Max Pahtayken
Local Journalism Initiative Reporter
Daily Herald
Saddle Lake Cree Nation made a groundbreaking announcement on Sep. 9, the 150 year anniversary of the signing of Treaty Six in Fort Pitt Provincial Park.
The nation announced that they will be creating a refuge for both first nations and non-first nations to seek gender affirming care, and are working towards a health law that exempts clinicians and physicians who practice on the reserve and territories from potential legal repercussions of providing gender affirming care for trans and two-spirit peoples, under the Medicine Chest Clause, unique to Treaty Six.
“The province cannot restrict a federal benefit, nor can they restrict a treaty benefit,” said Dr. James Makokis, a two spirit family physician in Saddle Lake Cree Nation. “I view this as a part of medical history, I view this as a part of history for Treaty Six and all the nations within Treaty Six, but most importantly, for our own two spirit people and their families who have been voiceless and who now have many allies that stand and support them.”
Treaty Six spans across central Alberta and Saskatchewan, with Onion Lake Cree Nation seated directly on the provincial border. Various chiefs and leadership from both Saskatchewan and Alberta attended the gathering over the course of the five days, with September 9 being the anniversary date that Chief Sakaskoch, and Chief Makaoo among other chiefs and eventually Chief Big Bear entered into Treaty Six.
Dr. James Makokis alongside Saddle Lake Cree Nation Chief Dale Steinhauer made the announcement at 3:30p.m. on the third day of the Fort Pitt gathering, hosted by Onion Lake Cree Nation in celebration of the later signing of Treaty Six in 1876, shortly after the signing in Fort Carlton and Beardy’s and Okemasis Cree Nation.
As written in the article of Treaty Six the Medicine Chest Clause reads as follows ‘That a medicine chest shall be kept at the house of each Indian Agent for the use and benefit of the Indians at the direction of such agent.’
“The vision and leadership of our elders at the time that really started universal health care,” Dr. Makokis said. “It was Tommy Douglas who took that concept and idea in the 1970’s that formed this Canadian value of publicly accessible, universally available public medicare in Canada. Our elders took those steps to put in with western notion of medicine and health care into our treaty specifically. We have to understand that not only is that a symbol in the past of what medicines were and what our elders saw European medications, pharmaceuticals and services, but what it would evolve into in the future.”
“That’s the component of our treaty that’s really important to understand is the symbolism and it’s not just stuck in the late 1800’s that much like medicine evolves, so too do the treatments, care, services, and equipment available for medical care, that includes gender affirming care.”
In December 2025 the United Conservative Party of Alberta passed Bill Nine known as the Protecting Alberta’s Children Amendment Act that restricts trans and gender diverse youth from accessing gender affirming care such as hormone suppressors or replacements, and restricted the participation of youth in sports.
“In February 2024, when the UCP Government announced they were passing these anti-trans laws, I knew that we could assert our treaty jurisdiction and sovereignty and also our medicine chest,” Dr. Makokis said.
Two spirit is a newer pan-indigenous term that describes a person who takes on both traditionally feminine and masculine roles within their community, culturally dating back to pre-contact. The term comes from the anishnaabemowin phrase ‘niizh manidoowag’ which translates to ‘two spirits,’ an umbrella term that now describes an indigenous person’s gender, and/or sexual identity.
“Especially indigenous, two spirit, trans youth, because of the intersection of racism, homophobia, transphobia, there’s an overrepresentation of mental health,” Dr. Makokis explained. “Issues that include anxiety, depression, social exclusion, and all of that culminates when we look at the statistics for trans indigenous youth, that 50 percent of them will have either attempted or committed suicide. It’s important for us as members of not only the two spirit community but all people to step in and be active allies and do something.”
The nation of Saddle Lake will create sites of refuge and safe haven for anyone on the reserve or territory to access gender affirming care. The other main part of the project is to exempt doctors and clinicians who practice gender affirming care on the lands from being sanctioned by their regulatory bodies.
Saddle Lake Cree Nation has also made steps towards creating the Two Spirit Health Law that will provide further protection for other physicians and clinicians in providing gender affirming care, to create opportunity for all needing that care to be able to receive it. Dr. Makokis also said that they will accept any Canadian Trained Health Professional to work on reserve lands and territories to incentivize non-indigenous practitioners to work in the communities and provide more opportunities in time of health human resource storage in indigenous communities.
Dr. Makokis also said that the UCP Government will be implementing the Neutrality Professions Act that will prevent lawyers, teachers, health practitioners and physicians from educations members about equality, diversity, inclusion and treaties.
“What limited education that health professionals and professionals were provided through courses and things like that are now going to be made illegal and that’s a violation of our treaty,” Dr. Makokis said.
“So passing these anti trans laws which eliminate a section our citizenship which include two spirit and trans people, violates our treaty. Banning medications which are within the medicine chest is a violation of our treaty.”
The nation has a GoFundMe set up for allyship all across the country to donate to, to assist in the legal battles that will inevitably follow the announcement and cases within the project. Their goal is $500,000 minimum to be raised, and they call on allies to stand together and support their motion towards sovereignty and utilizing their treaty rights.
“What we witnessed here today was actually something very historic where indigenous people, treaty nations are saying that they’ve had enough and that they’re using the tools provided to us by our ancestors who agreed to treaty 150 years ago to assert their jurisdiction, sovereignty and nationhood, specifically in the area of health,” Dr. Makokis said. “This has other implications for other parts, other areas too, which is really exciting to see how other nations take up those opportunities.”
editorial@paherald.sk.ca
