Indigenous and Northern Affairs Committee on May 13th, 2022

[Isabelle Wallace, Community Health Nurse, Madawaska Maliseet First Nation]

Thank you.

Qey, hello, bonjour.

N'toliwis [My name is] Isabelle Wallace and I am a community health nurse in the Madawaska Maliseet First Nation, which is where I come from and of which I am a member. I am a proud Wolastoqey nurse who has had the opportunity to practise in a number of First Nations, Métis and Inuit communities, including in New Brunswick on my traditional unceded land, and in northern Quebec, Ontario and Manitoba.

I have Indian status, and have had since I was born. I believe that my master's thesis on Indigenous cultural competence, my professional career, and my experience as a Wolastoqey woman equip me to make a considered judgment of the NIHB or Non-Insured Health Benefit Program. I am honoured to be able to share my opinion and suggestions in connection with this study. Thank you for inviting me to appear before the committee.

To put my testimony in its proper context, I'd like to tell you about the profile of my community. The Madawaska Maliseet First Nation is located in northwestern New Brunswick, on the Quebec border and the border with Maine, in the United States. We represent 196 members who live on the reserve land and 404 members who live off the reserve.

Ours is the only First Nations reserve where French is the majority language spoken and English is the minority. However, because of the violent assimilation measures imposed by successive governments over the years, no one in our community speaks Wolastoqiyik, our ancestral language.

In 2021, we won a victory in our land claim, after which we had a large part of the city of Edmundston recognized as being located on our "reserve" lands. So you can see that we are close to Edmundston and the members of our community have access to the regional hospital and various health professionals in the private sector.

As a community health nurse, my role is to provide care in various sectors of health care, including public health, community health, home care, and primary health care. Before the pandemic, we were already asking for a nurse to deal with a complex and flawed health care system. Now, we also have to do crisis management, plan numerous vaccination and testing clinics, educate the members of our community, and find innovative solutions to respond to health care needs.

The additional complexities generated by the NIHB program are therefore quite simply an unnecessary burden for a community health nurse. I am even prepared to say that the numerous flaws in the program fuel racism in our region.

A recent example was last week, when I contacted a private sector health care provider to facilitate communication between that professional and a client.

When we were discussing a member of my family, the person not being aware of that relationship and so that I am part of the community myself, the person said: "Personally, Indians, I don't deal with that."

After I asked for clarification so I could determine whether she was refusing to provide services only to First Nations, she told me that all clients had to pay in advance, but that, she said, she was going to have trouble getting paid by an "Indian".

I think my role, as a community health nurse, is to advocate for my clients and my family so they get access to equitable health care, while, at the same time, I also have to deal with racist remarks on a daily basis.

Because of a lack of training on the program, my role is to educate providers about navigating the system and to act as a facilitator.

Unfortunately, I have several other examples where I was able to feel and observe, concretely, the consequences of these failures and of the closed and unacceptable attitude on the part of health care providers, whether as a client or as a colleague.

I could say more about the laborious administrative duties that come with the program or the hours spent on following the appeal process. However, I think the essence of my testimony would get lost.

In my opinion, the lack of sensitivity and of rigorous, continuous training on the part of health care professionals in all sectors has extremely harmful consequences for the health of members of the First Nations and on Métis and Inuit.

Instead of looking after their welfare, the NIHB program contributes to widening the gulf between its clients and non-Indigenous people.

Woliwon. Thank you.

Thank you for giving me the opportunity to speak on this important subject and to represent the members of my community.

I will be happy to answer your questions.

[The Chair, Liberal, Marc Garneau]

Thank you, Ms. Wallace.

I notice that Grand Chief Kyikavichik of the Gwich'in Tribal Council is with us.

Over to you, Grand Chief. You have five minutes for your opening remarks.

[Grand Chief Ken Kyikavichik, Gwich'in Tribal Council]

Drin Gwiinzii. Good afternoon, Mr. Chair and honourable committee members.

My name is Ken Kyikavichik, and I am the grand chief of the Gwich'in Tribal Council of the Northwest Territories. I was elected in September of 2020, and I am here speaking on behalf of the over 3,500 participants in our Gwich'in Comprehensive Land Claim Agreement, which we signed with Canada in April of 1992.

I would like to thank you for the opportunity to speak to the committee on today's topic. Today I will focus on how we, as the Gwich'in Tribal Council of the Northwest Territories, feel that the non-insured health benefits program, or NIHB for short, is failing not only our Gwich'in participants but the broader majority-indigenous population of the Northwest Territories.

The confusion and miscommunication between the NWT health care system and the NIHB leads to gaps and non-client-centred care. The issue of medical escorts is a major concern for residents of the north. Our people are often at least a full day's travel away from larger medical facilities and centres in Yellowknife and Edmonton. For specialist care, community health centres in our communities of Aklavik, Fort McPherson and Tsiigehtchic, along with our regional hospital in Inuvik, NWT, are not well equipped. As a result, our residents are required to travel to these southern locations for the care they require.

It is common for us to hear of residents who require a medical travel escort and do not receive one. This is especially concerning when we are dealing with the elderly. Some examples that we flagged in the summer of 2021 for NWT health minister Julie Green included procedures with sedation, back surgery, those in a wheelchair or walker, and those who have language and mobility issues.

When medical travel escorts are sought from the NWT Health and Social Services Authority, our people are often caught in the bureaucracy and are required to prove their conditions, otherwise this essential support is seemingly automatically denied. As one can imagine, this leaves our residents and families feeling very angry, frustrated, disappointed, stressed and ultimately hurt, as they are engulfed in the policies, procedures and red tape associated with these government benefits in the NWT.

Esteemed members of this committee, picture yourself being in what are supposed to be your golden years. Perhaps you are a residential school survivor. You are told that you require a medical procedure in the south, far away from home. You are then told that you are to be picked up by a van for transport to the nearest airport. You get to the airport often hours in advance because there are other trips to coordinate. You fly almost six hours into Edmonton through Yellowknife and then wait for the transport to your accommodations. By the time you lay your head on your pillow, as many as 16 hours may have elapsed.

You wake in the morning, and you're told where to be for pick-up for your appointment. In all of this, it is expected that you are able to speak English, but there are many in the NWT who do not speak English as a first language. You arrive at the hospital, and you wait once again for your appointment. Sometimes you may see people arrive after you and be seen before you. You wonder why, but you really don't know who to ask.

When you finally see a physician or specialist, you may be asked some uncomfortable questions about your personal life, things such as, “Do you drink?” or “Do you smoke?” You may have limited means while in the city. Many are at the complete mercy of the system, and some cannot afford things such as a good place to eat, taxis or a hotel should they get lost in the shuffle. At times, you may feel judged about your lifestyle, which is not common in southern Canada. Some of these individuals are over 80 years of age.

You see, honourable committee members, we revictimize some of our residents when there is no advocacy or support. Many NWT residents go without a medical travel escort, even when they require support. It is often those most vulnerable who are left without support and advocacy. That is the reason I am here speaking with you today, to highlight the serious issues in which that we find ourselves in the Northwest Territories.

The interpretation of “escort” and exceptions policies appear to be a flashpoint for both the Government of the NWT and the NIHB. We often hear from the GNWT that the medical travel system is not a compassionate system. That is very odd terminology to be using in a post truth and reconciliation world.

Ultimately, honourable committee members, that is what we are seeking—basic care and compassion by the Government of the NWT and for NIHB to respond appropriately to the diverse and unique medical situations of our people. We must establish a common standard for all residents of the NWT, Yukon and Nunavut.

I would like to share that, first, the provision of NIHB benefits is not working for residents of the NWT, which includes our Gwich'in participants. Second, we are also seeing and experiencing systemic denials of medical travel escorts for our people, especially those who are indigenous. Third, the medical travel system in the Northwest Territories appears to lack the compassion that is required for these very sensitive situations our residents face. Fourth, to this end, the Gwich'in Tribal Council would be pleased to share our experiences with the governments of Canada and the Northwest Territories so that we can develop a more comprehensive and coordinated NIHB system for all.

In closing, the Gwich'in Tribal Council would like to recommend that, first off, a review be undertaken that looks into how the Government of the NWT works with NIHB on the provision of medical transportation services. It is our understanding that the NWT Health and Social Services Authority administers the NIHB medical transportation on behalf of NIHB to offer a more seamless provision of services for patients from the Northwest Territories accessing care outside of their communities. We need to assess the timeliness of the program, from approval to denial, and an expedited appeal process to provide some clarity.

Second, if there are any opportunities to review the NIHB medical transportation provisions more closely, the Gwich'in Tribal Council would be open to exploring options on behalf of the government for medical transportation that includes or involves our Gwich'in participants. We recently applied for and were denied an NIHB navigator position. The reasons for this denial cited a population-based formula that dictated the creation of NIHB positions across the country. It is apparently one NIHB navigator for every 65,000 residents.

Based on the complexity of the many issues and examples that I stated today, clearly the reality for northern residents is fundamentally different from that in the south. A standard, nationwide, formulaic approach once again does not meet the needs of the residents of the north.

Hai’. Thank you for your time and the opportunity to present today.

[The Chair, Liberal, Marc Garneau]

Thank you, Grand Chief.

We'll now go to our third witness, Betty Villebrun.

Ms. Villebrun, you have five minutes.

Can anybody else hear?

[The Clerk of the Committee, Ms. Vanessa Davies]

Mr. Chair, her microphone isn't plugged in.

[The Chair, Liberal, Marc Garneau]

Ms. Villebrun, your microphone doesn't appear to be connected. Can you check that part? Your headset is connected into the computer. Can you disconnect it and then reconnect? Let's try that.

[The Clerk]

We'll have IT contact Ms. Villebrun. In the meantime, Mr. Chair, you can start the questions.

[The Chair, Liberal, Marc Garneau]

Very good. We'll do that.

Hopefully, we'll get back to you, Ms. Villebrun, and be able to hear your testimony.

We'll start with the questions for the first round.

Mr. Vidal, you have the microphone for six minutes.

[Gary Vidal, Conservative, Desnethé—Missinippi—Churchill River, SK]

Thank you, Mr. Chair.

I want to thank our witnesses today for taking time to be with us.

Grand Chief, I'll start with you. It's good to see you again. We had a good conversation a few months back.

You answered a bunch of this in your testimony already, but I want to give you a little bit more of an opportunity to talk about the medical transportation issue. It's an issue that has come up in many of our meetings in the last few weeks of talking about this topic. It's obviously very different for you, where you come from, compared with my riding in northern Saskatchewan, which I know you're familiar with because you did some work in Saskatchewan some years back.

You have explained many of the challenges. I'm just wondering if you would take a minute and offer what you think some of the solutions would be to those travel challenges. You talked about initiating a review, but what specific things would work for your communities and be a significant improvement in that travel component of the medical transportation system of NIHB?

[Grand Chief Ken Kyikavichik]

Thank you for the question, MP Vidal.

I think that before we get into solutions I must also share about the two-tier system that we find ourselves with here in the NWT.

If you are a government employee, chances are, by a factor of four, that you are a non-indigenous person. Your medical travel benefits allow for a hotel of your choosing, rental vehicle or taxis, flexibility in travel and the treasury rate of approximately $135 per day for meals and incidentals. Many of the employees of the governments of NWT or Canada often use these medical travel excursions to extend and see family or go off to other destinations on personal travel. It is a true benefit.

If you are a resident of the Northwest Territories who is not a government employee, chances are you are indigenous as we compose the majority of the population. Some of these individuals are status Indians under the Indian Act. NIHB benefits apparently mandate that you either stay at the larga house in Edmonton or the Vital Abel home in the community called N'Dilo, which is adjacent to the city of Yellowknife. Your location depends on where your medical appointments or procedures may be located. If either of these facilities are at capacity, as they often are, you are required to stay at the Chateau Louis Hotel in Edmonton or the Slave Lake Inn hotel in Yellowknife, and I must say, you are mandated to those locations.

You're often told that you are to travel with as little notice as two to three hours prior to a flight and God forbid you need to modify your return. You are provided with a response from the administration at the NWT Health and Social Services Authority that this can only be done at your cost, which is often anywhere from $100 to $500. You are provided with transportation that, at times, can have individuals waiting in an airport for up to 90 minutes and a grand total of $18 per day for meals and incidentals. You then have to submit a travel expense for these costs. I might add, it's $18 a day and it may take as much as two months for a cheque or an EMT to arrive for you to be reimbursed for those expenditures.

I think that is the first thing that needs to be addressed, that two-tier system we have in the NWT.

I spoke about care and compassion, and we would welcome the opportunity at the Gwich'in Tribal Council to administer a medical travel program on behalf of NIHB, because we feel that nobody knows our people and the personal situations that many of them find themselves in better than our own people. A program administered by the council would be more understanding and provide a latitude for our managers to be able to make some of these decisions, because often what we find is that our government of the NWT staff who are enforcing the policy take a very narrow view of the policy, which results in denials that then get escalated. Appeals are denied and then they get escalated to elected officials such as the Minister of Health or people like me or other MLAs of the Northwest Territories. Then some of those decisions are finally rescinded, changed and overturned to allow for medical travel escorts, as I mentioned earlier.

Having that level of care, whichever way brings that level of care that I speak about that is so desperately needed in the system, however we did that, we certainly would see a dramatic improvement in the delivery of these services.

[Gary Vidal, Conservative, Desnethé—Missinippi—Churchill River, SK]

Thank you. I have a minute left. I want to ask one other quick question.

Ms. Wallace, my question is going to be for you.

We were having a conversation with somebody this morning—and I'm going to try to get this out quick—about the challenge of retention of nurses in northern and remote communities, which I'm sure you all experience. I just want to give you an opportunity to speak to that really quickly, as I think we see people moving towards more urban centres, and the challenge that creates in some of the northern and remote communities like the ones that you and I come from.

I'm going to give you some time to quickly speak to that, the challenge and maybe some ideas of solutions.

[Isabelle Wallace]

Thank you for your question. It's also a great question to close our nursing week.

I have experience in working in northern and remote communities. The last one I was in was in northern Ontario during the wildfires last summer. One of the many reasons why I had to leave was working conditions. We ended up being two nurses working 24-7, being on call and really just rotating between the two of us for a week. Our rotations were for a month at a time. While we were down south, we needed to self-isolate for two weeks at a time because of the pandemic before going back.

My community was facing a shortage too. We only have one nurse for our whole community, and she was on medical leave. They approached me and asked me to cover being the only RN for my community. I gladly accepted, but that's just one of the examples of why we have such a shortage of nurses. We're kind of sent everywhere, and by having the training in primary care, we're a rare commodity as well. My training with Indigenous Services Canada was a great asset for my community too.

The working conditions are terrible. They were terrible before the pandemic, but things have gotten worse. I see lots of nurses going through the onboarding program through Indigenous Services Canada. They last two to six months and then leave. I heard that one year in northern Ontario half of their onboarded staff left within the first year of their employment. That's a lot of costs.

I feel that if we just would invest more funding in the working conditions and the work satisfaction for nurses, we would avoid having some of those breaks in services. We've seen some communities without nurses sometimes, and that is tragic for me. I don't see how that is still happening in 2022.

[The Chair, Liberal, Marc Garneau]

Thank you very much.

We'll now go to Mr. McLeod for six minutes.

[Michael McLeod, Liberal, Northwest Territories, NT]

Thank you, Mr. Chair.

Mr. Chair, I was hoping that I'd be able to ask Betty Villebrun some questions. I'm not sure if we're going to reconnect with her.

[The Chair, Liberal, Marc Garneau]

If you want to do half now, hopefully, we can get to her. You can take that chance, or do all six minutes with the other two witnesses.

[Michael McLeod, Liberal, Northwest Territories, NT]

I'll start with Grand Chief Kyikavichik.

Ken, thank you for presenting here today. I think you brought us a lot of information, a lot of real-life scenarios and many things that I've also experienced and heard about.

We heard from the federal minister, who talked about the areas that they want to focus on, but there's one area that concerns me, and I want you to let us know if this is an area that you've had to deal with. It's regarding escorts. More specifically, it's about people who are medevaced out. They're usually in critical condition and on a stretcher. They're taken from the health centre and sent south. They don't have an escort. They're there for emergency purposes.

When things turn around, when they're better or it's time for them to go home, because they never came with an escort, they can't have an escort to leave. The hospital brings them to the door and says, “Okay, sir,” or “Okay, madam, it's time for you to go.” A lot of times they're not dressed properly or they don't speak the English language well enough. There are a couple of horror stories that I've encountered over the last while.

Can you talk about that as an area that maybe we need to start really focusing on to make sure that escorts are provided? For me as an MP, the biggest issue on medical travel is the issue of escorts.

[Grand Chief Ken Kyikavichik]

Marsi, MP McLeod. Thank you for the question.

I'd like to share with you, as I often do, a specific example. In October of 2020, we had a 75-year-old elder who truly lived a subsistence lifestyle in our territory. He found himself very ill at his remote camp in the Mackenzie Delta region. His family requested a medevac via helicopter, as this was during the fall freeze and the only means of transportation.

The local community health centre in Fort McPherson is operated by the NWT Health and Social Services Authority, and was the main point of contact for the family. The RCMP had also been engaged to assist. The family was advised that an extraction via helicopter may cost $20,000 to $30,000, for which they would be responsible. Recognizing the personal emergency and the apparent lack of affordable options, the family reached out to the Gwich'in Tribal Council for assistance. As we are a shareholder in a helicopter business in Inuvik called Gwich'in Helicopters, we dispatched a helicopter to extract the individual.

He then received the initial assessment of his condition at Inuvik Regional Hospital. He had a lung infection, an inflamed liver and a heart condition. X-rays that were taken revealed two masses that required further assessment. Two days later, he was taken by medevac to Yellowknife, and then eventually to Edmonton to receive further care.

All told, the helicopter extraction cost us a grand total of $2,215. However, it took an intervention by us as an indigenous government to make this happen. The charge was eventually reimbursed by the NWT Health and Social Services Authority two months later. To add insult to injury, when seeking travel to meet the patient as an escort, his sister was denied medical travel from Inuvik to assist and advocate for her brother. As a result, the family was required to pay for a one-way ticket from Inuvik to Edmonton at a cost of approximately $700, plus accommodations.

After the bureaucratic process of submitting multiple letters from an approved physician to the NWT Health and Social Services Authority, all of which were denied, a separate request was made directly to the NIHB program, by a social worker the family was in contact with, which then approved the hotels and meals five days after the helicopter dispatch.

Sadly, the patient in care passed away about a week later from cancer. NIHB required that the patient's sister return home on the following Saturday, two days after the elder's death. Arrangements with the funeral home to respect the patient's wishes for cremation were required. However, due to COVID-19, the funeral home was limited in its ability to respond quickly.

The family wanted their loved one cremated with his remains transported back to Inuvik, followed by a two-hour drive on the Dempster Highway to Fort McPherson. Once again, the GTC was required to intervene, cover the costs of accommodation and allow time for the family's wishes to be respected. Repeated requests to the NWT Health and Social Services Authority were denied due to a lack of disclosure of a reason for the patient's condition in the many letters that were submitted. The physician was limited in what they could include in the letter due to health information disclosure requirements. Thus, the request was caught in the conundrum of a catch-22 situation.

I see this as a prime example of why medevac situations, where you do have a patient that is suffering from a severe condition, should be automatically provided with a medical travel escort that would follow soon after, as many of these individuals are unable to actually travel in the medevac with the patient themselves.

[The Chair, Liberal, Marc Garneau]

Thank you very much.

I understand that Betty is with us now. Although I can't see her, I understand that she is with us.

Ms. Villebrun, you have five minutes to make your presentation.

Ms. Villebrun, we can't see you at the moment, but you are unmuted. Can you perhaps turn on your camera?

There we go. Would you like to start talking and see if we can hear you?

No, we're not hearing you, unfortunately. I'm very sorry. We'll have to see if we can at least get your written brief. We'll have to carry on with the panel today.

Ms. Gill, you have six minutes to question the witnesses who are now with us.

[Marilène Gill, Bloc, Manicouagan, QC]

Thank you, Mr. Chair.

Ms. Wallace, I would first like to congratulate you: you are the first Indigenous woman to hold a nursing position in the Madawaska Maliseet First Nation. I would also like to convey my recognition of the work you did in northern Quebec and northern Ontario during the COVID-19 pandemic. I have to say that I am biased, since my mother is a nurse herself. I know what things are like in that profession.

You mentioned nurses' working conditions. Of course, health care falls under both federal jurisdiction and the jurisdiction of the governments of Quebec and the provinces.

Generally speaking, do you think increasing funding by the federal government, that is, health transfers, might be a good thing when it comes to nurses' working conditions, particularly in the communities, and indirectly, when it comes to health care for Indigenous people and for the Métis and Inuit?

[Isabelle Wallace]

Thank you for the question.

Thank you for conveying your recognition. The members of my community are also very proud of that. They are really proactive when it comes to education. They supported me throughout my studies, from my bachelor's degree to my master's. I am really happy to finally be home, to give back to the community what I have received from it.

Regarding working conditions, it would certainly be a good thing to increase funding. Personally, being the only nurse working at the health centre, I find myself doing everything. That means I am working at 150 miles an hour. In a day, I may get 40 calls, and I also do home visits, since the doctor only comes to the health centre once a week. In the meantime, people are constantly coming in to consult me. I also handle vaccination, and I raise awareness in social networks. I take on so much work that I can't tell you everything I do in a day.

I often stop and say to myself, if I could just have help from a nursing assistant, from support staff, who would go to homes to be kind of my eyes and hands, I could be informed about problems that could be avoided before it was too late. That's when I experience mental distress as a nurse.

My colleagues are aware of the fact that I can't go on like this in the long term. During the pandemic, we realized that the workload was much heavier than before. I'm the only one who knows the system, and as the nurse, I have the responsibility of preparing announcements or looking for funding, for example. I have to argue my case to my chief and my councillors to get support, but I don't have enough time in a week to do it all. So the situation is very difficult.

If we had more money, it would enable me to get more help, to improve the working conditions, and increase job satisfaction as a result. I could devote more time to the young members of my community. For example, there is a young woman who comes to the clinic to help me. She is studying health sciences, because she wants to become a doctor. She would be the first doctor in the community. So I could mentor her. That's the goal I have adopted as a community health nurse.

[Marilène Gill, Bloc, Manicouagan, QC]

In fact, Ms. Wallace, the federal government needs to provide more health transfers. Certainly, additional funding would enable you to acquire more resources.

In a way, you are a model in your community. You are the first Indigenous woman to hold this position, and you certainly want to get other people involved, like the young woman you mentioned. If she sees that you are always tired or worn down by the weight of all the work you have to do, it may seem to her like a very difficult job. I am thinking about retaining staff, and especially about you. The community wants to bring in health care professionals like you, but that must not be done at the expense of their health.

Am I wrong about that?

[Isabelle Wallace]

That is absolutely it.

Even at my age—I'm still young—I have experienced burnout in the past because of my work in the north, for a number of reasons. There was the pandemic, forest fires, the shortage of nurses in the north. There are also the interaction with managers, emergency management, pharmacy management, and x-rays. A nurse does a lot of work in the north. I'm even trying to understand how I managed to function in that situation. We run on adrenaline, but burnout is very real among my colleagues.

[Marilène Gill, Bloc, Manicouagan, QC]

Working conditions are also difficult. You did well to mention that. You work in the community, but you also sometimes have to travel to remote regions, where I have in fact visited. All of that has to be taken into account.

From what I understand, it is harder to be a nurse in an Indigenous community, because you have to do more. You are kind of a specialist in pretty much all areas, even though you are a generalist professional.

Do you think this might endanger everyone's health, in other words, not just your own health, but patients' health as well?

[Isabelle Wallace]

Every week, we worked 24 hours a day, seven days a week. Imagine the situation. When I went to bed at night, I was careful to put the phone nearby, because, since I was on call, I couldn't refuse to take a single call. The phone rang all night. The next morning, I had to be at the clinic to do my job from 9:00 a.m. to 5:00 p.m. That was where I vaccinated children and provided various kinds of care, in addition to emergencies. I was so exhausted. I didn't have time to eat or stick to any daily routine, which would have been beneficial for my mental health.

One time, I was asked whether I had vaccinated the right person. I was so afraid that I felt my stomach turn. My colleague said, "Isabelle, you're good," but that was when I realized that it could become very dangerous. I worked on incident management at the national office in Ottawa. We reviewed cases where mistakes had been made. At that time, I didn't understand how that could happen, and that's one of the reasons why I went to work in Ottawa.

We have to remember that we hold people's health in our hands. We have to exercise critical judgment in making decisions. Fatigue is a factor that weakens our judgment. I have also seen assessments done by colleagues who had been on call all night. After reviewing the assessments, I realized, the next day, that there were critical factors in connection with a medical evacuation by air, or MEDEVAC, and that a request for a physician on board had to have been made. That might have fallen through the cracks.

[The Chair, Liberal, Marc Garneau]

Thank you, Ms. Gill.

Since you recognize that this is the week when we recognize our nurses, you mentioned your mother.

I'd like to take the opportunity to say that my mother was a nurse and I married a nurse. So bravo to our country's nurses.

With that, I'll go to Ms. Idlout.

Ms. Idlout, you have six minutes.