2018 2019

ᐋᔑᑯᒻ ᐱᐳᓐᐦ ᑎᐹᒋᒨᓯᓂᐦᐄᑭᓐ aashikum pipunh tipaachimuusinihiikin annual report ᒥᔪᐱᒫᑎᓰᐅᓐ ᐊᓈᓈᑭᒋᐦᑖᑭᓅᒡ miyupimaatisiiun anaanaakichihtaakinuuch cree board of health and social services of james bay YEAR AT A GLANCE

SPRING April 20, 2018 – Official 40th anniversary Regional Assembly on Health and Social Services in Waswanipi Launch of Cree Medical app Expanded medical support at Espresso Expanded air charter service to Waskaganish and Whapmagoostui 2018 Annual CHR Training, Chisasibi 2019 SUMMER MSSS approves funding for three birthing homes ᐋᔑᑯᒻ ᐱᐳᓐᐦ Traditional birthing knowledge gathering, Chisasibi ᑎᐹᒋᒨᓯᓂᐦᐄᑭᓐ FALL aashikum pipunh Blessing ceremony for Midwifery Program tipaachimuusinihiikin Regional Suicide Prevention Conference NAN delegation visit to Chisasibi annual Social Workers’ gathering, Val-d’Or CPDP annual meeting, Val-d’Or report Hiring of Jordan’s Principle PPRO FNHMA National Conference Bush to Table training Nurses’ training ᒥᔪᐱᒫᑎᓰᐅᓐ Opening of Robin’s Nest Women’s Shelter in Waskaganish Conclusion of CERP hearings ᐊᓈᓈᑭᒋᐦᑖᑭᓅᒡ WINTER miyupimaatisiiun Launch of integration program for new managers anaanaakichihtaakinuuch Expanded pharmacy opening hours cree board of health and Launch of audiology services social services of james bay Suicide Prevention Conference, Chisasibi Waapimaausuwin Home Away from Home activity, Val-d’Or Launch of Alfresco electronic document management system Adoption of PIJ software by Youth Protection Launch of vocational program for Pharmacy Technical Assistants CBHSSJB 40 year timeline 1978-2018

1978 Foundation of the CBHSSBJ

Chisasibi Hospital opens 1981

1985 Mercury Agreement

Start of diabetes monitoring 1989

Start of Youth Healing Services 1995 and Mental Health ᒥᓯᓈ ᐱᔅᑭᐦᐄᑭᓐ Special misinaapiskihiikin Oujé-Bougoumou 1999 General Assembly Cover photo (Tatiana Philptchenko) — Cayde and Ela Snowboy, first two babies born under the care of midwives in Chisasibi—the beginning of the implementation of midwifery services that will eventually be available to women MSSS agreement on throughout the region. 2001 Non-Insured Health Benefits

With the exception of all photographs, the information in this publication may be reproduced without charge or further Public Health Department created 2002 permission, provided that the CBHSSJB is identified as the source. Download a copy at: creehealth.org

Editor — Katherine Morrow 2003 First Strategic Regional Plan Copy Editors — Patrick McDonagh, Alison Scott Layout & design — Alison Scott Design Start of Nituuchischaayihtitaau Cree-Québec Agreement 2005 Photography — Tatiana Philiptchenko, with the exception of the following: Aschii research project and Funding Framework Paul Brindamour — page 21 Opening of Multi-service Day Iain Cook — page 24 2006 Jason Coonishish — page 34 Centres (MSDCs) Marcel Grogorick — pages 17, 77, 85, 101 First regional election for Pauline Lameboy — page 59 2008 Joshua Loon — pages 39, 107 CBHSSJB Chairperson Mary Monger — pages 32, 36, 104, 108 Katherine Morrow — page 42 Creation of Nishiiyuu 2011 Wemindji CMC — page 44 Unknown — page 126 Launch of website 2013 www.creehealth.org Annual Report of the Cree Board of Health and Social Services of James Bay, 2018-2019 © 2019 CBHSSJB Launch of medical air charter Box 250, Chisasibi, QC J0M 1E0 service with Air Creebec 2015

ISSN 11929-6983 (Print) Biennial Regional Assembly to ISSN 1929-6991 (Online) 2016 define Strategic Regional Plan Legal deposit — 3rd trimester 2019 National Library of Canada Opening of inland Robin’s 2017 Bibliothèque et Archives nationales du Québec, 2019 Nest Women’s Shelter Launch of midwifery Biennial Regional Assembly 2018 services in Chisasibi on community partnerships contents

ᐋᐦᑰ ᓃᔮᓐ aauuk niiyaan about us 8 ᐋᑎᔅᑳᑑᐦᒡ ᐋᐱᑎᓰᓲᐐᔨᒡ aatiskaatuuhch aapitisiisuuwiiyich organigram 10

ᐋᑎᔑᔨᒡ ᐄᔨᔨᐅᐎᒡ aatishiyich iiyiyiuwich population map 11

1 2 3 4 5 6

ᑳ ᐱᒥᐱᔨᐦᑖᑦ ᐱᒧᐦᑌᐦᐁᐤ ᓂᔒᔫ ᒥᔪᐱᒫᑎᓰᐅᓐ ᒥᔪᐱᒫᑎᓰᐅᓐ ᐋ ᐅᐦᒋ ᐱᒥᐱᔨᐦᑖᑭᓂᐎᒡ ᐋ ᒥᓯᓈᓱᑦ kaa pimipiyihtaat pimuhteheu nishiiyuu miyupimaatisiiun ᐋᐱᑎᓰᐎᓐ ᑳ ᐃᔅᐱᔨᑦ ᔔᔮᓐ miyupimaatisiiun aa uhchi pimipiyihtaakiniwich aa misinaasut kaa office of the chair pimuhteheu nishiiyuu Miyupimaatisiiun aapitisiiwin ispiyit shuuyaan Chair and Executive Director 14 Pre-Hospital Emergency miyupimaatisiiun Medical Affairs and Services 65 administrative financial Board of Directors 16 Services and Emergency AED Nishiiyuu DPSQA - Health 69 Measures 33 Miyupimaatisiiun 56 services statements Council of Nishiiyuu 17 Allied Health 72 Youth Healing Services 35 Human Resources 105 Breakdown of gross Executive and Senior Midwifery 74 expenses by program 117 Management 18 Youth Protection 36 Financial Resources 107 Psychosocial 76 CBHSSJB financial Corporate Services 19 Program Development Information Technology and Support 38 Chisasibi Hospital 77 Resources 108 statements 118 Council of Physicians, Dentists Specialized Services 81 and Pharmacists 20 Public Health 39 Material Resources 109 Council of Nurses 22 Community Wiichihiituwin Miyupimaatisiiun Centres (Cree Patient Services) 112 Service Quality and Complaints 24 (CMCs) 83 Population Health Profile 26 ᐋᐆᒃ ᓃᔮᓐ aauuk niiyaan About us

1978 ᑳ ᐄᒋᔅᑖᐦᒡ ᐊᔅᒌ ᐊᒋᐦᑖᓱᓐ ᐊᑰᐦᑦ ᐧᐄᔅᑳᒡ ᓂᔒᔫ, ᒥᔪᐱᒫᑎᓰᐅᓐ (ᒥᓯᐧᐋ ᐄᔨᔨᐤ ᐄᑕᐧᐄᓐᐦ Founded in 1978, the Cree Board of Health and In addition to CMCs, the CBHSSJB operates ᑳᐦ ᑎᑰᒡ ᒥᔪᐱᒫᑎᓰᐅᓐ ᑭᔮ ᓂᑐᐦᑯᔨᓐ ᐋᐧᐄᐦᒡ ᑖᐱᑎᐧᐃᐱᔨᐦᐆᒪᑳᓐᐦ) ᐋᐧᐄᔨᒡ ᑭᓂᐧᐋᐱᐦᑖᑲᓄᐄᔨᒡ Social Services of James Bay (CBHSSJB) is the 29-bed Chisasibi Regional Hospital, three ᑭᓂᐧᐋᐱᐦᑖᑭᓅᒡ᙮ ᒥᓯᐧᐋ ᐋᐧᐋᓐ ᐋ ᐧᐄᒋᐦᑦ ᐆᑦ ᐄᔨᔨᐤ ᐋᐱᑎᓰᐧᐄᓐ ᑭᔮ ᒥᓯᓂᐦᐄᒑᐅᑭᒥᒄ᙮ ᐅ ᒫᒃ ᒥᓯᓂᐦᐄᑲᓐ responsible for the administration of health and homes for youth at risk, a Regional Public ᐊᔅᒌᔨᒡ ᐊᑰᐦᑦ ᐧᐋᒡ ᑭᓂᐧᐋᐃᐦᑖᑯᓯᑦ᙮ ᐊᓐ ᒑ ᐄᔥ ᐧᐋᓯᑕᑲᓅᐧᐄᔨᒡ ᓂᔮᔨᓐᐦ ᐱᔅᑭᑎᓯᓂᐦᐄᑭᓐᐦ ᐋᐧᐄᐦᑕᑯᒡ ᑖᓐ social services for all persons residing perma- Health Department and program planning unit, ᑭᐧᐋᐱᐦᑎᒫᔨᒡ ᐋᐱᑎᓰᐧᐄᓐᐦ ᑭᔮ ᒥᔪᐱᒫᑎᓰᐅᓐ ᒧᔮᒻ ᐋ ᑳ ᐄᔅᐲᔨᒡ ᐋᐱᑎᓰᐧᐄᓐᐦ ᐅᑦ ᒥᓯᓂᐦᐄᒐᑭᒥᑯᒡ᙮ nently or temporarily in Region 18, the adminis- ­Wiichihiituwin (formerly Cree Patient Services) trative region of the Ministry of Health and Social liaison offices in Chibougamau, Val-d’Or and ᐄᔥ ᒥᓯᓈᑖᐦᒡ ᑯᐹᒃ ᐧᐄᔔᐧᐋᐧᐄᓐᐦ᙮ ᐹᐊᓛ ᐹᑕᐧᐋᐱᓅ ᓃᑳᓂᔅᑭᒻ ᐊᓂᔮ ᒥᓯᓃᐦᐄᒑᐅᑭᒥᑯᒡ Services of Quebec corresponding to the Cree Montreal, and a recruitment office in ­Montreal. ᐊᓐ ᐅᒋᒫᐤ ᒥᓯᓂᐦᐄᒑᐅᑭᒥᒄ ᐊᑰᐦᑦ ᐊ ᑎᑰᒡ ᒥᔪ ᐱᒫᑎᓰᐧᐄᓐ ᑭᔮ ᓂᑐᐦᑯᔨᓐ ᐋ ᐧᐄᔨᒡ territory of James Bay. Our mandate is defined in The Head Office is in Chisasibi. Chapter S-5—An Act respecting health services ᐊᓂᑖ ᒋᓵᓰᐱᔨᒡ᙮ ᓃᔮᔨᓐᐦ ᐊᓂᐦᐄ ᒑᐧᑳᓐ ᐋ ᑭᓂᐧᐋᐱᐦᑖᑭᓅᐧᐄᔨᒡ, ᐊᑯᑦ ᐊᔅᑎᐱᐦᔨᒡ ᐊᓂᔮ ᑳ and social services for Cree Native­ persons. The CBHSSJB is governed by an elected ᐋᐱᑎᓰᔅᑕᑲᓄᐧᐄᔨᒡ ᐅᑦ ᒥᓯᓃᐦᐄᒑᐅᑭᒥᑯᒡ: ᐊᓂᒋ ᐲᐦᑕᓰᓂᐧᐋᑲᓅᐧᐄᔨᒡ ᒑ ᒋ ᒫᒨᐧᐄᔅᑖᐦᒡ ᒥᔪᐱᒫᑎᓰᐅᓐ ᑭᔮ Board of ­Directors whose Chairperson is Bella ᒑᔅᑖᐱᑎᓰᔅᑖᐦᒡ ᒥᔪ ᐱᒫᑎᓰᐧᐄᓂᔫ ᒫᒧᐧᐃᐦᑕᐧᐃᒡ ᓂᑐᐦᑯᔨᓐ ᐋᐱᑎᓰᐧᐃᓐᔫ᙮ ᐊᓂᒌ ᒫᒃ ᑳ ᒫᒨᐧᐄᐧᐃᐱᔅᑖᐦᒡ In each of the nine communities of Eeyou Ist- M. ­Petawabano. Advisory Committees and ᐋ ᑭᓂᐧᐋᐱᐦᑖᐦᒡ ᐊᐱᑎᓰᐧᐄᓐᐦ: ᐱᒧᐦᑕᐦᐅ, ᒥᔪᐱᒫᑎᓰᐅᓐ ᑭᔮ ᓂᑑᑯᔨᓂᔫ ᐋᐱᑎᓰᐧᐃᓐᔫ ᐊᓐ ᑭᔮ chee, the CBHSSJB operates a Community Mi- ­Councils report directly to the Office of the ᐅᒋᒫᐤ ᑳ ᓈᑭᑎᐧᐋᔨᐦᑎᒃ ᐋᐦᐋᑳ ᓃᔅᑳᒑᔨᒡ ᐄᒧᐧᐄᓂᔫ yupimaatisiiun Centre (CMC), which is similar to Chair, as do the Service Quality and Complaints an Integrated health and social services centre Commissioner and the Medical Examiner.­ The ᑭᔭ ᐋᐱᑎᓰᐧᐄᓂᔫ, ᑭᔮ ᐊᓐ ᑳᓂᑑᒋᔅᒑᐄᐦᑎᐦᒃ (CISSS) elsewhere in Quebec. CMCs offer ser- Executive Director is Mr. Daniel St-Amour. ᓂᑐᐦᑯᔨᓂᔫ ᐋ ᐧᐄᔅᑖᐱᔨᐦᐧᐋᒡ᙮ ᑖᓂᔨᓪ ᓭᐁᓂᑦ - ᐋᐦᒨᕐ vices in general medicine, home care, ­dentistry, ᐋ ᐧᐄᐦᑰ ᐧᐋᒋᒫᐧᐄᑦ ᐊᓂᑖ ᒥᓰᓇᐦᐄᒐᐧᐄᑲᒥᑰᒡ᙮ social services and ­allied health. 8 9 aatiskaatuuhch aatishiyich iiyiyiuwich ᐋᑎᔅᑳᑑᐦᒡ ᐋᐱᑎᓰᓲᐐᔨᒡ aapitisiisuuwiiyich ᐋᑎᔑᔨᒡ ᐄᔨᔨᐅᐎᒡ EEYOU ISTCHEE POPULATION council of nishiiyuu JULY 2018 Puvirnituq council of physicians, dentists and pharmacists Chisasibi 4,843 board of Eastmain 849 directors council of nurses Mistissini 3,872 Nemaska 840 SERVICE quality and complaints Kuujjuak Oujé-Bougoumou 854 Waskaganish 2,473 Waswanipi 2,073 Wemindji 1,557 executive Whapmagoostui 1,031 direction CORPORATE SERVICES 18,394

Kuujjuaraapik

Whapmagoostui Great Whale Caniapiscau nishiiyuu administrative pimuhteheu miyupimaatisiiun Radisson La Grande miyupimaatisiiun services Chisasibi

Wemindji

Eastmain 10 pre-hospital community medical affairs human resources 11 Eastmain Nemaska emergency services development and services and emergency complementary medicine financial measures services and resources Waskaganish Rupert Mistassini programs dentistry Oujé- Bougoumou youth healing pharmacy information services organizational technology Mistissini quality and nursing resources Chibougamau youth protection cultural safety Matagami evaluation and allied health material 109 Waswanipi 167 program accreditation resources St-Jean Amos 113 Distance from Montréal development and client midwifery Saguenay Whapmagoostui 1757 km support experience and wiichihiituwin Rouyn organizational Noranda 117 Chisasibi 1466 km disability services psychosocial (formerly cree performance patient services) Val-d’Or Wemindji 1394 km (special needs) 155 Québec Eastmain 1232 km chibougamau maanuuhiikuu Nemaska 1033 km 117 (mental health) chisasibi Waskaganish 1130 km Trois Mistissini 795 km community Rivières chisasibi miyupimaatisiiun montreal hospital Oujé-Bougoumou 732 km public health centres 40 va l- d’o r 105 15 Waswanipi 820 km awash (0-9 yrs) 50 Cree community Gatineau Montréal uschiniichisuu (10-29 yrs) chisasibi chisasibi Ottawa CBHSSJB office chishaayiyuu (30+ yrs) hospital eastmain hospital serc (surveillance, hospital mistissini evaluation, research, airport units communications) nemaska town/city There is approximately an additional 5% non-permanent clinical oujé-bougoumou residents who also receive services from the CBHSSJB. services autoroute waskaganish The 0 to 4 year-old age group size has been corrected secondary highway nursing waswanipi using the MSSS 2013-2016 births (+ 2017 estimates) and the MSSS 2012-2015 deaths numbers. specialized wemindji gravel road services Sources: MSSS, JBNQA Cree beneficiary list, 2018; whapmagoostui MSSS Births databases 2013-2016; MSSS Mortality 0 100 200 300 administration databases 2012-2015; Statistics Canada 2016 Census. km ᐆ ᐱᔅᑭᑎᓯᓂᐦᐄᑭᓇᒡ ᐊᑰᐦᑦ ᒫᓯᓈᑖᐦᒡ ᑖᓐ ᐋᓯᓈᐦᑯᔨᒡ ᑭᔮ ᑖᓐ ᐋ ᒋᔅᑳᑑᔨᒡ ᒥᔪᐱᒫᑎᓰᐅᓐ ᑭᔮ ᓂᑐᐦᑯᔨᓐ ᐋᐱᑎᓰᐧᐄᓐ ᐋᐧᐄᐦᒡ ᑭᓂᐧᐋᐱᑖᑭᓅᒡ ᐋᐱᑎᓰᔖᐧᐄᔨᒡ ᐋᓯᓈᑰᔨᒡ ᐆᑦ ᐊᐱᑎᓰᐧᐄᓂᐧᐋᐤ ᐄᔨᔨᐧᐄᔨᒡ ᐋᐦᐋᐱᑎᓰᔅᑐᐊᑳᓅᐧᐄᔨᒡ᙮ uu piskitisinihiikinach akuuht maasinaataahch taan aasinaahkuyich kiyaa taan aa 13 chiskaatuuyich miyupimaatisiiun kiyaa nituhkuyin aapitisiiwiin aawiihch kiniwaapitaakinuuch aapitisiishaawiiyich aasinaakuuyich uut apitisiiwiiniwaau iiyiyiwiiyich aahaapitisiistuakaanuuwiiyich. 1 This chapter presents an overview of the CBHSSJB, the health of the population and the activities of the Board of Directors and Executive. ᑳ ᓃᑳᓂᐱᔥᑎᐦᒃ ᐆ ᒥᓯᓂᐦᐄᒑᐅᑭᒥᒄ kaa pimipiyihtaat office of the chair ᑳ ᓃᑳᓂᐱᔥᑎᐦᒃ ᒥᔨᐱᒫᑎᓰᐅᓐ ᐆᒋᒫᐤ ᒥᔨᐱᒫᑎᓰᐅᓐ ᐊᓈᓈᑭᒋᐦᑖᑭᓅᒡ ᐆᑏᔨᒨᐎᓐ ᐊᓈᓈᑭᒋᐦᑖᑭᓅᒡ ᐆᑏᔨᒨᐎᓐ kaa niikaanipishtihk miyupimatisiiun uuchinaau miyupimatisiiun anaanaakichihtaakinuuch anaanaakichihtaakinuuch uutiiyimuuwin uutiiyimuuwin MESSAGE FROM THE CHAIR MESSAGE FROM THE EXECUTIVE DIRECTOR

The year that has passed is marked by remark- I am proud of our team and our Executive This past year has been the year of partner- Another important effort has focused on reinvig- able achievements for our organization. Four Director Daniel St-Amour, who has earned the ships, as we set about building strong links orating the Miyupimaatisiiun Community Com- decades ago, in April 1978, the CBHSSJB was trust of our staff, our communities, and our gov- with each community and other Cree entities, mittees. While each community has one of these formed. Eeyou/Eenou control over health and ernmental and private sector partners. Daniel including the Grand Council of the Cree and committees, many are not very active. However, social services was an important condition works tirelessly for the benefit of our People, the Cree Nation Government, to implement the these committees are crucial for enabling us to of the 1975 James Bay and Northern Quebec not only in administering services, but also in comprehensive strategic plan given to us by develop strong and effective local partnerships, Agreement signed between Premier Robert securing long-term funding and ensuring that the population. which in turn will allow us to develop appropriate Bourassa and the Cree Nation led by the late capital projects benefit our communities. community projects. Billy Diamond. For instance, we worked with the communities When we began in 1978, many people doubted to sign all the First Responders agreements, so We are working closely with communities, The CBHSSJB took over operations of a small that we would be capable of running our own now each community provides the First Re- building partnerships and embarking on col- hospital on Fort George Island, eight tiny nurs- services. We proved the doubters wrong. Not sponders services and we support them with laborations because, ultimately, this is how we 14 ing posts and an annual budget of $2 million. only are we successful, but our model of gover- resources—a partnership that ensures a more can have the strongest impact on health care. 15 Everything that we have today, described in nance and organization are studied by other First sustainable and effective service. We also came Healthy individuals grow out of healthy families, detail in this report, has been developed in the Nations policymakers and by different levels of to an agreement with the Cree Trappers’ Asso- while the health of the family is closely bound to intervening years. government across Canada. I have been invited ciation and other partners to support the Bush that of the community. We are in a supporting to speak about our governance model to the First Kit program. And we are developing partner- role: we cannot ensure everyone’s health, but We started the year with a celebration of the Nations Health Management Association, the ships with community resources: for example, instead we have to work with partners to bring 40th Anniversary, that coincided with the sec- Federal NIHB, and the Nishnawbe Aski Nation. we are working with the Cree Nation of Was- about miyupimaatisiiun. That is our goal: we ond Regional Assembly in Waskaganish. The I also had the privilege of joining the Board of wanipi to pilot a long-term transition centre for are working to help communities, families and outcome of the Assembly was a Declaration of Directors of the Canadian Red Cross Society. Elders, with the eventual goal of having such a individuals to take charge of their health. Partnership signed by representatives of the 10 centre in every community. communities of Eeyou Istchee. As this report is being finalized, in June 2019, I met the two first babies born in Chisasibi under We made significant progress in developing our Later in the year we had a blessing ceremony to the newly launched midwifery program. We cel- infrastructure further, as the Ministry of Health Daniel St-Amour launch Midwifery Services in Chisasibi. Women ebrate new life and look forward with optimism and Social Services of Québec approved our Executive Director with low risk pregnancy are now able to be fol- as we face the challenges of the coming year, clinical plans for Community Miyupimaatisiiun lowed by a midwife and if all is well, give birth in and the decades to come. Centres in Waskaganish, Oujé-Bougoumou and the community. This is the realization of a long Whapmagoostui, as well as the clinical plans for held dream of the Eeyou/Eenou people, to bring the new hospital in Chisasibi. Further, we have birth back to our territory. Bella M. Petawabano built Youth Healing Services’ new custody cen- CBHSSJB Chair tre, and have developed a clinical plan for youth healing and addiction services. The clinical plan for long-term care in Chisasibi was approved by the Board of Directors this year, we opened our second Robin’s Nest women’s shelter in Was- kaganish, and we constructed 129 new housing units. So we continue to grow as we develop services to address the needs of the population. kaa niikaanipishtihch ᑳ ᓃᑳᓂᐱᔥᑎᐦᒡ board of directors

Regular meetings: 4 | Special meetings: 3 MEMBERS Clinical Staff Representative Chairperson Dr. Darlene Kitty Cree Regional Authority Representative­ Non-Clinical Staff Representative Bella M. Petawabano Reggie Tomatuk Vice Chairperson BOARD COMMITTEES | meetings: 5 Mistissini Community Representative Administrative & Human Resources­ Committee Christine Petawabano ᑳ ᒫᒨᐱᒡ ᓂᔒᔫ Bella M. Petawabano Executive Director Daniel St-Amour kaa maamuupich nishiiyuu Daniel St-Amour Christine Petawabano Council of ­nishiiyuu Community Representatives A. Thomas Hester L. George Pachanos, Chisasibi L. George Pachanos Jamie Moses, Eastmain Dr. Darlene Kitty ᑳ ᒫᒨᐱᒡ ᓂᔒᔫ ᒋᔅᒋᓄᐦᐅᒧᐙᐅᒡ The Council of Nishiiyuu­ provides Christine Petawabano, Mistissini Audit Committee | meetings: 4 Edna Neeposh, Nemaska Allan George ᑳ ᓃᑳᓂᔥᑭᒥᔨᒡᐦ ᓂᑐᐦᑯᔨᓐ guidance to the Board of Directors Minnie Wapachee, Oujé-Bougoumou Jonathan Sutherland ᐋᐱᑎᓰᐎᔨᐤ ᐅᐦᒋ ᐊᓂᔮ and the organization based on their A. Thomas Hester, Waskaganish L. George Pachanos knowledge of Cree ­history, values and Jonathan Sutherland, Waswanipi ᐅᒋᔅᒑᔨᐦᑎᒧᐎᓂᐙᐤ ᑳ ᐃᔅᐱᔨᔨᒡᐦ Vigilance Committee | meetings: 4 | conference calls: 2 ­traditional healing ­practices. Emmett Georgekish, Wemindji Bella M. Petawabano ᐙᔥᑭᒡ ᐄᔨᔨᐤᐦ, ᐃᔑᐦᑣᐎᓐᐦ ᑭᔮ Allan George, Whapmagoostui Daniel St-Amour Annie Weistchee, Washaw-Sibii (Observer­ status) 16 Christine Petawabano ᐄᔨᔨᐤ ᐋᓂᔅᒑᐤ ᓂᑐᐦᑯᐦᐄᐙᐎᓐᐦ᙮ 17 Jonathan Sutherland

Moses Petawabano Advisory Committee | mtgs: 5

Susan Esau submitted her resignation at the 2018 September board Bella M. Petawabano meeting, having accepted a position within the organization. A. Thomas Christine Petawabano Hester replaced her as the Waskaganish representative on the board. Edna Neeposh Emmett Georgekish was appointed as the Wemindji Representative in October 2018 to finish the remaining portion of Tyler Shanush’s mandate. Emmett Georgekish

Photo, left to right: Earl Danyluk, Nancy Danyluk, Jane Kitchen, Elizabeth Dick, Roderick Pachano, Robbie Dick. Missing: Laurie Petawabano, Robbie Matthew and Janie Pachano. Abel Kitchen passed in February 2018. ᑳ ᐱᒥᐱᔨᐦᑖᒡ ᐋᐱᑎᓰᐎᓂᔨᐤ ᐋ ᐎᒡ ᐎᔨᐱᔨᐦᑖᑭᓄᐐᔨᒡ kaa pimipiyihtaach aapitisiiwiniyiu executive and senior management ᐋᐱᑎᓰᐎᓐᐦ ᒥᓯᓂᐦᐄᒑᐅᑭᒥᒄ aa wich wiyipiyihtaakinuwiiyich aapitisiiwinh misiinihiichaakamikw Office of the Chair Bella M. Petawabano, Chairperson CORPORATE SERVICES Sarah Cowboy, Service Quality and Complaints Commissioner Nancy Shecapio-Blacksmith, Service Quality and Complaints Assistant Commissioner Corporate Services continues to provide sup- Following April 2018’s launch of the Alfresco Senior Management port to the Board of Directors and associated document management solution, Corporate Ser- CBHSSJB governance functions, and oversees vices was the first department to adopt the new GENERAL MANAGEMENT Local Directors corporate communications and translation tool for departmental collaboration. Implementa- Daniel St-Amour • Executive Director Community ­Miyupimaatisiiun Centres (CMCs) services. tion and training continues under the guidance Paula Rickard • Assistant to the Executive Director Jeannie Pelletier • Chisasibi of Project Manager Kandis Weiner, who helped Justin Ringer • Director, Strategy and Organizational Rita Gilpin • Eastmain th The CBHSSJB marked its 40 anniversary in the CBHSSJB deliver the project on time and on Development Alan Moar • Mistissini 2018. The celebration started in Waswanipi during budget. A key to success was the involvement of Laura Moses • Director, Corporate ­Services Beatrice Trapper • Nemaska the Second Regional Assembly on Health and a Steering Committee representing a broad range Louise Wapachee • Oujé-Bougoumou Social Services, at which all previous Executive of users from across the organization. PIMUHTEHEU GROUP Angela Etapp • Waskaganish (Interim)3 Taria Matoush • Assistant Executive Director (AED) Directors and Chairpersons were honoured. With- Virginia Wabano • Waswanipi th Robert Auclair1 • Director, Youth ­Protection (DYP) in the scope of the 40 anniversary celebrations, The Communications unit within Corporate Ser- Stella Lameboy-Gilpin • Wemindji Marlene Kapashesit • Assistant DYP Waskaganish CMC organized a similar event in vices provided strong support to the April 2018 Martine Constantineau • Whapmagoostui (Interim) Vacant • Assistant Director (AD), Youth Criminal September. Corporate Services, in collaboration Regional Assembly in Waskaganish, with veteran with the Office of the Chair, is instrumental in -or Communications Officer Iain Cook taking a lead Justice Act and Foster Homes ADMINISTRATIVE SERVICES GROUP 18 Maria MacLeod • Director, Youth ­Healing Services­ Liliane Groleau • AED Administration ganizing these types of regional and local events. role in planning and facilitating an Open Space 19 Anne Foro • Director, Program Development and process focused on engaging community part- Denis Tremblay • Director,­ Financial Resources Schedule permitting, the third day of the quar- Support ners in a shared effort to create a healthy future Jean-François Champigny • AD Financial terly Board of Directors meeting continues to be Resources for Eeyou Istchee. The Communications team has Public Health ­Department devoted to training on topics relevant for Board been working intensively to support the Alfresco Dr. Robert Carlin • Director, Public Health (Interim) Nathalie Roussin • Director, Human Resources (Interim) members. Trainings have focused on Accredita- project, an Intranet-like platform that has already Dany Gauthier • AD, Awash and ­Uschiniichisuu François Bérubé • Director, Information Technology tion (September 2018), Health Care Improvement contributed to streamlining internal communica- Paul Linton • AD, Chishaayiyuu (December 2018), and Crisis Communications Luc Laforest • Director, Material Resources tions and giving frontline workers rapid access Jill Torrie • AD, Surveillance, Evaluation, Research and (March 2019). to clinical protocols. CBHSSJB social media ­Communications (SERC) Helen B. Shecapio Blacksmith • Director Wiichihiituwin The framework for the elections of Clinical and platforms saw continued growth and positive Emanuelle Lambert • AD Wiichihiituwin NISHIIYUU MIYUPIMAATISIIUN GROUP Non-Clinical staff Board representatives was engagement. Building on the new visual identity Laura Bearskin • AED finalized and the Board of Directors approved and brand guideline developed last year, plans Julianna Matoush-Snowboy • Director Organizational the By-law respecting the Procedure for these are underway for a redeveloped creehealth.org Quality and Cultural Safety Elections in February 2019. The elections of website, to be launched in the spring of 2020. new clinical and non-clinical representatives MIYUPIMAATISIIUN GROUP The CBHSSJB continues to work with an in-house Michelle Gray • AED (Interim) will take place during the summer of 2019. Translator as well as an outsourcing partner for Christina Biron • Assistant AED Operations The By-law respecting the Procedure for the English-French translation, and a part-time Cree Dr. François Charette • Director, Medical ­Affairs and ­Election of the CNG Representative/Chairperson translator, Mary Shem, helps strengthen the role of Services of the Cree Board of Health and Social Services­ the Cree language in CBHSSJB communications. Mario Barrette • Assistant, Medical Affairs­ and of James Bay was adopted in March 2019. Services Facebook: p19.5% to 4,560 followers 1. Following DYP-Robert Auclair’s departure from the CBHSSJB, Taria Election timelines were adjusted, the number of Philippe Lubino • Director, Regional Hospital (Chisasibi) Matoush was nominated DYP by interim effective March 22, 2019. Twitter: p0.25% to 2,000 followers electors required to nominate a candidate was re- Karine Jones • Director, Professional Services and 2. Chloe Nahas was nominated in March 2019 and is available to p Quality Assurance (DPSQA) Nursing (Interim) begin work in May 2019. duced, and provisions were added to provide for Instagram: 30.1% to 865 followers 3. Angela Etapp has been interim Local Director since November a poll to be held in person or by electronic means. Nicholas Cardinal • Assistant DPSQA Nursing 2018; Bert Blackned is on progressive return in June 2019. Leah Dolgoy • DPSQA Allied Health (Interim) Vacant2 • DPSQA Psychosocial ᑳ ᓃᑳᓂᐱᔥᑑᐙᒡ ᓂᑐᐦᑯᔨᓐ, ᓅᑖᐱᑖᓱ ᑭᔮ ᓅᒋᐦᓂᑎᑯᔩᓈᓱ kaa niikaanipishtuuwiich nituhkuyin, naataapitaasu kiyaa naachihnitikuyiinaasu COUNCIL OF PHYSICIANS, DENTISTS AND PHARMACISTS

The Executive Committee and members of the ●● Electronic Medical Records (EMR): Council of Physicians, Dentists and Pharmacists Clinical information systems needs for the (CPDP) of Region 18 have had another busy year region were reviewed, the choice of an ap- in our daily work as clinicians, and in collabora- propriate EMR for the CBHSSJB has been tion with other health professionals and manag- made, and its implementation process has ers. Our goal remains to improve the health and begun. This will help to improve clinical CPDP meeting October 2018 social well-being of our patients, their families documentation, build capacity and support and the communities of Eeyou Istchee. continuity of care. We look forward to continuing to contribute to The members of the CPDP, that ●● Mental Health: The needs of our patients, The provision and quality of medical, dental new and ongoing initiatives, such as planning families and communities are complex and is Eeyou Istchee or Cree land, and pharmaceutical services, including the for the new Chisasibi Hospital and primary care resources are limited, but mental health re- value their Northern practice. The competence of its members, remains the focus in the Territory. mains a priority for the CPDP and the Board of the CPDP and its Executive Committee. The cultural aspects and interactions of Directors. Program planning, develop- CPDP also gives recommendations on clinical, PORTRAIT OF THE CPDP 20 ment of protocols, and the recruitment, with Cree patients and families is a 21 technical and scientific aspects of the organiza- The work of physicians, dentists and pharma- retention and training of Mental Health staff tion. In doing so, the CPDP collaborates with cists in the nine Cree communities of Region 18 unique and immensely rewarding will help increase and improve services. the Board of Directors and General Manage- is both challenging and gratifying. The clini- experience. cal work of physicians in the territory involves ment of the CBHSSJB. The mandated committees of the CPDP are hospital practice as well as work in Community engaged in advancing these priorities and other The CPDP monitors ongoing and new initia- Miyupimaatisiiun Centres and in public health. CPDP EXECUTIVE COMMITTEE projects. For example, the Cultural Safety Com- tives and supports its members and committees Dentists work either at the Chisasibi Hospital mittee meets regularly to help promote cultural Dr. Darlene Kitty, President through their contribution and collaboration in dental clinic or in dental clinics in other commu- safety in the region by increasing knowledge Dr. Michael Lefson, Vice-President planning and implementing the following priorities: nities, whereas pharmacists currently work either Dr. Myriam Aubin, Secretary and comprehension through learning opportu- in the Chisasibi Hospital or Mistissini CMC. Dr. Danie Bouchard, Treasurer ●● Low-Risk Birthing and Midwifery: This nities and resources. The CPDP members con- Dr. Carole Laforest, Chief of Medicine tinue to support reconciliation through learning program has progressed such that low-risk The members of the CPDP Region 18, that is Dr. Lucie Papineau, Chief of Dentistry about Cree culture and history as important deliveries by midwives will begin in April Eeyou Istchee or Cree land, value their Northern Anh Nguyen, Chief of Pharmacy adjuncts in giving culturally safe care. 2019, improving the prenatal and postpar- practice. The cultural aspects and interactions Dr. François Charette, Director of Medical tum health of Cree women and babies, and with Cree patients and families is a unique and ­Affairs and Services (ex-officio) Our clinical departments remain diligent in of- ensuring safe pregnancies and low-risk immensely rewarding experience. In addition, Dr. Nicole Seben, Family Physician fering and improving services and resources to deliveries. the geography, weather and remoteness of the Daniel St-Amour (ex officio) the Cree population. The CPDP will continue to Cree communities provide interesting realities ●● Collective Prescriptions: The develop- address challenges and advocate improvements and opportunities. This environment is a window ment of these therapeutic tools is progress- to the quality and capacity of these services into the magnificent northern landscape, outdoor ing to enable a standardized approach to and will continue to engage with the clinical lifestyle and Cree culture and traditions. care by nurses following the therapeutic departments, the Director of Medical Affairs and guide and associated prescriptions. Services and the CBHSSJB Board of Directors Dr. Darlene Kitty and Management to provide and improve care President offered to Cree Territory patients. CBHSSJB Nurses Annual training, Montreal, November 2018 ᑳ ᓃᑳᓂᐱᔥᑑᐙᐦᒡ GROUP 1 ᓂᑐᐦᑯᔨᓂᔅᒀᐤ kaa niikaanipishtuuwaahch nituhkuyiniskwaau COUNCIL OF NURSES

In 2018-19, the Council of Nurses pursued its The Executive meets monthly by conference goal of maintaining the quality of nursing activi- call. The Council of Nurses Executive must hold ties in Eeyou Istchee, and has come a long at least four meetings a year, two of which must way since its formation in 2015. The Board and be in person. These meetings bring together senior management both expect and welcome the Council of Nurses Executive, the Execu- our collaboration on matters relating to nursing tive Director and the Director of Professional care. To deepen our knowledge of provincial Services and Quality Assurance – Health; other

realities, we attended the OIIQ (nurses’ union) guests may also be invited. Face-to-face meet- Row 1: Jonathan Linton, Celyne Brodeur, Laurence Guindon, Martine Drolet, Luc Lamarche, Jessica St-Onge, Denis Croft, convention and the annual general meeting of ings occurred in May, September and Novem- Stéphanie Nann, France Roberge, Tassia Knight, Martin Nyles, Yvan Mccomb, Mathieu Pamerleau, Daniel Bedard, Mario Grégoire, Karine Lamarche, Julie Douville, Julie Léveillé,­ Serge Dion, Lucie Audet, Stéphane Larose, Mélanie Lepage, Philippe Émard, Karine the Quebec Association of Councils of Nurses. ber 2018; the February 2019 meeting did not Lamothe, Karine St-Pierre, Nicolas Cardinal take place. Row 2: Anetta Dyeth, Sonia Lachance, Lucie Montour, Josée Nadeau, Roberta Petawabano, Marie Chantale Roy, Gabrielle Garrel, The annual nurses training is a great opportu- Daphnée Haineault, Guillaume Roussin, Edith Bobbish, Monique Laliberté, Karine Jones Row 3: Cheryl Blackned, Chudney Pierre Louis, Karine Appleby, Shirley Blackned, Alizée Lamarre Renauld nity to raise awareness of our work among the In March 2017, the President of the Council of Row 4: Kimberly Bussieres, Priscilla Weapenicappo, Adela Pop, Annie Beaudette, Rachel Danyluk, Annika Vachon, Sarah Claude 22 nursing community. At this year’s training, many Nurses Executive became a member of the Jacques, Wendy Bayona Flores, Karine Gobeil, Eleanor Gull, Nellie Joseph, Pierre Larivière 23 members expressed interest in our work and in Editorial Committee of the Therapeutic Guide, joining our ranks. responsible for the Guide and its associated GROUP 2 Collective Prescriptions. The membership list was updated in fall 2018, and a call for nominations was issued for two The Council of Nurses Executive sent a del- vacant positions. As no candidates presented egate to all meetings of the Board of Directors. themselves, at the Annual General Meeting, The Council recognizes the importance of at- Angélique Laberge and Alexandre Bui-Giroux tending and presenting a brief summary of its were elected by acclamation as Represen- activities at Board meetings. tatives for Regional Services and Chisasibi Hospital, respectively. In October 2018, Patrice The Council is in the process of setting up three Larivée resigned as President of the Executive subcommittees: Committee, and Émilie Dufour was named Act- ●● Evaluation committee for the implementa- ing President. Following elections, the Execu- tion of the midwifery program in the Cree tive Committee includes: territory ●● Émilie Dufour, Representative for Coastal ●● Regional and local needs assessment com- Communities – President mittee on geriatric/end-of-life care ●● Alexandre Bui-Giroux, Representative for ●● Regional and local care needs assessment Chisasibi Hospital – Vice President committee on mental health Row 1: Kimberly Bussieres, Lynka Morin, Valérie Potvin, Mario Ricard, Genevieve Couvrette, Jessika Faucher, Jean Sébastien ●● Geneviève Bush, Representative for Inland The development of these subcommittees will Berlinguette, Nicolas Cardinal, Sophie Frédette, Alexandre Léveillé, Martin Lewis, Christian Rinfret, Stéphanie Grenier, Marie Paule Communities – Secretary continue in 2019-20. Camblard, Daniel Harper, Joffre Maneli, Philippe Tremblay, Maryse Gagné, Alain Jacob, Daniel Laliberté, Salma Benhmidou, Michael Alexandre Moutquin, Jean-Pierre Martin, Alexis Moffat Fréchette, Martin Gagné, Isabelle Fauchon, Roger Lachapelle, Carole Audet ●● Angélique Laberge, Representative for Re- Row 2: Mélanie Lepage, Brigitte Dionne, Genevieve Bush, Michelle Vallée, Gladys Gagnon, Émilie Moreau, Kelsey-Lynn Hamilton, Elizabeth Carrier, Karence Veilleux, Nicole Lefebvre, Lysandre Hélène Desilets, Chantale Parent, France Beaulieu, Claude Héroux gional Services – Communications Officer Row 3: Irene Chu, Monique Laliberté, Paula Menarick, Jean McKinnon, Stéphanie Côté, Caroline Fillion, Karine Lamothe, Caroline and Treasurer Girard, René Yves Cantin, Claudine Haché, Ghislaine Telemaque, Alexandra Audi, Martine Roberge Row 4: Adela Pop, Marie Josée Bourgouin, Audrey Martin, Ka Man Ho, Sébastien Tremblay Row 5: Guylaine Boulah, Manon Charron, Émilie Dufour, Carole Veilleux, Chudney Pierre Louis, Véronique Lessard, Karine Jones ᐋᑳ ᓂᐦᐋᒋᐦᐄᐙᒡ ᒑᒀᓐ ᐊᓂᑐᑯᐦᔩᓈᒡ ᑭᔮ ᐐᒋᐦᔨᐙᐎᓂᐦᒡ anitukuhyiinaach kiyaa wiichihyiwaawinihch Dr. François Charette Medical Examiner and Director of ­Medical Affairs and Services (DMAS) SERVICE QUALITY AND COMPLAINTS Sarah Cowboy, Service Quality and Complaints Commissioner; Nancy Shecapio-Blacksmith Assistant Service Quality and ­Complaints Commissioner

The Commissioner of Service Quality and The Quality Improvement Working Group MEDICAL EXAMINER whether or not a sanction will be discussed at Complaints is Sarah Cowboy. The office of the continued its work to improve communication The role of the medical examiner is to analyze the CPDP Executive and then referred to the Commissioner was strengthened with the ar- between local CMCs and Wiichihiituwin. Sadly, complaints that involve a member of the Council Board of Directors. A first disciplinary committee rival of Nancy Shecapio-Blacksmith as Assis- the President of the Wiichihiituwin Client Sup- of Physicians, Dentists and Pharmacists (CPDP). was completed with reference to the Board; two tant Commissioner in May 2018. port Group at Espresso Hotel passed this year. Each complaint must be reviewed within a pre- other committees are beginning their work. This, The Working Group is made up of clients who cise timeframe and leads to a written report to a healthy response to complaints, shows that During the year, the Commissioner and spend extended periods in Montreal, and who the complainant. The Medical Examiner for the the medical examiner will not tolerate behav- ­Assistant Commissioner visited 8 out of 9 therefore have a very good understanding of CBHSSJB is also the Director of Medical Affairs iours that are significantly out of line and that communities as part of a regional community the services and areas for improvement. and Services—a dual role acceptable consider- ­complaints are taken seriously. tour. The presentations to staff focused on the ing the low expected number of cases. In the complaints process, Users’ Rights, and Code We wish acknowledge the Vigilance Committee instance of a possible or apparent conflict of The medical examiner is collaborating closely of Ethics. of the Board, which provides advice and guid- interest, the Medical Examiner requests support with the office of the Commissioner of Service ance to the office of the Commissioner. Sarah Quality and Complaints, which has reorganised The Confidentiality of Clients’ Records Policy from another medical examiner in a neighbour- 24 Cowboy and Nancy Shecapio-Blacksmith wish ing region. This has not been necessary to date. with more personnel this year. This is a neces- 25 came into effect in January 2019 and the team to extend their gratitude to the clients, family sary collaboration considering the difficulty of began to train employees on the importance of members and employees who take the time The number of complaints referred to the reaching out to complainants living in different confidentiality. The goal is to train all employees to report situations. Their efforts help improve medical examiner grew again this year. This is communities and obtaining, for analysis, local by the end of the year. the overall quality of care provided by the a healthy evolution, as it indicates that patients, medical files as well as relevant files from hospi- The Office of the Commissioner was part of CBHSSJB. employees and others are taking the opportunity tals outside Eeyou Istchee. Professionals need the Eeyou Istchee Working Group in support to signal that services and providers may not be to be reached and the case discussed, which of the Public Inquiry Commission on relations at a sufficient level of quality. We welcome their can take longer than the targeted response time. between Indigenous Peoples and certain public complaints, which are usually constructive and are meant to assure that we correct an issue. The medical examiner’s goal, in the end, is services in Québec (known as CERP), which help improve health care services. In several concluded hearings in October 2019. The Three complaints received this year were of suf- instances, brief discussions held with the CBHSSJB provided input to the Commission ficient seriousness that they had to be referred complainant and professional can resolve on situations of systemic racism in the health FILES OPENED 2018-19 to the Executive Committee of the CPDP for the what at times is a simple misunderstanding or and social services and helped guide individu- formation of a disciplinary committee. Such a ­communication gap. als who wished to provide testimony to the committee is a quasi-judiciary group of the pro- Complaints 120 44.6% ­Commission about their own experiences. fessional’s peers that will review the complaint Finally, I appreciate the opportunity to be in direct contact with our clients, giving me the op- Requests for assistance 56 51.4% or complaints, hear out the complainant and the There was a significant increase in the num- portunity to better understand the realities and ber of files opened, which was to be expected professional involved, and report back to the Ex- Consultations 33 83.3% shortcomings of our services. given the team’s presence in the communities. ecutive of the CPDP, which will then recommend It remains a challenge to resolve files in the Interventions 26 116.7% expected timeframe. It is very helpful when lo- Referred to Medical Examiner 10 42.9% cal management take the time to address and Complaints The confidential toll-free number for complaints solve situations at the local level. Referred to HR and others 12q20.0% 1-866-923-2624 (1-866-923-2624) is connected to voicemail, so it is [email protected] essential that the caller state their name, phone number, creehealth.org/about-us/users-rights and community so that the Commissioner can call back. ᐄᔨᔫᐎᔨᒡ ᐅᒥᔨᐱᒫᑎᓰᐅᓂᐙᐤ iiyiyuuwiyich umiyupimaatisiiuniwaau POPULATION HEALTH PROFILE

Each year we report on the health status of the This rapid growth is reflected in the propor- Unlike the rest of Quebec, the region has few The region also shows differences from Quebec population, providing general evidence to sup- tion of youths to adults (youth population 0-19 low-birth-weight infants and a long history of in terms of chronic disease patterns. An analysis port the first strategic orientation of the Board: compared to working-age population aged many high-birth-weight ones (around 11% of of 2011 to 2015 found that cancer diagnoses and to catch up with the key indicators of health 20-64) greatly elevated compared to all Quebec births, about 10 times higher than the rest of deaths remain lower than or roughly the same as and social well-being observed for the general (73% versus 34%). Conversely, the proportion Quebec). Data from 2015-16 to 2016-17 indicate those of Quebec. Kidney cancer, while relatively population of Quebec. This year the focus is on of elders 65 and over to working-age adults rates of caesarean sections of Eeyou women rare elsewhere, is the most common cancer demographics and physical health, especially is much lower than in Quebec (12% vs. 31%). significantly higher than for women in the rest of diagnosed in the region, with lung and colorec- chronic diseases. Further, 30% of Eeyouch are under 15 (33% Quebec (31.6% vs 24.9%), but data for 2017-18 tal cancers ranked second and third. Notably, in 2013) compared to 16% for Quebec, while shows an important drop to a level similar to Eeyouch are being diagnosed with these can- The CBHSSJB provides services to all people 56% are under 30 (58% in 2013) compared to the rest of the province (25.2% vs 24.8%). Fetal cers at younger ages than elsewhere in Quebec in the nine communities within Health Region 33% for Quebec. There are relatively few older growth retardation has always been significantly (59.6 years compared to 67.7 years). This period 18. Based on 2016 census figures (unadjusted people: 6% aged 65 and over, compared to lower in Eeyou Istchee than in the rest of Que- saw on average 15 deaths per year from cancer, for undercounting), the total resident population 19% for Quebec. bec, but prematurity has increased in the last 10 primarily of lung and kidney cancer. 26 of the region was 17,141 including 16,220 First- years to a rate 27% higher than Quebec’s. 27 Nation residents (or 94.8% of the total resident The population also has extreme linguistic dif- Diabetes and related chronic diseases are the population) and 865 non-First-Nation residents ferences, an important point for services. Of In 2016, one young child in three was being most widespread of Region 18’s physical health (65 Inuit, 65 Metis or multiple aboriginal origins Indigenous residents, 97% speak Cree (96% raised in a lone-parent family in 2016, but these issues. In 1983, 2.4% of Eeyouch aged 20 or and 735 non-aboriginals, the latter being mostly report speaking Cree at home). Further, 95% children were also likely to be living in three- more had diabetes; by the end of 2017, this had transient professional workers). speak English and 23% French, with only 5% generation households. Almost one in five ba- increased to 26.7% – almost 3,000 people. The speaking neither. bies (17.5%) is born to a mother under twenty. good news is that the number of new cases is The James Bay and Northern Québec Agree- Between 2013 and 2017, there were on average remaining relatively stable, and over the past ment’s Eeyou beneficiary list provides another A baby boy born in Eeyou Istchee between 60 births annually to teenage mothers; of these, fifteen years, the age at which people are be- source of population figures. Since 1975, the 2012 and 2016 is expected to live 74.2 years 41% (25 births) were to mothers 17 or younger. ing diagnosed has been gradually increasing. Eeyou population of Region 18 has more than (70.9 if born between 1981 and 1985), signifi- The most recent information (2018) show that By 2017, 656 Eeyouch with prediabetes were tripled, going from 5,000 in 1976 to almost cantly lower than the 80.3 for Quebec; for a this age group has high rates of sexually trans- registered; ff these, 45%, or 292 Eeyouch, 9,100 in 1990, and now to 18,394 (adjusted baby girl, life expectancy is 79.4 years (76.3 if mitted infections. continue living diabetes-free, probably because for undercounting) in 2018. Just over 58% of born between 1981 and 1985), compared to they successfully made small but consistent life Eeyouch live in the coastal communities, with 84.3 years for Quebec. changes to remain healthy. almost 42% in the inland ones. Between 2013 and 2018, the Eeyou population has grown From 1983-87 to 2013-17, the fertility rate per 10.5% compared to about 4.1% for the rest of woman in the region has dropped from 2.3 to 1.5 42% INLAND COMMUNITIES Quebec. The region’s annual growth has re- times that of Quebec. From 2013-17, there were mained steady at 2.4% over the past 25 years. 342 births annually on average, a sharp decline from the 387 annual average births for 2003-12. Since 1975, the Eeyou population of Region 18 has more than tripled, going from 5,000 in 58% COASTAL COMMUNITIES 1976 to 18,394 in 2018. JBQNA BENFICIARIES (2018) When mothers are diagnosed with gestational One troubling statistic is the sudden increase The statistics for diabetes and heart disease diabetes (GDM), the transient form of diabetes in foot ulcers and diabetic amputations. In the show the importance of mobilizing communi- during pregnancy, their infants are more at risk three years between 2006-7 and 2008-9, 23 ties towards prevention. The traditional teach- of developing type 2 diabetes as adults; GDM Eeyouch aged 20 or over were hospitalised with ings to help individuals and families live healthy is also a risk factor for these mothers. In Eeyou foot ulcers; from 2015-16 to 2017-18, this had lives are generally known and understood, but Istchee, mothers diagnosed with GDM were increased to 67, which, when adjusted, is 7.1 many individuals remain vulnerable, and the diagnosed with type 2 diabetes on average 8 times greater than the Quebec rate. These hos- communities and the health care system need years later. However, many women have not pitalizations increased steadily from the earlier to work together on innovative, patient-centred progressed to type 2 diabetes. While we do not period to the latest. By contrast, amputations approaches to addressing the unmet needs of have complete records of women with GDM showed a relatively stable pattern up to the these patients. The change that will lead to a in the past, we are able to track 824 mothers 2012-13 to 2014-15 period, although roughly 7 healthier Nation will only come with real com- diagnosed during pregnancy. By the end of times the Quebec rate. However, between that mitment from the leadership and the commu- 2017, 29% of these women had progressed to a period and the most recent one, amputations nity members within the Cree Nation. This is the 28 diagnosis of type 2 diabetes. Of the remaining roughly doubled from 23 to 50. challenge for 2019-20. 29 588, 147 (25%) had been diabetes-free for 10 or more years since having had GDM. The remain- From 2013 to 2015, 22 Eeyouch died with dia- ing 441 (75%) were diabetes-free although they betes as an initial or secondary cause. Sig- had had GDM fewer than 10 years before. nificantly, the average age at death was much lower than in Quebec (68.0 vs 78.7). The traditional teachings to Diabetes in young Eeyouch remains a concern. help individuals and families Diabetes is a risk factor for circulatory dis- Almost one person in five with diabetes – 560 live healthy lives are generally people – is under 40, including 28 youth under eases, or the diseases associated with heart 20, most of whom have difficulty in managing and stroke. Even without diabetes, these also known and understood ... their disease (only 4 in 10 had been success- remain an important health problem in the re- the communities and the gion. From 2013 to 2015, 77 Eeyouch died from ful in keeping their glucose at target levels). health care system need to While all had normal kidney function on blood circulatory system diseases; again, the average tests, urine tests revealed 6 in 10 showing early age at death was significantly lower than in the work together on innovative, kidney damage. This group requires dedicated, rest of Quebec (69.9 vs 80.1). patient-centred approaches. specialized attention from health and commu- nity services to help them learn to live well with their diabetes. ᐱᒧᐦᑌᐦᐁᐤ ᐧᐄᒋᐦᐄᐧᐋᐱᔨᐤ ᒑ ᒋ ᒥᔅᑰᐦᑳᐴᑕᑭᓅᐧᐄᔨᒡ ᐋᐱᑎᓰᐧᐄᓐ ᐄᔨᔨᔫᐧᐄᔨᒡ ᐋᐱᑎᓰᔅᑖᐦᒡ ᒑ ᒋ ᒥᐧᔮᔩᑖᐦᑯᐦᒡ ᐋ ᐧᐄᒥᔅᑰᐦᑳᐳᐧᐄᔨᒡ ᐋ ᐧᐄᐧᐋᔫᐱᐦᑕᑲᓅᐧᐄᔨᒡ ᒥᔪᐱᒫᑎᓰᐅᓐ ᑭᔮ ᐄᔨᔨᐧᐄᔨᒡ ᐋ ᐧᐄᒋᑲᐳᔅᑐᐧᐋᑲᓅᐧᐄᔨᒡ ᒥᓯᐧᐋ ᐋᐧᐋᓂᒋ ᒑ ᒋ ᒥᔫ ᐱᒪᑎᓰᔩᐦᒡ ᐋ ᐧᐄ ᐧᐄᒋᐦᐋᑳᓅᐧᐄᒡ᙮ pimuhtahuu wiichihiiwaapiyiu chaa chi miskuuhkaapuutakinuuwiiyich aapitisiiwiin iiyiyiyuuwiiyich 31 aapitisiistaahch chaa chi miywaayiitaahkuhch aa wiimiskuuhkaapuwiiyich aa wiiwaayuupihtakanuuwiiyich miyupimaatisiiun kiyaa iiyiyiwiiyich aa wiichikapustuwaakanuuwiiyich misiwaa aawaanichi chaa chi miyuu pimatisiiyiihch 2 aa wii wiichihaakaanuuwiich.

The Pimuhteheu Group helps make our services stronger through good planning, and works on creating healthy communities through partnerships. ᐱᒧᐦᑌᐦᐁᐤ pimuhteheu ᐆ ᒋ ᒫᐤ ᒌᔩᔅᑎᐦᑉ ᐋ ᐐᔭᔅᑏᐦᒄ ᐊᐙᓐ ᐱᒧᐦᑌᐦᐁᐤ ᐊᐐᔔᒫᑭᐦᓂᐎᑦ uuchimaau pimuhteheu chiiyiistihp aa wiiyastiihkw awaan awiishuumaakihniwit MESSAGE FROM THE AED PIMUHTEHEU PRE-HOSPITAL EMERGENCY SERVICES

Taria Matoush AND EMERGENCY MEASURES Assistant Executive Director

This past year the Pimuhteheu Department led The Public Health Department has been heavily PRE-HOSPITAL EMERGENCY SERVICES providing immediate aid until medical personnel the Empowering Youth and Families project, involved in community development, building Pre-Hospital Emergency Services aims to: are able to treat more serious medical conditions a CBHSSJB priority as identified in the Stra- partnerships and providing networks to support and injuries to Cree hunters and trappers living tegic Regional Plan. While we are leading this youth and families; in addition, we have orga- ●● Ensure quality emergency pre-hospital on traditional territory. Bush Kit funding has been project, all of the CBHSSJB’s units and depart- nized some very inspiring and informative site services and health care, and secured with the Niskamoon Corporation, and ments are engaged in ensuring its success. visits to Harlem Children’s Zone for representa- ●● Perform continuous quality improvement policy outlines on training courses and respon- This highly collaborative effort has involved tives of Mistissini, Waswanipi and Oujé-Bou- along the Pre-Hospital Emergency Services sibilities of maintaining the Bush Kits have been aligning the core service units, including Youth goumou.The Empowering Youth and Families intervention chain. completed. Training manuals for land-based Healing Serv ices, Youth Protection and Public project also involves a major restructuring of Pre-Hospital Emergency Services is composed users and staff are being developed. Health, in addition to working closely with Miyu- group homes, with the intent of dedicating one of First Interveners, Call Centres (Police or Eeyou Eenou Police Force officers are being pimaatisiiun and Nishiiyuu Departments and the entirely to land-based healing programs. Youth CMCs), First Responders Services, Ambulance trained to use Automated External Defibrilla- CMC in the pilot community of Mistissini. Protection has also restructured their manage- Services and Reception Centres (CMCs). ment model with the aim of providing better tors; 47 out of 88 officers received the training, 32 The Empowering Youth and Families project administrative support to the teams in the Upon successful completion of 72 hours of and 25 defibrillators will be purchased. 33 aims to reduce the number of Youth Protection MSSSQ training, first responders receive a communities. The restructuring’s objective also Department representatives visited a Cana- interventions in Eeyou Istchee by enhancing certificate valid for three years. An overview of intends to create and support better collabora- dian Red Cross Emergency Response Unit in front-line services and developing community the pre-hospital emergency services training tion with the front-line services of the CMCs. Schomberg, Ontario, and participated in the partnerships that can provide safety networks quality was conducted this past year. In addi- Nanook-Nunalivut Operation to test mobile hos- for our young people. A further goal of the The Pimuhteheu Department has experienced tion, first responders service agreements were pital equipment in the Arctic. A memorandum program is to prevent as much as possible the several changes with experienced managers signed with the nine Eeyou Istchee communi- of understanding is under negotiation between removal of children from their families to foster leaving and new ones coming in. I especially ties, and relationships between first responders the Canadian Red Cross, the CHBSSJB and homes. To help us achieve this goal, we created want to thank Evike Goudreault, former co- and each community have improved. A registry the Cree Nation of Chisasibi, and a proposal is the Empowering Youth and Families work group ordinator of Disability Services, for her years of certified first responders is being developed in development. that is responsible for planning, organizing, with the CBHSSJB, Robert Auclair, who led the and statistics compiled in order to issue first leading and monitoring various services and Department of Youth Protection for ten years, responders honorarium payments. programs both within the organization and with and finally Julianna Matoush, who led Maan- our community partners. uuhiikuu (Mental Health) and has now moved to The switch from a paper to an electronic first NUMBER OF FIRST RESPONDERS AND the Nishiiyuu Department. I wish them all well in responders intervention form should provide a NUMBER OF CALLS RECEIVED their future endeavours. clearer picture of the first responders activities at the operational and clinical levels. The imple- Taria Matoush mentation of the electronic form will require Assistant Executive Director the creation of a skills maintenance training program as well as the organization of a new ChisasibiEastmainMistissiniNemaskaOujé-BougoumouWaskaganishWaswanipiWemindjiWhapmagoostui response system.

Pre-Hospital Emergency Services signed an 18 5 14 13 8 16 12 17 21 124 agreement with the Cree Trappers’ Association to make Bush Kits available for treating minor in- juries and addressing health conditions, and for 180 178 123 159 109 320 152 196 101 1,518 ᐅᔅᒋᐱᒫᑎᓰᐎᓐᐦ ᐋ ᒦᓂ ᓍ ᒋ ᐦ ᑖ ᑭᓄᐎᐦ ᒡ uschipimaatisiiwinh aa miininwaachihtaakinuwihch YOUTH HEALING SERVICES

EMERGENCY MEASURES Youth Healing Services (YHS) is mandated to plan was unsuccessful and they returned to the Emergency Measures are implemented to contribute to the protection, rehabilitation and Centre, with school work brought to them there, assist in the event of a natural disaster or any well being—physically, mentally, emotionally where educators could help them when needed. other event that may lead to an emergency and spiritually—of all youth in its care, through While the education program is incomplete and situation. Emergency Measures interventions programs that provide safety, security and, most does not pass students to the next grade, it gives for 2018-19 include: importantly, treatment. YHS is committed to pro- them a greater opportunity to succeed once they viding a compassionate, effective family-oriented return to school. YHS and the Cree School Board ●● Emergency response Code Orange (mass program with respect to traditional values, Cree are working on an agreement to improve services. casualty) and Code Silver (armed threat) cultural teaching and language. documents completed with Chisasibi, The Bush Program offers a holistic land-based Mistissini, Wemindji, Waskaganish, Oujé- All placements are referred from Youth Protection program with camps for both inland and coastal Bougoumou and Waswanipi (YP) and come from all nine Cree communities. communities. The program teaches cultural and ●● Road closures and coastal CMC closures The majority of youth are placed under the Youth traditional Cree life skills, with Cree Elders partici- 34 declared due to high winds, blizzards and Protection Act (ordered or voluntary measures), pating in guiding the program’s development and 35 bad weather in Waskaganish, Wemindji, while some are under the Youth Criminal Justice delivering traditional knowledge. This year saw 13 Nemaska and Whapmagoostui Act (open custody). successful activities, including multi-day canoe- ing, hunting and fishing trips. Other cultural activi- ●● Code Silver (armed threat) incidents YHS has 71 employees, including a director and Brigadier-General Patrick Carpentier, Canadian Armed Forces, ties were taught at the Perch River Elders’ camp. in Nemaska,­ Mistissini, Chisasibi, Commander Joint Task Force North and Jason Coonishish, three coordinators of resources, and operates ­Whapmagoostui and Oujé-Bougoumou ­Coordinator of Pre-Hospital and Emergency Measures, during Operation Nanook-Nunalivut, a joint exercise organized in the three facilities around the clock: the Upaachikush Most employees received training in the past ●● Medivac evacuations interrupted due to Arctic by the Canadian Armed Forces Group Home Reception Centre in Mistissini, and year. Training sessions included safe food han- problems with the lights on Nemaska air- Weesapou Group Home in Chisasibi. YHS is col- dling, Boscoville training (to create culturally port runway laborating with the Cree Justice Department to relevant training and support for care workers at ●● Code Grey (toxic leak) issued for a minor build another Reception Centre in Mistissini, to be YHS), Applied Suicide Intervention Skills training leak in Waswanipi arena opened around September 2019. (ASIST), Rainbow (grieving) training (to assist chil- dren grieving the loss of a loved one due to death, ●● Valise de garde implemented as an emer- Case management is as follows: with each youth divorce, deployment or trauma) and a three-day gency response tool for CBHSSJB manag- referred, there is an admission meeting between on-site internship in intensive supervision for YHS ers, and 25 licenses were put in operation the YP worker and the YHS intake worker. A case educators at Cité des Prairies. conference is held, and a healing path plan is developed with the youth and parents to set goals The YHS team has experienced many challenges and objectives. Weekly clinical meetings are held this past year and has made significant changes to update files and discuss approaches and strat- to maintain best practices and ensure quality egies. All reports are shared with YP. services as defined in the Youth Healing Services Action Plan, which the team has been developing While Upaachikush and Weesapou Group Home for three years. The team looks forward to the ad- clients attend public school, the education of dition of a new facility in the fall and the challenge youth in the Reception Centre has previously of receiving more clientele. been carried out by a teacher at the centre. This year, due to difficulties recruiting a suitable teacher, youth were sent to public school. This ᐊᐙᔑᔥ ᓯᑮᔅᒑᐦᔨᑎᒧᐎᓐ ᐊ ᐃᐦᑑᑖᑭᓂᐎᔨᒡ awaashish sikiischaahyitimuwin a ihtuutaakiniwiyich YOUTH PROTECTION

Youth Protection’s (YP) management team was The Reception and Treatment of Signalement The Empowering Youth and Family pilot ­project consolidated this year with a new assistant direc- (RTS) service has Cree-speaking workers who was implemented in Mistissini through the col- tor responsible for management and clinical ser- respond to reports regarding Cree children and laboration of many departments (CMC, YHS, vices for all children under YP. Three coordinators their families coming from concerned com- Public Health, NNADAP, Specialized Services) were hired, each assuming management of YP munity members. The service intervenes if the and external partners such as the Mistissini teams in their community, and a coordinator posi- security and development of a Cree child is Band Council. The project aims to: tion was created to manage regional services. All suspected to be compromised, as specified by these management positions are filled by Cree the Youth Protection Act. ●● coordinate actions of interveners to ensure persons. At the end of the year, Mr. Robert Auclair an effective response to the needs of youth announced his resignation as Director of YP after In 2018-19, RTS received 3,699 calls, with 863 and families through preventive and least ten years of commitment. An interim director is in reports being retained for further evaluation. intrusive approaches, while using cultural place, with the search for a new one underway. The remainder were not retained for a variety approaches and practices where possible of reasons. Once a signalement is retained, the ●● empower families with regard to their own 36 The previous data collection information sys- DYP must decide if the child’s security or de- responsibilities 37 tem, PAM, has been replaced with PIJ, which velopment is in danger, so the case is referred ●● ensure participation of youth, families and is used by all YP agencies in Quebec and is to the local YP team. In situations of presumed the community specifically developed to gather clinical infor- sexual or physical abuse, or severe neglect, mation. This system offers a better vision of a special investigator evaluates the situation ●● make better use of front-line services services and is an important tool for assessing and coordinates efforts with the local YP team ●● reduce the number of youth referrals to YP the performance of services. as well as with external partners. If the child’s ●● reduce the number of foster home placements security or development is determined to be YP’s Regional Services, mainly based in Chisa- in danger, the YP worker takes charge and sibi, include legal, administrative and liaison decides on measures required to put an end to supports—among them, a new liaison position the situation of child endangerment and prevent created to help follow youth placed in Youth it from recurring. Healing Services (YHS). Youth Criminal Justice Act services are also coordinated on a regional Staff turnover is high and the replacement of YP basis. The regional team includes four special workers and social emergency workers remains investigators designated to evaluate reports of a serious challenge. presumed sexual or physical abuse, or severe neglect of children. RECEPTION AND TREATMENT OF SIGNALEMENT (RTS) Staff turnover is high and the replacement of Youth Protection workers and social emergency workers remains a serious 3,699 863 challenge. CALLS REPORTS RECEIVED RETAINED ᐋᐱᑎᓰᐐᓐᐦ ᒑ ᒋ ᒥᔫᐲᑖᐦᑭᓄᐎᒡ ᒥᔪᐱᒫᑎᓰᐅᓐ ᐋᐧᐄᔨᒡ ᑭᔮ ᐋᐄᐦᐄᑭᔅᑮᐦᑭᓄᐎᒡ ᑭᓂᐧᐋᐱᐦᑖᑲᓄᐧᐄᔨᒡ apitisiiwiinh chaa chi miyuupiitaahkinuuwich kiyaa aaiihiikiskiihkinuwich miyupimaatisiiun awiiyich kiniwaapihtaakanuwiiyich PROGRAM DEVELOPMENT AND SUPPORT PUBLIC HEALTH

Over the last year, the department continued to ●● Support for implementing recommenda- The First International Conference on Health nel within our department over the past six years. strengthen its role of supporting and collabo- tions from the home care assessment, in Promotion took place in Ottawa, Canada over The following examples illustrate this capacity: rating with front-line services in the community. collaboration with the Miyupimaatisiiun 30 years ago on November 21, 1986. This con- It has expanded to include the new Midwifery Department ference established some guiding principles on ●● the provision of robust vaccination programs, 1 including the ability to review their quality Services unit, while the existing units—Mental ●● Collaboration with the Miyupimaatisiiun what is meant by health promotion . Health, Disability and Pre-Hospital Emergency Department on the evaluation of a project ●● the ability to respond to new health pro- Health promotion action means: Services and Emergency Measures programs— on dementia tection issues, such as the surveillance of have been reinforced by new members. opioid, drug and alcohol intoxications ●● Evaluation of speech therapy services, in ●● Building healthy public policy ●● the development of relationships with part- The Planning unit’s development of plans, collaboration with the Miyupimaatisiiun ●● Creating supportive environments ners through the Maamuu Uhpichinaausu- evaluations and collaborations with other de- Department ●● Strengthening community actions utaau committee, Miyupimaatisiiun Meeyo- partments was possible thanks to the arrival of Ongoing activities include: ●● Developing personal skills chimoon network or local Miyupimaatisiiun new staff. The team’s achievements include: ●● Development of a Miyupimaatisiiun service ●● Reorienting health services committees 38 ●● Approval of two clinical plans by the integration model ●● the delivery of breast cancer screening 39 When I read through this year’s Public Health MSSSQ for the construction of three birth- services to all the communities ●● Development of the framework for chronic report, skimmed the community stories of the ing centres and a regional centre for addic- disease management, in collaboration with CBHSSJB, and observed a variety of initiatives ●● the implementation of extensive research and tion rehabilitation the interdepartmental working group from entities within Eeyou Istchee, it reminded surveillance activities to inform our actions ●● Pilot phase implementation of the Awemi- ●● Evaluation of the client satisfaction survey, me about the collective effort that has taken The regional Public Health Department aims iniwaachihisuunanouch Program to support in collaboration with Miyupimaatisiiun place to contribute to the miyupimaatisiiun people with addictions, including training a to protect these gains, to continue to develop ●● Development of outreach services for ado- of the population. Hopefully, members of the first group of professionals on the ASI (Ad- the capacity of our department, to support the lescents, in collaboration with Public Health ­CBHSSJB Public Health Department have diction Severity Index) assessment tool actions and development of our own organiza- ●● Collaboration on the design of functional helped in this effort. tion as well as our community partners and to ●● Completion of the evaluation of the Bush and technical plans for the construction of respect the speed with which communities and Kit Program and the creation of local part- The capacity of our department to address some the Birth Houses, the Addiction Rehabilita- individuals can engage with us. nerships with the Cree Trappers' Associa- of these large-scale issues has increased over tion Centre, the CMCs and the Regional tion (CTA) and the Niskamoon Corporation. time. We have transitioned from a small unit lo- Hospital Centre Dr. Robert Carlin This was followed by obtaining funding for cated outside the region to a large and vibrant de- Director of Public Health the Bush Kit Program ●● Update of the resource directory in the pro- partment increasingly based out of Mistissini and vincial system, in accordance with MSSS made up of a diverse workforce. ●● Planning for and implementation of requirements It has been humbling as a pub- ­midwifery services ●● Preparation of activity reports for first lic health director to witness the ●● Support for the development of the Optilab ­responders growth and energy of the person- project, in collaboration with the coordina- tion team of laboratory services Dr. Anne Foro Director of Program Development and Support ●● Collaboration with the Band Council on the plan to improve services in the Elders home

Public Health Team 1. World Health Organization, The Ottawa Charter for Health Promotion https://www.who.int/healthpromotion/conferences/previous/ottawa/en/index1.html [accessed May 10, 2019] Promoting and improving the well- being of pregnant women, babies, children aged 0 to 9 and their families through a culturally-safe and ᐊᐧᐋᔥ integrated services approach with added psychosocial and community AWASH 0-9 development components

The  Mashkûpimâtsît Awash (AMA) ­Program This past year, the Breastfeeding Program EEYOU ISTCHEE IMMUNIZATION PROGRAM The Dental Health Program sent a question- offers ongoing psychosocial follow-up tailored and the Baby-Friendly Initiative (BFI) provided 2018-19 naire to all dental hygienists to acquire in- to the needs of families. AMA also aims to breastfeeding training and support to 68 front- formation on their needs. Seven completed develop partnerships at the local, regional and line workers. Furthermore, five communities School-age children (all grades) questionnaires were received, with the informa- provincial levels to promote better coordination organized activities to celebrate Breastfeeding tion indicating the need for dental hygienists’ considered protected 94.1% of existing services. This year four booklets of Week with mothers and their babies and fami- from measles 2.6% calibration (to ensure the sealant program is the AMA Guidelines were printed. A face-to- lies. Eeyou Istchee's breastfeeding needs as- administered in the same rigorous way by all) face meeting was held for the region’s com- sessment was a success, with 213 completed and other regional training. The new dental munity organizers. Regional partnerships were questionnaires from all nine communities, and health PPRO began a tour of the communities, Children & workers (all schools) pursued with five meetings of the Maamuu six communities holding focus groups. A litera- visiting Waswanipi and Mistissini. adequately protected 91% Uhpichinaausuutaau Committee, a network of ture review to collaborate in the development of against measles during partners interested in early child development. a handout on cannabis use while breastfeeding previous school year 32.8% In the past year, the Pour une maternité sans was done. The breastfeeding chapter of the danger (PMSD) Program processed and ana- 40 The Maternal and Child Health Program offers Obstetrical and Perinatal Care Guidelines was lyzed 129 requests, and compared them to stan- 41 support to assist local Awash teams to improve dard provincial practice guidelines. The evalua- updated. Children their counseling and teaching skills, to support tions and recommendations concern physical, DCaT-HB-VPI-Hib first 72% home visits and to enhance promotion and The Cree Leukoencephalopathy and Cree dose within 75 days biological, ergonomic, chemical and psycho- prevention efforts by applying evidence-based Encephalitis (CLE/CE) Program aims to improve (2 mos,14 days) 7.9% social risks during pregnancies. The CBHSSJB­ guidelines in maternal and child health interven- awareness about these genetic illnesses. This physician for PMSD provides support to the tions and activities. Collaboration with other past year, training that had been developed for health and safety nurse regarding the PMSD and CBHSSJB departments was maintained even school health nurses was adapted to the front- Children recommendations made through it. though the program saw notable staff turnover. line Awash nurses and given to them at the Men-C-C first dose within 379 47.8% annual nurses’ training; it was then evaluated by days 7.7% This past year, the Canada Prenatal Nutrition Sainte-Justine Hospital, an important partner (1 yr,14 days) Program within Awash received over seven for the Eeyou Istchee CLE/CE program. requests for financial support to help over 60 pregnant women in need. In addition, the first As in previous years, the Immunization Program Children OLO (oeuf, lait et orange) pilot project, Miyuu- prioritized the support of all Eeyou Istchee local RRO-Var 18-month dose 43.3% ashimishuh, is in preparation phase in two vaccinators. The flu campaign and immunization within 562 days (18 mos,14 days) q27.8% communities to provide food assistance as well schedule were posted on creehealth.org. Efforts as nutrition and food budgeting activities to were deployed to ensure adequate record keep- pregnant and breastfeeding mothers who wish ing and reporting of all vaccines administered to participate. in the communities. An evaluation of equipment and immunization product management was carried out in all CMCs, followed by a report with recommendations. Improving the health of youth through planning and implementation of appropriate health services in ᐅᔅᒋᓃᒋᓲ communities, clinics and schools and by addressing developmental needs USCHINIICHISUU 10-29 in the transition to adulthood

The Healthy Eeyou Youth Project (HEY) aims This past year, the Infectious Diseases Surveil- The objectives for the Dependencies and to facilitate access to psychosocial and clinical lance and Protection Program supported the Addictions Public Health Program include services in order to improve youth health and control of clusters and outbreaks of infectious strengthening knowledge and awareness about well-being in Eeyou Istchee. Collaboration with diseases as well as declarable infections. This various substances and their abuse. Pub- the Department of Program Development was program works closely with outside partners lic Health participated with multiple regional continued, and a needs assessment question- (including the Ministère de l’Agriculture, des partners in harm reduction activities focusing naire was administered and completed by front- Pêcheries et de l’Alimentation du Québec) to on substances impacting Eeyou Istchee. To line workers of all communities. Subsequently, support surveillance (including ‘vigie’), preven- address the legalization of cannabis, many training on different outreach approaches was tion, control and evidence-based management information and harm reduction posters and provided and the creation of a framework to of infectious diseases. The program aims to handouts were developed and distributed. support outreach workers throughout Eeyou improve population health by reducing (or con- An information section was published on Istchee is underway. Training, information ses- trolling) the incidence of infectious diseases and creehealth.org, and radio messages were aired sions and presentations were made at events their complications in the region. on local and regional radio. 42 such as the annual nurses training and the 43 Regional Youth Health Assembly. Collaboration The School Health Program has school nurses with the pilot project To Heal Oneself in Was- Concerning sexual health, the Uschiniichisuu are present in most communities, who receive sup- wanipi is ongoing and consists of supporting the most at-risk population segment, account- port from Public Health to improve health pro- the prevention outreach worker hired locally. ing for 92% of all chlamydia trachomatis cases motion and prevention in the schools. Channels and 87% of all gonorrhea cases on the terri- of communication between the Cree School The Injury Prevention and Safety Awareness tory. The main public health activities in 2018-19 Board and Public Health were maintained with Campaign on the use of helmets to decrease consisted of providing support and evidence- four meetings last year, leading to collaboration the incidence of head injuries by children and based recommendations to local clinicians in and engagement in new projects such as the youth focused on bicycling. The campaign, assessing and managing certain at-risk patients regional Breakfast Club Program. Chii Kayeh ᐊᔮᐧᑳᒥ! ᒋᔅᑎᐧᑳᓐ! entitled “Be careful! Your head! with STI, as well as their sexual contacts. The Iyaakwaamiih (“You too be careful”), a school- Ayâkwâmi! Chishtikwân!,” also added a new Public Health Department also promoted routine based module on healthy relationships and component: helmet use while playing hockey. annual screening (using a simple urine test) of all sexual health, was provided to many students, The campaign targets the child and youth pop- youth 10-29 years of age in the region. and its online training tool was available to ulation and uses older role models to ­influence teachers. the younger crowd.

Youth Wellness focused on consolidating the STI RATES USCHINIICHISUU (10-29) ACCESS – Open Minds Project, which is well 2018-2019 underway in Mistissini and is looking into ex- panding to Oujé-Bougoumou and Waswanipi. A newly developed program, it promotes youth Chlamydia trachomatis 325 Rate: 4,806 per 100,000 hab. wellness and the prevention of mental health 2.7% issues encountered by youth (such as issues connected with suicide and suicide ideation,

violence and sexual abuse, and loss of identity). Neisseria gonorrhea 41 Rate: 638 per 100,000 hab. 51.2% School Nurse ᒋᔖᔨᔨᐤ Promoting healthy lifetsyles and preventing chronic diseases for CHISHAAYIYUU 30+ adults and Elders

This year, various activities were organized to Our team participated in committees and We were involved in the organization of several follow our regional health promotion calendar. working groups, including the Committee on training sessions and workshops, including the This included Nutrition Month, Physical Activ- Access to Nutritious Food, the Traditional Food annual nurse, CHR (Community Health Rep- ity Month, Diabetes Awareness Month, the Drop Committee and the Urban Agriculture Work- resentative) and nutritionist trainings. To bring the Pop Challenge, the Walk-to-School Week, ing Group in Mistissini. We also contributed to awareness to the lateral violence present in our National Physical Activity Week and the 100-Mile the Chronic Disease Working Group, which is communities, 14 lateral kindness workshops Challenge, as well as running events, walking mandated to create and implement a regional were offered to different entities and groups. In clubs, snowshoe walks, the family challenge and diabetes and renal program. addition, our team offered support to daycares traditional activities. Community health and safety and CBHSSJB food services for developing messages such as ice, water, road and firearm In collaboration with Nishiiyuu, we supported menus, managing food services and implement- safety were also promoted throughout the year. local Miyupimaatisiiun Committees with their ing food safety and hygiene practices. planning and contributed to evaluating the Iiyuu The No Butts To It Challenge, which aims to get Atawin Miyupimaatisiiun Planning (IAMP) project. The Train the Trainer Program aims to increase 44 the whole community engaged in helping smok- health care providers’ knowledge on diabetes 45 ers to quit and non-smokers to stay smoke-free, To facilitate collaboration with different groups, management through training, mentorship took place in Chisasibi, Eastmain, Mistissini and departments, and entities, and to offer an op- and support. In 2018-19, on-site training was Oujé-Bougoumou. In all, 2,699 people signed portunity for networking, our team organized provided by regional diabetes educators in all up, more than doubling the previous year. monthly meetings of the Miyupimaatisiiun communities, some communities being vis- Meeyochimoon Network (Healthy Lifestyle Net- ited more than once. The diabetes team also The team also encouraged and supported work), the CBHSSJB Chishaayiyuu managers collaborated in all annual training meetings. communities to organize activities year round, and the nutrition team. Highlights included two multidisciplinary ses- with community projects to promote physical sions requested by doctors from Chisasibi and activity and healthy eating habits being funded Mistissini, as well as finalization and implemen- Wemindji clinic getting ready for selfie on World Diabetes Day through our Healthy Environment Active Liv- tation of tools to teach carbohydrate counting ing Program: 47 small grants were awarded to for diabetes management. community groups for healthy cooking work- shops, community walks, winter and summer Chishaayiyuu is involved in coordinating breast activity programs, afterschool programs and cancer screening in our region, working with community gardening projects. the local clinics and the Institut national de santé publique. This year, a needs assess- ment of the breast cancer screening process was conducted during the preparation and tour of the ClaraBus/SophieAir. Multiple quality ­improvement initiatives were implemented. ENVIRONMENT Regarding environmental emergencies, the OCCUPATIONAL HEALTH AND SAFETY Environmental Health within the Public Health team provided information at the start of sum- The Occupational Health team is responsible Department aims to inform and protect our mer on preparing for forest fires, compiled the for protecting the health of workers and pre- people from the effects of harmful substances Public Health Emergency Response Plan, held venting occupational diseases. Last year the in outdoor air, indoor air, water and food. It is regular meetings in public health emergency team recruited a prevention technician, who also concerned with reducing negative health response,; and developed plans to deploy a is now being trained. The team participated impacts of resource development projects, sensor network of forest fire smoke detectors in in a provincial working group on occupational encouraging healthy and safe community all communities. health resources, supported the CBHSSJB’s in- environments, and addressing environmental ternal health and safety efforts, and was invited emergencies. Much work involves collaboration The team validated the most recent mercury to workplaces to answer questions and em- with the Cree Nation Government (CNG), the monitoring results, updated the interactive ployee concerns. The SISAT information system Cree Trappers’ Association, First Nation Coun- mercury map, which provides fish consump- is being used to document interventions and cils and the James Bay Advisory Committee on tion recommendations for each trapline (cree- gather a portrait of needs and services across 46 the Environment. geoportal.ca), and developed and deployed Eeyou Istchee. After analyzing the risks and 47 strategies for promoting a transition to non-lead requests for services over the last 10 years, it is The team receives frequent requests from ammunition. apparent that indoor and outdoor air quality is a public and health professionals about manag- major concern for workers in our region. ing mold exposures and indoor air quality. This The team participated in the Eastmain Fo- year we collaborated with the CNG on a policy rum on Adaptation to Climate Change, and initiative around housing-related health issues. discussed climate change concerns with the First Nation of Mistissini, Waskaganish and We also submitted a proposal and started plan- ­Whapmagoostui. ning for a health impact assessment of parks and green spaces to be held collaboratively The team has been active in almost every file with the CNG Capital Works and the First Na- submission concerning developments in Eeyou tion ­Councils this year. Istchee, providing input on health impacts of projects including lithium mines (James Bay Water quality in community water distribution Lithium, Rose, Whabouchi) as well as gold systems is the responsibility of First Nation (Windfall Lake) and iron (Blackrock) develop- Councils; Public Health assisted with their pre- ments. We also required Hydro-Quebec to ventative measures for drinking water in order conduct a risk assessment on herbicides used to avoid health risks and also assisted the CNG on a new power line development. in drafting the drinking water law.

The team followed up on radon testing in Wemindji and supported another community in submitting a proposal for radon testing. ᑖᑭᔥ ᓈᑭᑎᐙᔨᐦᑎᑰᒡ ᑭᔮ ᔕᔥ ᐋ ᒋ ᓂᑐᒌᔅᒑᔩᑕᑭᓄᐎᒡ ᐋᐦᐊᑦ ᐄᔩᔭᒸᐦᐄᐙᒡ ᒑᒀᓐ taakish naakitiwaayihtikuuch kiyaa shash aa chi nituchiischaayiitakinuwich aahat iiyiiyamwaahiiwaach chaakwaan SERC, CLINICAL PREVENTIVE PRACTICES AND PUBLIC HEALTH COMPETENCY DEVELOPMENT

The SERC team is mandated to carry out public Activities around the opioid file extended be- Research provides valuable information which Public Health’s Communications strategy is health surveillance­—an exclusive and indepen- yond surveillance activities and involved many aids in preventing diseases and injuries and in organized around radio, social media and the dent core function of the regional Public Health other teams from the CBHSSJB, especially improving treatments and care to the population. CBHSSJB website, along with print materials Department—together with evaluation, research Public Health’s Uschiniichisuu team, the Plan- The CBHSSJB Research Committee has been in Cree, English and French. The team works and communications. ning and Support Department, the Pharmacy functional, holding monthly meetings from Sep- closely with Corporate Communications to use Department, the DPSQA-Health and Regional tember to June, and this past year many research social and digital media to distribute messages Surveillance is the ongoing systematic report- Pre-Hospital Services, as well as the Eeyou/ projects have been completed, are in progress or and share stories; to manage the public health ing on population health status and its underly- Eenou Police Force (EEPF). Training on opioid are under discussion. Subjects include: section of the website; to liaise between the ing determinants. The team’s work follows ob- overdose and naloxone administration was department and regional media entities to pro- jectives from the Strategic Regional Plan (SRP) developed and given to the EEPF officers and ●● physical health (interstitial lung disease mote Cree language communications; and to and those of the surveillance theme within the National Native Alcohol and Drug Abuse project, wound care technology evaluation) provide communications support for all depart- Québec’s Public Health Plan. Over 2018-19, the Program (NNADAP) workers. The first phase ●● social wellbeing (being two-spirited, social ment teams and personnel. The team also sup- surveillance team worked collaboratively with of a study of opioid prescribing practices in participation of Elders in community wellness) ports professionals in organizing their monthly other professionals and departments through- 48 Chisasibi and Mistissini was carried out through ●● health services (mental health impact on awareness campaigns and monitors how the 49 out the CBHSSJB, providing expertise mainly a review of patients’ medical charts, and results women sent to Montreal with problem preg- public responds to public health messages. in survey designs, data collection, data man- will be reported in 2019-20. As well, a pharma- nancies, genetic disease counseling evalu- The Miyupimaatisiiuun Dipajimoon Radio Show agement and analysis. The requests for new cist assessed opioid management in each of ation for CE-CLE, ACCESS Youth mental hosted 26 shows, averaging three health topics analyses and reporting, support, advice and the CBHSSJB pharmacies, and recommenda- health services, legal opioid prescription) per show. collaboration have increased markedly over the tions were implemented. last five years, whereas the staff of the surveil- ●● the environment (mining impacts, housing) With the recruitment of a new Information Of- lance team has not grown. Evaluation is a supportive function of Public Last year saw the creation of the Research ficer, the team provided training on spokesper- Health services. Even though no professional Advisory Panel as an advisory group for the son roles, media relations, and crisis communi- Several reports were completed: the cancer re- was in charge of the evaluation file last year, Research Committee. This Indigenous panel cations to the Board and Public Health. Several port, the diabetes report, a report on mortality the SERC team, and especially its surveillance consists of Elders, youth, community members communications tools have been recommend- linked to cardiovascular diseases and diabetes, team, collaborated on some evaluation files, and scholars with backgrounds in health-related ed to help improve internal and external com- and a comprehensive report on elementary providing advice on the Client Satisfaction research. Discussions are ongoing with the munications in emergency measures and crisis school students’ oral health. Other reports on Survey carried out by the Program Planning De- MUHC (McGill University Health Centre) Re- management. respiratory diseases, cannabis, suicide and se- partment and the design of the report AS-805 search Ethics Board about mutual aid for north- vere intoxications were developed. Our Global for Pre-Hospital Services. The team was also ern research review: the MUHC would review Health Report for Eeyou Istchee, an internal re- fully involved in all phases of the Breastfeeding projects for the CBHSSJB when needed, while port with ten thematic chapters, was updated, Needs Assessment Survey. The team is cur- the CBHSSJB could suggest members from the as was the statistical profile of health and the rently working with the CPDP and other CB- Research Advisory Panel to assist the MUHC demographic profile. HSSJB departments to improve end of life care with certain reviews of ­northern projects. services for Eeyou Istchee patients. We are also collaborating with the Program Planning De- partment on the Maamuuhkedaau (“Let’s do it together”) survey to measure the organizational attributes of the CBHSSJB primary­ health care system. ᓂᓈᐦᑳᑎᓰᐎᓐ ᐊᐐᐦᒡ ᐐᒋᑖᐦᑭᓄᐎᒡ ninaahkaatisiiwin awiihch wiichitaahkinuwich DISABILITY (SPECIAL NEEDS)

CBHSSJB’s Disability Services are responsible REGIONAL SERVICES completing applications. Presentations were ●● Behavior and autism training sessions for the development and provision of quality Regional services are offered to the nine Cree given in five communities and outside the region. in Waswanapi, Oujé-Bougoumou and culturally-relevant services pertaining to physi- communities through Disability Programs – Over 300 individuals attended these presenta- Montreal—these were filmed and made cal disabilities, intellectual disabilities and autism Specialized Services (DPSS) teams. tions, and a total of 35 applications have been available to local staff through web modules spectrum disorder. Their target clientele includes approved. ●● Sensory training in Montreal (three times) The DPSS Intervention team in composed of residents of the Cree territory living with a disabil- and Chisasibi (also filmed and made avail- a team leader and six clinical advisors (CAs). Special Needs Educator (SNE) positions were ity that persists over time and affects their ability able to local staff through web modules) to attain their goals; clientele also includes some Its mandate is to increase the knowledge and created to support the existing local rehabilitation ●● Case manager training in Mistissini Cree individuals residing outside of the territory. skill level in Eeyou Istchee to ensure clients with services. To date, seven SNEs have been hired disabilities receive the best services possible. and receive support from DPSS’s PPRO and ●● Presentation on FASD and Disabilities in In 2018-19, Disability Services focused on re- To achieve this, clinical advisors offered regular their local CMC or MSDC employees. New SNEs Whapmagoostui organizing and expanding its services, with the group support calls for local case managers, attended several trainings, participated in intern- The DPSS also restarted the Regional Advisory goal of offering a full spectrum of services as occupational therapists and speech language ships at local daycares, and observed local rehab Committee for special needs in partnership 50 close as possible to home for the Cree popula- pathologists, as well as punctual individual staff as a part of their orientation. The DPSS team with the Cree Nation Government and the Cree 51 tion. These services are community-based as support for complex or problematic situations. offered monthly phone support calls to SNEs as School Board, and initiated a partnership with well as regional. The CAs also travelled on 26 occasions to the well as four in-community support visits. the Nishiiyuu Miyupimaatisiiun Department to Cree communities to offer in-person support further adapt land-based activities and increase The DPSS is responsible for support to external COMMUNITY-BASED SERVICES to employees and caregivers. In 2018-19, the inclusion of individuals with disabilities. Community-based services are offered through intervention team supported local employees in residential resources and their Cree clients. the local Community Miyupimaatisiiun Cen- the follow-up of 302 clients with disabilities. In 2018-19, 21 clients resided outside of the To further increase the quality of services, the tres (CMCs) and Multi-Services Day Centres Cree region due to complex needs. The DPSS DPSS created and filled 13 new positions, (MSDCs), in collaboration with the department The Cree Neurodevelopmental Clinic complet- collaborated with local entities to ensure these including an occupational therapist support- of Allied Health. They include case manage- ed the full FASD (Fetal Alcohol Spectrum Dis- clients continued to receive culturally adapted ing external clients and residential resources, a ment and local rehabilitation services. Although orders) battery, including neuropsychology, oc- quality services: the team visited these external speech language pathologist acting as clinical these services are not directly under Disability cupational therapy, language assessments and resources and clients 14 times in 2018-19, in advisor and supporting the Cree Neurodevelop- Services, the coordinator is responsible for consultations with the development pediatrician addition to providing frequent phone support. mental Clinic, a social worker acting as clinical for 11 clients in four communities. An additional advisor, a specialized education technician act- ensuring access to these services, so a close Training sessions and presentations were given 40 clients were assessed in neuropsychology ing as clinical advisor and supporting the SNE partnership is important. Collaboration and a to ensure quality of services on territory and to as well as five in speech and language pathol- project, a PPRO for Jordan’s Principle, a PPRO common vision among partners is needed to ensure all local staff are equipped with the knowl- ogy, in six communities. 187 assessments are for the SNE project and seven local SNEs. ensure that quality services are offered to the edge and tools to best serve individuals with population. Since October 2018, the Disability still needed based on the current waiting list. disabilities and their loved ones. Some trainings In 2019-20, the DPSS will continue expanding Services coordinator traveled on eight occa- In October 2018, the CBHSSJB hired a full-time were also offered to two specialized foster homes its services and promoting interdisciplinary col- sions to the communities to meet local partners Planning and Programming Research Officer in Chisasibi and Mistissini: laboration to ensure integrated quality services and initiate collaborations. (PPRO) to promote the Jordan’s Principle Pro- are available within the communities; it also gram and to train and support communities in aims to ensure that Nishiiyuu remains at the core of Disability Services. NUUHiI A KU a U M ᒫᓅᐦᐄᑰ maanuuhiikuu ᒫ MENTAL HEALTH ᓅᐦᐄᑰ

In keeping with our vision statement, Maan- Plans for the coming year include continuing uuhiikuu has supported the communities in work on these initiatives and increasing and en- promoting positive mental health through hancing collaborations to developmental health prevention, intervention, treatment and ongoing programs and services. holistic care, so that everyone in Eeyou Istchee can enjoy a full and balanced life. PSYCHIATRY The child psychiatry program is now in its This past year saw the departure of the coor- fourth year, with two child psychiatrists on the dinator, and her replacement with an interim team. The regional clinical nurse works on the coordinator. We continued expanding com- child psychiatry file and supports the mental munity service coverage by recruiting new staff health nurses. The team collaborates closely (psychotherapist, art therapist, nurse, Planning with the Disability Program, daycares and and Programming Research Officer) to work in schools. 52 Chisasibi, Oujé-Bougoumou, Eastmain, Was- 53 wanipi and Mistissini. Two psychiatrists continue to provide adult nd psychiatric care in Eeyou Istchee, working with Making suicide awareness ribbons for the “lighting a candle” ceremony of remembrance, part of the 2 annual regional Suicide Prevention In addition, we offered trainings such as Mental Conference, September 10-14, Chisasibi one mental health liaison nurse and three local Health First Aid for First Nations in Oujé-Bou- mental health nurses (in Nemaska, Eastmain goumou and Chisasibi. In collaboration with and Chisasibi) to support clients. In addition, Nishiiyuu, we presented several sessions on SUICIDE WORKING GROUP INDIAN RESIDENTIAL SCHOOL (IRS) – a liaison nurse works from the Douglas Mental Cultural and Ethical Considerations for Working The working group continues to develop a RESOLUTION HEALTH SUPPORT PROGRAM Health Institute to provide support to Cree cli- in Cree Territory to different audiences. strategy for addressing suicide in our com- The Resolution Health Support Workers ents and their families. Video-conferencing has munities. This process includes networking (RHSW) provided emotional support to 438 been expanding and is regularly used for case We have also been collaborating with other with youth programs, collaborating with other former IRS students and 792 family members, discussions and follow-up with clients. departments on initiatives to improve services Cree entities and working with the Associa- while cultural support workers provided spiritu- on territory: tion Québécoise de Prévention du Suicide to al and traditional counselling to 155 former IRS PSYCHOLOGY develop a pilot project on the Implementation of students and 237 family members. The inter- ●● Supporting the ACCESS pilot project to Psychology services have been expanding in Good Practices in Suicide Prevention. generational impacts of the negative practices offer community-based youth mental health Eeyou Istchee and, with five full-time psycholo- of the IRS are being addressed as the younger services gists and six half-time psychologists/psycho- SEXUAL ABUSE WORKING GROUP generations are becoming more informed and therapists, services are providing more consis- ●● Working with the Psychosocial Depart- The working group delivered training programs aware. The Missing and Murdered Indigenous tent and frequent support to clients and local ment to continue developing Ishkotem, a for front line workers on using the Sexual Women file is being included within Maanuuhii- teams. We have begun to offer more support multidisciplinary pathway to better address Assault Response Protocol (SARP) and ac- kuu. According to Health Canada, this includes via telepsychology in Mistissini, Chisasibi and clients’ needs by improving communication companying Sexual Assault Response Manual missing girls, women and men. The RHSW Nemaska, improving continuity of care. between professionals and acknowledging (SARM). The training has been offered to front will be visiting all Cree communities to inquire Cree traditional approaches to well-being line workers in all nine communities; 59 workers about this file. ●● Collaborating with the Miyupimaatisiiun have completed all three phases of the program Department and DPSQA–Psychosocial to and are ready to respond to adult disclosures develop a standardized suicide intervention of sexual assault. Additional training sessions protocol for all CMCs are planned for next year. ᐆ ᓂᔒᔫ ᐧᑳᔅᒌᐧᔖᒥᑳᐦᒡ ᐊᓂᔮᔫ ᐧᐋᔅᑮᐦᒡ ᑳ ᐃᔥ ᐄᔮᑦ ᑭᔮ ᑳ ᐄᔥ ᒋᔅᒑᔨᑖᐦᒃ ᐄᔨᔨᐤ/ ᐄᓅᐧᐄᔨᒡ ᐱᒫᑎᓰᐧᐄᓂᔫ ᐋᔪᐧᐃᒄ ᐧᐋ ᐄᔥ ᑭᓂᐧᐋᐦᐱᑕᐦᒡ ᐊᓂᒌ ᐋᐧᐋᓂᒋ ᐄᔭᐲᐦᑎᓰᔅᑖᒡ ᐋᐱᑎᓰᐧᐄᓂᔫ᙮ ᐄᔨᔨᐄᑖᐦᐄᑎᒧᐧᐄᓐ ᔮᔨᑖ ᒑ ᒋ ᐋᐱᑎᐦᒡ ᐋ ᐧᐄᐦᐧᐄᒋᐦᐋᑳᓄᐧᐄᔨᒡ ᒥᓯᐧᐋ ᐄᔨᔨᐅᐧᐄᔨᒡ᙮ ᐋᑰᐦᑦ ᑭᔮ ᐊᔅᑎᐲᐦᒡ ᒋᓵᔫᐧᐄᔨᒡ ᐅᒋᒫᑳᓇᐦᒡ᙮ ᐋᑰᐦᑦ ᐧᐋᐄᔔᑖᐦᒡ ᓃᑐᐦᑰᔨᓐ ᐋᐱᑎᓰᐧᐄᓐ ᑭᔮ ᒑ ᒋᔅᑎᓈᔅᑖᐦᒡ ᒥᓯᐧᐋ ᒑᐧᑳᓐ ᑭᔮ ᒥᓯᐧᐋ ᐋᐧᐋᓐ ᒑ ᒋ ᒥᐧᔮᐱᑎᓰᐄᑦ ᐋ ᐧᐄᒋᐦᐋᑲᓅᐧᐄᔨᒡ ᐋᐧᐋᓂᒌ᙮ uu nishiiyuu kwaaschiishwaamikaahch aniyaayuu waaskiihch kaa ish iiyaat kiyaa kaa iish chischaayitaahk iiyiyiu/ iinuuwiiyich pimaatisiiwiiniyuu aayuwikw waa iish kiniwaahpitahch anichii aawaanichi iiyapiihtisiistaach aapitisiiwiiniyuu. iiyiyiiitaahiitimuwiin yaayitaa chaa chi aapitihch aa 55 wiihwiichihaakaanuwiiyich misiwaa iiyiyiuwiiyich. aakuuht kiyaa astipiihch chisaayuuwiiyich uchimaakaanahch. aakuuht waaiishuutaahch niituhkuuyin aapitisiiwiin kiyaa chaa chistinaastaahch misiwaa chaakwaan kiyaa misiwaa aawaan chaa chi miywaapitisiiiit aa 3 wiichihaakanuuwiiyich aawaanichii.

Nishiiyuu refers to the traditional ways of the Eeyou and Eenou people. The Nishiiyuu Group helps make sure that Cree knowledge and values are reflected in CBHSSJB services. ᓂᔒᔫ ᒥᔪᐱᒫᑎᓰᐅᓐ Nishiiyuu is the link with the Council of nishiiyuu miyupimaatisiiun Nishiiyuu. This department chairs the Clinical Coordination and Integration Committee (CCIC). ᐆᒋᒫᐤ ᓂᔒᔫ ᒥᔨᐱᒫᑎᓰᐅᓐ uuchimaau nishiiyuu miyupimaatisiiun MESSAGE FROM THE AED

NISHIIYUU MIYUPIMAATISIIUN Laura Bearskin Assistant Executive Director (AED) Nishiiyuu Miyupimaatisiiun The Nishiiyuu Miyupimaatisiiun Department NISHIIYUU HIGHLIGHTS FOR 2018-19 ORGANIZATIONAL CHART (January 2019) promotes a holistic approach to understanding The Nishiiyuu team more than doubled its and achieving good health and miyupimaatisii- numbers this past year, growing from nine to Assistant Mentorship un (well-being) through the principles of tradi- 21 employees. We welcome the arrival of these Director of Indigenous tional Cree knowledge and helping methods. Its new team members, and are happy to report Evaluation & Services Accreditation Canada emphasis on incorporating traditional knowl- that, with their addition, we have been able Gertie Shem Kim Neverson edge, healing practices and cultural safety in to develop two new sub departments: Iiyiyiu all programs and services of the CBHSSJB is Pimaatisiiun E Pimuhtaakanuuhch (Community an important component of the new Strategic Development) and Organizational Quality and Admin Coordinator Regional Plan (SRP). Cultural Safety. Process Translator (Coastal) Organizational PPROs Specialist Performance Vacant Vacant Our department’s main goals this year included Grace Ortepi NISHIIYUU ACTION-ORIENTED EVENTS Pauline enhancing the development of Complimentary Lameboy AND SERVICES AED Director Services and Programs and promoting the de- Admin OQCS 56 Under Complimentary Services and Programs, Nishiiyuu Technician 57 livery of culturally safe programs and services Laura Juliana we oversaw the continued development of the Amy Matoush Bearskin Sealhunter HROs throughout the CBHSSJB. We also sought to Snowboy Waapimausuwin Program. This included host- Coordinator Doris Bobbish advance community engagement and local Complementary Susan Esau ing the Gathering of Midwives, launching the Senior Translator Services & Michael Grant empowerment by sharing responsibilities for Advisor (Inland) Waapimausuwin Program and offering its teach- Programs developing community-driven programs and Kahá:wi Louise Iserhoff- PPROs ings through the Home Away from Home Project Diane George services. Jacobs Blacksmith Vacant in Val-d’Or. Traditional healing approaches were Vacant Much effort was placed on recruiting the best promoted through drafting the Engaging Elders staff possible to help us achieve our objectives Protocol in collaboration with the Nishiiyuu PPROs Council of Elders. Through Iiyiyiu Pimaatisiiun E Coordinator Clara Cooper and goals. With the majority of our positions Community Charles Esau now filled, this coming year we will be focussing Pimuhtaakanuuhch (Community Development), Development John George we shifted the focus from planning to an action- Liz Hester on evolving our work and enhancing collabora- Jeremiah Charlie Louttit Mianscum tions with others in the CBHSSJB. I would like oriented approach by formally developing and Patricia Menarick strengthening our community partnerships. We Darlene Shecapio- to give a special acknowledgement to Abraham Blacksmith have also mobilized resources to work in the Nancy Voyageur Bearskin, who retired from his coordinator Our emphasis on incorporating Vacant position on July 13, 2018. He was an important areas of organizational performance, accredita- member of this team, and we appreciate every- tion, evaluation and cultural safety trainings. traditional knowledge, healing thing he contributed to our department. practices and cultural safety I am proud and impressed with the teams’ ac- in all programs and services of complishments throughout this period of transi- the CBHSSJB is an important tion and growth, and look forward to continuing our journey to miyupimaatisiiun together, for the component of the new Strategic benefit of all Eeyou/Eenou. Regional Plan. Laura Bearskin AED, Nishiiyuu Miyupimaatisiiun COMPLEMENTARY SERVICES AND based program for youth who reside in Chisa- IIYIYIU PIMAATISIIUN E Our plan is to have a Nishiiyuu Planning and PROGRAMS sibi’s Weesapou Group Home. A literature review PIMUHTAAKANUUHCH (COMMUNITY Programming Research Officer (PPRO) in each We are working to implement three integral parts of existing land-based programs has begun, and DEVELOPMENT) community, who will collaborate with the Miyu- of our Action Plan: Waapimausuwin and Utinau- is a collaborative effort between Nishiiyuu, Pub- Robbie Matthew, one of our Elders, gave us pimaatisiiun committees to develop communi- suwin, Land-Based Healing, and Traditional lic Health and Youth Healing Services. We have the Cree name Iiyiyiu Pimaatisiiun E Pimuhta- ty-based strategies and pursue partnerships at Medicine, in alignment with the CBHSSJB’s also been exploring opportunities to partner with akanuuhch for Community Development, which the local level. The PPROs will also identify and Strategic Regional Plan (SRP). We have been others to develop land-based programs (e.g. means “carrying the Cree way of life”. communicate opportunities and priorities for making contacts with potential partners related to exploring a possible partnership with Jordan’s partnership with Chief and Council. As mem- the ongoing development of these services and Principle for a land-based project in Mistissini for We are working to activate Miyupimaatisiiun bers of the CCIC (Clinical Coordination Integra- programs. individuals with special needs). Committees in all communities and are eager to tion Committee) at the local CMC, their roles work with them on local priorities. To this end, are also to advise on matters of cultural safety The Waapimausuwin Home Away from Home For our Traditional Medicine and Healing Initia- we have met with related entities, including local and to be a bridge between CMC leadership, Project held its first activity in Val-d’Or this tive, we have also been exploring opportuni- CMC teams, the Cree Nation Government and traditional knowledge keepers and healers, and 58 past January. It was organized in partnership ties to partner with others to collaboratively the Cree School Board, to learn their thoughts the Miyupimaatisiiun Committee. In addition, 59 with the Friendship Centre, whose activities develop programs that acknowledge and on community development, share with them the work of Iiyuu Ahtaawin Miyupimaatisiiun are directed toward sharing Cree teachings. build on traditional approaches to healing. For our mandate and capabilities, and discuss how Planning (IAMP) was transferred to our depart- This activity focused on imparting traditional instance, preliminary discussions began with to best collaborate to address local priorities. ment, with ongoing collaborations with the Pub- Waspsuyan teachings. We also made progress the Allied Health Department to explore op- We are promoting the idea that these commit- lic Health Department for program evaluation. on the Miiwitt Project in Mistissini and Chisa- portunities to develop a Dementia Project that tees would work with Chiefs and Councils to sibi, with baby bundles having been made with would include a traditional Cree approach to consult broadly in their communities—engaging the assistance of Elders who also shared their imparting knowledge about this condition that individuals, families and organizations in the de- teachings on traditional birthing. affects elders in our communities. We also col- velopment of strategies to enhance miyupimaa- laborated with the Nishiiyuu Council of Elders tisiiun. We aim to support the committees, with Our collaborations with other entities for on the drafting of an Elders protocol, which other service providers as appropriate, with the Waapimausuwin also include drafting a memo provides guidance on how to consult with and goal of creating formal, multi-year partnership of understanding with a number of partners, in- request services of Elders. agreements. So far we have met with represen- cluding the Midwifery and Awash departments tatives from Mistissini, Waswanipi, Waskaganish, as well as the Cree Women of Eeyou Istchee In addition, we have started to plan and organize Wemindji and Chisasibi, and plan to meet with Association (CWEIA) and Cree Nation Govern- local gatherings to discuss traditional healing other communities in the coming year. ment (CNG). A one-day team building activity approaches in the communities. Information was held with Midwifery, Awash and Nishiiyuu gained from these gatherings will be used to departments to improve collaborations so we help us to develop programming in the coming can move forward into the new fiscal year with years and to shape the framework for the The good working relationships. Traditional Gathering of the Knowledge Keepers regional gathering scheduled for spring 2020. Our collaborations with other entities for ­Nitahuu Aschii Ihtuun (Land-Based Healing) initiatives include drafting a Memo of Understanding with Kinawit Cultural Camp site, Val-d’Or: Coaching & Facilitation Training photocredit: Pauline Lameboy the Nishiiyuu Council of Elders and holding a snowshoe walk in Waskaganish. We also began preliminary work on the development of a land- ORGANIZATIONAL PERFORMANCE the accreditation process. During the upcom- CULTURAL SAFETY This past year, Nishiiyuu also hosted a Cultural The Clinical Coordination and Integration Com- ing year, we will continue to meet with remaining The aim of Cultural Safety is to align all Day in Chisasibi for visiting representatives mittees (CCICs) and DPSQA/DMAS commit- departments to ensure that we have an overall CBHSSJB services with Cree cultural values from the Medical Affairs Department. The day tees are Nishiiyuu collaborations that provide portrait of the CBHSSJB. and realities. This process is supported by key included a guided tour of the Cultural Centre opportunities for dialogue between local repre- partners from the Nishiiyuu Council of Elders followed by traditional knowledge sharing by a We also had the opportunity to visit four CMCs sentatives and health professionals to ensure and the CBHSSJB’s Clinical Coordination local Elder and a traditional meal at the Elders this year, where we met with local directors and quality care is provided in our communities. and Integration Committee (CCIC). Nishiiyuu’s culture camp. coordinators. Our visits to Wemindji, Whapma- Our department continues to act as chair for continued role on the CCIC is to ensure that goostui, Waswanipi and Mistissini were very the Regional CCIC meetings. programs and services are delivered in cultural- Nishiiyuu also continued the collaboration helpful and eye-opening. They allowed us to ly safe ways. Local CCICs are multidisciplinary with the Maanuuhiikuu and the DPSQA-Social understand how services are organized, and to We also aim to create user friendly and accessi- teams that include a Nishiiyuu representative Departments to develop and deliver train- learn about the programs and services being ble client satisfaction surveys and evaluations for who advises local CMC directors. ing sessions aimed to promote culturally safe all programs and services. This year, we devel- delivered to communities. Visiting the hospital programming and services throughout the 60 oped and launched surveys to collect feedback and meeting with the director and coordinators CBHSSJB. We have made significant progress 61 from participants of a number of our projects, was also beneficial in providing us with a good in this area, with sessions provided to a number workshops and training sessions. This included overview of services. of front line and management staff in the past the Nishiiyuu Employee Satisfaction Survey, Cul- years (see table below), and we aim to provide ture Orientation Survey, Home away from Home Creating awareness around accreditation and more training sessions in the next fiscal year. Survey and Nishiiyuu Training/Retreat Survey. quality improvement was our second key ob- All feedback, comments and suggestions we jective. By delivering presentations to various groups and hosting a training session with the receive from these surveys are used to inform CULTURAL SAFETY TRAININGS DELIVERED and improve our programs and services. Board of Directors, we were able to provide information on the process and how it is used 2017 TOTAL NO. OF by health organizations to plan improvements; OCT EVALUATION & ACCREDITATION MAY JUNE PARTICIPANTS: 383 This year the Evaluation and Accreditation De- they also allowed us to answer initial questions and create engagement. Assessment checklist Mental health nurses orientation Social Workers: 25 partment team began preparing the CBHSSJB and nurses with enlarged roles 30 First Annual Gathering tools were developed and will be shared with to embark on the journey to accreditation. CHISASIBI MISTISSINI VAL-D’OR Accreditation is aligned with the CBHSSJB’s departments in the coming year to begin as- strategic objective of implementing best prac- sessing current services, identifying areas of 2018 tice standards throughout the organization, and strength and planning actions for areas requir- APRIL MAY SEPT OCT NOV DEC on continuously improving the quality of care, ing improvement. New nurses with enlarged roles CPDP AGA: physicians CBHSSJB nurses Wiichihiituwin programs and service delivery. We also collaborated on two working groups MISTISSINI (4 groups) (2 groups) Local Directors dentists and pharmacists 43 17 VAL-D’OR MONTREAL 133 MONTREAL This first year focused on gaining a better under- related to the Client Satisfaction Survey and the and DPSQA 90 CHISASIBI 18 standing of the CBHSSJB’s structure. By meet- Laboratory Services, which enabled us to con- Nishiiyuu team tribute information and make further linkages to CANNT Conference: meeting ing with various individuals and departments, Canadian Association MONTREAL 17 accreditation. Lastly, we participated in monthly we were able to gather information on the work 2019 of Nephrology Nurses being done, as well as existing improvement ini- teleconferences to network with accredited and Technologists QUEBEC CITY 10 tiatives and challenges. These discussions were CISSS and CIUSS in Quebec and learn from FEB their experiences. very useful and helped us make linkages with CHRs (2 groups) CHISASIBI ? ᒥᔪᐱᒫᑎᓰᐅᓐᔫ ᑳ ᒫᒨᐧᐄᔅᑖᐦᒡ ᒥᓯᐧᐋ ᓂᑐᐦᑰᔨᓂᔫ ᐋᐱᑎᓰᐧᐄᓂᔫ ᑳ ᑭᓂᐧᐋᐱᑖᐦᒡ ᒥᓰᐧᐋ ᐄᔨᔨᐧᐄᔨᒡ ᐋ ᐧᐄᐦᐧᐄᒋᐦᐋᑳᓅᐧᐄᔨᒡ ᒑ ᒋ ᒥᔪᐲᐦᐄᔨᒡ ᐅᐱᒫᑎᓰᐧᐄᓂᐧᐋᒡ᙮ miyupimaatisiiunyuu kaa maamuuwiistaahch misiwaa nituhkuuyiniyuu aapitisiiwiiniyuu kaa kiniwaapitaahch 63 misiiwaa iiyiyiwiiyich aa wiihwiichihaakaanuuwiiyich chaa chi miyupiihiiyich upimaatisiiwiiniwaach. The Miyupimaatisiiun Group is a the department that delivers 4 most of the health and social services to our clients. ᒥᔪᐱᒫᑎᓰᐅᓐ miyupimaatisiiun ᐆ ᒋ ᒫᐤ ᓂᑐᐦᑯᔨᓐ ᐋᐱᑎᓰᐐᓐᐦ ᑭᔮ ᒥᔨᐱᒫᑎᓰᐅᓐ ᐋᐄᔥ ᐋᐱᑎᓰᔅᑖᑲᓄᐎᔨᒡ uuchimaau miyupimaatisiiun nituhkuyin aapitisiiwiinh kiyaa aaiish aapitisiistaakanuwiyich MESSAGE FROM THE AED MEDICAL AFFAIRS AND SERVICES

MIYUPIMAATISIIUN MIchelle Gray AED (Interim) Miyupimaatisiiun

The Regional Miyupimaatisiiun Department is The organization is currently undergoing a GENERAL AND SPECIALIZED MEDICINE ONGOING PROJECTS responsible for delivering Health and Social major shift from a physical health perspec- The Department of General and Specialized The DGSM team continues to engage with a Services to the population of Eeyou Istchee, tive to focusing on behavioral or psychosocial Medicine (DGSM) is responsible for provid- range of projects and initiatives, including the in accordance with the Strategic Regional health, as the behavioral health approach has ing consistent medical coverage and services, finalization of the Therapeutic Guide, the return Plan (SRP)—our guide for identifying priori- been shown to improve client experience and and includes all family doctors and specialists of childbirth to the territory, the nurses’ training, ties and ensuring that people have access to to result in better care overall. working at the CBHSSJB. DGSM team mem- the standardization of clinical tools, and partici- safe quality care needed in a timely fashion. bers work together and engage with the rest of pation in local CCICs. The Emergency Medicine This process involves building strong partner- Within this shift, we have taken on the responsi- the organization to ensure integrated, seamless, unit is working on several projects, including ships to achieve objectives that are shared by bility for foster care resources. Many milestones culturally safe, effective and accessible medical standardization of emergency rooms and the other Cree entities and organizations, as no were reached for the foster care resource services for the entire population. development of Code Orange protocols. The one entity can be solely responsible for nurtur- program, from revising policies and procedures team continues its efforts to enhance special- ing miyupimaatisiiun in Eeyou Istchee. This is a to the development of a foster home guide. We TEAM STRUCTURE ized services in the territory and in our ser- holistic and collaborative effort. have implemented and will continue to adapt DGSM Chief Dr. Carole Laforest is supported vice corridors. The computerization of clinical 64 a new communication strategy to ensure the by nine Deputy Chief Medical Officers, who systems will continue to improve the quality of 65 I am proud to report that within the last year we ongoing safety of those requiring placement. coordinate the medical services of the nine care, and the electronic medical record project have witnessed many accomplishments. Among CMCs, and six Chief Medical Officers, who has made significant progress. MYLE software them, we supported the extended opening hours We have also been consolidating our manage- ment framework to nurture an environment for coordinate the specialized departments of Gen- has been selected and configuration of the at the Mistissini CMC, including pharmacy and eral Internal Medicine, Nephrology, Pediatrics, product has begun. laboratory services. We opened the second creativity, innovation and continuous quality improvement. In addition to ongoing monthly Psychiatry, Gynecology and Obstetrics, and Robin’s Nest Women’s Shelter. We reviewed the Medical Biology. Since its inception in 2015, PRIORITIES IN 2019-20 entire scope of Cree Home and Community Care meetings, we have launched a first cycle of per- formance appraisals, which will ensure that the the DGSM management group has been an Priorities for 2019-20 include developing and Services (CHCCS) to address the program’s important driver of the department’s develop- maintaining our dynamic and committed medical growing needs and to improve the safety and organizational vision is shared by all managers, professionals and staff. ment. In 2018, the heads of specialized services team, improving our local and regional clinical quality of care for our clients. Also, we have con- were integrated, so the management group is demand tracking systems (regional level and tinued working on our client satisfaction survey What does not and will never change is our complete and is a recognized decision-making service corridors), improving the organization of project. The opportunity to learn more about commitment to continuously adapt our health body in its own right. services and continuity of care, and developing how our communities perceive our services and and social services to better meet the needs of specialized services at the local level. programs is of tremendous value. Therefore, the population. We will do more of some things, MEDICAL STAFFING we have established teams for improving our perhaps less of others. We will measure key This year we reached an unprecedented level of service corridors and pathways to ensure that health indicators, share information, adopt best medical staff coverage: 90% in our small com- a broad range of services, including specialized practices and welcome more partners—all with munities and 100% for the rest of the territory, a services, are offered in the communities. the goal of providing the best possible health level that we hope to maintain. Thanks to ongoing In addition, we oversee important pilot projects and social services and programs. recruitment and retention efforts, we welcomed 40 MEDICAL DOCTORS such as the Desire to Heal Program, which five new family doctors and two new medical I want to thank our outstanding staff, whose MEDICAL SPECIALISTS enhances the continuum of services related to specialists, bringing our team to 63: forty medi- 6 dedication and talents are directly linked with cal doctors, six active medical specialists and 17 addictions, and the Home Hemodialysis pilot, our capacity to achieve our mission. 17 ASSOCIATE SPECIALISTS which will greatly improve the quality of life of associate specialists. The number of permanent patients with kidney failure. Warmly, doctors as well as their average length of stay continues to increase, thus reducing our use of Michelle Gray dépanneurs (temporary replacement doctors). AED (Interim) ᐋ ᓅᑖᐱᑖᓲᐙᓇᓅᐎᒡ aa nuutaapitaasuuwaananuuwich DENTISTRY

ᐲᐲᒑᐤ ᐅᒋᔥᑑᓐ The mandate of the Department of Dentistry Objectives for 2019-2020 include: is to provide quality general and specialized Piipiichaau Uchishtuun dental services throughout Eeyou Istchee. In ●● Renovating the Chisasibi dental clinic ROBIN’S NEST 2018-2019, the dental department staff treated ●● Implementing digital radiography in four 12,125 patients, of which 2,496 were children remaining clinics WOMEN’S SHELTER aged 9 and under. A total of 5281 different pa- ●● Planning the call for tenders for new dental tients were seen. The Piipiichaau Uchishtuun (Robin’s Nest) Women's Shelter software in Waskaganish was formally inaugurated at a ceremony on The past year saw a number of accomplishments: ●● Optimizing access by increasing the November 20, 2018. This project is a collaboration between ­number of replacement dental hygienists the CBHSSJB, the Cree Nation Government and the Cree ●● The second year of the dental assistant and dentists, according to need Women of Eeyou Istchee Association (CWEIA), with the support training program was completed ●● Implementing new training in the dental of the Cree Nation of Waskaganish. The Cree Nation Govern- ●● The new scanning system for ordering all ­assistant program 66 ment funded and oversaw construction of the building, and the dental products was implemented 67 CBHSSJB will operate the new facility with programs devel- ●● The dental chairs in Chisasibi were oped in partnership with CWEIA. changed for new chairs DENTAL CONSULTATIONS IN THE COMMUNITIES The new shelter will serve primarily women from the coastal ●● The department secured approval to build communities of Eeyou Istchee, complementing the services a recall list for hygienists and assistants in offered at a similar shelter operating since 2017 in the inland 2019 Chisasibi 2,320 p13.1% community of Waswanipi. Robin’s Nest will provide healing ●● Seven additional dental assistant positions q methods based on Cree traditions and values, while respecting were approved Eastmain 767 23.5% individual beliefs, for women and their children who are expe- Some challenges remain. The Chisasibi dental Mistissini 3,745 q6.9% riencing domestic violence, nanako akwiwaiisoon. The shelter clinic remains in a critical state on all fronts can accommodate women on their own or with children. (access, organization and equipment) and, until Nemaska 359 p39.8% adequate renovations take place, delivering Oujé-Bougoumou 744 q25.4% optimal dental services is not possible. In addi- tion, the department faced frequent absentee- Waskaganish 1,623 q22.0% ism and lateness by support staff; furthermore, the lack of training of support staff affects the Waswanipi 1,545 q10.8% department’s ability to deliver services efficient- Wemindji 977 p ly. Dental services in Nemaska and Whapma- 3.6% goostui had to be closed because of the lack of Whapmagoostu 356 p57.9% support staff. Eeyou Istchee 12,436 q3.7%

Robin’s Nest Spiritual Room ᓂᑐᑯᔨᓐ ᐋ ᑭᓂᐙᔨᐦᑎᑰᒡ ᑭᔮ ᐋ ᐐᒋᒥᔮᐙᓅᐎᒡ ᓂᑐᐦᑯᔨᓂᔅᒀᐤ ᐋᐱᑎᓰᐎᓐᐦ nitukuyin aa kiniwaayihtikuuch kiyaa aa wiichimiyaawaanuuwich nituhkuyiniskwaau aapitisiiwinh PHARMACY PROFESSIONAL SERVICES AND QUALITY ASSURANCE - HEALTH

The Pharmacy Department has continued New pharmacy software has been purchased The mission of DPSQA–Health is to maximize will increase our capacity to train nurses; a nurse building a foundation for offering safer services and is being configured. The implementation of the quality and efficiency of the contribution counsellor for Awash will be responsible for col- for the population. A main priority is to control this new software is planned for all communi- of nurses, Community Health Representa- laborating with midwives to align clinical practices access to medications in all CMCs. Security ties in the coming year. Moreover, other major tives (CHRs), Health Care Workers (HCWs) and and training to ensure the successful return of cameras and access cards are in the process of changes, including the automation and restruc- beneficiary attendants, in order to support to childbirth to the Territory, and a nurse counsel- being installed in every pharmacy. Cree phar- turing of pharmacy services, will be undertaken the improvement of the general health of the lor in renal health will support kidney health and macy technical assistants have been recruited in the next two years. population. The department is responsible for chronic diseases in Inland communities. for all communities as of March 2019. All phar- ensuring the competence of the professionals macist positions have been filled including a new under its mandate as well as the quality of the Colour code protocols and training were further pharmacist position created for Waskaganish. care provided by them. developed in order to ensure emergency pre- paredness at the local and regional levels. The A vocational program for pharmacy technical The department is guided by a commitment wound care program has made good progress assistants started in March 2019 in Chisasibi; to compassion, dignity and respect. Our in standardization of products and clinical 68 this program will help educate staff to dispense philosophy is to provide quality health care practices. Health professionals across the Ter- 69 safer services. Opening hours in Mistissini were through collaboration and partnerships with all ritory obtained over 400 consultations with our increased in December 2018 and February 2019 stakeholders in the organization, with differ- regional team. to better serve the community. ent institutions and organizations, and with the public, communities and patients. The DPSQA- TRAINING AND INTERNSHIPS Health continues to assume organizational and Once again this year, the DPSQA-Health con- clinical leadership while ensuring the alignment tributed to the development of annual training of the department’s mission and its mandates sessions in which Cree culture was empha- with the Strategic Regional Plan (SRP). In ad- sized. A drumming ceremony and a testimonial dition, we continue our efforts to support and from a survivor of residential schools comple- assist the organizational transformation toward mented the various training sessions given enhanced cultural competence and humility. to CMC nurses in November. The Chisasibi Hospital nurses’ training and the annual CHR A Planning and Programming Research Officer trainings were held simultaneously in February. (PPRO) for Risk Management was hired to sup- Workshops on cultural competency, diabetes, port the development of a risk management cul- wound care, emergency nursing, and collabo- ture in the organization. This year, emphasis was rating with patients were presented to ensure placed on continuing education, risk monitoring maintenance of skills and quality of care. and analysis, developing policies and procedures to establish standards of practice in risk man- This year also saw stronger ties and a part- agement, and working towards accreditation. A nership with the Université de Montréal, Mc- risk management committee is being created to Gill University and the Université du Québec ensure multidisciplinary follow-up at both local en Outaouais to offer clinical internships for and regional levels. An administrative processes graduating students in Bachelor of Nursing pro- specialist was hired to analyze needs and en- grams. Eight nurses from different universities sure coordination, logistics and support. Three completed clinical internships in CMCs. These new nurse counsellors joined the team: a nurse partnerships also strengthen the organization’s counsellor responsible for enlarged role training recruitment efforts. RISK MANAGEMENT INCIDENT/ACCIDENT REPORTING REPORTED EVENTS BY SEVERITY LEVEL NEXT STEPS IN INTEGRATED RISK

A PPRO-Risk Advisor joined the DPSQA-Health The following charts present the number, A 101 17.7% MANAGEMENT team in May 2018 and is responsible for coor- type and severity of incidents and accidents For the coming year, objectives include extend- B 202 dinating risk management activities, promoting ­reported for 2018-19. 35.3% ing risk management to the CBHSSJB’s human, a patient-safety culture, overseeing all systems C 175 30.6% material and technological resources, and es- directed at managing risk and increasing safety tablishing an integrated risk management com- REPORTED EVENTS D 76 13.3% in the delivery of health services. mittee. The adoption by the Board of Directors E1 10 1.7% A Fall 30 5.2% and/or Executive Committee of policies, proce- Several actions were implemented to strength- E2 5 0.9% dures and frameworks related to integrated risk en the risk management culture and to improve A Near fall 8 1.4% F 2 0.3% management are also among the objectives to processes promoting quality of care and pa- B Drug 194 33.9% be achieved in the upcoming year. tient safety. Training sessions on risk manage- G 0 0.0% B Treatment 66 11.5% ment were provided at Wiichihiituwin Montreal, H 0 0.0% the CMCs and MSDCs of Chisasibi, Mistissini B Diet 7 1.2% 70 I 0 0.0% 71 and Wemindji, at the CPDP and at the annual C Laboratory 78 13.6% Undetermined 1 0.2% nurses trainings in Montreal and Chisasibi. Ad- C Imaging 3 0.5% ditionally, individual training was given to the Total 572 100.0% D MDR MDR* 0 0.0% local directors and the coordinators of Miyupi- Data as of April 25, 2019 maatisiiun on completing the summary analysis E Material 18 3.1%

of the form AH-223. The PPRO-Risk Advisor E Equipment 7 1.2% continues to provide assistance by offering E Building 3 0.5% Incidents (A to B) account for 53.0% of events, personalized support to managers, employees, accidents (C to I) 46.8% and undetermined E Personal Effect 0 0.0% and professionals of the CBHSSJB. events 0.2%. No event caused permanent con- F Assault 5 0.9% In December 2018, the Board of Directors adopt- sequences to a client. G Other 153 26.7% ed an integrated risk management policy, and a There is a decrease of 13.6% in the reporting of memorandum was sent to all employees inform- Total 572 100.0% incidents and accidents compared to 2017-18, ing them of this policy and future developments *Medical Device Reprocessing from 662 to 572 events. 20 reports completed in risk management. Policies and procedures for Data as of April 25, 2019 were removed from the local register database the reporting and disclosure of an incident/acci- and sent to the Health and Safety Office. Edu- dent are currently under review and procedures cation was done in partnership with the Health The three most frequent events are drug errors,­ for integrated risk management and sentinel and Safety Office to distinguish the differences laboratory errors and assorted “other” errors, event management are being drafted. between patient safety and employee safety. accounting for 74.3% of incident or accident re- A prospective analysis on the implementation ports. Drug and laboratory errors were reviewed of midwifery services at the CBHSSJB is under by local management teams and other key stake- way. This proactive approach aims to identify holders when required. Control measures were the risks and the measures to be put in place to put in place to prevent recurrence of events. mitigate these risks. ALLIED HEALTH: HOURS OF SERVICE PROVIDED

Speech and language 4,408 ᐋ ᒫᒧ ᐎᒋᐦᑖᑭᓄᐎᔨᒡ 260 pathologists Psycho-educators 4,216 aa maamu wichihtaakinuwiyich occupational therapists 4,363 ALLIED HEALTH 471 physiotherapists 1,346

85 nutritionists 515 Eeyou Istchee totals Allied Health Services continues to grow, Our community Allied Health clinicians, who

nurtured by dedicated, creative staff working provide direct clinical services to our popula- 760 locally and regionally in Eeyou Istchee. The tion, have taken on many inspiring projects this 49 70 team includes many different professionals: year, ranging from a land-based pilot project 1,029 nutritionists, occupational therapists, physi- for youth with special needs, to an inter-gener- 13 280 cal therapists, speech-language pathologists, ational art-based respite project for Elders with 236 psycho-educators, psychologists, psychothera- dementia, to expanding speech therapy out- 680 96 pists, respiratory therapists and an audiologist. reach, and sharing Safety at Work education. 441 We are supported by collaborative relation- 591 ships within the organization—rehab monitors, We are proud of our continued partnership 487 education monitors, special needs educators with Minnie’s Hope pediatric centre in Whap- 12 740 and administrative support—as well as with magoostui. 2018-19 saw our agreement with 256 ­community and public partners. Minnie’s Hope put into action, including provid- 195 ing services at the centre as well as helping 72 767 786 73 Last year’s highlights include reinforcing recruit- Minnie’s Hope with the movement of cargo and 1,327 ment and clinician retention efforts, launching staff through our charter. special needs educators across Eeyou Istchee 688 947 576 as a collaboration with the Disabilities Program The growth and stability of the psychology 834 154 and implementing audiology. We have estab- team permits more consistent psychological support to clients and teams in Eeyou Istchee. 246 lished a contemporary protocol of hearing 401 387 screening, inspired by our neighbors in Nunavik. Next year, we look forward to increasing access 175 451 149 183 Waskaganish Whapmagoostui Waswanipi Nemaska Oujé-Bougoumou Wemindji Chisasibi Eastmain 26 Mistissini to speech therapy, working on clinical protocols In its first phase, our service model is focus- 3,087 447 2,465 605 1,105 1,918 1,683 1,943 1,595 ing on pediatric hearing screening. CHRs and for nutritionists to prescribe supplements, and speech therapists play a leading role, with a getting our multi council off the ground. regional audiologist providing support. Involving CHRs in performing the hearing tests reduces RESPIRATORY THERAPY the impact of professional turnover on the ser- Respiratory therapists Linda Charette and vice, while also empowering CHRs with more Sylvie Turpin performed 160 pulmonary func- knowledge and skills that will stay in the commu- tion tests, trained nurses in the use of CPAP/ nity. Testing children in the community saves on BPAP (continuous/bilevel positive airway pres- transportation, delays and disruption of com- sure) equipment, and completed certificates in munity life. We are also investing in screening polysomnography, giving them the knowledge equipment, to perform these tests on an ongoing to start a regional sleep clinic. Last year there basis—not just when the audiologist visits. were 796 referrals outside the territory for sleep-related issues such as sleep apnea. The sleep clinic will diagnose and treat patients and also encourage good diet, exercise and sleep habits, and help people use the CPAP face mask correctly and consistently for best results. ᓂᔒᔫ ᐙᐱᒫᐅᓲᐎᓐ nishiiyuu waapimaausuuwin MIDWIFERY

This year marked the blessing ceremony for ●● Signing the agreement with the CISSS Abitibi- Midwifery Services and the Nishiiyuu Waapi- Temiscamingue for medical consultations maausuwin program; it also witnessed the first and transfers by midwives midwifery services in a First Nation community ●● Signing the agreement with Chisasibi Hospi- since the profession’s legalization in ­Québec. tal for birthing with midwives in the hospital Bringing birth back to Eeyou Istchee and ●● Adopting a Memorandum of Understand- providing Waapimaausuwin teachings will help ing between the Nishiiyuu Council of Elders, build strong family bonds and a strong Cree Nishiiyuu and Midwifery Services, defining people. the collaboration for implementing the Waapi- Since September 2018, women in Chisasibi mausuwin teachings program Elders Beulah and John Crowe are given a blanket as a sign of appreciation. This Blessing Ceremony was organized by Nishiiyuu and the Midwifery have had access to perinatal care provided by ●● PPRO hiring by the Director of Program Team celebrating the launch of Midwifery and Waapimaausuwin Services, September 7, 2018 at the Mitchuap in Chisasibi. midwives; these family-centred services are Development and Support for evaluating 74 developed through collaboration with Awash midwifery services and their implementation, Midwifery Services goals for 2019-2020: 75 and Nishiiyuu to ensure culturally safe care. planning the training of Cree midwives and Midwives have been involved in the care of 32 writing the services framework ●● Launching birthing services under ­midwifery in Chisasibi, April 17, 2019 women since the services began. ●● Gaining Board of Directors approval for a third midwife contract, completing Chisasibi’s ●● Continuing implementation phase in Chisasibi Achievements and highlights include: team ●● Planning implementation in other communities ●● MSSSQ approval for three birthing homes in ●● Presenting teachings by midwives at the an- ●● Adopting the Midwifery Services Framework Eeyou Istchee in August 2018 nual training of the CHRs and nurses ●● Starting implementation evaluation in ●● Adopting the pathway for integrated services ●● Presenting testimony on the implementation Chisasibi in perinatal care by the Perinatal Working and Bringing birth back to of Midwifery Services and the Waapimaausu- ●● Signing and implementing the Memoran- Strategic Group win teaching program as innovative actions dum of Understanding with Nishiiyuu and Eeyou Istchee and providing ●● Taking part in the Nishiiyuu traditional birthing deposited at the Public Inquiry Commission NCOE (Nishiiyuu Council of Elders) Waapimaausuwin teachings knowledge gathering, August 2018 on relations between Indigenous Peoples and ●● Presenting the Cree midwifery training certain public services in Québec: listening, will help build strong family ●● Creating the local committee in perinatal care ­options to the Board of Directors in Chisasibi, in collaboration with Awash and reconciliation and progress, June 2018 bonds and a strong Cree ●● Submitting functional and technical plans Nishiiyuu teams, September 2018 ●● Participating in the Annual conference of the of Chisasibi’s birthing home to the MSSSQ people. ●● Implementing the MoreOB program for Canadian Association of Midwives, October ●● Signing agreements with the McGill Univer- continuous care improvement in obstetrics, 2018 sity Health Centre (MUHC) for consultations November 2018 ●● Launching a risk management analysis, in ac- and transfers by midwives concerning new- cord with this year’s adopted policy ●● “Cohesion gathering” with Awash and Nishi- borns and tertiary care for pregnant women iyuu to implement midwifery, January 2019 ●● Collaborating in six births, with midwives ●● Certifying physicians and nurses for neo- working with the medical teams at Chisasibi ●● Visiting with managers and architects of two natal resuscitation and training on unstable hospital before the start of birthing services birthing homes and La Maison Bleue, to help newborn care develop functional and technical plans for ●● Training first responders in emergency births the construction of the first birthing home in Chisasibi ●● Writing a code pink for Chisasibi Hospital ᒋᓵᓰᐲ ᒥᑐᓈᔨᐦᒋᑭᓐ ᓂᑐᐦᑯᔨᓂᑭᒥᒄ mitunaayihchikin chisasibi nituhkuyinikimikw PSYCHOSOCIAL CHISASIBI REGIONAL HOSPITAL

From left to right: Gary Chewanish, Coordinator of Administrative Unit; Maryse Glonet, Coordinator of Clinical Services; Annie Dumontier, Coordinator of Nursing Units; Philippe Lubino, Director of Hospital The Psychosocial Department focuses on front- Other highlights include the following: The Chisasibi Hospital’s teams invested time and SOCIAL SERVICES line social services provided by community work- energy in planning the renovations schedules Chisasibi Hospital launched its Social Services ers, human relations officers and social workers, ●● The department has begun working with for 2019-20, and all actively participated on the team in the summer of 2017, and program ensuring that quality services are accessible and Youth Protection (YP) to implement a col- Technical and Functional Plan as well as the Dos- continues to grow. In the past year, a second meet the needs of the population. laboration and communication protocol sier d’Opportunité (business plan) for the new social worker position was created to help ad- between YP and our front line social ser- Chisasibi Health Centre. dress the increasing needs in the emergency The department has experienced transition and vices, with the goal of enhancing working department and on the medicine ward. The growth in the past year, with new leadership in relationships while maintaining necessary NURSING team has been involved in managing the admis- the spring and the development of several key confidentiality. This protocol will result in The end of the fiscal year has been challenging sions increase for long-term care placement positions to be filled in the first half of 2019-20. more streamlined care for our population for the nursing team as the medicine ward has and has advocated for more resources and for Although short staffed in recent months, the ●● Last fall saw the first annual social worker been full, undermining the team’s ability to pro- strategies to limit re-admissions and interven- department has maintained its role supporting and human relations officer training, which vide respite care services. From January 2019, tion failures, in collaboration with managers, front-line clinical services. Our social workers, provided a great opportunity for exchange the team has been obliged to refuse all respite doctors and stakeholders in the communities. 76 human relations officer and community workers and learning, with many connections made requests, and since the fall of 2018 has seen While being available throughout the year to 77 play a vital role within our communities, and the across the region a significant increase in admissions due to the support communities, the Social Services team department provides guidance and support to ●● The department has started monthly tele- need for long-term care placements. As there has also developed connections with local the local teams. conferences with our social workers and are few resources to meet this need, those indi- resources through events such as the Residen- The addition last summer of the foster home pro- human relations officers in order to share viduals ended up staying longer at the hospital, tial School Gathering Week, Suicide Prevention gram under the DPSQA–Psychosocial was a key information, discuss social work best prac- decreasing the availability of acute care beds Awareness events and the dementia project. highlight. The department has worked to stabilize tices and exchange knowledge, tools and and lodging. The Care4 team and the hospital social worker resources service developed a statistical program to track the foster home program with the creation of a The nurse counsellor team worked on numer- program guide and manual for foster home work- ●● The department held a training on protec- the issues faced by the team. This ongoing ous projects: with midwifery services to prepare compilation of statistics began in July 2018 and ers and foster families, as well as by developing tion regimes and psychosocial evaluations for birth deliveries at the hospital; on the de- policies and procedures, and training to guide the for individuals with cognitive difficulty. This was presented to the annual gathering of social mentia project to improve care to this clientele; workers and the HRO in the fall of 2018. Cur- program’s operations. During the last fiscal year, was the initial stage of collaboration with and on code orange (disaster or mass casual- the department emphasized the updating and re- the Order of Social Workers and Family and rently, there are plans to implement this statisti- ties) and code white (violent client) initiatives. cal tool regionally. newing of assessments of foster homes through- Marriage Therapists of Quebec. We hope We observed an increase of medical evacua- out the region in order to sign contracts with to bring awareness and knowledge, and to tions (531 medevacs versus 474 in 2017-18), but foster parents and bring the active foster home build on a clear procedure for opening a HEMODIALYSIS the overall proportion for the Chisasibi Hospital The Hemodialysis Department continues to list up to date. This process is essential for being protection regime and defining the social remains at around 40% of all medevacs in able to access increased rates of remuneration workers’ role within its application­ operate at full capacity, even with two clients Eeyou Istchee. receiving transplants this year. The depart- for foster families; these new rates will take effect The department will experience a growth spurt ment also accommodated 15 visitors, enabling in the coming fiscal year. Much thanks is due to in the coming year, with several key positions to clients to return to the territory. One full-time Sarah Piercey Saganash, who has brought her vi- be staffed. sion for foster homes into reality with tremendous position as well as three compound positions heart and leadership. (medicine-hemodialysis) have been added to the team. LABORATORY DENTAL Laboratory Services worked throughout the year Dental assistant training continued with ses- on the redaction of SOPs (Standardized Orga- sions #3 and #4. A new permanent dentist, nizational Procedures) and ROPs (Required Or- Melanie Tam, has been nominated. CHISASIBI REGIONAL ganizational Practice), and their implementation HOSPITAL in our two laboratories in Chisasibi and Mistis- AUXILIARY SERVICES sini. The MSSS’s Optilab project (the Provincial The purchase of two new heavy duty wash- Laboratory Information System) continued to ers helped process laundry more quickly and 617 Admissions q18.6% advance with the writing and implementation of ­efficiently. 7,280 Hospitalization days p0.6% the Laboratory Quality Assurance Manual, which The department hired five new guards for the is essential to reach the standards for accredita- 78 Transfers to other health centres q1.3% tion. Two new positions were developed, which regional surveillance centre; they will monitor all allowed the Chisasibi Laboratory to extend its communities through surveillance cameras. The 12 Deaths p20.0% 78 working hours and to improve quality assurance. regional surveillance centre is fully installed, but 79 the training of the new guards will happen in the 12 Average stay in acute care (days) q31.0% next fiscal year. RADIOLOGY 71.2% Bed occupation rate p4.2% This fiscal year was the first to see a complete This year, three CB radios were installed at the 17,747 Clinic consultations q13.3% year with a service in obstetrical ultrasound hospital to improve communication between done by a certified autonomous technician, nurses and ambulance drivers. The three chan- 3,198 Specialist consultations p9.6% Caroline Beaulieu. nels available (hospital, local and private) will be useful for bush calls, as the hospital secure 7,713 Observation hours p36.7% ARCHIVES private channel will protect confidentiality. Archives Services have been regionalized under 150,435 Radiology technical units q12.5% the shared responsibility of the Chisasibi Hos- With the collaboration of the Hemodialysis N/A* Laboratory tests N/A pital and the Department of Medical Affairs and Department, the food services team offered Services (DMAS). A new structure (including healthy snacks to the hemodialysis clients. 2,348 Dialysis treatments q7.6% the Assistant Head position as well as two new medical archivist positions) was approved under In September 2018, all housekeeping employ- N/A Pre-dialysis N/A the direct supervision of the Hospital’s coordina- ees were trained in accordance with the minis- tor of clinical services. Difficulties in recruiting try program. *Technical coordinator absent in Mistissini; stats by August 2019 medical archivists has undermined the depart- ment’s development, but the situation improved WIICHIHIITUWIN CHISASIBI at the end of the fiscal year. Overall, the team Chisasibi’s Wiichihiituwin team has been sta- has answered numerous requests and actively bilized with the arrival of a second permanent participated in several projects, particularly on nurse. Efforts continued to improve and optimize the DME, the orientation of new archivists and the work and resources of the team. the new Chisasibi CMC medical charts. ᐋ ᒌᐦᑳᔮᔨᑖᑰᐦᒡ ᐄᐦᒡ ᐋᐄᔑᓈᑯᒡ ᓂᑐᐦᑯᔨᓐ ᐋᐱᑎᓰᐎᓐ aa chiihkaayaayitaakuuch iihch aaiishinaakuch nituhkuyin aaitisiiwin SPECIALIZED SERVICES

SPECIALISTS NORDIC PROGRAM OF SPECIALIZED With a focus on the most relevant base special- SERVICES ties, Specialized Services has recruited special- The Specialized Services team, the Department ists to spend 80% of their professional time of Medical Affairs and Services (DMAS) and the looking after Eeyou itschee people, visiting com- leadership team of general and specialized med- munities, responding to physicians and nurses icine are involved with partners to develop and (email, phone calls, training), doing telehealth, implement a comprehensive Nordic Program of caring for patients when they are outside the specialized care. Specifically, the Specialized territory, and helping to build comprehensive Services coordinator works on a project focus- care in their specialty. The first territory special- ing on managing resources for the specialists. ists include two adult and two pediatric psychia- Several trajectories have been mapped and clear trists, two pediatricians, one internist and one action items have been identified to improve the gynecology-obstetrician are. Another internist coordination of the specialists with the MUHC. 80 is expected to be recruited with specialists in One key element involves providing family 81 ears, nose and throat and ophthalmology being doctors with remote access to OACIS from targeted. For eye care, several optometrists have our region; this access will greatly improve the been recruited as well as an optician group hired circulation of the information about the care that to offer improved services to all communities. our patients receive at the MUHC. Several other Last year, the optometrist/optician combo made elements are also being considered to improve 11 visits on Cree territory, all in coastal commu- care, among them equipment needs, gover- nities, with plans to include inland communities nance models with the MUHC and the training of in the coming year. In some specialties, levels of corridor personnel on Cree culture. support have been negotiated along our corridor of services to bring health care as close to the TELEHEALTH patient as possible. Telehealth continues its slow and steady ex- pansion. With the completed regional team, we Delegations from the Ministry of Health and the expect to develop more services and to support McGill University Health Centre (MUHC) visited the CMC in the implementation of telehealth Chisasibi and Whapmagoostui to better under- services in the coming months. This year, in stand the reality and its challenges. Discussions Chisasibi and Mistissini, the team implemented were held about further collaborations and sup- a pilot project for wound care management. In ports to increase specialized services provision collaboration with the RUIS (Réseau Universita- to the region. ires Intégrés de Santé) McGill Telehealth team, The regional team has been complete since Jan- the specialized services team is testing the uary 2019 (one coordinator, one nurse counsellor use of a smart phone app that digitizes wound and one administrative process specialist), im- measurement and imaging. We expect that this proving the capacity to coordinate and structure type of technology will allow better tracking and specialized services. Next year should see more management of wound care and an improved improvements in the management of specialists, continuity of care. The results of this pilot project especially in the coordination and the support are expected in the next fiscal year. provided to CMCs to manage community visits. ᒥᓯᐧᐋ ᐊᓂᐦᐄ ᒥᔪᐱᒫᑎᓰᐧᐄᑳᒥᑯ ᐄᑖᐧᐄᓂᔨᒡ ᑳ ᒑᒥᑖᐦᒡ ᐋᑰᐦᑦ ᐧᐋᒡ ᒋᒥᑖᐦᒡ ᑭᔮ ᐧᐋᒡ ᑭᓂᐧᐋᐄᑕᑰᐦᒡ ᒥᔪᐱᒫᑎᓰᐅᓐ ᑭᔮ ᓂᑑᑯᔨᓐ ᐋᐧᐄᐦᒡ ᑭᓂᐧᐋᐱᑖᑭᓅᒡ᙮ ᒥᓯᐧᐋ ᒥᔪᐱᒫᑎᓰᐧᐄᑳᒥᑯ ᐄᑖᐧᐄᓂᔨᒡ ᑳ ᒑᒥᑖᐦᒡ ᐃᔮᐧᐄᔨᒡ ᓂᑐᐦᑯᔨᓂᑭᒥᒄ ᑭᔮ ᒥᔪᐱᒫᑎᓰᐅᓐ ᐊ ᑭᓂᐧᐋᐦᐱᑖᐦᒡ ᒑ ᒋ ᐧᐄᒋᐦᐋᑳᓄᐧᐄᔨᒡ ᐋᐧᐋᓂᒌ ᓃᓇᑰ ᐋᑐᐳᐧᓈᓰᐦᒡ: ᐊᐧᐋᔑᓰᔨᒡ (0-9) ᐆᔅᒋᓃᒋᓲᐦᒡ (10–29), ᑭᔮ ᒋᔖᔨᔨᔫᐧᐄᒡ (30+)᙮ misiwaa anihii miyupimaatisiiwiikaamiku iitaawiiniyich kaa chaamitaahch aakuuht waach chimitaahch kiyaa waach kiniwaaiitakuuhch miyupimaatisiiun kiyaa nituukuyin aawiihch kiniwaapitaakinuuch. misiwaa 83 miyupimaatisiiwiikaamiku iitaawiiniyich kaa chaamitaahch iyaawiiyich nituhkuyinikimikw kiyaa miyupimaatisiiun a kiniwaahpitaahch chaa chi wiichihaakaanuwiiyich aawaanichii niinakuu aatupunwaasiihch: awaashisiiyich (0-9) uuschiniichisuuhch (10–29), kiyaa b chishaayiyiyuuwiich (30+). 4 Community Miyupimaatisiiun Centres (CMCs) are the community presence of the CBHSSJB. Each CMC includes a walk-in clinic, as well as community health clinics serving Awash (0-9), Uschiniichisuu (10-29), and Chishaayiyuu (30 and older). ᐃᐦᑖᐎᓐ ᒥᔪᐱᒫᑎᓰᐎᑭᒥᒄᐦ miyupimaatisiiwikimikw itaawin community miyupimaatisiiun centres “A team from Chisasibi visited Alaska to view the Southcentral Foundation’s facilities and to take their core concepts training, which aims to enhance collaborations between workers,” says Jeannie Pelletier, the Chisasibi CMC’s local director. “With our upcoming move to the old arena, we have been chosen to pilot ᒋᓵᓰᐲ the SCF model, so we have designed the new facility so people will share an open space and will work in pods. We have to learn how to work together in groups now, after working in awash 0-91 944 q 2.8% silos for so many years.” chisasibi Jeannie Pelletier Uschiniichisuu 10-29 1,769  2.7% Local Director 4,843 Chisasibi CMC Chishaayiyuu 30+ 2,130  3.1% TOTAL2 4,843  1.6%

medical EVACUATIONS The Awash unit welcomed 63 new babies, The Uschiniichisuu unit continues to improve psychosocial intake, and its experienced com- EMERGENCY N/A including two delivered with midwives. Midwives its services and is extending outreach services munity workers team welcomed its first social scheduled N/A are now involved with the team and practice to provide support to the youth population. Last worker. The Multi-Service Day Centre (MSDC) current services delivery at the Chisasibi Hospital. A weekly year saw 262 patients treated for a chlamydia/ holds activities to help families care for their family doctor 3,743 collaboration meeting with nurses, midwives, gonorrhea infections; these patients had regular loved ones, including initiatives like the Demen- specialist md N/A Community Health Representatives (CHRs), follow ups and were given teaching and pre- tia Project, which offers inter-generational day other specialist N/A community workers, the social worker, the HRO vention information. Sixty patients are being activities to elders. The Land-Based Program’s nurse (walk-in) N/A Nishiyuu, the nutritionist and doctors aims to followed for chronic diseases. The clinic has life skills group includes a three-day bush com- 84 nurse (medication refill) N/A maximize the team’s success; one focus involves only one full-time nurse, who is responsible for ponent to nurture participation, communication 85 hemodialysis N/A defining a pathway to share information with the checking all the medical charts; the clinic should and autonomy in young adults. The Meals on awash Chisasibi community and to facilitate collabora- hire a medical secretary to carry out this task Wheels Program provides meals to approxi- nurse 2,446 tion between the Awash team, midwives and and to ensure efficient quality service delivery. mately 20 families. In a collaborative effort to CHR (individual) 934 Nishiiyuu. Â Mashkûpimâtsît Awash/Well Baby The CHRs performed a variety of tasks: hold- prevent a flu outbreak, an extra flu vaccination group activities by a chr 565 Clinic is continuing, as is the collaboration with ing awareness campaigns, helping organize the campaign was held in January. With the help of Community worker 99 Head Start and Childcare Services. Breastfeed- youth clinic, teaching on different health topics the Uschiniichisuu CHRs and the Awash nurse, social worker N/A ing Week, morning snacks at the elementary and supporting the dental hygienist and the the team was able to vaccinate 150 more than Uschiniichisuu school, weekly cooking workshops and baby Healthy School program. A temporary addic- at the regular session earlier that year. nurse 1,557 food workshops were also among the team’s tions worker was hired to assist the National Na- CHR (individual) 168 activities. Awash received a new coordinator in tive Alcohol and Drug Abuse Program (NNADAP) The Administration unit has been prepar- group activities by a chr 115 June 2018, and since then has welcomed three worker with an increasing workload. The new ing for the CMC’s move to its new location in Community worker 262 new nurses; interviews to complete the nursing community worker development position has spring 2019. The new site, a pilot for the South- social worker 311 central Foundation model, will provide clients NNADAP worker N/A team are ongoing. The team also welcomed a strengthened the social services team, injecting new social worker and a new community worker. energy into community outreach. with more integrated and accessible services. Chishaayiyuu We are still grieving the loss of our colleague The unit has recruited a new coordinator of nurse 4,340 The Chishaayiyuu unit emphasizes offering Chishaayiyuu and is preparing to recruit a new footcare nurse 176 Freddie Herodier, community worker. primary care focused on prevention and health coordinator of Uschiniichisuu as the current CHR (individual) 77 education, but is still missing a permanent coordinator is retiring. The MSDC kitchen staff group activities by a chr N/A coordinator. The team is working to improve now have permanent full-time positions, and Community worker 95 social worker N/A home care services for Elders, offering train- two part-time housekeeping positions have homecare visits N/A ing to home care workers in collaboration with been merged into one full-time position. A trial MSDC (participants end of year) 216 1. The 0-4 age group (a) is underestimated since newborns are DPSQ-Health. Chishaayiyuu increased its Meals on Wheels project is being prepared for meals served (indiv. servings) 216 often registered late in the JBNQA beneficiary list; and (b) has been Spring 2019. corrected using the MSSS 2013-2016 births (+ 2017 estimates) and doctor (individual) 1,787 2012-2015 MSSS deaths numbers. 2. Does not include 347 Inuit, Métis and/or non-aboriginals. mental health nurse (individual) 714 3. In Chisasibi, many clinical services are offered at the hospital. See page 77. “One of the highlights this year is the work of our mental health nurse, Claude-Aline Carrier, who has begun to shape our Men- tal Health/Maanuuhiikuu services,” says Rita Gilpin, local director of the Eastmain CMC. “Our newly developed Mental Health Program takes a team approach to addressing mental ᐄᔅᒣᐃᓐ health and social issues, as well as when celebrating achieve- ments. The mental health nurse has also initiated an adult social evening, helping those who want to socialize with others awash 0-91 186 0.0% to enjoy a stress-free evening.” eastmain Rita Gilpin Uschiniichisuu 10-29 295  4.6% Local Director 849 Eastmain CMC Chishaayiyuu 30+ 368  2.5% TOTAL2 849  2.7%

medical EVACUATIONS The Awash/Uschiniichisuu unit welcomed 16 The Current Services/Chishaayiyuu unit As of June 2018, the Cree Health and Commu- EMERGENCY 55 babies in 2018, and CHRs and Awash nurses provides full-time medical coverage to meet nity Care Program’s (CHCCP) nurse position has scheduled 956 continue to work with new parents and babies the community’s needs. Nursing staff includes been vacant. The CHCCP serves 17 home care current services to provide the best start. The team has part- an assistant head nurse and three permanent clients. The Multi-Service Day Centre (MSDC) family doctor 1,159 nered with Wabannutao Eeyou School, meeting full-time Current Services nursing positions, with also has 17 clients, its staff including an activity specialist md 156 monthly to address development issues; this last year seeing two positions filled. Our new team leader, educational monitor and rehabili- other specialist 20 past year the school experienced its highest ever Chishaayiyuu nurse (diabetes), hired in Octo- tation assistant. The physiotherapist position nurse (walk-in) 9,486 graduation rate at 60%. The Psychosocial team ber, is having a strong impact on follow-ups for has been vacant since August 2018, while the 86 nurse (medication refill) 3,263 has grown to five community workers and two diabetes patients. The unit also hired a social occupational therapist position is shared with 87 awash social workers, and benefits from the assistance worker. Our nutritionist and Community Health another community. Clients with disabilities have nurse 637 of our new mental health nurse. Prominent con- Representatives (CHRs) are working with all benefited from support across the CMC’s units CHR (individual) 320 cerns include gambling addiction, anxiety and departments and entities, leading workshops and programs. CHR (groups) 63 work-related stress and suicide ideation. Awash and sessions on cooking and healthy lifestyles, Community worker 78 also welcomed a new special needs educator; which have an ongoing positive impact. The Administration unit continues to operate social worker 49 the Special Needs team has worked closely with without a coordinator, with the coordinator of Uschiniichisuu regional services to assess referred children and Teleophthalmology screening continues, with Awash/Uschiniichisuu serving as interim co- nurse 406 youth and to develop care plans. A focus for the one nurse trained to support this project and ordinator until the position is filled. Eastmain CHR (individual) 255 coming year is to build wider partnerships for the other new permanent nurses scheduled to received two new triplexes for professionals, group activities by a chr 152 addressing special needs within the community, receive training in the coming months. Telehealth which will be a great asset. One of the main Community worker 63 and to host a local special needs conference in services for psychosocial needs has eased con- challenges is the lack of personnel on the recall social worker 141 August. The Awash/Uschiniichisuu unit will be sultations for our clients. list for replacements within the CMC and MSDC, NNADAP worker 78 growing as additional nursing positions have and the community still lacks sufficient housing Chishaayiyuu After a number of years of relying on replace- been posted. units, transits and storage facilities. nurse 37 ment dentists, Dental Services welcomed a footcare nurse 117 permanent full-time dentist, which has benefit- CHR (individual) 453 ted dental care in the community. Dental techni- group activities by a chr 0 cal assistant training is ongoing, with trainees to Community worker 132 be certified. social worker 0 homecare visits 435 Pharmacy Assistant Technician Training took MSDC (participants end of year) 1,175 place in February; this position will reduce the meals served (indiv. servings) 1,399 workload of the CMC nurses. 1. The 0-4 age group (a) is underestimated since newborns are often registered late in the JBNQA beneficiary list; and (b) has been corrected using the MSSS 2013-2016 births (+ 2017 estimates) and 2012-2015 MSSS deaths numbers. 2. Does not include 25 Inuit, Métis and/or non-aboriginals. “Last year a group from the CMC and Mistissini First Na- tions visited the Harlem Children’s Zone for three days,” says local director Alan Moar. “It was interesting to see how they educate young people there to make sure they succeed. Lots of good ideas came out of that visit. We also ᒥᔅᑎᓯᓃ had a group visit the Southcentral Foundation in Alaska, which has a more integrated model of health and social services, without silos, that we’re trying to work toward.” awash 0-91 649  0.6% mistissini Alan Moar Uschiniichisuu 10-29 1,448  2.3% Local Director 3,872 Mistissini CMC Chishaayiyuu 30+ 1,775  2.5% TOTAL2 3,872  2.1% medical EVACUATIONS EMERGENCY n/a scheduled n/a current services Mistissini CMC’s new local director began in The Awash unit welcomed 72 babies and The Chishaayiyuu unit has hired most of its all consultations 16,199 July, stabilizing local management. Objectives continues to support the well-being of families. staff. It supported visits by specialists through- family or specialist md n/a for the year included extending Current Servic- Last June’s Awash Fair was successful, and the out the year; chronic diseases and diabetes other specialist n/a es to 80 hours per week, supporting and devel- unit launched the Miyuu-ashimishuh Project, remain priorities. The Multi-Service Day Centre nurse (walk-in) 7,480 oping the Youth and Family Empowerment pilot providing pregnant women with nutritious food. (MSDC) is fully staffed and provides a com- nurse (medication refill) n/a project, and supporting visiting specialists by Awash is also providing a new gynecology plete range of services. Elder abuse is a major radiology exams 4,386 ensuring clients come for their appointments. service, and has regular visits by pediatricians. concern, so information on this subject will charts requested 61,314 This first objective has been achieved, while the The unit is active in partnerships with Mistis- be provided to community members to raise 88 hemodialysis 3,269 other two are ongoing. sini First Nation for family services, daycare awareness. Telehealth offerings are well-used, 89 awash and Head Start. Objectives for this year include enabling easier follow-ups with specialists. nurse (pgm, incl. vacc.) n/a This year, Current Services had over 16,000 strengthening front-line services, providing The Cree Home and Community Care Program CHR (individual) n/a visits, a thousand more than last year. Since more outreach and home visits, decreasing the (CHCCP) is providing quality care to patients, CHR (groups) n/a February, Current Services has operated 80 high-risk pregnancy rate and improving the of- including palliative care for those who wish to Community or social worker n/a hours per week, which may be the cause of this fice work environment. stay at home. This year’s objectives include Uschiniichisuu increase. The pharmacy and lab have extended improving social services, implementing Elec- doctor 228 their hours comparably. The Hemodialysis The Youth Health Fair, organized in partner- tronic Medical Records and addressing elder specialist md 416 Department is at full capacity with 20 patients ship with other local entities, was a highlight for abuse and chronic diseases. nurse 2,834 weekly. Objectives for this year are to increase Uschiniichisuu; National Addiction Awareness CHR (individual) 3,166 the Psychosocial team, to finalize the hiring of Week was also a success. The school nurse The Administration unit is awaiting 15 more group activities by a chr 125 Nursing and Social teams for extended hours, continued to work with families and students, lodging units, to be delivered June 2019. Sup- Community worker 1,842 and to implement Electronic Medical Records. and Dr. Justin Ross gave training to school port staff is fluid, with many on medical leave, social worker 551 teachers and staff regarding anxiety and panic making it difficult to stabilize a team. The Youth NNADAP worker 621 attacks. The Uschiniichisuu nurse delivered Protection group is moving to the old Youth Chishaayiyuu the vaccination campaign. The National Native Healing Services building this summer, free- doctor 228 Alcohol and Drug Abuse Program (NNADAP) ing office space for Chishaayiyuu to expand in ent 66 is concentrating on alcohol and drug abuse the CMC. The CMC parking expansion will be other specialist md 416 nurse 10,281 prevention efforts, and will host discussions completed in the summer. Objectives for next footcare nurse 693 on cannabis prevention in partnership with year include stabilizing support staff, providing CHR (individual) 2,609 the Mistissini First Nation. Objectives for the support to the maintenance files and ensuring group activities by a chr n/a coming year include launching Youth Outreach a communication plan for all employees about Community worker 243 clinics. Grieving workshops, requested by com- policies and procedures.

social worker n/a 1. The 0-4 age group (a) is underestimated since newborns are munity, will be developed in collaboration with avg no. of homecare clients 66.6 often registered late in the JBNQA beneficiary list; and (b) has been Mistissini First Nation. corrected using the MSSS 2013-2016 births (+ 2017 estimates) and MSDC (participants end of year) 1,355 2012-2015 MSSS deaths numbers. meals served (indiv. servings) 2,279 2. Does not include 161 Inuit, Métis and/or non-aboriginals. “We’ve had a lot of specialist visits this year, and I like to get feedback from people coming the community to identify areas to improve,” says Beatrice Trapper, local director of Nemaska’s CMC. “I’ve had some very positive responses, and have sent email to all staff to applaud their efforts in ᓀᒥᔅᑳ making the CMC a success.”

awash 0-91 177 q 2.8% nemaska Beatrice Trapper Uschiniichisuu 10-29 270 q 3.7% Local Director 840 Nemaska CMC Chishaayiyuu 30+ 393  1.0% TOTAL2 840 q 1.3%

medical EVACUATIONS The past year has been challenging for ular part-time psychologist, visiting psychiatrist The Awash/Uschiniichisuu unit has been EMERGENCY 46 Nemaska’s Current Services/Chishaayiyuu, and child psychiatrist. The psychologist has without a coordinator for the past year; a new scheduled 773 as the coordinator position was covered for been visiting monthly for a year and has devel- coordinator has been hired but will not start current services about six months by two different coordina- oped a strong and durable therapeutic relation- until summer 2019. Nursing staff was also family doctor 1,442 tors; a new coordinator joined the team in ship with her clientele. The Psychosocial team depleted and the team relied upon replace- specialist md n/a December. The Nursing team is available for has put a great deal of energy into reunifying all ment nurses. The unit is now hiring permanent other specialist 399 walk-in consultations for 36 hours per week psychosocial files, and procedures have been nursing to bring stability to the team. In addi- nurse (walk-in) 7,108 and provides lab intake two days a week from 8 implemented to ensure referral and case man- tion, some community workers and CHRs were 90 nurse (medication refill) 2,833 to 9 am. This year the team overcame the loss agement processes meet quality standards. on medical leave; the remaining community 91 awash last summer of two of the four Current Services The National Native Alcohol and Drug Abuse workers and CHRs worked hard to continue nurse 743 nurses, along with the school nurse and the Program (NNADAP) worker facilitates access to providing support and maintaining services and CHR (individual) 276 unit coordinator, who left for various reasons; treatment programs for clients and also over- programs for clients. In many cases, the CMC group activities by a chr n/a agency and category 5 nurses were used as sees aftercare programs, sharing circles and put the age grouping aside and simply found Community worker 163 replacements. Since then, local management traditional healing workshops. the most appropriate workers to address client social worker n/a has worked on hiring additional nurses to cover needs, regardless of their unit assignment. Uschiniichisuu the vacancies. Our permanent nutritionist was on parental leave nurse 146 and returned to work in early 2019. Both Ch- The Administration unit hired a new coordi- CHR (individual) 596 Community members have access to one ishaayiyuu Community Health Representatives nator for Current Services and Chishaayiyuu, group activities by a chr 25 full-time and three part-time physicians; the (CHRs) work closely with the nurse on a daily among other new personnel. In addition, it Community worker 12 addition of a part-time doctor resulted in more basis. They have also been working very closely organized or oversaw a number of training social worker n/a consultations in the past year. The commu- with the nutritionist, dental hygienists and the sessions for employees, including Health and NNADAP worker 201 nity telehealth officer has been supporting Awash team. Recruiting activities are ongoing in Safety training for managers, Virtuo/Barcode Chishaayiyuu the medical team of specialists by increasing an effort to hire a physiotherapist to replace the Implementation training, and Traditional Food nurse 503 the number of visio-conference consultations one who resigned in July 2016. The Cree Home Safety Handling. A number of renovations were footcare nurse 22 with patients. This significantly reduces costly and Community Care Program (CHCCP) has a carried out to lodgings, and the MSDC was CHR (individual) 1,270 and time-consuming travel for patients. More small, stable case load, and the team plans to repaired after flooding in the fall. IT services group activities by a chr n/a telehealth consultations should be added in have meetings in future with other CMC services supported all CMC and MSDC employees with Community worker 179 the coming year as services are developed to better identify clients who would benefit from new desktop and laptop computers. A lack of social worker n/a homecare visits 1,696 locally and regionally. The mental health nurse the program. The Multi-Service Day Centre housing continues to pose challenges for hiring MSDC (participants end of year) 251 has a case load of 78 clients whom she follows (MSDC) has been impacted by floods and was professionals. meals served (indiv. servings) 476 ­regularly; she collaborates closely with our reg- relocated for six months. During that time, the team welcomed 2-5 clients daily, offering mainly 1. The 0-4 age group (a) is underestimated since newborns are often registered late in the JBNQA beneficiary list; and (b) has been meals and moral support. In October, the team corrected using the MSSS 2013-2016 births (+ 2017 estimates) and 2012-2015 MSSS deaths numbers. returned to the MSDC premises and now wel- 2. Does not include 15 Inuit, Métis and/or non-aboriginals. comes 2-10 clients daily. “We have succeeded in filling all our nursing positions across all departments and have reduced the use of agency nurses,” says local director Louise Wapachee. “Thanks to the efforts and teamwork of each department, we have stabilized the quality of the CMC’s health care services. A ᐅᒉᐴᑯᒨ challenge for the CMC this coming year will be to maintain collaborations with partners, and we are making efforts to strengthen these relationships through our local Miyupi- awash 0-91 176 q 2.8% maatisiiun Committee.” oujÉ-bougoumou Louise Wapachee Uschiniichisuu 10-29 346  7.5% Local Director 854 Oujé-Bougoumou CMC Chishaayiyuu 30+ 332 q 0.6% TOTAL2 854  2.0%

medical EVACUATIONS Last year showed a slight decrease in some ser- This year the Awash/Uschiniichisuu unit hired The Administration unit hired a new Interim Co- EMERGENCY 122 vices, including walk-in clinics, social services an additional Awash nurse, an additional com- ordinator in December. Building and office main- scheduled N/A and the Multi-Service Day Centre (MSDC), but munity worker and a special needs educator. tenance has been a priority, as many profession- current services an increase in others, such as National Native Programming now includes follow-ups by nurses als and front-line workers have been reassigned family doctor 1,339 Alcohol and Drug Abuse Program (NNADAP), in the Maternal and Child Health Program, as to renovated offices. The trailer extension of the specialist md 114 Community Health Representative (CHR) roles well as in Special Needs Services, the Women’s Oujé-Bougoumou CMC requires the hiring of other specialist 26 in individual and group sessions, and visiting Health Program and the Sexual Health Program. a third housekeeper. The CMC signed a one- nurse (walk-in) 7,104 specialists. Prenatal classes continue, with the program now year contract for transits until 2020 to ensure 92 nurse (medication refill) 3,250 including a cultural component and being open adequate housing. The unit has experienced 93 awash In Current Services/Chishaayiyuu, the Nurs- to all women of childbearing age. Other pro- difficulties with the shortage in recall staff and is nurse 848 ing team is now complete. The unit also has a grams were maintained, including the No Butts currently working to rebuild the recall list. A chal- CHR (individual) 147 nutritionist, dental hygienist and physiotherapist, to It Challenge to support smoking cessation, lenge for the coming year will be to fill some key group activities by a chr 16 in addition to a psychologist two weeks a month National Addictions Awareness Week, Girls Club positions: two social workers, a psychotherapist, Community worker 42 and an occupational therapist for 3-4 weeks to support healthy self images, Breakfast Club an activity team leader, a community organizer, social worker 91 every 2-3 months. A physician provides medical in partnership with the school and Oujé-Bou- and a PPRO Nishiiyuu. Uschiniichisuu coverage 38 weeks of the year. However, the unit goumou Cree Nation, and a local Special Needs nurse 241 is still missing a social worker and a psycho- Summer Camp. After a year of being dispersed CHR (individual) 111 educator. The multi-disciplinary team is involved due to the extension of the CMC, the unit moved group activities by a chr 31 in many preventive educational activities and into its new section in December 2018 and is Community worker 42 workshops, including educational and cooking pleased to be together again. social worker 0 activities at the school, the Drop the Pop cam- NNADAP worker 178 paign, Diabetes Awareness Month, special nutri- Chishaayiyuu tion activities at the MSDC and Girls Club for nurse 382 teens, among others. The MSDC staff is missing footcare nurse 64 a community worker and the team is working CHR (individual) 186 hard to find ways to enlist more participants. group activities by a chr 0 The Cree Home and Community Care Program Community worker 313 (CHCCP) has included a rehabilitation monitor social worker 0 homecare visits 0 since October 2018 and is now fully staffed. MSDC (participants end of year) 203 meals served (indiv. servings) 601

1. The 0-4 age group (a) is underestimated since newborns are often registered late in the JBNQA beneficiary list; and (b) has been corrected using the MSSS 2013-2016 births (+ 2017 estimates) and 2012-2015 MSSS deaths numbers. 2. Does not include 85 Inuit, Métis and/or non-aboriginals. “We’ve stepped forward quite a bit this year, filling our physio- therapy and occupational therapy positions, and our CHCCP (Cree Home and Community Care Program) team members are happy to have this support,” says acting local director Ivan McComb, standing in for interim local director Angela Etapp. ᐙᔅᑳᐦᐄᑲᓂᔥ “Twelve new housing units were opened and we filled them right away, which helped alleviate our housing crisis. But we still need another 12 or more to fill all our positions!” awash 0-91 527  0.5% waskaganish Angela Etapp Uschiniichisuu 10-29 907  2.0% Interim Local Director 2,473 Waskaganish CMC Chishaayiyuu 30+ 1,039  3.2% TOTAL2 2,473  2.2%

medical EVACUATIONS The Current Services Nursing team remains In Chishaayiyuu, the nutritionist continues to The Administration unit has worked with the EMERGENCY 131 strong and is stabilizing after heavy staff host Healthy Snack and Meal workshops; she regional team to create an emergency binder scheduled 2,480 turnover, and the Human Resources team is has also been presenting baby food-making that presents standardized practices to ensure current services filling new development nursing positions. The and nutritious snacks programs for young safety protocols within the CBHSSJB facilities. family doctor 3,716 physician schedule was full for this year and parents—with some young fathers attend- The housekeeping team has welcomed a new specialist md 23 the integration of a third physician to the team ing along with mothers. The psychoeducator employee, which has helped in preparing reno- other specialist 512 has helped in providing excellent service to the has returned from maternity leave, joining the vated units and maintaining clean and safe en- nurse (walk-in) 14,859 community. occupational therapist and the school nurse vironments in the community’s growing number 94 nurse (medication refill) 3,948 on the social services team. The rehabilitation of facilities. Four older units on Shuushuuhkuo 95 awash The Awash/Uschiniichisuu unit welcomed team (physiotherapist, occupational therapist, Street were renovated, and four triplex build- nurse 1,169 41 babies, including an infant born on Febru- and rehabilitation monitor) has been address- ings have been completed, providing a dozen th CHR (individual) 1,484 ary 28 at the CMC. In September the team ing such key issues as diabetes and high blood much-needed two-bedroom units for our staff group activities by a chr 33 added a new special needs educator, and in pressure as well as trauma. The team is also and professionals. The Department of Youth Community worker 854 January 11 employees from the Robin’s Nest concerned about the elderly population, in both Protection and management and personnel social worker Shelter joined the CMC team, as the CMC took the Multi-Service Day Centre (MSDC) and Cree staff are now housed in two trailers next to the Uschiniichisuu on responsibility for that facility. Recruiting Home and Community Care Program (CHCCP), CMC, giving easy access to CMC services and nurse 2,148 Awash nurses is an ongoing concern, but the due to a slight increase in incidents of cognitive staff. Next year the CMC team will be increas- CHR (individual) 1,297 team adapted well to provide health, education instability and loss of strength. The CHCCP had ing to meet the needs of Waskaganish’s grow- group activities by a chr 22 and social services, frequently collaborating been extremely busy as our population is aging ing population. We look forward to housing all Community worker 112 on projects with Waskaganish First Nation and and there are no centres for short- or long-term CMC staff and services under one roof in the social worker 0 Waskaganish Wiichihiiwewin Centre. Finally, a respite for families. The MSDC team provides near future. NNADAP worker 67 school nurse was hired in January 2019, bring- services for 12 to 18 clients, continues to recruit Chishaayiyuu ing creative ideas for outreach to adolescent new clients, and also offers services to the nurse 693 populations, including starting a youth clinic. footcare nurse 566 community at large. The coming year will see a CHR (individual) 814 review of the MSDC program and the develop- group activities by a chr 0 ment of new recruitment strategies. Community worker 1,024 social worker homecare visits 3,924 MSDC (participants end of year) 2,026 meals served (indiv. servings) 1,995 1. The 0-4 age group (a) is underestimated since newborns are often registered late in the JBNQA beneficiary list; and (b) has been corrected using the MSSS 2013-2016 births (+ 2017 estimates) and 2012-2015 MSSS deaths numbers. 2. Does not include 85 Inuit, Métis and/or non-aboriginals. “Waswanipi has many projects going on, and they address all groups—elders, youth, women, children. We have pilot projects like the Home Hemodialysis and the Desire to Heal programs, and we’re working on hiring outreach workers. We also have the Robin’s Nest woman’s shelter, and the Ashuukin Services ᐙᔅᐙᓂᐲ fills gaps in respite and long-term care for elders,” says Virginia ­Wabano, who arrived in January as the CMC’s new local director.

awash 0-91 439 p 1.4% waswanipi Virginia Wabano Uschiniichisuu 10-29 793 p 4.2% Local Director 2,073 Waswanipi CMC Chishaayiyuu 30+ 841 p 0.8% TOTAL2 2,073 p 2.2%

medical EVACUATIONS Waswanipi CMC has experienced management Istchee after their studies. The occupational The Administration unit posted two perma- EMERGENCY 201 changes, including two new managers, an in- therapist is working with community partners nent positions, an administration officer and an scheduled 6 terim local director and an interim coordinator of to promote healthy living. Training for the Dental MSDC cook. The CMC needs more housing current services Current Services/Chishaayiyuu. The local direc- Assistant Program is ongoing, and the dental units for the upcoming hiring of vacant positions family doctor 935 tor was permanently hired in January 2019, but department’s administrative officer continues to and the return of employees who require a family specialist md 58 the coordinator of Current Services/Chishaay- participate with the training program. The pro- unit. The transits cannot accommodate the re- other specialist 65 iyuu remains an interim position. gram contains five modules; after completion the quests of replacement nurses, doctors and visi- nurse (walk-in) 6,935 trainees will be certified dental assistants. Pro- tors. An office move took place to create more 96 nurse (medication refill) 5,458 Current Services/Chishaayiyuu has a perma- gram promotion through social media has been space and integrate a collaborative care ap- 97 nurse (clinical lab tests) 1,175 nent physician and a number of regular visiting very helpful. Information shared regarding health proach, and staff is adjusting to the change. We awash specialists. Specialty clinics are functioning well, and wellness are evidence-based interventions have secured adequate office space for Regional nurse 1,034 including the regional mental health visits provid- that help the population to improve quality of life. team needs. Maintenance and Housekeeping CHR (individual) 503 ed by Maanuuhiikuu Services. Ongoing training teams work diligently to keep the CMC and other The Awash/Uschiniichisuu unit welcomed group activities by a chr 0 is provided for two Chishaayiyuu nurses to sup- facilities clean and functional. The Recall list 42 babies born this past year. The  Mash- Community worker 386 port the Home Hemodialysis patients and their must be upgraded as it is very low. Robin’s Nest social worker 0 kûpimâtsît Awash/Well Baby Clinic continues to families. The footcare clinic, which is essential was transferred under the management of the school nurse (incl.vaccinations) 1,343 provide support to mothers and children. The to chronic diseases such as diabetes, is working coordinator of Awash and Uschiniichisuu in Jan- hr officer 35 Awash team faces some challenges with visits to well. Chishaayiyuu provides ongoing promotions uary 2019, and co-managed with the coordinator Uschiniichisuu families, but is working to enhance the program of community programs and services and will of administration; Robin’s Nest’s administrative nurse 0 through community outreach and a team-orient- host booths monthly in the CMC. staff were delegated to the Administration Unit. CHR (individual) 0 ed approach. The Miitwat Program, in partner- group activities by a chr 0 The psychoeducator is working to increase ship with Nishiiyuu, is going well. In January, the Waswanipi CMC is building strong relationships Community worker 306 the mandate of the Multi-Service Day Centre Piipiichaau Uchishtuun-Robin’s Nest developed and healthy teams to ensure the delivery of social worker 0 (MSDC) by developing an action plan to meet a Working Transition Group to provide support quality services to the users of the organization. NNADAP worker 0 the needs of the users. We have hired a phys- during its transition under the local management Through the guidance and wisdom of our part- community worker (addictions) 337 iotherapist to make regular visits to the com- structure. The coordinators of the CMC provide ners, Waswanipi CMC will continue to develop Chishaayiyuu munity. Four McGill students carried out their managerial and maintenance support for the partnerships in the community to maximize nurse 1,663 preceptorship with the occupational therapist, Robin’ Nest team. As of March, the Waswanipi delivery of quality services. footcare nurse 81 and expressed interest in returning to Eeyou location has had 74 confirmed intakes, an aver- CHR (individual) 1,216 age of 6-7 participants per month. group activities by a chr 0 Community worker 310 social worker 0 1. The 0-4 age group (a) is underestimated since newborns are homecare visits 297 often registered late in the JBNQA beneficiary list; and (b) has been corrected using the MSSS 2013-2016 births (+ 2017 estimates) and MSDC (participants end of year) 1,114 2012-2015 MSSS deaths numbers. meals served (indiv. servings) 6,053 2. Does not include 20 Inuit, Métis and/or non-aboriginals. “CMC Wemindji is going through a period of substantial growth, with changes happening at all levels,” says Stella Lameboy-Gil- pin, the CMC’s local director. “This transformation has brought renewed enthusiasm amongst the staff through programming, services and activities that foster team building. Our main fo- ᐐ ᒥᓂ ᒌ cus is to build our team to partner with other entities; to align ourselves with the CBHSSJB strategic plan in promoting com- munity well-being; and to improve and expand our services awash 0-91 269 q 5.2% with the inclusion of Cree helping methods.” wemindji Stella Lameboy-Gilpin Uschiniichisuu 10-29 531 p 6.0% Local Director 1,557 Wemindji CMC Chishaayiyuu 30+ 757 p 0.8% TOTAL2 1,557 p 1.4%

medical EVACUATIONS WEMINDJI WILLIE MATCHES MEMORIAL Dental Clinic operations were slower this year. The Administration unit is fully operational with EMERGENCY 90 MIYUPIMAATISIIUN CENTER The main challenge remains enlisting replace- all positions filled; there are 22 full-time employ- scheduled 1,615 The Current Services/Chishaayiyuu unit suf- ment staff, and some curative services have ees in various support functions in food servic- current services fered from the lack of nursing staff due to sick been affected because of the lack of support es, housekeeping, maintenance, transportation family doctor 1,748 leave, maternity leave and a transfer, so agency staff and replacement dentists. A request for a and administrative support. The CMC has been specialist md 262 nursing resources were essential. In fall 2018, second permanent assistant has been accepted. hiring regular replacement housekeepers to other specialist the team hired a pharmacy technician to prepare clean transits when needed, but needs another nurse (walk-in) 5.997 regular medications, greatly reducing the nurs- The Awash/Uschiniichisuu unit welcomed 34 permanent housekeeper for this job. The kitchen 98 nurse (medication refill) 4.086 ing workload. The unit sees a number of clients births this past year. Infants, children and their runs the Meals on Wheels program for clients 99 awash regularly for health monitoring, and has collabo- mothers and families benefited from a number who cannot get to the MSDC, and continues nurse 1,143 rated with the Awash/Uschiniichisuu team to of initiatives over the year, such as Breastfeed- to revamp the program to ensure adhesion to CHR (individual) 475 launch a very popular indoor walking club. The ing Week activities, Baby Food and Healthy Meal the Nutrition Policy. The appointment system group activities by a chr 19 nutritionist hosted cooking workshops, pre- Workshops, a sewing group for prenatal and remains problematic, and the CMC team is Community worker 77 sented kiosks at the supermarket and at various postnatal women and bike safety workshops, looking forward to the new centralized system to social worker 0 public events, and held tastings at the daycare, among others. The unit established a Tuesday help organize appointments efficiently. Last year, Uschiniichisuu in addition to individual appointments. The team evening youth clinic, with a nurse, community a housing shortage meant some positions could nurse 974 also had the services of a physiotherapist, a worker and Community Health Representative not be posted; the addition of 12 new units this CHR (individual) 1,602 psychoeducator and an occupational therapist. (CHR), and also collaborated with the local Youth year should address this issue. Another chal- group activities by a chr 16 The Cree Home and Community Care Program Council to run the No Butts to It challenge. lenge this year was finding reliable replacements Community worker 39 lost several clients this past year, leaving seven and keeping the recall list up to date. social worker 0 clients at the start of 2019-20. NNADAP worker 10 The Wemindji CMC team benefitted from train- Chishaayiyuu ings and workshops in such areas as Conflict nurse 851 Resolution, Mediation and Lateral Kindness/ footcare nurse 28 Lateral Violence, as well as Health and Safety in CHR (individual) 283 the Workplace and PDSB training (Principals for group activities by a chr 18 Moving Clients Safely). Community worker 417 social worker 0 homecare visits 3,439 MSDC (participants end of year) 12,139 meals served (indiv. servings) 12,139 1. The 0-4 age group (a) is underestimated since newborns are often registered late in the JBNQA beneficiary list; and (b) has been corrected using the MSSS 2013-2016 births (+ 2017 estimates) and 2012-2015 MSSS deaths numbers. 2. Does not include 75 Inuit, Métis and/or non-aboriginals. “Our 12 new housing units have made it possible for us to develop our programs,”says Martine Constantineau, interim local director. “We have hired two full-time nutritionists, and we’re still looking to hire a nurse. Office space and hous- ing have been problems, although moving into a trailer gave ᐙᐱᒫᑯᔥᑐᐃ us space at the clinic to run the Awash program and we are using the MSDC for Chishaayiyuu. Now we can develop ser- vices that previously had not been not running at 100%.” awash 0-91 213  0.9% whapmagoostui Martine Constantineau Uschiniichisuu 10-29 404  3.1% Interim Local Director 1,031 Whapmagoostui CMC Chishaayiyuu 30+ 414  2.0% TOTAL2 1,031  2.2%

medical EVACUATIONS The Current Services/Chishaayiyuu unit’s The Awash/Uschiniichisuu unit welcomed 20 The past year has been busy for the Admin- EMERGENCY 181 nursing team experienced a year of change new babies this past year. Awash has, for the istration unit, as significant management scheduled 1,048 but is now complete and is working to improve first time, two program nurses and a school changes were imposed. The unit has arranged current services stability in services and programs. For the nurse. One of the team’s community workers new premises in four trailers and was able to family doctor 1,603 first time, the team has two full-time nutrition- is now formally recognized as a social worker, maximize workspace and replace all non-med- specialist md 423 ists, as well as two assistant technicians in the giving the team two social workers. The unit ical equipment for the CMC and other build- other specialist 38 pharmacy. Thanks to new housing facilities, implemented a partnership with Minnie’s Hope ings. The construction of 12 new housing units nurse (walk-in) 3,505 the unit has also been able to post additional Social Pediatrics Centre in late summer, and allowed the CMC to fill vacant positions. The 100 nurse (medication refill) 3,269 positions, including liaison nurse, assistant to has strengthened partnerships with the various maintenance team has prioritized the mainte- 101 nurse (vaccinations) 110 the immediate supervisor and Chishaayiyuu entities of the community. The Awash/Uschi- nance and renovation of the heating systems awash nurse. The arrival of another Community Health niichisuu team is pleased to have participated in all CBHSSJB buildings, which for years have nurse 1,351 Representative (CHR) is also enabling the more in the community’s first Symposium on Social been deficient. This year, and for the next few CHR (individual) 64 complete development of the unit’s programs. Issues. Prevention Week, organized annually years, the unit aims to acquire more training group activities by a chr 112 Two full-time physicians continue to offer high by the National Native Alcohol and Drug Abuse and support for our workers. Community worker 0 quality medical services. The Cree Home and Program (NNADAP) community worker, has social worker 48 Community Care Program, with the support of surpassed previous years thanks to strong Uschiniichisuu Human Resources, worked hard throughout the partnerships that have been established. nurse 1,277 year to recruit staff and to improve stability for CHR (individual) 93 its clients. Since December the CMC has been group activities by a chr 46 developing its telehealth services. Community worker 0 social worker 19 NNADAP worker 0 community worker (addictions) 0 Chishaayiyuu nurse 2,589 footcare nurse 0 CHR (individual) 155 group activities by a chr 0 Community worker 0 social worker 19 homecare visits 273 MSDC (participants end of year) 1,142 1. The 0-4 age group (a) is underestimated since newborns are meals served (indiv. servings) 1,216 often registered late in the JBNQA beneficiary list; and (b) has been corrected using the MSSS 2013-2016 births (+ 2017 estimates) and 2012-2015 MSSS deaths numbers. 2. Does not include 90 Inuit, Métis and/or non-aboriginals. ᐅᒋ ᒥᓰᓃᐦᐄᒑᓲᐧᐄᔨᒡ ᒥᓯᐧᐋ ᐋᐱᑎᓰᔅᑖᐦᒡ ᒑ ᒋ ᐧᐄᒋᐦᐋᑳᓅᐧᐄᔨᒡ ᐋᐱᑎᔑᓲ ᑭᔭ ᒑ ᒋ ᐧᐄᒋᐦᐄᐧᐋᐱᔩᒡ ᒥᓰᐧᐋ ᐋᐱᑎᓰᐧᐄᓐᐦ᙮ ᐄᔨᔨᐤ ᐋᐱᑎᓰᐧᐄᓐ, ᔔᔮᓐᓰᓇᐦᐄᑲᓐᐦ, ᓈᓃᑎᐧᐋᐱᐦᒌᑲᓐᐦ, ᒑᐧᑳᓐ ᐋᑦ ᒋᔅᑖᐱᑎᐦᒡ ᐋᐱᑎᓰᐧᐄᓂᔨᒡ ᐧᐄᐦᒡ, ᐧᐋᔅᑳᐦᐄᑳᓐᐦ, ᑭᔮ ᐧᐄᒋᐦᐄᑐᐧᐄᓐ ᐋ ᑭᓂᐧᐋᐦᐄᑖᑯᐦᒡ, (ᐅᑕᑯᔒᐧᐄᔨᒡ ᐋᒋᐧᐄᐦᒡ ᑭᓂᐧᐋᔨᑖᑯᔒᔨᒡ)᙮ uchi misiiniihiichaasuuwiiyich misiwaa aapitisiistaahch chaa chi wiichihaakaanuuwiiyich aapitishisuu kiya chaa chi wiichihiiwaapiyiich misiiwaa aapitisiiwiinh. iiyiyiu 103 aapitisiiwiin, shuuyaansiinahiikanh, naaniitiwaapihchiikanh, chaakwaan aat chistaapitihch aapitisiiwiiniyich wiihch, waaskaahiikaanh, kiyaa wiichihiituwiin aa kiniwaahiitaakuhch, (utakushiiwiiyich aachiwiihch kiniwaayitaakushiiyich). The Administrative Services Group 5 provides essential regional support functions to the organization. It includes Human Resources, Financial Resources, Information Technology Resources, Material Resources and Wiichihiituwin (formerly Cree Patient Services). ᐋ ᐅᐦᒋ ᐱᒥᐱᔨᐦᑖᑭᓂᐎᒡ ᐋᐱᑎᓰᐎᓐ aa uhchi pimipiyihtaakiniwich aapitisiiwin administrative services ᐆᒋᒫᐤ ᐋ ᐆᐦᒋ ᐄᔨᔨᐤ ᐱᒥᐱᔨᐦᑖᑭᓄᐎᒡ ᐋᐱᑎᓰᐎᓐ ᐋᐱᑎᓰᐧᐄᓐᐦ uuchimaau aa uhchi pimipiyihtaakiniwich aapitisiiwin iiyiyiu aapitisiiwiinh MESSAGE FROM THE AED HUMAN RESOURCES

ADMINISTRATIVE SERVICES Liliane Groleau Assistant Executive Director

Once again, it is time to share with you the This past year the Human Resources (HR) This year saw 335 new employees hired, elevat- fruits of the past year’s harvest. 2018-19 was Department focused its efforts on fulfilling its ing the total workforce to 2,217 employees, an exceptional in terms of projects, events and primary mission: ensuring the availability of suf- overall increase of 1.5%. Of these, 72% are unpredictable situations that our services had ficient, qualified, efficient and committed em- Cree beneficiaries. There was also a significant to face. ployees to achieve the CBHSSJB’s objectives. decrease in vacant positions available: from 370 last year to 250 currently. We foresee further Looking back, I am very proud of the Each HR unit has been structured according to decreases in vacancies next year. competent and dedicated staff who rolled up client groups, allowing a single respondent for their sleeves and took on challenges throughout managers and employees to ensure a rapid and The Recall List team aims to support CBHSSJB the year. We are always mindful of the need to effective response in all areas of HR manage- departments and services by managing the or- not only to do things, but to do them well, and ment activities. ganization’s needs for temporary replacements. within the framework of the budgets allocated This year, following the appointment of a team to projects and ongoing operations. HR units have seen a significant decrease in coordinator, four additional staff were hired. their turnover rate, from 14% in 2017-18 to 10% This report illustrates the extent of the The team is now developing and implementing 104 in 2018-19. 105 challenges faced in 2018-19 and provides an a client group approach. overview of the priorities of the departments The Staffing unit’s mandate is to support the The Human Resources Development (HRD) within Administrative Services. CBHSSJB in creating a strong and stable work- team’s mandate is to build a culturally safe I would be remiss if I did not emphasize the force. Many attraction and retention initiatives training base to support the objectives set work of our partners and our collaborators took place during the last year. The Summer forth in the Strategic Regional Plan. In 2018-19, who contribute to our success. They are rarely Students Program gave nearly a dozen Cree the team supported over 250 training activi- recognized at their true value, but are essential students the opportunity to learn relevant skills ties across the organization. It also worked on to achieving the strategic objectives of our and gain insight into health and social services developing a partnership with Collège Marie- departments. fields. The team continues to welcome students Victorin and Indigenous and Northern Affairs for internships within the organization, this year In conclusion, I would like once again to thank Canada to offer two college-level training inaugurating internships for nursing students. and congratulate the entire team for the quality programs with the goal that this program allow These programs aim to maintain contact with of the work done. I hope that the next year will 28 enrolled employees to obtain an Attestation students throughout their academic careers in be even better and that our teams will continue of College Studies in spring 2019. hopes of recruiting them after graduation. to rise to the challenges in such an impressive manner! The team partook in over 30 recruitment events STATUS OF HUMAN RESOURCES Liliane Groleau throughout the year. Local job fairs were orga- Assistant Executive Director nized in many communities, and more will be Administrative Services organized in the remaining communities in the coming year. 98 1,185 56 2,217 Total workforce Full-time managers Full-time regular Part-time regular 72% (including interim) employees employees Cree beneficiaries 1% 2% 5% ᔓᐧᐃᔮᓐ ᐋᐱᑎᓰᐧᐄᓐᐦ shuwiyaan aapitisiiwiinh FINANCIAL RESOURCES

A number of organizational development initia- This year, the team welcomed an additional The Financial Resources team continued its tives have emerged: personnel officer to provide more support to its ­efforts to improve the quality and efficiency managers and employees, and travelled to all of the services it provides. One approach to ●● The Integration Program for New Managers, communities to provide advice to management achieve this end involved reorganizing our launched in December 2018 and employees on the correct application of structure at the level of the management staff, ●● Climate Analysis and Diagnostics initiatives, the collective agreements and best practices to which allowed the hiring of two accounting/ which have been carried out in various retain and engage employees. finance professionals. areas of the organization The team also provided a series of trainings In line with its goal of reducing the use of ●● Tools and surveys giving information on for managers and employees, and launched its cheques, the Accounts Payable unit increased employee satisfaction Kiniwwaapimiisuutaau Campaign on dealing the proportion of payments made by electronic The HRD team will continue its initiatives and with conflict, from incivility and harassment to transfer by 8%, to 53% of all payments. will develop new tools and programs in the violence. The campaign began with Wiichihi- coming year. 106 ituwin, HR and the Eastmain CMC and will be The Procurement unit successfully central- 107 provided to all CBHSSJB departments. ized ordering and warehousing activities at the The Indigenous Succession Program (formerly Chisasibi Administrative Centre. This major the Cree Succession Plan) adopted new eligi- Finally, efforts were made to maintain a harmo- project was carried out in collaboration with bility criterion, so candidates can be Cree or nious partnership with unions: with the Confé- the Material Resources Department. In order to members of other Indigenous communities. The dération des sydicats nationaux (CSN) union, improve and accelerate the ordering process, executive management, in collaboration with 97 grievances were settled and/or withdrawn the Purchasing unit hired two new people. HR and a consultation firm, has been reviewing in the last year, and 172 remain active; with the the succession plan to enhance its quality and Fédération Interprofessionelle de la santé du Finally, the Cree Non-Insured Health Benefits ensure its alignment with CBHSSJB strategic Québec (FIQ), 97 grievances were settled and/ (CNIHB) team worked in committee to review all goals. Next year, emphasis will be placed on or withdrawn, and 16 remain active. policies and procedures associated with non- creating customized development plans for insured health benefits. The policies were ap- each employee in the program. The Health and Safety team aims to develop proved by the Board of Directors in March 2019. and implement strategies and programs to pro- The Compensation and Benefits team oversees vide employees with conditions that maximize the administration of employee files, including their work environment, quality of life at work payments by electronic determining and monitoring their compensa- and individual health. The team oversees, man- transfer tion and their benefits packages. Reorganiza- ages and supports the application of medico- tion in the past year aims to allow fast, efficient administrative measures regarding employee follow-up to requests. The team has also been absences. Several initiatives were implemented involved in the VIRTUO-GPRH project. By the to support employees, ranging from developing 8% 53% end of 2020, all CBHSSJB employees should new envelopes on HR information to compil- have access to an electronic time sheet. ing employees’ vaccination and immunization Labour Relations provides a front-line advisory status and visiting communities to explain the role to CBHSSJB managers in applying national team’s services. Overall, 398 salary insurance and local collective agreements within our or- files were treated in 2018-19. ganization, as well as various laws pertaining to health and social services. ᓈᓂᑑᐦᐙ ᐱᒋᑲᓐ ᒑᒀᓐ ᐋᐦᐋᐱᑎᒋᔅᑖᑭᓄᐎᔨᒡ ᓈᓂᑑᐦᒋᔅᒑᔨᐦᑎᒧᐎᓐ ᒑ ᒋ ᒥᔻᐱᑎᔒᓈᓄᐎᔨᒡ naanituuhwaapichikan naanituuhchischaayihtimuwin chaakwaan aahaapitichistaakinuwiyich chaa chi miywaapitishiinaanuwiyich INFORMATION TECHNOLOGY RESOURCES MATERIAL RESOURCES

During the past year, the Information Techology 4,700 2,200 The Material Resources Department’s (MRD) PROJECT MANAGEMENT HIGHLIGHTS (IT) Department has sought to provide quality REQUESTS INCIDENTS mandate is to create the best possible lodging ●● Construction of 130 lodging units in eight of services by setting up, both at the operational and working environment for clinical, adminis- the nine communities and strategic levels, effective technological and trative and other personnel of the CBHSSJB. ●● Plan and launch of the Regional Administra- system solutions to meet the CBHSSJB’s needs. The MRD maintains 572 lodging units and tion Building Project in Chisasibi 49 clinical administrative buildings. This past ●● Three new architects on the ­construction team The department’s main objectives are directly year construction and renovation expenditures related to the Strategic Regional Plan; to that included over $46 million on capital projects, $3 ●● Functional and Technical Plans (FTPs) for end, several innovations have been implemented million on MOA construction and $1.6 million on Waskaganish and Oujé-Bougoumou CMCs and new projects put forward. MRD special projects. (both awaiting MSSSQ authorization) and the Whapmagoostui CMC (95% finished) Several new technicians were hired in 2018-19, Material Resources’ Project Management Office ●● Plans for regional hospital reorganisation allowing the department to strengthen its service (PMO) completed files related to the Mainte- ●● Work on Healing Centre and Chisasibi delivery. Throughout the year, the IT department nance of Assets and Capital Funding Program 108 Birthing Home FTPs 109 supported the organization by solving more than on buildings throughout the CBHSSJB. 2,200 incidents and fulfilling over 4,700 requests. ●● Board approval for planning and purchas- The MRD is active in relocating regional adminis- ing buildings in Whapmagoostui, Wemindji The department developed a new master plan, tration offices to the recently acquired Regional and Waswanipi, as well as 24 housing units the IT Master Plan 2.0, which updates the 2012 Administrative Services building in Chisasibi. (awaiting MSSSQ approval) plan and adds the new projects required to This site will continue to be enhanced as the ●● Residential housing repairs and renovations support the mission of our organization. This IT remaining departments move into their spaces. in all nine communities Master Plan is comprised of projects totaling $26 million in investment, so sustained funding ●● Repairs on Mistissini and ­Nemaska Multi- from the MSSSQ and from the organization is an Service Day Centres (MSDCs) important element in achieving our goals. Infrastructure accomplishments include comple- tion of the Robin’s Nest women’s shelters; the expansion of office space in Oujé-Bougoumou, 129 Waskaganish and Whapmagoostui; work on the Wiichihiituwin administration building in Val-d’Or; and phase one of the regional administration LODGING UNITS building in Chisasibi. Ongoing projects include CONSTRUCTED phase two of the regional administration building and infrastructure replacement in Chisasibi.

The PMO established its IT division in May In the Non-Medical Equipment Funding frame- 2018. Accomplishments include migrating work, the MRD replaced almost $488,000 emails to Outlook, installing and configuring worth of equipment, mainly for offices and the Alfresco content management system, residences; in particular, furniture was replaced and developing software for regional housing in the Whapmagoostui clinic and offices. management. Ongoing projects include Elec- tronic Medical Records in CMCs, Electronic The Operations division underwent many Health Records in the regional hospital, new changes this year. Hotel reservation staff joined IT systems for Pharmacy and Dentistry, and IP the department, and the team began putting in Telephony consolidation, among others. place the support for vehicle fleet maintenance, inspections and repairs. Regional housing staff The Biomedical Department ensures that also started work on centralizing transit reser- medical equipment past its useful life will be vations and housing unit assignments. Software 110 replaced with new equipment. The depart- was developed to make the reservations, with 111 ment began work on a preventive maintenance Chisasibi and Waswanipi being integrated into program and a critical prioritisation of medical the program this year. The project will continue equipment. It now has a biomedical engineer in 2019-20. Leases were renewed for 42 Fort and three biomedical technologists to provide George and 18 motel rooms in Chisasibi, and services in all communities. The department for Wiichihiituwin’s 3rd Avenue office in Val-d’Or. replaced over $250,000 of medical equipment and purchased almost $135,000 of new equip- ment; $55,000 was directed to new equipment for the midwifery program.

ᐐᒋᐦᐄᑐᐎᓐ WIICHIHIITUWIN

Wiichihiituwin—to help one another—plays a HIGHLIGHTS Improved patient services in Montreal: Two WIICHIHIITUWIN vital role in providing access to medical and Employee well-being: New office space new positions, for an oncology nurse at the PATIENTS & ESCORTS social services not available to the population in was opened in Val-d'Or, accommodating the Royal Victoria Hospital and a social worker at Eeyou Istchee communities. Every year, Wiichi- dispatch team; this space has provided the the Montreal Children's Hospital, are in the re- PATIENTS hiituwin coordinates the travel, accommodation, team with an environment better suited to their cruitment process. Regular doctor visits to the 23,196 local transportation, meals and appointments needs. Also, a Wiichihiituwin employee satis- Espresso Hotel have increased medical sup- of thousands of customers passing through faction survey was conducted in December, port for long-term clients and their companions one of its four points of service: Chibougamau, identifying departmental strengths and areas in Montreal. The doctor, who acts as a family Chisasibi, Montréal and Val-d’Or. for improvement. physician for this clientele, also facilitates com- ESCORTS munication between Wiichihiituwin medical staff 9,313 There were 32,509 patient and escort arrivals Links with partners: The team began work last in Montreal and the community. during the past year, an increase of 3% over the year to make Wiichihiituwin’s partners aware of previous year. For the same period, the Wiichi- the culture and reality of our community mem- Updating policies and procedures: The poli- 112 hiituwin team organized 41,173 appointments bers, with training sessions on Cree culture cies and procedures of the Cree Non-Insured 113 in affiliated institutions at its service points, offered to staff in the Montreal area. Since 2017, Health Benefits Program (CNIHB) were re- generating more than 100,000 local patient and recurring meetings have been held in partner- viewed and updated in collaboration with the attendant transports. ship with Region 17 and RUIS McGill (Réseau CNIHB team (Financial Resources Department)­ Universitaire Intégré de Santé) to promote the and other stakeholders of the organization. This year, the Montreal site faced a mid-Febru- development and harmonization of specialized These went into effect in April 2019. ary reduction in service lasting for three weeks. services so that they are adapted to the popu- Montreal services were reduced to medical lation of Regions 17 and 18. evacuations and emergencies due to a lack of WIICHIHIITUWIN ARRIVALS FOR personnel to provide liaison nurse service. We Human Resources: A new coordinator posi- MEDICAL APPOINTMENTS NORTHERN OPERATIONS CENTRE The NOC (Northern Operations rapidly developed an action plan to restore ser- tion for the Espresso (Montreal) and Chisasibi TOTAL Centre) is the group responsible for vice as quickly as possible and to ensure that sites has been created, and a third liaison 32,509 (p3%) mechanisms are in place to prevent this situa- nurse position for Chisasibi has been added. managing all air transport for patients tion from recurring. To support the development of projects within and escorts, employees and any the department, two positions were created for VA L- D’O R consultants and guests authorized Wiichihiituwin drivers, Espresso Hotel, Montreal specialists in administrative processes. 12,327 (0%) to travel for the CBHSSJB. The NOC team ensures 24/7 emergency medi- cal evacuation (“medevac”) by air MONTREAL ambulance as well as passenger res- 10,064 (p13%) ervations on charter flights using Air Creebec planes. During the year, the CHIBOUGAMOU NOC coordinated transport for almost 8,145 (q4%) 24,000 passengers in total, includ- ing approximately 700 ­emergency CHISASIBI medevac flights. 1,973 (p6%) 115 6

ᐋ ᒥᓯᓈᓱᑦ ᑳ ᐃᔅᐱᔨᑦ ᔔᔮᓐ aa mininaasut kaa ispiyit shuuyaan financial statements BREAKDOWN OF GROSS EXPENSES BY PROGRAM

Current Exercise Previous Exercise Programs Expenditures % Expenditures % Service Programs Public Health $2,074,491 0.79% $2,167,016 0.93% General Services - Clinical and Assistance Activities 18,578,708 7.08% 13,539,127 5.79% Support for Autonomy of the Elderly 5,324,644 2.03% 4,038,665 1.73% Physical Disability 7,652,320 2.92% 7,086,340 3.03% Intellectual Disability and Autism Spectrum Disorders (ASD) 49,106 0.02% 44,511 0.02% 116 Youth in Difficulty 19,402,464 7.40% 18,749,442 8.01% 117 Dependencies 494,599 0.19% 409,491 0.17% Mental Health 4,035,161 1.54% 3,342,493 1.43% Physical Health 129,205,886 49.25% 119,882,160 51.25% Support Programs Administration 38,302,197 14.59% 30,838,742 13.18% Support to Services 10,839,698 4.13% 10,098,888 4.32% Management of Buildings and Equipment 26,400,457 10.06% 23,719,288 10.14% TOTAL $262,359,731 100.00% $233,916,163 100.00%

BUDGETARY BALANCE

The Cree Board of Health and Social Services of The capital funds shows a deficit ($2,084,465) James Bay (CBHSSJB) shows an operating funds due to depreciation on self-financed projects and deficit ($428,849), therefore contravening sec- funds transferred from operating to capital funds tions 3 and 4 of the Act to provide for balanced to finance medical and non-medical equipment budgets in the public health and social services purchases as well as construction projects. network (CQLR, chapter E-12.0001). However, the Considering the Government’s Financial Admin- CBHSSJB will use the surpluses accumulated in istration Manual requires the capital subsidy to the previous years against this deficit. be accounted for in the year the asset is acquired and the depreciation to be accounted for in subsequent years, it is not possible to maintain a surplus in the capital funds. CBHSSJB CBHSSJB STATEMENT OF OPERATIONS | 31 MARCH 2019 STATEMENT OF OPERATIONS | 31 MARCH 2019

CBHSSJB CBHSSJB Page 200-00 Page 358-00 STATEMENT OF OPERATIONS - OPERATION FUNDS │ 31 MARCH 2019 STATEMENT OF OPERATIONS - OPERATION FUNDS │ 31 MARCH 2019

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

MSSS Grants 1 249 998 757 258 826 219 10 379 179 269 205 398 240 066 468 MSSS Grants 1 240 232 396 258 826 219 258 826 219 231 122 463 Government of Canada 2 6 353 897 7 654 573 7 654 573 6 702 624 Government of Canada 2 6 353 897 7 654 573 7 654 573 6 702 624 User contributions 3 780 000 697 338 XXXX 697 338 788 074 User contributions 3 780 000 697 338 XXXX 697 338 788 074 Sale of services and recoveries 4 1 185 535 1 085 755 XXXX 1 085 755 1 201 184 Sale of services and recoveries 4 1 185 535 1 085 755 XXXX 1 085 755 1 201 184 Donations 5 Donations 5 Investment revenue 6 Investment revenue 6 Business revenue 7 Business revenue 7 Gain on disposal 8 Gain on disposal 8 9 XXXX XXXX XXXX XXXX XXXX 9 XXXX XXXX XXXX XXXX XXXX 10 XXXX XXXX XXXX XXXX XXXX 10 XXXX XXXX XXXX XXXX XXXX Other revenue 11 261 048 1 554 741 1 554 741 390 219 Other revenue 11 261 048 1 321 570 233 171 1 554 741 390 219 TOTAL (L.01 to L.11) 12 258 579 237 269 818 626 10 379 179 280 197 805 249 148 569 TOTAL (L.01 to L.11) 12 248 812 876 261 930 882 7 887 744 269 818 626 240 204 564

EXPENDITURES EXPENDITURES

Salaries, benefits and payroll taxes 13 130 848 122 138 646 685 XXXX 138 646 685 125 122 714 Salaries, benefits and payroll taxes 13 130 848 122 133 164 045 5 482 640 138 646 685 125 122 714

Medications 14 13 155 000 13 151 992 XXXX 13 151 992 12 174 619 Medications 14 13 155 000 13 151 992 XXXX 13 151 992 12 174 619 Blood products 15 96 985 XXXX 96 985 118 Blood products 15 96 985 XXXX 96 985 119 Medical and surgical supplies 16 4 316 900 4 218 117 XXXX 4 218 117 4 271 492 Medical and surgical supplies 16 4 316 900 4 218 117 XXXX 4 218 117 4 271 492 Food products 17 757 500 805 776 XXXX 805 776 782 975 Food products 17 757 500 805 776 XXXX 805 776 782 975 Honoraria paid to non-instutional resources 18 XXXX Honoraria paid to non-instutional resources 18 XXXX Financial charges 19 6 080 000 3 190 905 4 521 028 7 711 933 5 493 340 Financial charges 19 2 040 000 3 190 905 XXXX 3 190 905 1 399 661 Maintenance and repairs, including non-capital costs 20 3 681 341 3 055 180 3 055 180 2 858 679 Maintenance and repairs, including non-capital costs related to capital assets 20 3 681 341 3 054 459 721 3 055 180 2 858 679 related to capital assets Bad debt 21 XXXX Bad debt 21 Rent 22 6 249 415 6 660 278 XXXX 6 660 278 7 101 515 Rent 22 6 249 415 6 653 678 6 600 6 660 278 7 101 515 Capital asset depreciation 23 7 781 597 XXXX 7 942 616 7 942 616 6 303 319 Loss on disposal of capital assets 24 XXXX Transfer expenses 23

Transfer expenses 25 XXXX Other expenditures 24 87 764 598 98 023 774 2 397 783 100 421 557 87 033 882 TOTAL (L.13 to L.24) 25 248 812 876 262 359 731 7 887 744 270 247 475 240 745 537 26 XXXX XXXX XXXX XXXX XXXX

Other expenditures 27 87 764 598 100 421 557 100 421 557 87 033 882 SURPLUS (DEFICIT) OF THE YEAR 26 0 (428 849) 0 (428 849) (540 973) TOTAL (L.13 to L.27) 28 260 634 473 270 247 475 12 463 644 282 711 119 251 142 535 (L.12 - L.25)

SURPLUS (DEFICIT) OF THE YEAR (L.12 - 29 (2 055 236) (428 849) (2 084 465) (2 513 314) (1 993 966) L.28) CBHSSJB CBHSSJB STATEMENT OF ACCUMULATED SURPLUS (DEFICIT) | 31 MARCH 2019 STATEMENT OF FINANCIAL POSITION | 31 MARCH 2019

CBHSSJB Page 202-00 CBHSSJB Page 204-00 STATEMENT OF ACCUMULATED SURPLUS (DEFICIT) - ALL FUNDS │ 31 MARCH 2019 STATEMENT OF FINANCIAL POSITION - ALL FUNDS│ 31 MARCH 2019

Operating fund Capital assets Fund Current Year Prior Yr. Total FUND General Capital assets Current Year Total Prior Yr. Total (C1+C2) Current year Current year Total (C1 +C2) 1 2 3 4 1 2 3 4 FINANCIAL ASSETS Cash on hand (overdraft) 1 5 021 732 5 021 732 10 856 671 ACCUMULATED SURPLUS (DEFICIT) BEGINNING 1 17 509 956 25 405 052 42 915 008 44 908 974 OF YEAR, ALREADY ESTABLISHED Short-term investments 2 Accounting changes with prior year Receivables - MSSS 3 186 712 418 1 317 046 188 029 464 179 345 895 2 restatement (specify) Other receivables 4 6 603 599 6 603 599 3 412 584 Accounting changes without prior year restatement Cash advances to public institution 5 XXXX 3 XXXX (specify) Interfund receivables (payables) 6 12 534 680 (12 534 680) 0 ACCUMULATED SURPLUS (DEFICIT) BEGINNING 4 17 509 956 25 405 052 42 915 008 44 908 974 ADJUSTED (L.01 to L.03) Grant receivable (deferred grants) - accounting reform 7 5 620 243 (20 349 357) (14 729 114) (14 776 615)

Portfolio investments 8

SURPLUS (DEFICIT) FOR THE YEAR 5 (428 849) (2 084 465) (2 513 314) (1 993 966) Deferred debt issuance costs 9 XXXX 10 XXXX XXXX XXXX XXXX Other changes: 6 11 XXXX Inter-institution transfers (specify) Other items 12 2 356 651 7 176 181 9 532 832 3 739 520 Interfund transfers (specify) 7 (11 742 039) 11 742 039 0 TOTAL FINANCIAL ASSETS (L1 to L12) 13 218 849 323 (24 390 810) 194 458 513 182 578 055 Other items applicable to private establishments under 8 XXXX agreement (specify) 9 XXXX XXXX XXXX XXXX LIABILITIES TOTAL OTHER CHANGES (L.06 to L.09) 10 (11 742 039) 11 742 039 Short-term debt 14 165 102 618 379 042 165 481 660 178 399 554 Accounts payable - MSSS 15

ACCUMULATED SURPLUS (DEFICIT) END OF YEAR Other accounts payable and accruals 16 34 388 837 34 388 837 29 871 285 120 11 5 339 068 35 062 626 40 401 694 42 915 008 121 (L.04+ L.05 + L.10) Consisting of the following: Cash advances - decentralized envelopes 17 XXXX 12 XXXX XXXX External restrictions Accrued interest payable 18 284 883 1 317 046 1 601 929 1 323 733 Internal restrictions 13 XXXX XXXX 5 744 042 5 485 995 Unrestricted or Unrestricted balance (L.11 - L.12 - L.13) 14 XXXX XXXX 34 657 652 37 429 013 Deferred revenue 19 6 405 247 6 405 247 8 182 280 TOTAL (L.12 to L.14) 15 XXXX XXXX 40 401 694 42 915 008 20 XXXX XXXX XXXX XXXX

Long-term debts 21 XXXX 128 644 942 128 644 942 99 418 369

Liability for contaminated sites 22 XXXX Liability for employee future benefits 23 10 144 863 XXXX 10 144 863 8 892 839

24 XXXX XXXX XXXX XXXX

Other items 25 673 318 7 176 181 7 849 499 2 165 343 TOTAL LIABILITIES (L.14 to L.25) 26 216 999 766 137 517 211 354 516 977 328 253 403

NET FINANCIAL ASSETS (NET DEBT) (L.13 - L.26) 27 1 849 557 (161 908 021) (160 058 464) (145 675 348)

NON FINANCIAL ASSETS Capital assets 28 XXXX 196 970 647 196 970 647 185 177 004 Supply inventory 29 2 039 700 XXXX 2 039 700 1 686 076 Prepaid expenses 30 1 449 811 1 449 811 1 727 276 TOTAL NON FINANCIAL ASSETS (L.28 to L.30) 31 3 489 511 196 970 647 200 460 158 188 590 356

SHARE CAPITAL AND CONTRIBUTED SURPLUS 32 XXXX ACCUMULATED SURPLUS (DEFICIT) 33 5 339 068 35 062 626 40 401 694 42 915 008 CBHSSJB CBHSSJB STATEMENT OF VARIANCE OF NET FINANCIAL ASSETS/DEBTS | 31 MARCH 2019 CASH FLOW STATEMENT | 31 MARCH 2019

CBHSSJB Page 206-00 CBHSSJB Page 208-00 STATEMENT OF VARIANCE OF NET FINANCIAL ASSETS/DEBTS │ 31 MARCH 2019 CASH FLOW STATEMENT │ 31 MARCH 2019

Budget General Fund Capital Assets Total Current Yr. Total Prior Yr. Current Year Prior Year Fund (C2+C3) 1 2 OPERATING ACTIVITIES 1 2 3 4 5 Surplus (deficit) for the year 1 (2 513 314) (1 993 966)

NET FINANCIAL ASSETS (NET ITEMS NOT AFFECTING CASH FLOW 1 (145 675 348) 14 096 604 (159 771 952) (145 675 348) (99 089 911) DEBT BEGINNING ALREADY ESTABLISHED Provision tied to portfolio investments and loan guarantees 2 Accounting changes with prior year restatement 2 Supply inventory and prepaid expenses 3 (76 159) (689 608)

Accounting changes without prior year restatement 3 XXXX Loss (gain) on disposal of capital assets 4 Loss (gain) on disposal of portfolio investments 5 NET FINANCIAL ASSETS (NET DEBT BEGINNING 4 (145 675 348) 14 096 604 (159 771 952) (145 675 348) (99 089 911) Amortization of deferred revenue related to capital assets: ADJUSTED (L.01 to L.03) - Government of Canada 6 SURPLUS (DEFICIT) FOR THE YEAR 5 (2 055 236) (428 849) (2 084 465) (2 513 314) (1 993 966) - Other 7 (P.200, L.29) Capital asset depreciation 8 7 942 616 6 303 319 VARIANCE DUE TO CAPITAL ASSETS: 6 (20 000 000) XXXX (19 736 259) (19 736 259) (50 205 182) Capital loss 9 Acquisitions Amortization of debt issue costs and management 10 Annual depreciation 7 7 781 597 XXXX 7 942 616 7 942 616 6 303 319 Amortization of bond premium or discount 11 Gain/loss on disposal of assets 8 XXXX Proceeds of disposition 9 XXXX MSSS grants 12 (5 858 151) (4 850 326) Bad debts 10 XXXX Other (specify) 13 Capital asset adjustments 11 XXXX TOTAL ITEMS NOT AFFECTING CASH FLOW (L.02 to L.13) 14 2 008 306 763 385 12 XXXX XXXX XXXX XXXX Changes in financial assets and liabilities related to operation 15 (5 522 243) (36 840 425) 13 XXXX XXXX XXXX XXXX CASH FLOW RELATED TO CAPITAL ASSET INVESTMENT ACTIVITIES (L.01 + L.14 + L.15) 16 (6 027 251) (38 071 006) 122 TOTAL VARIANCE DUE TO CAPITAL ASSETS 123 14 (12 218 403) XXXX (11 793 643) (11 793 643) (43 901 863) (L.06 to L.13) VARIANCE DUE TO SUPPLY INVENTORY AND CAPITAL ASSET INVESTMENT ACTIVITIES PREPAID EXPENSES: Cash outflow related to capital asset purchases 17 (21 927 016) (47 261 227) 15 (10 000 000) (2 039 700) XXXX (2 039 700) (9 761 807) Proceeds of disposition of capital assets 18 Acquisition of supply inventory CASH FLOW RELATED TO CAPITAL ASSET INVESTMENT ACTIVITIES Acquisition of prepaid expenses 16 (1 900 000) (1 672 658) (1 672 658) (1 752 343) 19 (21 927 016) (47 261 227) (L.17 + L.18) Use of supply inventory 17 9 750 000 1 686 076 XXXX 1 686 076 9 507 160

Use of prepaid expenses 18 1 800 000 1 950 123 1 950 123 1 317 382 INVESTMENT ACTIVITIES TOTAL VARIANCE DUE TO SUPPLY INVENTORY AND PREPAID 19 (350 000) (76 159) (76 159) (689 608) Variance of short-term investments 20 EXPENSES (L.15 to L.18) Portfolio investments (made) 21

Proceeds of disposition of portfolio investments 22

Other variance in accumulated surplus (deficit) 20 (11 742 039) 11 742 039 0 Portfolio investments (completed) 23 CASH FLOW RELATED TO INVESTMENT ACTIVITIES (L.20 to L.23) 24

INCREASE (DECREASE) IN NET FINANCIAL ASSETS 21 (14 623 639) (12 247 047) (2 136 069) (14 383 116) (46 585 437) (NET DEBT) (L.05 + L.14 + L.19 + L.20)

NET FINANCIAL ASSETS (NET DEBT) 22 (160 298 987) 1 849 557 (161 908 021) (160 058 464) (145 675 348) END OF YEAR (L.04 + L.21) CBHSSJB CBHSSJB CASH FLOW STATEMENT (CONT’D) | 31 MARCH 2019 CASH FLOW STATEMENT (CONT’D) | 31 MARCH 2019

CBHSSJB Page 208-01 CBHSSJB Page 208-02 CASH FLOW STATEMENT (CONT'D) │ 31 MARCH 2019 CASH FLOW STATEMENT (CONT'D) │ 31 MARCH 2019

Current Year Prior Year Current Year Prior Year 1 2 1 2 FINANCING ACTIVITIES VARIANCE OF FINANCIAL ASSETS AND LIABILITIES RELATED TO OPERATION: Long-term debts - Debts incurred 1 Receivables - MSSS 1 (8 683 569) (46 351 369) Long-term debts - Debts repaid 2 Other receivables 2 (3 191 015) 1 182 299 Capitalization of discounts and premium on debt instruments 3 Cash advances to public institutions 3 Variance of short-term debts - generated fund 4 19 794 649 62 300 000 Grant receivable - accounting reform - employee future benefits 4 150 522 Short-term debts incurred - capital asset fund 5 2 324 679 30 606 174 Deferred debt issuance costs 5 Short-term debts repaid - capital asset fund 6 Other assets 6 (5 793 312) 464 359 Variance from government sinking fund 7 Accounts payable - MSSS 7 Other (specify P297) 8 Other accounts payable and accruals 8 6 708 310 6 808 079 CASH FLOW RELATED TO FINANCING ACTIVITIES (L.01 to L.08) 9 22 119 328 92 906 174 Cash advances - decentralized envelopes 9 Accrued interest payable 10 278 196 64 639 Deferred revenue 11 (1 777 033) 55 350 INCREASE (DECREASE) IN CASH AND CASH EQUIVALENTS Liability for contaminated sites 12 10 (5 834 939) 7 573 941 P.208-00, L.16 + L.19 + L.24 + P.208-01, L.09) Liability for employee future benefits 13 1 252 024 1 167 075 Other liability items 14 5 684 156 (381 379) TOTAL VARIANCE OF FINANCIAL ASSETS AND LIABILITIES RELATED TO OPERATION 15 (5 522 243) (36 840 425) CASH AND CASH EQUIVALENTS, BEGINNING OF YEAR 11 10 856 671 3 282 730 (L.01 to L.14)

OTHER INFORMATION: CASH AND CASH EQUIVALENTS, END OF YEAR (L.10 + L.11) 12 5 021 732 10 856 671 124 Capital asset acquisitions included in accounts payable as at March 31 16 1 664 126 3 854 883 125 Proceeds of disposition of capital assets included in receivables as at March 31 17 CASH AND CASH EQUIVALENTS, END OF YEAR INCLUDING: Other items not affecting cash and cash equivalents (specify P297) 18 (5 858 151) (3 688 097) Cash on hand 13 5 021 732 10 856 671 Short-term investments 14 INTEREST: TOTAL (L.13 + L.14) 15 5 021 732 10 856 671 Creditor interest (revenue) 19 Interest received (revenue) 20 Interest received (expenses) 21 7 711 933 5 493 340 Interest spent (expenses) 22 3 100 131 1 293 958

ᐃᐦᑖᐎᓐ ᒥᔪᐱᒫᑎᓰᐎᑭᒥᒄᐦ DIRECTORY ᐃᐦᑖᐎᓐ ᒥᔪᐱᒪᑎᓰᐎᓐᑭᒥᒄ ᒥᓯᓂᐦᐄᒑᐅᑭᒥᒄ REGIONAL SERVICES COMMUNITY MIYUPIMAATISIIUN Regional Administration CENTRES (CMCS) PO Box 250 Chisasibi, QC J0M 1E0 ᒋᓵᓰᐲ Chisasibi CMC T 819-855-2744 | F 819-855-2098 21 Maamuu Meskino Complaints 1-866-923-2624 Chisasibi, QC J0M 1E0 819-855-2844 Chisasibi Hospital 21 Maamuu Meskino ᐄᔅᒣᐃᓐ Eastmain CMC Chisasibi, QC J0M 1E0 143 Nouchimi Street 819-855-2844 Eastmain, QC J0M 1W0 819-977-0241 Recruitment Centre 1055 René Lévesque Boulevard East ᒥᔅᑎᓯᓃ th Mistissini CMC 7 floor 302 Queen Street Montreal, QC H2L 4S5 Mistissini, QC G0W 1C0 1-877-562-2733 418-923-3376 [email protected] ᓀᒥᔅᑳ Nemaska CMC Public Health Department 7 Lakeshore Road 260 Main Street Nemaska, QC J0Y 3B0 Mistissini, QC G0W 1C0 819-673-2511 418-923-3355 Montreal 514-861-2352 ᐅᒉᐴᑯᒨ Oujé-Bougoumou CMC 68 Opataca Meskino Wiichihiituwin Oujé-Bougoumou, QC G0W 3C0 Chisasibi Hospital 418-745-3901 819-855-9019 ᐙᔅᑳᐦᐄᑲᓂᔥ c/o Centre de santé de Chibougamau Waskaganish CMC 51, 3e rue 2 Taktachun Meskaneu Chibougamau, QC G8P 1N1 Waskaganish, QC J0M 1R0 418-748-4450 819-895-8833 1055 René Lévesque Boulevard East ᐙᔅᐙᓂᐲ Waswanipi CMC th 6 floor 1 West Aspen Montreal, QC H2L 4S5 Waswanipi, QC J0Y 3C0 514-989-1393 819-753-2511 c/o Hôpital de Val-d'Or ᐐ ᒥᓂᒌ 725, 6e rue Wemindji CMC Val-d'Or, QC J9P 3Y1 60 Maquatua Road 819-825-5818 Wemindji, QC J0M 1L0 819-978-0225 Youth Healing Services ᐙᐱᒫᑯᔥᑐᐃ Reception Centre Whapmagoostui CMC 282 Main Street Whapmaku Street Mistissini, QC G0W 1C0 Whapmagoostui, QC J0Y 1G0 418-923-3600 819-929-3307

Youth Protection Hotline 1-800-409-6884

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