Indigenous and Northern Affairs Committee on May 13th, 2022

[Caroline Lidstone-Jones]

Yes. It's huge.

We've seen a massive increase in the use of our traditional healing and medicines program, especially during times of COVID-19, where we had more increases in mental health concerns, people who had never experienced anxiety or depression before—all of those things—due to isolation.

Throughout our network, we have created land-based programs with various components. We have hunt camps, fish camps, traditional teachings and ceremonies where they can go in for specialized ceremonies or naming ceremonies. We've also had traditional healers who went out with our communities to learn how to pick traditional medicines, how to do and cure the medicines and how to use them for whatever purpose [Technical difficulty—Editor] picking.

We also found that the role-modelling and mentoring of having youth out on the land with people who are able to navigate the land is a huge piece, and that has been very successful for us. The other piece that we're working on in traditional healing—again, speaking in the Ontario context—is doing better at what we refer to as “two-eyed seeing”, incorporating primary care delivery with our traditional medicines and connecting those two services so that they become harmonized instead of two disjointed programs.

Those are things that we are working on right now. We are doing a lot of work in that area right now because we've seen the massive increase in utilization as a way forward, especially when it comes to mental health and addictions.

[Jaime Battiste]

Thank you.

That's about it for me, I think.

[The Chair, Liberal, Marc Garneau]

Thank you very much.

Ms. Gill, the floor is now yours for six minutes.

[Marilène Gill, Bloc, Manicouagan, QC]

Thank you, Mr. Chair.

I would like to thank the witnesses for being with us today.

I would like to talk about a very important subject that we addressed in another study, one that dealt with housing. Obviously, we noted the impact that lack of access to housing can have in remote communities: it has caused an exodus of the population to urban centres.

Is not having access to health care where they live also a factor that prompts people to leave their community?

Ms. Putulik, do you have any comments about that?

[Maggie Putulik]

Thank you for the question, Ms. Gill.

[Witness spoke in Inuktitut.]

A lot of people do leave the north due to a lack of housing. For sure, that's one big important reason, but most of the patients and escorts do go back home.

A lot of people from the north will leave the north seeking employment in the southern cities or due to various personal reasons. They leave the north escaping either violence or abuse. Many of them are affected by substance abuse once they are in the south, but the majority of our patients—

[Marilène Gill, Bloc, Manicouagan, QC]

I'm thinking of the problem that the need to get dialysis treatments three times a week can cause, for example.

So from what I understand, not having access to health services is not one of the factors that cause people to leave the communities.

[Maggie Putulik]

No.

[Marilène Gill, Bloc, Manicouagan, QC]

Thank you.

I'd like to ask the other witnesses to speak on this subject too.

[The Chair, Liberal, Marc Garneau]

Ms. Lidstone-Jones, do you want to take a crack at answering that question? Then we'll go to Dr. Tomkins.

[Caroline Lidstone-Jones]

Sure. I just found the translation, so hopefully I caught it all.

If I understand correctly, you were asking whether people leave their communities because of their treatment. The answer is yes. Some people do have to leave their community when it comes to treatment.

You mentioned the use of dialysis. Dialysis is huge. It's not only the accessibility of the program, but access to the quality of water that is in a lot of our communities. Some of them are having to leave those circumstances to be able to access that program and that service.

Anything that requires more specialized care.... You have some people, in fact, making the choice where they just choose that they're not going to do it because they have to travel so far, and their health care gets worse. The other thing is that, when they do leave, many times it's leaving by themselves to have that care, so there's the fear and the loneliness factor.

[Marilène Gill, Bloc, Manicouagan, QC]

I'm sorry, Ms. Lidstone-Jones.

I think my question was misunderstood. I didn't want to talk about leaving the community occasionally; I am talking about leaving permanently in order to access health care that is not accessible in the community.

I don't know whether that's how you had understood my question, Ms. Lidstone-Jones. Is your answer the same?

[Caroline Lidstone-Jones]

Yes, there are some who do that as well.

Again, it depends a lot of the times on the complexity. I can speak to that personally. I have a husband who has to be here in the GTA because of the complexity of the health care services we need. I'm originally from northern Ontario, and we're here because of health care.

[Marilène Gill, Bloc, Manicouagan, QC]

Thank you.

I wanted to be sure.

[Caroline Lidstone-Jones]

Yes, the answer is yes.

[The Chair, Liberal, Marc Garneau]

Dr. Tomkins, do you want to answer the question? I know you're in a different part of this discussion, but go ahead, if you wish.

[Dr. Lynn Tomkins]

I'll keep it short.

I would say that, in terms of dentistry, since most of the treatment we do is very much on time, it would not be a cause for somebody.... It would be very unusual unless somebody had a cranial facial disorder, for instance a child, that needed a lot of surgical care, but again, that would be viewed as a temporary—maybe six months to one year—leave and not a permanent move away from the community.

[Marilène Gill, Bloc, Manicouagan, QC]

I'd like to thank all the witnesses for their answers.

My next question concerns the accessibility of health care. The problem arises because of the cost, on the one hand, but also because of the distance to travel to get care and the availability of specialist practitioners. The communities do not necessarily have specialists living there.

Is there a solution to what I would imagine to be the two biggest problems, the availability of specialists and access to care?

It may be utopian to think there could be one big solution to this problem, but do you have any proposals to make to us on this subject?

What would your recommendations be?

Ms. Tomkins, I know it's a bit different for you, again, but I'd still like to hear your opinion on this subject.

[Dr. Lynn Tomkins]

Thank you.

I would have to say that if you build it, they will come. I'm thinking of dental specialists, especially in things like oral and maxillo-facial surgical specialties, who require highly technical operating suites. If we were to see surgical centres in communities that have a high utilization of NIHB services, then you would have the oral and maxillo-facial surgical specialists as well as the dental anaesthesia specialists.

Yes, that would be one of our recommendations.

May I ask Dr. Poon to comment on anything more technical on that?

[Dr. Philip Poon, Lead, Non-Insured Health Benefits Subcommitee, Canadian Dental Association]

Thanks for that, Dr. Tomkins.

That echoes my exact feelings. An example would be pediatric dentistry wait times. Presently in central Ontario we've heard wait-time stories of eight to 14 months for pediatric general anaesthesia for dental surgeries. I think setting up remote surgical centres would provide pediatric dentists an opportunity to go to the communities to perform the work.

I would echo those comments.

[The Chair, Liberal, Marc Garneau]

Thank you.

We'll now go to Ms. Idlout.

Ms. Idlout, you have six minutes.

[Lori Idlout, NDP, Nunavut, NU]

[Member spoke in Inuktitut, interpreted as follows:]

Thank you, Mr. Chairperson.

I will have a question for Maggie, but first I want to respond to Marilène's question. I know of two Inuit, one from Sanikiluaq originally and one from Pangnirtung originally, who had to leave their homes and communities because they could not get medical services in their communities. They had to move to Ottawa for medical care because of their dialysis needs. We do not have them in our communities.

Maggie, I enjoyed your presentation. You talked about how you have been involved for many years in health issues. I was very pleased when you said that you work with largas. You talked about medical escorts and how that could be improved, but we know that people who stay at larga have escorts and staff looking after them.

When they have escorts, how do you feel about the escorts being on the payroll with full-time jobs?

[Maggie Putulik]

[Witness spoke in Inuktitut, interpreted as follows:]

The escorts who are interpreters and assistants and who aid the patient leave their full-time jobs, often without pay, to take time off to do this service. It is very important. They should be called a patient navigator and be under a payroll, because they are an essential service to the person they're assisting.

It is a very critical job that they do. They should be remunerated as such, because the job they do is very important.

[Lori Idlout, NDP, Nunavut, NU]

[Member spoke in Inuktitut, interpreted as follows:]

Lastly, we all understand that we aboriginal people, we indigenous people, have very good traditional healers. You provide mental health services to first nations and Inuit. They use the counselling benefit under NIHB. What is the tracking system when it comes to mental health patients and outcomes?

They also need to have escorts when they travel. I believe they should be paid as well.

[Maggie Putulik]

[Witness spoke in Inuktitut, interpreted as follows:]

Yes. We ordinary people have support systems. We have people and counsellors whom we rely on for mental and spiritual health. We all need that in order to be whole and healthy. Traditional Inuit should be involved in traditional healing and medicines. It should be recognized as a very important service, because we practice it today. Many are in need of mental health supports. Many will suffer from terminal illnesses like cancer. They need someone to support them as well and to be there as a caregiver.

[Lori Idlout, NDP, Nunavut, NU]

[Member spoke in Inuktitut, interpreted as follows:]

We acknowledge them, but we should also acknowledge them with pay.

The situation in Cambridge Bay that you briefly talked about, can you put that in writing and explain it to us?