Past, Present and Future - Trailblazing for equitable healthcare for First Nations Children
- chatyrbok4
- Mar 14, 2021
- 6 min read
Updated: Mar 23, 2021
A boy that inspired a nation.....
Photo retrieve March 13, 2021 from https://unsplash.com/@avisindica?utm_source=wix-media-manager&utm_medium=referral
Introduction
I began working for Jordan’s Principle - Child First Initiative in 2017. It is a program that was initiated after an Indigenous boy Jordan River Anderson, who was born in Norway House Cree First Nation, Manitoba with multiple complex medical needs suffered the inequities of the Canadian healthcare system. Indigenous children face a disproportionate amount of health disparities related to colonialism and past traumas (Greenwood, 2015). At the age of two he was deemed medically stable enough to move back to his home community and leave Children’s Hospital in Winnipeg, Manitoba. Both Provincial and Federal governments began disputing over who was responsible for paying for equipment and services in his home on reserve. Jordan died at the age of five without ever having had an opportunity to live in his home community surrounded by his family. The Canadian Rights Tribunal in 2007 ruled that Indigenous children were in fact treated differently and received inequitable services and implemented Jordan’s Principle but due to such a narrow definition of services to be provided, it excluded many of the first nations children. In 2016, the Canadian Rights Tribunal “ordered the federal government to immediately stop applying a limited and discriminatory definition of Jordan’s Principle, and to immediately take measures to implement the full meaning and scope of the principle” (First Nation Child & Family Caring Society, 2021). Manitoba implemented Jordan’s Principle to its fullest scope.
The Past
In order to understand the health inequities faced by Indigenous children we must first understand the history that has lead us to where we are today. In the Indigenous culture it is believed that everything is interrelated and connected and that the children are precious gifts from the creator. The Indian Act of 1867 remains the only legislative direction for First Nation people, “which gave responsibility of health and health care for First Nations to the federal government, while for the general population, health was primarily a provincial responsibility” (Richmond & Cook, 2016). “There are documented health and socio-economic disparities between indigenous and non-indigenous peoples, including lower life expectancies, higher rates of chronic health conditions, higher rates of incarceration, and an increased likelihood of experiencing poverty” (Bethune et al., 2019). Colonialism and the intergenerational effects will take years to address. The impact of the sixties scoop, residential schools and continued structural racism is evident in the social determinants of health that continue to face the Indigenous population. Poor housing, education, socioeconomic status, just to name a few are slowly beginning to be addressed but will take years to really have a true impact.
Here is a historical timeline of Indigenous history.
The Present
In 2017, Manitoba instituted Jordan’s Principle to the full scope of services for children up to the age of 18. Manitoba has 63 reserves that are covered by 7 tribal councils. Each tribal council has representatives within each community, called case managers. Each case manager has an organized community team of child development workers, respite workers and a rehabilitation assistants. Some communities have even hired a cultural awareness worker and elders to incorporate traditional teachings. The community team offers services such as assisting children in school either for behaviors that might have kept them out of school or students that require additional academic help. They can offer respite services in home or at their Jordan’s Principle space. They arrange activities such as Grade 8 graduations, fishing trips, picnics, health days, Halloween parties etc. Each community has the ability to refer to one of the service providers in Manitoba for equipment, training and education support or services to be provided in community. Each of the service providers provides services directly in community at no cost to the family or band council. So for example, I train respite workers, family members and parents on seizure management, enteral tube feeding or diagnosis specific information etc. The Manitoba service providers are:
St. Amant Center – Consists of Nurse Consultants, Psychology Technicians, Social Workers, Counsellors, Dieticians, and Psychometric testing.
Special Services for Children and Youth – Consists of Occupational Therapy, Physiotherapy, and Speech and Language Therapy – for children 0-6 years’ old
Manitoba First Nation Education Resource Center – Provides services for school age children in schools which consists of occupational therapy, speech and language therapy and physiotherapy.
Manitoba Adolescent Treatment Center – Specialized counsellors for addictions, experience mental health, behavioral and/or emotional disorders.
Eagle Urban Transition Center – Provides respite for families while in the city for hospital stays or appointments for siblings.
Manitoba Possible – Provides services for deaf and hard hearing children
Manitoba thus far, is the only province that has a coordinated effort and collaboration between communities, service providers and tribal councils. We are providing support in communities to help families remain together as well as assist them to stay in their community without having to make the impossible decision to leave so their child can receive regular therapy. By providing services in their home community, decreases family stress, provides ongoing support network, builds capacity within each community, allowing families to be , just that, a family.
Raising any child can be difficult but raising a child with complex medical needs, takes a village of support people behind them.
In February 2021, the Canadian Human Rights Tribunal (CHRT) released decisions about compensation for First Nations children and family members that were affected by discrimination by child and family services, as well as children who experienced delays due to the narrow definition laid out in the 2007 ruling (Government of Canada, 2021).
The Future
One of the largest concerns I have working in the Jordan’s Principle program is that it covers children till the age of 18. What happens after that? Who takes over those services for the complex kids as parents and family members age? Programs must be put in place to continue these valued services past the age of 18. We finally have services being done in community so families don’t have to be away from their loved ones for weeks at a time or flying in and out of their community to attend appointments. Kids are able to attend school and not be sent home because teachers are being taught how to handle their behaviors. Parents are not having to make the difficult decision to move from their home community to be closer to hospitals as teaching and support are being given to the nursing stations and other family members to assist in home. Home renovations such as wheelchair ramps, accessible bathrooms, ceiling lifts are all happening to assist in keeping families together. There are so many positives that are coming out of Jordan’ Principle but we have a ways to go yet. Compensation is being given to residential school survivors and families affected by the discrimination by Child and Family Services. The country is beginning to heal and learn about the travesties of the past. Recognition is beginning to heal the racial divide but so much more needs to be done to put everyone back on a level playing field. Education on the past is essential in moving forward in the present so we don't repeat in the future.
Retrieved March 23, 2021 from https://www.youtube.com/watch?v=rRZYRIC69Bw
Conclusion
When looking to the future of Indigenous children we must look to highlight the resilience and resourcefulness of many Indigenous communities and people. We must move away from a deficit focus, that solely encases the negativity that continues to measure the failings of our governments for Indigenous populations. Instead a focus shift is needed to recognize the successful initiatives that are strengthening Indigenous well-being. This doesn’t mean forgetting the social determinants of health affecting many children but to just focus in on the negative aspects we need to be reminded of the positive ones as well. The saying “nothing for us, without us” truly means that future initiatives must be led by Indigenous peoples and grounded within their unique and diverse heritages that reflect their culture. There is still lots of work that needs to make services equitable in order to assist in improving child health of First Nations people. I am working myself out of a job with the vision is to see these services provided by Indigenous led organizations. We enter the communities with humility and ask what they need rather than us tell them what we think they need – again “nothing for us, without us”.
Equitable Health Care for First Nations Children retrieved March 21, 2021 from https://www.youtube.com/watch?v=6l0KkAnThfk
References
Bethune R, Absher N, Obiagwu M, Qarmout T, Steeves M, Yaghoubi M, Tikoo R, Szafron M, Dell C, Farag M. (2019) Social determinants of self-reported health for Canada's indigenous peoples: a public health approach. Public Health. Nov;176:172-180. DOI: 10.1016/j.puhe.2018.03.007
First Nation Child & Family Caring Society (2021) Jordan’s Principle Retrieved March 11, 2021 from https://fncaringsociety.com/jordans-principle
Greenwood M. (2005). Children as citizens of First Nations: Linking Indigenous health to early childhood development. Paediatrics & child health, 10(9), 553–555. https://doi.org/10.1093/pch/10.9.553
Government of Canada (2021). Jordan’s Principle Retrieved March 11, 2021 from https://www.sac-isc.gc.ca/eng/1568396042341/1568396159824
Richmond, C.A.M., Cook, C. (2016) Creating conditions for Canadian aboriginal health equity: the promise of healthy public policy. Public Health Rev 37, 2. https://doi.org/10.1186/s40985-016-0016-5
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