᕆᔪᓐᓇᖃᑕᐅᒻᒪᖔᒍ ᐊᑭᓕᖅᑕᐅᔾᔫᒥᔭᐅᔭᕆᐊᖃᕐᒪᖔᑦ ᐊᒻᒪᓗ ᖃᓄᖅᑑᑎᓂᑦ ᐱᖁᔨᕗᖔᕈᑎᓂᑦ ᐱᖃᕋᔭᕐᒪᖔᕐᐱ?
[Inuktitut text interpreted as follows:]
Caroline Lidstone-Jones, indigenous leaders who are involved in working with youth are providing a very important role as role models and mentors. They ought to be paid as well. What do you think?
Chief Executive Officer, Indigenous Primary Health Care Council
Absolutely. We actually pay them on a payroll. We view them as part of and in alignment with primary care. We hold them as valued as your doctors, nurses and NPs. That's where we hold ours.
Similar to.... I'm sorry, I'm missing the name of the previous speaker. We also fund our navigators. We call them “natural helpers”. Any time somebody goes out into a medical situation or as an escort, we will help give an actual honorarium to that individual per day, because they're there in a helper role. We also recognize the importance.
As you mentioned, the spirit is important. If we don't take care of that spirit, that is the way we do it as a community. That is part of our foundational teachings. A lot of us as Inuit people share that, so we recognize that. We're absolutely willing to share any policies and procedures we have about that with anybody who is interested.
Liberal
The Chair Liberal Marc Garneau
Thank you very much.
We're going to proceed to a quick second round, a shortened one, starting with Mr. Vidal.
Mr. Vidal, I can give you three minutes.
Conservative
Gary Vidal Conservative Desnethé—Missinippi—Churchill River, SK
Thank you, Mr. Chair.
Dr. Tomkins, I was watching your expression as my colleague, Mr. Schmale, was talking to Ms. Lidstone-Jones about some of the frustrations around the bureaucracy and providers not engaging. You just heard the chairman limit my time, which is fair, but I want to give you a quick chance to respond to your experience in your profession, and if that's true there. Maybe you could quickly add to that what you think some of the solutions might be to that challenge.
President, Canadian Dental Association
Thank you very much. I'll be brief, because I'll defer to Dr. Poon as well, who's our technical adviser.
Definitely as a provider it can be extremely frustrating, because you have a patient in the chair, they need the treatment, but you have to get pre-authorization or predetermination. You know from previous experience that it's going to be approved, but unless you get it approved they're not going to cover it. You have a patient who's in pain and sometimes you have to send them away with a prescription for an opioid or an antibiotic—which contributes to a whole bunch of other problems—and then have them come back to actually have the problem addressed. Between those appointments they might end up in the emergency department at a hospital, where all they do is give them more opioids and antibiotics.
If I may, I'll ask Dr. Poon to comment on that as well.
It is one of our recommendations to reduce the administrative burden and the amount of pre-authorization for things that always come back approved anyway.
Lead, Non-Insured Health Benefits Subcommitee, Canadian Dental Association
Thanks again.
I'll try to make it brief. Maybe I'll just give an example of what might happen in my office. I've been practising dentistry for 42 years, most of the time in downtown Winnipeg, which has a high proportion of indigenous patients. Some of them are from up north, because of the geography of Manitoba.
I'll give an example of what happens probably at least once a week, maybe once a month. We have a patient from Garden Hill, Manitoba, which is a fly-in reserve with winter ice roads. He's lost his front teeth from an accident. They were extracted on the reserve by the visiting dentist. He has to wait for the ice roads to come in. He drives into Winnipeg and comes to my office. The NIHB program is supposed to be a comprehensive program that includes all treatments. He comes in requesting a partial denture. I can't proceed with that partial denture. I have to do a predetermination or pre-approval with the predetermination centre. Sometimes it's by fax. The approval process may take three to 10 days.
This is the catch. It's so strange. It's never denied. Rarely is it denied. The patient meets the requirements for a partial denture. We know the rules. We submit it. It's not denied, but we still have to wait. After three or four days of being in town he has to go back, because he's only in town for a medical appointment or as an escort. We couldn't proceed with that treatment. I don't have to explain to the people here the costs of medical transportation, either to the system or to the patient.
That's my one in-person example where this is a problem.
Liberal
The Chair Liberal Marc Garneau
Thank you very much.
We will go to Mr. Badawey.
Mr. Badawey, you have three minutes.
Liberal
Vance Badawey Liberal Niagara Centre, ON
Thank you, Mr. Chair.
I guess my interest is with Ms. Lidstone-Jones with respect to some of the comments she made about community health centres and some of the initiatives you're already on.
Ms. Lidstone-Jones, what is your vision as it relates to indigenous communities in establishing community health centres, including the services we're discussing today, and other ancillary services that are accessible?
When I say ancillary services, I'm talking about endocrinology, cardiac, neuro and things that sometimes we don't see in indigenous communities and people have to travel for but that can be established within indigenous communities. Can you comment on that?
Chief Executive Officer, Indigenous Primary Health Care Council
Yes. I'm thrilled if you're thinking in that direction, for sure.
We promote a model of holistic health and well-being. That is our model of care. We have a lot of integrated services already, so wherever we can integrate, we do. I know one of the previous speakers asked a question about housing and things like that. Where we can do supportive relationships that way, those are the things....
For example, it became loud and clear during COVID that one of the places [Technical difficulty—Editor] secure people to do housing. That then became an impact on health care and health care delivery.
Absolutely, we are fully integrated. Right now we have nurses and physicians. We have midwifery under us. We have mental health and addictions. We have traditional healing and wellness. We have some rapid-access medicine programs. We have programs where we can link up with hospitals and do testing on site. Those specialists will come to us, and we will bring the patients into that setting, a setting that they are comfortable in and used to.
We have, in some cases, some oral health dental programs, not as much as we would like, but wherever there is an opportunity for us to expand those services, we 100% feel that's the way to go because then it creates a hub where people don't have to individually navigate pieces of the system. The system then is supportive of them rather than them trying to navigate the system. That, to us, is about our primary responsibility as health care providers. Wherever we can do that, we 100% do that. We have many models in place where we continue to integrate.
Some of the things we're starting to integrate now are, for example, home [Technical difficulty—Editor] people in their homes and be able to do that. We have also started to add in programs where we do palliation in the home, so we can help families navigate, deal with pain and all of those kinds of things.
Wherever we can keep people in communities or as close to the community as possible, we help facilitate.
Liberal
Vance Badawey Liberal Niagara Centre, ON
That's wonderful.
Mr. Chair, I know you're going to cut me off any time now, but I will just—
Liberal
Vance Badawey Liberal Niagara Centre, ON
—ask this in closing.
Ms. Lidstone-Jones, if you can contact my office so we could talk more about this, I would truly appreciate it because it is, in fact, something I'm looking at doing.
Chief Executive Officer, Indigenous Primary Health Care Council
I will, 100%. Absolutely.
Liberal
Bloc
Marilène Gill Bloc Manicouagan, QC
Thank you, Mr. Chair.
I'd like to hear Ms. Putulik's and Ms. Lidstone-Jones' comments on the question of the availability of physicians and access to health care.
What might be the best solution for Inuit and Indigenous communities?
Liberal
The Chair Liberal Marc Garneau
Thank you.
Ms. Lidstone-Jones, do you want to start, and then we will go to Ms. Putulik?
Ms. Putulik, did you hear that? Perhaps you could start.
Vice-President, Health Services, Nunasi Corporation
It would be best to invest in infrastructure to repatriate certain specialities, for instance, nephrology. People on dialysis have to be relocated to the south on a permanent basis until they are eligible for a kidney donor. It's very sad to see, especially unilingual elders having to leave their natural environment, their home community, not being able to speak a second language, permanently being away, having an escort once in a while and not having permanent family members with them at all times.
It is essential and vitally important to invest in infrastructure with proper water filtration systems for dialysis treatment centres. Thank you.
Liberal
NDP
Lori Idlout NDP Nunavut, NU
[Member spoke in Inuktitut as follows:]
ᖁᔭᓐᓇᒦᒃ, ᒥᒋᓐᒧᑦ ᐊᐱᕆᒃᑲᓐᓂᕐᓂᐊᕋᒪ. ᑖᒃᑯᐊ ᒪᓕᒐᓕᐅᖅᑎᔾᔪᐊᑎᒃᑲ ᑐᑭᓯᐊᓂᖅᑰᙱᒻᒪᑕ ᓲᕐᓗ ᐃᔨᓕᕆᓂᐅᑉ ᒥᒃᓵᓄᑦ ᐱᑕᖃᑦᑎᐊᙱᓐᓂᖏᓐᓂᑦ ᓄᓇᕗᒻᒥᐅᓄᑦ ᑐᑭᓯᐊᒋᐊᒃᑲᓐᓂᕈᓐᓇᐱᒌᑦ ᖃᓄᐃᒻᒪᑦ ᑖᓐᓇ ᐱᖁᔨᕗᖔᖅᑲᐅᙱᒻᒪᖔᖅᐲᑦ ᑖᑉᓱᒪ ᒥᒃᓵᓄᑦ?
[Inuktitut text interpreted as follows:]
Thank you.
My question is for Maggie.
I don't think the other members of Parliament fully understand that vision care is not really available in Nunavut.
Can you explain its importance and what we're lacking in vision care?
Vice-President, Health Services, Nunasi Corporation
[Witness spoke in Inuktitut as follows:]
ᑕᐃᒃᑯᐊ ᐃᔨᓕᕆᔩᑦ ᐃᔭᐅᑎᓕᕆᔩᓪᓗ ᐊᕐᕌᒍᑦ ᐃᓗᐊᓂ ᖃᑦᓯᕕᐊᐱᒃᓱᑎᒃ ᑭᓯᐊᓂ ᓄᓇᓕᓐᓄᑦ ᐊᕐᕕᑲᓲᖅ ᐊᒻᒪᓗ ᐃᑭᑦᑐᐊᐱᓐᓂᒃ ᐊᑯᓂᐅᙱᑦᑐᖅ ᓄᓇᓕᓐᓂ ᐃᓗᐊᓃᓐᓂᐊᖅᓱᑎᒃ, ᑕᐃᒃᑯᐊ ᐃᔨᓕᕆᔭᐅᔪᒪᒐᓗᐊᑦ ᐱᕕᑭᑦᑑᓗᐊᕐᒪᑦ ᐃᔨᓕᕆᔭᐅᔪᓐᓇᙱᑦᑐᑦ ᐊᒻᒪᓗ ᐊᒥᓱᐃᑦ ᑲᓛᑦ ᓄᑕᖅᑲᐃᑦ ᑕᒃᐲᑦᑑᑦᓱᑎᒃ ᐃᓕᓐᓂᐊᕆᐊᒃᐸᒃᑐᑦ, ᑕᑉᐲᑦᑑᑯᒥᓂᖓᓄᑦᑕᑯᔭᖃᕈᓐᓇᙱᓐᓇᓂ ᐊᓪᓚᑕᐅᔪᓂ ᐃᓕᑦᓯᓂᖏᑦ ᑭᖑᓯᖅᐳᑦ, ᑕᐃᒃᑯᐊ ᐃᔨᓕᕆᔩᑦ ᖃᖓᑦᓴᕋᓴᐅᓕᕐᒪᑦ ᑭᓯᐊᓂ ᓄᓇᓕᓐᓄᑦ ᐊᕐᕕᑕᓲᖑᒻᒪᑕ ᑕᒪᓐᓇ ᐋᖅᑭᒋᐊᕆᐊᓕᒃ ᐊᒻᒪᓗ ᐃᔨᓕᕆᕖᑦ ᓄᐃᑕᐅᒋᐊᖃᖅᓱᑎᒃ ᓄᓇᓕᒻᒥ, ᐊᕐᕕᑕᖅᑐᐃᑦ ᑭᓯᐊᓂ ᐱᒍᔾᔨᖃᑦᑕᕐᓂᐊᙱᒻᒪᑕ, ᑕᐃᓐᓇ ᐃᓪᓗᖅ ᐃᔨᓕᕆᔭᐅᕕᒃ ᓄᐃᑕᐅᓪᓚᕆᔭᐅᔭᕆᐊᖃᖅᑐᖅ ᓄᓇᓕᒫᓂ, ᖁᔭᓐᓇᒦᒃ.
[Inuktitut text interpreted as follows:]
Special eye care comes to the communities maybe once or twice a year. They have very limited time in the community. Those who want to see the eye specialist do not all get seen. Children, especially, who have eye problems are attending school with poor vision. That affects their learning.
The eye specialists do not come to the communities often or regularly enough. There are many patients to be seen in each community regarding eye problems. We need an eye clinic in the communities.
Thank you. I hope that is a good response and one that you are looking for.
Liberal
The Chair Liberal Marc Garneau
Thank you very much, Ms. Putulik.
Thank you, sincerely, to all of our witnesses today.
Thanks to Dr. Lynn Tomkins on the issue of dental care and her colleague, Dr. Philip Poon.
Thank you very much, Caroline Lidstone-Jones.
Thank you, Maggie Putulik, for shedding light on some of the challenges with respect to non-insured health benefits.
Thank you for answering our questions today. You've made an important contribution to our study.
With that, colleagues, we'll suspend very briefly and prepare for the next panel.
Liberal
The Chair Liberal Marc Garneau
I'd like to welcome our witness as we begin this second panel.
We have Ken Kyikavichik, Grand Chief of the Gwich'in Tribal Council, Isabelle Wallace, community health nurse, Madawaska Maliseet First Nation, and Betty Villebrun, Vice-President, Northwest Territory Métis Nation.
Welcome to our panel today.
This is just a reminder that, on the bottom of your screen in the centre, there's a symbol that looks like a globe. That's your interpretation button. If you use that, you can get translation into the language you want to listen to. Don't hesitate to use that because sometimes people will speak in French, English or Inuktitut.
With that, the way we start is with each witness being asked to make an opening statement of five minutes. I'll try to hold you to that.
I'm not sure which one is not with us, but I do see Isabelle Wallace in front of me on the screen.
Ms. Wallace, the floor is yours for five minutes to make your presentation.