ᐋᔑᑯᒻ ᐱᐳᓐᐦ ᑎ ᐹ ᒋᒨᓯᓂ ᐦᐄ ᑭ ᓐ annual report 2017 2018 ᒥᔪᐱᒫᑎᓰᐅᓐ ᐊᓈᓈᑭᒋᐦᑖᑭᓅᒡ cree board of health and social services of james bay 2017 2018 ᒥᔪᐱᒫᑎᓰᐅᓐ ᐋᔑᑯᒻ ᐱᐳᓐᐦ ᐊᓈᓈᑭᒋᐦᑖᑭᓅᒡ ᑎᐹᒋᒨᓯᓂᐦᐄᑭᓐ cree board of health and annual social services of james bay report contents ᐋᐆᒃ ᓃᔮᓐ 6 about us ᐋᑎᔅᑳᑑᐦᒡ ᐋᐱᑎᓰᓲᐐᔨᒡ 8 organigram ᐋᑎᔑᔨᒡ ᐄᔨᔨᐅᐎᒡ 9 population map

Photo credits Cover photo of Whapmagoostui taken by Carole Laforest

Pages 7, 14, 23, 70, 85(b), 97, 108 — Katherine Morrow 11 27 Pages 10, 12, 13, 14, 20, 38, 51, 54, 57, 63, 73, 77, 98, 101(b), 104, 122 — Tatiana Philiptchenko Page 14, 29, 34, 72, 101(a) — Mary Monger ᑳ ᐱᒥᐱᔨᐦᑖᑦ ᐱᒧᐦᑌᐦᐁᐤ Page 14 — Reggie Tomatuk Pages 15, 26 — Marcel Gregorick board & executive pimuhteheu Pages 19, 67 — Paul Brindamour Page 21 — Nasuna Stuart-Olin 12 Chair and Executive Director 30 Pre-Hospital Emergency Services and Page 22 — Iain Cook 14 Board of Directors Emergency Measures Page 25 — Rodolphe Beaulieu Poulin Pages 31, 74 — Jason Coonishish 15 Council of Nishiiyuu 32 Youth Healing Services Page 33 — Hélène Porada 16 Executive and Senior Management 34 Youth Protection Page 36 — Vanessa Gervais 17 37 Program Development and Support Pages 37, 93 — Kory Saganash Corporate Services Pages 40, 41 — Eve-Marie Richard 18 Council of Physicians, Dentists and 38 Public Health Pages 46, 47, 49, 71 — Joshua Loon Pharmacists Pages 43, 45, 53 — Catherine Rhéaume-Provost Page 58 — Cécelia Ariano 20 Council of Nurses Page 65(a) — Painting by Vanessa B. Stephen 22 Service Quality and Complaints 61 Pages 65(b) & 123 — Erika Eagle 24 Population Health Profile Page 68 — James Andrew Rosen Pages 69, 78 — Catherine Quinn ᒥᔪᐱᒫᑎᓰᐅᓐ Pages 81, 83, 85(a), 87, 89, 91 — Melanie Lameboy Pages 103, 107 — Jimmy Sam Miyupimaatisiiun Page 109 — Gaston Cooper, Air Creebec 55 Page 110 — Carole Laforest 64 Medical Affairs and Services 68 DPSQA - Health ᓂᔒᔫ ᒥᔪᐱᒫᑎᓰᐅᓐ 69 Allied Health With the exception of all photographs, the information in this publication may be reproduced without charge or further nishiiyuu 70 Midwifery permission, provided that the CBHSSJB is identified as the source. Download a copy at: creehealth.org miyupimaatisiiun 72 Psychosocial Editor — Katherine Morrow Copy Editors — Patrick McDonagh, Alison Scott, Mary Monger 74 Chisasibi Hospital Layout & design — Alison Scott Design 76 Specialized Services 79 Annual Report of the Cree Board of Health and Social Services of James Bay, 2017-2018 99 Community Miyupimaatisiiun Centres © 2018 CBHSSJB (CMCs) Box 250, Chisasibi, QC J0M 1E0 ᐋ ᐅᐦᒋ ᐱᒥᐱᔨᐦᑖᑭᓂᐎᒡ ISSN 11929-6983 (Print) ᐋᐱᑎᓰᐎᓐ ISSN 1929-6991 (Online) Legal deposit — 3rd trimester 2018 administrative services 111 National Library of Canada 102 Human Resources Bibliothèque et Archives nationales du Québec, 2018 ᐋ ᒥᓯᓈᓱᑦ 104 Financial Resources 105 Information Technology Resources ᑳ ᐃᔅᐱᔨᑦ ᔔᔮᓐ 106 Material Resources financial 108 Wiichihiituwin (Cree Patient Services) statements ᐋᐆᒃ ᓃᔮᓐ About us

1978 ᑳ ᐄᒋᔅᑖᐦᒡ ᐊᔅᒌ ᐊᒋᐦᑖᓱᓐ ᐊᑰᐦᑦ ᐧᐄᔅᑳᒡ Founded in 1978, the Cree Board of Health and ᑳᐦ ᑎᑰᒡ ᒥᔪᐱᒫᑎᓰᐅᓐ ᑭᔮ ᓂᑐᐦᑯᔨᓐ ᐋᐧᐄᐦᒡ Social Services of James Bay (CBHSSJB) is ᑭᓂᐧᐋᐱᐦᑖᑭᓅᒡ᙮ ᒥᓯᐧᐋ ᐋᐧᐋᓐ ᐋ ᐧᐄᒋᐦᑦ ᐆᑦ ᐄᔨᔨᐤ responsible for the administration of health and ᐊᔅᒌᔨᒡ ᐊᑰᐦᑦ ᐧᐋᒡ ᑭᓂᐧᐋᐃᐦᑖᑯᓯᑦ᙮ ᐊᓐ ᒑ ᐄᔥ social services for all persons residing perma- ᑭᐧᐋᐱᐦᑎᒫᔨᒡ ᐋᐱᑎᓰᐧᐄᓐᐦ ᑭᔮ ᒥᔪᐱᒫᑎᓰᐅᓐ ᒧᔮᒻ ᐋ nently or temporarily in Region 18, the adminis- trative region of the Ministry of Health and Social ᐄᔥ ᒥᓯᓈᑖᐦᒡ ᑯᐹᒃ ᐧᐄᔔᐧᐋᐧᐄᓐᐦ᙮ Services of Quebec corresponding to the Cree ᐊᓐ ᐅᒋᒫᐤ ᒥᓯᓂᐦᐄᒑᐅᑭᒥᒄ ᐊᑰᐦᑦ ᐊ ᑎᑰᒡ territory of James Bay. Our mandate is defined in 6 Chapter S-5—An Act respecting health services 7 ᐊᓂᑖ ᒋᓵᓰᐱᔨᒡ᙮ ᓃᔮᔨᓐᐦ ᐊᓂᐦᐄ ᒑᐧᑳᓐ ᐋ and social services for Cree ­Native persons. ᐋᐱᑎᓰᔅᑕᑲᓄᐧᐄᔨᒡ ᐅᑦ ᒥᓯᓃᐦᐄᒑᐅᑭᒥᑯᒡ: ᐊᓂᒋ ᒑᔅᑖᐱᑎᓰᔅᑖᐦᒡ ᒥᔪ ᐱᒫᑎᓰᐧᐄᓂᔫ ᒫᒧᐧᐃᐦᑕᐧᐃᒡ In each of the nine communities of Eeyou ᐋ ᑭᓂᐧᐋᐱᐦᑖᐦᒡ ᐊᐱᑎᓰᐧᐄᓐᐦ: ᐱᒧᐦᑕᐦᐅ, Istchee, the CBHSSJB operates a Community Miyupimaatisiiun Centre (CMC), which is similar ᓂᔒᔫ, ᒥᔪᐱᒫᑎᓰᐅᓐ (ᒥᓯᐧᐋ ᐄᔨᔨᐤ ᐄᑕᐧᐄᓐᐦ to a CISSS elsewhere in Quebec. CMCs offer ᑖᐱᑎᐧᐃᐱᔨᐦᐆᒪᑳᓐᐦ) ᐋᐧᐄᔨᒡ ᑭᓂᐧᐋᐱᐦᑖᑲᓄᐄᔨᒡ services in general medicine, home care, ᐋᐱᑎᓰᐧᐄᓐ ᑭᔮ ᒥᓯᓂᐦᐄᒑᐅᑭᒥᒄ᙮ ᐅ ᒫᒃ ᒥᓯᓂᐦᐄᑲᓐ ­dentistry, social services and ­allied health. ᐧᐋᓯᑕᑲᓅᐧᐄᔨᒡ ᓂᔮᔨᓐᐦ ᐱᔅᑭᑎᓯᓂᐦᐄᑭᓐᐦ ᐋᐧᐄᐦᑕᑯᒡ ᑖᓐ ᑳ ᐄᔅᐲᔨᒡ ᐋᐱᑎᓰᐧᐄᓐᐦ ᐅᑦ ᒥᓯᓂᐦᐄᒐᑭᒥᑯᒡ᙮ In addition to CMCs, the CBHSSJB operates the 29-bed Chisasibi Regional Hospital, three ᐹᐊᓛ ᐹᑕᐧᐋᐱᓅ ᓃᑳᓂᔅᑭᒻ ᐊᓂᔮ ᒥᓯᓃᐦᐄᒑᐅᑭᒥᑯᒡ homes for youth at risk, a Regional Public ᒥᔪ ᐱᒫᑎᓰᐧᐄᓐ ᑭᔮ ᓂᑐᐦᑯᔨᓐ ᐋ ᐧᐄᔨᒡ Health Department and program planning unit, ­Wiichihiituwin (formerly Cree Patient Services) ᑭᓂᐧᐋᐱᐦᑖᑭᓅᐧᐄᔨᒡ, ᐊᑯᑦ ᐊᔅᑎᐱᐦᔨᒡ ᐊᓂᔮ ᑳ liaison offices in Chibougamau, Val-d’Or and ᐲᐦᑕᓰᓂᐧᐋᑲᓅᐧᐄᔨᒡ ᒑ ᒋ ᒫᒨᐧᐄᔅᑖᐦᒡ ᒥᔪᐱᒫᑎᓰᐅᓐ ᑭᔮ Montreal, and a recruitment office in ­Montreal. ᓂᑐᐦᑯᔨᓐ ᐋᐱᑎᓰᐧᐃᓐᔫ᙮ ᐊᓂᒌ ᒫᒃ ᑳ ᒫᒨᐧᐄᐧᐃᐱᔅᑖᐦᒡ The Head Office is in Chisasibi. ᒥᔪᐱᒫᑎᓰᐅᓐ ᑭᔮ ᓂᑑᑯᔨᓂᔫ ᐋᐱᑎᓰᐧᐃᓐᔫ ᐊᓐ ᑭᔮ The CBHSSJB is governed by an elected ᐅᒋᒫᐤ ᑳ ᓈᑭᑎᐧᐋᔨᐦᑎᒃ ᐋᐦᐋᑳ ᓃᔅᑳᒑᔨᒡ ᐄᒧᐧᐄᓂᔫ Board of ­Directors whose Chairperson is Bella ᑭᔭ ᐋᐱᑎᓰᐧᐄᓂᔫ, ᑭᔮ ᐊᓐ ᑳᓂᑑᒋᔅᒑᐄᐦᑎᐦᒃ M. ­Petawabano. Advisory Committees and ᓂᑐᐦᑯᔨᓂᔫ ᐋ ᐧᐄᔅᑖᐱᔨᐦᐧᐋᒡ᙮ ᑖᓂᔨᓪ ᓭᐁᓂᑦ - ᐋᐦᒨᕐ ­Councils report directly to the Office of the ᐋ ᐧᐄᐦᑰ ᐧᐋᒋᒫᐧᐄᑦ ᐊᓂᑖ ᒥᓰᓇᐦᐄᒐᐧᐄᑲᒥᑰᒡ᙮ Chair, as do the Service Quality and Complaints Commissioner and the Medical Examiner.­ The Executive Director is Mr. Daniel St-Amour. CBHSSJB ORGANIGRAM ᐋᑎᔅᑳᑑᐦᒡ ᐋᐱᑎᓰᓲᐐᔨᒡ

council of nishiiyuu

council of physicians, dentists and pharmacists board of ᐋᑎᔑᔨᒡ directors council of nurses

SERVICE quality and complaints COMMISSIONER ᐄᔨᔨᐅᐎᒡ EEYOU ISTCHEE POPULATION JULY 2017 executive CORPORATE SERVICES direction 18,057

nishiiyuu pimuhteheu miyupimaatisiiun administrative miyupimaatisiiun services ᐙᐱᒫᑯᔥᑐᐃ

ᒋᓵᓰᐲ 8 pre-hospital community medical affairs human resources 9 emergency services development and services ᐐ ᒥᓂ ᒌ and emergency complementary medicine financial measures services and resources programs dentistry ᐄᔅᒣᐃᓐ youth healing pharmacy information services organizational technology ᓀᒥᔅᑳ quality and nursing resources youth protection cultural safety evaluation and allied health material program accreditation resources ᐙᔅᑳᐦᐄᑲᓂᔥ development and client midwifery ᒥᔅᑎᓯᓃ support experience and wiichihiituwin organizational disability services psychosocial (formerly cree performance patient services) (special needs) chibougamau ᐙᔅᐙᓂᐲ maanuuhiikuu ᐅᒉᐴᑯᒨ (mental health) chisasibi community chisasibi montreal hospital miyupimaatisiiun public health centres va l- d’o r awash (0-9 yrs) uschiniichisuu (10-29 yrs) chisasibi chisasibi chishaayiyuu (30+ yrs) hospital eastmain serc (surveillance, hospital mistissini There is approximately an additional 5% evaluation, research, non-permanent residents who also receive communications) units nemaska services from the CBHSSJB. clinical oujé-bougoumou The 0 to 4 year-old age group size has been services corrected using the MSSS 2012-2015 births waskaganish (+ 2016 estimates) and the MSSS 2012-2015 nursing waswanipi deaths numbers. specialized wemindji Sources: MSSS, JBNQA Cree beneficiary services list, 2017; MSSS Births databases whapmagoostui 2012-2015; MSSS Mortality databases administration 2012-2015; Statistics Canada 2016 Census. 1

ᑳ ᐱᒥᐱᔨᐦᑖᑦ board and executive 11

ᐆ ᐱᔅᑭᑎᓯᓂᐦᐄᑭᓇᒡ ᐊᑰᐦᑦ This chapter presents an ᒫᓯᓈᑖᐦᒡ ᑖᓐ ᐋᓯᓈᐦᑯᔨᒡ ᑭᔮ overview of the CBHSSJB ᑖᓐ ᐋ ᒋᔅᑳᑑᔨᒡ ᒥᔪᐱᒫᑎᓰᐅᓐ organizational structure, the ᑭᔮ ᓂᑐᐦᑯᔨᓐ ᐋᐱᑎᓰᐧᐄᓐ health of the population and ᐋᐧᐄᐦᒡ ᑭᓂ ᐧ ᐋ ᐱᑖ ᑭᓅᒡ the activities of the Board of ᐋᐱᑎᓰᔖᐧᐄᔨᒡ ᐋᓯᓈᑰᔨᒡ ᐆᑦ Directors and Executive. ᐊᐱᑎᓰᐧᐄᓂᐧᐋᐤ ᐄᔨᔨᐧᐄᔨᒡ ᐋᐦᐋᐱᑎᓰᔅᑐᐊᑳᓅᐧᐄᔨᒡ᙮ ᑳ ᓃᑳᓂᐱᔥᑎᐦᒃ ᒥᔨᐱᒫᑎᓰᐅᓐ ᐆᒋᒫᐤ ᒥᔨᐱᒫᑎᓰᐅᓐ ᐊᓈᓈᑭᒋᐦᑖᑭᓅᒡ ᐆᑏᔨᒨᐎᓐ ᐊᓈᓈᑭᒋᐦᑖᑭᓅᒡ ᐆᑏᔨᒨᐎᓐ

MESSAGE FROM MESSAGE FROM THE THE CHAIR EXECUTIVE DIRECTOR

As we approach our 40th Anniversary in April Along with Board colleagues and some senior This past year we have established the foun- The role of Nishiiyuu in the CBHSSJB continues 2018, I invite readers of this report to reflect on managers we made a second visit to South Cen- dation for the CBHSSJB’s Strategic Regional to grow as we integrate traditional Cree knowl- the unique nature of this institution, which was tral Foundation (SCF) in Alaska, which is another Plan by building infrastructure, strengthening edge and healing into our services. With the created as a direct outcome of the James Bay example of an Indigenous health and social partnerships, and ensuring that we are deliver- new midwifery program as well as support from and Northern Quebec Agreement (JBQNA). services agency. We draw inspiration from SCF’s ing culturally safe and appropriate services and Nishiiyuu Waapimaausun, we will bring child- The Cree Board of Health and Social Services culturally-based and client-centred approach. programs to the people of Eeyou Istchee. birth back to Eeyou Istchee, which is a very of James Bay (CBHSSJB), one of the pillars exciting prospect. We also continue to develop of Cree self-governance, is one of very few The lead up to the second Eeyou/Eenou Re- We have made significant advances in the the Cree succession plan as we look to the Indigenous-owned health and social services gional Assembly on Health and Social Services physical infrastructure supporting the orga- future and seek to ensure the sustainability of agencies operating within Canada’s universal in Waswanipi was a major focus of this report- nization. This past year we constructed 129 the organization. health care system. ing period. With this event I wish to invite our lo- houses, enabling us to hire the people needed cal and regional community partners to discuss to increase our services for communities. In These initiatives are critical to fulfilling our mis- It was only a few decades ago that the how they can work with us to realize the vision addition, we have submitted to the Ministère sion: to bring the best of health care to Eeyou 12 ­CBHSSJB consisted of isolated nursing out- embedded in the Strategic Regional Plan 2016- de la Santé et des Services Sociaux the plans Istchee, to promote miyupimaatisiiun, and to 13 posts and a small hospital. Today, we employ 2021. While next year’s report will showcase for new Community Miyupimaatisiiun Centres provide culturally safe, relevant and effective over 2,000 people and are held up as a model this event in more detail, I am very pleased to in Whapmagoostui, Waskaganish and Oujé- programs and services to our communities. of excellence in many areas of our services. Our report that we had a successful and deeply Bougoumou, and for the new Chisasibi health staff come from every part of the world, and we significant gathering where many partnerships centre, housing the CMC and the regional hos- On a personal note, this past year my nomina- value the unique contribution that each one of were forged. pital. The newly-purchased old arena in Chisa- tion as the Executive Director of the CBHSSJB them brings. The CBHSSJB is different from sibi will host the CMC on the first floor until the was approved by the Board of Directors. I am other health agencies of Quebec. Our Chairper- new hospital is built, and will be the permanent honoured and humbled by the trust shown in son and Board are elected from the communi- home to our administrative offices. me by the many people I serve in the organiza- ties, and programs like the Cree Succession tion and in the communities of Eeyou Istchee. We also continue to enrich our partnerships Plan exist to promote the development of Cree Bella M. Petawabano Thank you. human resources. This is an Indigenous-led CBHSSJB Chair with communities. Currently we don’t have institution that has been given the trust of the the institutions to address the needs of elderly Cree Nation to deliver health and social ser- people who are semi-autonomous or have vices according to Cree values and principles. experienced some loss of autonomy, so we are Daniel St-Amour The Nishiiyuu Group and the Council of Nishi- working with communities to develop programs Executive Director iyuu help and guide us in making sure that our that would enable them to stay in their homes, services reflect Eeyou/Eenou values, culture, with the full range of support they require. This knowledge and language. initiative would also allow us to build a long- term care facility to support those who are no longer autonomous. Currently we are awaiting the Ministry’s response to our proposal to de- velop the Ashuukin Services project long-term care facility in Waswanipi, which would operate with support from the CBHSSJB, the communi- ty, and the ministry, and would provide a model for future community projects. board of ᑳ ᓃᑳᓂᐱᔥᑎᐦᒡ directors

Regular meetings: 4 | Conference calls: 1 | Special meetings: 4 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: 7 Waskaganish Community Representative Administrative & Human ­Resources Committees Susan Esau Bella M. Petawabano Executive Director Daniel St-Amour Daniel St-Amour Susan Esau Community Representatives Dr. Darlene Kitty L. George Pachanos, Chisasibi Edna Neeposh Jamie Moses, Eastmain L. George Pachanos Christine Petawabano, Mistissini Audit Committee | meetings: 4 Edna Neeposh, Nemaska Susan Esau Minnie Wapachee, Oujé-Bougoumou L. George Pachanos Susan Esau, Waskaganish Minnie Wapachee Jonathan Sutherland, Waswanipi Vigilance Committee | meetings: 4 Tyler Shanush, Wemindji Bella M. Petawabano Vacant*, Whapmagoostui Daniel St-Amour Annie Trapper-Weistchee, Washaw-Sibii 14 Christine Petawabano 15 ­(Observer status) Jonathan Sutherland *Gloria George resigned in January 2018 Moses Petawabano Advisory Committee | mtgs: 5 ᑳ ᒫᒨᐱᒡ ᓂᔒᔫ Bella M. Petawabano Susan Esau Christine Petawabano Edna Neeposh Council of nishiiyuu­

ᑳ ᒫᒨᐱᒡ ᓂᔒᔫ ᒋᔅᒋᓄᐦᐅᒧᐙᐅᒡ The Council of Nishiiyuu­ provides ᑳ ᓃᑳᓂᔥᑭᒥᔨᒡᐦ ᓂᑐᐦᑯᔨᓐ guidance to the Board of Directors Bella M. Petawabano Daniel St-Amour ᐋᐱᑎᓰᐎᔨᐤ ᐅᐦᒋ ᐊᓂᔮ and the organization based on their ᐅᒋᔅᒑᔨᐦᑎᒧᐎᓂᐙᐤ ᑳ ᐃᔅᐱᔨᔨᒡᐦ knowledge of Cree ­history, values and ­traditional healing ­practices. ᐙᔥᑭᒡ ᐄᔨᔨᐤᐦ, ᐃᔑᐦᑣᐎᓐᐦ ᑭᔮ ᐄᔨᔨᐤ ᐋᓂᔅᒑᐤ ᓂᑐᐦᑯᐦᐄᐙᐎᓐᐦ᙮

Susan Esau L. George Pachanos Jamie Moses Chris Petawabano Edna Neeposh

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. Minnie Wapachee Jonathan Sutherland Tyler Shanush Annie Trapper-­ Darlene Kitty Reggie Tomatuk Weistchee ᑳ ᐱᒥᐱᔨᐦᑖᒡ ᐋᐱᑎᓰᐎᓂᔨᐤ ᐋ ᐎᒡ ᐎᔨᐱᔨᐦᑖᑭᓄᐐᔨᒡ executive and senior management ᐋᐱᑎᓰᐎᓐᐦ Facebook: up 33% to 3,817 followers Twitter: up 7% to 1,995 followers Office of the Chair Instagram: up 29% to 665 followers Bella M. Petawabano, Chairperson ᒥᓯᓂᐦᐄᒑᐅᑭᒥᒄ Creehealth.org: up 14% to 50,105 users Sarah Cowboy, Service Quality and Complaints Commissioner Total page views: 373,399 (43% mobile) CORPORATE SERVICES Most popular page: /career/job-posting

Senior Management Corporate Services, under the leadership Communications GENERAL MANAGEMENT Local Directors of Laura Moses, continues to provide sup- The unit’s main activities include managing the Daniel St-Amour, Executive Director Community ­Miyupimaatisiiun Centres (CMCs) port to the Board of Directors and associ- website, social media, photography, media rela- Paula Rickard, Assistant to the Executive Director Jeannie Pelletier, Chisasibi ated CBHSSJB governance functions, and tions, brand management, corporate publica- Laura Moses, Director of Corporate ­Services Rita Gilpin, Eastmain also oversees corporate communications and tions (like this report), strategic communications Paul Iserhoff, Mistissini (Interim) translation services. This was a difficult year (speech writing and policy-level presentations), PIMUHTEHEU GROUP Beatrice Trapper, Nemaska (Interim) for some members of the team, as some of us management of outsourced services, Cree trans- Taria Matoush, Assistant Executive Director (AED) Louise Wapachee, Oujé-Bougoumou dealt with losses and health issues. Neverthe- lation, and supporting departments with commu- Robert Auclair, Director of Youth ­Protection (DYP) Bert Blackned, Waskaganish 1 less, we managed to pull through and continue nications challenges. There is an increasing focus Marlene Kapashesit , Assistant DYP – Youth Criminal Alan Moar, Waswanipi Justice Act and Foster Homes to carry out our activities and functions. on internal knowledge management issues and Mary Shashaweskum, Wemindji (Interim) Maria MacLeod, Director of Youth ­Healing Services­ applying policies and standards. John Mamianskum, Whapmagoostui Jamie Moses from Eastmain, Tyler Shanush from Anne Foro, Director of Program Development and Wemindji and Edna Neeposh from Nemaska Highlights of 2017-2018 Support ADMINISTRATIVE SERVICES GROUP 16 were elected to the Board of Directors. Susan ●● Hiring of Mary Monger as Communications 17 Liliane Groleau, AED Esau, Christine Petawabano, L. George Pacha- Public Health ­Department Denis Tremblay, ­Director of Financial Resources Technician and part-time Cree translator, Dr. Robert Carlin, Director of Public Health nos and Jonathan Sutherland were re-elected Jean-François Champigny, AD of Finance – Mary Shem. Dany Gauthier, Assistant Director (AD) of Public for another term by their respective communi- Financial Management Units ●● The new corporate brand guideline was com- Health – Awash and ­Uschiniichisuu ties. In order to avoid a turnover of members at Marie Blais, Director of Human Resources pleted, consisting primarily of two formats of Paul Linton, AD of Public Health – Chishaayiyuu any given year in the future, the terms of office François Bérubé, Director of Information a new logo, colours and fonts. A gradual roll- Jill Torrie, AD of Public Health – Surveillance, were reviewed for certain communities. Three- Technology (Interim) out is seeing the new look applied to busi- Evaluation, Research and Communications­ (SERC) day Board meetings were reduced to two-day Luc Laforest, Director of Material Resources ness cards, stationery, forms and templates, meetings, the third day being reserved for orien- NISHIIYUU MIYUPIMAATISIIUN GROUP Helen B. Shecapio-Blacksmith, Director of signage and display, and digital platforms. tation and training activities with a focus on the Laura Bearskin, AED Wiichihiituwin (Interim) Strategic Regional Plan. ●● The Communications team provided a Proj- Vacant, Director – Organizational Quality and Cultural ect Manager and editorial services to assist Safety The organization has developed over the the editorial team responsible for the Thera- years and a review of the election process is MIYUPIMAATISIIUN GROUP peutic Guide. Thanks to a more structured Michelle Gray, AED (Interim)2 called for. A framework will be developed for approach, many chapters were completed. Dr. François Charette, Director of Medical ­Affairs and the elections of Clinical and Non-Clinical staff ●● The Communications Unit provided ma- Services (DMAS) representatives to the Board of Directors. The jor planning support to the Eeyou-Eenou Mario Barrette, Assistant DMAS framework will be in place for the elections for Second Regional Assembly on Health and Philippe Lubino, Director of Chisasibi Regional Hospital these positions in the summer of 2019. Social Services in Waswanipi in April 2018, Michelle Gray, Director of Professional Services and 1. Marlene Kapasheshit was nominated as Assistant DYP th in March 2018 and official start date was to be determined The Internal Knowledge Access (IKA) project, a which helped to kick off the 40 Anniver- Quality Assurance (DPSQA) - Health once the recruitment process for her current position of collaboration with IT Resources, completed a sary celebrations. Karine Jones, Assistant DPSQA - Health Assistant Director of Youth Protection for Foster Homes and call for tender for the new Electronic Document Next year’s focus will include the 40th Anniversa- Leah Dolgoy, DPSQA Allied Health (Interim)3 Youth Criminal Justice Act is complete. Management and Intranet system. The platform ry, brand implementation, and Alfresco deploy- Simon-Pierre Breton, DPSQA Psychosocial 2. Greta Visitor on leave. selected is Alfresco, which offers document man- ment, as well as a thorough website content Jessyka Boulanger4, DPSQA Midwifery 3. Adelina Feo on leave. agement as well as team collaboration features. review. A Communications retreat is planned Clarence Snowboy5, Assistant to the AED – Operations 4. Jessyka Boulanger, as Head Midwife, also covers ­Quality Assurance. to reflect on communication needs as a whole 5. Clarence Snowboy resigned in April 2018. and to identify longer term priorities within the context of the Strategic Regional Plan. ᑳ ᓃᑳᓂᐱᔥᑑᐙᒡ ᓂᑐᐦᑯᔨᓐ, ᓅᑖᐱᑖᓱ ᑭᔮ ᓅᒋᐦᓂᑎᑯᔩᓈᓱ COUNCIL OF PHYSICIANS, DENTISTS AND PHARMACISTS

It has been a productive and busy year for the ●● Collective Prescriptions: Collective The CPDP works in partnership with the clinical There are ongoing Executive Committee and Members of the Prescriptions and the Therapeutic Guide departments, the Director of Medical Affairs efforts to recruit and Council of Physicians, Dentists and Pharma- enable a standardized approach to care by and Services Dr. François Charette, and the cists (CPDP) of Region 18 in our daily work as nurses. The development of these thera- CBHSSJB Board of Directors to provide and retain permanent family clinicians. In collaboration with other health peutic tools is progressing. improve the medical, dental and pharmaceuti- physicians, as well professionals and the management team, we ●● Electronic Medical Records (EMR): cal care offered to patients in Eeyou Istchee. as to engage various continue to advocate to improve the health and Clinical information systems needs for the We look forward to continuing to contribute to social well-being of our patients, their families region were reviewed and the choice of new and ongoing initiatives, such as planning specialists to work in the and the communities of Eeyou Istchee. an EMR system that fits the needs of the for the new Chisasibi Hospital and primary care Cree communities. CBHSSJB will soon be decided by call for in the Territory. The priorities of the CPDP Executive Commit- tender. Implementation will begin next year. tee are the provision and quality of medical, Dr. Darlene Kitty CPDP EXECUTIVE COMMITTEE dental and pharmaceutical services, including The obligatory and mandated committees of the President Dr. Darlene Kitty, President 18 the competence of its members. The CPDP also CPDP are collaborating well to advance these Dr. Michael Lefson, Vice-President 19 gives recommendations on clinical, technical and priorities and other projects. Two new commit- Dr. Myriam Aubin, Secretary scientific aspects of the organization. In doing so, tees, the Cultural Safety Committee and the Dr. Danie Bouchard, Treasurer the CPDP collaborates with the Board of Direc- Land User Health Committee, were created be- Dr. Carole Laforest, Chief of Medicine tors and General Management of the CBHSSJB. cause of the CPDP members’ interests and mo- Dr. Lucie Papineau, Chief of Dentistry tivations. CPDP members continue their journey Anh Nguyen, Chief of Pharmacy In addition to monitoring ongoing initiatives, to reconciliation by learning about cultural safety, Dr. François Charette, Director of Medical the CPDP supports its members and commit- Cree culture and history as important adjuncts ­Affairs and Services (ex-officio) tees who are planning and implementing the to clinical care and mental health support. Dr. Nicole Seben, Family Physician ­following priorities: Daniel St-Amour (ex officio) Clinical departments are working diligently in ●● Mental Health: The needs of our patients, Physicians, Dentists and Pharmacists at the annual CPDP meeting several realms. For example, for the Depart- Val-d’Or, October 13-15, 2017 families and communities in Region 18 are ment of Medicine, there are ongoing efforts to complex and resources are limited. Mental recruit and retain permanent family physicians, Health remains a priority for the CPDP and as well as to engage various specialists to work the Board of Directors. Program planning, in the Cree communities. The Department of development of protocols and the hiring Pharmacy aims to adapt its services to fit the and training of staff in the Maanuuhiikuu needs of the communities, by training phar- Mental Health Department help to increase macy technicians, updating pharmacy software and improve services. and recruiting permanent pharmacists. The ●● Low-risk Birthing and Midwifery: There is Department of Dentistry continues to improve good progress in the support, development access to quality dental care by supporting and implementation of this program, which training for dental assistants and recruiting aims to improve the prenatal and postpar- permanent dentists. The CPDP will continue to tum health of Cree women and babies, and support and advocate for improvements to the ensure safe pregnancies and deliveries. quality and capacity of these services. ᑳ ᓃᑳᓂᐱᔥᑑᐙᐦᒡ Patrice Larivée ᓂᑐᐦᑯᔨᓂᔅᒀᐤ President, Council of Nurses COUNCIL OF NURSES

EXECUTIVE COMMITTEE COMPOSITION MOVING FORWARD Lastly, the Executive Committee is support- The Executive Committee of the Council of In the fall of 2017, Vice-President Marie-Josée This year, the Council of Nurses was able to ing the review of the nature of the role élargi, Nurses continues to be engaged in the profes- Morin resigned her position on the Executive secure funding for the CINAHL and Nursing its legal definition, and its deployment across sional arenas that guide nursing practice in Committee. Elections took place in November, Reference Centre Plus electronic platforms. all points of services in Eeyou Istchee. The Quebec. Our participation in the Congrès de one week prior to our Annual General Assem- These multimedia tools were deployed Executive Committee of the Council of Nurses l’OIIQ and the Symposium des leaders en santé bly. Two nurses submitted their candidacy for throughout the territory, including all CMCs, thus pursues its objective of maintaining the offered two great opportunities to be exposed the position of representative of the inland com- Chisasibi Hospital, Wiichihiituwin, and Public high quality of all nursing activities provided in to the realities of other regions and to better munities, and Geneviève Bush was duly elected Health. Providing access to a vast scientific Eeyou Istchee. understand their challenges. In addition, this for a two-year mandate. There was no nominee database of nursing and medical articles year, the Executive Committee attended the for the coastal representative. In February 2018, and a rich collection of online clinical tools Patrice Larivée Colloque de l’Association des CII du Québec, the Executive Committee held an extraordinary and educational modules, these platforms President an event in which we were able to forge links General Assembly in Chisasibi to elect a mem- will support and improve clinical nursing with our counterparts in other regions, to share ber for that position. Émilie Dufour submitted practice throughout the organization. With 20 our successes and discuss the challenges her candidacy, and was elected by acclamation the support of two active sub-committees, The CBHSSJB nurses are 21 inherent to our northern context. In fact, the for a two-year term. The roles of the Executive the Executive Committee of the Council of shaping a unique healthcare nursing practice in our territory is very different Committee officers for the next year are: Nurses is currently assessing the available from that of other regions of Quebec. Under resources on the territory for long-term care model: one that has the the guidance of an evolving Therapeutic Guide ●● President: Patrice Larivée of patients with mental health issues and for potential to inspire other policy (from regional services) and many collective prescriptions, of which those experiencing loss of autonomy. We also actors within our evolving the Council of Nurses remains a signatory, the ●● Vice-President: Émilie Dufour remain mindful of the ongoing implementation CBHSSJB nurses are shaping a unique health (from the coastal communities) of midwifery services and the restructuring provincial health system. care model: one that has the potential to inspire ●● Secretary: Geneviève Bush of prenatal care services, with potential other policy actors within our evolving provin- (from the inland communities) repercussions on nursing activities and cial health system. This is what inspires us to leadership in that field. A sub-committee will ●● Communication Agent: Alexandre Bui-Giroux participate in these provincial events. be created to study the provincial legislation (from Chisasibi Hospital) regarding end of life care (RLRQ, c. S-32-0001) and to issue recommendations on the role and responsibilities of nurses, especially homecare nurses, who may receive such requests.

Nurses Desiree Petawabano and Eleanor Gull Nurses Annual Training, November 2017 ᐋᑳ ᓂᐦᐋᒋᐦᐄᐙᒡ

ᒑᒀᓐ ᐊᓂᑐᑯᐦᔩᓈᒡ ᑭᔮ Dr. François Charette Medical Examiner and Director of Sarah Cowboy ­Medical Affairs and Services (DMAS) Service Quality and ᐐᒋᐦᔨᐙᐎᓂᐦᒡ Complaints Commissioner Nancy Shecapio-Blacksmith Assistant Service Quality and ­Complaints Commissioner SERVICE QUALITY (hired May 2018) AND COMPLAINTS

Following the departure of Louise Valiquette The CBHSSJB has been an active participant MEDICAL EXAMINER One complaint against a professional led the I assumed the role of Commissioner, leaving in the Public Inquiry Commission on Relations The role of the Medical Examiner is to analyze Medical Examiner to travel and interview es- vacant the position of Assistant Commissioner. between Indigenous Peoples and certain public complaints that involve a member of the Council sentially all employees of a sector., the result services in Québec (known as CERP). As a of Physicians, Dentists and Pharmacists (CPDP). of which was a satisfactory conclusion. Some One of the past year’s highlights has been work- member of the CERP Working Group for Eeyou Each complaint must be reviewed within a pre- complaints concern delays for consultations ing with Wiichihiituwin (Cree Patient ­Services) to Istchee, I encourage people who are filing cise timeframe and a written report delivered to and treatments. One must be careful not to ensure as smooth an experience as possible complaints to share their experiences with the the complainer. The CBHSSJB Medical Exam- unduly advantage a patient because (s)he when clients have to leave home to receive Commission. We have been working with CERP iner is also the Director of Medical Affairs and complains, allowing priority over others. At services not available in their community. Given to review all files dating back to 2002 that iden- Services. This dual role is acceptable consider- times, there will be delays because of limited the nonstop client movement between the tified discrimination, forwarding the information ing the relatively low expected number of cases. resources on our territory or in another re- communities and Chisasibi, Val-d’Or, Chibou- to the Commission. Collaboration took place In the instance of a possible or apparent conflict gion. Verifications were performed to assure gamau and Montreal, the department has made with CBHSSJB departments, who were asked of interest, the Medical Examiner would request no unreasonable delay was the issue in the major improvements through a client-focused to answer questions and provide statistics on support from another medical examiner from a cases presented. Other complaints have been 22 approach. Services are more accessible, specific files. neighbouring region. This has not been neces- received because expectations of a complete 23 dramatically improving north-south transporta- sary to date. cure did not materialize. It is then the duty of tion, communication and cultural safety and Again this year, there was an increase in the the Medical Examiner to explain that, unfortu- food service. There has been work with Public number of files opened, making it a challenge There were more complaints referred to the nately, there is only so much that medical or Health to oversee food safety at Hotel Espresso to respond to files in a timely manner. The Medical Examiner this year. These complaints dental science can do, and to reassure the pa- in Montreal, where clients have the facilities and CBHSSJB has addressed this by making the were at times quite complex, necessitating the tient that we remain available for him or her and are encouraged to cook traditional food. To ad- role of Commissioner full-time and adding the review of files covering several years of treat- will continue to offer the best possible care. dress ongoing issues, Wiichihiituwin set up the position of Assistant Commissioner. I am con- ments, which did not always allow the medical Quality Care Working Group to work with the fident that the upcoming year will see improve- examiner to respond by the target date. During As in past years, official complaints are often local CMCs, and the Wiichihiituwin Client Sup- ment and transformation. investigations, the Examiner must reach out to avoided. A misunderstanding or misinterpreta- port Group at Hotel Espresso. These multidisci- the person(s) filing a complaint as well as the tion is explained rapidly and there is no need plinary groups help to implement change. The Vigilance Committee of the Board deserves professional being complained about, which to go through the rigorous formal complaints recognition for their role in overseeing, and can be difficult. Members of the CPDP are not process. Complaints help us to recognize is- providing advice and guidance. I wish to thank always on the territory, and sometimes the com- sues. With each complaint, we not only manage FILES OPENED the Board of Directors, the Executive Director plainant can also be difficult to reach. a specific case, but are given the opportunity to and senior management for their compassion 2015 2016 2017 reassess or reorganize practices when needed -2016 -2017 -2018 for the clients. I especially wish to acknowl- to avoid further difficulties or complaints. Complaints 55 103 83 edge the clients who have taken the time to report unsatisfactory situations to the Office of Requests for assistance 26 60 37 the Commissioner, as well as the interveners Consultation 5 11 18 working with the CBHSSJB. All opinions are Intervention 1 0 12 valuable in our ongoing efforts to improve the Referred to HR 9 19 15 overall quality of services. Complaints The confidential toll-free number for complaints Referred to Medical Examiner 2 3 7 Sarah Cowboy 1-866-923-2624 1-866-923-2624 is connected to voicemail, so it is Total - Files opened 87 174 177 essential that the caller state their name, phone number, Service Quality and Complaints Commissioner [email protected] creehealth.org/about-us/users-rights and community so that the Commissioner can call back. The healthcare system itself is one of the underlying determinants ᐄᔨᔫᐎᔨᒡ of the health of a population. [It needs to be] sensitive to the unique historical background, ᐅᒥᔨᐱᒫᑎᓰᐅᓂᐙᐤ and responsive to the cultural POPULATION characteristics of the population. HEALTH PROFILE

Some researchers believe that to develop The picture is similar with circulatory diseases, Researchers have associated these patterns with An earlier study identified 65% of women ­optimal care strategies with patients1­, health primarily heart disease. In the mid 1990s, resi- underlying patterns acting as barriers to human had suffered from depression in their lifetime, care workers first need to better understand dents of Eeyou Istchee were hospitalized for the potential2. In terms of poverty, for example, the and 55% from anxiety. Half of Eenou women what makes some groups more at risk for first time about the same age as others in Que- profile of incomes in Eeyou Istchee shows greater reported having experienced physical abuse long-term health problems2. bec. But in the 2013-14 to 2015-16 period, they inequality between rich and poor than in other while 35% reported sexual abuse. For men, were, on average, only 58.5 years old the first regions of Quebec. Indeed, the 20% worst-off the numbers were 44% and 23% respectively. Health portraits in previous annual reports time they were hospitalized, whereas others in families have access to only 10% of the total These rates are all much higher than reported have shown that, as a group, Eenouch suffer Quebec had an average age of 70.2. Eeyou Ist- regional income as compared to 21% for the for the Quebec population. from ill health and injuries more than would chee has the lowest rate of deaths from circula- province of Quebec. Poverty has been associated be expected. This year, we want to ask if we tory diseases in Quebec; however, those who die with increased stressors, and some researchers Researchers then argued that other factors have evidence that the patterns of illness show have been much younger than others in the rest suggest this helps explain why people experienc- might be more important to explain the persis- evidence of underlying vulnerabilities, and then of Quebec—respectively 69.6 years old versus ing poverty have greater ill health1. tence of these patterns. They call these social consider what might predispose Eenouch as a 79.5 years during the 2008 to 2012 period. processes which make people feel excluded, 24 group to those vulnerabilities. Do we have evidence that people in Eeyou discriminated against and powerless when they 25 From this we see that residents of Eeyou Istchee Istchee live with more stress than others? In receive health care, in other words the social The researchers have identified vulnerabilities show patterns of ill health which have been the region, 20% of people reported not being in relations within our health care institutions2. 2 of health care users on three levels : first, the associated with a predisposition due to underly- good health, double what is reported in the rest Are these working as they should? Considering well known harmful health-related behaviours ing factors. Do we also have evidence for these of Quebec. And almost half of women reported diabetes, a prevalent chronic disease in Eeyou such as smoking, poor nutrition, misuse of ­factors which researchers have identified? living with a high level of psychological distress. Istchee, only about a third of all patients man- 3 alcohol and drugs and lack of physical activity ; age to control their disease, even fewer in the second, barriers to human potential such as We can show that Eenouch engage in some younger age groups. Similarly, we have very poverty, low levels of education, and unemploy- lifestyle patterns which lead to poor health. In high rates of young people being sent out of the ment combined with issues of social connect- the last health survey, 30% of persons said they region to hospital for mental health issues. The 2 edness such as belonging to a minority ; and consumed sugary drinks every day and almost health care system itself is one of the underlying third, what they call the social processes which 30% of men and 40% of women reported they determinants of the health of a population. And make people feel excluded, discriminated were not physically active. Not surprisingly, in the specific context of Indigenous communi- against and powerless when they receive health 60% of men and 70% of women reported they ties, the care system can have negative impacts care. Research has associated exposure to were obese. 40% of persons smoked ciga- on users’ health if not sensitive to the unique these kinds of vulnerabilities with earlier onset rettes, and only 50% reported drinking. How- historical background, and responsive to the 4 of chronic diseases and greater risk of injuries . ever, half of those reported binging—a risky cultural characteristics of the population3,4. drinking pattern. We know that residents of Eeyou Istchee are diagnosed with some common chronic diseas- The question is then: why do es much earlier than most others in Quebec. ­residents of Eeyou Istchee report In 2013-14, it was estimated that 1.8% of the 1. Orpana et al. Int J Behav Med 2007, 14:40. 2. Loignon et al. BMC Health Services Research 2010, 10:320. population of Quebec aged 25 to 44 had been more behaviours related to risky 3. Grabovschi et al. BMC Health Services Research 2013, 13:94. diagnosed with diabetes. Among Eenouch up lifestyles? 4. Sassevill et al. Int J Nursing Study 2018, 77:145. to the end of 2017, diabetes onset affected younger population groups: 1% of the popula- tion aged 10-19; 4% aged 20 to 29; and 40.3% 1. McKinlay et al. J Cormorbidity 2017, 7: 64. 2. Grabovschi et al. BMC Health Services Research 2013, 13:94. of those aged 30 to 39. 3. Fortin et al. BMC Health Services Research 2014, 14:686. 2

ᐱᒧᐦᑌᐦᐁᐤ pimuhteheu ᐱᒧᐦᑕᐦᐆ ᐧᐄᒋᐦᐄᐧᐋᐱᔨᐤ ᒑ ᒋ The Pimuhteheu Group 27 ᒥᔅᑰᐦᑳᐴᑕᑭᓅᐧᐄᔨᒡ ᐋᐱᑎᓰᐧᐄᓐ helps make our services ᐄᔨᔨᔫᐧᐄᔨᒡ ᐋᐱᑎᓰᔅᑖᐦᒡ ᒑ ᒋ stronger through good ᒥᐧᔮᔩᑖᐦᑯᐦᒡ ᐋ ᐧᐄᒥᔅᑰᐦᑳᐳᐧᐄᔨᒡ planning, and works ᐋ ᐧᐄᐧᐋᔫᐱᐦᑕᑲᓅᐧᐄᔨᒡ on creating healthy ᒥᔪᐱᒫᑎᓰᐅᓐ ᑭᔮ ᐄᔨᔨᐧᐄᔨᒡ communities through ᐋ ᐧᐄᒋᑲᐳᔅᑐᐧᐋᑲᓅᐧᐄᔨᒡ ᒥᓯᐧᐋ partnerships. ᐋᐧᐋᓂᒋ ᒑ ᒋ ᒥᔫ ᐱᒪᑎᓰᔩᐦᒡ ᐋ ᐧᐄ ᐧᐄᒋᐦᐋᑳᓅᐧᐄᒡ᙮ CBHSSJB ORGANIGRAM ᐋᑎᔅᑳᑑᐦᒡ ᐋᐱᑎᓰᓲᐐᔨᒡ ᐆ ᒋ ᒫᐤ Taria Matoush board of Assistant Executive Director directors ᐱᒧᐦᑌᐦᐁᐤ MESSAGE FROM THE AED PIMUHTEHEU executive direction At the close of 2017-2018, the Pimuhteheu chee, supported by midwifery services. A team ­Department smoothly transitioned to a new As- of midwives arrived in Chisasibi to implement sistant Executive Director (AED), Taria Matoush, services, and a clinical plan for birthing homes taking over from Interim AED Adelina Feo, who has been elaborated. The return of births is a successfully maintained the pace of development key step in strengthening family bonding and of this diverse planning-oriented department. the celebration of life, as well as the improve- ment of perinatal health and support at a criti- A lot of the work done in Pimuhteheu over the last cal time in a family’s life. nishiiyuu pimuhteheu miyupimaatisiiun administrative year concerned laying the groundwork for improv- miyupimaatisiiun services ing the well-being of families in Eeyou Istchee. In addition to developing plans to improve access Departments under Pimuhteheu have begun dis- to care in the region, the Program Development cussions toward a comprehensive understanding and Support department has been advocating for of what is needed to improve support to families better support for people living with addictions— 28 and ensure the welfare of children. crucial for improving the safety of family environ- 29 pre-hospital ments. Maanuuhiikuu, the Mental Health Depart- emergency services The Regional Department of Public Health’s ment, has worked relentlessly to increase access and emergency efforts toward building healthy communities measures to both on-territory and telehealth psychotherapy. have been furthered through various activi- Disability Programs and Services (formerly Spe- youth healing ties. Teams continue to support prevention and cial Needs) increased staff and is strengthening services promotion activities at the CMC level, while the services offered to families who have a loved building partnerships with communities and one living with a disability. youth protection entities for addressing nutrition issues, advis- program ing on environmental impact of mining projects, Youth Protection Services and Youth Healing Ser- development and promoting healthy schools, engaging in reflec- vices have started discussions with front-line ser- support tion on cannabis legalization, and carrying out vices to ensure a clear protocol for collaboration, disability services other prevention strategies. providing further initial support and leaving Youth (special needs) Protection interventions as a true last resort. maanuuhiikuu The Pre-Hospital Services and Emergency (mental health) Measures unit has grown, hiring new profession- These distinct initiatives have come together als. Recent collaborations helped deliver First to open a discussion on how we can combine public health Responders training, services quality assurance, our efforts with those of other departments to awash (0-9 yrs) protocols for emergency preparedness, and decrease the number of children in care and uschiniichisuu (10-29 yrs) enhanced communications. Partnerships with improve the support we provide young families. chishaayiyuu (30+ yrs) communities are being developed as part of a The future looks promising: together, we will serc (surveillance, evaluation, research, renewed vision. achieve the vision of strong families and youth. communications) The Pimuhteheu Department has collaborated Taria Matoush with Nishiiyuu and Miyupimaatisiiun to lay the Assistant Executive Director foundations for the return of births in Eeyou Ist- ᒌᔩᔅᑎᐦᑉ ᐋ ᐐᔭᔅᑏᐦᒄ ᐊᐙᓐ ᐊᐐᔔᒫᑭᐦᓂᐎᑦ PRE-HOSPITAL EMERGENCY SERVICES AND EMERGENCY MEASURES

PRE-HOSPITAL SERVICES Emergency Measures refers to the prompt NUMBER OF CERTIFIED FIRST The Quebec MSSS requires the certification coordination of actions, persons or property RESPONDERS PER COMMUNITY of First Responders. Service Agreements for in order to protect the health, safety or welfare Chisasibi 15 First Responders are presently in negotiations of people, or to limit damage to property or to Eastmain 6 with the Ministry. Upon successful completion the environment in the event of a present or Mistissini 13 of 72 hours of MSSS training, First Responders imminent incident. The Emergency Measures Nemaska 13 are certified for three years. coordinator assists departments in coordinat- ing responses to civil emergencies such as Oujé-Bougoumou 11 Dr. Isis Migneault, Director of Medical Pre- forest fires and floods. Some incidents involving Waskaganish 17 Hospital and Emergency, oversees Pre-Hospital emergency measures this past year include: Waswanipi 8 Services and the quality of First Responders training. A review of AS-805 forms is expected ●● Two violent incidents in Wemindji requiring Wemindji 13 to provide a better picture of the activities of a debriefing with doctor, nurses and other Whapmagoostui 21 30 First Responders at the operational and clinical front-line workers Total 117 31 levels, which then determine the implementa- ●● A cluster of severe intoxications in one Upon successful completion of 72 hours MSSS training, Jason Coonishish First Responders are certified for three years. tion of the skills maintenance training program, weekend in Eastmain, as well as power and Coordinator of Pre-Hospital Services and Emeregency Measures the organization of the response system, etc. communication outages Claude Dubreuil, First Responder Trainer and ●● The search and recovery of the remains of The 24/7 on-call Emergency Measures team of Quality Assurance, has been hired recently to four hunters lost in Rupert’s Bay Reggie Tomatuk, Jason Coonishish and Thomas­ help implement these improvements. Chakapash is planning emergency colour codes ●● A water blockage at the Chisasibi hospi- documentation in support of the emergency The Bush Kit Program, one of the oldest com- tal that required the evacuation of dialysis readiness of the CMCs and Hospital. ponents of CBHSSJB services, aims to provide patients, and another evacuation of the families who are hunting in remote areas with hospital for several hours when work crews Other highlights of the past year include (among first aid capacity and remote medical support. accidentally tapped into a nearby subterra- others) the updating of Emergency Manage- This year the program completed the policy for nean gas pocket ment plans for Mistissini, Waswanipi, Whap- maintaining the bush kit and its training course ●● A communication crash and power outage magoostui and Wemindji, significant progress and obtained two proposals for land-based in Nemaska toward the completion of Emergency Manage- user and staff training. The Cree Trappers As- ●● Three major fatal highway accidents near ment Plans with the Cree School Board, the sociation expressed a desire to have bush kits Oujé-Bougoumou launch of defibrillator training for Eeyou Police, available to hunters and trappers who are out and the completion of first responder draft ●● A fatal house fire and fatal highway acci- on the land. agreements with the Cree Nation Government. dents at Mistissini ●● A dump fire in Whapmagoostui that burned for two weeks, affecting patients with respi- ratory issues, and cases of dog rabies ●● An ambulance breakdown in Waswanipi, interrupting service for three weeks during the winter of 2018 “I am honoured to have such ᐅᔅᒋᐱᒫᑎᓰᐎᓐᐦ ᐋ a wonderful and very hard working team; without them I could not have made it through ᒦᓂ ᓍ ᒋ ᐦ ᑖ ᑭᓄᐎᐦ ᒡ this past year. Meegwetch!!” YOUTH HEALING SERVICES — Maria MacLeod, Director of YHS

The mission of Youth Healing Services (YHS) CASE MANAGEMENT ACTIVITIES: YHS have been through a lot of shuffles and -ex is to contribute to the protection, rehabilitation For every youth referred, there is an admission ●● Aboriginal Day, Mistissini citing challenges this past year, and other signifi- and all aspects of the well-being of the youth meeting between Youth Protection Worker and ●● Children are Important Week cant changes are yet to come in order to maintain in our care, through the implementation of YHS Intake Worker. Shortly after, a case confer- best practices and ensure quality services. All the ●● Mamoweedow Traditional Gathering, Chisasibi programs that provide treatment in a safe and ence is scheduled, and healing path plan devel- efforts to strengthen YHS services are defined in secure environment. The Department provides oped that involves youth and parents’ participation ●● Sonrise Teen Camp, Mistissini the Youth Healing Services Action Plan. a compassionate and family-oriented program to set goals and objectives. Weekly clinical meet- ●● Boating and Canoeing, Mistissini and Chisasibi YHS had projected to build a new facility that reflects traditional values, Cree cultural ings update files and discuss approaches and ●● Bear Hunt, LG3 (Chisasibi) in Chisasibi; however, since there is a large teachings and language, to provide a sense of strategies. All reports—whether for court, inci- ●● Moose Hunt, LG3 (Mistissini group) acceptance and belonging for youth experienc- dents, observations or discharge—are shared with number of staff already in Mistissini, it became ●● Bear Hunt, LG2 (Chisasibi group) ing many difficulties. Youth Protection. Senior staff meet once a month. apparent that this would create a great impact ●● Caribou Hunt, LG2 (Chisasibi group) in terms of rebuilding the team, especially given The majority of the youth are placed under EDUCATION ●● Moose Hunt, Route du Nord km 80 the years of training already built within the 32 the Youth Protection Act (ordered or voluntary The Cree School Board provides a teacher for ­(Mistissini group) employees, and this not only for the childcare 33 measures) and a few under the Youth Criminal workers, but for all the staff. the Reception Centre in Mistissini. Although the ●● WE Day, Montreal, invitation by Cree Justice Justice Act (open custody). program is not complete and does not pass the ●● M45 Moose Hunt and ice fishing The Department, led by Director Maria MacLeod, youth to the next grade level, it does give them has 71 staff including two coordinators, an intake a greater chance of success once they return to school. Group Home clients attend the public advisor, two clinical advisors, a psychologist YOUTH HEALING SERVICES STATISTICS (position currently vacant), a psycho-educator, 40 school. The Cree School Board and YHS have childcare workers and 14 residence guards/secu- open discussions and are working on a partner- Reception Upaachikush Weesapou Total rity guards. There are also 20 people on the recall ship agreement in order to improve the services. Centre Group Home Group Home list for occasional work. Total number of youth in placement 188 98 94 380 BUSH PROGRAM Youth Protection Act 177 98 94 369 YHS operates three residential facilities: Upaa- The Bush Program offers a holistic land-based Boys and girls 8-12 yrs 0 2 2 4 chikush Group Home in Mistissini, with 7 treat- program with camps for both inland and coastal Boys and girls 13-17 yrs 187 95 92 374 ment beds, the Reception Centre in Mistissini, communities where youth learn cultural and Youth Criminal Justice Act - open custody 9 0 0 9 with 12 treatment beds and 3 emergency beds, traditional Cree life skills. Cree Elders are invited and Weesapou Group Home in Chisasibi, with 9 to participate in guiding the program’s develop- Bush Program Activity (days) 181 39 173 393 treatment beds. The Department is working with ment and delivering traditional knowledge. Hospitalization 3 0 11 14 Cree Justice on a project to build another Re- Outing with unit 31 27 18 76 ception Centre in Mistissini in 2019 with 24 treat- EMPLOYEE TRAINING Absence without authorization (AWOL) 130 47 19 196 ment beds (10 girls and 10 boys), two intensive Employees received the following trainings: Safe Back-up Reception Centre/other centres 30 30 0 60 supervision beds and four closed custody beds. Food Handling, ASIST, Hear/Listen/Understand Home Leaves 880 506 400 1,786 by Cree Nation of Mistissini and Cree Justice, Total days presence 2,524 1,390 1,489 5,403 Basic Trauma Approaches, Restraint by Lee Number of youth discharged 32 10 23 65 Paquet, Communications, Respecting Boundar- ies, Dialogue for Life, Boscoville Training (on- Average number of youth in unit per day 132 71 71 274 going for three years), Mental Health First Aid, Transfer to foster home/other centre 16 13 9 38 Suicide Prevention, Intervention, Postvention. Average length of placement (months) 7.5 7.5 7.5 ᐊᐙᔑᔥ ᓯᑮᔅᒑᐦᔨᑎᒧᐎᓐ

ᐊ ᐃᐦᑑᑖᑭᓂᐎᔨᒡ Robert Auclair Director of Youth Protection YOUTH PROTECTION

Under the Youth Protection Act every decision COLLABORATION WITH CMC FRONT-LINE FOSTER HOME PROGRAM ACTIVE FILES BY COMMUNITY made must aim at keeping the child in the family SERVICES This year, based on the annual number of days Community Placement 0-17 pop % 0-17 environment1. The Youth Protection Act empha- A draft policy and protocol with training com- of placement, the annual average of children Chisasibi 208 1,728 12 sizes the protection of children as a collective re- ponents was developed to improve communi- placed in the Foster Home Care Program is Eastmain 14 306 4 sponsibility. The recent amendments of the YPA cations and interventions with our respective equivalent to 237 if they were in placement for Mistissini 212 1,347 15 also recognizes the rights of children to their departments. It sets out the clarification of roles the whole year. The average length placement of Nemaska 62 298 20 language and culture as a fundamental right. and responsibilities to better serve children and children under youth protection is 4.5 months. Oujé-Bougoumou 57 327 17 families in need of services. The Director of Youth Protection (DYP) inter- Close to half (47%) of the children who were Waskaganish 124 902 13 placed live(d) with their extended family venes only when children are in danger and COLLABORATION WITH YOUTH HEALING Waswanipi 112 776 14 member(s). As it always has been in Eeyou when their safety and development is compro- SERVICES Wemindji 43 504 8 ­Istchee, almost all of the foster families are mised. Youth Protection intervention is guided A protocol was developed to improve com- Whapmagoostui 44 372 11 by a legally specific clinical process of compro- Cree people who live in Eeyou Istchee. munication with our partners at Youth Healing Total 876 6,532 13 34 mising situations of children by a law that pro- Services. The protocol further clarifies roles and 35 tects the basic needs and fundamental rights responsibilities for both departments to better YOUTH PROTECTION STATISTICS Of the 834 active cases, 479 situations were of children. The criteria for involvement is a sys- serve youth and families while they are in care in This year, 3,608 calls were received at the RTS subject to court proceedings. Other situations tematically detailed mechanism not to breach the Group Home or Reception Centre setting. Intake Services 800-409-6884 number. Of those were under the evaluation/orientation process the fundamental human rights of children and calls 2,733 treated as reports. Of those reports and/or under provisional measures (30 days) or their parents. The situations are characterized 876 situations reported were retained and 1,902 TRADITIONAL ADOPTION voluntary measures (12 months or less). 42 of by the severity and complexity of the problems reports were transferred into existing files called The amendments to the Adoption Act and Civil those files were inter CJ files or files transferred as well as the degree of child vulnerability due a re-signalement. In addition, 593 files were not Code of Quebec legally recognizes Cree tra- from another region outside Eeyou Istchee in- to significant limitations of parents or caregivers retained (closed due to facts not founded or a ditional adoption. A Cree traditional adoption volving Cree children. A child cannot have more in exercising their parental role by not address- person was protecting a child and a situation working group was formed to look at all aspects than one file nor files in multiple regions (one file ing nor recognizing their difficulties to mobilize was resolved. Other closed files were referred to towards an implementation date in Eeyou Ist- one child rule). towards positive change. front-line social services for follow-up). chee for July of 2018. The consultation process had started and regular working group meetings 87 motions to the youth tribunal through visio/ YPA AMENDMENTS (PL-99)­­ were held. In the Youth Protection context, tradi- video conference hearings that were emergency These amendments are in the implementation tional adoption becomes an additional option for 11 situations. These short hearings in the commu- stage provincially and will preserve the links to adoption when it is clinically deemed ideal. 1% 81 nities prevented unnecessary travel of children family, community and Nation for Cree chil- 9% and families to the south (Amos or Val-d’Or). dren. They will also provide a greater emphasis 117 on culture and tradition in the approach to life 15% plans. Other regions now have made more REASONS FOR ‘SIGNALEMENTS’ efforts to call the Cree DYP and transfer files 461 Abandonment Physical abuse or risk of 52% 78 physical abuse 9% Sexual abuse or risk of back to the Cree Nation once they are aware sexual abuse Serious behavioural disturbance they are intervening with Cree children and 128 Psychological ill-treatment Neglect or risk of neglect families. 14%

The main factor for the majority of the situations reported that required intervention were related to excessive alcohol and drug 1. Youth Protection Act, s.4 abuse of the parents and/or youth (teenagers). ᐋᐱᑎᓰᐐᓐᐦ ᒑ ᒋ ᒥᔫᐲᑖᐦᑭᓄᐎᒡ ᑭᔮ Dr Anne Foro Director of Program ᐋ ᐄᐦᐄ ᑭ ᔅ ᑮ ᐦ ᑭᓄᐎᒡ Development and Support PROGRAM DEVELOPMENT AND SUPPORT

ACQUIRED RIGHTS FOR YP WORKERS AKWESASNE YOUTH TREATMENT CENTRE In the new organizational structure put in place Other projects being worked on: UNDER LAW 21 OF QUEBEC (IATC) in 2016, the Program Development and Support A provincial working group has been formed and Through a funding agreement with the Akwe- Department oversees several other depart- ●● Implementation of a pilot project for the is working on recognized continuous training sasne Mohawk Council under its Health and ments, and it also comprises its own small team deployment of the Awemiiniwaachihisuuna- and the development of a specific certificate/ Social Services department, Cree youth who which focuses on planning and programming. nouch program for support of people with diploma program offered by a college or univer- attend this treatment program will receive help addictions sity for working in First Nation and Inuit environ- with alcohol and substance abuse issues by During the previous year, the planning and pro- ●● Development of the chronic disease manage- ments, as well as for First Nation and Inuit em- improving their coping skills. Youth will learn gramming team contributed to the development ment program by an interdepartmental team of the 2016-2021 Strategic Plan. It collaborated ployees, respecting cultural safety. These efforts to make better and more informed choices ●● Support for the implementation of recom- on the development of functional and technical will provide recognition of workers to the Order upon returning to their home communities. This mendations resulting from the review of plans for the construction of new Miyupimaati- of Social Workers of Quebec (OTSTCQ). First Nations culturally-adapted and nationally the home care program carried out by the siiun Community Centres (CMCs) in Whapma- accredited program is offered to clients under department (in collaboration with DPSQA – Workers will enter positions with recognition of goostui, Waskaganish and Oujé-Bougoumou, youth protection aged 12 to 17. Health) 36 their skills through complementary training, sup- as well as the Eeyou Istchee Regional Hospital 37 port and annual evaluation by Preceptors (evalu- This year, 12 Cree youth went through the four- and the Chisasibi CMC. ●● Evaluation of the Bush Kit / Wilderness ators) towards the full recognition of their skills in month intensive program adapted for first na- ­Rescue Kit Program and support for the evaluating situations of children and families with tion youth including our Cree youth. Four beds A clinical plan for the project to build three birth- implementation of the recommendations cultural adaptations. These measures will ensure remain secured all year for Cree youth under ing centres has been submitted to the MSSS. ●● Customer Satisfaction Assessment Project, in that services offered to at-risk children and fami- the care of youth protection. The clinical plan for a regional centre for the collaboration with the Miyupimaatisiiun Group treatment and support of people suffering from lies are professional and respectful. ●● Development of youth and family services, We must find ways to work together to heal dependency, adopted by the CBHSSJB Board in collaboration with the departments of The provincial funding for this initiative covers children and families—too many children and of Directors, will also be submitted to the MSSS. Public Health, Youth Protection and Youth five years from 2016-2020. families are under the evaluation and inves- Healing Services tigation of the DYP. Likewise, the network of programs and services offered by workers or ●● Updating the resource directory (répertoire departments other than youth protection could des ressources) in the provincial system as be improved to prevent situations from dete- required by the Ministry of Health riorating. Clarification of roles and responsibili- The department also prepares activity reports ties is key, with the goal being to lessen the for First Responders and contributes to the ­involvement of youth protection. ­accountability of the CSST.

Breast Cancer Screening Program in Iiyiyu Aschii Programme de dépistage du cancer du sein dans la région d’Iiyiyiu Aschii

ᐧᐋᒋᔦ ᓃᒋᓴᓂᔅᐧᑫᒻ Wachiyeh Niichisaniskwem Clara Bus & Sophie Air are coming for Breast Cancer Screening ᒥᔪᐱᒫᑎᓰᐅᓐ ᐋᐧᐄᔨᒡ Program

Women aged 50-69 years old ᑭᓂᐧᐋᐱᐦᑖᑲᓄᐧᐄᔨᒡ should be tested!

Dr Robert Carlin PUBLIC HEALTH Directior of Public Health

Women aged 30-49 years old:

If your mother and/or your sister(s) had/ An overdose (also known as a The signs of overdose from depressants ("downers") Different kinds of drugs are different than the signs of overdose fromstimulants Lynda is a breast cancer survivor and her sister Lucy ("uppers"). Public policies are developed at the institutional, Public health systems have resources and have breast cancer, check with your “severe intoxication”) happens have different signs of will book an appointment with her doctor soon to see What is an when a person has too much Sometimes street drugs are tainted with deadly doctor for more information . substances like fentanyl. This can cause an overdose if she should be screened. overdose of a substance (like alcohol or overdose too, even in small amounts. community, regional, national, and international tools to allow systematic analysis of key public ? drugs) in their body. Whether it’s alcohol, street drugs or prescription medicine, if it reaches a Please contact your Chishaayiyuu CHR at your local CMC for more information! toxic level, the body becomes overwhelmed. This can cause serious harm, Signs of Signs of disability, or even death. DEPRESSANT STIMULANT levels. They influence the systems within which policies in order to influence those responsible Screening begins... This person needs medical help right away. OVERDOSE OVERDOSE Waswanipi Feb/March 2018 Substances or combinations that make you Substances or combinations that make you feel Whapmagoostui Dec 9 -12, 2017 Waskaganish Jan 9- 15, 2018 feel “down” or sleepy, even if it's legal: alcohol, excited or awake: cocaine, speed, meth, MDMA/ Ouje-Bougoumou Feb/March 2018 Nemaska Jan 17- 18, 2018 How can an opioids, “benzos”, "downers". ecstasy, “uppers”. Mistissini Feb/March 2018 If your tolerance is lower. we live, work, and play. They have an impact on for their adoption. These analyses are best (Sophie Air) Eastmain Jan 20 - 22, 2018 • Confusion Maybe it's a new drug, or you took a break from using. • Extreme agitation or overdose excitement Wemindji Jan 23 -27, 2018 • Drowsy, can’t wake up Chisasibi Jan 30 -Feb 11, 2018 • Fast heartbeat happen? • Slow breathing, hard to breathe (Clara Bus) • Sweating our overall health even when they are not formal crafted with the involvement of those impacted • Slow heartbeat • Chest pain If you're having health issues. • Blue lips and/or fingernails If you're tired, run down, dehydrated or have other health • Feeling very warm • Cold or clammy skin complications, you're at a higher risk to overdose. • Severe headaches health policies. So, what is the role of public by the policy. Over the past year, our regional www.creehealth.org/public-health/breast-cancer-screening • Tiny pupils • Seizures • Seizures • In and out of consciousness • Vomiting

health in policy development? public health department has been involved in Information: If you mix drugs. Even if it's prescription medicine, it's possible to An overdose can be deadly and needs medical attention immediately. If you or ­reviewing several public policies: overdose if you combine drugs without asking a doctor. someone nearby starts showing these signs, get medical help right away! MISTISSINI EMERGENCY NUMBERS Regional public health departments have a If the drugs are different or unknown. CMC (Clinic): (418) 923-3376 Maybe you changed dealers or towns, or maybe what Police / First Responders: (418) 923-3278 responsibility “to identify situations where inter- ●● Provided commentary as part of Quebec you're taking is stronger than usual or tainted. TAKE A PICTURE OF By accident. THIS SECTION WITH YOUR PHONE sectorial action is necessary to prevent dis- consultations on the regulation of cannabis in An adult or child might accidentally take a drug. TO HAVE THIS INFORMATION IF YOU NEED IT!

eases, trauma or social problems which have the province as a result of federal ­legalization; REGIONAL PUBLIC HEALTH If you or someone nearby might be overdosing, don't OVERDOSE AWARENESS AND HARM REDUCTION hesitate! Contact emergency medical services right away. CAMPAIGN 2018 FOR MORE INFORMATION: If you're calling emergency services for someone nearby, stay an impact on the health of the population, and, ●● Provided recommendations taking into Everyone can learn and help keep everyone safe. creehealth.org/OD with them until help arrives. 38 where the public health director considers it ap- ­account our regional context in the devel- propriate, taking the measures considered nec- opment of Canada’s Food Policy; essary to foster such action.” Our involvement ᒋᔥᑎᒫᐧᐃᓐ ᒋᒥᔪᐱᒫᑎᓰᐧᐃᓂᐦᒡ ᐊᓐ ᒑ ᒌ ᒥᐧᔮᐱᑖᔨᓐ! ●● Drafted policy and other responses that 䜀攀琀 瘀愀挀挀椀渀愀琀攀搀 琀栀椀猀 礀攀愀爀⸀ in public policy development is one example of 䠀攀爀攀ᤠ猀 眀栀攀渀 愀渀搀 眀栀攀爀攀 琀漀 最攀琀 礀漀甀爀 昀爀攀攀 ˻甀 瘀愀挀挀椀渀攀㨀 2 ᒥᓂᑯᔥ ᒑ ᓯᔮᐱᑖᔨᓐ 2 ᑎᐦᐧᑖᐤ ᐋᔑᑯᒻ ᒌᔑᑳᐤᐦ 䤀礀椀礀椀洀椀椀挀栀椀洀 might take place at the local and regional how we can foster such action in the promotion levels in response to cannabis legalization; 椀猀 栀攀愀氀琀栀礀⸀⸀⸀ of Miyupimaatisiiun. 戀甀琀 氀攀愀搀 椀猀 渀漀琀⸀ ●● Advocated for restrictions in the availability 䄀搀愀瀀琀攀搀 昀爀漀洀 洀愀琀攀爀椀愀氀猀 瀀爀漀瘀椀搀攀搀 戀礀 琀栀攀 䌀䐀䌀 Although influencing public policy is one way of lead shot used by hunters in an effort to 䰀攀愀搀 猀栀漀琀 椀猀 琀漀砀椀挀⸀ FLUORIDE TOOTHPASTE to act on the social determinants of health, it is encourage less toxic alternatives. important to keep in mind a few key factors as- Over the coming years, we will continue to sociated with this approach. 䰀攀琀✀猀 欀攀攀瀀 漀甀爀 昀愀洀椀氀椀攀猀 work in this area while taking into account Good oral health is important for miyupimaatisiiun! 愀渀搀 攀渀瘀椀爀漀渀洀攀渀琀 栀攀愀氀琀栀礀 community issues and priorities brought up THE SWEET BLOODS 戀礀 甀猀椀渀最 氀攀愀搀ⴀ昀爀攀攀 愀洀洀甀渀椀琀椀漀渀⸀ 1. There is a complex relationship between Brush your teeth through General Assemblies and other forms of OF EEYOU ISTCHEE: 2 minutes 2 times a day health outcomes and social determinants. Stories of Diabetes and 䴀愀欀攀 猀甀爀攀 礀漀甀爀 最甀渀 挀愀渀 栀愀渀搀氀攀 the James Bay Cree ­consultation within Eeyou Istchee. 渀漀渀ⴀ氀攀愀搀 猀栀漀琀⸀ 䤀琀ᤠ猀 琀椀洀攀 琀漀 猀眀椀琀挀栀⸀ 2. Policies are embedded in our contexts. This ABOUT “The stories contained in The Sweet Bloods of The Sweet Bloods of Eeyou Istchee is essential reading for Eeyou Istchee: Stories of Diabetes and the James means that relatively straightforward policies Dr. Robert Carlin anyone who knows anyone with diabetes, and for Bay Cree are incredible. They are life lessons, www.creehealth.org anyone interested in a contemporary rendering of they are tales of warning, they are songs of one of Canada’s vibrant, thriving, and highly adaptive resilience, they are prayers for a healthier may have different effects in different environ- Director of Public Health indigenous communities. life. Each one is its own entity, and each In this award-winning collection, Ruth DyckFehderau storyteller bravely and beautifully speaks out and 27 storytellers offer a rich and timely accounting so that we may all begin our own healing ments or the same environment over time. of contemporary life in Eeyou Istchee, the territory journey. This is a must-read book. I’ve not of the James Bay Cree of Northern Québec. seen something quite like it before.” Joseph Boyden Connecting these stories is a disease – diabetes – but 3. Policies that influence social determinants the stories themselves are not records of illness as much as they are deeply personal accounts of life in MEDIA the North: the fine, swaying balances of living both in The Conversation: Indigenous group tackles diabetes are multisectoral in nature. Although we town and on the land, of family and work and studies, with storytelling of healing from relocations and residential school Folio News: New collection of stories explores life histories while building communities of safety and with diabetes in northern Cree community where one may examine policies with a health lens, challenge and joy, of hunting and hockey, and much in three have the disease more. CBC: Cree Nation tells stories of living with diabetes in new book we need to keep in mind that other sectors AWARDS Finalist, Foreword Reviews 2017 INDIES Book of the LEARN MORE 1 Year Award (Winners will be announced June 15, 2018) have different values and perspectives. sweetbloods.org Silver medal, 2018 Independent Publisher Regional and [email protected] Ebook (IPPY) Awards facebook.com/sweetbloods Available for purchase on Amazon and via sweetbloods.org

A selection of promotional materials created by Public Health. In addition to posters and pamphlets, Public Health uses social media, web and 1. Gouvernement du Québec, 2010, National Collaborating Centre for Healthy Public Policy community radio to promote Miyupimaatisiiun. http://www.ncchpp.ca/202/Learn_about_public_policies_and_their_effects_on_health.ccnpps. ᐊᐧᐋᔥ AWASH 0-9 Promoting and improving the well-being of pregnant women, babies, children aged 0 to 9 and their families through a culturally-safe and integrated services approach with added psychosocial and community development components

The  Mashkûpimâtsît Awash (AMA) umbrella­ The Maternal and Child Health Program program offers an ongoing and intensive psy- (MCHP) supports local Awash teams to im- chosocial follow-up tailored to the needs of fami- prove their counseling and teaching skills and lies. AMA continued to be implemented in three increase home visits. This year, the MCHP communities (Mistissini, Oujé-Bougoumou, Was- concentrated efforts in the development of the kaganish) and was considerably strengthened in program’s check lists, a tool that allows the Chisasibi. AMA tools were updated and the sev- front-line worker to ensure all users receive en booklets of the AMA Guidelines were final- education on promoting Miyupimaatisiiun and ized. Continuous collaboration with many other preventing illness and unhealthy choices. Par- CBHSSJB departments was initiated. Com- ents’ booklets were also developed in collabo- munity development was maintained through ration with the Nishiiyuu department. joint activities such as the ­Nurturing Program in Waskaganish, Waswanipi, Oujé-Bougoumou, 40 Mistissini and Chisasibi and Come-Unity in 41 Waswanipi. Regional partnerships were pursued with four meetings of the Maamuu Uhpichinaau- suutaau committee.

Mothers preparing fish broth during the 2017 Breastfeeding Week in Waswanipi

This year, Breastfeeding Week in The goal of the Awash Nutrition Program is to The Breastfeeding Program’s goal is to Waswanipi was held November improve birth outcomes by improving maternal ­support breastfeeding, including the implemen- 20-23 in the local MSDC. Many mothers participated in the daily and child overall health through proper nutrition. tation of the Baby Friendly Hospital Initiative activities such as preparing fish broth, making baby purée, As in previous years, the program provided train- (BFHI), in all communities of Eeyou Istchee. This practicing baby wrap techniques, ing, continuing education and support to local past year, several training activities have been sewing a baby blanket, a discussion on breastfeeding and Awash teams. Food insecurity was addressed carried out with staff from local Awash teams. light exercises. An elder was also with seven requests for financial support to help Twelve nurses and seven CHRs were trained invited to share her knowledge with young mothers. Regional Public pregnant women in need. Furthermore, this past during annual training activities. Five of the nine Health supports local initiatives with program support and funding. year saw the first OLO type pilot project in the Eeyou Istchee communities requested funds to community of Mistissini. OLO—Oeufs, lait et or- organize activities to celebrate the Breastfeed- anges or eggs, milk and oranges—is a province- ing Week activities. A review of the literature on wide program developed to provide essential breastfeeding determinants was done in view nutrients to pregnant women. of developing a survey to obtain an overview of women’s needs with regards to services. CLE-CE REGIONAL SCREENING PROGRAM The Dental Health Program aims to improve During past year, a CBHSSJB public health A B C D E F G oral hygiene habits in the region and to reduce physician was trained by the Direction de santé the prevalence of tooth decay and oral health publique de la Capitale-Nationale in order to Registered Students at Students Students Students Students Students students** presentation counseled screened previously that reviewed refused problems. It carries out this preventative ef- act as a regional respondent for the evaluation from A from B from C tested of A ­results from E fort through public education and prevention of working environments of pregnant workers 32% 83% 54% 16% 28% 34% activities carried out by dental hygienists, CHRs who wish to benefit from the Pour une Mater- 595* 191 159 86 94 26 55 and other Awash professionals. The position nité Sans Danger (PMSD) program. There of PPRO Dental Health has been vacant since were 129 requests processed from April 1st * Students not registered: +/- 8 st ** From all Secondary 3, 4 and 5 and Work-Oriented Program March 2016. 2017 to March 31 , 2018, and 134 (5 received The proportions presented are based on the column denominator as indicated in title before April 2017) were analyzed and compared to standard provincial working environments The Cree Leukoencephalopathy and Cree EEYOU ISTCHEE IMMUNIZATION PROGRAM and provincial Guides de pratique. ­Encephalitis Program (CLE-CE) aims to Goal 2017-2018 42 improve awareness about CLE/CE through a 90% of school-aged children that 70.5% 43 program of education and carrier screening. This received ALL vaccines at the exact past year, eight of the nine Cree communities periods recommended by the calendar of the Programme québécois were visited (the ninth will be visited in early April d’immunisation. 2018). Registered secondary 3, 4 and 5 students 95% of school age children (all grades) 91.7%* (excluding sec 3 from Mistissini) attended an considered protected from measles. information session on CLE-CE and the results 80% of EI residents of all ages that 34.4%** are summarized in the accompanying table. received the influenza vaccine. The Immunization Program aims to reduce 95% of children that received their first 66.7%* the transmission of infectious diseases pre- dose of DCaT-HB-VPI-Hib in a delay of 75 days or less (2 months, 14 days). ventable by vaccination through effective vaccination services in all nine communities. 95% of children that received their first 44.4%* The past year was busy in terms of support dose of Men-C-C in a delay of 379 days or less (1 year, 14 days). and coaching, as efforts were deployed to * ensure adequate record keeping and reporting 95% of children that received their 60% dose of RRO-Var planned at 18 months of all administered vaccines in the communi- in a delay of 562 days or less (18 ties. A new agreement was negotiated for the months, 14 days). storage, handling and delivery of vaccines for * INSPQ. Portail de l’infocentre our region. Both vaccine components of the ** Rapport couverture vaccinale, 2016-2017 and 2017-2018 Système d’Information en Protection et Maladie Vaccination coverage presented is the proportion of vaccinations Infectieuses SI-PMI, the vaccination registry received at the exact periods recommended by the provincial vaccination calendar; the actual coverage of vaccinated children is and management of immunization products, much higher as children get vaccinated outside the cut-off periods. are fully functional in Eeyou Istchee. ᐅᔅᒋᓃᒋᓲ USCHINIICHISUU 10-29 Improving the health of youth through planning and implementation of appropriate health services in communities, clinics and schools and by addressing developmental needs in the transition to adulthood

The Healthy Eeyou Youth Project (HEY) aims This past year involved reflection on the The Infectious Diseases Surveillance and The School Health Program aims to improve to facilitate access to psychosocial and clinical ­different components covered in the Healthy Protection Program aims to improve popula- the effectiveness of health promotion and services in order to improve youth health and Schools Approach and an assessment of tion health by reducing the incidence of infec- prevention interventions in the schools. As of well-being in Eeyou Istchee and reach youth Miyupimaatisiiun-related activities already hap- tious diseases in the region. Priorities are to March 31, 2018, school nurses were present in through innovative outreach methods. This past pening within the schools of Eeyou Istchee. A support surveillance, prevention, control and all nine communities, and the program provided year, a collaboration was established with the tight link with the new pilot project Empowering evidence-based management of infectious support to all local coordinators and school Department of Program Support and Planning. Youth and their Families will be of essence. diseases. During this year, two dogs were nurses. The channels of communication be- This working group developed a questionnaire diagnosed with rabies in one of the communi- tween the Cree School Board and Public Health to conduct a state of situation in all CMCs and In terms of Sexual Health, the rate of Chla- ties. The Public Health Department worked were maintained with five meetings last year, other implicated departments. Subsequently, an mydia trachomatis and Neisseria gonorrhea closely with the actors in the local community, with collaboration and engagement in common outreach approach to be applied in collaboration are both elevated in the region for the 10-29 as well as the Ministère de l’Agriculture, des projects related to health. An online training with the addictions program was developed. age group. These infections are treatable and Pêcheries et de l’Alimentation du Québec, in tool of the Chii Kayeh Iyaakwaamiih You Too Be preventable. active surveillance and control of rabies among Careful school-based module on healthy rela- 44 In October 2017, following a needs assess- local dogs. Other infectious disease preven- tionships and sexual health was created to help 45 ment on children and youth injury prevention The Uschiniichisuu remain the most vulnerable population segment, as youths account for tion and control activities included, but were new teachers and local file holders familiarize and safety (ages 0 to 29), the joint Awash and not limited to, responding to two tuberculosis themselves with the module and their respec- Uschiniichisuu Injury Prevention and Safety 87% of all Chlamydia trachomatis cases and 80% of all gonorrhea cases in Eeyou Istchee. cases (one from a neighboring region with tive roles in implementing it. Program determined that promoting the use contacts in Eeyou Istchee), following up several of helmets by children and youth should be a The objectives for the Dependencies and CHLAMYDIA AND GONORRHEA AMONG patients and their contacts with invasive group priority. The campaign Be careful! Your head! Addictions Program include strengthening USCHINIICHISUU AGE GROUP A streptococcus infection, following up cases of Ayâkwâmi! Chishtikwân! uses older role mod- knowledge and awareness in Eeyou Istchee Chlamydia trachomatis Neisseria gonorrhea Hepatitis C infection and ensuring that patients els in the hopes of positively influencing the have access to treatment options, and following on various substances and dependencies. 334 cases 20 cases younger crowd. In collaboration with the Cree up patients with latent TB infection. This past year, focus has been placed on the Nation Government’s Department of Child and Rate: 5086.8 Rate: 304.6 upcoming legalization of cannabis; this includes Family Services and the Cree Nation Youth per 100,000 hab. per 100,000 hab. participating in working groups and sharing Council, Public Health also developed a second information with communities—including their campaign geared towards babies and toddlers governing bodies and the community members. with the distribution of household safety items. The Public Health Department also presented a statement as part of provincial consultations regarding this policy development.

Condom distribution, Maanuuhiikuu Youth Symposium, Chisasibi, August 2017 ᒋᔖᔨᔨᐤ CHISHA AYIYUU 30+ Promoting healthy lifetsyles and preventing chronic diseases for adults and Elders

The team promotes the adoption of healthy The Chishaayiyuu team also participated in To facilitate collaboration, partnership and The Patient Partnership Approach to Chronic lifestyles in the media through our Facebook committees and working groups address- networking, we organized regular meetings with Care in Eeyou Istchee Project saw the comple- pages or the radio, and also supports commu- ing chronic diseases and advancing healthy different internal groups and external entities tion of data collection from health care workers nity activities by providing professional support, lifestyles in Eeyou Istchee. For example, this (Chishaayiyuu Managers, the Nutrition Team, the and CMC managers. Preliminary results were training, tools and funding. year the team worked with the CNG-CBHSSJB Miyupimaatisiiun Meeyoochimoon Network). presented to nurses and nutritionists during Joint Committee on Access to Nutritious Food, their annual trainings. This year, over forty community projects to pro- the MSSS Committee on Decline of Caribou, The diabetes educators visited the communities mote physical activity and healthy eating habits the Regional Miyupimaatisiiun Committee, the several times to train local health care workers. At the beginning of 2018, all communities were were supported with Healthy Environment Ac- Chronic Diseases Working Group, and the Vio- The increased number of diabetes educators visited by the Clara bus or Sophie Air to of- tive Living funding. This program favours health lence Prevention Working Group. and additional Helpline numbers allowed us to fer mammograms to women fifty and older, education and/or skill development activities, answer local needs for training and provide more or those at risk of breast cancer. Preliminary such as Winter & Summer Active, Healthy The team completed the report on Access to daily support in diabetes management. Our needs assessment was conducted prior to the Cooking workshops, Nutrition & Diabetes Nutritious Food in the Stores of Eeyou Istchee, team also organized or contributed to several tour. Training and support were provided to lo- 46 months and gardening projects. and made presentations to different communi- trainings, such as daycare cooks’ nutrition train- cal healthcare teams. 47 ties and Cree entities. Working with partners on ing, annual nurses training, CHRs and nutrition- The team also developed resources to help the Committee on Access to Nutritious Foods, ists trainings, Food Safety and Hygiene, and the health care providers in their daily practice, and we developed a framework for action, drafted a CBHSSJB Traditional Food Program. a number of health promotion and information by-law regarding food retail businesses and a tools for community members. These resources regional action plan, and requested the inclu- Paul Linton, Assistant Director of Public Health, Chishaayiyuu, giving out copies of The Sweet Bloods of Eeyou Istchee include the Carb Counting toolkit, pamphlets sion of the communities in the Quebec law on diabetes and its complications, and health governing milk prices. promotion labels for stores.

The No Butts To It! tobacco reduction project was implemented in Wemindji, Oujé-Bougoumou, and Waswanipi. A total of 1,205 participants and 21 health workers were trained. The project included public awareness (in schools, clinics, community organizations,radio and social media) and a smoke-free challenge, followed by calls to smokers, individual counselling, and continuing tobacco education for the community.

Solomon Awashish walks from Oujé-Bougoumou to Mistissini to raise $9000 towards finding a cure for cancer, August 2017. Solomon retired after a long and meaningful career as a champion for diabetes prevention. ᑖᑭᔥ ᓈᑭᑎᐙᔨᐦᑎᑰᒡ ᑭᔮ ᔕᔥ

ᐋ ᒋ ᓂᑐᒌᔅᒑᔩᑕᑭᓄᐎᒡ ᐋᐦᐊᑦ Grand Chief Abel Bosum and Chairperson Bella Petawabano looking over the Cree Medical ᐄᔩᔭᒸᐦᐄᐙᒡ ᒑᒀᓐ app launched April 20, 2018 SERC, CLINICAL PREVENTIVE PRACTICES AND PUBLIC HEALTH COMPETENCY DEVELOPMENT

The primary function of the Surveillance, Evalu- Reporting on health status is complicated by The team continued to develop data capturing Communications goal is for public health ation, Research and Communications (SERC) the need for community-level data and the systems and provide ongoing support for the ­activities to be supported with robust plans and Team is surveillance, or the ongoing systematic ethical issues raised by the small size of the CE-CLE program, Allied Health and the Mistis- messages and for recurrent activities to develop reporting on population health and its underlying population. Core reports are prepared for use sini CMC Current Services. A chart review tool ‘evergreen’ tools and products which can be determinants. Surveillance underlies Orientation internally within the CBHSSJB or just within the was developed to capture youth mental health reused in the future (www.creehealth.org/public- 1 of the CBHSSJB Strategic Regional Plan region. The continuing challenge of providing services data. health/communications). This year the agenda (SRP). Evaluation, research and public health access to these reports will be greatly facili- of monthly health promotion themes continued communications are the other supports provided tated with the anticipated intranet. Our Global The Team contributed to improving access to with coordinated messages on various media: to public health teams and other departments. Health Report for Eeyou Istchee, an internal services (responding to Orientation 2 of the the weekly Cree language regional health show Members of the team provide expertise in report with ten thematic chapters, was updated Strategic Regional Plan), with the work of the on radio; the website (www.creehealth.org); areas such as methods of research and evalu- for Demographics, Maternal and Infant Health, Public Health Language Working Group to final- ­social media; and print ads and materials. ation, planning indicators, developing systems Employment and Economy and Physical Health ise the lexicon around cancer and to develop to gather data, managing data, data analysis, and Services. New reports on cancer, the 2016 and release the smartphone language app (see Key campaigns supported the Clara bus breast 48 reporting and communications planning. This census and on the Québec Population Health East Cree Medical in the app store); with the cancer screening, continuing helmet aware- 49 supports decision making (e.g. provide evidence Survey were produced while the 2017 diabetes research project on evaluating the integration of ness, continuing non-lead ammunition, continu- for CBHSSJB arguments with the Ministry); sup- report was in draft at the end of the year. As dental care within primary care; with the ongo- ing violence prevention and the ‘new’ evergreen ports better understanding of emerging issues usual, small reports to support public health ing evaluation of the CE-CLE genetic disease influenza vaccination so anyone, regardless of (e.g. the work on opioids); develops new areas programs were produced. screening program; and with training support previous experience on the file, is able to carry for services (e.g. the cancer project and the for community organizers. out the campaign. Along with ongoing planning Four discrete but linked actions to investigate with the Maamuu Uhpichinaausuutaau Regional language smartphone app); supports programs Work on Orientation 3 to promote chronic and services (e.g. various small data gathering opioid management, use and abuse and over- Committee, the new Public Health Incident dose readiness planning continued at the end disease screening and follow-up continued to Action Plan produced communications plans systems for services); and assists with planning improve the Cree Diabetes Information System (e.g. electronic medical records and the intranet). of the year, supported with an internal report on where the CBHSSJB has a primary role in crisis mortality and morbidity linked to intoxications, and work on a project adapting depression management and where it does not. As well, As described last year, the team’s work follows an analysis of the pharmacy databases and a screening for pregnant women. Emergency Planning now has communications objectives from the SRP and those of the sur- draft chart review tool for next year. The Team’s work promoted mental health plans adapted to the nature and severity of the veillance theme within Québec’s Public Health services under Orientation 4 through continued emergency. Plan. A complete report on the 2017-2018 ac- Three articles used data from the Environment and Health Study database to report on mer- support of the initiatives being piloted in Mistis- The book Sweet Bloods of Eeyou Istchee was tivities of the Team is on the website. The new sini to improve youth mental health under the Research Committee met twice. cury and women of childbearing age, lead and widely promoted in a continuing campaign (see traditional food use and nutrition. Investigation of umbrella of Aaschihkuwaatauch. www.sweetbloods.org) as was a project on the pulmonary fibrosis continued with implementing role of Indigenous Elders with community well- new service pathways and research planning. being (see the toolkit at: boaa-iet.org). We produced one-time reports for the Cree Nation response to questions from the Senate prior to the approval of the Cree Constitution bill and for the CBHSSJB response for the Northern Program for Integrated Specialist Services. ᓂᓈᐦᑳᑎᓰᐎᓐ ᐊᐐᐦᒡ ᐐᒋᑖᐦᑭᓄᐎᒡ DISABILITY SERVICES (SPECIAL NEEDS)

In 2017, following the Ministère de la Santé et For clients with complex disabilities and/or ●● Developed special needs educator In 2017-2018, our FASD Diagnostic and Inter- des Services sociaux framework for the or- complex behavioural profiles, more intensive ­positions in communities vention Clinic enlarged its mission by offer- ganization of services pertaining to physical services and additional support may require the ●● Provided five FASD training sessions ing assessment, diagnostic, and intervention disabilities, intellectual disabilities and autism involvement of Regional Specialized Disability services to a broader range of neurodevelop- ●● Advocated the development of community- spectrum disorder, the CBHSSJB focused on Services, which is composed of specialized mental disabilities, in addition to Fetal Alcohol based resources, increased inclusion of restructuring how services to clients with dis- multi-disciplinary professionals (occupational Spectrum Disorder. The main goal of this Cree special needs clients in day programming, abilities will be offered through specific com- therapists, social workers, neuropsychologists, Regional Neurodevelopmental Clinic is to and community-based long- and short- munity-based services and specialized regional speech-language pathologists, etc.) who work improve accessibility to professional assess- term respite services. In the fall of 2017, a PPRO was hired closely with community-based professionals to ments in Eeyou Istchee, without having to send and is working with a committee to oversee the offer remote support in combination with visits ●● Developed collaborative partnerships with clients out of their communities for assess- drafting of the Disability Programs framework. to the communities. This involves assessments, on-territory resources (school, daycare, ments. It also supports intervention strate- diagnoses, co-intervention, case discussions, Head Start, Youth Protection, Mental gies directly in communities, partners with the The Specific Disability Service consists of knowledge-transfer activities and training activi- Health), as well as with resources outside visiting pedo-psychiatrist and pediatricians, 50 community-based services offered by the ties. This year, Regional Specialized Disability communities and exchanges information with Wiichihiituwin 51 multi-disciplinary teams in each CMC under Services: ●● Guided and helped facilitate Waskaganish’s and Montreal Children’s Hospital. The biggest the Awash, Uschiniichisuu and Chishaayiyuu first support group for families with children current challenge is recruiting additional profes- programs. The service is composed of profes- ●● Created full-time permanent positions and with special needs, and established con- sionals to respond to the rapidly growing list sionals including community workers (often stabilized its team nections in other communities to create of referrals. In 2017-18 the clinic completed 29 acting as case managers), social workers, ●● Responded to community requests for more support groups referrals, and eleven assessments are currently physiotherapists, human relations officers, support/clinical advising through visits and ●● Supported the development of audiology ongoing. Presently, 56 clients are ready to be occupational therapists, speech-language phone calls services and the improvement of pediatric assessed, and an additional 70 referrals have pathologists, psycho-educators, psycholo- ●● Provided autism and behaviour trainings in services in Eeyou Istchee been received but not yet processed. gists, nurses, etc., who collaborate closely to Waskaganish (38 participants), Mistissini best meet the clients’ needs. The case man- ●● Supported the improvement of the corridor (100+ participants), Eastmain (45 partici- ager, who is the primary contact for the family, of service with Montreal Children’s Hospital pants), and Montreal (4 participants) participates in the coordination of the services For many individuals living around the client and communicates with other ●● Presented Case Management Trainings with disabilities, the specific involved agencies to help ensure a smooth ser- in Chisasibi, Eastmain, Mistissini, In 2017-2018, specialized foster homes vice dispensation for the client and his family. and Wemindji, reaching close to 140 opened in Waskaganish and Chisasibi, en- services available in their Intervention activities aim to maintain the client ­participants in total abling one client to return home and preventing CMC will be sufficient for another from being placed off-territory. Training at home, improve quality of life and autonomy, ●● Presented Sensory Training in Mistissini supporting them to live full, and increase participation in the community. (10 participants) is being offered to specialized foster homes as part of an initiative to establish more commu- For many individuals living with disabilities, the ●● Mentored community-based professionals well-balanced lives. nity-based homes accessible to clients with specific services available in their CMC will be (occupational therapists, speech-language special needs for respite and long-term care. sufficient for supporting them to live full, well- pathologists, physiotherapists, psycho- balanced lives. educators, social workers) ●● Initiated the creation of community-based Early Stimulation Groups and provided support to the rehabilitation staff in order to provide optimal therapy services NUUHiI A KU a U M ᒫᓅᐦᐄᑰ ᒫ MAANUUHIIKUU ᓅᐦᐄᑰ (MENTAL HEALTH)

This past year we continued to bring our Cree We have partnered with other departments on Psychology Services have been expanding: there The Sexual Abuse Working Group delivered a Mental Health and Wellness Strategy to life, various initiatives to improve services, such as are now five full-time psychologists and four training program for front-line workers in all nine working to improve the delivery of mental health working with Nishiiyuu to support the devel- half-time psychologists/psychotherapists. The communities on using the Sexual Assault Re- services to better meet the needs of people in opment of traditional approaches to positive enlarged team has stabilized services, providing sponse Protocol and its accompanying manual; the Cree Territory. Our mission is to promote mental health. Together we developed a pilot more consistent and frequent support to clients a total of 59 front-line workers have completed positive mental health through prevention, inter- land-based retreat for CBHSSJB employees, and local teams. Further support is offered via all three phases of the program, so are trained vention, treatment and ongoing holistic care so adding cultural context to the Employee and telepsychology in Mistissini, Chisasibi and Ne- and ready to respond to adult disclosures of that everyone in Eeyou Istchee can live full and Family Assistance Program. In partnership maska, improving continuity of care and decreas- sexual assault. Additional training sessions are balanced lives. with the Social Department, we are developing ing the need to send people south for care. planned for next year. Ishkotem—a multidisciplinary pathway to client Highlights of this past year include the addi- care that aims to better address clients’ needs The Suicide Working Group continued to The Indian Residential School Program con- tion of five staff psychologists/psychothera- by improving communication between profes- develop strategies for addressing suicide in our tinues to provide support services to Residen- pists, working in Mistissini, Oujé-Bougoumou, sionals and acknowledging Cree traditional communities, networking with Youth programs tial School survivors with the help of Resolution 52 Waskaganish, Chisasibi and Whapmagoostui, approaches to well-being. Collaborating with and collaborating with other Cree entities, in- Health Support Workers (RHSWs) and Cultural 53 bringing the total of staff therapists for the ter- Miyupimaatisiiun and the DPSQA – Psychoso- cluding the Iiyuu Ahtawin Miyupimaatisiiun Pro- Support Providers (CSPs). This past year, ritory to nine. A new mental health nurse was cial, we are developing a standardized suicide cess. The team collaborated with MikwChiyam RHSWs saw a total of 818 clients (369 former hired for Eastmain. intervention protocol for all CMCs. Plans for the to launch a regional suicide awareness poster students, 449 family members), while CSPs saw upcoming year include continuing work with and video campaign, and is also collaborating 731 (376 former students, 355 family members). In addition to providing regular services, Maan- with the Association Québécoise de Prévention Clients are becoming more open and beginning uuhiikuu offered training to the communities to these partners and increasing and improving collaborations with others. du Suicide to develop a suicide prevention pilot to understand the impacts of residential school increase our work force’s capacity to address project in two communities. and, importantly, there is increasing accep- the mental health needs of our people: we of- The Child Psychiatry Program is in its second tance of traditional teachings and practices. fered Mental Health First Aid for First Nations year, with two psychiatrists supported by the Training in Chisasibi and Waswanipi, supported regional clinical nurse and mental health nurs- the Applied Suicide Intervention Skills Training es. The team collaborates closely with Disability in Whapmagoostui and Chisasibi, and provided Services, daycares and schools. Dr. Janique­ training on how to respond to adults’ disclo- Harvey and Dr. Melissa Pickles continued to PSYCHIATRY PSYCHOLOGY/ sures of sexual assault to front-line workers in provide psychiatric care in Eeyou Istchee, sup- PSYCHOTHERAPY In-person Telehealth In-person Telehealth all communities. Sessions on Cultural and Ethi- TOTAL ported by one mental health liaison nurse and consult consult follow-up follow-up Autism Clinic 13 cal Considerations for Working in Cree Territory two local mental health nurses (in Nemaska Psychiatry 48 34 340 145 567 Consult 67 were given to social workers and to newly hired and Eastmain). In addition, a liaison nurse from Child psychiatry 8 6 11 3 28 Follow-up 618 nurses with enlarged roles. the Douglas Mental Health Institute provides TOTAL 56 40 391 148 645 IRS Program 16 support to Cree clients and their families. Use Psychotherapy 27 of video-conferencing has expanded into new No emergency cases. Wiichihiituwin Montreal responsible for handling 411 (64%) of cases Emergency 1,117 communities and is being used for case discus- sions and follow-up with clients. TOTAL 1,858 Wiichihiituwin Montreal was responsible for handling 1,848 (99%) of these cases 3

ᓂᔒᔫ ᒥᔪᐱᒫᑎᓰᐅᓐ nishiiyuu miyupimaatisiiun ᐆ ᓂᔒᔫ ᐧᑳᔅᒌᐧᔖᒥᑳᐦᒡ ᐊᓂᔮᔫ ᐧᐋᔅᑮᐦᒡ Nishiiyuu refers to the traditional 55 ᑳ ᐃᔥ ᐄᔮᑦ ᑭᔮ ᑳ ᐄᔥ ᒋᔅᒑᔨᑖᐦᒃ ways of the Eeyou and Eenou ᐄᔨᔨᐤ/ ᐄᓅᐧᐄᔨᒡ ᐱᒫᑎᓰᐧᐄᓂᔫ people. The Nishiiyuu Group ᐋᔪᐧᐃᒄ ᐧᐋ ᐄᔥ ᑭᓂᐧᐋᐦᐱᑕᐦᒡ ᐊᓂᒌ helps make sure that Cree ᐋᐧᐋᓂᒋ ᐄᔭᐲᐦᑎᓰᔅᑖᒡ ᐋᐱᑎᓰᐧᐄᓂᔫ᙮ knowledge and values are ᐄᔨᔨᐄᑖᐦᐄᑎᒧᐧᐄᓐ ᔮᔨᑖ ᒑ ᒋ reflected in CBHSSJB services. ᐋᐱᑎᐦᒡ ᐋ ᐧᐄᐦᐧᐄᒋᐦᐋᑳᓄᐧᐄᔨᒡ Nishiiyuu is the link with the ᒥᓯᐧᐋ ᐄᔨᔨᐅᐧᐄᔨᒡ᙮ ᐋᑰᐦᑦ ᑭᔮ Council of Nishiiyuu. This ᐊᔅᑎᐲᐦᒡ ᒋᓵᔫᐧᐄᔨᒡ ᐅᒋᒫᑳᓇᐦᒡ᙮ ᐋᑰᐦᑦ department chairs the Clinical ᐧᐋᐄᔔᑖᐦᒡ ᓃᑐᐦᑰᔨᓐ ᐋᐱᑎᓰᐧᐄᓐ Coordination and Integration ᑭᔮ ᒑ ᒋᔅᑎᓈᔅᑖᐦᒡ ᒥᓯᐧᐋ ᒑᐧᑳᓐ ᑭᔮ Committee (CCIC). The AED is ᒥᓯᐧᐋ ᐋᐧᐋᓐ ᒑ ᒋ ᒥᐧᔮᐱᑎᓰᐄᑦ Laura Bearskin. ᐋ ᐧᐄᒋᐦᐋᑲᓅᐧᐄᔨᒡ ᐋᐧᐋᓂᒌ᙮ ᐊᓐ ᓈᑲᓂᓰᔨᑦ ᓘᕌ ᐯᕈᔅᑮᓐ ᐃᓯᓂᑳᓲ᙮ CBHSSJB ORGANIGRAM ᐋᑎᔅᑳᑑᐦᒡ ᐋᐱᑎᓰᓲᐐᔨᒡ ᐆᒋᒫᐤ ᓂᔒᔫ Laura Bearskin Assistant Executive Director (AED) board of Nishiiyuu Miyupimaatisiiun directors ᒥᔨᐱᒫᑎᓰᐅᓐ MESSAGE FROM THE AED NISHIYUU MIYUPIMAATISIIUN executive direction The Nishiiyuu Miyupimaatisiiun Department The Waapimaausun is committed to promoting health and miyu- project on traditional pimaatisiiun by drawing on traditional Cree knowledge and practices to address the many birthing—which, with different factors that influence wellness. Nishi- the midwifery program, iyuu plays an enhanced role in the new Strate- aims to bring birth back gic Regional Plan, which emphasizes traditional knowledge and healing practices as well as to Eeyou Istchee—is now nishiiyuu pimuhteheu miyupimaatisiiun administrative cultural safety in all programs and services of miyupimaatisiiun services being launched in several the CBHSSJB. commmunities. This past year has seen Nishiiyuu Miyupimaa- tisiiun achieve some important milestones. The 56 Waapimaausun project on traditional birthing— 57 community which, with the midwifery program, aims to development bring birth back to Eeyou Istchee—is now being complementary services and launched in several communities. This is an im- programs portant accomplishment not just for Nishiiyuu but for the entire CBHSSJB, our partners and, organizational quality and indeed, the Cree nation. We also have contin- cultural safety ued our efforts in other programs, including the evaluation and Land-Based Healing Program and our initia- accreditation tive to preserve and even cultivate traditional client medicine and healing as well as other forms of experience and organizational traditional knowledge. performance Our responsibilities have expanded to include the Iiyuu Ahtaawin Miyupimaatisiiun Planning (IAMP) initiative, which aims to promote healthy communities, and we also play an important role in the Clinical Coordination and Integration Committees, which just finished the first year as a pilot project. We look forward to the coming year, as we continue to grow and to support traditional Cree knowledge and cultural safety in the programs and services of the CBHSSJB. Laura Bearskin AED, Nishiiyuu Miyupimaatisiiun ᓂᔒᔫ ᒥᔪᐱᒫᑎᓰᐅᓐ

NISHIIYUU MIYUPIMAATISIIUN This year the project reached a major milestone, The Nitahuu Aschii Ihtuun (Land-Based Responsibility for the Iiyuu Ahtaawin Nishiiyuu Miyupimaatisiiun draws on traditional with the Waapimaausun guide being approved Healing) Program continues and, among ­Miyupimaatisiiun Planning (IAMP) healthy Cree knowledge to support health and miyu- by the Board of Directors. The guide, which also its activities this past year, it supported five communities initiative is being transferred to pimaatisiiun in Eeyou Istchee. This approach presents Cree Natural/Spiritual Law, has been sundance ceremonies and a gathering for Nishiiyuu, and the Department is looking to is carried out in a number of projects this translated into inland dialect, although this draft residential school survivors, and delivered two hire a community development officer to work past year, including those in traditional birth- still needs to be finalized; it will also be trans- week-long employee retreats (October 2017 at with local directors on this file. There are now ing knowledge, land-based healing, traditional lated into coastal dialect. The guide ensures the Fort George and March 2018 near Mistissini) as Miyupimaatisiiun committees for all ten com- medicine and, most broadly, traditional knowl- passing on of traditional knowledge from gen- part of the cultural component of the Employee munities. Priorities and strategies identified at edge in general. The department has begun eration to generation, including knowledge on and Family Assistance Program. The Nishiiyuu the 2018 Waswanipi Assembly will provide the supporting the Iiyuu Ahtaawin Miyupimaati- pre-pregnancy, pregnancy, birth and newborns, team is in the process of editing guides for foundation form any IAMP action priorities, with siiun Planning project, which sees local com- and on rites of passage that connect Cree in- this program, and simultaneously preparing an support from local CMCs and communities. mittees working to bring miyupimaatisiiun to fants, children and families to Eeyou Istchee and extensive program review. As this transition occurs, it is critical that IAMP their communities—an effort which demands the history and culture of the Cree peoples. It partners—Nishiiyuu, CMCs and communities— 58 engagement with Cree traditional knowledge also explores the best approaches and practices The Traditional Healing and Medicine initia- all have clearly defined roles. 59 and culture. We are also involved in ensuring to sharing this traditional knowledge. tive has seen the drafting of a protocol with cultural safety in the CBHSSJB’s programs elders and traditional healers; the Nishiiyuu Nishiiyuu is also a partner in managing the and services through a wide range of activities, Nishiiyuu is now in the process of launching team will be meeting with elders and traditional Clinical Coordination and Integration including our involvement in the Clinical Coordi- Waapimaausun in Whapmagoostui, Chisasibi, healers in the coming year to refine and formal- ­Committees (CCIC), a one-year pilot program nation and Integration Committees. Waskaganish, Waswanipi and Mistissini; staff is ize this protocol. where clinical and administrative leadership still being recruited for the other communities meet regularly to discuss challenges and define The Waapimaausun–Traditional Birthing and, once appropriate staffing is in place, Waapi- Nishiiyuu continues its Gathering Traditional strategies for improving the delivery of health Knowledge Project, led by Cree women elders, maausun will be offered in these communities as Knowledge initiative. Currently a great deal and social services. Following the CCIC’s first aims to document and research Cree women well. The guide is a green document, so as the of information has been collected but much year, Nishiiyuu led a feedback survey that pro- elder’s personal stories, gather traditional knowl- program is implemented, the guide will continue remains to be done to organize this material posed an extension of the program, the iden- edge on traditional birthing and child rearing, to be developed. Nishiiyuu is also working with and make it accessible. As this effort is car- tification of specific priorities, and enhanced document men’s knowledge on birthing practic- midwives to determine how best to integrate mid- ried out, the team will also be able to identify meeting formats and communication pathways. es, and produce videos, publications and other wifery services with Waapimaausun.­ areas where further information needs to be tools for education and awareness. gathered. This project is closely integrated with Challenges currently include recruiting person- Nishiiyuu’s other projects, as much traditional nel across different areas: translators, PPROs knowledge being collected concerns traditional and HROs. As the Department is growing, and medicine, land-based healing and traditional many priorities from the 2018 Waswanipi as- birthing. The long-term objective is to build a sembly will be assigned to PPROs, the Depart- comprehensive and accessible resource library ment will need to adopt tools and implement of traditional knowledge. structures for tracking the progress and man- agement of its different projects. 4a

ᒥᔪᐱᒫᑎᓰᐅᓐ miyupimaatisiiun 61

ᒥᔪᐱᒫᑎᓰᐅᓐᔫ ᑳ ᒫᒨᐧᐄᔅᑖᐦᒡ The Miyupimaatisiiun ᒥᓯᐧᐋ ᓂᑐᐦᑰᔨᓂᔫ ᐋᐱᑎᓰᐧᐄᓂᔫ Group is the department ᑳ ᑭᓂᐧᐋᐱᑖᐦᒡ ᒥᓰᐧᐋ ᐄᔨᔨᐧᐄᔨᒡ that delivers most of the ᐋ ᐧᐄᐦᐧᐄᒋᐦᐋᑳᓅᐧᐄᔨᒡ ᒑ ᒋ health and social services ᒥᔪᐲᐦᐄᔨᒡ ᐅᐱᒫᑎᓰᐧᐄᓂᐧᐋᒡ᙮ to our clients. CBHSSJB ORGANIGRAM ᐋᑎᔅᑳᑑᐦᒡ ᐋᐱᑎᓰᓲᐐᔨᒡ ᐆ ᒋ ᒫᐤ MIchelle Gray board of AED (Interim) Miyupimaatisiiun directors ᒥᔨᐱᒫᑎᓰᐅᓐ MESSAGE FROM THE AED MIYUPIMAATISIIUN executive direction As part of our commitment to achieving the Another project initiated is our client satisfac- objectives outlined within the Strategic Re- tion survey. The primary focus is to solicit client gional Plan, the Miyupimaatisiiun Department feedback on our programs and services. This has focused on strengthening our relationships process will provide the necessary direction for within local and regional teams across the our leadership to improve and optimize service organization. This encompasses improving the delivery while meeting the needs and expecta- capacity and responsiveness of our regional of- tions of the population. fice and cultivating pivotal partnerships outside nishiiyuu pimuhteheu miyupimaatisiiun administrative the CBHSSJB. Achieving miyupimaatisiiun in Eeyou Istchee miyupimaatisiiun services demands that we establish strong relationships At a local level, all Community Miyupimaati- with partners locally and regionally. Therefore, we siiun Centres (CMCs) have established and are diligently working towards reaching out and begun holding regular Clinical Coordination and strengthening our connections with stakeholders 62 Integration Committee (CCIC) meetings. This outside the organization, as health and wellness 63 medical affairs local CCIC forum brings together key admin- cannot be delivered by the CBHSSJB alone. and services istrative and clinical leadership to discuss the medicine quality and delivery of services to the commu- Our partnerships are directly reflective of ac- dentistry nity it serves. These discussions enhance the complishments we are able to achieve. This pharmacy working relationships between departmental year, these accomplishments include Robin’s teams by fostering a collaborative approach to Nest, Minnie’s Hope and Awemiiniwaachihisuu- nursing solution-based decision making. For Chisasibi, nanouch. The Robin’s Nest women’s shelter is now operational in Waswanipi and construction allied health the facilitated discussions for CCIC include the regional hospital. This initiative starts the is completed for the shelter Waskaganish. We midwifery preparatory stages of planning the distribution recently entered into an agreement with Min- of services with the eventual construction of the nie’s Hope, a social pediatric service in Whap- psychosocial new regional hospital. magoostui, to support youth and families, and we have launched the Awemiiniwaachihisuu- The Miyupimaatisiiun Regional Office assessed nanouch (Desire to Heal Oneself) addiction

chisasibi community its mandate and structure to identify strate- and mental health project in Waswanipi. These hospital miyupimaatisiiun centres gies for improving the support we provide to facilities, programs and services are the result the CMCs and regional hospital. The assess- of close collaboration with the Cree Nation ment identified areas where we are meeting our Government and the local communities. chisasibi chisasibi mandate, as well as where improvements can hospital eastmain be made. The next step will be to implement Megwetch. hospital mistissini the recommendations in order to enhance the units nemaska Michelle Gray ­support provided to local teams. clinical oujé-bougoumou AED (Interim) services waskaganish nursing waswanipi specialized wemindji services whapmagoostui administration ᓂᑐᐦᑯᔨᓐ ᐋᐱᑎᓰᐐᓐᐦ ᑭᔮ ᐋᐄᔥ ᐋᐱᑎᓰᔅᑖᑲᓄᐎᔨᒡ MEDICAL AFFAIRS ᐲᐲᒑᐤ ᐅᒋᔥᑑᓐ AND SERVICES PIIPIICHAAU UCHISHTUUN DEPARTMENT OF MEDICINE ROBIN’S NEST WOMEN’S SHELTER The Department of General and Specialized A regional emergency medicine unit has been In December 2017, Piipiichaau Uchishtuun- Medicine is responsible for providing consistent established in order to better coordinate and Robin’s Nest in Waswanipi opened its doors and medical service and coverage. It includes all standardize emergency care. Their first success began its mission to deliver and provide health family physicians and specialists working for the was the deployment of ventilators in the nine and well-being based on Cree traditions and CBHSSJB. DGMS team members work together communities, thus allowing better management values, while respecting individual beliefs, for to ensure seamlessly integrated medical of patients requiring intubation. A new medical women and their children who are experiencing services that are culturally safe, effective, and biology unit has also been established, which domestic violence. The shelter offers options ᐲᐲᐦᒉᐤ ᐅᒋᔓᑑᓐ accessible to all. ROBIN’S NEST STATISTICS will coordinate biochemistry, hematology, micro- for reconciliation, rehabilitation, and reintegra- Piipiichaau UchistuunWomen Children Total The Department Chief Dr. Carole Laforest is biology and pathology services. tion with the support, knowledge and wisdom of Admissions 17 28 45 supported by nine Assistant Chiefs coordinat- the communities of Eeyou Istchee, and provides The department continues to work with other No-shows 3 0 3 ing the medical services of the CMCs, and six hope and safety for women and children fleeing departments on strategic projects, including the Referrals 20 28 48 medical Chiefs of the following specialized from domestic violence and abuse. development of the Therapeutic Guide and Col- services: general internal medicine, nephrol- lective Prescriptions, the integration of midwives Robin’s Nest has faced challenges as well as 64 ogy, pediatrics, psychiatry, gynecology and Total days 116 65 using a collaborative approach to maternal and growth opportunities, and its team has contin- obstetrics. The department is made up of 58 Average stay 5.8 child health care, nurses’ training, palliative and ued to address their mission with energy and active family physicians, about 50 medical-care end-of-life care, and the development of mental optimism, with collaborations and partnerships physicians, six active medical specialists and health protocols. Computerization of clinical developed to guide women and provide commu- 22 associate medical specialists. systems is advancing and remains a priority. nity outreach support. A 24-hour Crisis Line pro- vides crisis support for women in urgent need, HIGHLIGHTS OF 2017-2018 PRIORITIES FOR 2018-2019 as well as information for agencies and com- In the past year, the department adopted new ●● Maintain and continue the development of munity members. The team is hopeful that giving regulations that will have the effect of increasing medical services people the opportunity to become familiar with the overall average number of days worked per Robin’s Nest will encourage them to support the doctor in the territory and that will foster reten- ●● Acquire and implement an electronic medi- movement to end domestic violence. tion of physicians in the long term. cal record (EMR) system ●● Support major projects such as the relocation With the continued generosity of funding agen- Ongoing recruitment and retention efforts re- of the Chisasibi CMC, implementation of mid- cies, partners and supporters, the Robin’s Nest sulted in the recruitment of five new physicians wifery, and emergency measures planning team can address its participants’ needs and and the additional services of an internist, a ●● Continue negotiations to increase the other emerging issues. The Robin’s Nest team, gynecologist-obstetrician and a child psychia- number of permanent doctors and overall CBHSSJB and its departments, community part- trist. Medical coverage has been increased in medical coverage ners and participants have all contributed to build small and medium-sized communities. 20% of the strong foundation that is Piipiichaau Uchishtu- permanent physicians are providing services to ●● Formalize and structure the evaluation of un-Robin’s Nest today. Robin’s Nest and its team more than one community. the quality of the act will continue to strive for violence-free communi- ties, through prevention strategies, support for Abel Bosum, Linda Shecapio and Daniel St-Amour present a laced family medical women, and dedicated care of our own. banner at the inauguration of the Piipiichaau Uchishtuun Robin’s 58 physicians 6 specialists PreventingNest Opening Violence Ceremony, Waswanipi, September 25, 2017 Supporting Women Taking Care of Our Own medical-care associate 50 physicians 22 medical specialists ᓂᑐᑯᔨᓐ ᐋ ᐋ ᑭᓂᐙᔨᐦᑎᑰᒡ ᑭᔮ ᓅᑖᐱᑖᓲᐙᓇᓅᐎᒡ ᐋ ᐐᒋᒥᔮᐙᓅᐎᒡ DEPARTMENT OF DEPARTMENT OF DENTISTRY PHARMACY Anh Nguyen, Chief of Pharmacy

The Department of Dentistry is mandated to The department continues to face a number of The Pharmacy department met its aim of Pharmacies in Chisasibi and Mistissini extend- provide quality general and specialized dental challenges. Dentist recruitment remains dif- recruiting Cree pharmacy technical assistants ed their service hours as of June 2017 to better care throughout Eeyou Istchee. ficult, and the department had an estimated and decreasing reliance on agencies in Chisa- meet their community’s needs. A reorganization 3,200 hours (91 weeks) of unreplaced dentist sibi and Mistissini. New Cree staff were also of services is in progress, and the department This past year, the department succeed in hiring time this past year. In addition, the Chisasibi hired in Waskaganish and Nemaska in 2018, is acquiring a new pharmacy software that a Regional Dental Assistant Coordinator, inte- dental clinic remains in a critical state in terms and recruitment continues for staff in We- would answer the needs of both hospital and grating the department in Care 4-CNIHB/CPS of access, organization, and equipment and, mindji, Eastmain and Oujé-Bougoumou. Each community contexts. As the software will be a management, adding an endodontist to the spe- until adequate renovations are carried out, new technician followed an in-house train- core tool for safer and more efficient pharmacy cialized dental team, and opening a new general delivering optimal dental services is impos- ing program of four to six months. Contracts services, its thorough conception, configura- anaesthesia corridor of services in Val-d’Or. sible. Furthermore, frequent absenteeism and with agencies have been regulated in order to tion and implementation is a high priority for The department staff treated 5,732 different lateness at work, as well as lack of training of support this training, to control the quality and the department this year. Once implemented patients, with a total of 11,975 patient visits. Of support staff, affects the department’s ability to stability of the resources sent to the CBHSSJB, in Chisasibi and Mistissini, the software will these, 2,268 were children nine years old and deliver services efficiently. and to control agency costs. A partnership with also be made available for use by pharmacy 66 the Cree School Board led to a two-year Voca- staff in other communities, so prescriptions 67 under. For general anesthesia, a total of 287 Objectives for the coming year include continu- children were referred outside the territory. tional Program in Pharmacy Technical Assistant could be entered in the software and validated ing to improve access to dental services, reno- being offered in Chisasibi for local pharmacy by pharmacists. Within the next two years, the vating the Chisasibi dental clinic, continuing to employees; the program’s anticipated launch department aims to expand its services to all support the dental assistant training program, is fall 2018. Pharmacy employees from other the other communities by using the automated and finishing the dental purchasing templates communities will be able to enroll in similar pill organizer ‘Dispill’ system. for Virtuo. programs in the coming years. DENTAL CONSULTATIONS Furthermore, in partnership with NIHB and IN THE COMMUNITIES Wiichihiituwin (CPS), pharmacy services re- Community 2016-2017 2017-2018 ceived by patients outside Eeyou Istchee will Chisasibi 3,013 2,625 be overseen in order to ensure clear commu- An endodontist was added Pharmacies in Chisasibi nication between the external pharmacies and Eastmain 1,026 587 to the specialized dental and Mistissini extended CBHSSJB staff, thus increasing safety while Mistissini 3,726 3,488 team, and a new general their service hours as of reducing costs. Controlling access to medica- Nemaska 529 502 tions in CMCs with no pharmacy staff will be Oujé-Bougoumou 665 555 anaesthesia corridor of June 2017 to better meet a main priority in the coming year, and several Waskaganish 1,383 1,266 services opened in Val-d’Or. their community’s needs. measures will be explored to heighten safety Waswanipi 1,371 1,378 and control this access. Wemindji 1,264 1,012

Whapmagoostui 797 562 Eeyou Istchee 13,774 11,975

Children 0-9 2,833 2,268 ᓂᑐᐦᑯᔨᓂᔅᒀᐤ ᐋᐱᑎᓰᐎᓐᐦ ᐋ ᒫᒧ ᐎᒋᐦᑖᑭᓄᐎᔨᒡ PROFESSIONAL SERVICES AND ALLIED HEALTH QUALITY ASSURANCE - HEALTH

The Department of Professional Services and TRAININGS HELD The Allied Health team includes nutritionists, its completion in the next year. Ongoing is a Quality Assurance – Health continues its mis- The annual CHR training in May 2017 held occupational therapists, physical therapists, partnership to provide CBHSSJB support to sion to maximize the quality and effectiveness in Val-d’Or was a highlight of the year. 43 speech-language pathologists, psycho-educa- Minnie’s Hope, a social pediatrics centre in of the contribution of various stakeholders to participants received CPR certification tors, psychologists, psychotherapists, respiratory Whapmagoostui. improve the health and well-being of the popula- and increased their skills in diabetes, child therapists and, for the first time, an audiolo- tion of Eeyou Istchee. Maintaining, acquiring and development, smoking cessation, physical gist. The team works closely with rehabilitation In addition to the development of on-territory optimizing the skills of nurses, beneficiary at- activity, and other subjects. monitors, education monitors and administrative speech therapy services, an on-territory clini- tendants, home care workers and CHRs is at the In November 2017, the Annual Nursing Train- support—essential partners in the team’s work. cal pathway for audiology is being created. The heart of the department’s drive and philosophy. ing was held in Montreal, with more than 110 Motivated and passionate staff, and collaborative first successful trial run of hearing screenings will participants. Topics were related to the Thera- relationships with community and public partners, hopefully see a growth in service in the next year. Eight nurse-counselors carry out the depart- peutic Guide, which is the main tool defining have led to another year of tremendous growth. The growth and stability of the psychology team ment’s main mandates around staff compe- the Expanded Role of nurses working in the allows for more consistent psychological sup- tence, chronic diseases, wound care, infection ­CBHSSJB. Among the courses offered were The respiratory therapy team is operating at port to Eeyou Istchee. Telepsychology appoint- prevention and control, routine and pre-hospital Traumatology, CMDS-A, ventilatory assistance, clinical capacity, supporting the deployment of 68 ments are provided between in-person visits, 69 services, administrative support and training. a cultural presentation by Nishiiyuu, wound advanced technology in emergency respiration. with this change helping to stabilize and en- To support the counselors, a front-line special- care and the musculoskeletal system. The More The pilot project in implementing best practices hance the psychosocial and emotional support ized nurse practitioner joined the team in Chisa- OB Training presented by the Salus Group for dementia care in Chisasibi is in full swing. provided to individuals and families. The nutrition sibi. Multidisciplinary collaboration, teamwork aimed at developing obstetric skills in prepara- The speech therapy team has grown from one team continues to promote healthy eating habits and mutual support, and incorporating different tion for the return of births to the territory. to three clinicians, and is developing screening perspectives into a wholistic and culturally-safe tools and procedures to prevent families from and healthy lifestyles within the communities. vision is paramount, as is collaboration with the In January 2018 the annual Chisasibi Hospital traveling south for speech and language as- This year, the team offered nutrition counseling Executive Committee of the Council of Nurses. Training allowed participants to obtain the ENPC sessments. The team participated in the devel- and organized or took part in community activi- certification in pediatric traumatology. Psycholo- opment of the Projet Novateur Elder’s Home ties, including cooking workshops, educational Major projects this year included multidis- gist Suzy Goodleaf led a remarkable immersive Project for Waswanipi, and looks forward­ to activities in schools, information booths, radio ciplinary collaboration on chronic diseases, training on cultural safety. The Salus group once shows, and walking and snowshoeing events. logging of info-santé type calls, nursing pre- again passed on basic knowledge in obstetrics. scriptions, clinical tools, advancement of the ALLIED HEALTH: HOURS OF SERVICE PROVIDED preceptorship program, collaboration in the Speech and Total preparation of emergency measures (colour Physio- Occupational Psycho- Language Total Manager Nurses, Annual Nurses Training, Montreal 2017 Community Nutritionists therapists Therapists educators Pathologists 2017-2018 2016-2017 codes) and the reintroduction of bush kits. Chisasibi 1,114 742 1,374 334 326 3,890 5,074 Infection Control Nurses visited six communi- Eastmain 522 549 189 18 1,278 724 ties to strengthen partnerships with different Mistissini 1,039 500 1,175 761 100 3,575 3,815 jurisdictions to promote a culture of identifying Nemaska 253 471 15 739 143 and prioritizing needs in this area. Oujé-Bougoumou 119 631 270 189 1,209 1,715 The department is engaged with major tech- Waskaganish 345 129 230 167 100 971 969 nology-based projects including the Enterprise Waswanipi 744 670 592 2,006 3,215 Content Management/Intranet project known Wemindji 156 887 256 61 1,360 2,029 as IKA and the development an Electronic Whapmagoostui 146 66 486 88 786 278 Medical Records system. Eeyou Istchee 4,438 3,504 5,121 2,043 708 15,814 17,963 ᓂᔒᔨᔨᐤ ᐙᐱᒫᐅᓲᐎᓐ MIDWIFERY

This year marked the kick-off of the long await- MILESTONES AND ACCOMPLISHMENTS ●● In December, the CBHSSJB Executive TRAINING ed Midwifery Services, developed in response ●● Hiring of Jessyka Boulanger as Director Committee adopted a resolution that sup- Part of the Midwifery Program is to develop to the desire of the Cree communities to bring of Professional Services and Quality As- ports the Midwifery Action Plan and al- training of Cree midwives. With this in mind, back childbirth to the territory. Midwives are surance – Midwifery, as well as two other located budget for the deployment of the contacts were established with relevant groups. front-line professionals who perform compre- midwives; in January, the three midwives program in the three communities: Chisa- A telephone meeting with Inuit and Ontario hensive maternity (pregnancy, childbirth, post- moved to Chisasibi sibi, Mistissini and Waskaganish Aboriginal midwives took place in December. In natal) follow-ups in healthy women with normal ●● Adoption by the Board of Directors of the ●● Establishment of the Midwifery and Waapi- February, CBHSSJB midwives visited two birth- pregnancies. Clinical Plan for three birthing centres in maausun Implementation Advisory Com- ing centres that provide services to Indigenous Eeyou Istchee: Chisasibi, Mistissini and mittee in March 2018 families in a culturally safe space: Toronto Birth This historically significant project is working Centre and Six Nations Birthing Centre (In Waskaganish ●● Presentation to the Chisasibi Cree Nation to closely with Nishiiyuu to ensure that Midwifery Mohawk TSI NO: WE-IONNAKERATSTHA and ●● Participation by the Midwifery team in the establish a partnership develops culturally appropriate services. Ac- in Cayuga ONA: GRAHSTA). In February, the Annual General Meeting of the Council cording to the Strategic Regional Plan, Mid- ●● The Perinatal Working Group developed the midwives participated in three days of Nishiiyuu of Physicians, Dentists and Pharmacists wifery should be implemented in coordination Partnership Procedure for the Practice of cultural safety training. They also took part in 70 (CPDP), marking the beginning of a collabo- 71 with the Nishiiyuu Group Waapimaausuwin Midwifery in a Hospital Centre, established an Ampro OB program training with the team of ration with the medical team Program (see Chapter 3), which is document- between Chisasibi Hospital and midwifery nurses at the Chisasibi Regional Hospital. ing and transmitting Cree birthing knowledge ●● From November to March, a series of meet- services to women and families. Midwifery should also ings with physicians linked to the project, ●● Work is continuing on a medical collabora- proceed in collaboration with existing services including doctors at the Chisasibi Re- tion agreement with the CISSS of Abitibi- and the community, and by developing the nec- gional Hospital, the new obstetrician for the Témiscamingue essary agreements with the partners. ­CBHSSJB, Dr. Karine Wou, pediatricians at ●● Midwives had the unexpected privilege of the Montreal Children’s Hospital and the CIS- assisting in a delivery that took place under SS medical team in Abitibi-Témiscamingue. medical responsibility at the Chisasibi Re- The purpose of these meetings was to deter- gional Hospital mine the terms and conditions of collabora- tive agreements for consultation and transfer of mothers and newborn babies ●● In December, dialogue began between the Midwifery, Nishiiyuu and the Awash team in Chisasibi ●● A service offer was presented to the ­Perinatal Working Committee in February; With members of Nishiiyuu, there was a visit to a birthing centre in Montreal

Midwives Jessyka Boulanger, Jacqueline Raymond, Catherine Gerbelli Simon-Pierre Breton ᒥᑐᓈᔨᐦᒋᑭᓐ DPSQA Psychosocial PSYCHOSOCIAL

With a mandate similar to Medical, Health and As physical and mental health issues are often The Psychosocial team also consulted with the As physical and mental health Allied Health, the Psychosocial Department intertwined with social issues, it is important to Youth Protection Department and other stake- issues are often intertwined with focuses on front-line social services provided by assess the social context of clients and provide holders on youth protection and “S-5’’ placement community workers, human relations officers and support to them and their families. Priorities policy, to ensure these exceptional measures social issues, it is important social workers, ensuring that quality services are include access to appropriate psychosocial form one of the social interventions that empow- to assess the social context of accessible and meet the population’s needs. evaluation within the framework of the “person er users and families. clients and provide support to of full age protection plan”, with some temporary In October, the department—which has been solutions occurring locally. Continuity remains important for ensuring them and their families. without a stable director for six years—received that psychosocial services are effectively inte- a new DPSQA, Simon-Pierre Breton. In his first In light of this assessment, the Director was grated within each local interdisciplinary team, year, the director assessed services in Eeyou given the mandate to put in place the appropriate that front-line services are connected to Youth Istchee by learning from CMC workers and psychosocial services. In the coming year, steps Protection, and that users sent to outside com- managers about the strengths and challenges will be taken towards innovative and culturally munities receive appropriate and culturally safe 72 of delivering quality and culturally safe psycho- safe solutions to provide better services to youth care upon returning home. Policies and proto- 73 social services based on best practices. This and their families; this process will include foster cols have been developed, especially regarding has been an important step in identifying local home placements, after-hours emergency social referrals between Youth Protection and front-line and regional priorities. services, and the client pathway. services.

The assessment process revealed that Eeyou To ensure quality service, all psychosocial Finally, this year saw a first regional meeting with Istchee’s nine communities deal with a number of ­front-line staff has completed the six modules all human relations officers and social workers in psychosocial issues, including drug and alcohol of Psychosocial Child and Family Interven- Val-d’Or; the meeting focused on cultural ap- abuse, mental health issues (including suicidal tion ­Training, as well as the Charlie Training proaches to care and residential schools. ideation and attempts), physical and sexual Program. abuse (including domestic violence), poor parent- Next year will be a pivotal year, and will see the ing skills, severe distress of children, children and Moreover, because record keeping has been implementation of a pilot project in Mistissini that teenagers with severe behavior problems and/ identified as a top priority in ensuring appropri- features a collaboration between Youth Protec- or anxiety problems, vandalism by children and ate quality, continuity of services and respect of tion and front-line services to foster the empow- teenagers, violence and bullying at school, high users’ rights, and in light of new record-keeping erment of youth and their families. rates of single parenting (putting parents and standards of practice, all psychosocial teams children at risk), housing problems (leading to have received extra training on confidentiality overcrowded houses and homelessness), prob- and record-keeping. lematic use of social media, and elder abuse. Activities 2016-2017 2017-2018 Variation Admissions 790 758 - 4.1% Hospitalization days 6,568 7,236 10.2% ᒋᓵᓰᐲ Transfers to other health centres 123 79 -35.8% Deaths 7 10 42.9% Average stay in acute care (days) 6 17 171.1% ᓂᑐᐦᑯᔨᓂᑭᒥᒄ CHISASIBI Bed occupation rate 64.3% 68.4% 6.4% REGIONAL Clinic consultations 16,274 20,465 25.8% HOSPITAL CHISASIBI REGIONAL Specialist consultations 2,506 2,919 16.5% Fire response exercise at Chisasibi Hospital Observation hours 6,113 5,641 -7.7% HOSPITAL Radiology technical units 162,093 171,872 6.0% If one word could represent the past year at In November 2017, drilling performed close to the Laboratory tests 249,648 315,834 26.5% Chisasibi Hospital, it would be preparedness. hospital hit a gas pocket. This situation triggered Dialysis treatments 2,443 2,541 4.0% The Chisasibi Regional Hospital continues its a code green (complete evacuation). In thirty min- Pre-dialysis 210 N/A N/A steady pace of changes as it improves quality of utes and through the snow, the whole hospital care and prepares for accreditation. was evacuated to the nearby commercial centre, and a temporary emergency room was set up HEMODIALYSIS ARCHIVES Launched officially in December 2016, the there. Upon guarantees of the safety of the situa- Clinical­ Coordination and Integration Commit- The Hemodialysis department has maintained full With the coming move of the Chisasibi CMC to tion, all clients were reinstated safe and sound in capacity throughout the year despite two clients the CBHSSJB headquarters, the archivists team tee (CCIC) continued with a total of ten meetings their rooms, and all services resumed to normal. receiving transplants. There is now a schedule worked on the definition and design of the new organized in 2017-2018. A very positive impact The excellent collaboration between different de- for all visits and video conferences with ne- CMC chart that would better organize users’ has been observed, with fruitful discussions, ex- partments within the CBHSSJB and with external phrologists. An innovative technology for home- files. The team also began preparation of Chisa- changes and results focusing on topics ranging local partners was unanimously commended. dialysis has been presented to Cree Renal Health sibi CMC users’ charts separately from those of from preparation for the influenza season to case This event not only tested but proved the pre- Committee members. Under DMAS leadership, a Chisasibi Hospital users. Extended hours and management of long-term clients. 74 paredness of the staff for dealing with crises and home-dialysis pilot project is being developed. weekend coverage has translated into an in- 75 Last year—and for the coming years—the Chisa- emergencies, and also demonstrated their high crease in the archives’ statistics services. Finally, sibi Regional Hospital had to juggle the present level of professionalism and commitment. LABORATORY in addition to local responsibilities, the archivists with the future. While the team dedicated a good As per its regional mandate, laboratory services have been involved with numerous and various part of its energy to planning hospital renovation NURSING assessed point-of-care testing across the territory regional projects and committees. projects (in relation to the upcoming move of the The stabilization of the nursing workforce helped as one stage in developing and defining proce- Chisasibi CMC at the CBHSSJB headquarters), reduce the use of agency nurses, which led to a dures and protocols for the entire region. A main AUXILIARY SERVICES the team also collaborated with the Chisasibi better continuum of care. A new nursing struc- objective is to implement all recommendations With the opening of the Wiichihiituwin lounge at CMC team on the Technical and Functional Plan ture has been implemented with the addition mandatory for the accreditation of laboratory ser- Chisasibi’s Robert Kanatewat Airport, the kitchen for the new Regional Chisasibi Health Centre. of two assistant head nurses (day and evening vices. As for the MSSS’s Optilab project (Québec’s team ensured the preparation and delivery of shifts) and another to support the coordinator provincial Laboratory Information System), the meals and water at the lounge for charter pas- In accordance with the Strategic Regional Plan, of nursing. During the hospital nursing staff’s Coordinator of Clinical Services has worked to sengers. To ensure user and staff safety, the the Midwifery Project has also engaged the at- annual training week, 28 nurses were trained in ensure recognition of our region’s unique situation. ­CBHSSJB has been implementing a surveillance tention of the entire team, and preparations have different emergency measures. Cultural safety, The number of laboratory tests increased in both project for all installations. Preparations have been undertaken (specifically for the birthing Managing Obstetrical Risk Efficiently (More OB), Mistissini and Chisasibi compared to the last year. begun at the hospital for the installation of the room at the hospital) to welcome the first deliver- and Omega training were also part of this year’s surveillance centre to monitor all CBHSSJB’s ies under this project in 2018. training program. The management of long-term RADIOLOGY buildings. clients has begun to improve with the nomination One of the medical imaging technologists ob- EMERGENCY MEASURES of a case manager for this particular caseload. tained certification in Autonomous Obstetrical Ul- WIICHIHIITUWIN CHISASIBI Following the simulations from the previous year, Initiatives to clarify and improve transparency of trasound Practice in August, allowing for obstet- The year has been difficult for the Wiichihiituwin the hospital continued to develop its level of pre- the admission criteria for long-term clients are rical ultrasounds three days a week—a service Chisasibi team, whose instability and lack of paredness by working to finalize its code orange being conducted and will be pursued in the com- offered to all coastal communities. Patients and space required the commitment and generosity procedure (Disaster or Mass Casualties) and to ing year. In terms of medical evacuations (mede- their families appreciated the addition of a large of all. As anticipated, the number of client arrivals develop a code white procedure (violent client). vacs), the hospital managed 26% of all medevac TV screen in the ultrasound room, allowing a increased again last year by 19%—in line with the departures (300 from Chisasibi) and 15% of all better view of the baby during examination. Since increase in specialist visits in Chisasibi. arrivals (174 in Chisasibi). 2014, the radiology department has increased the number of technical units by 52%. ᐋ ᒌᐦᑳᔮᔨᑖᑰᐦᒡ ᐄᐦᒡ ᐋᐄᔑᓈᑯᒡ ᓂᑐᐦᑯᔨᓐ ᐋᐱᑎᓰᐎᓐ SPECIALIZED SERVICES

SPECIALISTS NORDIC PROGRAM OF INTEGRATED TELEHEALTH Although a majority of tele-consultations are Following intensive advocacy of the MSSS SPECIALIZED SERVICES (PNSSI) The IT department has worked hard in the still based in Chisasibi, the presence of ad- for the recognition of Eeyou Istchee’s particu- In the light of the needs of regions 17 (Nunavik) past few years to provide connectivity to all ministrative support in the communities has lar needs, the Director of Medical Affairs and and 18 (Eeyou Istchee), Dr. Michel A. Bureau, communities, a prerequisite for the use of allowed an expansion of telehealth service Services (DMAS) and the Chief of General and Deputy Minister for the MSSS, held a meeting video-conferencing. Fortunately, the three provision. The impact of the administrative Specialized Medicine obtained sixteen new spe- with members of both regions and the RUIS Mc- remaining communities (Eastmain, Waskagan- support staff has started to show some results, cialist positions for the region. Furthermore, the Gill to discuss the organization of the specialized ish and Whapmagoostui) that did not previ- and the overall number of telehealth sessions DMAS and his team worked closely with part- services. In order to improve access, continu- ously have access to the high-speed internet has increased. This was most significant in ners throughout the Réseau Universitaire Intégré ity, quality and cultural safety of ­services to the now have sufficient connectivity to use video the communities other than Chisasibi and in de Santé (RUIS) McGill to develop agreements inhabitants of our regions, a working group was ­conferencing services. particular in Wemindji and Mistissini, where this not directly with specialists but with the special- established to provide recommendations. It acceleration was remarkable. Specialties like ty’s department, in order to ensure continuity of became clear that the development and harmo- The administrative support staff hired and telepsychiatry have more than doubled their services and shared responsibility for the region nization of specialized services in regions 17 and trained for telehealth in the communities have number of sessions compared to the previous 76 within the department. Those agreements have 18 would be facilitated by the creation of a Nor- had their roles expanded, and they now also year; tele-internal medicine, which started in 77 been defined around six axes: dic Program of Integrated Specialized Services play an active part in the provision of special- 2016, has almost doubled its number of ses- (PNSSI), whose mandate will be to coordinate ized services for both in-person and remote sions. Telehealth services are being integrated 1. Leadership in the specialty, along with all actors involved as well as the steps needed consultations. more and more throughout the territory: for ­medical and administrative co-management to improve specialized services. The special- instance, teleconsultations have also begun in 2. Visits to Eeyou Istchee ized services coordinator, the DMAS and the neuro-pediatrics, which allows clientele fac- 3. Telehealth consultations Chief of General and Specialized Medicine have ing challenging conditions to obtain services in been highly involved in the work and discussions their own community. Telepsychology services 4. Specialized services according to the with all partners to develop and implement the began in Nemaska in March 2018 and will be ­corridor of services PNSSI. It is a very long road that lies in front of offered to other communities in the following Retinopathy screening using telehealth technology, Mistissini 5. Support to the family doctors (through us, but the potential results for our region are months; this program allows psychologists to email and/or phone) very promising. offer follow-up consultations in between visits 6. Leadership in continuous education in the community, directly from their profes- The recruitment of specialists began in internal sional laptop through secure software. This new medicine, pedo-psychiatry, pediatrics, psychia- service will offer flexibility in service delivery as try and obstetrics/gynecology. Next year, steps well as increased access and continuity of care. will be undertaken to continue the recruitment Overall there is now a better access to special- of specialists. ized care throughout Eeyou Istchee. Patients travel less outside the territory, the specialists coming instead to them through increased visits and telehealth. It is much preferable to be served close to your home than to travel to a city with a different culture, often with an es- cort, disrupting one’s normal life. We are com- mitted to increasing our ability to provide care as close as possible to our clients’ homes. 4b ᐃᐦᑖᐎᓐ ᒥᔪᐱᒫᑎᓰᐎᑭᒥᒄᐦ community miyupimaatisiiun centres ᒥᓯᐧᐋ ᐊᓂᐦᐄ ᒥᔪᐱᒫᑎᓰᐧᐄᑳᒥᑯ ᐄᑖᐧᐄᓂᔨᒡ Community Miyupimaatisiiun Centres ᑳ ᒑᒥᑖᐦᒡ ᐋᑰᐦᑦ ᐧᐋᒡ ᒋᒥᑖᐦᒡ ᑭᔮ ᐧᐋᒡ (CMCs) are the community presence ᑭᓂᐧᐋᐄᑕᑰᐦᒡ ᒥᔪᐱᒫᑎᓰᐅᓐ ᑭᔮ ᓂᑑᑯᔨᓐ ᐋᐧᐄᐦᒡ of the CBHSSJB. ᑭᓂ ᐧ ᐋ ᐱᑖ ᑭᓅᒡ ᙮ Each CMC includes a walk-in clinic, 79 ᒥᓯᐧᐋ ᒥᔪᐱᒫᑎᓰᐧᐄᑳᒥᑯ ᐄᑖᐧᐄᓂᔨᒡ ᑳ ᒑᒥᑖᐦᒡ as well as community health clinics ᐃᔮᐧᐄᔨᒡ ᓂᑐᐦᑯᔨᓂᑭᒥᒄ ᑭᔮ ᒥᔪᐱᒫᑎᓰᐅᓐ ᐊ serving different age groups: Awash ᑭᓂᐧᐋᐦᐱᑖᐦᒡ ᒑ ᒋ ᐧᐄᒋᐦᐋᑳᓄᐧᐄᔨᒡ ᐋᐧᐋᓂᒌ (ages 0-9), Uschiniichisuu (ages 10-29), ᓃᓇᑰ ᐋᑐᐳᐧᓈᓰᐦᒡ: ᐊᐧᐋᔑᓰᔨᒡ (ᐋᐱᔅᑑᐧᐋᔑᔨᒡ and Chishaayiyuu (ages 30 and above). 0-9) ᐆᔅᒋᓃᒋᓲᐦᒡ (10–29 ᐋᑐᐳᐧᓈᓯᐦᒡ ᐅᔅᒌᓂᒋᓲᐧᐄᔨᒡ), ᑭᔮ ᒋᔖᔨᔨᔫᐧᐄᒡ (30+ ᐊᓂᑖᐦ CMCs also offer dentistry, pharmacy, ᐋᐄᔥ ᒋᔖᔫᓈᓅᐧᐄᔨᒡ)᙮ mental health and social support, and home care and rehabilitation services ᒥᔪᐱᒫᑎᓰᐧᐄᑳᒥᑯ ᐄᑖᐧᐄᓂᔨᒡ ᑳ ᒑᒥᑖᐦᒡ including day programs at the local ᐧᐋᔅᑳᐦᐄᑲᓐᐦᒡ ᐋᑰᐦᑦ ᑭᔭ ᓅᑕᐱᑖᓅᐧᐄᔨᒡ, Multi-Service Day Centre (MSDC). ᓂᑐᐦᑰᔨᓐ ᐧᐋᐦᒡ ᒥᐧᐋᓅᐃᐦᒡ, ᑭᔮ ᒋᔖᔨᔨᐧᐄᔨᒡ ᐋ ᒥᒥᔫᑯᐧᐋᑲᓄᐧᐄᔨᒡ, ᐋᔖᔖᐧᐄᐱᐦᑕᑳᓅᐧᐄᔨᒡ Each CMC has an Administration ᐋᐧᐋᓂᒋ ᐊᓂᑖᐦ ᒋᔖᔨᔨᔫᑳᒥᑯᒡ᙮ department which takes care of areas such as financial management ᐊᓂᐦᐄ ᐧᐋᔅᑳᐦᐄᑳᓐᐦ ᑭᔮ ᒥᔪᐱᒫᑎᓰᐧᐄᑳᒥᑯ and maintenance of buildings and ᐄᑖᐧᐄᓂᔨᒡ ᑳ ᒑᒥᑖᐦᒡ ᒥᓯᐧᐋ ᒥᓯᓃᐦᐄᒑᐅᑲᒥᑯᐦ equipment. ᐋᑰᑦ ᐧᐋᐦᒡ ᐱᒻᐲᐦᔨᒡᔔᔭᓐ ᐋᐧᐄᔔᒪᑲᓅᐧᐄᑦ ᑭᔮ ᐧᐋᔅᑳᐦᐄᑲᓐᐦ ᐋ ᐧᐄᒋᓈᓅᐧᐄᒡ ᑭᔮ ᐋᓐ ᒑᐧᑳᓐ ᐋ ᒋᔅᑖᐱᑎᐦᒡ᙮ “The nurse practitioner has been focusing on STI prevention, and they have managed to decrease rates from previous years. Also, when the clinic did a trial extension of opening hours to 9 pm, we saw that youth clientele ᒋᓵᓰᐲ responded with more walk-ins,” says Jeannie Pelletier, local director of Chisasibi’s CMC. “And this coming year we’re looking forward to moving to the new building and working in an environment that doesn’t promote silos but awash 0-91 970 q 2.5% chisasibi helps us work collaboratively.” Jeannie Pelletier Uschiniichisuu 10-29 1,723  1.6% Local Director 4,758 Chisasibi CMC Chishaayiyuu 30+ 2,065  3.1% TOTAL2 4,758  1.4%

medical EVACUATIONS3 Miyupimaatisiiun is based on a strong cultural The Uschiniichisuu team shared its manager The Chishaayiyuu unit hired more nurses, EMERGENCY n/a holistic vision of health and should be the foun- with other services, but was able to extend including an assistant head nurse to stabilize the scheduled n/a dation on which our services are based. hours of services to accommodate more walk- workforce, ensuring increased services for the cli- current services3 ins. A nurse and a nurse practitioner were hired entele followed for chronic diseases as well as for doctors (pgm & clinic) 4,566 At the start of the year, the Awash coordina- to support the clinic, as growing case loads HCCP clients. The nutritionist, psychoeducator, tor became the CMC’s new local director, and awash3 were overwhelming for the one clinic nurse. The physiotherapist, CHRs, nurses and occupational nurse (pgm, incl. vacc.) 2,918 an interim coordinator appointed. Chisasibi unit also hired a new nutritionist and commu- therapist continue to coordinate many activi- CHR (individual) 243 welcomed 90 new births this year, including nity worker. The NNDAP worker continues to ties during the year, including diabetes month, a 80 CHR (groups) 209 one recently delivered with a midwife; midwives provide important services to the community walking club, cooking classes and after school 81 Community worker 285 have recently been hired and will be integrated members; we hope to use new federal funds workshops to youth with disabilities. Increased school nurse (incl. vacc.) n/a with Awash services under the guidance of to hire an additional community addictions psychosocial services is one of our priorities, and 3 Uschiniichisuu Nishiiyuu. The implementation of the  Mash- worker to manage outreach and awareness we are in the process of hiring additional social nurse (pgm & curative) 1,116 kûpimâtsît Awash Integrated Program and the campaigns, especially with new legislation and workers to assist community workers in manag- CHR (individual) 358 Well-Baby clinic continued, as did collabora- legalization regarding cannabis use. The team ing cases. Another priority is improving the clinic’s CHR (groups) n/a tions with Head Start and Childcare Services. met regularly with Youth Protection to ensure laboratory works. The unit’s coordinator left at the Community worker 438 Awash CHRs, nurses and community workers cases do not fall through the cracks, and pro- start of March 2018, so an interim coordinator has social worker 59 supported the eight-week Nurturing College, vided support to the newly hired elementary been in place since March 12. school social worker (ind.) n/a launched in January 2018 in collaboration with school nurse. NNADAP worker 244 daycare centres and the community. Team The Administration unit will finally move to the 3 Chishaayiyuu building will be the theme for Awash in the new location in the near future, and the remain- nurse (pgm) 5,690 coming year. ing CMC staff will follow when renovations to footcare nurse 248 the site are complete. Hopefully, all of CMC CHR (individual) 454 Chisasibi will move during the coming fiscal CHR (groups) n/a year, benefitting staff and community mem- Community worker 2,297 bers both. A new Administrative Technician social worker n/a homecare (no. of clients) 769 was hired to replace the previous technician, MSDC (attendance) 423 who resigned last fall. We still need to hire a MSDC (meals served) 2,781 new coordinator of Awash, and must also post the position for coordinator of Chishaayiyuu. Full-time positions for MSDC kitchen staff have

1. The 0-4 age group (a) is underestimated since newborns are finally been approved. The community needs often registered late in the JBNQA beneficiary list; and (b) has been more adaptive vehicles to support clients with corrected using the MSSS 2012-2015 births (+ 2016 estimates) and 2012-2015 MSSS deaths numbers. mobility constraints; this is a need that could be 2. Does not include 347 Inuit, Métis and/or non-aboriginals. 3. In Chisasibi, many clinical services are offered at the hospital. met through collaboration with the community. See page 74. “Last year we saw an improvement in medical services, with 90% coverage by doctors,” says Rita Gilpin, local director of the Eastmain CMC. “We’ve also hired a head nurse, and are in the process of hiring a Chishaayiyuu social worker. These ᐄᔅᒣᐃᓐ are new development positions, and they will make a big difference to our services.”

awash 0-91 186 q 4.6% eastmain Rita Gilpin Uschiniichisuu 10-29 282  7.6% Local Director 827 Eastmain CMC Chishaayiyuu 30+ 359  3.8% TOTAL2 827  3.0%

medical EVACUATIONS This year the Awash/Uschiniichisuu unit The medical services offered through Current The HCCP team includes a home care nurse, EMERGENCY 62 welcomed 22 new babies to Eastmain, and Services/Chishaayiyuu have improved as the community worker, rehabilitation monitor and scheduled 790 its CHRs and nurses continue to provide sup- CMC doctor coverage increased substantially. three permanent full-time health & social aides, current services port to the new mothers, their infants, and their The nursing staff includes one assistant head and serves 17 home care clients with personal doctors (pgm & clinic) 1,577 families, including new prenatal classes on nurse and three permanent full-time nurse hygiene, domestic chores and moral support. visiting specialists 133 healthy pregnancies and deliveries implemented positions; early this year two nurses resigned. The MSDC has 16 clients. The physiotherapist other 0 by Awash nurses. The team also focused on A new diabetes clinical nurse started her posi- and occupational therapist are actively engaged nurse (walk-in clinic) 9,988 addressing some of the community’s pressing tion in March, and a new development position with the programs, which has had a positive 82 nurse (refills) 3,420 health and social issues, such as anxiety and for a social worker has been posted. Teleoph- impact on clients with disabilities. Our nutrition- 83 nurse (clinical lab tests) n/a depression, strained family dynamics, suicide thalmology screening continues, with twenty- ist and physiotherapist promote healthy lifestyles awash ideations and drug issues. The second round of six patients being seen this year, but training by offering ongoing cooking workshops and nurse (pgm, incl. vacc.) 756 the Photovoice program was very successful; is needed for new staff. One nurse is trained physical activity programs, which have had an CHR (individual) 327 this program, facilitated with an external partner, to support this project, but further training is extremely positive impact on our services. CHR (groups) 0 enabled youth to use photographs to present needed for the other permanent nurses due to Community worker 19 their perspectives of the community to leaders a large turnover in staff. The Administration unit has been without a social worker n/a of local entities. The Awash/Uschiniichisuu team coordinator for three years, with the position’s Uschiniichisuu continues to work in close collaboration with Dental services still relies upon replacement responsibilities being shared by the other two nurse (pgm ) 653 local partners and regional resources, and this dentists, and clients with dental emergencies are units’ coordinators in collaboration with the CHR (individual) 205 coming year will retain its focus on providing the screened by nurses in Current Services and sent local director. Over the summer a university CHR (groups) 0 best services and programs for families. to neighbouring communities. Dental technical student was hired for ten weeks to perform ad- Community worker 100 assistant training started in the second last week ministrative duties, which helped significantly. social worker 61 of January, with three trainees to be certified. The CMC experienced a major problem as the NNADAP worker n/a main sewage line collapsed during the summer; Chishaayiyuu with the assistance with the Material Resources nurse (pgm & curative) n/a Department in Chisasibi, the problem was fixed footcare nurse 134 during the winter. The administration unit is now CHR (individual) 578 running with full capacity, as all staff were hired CHR (groups) 0 this year. However, the community still lacks Community worker 98 social worker 114 sufficient housing units. homecare (no. of clients) 2,392 MSDC (attendance) 882

MSDC (meals served) 878 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 2012-2015 births (+ 2016 estimates) and 2012-2015 MSSS deaths numbers. 2. Does not include 25 Inuit, Métis and/or non-aboriginals. “The delivery of new housing has been a major event: 15 new houses have been delivered, and 18 more will be delivered in June,” says Paul Iserhoff, who was named interim local director in November 2017. “Renovations to ᒥᔅᑎᓯᓃ upgrade our 10-unit transit have been completed, so we can accommodate more visiting professionals, which will have a very good impact on the community.”

awash 0-91 645 q 9.0% mistissini Paul Iserhoff Uschiniichisuu 10-29 1,416  4.5% Interim Local Director 3,792 Mistissini CMC Chishaayiyuu 30+ 1,731  1.9% TOTAL2 3,792  0.8%

medical EVACUATIONS EMERGENCY 495 During the last year Current Services’ walk-in The Uschiniichisuu unit was without a coordi- The Chishayiyuu unit faced many challenges scheduled n/a clinic welcomed 15,108 clients, with a signifi- nator until July 2017, but programs continued as it assumed new responsibilities; specialists’ current services cant proportion being clients 60 and over; as a thanks to the team’s concerted efforts. The visits are now carried out through this unit, and doctors (pgm & clinic) 5,230 result, the clinic is working with Chishaayiyuu to CHRs and community workers collaborated it is also now responsible of the pre-dialysis specialists 762 increase prevention strategies and follow-ups with the local school, HUB, and Access Pro- clinic, which demands significant responsi- foot specialist 185 with these clients. The walk-in clinic is extend- gram. The school nurse and the school social bilities and reorganization. Staff turnover and nurse (walk-in clinic) 15,108 ing opening hours to meet demand. The hemo- worker delivered presentations on mental lack of resources—notably, the lack of phys- nurse (refills) n/a dialysis department increased its treatments health to high school students. The NNADAP iotherapy services—remain an on-going issue 84 hemodialysis 2,624 and now supports 20 clients. worker and other team members collaborated that have a significant impact on our patients. 85 awash with the HOPE committee and Youth Council in However, the team ensured quality integrated nurse (pgm, incl. vacc.) 2,813 This year, Mistissini’s Awash team welcomed arranging activities and events for Mistissini Ad- care and services and continued to improve CHR (individual) 927 74 newborns. Awash continues to improve diction Awareness Week, holding presentations efficiency between social services, community CHR (groups) 168 the quality of care with the multi-disciplinary and workshops at the high school and youth health, medical and nursing staff, the HCCP, al- Community worker 359 Maternal and Child Health Program and the centre, and participating in radio talk shows. lied services, and the Multi Service Day Centre, social worker 1,067 Â Mashkûpimâtist Awash integrated approach. The school nurse and a Uschiniichisuu nurse as well as with other entities. Multidisciplinary Uschiniichisuu The team struggled with medical leaves and provided vaccinations at the elementary and meetings, staff and clinical meetings, and nurse (pgm ) 3,156 lack of nurses, but was able to deliver quality high schools. ongoing training activities facilitate and improve CHR (individual) 1,949 services. The team carried out a number of col- CHR (groups) 28 the provision and promotion of the health and laborative projects with partners, such as Head Community worker 1,461 wellbeing of our community. Start (Baby College), Day Care, School, Women social worker 240 Association and Maamuu (Avenir d’enfants). The Administration unit secured five mainte- NNADAP worker 360 Quebec Health Minister Dr. Gaétan Barrette and MNA Jean nance workers, one light housekeeping worker, mental health nurse 124 Boucher visit with staff of Mistissini CMC, December 2017 mental health comm. worker 380 and new nursing positions thanks to new devel- cons. with school nurse 1,039 opment funds. The CMC received 15 new units cons. with school chr 1,260 in January 2018 from the 33 to be constructed Chishaayiyuu in Mistissini. The second phase of renovations nurse (pgm & curative) 9,762 to transits at 392 Mistissini Blvd was completed footcare nurse 709 at the end of January. The Administration unit CHR (individual) 3,566 will continue to support the CMC’s integrated CHR (groups) n/a services and will focus on continually improving Community worker 284 the quality of care and services for all users. social worker n/a 1. The 0-4 age group (a) is underestimated since newborns are homecare (no. of clients) 786 often registered late in the JBNQA beneficiary list; and (b) has been MSDC (attendance) 969 corrected using the MSSS 2012-2015 births (+ 2016 estimates) and 2012-2015 MSSS deaths numbers. MSDC (meals served) 1,903 2. Does not include 160 Inuit, Métis and/or non-aboriginals. “We are really working collaboratively in partnerships with other services to serve our population,” says Beatrice Trapper, local director for the Nemaska CMC. “For instance, our Maamuu Uhpichinaausuutaau committee in Awash ᓀᒥᔅᑳ brings together representatives from the daycares, Wellness Centre, Cree Nation Government and the CBHSSJB to share ideas for supporting young mothers.”

awash 0-91 182  19.0% nemaska Beatrice Trapper Uschiniichisuu 10-29 280  1.1% Local Director 851 Nemaska CMC Chishaayiyuu 30+ 389  4.9% TOTAL2 851  6.2%

medical EVACUATIONS A new coordinator was hired for Chishaayiyuu/ The MSDC suffered significant water damage, The Administration unit hired three new EMERGENCY 106 Current Services last summer, but it remains which necessitated the complete relocation of administration officers and a driver. All posi- scheduled 621 challenging to stabilize medical services due to clients and activities to another site. The HCCP tions are filled except for an assistant cook for current services changes in medical staff. Fortunately, the ad- has a home care nurse, a community home the MSDC and a temporary full-time General doctors (pgm & clinic) n/a dition of a part-time and “depanneur” doctors care worker, and two home care workers. The Aid in Northern Institutions; the unit would visiting specialists 2,067 has increased the number of consultations this team offers regular foot care to diabetic clients, like to hire a building maintenance technician. other 194 past year by 43%, and the new Assistant to the as well as home management, social services Shortage of housing remains a major issue, nurse (walk-in clinic) 8,853 Immediate Supervisor Clinical Nurse position and home visits. and has restricted the CMC’s capacity to fill 86 nurse (refills) 2,788 is now filled, which will help stabilize service all professional positions, meaning that many 87 awash delivery. Telehealth consultations, mainly with The coordinator position for the Awash/­ clients must be sent out of the community to nurse (pgm, incl. vacc.) 576 the pediatrician and psychiatrist, have saved Uschiniichisuu unit is vacant, but the team receive the necessary care. There were training CHR (individual) 353 significant amounts of time and money by continued to work closely and saw 920 clients sessions on environmental hygiene for house- CHR (groups) n/a reducing patient travel. Nemaska’s specialized over the year. Staff turnover remains a chal- keeping staff, and the telehealth administrative Community worker 161 services include one occupational therapist lenge. The unit has three nurse positions (two officer and the Uschiniichisuu CHR received social worker n/a (shared with Oujé-Bougoumou), a mental health for Awash, one for Uschiniichisuu), but resigna- training on the Care4 system. In March, CMC Uschiniichisuu nurse, and a psychologist. There is a CMDSA- tions and relocations have reduced this number staff met with school committee members to nurse (pgm, incl. vacc.) 344 CPR monitor nurse on staff, who provides at points. The unit continues to build partner- discuss overlapping issues in education and CHR (individual) 321 other nurses with frequent training and practice ships with local entities to offer adapted inte- health and social services. CHR (groups) n/a workshops to maintain their resuscitation skills. grated services to community members. This Community worker 70 The CHR has received training and support past year saw visits from the Cree Neurode- social worker n/a from the nurses and nutritionist, and had 813 velopmental Diagnostic Clinic and the CE-CLE NNADAP worker n/a client meetings this past year. Physiotherapist program teams. Chishaayiyuu nurse (pgm & curative) 243 and social worker positions are vacant, mainly footcare nurse 139 because of lack of local housing. CHR (individual) 1,320 CHR (groups) n/a Community worker 498 social worker n/a homecare (no. of clients) 110 MSDC (attendance) 282 MSDC (meals served) 1,267 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 2012-2015 births (+ 2016 estimates) and 2012-2015 MSSS deaths numbers. 2. Does not include 15 Inuit, Métis and/or non-aboriginals. “It has been an exciting year: new facilities were leased and installed, positions were filled, staff was relocated and given new responsibilities, and throughout everyone has shown great patience, resilience and teamwork. We were also ᐅᒉᐴᑯᒨ involved in the planning for our new CMC,” says Louise Wapachee, local director of the Oujé-Bougoumou CMC. “And we have worked with our partners in the community, who share our mission to have healthy and vibrant awash 0-91 181 q 3.7% oujÉ-bougoumou community. Partnerships have been key to our successful Louise Wapachee Uschiniichisuu 10-29 322  1.9% Local Director 837 programs, projects and services.” Oujé-Bougoumou CMC Chishaayiyuu 30+ 334 q 2.1% TOTAL2 837 q 0.9%

medical EVACUATIONS Oujé-Bougoumou’s client visits to the walk-in The Awash/Uschiniichisuu unit saw new Since June 2017, the Chishaayiyuu unit has had EMERGENCY 173 clinic have increased by 2,611 this past year, modular units installed to accommodate the in place a full-time nurse addressing community scheduled n/a and to better address our client needs, Current growing team who were displaced and scattered health services, working closely with the CHR current services Services hired a permanent third nurse in Au- between the CMC and MSDC for seven months. and other professionals. Many activities over the doctorS (pgm & clinic) 1,334 gust. The pharmacy also experienced a notable The team delivered two sessions of prenatal year engaged all professionals (nurses, dental visiting specialists 69 increase in services. Our medical coverage classes in the spring and fall, and supported the hygienist, nutritionist, physiotherapist, psycho- other n/a has been increased over the year to 30 weeks Eenou Awash Piimaatsiiwin College, a program educator, community health representative and nurse (walk-in clinic) 9,858 (Increase of 147 visits). In June 2017 the coordi- that enhances parenting skills. A new special occupational therapist). The HCCP and MSDC 88 nurse (refills) 2,831 nator of Current Services assumed responsibility needs summer camp was offered, with summer staffs are in place and programs are meeting 89 awash for the First Responders service. students being hired to coordinate and facilitate client needs. nurse (pgm, incl. vacc.) 841 the camp according to each child’s needs. The CHR (individual) 151 team also supported two youth to attend the In spring 2017 the Administration unit signed CHR (groups) 12 Fourth Annual First Nations Leadership Camp, a contract for the two-year rental of the seniors Community worker 82 and organized a Tree Planting Project. These home in Oujé-Bougoumou, which has been social worker 193 projects encourage positive social behavior and converted into a seven-bedroom, fully furnished Uschiniichisuu focus on the strength of each participant. Many transit. Before the lease expires, we hope to own nurse (pgm, incl. vacc.) 395 of the team’s projects involved community part- a 10-bedroom transit to accommodate visit- CHR (individual) 20 nerships, including partnerships with Oujé-Bou- ing professionals. In October 2017, CHB trailers CHR (groups) 16 goumou Cree Nation, Waspshooyan Childcare arrived from Mistissini and major work began Community worker n/a Centre, Headstart & Waapihtiiwewan School. on new Awash buildings; the trailers were con- social worker n/a nected to our present clinic, while the old Awash NNADAP worker 41 trailer was converted to the Youth Protection Chishaayiyuu Department. Two triplexes were built last year nurse (pgm & curative) 442 and will soon be delivered, but even with this footcare nurse 34 new units, we still lack sufficient housing. CHR (individual) 44 CHR (groups) n/a Community worker 174 social worker n/a homecare (no. of clients) MSDC (attendance) 344 MSDC (meals served) 621

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 2012-2015 births (+ 2016 estimates) and 2012-2015 MSSS deaths numbers. 2. Does not include 85 Inuit, Métis and/or non-aboriginals. “We were really happy to receive 12 new housing units this year. Not only can we can give some of our professionals proper housing, but it opens our transits as well, as they were being used for these employees,” says Bert Blackned, ᐙᔅᑳᐦᐄᑲᓂᔥ local director of the Waskaganish CMC. “We also received two trailers, which helps our workspace environments. We are assigning these to Youth Protection, administration and other development positions.” awash 0-91 524 q 1.7% waskaganish Bert Blackned Uschiniichisuu 10-29 889  1.7% Local Director 2,420 Waskaganish CMC Chishaayiyuu 30+ 1,007  1.6% TOTAL2 2,420  0.9%

medical EVACUATIONS This past year the Awash/Uschiniichisuu The nutritionist presented programs in the The HCCP team is stabilizing care delivery EMERGENCY 123 team welcomed 43 new born babies. Due to schools and daycares, and with high-risk clien- thanks to having a second nurse on the team. scheduled 2,120 the increase in births each year, there had been tele, including people with diabetes, gestational The MSDC team continues to provide services current services delays in the community’s vaccination program diabetes, hypertension, elevated cholesterol to 20 to 24 clients, recruits new clients, and doctorS (pgm & clinic) 3,497 and in screening for developmental delays levels, anemia and obesity; she also hosted also offers services to the community-at-large. visiting specialists 0 among the four- and five-year-old children, so healthy cooking and healthy snacks workshops The program will be reviewed and new recruit- other 0 this past year the team worked to bring over a with her clientele and the staff of the CMC. The ing strategies developed in the coming year. nurse (walk-in clinic) 15,783 hundred young children and all 6-14 year olds psychoeducator is on maternity leave and will 90 nurse (refills) 4,796 up to date on vaccinations. The community return in the new fiscal year. The rehabilitation The Administrative unit is currently in transi- 91 nurse (clinical lab tests) 1,513 organizer has established her team of partners team (physiotherapist, occupational thera- tion, moving employees to two trailers to make awash and is actively involved in helping our young pist, and rehabilitation monitor) was extremely office space available at the clinic for upcoming nurse (pgm & curative) 3,872 families to live a healthy lifestyle. The commu- busy, addressing key issues including trauma, positions through new development funds. This CHR (individual) 1,444 nity workers, along with the NNADAP depart- diabetes and high blood pressure due to the year a number of housekeeping employees took CHR (groups) 221 ment, has seen an increase in patients coming prevalence of obesity and sedentary lifestyles; Hygiene & Safety training given by the Material Community worker 835 for services and seeking aid for addictions, the team is also concerned about the elderly, Resources Department. The support staff re- social worker 0 grieving and social assistance applications. The both in Multi-Service Day Centre programs and ceived Virtuo Training, as well as a minute-taking Uschiniichisuu unit is looking forward to hiring another Awash the Home and Community Care Program, due workshop and business writing workshop. Other nurse (pgm) 2,748 nurse and a head Awash Nurse. to a slight increase in the incidents of cognitive activities included managing housing for new CHR (individual) 459 instability and of loss of strength due to aging. permanent and temporary employees, and this CHR (groups) 0 In Current Services/Chishaayiyuu, the nurs- We are presently recruiting a physiotherapist. year Waskaganish received four new triplexes for Community worker 0 ing team is stabilizing after experiencing larger- professionals, which will be a great asset as we social worker 0 than-normal staff turnovers, with maternity and continue to develop our services. NNADAP worker 318 sick leaves. Two new positions have been im- Chishaayiyuu portant assets for the team: the Liaison Nurse nurse (curative) 0 and the Assistant to the Immediate Supervisor footcare nurse 613 Nurse. Other development positions will be CHR (individual) 1,374 introduced during the coming fiscal year. The CHR (groups) 0 physician services schedule was full for this Community worker 403 year and, with the integration of a third physi- social worker 0 homecare (no. of clients) 3,316 cian on a part-time basis, the team continues to MSDC (attendance) 2,293 provide excellent service to the population. MSDC (meals served) 2,284 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 2012-2015 births (+ 2016 estimates) and 2012-2015 MSSS deaths numbers. 2. Does not include 85 Inuit, Métis and/or non-aboriginals. “We’re running programs at the Multi-Service Day Centre for kids who are having trouble at school, and for kids with special needs,” says Alan Moar, local director of the Waswanipi CMC. “All types of activities have been set up, ᐙᔅᐙᓂᐲ some after hours, so kids are coming in after school. We’ve seen that girls in small groups can really open up and say things they might be scared to say in high school.”

awash 0-91 433 p 2.6% waswanipi Alan Moar Uschiniichisuu 10-29 761 p 1.1% Local Director 2,028 Waswanipi CMC Chishaayiyuu 30+ 834 p 3.9% TOTAL2 2,028 p 2.5%

medical EVACUATIONS This past year has seen much progress, and all The Awash/Uschiniichisuu unit welcomed 37 We now have four Cree nurses working in Was- EMERGENCY 135 last year’s priorities were met. However, the high newborns to Waswanipi this year, and we have wanipi, two of whom work on regional files. We scheduled 1 changeover of nursing staff creates difficulties in provided them, and their mothers, good sup- also have a regional mental health nurse and current services maintaining the stability in our nursing programs port through our CHRs and nurses. The team the Nishiiyuu program now bases two employ- doctors (pgm & clinic) 1,406 and services, and as a result we continue to continues to improve its important relationship ees in Waswanipi, forming an integral part of all visiting specialists 212 rely upon agency nurses. Chronic diseases and with Youth Protection. The front line psychoso- our programs and services. All have temporary other (footcare) 134 especially diabetes remain priorities and chal- cial group is now beginning to play an impor- offices in our CMC. nurse (walk-in clinic) 7,842 lenges for the coming years, and we hope to tant role and is making progress in addressing 92 nurse (refills) 5,902 implement more prevention programs. problems confronting youth and families. The Priorities for 2018/2019 include: continuing to 93 nurse (clinical lab tests) 1,616 school nurse has completed all the vaccina- request more living units and transits; continu- awash The Coordinator of Current Services/ tions at the schools, with help from the CHRs. ing our engagement with partners; continuing to nurse (pgm & curative) 807 Chishaayiyuu was on leave for over six This nurse provides much medical and social address chronic diseases and disability; pursu- CHR (individual) 2,335 months, but the team responded well. There support for students and parents. ing efforts to develop and promote a unique CHR (groups) n/a is rarely waiting time to see a nurse or CHR appointment system; supporting the Robin’s Community worker 427 for services. We have a permanent doctor and The Administration unit’s coordinator has Nest women’s shelter; implementing extended social worker n/a a number of regular depanneur doctors pro- experience in human resources management, hours for services and programs; supporting the school nurse (incl.vaccinations) 677 viding services for the community. Two new so this area has improved notably. Numerous implementation of the Intermediate Resource hr officer 185 nurses were hired through new development training sessions were provided for front line Centre on the first floor of the MSDC; and con- Uschiniichisuu funds, one in the Chishaayiyuu program and staff. The air shuttle service, the application tinuing our engagement with the Clinical Coordi- nurse (curative) 512 one liaison nurse. Foot care clinics are provided of lodging policy, maintenance, housekeep- nation and Integration ­Committee (CCIC). CHR (individual) n/a by our Chishaayiyuu nurse or homecare nurse. ing and medical bio-waste disposal are some CHR (groups) n/a All professionals in this department were ac- of the files that have improved this past year. Community worker 255 tive providing services to the community, and In addition, a second driver was hired for the school social worker n/a the Multi-Service Day Centre has been busy shuttle service. This past year we received six NNADAP worker n/a throughout the year. new two-bedroom units, which are critical for community worker (addictions) 231 enabling us to meet our development needs. Chishaayiyuu We are still in need of five two-bedroom units nurse (pgm & curative) 293 and five transits. footcare nurse n/a CHR (individual) 1,282 CHR (groups) n/a Community worker 488 social worker n/a 1. The 0-4 age group (a) is underestimated since newborns are homecare (no. of clients) 599 often registered late in the JBNQA beneficiary list; and (b) has been corrected using the MSSS 2012-2015 births (+ 2016 estimates) and MSDC (attendance) 1,297 2012-2015 MSSS deaths numbers. MSDC (meals served) 5,782 2. Does not include 20 Inuit, Métis and/or non-aboriginals. “This year we finally were able to get an optometrist and optician to come to the community for a week,” says Mary Shashaweskum, local director of the Wemindji CMC. “There was a big need, as we hadn’t had one for the past two years, ᐐ ᒥᓂ ᒌ so they were kept busy! There was still a big waiting list at the end of their visit, so we’re looking forward to them coming back in the summer.” — Mary Shashaweskum, Interim Local Director, Wemindji CMC wemindji awash 0-91 283 q 6.9% 1,535 Uschiniichisuu 10-29 501  0.2% Chishaayiyuu 30+ 751  2.2% TOTAL2 1,535 q 0.3%

medical EVACUATIONS The Current Services/Chishaayiyuu unit hired The Awash team welcomed 30 new infants to The Uschiniichisuu unit established youth- EMERGENCY 115 a new Assistant to Immediate Supervisor and Wemindji this year. Awash faced several chal- friendly health services in the form of a walk- scheduled 1,522 Liaison Nurse. Four new nurses received MDSA lenges, mainly due to many team members in Youth Clinic staffed by CHRs, the school current services training, and the community received a five-day being on sick leave. For this reason, Awash nurse, the community worker and the NNADAP doctors (pgm & clinic) 2,348 visit from an optometrist and optician; the oc- was unable to pursue its Fly Families Program worker, as well as a doctor; Youth Clinic is held visiting specialists 650 cupational therapist is on leave. The registered and focused instead on developing new cur- every Tuesday evening from 6-9 pm, offering other 0 nurse with the HCCP was replaced by agency ricula for workshops, which we hope to resume STI screening, pregnancy testing and counsel- nurse (walk-in clinic) 5,974 nurses for a total of 95 days; the program was in fall 2018. In light of the increased involve- ling on health and social issues. We also col- 94 nurse (refills) 3,782 also supported by the mobile nurse and a nurse ment of fathers at Well Baby Clinics, the team laborated with the Minor Sports Association’s 95 awash from Current Services. The team also received worked with partners to host a Paternity Week, ActivNation Sports Program to provide physical nurse (pgm & curative) 1,547 critical mental health support from Chisasibi in which saw a total of 339 individuals participate examinations for all of the youth entered in the CHR (individual) 726 response to a crisis for in July, and had ongoing in activities that included a father and child program. Further plans include an outreach CHR (groups) n/a post-crisis assistance from the regional mental luncheon, a radio panel discussion, a walk, free program as well as land-based and traditional Community worker 86 health team, including visits from a psychologist, family swim and youth basketball, as well as teaching activities with Elders. social worker 0 psychotherapist and psychoeducator. Some va- storybook readings at the childcare centres. Uschiniichisuu cancies remain to be filled, including the MSDC Awash also held a Special Needs Camp in July An interim coordinator for Administration was nurse (curative & PGM) 1,034 education monitor, nutritionist, psychoeducator, 2017 for children with disabilities. This year saw hired in January 2018 to help the management CHR (individual) 2,269 and Current Services registered nurse. a productive partnership with Disability Ser- team. We experienced a shortage in recall staff, CHR (groups) 0 vice’s regional team, which provided case man- especially in dental services, so we continue Community worker 115 agement training and support as well as ongo- working with HR to refill the recall list with new social worker 0 ing aid to establish a support group in Wemindji replacements. We are also working on training NNADAP worker 208 for parents of children with disabilities. existing employees interested in key areas such Chishaayiyuu as dental, archives and administrative officer/ nurse (pgm & curative) 1,844 technician. footcare nurse 38 CHR (individual) 351 Our housing shortage affects staffing, so many CHR (groups) 2 key positions cannot be posted; the regional Community worker 681 office is working on addressing these housing social worker 0 needs. The unit on Riverside was renovated, homecare (no. of clients) 1,735 but the absence of this four-bed transit for MSDC (attendance) 13,762 much of the year meant we had to use some of MSDC (meals served) 10,762 our units as transits. Local CCIC meetings be- 1. The 0-4 age group (a) is underestimated since newborns are often registered late in the JBNQA beneficiary list; and (b) has been gan in August but we have had difficulty main- corrected using the MSSS 2012-2015 births (+ 2016 estimates) and taining scheduled meetings due to holidays and 2012-2015 MSSS deaths numbers. 2. Does not include 75 Inuit, Métis and/or non-aboriginals. other leaves of team members. “This year we had four triplexes completed, which means we now have 12 apartments for professionals. This should make a big difference to staffing,” says John Mamianskum, the new local director of the Whapmagoostui CMC. “Also, this ᐙᐱᒫᑯᔥᑐᐃ summer we are scheduled to implement our agreement with Minnie’s Hope to provide services for youth and families in need. Our goal is to raise the bar of the standard of services in our community.” awash 0-91 211  11.1% whapmagoostui John Mamianskum Uschiniichisuu 10-29 392 q 0.5% Local Director 1,009 Whapmagoostui CMC Chishaayiyuu 30+ 406 0% TOTAL2 1,009  1.9%

medical EVACUATIONS The Current Services/Chishaayiyuu unit The Awash/Uschiniichisuu team consists of The Administration unit saw the addition of EMERGENCY 35 consists of physicians, nurses, physiothera- community workers, nurses, a social worker, four triplexes, providing twelve new units for scheduled 2,070 pists, occupational therapists, CHRs, commu- an NNADAP worker, a human resources officer, professionals, which helps address housing current services nity workers and social workers. The medical and a community organizer, in addition to visit- and staffing shortages. In addition, four trailer doctors (pgm & clinic) 1,180 staff provides medical care and collaborates in ing general and specialist physicians and other units were converted into additional office visiting specialists 445 administrating preventive, diagnostic and thera- professionals. The team established a formal space: three for CMC support staff and one for other 28 peutic care. The community and social workers agreement with Minnie’s Hope, a social pediat- administration. CCIC meetings have begun. nurse (walk-in clinic) 1,390 offer individual, family and or marital counsel- ric service, to support the community’s youth 96 nurse (refills) 1,794 ling where supportive assistance is required to and families, and collaborative projects with 97 nurse (vaccinations) 257 maintain healthy relationships and to improve Minnie’s Hope will begin this year. The com- awash the quality of life for families. The CHRs offer munity workers evaluate the cases of physical, nurse (pgm & curative) 777 additional support to patients, especially those emotional and mental abuses, provide coun- CHR (individual) 113 with diabetes. selling services, and if necessary recommend CHR (groups) 263 further psychological or psychiatric services. Community worker 89 The NNADAP educates the public on substance social worker 0 abuse and its dangers, and is involved in the Uschiniichisuu care and support for those seeking assistance nurse (curative & PGM) 691 for their addictions. CHR (individual) n/a CHR (groups) n/a Community worker n/a social worker 93 NNADAP worker n/a community worker (addictions) n/a Chishaayiyuu nurse (pgm & curative) 1,469 footcare nurse n/a CHR (individual) 331 CHR (groups) 55 Community worker 19 social worker 93 homecare (no. of clients) n/a MSDC (attendance) 1,286 1. The 0-4 age group (a) is underestimated since newborns are MSDC (meals served) 1,752 often registered late in the JBNQA beneficiary list; and (b) has been corrected using the MSSS 2012-2015 births (+ 2016 estimates) and 2012-2015 MSSS deaths numbers. 2. Does not include 90 Inuit, Métis and/or non-aboriginals. 5 ᐋ ᐅᐦᒋ ᐱᒥᐱᔨᐦᑖᑭᓂᐎᒡ

ᐋᐱᑎᓰᐎᓐ 99 administrative services

ᐅᒋ ᒥᓰᓃᐦᐄᒑᓲᐧᐄᔨᒡ ᒥᓯᐧᐋ The Administrative Services ᐋᐱᑎᓰᔅᑖᐦᒡ ᒑ ᒋ ᐧᐄᒋᐦᐋᑳᓅᐧᐄᔨᒡ Group provides essential ᐋᐱᑎᔑᓲ ᑭᔭ ᒑ ᒋ ᐧᐄᒋᐦᐄᐧᐋᐱᔩᒡ regional support functions to the ᒥᓰᐧᐋ ᐋᐱᑎᓰᐧᐄᓐᐦ᙮ ᐄᔨᔨᐤ organization. It includes Human ᐋᐱᑎᓰᐧᐄᓐ, ᔔᔮᓐᓰᓇᐦᐄᑲᓐᐦ, Resources, Financial Resources, ᓈᓃᑎᐧᐋᐱᐦᒌᑲᓐᐦ, ᒑᐧᑳᓐ ᐋᑦ Information Technology ᒋᔅᑖᐱᑎᐦᒡ ᐋᐱᑎᓰᐧᐄᓂᔨᒡ ᐧᐄᐦᒡ, Resources, Material Resources, ᐧᐋᔅᑳᐦᐄᑳᓐᐦ, ᑭᔮ ᐧᐄᒋᐦᐄᑐᐧᐄᓐ ᐋ which manages our buildings, ᑭᓂᐧᐋᐦᐄᑖᑯᐦᒡ, (ᐅᑕᑯᔒᐧᐄᔨᒡ ᐋᒋᐧᐄᐦᒡ and Wiichihiituwin (formerly Cree ᑭᓂᐧᐋᔨᑖᑯᔒᔨᒡ)᙮ ᐋᓐ ᑏᔭᒋᔅᑮᐧᐋᑦ Patient Services). The AED is ᐅᒋᒫᐤ ᓕᓖᐊᓐ ᑰᐦᕉᓖᐤ ᐃᓯᓂᑳᓲ᙮ Liliane Groleau. CBHSSJB ORGANIGRAM ᐋᑎᔅᑳᑑᐦᒡ ᐋᐱᑎᓰᓲᐐᔨᒡ

Liliane Groleau board of ᐆᒋᒫᐤ ᐋ ᐆᐦᒋ Assistant Executive Director directors ᐱᒥᐱᔨᐦᑖᑭᓄᐎᒡ

executive ᐋᐱᑎᓰᐎᓐ direction MESSAGE FROM THE AED ADMINISTRATIVE SERVICES

The Administrative Services group has a mandate to support­ all sectors of the organization. The professionalism and the nishiiyuu administrative pimuhteheu miyupimaatisiiun dedication of all employees of this group miyupimaatisiiun services are crucial for our ability to provide the best services to clients. In 2017-2018, many projects were successfully realized and I am proud to present you the following report.

100 human resources Liliane Groleau 101 Assistant Executive Director financial Administrative Services resources

information technology resources

material resources

wiichihiituwin (formerly cree patient services) chibougamau chisasibi montreal va l- d’o r ᐄᔨᔨᐤ ᐋᐱᑎᓰᐧᐄᓐᐦ Cree Succession Plan Focus Group HUMAN RESOURCES Chisasibi, November 2017

STAFFING The past year also marked a turning point for OCCUPATIONAL HEALTH AND SAFETY CREE SUCCESSION PLAN The creation of a strong and stable workforce the unit in our collaborative approach with the The Occupational Health and Safety Unit The CBHSSJB is helping employees reach plays an important strategic role in the develop- Finance team and the managers. We worked to- ­promotes a safe workplace environment and personal goals while developing the next ment of the CBHSSJB and its capacity to offer gether closely to review all the positions included supports managers in such issues as workplace generation of leaders through the Cree Suc- quality care. The Staffing Unit continued its in our inventory of positions to optimize its accu- attendance. The unit managed 45 maternity and cession Plan, approved and put in place in fall efforts to meet the CBHSSJB’s ongoing needs racy and ensure it reflects CBHSSJB needs. parental leaves and a total of 185 medical files. 2015. The plan enables JBNQA Beneficiary and and demands. Of the current 2,176 employees, A training was organized for all managers to ex- Indigenous employees who show management 296 new people were recruited from outside the There are still close to 370 vacant positions; plain their responsibilities regarding maintaining potential to bridge educational and skills gaps organization this year. however, given the many new positions created a healthy and safe workplace, ensuring work- in order to qualify for management positions. in the last year, we have succeeded in main- place attendance, and protecting the well-being Three cohorts from a partnership with McGill The Staffing Unit supports the goal of work- taining a stable number of vacant positions. In of all persons in the workplace. University will graduate in the Fall of 2019: 32 force stabilization. This year, close to 150 tem- addition, when seeking to fill a vacant position employees are pursuing an undergraduate porary positions were made permanent, and we must also consider the availability of office HUMAN RESOURCES DEVELOPMENT certificate and 18 employees are studying for a 102 over 80 of these positions were filled with Cree space and housing, areas where the Material The HRD team supported over 250 training graduate diploma, for a total of 50 employees. 103 employees. This process has had a very posi- Resources team has been a great help. activities for a total cost of $2.7 million. A new More employees will be invited to apply to the tive effect on employee recruitment and reten- The Virtuo GPRH Project Phase 2, currently development is the Annual Community Health program in the fall of 2018. tion, and will help teams to improve the quality, Representatives Training, a one-week train- continuity and accessibility of services. in progress, consists mainly of fine tuning HR processes and deploying the application to the ing in Val-d’Or with 45 CHRs in attendance. The COMPENSATION AND BENEFITS AND New development funds from the MSSS managers. Dental Assistant Training Program started in LABOUR RELATIONS helped the organization improve services. In January 2017 in partnership with the Lester B. The Labour Relations Unit advises manag- 2017-2018, over 120 positions were created. Pearson School Board, and fifty employees are ers and employees on collective agreements Furthermore, as this year was the last year of being trained in all nine communities. and meets regularly with both the nurses’ union the current Development Funds agreement, the (FIQ) and the union to which the majority of The HRD team began working on organiza- non-management employees belong (the CSN). unit reviewed all development funds requests tional development issues, including designing to ensure all positions requested were created The local negotiations begin in the coming programs to improve certain aspects of the months. For grievances filed with the CSN, 91 and could be developed shortly. As of March organization. The team has also begun offering 31, close to 105 of all the development posi- were settled and/or withdrawn in the last year, role-consulting services to various managers in and 269 remain active. For those with the FIQ, tions created in 2017-2018 have been filled, and the organization, with the aim of providing them we are working hard to ensure all are filled. 73 grievances were settled and/or withdrawn, with tools to manage a range of issues facing and 109 remain active. their teams. For example, the HRD conducted needs analyses and organizational diagnoses, proposed personalized action plans, and sup- STATUS OF HUMAN RESOURCES ported managers in solving human relations problems. We are also developing a program 2015-2016 2016-2017 2017-2018 % variation to facilitate the integration of new managers; Full-time managers (including interim) 77 83 99 16.2% this program, to be launched in 2018, aims to Full-time regular employees 979 954 1,150 17% enhance support for managers in their first Part-time regular employees 66 72 59 -22% year of service, whether they are newly hired, ­promoted, interim or changing departments. ᔓᐧᐃᔮᓐ ᓈᓂᑑᐦᐙ ᐱᒋᑲᓐ ᐋᐱᑎᓰᐧᐄᓐᐦ ᓈᓂᑑᐦᒋᔅᒑᔨᐦᑎᒧᐎᓐ FINANCIAL INFORMATION TECHNOLOGY RESOURCES RESOURCES

The Financial Resources team led by Denis During 2017-2018, the IT Department pursued its ACCOMPLISHMENTS Tremblay has maintained efforts to improve the mandate of providing quality services to users ●● Replacement of 300 Desktop and 80 quality and efficiency of services. The recruit- by setting up—at the operational and strategic ­laptops under Maintenance of Asset (MOA) ment of experienced staff has helped address levels—effective technology and system solu- in all communities significant needs in the budget process, statis- tions that meet the needs of the organization. ●● Call for tender process for a new intranet tics, the creation of management reports and and electronic document management sys- financial analysis. TEAM tem and new pharmacy information system François Bérubé stepped in as Interim Director ●● Bell Megalink services between Chisasibi In keeping with its objective of reducing the use following the departure of Thomas Ro early in and Whapmagoostui of printed checks, the Accounts Payable Unit 2018. Several new members joined this year, increased the proportion of payments made enabling strengthened service delivery. ●● Waswanipi Robin’s Nest Women’s Shelter by electronic transfer by 7%, for a new total of infrastructure installation 45% of payments made electronically. FUNDING AGREEMENT ●● Eastmain fibre-optic connection 104 The Purchasing Unit is finalizing the installa- The MSSS and CBHSSJB funding agreement ●● Waskaganish fibre-optic connection 105 tion of an electronic ordering system that facili- is ready for final signature by the Cree Nation Government, CBHSSJB and the MSSS, with CHALLENGES FOR THE COMING YEAR tates and ensures the availability of products ●● The replacement of server infrastructure to and equipment in customer service centers. the Executive responsible for the implementa- tion. The department strives to use resources meet increasing demands for processing In order to reduce the cost of purchasing wisely and make good use of public funds. capacity and storage. products, equipment and services, we have ●● The deployment of new province-wide and continued to participate in the Eastern Quebec The IT Department has implemented new ap- organization-level systems such as: proaches to give users more control of routine Supply Group (GACEQ). This exercise is done in ●● Intranet and Electronic Document functions such as password reset. This reduces partnership with our colleagues and clients for ­Management (EDM) system these purchases. the number of calls to the IT Helpdesk. Other solutions will be added to improve the use of ●● Electronic Medical Record (EMR) system The Cree Non-Insured Health Benefits (CNIHB) information technologies in the organization. ●● MSSS Unified integrated system Program has implemented new versions of ●● Hospital Crystal-Net the two financial systems used in to manage These are just some examples of what will the program. These changes are intended to be achieved in the next year. The challenges facilitate the administration of benefits to Cree INCIDENTS AND HELPDESK are not only technological; they also consist Beneficiaries under the JBNQA. Both of the in delivering a service that is targeted to meet systems are web-based and can be accessed the evolving needs of our organization. The IT in all the communities. Department will continue to improve the qual- 4,665 ity of service by streamlining and standardizing 3,094 HELPDESK processes, and it will continue to support all TOTAL REQUESTS INCIDENTS departments’ efforts to improve the quality of services and to meet their Strategic Regional Plan objectives. ᒑᒀᓐ ᐋᐦᐋᐱᑎᒋᔅᑖᑭᓄᐎᔨᒡ ᒑ ᒋ ᒥᔻᐱᑎᔒᓈᓄᐎᔨᒡ MATERIAL RESOURCES

The Material Resources Department (MRD) is CONSTRUCTION PROJECTS OTHER PROJECTS AND ACTIVITIES Numerous other activities were carried out by mandated to create the best possible lodging The MRD’s project management division con- This year, the MRD increased administrative the MRD. Among them: leases for Wiichihiitu- and working environments for clinical, admin- ducted audits of all nine communities, identifying spaces in Whapmagoostui, Waskaganish, win were renewed at the Val-d’Or Hospital and istrative, and other personnel of the CBHSSJB. a building deficit that resulted in supplemen- and Oujé-Bougoumou so that CMC clinical extra office space was negotiated in a separate The MRD maintains 572 lodging units and 49 tary funding of $5.2 million from the Ministry. services could operate more efficiently; some location; the Elders’ home on Opemiska Street clinical and administrative buildings, including The projects carried out on existing buildings installations in Eastmain were also improved. in Oujé-Bougoumou was leased and used the new housing development built through in 2017-18 amounted to almost $1.85 million in In Chisasibi, 12 Maamuu (the old arena) was as transit units; and environmental disinfec- Capital Projects. In 2018, a youth rehabilitation construction costs, and included repairs to the purchased by the CBHSSJB and will be reno- tion trainings consistent with Quebec Ministry facility will be added to the list of buildings. healing centre roof in Oujé-Bougoumou and to vated in 2019 to accommodate the CMC, Youth standards for the CMCs and MSDCs were the HVAC system at Whapmagoostui’s CMC and Protection, Mental Health, and various admin- provided in six communities, which now places The department has acquired sufficient MSDC, the construction of the Nishiiyuu office istration services, including general adminis- the cleaning staff on the same level as the clini- experience to expand into a Project in Chisasibi, and treatment for radon in housing tration, IT, purchasing, and MRD maintenance cal staff in terms of providing Quality Care to Management Office (PMO), with the objective of and the MSDC in Wemindji. services. Once the new hospital is built, clinical users and co-workers. In addition, a construc- 106 spearheading future CBHSSJB capital projects services will be relocated to the new building tion coordinator position was added to project 107 and monitoring the mandates of the professional MEDICAL AND NON-MEDICAL PURCHASES and 12 Maamuu will become the CBHSSJB management operations to ensure proper firms to ensure that the organization’s needs In the non-medical funding framework, the MRD administrative building. The purchase of this supervision, quality control and standardization are respected. The PMO team has three replaced almost $500,000 worth of equipment, building permits the expansion of services at of methodology for all construction projects, professionals—an architect, an engineer and including nine vehicles. The Biomedical Depart- Chisasibi’s existing regional hospital. The MRD and an IT management office and construction an accountant—and was involved in developing ment spent close to $721,000 purchasing new also supports the CBHSSJB in an advisory role division was created. the Functional and Technical Plans for new medical equipment, replacing existing medical with certain files or projects that directly impact CMCs in Oujé-Bougoumou, Waskaganish equipment, and purchasing service contracts the services delivered in any given community; and Whapmagoostui and for the new regional and extended warranties to protect specialized these range from equipment upgrades and hospital in Chisasibi. The PMO has also been medical equipment. This includes (among other major maintenance to floor renewals and the involved with the construction of 129 housing things) emergency transport ventilators for all cleaning of ventilation systems. units and is now working on phase 2 of the nine communities, a patient monitoring sys- housing program. tem for Chisasibi Hospital’s Emergency Room, infusion pumps for the Hospital’s Hemodialysis Clinic, and a multipurpose ultrasound scan- ning system capable of sharing images during ­teleconsultations for the Mistissini CMC.

Signing of agreement between CBHSSJB and Cree Nation of New employee Chisasibi for 12 Maamuu and 48 housing in Chisasibi housing units, March 2018 Client kitchen Espresso Hotel, Montreal

ᐐᒋᐦᐄᑐᐎᓐ WIICHIHIITUWIN

Wiichihiituwin is a very active department with The development and stabilization of human ●● Office hours were increased in order to APPOINTMENTS SERVED the responsibility of coordinating travel, lodg- resources have allowed Wiichihiituwin (formerly provide better support to patients and BY WIICHIHIITUWIN ing, meals, local transportation and medical Cree Patient Services) to review and rethink sev- ­communities 2017-2018 % variation appointments for all clients who are required eral aspects of the services offered, all with the ●● New policy on financial aid for long-term Chibougamau 7,590 8.43% to travel outside the Territory for medical and objective of improving service, accessibility and patients ensures viability of this financial Chisasibi 2,586 19.25% social services that are not available in their cultural safety. In terms of logistics and transport, support Montreal 15,033 13.31% home community. A total of 31,609 patients and a change in the job title of drivers formalizes their ●● Passengers on the CBHSSJB Air Charter Val-d’Or 13,259 4.78% escorts (more than 85 people per day) arrived medical transport responsibility. Drivers in Mon- flights now have tastier and healthier meals. Total 38,468 in one of the four points of service: Chisasibi, treal received training in customer service and The improved menu was a joint effort initi- Val-d’Or, Chibougamau, and Montreal. techniques to assist clients with mobility issues, ated by the NOC and Wiichihiituwin Depart- and new vans were delivered in Montreal. ment, along with the Public Health nutrition- NORTHERN OPERATION CENTRE WIICHIHIITUWIN ARRIVALS FOR ist, Air Creebec and the catering staff. The ●● Expanded air charter services: More daily FURTHER IMPROVEMENTS IN 2017-2018 MEDICAL APPOINTMENTS meal boxes abide by Canada Food Guide flights between Val-d’Or and Chisasibi, and ●● Three new management positions were cre- 108 recommendations more flights with stretchers on board. 109 ated, including a management assistant and ●● Numbers of passengers on CBHSSJB Air two coordinators ●● Cree parents and children staying at +4% the Montreal Children’s Hospital and at Charters continues to increase. ●● A CBHSSJB nurse is now present on all Espresso Hotel will be able to read books chibougamau medical charter flights operated by Air 8,488 in Cree thanks to a book donation by Child CHARTER PASSENGERS val-d’or Creebec and the Northern Operation Centre +4% and Family Services of the Cree Nation 2016-2017 2017-2018 % variation 12,371 (NOC), the internal unit which coordinates Government client transportation 1,620 2,277 40% chisasibi ●● A volunteer committee of long-term Wiichi- 1,862 ●● A nurse is also available to patients lodged +19% hiituwin clients staying at Espresso Hotel or at the CBHSSJB facilities at Espresso Hotel montreal living in Montreal meets once a month. At 8,888 in Montreal the meeting, clients can express themselves total ●● The Wiichihiituwin Department in Val-d’Or, on their experiences and needs, and recom- 31,609 in collaboration with Hôpital de Val-d’Or, mendations follow. Two main recommenda- +6% ­offered English and Cree information ses- tions are that social activities be planned sions on baby care and childbirth for preg- and that an additional kitchen be built. Sarah WIICHIHIITUWIN nant women and their family escorts who Cowboy sits on this committee and Commu- PATIENTS & ESCORTS are in waiting to give birth in Val-d’Or nity Worker Jennifer Russel plans and sub- ●● For the last two years, Alcoholics Anony- mits reports to Helen Shecapio-Blacksmith, mous meetings have been held at Espres- interim Director of Wiichihiituwin so. This centre has now become an official

escorts total AA site, which increases clients’ access to 9,472 arrivals this resource patients 31,609 22,137 ●● A newly-hired Wiichihiituwin Community Worker provides information about Cree Official launch of the Wiichihiituwin Client culture to the centres serving our clientele Lounge at the Robert Kanatewat Airport in Chisasibi, and announcement of improved charter flight schedules May 2017 6

ᐋ ᒥᓯᓈᓱᑦ 111 ᑳ ᐃᔅᐱᔨᑦ ᔔᔮᓐ financial statements Note: In addition to the information presented in this sec- tion, detailed annual financial statements of the Cree Board of Health and Social Services of James Bay (Region 18) are available online through the Ministry of Health and Social Services of Quebec. Download AS-471 for Region 18: http://publications.msss.gouv.qc.ca/msss/document-002116/.

BREAKDOWN OF GROSS EXPENSES BY PROGRAM

Current Exercise Previous Exercise Programs Expenditures % Expenditures % Service Programs Public Health $2,167,016 0.93% $2,548,366 1.16% General Services - Clinical and 13,539,127 5.79% 12,856,892 5.86% Assistance Activities Support for Autonomy of the Elderly 4,038,665 1.73% 3,832,500 1.75% Physical Disability 7,086,340 3.03% 7,191,126 3.28% Intellectual Disability and Autism 44,511 0.02% 56,500 0.03% Spectrum Disorders (ASD) 112 Youth in Difficulty 18,749,442 8.01% 18,698,370 8.52% 113 Dependencies 409,491 0.17% 355,306 0.16% Mental Health 3,342,493 1.43% 2,907,395 1.32% Physical Health 119,882,160 51.25% 111,511,966 50.81% Support Programs Administration 30,838,742 13.18% 25,988,798 11.84% Support to Services 10,098,888 4.32% 10,257,524 4.67% Management of Buildings and Equipment 23,719,288 10.14% 23,265,883 10.60% TOTAL $233,916,163 100.00% $219,470,626 100.00%

BUDGETARY BALANCE

The Cree Board of Health and Social Services Capital funds show a deficit ($1,452,993) due of James Bay (CBHSSJB) shows an operating to depreciation on self-financed projects and funds deficit ($540,973), therefore contravening funds transferred from operating to capital Sections 3 and 4 of the Act to provide for bal- funds to finance medical and non-medical anced budgets in the public health and social equipment purchases as well as construction services network (CQLR, Chapter E-12.0001). projects. Considering the government's Finan- However, the CBHSSJB will use surpluses ac- cial Administration Manual requires capital sub- cumulated in previous years against this deficit. sidy to be accounted for in the year the asset is acquired and depreciation to be accounted for in subsequent years, it is not possible to ­maintain a surplus in capital funds. CBHSSJB CBHSSJB STATEMENT OF OPERATIONS | 31 MARCH 2018 STATEMENT OF OPERATIONS | 31 MARCH 2018

FOR OPERATING FUND

CBHSSJB CBHSSJB STATEMENT OF OPERATIONS -­ OPERATION FUNDS │ 31 MARCH 2018 STATEMENT OF OPERATIONS -­ OPERATION FUNDS │ 31 MARCH 2018

Budget Operations Cur. Yr. Capital Assets Current Year Prior Yr. Total Budget Main activities Incidental activities Total (C2 + C3) Prior year Current Yr. Total C2 + C3 1 2 3 4 5 1 2 3 4 5 REVENUS REVENUS

MSSS Grants 1 233 074 095 231 122 463 8 944 005 240 066 468 229 653 383 MSSS Grants 1 223 242 264 231 122 463 231 122 463 219 905 641 Government of Canada 2 6 175 447 6 702 624 6 702 624 6 468 624 Government of Canada 2 6 175 447 6 702 624 6 702 624 6 468 624 User contributions 3 703 741 788 074 XXXX 788 074 697 771 User contributions 3 703 741 788 074 XXXX 788 074 697 771 Sale of services and recoveries 4 215 324 1 201 184 XXXX 1 201 184 410 854 Sale of services and recoveries 4 215 324 1 201 184 XXXX 1 201 184 410 854 Donations 5 Donations 5 Investment revenue 6 Investment revenue 6 Business revenue 7 Business revenue 7 Gain on disposal 8 23 033 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 11 299 553 390 219 390 219 655 056 Other revenue 11 299 553 263 469 126 750 390 219 655 056 TOTAL (L.01 to L.11) 12 240 468 160 240 204 564 8 944 005 249 148 569 237 908 721 TOTAL (L.01 to L.11) 12 230 636 329 233 375 190 6 829 374 240 204 564 228 137 946

EXPENDITURES EXPENDITURES Salaries, benefits and payroll taxes 13 112 468 647 125 122 714 XXXX 125 122 714 116 118 841 Salaries, benefits and payroll taxes 13 112 468 647 120 088 895 5 033 819 125 122 714 116 118 841 114 Medications 14 10 350 524 12 174 619 XXXX 12 174 619 10 204 598 Medications 14 10 350 524 12 174 619 XXXX 12 174 619 10 204 598 115 Blood products 15 75 000 XXXX 71 963 Blood products 15 75 000 XXXX 71 963 Medical and surgical supplies 16 4 935 308 4 271 492 XXXX 4 271 492 4 288 053 Medical and surgical supplies 16 4 935 308 4 271 492 XXXX 4 271 492 4 288 053 Food products 17 753 879 782 975 XXXX 782 975 691 726 Food products 17 753 879 782 975 XXXX 782 975 691 726 Honoraria paid to non-­instutional resources 18 XXXX Honoraria paid to non-­instutional resources 18 XXXX Financial charges 19 5 261 181 1 399 661 4 093 679 5 493 340 5 063 418 Financial charges 19 1 000 000 1 399 661 XXXX 1 399 661 811 996 Maintenance and repairs 20 2 515 355 2 858 679 2 858 679 2 808 432 Maintenance and repairs, including non-­capital costs 20 2 515 355 2 858 639 40 2 858 679 2 808 432 Bad debt 21 XXXX related to capital assets Rent 22 7 957 029 7 101 515 XXXX 7 101 515 6 690 494 Bad debt 21 Capital asset depreciation 23 5 570 650 XXXX 6 303 319 6 303 319 6 269 307 Rent 22 7 957 029 7 082 868 18 647 7 101 515 6 690 494

Loss on disposal of capital assets 24 XXXX Transfer expenses 23 Transfer expenses 25 XXXX Other expenditures 24 90 580 587 85 257 014 1 776 868 87 033 882 84 575 778 26 XXXX XXXX XXXX XXXX XXXX TOTAL (L.13 to L.24) 25 230 636 329 233 916 163 6 829 374 240 745 537 226 261 881 Other expenditures 27 90 580 587 87 033 882 87 033 882 84 575 778 TOTAL (L.13 to L.27) 28 240 468 160 240 745 537 10 396 998 251 142 535 236 782 610 SURPLUS (DEFICIT) OF THE YEAR (L.12 -­ L.25) 26 0 (540 973) 0 (540 973) 1 876 065

SURPLUS (DEFICIT) OF THE YEAR (L.12 -­ L.28) 29 0 (540 973) (1 452 993) (1 993 966) 1 126 111 CBHSSJB CBHSSJB STATEMENT OF ACCUMULATED SURPLUS (DEFICIT) | 31 MARCH 2018 STATEMENT OF FINANCIAL POSITION | 31 MARCH 2018

CBHSSJB CBHSSJB STATEMENT OF ACCUMULATED SURPLUS (DEFICIT) -­ ALL FUNDS │ 31 MARCH 2018 STATEMENT OF FINANCIAL POSITION -­ ALL FUNDS│ 31 MARCH 2018

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

ACCUMULATED SURPLUS (DEFICIT) BEGINNING OF Cash on hand (overdraft) 1 10 856 671 10 856 671 3 282 730 1 38 024 080 6 884 894 44 908 974 43 782 863 YEAR, ALREADY ESTABLISHED Short-­term investments 2 Accounting changes with prior year restatement (specify) 2 Receivables -­ MSSS 3 178 216 271 1 129 624 179 345 895 132 994 526 Other receivables 4 3 412 584 3 412 584 4 594 883 Accounting changes without prior year restatement (specify) 3 XXXX Cash advances to public institution 5 XXXX ACCUMULATED SURPLUS (DEFICIT) BEGINNING 4 38 024 080 6 884 894 44 908 974 43 782 863 Interfund receivables (payables) 6 6 865 140 (6 865 140) 0 ADJUSTED (L.01 to L.03) Grant receivable (deferred grants) -­ accounting reform 7 5 620 243 (20 396 858) (14 776 615) (13 908 769)

SURPLUS (DEFICIT) FOR THE YEAR 5 (540 973) (1 452 993) (1 993 966) 1 126 111 Portfolio investments 8 Other changes: Inter-­institution transfers (specify) 6 Deferred debt issuance costs 9 XXXX Interfund transfers (specify) 7 (19 973 151) 19 973 151 0 10 XXXX XXXX XXXX XXXX Other items applicable to private establishments under 8 XXXX Assets held for sale 11 XXXX agreement (specify) Other items 12 2 241 978 1 497 542 3 739 520 4 203 879 9 XXXX XXXX XXXX XXXX TOTAL FINANCIAL ASSETS (L1 to L12) 13 207 212 887 (24 634 832) 182 578 055 131 167 249 TOTAL OTHER CHANGES (L.06 to L.09) 10 (19 973 151) 19 973 151

LIABILITIES ACCUMULATED SURPLUS (DEFICIT) END OF YEAR 11 17 509 956 25 405 052 42 915 008 44 908 974 Short-­term debt 14 145 307 969 33 091 585 178 399 554 86 655 609 (L.04+ L.05 + L.10) Accounts payable -­ MSSS 15 116 Consisting of the following: External restrictions 12 XXXX XXXX 117 Internal restrictions 13 XXXX XXXX 5 485 995 4 927 151 Other accounts payable and accruals 16 29 871 285 29 871 285 20 119 251 Unrestricted balance (L.11 -­ L.12 -­ L.13) 14 XXXX XXXX 37 429 013 39 981 823 Cash advances -­ decentralized envelopes 17 XXXX TOTAL (L.12 to L.14) 15 XXXX XXXX 42 915 008 44 908 974 Accrued interest payable 18 194 109 1 129 624 1 323 733 1 259 094

Deferred revenue 19 8 182 280 8 182 280 8 126 930

20 XXXX XXXX XXXX XXXX

Long-­term debts 21 XXXX 99 418 369 99 418 369 103 823 790

Liability for contaminated sites 22 XXXX Liability for employee future benefits 23 8 892 839 XXXX 8 892 839 7 725 764

24 XXXX XXXX XXXX XXXX

Other items 25 667 801 1 497 542 2 165 343 2 546 722 TOTAL LIABILITIES (L.14 to L.25) 26 193 116 283 135 137 120 328 253 403 230 257 160

NET FINANCIAL ASSETS (NET DEBT) (L.13 -­ L.26) 27 14 096 604 (159 771 952) (145 675 348) (99 089 911)

NON FINANCIAL ASSETS Capital assets 28 XXXX 185 177 004 185 177 004 141 275 141 Supply inventory 29 1 686 076 XXXX 1 686 076 1 431 429 Prepaid expenses 30 1 727 276 1 727 276 1 292 315 TOTAL NON FINANCIAL ASSETS (L.28 to L.30) 31 3 413 352 185 177 004 188 590 356 143 998 885

SHARE CAPITAL AND CONTRIBUTED SURPLUS 32 XXXX ACCUMULATED SURPLUS (DEFICIT) 33 17 509 956 25 405 052 42 915 008 44 908 974 CBHSSJB CBHSSJB STATEMENT OF VARIANCE OF NET FINANCIAL ASSETS/DEBTS | 31 MARCH 2018 CASH FLOW STATEMENT | 31 MARCH 2018

CBHSSJB CBHSSJB STATEMENT OF VARIANCE OF NET FINANCIAL ASSETS/DEBTS │ 31 MARCH 2018 STATEMENT OF FINANCIAL POSITION -­ ALL FUNDS│ 31 MARCH 2018

Budget General Fund Capital Assets Total Current Yr. Total Prior Yr. FUND General Capital assets Current Year Total Prior Yr. Total Fund (C2+C3) (C1+C2)

1 2 3 4 1 2 3 4 5 FINANCIAL ASSETS Cash on hand (overdraft) 1 10 856 671 10 856 671 3 282 730 NET FINANCIAL ASSETS (NET Short-­term investments 2 1 35 300 336 (134 390 247) (99 089 911) (99 642 647) DEBT) BEGINNING ALREADY ESTABLISHED Receivables -­ MSSS 3 178 216 271 1 129 624 179 345 895 132 994 526 Accounting changes with prior year restatement 2 Other receivables 4 3 412 584 3 412 584 4 594 883 Cash advances to public institution 5 XXXX Accounting changes without prior year restatement 3 XXXX Interfund receivables (payables) 6 6 865 140 (6 865 140) 0 NET FINANCIAL ASSETS (NET DEBT) BEGINNING 4 35 300 336 (134 390 247) (99 089 911) (99 642 647) Grant receivable (deferred grants) -­ accounting reform 7 5 620 243 (20 396 858) (14 776 615) (13 908 769) ADJUSTED (L.01 to L.03) SURPLUS (DEFICIT) FOR THE YEAR (P.200, L.29) 5 (540 973) (1 452 993) (1 993 966) 1 126 111 Portfolio investments 8 VARIANCE DUE TO CAPITAL ASSETS: Acquisitions 6 XXXX (50 205 182) (50 205 182) (6 184 411) Deferred debt issuance costs 9 XXXX Annual depreciation 7 XXXX 6 303 319 6 303 319 6 269 307 10 XXXX XXXX XXXX XXXX Gain/loss on disposal of assets 8 XXXX (23 033) Assets held for sale 11 XXXX Proceeds of disposition 9 XXXX 50 000 Other items 12 2 241 978 1 497 542 3 739 520 4 203 879 Bad debts 10 XXXX TOTAL FINANCIAL ASSETS (L1 to L12) 13 207 212 887 (24 634 832) 182 578 055 131 167 249 Capital asset adjustments 11 XXXX 12 XXXX XXXX XXXX XXXX XXXX LIABILITIES 13 XXXX XXXX XXXX XXXX XXXX Short-­term debt 14 145 307 969 33 091 585 178 399 554 86 655 609 TOTAL VARIANCE DUE TO CAPITAL ASSETS Accounts payable -­ MSSS 15 118 14 XXXX (43 901 863) (43 901 863) 111 863 119 (L.06 to L.13) Other accounts payable and accruals 16 29 871 285 29 871 285 20 119 251 VARIANCE DUE TO SUPPLY INVENTORY AND PREPAID EXPENSES: 15 (9 761 807) XXXX (9 761 807) (8 792 701) Cash advances -­ decentralized envelopes 17 XXXX

Acquisition of supply inventory Accrued interest payable 18 194 109 1 129 624 1 323 733 1 259 094 Acquisition of prepaid expenses 16 (1 752 443) (1 752 443) (1 304 515) Deferred revenue 19 8 182 280 8 182 280 8 126 930 Use of supply inventory 17 9 507 160 XXXX 9 507 160 8 632 386

20 XXXX XXXX XXXX XXXX Use of prepaid expenses 18 1 317 382 1 317 382 779 592 Long-­term debts 21 XXXX 99 418 369 99 418 369 103 823 790 TOTAL VARIANCE DUE TO SUPPLY INVENTORY 19 (689 608) (689 608) (685 238) AND PREPAID EXPENSES (L.15 to L.18) Liability for contaminated sites 22 XXXX Liability for employee future benefits 23 8 892 839 XXXX 8 892 839 7 725 764

Other variance in accumulated surplus (deficit) 20 (19 973 151) 19 973 151 0 24 XXXX XXXX XXXX XXXX Other items 25 667 801 1 497 542 2 165 343 2 546 722 INCREASE (DECREASE) IN NET FINANCIAL ASSETS TOTAL LIABILITIES (L.14 to L.25) 26 193 116 283 135 137 120 328 253 403 230 257 160 21 (21 203 732) (25 381 705) (46 585 437) 552 736 (NET DEBT) (L.05 + L.14 + L.19 + L.20)

NET FINANCIAL ASSETS (NET DEBT) (L.13 -­ L.26) 27 14 096 604 (159 771 952) (145 675 348) (99 089 911) NET FINANCIAL ASSETS (NET DEBT) 22 14 096 604 (159 771 952) (145 675 348) (99 089 911) END OF YEAR (L.04 + L.21) NON FINANCIAL ASSETS Capital assets 28 XXXX 185 177 004 185 177 004 141 275 141 Supply inventory 29 1 686 076 XXXX 1 686 076 1 431 429 Prepaid expenses 30 1 727 276 1 727 276 1 292 315 TOTAL NON FINANCIAL ASSETS (L.28 to L.30) 31 3 413 352 185 177 004 188 590 356 143 998 885

SHARE CAPITAL AND CONTRIBUTED SURPLUS 32 XXXX ACCUMULATED SURPLUS (DEFICIT) 33 17 509 956 25 405 052 42 915 008 44 908 974 CBHSSJB CBHSSJB CASH FLOW STATEMENT (CONT’D) | 31 MARCH 2018 CASH FLOW STATEMENT (CONT’D) | 31 MARCH 2018

CBHSSJB CBHSSJB CASH FLOW STATEMENT (CONT'D) │ 31 MARCH 2018 CASH FLOW STATEMENT (CONT'D) │ 31 MARCH 2018

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 (46 351 369) (13 477 928) Long-­term debts -­ Debts repaid 2 Other receivables 2 1 182 299 (2 036 488) Capitalization of discounts and premium on debt instruments 3 Cash advances to public institutions 3 Variance of short-­term debts -­ generated fund 4 62 300 000 16 007 969 Grant receivable -­ accounting reform -­ employee future benefits 4 150 522 Short-­term debts incurred -­ capital asset fund 5 30 606 174 3 674 960 Deferred debt issuance costs 5 Short-­term debts repaid -­ capital asset fund 6 Other assets 6 464 359 600 755 Variance from government sinking fund 7 Accounts payable -­ MSSS 7 Other (specify P297) 8 Other accounts payable and accruals 8 6 808 079 (4 485 993) CASH FLOW RELATED TO FINANCING ACTIVITIES (L.01 to L.08) 9 92 906 174 19 682 929 Cash advances -­ decentralized envelopes 9 Accrued interest payable 10 64 639 1 222 Deferred revenue 11 55 350 (536 596)

INCREASE (DECREASE) IN CASH AND CASH EQUIVALENTS (P.208-­00, L.16 + L.19 + L.24 + P.208-­01, L.09) 10 7 573 941 (4 576 474) Liability for contaminated sites 12 Liability for employee future benefits 13 1 167 075 1 091 150 Other liability items 14 (381 379) (418 172)

CASH AND CASH EQUIVALENTS, BEGINNING OF YEAR 11 3 282 730 7 859 204 TOTAL VARIANCE OF FINANCIAL ASSETS AND LIABILITIES RELATED TO OPERATION (L.01 to L.14) 15 (36 840 425) (19 262 050)

OTHER INFORMATION: 120 CASH AND CASH EQUIVALENTS, END OF YEAR (L.10 + L.11) 12 10 856 671 3 282 730 Capital asset acquisitions included in accounts payable as at March 31 16 3 854 883 910 928 121 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 (3 688 097) (5 496 320)

Cash on hand 13 10 856 671 3 282 730 INTEREST: Short-­term investments with a maturity not exceeding three months 14 TOTAL (L.13 + L.14) 15 10 856 671 3 282 730 Creditor interest (revenue) 19 Interest received (revenue) 20 Interest received (expenses) 21 5 493 340 5 063 418 Interest spent (expenses) 22 1 870 857 772 762 ᐋᒋᐦᒋᔅᒋᑐᐙᑲᓅᐐᔨᒡ ᐋᓂᒌ ᔖᔥ ᑳ ᒫᒋᔩᐦᒡ IN MEMORIAM

ᐋᐃᐱᓪ ᑭᒋᓐ Abel Kitchen ᑭᕃᑖ ᓓᐄᑆᐦᐄ Greta Lameboy ᓰᒸᓐ ᐯᕐᓈᕐ-ᓓᐄᑆᐦᐄ Simone Bernard-Lameboy

ᐙᔅᐙᓂᐲ ᐄᔨᔨᐤ ᐋᐃᐱᓪ ᑭᐦᒋᓐ ᒌ ᐐᑎᐦᐱᒪᐤ ᑳ ᒫᒨᐱᒡ ᓂᔒᔫ᙮ Abel S. Kitchen of Waswanipi was a member of the Nishiiyuu Council of Elders. 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

Cree Board of Health and Social Services of James Bay Box 250, Chisasibi, QC J0M 1E0 [email protected] | www.creehealth.org Follow @creehealth on Facebook, Instagram, Twitter and LinkedIn