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Vancouver Island families discuss governance, relationships and health transformation in Snuneymuxw territory

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From April 18-20, 2018, political and health representatives from the three Island families—Kwakwaka'wakw, Nuu-chah-nulth and Coast Salish—gathered in Snuneymuxw territory for Vancouver Island Spring Regional Caucus. The three days of community engagement were attended by 112 delegates, including 32 political leads, 27 health leads and nine social leads.

Snuneymuxw Elder Eleanor White opened day one in a good way with prayer and a welcome to the territory and Bill Cranmer ('Namgis), Corner Post for the Vancouver Island Region, shared words in Kwa'kwala and a song to the Creator "to give us wisdom in our work."

FNHA service and program updates 

The first day of Caucus was dedicated to health services and programming offered through FNHA, and partnership work ​with the provincial and federal government.

A panel of FNHA leaders were called on to present on the updates.

Richard Jock, Chief Operating Officer, presented a snapshot of the FNHA's 2018/2019 Summary Service Plan, which outlines the organization's goals and priorities for the following year. Richard also went over budget highlights for 2018.

Text-based technology was then used to survey Caucus delegates on their priorities for funding allocations. Top priorities were:  

​• 55% Addictions Workers

• 25% Home Care Nurses

• 16% Nursing Increases

•​ 4% Accreditation

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Chief Nursing Officer Dr. Becky Palmer also shared that FNHA is currently developing a Nurse Practitioner model of service delivery in partnership with NPs and communities in each region.

Devi Goberdhan, Director of First Nations Health Benefits Operations and Darren McKnight, Director of Health Benefits Management then presented on PharmaCare Plan W and FNHA Health Benefits. Darren shared lessons learned on the transition, noting primarily that the Health Benefits support line required more adequate resources and that better communications were needed throughout the transition.

Ultimately, both Directors noted the importance of community engagement sessions, like Caucus, to support their team to do better in future.

Mental health and wellness and overdose response

A presentation on Mental Health and Wellness and implementation of Jordan's Principle was led by Sonia Isaac-Mann, FNHA VP, Programs and Services. Allan Campbell, Project Manager for the Vancouver Island Regional Team and Lisa Murphy, a Director at Island Health Cowichan North, then joined Sonia for a presentation on Opioid Emergency Response.

Sonia shared information on the Indigenous Harm Reduction Grants initiative that support community-driven, Nation-based responses to the overdose crisis. The initiative was so successful that they increased funding allotments to support 13 projects on the Island.

Allan spoke on the regional implementation of overdose crisis response, noting some of the challenges identified in the region. He then outlined what his team's immediate actions will be, such as establishing a Regional Mental Health & Wellness Team.

Lisa presented on Island Health's Substance Use Continuum of Care, and the provincial opioid response structure. She noted, however, that not all communities have local support. Her team is currently seeking input on how to best partner with communities on this crisis.

Renewing the VI Regional Health and Wellness Plan

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The next presentation was from Vancouver Island Regional Director Brennan MacDonald on the renewal of the VI Regional Health and Wellness Plan. As the region updates the plan, Brennan shared some of the findings from engagement with Island families, noting that her team is taking extra time to integrate community recommendations moving forward.

The plan is "the voice of our leadership on how we assert our voices on health and wellness," she said, so it's important to get it right. The draft progress report was shared with delegates, with a revised plan to be reviewed in May.

Leadership dialogue

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The room was opened up to Island families for response and dialogue on the presentations.

The most discussed theme of the engagement session was the transition to PharmaCare Plan W, with a number of leaders voicing concerns with communication about the transition, and raising issue with the complexity of processing certain benefits items. Devi Goberdhan and Darren McKnight thanked the speakers and emphasized that their team is always looking to identify where they can improve processes or fix provider issues.

Another theme of the discussion was the need for improved primary care in community and greater attachment rates to family physicians. It was noted that lack of attachment can also prevent proper diagnosis, especially when it comes to mental health support.

Partnership work on Vancouver Island

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The final presentation of the day was on partnership work between FNHA and Island Health.

Ian Knipe, Director of Aboriginal Health presented on current collaborative projects between FNHA and Island Health, like the Kwakwaka'wakw Maternal Child Health project, which expands birth services in the North Island, and a recent cleansing ceremony that took place at Tofino General Hospital.

FNHA's Eyrin Tedesco then discussed FNHA's Primary Care++ model as a path toward primary care that better meets community needs. This new model will include oral health and traditional wellness supports, which are not typically included in primary care.

FNHDA mentorship circle dinner

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In the evening, the FNHDA held a mentorship dinner to discuss Health Director best practices and the Strategic Plan, hosted by Board Members Vanessa Charlong (Hupacasath First Nation) and Jennifer Jones (Cowichan Tribes).

Following dinner, Georgia Cook, Board Member and Health Director for 'Namgis First Nation shared a video on Kwakwalatsi Child and Family Services in Alert Bay, where no child has entered care since 2007. 'Namgis has adopted a strengths-based system to ensure that children and family are supported within the community.

The group then convened to review the goals and objectives of the 2015-2018 Strategic Plan to ensure that all goals remain relevant and to discuss emerging priorities. Members agreed that Community Health and Wellness Planning; Certification; Training; and the Head-to-Heart Campaign were initiatives of priority.

Day two: leadership discussion and cultural sharing

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[During lunch hour, dancers from Ahousaht, from infants to Elders, shared their culture.]

Day two was opened with prayer by Interim Elder Advisor Wickaninnish Cliff Atleo and chaired by FNHC representatives Nick Chowdhury (Da'naxda'xw/Awaetlala First Nation) and Paul Sam (Tsartlip First Nation). Day two was dedicated to health governance discussions.

Island families voiced concern regarding governance processes in relation to the Social Determinants of Health Strategy, expressing a need for greater transparency in the development and application of the document. While most delegates agreed that it was important to pursue actions related to the social determinants of health, some communities wanted further engagement in the development of the priorities. Regarding these concerns, the agenda was amended to remove any sessions referencing Nation-to-Nation work, creating more time for leadership dialogue.

Leadership dialogue included an in-camera session held privately for political and health leads and regional FNHA staff to discuss key health priorities. Seven recommendations for future caucus engagement came out of the session.

FNHDA Board Members Georgia Cook, Vanessa Charlong and Jennifer Jones presented on Health Directors perspectives on the social determinants of health. Georgia Cook shared that "the purpose of the social determinants of health is to become whole again," but noted that Health Directors need the support of leadership on these journeys. Jennifer Jones echoed her sentiment, and expressed that the path to better health is to work together as partners and communities.

Nick Chowdhury, Paul Sam and Eunice Joe, FNHA Regional Manager for Vancouver Island, also presented on the Island families' priorities for mental health and wellness and the FNHC's proposal for a tripartite partnership on mental health and wellness to leverage long-term, flexible funding for First Nations in BC.

The day ended with tabletop discussion on the mental health and wellness proposal to identify opportunities and next steps.

Day three: united through culture

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Day three opened with cultural sharing from Gwa'sala 'Nakwaxda'xw Nation, where youth from kindergarten to grade seven learn traditional songs and dances. Gwa'sala 'Nakwaxda'xw Chief, Paddy Walkus, stood and acknowledged the hard work of the young dancers. "Cultural genocide was real in our communities," he said, but he shared the hope and pride he feels when he sees youth upholding culture and traditions for future generations.

Vancouver-Island-Spring-Caucus-2018-3.jpgCliff Atleo also provided opening words for the day, acknowledging in particular the leadership of the Snuneymuxw people and the respect they demonstrated as hosts.

Next steps for VI Caucus

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A final discussion was held to gather feedback on Caucus processes and next steps. The major themes were collected through text engagement. Findings included a desire for greater engagement in the processes and planning of Caucus sessions; greater communication with communities as well as increased communication between regions; and to emphasize culture, traditional wellness and Indigenous knowledge keepers within the agenda.

Finally, as Living Marker for the region, Jennifer Smith provided closing remarks. "What did I see?" asked Jenn. "I saw leadership." She noted that while Island families voiced concerns and didn't always see eye-to-eye, that the end goal is the same and that "we're going to get it right together."

The day ended with Cliff Atleo asking all Nuu-chah-nulth family members to join in closing the day in song.

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