Mahsi, Mr. Chairman. Mr. Chairman, many people told us that our health and social services do not reflect their culture, traditions and healing practices. We heard a number of aboriginal residents, in particular, saying that they are even afraid to seek medical care because the system seems so unfamiliar to them. This seeming lack of sensitivity on the part of our own government is totally unacceptable.

Our system must be relevant to the people it is supposed to serve if it is to have any credibility and serve any meaningful purpose.

We heard of at least three ways in which the cultural sensitivity of our health and social services can be increased.

First, front line workers from outside the community should receive formal cross-cultural training before taking up their duties. This could ease the process of adjustment that workers and local residents experience as they become acquainted with one another. It could help workers gain the trust and confidence of local residents. It could give workers a better understanding of the traditions and practices that are important to the community. It may also lead these workers to serve longer in their positions within the same community. This could result in a more personal and positive relationship with local residents.

Second, our health and social services should include more traditional healing practices. It is an important aspect of treatment for many people. For example, a healing circle was offered to front line workers attending a recent conference in Hay River. The circle was so popular that a second one had to be added. Workers attending a conference from two Inuit communities were so impressed that they started healing circles in their communities when they returned home. Traditional healers report that they are swamped with requests for their help from communities across the north.

Finally, people support a program designed to increase the number of northern and especially aboriginal front line workers, government officials and students in health and social services. At the same time, we were told that this goal should not be pursued at the expense of the skills, quality and standards of care people expect of these services.

This can be achieved in part by developing career paths for northern personnel. Candidates could first be recruited into entry level positions. They could then be provided with the training, support and continuing education that would allow them to advance their careers.

We Heard That Our Front Line Workers Need More Support

Mr. Chairman, we heard many positive comments about the majority of our front line workers. Most of these men and women are seen as able, professional and dedicated to their work. They are clearly viewed as a tremendous resource in most communities. And a number of these workers have developed very strong ties to the people they serve.

Our survey of 280 front line workers revealed that 73 percent of them have lived in the north for 20 years or more. They have lived in their communities an average of 19 years. A typical worker has at least five years of front line experience and has been in the current position for about three years.

From information provided by the public and front line workers, it is clear that the people who deliver our health and social services face a number of tremendous challenges in doing their job. Here are just some of them:

First, they are asked to do much with too few resources. Most of their time has to be spent dealing with immediate crises or balancing the range of services they must provide. As a result, they have little or no time to conduct follow-up and prevention work. Most front line workers we surveyed said that this lack of resources was the greatest problem they face in performing their jobs.

Second, there is a concern over the kind of training they receive. We heard that better training might reduce the need for visits to the communities by various specialists. Front line workers themselves, identified the issue of training as the second greatest professional problem they face. They are concerned that a number of formal job descriptions may not reflect the actual needs of the community.

Third, people are concerned by the high rate of turn over among doctors, nurses, dentists and specialists serving their communities. This degree of change makes it difficult to establish effective health professional/patient relationships. Quite simply, people want to see more of the same health care personnel. At the same time, we heard that these workers would consider staying longer if they received greater support from local residents.

Fourth, workers experience "burn out." This is caused by heavy case loads, changes in cultural surroundings, stress, low compensation, the lack of other workers in the community with whom to share information and the accumulated burden of their responsibilities.

Finally, some people told us they didn't like the daily clinic hours of their community health centres. We heard that health workers receive fewer requests for appointments during the morning hours. Patients seem to prefer evening visits, when most centres are closed. People told us that clinic hours should better reflect the needs of the community.

People Expressed Concern That The Confidentiality Of Information Be Respected

Mr. Chairman, the confidential nature of patient and client information is one of the most important features of any health and social service system. We heard concerns, both about the inappropriate sharing of information between front line workers and community members, as well as the lack of communication between government departments.

People are concerned about the possibility that information about themselves might be revealed to members of the community. This concern is explained, in part, by the fact that local workers may be close friends or even relatives of the patient. People want to be assured that any sharing of confidential information will be limited to professional staff and not made available to the community.

On the other hand, people feel that more sharing of information is required between government departments in order to better serve the needs of clients. Present confidentiality procedures require client consent for the disclosure of information. There is support for encouraging workers to obtain consent for the disclosure of information so that this problem may be remedied.

There Is Concern About Specialist Services In The Communities

Mr. Chairman, we heard that our system's reliance on specialists may not always provide the best level of service to the communities. Part of the problem is that the need for these services is seen to reflect a lack of support and resources available to front line workers. People told us that these workers should be able to involve other local resources, such as respected elders, in providing some of the services currently provided by specialists.

People mentioned a number of concerns about specialists. Communities may not have enough input into the process of assigning specialists to various locations. They do not visit often, and when they do, it may only be for a few hours at a time. People may not even be able to meet with them if these hours are not convenient. These brief visits are not seen as providing enough time for the specialist to develop an understanding of the community. This problem is made worse by the lack of follow-up to these visits. We also heard the view that specialists do not have -- or do not take -- the time to provide instruction and training for community front line workers.

We Became More Aware Of The Important Role Of Volunteer Organizations

Mr. Chairman, we heard a number of positive and useful programs provided by volunteer organizations across the north. People told us that these activities reflect their desire for greater responsibility over their lives and over the services provided their communities. We heard that these groups should be recognized and encouraged to expand their involvement.

We also heard that increased voluntarism reflects the view that government workers and professional health and social service workers are only a part of the solution.

People Told Us That Public Officials Are Expected To Act As Role Models

Mr. Chairman, public officials, community leaders and workers who provide health and social services are recognized members of the community. A number of them are also viewed as role models. People want them to follow a high standard of behaviour, especially on such matters as sobriety and violence. These role models are also expected to recognize and acknowledge any problems they may have and to act responsibly in dealing with them.

At this time, Mr. Chairman, I would like to ask Mrs. Marie-Jewell to continue.