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Small, Rural and Northern Healthcare

By Mark Michasiw, Director, Parkin Architects Limited

Parkin has a history of service to northern and First Nations communities, both for healthcare facilities and for justice related projects. We’ve had the recent experience of working on a Master Plan (Stage 1B) services for Weeneebayko Area Health Authority in pursuit of replacement healthcare facilities for Moosonee, Moose Factory and Kashechewan on the James Bay Coast in Northern Ontario.

In Ontario, this is the first of its kind, where the provision of healthcare services has been placed with the provincial Ministry of Health and Long Term Care, rather than the historic nation-to-nation relationship between the first nation groups and the federal government. Under the Weeneebayko Area Health Integration Framework Agreement (WAHIFA) these services and capital investment to support these services would be provided. The principle is to sort out an effective service delivery model, recognizing the profound issues of distance, small populations, challenging operational conditions and chronic disease management that must be addressed in a plan for this renewal. Aspects of this remain controversial due to a wide array of local interests in the context of the federal government’s inaction on first nations’ healthcare. We worked closely with Hospital staff and their programmer, Agnew Peckham, along with our sub-consultants Smith Carter (now Architecture 49), PBK (also Architecture 49) and AKDG with H. H. Angus for engineering services, to provide a comprehensive and interactive team, covering off key aspects of the government mandated requirements, yet responding to the particular needs and focus of the First Nations groups.

Within the terms of our assignment, we needed to prove out the master program on fundamental good planning principles and the established MOHLTC process including engagement of both clinical users and the communities who would use the institution.

Of greatest controversy is the location of the main hospital plant, either at Moose Factory or with closer relationship to transportation (inbound and outbound) in Moosonee. A series of options examined renewal, addition/renovation and a new site. The historic provision of service on Moose Factory Island, no matter how remote has had strong resonance with on of the first nations groups on the island. In any case, the Weeneebayko health system will continue to provide ongoing ambulatory services on Moose Factory through a new health centre.

The project also gave us, Parkin, a first hand look and some of the challenges in building in the James Bay Lowlands and an approach to working with the First Nations groups. Together with our consultants and the hospital, Parkin participated in a series of engagement sessions including Peawanuk, Attawapiskat, Kashechewan, Fort Albany, Moose Factory and Moosonee. In all cases the First Nations groups were insightful and clear as to their priorities and needs. The greatest challenge with the project is, in the face of the extraordinary need of the populations, the glacial pace of government approval process. We were struck as well that this is where the creative efforts of public-private consortia and ingenuity of the aboriginal people could produce a creative solution to expedite delivery of health renewal in the north.

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