When Keith Wynne arrived at the nursing station on the Kashechewan First Nation on July 17 complaining of back pain, the nurses sent him home with Tylenol and Advil. They didn't help.
Over the following month, the 29-year-old made five trips to the same Northwestern Ontario medical facility and reported the same symptoms. Each appointment resulted in an offer of painkillers. On the fifth visit, his mother, Jane, demanded that her son be given a blood test.
The nurses called the next day, Ms. Wynne said in an interview after recounting the story to a conference on Indigenous health care in Timmins, Ont., this month. The tests showed something was wrong. Keith was evacuated to Moose Factory and then to a hospital in Kingston, where, on Aug. 30, he was diagnosed with leukemia. He died on Oct. 6.
"You have to wait three to four hours to hear from a doctor, when a nurse [in Kashechewan] calls a doctor for advice," said Keith's father, Henry. "That's really frustrating." Often, he added, it is easier for the nursing staff to dispense the medication than to keep patients waiting for a doctor's diagnosis.
The disparity between the health care offered on reserves and the services available in the rest of Canada is well documented. So is the gap in health outcomes between Indigenous people and other Canadians. It is a problem that governments at multiple levels have been grappling with for years.
Jane Philpott, the federal Minister of Indigenous Services, met with the Wynnes at the Timmins conference and has promised that her department will conduct a full review of Keith's case.
But in the long run, Dr. Philpott said in an interview, the solution is to give First Nations people control over their own health care. That is the main tenet of the deal she struck this year with the Nishnawbe Aski Nation, the political body that represents 49 Northern Ontario First Nations, including Kashechewan.
For too long, she said, decisions about Indigenous health care have been made by bureaucrats in places such as Ottawa.
"Just as in many other sectors of life, what Indigenous people want, deserve and need is self-determination. They need to have control over their health systems," she said. "They can make the right decisions in terms of what areas need to be improved and to be put in charge of the data that's gathered so we know where the improvements need to be made."
There is no way of knowing whether giving more control of health-care delivery to the people of Kashechewan would have led to a quicker diagnosis for Keith Wynne or whether it would have bought him more time.
But his parents certainly believe he did not get the care he deserved.
"What happened to my son, he should have been taken care of the first time. That didn't happen," Henry Wynne said. "Too many people died in that clinic … the nurses do the best they can, but the thing is, they don't have the stuff they need."
The federal government, which is responsible for the delivery of health care on reserves, spent $2,100 per capita for those services in 2016. That includes the cost of things that are not part of primary care, such as public health services. But it does not take into account the large amounts of money contributed by the provinces, which pay the bills when First Nations people need to be treated in hospitals off the reserves, among other things.
So it is difficult to say exactly how money is being directed to First Nations health care, and the only way to determine whether enough is being spent is to assess the results.
A 2015 Auditor-General's report exposed significant failings in the delivery of health care on First Nations. It said not all nurses on reserves had completed mandatory training courses; that nursing stations had unaddressed health and safety issues; and that Health Canada had not assessed whether each nursing station was capable of providing essential health services.
The federal government responded to that report in the most recent budget, agreeing to spend an additional $828.2-million over five years to improve health outcomes for First Nations and the Inuit.
Valerie Gideon, the assistant deputy minister of the First Nations and Inuit Health Branch of Health Canada, says significant improvements have been made in the past two years: More nurses working on First Nations have received the mandatory training, the government is keeping better track of the services provided in each community, the number of nurses has been increased and there is a process that identifies needed repairs to nursing stations and sees that they are completed.
But the First Nations say even more needs to be done – and that the time it took to diagnose Keith Wynne is part of that.
"Lives are being lost. There is needless suffering and, in some cases, needless deaths as a result of the current failures of the current system," said Alvin Fiddler, the Grand Chief of the Nishnawbe Aski Nation.
The review of Keith's treatment promised by Dr. Philpott "will look at what happened, what were the gaps, what were the failures," Mr. Fiddler said, "and we need to identify what those are and to look at the recommendations that will result from the review and to put those in place immediately."