If the recent H1N1 pandemic posed a challenge for Quebec health authorities, it was a double challenge for the Cree Board of Health and Social Services (CBHSS), which faces shortages of staff and facilities in most of the James Bay Cree’s far-flung communities.

Quebec was recently recognized as having the highest H1N1 vaccination rate of any jurisdiction in the world. But among Quebec’s 18 regional health boards, the CBHSS topped the vaccination rate for the whole province. “That means we had the highest vaccination rate in the whole world,” declared a proud James Bobbish, the chairperson of the CBHSS.

Bobbish and his staff will soon be better equipped to face these health scares, however. During a visit to Chisasibi February 3 and 4, Quebec’s Aboriginal Affairs Minister Pierre Corbeil and the provincial Health and Social Services Minister Yves Bolduc announced the roll-out of $58 million in funding for integrated health and social service centres in the communities of Nemaska and Eastmain, and the enlargement of facilities in Waswanipi and Waskaganish.

The Integrated Services Centres, or CMC, are called “Miyupimaatisiiun” in Cree, which, says Bobbish, means, “Being alive, well.”

“Basically, this lets us use a more holistic approach, from prevention to programming, all from a public-health perspective,” said Bobbish. “Among other things, we can now implement ‘one-stop shopping’ integrated services in other Cree communities and improve services such as access to dialysis and even introduce the use of tele-health technology.”

Among the advantages of this approach are the individualized care plans that can be designed to meet the needs of Cree patients. In the past, particularly with the federal nursing stations that existed in the 1960s and 1970s, Bobbish noted, there was a very narrow health model that didn’t take into account the social impacts on health.

This began to change once the Crees assumed control over their own health care under a public-health directorate. The CMC model is the culmination of this evolution in care.

The money derives from the $112 million 2005 agreement on health services that finally put an end to the part of the Coon Come lawsuit against Quebec for non-respect of Section 14, among others, of the James Bay and Northern Quebec Agreements. The table to negotiate the agreement was set up in 1999-2000. But it’s now being sold as a benefit of the 2002 Paix des Braves Agreement, which pulled the health negotiations into a global approach that included other issues.

Cree Grand Chief Matthew Coon Come emphasized that point in a press release, saying, “A tangible example of partnership of the Paix des Braves between Quebec and the Cree Nation to improve the lives of the people of Eeyou Istchee.” Likewise, for Corbeil, it is “proof that though our combined effort, Paix des Braves gives concrete results.”

Others could note that it’s an investment that is decades overdue. For Bobbish, it means that he can finally expand staffing at Cree health facilities. He said the CBHSS is operating at about 60% of its capacity simply because the Board lacks the physical infrastructure for the medical and social services staff that is needed in Cree communities.

Because more non-Cree health professionals will need to be hired for the new facilities, there is also a housing component for newcomers to the communities. But there are other needs that will require funding.

Bobbish noted that costs for materials and contractors have risen sharply since the health agreement was struck five years ago. This leaves holes in his plan for the communities of Oujé-Bougoumou, Chisasibi and Whapmagoostui.

In Oujé-Bougoumou, for example, Bobbish said the design of the current health building is such that it cannot be enlarged, which could necessitate the addition of a new facility. In Whapmagoostui, meanwhile, the Cree and the Inuit share a building with duplicated services – one side Cree, the other Inuit. The CBHSS and the twin communities of Whapmagoostui need to negotiate how a CMC could be implanted for the Cree who live there.

Finally, Bobbish says, there is strong support to bring back an obstetrics and midwifery unit for the hospital centre in Chisasibi, the largest Cree community in Eeyou Istchee. “There is high interest in bringing this about for the Chisasibi hospital, but all the money from the health agreement has been designated,” he said, noting that the CMC in Wemindji has been completed while Mistissini’s is currently under construction and will open in 2011.

Despite these problems, Bobbish is satisfied that progress is being made. The new facilities “will allow us to better respond to basic community needs,” he said.