The first time Harlen Laboucan died, his father was at his side.
Six-year-old Harlen started vomiting during the early morning of Nov. 13, 2020. His father, Kenton Laboucan, doesn’t have a phone. So he took his son to his grandmother’s house down the street and called The Little Red River Cree Nation Fox Lake nursing station at around 6 a.m.
Harlen couldn’t keep anything down. He told his father he was in pain.
Laboucan called the nursing station four times between 6 a.m. and 8 a.m., asking if he could bring in his son. Each time, the father said he was told to call back or wait until the clinic opened.
So he did what his little boy asked, and what most little boys want when they’re feeling sick.
“I took my boy home to see his mom,” Laboucan said.
That is, until he couldn’t wait any longer. Harlen was loaded into the car and they made the short drive to the clinic, arriving around 8:20 a.m.
“And I waited for the nurses to show up,” Laboucan said.
Laboucan said that when he arrived, there was nobody in sight. By this point, his son’s lips were turning blue, his face had little red spots and his hands and legs were turning cold to the touch.
Ten minutes after they arrived, a nurse finally emerged.
“I told her my boy is in pain and she rushed him to go inside.”
The next 45 minutes were a blur for Laboucan.
“They put oxygen on his face and started … the heart monitors. They checked IVs and everything was good. No dehydration. Nothing,” he said. “Everything was good.”
Then his son died — for the first time.
“I was there sitting right beside him. His little heart stopped and they started giving him CPR and he came back.”
Laboucan was led out of the room, and was told his son was doing better.
But just 45 minutes after they arrived at the clinic, the doctors gave Laboucan the worst possible news.
“They said, ‘Sorry Kenton, we did everything we could. He’s gone.’”
Harlen Laboucan was born on May 21, 2014. He loved toy dinosaurs, playing with his siblings and eating popsicles. He was a normal little boy living in Fox Lake. As his father said, he was “a happy little guy.”
Healthcare for First Nations in Canada has long been seen as substandard compared with the rest of the country. With higher infant mortality, lower longevity and lack of access to modern healthcare facilities and technologies, successive governments have failed to close the gap between the healthcare received in First Nations communities and other parts of Canada.
A report prepared by the Public Health Agency of Canada in 2018 titled “Key Health Inequalities in Canada: A National Portrait” highlights the disparity. Life expectancy at birth was found to be lower by 11.2 years in areas with a high concentration of First Nations.
The report also states that if there were no inequalities between people living in areas with low and high concentrations of Indigenous groups, there would be a life expectancy increase of between 9.2 per cent and 17.2 per cent.
Indigenous Services Canada, under the Federal Government, is mostly responsible for delivering care to on-reserve First Nations in Canada. But the reality is that there is a confusing mix of funding and management by the federal, provincial and First Nations themselves.
Global News contacted all 45 First Nations in Alberta to get a better picture of the situation in this province. Out of the 31 Nations Global News spoke with, only one has a physician on-site five days a week. One Nation didn’t want to comment and 16 didn’t respond. Some Nations said they have a physician visit a handful of times a month, while others have none at all. If there is no physician, band members must travel to the closest city or town for appropriate care. Depending on the remoteness of the First Nation, this can range from a quick 15-minute drive to over an hour in others. Some even have to cross the border into the Northwest Territories for care.
One area not handled by Indigenous Services is the hiring of physicians. That falls to each individual band.
Separate band funding is then used to provide the infrastructure needed to support a physician or nurse practitioner in their community. This can include things like clinics, medical equipment and electronic medical records.
The Little Red River Cree Nation Fox Lake Nursing Station serves the entire community of Fox Lake, which is about 150 kilometres east of High Level. Fox Lake is an isolated community with no year-round road access. According to a Facebook page, the nursing station provides “Primary Care, Emergency Health Services, and other Health programs.”
Indigenous Services Canada said that staffing at the Fox Lake nursing station includes six registered nurses, one nurse practitioner, and two advanced care paramedics. The department said additional staff are employed by Little Red River Cree Nation and Alberta Health Services, but there is no physician.
Conroy Sewepagaham, the Chief of Little Red River Cree Nation, believes that isn’t enough.
“This is to handle a population of 3,000 people, 24/7,” he said.
The Laboucans and Sewepagaham wonder if lack of healthcare support may have played a part in Harlan’s death.
On Nov. 15, two days after Harlan died, a letter was sent from Indigenous Services Canada addressed to “The Membership of Little Red River Cree Nation and the Community of Fox Lake.”
“It is with a heavy heart that we write you today to offer our sincere condolences to all those impacted by the tragic events that have taken place over the last 48 hours,” the letter reads. It highlights the importance of seeking out mental health support, if needed, and lists different resources available.
“Please be assured, quality essential primary and public health services continue to be available at the Fox Lake Nursing Station to support community health and wellbeing.”
Sewepagaham said getting a letter like this was a first.
He said Indigenous Services Canada flew to Little Red River Cree Nation to sit down with him and council to discuss what happened and ensure Harlen’s family was being cared for.
A spokesperson for Indigenous Services Canada said the decision to send a letter was made in partnership with the leadership of Little Red River Cree Nation. Despite knowing about the letter, Sewpagaham did not sign it. The government said the letter was “a means to acknowledge the tragedies and share with community members that there are avenues of support, when support is needed.”
RCMP confirmed to Global News that they are investigating a sudden death involving a child on Nov. 13 at Fox Lake. An autopsy was scheduled. A spokesperson for the RCMP told Global News in February that the cause of death is deemed to be non-suspicious pending the final report from the Medical Examiner and toxicology report.
A spokesperson for Indigenous Services Canada said, “When an unexpected death occurs in a federally operated health facility, it is federal practice to conduct a thorough patient safety and incident review.”
But Sewepagaham said the issue isn’t whether the death is or isn’t suspicious; it’s whether recurring healthcare issues like Harlan’s case are.
“Would this happen if Harlen was in a local community care centre, or in a town like High Level, Fort Vermillion … or Edmonton, for that matter?”
Dr. James Makokis, a two-spirit family physician who practises in Kehewin Cree Nation, doesn’t think so.
“There’s a huge disparity across the province in terms of who has access to primary care or specialists or laboratory services,” Makokis said.
Most Nations have a nurse practitioner. According to AHS, nurse practitioners are RNs with advanced degrees who are trained to assess, diagnose, treat and prescribe medications. But Makokis said that’s not good enough.
“What has happened over the years under the federal nursing program is the nurses that work in the Health Canada system have repeatedly had their scope of practice reduced,” he said. “And this is the exact opposite of what needs to happen in remote and isolated communities, where we need to have people operating at their full capability and scope of practice.”
As an example, Makokis said that nurses now can’t give patients Nix, a shampoo that is used to treat lice.
Sewepagaham said that since Harlen’s death, community members have started coming forward with their own stories about dealing with the healthcare system. It’s revealing a stark gap in care, he said.
“I think what the pandemic is doing is really showing those glaring disparities that separate Canada’s Indigenous and non-Indigenous populations in terms of healthcare.”
Sewepagaham doesn’t blame any of the workers at the nursing station. Rather, he believes it leads back to the underfunding of First Nations health.
It’s a statement echoed by Makokis and Dr. Lana Potts, medical director of Piikani Aakomkayii Health Centre, who both see it first hand in their own practices.
“I often say my job is not hard because I’m working in the community. My job is hard because of the lack of resources and lack of referral agencies we need for our patients,” Potts said.
“When we look at equity across all government programs, we know that the federal government is responsible for looking after different groups including the military, the navy, the armed forces, the RCMP and their own health coverage for MPs,” Makokis said. “If we were to look at those programs side by side, the non-insured health benefits program for treaty people is significantly less than any of those other programs, in spite of being covered by the federal government.”
Without a full-time, permanent physician working in communities, Potts and Makokis agree the situation can often be fatal.
Screening options are limited or non-existent, which makes preventative care extremely difficult.
Potts believes that in the end, it’s the children who suffer the most.
“So often we see things in a very urgent state, when prevention may have helped a lot of these kids,” she said. “As adults, we can speak up and say, ‘I need to see a doctor, perhaps I could travel to a town or a city,’ but children often get the healthcare that’s immediately available to them.”
For some, that could be nothing.
Widespread change needed across the country
Sewpagaham wants to see change. Not just for Little Red River Cree Nation, but across Canada.
“There’s quite a bit of health disparities and health inequalities, and not only with our First Nations here in Little Red River Cree Nation,” he said.
And a blanket solution isn’t the answer.
“First Nations people are often talked about as being the same, and they use that very collective word around First Nations,” Potts said. “But there’s more than 630 First Nations and each one has distinct languages, cultures, and ways of being and ways of having their own healthcare.”
For Makokis, this involves a blend of their own Indigenous medicine and Western medicine.
“Until that does happen, Indigenous people will continue to experience the highest rate of morbidity and mortality because we don’t have access to our own Indigenous healing system.”
There is also systematic racism that needs to be addressed within the healthcare system. Potts said getting her patients to even consider getting care outside of their Nation is a struggle.
“Patients don’t want to go. They don’t even want to get in an ambulance because they’re worried they’re going to be left in the city, left in the town with no way to get home,” she said.
It’s something Makokis sees as well.
“If they’re not able to be provided care in their own communities, and they experience racist harmful care in tertiary care centres, or hospitals, then where are they supposed to get adequate care?”
It’s a vicious cycle the two doctors feel like they’re stuck in.
“In the end, it’s more expensive to the health system to cause people to access the emergency room than if we were just to provide primary care locally in the communities,” Makokis said.
Especially when the answer seems so simple to them.
“What we’re asking for, in the scheme of healthcare budgets, is very small,” Potts said. “It’s not billions of dollars. It’s really just hundreds of thousands of dollars that can actually change and impact lives long term.”
In the end, the fight for adequate health care for First Nations and their communities isn’t just about staffing.
“It’s not about funding physicians, it’s not about funding nurses. It’s about saving lives and really just providing care to people who are not cared about at this moment,” Potts said.
“What I want to see in my lifetime is Indigenous health changed in a fundamental way,” Makokis said.
For the Laboucan family, they are learning to cope with Harlan’s death. Having to explain it to Harlan’s siblings has been difficult, especially to his younger brother.
“He says he wants him to come and live with us. I don’t know how to explain it to him. He’s five years old,” Laboucan said.
Laboucan hopes that no other parent has to go through what he is enduring.
“When the night time hits, that’s the hardest,” he said. “Thinking of my boy and missing him playing around.”