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Brock University history professor Maureen Lux has documented a part of this recent past in her new book, Separate Beds: A History of Indian Hospitals in Canada, which describes a period from the 1920s to 1980s, when the nation effectively had two health-care systems - one for aboriginals and one for everyone else.

In these hospitals, First Nations patients often received substandard care in facilities that were, in Lux's words, underfunded by design. Some patients were experimented on by surgeons using outdated and ineffective treatments for illness like tuberculosis, leaving them disfigured. "It was all part of an attempt, frankly, to prevent white Canadians from having to share hospital space with aboriginals," she said. Although there were so-called Indian hospitals prior to the mid-1940s, they didn't really take off until after the Second World War ended. This was the period where Canada began to move toward universal health care. While the politicians argued over what that might look like, federal funding was made available to build hospitals. Lux said that by 1948, that money created more than 46,000 new hospital beds in Canada. At the same time, the federal Indian Health Service was responsible for a separate, segregated hospital system for First Nations communities.

Unlike the facilities for non-aboriginal Canadians, these hospitals were not new buildings, but established in army bases Ottawa no longer needed. The pay for medical staffin these hospitals was low, attracting doctors and nurses who, Lux said, "could not get a job anywhere else." Lux tracked how tuberculosis patients were treated in these Indian hospitals compared to the rest of the nation, and the results are chilling. Prior to the 1950s there were few effective treatments for tuberculosis. Beyond bed rest, there were some surgical attempts, including deflating lungs and removing ribs, to halt the disease.

"But that was never very effective, but at the time there were no other options," Lux said. "But by the 1950s, you have effective antibiotics and instead of staying at the hospital, most times you were given your meds and sent home." Unless you were an aboriginal person. The prevailing attitude was that First Nations people could not be trusted to take their medications, so they were kept in hospital and, instead of using antibiotics, doctors continued to use ineffective, invasive treatments. In fact, First Nations people could not even use Canada's proper hospitals. Prior to national health care, Canadians still needed private health insurance. So if an aboriginal person came to a hospital, they were asked how they would pay. Usually the answer was the Indian Health Service, which only paid for treatment in Indian hospitals. Patients often died. If an aboriginal person was in a facility far from home, the federal government would only pay for them to be buried at the nearest grave yard, rather than be sent home for a funeral. Lux said many First Nations people were buried in unmarked graves in the back of graveyards as a result.

The decommissioning of this segregated system didn't start until 1968 with the arrival of universal health care, but some facilities continued to operate until the 1980s. Lux said in a few remote communities, a few of the hospitals still exist, although they operate more as medical clinics than hospitals. The point is there are First Nations Canadians alive today who were treated in those hospitals, and would have been subjected to poor, even dangerous, care simply because they were aboriginals. So when someone asks why, when it comes to First Nations issues, the past cannot be left in the past, you can tell them it's because that history is very much alive for many people. And until we learn to deal with the reality of that, nothing is going to change. Lux's book is available from the University of Toronto Press and on Amazon.

"I don't see how we can go another four years with this government, frankly. The past nine years have been disastrous in terms of us as First Nations accomplishing what we set out to do for our peoples. A lot of that has to do with the failure of First Nations policy in this country," said Ghislain Picard, the AFN's regional chief for Quebec and Labrador. Rarely has First Nations anger translated into such pragmatic talk, but aboriginal leaders will have to change a political culture that has traditionally shied away from involvement in federal and provincial politics with just three months left between now and the Oct. 19 election. "I know these are not our governments, but this is a strategic vote," said Grand Chief Patrick Madahbee of the Union of Ontario Indians, which represents 39 First Nations in the province.

Madahbee criticized Prime Minister Stephen Harper for signing trade deals that involve resources pulled from the land without the consultation or agreement of First Nations. But such complaints will receive little traction with federal parties if aboriginal people maintain their low-rates of election participation, he said. "The Indo-Canadians, the Chinese Canadians ... There's a whole number of groups that have learned that already. They have mobilized and they have influence. Right now we're being ignored." Bellegarde said the AFN is looking for politicians to implement the recommendations of the Truth and Reconciliation Commission, call an inquiry into the large numbers of missing and murdered aboriginal women and end a 20-year funding freeze for aboriginals that has contributed to problems with aboriginal health, housing and education that other Canadians never have to experience. "Invest in the fastest-growing segment of Canada's population, our young men and women. Invest now and there will be huge rates of return on investment in the future," Bellegarde said.

Both New Democratic Party Leader Tom Mulcair and Liberal Leader Justin Trudeau spoke at the AFN meeting Monday and committed to improving the relationship between the federal government and aboriginal people. Both noted the fact that they had prominent and numerous aboriginal candidates who will be running for their parties in the next election. "Aboriginal Canadians have understood for 10 years now what happens when their voices are not heard by the political process, when they are written off as they are by this Harper government," said Trudeau.

It's a hopeful sign for Tyrone Souliere, of the Garden River First Nation in Sault Ste. Marie, Ont., who has taken it upon himself to lobby chiefs and band councils to get their people registered to vote in the October election. Founded in frustration with the federal Conservative government, Souliere estimates there are some 30,000 eligible aboriginal voters in Ontario alone who could be harnessed to advance the cause of indigenous people in the coming election campaign. His efforts are focused on educating eligible voters about the issues and on what they steps they need to take to ensure they can cast a ballot in the election, following changed to the Elections Act that place higher standards on what can be used to confirm one's identity. "The only way to change how the government treats us is to change the government and to get that message to the politicians that there's a block of votes in Indian country and it will be available to the one party that will best represent treaty, charter and indigenous rights in Parliament," Souliere said.

"That's the goal." What the leaders say Tom Mulcair promises: Every government decision will be reviewed by a cabinet committee to ensure they respect federal responsibilities toward aboriginal people. Increasing federal funding for aboriginal education so that it rivals that spent on non-aboriginal children in Canada. Federal environmental assessments for resource development projects will become more rigorous. Justin Trudeau promises

There will be a legislative review that scraps or amends laws dealing with aboriginals that are deemed to be a violation of a section of the Constitution that affirms aboriginal rights. A guaranteed annual meeting between the prime minister and First Nations leaders. The 2-per-cent freeze on aboriginal funding will be lifted to make more money available of the likes of education, health and housing.

We need to stabilize the situation in Attawapiskat in terms of making sure they have the health support they need,” Mr. Angus (Timmins-James-Bay, Ont.) told The Hill Times last week. “We need a plan to get people who are needing help in any of the communities to get that help.”

A rash of attempted suicides prompted Mr. Angus, who’s also the NDP critic for indigenous and northern affairs, to call for an emergency debate on the ongoing suicide crisis in the James Bay community of about 2,000. As a result, the House of Commons convened until midnight last Tuesday for an emotionally charged discussion on mental health services following a string of incidents in northern reserves in recent months. Several MPs choked up during their statements, recounting suicide incidents in their ridings and personal lives.

Sometimes partisan politics need to be put aside and members need to come together to find solutions to prevent another unnecessary loss of life,” Conservative MP Todd Doherty (Cariboo-Prince George, B.C.) said during the debate. NDP MP Georgina Jolibois (Desnethé-Missinippi-Churchill River, Sask.) said the suicide rate went up in her home community of La Loche in northern Saskatchewan after a shooting spree that killed four people last January.

Liberal MP Robert-Falcon Ouellette (Winnipeg Centre, Man.) recalled visiting the northern Manitoba Pimicikamak Cree Nation, which declared a state of emergency over a series of suicide attempts last month.

Mr. Angus made an emotional appeal to action in his opening remarks during the emergency debate. “We have to end the culture of deniability whereby children and young people are denied mental health services on a routine basis, as a matter of course, by the federal government,” he said. Eleven people attempted to take their lives in Attawapiskat two Saturdays ago, prompting the First Nation to declare a state of emergency—the fourth one since 2006. There has been more than 100 suicide attempts in the reserve since the month of September, many of which involved children. The community has been plagued by flooding and several housing crises in recent years.

Eighteen mental health workers were dispatched to Attawapiskat on Tuesday, including two counsellors, one crisis worker, two youth support workers, and one psychologist. While there is no set timeline, they’re not expected to leave for at least two weeks, said Health Canada assistant deputy minister Keith Conn during a teleconference last week.

Some of the people treated for mental health problems last week had previously been airlifted out of the community for assessment before being sent back after their examination, according to Mr. Conn. This past Tuesday, at least 13 people, including a nine-year-old child, had made plans to overdose on prescription pills as part of a suicide pact. The Nishnawbe-Aski Police Service apprehended them before sending them to the local hospital for a mental health assessment.

Mr. Conn said he’s heard criticism of the mental health assessment process from Attawapiskat First Nation Chief Bruce Shisheesh. Individuals who are identified as likely to commit suicide are typically sent to a hospital in Moose Factory, Ont., to be psychologically evaluated by a psychologist or psychiatrist. They are then discharged and sent back to the community, where some try to take their life again. Mr. Conn said Health Canada does not “control the process,” but he personally committed to review the mental health assessment effectiveness.

No federally funded psychiatrists were present in the region prior to the crisis, despite reserve health-care falling under the purview of the federal government. Mr. Conn said the Weeneebayko Area Health Authority (WAHA), a provincial health unit servicing communities on the James Bay coastline, is usually responsible for the Attawapiskat First Nation following an agreement struck with the federal government about 10 years ago.

A mental health worker position for the reserve has been vacant since last summer, in part because there’s a lack of housing for such staff. The community has been left without permanent, on-site mental health care services. Since then, the position has been filled by someone already living on reserve. During the emergency debate in the House last week, Health Minister Jane Philpott (Markham-Stouffville, Ont.) emphasized the need for short- and long-term responses to the crisis.

We need to address the socio-economic conditions that will improve indigenous people’s wellness in addition to ensuring that First Nations and Inuit have the health care they need and deserve,” she said. Ms. Philpott pointed to the Liberal government’s budget, which includes $8.4-billion for “better schools and housing, cleaner water, and improvements for nursing stations.”

“Our department and our government are ensuring that all the necessary services and programs are in place,” she said during the debate. “We are currently investing over $300-million per year in mental wellness programs in these communities.” Yet, Mr. Angus said the budget includes “no new mental health dollars” for First Nations communities. In addition to allocating more funds for mental health services to indigenous communities, Mr. Angus said there needs to be a concerted effort to bring in the aboriginal youth in the conversation.

We need to bring a special youth council together,” he told The Hill Times on Wednesday. “We need to have them be able to come and talk to Parliament about their concerns, so we’re looking at those options now.” Emotion was audible in Mr. Angus’ voice when he read letters he received from Aboriginal youth during the emergency debate, which expressed a desire to work with the federal government to solve the crisis.

The greatest resource we have in this country is not the gold and it is not the oil; it is the children,” he said. “The day we recognize that is the day that we will be the nation we were meant to be.” Mr. Angus met with Indigenous and Northern Affairs Minister Carolyn Bennett (Toronto—St. Paul’s, Ont.) earlier in the week to discuss potential long-term solutions to the suicide crisis. “I’ve always had an excellent relationship with Carolyn Bennett, and as minister we’re trying to find ways to work together on this, to take the tension down, to start finding solutions,” Mr. Angus said. Mr. Angus criticized “Band-Aid” solutions that have been thrown at First Nations issues over the years and said there needs to be a “transformative change” this time.

That’s where we have to move beyond the positive language to actually the brass tacks,” he said. During the emergency debate, Mr. Angus supported the idea of giving more resources to frontline workers such as on-reserve police, and health and treatment centres. 0eMr. Angus’ riding sprawls from shores of the Hudson Bay to the Timiskaming district on the border with Quebec, an area roughly equivalent in land size to that of Guinea. He holds two constituency offices in Timmins and Kirkland Lake.

Native men were twice as likely to die prematurely from avoidable causes and native women were 21/2 times as likely, the study found. The highest risk was found among First Nations members between 25 and 34 years of age. The risks for both men and women fell substantially when education and income were taken into account, suggesting, the researchers conclude, that socioeconomic factors "explain a substantial share" of the disparity. The new numbers follow the report from the Truth and Reconciliation Commission earlier this year, which identified lingering health effects as a legacy of residential schools, and called on the federal government to take action to close the health gap and to provide sustainable funding for aboriginal healing centres and the integration of indigenous medicine in health care. For Josee Lavoie, the director of the Manitoba First Nations Centre for Aboriginal Health Research at the University of Manitoba, the results are sadly familiar.

She called the numbers "shocking," but suspects they actually underreport the disparity because the census undercounts aboriginal people, who represent a disproportionate percentage of the country's homeless population and those that are "highly mobile." "To me, this is compelling evidence that we need to take serious the recommendations of the [Truth and Reconciliation Commission]," said Dr. Smylie, director of Well Living House, an indigenous action research centre at Toronto's St. Michael's Hospital. It is also important, Dr. Smylie said, to remember the link between alcohol and drug use and unresolved complex trauma when looking at the causes of death. The Statistics Canada study covers the period between June, 1991, and the end of 2006, and includes individuals 25 and older. It divides "avoidable mortality" into two groups: preventable deaths caused by factors such as injuries; and treatable mortalit

which is a death that potentially could have been averted by screening, early detection and successful treatment, such as tuberculosis and female breast cancer.

"If you have to choose, then you lose that impartiality and non-partisanship," he said. At the news conference, Mr. Bellegarde unveiled the AFN's election priorities, to which it wants all parties to commit. The priorities - including increased funding for First Nations education, training, child welfare, health care and police services, creation of a national inquiry into missing and murdered indigenous women and an action plan to address violence against aboriginal women - are aimed at "closing the gap" between aboriginal people and other Canadians. "First Nations are a major factor in this election," Mr. Bellegarde said. "Our voices matter, our priorities matter and our votes matter." Mr. Bellegarde later acknowledged his own refusal to vote might hurt his message "a little." Nevertheless, he still expects turnout among aboriginal voters to increase, due to social-media campaigns that are engaging young aboriginal people and education campaigns launched by the AFN and others.

"Out of respect for those old people, I think that's why I haven't voted." Such views are not uncommon among aboriginal peoples and are at least partly responsible for abysmally low turnout in elections. Elections Canada estimates that the average turnout for eligible voters on First Nations reserves is 44 per cent, well below the overall 61 per cent turnout in 2011. Pressed by reporters to explain how he hopes to encourage others to vote if he won't do it himself, Mr. Bellegarde suggested he'll "revisit" his decision to refrain from voting. But in an in... terview a short time later, he dug in his heels, stressing his need to remain strictly neutral so that he can work with whomever forms government.

The AFN has sent voting kits to all First Nations chiefs, with information on how to get ballot boxes to remote locations, the voting process and the new rules on identification each voter will need to produce. The Conservative government's Fair Elections Act requires every voter to produce two pieces of ID, one of which must include the voter's address. Experts have warned the proof of residency rule could disenfranchise hundreds of thousands of voters, particularly those on reserves where there are often no addresses. To overcome that new hurdle, which Mr. Bellegarde called "voter suppression," the AFN's voter kit includes a form letter that chiefs or band managers can sign to verify residency for eligible voters.

He said his wife, Laura Shewaybick, was having difficulty breathing when she arrived at Webequie’s nursing station last September. There was only one full oxygen canister in the building, he said, and the tank ran out before medevac transportation could arrive. He said he helped his wife breathe using mouth-to-mouth until she could be airlifted to Thunder Bay. She spent a month in intensive care and had recovered enough to be transferred into a regular hospital room, he said, but she died on Oct. 8.

Those problems are well documented. Last spring, the country’s Auditor-General issued a scathing report assessing the delivery of health programs to remote First Nations communities in Northern Ontario and Manitoba, where people face significant health challenges and have limited access to provincial services.

Health Canada operates nursing stations in remote communities as the first point of contact for residents needing medical care. Among a number of criticisms, the Auditor-General’s report said Health Canada had not assessed whether each station was even capable of providing all services deemed essential by the department. Moreover, the department had not communicated to First Nations people what essential services each nursing station should provide. Shewaybick’s walk prompted promises from Health Canada representative at a meeting held on Tuesday.

“We are now instituting a whole review of all our nursing stations in Northern Ontario,” said Keith Conn, the regional director of the First Nations and Inuit Health Branch of Health Canada. “Second to that, we are going to be purchasing and acquiring oxygen concentrators for each and every community. … It’s only the beginning. It’s not the end. There needs to be a lot more work in terms of collaboration, short-term, intermediate and long-term actions.”With reports from Adrienne Fox and Brent Wesley in Webequie First Nation

Paramedic Lisa Jennings says she was in a psychiatric ward, having contemplated suicide the night before, when she decided to start a grassroots movement for emergency workers suffering from post-traumatic stress disorder. 

Psychiatrist Jitender Sareen says he hopes that recent legislation adopted by some provinces will help first responders with PTSD to get access to treatment and other services quickly. (University of Manitoba)

Canada ranked No. 8 last year on the United Nations human development index, but the same indicators would place indigenous people in Canada at about 63, added Hoskins.“These inequities can no longer be ignored,” he said. “It’s not up to First Nations to right the wrongs of colonization. Government must invest in meaningful and lasting solutions so communities can heal and have hope.”

The Ontario plan will increase physician services for 28 communities across the Sioux Lookout region in the north by up to 28 per cent, and establish up to 10 new or expanded primary care teams that will include traditional healing.There will also be cultural competency training for front-line health-care providers and administrators who work with First Nations communities, more public health nurses and a dedicated medical officer of health.The government says it will also increase access to fresh fruits and vegetables for about 47,400 indigenous children, and expand diabetes prevention and management in northern and remote communities.

Recently, the Canadian Human Rights Tribunal ruled that Canada discriminates against First Nations children on reserves by failing to provide the same level of child welfare services as exist elsewhere. The tribunal ordered the federal government to speed up changes in response to that ruling.

Corresponding to the devolution process have been revisions to the Indian Act as it relates to Indian status. From the "honorary white man" policy of the 1850s, Canadian legislation has intended to unmake Indians in the legal sense. Much of this strategy has focused on attacking women, removing their status if they marry a non-status Indian, which resulted in the disenrollment of tens of thousands of individuals who rightfully belonged within their nations. In post-Charter Canada, the Indian Act was successfully challenged and amendments in 1985 and 2011 partly ended the discrimination, precipitating a surge in the "official" First Nation population.

While much has been made of the "marry out, get out" provision at Kahnawake, the membership law, as well as many other First Nation membership laws, is more complex. The objective is to separate Indian status from band membership and take control of the latter from the federal government. "Membership" in this sense includes residency qualifications, electoral rules and treaty rights, eligibility guidelines on business operations and even burial plot designation. In reserve politics, or "reserve nationalism" as Audra Simpson calls it, this might be described as citizenship and even immigration policy. In a general sense, it is about who belongs.

There are two extremes in this conversation. The "exclusive" membership perspective views lineage as the crucial qualification to belonging. Citizens must be descended from indigenous peoples, inculcated in indigenous culture. They exclude those with weak lineage or none at all, especially if taking up land or resources. Of course, communities today have increasing numbers of both groups. About three-dozen of those who share this conservative approach to membership at Kahnawake are responsible for taking the initiative to evict non-indigenous people from the community.

The "inclusive" perspective advocates for a more open community not necessarily delimited by strict ancestral connection but inter-community relationships. It is the far more common practice among indigenous peoples (extending the rafters of the longhouse, the ever-expanding circle, etc.). Non-indigenous people who can make a contribution to the community while reflecting indigenous values should be welcome. In the case of Kahnawake, a handful of these inclusive proponents are appealing to the Quebec Superior Court to protect this view. In many ways, the debate revolves around claims of authenticity: a contentious notion after 150 years of Indian policies that have cultivated artificial governments and islands of reserved lands, imposed patriarchy and domesticated sovereignty.

Indeed, indigenous peoples would be justified in evicting white people from the little land we have left if that were the case. But this is a crude simplification.

Despite the opinions of pundits or politicians on the allegedly racist law at Kahnawake (or elsewhere), this is fundamentally about people passionately and earnestly working towards visions of community well-being amid very real, long-standing and external constraints. This is about striving to be Kanien'keha:ka or Anishinaabe in a place traditionally hostile to that very proposition. Hayden King is Anishinaabe from Beausoleil First Nation. He is the director of the Centre for Indigenous Governance at Ryerson University. Jessica Deer is a Kanien'keha:ka from Kahnawake. She is a reporter for The Eastern Door.

Ambulance NB has a number of resources already in place to support its paramedics, flight nurses and medical dispatchers. There's a critical incident stress-management program, which is supported by the Department of Health and the College of Psychologists of New Brunswick. It offers peer-to-peer support for paramedics who've responded to difficult calls. The provincial ambulance service also has a free, confidential employee and family assistance program. It's available around the clock and offers employees one-on-one counselling to help them cope with stresses from work or home. Tracy Bell, a spokeswoman for Ambulance NB, told The Daily Gleaner in February that the organization was taking steps to expand its offerings to paramedics.

"We recognize that we need to do more to support our front-line employees and are taking the necessary steps to get there," she said. "In addition to existing resources, Ambulance NB will be introducing an expanded employee support program in the coming weeks. We are also looking seriously at what options are available in terms of facilitating direct access to a mental health professional or network of professionals for our employees. We hope to be able to be able to share news of these new initiatives with staff very soon." When the newspaper asked for an update this week, Bell said Ambulance NB is still working on this project. "Ambulance NB looks forward to being able to share news of new mental health supports with our employees soon," she said. "Our priority is to share information first with our paramedics, dispatchers and flight nurses." Judy Astle, president of paramedics union CUPE Local 4848, said she's still waiting for some more information. "They supposedly have what they're calling an enhanced employee assistance program. But we have not seen the details as a union yet," she said.

"We have a labour management meeting coming up next week. They may present it there. That's what we're hoping." Astle said enhancing the mental health resources for paramedics should help many professionals deal with the difficulties they experience in the line of duty. "Anything that's going to try to prevent high levels of stress in our job is valuable. It's hard to do. But the support is needed out there," she said. "It's a very trying job, to say the least. What affects me may not affect someone else. But what could affect them may not affect someone else. It's often a build up of things." MLA Ross Wetmore, the Progressive Conservative member who represents the Gagetown-Petitcodiac region, recently introduced a private member's bill in the New Brunswick legislature designed to eliminate the need for first responders to prove their post-traumatic stress disorder was caused while on the job. If it passes, that could eliminate the mountains of red tape that many first responders now face as they seek benefits while on leave for treatment.

Specifically, Bill 15 would amend the Workers' Compensation Act to presume post-traumatic stress disorder in first responders has been caused by "a traumatic event or a series of traumatic events to which the worker was exposed" while at work. That would apply to both current and former firefighters, paramedics, police officers and sheriffs who have been diagnosed as having PTSD by a physician or psychologist. A second part of the bill would require workers' compensation to offer, "treatment by culturally competent clinicians who are familiar with the research concerning treatment of first responders for post-traumatic stress disorder." Astle said she supports the bill, and says it could really help first responders as they struggle to get the help they need. "That was fantastic. That's a step in the right direction," she said. "People are talking about it more, are relating to it more. In our job, we're supposed to be the 'tough guy.' We have to share with our co-workers some of the things that are bothering us. Most of us do that. We talk it out." Chris Hood, executive director of the Paramedics Association of New Brunswick, said he's going to be meeting with government soon to ask for their support of this legislation, though he currently doesn't know how they feel about such a program. "We don't know whether or not government is going to support it," he said.

Hood said his organization wants to join the effort to make life easier for paramedics. So it's announced a few goals for the future. "We're working towards increased screening and education prior to entering the profession, improved training during the (early stages of your career), high-quality mental health support through a team of dedicated practitioners during your employment, and then the presumptive diagnosis legislation (introduced by Wetmore)," he said.

For decades, the Ontario health-care system has been planned, operated and overseen by doctors, hospital administrators, health ministry bureaucrats and executives in agencies such as the Local Health Integration Networks and Community Care Access Centres (CCACs) responsible for home care. What's been missing is the voice of patients and caregivers. That's inexcusable, given that some 400,000 people are employed in the Ontario health system and several million patients are treated in hospitals, at home and in community settings each year.

Until now, those patients have had few places to turn when they ran into roadblocks in the system, or have been frustrated trying to find their way through the layers of bureaucracy and in getting anyone in authority to deal with their issues. As health ombudsman, Elliott is to work with patients and caregivers to resolve complaints about their health-care experience. She will also investigate health-sector organizations on her own initiative, make recommendations for improvements and make annual reports to the minister.

Although her five-year appointment doesn't come into effect officially until July 1, 2016, she will start preliminary work on recruiting a staff of 12-15 people early next year. She will earn about $220,000 a year. Elliott quit provincial politics in August, three months after losing the Tory leadership race to Patrick Brown. Hoskins said Elliott was chosen from more than 400 candidates. Her "advocacy for vulnerable people, extensive knowledge of the health-care system and commitment to the betterment of this province make her the perfect choice for Ontario's first patient ombudsman," he said. While some people question the ombudsman's independence because the post reports to the minister, patient advocate groups are delighted with Elliott's appointment, suggesting she will be taken seriously at Queen's Park. As an MPP, she fought for better treatment for stroke victims and people with disabilities, and was a driving force behind a legislative committee's push for the auditor general to review the operations of the troubled CCACs.

There is much to be done in alerting the public and the minister to where patients fall through the cracks and get bad outcomes," says Michael Decter, a former Ontario deputy health minister and chair of Patients Canada, a national advocacy group. "For example, transitions from hospital to home are a major area of problems for patients." As encouraging as this move is, there is still more the government can do to give patients a true voice in health care. One suggestion circulating in the upper levels of the health ministry is to appoint an assistant deputy minister for patient experience. The proposal was first revealed in a blog by Steve Paikin, host of The Agenda on TVO.

The health ministry now has 16 assistant deputy ministers or their equivalents. Their areas of responsibilities range from provider agencies to doctors and pharmaceuticals. Although they may not realize, such bureaucrats can sometimes get captured by and become advocates for those interests over time. None of them, however, have prime responsibility for patients. That means there is no voice for patients or caregivers around the table when the top bureaucrats meet to formulate future policies and procedures or to assess how existing programs are working. It's a stunning absence, given that many universities, such as the University of Toronto, have created positions in recent years to deal specifically with student experiences.

Also, some hospitals have established jobs to deal with patient experience and many private companies have executives assigned to customer care. Naming a health ombudsman is a positive first step in giving patients a voice. Appointing such an assistant deputy minister, though, could be exactly what's needed to shake up the health ministry and focus its attention laser-like on where it should be - the patients and caregivers of Ontario. Bob Hepburn's column appears Sunday. bhepburn@thestar.ca

Christine Elliott is a good choice for the position of patient ombudsman, but there is more that Queen's Park can do to ensure that patients' concerns and needs are put first, Bob Hepburn writes.

CIHR’s decision-making style, which resulted in it going ahead with changes to funding despite objections from Indigenous and non-Indigenous researchers, “is not consistent with the recommendations of the Truth and Reconciliation Commission,” says Rod McCormick, a Mohawk researcher and co-chair of the Aboriginal Health Research Steering Committee.

There is no recognition or provision for the fact that systemic policies, when applied across the board, can have damaging impacts for groups that are different,” McCormick told an emotionally charged meeting at the Wabano Centre for Aboriginal Health in Ottawa on Jan. 25.

In 2014/15, funding for Aboriginal health research was $31 million, down from $34 million at its annual peak 2004–2008, the Aboriginal Health Research Steering Committee reported.

McCormick and co-chair Frederic Wien, the principal investigator for the Atlantic Aboriginal Health Research Program, urged CIHR to revisit its changes and rebuild what Wien called “a respectful relationship with First Nations, Métis and Inuit people.” Given the crisis in the health and well-being of many of these communities, the researchers want CIHR to prioritize Aboriginal health research.

We have gone through major changes at CIHR. I do not deny that,” Beaudet said. “But I would deny ... that these changes are affecting particularly the Aboriginal community.”

Marlene Brant Castellano, co-director of research for the Royal Commission on Aboriginal Peoples, believes CIHR is out of step with the Truth and Reconciliation Commission’s recommendations.

Beaudet made the remarks just three days after the shootings at La Loche, Saskatchewan. The murder of two teenagers, a teacher and a teacher’s aide in the largely Dene community underscored for some attendees the crises in suicide, lack of mental health support and poverty that affect many Aboriginal youth and families.

Beaudet said Aboriginal health research is “extremely important” for CIHR, and its strategic investments will reflect that. CIHR has been working with the Aboriginal Health Research Steering Committee for 14 months and, according to the institute’s media specialist David Coulombe, is committed to “co-building research initiatives” that “will improve the health of Canada’s First Nations, Inuit and Métis peoples.”

While Beaudet acknowledged both the magnitude of the recent changes and the fact that the Aboriginal health research budget has “flatlined,” he said it has done so parallel to CIHR’s overall budget. CIHR’s billion-dollar annual federal budget has not increased since 2009, meaning that its spending power has declined by roughly 25% since then.

CIHR’s president denied any need for the federal agency to engage in reconciliation. “I would like to bring my personal views, not only those of CIHR, about the stormy weather we have been experiencing lately,” Dr. Alain Beaudet told attendees at the January meeting. “But not in the spirit of reconciliation, because I don’t think anything has been broken.”

The Aboriginal Health Research Steering Committee contends that CIHR disadvantages researchers working in Aboriginal health through recent changes such as scrapping an Aboriginal-specific peer review process, requiring matching funds for several granting programs, and reallocating almost half the open competition funding for stellar emerging and establishing scholars.

But Beaudet said the changes promote more “out-of-the-box” research that will enable Canada to achieve more international success. He also suggested that those critical of the new system are afraid of change, and advised researchers that “looking back doesn’t work.” Learning from the past is a critical Indigenous value. CIHR is starting to analyze the

results of its initial investments, but it will take seven years for the new system to take full effect and before “meaningful” figures result, Beaudet said. “We’ll work as quickly as we can, but we need the data. I’m saying ‘Yes, trust us,’ because if you look at CIHR’s record, we’ve done a lot, and we’ve done it in good faith.”

Most of the researchers and representatives of Aboriginal political organizations at the meeting did not seem inclined to trust Beaudet’s reassurances.

You’re really saying to this group, ‘Trust us.’ And I just want to remind you that there’s very little basis for trust,” said Scott Serson, a former deputy minister of Indian Affairs and Northern Development, now with Canadians for a New Partnership, a group working for a new relationship between Indigenous and other Canadians.

The Aboriginal Health Research Steering Committee asked CIHR to set aside half a day at the June meeting of its governing council to address these issues. In an online statement, Beaudet acknowledged the request for an in-depth discussion at “a future meeting” of the governing council. He also urged Indigenous health researchers and community members to apply as members of the new Institutes Advisory Board on Indigenous People’s Health and a new College of Reviewers.

Marlene Brant Castellano, co-director of research for the Royal Commission on Aboriginal Peoples and the Mohawk elder who closed the meeting, described Beaudet and CIHR’s response to the committee’s requests as “disconnected” from the prevailing political environment.

Castellano, who is revered as the first Aboriginal full professor at a Canadian university, brought many in the audience to tears. Instead of recognizing the need for a new relationship between Canada and its Indigenous peoples, Beaudet’s remarks echoed a too-familiar demand that Aboriginal researchers “get with” CIHR’s program because, eventually, they would discover it was good for them, Castellano said.

“We have 400 years as Indigenous people trying to make things work in other people’s agendas, and that is where we’ve gotten to the place now, where we still are, of watching our children dying,” she said, tears streaming down her cheeks.

Beaudet had already left the meeting before Castellano went to the podium, and the two CIHR vice-presidents who had stayed for most of the discussion left as she began to speak, citing prior commitments. Only Malcolm King, scientific director of CIHR’s Institute of Aboriginal Peoples’ Health and a member of the Mississaugas of the New Credit First Nation, remained for the duration of the meeting.

According to Coulombe, Beaudet had a phone conversation with Castellano on Jan. 29, and “agreed to continue working collaboratively with community representatives and leaders in the future.”

But McKenna argued nurses in the long-term sector have gone into rooms where a homicide has occurred, and those in emergency rooms constantly deal with victims of violence and horrible accidents.

"You shouldn't exclude particular workers because they might not be the first one to step their foot into a vehicle accident setting," she said. The legislation would mean first responders could access Workplace Safety and Insurance Board (WSIB) benefits far more easily than they can now.

The presumptive legislation, if it passes third reading as expected, is slated to be proclaimed into law Wednesday. It had been long sought and has now been widely lauded by first responders.

In a statement issued on behalf of 8,000 Ontario paramedics, the Canadian Union of Public Employees (CUPE) said the bill will help lessen the stigma associated with PTSD and help first responders get treatment "before it's too late."

"Research shows that because of frequent exposure to traumatic situations, paramedics and other first responders are at least twice as likely to suffer PTSD than the general population," the CUPE statement says.

Craig MacBride, spokesman for Labour Minister Kevin Flynn, said the government is committed to workplace safety for nurses, creating a leadership table on violence in health care and also amending the Occupational Health and Safety Act to help prevent workplace violence and harassment.

It's also important to remember that nurses, like all Ontario workers, are covered for PTSD through the WSIB. Bill 163 simply creates a more responsive process for those who are most likely to face traumatic experiences on a regular basis," MacBride said.

principles of OCAP: ownership, control, access and possession. (Métis and Inuit groups have similar concerns, but this article focuses on First Nations communities.)

Gathering First Nations health data

Developing a First Nations Health Quality Council

Louie has said their self-government agreement says the band does not need approval from the province to build and run the hospital. But Christie says the agreement doesn't deal with issues like a First Nation operating a hospital for profit.

"This proposed health facility would raise Canada Health Act concerns if insured persons are charged for insured health services provided there."

"We've had discussions with Johns Hopkins but nothing is concluded yet.

"Patients could drink a nice bottle of wine the night before [their surgery] and there will be chefs preparing food," said Louie, adding the facility would not provide emergency, maternity or psychiatric care .

"The way legislation is written, you can't call it a hospital but that's what it will be, although it will also be a holistic medical wellness centre

A Health Canada spokesman said the federal government would be concerned if Canadian patients were charged for insured health services.

intention to serve inter-national clientele while improving health care access for WFN members.

The clinic would also benefit Canadians on waiting lists who might otherwise seek care outside the country, Louie added.

meetings about the medical facility have included Dr. Lyle Oberg, a former Alberta Conservative cabinet minister who is now an adviser to that province's Wildrose Alliance Party.

Oberg, who retired from political office nearly five years ago, was a founder of an Edmonton-based company called the Canadian Centre for DNA Diagnostics (C2DNA) which was touted as the first private DNA sequencing lab in Canada.

Mark McLoughlin is a partner

"We're not looking at any money from the government or any other agency.