On the Rolling River First Nation
reserve, three hours north of Win-nipeg, a nine-year-old
girl with Rett Syndrome, unable to contract any of her
muscles, is fed, cleaned and exercised by her loving
parents and a concerned nurse — and no one else.
The problem isn't that treatments
don't exist, or that they're unavailable in Canada,
or that they're not covered for residents of Manitoba.
The problem is that the girl has fallen between the
cracks of the aboriginal healthcare system: neither
the federal nor the provincial government is willing
to claim responsibility.
A
REAM OF RED TAPE
This classic game of hot potato became familiar to the
world when the Ontario government evacuated the E
coli-infected Kashechewan reserve in October. Many
attributed the government's sluggish response to the
community's long-standing problem with sewage in the
drinking water to confusion over who's responsible for
ensuring clean drinking water on reserves.
At the First Ministers' Meeting
on aboriginal issues in Kelowna at the end of November,
aboriginal leaders, the federal government and the premiers
committed to a ten-year plan which promises over $1.3
billion for health, including reducing infant mortality,
obesity and diabetes among kids by 20% over the next
five years. They also promise to double the number of
doctors and nurses dedicated to aboriginal health —
to 300 doctors and 2,400 nurses.
All good news, but what the deal
doesn't promise is to simplify the issue of jurisdictional
confusion in which many patients and healthcare providers
become mired. In a nutshell, the provincial government
provides physician and hospital services and social
services while the Department of Indian and Northern
Affairs Canada (INAC) handles "non-insured health benefits"
like prescription drugs. At least that's how it works
on paper. In practice, tight budgets and a Byzantine
system of reimbursement mean many non-insured services
are virtually inaccessible to rural aboriginals.
"You need a prescription in order
to be reimbursed," explains Eva Whitebird. But ever
since the Rolling River ED was shut down two years ago
and the community's three doctors packed up and left,
people have to visit the doc in a town many kilometres
away. So prescriptions are hard to come by.
JORDAN'S
STORY
Trudy Lavallee, a policy analyst for the Assembly of
Manitoba Chiefs (AMC), is determined to see things change.
She's advocating what she calls Jordan's Principle,
which recommends that the first governmental department
to encounter an aboriginal patient be required to help
the patient immediately, and sort out the funding later.
The proposal is named after Jordan,
a severely disabled child from a northern Manitoba reserve
who spent two unnecessary years in hospital while the
Department of Indian Affairs argued with the province
over who would pay for the specialized foster care he
needed. "The child welfare agency wasn't going to put
him in a foster home until they knew that their per
diem would be reimbursed. They never got approval,"
Ms Lavallee explains. What should have been a simple
act of coordination between two departments turned into
a years-long battle. In the end, Jordan died at the
age of four without having left the hospital.
In an article for the November
2005 issue of Paediatrics & Child Health,
Ms Lavallee argued the government's actions in cases
like Jordan's violate both the Canadian Charter of Rights
and the United Nations Convention on the Rights of the
Child, to which Canada is signatory. The AMC is currently
working with the Public Interest Law Centre to build
a human rights case against the Canadian government.
SELF-DETERMINED
SOLUTION?
In Kahnawake, a First Nation near Montreal, residents
are taking control of their own healthcare. The reserve's
unified health and social services organization, Shakotiia
Takehnhas Community Services, receives federal funding
and is finding ways to fill in the cracks. Keith Leclaire,
senior policy analyst for Shakotiia Takehnhas, says
the system is working well: the community boasts several
native doctors and nurses, and an internationally recognized
diabetes prevention program. But, as he points out,
Kahnawake's circumstances aren't necessarily typical;
as a large community located only a short ambulance
ride away from several Montreal hospitals, Kahnawake
has the resources in place to make the transfer work.
"In rural communities out west, it might be a different
story," he says.
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