Pandemic Planning and First Nations

[First Nations / Pandemic Flu]

July 2011
Research shows Aboriginal Canadians who took the 2009 H1N1 flu vaccine
were well protected and responded "robustly"
http://www.turtleisland.org/discussion/viewtopic.php?p=13541#p13541
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First Nations experience with the Pandemic H1N1
January 2010 . . .
http://www.turtleisland.org/discussion/viewtopic.php?p=10923#p10923

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American Indians and Alaska Natives represent a disproportionate number of deaths from the H1N1 virus.
December 2009
http://www.turtleisland.org/discussion/viewtopic.php?p=10874#p10874
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Influenza Self-Assessment Tool
http://www.health.gov.on.ca/en/ccom/flu/h1n1/public/tools/assessment
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On November 10, 2009 at 12:00 noon EST
Health Minister Leona Aglukkaq and National Chief of the Assembly of First Nations (AFN) Shawn Atleo
will co-host a Virtual Summit on H1N1 preparedness for First Nations communities.
For more information . . .
http://www.turtleisland.org/discussion/viewtopic.php?p=10667#p10667
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Health Canada has approved vaccine to fight H1N1 flu virus
October 21st, 2009
http://www.turtleisland.org/discussion/viewtopic.php?p=10596#p10596
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BC unveils vaccine plans to fight H1N1 outbreak . . .
October 21, 2009
http://www.turtleisland.org/discussion/viewtopic.php?p=10599#p10599
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http://www.phac-aspc.gc.ca/alert-alerte/h1n1/guide/index-eng.php

http://www.phac-aspc.gc.ca/alert-alerte/h1n1/guide/index-eng.php

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The spring outbreak of 2009 influenza A(H1N1) infection in Canada affected primarily young, female, and Aboriginal patients
http://www.turtleisland.org/discussion/viewtopic.php?p=10557#p10557
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October 6, 2009
BC
Tripartite First Nations Health Plan
An Information Bulletin from the Tripartite First Nations H1N1
Working Group
Dear First Nations Community Members . . .
http://www.turtleisland.org/discussion/viewtopic.php?p=10548#p10548
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H1N1 Community Checklist
Dear First Nations Chiefs and Health Directors,
As you are all aware, cases of the H1N1 flu virus have occurred in people throughout BC and Canada, including in First Nations communities.
The vast majority of these people have had mild to moderate illness and most of those affected have recovered successfully at home.
It’s important to ensure your community is in a state of readiness - primarily through a pandemic plan - and is using preventative measures.
http://www.fnhc.ca/index.php/news/article/h1n1_checklist_for_leadership/

http://www.fnhc.ca
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The Pandemic H1N1 Virus and Your Community
B.C. First Nations H1N1 action plan
http://www.turtleisland.org/discussion/viewtopic.php?p=10428#p10428
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Watch a Public Service Announcement . . .
http://www.youtube.com/user/H1N1BC
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Pandemic Planning and First Nations
http://www.turtleisland.org/discussion/viewtopic.php?p=10229#p10229
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Swine Flu News and Information Updates - Google search . . .
http://www.google.com/search?=en&q=swine+flu
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Pandemic planning
The need for First nations to control public health
http://www.turtleisland.org/discussion/viewtopic.php?p=10232#p10232

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PERSPECTIVES on PREPAREDNESS . . .
http://www.turtleisland.org/discussion/viewtopic.php?p=10233#p10233
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First Nations Pandemic Planning
http://www.turtleisland.org/discussion/viewtopic.php?p=7049#p7049

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http://www.bccdc.ca

http://www.bccdc.ca

H1N1 Influenza Virus (Human Swine Influenza)
http://www.healthlinkbc.ca/healthfiles/hfile108.stm

Provincial Infection Control Network of British Columbia.
http://www.picnetbc.ca/page229.htm

H1N1 in Indian Country . . .
May 2009
http://www.indiancountrytoday.com/natio ... 90197.html
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A Holistic Approach to Pandemic Readiness
http://www.afn.ca/misc/HPR.ppt


An AFN Pilot Project Presented by Sucker Creek First Nation Health Team
Sucker Creek First Nation Assembly of First Nations Pilot Project: A Holistic Approach to Pandemic Readiness
http://www.afn.ca/misc/PP.pdf

Katzie First Nation Influenza Pandemic Planning Project
http://www.afn.ca/misc/KP.pdf
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May 2008
The Southern Chiefs' Organization (SCO) is currently working to develop a Pandemic Influenza Preparedness plan. The nature of this plan is to ensure our member First Nation Communities are prepared in the event of a pandemic outbreak.

The purpose of the information below is to provide all of our constituents with information regarding Pandemic Influenza:


What is a pandemic?
A pandemic is an outbreak of a viral infection or disease, which spreads easily from one person to another. The virus or disease can spread rapidly and affect the entire human population.

How often do pandemics occur?
In the last three hundred years, the world has seen 10 pandemics. A pandemic occurs every 10 to 40 years. Although it is impossible to predict the exact timeline of a pandemic occurrence, experts are predicting that the world could be on the brink of a pandemic outbreak.

When did the last pandemic occur?
The last pandemic called "Hong Kong Influenza," occurred in 1968 and resulted in the deaths of one million people. Prior to this, the "Avian Influenza" happened in 1957 and claimed the lives of 2 million people. However, the deadliest pandemic was in 1918. During this period, the 'Spanish Influenza", it is estimated that between forty to fifty million people died as a result of this disease.

How does a Pandemic occur?
The World Health Organization has identified that a pandemic occurs in six phases. Currently, the world is in the third phase of this pandemic, which means there is no or very limited human to human contact in spreading this virus. This does not mean we should take this lightly. We need to act now before a pandemic reaches huge proportions.

What is Avian Influenza?
Although Avian Influenza is known amongst scientists as the H5N1 virus, it is more commonly referred to as "Bird Flu" as many bird populations have been affected by this disease. However, the world has seen an increase of this virus in humans. In 1997, six people died and eighteen became seriously ill as a result of this virus.

Since 2003, 263 humans have been diagnosed with this virus. In 2007, this number increased by 21 percent (69 people), bringing the total to 332. However, since 2003, 158 humans died as a result of this virus. Another 46 people died in 2007, which brought the total number of deaths to 204. Although seemingly low this number has increased.

Are only certain age groups affected by the Avian Influenza?
Currently, it is impossible to predict who will be affected by the virus. However, in the event of an outbreak, it is likely that very few people will be immune to this. As of April 17, 2008, a two year old child in Egypt is the latest human to be diagnosed with this strain. On April 15, 2008, a thirty-year-old woman from Egypt died after contracting the disease only thirteen days earlier.

How is this flu spread?
Avian Influenza is spread by wild and domestic birds. Currently, humans cannot spread the virus to each other, but can come into contact with the virus when handling sick or dead birds, or by coming into contact with contaminated feces (bird droppings).

Can I become infected if I have eaten poultry products contaminated with the "Bird Flu" virus?
Currently, there is no research or evidence to show that contaminated food products (such as poultry) have caused an infection within humans. However, caution of proper handling, preparation and cooking of such products should be taken. Food should be cooked fully, as a normal cooking temperature (70º Celcius) kills the virus. It is strongly advised that egg yolks also be cooked fully.

Why shoud First Nations Communities be concerned?
According to the Department of Indian and Northern Affairs (1999) and Health Canada (2003), the living conditions and quality of life amongst First Nation Communities is currently ranked 63rd, or amongst Third World conditions - the root cause of poor health.

In addition, overcrowded housing, mold, and unsafe drinking water helps spread communicable diseases at a rate of 10 to 12 times higher than the national average.

Further, over 40 per cent of homes on First Nation communities are considered as inadequate shelter.

Finally, the World Health Organization states that "Malnutrition, poor access to health services, poor infection control and hygiene practices will lead to higher disease and death rates."

Is Avian Influenza in Canada?
No. There have not been any identified human cases in Canada or the United States. Although the virus has been identified in areas of Asia, Africa, Europe and the Middle East, there is no pandemic influenza anywhere in the world.

What can I do to help prevent the spread of the "Bird Flu" virus?
To help prevent the spread of the Bird Flu virus, you can follow these few simple steps.

1. Ask your health care provider about receiving an annual flu shot
2. Wash your hands with soap and warm water for 15 - 30 seconds
3. Use a clean tissue or your sleeve when you cough or sneeze, and wash your hands afterwards
4. Throw away each tissue after use as reusing them spreads the germs further
5. Keep surfaces at home clean and sanitized regularly by using disinfectants
6. If you do not feel well, stay home from school or work
7. Contact your health care professional, health centre or local nursing station for further advice

Do you have more information available?

Yes. Additional information may be found at the following websites:

Government of Canada
http://www.influenza.gc.ca/index_e.html

Public Health Agency of Canada
http://www.phac-aspc.gc.ca/influenza/in ... andemicflu

Southern Chiefs' Organization, Inc
http://www.scoinc.mb.ca

World Health Organization - Pandemic Influenza
http://www.who.int/topics/avian_influenza/en/

If you have further questions or are seeking more information regarding Pandemic Influenza, the following procedures may be followed.

1. Contact your local federal, provincial or local government and ask for information.
2. Seek information from your health care professional.
3. If you are a member of the Southern Manitoba First Nations, speak to your Health Centre. The Southern Chiefs' Organization, Inc is is working closely with the Health Centres and is committed in ensuring a Pandemic Preparedness Plan is available for all of our First Nation communities.

Meegwetch, Ekosi, Thank You
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World Health Organization Commission on Social Determinants of Health
June 2007
http://www.afn.ca/cmslib/general/07-05- ... Health.pdf

A First Nations Wholistic Approach to Pandemic Planning: A Lesson for Emergency Planning
June 2007
http://www.afn.ca/cmslib/general/pan-pl ... 310219.pdf

First Nations Public Health: A Framework for Improving the Health of Our People and Our Communities
November 2006
http://www.afn.ca/cmslib/general/FNPB-IH.pdf

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Avian Flu
World Health Organization. . .
http://www.who.int/csr/disease/avian_influenza/en/

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Pandemic Planning

Canada. . .
http://www.phac-aspc.gc.ca/cpip-pclcpi/
December 9, 2006

The revised Canadian Pandemic Influenza Plan for the Health Sector was released today along with a summary booklet entitled Highlights from the Canadian Pandemic Influenza Plan for the Health Sector. Both documents are available on the Public Health Agency of Canada website at http://www.phac-aspc.gc.ca

The updated Plan was released today at the annual meeting of federal,
provincial and territorial health ministers in Moncton, New Brunswick.

The Plan - developed collaboratively by federal, provincial and territorial governments with input from health experts and officials - provides guidelines and recommendations to assist governments and organizations in planning their own responses.

Updated regularly since it was first published in 2004, the current version now includes new guidelines on influenza surveillance and public health measures. The Plan will continue to be updated with new information.

For more information about pandemic influenza, visit http://www.influenza.gc.ca

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United States. . .
http://www.pandemicflu.gov/

Australia. . .
http://www.health.gov.au/pandemic

New Zealand. . .
http://www.moh.govt.nz/pandemicinfluenza

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Mohawk community and advanced pandemic planning. . .
http://www.indiancountry.com/content.cfm?id=1096413682
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First Nations are involved in pandemic planning in Northwestern Ontario
http://www.nwhu.on.ca/pandemic-flu-plan.php

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Preparing for an Influenza Pandemic
http://www.influenza.gc.ca/index_e.html

A pandemic is a worldwide outbreak of a specific disease which affects a large proportion of the population. There is no influenza pandemic activity anywhere in the world at this time, but scientists agree there will be a global outbreak of influenza (flu) sooner or later.

The federal, provincial and territorial governments in Canada are working on pandemic preparedness, and many municipalities, companies and health care facilities also have plans in place. Although there is no need to panic, it is a good idea for Canadian families to take small steps now that will help them respond, if necessary, to a flu pandemic, as well as other emergency situations.

The Issue

A pandemic is a worldwide outbreak of a specific disease which affects a large proportion of the population. There is no influenza pandemic activity anywhere in the world at this time, but scientists agree there will be a global outbreak of influenza (flu) sooner or later.

The federal, provincial and territorial governments in Canada are working on pandemic preparedness, and many municipalities, companies and health care facilites also have plans in place. Although there is no need to panic, it is a good idea for Canadian families to take small steps now that will help them respond, if necessary, to a flu pandemic, as well as other emergency situations.

Background

People are exposed to different strains of influenza viruses many times during their lives. Even though the virus changes, a previous case of influenza may offer you some protection against infection caused by a similar strain of the virus. However, in the past it has been observed that three to four times each century, for unknown reasons, a radical change takes place in the influenza A virus, causing a new strain to emerge.

A pandemic flu virus can emerge if an avian influenza (bird flu) virus mixes with a human flu virus or if an existing virus mutates, creating a new strain that can infect humans.

Since people have no immunity against the new strain, it can spread rapidly around the world, causing a pandemic. The last three influenza pandemics occurred in 1918-1919, 1957-58 and 1968-69.

It is impossible to predict exactly when the next one will hit, but experts agree it is overdue.

Concerns that Avian Influenza H5N1 Asian strain may become Pandemic Influenza

Wild waterfowl are natural carriers of influenza A viruses. Usually, the avian influenza viruses carried by wild birds cause them little or no harm. Other birds (e.g., domestic poultry) and some animals (e.g., pigs) are also able to contract and transmit the bird flu virus. Bird flu viruses caused by wild birds do not generally infect or cause harm in humans.

Currently, a strain of avian influenza called H5N1 (Asian) is circulating in Southeast Asia, and parts of Europe and Africa. This strain is deadly to poultry and has infected many poultry populations. A limited number of people have been infected, mainly through close contact with infected poultry.

At the moment, there is no evidence that the H5N1 avian flu virus can spread easily from human to human. However, there are concerns that this virus could mutate – or, if someone infected with human influenza also becomes infected with H5N1 avian influenza, the viruses could "mix," creating a new strain. If the new strain spreads easily from person to person, the virus could spread rapidly around the world, causing an influenza pandemic.

The Potential Effects of Pandemic Influenza

It is very difficult to predict the impact of a pandemic, since no one knows how the virus would behave or how serious the pandemic would be. During a severe flu season, as many as 8,000 Canadians die from influenza and its complications; on average there are 4,000 deaths from annual flu. In a moderately severe pandemic, it is estimated that between 11,000 and 58,000 deaths may occur in Canada. These numbers are based on an assumption that the virus would cause illness in 15 to 35 per cent of the population.

In addition to deaths, a pandemic may cause significant illness and social disruption. It is important for Canadian families to plan ahead for a pandemic, because services provided by hospitals and clinics may be reduced or unavailable. Also, grocery stores and pharmacies may have limited supplies and banks may close.

Minimizing Your Risk - Preparing for an Influenza Pandemic

Start preparing your family for the possibility of an influenza pandemic by getting informed and thinking about how this event could affect your day to day life. Many of the steps you can take are just as important in non-pandemic situations and can be implemented now.

For example:

* Practice "good respiratory etiquette" to help prevent the spread of influenza. Use a tissue, or raise your arm to your face to cough or sneeze into your sleeve. Stay home when you are sick.

* Wash your hands frequently or use an alcohol based sanitizer if no water is available. Teach your children to do these things, too. Remember, good respiratory etiquette combined with an influenza vaccination (flu shot) is the most effective way to avoid getting and spreading the flu.

* Follow general emergency preparedness guidelines. This means having an emergency plan. You should also have an emergency kit with the right supplies to take care of your family, with no outside assistance, for at least 72 hours. The kit should contain food that will not spoil, a can opener, water, medications and first aid supplies, as well as matches, a flashlight, a battery-operated radio, extra batteries, some cash, etc.

Since no one can predict what would happen in a pandemic, you must be ready to adapt as the situation evolves. It is important to get informed and stay informed.

* Visit your city or municipal Web site or call the public health department to ask if your community has a pandemic plan. If one exists, ask for a copy (or download it, if applicable). You can do the same at the provincial/territorial and national level.

* Keep a list of important telephone numbers nearby, including numbers for municipal, provincial or territorial health information lines. Also, bookmark reliable Internet Web sites (e.g., municipal, provincial/territorial and Government of Canada sites) on your computer, so you can follow developments as they unfold.

* During a pandemic, childcare facilities and schools may temporarily close. Be prepared to make other arrangements for childcare should this be necessary.

* Transportation services may be disrupted. If you use public transit to get to work or to travel to others who rely on your care, consider a contingency plan to deal with these situations.

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Manitoba Pandemic Planning. . .
http://www.gov.mb.ca\pandemic

An influenza pandemic is a global disease outbreak. A pandemic occurs
when a new influenza virus emerges for which people have little or no
immunity person to person, causes serious illness, and can cross the
country and the world in a very short time.

It is difficult to predict when the next pandemic will occur or how severe it
will be. Whenever and wherever a pandemic starts, everyone around the
world is at risk. Countries might, through measures such as border
closures and travel restrictions, delay the arrival of the virus, but cannot
stop it.

Designing a Pandemic Response Plan that will facilitate a rapid response includes:

- Surveillance
- Protective Public Health Measures
- Vaccines and Antivirals
- Health Care and Emergency Response
- Workforce Support
- Staff Education
- Public Education
- Communications

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Factsheet for Pandemic Preparedness (British Columbia)

4 KEY WAYS
Local Governments can Prepare for a Pandemic

Pandemic influenza will pose unique challenges. B.C. could see up to three waves of illness before it is done, and these waves may affect individual communities for weeks at a time. Since it takes time to implement strategies, local governments are encouraged to start planning now for continuity of essential services during a pandemic.

1.) Intergovernmental Cooperation
• Check that existing contingency plans are applicable to a pandemic and core local government functions, such as sanitation, water, fire, police and power, can be sustained over a number of weeks with higher rates of absenteeism due to illness or caregiving.

• Identify essential functions and the people who perform them. Build in the cross training redundancy necessary to ensure work can continue for all essential services.

• Work with health authorities to understand the nature of an influenza pandemic and to coordinate planning, including the use of municipal buildings if required, to support people who are sick in the community and do not need hospitalization.

• Review procedures with first responders to ensure there is a process in place for worker safety, and training for procedures that will be used during a pandemic.

2.) Community Involvement

• Encourage community groups, including service clubs, schools, businesses, and non-profits to partner with you to support people in your community who are sick or grieving.

• Network with health authorities, and community and volunteer organizations to build volunteer participation for events outside the norm, including a pandemic.

• Work with the local Chamber of Commerce to assess potential impacts to business, and include local business in planning so that community services, such as grocery delivery, are maintained.

3.) Employee Health

• Maintain a healthy work environment by ensuring fresh air circulation and posting tips on how to stop the spread of illness at work.

• Encourage employees to stay home when ill, and update sick leave, and caregiver, family and medical leave policies. Concern about lost wages is the largest deterrent to self-quarantine.

• Promote hand washing, and coughing and sneezing etiquette among employees. Ensure wide and easy availability of alcohol-based hand sanitizer products

• Establish or expand policies and tools where possible that enable employees to work from home with appropriate security and network access.

4.) Financial Planning

• Assess the potential financial impact of a pandemic on the local government, and plan for the possibility of short-term decrease in revenue. Consider funding available through the Provincial Emergency Program.

For more information and tools, visit http://www.health.gov.bc.ca/pandemic
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Preparing for an influenza pandemic . . .

"The federal government recognizes its primary role in public health on First Nations' reserves. All governments recognize the need for integrated plans that include First Nations and other Aboriginal communities. All Ministers reaffirmed that antivirals from the joint National Antiviral Stockpile, vaccines and essential supplies will be available to First Nations and Aboriginal communities on the same basis as they are provided to other Canadians."

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Conference of Federal-Provincial Territorial Ministers of Health Toronto, Ontario

TORONTO, May 13,2006

Federal, Provincial and Territorial Ministers of Health have agreed to step up their efforts to strengthen public health capacity in preparing for an influenza pandemic and other public health threats.

There is no influenza pandemic at this time, but scientists agree that a global outbreak could occur at any time. A pandemic occurs when a new
influenza virus emerges against which humans have little or no immunity. Historically, influenza pandemics have occurred every 10 to 40 years, with the most recent in 1968.

Ministers of Health are determined to ensure Canada remains at the forefront of pandemic influenza planning. Recognizing the extensive work already under way by all governments, Ministers reaffirmed their leadership in preparing for and responding to a pandemic.

Ministers agreed to work together to:

- Seek authority as necessary to increase the joint National Antiviral
Stockpile from 16 million to 55 million doses. Officials will continue
to review the best scientific evidence on the appropriate use and
stock of antivirals.

- Finalize a Memorandum of Understanding by December 2006 to formalize roles and responsibilities, including funding, as outlined in the
current federal budget, in pandemic preparedness and response.

- Finalize a mutual assistance agreement to enable the sharing of
health human resources and supplies across jurisdictions during a
public health emergency, reflecting best practices and shared
priorities.

- Complete a pan-Canadian public health information system and an
agreement on the timely sharing of information in preparing for and
responding to a public health emergency.

- Develop a coordinated, pan-Canadian communications strategy to provide Canadians with the information they need to prepare for and respond to a pandemic.

- Contain the spread of a potential outbreak of avian influenza by
collaborating with agricultural, environmental and other sectors.

- Coordinate planning exercises to ensure the effectiveness of each
government's plans and state of readiness.

The federal government will continue to work with industry and
international partners on the development, testing and licensing of an
effective vaccine.

The federal government recognizes its primary role in public health on
First Nations' reserves. All governments recognize the need for integrated
plans that include First Nations and other Aboriginal communities. All
Ministers reaffirmed that antivirals from the joint National Antiviral
Stockpile, vaccines and essential supplies will be available to First Nations
and Aboriginal communities on the same basis as they are provided to other Canadians.

"Today we took concrete steps forward in our efforts to protect Canadians
in the event of a pandemic or an outbreak of avian influenza," said Federal
Minister of Health, Tony Clement. "While we are making steady progress, more needs to be done. We are committed to moving forward together to engage and involve all Canadians in our plans and preparations."

"Governments across Canada are determined to be ready for the next
pandemic, and we are committed to ensuring any further work that needs to be done is completed," said New Brunswick Health Minister Brad Green. "It is vital to Canadians that their governments are working together on this important issue."

Ministers also highlighted the need for and benefits of non-governmental
and private sector organizations continuing to develop appropriate pandemic preparedness and business continuity plans. Governments and the private sector will work together to ensure continuity of supply of key goods and services. All sectors of society must do their part to enhance preparedness for any potential public health emergency.

In the wake of the Severe Acute Respiratory Syndrome (SARS) outbreak in 2003, federal, provincial and territorial governments have been working
together to enhance Canada's capacity to respond to emerging health threats. Ministers are committed to a strong and effective partnership in preparation for an influenza pandemic, the appearance of avian influenza in Canada or any other public health emergencies. Health Ministers asked that their officials include pandemic planning as a standing item on all their ministerial meetings.

Backgrounders: Canadian Pandemic Influenza Plan
Antivirals

Egalement disponible en français

Canadian Pandemic Influenza Plan Backgrounder

Health Minister Conference of Federal-Provincial-Territorial Ministers of Health

May 12-13, 2006 - Toronto

The Canadian Pandemic Influenza Plan maps out how Canada will prepare for and respond to an influenza pandemic. Federal, provincial and territorial governments collaborated on its development.

The Canadian Pandemic Influenza Plan is designed for:

- federal, provincial and territorial departments of health
- emergency workers,
- public health officials, and
- health care workers

The plan includes guidelines and checklists that these groups can use in
emergency response planning and creates a framework that guides the actions of all levels of government in the event of an influenza pandemic.

The plan covers the following activities:

- Prevention activities, such as surveillance programs and the
establishment of an infrastructure for manufacturing sufficient
vaccines to protect all Canadians at the time of a pandemic.

- Preparedness activities, include the preparation of actual plans for a
pandemic. The preparedness section addresses key activity areas, such as vaccine programs, surveillance and public health measures in terms of their current status and future requirements.

- Response/Implementation activities for controlling the pandemic,
minimizing deaths and any social disruption it causes, including
communication activities. Implementation also involves documenting
the current activities and outcomes to determine if any changes need
to be made to the response.

The plan describes the different phases of a pandemic and the roles and
responsibilities for each level of government at each phase. The phases
described in Canada's plan are based on the World Health Organization's
pandemic phases. These phases are helpful for planning concrete steps under key activity areas for each phase. When put together, the phases provide guidance on what needs to be done as a pandemic unfolds.

The plan is currently in the process of being updated to reflect recent
revisions made to the WHO pandemic phases.

The plan also includes a series of annexes that offer detailed guidance
on specific areas such as infection control, clinical guidelines and
communications. The annexes cover the following topics:

- Pandemic Influenza Planning Considerations in First Nations
Communities
- Laboratory Procedures
- Vaccines
- Antivirals
- Infection Control and Occupational Health Guidelines
- Clinical Care Guidelines and Tools
- Resource Management Guidelines for Health Care Facilities
- Guidelines for the Management of Mass Fatalities
- Guidelines for Non-Traditional Sites and Workers
- Communications
- Federal Emergency Planning Documents



INFORMATION MAY 2006

ANTIVIRALS
------------------------------------------------------------------------

Antivirals are drugs used for the prevention and early treatment of
influenza. If taken shortly after (within 48 hours) getting sick, they can
reduce influenza symptoms, shorten the length of illness and potentially
reduce the serious complications of influenza. Antivirals work by reducing the ability of the virus to reproduce but do not provide immunity against the virus.

Vaccines, the most effective public health tool to fight an influenza
pandemic, provide immunity against the influenza virus but cannot be produced until the pandemic strain of influenza has emerged. Antivirals, however, can be stockpiled in advance.

Two classes of antivirals are currently available in Canada and have a
role in the prevention and treatment of influenza: M2 ion channel inhibitors
and neuraminidase inhibitors.

M2 ion channel inhibitors stop the virus from reproducing and are
effective against influenza A viruses but not influenza B. Amantadine and
rimantadine are examples of M2 ion channel inhibitors. Currently, only
amantadine is licensed for use in Canada. Research, however, shows that
influenza viruses rapidly develop resistance to amantadine when it is used for treatment.

Zanamivir and oseltamivir are examples of neuraminidase inhibitors. These drugs interfere with replication of both influenza A and B viruses in three ways:

- They interfere with the release of virus from infected cells
- They cause the aggregation of virus
- They may help respiratory secretions make the virus inactive

Based on research, neuraminidase inhibitors are the preferred drugs for
use during a pandemic because they have a lower risk of adverse events and decreased evidence of drug resistance.

The World Health Organization (WHO) has recommended oseltamivir
specifically for treatment of avian influenza and has recommended that
countries consider stockpiling it for use against a pandemic strain of
influenza. Studies done through the WHO Global Influenza Surveillance Network have shown that the H5N1 strain of avian influenza, considered a pandemic-like virus, is susceptible to oseltamivir. The strain has demonstrated resistance to the M2 inhibitors.

The use of antivirals should be combined with other public health measures, including proper personal hygiene such as frequent hand washing to reduce the spread of the virus.

For further information: Media Inquiries: Aggie Adamczyk, Public Health
Agency of Canada, (613) 941-8189; Johanne LeBlanc, New Brunswick Department of Health, (506) 453-2536

[FirstNations PandemicPlan]

First Nations Pandemic Planning . . .
A global pandemic was declared by the World Health Organization because of the H1N1 outbreak.
June 2009
World Health Organization - Pandemic Influenza
H1N1 . . . http://www.who.int/csr/disease/swineflu/en/index.html
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Watch a Public Service Announcement . . .
http://www.youtube.com/user/H1N1BC
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The Pandemic H1N1 Virus and Your Community
B.C. First Nations H1N1 action plan
http://www.turtleisland.org/discussion/viewtopic.php?p=10428#p10428
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FIRST NATIONS and the FLU PANDEMIC
* * * * * DETAILS * * * * ** *
viewtopic.php?p=10229#p10229
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H1N1 Frequently Asked Questions
First Nations Health Council of BC
June 2009 . . .
http://www.turtleisland.org/healing/h1n1-fnhc09.html
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Pandemic Preparedness

H1N1 Flu Virus (sometimes called Human Swine Flu) is a strain of the influenza virus that usually affects pigs, but which may also make people sick. H1N1 flu virus is a respiratory illness that causes symptoms similar to those of the regular human seasonal flu.
Frequently Asked Questions . . .
http://www.phac-aspc.gc.ca/alert-alerte ... 04-eng.php
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The Canadian Pandemic Influenza Plan for the Health Sector
NOTE: Influenza Pandemic Planning Considerations in
On Reserve First Nations Communities
http://www.phac-aspc.gc.ca/cpip-pclcpi/ ... _b-eng.pdf
June 2009
Also available here . . .
http://www.turtleisland.org/healing/flujune09.pdf
- - -

Here is an example of a Pandemic Plan template for First Nations communities
(it is in powerpoint format) . . . http://www.turtleisland.org/healing/pandplan09.ppt
- - -

Here Are Additional Authoritative Information Sources

Government of Canada
http://www.influenza.gc.ca/index_e.html

Public Health Agency of Canada
http://www.phac-aspc.gc.ca/influenza/pandemic-eng.php

CANADA HOTLINE: 1-800-454-8302
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U.S. Centers for Disease Control and Prevention
H1N1 Flu (Swine Flu)
http://www.cdc.gov/h1n1flu/
- - -

U.S. Department of Health & Human Services
http://pandemicflu.gov/

UNITED STATES HOTLINE: 1-800-232-4636
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How To Protect Yourself . . .
http://www.fightflu.ca
- - -

General Instructions for Disposable Respirators
http://www.youtube.com/watch?v=0d_RaKdq ... re=channel

NOTE: There really is not any one-fits-all disposable respirator.
Respirator technicians are available to assist you.
For example - Mid Island Safety Services
http://www.midislandsafety.com

There are legal requirements that health workers must meet while wearing protective equipment (for example there is specific training, fitting and testing in the proper use of masks and respirators) to ensure they are protecting themselves and the patients they are assisting.
- - -

General information . . .
http://www.phac-aspc.gc.ca/alert-alerte ... ne-eng.php
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Ontario First Nations Pandemic . . .
http://www.pandemic.knet.ca/

First Nations - The Flu - Pandemic Planning
June 2009 . . .
viewtopic.php?p=10229#p10229

Pandemic planning - The need for First nations to control public health
viewtopic.php?p=10232#p10232

FIRST NATIONS Pandemic Planning . . .
http://www.turtleisland.org/digest/pandemic09.gif
Inter Tribal Health Authority on Vancouver Island
http://www.intertribalhealth.ca/Pandemi ... edness.htm
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First Nations Emergency Services
British Columbia . . .
http://www.fness.bc.ca/
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British Columbia . . .
First Nations Health Council
http://www.fnhc.ca
- - -

BC Ministry of Health
http://www.gov.bc.ca/govt/swine_flu.html

Questions?
In BC you can dial 811
It is a 24 hour a day, seven days a week BC Government service
- - -

Vancouver Island Health Authority
http://www.viha.ca/mho/public_health_alerts/

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Ontario Ministry of Health
http://www.health.gov.on.ca/english/pub ... e_flu.html
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Preparing for Pandemic Influenza in Manitoba . . .
http://www.gov.mb.ca/health/publichealth/pandemic.html
- - -

PERSPECTIVES on PREPAREDNESS . . .

Swine flu outbreak tests Canadian preparedness
Ann Silversides
CMAJ 2009
http://www.cmaj.ca/cgi/content/full/180/12/E93?etoc
- - -
Canada's ability to respond to a national health crisis hampered by jurisdictional issues, untested emergency plans
Ann Silversides
CMAJ 2009
http://www.cmaj.ca/cgi/content/full/180/12/1193?etoc
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NW Tribal Emergency Management Council
Washington State . . .
Information for H1N1 Flu Virus "Swine Flu"
http://www.nwtemc.org/H1N1.aspx
- - -


British Columbia . . .
First Nations Health Council
http://www.fnhc.ca/index.php/news/press_releases/

Tripartite Partners Respond to H1N1 influenza
The Tripartite Partners to the First Nations Health Plan are working collaboratively to mitigate the affect of H1N1 Influenza on BC First Nations communities.

The First Nations Health Council senior management team has been in daily communication with our Tripartite Partners to monitor, assess, and respond to the recent outbreak of Swine Influenza. Clinical support is being provided by Dr. Marcus Lem, Director, Health Protection, First Nations and Inuit Health and Dr. Evan Adams Aboriginal Physician Advisor, Ministry of Healthy Living & Sport.

It is important for communities to be prepared by developing, testing, and refining pandemic plans, as well as increasing surveillance efforts.
H1N1 INFLUENZA

TRIPARTITE ROLES, RESPONSIBILITIES & ACTIVITIES

BACKGROUND:
Health Canada, First Nations Inuit Health Branch (FNIH), Ministries of Health Services
(MoHS) and Healthy Living and Sport (MHLS), and health authorities, have a shared
responsibility for ensuring the provision of health services for First Nations living on and
off‐reserve. FNIH provides funding for First Nations pandemic planning on‐reserve.
Indian and Northern Affairs Canada (INAC) is responsible for emergency management.
Out of 200 First Nations communities in BC, 195 have community pandemic influenza
plans. The plans have not been formally reviewed by the Province of British Columbia.
In addition to establishing community specific pandemic plans, FNIHB has been working
with health authorities on communicable disease integration plans which include
pandemic planning and response.

ROLES, RESPONSIBILITIES & ACTIVITIES:
Federal funding to provinces for stockpiles of anti‐virals include supplies for
First Nations. FNIHB Regional Medical Health Officer (MHO), Dr. Marcus Lem, states
that FNIHB will work in partnership with health authorities to ensure that First Nations
receive the same medical treatment as is provided to non‐First Nations citizens.

First Nations Inuit Health, Health Canada
Fiduciary responsibility for First Nations health care on reserve.
Key contact: Dr. Marcus Lem, Regional Medical Health Officer.
To provide notifications and continuing updates to FNIH Nurses, Transfer Nurses,
and Health Directors within First Nations communities.
Dr. Lem attends daily teleconferences for provincial MHOs and participates in
ongoing discussions with health authorities, Public Health Agency of Canada (PHAC),
and INAC regarding coordination and integration of emergency planning and
pandemic preparedness activities.

Ministry of Healthy Living and Sport
Responsible for health care for all British Columbians.
Key contact: Dr. Evan Adams, Aboriginal Physician Advisor, Office of the Provincial
Health Officer.
Dr. Adams is in daily contact with Dr. Eric Young, Deputy Provincial Health Officer,
Dr. Marcus Lem, FNIHB; and Deborah Schwartz, Executive Director, Aboriginal
Healthy Living Secretariat (AHLS).
Dr. Adams is also in daily contact with the First Nations Health Council (FNHC)
through Joe Gallagher, Chief Executive Officer of the First Nations Health Society.
A Tripartite letter has been issued by Dr. Adams, Dr. Lem, and Joe Gallagher,
identifying symptoms and contacts for more information.
Regular teleconferences are in process between MHLS, Dr. Adams, all Aboriginal
Health Leads, Dr. Lem, and Mary Guimont, FNHC, to ensure consistent updates.
2009-05-08. Prepared by the First Nations Health Council, with files from Ministry of

First Nations Health Council
Advocate for and support First Nations communities
Communications link: For many communities and individuals First Nations Health
Council is the first point of contact.
Clinical inquiries to FNHC are referred to the appropriate personnel within federal
and provincial governments.
FNHC website serves as repository for tripartite information as related to H1N1.
Policy support is being led by Mary Knox‐Guimont with support from Derina Peters.
Provincial Emergency Program (PEP)
Through a Letter of Agreement with the province, PEP will, when requested,
coordinate the non‐health response and recovery on First Nations lands.
Kirsten Brown, Manager, Provincial Emergency Program, is coordinating with MHLS,
the FNHS, Aboriginal Health Leads, and Dr. Adams, to include First Nations in
teleconferences from their Regional Emergency Operations Centres with each health
authority.

Health Authorities
Information and support is being provided to First Nations communities through
email communications and links to health authority websites, through either the
MHO or the Aboriginal Health Lead.
Aboriginal Health Leads are working closely with health authority Pandemic
Coordinators and MHOs as required.
Identify and establish connections with First Nations Communities

First Nations Communities
To review pandemic plans, and assess and revise as necessary.
Identify key communication links, including establishing contact with Aboriginal
Health Leads through regional health authorities.
Work with community health worker or community health nurse to ensure you have
up to date information.
Ensure that your band schools and band offices have adequate hand washing
equipment.
- - -

H1N1 Influenza Virus (Human Swine Influenza)
http://www.healthlinkbc.ca/healthfiles/hfile108.stm

Provincial Infection Control Network of British Columbia.
http://www.picnetbc.ca/page229.htm
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April 30, 2009
Dear First Nations community members,
Re: Swine Influenza Outbreak
The Tripartite Partners to the First Nations Health Plan are working closely to monitor, assess and respond to the recent Swine Influenza Outbreak, and to ensure that First Nations communities are supported during this time. Collectively, many agencies are working together in British Columbia – health authorities, the British Columbia Centre for Disease Control, the Public Health Agency of Canada, First Nations & Inuit Health, British Columbia Region, and the Office of the Provincial Health Officer, among other partners – to investigate and respond to the recent spread of swine flu. A small number of human cases of swine flu have been confirmed in British Columbia – none in First Nations on-reserve communities.

Swine flu is a respiratory disease of pigs caused by type A influenza viruses that regularly cause outbreaks of flu in pigs. Natural changes to this particular swine flu virus have allowed it to infect humans.
The symptoms of swine flu in people can be similar to the symptoms of a regular seasonal flu infection, which may include fever, cough, headache, general aches, fatigue and other symptoms. Some people with swine flu have also reported runny nose, sore throat, nausea, vomiting and diarrhoea.

In response to the recent spread of swine flu, we are making the following precautionary recommendations:

Continue all school, community and day-to-day activities as per normal procedures;
Allow travelers arriving from Mexico, or other swine flu affected areas, to participate in regular activities if they are feeling well. Travelers should monitor themselves for symptoms and, if experiencing flu-like illness, should follow the prevention tips below to avoid spreading illness to others;
Encourage the following flu prevention tips within your communities’ population:
Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it. If you do not have a tissue, cough or sneeze into your sleeve;
Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand gels are also effective. Clinics, schools, band offices and other office buildings may wish to consider keeping these readily available;
Try to avoid close contact with sick people;
Avoid touching your eyes, nose or mouth; Germs spread that way;
If you get sick with mild illness, stay home and limit contact with others to keep from infecting them;
There is no need to rush to emergency rooms or local clinics. A good place to start if you have questions or concerns is HealthLink BC 811 any time day or night. If your symptoms become more severe, contact your health care provider.

Furthermore, we recognize that in some areas of the province, the health authorities’ medical health officers are well connected with the First Nations in their region. In the remaining regions, the federal FNIH Regional Medical Health Officer, Dr. Marcus Lem, is the direct link into the First Nations communities.
Dr. Lem states FNIH will ensure that First Nations receive the same medical treatment as is provided to non-First Nations citizens in the province.

Federal funding to provinces for anti-virals and vaccines includes supplies for First Nations and the needs of First Nations’ citizens are accounted for in the provincial plans and stockpiles. Health Canada will be working with the British Columbia Centre for Disease Control and the Local Health Authorities to work out the logistics for the delivery of these supplies to your communities, should the need arise.

Virtually all British Columbia FN communities have developed a Pandemic Influenza Community Plan and it is a good time for your community to review and revise your plans. Over the coming months, Health Canada and its contractor, JEL Protection Ltd., will be engaging many of your communities in table top exercises, mass immunization exercises and other activities to strengthening your linkages to local public health and the level of community preparedness. Further information can be found on JEL’s learning website (http://www.jelearning.com).

The power of any preparedness plan is in the community. We encourage you to talk to the members of your community who have been directly involved with Pandemic Influenza Community Plan, such as the Health Directors, CHRs, Nurses and leadership to discuss your concerns and to see how you can be involved to make sure that your Pandemic Influenza Community Plan reflects the strength and resilience of your community.

The First Nations Health Council is in daily communication with British Columbia and Health Canada to ensure that our communities have accurate and pertinent information. If require any assistance in reaching appropriate federal or provincial supports please do not hesitate to contact the Health Council office.
For more information on swine flu in British Columbia and links to national and international sites, please visit:
http://www.gov.bc.ca/govt/swine_flu.html

Sincerely,

Evan Adams, MD, Aboriginal Health Physician Advisor Office of the Provincial Health Officer Ministry of Healthy Living & Sport 1515 Blanshard St., 4th Floor Victoria, BC
V8W-3C8 Ph: 250-952-1349 evan.adams@gov.bc.ca

Joe Gallagher
Chief Executive Officer
First Nations Health Council
#1205-100 Park Royal South
West Vancouver, BC
V7T 1A2
Ph : 604-913-2080

Marcus Lem, MD, MHSc, FRCPC Director, Health Protection First Nations and Inuit Health British Columbia Region, Health Canada 406 - 1138 Melville Street Vancouver, BC
V6C 4S3
Ph; 604-666-9092
- - -

A Message from the First Nations Health Council
Re: Postponement of Gathering Wisdom

The well‐being of our children speaks to our accountability, the protection of our families speaks to our
integrity, and the weight of the memory of our Ancestors speaks to our collective desire to ensure the
resiliency of our communities. Our Ancestors define all of who we are and where we come from, and we
pray that our children carry forward all that we work for and aspire to. We are nations of people always
praying for the wellbeing of our children and families.

In our not too distant past, the spread of disease claimed many of our Ancestors. The impact of
this history is still felt today in many of our communities. Our retelling of the past serves as
proof that the destruction left behind of new diseases had a great and profound effect on how
we protected our children and families.

Our Ancestors understood the need to react to threats. Many of our people enacted timehonored
institutions to defend their communities against outbreaks. These included isolation
sites, where affected families and communities would gather. Our communities also relied on
complex kinship ties for support. Our Ancestral leaders’ collective efforts to shield their
communities from disease provided us the opportunity to recover, grieve and thrive.

In a time of change in health services, we recognize the constant struggle for expertise,
resources, community planning, and the capacity to affect policy that allows First Nations in
British Columbia to protect their children and families. There is a need for all of us in this time
of uncertainty to consult with each other and to be brave enough to assign social responsibility
and an opportunity for transformative change. We have formed partnerships with the
government of British Columbia and Canada, under the Transformative Change Accord: First
Nations Health Plan and the Tripartite First Nations Health Plan, to confront the difference in
health outcomes between First Nations and other British Columbians.

As we work collaboratively to address the critical developments of the Influenza A (H1N1) virus
‐ also referred to as the Swine Flu virus ‐ in our First Nations communities, an important step
will be to ensure that hearing the needs of our people is linked to a coordinated process of
engagement, dialogue and response to this disease. Both governments have reacted with
concern to support First Nations and the First Nations Health Council. The Tripartite Partners
have pledged to work with First Nations communities in the areas of planning, coordination and
emergency response, and ensure that the safety of our communities is underpinned with
security and resiliency.

The First Nations Health Council acknowledges the work and dedication of BC First Nations
leadership, their health workers, and the management of health services within each of your
communities. We know that the work that all of you do is in direct concern for your children,
families and communities. And it is for this reason that measures were taken to suspend the
annual Gathering Wisdom for a Shared Journey Forum 2009 and help support you at your posts.

The First Nations Health Council and the Tripartite Partners sincerely apologize for any
inconvenience the rescheduling of Gathering Wisdom for a Shared Journey Forum 2009 to later
in the fall may cause. We anticipate a Gathering in the fall of 2009 in which all of us can reflect
on current decisions made in the interest of the health and well‐being of our people.

Sincerely,
Debbie Abbott
Co‐Chair

Joe Gallagher
Chief Executive Officer
First Nations Health Council First Nations Health Council
1205‐100 Park Royal South 1205‐100 Park Royal South
Vancouver, BC Vancouver, BC
V7T 1A2 V7T 1A2
- - -

H1N1 in Indian Country . . .
May 2009
http://www.indiancountrytoday.com/natio ... 90197.html
- - -

April 29, 2009
TO: ALL FIRST NATIONS CHIEFS AND COUNCILS, AND HEALTH
MANAGERS/DIRECTORS
RE: SEVERE RESPIRATORY ILLNESS (SRI) IN MEXICO
(SWINE FLU)
___________________________________________________________________
BACKGROUND
The Public Health Agency of Canada (PHAC) has been alerted to clusters of a
severe respiratory illness confirmed to be from a new strain of influenza (H1N1),
more commonly called the Swine Flu. Outbreaks originated in Mexico and similar
outbreaks have occurred in the US. There are an increasing number of cases in
Canada. Individuals who have recently travelled to Mexico and who are experiencing
flu-like symptoms are currently at risk.
So far, there are no reported cases involving First Nations.
The virus includes influenza-like symptoms which are usually felt all over the body in the
form of fever, muscle aches, head ache, chills, nausea, vomiting, tiredness, and a dry
cough. The current cases in Canada have exhibited mild symptoms while those in
Mexico have been more severe.
The World Health Organization is monitoring the spread of the virus and will adjust
the pandemic alert level as needed. This in turn will guide the decisions of the
Public Health Agency of Canada who have the lead on Pandemic Emergencies in
Canada.
How do people get it?
Influenza and other (severe) respiratory infections are transmitted from person to
person via the respiratory route. Coughs and sneezes release the germs into the air
where they can be breathed in by others. Germs can also rest on hard surfaces like
counters and doorknobs, where they can be picked up on hands and transmitted to
the respiratory system when someone touches their mouth and/or nose.
First Nations
While there have been no reported cases among First Nations, these events
demonstrate the need for pandemic planning. Some First Nations communities have
already developed and tested comprehensive pandemic plans and are doing regular
surveillance activities. Others are at the beginning stages of developing plans and
are not adequately prepared in the event of an outbreak.
First Nations and Inuit Health Branch (FNIHB) work closely with PHAC in developing
approaches to on reserve preparedness. FNIHB has supported many Regional
activities by assisting communities with the development of pandemic plans and
have initiated testing exercises in many Regions. More work is needed to ensure
adequate preparedness in all FN communities.
What can be done to prevent the spread of the flu?
The Public Health Agency advises Canadians to:
• Wash hands thoroughly with soap and warm water, or use hand sanitizer
• Cough and sneeze in your arm or sleeve
• Get your annual flu shot
• Keep doing what you normally do, but stay home if sick
• Check http://www.fightflu.ca for more information
• Check http://www.voyage.gc.ca for travel notices and advisories
• Talk to a health professional if you experience severe flu-like symptoms
The AFN is recommending that community leaders work with their emergency
preparedness coordinators to support increased pandemic planning activities
as needed. This should also be done in collaboration with FNIH Medical
Officers of Health.
For more information, visit:
Public Health Agency of Canada: (Hotline 1-800-454-8302)
• http://www.phac-aspc.gc.ca/index-eng.php
US Centre for Disease Control
• http://www.cdc.gov/
World Health Organization
• http://www.who.int/en/
http://www.afn.ca or please contact:
Karyn Pugliese, AFN Health Communications Officer: 1-866-869-6789, ext 210,
kpugliese@afn.ca
Jonathon Thompson, AFN Health Director: 1-866-869-6789, ext 235,
jthompson@afn.ca
Kim Barker, AFN Public Health Advisor: kbarker@afn.ca

- - - - -

A Holistic Approach to Pandemic Readiness
http://www.afn.ca/misc/HPR.ppt


An AFN Pilot Project Presented by Sucker Creek First Nation Health Team
Sucker Creek First Nation Assembly of First Nations Pilot Project: A Holistic Approach to Pandemic Readiness
http://www.afn.ca/misc/PP.pdf

Katzie First Nation Influenza Pandemic Planning Project
http://www.afn.ca/misc/KP.pdf

- - -

Also of interest . . .

Communiqué to First Nations Communities April 29, 2009
TO: ALL FIRST NATIONS CHIEFS AND COUNCILS, AND HEALTHMANAGERS/DIRECTORS

RE: SEVERE RESPIRATORY ILLNESS (SRI) IN MEXICO(SWINE FLU) BACKGROUND The Public Health Agency of Canada (PHAC) has been alerted to clusters of asevere respiratory illness confirmed to be from a new strain of influenza (H1N1),more commonly called the Swine Flu. Outbreaks originated in Mexico and similaroutbreaks have occurred in the US. There are an increasing number of cases inCanada. Individuals who have recently travelled to Mexico and who are experiencingflu-like symptoms are currently at risk. So far, there are no reported cases involving First Nations.

The virus includes influenza-like symptoms which are usually felt all over the body in theform of fever, muscle aches, head ache, chills, nausea, vomiting, tiredness, and a drycough. The current cases in Canada have exhibited mild symptoms while those inMexico have been more severe. The World Health Organization is monitoring the spread of the virus and will adjustthe pandemic alert level as needed. This in turn will guide the decisions of thePublic Health Agency of Canada who have the lead on Pandemic Emergencies inCanada. How do people get it? Influenza and other (severe) respiratory infections are transmitted from person toperson via the respiratory route. Coughs and sneezes release the germs into the airwhere they can be breathed in by others. Germs can also rest on hard surfaces likecounters and doorknobs, where they can be picked up on hands and transmitted tothe respiratory system when someone touches their mouth and/or nose. First Nations While there have been no reported cases among First Nations, these eventsdemonstrate the need for pandemic planning. Some First Nations communities have already developed and tested comprehensive pandemic plans and are doing regularsurveillance activities.

Others are at the beginning stages of developing plans andare not adequately prepared in the event of an outbreak.

First Nations and Inuit Health Branch (FNIHB) work closely with PHAC in developingapproaches to on reserve preparedness. FNIHB has supported many Regionalactivities by assisting communities with the development of pandemic plans andhave initiated testing exercises in many Regions. More work is needed to ensure adequate preparedness in all FN communities. What can be done to prevent the spread of the flu?

The Public Health Agency advises Canadians to: Wash hands thoroughly with soap and warm water, or use hand sanitizer Cough and sneeze in your arm or sleeve Get your annual flu shot Keep doing what you normally do, but stay home if sick Check http://www.fightflu.ca for more information Check http://www.voyage.gc.ca for travel notices and advisories Talk to a health professional if you experience severe flu-like symptoms

The AFN is recommending that community leaders work with their emergencypreparedness coordinators to support increased pandemic planning activitiesas needed. This should also be done in collaboration with FNIH MedicalOfficers of Health.

For more information, visit: Public Health Agency of Canada: (Hotline 1-800-454-8302)
http://www.phac-aspc.gc.ca/index-eng.php

US Centre for Disease Control
http://www.cdc.gov

http://www.who.int/en/ http://www.afn.ca or please contact:
Karyn Pugliese, AFN Health Communications Officer: 1-866-869-6789, ext 210, kpuglieseOjafn.ca
Jonathon Thompson, AFN Health Director: 1-866-869-6789, ext 235, ¡thorn pson(5)afn.ca
Kim Barker, AFN Public Health Advisor: kbarker@afn.ca
- - -

1862 epidemic decimated native population
Government, police handling of smallpox outbreak among native peoples in Victoria was shameful
By Andrei Bondoreff, Times Colonist
May 24, 2009
http://www.timescolonist.com/Health/186 ... story.html
- - -

UPDATES . . .
viewtopic.php?p=10233#p10233


- - -

NOTE: PAST DATES on this . . .
First Nations & Inuit Health

Fact Sheet on Avian Influenza - Fall 2006
http://www.hc-sc.gc.ca/fnih-spni/pubs/i ... dex_e.html

What First Nations People and Inuit Need to Know About...Avian Influenza or "Bird Flu"

Most of us have heard about the flu (or influenza), but what is avian influenza or bird flu? This communique will help you understand what the bird flu is, and what precautions you should take to reduce your risk.

What is the Flu?

Human influenza, or the flu, is an infection of the lungs caused by the influenza virus. Various strains of the virus circulate throughout the world year-round, causing local outbreaks.

How is the Flu Spread?

The influenza virus spreads through droplets that have been coughed or sneezed into the air by someone who has the flu. You can get the flu by breathing in these droplets through your nose or mouth, or by the droplets landing directly on your eyes. The flu virus is also found on the hands of people with the flu and on surfaces they have touched. You can become infected if you shake hands with infected persons or if you touch things that they have touched and then touch your own eyes, nose or mouth.

What is "bird flu" or avian influenza?

Avian influenza is a virus that can affect all species of birds but can, less commonly, infect mammals including people. Wild birds are not generally affected by bird flu but can still spread it to domestic birds such as chickens, geese and turkeys.

Why are some domestic birds and people getting sick?

Right now there is a strain of bird flu called H5N1 circulating throughout Southeast Asia and parts of Europe. This particular strain of flu will kill most domestic birds it infects, including chickens, ducks and geese. Avian influenza viruses such as the H5N1 virus can, on rare occasions, infect people. To date, most human cases have been linked to direct contact with infected poultry or their droppings. This contact often includes exposure to the virus during the slaughter, de-feathering and preparation of poultry for cooking.

Should I avoid eating domestic poultry or eggs?

There is no evidence to suggest that people can become infected with bird flu by eating cooked eggs or birds like chickens, ducks and geese. It is important that meat, poultry and eggs are always well cooked. You should wash your hands (or use an alcohol-based hand sanitizer) when cooking. You should keep meat, eggs and poultry away from other food when they are stored in your fridge and when you are cooking with them.

Do First Nations people and Inuit need to be concerned?

Although the risk of catching bird flu is very low, hunters and people who prepare and cook traditional foods, including wild birds, should take the following precautions to help reduce any risk:

* do not handle or eat sick birds or birds that have died from unknown causes;
* avoid touching the blood, secretions or droppings of wild birds;
* do not rub your eyes, touch your face, eat, drink or smoke when cleaning wild game birds;
* keep young children away when cleaning game birds and discourage them from playing in areas that could be contaminated with wild bird droppings;
* when preparing game, wash knives, tools, work surfaces and other equipment with soap and warm water followed by a household bleach solution (0.5% sodium hypochlorite);
* wear water-proof household gloves or disposable latex/plastic gloves when handling or cleaning game;
* wash gloves and hands (for at least 20 seconds) with soap and warm water immediately after you have finished preparing game or cleaning equipment. If there is no water available, remove any dirt using a moist towlette, apply an alcohol based hand gel (between 60-90% alcohol) and wash your hands with soap and warm water as soon as it is possible;
* if clothing and shoes become soiled when handling a bird, keep them in a sealed plastic bag until they can be washed.
* thoroughly cook poultry/game meat by ensuring that inside temperature reaches 85°C for whole birds or 74°C for bird parts (i.e. no visible pink meat, and juice runs clear); and,
* never keep wild birds in your home or as pets.

If you become sick while handling birds or afterwards, see your doctor. Tell your doctor that you have been in contact with wild birds.

In addition, if you often hunt or handle wild birds, you should consider getting an annual vaccination against seasonal human influenza. This vaccination will not protect you against bird flu, but it will reduce the likelihood that you will become infected with both human and bird flu strains at the same time. This will limit the chances of flu viruses mixing to create a new strain of flu virus to which people have little or no immunity.

It is considered safe to hunt, handle and eat healthy wild birds if these precautions are taken.
Where can I get more information?
swan

Contact your local health authority (for example, an Environmental Health Officer, community health centre or nursing station near you) or visit the Public Health Agency of Canada's website http://www.pandemicinfluenza.gc.ca for more information about influenza.

- - - - - - -

News and Comment
by Tehaliwaskenhas
Bob Kennedy, Oneida
Copyright
Turtle Island Native Network
http://www.turtleisland.org

May 31, 2006

Inter Tribal Health Authority and First Nations communities across Vancouver Island in partnership with the Vancouver Island Health Authority are working together to map out how they will prepare for and respond to a pandemic influenza outbreak.

It is the first jurisdiction in Canada to implement Health Canada’s guiding frameworks to assist First Nation communities in the development of their community pandemic influenza plans.

These efforts will ensure aboriginal communities are supported in preparing for a potential pandemic by developing effective interventions to mitigate the impact of a pandemic if it occurs.

David Bob of the 'Snaw Naw As' First Nation (Nanoose), Chair of the Inter Tribal Health Authority, said it is the type of response First Nations expect and deserve. "Coordination is the key to success," he added.

The goal of pandemic influenza preparedness and response is to minimize serious illness and overall deaths, and minimize disruption in the communities as a result of a pandemic.

This health partnership project includes planning between First Nations communities, Health Authorities and local Government about actions to be taken during a pandemic, such as roles and responsibilities in emergency response, distribution of vaccine and antivirals, clinical health services and surveillance - resource management and communication.

A key project goal is to increase awareness of the challenges faced in managing a pandemic influenza outbreak, and to familiarize First Nations communities with emergency response capabilities to react to a pandemic.

Local health officials point out that while urban Aboriginals are served by broader pandemic plans, "there are 13,000 First Nation’s residents living on reserves who have had minimal pandemic planning and who were not provided for under other plans".

48 of 51 First Nation communities have completed, or are in the process of completing their pandemic influenza plans - owned by the community, are culturally and community appropriate and compliment adjacent community plans.

- - - - - - -

Previously reported. . .

Health Ministers who recently met to discuss preparations for an influenza pandemic stated their commitment to First Nations. . .

"The federal government recognizes its primary role in public health on First Nations' reserves. All governments recognize the need for integrated plans that include First Nations and other Aboriginal communities. All Ministers reaffirmed that antivirals from the joint National Antiviral Stockpile, vaccines and essential supplies will be available to First Nations and Aboriginal communities on the same basis as they are provided to other Canadians."
viewtopic.php?t=4526

[Pandemic Influenza]

Over 40% of critical healthcare workers may not go to work when a pandemic hits

Proper planning and preventive medicines are critical to ensure essential
frontline healthcare services function during a pandemic

TORONTO, Nov. 14, 2007

Results from a national survey reveal that almost one quarter (23 per cent) of our nation's healthcare workers would be uncomfortable reporting to work if someone in Canada was to be diagnosed with pandemic influenza. Even more alarming is that if people in their city were diagnosed with the flu pandemic, 43 per cent of healthcare workers, including nurses, pharmacists and medical technicians would be uncomfortable reporting to work.

However, the likelihood of reporting to work during a pandemic flu outbreak is 90 per cent if healthcare workers know that their employers are able to make preventive medicines available to them.

Another critical factor which can reduce the level of discomfort about reporting to work during a pandemic is knowing that a pandemic plan is in
place. With knowledge of such a plan, level of discomfort among healthcare
workers is reduced by more than 20 percentage points, even if the flu pandemic was to hit their city.

"We know that the need for health care will increase substantially during a pandemic, and it is critical that all parts of the healthcare system continue to function," said Dr. McGeer, microbiologist and infectious disease consultant, department of microbiology, Mount Sinai Hospital. "Our greatest challenge is human resources, and all of the planning in the world will be irrelevant if our frontline healthcare workers don't show up to work. Our plans must address the needs of all the staff that provide healthcare services, and all of these staff must know what the plans are, and be comfortable with what their role will be."

The national survey, conducted by Leger Marketing and sponsored by
GlaxoSmithKline, used a combination of telephone and online interviews with
700 healthcare workers, which includes nurses; hospital support staff such as
custodial, clerical or food preparation; medical technicians such as
radiology, x-ray or laboratory; and pharmacists and pharmacy technicians. More key findings are included at the end of the release under "Note to the
Editor."

Protection Against Flu Pandemic: Antivirals

According to the World Health Organization (WHO) Guidelines(1):

- Antivirals are effective for both treatment and prophylaxis and are
an important adjunct to vaccination as a strategy for managing
pandemic influenza

- Prophylaxis is more likely to prevent serious complications from
influenza than treatment

- The neuraminidase inhibitors (zanamivir and oseltamivir) are
preferred for stockpiling

- Pandemic plans should address advance stockpiling, selection of
appropriate agents, rapid distribution of drugs and monitoring of
resistance

Current Thought Leadership on Stockpiling and Antivirals

Since antiviral resistance contributes to the failure of therapy, it cannot be overlooked as an important factor in planning for a pandemic. In response to recent reports that some strains of the H5N1 virus are becoming resistant to oseltamivir, the U.S. Department of Health and Human Services (HHS) has changed its stockpiling strategy to decrease the share of oseltamivir from 90 to 80 per cent and increase the share of zanamivir from 10 to 20 per cent(2). In the U.K., an influential group of scientists has recommended the government modify the national stockpile to 50 per cent zanamivir and 50 per cent oseltamivir(3).

"A key factor to Canadian pandemic planning and preparation is ensuring a
diversified stockpile, including adequate amounts of more than one antiviral,
which is essential to pandemic preparation in order to protect against
drug-resistant strains of pandemic flu," said Dr. McGeer.

The Last Century Of The Flu

History shows that influenza pandemics have occurred three to four times
per century(4). Scientists believe pandemic flu viruses develop in two key
ways. First, a new subtype can result from the mixing (or "re-assortment") of
human and avian viruses, which is what scientists believe started the last two
influenza pandemics in 1957 and 1968. Because humans had no defence against the new strain, it spread rapidly around the globe, causing widespread illness and higher rates of death compared to seasonal influenza. These pandemics each resulted in more than one million deaths globally.

Second, a new pandemic strain can develop if an avian influenza virus
changes (or mutates) into a virus that can cause human illness and spread
easily from person to person. This is likely how the "Spanish flu" killed
between 20 to 50 million people worldwide in 1918 and 1919, including about
30,000 to 50,000 in Canada.(5)

---------------------------------
(1) World Health Organization. Department of Communicable Disease
Surveillance and Response, WHO Guidelines on the Use of Vaccines and
Antivirals during Influenza Pandemics. 2004.
(2) The Congress of the United States, Congressional Budget Office. A
Potential Influenza Pandemic: An Update on Possible Macroeconomic
Effects and Policy Issues. May 22, 2006; revised July 27, 2006:
13-14.
(3) The Royal Society & the Academy of Medical Sciences, Pandemic
influenza: science to policy, November 2006.
(4) http://www.phac-aspc.gc.ca/cpip-pclcpi/ ... ex.html#ip
(5) The Canadian Pandemic Influenza Plan for the Health Sector. Public
Health Agency of Canada, Revised November 2006.

ABOUT GLAXOSMITHKLINE

GlaxoSmithKline - one of the world's leading research-based
pharmaceutical and health-care companies - is committed to improving the
quality of human life by enabling people to do more, feel better and live
longer. In Canada, GlaxoSmithKline is among the top 15 investors in research
and development, contributing more than $176 million in 2006 alone. GSK is an Imagine Caring Company, and is consistently recognized as one of the 50 Best Employers in Canada. For company information, please visit www.gsk.ca


NOTE TO EDITOR - Flu Pandemic Survey, conducted by Leger Marketing

<<
About the Survey
- A 13-minute survey was conducted between August 7th and August 23rd, 2007.
- With a national sample of 2000 respondents, results can be considered
accurate to within +/-2.2 per cent, 19 times out of 20. When looking
at either business continuity or healthcare workers separately
(n= 1300 and 700, respectively), results can be considered
accurate to within +/-2.7 and +/-3.7 per cent respectively.
- Business continuity workers comprised of: utilities or city/regional
workers such as water, electricity, gas, garbage collection, parks
and recreation, city hall and mail delivery; transportation such as
trucking, shipping, courier and public transit; banking;
communication providers such as telephone, mobile, cable and IT;
grocery and food warehousing; and medical product manufacturers
involved with pharmaceuticals, diagnostics, warehousing and
distribution.

Key Findings
- Only 64 per cent of healthcare workers believe their employer has a
pandemic plan in place.
- Of this group 69 per cent feel their employer's pandemic plan
looks after their needs to stay safe in the work environment.
- Less than half (only 49 per cent) feel their employer's pandemic
plan looks after the needs of their families.
- One quarter of healthcare workers don't think that a flu pandemic
will likely come to Canada
- More than a quarter of healthcare workers are not aware that there
are medicines that can reduce or prevent the impact of pandemic flu
- Only 64 per cent of healthcare workers get an annual flu shot
- One-third of healthcare workers surveyed note that their sense of
responsibility would motivate them most to report to work, regardless
of the outbreak's proximity to them. Less than a quarter of
healthcare workers surveyed noted that helping others would motivate
them most, but this does not hold true across all scenarios, as the
percentage who note this as a motivator after an outbreak is found in
their city drops significantly (14 per cent).
- If a flu pandemic were to hit the world and someone in Canada was
diagnosed with it, 67 per cent of healthcare workers would be
comfortable with shaking hands or being handed something from
someone; however, this number significantly drops to 39 per cent as
the outbreak hits closer to home (in the city)
- This means that 60 per cent of healthcare workers are not
comfortable if people in their city were diagnosed with the flu
pandemic

For further information: or an interview in Toronto, Montreal, Calgary or Vancouver, please contact: GlaxoSmithKline, (905) 819-3464, peter.j.schram@gsk.com; TORONTO, Pamela Arora, (416) 586-0180,
parora@national.ca
MONTREAL, Roch Landriault, (514) 843-2345,
rlandriault@national.ca
CALGARY, Tanja Vick, (403) 531-0331 x261,
tvick@national.ca; VANCOUVER, Claire Munroe, (604) 684-6655 x237,
cmunroe@national.ca[code][url][/url][/code]

[admin]

Pandemic Planning and First Nations
2009
viewtopic.php?f=9&t=4526

[admin]

Watch a Public Service Announcement . . .
http://www.youtube.com/user/H1N1BC
- - -

The Canadian Pandemic Influenza Plan for the Health Sector
NOTE: The Public Health Agency of Canada has released an updated plan . . .
Influenza Pandemic Planning Considerations in On Reserve First Nations Communities
http://www.phac-aspc.gc.ca/cpip-pclcpi/ ... _b-eng.pdf
June 2009
Also available here . . .
http://www.turtleisland.org/healing/flujune09.pdf
- - -

Pandemic Preparedness

H1N1 Flu Virus (sometimes called Human Swine Flu) is a strain of the influenza virus that usually affects pigs, but which may also make people sick. H1N1 flu virus is a respiratory illness that causes symptoms similar to those of the regular human seasonal flu.
Frequently Asked Questions . . .
http://www.phac-aspc.gc.ca/alert-alerte ... 04-eng.php
- - -

Here Are Additional Authoritative and Reliable Sources for Information

World Health Organization - Pandemic Influenza
http://www.who.int/topics/avian_influenza/en/
- - -

Government of Canada
http://www.influenza.gc.ca/index_e.html

Public Health Agency of Canada
http://www.phac-aspc.gc.ca/influenza/pandemic-eng.php

CANADA HOTLINE: 1-800-454-8302
- - -

U.S. Centers for Disease Control and Prevention
H1N1 Flu (Swine Flu)
http://www.cdc.gov/h1n1flu/
- - -

U.S. Department of Health & Human Services
http://pandemicflu.gov/

UNITED STATES HOTLINE: 1-800-232-4636
- - -



How To Protect Yourself . . .
http://www.fightflu.ca
- - -

General information . . .
http://www.phac-aspc.gc.ca/alert-alerte ... ne-eng.php
- - -

Ontario Ministry of Health
http://www.health.gov.on.ca/english/pub ... e_flu.html
- - -

Preparing for Pandemic Influenza in Manitoba . . .
http://www.gov.mb.ca/health/publichealth/pandemic.html
- - -

BC Ministry of Health
http://www.gov.bc.ca/govt/swine_flu.html

Questions?
In BC you can dial 811
It is a 24 hour a day, seven days a week BC Government service
- - -

FIRST NATIONS Pandemic Planning . . .
http://www.turtleisland.org/digest/pandemic09.gif
Inter Tribal Health Authority on Vancouver Island
http://www.intertribalhealth.ca/Pandemi ... edness.htm
- - -

First Nations Emergency Services
British Columbia . . .
http://www.fness.bc.ca/
- - -

British Columbia . . .
First Nations Health Council
http://www.fnhc.ca/index.php/news/press_releases/

Tripartite Partners Respond to H1N1 influenza
The Tripartite Partners to the First Nations Health Plan are working collaboratively to mitigate the affect of H1N1 Influenza on BC First Nations communities.

The First Nations Health Council senior management team has been in daily communication with our Tripartite Partners to monitor, assess, and respond to the recent outbreak of Swine Influenza. Clinical support is being provided by Dr. Marcus Lem, Director, Health Protection, First Nations and Inuit Health and Dr. Evan Adams Aboriginal Physician Advisor, Ministry of Healthy Living & Sport.

It is important for communities to be prepared by developing, testing, and refining pandemic plans, as well as increasing surveillance efforts.
H1N1 INFLUENZA

TRIPARTITE ROLES, RESPONSIBILITIES & ACTIVITIES

BACKGROUND:
Health Canada, First Nations Inuit Health Branch (FNIH), Ministries of Health Services
(MoHS) and Healthy Living and Sport (MHLS), and health authorities, have a shared
responsibility for ensuring the provision of health services for First Nations living on and
off‐reserve. FNIH provides funding for First Nations pandemic planning on‐reserve.
Indian and Northern Affairs Canada (INAC) is responsible for emergency management.
Out of 200 First Nations communities in BC, 195 have community pandemic influenza
plans. The plans have not been formally reviewed by the Province of British Columbia.
In addition to establishing community specific pandemic plans, FNIHB has been working
with health authorities on communicable disease integration plans which include
pandemic planning and response.

ROLES, RESPONSIBILITIES & ACTIVITIES:
Federal funding to provinces for stockpiles of anti‐virals include supplies for
First Nations. FNIHB Regional Medical Health Officer (MHO), Dr. Marcus Lem, states
that FNIHB will work in partnership with health authorities to ensure that First Nations
receive the same medical treatment as is provided to non‐First Nations citizens.

First Nations Inuit Health, Health Canada
Fiduciary responsibility for First Nations health care on reserve.
Key contact: Dr. Marcus Lem, Regional Medical Health Officer.
To provide notifications and continuing updates to FNIH Nurses, Transfer Nurses,
and Health Directors within First Nations communities.
Dr. Lem attends daily teleconferences for provincial MHOs and participates in
ongoing discussions with health authorities, Public Health Agency of Canada (PHAC),
and INAC regarding coordination and integration of emergency planning and
pandemic preparedness activities.

Ministry of Healthy Living and Sport
Responsible for health care for all British Columbians.
Key contact: Dr. Evan Adams, Aboriginal Physician Advisor, Office of the Provincial
Health Officer.
Dr. Adams is in daily contact with Dr. Eric Young, Deputy Provincial Health Officer,
Dr. Marcus Lem, FNIHB; and Deborah Schwartz, Executive Director, Aboriginal
Healthy Living Secretariat (AHLS).
Dr. Adams is also in daily contact with the First Nations Health Council (FNHC)
through Joe Gallagher, Chief Executive Officer of the First Nations Health Society.
A Tripartite letter has been issued by Dr. Adams, Dr. Lem, and Joe Gallagher,
identifying symptoms and contacts for more information.
Regular teleconferences are in process between MHLS, Dr. Adams, all Aboriginal
Health Leads, Dr. Lem, and Mary Guimont, FNHC, to ensure consistent updates.
2009-05-08. Prepared by the First Nations Health Council, with files from Ministry of

First Nations Health Council
Advocate for and support First Nations communities
Communications link: For many communities and individuals First Nations Health
Council is the first point of contact.
Clinical inquiries to FNHC are referred to the appropriate personnel within federal
and provincial governments.
FNHC website serves as repository for tripartite information as related to H1N1.
Policy support is being led by Mary Knox‐Guimont with support from Derina Peters.
Provincial Emergency Program (PEP)
Through a Letter of Agreement with the province, PEP will, when requested,
coordinate the non‐health response and recovery on First Nations lands.
Kirsten Brown, Manager, Provincial Emergency Program, is coordinating with MHLS,
the FNHS, Aboriginal Health Leads, and Dr. Adams, to include First Nations in
teleconferences from their Regional Emergency Operations Centres with each health
authority.

Health Authorities
Information and support is being provided to First Nations communities through
email communications and links to health authority websites, through either the
MHO or the Aboriginal Health Lead.
Aboriginal Health Leads are working closely with health authority Pandemic
Coordinators and MHOs as required.
Identify and establish connections with First Nations Communities

First Nations Communities
To review pandemic plans, and assess and revise as necessary.
Identify key communication links, including establishing contact with Aboriginal
Health Leads through regional health authorities.
Work with community health worker or community health nurse to ensure you have
up to date information.
Ensure that your band schools and band offices have adequate hand washing
equipment.
- - -

H1N1 Influenza Virus (Human Swine Influenza)
http://www.healthlinkbc.ca/healthfiles/hfile108.stm

Provincial Infection Control Network of British Columbia.
http://www.picnetbc.ca/page229.htm
- - -

April 30, 2009
Dear First Nations community members,
Re: Swine Influenza Outbreak
The Tripartite Partners to the First Nations Health Plan are working closely to monitor, assess and respond to the recent Swine Influenza Outbreak, and to ensure that First Nations communities are supported during this time. Collectively, many agencies are working together in British Columbia – health authorities, the British Columbia Centre for Disease Control, the Public Health Agency of Canada, First Nations & Inuit Health, British Columbia Region, and the Office of the Provincial Health Officer, among other partners – to investigate and respond to the recent spread of swine flu. A small number of human cases of swine flu have been confirmed in British Columbia – none in First Nations on-reserve communities.

Swine flu is a respiratory disease of pigs caused by type A influenza viruses that regularly cause outbreaks of flu in pigs. Natural changes to this particular swine flu virus have allowed it to infect humans.
The symptoms of swine flu in people can be similar to the symptoms of a regular seasonal flu infection, which may include fever, cough, headache, general aches, fatigue and other symptoms. Some people with swine flu have also reported runny nose, sore throat, nausea, vomiting and diarrhoea.

In response to the recent spread of swine flu, we are making the following precautionary recommendations:

Continue all school, community and day-to-day activities as per normal procedures;
Allow travelers arriving from Mexico, or other swine flu affected areas, to participate in regular activities if they are feeling well. Travelers should monitor themselves for symptoms and, if experiencing flu-like illness, should follow the prevention tips below to avoid spreading illness to others;
Encourage the following flu prevention tips within your communities’ population:
Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it. If you do not have a tissue, cough or sneeze into your sleeve;
Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand gels are also effective. Clinics, schools, band offices and other office buildings may wish to consider keeping these readily available;
Try to avoid close contact with sick people;
Avoid touching your eyes, nose or mouth; Germs spread that way;
If you get sick with mild illness, stay home and limit contact with others to keep from infecting them;
There is no need to rush to emergency rooms or local clinics. A good place to start if you have questions or concerns is HealthLink BC 811 any time day or night. If your symptoms become more severe, contact your health care provider.

Furthermore, we recognize that in some areas of the province, the health authorities’ medical health officers are well connected with the First Nations in their region. In the remaining regions, the federal FNIH Regional Medical Health Officer, Dr. Marcus Lem, is the direct link into the First Nations communities.
Dr. Lem states FNIH will ensure that First Nations receive the same medical treatment as is provided to non-First Nations citizens in the province.

Federal funding to provinces for anti-virals and vaccines includes supplies for First Nations and the needs of First Nations’ citizens are accounted for in the provincial plans and stockpiles. Health Canada will be working with the British Columbia Centre for Disease Control and the Local Health Authorities to work out the logistics for the delivery of these supplies to your communities, should the need arise.

Virtually all British Columbia FN communities have developed a Pandemic Influenza Community Plan and it is a good time for your community to review and revise your plans. Over the coming months, Health Canada and its contractor, JEL Protection Ltd., will be engaging many of your communities in table top exercises, mass immunization exercises and other activities to strengthening your linkages to local public health and the level of community preparedness. Further information can be found on JEL’s learning website (http://www.jelearning.com).

The power of any preparedness plan is in the community. We encourage you to talk to the members of your community who have been directly involved with Pandemic Influenza Community Plan, such as the Health Directors, CHRs, Nurses and leadership to discuss your concerns and to see how you can be involved to make sure that your Pandemic Influenza Community Plan reflects the strength and resilience of your community.

The First Nations Health Council is in daily communication with British Columbia and Health Canada to ensure that our communities have accurate and pertinent information. If require any assistance in reaching appropriate federal or provincial supports please do not hesitate to contact the Health Council office.
For more information on swine flu in British Columbia and links to national and international sites, please visit:
http://www.gov.bc.ca/govt/swine_flu.html

Sincerely,

Evan Adams, MD, Aboriginal Health Physician Advisor Office of the Provincial Health Officer Ministry of Healthy Living & Sport 1515 Blanshard St., 4th Floor Victoria, BC
V8W-3C8 Ph: 250-952-1349 evan.adams@gov.bc.ca

Joe Gallagher
Chief Executive Officer
First Nations Health Council
#1205-100 Park Royal South
West Vancouver, BC
V7T 1A2
Ph : 604-913-2080

Marcus Lem, MD, MHSc, FRCPC Director, Health Protection First Nations and Inuit Health British Columbia Region, Health Canada 406 - 1138 Melville Street Vancouver, BC
V6C 4S3
Ph; 604-666-9092
- - -

A Message from the First Nations Health Council
Re: Postponement of Gathering Wisdom

The well‐being of our children speaks to our accountability, the protection of our families speaks to our
integrity, and the weight of the memory of our Ancestors speaks to our collective desire to ensure the
resiliency of our communities. Our Ancestors define all of who we are and where we come from, and we
pray that our children carry forward all that we work for and aspire to. We are nations of people always
praying for the wellbeing of our children and families.

In our not too distant past, the spread of disease claimed many of our Ancestors. The impact of
this history is still felt today in many of our communities. Our retelling of the past serves as
proof that the destruction left behind of new diseases had a great and profound effect on how
we protected our children and families.

Our Ancestors understood the need to react to threats. Many of our people enacted timehonored
institutions to defend their communities against outbreaks. These included isolation
sites, where affected families and communities would gather. Our communities also relied on
complex kinship ties for support. Our Ancestral leaders’ collective efforts to shield their
communities from disease provided us the opportunity to recover, grieve and thrive.

In a time of change in health services, we recognize the constant struggle for expertise,
resources, community planning, and the capacity to affect policy that allows First Nations in
British Columbia to protect their children and families. There is a need for all of us in this time
of uncertainty to consult with each other and to be brave enough to assign social responsibility
and an opportunity for transformative change. We have formed partnerships with the
government of British Columbia and Canada, under the Transformative Change Accord: First
Nations Health Plan and the Tripartite First Nations Health Plan, to confront the difference in
health outcomes between First Nations and other British Columbians.

As we work collaboratively to address the critical developments of the Influenza A (H1N1) virus
‐ also referred to as the Swine Flu virus ‐ in our First Nations communities, an important step
will be to ensure that hearing the needs of our people is linked to a coordinated process of
engagement, dialogue and response to this disease. Both governments have reacted with
concern to support First Nations and the First Nations Health Council. The Tripartite Partners
have pledged to work with First Nations communities in the areas of planning, coordination and
emergency response, and ensure that the safety of our communities is underpinned with
security and resiliency.

The First Nations Health Council acknowledges the work and dedication of BC First Nations
leadership, their health workers, and the management of health services within each of your
communities. We know that the work that all of you do is in direct concern for your children,
families and communities. And it is for this reason that measures were taken to suspend the
annual Gathering Wisdom for a Shared Journey Forum 2009 and help support you at your posts.

The First Nations Health Council and the Tripartite Partners sincerely apologize for any
inconvenience the rescheduling of Gathering Wisdom for a Shared Journey Forum 2009 to later
in the fall may cause. We anticipate a Gathering in the fall of 2009 in which all of us can reflect
on current decisions made in the interest of the health and well‐being of our people.

Sincerely,
Debbie Abbott
Co‐Chair

Joe Gallagher
Chief Executive Officer
First Nations Health Council First Nations Health Council
1205‐100 Park Royal South 1205‐100 Park Royal South
Vancouver, BC Vancouver, BC
V7T 1A2 V7T 1A2
- - -

NW Tribal Emergency Management Council
Washington State . . .
Information for H1N1 Flu Virus "Swine Flu"
http://www.nwtemc.org/H1N1.aspx
- - -

H1N1 in Indian Country . . .
May 2009
http://www.indiancountrytoday.com/natio ... 90197.html
- - -

April 29, 2009
TO: ALL FIRST NATIONS CHIEFS AND COUNCILS, AND HEALTH
MANAGERS/DIRECTORS
RE: SEVERE RESPIRATORY ILLNESS (SRI) IN MEXICO
(SWINE FLU)
___________________________________________________________________
BACKGROUND
The Public Health Agency of Canada (PHAC) has been alerted to clusters of a
severe respiratory illness confirmed to be from a new strain of influenza (H1N1),
more commonly called the Swine Flu. Outbreaks originated in Mexico and similar
outbreaks have occurred in the US. There are an increasing number of cases in
Canada. Individuals who have recently travelled to Mexico and who are experiencing
flu-like symptoms are currently at risk.
So far, there are no reported cases involving First Nations.
The virus includes influenza-like symptoms which are usually felt all over the body in the
form of fever, muscle aches, head ache, chills, nausea, vomiting, tiredness, and a dry
cough. The current cases in Canada have exhibited mild symptoms while those in
Mexico have been more severe.
The World Health Organization is monitoring the spread of the virus and will adjust
the pandemic alert level as needed. This in turn will guide the decisions of the
Public Health Agency of Canada who have the lead on Pandemic Emergencies in
Canada.
How do people get it?
Influenza and other (severe) respiratory infections are transmitted from person to
person via the respiratory route. Coughs and sneezes release the germs into the air
where they can be breathed in by others. Germs can also rest on hard surfaces like
counters and doorknobs, where they can be picked up on hands and transmitted to
the respiratory system when someone touches their mouth and/or nose.
First Nations
While there have been no reported cases among First Nations, these events
demonstrate the need for pandemic planning. Some First Nations communities have
2
already developed and tested comprehensive pandemic plans and are doing regular
surveillance activities. Others are at the beginning stages of developing plans and
are not adequately prepared in the event of an outbreak.
First Nations and Inuit Health Branch (FNIHB) work closely with PHAC in developing
approaches to on reserve preparedness. FNIHB has supported many Regional
activities by assisting communities with the development of pandemic plans and
have initiated testing exercises in many Regions. More work is needed to ensure
adequate preparedness in all FN communities.
What can be done to prevent the spread of the flu?
The Public Health Agency advises Canadians to:
• Wash hands thoroughly with soap and warm water, or use hand sanitizer
• Cough and sneeze in your arm or sleeve
• Get your annual flu shot
• Keep doing what you normally do, but stay home if sick
• Check http://www.fightflu.ca for more information
• Check http://www.voyage.gc.ca for travel notices and advisories
• Talk to a health professional if you experience severe flu-like symptoms
The AFN is recommending that community leaders work with their emergency
preparedness coordinators to support increased pandemic planning activities
as needed. This should also be done in collaboration with FNIH Medical
Officers of Health.
For more information, visit:
Public Health Agency of Canada: (Hotline 1-800-454-8302)
• http://www.phac-aspc.gc.ca/index-eng.php
US Centre for Disease Control
• http://www.cdc.gov/
World Health Organization
• http://www.who.int/en/
http://www.afn.ca or please contact:
Karyn Pugliese, AFN Health Communications Officer: 1-866-869-6789, ext 210,
kpugliese@afn.ca
Jonathon Thompson, AFN Health Director: 1-866-869-6789, ext 235,
jthompson@afn.ca
Kim Barker, AFN Public Health Advisor: kbarker@afn.ca

- - - - -

A Holistic Approach to Pandemic Readiness
http://www.afn.ca/misc/HPR.ppt


An AFN Pilot Project Presented by Sucker Creek First Nation Health Team
Sucker Creek First Nation Assembly of First Nations Pilot Project: A Holistic Approach to Pandemic Readiness
http://www.afn.ca/misc/PP.pdf

Katzie First Nation Influenza Pandemic Planning Project
http://www.afn.ca/misc/KP.pdf

- - -

Also of interest . . .

Communiqué to First Nations Communities April 29, 2009
TO: ALL FIRST NATIONS CHIEFS AND COUNCILS, AND HEALTHMANAGERS/DIRECTORS

RE: SEVERE RESPIRATORY ILLNESS (SRI) IN MEXICO(SWINE FLU) BACKGROUND The Public Health Agency of Canada (PHAC) has been alerted to clusters of asevere respiratory illness confirmed to be from a new strain of influenza (H1N1),more commonly called the Swine Flu. Outbreaks originated in Mexico and similaroutbreaks have occurred in the US. There are an increasing number of cases inCanada. Individuals who have recently travelled to Mexico and who are experiencingflu-like symptoms are currently at risk. So far, there are no reported cases involving First Nations.

The virus includes influenza-like symptoms which are usually felt all over the body in theform of fever, muscle aches, head ache, chills, nausea, vomiting, tiredness, and a drycough. The current cases in Canada have exhibited mild symptoms while those inMexico have been more severe. The World Health Organization is monitoring the spread of the virus and will adjustthe pandemic alert level as needed. This in turn will guide the decisions of thePublic Health Agency of Canada who have the lead on Pandemic Emergencies inCanada. How do people get it? Influenza and other (severe) respiratory infections are transmitted from person toperson via the respiratory route. Coughs and sneezes release the germs into the airwhere they can be breathed in by others. Germs can also rest on hard surfaces likecounters and doorknobs, where they can be picked up on hands and transmitted tothe respiratory system when someone touches their mouth and/or nose. First Nations While there have been no reported cases among First Nations, these eventsdemonstrate the need for pandemic planning. Some First Nations communities have already developed and tested comprehensive pandemic plans and are doing regularsurveillance activities.

Others are at the beginning stages of developing plans andare not adequately prepared in the event of an outbreak.

First Nations and Inuit Health Branch (FNIHB) work closely with PHAC in developingapproaches to on reserve preparedness. FNIHB has supported many Regionalactivities by assisting communities with the development of pandemic plans andhave initiated testing exercises in many Regions. More work is needed to ensure adequate preparedness in all FN communities. What can be done to prevent the spread of the flu?

The Public Health Agency advises Canadians to: Wash hands thoroughly with soap and warm water, or use hand sanitizer Cough and sneeze in your arm or sleeve Get your annual flu shot Keep doing what you normally do, but stay home if sick Check http://www.fightflu.ca for more information Check http://www.voyage.gc.ca for travel notices and advisories Talk to a health professional if you experience severe flu-like symptoms

The AFN is recommending that community leaders work with their emergencypreparedness coordinators to support increased pandemic planning activitiesas needed. This should also be done in collaboration with FNIH MedicalOfficers of Health.

For more information, visit: Public Health Agency of Canada: (Hotline 1-800-454-8302)
http://www.phac-aspc.gc.ca/index-eng.php

US Centre for Disease Control
http://www.cdc.gov/World Health Organization

http://www.who.int/en/ http://www.afn.ca or please contact:
Karyn Pugliese, AFN Health Communications Officer: 1-866-869-6789, ext 210, kpuglieseOjafn.ca
Jonathon Thompson, AFN Health Director: 1-866-869-6789, ext 235, ¡thorn pson(5)afn.ca
Kim Barker, AFN Public Health Advisor: kbarker@afn.ca
- - -

H1N1 in Indian Country . . .
May 2009
http://www.indiancountrytoday.com/natio ... 90197.html
- - -

1862 epidemic decimated native population
Government, police handling of smallpox outbreak among native peoples in Victoria was shameful
By Andrei Bondoreff, Times Colonist
May 24, 2009
http://www.timescolonist.com/Health/186 ... story.html

[admin]

First Nations need control of Public Health: Beaucage

WINNIPEG, June 10, 2009

John Beaucage, candidate for the office of
National Chief of the Assembly of First Nations (AFN) is concerned over the
lack of public health infrastructure in First Nations communities in light of
the outbreak of H1N1 influenza that has embattled a First Nation community in
Manitoba. Beaucage is calling for additional investment in health care, public
health and the consolidation of First Nations health services to better serve
the needs of First Nations citizens across Canada.

"First Nations need to take a stronger role in the future of health care
in their communities. We can no longer be dependant on the Crown for our
well-being," said Beaucage. "Health Canada is failing First Nations people."

More than 200 people from St. Theresa's Point First Nation have fallen
ill since last week. The majority of their citizens are being treated in the
community, however two young children have recently been hospitalized. A
tremendous strain is being put on the First Nations, the health care system
and Manitoba public health.

"My heart goes out to the people who are recovering from this flu, and
the families of those who are caring for them," added Beaucage. "The situation
in Manitoba is indicative of a greater issue. This outbreak could have been
prevented if there was proper support to the leadership of this community, and
if the public health system was managed by First Nations themselves," said
Beaucage.

As a part of his 10-point Framework for "A New AFN", Beaucage suggests
the need for a complete overhauling of First Nations Health Services, "through
integration of federal/provincial/local health programs, a renewed focus on
prevention and chronic disease management, a renewed focus on nutrition and
exercise, and implementing systemic health indicators to measure success."
However, First Nations public health needs a special focus and will be a
priority in his first days in office, if elected.

Beaucage acknowledges the work that has been done in recent years around
pandemic planning, and praises the efforts of local First Nations health
professionals. But he states that this must be controlled by First Nations.

"Currently, the government funds and administers First Nations health
services through cost control measures and funding formulas. Our health care
can be greatly improved by local control, and through the integration of
health support and funding from all levels with a focus on improving health
outcomes," added Beaucage. "We should measure success by how many lives are
saved, not how many dollars are saved."

The Assembly of First Nations (AFN) is the National organization
representing First Nations in Canada. There are over 630 First Nation
communities in Canada. The elected Chiefs from each First Nation will cast
their vote to elect the National Chief in Calgary, Alberta on July 22, 2009.

John Beaucage is a citizen of Wasauksing First Nation, and served as
Grand Council Chief of the 42 member First Nations of the Anishinabek Nation
in Ontario from 2004-2009. He received an honourary doctorate of letters from
Nipissing University on June 5.



For further information: Marci Becking, Communications Advisor, Cell Ph:
(705) 494-0735, Ph: (705) 497-9127 Ext. 2290, E-mail: becmar@anishinabek.ca

[admin]

A global pandemic was declared by the World Health Organization because of the H1N1 outbreak.
World Health Organization - Pandemic Influenza
http://www.who.int/topics/avian_influenza/en/
- - -

Watch a Public Service Announcement . . .
http://www.youtube.com/user/H1N1BC
- - -

Swine Flu - News and Information UPDATES! . . .
http://www.google.com/search?hl=en&q=sw ... rst+nation
- - -

Pandemic Preparedness

H1N1 Flu Virus (sometimes called Human Swine Flu) is a strain of the influenza virus that usually affects pigs, but which may also make people sick. H1N1 flu virus is a respiratory illness that causes symptoms similar to those of the regular human seasonal flu.
Frequently Asked Questions . . .
http://www.phac-aspc.gc.ca/alert-alerte ... 04-eng.php
- - -

The Canadian Pandemic Influenza Plan for the Health Sector
NOTE: Influenza Pandemic Planning Considerations in
On Reserve First Nations Communities
http://www.phac-aspc.gc.ca/cpip-pclcpi/ ... _b-eng.pdf
June 2009
Also available here . . .
http://www.turtleisland.org/healing/flujune09.pdf
- - -

Here is an example of a Pandemic Plan template
it is in powerpoint format . . .
http://www.turtleisland.org/healing/pandplan09.ppt
- - -

Ontario First Nations Pandemic . . .
http://www.pandemic.knet.ca/
- - -

Here Are Additional Authoritative Information Sources

Government of Canada
http://www.influenza.gc.ca/index_e.html

Public Health Agency of Canada
http://www.phac-aspc.gc.ca/influenza/pandemic-eng.php

CANADA HOTLINE: 1-800-454-8302
- - -

U.S. Centers for Disease Control and Prevention
H1N1 Flu (Swine Flu)
http://www.cdc.gov/h1n1flu/
- - -

U.S. Department of Health & Human Services
http://pandemicflu.gov/

UNITED STATES HOTLINE: 1-800-232-4636
- - -

How To Protect Yourself . . .
http://www.fightflu.ca
- - -

General Instructions for Disposable Respirators
http://www.youtube.com/watch?v=0d_RaKdq ... re=channel

NOTE: There really is not any one-fits-all disposable respirator.
Respirator technicians are available to assist you.
For example - Mid Island Safety Services
http://www.midislandsafety.com

There are legal requirements that health workers must meet while wearing protective equipment (for example there is specific training and testing in the proper use of masks and respirators) to ensure they are protecting themselves and the patients they are assisting.
- - -

General information . . .
http://www.phac-aspc.gc.ca/alert-alerte ... ne-eng.php
- - -

Ontario First Nations Pandemic . . .
http://www.pandemic.knet.ca/

First Nations - The Flu - Pandemic Planning
June 2009 . . .
viewtopic.php?p=10229#p10229

Pandemic planning - The need for First nations to control public health
viewtopic.php?p=10232#p10232

FIRST NATIONS Pandemic Planning . . .
http://www.turtleisland.org/digest/pandemic09.gif
Inter Tribal Health Authority on Vancouver Island
http://www.intertribalhealth.ca/Pandemi ... edness.htm
- - -

First Nations Emergency Services
British Columbia . . .
http://www.fness.bc.ca/
- - -

British Columbia . . .
First Nations Health Council
http://www.fnhc.ca
- - -

BC Ministry of Health
http://www.gov.bc.ca/govt/swine_flu.html

Questions?
In BC you can dial 811
It is a 24 hour a day, seven days a week BC Government service
- - -

Vancouver Island Health Authority
http://www.viha.ca/mho/public_health_alerts/

- - -

Ontario Ministry of Health
http://www.health.gov.on.ca/english/pub ... e_flu.html
- - -

Preparing for Pandemic Influenza in Manitoba . . .
http://www.gov.mb.ca/health/publichealth/pandemic.html
- - -

PERSPECTIVES on PREPAREDNESS . . .
viewtopic.php?p=10233#p10233

- - -
NW Tribal Emergency Management Council
Washington State . . .
Information for H1N1 Flu Virus "Swine Flu"
http://www.nwtemc.org/H1N1.aspx
- - -


British Columbia . . .
First Nations Health Council
http://www.fnhc.ca/index.php/news/press_releases/

Tripartite Partners Respond to H1N1 influenza
The Tripartite Partners to the First Nations Health Plan are working collaboratively to mitigate the affect of H1N1 Influenza on BC First Nations communities.

The First Nations Health Council senior management team has been in daily communication with our Tripartite Partners to monitor, assess, and respond to the recent outbreak of Swine Influenza. Clinical support is being provided by Dr. Marcus Lem, Director, Health Protection, First Nations and Inuit Health and Dr. Evan Adams Aboriginal Physician Advisor, Ministry of Healthy Living & Sport.

It is important for communities to be prepared by developing, testing, and refining pandemic plans, as well as increasing surveillance efforts.
H1N1 INFLUENZA

TRIPARTITE ROLES, RESPONSIBILITIES & ACTIVITIES

BACKGROUND:
Health Canada, First Nations Inuit Health Branch (FNIH), Ministries of Health Services
(MoHS) and Healthy Living and Sport (MHLS), and health authorities, have a shared
responsibility for ensuring the provision of health services for First Nations living on and
off‐reserve. FNIH provides funding for First Nations pandemic planning on‐reserve.
Indian and Northern Affairs Canada (INAC) is responsible for emergency management.
Out of 200 First Nations communities in BC, 195 have community pandemic influenza
plans. The plans have not been formally reviewed by the Province of British Columbia.
In addition to establishing community specific pandemic plans, FNIHB has been working
with health authorities on communicable disease integration plans which include
pandemic planning and response.

ROLES, RESPONSIBILITIES & ACTIVITIES:
Federal funding to provinces for stockpiles of anti‐virals include supplies for
First Nations. FNIHB Regional Medical Health Officer (MHO), Dr. Marcus Lem, states
that FNIHB will work in partnership with health authorities to ensure that First Nations
receive the same medical treatment as is provided to non‐First Nations citizens.

First Nations Inuit Health, Health Canada
Fiduciary responsibility for First Nations health care on reserve.
Key contact: Dr. Marcus Lem, Regional Medical Health Officer.
To provide notifications and continuing updates to FNIH Nurses, Transfer Nurses,
and Health Directors within First Nations communities.
Dr. Lem attends daily teleconferences for provincial MHOs and participates in
ongoing discussions with health authorities, Public Health Agency of Canada (PHAC),
and INAC regarding coordination and integration of emergency planning and
pandemic preparedness activities.

Ministry of Healthy Living and Sport
Responsible for health care for all British Columbians.
Key contact: Dr. Evan Adams, Aboriginal Physician Advisor, Office of the Provincial
Health Officer.
Dr. Adams is in daily contact with Dr. Eric Young, Deputy Provincial Health Officer,
Dr. Marcus Lem, FNIHB; and Deborah Schwartz, Executive Director, Aboriginal
Healthy Living Secretariat (AHLS).
Dr. Adams is also in daily contact with the First Nations Health Council (FNHC)
through Joe Gallagher, Chief Executive Officer of the First Nations Health Society.
A Tripartite letter has been issued by Dr. Adams, Dr. Lem, and Joe Gallagher,
identifying symptoms and contacts for more information.
Regular teleconferences are in process between MHLS, Dr. Adams, all Aboriginal
Health Leads, Dr. Lem, and Mary Guimont, FNHC, to ensure consistent updates.
2009-05-08. Prepared by the First Nations Health Council, with files from Ministry of

First Nations Health Council
Advocate for and support First Nations communities
Communications link: For many communities and individuals First Nations Health
Council is the first point of contact.
Clinical inquiries to FNHC are referred to the appropriate personnel within federal
and provincial governments.
FNHC website serves as repository for tripartite information as related to H1N1.
Policy support is being led by Mary Knox‐Guimont with support from Derina Peters.
Provincial Emergency Program (PEP)
Through a Letter of Agreement with the province, PEP will, when requested,
coordinate the non‐health response and recovery on First Nations lands.
Kirsten Brown, Manager, Provincial Emergency Program, is coordinating with MHLS,
the FNHS, Aboriginal Health Leads, and Dr. Adams, to include First Nations in
teleconferences from their Regional Emergency Operations Centres with each health
authority.

Health Authorities
Information and support is being provided to First Nations communities through
email communications and links to health authority websites, through either the
MHO or the Aboriginal Health Lead.
Aboriginal Health Leads are working closely with health authority Pandemic
Coordinators and MHOs as required.
Identify and establish connections with First Nations Communities

First Nations Communities
To review pandemic plans, and assess and revise as necessary.
Identify key communication links, including establishing contact with Aboriginal
Health Leads through regional health authorities.
Work with community health worker or community health nurse to ensure you have
up to date information.
Ensure that your band schools and band offices have adequate hand washing
equipment.
- - -

H1N1 Influenza Virus (Human Swine Influenza)
http://www.healthlinkbc.ca/healthfiles/hfile108.stm

Provincial Infection Control Network of British Columbia.
http://www.picnetbc.ca/page229.htm
- - -

April 30, 2009
Dear First Nations community members,
Re: Swine Influenza Outbreak
The Tripartite Partners to the First Nations Health Plan are working closely to monitor, assess and respond to the recent Swine Influenza Outbreak, and to ensure that First Nations communities are supported during this time. Collectively, many agencies are working together in British Columbia – health authorities, the British Columbia Centre for Disease Control, the Public Health Agency of Canada, First Nations & Inuit Health, British Columbia Region, and the Office of the Provincial Health Officer, among other partners – to investigate and respond to the recent spread of swine flu. A small number of human cases of swine flu have been confirmed in British Columbia – none in First Nations on-reserve communities.

Swine flu is a respiratory disease of pigs caused by type A influenza viruses that regularly cause outbreaks of flu in pigs. Natural changes to this particular swine flu virus have allowed it to infect humans.
The symptoms of swine flu in people can be similar to the symptoms of a regular seasonal flu infection, which may include fever, cough, headache, general aches, fatigue and other symptoms. Some people with swine flu have also reported runny nose, sore throat, nausea, vomiting and diarrhoea.

In response to the recent spread of swine flu, we are making the following precautionary recommendations:

Continue all school, community and day-to-day activities as per normal procedures;
Allow travelers arriving from Mexico, or other swine flu affected areas, to participate in regular activities if they are feeling well. Travelers should monitor themselves for symptoms and, if experiencing flu-like illness, should follow the prevention tips below to avoid spreading illness to others;
Encourage the following flu prevention tips within your communities’ population:
Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it. If you do not have a tissue, cough or sneeze into your sleeve;
Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand gels are also effective. Clinics, schools, band offices and other office buildings may wish to consider keeping these readily available;
Try to avoid close contact with sick people;
Avoid touching your eyes, nose or mouth; Germs spread that way;
If you get sick with mild illness, stay home and limit contact with others to keep from infecting them;
There is no need to rush to emergency rooms or local clinics. A good place to start if you have questions or concerns is HealthLink BC 811 any time day or night. If your symptoms become more severe, contact your health care provider.

Furthermore, we recognize that in some areas of the province, the health authorities’ medical health officers are well connected with the First Nations in their region. In the remaining regions, the federal FNIH Regional Medical Health Officer, Dr. Marcus Lem, is the direct link into the First Nations communities.
Dr. Lem states FNIH will ensure that First Nations receive the same medical treatment as is provided to non-First Nations citizens in the province.

Federal funding to provinces for anti-virals and vaccines includes supplies for First Nations and the needs of First Nations’ citizens are accounted for in the provincial plans and stockpiles. Health Canada will be working with the British Columbia Centre for Disease Control and the Local Health Authorities to work out the logistics for the delivery of these supplies to your communities, should the need arise.

Virtually all British Columbia FN communities have developed a Pandemic Influenza Community Plan and it is a good time for your community to review and revise your plans. Over the coming months, Health Canada and its contractor, JEL Protection Ltd., will be engaging many of your communities in table top exercises, mass immunization exercises and other activities to strengthening your linkages to local public health and the level of community preparedness. Further information can be found on JEL’s learning website (http://www.jelearning.com).

The power of any preparedness plan is in the community. We encourage you to talk to the members of your community who have been directly involved with Pandemic Influenza Community Plan, such as the Health Directors, CHRs, Nurses and leadership to discuss your concerns and to see how you can be involved to make sure that your Pandemic Influenza Community Plan reflects the strength and resilience of your community.

The First Nations Health Council is in daily communication with British Columbia and Health Canada to ensure that our communities have accurate and pertinent information. If require any assistance in reaching appropriate federal or provincial supports please do not hesitate to contact the Health Council office.
For more information on swine flu in British Columbia and links to national and international sites, please visit:
http://www.gov.bc.ca/govt/swine_flu.html

Sincerely,

Evan Adams, MD, Aboriginal Health Physician Advisor Office of the Provincial Health Officer Ministry of Healthy Living & Sport 1515 Blanshard St., 4th Floor Victoria, BC
V8W-3C8 Ph: 250-952-1349 evan.adams@gov.bc.ca

Joe Gallagher
Chief Executive Officer
First Nations Health Council
#1205-100 Park Royal South
West Vancouver, BC
V7T 1A2
Ph : 604-913-2080

Marcus Lem, MD, MHSc, FRCPC Director, Health Protection First Nations and Inuit Health British Columbia Region, Health Canada 406 - 1138 Melville Street Vancouver, BC
V6C 4S3
Ph; 604-666-9092
- - -

A Message from the First Nations Health Council
Re: Postponement of Gathering Wisdom

The well‐being of our children speaks to our accountability, the protection of our families speaks to our
integrity, and the weight of the memory of our Ancestors speaks to our collective desire to ensure the
resiliency of our communities. Our Ancestors define all of who we are and where we come from, and we
pray that our children carry forward all that we work for and aspire to. We are nations of people always
praying for the wellbeing of our children and families.

In our not too distant past, the spread of disease claimed many of our Ancestors. The impact of
this history is still felt today in many of our communities. Our retelling of the past serves as
proof that the destruction left behind of new diseases had a great and profound effect on how
we protected our children and families.

Our Ancestors understood the need to react to threats. Many of our people enacted timehonored
institutions to defend their communities against outbreaks. These included isolation
sites, where affected families and communities would gather. Our communities also relied on
complex kinship ties for support. Our Ancestral leaders’ collective efforts to shield their
communities from disease provided us the opportunity to recover, grieve and thrive.

In a time of change in health services, we recognize the constant struggle for expertise,
resources, community planning, and the capacity to affect policy that allows First Nations in
British Columbia to protect their children and families. There is a need for all of us in this time
of uncertainty to consult with each other and to be brave enough to assign social responsibility
and an opportunity for transformative change. We have formed partnerships with the
government of British Columbia and Canada, under the Transformative Change Accord: First
Nations Health Plan and the Tripartite First Nations Health Plan, to confront the difference in
health outcomes between First Nations and other British Columbians.

As we work collaboratively to address the critical developments of the Influenza A (H1N1) virus
‐ also referred to as the Swine Flu virus ‐ in our First Nations communities, an important step
will be to ensure that hearing the needs of our people is linked to a coordinated process of
engagement, dialogue and response to this disease. Both governments have reacted with
concern to support First Nations and the First Nations Health Council. The Tripartite Partners
have pledged to work with First Nations communities in the areas of planning, coordination and
emergency response, and ensure that the safety of our communities is underpinned with
security and resiliency.

The First Nations Health Council acknowledges the work and dedication of BC First Nations
leadership, their health workers, and the management of health services within each of your
communities. We know that the work that all of you do is in direct concern for your children,
families and communities. And it is for this reason that measures were taken to suspend the
annual Gathering Wisdom for a Shared Journey Forum 2009 and help support you at your posts.

The First Nations Health Council and the Tripartite Partners sincerely apologize for any
inconvenience the rescheduling of Gathering Wisdom for a Shared Journey Forum 2009 to later
in the fall may cause. We anticipate a Gathering in the fall of 2009 in which all of us can reflect
on current decisions made in the interest of the health and well‐being of our people.

Sincerely,
Debbie Abbott
Co‐Chair

Joe Gallagher
Chief Executive Officer
First Nations Health Council First Nations Health Council
1205‐100 Park Royal South 1205‐100 Park Royal South
Vancouver, BC Vancouver, BC
V7T 1A2 V7T 1A2
- - -

H1N1 in Indian Country . . .
May 2009
http://www.indiancountrytoday.com/natio ... 90197.html
- - -

April 29, 2009
TO: ALL FIRST NATIONS CHIEFS AND COUNCILS, AND HEALTH
MANAGERS/DIRECTORS
RE: SEVERE RESPIRATORY ILLNESS (SRI) IN MEXICO
(SWINE FLU)
___________________________________________________________________
BACKGROUND
The Public Health Agency of Canada (PHAC) has been alerted to clusters of a
severe respiratory illness confirmed to be from a new strain of influenza (H1N1),
more commonly called the Swine Flu. Outbreaks originated in Mexico and similar
outbreaks have occurred in the US. There are an increasing number of cases in
Canada. Individuals who have recently travelled to Mexico and who are experiencing
flu-like symptoms are currently at risk.
So far, there are no reported cases involving First Nations.
The virus includes influenza-like symptoms which are usually felt all over the body in the
form of fever, muscle aches, head ache, chills, nausea, vomiting, tiredness, and a dry
cough. The current cases in Canada have exhibited mild symptoms while those in
Mexico have been more severe.
The World Health Organization is monitoring the spread of the virus and will adjust
the pandemic alert level as needed. This in turn will guide the decisions of the
Public Health Agency of Canada who have the lead on Pandemic Emergencies in
Canada.
How do people get it?
Influenza and other (severe) respiratory infections are transmitted from person to
person via the respiratory route. Coughs and sneezes release the germs into the air
where they can be breathed in by others. Germs can also rest on hard surfaces like
counters and doorknobs, where they can be picked up on hands and transmitted to
the respiratory system when someone touches their mouth and/or nose.
First Nations
While there have been no reported cases among First Nations, these events
demonstrate the need for pandemic planning. Some First Nations communities have
2
already developed and tested comprehensive pandemic plans and are doing regular
surveillance activities. Others are at the beginning stages of developing plans and
are not adequately prepared in the event of an outbreak.
First Nations and Inuit Health Branch (FNIHB) work closely with PHAC in developing
approaches to on reserve preparedness. FNIHB has supported many Regional
activities by assisting communities with the development of pandemic plans and
have initiated testing exercises in many Regions. More work is needed to ensure
adequate preparedness in all FN communities.
What can be done to prevent the spread of the flu?
The Public Health Agency advises Canadians to:
• Wash hands thoroughly with soap and warm water, or use hand sanitizer
• Cough and sneeze in your arm or sleeve
• Get your annual flu shot
• Keep doing what you normally do, but stay home if sick
• Check http://www.fightflu.ca for more information
• Check http://www.voyage.gc.ca for travel notices and advisories
• Talk to a health professional if you experience severe flu-like symptoms
The AFN is recommending that community leaders work with their emergency
preparedness coordinators to support increased pandemic planning activities
as needed. This should also be done in collaboration with FNIH Medical
Officers of Health.
For more information, visit:
Public Health Agency of Canada: (Hotline 1-800-454-8302)
• http://www.phac-aspc.gc.ca/index-eng.php
US Centre for Disease Control
• http://www.cdc.gov/
World Health Organization
• http://www.who.int/en/
http://www.afn.ca or please contact:
Karyn Pugliese, AFN Health Communications Officer: 1-866-869-6789, ext 210,
kpugliese@afn.ca
Jonathon Thompson, AFN Health Director: 1-866-869-6789, ext 235,
jthompson@afn.ca
Kim Barker, AFN Public Health Advisor: kbarker@afn.ca

- - - - -

A Holistic Approach to Pandemic Readiness
http://www.afn.ca/misc/HPR.ppt


An AFN Pilot Project Presented by Sucker Creek First Nation Health Team
Sucker Creek First Nation Assembly of First Nations Pilot Project: A Holistic Approach to Pandemic Readiness
http://www.afn.ca/misc/PP.pdf

Katzie First Nation Influenza Pandemic Planning Project
http://www.afn.ca/misc/KP.pdf

- - -

Also of interest . . .

Communiqué to First Nations Communities April 29, 2009
TO: ALL FIRST NATIONS CHIEFS AND COUNCILS, AND HEALTHMANAGERS/DIRECTORS

RE: SEVERE RESPIRATORY ILLNESS (SRI) IN MEXICO(SWINE FLU) BACKGROUND The Public Health Agency of Canada (PHAC) has been alerted to clusters of asevere respiratory illness confirmed to be from a new strain of influenza (H1N1),more commonly called the Swine Flu. Outbreaks originated in Mexico and similaroutbreaks have occurred in the US. There are an increasing number of cases inCanada. Individuals who have recently travelled to Mexico and who are experiencingflu-like symptoms are currently at risk. So far, there are no reported cases involving First Nations.

The virus includes influenza-like symptoms which are usually felt all over the body in theform of fever, muscle aches, head ache, chills, nausea, vomiting, tiredness, and a drycough. The current cases in Canada have exhibited mild symptoms while those inMexico have been more severe. The World Health Organization is monitoring the spread of the virus and will adjustthe pandemic alert level as needed. This in turn will guide the decisions of thePublic Health Agency of Canada who have the lead on Pandemic Emergencies inCanada. How do people get it? Influenza and other (severe) respiratory infections are transmitted from person toperson via the respiratory route. Coughs and sneezes release the germs into the airwhere they can be breathed in by others. Germs can also rest on hard surfaces likecounters and doorknobs, where they can be picked up on hands and transmitted tothe respiratory system when someone touches their mouth and/or nose. First Nations While there have been no reported cases among First Nations, these eventsdemonstrate the need for pandemic planning. Some First Nations communities have already developed and tested comprehensive pandemic plans and are doing regularsurveillance activities.

Others are at the beginning stages of developing plans andare not adequately prepared in the event of an outbreak.

First Nations and Inuit Health Branch (FNIHB) work closely with PHAC in developingapproaches to on reserve preparedness. FNIHB has supported many Regionalactivities by assisting communities with the development of pandemic plans andhave initiated testing exercises in many Regions. More work is needed to ensure adequate preparedness in all FN communities. What can be done to prevent the spread of the flu?

The Public Health Agency advises Canadians to: Wash hands thoroughly with soap and warm water, or use hand sanitizer Cough and sneeze in your arm or sleeve Get your annual flu shot Keep doing what you normally do, but stay home if sick Check http://www.fightflu.ca for more information Check http://www.voyage.gc.ca for travel notices and advisories Talk to a health professional if you experience severe flu-like symptoms

The AFN is recommending that community leaders work with their emergencypreparedness coordinators to support increased pandemic planning activitiesas needed. This should also be done in collaboration with FNIH MedicalOfficers of Health.

For more information, visit: Public Health Agency of Canada: (Hotline 1-800-454-8302)
http://www.phac-aspc.gc.ca/index-eng.php

US Centre for Disease Control
http://www.cdc.gov/World Health Organization

http://www.who.int/en/ http://www.afn.ca or please contact:
Karyn Pugliese, AFN Health Communications Officer: 1-866-869-6789, ext 210, kpuglieseOjafn.ca
Jonathon Thompson, AFN Health Director: 1-866-869-6789, ext 235, ¡thorn pson(5)afn.ca
Kim Barker, AFN Public Health Advisor: kbarker@afn.ca
- - -

H1N1 in Indian Country . . .
May 2009
http://www.indiancountrytoday.com/natio ... 90197.html
- - -

1862 epidemic decimated native population
Government, police handling of smallpox outbreak among native peoples in Victoria was shameful
By Andrei Bondoreff, Times Colonist
May 24, 2009
http://www.timescolonist.com/Health/186 ... story.html
- - -

PERSPECTIVES . . .

Swine flu outbreak tests Canadian preparedness
Ann Silversides
CMAJ 2009
http://www.cmaj.ca/cgi/content/full/180/12/E93?etoc

- - -
Canada's ability to respond to a national health crisis hampered by jurisdictional issues, untested emergency plans
Ann Silversides
CMAJ 2009
http://www.cmaj.ca/cgi/content/full/180/12/1193?etoc

[admin]

AFN says urgent measures on H1N1 must be in place before the fall

OTTAWA, June 23, 2009

Today, AFN Regional Chief Angus Toulouse who holds the portfolio for health called for three urgent measures to improve the response to pandemic outbreaks of H1N1 in First Nations communities.

These include: striking an independent taskforce to study the recent
outbreaks in Ontario and Manitoba and make recommendations to ensure more
seamless service; developing and instituting national guidelines for service
to First Nations; and providing investments that will allow every First Nation
to develop a pandemic plan, as well as investing in Annex B which is the
portion of the Canadian Pandemic Influenza Plan that addresses outbreaks in
First Nations.

"So far the majority of H1N1 cases have been mild, but if this outbreak
had been more virulent our communities would have been devastated," said
Regional Chief Angus Toulouse, who pointed out that the World Health
Organization (WHO) has warned that H1N1 could reappear in the fall and cause
more severe illness. "There is an urgent need to ensure every First Nations
community across Canada can equally access emergency health services before
the fall."

As outbreaks of H1N1 spread through northern Manitoba and Ontario over
the last few months, First Nations communities witnessed delays in receiving
urgently needed medical supplies, or breakdowns in communications between
provincial and federal governments and a lack of consistency in managing the
outbreaks between the provinces. It was also clear that measures aimed at
containing the virus were ill-suited to the social realities of First Nations,
for example being told to avoid contact with others while living in cramped
and overcrowded conditions or being told to wash their hands frequently when
running water was not available.

The Regional Chief blamed a lack of national standards for the
inconsistencies. He added that while Canada invested $1 billion into the
Canadian Pandemic Influenza Plan, no investments were made into Annex B, the
guidelines that federal, provincial and territorial governments should follow
when addressing outbreaks in First Nations communities.

The World Health Organization (WHO) has been clear that there is a link
between the severity of influenza cases and pre-existing chronic diseases,
living in poor and overcrowded housing, poor-quality drinking water and
sub-standard healthcare.

"Conditions in many of our communities are akin to those of the
developing world. This has placed our communities at the highest level of risk
in Canada. Clearly, if there is no improvement in planning and services, the
worsening of this virus could have tragic consequences in the fall," said
Regional Chief Angus Toulouse.

For further information: Karyn Pugliese, AFN Heath Communications
Officer, (613) 292-1877, kpugliese@afn.ca

[admin]

SPEAKING NOTES FOR ASSEMBLY OF FIRST NATIONS
Dr. Kim Barker, Senior Public Health Advisor
Presentation on Pandemic Planning and H1N1 to the Standing Senate Committee on Aboriginal Peoples
June 23rd, 2009

CHECK AGAINST DELIVERY

[15 -20 minutes.]

(Traditional greeting)
 
Introduction
 
I would like to thank the Standing Senate Committee on Aboriginal Peoples for providing this opportunity to present on behalf of the Assembly of First Nations. I congratulate the Committee for its speed and diligence in addressing this important health issue.

As you know the Assembly of First Nations is the national organization representing First Nations citizens across Canada.

It has become increasingly reported now that a growing number of First Nations communities are being stricken very hard by the H1N1 virus.

I think there are three very important points to make immediately about this pandemic.  

First, H1N1 has thus far, been a mild virus, and there have been few deaths across Canada.

As of June 22 the total number of infections in Canada was 6457, of which 404 have required hospitalization and caused death in 15 cases.
 

You may have heard some media reporting that H1N1 has caused fewer deaths than normally occur during a regular flu season.

It is certainly fortunate that H1N1 was not more virulent, because if it had been, the impact on First Nations communities would have been devastating. I’ll speak a bit more to that in a moment.

Second, despite the fact that the majority H1N1 cases have been mild so far, we do have great cause to be concerned about the potential impact of this virus upon First Nations.

We need to be concerned about H1N1 because as the World Health Organization has warned, H1N1 could return in a more virulent form this autumn.

If there is no improvement in planning and services, we fear that any worsening of this virus could have a tragic impact on First Nations communities.

Third, the World Health Organization (WHO) has also been very clear that there is a link between the severity of influenza cases in First Nations communities and pre-existing chronic diseases, living in poor and overcrowded housing, poor-quality drinking water and sub-standard healthcare.

The Senate Subcommittee on Population Health has recently issued an excellent report addressing the impact of social determinants upon health and health outcomes. The impact social determinants have upon health must also be considered during outbreaks of pandemic influenza.

We know that conditions akin to those of the developing world exist in many First Nation communities. This has placed our communities at the highest level of risk in Canada .

As Dr. Joel Kettner, Manitoba ’s Chief Medical Officer of Health has pointed out, First Nations people are among the most severe cases in his province.  From a population and demographic perspective, there is an over-representation of First Nation cases.

According to Dr. Kettner’s numbers, two-thirds of the 24 Manitobans in intensive care units with H1N1 last week were First Nations people. Given that aboriginal peoples make up only 10 to 15 per cent of the population of that province, the number show an unduly large proportion. 

In addition, we know from past experience, whether it has been the pandemic of 1918, or more recent outbreaks of diseases like tuberculosis that First Nations have been most vulnerable in the past and the present.

It is necessary for the federal government to act upon its fiduciary responsibility to First Nations to ensure they enjoy the same level and quality of health care and protection as others in Canada.

However, achieving the same level of care is not possible by simply applying pan-Canadian approach. Doing so would not achieve the same results.

A pandemic plan for First Nations must take into account geography, the social determinants of health, pre-existing health conditions and the unique cross-jurisdictional arrangements that make up the First Nations health care system.

I would now like to return to the point I made earlier, when I said that it is fortunate that H1N1 was not more virulent, because it could have devastated First Nations communities.

Knowing already that First Nations are a highly vulnerable group for a pandemic, and knowing the social realities that exist in far too many of our communities, we have further concerns about how outbreaks have been managed. 

As outbreaks of H1N1 spread through northern Manitoba and Ontario over the last few months, First Nations communities witnessed delays in receiving urgently needed medical supplies, or breakdowns in communications between provincial and federal governments and a lack of consistency in managing the outbreaks between the provinces.

It was also clear that measures aimed at containing the virus were ill-suited to the social realities of First Nations. For example, First Nations were told to avoid contact with others even though most live in cramped and rampantly overcrowded conditions.  Similarly, being told to wash their hands frequently when running water is not available is not an effective approach to deal with this crisis.  I would like to flag some of our concerns regarding the Manitoba breakout.


Concerns regarding the Manitoba outbreak

In the case of St. Theresa’s point in Manitoba, the nursing station in that community reported that 1356 people in the community – that is more than one-third of their population – reported an illness to the nursing station during the month of May.

567 of these patients reported respiratory illness.

As far as we can tell, no testing for H1N1 took place until the very last days of May or early June.

We were quite concerned when on June 4, we heard the Theresa Oswald, the Manitoba Minister of Health state that the province had offered to supply anti-virals to the community more than 13 times during the month of May, but that these offers were refused by Health Canada . 

It is true that the federal Minister of Health denied the Manitoba Minister's assertion.

But the fact remains that no anti-virals were sent to the community until June 3 –  the day it was revealed that 12 residents St. Theresa’s Point had been medivaced to Winnipeg and hospitalized with the virus. By this time, hundreds of community members at St. Theresa point were suffering from flu-like symptoms.

As the outbreak spread to Garden Hill the response continued to be slow. On June 3 the first H1N1 case was confirmed in Garden Hill , Manitoba . Supplies such as masks, gloves, sanitization equipment and anti-virals were ordered for the community. However they took more than a week to arrive.

On June 11th Manitoba Health stated that they were working to find an additional doctor for Garden Hill, but that it could take up to a week.


Again, I assert that if H1N1 was more virulent, these communities would have been devastated. Now, let's compare the scenario in Manitoba with the more recent outbreak in Ontario.

When 10 cases of H1N1 were confirmed in Sandy Lake on June 13 and 14, a shipment of 500 treatments of Tamiflu, an anti-viral drug that combats the flu, was sent immediately with the instructions to provide the drugs to anyone showing signs of illness, forgoing the usual testing to determine if patients indeed had the H1N1 virus.

The Assembly of First Nations does not wish to point a finger at anyone. It is possible that what happened in the province of Manitoba might  have occurred in any other province or territory.


However, with sincere respect to the good people working at Health Canada, PHAC, and in the provincial health systems, we must discover the full facts and identify any gaps or barriers that have occurred in the system if we are to ensure that First Nations are equally prepared and protected in the event of a more severe outbreak this fall and any future pandemics.

Recommendations #1 and 2

For this reason the Assembly of First Nations is recommending that an independent taskforce be struck to study the recent outbreaks in Ontario and Manitoba and make recommendations to ensure more seamless service. First Nations health experts must also be on this taskforce for it to produce effective and targeted results. 
 
There is also a need for the federal government to review with the provinces and First Nations the inter-agency protocols in place during an outbreak, including the public communication and information sharing components, and conduct real-scale simulations to validate these protocols.

Further we would like to recommend that governments work with First Nations to develop and implement national guidelines for emergency health services to First Nations.

It is our hope that this work can take place and implemented by the fall.

Your committee may wish to request an annual 'state of preparedness' report from the federal Departments involved until such point that you are assured that a plan is in place and simulations have been performed to ensure it will function as planned.


Concerns with Annex B and recommendations

I would now like to address a few concerns we have surrounding the Canadian Pandemic Influenza Plan.

We have heard federal Minister of Health repeatedly assure the public that the 1 billion dollar investment into Canada 's pandemic plan has resulted in robust preparedness activities across the country.

However, despite Canada ’s $1 billion to the Canadian Pandemic Influenza Plan there have been no investments in Annex B, which is the portion of the Canadian Pandemic Influenza Plan that addresses outbreaks in First Nations.

As a result very few First Nations communities have a pandemic plan in place and the majority of communities are unprepared for a pandemic outbreak. 

Furthermore we are gravely concerned that there remain large gaps in the level of preparedness for federal, provincial and territorial responses to the needs of First Nations during a pandemic.

We are even more concerned because the AFN has been raising these issues with the federal government since the SARS outbreak a few years ago.

It is our recommendation that immediate investments be made into Annex B to ensure First Nations, federal, provincial and territorial governments can carry out the activities outlined in Annex B.

We have two other key concerns with Annex B.

First Annex B does not contain language inclusive of First Nations communities North of 60. It is our hope that government will work with the Assembly of First Nations to ensure that communities in the Yukon and the Northwest Territories are equally protected. Should an outbreak occur, we do not wish for confusion over the language contained in Annex B to prevent urgently needed health services from reaching these communities.

Finally, we are concerned that Department of Indian and Northern Affairs may not be prepared for its role as outlined in Annex B.

According to Annex B, in preparing for and responding to the threat of an influenza pandemic in an on reserve First Nations community, INAC is responsible for the following:
To ensure the continuity of its governance and provision of essential services through implementation of the department’s Pandemic Influenza Business Continuity Plan;
Emergency management on all reserve lands across Canada, except where the responsibility (e.g. public health) falls within the mandate of another federal department (i.e. Health Canada).

To date we do not know if INAC has plans in place to fulfill its responsibilities. If it does, we have not seen them.

It is critical to ensure these plans are established and are in place and that funding is available to support them. We would recommend that your committee approach INAC to seek clarification on this matter.

The health and success of First Nations peoples, in my opinion, is the single most important public health goal in Canada. The system must be inclusive, fair and it must also fit the unique needs of First Nations.

Thank you. 

[admin]

THE STANDING SENATE COMMITTEE ON ABORIGINAL PEOPLES

EVIDENCE

OTTAWA, Tuesday, June 23, 2009

The Standing Senate Committee on Aboriginal Peoples met this day at 9:30 a.m. to study on the federal governmentís constitutional, treaty, political and legal responsibilities to First Nations, Inuit and Metis peoples; and on other matters generally relating to the Aboriginal Peoples of Canada (topic: update on efforts to address the spread of H1N1 in First Nations communities.)

Senator Gerry St. Germain (Chair) in the chair.

[English]

The Chair: Good morning. I would like to welcome all honourable senators, members of the public and all viewers across the country who are watching these proceedings on CPAC or on the Web.

I am Senator St. Germain, from British Columbia, chair of this committee. Our mandate on this committee is to examine legislation and matters relating to Aboriginal peoples of Canada. Today, the committee is looking for answers. Members have expressed their desire to get an update on the efforts made to address the spread of H1N1 in First Nations communities.

[Translation]

Today, we welcome witnesses from a national First Nations organization, as well as officials; they are going to provide us with an update on the efforts to address the spread of H1N1 influenza in First Nations communities.

[English]

First, let me introduce the members of the committee who are present. On my left is the Deputy Chair, Senator Sibbeston, from the Northwest Territories. Next to Senator Sibbeston is Senator Brazeau from the Province of Quebec. Then we have Senator Lang, from the Yukon; Senator Lovelace Nicholas, from New Brunswick; Senator Dyck, from Saskatchewan; and Senator Hubley, from Prince Edward Island. On my right is Senator Peterson, from Saskatchewan; Senator Campbell, from British Columbia; and next is Senator Watt, from Quebec; and Senator Carstairs, from the Province of Manitoba.

Senators, let me introduce the witness who will address us this morning. First, from the Assembly of First Nations, we have Dr. Kim Barker, Senior Public Health Advisor.

Dr. Barker, we thank you for coming this morning. I know it was on short notice, but thankfully you made it here. If you would be so kind to keep opening remarks as precise and concise as you can to leave time for the senators to ask questions of you.

If you are comfortable and ready, you have the floor.

Dr. Kim Barker, Senior Public Health Advisor, Assembly of First Nations: Thank you very much.

[Translation]

First, I would like to tell you that I will be speaking in English today.

[English]

I would like to thank the Standing Senate Committee on Aboriginal Peoples for providing this opportunity to present on behalf of the Assembly of First Nations. I congratulate the committee for its speed and diligence in addressing this important health issue. As you know, the Assembly of First Nations is the national organization representing First Nation citizens across Canada.

It has become increasingly reported that the H1N1 virus is striking very hard at a growing number of First Nations communities. I think there are three very important points to make immediately about this pandemic. First, H1N1 has thus far resulted in mild symptoms, and there have been few deaths across Canada. In fact, as of last week, the total number of infections in Canada was 6,457, of which 404 have required hospitalization and caused death in 15 cases.

You may have heard some media reporting that H1N1 has caused fewer deaths than normally occur during a regular flu season. It is certainly fortunate that H1N1 was not a more virulent virus because, if it had been, the impact on First Nations communities would have been devastating. I will speak to that a bit more in a moment.

However, I want to raise a second important point: Despite the fact that majority of H1N1 cases have been mild so far, we do have great cause to be concerned about the potential impact of this virus upon First Nations. We need to be concerned about H1N1 because, as the World Health Organization has warned, H1N1 could return in a more virulent form this autumn. If there is no improvement in planning and services, we fear that any increase in the virulence of this virus could have a tragic impact on First Nation communities.

Third, the World Health Organization has been very clear that there is a link between the severity of influenza cases in First Nation communities and pre-existing chronic diseases: living in poor and overcrowded housing, poor access to clean water and substandard health care.

The Senate Subcommittee on Population Health has recently issued an excellent report addressing the impact of social determinants upon health and health outcomes. The impact social determinants have upon health must also be considered during an outbreak of pandemic influenza.

We know that conditions akin to those of the developing world exist in many First Nations communities. This has placed our communities at the highest level of risk in Canada. As Dr. Joel Kettner, Manitoba's Chief Medical Officer of Health, has pointed out, First Nations people are among the most severe cases in his province. From a population and demographic perspective, First Nations are overrepresented in the severe cases.

According to Dr. Kettner's numbers, two-thirds of the 24 Manitobans with H1N1 in intensive care units requiring mechanical ventilation are First Nations peoples. Given that Aboriginal peoples make up only 10 per cent to 15 per cent of the population of the province, two-thirds on mechanical ventilation surely shows an unduly large proportion of illness.

In addition, we know from experience that whether it was the pandemic of 1918 or the frequent outbreaks of tuberculosis in the provinces of Manitoba and Saskatchewan, First Nations have been most vulnerable in the past and present. It is necessary for the federal government to act upon its fiduciary responsibility to First Nations to ensure they enjoy the same level and quality of health care and protection as others in Canada. However, achieving the same level of care is not possible by simply applying pan-Canadian approaches to pandemic preparedness; doing so would not achieve the same results.

A pandemic plan for First Nations must take into account geography, social determinants of health, pre-existing health conditions and the unique cross-jurisdictional arrangements that make up the health care system for First Nations.

I would now like to return to the point I made earlier when I said that it is fortunate that the H1N1 virus was not more virulent because it could have wreaked devastation on First Nation communities.

Knowing already that First Nations are a highly-vulnerable group for a pandemic and knowing the social realities that exist in far too many of our communities, we have further concerns about how the outbreaks have been managed so far. As outbreaks of H1N1 spread through Northern Manitoba and Ontario over the last two months, First Nations communities witnessed delays in receiving urgently-needed medical supplies, breakdown in communication between provincial and federal governments, and a lack in consistency in managing the outbreak between the provinces.

It was also clear that measures aimed at containing the virus were ill-suited to the social realities of First Nations. For example, First Nations were told to avoid contact with others, even though most live in cramped and overcrowded conditions. Similarly, they were told to wash their hands frequently, even though many did not have running water in their homes. This is not an effective approach to dealing with this crisis.

I would like to flag some of our other concerns regarding the Manitoba breakout. In the case of St. Theresa Point, Manitoba, the nursing station in that community with a population of 3,200 people had 1,356 people in the community ó more than one third of their population ó reporting an illness to that nursing station during the month of May. Five hundred and sixty-seven of the people living in that community reported respiratory-like symptoms.

During that month of May, there was no increase in access to health care services. In fact, other First Nations communities had to sacrifice their own nurses from Norway House, for example, to be able to service other communities that were suffering with these high burdens of illness. Furthermore, no antivirals were sent to the community until June 3, the day it was revealed that 12 residents of St. Theresa's Point had been sent by medevac to Winnipeg and hospitalized with the virus. By this time, hundreds of community members from St. Theresa Point were suffering from flu-like symptoms.

As the outbreak spread to Garden Hill, Manitoba, the response continued to be slow. On June 3, the first H1N1 case was confirmed in Garden Hill. Supplies such as masks, gloves, sanitization equipment and antivirals were ordered for the community. However, they took so long to arrive that the chief himself had to drive hundreds of miles to purchase these supplies. When he came to Ottawa last week and met with the Minister of Health and the Public Health Agency of Canada, he was told masks were not required and therefore he would not be reimbursed for the purchases that he made for his community.

Again, I assert that if H1N1 had been more virulent, these communities would have been devastated.

Let us compare the scenario in Manitoba with the more recent outbreak in Ontario. When 10 cases of H1N1 were confirmed in Sandy Lake First Nation in Northern Ontario on June 13 and 14, a shipment of 500 treatments of Tamiflu, the antiviral drug that combats the flu, was sent immediately. The instructions were to provide the drug to anyone showing signs of illness, forgoing the usual testing to determine if patients indeed had the H1N1 virus.

The Assembly of First Nations does not wish to point fingers at anyone. What we want to highlight to this committee is the lack of consistency in managing these outbreaks and, as important, how crippled the health care system became in Manitoba with only a few communities involved. Let us imagine in fall if there is an increase in the number of communities. How prepared will the Province of Manitoba and other provinces of Canada be to be able to respond appropriately?

However, with sincere respect to the good people working at Health Canada, the Public Health Agency of Canada and in provincial health care systems, we must discover the full facts and identify any gaps or barriers in the system if we are to ensure that First Nations are equally prepared and protected in the event of a more severe outbreak this fall.

For this reason, the Assembly of First Nations is recommending that an independent task force be struck to study the recent outbreaks in Ontario, Manitoba and Saskatchewan and make recommendations to ensure a more seamless service approach. First Nations health experts must also be on this task force for it to produce effective and targeted results. There is also a need for the federal government to review with the provinces and First Nations the inter-agency protocols in place during an outbreak, including the public communication and information sharing components and conduct real-scale simulations to validate these protocols.

There must be an agreed-upon approach and standards to prevent the feeling that varying approaches across the country might create a sense of some regions servicing First Nations more appropriately than in other regions. Further, we would like to recommend that the government work with First Nations to develop and implement national guidelines for emergency health services to First Nations. It is our hope that this work will take place and be implemented by the fall.

Your committee may wish to request an annual state of preparedness report from the federal departments involved until such point that you are assured a plan is in place and simulations have been performed to ensure it will function as planned.

I would now like to turn the committee's attention to Annex B: Influenza Pandemic Planning Considerations in On Reserve First Nations Communities, which I believe was provided to you over the weekend, both in English and French. I would like to say that this is an annex to the Canadian Pandemic Influenza Plan of which the Public Health Agency of Canada has the lead. I would also like to let this committee know that the Assembly of First Nations was involved in the development of this annex and we support it fully.

However, we have concerns regarding this annex that I would like to turn your attention to. We have repeatedly heard over the last few weeks the federal Minister of Health assuring the public that the $1 billion investment into Canada's pandemic plan has resulted in a robust preparedness and several activities across the country. This investment was indeed made. However, it was made and funds were allocated in advance of the development of Annex B. The $1 billion investment has not been allocated to activities of Annex B that is the portion of the Canadian Pandemic Influenza Plan to address outbreaks in First Nations. We know that insufficient numbers of First Nations communities have pandemic plans in place. The majority of communities are unprepared for a pandemic outbreak.

Furthermore, we are gravely concerned that the level of activities listed in Annex B for the provincial, territorial and federal governments are not sufficiently supported in order to implement the guidelines as listed. We are even more concerned because the Assembly of First Nations has been raising the issue with the federal government since the SARS outbreak a few years ago. We had hoped lessons from SARS would have been learned and applied to pandemic planning.

It is our recommendation that immediate investments be made into Annex B to ensure First Nations, federal, provincial and territorial governments can carry out the activities outlined in Annex B.

Finally, we have two other points concerning the annex. First, Annex B does not contain language inclusive of First Nations communities north of 60. It is our hope that governments will work with the Assembly of First Nations to ensure that communities in the Yukon and the Northwest Territories are protected equally. Should an outbreak occur, we do not wish for confusion over the language contained in Annex B to prevent urgently-needed health services from reaching these communities.

Second, we are concerned that the Department of Indian and Northern Affairs may not be prepared for its role as outlined in Annex B. According to Annex B, in preparing for and responding to the threat of an influenza pandemic in on-reserve First Nations communities, INAC is responsible for the following:

Ensuring the continuity of its governance and provision of essential services through implementation of the departmentís Pandemic Influenza Business Continuity Plan; and

Emergency management on all reserve lands across Canada, except where the responsibility (e.g. public health) falls within the mandate of another federal department (i.e. Health Canada).

To date, we do not know if INAC has plans in place to fulfill its responsibilities. If it does, we have not seen them. It is critical to ensure these plans are established and in place and that funding is available to support them. We recommend that your committee approach INAC to seek clarification on this matter.

The health and success of First Nations peoples, in my opinion, is the single-most important public health goal in Canada. The system must be inclusive, fair and it must also fit the unique needs of First Nations. The Canadian pandemic plan is only as strong as its weakest link. We have all borne witness to that weak link in the last two months.

I would like to thank the Standing Senate Committee on Aboriginal Peoples for this opportunity to speak. I would welcome questions.

Senator Brazeau: Dr. Barker, you cited a few statistics with respect to individuals that have been affected by this disease as well as those who have had respiratory problems. Is this data that the Assembly of First Nations has gathered or is this data already cited in the media?

Dr. Barker: We receive this data daily from the provincial medical officer of health. We have teleconferences with Dr. Joel Kettner.

Senator Brazeau: Could you elaborate on the level of engagement that you have had with both federal and provincial governments and the affected leadership of the First Nations communities in dealing with this issue?

Dr. Barker: We have had daily teleconferences with the Assistant Deputy Minister of Health for FNIP, and occasionally the Public Health Agency of Canada participated in that teleconference. There has been an opportunity for us to raise our concerns and, similarly, for them to attempt to reassure us that everything is under control.

Senator Brazeau: You mentioned the fact that we should not be looking toward a pan-Canadian approach. Can you elaborate on that, please?

Dr. Barker: At the moment, the pandemic plan services all Canadians as though everyone was at the same level of risk. The plan assumes that all Canadians are able to access services within the same level.

Our concern is that having stockpiles of antivirals in Edmonton, for example, and assuming they can be distributed equally and quickly to all communities is probably shortsighted, given the access issues.

We are looking to develop guidelines, and encourage the government to develop guidelines, for remote communities to ensure they are not treated as downtown Edmonton or downtown Toronto.

Senator Brazeau: Obviously, we are dealing with an urgent matter, an important matter. I think every Canadian sees this as being a serious matter. What I have heard this morning is the recommendation to strike a task force; the fact that perhaps some are not happy with language utilized in the preparedness or the strategies that have been put in place; the fact that, in your opinion, the federal government has not properly addressed recommendations following the SARS outbreak ó we are talking about responsibilities and jurisdiction, which are important; and the fact that this pan-Canadian approach is not the desired approach.

Is not the most important goal to ensure that Aboriginal peoples have access to the supplies and treatment that they need, first and foremost, before talking about these processes to be set up that would take a longer period of time? Instead of getting to the action, we would be embroiled in processes and a lot of talk and very little action.

Dr. Barker: That is always the concern. However, I think you would agree, senator, that in order for change to happen, there is a process that one must respect. Unfortunately, it tends to be a lengthy bureaucratic process, but that is why we are requesting that this action happen before the fall.

Senator Lang: I just want to put a couple things on the record. I do not know how the nursesí stations run in these small communities. I have not been in these small communities personally. However, I first want to say that for those people that are working on the ground, I think that we should give them accolades for what they do and how they do it. It concerns me that there seems to be a lot of ability to always lay a lot of blame on whomever. Hindsight is 20-20.

From the evidence you have provided us so far, I gather that you are in constant communication with the AFN and Health Canada in respect to this issue.

In May, when this first became known, what advice did you give Health Canada that they could do to help accommodate the situation that obviously came as a surprise to everyone?

Dr. Barker: We were concerned about the lack of nursing in the community and the delay in identifying the outbreak. We suspect that is linked to the rapid turnover of nurses that come in and go within 24 hours. Therefore, our first approach was to suggest an increase the number of permanent health care workers so that they recognize an outbreak much sooner.

With respect to antivirals, we were very concerned about the number of Medevacs. We suggested that antivirals be implemented much earlier in a more aggressive early- treatment approach in the community. However, we were told there was not sufficient scientific evidence to support that implementation.

Senator Lang: You mentioned planning and service, looking ahead in respect to the autumn. I share Senator Brazeau's concern. A committee will not fix this, even in the fall, I suspect.

What have you requested that Health Canada do to meet the situation that these people may face on a day-to-day basis? What can be improved?

Dr. Barker: Senator, I think the biggest success we could hope for is that funding to support the activities listed in Annex B be provided. We have all signed off on it; every Deputy Minister of Health from across the country has signed off on Annex B, and we have approved Annex B from all of our communities.

What we need is financing to support the activities listed. As you can see, there is a ton of activities that provinces are expected to take on. No province will undertake those activities if they do not have a commitment from the federal government that they can keep their receipts and be reimbursed afterwards.

The Chair: I have a quick question. In view of the fact this is possibly affecting First Nations more severely than other communities, it has to be a concern of the provinces and all of us. Unless these communities are put under quarantine, this disease could spread. We know that these people move around and with them the virus.

I can see why we have to focus on the First Nations, but I think all Canadians are concerned. Most of us travel on airplanes continually; and our exposure, as politicians, is most likely greater than most.

I sympathize with your concerns in dealing with the First Nations because that is why we are here this morning. Senator Carstairs suggested this hearing and I think it was the right move, but what I am trying to get through my mind is this must be as important to the provinces and their populations as it is to anyone.

To me, this is important right across the population. What is your reaction to that, Dr. Barker?

Dr. Barker: I think that is a very valid point. The one comment I would make to that is to reassure this group that as a healthy, wealthy group of gentlemen and ladies sitting around this table, the likelihood of you having a severe illness is minimal. We have noticed that mild cases in Canadians tend to be among our healthy and wealthy.

What we do not see is that First Nations, who generally represent a more impoverished group, are having the same reaction to the infection. We are suggesting that we need to identify at-risk populations. Given that, for the most part, First Nations communities are living in poverty, we feel that is what largely puts them at risk ó just like the people who live in the Mexican slums.

Senator Carstairs: I was informed that the pandemic plan for Aboriginal communities provides $3,000 for each community. If you live in any of those communities that you mentioned today ó St. Theresa Point, Garden Hill ó that would amount to taking a maximum of three people out of the community to have any discussions whatsoever.

How are Aboriginal communities supposed to develop, within Annex B, the kind of pandemic planning that is necessary on $3,000 per community?

Dr. Barker: We agree with you and that is an ongoing concern. The point behind Annex B is not that it necessarily needs funding just to First Nations communities, but it needs funding to facilitate greater partnership between regional health authorities and the provinces.

Frankly, if there was to be a widespread outbreak, we cannot expect that Ottawa will be able to service all 633 communities. It is absolutely essential that the regional health authorities and provinces have strong relationships to be able to service communities in a given outbreak.

Similarly, another challenge is that many of these communities have experienced epidemics of suicide, diabetes, and mental health issues. Asking chiefs to make this a priority is difficult when they are struggling with so many other priorities. It is incumbent upon us to ensure that they have the resources, partnerships and facilitated communications to ensure that community members are prepared.

Senator Carstairs: Dr. Allison McGeer, who was on the front line of the SARS epidemic and contacted SARS, has urged the implementation of a pilot program whereby Tamiflu would be used as a prophylactic.

Has there been any discussion with Aboriginal communities, in particular with the AFN, about using Tamiflu in this way to determine whether it might significantly reduce the number of cases within a community?

Dr. Barker: There has been a great deal of discussion, in particular in Ontario where we saw that early aggressive treatment was very effective in reducing the number of severe cases. Certainly, many chiefs came forward and said they would like to be able to identify people with chronic underlying conditions that make them more at risk to go on prophylaxis before they become sick. The chiefs are interested. Unfortunately, there are many other considerations, such as the side effects. Might we potentially cause a mutation within the virus? Might Tamiflu no longer work in the fall when we have a new outbreak? There are many other questions that need to be considered, but I agree that we need to look at prophylactic use as a sincere option.

Senator Carstairs: One of the real problems in communities like Garden Hill and St. Theresa Point, as you said, is that they do not have running water. The need for alcohol-based hand sanitizers became critical but they were not available in the community. As you indicated, Chief Harper had to drive out of the community to obtain hand sanitizers. Meanwhile, empty medevac planes were flying into the communities.

An issue was raised that concerned me greatly. There was some discussion about whether hand sanitizers should be made available because they are alcohol based.

Dr. Barker: I must say that I was equally devastated. I quickly pointed out that it is as easy to get a bottle of Lysol in these communities as anything else. If people think that Purell will be purchased so they can become intoxicated, then that is an outrageous leap to make. We heard that argument and that people were spending days discussing the pros and cons of a non-alcohol-based hand sanitizer versus an alcohol-based sanitizer because of the concerns about addictions in communities. It was absolutely outrageous.

Senator Carstairs: I have many other questions for the second round, if I may.

Senator Stratton: I will follow Senator Carstairs line of questions. I had the good fortune, if you want to call it that, of having a mother-in-law who was a public health nurse on northern reserves for years. I had the experience of visiting most of these communities. I can understand fully the problems that these communities face today.

I will relate anecdotal evidence of Southern Manitoba. I take French language training at St. Boniface College. My French professor looks after special education children in Southern Manitoba communities and small villages. I asked her what the incidence of H1N1 was in the francophone school division and she said that there were very few cases. She explained that in the francophone school divisions, the children wash their hands as soon as they enter the school at nine o'clock in the morning. They wash their hands when they go to recess and when they return. At lunch, they wash their hands and when they come back from lunch, they wash their hands. They wash their hands before leaving for the day. I am not saying that is the complete solution to the problem, but it is part of the procedure in the francophone school divisions. Is that happening in schools in Northern Manitoba? If not, why not?

Dr. Barker: I am not familiar with whether schools are following that routine. Senator, I think that is a good idea, but I have to ask whether the schools have running water.

Senator Stratton: I have been in many schools up North, and they have running water. I would be surprised to learn that they did not have it, at least in any of the schools that I have seen.

Dr. Barker: I have been to a few schools that do not have running water. I agree that it is a terrific public health measure.

Senator Stratton: It accomplishes two things. It teaches the children how critical hand washing is to health, because young children can be walking plagues. I have six grandchildren and know about all the germs they might pick up from other children at school. Surely, we have to try to take the simple measure of keeping those kids' hands as clean as possible.

Dr. Barker: I agree. As well, it highlights another point: Collectively, we are responsible for recognizing the roles that we can play. It is not simply up to the nurses and doctors but up to leadership, schools and even the grocery store manager to ensure that he is stocking nutritious food. Everyone has a role in this issue.

Senator Dyck: Thank you for your clear presentation, Dr. Barker. My question is about the age of the people who have contracted the disease. You were saying that two-thirds are on mechanical ventilation and that chronic disease and social determinants are playing a role. I assume that the people who have been affected most seriously are adults. Is that the case?

Dr. Barker: They are young adults and older youth.

Senator Dyck: In general, the virus seems to have targeted people that are 5 years to 24 years of age. As you well know, 50 per cent of the Aboriginal population is 24 years old and younger. Does this demographic add a greater emphasis to the need to put plans in place?

Dr. Barker: Absolutely, yes. That is a very good point.

Senator Dyck: Presumably that age group is the healthiest in a population.

Dr. Barker: One would presume so, but there are other reasons that a virus would cause more severe symptoms. It can occur when an immune system is not well nourished and overreacts to certain infections, causing greater damage to lungs and so on.

Senator Dyck: How do we identify the most vulnerable, which seems to be the younger-aged group? Perhaps developing a program for use in the school system might help to control the spread of infection there but not necessarily at home. You said that there are 633 First Nations across Canada. Do we have any way of knowing which of these communities would be most vulnerable?

Dr. Barker: The hope is that once we have a vaccine, we will target Canadians at large, beginning with those who are under 40 years of age and children, as well as all Aboriginal Canadians. Our hope is that before we see the next major flu, we will have that vaccine in place for everyone.

Senator Dyck: That would include all 633 First Nations.

Dr. Barker: Yes. I do not think we would try to figure out which one over which other. That would be tricky.

Senator Sibbeston: Dr. Barker, apart from the poverty that exists amongst Aboriginal people, do have any information as to whether the fact that they may be less immune to viruses like H1N1 plays a part in Aboriginal people being more vulnerable to this sickness?

Historically, we know that diseases have ravaged Aboriginal people since their first contact with Europeans. Is there any information to suggest that Aboriginal people are perhaps more vulnerable to these diseases than other people?

Dr. Barker: That is a very good question and one that was raised during our meetings. First, we know that the immune response of First Nations and Inuit people to tuberculosis is completely different to the immune response of non-Aboriginal Canadians.

We also know that the Public Health Agency of Canada has been focusing on H5N1, anticipating we would be looking at chickens from China rather than pigs from Mexico as the cause of the outbreak. Within that, the agency specified that they really did want to ensure they had done studies on serum from First Nations to ensure that their response to the vaccine and to the virus was similar. Of course, our concern is that the vaccine may not actually work on First Nations or may be less effective on First Nations communities because of the way in which the immune system is stimulated.

Now that we are focusing on H1N1 and not H5N1, we hope we will be looking at another opportunity for funding for such studies. You are absolutely right; it is necessary to look at that.

Senator Lovelace Nicholas: Do you think the pandemic would have gone as far as it did if the government and INAC had done their jobs, such as ensuring there is running water and proper housing?

Dr. Barker: I think we would have seen a very different situation if First Nations had proper housing without overcrowded conditions, with running water and proper food security. I think we would have seen a very different situation.

Senator Lovelace Nicholas: They are responsible for essential services in First Nations communities. Why do you think there was a gap in this type of situation? Not every community was as bad as Manitoba and remote places. Why do you think there was such a gap?

Dr. Barker: I think it was just unlucky that communities in Manitoba were struck. If the virus had reached any other location that had similar demographics and similar social determinants, it would have behaved in a similar way.

I think this is a major wakeup call and I hope that Canadians will recognize the need to address the underlying social determinants of health if we are to make any progress in First Nations communities.

Senator Lovelace Nicholas: I have noticed that health care in general has diminished in First Nations. What was covered previously is not covered now. I would like you to explain, if you can, who is responsible for that.

Dr. Barker: That is a very complex question. However, I would say that every one of us who has the power to elect our government is responsible.

Senator Peterson: Thank you, doctor, for your presentation. It is my understanding that there is not enough vaccine to immunize the Canadian population; in fact, it will be available in batches. As a result, the Public Health Agency of Canada is preparing a priority list. Is that list completed and have you seen it?

Dr. Barker: No, we have not seen it and they are busy preparing it.

Senator Peterson: How long will they be preparing it?

Dr. Barker: I have no idea, but we hope it will be on the agenda this Friday, when we will be meeting with them to discuss rural and remote communities.

Senator Campbell: Thank you very much for appearing today. I find myself looking at this and saying, "We have what we have; this is where we are right now. What will we do?"

I do not see a task force as an answer. We have a situation on our hands where we have an emerging emergency in First Nations and, by the time we get around to a task force, it will be fall before they even figure out who should be on said task force.

You have Annex B and everyone has signed off. There is $1 billion floating around somewhere for something to do with the pandemic. What is the holdup for us getting resources? When I talk about resources, I am talking nurses and, as Senator Stratton said, the basics. I am talking about just having tissues and all that type of stuff.

How do we get this going? This will certainly not be the last we see of this on First Nations, or in other isolated communities. How do we get this moving?

Dr. Barker: The $1 billion is already gone; $657 million went to the Canadian Food Inspection Agency to monitor chickens with H5N1; the remaining $350 million has been allocated and spent. Part of our concern is that part of those dollars was spent in developing Annex B but there is no money left to implement it.

Senator Campbell: Who should we be talking to about getting more money? I will read from Annex B under the First Nations responsibilities. I believe Senator Carstairs brought it up. It is on page 11:

. . .First Nations leadership and health care providers are responsible for the following:

Developing, testing and regularly updating a community influenza pandemic plan in collaboration with the appropriate partners and stakeholders.

It seems to me this is not a tough thing to do. These communities look very much alike and they have many of the same problems. Why are not all of the providers getting together? Why can that not be done? You cannot do it for $3,000 when you have to fly in and out of these remote communities.

All of these communities have commonalities. I do not know why the communities could not be brought together in one spot and develop a plan. Once they have the plan, they could lay down all of the resources and get those resources to where they are needed most. I do not understand the issue. Why does this happen?

Dr. Barker: We do not understand, either.

Senator Campbell: Who is responsible? I hate the term "responsible" but who has the task of taking care of this problem?

Dr. Barker: The First Nation and Inuit Health Branch is responsible for ensuring pandemic plans are in place for First Nations communities. Indian and Northern Affairs Canada is responsible for ensuring that emergency preparedness plans are in place. There are overlapping roles and responsibilities that require financial resources that may not be available.

Senator Watt: Welcome, Dr. Barker. I might be a little bit different from the rest of the senators. I will not focus so much on the disease itself but on the condition of the communities.

Does the AFN have an inventory of all the communities right across the country in terms of the condition of the communities?

Dr. Barker: What would be on that inventory list?

Senator Watt: The list could include quality of water, the quality of communities, housing issues, overcrowding and available health services. It is the information necessary to have a community function properly. Do we have an information inventory that has been prepared and brought up to date? Who has that information? Is it the Department of Indian and Northern Affairs or the Assembly of First Nations?

Dr. Barker: The Department of Indian and Northern Affairs would keep a lot of the information. However, it would be in silos. The person responsible for water would have one bit and the person responsible for housing would have another bit and as a result, no one person could give you a total picture of what every community looks like.

Senator Watt: Unless we have a clear idea of what exists in the community itself, this disease, which seems to be warming up, will not improve until we focus on community requirements.

What are we doing here? This is my question. We talk a lot about the disease, but we cannot do anything about the disease unless we have a clean community. That is a big part of it.

At some point, this committee will have to make recommendations to the government. The only thing I can think of is to get the military involved because of the urgency. The virus will spread in those communities. Some of my colleagues have indicated, especially the chair of the committee that it will spread not only within the community itself but it will spread on the outskirts into Aboriginal communities and non-Aboriginal communities.

Dr. Barker: We will all be competing for very few ventilators.

Senator Watt: Exactly.

We talk about people on-reserve. What about the people off-reserve? Some communities are even worse off than the reserves. We need to have that report. Maybe it already exists. With all of this information, this committee must make a decision or a recommendation. We cannot handle it ourselves anymore. It is too big. It will get bigger and bigger.

Senator Hubley: A small paragraph in Appendix B refers to ethics. It states, "There are a variety of ethical principles that guide decision making during any emergency, including an influenza pandemic."

Does having that paragraph give some protection to our First Nations' communities? Does it bring their conditions to the forefront if we have a plan indicating that we must treat those communities hardest hit during a pandemic? What is your opinion on the ethical principles involved?

Dr. Barker: We felt it was important to include something in the area of ethics. We went across the country speaking to First Nations' communities about pandemic preparedness and use of antivirals.

For example, if elders in the community were not on the Public Health Agency of Canada's list of priority groups in the discussion around decision making, what flexibility might exist within a community who value their elders tremendously to make that decision for themselves? Another issue was around the use of traditional medicine ó that its use be respected and ethics around the respect of permitting the use of traditional medicines.

Different ethical issues come out of pandemic planning. We wanted to ensure it was included.

Senator Carstairs: My question has to do with vaccines. There has been some talk that first availability of vaccines would be to Aboriginal communities. Is there such a commitment?

Dr. Barker: This is not a commitment yet; it is a draft in progress. It is important to remember that even once it is written down that Aboriginal people will be getting vaccines first, I would be delighted to see the logistics involved in that.

We saw the delays in getting essential supplies to one community. What will happen when we are trying to get vaccines to 633 communities? The support and logistics will be as important as any commitment to vaccination of a priority population.

Senator Lang: I want to follow up on Senator Watt's observation about the inventory in these communities. I am not familiar with Northern Manitoba. I have not been there. Have you been to all of the communities in Northern Manitoba?

Dr. Barker: I have not been to all of the communities, but I have been to several of them.

Senator Lang: It troubles me with the broad statements made that there are many schools without running water. I would like verification of that statement. In deference to us, it sounds as though there is not a water truck or well or any infrastructure in all of Northern Manitoba. Frankly, I do not believe that statement. It is important that we find out how many communities do not have trucked water, piped water or well water.

Dr. Barker: I certainly did not mean to suggest that none of the schools have water; however, some of the schools I have visited do not.

Senator Lang: I think the committee should have that information.

The Chair: We will try to get that information.

Senator Dyck: Which communities are most vulnerable? You said you needed to identify at-risk communities. That type of information is critical. It could be that the affected communities are the most overcrowded communities without clean drinking water. We must have that information; it is critical to the control of the disease.

We need to know the magnitude of the problems across the country with respect to clean drinking water and overcrowding.

Dr. Barker: Senator, to build on what you are saying, we also have to recognize that this is a new virus. We are still learning who is at risk and what characteristics put an individual or a community at increased risk.

It has been a difficult situation for health care professionals to make difficult decisions in the absence of valid information. Hopefully, with more data and more evaluation over the summer, we will be better able to describe those at-risk populations.

The Chair: Dr. Barker, the chickens are coming home to roost and the lights are going on. This is about all Canadians. It is not a partisan issue. Government after government ó provincial and federal ó have watched this situation deteriorate. It also includes Aboriginal politics.

Unless we do something different, we will continue to have the same results. We have to do something on First Nations reserves and off-reserve. If we do not, we will have more of these situations. You can blame everyone, but you should not point any fingers. We have created a horror story for First Nations people for the last hundred or more years.

It is time for the AFN and every group ó governments, oppositions, whoever ó to start working together and to make a difference in the quality of life for our First Nations people. Otherwise, it will victimize all of us.

I want to thank you for being here this morning and for being straightforward and candid. As you point out, we are the healthy and the wealthy. It is up to us to do something.

We now have with us representatives from the federal government to discuss the situation regarding the spread of H1N1 on the reserves in First Nations communities. Ms. Anne-Marie Robinson is the Assistant Deputy Minister, First Nations and Inuit Health Branch. I would presume you have a presentation to make to the committee, Ms. Robinson.

Anne-Marie Robinson, Assistant Deputy Minister, First Nations and Inuit Health Branch, Health Canada: Good morning, honourable chair and senators. I would like to take the opportunity to introduce my colleagues. Dr. Danielle Grondin is the Acting Assistant Deputy Minister, Infectious Disease and Emergency Preparedness Branch. She is here on behalf of the Public Health Agency of Canada. As well, Shelagh Jane Woods is the Director General, Primary Health and Public Health Directorate, First Nations and Inuit Health Branch; and Michelle Kovacevic is the Director General, Strategic Policy, First Nations and Inuit Health Branch. The latter two individuals are from the First Nations and Inuit Health Branch at Health Canada.

I will be providing you with an outline of roles and responsibilities of Health Canada in supporting influenza pandemic preparedness and response in on-reserve First Nations communities.

[Translation]

As you are aware, the Public Health Agency of Canada is the overall federal lead for public health emergency preparedness and response, including influenza pandemic planning.

[English]

Health Canada, through the Public Health Agency of Canada and the First Nations and Inuit Health Care Branch, which I oversee, along with the regions and program branch, are responsible for ensuring that the special concerns and needs of on-reserve First Nations are considered in planning and response activities of provinces and territories. To ensure a comprehensive and coordinated response to public health emergencies, such as an influenza pandemic, Health Canada works closely with the Public Health Agency of Canada, other federal departments, provinces and national and regional First Nations organizations.

[Translation]

Health Canada promotes the delivery of primary care services in approximately 200 remote and isolated on-reserve First Nations communities, where provincial services are not readily available.

[English]

Through these services, Health Canada manages the response to health emergencies in communities following provincial guidelines.

Health Canada's planning and response to influenza is guided by the Canadian Pandemic Influenza Plan for the Health Sector and, in particular, Annex B for on-reserve First Nations communities. As part of our plan, we provide technical expertise and financial support to help on-reserve First Nations communities develop, test and revise community level influenza pandemic plans.

We have also positioned a stockpile of personal protective equipment, such as masks, in many locations, including remote and isolated communities; and we are in the process of procuring additional supplies to meet longer-term needs of health care workers providing health care services on-reserve. We are also collaborating with provinces to distribute and administer antiviral drugs and vaccines, once available, and many other types of supplies, as we have done over the past few weeks to First Nations communities in the North.

Finally, with the Public Health Agency of Canada, we have established a proactive communications plan, including a campaign to raise awareness and increase personal protection against the virus. This campaign includes public health notices sent to First Nation communities in print media reaching First Nations audiences, and to over 1,400 Aboriginal health organizations.

Nevertheless, despite our best plans, there are some key risks and challenges when First Nation communities are faced with a public health emergency. There are multiple jurisdictions and parties involved. This requires timely coordination, which has been done effectively in response to outbreaks in these communities.

The 200 communities in which Health Canada supports the provision of primary care services are remote, isolated and dispersed over a wide geography. This can present a challenge for responding and requires solid planning. We are working with the Public Health Agency of Canada, provinces and territories to develop specific guidelines to address unique challenges as we continue to plan and go forward.

First Nations communities also have higher incidence of respiratory and other chronic diseases. This may make them more vulnerable to complications related to any influenza-like illness, including H1N1.

We also recognize the challenges faced by First Nations communities with respect to overcrowding and safe access to drinking water. In addition to investments in on-reserve housing made in Budget 2009, we continue to coordinate efforts with all levels of government and First Nations leadership to address these challenges.

Finally, any increase in demand on the health care system across the country and on-reserve no doubt stretches everyone's resources. However, to date, we have been able to provide the care needed.

[Translation]

I understand that you have a particular interest in the situation in Manitoba. We are concerned with the current situation in some reserves and continue to closely monitor them.

[English]

Health Canada has sent, over the past month or so, additional health care professionals, as has the province, to the affected communities in Manitoba to enhance existing primary care services. We have distributed personal protective equipment for front line health care workers in communities and pre-positioned these supplies in other locations in the event of further spread. The Public Health Agency of Canada has also provided ventilators to Manitoba.

Antivirals have been long pre-positioned in some communities in Manitoba to ensure rapid access. Health Canada, in collaboration with its partners, has also distributed hand sanitizers in Manitoba communities, including Garden Hill and door-to-door in St. Theresa Point. We will continue to assess the needs of each community to determine what additional resources are required and to provide ongoing education to residents of First Nations communities on prevention and self-care. Health Canada and the Public Health Agency of Canada are also doing epidemiological work to better understand the impact of H1N1 on First Nations on-reserve.

As with all severe cases across Canada, information on risk factors is being collected and analyzed, and guidelines have been adapted. We continue to do that on a daily basis. When this evidence becomes available, we will continue to have better ideas about the role that things like chronic disease, pregnancy and age play in terms of the severity of the illness.

In the meantime, we are doing everything possible to ensure that First Nations people have access to quality health care. Responding to the outbreak of H1N1 is our top priority. We will continue to work with the Public Health Agency of Canada, provincial public health officials and First Nations in monitoring the developments and assessing potential impacts to on-reserve First Nations communities to ensure that First Nations receive the care they need when they need it.

The Chair: Ms. Robinson we have heard in the news that the Garden Hill chief had to come off the reserve to pick up supplies for the community. Was there a breakdown and where did it occur? Do you have an explanation as to why supplies were not made available to that area, given the high concentration of population in these particular reserves in Northeast Manitoba?

Ms. Robinson: I can confirm to the committee that we had all the necessary supplies in our nursing stations for the community in terms of hand sanitizers, masks, personal protective equipment and other medications. There was some confusion, and I would concede that we continue to reach out to all chiefs. We need to continue to speak to them about what, from a public health perspective, is important to have in communities. In that case, I believe there was some confusion about whether we needed to have, for example, N95 masks being used by health care professionals and other surgical masks for people in the waiting room, as recommended in the guidelines, versus whether people needed N95 masks in their homes, which, from a public health perspective, has not been recommended. There was some confusion about what kinds of supplies were needed. I met with the chiefs last week and we sorted it out. I believe we increased the understanding.

As well, the chiefs had asked for hand sanitizers, and those items have been delivered. We had some difficulty procuring those items but we got them into the communities. In addition to that, we are working with communities about other effective ways to deal with the issue. As we heard in the previous testimony, water is a key concern in some of these communities. Some households, not all, have challenges accessing water. We work with communities to ensure that their water supply is functioning. We do that through our partnership with the Department of Indian and Northern Affairs.

Senator Carstairs: We know that the chief from Garden Hill went into Winnipeg on June 12 to pick up supplies. He informed me that the nursing station did not receive an adequate supply until June 15, which was three days after he brought supplies into the community. Given that the first case was diagnosed on June 3, why were supplies not brought up to speed immediately? Why was there not a physician on site until after June 11?

Ms. Robinson: I can confirm that we have had supplies in nursing stations throughout Northern Manitoba in response to preparations for the pandemic. There is generally a shortage of physicians who are able to go to the North, but we have been able to put physicians in the communities to see patients as required. The Province of Manitoba provides physicians and, through our coordination with the province, we prioritize where the physicians go based on the severity of the outbreak.

We did not always have 24-7 coverage of physicians in Garden Hill, but we significantly improved the coverage. During times when a physician is not available, other safeguards are put in place. For example, we use Telehealth so that a nurse can access a physician for a patient as required. Of course, we also have access to medevac services and LifeFlight, which is an air ambulance for Manitoba Health. LifeFlight can medevac critical patients in remote communities to larger hospital facilities.

Senator Carstairs: That is interesting because I am told that the average amount of time to medevac someone out of the community is between 10 hours and 15 hours, and at times it has taken 24 hours. I understand that the medevac service has been turned over to the province of Manitoba without any consultation with First Nations. Why are they flying out of Brandon as opposed to flying out of Winnipeg, which is faster?

Ms. Robinson: We do not operate a medevac service in First Nations and Inuit Health. I am new in my position but it is my understanding that we never operated medevac as they are provincially operated.

I heard the concerns from chiefs about the length of time for medevac services, so I inquired with the province. Even though it is a provincially-run service, we would be concerned about that because we have to ensure that people diagnosed in communities receive timely access. The province shared a report with us. In that report, I saw that in a one-week period at the height of the flu, the medevac response in the St. Theresa Point-Garden Hill area ranged from less than one hour to a maximum of eight hours. The average time was in the range of three to four hours.

With all due respect I was looking at the time it took from the call made by the nursing situation to medevac to the time that it arrived. Perhaps someone else looked at another time period. I am just reporting what I found. I was happy to learn from the province that in critical cases, they have the alternative LifeFlight available to fly people out of the community if they are not in stable condition.

Senator Carstairs: We know that 31 ICU beds in Winnipeg were occupied by H1N1 patients, two thirds of whom were Aboriginals on ventilators. What has been the impact on the usual hospital population as a result of this additional number? It would be rare to have 20 Aboriginal patients in ICU units in Winnipeg. What has the impact been on health services for all other Manitobans as a result? For the committee's information, 65 per cent of all Manitobans live in the city of Winnipeg, where most of the ICU beds are located.

What other alternatives are being considered? I know that First Nations requested a field hospital, which, apparently, was denied. How are we dealing with this emergency in order to find the appropriate level of care?

Ms. Robinson: Senator, the Province of Manitoba would have to answer most of your question. However, we have daily communication with the Province of Manitoba, and I know they went to great effort to extend the capacity of the hospitals in Winnipeg and Brandon to ensure that there was sufficient ICU support. The field hospital request was raised by a few chiefs from the Garden Hill-St. Theresa Point area. As well, it was discussed recently with our tripartite chiefs committee in Manitoba. Our concern with the field hospital is that it is primarily designed to deliver primary care and we have been able to provide adequate primary care support to First Nations people through our nursing stations.

When people are ill with this kind of flu, they tend to be either mildly ill or moderately ill and they are able to stay at home. Alternatively, they might be very, very ill and, in our view, a field hospital would not provide adequate care for them. The priority must remain on getting very ill people flown to the best hospitals in the country. Through the Canadian Pandemic Influenza Plan, if space is not available in local provincial hospitals, the plan is designed so there is support all across the country. I have already seen that happen. I have seen people from other jurisdictions come into hospitals in other provinces.

Senator Lang: I want to follow up on two areas. First of all, on the question of water, once again we are left with the impression that many of these communities have no water, are very poorly serviced by the water they have or whatever. I would ask any one of the witnesses to tell me how many schools in these reserves in Northern Manitoba are without water. I should say I cannot believe that a school could function without water. I would think it would have to be closed down for health reasons.

Ms. Robinson: I do not have the exact answer to the question because I do not know. We work closely with the Department of Indian and Northern Affairs and we do have data on which communities have trouble with water supply in general. In those communities, we are able to work with the community to look at alternatives and, more importantly, ensure what water supply is actually functioning.

If they have cisterns and they need to have water trucked in, then it is critical. It is critical all the time, but it is particularly critical through this outbreak that we ensure water is trucked in.

We have some communities in Ontario, as well, where INAC is working through us and working, of course, with the chief and council. Every community is different, so it is critical that the chief and council play a key role in this planning. In some communities we have taken in bottled water to assist people in terms of personal hygiene with bottled water where other water is not available.

I cannot give you that information today, but I am quite confident that our regional director generals in our communities, who work very closely with INAC, know which communities are vulnerable from a pandemic perspective, not just because of water but because of many other issues.

We have identified those communities and are working with them to figure out what gaps exist and how we can fill those gaps.

Senator Lang: I want to follow up a little further on Senator Stratton's questioning on hygiene. Have you given instructions or worked out agreements with the schools in these communities where there is water ó I am assuming there is water ó that children wash their hands four times a day so they get in the habit of doing it and may subsequently prevent something from happening?

Ms. Robinson: I cannot confirm that we have given that specific instruction that you have outlined to schools, but we have widely distributed and had meetings with communities and chiefs, providing information about public health. This is to ensure that in addition to schools, public gatherings, festivals, social gatherings, at home, band council meetings, and every kind of event, people continue to use good hygiene.

Shelagh Jane Woods, Director General, Primary Health and Public Health Directorate, First Nations and Inuit Health Branch, Health Canada: One of the key responsibilities of our nurses in the nursing stations is to continue to spread public health messages. For this, we rely on the messages put out by each individual province. Our nursing stations operate as though they were under the jurisdiction of a province. They take all of the public information a province provides to all of its citizens and ensure the appropriate people in the communities have access to that information.

As Ms. Robinson said, we communicate with the Deputy Minister of Health in Manitoba and her staff each day. We are relentlessly reinforcing those messages and ensuring that communication is going forward to the communities.

As I say, the nurses take responsibility, but they then work with all of the allied health workers in the community to ensure that message is going out. Therefore, the home-care nurses get it, the janitors in the schools get it, the leaders in the school get it; everyone is getting those public health messages.

Senator Lang: This is just an observation, but it seems to me that the principals of each school should be giving these instructions to the students. It is not enough to send this message electronically or through the media. The message should come first hand from the principal of the school.

We have 200 remote communities, and I assume that in most cases, the only access is by plane. Have you considered quarantining those communities that have not had any flu symptoms for a period of time, or at least in part, so these communities can stay healthy without people coming in or out until this thing is sorted out?

Dr. Danielle Grondin, Acting Assistant Deputy Minister, Infectious Disease and Emergency Preparedness Branch, Public Health Agency of Canada: It has been very much entrenched in the communities. On the question of quarantine, based on the evidence, there is no benefit to apply quarantine when dealing with respiratory viruses. We are in discussions with provinces, territories, as well as with our partners to review the whole question of "borders." At this point, quarantine and restricting travel are not necessarily the most effective measures.

In short, at this stage, no, there is no quarantine question. Quarantine issues are part of public health measures. It is one of the six key elements of the Canadian Pandemic Influenza Plan. That is one of the key guides we use for public health measures. Although we say that we are not quarantining those communities, quarantine is looked at in terms of whether it will be effective or not.

At this stage, quarantine will likely have no benefit at all. It is more important to go with other measures as explained by Ms. Robinson, and what is being done as well in ensuring people know what to do and practice good hygiene. Particularly people who are ill should stay at home and have access to antiviral medication. That plan has been put in place. Those who are ill are to seek medical care.

Senator Brazeau: Good morning to you all, and thank you for being here.

Earlier there was discussion here about the use of hand sanitizers, and that perhaps one of the reasons they were not distributed was because they were alcohol-based. To your knowledge, have those discussions actually taken place? If you do not know the answer, could you please look into it and get back to the committee?

Ms. Robinson: Yes, I can confirm that those discussions took place, both with chiefs and public health officials. We have had some rare experiences in our communities where we have had theft of hand sanitizers. We are concerned about it. We do have communities where we have large proportions of people who suffer from addiction. We decided on that issue it is best if we work community by community. Everything we do in all 633 communities must be in response to the specific needs of those communities.

We have had a number of people come forward, and some evidence, where this could potentially put people at risk. For the vast majority of people it is not an issue, but that discussion was with the best interests of our clients in mind, and we have now distributed hand sanitizers.

For those communities where we are concerned about having alcohol-based products, we have looked into another product which is not alcohol based. We have some on back order, but unfortunately we have not been able to secure the product in time.

In addition, we think it is most important to ensure a good water supply, not just in those communities, but broadly speaking, so that people also have the option of doing hand cleansing through washing with soap and water.

Senator Brazeau: Were these concerns raised by Health Canada or did leaders in the communities also raise them?

Ms. Robinson: Both have done so over the years.

Senator Brazeau: Today, can you tell this committee if proper basic supplies are in those communities for those who may need to prevent the spread of the disease, or gain treatment, if it is further along?

Ms. Robinson: I can confirm that our communities have adequate supply. Health Canada has a small stockpile of personal protective equipment, such as hand sanitizers and other things, in a warehouse in Edmonton. However, the backbone of our pandemic plan is to work through the provinces. Therefore, our surge capacity is the province. If the province has a shortage of supplies, then the surge capacity for the province is the federal government, which has stockpiles.

So far, we have access to surge capacity by design of the province, and I can say that has worked seamlessly. The Province of Manitoba has been incredibly helpful to us in ensuring that, when we need supplies in communities and when we need support in terms of health care professionals, those professionals have been made available to us.

Senator Brazeau: Therefore, the province has confirmed that they have forwarded adequate supplies to those communities to the federal health department, is that correct?

Ms. Robinson: Yes. Generally, we transport them but we access their stockpile. If there is any issue with their stockpile, then the federal stockpile has been designed as a backup to the provincial stockpiles.

Senator Lovelace Nicholas: You mentioned that Health Canada works closely with the Public Health Agency of Canada, other federal departments, provinces and national and regional First Nations organizations.

If you work so closely together, why did it take so long to deal with this crisis in First Nations communities?

Ms. Robinson: Again, in terms of managing the outbreak, Canada was first notified that there was a flu situation in Mexico on either the April 17 or April 21. From the beginning of this outbreak and this new flu, the First Nations and Inuit Health Care Branch was included in the public health network across the country, which is comprised of medical officers of health from all of the provinces, as well as our own medical officers of health and all the experts on the facts. We were included right from the beginning in terms of planning. As a result of that, we were able to ensure that First Nations communities had supplies. We also put out lots of information to communities, as previously mentioned, about hygiene and protecting individuals.

When we saw the first outbreaks in the communities in Manitoba, like everyone else, we were very concerned about the severity of some of the illnesses in some of those communities. The next thing we did, as soon as we saw that was our first pattern of severe illness in the country, I believe ó Dr. Grondin can confirm that, but I am looking at First Nations communities ó it was critical at that point to ensure we understood, from an epidemiological perspective, why First Nations communities were being impacted that way.

We immediately sent in epidemiologists from the Public Health Agency. For me, that is the most critical question to understand. We can put supplies into communities and we can ensure that First Nations have access to antivirals. Another crucial question was who should receive first-priority vaccines. The risk factors have to be well understood. Those are the critical questions.

Even with all the supply in the communities, we have still seen a cluster of serious respiratory illness. We need to understand that from an epidemiological perspective. Our primary concern is to ensure we have the most effective response in place so we can identify people who are sick and continue to adapt our strategies vis-‡-vis using antivirals and targeting people within populations who are the most vulnerable.

Senator Lovelace Nicholas: I think we know why First Nations are mostly affected. I think most senators here know why. However, I agree with the senator over here that something should be done now in order to end this problem.

Senator Dyck: Thank you for your presentations and welcome. You were saying that the First Nations and Inuit Health Branch is responsible for 20 communities in remote and isolated areas of Canada. How many people does that involve?

Ms. Robinson: We are responsible for 200 isolated communities. The number of people on reserve is in the range of 400,000 to 500,000.

I do not know how many people are in the remote communities. It is approximately one-third of all communities. I would not want to say that it is one-third of that population number.

Ms. Woods: We can certainly get that number for you.

Senator Dyck: I think it would be important to know how many people you are concerned about. If you are trying to stockpile antivirals, thinking about vaccinations or targeting those groups for priority, you should probably know how many people you are dealing with.

That leads me to my next question. Much of what you presented this morning seems to be emphasizing personal protection, such as hand-washing in schools, for example. School is out now so that will not work. It is summer recess.

When do we decide that we have gone past the point of personal protection and we need to take more aggressive action? When do we start giving out those antivirals? When will we start vaccinating and how will we decide who will get priority? Will these remote communities get priority in terms of antiviral protection and vaccinations?

Ms. Robinson: I apologize for not knowing the answer about the number of people because I agree with you it is critical. However, I can assure you that number is well known by our operation and is included in our planning.

Antivirals are available in all of our communities. The physician makes a decision that the patient requires an antiviral. We have had no issue in terms of having antivirals available in communities. The guidelines are evolving as we understand what the risk factors are in the population.

In terms of vaccination, Dr. Grondin may want to comment. However, my understanding is that a vaccination will not be available until the fall.

The critical question now is based on what we are seeing in terms of how this particular flu is impacting the Aboriginal population. We need to feed that information into the process, which is being done as we speak, to ensure that we appropriately prioritize First Nations access to the vaccination. From what we are seeing on the face of it, there are certainly indications that the impact on First Nations communities is severe, which would mean our planning would account for that.

We do have nurses in all of these communities and our nurses are capable and able to deliver vaccines and to give them to the whole population. We do this on a regular basis for children. We have programs in all of these communities where our public health nurses vaccinate Aboriginal children.

Senator Dyck: I think I heard you say the decision as whether to give the antiviral was up to the individual physician, is that correct.

Ms. Robinson: That is correct. Yes, that is the way the public health guidelines are designed. I will ask Dr. Grondin to comment.

Dr. Grondin: The antiviral is not specific to H1N1 flu viruses. It is a medication prescribed for seasonal influenza. There are two of them, Tamiflu and RELENZA. These are medications you can get under prescription. This practice does not change with the H1N1 outbreak.

To decide to give a prescription medication or not is based on the clinical presentation. This does not change; this is part of sound clinical practice in Canada. The reason to prescribe Tamiflu, mainly, or RELENZA is based on a clinical assessment. However, in the context of H1N1, we have put guidelines for health care practitioners on our website. We have also provided explanations to the general public. Guidelines for the prescription of antivirals do not recommend that they be given as prophylaxis. We must understand that we are in a world pandemic. All Canadians are facing this pandemic.

It is very important to note that we now appear to have antivirals that seem effective against H1N1. The last thing we want from a public health perspective is for the virus to develop resistance to the antivirals. It is very important to use the antiviral judiciously. That is the reason prophylactic use is not recommended. The recommendation is for use in treatment. This is the present public health recommendation in Canada and other countries. That is the reason the guidelines were issued in this manner.

As Ms. Robinson has said, we have antiviral stockpiles in Canada to treat all Canadians that need treatment. That includes First Nations, Inuit and Metis populations. The provinces are responsible for health care. They have a supply of the antivirals, which they will distribute. Should the province's supply run out, we also have our own federal emergency supply.

Senator Stratton: Schools in Manitoba are not out yet. It varies across the country. Schools in Manitoba are out June 30.

Senator Peterson: Who is the lead agency on this file?

Ms. Robinson: We have different roles. My responsibility is to ensure that supplies and medical response within reserve boundaries takes effect. The Public Health Agency has a broader public health role in surveillance and guidance on pandemic planning. The province is a key partner in ensuring First Nations people have surge capacity in terms of supply, public health information or guidelines; and in providing hospital care.

I am sure you know that we have primary care facilities in communities where our nurses and physicians work to identify and triage people in terms of understanding their illness. When someone is determined to be seriously ill, he or she has to be flown to provincial hospitals where the province is responsible for his or her care.

Senator Peterson: Would a progress report on how things are going come from your department?

Ms. Robinson: Yes, we would be the focal point in coordinating and ensuring that First Nations have access to appropriate health care.

Senator Peterson: Is the priority list for the vaccine completed?

Ms. Robinson: I am not preparing a priority list.

Dr. Grondin: There is no priority list. There has been a misunderstanding.

Canada has a contract with the company to produce vaccine. We expect to have the vaccine ready in the fall as Ms. Robinson has said. We will have enough vaccine available to immunize all Canadians who wish to receive it, including First Nations, Inuit, Metis and remote communities. Everyone will be able to be vaccinated if they so wish.

Having said that, you can understand there are complex logistics for mass immunization. Who to start with will be based on epidemiological factors and indicators ó who is more at risk, how people react, et cetera. It is also based on the severity of the disease and what we are learning. You have to understand that we do not yet know what will happen in the second wave of this disease. We are watching closely to understand what will happen.

We are working closely with other groups including various provinces as well as Ms. Robinson to establish what you call priorities ó who we should start with first. Regardless of what will happen, all Canadians that want a vaccine will get it on time within the flu season.

Senator Watt: What is your relationship with the Department of Indian Affairs in coordinating conditions in communities? We are not dealing with heavily populated communities. Everyone seems to know each other in such communities and there is usually good coordination. Do you have a function to make recommendations concerning housing requirements, drinking water and conditions of the communities and things of that nature to the Department of Indian Affairs?

Ms. Robinson: We coordinate with INAC on two levels. First, in terms of logistics with the flu outbreak, INAC has been on standby to help us if we need to store products, to fly things into communities or we need extra personnel.

Second, in the longer term, I take your point about the determinants of health being amongst the most important issues. Things like the water supply and conditions for housing are of critical importance to Health Canada. It is not only for H1N1, but also as we look at communicable diseases generally. Dr. Barker mentioned outbreaks of tuberculosis and the high incidence of chronic disease. We know some of these things are related to living conditions and poverty.

We have a relationship with INAC on an ongoing basis. We do all the testing for water and we ensure that chiefs, council and the Department of Indian affairs have information about the water supply because our interest in delivering good health care is to ensure First Nations have healthy environments.

The same is true for housing. We have environmental inspectors that go into houses and look for things like mould or vermiculite and other serious health issues. It is not critical not only for H1N1. As Dr. Barker said, we may be seeing more severe result in First Nations with this flu, but it is something we see with many other illnesses in communities. We know we must focus on the long-term social determinants in order to mitigate and avoid these kinds of outcomes.

Senator Sibbeston: I am always amazed by government, particularly civil servants. Whereas people in the community think there is a problem, civil servants at your level always give the impression that things are okay. I do not know if this is the result of the fact that you live and work in a place like Ottawa, very far from the communities where things are actually happening.

Have you been in contact with or have you been in those places where the epidemic situations are located? Have you been in touch with Minister Aglukkaq yourself? She is an Inuit and ought to be very concerned about this issue. Has she made any difference in dealing with this problem?

Ms. Robinson: Thank you for that question. It is something I struggle with a lot.

We have a very large and complex system. To ensure we are doing our job properly in managing the response, it is not only about logistics to ensure supplies are in place and people have access. Communications is a huge part of this system. We have a communications plan but it is not always perfect. That is probably the area where we need to continue to dialogue.

I have personally not been in those particular communities during the pandemic, due to my duties here. However, I can assure you that senior people in our department have visited those communities and visit them on an ongoing basis.

I have visited many other communities. I am also a First Nations person so I understand many of the realities these communities face. We have a large number of people working in our regional offices and other areas who are in constant contact with these communities and understand the realities.

We are pleased to have a minister who is Aboriginal. She has made a huge difference in terms of our ability to manage this file because she immediately understands the issues. She grew up in an environment in the North, which is not unlike the environment we are facing.

She has made herself available to us when required. We have had numerous meetings. In fact, I am meeting her again at noon today for her regular update on how the pandemic is being managed and what needs to be done next.

The Chair: Thank you, Ms. Robinson, and your entire panel. I have one quick question. Do you think you have a good handle on the situation? Have you got it under control, yes or no?

Ms. Robinson: I think we have the logistics under control in terms of putting supplies in the communities as needed. We have the cooperation of all the governments involved. The piece that none of us understand is what the virus will do next.

I should say that our planning assumption is that going into the fall, this will be a serious event. Even though we do not know what will happen next, from a planning perspective, we have decided to plan for the worst outcome. That is not to say that is what will happen, but I think that is really our only option.

The Chair: I thank you again, Dr. Grondin, Ms. Robinson, Ms. Woods and Ms. Kovacevic.

Colleagues, a suggestion has been made to me that we have the analysts draft a letter, and the steering committee, which is Senator Sibbeston, Senator Hubley and myself, will look at it. The draft letter will itemize the issues of concern; and on behalf of the committee, we will submit to Health Canada some of the observations that have been discussed here today.

Senator Carstairs: I have no difficulty with that. I think that is a reasonable option, but I would not want it just to go to Health Canada. I would also want it to go to INAC.

The Chair: Fine; very well.

Senator Brazeau: I think we should do the same perhaps with the health officials in the province of Manitoba.

The Chair: Fine. Colleagues, we are running really short of time. I want to thank all the support staff for the support they have given us to this point in time. I know they will continue.

Colleagues, our clerk is taking leave from the committee. She is going on to greater things, so I want to thank GaÎtane Lemay on behalf of all of us for the excellent service she has provided as a clerk of this committee.

There is a question about Inuit schools. Senator Watt, the steering committee has looked at this. I will discuss it with you and we will deal with this.

I wish you all a great summer. If anything urgent comes up, please contact me or Senator Hubley or Senator Sibbeston. Have a great summer. The meeting is adjourned.

(The committee adjourned.)

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More about the Swine Flu and First Nations . . .
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The Pandemic H1N1 Virus and Your Community
B.C. First Nations H1N1 action plan
http://www.turtleisland.org/discussion/viewtopic.php?p=10428#p10428
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Pandemic Influenza
Preparing Communities; Preparing You

courtesy of the Assembly of Manitoba Chiefs and
the Southern Chiefs Organization of Manitoba

"I was at the point where everything hurt . . ." - a First Nation survivor of a 20th Century pandemic influenza attack.

View video here . . .
http://www.manitobachiefs.com/pandemic/video.html

alternate links for this video . . .
http://www.manitobachiefs.com/pandemic/video.fla

http://www.manitobachiefs.com/pandemic/pandemic.swf

http://www.manitobachiefs.com/pandemic/video.swf

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Pandemic Influenza and Wellness . . .
Video presentation . . .
http://www.cha-bc.org/index.php/Influenza-Training.html
- - -

First Nations Community Preparedness
Family Health Care Before and During a Pandemic
Video presentation
http://www.jelprotection.com/chabc/fhc/player.html
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MORE ABOUT THE SWINE FLU . . .
viewtopic.php?p=10153#p10153

[admin]

July 10, 2009
For Immediate Release

Government of Canada Releases Guidelines for Health Professionals on Caring for Pregnant Women with the H1N1 Flu Virus
(OTTAWA) – Health Minister Leona Aglukkaq and Chief Public Health Officer Dr. David Butler-Jones today released guidelines for health professionals on caring for pregnant women with H1N1 flu virus.

"Thankfully the majority of H1N1 illness in Canada is mild, but we are seeing that some people, including pregnant women, are more susceptible to serious illness and complications," said Minister Aglukkaq. "To help protect mothers and their babies, experts at the Public Health Agency of Canada have worked with their provincial and territorial partners to develop clinical care guidelines that will help healthcare professionals treat pregnant women more effectively."

The H1N1 flu virus has now been reported in every province and territory in Canada and appears to be spreading similarly to seasonal flu. While pregnant women are at no greater risk of becoming infected with H1N1 virus, preliminary research shows that they are more likely to suffer severe illness and complications if they catch the virus.

In addition to the guidelines for health care professionals, the Public Health Agency of Canada (PHAC) has also developed a factsheet for expectant mothers. This factsheet offers advice on how to prevent infection, and when to seek medical care. This factsheet will be available online and distributed through community and health organizations used by pregnant women.

"We understand that pregnant women might be nervous about how H1N1 flu virus might affect their health and the health of their babies," said Dr. Butler-Jones, "That’s why we want to help inform them of the precautions they should take to help maintain their health, like practising basic infection control, avoiding large crowds, and seeking medical attention if they begin to exhibit symptoms."

Canada has a National Antiviral Stockpile which includes 55 million doses of both oseltamivir (Tamiflu) and zanamivir (Relenza). Both drugs are effective in treating H1N1 virus, and both are safe for pregnant women. Recent scientific evidence suggests Tamiflu may be more effective. The Government of Canada also maintains the National Emergency Stockpile System, which provides a surge capacity of medical equipment and supplies to support provinces and territories during public health crises. PHAC is currently negotiating the purchase of 370 additional ventilators and has secured the purchase of 1.9 million N-95 masks to bolster the existing stockpile and to increase the Government of Canada’s capacity to support provinces and territories.

PHAC is also focusing on how to prevent complications from the flu by learning more about how and why the virus rapidly escalates to severe illness in some individuals. PHAC’s National Microbiology Laboratory (NML) is involved in organizing and coordinating a national study of severe cases of H1N1 flu virus. The NML will partner with intensive care units across the country to try and answer the important questions of how and why severe illness affects some patients with H1N1 flu virus. Samples are already being collected for the study. Results will be published in medical journals when research is completed.
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July 2009

As an expectant mother, it’s natural to be concerned about how the flu pandemic might affect your pregnancy and your unborn child. The Public Health Agency of Canada wants to provide pregnant women, their families and communities with the information they need to make decisions that will help protect the health of both mother and child.

Pregnant women are not more likely to get the flu, but if they do catch the H1N1 flu virus, they are more likely to suffer complications, like pneumonia and severe respiratory distress, which can put both mother and baby’s health at risk. Severe complications from the flu could lead to early delivery or miscarriage.

This is why it’s important for mothers-to-be to take the following steps to help protect their health:

Practice basic infection control
PHAC advises all Canadians to

Wash hands thoroughly with soap and warm water, or use hand sanitizer ( i.e. an alcohol-based hand-rub)
Cough and sneeze in your arm or sleeve, not your hand
Keep common surfaces and items clean and disinfected
Keep doing what you normally do, but stay home if sick.
Seek medical care if symptoms worsen
Check the www.fightflu.ca for more information.
It’s important for pregnant women and the people around them to follow these guidelines to help reduce the risk of H1N1 exposure, which decreases the chance that moms-to-be will pick up the virus.

Consider avoiding crowds
It’s important that we continue to go about our daily lives during the H1N1 flu pandemic. PHAC recommends that pregnant women continue normal activities like going to work, community events or worship services. Caution should be taken; however, when entering situations where there are many people in close quarters with little control over personal contact.

It’s recommended that pregnant women be even more vigilant with handwashing and carrying a hand sanitizer, as well as other infection control measures. This will help to reduce the risk that pregnant women will pick up the virus in these types of settings.

Know what to look for
Symptoms of the H1N1 flu virus may include but are not limited to: rapid onset of fever, cough, sore throat, wheezing, and fatigue. Nausea, vomiting and diarrhea may also occur. Fever may not be prominent.

Talk to a medical professional if you have flu-like symptoms, and seek care if symptoms worsen
As stated, pregnant women are not more likely to get the flu, but they are more likely to suffer complications that could put their health and the health of their babies at risk if they get the virus. The risk of complications is greater in the second and third trimesters of pregnancy. Early treatment can help to reduce the risk of complications, so it’s important that pregnant women speak to a medical professional if they develop flu symptoms, and seek medical care if the symptoms worsen.

The H1N1 flu virus can be treated with drugs called antivirals. Canada has enough doses of two kinds of antivirals, Tamiflu and Relenza, for Canadians who need them. Both Relenza and Tamiflu can be used for the treatment of influenza in pregnant women. Recent scientific evidence suggests Tamiflu may be more effective.

Your medical professional will decide if antivirals are necessary for you, but in order to be effective, they must be administered within 48 hours of the onset of symptoms, so it’s important to contact a health professional as soon as you start to feel sick.

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The Pandemic H1N1 Virus and Your Community
B.C. First Nations H1N1 action plan
http://www.turtleisland.org/discussion/viewtopic.php?p=10428#p10428
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Swine Flu - News and Information . . .
CANADA UPDATES!
http://news.google.com/news?=en&q=swine+flu+canada

U.S.A. UPDATES!
http://news.google.com/news?=en&q=swine ... ted+states

WORLD-WIDE UPDATES!
http://news.google.com/news?=en&q=swine+flu+world-wide

ABORIGINALS UPDATES!
http://news.google.com/news?=en&q=swine+flu+aboriginals
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FIRST NATIONS and the FLU PANDEMIC
* * * * * DETAILS * * * * ** *
viewtopic.php?p=10229#p10229
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More about community planning, preparation and responses . . .
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Aboriginal Nurses concerned about impact of H1N1 on First Nations, Métis and Inuit people at high health risk

OTTAWA, July 16, 2009

In response to the World Health
Organization's announcement Monday that all nations need to set priorities for
the H1N1 vaccine as the pandemic is deemed unstoppable, the Aboriginal Nurses
Association of Canada (A.N.A.C.) wants to highlight the critical need for
ensuring the priority of First Nations, Inuit and Métis in receiving the
seasonal flu vaccine when available in September and the pandemic H1N1 later
in October or November.

Rosella Kinoshameg, President of A.N.A.C., stressed the importance of
"keeping the needs of Aboriginal peoples, in both urban and traditional
territories, in mind when setting priorities." Both WHO and the Public Health
Agency of Canada (PHAC) have identified priority categories highlighting
youth, pregnant women and for people with underlying health conditions.

As the H1N1 virus evolves and changes, it continues to disproportionately
affect young people and Canada's Aboriginal population is very young.
Approximately 50% of First Nations are 25 years or younger compared to the
median age of 40 for non-Aboriginals Canadians. Of these, over 1/3 of all
First Nation children are under 15 years of age (Source: First Nations
Peoples: Selected Findings of 2006 Census - May 12, 2009). Aboriginal people
also have disproportionately more underlying health conditions than the
average Canadian population primarily related to long standing issues of
poverty, inadequate housing, unemployment and access to ongoing economic
development opportunities.

Of particular concern to A.N.A.C. is the impact that treating multiple
cases of H1N1 will have on smaller and more remote communities, particularly
as many Aboriginal people continue to live in very overcrowded conditions and
over 100 First Nation communities still do not have clean running water. The
issue is not only the immediate identification and treatment of cases, but
also for the nursing support needed for severe cases which can result in
extended hospital stays as well as for lengthy home support in the community
after hospital discharge. Compounding this issue is the shortage of nursing
and other health care staff, particularly in rural and remote areas.

Kinoshameg noted that this has resulted in situations where nurses working in
First Nation communities are being overworked and burned out. PHAC is aware of
these psychological and social needs and are now taking them in account in
their planning.

Representatives from PHAC have assured all Canadians and Aboriginal
organizations that while supplies, such as equipment, masks and vaccines can
be mobilized quickly, they acknowledge that qualified human resources issues
continue to be an issue, especially in remote areas. As the capacity to
support the fall vaccination process as well as the care for H1N1 cases will
stretch all health service delivery resources, A.N.A.C. is very proud of the
role its members and other health care providers are doing to work with
communities in prevention activities, stressing hand washing and the use of
sanitizers, as well as in supporting the needs of the those affected by H1N1.

A.N.A.C. has also started compiling a list of recently retired members
who would be willing to help as needed. The response has been positive and we
are honoured by the commitment of our members to offer assistance as the fall
flu season rapidly approaches.

Background
The Public Health Agency of Canada (PHAC), in collaboration with
provincial and territorial governments, has been providing the leadership
co-ordination on the H1N1 situation in Canada. They are working with
Aboriginal organizations to focus on the specific health needs and inequities
facing Aboriginal peoples. For information on H1N1, visit PHAC's website at
http://www.phac.gc.ca or call 1-800-454-8302 to talk to a PHAC representative.

For further information: Audrey Lawrence, Executive Director, A.N.A.C.,
at (613) 724-4677, ext. 23, or send an e-mail to alawrence@anac.on.ca
- - -

HERE IS MORE ABOUT THE H1N1 Swine Flu . . .
viewtopic.php?p=10153#p10153

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"This is a community thing and we have to fight this together for everyone."

July 18th, 2009

Swine flu fear sparked a recent incident of violence (someone had targeted a family they believed had a child sick with the H1N1 flu virus and burned their mailbox), prompting the issuing of the following news release at Ohsweken.

Six Nations Elected Council (SNEC) Chief William Montour is calling upon community members to stay calm and learn how to reduce the risk of getting H1N1. News of a confirmed mild H1N1 case has created uncertainty in the community that Six Nations Elected Council, Ohsweken Public Health and SN Health Services are addressing.

"Acts of aggression against unfortunate community members, who have contracted this influenza at no fault of their own, cannot be tolerated," stated Chief Montour. "This is a communicable disease that can affect anyone who may come in contact with persons suffering from this flu." Chief Montour also pointed out, "There is no possible way for anyone to be able to assess who may be carrying this disease in gatherings of people. Common sense must prevail and precautions can be taken."

Six Nations Health Services Director Ruby Miller offered reassurance through information and actions taken. "We're going to work together to eliminate what we can. We need to work together to support each other," she said. The best line of defence is thorough and frequent hand washing or by using an alcohol-based hand rub with a 60 to 90 per cent alcohol content. Cover your cough in the fabric of your sleeve or with a tissue (not your hands) and throw the tissue in the garbage. Stay home when you are sick and keep children home when they are sick. Avoid close contact with those who are sick. Avoid touching your eyes, nose and mouth to prevent viral infection. Practicing good health habits keeps the immune system strong. Get plenty of sleep and exercise and eat nutritious food and drink plenty of water. Consider stopping smoking because it weakens the immune system. H1N1 symptoms include fever and/or chills, a new or worse cough, sore throat, body aches, headaches, loss of appetite and fatigue. Contact your doctor to report symptoms. Most people recover at home but if symptoms worsen, see your doctor. Anti-viral medication may be prescribed by physicians to patients with a great risk for complications. Recovery times are different for everyone. People with flu symptoms should stay home for up to seven days or 48 hours after symptoms are gone. People who have no symptoms but have been in contact with a person with flu symptoms should limit community activities and watch for symptoms and report them to a doctor if they occur. Pregnant women should avoid providing care to others.

Ohsweken Public Health and SN Health Services are preparing for mass vaccinations when the vaccine is available to the community possibly in late fall. While a person can transmit the virus 24 hours before symptoms appear, the risk is very low due to the low level of virus in the early stages of illness. A person can transmit the virus up to seven days after symptoms appear. Tests, when ordered by a doctor, take five to seven days to come back. Doctors follow Ontario Ministry of Health protocols and do not routinely orders tests for people in contact with a sick person.

Further information including how to care for a sick family member is in the H1N1 booklet created by Health Services. On July 24, the booklet will be delivered by mail to community homes accepting flyers. The booklet is posted on the Six Nations Elected Council's website, http://www.sixnations.ca - On July 24 it can be picked up at the SN administration building.

"Ohsweken Public Health and Six Nations Health Services are working diligently to prepare our response to the coming flu season as well as continuing business as usual," said Director Miller. "We are happy to take calls and to give the correct information." Health Services and Public Health recently met with the Grand River Pow Wow committee to outline prevention action.

H1N1 booklets will be available at the Health Services booth and hand washing will be promoted throughout Chiefswood Park. Ohsweken Public Health and SN Health Services spoke to parents at the Stoneridge Day Care on July 16. Health Director Miller told them that Six Nations has done a tremendous job in developing Six Nations Emergency Response Plan that includes an influenza plan.

"Planning has been going on and this community is much more prepared than most communities," noted Director Miller. Chief Montour said lessons were learned from SARS. "We've been expecting this," he added. "This is a community thing and we have to fight this together for everyone."

H1N1 booklet created by Health Services . . .
http://www.sixnations.ca/H1N1InfoBooklet.pdf