Northwestern Health Unit

Encouraging healthy behaviours and lifestyles by promoting and protecting conditions in which all people can achieve an optimal level of health

Inspection Report on the Pikangikum Water and Sewage Systems

September 20 06

Introduction

In mid-2005, Pikangikum First Nation requested a consultation from the Northwestern Health Unit (NWHU) regarding the community's water and sewage systems. We agreed to provide this opinion, at no charge other than expenses incurred, as the community lies within our service region. Four members of the Health Unit's staff visited Pikangikum in February and again in June, for a day each. The four NWHU staff members, and their positions and qualifications, were:

- Bill Limerick, Public Health Inspector, CPHI(C), and Director of the Environmental Health and Health Protection departments; - Lyle Wiebe, Public Health Inspector, CPHI(C), and Program Manager for Environmental Health; - Valerie Mann, PhD, Director of Planning and Evaluation, and epidemiologist; - Pete Sarsfield, MD, FRCP(C), Medical Officer of Health and Chief Executive Officer.

The Northwestern Health Unit's understanding of relevant background information is:

- The Northwestern Health Unit (NWHU) is a Public Health agency, providing programs and services in the areas of disease prevention, health promotion, and health protection;

- The NWHU is governed by an independent Board of Health, and funded approximately 80% by the Provincial Government of Ontario and approximately 20% by the nineteen municipalities of the Kenora and Rainy River districts. The NWHU is not a department of the provincial or municipal governments and staff are not civil servants;

- The total budget of the NWHU is approximately $12 million/year, with approximately 150 staff in fourteen offices in thirteen communities throughout the region, and with the central administrative office in Kenora. Ignace, Pickle Lake, Sioux Lookout, Dryden, Vermilion Bay, Ear Falls, Red Lake, Kenora (2 offices), Sioux Narrows-Nestor Falls, Atikokan, Fort Frances, Emo, and Rainy River are the sites of our offices;

- While many aspects of our work require legislated direction and support from multiple provincial laws and regulations, the central and key legislation supporting our work is Ontario's Health Protection and Promotion Act (1997), and the provincial ministry which most influences our work is the Ministry of Health and Long-Term Care (MOHLTC). The NWHU is directed by provincial standards and legislation. Dr. Sheela Basrur is currently the Chief Medical Officer of Health for Ontario;

- Many First Nation ("on-Reserve") residents utilize our programs and services in some of our municipally-based offices and our staff also occasionally serve First Nation communities, upon request of the Chief and Council;

- We are aware that the primary responsibility for health services for First Nation communities, including Public Health services, is Health Canada's First Nation and Inuit Health Branch (FNIHB), and we are also aware that the existing provincial legislation empowering Public Health Units (the Health Protection and Promotion Act) states that if someone is not providing the 'mandatory' Public Health service, the regional Public Health Unit shall do so;

- The NWHU has concerns regarding infrastructure problems facing many First Nation communities in this region, including housing and water/sewage systems. Pikangikum has been

Inspection Report on the Pikangikum Water and Sewage Systems

under a FNIHB-imposed "Boil Water Advisory" in intermittent fashion for years and was at the time of the inspection.

Our requested visit to Pikangikum First Nation was understood by the NWHU to provide an expert opinion on the drinking water provision and sewage disposal systems, and on potential water- related health issues through consideration of epidemiological data and discussions with health workers. Bill Limerick and Lyle Wiebe reviewed the water and sewage systems, while Val Mann reviewed available epidemiologic data and interviewed several health workers familiar with the community, with both involving Pete Sarsfield, who directed the consultation.

Inspection Report on the Pikangikum Water and Sewage Systems

Description of Community Location and Population

Location:

Pikangikum First Nation is a remote-access community located on the eastern shores of Pikangikum Lake at the Berens River in the Sioux Lookout Zone District of northwestern Ontario (latitude 51o 47’ 59” N and longitude 93o 58’ 0” W), approximately 100 kilometres northwest of Red Lake (www.pikangikumfirstnation.ca). Pikangikum No. 14 Reserve has a land area of 8.6 square kilometres. According to the Indian and Northern Affairs (INAC) database, Pikangikum First Nation is classified as a Zone 4 community (no year-round road access to a service centre and as a result, experiences a higher cost of transportation), Subzone 3 (distance, measured directly, to the nearest service centre is between 240 km and 320 km) and Index C (geographic location between 50 and 55 degrees latitude).

Primary access to this community is via Pikangikum airport, located 1.85 km northeast of Pikangikum. Winter access is available via an ice road to Red Lake.

Atlas of Canada online access to the National Topographic System: Toporama

Inspection Report on the Pikangikum Water and Sewage Systems

Population:

Pikangikum contains one of the highest on-Reserve populations in northern Ontario, estimated by the First Nation to be approximately 2,300 with an estimated 75 percent of the population to be under the age of 25 years (http://www.pikangikumfirstnation.ca/). With the highest per capita birth rate in the zone, the population growth is estimated at 3% annually (www.ifna.ca/pikangikum.html).

The population chart below is based on the INAC 2005 Indian Register Population. Please note that according to a number of First Nations communities, the INAC Indian Register may underestimate the population due to the time periods required to register new births.

Pikangikum Population by Age, 2005

70.0 n tio la

60.0 u p o P

50.0 r t te s n 40.0 i e g e c r R

30.0 n Pe ia

20.0 d n I

10.0 0 0 2

0.0 C

0-24 Years 25-44 Years 45-64 Years 65 Years or Older A N I

The primary language of the community is Ojibway (Pikangikum dialect, 97% retention) and the secondary language is English. The following description of the residents of Pikangikum Reserve appears on the Pikangikum First Nation’s website (http://www.pikangikumfirstnation.ca/):

“The people of Pikangikum are known for the tenacity with which they have retained their aboriginal language and land-based cultural values and practices. A recent language survey carried out by the Wawatay Native Communications Society found that Pikangikum people have the highest rate of indigenous language retention in Northern Ontario. A majority of Pikangikum members still derive a significant portion of their domestic and livelihood needs from the forest and spend a significant portion of the year living on the land.”

Pikangikum No. 14 Reserve contains 387 housing units with a housing density calculated to be approximately 6 persons/house (Ontario Clean Water Agency, 2001). However, it must be also noted that these houses are small, one story, wood-frame houses containing few rooms. Personal communications with members of the Band Council indicated that there may be as many as 18 persons living in one house. Approximately 95 percent of these houses do not have piped water or sewage disposal services.

The Reserve has an on-site Band administrative office, health centre, school, recreation arena, police detachment, heat/hydro(off-grid)/water utility and garbage/sewage facility (First Nations

Inspection Report on the Pikangikum Water and Sewage Systems

Connectivity Profile, 2005). Also found in the community are three variety stores, a radio station, a laundromat, three churches and a hotel with a restaurant (http://forcedata.net/pea/about_us). Programs and services delivered by Pikangikum First Nation include the Pikangikum Educational Authority, the Health Authority, Public Works and Economic Development including the Waabameeagwan Community Development Corporation, Eshkotay Wayab power authority, Whitefeather Forest Initiative and Whitefeather Waters Alliance (tourism).

The Band administrative office is located in the former nursing station, built approximately 35 years ago, and consists of over ten rooms. The building also houses a child playcentre located in the previous nurses’ residence section. There is no water or sewage service connected to this building.

Eenchokay Birchstick school, built in 1986 to accommodate 250 students, currently has 780 students from kindergarten (K4) to Grade 12, with a Special Education department as well (http:www.ECN:Pikangikum Education Authority). Of these students, 172 students are high school students. The staff consists of 60 Elders, teachers, and paraprofessionals. There are 17 classrooms, a gymnasium, two computer labs, and several offices. The school originally contained 15 classrooms; however, the library and a closet/storage area have been since converted into classrooms. In addition, there are three permanent buildings housing two classrooms each, as well as five temporary portables. The residence for teachers (Teacherage) is located near the school.

The Pikangikum Nursing Station is designed to be an eight nurse station (www.zonedocs.com). At the time of our visits, Independent First Nations Alliances (IFNA) contracted fly-in physicians to service this and a number of other communities. The nurses are provided by First Nations and Inuit Health Branch (FNIHB) and at the times of the visits, three to four nurses were present at the nursing station.

Health Status:

1. First Nations National Health Information:

Health Canada produced a report titled “A Statistical Profile on the Health of First Nations in Canada for the Year 2000” , available on the Health Canada website: http://www.hc-sc.gc.ca/fnih- spni/pubs/gen/stats_profil_e.html. Selective highlights from that report as reported on the website are as follows:

“In 2000, life expectancy at birth for the Registered Indian population was estimated at 68.9 years for males and 76.6 years for females. This reflects differences of 7.4 years and 5.2 years, respectively, from the Canadian population's life expectancies.

In 2000, the First Nations birth rate was 23.4 births per 1,000 population -- more than twice the Canadian rate. One in five First Nations births involved teenaged mothers; by contrast, far fewer births occurred among Canadian teen women (5.6%).

In 2000, the infant mortality rate for First Nations was 6.4 deaths per 1,000 live births -- 16% higher than the Canadian rate of 5.5. The First Nations rate has been falling steadily since 1979, when it was 27.6 deaths per 1,000 live births.

Inspection Report on the Pikangikum Water and Sewage Systems

Combined, circulatory diseases (23% of all deaths) and injury (22%) account for nearly half of all mortality among First Nations. In Canada, circulatory diseases account for 37% of all deaths, followed by cancer (27%). Unintentional injury and suicide were approximately 6% of all deaths among First Nations in Canada.

The most common cause of death for First Nations people aged 1 to 44 years was injury and poisoning. Among children under 10 years, deaths were primarily classified as unintentional (accidental). For First Nations aged 45 years and older, circulatory disease was the most common cause of death.

Suicide and self-injury were the leading causes of death for youth and adults up to age 44 years. In 2000, suicide accounted for 22% of all deaths in youth (aged 10 to 19 years) and 16% of all deaths in early adulthood (aged 20 to 44 years). This compares with 20.4% in Canadian youth.

Compared with the overall Canadian population, First Nations had elevated rates of pertussis (2.2 times higher), rubella (7 times higher), tuberculosis (6 times higher) and shigellosis (2.1 times higher) for the year 2000.

First Nations hospitalization rates were higher than the Canadian rates for all causes except circulatory diseases and cancers. Where the principal diagnoses were respiratory diseases, digestive diseases, or injuries and poisonings, the rates were approximately two to three times higher than their corresponding Canadian rates.

In 2000/01, 55.8% of homes on First Nations reserves were considered adequate. This was an increase of 12 percentage points from 10 years earlier. Indian and Northern Affairs Canada (INAC) reports show that 15.7% were in need of major repairs, and 5.3% were no longer habitable or had been declared unsafe or unfit for human habitation.

In 2000/01, 98.2% of First Nations homes were evaluated as having an adequate water supply. In terms of water delivery, 60.9% of homes relied on water service provided by a piped pressurized system.” “A Statistical Profile on the Health of First Nations in Canada for the Year 2000”, Health Canada, 2005

2. Sioux Lookout First Nations Health Authority-Specific Health Information:

The Sioux Lookout First Nations Health Authority represents and addresses the health needs of 30 First Nations in the Sioux Lookout Zone including First Nations from the Shibogama, Windigo, Keewaytinook Okimakanak, Matawa, Bimose, Independent First Nations Alliance (IFNA) and Non-Affiliated Tribal Councils. Pikangikum is a member of the Independent First Nations Alliance. The following information was presented by the Sioux Lookout Health Authority:

“In 2002, 54.7% of population of the SLZ First Nations communities were under the age of 25 years. Of the rest of the population, 28.9% were between the ages of 25 and 44 years, 11.9% were between the ages of 45 to 64 years and the remaining 4.5% were over the age of 65 years.

Inspection Report on the Pikangikum Water and Sewage Systems

From 1986 to 2001, 228 suicides in all age groups were reported by the area served by Nodin (SLZ).

The TB rate in SLZ has been decreasing since its peak in 1992, although still remains high. 76% of Aboriginal TB cases in Ontario (1996-99) occurred in SLZ. Twenty-two of 33 SLZ communities experienced active TB in the past decade.

Communities require accurate and up-to-date data to use for planning of health services. Health information and data is scattered among many organizations and across different jurisdictions.” Janet Gordon, Sioux Lookout Health Authority, 2003 (http://www.changefoundation.com)

3. Pikangikum Health Information:

Searches for health status information specific for the residents of the Pikangikum First Nation were not successful. A few quotes regarding health of the Pikangikum residents were identified:

“The community often faces health, social and crime-related crises, such as medical emergencies, suicides, alcohol/drug/solvent abuse incidents, and a higher crime rate.” (www.ifna.ca/pikangikum.html)

“Pikangikum has a high number of children and young people, with high rates of pediatric respiratory disease, infection and high risk obstetrics.” (www.chiefs-of-ontario.org)

“The Pikangikum reserve, with roughly 2,000 people, has an eight year average of 213 suicides per 100,000 people, which is 36 times our national average.” (http://www.parl.gc.ca/37/2/parlbus/chambus/house/debates/011_2002-10- 21/han011_1810-E.htm)

4. Health Professionals Survey:

As a result of being unsuccessful at obtaining Pikangikum-related health information and given the limitations of time, staff, privacy issues, permission and finances required to perform either a chart review for the Pikangikum residents accessing health care at the Pikangikum nursing station or a community-wide health status survey of the residents, it was decide to interview health care personnel from the Pikangikum nursing station to determine their impressions of the prevalence and incidence of potential water-related illness. The design was a qualitative in-depth interview survey.

The interviews were structured around a survey form with the following categories: - gastrointestinal infections - skin infections - lice - eye/ear infections - urinary tract infections - viral meningitis - hepatitis - general question regarding other potentially water-related issues

Inspection Report on the Pikangikum Water and Sewage Systems

For each category, when possible and appropriate, the following questions were asked: - type of illness - health consequences - prevalence/incidence (overall amount of disease versus number of new cases) - numbers above or below expected - attributable to water - any other comments

As further definition to the “attributable to water” question, water-related illness may be categorized based on four different transmission routes and this scheme was used in defining potentially water- related illness during the interviews of the health care personnel.

1- Water-borne transmission - Water is consumed that contains pathogens, which subsequently infect the host. Water-borne diseases are faecal-oral, they pass from the faeces of one host to the mouth of another.

2- Water-washed transmission - Water serves as the positive factor through its use for personal and domestic hygiene. Faecal-oral pathogens are washed away preventing transmission.

3- Water-based transmission - Parasitic worms residing in water infect host directly through the skin.

4- Water-related insect vector transmission - Insects (e.g. mosquitoes) breeding in water or biting near water.

Common infectious agents potentially present in raw domestic wastewater: ORGANISM RESULTING DISEASE

BACTERIA Shigella species Bacillary dysentery Salmonella species Salmonellosis (gastroenteritis) Salmonella typhi Typhoid fever Vibrio cholerae Cholera Enteropathogenic Escherichia coil Gastroenteritis Yersinia species Gastroenteritis Campylobacter jejuni Gastroenteritis Legionella pneumophilia Legionellosis Leptospires species Leptospirosis

VIRUSES Hepatitis A Infectious hepatitis Norovirus (Norwalk) Gastroenteritis Rotavirus Gastroenteritis Polioviruses Poliomyelitis Coxsackie viruses “Flu-like” symptoms Adenovirus Respiratory disease Reovirus Gastroenteritis

Inspection Report on the Pikangikum Water and Sewage Systems

PROTOZOA Entamoeba histolytica Amebiasis (amoebic dysentery) Giardia lamblia Giardiasis (gastroenteritis) Cryptosporidium Cryptosporidiosis (gastroenteritis) Balantidium coli Balantidiasis (gastroenteritis)

HELMINTHS Ascaris Ascariasis (roundworm infection) Taenia saginata Taenasis (tapeworm infection) Enterobius vericularis Enterobiasis (pinworm) Taenia solium Pork tapeworm

As the nursing station health care staff was not numerous (usually one physician and three to four nurses per visit), in total, two nurses and two physicians were interviewed. Three of the health care personnel participated in a less structured interview during the first visit on February 13, 2006. Two people, including one of the original interviewees, participated in the second interview conducted on June 28, 2006.

From the interview responses, the health care professionals working in the Pikangikum First Nation Nursing Station felt that the lack of safe potable water and accompanying lack of water distribution infrastructure has contributed to the burden of illness for the Pikangikum residents. In addition, related medical issues were described, for example, lack of clean water for personal hygiene, home care of wounds and oral health care.

Specifically, it was indicated by the health professionals that the prevalence of gastrointestinal infections, skin infections, lice infestations, urinary tract infections and eye/ear infections were increased in this community compared to other regional First Nation communities and non- Aboriginal communities, and that it was probable that some of the increased prevalence could be attributed to the lack of an adequate and safe water supply system.

Inspection Report on the Pikangikum Water and Sewage Systems

Water and Sewage

Introduction:

At the request of the Chief and Council of Pikangikum First Nations, an assessment was conducted of the drinking water and wastewater services for this community. Two one-day visits were made to Pikangikum in February and June of 2006. Mr. Lyle Wiebe and Mr. Bill Limerick of the Northwestern Health Unit conducted the inspection of the water and sewage systems. The brief assessment was based on an on-site inspection of several houses, the Northern Store, police station, arena, water treatment plant, public works garage, nursing station, Teacherage, school, and sewage lagoon.

Several photographs were taken during both visits and water samples were taken for bacterial analysis during the June visit as seen in Appendix A – Photos of Pikangikum and Appendix B Bacteriological Water Analysis Results.

Although the responsibility for water and waste-water services to First Nations is shared among Band Councils, Health Canada, and Indian and Northern Affairs Canada (INAC), it was evident to the NWHU that there are many gaps and barriers that have led to a potentially dangerous public health situation. On March 21, 2006, the Honourable Jim Prentice, Minister of Indian Affairs and Northern Development, identified twenty-one Canadian First Nation communities with high risk drinking water systems, which include the water treatment and distribution systems. Our understanding is that Pikangikum was not identified as a “high risk” because it has a water treatment plant but does not have a widely connected water distribution system.

Background Information for Water Supply & Sewage Disposal:

Associated Water Management Practices in Ontario First Nation Communities, conducted by the Ontario Clean Water Agency in 2001, provided the following information on the community of Pikangikum:

“ Number of houses: 387 Number of houses with water holding tanks and trucked water: 43 Number of houses with sewage holding tanks and trucked sewage: 43 ”

A physical count of the houses was not done to confirm these numbers. According to the community Supervisor of Public Works, in June 2006, only 20 homes have hauled water and sewage services. Therefore, 367 houses or 95 percent of the community homes have no services.

Description of the Water System – Existing Facilities:

The water treatment plant was constructed in 1995 but as stated, is not connected to the vast majority of the houses. The existing facilities consist of a piped water distribution system that services the school, nursing station, Teacherage and hotel. The raw water source for the water treatment plant is from Pikangikum Lake and is fed into two conventional filtration package treatment units with chlorination (sodium hypochlorite). There is a truck-fill bay with a swing arm for the filling of water haulage trucks. Two trucks are available to deliver water. There are two

Inspection Report on the Pikangikum Water and Sewage Systems

11 public fill taps, one inside and one outside (seasonal) of the water treatment plant. The integrity of the water distribution system is unknown.

The community was on a Boil Water Advisory, at the time of inspection, because of the poor condition of the distribution system, as seen in Appendix C – Boil Water Advisory. There have been numerous breaks in the distribution lines and four dead ends in the system causing concern for maintaining correct chlorine residuals.

Strengths of the Water System; Treatment and Distribution:

1. The water operator was trained as a Class 2 Operator for water treatment and distribution. He was very knowledgeable regarding the operation of the plant. There are four water operators in total, including one Class 2 and one Class 3.

2. Water treatment at the plant was sufficient to produce potable water for the community.

3. Bacterial analysis of water could be completed on-site using the IDEXX Colilert reagent. The operator was very knowledgeable about this bacterial detection system and performed weekly routine tests.

4. Free available chlorine (FAC) was tested every day at the water treatment plant.

5. Access to potable water for general public use was present via public fill taps, as seen in the attached photos.

Problems/Barriers of the Water System; Treatment and Distribution:

1. Records indicated that appropriate chlorine residuals were adequate when taken. Unfortunately, the chlorine tests were taken sporadically at both the water treatment plant and at the end of the water distribution system.

2. Maintenance of the existing water treatment plant is required. At the time of the inspections both in February and June, the mixer used for flocculation was inoperable. The mixer should be repaired, as it is part of the operating specification of the water treatment system.

3. The water distribution system is very limited. Therefore, many residents are required to travel to the water plant to obtain their water which is collected using pails or other water containers as seen in Appendix A. It was observed that these pails are not cleaned or disinfected prior to use.

4. The water treatment plant is not accessible to all residents because of the distance and/or lack of transportation. Therefore, many residents use untreated water from the lake.

5. The water haulage trucks service only 20 houses. The water is then put into plastic holding tanks approximately 100 gallons in size. These tanks are not cleaned or disinfected nor are they connected directly to the houses. Residents state that the water from the water storage tanks is used only for cleaning/washing purposes and that drinking water is taken directly from the lake or hauled from the water treatment plant. The outside water storage tanks are not used during the winter months.

Inspection Report on the Pikangikum Water and Sewage Systems

6. The school is connected to the water distribution system, but on the advice from the principal, the school purchases drinking water from the Northern Store. The school purchases their water because of the ongoing Boil Water Advisories in 2001, with another in November of 2005. Drinking water is transported in plastic containers that are not cleaned or disinfected between fillings. The numerous and lengthy Boil Water Advisories have created a state of distrust and concern in the community regarding the safety of the drinking water from the water distribution system.

7. The water source for the Northern Store is the lake. The water treatment system for the Northern Store includes cartridge filters and an ultraviolet light. Three cartridge filters were installed to filter to one micron for parasitical removal, but no cartridges were installed. The ultraviolet light was not suitable for disinfection of parasites and therefore cartridges should be installed to ensure potable water. Secondary disinfection using chlorine is not used in the store although available as seen in Appendix A. There are no records of sampling for bacterial analysis. This water system is used in the meat department, produce department and the food premise.

8. Samples submitted from the Northwestern Health Unit on June 2006 indicated bacterial growth, as shown in Appendix B. Most residents obtain their drinking water from either the lake or water treatment plant. The containers/pails used in the homes, did not appear to be cleaned or disinfected. Samples taken from these containers indicated bacterial contamination as shown in Appendix B.

9. Even though the water from the treatment plant is bacteriologically safe, the water storage containers may become contaminated within the houses.

10. Power to the water treatment plant is provided by a diesel generator which sometimes fails. In the event of a power failure, there was no back-up power provided to the community, specifically the water treatment plant, for the past 3 years.

11. The Northern Store has a reverse osmosis water treatment system that is used to supply potable water for sale to the public. The manager of the Northern Store could not demonstrate the safety of this water through bacterial analysis. Samples taken from the reverse osmosis system and submitted by the Inspectors on June 2006 indicated that the water was bacteriologically safe for consumption as seen in Appendix B.

12. The arena, although it has a drilled well for making ice, has no other taps for drinking or the washing of hands. The non-availability of potable water for handwashing is a public health concern due to the lack of sanitary facilities (washrooms) as described in #3 under Problems/Barriers of the Sewage/Wastewater Disposal.

13. According to community sources, Health Canada Environmental Health Officers’ (EHOs) visits were infrequent. Water sampling, chemical testing, inspection and education usually provided by EHOs were therefore insufficient to ensure safe water for the community.

14. There are no design specifications of the water distribution system available at time of inspection. The integrity of the distribution system is suspect due to its speculated date of construction (approximately dated at 1950-1960). Frequent breaks in the line may also indicate a failing and aged water distribution system.

Inspection Report on the Pikangikum Water and Sewage Systems

Description of the Sewage/Wastewater Disposal:

Twenty of the 387 homes are serviced by holding tanks and truck hauled sewage. The hotel and Teacherage is also serviced by a holding tank system. Three hundred and sixty seven houses rely on pit privies for sewage disposal. The school, laundromat and nursing station have a piped sewage collection system that is pumped to the existing lagoon. The Northern Store has an aerobic system discharging into a septic field. Pumped sewage, from holding tanks, is trucked to a four-celled facultative lagoon. The lagoon is approximately 7.6 hectares and is located on the northwest edge of the community. The lagoon discharges upstream of the intake for the water treatment plant and the community.

Problems/Barriers of the Sewage/Wastewater Disposal:

1. The aerobic system servicing the Northern Store does not function properly. Sewage was overflowing from this system during the February visit and was discharged towards the lake. During the June inspection, the septic field was saturated and ponding on the surface of the ground. Photos of the Northern Store’s failing septic field are available in Appendix A.

2. Most of the pit privies observed were in a very poor state of repair. The majority were full and overflowing with sewage. Doors, in most instances, did not exist and these structures are not secure as to prevent the entrance of flies and animals. Photograph may be seen in Appendix A.

3. There are no pit privies or other sanitary facilities to service the arena.

4. Grey water (including sink, shower and wash water) from houses is discharged directly upon the ground.

5. The septic tank and field system servicing the police station is malfunctioning and sewage discharges onto the ground in proximity to the recreational swimming area.

6. The sewage holding tank servicing the hotel has a lid that is not secure to prevent the entrance of flies as seen in Appendix A.

7. The holding tank servicing the Teacherage has a broken lid and is covered with a table as seen in Appendix A.

8. The lagoon, although underutilized, was not secure and should be fenced to restrict public access. There are manholes that do not have lids within the lagoon area that may present a safety hazard.

Limitations:

The site visit and assessment was completed within two one-day visits. Detailed assessments of the water treatment, distribution, and sewage disposal for the community of Pikangikum were not completed. The community’s environmental health status was not addressed, but rather a brief assessment of water and sewer services was performed, as outlined in this report.

Inspection Report on the Pikangikum Water and Sewage Systems

Recommendations

Section A: Overall Recommendation

Northwestern Health Unit Observations:

a) The most basic of twentieth century (ie last century) health-supporting water/sewage infrastructures are not available to Pikangikum First Nation residents. This includes (but is not limited to) housing, air/water/soil contamination control and regulation, drinking/water provision and sewage disposal. In multiple conversations with federal and provincial representatives, the longstanding neglect is explained, in various rhetorical guises, through a citing of resource constraints and "big picture" considerations. b) As the "big picture" focus has been accompanied by a progressive deterioration of this community's infrastructure, it is our opinion that an immediate change in focus is needed. c) The lack-of-resources rationale is also ongoing, progressive, and equally destructive. d) The conditions witnessed at Pikangikum First Nation were, by far, the worst we have seen in the region.

Northwestern Health Unit Recommendation:

It is recommended that, in the presence of, and led by, Pikangikum Elders, Chief and Council, and consultants of the community's choosing, an immediate (in 2006) meeting of the federal and provincial Ministries of Health, INAC, and the Public Health Agency of Canada, be held in Pikangikum regarding the urgent and longstanding need for adequate water provision, housing, and sewage disposal in the community. Tangible outcomes from this meeting are required. Anything less than this constitutes a tacit approval of the present illness-producing situation, and a continued liability regarding such health hazards as outbreaks of water/sewage-related illness.

Section B: Water and Sewage Specific Recommendations

1) Safe Water Supply

Northwestern Health Unit Observations:

a) A supply of safe drinking/washing water at adequate volume is an essential requirement for a healthy community. b) Pikangikum First Nation has high-risk water provision and sewage disposal systems, with inadequate or non-existent remediation, maintenance, regulation or replacement. c) A modern and adequate water treatment plant is present in the community and is not connected to 95 percent of the homes.

Northwestern Health Unit Recommendations:

a) In 2006, using decades-old technology familiar in other parts of northern Canada, enhanced in-home water provision by trucks, appropriately provided, cleaned, and monitored, be initiated and/or improved, and this be done without charge to the residents. b) By 2010, the water treatment plant be connected to all houses in the community.

Inspection Report on the Pikangikum Water and Sewage Systems

2) Water Storage

Northwestern Health Unit Observations:

a) Surface water sources (lakes and rivers) are vulnerable to contamination. b) In-home water storage systems are subject to contamination.

Northwestern Health Unit Recommendation:

Elders, Chief and Council, and residents of Pikangikum First Nation be immediately provided with information regarding safe in-home water storage and consumption, and for treatment of possibly-contaminated local surface water.

3) Private/Residental Sewage Disposal

Northwestern Health Unit Observations:

a) Safe sewage disposal is an essential requirement for the health of individuals. b) The inadequate and decrepit wooden outhouses, used by most community residents, are dangerous to the health of the community residents. c) Most of the present homes in Pikangikum do not have the space or the structural integrity to support bathroom facilities.

Northwestern Health Unit Recommendations:

a) In 2006, utilizing decades-old technology familiar in many parts of northern Canada, community and climate-appropriate in-home and/or modern external portable-toilet sewage disposal be provided by government, at no cost to community residents. b) By 2010, homes be repaired or replaced to ensure they support bathroom facilities.

4) Community Sewage Disposal System

Northwestern Health Unit Observations:

a) Safe sewage disposal is an essential requirement for a healthy community. b) Inadequate or inappropriate community sewage disposal is contaminating nearby surface water sources, including those used for provision of drinking/washing water for many residents, and for recreation. c) There is an ongoing absence of effective provision, monitoring and regulation, safeguarding and control of community septic fields and tanks, the sewage lagoon, and chemical and wastewater disposal from the water treatment plant, by such government agencies as Health Canada, INAC, and the police station, and including the central establishments of school, Northern Store, Teacherage, and Community Arena.

Northwestern Health Unit Recommendations:

a) Immediate and coordinated increased activity by such agencies as INAC and the First Nation and Inuit Health Branch of Health Canada, and possibly (if wished by the community) the Ontario provincial government, with the accompanying active and guiding

Inspection Report on the Pikangikum Water and Sewage Systems

cooperation of the Elders, and Chief and Council in implementing these agencies' increased scrutiny and activity, is urgently required. b) By 2010, all residences be connected to the sewage collection system.

5) Community Health Status

Northwestern Health Unit Observation:

The inadequate water supply and sewage disposal systems have placed Pikangikum First Nation at high risk of illness, and it is probable that many residents of the community have suffered illnesses as a result of these dysfunctional and unregulated water and sewage systems.

Northwestern Health Unit Recommendation:

With the active and guiding cooperation of community representatives, an immediate and extensive epidemiological research process must be initiated to determine the extent of damage done by the ongoing neglect of basic health-related infrastructures.

Inspection Report on the Pikangikum Water and Sewage Systems

Conclusion

The Northwestern Health Unit representatives appreciate having had the opportunity to visit Pikangikum First Nation and to communicate with community Elders, residents, and Chief and Council. None of the four NWHU members who visited are new to the topics under consideration, nor are we naive, but we were all shocked at the extent of the neglect we witnessed. We are all willing to testify, in any forum and in a formal or informal manner, regarding our observations. We stand-by these observations but are aware that our accompanying recommendations for remedy may require community-specific modification by Pikangikum First Nation.

It has been a pleasure interacting with Pikangikum First Nation. If we can be of future assistance, please ask.

Pete Sarsfield, MD, FRCP(C) Medical Officer of Health and CEO Northwestern Health Unit 21 Wolsley Street Kenora, ON P9N 3W7 (807) 468-3147 (807) 468-4970 (Fax) [email protected]

And for:

Bill Limerick, Public Health Inspector, CPHI(C), and Director of the Environmental Health and Health Protection departments

Lyle Wiebe, Public Health Inspector, CPHI(C), and Program Manager for Environmental Health

Valerie Mann, PhD, Director of Planning and Evaluation, and epidemiologist

Inspection Report on the Pikangikum Water and Sewage Systems

Appendix A

Photographs of Pikangikum Water and Sewage Systems taken during the February and June, 2006 visits by Bill Limerick