Protecting Our Home Fires Strategy

Due to systemic racism, colonialism and intergenerational trauma Indigenous Peoples experience negative health outcomes. During the 2009 H1N1 pandemic, Indigenous communities experienced the highest fatality rates. To date, during the COVID-19 pandemic, hospitalizations among those with reported underlying conditions, such as those experienced by many Indigenous Peoples, is 6 times higher and deaths are 12 times higher than those with no reported underlying conditions.

In response, the recently developed “Protecting Our Home Fires Strategy” will be upscaled in conjunction with the following:

1. Prevention - community engagement and vaccine education; SARS-CoV-2 mobile testing; isolation support for individuals who test positive or are close contacts to confirmed cases; and; long term societal change (views on vaccines, pandemic/crisis preparedness); and 

2. Management - Knowledge Dissemination through provision and culturally safe adaptation of information on COVID-19; and

3. Capacity Building - mentoring and training locals up to support and lead the initiative.

In Saskatchewan, nearly half of all cases of COVID-19 have occurred in the far northern part of the province, despite only accounting for only 3 % of the provincial population. There are more cases in these northern communities per capita than anywhere else in Canada. Our proposal aims to solve the problem that Indigenous individuals are disproportionately affected by COVID-19 in Saskatchewan. This problem exists directly due to systemic racism, colonial structures and generations of inequality in service provision and support. 

Particularly, La Loche and surrounding north-west communities have faced an unprecedented crisis with the arrival of COVID-19 in that region. Other communities in the north-eastern part of the province including Sandy Bay and Pelican Narrows also remain vulnerable to the potential presence of COVID-19 cases within their region.

It has become evident that these communities require additional support in order to be adequately prepared for any subsequent waves of COVID-19. Issues such as insufficient local staffing capacity, infrastructure, requirements for local staff training and experience required for sustained response to the pandemic need to be addressed. Building local capacity, such as that included in our initiative, has high potential of retention and cultural appropriateness and effectiveness.

Secured trailers will be utilized in a combination of ways: as isolation sites for those requiring isolation support (e.g. confirmed case of COVID-19, close contact to a case, or presence of other vulnerability factors that impact their ability to safely self-isolate); as sites for testing and education delivery; as medical response units, and as stations for provision of other needs including food services.   

The testing trailer will be placed at a location that is determined by the community as appropriate, and separated from the isolation site; serving as both a location for testing, and education for those who present.  During the time of testing, COVID fact sheets, education around influenza immunizations and Protecting our Home Fires packages will be distributed and explained to each family using local indigenous languages if needed.  When a person is laboratory confirmed as positive, as part of the response and follow-up through public health, rigorous contact tracing will be undertaken to ensure that any close contacts are identified, isolated and tested as needed. Public health processes are already in place to coordinate and implement this work – additional resources including infrastructure and capacity building of local staff will improve the capacity in this area.

The immediate beneficiaries are the Indigenous communities of northern Saskatchewan; however, we anticipate ours will be a working model for other vulnerable communities throughout Canada and globally.

The potential impact on health security for all rural and remote Indigenous communities is enormous.  If our efforts mitigate COVID-19 outbreaks in these vulnerable communities who face several challenges including limited access to health care services, it could save lives of those in the community who have pre-existing conditions predisposing them to complications if they contracted the virus.  Providing testing opportunities and education around COVID-19 and vaccines will help to overall decrease the risk of acquisition and transmission of COVID-19 and support the planning for communities' pandemic and crises preparedness.  The isolation sites will provide immediate options for alternate shelter for those who are required to isolate away from their families. This isolation support will help to prevent community transmission/outbreaks.

The capacity building of community members to work within the testing and isolation sites will also be of great impact, increasing the employability of those trained during the response to this pandemic and in the future.This is especially important within these northern communities which have much lower rates of employment and education.

This is a direct response to the current COVID-19 pandemic and the health security of Indigenous Peoples in North Saskatchewan during this unprecedented time. Embedded within this process is planning for future pandemic and crises responses to ensure health security beyond this initial response.  The infrastructure established during this current response/initiative will ensure the capacity for much needed refuge/isolation during future pandemic and crises preparedness plans.  This is imperative as many North Saskatchewan communities experience overcrowded housing which makes physical distancing during pandemics almost impossible.  These communities are also often faced with displacement when fires and floods cannot be contained.

This is a responsive solution to community requests to be supported as high-risk populations during this pandemic.  Due to the unique challenges faced by these populations, we had to think outside of a typical response.  While we are being reactive in the La Loche areas with their high number of confirmed COVID-19 cases, we have also thought of ways in which we can be proactive within this area and others in north Saskatchewan (Sandy Bay, Pelican Narrows, and Batoche) for the inevitable second wave of the virus.  We are working with communities to do this work in a good way and ensuring Indigenous leads and the use of Indigenous Methodologies in all aspects of the solution efforts and collection, analysis and dissemination of any data.  We are currently working on setting up a community Elder guiding council for our efforts.

Since the northern communities started having COVID-19 cases, it has been recognized that individuals and communities have experienced stigma as a result. This stigma can contribute to hesitancy of people to get tested. Normalizing the testing process will help to reduce the associated stigma, as has been done in the past within these communities with diseases such as HIV and Hepatitis C.

The GeneXpert we will be using for testing offers a suite of systems that make on-demand molecular testing availabl to everyone with unprecedented speed and ease of use.  With the GeneXpert System, labs (such as our mobile testing site) no longer ned rows of equipment and extensively trained staff to deliver molecular results.  This system returns most test results in about an hour, including sample preparation which is faster than many alternative technologies such as EIA or Immunoassay.  The system patented cartridges also deliver unsurpassed accuracy across the broadest possible menu.  

In fact, due to the recent World Health Organization (WHO) endorsement of our systems, Cepheid is now making molecular diagnostics a reality, even in the most remote places on earth.  The decreased system footprint and consolidated testing design creates space-saving efficiency, reducing the need for multiple testing platforms. These new systems are also
designed to be stackable, for those labs where space is a particular issue.

These systems are a recognized technology and sold world-wide.

All North Saskatchewan residents, approximately 39,000 (https://populationhealthunit.ca) and potentially much of Saskatchewan (population 1.174 million).  As we get the virus under control in the north there is less chance of further transmission into other parts of Saskatchewan; significant travel between north and south communities occurs for a variety of purposes (health care, groceries, connecting with family and friends). 

However, the substantial potential for this model to be one for other vulnerable communities nationally and globally to utilize in their response efforts could be innumerable.  Especially due to the national and international networks of many members of our team.

Within the next year, our goal is to have very minimal COVID-19 positive cases affecting these vulnerable communities and for those that exist to be self contained and not be transmitted more widely.  We also aim to increase vaccine/immunization uptake in these communities through our education efforts in order to mitigate pre-existing conditions.  It is also our aim within this work to build capacity based on community needs and lead of the initiative.  Within the next 5 years, our goals are to continue to reduce community transmission of COVID-19 to a minimum, leave these mobile units for communities to be able to use for additional housing since there is a lack of adequate housing in their communities.  These structures can also be used as part of the future pandemic and crises plans as places of refuge or isolation for those in the north affected by fires, floods or future pandemics.  The continued building of local capacity with the aim of future employability is also a significant aim for this initiative to sustain over the next 5 years.

Infrastructure, adequate health care capacity, transportation, mental health vulnerability, stigma and funding are foreseen barriers which will be mitigated by engaging with community leaders and other stakeholders for solutions. Getting people to a test site and transportation of samples for processing are challenging; some communities who have faced stigma around disease may be less willing to report symptoms; pre-existing vulnerabilities and psychological impacts of testing or isolation may also present challenges. Also there may be significant difficulty to make change and incorporate cultural competency/humility into historically colonial structures that currently exist throughout health systems. Given the extensiveness of this initiative across various disciplines, it is difficult for our work to fit within some of the funding opportunities currently available.

• To mitigate the lack of infrastructure, we are currently working with Canada Mortgage and Housing Corporation (CMHC) to hopefully fund and establish mobile workers camps to temporarily be the testing and isolation sites and more permanently be housing and/or pandemic and crises response spaces.

• To reduce the impact of the lack of adequate health care capacity, we will be training local Indigenous Peoples to both build the community capacity, but also to help staff the testing and isolation sites.

• To alleviate transportation challenges we will be working closely with the community leaders for solutions.

• In response to mental health vulnerabilities and stigma we will be including psychologists, addictions counsellors and other necessary health workers to support in these areas of challenge.

• In response to the colonial structures, we will be led by the Indigenous Elders, Knowledge keepers and community members to express the need for systemic change.  We will also utilize the network of the influential Metis member of our team to push for change required.

Our planning team is made up of partners from North Saskatchewan Health Authorities, Indigenous Community Organizations, the Morning Star Lodge - Indigenous Community-Based Health Research Lab and the University of Saskatchewan.

Our planning and implementation team is made up of ten professionals; full time staff (health workers, cleaners, food preparation, etc.) will total 6/site, with a total of 18; part time staff (psychologist, researchers, educators etc.) 2/site, with a total of 6; Contractors (to move workers camps) 2/site, with a total of 6.

With our diverse team of doctors, public health, community health and epidemiology researchers, and a professor in pathology and laboratory medicine we are adequately equipped to plan and execute our responsive solution to the COVID-19 pandemic in high risk populations in north Saskatchewan.  All of us have either had extensive experience working with these and other communities like them, or live and work on the ground in these communities.  Many of the team have also been very successful in the dissemination of research-driven solutions to various challenges. 

The doctors working in the north with these communities have established relationships which is imperative to fully engaging the communities in this initiative.  The other members have students and RA's who can ensure the initiative runs smoothly by doing a lot of the behind the scenes work such as finding workers camps (infrastructure), organizing for infrastructure to be moved to the areas, purchasing and delivering required supplies, organizing training and so on.

Local health authorities such as Northern Inter-Tribal Health Authority and the Saskatchewan Health Authority are involved in the planning, implementation and dissemination of this project. 

Currently engaged partners are:

Northern Inter-Tribal Health Authority

Northern Population Health Unit (Saskatchewan Health Authority)

Saskatchewan Health Authority

University of Saskatchewan - Departments of Community Health and Epidemiology and Pathology and Laboratory Medicine

Morning Star Lodge - Indigenous Community Based Health Research Lab

SPOR-Primary Integrated Health Care Innovation Research Network, Saskatchewan

Metis Leaders Northern Medical Services

Community leadership

We are currently working to engage with:

*Community organizations 

Northern Medical services

*Since most community organizations are a challenge to engage with if not in person, COVID-19 restrictions have made this engagement a slower process than normal.

We do not have a business model.

To fund one of the largest aspects of our project, the infrastructure required, we have engaged the Canadian Mortgage and Housing Corporation to provide this funding.  Otherwise, we have been and will be applying to other funding opportunities as necessary to ensure this response is successful.

We are applying to Solve as we believe our work fits perfectly within the health security and pandemics challenge and within various UN Sustainable Development Goals.  While Canada is a first world country, our rural and remote communities do not have the same access to services as most of Canada's population and often are living in third-world conditions. 

Funding from Solve would support us to meet an immediate need as well as potential future needs of these vulnerable communities.  We also believe this work will be an exemplar for others who are facing similar circumstances globally.  A large barrier to our initiative is funding, especially in a timely manner as we try to respond effectively before the second wave of COVID-19 affects these communities.  We believe Solve, and/or the Solve networks can support us in at least getting this initiative off the ground so hopefully we will still have a proactive approach instead of only responding to crisis situations with this pandemic significantly affecting these very vulnerable communities.

Given that this will be a community-led process, and that our team is well-equipped to ensure the success of this initiative, at this time, we do not feel the need for partners or support other than funding.  However, we would be open to partnering with any Solve members who are willing to follow community leads on and add expertise to solutions to the current and future pandemic response.

We would be open to partnering with any Solve members who are willing to follow community leads on and add expertise to solutions to the current and future pandemic response.

Currently many rural and remote Indigenous communities are challenged by developing their own responses to the current COVID-19 pandemic and are reaching out for support.  We are responding to this significant need in a way that we hope is generalizable to other rural and remote Indigenous and high risk communities globally.  We are a diverse team with the background and experience to create a lasting, positive impact with these communities and potentially for other similarly vulnerable communities.  If others can pull together (like our team has with communities) to help those who are at a higher risk of experiencing detrimental effects of COVID-19 and other pandemics and crises, all of society can be impacted positively.  We believe we are qualified for this prize as we work in tandem with these vulnerable communities to set an example of how we can respond effectively and efficiently together to ensure the safety and health security of those affected most.  Our aim is for this work to be an exemplar for others who have the means to support those who are struggling, no matter what the circumstances.

Ensuring healthy, COVID-19-free lives and promoting wellbeing for all those in vulnerable Indigenous communities despite the various challenges which they face -, including limited access to adequate health services - is the main goal of this work.  We will do this by providing testing, community-based solutions, and quality, region-translated education about COVID-19 and recommended prevention measures. In addition we will provide targeted education about influenza vaccines, in anticipation of the upcoming influenza season. We will also be building capacity within these communities by providing training related to all operations that will be part of this initiative (including the testing and isolation sites which will require staffing). The aim being to employ as many local people as possible to staff these sites.  We believe that our innovative initiative will provide more equitable health care/services to these communities in the short term and in the long term more equitable access to adequate housing and emergency shelter options close to or within their communities.  We believe that all of these efforts fit within the UN sustainable development goals and therefore this project is an excellent candidate for the People’s Prize.