Northern First Nations Declare Health Emergency

(the following story appears in the March 10 edition of NOW Magazine)

By Matthew Behrens

Last month, Norman Shewaybick trekked 17 days along 550 km of treacherous ice roads from Thunder Bay to his Webequie home, hauling a full oxygen tank to highlight the crisis afflicting Northern Ontario’s First Nations health care.

            “It’s not about being a hero, it’s about saving lives, and how our health system isn't doing its part for us,” says Shewaybick, a high school teacher and grandfather of 6. Joined by his sons and two other supporters, what Shewaybick calls “a healing journey home” was inspired by the deathbed promise he made to his wife of 26 years, Laura Jean, whose respiratory distress last October could not be properly treated because the local nursing station ran out of oxygen. Her passing at age 51 marked another casualty of what critics call a two-tiered medical system in which Indigenous people continue to suffer from inadequate health care. 

            “She was loved by so many, and many still grieve,” says Shewaybick. “I will miss her for the rest of my life. My grandkids come here and keep asking, ‘Where’s Grandma?’”

The oxygen tank Shewaybick brought home was symbolic of basic medical devices such as defibrillators, x-ray machines and other diagnostic equipment that are often in disrepair or wholly absent from northern First Nations communities. That serious problem was highlighted February 24 when leaders of the Nishnawbe Aski Nation and Sioux Lookout First Nations Health Authority declared a public health emergency to address “needless deaths and suffering caused by profoundly poor determinants of health” as well as “a level of health care that would be intolerable to the mainstream population of Ontario.” 

Nishnawbe Aski Nation Grand Chief Alvin Fiddler personally hands a copy of the emergency declaration to Justin Trudeau, but no response yet from the PMO.

 The Sioux Lookout region is home to 33 First Nations communities, 80% accessible only by air, with a total population of 30,000. The emergency declaration was built on a litany of misery, with over 600 documented suicides since 1986 (a conservative estimate that does not include countless more serious failed attempts); “rampant” prescription drug use and opioid addiction; chronic diseases like diabetes (with the highest amputation rates in Ontario); severe obstacles to basic child health screening and, when diagnoses are produced, poor access to treatment; lack of proper diagnostic equipment and depleted stocks of basic medications; staff who are not fully trained; and jurisdictional spats over which level of government covers what service.

Shibogama Health Authority director Sol Mamakwa likens his 8 years of work in northern communities to a war zone in which multigenerational trauma and the debilitating legacies of residential schools – combined with alarmingly high rates of substance abuse, mental health issues, and physical disease – have become a toxic mix with severe consequences. He finds  “the status quo has become acceptable and normalized. We have 10-year-old children committing suicide, and our people are living week to week with these serious issues.”

            While he does not begrudge them, Mamakwa notes “we are a community about the same size as the number of Syrians who just came to Canada, and it would be great to receive the same sympathy and the same access to health care, to housing, to education.” Instead, the communities he serves are caught in a “jurisdictional black hole” between the federal government and Queen’s Park which, instead of providing desperately needed services, “play ping pong over the health of our people.”

            Mamakwa points out health care bureaucracies appear more interested in cost-cutting, noting that despite the vulnerabilities faced by young people, these northern communities can access a resident pediatrician only 5 days per month.

 The plight of Sioux Lookout children was highlighted last October by Canadian Family Physician’s peer-reviewed study on incidences of acute rheumatic fever (ARF), long considered a disease of the past. Physicians documented the role of inadequate and crowded housing as well as health care system deficiencies in contributing to at least 8 ARF cases, with an average age of 9 years. Two 4-year-old children died, and the remainder were left with rheumatic heart disease. Despite determining the ARF rate was more than 75 times higher than in the non-Indigenous population, the report barely caused a ripple on the federal election campaign trail.

One of the authors of that report, physician Michael Kirlew, has worked in the north for 9 years. Speaking to NOW just after he gets a patient on a Medevac, he’s furious at the conditions he sees on a daily basis, noting federally-run nursing stations are “providing a standard of care that is far, far inferior to what other Canadians receive in almost every single respect. There’s no checks and balances, and mechanisms for accountability are virtually non-existent. Care is being routinely denied to people, under the non-insured benefits system, which really serves as a gatekeeper to care to decide which patient is or isn't going to get what they need. It’s just egregious. And we also have bacteria that take advantage of social determinants like lack of housing and clean water, so it’s a recipe for disaster.”

Kirlew has also worked in Haiti, Guyana and other overseas locations, and “people’s jaws drop when they hear about these types of situations in Canada. So we need a fundamentally different way forward that is not based on the dynamics of an unequal system that is steeped in 350 years of colonialism. The patient, the community, and its values need to be at the centre, and the system we have right now fails on all three of those points.”

Despite the obstacles, some health care practitioners and community leaders are cautiously hopeful that political rhetoric about a respectful nation-to-nation relationship will translate into concrete action. At last week’s First Ministers meeting in Vancouver, Nishnawbe Aski Nation Grand Chief Alvin Fiddler personally handed a copy of the emergency declaration to Justin Trudeau, reminding the PM of the urgency to address the crisis. While Fiddler hopes to chat soon with federal health minister Jane Philpott, he’s already heard from provincial minister Eric Hoskins, in addition to receiving offers of support from a number of corporate players as well as the Red Cross and Heart & Stroke Foundation.

“I think they’re starting to realize the gravity of the situation,” he says, noting that symptoms of the crisis were further documented in a damning 2015 federal Auditor General’s report. “They found Health Canada does not take into consideration the needs of our communities when allocating their resources. Right now, the funding we get is based on the Indian Health Policy from 1979.”

The Auditor General also found that only one of 45 nurses working in the area had completed all five mandatory training courses, while some 30 separate deficiencies identified by Health Canada itself had not been addressed. In addition, even though Health Canada had defined the scope of essential services necessary for remote nursing stations, there was no proper assessment to ascertain whether they could be provided under existing infrastructure.

 “One of the residences at a nursing station that we visited had been unusable for more than two years because the septic system had not been repaired,” the AG report found.  “Consequently, health specialists cancelled their visits to the community.”

Indigenous leaders point out that solving the current crisis in Northern Ontario, as well as other communities across the country suffering similar health care challenges, goes beyond possible funding increases in the federal Liberals’ upcoming budget. Indeed, it will require modernizing outdated policies, community-based consultations, and a holistic approach that, for example, considers colonial legacies, implements the recommendations of the Truth and Reconciliation Commission, respects Indigenous cultures, and tackles racism.

That was the finding of a landmark 2015 Wellesley Institute report, “First Peoples, Second Class Treatment,” which concluded that “Indigenous peoples experience the worst health outcomes of any population group in Canada, underscoring the urgency and importance of understanding and addressing racism as a determinant of Indigenous health.”

That rings true for Mamakwa, who says “cultural safety is really important, and it doesn’t mean putting a piece of woodland art in your doctor’s office. People need to learn who we are, our history, and how institutions like education, health care and prison can sometimes be very racist. People also need to recognize that we are Ontarians, Canadians, First Nations people who are a part of this country. Right now, we don't just need health care. We need care.”

A Call to Recognize on Whose Land We Live

(The following was delivered by Maureen Bostock, of Lanark County Neighbours for Truth and Reconciliation, to Perth Town Council on March 1, 2016. While Perth is celebrating its 200th anniversary, the Algonquin people have lived in this unceded territory for some 8,000 years. The establishment of the Town was in contradiction to British law and the Royal Proclamation of 1763, which stated that no land could be granted to settlers without a prior agreement between First Nations and the Crown.)

Thank you for the opportunity to address Mayor and Council.  I am speaking today on behalf of a local ad hoc committee made up of settlers, recent immigrants and members of local Aboriginal communities. 

The 200^th Anniversary celebrations taking place in Drummond/North Elmsley, Beckwith, Tay Valley townships and the town of Perth offer us an opportunity to reflect on the relationship between settlers, immigrants and First Nations people going back beyond the 200^th anniversary year of 1816 to the time of first contact.

This was not an empty land but a homeland.  The settlers were welcomed and befriended and helped through the early years of settlement.  And in exchange the newcomers took over more and more of the traditional territory – pushing aside Algonquin people with little regard for the cultural, material or spiritual needs of the Algonquin people or the land that sustained them. From At Home in Tay Valley, The Omamiwinini, a chapter written by Paula Sherman quotes Kaondinoketch an Omamiwinini leader from 1840 addressing a council meeting: “Our hunting grounds that are vast and extensive and once abounded in the richest furs and swarmed with deer of every description are now ruined.  We tell you the truth, we now starve half the year through and our children, who were accustomed to being comfortably clothed, are now naked.  We own, brother, that we are partly the cause of these present misfortunes; we were too good and generous; we permitted strangers to come and settle on our grounds and to cultivate the land; wood merchants to destroy our valuable timber, who have done us much injury, as by burning our rich forests, they have annihilated our beaver and our peltries, and driven deer away.” 

The chapter also records the Omamiwinini people’s response to the actions of newcomers: “When they came across Philemon Wright cutting down their sugar bush in the early 19^th century, they were quite upset, and questioned him about his actions.  From what I can tell from the documentary evidence and oral tradition around the incident, Wright lied and told them he had papers given to him by the Colonial Office.  This was untrue as it turns out; he was a land speculator from Massachusetts and had no such papers.  While the Omamiwinini people found it difficult to understand how he had “acquired” these lands, they didn’t question the truth of his statement.  To do so would have been an insult and disrespectful.  They did not lie.  Instead, given that he was already there, they chose to welcome and incorporate him into already existing protocols for relationships with neighbours.”

The land on which we stand was then and continues to this day as unceded Algonquin territory.  No agreements have been signed to state how the land shall be shared.  It is a fundamental truth of our collective history that the Perth settlement was established in contradiction to British law and the Royal Proclamation of 1763 which stated that no land could be granted to settlers without a prior agreement between First Nations and the Crown. The Proclamation was ratified at the Treaty of Niagara in 1764 where delegations from Indigenous peoples from across what is now southern Ontario met and exchanged wampum belts with a representative of the British Crown. Through this peace process the Algonquin people agreed to share the land but did not then nor ever since surrendered their title and rights to the land. The history of broken treaties began almost immediately as the Crown granted parcels of unceded land to reward soldiers for their service.

On June 3^rd, 2015 the Truth and Reconciliation Commission published its report on the legacy of Residential Schools in which the documentation of the brutal treatment of Aboriginal children in Residential Schools led to a greater truth: that reconciliation requires that we understand the truth about the way in which Canadian society continues to perpetuate the colonialism and racism of the settlement of this country and that reconciliation requires us to commit ourselves on a national, regional and local level to respectful, responsible relationships with First Nations, Métis and  Inuit peoples.

 In the Calls to Action from the Truth & Reconciliation Commission, the responsibilities of all levels of government including municipalities have been addressed:

#43 We call upon federal, provincial, territorial and municipal governments to fully adopt and implement the United Nations Declaration on the Rights of Indigenous Peoples as the framework for reconciliation.

#57 We call upon federal, provincial, territorial and municipal governments to provide education to public servants on the history of Aboriginal peoples, including the history and legacy of residential schools, the United Nations Declaration on the Rights of Indigenous Peoples, Treaties and Aboriginal rights, Indigenous law, and Aboriginal-Crown relations.  This will require skills-based training in intercultural competency, conflict resolution, human rights, and anti-racism.

 Since the publication of the report of the Truth & Reconciliation Commission, the Federation of Canadian Municipalities has welcomed the findings and urges its members to endorse the report. Municipalities such as Vancouver and Fort St. James have passed resolutions similar to the one we present today as a first step towards reconciliation. The Canadian Coalition of Municipalities Against Racism (CCMARD) identifies the importance of “promoting respect, understanding and appreciation of cultural diversity and the inclusion of Aboriginal and racialized communities into the cultural fabric of the municipality” in its toolkit for municipalities.

Therefore we present the following resolution:

Whereas the 200^th Anniversary celebrations taking place in Drummond/North Elmsley, Beckwith, Tay Valley townships and the town of Perth offer us an opportunity to reflect on the relationship between settlers, immigrants and First Nations people going back beyond the 200^th anniversary year of 1816 to the time of first contact;

Whereas when the Europeans arrived, this was not an empty land but a homeland; the settlers were welcomed and befriended and helped through the early years of settlement yet, there was little regard for the cultural, material or spiritual needs of the Algonquin people or the land that sustained them. As their lands were increasingly settled the Algonquin people were denied secure access to a land base to sustain themselves;

Whereas the land on which we stand was then and continues to this day as unceded Algonquin territory.  The land was not acquired by lawful process under British law and was given to settlers in contravention of the Royal Proclamation of 1763 and the Treaty of Niagara of 1764.  This is a fundamental truth of our collective history;

Whereas in the Calls to Action from the Truth & Reconciliation Commission, the responsibilities of all levels of government including municipalities have been addressed;

Therefore be it resolved that the Town of Perth:

a)    formally acknowledge that the Town of Perth is on the unceded traditional territory of the Algonquin nation;

b)    endorse and implement the Calls to Action of the Truth & Reconciliation Commission;

c)     that the following declaration be read out at the opening of all official meetings of the Perth Council and public events: “We hereby acknowledge that the Town of Perth is situated on unceded traditional Algonquin territory and with this acknowledgement comes respect for the land, people and the unique history of the territory.”

d)     that as well as recognizing the Algonquin nation’s ongoing contributions to our communities, the Town of Perth takes upon itself the responsibility to include and celebrate Algonquin history and culture as part of the 200^th anniversary celebration.

e)    And that the town of Perth issue a proclamation on June 21st National Aboriginal Day each year as an expression of an ongoing commitment to reconciliation and cultural inclusiveness.