Indigenous-led partnerships boosted vaccinations province-wide
- NC Raine | July 26, 2021
At the tail end of 2020, Neil Sasakamoose wasn't optimistic. In fact, he felt defeated. Sasakamoose had lost his father, hockey legend Fred Sasakamoose, in late November, weeks after Fred was diagnosed with COVID-19.
People were negligent of the health guidelines, Neil said, and with a vaccine only a couple months away, he knew the loss could have been prevented.
“I was really frustrated with people,” said Sasakamoose, the Executive Director of Battlefords Agency Tribal Chiefs (BATC).
“Once he passes, I kind of give up. I just start telling people, 'if you don't believe in it, then go out and get it.' My father was 60 days away from getting a vaccine.”
According to his son, Fred Sasakamoose died without any family by his side, as health protocols prohibited visits from family and friends. Sasakamoose died November 24, 2020, at age 86. The family had to wait 10 days before they were able to have a small funeral.
Then, after the Christmas break, Neil had a realization.
“I came out of a dark place. I remember thinking, 'I don't want people to go through what my family went through.' It effected me so much because I was in a position to help people get their vaccine, to promote safety.”
It was around that time, in January 2021, that Saskatoon Tribal Council (STC) Chief Mark Arcand, Prince Albert Grand Council (PAGC) Chief Brian Hardlotte, Jocelyn Andrews from Indigenous Services Canada (ISC), and Sasakamoose began exploring the idea of a partnership that would bring vaccination clinics into large urban centres for Indigenous people.
As of late July 2021, three vaccination clinics operated by STC, PAGC and BATC, have administered more than a combined 50,000 vaccinations. The partnership, known at the Central Saskatchewan Indigenous Vaccination Sites (CSIVS) and the clinics it hatched, have been an overwhelming success. At their peak, all three clinics were vaccinating about a thousand people per day.
As Saskatchewan prioritized first vaccine recipients by age, as well as those living on-reserve, the tribal council clinics were originally conceived as a way to fill the gaps for Indigenous people off-reserve.
“The pandemic was scary because it created problems we didn't know how to solve. I didn't have an answer for it. We just started working together in trying to become part of the solution,” Arcand said. He started by doing what he's known for: negotiating. Arcand called Saskatchewan Health Minister Paul Merriman to present him with an idea of establishing a vaccination clinic for the approximately 26,000 Indigenous people in Saskatoon. The facility would operate as any other within the Saskatchewan Health Authority (SHA), with the same rules, standards, and regulations. The only difference is that it would be operated by Indigenous people.
“Minister Merriman knows when I say I'm going to deliver, I'm going to deliver,” Arcand said.
“We basically sat down and had a conversation on how we were going to make this happen. To this day, Minister Merriman is hearing nothing but praises about our (clinics).”
CSIVS partners set a basic principle to keep things consistent: services would overlap for all members of each community. So, if someone from Saskatoon happened to need a vaccination in Prince Albert or North Battleford, they'd be covered.
Upon receiving the green-light, and operational funding from ISC, based on a proposal from Arcand, STC needed a site, staff, immunizers, and vaccines to make the clinic a reality. For the site, Arcand had an in at the city's largest arena, the Sasktel Centre, where he serves as a board member.
“It was probably one of the best facilities we could have used. It was one way in, one way out. We could use private suites in order for people to have their own privacy. It was on the main level, so we could use a golf-cart to transport the elderly, both Indigenous and non-Indigenous.”
To make the clinic function seamlessly, they created a team of operational staff: greeters, temperature takers, flow workers, and registration workers. Arcand hired all Indigenous, post-secondary students from within the province, while nurses and immunizers were provided by SHA.
They had a two-day orientation to get everyone up to speed.
“We had about 40 staff on the operations side, and about 15 to 20 immunizers, so we had about 60 people on the same site, working for the same cause. We had practice rounds where we kept running through every stage, over and over, until we had a well oiled machine,” said Dalyn Bear, Project Manager for the Saskatoon site.
As of April 1, the opening day for the CSIVS clinics, Saskatchewan had delivered more than 191,000 doses, the majority of which were given to those over 60. With demand for vaccinations high, Saskatchewan lowering the minimum age to 58 on April 2, and the SHA ready to supply the vaccinations, the tribal councils decided they would offer vaccinations to everyone, Indigenous and non-Indigenous.
“It was exciting to have people come to our reserve,” said Shirley Woods, Director of Health and Social Development at PAGC, who ran the vaccination site at the Chief Joseph Custer urban reserve.
“I know some people have never been to a reserve. The site brought so many people to this integral part of the community,” she said.
In March, thanks to an agreement with SHA, the PAGC started doing about 20 vaccinations per day at its main health office. On April 1, with funding also secured from ISC, they expanded operations, moving to the Senator Allen Bird Memorial Centre on the urban reserve, with appointments scheduled through the SHA booking system.
“We wanted very much a place for our urban First Nations people where they would feel comfortable, where they would be familiar with,” said Woods. “Being on the (urban reserve), and our facility being used for a number of different events, this would have been familiar to people. We wanted it to be very friendly and open.”
BARRIER AT BATTLEFORD
While the vaccination sites in Saskatoon and Prince Albert were brought to life with very few snags, Battleford was another story.
“It wasn't easy,” said Sasakamoose. “There was big resistance at first.”
Like STC and PAGC, Sasakamoose and BATC had support from ISC, but unlike those, BATC could not, for reasons that remain unclear, get authorization for the clinic from their regional Chief Medical Officer, Dr. Mandiangu Nsungu.
As a vaccine is a publicly funded medical product, it is administered only in certain medical environments and under authorization. All public medical practices happen through a regulatory process, and have a set of ethics, standards, and authorizations needed. Even the immunizers must have proper credentials. So, as the vaccines were provided by the SHA, authorization for their site was critical in every aspect of their project.
“The Chief Medical Officer would not endorse that site. He still hasn't, to this day. I have no idea why,” said Sasakamoose.
“From those health professionals, from the bureaucracy, it wasn't easy. They had no argument against it. They didn't even put a dollar into it, it was all funded from the federal side.”
The vaccination site needed authorization and coverage from SHA to open.
Sasakamoose went to the regional health officer for ISC, Dr. Ibrahim Khan, as the vaccination site would not have the authorization and coverage from SHA regional Health Officer it needed to open. But Khan's jurisdiction is primarily for First Nations people living on-reserve. The clinic would be vaccinating individuals both Indigenous and non, off-reserve.
Dr. Nsungu was on vacation until August 3 and not available for an interview at the time of writing this article.
Somehow, Kahn solved the problem.
“That Dr. Kahn – I can't say enough about him. He phoned me one day and said, 'Neil, I'm going to do it.'” said Saskamoose. “I don't know how but he authorized the site.”
“ISC became our Medical Officer, which is unheard of. It breaks all the rules. They're not supposed to offer their insurances off reserve, they don't have that jurisdiction. But they did it for us. Whatever amendment or policy change they needed to do, they did it for us.”
In an interview with Eagle Feather News, Khan explained that all medical officers working in Saskatchewan are designated by the provincial health minister and the chief medical health officer of the province. As such, they have cross-coverage, and Khan – as an ISC health officer – will cover for other medical health colleagues when he's on call. He has worked with Nsungu in the past, providing coverage for the Battleford Sexual Health Clinic.
“In Saskatchewan we are very lucky, we have a very integrated public health system,” Khan said.
“The urban clinic in Battleford is nothing but a marvellous success story from A to Z. Nothing in the pandemic was easy or simple. Everything was being done for the first time.”
The difficulty Sasakamoose and BATC faced getting authorization from their SHA health officer, might have been a question of time, Khan said.
“All of these sites were operated on the same premises, the same principles and regulations. I would say one thing: for every jurisdiction, people take time to understand in what sort of authority or premises a particular service will be provided, and not everyone is at the same pace of the First Nations health and the First Nations cultural understanding, and sometimes it takes time to understand. The success of the sites tell you it went smoother, but no work we did in this pandemic was easy in the beginning,” he said.
“It took me a while to understand what I can do to support my First Nations communities in a better way. Every jurisdiction needed time in their understanding,” he said.
While Saskatoon and Prince Albert had partnerships with their regional Medical Officers, North Battleford was authorized by a federal public health officer. As such, the BATC vaccination clinic became the one and only tribal council site that operated as a federal vaccination clinic.
“Maybe they thought, 'okay it's not our responsibility, it's an Indigenous site'. We have no idea what it was, we never got an explanation. What it did, though, it spoiled a relationship between a tribal council and them. We have a health division, but its spoiled our relationship,” said Sasakamoose.
THEY CAME OUT IN CARLOADS
Once open, the tribal council clinics could barely keep up with the demand.
“When we opened these sites, we were only given about 125 doses per day,” said Paul Ledoux, Project Lead for CSIVS.
“We were sometimes administering 125 vaccines within the first couple hours. So what do you do with the rest of the day?”
The partners petitioned SHA to provide more vaccines. Within a few weeks, the clinic in Saskatoon went from 125-150 doses a day, to 300, to more than 1,000. Similarly, the clinics in Prince Albert and North Battleford were seeing an immediate spike in immunizations.
“We just wanted to get vaccines in people's arms. It didn't matter what type it was,” Woods said.
As news reports about the AstraZeneca vaccine causing blood clotting issues in rare circumstances, public concerns needed to be addressed.
“When the SHA asked us what kind of vaccines we wanted, we said Pfizer,” Arcand said. “We tried AstraZeneca once, but there was no uptake for it. It was a really good for (SHA) to see our deliverables on the vaccinations, because so many people were coming to get it, so we continued to get Pfizer from day one,” he said.
Soon after the clinics opened in April, the Métis Nation-Saskatchewan (MN-S) joined the CSIVS partnership, participating in the weekly meetings, informing their citizens on how and where to get vaccinated, and contributing funding for the operation of the three sites.
Administering vaccines in culturally appropriate, welcoming, and inclusive ways was integral to operations at each clinic. At each site, MN-S had a visible presence for their citizens, with flags, posters, and sashes.
“I was looking at social media and saw some people who were Métis taking photos by the Métis flag and sash after receiving their vaccine,” said Adel Panahi, MN-S Director of Health.
“It is important for everyone to feel welcome and represented. This is based on partnership. It's not just First Nations, it's not just general public, it's for us all,” said Panahi.
In Prince Albert, PAGC made sure there were always Cree and Dene speakers on site and had translation services in 10 different languages, including Mandarin, Hindi, Arabic, and Finnish.
All facilities were regularly smudged, Elders were present for support, and visitors at each clinic left with nîkihk gift boxes – a new line of cleaning products created by BATC with locally sourced, natural products. In Prince Albert, the required 15 minute wait after being vaccinated was filled with TV episodes of Who Wants to be a Millionaire?
“It can be a bit boring sitting there for 15 minutes,” laughs Woods. “So we even have surveys. About 95 percent were completed, and we received so many positive comments and thanks.”
In Saskatoon, as temperatures around the province were setting record highs, Bear was ensuring everyone was properly cared for.
“We ordered wheel barrows, filled them up with ice, and took water around to people waiting. We had vulnerable people waiting - people in wheelchairs or with babies. So I had my staff let them know that we could get them in right away. We don't want vulnerable people standing there in the heat. And we did everything we could to make the more healthy people comfortable as well.”
Each clinic also rented vehicles to give rides when needed. In Saskatoon, five vehicles made as many as 16 trips to and from the arena per day.
“I've got a stack about three feet high of thank you notes from individuals who evaluated our site. It was nothing but positive responses,” said Arcand.
Despite not having authorization from the SHA, Sasakamoose said the Battleford site became the “go-to” site in the area. As of July 16, it had administered more than 11,000 vaccinations, about three-quarters of which were given to non-Indigenous people.
“Everyone came to our site,” said Sasakamoose. “The non-First Nations people would come in carloads.”
“When we host something, we make sure it's special. Something like this, it's a ceremony. Everything about it should be inviting, clean, secure, warm. That's what non-First Nations picked up on coming into these sites. It's like a womb. Inside there, you feel safe.”
OUTSIDE THE CLINICS
Senator Allen Bird Memorial Centre is roughly three kilometres from central Prince Albert, the Dekker Centre is about four kilometres from central North Battleford, and the Sasktel Centre about ten kilometres from downtown Saskatoon. So while many had access to the clinics, and transportation was provided when needed, outreach services were implemented by each tribal council to ensure vulnerable people weren't being overlooked or left behind.
While the MN-S directed its citizens to the nearest tribal council clinic, it also opened its own, temporary pop-up clinics at its Saskatoon office.
“We had citizens in their 60s and 70s who should have been vaccinated earlier, but no one had called them. So we called them, asked if they wanted a vaccine, and brought them to the clinic. In some cases, we were even sending taxis to pick them up,” said Panahi.
The clinics, which ran two days in April and two in June, administered 584 vaccinations to MN-S citizens and their family members, with most walking away with gifts, including sashes, sanitization kits, lanyards, and bannock.
“People were so appreciative,” said Panahi. “At both (MN-S and tribal council sites) we provided vaccinations for individuals who might not have been comfortable in healthcare systems. We provided a culturally safe and welcoming environment for them.”
In Saskatoon, SHA mobile units set up in strategic spots such as the Lighthouse homeless shelter, while in Prince Albert, PAGC sent vehicles and outreach nurses to the river bank, a grocery store parking lot, and the University campus to offer vaccines to transient people.
“The reaction was really good,” said Anthony Blackburn, lead nurse of the PAGC outreach program.
“People were very curious when we got there, and very willing to have doses of immunizations. The big fears were that they wouldn’t be accepted at shelters (if they weren't vaccinated), so they wanted to get it done.”
“One letter we got complained that we should have been playing country instead of rock music,” laughs Arcand.
Aside from variations in musical taste, misinformation and fear were a challenge for the clinics during their four months of operation, Arcand said.
“I had protesters coming to my office saying that we're killing everyone. And that it's just like the federal government used to do back in the day with chicken pox,” he said.
“Do you worry about the negativity? Absolutely. But how do you change their minds? You lead by example and show them its the right thing to do.”
Despite outreach initiatives, access to vulnerable people remained a challenge.
As of mid-July, Saskatchewan had administered 1.3 million doses, according to SHA data. About 63 per cent of Saskatchewan’s population had had at least one dose, and 51 per cent were fully vaccinated, according to the Government of Canada, ranking as the third lowest vaccinated province or territory, above only Alberta and Nunavut.
“One of the biggest challenges was access to our most vulnerable, at-risk population. We advertised and marketed the sites, and had mobile units, but finding those vulnerable individuals (was difficult),” Arcand said.
The other challenge, particularly early on, was obtaining enough vaccines. The site in Saskatoon often exhausted its supply of 150 vaccines by mid-morning, said Ledoux, so they were regularly pushing the SHA to supply as many as possible.
“I remember Dalyn Bear saying to them, 'you give us a thousand doses and we'll do a thousand doses,'” Ledoux said.
Panahi was disappointed with the lack of priority Saskatchewan placed on Indigenous people.
“Other provinces, like Ontario, BC, and Alberta prioritized Indigenous people, but in Saskatchewan, based on their own analysis and data, they based (those prioritized) on age,” said Panahi.
In Saskatchewan, vaccinations were made available to the elderly first and those on-reserve and in isolated communities with less access to healthcare.
“Because of the health disparities between Indigenous and non-Indigenous populations, and the mortality rates, the high chronic disease rates, it would be good to prioritize Indigenous populations in the time of a pandemic. Saskatchewan didn't do that, but the did on age, which was still successful.”
Vaccinations clinics in Saskatchewan, including the CSIVS in Saskatoon, Prince Albert and North Battleford will remain available through July.
By then the three sites are hoping to reach a cumulative 60,000 vaccinations, said Ledoux – a number significantly higher than the partnership’s original expectation. Opening up to everyone in Saskatchewan enabled more immunizations across the province and created a stronger sense of community.
“What we've done is build a bridge. When I look at how and why we did things, it was actually to be inclusive. Inclusive of how we can solve problems together,” said Arcand.
“It's shown non-Indigenous people that Indigenous organizations like STC are quality organizations. That's the biggest thing I kept telling people. We, as Indigenous people, have value and we can help people. This opened the eyes of a lot of people.”
About 75 per cent of those vaccinated at CSIVS were non-Indigenous.
“I think it shows that we're part of this community, we're able to help. As First Nations people, we're always giving, our hand, our doors, are always open. That's who we are,” said Bear.
“We're all human beings, we can all be affected by this virus. We can all pass it, it doesn't matter what colour you are. It doesn't matter what needle goes in what arm, we just want to get it done so we can all be safe,” he said.
Partnership, communication, and support from the SHA, ISC and from the tribal councils and MN-S were paramount in bringing these clinics to life, they said. All had inspirations they drew from. For Neil Sasakamoose, it was the man COVID-19 took from him and his family.
“I always go back to the beginning of this whole pandemic, when my dad caught COVID-19. I really hope that the people who came in here, Indigenous or non-Indigenous, that their families were saved,” said Sasakamoose.
“Ten years from now, 20 years from now, when they're making documentaries about COVID-19, I'll remember. I'll sit back and remember how we helped.”