April 29, 2018:

I sat, stunned. The Ontario Medical Association Council had voted not to start their Council meetings with a land acknowledgement.

Today is my first day as the OMA President.

My first thought, “seek first to understand.” It’s one of the rules of being a good Board Director and, out of the hours of governance training I’ve had up to now, it’s the one that’s stuck with me the longest.

So I asked. And because many Council members trust me, they opened up and told me why they had voted the way they did. And while the reasons weren’t malevolent, I realized that there was a general misunderstanding of the importance of the land acknowledgement to Indigenous health, why it is a recommendation from the Truth and Reconciliation Committee. Not to point fingers, but I had to admit, I myself didn’t know enough about the First Nations communities. I knew the history that I had learned through school and through readings on my own. I had worked in Moose Factory, which is a small community hospital on a Cree reserve. But I did not see myself as an expert. For the OMA to find a way through this unexpected event, I had to learn more. The organization had to learn more.

This became one of the first projects I tackled as OMA President. With then-CEO Tom Magyarody, I began the work of understanding the lives of our First Nations citizens.

That meant going to meet them where they were at.

Part 1: Flying out

It took Kirsten Hudak and I most of a day and three planes to fly out to northern Ontario’s First Nations communities: Toronto to Thunder Bay to Sioux Lookout to Keewaywin and North Caribou Lake First Nations reserves. Roughly the same amount of time it takes to fly across the country from Toronto, ON to Vancouver, BC. 

Kirsten prepared a thorough memo for me, detailing the historical and political landscape for the First Nations in Ontario. None of it prepared me for what I witnessed.

We were guided on this trip by James and John Cutfeet, brothers from the Big Trout Lake community who are both involved in Health Policy leadership and the Health Transformation leadership for the Nishnawbe Aski Nation. With kindness and self-deprecating humour, what they showed us was eye-opening. 

Life is hard up here, hard in ways that it simply shouldn’t be. 

July 31, 2018 - Sioux Lookout

We started in Sioux Lookout. Population: 5000. The weather was cool. Wood siding houses in neutral colours were scattered along roads that wound around Pelican Lake. The landscape was intensely beautiful.

Meno Ya Win Health Centre is the local hospital here. The go-to hospital for an area consuming 2/3 of Ontario. A massive geography to serve. 

“This is a First Nations hospital. This is our hospital,” said Douglas Semple, fiercely, proudly. By the end of the trip, I understood his fierceness and pride.

First Nations culture is embedded into the brick and mortar of Meno Ya Win’s design. The Obstetric wing is in the east because east is life-giving. Palliative care faces the North because north signifies the end of a life cycle.

There is a healing room, where the fire-pit contains a handful of soil from each Northern First Nations community. A grandmother drum sits in the centre of the room, beneath the skylight, and bundles of tobacco, sage, cedar and sweetgrass sit in bowls on a shelf. 

There is even a school inside the hospital. Sometimes, patients fly down for treatment that lasts weeks to months, and many times, kids accompany them because they are their main caregivers.

Because everything requires a flight in, the hospital is working on using telemedicine for follow-up care. At least it saves the patients the time and commitment to fly down, just for a 30 minute appointment.

A nearby 100-bed hostel serves as quarters for the patients and families who fly down and must stay overnight — to deliver a baby, to see a consultant, to get dialysis or surgery. The hostel is already exceeding capacity, seeing averages of 3000-4000 patients per year. So, families are housed in local hotels because of overcrowding at the hostel. James tells me he’s working on local government to help build more capacity.

The docs up here amaze me. Dr. Eric Touzin, was the only general surgeon up here for years; they’re now up to 3, which makes 24/7 call coverage bearable. Dr. Barbara Russel-Mahoney talks about how family docs in the area have expanded their skills to cover OB and C-sections, palliative care, addiction medicine, trauma, chemotherapy, mental health and so on. 80% of their patients are First Nations. Many of these docs fly up to the communities for 5 days each month, 60 days per year, to provide on-site care. But the contract negotiated with the government is a decade old, and it is inadequate for the work they now have to do.

Part 2: First Nations Tour

August 1, 2018: Keewaywin First Nations

Kirsten and I are belted into a 4-person charter plane with James and John Cutfeet on our way into the far North in Ontario. I could stretch my arms and touch the pilot’s shoulder, that’s how small it is. I look out the window and see vast stretches of forest and lake. It’s breathtaking in its beauty and isolation. The plane dips abruptly, swaying. It flies at a lower altitude than the commercial airlines so we feel each gust of wind, each sharp updraft.

Keewaywin is a reserve community with a population of about 300-odd First Nations men, women and children. Their airport is an unpaved runway and a one-room building. We pile into a rusty jeep and head into town. 

The houses we pass are in disrepair, the windows covered by t-shirts and plastic sheets. Forest — birch, poplar, spruce — line the dirt roads. It’s a perfect summer day, crisp, sunny, but there are no kids playing on the streets. 

We visit the empty nursing station. Usually manned by 2 nurses and assorted local workers, the nursing station has 2 exam rooms, 1 with resuscitation equipment. The admin office triples as a kitchen and a dental consult room. The dispensary is little more than a locked closet. 

We visit the local Band office and sit with the elected Councillors, headed by a young man, Johnny Fiddler. The Chief is away, but the others fill us in. At first, they are unsure of our intentions. James and John introduce us, but I also realize, the OMA is one of the few healthcare organizations that has flown up to meet with the Councillors. 

Their office is in need of repairs, but the most gorgeous paintings depicting First Nations beliefs hang on the walls. The contrast is shocking.

As the Councillors talk, my heart breaks:

• No roads lead to Keewaywin, so everything must be flown up or driven over the ice roads. Global warming has made these ice roads less and less reliable so they are open fewer days each year. Transportation costs for supplies, fuel, food and so on are prohibitive. This alone has a hugely isolating effect on the community.

• The houses are in disrepair because they are built using “cheap substandard” material. Mold and lack of insulation are rampant. Running water and reliable power are not always the norm. One band Councillor mentioned a young couple who delivered a baby in a trailer without power, without running water, without any other option. If a roof leaks, the Band must apply to the federal government for funds and approval to fix it. These houses are not theirs, this land is not theirs.

• Extended families of 14 to 15 live in 3 bedroom houses because the waitlist for a house is in the federal government’s hands. The housing shortage has been unresolved for decades.

• Agency nurses rotate seemingly at random in and out of the nursing station. Some are kind, some are too wet behind the ears to work in such a severely under-resourced area, some were openly racist and unkind. There seem to be no standard skillset, no regulatory bodies. The families file complaints that go unanswered. “We are second-class citizens,” one Councillor states.

• Medications are shipped up each week. Sometimes, if the weather is inclement, a shipment is delayed and they run out. 

• Every single family has a story of a close-call: a sick child or wife or son who sees the nurse, is given Tylenol and sent home, only to be medevaced out the next day. 

“My wife’s asthma just got worse and worse. The nurse saw her and told her to take Tylenol and go home. So I paid $300 and flew her to Winnipeg where they put her in hospital for a week. They told me she could have died.”

“My son saw the nurse with a fever and a cough, was told to take Tylenol and go home. The next day, he was medevaced out. He died a week later.”

• Everyone acknowledges that resources are limited. The nearest lab or x-ray is in Sioux Lookout, about 200km away. Doctors come up for 5 days a month. When it’s the same doc again and again, the community is healthier, better taken care of. But that is uncommon, and it adds to the isolation and wariness.

• There is a distrust of the health care system, a suspicion that care given is inadequate. I’m not surprised because this is not a health care system at all; it’s not even the bare necessities. 

“Would you want your loved ones to live like this?” asks Johnny Fiddler, Head Councillor.

I can’t lie. “No. Never.”

On the flight out, I am angry that people are forced to live in such poor conditions in a first-world province like ours. No sense of ownership. No reliable access to the basic necessities of life. No ability to speak up. No ability to change their destiny. Even self-determination is a fight.

I turn to John Cutfeet: “How do you live with this, this heartache? The weight of all that is wrong here?”

He sighs. “Many who live on reserves have lived like this for so long, they don’t know anything different. They have been told they are no better. Forced to go to residential schools. Forced to live on reserves. Forced to give up their cultural identity. That is colonialism. So they can’t imagine better for themselves. It is hard to break free from that and fight for more. But it’s the only home we have. And we are beginning to speak up more and more.”

Part 3: First Nations Tour

August 1, 2018: North Caribou Lake First Nations

A bridge connecting the North Caribou community to the rest of Ontario, was finally finished in 2017. Chief Dinah Kanate smiles broadly talking about the bridge. Before the bridge, North Caribou Lake was a fly-in, fly-out community — much like Keewaywin. But now, they have year-round access to resources. It’s still an 8-hour drive through dense forest to Sioux Lookout, but it feels like freedom.

Like Keewaywin, the North Caribou Lake airport is an unpaved runway and a one-room building. But the paint is less chipped, the benches less rusty. I climb into the bed of the pickup truck and perch on the side, gripping the edges so I don’t fall out. We drive into town, the wind whipping our hair, the dirt road bumpy and winding.

North Caribou Lake is a large reserve with strong leadership. They are about 320 km outside of Sioux Lookout with year-round road access. Population at last headcount: just over 1300. 

Like Keewaywin, there are no sidewalks, no crosswalks, no traffic signals. Dirt roads wind through the community. Everything — vegetables, milk, meat — is expensive because it all has to be trucked across the vast geography. The grocery store, the Northern, is not at all like the SuperStore or the Metro. Choices are limited to food that lasts — foods with tons of preservatives, tons of salt and sugar, like chips and pasta which wreaks havoc with the diabetes rampant in the community. That’s why young men and women in their 30s are getting toes amputated; it’s why so many middle-aged adults are on dialysis.

There is no power grid here. Like surrounding reserves, everything runs on diesel and back-up generators. And if that fails... you’re left in the cold and dark. Worse, the dialysis machine in the nursing station won’t work, and you either get medevaced out or you die.

The nursing station has multiple exam rooms and multiple programs to serve the community’s needs — from diabetes to Hep C to Suboxone for addiction to Choose Life for adolescent mental health. We meet two doctors who work there, and a medical student. A number of nurses and allied health work in various capacities. It feels more familiar, more similar to the family medicine clinics I see down south.

I look at the posters in the waiting room, and am surprised to see a boil water advisory. I ask James Cutfeet about it, and he shrugs. “So it goes,” he says. It is a stark reminder that though this community is further along, it’s still nowhere near the norm seen in Southern Ontario.

Unlike Keewaywin, the houses appear in better condition. But Chief Kanate is quick to point out, 125 families are on the waiting list for houses, and the government has contracted ... a grand total of 2 this year. Still, children play in front yards. Community folk drive back and forth to the Northern. 

There is more life, more activity in this lake-side community.

We visit the Choose Life Project. Barely a year old, the program has youth workers who organize land-based programs, recreational programs, self-esteem/ relationship programs and crisis response programs. Already, Chief Kanate is seeing a significant decline in teens texting her in the middle of the night, hopeless and in crisis. Suicide attempts in the community are dropping, especially among the children. A small hostel is being built next to the Choose Life building so that teens in crisis can be monitored more closely by the mental health workers next door instead of at the medical clinic.

Finishing our tour of the Band Office, I see diplomas proudly displayed on the walls. I stop. High-school diplomas nailed to the wall in plastic sleeves. Dinah looks for hers. Many are from the Keewaytinook Internet High School.

“Dinah, what is an internet high school? Why do you need it?” I ask.

She explains: very few reserves are allowed to have their own high school. Most will have a teacher who teaches from kindergarten to grade 8. But for education beyond that, teens must either attend the internet high school (if able) or move down to Sioux Lookout, Dryden, Thunder Bay etc (if able), or remain uneducated. 

North Caribou Lake with its population of 1300 has not been permitted a high school yet. The nearest one is in Sioux Lookout, 320 km away. This is partly why so many First Nations do not attend high school, and of those who do, most do not finish. A high school education means a 25% higher rate of employment and a chance to break out of poverty, out of dependency, out of hopelessness. 

I’m staggered. 

Part 4: Home

I didn’t realize before how much I take for granted. I don’t just mean a functional health care system that I rely on and work within. But the ability to get an education. Buy a house and take care of it. Flip a switch and have reliable power. Turn on the tap and drink clean water. Live with my children, watch them grow and learn, and be educated.

The barriers that thousands of First Nations live with are complex, layered with decades of neglect, denial, colonialism, and obsolete legislation. 

James Morris, CEO of the Sioux Lookout First Nations Health Authority, described it well: “The settlers came. They didn’t understand the social systems already in place guiding the First Nations. They didn’t understand our systems though these systems allowed us to live on the land all across Ontario for centuries. So the settlers dismissed us as uneducated, un-evolved, to be replaced. The system works the way it was designed.”

Now, First Nations are governed by the Indian Act and a smattering of funding arrangements that also cover the military and prisoners. They struggle with a legacy of disempowerment, cultural genocide and trauma from the Residential Schools and the Sixties Scoop. 

John Cutfeet smiles proudly, telling me about his mom: “When the Indian agents came for me, my mom stopped them. Said they can’t take us. The Agents told her that if she didn’t give us up, she would get nothing from the government, no support. She laughed in their faces. She said, ‘I’ve been living for years without your support; my children and I will keep on living without it.’”

The federal government is responsible for the welfare of the First Nations people. Yet they are and have been stripped of ability towards self-empowerment and self-determination. This is the downstream effect of colonialism. To access all the things I take for granted — safe housing, clean water, basic education, basic healthcare — these communities file application after application, answer question after question, appeal rejections and, educate denial and ignorance. So it has gone for decades. 

“Would you want to live like this?” The young Keewaywin Head Councillor’s words echo in my head. I shake my head.

On the flight home, I naively ask Kirsten, “Why don’t they just leave?”

Kirsten has been involved with First Nations advocacy for a number of years — even working on some of the land claim negotiations for the federal government. She shares what people from First Nations communities have shared with her. “This is home and a connection to community for many people,” she explains “leaving can be just as hard as managing the different challenges people face on reserve.”  

I begin to understand. Keewaywin, North Caribou Lake — it’s home. Their families are here, their Elders are here, their history is here. And the backbone of First Nations culture is the family unit. To leave is a serious undertaking. For one, though they keep their First Nations status, they lose access to certain benefits, meagre as they are. And for a Peoples whose majority are left undereducated — not even a high school diploma — for them to succeed off the reserve, to find employment even, seems impossible. The federal system has set up some support for them. To cross over into an entirely different system is beyond difficult. For another, these communities are their home, their people.

But bleak as things can be, there is change brewing. Younger generations are taking up the mantle of leadership, of advocacy. Communities are pulling together to build programs to take care of their own.

This experience has changed me. The persistence of the First Nations, their refusal to give in to hopelessness, to the years of trauma and open neglect they have faced as a culture, to the systemic barriers that have been set up to keep them boxed in on the reserves — in the face of such odds, their determination is epic. 

All this was brought home to me in vivid, in-your-face detail over the two days up in the far North.