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Federal health department lax in dealing with remote First Nations' needs, says Auditor General

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Photo: flickr/ Connor Tarter

Earlier this year, an institute associated with St. Michael's Hospital in Toronto came out with a wide-ranging report on Indigenous health in Canada. 

It was entitled "First Peoples, Second Class Treatment," and the title tells it all.

The report provides a detailed, documented account of the ways in which Canada's nasty dealings with its first peoples, going back to the earliest colonial times, have yielded the results we know today. 

Indigenous Canadians are markedly poorer than other Canadians. They live with miserably inadequate housing, unsafe drinking water, and inferior education. 

As a consequence, Indigenous Canadians suffer disproportionately from a myriad of medical conditions, which include diabetes, infectious diseases and addiction.

Indigenous Canadians die, on the average, eight years younger than other Canadians.

Federal Auditor General (AG), Michael Ferguson, has just, at least in part, confirmed the St. Michael's study's findings.

On Tuesday, the AG released a report on the health services provided by the federal Department of Health, Health Canada, to remote, northern First Nations communities.

The AG studied access to health service in 54 remote First Nations in Manitoba and Ontario. These are communities where there are no roads to the outside world, and which are usually hundreds of kilometres from the nearest hospital.

In such communities, front-line health care is provided by nursing stations, which have a small number of resident nurses (sometimes only two). 

There are occasional visits from doctors, dentists and other health professionals. But for most serious health conditions, patients in such remote communities must be flown out to larger centres. 

The AG concludes that "overall the Department of Health did not have reasonable assurance that eligible First Nations individuals living in remote communities in Manitoba and Ontario had access to clinical and client services and medical transportation benefits..."

Nurses must go beyond 'normal' duties, but have no support

Anyone who has ever visited a remote northern First Nation will know that the nurses who serve there are dedicated and committed professionals, who see themselves as part of the communities they serve.

Nonetheless, the AG tells us, many nurses in its study group lack proper training and qualifications.

Nurses in remote communities must perform tasks outside their professional scope, such as prescribing drugs and doing x-rays. But the Department of Health, the AG report says, has failed to put in place "supporting mechanisms" to help nurses carry out these "outside of scope" tasks.

The report also notes that only one nurse in the group the AG studied had completed all of the mandatory training courses.

Beyond the matter of nurses' qualifications, the report says the Department of Health did not make sure each nursing station was "capable of providing essential services." 

In fact, the AG says the Department of Health has not seen to it that nursing stations are able to clearly communicate the kind of services they offer to their First Nations "clients."

And there's more.

The federal Department of Health, the AG comments, even fell down in basic maintenance of the "physical plants" of nursing stations. Many nursing station buildings, the AG remarks, are substandard. 

The AG cites one case where visiting medical personnel had to take a pass on a First Nations community because of a faulty septic system at the nursing station.

This indifferent attitude toward even minimally maintaining basic infrastructure is a story one hears frequently in relation to First Nations communities. 

First Nations' nursing stations, it seems, suffer the same neglect as do their water treatment systems, schools, air strips and roads.

First Nations subject to bureaucrats' capricious decisions

On medical transportation -- shipping sick people away for medical treatment when necessary -- the AG notes that the Department of Health seems to take a nitpicking and bureaucratic approach. The Department of Health turned down about 5,000 requests for medical transportation benefits, but could provide no information as to its reasons for doing so. 

It sounds too much like the familiar story of First Nations people being subject to bureaucrats' unexplained and seemingly capricious decisions.

Finally, the AG reports that the Department of Health failed to "take into account community needs when allocating its support to remote First Nations communities."

In other words, the Department of Health simply allocated resources based on what had been done in the past, without examining the particular current situation of each community. 

Worse than that, the Department of Health failed to assure that remote First Nations communities received comparable care to that offered by the provinces in similar non-native communities.

That latter point echoes the longstanding and well-documented complaint against the Department of Aboriginal and Northern Affairs' funding of First Nations education. Per capita, the federal government spends far less on First Nations children than do the provinces on children in their schools.

Most First Nations' services are the responsibility of the Department of Aboriginal and Northern Affairs.

Health is an exception. The federal Department of Health gets that one.

But based on the most recent AG report, it seems to be a case of: "Different Department, Same Story."


Photo: flickr/ Connor Tarter

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