Debates of February 18, 2005 (day 39)

Thank you, Mr. Ramsay. Mr. Miltenberger.

Thank you, Madam Chair. I appreciate the Member’s comments. As indicated yesterday that as we move ahead with the document that’s going to deal with the facilities, flowing out of that will be the conclusion of the master planning for Stanton, as well as Hay River and Fort Smith. So there will be an opportunity to look at that and to have that input. As well, just to state the obvious to the Member, very clearly, as a department, officials in Yellowknife are tracking the discussion in this House and issues that are raised and commitments that we made for follow up and to identify as well concerns from this Legislature. So that will be noted as well. Thank you.

Thank you, Mr. Miltenberger. Mr. Ramsay.

Thank you, Madam Chairperson. I don’t know if the Minister has had a chance, but he probably knows this information anyway and maybe Mr. Murray as well, but the abortion rates are the highest in Canada in the Northwest Territories and this causes me some concern because Yellowknife is the only place in the Northwest Territories where women can get an abortion. I would hate to think that some women may be using abortion as a form of birth control and when you get up to the five, six and seven abortions, then you have to start to wonder if that’s the case. It’s costing the people that live here in the Northwest Territories and the Government of the Northwest Territories a tremendous amount of money to bring people into Yellowknife to have this abortion take place. I wanted to ask the Minister what our plans are in trying to address why the abortion rates in the Northwest Territories are the highest in the country. We’re 25 percent higher than even the next closest jurisdiction in terms of abortion rates. It causes me some concern because maybe we’re not doing enough in terms of educating our young people about birth control and safe sex and the like, and the cost of maybe not doing this type of education is having on our health care system. It’s obvious that it is having an impact on our health care system because the costs are there and it can be substantiated. So I’d like to hear from the Minister what his plans are to address these abortion rates and what steps we’re going to take to try to address this. Thank you.

Thank you, Mr. Ramsay. Mr. Miltenberger.

Thank you, Madam Chair. Madam Chair, this is a companion issue or a related issue to the issue of the STIs and the statistics that we were talking about in this House as well. The issue of unprotected sex is not just an issue of disease; it’s an issue of unwanted pregnancies. The plan that pertains to STIs will have a direct impact as well when you’re talking to young people both male and female.

The issue of abortion, which deals with the education issue, is an issue that’s dealt with between the doctor and the individual patient. We have no plans to place any strictures on that particular service. I appreciate the Member’s concerns. We’re going to focus on the education side, but of anything in terms of access to abortions or how many would be deemed to be appropriate at this point is not an issue that we intend to delve into. We’ve made the determination it’s an issue. There will be abortions available and it’s a woman’s choice, in discussion with her physician. Thank you.

Thank you, Mr. Miltenberger. We are on Mr. Ramsay.

Thank you, Madam Chairperson. The question that I’d have in terms of when a woman becomes pregnant if she’s from one of the regions, what kind of help does she get in determining her options? Is it the social worker, is it the doctor, is it her pastor? Who helps this young woman out in terms of what she’s going to do with her pregnancy? If they get pregnant and they’re not getting the support or advice that maybe perhaps they should look at keeping the pregnancy and seeing it through, or is it just the fact that the doctor or whoever they are consulting with is telling them to have an abortion and it’s okay, just go and have an abortion? What’s happening out there? Can the Minister give me a sense of what’s happening out there that our abortion rates are as high as they are? Thank you.

Thank you, Mr. Ramsay. Mr. Miltenberger.

Yes, Madam Chair, not wanting to be flippant, but clearly what’s happening out there that results in this of course is the fact that there is a lot of unprotected sex and individuals not practicing using birth control or appropriate methods to prevent pregnancy or disease and there is a distinct correlation to that activity in STIs and pregnancies. So you have to look on the individual basis. If a lady gets pregnant or a female gets pregnant, there’s no standard response. If there’s a situation that requires support and it’s a single mother or a very young lady then, yes, there are services there. But you asked what does the doctor tell the patient. Well, very clearly, that is privileged information between the patient and the doctor and they make the medical decision.

So there are services out there. It goes back to the issue of personal choice and education, in my opinion. Why there are so many abortions I think is tied into the education because people are careless, there’s alcohol involved, they don’t take advantage of the technologies that are available to prevent disease or pregnancy and they are readily available and so they pay a terrible price. Thank you.

Thank you, Mr. Miltenberger. Mr. Ramsay.

Thank you, Madam Chair. The stats don’t lie and they’re something that the Minister and the department can track on an ongoing basis and I think education is the key thing here. I know the Minister spoke of what really is happening out there and maybe we aren’t doing enough to promote the healthy lifestyle, the safe sex and the like. What are the plans from hereon, from today? We know our rates are at least 25 percent higher than the next closest jurisdiction. What type of performance measurement are we going to use to see if we’re making any headway here, because obviously we’ve got a long way to go with our abortion rates being the worst in the country? I’d like to hear from the Minister what his plans are on educating the people that live here, especially the young people about abortion and about healthy lifestyles so that we don’t have the highest rates in the country. Thank you, Madam Chairperson.

Thank you, Mr. Ramsay. Mr. Miltenberger.

Thank you, Madam Chair. Madam Chair, of course the direction that the health numbers are traveling will be our biggest outcome and are measurable. With regard to over and above what we are attempting to do right now, one of the proposed uses of the federal money is to put an additional $1 million towards prevention and promotion activities to deal specifically with issues related to youth, active living, healthy living, right choices, education on all those critical personal choice items that we’ve talked about extensively in this House. Thank you.

Thank you, Mr. Miltenberger. Mr. Ramsay.

Thank you, Madam Chairperson. I know one of the better educational tools that I’ve seen is the Don’t Be a Butthead campaign and that the department and the anti-smoking advocacy groups have come up with in the past few years in trying to educate young people about the dangers of smoking. Perhaps that’s something the department could look at. I don’t know if you go out and find a super hero for safe sex like “Condom Man” or something like that, but you could look at doing something like that, Mr. Minister, in trying to educate young people on safe sex and try to get a handle on where our abortion rate is and where we are going with that. I would suggest something like that, a campaign of that nature. Thank you.

Thank you, Mr. Ramsay. Mr. Miltenberger.

Thank you, Madam Chair. I appreciate the Member’s comments and suggestions and we’ll definitely consider them as we move forward in this area. Thank you.

Thank you, Mr. Miltenberger. Mr. Ramsay. We’re on page 6-17, the Department of Health and Social Services, directorate, operations expenditure summary, $6.182 million.

Agreed.

Agreed, thank you. Page 6-18, directorate, grants and contributions, contributions, $30,000.

Agreed.

Page 6-20, directorate, active positions.

Agreed.

Page 6-21, directorate, active positions.

Agreed.

Page 6-23, program delivery support, operations expenditure summary, $31.274 million. Ms. Lee.

Thank you, Madam Chair. I believe this is where we deal with the contracts for physicians. Correct me if I’m wrong. No? Okay, I will wait for the right area for that question, sorry. Here is also where I could, I think, speak about infections and diseases. Madam Chair, I know, from having been through a lot of briefings, that the GNWT also tops the national stats on the rate of infectious diseases, including sexually-transmitted diseases. I think this section deals with all of them. I know that the department is trying to increase their activities in this area and I think that the publication that was the subject of discussion here in the House was one item of that. Could I just ask for those who have the benefit of briefings, I think it is good that we don’t have as much of an increase and rapid growth in AIDS, luckily, but we do have upward mobility in all the other areas. I would like to know from the Minister what sorts of initiatives he has planned this year to address that issue. Thank you.

Thank you, Ms. Lee. Mr. Miltenberger.

Thank you, Madam Chair. There are some general directions laid out in the STI document that was in this House for discussion. It will better guide the services we have in place with nurses and social workers and public health nurses and the folks dealing on the frontlines in the communities with individuals, to be more vigilant and to be more assertive in dealing with the issue of right choices, safe sex, those types of things.

As well, we’ve indicated there is work going on with Education, Culture and Employment to revise curriculum. We have buy-in from the Dene Nation, the Status of Women and Native Women’s to work with us as we look at the communities to see how we can be more effective in promotion and prevention. We are also looking at the protocols that currently exist in the health facilities to make sure that we have the best protocols necessary to deal with the individual who comes in who may have an infection, as well as making sure that we can follow the contacts so we can try to be as effective as possible.

One of the issues now is it’s often difficult to get individuals to provide the contacts of their partners. It tends to grow exponentially if there isn’t that kind of extra work done to track down the other people who may be infected. The Member is very correct that we have escaped the rapid growth of HIV, but it has been more fortuitous and good luck than anything else. With the rates of sexually-transmitted infections, it is statistically a growing issue that may be upon us. Thank you.

Thank you, Mr. Miltenberger. Ms. Lee.

Thank you for that. I will be watching this issue and will pursue it at a later time.

I see on page 6-22 it says that this division is responsible for physician negotiations, vital statistics registration, acute and long-term care planning and other things. I just want to throw in here a question about the fact that the physician negotiations have been completed and the contract is good for the next four years. We know that the bargaining is going on between the government and the UNW that includes the nurses and other health care professionals. I wonder, because I am very intrigued by what the Minister had to say about configuring and looking at different ways of delivering different health care programs in the city that includes consolidating some of the clinics, I appreciate that this is at the very initial stages, but I did not get a clear picture of this. I know the Minister is telling us we have to wait until Cabinet has considered this, but that’s not good enough. In light of the fact that we are approving the budget for the whole department for the next year, this is setting out the work of the department and the government in Health and Social Services for the year and we should have some say in that. I think the government and the Minister have some obligation to let us know what’s going on.

Even if the whole thing is subject to approval, the Minister must have given thought to this. If there are any plans to consolidate or reconfigure health facilities in Yellowknife, I would think the Minister should be talking to health care professionals and doctors, the people who are on the ground having to live the changes. I would like to know what sort of consultation the Minister has done in terms of just talking to the stakeholders about looking at the flow of the patients and where the most demands are and how best these programs can be delivered. I am sure the Nurses' Association or Medical Association and every other health care provider in the city would be happy to talk with him about what they see as areas that the Minister should pay attention to. Could the Minister give me any idea of what kind of work he has done in that area? Thank you.

Thank you, Ms. Lee. Mr. Miltenberger.

Thank you, Madam Chair. I want to assure the Member that I just don’t sit in my office gazing out at the lake thinking what we should do today to the health care system. We work very closely with all the boards, all the CEOs, and the senior staff across the Northwest Territories. In fact, this issue of consolidation of clinics has been on the table now for a number of years, put forward by Yellowknife Health and Social Services. There have been the senior managers and other professionals brought to the table to deal with health issues who have discussed this issue already. What we are proposing now is somewhat broader than what was contemplated by Yellowknife Health and Social Services. Cabinet has yet to see the document I referred to; the Regular Members have yet to see the document. This work has been done by the authorities and the department collectively. We have a piece of work that is now ready to move forward. I want to assure the Member that it will be moved forward to Cabinet, to the Regular Members and then, clearly, there will be consultation as the plans are agreed to and the implementation planning is laid out in all these different areas. As I indicated, there are, I believe, 42 recommendations in the document and we will try to move on all of them and they will require consultation not only in Yellowknife, but in all other communities with all other authorities. Thank you.

Thank you, Mr. Miltenberger. Ms. Lee.

Just as a short follow-up, Madam Chair. I know that people listen to what goes on here just when we don’t think that they are. One observer e-mailed me to let me know that there was an ad in the paper, in News/North, asking for a tender to renovate one of the clinics, I think it was Great Slave Clinic. She heard the Minister in the House going back and forth about options of consolidating clinics and she wanted to know if there were any plans to consolidate these, then why are we renovating one of these clinics. For the benefit of the public and for me, could the Minister give some information on that? Thank you.

Thank you, Ms. Lee. Mr. Miltenberger.

Thank you, Madam Chair. Madam Chair, those of us at this table are unaware of plans to do any major capital projects. We know there is no money in the budget for that. Yellowknife Health and Social Services may be doing some required renovations, but they are, as well, fully apprised and aware of what is being contemplated in terms of possible consolidations. We will follow up with the chair and the CEO. Thank you.

Thank you, Mr. Miltenberger. Mr. Ramsay.

Thank you, Madam Chair. Maybe the Minister can help me too with this one; or Mr. Murray, perhaps. I know two of my colleagues have raised this issue; not this issue specifically, but the publication that just recently came out on STIs. Who made the decision to go from what was termed a sexually-transmitted disease to a sexually-transmitted infection? The reason I say that is because disease puts the fear of God into young people, if they think they are going to get a disease as opposed to an infection. If you go strictly on that, it’s counterproductive to start calling it an STI when most young people and most residents know it as an STD. I think the disease part of that equation really causes people to pay attention. If it’s an infection, it’s just an infection, so I will go sleep with this person or that person and not worry about it. So I think what we’ve done is backtracked on where we are going with promoting healthy lifestyles. Maybe the Minister could comment on that. Who made the decision to go to STIs as opposed to STDs? Thank you.

Thank you, Mr. Ramsay. Mr. Miltenberger.

Thank you, Madam Chair. There is a different definition between disease and infection. Dr. Corriveau indicated to me this is not an arbitrary, unilateral decision that we thought it would be more effective. My understanding is the current thinking in the field is a more accurate depiction of what we are dealing with is an infection as opposed to a disease, so that they are now referred to as infections as opposed to diseases. They indicate that that is the new terminology and that’s what we go with.

That’s really enlightening. Thank you, Mr. Miltenberger. Mr. Ramsay.

Thank you, Madam Chair. I guess even sexually-transmitted diseases have politically correct names nowadays. I suppose there’s a medical reason why it’s done that way, but I know most young people out there would certainly fear a disease much more than they would fear an infection. I will just leave it at that, Madam Chair.

That’s a comment. Would Mr. Miltenberger like to respond?

Thank you, Madam Chair. I don’t want to quibble with the Member. The change to STI is very, very recent. The numbers of what we are talking about in terms of what used to be STDs have been accumulated for many years when they were called STDs. So the disease label clearly didn’t really hold anybody back from unsafe sex practices, I would submit. Maybe STIs will, combined with all the other work we intend to do. Thank you.

Thank you, Mr. Miltenberger. Mr. Yakeleya.

Thank you, Madam Chair. The information that I guess I would be looking for from the Minister is regarding different physicians who come to smaller communities. We know that we wait five weeks to three months for some of the physicians to come into our communities. Sometimes people are out on the land or somewhere else and they don’t get to see that doctor that day or that week. Then they don’t see them for another three months. Mr. Chairman, is the department looking at putting some of the money towards Telehealth into our communities, which is a lot easier? I like the system. I know Deline has the Telehealth system. I am not sure if it’s fully operational because we don’t have doctors who come into our communities on a daily basis. We have them on a quarterly basis, every three months, if we are lucky. If the weather holds out and there is nothing wrong with the airplane and it can fly that day, they will come in. I think Telehealth is one good move that this government invested in. I would like to see somewhere in this budget that Telehealth will be introduced into the small communities that don’t have physicians visit them on a daily basis. Thank you, Mr. Chairman.

Thank you, Mr. Yakeleya. Mr. Minister.

Thank you, Mr. Chairman. Mr. Chairman, I agree with the Member and we are trying to expand Telehealth services. One of the issues that became clear to us is we had spent a lot of time on the technical system side and not enough time on the actual program development dealing with the services and systems used by health practitioners. We now have brought on board into the department a champion on the use of Telehealth. It’s not so much a focus on the system side, but making sure it’s used to its full capacity. We have done that, as well. There is money in the budget to continue the expansions. So we are committed to trying to make sure we use that resource to the best of our ability. Thank you.