2012 2013

ᓂᑐᑯᔭᓐ ᑲᔭ ᐎᒋᐦᐃ ᐙᐎᓐ ᐋᔑᑯᒻ ᐱᐳᓐᐦ ᑎᐹᒋᒨᓯᓂᐦᐄᑭᓐ ᐊᓇᓇᑲᒋᑕᑳᓂᐅᒡcree board of health and annual social services of james bay report

2012 ᓂᑐᑯᔭᓐ ᑲᔭ 2013 ᐎᒋᐦᐃ ᐙᐎᓐ ᐋᔑᑯᒻ ᐱᐳᓐᐦ ᑎᐹᒋᒨᓯᓂᐦᐄᑭᓐ ᐊᓇᓇᑲᒋᑕᑳᓂᐅᒡcree board of health and annual social services of james bay report Photo credits Cover by Vanessa Gervais Staff portraits by Harriet Petawabano Alexandre Claude — page 60 Gaston Cooper — page 78 Maggie Etapp — page 80 Vanessa Gervais — cover, pages 6, 9,15, 23, 25a, 35, 51, 65, 75, 81 Sam W. Gull — page 25c Carole Laforest — pages 29, 32 Mae Lafrance — pages 54, 63 Simon Leslie — pages 13, 25b, 68 Alison Scgott — page 25d Reggie Tomatuk — pages 17, 24, 64, 73

With the exception of all photographs, the information in this publication may be reproduced without charge or further permission, provided that the CBHSSJB is identified as the source. Download a copy at: creehealth.org

Editor — Katherine Morrow Copy Editor — Patrick McDonagh Layout & design — Alison Scott Design | Infographics — Tyrone Smith Data preparation — Martine Vaillancourt

Annual Report of the Cree Board of Health and Social Services of James Bay, 2012-2013 © 2013 CBHSSJB Box 250, Chisasibi, QC J0M 1E0

ISSN 1929-6983 (Print) ISSN 1929-6991 (Online) Legal deposit — 3rd trimester 2013 National Library of Canada Bibliothèque et Archives nationales du Québec, 2013 Table of contents

1 6 introduction about us

2 14 office of the chair & executive group

3 22 nishiiyuu miyupimaatisiiun group

4 26 miyupimaatisiiun group

5 52 pimuhteheu group

6 76 administrative resources group

7 82 annex financial statements 1 ᐋ ᑎᐹᒋᒥᑭᐎᔮᐦᒡ

introduction about us

6 About the CBHSSJB ᐋ ᑎᐹᒋᒥᑭᐎᔮᐦᒡ Founded in 1978, the Cree Board of In addition to CMCs, the CBHSSJB op- Health and Social Services of James Bay erates the 29-bed Chisasibi Regional (CBHSSJB) is responsible for the adminis- Hospital, three homes for youth at risk, tration of health and social services for a Regional Public Health Department all persons residing either permanently or and program planning unit, Cree Patient temporarily in Region 18, the administra- Services liaison offices in Chibougamau, tive region of the Ministry of Health and Val d’Or and Montreal, and a recruitment Social Services of Quebec corresponding office in Montreal. The Head Office is in to the Cree territory of James Bay. Our Chisasibi. mandate is defined in Chapter S-5 - An Act respecting health services and social The CBHSSJB is governed by a Board of services for Cree Native Persons. Directors whose Chairperson is Bella M. Petawabano. Advisory Committees and In each of the nine communities of Eeyou Councils report directly to the Office of Istchee, the CBHSSJB operates a Com- the Chairman, as do the Commissioner munity Miyupimaatisiiun Centre (CMC), of Complaints and Quality of Services which is similar to a CSSS elsewhere in and the Medical Examiner. The Executive Quebec. CMCs offer services in general Director is Mrs. Mabel Herodier. medicine, home care, dentistry, social services and allied­ health.

ᐙᐱᒫᑯᔥᑐᐃ 888 Whapmagoostui

Region 18 Communities ᒋᓵᓰᐲ jbnqa beneficiary Population July 2012 - 4,143 Chisasibi

ᐐᒥᓂᒌ 1,403 Wemindji

ᐄᔅᒣᐃᓐ 680 Eastmain

ᓀᒥᔅᑳ 722 Nemaska ᒥᔅᑎᓯᓃ 2,159 3,512 Mistissini

Waskaganish ᐅᒉᐴᑯᒨ Non-permanent ᐙᔅᑳᐦᐄᑲᓂᔥ 793 Oujé-Bougoumou residents make up an estimated additional 5% 1,710 Waswanipi of the regional ᐙᔅᐙᓂᐲ population. 7 CBHSSJB organigram

Council of Chishaayiyuu (elders)

Council of Physicians, Dentists and Pharmacists Board of Directors Office of the Chair Commissioner of Complaints and Quality of Services / Medical Examiner

Executive Direction

Nishiiyuu Administrative Miyupimaatisiiun Miyupimaatisiiun Pimuhteheu resources

Medical Affairs Public Health Human Resources and Services Information Departments of Program Planning Technology Medicine, Dentistry Professional & Pharmacy Material Resources Services and Hospital Services Quality Finance Assurance Youth Protection

Youth Healing Services Cree Patient Services Cree Non-Insured Health Benefits

Community Miyupimaatisiiun Centres (CMCs)

Chisasibi Waskaganish

Eastmain Waswanipi

Mistissini Wemindji

Nemaska Whapmagoostui

Oujé-Bougoumou 8 establishments REGIONAL SERVICES COMMUNITY MIYUPIMAATISIIUN Regional Administration CENTRES (CMCS) PO Box 250 Chisasibi CMC Chisasibi, QC J0M 1E0 Box 250 Phone 819-855-2744 Chisasibi, QC J0M 1E0 Fax 819-855-2098 Phone 819-855-9025 Complaints 1-866-923-2624 Eastmain CMC Chisasibi Regional Hospital Eastmain, QC J0M 1W0 Chisasibi, QC J0M 1E0 Phone 819-977-0241 819-855-2844 Mistissini CMC Recruitment Centre Mistissini, QC G0W 1C0 277 Duke Street Phone 418-923-3376 Montreal, QC H3C 2M2 Phone 1-877-562-2733 Nemaska CMC Email [email protected] Nemaska, QC J0Y 3B0 Phone 819-673-2511 Public Health Department 200 Sam Awashish Street Oujé-Bougoumou CMC Mistissini, QC G0W 1C0 PO Box 1170 Phone 418-923-3355 Oujé-Bougoumou, QC G0W 3C0 Montreal 514-861-2352 Phone 418-745-3901 Cree Patient Services Liaison Offices Waskaganish CMC CPS Chisasibi Hospital PO Box 390 Phone 819-855-9019 Waskaganish, QC J0M 1R0 c/o Centre de santé de Chibougamau Phone 819-895-8833 51, 3e Rue Chibougamau, QC G8P 1N1 Waswanipi CMC Phone 418-748-4450 Waswanipi, QC J0Y 3C0 Phone 819-753-2511 1610 Ste-Catherine West Suite 404 Wemindji CMC Montreal, QC H3H 2S2 Wemindji, QC J0M 1L0 Phone 514-989-1393 Phone 819-978-0225 c/o Hôpital de Val-d'Or 725, 6e Rue Whapmagoostui CMC Val-d'Or, QC J9P 3Y1 Whapmagoostui, QC J0Y 3C0 Phone 819-825-5818 Phone 819-929-3307 Youth Healing Services Youth Protection Hotline 1-800-409-6884 Reception Centre 139 Mistissini Boulevard Mistissini, QC G0W 1C0 Phone 418-923-3600 Upaahchikush Group Home Mistissini, QC G0W 1C0 Phone 418-923-2260 Weesapou Group Home Chisasibi, QC J0M 1E0 Phone 819-855-2681 9 message from the chair

It has been my privi- oversee. In this work we are inspired by lege to serve as Chair the model adopted by the Cree School of the Board of Directors of the CBHSSJB Board, but the two organizations are very since I was elected to this role by the different, and require different solutions. people of Eeyou Istchee in September 2012. We are lucky to have a group of In 2013-2014 the Commissioner of Com- committed, thoughtful people involved plaints and Quality of Services will tour in the governance of this organization, the Cree communities to explain her role and they have supported me whole- and listen to local concerns. I support her heartedly during my first year as their efforts to make the complaints process team leader. I thank them. more accessible to users.

The central platform of my campaign As part of our continuing effort to bring was to support sustained efforts to im- increased transparency to organization, prove the quality of services in our com- our new website, www.creehealth.org, munities. To do this, we need to give the was launched in December 2012. The Board the tools they need to ask the right site is one of the most important tools we questions. We must be open to feed- have to communicate with our clients back and criticism, so that we can learn and stakeholders about regional and to improve, and we must be transparent local services, health topics, and mat- and accountable to our stakeholders. ters of governance. The site contains information about the Board of Directors, One of the major challenges of my ten- including audio recordings, in the Cree ure will be to review and propose chang- language, summarizing the outcomes of es to the Quebec legislation that governs Board meetings. our work at the CBHSSJB. In particular, Bill S-5 requires comprehensive updating to Finally, I wish to welcome three new bring it into line with changes to the main members to our Board this year: Patricia Quebec health law, known as S-4.2. This George of Whapmagoostui, George L. work is sensitive and complex, and to en- Pachanos of Chisasibi and Lisa Shecapio able our Board members to participate of Oujé-Bougoumou. Remember, your meaningfully in the process, I have initi- elected community representative is ated an in-depth orientation program for there to listen to your concerns and sug- Board members on the legal and regu- gestions about health and social services latory framework for health and social provided by your Cree Heath Board. services in our region and in the province In speeches I gave this year at confer- as a whole. ences on health and healing, I spoke Another area we are working on as a repeatedly about Chiyaameihtamuun – team is an examination of governance living together in harmony, according to models – the rules that govern the scope our most cherished traditions. By striving and limits of our mandate as a Board of for excellence, the CBHSSJB can act as a Directors. It is my aim to put in place a pillar of strength and healing for the Cree governance model that will give a clear people. vision to the Board, and that will make the organization function better by clear- ly defining the areas that the Board must Bella M. Petawabano 10 message from the executive director

2012-2013 has been The changing political landscape of our a very significant year region raises some jurisdictional issues for for the CBHSSJB and the Crees of Eeyou the health services. The Agreement on Istchee. On July 20, 2012, a long process Governance in the Eeyou Istchee Territory of negotiation culminated in the signing of James Bay, signed between the Qué- of the new funding agreement for 2013- bec Government and the Grand Council 2018 with the Québec government. This of the Crees (Eeyou Istchee) on July 24, provides us with resources to implement 2012, calls for the creation of a new re- our Strategic Regional Plan. gional government to replace the Munici- palité de Baie-James, one that involves On September 26, 2012 the Cree people power-sharing between the Crees and elected a new Chair of the CBHSSJB, Bella the Jamésiens. M. Petawabano. I have been working closely with Bella since her election, and I I am involved in discussions with the Se- am confident that we can form a strong crétariat aux affaires autochtones regard- and productive team. Bella requires ing infrastructure necessary to support little orientation since she has worked expanded health facilities and associated for the Board for many years as Assis- housing, and we are seeking clarity on tant Director of Public Health for Awash responsibility for adapted transportation ­Miyupimaatisiiun. and first responders in the Cree territory of Eeyou Istchee, particularly in remote I offer my sincere thanks to the outgoing areas, where it imperative that there be Chair James Bobbish for his four years of adequate emergency medical response. service. He has left a lasting impact, par- ticularly in the area of customary adop- The budget envelopes for maintenance tion. James was instrumental in fighting for of assets, information technology and Bill 81, which outlines changes to the Civil housing remain to be negotiated with Code to harmonize provincial adoption the Ministry of Health and Social Services. legislation with Cree Aboriginal and treaty The Québec election on September 4 rights in relation to adoption matters. has given us a new set of partners in the National Assembly to work with on these New and expanded facilities are under issues. Key partners moving forward will be construction in many communities. I was Dr. Réjean Hébert, Minister of Health and pleased to oversee the official open- Social Services, Véronique Hivon, Minister ing of the Waswanipi CMC building for Social Services and Youth Protec- extension on January 18, 2013, and the tion, and Élizabeth Larouche, Minister for completion of the $29 million new Mistis- ­Aboriginal Affairs. sini CMC, which will be fully operational in June, 2013. New CMCs in Eastmain We have much to be proud of, and and Nemaska are nearing completion, much to celebrate, as we pass the and in the coming year we will break 35th Anniversary of the founding of the ground on a new Regional Administration ­CBHSSJB on April 20, 2013. I wish to thank Centre in Chisasibi and a new CMC for all the employees for their dedication and ­Waskaganish. hard work.

Mabel Herodier 11 population health overview The Cree Board of Health provides infections. While one young child in five is services to all people in the nine com- being raised in a lone-parent family, these munities within Health Region 18. This children are also most likely to be living in population is 95% Eeyouch (Cree), with three-generation households. non-Eeyou transient professional work- ers making up most of the other 5%. The 2006 census data shows that house- In mid 2012, the official population of holds are constituted of multiple families Cree Beneficiaries of the James Bay and at a much higher rate than in Quebec Northern Québec Agreement in Eeyou (16.6% vs 0.8%), that the number of per- Istchee was 16,010, with almost 60% liv- sons per room is also much higher (0.7 ing in the five coastal communities and vs 0.4), and that, even if the number of just over 40% in the four inland ones. rooms in a dwelling is about the same (6.0 vs 5.8), the number of rooms being used To 2012, the five-year average rate of as bedrooms is also higher (3.4 vs 2.5). growth of the beneficiary population was 2.15% per year. A baby boy born in Eeyou In surveys, Eeyouch report strong social Istchee between 2005 and 2009 is expect- supports and identify with their communi- ed to live 74.6 years, compared to 78.4 for ties, but they also express great concern boys in the rest of Quebec; for a girl baby, about social issues. In a 2006-2007 survey, life expectancy is 81.8 years, compared 44% of men and 50% of women reported to 83.1 years for girls in the rest of Quebec. having been physically abused in their From 1987-1991 to 2007-2011, the total lifetime, and 23% of men and 35% of fertility rate per woman in the region has women reported having been sexually remained almost double that of Quebec. abused. As well, just over 3% of all self- In 2011, there were 372 births. described gamblers meet the criteria to be classified as “problem” gamblers, Data for 2006-2007 to 2010-2011 for while close to 30% can be classified as caesarean sections suggest for the first moderate to high risk gamblers. time that rates in the region are slightly above the general Quebec rate (27.1% Youth and young adults up to age 29 vs 23.1%). Eeyou Istchee compares well continue to show very high rates of sexu- to Quebec on almost all the indicators ally transmitted infections (STIs). These related to fetal growth retardation and rates tend to range between seven to prematurity. Unlike Quebec, the region eleven times higher than the rates in has few low-birth-weight infants and ­Quebec. many high-birth-weight ones (around Rates of hospitalisations are higher in 10% of births). Eeyou Istchee for almost all health condi- Almost one in five babies (17.5%) is born tions. Excluding hospitalisations for nor- to a mother under the age of twenty. mal pregnancy and childbirth, as well Between 2007 and 2011, there were an as those pertaining to factors to do with average of 70 births each year to teen- people in the system (e.g. waiting for age mothers; of these, 45%, or an aver- long-term care beds, etc), there were on age of 31 births, were to mothers aged 17 average 2,150 hospitalisations each year or younger. In the 2003 health survey, one over the five-year period from 2006-2007 in four younger mothers reported drinking to 2011-2012. Hospitalisations for injuries during her pregnancy, and this age group have been increasing, especially for also has high rates of sexually transmitted “intentional”­ injuries. 12 Hospitalisations for suicide attempts almost one in four individuals (24.1%) liv- and suicide ideation are ten times ing with diabetes was under forty years the rate for the rest of Quebec, but of age. At the end of 2011, more than a the rate of completed suicide is at or quarter of all patients (26.3%) had been even slightly below the Quebec aver- diagnosed with diabetes within the past age. Between 2007 and 2011, Eeyouch four years, and 56.1% had been diag- died from cancer (21.2% of all deaths), nosed in the past nine years. circulatory diseases (17.9%), and exter- Heart disease is also increasing among nal causes which were mainly due to Eeyouch, both those with and those injuries (16.1%). Infant mortality rates in without diabetes. This increase is not sur- Eeyou Istchee have fallen from 50 per prising since the lifestyle risks for diabetes 1,000 live births in 1976 to nine per 1,000 are the same as those for heart disease in the 2000–2009 period, but this rate is and cancer: poor diet, lack of a physi- still double that of the rest of Quebec. cally active lifestyle, smoking, and obe- Some of these deaths are from an incur- sity. The statistics for diabetes show the able genetic condition. importance of mobilizing the communi- In 1983, 2.4% of Eeyouch had diabetes, ties to halt or slow the diabetes epidem- but by 2011 this rate had increased to ic, which would also have an impact on 22.1%, or 2096 individuals. In 2009, this the heart disease epidemic and would rate was already 3.3 times higher than help to slow the rise of colorectal can- the rate in Quebec. Since 1983, the cer in men. However, the poor diet and number of new cases has doubled every sedentary lifestyles of youth may be decade. In 2009-2011, 337 Eeyouch were the hidden time bomb. Overall, it is not newly diagnosed with diabetes, which clear how the health care system will be now affects more than one adult in five. able to manage the growing numbers of people with serious chronic diseases, Eeyouch are also being diagnosed and these trends in chronic diseases are at younger ages, which puts them at unlikely to change unless the underlying greater risk of eventually developing social issues are first addressed. complications from diabetes. In 2011, Prepared by Public Health Department

13 2 ᑳ ᐱᒥᐱᔨᐦᑖᑦ

office of the chair & executive group

Council of Chishaayiyuu (elders)

Council of Physicians, Dentists and Pharmacists Board of Directors Office of the Chair Commissioner of Complaints and Quality of Services / Medical Examiner

Executive Direction

14Nishiiyuu Administrative Miyupimaatisiiun Miyupimaatisiiun Pimuhteheu Services

Medical Affairs Public Health Finance and Services Departments of Program Planning Human Resources Medicine, Dentistry Information & Pharmacy Professional Services and Technology Hospital Services Quality Material Resources Assurance Youth Protection

Youth Healing Services Cree Patient Services Cree Non-Insured Health Benefits

Community Miyupimaatisiiun Centres (CMCs)

Chisasibi Waskaganish

Eastmain Waswanipi

Mistissini Wemindji

Nemaska Whapmagoostui

Oujé-Bougoumou Standing: Noah Coonishish, Lisa Shecapio, Patricia George, George L. Pachanos, Reggie Tomatuk. Seated: Angus Georgekish, Dr. Darlene Kitty, Bella M. Petawabano, Mabel Herodier, Jonathan Sutherland. Missing: Eva Louttit, Thomas Jolly, Shirley Diamond, Gloria Polson board of directors Regular meetings: 4 | Special meetings: 4 | Trainings: 3 ᑳ ᓃᑳᓂᐱᔥᑎᐦᒡ

MEMBERS April 1, 2012 – March 31, 2013 Clinical Staff Representative Chair and Cree Regional Authority Dr. Darlene Kitty ­Representative Bella M. Petawabano Non-Clinical Staff Representative Reggie Tomatuk Executive Director of the CBHSSJB Mabel Herodier Administrative Committee Bella Moses Petawabano Community Representatives Mabel Herodier Eva Louttit| Eastmain Dr. Darlene Kitty L. George Pachanos | Chisasibi Angus Georgekish Thomas Jolly| Nemaska (Vice-Chairman) Reggie Tomatuk Noah Coonishish| Mistissini Meetings: 10 Lisa Shecapio| Oujé-Bougoumou Shirley Hester Diamond| Waskaganish Audit Committee (appointed December 2012) Jonathan Sutherland| Waswanipi Thomas Jolly Patricia George| Whapmagoostui Patricia George Angus Georgekish| Wemindji Jonathan Sutherland Gloria Polson| Observer for Washaw-Sibi Meetings: 0

15 ᑳ ᐱᒥᐱᔨᐦᑖᒡ ᐋᐱᑎᓰᐎᓂᔨᐤ executive and senior management (Directors and above)

OFFICE OF THE CHAIR CMC DIRECTORS Bella M. Petawabano | Chair of the Board Jules Quachequan | Chisasibi of Directors Rita Gilpin | Eastmain Louise Valiquette | Commissioner of Annie Trapper | Mistissini ­Complaints (I) Beatrice Trapper | Nemaska Susan Mark | Oujé-Bougoumou EXECUTIVE DIRECTORATE Alan Moar | Waswanipi Mabel Herodier | Executive Director Bert Blackned | Waskaganish Laura Moses | Director of Corporate ­Services Greta Visitor | Wemindji Richard St-Jean | Assistant to Executive John George | Whapmagoostui Director PIMUHTEHEU GROUP NISHIIYUU MIYUPIMAATISIIUN GROUP Laura Bearskin | AED Sam W. Gull | Assistant Executive Director Vacant | DPSQA Psychosocial Adelina Feo | DPSQA Allied Health (I) MIYUPIMAATISIIUN GROUP Vacant | DPSQA Nursing Lisa Petagumskum | AED Vacant | Director of Planning and Programming Dr. Laurent Marcoux | Director of Medical Dr. Robert Carlin | Director of Public Health (I) Affairs and Services ASSISTANT DIRECTORS OF PUBLIC HEALTH Daniel St-Amour | Taria Coon | Awash (I), Uschiniichisuu Director of Hospital Services Paul Linton | Chishaayiyuu Robert Auclair | Director of Youth Jill Torrie | Surveillance, Evaluation, Research ­Protection (DYP) and Communications (SERC) Mary Bearskin | Assistant DYP Vacant | Assistant Director, YCJA and Foster Homes ADMINISTRATIVE RESOURCES Gordon Hudson | Director of Youth GROUP ­Healing Services Clarence Snowboy | AED Caroline Rosa | Director of Cree Patient Martin Meilleur | Director of Finance Services (CPS) Vacant | Assistant Director of Finance Gloria Ann Cozier | Assistant to Thérèse Lortie | Director of Human Resources (I) AED, Services Thomas Ro | Director of IT Resources Janie Moar | Assistant to AED, Operations Richard Hamel | Director of Material ­Resources (I)

(I) Interim AED – Assistant Executive Director CMC – Community Miyupimaatisiiun Centre DPSQA – Director of Professional Services and Quality Assurance DYP – Director of Youth Protection

16 ᑳ ᐱᒥᐱᔨᐦᑖᒡ ᐋᐱᑎᓰᐎᓂᔨᐤ

Standing: Robbie Dick, Elizabeth Dick, Nancy Danyluk, Earl Danyluk. Seated: Roderick Pachano, Robbie Matthew, Jane Kitchen, Abel Kitchen. Missing: Laurie Petawabano Council of ­Chishaayiyuu The Council of Chishaayiyuu­ (elders) provides guidance to the Board of Directors and the organization based on their knowledge of Cree history,­ values and traditional­ healing practices.­ ᑳ ᒫᒨᐱᒡ ᒋᔖᔨᔨᐅᒡ ᑳ ᒫᒨᐱᒡ ᒋᔖᔨᔨᐅᒡ ᒋᔅᒋᓄᐦᐅᒧᐙᐅᒡ ᑳ ᓃᑳᓂᔥᑭᒥᔨᒡᐦ ᓂᑐᐦᑯᔨᓐ ᐋᐱᑎᓰᐎᔨᐤ ᐅᐦᒋ ᐊᓂᔮ ᐅᒋᔅᒑᔨᐦᑎᒧᐎᓂᐙᐤ ᑳ ᐃᔅᐱᔨᔨᒡᐦ ᐙᔥᑭᒡ ᐄᔨᔨᐤᐦ, ᐃᔑᐦᑣᐎᓐᐦ ᑭᔮ ᐄᔨᔨᐤ ᐋᓂᔅᒑᐤ ᓂᑐᐦᑯᐦᐄᐙᐎᓐᐦ᙮

Bella Petawabano, Darlene Kitty, Board member Gloria Polson, Reggie Tomatuk, Laura Moses Journey of Nishiyuu, 2013

17 Complaints and Quality of Services­

COMMISSIONER OF COMPLAINTS Objectives for the coming year are to The Interim Commissioner of Com- work with the Board of Directors in the plaints and Quality of Services, Louise creation of a Watchdog Committee ­Valiquette, received eleven formal (Comité de vigilance), to conduct an complaints in 2012-2013, down slightly awareness raising tour of the Cree com- from 13 last year. Five of the complaints munities, and to examine the state of were received in the last quarter of the dialysis services in the region. year. An additional three complaints concerned the actions of physicians, MEDICAL EXAMINER dentists or pharmacists, and were there- The Medical Examiner, Dr. François fore referred to the Medical Examiner. Charette, addressed three complaints Nine complaints were referred to other this year. One complaint involved re- departments. lationships among the staff of a dental clinic. This was a complex issue pertain- Looking at the nature of the complaints, ing to work responsibilities, respecting one concerned access to services, one schedules, and accepting leadership. A concerned a breach of confidentiality, second complaint involved a request for two were related to financial issues, and dental care in Montreal because of the five had to do with the quality of care. perceived lack of expertise locally. The There have been many complaints Medical Examiner addressed the issue regarding Youth Protection in the past through emails with the patient explain- years. Most of these have now been re- ing the rules about financing care out- solved, but there is a systemic problem side the community, and discussed the that is being addressed through chang- quality concerns with the Head of Den- es within the Department, overseen by tistry. The last complaint concerned the the Board of Directors. working relationship between a replace- There is a need to explain to the popu- ment pharmacist and the local medical lation that there is a Commissioner of team in the community. Complaints and Quality of Services and In his report to the Board of Directors, what her role is. A community tour for the Medical Examiner concurred with that purpose will begin in summer 2013. the Commissioner of Complaints that The Commissioner participates in meet- there is a need to increase the visibility ings of the Table ministérielle des com- and understanding of the complaints missaires régionaux du Québec de la process in the region, both among pa- Direction de la Performance et de la tients as well as among the professionals.­ qualité du Ministère de la santé et des Services ­Sociaux.

complaints 1-866-923-2624 [email protected] 18 Council of Physicians, Dentists and Pharmacists

The Council of Physicians, Dentists and The Council and its obligatory commit- Pharmacists (CPDP) and the Executive tees continue to work on very important Committee for Region 18 have had an protocols and projects. The Pharmaco- interesting and productive year. We therapeutics Committee has developed have striven to help improve resources more medication protocols, including and services to the population while ad- those required for cardiac conditions, vocating for our patients, families and resuscitation and emergency proce- communities in Eeyou Istchee. The prior- dures. The Editorial Committee is con- ity of the CPDP is to ensure the quality of tinuing its work on the Ordonnances the medical, dental and pharmaceuti- Collectives, or collective prescriptions, in cal services and the competence of collaboration with other regions in north- its members, working with the Board of ern Quebec. The Materials Committee Directors and Administration of the Cree is working hard to standardize medical Health Board to address the outstanding equipment in Chisasibi Hospital and the issues on health services. villages, including that used in emer- gency situations. Given the concerns of For example, mental health issues are last year, the Pharmacy Department will more common than diabetes in Eeyou focus on recruiting new pharmacists to Istchee; they affect every person, ev- the region and improving services with ery family and every community. Yet support from the Order of Pharmacists the Territory lacked resources such as of Quebec. The Department of Den- psychiatric care and counselling of tistry continues to conduct its services various modalities. After raising this issue and public health initiatives well. As in and meeting to find solutions, the CPDP the past, the CPDP will assess and ana- physicians are collaborating to orga- lyze the quality and capacity of these nize and increase staffing and services services through intermittent formal or within the Regional Mental Health De- informal departmental evaluations. partment. Psychiatrists from the Douglas Hospital are more available on site or The primary objective of all these efforts by phone to assess, diagnose and treat is to provide and improve the medical, patients, and to provide advice to phy- dental and pharmaceutical care to sicians and nurses in the Territory. the patients on the Cree territory, while collaborating with the relevant depart- ments, the Director of Medical Services and Affairs, management, and the Board of Directors of the CBHSSJB.

Darlene Kitty, MD, CCFP President, CPDP Region 18

19 Active members of the CPDP DEPARTMENT OF MEDICINE DEPARTMENT OF DENTISTRY Dr. Raffi Adjemian Dr. Danie Bouchard Dr. Catherine Beauce Dr. Louise Desnoyers Dr. Roxanna Bellido Dr. Magalie Laurin Dr. Julian Carrasco Dr. Geneviève Gaumond Dr. Éric Contant Dr. Diane Leroux Dr. James Copley Dr. Audrey-Anne Mercier Dr. Gerald Dion Dr. Kim Chi Ngo Dr. Tinh Van Duong Dr. Lucie Papineau Dr. Eric Lee Dr. Stéphane Rousseau Dr. Toby Fainsilber Dr. Manon St-Pierre Dr. Barry Fine Dr. Catherine Sweeney Dr. Vanessa Gervais Dr. Philippe Wang Dr. Kavi Gosal DEPARTMENT OF PHARMACY Dr. Janique Harvey, psychiatrist Marc-André Coursol-Tellier Dr. Shelly Jiang Claudia Dutil Dr. Rosy Khurana François Lavoie Dr. Darlene Kitty Dr. Carole Laforest DEPARTMENT OF PUBLIC HEALTH Dr. Michael Lefson Dr. Anne Andermann Dr. Alexandra Orr Dr. Robert Carlin Dr. Guy Paquet Dr. David Dannenbaum Dr. Sylvie Pépin Dr. Kianoush Dehghani Dr. Danielle Perreault Dr. Félix Girard Dr. Hélène Perreault Dr. France Morin Dr. Olivier Sabella Dr. Elizabeth Robinson Dr. Adrien SelimCMDP Positions filled per community Dr. Claude Sirois, ophthalmologist Dr. Nadia Waterman 2012-2013 Dr. Grace Zoghbi

Full time Full time Full time equivalent recruitment equivalent recruitment equivalent recruitment in place Target in place Target in place Target Chisasibi 7.5 8 2 3 0 3 Eastmain 0 1 1 1 0 0 MISTISSINI 7.5 4 2 3 0 3 NemAska 0.5 0 1 1 0 0 Oujé-Bougoumou 0 1 2 2 0 0 Waskaganish 0 3.5 1 1 0 0 Waswanipi 1 2.5 1 1 0 0 Wemindji 1 1.5 1 1 0 0 WHAPMAGOOSTUI 1.5 0.5 0.5 1 0 0

Doctor Dentist Pharmacist

cpdp positions filled per community 2012 - 2013 20 Corporate Services

The Director of Corporate For 2013-14, Corporate Services will Services, Laura Moses, continue to support the governance re- acts as Corporate Secre- newal process and will also put in place tary to the Board and is responsible for a system to ensure that resolutions, the proper functioning of the Board of mandates, policies and procedures are Directors operations and meetings. The compiled in areas that will facilitate ac- Department acts as a bridge between cessibility to senior management and the Office of the Chairman and the their staff for follow-up and implemen- Office of the Executive Director. Corpo- tation. The hiring of a communication rate Services also oversees translation officer in 2013 will bring the Corporate and communication services for the Services team up to full capacity. ­organization.

With the election of Bella M. Petawa- bano as Chair last fall, the department was called upon to make adjustments to better assist the office of the Chair- person. The Department provided more support to the Board of Directors, as a new governance model is being de- veloped and implemented; training sessions on governance were delivered and will continue in the coming year. In order to meet all these requirements, additional resources were allocated to the Department.

One of the major achievements this year was the launching of the CBHSSJB corporate website in December 2012. Acknowledgements go to our website developer Fenix Solutions, to the Ad- visory Committee who oversaw and guided the work through weekly confer- ence calls; to all those who contributed towards the website and, most of all, to Katherine Morrow, Coordinator of Communications, whose expertise was ­invaluable throughout the process.

CBHSSJB corporate website www.creehealth.org

21 3 ᐊᓂᔒᔨᔨᐤ

Nishiiyuu Miyupimaatisiiun

group The Nishiiyuu Miyupimaatisiiun Group works to find ways of in- tegrating Cree healing traditions into the clinical and social servic- es provided by the CBHSSJB.

Sam W. Gull Assistant Executive Director

22 Mission NISHIIYUU STRATEGIC PLAN The Nishiiyuu Miyupimaatisiiun Group is In 2011, resources were identified for de- committed to transforming the way of velopment of a five-year Strategic Plan. life, health and wellness of Cree indi- So far, Nishiiyuu has identified the follow- viduals, families and communities. The ing strategic goals: group draws upon traditional knowl- 1. To support Cree elders and commu- edge and culture to enhance Miyupi- nity-delivered programs. maatisiiun in the Eeyou/Innu Nation. 2. To support community-based strate- Cree values and traditions have been gic plans, partnerships and collabo- envisaged as key to the development rations. of health and social service delivery systems in the JBNQA and in Orientation 3. To support Elders’ Councils to lead, 8 of the 2004 Strategic Regional Plan advise and direct land-based heal- of the CBHSSJB. In order to implement ing and birthing programs. this vision, the Nishiiyuu Miyupimaatisiiun Group works in close collaboration with 4. To partner with the Council of Ch- the Council of Chishaayiyuu – the elders ishaayiyuu of the CBHSSJB on the who guide the CBHSSJB. development of Nishiiyuu programs.

This past year the Nishiiyuu team has 5. To draft new legislation to govern the been developing a strategic plan and use of Cree medicine and healing pilot programs in several communities, approaches in the delivery of health with an emphasis on land-based heal- and social services. ing and rites of passage, especially The next step is to finalize the strategic birthing. It has expanded the team with plan and present the document to the the addition of two PPROs, Clara Coo- Executive and Board of the CBHSSJB in per and Charlie Louttit. the summer of 2013.

23 LAND BASED HEALING The Nishiiyuu Miyupimaatisiiun team, with Cree elders often say that “the land is the Council of Chishaayiyuu and other our teacher,” and that Cree knowledge stakeholders, conducted a fact-finding and culture comes from the land. Land- visit to aboriginal healing and wellness based activities like canoe brigades in centres in Ottawa, Six Nations, Oneida the summer and wellness journeys in the and Toronto. The tour focused on collab- winter are a feature of life in many Cree orative program delivery, healer protocols communities, and are a pathway for and policies, patient-centered delivery, spiritual and physical healing as well as client safety, traditional healing methods, for learning about Cree survival skills. The efficacy and patient satisfaction. Nishiiyuu Nishiiyuu Group is working with partners in will continue to collaborate with the Six several communities to create a working Nations Birthing Centre in Ontario.On the model of a land-based healing program last day of the study visit in Ottawa, the that could play a role in both addictions elders went to the Museum of Civiliza- treatment and culturally-based justice tion to see the Eastern James Bay Cree programs, and which could eventually Collection. The Council of Chishaayuu be scaled up. The intent is to find out handled and viewed over 80 objects what works at the local level, with the from the Museum’s collection, includ- acceptance of community partners, and ing clothing, tools, and other traditional to learn from these experiences in the objects. The elders where pleased to development of a regional program. note that many of the objects they saw are still being made and used every day RITES OF PASSAGE / BIRTHING in the Cree territory, demonstrating that The Nishiiyuu Group is exploring ways of in many respects, Cree traditional knowl- bringing Cree cultural knowledge to life edge is still thriving. events that have been largely medical- ized in recent years, such as the moment LOCAL NISHIIYUU PLANNING of birth. Today, Cree women give birth in The Strategic Plan aims to support lo- hospitals outside the Cree territory, usu- cal collaborations that use Cree cultural ally in Val d’Or, in contrast to their elders, approaches to bring about Miyupimaati- who gave birth on the land with the as- siiun. This year saw the beginning of pilot sistance of midwives. projects in four communities. Nishiiyuu began research and develop- ment for a pilot initiative where elders LIFE SKILLS TRAINING The Nishiiyuu Life Skills Training takes a will provide birthing advice to pregnant “train-the-trainer” approach that aims to mothers, fathers and families. This initia- instill in young people the knowledge of tive will utilize research from the Cree traditional ways of helping and healing birthing research and documentation so that they can then bring this knowl- initiative, which will eventually interview edge to their home communities. The elders in all 10 Cree communities. trainees receive teachings directly from In March 2013, Nishiiyuu held a two- members of the Council of Chishaayiyuu. day training session for researchers and Since 2012, 26 individuals have complet- videographers who will be using video to ed the Life Skills Training. In the final ses- document the traditional knowledge of sion, in February-March 2013, the newly Cree midwives in each community. The formed trainers developed their portfolios interviews and documentation will begin to enable them to deliver life skills training in 2013-2014. in the Cree communities.­ 24 CHISASIBI The Chisasibi Miyupimaatisiiun ­Committee has accepted a pilot proj- ect for land-based healing, which will be the main resource for designing and testing a land-based healing program that could be adopted in other com- munities. The experiences of the pilot program will provide the foundation for a video and a program manual.

MISTISSINI In Mistissini, George Blacksmith, PhD, is developing a five-year Traditional Medicine Strategic Plan. He is also assisting PPRO Charlie Louttit in the develop- ment of the regional land-based healing program.

WASWANIPI In Waswanipi, PPRO Clara Cooper worked ­closely with Abel Kitchen, a member of the Council of Chishaayiyuu, to develop a Nishiiyuu Health Plan for Waswanipi in collaboration with elders, community groups and local leadership. Among the activities were workshops on tradi- tional medicine for the local youth. This initiative was a success and some youth are now request- ing further land-based teachings.

WHAPMAGOOSTUI The Journey of Nishiiyuu began in Whapma- goostui and became a source of inspiration and hope for people around the world. The CBHSSJB’s Nishiiyuu Group aided the Nishiiyuu Journey walk- ers with support for their website and communi- cations needs, as well as direct support for the walkers themselves. Former Grand Chief Matthew Mukash used video and photographs to docu- ment the transfer of knowledge from Cree elders of Whapmagoostui to the youth involved in the Journey, and he is currently­ leading the develop- ment of a local Nishiiyuu­ plan in Whapmagoostui.­ 25 4

ᒥᔪᐱᒫᑎᓰᐎᓐ

Miyupimaatisiiun Miyupimaatisiiun means "being alive group well" - health in the broadest sense of the word. This is the largest Group in the CBHSSJB, encompassing regional health and social services, Chisasibi Regional Hospital, and the network of Community Miyupimaatisiiun Cen- tres (CMCs) in the nine communities of Eeyou Istchee.

Lisa Petagumskum Assistant Executive Director

26 Miyupimaatisiiun Doctors hold teleconferences monthly and meet face-to-face annually. These Medical Affairs meetings enable the team to stay cohe- and Services sive and well-informed, allowing doctors Departments of to discuss and decide together on issues Medicine, Dentistry & Pharmacy affecting the orientation of patient care. Hospital Services Although there is still a shortfall in the Youth Protection number of doctors working in Eeyou Ist- chee, several new physicians were hired Youth Healing Services this year. The recruitment committee is Cree Patient employing various strategies and tools to Services attract permanent doctors to the Cree Cree Non-Insured Territory, and is using the CBHSSJB web- Health Benefits site to support these efforts.

The department is also pursuing ongoing Community Miyupimaatisiiun Centres (CMCs) negotiations with the MSSS to increase the number of physicians allocated to the region, with the next meeting sched- Chisasibi Waskaganish uled for June 2013. Eastmain Waswanipi Department members are revising and Mistissini Wemindji updating the Therapeutic Guide, devel- Nemaska Whapmagoostui oping collective prescriptions in several Oujé-Bougoumou areas, and developing clinical protocols to standardize care across the nine com- munities. The Department is also work- MEDICAL AFFAIRS AND ing towards standardizing the medical ­SERVICES equipment used in every community. Regional Department of The department is contributing to the ­Medicine development of a mental health ac- Physicians working for the CBHSSJB are tion plan; this area has already seen organized into a Regional Department of a number of improvements, thanks to Medicine. The mandate of the depart- increased nursing resources. ment is to organize and coordinate med- In addition, department members are ical services, including chronic care and participating in developing telehealth mental health services. The focus is on capacity (with tele-ophthalmology be- the quality of patient care and the safety ing a priority), updating the Bush Kit, and of the patient. The Head of the Depart- exploring options for a virtual library for ment, Dr. Carole Laforest, maintains clinical workers. active links with Dr. Laurent Marcoux, the Director of Medical Affairs amd Services, There have been ongoing efforts to for- the Council of Physicians, Dentists and malize corridors of service with partner Pharmacists (CPDP), and the Executive institutions in other regions, and to bring and Board of the CBHSSJB. new specialized services to the Cree Territory.

27 Department of Dentistry for treatment in most clinics is satisfactory, Dental Services except for Chisasibi and Mistissini where number# of of consuconsultationsltations wait times exceed six months and emer- gency appointments remain the norm 2012-2013 % Change on a daily basis. The department is re- Chisasibi 4,644 -3% evaluating the schedule to provide equal Eastmain 951 194% access to the population and offer better MISTISSINI 2,840 20% services with the resources available. NEMASKA 475 -3% Oujé-Bougoumou 958 -11% The Dental Residency program was aban- Waskaganish 2,056 16% doned this year, mainly due to a lack of Waswanipi 1,212 42% funds to encourage dentists to participate Wemindji 1,702 119% and the need for the Cree Health Board WHAPMAGOOSTUI 1,185 57% and the universities to revise Total 16,023 21% administrative policy and procedures. dental services Most specialized dental increased 21% this year. of services were provided in 36% dental services The Dentistry Department’s mission is to Mistissini and Chisasibi. were for children provide quality general and specialized under 10. dental services throughout the territory. The James Bay Study Club continues its training activi- Over the past year, priorities have includ- ties, bringing peers together to ed reorganizing the Abeldent procedures share information and knowledge; this and developing an Abeldent training, past year it also invited dental hygienists primarily to keep statistics more effec- to participate. tively; the department has also finalized discussions on implementing the Care 4 Dentists continue to be involved in the software. Other priorities have included local management and training of staff identifying recommendations for an CNI- in their respective clinics. There is an effort HB dental section, putting in place a re- being made to delegate most of the cleri- gional administration officer for the dental cal duties to the secretary and support department, providing a departmental staff, thus relieving dentists to perform their proposition to the negotiation committee clinical duties. This major shift will have to meeting with the MSSS, and coordinat- be sustained by an organized training ing with general contractors and other program if the department is to achieve groups working on new CMC buildings. its goals of increasing productivity and ­accessibility. Between April 1st 2012 and March 31st 2013, the Dentistry Department staff Despite the hard work of the dental treated 16,023 patients, including 3,505 department, many challenges remain. children nine and under; 251chil- Efforts to extract dental statistics from Abeldent were hampered due to a dren were treated in Montreal un- There were der general anaesthesia. The loss lack of uniformity in the use of the 3113 no-shows software. Managing­ service deliv- of one dental treatment room in for dental ery according to the needs of the Mistissini in 2011 and the ab- appointments, up population, taking into account sence of a second permanent 13% from last dentist have greatly affected the year. the respective local demands, re- mains difficult, as does ensuring ef- services offered. The waiting time fective scheduling of appointments 28 and the subsequent attendance by patients at their appointments. We also experience chronic difficulties­ related to staff turnover, notably those related to predictable replacement coordina- tion and to providing sufficient train- ing; related challenges are posed by a chronic lack of recall list staff availability and of permanent resources allocated to the yearly training and support of all dental staff.

Priorities for 2013-2014 include continu- Dr Laurent Marcoux and Dr Carole Laforest ing the training of the secretaries in order ORGANIZATION OF SERVICES to transfer administrative responsibilities Since there are no commercial pharma- from professional to support staff, thus cies in Eeyou Istchee, all medications are freeing dentists to meet their clinical du- acquired and dispensed by pharmacy ties. In addition, the Dentistry Department services within the CBHSSJB. Doctors,­ will implement and support an increase as well as nurses trained under the rôle in specialized services, especially prosth- élargi, have the ability to prescribe medi- odontics services, and will aid efforts to cations. Two pharmacist positions exist implement a dental section for the Cree in Chisasibi, and two in Mistissini, to fill NIHB. Finally, the department plans to orders and coordinate distribution for the begin revising its Dentistry Policies and smaller communities, where medication Procedures manual, evaluate the resi- is dispensed by a Pharmacy Technician dency program, and review administra- working in the CMC. tive procedures and contracts. ACTIVITIES IN 2012-2013 Department of Pharmacy Under Dr. Marcoux’s leadership, the CB- HSSJB is implementing recommendations As the position of Head of Pharmacy is made by the Comité d’Inspection profes- currently vacant, Dr. Laurent Marcoux, sionnelle de l’Ordre des Pharmaciens du Director of Medical Affairs and Services, Québec to ensure the quality and safety has been fulfilling the role of Interim Head of pharmacy services in Region 18. Steps of Pharmacy in addition to performing his taken in the last year include restructuring regular duties. the workflow around filling prescriptions The department of Pharmacy ensures the and reorganizing the workspaces in the safe and effective supply and distribution pharmacy areas of the CMCs in order to of medication to meet patients’ needs make better use of the restricted space in Eeyou Istchee. The department’s em- and to enable the pharmacists to work ployees maintain inventories, verify pre- without interruptions. Recruitment, train- scriptions, prepare medications, and offer ing and supervision of Pharmacy Techni- professional advice as necessary. cians is an ongoing challenge. Following recommendations of the Order of Phar- macists, the CHBSSJB has revised the per- sonnel plan in Mistissini in order to attract and retain pharmacy staff.

29 PHARMACY PRIORITIES chronic care, and three for respite care. The main priority of the department is The Hemodialysis Unit has nine dialysis to complete a transition plan to satisfy stations, and there is a partial pre-dialysis the requirements of the Quebec Order program two days a week. of Pharmacists. The CBHSSJB must put in place regulations to ensure medications Chisasibi Hospital has a laboratory, a are acquired and distributed safely and radiology department, archives, a liaison in accordance with the standards set by department, physiotherapist and nutri- the profession in this province. tionist services, and a dental clinic.

Recruitment is an urgent issue for the The management team is led by Daniel ­department. A permanent Head of St-Amour; Annie Dumontier coordinates Pharmacy is essential to oversee imple- the Nursing Unit and Gary Chewanish mentation of the recommendations of coordinates the Hospital Administrative the Quebec Order of Pharmacists and to Units. The position of Clinical Services ensure sound management of pharmacy Coordinator has been vacant since services. At this time, there are no perma- ­December, 2012. nent pharmacists in the CBHSSJB. The task of constantly searching for personnel and REGIONAL SERVICES managing a rotating schedule of tempo- The hospital’s objective for this year has rary pharmacists is time-consuming and been to assume a greater regional role, takes energy from other clinical priorities. and as a result the team was involved in In addition, there is a high turnover of several key regional files. Pharmacy Technicians in the communi- The hospital led development of the ties, and the training of Pharmacy Assis- Cree Renal Care Program, which has tants is a constant preoccupation. as its objective to provide superior renal The organization must also put in place (kidney) care in the region. an efficient and secure electronic pre- The Risk Management Committee, scription system, and the Therapeutic established in 2011, ensures that all Guide must be updated to ensure that possible measures are in place to offer prescriptions conform to Quebec’s Law a secure environment to the users and 90. Finally, in the coming year the Mistis- personnel of the hospital. A risk assess- sini pharmacy will move to that commu- ment is now being planned for health nity’s new CMC building care procedures in all the communities within Eeyou Istchee.

Chisasibi Hospital­ The Medical Archives Department has The Chisasibi Hospital’s mission is to implemented a process to establish a provide quality primary and secondary Master Patient Index (MPI), giving each healthcare services to the population of user a unique file with a single identifica- Eeyou Istchee. The main clientele is from tion number. The MPI will ensure that a Chisasibi, but the hospital also receives patient is represented only once across patient transfers from other Cree com- all software systems, including the Labo- munities on the James Bay coast. ratory Information System, the Radiology Information System, and Medi-Patient. The medical team includes eleven full and part-time doctors and 27 registered nurses. The archivist is now visiting all the commu- The hospital has 29 beds, of which 17 are nities to begin integrating all CBHSSJB users for acute care (five paediatric), nine for within a unique regional index. 30 50% of Chisasibi Regional Hospital in the context of the hospital patients do 2011-2012 2012-2013 Indian Residential Schools Settlement not have a Admissions 602 615 valid ramq Agreement. However, Hospitalization Days 3,308 3,421 card.

Transfers to other health centres 175 184 50% of the individuals Deaths 10 19 using the hospital do not

Average stay in acute care (days) 5.8 6.1 have a valid health insur- Bed Occupation Rate 63% 63% ance card, making it difficult to keep Clinic Consultations 16,614 17,687 files updated. Specialist Consultations 1,141 1,078 Observation hours 2010 3,530 Significant effort has been dedicated to Radiology Technical Units 85,782 103,433 the improvement of internal and exter- Laboratory Tests* 257,425 204,219 nal quality processes. The process of Dialysis Treatments 2,894 2,894 exchanging laboratory tests results with

*Chisasibi Hospital RUIS McGill directly from the Laboratory performs laboratory Information System is almost completed. tests for other Cree communities as well as However, improved access to radiology Chisasibi. and transcription services remains a key factor in providing timely diagnostic sup- ADMINISTRATIVE UNIT port to our physicians. Three initiatives have been launched to increase quality and safety. NURSING UNIT To ensure that the hospital is meeting Updating medical equipment, restruc- MSSS housekeeping standards and best turing the medicine department, and practices, regular internal audits are implementing videoconference training now being conducted and the results were keys to the improvement of the reported to the Risk Management Com- nursing care provided by the Nursing mittee. Unit.

To prevent cross-contamination, meals The acquisition of five new blood pres- are now served in a specially designed sure machines has helped nurses evalu- trolley that includes temperature con- ate patient vitals more efficiently, and trols. the monitoring of cardiac patients has greatly improved since the ward re- To ensure emergency measures are in ceived five mobile cardiac monitors place, the Hospital Fire Plan has been linked to a central console. ­updated and all departments have re- ceived training. A major exercise is being The newest acquisition is a neonatal planned for the summer of 2013. resuscitation table and radiant warmer. This equipment has enabled the nursing CLINICAL SERVICES UNIT staff to cover a wide range of needs, A Medical File Committee was created from routine warming of the newborn, to standardize clients’ medical files and to the emergency respiratory interven- the information they contain, including tion sometimes needed in deliveries, to abbreviations. intensive phototherapy.

The Medical Archives Department has A “bubble team” concept has been seen a 116% increase in requests for implemented on the ward. This ap- medical files and a 58% increase in the proach consists of pairing a nurse to a number of photocopies made, mostly Cree beneficiary attendant. Thesystem ­ 31 has improved patient security and workload for YP workers this year is 58 safety and has promoted collaboration files per worker, based on 19 YP workers between staff. in the region. Of the 1103 cases retained this past year, almost 80% were related to Recruitment was difficult earlier in the negligence due to lifestyle factors, such year, and as a result, the nursing team as continuous alcohol and drug abuse by became unstable. A sustained effort the youth’s parents. There were 584 active was launched in January 2013 to recruit YP files, 17 files in the adoption stage, and nurses with specific skills needed on the 16 Young Offender files. There were 332 ward, the external clinic and the hae- Voluntary Measures signed and 173 Court modialysis unit. This effort was successful Ordered Measures in place, for a total of in stabilizing the team and is expected 505 measures.­ to improve staff retention. A number of projects are ongoing, in- cluding the development of a training Youth Protection­ program for foster home workers and amendments to protocols for handling The work carried out by the Youth Pro- child abuse and neglect. Work is ongoing tection Department (YPD) is directly to finalize an orientation package and a linked to the laws and provisions of the manual for foster home workers, a foster Youth Protection Act (YPA) and Youth parent orientation handbook, a recruit- Criminal Justice Act (YCJA). The YPD aims ing strategy for foster care, and a public to secure the safety and security of all awareness campaign for foster care. children under 18 years of age in Eeyou Istchee, with the ultimate goal in re-uniting A long-term plan is to have a certified ­children with their biological parents or pri- training program for all YP workers and mary caregivers. When this is not possible, front line staff, along with policies and various processes and services are put procedures and training for front-line in place to carry out legally mandated staff performing investigative interviews alternatives, always with the fundamental of children who disclose sexual abuse. principle of legally intervening to serve the In the Young Offenders Program, new best interest of children in Eeyou Istchee. legislation in the Youth Criminal Justice Act (YCJA) will require the training of the Young Offender workers in each The year 2012-2013 saw an increase in the ­community. reports of youth at risk received and those retained for follow-up intervention/orien- tation by the YPD. The regional average­ Reports to the DYP reports("signalement to the dyps") (“signalements”)

2012-2013 % Change

Reports received 1,540 26% Retained 1,103 25% % of reports retained 71.6% -1%

32 Youth drummers, Chisasibi The Youth Protection File Management client files in accordance to the legal System has been deployed within the ­requirements of the Youth Protection Act. YP Intake Services department. We are still in the process of implementing the Finally, the DYP has secured the services software in all communities. of the Akwesasne Youth Treatment Cen- ter to support its efforts to help youth YOUTH PROTECTION ACTION PLAN with alcohol and drug abuse issues improve their coping skills and make Responding to recommendations of the better life choices. Human Rights Commission, the DYP has developed a Youth Protection Action These service improvements are regu- Plan, created with the guidance of a larly updated in the YP Action Plan as consultant appointed by the MSSS, Gilles approved by the Board of Directors on Cloutier. The Action Plan will significantly July 22, 2012, and have been presented improve organizational structure, em- to the MSSS as well as to the Human ployee training, file management and in- Rights Commission. tervention, follow-up/orientation monitor- ing, regular supervision procedures, and intake tracking processes (signalement). Youth Healing Services In relation to this latter point, DYP has a The mission of Youth Healing Services new regional number (1-800-409-6884) (YHS) is to contribute to the protection for workers and any other person wishing and well being of youth through a pro- to report a situation concerning a child, gram of accountable care that provides along with dedicated cell phones and safety, security, and, most importantly, numbers for on-call local emergency treatment. We are committed to pro- workers in the communities. viding a compassionate and effective family-oriented program for youth who Employee training will be enhanced experience a wide scope of difficulties. through participation in the National Training Program (through the Associa- YHS operates Upaachikush Group Home tion des Centres Jeunesse du Quebec) in Mistissini and Weesapou Group Home and the MSSS-recognized CHARLIE Train- in Chisasibi. It also runs the Youth Healing ing. There will also be training sessions in Services Reception Centre in Mistissini. the Psycho Social Intervention of Families and a Transfer of Learning Process. CASE MANAGEMENT Youth Healing Services uses the Youth Lev- The DYP is still in the process of final- el of Service/Case Management Inven- izing a supervision protocol for workers, tory (YLS/CMI) structured tool to assess risks evaluation tools, amendments to exist- and needs for each youth, and links these ing Youth Protection policies and pro- factors with the development of a case cedures, and forms involved in plan to provide a safe, supportive place youth healing path plans where youth can experience new oppor- and life plans. The depart- tunities, overcome barriers, build positive ment is also developing the average relationships and develop confidence processes and recom- case load of a youth and life skills. Case plans are reviewed mendations for the file protection weekly during staff meetings under the su- management system, worker is pervision of the coordinator of resources, which will provide a 58 files. clinical advisor, group leader and child much-needed tracking care workers. The YLS/CMI case plan does and monitoring system for 33 not replace Case Conference Planning GROUP HOMES and Healing Path Plans, but offers a more The Weesapou and Upaachikush Group direct, detailed case plan designed spe- Homes aim to educate youth and to cifically for and with the individual youth ensure that their safety and security is to set goals while in placement. respected. Placements are referred from Youth Protection. Group home staff hold SCHOOLING weekly clinical meetings to update files The YHS Reception Centre has an in-unit on youth entering or already residing in teacher provided by the Cree School the homes, discussing approaches and Board (CSB) to support school re-integra- determining when to move on to the tion. Youth entering YHS tend to have next objective for each individual. gaps in their education. Presently, the CSB can only offer reading, writing and math A healing path plan must be devel- instruction, and while this program does oped for each youth. Further, all reports, not pass youth to the next grade level, whether for court, incidents, observations it does give them a greater opportunity or discharge, must be shared with Youth to succeed once they return to school. Protection, so it is essential that work- For the program to move from provid- ers know how to record an individual’s ing progress reports to awarding actual development. In addition, youth need grades recorded with the MELS, the CSB to have constructive contact with their would have to provide another teacher family members for the treatment to be to enable youth to follow the required successful. This contact also helps to im- courses for their grade level. prove social and emotional adjustment by strengthening the youth’s feelings of CIRCLE OF COURAGE AND connection to family and community. ­RESPONSE ABILITY PATHWAYS (RAP) YHS is adopting the Circle of Courage/ Response Ability Pathways models developed by Reclaiming Youth Inter- national. This strength-based model identifies the four universal needs of all children: Belonging, Mastery, Indepen- dence, and Generosity. Response Ability Pathways (RAP) uses the Circle of Cour- age for teaching skills to connect with youth in need, to clarify problems, and to restore bonds. youth youthin yhs in re yhssident residentialial fa facilitiescilities

2012-2013 % variation

weesapou group home, chisasibi 21 -67%

reception centre, misitissini 69 -52%

upaachikush group home, misitissini 26 -66% total 116 -59%

Note: the decline is due to a change of approach. YHS took in fewer youth for longer stays compared to previous years. 34 BUSH PROGRAM STAFFING YHS has many approaches in helping YHS has 71 employees, including two very high risk youth who are struggling clinical advisors (inland & coastal), 36 with addictions and AWOL behaviour; childcare workers, 14 guards and two however, Cree Traditional Therapy in a full-time security guards, an activity bush environment is the most effective. team leader for the Bush Program, and four Bush Program childcare workers. The Bush Program offers a holistic land- based program with camps for both This past fiscal year YHS had 25 long- inland and coastal communities. The term sick leaves and 11 resignations. program staff for each camp have experience and knowledge in teaching YHS has developed an orientation manual hunting and trapping skills. Presently, the for new employees, which will also serve as program operates two bush camps, one a tool to remind existing staff of the neces- at LG2 and the other near Mistissini; both sary procedures. Priorities for the coming camps are used each year. The program year are to fill all the vacant positions and is also run across the nine Cree communi- to provide ongoing staff training. ties. Cree Elders are invited to participate in guiding the program’s development and delivering traditional knowledge.

35 Regional Special Needs prevention of FASD a priority. The resolu- Services tion further recommended that entities work in collaboration with one another The mission of the Regional Special to reduce the prevalence of FASD; that Needs Services (RSNS) is to support indi- they provide services raising awareness viduals who require assistance to meet of the effects of prenatal exposure to their basic needs due to a long-term, alcohol; that they help increase compas- chronic condition that affects their sion for individuals affected by prenatal capacity to achieve their full potential exposure to alcohol; and that they work intellectually, physically, cognitively and/ together to minimize further effects of or socio-emotionally. We encourage and FASD and ensure healthier communities. help local CMCs and other agencies in using a family-centered, community- In January 2013, the RSNS team orga- based, multi-disciplinary approach to de- nized a three-day FASD Action Forum liver services to clients with special needs. in Montreal. The event united over one hundred health care workers (including We are actively involved in the Cree physicians, nurses, and community health Regional Advisory Committee for Special representatives), social workers, educa- Needs, which aims to provide support tors, and representatives of other com- and direction for agencies and organiza- munity support services to generate ideas tions involved in the delivery of services around how to address the challenges to the special needs population. posed by FASD. The first day focused on In 2012-2013, RSNS consisted of a full-time sharing information about FASD, with the coordinator, a family/community support most compelling stories coming through worker, and a part-time clinical support testimonials from youth and families living worker. Our family support worker acts as a with FASD, whose presentations provided liaison, linking families to community ser- participants with insight into what it is like vices. Our clinical support worker provides to live with this disability. During the sec- support to the professionals working with ond day, workshops focused on different the clients with special needs. strategies that educators, social workers, health care workers, and others can use Working with the local CMCs, this team to educate young people to avoid FASD of two and a half was involved in forty- and to support those who are already five cases involving multi-disciplinary case affected by FASD. On the final day, each management; the team also supported of the nine Cree communities developed eighteen individuals who are living outside action plans for raising awareness about of their communities due to the complex- FASD prevention and support. These ac- ity of their needs. tion plans are already taking shape as short- and long-term FASD prevention and FASD support plans in the communities, and Our main focus during the 2012- 2013 range from the development of educa- fiscal year was on Fetal Alcohol Spec- tional activities for schools to information- trum Disorder (FASD). In August 2012, a sharing collaborations with the Youth presentation to the Grand Council of Council, radio broadcasts, and annual the Cree (Eeyou Istchee/Cree Regional FASD Awareness campaigns. Authority) at their Annual General As- sembly in Waskaganish led to the signing At the regional level RSNS is develop- of a resolution recommending that all ing plans for the Mobile FASD diagnostic Cree entities of Eeyou Istchee make the clinic, with operations expected to start in 36 Reasons for Medical Evacuation 2012-2013

the next fiscal year. This will be a ground- breaking initiative for the Cree, since it 7% reasons for Emergency will be the first diagnostic clinic in the travel ­province of Quebec. 2012-2013 RSNS has also been working on plans for a Regional Residential/Respite Care Facility for Cree children and youth with special needs. This facility, to be opened 93% in Chisasibi in April 2014, will become the Scheduled Appointment central point for a range of direct care and outreach services and for the devel- opment and formalization of collabora- tions between various service providers. It will begin to address the overwhelming The three CPS locations outside Eeyou needs of individuals with special needs, Istchee have a total of 60 full-time and 9 their families, and those mandated to part-time employees. support them, with the main focus being on respite care for the families. Since January 2013, CPS Chibougamau has established a positive cooperative relationship with Centre Régional de Santé et Services Sociaux in Chibouga- Cree Patient Services mau. CPS management feels that there When patients are referred by CBHSSJB is now an openness toward our clients physicians for treatment outside Eeyou that had been missing in the past. Istchee, Cree Patient Services (CPS) co- ordinates and organises the necessary CPS Montreal, situated at the Faubourg ­accommodations, transportations and in downtown Montreal, continues to face medical appointments. The CPS’s phi- difficulties in recruiting employees, and losophy is based on the ideals of respect used the services of five agency nurses and equality for everyone. for a total of 5717 hours (the equivalent of three full-time positions). CPS Montreal cree patientnumber Ser ofvice tripss is still in the process of expanding to ac- # of patient transfer2012-2013s commodate services to our clientele.

2012-2013 % Change CPS Val d’Or, situated in the Hôpital de Val-d’Or, is alsoNu mberfinding of recruitment trips outside of the Chisasibi 3,935 16% qualified employeesRe gionto be hanchallengdled- by CPS, Eastmain 1,073 38% regional total MISTISSINI 7,635 12% 2012-2013 NEMASKA 1,026 11% number of trips Oujé-Boug. 1,129 0.4% handled Waskaganish 2,004 29% by cps Waswanipi 3,472 21% regional Wemindji 1,606 21% 6,342 total Escorts WHAPMAGOOSTUI 1,237 8% 2012-2013 Total 23,117 16% 16,775 Clients

37 ing, and drew upon the services of one Cree Non-Insured Health agency nurse for the equivalent of one Benefits Program (CNIHB) full-time position. Another major chal- CNIHB helps members of the Cree lenge in Val d’Or is to accommodate communities of Eeyou Istchee access clients’ adapted transportation needs. the additional health benefits they are The Care 4 software implementation pro- entitled to under the James Bay and gram is in its second year, with the third Northern Quebec Agreement. These and final planned development ending include: prescription drugs, medical in April 2013. During the next year, the supplies and equipment, hearing aids, CMCs will be able to view and add to client transportation for health reasons, the Care4 data. vision care services, dental care, includ- ing orthodontics, emergency/short-term In the coming year, priorities include mental health services and repatriation working with the CNIHB Coordinator to of the deceased. create and distribute brochures on CNIHB policies and to promote these policies by The total expenditures under this pro- visiting each community’s CMC and First gram were $39.6 million in 2012-2013, Nation office. up 6% overall from last year. The largest components were drug reimbursements number of arrivals in cps ($7.7 million, up 17%) and dental ser- liaison offices vices (almost $3.4 million, up 40% from 2011-2012). Spending on contracted (clients + escorts) services increased 76% to $698,456, and 2012-2013 spending on walkers, wheelchairs and similar equipment, as well as artificial limbs, increased 52% to $152,659. 8,312 Chibougamau In 2012-2013, software was implemented 11% 6,027 Montreal in all the CMCs to decentralize service 12% authorizations. The revision of the CNIHB policies is still ongoing, as is the plan to move the program from Administra- tive Resources to the Miyupimaatisiiun Total 23,117 7,897 14% Group. To help beneficiaries understand 881 Val d’Or and access the benefits, CNIHB added Chisasibi 15% an information page to the website 137% www.creehealth.org. Next year, the program will organize an awareness

Note: large increase in Chisasibi is due to an increase raising tour of communities and post- in the number of escorts compared to last year secondary institutions attended by Cree beneficiaries.

For information: http://creehealth.org/ services/cree-non-insured-health-bene- fits-cnihb

38 Community to maintain the level of services that was necessary. A Chishaayiyuu nurse was Miyupimaatisiiun hired and two clinical rooms were cre- ated to meet the clinical needs of this Centres clientele. The Administration Department (CMCs) hired two new administrative technicians in Human Resources and Finance. Our challenge remains to acquire the office space to hire more staff.

Our priorities for next year include hiring Chisasibi interim managers to replace those who Population 4,143 are on leave. In the Awash, Uschiniich- # Consultations isuu and Chishaayiyuu Units, we will hire professional and paraprofessional staff to Walk-In Clinic 17,687 start developing, implementing and ap- Dentist 4,644 plying each department’s programming. Spespecialiscialist (Int Hospit(in hospitalal)) 1,078 By summer, we will regain the building *Community Health 12,785 that housed Chishaayiyuu and Admin- istration staff, giving us much-needed Note: Specialist includes pediatrician, psychiatrist, eye space. doctor (opthalmologist or optometrist), and ear nose and throat (ENT) doctor. AWASH Awash continued to provide clinical services and address other needs of its In Chisasibi many services are provided at the hospital, so statistics vary from other communities. See Chisasibi target population. This year, Chisasibi had Hospital statistics earlier in this chapter. 108 births, and CHRs, often working in col- laboration with the Uschiniichisuu nutri- The Chisasibi CMC has encountered tionist, were active in providing outreach many challenges since its November activities such as baby food workshops 2011 relocation. The physical reloca- and breastfeeding support groups. CHRs tion of psychosocial services and clini- were also included in the psychosocial cal services had a tremendous impact training that was provided for frontline on the staff, especially concerning the workers to help them adopt a holistic ap- delivery of services, as the distance of proach in addressing the needs of Awash services led to loss some of clients. Em- clients. Our focus remains on implement- ployees also had to make many adjust- ing Awash programming and developing ments to meet the needs of the clients, more services for 2013. which created stress on our frontline staff. The Awash team continued to provide health care services to the Chishaayiyuu USCHINIICHISUU population, although it was impossible Despite the challenges faced by the Uschiniichisuu Unit, it maintained psycho- social, nutritional and clinical services for its target population. The main priority this *Editor’s Note: Community Health includes visits to Awash, year is to continue to develop the clini- Uschinichisuu and Chishaayiyuu clinics. Consultation may be with a nurse, Community Health Representative cal sector of the services by hiring more (CHR), social worker or other caregiver and includes telephone consultations and support groups. This year, nurses and CHRs; the unit also hired an CMCs defined and measured consultations differently, so Attendant in a Northern Establishment to the totals for community heath should not be compared or correlated with the population. assist with Mental Health Services. Since 39 October 2012 there have been numer- of patience, team work and understand- ous training sessions for frontline staff, ing from all employees. The department enabling them to gain the psychosocial is anticipating that the move back into and clinical tools to maintain best prac- the main building will allow it to further tices; the delivery of services has been develop its services. maintained during these periods by replacement workers. Eastmain CHISHAAYIYUU Population 680 The MSDC’s clientele attendance has remained steady and the MSDC is plan- ning to create more outdoor activities # Consultations this year. In terms of mental health ser- doctor 591 vices, the psychiatrist visits are now on nurse (walk-in) 11,908 a regular schedule, and the CMC plans to recruit a Mental Health Nurse and Specialist (In Hospitdentisalt) 951 a Mental Health Social Worker to help specialist doctor 206 provide fuller services. Rehabilitation ser- Community Health9,916 vices continues with its challenges, which Note: Specialist includes include a lack of office space that limits pediatrician, psychiatrist, eye the services that can be offered, espe- doctor (opthalmologist or optometrist), and ear nose cially for the clinical management team. and throat (ENT) doctor. Chishaayiyuu is in the process of moving back to the Social Services trailer from the Community Health trailer. The Interim Coordinator of Chishaayiyuu left in the CURRENT SERVICES AND spring of 2012, so Chisasibi was without a ­CHISHAAYIYUU Chishaayiyuu manager throughout the Eastmain’s Current Services and Ch- 2012-2013 year. ishaayiyuu Unit has four nurses whose main responsibilities involve providing ADMINISTRATION acute care, carrying out follow-ups, per- The Administration Unit has grown this forming blood tests, changing dressings past year, welcoming new staff mem- and refilling medications. Challenges bers to the team. As of April 1st 2012, all include addressing suicides and suicide purchasing orders have gone digital with attempts; in addition, the team is seeing the use of Virtuo – one of many steps an increase in complications from dia- taken to digitalize work orders and mini- betes, hypertension, and cardiac­ cases mize paper work for employees. Statisti- over years past. cal tools have also been developed, One of the main priorities is to help facilitating the year-end calculations for diabetes and hypertension patients to front-line workers. In collaboration with make healthy choices in terms of diet Material Resources, the maintenance and lifestyle. While we had a change team is now trained to work with a new in our regular doctor this past year, our software, allowing the team to focus on replacement doctor, who has since be- preventive maintenance. Over the past come a regular, has supported our abil- year and more, the CMC has been very ity to provide necessary medical care. well managed and has coped effec- tively with its ongoing office space issues. The Current Services and Chishaayiyuu Still, this effort has required a great deal team members have worked together 40 and with the other teams in our CMC to Mistissini find solutions to the challenges facing Population 3,512 effective service provision. Our team’s priority is to work with all available re- sources to provide the best care pos- # Consultations sible for the community of Eastmain. doctor 4,338

nurse (walk-in) 23,176 AWASH AND USCHINIICHISUU Specialist (In Hospital) 2,840 Eastmain’s Awash and Uschiniichisuu Unit dentist is committed to providing the best care specialist doctor 280 for our community’s babies, children, Community Health 832 and youth. The unit consists of two full- Note: Specialist includes time Awash nurses, a community worker pediatrician, psychiatrist, eye and an NNADAP worker. Other positions doctor (opthalmologist or optometrist), and ear nose should be filled within the year. and throat (ENT) doctor.

This year twenty babies were born in East- main. The Awash team provides pre-natal PRIORITIES programming as well as healthy baby For the past year the Mistissini CMC has clinics, baby and mother clinics, immu- concentrated on improving the quality nization services, post-partum support, of services to the community. It has also one-on-one counseling and support, assis- increased the quantity of services by tance to those needing access to treat- hiring more Community Health person- ment programs, support to special needs nel. The new CMC building will also help clientele, and school outreach visits. The raise the quality and quantity of care. team collaborates with other CMC units There are a number of priorities for the to ensure the best care for our community coming year: completing the transition members and also works with local enti- into the new CMC building; planning ties to address current issues. and implementing services for the new The team has seen an increase in young Radiology, Laboratory & Hemodialysis pregnancies and young parenting. In units; completing the implementation addition, drug and alcohol abuse contin- of the organizational chart for Mistissini; ues to be a factor in family issues. Suicide implementing a maintenance of assets ideations among youth remain prevalent, program; and continuing training on and last year the “choking game” was a Integrated Services. specific concern. Finally, addressing prob- lems of childhood obesity, high blood CURRENT SERVICES pressure and cholesterol, and pre-diabe- During the last year Current Services was tes and gestational diabetes mellitus with involved in 24,732 interventions. Posi- pregnant women has become a priority. tions filled include the assistant head nurse for the Hemodialysis Unit and the These issues will be addressed by the technical coordinator for the Laboratory team in the coming year through pro- Unit. The team is preparing for the transi- grams and services promoting fitness and tion from the old clinic to the new one, healthy lifestyles. These will include sessions while ensuring that appropriate services on healthy cooking and eating, healthy to the community are maintained. The relationships, and STIs, and will involve opening hours of the present clinic were school and home visits, workshops, and extended from 8am to 5pm, which has other tools. been much appreciated. The number 41 of medical personnel for Mistissini has Objectives for the coming year include also increased to meet the growing hosting a parenting skills workshop, car- needs of the community and to improve rying out developmental screening, and quality of care. offering prenatal classes.

AWASH USCHINIICHISUU There were 67 births in Mistissini this past The Uschinichisuu Unit continues to de- year: 29 boys and 38 girls. The Awash velop and provide projects and activi- Unit aims to improve the quality of life ties at the school and community level, for these infants, and all of the commu- with the aim of promoting health and nity’s other children and young families, well being, raising awareness for the through individual, group and commu- prevention of diabetes, STIs, and obesi- nity efforts that address the medical, ty, and addressing related health issues. social, environmental and cultural issues Uschinichisuu also initiated school-based affecting health. projects that included families in order to help promote healthy lifestyles for The unit’s initiatives require continu- children, and it continues to work closely ous monitoring to assess their efficacy with teachers to support the Chii keyah and, when necessary, adjust strate- program on healthy sexuality and re- gies. A three-phase evaluation of the lationships. This year, the Uschinichisuu implementation process of the  Mash- team worked with Voyageur Memorial kûpimâtsît Awash program is now in School, Mistissini Youth Department,­ and progress: phase one was completed the Community Wellness Division of the in the summer and fall of 2012 with the Cree Nation of Mistissini to implement a review of 147 files; phase two involved “Breakfast for Learning” program at the staff interviews and phase three will in- elementary school. volve interviews with families to discover if the program has met their needs. CHISHAAYIYUU The Awash team, working with the The Chishaayiyuu Unit’s Community Uschiniichisuu team, hosted a success- Health team improved collaborations ful vaccination and health education between the nurses and the CHRs by clinic at Voyageur Memorial School in establishing priorities and revising tools. June which will be repeated next year. In Social Services, the process of chang- Breastfeeding Week was held at the ing the social services files to medical Head Start facilities and the MSDC. file numbers is almost completed. Staff meetings brought together members of Awash community workers received the Social Services and Community Health National Training Program’s CHARLIE units in order to share information and training for social services frontline work- increase effectiveness. ers. Staff also benefited from a workshop on interdisciplinary approaches to pro- The Home and Community Care Pro- viding services. gram held regular multidisciplinary meetings and revised its policies and This year saw the creation of a differ- procedures. It also established an ongo- ent case registry for interveners and the ing collaboration with Elders Home staff updating of the prenatal pathway/as- in order to ensure more effective and sessment needs/prioritization grid cohesive services.

42 The MSDC program benefited from the Plan. Our working relationships with local hiring of the psychoeducator this past entities is getting stronger every year, year. In addition, the team completed and we will continue to build these its revision of care plans. ­connections.

ADMINISTRATION CURRENT AND CHISHAAYIYUU While this past year was challenging for This past year the Current Services and the administrative staff, renovations to Chishaayiyuu Unit was concerned with the new CMC building went very well transferring programs to the appropriate and the move to the new CMC is now age groups. on target. In other positive news, 95% of the CMC positions have been filled. The doctor increased his visits from 10- 12 to 15 days a month; we continue to provide medical services for the nearby Hydro camp, and last year saw a slight Nemaska increase in these clients. Population 722 The visiting dentist sees patients primarily # Consultations for emergency situations, and has little time remaining for prevention treat- doctor n/a ments. However, a dental hygienist visits nurse (walk-in) 8,445 from another community to work with Specialist (In Hospitdentisalt) 475 CHRs and the nutritionist on prevention specialist doctor 185 activities at the school and daycare, as well as within the community. Community Health 4,165

Note: Specialist includes We have maintained our relationship pediatrician, psychiatrist, eye with First Nation First Responders team doctor (opthalmologist or optometrist), and ear nose for ambulatory services in emergencies. and throat (ENT) doctor. This year the First Responders team was certified for defibrillation, and a refresher course has been implemented. This year much effort went into relo- cating to the new CMC building and The CHRs work closely with the nutritionist launching the age group programs in and the nursing team, and last year saw a their proper departments. New housing total of 1,515 clients, a significant increase facilities – a five-plex (transit) and a tri- over the 1,051 seen the previous year. The plex (permanent) – are in the final stage nutritionist serves clients in home care as of completion. However, we still face a well as in the clinic; this year’s activities in- challenge in filling vacant positions. cluded grocery tours, information booths, the “healthy snacks” campaign, and We officially moved into our new CMC various other prevention programs. The on August 20, 2012, and had a very community worker continues to do follow- successful open house for community ups and evaluates client progress. members two days later. The official Grand Opening is planned for July 2013. The Home and Community Care Pro- With all CMC services located in one gram had 13 regular and three temporary building, we now need to focus on inte- clients over the year. There was a notice- grated services and team building, and able increase in family participation this we must fill all positions so that we can year. The Multi Service Day Center had a fully implement the Strategic Regional total of 443 visits this past year. The kitchen 43 has not been operational, as it requires Chi kayeh program on sexual health is new propane and ventilation systems; in in its second year for secondary 4 and 5 the meantime, a teepee has been used students. for cooking. Two community workers and the Awash Staff training this past year included ses- CHR completed the CHARLIE Training for sions in CPR, diabetes, and case man- frontline social service workers to help agement. There was also CHARLIE Training them with intervention planning. for frontline social services staff, Virtuo and computer training, Combitube-Defibrilla- Goals for the coming year include in- tion/SADM-C, and the annual training ses- creasing the number of home visits, sion for nurses. The nursing team continues increasing the number of team meetings, to upgrade capacity through a monthly offering an exercise program for children teleconference with RUIS McGill. and pregnant women, and raising aware- ness of Cree Leukoencephalopathy and Most of last year’s objectives have been Cree Encephalitis. met, and this year’s focus will be on de- veloping action plans, providing training ADMINISTRATION and supporting employees to take full The move to the new CMC was a great advantage of this training, supporting challenge. The transition required effec- interdisciplinary team meetings, increas- tive teamwork so as not to disrupt ser- ing participation at the MSDC, and vices to the community. Regular meet- recruiting foster families. ings are still taking place with the project manager and CMC team. In addition, AWASH AND USCHINIICHISUU renovations to the transit unit and the Although the program is not fully staffed MSDC require immediate attention. (five positions remain to be filled), this past year has been successful as the team This year saw an emphasis on staff train- continues to work toward integrated ing. Sessions were offered in Microsoft Of- services. Most of the relevant programs fice 2010 and Virtuo software programs, previously supported by Current Services project management, risk management, have been transferred to the Awash Unit. and hazardous materials management. Challenges include reducing absentee- Nemaska proudly welcomed thirty ba- ism, promoting punctuality, and finding bies this year. The Awash team regularly reliable replacements. The unit will be performs prenatal and postnatal home conducting workshops on these issues, visits, and Well Baby Clinics and follow-ups and plans to work with supervisors to find have been improved now that the team ways of improving employee morale. has its own area of the clinic. In April 2013 the Awash CHR began Nipissing Devel- opmental Screening at the daycare to identify developmental delays.

Activities and workshops aimed to edu- cate parents about breastfeeding, baby food preparation, nutrition and oral hygiene. The community workers met with the school’s head teacher and ran workshops with secondary students on the dangers of drug and alcohol use. The 44 Oujé-Bougoumou The MSDC, in operation since 2007, had Population 793 397 visits. Summer is busier as elders still living off the land are in the bush all win- ter and come to the community for the # Consultations summer months. Services are offered doctor 1,155 three days a week, and transportation is

nurse (walk-in) 6,164 provided for clients. Specialist (In Hospitdentisalt) 958 AWASH AND USCHINIICHISUU specialist doctor 62 The Awash and Uschiinichuu Unit has Community Health 1,593 been implemented progressively since

Note: Specialist includes 2009; the team consists of a nurse, a pediatrician, psychiatrist, eye CHR, a community worker (on a tempo- doctor (opthalmologist or optometrist), and ear nose rary basis), an NNADAP worker, and a and throat (ENT) doctor. community organizer. Still to be hired are social workers, a school health nurse, a second community worker and a sec- ond CHR. The coordinator is on maternity CURRENT SERVICES AND leave until January 2014. ­CHISHAAYIYUU Oujé-Bougoumou’s Current Services ADMINISTRATION and Chishaayiyuu Unit saw significantly Limited office space and lodging have more clients this past year, thanks to a meant that it has not been possible to steady flow of doctors to provide servic- hire any new staff, which is slowing the es. The optometrist did not visit this year, implementation of the Strategic Regional but most clients have regular visits with Plan. Restricted clinic space led to the an optometrist in nearby Chibougamau. Awash team moving into a trailer. The The unit has no social worker or occu- Administration Unit still has much to ac- pational and speech therapists due to a complish to make the Awash trailer fully lack of office and housing space. operational.

There were 94 medical evacuations this This spring a transit unit was transformed past year, and 551 clients were trans- to permanent housing. Oujé-Bougoumou ported on a twice-daily basis, five days now has three transits (six beds total) and a week. urgently needs more houses and transits The Chishaayiyuu Unit ran success- to accommodate employees and visit- ful vaccination campaigns as well as ing professionals. a women’s health program. The CHR Computer training for Microsoft Word, for Current Services has been active Excel, Power Point, and Lotus Notes took but the program had difficulty hiring a place in early 2013, with 22 employees community worker, as no community participating. members applied; eventually the posi- tion was filled by someone from another community, who travels to Oujé-Bou- goumou for work each day.

45 Waskaganish card on every visit to the clinic. Initially only 20-30% of the population was doing Population 2,159 so, but that number has since increased to 60-70% and is steadily improving. The # Consultations team will continue to request RAMQ doctor 2,142 cards with each visit, and will help

nurse (walk-in) 20,174 people to complete the forms or do whatever else is necessary for them to Specialist (In Hospitdentisalt) 2,056 acquire a RAMQ card. specialist doctor 606 Community Health8,477 The team plans to address the ongoing “no show” problem with clinic appoint- Note: Specialist includes pediatrician, psychiatrist, eye ments. While the “no show” incidence doctor (opthalmologist or for the regular clinic has decreased with optometrist), and ear nose and throat (ENT) doctor. the introduction of the “Bonjour Santé” software, the attendance rate to spe- cialty clinics has not changed. The team Few changes have occurred in our aims to raise the rate of attendance CMC in the past year, although we from 80% to 90-95%, especially for spe- have taken many steps to improve our cialty appointments in the south. services to the community. We com- menced staff training sessions in the AWASH AND USHCHINIICHISUU psycho-social field, and will develop Waskaganish welcomed fifty one ba- training in more areas in the coming bies this year. It is a blessing to have year. the babies and mothers come to the Obstacles to overcome include high Waskaganish clinic to be greeted by staff turnover and difficulties in recruiting one of two Awash nurses or one of three recall workers. In addition, our buildings, Awash CHRs, who support mothers to new and old, have some deficiencies, breastfeed their babies and get them and maintenance is working diligently vaccinated, who assist bonding be- to make necessary corrections. Finally, tween mother and child, and who help as we hire new staff, office and storage new parents adjust to a family lifestyle. space is becoming limited. We need Clients can also receive additional to define our immediate needs for the counseling from the Awash community proposed new CMC so that all services worker. can be housed under one roof. Training sessions this year focused on building supportive relationships with cli- CURRENT SERVICES ents, encouraging self care, and follow- The nursing team remains strong and ing legislated workplace procedures. stable with the normal staff turnover, maternity leaves and extended sick The team has identified a greater need leaves. However, Physician Services to support clientele through therapeu- has a number of uncovered days in the tic groups. As a result, it plans to create schedule. Current Services plans to re- groups focused on single parenting, self cruit replacement staff to fill the roster. help, breastfeeding, parenting skills, and attending to medical follow-ups. From August 2012 the Current Services team has been asking community members to present their RAMQ health 46 CHISHAAYIYUU Challenges have included shortages The Chishaayiyuu Unit has experienced of reliable recall workers and certified some personnel shuffles. The occupa- tradesman, as well as a lack of office, tional therapist has taken a one-year housing and storage space. leave of absence; a replacement has Certain facilities have also experienced been recruited from the recall list. A problems – some quite severe – that nutritionist and a psycho-educator have have included water leaks, furnace mal- recently been hired, and the physio- functions in older residential units, and therapist will be returning from maternity excess heat problems at the clinic. leave in May. Priorities are to attract recall workers The Home and Community Care Pro- more effectively and to obtain more gram will participate in a pilot project office and storage space. The depart- to institute a new policy and procedure ment is optimistic that the new CMC will manual and will implement a service accommodate all staff, health profes- delivery plan over the next few months. sionals and services under one roof. The long-time home care nurse is mov- ing to another Cree community, so the department will recruit for this position in the coming year. Waswanipi Population 1,710 There has also been a staffing change at the Multi-Service Day Centre, as the # Consultations long-time activity team leader left; the doctor 578 department was fortunate to hire a nurse (walk-in) 14,909 replacement quickly. The new activity team leader brings a new energy to the Specialist (In Hospitdentisalt) 1,212 position and has a very exciting agenda specialist doctor 112 for the coming year. Community Health6,248 Overall, the Chishaayiyuu team antici- Note: Specialist includes pediatrician, psychiatrist, eye pates the coming year to be a one of doctor (opthalmologist or growth, education, and miyupimaatiisuin. optometrist), and ear nose and throat (ENT) doctor. ADMINISTRATION This has been a challenging year in Was- The Administration Unit’s mandate is to wanipi because of the extension and provide support to the CMC and MSDC. renovation of the main clinic. We worked The unit has over 20 full and part-time very closely with the contractor through- staff. out the process, during which the Admin- Highlights this past year include the istration and Youth Protection teams were Crawl Space Project, overseen by Mate- relocated to a trailer. In September 2012, rial Resources. In addition, staff received all teams moved into the spacious new training on computers and on collecting CMC. Dentistry has a new modern clinic statistical information for the organiza- with a waiting room, while Youth Pro- tion’s records. The department is transi- tection has new offices in its sector and tioning to using a facility management awaits extra office space and renovations program. for its entrance. The open house for the new CMC was held on January 18, 2013, with the Executive Director present. 47 With staff now clustered according to their In collaboration with Cree Patient Ser- unit and programs, the process of imple- vices, the unit has started using the menting integrated services and programs “Care 4” software to book clients with has been made much easier. The com- outside health facilities. munity workers, managers, CHRs and so- cial workers received the National Training The unit continues its regular staff meet- Program’s CHARLIE training to help them ings with all human resource officers, deal with the psycho-social issues they social workers and community workers. face in their work. Our community orga- There have also been regular meet- nizer has been very busy with community ings on case reviews of active files. This health and social files and issues. group works closely with the local Youth Protection team and with the various Recruiting health and social services pro- Waswanipi First Nation social groups. fessionals remains a priority, as there is a significant rotation of professional health The MSDC has faced challenges this year, staff in all sectors. but continues to host regular activities and to provide clients with hot meals at noon. We continue to work closely with the Waswanipi First Nation organization, and AWASH AND USHINIICHISU have good relations with the CBHSSJB New permanent nurses have been hired community board member, the Chief for the Awash and Ushiniichisu Unit. As and the Council members. they are based within the clinic, they work closely with the Current and Ch- The main priority for the coming year ishaayiyuu Department’s programs and is to be involved in realizing the new services. Strategic Regional Plan. We plan to continue hiring professional staff and to The unit’s programs and projects include train them to ensure the highest qual- the Diabetes Prevention Walk, informa- ity of programs and services for the tion booths at community general as- community. Finally, we are planning an semblies, a sexual abuse working group, exterior renovation for our six-apartment a Youth Outreach worker program unit, and will update the maintenance (held twice a year), training sessions of assets file. for NNADAP workers, training in suicide prevention, CHARLIE training for frontline CURRENT SERVICES AND social service workers, and sessions in ­CHISHAAYIYUU FASD and Chiiwetau. Construction and renovation had a The CHRs continue to support pregnant major impact on the Unit’s services for women and mothers, children and this first half of the past year. However, families, and school programs. They also the new CMC offers appropriate exami- provide or support home visits, breast- nation rooms and equipment for the feeding programs, baby-food making medical staff, enhancing health care workshops, menu plans, well baby clinics, provision. sexual health presentations, vaccina- A psychologist, psychiatrist, pediatrician tions, the “Drop the Pop” campaign, and and ophthalmologist visit Waswanipi on awareness-raising efforts such as pam- a regular basis. However, the lack of a phlets and radio news shows. The CHRs nutritionist makes it difficult to follow up work closely with other health profession- on clients with diabetes. The number of als – especially the nutritionist, the nurses dialysis patients continues to increase. and the dental hygienist. 48 The community organizer helps teams Wemindji to work effectively with the community Population 1,403 and led the RAMQ health card cam- paign, which has seen a 33% increase in # Consultations card holders. The community organizer is also involved with the local Anti-Bullying doctor 1,631 Working Group, the Elders’ Abuse file, nurse (walk-in) 15,364 the local Suicide Prevention Team (linked Specialist (In Hospitdentisalt) 1,702 closely with the Come Unity Committee), specialist doctor 371 Addictions Awareness Week, Fetal Alco- Community Health8,279 hol Syndrome Disease (FASD) Week, and the follow-up of the Addictions Sympo- Note: Specialist includes pediatrician, psychiatrist, eye sium held in November 2012. doctor (opthalmologist or optometrist), and ear nose The school-based social worker works and throat (ENT) doctor. closely with students, teachers, parents and families. This service is much appre- ciated, demonstrating a need for addi- This past year’s focal point was capacity tional professional support at school. building, as many staff members par- ticipated in professional development ADMINISTRATION activities ranging from First Aid and CPR All employees have been hired in this training to management training to sector, and the Administration Unit is well educational sessions on FASD. Computer equipped with the new “ShoreTel” tele- training for all staff will begin this fall. phone system, computers for all staff, a The management team has been imple- security camera system and electronic menting measures to bring greater ac- doors with cards. The unit continues to countability within the organization. Ac- improve services in archiving, housekeep- tion plans are being developed. Monthly ing, maintenance, administration and management meetings have helped us financial services. to maintain strong communication links. An important responsibility is maintenance This spring the management team orga- of all modern heating and cooling sys- nized an Employee Appreciation Week, tems, supported by computer programs in which entailed team-building activities the two main buildings (CMC and MSDC). bringing staff together to participate in All residences and transits are now well activities such as “the trust walk” and maintained and equipped; two lodgings street hockey; self-care activities were that had water infiltration problems have also encouraged (for instance, ap- been renovated and repaired. pointments with a registered massage therapist). The week concluded with a staff luncheon. These events build team confidence, morale and cohesion.

CURRENT SERVICES AND ­CHISHAYIYUU The nursing team has been stable with the exception of the home care nurse. The permanent nurses have contin- ued with the RUIS-McGill bi-weekly 49 ­teleconference. Two nurses were trained CMC, MSDC and transit buildings. Priori- to be trainers for MDSA and CPR. ties for this year include landscaping and paving ten units at Visitor Drive. A nutritionist joined the team in mid-Janu- Material Resources is implementing the ary. Team members gave a presentation maintenance software, which helps the on the unit’s services to the community. team to ensure the buildings are well- The nutritionist has also given presenta- maintained and fully operational. tions during hockey tournaments.

The CHRs have been integrated with the nursing team, which has enhanced care Whapmagoostui and prevention efforts. One CHR is on Population 888 maternity leave. In Social Services, the human resources officer position has not # Consultations been filled. doctor 141 AWASH nurse (walk-in) 14,168 The Awash Unit continues to experience Specialist (In Hospitdentisalt) 1,185 fluctuations at certain periods in specific specialist doctor 555 sectors, depending on the focus for that Community Health 14,503 period (for example, flu shot campaigns, diabetes awareness, etc.). Note: Specialist includes pediatrician, psychiatrist, eye doctor (opthalmologist The nurses’ individual consults declined or optometrist), and ear in the latter portions of the year, mainly nose and throat (ENT). because of staff shortages. CHRs and community workers participate in the The Whapmagoostui CMC faces chal- nurses’ RUIS-McGill teleconference train- lenges in fully implementing the Strate- ing, if the subject pertains to maternal gic Regional Plan due to lack of working and child health. and residential space. This lack prevents units from hiring the staff needed to USCHINIICHISUU provide quality essential medical and The main element of the Uschiniichisuu professional services and programs to Unit’s programming continues to be the community. outreach services. Outreach is made possible because of strong partner- CURRENT SERVICES AND ships developed with the school and ­CHISHAAYIYUU other community partners. The CHR led Priorities for Current Services and Ch- a number of initiatives over the year, ishaayiyuu include hiring staff to full including those focusing on nutrition, capacity, building residential units, and dental hygiene, and FASD. extending the present clinic to accom- modate all staff. A primary challenge is to ADMINISTRATION hire and retain permanent nursing staff. The Administration Unit has 20 full-time Lack of medical equipment and quali- positions and provides a range of sup- fied, trained staff means that the unit must port services, including food services, resort to long-term placements or sending housekeeping, maintenance and vari- patients out of the community, disrupting ous administrative functions. Despite the or destabilizing family life. challenges faced in recruiting human resources, Wemindji has well-maintained 50 The CHRs continue to use workshops, AWASH AND USCHINIICHISUU pamphlets and other tools to provide The Awash and Uschiniichisuu Unit con- people with information on issues such as sists of community workers, nurses, CHRs diabetes, dental heath, the bush kit pro- and other professionals, including an gram and the prevention of STIs. occupational therapist, a physiothera- pist, and specialized medical doctors. The NNDAAP worker provides assistance The CHRs participate in programs, per- to those requiring extra help dealing with form outreach to schools, and provide substance abuse. The worker identifies essential information on issues such as local and external resources and also diabetes, dental health, nutrition, the provides counseling services to individuals bush kit program, and AIDS/HIV preven- and groups. tion. As the community workers work The Home and Community Care Program with multigenerational families in their aims to promote, restore and/or maximize assessments, they collaborate closely independence for those who face physi- with the Chishaayiyuu team. cal and cognitive challenges. ADMINISTRATION The MSDC takes an integrated ap- The Administration Unit’s priority for next proach to supporting and maintaining year is to extend the clinic building. This people in their community, including extension would also allow the postings those with physical and cognitive chal- of positions required to fully implement lenges. It also enables participants to the Strategic Regional Plan. In addition, maintain their connection to cultural Whapmagoostui is in desperate need of activities related to their Cree way of a centre for respite care for homecare life. However, the MSDC requires proper clients; last year saw a total of 312 foster resources if it is to succeed in its goals. home placements for youth, adults and elders. In Social Services, the community worker offers individual, family and or marital counseling to those needing help main- taining healthy relationships and family life. The community worker works with the medical teams where illnesses have created or aggravated a person’s so- cial issues, performs intake assessments, evaluates and determines service plans, and makes further referrals, if required.

51 5

ᐱᒧᐦᑌᐦᐁᐤ

pimuhteheu

Pimuhteheu means "walking group ­alongside". This Group is about ­planning, prevention, and strengthening and improving health and social services.­ It includes the Regional Public Health Department­ ­(including research and surveillance functions) and regional services planning departments.

Laura Bearskin Assistant Executive Director

52 Pimuhteheu

Public Health

Program Planning

Professional Services and Quality Assurance

Public Health Department schools, workplaces, communities, and regional organizations. Some of the high- As a Family Physi- lights from each Public Health team in cian, my goal is 2011-2012 include: to work with each individual patient to • The Awash team’s  Mashkûpimâtsît improve his or her Awâsh program, which aims to health. As a Public strengthen support for families with Health Director, my young children. This program has goal is to work with been piloted in three communities the population to and evaluations have begun; improve its health. Our role as a regional • The Uschiniichisuu team’s Bimuhtidah Public Health Department is to under- Shdiyimuwn, or Cree Regional Sum- stand what is affecting the health of the mit on Addictions, which was held in population and to develop prevention November 2012 and which identified programs and activities to help improve priority actions on dependencies; the Miyupimaatisiiun of Eeyou Istchee. • The Chishaayiyuu team’s Cree Health The traditional program areas of public Board Nutrition Policy, adopted by the health in Quebec include community de- Cree Health Board this past year. velopment activities, lifestyles and chronic At the beginning of 2013, the department diseases, injuries, infectious diseases, reviewed the implementation of activi- environmental health, and occupational ties and programs contained in a 2007 health; public health is also concerned regional action plan. We are hoping that with social adjustment and integration. community involvement such as that seen Over recent years, the regional Public with Maamuu Nakaahehtaau will guide a Health Department has worked on rein- revised Public Health Action Plan for Eey- forcing, adapting, and introducing these ou Istchee and lead to the development programs within Eeyou Istchee, which of local action plans for each community. has been accomplished by working with Community Miyupimaatisiiun Centres, Robert Carlin, MDCM, CCFP, FCFP Interim Director of Public Health

53 Awash PRENATAL NUTRITION PROGRAM The Prenatal Nutrition Program’s man- Dedicated to the improvement date is to improve birth outcomes by of the health and the well-being improving maternal and child overall of children from 0-9 years old. health through proper nutrition. The pro- gram offers nutrition screening, counsel- ling and education, maternal nourish- ment, and breastfeeding education, promotion and support, in collaboration with the Breastfeeding Program. MATERNAL AND CHILD HEALTH Local Awash teams have been provid- PROGRAM ed with educational materials and tools The mission of the Maternal and Child as well as financial resources to hold Health Program (MCHP) is to provide local activities and/or to assist preg- preventive healthcare to mothers, ba- nant women and new mothers facing bies and their families. It is implemented food insecurity. Regional projects and in the CMCs and throughout communi- activities included training, continuing ties via home visits as well as community- education and support to local Awash based projects. The MCHP is based on teams, revision of the MCHP binder’s the McGill nursing model of family health and pamphlet’s nutrition content, dis- care and involves primary prevention us- tribution of nutrition and breastfeeding ing a holistic ecological model of health. promotional items and of the ″Tiny Tot to The Public Health Department provides Toddler” guide, and collaboration with training, tools and onsite support through the Breastfeeding PPRO on breastfeed- regular visits to each community. ing files and with Public Health nutrition- ists on nutrition files. Home-visiting programs in the prenatal, perinatal and postpartum period are In the coming year the PNP will empha- developing at each community’s pace. size the creation and the delivery of a The priority for next year is to work with hands-on training component as well Ste Justine’s Hospital to implement the as information on maternal nutrition, Shaken Baby Syndrome project, to de- with a focus on folic acid supplementa- velop knowledge and programs related tion and iron-rich foods. Two flipcharts to Fetal Alcohol Spectrum Disorder, and are being developed: one on iron to add annual visits and well-child visits to deficiency anemia and another on the the present program. introduction of complementary foods to infants aged 6 to 24 months.

BREASTFEEDING PROGRAM The mission of the Breastfeeding Pro- gram remains the implementation of the Baby-Friendly Initiative in all communities of Region 18. Our priorities are to in- crease the rate of exclusive breastfeed- ing to six months and the rate of total breastfeeding with added complemen- tary foods to two years and beyond.

54 Nutrition counselling, Mistissini This past year, the focus was on the it ­offered to the community organizers, development of tools for breastfeed- the AMA initiated a regional support ing promotion and evidence-based structure through regional meetings best practices: the Creebreastfeeding. between these local community orga- com blog and Facebook page were nizers. continued as was the development of two tools, the Breastfeeding Index Cards The main objective for 2013-2014 is to and the Guide to the Breastfeeding consolidate AMA in the communities Flipchart. Also, numerous efforts went where it has been implemented and into the upkeep of peer-to-peer support to introduce the program in two other groups. Special attention was given to communities. In the interim, the AMA the adaptation of the Breastfeeding guidelines and process evaluation will Tradition Protection Act (previously the be completed; both will guide further Breastfeeding Policy). Finally, there was implementations of the program in the ongoing training of health care workers. remaining communities. The creation of web-based trainings DENTISTRY AND ORAL HEALTH on breastfeeding management mat- Dentistry and Oral Health programs aim ters was postponed and is next on the to improve oral hygiene habits in the agenda, along with the creation of an region and to reduce the prevalence of advisory committee and the revamping tooth decay and oral health problems. of the peer-to-peer support group proj- This objective is pursued through a com- ect. The Breastfeeding Tradition Protec- bination of public education and pre- tion Act will be the main file this coming vention activities carried out by dental year. hygienists and CHRs.

 MASHKÛPIMÂTSÎT AWÂSH In the last year, the two priorities were  Mashkûpimâtsît Awâsh (AMA) is a to conduct the data collection for the family-centered program that delivers Dental Health Survey and to maintain culturally competent services to indi- our School-Based Prevention Programs. viduals and families in perinatality and The Dental Health Survey in Elementary early childhood. AMA also aims to cre- Schools has experienced excellent co- ate “family-friendly” communities. operation from local schools and CMCs. Efforts this year focused on maintaining As of March 31, the Survey has complet- regular and consistent support to the ed data collection in six communities, Awash team members of the 3 AMA pi- examining more than 150 children in lot projects (Mistissini, Oujé-Bougoumou, Grades 2 and 6. This survey will provide and Wemindji) and accompanying important surveillance data on tooth Waskaganish for a gradual implemen- decay, fillings, sealants, fluorosis (white tation of the program. Implementation spots on teeth), gum diseases, broken and intervention tools have been further teeth and dental hygiene, which will developed, sections of the guidelines help improve the region’s public health have been written, and phases 1 and programming and dental services. 2 of the process evaluation have been The Dentistry program provided dental initiated. Five community organizers are sealants and fluoride applications, sup- in place in their communities to sup- ported daily tooth brushing activities in port a local network and to develop schools and daycare centres, and orga- partnerships. In addition to the support nized radio broadcasts to reach parents 55 and the public. In some communities, with the Nutrition PPRO to prepare nutri- the program also provided counselling tion and oral health month events; for and fluoride applications in the context instance, The Drop the Pop challenge of the Maternal and Child Health Pro- was carried out during Nutrition Month gram (MCHP). (March) and Oral Health Month (April) with the collaboration of nutritionists and Plans for 2013-2014 include completing dental hygienists. data collection for the Dental Health Survey 2012-2013; maintaining the The program also supported the integra- school-based programs, and integrat- tion of the Oral Health activities into the ing evidence-based practices into the MCHP by updating educational mate- MCHP, wherever possible; reporting on rial and developing new documents the survey of public expectations for such as the “Lift the Lip” pamphlet, dental services; updating educational which helps parents detect early signs of and promotional material, especially tooth decay. The update of the MCHP the reference documents for the MCHP; pamphlets is ongoing. promoting best practices in dental In 2013-2014 the program will continue prevention among all health care to help dental hygienists integrate Oral professionals (dental and non-dental); Health activities into the MCHP in the and raising leadership awareness of the Awash clinics. It will coordinate the cre- benefits of fluoridated drinking water. ation and adaptation of different working The Oral Health program aims to im- tools and educational materials and will prove oral hygiene habits, to reduce finish updating pamphlets for the MCHP. tooth decay among youth under 18, It will maintain partnerships with other and especially among children be- Awash PPROs and will collaborate with tween 0 and 5 years, and to reduce the Healthy School PPRO to support a the prevalence of periodontal disease daily tooth-brushing program in daycares among adults. and schools, beginning with the launch of a pilot project in Wemindji. It will also mon- This past year the program provided itor specific projects for Oral Health month dental hygienists with up-to-date edu- and collaborate with other partners. cational material offering information and counselling to pregnant women and young mothers regarding their oral health and the links between tobacco use, breastfeeding, healthy nutrition and early childhood issues. It also aimed to engage parents in oral hygiene practic- es, carried out educational activities on oral health and nutrition in daycare cen- ters and schools, implemented a daily tooth-brushing program in daycares and schools, and worked with nutrition- ists to promote oral health hygiene, healthy living habits and good nutrition. In addition, it distributed educational and promotional tools in all the commu- nities, including a new poster to pro- mote tooth brushing, and also worked 56 IMMUNIZATION SURVEILLANCE AND PROTECTION­ The Immunization program aims to re- FOR INFECTIOUS DISEASES­ duce or eliminate vaccine-preventable This Surveillance and Protection pro- illnesses and ensure that vulnerable gram aims to protect the population of groups have access to vaccination. Eeyou Istchee through the prevention and control of infectious diseases. This The main priority for 2012-2013 was to goal is accomplished by surveillance of maintain high vaccination coverage to infectious diseases on the territory and children from 0 to 5 years old and to con- by stressing primary prevention (includ- tinue the school vaccination program. ing immunization). The program is also The influenza campaign took place with concerned with secondary and tertiary the introduction of a nasal vaccine rath- prevention of infectious diseases, which er than an injection for youth. The next includes ensuring appropriate post- priority will be to fill the position of Immu- exposure treatment as well as contact nization Nurse Counsellor. We will strive to follow-up and outbreak management, maintain our high vaccination coverage reporting declarable infections, and in 2013-2014. We will also promote and alerting authorities within the CBHSSJB support standards for the availability and and the MSSS to potential infectious quality of basic and continuous train- threats to public health. ing in immunization. In addition, we will support the implementation of the elec- The main priority for 2012-2013 was to tronic system to manage immunization maintain existing surveillance systems products. However, these objectives are and to support immunization programs contingent on filling the Immunization (particularly the annual influenza vac- Nurse Counsellor position. The Direction cination campaign) in the absence de Santé Publique in Montreal has col- of a nurse counsellor. The Clinical De- laborated in the interim to ensure that partment of Public Health continues to immunization products are appropriately provide a 24/7 call system to address distributed on the territory. urgent requests from the region (mainly from clinician nurses & doctors) outside of regular office hours. Reference mate- rial is available electronically to respond to regional questions and is shared through the Cree Health Board website.

As a follow-up to a signalled cluster of infections, information was provided to the clinics to assist in the control of com- munity-acquired MRSA (an antibiotic-re- sistant bacteria that causes skin and soft tissue infections). Contact management was also initiated for an active case of tuberculosis, which involved multiple communities in Eeyou Istchee and other regions in Quebec.

Ongoing support was provided to the community nurses and doctors for the prevention and control of infections of public health importance (including 2012 influenza vaccination campaign 57 STIs, rabies, and respiratory infections). In order to address the epidemic, we The program also helped produce hosted a meeting in Chisasibi for people documents on STIs in the region and on involved in STI management, providing interventions involving measles vaccina- basic information about this concern tion in school-aged children. A regional and sharing tools to help us all work to- mobilization plan for dealing with public gether to address it. We also met often health emergencies (i.e. outbreaks) was with the heads of the laboratories in also drafted, and the current logisti- Chisasibi and Chibougamau and with cal system for managing microbiology CUSM-RUIS microbiologists in order to specimens from the region was as- develop improved lab testing of gonor- sessed, with support from microbiology rhoea, chlamydia and syphilis. staff from the Jewish General Hospital All cases of gonorrhoea infection and and the MUHC. many cases of chlamydia were ana- Priorities for the coming year involve lyzed through an “epidemiologic en- standardizing the management of mi- quiry”. In addition, and in accordance crobiology specimens from across the with MSSS requirements, every case of territory, improving infectious disease gonorrhoea and chlamydia in pregnant surveillance (particularly for STIs), improv- women was declared to public health ing the primary, secondary and tertiary officials and analyzed through an epi- prevention of infectious diseases (with demiologic enquiry. an emphasis on TB, STIs, rabies, influenza Clinical tools for STI management and and vaccine-preventable diseases), treatment were reviewed, updated and and finalizing a regional public health placed on the medicine department mobilization plan. web site. New guidelines for screening and treatment were distributed. In ad- HEALTHY SEXUALITY AND dition, meetings were held to support ­INFECTIOUS DISEASES frontline health professionals in updating The Healthy Sexuality and Infectious the contraceptive collective prescrip- Diseases Program aims to reduce or tion protocol (ordonnance collective de eliminate sexually transmitted infections contraception hormonale). The results (STIs) and to prevent unwanted preg- of a study on STIs in James Bay were nancies, especially among teenagers. presented to the Conseils des médecins, To this end, the program monitors STIs in dentistes et pharmaciens. the territory, organizes actions to deal with outbreaks, and reports to authori- Priorities for 2013-2014 are to maintain ties within the CBHSSJB and the MSSS. existing STI surveillance systems and to continue developing a strategy to Recent years have seen a constant curtail the chlamydia and gonorrhoea increase in cases of gonorrhoea and epidemic among youth. chlamydia in Eeyou Istchee; these conditions can be responsible for com- plications such as infertility, still birth and chronic abdominal pain. Consequently, the main priority for 2012-2013 was to sensitize microbiologists (RUIS consul- tants) to the ongoing STI epidemic and to the testing challenges in our region.

58 EDUCATION AND SCREENING FOR Uschiniichisuu CLE AND CREE ENCEPHALITIS This Education and Screening program Miyupimaatisiiun Team seeks to increase awareness about two Dedicated towards the genetic diseases, Cree leucoencepha- lopathy (CLE) and Cree encephalitis (CE), improvement of the health and the and offers counselling and screening to well-being of Youth between the people of childbearing age. It also assists ages of 10 and 29 years. the Eeyou Awaash Foundation.

This past year the school-based program for students over fourteen continued, along with other efforts to ensure that people are aware of the screening pro- gram. Counselling and screening tests continue, with an increasing number of CHII-KAYEH IYAAKWAAMIIH requests from across Eeyou Istchee. An ­PROGRAM ON RELATIONSHIPS­ ongoing liaison with the EAF has support- AND SEXUAL­ HEALTH ed that foundation’s activities. An agree- Chii kayeh iyaakwaamiih (“You too be ment with the Cree School Board is still careful”) is a school-based Public Health pending and will be addressed in the next Program for Secondary 3 or Secondary 4 year. An evaluation project supported by students. The program aims to help youth the CIHR will start next year; this project in- develop the skills they need to prevent volves a collaboration between the Cree STIs, HIV/AIDS and unplanned pregnan- Health Board and Ste-Justine Hospital. cies. To this end, students participate in Priorities for 2013-2014 are to finalize an various activities that help them to con- agreement with the Cree School Board, nect to their Cree culture, define their continue our participation with Ste-Justine own personal goals, develop positive Hospital in the program evaluation, and self-esteem, resist negative peer pres- increase the program’s visibility through- sure, develop the ability to communi- out Eeyou Istchee. The ethical questions cate assertively, and solve problems. The associated with genetic screening remain program counsels them to wait until they a major preoccupation. are sure they are ready to have sex and, once they do decide to have sex, to use a condom.

An important component to this pro- gram is the aashuumiih, during which students share what they have learned with other students in the school or com- munity through a team project. Last year students in two communities made public service announcements to inspire oth- ers to resist peer pressure, think about the consequences of becoming a par- ent at an early age, wait to have sexual relations, and always use condoms. In another community, students produced a booklet entitled “Take It From Me: a artwork used for genetic education and screening program 59 compilation of Peer-Educational Articles DEPENDENCIES AND ADDICTIONS on Relationships and Sexual Health”. The Dependencies and Addictions pro- Copies of this booklet are now available gram’s mission is to address and resolve through clinics in all nine communities. issues related to substance abuse and Eight schools are offering the Chii kayeh negative dependencies, which diminish iyaakwaamiih program this year. holistic wellness and healthy lifestyles. Our priorities are to prevent or delay the This past year, Uschiniichisuu team mem- age of first use of addictive substances bers, teachers, Youth Fusion members for all Cree, and to foster, support and and others from two communities re- maintain a successful transition to a ceived training in the program. We hope healthy Cree life style free of substance to offer further training to other Uschiniich- abuse. isuu teams as soon as they are ready to take on their supporting roles. Because of The Eeyou Istchee Summit for Actions a turnover in staff, videoconference train- on Addictions, from November 19 – 21st, ing was also carried out with new teach- 2012, engaged about 160 Eeyou, Ee- ers in two communities. nou and others, representing nine Cree regional and local entities, to identify Currently, the program is not being of- approaches to addictions and de- fered each year in every community, and pendencies in Eeyou Istchee. The most it is becoming increasingly difficult to find important local priority actions were a space for it in the school schedule. We to establish the local Miyupimaatisiiun are considering the possibility of integrat- Committees, strictly enforce all laws, by- ing the lessons into the school curriculum laws and regulations dealing with ad- at an earlier point, starting in secondary 1 dictions and dependency, develop and through to secondary 3, in order to reach implement a school curriculum com- students at a younger age and also to ponent that teaches and reinforces a ensure the program’s sustainability. healthy Eeyou Eenou lifestyle, promote The priorities for the coming year include and celebrate positive Cree role mod- collaborating with the CSB to adapt cur- elling, and get more people enjoying­ rent pedagogical materials and produce healthy, productive activities. Central new ones to support the integration of the to all of the above was the call to get lessons into the new curriculum for Sec- Elders and Youth directly involved in ondary 1, Secondary 2, and Secondary 3. We also plan to reinforce healthy parent- ing skills in the area of sexual health as part of the Parenting Skills Development Program and to create a workshop for parents and significant individuals. Finally, we plan to extend the program to reach youth not attending school.

60 Youth Fusion Leadership Conference, Waswanipi addressing addiction and dependency HEALTHY SCHOOLS issues, and to make much better use of The Healthy School program seeks to land-based and culturally based activi- establish, for the benefit of the student ties and knowledge. The priority actions population, a means of networking at the regional level include supporting between and within entities in order to local entities as they work together to coordinate the services, programs and achieve the local priorities. A second activities taking place in the schools of priority is to develop and enforce re- Eeyou Istchee. gional standards dealing with addic- tions and dependencies. Priorities for this year were to enhance our understanding of the Healthy School We have extended our consultations approach and to identify a community as we plan a Parenting Skills program. interested in implementing the ap- Training to addiction workers was of- proach as a pilot project. A first pilot was fered through our collaboration with the launched in Wemindji last fall, led by the First Nations Health and Social Services Wemindji community organizer, work- Commission of Quebec and Labrador ing with the support of the Public Health and Health Canada. The community- department and local partners. based addiction recovery program project has been delayed this year, but Priorities for 2013-2014 are to continue we hope to be able to resume it in the support the Wemindji project, and to year to come. Finally, we continued learn lessons from this experience to providing prevention awareness and inform further implementations of the educational material to the Addiction Healthy School program. NNADAP interveners, as well as to the general population using the local and regional radio.

Priorities for 2013- 2014 include ensuring Smoking Sucks Workshops Training Cree youth as peer-educators that actions identified at the Summit will in tobacco reduction be implemented, developing the Par- enting Skills program by creating specif- ic focus groups of elders, young parents and youth, and producing material to raise awareness as well as for educa- tional and intervention activities. Finally Cree Board of Health and Social Services of James Bay we will conduct a study on the psycho- social needs of community members struggling with substance abuse. Handbook for Smoking Sucks Workshop

61 Chishaayiyuu SUPPORT TO COMMUNITY ­INITIATIVES - H.E.A.L. (HEALTHY The Chishaayiyuu team’s mandate EATING ACTIVE LIVING) is to promote health and well-being Using funding from the Aboriginal Diabe- among persons thirty and older. tes Initiative (ADI), Public Health provides small grants to support regional and local activities areas related to diabetes primary prevention. In 2012-2013, these grants were awarded to various community groups who requested financial assistance for their projects, which included activities related to Diabetes Awareness Month, healthy cooking in schools, community walks, afterschool programs and other physical activity and nutrition projects.

SMOKING PREVENTION AND Prevention of chronic ­CESSATION ­diseases This year the Smoking Prevention and MAAMUU NAAKAHEHTAAU Cessation program pursued its work- shop project, training peer-educators Launched in 2010, Maamuu Nakaa- for tobacco reduction among Cree hehtaau combats diabetes and pro- youth. The program worked with the motes healthy lifestyles by calling upon Consultancy for Alternative Education leaders to make a central priority of to produce a booklet, which was then supporting people in their efforts to live distributed to workshop participants. The a healthy life. The program aims to unite program also continued to support the local forces to build a supportive environ- smoking cessation counsellors. ment, to create sustainable behavioural changes that will encourage physical activity, healthy eating (including tradi- PHYSICAL ACTIVITY PROMOTION tional food), and positive thinking, and to The annual Active School Project was promote Cree values, culture, tradition, repeated this year, with schools being and holistic healing. This year, Maamuu encouraged to submit a project of their Nakaahehtaau was presented to band choice related to physical activity or councils and/or the population during healthy nutrition. In 2012 three schools local general assemblies in four com- (Luke Mettaweskum School, Annie Whis- munities. A community consultation was keychan School, and Voyageur Memorial conducted in one community, and the School) received funding for their proj- Maamuu team presented at the GCC/ ects, while others also organized a range CRA annual general assembly, Cree of activities around physical activities and Trappers’ Association general assembly, healthy nutrition. National Physical Activ- and during the Regional Conference ity Week (in May 2012) was promoted in on Residential Schools. Maamuu Na- communities and schools and through kaahehtaau is also collaborating with the local and regional radio. Over the the Strategic Health Planning Project to summer, the annual 100 Challenge was develop local and regional health plans organized throughout the Cree region, and integrate them into an Eeyou Ist- with communities registering with their lo- chee strategic plan for Miyupimaatisiiun. cal CHR and pedometers being given to 62 participants to enable them to record the Finally, the “Family School Challenge number of miles walked during the week. Week” was again organized at Voya- Chisasibi, Wemindji, Waswanipi, Nemaska geur Memorial School in Mistissini, with and Mistissini created walking/running students, parents and school staff taking clubs during the summer months, and part in a week of outdoor activities. This some organized a 10 km event. Some activity is directed towards the elemen- communities also organized a “Walk to tary level, with different grades sched- Work Day” (no vehicle day). In the fall, the uled for each day; it will be introduced “Walk to School Week” was launched, to other schools next year. aimed at the elementary level, with schools throughout the Cree region being PROMOTING HEALTHY EATING encouraged to organize and promote Our team provided support for the orga- it. The “Winter Active” campaign over nization on a variety of nutrition activities January-March 2013 encouraged com- throughout the year, such as Drop the munity members to be physically active Pop and Nutrition Month. The 2013 slo- during the winter months; this year, Chisa- gan for nutrition month was «Hunt. Fish. sibi, Waswanipi, Nemaska, Waskaganish Cook. Enjoy together! Muukshek!» In the and Mistissini organized regular snow- year to come, tools and other supports shoe walks. Some communities set up will continue to be provided to local traditional campsites where participants teams and regional nutrition promotion were able to snowshoe, cross country campaigns will also take place. ski or walk/run, and eat traditional food. Also, as part of the Winter Active project, CHBSSJB Nutrition Policy the third winter triathlon was organized The Nutrition Policy governing food on March 16, 2013 in Mistissini with recre- service in CBHSSJB establishments was ational and children/family categories. adopted by the Board of Directors in The Triathlon is truly a community-based December 2012. Regional and local initiative involving many entities as well as implementation committees will be volunteers from the community.­ formed in the coming months; our team will be involved in these committees and will support managers and staff by providing training in nutrition and ­hygiene.

Food Security Last year, stores from the region and in nearby urban centres where Eeyouch regularly purchase foods were visited to identify availability and cost of food. The report of this project, “Access to a Nutritious Food Basket in Eeyou Istchee,” was recently completed. In the coming months, results will be shared with local and regional organizations in order to explore solutions to improve availability of nutritious foods at a reasonable­ cost.

Drop the Pop challenge 63 Cree Traditional Nutrition in Childcare Centers Most childcare centers were visited Food Safety Workshop again this year to follow up on the implementation of their Nutrition Policy, Operated with the assistance of Cree update their menus and provide train- Elders and MAPAQ, the traditional ing in nutrition, food allergies, and food food safety workshop is always popu- safety and hygiene. lar and well-attended in the communi- ties. The Elders are experts in the skin- BREAST CANCER SCREENING ning, butchering and naming of the The Québec Breast Cancer Screening body parts in Cree, and the workshop Program (QBCSP) is a key element in uses freshly harvested game animals. the fight against breast cancer. It offers Workshop participants are encour- mammography exams every two years aged to experience hands-on training to women aged 50 to 69 years. This exam as much as is the only scientifically recognized meth- possible. Hunt- od for reducing the risk of death from breast cancer. ers must take this workshop Our priorities in 2012-2013 were twofold: prior to par- to invite all women in the Cree Territory ticipating in who were turning 50 to take part in the Caribou Hunt QBCSP; and to monitor daily the indi- for the “Chisa- vidual results of mammograms in order to sibi Hospital start the investigation process if required. ­Caribou Meat Eight screening visits were held in 2011- Project.” George Diamond, 2012, so there were no screening visits Traditional Food Safety Workshop on the territory this year. Eighty invitation letters were sent. Twenty-nine women were screened through the provincial program in screening centers outside Eeyou Istchee. Three of them needed further investigation exams, and these follow-ups were performed.

In 2013-2014, all the communities except Oujé-Bougoumou will be visited by the mobile X-ray units Clara or Sophia. Par- ticipants from Oujé-Bougoumou have in the past expressed their preference Food Safety and Hygiene to be screened at the Chibougamau Staff and managers of the hospital, MS- Hospital. DCs, group homes, elders’ centers and daycares, as well as students from the Waswanipi vocational school, were in- vited to participate in food safety train- ing to receive their provincial food han- dler’s certification. Two traditional food safety workshops were also organized,­ in Mistissini and Chisasibi. 64 SUPPORT FOR DIABETES CARE AND ENVIRONMENTAL HEALTH CHRONIC DISEASE PREVENTION IN The goal of Environmental Health activi- THE CMCS ties is to prevent illness due to factors in Support to health care providers (HCP) our physical surroundings – on the land, caring for patients with diabetes contin- in the air we breathe, in the water we ues to be offered through the telephone drink, and in the food we eat. helpline, initial training given to all new nurses coming to work in the region, and local visits to all HCPs. A new compo- nent was added this year, as initial and ongoing trainings for CHRs were started within CMCs. Various materials (such as pamphlets and sections of the diabetes manual) were prepared, revised, up- dated or translated this year in order to support HCPs. Regular telephone meet- ings with the heads of Chishaayiyuu and local directors were organized to discuss the services provided. Members of the Cree Diabetes Network continued to meet throughout the year to share and discuss local and regional initiatives to promote healthy lifestyles. Violate Bates, Chisasibi Nituuchischaayihtitaau Aschii Environ- ment and Health Study WHAT IS The Nituuchischaayihtitaau Aschii En- vironment and Health Study aimed to assess contaminant levels and health GDM? indicators such as nutrition, physical ac- A guide to understanding tivity, diabetes, and obesity in the Cree gestational diabetes communities. During this past year, the mellitus (GDM) report’s current results were presented to the James Bay Advisory Committee on the Environment. A final report that will include results from all nine communities will be completed in June 2013, and a PDF version will be made available online at creehealth.org.

Following a request from Niskamoon Cor- poration, a consultant was hired to write individual reports for each community in which the Nituuchischaayihtitaau Aschii Study carried out field work. These reports will be written in non-technical language accessible to members of Niskamoon, Third booklet in the “What is diabetes?” series Hydro Québec and Cree Nation lo- cal representatives. PDF versions will be ­available online at creehealth.org. 65 Contaminants (mercury and lead) Radon The Quebec toxicology lab notifies the Radon, a naturally occurring radioac- Public Health Department when a blood tive gas given off by some types of rock test result shows high contaminant lev- and soil, can accumulate in basements els (usually either lead or mercury in our and may cause lung cancer. The Public region). These results are entered into the Health Department collaborated with provincial database, and in some cases the Cree School Board to test radon in the physician who ordered the test is each school of Eeyou Istchee; this proj- contacted to carry out an investigation. A ect is an initiative of Quebec’s Ministry report of these contaminant test results for of Education. A report on radon levels the period 2005–2011 is being finalized. assessed by our department in four Cree communities was presented to the Assessing health impacts of development Directors of Housing at the CRA’s Eeyou projects and climate change Mitchuwaap Department. Quebec’s Ministry of Health regularly solicits the opinion of the Public Health Drinking Water Surveillance Department on the environmental and Tap water in the Cree communities is social impact assessments carried out by tested by the local water operators, and the promoters of new projects in Eeyou the quality of water in the community Istchee. Such requests may be expected water distribution system is the responsi- more frequently in the future, due to the bility of First Nation Councils. The Public opening of new mines and other projects Health Department is legally required to that are part of the Quebec govern- respond when an authorized lab sends it ment’s northern development plan. a report of water quality not conforming to Quebec regulations. The environmental health team and its partners continued work on a project The Public Health Department compiles looking at how public health depart- results of Colilert (bacterial) testing of ments can better assess the health and drinking water carried out under the social impacts of development projects authority of the Local Environment Ad- in light of climate change. Members of ministrators (LEAs) in each community. the Public Health Department continued However, not all communities report their their participation in the Joint CHB-Hydro results to the Public Health Department. Québec committee on Cree health, created to monitor the health impacts of new hydro-electric developments start- ing in 2006. They were also involved in developing a document on the impacts of northern development on health and health services in Eeyou Istchee. Insert cover Indoor air quality problems due to mould image from The Environmental Health and Occupa- Northern Fish.... tional Health teams collaborated to evalu- ate indoor air quality and assess the health risk of mould in several buildings within and Cover of The Northern Fish Nutrition Guide outside of the CBHSSJB. In the future, we plan to do more prevention work in this area, rather than simply responding to requests for help with problems. 66 Abnormal results of drinking water tests are dealt with according to a protocol developed by our team in 2007. Our ac- tions included contacting the LEA to find out how they are dealing with the ab- normal results, and contacting the local clinic to find out whether excess cases of gastroenteritis have occurred. No infec- tious disease outbreaks linked to com- munity water supply contamination were reported in the region this year.

In addition to the activities described in the sections above, over this past year Environmental Health and Oc- cupational Health were also involved with addressing mould problems, car- rying out projects on the environmen- tal impacts of Plan Nord activities and on development projects and climate change, drafting and producing reports 2012 Water Safety Campaign on environmental health, and contribut- 2012, the Occupational Health and ing to fish consumption advice in a new Safety program visited the nine commu- edition of Northern Fish Nutrition Guide. nities and met employers and employ- ees working in municipal garages, water HEALTHY & SAFE COMMUNITIES­ and waste water treatment plans, the Injury Prevention fire department and the police force. A Annual Injury Prevention campaigns in- report was produced for each visit and volve advertisements in Nation and Cree department. In addition, the program Hunter magazines, posters, radio inter- continued to monitor the air quality in views and dramas, and website podcasts. the old Mistissini clinic, and program rep- These campaigns include Firearms Safety, resentatives participated in a number Driving and Road Safety, Seat Belt Use for of professional meetings and training Children, Ice Safety, and Cree Traditional sessions. Safe Food Handling Practices. For expect- Priorities for next year involve meeting ing and new mothers, the Baby Shower with the Director of Operations and/or Program aims to teach participants how Public Works of the nine communities to and why to use baby seats and child present the industrial hygiene and first restraints in vehicles. This program will be aid reports based on last summer’s work. available throughout Eeyou Istchee as Other goals include presenting the Spe- soon as it has gained approval. cific Occupational Health Program (as Occupational Health and Safety mandated by the CSST); organizing a We have a legal mandate to protect regional CHB committee on mould pre- the health of the workers in Quebec vention in our communities; organizing a and to help employers and employees training session with the Canadian Stan- to take charge of their duties and re- dards Association on mould; and moni- sponsibilities in order to prevent occu- toring employee health, especially as it pational injuries and illnesses. In ­summer may be affected by mould exposure,­ at the new Mistissini Clinic. 67 Surveillance, SERC evaluation, research SURVEILLANCE Public Health Surveillance maintained and communications and updated data, and produced (sERC) reports and analyses to support services and policymaking in the areas of ma- The ‘SERC’ team is responsible for ternal health and child birth, diabetes, public health surveillance – one of mental health, nutrition, environmental the core functions of public health – health and housing. With the INSPQ as well as the “supportive” functions and other partners, the unit is working of evaluation, research, communi- on linking CBHSSJB data with provincial cations, clinical preventive practic- surveillance, particularly in the areas of birth outcomes and diabetes care. The es, and public health competency unit is working on a series of final reports development. of the seven-year project Nituuchis- chaayihtitaau Aschii: Environmental and Health Multi-Community Study, which examined the impacts of Hydro devel- opment on health. The Surveillance unit contributed to analysis by the MSSS of the relationship between health and northern development. As part of the Cree Health Board-Hydro Québec Joint Committee, the team assisted in the planning of the final workers survey car- ried out by Hydro Québec and began planning for the final report on health determinants.

EVALUATION Jill Torrie, Assistant Director of Three programmes from the Public Public Health, SERC Health Awash unit began evaluations this year. In collaboration with the IN- SPQ, the team began an evaluation of charts and program operations from the Maternal and Infant Health Pro- gram. It also began initial evaluation of the  Mashkûpimâtsît Awâsh Program. An evaluation of the CE/CLE Genetic Counselling Program was launched with researchers from Ste-Justine Hospital, and will continue throughout 2013-14. As reported last year, the evaluation of patient perceptions of diabetes services continued.

68 RESEARCH some plain language versions were pre- As reported last year, because the pared for the website. New publications Board’s Research Committee had nei- were produced or are in preparation ther terms of reference nor a chair for on a number of topics: the use of tradi- many years, it ceased to function. How- tional foods; Vitamin D; trans-fats; asso- ever, new ideas for research projects ciations between lifestyle factors (espe- and reviews of documents prepared cially nutrition) and the development from existing projects continued through of chronic diseases; the health impact the proposal/publication and review of mercury; and the health impacts of consultation (PARC) process in order to persistent organic pollutants. ensure the necessary ‘buy-in’ for proj- ects proposed from within the CBHSSJB Publications were produced this year and the materials produced through from new analyses originating from the these projects. All new ideas for projects CIHR Team in Aboriginal Anti-Diabetic are approved through the Public Health Medicines (2003-2012); the children’s Management Committee and, if war- health study in Mistissini and Waskagan- ranted, the Executive Committee. ish; the initial evaluation from the ge- netic counseling programme; the report Work continued on revising research ad- to Wemindji from the Roots of Resilience ministration tools, which will be placed study; and the report from the former on the website as they are updated. CreeC project on educating mothers Informal discussions were initiated with about infant dental health. CRA partners on the need for a cen- tralized licensing system and regional Although the CIHR Team in Aboriginal research inventory in Eeyou Istchee. Anti-Diabetic Medicines project has formally ended, we continued to re- Research Projects view scientific publications throughout We continued to collaborate in the the year and eventually organized a community approval process for sci- renewal of the Research Agreement. entific publications from past research We continued to work on and review projects by providing comments on publications from studies on percep- drafts, ensuring that community names tions of cancer, child health in Mistissini are not used without community permis- and Waskaganish, Chiya’may’timun sion, and working with authors to put a ndu’chischay’tak’nuch Abitsiwin (In the results into plain language. We also Search of Peace of Mind), and Kimaa carried out projects within the CBHSSJB. Miywaapitet Nitawaashiim (the evalua- Once completed, all the results of this tion of dental education for Cree moth- work are placed on the website. ers). We also continued various small projects on the better understanding Reporting and planning continued and management of kidney disease. with many long-term projects. Specifi- The reporting on the dental varnish proj- cally, work continued on the final report ect (since 2004) stalled this year. of the Nituuchischaayihtitaau Aschii: Environmental and Health Multi-Com- The CBHSSJB continued as a community munity Study; seven community reports partner with several Canadian research and one popular regional report were networks but with little activity, as this prepared, although they will only be past year was the final year of funding. released in 2013-14 after consultations However, we joined a proposal to cre- with the communities. The study’s sci- ate a Northern Aboriginal Mining Re- entific publications were reviewed and search Network, which received funding 69 ehea re lt .c h w .o r w g

at the end of the year. We also began the entire organization, w 150 page the process of working on the housing continued liaison work views per and health file, which will also involve between the department day, up 95% a university-based partner and various and regional media enti- departments of the CRA. ties to promote Cree lan- guage communications, COMMUNICATIONS produced 10 newsletters for In 2012-13, the Communications Of- Pimuhteheu Department em- ficer continued to produce ployees (http://creehealth.org/library/ monthly themes in multi-me- online/corporate/pimuhteheu-depart- dia (radio, website, social ment-staff-newsletters), and conducted 404 Facebook media, posters, videos a communications workshop at the likes, up etc). The monthly themes Nishiiyuu-PHD training “From Evidence to 156% involved the production Story.” of twelve themed ads and posters, seventeen CLINICAL PREVENTIVE PRACTICES radio PSAs, and thirteen The explicit work from the SERC team website community stories. on this file continues to focus on train- ing health care workers in Motivational The Communications Officer is also using Interviewing (MI), which has been shown social and digital media to distribute to be the basis for effective self-man- messages and share stories. agement of chronic diseases. Training • The “CreeHealth” Facebook page events organized by other units also has 409 ‘Likes’, an increase of 156% have had sessions on MI incorporated from the previous year by the SERC team. The team continues to directly and indirectly support the • The Twitter feed is being followed by implementation of clinical prevention 707 individuals and organizations, an in- practices within public health clinical crease of 168% from the previous year and health promotion programs, espe- • Website page views for creehealth. cially the Maternal and Infant Health org increased by 95% from the same Program, the AMA Program, and tobac- period in the previous year (before co cessation activities. the transition to the website for the entire organization) PUBLIC HEALTH COMPETENCY • Health radio programming is avail- ­DEVELOPMENT able as podcasts at Cree Health Ra- As in the past, with no dedicated staff dio (www.creehealthradio.com) and resources, public health competency on the Cree Health Facebook page. development focused on encouraging • A total of 30 health videos are online professionals to develop these compe- at youtube.com/creehealth. tencies through training modules avail- able from the INSPQ and the Public­ Health Agency of Canada (PHAC). Administratively, the twitter Building on planning that took place Communications Officer 707 followers, in 2011-12, work began on develop- worked closely with the up 168% ing the website providing information Communications Co- on access to electronic journals for ordinator of CBHSSJB to professional staff; the project will be transition the public health ­completed in early 2013-14. website into the website for 70 ehea re lt .c h w .o r w g w Allied Health not, for various reasons, fill their positions. The mandate of the Director of Profession- This resulted in more than 6335 hours of on- al Services and Quality Assurance – Allied territory allied health services given by 21 Health, Adelina Feo, is to ensure the quality permanent allied health professionals and of allied health services for the scope of three professionals on occasional status. the programs of the CBHSSJB. Allied health Program development was also an im- services include nutrition, occupational portant part of the work accomplished therapy, physical therapy, psycho-educa- this year. The department participated tion and speech-language pathology. in developing services for Fetal Alcohol Recruitment has always been a priority for Spectrum Disorder, respite care for special this department, and special efforts have needs youth, and plans for long-term care been deployed to recruit professionals services; it also worked with a committee in all allied health disciplines. Thanks to a to develop a mental health framework for great partnership with the Department the territory. The department provided in- of Human Resources, there has been put on Multi-Service Day Centre programs significant progress in most professional and was involved in evaluating resources categories. Greater collaboration with for developing capacity of rehabilitation Human Resources allowed the Director to assistants. Work with the Chisasibi Hospital respond quickly to new applicants and to Risk Management Committee continued, facilitate new employees’ relocation to resulting in the approval of a Risk Manage- the communities. Efforts were also made ment Plan in September 2012. to open the door to occasional profes- 2013-2014 will be a busy year with exciting sional coverage, with the pleasant result new projects. The department will lead being that some of the workers decided MSSS-supported projects targeting recruit- to stay for longer and repeated engage- ment and retention of rehabilitation profes- ments. By the end of the year, all posted sionals and the development of speech- nutrition positions were filled. The CBHSSJB language pathology services in the region. also hired two psycho-educators, bringing The CBHSSJB will explore tele-health pos- the number to four throughout the territory. sibilities in these fields. The department will Two physical therapists and one occupa- also pursue its activities to consolidate the tional therapist were also hired. Occasional participation of allied health profession- coverage allowed physiotherapy services als in CBHSSJB programs, especially in the to be given to communities which could Hours of direct fields of specialservices needs and tomental clients health. # of hours of direct service to2012-2013 clients

Nutritionist Physiotherapist Psychoeducator Occupational Therapist allied Chisasibi 672 1,160 997 157 Eastmain 0 0 0 0 health MISTISSINI 868 722 3,010 227 services NEMASKA N/A 93 0 0 2012-2013 Oujé-Bougoumou 209 254 72 0 Waskaganish 0 13 20 0 Waswanipi 64 159 0 0 Wemindji 80 455 0 0 WHAPMAGOOSTUI 0 112 0 0 Total 1,893 2,968 4,099 384

71 Current and Ambulatory gregory brass Services Coordinator of Mental Health NURSES’ TRAINING The annual nurses’ training was held In September Gregory Brass was hired in November and the following topics as the new Coordinator of Mental were covered: new protocol on ges- Health and took over the role after tational diabetes mellitus, nephrology, a 3 month orienta- revisions to the Therapeutic Guide, tion period led by collective prescription on otitis media, interim coordinator management of patient safety risks, ma- Mary Ortepi. Gregory ternal and infant health, traumatology, Brass has an exten- and SADM-C recertification. In March sive background in 2012, 13 new nurses received their cer- Aboriginal mental tification for SADM-C (3 days) and for health research. traumatology (2 days).

CLINICAL SUPPORT AND TOOLS The Coordinator worked on standard- ization of emergency material/supplies and the purchase of medical equip- ment. She participated in the Archives Mental Health – Committee, the Bush Kit Committee, ­Awamiiniwachuwanouch the Steering Committee of the Distance PSYCHOSOCIAL SERVICES Teaching and Learning Centre of the There are five visiting psychologists, two Northern Health Program at McGill, and therapists and one traditional healer on the Therapeutic Guide and Collective service contracts coordinated by the Prescriptions Editorial Committee. She regional Mental Health Program. Over also participated in the development of the 2012-13 year they provided 1,516 a screening program for diabetic reti- consultations over a span of 461 days in nopathy, one of the frequent complica- all nine Cree communities. There were tions of diabetes. 164 consultations over 28 emergency

mental health mental healthconsultations consultations 2012-20132012-2013

psychologist psychiatrist

Chisasibi 201 29 Eastmain 143 1 of MISTISSINI 145 35 68% NEMASKA 239 17 mental health Oujé-Bougoumou 178 29 clients are Waskaganish 192 3 girls and Waswanipi 178 16 women. Wemindji 120 2 WHAPMAGOOSTUI 151 6 Total 1547 138

223 consultations outside the territory

72 day visits. There were 138 requests for SUICIDE PREVENTION, INTERVEN- outside psychological services and 85 TION AND POSTVENTION emergency requests. Consistent with The regional working group continues to previous years the leading reasons for seek recognition and support for its activi- psychosocial services were conjugal dif- ties related to suicide prevention, interven- ficulties, single family issues, parent-child tion and postvention. To date they have relational issues, depression, parenting received six resolutions of support from skills, anxiety, alcoholism, stress, insomnia, Chief and Councils and are awaiting six and stress related to work. other resolutions from communities and Cree entities. They have letters of support PSYCHIATRIC SERVICES from Eeyou Eenou Police and secured rep- The mental health department contin- resentatives from the Cree Nation Youth ues to strengthen its relationship with Council and Regional Elders Council. the Douglas Hospital as well as working towards fulfilling its obligations under the Prevention and intervention accom- service agreement. In December 2012 plishments include ten individuals who Dr. Harvey, who has been instrumental in attended ‘train the trainer’ workshops developing this service, went on maternity for the Applied Suicide Intervention Skills leave. Prior to her leave temporary cover- Training (ASIST), three of whom are await- age was secured for all the communities. ing certification. One individual attended Three visiting psychiatrists, Drs. Eduardo the one day training for SafeTalk. In the Chachamovich, Jason Bourque and upcoming year the working group will Michele Belanger, will cover the coastal benefit fromsuicide ­ prevention training. communities. Dr. Vachon, a psychiatrist at the Chibougamau Hospital, has agreed SEXUAL ABUSE to cover the inland communities. This past Sexual abuse is a very delicate issue and year two liaison nurses, one inland and when an intervention is done without one at the Douglas, were hired to coor- sensitivity or mismanaged it can have dinate psychiatric services for Cree pa- devastating long term consequences on tients. In the few short months since they individuals, families and communities. The were hired there has been a noticeable Sexual Abuse Working Group (SAWG) improvement in services for Cree pa- continues its mandate with care, caution tients at the Chibougamau and Douglas and determination. A survey conducted ­Hospitals. by the SAWG generated more than 260 responses and found that all communities are affected by the issue but lack the tools and training to deal with it. Over the years SAWG has built strong links with a number

73 of services, including Centre d’Expertise and abuse. More than 150 people at- Marie Vincent in Montreal, and with many tended and found the conference very leading experts. SAWG had been working helpful in understanding their own expe- on intervention tools for frontline workers to riences and those of older generations respond to children who have been sexu- of survivors. Funding was provided by ally abused. Development of an interven- Health Canada, the Cree Regional Au- tion protocol is now the responsibility of thority/Grand Council of the Crees and Youth Protection. The focus will now be on the Mental Health Department. More the development of a protocol for clients regional and community events are be- aged 18 and over, and on training needs ing planned for the upcoming year. of frontline workers. The Truth and Reconciliation Commission INDIAN RESIDENTIAL SCHOOL RESO- has also been very active in the prov- ince. They held a statement gathering LUTION HEALTH SUPPORT PROGRAM in Val d’Or in early February, which was Reliving the residential school experi- followed by a regional event in Chisasibi ence is traumatic and Resolution Health in mid-March. The Mental Health Depart- Support Workers provide a critical ser- ment was not directly involved in organiz- vice for those individuals going through ing these events but provided support the Independent Assessment Process services for survivors. A larger four-day (IAP). The Resolution Health Support national event is scheduled for late April Workers travelled throughout the region 2013 in Montreal and RHSWs will be on over the summer to ensure all former res- site. Over the coming year RHSWs will con- idential school students who are eligible tinue to provide support at these regional have their IAP forms filled out before the and national events and IAP hearings. September 19, 2012 deadline. However, it was noted by RHSWs that many for- OTHER DEVELOPMENTS mer survivors missed the IAP deadline In December 2012 the Board of Directors because they were not ready and were approved a mental health planning pro- very reluctant to disclose information cess to provide guidance and make rec- about their past IRS experiences. The ommendations for the delivery of mental legacy of the IRS system continues to health services in the region. Since this be a highly sensitive issue in many com- time, an executive committee and steer- munities and difficult to speak about ing committee have been formed and openly within some Cree families. have secured the services of a consul- A three-day Cree Regional Conference tant. It is expected this planning process on Indian Residential Schools was held will take between one to two years to in Val d’Or in early March 2013. The con- complete its mandate. Consultations with ference provided a forum for those who communities and stakeholders will begin attended Indian Residential Schools to over the coming year. share their experiences, gain under- standing and break the silence of their experiences. Chairperson Bella Petawa- bano and Grand Chief Matthew Coon Come gave opening addresses. The conference provided multiple talking circles, three intensive workshops on the historical intergenerational effects, fam- ily dynamics, and dealing with trauma 74 Pre-hospital Services and CIVIL SECURITY Emergency Measures The CBHSSJB is involved in civil security mat- First responders certified ters as it relates to emergency measures first responders certified involving vulnerable populations. Other- wise civil security falls under the responsibil- 2012-2013 ity of the Cree Regional Authority (CRA). In Chisasibi 16 times of civil emergencies both agencies Eastmain 0 coordinate efforts to address the situation. MISTISSINI 14 Calls to the Civil Security On-Call Service NEMASKA 13 are covered 24/7. The on-call service helps Oujé-Bougoumou 0 ensure civil security in Eeyou Istchee. In 2012-2013, emergency responses were Waskaganish 5 provided for the following reasons: plane Waswanipi 5 crash, potential forest fires, major power Wemindji *6 outages, and potential flood. However, WHAPMAGOOSTUI 0 the communities also used their own Total 59 ­resources during emergency situations.

*30-hour refresher course EMERGENCY MEASURES The Coordinator of Pre-hospital Services and Emergency Measures participates in the MSSS Civil Security Mission Santé meetings and in the Organisation ré- FIRST RESPONDER TRAINING AND gionale de la sécurité civile du Québec CERTIFICATION conference calls. Within region 18, the Coordinator attends meetings of the The Quebec MSSS requires First Respond- Eeyou Istchee Fire Chiefs. In addition, he ers to be certified. Upon successful ensures that the Executive members of completion of 72 hours MSSS training, the CBHSSJB are informed and updated­ First Responders are certified for three on civil security matters. years. This year, 59 First Responders in six ­communities were certified.

75 6 ᐋ ᐅᐦᒋ ᐱᒥᐱᔨᐦᑖᑭᓂᐎᒡ ᐋᐱᑎᓰᐎᓐ administrative resources

The Administrative Resources group Group supports the functioning of the organization by providing the following services: human resources, finance and payroll, information technology, and management of material resources ranging from buildings to medical supplies.

Clarence Snowboy Assistant Executive Director

76 76% of Administrative Furthermore, the Staff- employees resources ing Unit supported are cree or managers in improving first nations. the quality and consis- Human Resources tency of hiring and pro- motion practices. Human Information Resources team members Technology met with local directors of the CMCs to inform them of the staffing process and how they could help Human Resources Material Resources to fill the positions in their communities. The Human Resources Department is Finance completing a web site that will be at- tached to the main CBHSSJB website and which will increase visibility signifi- Human Resources cantly by using new ways of reaching The Human Resources Department plays people through Facebook and other an important role in the implementa- media. The Human Resources website tion of the Strategic Regional Plan. In will include an Applicant Tracking Sys- support of funding negotiations with the tem that will enable the department to Ministry of Health and Social Services handle recruitment needs electronically. of Québec, the department provided cost projections for human resources To conclude, the Staffing Unit is devel- management, recruitment, training and oping and revising recruitment policies, development, and employee lodging recruitment tools, interview question- needs for the next five years. naires and selection tests in order to be more efficient. The department continues to make significant progress in improvingPositions its core filled during the fiscal yEAR operations and providing consistency in positions filled during20 12-2013 recruitment and human resources man- the fiscal year 2012-2013 agement across the organization. The Human Resources Development file will be implemented in the 2013-2014.

STAFFING 39 PROFESSIONALS Recruitment is one of the most important 97 SUPPORT elements in the implementation of the STAFF Strategic Regional Plan. In addition to placing over 75 advertisements in web and print media, in 2012-2013 the Staffing Unit participated in three career fairs in 39 the Cree communities, and had booths 2 NURSES at over 25 professional recruitment events Managers Total 177 in Montréal, Québec and Ottawa. total 177 Nurses’ recruitment was particularly successful this year, as 39 new nurses were hired in 2012-2013, out of 97 total ­positions. 77 Number of employees by status 2012-2013

number of employees by status Number of Employees 2012-2013 % change

Status 1 - Permanent full-time 721 20% Status 2 - Temporary full-time 277 5% Status 3 - Permanent part-time 64 10% Status 4 - Temporary part-time 14 - Status 5 - Occasional/recall 1,425 18% TOTAL 2,501 17%

EMPLOYEE AND LABOUR­ RELATIONS 39 new The Employee and Labour Relations Unit provides nurses were ongoing guidance to hired this managers and employees year. with respect to the cor- rect application of Human Resources policies. The Unit has regular meetings with the main employee unions, CSN and FIQ, to discuss union matters and resolve griev- ances. Approximately twenty grievances Shepell-fgi Employee were filed by CSN employees during the year, of which four were later withdrawn. Assistance Program Nurses unionized under the FIQ filed 19 grievances in 2012-2013. The Unit made The Shepell-fgi Employee ­Assistance several inquiries concerning work-related Program (EAP) is a free, confidential issues and, in doing so, listened to the and voluntary support service of- concerns of many employees. In addi- fered to CBHSSJB employees and tion, the Employee and Labour Relations their family members (as defined in team reviewed retention premiums and the employee benefit plan). EAP of- is preparing training for Administrative fers counseling and advice to help staff in early fall of 2013. employees solve all kinds of prob- A Personnel Officer and the representa- lems and challenges in their lives, tive of Shepell-fgi toured CBHSSJB facili- including work-related issues.­ EAP ties in August 2012 to present the Health offers support over the telephone, in and Safety Program and to educate person, and online, 24 hours a day, employees about the Employee Assis- seven days a week. ­ tance Program provided by Shepell-fgi. Website: www.shepellfgi.com 78 Information Technology Thomas Ro Resources Director of Information ­Technology In December 2012 the CBHSSJB success- Resources fully recruited a new Director of Informa- tion Technology Resources, Mr. Thomas Thomas Ro joined the CBHSSJB as Ro. Under stable leadership for the first ­Director of the Information Technolo- time in many months, the department gy Resources Department in Decem- has begun improving its quality of ser- ber 2012. Formerly Director of IT and vice through process adjustments and Telecommunications at the Research­ organizational changes, which will help Institute of the McGill University to increase productivity and resilience Health Centre and Senior Technol- to employee turnover. The priorities of ogy Architect at MUHC, Thomas Ro the department will now be determined by the seven-year IT Master Plan pre- has a solid back- sented by the Department and adopt- ground in infrastruc- ed by the CBHSSJB in December 2012. ture architecture, implementation, From April to December 2012 the de- and operations in partment was severely understaffed, the Québec health- and many of last year’s objectives were care sector. He is deferred pending the recruitment of the the author of the IT new director and the adoption of the Master Plan. Master Plan. However, with the help of existing and new service partners, the IT Resources Department managed the network and also supported numerous relocation projects, including those of The objectives outlined in the first year of the head offices in Chisasibi and the the plan are already being implement- new CMCs in the communities. ed. They include:

Adopted as a resolution by the CHBSSJB • improving performance and capacity Board of Directors last December and of the infrastructure deposited at the Quebec Ministry of • commissioning a self-sufficient mobile Health and Social Services in February computer room 2013, the seven-year IT Master Plan aims to modernize every aspect of the CB- • creating a network operations centre HSSJB information technology portfolio, to remotely monitor and manage the starting with the replacement of the ag- network and applications ing communications and hosting infra- • developing an organizational web por- structure with a new one that will enable tal for information access and sharing the CBHSSJB to accommodate the latest • analyzing existing applications and clinical and administrative applications. data to contribute to future integra- The vision of the plan is to create a tech- tion and implementation of an Elec- nology-enabled organization in which all tronic Medical Record and Decision employees can easily access relevant Support System information and value-added services at • implementing a project management any time and from anywhere, so that the framework and industry best practices. technology works for the people. 79 Material Resources In ­Chisasibi, four former residential units In the last eight years, the CBHSSJB has being used for temporary offices were become a significant property manag- closed; the department also started er: since 2004, it has entered into leases working on several other problem sites in for 264 houses, and has built and now Mistissini and Nemaska. operates nine multi-service day centres, The Department is modernizing its pre- a new CMC in Wemindji and a newly ventive maintenance with the introduc- expanded CMC in Waswanipi. These tion of property-management software, properties, in addition to the facilities and the upcoming year will see requests that had previously existed, mean that for corrective maintenance integrated overall the CBHSSJB is responsible for into this software. This approach signals more than 976,000 square feet, includ- a shift in the role of the Department, ing 47 institutional facilities and 443 moving from an operational mode to residential units located in the nine Cree a strategic role where it is focused on communities as well as in Montreal, programs, policies and the provision of Chibougamau and Val d’Or. specific expertise to operational units.

In 2012-2013, four new lodgings were At the end of the financial year Luc opened in Eastmain and eight in Ne- Laforest was recruited as Director. As in maska. A new CMC in Nemaska has other departments, staffing and been delivered, while the Mistissini and turnover is a continuing chal- Eastmain CMCs will open in a few lenge, but many full-time months. In Nemaska and Waswanipi, the cbhssjb positions were filled in the department ended leases for manages 2012-2013. temporary office space as employ- 976,000 square ees moved to permanent build- feet of buildings, ings. On the other hand, it entered including 443 into a lease in Oujé-Bougoumou for residential units. the Awash team; their new CMC is set to be built in the coming years. In Chisasibi, two modular buildings were rented to accommodate Administrative Resources.

A January 2013 meeting in Chisasibi focused on potential locations for the new Chisasibi Administration Head Of- fice and Hospital, and a decision should be made in the coming year. A techni- cal and functional plan will be prepared for a multipurpose facility for technical services in Chisasibi.

Problems with older facilities continued to absorb a great deal of the depart- ment’s time in 2012-2013. Work was conducted at the Waskaganish CMC to prevent the development of mould due to seepage under the building. Waswanipi Clinic opening 80 Financial Resources­ The Financial Resources Department maintains the CBHSSJB’s financial records, ensures all debts are promptly satisfied, safeguards assets, and provides financial information and support to management and the Board of Directors. The depart- ment maintains an internal control struc- ture to ensure that the CBHSSJB’s assets are protected from loss, theft or misuse and that adequate accounting data is compiled to allow for the preparation of the CBHSSJB year-end audit.

The combined statement of revenue and expenditure shows that total fund- ing rose from $169,485,478 in 20011/12 to $178,668,269 this year.

The department supported negotiations with the MSSS to ensure sufficient opera- tion funding for the next five years and enough capital for the next seven years. New budget templates were developed to plan for the next five years in terms of base operation funding, future services development, infrastructure operation and maintenance both for housing and for commercial and institutional build- ings, and new housing construction as per development.

In addition to negotiating the new agree- ment, the department entered 433,499 financial transactions and 888,615 payroll 433,399 transactions. financial For the upcoming year, the department transactions will focus on understanding and imple- were processed menting the new agreement with the this year. MSSS. Other objectives include recruit- ing an Assistant to the Finance Director, implementing bar code scanning tech- nology for timely re-ordering of medical total supplies, implementing a standardized funding for electronic budgeting system, negotiat- the year was ing procurement agreements with sup- over $178 pliers, implementing data warehouse, million. linking Virtuo with other MIS software, and ­integrating unit measures to the AS 471. 81 7

ᐋ ᒥᓯᓈᓱᑦ ᑳ ᐃᔅᐱᔨᑦ ᔔᔮᓐ

financial statements annex

The information on the following pages is an overview. A more detailed Summary Financial Statement will be available as a download from www.creehealth.org/annual-reports after this report is tabled in the National Assembly of Quebec in the autumn 2013 parliamentary session.

82 cbhssjb balance sheet 31 march 2013

CREE BOARD OF HEALTH AND SOCIAL SERVICES OF JAMES BAY OPERATING FUND BALANCE SHEET MARCH 31, 2013

2013 2012 $ $

FINANCIAL ASSETS

Cash 19,964,717 22,022,422 Accounts receivable - MSSS 29,110,555 18,918,161 Accounts receivable 9,490,255 3,418,687 Due from Long-term assets Fund 17,434,894 43,386,488

76,000,421 87,745,758

LIABILITIES

Accounts payable and accrued charges 13,707,947 17,810,078 Wages and fringe benefits payable 10,021,685 8,053,542 Due to Assigned Fund 17,350 37,091 Reserved funds - new residential facilities 3,664,447 3,087,075 Deferred revenue 4,236,194 7,374,075

31,647,623 36,361,861

NET FINANCIAL ASSETS (NET DEBT) 44,352,798 51,383,897

NON-FINANCIAL ASSETS

Prepaid expenditure 1,154,736 388,866 Inventories 905,605 951,608

2,060,341 1,340,474

FUND BALANCE

SURPLUS 46,413,139 52,724,371

83 cbhssjb changes in fund balance 31 march 2013

CREE BOARD OF HEALTH AND SOCIAL SERVICES OF JAMES BAY OPERATING FUND STATEMENT OF CHANGES IN FUND BALANCE YEAR ENDED MARCH 31, 2013

2013 2012 $ $

BALANCE - BEGINNING OF YEAR 52,724,371 52,875,703 Excess (deficiency) of revenue over expenditure (6,311,232) (151,332) BALANCE - END OF YEAR 46,413,139 52,724,371

The fund balance can be detailed as follows:

Excess (deficiency) of revenue over expenditure 2004-2005 (4,717,687) (4,717,687) Excess of revenue over expenditure 2005-2006 21,042,033 21,042,033 Excess of revenue over expenditure 2006-2007 7,820,381 7,820,381 Excess of revenue over expenditure 2007-2008 13,972,865 13,972,865 Excess of revenue over expenditure 2008-2009 11,035,286 11,035,286 Excess of revenue over expenditure 2009-2010 4,715,321 4,715,321 Excess (deficiency) of revenue over expenditure 2010-2011 (992,496) (992,496) Excess (deficiency) of revenue over expenditure 2011-2012 (151,332) (151,332) Excess (deficiency) of revenue over expenditure 2012-2013 (6,311,232) - Accumulated surplus as at March 31, 2013 46,413,139 52,724,371

84 cbhssjb revenue and expenditure 31 march 2013

CREE BOARD OF HEALTH AND SOCIAL SERVICES OF JAMES BAY OPERATING FUND STATEMENT OF REVENUE AND EXPENDITURE YEAR ENDED MARCH 31, 2013

Budget Actual Actual 2013 2013 2012 $ $ $

REVENUE MSSS - General Base - Operations 109,431,590 110,209,220 106,724,811 MSSS - Specific allocations - 52,617,546 49,944,063 MSSS - Special allocations - 714,668 720,405 Secrétariat Général du Secteur de la Santé et des Services Sociaux - 3,717,010 - Family allowances (Federal Government) - 319,915 277,425 CRA - CHRD - - 128,925 Other - 225,675 404,861

109,431,590 167,804,034 158,200,490

EXPENDITURE General Base - Operations 109,431,590 108,399,731 97,528,262 Specific allocations - 52,617,546 49,944,063 Special allocations - 714,668 720,405 Use of surplus - 12,383,321 10,159,092

109,431,590 174,115,266 158,351,822 EXCESS (DEFICIENCY) OF REVENUE OVER EXPENDITURE - (6,311,232) (151,332)

85

CBHSSJB regional network CBHSSJB health (msss and Regionsocial ser 18)vice network (MSSS region 18)

Whapmagoostui CMC - Community Miyupimaatisiiun (health) Centre H18 Hospital (region) CPS Cree Patient Services H18 CPS Chisasibi Airport Radisson Air

Road Wemindji

James Bay Eastmain

Nemaska Mistissini Waskaganish Oujé- Bougoumou Chibougamau H10 CPS

N Waswanipi

Quebec Ontario Amos H08 H08 CPS Val d’Or Rouyn- Noranda H08

Scale 0 100 200 km Montréal Gatineau H06 CPS

Cree Board of Health and Social Services of James Bay Box 250, Chisasibi, QC J0M 1E0 Tel 819-855-2744 | Fax 819-855-2098 Email [email protected] Web www.creehealth.org