Episode 6 – The Effects of COVID-19 & the COVID Vaccination of the Indigenous People of Canada

Dr Evan Adams MD – Deputy Chief Medical Officer, Indigenous Services Canada talks about the experiences of the First Nations, Inuit and Metis people of Canada during the COVID-19 pandemic and the COVID vaccination of these communities.

https://www.rcaanc-cirnac.gc.ca/eng/1100100013785/1529102490303

https://www.sac-isc.gc.ca/eng/1606941379837/1606941507767

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TRANSCRIPT:

Kojala Medical presents COVID 19 the answers the show that delivers the scientific evidence-based knowledge that can safely return us all to our pre-COVID lives. My name is Dr. Funmi Okunola and I’ll be hosting the show every week you can listen to me interview a highly respected professional about the science that can reduce your risk of becoming infected with this coronavirus.

Welcome to episode 6 of COVID 19: The Answers, titled ‘The vaccination of the Indigenous People of Canada and the effects of COVID 19 on the Indigenous People of Canada I’d like to introduce you all to Dr Evan Adams, Dr Adams is from the Tla’amin First Nation near Powell river in British Columbia Canada. Dr Adams completed his doctor of medicine degree at the University of Calgary and his aboriginal family practice residency at Saint Paul’s hospital UBC in Vancouver Canada as chief resident. He then went on to acquire a Masters of Public Health degree from John Hopkins University in Baltimore in the USA. He was the first ever aboriginal health physician advisor in the office of the Provincial Health Officer and became the deputy Provincial Health Officer in the province of British Columbia Canada in 2014 he became the first chief Medical Officer for the newly formed First Nations Health Authority in BC. 

Dr Adams is currently the Deputy Chief Medical Officer for Indigenous Services Canada Dr Adams is a multi-award-winning actor, most famously starring as Thomas Builds-The-Fire in the movie, ‘Smoke Signals’ and has over 30 years experience as a motivational speaker. Dr Evan Adams is one of the most famous, honored and much-loved persons amongst the indigenous people of Canada. Welcome! Ah thank you, what a very generous introduction. Oh it’s very true.

I’ve spoken to many indigenous people and I hear nothing but high praise. Ah that’s a that’s a nice feeling, thank you. So, I’ve been dying to ask, how a medical physician came to be a famous actor and did you have to choose between the two professions? Yeah, it actually happened the other way around. I was uh, you know, I was a fairly good student and and as a you know as a high school student was told ‘oh we we so need you to get an education and return home and help with all of those all of those issues’ and I think as a as a young person, that’s pretty daunting and so when I was in University I was studying Biochemistry in my second year, a woman came up to me on the street and she said are you an actor and I just lied. Why did I say yes?

She said come and read for me tomorrow and I did, and I was cast in the second lead in a in a film and it was actually quite wonderful. I thought oh this is really fun, it’s much better than the drudgery and the the burden of uh training and going home and serving. It’s just really light fun, but of course I did it with all my heart and I was uh, I think 18. I looked 16 I thought I was uh you know akin to an English major or a performance artist and I just uh, I just kept working, but by the time I hit 30 I thought oh I better go back to my original dream before I age out and see if I see if i can do it so here I am. I’ve done them both and it’s been really quite a journey. That is fantastic and a real inspiration to lots of other students. I mean I often tell people now you can have more than one career. And that’s that’s just a great story. Thank you. Oh,  

you’re welcome and I hope it does encourage people to at the very least recognize that we all play many roles right like we’re not just we don’t just want to be good at our one profession, we also have uh you know we want to be a good person, we want to be a good partner, we want to be a good parent, we want to be clear honest authentic. Right there, there are lots of goals and I feel like sometimes we’re raised up, just for excellence and work and that’s just not enough. Yes, and, and I think when you’ve had those sorts of experience,

it gives you breadth and depth of character too. It helps you to relate to people better. Yes and it’s also humbling, which is very important. I think it’s important for people to not position themselves as subject matter experts, or as de facto experts right? As physicians we can be we can think of ourselves as as god-like. I always joke doctors, they’re just like people, and I really want to avoid that, especially of course with my people

you know, who I was seeing as patients, but now take take care of as a public health doctor. I needed to be seen as really quite approachable and not as you know, some fancy doctor coming from a far away city, who, who was you know, going to institute, you know, things that were not helpful are meaningful to them. Indeed.

before i go on if you’ve got a hard stop um at three yes i do yeah okay

um

We have an international as well as a national audience, so I thought I’d start the program with a definition of indigenous people and communities pulled from the Canadian government website Indigenous Peoples is a collective name for the Original Peoples of North America and their descendants often Aboriginal Peoples is also used the Canadian constitution recognizes three groups of aboriginal peoples Indians more commonly referred to as First Nations, Inuit and Metis. These are three distinct peoples with unique histories, languages, cultural practices and spiritual beliefs. More than 1.6 million people in Canada identify themselves as an aboriginal person according to the 2016 census. Aboriginal pupils are the fastest growing population in Canada they grew by 42.5 percent between 2006 and 2016 and the youngest population in Canada about 44 were under the age of 25 in 2016. There are more than 630 first nation communities in Canada which represent more than 50 nations and 50 indigenous languages. Evan is there anything that you’d like to add to that statement? Yeah I think uh you know, the the United Nations and uh the World Health Organization 

speaks of at least 80 countries that have Original Peoples and Indigenous populations who are affected by waves of migration and migration is not a bad word. We have feet, we’re not barnacles people go to different places and set up their homes, but sometimes for indigenous peoples the commonalities between us you know we’re not DNA cousins but we’re cousins by our colonial experience. And so definitely, in Canada indigenous peoples, you know, their health was going in one direction health interrupted and now it’s going in another direction and we actually have the worst health of any ethnic group in the country in our in our own territories. All right that’s so great. So, I’m moving on to the questions. 

I think it’s important for our International audience to understand some of the nefarious history between the Canadian Government and the Indigenous People of Canada, although this was well known for decades within Indigenous communities the recent discoveries of mass graves at past residential school sites across Canada, has cast a spotlight on the treatment of Indigenous People here across generations,

which frankly, a significant proportion of the general public were ignorant of. In order to try to understand the mindset and lack of trust within the indigenous community for Canadian governmental systems, can you please provide some of the background of the racist and genocidal practices perpetrated by the colonial system to the Indigenous people of Canada?

Thank you, thanks, and I think of colonization in many other countries that are kind of illustrative of you know, what was happening here. There were Indigenous Peoples um all over the Americas including of course Central and South America. And i think of places like Hawaii, Tahiti and, and of course there are many other places. I mean you could even you could even say the experiences of of Indians or of Africans you know,

their quite violent histories where people were subjugated and their lands and wealth went from them to other hands, and that was really essentially the case here. Indigenous Peoples in Canada had to live under what was called the Indian Act and there was no other Act for any other ethnic group. Just for us and let’s not be naïve, part of it was to separate us from our lands and to contain us. Put us on reserves or reservations and part of that was an attempt by uh the Canadian Government in allyship with many churches to take children from their indigenous families to institutionalize them and to try and get them to forget where they were from, and to accept a different way of being and knowing, and those those places residential schools and they weren’t really schools they were really much more like like prisons had a very high fatality rates and many many children died. So, so now Canada has gone through a process of trying to reconcile what has happened. Lest we forget. And we are finding all kinds of unmarked graves with thousands of children’s uh bodies and we as a nation have to deal with, and ask what happened who, who are we. That this could occur in this country because I think Canadians are are proud of themselves on the International stage they Canadians like to think of themselves as being a fair people but um you know this is definitely a stain in there in their history and for us my parents went to extension school for us it is definitely a reckoning as well like what does this what does this mean for us in our own lands?

Evan you were the first chief medical officer for the first nations health authority in Canada based in British Columbia the only health organization in Canada set up to directly provide health services to first nation people by first nation people can you please tell the audience why this was set up? Sure, the health system or health setup for Canadian citizens is delivered by our provinces, however for indigenous people their healthcare system was created separately and was seen as a Federal system. So around all other Canadians, except for maybe the armed forces, around all other Canadians oh, and prisoners too, they’re considered Federal subjects um they would have hospitals and physicians employed by their provinces but we would have the separate system or we did have this separate system, run by the federal government and it was exceedingly inefficient to have healthcare delivered from the capital city, Ottawa uh several , 

that’s not several, a few thousand miles away, or from the provincial capital uh hundreds of miles away, or kilometers away, and so we 

enacted in our province and amongst uh the the indigenous peoples NBC a system that was run by by us essentially so for a large first nations health service organization created to help um indigenous peoples particularly first nations peoples um to to be better and it really has been uh quite an important step in self-determination in improving outcomes achieving equity in service and i think as well having people be less subjugated and participate more in in their own wellness but also in in society as well. Thank you.

Could you tell us about your two-year secondment at Indigenous Services Canada and your role as Deputy Chief Medical Officer. Were you invited to take up this role? Uh, when I was at the First Nations Health Authority and serving the First Nations people of British Columbia and working as a really a Public Health Official as a a physician with authority to to vocalize and direct uh care and attention to specific areas like mental health or um exploitation of women, or substance use, uh that was really a lovely piece. I did that for many many years, but I did feel like there was more work to be done in other areas and I feel like the pandemic gave me an opportunity to say well let me go Federally, let me work Nationally and work on all things code. Because actually, like everywhere, many healthcare workers and other workers were being redeployed to deal with COVID issues so uh really in in a way, and i asked for this, I was, I was, redeployed and sent to a National position in our National Capital in Ottawa.

All right, so moving on to the COVID vaccination of the indigenous people of Canada the reason why I 

wanted to do this interview amongst others, is to highlight the marvelous achievement that you were part of with regards to the scale-up and execution of the national COVID vaccination program for the indigenous People of Canada. You achieved an eighty percent two-shot vaccination rate on reserves up to a year before this was achieved nationally. The vaccination program involved a brand new vaccine formulated from mRNA technology. Indigenous People have injured significant human rights abuses from the Canadian medical system as a result of historical colonial practices and continue to suffer racism in the health system prior to the arrival of the COVID vaccines what medical psychological and social impacts did COVID 19 have on indigenous communities? 

Yes, the pandemic was absolutely frightening for all of us. Particularly for our small communities. We have many small communities. About 650 different first nations communities in Canada many of them are quite remote and because of their remoteness and their size they don’t have tertiary care. So they were identified quite early on as being vulnerable just on, on just on a geographic basis if they got COVID they would have very few means to help anyone there to stop up to stop an outbreak, or to care for those who were who were sick. 

Of course there were other risk factors that we brought forward a number of us and my team included where we said Indigenous People have the poorest health of anyone, so um you know, they, they do have um elevated risk compared to the average Canadian and we have a special relationship with the crown with the country of uh Canada. So we’re we’re actually different from other marginalized groups and chiefs, or our leaders were clear that in their relationship the health of our Peoples was important and this happened in many countries. This happened in Hawaii in the United states. In New Zealand, in Australia.

Those countries named their indigenous peoples as having special risk and so they were given more of a priority than the the average citizen in those uh countries, so we did that here. We got the word out that we would have you know, some availability of the vaccine eventually. Our people did really well at the beginning because we were so remote and in part because we protected our borders. We protected our communities from importation. We actually literally set up roadblocks and asked people’s business going in and out of our tiny communities, but eventually uh our infection rate and our mortality rate and our complication rate were worse than other Canadians around. So now about two and a half times worse, roughly from the data that we have um so we did push hard in communities and we said please let’s look after each other we we can’t afford to do badly at this time we’ve had a long history of communicable diseases that were very bad for us including smallpox and uh tuberculosis and even uh even modern scourges like HIV and uh and also we had been already giving uh health messages to our people um so anyway we we talked it up we encourage people to be vaccinated and yeah we did fairly well even though in my mind i would like to do better! No, you did remarkably well. So i think you’ve answered question three, so Indigenous Communities in Canada have specific experiences via Provincial territorial and local Public Health systems concerning the management of their health and access to vaccines and past pandemics. Could you please tell the audience about their experiences of the H1N1 pandemic back in 2009 and the lessons learned?

Thanks, yes I was in charge of the indigenous response to H1N1 in 2009 in my province. I was working provincially then remember my previous job was with First Nations NBC but my job before that was with the province of BC looking after indigenous peoples so H1N1 happened and again we were nervous about what would happen to us we knew that our communities were not prepared much less prepared than they were this time around in that for instance they didn’t have communicable disease and pandemic plans at a community level but almost no one knew them they were on a shelf collecting dust large uh pandemics was was not really front of mind for those little tiny communities that were having um struggles in lots of other ways. So we we knew that they needed help and so i was part of a team uh provincially remember our services are delivered provincially including Public Health services so we would work with those largely those Public Health teams to make sure that communities were ready. My gosh that was uh we were so we were so lucky. We did everything we could, 

but we were so lucky that ultimately H1N1

wasn’t that bad, I guess you could say it um yeah it could have been a lot worse. 

So, what did you learn from that experience that helped channel your sort of management of COVID 19 well in DC? We learned that we needed to cooperate with the province that first nations needed to cooperate with the province we knew that public health centers those local public health centers needed to take us into consideration uh they didn’t even know for instance sometimes that they needed to vaccinate us that that was their job that you know they thought they thought they were vaccinating everyone else but when it came to us they thought oh well really we we have to do that we we have to speak to those people or go to those communities and and vaccinate uh we didn’t we didn’t know that so we’d have to we’d have to like literally go and tell them and explain well here’s why we you need to go over there

so that was part of it but also we needed to make sure that communities understood their pandemic plans so that it was quite a lot of work to engage those health workers and those indigenous leaders that another pandemic could happen and we needed to be ready and we spent a lot of time there and lo and behold my gosh, COVID happened 11 years after H1N1 and the the indigenous communities in BC I think were pretty pretty ready, yes gosh that’s astonishing what you said about how public health didn’t realize their their responsibilities now let’s contrast the previous pandemic experiences of the indigenous community to the current COVID pandemic several working groups were set up by the government of Canada to facilitate the success of the COVID 19 vaccine program for indigenous communities. Evan could you please describe the work of the indigenous services Canada or ISC led COVID 19 vaccine planning working group sure indigenous services Canada was most importantly part of the federal family so we would be in the same meetings as health Canada or the Canadian armed forces we would interact with the national association sorry it was nasty again that basically the national immunization committee and we would be we would hear what they were planning and we would be able to say oh and remember first nations inuit met wherever they are need to be included and not just included but prioritized a lot of the operational stuff of getting vaccine paid for and then sent out from where they were being manufactured to major cities and then flown or driven out to our communities you know was was quite a piece i think of it as being uh a bit like a a military campaign it was that operational uh and and so we we were making sure that we were in on that every step of the way uh as in uh sometimes local public health wasn’t sure how to get uh vaccines into arms of our citizens in our communities that were you know several kilometers or dozens of kilometers away from uh from them they hadn’t been vaccinating us in the past so how did they vaccinate us uh now how did they count our cases how did they report on those cases we wanted to be involved in that data gathering and reporting so yeah there was there was definitely a lot of coordination to do and my team absolutely helped with that and part and part of our work too was to assist with messaging core messaging that needed to go to all indigenous peoples in in the country even though much of that work was being done on a local level at a regional level or a provincial territorial level yeah it was a lot

one of the many challenges of the ISC COVID 19 vaccine plan must have been accessing communities in remote and isolated regions of Canada such as the Yukon and the northwest territories and parts of Ontario Alberta Manitoba and Quebec to give the audience some background these regions can have infrequent flights roads can be interrupted by weather conditions and there can at times be no roads in or out of the community internet access can be slow or absent and there can be infrequent radio and phone connection how did ISC overcome these challenges and provide COVID vaccination support to First Nations Inuit and Metis communities in these remote areas now we we just made sure that we were in every part of the operation so we were keeping an eye on hundreds of communities and hundreds of deliveries and and they would each have their unique challenges and we weren’t like solely responsible for instance for getting that small plane to go to that small community we were a part of it so we would be helping with coordination and planning and we would send nurses up we would be part of reassuring communities yes the vaccine will be there on time it’ll be here on it’ll be there on that date uh if you need extra vaccinators we’ll send them up um or if they were having an outbreak how are you doing do you are you getting a bit overwhelmed should we send you respite do you need you know is it so bad do we need to send the Canadian armed forces do we need to send the red cross so basically we were in touch with all of those communities as they were going through going through COVID and even checking in and saying you know how are you doing mentally and uh spiritually like do you need those kinds of supports should we send counselors to help with mental wellness is there a community straining are they having for instance uh deaths uh have you lost um elders um are you having runs of suicides we will assist and again we weren’t the only uh game in town there were many many helpers but we um you know we were Indigenous Services Canada we were seen to seen as an important part of of the effort and often would play a leadership role but but in coordination with local leaders because the local leaders if they didn’t like us or they didn’t want us there they could very easily keep us out so we definitely had to be diplomatic and say no we’re we’re we’re here to help you can you can count on us what a fabulous response um so um i saw some figures about a year ago you may be able to update me the vaccination of indigenous people living off reserve or away from their communities particularly in urban areas hasn’t been as successful could you describe the challenges that are faced with getting this group of people COVID vaccinated yes our people in the cities um have special risks because they’re not in our villages amongst their family members and where there’s a social network right a a community center a nursing center resources to support them they’re away they’re they’re in the city in the city i would say they’re probably not treated as well as they could be many of them are impoverished or marginalized in the cities there are often inner city portions where many of our people with mental health and substance abuse issues are under housed and exploited and you know the cities can be unkind and also the cities may not give them neighborhoods or collections of indigenous people who support each other and and live together so we have you know a city a city site where there are a hodgepodge of indigenous peoples living here and they’re disconnected from each other disenfranchised poor often with social issues that are create obstacles for us vaccinating or accessing or caring for them and we would have to call on local services we would call on local chiefs what can we do how do we how do we help with these efforts often the city itself where those indigenous people were and the province or territory that they were in had some responsibility in fact they would say well you know they’re they’re off-reserve peoples um we’re supposed to we’re supposed to um help look after them because my agency spends uh for better or for worse um a little more time in our communities like on reserve and they do off-reserve so there was a lot again uh to coordinate there were a lot of challenges and um luckily uh a lot of uh our agencies in the cities stepped up and said we will help good

so um moving on to the effects of COVID 19 on the indigenous people of Canada I’d like to delve deeper and explore the direct and indirect effect of COVID 19 in indigenous communities now that we are two years into the global COVID 19 pandemic at present as you’ve already mentioned the rate of active COVID 19 cases recorded in indigenous communities living on reserve is double that of the overall Canadian population yet just a few minutes ago we explained how a two-shot COVID immunization was a huge success in the indigenous community on reserve with an 80 vaccination rate do you have any theories as to why the increased rate of COVID cases is occurring yes because we have the poorest health of any ethnic group in the country and because um the social determinants of health are poorer in our communities generally we did worse so for instance you can imagine in the north where there are lots of housing challenges if one member of the family got COVID many others would get it and they would be far from care they would be far from public health personnel who could assist like with contact tracing or moving them towards a vaccination really quickly they would be away from centers that had been converted to care for persons with COVID because not every hospital right was equipped to deal with COVID only certain ones you know there are only a few at the beginning many more at the end but our people would have difficulty accessing them because of their geographic um challenges but also social challenges means that it can be harder for them to move towards care and help so there were lots of um oh and also uh for instance uh not even having um great water for hygiene you know for washing and cleaning services could be could be a problem and uh for many of our communities because they’re northern and indoors they’re indoors more we supposition that maybe the transmission rate was was worse so uh so we so we did see that our our infection rate was quite high but we also noted that our complication rate was lower like around three quarters that of other of other Canadians uh so our hospitalization rate even though we had twice as many people affected infected um uh about about we had about three quarters the rate of other Canadians for hospitalization and death and we don’t know what that’s about that’s interesting that sounds like a research project that should happen in the making the omicron wave has been particularly prevalent and destructive worldwide leading to the highest hospitalization rates and death than any of the other variants what are your own personal experiences of this occurrence in indigenous communities gosh so my office uh along with others of course but we were at the center of intel as it was coming in we were watching over uh communities and we would hear very quickly when a community was affected so we would keep count of and we would daily counts of uh how many people uh were active cases uh how many of our people were new cases how many of our people were hospitalized how many had died uh that day and we would see the numbers um increase we would keep track of uh what we call communities of concern communities that vary that had high numbers more than 10 cases in the village at any given time and that numb we would see that number start to start to grow community leaders as well would call us and say just in case you didn’t see the stats we’re in trouble here we need we need some help we’ll need some support we’re going to be calling you we’re going to be calling you often

about what’s happening here on the ground so it did feel like we felt the waves like we literally felt the waves in our bones because it would get to be bone-crushing very time-consuming work when a lot of our communities had a lot of cases so so omicron was quite a large wave and we were all tired by the time omicron occurred we started to talk about oh we we really are much less concerned with mild cases because Omicron did have a number of mild cases and more concerned about the hospitalized cases for sure and uh we started to talk about long COVID you know what was were those mild cases truly mild maybe they were mild for the first several days but really were there were they sequelae and do we need to keep track of um of those people who in the acute setting we weren’t watching over um yes so that’s that’s what happened

um from my understanding women and children are being particularly affected by COVID 19 in indigenous communities Evan could you please explain why yeah that was uh that was the surprising piece that we saw in our data was that women and children were much more affected than um other other age groups uh generally all of our age groups had higher numbers but we saw particularly so uh with children and with women we suppositioned uh that well because we have so many children like where our our populations are really young and that perhaps children are overly affected by the social determinants of health like you know younger families perhaps have poorer housing or they’re just poorer in general they don’t have the resources of older people uh we supposition maybe because um they went to schools or because you know they were much more social than uh than older groups we suppositioned that women because women are caregivers or the heads of families and thus had to had to go out and take risks go to the store or go to work ride the bus

pick up their children at school that um maybe that’s why that was occurring we also had this other perhaps notion that um you know maybe the men were uh we used this expression um cowboys they were too macho to go and get tested and so maybe we under counted them these are all just uh theories about why we why we saw that

um what have been the economic consequences of COVID 19 in indigenous communities how has ISC stepped in to help alleviate these burdens yeah so um indigenous services Canada did set up a few funds that were COVID related that had very loose parameters on them so people could use them easily and freely when they needed them uh we at the beginning uh you know up until i would say weeks ago we did not hear a community saying that we were having other effects from COVID then infection they weren’t saying to us we’ve had a loss of revenue we we’re we don’t you know we need food stamps food security’s done we weren’t hearing that um you know we didn’t hear that uh families were in trouble economically or that people’s um opportunity for work was affected we did hear of course that um their opportunity for education uh was affected but everyone was talking about that so yeah we we were surprised we’re hearing it now we’re hearing it now uh prices are rising uh people don’t have the the uh the resources to um to cope now and we’re getting um requests for financial assistance so uh with with those starting to come in we are definitely reacting to see how we can um do the very best that we can would the tactic be for instance um food security would the tactic be um a fund like the former um COVID fund even though it’s not directly related to COVID at the moment uh like something like a COVID fund would we need to do something um local because the uh food security is partly dependent on geography right how does food get delivered can food grow in your northern or southern community and so maybe you know a regional response would be most appropriate so we’re again as tired as we are i’m seeking uh seeking to help and i think we’re going to hear more and more uh not just from indigenous people but from around the world um some of those um um indirect consequences of of COVID we’re in a very active recovery phase and and the recovery doesn’t mean just physical recovery at all, it needs lots of different kinds of recovery. Okay thank you there’s something tapping um every now and then when you speak i think um i think it’s the arm of my it’s the arm of my here I’ve just moved it so that it’s moving less with my face than job okay um. While we would all love to get back to pre-COVID life we have all endured strict governmental particularly public health measures these last two years now society is being told by government agencies to live with the coronavirus and encouraged to believe that we are entering an endemic phase on the back end of the pandemic many of the medics and scientists i speak to regularly recognize that we are clearly still in a global COVID 19 pandemic this is confusing mixed messaging for anyone in your opinion what effect is this change in public health policy and attitude having on indigenous communities

it’s been a very difficult time for us to reach this point of opening up and it is in part because of COVID fatigue it is in part because of politics you know political leaders who are not health leaders or health experts political leaders saying we need to open up it’s partly economic we need to get back to work get back to school in spite of um the risk you know the safest thing to do is to stay home and to see no one but maybe that’s not something that’s sustainable on the other hand uh for us in public health we’re really worried about the next wave that this opening up all over the world we’re getting some signals that there can be some large scale outbreaks and another wave because of the opening up and of course there’s still the specter of other variants of concern that we will have to react to and the re-imposition of those public health measures so you know I’m a health person, I’m much more concerned with human health than say economic recovery economic recovery is not my job or how much politicians are are liked or not liked because of public health measures is not my work so definitely definitely from my point of view we need to continue to be cautious and we have been saying to individual communities we know that your provinces and territories and towns nearby are opening up but it’s but it’s up to you and you might want to consider how much COVID is around you how much you have to lose because you know uh you know protect your knowledge keepers and your your elders and your babies please uh you know that they could go slower if they if they so chose to do that thank you

last week we discussed the impact of school closures during lockdowns on children’s education safety and health women and children can be particularly vulnerable to abuse in these scenarios what has been done to support indigenous communities with regards to safeguarding of education and protection from abuse hmm those are really good questions um family violence and women’s health are part of our part of our team

they are not directly involved in the COVID response however chiefs and community leaders have already identified uh family violence and the risk to women and children and the mental health risks like uh suicidality in young people as being major concerns for them and they’ve been saying that since the 80s so there are programs in place there are personnel whose job is exactly that the safety of families to respond to mental health crises to offer counseling and assistance so those teams are already in place however as we all know services uh were quite interrupted by COVID so even though uh violence uh and mental health were getting worse services were

pulled back or they couldn’t be delivered in the way that they used to be so you can assume that there was much more suffering during the pandemic than there was before again uh the leaders would say that to us at all of our meetings they would say and not only are we worried about COVID but our our people are are straining and uh you know bad things are are happening so we would uh

continue to offer our mental health services continue to try and uh respond to particular places of concern and uh you know it’s not like all of the communities we’re doing badly all at once some communities would be doing badly and then the you know the next month it would be a totally different group of communities that were doing badly because of their particular circumstances

yeah so i think once we go back and we look at what happened I do suspect that we will say uh yeah some bad stuff happened and uh people are starting to talk about how bad it was and uh um maybe we we could have done things uh in a different way so that there was more safety than was available on the day so that’s something to build on i guess yes i i and i think it’s important and it’s okay for us to say yeah we could do better or we could have done i’m better because for for me i mean any um woman or child or family uh under threat is one too many uh and so you know there were a number of our families that were under duress who who probably could have done with um better help and our you know our services were not as good as they were before COVID so is there something more that we could have done i think that’ll be part of the part of the analysis and i think i think we will learn to do better i know when i was with the first nations health authority in bc for instance we had quite large mental health teams and that they evolved to have a kind of roving function they would go where they were needed so rather than you know one worker in one community and another worker in another community those mental health workers could band together and say hello look the trouble is over there that’s a few of us go over there and respond and then if there’s another if we’re needed somewhere else at a different location we’ll go to that other location so that seems you know to be a sensible a sensible model but there will be other uh uh teammates and uh stakeholders i think who will who will help shape mental health in the future definitely it has been seen as an issue so for instance the Canadian government newly created a ministry um just several months ago a ministry of mental health and it deals with exactly these kinds of issues and substance use as well well that’s welcome to hear and and i think that’s one of the positive things to come out of the pandemic that you know mental health isn’t isn’t going to be as stigmatized because it seems that everybody has suffered mentally and i think some of the challenges that you’ve experienced in indigenous communities with retraction of supports has happened universally everywhere so but looking forward um we started on a positive note highlighting that your successful vaccination rollout in the indigenous community and now I’d like to end on a positive note the cooperation and organization of governmental agencies with the leaders and healthcare workers of the indigenous communities in Canada to deliver COVID vaccines appears to be unprecedented what future projects and programs can be built on this new attitude and possible infrastructure that will really benefit indigenous people and their health care

yes uh COVID definitely highlighted weaknesses within the system so for instance the there can be a lack of cooperation between an indigenous village and provincial health staff our national public health data system could absolutely use uh improvements uh and uh each province interrogatory is kind of idiosyncratic in how they collect data and then share that data like share it with other provinces and territories or share it with the federal government or share it with other data holders and match those data so for instance a first nations membership list and provincial hospital data could be matched and you could get a sense of first nations hospitalizations uh so by and large that that kind of sharing absolutely could be improved but i think the bottom line is that we’ve seen we have to speak to each other uh the worst case scenario is poor people or marginalized people are left to manage their own marginalization or their own poverty the best case scenario is everyone shows up and says we absolutely need to do this no one left behind equity is a goal equity of service but also equity of outcome in fact during the pandemic we talked about that becoming a law not just something that would be nice but something that would be a requirement that every system like say a hospital would have equity as a goal you know are is your transplantation rate for whites the same as it is for blacks as it is for indigenous people um are you serving people in the same way so so for instance studies around pain control is the pain control that you’re meeting out for white canadians or the white people in your neighborhood the same as for black or indigenous people you know those are important questions that we can have at the table when all the stakeholders are together the old way of doing business is for instance a premier not premier of the province refusing to meet with indigenous peoples or leaders and you know not have their needs enunciated or recorded or responded to and that definitely used to happen so we can get better we can get better at that and i think we’ve named that and we’ve named public health data collection as as you know very clear goals that we just have to attain we can’t keep leaving people out or leaving them behind thank you so much for uh joining us today Dr Adams um it’s been a real pleasure to hear your thoughts and opinions and experiences of the COVID 19 pandemic and and to provide a voice for indigenous communities because personally as one of my main drivers for having this podcast is i haven’t heard the indigenous voice uh in COVID 19 and thank you so much for being such an honored and well-loved representative of that voice ah you’re you’re so kind and thank you for the opportunity to to speak at this level i almost never get to describe what this work is like and it is definitely difficult to be included in this kind of work and this kind of response right it’s it’s it’s it’s been a challenge but uh i can definitely sleep at night that um you know I’m trying to do good things so thank you and and so many people are so grateful for it thank you so much thanks for listening to this week’s episode of COVID 19 The Answers if you enjoyed the episode please subscribe rate and review and do visit our website kojalamedical.com/covid19 the answers