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Another Year, Another Attack on Rural Manitoba

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Mr. Pallister,
Another year, another attack on rural Manitoba by your government. 
On January 24, 2020, which has become locally referred to as Black Friday, your government announced the closure of the Dauphin Correctional Centre (DCC) by the end of May 2020. 
This was one of multiple sweeping announcements made that day, which ironically also included a promise to “continue to lay a foundation for private-sector investment and job creation in Dauphin and the wider Parkland region.” 
Safety concerns and an aging facility, which needs modernization, were cited as some of the reasons for this closure. I will not argue that. There are legitimate issues and concerns that have arisen from these very conditions. DCC is also a provincial government-owned building. Technically, your government is within your jurisdiction to implement changes to this building.
However, as is becoming a key characteristic of your government, to do so suddenly, without any warning to the community, the Corrections Officers and their families, the incarcerated and their families, and worst of all: without any transparent plan in place, is not only exceptionally short-sighted, but it provides the setting for the very type of unsafe conditions you claim to care about. 
In brief, relocating the approximately 60-70 incarcerated adults housed at DCC to other facilities places strain on the systems (Corrections, Sheriff's Office, RCMP, city police, health care providers, etc.) responsible for the care and management of these inmates. As previously reported by news sources such as CBC (“Every Manitoba jail over capacity: Inmates 'will be living in tents,' warns advocate” - CBC, November 2, 2016), every provincially run jail has more inmates than they are rated to hold. Further overcrowding of inmates in facilities that are already over capacity is like stacking dynamite on top of a powder keg.
As I have been told anecdotally: “It is already known within Corrections, that there are regular occasions when one or more inmates must be transferred out of a facility to another - whether it is due to incompatibility, rival gang members being housed together, or due to concerns about maintaining facility order (i.e. inmate or staff safety concerns). With the removal of DCC, there will be one less option for these transfers.  Removing Dauphin as the hub for correctional services in rural MB north of Brandon makes no sense and adds risk to everyone involved.” 
As was brought forward at the Town Hall on February 3, 2020, and again at the MGEU (Manitoba Government and General Employees Union) Rally held on February  4, 2020, economically, this closure for Dauphin and the Parkland region is the equivalent of over 8,000 jobs in Winnipeg being eliminated overnight. This would be considered unacceptable in Winnipeg. Why is the economic impact on the Parkland region so disregarded?
The social impact of your government’s decision on the Parkland region is immeasurable. 
80 families were blind-sided overnight. They are now a position I would never wish upon anyone. Do they leave the community that has become their home? Do they leave in the midst of a school year, as one (or both) parents must seek out work elsewhere? What other families in Brandon, Winnipeg, Headingley and The Pas will be displaced if Dauphin Corrections’ families use their ‘bumping rights’ to transfer to another community? 
As a Parkland area resident, I have heard only a fraction of how much stress, anxiety and trauma this situation is causing the Corrections Officers and their families. As one spouse of a Corrections Officer put it: “I have learned to heal from an incredibly difficult life of childhood trauma. I do not even feel right speaking about the effects of DCC closure on my family. This is a whole other level of trauma”.
That is not the main point of my letter today. I am going to break down your parochial decision from a healthcare and population health standpoint. I am also going to do what you and your government have failed to provide to the Parkland area: an alternative option to the jail closure. 
The Social Determinants of Health (commonly referred to as “the determinants of health”) are the conditions in which people are born, grow, live, work and age. The determinants of health are mostly responsible for health inequities - the unfair and avoidable differences in health status that is seen within and between communities.
The Social Determinants of Health are complex, and interrelated. At present, there are 12 determinants of health. The first and most important is one that you will understand: Income and Social Status. Almost all health status disparity can be traced back to income in some way, shape, or form. 

Population Health also classifies prevention of health problems (disease, injury, etc.) into three levels: 

  • Primary prevention involves activities aimed at reducing factors leading to health problems (i.e. to reduce the chance that the health problems will occur at all).

  • Secondary prevention activities involve early detection of and intervention in the potential development or occurrence of a health problem.

  • Tertiary prevention is focused on treatment of a health problem to lessen its effects and to prevent further deterioration and recurrence.

A Rehabilitation Centre is an example of primary, secondary and tertiary prevention. It is an opportunity to intervene as people have started to become involved with the justice system, and it provides the setting to provide programs and services that can address some of the socioeconomic and social issues that are the root cause of their predicaments. 
The Federal Government of Canada also goes into great detail on their website regarding Population Health. Included here are a few salient points:

  • Politicians, public servants and organizations at all levels are increasingly called upon to be transparent, open to comment and scrutiny, and accountable for the short- and long-term impact of their decisions. 

  • Accountability is the obligation to answer for responsibilities and decisions conferred. A key element of accountability is transparency provided in a manner that can be easily observed and understood by the public. 

Rather than simply closing DCC without a clear plan, I propose the building of a Rehabilitation Centre. There have been government promises to build a Rehabilitation Centre in Dauphin for decades. 
A Rehabilitation Centre provides those who are within the justice system and/or are currently incarcerated with resources in a safe setting to address and heal from the core issues that resulted in their involvement with the justice system in the first place. A Rehabilitation Centre provides opportunities for inmates to obtain education (as many do not have a high school diploma or equivalent), the skills necessary to obtain gainful employment outside of incarceration, and the coping skills to face future challenges in a more positive manner. 
A small, non-comprehensive list of the existing programming within the DCC includes Triple P Parenting, End to Aggression (anger management), Reclaiming Our Identity (for Indigenous people seeking to reclaim their culture and heritage) and Coming to Terms (strategies to cope with alcohol and drug use in oneself and others). Literacy training, food safety/handling and the development of various job skills are also offered at DCC. All of these programs could be expanded upon and provided within a rehabilitation setting. 
Access to services and support from the Addictions Foundation of Manitoba (AFM) office in Dauphin could additionally be on-site. This would make it far easier and more likely for inmates to attend and access these resources. In addition to AFM, there is an incredible opportunity to hire Registered Psychiatric Nurses within the Corrections system for impact regarding co-occurring disorders, addiction, and counseling services.
Corrections Officers in Dauphin are regularly stopped by people that thank them for delivering programming that has allowed them to regain custody of their children, that they are currently enrolled in training, ongoing education, or that they are making positive progress towards less reliance on alcohol and substances.  A Rehabilitation Centre provides an environment that has a positive trickle down effect on the larger community as well. The Corrections Officers, who are losing their jobs under your regime, would have the opportunity for retraining and employment at this centre. 
Enabling incarcerated citizens to deal with the core socioeconomic factors, intergenerational trauma, and undiagnosed or undertreated mental health concerns will reduce the number of people within the justice system and those who are incarcerated. It will result in fewer community members struggling with undertreated mental health concerns and addictions to substances and alcohol. 
Your government has vaguely indicated that there are plans to expand upon and provide updates to the Dauphin Courthouse - but then what? Where will the inmates go? Why would you transport someone to Dauphin for a court appearance, only to have them be transported to yet another community for incarceration? To me, that sounds like an unnecessary waste of the RCMP and Corrections Officers’ time transporting these individuals safely. It also sounds like a waste of what you really care about: taxpayer dollars.
Why wouldn’t a government want to build a rehabilitation centre, especially when it benefits communities and creates a better future? Money and politics. Preventative care does not give the instant financial results that you and your government want. It takes years before the full impact of primary and secondary preventative measures become apparent. The money that a centre like this conclusively saves is subtle. It is evidenced through fewer incarcerations, fewer court cases and appearances, fewer inmates who must be seen in the ER for mental and physical health concerns, fewer impacts to the children and families of incarcerees, and more. 
Ultimately, it is as simple as this: build the building that was promised! 
I am well aware that politicians think in four-year terms. If you are not in power, you do not care. Even when you are in power, decisions have been made which do not reflect the best interests of rural Manitobans. For example, in 2017, your government cut a restorative justice program with the John Howard Society that had existed for decades. This program aimed to resolve cases as much as possible through alternative avenues because incarceration is extremely expensive. A year later, your government eliminated a program in four carceral institutions that helped teach inmates trades (including carpentry, graphic arts, animal husbandry, gardening, and computer refurbishment. You blame the opposition parties for the lack of follow-through on your own promises, rather than accept responsibility for your own shortcomings. 
Prior to publication, my letter has been proofread and has received approval from a representative grouping of Dauphin and Parkland citizens. Some work within health care, but many do not. How bizarre it is that in writing this letter, I have put in more of a consultation effort with rural citizens than your government did before announcing the closure of DCC. I have also put in considerable time listening to others in order to better understand how your PC Caucus’ appalling decisions directly impact the families and businesses in Dauphin and the Parkland region.
I focus on rural healthcare because it is the area that I know best. I am not a politician. Yet, I know for a fact that I am doing what you and your government consistently fail to do: to represent rural Manitobans. I speak up about injustice for those who cannot because I choose to use my position of earned power and privilege to try to bring about positive change. 
I am at the start of my career. I will be here for decades to come. Long after your political career is over. It is people like myself who will have to deal with the fallout of your shortsighted decisions. I will care for the increase in mental health visits and crises that occur as families are separated. I will care for the flare ups of pre-existing autoimmune conditions and the worsening of metabolic/endocrine conditions (such as diabetes) that occur as a result of the excessive levels of stress and anxiety experienced due to this crisis of your government’s making. I will care for the increase in addictions, overdoses and withdrawals from alcohol and substances as people struggle to cope. I will deal with an increase in patients struggling with poverty on a daily basis since you chose to obliterate 80 jobs. There would also be a loss of employment skills within the area from former inmates who gained these skills within DCC’s rehabilitation programs. Your erroneous decisions will have a clear impact on the health of the communities that I serve for years and generations to come.
I assume the responsibility and accountability associated with my daily decisions as I provide medical care in the communities that I serve. If I can do this as a 29-year-old attending physician within rural MB, what is your excuse?
Do not just take my word for it. 
Another person who was born and raised on the Canadian Prairies once said: “We are all in this world together, and the only test of our character that matters is how we look after the least fortunate among us. How we look after each other, not how we look after ourselves. That’s all that really matters, I think.” This person also felt compelled to fight for a better future for rural Canadians. 
That person was Tommy Douglas. Perhaps you have heard of him? He was a far better politician than you will ever be. He had something rarely seen in politics these days - a strong obligation to help ALL citizens. Not just the upper echelon of voters.
Another quote from Tommy Douglas, which was used to describe a political opponent’s policies that only represented the interests of the wealthy, also feels applicable in this modern situation: “[He was] the only man I ever knew who could get money from the rich and votes from the poor with the promise to protect them from each other”. 
I will not hold my breath for a reply from you. It took over 4 months the last time I wrote an open letter to you about my concerns regarding healthcare and rural Manitoba, which was published by two media outlets (CBC Point of View - “Doctor gives rural health a grim prognosis in open letter to premier” April 2, 2019 and Brandon Sun - “Sweeping health care changes won’t help” April 4, 2019). I ensured that a copy of my letter was hand-delivered to your office. In return, I received a canned, copy-and-pasted reply from one of your subordinates. I know that you will once again pretend that you did not see or hear about this letter. You will hide behind the Buildings on Broadway, or out of country, as you have done before. 
What I will do: I will continue to write letters. Make phone calls. Send emails. Sign petitions. Attend Town Halls and engage in Community Meetings. I will continue to encourage everyone affected by your governments’ atrocious decisions, which benefit only the Ivory Tower of Winnipeg, to do the same. 
I will not remain silent while you and your government go out of your way to neuter and eradicate small towns and rural Manitoba. I will continue to put myself out there to be an advocate for the people that live here. 
Because someone has to. 

Dr. Danielle Paradis

**The views and opinions expressed in this piece represent those of Dr. Paradis alone, and do not necessarily represent the official policy or position of any other health care provider or organization**

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