“The pilot won’t let you on the plane if you’re not dressed for survival”: This Toronto doctor travelled to Northern Ontario to vaccinate people in fly-in Indigenous reserves

Suzanne Shoush, a long-time family physician at St. Michael’s Hospital, was selected to take part in Ornge’s Operation Remote Immunity initiative, joining staff and physicians to vaccinate members of 31 First Nations communities in Northern Ontario. Here’s what the experience was like.

—As told to Kelly Boutsalis

“My mom is Coast Salish, and my dad is Black from Sudan. Growing up in Edmonton, I thought I would become a university math professor, but instead I took a winding pathway that led me to community medicine. During the pandemic, I’ve been working at Auduzhe Mino Nesewinong (the Place of Healthy Breathing), an Indigenous-led site that’s a collaboration between Na-Me-Res, Seventh Generation and Well Living House. It started as site for testing, contact tracing and support, and has since evolved into an urban Indigenous vaccination clinic. Many of my patients are in Indigenous and Black communities, and a lot of Indigenous people I meet talk about how grateful they are to have a health care provider they can relate to on a cultural level. It’s the same for me. With my patients, I feel so peaceful.

“We have often seen pandemics disproportionately affect First Nations, Inuit and Métis people in Canada, because reserves were designed as a system of disenfranchisement without basic infrastructure. Fly-in communities do not have the same access to health care services that other communities have. There are dangerous public health conditions in many First Nations reserves, and the basic steps to stop pandemic spread are not available—thus the urgency of vaccination.

“Operation Remote Immunity is an incredible feat of logistics, planning and execution to deliver thousands of vaccines to 31 remote fly-in northern Ontario communities in the dead of winter. It’s the phenomenal work of Ornge, Ontario’s air ambulance, in partnership with the provincial government and Nishnawbe Aski Nation, which represents 49 First Nations in Northern Ontario. This equitable vaccine rollout for fly-in communities is brand new—we’ve never had a social lens on vaccine rollout before. Until now, First Nations communities have often been ignored when it comes to resource allocation. This program is new and strange and good.

“When my friend forwarded me a poster about the project that was circulating in the hospital, I immediately emailed Homer Tien, the president and CEO of Ornge, and volunteered. He recognized the importance of including First Nations physicians in the rollout, and welcomed me on board right away. I was selected to go to Webequie First Nation, about 600 kilometres from Thunder Bay, at the end of January, and Sandy Lake, about 300 kilometres from Sioux Lookout, in early March.

“Webequie is an absolutely beautiful Ojibway community, with a total population of about 850 and a vaccine-eligible population of around 300 to 400 adults over 18. Sandy Lake is a much larger Oji-Cree community, with 3,000 members and an eligible vaccine population of about 1,350. Both communities are accessible only by air or winter road networks. In both spots, there was strong leadership devoted to protecting the health of the community. That included aggressively testing, contact tracing and isolating, and they were managing positive cases when I was there.

“Before we could even enter these communities, we had to take the San’yas Indigenous Cultural Safety program on culture, stereotyping and the impacts of colonization, as well as mandatory vaccine training regarding the prep, administration, aftercare and side effects. We also had to learn how to dress for the weather. I have Alpaca wool sweaters, deerskin gloves, beaver fur hats and, the most underrated accessory, snow pants. The pilot won’t let you on the plane if you’re not dressed for survival. We also learned how to avoid walking into the airplane wings or getting your head cut off by the propeller. I was vaccinated with two doses before flying up, and I still had to take a Covid test, observe social distancing, masking and hand-washing while there. As Indigenous people, we’ve never been first in line for something positive—for infrastructure, water, internet. It’s so unusual to be offered something good ahead of others.

“Our preparation included a lot of discussion about how to build vaccine confidence and trust in the health care system that for so long neglected and harmed Indigenous people. Vaccine hesitancy is not new to me: I’ve seen it with new moms over childhood vaccines. I used to make the mistake of going over the top when touting vaccine successes. Then I would notice that the moms didn’t come back for their appointments, and I was losing patients. Indigenous people face everyday racism and discrimination, and and it can wear on you to the point of skepticism and mistrust. Now, when my patients say they’re not ready, I accept it. I no longer act as a vaccine salesperson; I don’t own stock in Pfizer or Moderna, though I wish I did. Instead, I share information on risks, benefits and alternatives. I just want patients to have the information from someone they trust. I see their fears of the unknown. Many people perceive the vaccine as being rushed out, and they’re worried that trials didn’t include pregnant or nursing people.

“For fly-in communities, there were three bases, in Thunder Bay, Sioux Lookout and Timmins. During my week in Webequie First Nation, I slept at a hotel in Thunder Bay, woke up every morning at 6 and met the team downstairs at 6:30. Each team had two Ornge paramedics as leads, at least one MD and, depending on the size of the community, one or more logistics or administrative managers. We’d also have several vaccinators, who could be registered nurses, nurse practitioners, MDs or medical learners. Someone from the community would be on the team, and in Webequie, our nurse practitioner had been there for 13 years.

“Then we’d go to the base, where the vaccines and supplies are kept. The Moderna vaccines were kept in something called a Crēdo Cube: a deep freezer that’s digitized and designed to keep the vaccine from being shaken. It’s an mRNA vaccine, which instructs your body on how to create antibodies. If it’s vibrated, the instructions come apart. The Cube keeps it nice and cold—the temperature ranges from minus-40 to minus-15—and you can only open it 15 times, period. Otherwise, the temperature could drop and  compromise the integrity of the vaccine.

“We’d load up the equipment, including emergency food and water, plus emergency sleepover stuff like sleeping bags, cots, blankets and satellite phones, in case we got stuck there or our plane unexpectedly had to land in an emergency. We had to go back to the base every day, because the vaccine supply is so heavily monitored and regulated. You’re only allowed to take what you can use in a day, and we never wasted a dose. Then we’d fly in a little six-seater to Webequie. My daily flights were between an hour and an hour and a half each way, and I had 10 flights in a week. When I got back to Thunder Bay, I’d count everything, restock for the next day and either go to bed or go to Walmart.

“When I was growing up, my mom was the director of Aboriginal Justice Initiatives in Alberta; she travelled to every single reserve in the province, and she always brought fruit. I was always so embarrassed, because I thought people would think she was crazy. Now I’ve realized that bringing a gift is a beautiful and welcoming gesture. We were allowed to bring 25 pounds of luggage onto the small planes, and I packed fruit, like grapes, avocados, oranges and apples, plus things people asked for, like nail polish, specific bars of soap, lotion, shampoo, toothpaste and sturdy garbage bags. I never brought my own stuff. I even started my own trading post—sometimes I’d trade beaded earrings from the reserve for supplies the community needed from Walmart.

“The community in Webequie set up their vaccination site in an elementary school, and they did it perfectly, with screening, check-in, registration and vaccine booths scattered through the gym, plus an observation area. We’d start each day by gathering and saying a prayer and a land acknowledgment, and we’d smudge over the vaccine and ourselves. Then we’d have a 14-hour day, vaccinating several hundred people a day, ranging from 18 to 90 years old. The first day was devoted to vaccinating the elders, community leaders and those with high-risk health conditions. Then anyone who wanted a vaccine would get one.

“I’ll never forget one woman I met. She was a residential school survivor who was in her mid-70s. She would only speak Oji-Cree, so she spoke through a translator about her fear of medical violence, experimentation and the pandemic. She said, ‘I went to residential school, and I can’t get hurt anymore.’ Holding her hand, I told her that my mother’s family survived residential schools, and that we didn’t need to do the vaccination right away, because I would never knowingly hurt her. She sat there silently for so long. Suddenly, in English, she said, ‘I’ll take the vaccine.’ I laughed so hard, because she could speak English but, on principle, refused to do so until she realized that my mother was Indigenous.

“While in the community, we did elders teas, Facebook Live sessions and radio appearance talking about the vaccine. There was even a ‘black radio,’ which is just a communal walkie-talkie with everyone tuned in to the same frequency. Elders and community leaders were amazing on the radio, speaking mostly Oji-Cree, and the Facebook Lives were a fantastic way to let people know how many doses were left that day, or when they could come during a lull in the day. The elder teas were so funny. They’d say, ‘The only thing we want to know is if the vaccine will improve our sex lives!’

“One of my favourite experiences in Webequie was when I gave this one guy a vaccine. His eyes started rolling back, his whole upper body was seizing, his head was rolling back and forth and he was grunting and gurgling. The entire time his arm was perfectly straight and he was recording himself by video. When I finished giving him the vaccine, he suddenly stopped moving and looked like he was dead. Then he turned off the camera, stood up and said, ‘I didn’t even feel it. Don’t worry: that was just for Facebook.’

“There was so much humour there, and so many amazing, talented people. We did home visits for people who are homebound, and they would just be chilling at home, making a beautiful pair of moccasins or beading something miraculous.

“At the beginning of March, I visited Sandy Lake. The reserve’s chief, Delores Kakegamic, NDP MPP Sol Mamakwa and Nishnawbe Aski Nation Grand Chief Alvin Fiddler did so much community building. It was like a well-oiled machine. The community there has so many amazing stories; for example, one of the Canadian rangers started a long-distance running club. She takes youth all over the world to run, including the Cayman Islands. That week, we did more than 1,000 vaccinations, and ended up getting almost 95 per cent of the eligible population vaccinated.

“In Toronto alone, there are 80,000 Indigenous people, with an estimated 60,000 eligible for vaccination. In Toronto, 90 per cent of First Nations, Inuit and Métis adults in Toronto live below the low-income cutoff, and one-third are functionally homeless. There’s a huge need for vaccinations, testing, contact tracing and support. We’ve had to fight and advocate relentlessly for resources and vaccines for the urban community. In Toronto, we don’t have the partnership or leadership from public health and the government to co-lead a massive logistical rollout that would compare to Operation Remote Immunity.

“Indigenous-led clinics like Anishnawbe Health and Auduzhe Mino Nesewinong are working hard to get vaccines delivered in a reassuring, culturally safe and effective manner. We’re also working with hospitals like St. Mike’s to offer online, low-barrier vaccine appointments to anyone who identifies as First Nations, Indigenous or Métis. Sunnybrook has partnered with Auduzhe to offer mass Indigenous vaccine days, and Michael Garron is also stepping up in an incredible way to get vaccines into Indigenous communities. Indigenous people are valuable, and our knowledge, culture and languages are important. We have to be healthy and protect everyone we can, because Indigenous life is sacred. My participation in the Ornge project was just two weeks, but it was the most incredible experience of my life.”