Healthcare Delivery to Ontario's Indigenous Communities During the COVID-19 Pandemic

May 4, 2022

The Empire Club of Canada Presents

Health Care Delivery to Ontario’s Northern Remote Indigenous Communities During the COVID-19 Pandemic

Chairman: Sal Rabbani, First Vice-President, Board of Directors, The Empire Club of Canada

Moderator

Willow Fiddler, Staff Reporter, The Globe and Mail

Panelists
Dr. Isaac Bogoch, Infectious Diseases Specialist, University of Toronto and Toronto General Hospital
Alvin Fiddler, Health Transformation Lead and Negotiator, Nishnawbe Aski Nation
Dr. Homer Tien, MD, President & CEO, Ornge

Distinguished Guest Speakers
Carrie Bois, CEO, Touch Medical
Gene Cabral, Executive Vice-President, Billy Bishop Toronto City Airport

Introduction
It is a great honour for me to be here at the Empire Club of Canada today, which is arguably the most famous and historically relevant speaker’s podium to have ever existed in Canada. It has offered its podium to such international luminaries as Winston Churchill, Ronald Reagan, Audrey Hepburn, the Dalai Lama, Indira Gandhi, and closer to home, from Pierre Trudeau to Justin Trudeau. Literally generations of our great nation's leaders, alongside with those of the world's top international diplomats, heads of state, and business and thought leaders.

It is a real honour and distinct privilege to be invited to speak to the Empire Club of Canada, which has been welcoming international diplomats, leaders in business, and in science, and in politics. When they stand at that podium, they speak not only to the entire country, but they can speak to the entire world.

Welcome Address by Sal Rabbani, Vice-President, Board of Directors, The Empire Club of Canada
Good afternoon fellow directors and past presidents, members and guests. Welcome to the 118th season of the Empire Club of Canada. My name is Sal Rabbani, and I’m the First Vice-President, Board of Directors of the Empire Club of Canada, your host for today's virtual event, titled “Health Care Delivery to Ontario's Northern Remote Indigenous Communities During the COVID-19 Pandemic.”

I'd like to begin this afternoon with an acknowledgement that I'm hosting this event within the Traditional and Treaty Lands of the Mississaugas of the Credit, and the homelands of the Anishinaabe, the Haudenosaunee, and the Wyandot Peoples. We encourage everyone tuning in today to learn more about the Traditional Territory on which you work and live.

The Empire Club of Canada as a not-for-profit organization, so I now want to take a moment to recognize our sponsors, who generously support the Club, and make these events possible, and complimentary, for our supporters to attend. Thank you to our lead event sponsors, Billy Bishop Toronto City Airport, and Touch Medical. Thank you to today's supporting sponsor, LifeLabs. Thank you also to our season sponsors, Bruce Power, Canadian Bankers Association, LiUNA, and Waste Connections of Canada.

Now, before we get started, a few housekeeping notes. I wanted to remind everyone participating today, that this is an interactive event. Those attending live are encouraged to engage by taking advantage of the question box, by scrolling down below your on-screen video player. We've reserved some time for audience questions at the end of the discussion. We also invite you to share your thoughts on social media, using the hashtags displayed on the screen throughout the event. If you require technical assistance, please start a conversation with our team using the chat right-hand side of your screen. To those watching on-demand later, to those tuning in on the podcast, welcome.

It is now my honour to welcome our guests today to the Empire Club of Canada's virtual stage for the first time. They include Dr. Isaac Bogoch, Alvin Fiddler, Dr. Homer Tien, and Willow Fiddler. You'll hear more about them shortly, and you can find their full bios on the page below the video player on your screen. Before we hear from the panel, I'd like to invite Carrie Bois, CEO of Touch Medical, to deliver some opening remarks and introduce our guests. Welcome Carrie, and over to you.

Opening Remarks by Carrie Bois, CEO, Touch Medical
Thank you Sal. I would like to thank the Empire Club of Canada for providing Touch Medical with the opportunity to sponsor this event. I'm Carrie Bois, CEO of Touch Medical, and I started my career in healthcare in Northern Ontario, and have had the opportunity to pivot into the tech sector. I've also been pretty passionate about helping start-ups in Canada. Growing up in an under-serviced medical community, I am particularly drawn to today's topic. The COVID pandemic has highlighted and exploited many of our disparities in certain communities, especially northern remote Indigenous communities. One of our co-founders Josh, actually has a family member who's teaching in Cape Dorsett, located at the southern tip of Baffin Island, where there was a real connection to the challenges and resiliency during COVID. At the heart of Touch Medical, is the overall desire to develop technology that leverages AI, and focuses on the healthcare sector, that we feel has been underserviced in this area. We developed a consumer-based solution that is beta testing right now, that would bridge the gap of consumers who want to track and monitor their health, or those who do not have access to healthcare

One of the projects that we are considering, of particular interest with our product team, is the opportunity to try and solve the long-COVID challenge. By adapting our solution to track, monitor, and allow consumers to effectively manage, and engage with their health teams. Our global team is committed to providing value-added tools that will allow technologies do some of the heavy lifting in the healthcare sector. We are proud to support today's event, and look forward to hearing from this power panel on how we can continue to support the efforts to deliver healthcare to Northern remote communities. Before I hand over to them to get started, I have the privilege of introducing today's guest speakers, Dr. Isaac Bogoch, Infectious Disease Specialist at University of Toronto, and Toronto General Hospital; Grand Chief Alvin Fiddler, Health Transformation Lead Negotiator, Nishnawbe Aski Nation; Dr. Homer Tien, President and CEO of Ornge; and our moderator today, Willow Fiddler, Staff Reporter at The Globe and Mail. And now, handing it over to Willow to get us started. Willow, it's all yours.

Willow Fiddler, Staff Reporter, The Globe and Mail
Thank you, Miigwetch Carrie and Sal, for those introductions. I'm coming to you today from Traditional Treaty Three Territory, and I'm really excited to be a part of this panel discussion. As a reporter who's covered COVID and First Nations, and as a member of a remote community in Nishnawbe Aski Nation, I think there's so much that the rest of the province, and country, can learn from how communities have had to protect themselves in the face of so many systemic challenges. So, let's get started right away. Alvin, we're gonna start with you. And I should actually just—I just want to quickly clarify, I know Alvin was introduced as Grand Chief of Nishnawbe Aski Nation; he technically is no longer considered Grand Chief Nishnawbe Aski Nation—he previously was—he is now the Lead for the Health Transformation for Nishnawbe Aski Nation, another very, very important role that he's taken on since he stepped down from the Grand Chief position. So, his experience comes from his terms as Grand Chief of Nishnawbe Aski Nation, so, very excited to have him here. Alvin, if you can take us, please, to Northern Ontario, Northwestern Ontario, and briefly describe the state of healthcare and services in Nishnawbe Aski Nation. Geographically, it's the largest region of Ontario. It's as big as France, and home to close to 50 First Nations; many of them mostly remote and isolated. So, if we can just start with, what did healthcare look like pre-pandemic?

Alvin Fiddler, Health Transformation Lead and Negotiator, Nishnawbe Aski Nation
Miigwetch Willow, and Miigwetch Sal and Carrie for the introduction, and for inviting us to be a part of this, what I consider a very important conversation, talking about our communities, especially in the Far North—and we tend to forget those communities that are not within the vicinity of the centre of the universe, Toronto. So, thank you for inviting us to talk about our communities, and our challenges, and our successes. Going back to Willow’s question, I think it's important for those in the audience to continue to educate themselves about Indigenous issues generally. I know, over the last year or so with the discovery of children's graves across the country at the former Residential School sites, it's shining a light on the colonial history of this country, and it's no different in healthcare. You know, the fact that we are governed differently, under the Indian Act, and the Indian Health Policy, it's always been a two-tiered system. And we even had Indian hospitals—I was born in one of them, in Sioux Lookout, many years ago—and we all know that that system that was designed for Indigenous people is far inferior. And when the pandemic hit, you know, those gaps that were there just became more and more pronounced, the deeper we went into the pandemic. And that's the work we've been doing over the last two years plus, during this pandemic, is to not only bridge those gaps, but to build new systems that weren't there before, public health, for example, or mental health. So, it's forced us, not just NAN, but the Ontario and Canada, our government partners, to collaborate, to work together. And then protecting our loved ones, our Elders, our children, our kids, from COVID-19. And just making sure that we have a good pathway moving forward, as we move into the post-pandemic world.

Willow Fiddler
Can you just share a little bit about—I recall early on in the pandemic, there was an immediate sense of urgency for the remote First Nations because of the current state of healthcare, or lack of, I should say. Can you maybe just talk a little bit about a couple of the, what were the higher risks for remote Indigenous communities that really compelled that sense of urgency?

Alvin Fiddler
Yeah, I think NAN was fairly quick to act with the threat of COVID. Even back in January 2020, we knew something bad was coming to our Territory, to our communities, and we started writing letters to our leadership, to sort of get ready, to try to prepare ourselves for this virus that we heard about that was overseas, and that was coming, and just tried to put together their own pandemic plans, their own teams. And, you know, we were very fortunate that we were able to put together, on day three of the pandemic, our own pandemic response team, made up of Knowledge Keepers, Elders, traditional healers, experts, that came together very quickly, to help support our communities, and just making sure that whatever the communities needed to protect themselves, that they had access to those resources that were so critical, especially in the early days of the pandemic.

Willow Fiddler
Dr. Bogoch and Tien, I'll open it up to you if you want to add anything. You both have been involved in the delivery of services required for the First Nations in NAN. What did you guys learn about the state of healthcare in remote Northern Ontario?

Dr. Isaac Bogoch, Infectious Diseases Specialist, University of Toronto and Toronto General Hospital
I'll jump in real quick. So, for starters, thanks, Willow for that question. And, obviously, it's an extremely important point, because—you know, just calling it how it is—I'm literally sitting on the 14th floor of the Toronto General Hospital in downtown Toronto. and it's not fair to say that, you know, hundreds and hundreds of miles away, we should have any meaningful thoughts about how things should run in Northern Ontario. The key here is to really listen to local communities and local leadership, to really have a better assessment of what the healthcare capacity is, what the healthcare needs are, what the needs of the community are, the perception of the community, and, you know, I think perhaps throughout the this chat we're having, you're gonna see a recurring theme, and that's listen to local leadership, listen to local communities, and work together with local leadership; and that's exactly what we did. I was heavily involved in the vaccination campaign, for example, here in Ontario, and my role was really to listen to what local leaders had to say about what their community needs were, what were their perceptions, what were their questions, what did they want to know about the vaccines, for example. And we just spent, you know, endless hours on Zoom and Skype and group chats, just listening. Just listening to what their questions were, and listening to what the local needs were, and, you know, they were great. And it's not to say that they were the same, they were actually different than some of the needs and perceptions and issues that we were to have in, for example, Southern Ontario. So, lots of listening, lots of learning, two-way flow of information, and really leaning heavily on Alvin Fiddler and his team, and the local leaders in Northern Ontario and Indigenous communities.

Dr. Homer Tien, MD, President & CEO, Ornge
I’ll just jump in as well—and thanks, Willow. I think what Alvin said, and what Isaac said, in terms of some of the infrastructure problems, the human health resources, and really, I think when we talk about Northern Ontario, I think we have a sense, you know, for those of us who live in Toronto, to think of Northern Ontario as anything north of Steeles. But I think the geography that we're talking about here is, to give it a perspective, say from our major airbase in Northwestern Ontario in Thunder Bay, it might be 900 kilometres one-way to the northernmost NAN community of Fort Severn. And so, when you think that, you know, in the setting of lack of human health resources, lack of infrastructure, and then you add in the effect of long distances and weather, poor weather reporting, and poor de-icing facilities in the North, I think there's a combination of things that make it very difficult for people to access healthcare.

Willow Fiddler
Alvin, Health Transformation in NAN started before the pandemic. Can you briefly describe what health transformation is, and what did that look like, during the pandemic? Because we we've seen it in action, if you can tell us about that.

Alvin Fiddler
Well, back in 2015, when I started my first term as Grand Chief of NAN, the Chiefs, the communities of Nishnawbe Aski Nation, mandated us, gave us direction to declare a state of emergency on health and public health, because of just how deplorable the situation was on the ground. And we made that declaration shortly after that. And we came together, the province, the provincial government—at the time, it was the Liberal government, Eric Hoskins was a Minister, federal government was represented by Minister Jane Philpott—and we met here in Toronto, actually, and we agreed on a set of principles in terms of what we should do, what we can do, to begin to transform healthcare for our communities. We signed that agreement, and in some ways, it's ground-breaking when I look back now on what the agreement says. So we began that work in 2019, we had to build our team, and had some initial committee visits, and then the pandemic hits 2020 spring, and we had to keep moving forward. We couldn't use this pandemic as an excuse just to stop and sit at home in our basements, we actually had to put health transformation to action. And we saw that on the ground at the community level, with our leadership, with Chiefs, making their declarations on lockdowns, passing their own laws and VCR’s by Council resolutions, and just transforming public health, and really being forced to build systems that weren't there before, like public health, mental health and NAN Hope. Just the incredible response that we saw across the NAN Territory from our leadership was, I think, to me, it shows why health transformation is the way forward, why we need to, even as this pandemic hopefully goes away, that we need to keep on that path. And we need to build on the work that our communities, and both Ontario and Canada have done over the last two years or so, with a COVID response, to just keep building on that path.

Willow Fiddler
Thank you. Homer, I'm gonna move on to you. You helped lead the successful task of vaccinating thousands of people in NAN, as part of Operation Remote Immunity. What were some of the challenges that you encountered, and what was the response plan or strategy required to pull that off?

Dr. Homer Tien
Yeah, thanks, Willow. I think we've already talked a bit about geography and weather, those are sort of ever-present factors in the North. There was a huge time pressure, and I think Alvin would remember this as well, basically, I think both NAN and Ornge were asked to co-lead this and co-develop this in late December 2020. The vaccine had just arrived, and we were—you know, one of the principles was, we didn't want to bring COVID into the communities, and everyone had to be doubly vaccinated; we had to find people that to go there. And we had to finish by early April, because of the risk of spring flooding, and because of the risk of evacuations for forest fires of the communities that would spread people all over the North. And so, there really was a sense of, we don't have a lot of time. But these were really just operational challenges, and solvable. I think, you know, I think if you asked any of this group, the really big challenge was from a vaccine confidence, a deep-seated mistrust of government and outside agencies. And I think you can say that this is really, you know, generations of colonialism, systemic racism, Residential Schools, and broken promises. And so, this really resulted in that suspicion of the vaccine, the vaccine program, and the entire health system by the community members. And you know, the solution is simple, yet extremely complicated. You know, the solution, in a word, might be trust, build trust, but boy, that's a hard thing to do. And luckily, Alvin was there, former Grand Chief Fiddler was there, really step-by-step helping with this, and I think it's concepts of Indigenous leadership and autonomy, that are simple words, but really putting those into effect. And so, we had Indigenous leaders fully involved in the development of the plan, and implementation at all levels. And I think the community members needed to see that their leaders were confident the plan. So, they were all involved in the development, they saw the leaders getting the first shots in each of the communities. I think this group, former Grand Chief Filler, Isaac and I, we were on multiple calls over Christmas and in January, answering questions about the vaccine, about the vaccine program. And I think, for trust, the last thing I'll say is that you have to do what you say you're going to do. So, if you're gonna say something, be thoughtful about it, and make sure you do it. And one of the things I remember that NAN had asked for, and we promised to do, was translated consent forms. And let me tell you, it's, it's a lot harder than I might have thought to get translated consent forms in Cree, the Ojibwe, and Oji-Cree, and have them approved by vetted translators. And, you know, but luckily, the Ministries of Health and Indigenous Affairs were super motivated, worked extremely hard, and got them done for us. And it's important to do these things, to show that we mean what we say, and that we respect the culture, and Indigenous leadership and autonomy.

Willow Fiddler
Thank you, a lot of really great points there, Homer. Isaac, you put your thumbs up there when he started talking about the mistrust, and the hard work involved to change that. You had some experience with patients where you work, patients who've had to come down to the Toronto hospital. Can you explain, what are some of the things that you've learned throughout the pandemic about health transformation and the needs in the North?

Dr. Isaac Bogoch
Right. I mean, thanks, Willow, that's a great point, and appreciate you bringing it up. I mean, long before the pandemic, we know, sadly, there's just limited healthcare capacity in many of the remote and Indigenous communities. And oftentimes, if people are sick enough, they're transferred to other places in the province, and some of the larger hospitals in bigger centres. I'm at Toronto General Hospital, this place is no different, we’ll often see patients transferred from Indigenous communities who require hospital-level care, and just care that can be provided locally. And again, always happy to help, always happy to see, and I know there's relationship and arrangements, but—you know, just calling it how it is—it's always best to care for people at or near their home, where they're comfortable, where they have the support system, where they have the support network. And sometimes—again, this predates the pandemic—when we see people who have been flown out for procedure A, or procedure B, at our hospital, they don't have their family or their community support network, and that just poses additional challenges to care. Often the medicine is not that hard, right? We know what the issue is, we know how to help out, we know how to get to the bottom of it. But really, it just exemplifies how much of a social support network and a community support network really goes into the healing and recovery of individuals. And as you point out, the trust is so crucial. I mean, we have these conversations with people, and again, as a physician, you just want to do your best to help the patient out. But you know, sometimes we have these conversations with patients, and you can tell, there is that mistrust, there is that sense of, are we actually on different teams? And, you know, we do our best in an imperfect situation. Call family, call friends, call community members to get on the phone with the individuals; sometimes we even have other community members as an ally, who is in the hospital with the patient, but it's challenging. And you know, we always try our best, but of course, there are significant challenges.

I'll stop blabbing, but one other point. During the pandemic, of course, we saw this exemplified, and as Alvin and Homer will point out, you know, when we were discussing vaccinations or treatments, you know, the whole goal was to do everything we could to provide the best care possible, support local communities with knowledge, and with information, and with technology, and with medication, and of course, with vaccines, to really ensure that people have the best possible care at home, so that they wouldn’t need to be transferred; and that's a laudable goal. Now, last point, and then I really will stop. Obviously, there's a long way to go. And, you know, I'll lean heavily on Alvin to go into what those details are, but really, there's a long way to go in terms of improving trust, improving support, and you know, both training of individuals and personnel, plus actual hardware and actual infrastructure, to provide better medical care, and psychosocial care in Northern Ontario communities.

Willow Fiddler
Thank you, Isaac. I just want to remind the audience; please submit any questions you may have for any of these gentlemen here. We will take some time in a bit to get into some questions, but we'll keep this discussion going. So, there is a consensus here that, you know, healthcare really can't return to status quo. You know, as Alvin mentioned, as we hopefully now begin to move out of this pandemic, and that there really is an opportunity here that shouldn't and can't be overlooked. Alvin, what's next for health transformation?

Alvin Fiddler
Well, you know, just to keep building on the work we've done. I'll keep repeating that message to both Ontario and Canada; I want them to not forget the important work that they were a part of. And it was extraordinary to witness, you know, just how quickly we can move on issues that traditionally would take us a year, or two years, we were able to put in place those things like in a week or two weeks. You know, cutting the red tape, bypassing certain processes, and just moving quickly, knowing that the there was a huge sense of urgency on the ground that we could not do things the way we used to do them before. We created a trilateral table, for example, where we got senior officials from NAN, from our communities, from Ontario, from Canada, that convened once a week. And they would talk about the urgent needs of our communities, and just making sure that things happened right after the meeting. There was an accountability table that we built, to make sure that things that we talked about were actually followed up on. And, to me, I think that's a great roadmap for all of us. You know, my fear is that Canada, or the federal government, or Ontario will start going back to the way things were, and we cannot afford to go back. And I hope that they—and it's a credit to every one of us that were a part of this important mission, that we did this together, and we can continue to build on that work, and really, truly transforming healthcare. And NAN in the North is continuing with that true collaboration that that we witnessed and that we were a part of during the pandemic.

Willow Fiddler
Thank you. Homer, what, in your opinion, what will it take to continue health transformation in the North?

Dr. Homer Tien
One of the things that I really enjoyed about Operation Remote Immunity, I think my favourite moment was hearing from some of the community members that really, they were shocked to learn that their communities were prioritized, for the very first time, for vaccinations—I think Alvin may have mentioned it to me, and I've heard that from different people. Because they would say, we're always the last to get something, or anything, something that is important, something that other people want. And this is something that, if you remember, in the end of 2020-beginning of 2021, everyone wanted it. And the Indigenous communities, particularly in the North, were prioritized to get the vaccine. And so, I think that they were surprised, and hopeful, that this signaled a change in how we think about things and view things. So, I don't know if this is true, but maybe we might have earned a tiny bit of trust with the communities and leadership, I hope that's true. We might have earned a tiny bit of credibility, again, I don't know if that's true, but I hope that's true. And hopefully, we can build on this to work with Indigenous leaders to keep developing solutions that work. We know what these solutions are. So, I'm not a high-level policy guy, you know, Ornge is a is an air ambulance, and we have paramedics and pilots, we put boots on the ground to deliver healthcare. And so, we know that there are operational solutions to some of these problems. And my background is trauma surgery, so I know that there are best practices for trauma systems and trauma care that we can implement, to help improve trauma care in the northern communities. Obviously, we can't just take them in and transport them as a whole to these communities, but we have to work with Indigenous leadership, we have the respect the Indigenous autonomy, to develop solutions that work for the communities, but we can help provide technical advice, and work with the leadership to come up with solutions that work. So, I really hope that moving forward, with this bit of trust and credibility that we might have built, we can continue to look at discussing solutions that might work, and making them work for the communities, if the leadership is supportive.

Willow Fiddler
Thank you, again, a lot of great points in there. I think you've all touched on partnerships and the in the need to collaborate. Alvin, can you expand on that just a little bit? What kind of partnerships and collaborations have really worked best in these scenarios?

Alvin Fiddler
Well, one of the first things that we acknowledged when we began our health transformation journey four and-a-half years ago was that we are not experts on health or healthcare. So, we had to reach out, not only to Ontario and Canada, but people like Homer, Ornge, the College of Physicians, the nursing community, the medical schools, people that do research in certain areas. So, we built—I think we currently have 15, or close to 15, MOU agreements with professional health designation bodies, because we knew that we could not do this by ourselves. And I think what the pandemic has shown us is that we know that's the way we need to go with that, we need to work with others. I think one of the greatest lessons for me during the last two years or so, is how important, you know, Homer talked about trust, and relationships, the partnerships. And the communities really stepped up when they saw that collaboration happen. But they felt safe, they felt comfortable, and they really stepped up to be a part of that work that happened.

Willow Fiddler
I just want to quickly want to touch on that there, because you both make a good point. Homer, you said we might have earned some credibility, and I see that there's a risk, you know, of kind of one step forward, and then two steps back. How do we avoid that from happening here? Anybody can chime in here.

Dr. Isaac Bogoch
Can I start? Even though I'm the least qualified person, and I really would want to hear what Alvin says, but I just want to say something before the thought leaves my head. I think the key here is sustained pressure, in the sense that we need sustained collaboration, so it’s not just sustained goodwill, but meaningful action. Okay. This was, through Alvin and Homer, Operation Remote Immunity was one of the biggest glowing successes of the pandemic response. It was, you know, a geographic challenge, there were, you know, historic cultural challenges—to put it politely—everything was not working in favour of this being successful. And through going through the right process, in terms of truly listening to the communities, listening to the leadership, providing information and tools that were necessary to get people vaccinated, which would protect the communities—it worked; and it also worked in a very short timeframe, right? You're not going to—we can't pretend that, you know, in a few months, we can put a band-aid over hundreds of years of neglect and abuse. Like, that's not going to happen, and I don't think we should pretend that's going to happen. But if we, you know, these are still meaningful arrows, and meaningful, this is a meaningful move in the right direction. And I think, just like everyone on this has suggested before, if we talk about trust, if you say you're going to do something, do it, if you're, you know, listen to the leadership, work closely with the leadership of the communities. And again, it's not it's not rocket science, like it's, it's pretty straightforward, actually. But we actually have to make an ongoing, continual effort, to continue to keep this up. And it can expand, obviously, well beyond vaccine uptake, and hopefully into mental healthcare, other healthcare, other issues unrelated to health as well.

Willow Fiddler
Thank you. Homer or Alvin?

Dr. Homer Tien
Maybe I'll add something, and then I'll turn it over to Alvin. I think what Isaac said about sustained pressure is important. I think, you know, having a scheduled transformation may have different domains where they want things improved, diabetic care, trauma care, or so forth. And I think, you know, a schedule with an implementation on a tactical level is something that can put sustained pressure on moving the ball forward for health transformation. I think strategically, we need to focus on—we focus sometimes on personal relationships, which are important. So like, Alvin and I have worked very closely together, but I think the relationships transcend the individual. And so, I think what NAN is doing in terms of MOU’s, and arrangements with, or between organizations, and then on a larger extent, between Nations, with the federal government or the provincial government. I think these types of things cement the relationships, that start the conversation that builds a bit of the trust, and we can keep moving things forward. Obviously, NAN has been doing that all along. I think for organizations like mine, though, we don't want it dependent on personalities, and we want, say, Ornge, to continue to support the efforts of NAN, because we are a part of healthcare access to NAN's communities. And so, I think these things have to transcend personal relationships and trust, and be institutional trust.

Willow Fiddler
We're gonna get to some questions shortly, but Alvin, you've said, we need to build on that work as a country, what can others do to help?

Alvin Fiddler
I just wanted to quickly add on to what both Isaac and Homer have said, in terms of our health transformation journey. I think it's important that our government partners understand what that really means. You know, they need to understand when we say health transformation, what that means to us and for us. That is not about taking over, or inheriting a broken system, or taking over programs that are underfunded, it's so much more than that. And I think that's an ongoing conversation that we will have with our government partners, that they need to understand what it is that we’re talking about when we're talking to them about health transformation. So, I hope to carry on with those conversations in the weeks and months ahead, because it's important that we begin, or that we really need to demonstrate our communities that what health transformation looks like on the ground. If we had utilized the old system during this pandemic, if we had utilized the old policies, the old ways of doing things, it would have devastated our communities, it would have killed a lot of our people. That's why it's so important that we stop, and I'm so grateful for a start have this conversation today, because it sort of gives us an opportunity to reflect on the work that's been done, and why it's important that we need to keep moving on this journey.

QUESTION & ANSWER

Willow Fiddler
Thank you. I'm gonna get into some questions here; We've got a few. So, just going off of that, Alvin, what would you like to see governments commit to, in terms of improving First Nations healthcare? These are the questions now, guys.

Alvin Fiddler
For sure. You know, there has to be legislation that backs health transformation, and right now, there's work that’s sort of happening federally. There's discussions about the federal health framework, similar to the child welfare legislation we saw, for example, a year and-a-half ago, that there has to be, as we build a system, it needs to be backed by legislation. And I would hope that the government's commitment to build this legislation is real commitment to that change, that it has to be a truly collaborative process. You know, even word for word, similar to what we did on policing, for example, with Ontario, to make our police service an essential service, so similarly to healthcare. That's one piece. Legislation is, I think is important, and we need to be at the table as equal partners.

Willow Fiddler
Homer and Isaac, do either if you want to jump in there?

Dr. Isaac Bogoch
I don’t really have much to add on that one.

Willow Fiddler
There's a few questions here that have to do, I think people are curious to hear more about what the communities look like now in terms of infrastructure. There's a question here about what infrastructure exists for ill patients in the North. Are there negative pressure rooms for safety of community and staff, isolation locations, how are they cared for before evacuation? There's another question here; do all First Nation communities have landing strips for fixed-wing aircraft to land, or are helicopters needed in some areas? And then this one, I think, is related as well, what factors identified Indigenous communities as highest risk in COVID-19 response? That's kind of a jumble, but yeah, I think people are curious to hear more about Alvin and Homer.

Dr. Isaac Bogoch
That’s for Alvin. Those are Alvin and Homer questions.

Alvin Fiddler
Yeah, no, thank you for the question, or questions. And I think it's important for all of us to realize that when we talk about healthcare, it's more than just talking about nurses or doctors. We're talking about the community, the environment where we live, our access, for example, to clean safe drinking water, and the homes, the overcrowding, and the challenges that existed before in our communities, in terms of the whole infrastructure of the communities, access to power, for example. You know, I think it just became more pronounced during the pandemic. And water, for example, just how important—I mean, that was one of the public health messaging in the early days of COVID was that, you know, make sure you have you keep hydrated, you drink lots of water. Well, we couldn't say that to 14 of our communities, because they are on boil water advisory, including Muskrat Dam, we've been on that list since 2004, or Neskantaga, for over 30 years now. So, those were the challenges that we had to consider in during this work, making sure that all our communities had access to clean, safe drinking water, including Sandy Lake, that community that has over 3000 people there. So, these were added challenges that we had to factor into our work. Isolation sites, again, it was very important that if there was a positive or a couple of cases in the community, that we remove them from their homes, and, you know, just the difficulty and the challenges to find adequate space for them in the community where they can isolate for 10 days, or whatever the protocol was at the time. So, those are some of the ongoing challenges that we will still face moving forward, and I would hope that, you know, that we work with our communities to address. These are long-standing issues that need to be addressed.

Willow Fiddler
Homer, I don't know if you want to speak to the airstrips question?

Dr. Homer Tien
Sure. I can speak a bit about some of the aviation, and maybe some of the actual healthcare resources. I think, you know, at a lot of the nursing stations, I think they're filled with extremely motivated and great healthcare practitioners, that really offer a lot, and care deeply for the communities. I think sometimes they're not as well-equipped with the equipment and resources to provide the care. And I think, if you can imagine that in some of the communities, if you call 911, there is no 911. And so, there is no pre-hospital system, so to speak, to get you from where you were injured or where you were sick at home, to get to the nursing station or the primary care clinic. And then when there, say you had a heart attack, there may not be some of the life-threatening clot-busting drugs, or if you're bleeding there may not be blood products. And so, it's really through an aircraft that arrives, a fixed wing aircraft that lands, that brings the care that you normally would expect to see in an emergency department in Toronto. And that would be your first sort of opportunity, in some of the communities, not all of them, to have some of these therapies initiated. Most of the communities have airstrips, there's a couple that do not, and are reliant on a helicopter to have access, particularly if they're on an island. And you know, in the summer, you can access it by boat, in the winter on an ice road. But during the freeze-up and breakup of the ice on a river, or the surrounding water, they're completely dependent on helicopter for access. And that type of access can be limited, because helicopters are very mechanically dependent, and they don't have the same ability to fly in all weather as fixed wing aircraft.

Willow Fiddler
Thank you for that. There's another question here, wondering, are there opportunities and the potential for virtual care to be used? A really great question. What does that look like in Northern Ontario? Isaac, please go ahead.

Dr. Isaac Bogoch
We do it. We already do. It's pretty good. There's obviously room for improvement, but virtual care certainly is being done with some with some communities. I can attest that, like, I myself have been involved with seeing some patients, and it doesn't necessarily mean you even need a big fancy video camera. That’s always helpful, but sometimes it's even done with a simple telephone call as well. But it is being done formally, and informally. There is certainly room to expand it. And of course, this is really helpful because now, you know, geography doesn't matter nearly as much, and you can access the sub-sub-sub-specialists that's, you know, in a major urban centre hospital, and help at least provide care. I would say—again, I'd be very curious to hear what others on the chat, and of course everyone in the in the audience has to think—but like virtual care is helpful? —upward inflection question mark? But it's by no means the same quality of care. And there truly is no substitute for seeing someone face-to-face for, obviously, certain medical conditions. For some things it's okay, a quick checkup, you know, discussion of some bloodwork, and some updates, but really face-to-face care, and in-person care, reigns supreme the vast majority of the time.

Alvin Fiddler
Yeah, I would add that one of the projects that I think is exciting, one of the health authorities is pursuing right now, is this idea of, “hospital without walls,” or, “hospital without borders,” in one of our communities, in one of our bigger communities, and just the possibilities of that. I think especially now with the technology, I think there's so much potential there. And I think it was a question earlier from one of the audience members about how can we, the members of this Club, or the members that are on this call, for example, how they can be a part of this work. Sometimes I read about, you know, this foundation making a big donation at the Cancer Centre in Toronto, or the Peter Munk Centre, you know what I mean? There is no reason why you can’t, you know, you can also make donations to our communities, is what I'm trying to say. You know, as we build these projects, there'll be opportunities for private foundations or individuals, to support us with some of these exciting projects that we will be undertaking, move forward. So, this idea of a remote hospital in one of our communities is something that I think has real possibilities.

Willow Fiddler
I think there's a saying, “put your money where your mouth is;” maybe that came to mind there.

Alvin Fiddler
That’s right. You said it.

Willow Fiddler
A couple more questions. Here's an interesting one—maybe Alvin, you can talk to this—wondering how health transformation takes into account Indigenous knowledge, and incorporating Indigenous knowledge into healthcare processes, which is key to building trust.

Alvin Fiddler
Yeah, I mean, that's very important. And, you know, at the beginning of this broadcast, or this meeting, I talked about the missing children, the remains are being discovered across this country. And, you know, I think there's an opportunity for this country, for the federal government, and other jurisdictions, to really be a part of the of the reconciliation that needs to happen, the journey that all of us need to be on, if we're going to be—to move beyond the messy, the trauma that we always find ourselves in, the crisis that we're always in. Because it is tiring, it's exhausting, and we need to find a path that will allow us to move beyond that. And I would just encourage our government partners, including the federal government, that it has to be a respectful process, whether you're talking about creating legislation, or just working with us. That is so important, that the trust that Homer talked about, and why we saw that demand during the rollout of the of the vaccine. That is so critical.

Willow Fiddler
I'm going to combine two questions into one last question, because it has to do with moving next steps forward, and accountability—and anyone can jump in here. How do those of us outside of the Indigenous community hold government and others accountable for not going backwards, and actually using this as the new baseline? The word accountability is key. Another question is, I'm concerned about bureaucracy and delays in government, how can we replicate the urgency and alignment from your success to get appropriate informed solutions executed in a timely manner?

Dr. Isaac Bogoch
That's tough. Obviously, that's really tough. Accountability, I mean, right. I don't know how to address that in the sense that we hear a lot of words and a lot of promises, but it also has to translate into meaningful sustained impact. And it's, you know, it's easy to talk in high-level terms, you know, “keeping the pressure on,” you know, “holding people accountable,” but actually operationalizing that is probably, and sadly, a lot more challenging. And, you know, back here on planet Earth, this has been an ongoing issue for a long, long time, and I know, Alvin can speak to that much more eloquently than I can. But it's interesting, and, you know, just getting back to what Homer mentioned earlier, there's real, perhaps there's growing trust, and growing momentum, and also, it's not every day that these issues make their way so prominently in the national media, and are discussed with the same degree of intensity among non-Indigenous people in places that are distant from Northern Ontario. And, you know, maybe I'm being overly optimistic, but this seems to be a growing issue that's appreciated by non-Indigenous communities and other Canadians, because of a lot of the attention and momentum that we've seen over the course of the pandemic that's highlighted a lot of the inequities in care. And I think one of the key issues is not losing that momentum. I'm not entirely sure how, but like any complex issue, I think—pardon the term—multifactorial approaches are the best approach. And that means, obviously, sustained pressure from local leadership continues, continue national media coverage, ensuring people of all ages in all parts of the country are aware of the issues that face Indigenous communities; I know it's being taught with increasing frequencies in the schools as well. So, there's just growing awareness, and I think that adds to a lot of the help, but I think truly getting down to the nuts and bolts of operationalizing accountability is very challenging. I'd love to hear what the others have to say.

Willow Fiddler
We’ll hear from Homer and Alvin, if you quickly want to add your thoughts on that.

Dr. Homer Tien
I'll just say quickly, like, as a non high-level policy guy, as someone, I guess, who's sort of boots on the ground is my organization, I think there are a lot of operational problems that we can help solve if we work with Indigenous leadership. And there's a problem of, you know, how do we improve cardiac care, like for an acute heart attack? How do we improve stroke care? There are solutions to this that are operational, that are based on relationships with other hospitals and different healthcare organizations, and with the community. I think if we identify targets, timelines, that we can certainly come up with solutions to that. I think sometimes we get bogged down in these large, sort of nation-level problems, but you know, if we can save two people tomorrow with a stroke, three people from bleeding the next day, I think we've advanced the ball. And then hopefully, when Alvin and his team does the high-level work, it's complimentary, and it ends up moving the ball forward in all domains, both tactically and strategically.

Willow Fiddler
Thank you. Alvin, we'll quickly wrap it up with you.

Alvin Fiddler
So, just to whoever's listening on this call, you know, the fact that you're here, tuning in, is important. I always try to end my talks, and whenever I'm invited to speak at a forum, about what you have learned, or what you're learning, during this pandemic. You heard about the missing children being found across the country, you probably heard about Joyce Echaquan, who died at a Montreal hospital while she needed care—the nurses laughed at her, the doctors mocked her, and she died. There was an inquest that happened. You hear about these stories in the media, and it's like the country is finally waking up to what we've been talking about for a long time. And we just need you to stay awake. We need you to be part of the work that we all need to do going forward, so that we can not only bridge those gaps, but, you know, just the equity that we always talk about in healthcare, especially as it relates to our children. There's going to be a lot of work that we’ll need to do post-pandemic, we all need to make sure that we have a recovery plan for our children—the toll that this pandemic has taken on our kids, for example, is incredible. And that work will be ongoing in the months and years ahead.

Willow Fiddler
Miigwetch. Thank you so much for this great conversation. We're gonna hand it over, back to Sal now. Thank you.

Sal Rabbani
Thank you, Willow, Dr. Bogoch, Dr. Tien, and Alvin, for sharing your insights, and perspective, and knowledge with us today; I appreciated the conversation. I’d now like to take the opportunity to welcome Gene Cabral, Executive Vice-President of Billy Bishop Toronto City Airport to deliver some appreciation remarks. Gene, over to you.

Note of Appreciation by Gene Cabral, Executive Vice-President, Billy Bishop Toronto City Airport
Thank you. Thank you, Sal. So, as Sal mentioned, my name is Gene Cabral, and I am the Executive Vice-President at Billy Bishop Toronto City Airport. Billy Bishop Airport is a proud sponsor of today's event, and an even prouder base of operations for Ornge Medivac Services. As I sit here and reflect back on some of the notes from this powerful panel discussion, it was eye opening, and enlightening on the approach of the issue. Some of the pieces I take away: focusing on the local needs, focus on two-way dialogue and co-ordination, building trust, do what you say you're going to do, from Homer, Alvin identifying cutting through the red tape to build efficiencies needed on a critical timing issue like these. Powerful statements that we take away from this.

As many of you know, Billy Bishop Airport is located on the Toronto Island, just a few kilometres from downtown, and the majority of the hospitals in the Toronto area. Its proximity has allowed us the efficient provision of emergency services, and organ transfers, through our airport, and our teams work together to facilitate this urgent care. As we heard today, during the pandemic, the Ornge Service at Billy Bishop Airport also spearheaded Operation Remote Immunity, to ensure that the northern communities received timely access to vaccinations in the fight of COVID-19. For reference, Ornge flew more than 5091 emergency flights and 2021, that's an increase of 7% over 2020. As I reflect back to a conversation Homer and I had in March of 2020, when we talked about alignment on making sure that the airport remained open during the lockdown days of the pandemic, today, sitting here looking back, and realizing the grateful role that we played, and the small role that we played in facilitating that for Ornge.

Another organization that Billy Bishop Airport supports, and which operates to and from the facility, is Hope Air, an organization that provides flights to remote communities so patients can access Toronto's healthcare facilities. This takes the form of free flights aboard our commercial air carriers, and also private pilots, who donate their time and aircraft to bring patients to heir appointments downtown. One of the key themes today we've been hearing is about keeping the lifeline open between northern communities and the healthcare services they need, which are so often so far away. Ornge Medevac, and charities like Hope Air, have been critical in connecting patients to medical appointments, and emergency medical services here in the south. And we at Billy Bishop Airport are proud to do our part in keeping this lifeline open. I'd like to thank our speakers, Dr. Bogoch, Mr. Alvin fiddler, Dr. Homer Tien, for sharing your insights, and the power and perspective of the important topic that took place today. And I’d also like to thank Willow, for your expert moderation of this discussion. I will now turn things back over to Sal for his closing remarks.

Concluding Remarks by Sal Rabbani
Thanks again to Billy Bishop, Toronto City Airport, and all our sponsors for their support. Thank you to our guests, and everyone joining today, or tuning in later on-demand. I'm delighted to announce that our next event will be our first in-person Empire Club event in two years. Join us next week, on Thursday May the 12th, for an evening of networking and learning with our panel of political pundits, the inside scoop on the upcoming 2022 Ontario provincial election. More details and tickets are available at empireclubofcanada.com. As a club of record, all Empire Club events are available to watch and listen to on-demand on our website. The recording of today's event will be available later today, and everyone registered will receive an email with the link. Please feel free to forward it on to your colleagues, family friends. Thanks again for joining us today. I wish you all a great afternoon. Take care and stay safe.