Aboriginal health programs developed and delivered without local support are failing
All successful community programs and services require local input and support during all stages of development and operation. Seems simple enough. But the newspaper article below shows that some things never change when it comes to control of the resources (millions of dollars) to address issues, especially when it comes to Aboriginal health initiatives. The Health Canada controlled Labrador Innu Comprehensive Healing Strategy and the FNIB Pandemic Planning initiative are two examples presented below.
Helping the Innu help themselves
Alcohol abuse, kids sniffing gasoline prompted a government healing strategy for the Labrador Innu
But there is a growing gulf between the healers and the people to be healed, Marie Wadden reports
Nov. 18, 2006. 06:38 AM
MARIE WADDEN - ATKINSON FELLOW
In Natuashish, an Innu community in Newfoundland and Labrador, 8-month-old Thomas James Rich is just starting to make sense of the world around him. He gets excited and kicks his tiny feet whenever his 20-year-old mother, Victoria, picks him up.
Thomas is one of the new generation of Innu, growing up under the care of an unprecedented government campaign designed to give him a better life.
But 400 kilometres away in Goose Bay, Nympha Byrne, a Natuashish native who works for Health Canada, feels slapped in the face by people who are part of the same campaign.
Such is the contradiction and the missteps that haunt the Labrador Innu Comprehensive Healing Strategy, a federal program designed to heal the social, health, drug addiction, alcoholism and safety problems of 3,000 people in the Innu communities of Natuashish and Sheshatshiu.
Despite lofty intentions and even some victories, the program's worst enemies are the people who run it and who have shut the Innu out of the decision-making process. It has created an ever-widening gulf between the healers and the people to be healed.
At stake are the youth, who are dying at an alarming rate from suicide and addiction, and babies like Thomas, whose future depends on stopping the cycle of tragedy in the communities.
Thomas's 20-year-old father, diagnosed five years ago with fetal alcohol spectrum disorder, just got out of jail and is back to inhaling gasoline. Thomas's 19-year-old uncle committed suicide in April. His mother, sober now, dropped out of school at 12 and spent her teenage years inhaling gasoline fumes. In this baby's community, suicide and alcohol abuse are the main causes of death.
The Healing Strategy, initiated in 2001, is halfway through its 10-year mandate. Two consultants' reports — completed in 2003 but whose contents were just recently made public — have been critical of its progress.
The reports — one by the Health Research Unit at Memorial University in St. John's, the other by IER Planning and the Aboriginal Research Institute of Ottawa — say bureaucrats got off to a bad start by making decisions without Innu input, and showed a lot of insensitivity toward the people they're supposed to be helping.
"The federal government and the province of Newfoundland and Labrador have not shared sufficient information with the Innu regarding the Healing Strategy," says the IER report. "This must change. The Labrador Innu need to be brought into the loop of information."
Both studies make recommendations to strengthen the plan, but the Innu have seen little improvement.
"The Healing Strategy is unknown to people in the community," a Natuashish leader told the Memorial University evaluators. "A presentation has never been made within the community."
Not enough has been done to train Innu in the field of social work, addictions and mental health, the evaluators say, yet these skills are necessary since it's difficult to attract qualified outsiders to these communities.
"I'd love to be trained as a therapist," says Rose Gregoire, who spends her days pushing paper as case manager for the alcohol treatment program in Sheshatshiu. Gregoire is well suited for therapy because she is highly respected and worked for years in her community helping social workers who didn't speak the language or know Innu families.
Sarah Archer, Health Canada's regional director in Atlantic Canada, says there's an assessment underway to find out what training Innu health workers need. The Innu say this has taken so long there'll be few graduates by the time the Healing Strategy ends.
The evaluators agree it's taking a long time to make decisions.
"The Healing Strategy has a significant number of committees, tables and working groups," the IER report notes. "However, there does not seem to be a clear decision-making relationship. This is demonstrated by a high level of uncertainty — certainly among the Innu — about how decisions are being made and who is making them."
This disconnect was very real to Byrne, the only Innu working for the Labrador Health Secretariat, a branch of Health Canada based now in Goose Bay but first established in Halifax, thousands of kilometres away from the people it was created to help. In July, an internal draft memo titled Safety and Security: Travelling to Natuashish was placed on her desk.
"The well-being of staff is of utmost importance when travelling," the memo read. "It is preferred that staff travel in pairs when going to Natuashish."
The people Byrne loves most in the world live in Natuashish. It's her hometown. She doesn't think it's a dangerous place, but her boss and colleagues do. She was humiliated and insulted by the memo.
"I couldn't face the staff meeting, I just went home," she says. Byrne received an apology from her boss, but it hasn't made her feel any better. She can't understand why the warning was necessary since no Health Canada employee has ever been hurt in Natuashish.
"I don't think that's fair to our people," she says.
The memo has also offended the chief of Sheshatshiu.
"Why are Health Canada staff talking about their own safety when we have children who are not safe in our communities?" asks Anastasia Qupee. "We still have children walking around late at night, there are lots of drugs in the communities, a lot of children in temporary care. They're supposed to be helping us. What are they doing? It may have ended our only hope of being able to work together."
Archer says problems like this are not unusual. "The process of relationship-building takes much longer with Aboriginal people than it does with other communities," she says. The secretariat was based first in Halifax, she says, because it was hard to attract staff to Labrador.
The evaluators would like to see more money spent on Innu initiatives that take troubled families to remote camps for spiritual and traditional treatment.
When the Labrador Innu Comprehensive Healing Strategy was created, the federal government committed $81 million over three years, with $59 million going to Indian and Northern Affairs (to relocate Davis Inlet residents to Natuashish), $20 million to Health Canada and $2 million to the former solicitor general's ministry.
Bureaucrats from all three departments, plus the province of Newfoundland and Labrador, were asked to design the strategy. Unbelievably, Innu representatives were not invited to these meetings.
Today, the Innu are invited to frequent meetings chaired by a federal negotiator, but remain frustrated. They see what's happening now as a repeat of past federal government policies.
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Little Thomas Rich's future was compromised 40 years ago.
"In the 1960s, the self-sufficient lifestyle of the Labrador Innu came to an abrupt end with the settling of the two communities of Davis Inlet and Sheshatshiu by the federal government," the IER evaluators write. "Signs of addictive behaviour and social/family dysfunction became apparent. Widespread alcohol use was prevalent by 1970."
Alcohol abuse was certainly prevalent when Thomas's mother, Victoria, was born in 1986 to parents who were both alcoholics.
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`I see kids on the road sniffing gas, and I'm not allowed to counsel them'
Nympha Byrne, an Innu who works for Health Canada
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Her birthplace, Davis Inlet, on the Labrador coast, was an isolated "fly-in" community with some boat transportation during the summer. It was a bad place to relocate a hunting society since for most of the year, the 600 Innu had no way to get off the small island that also lacked adequate fresh water for a growing population.
Despite the isolation, it made international headlines a number of times during Victoria's childhood. When she was 5, a fire killed six preschool children who had been left alone while their parents were out drinking.
A few months later, a native constable took video that was broadcast around the world, showing teens in Davis Inlet, high on gasoline, threatening to kill themselves.
The publicity didn't change the living conditions. By the time Victoria was a teen, she was inhaling gas fumes, too.
"I seen everything I didn't see before," she says about her fume-induced hallucinations. "Boys. They were small. Tiny-like. They are on my eyes. But everybody told me there's nothing in my eye. I told them I saw the Backstreet Boys, but they said it was nothing. I was seeing it because I was sniffing gas."
In the 1990s, the band council hired a psychologist, Dr. Wayne Hammond, who had helped troubled native children in Western Canada kick solvent abuse.
"Our plan was to build a stabilization home where kids who were really out of control could be brought and where we would work with the family as a whole," Hammond says.
"We also planned to develop alternate activities for kids in town so they'd have something else to do instead of hanging out at night. We were looking at a kind of caregiver model where we would train people within the community to work with kids and families."
Hammond says a lot of public money might have been saved had the bureaucrats respected the Innu plan. Instead, the problems reached a crisis point in December 2000, and Victoria and 39 other children had to be evacuated for their own safety.
"They took us to St. John's," she remembers, "and they locked us in a room for two or three hours. The gas sniffers, they break all the stuff. They break the toilet and the wall and they steal. They wanted to get out. I felt scared."
The children were kept in a decommissioned hospital for four months, then sent to treatment centres and foster homes across Canada — but not cured.
"I think we delayed the healing of the community by 10 or 15 years," Hammond says, "because Health Canada and Indian and Northern Affairs didn't have the courage to step out of the box."
Victoria doesn't inhale gasoline now, or drink alcohol. What has helped her most, she says, is her parents' sobriety.
"My mother and my father, they stopped drinking almost two years now, and I'm happy for them and I'm trying to get along with them," she says.
Her parents' sobriety is one of the Healing Strategy's success stories. The relocation of Davis Inlet residents to Natuashish has given people a reason to stop drinking. A treatment program designed and administered by Indians in Western Canada is doing the rest.
In Natuashish, there's clean drinking water, a state-of-the-art septic system, beautiful homes, a large, light-filled school, an arena, band council building and, coming soon, a healing lodge and shelter for victims of family violence.
"Physical construction and relocation is a qualified success, but social reconstruction is lacking," the IER report noted in 2003.
Victoria and her mother, Mary Agathe, are part of the Innu-run Natuashish Health Clinic where sobriety is a condition of employment.
Much of the sobriety is thanks to Nechi (the Cree word for "friend"), an educational, research and health promotions centre created by Indians in Alberta 35 years ago, specializing in addiction recovery.
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The Innu want the Labrador Health Secretariat disbanded so they can use its funding to administer the remaining years of the Healing Strategy themselves.
This is not likely to fly with the civil servants who administer the program at Health Canada's First Nations and Inuit Health Branch (FNIB), says Dr. Valerie Gideon.
Gideon, the senior director of Health and Social Policy at the Assembly of First Nations, says federal government departments will always support their own staff at the expense of communities.
"For pandemic planning, FNIB has set up a major office of community medicine in Ottawa and hired 40 people," Gideon says. "They have not replicated that investment in First Nations communities or in First Nations organizations, so that is a perfect example."
Part of the solution rests with Sharon Clarke's National Native Addictions Partnership Foundation, which is creating a cross-cultural course that will be available to bureaucrats and others working in Aboriginal communities. Clarke hopes it will make them less fearful of their clients by teaching about language, traditions and the historical context of social problems.
"So that anybody who wants to work in Aboriginal communities has to have that module before they go in," she says.
For Nympha Byrne, the solution lies in helping the Innu heal Innu.
"Sometimes, I'm ashamed to say that I'm a Health Canada worker," says Byrne, who was hired as an addictions therapist but is not doing that job. "I see kids on the road sniffing gas, and I'm not allowed to counsel them. I'm only allowed to do presentations. I find that really painful."
Byrne, the only secretariat employee who speaks the Innu language, believes she'd be more useful working in her home community rather than from an office in Goose Bay.
"I don't think they trust me to work out of their sight," she says.
"They're supposed to be providing expertise," says Mary May Osmonde, director of social health in Sheshatshiu. "But we rarely see them in our communities. We don't know what they are doing in their offices.
"I'm very disappointed. Maybe the government wants us to fail. If we succeed and our people are healed, many bureaucrats will lose their jobs."
But Archer says Byrne and the rest of the secretariat staff are not supposed to provide direct services like counselling; their job is to provide advice and help manage the money that is being spent.
In spite of the gulf that exists, there is one fundamental that everyone involved in the Healing Strategy agrees on: Thomas James Rich and children like him deserve a better life.