Lessons learned during H1N1 guide Ottawa’s response to COVID-19 in First Nations

The federal government is looking to hire paramedics who can fly up to remote First Nations in case there’s a surge of COVID-19 cases — evidence, officials say, of a different approach to Indigenous health care than during the H1N1 outbreak.

It’s “a proactive move in terms of making sure that we’ve got surge capacity available for Indigenous communities, should the capacity of the health professionals on the ground be surpassed,” said Robin Buckland.

She’s the chief nursing officer for Indigenous Services Canada and director-general for the department’s office of primary health care.

“It’s really being put in place to make sure that … we’re ahead of that curve.”

So far, the numbers of COVID-19 cases on-reserve in Canada remains relatively low, although a recent outbreak in northern and Indigenous communities in Saskatchewan is alarming public health officials and First Nations leaders.

As of Thursday afternoon, Saskatchewan had 196 active cases, with 138 of those in the province’s far north region and 39 in the north region.

The request for proposals for the paramedic contract closed April 27, and officials hope to award the contract within two to four weeks.

The contract is for three months and focuses on 51 Indigenous Services-managed nursing stations and communities in Manitoba and Ontario, but there is an option to shift paramedics to other regions and extend the timeframe, if necessary.

Paramedics will provide a range of care, including emergency care, working as part of a team of physicians, nurses and nurse practitioners.

“That said, my paramedic colleagues would remind me that they also are excellent providers in terms of providing community support as well,” Buckland said.

The chief nursing officer for Indigenous Services Canada explains how paramedics will fit into the health-care teams on remote First Nations. 3:02

The money to hire the paramedics is part of $100 million in federal funding for COVID-19 public health measures, announced in March.

Buckland says Ottawa’s approach to COVID-19 is much different than in 2009, when remote First Nations in Manitoba were hit hard with H1N1.

Indigenous leaders were horrified to find dozens of body bags in shipments of hand sanitizer, gloves and masks sent by Health Canada.

An investigation found Health Canada made a “clear overestimation” of the need for body bags, and there was no “ill will.”

“First Nations have worked hard over the last number of years since H1N1 in making sure that they’ve got a fulsome pandemic preparedness plans in place,” Buckland said, adding the paramedic contract is part of ensuring Indigenous Services can help implement those plans.

‘Willingness to collaborate’

Alvin Fiddler, grand chief of Nishnawbe Aski Nation — which represents northern Ontario First Nations — supports any surge capacity Ottawa is arranging, saying the 49 First Nations his organization represents are at a high risk for COVID-19 because of overcrowding and chronic health conditions.

“But we also understand this RFP is in response to COVID, and will be limited in scope and not ongoing,” he said.

Nishnawbe Aski Nation is also developing partnerships with several health service delivery organizations, including the non-profit Ornge air ambulance service and the Paramedic Association of Canada. Its long-term business model involves recruiting and training community members to become paramedics, Fiddler said.

Nishnawbe Aski Nation Grand Chief Alvin Fiddler says there are still gaps in the pandemic preparedness plans of many communities, but says Ottawa’s response to COVID-19 is a considerable improvement from the response to H1N1. (Dave Rae/CBC)

While there are “gaps in the response” — including a need for more funding for personal protective equipment, oxygen therapy equipment and substance abuse programs — Fiddler said he has seen a different response from Ottawa during this COVID-19 pandemic than during H1N1.

“We have noticed a willingness to collaborate on issues of urgent need,” he said.

“While the response has not been perfect, communication and collaboration are much more apparent in this pandemic, and we are hopeful that this will continue as we work together to ensure the health and safety of our communities.”

The paramedic contract will work in co-operation with existing primary care physicians who fly into remote First Nations.

In Manitoba, Ongomiizwin Health Services — the Indigenous health institute based at the University of Manitoba — also runs a dialysis unit, programs for foot care and retinal screening, occupational therapy and rehab services.

Medical director Dr. Ian Whetter wasn’t familiar with the paramedic contract, but said he sees it as a promising partnership.

“I think that we are collaborating really well in this province across federal and provincial and community leadership lines, First Nation lines,” he said.

“I don’t see it as competitive at all,” he said, adding he’s happy to see “jurisdictional boundaries that in the past have created some barriers to collaboration have really … been dissolved.”

Trying to limit COVID-19 exposure

Many First Nations have locked down their communities, putting up roadblocks, checkpoints and barricades to keep visitors out and limit exposure to the coronavirus.

It means fly-in health-care professionals also have to change the way they do things.

Dr. Ian Whetter heads an organization that provides primary care physician services to remote First Nations. He says there has been great co-operation between Ottawa, the Manitoba government and First Nations. (University of Manitoba)

Whetter says his physicians usually fly into the communities where they work on Mondays and return to Winnipeg on Thursdays, with phone coverage over the weekends — but COVID-19 has changed all that.

“We’ve tried to lengthen the amount of times that our providers are in community” because of concerns over spread of the virus, including fears the doctors themselves could be vectors for transmission.

“Because communities have asked us to try to minimize the risk of spread of the virus into communities, and because we are concerned about the potential for health care providers to be a vector of transmission to communities,

Dr. Ian Whetter explains the changes made so physicians flying into remote First Nations don’t expose communities to COVID-19. 4:30

Now, physicians stay in communities from 11 to 30 days at a time.

They’re also limiting travel for any doctors who have worked in environments putting them at high risk for exposure to COVID-19, and requiring them to do twice-daily temperature and symptom checks.

At the same time, there’s a balance to ensure the health-care workers can stay connected with their families, and maintain their own mental health during what could be a months-long response to the pandemic, he said.

Dr. Chona Lin is one of the primary care physicians working in remote Manitoba First Nations through Ongomiizwin health services. She recently bought and donated a box of masks for Garden Hill First Nation. (University of Manitoba)

Schedules for nurses have also been shifted to address concerns by some chiefs that outsiders may bring COVID-19 into their communities.

“Communities have indicated that they would like to reduce the amount that nurses, for example, are going in and out,” Buckland said, so they’ve moved nurses to a new four weeks in, four weeks out rotation.

Nurses are screened before their shifts and are flown in on charter flights so they don’t have to spend time at airports, reducing their risk of exposure.

The same measures will apply to any paramedics hired under the new contract.

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