When the COVID-19 pandemic first struck, remote and northern Indigenous communities – which already lacked doctors, properly stocked and supplied health clinics and clean running water – had to scramble. First Nations leaders had to create public-health systems out of thin air. And in Northern Ontario, it seemed like the region was headed into another health crisis that would disproportionately hurt Indigenous people.
Instead, in January, 2021, there was a swift health response, thanks in large part to Nishnawbe Aski Nation leaders, who pulled together a team of physicians, nurses, government officials, and members of the Canadian Armed Forces and the Canadian Rangers to organize or deliver vaccinations to remote fly-in communities. This unprecedented, three-phase effort was called Operation Remote Immunity.
That operation showed us what is possible. As Canadians worked with First Nations to fight COVID-19, traditional silos in medicine crumbled; health care professionals from across the province hopped on planes to communities such as Bearskin Lake and Moose Factory, which they may not have otherwise ventured to or even heard about. They had the opportunity to see, firsthand, the inequitable realities of Canada’s “universal” health care system for First Nations peoples.
Surely, then, the Canadian public is now more aware of the immense logistical challenges involved in life in remote communities. These are places without so much basic infrastructure, including proper roads or runways, sanitation systems, ambulances, fire trucks, housing or hospitals. And surely, Operation Remote Immunity taught us enduring lessons about how to come together to consider the most vulnerable first, in future crises.
Sadly, though, those lessons have apparently vanished – just in time for the latest national health crisis.
In recent months, Canadian hospitals have become overwhelmed by three surging factors: respiratory syncytial virus (RSV) in children, the flu and COVID-19. Many public-health officers in Canada have recommended that Canadians return to masking indoors, in an effort to protect the system from further pressure. Worse, Canadian parents and kids have also been struggling with a countrywide shortage of many children’s pain and fever medications.
But this crisis has again played out differently in northern Ontario. On Sept. 2, Laura McCluskey – an Ontario regional pharmacist for the First Nations Inuit Health Branch, which is part of Indigenous Services Canada (ISC) – sent a memo to nursing staff warning of the coming children’s medication shortage. She said that with the dangerously low supply of these front line fighters of pain and fever in wee ones, nursing stations should “dispense these products judiciously” until the back order was resolved.
What was most surprising, though, was this advisory: “Please keep expired product at this time, in the event that expired product needs to be utilized.”
Medical professionals have debated the wisdom of using medication past its due date. Dr. Isaac Bogoch, of the University Health Network, told me there is “growing data demonstrating that expiration dates have little to no impact on the utility of many medications,” and that a co-ordinated push might be coming to extend them.
However, he added that “we still have to be careful with expiration dates and go through official channels to ensure safety of the medications used; however, medication shortages will disproportionately impact northern communities.”
And indeed, that inequity is on full display in this memo, regardless of drug effectiveness. After all, there is apparently not enough data available on administering expired children’s medication, and Health Canada has advised against doing so. Two Globe and Mail health reporters were also unable to find other hospitals or associations in Canada that have recommended the practice. So why does advice seem to be different for Indigenous kids? (On Thursday, ISC spokesperson Vincent Gauthier did not deny the existence of the memo, but told The Globe and Mail that “the use of expired pain medication is not standard practice in remote and isolated nursing stations and is not being considered at this time. The use of expired medication would only be considered in extraordinary circumstances.”)
There have long been two sets of standards in a country that likes to proudly trumpet the universality of its health care system. Yet, to my knowledge, there has been no universal call to even consider the using expired medications to treat the millions of children who do not live in First Nations communities.
Our children feel the same pain as non-Indigenous ones; they require the same care. Is this the extent of what has changed about emergency planning in our health care system, even after the shocking pandemic forced us to improvise?
The nationwide crisis will also compound existing problems in remote areas. What will air ambulance services do when they can’t medically evacuate ill or injured children because the pediatric hospitals in cities are over capacity? Would it be responsible to leave the children in communities where expired meds could apparently be the emergency option?
Article 24 (2) of the United Nations Declaration on the Rights of Indigenous Peoples says that Indigenous peoples must have the right to access the same standard of health care as non-Indigenous people. Where you live and who you are should not play a role here. And yet, apparently, it does.