The Stoney Health Centre at Morley. Photo courtesy of Stoney Nakoda First Nation

The complexity of the pandemic for First Nations

Data is limited — but there’s a reason for it.

In the event there is a COVID-19 outbreak on reserve, First Nations in Alberta are following public health directives. But the painful legacy of colonialism has created a unique set of circumstances for Indigenous people broadly and within each nation.

“It’s very difficult to pinpoint just how this pandemic is affecting First Nations, because it’s connected to those broader systems of oppression that really defined the experiences of First Nations people here in Canada,” said Gabrielle Lindstrom, an Indigenous studies professor at Mount Royal University who was born and raised on the Blood Tribe reserve—the nation’s largest with 4,570 residents.

Blood Tribe recently had a COVID-19 outbreak, with 14 confirmed cases, 11 of which were active as of May 19.

Lindstrom says there are several specific challenges in combating COVID-19 on reserves.

“The biggest challenge is access to healthcare and adequate testing materials,” Lindstrom said.

It’s very difficult to pinpoint just how this pandemic is affecting First Nations.

Gabrielle Lindstrom,

MRU Professor

“Another is the lack of access to other resources, like transportation for tribal members. We have very isolated members of the tribe who don’t get around, who may not have access to vehicles," she added.

"Access to information is another, because lots of time information spreads through the internet quite quickly and a lot of members don’t have access to the internet, because they simply cannot afford a computer.”

The extent of these roadblocks vary from reserve to reserve, she emphasized.

Different plans for different reserves

The entire world is dealing with the same pandemic, but each community has different needs, priorities and resources. It’s no different for First Nations.

Ryan Robb, CEO of Stoney Nakoda, says First Nations are co-ordinating with each other through the various treaties and the national Assembly of First Nations, as well as public health officials.

“I think it’s important to recognize that all First Nations are just that—autonomous nations,” Robb said. “Different nations will have different capacities and capabilities, and even different focuses on what they want to do.”

The Stoney Nakoda First Nation—located between Banff and Calgary—consists of three bands residing on three different reserves. The Bighorn, Morley and Eden Valley reserves are home to the Wesley, Chiniki and Bearspaw peoples.

Stoney Nakoda had Alberta’s first major outbreak on reserve in Eden Valley, with 18 of 600 residents testing positive. This outbreak was traced back to the Cargill facility in High River, where a number of residents work.

I think it’s important to recognize that all First Nations are just that — autonomous nations.

Ryan Robb,

CEO of Stoney Nakoda First Nation

Like many Cargill employees elsewhere, those in Eden Valley often live in cramped quarters and carpool to work, increasing the chances of transmission.

While High River’s positive test results skyrocketed, Stoney Nakoda successfully contained the spread. All 18 cases in Eden Valley, as well as a lone positive test result in Morley, have since recovered.

Robb says the tribal administration was uniquely well positioned to manage the pandemic. This seems to come as a result of their past experience in emergency preparation, resulting from the 2013 floods in southern Alberta, which hit Morley, and led to the implementation of the Incident Command System—a standard used by industry and municipalities across Canada.

“It’s a management system so we can identify where we have risks, where we might have issues and what we can do about it,” explained Robb, who is familiar with this system from his time employed at Suncor. “We were unique. Very few First Nations had this system in place.”

Another reason for their successful management, Robb says, is that Stoney Nakoda is a consultant nation on the Trans Mountain pipeline expansion, so they already had a robust emergency planning system for various scenarios, which could be adapted towards a pandemic.

“It let us plan ourselves exceptionally well. We were the first nation in Alberta, and possibly Canada, to have isolation centres on reserve,” said Robb.

'We're doing a lot more phone visits'

Linda Wonitoway-Raw is a registered nurse at Alexis Nakota Sioux Nation’s health centre. She says that the reserve—located about 85 kilometres northwest of Edmonton—has had zero confirmed COVID-19 cases, but is working on plans in the event there’s an outbreak.

As elsewhere, the number of in-person visits to healthcare facilities has been limited as focus has shifted to physical distancing and COVID-19 testing, she says.

It’s very, very different from everything that we’ve been taught.

Linda Wonitoway-Raw,

Registered Nurse

“People are staying at home. We’re doing a lot more phone visits,” said Wonitoway-Raw. “It’s very, very different from everything that we’ve been taught. As a nurse practitioner or physician, you really don’t want to be diagnosing patients over the phone.”

Thus far, they’ve conducted about 20 COVID-19 tests out of the reserve’s total population of 1,170, she says.

However, members of the nation, particularly patients residing off-reserve, have the option of going to the nearest Alberta Health Services (AHS) site for testing.

The dynamics of physical distancing are complicated by the large number of multi-generational homes on reserve. This has also been an issue in High River, as observed in the outbreak connected to the Cargill meat plant, says Wonitoway-Raw.

In the event there’s a positive swab result, she says the sample would be sent to the chief medical officer of health for contact tracing, which can be challenging on reserve.

Sometimes our patients don’t always have their own phone number or they’re staying with relatives.

Linda Wonitoway-Raw,

Registered Nurse

“That could be a little more difficult, because sometimes our patients don’t always have their own phone number or they’re staying with relatives, so there’s a lot more informal methods of trying to track down patients,” said Wonitoway-Raw.

“If it spreads in our community, it’s going to be a little more difficult to find patients who have been known contacts, because some of them are a bit more transient.”

In the event of an outbreak, the health centre has support workers on the ground who reside on reserve and “are enmeshed in the community,” so they can track down those who might be harder to get a hold of, she says.

Public data could be weaponized against First Nations

Alberta Health doesn’t provide COVID-19 figures specific to each First Nation but Tom McMillan, a spokesperson for AHS, says they have been working closely with First Nations to share data.

“We are aware that vulnerable and marginalized populations can encounter unique barriers in accessing health services, including testing and treatment for COVID-19,” said McMillan.

Although Dr. Deena Hinshaw, Alberta's chief medical officer of health, said AHS would look into collecting race-based data in the future, McMillan says it’s not in the cards at this time, at least as it pertains to First Nations. However, their data is included in the total daily figures.

“Individual Nations are free to share relevant information as they see fit,” he said, emphasizing that AHS would need each nation’s consent to share those details publicly.

However, the federal government publishes aggregate on-reserve data for each province. Alberta reserves have 37 cases as of May 20.

There’s a real mistrust among First Nations of researchers, because of the way we’ve been researched in the past and continue to be.

Gabrielle Lindstrom,

MRU Professor

There’s a certain reticence among some First Nations towards publicly sharing data with Canadian authorities, given how information about them has been historically weaponized against them by settler society, explains Lindstrom.

It's a phenomenon which continues in the present.

“There’s a real mistrust among First Nations of researchers, because of the way we’ve been researched in the past and continue to be researched. Even though data-sharing can bring out a lot of good things, there’s just a real lack of trust on the part of First Nations and for good reason,” she said.

“So many of the statistics that track First Nations people involve everything that’s wrong with them. You can find statistics that speak to the overrepresentation of First Nations people in the criminal justice system and the underrepresentation of First Nations people in the employment sector, but you’re going to be hard-pressed to find a reliable indicator of First Nations PhDs in communities across the country and their success.”

Jeremy Appel is a Medicine Hat-based reporter and columnist. He also co-hosts two podcasts—the Forgotten Corner, a regionally-focused current affairs show, and Big Shiny Takes, which skewers the Canadian pundit class.

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