Federal government to fund safer drug supply pilot project in Peterborough

Greg Davis 

© AP Photo/Patrick Sison, File The federal government is launching a safe supply drug pilot project in Peterborough, Ont.

The federal government is providing $200,000 to help launch a safe supply drug project in Peterborough to address the region's increase in opioid overdose deaths.

On Monday, Peterborough-Kawartha MP Maryam Monsef announced that over the next 27 months a safe supply project will be run in the city, providing a pharmaceutical alternative to the toxic illegal drug supply and helping prevent overdoses. The project is being funding by Health Canada’s Substance Use and Addictions Program. The cost of medication for participants on the pilot program is covered by provincial drug plan benefits.

As of early May, there have been 20 suspected opioid-related deaths so far in 2021 in the Peterborough area. In 2020, opioid-related emergency room visits in Peterborough were nearly double that of the provincial average.

Read more: Suspected opioid deaths in Peterborough area rise to 20 so far in 2021, health unit says

"Just like many communities across Canada, Peterborough has suffered tragic losses due to the overdose crisis," said Monsef. "The Government of Canada is proud to support projects like this one that will help expand the services and treatments available for those at risk of overdose in communities like Peterborough."

The initiative will pilot the use of a nurse practitioner to deliver safer drug supply to 10 patients in Peterborough. The project is being led by the Peterborough 360 Degree Nurse Practitioner-Led Clinic (NPLC), which focuses on accessible health-care for marginalized individuals, in partnership with Trent University/Fleming College School of Nursing.

360 Degree executive director Suzanne Galloway says the project is another tool to help reduce the "tragic impact of opioid poisonings from the illegal drug supply in the community."

She says the first phase of the project will include research from August to December involving prescribers, pharmacists, addictions treatment providers, harm-eduction professionals and people who use drugs to help develop a model of safer supply that can work for Peterborough.

That will be followed in 2022 with a "small-scale" eight- to 10-month pilot project in 2022 involving a "heavy evaluation" component, said Galloway.

The 10 participants will receive an "opioid-replacement therapy" such as a pharmaceutical-grade opioid, says Galloway, to replace the fentanyl from the street-acquired supply they have been relying on. Individuals will work on their goals — whether it's to eliminate drug use completely or reduce use.

There will be no physical clinic per se, but it will be a part of the individuals' primary health care. The pilot also aims to create a long-term sustainable model — and possibly scale up the model, said Galloway.

"We will be reviewing the outcomes of the participants, the providers and the community to refine our local approach," Galloway said. "And share our knowledge of how the promising practice of safer supply projects might be offered in other small communities across Canada."

Read more: Calls for safer opioid supply grow as COVID-19 pandemic compounds overdose crisis

The project will also study what wraparound supports can be created for the individuals, such as housing, counselling and a potential safe consumption site in the city.

"We intend to have a pretty strong peer-support element as well to access social services," said Galloway. Our clinic’s vision is a community where all people have access to high-quality primary healthcare and an equal opportunity to be healthy. Safer Supply is one of the ways that we can reach this vision."

Kathy Hardill, lead/clinical direction at 360 Degree, says the project will engage with individuals at "high risk" to enable comprehensive provision of primary care.

"The aspiration of the project is to create a community-wide, community practice for safe supply prescribing," she said. "These 10 individuals may be patients of the clinic or the broader primary care community. We look forward to creating those collaborations and partnerships."

On behalf of Mayor Diane Therrien, city Coun. Andrew Beamer thanked the federal government for its leadership and funding to help address the opioid crisis, which he says has devastated many families in the community.

"So my families have been devastated by this — it's heartbreaking," he said. "This funding and support will go a long way to support the community. It will go a long way to support the health and the well-being of individuals and families. And it will save lives."

Peterborough Police Service Chief Scott Gilbert says the service is happy to be a partner in the project.

"The Safer Supply Project will be another tool in the toolbox for assisting community members with addictions," he said.

Monsef says while there may be critics of the safe supply project, she says the government is following evidence and calls from families of victims and those overcoming addictions.

"Our approach will be compassionate, it will be based on evidence and we will trust community leaders to lead," she said. "The goal here is to save lives."

— More to come.

Video: Suspected opioid deaths rise to 20 in Peterborough region: health unit

Exodus to jungles, villages as Myanmar troops retake town

(Reuters) - Thousands of residents of a hill town in northwest Myanmar were hiding in jungles, villages and valleys on Monday after fleeing an assault by state troops, witnesses said, as the army advanced into the town after days battling local militias.

© Reuters/Stringer . FILE PHOTO: GOVT SOLDIER

Mindat, about 100 km (60 miles) from the Indian border in Chin state, has seen some of the most intense fighting since a Feb. 1 coup that has led to the emergence of ragtag local armies that are stifling the junta's bid to consolidate power.

Martial law was declared in Mindat on Thursday before the army launched its assault, using artillery and helicopters against a newly formed Chinland Defence Force, a militia armed mainly with hunting rifles, which said it had pulled back to spare civilians from being caught in the crossfire.

Several residents reached by Reuters said food was in short supply and estimated as many as 5,000 to 8,000 people had fled the town, with roads blocked and the presence of troops in the streets preventing their return.

"Almost everyone left the city," said a volunteer fighter who said she was in a jungle. "Most of them are in hiding."

A representative of the local people's administrative group of Mindat said he was among some 200 people, including women and children, who had trekked across rocky roads and hills carrying blankets, rice and cooking pots.

He said the group was attacked with heavy weapons when troops spotted smoke from their cooking fires.

"We have to move from one place to another. We cannot settle in a place in the jungle," he told Reuters by phone.

"Some men were arrested as they went into town to get more food for us. We cannot get into town currently. We are going to starve in few days."

The Chinland Defence Forces in a statement on Monday said it had killed five government troops in Hakha, another town in Chin State.

The United Nations children's fund UNICEF in a tweet urged security forces to ensure safety of children in Mindat, the latest international call for restraint after human rights groups, the United States and Britain condemned the use of war weapons against civilians.

MULTIPLE FRONTS

The United States, Britain and Canada on Monday announced more sanctions against businesses and individuals tied to the junta. U.S. Secretary of State Antony Blinken urged more countries to follow suit.

Myanmar has been in chaos since the coup, with the military battling armed and peaceful resistance on multiple fronts, adding to concerns about economic collapse and a humanitarian crisis from old conflicts reigniting in border regions.

The fighters in Chin State say they are part of the People's Defence Forces of the shadow government, which has called on the international community for help.

In an effort to coordinate the anti-junta forces, the shadow government on Monday issued a list of instructions to all the civilian armies, which it said must operate under its command and control.

Aid groups in direct contact with residents of Mindat made urgent calls on social media on Monday for donations or food, clothing and medicine.

Salai, 24, who has been organising an emergency response, said she had spoken to people hiding in a valley and on farmland who had fled the advance of soldiers.

"They looted people's property. They burned down people's houses. It is really upsetting," said Salai.

"Some in the town were injured by gunshots, including a young girl. She cannot get medical treatment."

A military spokesman did not answer calls or messages seeking comment.

In its nightly news bulletin, state-run MRTV said security forces returned fire after coming under attack from insurgents in Mindat, who fled, and that government troops had been attacked elsewhere in Chin State.

So far, 790 people have been killed in the junta's crackdown on its opponents, according to the activist group the Assistance Association for Political Prisoners.

The military disputes that figure. Reuters cannot independently verify arrests and casualty numbers.

The military says it intervened after its complaints of fraud in a November election won by Aung San Suu Kyi's party were ignored.

An international monitoring group on Monday said the results of that election "were, by and large, representative of the will of the people of Myanmar".

(Reporting by Reuters Staff; Writing by Martin Petty; Editing by Nick Macfie)

Backers of WTO vaccine waiver ask opponents to join talks - document

By Emma Farge

© Reuters/Denis Balibouse World Trade Organization (WTO) in Geneva

GENEVA (Reuters) - Supporters of a proposal to waive patent rights on COVID-19 vaccines at the World Trade Organization are set to call on opponents to join the negotiations, stressing the gravity of the pandemic, a draft document showed on Monday.

Talks at the WTO on temporarily waiving IP rights have been deadlocked for months, but U.S. President Joe Biden's decision earlier this month to back talks for a waiver has raised hopes that the few remaining wealthy-country opponents could also switch camps.

The EU has since backed a U.S. proposal to discuss waiving patent protections, although Switzerland said it left many questions unanswered.

"The cosponsors call on all delegations who have not yet indicated that they will join text-based discussions, to do so as soon as possible," the 62 proponents of the waiver, including India and South Africa that initially floated the proposal, said in a co-authored draft statement.

"Continuous mutations and emergence of new variants of SARS-COV-2 highlight the significant uncertainties and complexities of controlling SARS-COV-2 and underscore the urgency of this proposal," they said.

"A failure to respond in a timely manner on the waiver proposal undermines the legitimacy and credibility of the WTO."

India's and South Africa's original waiver proposal last October argued that IP rules are hindering the scale-up of COVID-19 vaccine production.

Critics, including large pharmaceuticals industry groups as well as Pfizer that makes a COVID-19 vaccine, say an IP waiver will not immediately increase vaccine production and that the current supply issues are more complex.

Pfizer has said any waiver could disrupt the flow of raw materials.

The statement from proponents seen by Reuters said that a new proposal would be issued soon to clarify its scope and the time period of its application.

However, experts have warned that getting agreement at the WTO, which typically operates through consensus, could still take months even with U.S. backing.

The next formal TRIPS council meeting at the WTO is scheduled for June 8.

(Reporting by Emma Farge, editing by John Miller)

RCMP move to end blockade against logging of forest on Vancouver Island

PORT RENFREW, B.C. — The RCMP say they have begun enforcing a court injunction banning blockades of logging activities in an area of western Vancouver Island.

© Provided by The Canadian Press

In a statement, the RCMP say they are temporarily controlling access to the Fairy Creek Watershed area northeast of Port Renfrew as they enforce the civil injunction.

It says the controls were imposed today to allow loggers with Teal-Cedar Products to start work.

A checkpoint on a forest service road leading to the area will remain in place until the company has completed its work.

The RCMP say enough police officers are in the area to keep the peace.

The B.C. Supreme Court issued the injunction April 1 allowing logging in an area that protesters say is one of the last remaining stands of old growth timber on southern Vancouver Island.

This report by The Canadian Press was first published May 17, 2021.

The Canadian Press

CRIMINAL CAPITALI$M

Swiss parliament to look into Credit Suisse fiasco - paper

ZURICH (Reuters) - A Swiss parliamentary committee will discuss the fallout from billions of dollars worth of losses at Credit Suisse amid risk-management failures, bringing political scrutiny to bear on the financial sector, a Sunday paper reported.

© Reuters/ARND WIEGMANN FILE PHOTO: Logo of Swiss bank Credit Suisse is seen in Zurich

"It's the politicians' turn on the Credit Suisse issue," the SonntagsZeitung quoted Prisca Birrer-Heimo, a Social Democrat member of the lower house's economic affairs committee, as saying ahead of committee hearings set for Monday and Tuesday.

Credit Suisse declined to comment on the report.

Political intervention in the private sector is unusual in Switzerland and the prospect for concrete action remains unclear despite the crisis at the country's second-biggest bank.

Credit Suisse is raising capital and has halted share buybacks, cut its dividend and revamped management after losing more than $5 billion from the collapse of investment fund Archegos and having to suspend asset management funds linked to insolvent British supply chain finance firm Greensill.

New Chairman Antonio Horta-Osorio has said the scale of the bank's problems is his biggest challenge yet, and promised a thorough review of what went so badly wrong.

Birrer-Heimo said the question was "whether and how the regulation of the big banks needs to be tightened", citing risk-management shortcomings, a bonus-driven incentive system, and the size of capital buffers banks must hold to ride out crises.

Even business-friendly politicians think it might be time for the public sector to weigh in, the paper said.

"We don't have an existential crisis today," former MP and Liberals party leader Philipp Mueller was quoted as saying, "but I was still surprised that there have been no political reactions so far."

FINMA has already opened proceedings against Credit Suisse in connection with Archegos and Greensill case and imposed extra capital requirements on the bank.

Credit Suisse said this month it will keep limits on its risk-weighted assets and leverage while it remains under regulatory scrutiny.

(Reporting by Michael Shields; Editing by Raissa Kasolowsky)

Hub promoting affordable, net-zero lifestyle to rural, Indigenous communities

A partnership between an Indigenous hub and a non-profit has resulted in the creation of a centre aiming to bring economic and environmental changes to rural and Indigenous communities.

The Charlton Sustainability Hub (CSH) will offer resources, tools and knowledge on how to lead a sustainable, affordable, low-carbon lifestyle.

The non-profit Northern Ontario Centre for Sustainable Development Co-Op Inc. (NOCSDC) is partnering with Keepers of the Circle on establishing the hub.

It will be operated out of the former public school in Charlton, a small community on Highway 11 near Englehart. The centre's concept was inspired by successful sustainability hubs in Europe, specifically Denmark.

The centre’s teaching and modelling programs will focus on five pillars: reversing youth out-migration, renewable energy, food security, reclaiming traditional ecological knowledge and transitioning to a new green economy.

The school, powered by solar net metering energy, will have computer offices, a community kitchen and a gym, which will be used for community space.

CHS will also provide short-term accommodations for 30 people. According to Ambrose Raftis, NOCSDC chairman, people who stay at the hub will be immersed in a low-carbon environment.

"Part of the reason for the centre is to bring young people, school-aged children and youth in and show them like, ‘Here’s an alternative way of living, you can live with renewable energy and local food with high quality of life. And you can do it in your community,’” Raftis said.

Once renovations are done, the hub is expected to officially open to the public in the fall of 2021 or early 2022.

According to the hub's website, the centre will offer guided tours, tailored courses, online and hands-on programs.

“We supply training information and support at a cost-recovery rate, so people who don’t have a lot of money can afford to learn more and be a part of the economy and the change,” Raftis said. “Because the reason they want a change is the economy is not working for them including Indigenous communities.”

The Keepers of the Circle will also be located on-site delivering traditional land-based skills, teaching how to grow and preserve food, how to start green businesses and live off the grid, said Rachel Lachance, the hub’s Indigenous liaison.

In February, the first initiative was launched through the hub. It was a federally-funded program called Pathways to Resilience: Intro to Emerging and Established Careers for Indigenous Women.

Lachance said the feedback and the data the organizers received from the seven-week program were “phenomenal.” She said more than 175 Indigenous women from northeastern Ontario applied for the program but only 100 people could be accepted.

"It's an actual reconciliation project where you're dealing with co-operative and dealing with an Indigenous organization, so it's a really great partnership in that way because we really focus on Calls to Action and MMIWG's Calls to (Justice)," she said.

During the first week, there was a virtual job fair where participants were introduced to career opportunities in sectors like construction, entrepreneurship, security and policing, green living, and environmental impact assessment.

The following six weeks focused on curriculum-based pre-employment training in each of the five sectors. There were expert speakers from each of the sectors who talked more about how to get into those careers as well as assignments and competency training.

To help participants during the course, they were offered laptops and printers, help with the internet, childcare services and weekly honorariums, according to Lachance.

Currently, the Pathways program is in Phase 3 as the Keepers of the Circle are working on personal and professional development plans with each participant.

"For the whole rest of the year, we're going to be supporting each of these women to reach those goals," Lachance said.

With the internet on-site and as a non-profit with charitable status, the centre can connect and bring people together, Raftis said.

“We may bring six or eight people down from one community and connect the rest of the community via the internet and have community training sessions,” Raftis said.

The site can also be used to house community members in the event of a forest fire, drought or power failure.

“We have a backup system, we can bring people in there and feed them and stuff like that, from local communities,” Raftis said.

The collective applied for community outreach funding and is waiting to hear back from FedNor and the Northern Ontario Heritage Fund Corp., Raftis said. The funding will help gather input from local municipalities and Indigenous communities on the development of the project.

Dariya Baiguzhiyeva, Local Journalism Initiative Reporter, TimminsToday.com

PET WISDOM

 

NOT EDUCATION BUT SCHOOLING

Pandemic's economic burden fell hardest on less-educated Americans, Fed survey shows

By Jonnelle Marte and Howard Schneider

© Reuters/Leah Millis FILE PHOTO: Federal Reserve Board building on Constitution Avenue is pictured in Washington

(Reuters) - The coronavirus pandemic had a more devastating impact on Americans with lower levels of education and those least equipped financially to handle such a blow, according to a report released on Monday by the Federal Reserve.

The financial chasm between adults with a bachelor's degree and those with less than a high school degree widened during the pandemic, which caused job losses that disproportionately affected low-wage workers, according to the U.S. central bank's annual Survey of Household Economics and Decision making.

"Even as the economy has improved, we can certainly see that some are still struggling, especially those who lost their jobs and those with less education, many of whom fell further behind," Fed Board Governor Michelle Bowman said in a statement.

Some 89% of adults with at least a bachelor's degree said they were doing at least "okay" financially, compared to 45% of those with less than a high school degree, according to the survey, which was conducted in November 2020. That gap increased to 44 percentage points in 2020 from 34 percentage points in 2019.

The divide also played out along racial lines, although to a lesser extent. Less than two-thirds of Black and Hispanic adults said they were doing at least "okay" financially in 2020, compared with 80% of white adults and 84% of Asian adults. The gap between white adults and Black and Hispanic adults has grown by 4 percentage points since 2017.

The overall share of adults who said they were worse off financially when compared to a year earlier rose to nearly 25% at the end of 2020, from 14% in 2019.

But despite that increase, most Americans believed they were still at least doing "okay" financially. Some 75% of adults said they were living comfortably or doing "okay" financially in November, a share that fluctuated throughout the year but ended at the same level as in 2019.

The survey found that some parents became unable to work during the pandemic because of disruptions to child care and in-person schooling. Some 9% of parents said they were not working and 13% were working less because of such disruptions as of November. That amounted to a decline of roughly 2 percentage points in the share of adults who were working overall.

(Reporting by Jonnelle Marte and Howard Schneider; Editing by Paul Simao)

Fauci says pandemic exposed 'undeniable effects of racism'

ATLANTA (AP) — The immunologist who leads the COVID-19 response in the United States said Sunday that “the undeniable effects of racism” have led to unacceptable health disparities that especially hurt African Americans, Hispanics and Native Americans during the pandemic.

© Provided by The Canadian Press

“COVID-19 has shone a bright light on our own society’s failings,” Dr. Anthony Fauci said during a graduation ceremony for Emory University.

Speaking by webcast from Washington, Fauci told the graduates in Atlanta that many members of minority groups work in essential jobs where they might be exposed to the coronavirus. He also said they are more likely to become infected if exposed because of medical conditions such as hypertension, chronic lung disease, diabetes or obesity.

“Now, very few of these comorbidities have racial determinants,” Fauci said. “Almost all relate to the social determinants of health dating back to disadvantageous conditions that some people of color find themselves in from birth regarding the availability of an adequate diet, access to health care and the undeniable effects of racism in our society.”

Fauci said correcting societal wrongs will take a commitment of decades, and he urged the graduates to be part of the solution.

Fauci said that once society returns to “some form of normality,” people should not forget that infectious disease has disproportionally hospitalized and killed people of color.

Fauci on Sunday was awarded the Emory University president's medal. Previous recipients include former President Jimmy Carter, the Dalai Lama and the late U.S. Rep. John Lewis, a civil rights icon. In accepting the award, Fauci denounced the destruction of division.

“Societal divisiveness is counterproductive in a pandemic," Fauci said. “We must not be at odds with each other since the virus is the enemy, not each other.”

He praised the graduates for handling the profound disruption of the pandemic.

“Not since the influenza pandemic of 1918 has humanity faced a public health crisis of this magnitude," he said. "Each of you deserves enormous respect for your extraordinary adaptability, resilience and dedication to learning, completing your studies and graduating despite immense difficulties and uncertainties.”

The Associated Press

SYSTEMIC MEDICAL RACISM

Canada’s Indigenous communities at greater risk post-surgery, study shows

Research published on Monday showed that Indigenous peoples had a 30 per cent increased risk of death after surgery and higher rates of complications, including post-operative infection, pneumonia and hospital readmission.

Saba Aziz 
GLOBAL NEWS

© Lucas Oleniuk/Toronto Star via Getty Images TORONTO, ONTARIO - APRIL 9: Women's College Hospital is revolutionizing the way knee-replacement surgery is done. It is starting to provide the procedure as an ambulatory service. Patients can go home…

Canada’s Indigenous communities are at a greater risk of death and health complications after undergoing surgery compared to other populations, according to a new study highlighting disparities in the country’s healthcare system.

Research published in the Canadian Medical Association Journal (CMAJ) on Monday showed that Indigenous peoples had a 30 per cent increased risk of death after surgery and higher rates of complications, including post-operative infection, pneumonia and hospital readmission.

Read more: Indigenous communities grapple with PPE shortages

They were also less likely to undergo life-saving procedures, including cardiac surgery, transplant and cesarean delivery, the review of 28 different studies showed. Indigenous peoples also experienced longer wait times by three-to-seven months for kidney transplants.

“This research illuminates inequities that are built into our surgical system,” said Dr. Jason McVicar, a Métis anesthesiologist at the Ottawa Hospital, and lead author of the study.

The research included 1.9 million patients, 10 per cent of whom were Indigenous.

Video: Red Dress Day in Edmonton honours Canada’s missing and murdered Indigenous people

These findings are consistent with inequities in surgical outcomes for Indigenous peoples in other high-income countries, the authors noted.

A lack of access to good quality healthcare and nutrition, as well as poor housing conditions means many are at an advanced stage of disease when they do undergo surgery in Canada, said Dr. Donna May Kimmaliardjuk, Canada’s first Inuk heart surgeon. This makes procedures more difficult and increases the likelihood of complications, she told Global News.

Distrust of the healthcare system is why members of the Indigenous communities are even hesitant to seek medical attention, Kimmaliardjuk said.

“It's important to provide equitable care to all patients, regardless of where you live," she added.

“But if you provide better care and better outcomes to the fastest-growing population, it can have not only good outcomes for the general health, but perhaps it can save on costs as well for the government.”

In a high-profile case last September, an Indigenous woman livestreamed video from a hospital in Joliette, Que., as female staff were heard insulting and mocking her.

Joyce Echaquan, 37, an Atikamekw mother of seven, was taken to hospital by ambulance with stomach pains on Sept. 26. She died there on Sept. 28, not long after posting the video.

Video: Coroner’s inquest begins into Joyce Echaquan’s death

“We see the difference. Sometimes it's unbelievably egregious and right in our face,” said Dr. Nadine Caron, First Nations Health Authority Chair (FNHA) in Cancer and Wellness at the University of British Columbia (UBC).

Indigenous peoples have also been disproportionately affected by the COVID-19 pandemic.

Read more: Ontario’s urban Indigenous communities, dialysis patients now have shorter COVID-19 vaccine intervals

As of May 13, 28,319 cases of COVID-19 had been confirmed on First Nations reserves, while 328 people had died from the disease, according to Indigenous Services Canada (ISC).

The rate of reported active cases among First Nations people living on reserves is currently 65 per cent of the rate for the general Canadian population.

McVicar said COVID-19 has exposed social disparities in Canada. He stressed the need for policymakers to take notice and action.

“We need to make sure that ... every step along the way that we are providing care that is culturally competent and is putting the needs of the patient and the community ahead of the conveniences of the healthcare system.”

-- with files from the Canadian Press.

Indigenous patients face higher risk of death post-surgery, study suggests

"The Canadian health-care system is currently getting the outcomes it is designed to get. It is based on a highly colonial structure." 

 "If we are honest about transformative change in terms of improving outcomes for First Nations, Inuit and Métis people, then we need to address change at every level in the system."

© Provided by The Canadian Press

Indigenous surgery patients are nearly a third more likely to die after their procedures than other populations in Canada and face higher risks of complications, new research suggests as doctors warn these inequities could worsen with the COVID-19 crisis.

The Canadian Medical Association Journal published a systemic review on Monday consisting of 28 separate studies. The research involved roughly 1.9 million participants — about 10 per cent of whom identified as Indigenous — to assess the surgical outcomes for Indigenous patients in Canada across a range of procedures.

Lead author Dr. Jason McVicar said the findings underscore the need for the First Nations, Inuit and Métis communities to lead a data-informed overhaul of health care, particularly as the pandemic raises concerns that Indigenous patients will fall behind in the mounting backlog of surgeries.

"This study tells Canadians two things: that we need better data, and the data that we have tells us that we need to do better," said McVicar, a Métis anesthesiologist at The Ottawa Hospital.

Researchers found Indigenous Peoples face a 30 per cent higher death rate after surgery compared to non-Indigenous patients, according to data from four studies with a combined 7,135 participants.

The authors also analyzed literature indicating that Indigenous patients suffered higher rates of surgical complications, including post-operative infections and readmissions to hospital.

The data also showed Indigenous patients were less likely to undergo surgeries aimed at improving quality of life, such as joint replacements, as well as potentially life-saving procedures including cardiac surgery, transplants and caesarean sections.

McVicar said the findings were limited by the scant and poor quality research available, noting that none of the data specifically pertained to Inuit and Métis communities.

He called for a national strategy to measure and address the disparities in surgical outcomes for Indigenous Peoples. But for such an effort to work, McVicar argued it should be led by the First Nations, Inuit and Métis health workers, researchers and organizers who are best equipped to meet the needs of their communities.

"The Canadian health-care system is currently getting the outcomes it is designed to get. It is based on a highly colonial structure," he said. "If we are honest about transformative change in terms of improving outcomes for First Nations, Inuit and Métis people, then we need to address change at every level in the system."

The issue is all the more urgent in light of the COVID-19 pandemic's disproportionate impact on Indigenous communities, said McVicar, adding such inequities could ripple through the medical system for years to come if Indigenous patients aren't prioritized for treatment amid a growing backlog of postponed surgeries. In Ontario alone, that number stretches into the hundreds of thousands.

"When we go back to address that backlog, we know that those with the political agency to strongly advocate for themselves will inevitably get to the front of the line," McVicar said. "This again will disproportionately impact First Nations, Inuit and Métis communities."

The research comes amid a national reckoning over anti-Indigenous racism in the health-care system after Joyce Echaquan, a 37-year-old Atikamekw woman, died last September in a Joliette, Que., hospital after filming staff making derogatory comments about her.

The widely shared video prompted the federal government to host a two-day summit to discuss systemic racism against Indigenous Peoples in health care. A Quebec coroner's inquest into Echaquan's death got underway last week.

Dr. Alika Lafontaine, an Indigenous health advocate and incoming president of the Canadian Medical Association, said Monday's research represents the tip of the iceberg in unpacking the layers of discrimination against Indigenous patients.

"The pandemic has revealed a lot of things that those of us who treat high proportions of Indigenous patients in our practices, or are Indigenous ourselves, have appreciated for years," said Lafontaine, an anesthesiologist in Grande Prairie, Alta.

"It's a big problem that we haven't spent a lot of time studying, and even less time trying to solve."

As the COVID-19 crisis has laid bare the life-threatening consequences of medical racism, Lafontaine said it has also provided an opportunity to implement the sweeping changes needed to ensure all Canadians have access to first-class health care.

"This research becomes so much more important, because it identifies the people and the populations that we haven't designed the system around, so we can build a better system after," he said. "That's the real promise, I think, of a post-pandemic health-care system."

This report by The Canadian Press was first published May 17, 2021.

Adina Bresge, The Canadian Press