The Dominion - health

Jeremy’s Case, Jordan’s Principle

dawn — Fri, 15 Jun 2012 14:35:50 +0000

Historic court case in Halifax identifies gap in health services for First Nations children

HALIFAX—In a precedent-setting case that continued in Halifax on Monday, Maurina Beadle and Pictou Landing First Nation took the Government of Canada to court over its failure to provide Beadle’s son the same level of health care that a child living off-reserve would receive from the province of Nova Scotia.

On the fourth anniversary of Prime Minister Stephen Harper's historic apology to First Nations people for the forced separation of children from their families under the residential school system, the Mi'kmaq mother was in court fighting for the health services that would allow her son Jeremy to remain at home under her care.

"All the things that were promised in Harper's apology are things they are not doing for Jeremy," said Philippa Pictou, Health Director for Pictou Landing First Nation, sitting on a bench in courtroom 501 in the Law Courts on Lower Water Street in Halifax on Monday morning. "Kids being pushed into institutions, instead of being cared for at home."

Jeremy Meawasige is a 17-year-old from Pictou Landing First Nation who was born with a complex array of disabilities and medical conditions. His mother, Maurina Beadle, had been providing all of his care without government assistance until a double stroke in May 2010 left her physically unable to meet his needs at home.

When, with help from the First Nation, Beadle applied for funding for home care health services, she found that her family's Aboriginal status caught her son in jurisdictional red tape that prevented him from receiving the same care on-reserve that he would be provided with by the province of Nova Scotia if he lived off-reserve.

With the support of Pictou, Beadle is invoking Jordan’s Principle for the first time in its history. The child-first policy passed unanimously in the House of Commons in 2007. It dictates that in the instance of a jurisdictional dispute over which level of government foots the bill for a First Nations child in need of medical care, the government first contacted must come up with the funds; any arguments over who ultimately pays for the child's care are to be argued later.

Jordan's Principle is named after Jordan River Anderson of Norway House Cree Nation, who lived all four years of his life in hospital while the governments of Manitoba and Canada fought over which level of government was responsible for paying for his home care.

Jordan's Principle has never been implemented in any province or territory.

"Should a disabled First Nations child on-reserve be entitled to the level of care available to any child off-reserve?" asked Paul Champ, the lawyer representing Beadle and Pictou Landing First Nation, in his opening comments.

Provincial governments generally provide continuing care health services in the home. But because First Nations fall under federal jurisdiction, provincial governments do not provide on-reserve health services.

The federal government, either under Health Canada or Aboriginal Affairs and Northern Development Canada (AANDC, formerly INAC), is responsible for allocating to First Nation bands the resources to provide services "reasonably comparable to those provided by the province," Champ told the court on Monday. Bands must "administer program according to provincial legislation and standards."

In her decision to deny Beadle the requested funding, AANDC official Barbara Robinson argued that Beadle and Pictou Landing First Nation were requesting services above and beyond the "normative standard of care in Nova Scotia."

Champ argued that Robinson's interpretation of the normative standard of care in Nova Scotia is flawed. She determined that Jeremy Beadle is eligible to receive $2,200 per month, "full stop," explained Champ. $2,200 per month is the standard respite cap in Nova Scotia, according to a Community Services policy document.

However, a support program available for persons with disabilities in Nova Scotia—one designed to "maintain the integrity of families," including enabling people with disabilities to live at home&mdashincludes a section in which "exceptional circumstances" allow for additional respite funding. These circumstances are defined in a number of points, and all apply to Jeremy.

Upon cross-examination, Robinson conceded that the Beadles meet all exceptional circumstances criteria, but she also said that the "exceptional circumstances" part of the policy doesn't apply to Jeremy's case. Her reasoning, explained Champ, was that she relied on what happens "in practice," not necessarily in policy or law.

According to the Social Assistance Act, the government "shall furnish assistance to all persons in need," and this includes home care. Cabinet can prescribe maximum levels of assistance. No maximum has been legally established; the $2,200 cap is, effectively, arbitrary.

On Monday afternoon, the proceedings turned to Section 15 of the Charter of Rights and Freedoms, the equality guarantee that ensures that all people have access to equal benefit of the law. Champ reminded the court that the purpose of the Charter is to entrench the goal of equality, in particular to protect those who have been historically disadvantaged.

"The disadvantage that First Nations have historically faced on reserves has never been resolved," said Champ. "Never. Never. First Nations people do not have equal access to schools, home care, or health."

Robinson, when making her decision in the Beadle case, stated that the Charter doesn't apply. Champ explained the exception to the guarantee of equality that excludes First Nations people who, because of their unique status, are not entitled to the equal benefit of the law.

First Nations people are the only legal group in Canada identified by race; they therefore fall into a "legal no-man's-land" because their situation can't be compared to anything--there is no comparative group with respect to which they can be discriminated. Therefore the Charter, and cases argued on the basis of discrimination, cannot be argued. Champ submitted that this is an improper way to interpret Section 15 of the Charter of Rights and Freedoms.

The services provided by the federal government--either by Health Canada or by Aboriginal Affairs--to people on-reserve, are not provided by legal obligation, but as a matter of policy, based on agreements and programs negotiated with First Nations band councils.

These services are policy, not law, Champ told the court. They are therefore discretionary, and provided according to the government official who interprets the policy. These agreements use such language as "Canada has elected to provide" a given service. These services are therefore a choice, provided at the discretion of the Government of Canada.

One such policy is Jordan's Principle. As an "expression of the House," it is not legally binding, but the federal government is seeking to implement the principle across the country. Where there is no formal agreement, there are dialogues premised on Jordan's Principle, said Champ. He added that in any other case he would not make the argument that Jordan’s Principle legally applies.

"But in this case, there are no statutes. We have policy manuals, funding agreements that change over time in content and funding levels essentially at the whim of the federal government. Do these policies have the form of law? Yes, because there is nothing else," said Champ. "This is, in a sense, is the best that we have."

The animated purpose of Jordan's Principle, he said, is to acknowledge the fact that First Nations people are in a unique legal situation, and also to rectify the historical disadvantage of First Nations people.

A breach of Jordan's Principle is evidence of discrimination, said Champ. "When a child is denied service for one day, as a result of a jurisdictional dispute, that is a breach of Jordan's Principle, and it is always a breach of Section 15 of the Charter."

After the Crown’s submissions and the applicants' responses, Judge Mandimen acknowledged that the case is time-sensitive. Recognizing that the Pictou Landing First Nation cannot continue to provide funding for Beadle’s home care, Mandimen said that he would move his decision through as soon as possible.

Beadle—and First Nations across the country who are watching this case—will still have to wait up to six months for a ruling, although after the trial Champ said he hopes for a ruling by the end of August.

"I know this [case] won’t necessarily change things for Jeremy, by the time it’s over," said Beadle. "But this isn’t for Jeremy. This is for children across the country. They shouldn’t have to wait while the people in power procrastinate."

Moira Peters lives and bikes in Halifax.

A version of this article was originally published by the Halifax Media Co-op as a series, including an introductory article and blog posts about Monday’s morning and afternoon court proceedings. The last post of the series covering Monday’s court proceedings will be published by the Halifax Media Co-op later today.

Maurina Beadle at Pictou Landing

It's a Matter of Jordan's Principle

Martin Lukacs — Wed, 05 Oct 2011 10:43:16 +0000

Canada's health care system leaves Native child behind

PICTOU LANDING, NS—Maurina Beadle doesn’t sleep at night. She naps. While her son Jeremy sleeps on a bed attached to her own, Beadle has trained herself to be constantly alert.

“After 16 years, your body gets used to it,” she says.

Jeremy Beadle Meawasige, known as Kicking Bear in his hometown of Pictou Landing First Nation in Nova Scotia, has been diagnosed with hydrocephalus, cerebral palsy, spinal curvature and autism. He needs to be fed, changed and dressed. He can’t walk by himself. He frequently visits the hospital and has undergone numerous operations.

Beadle was always the sole caregiver for the 16-year-old. Their lives changed dramatically last May, when she suffered a double stroke that left her incontinent, in a wheelchair and unable to use her hands. "Doctors said I would never walk again," says Beadle.

"Maurina never had any help," says Philippa Pictou, Health Director for Pictou Landing First Nation, who has known the family for years. She said that after Beadle's stroke, "she worked really hard to regain capacity with writing exercises—hours and hours. She was determined to walk again."

Maurina Beadle walks with a cane and opts for the lighter plates in the cupboard to serve dinner. Her strong features and wit more than compensate for her modest stature.

She now accepts day workers into her home to help with housekeeping and caring for her son, although she says this was difficult for her at first.

"Maurina is committed to caring for Jeremy," says Pictou, but when the stroke made it impossible for Beadle to do so by herself, the health director began the process of accessing an $11 million federal fund for First Nations children with complex disabilities.

The fund was initiated by Health Canada in response to Jordan's Principle, a "child-first" policy designed to ensure First Nations children do not suffer delays or disruptions in essential health services if the funding source for their care becomes unclear.

Pictou’s inquiry was stymied first at the federal level, which is responsible for First Nations health care. Then it was stymied by the province, which controls most of, arguably the best, and certainly the most readily available health services.

In spite of Pictou and Beadle’s diligence, it took five months for any level of government to offer Jeremy health services. Jeremy's case is just one more added to the astounding statistics that show how the most vulnerable people in Canada—First Nations children—have the greatest difficulty receiving the health care they need.

A year-and-a-half later, Jeremy’s future care remains unsettled, and the family has decided to take the federal government to court.

"Through all this," says Beadle, as she lifts her right ankle on top of her left knee and lights a cigarette, "I think about the things that nobody saw, the years of seeing him puke, seeing him take off his diaper and play with his..." She trails off. "And I had to put him in a tub with a little water so he could play around—not too much water—while I cleaned up."

Jeremy sits on the couch, ankle crossed over his opposite knee, balancing his toy piano across his lap, trumpeting his lips to the machine's rendition of "Besame Mucho." A t-shirt holds his arms loosely against his chest—to prevent him from hitting himself—and his long fingers press the toy's buttons. His smile grows wide when George Billington, his evening caretaker, asks whether he wants to go for a cruise. "Socks 'n' shoes on," says Jeremy. "Seatbelt on for safety."

"When I was trained by FNIH [First Nations and Inuit Health], we were given workshops and attended meetings about Jordan's Principle and what it meant," says Pictou, who was also trained in the child-first policy while she worked for Health Canada. "It didn't occur to me that when we ran into a situation that fell under Jordan's Principle that [the funding] would be so hard to access."

Jordan's Principle is named in honour of Jordan River Anderson of Norway House Cree Nation, who spent all his life in hospital while the province of Manitoba and the government of Canada argued over who was responsible for funding the child's care at home. Jordan died at the age of four, having never lived at home.

"To access Jordan's Principle, we had to prove what kind of care Jeremy would get if he were off-reserve," says Pictou. An assessment was required, one that would identify the normative—standard—level of health services any non-status Nova Scotian child would receive.

In the meantime, while Beadle was recovering in hospital, Pictou Landing Band Council hired home-care workers to take care of Jeremy, "without knowing whether we were doing the right thing, whether the workers were able to provide Jeremy what he needed," says Pictou.

Five months after Beadle's stroke, Pictou Landing received approval from the office of Maureen MacDonald, Health Minister of Nova Scotia, for Continuing Care to assess Jeremy's needs. Continuing Care—the provincial service that performs home assessments—uses sophisticated computerized programs and trained staff whose services could weigh Jeremy’s needs against available provincial programs. However, Nova Scotia Continuing Care’s policy does not allow staff to work on reserves—First Nations health care is supposed to be covered by the federal Aboriginal Affairs and Northern Development (AAND). However, no equivalent assessment program exists for First Nations in Nova Scotia.

"The Minister's office made it clear that the approval was for one instance only, and that no other services would be provided," says Pictou.

According to a report by an ad-hoc coalition of Aboriginal and social justice organizations, First Nations children receive two-and-a-half times fewer resources than non-status Canadian children. Although AAND (previously Indian and Northern Affairs Canada—INAC) has committed to mirror provincial health care programs for people living on reserves, the relative geographic isolation of reserves across the country means resources for people living on reserve are distributed over greater distances, making specialized services particularly difficult to access.

After months of conferences with the Pictou Landing community health nurse, INAC, Health Canada, Jeremy's school, the tribal council, Band lawyers and the Band council, the provincial and federal governments decided that the funding to be offered to Jeremy for respite (at-home) services would be $2,200 per month—the standard respite cap in Nova Scotia. If Jeremy's care cost more than that—which it does—he would have to be moved to an institution.

According to Nova Scotia’s Department of Community Services, no institution in Nova Scotia can meet Jeremy's round-the-clock needs.

Situations such as Jeremy’s are not uncommon, and they are compounded by disputes between governments over who is responsible for paying for health care for status-Indian children. Research in the First Nations Child and Family Caring Society of Canada 2005 Wen:de Report indicates that these bureaucratic conflicts are common, with 393 cases in 12 sample First Nations in 2005.

“[J]urisdictional disputes continue to have significant impacts on the lived experiences of First Nations children—particularly those with special needs. Although both the federal and provincial governments embrace the principle that the safety and well being of the child is a paramount consideration, in practice jurisdictional disputes often supersede the interests of children," according to the report.

Jordan's Principle was supposed to fill this gap in health services. The bill states, "The obligation to meet the needs of the child first always supersedes government interests to establish jurisdictional dispute processes." Although Jordan's Principle passed unanimously in the House of Commons in 2007 as Private Members Bill 296, it has never been implemented in full, either by the federal government or the provinces and territories.

In 2008, a bill for the implementation of Jordan's Principle never made it through the Manitoba Legislature.

"When the bill comes to be paid," said Manitoba Premier Gary Doer, concerned for the cost to the provincial tax-payer, "the federal government goes to the bathroom."

When asked how Nova Scotia sees the province’s role in providing health care services to children such as Jeremy who fall between jurisdictional cracks, the office of Maureen MacDonald responded, "[W]e support the child-first concept behind Jordan's Principle and recognize the importance of governments working together to ensure that all children, including First Nations children, receive the supports and services they need here in Nova Scotia." While it may support the child-first concept, the province has never implemented Jordan's Principle, which would require services to be provided without delay.

The response from the Nova Scotia health minister’s office goes on: "Fundamentally, we provide the best care we can in circumstances like this and there are negotiations about funds that sometimes follow."

"There's a complete lack of access across the country to Jordan's Principle," says Pictou. "This is a gatekeeper practice. The feds can say there are no jurisdictional issues and therefore the need for [Jordan's Principle] doesn't exist."

Pictou believes political conveniences encourage the institutionalization of First Nations children.

"It's a win-win situation for governments," she says. "Evergreen [Home for Special Care] is the only institution for under-18 children [with complex disabilities] in Nova Scotia. It only has 20 beds, currently four vacancies. If an off-reserve child is taking up a bed, the province pays. If a First Nations child is in a bed, the federal government pays."

In other words, the province benefits financially—to the tune of $350 per day—when status-Indian children are kept in care facilities. AAND, under pressure to deliver health care equal to provincial programs, benefits because it is seen to be providing good services.

According to Pictou, if he is moved out of his community, Jeremy will lose his culture, language and, most significantly, his mother's involvement in his life. "It would be a huge loss for Jeremy. I can't imagine it. The idea is inhumane."

The $350 per day cost at Evergreen is double what it would cost to keep Jeremy at home.

"It would make a lot of sense to have a small-options home in Pictou Landing," says Pictou. "Three to four beds, 24-hour staff. It would create more economic viability in the community.”

Pictou Landing First Nation is a community in pain. The reserve is sandwiched between Boat Harbour and Pictou Harbour, a stunning coastline where doctors and lawyers used to own summer cottages. But in 1965 Scott Maritimes built a pulp millon in Pictou Harbour and began dumping effluent in Boat Harbour via a long underground pipe. For 46 years, pulp waste has been gushing into Boat Harbour at the rate of 50,000 gallons per day. Sulfurous smog lies over the harbour, the beach and the bluffs. Residents of Pictou Landing say there have been no natural deaths in the community in the past four decades. There is no doubt that the reserve could use more health resources.

Plus, for Pictou, the sensible alternative to the expense and emotional pain of moving Jeremy out of his home is to move the services, not the child.

"I've worked in public health and in housing. I've fought for low-income families to get special needs funding," says Pictou. "I really don't think this happens off-reserve."

She began researching other options.

Pictou’s research revealed a bureaucratic gap between respite paid by the province to non-status children, and the at-home care available to on-reserve children through AAND. Nova Scotia offers a support program for persons with disabilities, designed to "maintain the integrity of families," including enabling people with disabilities to live at home and preventing the need for them to be moved out of their homes, according to the 2006 provincial policy document.

For Pictou, the interesting part of the policy is a section titled, "Exceptional Circumstances for Funding over $2,200."

The document outlines six criteria to be evaluated for approval of long-term funding above the $2,200 respite cap, and four criteria for additional short-term respite.

"Maurina and Jeremy fulfill every single one," says Pictou, as she scrolls through the lists and reads them aloud.

When Pictou raised this, AAND said its commitment to status-Indians does not include exceptional circumstances such as those identified by the provincial program.

In March 2011, a few days after AAND refused Beadle's application for extra funding, a Nova Scotian family in a similar situation filed for a judicial review of the $2,200 respite cap. They won. The judge ruled that the cap was an administrative policy designed to save money, and that it contradicted the Social Assistance Act. Nova Scotia Community Services was required to pay for the care necessary to keep Brian Boudreau, a 34-year-old with autism, at home.

The Pictou Landing Band Council and Maurina Beadle have brought the matter to court, challenging AAND, Health Canada and the Government of Canada on its decision to deny the Beadles additional at-home support.

Theirs is the first court challenge to use Jordan's Principle. In their notice of application, Band lawyers call the federal decision "contrary to provincial statutes and policies, Jordan's Principle and the right to equality under section 15 of the Canadian Charter of Rights and Freedoms." Section 15 of the Charter says that every Canadian has the right to "equal benefit of the law without discrimination and, in particular, without discrimination based on race."

Pictou expects to be in court by January or February 2012.

"What irks me is I know what we could access if [Jeremy] were off-reserve, and it seems that roadblocks are put in place deliberately," says Pictou. "The same philosophies that drove the establishment of residential schools—that governments can raise children better than First Nations can—are behind the policies that trickle down today.”

The smog rolls over Beadle’s back porch. “No matter how long you live here, you never get used to it,” she says. It’s unclear whether she is talking about the pulp mill’s discharge, or something broader, deeper. An outsider can’t help wondering why the people in Pictou Landing don’t simply up and leave.

"When reporters ask me what I’ll do if Jeremy is moved to an institution, I tell them, 'Over my dead body,'" says Beadle. She watches Melanie Thomas, Jeremy’s day-time care worker, spoon-feed Jeremy his lunch.

"He won’t get no love in an institution."

A rally in support of implementing Jordan's Principle will take place in Halifax tomorrow.

Moira Peters lives and bikes in Halifax.

Jordan's Principle.Jeremy

Jordan's Principle.Maurina

The "Trade" Agreement Ottawa and Nova Scotia Want Kept Secret

Martin Lukacs — Wed, 27 Jul 2011 09:06:28 +0000

Packed room hears Canada-Europe trade negotiations denounced

HALIFAX—A standing-room-only crowd packed a Halifax meeting room on a summer night to hear about a secret.

Two national speakers, Maude Barlow of the Council of Canadians and Canadian Union of Public Employees (CUPE) President Paul Moist, provided a harrowing account of the Harper government's "trade" negotiations with Europe that they said will transfer decision-making power from local governments to multinational corporations.

The vehicle for this wholesale corporate power grab is the Comprehensive Economic and Trade Agreement (CETA), said the speakers.

Unlike the earlier Free Trade Agreement and North American Free Trade Agreement, CETA would reach into provincial and municipal policy-making and purchasing, Moist said. It would seriously threaten local job creation and "Buy-Local" policies; it would encourage privatization of Canada's drinking water and waste-water services (no matter what local citizens wanted); and it would cause prescription drug costs to skyrocket by at least $2.8 billion per year.

CETA is essentially a corporate bill of rights which puts companies and their profits first and the wishes of local citizens last, said Barlow. For example, European corporations could seek compensation for business lost as a result of any government regulation or policy. This includes banning a carcinogenic additive to gasoline (this has already happened under existing "trade" deals) or paying millions to a pulp and paper company that abandoned Newfoundland and Labrador.

"We have nothing against trading with Europe and much of our trade is now free or becoming free of tariffs," said Moist. "But this deal goes well beyond trade issues into interfering with how local people can make decisions about how to run their communities."

A Nova Scotia speaker, Mark Austin, Executive Director of the Rural and Coast Communities Network, added a number of concerns. "This deal has huge implications for Nova Scotia, particularly rural areas, yet we have heard nothing about it," Austin said. It would likely result in overfishing, and would threaten food sovereignty through attacks on agricultural policies such as farm marketing boards, he added.

And buy-local initiatives, like one Austin is involved with in Truro, could become impossible.

"While there might be small short-term gains in trade with Europe, you have to give up control of your long-term local economic prospects. It's like the Canucks playing in Boston—you can score one goal, but you have to give up five."

CUPE Nova Scotia President Danny Cavanagh, who chaired Tuesday's event, said CETA negotiations would resume in Brussels on July 10. Prime Minister Harper hopes to sign a completed deal by the end of the year. Premier Darrell Dexter and other provincial premiers, who also need to sign off on the deal, are part of Canada's little-publicized discussions.

Barlow said that while it may be unrealistic to expect a provincial government not to sign the agreement, she hopes that public pressure motivates premiers to drive a harder bargain and seek exemptions from the most damaging aspects of the currently proposed deal.

Despite the devastating potential impact, the speakers noted that the Nova Scotia government has done nothing to alert citizens of what is at stake. Moist said that the Nova Scotia and Manitoba governments have agreed to talk in private with CUPE and the Council of Canadians research staff about the negotiations, but no consultations with the general public are planned.

The European Parliament receives regular status reports in public on the CETA negotiations, Moist said. "Why can't Canadians get such reports?"

Dartmouth MP Robert Chisholm, the federal NDP trade critic, was at the meeting, as was Halifax NDP MP Megan Leslie. No provincial politicians attended.

"It's not too late to stop the deal," Barlow said.

The speaking event was part of a national campaign entitled, "Canadian communities are not for sale.” More information is available as part of a “CETA toolkit” at http://cupe.ca/ceta, or at www.canadians.org.

This article was originally published with the Halifax Media Co-op.

Jim Guild, of Halifax, recently retired from a staff rep. position with the NS Government and General Employees Union (NSGEU) and has been active of late with the Halifax Media Co-op.

Barlow CETA2

The Other Drug Trade

hillarybain — Fri, 25 Feb 2011 06:03:44 +0000

New bill could make cheap HIV meds easier to access

HALIFAX—On March 9, Members of Parliament will have a very simple choice to make, according to Richard Elliott, executive director of the Canadian HIV/AIDS Legal Network. They can vote for Bill C-393, and make it easier for people in the developing world to access affordable HIV medication.

“When you could do something with the most minimal of efforts to prevent these [HIV related] deaths from happening, to not [do so] is profoundly immoral,” says Elliott.

Despite Elliott’s confidence in the importance of the Bill, its passing on March 9 in the House of Commons is far from certain.

Bill C-393 seeks to amend a piece of legislation enacted in 2005, known as Canada’s Access to Medicine Regime (CAMR). CAMR was created to help Canadian generic companies produce and export generic medicines at reasonable prices to the countries that need them most.

In 2009, almost 15 million people in low- to middle-income countries were living with HIV, and only five million of them received treatment, according to the World Health Organization (WHO).

Despite these numbers, CAMR has been used only once. Advocates for Bill C-393 argue that CAMR is too complicated and must be fixed to make it easier to export affordable medication.

Apotex, a Canadian generic drug company, successfully shipped anti-HIV drug Apo-TriAvir to Rwanda in 2008 and 2009 under CAMR. The shipments contained enough medication to treat 21,000 people living with HIV for one year.

Turns out, this feat was a one-hit wonder.

“We're not likely to repeat the process under [CAMR],” said Bruce Clark, Apotex’s Senior Vice-President, Medical and Regulatory affairs. Clark says CAMR is not easy to use. “It’s a practical reality that no second country has made a request under the regime because it’s so complicated.”

Many steps are required before a shipment of drugs can be made. It took four years for Apotex to complete the process and get their shipment authorized by the Canadian government.

Four years is a long time to wait, considering approximately two million people died from AIDS in 2009, according to the WHO.

Despite this, the pharmaceutical industry insists Apotex’s process was “extremely quick” and CAMR is working well.

“There was tremendous co-operation on the industry’s part because we support the intention of CAMR,” said Wendy Zatylny, Vice President of Government Affairs at Rx&D, the association of research-based pharmaceutical companies in Canada.

Rx&D represents the interests of 50 drug companies, including GlaxoSmithKline (GSK), Shire and Boehringer Ingelheim, which were the three patent holders for the drugs that Apotex needed to produce Apo-TriAvir.

Apotex requested voluntary licenses from the three companies in July 2007. Within a month, all three responded and granted permission to manufacture the drugs royalty-free, according to Rx&D’s records.

Many conditions were attached to the voluntary licenses.

“Two of the patentees went so far as to expressly reserve all rights with respect to their trademark rights, effectively threatening suit,” Clark said.

In the end, after fruitless negotiations, the patent holders retracted the voluntary licenses and Apotex applied for a compulsory license in September 2007 under CAMR, he added.

It took 68 days from the time Apotex asked for voluntary licenses to when the government granted the compulsory license. But the entire process took four years because of the details Apotex needed in order to start the process in the first place.

“We were turned back as the request was, in their words, 'premature' as no country had confirmed an order,” Clark said

The developing country has to put forward a request for an exact quantity of drugs to be produced and exported in order for the process to begin. It is difficult for a country to accurately estimate the amount of medicine it needs at any given time. This is particularly true for infectious diseases like HIV, where predicting how many people are infected, and will be infected in the near future, is difficult.

In addition to the barriers to getting permission for exporting generic drugs, CAMR mandates an expiry date of two years on the compulsory license.

Once Apotex had delivered medication to Rwanda, the country wanted to order more. In order to do this, however, both Rwanda and Apotex would have had to go through the entire process again.

So they didn’t.

After this one and only experience working with CAMR, its advocates started discussing how to improve it. The outcome was Bill C-393, which former NDP MP Judy Wasylycia-Leis introduced as a private member’s bill in 2009.

The bill proposes a “one-license solution.” If passed, a generic company would be able to distribute drugs anywhere in the developing world simply by getting a single license from the brand-name companies. This would eliminate the daunting task of having to negotiate a separate license for each country that makes a request.

Furthermore, the bill wants to expand the list of drugs that qualify for compulsory licenses. CAMR only allows the export of certain drugs for certain diseases. Advocates of the bill argue that this list is too restrictive.

“That’s an unnecessary and unjustifiable restriction to the [CAMR] regime,” said Elliott. “It is both unethical and bad public health policy for Canada to tell developing countries that CAMR can only be used to get certain medicines for certain public health problems.”

A parliamentary committee gutted these two provisions from the bill in November 2010. The Conservative MPs in the committee and Liberal Marc Garneau took the position that CAMR works in its current form, a stance shared by Rx&D.

The removal of these provisions from the bill did not come as a shock to Elliott.

“I think there is of course tremendous pressure from Big Pharma,” said Elliott. “They're all over Parliament Hill arguing against the bill.”

During the second vote on the bill in 2009, the liberal MPs who voted against it sat in ridings where many pharmaceutical companies reside. For example, Abbott Laboratories, AstraZeneca and GSK operate within the ridings of Liberal MPs Marc Garneau and Stephane Dion.

In January this year, NDP MP Megan Leslie re-introduced the provisions as amendments to the bill in hopes of salvaging it. These amendments will be voted on in March.

While parliament continues to fight out this battle around reforming CAMR, the developing world faces a cruel reality. There is currently a global deficit of anti-HIV drugs suitable for children and many countries don't have the manufacturing capacity to develop and produce them.

"Unless Apotex or any of the other generic companies see a potential market, they're not going to go ahead on their own to produce the pediatric formulas," said Joel Lexchin, professor at York University. "And there's no market without a reformulation of CAMR."

Apotex has already committed to making and delivering infant and children-suitable HIV drugs if parliament votes to fix CAMR.

“It’s hard to imagine why there’s so much resistance to making this bill more workable and I think we continue to say whose interest[s] we’re protecting in the way the bill currently stands,” Clark from Apotex said. “It’s clearly not those of the developing world and not those [of people] suffering from AIDS.”

Steph Law is a freelance journalist, health rights activist and an epidemiologist. @lawsteph

CAMR 1

CAMR 2

A Pharm Reduction Approach

Maya Rolbin-Ghanie — Fri, 09 Apr 2010 05:38:25 +0000

Canada’s Access to Medicines Regime barely workable

MONTREAL—The city of Montreal is set to be centre-stage in the coming months as a battle is waged between brand-name pharmaceutical companies, MPs, and a host of civil society organizations.

At stake is Bill C-393 (or drugs for international humanitarian purposes), a bill supporters say will help make Canada’s Access to Medicines Regime (CAMR) more workable.

Passed in 2004, CAMR was intended to facilitate the export of life-saving, generic medicines to “developing” countries.

Under CAMR, if patent-holders will not grant a voluntary license to the generic manufacturer, the company can approach the Canadian Commissioner of Patents and request a compulsory license be issued. This would give the manufacturer the right to by-pass patent holder's rights and produce a given medication, and in theory, allow generic medicines to be produced for export in public health emergencies.

But some organizations, including the Canadian HIV/AIDS Legal Network and Canadian Grandmothers for Africa, say the legislation is unnecessarily bureaucratic and must be reformed; thus far, a single order of medications has left the country.

C-393 has passed its second reading in the House of Commons but is expected to continue to face opposition from several Montreal MPs including Liberal Science and Technology critic Marc Garneau and Liberal MP Stephane Dion. Dion’s riding, Saint Laurent-Cartierville, is home to such brand-name, research-based pharmaceutical companies as Abbott Laboratories, AstraZeneca and Glaxo Smith Kline. Russell Williams, President of Rx&D, the association that advocates on behalf of Canada’s research-based pharmaceutical companies, has repeatedly stated that CAMR does not need to be reformed.

Bureaucracy bars access

Shortly after CAMR was passed in 2004, Medecins Sans Frontieres (MSF) approached Canadian generic manufacturer Apotex Inc. and urged them to produce a much-needed generic AIDS medication.

As Rachel Kiddell-Munroe, then Coordinator of MSF’s Access to Essential Medicines Campaign describes, Apotex had to overcome a daunting series of hurdles to make use of CAMR. These included applying to have the drug added to a list of medications eligible for use under CAMR, getting it tested by Health Canada despite the fact that it was pre-qualified by the World Health Organization and attempting to negotiate a voluntary license with Canadian patent-holders, a license none of the brand-name pharmaceutical companies was willing to grant in terms Apotex found acceptable.

“CAMR is extremely complex. These processes took over two years,” says Kiddell-Munroe of the back-and-forth she witnessed between Apotex, Health Canada and the Canadian patent-holders.

Even after going through these steps, the long journey was not over. MSF and Apotex still had to wait for a country to request the medication.

In 2007, Rwanda became the first and only country to ask for Canada’s help when it told the World Trade Organization (WTO) that it wanted to buy 260,000 packages of a triple-drug antiretroviral therapy—enough to treat 21,000 HIV-positive people for one year.

It wasn’t until September 2007, three years after CAMR was first passed, that Apotex was granted a compulsory license—the main aim of CAMR—and could finally begin production of the life-saving medication to send to Rwanda.

Kiddell-Munroe says these delays are unacceptable.

“Ten million people die each year from diseases that have available cures. Nearly a third of the world’s population does not have regular access to essential medicines, and in the least developed countries of Africa and Asia, this figure is more than fifty per cent,” she says.

Barking up the wrong tree

As Richard Elliott, Executive Director of the Canadian HIV/AIDS Legal Network explains, CAMR is made much more complicated than it needs be. The generic manufacturer is required to apply for a separate compulsory license for each country to which it wants to export, and for each quantity it wants to export. Elliott is an advocate for the “one-license solution” proposed in Bill C-393, explaining how it would work.

“You instead give the generic manufacturer a license that’s not limited to supplying one country but is actually authorization to supply multiple countries already named in the legislation; and you don’t fix the quantity ahead of time, because obviously you need to actually discuss with those countries what their needs are and those needs will change over time,” says Elliott.

Critics of reform, including Montreal-area Liberal MP Bernard Patry, argue that changes proposed in Bill C-393 would stifle innovation and remove incentives for research and development in Canada.

“Recognizing intellectual property rights is crucial for the future discovery of drugs that will save lives,” said Patry in the House of Commons in November 2009, during the bill’s second reading.

“If we do not protect intellectual property rights, we will deprive ourselves of key research, not only in the pharmaceutical sector but in all sectors driven by research,” he said.

As Elliott explains, generic medications manufactured under CAMR can only be exported to a limited list of low-income countries, pre-determined by the WTO.

“CAMR excludes export to all of the countries that account for the vast majority of the profits made by the brand-name pharmaceutical industry,” says Elliott.

“In doing this [reforming CAMR], there is nothing that would in any way undermine the ongoing presence of the brand-name pharmaceutical industry in Canada, in Quebec, so he’s barking up the wrong tree.”

Garneau has repeatedly voiced concerns that reforming CAMR will do little to actually improve access to medicines.

“The reasons why CAMR does not work as we had hoped have to do with real problems in the field, in the countries that need these medicines,” he said in the House of Commons during debate on C-393.

“They have to do with access to properly trained medical staff. ... In short, they have to do with poverty.”

Elliott says that alleviating poverty and reforming CAMR are not mutually exclusive.

“We know from experience that having compulsory licensing regimes that work, and the competition by generics that they enable, is what brings the prices of medicines down for developing countries. ... If you can actually make the medicines affordable, then whatever resources you mobilize to actually buy the medicines will go that much further,” he says.

Kiddell-Munroe agrees. “You cannot have doctors and nurses in beautifully pristine clinics in the middle of Africa and they’ve got no drugs in their pharmacy,” she says. “It’s not one or the other. It's both.”

Garneau’s office did not respond to The Dominion’s request for a comment.

Nikki Bozinoff is a Montreal-based writer, agitator and health-enthusiast.

Fenced In Pharmaceuticals

Students calling for CAMR reform outside MP Marc Garneau's office

Thousands Protest Fee Hikes in Montreal

dru — Fri, 02 Apr 2010 17:23:52 +0000

Students, community groups, unions oppose privatization of pulic services

MONTREAL—Thousands took to the streets of downtown Montreal yesterday to protest the Quebec Liberal government's 2010 budget. Quebec's grassroots student union l'Association pour une solidarite syndicale etudiante (ASSE) joined forces with a wide coalition of community organizations, bringing forward a public critique of a budget that introduces fee hikes for cornerstones of the public sector, including health-care and education.

"This budget is bad because it attempts to introduce major changes to the public nature of Quebec society—a move towards people paying for public services," outlines Marie Blais, vice-President of the Federation nationale des enseignantes et enseignants du Quebec (FNEEQ). "Education and health-care are public rights, not products that we purchase as citizens."

Key to the critique of the Quebec budget is a proposed obligatory health-care fee for Quebec residents, fixed to increase annually toward a $200-per-year flat tax by 2012.

"Today's budget rests on the backs of the most vulnerable in Quebec," said Christian Dubois of political party Quebec Solidaire(QS). "The health-care tax is regressive, if you are making $15,000 per year, you will pay the same amount in tax as someone making $300,000 per year—a fundamentally unequal and unjust social equation."

Quebec's public health care infrastructure has faced increasingly tight budgets since the current Liberal government came to power. As waiting rooms in Quebec's major hospitals often remain jam-packed, the government has moved to increase the role of public-private health care partnerships, instead of increasing public spending.

Since coming to power in 2003, Quebec Premier Jean Charest has faced successive protests, the largest in 2005 when an estimated 100,000 students went on strike across the province, staging protests across Quebec and carrying out direct actions in Montreal. The strike marked a major victory for Quebec social movements, helping to end the government's plan to cut $103 million from the student loan and bursaries program.

A tradition of popular protest has played a key role in shaping government policy in Quebec. Social movements exercise street-level democracy rooted in extensive networks of community organizations, workers unions and student federations that that can be traced back to the massive social movements born in the 1960s and 1970s. These groups helped to build Quebec's strong public sector, which cushioned the blow of the recent world economic crisis.

"The economic crisis was created by the corporate sector and now Charest has placed the public sector into a corporate economic vision of privatization that created the global financial crisis," QS' Blais told The Dominion. "It is unacceptable to propose an economic plan that basically considers public institutions within a corporate model."

"We want to ensure accessibility, not privatization. It is simple that with higher fees fewer people in Quebec will go to university and access proper health care."

For more information, visit l'Association pour une solidarite syndicale etudiante (ASSE).

Stefan Christoff is a regular contributor to The Dominion and is on Twitter at @spirodon.

Students Demonstrate Against Charest Budget in Montreal

Seul la Lutte Paie

All That Glitters Isn't Gold

Van Ferrier — Tue, 11 Nov 2008 18:18:41 +0000

This report tells the stories of community members residing near Goldcorp's San Martin open-pit gold mine in Honduras' Siria Valley. San Martin was the first mine to be developed under Honduras' controversial new mining law that was passed in the wake of Hurricane Mitch in 1998. It was opened in 2000 and is the largest open-pit heap-leach mine in Honduras.

The Real Costs of Gold Mining

Van Ferrier — Tue, 11 Nov 2008 18:06:37 +0000

In 2007, a film maker travelled to the Siria Valley in Honduras to interview locals about the impact of gold mining on their lives and communities. He produced this short documentary. In it, people of the Siria Valley speak for themselves.

Working to Death

dawn — Sun, 02 Nov 2008 10:04:28 +0000

Canada's asbestos legacy

SARNIA, ONTARIO–Industrialized countries are facing a global disease epidemic.

Every year, two million workers die of occupational causes, according to the International Labour Organization (ILO). Seventy-five per cent of these preventable deaths are due to work-related disease. Of these diseases, cancer is the biggest killer. The single largest contributor to this work-related cancer epidemic is exposure to asbestos, causing 100,000 to 140,000 deaths annually worldwide. The World Health Organization estimates that between 5 and 10 million people will ultimately die from asbestos-related diseases.

Historically, Canada has been one of the world’s leading sources of chrysotile asbestos, the most common variety.

Used in thousands of products for its heat-resistance, its insulating properties and its strength, over 300 million tonnes of asbestos have been mined in the last century.

Most common uses of asbestos have been banned since the 1980s, but today it is used primarily in cement materials manufactured and used in developing countries.

For over 60 years, the asbestos industry knew about the carcinogenic potential of asbestos, but actively kept this information from its employees and the public. Since the information became widely known, insurance claims and lawsuits forced American asbestos manufacturers in the United States out of business; many are under bankruptcy protection.

Among industrialized countries, Canada has remained essentially alone in failing to acknowledge and act upon cases of mesothelioma and other asbestos-related cancers and respiratory diseases.

Two recent reports – one on asbestos-related diseases in Quebec, the centre of Canadian asbestos mining, and the other on work-related mortality in Canada – reveal a startling set of findings.

In the case of Quebec, the government report found rates of mesothelioma – a disease caused almost exclusively by exposure to asbestos, in which malignant cells develop in the protective lining of the body's internal organs, and for which the prognosis is poor – to be some of the highest in the world.

The report on Canadian occupational mortality, entitled “Five Deaths a Day: Workplace Fatalities in Canada, 1993-2005,” estimates asbestos-related deaths at almost 31 per cent of all workplace fatalities. The authors further suggest that almost 70 per cent of the increase in workplace fatalities between 1996 and 2005 was due to asbestos.

In industrial communities such as Sarnia-Lambton, Ontario, the toll of asbestos-related disease has been devastating. Sarnia-Lambton is home to a large petrochemical complex that produces approximately 40 per cent of Canada’s chemicals. The community has age-adjusted rates of mesothelioma that are comparable to some of the worst international asbestos disease hot-spots, such as areas in Scotland, where shipbuilding exposed tens of thousands of workers to asbestos.

The asbestos disease tragedy in Sarnia-Lambton has garnered national and international media attention. Between 1999 and 2008, the Occupational Health Clinic for Ontario Workers (OHCOW) recorded and diagnosed approximately 700 workers or family members with asbestos-related cancers or asbestosis, a chronic inflammation of the lungs. Over 1,000 of the asbestos-exposed workers with pleural plaques are being examined at Princess Margaret Hospital in Toronto with the use of low-dose CT (medical imaging) scans in the hope of detecting lung cancer in its early stages, when is still treatable.

Major health organizations, such as the International Agency for the Research of Cancer (IARC), the Collegium Ramazzini, the US National Toxicology, and the WHO, classify all forms of asbestos as human carcinogens and have determined that there is no safe threshold of exposure to the chemical. In 2007, the Canadian Cancer Society joined the above-mentioned organizations and called for the "elimination of exposure to asbestos."

The government of Canada maintains that Canadian asbestos –chrysotile, or white asbestos – is a weak carcinogen, despite scientific consensus to the contrary.

In fact, the federal government provides economic and political support for the asbestos industry and helps to maintain global asbestos markets by funding the industry-sponsored Chrysotile Institute over $20 million. Ottawa also exerts diplomatic pressure on behalf of the industry, funds legal challenges and defends against economic threats.

The Canadian federal government brought a legal challenge to the World Trade Organization (WTO) to reverse the European asbestos ban, but in 2000, the WTO ruled in favour of the ban, saying Canada was unable to disprove evidence regarding the carcinogenicity and other harm to human health caused by exposure to chrysotile asbestos. Canada unsuccessfully appealed the decision.

At the time of the WTO dispute, Canada was the world’s largest exporter of asbestos. While asbestos is still mined in Canada, it is now more profitably mined in developing countries. However, Canada continues to work in tandem with the global asbestos industry by providing technical expertise and political influence.

Canada’s generally positive global reputation allows it to promote this hazardous substance with minimal scepticism. The Canadian government has blocked efforts through the United Nations to have chrysotile asbestos included in the Rotterdam Convention, a global treaty that obligates producing countries to warn of the possible harm posed by their exports – essentially a right-to-know treaty for toxic substances.

Recently obtained federal government documents contained briefing notes for Gary Lunn, Minister of National Resources, which explained Canada’s opposition to the Rotterdam Convention. A group that included Gary Nash, an assistant Deputy Minister and former founding President of the Chrysotile Institute in Montreal, prepared the background information.

The documents reveal that the international asbestos industry is intentionally keeping the price of chrysotile asbestos inflated so Canadian mines can remain competitive, allowing the Canadian government to use its international standing to promote and protect the global asbestos industry.

The Globe and Mail reported that “federal officials believe there is a type of informal quid pro quo operating in the industry, with Canada using its good image abroad to promote asbestos, in return for foreign companies treating Canadian miners with kid gloves in the battle for market share."

The document, which was prepared by high-level bureaucrats for the Minister, stated, "Foreign producers tolerate higher-cost Canadian producers because of Canada’s leadership and credibility in promoting the safer use of chrysotile."

A blacked-out bullet point follows. The document goes on to say that lower-cost producers could, at will, "...withdraw support for the Canadian chrysotile industry in that they could easily reduce prices to eliminate Canadian competition," revealing the global strategy of the asbestos industry. Rather than have the Canadian industry forced out of business by global competition, asbestos-producing countries will tolerate an artificially inflated price in order to maintain the Canadian political and diplomatic role in defence of asbestos.

The true extent of the asbestos disease epidemic continues to be hidden from the Canadian public. Every year, hundreds of cases of mesothelioma are diagnosed while the majority are never submitted to the provincial compensation boards. Other asbestos-related cancers are left almost totally unrecognized and uncounted. The lack of public and medical awareness about the true extent of these diseases leaves individual workers and their families suffering and grieving without acknowledgement and support. Meanwhile, the public healthcare system is forced to cover the costs of treatment that, by law, should be borne by employers through compensation insurance.

This public health and social policy scandal has brought together a growing number of voices that are demanding an end to Canada’s century-long failure to protect workers from preventable asbestos diseases. A national network of trade unions, environmentalists, medical and scientific associations and victims’ groups have formed an organization called Ban Asbestos Canada.

A ban would end the export of Canadian asbestos and disarm the global asbestos promotion campaign that has been based in Canada. It might also help restore a semblance of credibility to Canada’s reputation as a just, caring and equitable nation.

Since the writing of this article, Canada successfully opposed the addition of chrysotile asbestos to a global dangerous-substance register at a conference in Rome, Italy.

This article was adapted from a longer version first published in the International Journal of Occupational and Environmental Health, entitled "Canada's Asbestos Legacy."

Margaret Keith and James Brophy are cancer researchers, currently involved in two breast cancer studies. They have each worked in occupational and environmental health for 30 years.

Asbestos

Asbestos Hazard

Hard Times Sold in Vending Machines

dru — Tue, 08 Jan 2008 18:48:30 +0000

Worker migration from Atlantic Canada to the tar sands

For Atlantic Canadians, the story of worker migration couldn't be more familiar. Leaving the region for the "boom town" of the day has practically been a rite of passage since the 1970s. The successive waves of worker migration from east to west have been many--the last Alberta energy boom in the seventies, the construction boom in Toronto in the '70s and '80s, the collapse of the cod fishery in Newfoundland, followed by the collapse of coal mining in Cape Breton--and have always resulted in a particular pull for young workers away from the region. This regional story was immortalized by Donald Shebib's classic 1970 film "Goin' Down the Road," which follows two men who leave Cape Breton in search of a better life in Toronto, only to end up bouncing from one poorly paid job to another. The shock of rural life colliding with urban poverty was aptly captured in Bruce Cockburn's song of the same name, which he wrote for the film: "I came to the city with the sun in my eyes/ My mouth full of laughter and dreams/ But all that I found was concrete and dust/ And hard times sold in vending machines."

Today, it is difficult to exaggerate the impact that worker migration to the Alberta Tar Sands has had for Atlantic Canada. Although credible estimates for numbers of workers who have been moving west are difficult to gauge, few doubt that they are in the tens of thousands. One would be hard pressed to find anyone in the region who does not know someone working out west.

But the move by thousands of Atlantic Canadians to Fort McMurray in recent years differs from past worker migrations.

"The key difference," says Reg Anstey, president of the Newfoundland Federation of Labour, "is that in the other outmigrations of significance, like when the fisheries shut down, a lot of people took pretty lousy jobs."

According to Anstey, unlike during other times of economic collapse in Newfoundland, when workers took jobs in fish or meat-packing plants in Atlantic Canada and Ontario, Newfoundland labour is now a much sought-after commodity.

"This is the first time where almost everyone who's working out there, their way up is paid and their way back is paid by the company," says Anstey.

As of 2006, the shortage of workers across the province was estimated by the Alberta government to be around 100,000 workers. Canadian National Resources Limited has begun offering three flights a week from Alberta to Newfoundland, while Air Canada has added a 'Fort McMurray Express.' The National Post reported in May that almost a third of the residents of Fort McMurray were believed to be from Newfoundland alone.

Anstey sees many advantages for Newfoundland from the oil boom. The province, like other regions of Atlantic Canada, is in the relatively early stages of developing its own oil and gas sector. Until the Lower Churchill Valley hydroelectric project and the Hebron offshore oil project are able to deliver high-paying jobs for Newfoundland's workforce, Anstey sees the migration of workers, whose return flights are likely booked in advance by their employers, as a method of training a generation of workers for these projects.

However, the pull of workers from the region is still somewhat alarming. The populations of Newfoundland and Labrador and Nova Scotia are shrinking, according to Statistics Canada, while New Brunswick and Prince Edward Island registered the lowest population growth rate of all provinces in Canada between 2006 and 2007. Newfoundland in particular, with an economy that has not yet recovered from the collapse of the commercial fishery in the early 1990s, is now in a state of population decline, with more people dying than are being born. Regional papers frequently carry stories about labour shortages for local trucking companies and fish plants. This shortage, in a startling parallel to Alberta's own industry "solution" to its own tar sands-fueled labour shortage, is prompting increasing calls from east coast business leaders to fill these positions by importing Temporary Foreign Workers.

However, for Atlantic Canadian workers travelling to Fort McMurray, the effects of this migration may not be fully known for years to come.

Steve Gaul, a resident of Halifax, worked various stints in the oil fields for a total of three years, most recently as a roughneck on a rigging crew. When asked about conditions on the job, Gaul says he discovered that exposure to harmful chemical agents was frequent.

"There's lots of Benzene and substances that you're gonna come in contact with fairly frequently. These kinds of things are very unhealthy, they even [result in] birth defects," said Gaul.

Material Safety Data Sheets detailing information about the various chemicals with which workers might come in contact were "diligently provided" to workers, but Gaul says that workers are not given time to read them.

Despite this, Gaul is quick to point out that his contractor instituted a "safety bonus" each hour for crews who maintained the safety of all members. Overall, however, he notes that rigging work is "a dangerous job by nature."

The effects of such chemicals may appear long after a worker has left a job site. As pointed out in an April 2006 column by Alberta Federation of Labour researcher Jason Foster, cancer caused by workplace exposure to chemicals like benzene are not recognized, nor even recorded by the Alberta Workers' Compensation Board (WCB)or the Alberta government.

According to WCB statistics, the WCB accepted 29 new claims for work-related cancer and recognized 38 fatalities due to occupational cancer in 2005. However, the Alberta Cancer Board estimates that eight per cent of all cancers in Alberta are work-related. This means over 1,000 new cases of work-related cancer are diagnosed and more than 400 workers die of occupational cancer each year.

Fewer than one in 10 occupational cancer fatalities are recognized by the WCB.

In addition, Alberta currently has one of the highest rates of workplace deaths in the country, and the number of workplace accidents reported in the province in 2006 was 181,159--an increase of 7.4 per cent from the previous year.

Stories of injuries and close-calls are not hard to come by. George Marshall, a 26-year-old PEI resident worked only a few days in 2006 as a labourer but "almost died twice" on the job. The first close call, according to Marshall, was on account of a fall, while the second was due to "a piece of the rig [that] disconnected and came hurtling toward me."

Jason Fraser, a 24-year-old iron worker from Chester, Nova Scotia, recently spent six weeks working in Fort Mackay. During his last week on the job, there were two serious injuries at his worksite: a structural steel worker injured both heels after a fall and a platefitter sustained facial cuts from a piece of steel. He believes that some contractors deliberately undercount the number of workplace injuries.

Fraser had difficulty adjusting to life within the work camps, which he says resembled university dorms, aside from the fact that they "basically look like a bomb dropped [on them]." After work, there was little to do within the camps.

"I've had problems with alcoholism and I just drank every night for five weeks."

Fraser also had a number of moral qualms with his work, which he believes may have contributed to his drinking.

"Nobody ever thought about the environmental impact," he says. "I had a lot of moral repression. I felt really bad for what I was taking part in."

Gaul also points out that few workers showed regard to the ethics and sustainability of the oil projects, and recalls that the subject of climate change was laughed at by instructors and workers alike during one of his training courses. He also believes that the long hours of work, coupled with the boredom of camp life, often leads to a general feeling of isolation.

"As far as the social atmosphere in the camps, it's not really the most healthy environment. There's a lot of negativity and built-up misery being shared and communicated. There are a lot of people that are in the situation where they're spending way too much time away from their family to have any kind of semblance of regular family life."

It is likely due to these "quality of life" issues that many workers from Atlantic Canada view their positions in Alberta as being largely temporary. Fort McMurray, with its overwhelming growth rate and its infrastructural inability to cope with this growth, is an unlikely candidate for long-term settlement for Atlantic Canadian workers. East Coast workers, though perhaps as naive to the hazards of the oil industry as their predecessors were to the reality of life in Toronto in the 1970s, are by now no strangers to moving to where the work is. Many recognize the higher cost of living in the West, as well as the sky-high rate of inflation in Alberta and realize that their money will stretch further on the East Coast than it will in Alberta. Some, like Anstey, see the abundance of Atlantic Canadians in the Alberta oil patch as an interim gig, as workers tide themselves over in advance of the opening of the Hibernia and Lower Churchill Valley projects. These mega-projects are likely to yield their own environmental and social impacts as well in the years to come, as the East Coast as a whole shifts its economy towards the production of oil and gas resources for export.

Still, many expect to one day see a similar job boom in the east, one that they believe might break their diet of "hard times sold in vending machines."

Acadie en Alberta

Passing Out in Upgrader Alley

dru — Sat, 20 Oct 2007 14:31:27 +0000

In Alberta's "Industrial Heartland," massive developments rival those of the Athabasca tar sands region

When the sirens go off at Shell's upgrader near Fort Saskatchewan, Alberta, nearby resident Kathy Radke knows there has been another accident. As plumes of toxic vapour are picked up and scattered by the wind, she is expected to call an emergency hotline set up for the handful of families living in the immediate vicinity. The hotline is meant to tell residents the severity of the accident, and whether to "shelter in place" or to evacuate the area.

"Half the time, the info hasn't even been updated when we call," says Radke. She wonders why Shell doesn't supply the nearby residents with air packs that they can put on as soon as the alarms go off.

Welcome to Alberta's Industrial Heartland, a 78,550-acre area about a half-hour's drive northeast of Edmonton. This industrial sacrifice zone, home to dozens of refineries, petrochemical plants and other industrial facilities, is where much of the bitumen pulled from Alberta's tar sands operations will be upgraded. Some is already pumped here, through a 493-km pipeline, to the Shell upgrader. With two more upgraders under construction, and another 10 in various stages of proposal or development, the area is popularly known as "Upgrader Alley."

A few decades ago, it was mostly farmland. Several families still live scattered on patches of land between the massive industrial facilities. The Radkes live and farm on land that was bought from Kathy's in-laws in the 1980s by Atco Gas, which stores natural gas underneath the property in salt mines. When Kathy and her husband moved in, leasing their home from Atco, they were told they would be able to live and farm there safely for decades. With the rapid growth of industry in the area, the Radkes were soon surrounded by the clanking of machinery, heavy truck traffic and air pollution. Their house is two kilometres east-—and downwind—-of Shell's massive Scotford operation, which boasts the existing upgrader, a second under construction and a refinery. To the north, BA Energy is also building a new upgrader.

Since Shell built its first upgrader in 2003, accidents have occurred at the rate of about four or five a year, says Kathy. Last September, there were two gas leaks in the space of one week. Nearby residents were instructed to stay in their homes for several hours. Some later reported sore throats and headaches that lasted for days.

Shell's neighbours are exposed to routine emissions of sulphur dioxide and other toxic gases, which temporarily spike above regulated maximum levels on a regular basis. Over the past two years, Kathy's family has lost 45 dairy cows out of a herd of 140 and she suspects that the air pollution has something to do with it.

The region's flurry of upgrader construction is linked to the fact that what comes out of the tar sands is not in fact oil or tar, but bitumen, a low-grade, heavy fossil fuel. Upgrading is the process by which the thick, tarry muck is turned into a synthetic crude oil that can be sent to refineries. This extra step is part of what makes the production of oil from tar sands so energy-intensive, with greenhouse gas emissions three times higher than those associated with conventional oil production. More natural gas is eaten up by bitumen upgrading than by the mining process itself.

Some of the upgrading happens in Alberta's north, where the bitumen is extracted. But with its lower costs and easier access to workers, the industrial region northeast of Edmonton has become the place of choice for upgraders in the province.

The bulk of Alberta's bitumen, however, is still upgraded in the United States—-where the vast majority is also refined, sold, and consumed. Alberta politicians have been calling for a dramatic ramping-up of the province's upgrading capacities. "If we insist on just sending raw product out of this province and adding value to that product in another jurisdiction, the taxes on the value-added product will be paid in that jurisdiction, not in the province of Alberta," Premier Stalmach told reporters last December. Energy minister Mel Knight has been quick to reassure the public that Alberta should have enough capacity to upgrade about 80 per cent of its bitumen within a decade or so.

Albertans face a paradox. With the havoc created by the mining and in-situ extraction of bitumen from the tar sands, they already shoulder the brunt of the pollution created by the wrestling of oil from tar sands, while capturing only a small fraction of the profits. Greater involvement in the value-added process of upgrading would increase the public's economic return, but it would also concentrate even more of the pollution in Alberta.

There is also the possibility that the upgrader boom could overwhelm Fort Saskatchewan and other towns in the area, in much the same way that Fort McMurray--epicentre of the tar sands extraction operations--is already overwhelmed by economic growth that most locals say is too big, too fast. The growing pains experienced by Fort McMurray include rocketing housing costs, a homelessness crisis and a severe shortage of health care and other services. "Our water treatment plant will be at capacity next year. Our recreational facilities are overtaxed. Our landfill site is full," the city's mayor recently told a parliamentary committee. Is this what Fort Saskatchewan has to look forward to?

"What we're facing is a huge expansion to roads, infrastructure, sewer systems, water systems, bridges. How is that going to be paid?" asked Edmonton mayor Stephen Mandel in 2006. He estimated that the money invested in the last five years in Fort McMurray pales in comparison to what is proposed for the "Industrial Heartland."

For now, the protests of Kathy Radke and the handful of other residents directly affected by the upgraders are largely overshadowed by the spectre of jobs and money rushing into the region. But if things go the way of Fort McMurray, it won't be long until all of the area's residents experience the ugly side of Alberta's bitumen boom.

Shell Upgrader, Fort Saskatchewan

¡Salud! tells the story of Cuba's medical internationalism

dru — Fri, 14 Sep 2007 21:21:36 +0000

Film Review

[This article originally appeared in Seven Oaks Magazine]

Michael Moore’s Sicko, an incendiary expose of the for-profit health care system in the United States, generated some predictable backlash from right-wing pundits. More than anything else in the film, what tended to get them especially enraged was the role of Cuba in the documentary.

After comparing and contrasting the US system with health care in Canada, Britain and France, Moore delivers the coup de grace by taking a number of 9/11 rescue workers to Cuba to get treatment for work-related illnesses that the U.S. system would not cover. These scenes feature friendly Cuban medical professionals providing free, quality care to the sick 9/11 heroes so shamefully neglected by their own government. Contrary to the hysterical claims of Moore’s critics, these acts of generosity were not mere propaganda set-ups; in reality, the provision of free treatment for the 9/11 workers only scratches the surface of Cuba’s exemplary medical internationalism.

Director Connie Field’s Salud! picks up from Moore’s Sicko with a documentary that examines Cuba’s long and elaborate history of exporting the gains of socialized medicine. In addition to telling an inspiring story that has received next to no mainstream media coverage in the western world, Salud! also presents an important debate, counterposing two very different philosophies as to what it means to be a physician.

Field’s documentary begins with some of the basic history of the Cuban revolution. The dire state of health care, especially in the countryside, was a factor in bringing about a mass movement and fuelling support for the guerrilla army that toppled Batista in 1959. In the early 1960s, free health care became a right for all Cubans, and a rapid process of training new health professionals was undertaken. Within only a few years, Cuba began to send brigades of medical volunteers to allies and various needy Third World countries. The extent of Cuba’s “doctor diplomacy,” as it has been called, is truly staggering. Over the past five decades, more than 100 000 Cuban medical professionals have served abroad, often in the most remote, isolated and impoverished locations.

Salud! covers a lot of ground for a medium-length documentary, highlighting the accomplishments of Cuba’s doctors in The Gambia, South Africa, Central America, and Venezuela. To its credit, the documentary lets the story unfold primarily through the observations of the doctors and patients themselves, supplemented by some experts in the field, such as the innovative and tireless internationalist Dr. Paul Farmer.

The segments in Africa are particularly poignant. We see experienced Cuban doctors literally reduced to tears by the extreme poverty and suffering of their patients. In The Gambia, the Cubans have helped to build a basic health care system from the ground up, beginning with simple measures to reduce the scourge of malaria. In many cases, following their community health model, Cuban doctors live in small villages that have never before had the benefit of medical attention.

In South Africa, while many of the local doctors and private practitioners live like kings, the country’s health care system is stressed beyond its limits by the AIDS crisis and a lack of personnel and funding. In one scene, we see a Cuban physician who has “defected” from his compatriots’ team in South Africa. Now in private medicine, the born-again capitalist happily shows off his mansion and boasts of his new lifestyle in “a white neighbourhood”. A Cuban medical official explains that only roughly 2% of all of their internationalist physicians have left to pursue this more lucrative type of medicine. South African and other African health officials, for their part, complain of a much higher percentage of “brain drain” with their graduates, as they watch helplessly as doctors are lured by contracts from North America and Europe.

In Venezuela, too, the film demonstrates the clash of medical philosophies between the Cubans and the local physicians. When the government of Hugo Chavez initiated community health clinics in the poorest barrios, Venezuelan doctors refused to sign on, so the government called in thousands of willing Cubans to do the job. Now, for the first time, the barrios around Caracas have doctors living and working in poor communities.

The last segment of Salud! covers the incredibly ambitious efforts of Cuba to offer free medical training to students from throughout Latin America, Africa, and – believe it or not – even the United States. Some of the most delightful interviews in the film are with these young students. In two notable cases – a young man from rural Honduras and a dynamic young woman from a barrio in Caracas – the students tell of being inspired to become doctors after witnessing the selfless efforts of Cuban doctors in their communities.

The thousands of students receiving medical training in Cuba represent a real hope for developing a ‘New Doctor’ for the 21st century, not driven by a desire for money or social status, but instead motivated to serve those in need and live as an equal with those in his or her community.

Salud! is an important documentary, and not just because it deals with one of the great and almost unknown accomplishments of the Cuban revolution. The film also confronts crucial issues about our collective right to health care in a world where so many still die needless, preventable deaths because of the greed or indifference of others.

» ¡Salud!: Official Site

Images from Salud

US Company Banned From Conducting Screenings in Ontario

Sat, 23 Oct 2004 20:26:10 +0000

A US company that tried to set up for-profit medical screenings in Ontario has been accused of preying on the fears of senior citizens. US-based Life Lines Inc. had planned to set up Magnetic Resonance Imaging (MRI) screening clinics throughout Hamilton and the Niagara Peninsula early in October, but the Ontario government stepped in and banned the company before they arrived. Those who made appointments for the $60 screenings were offered free screenings in the United States.

MRI screenings are covered by Ontario Health Insurance (OHIP) when prescribed by a doctor. Advertisements by the company say that the tests can help prevent strokes. Some observers warn that it is just a matter of time before more U.S. companies start trying to charge Canadians for screenings that are paid for by public health care.

The new leader of the Ontario Progressive Conservative Party, John Tory, has said that more companies should be allowed to operate for-profit clinics in the province.

Shella Gardezi

» Onlypunjab.com: Ontario bans U.S. mobile ultrasound clinic

» National Union of Public and General Employees: Ontario drives away predatory U.S. health company

» Joan Walters, Torstar News Services: Ontario slams door on U.S. van scams

Pharmaco Funding Compromises Drug Approval Process: CCPA

Thu, 21 Oct 2004 00:40:07 +0000

A new study released by the Canadian Centre for Policy Alternatives (CCPA), authored by Dr. Joel Lexchin, Associate Professor in the School of Health Policy and Management at York University, finds that drug regulation in Canada is not as open, as safe, and as efficient as it should be. The study, entitled "Transparency in Drug Regulation: Mirage or Oasis", argues that Health Canada and the brand-name pharmaceutical industry are too closely tied to each other for the consumer's good.

The report shows that "about half" of the Therapeutic Products Directorate (part of Health Canada) drug testing budget is funded by the pharmaceutical industry. This "cost recovery" fundraising is to offset deep budgeting cuts by the federal government in the 1990s. Dr. Lexchin writes that this relationship seriously compromises the safety and efficacy of the drug approval process.

Dr. Lexchin also writes that "There is no justification for Canada's failure to match the US standard." In the US, the report shows, the Food and Drug Administration (FDA) drug approval process is more transparent, and thus safer for eventual users.

» Centre for Policy Alternatives

Privatization of Health Care Costly to Canadians: Study

Fri, 25 Jun 2004 17:05:42 +0000

A McMaster study just published in the Canadian Medical Association Journal shows that Canadians would pay an extra $7.2 billion a year if the federal government decides to fund private health care with public money. The study lists profit, larger executive bonuses, and more administration costs as the top three reasons why the system would cost Canadians so much more money.
Gordon Guyatt, the NDP candidate running in the Ancaster-Dundas-Flamborough-Westdale riding, is one of the ongoing study's researchers. Since the NDP is the only mainstream party that is solidly against health care privatization, a bias could easily be associated with the study. However, the study is exhaustively based on eight others involving over 350,000 patients that were treated in both not-for-profit and for-profit US hospitals between 1980 and 1995. As well, two Harvard professors, in writing the editorial accompanying the study, praised the study as "meticulous."

The Conservatives have said that they will not oppose provinces that decide to privatize health care. Alberta premier Ralph Klein has already stated that that on June 30--immediately after the election--he will introduce changes that will allow for more private health-care options in Alberta. The Liberals say they prefer to keep health care public, but a variety of private services are already being provided without much opposition.

» Hamilton Spectator: Private Health Would Cost $7.2B More