Healthcare
Tuberculosis
I’ve chosen to focus on one healthcare issue -- tuberculosis -- because it is representative of much of what is happening with FNMI people’s health.
Legacy of the Indian Act
Europeans brought tuberculosis to North America with the first settlers. It spread rapidly once the Indian Act forced people onto crowded reserves, limited their ability to hunt, fish and farm, and sent the children to be malnourished at residential schools. “Death rates in the 1930s and 1940s were in excess of 700 deaths per 100,000 persons, among the highest ever reported in a human population” (Canadian Public Health Association).
The government knew that children at residential schools were “dying like flies” because the Chief Medical Officer at Indian Affairs told them so. But Deputy Superintendent-General Duncan Campbell Scott said, “It is readily acknowledged that Indian children lose their natural resistance to illness by habituating so closely in the residential schools, and that they die at a much higher rate than in their villages. But this alone does not justify a change in the policy of this Department, which is geared towards a final solution of our Indian Problem” (“The Indian Act").
In the 1950s and 1960s, tuberculosis epidemics spread north to the Inuit people where at least one-third were infected. During the summer, a coast guard ship would arrive at Inuit communities to test people for TB. Those infected stayed on the ship and were taken south for treatment. Many were never seen again, and many families remaining in the north were never informed that their loved ones passed away (Canadian Public Health Association). Trudeau has since apologized for this treatment (Hogan)
Some of the patients treated for TB at Indian Hospitals have launched a $1.1 billion class action lawsuit against the government for the abuse they received during their stays. Child patients reported abuse similar to that received at residential schools. They were kept at the hospitals so long they also forgot their language when they returned home (Moore).
The Situation Today
The Inuit in Canada’s north still suffer from high rates of TB: 290 times higher than for non-indigenous people in Canada (Hogan).
Canada’s public health association reports the average rate of infection in Canada's 10 provinces in 2017 was 4.46 per 100,000 people. In Nunavut, it was 265.8. Inuit make up about 85 per cent of Nunavut's population (Hogan).
The world’s poorer nations see a rate of infection between 150 and 400 per 100,000, so Nunavut falls in the middle of that range (Hogan).
The reasons that TB persists in Indigenous communities are linked to a host of interconnected factors like lack of access to healthcare services, housing, poverty, poor nutrition and loss of traditional medicine.
"Many Inuit people live in overcrowded homes that are poorly ventilated ... they're very airtight," said Dr. Anna Banerji, who has researched respiratory infections in babies in Canada's Arctic for many years. "Also, there is quite a bit of poverty, which can make tuberculosis worse. Malnutrition can exacerbate tuberculosis" (Hogan).
Due to what happened in the 50s and 60s, many Inuit also distrust Western medicine and are hesitant to leave their homes for treatment. This prevents patients from getting the antibiotics that would fight the disease.
"Many Inuit people have been impacted by colonialism, some people with residential schools, some people with the Sixties Scoop," Banerji said. "Also, policies that have led to poverty and discrimination as far as employment and funding" (Hogan).
GRAPHIC: TB Rates Across Canada by Public Health Agency of Canada
Nunavut’s high TB rate was brought into the spotlight in 2017 when 15-year-old Ileen Kooneeliusie died of the disease after doctors repeatedly failed to correctly identify the cause of her breathing difficulties until just hours before she died.
Food security, better housing, and doctors and nurses trained in Indigenous health are seen as solutions to this problem. In 2018, the federal government and Canada’s national Inuit organization announced a $27.5 million plan to tackle TB and eliminate it by 2030, but funding has dropped off and TB cases have not decreased. Even if there was enough funding to reduce the number of TB cases, all that work would be undone without the required investments in housing and nutrition. Nunavut Tunngavik Incorporated, which represents Inuit in Nunavut, had been planning on unveil a regional plan to eliminate TB in March, but that's on hold because of COVID-19 (Oudshoorn).
Connections to TRC (with my thoughts in [ ])
18. We call upon the federal, provincial, territorial, and Aboriginal governments to acknowledge that the current state of Aboriginal health in Canada is a direct result of previous Canadian government policies, including residential schools [Crown-Indigenous Service Minister Carolyn Bennett has done this], and to recognize and implement the health-care rights of Aboriginal people as identified in international law, constitutional law, and under the Treaties.
19. We call upon the federal government, in consultation with Aboriginal peoples, to establish measurable goals to identify and close the gaps in health outcomes between Aboriginal and non-Aboriginal communities, and to publish annual progress reports and assess long- term trends. Such efforts would focus on indicators such as: infant mortality, maternal health, suicide, mental health, addictions, life expectancy, birth rates, infant and child health issues, chronic diseases, illness and injury incidence, and the availability of appropriate health services. [This has been started for TB, but the reports show the rate did not drop because of a funding shortfall].
21. We call upon the federal government to provide sustainable funding for existing and new Aboriginal healing centres to address the physical, mental, emotional, and spiritual harms caused by residential schools, and to ensure that the funding of healing centres in Nunavut and the Northwest Territories is a priority. [This would help encourage people with TB to get help because they wouldn’t have to leave and go into a system they distrust.]
23. We call upon all levels of government to:
i. Increase the number of Aboriginal professionals working in the health-care field.
ii. Ensure the retention of Aboriginal health-care providers in Aboriginal communities.
iii. Provide cultural competency training for all health- care professionals.
24. We call upon medical and nursing schools in Canada to require all students to take a course dealing with Aboriginal health issues, including the history and legacy of residential schools, the United Nations Declaration on the Rights of Indigenous Peoples, Treaties and Aboriginal rights, and Indigenous teachings and practices. This will require skills-based training in intercultural competency, conflict resolution, human rights, and anti-racism. [Some medical schools have started doing this. [The University of Toronto, McGill, and the universities of Ottawa and Manitoba have made Indigenous health issues part of their students' med school training. ]
Local Action
I’m not sure what the assignment means when it says what actions could be taken locally. I guess as teachers we can make students aware of this issue in Civics, history or law to help increase public support for funding Indigenous health care. Start a letter-writing campaign, send petitions, etc.
Sources:
Canadian Public Health Association. “TB and Aboriginal People. https://www.cpha.ca/tb-and-aboriginal-people
Hogan, Stephanie, “Tuberculosis rate among Inuit is 290 times higher than for non-Indigenous people in Canada. Here's why.” CBC News. March 8, 2019. https://www.cbc.ca/news/health/cbc-explains-tuberculosis-banerji-tb-1.5046336
“The Indian Act, residential schools and tuberculosis cover up,” Indigenous Corporate Training. May 17, 2016. https://www.ictinc.ca/blog/the-indian-act-residential-schools-and-tuberculosis-cover-up
Moore, Holly. “‘Indian Hospitals’ lawsuit triggers memories of horrific abuse at Manitoba TB sanatorium” APTN. Feb. 26, 2018. https://www.aptnnews.ca/investigates/indian-hospitals-lawsuit-triggers-memories-of-horrific-abuse-at-manitoba-tb-sanatorium/
Oudshoorn, Kieran, “Progress on TB-elimination in Nunavut stalled due to lack of funding,” CBC News. Jan. 20, 2020. https://www.cbc.ca/news/canada/north/tuberculosis-nunavut-philpott-update-1.5431199
I researched inequity in health care, more specifically in Manitoba with an emphasis on First Nations in the north of the province. On a province wide scale the inequities have been getting worse over the last two decades. “Early death rates are three times higher for First Nations people, according to The Health Status of and Access to Healthcare by Registered First Nation Peoples in Manitoba.” On top of that “the life expectancy of First Nations women is 72 years compared to 83 years for other female Manitobans, while First Nations men is 68 years compared to 79 years for other male Manitobans.” Additonally, “First Nations Manitobans are four times more likely to attempt or die by suicide.” There is a clear problem here on a provincial scale with a lack of health care close to home leading to higher death rates. These are just the statistics. Next I want to examine the lived experience of First Nations People navigating health care in Manitoba.
Many First Nations People in Manitoba’s north end of having to relocate, temporarily or permanently, to Winnipeg to access appropriate health services. This is problematic on many levels and happens because there are no, or over burdened, local services in their communities. For example, O-Pipon-Na-Piwin Cree Nation only has a nursing station so despite the fact that it is 1000km north of Winnipeg (a 12 hours drive) people are forced to make the trek to Winnipeg for services. Some people travel short term while others have to stay for regular treatment for things like kidney dialysis. There is one northern service centre for dialysis but it is overburdened and sometimes closed due to poor water and sewer conditions. This forces people to move to Winnipeg where a myriad of problems start. The federal government only covers costs for First Nations People forced to move for health care for 3 months. After that the provincial and federal governments often argue about costs and the people do not get the support they need. They are left in a new city, without knowledge of local systems, often with no credit or rental history trying to find a place to live and find supports. “A new report suggests that Anishininew people from the Island Lake region in Manitoba who relocate to Winnipeg for medical treatment face social isolation, a lack of affordable housing and lack of support services.” All people interviewed spoke of loneliness and isolation from their community and culture.
A First Nations woman with a father seeking medical care in Winnipeg stated ““When you father tells you, ‘I just want to die because I miss home,’ that really shows you how First Nations patients are treated…have to leave their homes and being told they have to stay in a hotel room where even the quality of food is not appropriate with what the dietician tells you.” Another man, Andy Wood, who is from Wasagamack First Nation and is the executive director at Neewin Health Care Inc said "they're not here because they want to be here, they're here because they have to be here if they want to live any longer.” This strikes me as so sad and such an upsetting choice to have to make. People are forced to leave their community just to have the care everyone in this country should have.
So where do we go from here? It is clear there needs to be more money to develop community medical services and train Indigenous People in health care. There also needs to be a consideration for the “social determinants of health, which include a person's environment, access to water, housing and services [which] all affect health.” Until these things are in place there also needs to be culturally aware training for health care workers in Winnipeg so there is not subtle or blatant racism present in treatment.
There is some progress on this front as the Winnipeg Regional Health Authority Indigenous Health works “to support the holistic needs of First Nations, Métis, and Inuit people” with “regional programs and facilities in helping identify, develop and implement culturally safe environments, practices and services.” There was also a step towards more local First Nations health systems when in 2018 “Jane Philpott, Minister of Indigenous Services Canada (ISC), announced the Government of Canada [would] invest nearly $68 million across Canada for First Nation-led health transformation, over the next three years.” They said there would be a focus on Manitoba, Saskatchewan and Ontario. Northern Manitoba saw some benefit when in 2019 Red Sucker Lake First Nation opened a new facility that costs $13.5 million. The government also promised to “spend about $50 million to upgrade health facilities in Manitoba First Nations.”
Extra: I did not have time to read this but this is something I would be interested in reading in the future. It talks about social determinants of health for Indigenous People: http://ccnsa.ca/docs/nccah%20reports/LoppieWien-2.pdf
Specific TRC Calls to Action Connected to this:
Essentially all of the health calls to action connected. The things listed in the calls need to be done in Manitoba. More specifically for Winnipeg it is important that culturally aware training continues and that money is put into developing community based health centers with advanced care and capacity.
18. We call upon the federal, provincial, territorial, and Aboriginal governments to acknowledge that the current state of Aboriginal health in Canada is a direct result of previous Canadian government policies, including residential schools, and to recognize and implement the health-care rights of Aboriginal people as identified in international law, constitutional law, and under the Treaties.
19. We call upon the federal government, in consultation with Aboriginal peoples, to establish measurable goals to identify and close the gaps in health outcomes between Aboriginal and non-Aboriginal communities, and to publish annual progress reports and assess longterm trends. Such efforts would focus on indicators such as: infant mortality, maternal health, suicide, mental health, addictions, life expectancy, birth rates, infant and child health issues, chronic diseases, illness and injury incidence, and the availability of appropriate health services.
21. We call upon the federal government to provide sustainable funding for existing and new Aboriginal healing centres to address the physical, mental, emotional, and spiritual harms caused by residential schools, and to ensure that the funding of healing centres in Nunavut and the Northwest Territories is a priority.
22. We call upon those who can effect change within the Canadian health-care system to recognize the value of Aboriginal healing practices and use them in the treatment of Aboriginal patients in collaboration with Aboriginal healers and Elders where requested by Aboriginal patients.
23. We call upon all levels of government to: i. Increase the number of Aboriginal professionals working in the health-care field. ii. Ensure the retention of Aboriginal health-care providers in Aboriginal communities. iii. Provide cultural competency training for all healthcare professionals.
24. We call upon medical and nursing schools in Canada to require all students to take a course dealing with Aboriginal health issues, including the history and legacy of residential schools, the United Nations Declaration on the Rights of Indigenous Peoples, Treaties and Aboriginal rights, and Indigenous teachings and practices. This will require skills-based training in intercultural competency, conflict resolution, human rights, and anti-racism.
Resources:
https://www.cbc.ca/news/canada/manitoba/first-nations-health-gap-report-1.5287836
https://www.cbc.ca/news/indigenous/anishininew-island-lake-health-care-relocation-report-1.4743315
https://www.cbc.ca/news/canada/manitoba/st-theresa-point-health-rally-1.5254648
https://wrha.mb.ca/indigenous-health/
Power Generators
The following situation is life threatening. Here is a link to an article about failing power generators.
Nibinamik First Nation declares state of emergency after generator failure
This community 500 Km north of Thunder Bay relies on diesel generators for power. The generators are failing and if/when they do the community will have no source of electricity. This is compounded by the fact that their internet and cell phone service is not reliable and provides spotty service. So even with power the internet/cell service is not reliable.
Chief Sheldon Oskineegish along with councillors made the declaration on Wednesday, May 13, 2020 at 5 p.m."Existing infrastructure, specially the Diesel Generators are failing causing frequent power outages, causing Interruptions in heating, light, water and sanitation services," the band council resolution stated. (CBC, 2020).
This is especially concerning during this time of COVID19. It impacts their ability to deal with cases of COVID and to get help if needed.
This situation is life threatening, any person in the community who relies on power to run medical equipment is in jeopardy. Food storage is dependent upon electricity.
To combat these issues, the resolution is asking:
For all available personnel and resources are being redirected to support the health and well being and security of the community
The CRTC, government and internet service providers to increase bandwidth availability in the community
Community members to practice increased hygiene and social distancing
Agreements made for two new generators for Nibinamik, delivered over winter road
For the community to start gathering traditional foods and medicines
To meet with the Regional Director General and calling on federal government to ensure the new generators are installed (CBC, 2020).
Looking at a number of issues within our more remote communities infrastructure or lack of it seems to be a recurring issue. In my humble opinion this should not be a problem, we should be actively identifying and rectifying issues of infrastructure.
One of the things that has been highlighted throughout this time of pandemic, in our country and countries around the world, is that we all need to do better for our vulnerable populations. We all need to do better.
Relationship to the TRC
I went through it twice and did not find anything which particularly spoke to the lack of infrastructure in Indigenous communities, especially ones in the north.
I am therefore linking to the parts on the United Nations.
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.
We call upon the Government of Canada to develop a national action plan, strategies, and other concrete measures to achieve the goals of the United Nations Declaration on the Rights of Indigenous Peoples.
Local Initiatives
I guess this depends upon your view of local, if you mean the community, they are doing what they need to do by declaring the state of emergency and working towards getting replacements and asking for better broadband.
If it means locally here, then we can educate our students to understand the issues and problems caused by the lack of infrastructure. An awareness activity where they have to go without electricity, cell phone and internet for a day, only begin to raise awareness for them.
When I was researching tuberculosis, I came upon some articles about the "Indian Hospitals" which sounded like horrifying residential-school-type places. A five-year-old Inuit boy with TB was sent to an Indian Hospital where everyone communicated in English, so he never new what was going on. He had to stay for over a year, by which time he'd learned English but lost his mother tongue and then couldn't speak to his parents when he returned home!
How can anyone receive good health care if they don't know what the doctor or nurse is saying, or what the information on the bottle of Tylenol is saying for that matter? And why would a FNMI person trust Western medicine anyway after some of the horrible things that have happened, like the forced sterilization of First Nations women?
he inequalities of health care and health incomes of indigenous peoples in canada compared to the general population has many intertwined factors that are still being understood. Indigenous peoples have “higher rates of infant mortality, unintentional injury and death, tuberculosis, obesity and diabetes, mental illness and suicide, and exposure to environmental contaminants” (1). From my research some of the main factors are the history of colonization, geography, and a lack of information on indigenous healthcare.
History
The inequities and conditions that indigenous people have faced throughout Canada’s history having lasting effects through the generations. In one of the previous posts we learned about the multigenerational effect of trauma and how it can influence genetics.
It also has an effect of behavior. Medical Student Paul Kim summarizes this well by saying “The reason why we still see health inequity over time, even though the residential school system doesn’t exist anymore, is because of longitudinal policies that influenced parenting habits, influenced diet habits, [and] influenced lifestyle habits”. Trauma experienced even in past generations therefore has many effects. The fact that the Canadian government has lost trust and credibility with indogenous people can also deter them from seeking medical aid when needed (3). This trauma not only keeps people away from healthcare professionals, but then can be compounded by further traumaitic experiences in the healthcare system such as discrimination. This trauma may prove especially detrimental for children and youth that have developing brains which can be affected by traumatic events (2). Realization and acceptance of the profound effects of colonization on healthcare is mirrored in the TRC document which calls for all involved to “acknowledge that the current state of Aboriginal health in Canada is a direct result of previous Canadian government policies, including residential schools.”
Two strategies that I came across to mitigate these factors are “Trauma informed care” and the “cultural safety” approach. Trauma informed care seeks to give care in a way to be sensitive to the trauma experienced by the patient. Cultural Safety, originally designed by Maori nurses, switches from a “cultural checklist” and aims to realize the power imbalances in the healthcare system. Another way to help with the relationship between indigenous groups and the healthcare system would be to embrace indignous knowledge systems.
Geography/ Logistics
Proximity and availability of healthcare services is a major factor in the health of individuals. With many indignous communities living in rural parts of Canada it is not only a far journey to reach services, but with the small populations it can be difficult to recruit, train, and maintain healthcare professionals(4). Below is an example of the type of travel Inuit people may have to make to seek medical care.
Inuit Medical Travel Map:
One of the main ways to help remedy this is resources. I’m not sure if this would be in the form of enticing healthcare workers with more money/ resources, or perhaps training members of the community. Either way more access to services is clearly needed. This is outlined in the TRC document as follows:
“We call upon the federal government to provide sustainable funding for existing and new Aboriginal healing centres to address the physical, mental, emotional, and spiritual harms caused by residential schools, and to ensure that the funding of healing centres in Nunavut and the Northwest Territories is a priority.”
Information/Research
The TRC document calls on “the federal government, in consultation with Aboriginal peoples, to establish measurable goals to identify and close the gaps in health outcomes.” I have referenced the report above, but there is clearly more work to do. Things such as multi-generational trauma effects on genetics are just coming to the forefront. Mental health services are just now being recognized as severely underfunded in the general population. More data on these topics, and with respect to their interaction to variables such as I have stated above, is needed. As Gao states in his research paper, we must “document disparities, understand the specifics of the causes, and then move forward collaboratively on changes”(3).
Sources:
(1) https://www.nccah-ccnsa.ca/docs/other/ExecSummary-GovCan-HIR-EN.pdf
(3) https://www.cmaj.ca/content/179/10/985.short
(4) https://www.nccih.ca/docs/determinants/FS-AccessHealthServicesSDOH-2019-EN.pdf