TO HAVE AND TO HAVE NOT
Moosonee and Moose Factory are historic northern neighbours
separated only by a bit of open water. But that's where the
similarity ends. One community is thriving and being given
excellent health care. The other is not.
Guess which of the two is a native reserve
By JOHN STACKHOUSE
Monday, November 12, 2001 Print Edition, Page A10
Rheal Cool steers his old Suburban down the dusty main street of Moosonee and shows a visitor some highlights: an aging hockey arena, a train station so inadequate, he says, that summer tourists have to walk like cattle across the tracks and, in every direction, potholes.
"Excuse the dust," the mayor says, rolling up his window to block the sand particles that arrive every spring with the predictability, and force, of black flies. "You can imagine what this does to people's lungs, especially little children."
Mayor Cool would like to say more about the state of health in Moosonee, but he won't. He knows that in these parts, near the southern tip of James Bay, nothing is more politically explosive than the great hospital fight, because nothing so exposes the 330-year-old divide here between natives and whites.
Across the placid Moose River, which rises and falls with the day's tides, is the region's major hospital, built on the island native reserve of Moose Factory. The region's only doctors, all non-native, are usually over there too, as are most of the tourist attractions.
Cool was elected last year to win a few things for his own struggling community, but so far the fight has been a losing one. His request to the province for a doctor to serve the 2,600 people of Moosonee has been ignored.
And now the hope for a new $30-million regional hospital is pulling the communities even farther apart -- in a direction few locals might recognize.
"The first nations get much better health care than the rest of us do here in Moosonee," the mayor says. "I'm not saying they shouldn't [have good care]. I'm just saying we should all have the same level of service."
When the last missionaries pulled out of this former fur-trading post in the 1960s, they could not have imagined the fissure they were leaving behind in Moosonee and Moose Factory, or how decades later the tables would be turned. Today, the two communities endure a two-tier health-care system that represents two very different ambitions and poses a critical challenge for northern health care.
On the island, the native community enjoys a parade of federal money over which it is gaining more and more control. On the mainland, the racially mixed community has watched, with a growing sense of abandonment, a steady retreat of provincial funds.
With Moosonee's air force base and a range of government services gone, and tourism struggling, most of the non-natives who once administered the James Bay region have pulled out.
Last year, when the province forced it to become an official municipality, Moosonee discovered that it did not have enough money to maintain the new water-treatment plant that was to end years of boil-water advisories, or to pay for its local police.
But the greatest disparity may only now be emerging in health care. Both communities had been served by hospitals since missionary days -- the Catholics ran one in Moosonee, the Anglicans in Moose Factory -- but in the 1990s they were told by the provincial and federal governments to prepare to amalgamate them.
Then, when a new regional health authority was created in 1996, all the key positions went to the native-run hospital at Moose Factory. The two posts for resident physicians in Moosonee disappeared, leading to a boardroom struggle that left the two communities at odds and many patients out in the cold.
To see a doctor on the island, mainlanders have to take a $5 trip by boat taxi in the summer months or, during the spring thaw and autumn freeze, a $25 helicopter ride. In winter, which is six months of the year, the river's ice is thick enough to support ambulances, as well as trucks, buses and a sloth of bears that claim the island as theirs. But if a storm comes up, in any season, Moosonee people must settle for a nurse in their clinic.
Most of them know the situation for patients on the reserve, where waiting times are almost unknown. Under a federal program, natives are guaranteed free travel to better hospitals in the south, most commonly to Queen's University in Kingston, Ont., on a daily charter flight.
"People here complain if they have to wait an hour or an hour and a half," says Ernest Beck, a former chief of the Moose Crees and now chief executive of the native hospital.
The federally funded Non-Insured Health Benefits program also covers the costs of prescription drugs, eyeglasses and other medically needed services not covered by provincial or private plans.
Across the river, "people around here complain of waiting three weeks just to see a physician," says Barbara Pappas, a Moosonee bookkeeper who discovered that she had cancer this year only after spending $1,400 to travel to Toronto to see a doctor.
"The perception is Moose Factory is hogging everything," she says.
As he turns up the dirt road that trails the river, Cool glances across the water to a channel leading to the reserve and tries as best he can to put a diplomatic spin on his town's health-care crisis.
Before he became mayor, he thought he could live with the many concessions given to Moose Factory, knowing how important it was for the local native communities to take charge of their own affairs.
He had moved to Moosonee as a teen, in 1953, with his parents, and decided to stay on as an adult. He eventually bought what remained of the Hudson Bay Transport Co., running barges up the coast to a smattering of native reserves that enjoy little other contact with the rest of Canada.
To him, everyone in these parts is simply a northerner. More than half his town is native. Most of his council is white. His mother was part Ojibwa. One of his sons married a local Cree woman, and three-quarters of his work force, he figures, is native too.
So intertwined is native and white life in Moosonee that Cool did not think much about aboriginal issues until he became mayor, defeating three native men. Then he began to see a new side of Indian politics.
Whenever he visits the island reserve, Cool sees a community blessed with so much outside assistance that it now has its own luxury hotel, cable TV company, shopping mall and new elders home.
There is no record of how long the Crees have been on this long strip of land, sheltered by one of the last spruce stands heading north, but white people have been tramping around the island and the surrounding coastline known as the great muskeg for more than three centuries. In 1673, Hudson's Bay Co. set up a trading post and permanent dwelling on the island, and later built a staff quarters that still stands.
If the Europeans brought a sense of commerce, it stuck with the Moose Crees who run one of northern Ontario's few successful reserves. In a depressed region, where alcoholism and domestic abuse are so common that scores of children every year are taken away from their parents and shipped south, the Moose Crees follow their own course. They have bought construction equipment and are busy clearing trees and building rows of houses as though trying to hook up with Toronto's sprawl 800 kilometres to the south.
When two islanders died from kidney failure last year, the band put up $95,000 as seed capital for a dialysis machine.
The island is shared by another band, the descendants of squatters from Quebec known as MoCreeBec, who first came here to attend residential schools, and are more entrepreneurial still. Until the 1980s, they lived in tents. Now, they own the cable TV company, a bakery and a construction outfit that is busy laying water mains across the island.
"If you don't have ownership, you won't have responsibility," says Allan Jolly, a local entrepreneur who grew up in the forest, went to a residential school when he was 9 and now runs the cable TV operation, which is laying fibre-optics lines to the island.
The island's gumption helped to produce Jonathan Cheechoo, a young hockey prospect for the San Jose Sharks. It also has peppered the pleasant dirt cul-de-sacs with fast-food shacks selling ribs, burgers and French fries from private kitchens. The band-run gas station has a Pizza Hut outlet.
But nothing pleases the island Crees more than their hospital, an old sanitorium erected in 1950 during a tuberculosis outbreak. Shaped like a Cross of Lorraine -- the symbol of TB treatment -- the hospital retains its secluded air, built at a remove from the community and brightened by sunshine cascading through tall windows on all sides. Down each corridor, there are long, empty spaces, the remains of a 200-bed facility that has been whittled down over the decades to 38 beds.
Outside, a helipad to one side allows patients to be whisked to the mainland airport, and from there to some of the world's best medical care in Southern Ontario.
At the moment of Canada's creation, the British North America Act of 1867 set out provincial responsibility for health care, except in the case of natives, who became a federal responsibility. Since the native population at the time was largely remote and scattered, Ottawa assigned its burden to private agencies, notably the churches.
In Ontario's muskeg, church-run hospitals, as well as residential schools, became part of a regional race for converts. The Anglican Church gained a toehold on Moose Factory, but in Moosonee and several coastal communities, health care went to the Catholic Hospitals of James Bay.
A schism in health care grew and resulted in a sharp turn in 1969, when the Catholic-run Assumption Hospital in Moosonee burned down. The church asked the province to take over the hospital, as well as nursing stations in Fort Albany and Attawapiskat on the James Bay coast.
Those three communities have since enjoyed provincially run health-care services, although for native patients Ottawa pays the bills. In Moose Factory, and the remote communities of Kashechewan and Peawanuck, the federal government resumed direct control of health care.
But in 1989, another change in direction occurred, as Ottawa began to transfer control of health care to native communities. Some of the experiments were disasters, with doctors quitting en masse from native-run hospitals that couldn't pay their wages. A few fell prey to corruption, such as Manitoba's Virginia Fontaine Memorial Centre, which was closed this year for financial mismanagement.
The Moose Factory hospital, which has a long-standing partnership with Queen's University, became a success. In 1996, management was handed over to a local native authority, and the hospital was renamed Weeneebayko, meaning "of the two bays."
Some locals thought it would mean a return to traditional native medicine, at least until they learned the burning of sweetgrass in a hospital was against fire regulations. Others thought it would be a free-for-all in which the slightest ailment would lead to a round-trip ticket down south, at least until the hospital's new management cracked down on unnecessary travel. No longer were coastal residents, for example, allowed to refer themselves for a psychiatric appointment, which had become a common cover for weekend shopping junkets.
The Weeneebayko managers say they have created something different, something that bridges the vast medical expertise of Southern Canada with the vast social needs of the North. If so, the bridge is held up by Michael Green and Elaine Wabano.
The overnight shift at Weeneebayko is beginning and Green, a preppy 32-year-old from Vancouver, enters the emergency room in khaki pants, a golf shirt and loafers, and prepares to patch up the wounds of an afflicted society.
The son of international development workers, he has lived in Uganda, Nigeria and the South Pacific, and practised medicine from Papua New Guinea to a native hospital in the Miramichi region of New Brunswick.
But here, 300 kilometres from the nearest city, he faces a different task as Weeneebayko's chief of staff.
Early in his 12-hour shift, a call comes across the radio from an ambulance crew en route with an injured man whom Green guesses, rightly, is "HBD," for "has been drinking." The acronym comes across the radio so frequently it begins to sound as repetitive as "fries" to a drive-through attendant.
Green isn't fazed. He did a stint at an inner-city hospital in Vancouver and knows full well about the causes and consequences of intoxication. His first patient tonight -- a middle-aged man named Michael -- arrives with his head bloody from an apparent fall. Green stitches his forehead and orders a blood test. The man's alcohol level is 56 millimoles per litre -- a good many times the intoxication threshold of 12. He's much closer, in fact, to death (the lethal level is 80). But Green says he'll be fine.
In a short while, another call comes from the nursing station up the coast at Fort Albany, where a drunk has just come off a binge and can't find his blood-pressure medication. Later, a woman is rushed into the emergency room, her left wrist slashed so deeply by a broken beer bottle that two sliced tendons stand visible. She, too, is HBD, and suicidal. Green welcomes her back.
He has seen enough of the north, and the world, to know he can do little more than treat people's injuries here, and help develop a better hospital. During his six years at Moose Factory, he has seen too many other doctors who consider themselves saviours, no different really from the missionaries who once ran this hospital.
"I'm not going to march down to the council chamber and say, 'You have a problem with drugs,' " Green says during a lull in the middle of the night. The inebriated man and suicidal woman are sitting on their ER beds chatting.
"The community is aware of what its issues are," the doctor continues. "Sometimes outside people may have a different sense of what the priorities may be."
The danger of outsiders may not last long anyway.
Despite the impression across the river that Moose Factory is pampered, its hospital struggles like every other one in the North to keep health-care professionals from moving south. As a regional facility, Weeneebayko is supposed to have 10 doctors, but is down to four, leaving Green with a greater burden. In the past week, he has put in 56 hours of clinical work and 14 of administration.
The pressure is more acute up the coast, where half a dozen native communities can be reached only by airplane, freighter or winter road. One community, Kashechewan, had to train a janitor to operate the local X-ray machine.
The only hope seems to lie in people like Elaine Wabano.
A MoCreeBec nurse-practitioner who will take over much of Green's work when daylight comes, she has had additional training that allows her to handle several basic tasks previously left to doctors. She also can work with patients on preventive health care. And she's not likely to vanish to Toronto, or Texas.
When daylight comes, Wabano's shift begins a bit later than normal. She is flying back that morning from Kingston, with her mother, a nurse's aide, who has been diagnosed with cancer. Their travel costs, as patient and escort, will be covered by Ottawa.
Wabano is a year older than Green, and grew up near the hospital in one-room hut with wood walls and a canvas roof. Five of the six children in her family shared a pullout bed. She remembers the thrill of her family getting a two-bedroom home with indoor plumbing when the federal government agreed in the 1980s to recognize the MoCreebec and build them proper homes. When she became a teenager, she had to share a bed with only two others. "It was a really big deal," she laughs.
Wabano had her first child when she was 17, a few weeks shy of her high-school graduation, forcing her to turn down the many community colleges in Southern Ontario that had offered her a place. She chose instead to study nursing -- she had always liked the nurses at the hospital -- at Northern College's local satellite campus.
Largely thanks to this program, set up by the province to train northerners for jobs in health care, nearly 50 of Weeneebayko's 58 nurses come from the local community, and every remote post has at least one local resident on staff.
Wabano went on to Lakehead University in Thunder Bay with her husband and five children -- she for additional training to become a nurse-practitioner, he for studies to become a teacher.
Today, in her afternoon "urgency clinic," she can diagnose patients, prescribe drugs and make referrals. She is also coaching women to search for signs of breast cancer, and recently received funds to produce a Cree video on the subject.
But what she knows she really must do is persuade her friends, neighbours and relatives to modify a new lifestyle that is killing the Crees of Canada's North.
After gulping the last of a Diet Pepsi, Wabano picks up a stack of patient files and enters a packed waiting room. Every seat is occupied with the very old, the very young and the very large. Many people in Moose Factory are fat.
The pizza outlet, and a grocery store packed with potato chips and pop, are among the many reasons for an epidemic of obesity on the island that has produced extraordinary rates of adult-onset diabetes -- roughly three times greater than the non-native average in Canada.
On one level, the reasons are thought to be very simple. Wabano's grandparents spent most of their lives on trap lines, engaged in demanding physical work while scrounging for food. Cree bodies had become accustomed to feasts and famines, and were very efficient at storing fat.
Now, all they see is feasting. And a sedentary lifestyle through long winters on snowmobiles, not snowshoes, and short summers in speed boats, not canoes.
The federal government has given $64,000 to Weeneebayko to launch a new native diabetes program, although the hospital had requested $507,000. A local group has also started a "Chub Club." Its motto: Eat less, move more.
But Wabano knows how deeply Western ways permeate her culture. She remembers her first pizza the way she remembers the arrival of indoor plumbing. It was good.
Whether Wabano and the other nurse-practitioners can do enough for their patients depends greatly on Moose Factory and Moosonee settling their health-care feud. They were told to merge to save money and make better use of their few doctors.
But federal-provincial tensions that plague so much of Canada quickly came to haunt the two communities.
In 1996, when Weeneebayko gained its autonomy, a new native-run board discovered it was headed for a huge deficit. Some directors blamed Ottawa for miscalculating costs, but that didn't change the reality: Within two years, the native organization was $2-million in the hole, and facing a sharp increase in government-approved wages and pharmaceutical prices.
The hospital's treasurer, George Small, says he wanted to keep the losses going, if that's what it would take to maintain health care. He figured the natives would find the money later. They always do, he maintains.
Like many native leaders in the area, Small cannot imagine cutting health care for his people. Similarly, Moosonee officials cannot imagine merging their work with a money-losing operation, not when they are governed by the strict rules of the provincial hospitals act.
Across the water, Moosonee's non-native health care managers say efficiency, as much as politics, is the issue.
Peter Fabricius, a career administrator from Southern Ontario who runs the James Bay General Hospital in Moosonee, points to some simple examples. When his board of directors gathers, the meetings last three to four hours, with every director allowed to speak for only five minutes on any issue. At Moose Factory, the meetings last three to four days, with directors allowed to speak until they feel they have expressed their views.
The Moose Factory board gets a per diem of $150. The James Bay board gets nothing. The Moose Factory board deals with a litany of patient complaints and concerns, such as a native's application this year for a wheelchair. The James Bay board deals only with organizational issues, with a standard set of performance criteria evaluated at each meeting and a new rule barring directors from bringing up complaints best left to the administration.
After a career in the hospital business, and a year in Moosonee, he can only shake his head, and say: "I've never seen anything quite like this."
The latest hope for an amalgamation fell apart last Feb. 15. At a special meeting of the regional health authority, the two sides simply could not agree on where to place a new regional hospital.
Moose Factory threatened to pull out of the authority if it didn't get its way. The Moosonee delegation, feeling the issue was too heated politically, left the meeting, along with its three partner communities from the coast, and a fourth that agreed to abstain from any vote.
The dissidents thought the choice was absurd. Moose Factory is an island without an airport. How could it house a regional hospital?
But the islanders had their own concerns. If a new hospital were built on provincial land in Moosonee, by the airport, wouldn't they as natives risk losing their special federal funding? Besides, the town has been in decline for years, while the island is on the move, economically and demographically. It's even willing to build an airstrip, if that's what is needed.
Moose Factory's arguments seemed to work, as three inland reserves voted alongside its two voting members -- the Moose Crees and MoCreeBec -- to produce a bare majority. The hospital would go to the island. "For the first time in a long time, it's made everyone uncomfortable," says Beck, Weeneebayko's chief executive.
Afterward, when a lawyer was hired to bring the two sides together, he couldn't get them in the same room. At one point, Beck says, "it was hard for people to look at each other in the eye."
The Moose Crees believe they can push on despite the tensions. For 330 years, they have struggled with outsiders, and now that they seem to hold the upper hand they are not about to give up. They consider their special arrangement with Ottawa more than a good deal; it's an inherent right. If others see it as two-tier medicine, well, they as aboriginal people have lived in a two-tier society for much longer.
But the division along the Moose River is more complicated than race. Moosonee, dependent on a provincial government that thinks little about Ontario's far north, has more natives than non-natives to worry about. Most of them voted for Rheal Cool, thinking he could get a better deal. But the mayor knows he can do little to change how the reserve manages its affairs, and nothing to change how Ottawa and Ontario deal with each other.
Last spring, the local health authorities asked Health Canada and Queen's Park to address the financial troubles at Weeneebayko -- in effect, to clear the slate before any amalgamation went ahead. They haven't heard back.
Even those who would like to build a bridge between their separate existences feel they cannot do much now. They cannot change the fundamental reasons for their two solitudes.
And so, Cool must wait, knowing that on the great muskeg, two very old societies -- rivals, friends, neighbours, in-laws -- will again have to see their fates decided from afar.