Bearskin & Dumont: Cree Heallh Board 123

THE CREE BOARD OF HEALTH AND SOCIAL SERVICES OF JAMES BAY: THE FIRST TWELVE YEARS -1978-1990

Stephen Bearskin and Charles Dumont

Cree Board of Health and Social Services of James Bay, Chisasibi, Quebec, Canada

The Cree Board of Health and Social Services of Gray Nuns opened a hospital in Chisasibi. James Bay is a Cree organization which as it's name After World War II the federal government suggests takes care of the health and the social started building nursing stations in most villages. In services for the Cree of James Bay in Northern most nursing stations there was a nurse who was Quebec. providing health care. There are presently about 9,000 Cree living on the In 1962, the Quebec pemment started to be James Bay territory. They are spread among nine more interested in the area and began to provide communities which can be seen on the map. Five funds for a hospital in Chisasibi and Social Aid communities are along the coast of James Bay and progralllli for both Indians, and non-status Indians. Hudson'sBayandfourcommunitiesareinland(Fig­ By 1971 there were at least four government de­ UJC 1). partments involved in health care for the James Bay The James Bay territory has been inhabited for 2 Cree: the Department of National Health and Wel­ to 3 thousand years before the arrival of Europeans fare, the Department of Indian Affairs, the Quebec· (1). With the arrival of the Europeans, the James Department of Health and the Department of Nat­ Bay Cree became involved in the fur trade (2). Tra­ ural Resources. Needless to say, the activities of all ditionally Cree are hunters and trappers living off these departments were not always coordinated and the land. However, there have been many changes there was often a rivalry between them. in recent years in Cree society, as Cree have had In the spring of 1971 the pernment of Quebec more contact with non-native technology and values. made public its intention to develop hydro-electric Cree tend to spend more time in the settlement than resources in the James Bay area. After various legal in the past to access opportunities for education, proceedings the Quebec government agreed to ne­ health care and employment. The traditional values gotiate with the Cree. This negociation led to the and activities are still of great importance despite signing of the James Bay and Nortbem Quebec the influence by non-native contact. Agreement in 1975. Prior to the 20th century, most health care was Part of this agreement deals with health and social traditional although some sources were sporadically services. During those negotiations the Cree wanted provided by European missionaries or merchants. 1) to be able to run their own health services and 2) In the 1920's a physician accompanied the ship that to have access to the same health services as the brought supplies to the communities of James Bay other Quebecers and Canadians. and Hudson's Bay. In the 1930's the Oblates and the In April 1978 the Cree Board of Health and Social Services of James Bay was created by the Quebec Figure 1. pemment. This Board had the mandate of any regional health board in Quebec as well as the man­ date to manage directly its health and social services in the James Bay Cree territory. The transfer of jurisdiction of existing health care facilities to the Cree Health Board was not easy. The Cree had to undertake legal proceedin~ and take political action to avoid a transfer of responsibilities without the concomitant transfer of resources, and so ensure adequate funding of the services that were required. There was an attempt to put the Cree Board of Health under trusteeship in 1980. Regionalization of health administration in the North was a new experience in Quebec and the

; lllllSTISSINI. administrators of the Cree Health Board had to face jOWflklu:iol.a.oJ. a considerable amount of mistrust from the Quebec ,""5~. pemment which provided most of its funding. \ Even recently a Quebec pernment representative bas taken the position that all the health tcsearch of the Cree Board of Health must be ~ by a Montreal hospital. This is obviously contraiy to the 124 Hea/Jh services Jelivoy

Figure 2. Cree Board of Health and Social Services

BOARD OF DIRECTORS ------1 C.M.D.P. I

GENERAL MANAGEMENT

HEALTH AND SOCIAL ADMINISTRATIVE P.P.C.R.G.S SERVICES SERVICES SERVICES

AUXUARV SERVICES Pl.ANNINGl'ROORAMMNG HUMAN RESOURCES ~TION FINANCE RESEARCH GEJERAL SECRETARIAT

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James Bay and Northern Quebec Agreement. fonn communication services such as the produc­ The organization of the Cree Board of Health is tion of audio-visual material. defined in general terms in the James Bay and The Regional Hcspital Center is a 32 bed general Northern Quebec Agrecmenl The agreement spec­ hcspital providing obstetric services, minor swgeq, ifies that Cree are to manage their own health ser­ general pediatric care, general medical care and vices. This is the reason for creating the Cree Board dentistty. It bas radiology, laboratoiy, and elcctn>­ of Health and Social Services of James Bay. The cardiographic services. The Local Community Ser­ organi7.ation chart of the Board has evolved some­ vice Centers arc administrative structures wbidl what since its cn:ation in 1978 (Figure 2). oversee the health and social services given in the There are representatives from each Cree commu­ various villages. The LI>cal Community Service Cca­ nity on the board. There are also representatives ters provide primaty care and public health serviceS from the clinical and non-dinical staff, one from the by nurses and physicians. Hcspitali7.ation is done Cree Regional Authority and one representative either in Cbisasibi, Cbtl>ougoumou, Val d'Or or from the Department of Community Health of the Montreal depending on the nature of the c-. Montreal General hospital. This Board detennines There are also some specialists who visit the com­ the general orientation and oversees the functioning munities. These specialists will come from Val d'Or and performance of the Cree Health Board. The or Montreal. health and social service mandate includes the So­ The same thing could be said about the Social cial Service Center, the CoastaJ Local Community Service Center which is a grouping of spcciali7.ed Service Center, the Inland Local Community Ser­ social services. vice Center and the Regional Hcspital Centre. Most of the primaty care is provided by commu· There are also some other relevant structures such nity workers in the community themselves. They as the Council of physicians, dentists and offer counselling to individuals in the community pbamacists, which will give recommendations to the and offer school social services. There are home cate Board on technical matters and on the hiring of workers who offer assistance to elderly or handi­ certain categories of professionals. There is also the capped persons. Internal Management Committee which is made of There are other programs such as NADAP (a all the senior managers of the Cree Health Board, Federal program to prevent drug and alcohol who oversee the day to day operations of the Board. abuse), youth protection, adoptions, placement oC Administrative services include support services persons in foster home or centers, and group homes such as rmance, personnel, kitchen, maintenance, for the youth. Social Services arc provided primarily etc. Plannin& programming, rcscan:h, communica­ by Cree who have been trained on the job. Then: are tion and general secretariat are most similar to a also some non-Cree social service professionals. regional health Board in Southern Quebec. Its man­ Initially, all services were managed directly by the date is to anticipate future developments to ensure Cree Health Board in Cbisasibi. However, with the that all required resean:h is carried out and to per- distances involved and an emerging expanded strUC· Beanlcin & Dumont: Cree Heablr &-a 125 ture it became more difficult to continue this direct to get to know how such an organization functions management. Management was thus decentralized and to integrate it smoothly into their society. In· to the CL5Cs. deed it is even felt by many Cree to be a non-Cree After twelve years of experience, what lessons entity. have we learned? Other problems mentioned by Cree arc problems The fact that the Cree Board of Health is con­ of confidentiality. Many persons complain that in­ trolled by Cree has had a significant impact on formation given confidentially circulates freely in health policies and priorities. In addition many more the community. Difficulties with confidentiality are Cree have become knowledgeable about the way problems everywhere, even in large cities. However that health services are given. in a small communitywhere everybody knows every­ It is easier for a Board controlled by Cree to give body, it can be even more damaging to reputations priority to Cree personel when positions become and cause tensions between people. available. This means more money circulating in the Another problem that has been solved only par­ community. Thus the Cree Health Board has also an tially is the problem of medical care of Cree who economic impact on the community. have left the territory voluntarily. These persons The agreement guaranteed funding to provide must often go through a number of bureaucratic non insured services that other Native people in hassles to obtain certain types of services which are Canada are entitled to and also the same services as not COYCred by the provincial health care program. all other Quebecois. This guarantee has turned out With a few exceptions non resident employees do to be crucial in the negotiations with the government not stay long in James Bay. This means that many of to obtain adequate funding. them do not have time to get to know their job well This has not occurred without difficulty. There or to know the Cree well. Often they do not stay long were many challenges that had to be faced and many enough to see the impact of their work. They may problems to solve. Many problems have yet to be leave with the frustrating impression that they have solved. worked for nothing, not realizing that changes take The first challenge that faced the Cree Health time to happen. Rapid turnover of personnel means Board was to have the various levels of government also that the non-resident personnel spend a signif­ accept their obligations coming from the James Bay icant part of their time north training rather than and Northern Quebec Agreement. As previously working. Notwithstanding all the other repercus­ stated, it was often felt that government transferred sions, this has a significant impact on the cost of the responsibilities to the Cree without giving them running the health board. appropriate resources. Service provision in the There are also often subtle unofficial negociations north is much more costly than in the south because for the sharing of power between Cree and non­ of distances and isolation involved. It is also more Cree within the Cree Board of Health organisation. costly because of the high turnover of personnel. The Cree Health Board is also challenged by re· This high tumoYCr has an even greater impact be­ cent changes in Cree society. These changes have cause any person hired from the south has to have brought with them many new health problems, heart an orientation period before this person can func­ disease, diabetes, diseases of the thyroid gland, sub­ tion adequately. The northern milieu is different stance abuse, etc.. SOcially, culturally and geographically from what he The problems and challenges tmt the Cree Health or she is used to. These high costs have not always Board faces in the next ten :years are enormous. been fully recognized by the governments. GOYCrnments and other southern organizations can Although there arc a number of Cree who hold key be partners but the solution to these probletns must positions within the Cree Health Board there are lie with the Cree. not enough of them. This can be explained by the following facts. There are no role models among the REFERENCES Cree. The level of schooling among Cree is not as high as it is in affluent southern urban areas. 1. Administntion rigiooale Cric. La s,nt.bCle m:h(ologiquc et ethnobiotorique du Compleiae La Grande, 1985. The Cree Health Board is a new entity not only for the government but also for the Cree. It is distant 2. Francis 0, Monntz T. Partners in fur: a history of fur trade in eaotern James Bay 1600-1870. Montteal: from the traditional organizations that the Cree are Mc:Gill-Ot-.•s University Press. 1983. used to. So enough time must be given for the Cree