“Pandemic Plan? … Not here.”

The first thing Chief Dale Harper of Garden Hill, Man., did when he got off the plane from Winnipeg on Wednesday was check to see if the supplies had been delivered. “Nothing,” he says.  “Nothing came in. And nothing is scheduled to come.”

His community—which now reports two confirmed cases of H1N1, or, swine flu—has been asking for basic medical supplies all week. But so far, the province has not delivered. And Harper says the situation is getting worse, with 30 to 50 people now showing flu-like symptoms. “So far the only response is, yes we have a pandemic plan in place,” Harper explains.  “But where is? That’s our question. Where is it? Because it’s not here.”

Thursday, the World Health Organization (WHO) held an emergency meeting on swine flu, declaring the first flu pandemic in 41 years.  That afternoon, Canada confirmed 533 new cases of its own. Among those was a second case of swine flu in Harper’s small northeast community of Garden Hill, as well as a handful of new incidents in nearby St. Theresa Point. Residents on the infected reserves are not too surprised. Garden Hill and St. Theresa Point—both part of Manitoba’s Island Lake region—are some of the province’s most isolated First Nations reserves.  And what is increasingly clear, as the national swine flu count rises, is that these very kinds of communities are being disproportionately affected by the pandemic.

The plight of Canadian First Nations has captured attention at the highest levels.  Early this week, WHO acting assistant director-general, Keiji Fukado, said the organization was particularly alarmed by the number of flu cases appearing in Manitoba’s aboriginal communities. And Nunavut, with 96 confirmed cases of its own, is also cause for concern.

Some have suggested that aboriginals may be genetically predisposed to getting the flu.  But Harper is quick to dismiss those claims. “You don’t even go there,” he warns.  “That shouldn’t even be considered.” Joel Kettner, Manitoba’s Chief Medical Officer of Health, agreed Thursday that there was no evidence of a genetic link. What is more likely is that poverty, poor health, and cramped living conditions on northern reserves are to blame. And mismanagement of the problem by provincial and federal authorities has added to the mess.

Garden Hill, for example, has no doctor. Instead, it has to rely on nurses, in between visits from part-time physicians who fly between reserves. When the reserves’ first flu victim—an 18-month child—was diagnosed, it took one week before authorities had him medevaced to a hospital. And that only happened after the baby’s grandfather pleaded with local nurses. After that, locals asked for a permanent doctor. The Chief has been assured that one will come, but not until next week.

In the meantime, the dozens of people who now show symptoms are still at home—in houses that often shelter 3 or 4 families. “They’re still in the community.  There’s no doctor to say this is an emergency situation and [that the patients] have to be shipped to Winnipeg.” Harper says he has done what he can, but he’s losing hope.  He asked the province for gloves, masks and hand sanitizers to help him keep his community clean.  But so far, he says, he has nothing.

Some health officials report a different story. Terry Goertzen, Manitoba Health’s assistant deputy minister, claims that 9,000 surgical masks and 2,600 N95 masks have been sent to First Nations and Inuit Health. But he acknowledges that his office does not regulate distribution to individual communities. Instead, he says, it’s up to regional authorities to distribute supplies as they see fit. And Jim Wolfe, regional director for Health Canada’s aboriginal branch in Manitoba, says a decision has been made to send hand sanitizer to all First Nations. That’s good news. “Frequent handwashing,” as Health Canada recommends as a measure to prevent the flu spread, is awfully hard to do in a town where half the residents lack access to running water.  And it’s hard to take precautions, Harper points out, when residents are not even clear about what H1N1 is.

In Nunavut, it seems like more of the same. Chief medical officer Dr. Isaac Sobol denied that there is a problem unique to aboriginals—even as 71 newly confirmed cases in his district were reported Thursday.  And he dismissed a remark from WHO’s Fukuda, citing a “disproportionate number of serious cases occurring” in Inuit communities in Canada. “I have no idea why [the organization] would’ve made that statement because it’s not based on any evidence I’m aware of,” Sobol told reporters.

In preparation for a worsening situation in Manitoba—the province’s medical officer believes hundreds of thousands will soon be infected—Garden Hill is calling for an emergency hospital base to be set up to serve the region. That might save the province some money, as well as providing reassurance those living on reserves. Right now, the government is paying to have infected patients flown to Winnipeg hospitals for treatment. Harper prices the cost of the medevacs from Island Lake Region at over $1 million, although Manitoba Health could not confirm that estimate.

Harper says he has invited the Health Minister to come to Garden Hill and see the problem firsthand.  But so far, she has not responded to the invitation. He called her office yesterday, but was not able to speak with her directly. Until his community gets its due attention, the Health Minister can expect daily phone calls from him. He’s giving her a week. “We’re going to start pressuring. There’s ways.”

Harper has not ruled out flying the community’s sick children to Ottawa. Anything, he says, to get the attention of officials