Darlene Kitty says she feels lucky to be working as a physician in the northern Quebec Cree community of Chisasibi, despite the nearest intensive care unit being nearly 1,000 kilometres away.

Chisasibi, on James Bay in the vast territory of Eeyou Istchee, is one of the northernmost Cree communities accessible by road in North America.

“I really feel lucky to be where I am,” Kitty said. “The blessing we have, I think, is being a remote community.

“We can have some control over our lives.”

But she recognizes that feeling of being in control could quickly unravel.

The hospital in Chisasibi serves patients from the five coastal Cree communities in Eeyou Istchee, a Northern Territory that covers more than 5,000 kilometres and has five confirmed COVID-19 cases as of April 17.

Kitty said they’re well equipped to deal with the pandemic, but that could change drastically in the face of a serious outbreak.

“We accept patients from other communities for acute issues. We also have some patients who become our chronic patients that come from other communities,” she said. “But we don’t have a CT scan or an ICU right? Our sick patients that are critically or seriously ill usually get sent off to our referral centres …. The nearest one is Val-d’Or, which is about 1,000 kilometres away.”

Kitty was not the only person living in an isolated Indigenous community to use the world “blessing” or “blessed” to describe to the Star how they’re currently feeling.

Some people are feeling more anxious.

David Harper, who was chief of Garden Hill First Nation in northern Manitoba during the 2009 H1N1 pandemic, remembers asking the federal government for help at that time and receiving body bags. The community was ravaged by H1N1; hundreds of people were sick, and there were several deaths.

Garden Hill is one of four First Nations on Island Lake, a remote Oji-Cree community near the Ontario border which is not accessible by road. The area does not have any confirmed COVID-19 cases, and the only people allowed in and out of the community are health care workers.

Harper said these are probably the best circumstances they can ask for right now. But he was alarmed to read recently how a nurse brought the virus into the northern Saskatchewan Dene community of Black Lake First Nation, near the Northwest Territories.

“That is our greatest fear: that if one comes in, it’ll spread like wildfire,” Harper said. “We knew that when it happened during H1N1. Everything that happened there, it only took one (infection).”

He appreciates that health care workers are at the most risk and must do their jobs, which is a double-edged sword. He wonders if there are further precautions that can be taken to minimize the risk of people accidentally bringing the virus back with them when flying in and out of the community.

“That has to be examined. It’s a concern for everybody,” Harper said.

George Poitras is the CEO at Mikisew Cree First Nation, a fly-in reserve in northern Alberta, accessible by plane year-round and an ice road in the winter. He spoke to the Star not long after a phone call with other leaders and aviation companies in the area, agreeing to shut down all non-essential travel.

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“The gap in terms of our protection from the pandemic is these flights that come in and out of Fort Chipeywan …. We rectified that today,” he said Wednesday.

He said people looking to fly out of the community must now provide a reason for their travel, and a local airline has agreed to provide a manifest before the flight to a government committee who will determine if each person’s reason is valid.

“We’re not immune to this, and anybody coming into the community can unknowingly bring this virus to the community,” Poitras said. “But having said that, we feel blessed that we’re isolated.”

Some First Nations leaders are more concerned, especially based on how H1N1 spread in Manitoba. Jerry Daniels, Grand Chief of the Southern Chiefs’ Organization, represents 34 Anishnaabe and Dakota communities in Southern Manitoba, including three that are fly-in only.

“Health Services have been difficult to have in our communities because of the isolation and distance from urban settings,” he said. “Even to get somebody to come into our communities and to stay there to help with the planning and that, in itself, is very difficult.”

He recently added his name to a petition urging the federal government to send additional resources to isolated First Nations and Indigenous communities and to consider measures such as using the Canadian Armed Forces and partnering with Cuban doctors.

“It’s unfortunate, but I mean, First Nations, we have to do what we have to do in order to create better outcomes … and sometimes international countries and people around the world are better situated because they don’t have an interest,” Daniels said.

He said one of the reasons he signed the petition is a sense the federal government failed Manitoba First Nations during the 2009 H1N1 pandemic. He also wants to make sure there is better co-ordination and communication between First Nations and regional health entities to ensure accurate information is being shared.

“Part of the problem with that is that there’s a communication barrier with the regional health entities in that there isn’t clarity on the availability of beds and that kind of stuff sometimes,” Daniels said. “So, in the event of an emergency, sometimes people are redirected.”

Anna Banerji, an infectious disease expert at the University of Toronto, previously told the Star how First Nations and Indigenous communities are at much greater risk of seeing COVID-19 outbreaks due to infrastructure issues such as overcrowded housing, poor sanitation and inadequate ventilation in households.

She started the petition to bring greater attention to the precarious circumstances for fly-in, remote communities. In particular, she’s concerned about medical evacuation teams being able to meet demand in the face of a major outbreak.

“If there’s only a limited number of medical evacuation teams, you might end up waiting days. And if you don’t have a way to put someone on life support, they’re going to die,” she said.

“It hasn’t started yet in most of these communities, because they’re physically separated … but it’s only a matter of time.”

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