ᐋᔑᑯᒻ ᐱᐳᓐᐦ ᑎ ᐹ ᒋᒨ ᓯᓂ ᐦᐄ ᑭ ᓐ aashikum pipunh tipaachimuusinihiikin ANNUAL REPORT

ᒥᔪᐱᒫᑎᓰᐅᓐ ᐊᓈᓈᑭᒋᐦᑖᑭᓅᒡ miyupimaatisiiun anaanaakichihtaakinuuch CREE BOARD OF HEALTH AND SOCIAL SERVICES OF JAMES BAY 2019-20 2019-20 ᐋᔑᑯᒻ ᐱᐳᓐᐦ ᑎ ᐹ ᒋᒨ ᓯᓂ ᐦᐄ ᑭ ᓐ aashikum pipunh tipaachimuusinihiikin ANNUAL REPORT 1 2 3 ᑳ ᓃᑳᓂᐱᔥᑎᐦᒃ ᐆ ᐱᒧᐦᑌᐦᐁᐤ ᓂᔒᔫ ᒥᔪᐱᒫᑎᓰᐅᓐ ᒥᓯᓂᐦᐄᒑᐅᑭᒥᒄ kaa niikaanipishtihk aa pimuhteheu nishiiyuu misinihiichaaukimik miyupimaatisiiun OFFICE OF THE CHAIR AND GENERAL MANAGEMENT

12 Chair and Executive 29 Executive Summary 49 Executive Summary Director ᒥᓯᓈ ᐱᔅᑭᐦᐄᑭᓐ 30 Pre-Hospital Emergency 50 AED Nishiiyuu 14 Board of Directors and Emergency Services Miyupimaatisiiun misinaapiskihiikin 15 Executive and Senior 32 Youth Healing Services With the exception of all photographs, the information in this publication may be reproduced without charge or further Management 33 Youth Protection permission, provided that the CBHSSJB is identified as the source. Download a copy at: creehealth.org 17 Corporate Services 34 Program Development Editor — Katherine Morrow 18 Organizational and Support Copy Editors — Patrick McDonagh, Jennifer Morrow, Alison Scott Development and Strategy 39 Public Health Layout & design — Alison Scott Design 20 Council of Physicians, Dentists and Pharmacists Cover photo of stained glass goose in the Eastmain CMC waiting room by Joshua Loon. 22 Council of Nurses Photography & photo editing — Tatiana Philiptchenko, with the exception of the following: 24 Service Quality and Pages 4 (first on left) & 5 (last on right): Joshua Loon Complaints Page 11: Brian Stewart Page 20: Marcel Grogorick & Marie-Jacinthe Plouffe 26 Population Health Profile Page 21: Bella Petawabano Page 23: P. Beriault Page 24 (far right): Kristen Iserhoff Pages 25, 48, 54 & 95: Marcel Grogorick Page 29 & 89: Mary Monger Page 30: Jason Coonishish Pages 32, 33 (bottom of pages), 39, 106 & 107: Maitee Saganash 4 5 6 Page 57: Jimmy Sam ᒥᔪᐱᒫᑎᓰᐅᓐ ᐋ ᐅᐦᒋ ᐱᒥᐱᔨᐦᑖᑭᓂᐎᒡ ᐋ ᒥᓯᓈᓱᑦ ᑳ ᐃᔅᐱᔨᑦ Page 60: Virgina Wabano Page 65 & 90: Jennifer Morrow ᐋᐱᑎᓰᐎᓐ ᔔᔮᓐ Page 88: Dr. Danielle Perreault miyupimaatisiiun aa uhchi pimipiyihtaakiniwich aa misinaasut kaa ispiyit Page 93: Trame Architecture aapitisiiwin shuuyaan ADMINISTRATIVE SERVICES FINANCIAL STATEMENTS Annual Report of the Cree Board of Health and Social Services of James Bay, 2019-2020 55 Executive Summary Executive Summary Breakdown of Gross © 2020 CBHSSJB 89 97 Expenses by Program Box 250, Chisasibi, QC J0M 1E0 56 Medical Affairs and Services 90 Human Resources CBHSSJB Financial 59 (DPSQA) Psychosocial 91 Financial Resources 98 ISSN 11929-6983 (Print) Statements ISSN 1929-6991 (Online) 61 (DPSQA) Health 92 Information Technology Legal deposit — 3rd trimester 2020 Resources National Library of Canada 62 (DPSQA) Allied Health Bibliothèque et Archives nationales du Québec, 2020 64 Chisasibi Hospital 93 Material Resources 66 Specialized Services 94 Wiichihiituwin 69 Community 106 List of acronyms Miyupimaatisiiun Centres (CMCs) ᐋᐆᒃ ᓃᔮᓐ aauuk niiyaan About us

1978 ᑳ ᐄᒋᔅᑖᐦᒡ ᐊᔅᒌ ᐊᒋᐦᑖᓱᓐ ᐊᑰᐦᑦ ᐧᐄᔅᑳᒡ ᓂᔒᔫ, ᒥᔪᐱᒫᑎᓰᐅᓐ (ᒥᓯᐧᐋ ᐄᔨᔨᐤ ᐄᑕᐧᐄᓐᐦ Founded in 1978, the Cree Board of Health In addition to CMCs, the CBHSSJB operates ᑳᐦ ᑎᑰᒡ ᒥᔪᐱᒫᑎᓰᐅᓐ ᑭᔮ ᓂᑐᐦᑯᔨᓐ ᐋᐧᐄᐦᒡ ᑖᐱᑎᐧᐃᐱᔨᐦᐆᒪᑳᓐᐦ) ᐋᐧᐄᔨᒡ ᑭᓂᐧᐋᐱᐦᑖᑲᓄᐄᔨᒡ and Social Services of James Bay (CBHSSJB) is the 29-bed Chisasibi Regional Hospital, three ᑭᓂᐧᐋᐱᐦᑖᑭᓅᒡ᙮ ᒥᓯᐧᐋ ᐋᐧᐋᓐ ᐋ ᐧᐄᒋᐦᑦ ᐆᑦ ᐄᔨᔨᐤ ᐋᐱᑎᓰᐧᐄᓐ ᑭᔮ ᒥᓯᓂᐦᐄᒑᐅᑭᒥᒄ᙮ ᐅ ᒫᒃ ᒥᓯᓂᐦᐄᑲᓐ responsible for the administration of health and group homes for youth at risk, a Regional Public ᐊᔅᒌᔨᒡ ᐊᑰᐦᑦ ᐧᐋᒡ ᑭᓂᐧᐋᐃᐦᑖᑯᓯᑦ᙮ ᐊᓐ ᒑ ᐄᔥ ᐧᐋᓯᑕᑲᓅᐧᐄᔨᒡ ᓂᔮᔨᓐᐦ ᐱᔅᑭᑎᓯᓂᐦᐄᑭᓐᐦ ᐋᐧᐄᐦᑕᑯᒡ ᑖᓐ social services for all persons residing perma- Health Department and program planning unit, ᑭᐧᐋᐱᐦᑎᒫᔨᒡ ᐋᐱᑎᓰᐧᐄᓐᐦ ᑭᔮ ᒥᔪᐱᒫᑎᓰᐅᓐ ᒧᔮᒻ ᐋ ᑳ ᐄᔅᐲᔨᒡ ᐋᐱᑎᓰᐧᐄᓐᐦ ᐅᑦ ᒥᓯᓂᐦᐄᒐᑭᒥᑯᒡ᙮ nently or temporarily in Region 18, the admin- ­Wiichihiituwin (formerly Cree Patient Services) istrative region of the Ministry of Health and liaison offices in Chibougamau, Val-d’Or and ᐄᔥ ᒥᓯᓈᑖᐦᒡ ᑯᐹᒃ ᐧᐄᔔᐧᐋᐧᐄᓐᐦ᙮ ᐹᐊᓛ ᐹᑕᐧᐋᐱᓅ ᓃᑳᓂᔅᑭᒻ ᐊᓂᔮ ᒥᓯᓃᐦᐄᒑᐅᑭᒥᑯᒡ Social Services of Quebec corresponding to Montreal, and a recruitment office in ­Montreal. ᐊᓐ ᐅᒋᒫᐤ ᒥᓯᓂᐦᐄᒑᐅᑭᒥᒄ ᐊᑰᐦᑦ ᐊ ᑎᑰᒡ ᒥᔪ ᐱᒫᑎᓰᐧᐄᓐ ᑭᔮ ᓂᑐᐦᑯᔨᓐ ᐋ ᐧᐄᔨᒡ the Cree territory of James Bay. Our mandate The Head Office is in Chisasibi. is defined in Chapter S-5—An Act respecting ᐊᓂᑖ ᒋᓵᓰᐱᔨᒡ᙮ ᓃᔮᔨᓐᐦ ᐊᓂᐦᐄ ᒑᐧᑳᓐ ᐋ ᑭᓂᐧᐋᐱᐦᑖᑭᓅᐧᐄᔨᒡ, ᐊᑯᑦ ᐊᔅᑎᐱᐦᔨᒡ ᐊᓂᔮ ᑳ health services and social services for Cree The CBHSSJB is governed by an elected ᐋᐱᑎᓰᔅᑕᑲᓄᐧᐄᔨᒡ ᐅᑦ ᒥᓯᓃᐦᐄᒑᐅᑭᒥᑯᒡ: ᐊᓂᒋ ᐲᐦᑕᓰᓂᐧᐋᑲᓅᐧᐄᔨᒡ ᒑ ᒋ ᒫᒨᐧᐄᔅᑖᐦᒡ ᒥᔪᐱᒫᑎᓰᐅᓐ ᑭᔮ ­Native persons. Board of ­Directors whose Chairperson is Bella ᒑᔅᑖᐱᑎᓰᔅᑖᐦᒡ ᒥᔪ ᐱᒫᑎᓰᐧᐄᓂᔫ ᒫᒧᐧᐃᐦᑕᐧᐃᒡ ᓂᑐᐦᑯᔨᓐ ᐋᐱᑎᓰᐧᐃᓐᔫ᙮ ᐊᓂᒌ ᒫᒃ ᑳ ᒫᒨᐧᐄᐧᐃᐱᔅᑖᐦᒡ M. ­Petawabano. Advisory Committees and ᐋ ᑭᓂᐧᐋᐱᐦᑖᐦᒡ ᐊᐱᑎᓰᐧᐄᓐᐦ: ᐱᒧᐦᑕᐦᐅ, ᒥᔪᐱᒫᑎᓰᐅᓐ ᑭᔮ ᓂᑑᑯᔨᓂᔫ ᐋᐱᑎᓰᐧᐃᓐᔫ ᐊᓐ ᑭᔮ In each of the nine communities of Eeyou ­Istchee, ­Councils report directly to the Office of the the CBHSSJB operates a Community Miyupimaa- Chair, as do the Service Quality and Complaints ᐅᒋᒫᐤ ᑳ ᓈᑭᑎᐧᐋᔨᐦᑎᒃ ᐋᐦᐋᑳ ᓃᔅᑳᒑᔨᒡ ᐄᒧᐧᐄᓂᔫ tisiiun Centre (CMC), which is similar to an Inte- Commissioner and the Medical Examiner.­ The ᑭᔭ ᐋᐱᑎᓰᐧᐄᓂᔫ, ᑭᔮ ᐊᓐ ᑳᓂᑑᒋᔅᒑᐄᐦᑎᐦᒃ grated health and social services centre (CISSS) Executive Director is Mr. Daniel St-Amour. ᓂᑐᐦᑯᔨᓂᔫ ᐋ ᐧᐄᔅᑖᐱᔨᐦᐧᐋᒡ᙮ ᑖᓂᔨᓪ ᓭᐁᓂᑦ - ᐋᐦᒨᕐ elsewhere in Quebec. CMCs offer services in ᐋ ᐧᐄᐦᑰ ᐧᐋᒋᒫᐧᐄᑦ ᐊᓂᑖ ᒥᓰᓇᐦᐄᒐᐧᐄᑲᒥᑰᒡ᙮ general medicine, home care, dentistry,­ social services and ­allied health, among others. ᐋᑎᔑᔨᒡ ᐄᔨᔨᐅᐎᒡ ᐋᑎᔅᑳᑑᐦᒡ ᐋᐱᑎᓰᓲᐐᔨᒡ aatishiyich iiyiyiuwich aatiskaatuuhch aapitisiisuuwiiyich EEYOU ISTCHEE POPULATION JULY 2019

Chisasibi 4,920 Eastmain 862 Council of Physicians, Dentists and Pharmacists Mistissini 3,974 Board of Council of Nurses Nemaska 852 Directors Service Quality and Complaints Commissioner Oujé-Bougoumou 863 Waskaganish 2,509 Puvirnituq Waswanipi 2,082 Wemindji 1,582 Whapmagoostui 1,036 Executive Corporate Services Direction 18,681 Organizational Development and Strategy Kuujjuak For detailed information on the health status of the population please consult our website: www.creehealth.org.

There is approximately an additional 5% non-permanent residents who also receive services from the CBHSSJB. The 0 to 4 year-old age group has been corrected using MSSS 2015-2018 births (+ 2019 estimates) and MSSS 2014-2018 deaths numbers. Sources: MSSS, JBNQA Cree beneficiary list, 2019; MSSS Births databases 2015-2018; MSSS Mortality databases 2012-2015; Statistics Canada 2016 Census. nishiiyuu Administrative pimuhteheu miyupimaatisiiun miyupimaatisiiun Services

Kuujjuaraapik

Whapmagoostui Great Whale Caniapiscau Pre-hospital Emergency Organizational Medical Affairs Health (Nursing) Human Resources La Grande Radisson Services and Emergency Quality and and Services Psychosocial Financial Chisasibi Measures Cultural Safety Medicine Resources Evaluation and Dentistry Foster Homes Youth Healing Services Accreditation Information Wemindji Group Homes Pharmacy Allied Health Community Technology Eastmain Development Youth Protection Eastmain Nemaska Distance from Montréal Client Experience Material Resources and Organizational Community Whapmagoostui 1757 km Program Development Chisasibi Performance Miyupimaatisiiun Wiichihiituwin Waskaganish Rupert Mistassini Chisasibi 1466 km and Support Hospital Centres Oujé- Complementary Wemindji 1394 km Maanuuhiikuu Bougoumou Eastmain 1232 km Services and Nemaska 1033 km Disability Programs/ Programs Mistissini Waskaganish 1130 km Special Needs Clinical Chisasibi Chibougamau Mistissini 795 km Services Midwifery Services Eastmain Matagami Oujé-Bougoumou 732 km Nursing Waswanipi 820 km Mistissini Services 109 Waswanipi 167 Public Health Nemaska St-Jean Amos 113 Cree community Awash (0-9 yrs) Specialized Oujé-Bougoumou Saguenay Services CBHSSJB office Uschiniichisuu (10-29 yrs) Waskaganish Rouyn- Administration Noranda 117 Chishaayiyuu (30+ yrs) Waswanipi Val-d’Or hospital 155 Wemindji Québec airport SERC (Surveillance, Evaluation, Research, Whapmagoostui 117 town/city Communications) Trois- Rivières autoroute 40 secondary highway 105 15 50 gravel road Gatineau Montréal Ottawa 0 100 200 300 km 11

Left to right: Daniel St-Amour (Executive Director of the CBHSSJB), Sylvie D’Amours (Minister Responsible for Indigenous Affairs), Danielle McCann (Minister of Health and Social Services), Grand Chief Dr. Abel Bosum (Grand Council of the Crees - Eeyou Istchee), Bella Moses Petawabano, (Chairperson of the CBHSSJB) and Davey Bobbish (Chief of the Cree Nation of Chisasibi). ᐆ ᐱᔅᑭᑎᓯᓂᐦᐄᑭᓇᒡ ᐊᑰᐦᑦ A new five-year health agreement with the Cree Nation ᒫᓯᓈᑖᐦᒡ ᑖᓐ ᐋᓯᓈᐦᑯᔨᒡ ᑭᔮ ᑖᓐ Government and Government of Quebec was signed ᐋ ᒋᔅᑳᑑᔨᒡ ᒥᔪᐱᒫᑎᓰᐅᓐ ᑭᔮ on October 7th, 2019, to establish a funding framework ᓂᑐᐦᑯᔨᓐ ᐋᐱᑎᓰᐧᐄᓐ ᐋᐧᐄᐦᒡ and funding rules for the Cree Board of Health and Social Services of James Bay for 2019-2024. 1 ᑭᓂᐧᐋᐱᑖᑭᓅᒡ ᐋᐱᑎᓰᔖᐧᐄᔨᒡ ᐋᓯᓈᑰᔨᒡ ᐆᑦ ᐊᐱᑎᓰᐧᐄᓂᐧᐋᐤ This new agreement allows for further development of ᐄᔨᔨᐧᐄᔨᒡ ᐋᐦᐋᐱᑎᓰᔅᑐᐊᑳᓅᐧᐄᔨᒡ᙮ the services offered to the Cree communities of Eeyou Istchee, including specialist services, to construct new ᑳ ᓃᑳᓂᐱᔥᑎᐦᒃ facilities and to invest in information technology and uu piskitisinihiikinach akuuht human resources. maasinaataahch taan aasinaahkuyich kiyaa ᐆ ᒥᓯᓂᐦᐄᒑᐅᑭᒥᒄ taan aa chiskaatuuyich miyupimaatisiiun kiyaa nituhkuyin aapitisiiwiin aawiihch kaa niikaanipishtihk aa kiniwaapitaakinuuch aapitisiishaawiiyich misinihiichaaukimik aasinaakuuyich uut apitisiiwiiniwaau iiyiyiwiiyich aahaapitisiistuakaanuuwiiyich. OFFICE OF THE This chapter presents an overview of the CHAIR AND GENERAL CBHSSJB, the health of the population and the MANAGEMENT activities of the Board of Directors and Executive. ᑳ ᓃᑳᓂᐱᔥᑎᐦᒃ ᒥᔨᐱᒫᑎᓰᐅᓐ ᐆᒋᒫᐤ ᒥᔨᐱᒫᑎᓰᐅᓐ ᐊᓈᓈᑭᒋᐦᑖᑭᓅᒡ ᐆᑏᔨᒨᐎᓐ ᐊᓈᓈᑭᒋᐦᑖᑭᓅᒡ ᐆᑏᔨᒨᐎᓐ kaa niikaanipishtihk miyupimatisiiun uuchinaau miyupimatisiiun anaanaakichihtaakinuuch uutiiyimuuwin anaanaakichihtaakinuuch uutiiyimuuwin MESSAGE FROM THE CHAIR MESSAGE FROM THE EXECUTIVE DIRECTOR

For the Cree Board of Health and Social Services­ A central goal of the now fully funded Strategic This has been another exciting year of growth The challenges presented by the past year of James Bay, 2019-20 was a ­defining year. At Regional Plan is to bring services closer to and accomplishments for our organization, brought into focus our organization’s strengths the time of writing this introduction, four months home and thus reduce the need for medical highlighted by the signing in October of a new and urgent priorities. There is a clear need to after the declaration of a global pandemic by travel outside our region. Our experience of five-year health agreement with the Cree Na- accelerate the building of the three new Elders’ the World Health Organization, Eeyou Istchee the first months of the pandemic has confirmed tion Government and Government of Quebec. Homes, which will ensure our most vulnerable has no cases within our territory. The 10 cases that we are on the right path with our strategy The new agreement allows us to further de- clients can remain on-territory, and we can we experienced in our communities to date have to strengthen infrastructure and services within velop the services offered to the Cree com- repatriate clients currently residing in similar fully recovered. our region and to use technology to bridge the munities of Eeyou Istchee, including specialist facilities outside of our region. Restructuring distance between our clients and expert care services, to construct new facilities, and to around three regional poles will improve our This is not to say that we have not suffered and diagnostics. Among the new services we invest in information technology and human responsiveness to local needs and facilitate losses. Because of the lack of long-term care are building are Birthing Homes and Elders’ resources. These important investments further coordination of services. The current crisis in our communities, many Eeyou and Eenou homes, so that during these important phases reduce the need for our clients to travel out of reveals the vital importance of telehealth to 12 ­elders who have experienced a loss of auton- of life, our people can receive care in a cultural- the region to receive care, and allow us to ad- provide services remotely to our clients and 13 omy reside in facilities outside Eeyou Istchee, ly safe environment, surrounded by loved ones. vance our work to incorporate traditional Cree virtual meeting applications to keep our teams many of them in the Montreal area. As the dis- healing practices and provide culturally safe connected. ease swept through long-term care institutions I am proud of all that we have accomplished settings for our clients. during the spring of 2020, three beloved Elders this year, both before and after the start of the As we adapt to a new reality of providing passed away of COVID-19. These losses confirm pandemic. I would like to pay a special ­tribute The year will undoubtedly be remembered for ­services in the context of an ongoing pan- the vital importance of building Elders’ Homes to Dr. Faisca Richer and the Department of the COVID-19 pandemic and the way we all demic, in the coming year we will need to foster in our communities. Public Health, which has led the pandemic came together to respond to this historic chal- an organizational culture based on safety and response in our organization. We would not lenge. When the pandemic arrived in Canada risk reduction. The integrated risk manage- In the summer and fall of 2019, before the be where we are today without our trusted and Quebec, we mobilized to ensure the safety ment system recently approved by the Board emergence of this new disease, our major partners at all levels of government and our of the population and our workers. Under the of Directors will allow us to more clearly iden- priority as an organization was the comple- excellent Board of Directors, management and leadership of our Public Health department, we tify and reduce risks of all kinds. It will allow us tion of financial negotiations to enable us to workforce. All have worked tirelessly to protect quickly developed and implemented the neces- to discuss more openly the opportunities to fulfill an ambitious, yet greatly needed, Stra- Eeyou Istchee and provide culturally safe care sary systems, guidelines and protocols to re- improve, to prioritize actions accordingly and to tegic ­Regional Plan. On October 7, 2019, we to our people, now and for years to come. spond to every potential scenario. We worked ensure the necessary follow-ups. welcomed Grand Chief Dr. Abel Bosum and in close collaboration with the Cree Nation Ministers McCann and D’Amours to Chisasibi Government and our other regional partners to To say it has been a challenging year is an for the signing of the Agreement and Funding help Cree leaders create informed, measured understatement. However, the knowledge we Framework for 2019-2024. Bella M. Petawabano have gained and foundations we have laid over CBHSSJB Chair and unified strategies to ensure the safety of all the communities of Eeyou Istchee. the past 12 months have prepared us well for the upcoming year, and will allow us to continue I am extremely proud of how everyone in our providing the highest level of care possible and organization responded to the crisis. The pro- keep the people of Eeyou Istchee safe. fessionalism and commitment we demonstrat- ed and continue to demonstrate is the reason why the virus has had such a minimal impact in Daniel St-Amour our region. CBHSSJB Executive Director ᑳ ᓃᑳᓂᐱᔥᑎᐦᒡ ᑳ ᐱᒥᐱᔨᐦᑖᒡ ᐋᐱᑎᓰᐎᓂᔨᐤ kaa niikaanipishtihch kaa pimipiyihtaach aapitisiiwiniyiu BOARD OF DIRECTORS EXECUTIVE AND SENIOR MANAGEMENT

Office of the Commissioner of Service Quality and Complaints Sarah Cowboy Chairperson Assistant Commissioner of Service Quality and Complaints Nancy Shecapio-Blacksmith Bella M. Petawabano • Chairperson BOARD COMMITTEES Christine Petawabano • Vice Chairperson Administrative/HR Committees Daniel St-Amour • Executive Director Bella M. Petawabano General Executive Director Daniel St-Amour Daniel St-Amour meetings Management Assistant to the Executive Director Paula Rickard Community Representatives Director of Corporate ­Services Laura Moses Christine Petawabano 5 L. George Pachanos • Chisasibi Director of Strategy and Organizational Development Justin Ringer A. Thomas Hester Jamie Moses • Eastmain Director of Medical Affairs and Services­ (DMAS) Dr. François Charette L. George Pachanos Assistant Director (AD) of DMAS Mario Barrette Christine Petawabano • Mistissini Nicholas Ortepi Stella Moar1 • Nemaska Liliane Groleau3 Pimuhteheu Assistant Executive Director (AED) - Pimuhteheu Taria Matoush Darlene Shecapio-Blacksmith • Oujé-Bougoumou Marie Blais3 Director of Youth ­Protection (YP) Marlene Kapashesit A. Thomas Hester • Waskaganish AD of Youth Protection Helen Voyageur (I) Jonathan Sutherland • Waswanipi Audit Committee Director of Youth ­Healing Services­ (YHS) Maria MacLeod Emmett Georgekish • Wemindji Stella Moar Director of Program Development and Support Anne Foro meetings Director of Public Health (DPH) Dr. Faisca Richer Allan George • Whapmagoostui Jonathan Sutherland 4 Assistant DPH - Awash Miyupimaatisiiun­ Dany Gauthier 2 L. George Pachanos Kerrie Hester • Washaw Sibi (Observer­ status) Assistant DPH - Chishaayiyuu Miyupimaatisiiun­ Paul Linton Vigilance Committee Assistant DPH - Surveillance, Evaluation, Research Clinical Staff Representative Bella M. Petawabano and Communications­ (SERC) Isabelle Duguay Dr. Robert Tremblay Daniel St-Amour meetings conference Nishiiyuu AED of Nishiiyuu Miyupimaatisiiun­ Laura Bearskin Non-Clinical Staff Representative Christine Petawabano calls 14 4 Miyupimaatisiiun Director of Organizational Quality and Cultural Safety Julianna Matoush-Snowboy 15 Nicholas Ortepi Jonathan Sutherland 2 Miyupimaatisiiun AED of Miyupimaatisiiun­ Greta Visitor (L) Michelle Gray (I) Moses Petawabano Advisory Committee Assistant AED Operations Christina Biron regular special Bella M. Petawabano meetings meetings Director of the Regional Hospital (Chisasibi) Philippe Lubino Christine Petawabano Director of Professional Services and Quality Assurance 4 4 meetings Jamie Moses 5 (DPSQA) - Health Michelle Gray (S) Karine Lamothe (I) A. Thomas Hester Assistant DPSQA - Health Karine Jones (I) DPSQA Allied Health Adelina Feo (L) Leah Dolgoy (I) 1. Edna Neeposh’s 3-year mandate ended July 2019. Nemaska elections were held February 2020, and Stella Moar was elected as the new CBHSSJB DPSQA Psychosocial Chloe Nahas representative for Nemaska. She was appointed on the Audit Committee in March. 2. Kerrie Hester submitted her resignation February 2020, with no replacement to date for the Washaw Sibi Observer. Community Chisasibi Jeannie Pelletier 3. The HR Committee is composed of the members of the Administrative Committee, the Assistant Executive Director - Administration, and the Director of ­Miyupimaatisiiun Eastmain Rita Gilpin Human Resources Centres (CMCs) Mistissini Alan Moar Local Directors Nemaska Beatrice Trapper Oujé-Bougoumou Louise Wapachee Waskaganish Bert Blackned (L) Angela Etapp (I) Waswanipi E. Virginia Wabano Wemindji Rachel Danyluk (I) Whapmagoostui Hannah Kawapit

Administrative AED of Administrative Resources Liliane Groleau Services Director of Financial Resources Jean-François Champigny AD of Financial Management Units Nora Bobbish Director of Human Resources Marie Blais Director of Information Technology Pino Virgilio Director of Material Resources Luc Laforest Director of Wiichihiituwin Helen B. Shecapio-Blacksmith AD of Wiichihiituwin Emanuelle Lambert (I) = interim (L) = on leave (S) = secondment Corporate Services and Public Health collaborate on a wide ᐋ ᐎᒡ ᐎᔨᐱᔨᐦᑖᑭᓄᐐᔨᒡ range of culturally safe materials to inform and educate the population about COVID-19 precautionary measures. ᐋᐱᑎᓰᐎᓐᐦ ᒥᓯᓂᐦᐄᒑᐅᑭᒥᒄ THE BEST WAY TO AVOID CONTAMINATING YOURSELF AND OTHERS IS TO aa wich wiyipiyihtaakinuwiiyich aapitisiiwinh ᒑ ᒋᔥᑖᐹᐅᑎᐦᒑᔨᓐ misiinihiichaakamikw CHAA CHISHTAAPAAUTIHCHAAYIN / CHÂ CHISHTÂPÂUTIHCHÂYIN CORPORATE SERVICES WASH YOUR HANDS Corporate Services provides support to the Alfresco document management solution imple- Board of Directors and associated governance mentation continues, proving to be an essential 1 2 3 functions of the CBHSSJB, and oversees corpo- tool for the management of clinical guidelines rate communications and translation services. and other documentation associated with the COVID-19 pandemic response. An Administra- Wet your hands Apply soap Rub your hands together for at least 20 seconds The Department coordinates orientation and tive Process Specialist (APS) was hired November 4 5 6 training for Board members as part of regular 2019 to oversee the management of and train- Board meetings. In 2019-20, the Board of Direc- ing on Alfresco. A second APS position remains tors received the following training sessions: Wash all surfaces, Rinse your hands Carefully dry vacant. A supplier was chosen for the renewal of including nails, thumbs and with running your hands between your fingers tap water Kiniwaapimiisuutaau “Let’s reflect on the creehealth.org website, a project due to be How to make a cloth mask ● MASKS For more information completed in 2020, slightly delayed by COVID-19. ᒉin Englishᐃᔑᓈᑯᐦᑖᔨᓐ and Cree on the COVID-19 ᒋᐳᑐᓀᐦᐱᓱᓐ ᐁ ᐅᔑᐦᑖᔨᓐ ourselves” training on healthy workplace che ishinaakuhtaayin(Coronavirus) visit our website chiputunehpisun : e ushihtaayin to helpcreehealth.org/coronavirus fight COVID-19 ᔦᐦᔦᐙᔅᐱᓀᐎᓐ ᐁ ᐋᔔᒦᑐᓈᓅᒡ behavior; VSN-B2 20200313 NC Cotton fabric (tightly woven, like sheets) NOTE: Each person On March 11, 2020, when the World Health Orga- What you need should have 2 or 3 ᒉᐧᑳᓐ ᒉ ᐋᐸᒋᐦᑖᔨᓐ Two 6-inch pieces of elastic* cloth masks so you ● Strategic overview of JBNQA and gover- chekwaan che Needle and thread or sewing machine can wear a clean one nization declared the COVID-19 global outbreak aapachihtaayin each time Scissors nance, community consultation, strategy 16 a pandemic, the team moved quickly to support 17 and performance and government rela- Cut out two 10-by-6-inch rectangles of cotton fabric. CBHSSJB's rapid response. Secure videocon- 6 1 Stack the two rectangles. You will inches tions; sew the cloth mask as if it was a ferencing was implemented for the Board of single piece of fabric. My COVID-19 story 10 inches ● Youth Protection Act including PL-99, role Directors and committees, and large quantities A social-story on how to talk STITCH ¼ inch FOLD to children about COVID-19 FOLD FOLD of the CDPDJ (Human Rights –Youth Divi- of clinical guidelines were translated from French Fold over the Created by Benjamin Gormley with assistance from Dominique Wright, Geneva Coonishish and Jannah Loon long sides ¼-inch sion), CBHSSJB recommendations for the Illustrations used from Boardmaker, as well as with 2 and hem. Fold into English. The Director took over end-of-year permission from Christine Sioui Wawanoloath the short sides Layout and design by Alison Scott ½-inch and hem. COVID-19 (Coronavirus) Viens Commission, National Enquiry on administration from the Coordinator of Commu- FOLD STITCH ½ inch Missing and Murdered Indigenous Women THREAD nications, Katherine Morrow, so the communica- THROUGH Thread each piece of elastic through the wider hem on each and Girls, and Laurent Commission; KNOT side. These will be the ear loops. tions team could focus on informing the popula- 3 Tie the ends tight. (If you have string, you can make the ties longer Building the Nishiiyuu Miyupimaatisiiun tion. The team set up a dedicated website and and tie the mask behind your head.) ● Framework on Traditional Healing. implemented rapid production and dissemination CBHSSJB TUCK IN KNOT Gently pull on the elastic so that of culturally safe guidelines, educational materi- the knots are tucked inside the Under a by-law approved in February, elec- PUBLIC HEALTH hem. Gather the sides of the mask 4 and adjust so the it fits your face. STITCH als, radio spots, posters and videos. Communica- Securely stitch the elastic in place to tions were held October 25 for the positions of GUIDELINES keep it from slipping. tions efforts were tightly coordinated with Public *or rubber bands, string, cloth strips or hair ties Clinical and Non-Clinical Staff representatives Health, MSSS and the Cree Nation Government. for ᐹᔨᑯᑖᓂᐤ on the Board of Directors. Nicholas Ortepi was elected non-clinical staff representative, and Dr COVID-19 Paayikutaaniu Meegwetch to the team for the dedication, ᔦᐦᔦᐙᔅᐱᓀᐎᓐ ᐁ ᐋᔔᒦᑐᓈᓅᒡ ACTIVITY BOOK Robert Tremblay clinical staff representative, commitment and endless both 3-year terms. Corporate Services imple- hours of hard work mented electronic voting for these positions, a in support of the @creehealth FOLLOWERS challenging exercise, and the returning officers ­response to and IT prepared recommendations to improve COVID-19. p27.3% to 5,767 the process. Meegwetch to the people from p the CMCs who were involved at different times 8.1% to 2,169 throughout the election. p35.7% to 983 p87.1% to 737 ORGANIZATIONAL DEVELOPMENT AND STRATEGY

RISK MANAGEMENT 2019-20 Reported Events 2019-20 Reported Events by Severity In January 2020, risk management moved Level A Fall 17 2.4% under the newly formed ­Organizational Devel- 3.2% A Near fall 2 0.3% A 23 1.3% opment and Strategy Department and the team undetermined B 96 13.5% grew to two full-time employees. B Drug 319 44.9% C 337 47.5% B Treatment 75 10.6% D 218 30.8% 16.7% The team’s mandate is to promote and support A to B 1.8% the development of a safety and risk culture at B Diet 4 0.6% E1 13 E2 9 1.3% all levels of the organization. To achieve this, over C Laboratory 130 18.3% 0.6% the past year the risk management team has F 4 78.3% C Imaging 7 1.0% 0.0% C to I developed different evaluation and reporting G 0 0 0.0% tools, offered personalized support to manag- D MDR MDR* 0 0.0% H I 0 0.0% ers, employees and professionals, and provided E Material 10 1.4% Undetermined 9 1.3% individual and group trainings to 300 employees E Equipment 6 0.8% Total 710 100.0% 18 across all the communities. These activities have 19 Building 5 0.7% helped further develop the organization’s ability E No event caused permanent consequences to a client. Personal 0.1% Increases from 2018-19 relate to recent changes in defini- to identify, measure, analyze, improve and con- E 1 Effect tions used for different levels and a detailed revision of all trol clinical and non-clinical risks. 0.8% F Assault 6 710 declarations to ensure proper classification. Other 18.0% In March 2020, the Board of Directors adopted G 128 the Risk Management Committee by-law, dem- Total 710 100.0% onstrating their commitment to applying an *Medical Device Reprocessing NEXT STEPS integrated risk management approach as part For 2020-21, the main objective is to continue 319 of their governance role. The Risk Management of events medication the development and implementation of inte- Committee, which will include two independent declared are errors 65% 63.2% medication grated risk management throughout the orga- Eeyou/Eenou client representatives (one inland and laboratory 130 nization. An important step towards this goal errors laboratory and one coastal), will be responsible for review- errors 67% is to launch the Risk Management Committee, ing the organization’s clinical and non-clinical which will assess and mitigate the organiza- The rise in declared drug and laboratory errors is related to increased risks on a regular basis, providing guidance vigilance and reporting by the departments most directly involved. tion’s risks. The committee will adopt a new on possible mitigation strategies and ensuring risk management framework and associated ­accountability for those strategies. policies and procedures, and the Risk Manage- ment team will provide the training to support the adoption of these measures by managers, Number of Declared Events The Risk Management team reviews each event professionals and employees. with local teams to identify root causes and 2018-19 2019-20 recommend improvements. New protocols and Finally, a working group composed of the updated work processes are being developed to Nishiiyuu Quality and Cultural Safety team and address medication and laboratory declarations. the Risk Management team will begin providing 572 710 19.4% tools, training and support to help local teams test and make the changes they feel are neces- sary to improve the delivery of our services. ᑳ ᓃᑳᓂᐱᔥᑑᐙᒡ ᓂᑐᐦᑯᔨᓐ, ᓅᑖᐱᑖᓱ ᑭᔮ ᓅᒋᐦᓂᑎᑯᔩᓈᓱ kaa niikaanipishtuuwiich nituhkuyin, naataapitaasu kiyaa naachihnitikuyiinaasu

COUNCIL OF PHYSICIANS, DENTISTS AND PHARMACISTS Dr. Darlene Kitty CPDP President

The Executive Committee and members of The CPDP monitors strategic priorities, ­ongoing The obligatory and mandated committees of The CPDP also contributes to new and ongoing the Council of Physicians, Dentists and Phar- and new initiatives, and supports its members the CPDP are well-engaged to advance these capital projects as well as the organization of macists (CPDP) of Region 18 continue to work and committees in their collaboration and priorities and other projects. As an example, services, such as planning for new clinics, the diligently in their clinical and administrative contribution to enhance the quality of care and the Cultural Safety Committee meets regularly Chisasibi Hospital, Elders' Homes and Healing roles. As per CPDP by-laws, the CPDP advises provision of services. Recent work includes: to support reconciliation, with all CPDP mem- Lodges in the Territory. the Board of Directors and General Manage- bers learning about Cree culture and history as ment of the CBHSSJB on matters related to the ● Low-risk Birthing and Midwifery: Low- important adjuncts to culturally safe care. In March 2020, the CBHSSJB—with its Public provision of high quality medical, dental and risk deliveries by midwives began in April Health Department, the CPDP and members— ­pharmaceutical services. 2019, as did prenatal and postpartum care Clinical departments remain diligent in offering was urgently making preparations given the of Cree women and babies, ensuring safe and improving services and resources to the COVID-19 pandemic. However, whether in The CPDP monitors the competence of its mem- pregnancies and low-risk deliveries. Cree population. The Department of Medicine the context of the pandemic or not, the CPDP bers, as well as the clinical, technical and scien- ● Mental Health: The needs of patients, remains active in the recruitment and retention remains an important voice in advocating for tific aspects of the organization. ­Collaborating families and communities are complex and of permanent family physicians and specialists. prioritized services and resources to improve 20 well with other health professionals and manag- resources limited, but mental health remains The Department of Pharmacy is working to the health and social well-being of the Crees of 21 ers, the CPDP aims to improve the health and a priority. Staff recruitment, building capac- improve services on various aspects of medica- Eeyou Itschee. social well-being of patients, their families and ity and increasing services are ongoing. tion distribution and related priorities, and the the communities of Eeyou Istchee. Department of Dentistry continues to support As President of the CPDP, I would like to thank Primary Care Reform: Our members are ● dentists and other team members to provide our members for their dedication and effort in contributing to the review, organization and quality dental care. caring for Eeyou Istchee patients, families and provision of CMC clinics, which are being communities so diligently. adapted to improve logistics, care and The CPDP and its committees will continue ­access using the Nuka model of Integrated to support these clinical departments by Chinskumituiin, Care Teams. addressing challenges and advocating for Dr. Darlene Kitty improvements in the quality and capacity of President these services. Collaboration with the Direc- CPDP trip to Fort George during the Annual meeting and training, September 21, 2019 tor of Medical Affairs and Services (DMAS), the CBHSSJB Board of Directors and Management is needed to collectively optimize medical, ­dental and pharmaceutical services. ᑳ ᓃᑳᓂᐱᔥᑑᐙᐦᒡ ᓂᑐᐦᑯᔨᓂᔅᒀᐤ kaa niikaanipishtuuwaahch nituhkuyiniskwaau COUNCIL OF NURSES

The Council of Nurses is made up of all the The Annual General Assembly of the Council of nurses who work for the CBHSSJB, including Nurses took place during the nurses’ training those who hold managerial positions related to in Montreal in November 2019. It was a great nursing services. The Council plays an advisory opportunity for members to learn about the role to the Board of Directors. The aims of the Council of Nurses and to bring their concerns Council of Nurses are to promote understand- and feedback to the attention of the Executive. ing of the contribution of nurses in improving Elections were held and two new members the health status of clients and the performance of the Executive Committee were elected by of the health system in general. acclamation. There remains one vacant seat on The nurses annual training brings the Executive Committee. all nurses employed by the In 2019-20, the Executive Committee of the CBHSSJB together for continuing Council of Nurses continued its involvement in In 2019-20, members of the Executive reviewed skills development and team building. It is the only time the the policy circles that guide nursing practice in three chapters of the Therapeutic Guide and nurses meet in such a large group. Québec. The Council sent a representative to four pre-written order sheets, and compiled a To keep services operating while 22 the nurses are learning, the group every regularly scheduled meeting of the Board list of essential protective equipment for First is divided in two cohorts. of Directors and the Executive attended the Responders. In September, thanks to the ef- annual OIIQ (Ordre des infirmières et infirmiers forts of the Council of Nurses, the CBHSSJB du Québec) General Assembly and the annual joined a partnership with the Université de General Assembly of the Association des CII du Montréal to give all professionals working for Québec (Association of Councils of Nurses of the CBHSSJB access to a complete scientific Québec). The Council’s aim next year is to join database online. the delegation representing the Ordre régional du Saguenay-Lac-St-Jean/Nord du Québec at the annual OIIQ General Assembly.

EXECUTIVE COMMITTEE MEMBERSHIP President Representative of Chisasibi Hospital Alexandre Bui Giroux Vice-President Representative of Coastal Communities Edith Bobbish (elected by acclamation November 2019) Secretary Representative of Regional Services Angélique Laberge Communication Agent and Treasurer Cree Representative Rachel Danyluk (elected by acclamation November 2019) Representative of Inland Communities Vacant working executive group meetings meetings Contact the Council of Nurses: [email protected] 2 8 ᐋᑳ ᓂᐦᐋᒋᐦᐄᐙᒡ ᒑᒀᓐ ᐊᓂᑐᑯᐦᔩᓈᒡ ᑭᔮ ᐐᒋᐦᔨᐙᐎᓂᐦᒡ anitukuhyiinaach kiyaa wiichihyiwaawinihch Dr. François Charette Medical Examiner and Director of SERVICE QUALITY AND COMPLAINTS ­Medical Affairs and Services (DMAS)

The Service Quality and Complaints­ Files Opened 2019-20 MEDICAL EXAMINER The number of complaints referred to the ­Commissioner (SQCC) office consists of The role of the Medical Examiner is to analyze Medical Examiner was relatively stable this year, Sarah Cowboy, Complaints Commissioner, Complaints 77 complaints involving a member of the Council with several interventions made with the SQCC, q36.4% Nancy Shecapio-Blacksmith, Assistant Com- of Physicians, Dentists and Pharmacists (CPDP). avoiding a formal complaint. The Medical plaints Commissioner, and Kristen Iserhoff, 67 Each complaint must be reviewed within a Examiner collaborates closely with the SQCC ­Administrative Processing Specialist, welcomed Requests for assistance 21.8% precise timeframe and leads to a written report office, now reorganised with more personnel— in January 2020. to the complainant. At times, miscommunica- necessary considering the difficulty reaching 16 tion is the basis of a misunderstanding between out to complainants in different communities. The SQCC handles complaints, assistance, Consultations q51.2% professional and client, which can be remedied ­interventions and consultations. 2019-20 saw through short explanations and awareness of Responding to all complaints within the expect- a decline in the number of files opened com- perceptions from both sides. In other circum- ed timeframe was challenging, given the move- Interventions 25 pared to 2018-19, given the collaborative effort q3.8% stances, a significant issue necessitates review of ment of both clients and professionals. Of the between the office and the local manage- files and interviews with different people (other two disciplinary committees, one was terminat- ment of Community Miyupimaatisiiun Centres healthcare workers, client's family, other patients) ed given the non-renewal of the professional's 24 Total files opened 185 q21.3% 25 (CMCs), Wiichihiituwin and Youth Protection. to understand the situation and make adequate privileges, and the other continues to examine The SQCC will continue this collaboration, recommendations to avoid a similar issue in the a complex issue. The Board has final say on bringing necessary recommendations to im- disciplinary sanction following recommendation Thank you to the Vigilance future. Quite often the client or their representa- prove the services provided by the CBHSSJB. tive simply wants to officially point out a prob- from the CPDP Executive. Constituting disci- Committee for their support lem, hoping the situation will not continue or plinary committees is a serious matter, involving Complaint forms will be distributed shortly a quasi-judiciary group of the professional’s to all CBHSSJB establishments, including the and direction, and to the clients, repeat. The Medical Examiner is grateful for the unique opportunity to hear directly from clients peers who review the complaint, hear both creehealth.org website for clients wishing to family members and employees complainant and professional and report back. file a complaint online. Great effort was made on the issues that confront them, and to be able who take the courage and time to address them. Complaints are taken seriously and behaviours to have them available in Cree (Inland and significantly out of line will not be tolerated. ­Coastal), English and French. to report situations. Their efforts The Medical Examiner is also the Director of In the end, the goal is to help improve health- In addition, the department developed the help improve the overall quality of Medical Affairs and Services (DMAS)—a dual role ­acceptable considering the low expected care services. The opportunity to be in direct ­Elder Abuse Policy with Brenda House, Plan- care provided. contact with clients allows for a better under- ning and Programming Research Officer for number of cases. As of 2020, an approved sub- stitute medical examiner has been recruited to standing of the realities and occasional short- Elder Abuse, and the Cree Nation Government comings of CBHSSJB services. (CNG) CAVAC and Justice departments. We are substitute in cases where the Medical Examiner proud to announce that the work was complet- is either not able to accomplish a complaint ed and will come into force very soon. The next analysis within the prescribed timeline or faces phase is to develop awareness campaigns and a conflict of interest. promote teachings on Elders abuse awareness.

The revision of the Code of Ethics (2016) has From left to right: Sarah Cowboy, Service Quality and Complaints Complaints The confidential toll-free number for complaints Commissioner (SQCC); Nancy Shecapio-Blacksmith, Assistant begun and completion is expected in the (1-866-923-2624) is connected to voicemail, so it is essential SQCC and Kristen Iserhoff, Administrative Processing Specialist. ­coming months. Once approved by the Board, 1-866-923-2624 that the caller state their name, phone number and [email protected] it will be available to staff and the public. community so that the Commissioner can call back. creehealth.org/about-us/users-rights ᐄᔨᔫᐎᔨᒡ ᐅᒥᔨᐱᒫᑎᓰᐅᓂᐙᐤ iiyiyuuwiyich umiyupimaatisiiuniwaau POPULATION HEALTH PROFILE

Each year we report on the health status of the Important gaps in the socio-economic situation Almost 4 in 10 (38%) people report having a high Diabetes and its consequences are the most population, providing general evidence to sup- between our population and that of the rest of level of psychological distress (compared to 28% frequent and rapidly growing chronic disease port the first strategic orientation of the Board: Quebec continue to influence health outcomes. of the rest of Quebec). More than 60% of 15-24 issues in the region. Diabetes prevalence in the to catch up with the key indicators of health Although life expectancy has increased by about year-olds experience high psychological distress population over 20 increased from 2% in 1983 and social well-being observed for the general five years over the last two decades, it remains compared to 36% in Quebec. to 27% by the end of 2017, for a total of almost population of Quebec. lower than that of the rest of Quebec, at 74 years 3,000 people. The good news is that the number old for men and 80 for women, compared to a Psychological and emotional stress is known to of new cases diagnosed each year has remained The size of the population has more than tripled Quebec average of 80 and 84, respectively. influence people’s propensity to smoke or use relatively stable over the last 15 years. In addi- 1 2 in 40 years , from 5,000 in 1976 to 18,681 in psychoactive substances as coping mechanisms. tion, out of the 656 Eeyouch/Eenouch diagnosed 2019. Between 2014 and 2019, the Eeyou popu- Family life and children are central to Cree soci- Although the rate of smoking in Eeyou Istchee with prediabetes in 2017, 45% continue living lation has grown at a rate that is more than twice ety, and families tend to be larger than in Que- remains about twice that of Quebec, it has diabetes-free, probably because they successfully 7 that of the Quebec population (9% compared bec, although family size is decreasing over time. dropped from 53% in 1991 to 43% in 2015 . Few- made small but consistent life changes to remain to 4%). This rapid growth is reflected in the fact The fertility rate per woman dropped from 2.3 er people report drinking alcohol (54%) than in healthy. Diabetes in youth is a growing concern. 7 that 30% of the population are under 15 com- to 1.5 times that of the rest of Quebec in the last Quebec (82%) and regular consumption (29%) is Almost one person in five with diabetes (560 26 3 6 27 pared to 16% for the rest of Quebec . According 30 years . Cree women often start their families nearly half of Quebec's rate (55%). Yet, excessive people) is under 40, including 28 youth under 20, to the 2016 census, 97% of the Eeyou/Eenou early, as there were on average one in five births drinking is three times higher than in the rest of most of whom have difficulty managing their dis- 7 population speak Cree, with English as the most annually to women aged 20 or younger . the province (57% vs 19%). In the past year, 10% ease. This group requires dedicated, specialized common second language. of people reported using cocaine and over 25% In Eeyou Istchee, about 18% of the population attention from health and community services to of people declared cannabis consumption, rates help them learn to live well with their diabetes. One in four (25%) families is considered low- lives in multi-family households, compared to also higher than the rest of the province. income compared to one in 10 (10%) of fami- 1% of Quebec. One young child in three was The information presented here shows the 4 lies in Quebec , and this proportion increases being raised in a single-parent family in 2016, Cancer diagnoses and deaths remain lower than importance of mobilizing communities towards to almost half (48%) of single-parent families but these children were also likely to be living in or roughly the same as the Quebec average. Kid- health promotion and prevention strategies. To (compared to 27% of single-parent families in three-generation households. Due to a housing ney cancer, relatively rare elsewhere, is the most address these challenges, the CBHSSJB is work- 5 Quebec). As per the latest data available , the shortage, approximately 18% of dwellings in the common cancer diagnosed in the region, followed ing hand in hand with the leadership and com- graduation rate for Eeyou Istchee students is region have more than one person per room, by lung and colorectal cancers. Eeyouch/Eenouch munity members to foster the development of a 32% on average, compared to 82% in Quebec. compared to 1% of dwellings in Quebec. are being diagnosed with cancer at a younger age healthy and strong Cree Nation that is reflective than elsewhere in Quebec (60 vs 68 years). of Miyupimaatisiiun.

Population Growth rate Cree speakers Youth under 15 Life expectancy Smoking rate Households Diabetes prevalence

1976 2019 27% 5 yrs 18% 97% 53% 9% 4% 1991 43% Eeyou Quebec 30% 2015 multi-family or 5000 18,681 Istchee of population 20 yrs multi-generational adults >20

1. Using the James Bay and Northern Québec Agreement’s Eeyou beneficiary list 2. Data adjusted for undercounting 3. Data from 2014 8. Data from the Quebec Population Health Survey (EQSP 2014-15) 4. Data from 2016 5. 2017-2018 school year 6. from 1983-87 to 2014-18 7. Data from 2014-18 9. Please note that QC data is 12+ while Eeyou Istchee data is 15+; the large gap be- tween the 2 statistics, however, is unlikely to be explained by this age difference alone. ᐱᒧᐦᑌᐦᐁᐤ pimuhteheu EXECUTIVE SUMMARY

Taria Matoush Assistant Executive Director

The Pimuhteheu Department now has a full The new Youth Healing Centre was inaugurated team of permanent directors in place, including in March, just prior to the COVID-19 lockdown. a Director of Public Health. This full roster has This facility replaces the Reception Centre, and facilitated the Department’s response to the offers expanded capacity to support the needs COVID-19 pandemic, in addition to more effec- of youth at risk. tively addressing its regular responsibilities. The Ministry has approved clinical plans for a This past year, the Department made two number of important projects, including the ­presentations to the Laurent Commission on birthing centre, the long term care home, the the Rights of the Child and Youth Protection, healing lodge for treating addiction and three with the valuable support of the CBHSSJB new CMCs. Some operational and technical Chairperson and Executive Director. plans remain to be approved, but this approval is expected shortly. ᐱᒧᐦᑌᐦᐁᐤ The Mistissini-based Empowering Youth and Families project continues with its focus on The end of the fiscal year saw a focus on pro- 29 ᐧᐄᒋᐦᐄᐧᐋᐱᔨᐤ ᒑ strengthening front-line and community devel- tecting Eeyou Istchee during the COVID-19 ᒋ ᒥᔅᑰᐦᑳᐴᑕᑭᓅᐧᐄᔨᒡ opment through collaborations with community pandemic. Partnerships to address the crisis ᐋᐱᑎᓰᐧᐄᓐ ᐄᔨᔨᔫᐧᐄᔨᒡ partners. were quickly established with the Cree Nation Government, Cree Nation Councils, the Cree ᐋᐱᑎᓰᔅᑖᐦᒡ ᒑ ᒋ Three communities—Mistissini, Oujé-Bougou- School Board, the Eeyou Eenou Police Force ᒥᐧᔮᔩᑖᐦᑯᐦᒡ ᐋ ᐧᐄᒥᔅᑰᐦᑳᐳᐧᐄᔨᒡ mou, and Waswanipi—were visited by rep- (EEPF) and other Cree entities, as part of the resentatives from the Ministry of Health and ᐋ ᐧᐄᐧᐋᔫᐱᐦᑕᑲᓅᐧᐄᔨᒡ successful effort, thus far, to contain this virus in Social Services, who were invited to experience Cree communities. ᒥᔪᐱᒫᑎᓰᐅᓐ ᑭᔮ ᐄᔨᔨᐧᐄᔨᒡ first-hand the context in which the CBHSSJB ᐋ ᐧᐄᒋᑲᐳᔅᑐᐧᐋᑲᓅᐧᐄᔨᒡ ᒥᓯᐧᐋ operates. The ministry representatives were presented with and approved a plan to alter how ᐋᐧᐋᓂᒋ ᒑ ᒋ ᒥᔫ ᐱᒪᑎᓰᔩᐦᒡ ᐋ ᐧᐄ funding is used, giving the Department and the ᐧᐄᒋᐦᐋᑳᓅᐧᐄᒡ᙮ CBHSSJB greater autonomy in distributing fund- ing to meet the needs of Eeyou Istchee.

pimuhtahuu wiichihiiwaapiyiu chaa chi miskuuhkaapuutakinuuwiiyich aapitisiiwiin iiyiyiyuuwiiyich aapitisiistaahch chaa chi miywaayiitaahkuhch aa wiimiskuuhkaapuwiiyich aa wiiwaayuupihtakanuuwiiyich miyupimaatisiiun kiyaa iiyiyiwiiyich aa wiichikapustuwaakanuuwiiyich misiwaa aawaanichi chaa chi miyuu pimatisiiyiihch aa 2 wii wiichihaakaanuuwiich. ᐱᒧᐦᑌᐦᐁᐤ The Pimuhteheu Group helps make our services stronger through good planning, and works on pimuhteheu creating healthy communities through partnerships. ᒌᔩᔅᑎᐦᑉ ᐋ ᐐᔭᔅᑏᐦᒄ ᐊᐙᓐ ᐊᐐᔔᒫᑭᐦᓂᐎᑦ chiiyiistihp aa wiiyastiihkw awaan awiishuumaakihniwit PRE-HOSPITAL EMERGENCY AND EMERGENCY SERVICES

PRE-HOSPITAL EMERGENCY SERVICES BUSH KIT PROGRAM EMERGENCY MEASURES Pre-hospital Emergency Services ensure that Last year, the department unveiled the Cree Earlier this year, as news of the novel coronavi- first responders are equipped to provide the Medical Bush Kit Program in collaboration with rus began to spread, the Emergency Measures best quality care in the critical interval between Cree Trappers' Association and SiriusMedx, with team worked closely with the Regional Public a call for help and a patient’s transfer to the financial support from Niskamoon Corpora- Health Department to coordinate the COVID-19 clinic or hospital. tion and Apatisiiwin Skills Development. Cree pandemic response across Eeyou Istchee. The Medical Bush Kit training took place in Whap- unit played a critical coordination role, ensuring The CBHSSJB supports first-response partners magoostui and Waskaganish. The department is that Cree enterprises were aware of and adapt- in each community, including the police, first preparing a Train the Trainer course to acceler- ing to public health and safety measures. responders and ambulance services, providing ate learning in all communities. operational and administrative coordination for The coordinated response on the ground in safe and efficient patient transfers. The depart- each community was the result of a strong rela- ACTIVITIES ment also helps communities access CBHSSJB tionship between the CBHSSJB, Public Security ● First Responder Agreements: Three-year 30 resources, material and expertise for the contin- proposals with Fire Departments in all com- Officers (PSOs) and Band Councils. 31 uous improvement of the quality of emergency munities to centralize all emergencies services. The department coordinates training

and certification for first responders. ● Mobile Emergency Hospital Services: Planning session held with the Cree Nation of Chisasibi and the Canadian Red Cross EMERGENCY COLOUR CODES The department further developed the imple- ● Defibrillator kits: Agreement signed to IN MEMORAM lend the Eeyou Eenou Police Force (EEPF) mentation of the colour code system for GEORGE HE was a nurse with the emergency measures. A live simulation Code 25 automated external ­defibrillators Bayshore agency who worked in Orange—a mass casualty event—was conducted Waskaganish, Eastmain, Wemindji and in Chisasibi, and a table-top simulation was held Nemaska. He died November 2019 when in Waskaganish. All Community Miyupimaati- siiun Centres (CMCs) now have protocols. The his vehicle was stranded on a remote exercises enabled airports in these communities road in winter weather. Jason Coonishish to renew their permits with Transport Canada personally assisted in the search effort Aviation. The department is now developing led by Sûreté du Québec. Following Code Pink (pediatric cardiac arrest) and Code this tragedy, the CBHSSJB issued new Green (evacuation to mobile hospital) protocols. guidelines for workers travelling in areas Protocols for code silver—threatening use of a without cell service, including the use of weapon—are mostly in place, and simulations are satellite GPS messenger devices. From left to right: Brandy Gunner (First Responder), Thomas Chakapash planned for the future. (PPRO-Emergency Measures, CBHSSJB), Natasha Shecapio (Deputy Fire Chief), Thomas Longchap (First Responder) and Jason Coonishish (Coordinator of Pre-Hospital, CBHSSJB), August 2019 60 out of 88 Eeyou police officers received defibrillator training Code orange crash simulation exercise Chisasibi September 4, 2019 YHS ᐅᔅᒋᐱᒫᑎᓰᐎᓐᐦ ᐋ 90 ᐊᐙᔑᔥ ᓯᑮᔅᒑᐦᔨᑎᒧᐎᓐ ᒦᓂ ᓍ ᒋ ᐦ ᑖ ᑭᓄᐎᐦ ᒡ employees ᐊ ᐃᐦᑑᑖᑭᓂᐎᔨᒡ

uschipimaatisiiwinh aa miininwaachihtaakinuwihch Number of activities hosted awaashish sikiischaahyitimuwin a ihtuutaakiniwiyich by the Bush Program YOUTH HEALING SERVICES YOUTH PROTECTION

This year saw the culmination of Youth Healing The Bush Program, which offers­ 18 The Department of Youth Protection (DYP) is Youth Protection made strides towards consoli- Services' (YHS) three-year Youth Healing Action youth a holistic land-based concerned with the safety and security of all dating services and engaging in new collabora- Plan that included training staff and educators experience with camps for both inland and children under the age of 18 in Eeyou Istchee tions with Cree entities. and efforts to improve quality of services. Mis- coastal communities, hosted activities, includ- and works to reunite them quickly and efficient- tissini's new Regional Centre gives YHS three ing hunting and fishing trips. These multi-day ly with their biological parents or guardians. Working with Human Resources, DYP put in residential facilities to support youth clientele expeditions are an opportunity for youth to place new recruitment and retention strate- on their healing journey. learn life-skills rooted in Eeyou/Eenou culture The Department provides legal, administrative gies to address high turnover. In March 2020, and traditions. Elders help guide the program and liaison support to youth placed in YHS and Marlene Kapashesit was nominated Director of The Cree School Board (CSB) provides a teacher and share traditional knowledge. other services under the Youth Criminal Justice Youth Protection. for youth at Mistissini's Regional Centre to sup- Act (YCJA). The regional team includes four port school re-integration­—a program started YHS staff benefit from regular training through- special investigators designated to evaluate The Department continued to expand the in November 2019. Youth attend public school in out the year, including intensive Boscoville reports of suspected abuse or severe neglect. Projet intégration jeunesse (PIJ) data collection the community but, when unable to, they work training—culturally relevant training and sup- system begun last year. Once complete, the PIJ with ­educators at the Centre. While youth are port for care workers, an intensive supervision The Reception and Treatment of Signalements platform will provide a secure environment for 32 unable to complete the educational program unit simulation at Cité des Prairies, Omega (RTS) service includes Cree-speaking staff who the storage and management of clients’ files, 33 and move up to the next grade level, the pro- Training and training in Joint Clinical Process. respond to reports by community members of and the generation of statistics. situations of child endangerment or neglect. gram does provide a better chance to succeed Training and collaboration were strengthened once they return to school. Both the CSB and The service intervenes when the security and well-being of a Cree child are compromised. with CMCs and other departments support- YHS are working together to improve services. ing children and families—Awash, Nishiiyuu In November, the CBHSSJB was invited to and Robin’s Nest Women’s Shelters. Regular Residential facilities meetings with Disability Programs, Foster Care, SQCC and the CSB help to improve case coor- Additional RTS staff has dination and continuity. Upaachikush resulted in a Group Home New YHS Regional Centre, Mistissini, August 2019 24-hour service Like many other essential services, the Depart- Mistissini ment had to adapt to the impact of COVID-19 on its clients. During confinement, the number testify before the Special Commission on the of reports declined as children were no longer in Rights of the Child and Youth Protection (the contact with their school or daycare—often the Weesapou Laurent Commission). The hearing gave the YP Group Home sources of reports. YP workers were unable to On March 6, 2020, the CBHSSJB and Cree Nation team an opportunity to help policymakers un- Chisasibi follow up and visits between children and youth Government inaugurated the new YHS Regional derstand how Cree culture shapes interventions in placement and their families were curtailed Centre in Mistissini—for youth who require intensive under the Youth Protection Act (YPA). Next year due to the ban on non-essential inter-community NEW healing outside their family setting for addictions, promises to be very exciting with implementing trauma and other serious issues. Replacing the travel. However, workers used means such as more inclusive and empowering approaches to ● 26 beds Reception Centre, it increases treatment capacity by videoconference to maintain contacts, and court ● separate units for boys and girls child welfare in the Cree Nation. YHS Regional eight places, and is being adapted for youth in closed Centre ● Youth Criminal Justice Act (YCJA) unit hearings stayed on schedule. Intensive Supervision unit Mistissini ● custody under the YCJA to participate in rehabilitation ● Education, cultural and recreational spaces programs within the Cree community. NUUHiI A KU a U ᐋᐱᑎᓰᐐᓐᐦ ᒑ ᒋ ᒥᔫᐲᑖᐦᑭᓄᐎᒡ M ᑭᔮ ᐋᐄᐦᐄᑭᔅᑮᐦᑭᓄᐎᒡ ᒫᓅᐦᐄᑰ apitisiiwiinh chaa chi miyuupiitaahkinuuwich kiyaa aaiihiikiskiihkinuwich maanuuhiikuu ᒫ PROGRAM DEVELOPMENT AND SUPPORT MENTAL HEALTH ᓅᐦᐄᑰ

Program Development and Support ­strengthens ACHIEVEMENTS Maanuuhiikuu supports communities in pro- INDIAN RESIDENTIAL SCHOOL (IRS) – the range and quality of front-line services in ● Clinical plans for three Elders' homes and moting positive mental health through preven- RESOLUTION HEALTH SUPPORT PROGRAM communities. The Department, which includes the Weesapou Group Home tion, intervention, treatment and holistic care Pre-Hospital Emergency and Emergency Ser- ● Functional and Technical Plans for capital in Eeyou Istchee. The team works with partners vices, Maanuuhiikuu, Disability Programs and projects on and off the territory, including local Com- RHSW provided emotional support to: Specialized Services (DPSS) and Midwifery, munity Miyupimaatisiiun Centres (CMCs) and Implementation of recommendations to 187 former IRS students recruited new team members to plan programs, ● the Douglas Mental Health Institute, to ensure improve home care 260 family members conduct evaluations and develop internal and access to a wide range of culturally safe ser- external collaborations. ● Client satisfaction evaluation report vices—psychology, psychiatry, addiction help Cultural support workers provided ­spiritual and traditional counselling to: ● Data collection for a status report on and support for Indian Residential School (IRS) Despite initial difficulties, Waswanipi's Regional chronic disease management survivors and their families. 356 former IRS students Addictions Pilot delivered promising results, family members Status report on CMC capacity to provide 656 benefiting from a joint effort between Was- ● In 2019-20, Maanuuhiikuu expanded services by integrated approach to front-line services wanipi's Maanuuhiikuuu team and Public Health. recruiting new staff and developing new pro- RHSW and Missing and Murdered Indige- nous Women (MMIW) workers supported: 34 An evaluation is underway to make adjustments ● Support of Robin’s Nest women's shelter grams, collaborations and capacity of local care 35 before rolling out the pilot in other communities. team transition workers to respond to mental health emergen- 247 family members For 2020-21, Maanuuhiikuuu aims to stabilize its ● Collaboration on joint Optilab project for cies. Pauline Bobbish was named Coordinator of resources, develop telepsychology and telepsy- Eeyou Istchee and Nunavik Maanuuhiikuu in January. A permanent psycholo- CSP and MMIW workers supported: chiatry, and strengthen traditional counseling, in gist was recruited for Wemindji, and a Human ● Methodology for compiling and analyzing 47 family members collaboration with Nishiiyuu. data on First Responder services and up- Relations Officer and Administrative Process Spe- dated resource directory for the region cialist were hired. Expanding the team stabilizes With the return of Midwifery Services in 2019 services and support to clients and local teams. in Chisasibi, coverage of perinatal services can ● Contribution to HEY-Uschiniichisuu (Healthy now be extended to other communities. Eeyou Youth!) project With COVID-19, therapists quickly adjusted ser- The Resolution Health Support Workers (RHSW) vice delivery, relying on telephone sessions and The COVID-19 pandemic brought about some program is also supporting youth in under- DPSS, for clients with physical and intellectual eventually video conferencing. Secure video- rapid but significant changes. In particular, the standing the intergenerational impact of the disabilities, began several joint projects—the conferencing, expanded in recent years, became Department of Pre-Hospital Emergency and IRS system. Land-based Healing Program with Nishiiyuu, a necessary part of care during the COVID-19 Emergency Services mobilized quickly to en- the Jiiwaahtauu Project to return community pandemic, allowing for case discussions and client With the conclusion of the IRS Court Hearings sure the readiness of communities and health- members in long-term care outside the ter- follow-up. More support is being offered via tele- in the region, claimants have begun to receive care workers in the face of this novel virus. ritory, and a resource for disability needs in psychology in Mistissini, Chisasibi and Nemaska, compensation under the Federal Indian Day Eastmain. DPSS is also responsible for imple- improving the continuity of care and decreasing School Settlement Agreement. Sixties Scoop menting Jordan’s Principle to ensure access to the need to send people south for care. claimants are still awaiting compensation. government services for children up to age 18 and their families. Individual and group ap- The Aboriginal Focusing Therapy training pro- SUICIDE PREVENTION gram is working online with 22 participants to plications were made for the Access to Ser- Suicide prevention is a top priority for the complete the final module. vices Support Fund, helping with health, social CBHSSJB. The Suicide Working Group contin- and educational needs not covered by the ues to implement a suicide prevention strategy CBHSSJB. The program will continue to de- in all communities. A project with the Associa- velop, with new projects to promote awareness tion Québécoise de Prévention du Suicide and deliver services to disabled children. (AQPS) is supporting the implementation of Good Practices­ in Suicide Prevention. ᓂᓈᐦᑳᑎᓰᐎᓐ ᐊᐐᐦᒡ ᐐᒋᑖᐦᑭᓄᐎᒡ ninaahkaatisiiwin awiihch wiichitaahkinuwich DISABILITY PROGRAMS AND SPECIALIZED SERVICES

MAANUUHIIKUU COLLABORATIONS The Disability Programs and Specialized As of March 2020, 18 clients with complex ● ACCESS pilot project—community-based ­Services (DPSS) Department provides culturally needs were living in residences outside Eeyou mental health services to youth relevant services to support clients in Eeyou Istchee. DPSS works with case managers on ● Nishiiyuu—linking clients with traditional Istchee living with physical and intellectual dis- the territory to ensure these clients continue to ­healers and cultural support abilities and autism spectrum disorder. receive high quality, culturally adapted services. Psychosocial, Disability­ Programs and Youth Intensive Ideally, all clients with disability needs should ● Services 764 Access to culturally safe disability services within Protection and Youth Healing—identifying therapy receive care at home. Jiiwaahtauu is a three- outside of the Eeyou Istchee is a priority. In 2019-20, the team phased project to identify resources needed on different types of assessment needs Emergency community focused on improving its capacity to provide a the territory to bring home clients living outside CMC staff and other service providers (e.g. mental 955 ● health full spectrum of services as close as possible to Eeyou Istchee. As of 2019-20, the first phase of Robin’s Nest)—providing psychotherapy, home. DPSS worked with other CBHSSJB depart- the project—a gap analysis—was complete. psychoeducation and art therapy ments—Nishiiyuu and local entities—to expand ● Partners in mental health services for Cree and enhance the quality of services and support DPSS provided two trainings on behavior, autism Nation beneficiaries outside the region to clients in their communities. Initial phases of and other disabilities in Chisasibi and Mistissini 36 two new projects were completed: one to bring to all community members, and one on FASD 37 home clients who reside off the territory due to (Fetal Alcohol Syndrome Disorder) to Com- 2019-20 Maanuuhiikuu Services Provided complex needs, and another to enable clients to munity Health Representatives (CHRs). DPSS connect with land-based experiences. and Nishiiyuu are working together to make # clients # no # # telehealth % no- rate/ # visits seen shows appointments sessions shows population 1000 people land-based activities accessible to people with Prior to the COVID-19 pandemic, Clinical disabilities. In September 2019, Allied Health, % ­Advisors travelled to communities to work with the Cree School Board and the Cree Nation of ? ? local case managers, occupational therapists Whapmagoostui formed a pilot project to en- and speech language pathologists, supporting able participants with disabilities to experience Chisasibi 187 739 378 1575 67 33.8 4920 150.2 follow-up appointments with 195 clients with dis- the routine and activities of a land-based camp. Eastmain 8 96 45 141 31.9 862 111.4 abilities. The pandemic meant that the depart- Mistissini 11 191 77 28.7 3974 48.1 ment’s intervention team was unable to travel The Cree Neurodevelopmental Diagnostic Clinic,­ around the region after March 2020. To stay which implemented the FASD assessments last Nemaska 7 156 31 187 16.6 852 183.0 connected to clients and staff in communities, year, paused for evaluation in the spring of 2019. Oujé-Bougoumou 5 201 117 310 18 36.8 863 232.8 the team developed downloadable resources The clinic is set to resume in fall 2020. Waskaganish 12 131 97 N/A 9 42.5 2509 52.2 and started a weekly online sharing circle to help DPSS will continue to expand its services and Waswanipi 17 328 81 383 12 19.8 2082 157.6 break the isolation often felt by caregivers and promote interdisciplinary collaboration to ensure Wemindji families of clients with disabilities. 2 247 95 344 4 27.8 1582 156.1 integrated, high quality services are available Whapmagoostui 32 187 78 265 29.4 1036 180.5 The Jordan’s Principle Program, which offers within all communities and that Nishiiyuu values Total 281 2276 999 3205 110 30.5 18,681 121.8 additional funding for prod- remain at the core of the Department. ucts, services and support so Montreal 50 33 90 39.8 Cree children may access public 93 ­applications Visio + phone consults 68 15 83 18.1 services, held presentations for approved for a Intensive therapy/ more than 200 individuals. total of $1,165,353 Wiichihiituwin clients 48 13 78 21.3

Note: Consultations could be occurring in more than one, or different, communities. ᒥᔪᐱᒫᑎᓰᐅᓐ ᐋᐧᐄᔨᒡ ᓂᔒᔫ ᐙᐱᒫᐅᓲᐎᓐ ᑭᓂᐧᐋᐱᐦᑖᑲᓄᐧᐄᔨᒡ nishiiyuu waapimaausuuwin miyupimaatisiiun awiiyich kiniwaapihtaakanuwiiyich MIDWIFERY PUBLIC HEALTH - EXECUTIVE SUMMARY By offering culturally safe and dignified care that respects the Cree ways 2019-20 marked the return of midwife-assisted of life during childbirth, Public Health’s goal “is to ensure conditions in The Public Health Department believes that birthing in Eeyou Istchee for the first time since ­Midwifery Services which people can be healthy […] The success preserving the health of the Cree population the legalization of midwifery in Quebec—a earned a pan-Canadian of public health depends on adhering to the depends on our privileged position in an In- victory for Eeyou/Eenou women reclaiming the basic rules of equity, partnerships, and social digenous context that is entirely self-governed. award for patient safety right to give birth on the land. justice.”1 The success of the Cree population in this from Salus Global. and previous pandemics is a clear sign of the Training has been critical in integrating The current pandemic has raised awareness of strength we draw from the Eeyou/Eenou ways. ­midwifery into the CBHSSJB. The Department the role of public health in the overall health worked with the Montreal Children’s Hospital system. Public health is much more than infec- We will continue along this path once the pan- to train the medical team on the procedure for HIGHLIGHTS tious disease surveillance and outbreak control. demic is over; putting people at the heart of Interviews across Eeyou Istchee on Cree stabilizing a vulnerable newborn. A midwife ● It also aims to create the conditions for popula- our actions, and continuing our efforts to place Midwifery Training program and family physician became instructors in the tions to become healthier and to thrive. Cree staff in key decision-making positions. Neonatal Resuscitation Program and organized ● Plan for temporary Chisasibi birthing home certification courses for nurses, physicians and ● Technical plan for Chisasibi birthing home Health is not a goal in itself, but a valuable There can be no real health for Indigenous peo- 38 midwives. With the support of the Regroupe- sent to the MSSS and a site identified resource that individuals and groups need in ple without self-governance and reconciliation. 39 order to enjoy the right to live and build their Reconciliation is not an "Indigenous" issue, but ment Les Sages-femmes du Québec, midwives ● Agreement with MUHC allowing midwives to trained first responders on precipitated birth. transfer clients to tertiary health centres future as they see fit, in the socio-cultural, a social issue that affects us all. Learning from ­economic and political spheres. our collective history, and moving forward. ● Implementation of tele-midwifery in MoreOB (Managing Obstetrical Risk ­Efficiently) Together. ­collaboration with Specialized Services completed its first year. Supporting culturally safe Participation in annual week on breastfeed- and dignified care, it respects the Cree way of life ● ing, and in working group developing guide- by building confidence in normal births empow- lines for diabetes care during pregnancy ered by informed choice. Workshop participants exchanged views on birth and woman-centered Next year, Midwifery Services plans to expand care. Through birth stories, Elders spoke of the its Chisasibi-based services to women in Whap- sacredness of the first to touch new life, preg- magoostui and Wemindji, and is working on nancy and learning through observation. structuring services to offer ­out-of-hospital births including home and teepee births. New staff, including a fourth midwife, were welcomed. The International Meeting on Indige- nous Women’s Health, the Canadian Association normal birthing workshops 6 (Elders, nurses, physicians, of Midwives Congress and the Society of Obste- midwives, CHRs & new parents) tricians and Gynecologists of Canada conference were attended—building global partnerships with Indigenous maternal care initiatives. benefitted from 110 Midwifery Services The COVID-19 pandemic resulted in the sus- received care from a pension of some services and the addition of 81 midwife (pregnancy/ new ones. Mom’s Support Group and Prenatal birth/post-natal) 27 Gatherings, jointly with Awash and Nishiiyuu, referrals from Wemindji and Midwife-assisted went ahead in February 2020, but was post- 2 Whapmagoostui births in Chisasibi 1. Schmitt N., Schmitt J. (2008) Definition of Public Health. In: Kirch W. (eds) Encyclopedia of Public Health. Springer, Dordrecht poned for March due to the pandemic. Promoting and improving the well-being of pregnant women, babies, children aged 0 to 9 and their families through ᐊᐧᐋᔥ a culturally-safe and integrated services approach with added psychosocial and AWASH 0-9 community development components

The  Mashkûpimâtsît Awash (AMA) Program The Breastfeeding Program aims to increase The Immunization Program continues to The Dental Health Program delivered by ­dental provides ongoing health and psychosocial sup- breastfeeding rates in Eeyou Istshee by imple- ­prioritize support and coaching for all Eeyou hygienists included individual preventative port services tailored to families. As well as a menting the Baby-Friendly Initiative (best breast- Istchee local vaccinators. The flu campaign was follow-ups with fluoride application, and sealant three-day meeting on AMA Guidelines for com- feeding practices) within regional health servic- promoted on social media, and community flu screening and application on first and second munity organizers, the AMA continues partner- es, and supporting local initiatives that promote, immunization schedules were published on permanent molars. Two new dental hygienists ships on early child development and family protect and support breastfeeding. 15 new creehealth.org. The Program ensured adequate received training and calibration on the selec- wellbeing, and coordinating and creating activi- employees participated in four two-day breast- record keeping and reporting of all vaccines tion of tooth surfaces to be sealed. The Den- ties. Collaborations took place locally (Empow- feeding training sessions. Breastfeeding work- administered in the communities. tal Health PPRO (Planning and Programming ering Youth and Families), regionally (Regional shops and individual case discussions were held Research Officer) community tour continued Eeyou Istchee Vaccination Program Parenting Conference, Perinatal Care Working in response to needs expressed by Awash health in Waskaganish, Eastmain and Chisasibi, and Group, Integrated Care Model Working Group, care workers. 10 local projects were implement- Infants 5 months DCaT-HB-VPI-Hib (2 & 4 months) an Oral Health and Diabetes presentation was CNG, Maamuu Uhpichinaausuutaau) and provin- ed with support from the regional public health 100% first dose given at the annual CHR training. cially (Politique de périnatalité 2008-18, Provincial breastfeeding program, including activities to 83.2% both doses Respondants Committee for Services intégrés en mark Breastfeeding Week in five communities, a 40 4366 666 41 perinatalité et pour la petite enfance (SIPPE)). breastfeeding promotion calendar and a “Home Toddlers 15 months Men-C-C (12 months) Away From Home” activity day organized by The Maternal and Child Health Program (MCHP) Niishiiyuu in Val-d’Or, that included workshops 81.8% required dose supports local Awash teams with counseling and on breastfeeding and creating comfortable coaching skills, home visits, and promotion and spaces for breastfeeding mothers. Tools to prevention efforts by applying evidence-based promote breastfeeding were developed for local Toddlers 24 months RRO-Var (12 & 18 months) guidelines in maternal and child health interven- Flouride applications Children who Awash teams and for a prenatal group meeting 86.8% first dose (schools and child received dental tions and activities. Local Awash teams received on breastfeeding (Prenatal classes framework in care centres) sealants both doses clinical support and training for AMA/MCHP collaboration with MCHP), and for health care 85.1% via community visits, working groups, monthly workers to discuss breastfeeding with pregnant We are on the way to achieving good vaccine coverages in the The Pour une maternité sans danger (PMSD) nurses’ phone meetings and CHR (Community region; however, a big proportion of children are behind schedule. women and families. Program processed and analyzed 105 requests, Health Representative) Matcare Committee comparing them to standard provincial practice conference calls. MCHP updated materials and The Cree Leukoencephalopathy and Cree Considered protected from measles (infocentre-INSPQ) guidelines that concern physical, biological, er- tools for local Awash nurses and CHRs in col- Encephalitis (CLE/CE) program aims to increase elementary 96.2% gonomic, chemical and psychosocial risks during laboration with other programs (Prenatal Classes awareness on these genetic diseases, inform on secondary pregnancies. The CBHSSJB physician for PMSD Framework, daycare toolkit, CHR teaching tool the availability of screening, and support carrier 98.6% provides support for the health and safety nurse on healthy lifestyle for postpartum mothers). couples in reproductive choices. In 2018-19, 64.2% teachers & staff regarding PMSD recommendations. MCHP pamphlets and parenting booklet drafts training designed for school nurses was adapt- were revised and merged. ed for front-line nurses and then evaluated by Received flu vaccine1 the Sainte-Justine Hospital, with the hospital Number of pregnant women and 13.3% all ages children benefiting from the Canadian receiving an additional grant in 2019-20 to 75 and over 200 Prenatal Nutrition Program assess the skills of front-line nurses, one year 45.5% post-training. The program and adapted train- 10.2% pregnant women2 Number of pregnant women benefiting ing were presented to the CBHSSJB's new Ad- Vaccine abbreviations: from Miyuuashimishuh, a new project visory Panel of the Research Committee, with 1. In Eeyou Istchee, the vaccine is free of charge, unlike in the rest DCaT-HB-VPI-Hib = diphtheria, pertussis, tetanus, hepatitis B, 100 to reduce food insecurity of Quebec. Thus, we should see higher vaccination coverage. poliomyelitis and Hib infections (in 2 communities, soon 5) content culturally adapted. 2. Estimate of pregnant women in 2nd or 3rd trimester, calculated from Men-C-C = meningococcal disease Quebec live births and stillbirths—birth rate higher in Eeyou Istchee. RRO-Var = measles, mumps, rubella Improving the health of youth through planning and implementation of appropriate health services in ᐅᔅᒋᓃᒋᓲ communities, clinics and schools and by addressing developmental needs in the USCHINIICHISUU 10-29 transition to adulthood

PROVIDING ADAPTED SERVICES TO YOUTH PROMOTING HEALTH AND WELLBEING IN PREVENTION OF STIs AND OTHER IN THE COMMUNITIES SCHOOLS REPORTABLE INFECTIOUS DISEASES 292 The Healthy Eeyou Youth Project (HEY) facilitates The School Health Program provided support to The Sexual Health Program supported local

access to psychosocial and clinical services for school nurses, now present in all nine communi- ­clinicians in their investigation and management Chlamydia 10.2% youth. This year, HEY/Uschiniichisuu completed ties. In addition, many students participated in of STI cases and their sexual contacts. The Pro- Rate: 1,587.6 per 100,000 hab. the Community Consultations in Planning Cree the Chii Kayeh Iyaakwaamiih (“You too be care- gram promoted routine STI screening by raising Youth Friendly Health Services in Eeyou Istchee. ful”) program on healthy relationships and sexual awareness of the availability of non-invasive urine All nine Uschiniichisuu CMC departments and health, which includes an online training tool tests. Public Health also offered school nurses 22 more than 120 front-line workers participated for teachers. Collaboration between the Cree and local health professionals updated training on and the results of a needs assessment are under School Board and Public Health Department led the new ministry standards for STI testing. Neisseria Gonorrhea 46.3% review by the Uschiniichisuu and the Planning and to the development of new projects, such as the Rate: 1,785.7 per 100,000 hab. Support Services teams. regional Breakfast Club Program. The Infectious Diseases Surveillance and Protection Program continued to support the The outreach pilot project in Waswanipi is also With the addition of a new PPRO for Wellness control of clusters and outbreaks of infectious 42 being evaluated. In addition to training CHRs this and Coping, the program reinforced the links diseases. This program works closely with pro- 43 year, the project produced a framework/living between Public Health and the Cree School vincial partners to support surveillance (vigie), The Uschiniichisuu population remains document, monitoring tools and training docu- Board. Pilot projects in Mistissini elementary and prevention and interventions to reduce the at higher risk of contracting these ments to support front-line workers in implement- high schools included: incidence of reportable infectious diseases and infections and living with life-long ing the outreach approach. their complications. consequences. Numbers reported ● mental health support for students—work- justify CBHSSJB efforts at increasing The Dependencies and Addictions Program shops on coping with anxiety, dealing with screening, especially among young men PROMOTING HELMET USE IN THE REGION worked with regional partners on harm reduc- deadlines, healthy lifestyles, self-esteem, and asymptomatic youth. THROUGH ROLE MODELING tion activities focused on substance use in Eeyou harm reduction The “Be careful! Your head! ᐊᔮᐧᑳᒥ! ᒋᔅᑎᐧᑳᓐ! Istchee. The Cannabis Regional Awareness Pre- ● wellness workshops with the school nurse— Ayâkwâmi! Chishtikwân!,” safety awareness cam- vention Project disseminated information about the importance of expressing emotions, paign continued to promote the use of helmets cannabis use to Grade 5-6 students and high self-care, coping skills, and the promotion while playing sports, riding bikes, scooters and school students. This harm reduction initiative of positive relationships and prevention of off-road vehicles. The campaign targets children included evening video production sessions with self-injury and youth through influential role models. Rupert Stream (a Waskaganish video production support for the Special Education Depart- company) at the Youth Centre in Waskaganish. ● ment, the Study Method class and Youth 500 >8000 Fusion programming

helmets distributed social media reach in all Eeyou Istchee of helmet awareness communities videos (2) ᒋᔖᔨᔨᐤ Promoting healthy lifestyles and preventing chronic diseases for adults CHISHAAYIYUU 30+ and Elders

CHRONIC DISEASE PREVENTION The team participated in various committees The Train the Trainer Program aims to increase ENVIRONMENTAL HEALTH This year, various activities were organized and working groups, such as the Committee health care providers’ knowledge of diabetes Environmental Health within the Public Health ­following the Public Health regional health on Access to Nutritious Food, the Elders Fund management through training, mentorship and Department aims to protect people from the ef- promotion calendar—Nutrition Month, Physical Initiatives, the Quality Improvement Working support. In 2019-20, the regional diabetes team fects of harmful substances in outdoor air, indoor Activity Month, Diabetes Awareness Month, the Group, and No Butts To It local and regional visited all communities to offer training and air, water and food. It is also concerned with Walk-to-School Week, National Physical Activity working groups. support, some more than once. They also con- reducing negative health impacts of resource Week and the 100-Mile Challenge, and running tinued to provide peer support for youth living development projects, encouraging healthy and events, walking clubs, snowshoe walks, school To facilitate collaboration, the team organized with diabetes. The team gave a poster and oral safe community environments, and addressing health promotion activities, summer camps and monthly meetings of the Miyupimaatisiiun presentation on the Train the Trainer Program environmental emergencies. Much of this work traditional activities. Community health and Meeyochimoon Network (Healthy Lifestyle at the Diabetes Canada national conference in involves collaboration with the Cree Nation Gov- safety messages such as ice, boat, driving and Network) with Chishaayiyuu managers and the Winnipeg. ernment (CNG), the Cree Trappers’ Association, firearm safety were also promoted throughout nutrition team. Cree Nation Councils and the James Bay Advi- the year. The team also continued to develop various sory Committee on the Environment. The team was involved in organizing training ses- health information pamphlets and tools used in 44 The No Butts To It Challenge—getting the sions and workshops for the annual trainings for all communities, with many translated into Cree The team receives frequent requests from the 45 whole community engaged in helping smokers nurses and Community Health Representative and French. public and health professionals about manag- quit and non-smokers stay smoke-free—took (CHR) training. Lateral Kindness Workshops were ing mold exposure and indoor air quality. This place in Oujé-Bougoumou, Waskaganish and provided to various entities and groups. The Chishaayiyuu is involved in planning and co- year they collaborated with the CNG on a policy Eastmain (where 65% of the eligible population team offered training and support to daycares ordinating cancer screening, including breast, initiative about housing-related health issues. signed up). Waswanipi had to be cancelled due and CBHSSJB food services to develop menus, colorectal and cervical cancers. Following last to COVID-19. A program evaluation is underway. manage food services and implement food year’s breast cancer quality improvement initia- Two new employees joined the team—one safety and hygiene practices. tives, a guidebook was developed, and training working on a health impact assessment of parks Under the Healthy Environment Active Living sessions were offered to health workers. A public and green spaces in collaboration with the CNG (HEAL) Program, 45 small grants were awarded awareness campaign helped ensure informed Capital Works and Cree Nation Councils, and the to community groups for healthy cooking work- decision making. This year, breast cancer screen- other on a mandate from the Ministry of Health shops, community walks, winter and summer ing took place in Nemaska and Waskaganish. and Social Services of Québec (MSSS) to im- activity programs, afterschool programs and No Butts To It! Unfortunately, screenings scheduled for other prove the consideration of health and well-being community gardening projects. The new Food communities were postponed due to COVID-19. during the opening of large development proj- Security Fund supported 21 initiatives, including 1274 14 ects in Eeyou Istchee. The Windfall Lake mine meal programs, meals on wheels, community signed up challenges within the traditional territory of the Cree Nation soup kitchen, collective kitchens, community of Waswanipi was used as a case study. fridge, freezer and food banks, harvesting, gar- 7 7338 dening and a grocery discount program. communities participants

The team promoted the adoption of healthy lifestyles at local and regional events (assem- blies, health conferences) via presentations, information booths and local and regional media (radio, newsletters, social media). Promotional items such as step counters and snowshoes were distributed in all nine communities. ᑖᑭᔥ ᓈᑭᑎᐙᔨᐦᑎᑰᒡ ᑭᔮ ᔕᔥ ᐋ ᒋ ᓂᑐᒌᔅᒑᔩᑕᑭᓄᐎᒡ ᐋᐦᐊᑦ ᐄᔩᔭᒸᐦᐄᐙᒡ ᒑᒀᓐ taakish naakitiwaayihtikuuch kiyaa shash aa chi nituchiischaayiitakinuwich aahat iiyiiyamwaahiiwaach chaakwaan SURVEILLANCE, EVALUATION, RESEARCH AND COMMUNICATIONS

Water quality in community water distribution OCCUPATIONAL HEALTH AND SAFETY SERC (Surveillance, Evaluation, Research and linked to monthly themes, 26 episodes of the systems is the responsibility of the Cree Nation This team is part of the Réseau public de santé Communications) is a hub of expertise within radio program Miyupimaatisiiuun Dipajimoon Councils, and Public Health assisted with pre- au travail du Québec, whose mandate is to Public Health providing support to key functions were broadcast with the JBCCS, our regional ventative measures for drinking water to avoid protect the health of workers by preventing oc- in the CBHSSJB—disease surveillance, evaluation radio broadcast partner. Interviews were coordi- health risks. cupational diseases and injuries. The team or- methods, research and knowledge translation, nated with Cree media, CBC and other media on ganized the training of new workers, including a public health communications, preventive clinical health topics. The communications team within A three-year project on climate change has prevention technician for one year and a nurse practices and public health capacity building. The SERC provided training to the Board of Directors started, funded by Health Canada and support- for three months. A private occupational health effectiveness with which the CBHSSJB managed and the Public Health team on crisis communica- ed by the Institut national de santé publique du firm specializing in northern regions provided the current COVID-19 crisis is due in part to the tions and spokesperson roles. Québec (INSPQ). The project’s goal is to con- training in industrial hygiene, including the han- strong capacity that exists within this team. duct a thorough literature review on current and dling and calibration of instruments. Following The SERC team played a key role in CBHSSJB’s projected impacts of climate change on health, a few reported incidents, the team visited work Until the pandemic emerged as a focus, the response to the pandemic, providing the Direc- to assess health vulnerabilities to climate change sites to identify and eliminate health threats to team carried out its usual functions. It updated tor of Public Health and other decision makers 46 at a regional level and to propose a regional workers such as carbon monoxide and other a ten-chapter internal report on the health with detailed and rapid surveillance and analy- 47 health adaptation plan. biological hazards. of the population of Eeyou Istchee, and the sis of COVID-19. SERC assisted with contact statistical and demographic profile of the tracing and the rapid creation of culturally safe A radon testing campaign was carried out in col- region. The Research Committee that oversees materials to inform and educate policymakers laboration with Nemaska, and support provided research partnerships was strengthened. The and the public. Within SERC, a COVID docu- to other communities with radon requests. team produced a report on the oral health mentation team was established to address the Regarding environmental emergencies, the of elementary school students, and SERC significant information management challenges group held regular meetings on public health worked with the Public Health Uschiniichisuu associated with the pandemic response. emergency response and, during winter, pre- team to improve opioid management in the region and to initiate a harm reduction ap- 2019-20 was a year of transition with Isabelle pared for the COVID-19 pandemic response. Duguay appointed Assistant Director of Public Fire chiefs were presented with plans to deploy proach. SERC also assisted the Uschiniichisuu team with a regional survey on breastfeeding Health for SERC. Jill Torrie retired from the role a sensor network of forest fire smoke detectors after many years of service. in all communities. support needs. A project to improve end-of- life care was approved in March 2019 with a For the coming year, COVID-19 will continue to funding agreement signed in December. The The team validated the most recent mercury be a focus of SERC efforts. Ongoing projects in Maamuuhkedaau ("Let's do it together") survey monitoring results, continued to promote other areas will continue, including a community to assess primary care is in the planning stages. fish consumption recommendations (see suicide monitoring system and the End-of-Life creegeoportal.ca), and developed and de- A three-person communications team within Care Project in partnership with the Cree Nation ployed strategies for promoting a transition to Goverment, the Cree Women's Association of non-lead ammunition. SERC works closely with the regional communi- cations team in Corporate Services to create and Eeyou Istchee (CWEIA), the Nishiiyuu Council of Active in almost every file submission concern- disseminate information to promote collective Elders and other CBHSSJB departments. The ing mining projects in Eeyou Istchee, the team and individual wellness—­miyupimaatisiiun. In ad- COVID-19 crisis demonstrates the urgency of provides input on the health impacts of projects dition to online and print awareness campaigns developing these services in Eeyou Istchee. including lithium mines (James Bay Lithium, Rose, Whabouchi), and gold (Windfall Lake) and iron (Blackrock) developments. ᓂᔒᔫ ᒥᔪᐱᒫᑎᓰᐅᓐ nishiiyuu miyupimaatisiiun

EXECUTIVE SUMMARY Laura Bearskin Assistant Executive Director (AED)

ᐆ ᓂᔒᔫ The Nishiiyuu Miyupimaatisiiun Department The framework will reflect a collective vision for ᐧᑳᔅᒌᐧᔖᒥᑳᐦᒡ ᐊᓂᔮᔫ provides the link with the Nishiiyuu Council of traditional medicine and healing that aims to ᐧᐋᔅᑮᐦᒡ ᑳ ᐃᔥ ᐄᔮᑦ Elders and chairs the regional Clinical Coordi- ensure Eeyou/Eenou have access to Traditional ᑭᔮ ᑳ ᐄᔥ ᒋᔅᒑᔨᑖᐦᒃ nation and Integration Committee (CCIC). In Healing Pathways. The Gathering of Knowledge ᐄᔨᔨᐤ/ ᐄᓅᐧᐄᔨᒡ 2019-20 the Nishiiyuu team added seven ad- Keepers on Traditional Medicine, held in Chisa- ᐱᒫᑎᓰᐧᐄᓂᔫ ᐋᔪᐧᐃᒄ ᐧᐋ ditional staff and now has 26 employees. sibi in June 2019, helped create the foundation of the framework. ᐄᔥ ᑭᓂᐧᐋᐦᐱᑕᐦᒡ ᐊᓂᒌ The team worked intensively as the lead ᐋᐧᐋᓂᒋ ᐄᔭᐲᐦᑎᓰᔅᑖᒡ department in planning and developing the Re- Documents produced in the context of planning ᐋᐱᑎᓰᐧᐄᓂᔫ᙮ ᐄᔨᔨᐄᑖᐦᐄᑎᒧᐧᐄᓐ gional Assembly on Health and Social Services, for the Health Assembly also inform the Frame- 49 ᔮᔨᑖ ᒑ ᒋ ᐋᐱᑎᐦᒡ ᐋ originally planned for March 31-April 3, 2020 work, including a summary report of the Nishi- ᐧᐄᐦᐧᐄᒋᐦᐋᑳᓄᐧᐄᔨᒡ ᒥᓯᐧᐋ in Chisasibi. The Assembly was postponed iyuu Survey on Traditional Medicine, two litera- due to the coronavirus pandemic. When the ture reviews and an evaluation of the Nishiiyuu ᐄᔨᔨᐅᐧᐄᔨᒡ᙮ ᐋᑰᐦᑦ ᑭᔮ ᐊᔅᑎᐲᐦᒡ Health Assembly does take place, Nishiiyuu Miyupimaatisiiun Strategic Plan 2013-18. ᒋᓵᔫᐧᐄᔨᒡ ᐅᒋᒫᑳᓇᐦᒡ᙮ ᐋᑰᐦᑦ ᐧᐋᐄᔔᑖᐦᒡ will be seeking input from the communities on ᓃᑐᐦᑰᔨᓐ ᐋᐱᑎᓰᐧᐄᓐ ᑭᔮ ᒑ ᒋᔅᑎᓈᔅᑖᐦᒡ priorities and strategies for moving traditional The Nishiiyuu team will continue to engage with ᒥᓯᐧᐋ ᒑᐧᑳᓐ ᑭᔮ ᒥᓯᐧᐋ ᐋᐧᐋᓐ ᒑ ᒋ healing forward. key stakeholders in the communities to further ᒥᐧᔮᐱᑎᓰᐄᑦ ᐋ ᐧᐄᒋᐦᐋᑲᓅᐧᐄᔨᒡ ᐋᐧᐋᓂᒌ᙮ refine the framework in order to guide traditional Meanwhile, work continues on the develop- healing processes in Eeyou Istchee. uu nishiiyuu kwaaschiishwaamikaahch ment of the Framework for Traditional Healing aniyaayuu waaskiihch kaa ish iiyaat kiyaa Pathways in Eeyou Istchee. kaa iish chischaayitaahk iiyiyiu/ iinuuwiiyich pimaatisiiwiiniyuu aayuwikw waa iish kiniwaahpitahch Our vision is anichii aawaanichi iiyapiihtisiistaach aapitisiiwiiniyuu. Aapiimuudiihehkuud iiyiyiiitaahiitimuwiin yaayitaa chaa chi aapitihch aa wiihwiichihaakaanuwiiyich misiwaa iiyiyiuwiiyich. aakuuht piimaadiisiiwiiniiuu Kiiyah 3 kiyaa astipiihch chisaayuuwiiyich uchimaakaanahch. a achiisachiinuutiihehkuud aakuuht waaiishuutaahch niituhkuuyin aapitisiiwiin kiyaa chaa “Achieving miyupimaatisiiun chistinaastaahch misiwaa chaakwaan kiyaa misiwaa aawaan through the guidance of ᓂᔒᔫ chaa chi miywaapitisiiiit aa wiichihaakanuuwiiyich aawaanichii. ancestral teachings”. Nishiiyuu refers to the traditional ways of the Eeyou and Eenou people. Our vision is Aapiimuudiihehkuud piimaadiisiiwiiniiuu Kiiyah ᒥᔪᐱᒫᑎᓰᐅᓐ a achiisachiinuutiihehkuud (achieving Miyupimaatisiiun through the guidance of ancestral teachings). The Nishiiyuu Miyupimaatisiiun NISHIIYUU department works to ensure that Cree knowledge and values are MIYUPIMAATISIIUN reflected in CBHSSJB services. Nishiiyuu team 26 7

COMPLEMENTARY SERVICES AND Under the Traditional Medicine and Healing IIYIYIU PIMAATISIIUN E The Community Development team worked PROGRAMS Initiative, the team discussed traditional healing PIMUHTAAKANUUHCH (COMMUNITY closely with the Complementary Service team This unit within Nishiiyuu is working to approaches and transfer of knowledge on tradi- DEVELOPMENT) to plan, develop and carry out land-based ­implement three integral parts of the Nishiiyuu tional medicine at local community gatherings This unit works to support Miyupimaatisiiun projects and local gatherings with Traditional Strategic Plan in alignment with the CBHSSJB held in Chisasibi, Oujé-Bougoumou, Mistissini, Committees in all communities and encourage Knowledge Keepers, in collaboration with Strategic Regional Plan (SRP): Waapimausuwin Waswanipi and Whapmagoostui. Informa- them to work with Chiefs and Councils and to other Cree entities. A two-day local traditional and Utinausuwin, Land-Based Healing and tion gained from these gatherings is guiding consult broadly in their communities—engag- gathering took place in Oujé-Bougoumou in Traditional Medicine. Contacts are being made program development. Traditional medicine- ing individuals, families and organizations in the collaboration with the Oujé-Bougoumou Cree with potential partners related to the ongoing making workshops were held in Waswanipi development of strategies to enhance Miyupi- Nation Culture Department and Youth Depart- development of these services and programs. and Mistissini. During the COVID-19 pandemic, maatisiiun. The goal is to have a Nishiiyuu Plan- ment, developing programming that is inclusive the team consulted with Traditional Healers to ning and Programming Research Officer (PPRO) of people with special needs. A Gathering of Work continued on the Waapimausuwin Home provide guidance in understanding and ap- in each community, who will collaborate with Traditional Knowledge Keepers was organized Away from Home Project to share traditional proaching this disease. Traditional medicines the Miyupimaatisiiun Committee to develop in collaboration with the Cree Nation of Mistis- 50 Waspsuyan teachings with young parents. The were collected, prepared and distributed to community-based strategies and pursue part- sini and local radio CINI-FM. Interviews with 51 Miiwitt Project delivered workshops on baby community members. nerships at the local level. The PPROs already in Elders at these gatherings led to the collection bundle teachings and shared baby bundles place are helping to identify and communicate of valuable information about traditional medi- with families to help welcome their new ones to Two extensive literature reviews were carried opportunities and priorities for partnerships cines and their uses that will inform Nishiiyuu’s this world. The team is happy to have worked out to inform program development. The first, with Chiefs and Councils. As members of local work for years to come. This team also pro- in collaboration with Midwifery and Awash in collaboration with Public Health and Youth Clinical Coordination Integration Committees moted Cree cultural activities such as snow- in Chisasibi and Child and Family Services in Healing Services, reviews published and un- (CCICs), the PPROs act as a bridge between shoe making and the Pipun Ihtun Festival in Waskaganish. published literature on land-based programs in CMC (Community Miyupimaatisiiun Centre) ­Waswanipi, the moose hide project in Mistissini Eeyou Istchee and elsewhere. The information leadership, Traditional Knowledge Keepers and and a number of sweat lodge ceremonies. Collaborations with other groups, such as provided in the report will help guide collabo- Healers and the Miyupimaatisiiun Committee. ­Disability Programs and Weesapou for Nitahuu rations to develop a land-based program for Aschii Ihtuun (Land-Based Healing) initiatives, youth through the Weesapou Group Home. The resulted in nine land-based activities this year. second literature review examines the different These activities provided opportunities to delivery practices, legislation and barriers to transfer knowledge on traditional life skills and delivery of traditional medicine in communities. foster individual healing through ceremonies in Chisasibi, Whapmagoostui, Oujé-Bougoumou and Mistissini.

Gathering of Traditional Knowledge Keepers, Traditional Medicine Mistissini, August 2019 Cultural Safety Presentations and Trainings EVALUATION AND ACCREDITATION CULTURAL SAFETY Efforts to bring accreditation to the CBHSSJB The aim of Cultural Safety is to align all CBHSSJB 30 APR 7 JUNE 1 AUG 11 SEPT 13 SEPT 3 OCT 31 OCT continued. Accreditation is a CBHSSJB strategic services with Cree cultural values and reali- 2019 2019 2019 2019 2019 2019 2019 objective—part of the process of implement- ties. This process is supported by consultation MUHC staff (MDs, Mental Health Day, Midwives Maanuuhiikuu Nurses Disability Pimuhteheu ing standards, best practices and continuous with the Nishiiyuu Council of Elders, bringing a nurses, volunteers): Douglas Hospital: and other Team Program Regional Mental Health Cree Perspectives on staff Team Team improvement of services. cultural safety perspective to local and regional (Psychiatry) and Mental Well-being / CCICs, and providing cultural safety training to Spirituality Trauma Informed Care Creating awareness around accreditation and different groups within the organization. quality improvement was a key objective this 15 20 15 23 6 17 12 year. The team worked with Chisasibi Hospital This past year, the team collaborated with the Note: Activities were interrupted during the planning phase of the Health Assembly; the program will resume in 2020. leadership to explore sharing and preparing Maanuuhiikuu Department to deliver presenta- information, identifying key issues at the hospi- tions to CBHSSJB and McGill University Health tal, and introducing accreditation priorities, key Centre (MUHC) staff on cultural and spiritual processes and practices. People-centered care considerations in trauma-informed care and The Gathering of Knowledge Keepers on Traditional Medicine, held in Chisasibi in June 2019, was part of 52 the lead up to the Regional Assembly on Health and Social Services, a major regional event postponed is one of the emerging priorities of the accredi- psychiatry. They collaborated with Maanuuhii- due to COVID-19. The Chisasibi gathering laid the foundation for the Framework for Traditional Healing 53 Pathways in Eeyou Istchee, which will be the central focus of the Assembly when it is rescheduled. tation program. The team drafted a Quality Im- kuu to develop the Suicide Prevention file for provement Plan that links with the SRP 2016-21 Eeyou Istchee, and continue to collaborate with and the Leadership Accreditation standards. DPSQA-Psychosocial on training sessions to pro- Once finalized, the plan will allow leadership mote culturally safe programming and services to track what is completed, identify areas that throughout the organization. require collaboration with other departments and create quality improvement projects with Nishiiyuu staff helped adapt the content of the their teams. Core Concepts training to better reflect Cree values, and co-facilitated the three-day Core The Evaluation and Accreditation team worked Concepts training for CBHSSJB staff in Montreal with the SQCC to link the complaints process— in November 2019. A number of Nishiiyuu and which identifies gaps and shortcomings—and ac- Maanuuhiikuu staff attended Cultural Safety creditation standards. They worked with DPSQA- Training at UQAT (Université du Québec en Health to develop standards relating to infection Abitibi-Témiscamingue), to learn what is be- prevention and sterilization of medical devices. ing done elsewhere and to further develop the Future plans include an accreditation workshop ­CBHSSJB approach to cultural safety training. for Local Directors and visits to CMCs.

Individuals who received training in cultural safety since the program 548 began in late 2017 ᒥᔪᐱᒫᑎᓰᐅᓐ miyupimaatisiiun EXECUTIVE SUMMARY

MIchelle Gray AED (Interim) Miyupimaatisiiun

Reflecting on the achievements of the last year The COVID-19 pandemic sparked many ­changes. is impossible without acknowledging the con- Local and specialized medical services rapidly tribution of front-line workers and leaders. Their transferred to telehealth delivery where possi- accomplishments have advanced the objectives ble, accelerating the uptake of telehealth across of the CBHSSJB Strategic Regional Plan (SRP). the territory. Other health care workers—nurses, CHRs (Community Health Representatives), and The launch of the 24/7 psychosocial on-call ser- community workers—used telehealth to reach vice enhances access to front-line and mental out to clients. This proactive approach aims to health services; through this initiative, those ensure the safety of clients, especially those seeking assistance can receive support from a identified as vulnerable, through regular contact, psychologist, social worker or traditional knowl- rather than waiting for clients to come to the edge keeper. Outreach services for youth were Commuity Miyupimaatisiiun Centre (CMC) if they expanded, making evening support accessible feel unwell. It has proven successful in containing to help youth facing challenges and to enable the coronavirus, much to the credit of our health- 55 early detection of those struggling with anxi- care workers and collaborations with the Cree ety, suicidal ideation or addictions. Steps were Nation Government (CNG), local Cree Nations ᒥᔪᐱᒫᑎᓰᐅᓐᔫ taken to address Elder abuse and homecare and other entities. ᑳ ᒫᒨᐧᐄᔅᑖᐦᒡ services were enhanced to ensure the best of ᒥᓯᐧᐋ ᓂᑐᐦᑰᔨᓂᔫ care for Elders. Another consequence of the pandemic: Elders who were long-term clients at the Chisasibi ᐋᐱᑎᓰᐧᐄᓂᔫ ᑳ Access to dialysis was increased, and the Home Hospital have been moved to the MSDC (Multi- ᑭᓂᐧᐋᐱᑖᐦᒡ ᒥᓰᐧᐋ Dialysis Pilot Project was launched in Waswanipi.­ Service Day Centre), a more welcoming environ- If successful, home dialysis will provide an option ᐄᔨᔨᐧᐄᔨᒡ ᐋ ment. The site is being considered an interim for diabetes management that enables clients Elders' Home, awaiting the construction of new ᐧᐄᐦᐧᐄᒋᐦᐋᑳᓅᐧᐄᔨᒡ who qualify to remain in their home communi- long-term care facilities. ᒑ ᒋ ᒥᔪᐲᐦᐄᔨᒡ ties. The Department has also worked to im- prove both monitoring and follow-up of other The Client Satisfaction Survey addressed ᐅᐱᒫᑎᓰᐧᐄᓂᐧᐋᒡ᙮ chronic diseases in Eeyou Istchee. ­physical environment, accessibility, cultural safety and courtesy, holistic care and organiza- miyupimaatisiiunyuu kaa tion of services, and has provided important in- formation for the improvement of our services. maamuuwiistaahch misiwaa nituhkuuyiniyuu aapitisiiwiiniyuu Committed more than ever to engaging with kaa kiniwaapitaahch clients, staff and partners, the team has fo- misiiwaa iiyiyiwiiyich aa cussed on improving access to care for Eeyou wiihwiichihaakaanuuwiiyich Istchee, while also enhancing the quality and 4a chaa chi miyupiihiiyich experience of the care provided. upimaatisiiwiiniwaach.

ᒥᔪᐱᒫᑎᓰᐅᓐ The Miyupimaatisiiun Group is the department that delivers most of the MIYUPIMAATISIIUN health and social services to our clients. ᓂᑐᐦᑯᔨᓐ ᐋᐱᑎᓰᐐᓐᐦ ᑭᔮ ᐋᐄᔥ ᐋᐱᑎᓰᔅᑖᑲᓄᐎᔨᒡ ᐋ ᓅᑖᐱᑖᓲᐙᓇᓅᐎᒡ nituhkuyin aapitisiiwiinh kiyaa aaiish aapitisiistaakanuwiyich aa nuutaapitaasuuwaananuuwich MEDICAL AFFAIRS AND SERVICES In June 2019 the CBHSSJB organizational structure DENTISTRY was adjusted so that the Department of Medical Affairs and Services with its related departments of Medicine, Dentistry and Pharmacy were moved to General Management. These departments retain a functional relationship to Regional Miyupimaati- The Dentistry Department is responsible for GENERAL AND SPECIALIZED MEDICINE siiuun Services. For the convenience of the reader, 2020-21 OBJECTIVES The Department of General and Specialized the annual reports of these departments are providing quality general and specialized ● Digital radiography in the four clinics Medicine (DGMS) includes all CBHSSJB fam- included in the Miyupimaatisiiuun chapter in the ­dental services throughout Eeyou Istchee. ­without this capacity present document. ily physicians and specialists. The DMGS team Planning, evaluation and calls for tender for The Chisasibi Dental Clinic remains in a critical­ ● work together with colleagues in other profes- new dental software sions to ensure integrated medical services state in terms of access, organization and equipment and, until adequate renovations are ● Implementing the second wave of den- are continuous, culturally safe, effective and The team has once again mobilized with great done, optimal dental services are not possible. tal assistant­ training and a new Dental ­accessible to the entire population. commitment for the good of the communities In Nemaska, the loss of the permanent den- ­Secretary Training Program in order to maintain medical coverage that now The DGMS head is Dr. Carole Laforest. She is tist and the absence of trained personnel has approaches 100% for the entire territory. supported by nine Chief Medical Officers, three ­significantly reduced access to services. 9 Graduates from Dental Assistant Chief Medical Officers, a Chief Medi- Work continues on the revision and finalization Assistant Training Program The beginning of the COVID-19 required cal Officer for Emergency Medicine and six of the therapeutic guide, training of nursing staff, ­considerable modification of dental services. Chief Medical Officers coordinating specialized standardization of clinical decision support tools, 56 To protect both personnel and patients, dental 57 services in the following fields: general internal participation in local Clinical Coordination and activities were limited to the treatment of emer- medicine, nephrology, pediatrics, psychia- Integration Committees (CCICs), cleaning up wait- gency cases. In collaboration with the Material try, gynecology and obstetrics, and medical ing lists for investigations and specialized services Resources Department, workplaces are being biology. In 2019-20 ophthalmologists visited and standardizing emergency rooms. Efforts modified to ensure adequate ventilation, which Chisasibi and Mistissini with a plan to recruit a continue to enhance specialized services in the will allow for the reopening of all services. permanent ophthalmologist for the region. territory and in service corridors. A major proj- ect to implement electronic medical records will Recruitment and retention efforts in family significantly improve the quality and continuity medicine led to the hiring of six permanent and of care. MYLE software has been optimized and three part-time family physicians, bringing our deployed in pre-production,­ and a pilot project Dental Statistics for Eeyou Istchee team to 72 active members. The number of % will begin at the Mistissini CMC. st % children emergency permanent physicians as well as their average consultations 1 visit % no-shows length of stay continues to increase, reducing PRIORITIES the use of locum physicians, ensuring better ? ● Develop and maintain a dynamic and continuity of services. ­committed team Chisasibi 1745 58.1 16.0 51.5 18.0 Improve clinical information management ● Eastmain 647 48.1 17.2 37.9 19.6 and deploy the electronic medical record system in as many communities as possible Mistissini 3705 43.6 22.7 22.3 26.8 DGMS team Nemaska 127 55.1 17.3 48.8 9.9 ● Improve the organization, ­integration and 72 members continuity of care and increase the supply Oujé-Bougoumou 596 52.7 14.4 29.9 30.2 30 locum physicians of medical services Waskaganish 1617 3.4 10.8 44.3 25.0 ("dépanneurs") 6 specialists ● Increase access to specialized ­services in Waswanipi 1280 57.9 20.6 42.9 35.8 20 associate specialists the North Wemindji 1165 44.5 16.1 28.0 19.5 ● Develop telehealth in both front-line and Whapmagoostui 630 31.9 9.4 38.9 17.0 specialized medicine Total 11,512 42.0 17.6 35.1 25.0 ᓂᑐᑯᔨᓐ ᐋ ᑭᓂᐙᔨᐦᑎᑰᒡ ᑭᔮ ᐋ ᐐᒋᒥᔮᐙᓅᐎᒡ ᒥᑐᓈᔨᐦᒋᑭᓐ nitukuyin aa kiniwaayihtikuuch kiyaa aa wiichimiyaawaanuuwich mitunaayihchikin Training and meeting for CBHSSJB psychosocial employees, 28 November PHARMACY (DPSQA) PSYCHOSOCIAL 2019, Montreal

The Pharmacy Department continues to build The Psychosocial Department focuses on The Foster Home Program has been stabilized the foundation for safe quality services for the ­front-line social services provided by commu- with three team leaders and new guides and population. Security cameras and access cards nity workers, human relations officers and social manuals. This past year, the Department updat- were installed in Chisasibi, Mistissini and Was- 60% workers, ensuring quality services are accessible ed and renewed assessments of foster homes kaganish pharmacies in 2019, and pharmacy of the Eeyou and meet the population's needs. The Depart- and applied new compensation rates. opening hours were extended­ in Chisasibi and Istchee population ment continues to grow, with new leadership Mistissini. now benefit from and several key positions—a strong and stable HIGHLIGHTS the services of a team that reflects Nishiiyuu values in an effort to ● Robin's Nest Training—management, action This year's opening of the first pharmacy in pharmacist. empower psychosocial workers. plan, guidelines, standardized forms in both ­Waskaganish is a major achievement. This new shelters, links between CMCs and shelters patient service is allied with one of the orienta- The Psychosocial Team is building an action plan Standardized record keeping and archives/ tions of the CBHSSJB Strategic Regional Plan in line with the 2016-21 Strategic Regional Plan ● psychosocial clinical process in collabora- (SRP): Access to quality front-line services and (SRP), with input from front-line workers to meet tion with the regional­ archivist specialized care along the service corridors. the needs of all communities. Resources will be 58 allocated in line with the development plan and ● Development of training on the Sexual 59 Toward the end of the reporting period, as the Three out of the nine communities—Chisasibi, approved by the Board. Assault Kit, in collaboration with DPSQA Mistissini and Waskaganish, representing 60% COVID-19 pandemic was evolving in Quebec, Health, to link victims with psychosocial of the CBHSSJB population—now benefit from the Department adjusted its operations to as- This year, the Department met an important workers in each intervention sure the safety of both personnel and patients. prescription validation, drug distribution and milestone with the creation of a psychosocial ● Train-the-trainer approach with each drug information provided by a pharmacist. Clients received one month of medication emergency support resource for communities. ­community, in line with YP/CMC protocol refills, all provided in new vials. The department This is an important step in the development of The Wiichihiiwaauwin Helpline (833-632-4357) ● Elder Mistreatment Policy, in approval also provided home delivery. All personnel basic pharmacy services within Eeyou Istchee, started as a pilot project in Mistissini in De- process, and a regional committee for Elder were required to wear masks, wash hands fre- access to which is part of the front-line health cember 2019 but, with the COVID-19 outbreak, Mistreatment Operational Plan and Policy quently, and disinfect all materials and surfaces care services available to all Québec and expanded to serve all of Eeyou Istchee. Region- Two certified trainers in Dementia Working several times a day. ● ­Canadian citizens. We are striving to ensure al on-call professionals from Nishiiyuu, Maan- Group that all patients in Eeyou Istchee have quality uuhiikuu and DPSS provided local wellness Bill 21 development ­meetings and timely pharmaceutical services. and support for psychosocial emergencies. As ● part of a transitional ● MCAT (multi-clientèle evaluation) training in The Ordre des Pharmaciens du Québec, the plan, the Helpline will Waskaganish, November 2019 pharmacy regulatory and licensing authority in develop community- ● Committee with MSSS for implement- Québec, visited Chisasibi pharmacy in September level teams, starting 3 clinical advisors ing the OCCI (Les outils de cheminement 2019, and presented many recommendations for ­clinique informatisés) on the territory with ­Oujé-Bougoumou, 1 PPRO, Elder improving the quality of pharmacy services on ­ followed by Chisasibi. mistreatment ● All psychosocial documents and forms add- the territory. Among them was the provision of ed to intranet, with front-line staff training pharmacy services to the remaining six communi- ties, one of our challenges­ for 2020-21.

2019-20 Training First annual community worker Social Workers and Human First annual Foster Care training (suicide prevention, Relations Officers (HROs) workers training focussed addictions and mental health with focussed on crisis intervention, on communication and co-occurring disorders, wellness) postvention and wellness leadership skills ᐲᐲᒑᐤ ᐅᒋᔥᑑᓐ Piipiichaau Uchishtuun ᓂᑐᐦᑯᔨᓂᔅᒀᐤ ᐋᐱᑎᓰᐎᓐᐦ ROBIN’S NEST WOMEN’S nituhkuyiniskwaau aapitisiiwinh SHELTER ᐲᐲᐦᒉᐤ ᐅᒋᔓᑑᓐ (DPSQA) HEALTH Piipiichaau Uchistuun

The Piipiichaau Uchishtuun (Robin’s Nest) DPSQA-Health is committed to helping improve The Department welcomed several new nurse Women's Shelter in Waskaganish was a collabo- the health and social wellness of the population counsellors in various areas such as renal ration between the CBHSSJB, the Cree Nation of Eeyou Istchee, ensuring quality of care and health, sterilization and purchasing, prevention Government (CNG), and the Cree Women of competency of the organization’s nurses, CHRs and control of infection, and chronic diseases. Eeyou Istchee Association (CWEIA), with the (Community Health Representatives), home care These new nurses have put forward operational support of the Cree Nation of Waskaganish. workers and beneficiary attendants. The Depart- plans in accordance with the Strategic Regional The CNG funded and oversaw construction of ment’s vision is rooted in Eeyou/Eenou culture Plan (SRP). This past winter, a Home Hemo- the building, and the CBHSSJB operates the and aims to offer a culturally safe environment dialysis Project was initiated in Waswanipi in facility with programs developed in partnership and practice for the population. DPSQA-Health collaboration with local authorities and MUHC with CWEIA. strives to ensure a holistic approach to mental, partners. This innovative project allows patients ­spiritual, emotional and physical health. to self-dialyze while remaining in their commu- The Waskaganish shelter serves primarily women nities with families and loved ones. The SWIFT from the coastal communities of Eeyou Istchee, Understanding and incorporating the historical Application Pilot Project was a success, provid- 60 complementing the services offered at a simi- experience of the Cree people into the onboard- ing remote specialized wound care support ser- 61 lar shelter operating since 2017 in the inland ing process for new staff has been a priority. vices and enhancing wound care management. community of Waswanipi. Robin’s Nest provides Trauma-informed care sessions were held in No- healing methods based on Cree traditions and vember at the annual nurses training in Montreal. The DPSQA-Health team has mobilized values, while respecting individual beliefs, for Annual trainings in Chisasibi for nurses and CHRs ­different resources to support local teams in women and their children who are experiencing were also successful, with workshops on lateral managing the COVID-19 pandemic. All mem- domestic violence, nanako akwiwaiisoon. kindness, mental health, diabetes and pediatric bers of the Department have been part of the emergencies. emergency preparedness response and reor- ganization of services. The goal has been to collaborate and coordinate with different stake- holders and partners to secure essential ser- vices while ensuring safety and quality of care. Taking into consideration Cree self-governance, procedures and guidelines were developed in accordance with public health recommenda- tions and best practices in a difficult and ever- evolving situation. Trainings specific to pre- Protecting patients and staff of the Waswanipi Women's Shelter vention and control of infection and personal during COVID-19. protective equipment are prioritized. The crisis has generated an extraordinary response and resulted in the acceleration of new approaches, like teleconsultation. The Department is con- fident in its capacity to face challenges and Preventing Violence adapt to change while remaining committed to Supporting Women CBHSSJB values. Taking Care of Our Own Labrador tea tasting during the home hemodialysis Robin’s Nest Spiritual Room launch in Waswanipi, September 2019 ALLIED HEALTH TEAM: nutritionists occupational therapists physical therapists speech-language ᐋ ᒫᒧ ᐎᒋᐦᑖᑭᓄᐎᔨᒡ pathologists psycho-educators aa maamu wichihtaakinuwiyich psychologists psychotherapists (DPSQA) ALLIED HEALTH respiratory therapists audiologists

DPSAQ-Allied Health encompasses a wide This year’s commitment to training and Allied Health - Summary of Group Activities 2019-20 range of professionals and para-professionals, ­mentorship began with a powerful training ses- working closely with rehab and education moni- sion delivered by Suzy Goodleaf to a group of Speech & tors, special needs educators and administra- 50 at June's annual rehabilitation team meeting Occupational Psycho- Language Rehabilitation Regional Physiotherapy therapy education Pathology Nutrition monitors team tive support—all essential partners. in Chisasibi. It was on inter-generational trau- ma, colonialism, the residential school experi- ... The services evolve and change, powered by ence, and worker self-care, and the experience the compassion, creativity and clinical leader- informed the team's work in meaningful ways. ship of regional and local teams, as well as the Number of group 83 70 85 2 590 12 >402 Eeyou Istchee population's need for greater 1 HIGHLIGHTS activities access to services. ● Rehabilitation presentations at four univer- Number of sities participants 662 1144 661 14 8566 58 N/A 2019-20 GOALS Over 20 nurses trained on mechanical ven- 1. Stabilize human resources ● 1. Some professionals and paraprofessionals participate in the same group activities (so possible repetition in number of activities) 62 tilation and airway management 2. Over 40 categories of projects 63 2. Grow training and mentorship programs ● The Waswanipi Rehab Team's occupational 3. Expand regional services—audiology, therapist, together with McGill students, speech therapy, and respiratory therapy community partners and local CMC man- 4. Optimize Multi-Service Day Centres agement, piloted extensive rehabilitation (MSDCs) and the Rehab Monitor Training monitor training Program, launch of the CBHSSJB Multi- ● The above training was extended to Disciplinary Council homecare workers and others to learn The MSDCs have been developing a new vision. techniques on implementing therapeutic Multi-Council by-laws, updated at the March goals in rehabilitation—11 sessions were board meeting, are ready to be implemented. conducted with 151 people The Audiology Screening Program expanded ● Several masters level occupational therapy into two communities, and the Respiratory Ther- and physical therapy students were wel- apy Program grew to a staff of three, with new comed into the region, a strategy proven mandates for training and support for the re- effective in injecting new energy into our gion. The Speech Therapy Program had a more programs—in the last three years, six posi- challenging year—only one full-time therapist for tions have been filled with former stagiaires half the year. Jordan’s Principle funds were put Despite some projects slowing down due to towards contract therapists, and will see a more the COVID-19 crisis, the team looks forward to sustainable tele-health service model for 2020. launching a regional sleep study clinic, increasing Clinicians have been providing training for the access to speech therapy, getting the multi-coun- population, healthcare providers and communi- cil running, and recovering from the pandemic ty partners within and outside of Eeyou Istchee. stronger and more connected to each other. ᒋᓵᓰᐲ ᓂᑐᐦᑯᔨᓂᑭᒥᒄ chisasibi nituhkuyinikimikw CHISASIBI REGIONAL HOSPITAL

The Chisasibi Hospital provides primary and The hospital had to reduce respite care this The Radiology Department saw the departure secondary healthcare services to the popu- year due to increased requests for social and of two experienced technologists; however, the lation of Eeyou Istchee. The hospital is set long-term admission. Social Services were able team was able to avoid a breach while manag- to undergo a major transformation with the to identify resources for respite care off the ing a rise in demand for obstetric consultations development of the Chisasibi Health Centre in territory, and developed guidelines to access via telehealth. 2025, which will be equipped to provide highly these services in collaboration with the DPSQA specialized tertiary care in a new facility. Psychosocial team. Archives Services, now under the hospital and DMAS, worked with the Risk Management Unit In 2019-20, the hospital team continued to work The Social Services team also welcomed a new to develop a risk management strategy to help on the tertiary accreditation process as well community worker, Roxanne Pelchat, whose ensure the security of patient data. The team as the renovation of an existing space for the knowledge of the Cree language and culture continues to work with the Project Management pharmacy extension. are important assets in interventions. Office (PMO) on the Electronic Medical Records (EMR) Pilot Project, including chart digitization. Many of the projects and plans scheduled for 64 this period were halted by the COVID-19 pan- Due to COVID-19, all training normally con- 65 demic as personnel responded to the urgent 24 3 ducted by Auxiliary Services was cancelled until need to prevent the spread of infection. With further notice. Ambulance drivers and security the collaboration of external partners and guards received Omega training in December Material Resources Department (MRD), the 2019; however, security guard certification hospital modified the physical space to accom- clients receiving dialysis kidney training could not take place. Fit testing employees as part of COVID-19 preparedness efforts, Chisasibi Hospital treatments in Chisasibi transplants modate green and red zones, set up parti- tions, antechambers and walls, etc. Despite the upheaval, the team demonstrated its shared commitment to provide the best possible care. The Hemodialysis Department remained at Chisasibi Regional Hospital ­capacity, and the team is working towards The Medicine Unit continued to be busy, espe- opening six days a week, allowing more clients cially with a shortage of nurses in December. to have treatment in Chisasibi. This year saw an increase in the number and duration of hospital stays, as well as a reduction Laboratory Services continued to develop and implement new procedures so Chisasibi and in the number of clients being transferred to 498 19.3% admissions Mistissini laboratories can meet hospital ac- other health facilities. 7,460 2.5% hospitalization days creditation standards. The Committee on Delo- 65 16.7% transfers to other health centres calized Medical Biology Exams (EBMD) oversaw 8 33.3% deaths a pilot project in four communities to measure 65% 7 60.0% average days in acute care blood tests. This project's aim is to shorten 73.0% 2.5% bed occupation rate the time to obtain results, reducing the need 18,046 1.7% clinic consultations for patient transfers to the Chisasibi hospital 118% 4,267 33.4% specialist consultations or off-territory health centres. If successful, the rise in hospitalization decline in patient 3,604 27.5% observation hours days* transfers* project will be extended to the other communi- 153,450 2.0% radiology technical units ties. 316,908 4.8% lab tests * since 2013 2,633 12.1% dialysis treatments ᐋ ᒌᐦᑳᔮᔨᑖᑰᐦᒡ ᐄᐦᒡ ᐋᐄᔑᓈᑯᒡ ᓂᑐᐦᑯᔨᓐ ᐋᐱᑎᓰᐎᓐ aa chiihkaayaayitaakuuch iihch aaiishinaakuch nituhkuyin aaitisiiwin SPECIALIZED SERVICES

Specialists The regional team, which has expanded to NORTHERN PROGRAM OF SPECIALIZED CRDS meet the increased need for visits on the terri- SERVICES (NPSS) The mission of the CRDS (Centre de répartition­ 4 pediatricians tory and in telehealth clinics, will be recruiting To increase support for family physicians, the des demandes de service, Service Request Dis- 2 psychiatrists two clinical nurses and another administrative NPSS has collaborated with the McGill Universi- tribution Centre) is to facilitate the work of front- 2 pediatric psychiatrists process specialist next year. This year included ty Health Centre (MUHC) partnership office on line family physicians by guaranteeing patients nephrologist organizing telehealth clinics, offering more sup- different projects: access to the OACIS (MUHC access to specialized services. It also assures port to communities and stabilizing the orga- electronic medical records), a pilot project for medical specialists that the request is complete, OBGYN nization of specialist visits on the territory. The teleconsultation and clarifying trajectories to appropriately prioritized and addressed to the 2 interns team aims to launch a Regional Appointment ensure access to specialists in an efficient and right point of service. The CRDS nurse does a Centre for Specialized Services to support the timely manner. triage based on the patient’s condition, priority coordination of appointments in Eeyou Istchee. and available services, then prioritizes appro- A regional nurse will prioritize patients, monitor WAITING LIST REVIEW priate services in our region (in person or by clinical timelines and provide quality assurance. In collaboration with DMAS and family physi- telehealth). If the service is not available in the 66 Regional team The goal of the Regional Appointment Centre cians in each community, a review of all pend- patient’s CRDS region, the consultation request 67 for Specialized Services is to ensure that as ing appointments inside and outside the region is sent to the nearest region where the required coordinator many appointments as possible are performed was carried out, with the following objectives: specialty is available, while respecting our ser- nurse counsellor on the territory, either in-person during special- vice corridors. The CRDS Eeyou Istchee will be administrative process ists’ visits or through telehealth. ● revise pending appointments to ­reprioritize, part of the Regional Appointment Centre. specialist cancel or update consultations or follow-up administrative ● catch up on all delayed consultations technician TELEHEALTH The development of Telehealth services ● reroute consultations on the territory 5,000 ­increased dramatically with the COVID-19 ● provide an overview of specialized services/ pandemic, which required the suspension of telehealth needs Specialized Services oversees specialist visits, on-site visits for specialists. The MSSS financial telehealth services, service corridors and the contribution enabled the CBHSSJB to increase ● reduce unnecessary appointments and travel, and redirect to other service points if Consultations managed by the CRDS Eeyou CRDS (Centre de répartition­ des demandes de existing telehealth services and accelerate the Istchee in 2019-20 service) Eeyou-Istchee, with a mandate linked to development of new ones. This includes the needed to ensure priority is respected the CBHSSJB Strategic Regional Plan (SRP). rerouting through telehealth of appointments Waiting list review will continue in the next fis- initially planned down south. Teleclinics in ne- cal year with a thorough analysis of the situa- During the COVID-19 pandemic, Specialized SPECIALISTS phrology, pedopsychiatry and pediatrics have tion to improve process and quality assurance Services prepared a contingency plan with the The Department currently has 12 specialists been organized, and internal medicine using across the organization. recommendations of DMAS and Public Health. ­caring for the population in Eeyou Istchee. It telehealth has expanded to seven communities. Specialized Services continued through tele- also has 26 weeks of optometry coverage— However, the deployment in all communities health since in-person visits were cancelled for mostly coastal communities—but plans to of TeleWound Care (management of wounds an undetermined period. The Department con- extend service to all inland communities. There through an application) has been postponed tinues to ensure safe delivery of services to the are additional visits from ophthalmology, pedi- to next fiscal year. Other new and innovative population, while limiting the risk of COVID-19 atric cardiology and internal medicine for car- telehealth services are planned for next year, transmission in the territory, and has been pro- >8,000 allowing for quality and culturally safe care and Number of appointments active in this pandemic, providing replacement diac ultrasound. An ENT (Ear, Nose and Throat) needing review specialist, an ophtalmologist and possibly an easier access to specialized services for the services to the population. orthopedist will be recruited. people of Eeyou Istchee. ᐃᐦᑖᐎᓐ ᒥᔪᐱᒫᑎᓰᐎᑭᒥᒄᐦ miyupimaatisiiwikimikw itaawin EXECUTIVE SUMMARY

Community Miyupimaatisiiun Centres (CMCs) In the past year, all nine CMCs have seen a play a central role in achieving the objectives ­notable increase in telehealth services, and laid out in the CBHSSJB’s Strategic Regional have extended their hours to meet the needs Plan (SRP). The CMCs are at the front-line of of the population of Eeyou Istchee. Toward the ᒥᓯᐧᐋ ᐊᓂᐦᐄ services in Eeyou Istchee’s nine communities, as end of the fiscal year, teams from each CMC ᒥᔪᐱᒫᑎᓰᐧᐄᑳᒥᑯ ᐄᑖᐧᐄᓂᔨᒡ they are the location of each community’s clinic were also involved local and regional collabo- (except in Chisasibi, where some functions are rations to plan for the COVID-19 pandemic. In ᑳ ᒑᒥᑖᐦᒡ ᐋᑰᐦᑦ ᐧᐋᒡ performed by the regional hospital). The CMCs each community, the CMC participated in col- ᒋᒥᑖᐦᒡ ᑭᔮ ᐧᐋᒡ ᑭᓂᐧᐋᐄᑕᑰᐦᒡ are also home to the range of community ser- laborations with Cree Nations and other entities 69 ᒥᔪᐱᒫᑎᓰᐅᓐ ᑭᔮ ᓂᑑᑯᔨᓐ vices offered through Awash, Uschinichisuu and to prepare for, and then manage the threat. ᐋᐧᐄᐦᒡ ᑭᓂᐧᐋᐱᑖᑭᓅᒡ᙮ ᒥᓯᐧᐋ Chishayiyuu Departments. As such, the CMCs The efforts have paid off, as so far there has are also the most recognizable embodiment of been no community transmission of COVID-19 ᒥᔪᐱᒫᑎᓰᐧᐄᑳᒥᑯ ᐄᑖᐧᐄᓂᔨᒡ ᑳ the CBHSSJB in the individual communities. in Eeyou Istchee. ᒑᒥᑖᐦᒡ ᐃᔮᐧᐄᔨᒡ ᓂᑐᐦᑯᔨᓂᑭᒥᒄ ᑭᔮ ᒥᔪᐱᒫᑎᓰᐅᓐ ᐊ ᑭᓂᐧᐋᐦᐱᑖᐦᒡ ᒑ ᒋ ᐧᐄᒋᐦᐋᑳᓄᐧᐄᔨᒡ ᐋᐧᐋᓂᒌ ᓃᓇᑰ ᐋᑐᐳᐧᓈᓰᐦᒡ: ᐊᐧᐋᔑᓰᔨᒡ (0-9) ᐆᔅᒋᓃᒋᓲᐦᒡ 4b (10–29), ᑭᔮ ᒋᔖᔨᔨᔫᐧᐄᒡ (30+)᙮ misiwaa anihii miyupimaatisiiwiikaamiku iitaawiiniyich ᐃᐦᑖᐎᓐ kaa chaamitaahch aakuuht waach chimitaahch kiyaa waach kiniwaaiitakuuhch miyupimaatisiiun kiyaa nituukuyin aawiihch kiniwaapitaakinuuch. misiwaa ᒥᔪᐱᒫᑎᓰᐎᑭᒥᒄᐦ miyupimaatisiiwiikaamiku iitaawiiniyich kaa chaamitaahch iyaawiiyich nituhkuyinikimikw kiyaa miyupimaatisiiun a kiniwaahpitaahch chaa chi wiichihaakaanuwiiyich miyupimaatisiiwikimikw aawaanichii niinakuu aatupunwaasiihch: awaashisiiyich (0-9) itaawin uuschiniichisuuhch (10–29), kiyaa chishaayiyiyuuwiich (30+).

COMMUNITY Community Miyupimaatisiiun Centres (CMCs) are the MIYUPIMAATISIIUN community presence of the CBHSSJB. Each CMC includes a CENTRES walk-in clinic, as well as community health clinics serving Awash (0-9), Uschiniichisuu (10-29), and Chishaayiyuu (30 and older). ᒋᓵᓰᐲ CHISASIBI Population The Chisasibi CMC reached a significant Chishaayiyuu experienced some challenges milestone as all services moved to the new towards the end of the year as Elders who had 1 q awash 0-9 923 2.2% facility at 21 Maamuu, marking the first time been in long-term care in the Chisasibi Hospital uschiniichisuu 10-29 1,804  2.0% all services have been housed together under were transferred to the MSDC, and will likely chishaayiyuu 30+ 2,193  3.0% one roof and enhancing the team’s capacity to remain there for some months. The team has work collectively with clients. The new site also continued to support telehealth, which is grow- 2  TOTAL 4,920 1.6% serves as a pilot for Southcentral Foundation’s ing in use and popularity as clients become

1. The 0-4 age group is underestimated since newborns are often registered relationship-based model of care. The build- more familiar with it. late in the JBNQA beneficiary list and has been corrected using MSSS 2015-2018 births (+ 2019 estimates) and 2014-2018 MSSS deaths numbers. ing’s entrance has a quick-touch survey to help 2. Does not include 347 Inuit, Métis and/or non-aboriginals. the team track client satisfaction and a blood The Administration team introduced a new 3. In Chisasibi, many clinical services are offered at the hospital. See page 64. pressure monitoring station so clients can model for collecting statistics. New houseclean- monitor their own blood pressure; the station ing policies were established, and trainings provides parameters to inform clients whether organized to support these. The pandemic 70 Medical Evacuations they should discuss their blood pressure with a required the hiring of new housekeeping staff, 71 nurse or doctor. because of the MSDC’s shift to long-term care.

N/A N/A The Awash Unit welcomed 99 new babies in the EMERGENCY SCHEDULED past year, with 27 of these babies being born Current Services in Chisasibi, with midwifery services. Pregnant women in Chisasibi can choose to be followed “Our new site at 21 Maamuu has a by a doctor and/or nurse or by midwife—or by welcoming environment designed 0 0 0 0 0 both, if they prefer. FAMILY SPECIALIST OTHER NURSE NURSE to facilitate the relationship-based DOCTOR MD SPECIALIST (WALK-IN) (MED. REFILL) The Uschinichisuu Unit has focused heavily on approach of the Southcentral Awash outreach, aiming to connect with clients who Foundation, which we are piloting,” says do not engage with the Department’s services. The unit has a new coordinator who will take Jeannie Pelletier, local director of the 1158 1825 1016 410 0 0 the lead in collaborating with external partners Chisasibi CMC. “One of the goals is to FAMILY NURSE CHR CHR COMMUNITY SOCIAL DOCTOR (INDIV.) (GROUP) WORKER WORKER to structure effective outreach services. A tent demystify health. We want the client has been set up to provide services in the eve- to tell us how they feel about their Uschiniichisuu ning and at night, and also to support aware- ness-raising about social distancing during the health, and what they want to achieve.” COVID-19 pandemic. 103 237 826 322 235 0 0 0 FAMILY NURSE SCHOOL CHR CHR COMMUNITY SOCIAL NNADAP DOCTOR NURSE (INDIV.) (GROUP) WORKER WORKER WORKER

Chishaayiyuu

2478 1782 338 3739 743 136 116 0 0 0 34161 372 DOCTOR OPTHAL- NURSE MENTAL FOOTCARE CHR CHR COMMUNITY SOCIAL HOMECARE MSDC MEALS MOLOGIST HEALTH NURSE (INDIV.) (GROUP) WORKER WORKER VISITS PARTICIPANTS SERVED NURSE 1. Male only ᐄᔅᒣᐃᓐ EASTMAIN Population Medical coverage through Current Services/ Administration staff have received training to Chishaayiyuu remains at full capacity, enabling improve efficiency. Six new staff housing units awash 0-91 174 q 6.5% effective community follow-ups. The nursing have been completed, and external renovations uschiniichisuu 10-29 306  3.7% staff includes one assistant head nurse and to another two units have also been completed. chishaayiyuu 30+ 382  3.8% three permanent full-time current nurses. The Plans to develop the capacity of the staff and to Chishaayiyuu nurse works with the CHR (Com- address administration needs are in process. 2  TOTAL 862 1.5% munity Health Representative) to meet the needs of clients with diabetes or renal disease. 1. The 0-4 age group is underestimated since newborns are often registered late in the JBNQA beneficiary list and has been corrected using MSSS Telehealth services have become important for 2015-2018 births (+ 2019 estimates) and 2014-2018 MSSS deaths numbers. 2. Does not include 25 Inuit, Métis and/or non-aboriginals. psychosocial therapy and counselling, psychia- try, nephrology and ophthalmology, and have “The hard work and dedication of decreased patient travel to the south. Dental our Chishaayiyuu chronic diseases Services has a permanent full-time and a per- Medical Evacuations nurse, Claudine Haché, has helped 72 manent part-time dentist, and one permanent 73 dental hygienist, which has a positive impact prevent and decrease complications in on dental services in Eastmain. The Pharmacy’s 45 N/A our clientele with diabetes and renal EMERGENCY SCHEDULED assistant technician is in place, making the disease,” says Rita Gilpin, the CMC local pharmacy more efficient. Current Services director. “She is a true leader of her team, The Home Care Program serves 20 clients; whose activities have extended to the the Program has two vacant nursing positions 1060 0 0 9098 2951 which, once filled, will stabilize the team. The Uschiniichisuu diabetes program and FAMILY SPECIALIST OTHER NURSE NURSE DOCTOR MD SPECIALIST (WALK-IN) (MED. REFILL) MSDC (Multi-Service Day Centre) serves 21 weekly walk challenge, encouraging the clients. The Department has been without a population to embrace healthy lifestyles.” Awash nutritionist since February 2019, and is looking at ways to support this need. - 646 288 10 9 5 The Awash/Uschiniichisuu team continues to FAMILY NURSE CHR CHR COMMUNITY SOCIAL DOCTOR (INDIV.) (GROUP) WORKER WORKER address issues affecting family, children and youth, and has worked on building commu- Uschiniichisuu nications with community partners, including the Cree Nation of Eastmain and other local entities. Special needs and mental health areas - 616 - 250 131 59 24 23 have been further developed. A Youth Diabetes FAMILY NURSE SCHOOL CHR CHR COMMUNITY SOCIAL NNADAP DOCTOR NURSE (INDIV.) (GROUP) WORKER WORKER WORKER team has been established to focus on this is- sue and is now creating an action plan address- Chishaayiyuu ing this concern.

1943 - 648 209 646 13 124 265 335 824 DOCTOR NURSE FOOTCARE CHR CHR COMMUNITY SOCIAL HOMECARE MSDC MEALS NURSE (INDIV.) (GROUP) WORKER WORKER VISITS PARTICIPANTS SERVED ᒥᔅᑎᓯᓃ MISTISSINI Population Mistissini’s management team meets frequently The Chishaayiyuu Unit’s services and programs and regularly to find solutions to CMC prob- focus in particular on chronic diseases, diabe- 1 q awash 0-9 644 0.7% lems and issues. This past year saw extended tes, special needs and elders; the team also Uschiniichisuu 10-29 1,491  3.0% hours implemented at the CMC and the phar- assists specialists visiting Mistissini. The MSDC Chishaayiyuu 30+ 1,839  3.6% macy, now open evenings and weekends. The provides services and programs to Elders and CMC is implementing the Electronic Medical special needs clients, and its Meals on Wheels 2  TOTAL 3,974 2.6% Records pilot project. The use of telehealth has Program continues. The Homecare Program increased, and is being employed for a number has about seventy clients. 1. The 0-4 age group is underestimated since newborns are often registered late in the JBNQA beneficiary list and has been corrected using MSSS of services. The Youth and Family Empower- 2015-2018 births (+ 2019 estimates) and 2014-2018 MSSS deaths numbers. In the Administration Unit, responsibility for 2. Does not include 161 Inuit, Métis and/or non-aboriginals. ment Pilot Project, a collaboration with the Mis- tissini Cree Nation, is underway, and the Youth housing and transits has been moved to the Council has sponsored two local youth assem- Material Resources Department in Chisasibi. blies to promote empowerment. The CMC has This past year maintenance workers received 74 Medical Evacuations begun implementing the CMC – Youth Protec- equipment and vehicles to support their activi- 75 tion protocol. ties. Numerous trainings were held, including for housekeeping staff, which was especially N/A N/A Current Services now has a Psychosocial team helpful when the COVID pandemic hit. EMERGENCY SCHEDULED and a psychosocial on-call service for evenings Current Services and weekends. The hemodialysis clinic is at full capacity. Current Services supports the radiol- ogy team and the laboratory, and has seen an - - 601 16,861 - increased number of specialist visits this year. “We have a good connection with the FAMILY SPECIALIST OTHER NURSE NURSE DOCTOR MD SPECIALIST (WALK-IN) (MED. REFILL) Cree Nation of Mistissini and other The Awash Unit welcomed 71 births. The Awash Awash team aims to enhance its support for mothers entities, and we're working together to and their children by strengthening front-line address a lot of community issues,” says services and increasing client outreach this local director Alan Moar. “The Youth and 886 2748 1604 631 264 0 coming year. The annual Awash Fair in June was FAMILY NURSE CHR CHR COMMUNITY SOCIAL Family Empowerment Project is a good DOCTOR (INDIV.) (GROUP) WORKER WORKER a success, with 73 participants. example. The Youth Council organized Uschiniichisuu Uschiniichisuu highlights include providing frequent outreach for youth in the summer and two assemblies, showing that our young during the Christmas holidays. Uschiniichisuu’s people are interested in exploring - 2088 - 2142 0 942 248 325 supports for youth also include nurses who meet what empowerment means to them.” FAMILY NURSE SCHOOL CHR CHR COMMUNITY SOCIAL NNADAP clients for medical issues and a mental health DOCTOR NURSE (INDIV.) (GROUP) WORKER WORKER WORKER nurse who works closely with the social team. Chishaayiyuu

2255 - 12,328 855 5265 295 486 341 845 1359 DOCTOR NURSE FOOTCARE CHR CHR COMMUNITY SOCIAL HOMECARE MSDC MEALS NURSE (INDIV.) (GROUP) WORKER WORKER VISITS PARTICIPANTS SERVED ᓀᒥᔅᑳ NEMASKA Population The Nemaska CMC was able to fill all coordina- Telehealth services have grown in the past year, tor positions this past year, completing the full especially psychosocial services, which has 1 q awash 0-9 173 2.3% management team. proven especially helpful in adapting to COVID. uschiniichisuu 10-29 276  2.2% The Awash/Uschiniichisuu Unit welcomed 18 The Administration Unit hosted a number of  chishaayiyuu 30+ 403 2.5% babies this past year. The Awash team con- trainings this past year, in Virtuo, infection con- TOTAL 2 852  1.4% tinuously works with new mothers through the trol and prevention, and housekeeping. Six new Well-Baby Clinic, supporting young parents. With housing units are being constructed and should 1. The 0-4 age group is underestimated since newborns are often registered late in the JBNQA beneficiary list and has been corrected using MSSS the efforts of community workers and through be completed this summer, enabling the CMC 2015-2018 births (+ 2019 estimates) and 2014-2018 MSSS deaths numbers. Jordan’s Principle funding, art therapy sessions to hire additional personnel. Two new vehicles 2. Does not include 15 Inuit, Métis and/or non-aboriginals. were offered for school age children and youth. were received—an adapted bus for the MSDC There were a number of activities and initiatives and a compact SUV for the CMC. promoting healthy eating, including workshops Medical Evacuations and information booths. Other initiatives targeted 76 road and bicycle safety, diabetes awareness, and 77 addiction awareness. Many of these initiatives 100 813 were collaborations with other local and regional “We had the first COVID-19 cases in EMERGENCY SCHEDULED entities. The Maamuu Upimchinnaausuutaau Eeyou Istchee, but we were prepared as Current Services Program gathering, “Sharing our Traditional we had already connected with other Knowledge and Skills,” was held in December—a collaboration between the Maamuu Committee, community leaders to plan what we 1680 0 207 6720 1025 the community organizer, community Elders, the FAMILY SPECIALIST OTHER NURSE NURSE would do if COVID appeared here. So DOCTOR MD SPECIALIST (WALK-IN) (MED. REFILL) Cree Nation of Nemaska, and the Cultural and it was challenging but we had a good Wellness Departments. Staff benefitted from Awash  Mashkûpimâtsît Awash training in February. collaborative approach,” says local Other highlights include the hiring of an Awash director Beatrice Trapper. “I think this nurse in May 2019 and a school nurse in Septem- - 601 341 0 215 0 also helped the other communities FAMILY NURSE CHR CHR COMMUNITY SOCIAL ber 2019, and a social worker has also been hired DOCTOR (INDIV.) (GROUP) WORKER WORKER to start in August 2020. plan the strategy on how to manage outbreaks. It was a learning experience Uschiniichisuu In March, Nemaska had the first COVID-19 and opened my eyes to see how we could cases in Eeyou Istchee, from travellers arriving from out of the country. Careful planning, effec- collaborate and provide services better.” - 106 - 1137 24 15 0 0 tive collaboration with the Cree Nation of Ne- FAMILY NURSE SCHOOL CHR CHR COMMUNITY SOCIAL NNADAP DOCTOR NURSE (INDIV.) (GROUP) WORKER WORKER WORKER maska and other entities, and the cooperation of the individuals involved, ensured that the dis- Chishaayiyuu ease was contained, and everyone recovered.

1454 - 548 14 699 0 241 0 609 976 DOCTOR NURSE FOOTCARE CHR CHR COMMUNITY SOCIAL HOMECARE MSDC MEALS NURSE (INDIV.) (GROUP) WORKER WORKER VISITS PARTICIPANTS SERVED ᐅᒉᐴᑯᒨ OUJÉ-BOUGOUMOU Population The CMC has experienced significant turnover The Current Services/Chishaayiyuu nursing team in the nursing team, as almost half of the nurs- experienced substantial turnover this past year. 1 q awash 0-9 172 2.3% ing team (6 out of 13) have resigned, retired, or However, a social worker and an occupational uschiniichisuu 10-29 348  0.5% gone on leave. therapist were recruited as full-time employees. chishaayiyuu 30+ 343  3.3% The physician provides medical coverage 45 The Awash and Uschinichisuu Unit added the weeks of the year, and the psychiatrist visited 2  TOTAL 863 1.1% Food Security Program, food baskets and pre- twice. There was a slight decrease in patient natal classes to its programs. Family-oriented visits to the physician, while community work- 1. The 0-4 age group is underestimated since newborns are often registered programs include Eenou Awaash Piimaatsiiwin late in the JBNQA beneficiary list and has been corrected using MSSS ers saw an increase in individual consultations. 2015-2018 births (+ 2019 estimates) and 2014-2018 MSSS deaths numbers. College, an eight-week session which supports 2. Does not include 15 Inuit, Métis and/or non-aboriginals. The gradual integration of telehealth is enabling parents with children aged 0-5. This project the community to adapt to this new technology. is a partnership with Head Start and the local Current Services saw 6707 clients, 397 fewer Wellness Department. A parent support group than last year. The MSDC saw an increase of 78 Medical Evacuations meets monthly for families with pre-teens and 90 participants for a total of 293. Professional 79 teenagers; group discussions focus on healthy services included visits from the psychiatrist, eating, personal organization, and similar top- pediatrician, gynecologist and psychologist. 69 N/A ics. The breakfast club ran from the beginning EMERGENCY SCHEDULED of the school year until the pandemic, and Staff participated in many activities, workshops Current Services then, in collaboration with community partners, and trainings related to their field of work. continued to support low-income families. Wabin-Juksh Summer Camp is in its 4th year The Administration Unit’s achievements include 1314 0 0 6707 2862 of providing services for children with special the completion of two triplex staff housing FAMILY SPECIALIST OTHER NURSE NURSE DOCTOR MD SPECIALIST (WALK-IN) (MED. REFILL) needs. NNADAP supported clients and families units, with another on the way. The transit has requiring assistance in addressing addictions; an 88% occupancy rate. Network capacity is at Awash monthly AA meetings were held, and National maximum with many disruptions over the year, Addictions Awareness Week featured a com- so this issue must be addressed. Additional housekeepers and drivers are also needed to - 1199a 306 15 b munity walk and celebration. A social worker for 113 0 effectively perform our services. FAMILY NURSE CHR CHR COMMUNITY SOCIAL school-aged clientele was hired. The psycho- DOCTOR (INDIV.) (GROUP) WORKER WORKER educator and speech language pathologist are on leave, which constrains some services. Uschiniichisuu “Our CMC has experienced significant

- 225 - 133 0 99 0 152 changes with the fluctuations of FAMILY NURSE SCHOOL CHR CHR COMMUNITY SOCIAL NNADAP professionals, and so our para- DOCTOR NURSE (INDIV.) (GROUP) WORKER WORKER WORKER professionals have been vital,” says local Chishaayiyuu director Louise Wapachee. “Thanks to

691 them, we have continued to have a strong a - - 464 25 278 5 260 135 0 293 and stable workforce and I commend DOCTOR OPTHAL- NURSE FOOTCARE CHR CHR COMMUNITY SOCIAL HOMECARE MSDC MEALS MOLOGIST NURSE (INDIV.) (GROUP) WORKER WORKER VISITS PARTICIPANTS SERVED their commitment and vitality!” a. Combined curative and vaccination b. Combined individual and group activities ᐙᔅᑳᐦᐄᑲᓂᔥ WASKAGANISH Population The Current Services nursing team remains units of the primary and secondary schools strong and is stabilizing after a larger than nor- and the child care centres to assist with Special 1  awash 0-9 531 0.7% mal number of staff changes. Some develop- Needs Education Programs. The Rehabilitation uschiniichisuu 10-29 928  2.3% ment nursing positions have been introduced team has been busy with key issues, including chishaayiyuu 30+ 1,050  1.2% and are being filled. The Physician Services chronic diseases, and has become increasingly team is stabilizing and had a full schedule this focused on home adaptation and palliative 2  TOTAL 2,509 1.5% year; the integration of a third physician en- care. The team works with the elderly and cog- abled the team to provide excellent service. nitively challenged in both the MSDC and the 1. The 0-4 age group is underestimated since newborns are often registered late in the JBNQA beneficiary list and has been corrected using MSSS Home Care Program, and has been busy as the 2015-2018 births (+ 2019 estimates) and 2014-2018 MSSS deaths numbers. The Awash Unit welcomed 61 babies. Two 2. Does not include 85 Inuit, Métis and/or non-aboriginals. population is aging. The lack of referral centres Awash nurses and one Awash head nurse for respite care presents a major challenge. The were hired, as was an NNADAP worker in July. MSDC team provides a day program for 8 to 11 The Awash team has worked with community clients, and continues to recruit new clients and Medical Evacuations partners on group activities such as parenting offer services to the community at large. 80 workshops, a breastfeeding calendar and the 81 anti-smoking campaign. The Administration Unit’s housekeeping team 124 2490 added a temporary employee during the EMERGENCY SCHEDULED The Uschinichisuu school nurse faced chal- pandemic and recently received training on Current Services lenges with suicidal ideation among second- provincial standards. A newly received fleet of ary students, which led to a Suicide Training vehicles ensures that transportation needs of among the community partners this year. workers and clientele are met. Housing remains 4244 0 26 15,1881 3588 a challenge, as the housing acquired two years FAMILY SPECIALIST OTHER NURSE NURSE Robin’s Nest is experiencing a challenging DOCTOR MD SPECIALIST (WALK-IN) (MED. REFILL) transitionary phase. Employees were trained ago filled quickly. Awash in suicide intervention skills and mental health first aid, but the management team and front- line workers would benefit from a more com- - 940 1236 196 895 0 prehensive orientation. “Everything has been steady here FAMILY NURSE CHR CHR COMMUNITY SOCIAL DOCTOR (INDIV.) (GROUP) WORKER WORKER In Chishaayiyuu, the nutritionist continues to in Waskaganish,” says local director host workshops, and has been presenting baby Bert Blackned. “Our teams have Uschiniichisuu food making and nutritious snacks for young been working well together and parents, including some fathers. In March, she with our community partners.” - 1674 - 1734 65 204 0 55 collaborated with the Cree Nation of Was- FAMILY NURSE SCHOOL CHR CHR COMMUNITY SOCIAL NNADAP kaganish and the Wellness Society as one of DOCTOR NURSE (INDIV.) (GROUP) WORKER WORKER WORKER the leads in the Food Security Program. The Chishaayiyuu psycho-educator continues to work with the Social Services team, the special needs educa- 1268 tor, the occupational therapist and the school - - 1409 393 1167 0 1404 0 3941 1297 CHR to consult and provide programming; she DOCTOR OPTHAL- NURSE FOOTCARE CHR CHR COMMUNITY SOCIAL HOMECARE MSDC MEALS also collaborates with the guidance ­counselling MOLOGIST NURSE (INDIV.) (GROUP) WORKER WORKER VISITS PARTICIPANTS SERVED

1. Combined walk-in/follow-ups ᐙᔅᐙᓂᐲ WASWANIPI Population Waswanipi hosted its first local diabetes con- One notable consequence of the COVID-19 ference in December 2019. The two-day event lockdown is that the clinic saw an increase in 1 q awash 0-9 418 4.8% included presentations, activities and workshops telephone calls for health information and in Uschiniichisuu 10-29 811 p 2.3% on diabetes management and awareness, as attendance at appointments. This suggests Chishaayiyuu 30+ 853 p 1.4% well as on nutrition, physical activity and other that people are taking a more active interest in related topics. their own health which, despite the unfortunate 2 p TOTAL 2,082 0.4% circumstances, is a positive response. Waswanipi’s Current Services/Chishaayiyuu Unit 1. The 0-4 age group is underestimated since newborns are often registered late in the JBNQA beneficiary list and has been corrected using MSSS launched the Home Hemodialysis Pilot Project The coordinator of Awash/Uschiniichisuu retired 2015-2018 births (+ 2019 estimates) and 2014-2018 MSSS deaths numbers. this year with the first dialysis candidate receiv- this past year; her replacement has recently 2. Does not include 20 Inuit, Métis and/or non-aboriginals. ing treatment at home on November 25, 2019, been hired and is expected to join the team in making history as the first in-home dialysis user July 2020. The  Mashkûpimâtsît Awash/Well in Quebec. This project, a collaboration be- Baby Clinic continues to provide support to Medical Evacuations tween the CBHSSJB, the Cree Nation of Was- mothers and children, while the Miiwat project, 82 wanipi and the Montreal General Hospital, will in partnership with Nishiiyuu, is going well. 83 assess the feasibility of home dialysis for eligible The Awemiiniiwaachihisuunanouch “Desire to 156 13,111 clients. Currently two community members Heal” Pilot Project continues its outreach work EMERGENCY SCHEDULED are using home dialysis. Several other clients with youth. Once this project is completed on Current Services were also identified as good candidates for the August 31, the CMC hopes to staff the positions project, but their training in home dialysis was on a full time basis, as the current workers have suspended due to the COVID-19 pandemic; this been very innovative in their efforts to engage 1033 114 44 7079 5167 training will resume once it is safe to do so. youth. After COVID-19 appeared, they began FAMILY SPECIALIST OTHER NURSE NURSE DOCTOR MD SPECIALIST (WALK-IN) (MED. REFILL) developing harm reduction activities as well The Ashuukin Services Elders Home Project con- as promoting fitness, social development and Awash tinues, with a current focus on developing the healthy living that could be carried out following governance structure; this project is a collabo- physical distancing measures: for instance, by ration with the Cree Nation of Waswanipi. The - 959 953 0 organizing activities such as archery. 291 140 home will be a nine-bed facility for people who FAMILY NURSE CHR CHR COMMUNITY SOCIAL DOCTOR (INDIV.) (GROUP) WORKER WORKER require social placement according to criteria established by the working group. “The local diabetes conference was a big Uschiniichisuu deal, not only for our community, but even within the Cree Health Board,” - 18 - 0 0 166 0 97 says CMC local director E. Virginia FAMILY NURSE SCHOOL CHR CHR COMMUNITY SOCIAL NNADAP DOCTOR NURSE (INDIV.) (GROUP) WORKER WORKER WORKER Wabano. “These are initiatives that that

Chishaayiyuu they would like to see happening in communities across Eeyou Istchee.” 6190 - - 3263 115 1081 0 345 0 1978 2003 DOCTOR OPTHAL- NURSE FOOTCARE CHR CHR COMMUNITY SOCIAL HOMECARE MSDC MEALS MOLOGIST NURSE (INDIV.) (GROUP) WORKER WORKER VISITS PARTICIPANTS SERVED ᐐ ᒥᓂ ᒌ WEMINDJI Population The Wemindji Willie Matches Memorial CMC The Administration team organized a number welcomed its new interim local director, Rachel of trainings, including ASIST Suicide Prevention 1 q awash 0-9 256 4.8% Danyluk, in January. training, Mental Health First Aid, Kiniwaapimi- uschiniichisuu 10-29 541 p 1.9% isuutaau – Let’s Reflect on Ourselves training The Awash/Uschiniichisuu unit welcomed 29 chishaayiyuu 30+ 785 p 3.7% to address workplace harassment, and Commu- new babies this year. Despite facing many nication and Etiquette training. TOTAL 2 1,582 p 1.6% challenges to service delivery due to staffing shortages, the team was fortunate to gain a In December, the community held a candlelight 1. The 0-4 age group is underestimated since newborns are often registered late in the JBNQA beneficiary list and has been corrected using MSSS permanent Awash nurse. Special needs staff vigil for George He, whose time working as a 2015-2018 births (+ 2019 estimates) and 2014-2018 MSSS deaths numbers. worked hard to create new services and tools nurse in Wemindji had won him many friends. 2. Does not include 75 Inuit, Métis and/or non-aboriginals. for children with disabilities and their parents, including applications for Jordan’s Principle, the creation of a Goose Break package for Medical Evacuations developmental stimulation, and the planning 84 and preparation for a parent support group. “I arrived in Wemindji as the interim 85 The Uschiniichisuu CHRs worked on a variety of local director at the beginning 159 N/A promotion and prevention activities for youth. EMERGENCY SCHEDULED of January and have now been The main goal for the coming year is to get the Current Services Youth Clinic up and running again. oriented to the position,” says Rachel Danyluk. “I been working as a nurse The Chishaayiyuu team added a social worker 1927 444 0 6714 4563 in October, and in November saw two students for 21 years, including 18 years in the FAMILY SPECIALIST OTHER NURSE NURSE DOCTOR MD SPECIALIST (WALK-IN) (MED. REFILL) graduate from the Dental Assistant Program to Home & Community Care Program be certified dental assistants. The community in Mistissini. I graduated from the Awash had its first internal medicine visit in January, and looks forward to regular visits from specialists. Cree Succession program in 2020.”

- 1006 632 0 52 0 FAMILY NURSE CHR CHR COMMUNITY SOCIAL DOCTOR (INDIV.) (GROUP) WORKER WORKER

Uschiniichisuu

- 0 - 507 74 88 0 57 FAMILY NURSE SCHOOL CHR CHR COMMUNITY SOCIAL NNADAP DOCTOR NURSE (INDIV.) (GROUP) WORKER WORKER WORKER

Chishaayiyuu

13,830 - - 484 56 373 5 590 32 143 13,830 DOCTOR OPTHAL- NURSE FOOTCARE CHR CHR COMMUNITY SOCIAL HOMECARE MSDC MEALS MOLOGIST NURSE (INDIV.) (GROUP) WORKER WORKER VISITS PARTICIPANTS SERVED ᐙᐱᒫᑯᔥᑐᐃ WHAPMAGOOSTUI Population The Whapmagoostui CMC welcomed a new In addition to providing support for young local director, Hannah Kawapit, in November. children and families, the Awash team collabo- 1 q awash 0-9 206 3.3% The team is still working to fill three coordinator rates with and participates in programs with the uschiniichisuu 10-29 405  0.2% positions. Whapmagoostui First Nation and other entities, chishaayiyuu 30+ 425  2.7% including programs at Minnie’s Hope Centre, The Whapmagoostui Healing Conference, which provides social pediatrics programming. TOTAL 2 1,036  0.5% entitled “Families Empowerment & Suicide Prevention,” was held from March 9-13, 2020. The Administration team acquired new vehicles, 1. The 0-4 age group is underestimated since newborns are often registered late in the JBNQA beneficiary list and has been corrected using MSSS The conference, a collaboration with the Whap- including an adapted van for Elders and anoth- 2015-2018 births (+ 2019 estimates) and 2014-2018 MSSS deaths numbers. magoostui First Nation, focussed on healing er vehicle for operations. The team organized 2. Does not include 90 Inuit, Métis and/or non-aboriginals. workshops and one-on-one sessions, and also trainings to support staff in a range of areas. invited people to physiotherapy, reflexology A Medical Bush Kit Training Pilot Project took and acupuncture sessions with community place, and has been evaluated. 86 Medical Evacuations members. 87 The Current Services/Chishaayiyuu team 124 926 launched a major building clean-up in the fall, EMERGENCY SCHEDULED and reviewed the organization of some ser- “We’re working to improve programs Current Services vices. The team has hosted a number of work- and services,” says Hannah Kawapit, the shops in such areas as nutrition and healthy new local director in Whapmagoostui. cooking, and ran a diabetes survey in February. 980 0 448 9524 0 The team has also organized awareness-raising “We want to get all our programs to FAMILY SPECIALIST OTHER NURSE NURSE DOCTOR MD SPECIALIST (WALK-IN) (MED. REFILL) walks on diabetes and violence against women. full capacity, from housekeeping and cleaning to professional services.” Awash A cultural calendar of events helps keep Elders mentally and physically active. Once a year the team runs a major clean-up service for some - 0 0 0 106 0 Elders who live alone and don’t have anyone FAMILY NURSE CHR CHR COMMUNITY SOCIAL to help them around the house. When the DOCTOR (INDIV.) (GROUP) WORKER WORKER COVID-19 pandemic started the team began a Uschiniichisuu Meals on Wheels Program.

A Tuberculosis Testing Initiative, a collaboration - 0 - 0 0 48 69 833 with the Inuit community of Kuujjuarapik, began FAMILY NURSE SCHOOL CHR CHR COMMUNITY SOCIAL NNADAP testing individuals in the fall. DOCTOR NURSE (INDIV.) (GROUP) WORKER WORKER WORKER

Chishaayiyuu

1728 - - 0 0 0 0 138 42 0 1493 DOCTOR OPTHAL- NURSE FOOTCARE CHR CHR COMMUNITY SOCIAL HOMECARE MSDC MEALS MOLOGIST NURSE (INDIV.) (GROUP) WORKER WORKER VISITS PARTICIPANTS SERVED ᐋ ᐅᐦᒋ ᐱᒥᐱᔨᐦᑖᑭᓂᐎᒡ

Lilliane Groleau ᐋᐱᑎᓰᐎᓐ Assistant Executive Director aa uhchi pimipiyihtaakiniwich aapitisiiwin EXECUTIVE SUMMARY

In a year defined by unprecedented ­challenges, But the pandemic should not overshadow staff in Administrative Services rolled up ­earlier achievements. their sleeves to ensure that the CBHSSJB was equipped to respond rapidly to new and ever- Thanks to the work of MRD and our partners, changing demands. Thanks to their dedication the CBHSSJB celebrated the inauguration of to professionalism, all departments were able the Youth Healing Services Centre in Mistis- to progress on their strategic objectives while sini. The department also secured more than ᐅᒋ ᒥᓰᓃᐦᐄᒑᓲᐧᐄᔨᒡ addressing pressing needs from all sides. $170 million for new capital projects. ᒥᓯᐧᐋ ᐋᐱᑎᓰᔅᑖᐦᒡ ᒑ ᒋ Wiichihiituwin, which links patients with medical IT, which ensures employees and facilities have ᐧᐄᒋᐦᐋᑳᓅᐧᐄᔨᒡ ᐋᐱᑎᔑᓲ care outside Eeyou Istchee, worked closely with stable, reliable technology and timely technical help, responded to more than 7,000 requests. ᑭᔭ ᒑ ᒋ ᐧᐄᒋᐦᐄᐧᐋᐱᔩᒡ Public Health to implement new measures de- 89 signed to protect patients who had no choice ᒥᓰᐧᐋ ᐋᐱᑎᓰᐧᐄᓐᐦ᙮ ᐄᔨᔨᐤ On the staffing front, the CBHSSJB increased but to travel down south for treatment during the number of managers and full-time employ- ᐋᐱᑎᓰᐧᐄᓐ, ᔔᔮᓐᓰᓇᐦᐄᑲᓐᐦ, the COVID-19 pandemic. ees, and also recruited more employees than the ᓈᓃᑎᐧᐋᐱᐦᒌᑲᓐᐦ, ᒑᐧᑳᓐ ᐋᑦ The pandemic precipitated a massive shift to previous year. The workforce is now 71% Cree. ᒋᔅᑖᐱᑎᐦᒡ ᐋᐱᑎᓰᐧᐄᓂᔨᒡ ᐧᐄᐦᒡ, telework. IT responded with the rapid deploy- With the arrival of a new Director of Information ᐧᐋᔅᑳᐦᐄᑳᓐᐦ, ᑭᔮ ᐧᐄᒋᐦᐄᑐᐧᐄᓐ ment of Zoom and other platforms to ensure Technology, Administrative Services now has ᐋ ᑭᓂᐧᐋᐦᐄᑖᑯᐦᒡ, (ᐅᑕᑯᔒᐧᐄᔨᒡ the continuity and efficiency of services. IT was stable leadership in place, which will help de- also key in establishing the COVID-19 Info-line ᐋᒋᐧᐄᐦᒡ ᑭᓂᐧᐋᔨᑖᑯᔒᔨᒡ)᙮ partments address what promises to be another and the Wichihiiwaawin Helpline to support challenging year. 5 clients and the public. uchi misiiniihiichaasuuwiiyich misiwaa Quickly changing travel and self-isolation aapitisiistaahch chaa chi wiichihaakaanuuwiiyich ᐋ ᐅᐦᒋ restrictions put front-line services at risk. To aapitishisuu kiya chaa chi wiichihiiwaapiyiich answer the deluge of questions, Human Re- misiiwaa aapitisiiwiinh. iiyiyiu aapitisiiwiin, sources put in place a dedicated email address shuuyaansiinahiikanh, naaniitiwaapihchiikanh, and launched an Employee Bulletin focussed ᐱᒥᐱᔨᐦᑖᑭᓂᐎᒡ chaakwaan aat chistaapitihch aapitisiiwiiniyich on COVID-19. wiihch, waaskaahiikaanh, kiyaa wiichihiituwiin aa kiniwaahiitaakuhch, (utakushiiwiiyich aachiwiihch ᐋᐱᑎᓰᐎᓐ kiniwaayitaakushiiyich). aa uhchi pimipiyihtaakiniwich The Administrative Services Group provides essential aapitisiiwin regional support functions to the organization. It includes Human Resources, Financial Resources, Information ADMINISTRATIVE Technology Resources, Material Resources and SERVICES Wiichihiituwin (formerly Cree Patient Services). ᐄᔨᔨᐤ ᔓᐧᐃᔮᓐ ᐋᐱᑎᓰᐧᐄᓐᐦ ᐋᐱᑎᓰᐧᐄᓐᐦ iiyiyiu aapitisiiwiinh shuwiyaan aapitisiiwiinh HUMAN RESOURCES FINANCIAL RESOURCES

The Human Resources Department has The Staffing Unit's Summer Student Program With close to 1,000 employees on the Recall The Financial Resources team continued its ­expanded over the past year, with six units now encourages Cree students to acquire skills and List to provide temporary replacements, the efforts to improve the quality and efficiency in place to provide structured, professional and knowledge in health and social services. It aims unit is developing an integrated replacement of the services it provides. One approach to practice-based services to the various depart- to maintain contact with the students, with the planning and management system to allow for achieve this end involved reorganizing our ments and employees. hope of recruiting them after graduation. greater efficiency and fluidity in replacements. structure at the level of the procurement staff, which allowed the creation of two procurement The Compensation and Benefits Unit has been The mandate of the Human Resources Devel- officer positions. restructured to better serve employees. A gen- opment team is to deploy a training plan that eral e-mail was created to respond to employee respects Cree culture, with the unit offering 250 The Procurement Unit successfully centralized queries: [email protected]. training sessions in 2019-20. ordering and warehousing activities related to COVID-19 in Mistissini. This major project was The Labour Relations Unit advisors visited The HRD team also continued to promote the in collaboration with the Material Resources almost every community this year to provide Indigenous Succession Plan to enable employ- Department (MRD) and Mistissini CMC. support and build trust with clients and em- ees to move into key roles within the organiza- 90 ployees as part of the Let’s Reflect on Our- tion. The unit is working with the Cree School The Cree Non-Insured Health Benefits (CNIHB) 91 selves campaign on workplace relations, with Board to develop educational programs based team continue to work in committee to review many requests for help in resolving workplace on current and developing hiring needs. all policies and procedures associated with conflicts. non-insured health benefits in order to propose a CNIHB Program Framework to the MSSS. Indigenous Succession Plan The Health and Safety Unit formed a new joint The Board of Directors approved the CNIHB committee to ensure a healthy work environ- graduates 27 total Program Framework in December 2019. ment for all employees, and was responsible In early 2020, nurses, doctors, technicians and other staff who (17 with post- 44 employeees for a successful 2019 flu vaccination campaign work directly with patients were fitted with N-95 masks as part of secondary region-wide efforts to protect the population from the spread of diplomas) for employees. As the COVID-19 virus began to COVID-19. 17 who are continuing spread, the unit conducted a massive exercise to studies Payments by electronic transfer fit-test front-line staff for N-95 medical masks.

The team is also developing a Performance ­Appraisal Program to enable employees and 64% Staffing managers to take stock of work performance and the development ­objectives targeted by 2,264 2% total employees 71% Cree employees. 28% 104 6% permanent managers 1,263 6% full-time employees 9% 32 432 36%* vacancies recruitment employees 238 events hired 30 summer students (29 Cree) 20 internships

* Since 2017-2018 ᓈᓂᑑᐦᐙ ᐱᒋᑲᓐ ᒑᒀᓐ ᐋᐦᐋᐱᑎᒋᔅᑖᑭᓄᐎᔨᒡ ᓈᓂᑑᐦᒋᔅᒑᔨᐦᑎᒧᐎᓐ ᒑ ᒋ ᒥᔻᐱᑎᔒᓈᓄᐎᔨᒡ naanituuhwaapichikan naanituuhchischaayihtimuwin chaakwaan aahaapitichistaakinuwiyich chaa chi miywaapitishiinaanuwiyich INFORMATION TECHNOLOGY RESOURCES MATERIAL RESOURCES

The Information Technology (IT) Department ACHIEVEMENTS The Material Resources Department (MRD) aims The Biomedical Engineering Team relocated is responsible for the technical infrastructure ● Upgrading and replacing servers for to create the best possible lodging and work- the Chisasibi CMC, upgraded laboratory ana- of the CBHSSJB and implements solutions and ­Nemaska Clinic ing environment for clinical, administrative and lyzers and purchased equipment for Midwifery systems that meet the organization’s operation- ● Point of Sales (POS) deployment in all com- other CBHSSJB personnel. Capital projects rep- Services. The Department participated in a al and strategic needs. munity ­pharmacies resent a major investment in the organization’s pilot project to equip certain communities with mandate to improve the scope and quality of delocalized laboratory testing equipment, al- Airport direct line phone to answer ques- The Department objectives are linked to the ● services across Eeyou Istchee. lowing these communities to improve diagnos- tions from Wiichihiituwin clients—Chisasibi CBHSSJB Strategic Regional Plan (SRP) and tic capacities and reduce medical evacuations. critical to the expansion of healthcare services pilot project, eventually in all airports In recent years, MRD has overseen construc- in Eeyou Istchee. The Department maintains a tion and maintenance of critical infrastructure, During COVID-19, MRD procured and complex IT infrastructure enabling the organiza- including Robin’s Nest women’s shelters, new ­purchased secondary sites, equipment and tion to meet local needs and align with CBHSSJB CMCs and residential housing. 2020 saw the storage and negative pressure rooms, and and MSSS objectives. inauguration of Mistissini's new YHS Regional trained personnel in health and hygiene, Centre. A new CMC was completed in Chisa- ­cleaning methodologies and security detail. 92 The Service Centre is the gateway for all sibi and the Uschiniichisuu and Awash Depart- 93 requests for support regarding the use or ments have moved in. All construction projects PRIORITIES maintenance of assets in our network. Informa- REQUESTS 7,271 OCT 2019 - MAR 2020 were put on hold during the pandemic. New ● Regional hospital in Chisasibi (2025) tion security plays a role in maintaining user construction sector regulations and workplace CMCs in Waskaganish, Oujé-Bougoumou confidence. With more services moving online, ● restrictions to prevent the spread of COVID-19 and Whapmagoostui the IT Department is focused on preserving the will require MRD to adapt as it moves ahead. ● Birthing Home in Chisasibi security of the infrastructure, including patient Presently we can only work with local contrac- ● Land-based Healing Centres data and other confidential records. tors (structure carpentry and civil work). In ● 80 transit units in Chisasibi The COVID-19 pandemic highlighted the the North there is a lack of specialized labour (ventilation, refrigeration, electricity, instrumen- ● Multi-unit housing in Nemaska and importance of reliable technology and timely ­Oujé-Bougoumou technical help. In response to the urgent need tation) which is needed in all construction. Elders' Home to communicate to the population at large, ● PLANNED SPENT MAINTAINED IT set up new toll-free telephone lines—the COVID-19 Info-line and the Wiichihiiwaauwin $174 million $1.6 million $1.37 million $400,000 587 50 Helpline. With staff working from home and capital projects construction and new and upgraded medical lodging clinical unable to meet clients and colleagues, the renovation projects non-medical equipment equipment administrative units buildings Department rapidly deployed Zoom and the infrastructure needed to enable all healthcare workers to continue to provide specialized, non-specialized, administrative and support services during a particularly stressful time.

COVID-19 Info-line 866-855-2811 Wiichihiiwaauwin Helpline 833-632-4357 (HELP)

Architectural plan for birthing home in Chisasibi ᐐᒋᐦᐄᑐᐎᓐ WIICHIHIITUWIN

Wiichihiituwin—to help one another—links HIGHLIGHTS clients to medical and social services that are ● Business process analyst engaged to advise not available to the population in Eeyou Istchee. on logistical efficiency The Department coordinates travel, accommo- ● New nurse advisor to monitor patient ser- dation, local transportation, meals and appoint- vices, and several new projects dedicated ments for thousands of clients in four service to patients living outside Eeyou Istchee hubs: Chibougamau, Chisasibi, Montreal and Working group to tackle persistent and costly Val-d’Or. The Department also collaborates with ● problem of no-shows for scheduled charter other institutions in the Quebec health system, flights; fear of contracting COVID-19 led to particularly in Montreal, Nord-du-Québec and many no-shows, despite efforts to reassure Rouyn Noranda. the public on precautionary measures in The COVID-19 pandemic required Wiichihiitu- place win to make rapid service changes. All non- ● Steps were taken to review service propos- 94 essential appointments were postponed and als for lodging clients in Val-d’Or to ensure 95 converted to telehealth via phone. Commu- the best quality of service nity kitchens and other common spaces were ● Wiichihiituwin new team members: closed, and clients and escorts who could not Social worker providing exclusive postpone treatment were obliged to self-iso- ● services to youth under 18 years of age late during their stay down south. The Espresso from the Montreal Children's Hospital Hotel in Montreal and Continental Hotel in Val d’Or created zones on separate floors to ● Oncology pivot nurse for Cree clientele help protect the most vulnerable clients from in the Royal Victoria, ensuring cancer potential exposure. Although Wiichihiituwin’s patients and families receive the sup- WIICHIHIITUWIN ARRIVALS team managed COVID positive patients, the port they need FOR MEDICAL APPOINTMENTS team’s collaboration at all four locations and ● Coordinator to support administration of the cooperation of clients helped reduce the two offices in Val-d'Or and Chibougamau risk of transmission. ● Coordinator to support Espresso and VAL-D’OR 12,510 (8.5%) the Chisasibi team

MONTREAL 19,911 (p13.2%)

WIICHIHIITUWIN PATIENTS & ESCORTS CHIBOUGAMAU 7785 (5.0%)

PATIENTS ESCORTS 21,704 10,683 CHISASIBI 1008 (51.2%)

a decrease of 6.4% due to the cancellation of all TOTAL 41,214(p1.1%) but essential medical appointments.

Note: Numbers refers to arrivals in all service locations In addition to the information presented in this section, detailed annual financial statements of the Cree Board of Health and Social Services of James Bay are available online through the Ministry of Health and Social Services of Quebec. Download AS-471: publications.msss.gouv.qc.ca/msss/recherche/.

BREAKDOWN OF GROSS EXPENSES BY PROGRAM

Current Exercise Previous Exercise Programs Expenditures % Expenditures % Service Programs Public Health $2,580,286 0.89% $2,074,491 0.79% General Services - Clinical and Assistance Activities 18, 4 37, 8 8 0 6.37% 18,578,708 7.0 8% Support for Autonomy of the Elderly 5,740,872 1.98% 5,324,644 2.03% Physical Disability 8,148,970 2.81% 7, 652, 320 2.92% Intellectual Disability and Autism Spectrum Disorders (ASD) 47, 4 0 9 0.02% 49,106 0.02% Youth in Difficulty 25,426,117 8,78% 19,402,464 7.40% Dependencies 504,293 0.17% 494,599 0.19% Mental Health 4,133,097 1.42% 4,035,161 1.54% Physical Health 141,503,689 48.85% 129,205,886 49.25% 97 Support Programs Administration 42,420,449 14.64% 38,302,197 14.59% Support to Services 11,543,593 3.99% 10,839,698 4.13% Management of Buildings and Equipment 29,202,851 10.08% 26,400,457 10.06% 6 TOTAL $289,669,506 100.00% $262,359,731 100.00% ᐋ ᒥᓯᓈᓱᑦ BUDGETARY ᑳ ᐃᔅᐱᔨᑦ BALANCE Under sections 3 and 4 of the Act, to provide for balanced budgets in the public health and social services network (CQLR, chapter E-12.0001), ᔔᔮᓐ the Cree Board of Health and Social Services of James Bay shows a surplus of $505,015, ­therefore aa mininaasut kaa ispiyit respecting this legal obligation. shuuyaan FINANCIAL SERVICES CBHSSJB CBHSSJB STATEMENT OF OPERATIONS | 31 MARCH 2020 STATEMENT OF OPERATIONS | 31 MARCH 2020

CBHSSJB Page 200-00 CBHSSJB Page 358-00 STATEMENT OF OPERATIONS - OPERATION FUNDS │ 31 MARCH 2020 STATEMENT OF OPERATIONS - OPERATION FUNDS │ 31 MARCH 2020

Budget Operations Cur. Yr. Capital Assets Current Year Prior Yr. Total Budget Main activities Incidental activities Total (C2 + C3) Prior year (R.of P358 C4) Current Yr. (Note 1) Total C2 + C3 1 2 3 4 5 1 2 3 4 5 REVENUES REVENUES

MSSS Grants 1 284 533 332 289 677 233 11 144 564 300 821 797 269 205 398 MSSS Grants 1 272 589 618 289 677 233 289 677 233 258 826 219 Government of Canada 2 6 607 052 9 990 066 9 990 066 7 654 573 Government of Canada 2 6 607 052 9 990 066 9 990 066 7 654 573 User contributions 3 700 000 713 998 XXXX 713 998 697 338 User contributions 3 700 000 713 998 XXXX 713 998 697 338 Sale of services and recoveries 4 1 270 568 2 035 030 XXXX 2 035 030 1 085 755 Sale of services and recoveries 4 1 270 568 2 035 030 XXXX 2 035 030 1 085 755 Donations 5 Donations 5 Investment revenue 6 Investment revenue 6 Business revenue 7 Business revenue 7 Gain on disposal 8 Gain on disposal 8 9 XXXX XXXX XXXX XXXX XXXX 9 XXXX XXXX XXXX XXXX XXXX 10 XXXX XXXX XXXX XXXX XXXX 10 XXXX XXXX XXXX XXXX XXXX Other revenue 11 350 000 680 502 680 502 1 554 741 Other revenue 11 350 000 290 411 390 091 680 502 1 554 741 TOTAL (L.01 to L.11) 12 293 460 952 303 096 829 11 144 564 314 241 393 280 197 805 TOTAL (L.01 to L.11) 12 281 517 238 292 716 672 10 380 157 303 096 829 269 818 626

EXPENDITURES EXPENDITURES Salaries, benefits and payroll taxes 13 142 945 355 154 850 106 XXXX 154 850 106 138 646 685 Salaries, benefits and payroll taxes 13 142 945 355 148 356 083 6 494 023 154 850 106 138 646 685 Medications 14 12 750 000 14 710 363 XXXX 14 710 363 13 151 992 98 Blood products 15 182 690 XXXX 182 690 96 985 Medications 14 12 750 000 14 710 363 XXXX 14 710 363 13 151 992 99 Medical and surgical supplies 16 4 725 600 4 710 781 XXXX 4 710 781 4 218 117 Blood products 15 182 690 XXXX 182 690 96 985 Food products 17 814 400 875 810 XXXX 875 810 805 776 Medical and surgical supplies 16 4 725 600 4 710 781 XXXX 4 710 781 4 218 117 Food products 17 814 400 875 810 XXXX 875 810 805 776 Honoraria paid to non-instutional resources 18 XXXX Honoraria paid to non-instutional resources 18 XXXX Financial charges 19 8 512 578 2 479 202 4 664 507 7 143 709 7 711 933 Maintenance and repairs, including non-capital Financial charges 19 4 000 000 2 479 202 XXXX 2 479 202 3 190 905 20 5 164 960 3 634 198 3 634 198 3 055 180 costs related to capital assets Maintenance and repairs, including non-capital 20 5 164 960 3 633 110 1 088 3 634 198 3 055 180 Bad debt 21 XXXX costs related to capital assets Rent 22 6 709 054 6 993 533 XXXX 6 993 533 6 660 278 Bad debt 21 Capital asset depreciation 23 8 924 112 XXXX 9 022 208 9 022 208 7 942 616 Rent 22 6 709 054 6 979 002 14 531 6 993 533 6 660 278 Loss on disposal of capital assets 24 XXXX Transfer expenses 23 Transfer expenses 25 XXXX Other expenditures 24 104 407 869 107 742 465 3 870 515 111 612 980 100 421 557 26 XXXX XXXX XXXX XXXX XXXX TOTAL (L.13 to L.24) 25 281 517 238 289 669 506 10 380 157 300 049 663 270 247 475 Other expenditures 27 104 407 869 111 612 980 111 612 980 100 421 557 SURPLUS (DEFICIT) OF THE YEAR TOTAL (L.13 to L.27) 28 294 953 928 300 049 663 13 686 715 313 736 378 282 711 119 26 0 3 047 166 0 3 047 166 (428 849) (L.12 - L.25)

SURPLUS (DEFICIT) OF THE YEAR 29 (1 492 976) 3 047 166 (2 542 151) 505 015 (2 513 314) (L.12 - L.28) CBHSSJB CBHSSJB STATEMENT OF ACCUMULATED SURPLUS (DEFICIT) | 31 MARCH 2020 STATEMENT OF FINANCIAL POSITION | 31 MARCH 2020

CBHSSJB Page 202-00 CBHSSJB Page 204-00 STATEMENT OF ACCUMULATED SURPLUS (DEFICIT) - ALL FUNDS │ 31 MARCH 2020 STATEMENT OF FINANCIAL POSITION - ALL FUNDS│ 31 MARCH 2020

Operating fund Capital assets Fund Current Year Prior Yr. Total FUND General Capital assets Current Year Total Prior Yr. Total Current year Current year Total (C1 +C2) (C1+C2) 1 2 3 4 1 2 3 4 FINANCIAL ASSETS

ACCUMULATED SURPLUS (DEFICIT) Cash on hand (overdraft) 1 15 271 539 15 271 539 5 021 732 1 5 339 068 35 062 626 40 401 694 42 915 008 BEGINNING OF YEAR, ALREADY ESTABLISHED Short-term investments 2 Accounting changes with prior year Receivables - MSSS 3 137 763 855 1 306 472 139 070 327 188 029 464 2 restatement (specify) Other receivables 4 5 953 671 5 953 671 6 603 599 Accounting changes without prior year restatement 3 XXXX Cash advances to public institution 5 XXXX (specify) Interfund receivables (payables) 6 17 791 073 (17 791 073) 0 ACCUMULATED SURPLUS (DEFICIT) 4 5 339 068 35 062 626 40 401 694 42 915 008 Grant receivable (deferred grants) - accounting BEGINNING ADJUSTED (L.01 to L.03) 7 5 620 243 (21 113 012) (15 492 769) (14 729 114) reform Portfolio investments 8 SURPLUS (DEFICIT) FOR THE YEAR 5 3 047 166 (2 542 151) 505 015 (2 513 314) Deferred debt issuance costs 9 XXXX

Other changes: 10 XXXX XXXX XXXX XXXX 6 Inter-institution transfers (specify) 11 XXXX Interfund transfers (specify) 7 (1 294 599) 1 294 599 0 Other items 12 2 404 635 2 404 635 9 532 832 Other items applicable to private establishments TOTAL FINANCIAL ASSETS (L1 to L12) 13 184 805 016 (37 597 613) 147 207 403 194 458 513 8 XXXX under agreement (specify)

9 XXXX XXXX XXXX XXXX LIABILITIES TOTAL OTHER CHANGES (L.06 to L.09) 10 (1 294 599) 1 294 599 Short-term debt 14 131 200 994 7 099 428 138 300 422 165 481 660 Accounts payable - MSSS 15 ACCUMULATED SURPLUS (DEFICIT) END OF 11 7 091 635 33 815 074 40 906 709 40 401 694 100 YEAR (L.04+ L.05 + L.10) Other accounts payable and accruals 16 31 443 653 31 443 653 34 388 837 101 Consisting of the following: 12 XXXX XXXX Cash advances - decentralized envelopes 17 XXXX External restrictions Internal restrictions 13 XXXX XXXX 5 941 133 5 744 042 Accrued interest payable 18 165 847 1 306 473 1 472 320 1 601 929 Unrestricted or Unrestricted balance (L.11 - L.12 - 14 XXXX XXXX 34 965 576 34 657 652 L.13) Deferred revenue 19 6 179 198 6 179 198 6 405 247 TOTAL (L.12 to L.14) 15 XXXX XXXX 40 906 709 40 401 694 20 XXXX XXXX XXXX XXXX

Long-term debts 21 XXXX 124 597 377 124 597 377 128 644 942

Liability for contaminated sites 22 XXXX Liability for employee future benefits 23 11 951 470 XXXX 11 951 470 10 144 863

24 XXXX XXXX XXXX XXXX

Other items 25 623 456 623 456 7 849 499 TOTAL LIABILITIES (L.14 to L.25) 26 181 564 618 133 003 278 314 567 896 354 516 977

NET FINANCIAL ASSETS (NET DEBT) (L.13 - L.26) 27 3 240 398 (170 600 891) (167 360 493) (160 058 464)

NON FINANCIAL ASSETS Capital assets 28 XXXX 204 415 965 204 415 965 196 970 647 Supply inventory 29 2 233 082 XXXX 2 233 082 2 039 700 Prepaid expenses 30 1 618 155 1 618 155 1 449 811

TOTAL NON FINANCIAL ASSETS (L.28 to L.30) 31 3 851 237 204 415 965 208 267 202 200 460 158

SHARE CAPITAL AND CONTRIBUTED SURPLUS 32 XXXX

ACCUMULATED SURPLUS (DEFICIT) 33 7 091 635 33 815 074 40 906 709 40 401 694 CBHSSJB CBHSSJB STATEMENT OF VARIANCE OF NET FINANCIAL ASSETS/DEBTS | 31 MARCH 2020 CASH FLOW STATEMENT | 31 MARCH 2020

CBHSSJB Page 206-00 CBHSSJB Page 208-00 STATEMENT OF VARIANCE OF NET FINANCIAL ASSETS/DEBTS │ 31 MARCH 2020 CASH FLOW STATEMENT │ 31 MARCH 2020

Budget General Fund Capital Assets Total Current Yr. Total Prior Yr. Current Year Prior Year Fund (C2+C3) 1 2 OPERATING ACTIVITIES 1 2 3 4 5 Surplus (deficit) for the year 1 505 015 (2 513 314)

NET FINANCIAL ASSETS (NET ITEMS NOT AFFECTING CASH FLOW 1 (160 298 987) 1 849 557 (161 908 021) (160 058 464) (145 675 348) DEBT BEGINNING ALREADY ESTABLISHED Provision tied to portfolio investments and loan guarantees 2 Accounting changes with prior year restatement 2 Supply inventory and prepaid expenses 3 (361 726) (76 159) Loss (gain) on disposal of capital assets 4 Accounting changes without prior year restatement 3 XXXX Loss (gain) on disposal of portfolio investments 5 NET FINANCIAL ASSETS (NET DEBT Amortization of deferred revenue related to capital assets: 4 (160 298 987) 1 849 557 (161 908 021) (160 058 464) (145 675 348) BEGINNING ADJUSTED (L.01 to L.03) - Government of Canada 6 SURPLUS (DEFICIT) FOR THE YEAR - Other 7 5 (1 492 976) 3 047 166 (2 542 151) 505 015 (2 513 314) (P.200, L.29) Capital asset depreciation 8 9 022 208 7 942 616 VARIANCE DUE TO CAPITAL ASSETS: Capital loss 9 6 (20 000 000) XXXX (16 467 526) (16 467 526) (19 736 259) Acquisitions Amortization of debt issue costs and management 10 Annual depreciation 7 8 924 112 XXXX 9 022 208 9 022 208 7 942 616 Amortization of bond premium or discount 11 Gain/loss on disposal of assets 8 XXXX Proceeds of disposition 9 XXXX XXXX XXXX XXXX XXXX MSSS grants 12 (6 480 060) (5 858 151)

Bad debts 10 XXXX Other (specify) 13 Capital asset adjustments 11 XXXX TOTAL ITEMS NOT AFFECTING CASH FLOW (L.02 to L.13) 14 2 180 422 2 008 306 12 XXXX XXXX XXXX XXXX XXXX Changes in financial assets and liabilities related to operation 15 47 140 027 (5 522 243) 102 13 XXXX XXXX XXXX XXXX XXXX CASH FLOW RELATED TO CAPITAL ASSET INVESTMENT ACTIVITIES (L.01 + L.14 + L.15) 16 49 825 464 (6 027 251) 103 TOTAL VARIANCE DUE TO CAPITAL ASSETS 14 (11 075 888) XXXX (7 445 318) (7 445 318) (11 793 643) (L.06 to L.13) CAPITAL ASSET INVESTMENT ACTIVITIES VARIANCE DUE TO SUPPLY INVENTORY AND Cash outflow related to capital asset purchases 17 (15 590 569) (21 927 016) PREPAID EXPENSES: 15 (2 100 000) (2 233 082) XXXX (2 233 082) (2 039 700) Proceeds of disposition of capital assets 18 Acquisition of supply inventory CASH FLOW RELATED TO CAPITAL ASSET INVESTMENT ACTIVITIES 19 (15 590 569) (21 927 016) Acquisition of prepaid expenses 16 (1 700 000) (1 618 155) (1 618 155) (1 672 658) (L.17 + L.18) Use of supply inventory 17 2 039 700 2 039 700 XXXX 2 039 700 1 686 076

Use of prepaid expenses 18 1 449 811 1 449 811 1 449 811 1 950 123 INVESTMENT ACTIVITIES

TOTAL VARIANCE DUE TO SUPPLY Variance of short-term investments 20 INVENTORY AND PREPAID 19 (310 489) (361 726) (361 726) (76 159) Portfolio investments (made) 21 EXPENSES (L.15 to L.18) Proceeds of disposition of portfolio investments 22

Portfolio investments (completed) 23 Other variance in accumulated surplus (deficit) 20 (1 294 599) 1 294 599 0 CASH FLOW RELATED TO INVESTMENT ACTIVITIES (L.20 to L.23) 24

INCREASE (DECREASE) IN NET FINANCIAL 21 (12 879 353) 1 390 841 (8 692 870 (7 302 029) (14 383 116) ASSETS (NET DEBT) (L.05 + L.14 + L.19 + L.20)

NET FINANCIAL ASSETS (NET DEBT) 22 (173 178 340) 3 240 398 (170 600 891) (167 360 493) (160 058 464) END OF YEAR (L.04 + L.21) CBHSSJB CBHSSJB CASH FLOW STATEMENT (CONT’D) | 31 MARCH 2020 CASH FLOW STATEMENT (CONT’D) | 31 MARCH 2020

CBHSSJB Page 208-01 CBHSSJB Page 208-02 CASH FLOW STATEMENT (CONT'D) │ 31 MARCH 2020 CASH FLOW STATEMENT (CONT'D) │ 31 MARCH 2020

Current Year Prior Year Current Year Prior Year 1 2 1 2 FINANCING ACTIVITIES VARIANCE OF FINANCIAL ASSETS AND LIABILITIES RELATED TO OPERATION: Long-term debts - Debts incurred 1 Receivables - MSSS 1 48 959 137 (8 683 569) Long-term debts - Debts repaid 2 Other receivables 2 649 928 (3 191 015) Capitalization of discounts and premium on debt instruments 3 Cash advances to public institutions 3 Variance of short-term debts - generated fund 4 (33 901 624) 19 794 649 Grant receivable - accounting reform - employee future benefits 4 Short-term debts incurred - capital asset fund 5 9 916 536 2 324 679 Deferred debt issuance costs 5 Short-term debts repaid - capital asset fund 6 Other assets 6 7 128 197 (5 793 312) Variance from government sinking fund 7 Accounts payable - MSSS 7 Other (specify P297) 8 Other accounts payable and accruals 8 (3 822 141) 6 708 310 CASH FLOW RELATED TO FINANCING ACTIVITIES (L.01 to L.08) 9 (23 985 088) 22 119 328 Cash advances - decentralized envelopes 9 Accrued interest payable 10 (129 609) 278 196 Deferred revenue 11 (226 049) (1 777 033) INCREASE (DECREASE) IN CASH AND CASH EQUIVALENTS Liability for contaminated sites 12 10 10 249 807 (5 834 939) P.208-00, L.16 + L.19 + L.24 + P.208-01, L.09) Liability for employee future benefits 13 1 806 607 1 252 024 Other liability items 14 (7 226 043) 5 684 156 TOTAL VARIANCE OF FINANCIAL ASSETS AND LIABILITIES RELATED TO OPERATION 15 47 140 027 (5 522 243) CASH AND CASH EQUIVALENTS, BEGINNING OF YEAR 11 5 021 732 10 856 671 (L.01 to L.14)

OTHER INFORMATION: CASH AND CASH EQUIVALENTS, END OF YEAR (L.10 + L.11) 12 15 271 539 5 021 732 104 Capital asset acquisitions included in accounts payable as at March 31 16 2 541 083 1 664 126 105 CASH AND CASH EQUIVALENTS, END OF YEAR INCLUDING: Proceeds of disposition of capital assets included in receivables as at March 31 17 Other items not affecting cash and cash equivalents (specify P297) 18 (6 480 060) (5 858 151) Cash on hand 13 15 271 539 5 021 732

Short-term investments 14 INTEREST: TOTAL (L.13 + L.14) 15 15 271 539 5 021 732

Creditor interest (revenue) 19 Interest received (revenue) 20 Interest received (expenses) 21 7 143 709 7 711 933 Interest spent (expenses) 22 2 598 239 3 100 131 Acronyms

AED Assistant Executive Director AGA Annual General Assembly AGM Annual General Meeting AMA Â Mashkûpimâtsît Awash APS Administrative Process Specialist AQSP Association Québécoise de Prévention du Suicide CAVAC Crime Victims Assistance Centre CBHSSJB Cree Board of Health and Social Services of James Bay CCIC Clinical Coordination and Integration Committee CHR Community Health Representative CISSS Centre intégré de santé et de services sociaux CLE/CE Cree Leukoencephalopathy and Cree Encephalitis CMC Community Miyupiimaatisiiun Centre CNG Cree Nation Government CNIHB Cree Non-Insured Health Benefits COVID Coronavirus Disease (2019) CPDP Council of Physicians, Dentists and Pharmacists CSB Cree School Board CTA Cree Trappers' Association CWEIA Cree Women's Association of Eeyou Istchee DGMS Department of General and Specialized Medicine DMAS Director of Medical Affairs and Services DPH Director of Public Health DPSQA Department of Professional Services and Quality Assurance DPSS Disability Programs and Specialized Services EEPF Eeyou Eenou Police Force 106 EMR Electronic Medical Records FASD Fetal Alcohol Syndrome Disorder HEY Health Eeyou Youth Project HRD Human Resources Department IRS Indian Residential Schools IT Information Technology JBCCS James Bay Cree Communications Society JBNQA James Bay Northern Quebec Agreement MCHP Maternal and Child Health Program MMIW Missing nad urdered Indigenous Women MoreOB Managing Obstetrical Risk Efficiently MRD Material Resources Department MSDC Multi-Service Day Centre MSSS Ministère de la Santé et des Services sociaux MUHC McGill University Health Centre NNADAP National Native Alcohol Abuse Program OIIQ Ordre des infirmières et infirmiers du Québec PH Public Health PMO Project Management Office PMSD Pour une maternité sans danger PPRO Planning and Programming Research Officer RHSW Resolution Health Support Worker SERC Surveillance, Evaluation, Research and Communications SIPPE Services intégrés en perinatalité et pour la petite enfance SQCC Service Quality and Complaints Commissioner SRP Strategic Regional Plan STI Sexually Transmitted Infection UQAT Université du Québec en Abitibi-Témiscamingue YCJA Youth Criminal Justice Act YHS Youth Healing Services YP Youth Protection ᐃᐦᑖᐎᓐ ᒥᔪᐱᒫᑎᓰᐎᑭᒥᒄᐦ ᐃᐦᑖᐎᓐ ᒥᔪᐱᒪᑎᓰᐎᓐᑭᒥᒄ ᒥᓯᓂᐦᐄᒑᐅᑭᒥᒄ REGIONAL SERVICES COMMUNITY MIYUPIMAATISIIUN Regional Administration CENTRES (CMCS) PO Box 250 Chisasibi, QC J0M 1E0 ᒋᓵᓰᐲ Chisasibi CMC T 819-855-2744 | F 819-855-2098 21 Maamuu Meskino Complaints 1-866-923-2624 Chisasibi, QC J0M 1E0 819-855-2844 Chisasibi Hospital 21 Maamuu Meskino ᐄᔅᒣᐃᓐ Eastmain CMC Chisasibi, QC J0M 1E0 143 Nouchimi Street 819-855-2844 Eastmain, QC J0M 1W0 819-977-0241 Recruitment Centre 1055 René Lévesque Boulevard East ᒥᔅᑎᓯᓃ Mistissini CMC 7th floor 302 Queen Street Montreal, QC H2L 4S5 Mistissini, QC G0W 1C0 1-877-562-2733 418-923-3376 [email protected] ᓀᒥᔅᑳ Nemaska CMC Public Health Department 7 Lakeshore Road 168 Main Street Nemaska, QC J0Y 3B0 Mistissini, QC G0W 1C0 819- 673-2511 418-923-3355 Montreal 514-861-2352 ᐅᒉᐴᑯᒨ Oujé-Bougoumou CMC 68 Opataca Meskino Wiichihiituwin Oujé-Bougoumou, QC G0W 3C0 Chisasibi Hospital 418-745-3901 819-855-9019 c/o Centre de santé de Chibougamau ᐙᔅᑳᐦᐄᑲᓂᔥ Waskaganish CMC 51, 3e rue 2 Taktachun Meskaneu Chibougamau, QC G8P 1N1 Waskaganish, QC J0M 1R0 418-748-4450 819-895-8833 1055 René Lévesque Boulevard East ᐙᔅᐙᓂᐲ Waswanipi CMC 6th floor 1 West Aspen Montreal, QC H2L 4S5 Waswanipi, QC J0Y 3C0 514-989-1393 819-753-2511 c/o Hôpital de Val-d'Or ᐐ ᒥᓂᒌ 725, 6e rue Wemindji CMC Val-d'Or, QC J9P 3Y1 60 Maquatua Road 819-825-5818 Wemindji, QC J0M 1L0 819-978-0225 Youth Healing Services ᐙᐱᒫᑯᔥᑐᐃ Reception Centre Whapmagoostui CMC 282 Main Street Whapmaku Street Mistissini, QC G0W 1C0 Whapmagoostui, QC J0Y 1G0 418-923-3600 819-929-3307

Youth Protection Hotline 1-800-409-6884

COVID-19 Info-line 866-855-2811 Wiichihiiwaauwin Helpline 833-632-4357 (HELP) Cree Board of Health and Social Services of James Bay Box 250, Chisasibi, QC J0M 1E0 Robin's Nest Women's Shelter [email protected] | www.creehealth.org 855-753-2094 Follow @creehealth on Facebook, Instagram, Twitter and LinkedIn