Author Archives: raisa vecina

https://www.healthcarecan.ca/wp-content/themes/camyno/assets/document/IssueBriefs/2016/EN/TRCC_EN.pdf

The final report of the Truth and Reconciliation Commission of Canada (TRC) released in 2015 included a few recommendations specifically for health. Some of these include:

• acknowledgement that the current state of Aboriginal health in Canada is a direct result of previous Canadian government policies
• recognition of and implementation of health care rights for Aboriginal people
• establishing measurable goals to identify and close gaps in health outcomes between Aboriginal and non-Aboriginal communities
• providing progress reports, ensuring medical and nursing schools include courses dealing with Aboriginal health issues
• providing skills-based training in intercultural competency, conflict resolution and anti-racism.

This report also includes some potential steps to reach these recommendations.

This was a wonderful webinar shared through my workplace (Vancouver Coastal Health) and shared with all health care workers. It is a round table discussion with Indigenous Aunties & Grandmothers as they share and discuss their experiences supporting Indigenous Birthers. The presenters include Elders from various nations who have been involved in teachings, advocacy and support for both Indigenous and Non-Indigenous health care delivery. These are educators, facilitators, and leaders who share their experiences and strategized together to support Indigenous parents and birthers.

It also delves into issues such as perinatal substance use and discusses key challenges faced by communities and health care services, from the perspective of the elders in these communities. I think it is a very reflective, personal round table discussion that provides a lot of reflection for me, as a health care worker.

Link to article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5764719/

This review describes how access to health care has been a significant challenge for Indigenous people in Saskatchewan, specifically in northern rural communities.

There have been pilot projects implemented and one of them is the use of Remote Presence Robotic Technology (RPRT) as a form of telemedicine. It provides a sense that a health care practitioner is by the patient’s side and enables health care delivery in real time. There are other piloted projects that have successfully used digital technology to close the gap in access of health care delivery through modalities such as robotic ultrasonography for prenatal care, using cell phones for HIV positive patients to improve compliance with anti-retroviral therapy and using technology to aid in better analysis of lab samples.

These have shown to enhance access delivery but also provide comfort to patients. Since a lot of these communities are quite remote, it prevents unnecessary transportation for these communities away from their families.

This video developed by Northern Health BC highlights information shared by women from the Tsimshian, Tahltan, Haisla, Gitxsan, and Nisǥa’a nations. In this video they share their cultural practices around birth and how these impact their health care needs.

The women explain that around birth, they often want family members present to be involved in traditional ceremonies. There are even certain practices that are important to these women such as cord cutting, examining the baby as soon as they are born, saving the placenta and so on. There is a notion that a lot of these practices are often not discussed in advance with health care practitioners. It’s important that these practices are discussed in advance so there is a partnership between these women and health care delivery. I will examine how technology can perhaps close this gap, specifically around rural communities.

http://www.perinatalservicesbc.ca/Documents/Resources/SystemPlanning/Rural/SafetyRuralMaternityServicesWithoutLocalAccessCsection_2015.pdf

This is an applied policy research review asking the question “What is the relative safety of rural maternity health services without local access to caesarean section?”. I chose this research article to further understand the gaps in health care delivery that Indigenous women (especially in rural areas) experience.

Some key takeaways from this study that are required:

1.Skilled and confident maternity care providers with an understanding of the contextual realities of supporting childbirth in a low-resource setting;
2. Local maternity services must correspond to population need. Where higher resourced maternity services can be sustained, primary maternity without surgical support is not a replacement.
3. The primacy of birth for families, communities and the health system, where birth is the most common reason for hospitalization
4. That patient centred care means a health system that matches both the health needs and values of the people using the system
5. That risk and safety each have many definitions and perspectives, all of which must be considered when optimizing health system outcomes.

This talk by Dr. Anderson-DeCoteau walks us through the instutional racim and epistemic racism that often plagues our health care system. There has been an imperialist implementation of colonial policies that have stigmatized, othered and affected access to resources in our Indigenous communities. Our health care system has been based on western values and framework. For example, the gold standard for research has been through large randomized control trials, and oftentimes, the indigenous way of knowing is not often included in these trials/studies.

Dr. Anderson-DeCoteau walks us through these barriers and some ways to overcome these through Indigenous ways of knowing through values like love, humility and knowledge.

I found this article in this 2015 Spirit Magazine issue: “Maternal Child Health through a Traditional Lens”. It speaks of the journey of women from conception to early newborn years. See link: https://issuu.com/firstnationshealthauthority/docs/spirit-magazine-the-womens-issue

The author describes how ‘kitchen table’ stories used to be passed down from generation to generation and this is where women from the family learned from others’ experiences in their families. This article was particularly eye opening in that it walks through some traditional views of maternal/child health from an Indigenous point of view.

‘Staggering disparity’: Study finds Indigenous people travel farther to give birth

Being in health care, I first-hand see the staff shortages, lack of resources and burnt out front line health care workers that is plaguing our current health care system. While I work in an urban facility, these challenges still occur. What I have started to realize, however, is the waning in resources that have affected our rural communities, including our Indigenous peoples. In this study, linked here (https://www.cmaj.ca/content/193/25/E948), Indigenous people living in rural Canada are 16 times more likely to travel long distances than non-Indigenous women.

A comment from the author struck me in particular: “Smylie said that for First Nations, Inuit and Métis people, giving birth close to home is a very important tradition because the land is considered a part of their family.”

When these women do have to travel the long distance to give birth, they are often having to give birth alone, perhaps at a place where they don’t speak the language, and where health care providers don’t often understand the culture.

This is definitely a gap that needs to be filled; whether it’s providing the primary care resources for these women at their communities (midwives, community workers, health care planners), or through education at all facilities (including urban facilities) about how to support culturally safe care.

I thought this was a very unique way to connect with communities through the use of educational technology and digital media…

A 3-day virtual tournament was held by the Savage Society and the Arts Council of New Westminster to help communities cultivate connections despite the barriers of the pandemic. Participants in this tournament played traditional Indigenous games through Zoom:

The teams began with equal amount of sticks and a set of “bones,” which are either marked with a stripe or unmarked. Alternating back and forth, one team would sing and drum, while a team-member switched the “bones” from hand to hand. The other team then guessed which hand held the unmarked “bone.”  For each incorrect guess, that team lost a stick to the other team. 

There was also song and dance and sharing of stories associated with this event. I thought it was an amazing way to continue connecting between communities especially during the pandemic and celebrate their uniqueness and connectedness through the use of digital media.

For more information, see: https://www.fnha.ca/wellness/sharing-our-stories/first-nations-communities-connect-and-have-fun-with-a-virtual-traditional-stick-game-tournament

I am proud to work in British Columbia where we have become partners and advocates for and with our First Nations communities. A lot of people may not know this, but the First Nations Health Authority exists! it is ‘a health and wellness partner to each and every First Nations person living in BC.’

The FNHA’s mandate is to partner with our First Nations communities in their wellness journeys. The infosketch above identifies that there is a true partnership between the Health Authority and the communities involved and this partnership MEETS the communities in their definition of wellness. The FNHA also provides tools, education and resources and I think this is where educational technology can really be utilized to better the access to care and wellness in a culturally safe manner.

I really appreciate that there is a lot of onus on the individuals in our communities – that being a true partner with all aspects of our communities, we have to ‘live it’ and practice our own definition in wellness – whether it’s in our workplaces, communities, families and so on. This circle of influence extends to communities around us and ultimately we can partner up with First Nations communities to understand and walk with them in their wellness journeys.

I appreciate that the FNHA’s approach is grounded in cultural safety and cultural humility:

Cultural safety is an outcome based on respectful engagement that recognizes and strives to address power imbalances inherent in the health care system. It results in an environment free of racism and discrimination, where people feel safe when receiving health care.