Dr Evan Adams MD - Deputy Chief Medical Officer, Indigenous Services Canada talks about the experiences of the First Nations, Inuit and Metis people of Canada during the COVID-19 pandemic and the COVID vaccination of these communities.

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https://www.rcaanc-cirnac.gc.ca/eng/1100100013785/1529102490303

https://www.sac-isc.gc.ca/eng/1606941379837/1606941507767

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TRANSCRIPT:

Kojala Medical presents COVID 19 The Answers. The show that delivers the scientific evidence-based knowledge that can safely return us all to our pre-COVID lives. My name is Dr. Funmi Okunola and I'll be hosting the show. Every week you can listen to me interview a highly respected professional about the science that can reduce your risk of becoming infected with the coronavirus.

Welcome to episode 6 of COVID 19: The Answers, titled 'The vaccination of the Indigenous People of Canada and the effects of COVID 19 on the Indigenous People of Canada I'd like to introduce you all to Dr Evan Adams, Dr Adams is from the Tla'amin First Nation near Powell river in British Columbia Canada. Dr Adams completed his doctor of medicine degree at the University of Calgary and his aboriginal family practice residency at Saint Paul's hospital UBC in Vancouver Canada as chief resident. He then went on to acquire a Masters of Public Health degree from John Hopkins University in Baltimore in the USA. He was the first ever aboriginal health physician advisor in the office of the Provincial Health Officer and became the deputy Provincial Health Officer in the province of British Columbia Canada in 2014 he became the first Chief Medical Officer for the newly formed First Nations Health Authority in BC. 

Dr Adams is currently the Deputy Chief Medical Officer for Indigenous Services Canada Dr Adams is a multi-award-winning actor, most famously starring as Thomas Builds-The-Fire in the movie, 'Smoke Signals' and has over 30 years experience as a motivational speaker. Dr Evan Adams is one of the most famous, honored and much-loved persons amongst the Indigenous People of Canada. Welcome! Ah thank you, what a very generous introduction. Oh it's very true.

I've spoken to many Indigenous People and I hear nothing but high praise. Ah, that's a that's a nice feeling, thank you. So, I've been dying to ask, how a medical physician came to be a famous actor and did you have to choose between the two professions? Yeah, it actually happened the other way around. I was uh, you know, I was a fairly good student and and as a you know as a high school student was told 'oh we we so need you to get an education and return home and help with all of those all of those issues' and I think as a as a young person, that's pretty daunting and so when I was in University I was studying Biochemistry in my second year, a woman came up to me on the street and she said are you an actor and I just lied. Why did I say yes?

She said come and read for me tomorrow and I did, and I was cast in the second lead in a, in a film and it was actually quite wonderful. I thought oh this is really fun, it's much better than the drudgery and the burden of training and going home and serving. It's just really light fun, but of course I did it with all my heart and I was uh, I think 18. I looked 16 I thought I was you know akin to an English major or a performance artist and I just uh, I just kept working, but by the time I hit 30 I thought oh I better go back to my original dream before I age out and see if I see if I can do it so here I am. I've done them both and it's been really quite a journey. That is fantastic and a real inspiration to lots of other students. I mean I often tell people now you can have more than one career. And that's, that's just a great story. Thank you. Oh, 

you're welcome and I hope it does encourage people to at the very least recognize that we all play many roles right like we're not just we don't just want to be good at our one profession, we also have you know we want to be a good person, we want to be a good partner, we want to be a good parent, we want to be clear honest authentic. Right there, there are lots of goals and I feel like sometimes we're raised up, just for excellence and work and that's just not enough. Yes, and, and I think when you've had those sorts of experience, 

it gives you breadth and depth of character too. It helps you to relate to people better. Yes and it's also humbling, which is very important. I think it's important for people to not position themselves as subject matter experts, or as de facto experts right? As physicians we can be, we can think of ourselves as as God-like. I always joke. Doctors, they're just like people. And I really want to avoid that, especially of course with my people

you know, who I was seeing as patients, but now take care of as a public health doctor. I needed to be seen as really quite approachable and not as you know, some fancy doctor coming from a far away city, who, who was you know, going to institute, you know, things that were not helpful are meaningful to them. Indeed.

um

We have an international as well as a national audience, so I thought I'd start the program with a definition of Indigenous People and communities pulled from the Canadian government website Indigenous Peoples is a collective name for the Original Peoples of North America and their descendants often Aboriginal Peoples is also used the Canadian constitution recognizes three groups of aboriginal peoples Indians more commonly referred to as First Nations, Inuit and Metis. These are three distinct peoples with unique histories, languages, cultural practices and spiritual beliefs. More than 1.6 million people in Canada identify themselves as an aboriginal person according to the 2016 census. Aboriginal Peoples are the fastest growing population in Canada they grew by 42.5 percent between 2006 and 2016 and the youngest population in Canada about 44 were under the age of 25 in 2016. There are more than 630 first nation communities in Canada which represent more than 50 nations and 50 indigenous languages. Evan is there anything that you'd like to add to that statement? Yeah I think you know, the the United Nations and the World Health Organization 

speaks of at least 80 countries that have Original Peoples and Indigenous populations who are affected by waves of migration and migration is not a bad word. We have feet, we're not barnacles people go to different places and set up their homes, but sometimes for Indigenous Peoples the commonalities between us you know we're not DNA cousins but we're cousins by our colonial experience. And so definitely, in Canada Indigenous Peoples, you know, their health was going in one direction health interrupted and now it's going in another direction and we actually have the worst health of any ethnic group in the country in our in our own territories. All right that's so great. So, I'm moving on to the questions. 

I think it's important for our International audience to understand some of the nefarious history between the Canadian Government and the Indigenous People of Canada, although this was well known for decades within Indigenous communities the recent discoveries of mass graves at past residential school sites across Canada, has cast a spotlight on the treatment of Indigenous People here across generations,

which frankly, a significant proportion of the general public were ignorant of. In order to try to understand the mindset and lack of trust within the indigenous community for Canadian governmental systems, can you please provide some of the background of the racist and genocidal practices perpetrated by the colonial system to the Indigenous People of Canada?

Thank you, thanks, and I think of colonization in many other countries that are kind of illustrative of you know, what was happening here. There were Indigenous Peoples all over the Americas including of course Central and South America. And I think of places like Hawaii, Tahiti and, and of course there are many other places. I mean you could even you could even say the experiences of of Indians or of Africans you know,

their quite violent histories where people were subjugated and their lands and wealth went from them to other hands, and that was really essentially the case here. Indigenous Peoples in Canada had to live under what was called the Indian Act and there was no other Act for any other ethnic group. Just for us and let's not be naïve, part of it was to separate us from our lands and to contain us. Put us on reserves or reservations and part of that was an attempt by the Canadian Government in allyship with many churches to take children from their indigenous families to institutionalize them and to try and get them to forget where they were from, and to accept a different way of being and knowing, and those those places residential schools and they weren't really schools they were really much more like like prisons had a very high fatality rates and many many children died. So, so now Canada has gone through a process of trying to reconcile what has happened. Lest we forget. And we are finding all kinds of unmarked graves with thousands of children's bodies and we as a nation have to deal with, and ask what happened who, who are we. That this could occur in this country because I think Canadians are are proud of themselves on the International stage they Canadians like to think of themselves as being a fair people but you know this is definitely a stain in there in their history and for us my parents went to extension school for us it is definitely a reckoning as well like what does this what does this mean for us in our own lands?

Evan you were the first Chief Medical Officer for the First Nations Health Authority in Canada based in British Columbia. The only health organization in Canada set up to directly provide health services to first nation people by first nation people can you please tell the audience why this was set up? Sure, the health system or health setup for Canadian citizens is delivered by our provinces, however for Indigenous People their healthcare system was created separately and was seen as a Federal system. So around all other Canadians, except for maybe the armed forces, around all other Canadians oh, and prisoners too, they're considered Federal subjects they would have hospitals and physicians employed by their provinces but we would have the separate system or we did have this separate system, run by the federal government and it was exceedingly inefficient to have healthcare delivered from the capital city, Ottawa several , 

that's not several, a few thousand miles away, or from the provincial capital hundreds of miles away, or kilometers away, and so we

enacted in our province and amongst the the Indigenous Peoples NBC a system that was run by by us essentially so for a large First Nations health service organization created to help Indigenous Peoples particularly First Nations peoples to to be better and it really has been quite an important step in self-determination in improving outcomes achieving equity in service and I think as well having people be less subjugated and participate more in in their own wellness but also in in society as well. Thank you.

Could you tell us about your two-year secondment at Indigenous Services Canada and your role as Deputy Chief Medical Officer. Were you invited to take up this role? Uh, when I was at the First Nations Health Authority and serving the First Nations people of British Columbia and working as a really a Public Health Official as a a physician with authority to to vocalize and direct care and attention to specific areas like mental health or exploitation of women, or substance use, that was really a lovely piece. I did that for many many years, but I did feel like there was more work to be done in other areas and I feel like the pandemic gave me an opportunity to say well let me go Federally, let me work Nationally and work on all things code. Because actually, like everywhere, many healthcare workers and other workers were being redeployed to deal with COVID issues so really in in a way, and I asked for this, I was, I was, redeployed and sent to a National position in our National Capital in Ottawa.

All right, so moving on to the COVID vaccination of the Indigenous People of Canada the reason why I

wanted to do this interview amongst others, is to highlight the marvelous achievement that you were part of with regards to the scale-up and execution of the national COVID vaccination program for the Indigenous People of Canada. You achieved an eighty percent two-shot vaccination rate on reserves up to a year before this was achieved nationally. The vaccination program involved a brand new vaccine formulated from mRNA technology. Indigenous People have injured significant human rights abuses from the Canadian medical system as a result of historical colonial practices and continue to suffer racism in the health system prior to the arrival of the COVID vaccines what medical psychological and social impacts did COVID 19 have on indigenous communities? 

Yes, the pandemic was absolutely frightening for all of us. Particularly for our small communities. We have many small communities. About 650 different First Nations communities in Canada many of them are quite remote and because of their remoteness and their size they don't have tertiary care. So they were identified quite early on as being vulnerable just on, on just on a geographic basis if they got COVID they would have very few means to help anyone there to stop up to stop an outbreak, or to care for those who were, who were sick.

Of course there were other risk factors that we brought forward a number of us and my team included where we said Indigenous People have the poorest health of anyone, so you know, they, they do have elevated risk compared to the average Canadian and we have a special relationship with the crown with the country of Canada. So we're we're actually different from other marginalized groups and chiefs, or our leaders were clear that in their relationship the health of our Peoples was important and this happened in many countries. This happened in Hawaii in the United states. In New Zealand, in Australia. 

Those countries named their Indigenous Peoples as having special risk and so they were given more of a priority than the the average citizen in those countries, so we did that here. We got the word out that we would have you know, some availability of the vaccine eventually. Our people did really well at the beginning because we were so remote and in part because we protected our borders. We protected our communities from importation. We actually literally set up roadblocks and asked people's business going in and out of our tiny communities, but eventually our infection rate and our mortality rate and our complication rate were worse than other Canadians around. So now about two and a half times worse, roughly from the data that we have so we did push hard in communities and we said please let's look after each other we we can't afford to do badly at this time we've had a long history of communicable diseases that were very bad for us including smallpox and tuberculosis and even even modern scourges like HIV and and also we had been already giving health messages to our people so anyway we we talked it up we encourage people to be vaccinated and yeah we did fairly well even though in my mind I would like to do better! No, you did remarkably well. So I think you've answered question three, so Indigenous Communities in Canada have specific experiences via Provincial territorial and local Public Health systems concerning the management of their health and access to vaccines and past pandemics. Could you please tell the audience about their experiences of the H1N1 pandemic back in 2009 and the lessons learned?

Thanks, yes I was in charge of the indigenous response to H1N1 in 2009 in my province. I was working provincially then remember my previous job was with First Nations NBC but my job before that was with the province of BC looking after Indigenous Peoples so H1N1 happened and again we were nervous about what would happen to us we knew that our communities were not prepared much less prepared than they were this time around in that for instance they didn't have communicable disease and pandemic plans at a community level but almost no one knew them they were on a shelf collecting dust large pandemics was was not really front of mind for those little tiny communities that were having struggles in lots of other ways. So we we knew that they needed help and so I was part of a team provincially remember our services are delivered provincially including Public Health services so we would work with those largely those Public Health teams to make sure that communities were ready. My gosh that was we were so we were so lucky. We did everything we could,

but we were so lucky that ultimately H1N1

wasn't that bad, I guess you could say it yeah it could have been a lot worse. 

So, what did you learn from that experience that helped channel your sort of management of COVID 19 well in DC? We learned that we needed to cooperate with the province that First Nations needed to cooperate with the province we knew that public health centers those local public health centers needed to take us into consideration they didn't even know for instance sometimes that they needed to vaccinate us that that was their job that you know they thought they thought they were vaccinating everyone else but when it came to us they thought oh well really we we have to do that we we have to speak to those people or go to those communities and and vaccinate we didn't we didn't know that so we'd have to we'd have to like literally go and tell them and explain well here's why we you need to go over there

so that was part of it but also we needed to make sure that communities understood their pandemic plans so that it was quite a lot of work to engage those health workers and those indigenous leaders that another pandemic could happen and we needed to be ready and we spent a lot of time there and lo and behold my gosh, COVID happened 11 years after H1N1 and the the indigenous communities in BC I think were pretty pretty ready, yes gosh that's astonishing what you said about how public health didn't realize their their responsibilities now let's contrast the previous pandemic experiences of the indigenous community to the current COVID pandemic several working groups were set up by the government of Canada to facilitate the success of the COVID 19 vaccine program for indigenous communities. Evan could you please describe the work of the indigenous services Canada or ISC led COVID 19 vaccine planning working group sure indigenous...

Kojala Medical presents Covid-19 The  Answers. The show that delivers the

scientific evidence-based knowledge that can  safely return us all to our pre-COVID lives.

My name is Dr. Funmi Okunola  and I'll be hosting the show.

Every week you can listen to me  interview a highly respected professional

about the science that can reduce your risk  of becoming infected with the coronavirus.

The  Answers, titled 'The vaccination of the

Indigenous People of Canada and the effects  of Covid-19 on the Indigenous People of Canada

I'd like to introduce you all to Dr Evan Adams,  Dr Adams is from the Tla'amin First Nation

near Powell river in British Columbia  Canada. Dr Adams completed his doctor of

medicine degree at the University of Calgary  and his Aboriginal family practice residency

at Saint Paul's hospital UBC in Vancouver Canada  as chief resident. He then went on to acquire a

Masters of Public Health degree from John Hopkins  University in Baltimore in the USA. He was the

first ever Aboriginal health physician advisor  in the office of the Provincial Health Officer

and became the deputy Provincial Health Officer  in the province of British Columbia Canada in 2014

he became the first Chief Medical Officer for the  newly formed First Nations Health Authority in BC.

Dr Adams is currently the Deputy Chief  Medical Officer for Indigenous Services Canada

Dr Adams is a multi-award-winning actor, most  famously starring as Thomas Builds-The-Fire in

the movie, 'Smoke Signals' and has over 30  years experience as a motivational speaker.

Dr Evan Adams is one of the most famous, honored  and much-loved persons amongst the Indigenous

People of Canada. Welcome! Ah thank you, what a  very generous introduction. Oh it's very true.

I've spoken to many Indigenous People and I  hear nothing but high praise. Ah, that's a nice

feeling, thank you. So, I've been dying to ask,  how a medical physician came to be a famous actor

and did you have to choose  between the two professions?

Yeah, it actually happened the other way around. I  was a fairly good student and as a school student

was told 'oh we we so need you to get an education  and return home and help with all of those

all of those issues' and I think  as a as a young person, that's

pretty daunting and so when I was in University  I was studying Biochemistry in my second year, a

woman came up to me on the street and she said are  you an actor and I just lied. Why did I say yes?

She said come and read for me tomorrow and I  did, and I was cast in the second lead in a,

in a film and it was actually quite wonderful. I  thought oh this is really fun, it's much better

than the drudgery and the burden of training and  going home and serving. It's just really light

fun, but of course I did it with all my heart and  I was uh, I think 18. I looked 16 I thought I was

you know akin to an English major or a performance  artist and I just uh, I just kept working, but by

the time I hit 30 I thought oh I better go back  to my original dream before I age out and see if I

see if I can do it so here I am. I've done them  both and it's been really quite a journey. That is

fantastic and a real inspiration to lots of  other students. I mean I often tell people now

you can have more than one career. And  that's just a great story. Thank you. Oh,

you're welcome and I hope it does encourage people  to at the very least recognize that we all play

many roles right like we're not just we don't  just want to be good at our one profession,

we also have you know we want to be a good person,  we want to be a good partner, we want to be a good

parent, we want to be clear honest authentic.  Right there, there are lots of goals and I

feel like sometimes we're raised up, just for  excellence and work and that's just not enough.

Yes, and, and I think when you've  had those sorts of experience,

it gives you breadth and depth of character  too. It helps you to relate to people better.

Yes and it's also humbling, which is very  important. I think it's important for people

to not position themselves as subject matter  experts, or as de facto experts right? As

physicians we can be, we can think of ourselves  as God-like. I always joke. Doctors, they're just

like people. And I really want to avoid  that, especially of course with my people

you know, who I was seeing as patients, but  now take care of as a Public Health doctor.

I needed to be seen as really quite approachable  and not as some fancy doctor coming from a far

away city, who was going to institute things that  were not helpful, or meaningful to them. Indeed.

We have an international as well as a national  audience, so I thought I'd start the program with

a definition of Indigenous People and communities  pulled from the Canadian government website

IndigenousPeoples is a collective name for  the OriginalPeoples of North America and

their descendants often Aboriginal Peoples is  also used the Canadian constitution recognizes

three groups of Aboriginal Peoples Indians  more commonly referred to as First Nations,

Inuit and Metis. These are three  distinctPeoples with unique histories,

languages, cultural practices and spiritual  beliefs. More than 1.6 million people in

Canada identify themselves as an Aboriginal person  according to the 2016 census. Aboriginal Peoples

are the fastest growing population in Canada  they grew by 42.5 percent between 2006 and

2016 and the youngest population in Canada  about 44 were under the age of 25 in 2016.

There are more than 630 first nation communities  in Canada which represent more than 50 nations and

50 Indigenous languages. Evan is there anything  that you'd like to add to that statement?

Yeah I think you know, the United  Nations and the World Health Organization

speaks of at least 80 countries that have  Original Peoples and Indigenous populations

who are affected by waves of migration and  migration is not a bad word. We have feet,

we're not barnacles people go to different  places and set up their homes, but sometimes

for IndigenousPeoples the commonalities  between us you know we're not DNA cousins

but we're cousins by our colonial experience.  And so definitely, in Canada IndigenousPeoples

their health was going in one direction  health interrupted and now it's going in

another direction and we actually have  the worst health of any ethnic group in

the country in our own territories.  All right, that's sobering. So, I'm

moving on to the questions. I think it's important for our

International audience to understand some of the  nefarious history between the Canadian Government

and the Indigenous People of Canada, although  this was well known for decades within Indigenous

communities the recent discoveries of mass graves  at past residential school sites across Canada,

has cast a spotlight on the treatment of  Indigenous People here across generations,

which frankly, a significant proportion  of the general public were ignorant of.

In order to try to understand the mindset and  lack of trust within the Indigenous community

for Canadian governmental systems, can you please  provide some of the background of the racist and

genocidal practices perpetrated by the colonial  system to the Indigenous People of Canada?

Thank you, thanks, and I think of colonization in

many other countries that are kind of  illustrative of what was happening here.

There were IndigenousPeoples all over the Americas  including of course Central and South America.

And I think of places like Hawaii, Tahiti,  and of course there are many other places. I

mean you could even you could even say the  experiences of of Indians or of Africans

their quite violent histories where people  were subjugated and their lands and wealth

went from them to other hands, and that  was really essentially the case here.

IndigenousPeoples in Canada had to live under what  was called the Indian Act and there was no other

Act for any other ethnic group. Just for us and  let's not be naïve, part of it was to separate

us from our lands and to contain us. Put us on  reserves or reservations and part of that was

an attempt by the Canadian Government in allyship  with many churches to take children from their

Indigenous families to institutionalize them  and to try and get them to forget where they

were from, and to accept a different way of being  and knowing, and those those places residential

schools and they weren't really schools they were  really much more like like prisons had a very high

fatality rates and many many children died. So  now Canada has gone through a process of trying to

reconcile what has happened. Lest we forget. And  we are finding all kinds of unmarked graves with

thousands of children's bodies and we as a nation  have to deal with, and ask what happened who,

who are we. That this could occur in this country  because I think Canadians are proud of themselves

on the International stage they Canadians like  to think of themselves as being a fair people but

this is definitely a stain in their history  and for us, my parents went to residential

school. For us, it is definitely a reckoning,

as well like what does this  mean for us in our own lands?

Evan you were the first Chief Medical Officer  for the First Nations Health Authority in Canada

based in British Columbia. The only health  organization in Canada set up to directly provide

health services to first nation people by first  nation people can you please tell the audience

why this was set up? Sure, the health system or  health setup for Canadian citizens is delivered by

our provinces, however for Indigenous People  their healthcare system was created separately

and was seen as a Federal system. So around  all other Canadians, except for maybe the

armed forces, around all other Canadians oh, and  prisoners too, they're considered Federal subjects

they would have hospitals and physicians  employed by their provinces but we would have

the separate system or we did have this separate  system, run by the federal government and it

was exceedingly inefficient to have healthcare  delivered from the capital city, Ottawa several ,

that's not several, a few thousand miles away,  or from the provincial capital hundreds of miles

away, or kilometers away, and so we enacted in our province and amongst

the IndigenousPeoples NBC a system that was  run by by us essentially so for a large First

Nations health service organization created  to help IndigenousPeoples particularly First

NationsPeoples to be better and it really has been  quite an important step in self-determination in

improving outcomes achieving equity in service and  I think as well having people be less subjugated

and participate more in their own wellness  but also in society as well. Thank you.

Could you tell us about your two-year secondment  at Indigenous Services Canada and your role as

Deputy Chief Medical Officer. Were  you invited to take up this role?

When I was at the First Nations Health  Authority and serving the First Nations people of

British Columbia and working as a really a Public  Health Official as a physician with authority to

vocalize and direct care and attention to specific  areas like mental health or exploitation of women,

or substance use, that was really a lovely  piece. I did that for many many years, but

I did feel like there was more work to be  done in other areas and I feel like the

pandemic gave me an opportunity to say well  let me go Federally, let me work Nationally and

work on all things code. Because actually, like  everywhere, many healthcare workers and other

workers were being redeployed to deal with COVID  issues so really in a way, and I asked for this,

I was redeployed and sent to a National  position in our National Capital in Ottawa.

All right.

So moving on to the COVID vaccination of the  Indigenous People of Canada. The reason why I

wanted to do this interview amongst others, is to  highlight the marvelous achievement that you were

part of with regards to the scale-up and execution  of the national COVID vaccination program

for the Indigenous People of Canada. You achieved  an eighty percent two-shot vaccination rate on

reserves up to a year before this was achieved  nationally. The vaccination program involved a

brand new vaccine formulated from mRNA technology.  Indigenous People have endured significant human

rights abuses from the Canadian medical system  as a result of historical colonial practices

and continue to suffer racism in the health  system prior to the arrival of the COVID vaccines

what medical psychological and social impacts  did Covid-19 have on Indigenous communities?

Yes, the pandemic was absolutely frightening for  all of us. Particularly for our small communities.

We have many small communities. About  650 different First Nations communities

in Canada many of them are quite remote and  because of their remoteness and their size

they don't have tertiary care. So they were  identified quite early on as being vulnerable

just on, on just on a geographic basis if they  got COVID they would have very few means to help

anyone there to stop an outbreak, or to  care for those who were, who were sick.

Of course there were other risk factors that  we brought forward a number of us and my team

included where we said Indigenous People have  the poorest health of anyone, so they do have

elevated risk compared to the average  Canadian and we have a special relationship

with the crown with the country of Canada.  So we're actually different from other

marginalized groups and chiefs, or our  leaders were clear that in their relationship

the health of ourPeoples was important  and this happened in many countries.

This happened in Hawaii in the United  states. In New Zealand, in Australia.

Those countries named their IndigenousPeoples  as having special risk and so they were given

more of a priority than the average citizen in  those countries, so we did that here. We got

the word out that we would have some availability  of the vaccine eventually. Our people did really

well at the beginning because we were so remote  and in part because we protected our borders.

We protected our communities from importation.  We actually literally set up roadblocks and

asked people's business going in and out  of our tiny communities, but eventually our

infection rate and our mortality rate and our  complication rate were worse than other Canadians

around. So now about two and a half times  worse, roughly from the data that we have

so we did push hard in communities and we said  please let's look after each other we we can't

afford to do badly at this time we've had a  long history of communicable diseases that

were very bad for us including smallpox and  tuberculosis and even modern scourges like

HIV and also we had been already  giving health messages to our people

so anyway, we we talked it up we encourage people  to be vaccinated and yeah we did fairly well,

even though in my mind I would like to do better!

Indigenous communities in Canada have specific

experiences via Provincial territorial and local  Public Health systems concerning the management

of their health and access to vaccines and  past pandemics. Could you please tell the

audience about their experiences of the H1N1  pandemic back in 2009 and the lessons learned?

Thanks, yes I was in charge of the  Indigenous response to H1N1 in 2009

in my province. I was working provincially  then remember my previous job was with First

Nations NBC but my job before that was with the  province of BC looking after IndigenousPeoples so

H1N1 happened and again we were nervous about  what would happen to us we knew that our

communities were not prepared much less  prepared than they were this time around in that

for instance, they didn't have communicable disease  and pandemic plans at a community level but almost

no one knew them they were on a shelf collecting  dust large pandemics was was not really front of

mind for those little tiny communities that were  having struggles in lots of other ways. So we knew

that they needed help and so I was part of a team  provincially remember our services are delivered

provincially including Public Health services  so, we would work with those largely those Public

Health teams to make sure that communities  were ready. My gosh that was we were so we

were so lucky. We did everything we could, but we were so lucky that ultimately H1N1

wasn't that bad, I guess you could say  it yeah, it could have been a lot worse.

So, what did you learn from that experience that  helped channel your sort of management of Covid-19

well in BC? We learned that we needed to cooperate  with the province. That First Nations needed to

cooperate with the province we knew that Public  Health centers those local Public Health centers

needed to take us into consideration they didn't  even know for instance sometimes that they needed

to vaccinate us that that was their job that  they thought they thought they were vaccinating

everyone else but when it came to us they thought  oh well really we we have to do that we we have to

speak to those people or go to those communities  and vaccinate we didn't know that, so we'd have to

like literally go and tell them and explain,  well here's why we you need to go over there

so that was part of it, but also we  needed to make sure that communities

understood their pandemic plans. So that it was  quite a lot of work to engage those health workers

and those Indigenous leaders that another  pandemic could happen and we needed to be

ready and we spent a lot of time there and low and  behold my gosh, COVID happened 11 years after H1N1

and the Indigenous communities in BC I think were  pretty, pretty ready. Yes gosh that's astonishing

what you said about how Public Health didn't  realize their their responsibilities. Now let's

contrast the previous pandemic experiences of the  Indigenous community to the current COVID pandemic

several working groups were set up by the  government of Canada to facilitate the success

of the Covid-19 vaccine program for Indigenous  communities. Evan could you please describe the

work of the Indigenous services Canada or ISC  led COVID-19 vaccine planning working group?

Sure, Indigenous Services Canada was most  importantly part of the Federal family, so we

would be in the same meetings as Health Canada, or  the Canadian Armed Forces. We would interact with

the National Association, sorry what was NACI again? Basically the National Immunization Committee

and we would be we would hear what they were  planning and we would be able to say oh and

remember First Nations Inuit MET wherever they  are, need to be included and not just included

but prioritized. A lot of the operational stuff of  getting vaccine paid for and then sent out from

where they were being manufactured to major cities  and then flown or driven out to our communities

was was quite a piece I think of it as being a bit  like a military campaign. It was that operational

and so we we were making sure that we were in on  that every step of the way as in sometimes local

Public Health wasn't sure how to get vaccines into  arms of our citizens in our communities that were

several kilometers or dozens of kilometers away  from them they hadn't been vaccinating us in the

past so how did they vaccinate us now? How did they  count our cases? How did they report on those cases?

We wanted to be involved in that data  gathering and reporting so yeah there

was there was definitely a lot of coordination  to do and my team absolutely helped with that

and part of our work too, was to assist  with messaging core messaging that needed to go

to all Indigenous Peoples in the country,  even though much of that work was being

done on a local level at a regional level or a  provincial territorial level. Yeah, it was a lot.

One of the many challenges of the ISC COVID-19  vaccine plan must have been accessing communities

in remote and isolated regions of Canada such as  the Yukon and the northwest territories and parts

of Ontario, Alberta, Manitoba and Quebec, to give  the audience some background these regions can

have infrequent flights roads can be interrupted  by weather conditions and there can at times be

no roads in or out of the community internet  access can be slow or absent and there can be

infrequent radio and phone connection. How did  ISC overcome these challenges and provide COVID

vaccination support to First Nations Inuit  and Metis communities in these remote areas?

Now we we just made sure that we were  in every part of the operation so

we were keeping an eye on hundreds of communities  and hundreds of deliveries and they would each

have their unique challenges and we weren't like  solely responsible for instance for getting that

small plane to go to that small community. We  were a part of it, so we would be helping with

coordination and planning and we would send nurses  up. We would be part of reassuring communities, yes

the vaccine will be there on time it'll be here  on it'll be there on that date if you need extra

vaccinators we'll send them up or if they were  having an outbreak how are you doing? Do you,

are you getting a bit overwhelmed, should we send  you respite? Do you need? Is it so bad? Do we need

to send the Canadian Armed Forces? Do we need to  send the red cross so basically we were in touch

with all of those communities as they were going  through COVID and even checking in and saying how

are you doing mentally and spiritually like do  you need those kinds of supports? Should we send

counselors to help with mental wellness? Is  there a community straining are they having

for instance, deaths. Have you lost  Elders? Are you having runs of suicides?

We will assist and again, we weren't the only game  in town. There were many, many helpers. But we

you know, we were Indigenous Services Canada  we were seen to seen as an important part of

of the effort and often would play a leadership  role but in coordination with local leaders,

because the local leaders if they didn't  like us, or they didn't want us there,

they could very easily keep us out. So we  definitely had to be diplomatic and say no

we're here to help you. Can, you can  count on us. What a fabulous response.

I saw some figures about a year ago, you may be able to update me? That vaccination

of Indigenous People living off reserve or away  from their communities particularly in Urban areas

hasn't been as successful. Could you describe the  challenges that are faced with getting this group

of people COVID vaccinated? Yes our people in the  cities have special risks because they're not in

our villages amongst their family members  and where there's a social network right?A

a community center, a nursing center, resources to  support them, they're away, they're in the city.

I would say they're probably not treated  as well as they could be many of them are

impoverished, or marginalized in the cities. There are often inner city portions where many

of our people with mental health and substance  abuse issues are under housed and exploited and

the cities can be unkind and also the cities  may not give them neighborhoods or collections

of Indigenous People who support each other and  live together so we have a city site where there

are a hodgepodge of Indigenous Peoples living  here and they're disconnected from each other

disenfranchised, poor, often  with social issues that

create obstacles for us vaccinating, or accessing,  or caring for them. And we would have to

call on local services. We would call  on local chiefs. What can we do? How

do we help with these efforts? Often the city  itself where those Indigenous People were and

the Province or territory that they were in had  some responsibility. In fact they would say well

they're off-reserve Peoples. We're supposed  to help look after them because my agency

spends for better or for worse. A little more  time in our communities like on reserve and

they do off-reserve so there was a lot again to  coordinate there were a lot of challenges and

luckily, a lot of our agencies in the cities  stepped up and said we will help. Good.

So moving on to the effects of COVID-19 on the  Indigenous People of Canada. I'd like to delve

deeper and explore the direct and indirect effect  of COVID-19 in Indigenous communities. Now that we

are two years into the global COVID-19 pandemic.  At present, as you've already mentioned the rate

of active Covid-19 cases recorded in Indigenous  communities living on reserve is double that of

the overall Canadian population, yet just a few  minutes ago we explained how a two-shot COVID

immunization was a huge success in the Indigenous  community on reserve, with an 80% vaccination

rate. Do you have any theories as to why the  increased rate of COVID cases is occurring?

Yes. Because we have the poorest health of  any ethnic group in the country and because

the social determinants of health are poorer in  our communities. Generally we did worse, so for

instance you can imagine in the North where there  are lots of housing challenges. If one member

of the family got COVID, many others would  get it and they would be far from care.

They would be far from Public Health personnel who  could assist like with contact tracing, or moving

them towards a vaccination really quickly. They  would be away from centers that had been converted

to care for persons with COVID because not every  hospital right was equipped to deal with COVID

only certain ones there are only a few  at the beginning many more at the end,

but our people would have difficulty accessing  them because of their geographic challenges

but also social challenges means that it  can be harder for them to move towards

care and help so there were lots of oh and  also for instance, not even having great water

for hygiene you know, for  washing and cleaning services

could be a problem and for many of our  communities because they're northern and indoors

they're indoors more we supposition that maybe  the transmission rate was was worse so we did see

that our infection rate was quite high, but we  also noted that our complication rate was lower

like around three quarters that of other  Canadians. So our hospitalization rate, even though we had twice as many people infected. We had about three quarters the

rate of other Canadians for hospitalization  and death. And we don't know what that's about.

That's interesting. That sounds like a research  project that should happen in the making.

The Omicron wave has been particularly  prevalent and destructive worldwide

leading to the highest hospitalization rates  and death than any of the other variants.

What are your own personal experiences of  this occurrence in Indigenous communities?

Gosh, so my office along with others of course,  but we were at the center of intel as it was

coming in. We were watching over communities and  we would hear very quickly when a community was

affected, so we would keep count of and we would  daily counts of how many people were active cases

how many of our people were new cases how many  of our people were hospitalized how many had died

that day and we would see the numbers increase  we would keep track of what we call communities

of concern communities that vary that had high  numbers. More than 10 cases in the village at any

given time. We would see that number  start to start to grow. Community leaders as well

would call us and say just in case you didn't see  the stats we're in trouble here we need we need

some help we'll need some support we're going to  be calling you we're going to be calling you often

about what's happening here on the ground. So it  did feel like we felt the waves. Like we literally

felt the waves in our bones, because it would get  to be bone-crushing very time-consuming work when

a lot of our communities had a lot of cases so  Omicron was quite a large wave and we were all

tired by the time Omicron occurred we started  to talk about, oh we really are much less

concerned with mild cases because Omicron  did have a number of mild cases and more

concerned about the hospitalized cases for sure  and we started to talk about long COVID what was

were those mild cases truly mild maybe they  were mild for the first several days but

really were there were they sequelae and do  we need to keep track of of those people who

in the acute setting, we weren't watching  over. Yes, so that's that's what happened.

From my understanding women and children are being  particularly affected by Covid-19 in Indigenous

communities. Evan could you please explain why? Yeah,  that was that was the surprising piece that we saw

in our data was that women and children were  much more affected than other other age groups

generally all of our age groups had  higher numbers but we saw particularly so

with children and with women we suppositioned  that well because we have so many children

like where our our populations are really young  and that perhaps children are overly affected

by the social determinants of health like  younger families perhaps have poorer housing

or they're just poorer in general. They don't have  the resources of older people. We supposition maybe

because they went to schools or because  they were much more social than than

older groups we suppositioned that women because  women are caregivers or the heads of families

and thus had to had to go out and take risks  go to the store or go to work ride the bus

pick up their children at school that maybe that's  why that was occurring we also had this other

perhaps notion that maybe the men were, we used  this expression cowboys they were too macho to go

and get tested and so maybe we under counted them  these are all just theories about why we saw that.

What have been the economic consequences  of Covid-19 in Indigenous communities?

How has ISC stepped in to  help alleviate these burdens?

Yeah, so Indigenous Services Canada did set  up a few funds that were COVID related that

had very loose parameters on them so people could  use them easily and freely when they needed them.

We at the beginning, up until I would say  weeks ago we did not hear a community saying

that we were having other effects from COVID then  infection they weren't saying to us we've had

a loss of revenue. We don't. We need food stamps. Food security's done. We weren't hearing that .

We didn't hear that families were in trouble  economically or that people's opportunity

for work was affected. We did hear of course, that  their opportunity for education was affected but

everyone was talking about that so, yeah. We  were surprised. We're hearing it now. We're

hearing it now prices are rising, people don't  have the resources to cope now and we're getting

requests for financial assistance so with those starting to come in we are definitely

reacting to see how we can do the very best that  we can. Would the tactic be for instance, food

security? Would the tactic be a fund ? Like the  former COVID fund even though it's not directly

related to COVID at the moment like something  like a COVID fund would we need to do something

local because the food security is partly  dependent on geography, right? How does food

get delivered? Can food grow in your Northern  or Southern community and so maybe a regional

response would be most appropriate so, again as  tired as we are. I'm seeking seeking to help and

I think we're going to hear more and more not just  from Indigenous People but from around the world

some of those indirect consequences of of COVID  we're in a very active recovery phase and the

recovery doesn't mean just physical recovery at  all, it needs lots of different kinds of recovery.

While we would all love to get back to pre-Covid live, we have

all endured strict governmental, particularly  Public Health measures, these last two years

now society is being told by government  agencies to live with the coronavirus

and encouraged to believe that we are entering  an endemic phase on the back end of the pandemic

many of the medics and scientists I speak to  regularly recognize that we are clearly still

in a global Covid-19 pandemic. This is confusing  mixed messaging for anyone. In your opinion what

effect is this change in Public Health policy  and attitude having on Indigenous communities?

It's been a very difficult time for  us to reach this point of opening up

and it is in part, because of COVID  fatigue, it is in part because of politics.

Political leaders who are not health leaders,  or health experts Political leaders saying

we need to open up. It's partly economic. We  need to get back to work, get back to school,

in spite of the risk, the safest thing to do is to  stay home and to see no one, but maybe that's not

something that's sustainable. On the other hand  for us in Public Health we're really worried about

the next wave. That this  opening up all over the world

we're getting some signals that there  can be some large scale outbreaks and

another wave because of the opening up and of  course there's still the specter of other variants

of concern that we will have to react to and the  re-imposition of those Public Health measures

so , I'm a health person. I'm much  more concerned with human health

than say economic recovery. Economic recovery is  not my job, or how much politicians are are liked,

or not liked because of Public Health measures is  not my work, so definitely from my point of view

we need to continue to be cautious and we have  been saying to individual communities We know

that your provinces and territories and towns  nearby are opening up, but it's up to you. And

you might want to consider how much COVID is  around you. How much you have to lose because,

protect your knowledge keepers and  your elders and your babies please!

That they could go slower if they  so chose to do that. Thank you

Last week, we discussed the impact of  school closures during lockdowns on

children's education safety and health women  and children can be particularly vulnerable to

abuse in these scenarios. What has been done to  support Indigenous communities with regards to

safeguarding of education and protection from  abuse? hmm those are really good questions

family violence and women's  health are part of our team

they are not directly involved in the COVID  response however chiefs and community leaders

have already identified family violence  and the risk to women and children and the

mental health risks, like, suicidality in  young people, as being major concerns for them

and they've been saying that since the 80's  So there are programs in place, there are

personnel whose job is exactly that the safety  of families to respond to mental health crises to

offer counseling and assistance. So  those teams are already in place,

however as we all know services were  quite interrupted by COVID so even though

violence and mental health were  getting worse services were

pulled back or they couldn't be delivered  in the way that they used to be, so

you can assume, that there was much more suffering  during the pandemic than there was before

again the leaders would say that to us at all  of our meetings they would say and not only

are we worried about COVID but our our people are  straining and bad things are happening so we would

continue to offer our mental health services  continue to try and respond to particular

places of concern and it's not like all of  the communities we're doing badly all at once

some communities would be doing badly and then  the next month it would be a totally different

group of communities that were doing badly  because of their particular circumstances

yeah so I think once we go back and we look at  what happened. I do suspect that we will say yeah

some bad stuff happened and people are starting  to talk about how bad it was. And maybe we could

have done things in a different way. So that there  was more safety than was available on the day

so that's something to build on I guess yes  I and I think it's important and it's okay

for us to say ‘yeah, we could do better’ or ‘we  could have done I’m better’ because for for me,

I mean any woman or child or family under threat  is one too many and so there were a number of our

families that were under duress who probably could  have done with better help and our services were

not as good as they were before COVID so is  there something more that we could have done I

think that'll be part of the part of the analysis  and I think I think we will learn to do better

I know when I was with the First Nations health  authority in bc for instance we had quite large

mental health teams and that they evolved to have  a kind of roving function they would go where

they were needed so rather than one worker in one  community and another worker in another community

those mental health workers could band together  and say hello look the trouble is over there

that's a few of us go over there and respond and  then if there's another if we're needed somewhere

else at a different location we'll go to that  other location so that seems to be a sensible

a sensible model but there will be other  teammates and stakeholders I think who will

who will help shape mental health in the  future definitely it has been seen as an

issue so for instance the Canadian government  newly created a ministry just several months ago

a ministry of mental health and it deals  with exactly these kinds of issues and

substance use as well. Well that's welcome to hear  and I think that's one of the positive things to

come out of the pandemic that mental health isn't  isn't going to be as stigmatized because it seems

that everybody has suffered mentally and I think  some of the challenges that you've experienced

in Indigenous communities with retraction of  supports, has happened universally everywhere

Looking forward. We started on a positive note highlighting your successful vaccination

rollout in the Indigenous community and  now I'd like to end on a positive note

the cooperation and organization of governmental  agencies with the leaders and healthcare workers

of the Indigenous communities in Canada to  deliver COVID vaccines appears to be unprecedented

what future projects and programs can be  built on this new attitude and possible

infrastructure that will really benefit  Indigenous People and their health care

yes COVID definitely highlighted weaknesses  within the system. So for instance, there

can be a lack of cooperation between an Indigenous  village and provincial health staff our national

Public Health data system could absolutely use  improvements and each province interrogatory

is kind of idiosyncratic in how they collect data  and then share that data like share it with other

provinces and territories or share it with the  federal government or share it with other data

holders and match those data. So for instance  a First Nations membership list and provincial

hospital data could be matched and you could  get a sense of First Nations hospitalizations

so by and large that that kind  of sharing absolutely could be

improved but I think the bottom line is that  we've seen we have to speak to each other

the worst case scenario is poor people  or marginalized people are left to manage

their own marginalization or their own poverty the  best case scenario is everyone shows up and says

we absolutely need to do this no one left behind  equity is a goal equity of service but also equity

of outcome in fact during the pandemic we  talked about that becoming a law not just

something that would be nice but something that  would be a requirement that every system like say

a hospital would have equity as a goal you know  are is your transplantation rate for whites the

same as it is for blacks as it is for Indigenous  People are you serving people in the same way so

for instance studies around pain control is the  pain control that you're meeting out for white

canadians or the white people in your neighborhood  the same as for Black, or Indigenous People.

Those are important questions that we can have at  the table When all the stakeholders are together,

the old way of doing business is for instance,  a Premier, not Premier of the Province,

refusing to meet with Indigenous Peoples or leaders  and not have their needs enunciated, or recorded

or responded to and that definitely used to happen  so we can get better. We can get better at that

and I think we've named that. And we've named  Public Health data collection as you know very

clear goals that we just have to attain we can't  keep leaving people out or leaving them behind .

Thank you so much for joining us today Dr. Adams,  it's been a real pleasure to hear your thoughts

and opinions and experiences of the Covid-19  pandemic. And to provide a voice for Indigenous

communities because personally as one of my main  drivers for having this podcast is I haven't heard

the Indigenous voice in Covid-19 and thank you  so much for being such an honored and well-loved

representative of that voice. You're you're  so kind and thank you for the opportunity to

speak at this level I almost never get to describe  what this work is like and it is definitely

difficult to be included in this kind of work and  this kind of response right it's been a challenge

but I can definitely sleep at night that  I'm trying to do good things so thank you

and so many people are so  grateful for it. Thank you so much.

Thanks for listening to this week's episode of  'Covid-19 The Answers.' If you enjoyed the episode

please SUBSCRIBE, RATE and REVIEW and do visit  our website kojalamedical.com/covid19theanswers