Written by Elizabeth Clarke – Edited by Madeleine Hamilton
Longstanding systemic barriers in Canada perpetuate a nation polarised by health inequities that disproportionately impact Indigenous populations. Among these barriers are limited access to primary and specialist care, underrepresentation of Indigenous healthcare professionals, and lack of culturally safe, locally-informed programs. At the end of February 2023, with financial support from the Mastercard Foundation, Queen’s University and the Weeneebayko Area Health Authority (WAHA) announced their joint Health Education Program with the bold – but necessary – vision of transforming healthcare in the western James Bay coast area of Northern Ontario. The partnership will see expanded training of Indigenous health professionals from these regions at a local campus beginning in 2025, creating career pathways for local Indigenous youth and ultimately building a more sustainable, community-based, and culturally influenced healthcare system.
The southern appendage of Hudson Bay, James Bay – Weeneebeg (Western Cree)/Wiiniibek (Eastern Cree) – spans about 160 kilometres between Northern Québec and Ontario, with the provincial border at the bottom of the bay. First Nations communities spanning the coast and its many branching rivers, long functioned as trade posts for the Hudson’s Bay Company, including Fort Rupert, Québec (Eastern Cree, Eeyou territory), and Moose Factory Island and Fort Albany, Ontario (Western Cree, Mushkegowuk territory). The largest and most urban settlement in this region is the town of Moosonee, Ontario, on the mainland about five kilometres across the Moose River from Moose Factory Island. While Moosonee is formally recognized as a municipality in the Province of Ontario rather than a First Nation, its population of approximately 3,500 residents is predominantly – about 70% – of Cree lineage. Moosonee is notably the northern terminus of the Ontario Northland Railway and a deep sea port for the transportation of materials to communities on both sides of James Bay. It is a crucial hub for the more remote surrounding Mushkegowuk communities which are accessible only by ice road in the winter months.
The Mushkegowuk Council governs eight First Nations along the James Bay coast of Northern Ontario, five of which are located within the six communities served by the Weeneebayko Area Health Authority (WAHA): Moose Factory Island (Moose Cree First Nation), Fort Albany (Fort Albany First Nation), Attawapiskat (Attawapiskat First Nation), Kashechewan (Kashechewan Cree First Nation), Peawanuck (Weenusk First Nation), and Moosonee. WAHA was established in 2010 as a “regional, community-focused organisation, committed to providing optimum health care as close to home as possible”. WAHA provides a broad range of healthcare services through facilities in each of the six communities. The largest facility governed by WAHA is the Weeneebayko General Hospital (WGH) in Moose Factory, a 37-bed facility with 12 resident and rotational physicians. Emergencies and specialist appointments beyond the scope and/or capacity of WGH require transfer to Kingston General Hospital (KGH) or Timmins. Reciprocally, physicians and nurses from these cities have been rotationally providing medical services in Weeneebayko for nearly six decades.
There exists a particularly well-established relationship and mutual trust between Queen’s University and the Weeneebayko region, which began in the Department of Pediatrics, and later expanded to the broader Health Sciences faculty. Since the mid-1960s, Queen’s physicians have provided clinical care at Moose Factory’s hospital. In a 2020 blog account of his experience in Moose Factory as a medical student in the 1980s, head of the Queen’s Department of Medicine, Dr. Stephen Archer, recalls “[providing] local care and even [travelling] further north by helicopter to pick up patients to transport south.” Dr. Archer also described the more recent “erosion in [Queen’s physicians travelling to Moose Factory] and an increase in… patients coming to Kingston” for regularly scheduled appointments at KGH. Dr. Brikrampal Sidhu of Queen’s University and KGH aptly criticised this physician-centred model as “implicitly, if unintentionally, [valuing] physician time as infinitely more valuable than patient time.” From a public health perspective, burdening patients with mandatory travel to medical appointments introduces travel expenses, lost days of work, and detachment from social and cultural support networks during times of health-related stress. These barriers to accessing healthcare contribute to the longstanding health inequities experienced by Indigenous populations in Canada. To better align with the Truth and Reconciliation Commission’s (TRC) report, both Dr. Archer and Dr. Sidhu proposed expanded on-site physician care. However, while on-site care from Queen’s physicians is invariably a better approach than burdening patients from the north with travel to Kingston, it creates a cycle of dependency. The more upstream, long-term solution to increasing equitable access to healthcare for Indigenous populations would be to empower members of these communities with the education and resources to be self-sustaining. This is exactly the aim and trajectory of the new Queen’s University-WAHA Partnership.
In a recent interview for Inquire Publication, Dr. David Taylor, Queen’s and KGH physician and the Senior Advisor of the Queen’s-WAHA Partnership, described the thought process that sparked the project. “The idea was… what if we were to move from just having a clinical relationship, [to] having an educational relationship. [Queen’s] learners have always gone with physicians doing work up there, but could we actually deliver training programs in the community there that would recruit youth from those remote northern communities, so that they could be trained in health education, in the context in which they would ultimately move out and practice.” Dr. Jane Philpott, Dean of the Queen’s Faculty of Health Sciences, recalls first pitching the idea to WAHA CEO and President Lynne Innes and her team in November 2020 and their “enthusiastically positive” response. WAHA’s trust for collaboration with Queen’s on this project was importantly catalysed by their successful past clinical collaboration. Co-creation between WAHA and Queen’s Health Sciences during the following two years yielded a plan for the Queen’s Weeneebayko Health Education Partnership, which would be financially supported by a gift of over $31 million from the Mastercard Foundation. The partnership was officially announced in Moosonee on February 28, 2023.
Under the Health Education Program, WAHA and Queen’s Health Sciences will co-develop a curriculum for health sciences education in the region. It will be designed to prepare members of these communities for careers in not only medicine and nursing, but also in physiotherapy, occupational therapy, midwifery and paramedicine. The initiative will also implement a Health Career Pathways Program to inform, encourage, mentor and otherwise support First Nations youth interested in pursuing opportunities in healthcare by preparing them for post-secondary education.
The program follows a hub-and-spoke model in which the main training campus – the “hub” – will be in Moosonee, and regional sites – the “spokes” – will reach out to the other WAHA First Nations communities. This nuanced decision not to designate the Kingston campus as the hub “changes the positionality of Queen’s with respect to the education programming that will be delivered” by relieving the cycle of dependency. Instead, it bestows greater ownership and autonomy to the communities served by WAHA. As a health authority, WAHA cannot grant diplomas to certify graduates. Queen’s is a degree-granting institution, which is why – although the campus will be located in Moosonee, and all training will occur there – it must be officially considered a “Queen’s campus” to satisfy governance rules. However, in the proposed plan, “Queen’s Health Sciences functionally will be a partner on the side… [which] makes it much more of a partnership, a bilateral relationship in which we can support each other in delivering education” says Dr. Taylor. The program also demonstrates active commitment to preventing undertones of white saviorism in that its structure and curriculum will be developed in collaboration with WAHA, and informed by First Nations’ knowledge and cultural teachings. Course delivery for nursing and health sciences education is expected to begin in 2025 with 60-student cohorts for each discipline.
Insofar as federal and provincial government involvement, Dr. Taylor mentioned that preliminary engagement revealed clear interest. However, he cautions that there remains “a lot of work that has to be done to really ensure that we’re able to bring the government effectively to the table in a way in which they don’t just support [the project] in sentiment, but they support this financially.” The government may, in some ways, view the Queen’s-WAHA partnership as a pilot project, and gauge its success to evaluate whether this model can be adopted in other communities and provinces.
The Queen’s-WAHA partnership is exciting, and shows promise in increasing equitable access to high-quality, “culturally safe” healthcare for First Nations communities along the western James Bay coast. While Queen’s will play a continued role in health education delivery in the Weeneebayko region, the eventual goal of the partnership is to relieve these communities of their dependency on Kingston, and instead empower them with a locally sourced, locally trained healthcare workforce. To quote TRC Chair and Queen’s Chancellor Justice Murray Sinclair, “it offers hope for reconciliation through new approaches to educating and supporting Indigenous youth… I believe this can help deliver the transformation needed in Indigenous health care in Canada.” The fundamental essence of the Queen’s-WAHA Education Partnership is succinctly conveyed by Justice Sinclair’s famous 2015 statement:
“Education, or what passed for it, got us into this situation, and education is what will lead us out.”
Thank you to Dr. David Taylor for sitting down with Inquire to provide information for this article.
Clark, M. (2010). Moosonee Town Map. photograph, Moosonee.
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