Winnipeg Free Press - PRINT EDITION

Hospitals on reserves overdue

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Assurances from Canada's chief of public health that there is no good evidence that aboriginal people are at elevated risk from H1N1 flu might surprise those living on reserves in Manitoba. They have elevated risks from epidemics because they suffer disease at higher rates than non-aboriginals, they live in crowded, substandard housing conditions and are served inadequately with health services. Nursing stations are not hospitals.

Those nursing stations have been shown inadequate to the job that is thrust upon them now, with the spread of swine flu on some of Manitoba's northern isolated First Nations communities. But the problem the federal government is having recruiting sufficient numbers of nurses for the stations is a chronic, well-known issues. This epidemic -- now considered a pandemic by the World Health Organization -- only highlights the gravity of the issue and the danger to residents who are at elevated risk of getting hard hit by illnesses that hit the respiratory tract.

Dr. David Butler-Jones is right in one respect: It will take time to figure out whether the flu's spread in the Island Lakes region was unusual -- that more people contracted the flu itself -- or whether the impact of the virus hit that population harder than other populations. So far, swine flu in Canada has proven to be a virus similar to those that circulate during seasonal flu outbreaks -- striking a wide population but making only a limited percentage ill to the point of requiring hospitalization.

But general observations in Manitoba are reinforcing the experience with respiratory diseases that prey upon those most vulnerable: Of the 24 people in intensive care at Manitoba hospitals, two-thirds are aboriginal. The impact on the Island Lakes region has been considerably harder, and especially so because the people there who got sick could not stay in their home community, but were airlifted out to a Winnipeg hospital.

Most reserves are not well-served with adequately equipped health facilities. Nursing stations are staffed typically by nurses, many on longer contracts, who possess higher skills for the primary care required. But they work with limited equipment, usually low technology and are augmented by doctors who fly in for a short-term. A flu spreading through an isolated native community can wreak havoc on a population with high rates of asthma, tuberculosis, diabetes or other conditions compound an illness that hits the respiratory tract.

Responding to daily and epidemic health issues requires good, modern health care facilities. But the typical fall back for small northern reserves has been to airlift patients out to city hospitals. In southern Manitoba, a community of 10,000 is likely to have a well-equipped hospital. Island Lakes, comprised of four reserves, has a population of 10,000 but copes with nursing stations.

The pressures on the nurses -- many of whom leave their homes and families for months at a time -- and the struggle to recruit them would be alleviated with improved working conditions that accompany a well-equipped and staffed hospital.

Health Minister Leona Aglukkaq is proud of the country's plans for pandemic, but the swine flu has revealed a hole in how the country has met the challenge of H1N1. Using nursing stations to meet the daily or emergency needs of a community of the size of Island Lakes is getting by on the cheap. It is insufficient to the demands. Ms. Aglukkaq should make hospital construction a priority for sizable First Nations communities.

Editorials are the consensus view of the Winnipeg Free Press’ editorial board, comprising Gerald Flood, Catherine Mitchell, David O’Brien and Paul Samyn.

Republished from the Winnipeg Free Press print edition June 13, 2009 A18

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