“Wash hands frequently” and “Self-isolate” for COVID-19 are akin to “let them eat cake” in Manitoba First Nations with Overcrowded Homes lacking piped water.

Blog by-  Thompson, S., Bonnycastle, M., Hill, S.

Emergency measures are deemed universally necessary to prevent the transmission and control of COVID-19. Around the world people are being told to: Wash your hands often, maintain physical distance, quarantine in your shelter, stay home from work and schools if possible, depend on digital communication technologies (WHO, 2020, Health Canada, 2020). Yes, these measures work to prevent the transmission of the virus, (WHO, 2020) but in communities with overcrowded homes that lack piped water and with no hospitals – are they a pipe dream?

This article analyzes the applicability of Canada’s self-help instructions to isolate-in-place and wash your hands to deal with health risk implications of COVID-19, considering the First Nation conditions of overcrowding, water, and other infrastructure problems. Asking people who have to ration water to wash frequently is like asking people who can’t afford bread, to eat cake.  And where do you isolate to – when you are sharing a small house with one bathroom among 10 to 25 people? NDP MP Niki Ashton, whose riding of Churchill-Keewatinook, includes many First Nations, voiced her concern “that the government’s failure to deal with issues around housing, infrastructure, and water quality have allowed conditions that increase the threat of a virus to persist… People are very concerned particularly around the issue of self-isolation,” she said. “If you do get sick, where would you go?” (Young, 2020). Where do you go in a community with overcrowding, no hospital, and for the 17 remote First Nation communities in Manitoba, no roads?

This is an extraordinary time, when the cracks in the fabric of globalized society have been exposed by COVID-19. So many systems, including the health system and the food supply system, have been seriously disrupted in many places. However, not only cracks but an abyss was visible in First Nation communities, prior to COVID-19, due to government underfunding of housing, water, education, roads, health and other infrastructure on reserve which has been compromising well-being for many decades (Palmater, 2019; Elash and Walker, 2019).

The H1N1 crisis sent a wake-up call in 2009 of the deadly impacts of pandemics without adequate infrastructure on First Nation reserves when one of Manitoba’s 17 remote fly-in communities, Garden Hill First Nation (population 4074 at the time)  (INAC, 2013) had hundreds of people sick from H1N1 and three of the 11 Manitobans who died from H1N1. The government’s immediate response to the epidemic was sending in body bags, but its long-term approach seems just as sadistic. Retrofitting homes with water and sewage cisterns provided a short-sighted, unsafe, and incomplete fix in Island Lake (and other First Nation communities) to deal with the health inequity problem. The difficulty in filling and cleaning cisterns presents quality and quantity problems and so should only ever be considered a temporary measure (Bradford et al, 2018; Thompson and Pritty, 2020). Many houses still use barrels, as at that time could not be upgraded due to the housing having a lack of electricity, a broken cistern, or structural issues (Harper and Thompson, 2018). See Graph 1 to show that 21% of 384 houses surveyed in Garden Hill in 2018 use pails for water and 27% cisterns (Barkman, Monias and Thompson, 2018). Based on this survey the CBC reported 180 households were without running water (Elash & Walker, 2019).

See also, CBC News Report on bad housing, water and Sanitation condition in Northern Manitoba.

 

VideoHousing crisis in Northern Manitoba reserves, Wasagamack First Nation.

Frequently washing your hands while rationing and running out of water.

Washing hands is important to prevent COVID-19, but what if you are rationing water or your cistern has run out of water? Rationing water is a necessity for many houses in the North (Norway House, God’s Lake, Wasagamack, South Indian Lake, Garden Hill, etc.) due to some homes lacking water service and others having water delivered to barrels or cisterns. This may explain many higher rates of viral infection and other diseases. For example, the rate of viral hepatitis infection, which is known to be spread by contaminated water and food, was almost universal (92%) by the age of 20 years in 315 inhabitants (27%) of a central Manitoba First Nations community (Minuk et al, 2003). This link of viruses to inadequate water supply is very concerning, pointing to the risk of COVID-19 spreading like wildfire in First Nations, being much more contagious than hepatitis.

Lack of water systems is linked to disease transmission (WHO, 2004). Without functioning faucets, sinks, and toilets, these First Nation people using barrels are at much greater risk from COVID-19 and other diseases due to this set-up creating unhygienic conditions. In South Indian Lake First Nation, a survey found 33% use barrels, that are not attached to any plumbing system for water that are less than 500 gallons, as either their cisterns were damaged or never installed (Thompson and Pritty, 2020). These families are at risk with very limited water supply delivered each week that may only last a few days, even with rationing. As well, in South Indian Lake First Nation, 47.5% of homes use “honey buckets” or “slop buckets”, with their houses having, instead of a toilet, a pail, that requires manual disposal. Community members typically dump this slop pail in the back yard, which provides an on-going source of contagion. Similarly, the 2018 survey in Garden Hill First Nation found 21% had no toilet, only honey buckets (Barkman, Monias and Thompson, 2019). Another 27% had cisterns for sewage of the 384 houses surveyed.

Cisterns, although larger, also provide a limited quantity of water to the home, with insufficient water trucks to keep up with the water demand and need to pump sewage (Harper & Thompson, 2018). For example, Norway House First Nation requires water to be delivered to cisterns for half of its homes, with problems of water shortages routinely reported. According to Chief Larson Anderson from Norway House: “About half of homes in Norway House are often left without water for one to 10 days, because of overcrowding and tanks that quickly run dry.” As well as quantity, quality of water is a concern, as cisterns are easily contaminated by soil, groundwater, as well as rodents, which necessitates regular cleaning, but without adequate budgets to do so (Lebel & Reed, 2010; IAND, 2006).  Contamination can occur at many points including initial treatment; during the transportation process; during transfer to barrels or cisterns; in a storage container as microbial growth occurs over time in the cistern; and by existing contaminants in the household distribution system (Bradford et al, 2018).  Clearly, this labour-intensive system to deliver water by truck is easily disrupted under normal conditions, but under emergencies, like COVID-19, this delivery system is a disaster waiting to happen. Despite this, only 2% of First Nation water systems have an emergency plan, or back-up plan (74% had no backup operator and no certification) (Neegan Burnside Ltd, 2011).

Award-winning presentations at the University of Manitoba’s fifth-annual First Nation water and sanitation security conference.
1. Lakisha Barkman[1],  Household water and Sewage Survey and program in Garden Hill First Nation PDF and  Video of Presentation.
2. Jerome Harper[2], Sewer and Water Retrofit of Housing: From Pails to Cisterns in Wasagamack, Island Lake  PDF and Video of Presentation.
3. See also – UM Today report on First Nations and students collaborate on cleaner water

The COVID-19 big picture in remote and rural First Nation communities

That these four Island Lake communities share only one helicopter, which they depend on for not only food at present but for medical evacuation of people out to the airport, creates a bottleneck that is going to cost lives and make food scarce. No hospitals and only one helicopter for 8000 people in the four communities of Island Lake places these communities at high risk. If they were required to evacuate due to fire or long-term energy outage– during that time heaven help them (Beardy, 2020).

COVID-19 response in First Nations

First Nations have declared states of emergencies to allow their First Nation leadership to put in place lock-downs and other ways of protecting their communities, knowing that the lack of infrastructure provided by the Federal government is a death sentence under COVID-19. Proactively, barricades were put in place in most remote Northern Manitoba First Nation communities in mid-March to limit outsiders coming in with contagion. Several teams have been working and collaborating to implement various measures to prevent a viral infection from entering the communities such as locking down of borders to outside travel from and to the First Nation reserves and forming local pandemic teams to implement prevention measures. Each First Nation has done this but calls for the Province to follow through on its promise to limit access to Northern Manitoba through Grand Rapids.

As well as implementing measures to prevent the COVID-19 virus from entering their community, First Nations in northern Manitoba are preparing in the case of an infection. First Nations have worked with the various levels of government, federal and provincial, and in some cases, municipal. Preparation measures have also been developed in the event of an infection in the community such as isolation sites, quarantine sites, transport plans of patients out of the community. As well, some measures and plans to protect the vulnerable, such as Elders, as well as young children and people with health conditions, like asthma and diabetes.

Through this whole process of prevention and preparation planning, weaknesses or gaps in the systems have become apparent such as non-First Nation resource developments and energy infrastructure projects not cooperating with First Nation people and communities. While such projects in mining and hydroelectric development have pandemic plans in place at HudBay mining and Keeyask in northern Manitoba, these entities are not being considerate of the risk they impose on neighbouring First Nation communities. These corporate projects have had poor communication with First Nation communities and have not taken seriously First Nation calls for a shut down of their operations during this critical time to halt the pandemic. These resource development projects continue to have workers travel in and out of northern Manitoba in the initial period of the pandemic and at the time of the writing of this article, have only begun to implement a two-week quarantine conditions for workers from outside of Manitoba with the new order under the Public Health Act. However, whether these measures will be adhered to or implemented remains to be seen. The impact of their approach of business-as-usual is evident in Northern Ontario’s Gull Lake First Nation, which started with six people having COVID-19 after 17 people at the nearby mine contracted it (Walters, 2020).

Physical distancing is how people in northern Manitoba survived in the past without immunity to European contagions. Northern Manitoba Anishiniwuk and Ininiw (previously described as Oji-Cree and Cree, respectively) were able to survive tuberculosis and other disease plagues with sustenance (food, fish, medicines, etc.) from the land and by applying physical distances through living on their traplines before they were forced into reserves (Thompson, Whiteway and Harper, 2020). Many are sending out hunters and fishers to their traplines to both provide physical distancing and obtain food from the land. The supports for wild foods (fishing nets, gas, seeds and tarps for living on the land) will help to provide continuous supplies of traditional food to people living on reserve and the land. With many skilled hunters and fishers in the community, as well as abundant wildlife and vast areas, wild foods provide an important, sustainable source of food, to supplement commercial foods.

So, rather than a one-size fits all unique resources and supports are needed to address the risks resulting from the impoverished infrastructure on remote First Nation communities to all people to isolate and remain healthy, housed, and well-fed, in addition to following healthy practices (e.g., isolation and handwashing). A few self-help actions to wash hands regularly and self-isolate provide limited prevention hopes for First Nations communities with critical infrastructure issues (Belanger, Weasel Head, & Awosoga, 2012). With higher rates of chronic diseases, domestic violence, and precarious access to the Internet – supports for a community-led plan are needed.

Policy recommendations

Lack of infrastructure on First Nation reserves have been dismissed as not a key government priority, but in contrast bailing out U.S. energy firm Kinder Morgan for C$4.5 billion for a dinosaur of an oil pipeline was. COVID-19 has shown us that the priority should be on people and that requires supporting vulnerable households, adequate health care from birth to end of life, and northern housing. COVID-19 crisis requires that we address the precarious housing, inadequate infrastructure, the lack of services, and the poverty on First Nation reserves, particularly remote ones. “If we do not address these inequalities, we will continue to find ourselves treating the symptoms and not the causes of vulnerability to pandemics” (The Conference Board of Canada, 2020). For example, cisterns were a bandaid for water delivery and has to be replaced with a permanent solution, as these systems are high risk for disruption and contamination.

In the short- term, First Nation leadership efforts to prevent contagions entering communities needs to be supported. The decision to lock down borders and erect barricades to limit people going in and out of First Nation communities has to be fully respected by outsiders and supported by RCMP and other levels of government. Preventing contagions reaching these communities until a vaccine is achieved is the key way to stop transmission of COVID-19. Preventing COVID-19 gaining entry is key as inadequate infrastructure does not allow many First Nation people on reserve to isolate at home and wash hands frequently and will allow COVID-19 to spread like wildfire. The Province has to follow through on its promise to limit access to Northern Manitoba through a Grand Rapids checkpoint to prevent outsiders coming through with possible contagion, including resource worker, after Gull Lake First Nation contagion of COVID-19 linked to mining personnel (Wallace, 2020).  Shutting-down HudBay and Keeyask Dam is required during this critical pandemic period, as their workers migrate across borders create undue risk. The lack of infrastructure and vulnerability of First Nations has to be considered in every decision by every level of government, which necessities non-essential services, such as HudBay and Keeyask Dam, in close vicinity to First Nations to shut down. The provincial and federal governments should create mechanisms to achieve collaboration among all service providers, for example, health, RCMP, mental health, and private industries.

As well, in the short term, special measures have to be put in place on reserve considering their lack of infrastructure. A funding application by Island Lake Tribal Council to provide gas for a 2nd shift of the water trucks, fishing nets for local food procurement and start-up funds for AKI Foods to deliver a food market approach to First Nation communities was recently turned down. Although this proposal was not deemed sufficiently innovative, safe water and healthy food needs to be supported during the new normal of COVID-19.

In the intermediate term, local capacity building that results in healthy, culturally-appropriate approaches to housing, food, and water is required. Funding apprentice programming in secondary schools on every reserve would help assist with the lack of tradespeople to build homes and infrastructure. Also, funding community-led post-secondary programs that build capacity but also houses and food security is needed. The Mino Bimaadiziwin Homebuilder program is building three houses in two communities while training 32 youth and an Indigenous Food Systems program at Brokenhead will not only grow food but also youth.

In the long term, enabling First Nations to govern their lives, communities, and territories under a self-government structure considerate of the huge value of the resources they agreed to share in treaties needs to be examined. For example, what is the water worth to Canada as a nation having benefited from the resource since the signing of treaties in the late 1800’s and 1900’s? The number in dollars is substantial and this can be used to set up water structures and systems that will serve the First Nations for all time as well as enable the people to govern themselves and determine their own destinies. Water, and the question of water access and supply to First Nations, may well be the catalyst that determines the dialogue that needs to happen in terms of governance and societal sustainability.

Conclusion

To conclude, in addition to the policy recommendations, there is one overriding recommendation for governments. Make “Stay Home” policy and “Wash your hands frequently” a true option for everyone in First Nations communities by supporting lockdowns and committing to supply adequate resources for First Nations to build local capacity and infrastructure for homes, water, and other necessary infrastructure.

For further information contact Shirley Thompson at 204-291-8413 or s.thompson@Umanitoba.ca.  

[1] Member of Garden Hill First Nation  & U of Manitoba,  Engineering Access Program student.

[2] Member of Wasagamack First Nation  & U of Manitoba Undergraduate student.

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