Cree health and social services are at a critical stage. Budget cuts are looming and there is a high turn-over rate due to the large number of non-Cree professionals. Also, there is the challenge of getting a more Cree approach into the health care system.
James Bobbish has guided the Cree Health Board through these challenges since last September, when he became executive director responsible for administrative services at the health and social services board. Fresh from attending the opening of Ouje-Bougoumou’s new health clinic on April 8, Bobbish spoke to The Nation about the challenges ahead.
The Nation: What expectations did you have coming into this job?
James Bobbish: I knew there were a lot of challenges being a person from Chisasibi and also because of the high profile the Cree Health Board has in the community and the expectations of the communities being served and my knowledge of the situation by being close to the Cree organizations. I understood the job was going to be a real challenge.
Do you enjoy the challenge or has it become frustrating as it went on?
The nature of the job is challenging to start with and it would depend on people’s personal outlook and commitment as to how they would deal with those challenges. Some people would find it frustrating. I think I’ve been around enough of the types of jobs that require responsibility and the need not to overreact to situations. There are a lot of what people would consider surprises and unusual situations in a job like this.
What was your perception besides it being a challenge? Did you come in saying you were going to make all these changes and then found out it wasn’t actually like that?
First, I came in with a sense of challenge but also at the same time I still think there is a need for some real changes with the organization. I would say not only with the organization, but with people’s approach and in how the communities deal with their own responsibilities in terms of health.
I think one of the first things we had to deal with is stabilizing the administration because there had been quite a few departures within a very short time. Also there was a need to control expenses. Those goals are still there and I think we have put in some stability.
So now that you have some stability, what are your goals for the future?
It was stabilization on a short notice, but there is still a need for development. We figure that to be a real challenge because the government policy at this time is going for some very significant cuts in the budget and as a developing organization we feel we’re not able to keep developing if we have such cuts in our budget. There has to be a stand not only by the board, but by Crees in general as to how they will deal with these new government policies.
When we look at health care, the Crees as a society had their own way of dealing with health problems. How do you keep a Cree perspective within an organization that big?
At this point, it’s very hard to do things based on a Cree perspective. But certainly that perspective is there because we hear it all the time from the communities and individuals. The system was set up in the South, and we’re starting to realize that those policies that are developed and given to us without a community-based approach are not successful to a large extent. We feel there has to be a look at what we would consider to be a Cree approach to giving health and social services, which would call in the social and cultural perspectives.
But if you were to ask me today what is the Cree approach, it would be very hard for me to answer because we need input from the communities and Cree Nation.
You mentioned that the Cree Health and Social Services Board is at a critical point in its development. Does that mean the current system is not geared to providing the services people need in the communities?
We’re facing some very serious concerns by the communities because they feel we are not responding to those needs. About 98 percent of our professional staff is non-Cree or non-native. These people are competent in their own right and that’s why we hired them in the first place. But the manpower is stretched to the limit, and we have a lot of people who are doing lots of duties beyond what they would normally do.
So if you were to make changes in how the services were delivered, would the present budget cover it?
With the present budget, we have been making some modifications to how we structure our service. But to be honest, there have to be additional resources.
What are the guarantees in terms of the budget in the James Bay Agreement? Is it indexed to inflation?
The budget itself is a very serious consideration for us. In the James Bay Agreement, there are no specific provisions that say what we’re supposed to have from year to year. We’ve done a calculation which takes into account what should have been the starting base of operations and the indexation. We found we are about $10 million short of what we need to operate.
Do you reach an agreement with the government on a year-to-year basis?
There is no agreement about the budget on a year-to-year basis. The budget is decided by the government and we actually have to wait for them even shortly after the fiscal year begins to see what we’re going to get. If they tell us we have to make some cuts in various sections of our budget and we say we can’t afford to live with that, then they say we’ll wait until you’re finished with that exercize. Otherwise, the whole budget process doesn’t move and the money is not released.
So what would you like to see in terms of year-to-year operations?
I think if we as the Cree people say we want to establish our own system of health and social services, we would have to do a very in-depth exercize of what are the needs, based on a good understanding of the health and social services situation in the Cree communities. And from there, I think we would be able to come up with a good calculation of the required resources.
I think also we would have to get away from a strict calculation of indexation that is exercized in the more southern regions, because the cost of living in this territory is much higher than down South.
Is it more expensive to provide health care per capita in the North?
I would think it’s much more expensive to provide health and social services in the North. A lot of the costs are related to transportation which you would not find in places where there are specialized centres close by. We rely on emergency medevacs or even transportation from airport to airport. And then there’s the added dimension of having to evacuate people from their hunting grounds.
Also, staff hired from the South has extra benefits because of the isolation.
Is it tough to get some people to come up North?
We’re having difficulty recruiting people for several reasons. I know some people have declined to work for us because
our lodging facilities were not adequate. And there are some people hired who would work well in another situation, but cannot get accustomed to living in places like the Cree communities. So it takes them a few weeks or sometimes even
months before they realize that they’d like to go. There is a high turn-over rate for our staff, and there are additional costs related to that because we have to do a lot of recruiting, and that costs a lot of money.
So what would you say to a student reading this who was going into health?
I would say there are lots of opportunities, especially in the professional fields in health and social services in the Cree communities. It doesn’t mean that when they do have those jobs, it would be easy. The nature of the job is very tough and the demands are high. It needs commitment. I don’t think it’s only because a person is Cree that they are able to meet all the requirements of the work.
But by and large, I think to come up with a system in the future, more people will have to enter educational fields in the health and social services area. This would lower the turn-over rate. There would be a closer social and cultural understanding of clients. And also, the living costs we pay right now for non-natives would not be as high.
When you talk about Bill 120 [Quebec’s recent health and social services reform], what came out of the meetings with the board of directors?
We have discussed the question at the last two board meetings, and our primary concern is that we don’t feel the Crees should be stepping into a new realm of legislative conditions before we have fully answered what are the government’s obligations under the James Bay Agreement.
Are you going to be affected negatively by this bill?
If they don’t take into account the level of services in the Agreement signed in 1975, we would have to rationalize our budgets before our organization has become fully mature. To become mature, it will take another 10 or 15 years because of the high ratio of non-Cree to Cree staff.
Also, the legislation would make it very tough for us to get into the exercize of establishing what are the social and cultural aspects of health and social services for the Crees.
There is only one person in the planning department and one person in human-resource development for the whole Cree Nation. Where would you like to see that going?
The board would like to see the planning department have at least five or six people, and at least five or six people in human-resource development.
Just because we have a small number of people in the organization and the population doesn’t lessen the overall responsibilities on the services we have to deliver. The whole spectrum of needs is there.
What are your priorities for the next little while?
First of all, in order to do things effectively, you need adequate staff. For us that is the main issue so we can get the major establishments we would like to see in our territory, like rehabilitation services for person with intellectual or physical difficulties.
We also need to establish programs such as mental health, service centres for the elderly and a more comprehensive drug and alcohol program. We would also like to see a centre for the youth in the territory.
We are talking about the possibility of incorporating some traditional medicine into our programs, and we are concerned at the same time about adequate medical and dental manpower in the territory.
So there is a lot to consider. But it starts with having a solid organization.
We are still a few steps away from getting an understanding of how to do that, considering the rationalization the government is putting in place right now.