EDMONTON—There are no full-time physicians in the isolated northern Saskatchewan community of Waterhen Lake First Nation.

The community depends on a doctor who visits about twice a month. Sometimes, residents can fulfill an additional appointment via video conference, in what is known as “Doc in a box.”

Ester Sunchild, a registered nurse on the reserve, worries what that might mean if the First Nation is hit by COVID-19. Sunchild and her fellow health practitioners met this week to discuss their pandemic response.

“As a community member, I am worried about my family. … And I worry about the ones who are at risk,” she said. “The ones with diabetes, chronic lung diseases, renal failure, the ones who are immunocompromised.”

Indigenous peoples were significantly overrepresented among Canadians who were affected by H1N1 in 2009. Representing approximately 4.3 per cent of the population, they accounted for 27.8 per cent of all hospital admissions reported to the Public Health Agency of Canada during the first wave of the pandemic, according to a report from the National Collaborating Centres for Public Health.

In 2009, Maclean’s magazine reported that the national H1N1 infection rate was 24 per 100,000 people among the general population. Among First Nations people, the rate was 130. In Nunavut, the rate was more than 1,000 per 100,000 people.

This week, Manitoba NDP MP Niki Ashton criticized the federal government for not including the minister of Indigenous services in its coronavirus committee. She said the disproportionate rate of H1N1 infection in Indigenous communities was directly linked to “Third World living conditions” and the lack of access to private health care on reserve.

“When we hear the federal government telling people to wash their hands, how do you do that when there’s no running water?” she said at an Ottawa news conference.

As of February, there were 61 long-term drinking water advisories on reserves nationwide.

On Thursday, CBC News reported the federal government was prepared to use isolation tents and temporary shelters for screening and testing in Indigenous communities. The Public Health Agency of Canada forwarded questions to Indigenous Services Canada, which did not respond.

Sunchild, who has been a nurse for about 25 years, remembers what it was like in 2009 when the H1N1 influenza virus swept through Saskatchewan First Nations. During that pandemic, Sunchild says, she worked constantly, sometimes until 9 or 10 p.m., while also worrying about her own family getting sick.

“When we had that pandemic with the H1N1, you had to pull nurses from other communities to come and help. … If we were to have that coronavirus here, it would be hectic,” she said, adding they would probably have to hire more nurses as they currently only have three in their clinic, although a fourth is set to arrive soon.

Indigenous peoples in Canada face a higher risk of serious or fatal outcomes from viruses that cause respiratory problems, such as COVID-19, says Anna Banerji, an associate professor and infectious disease expert at the University of Toronto. Her research has shown how First Nations and Inuit peoples in Canada have some of the highest rates of lower respiratory tract infections (such as pneumonia and acute bronchitis) in the world.

“We don’t know how this virus will impact people in remote communities,” Banerji said. “There are a lot of elders in these communities that have health issues.”

While there have been no reported cases of COVID-19 on First Nations in Canada or in the territories, Banerji is concerned that COVID-19 could spread rapidly in some Indigenous communities due to issues some face such as overcrowded housing, malnutrition, poor sanitation, inadequate ventilation in households and lack of access to health services.

“Overcrowding in general is a problem in many Indigenous communities across Canada,” Banerji said. “In some communities, for example, in the North and in Nunauvut, it's critical. And so if there is a virus there, it could spread very quickly among households.”

There are also underlying health conditions that make contracting COVID-19 much more dangerous, Banerji said. Diabetes, obesity, smoking and chronic lung disease put a person at greater risk of experiencing serious complications or even death. All of these factors are more widespread among Inuit and First Nations people who live on reserve. All are connected to poverty and the legacy of colonization, Banerji said.

Sunchild said the infrastructure issues Banerji says put communities at risk of higher rates of infection are all common on Waterhen Lake First Nation. There are about 1,000 band members who live on reserve, which is located four hours north of Saskatoon.

“There is overcrowding, you can have 10 people in a house. And there is a lot of poor ventilation, we do see a lot of mould. And that causes a lot of health problems,” she said.

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She said during the regular flu season, transmission rates in the community are high.

“Even with just your regular influenza season, we do see a lot of people with the flu,” Sunchild said. “We work from Monday to Friday. By Friday, we’re tired. Because we see patient after patient after patient.”

Often, they have to get medication from the nearby larger urban centres of Meadow Lake or Cold Lake, about an hour or two drive away, or order from Prince Albert. Sunchild worries the clinic wouldn’t be able to meet the community’s health needs if there were a major outbreak.

“Because there are other First Nations in the North that deal with the same pharmacy, I don't know if they can keep up with the demand,” she said. “That's one thing I think about.”

For more serious medical procedures, residents have to travel to Edmonton or Saskatoon, said Dustin Ross Fiddler, a councillor at Waterhen Lake First Nation.

“When you have a barrier like that, because it is a barrier, you have people who don’t reach out. … Because they know the burden of possibly having to be transported to Saskatoon or Edmonton,” he said.

He said he’s worried what that might mean if people in the community are infected with COVID-19, or if there’s an outbreak.

One of the major concerns is that necessary goods at local service centres, such as propane and chemicals needed to allow water treatment, will become more scarce and less accessible. The First Nation is looking into how to stay stocked on important supplies.

“Being a remote First Nation … if those services start to break down, we’re going to have a lot more issues on our hands on top of the declining health and the possible outbreak,” such as a potential water shortage, Fiddler said.

During the H1N1 pandemic, Manitoba was hit particularly hard, noted Michelle Driedger, a professor at the University of Manitoba. She has researched how public health agencies communicated risk messaging during the 2009 H1N1 outbreak.

Driedger, who is Métis, said it’s hypocritical for public health agencies to tell people one of the most important things they can do to avoid infection is wash their hands when many Indigenous communities don’t have clean drinking water.

“If hand washing is your first line of defence and you don't have a reliable water system, that is already compromising your ability to try to fight infection,” she said.

She, too, has observed infrastructure limitations in Indigenous communities in Manitoba, although they vary from place to place.

“In a lot of these communities, drug stores aren’t available like they are in urban centres,” Driedger said. “In some of these communities, like some of the Métis communities that I work with, they don't even have a grocery store.”

Several communities in the North are fly-in communities, which means by the time infected individuals arrived in Winnipeg for H1N1 treatment, their condition was already much more severe.

Fiddler is hopeful the federal government prioritizes the health and safety of Indigenous communities.

“We often feel like, as First Nations in the North, that we’re not as heavily considered. … We need some sort of guarantee that we’re not to going to be put on the back shelf when Canada’s dealing with a crisis such as this outbreak.”

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