Editorial

Welcome to this two-part guest edition of the International Journal of Indigenous Health (IJIH), produced by the First Nations Health Authority (FNHA) in the province of British Columbia (BC), Canada. As guest co-editors, we are pleased to present to you this collection of research, promising and wise practices, innovations, and Indigenous Knowledge on health and wellness. These papers constitute a substantive contribution to, as our call for submissions framed it, “Health Systems Innovation: Privileging Indigenous Knowledge, Ensuring Respectful Care, and Ending Racism toward Indigenous Peoples in Service Delivery.”

Editorial

Welcome to this two-part guest edition of the International Journal of Indigenous Health (IJIH), produced by the First Nations Health Authority (FNHA) in the province of British Columbia (BC), Canada. As guest co-editors, we are pleased to present to you this collection of research, promising and wise practices, innovations, and Indigenous Knowledge on health and wellness. These papers constitute a substantive contribution to, as our call for submissions framed it, “Health Systems Innovation: Privileging Indigenous Knowledge, Ensuring Respectful Care, and Ending Racism toward Indigenous Peoples in Service Delivery.”

Introduction

On behalf of the First Nations Health Authority (FNHA) in British Columbia (BC), and FNHA’s Board of Directors, we welcome you to this two-part guest edition of the International Journal of Indigenous Health (IJIH): “Health Systems Innovation: Privileging Indigenous Knowledge, Ensuring Respectful Care, and Ending Racism toward Indigenous Peoples in Service Delivery.” This guest edition encompasses two issues, “Honouring the Sacred Fire: Ending SystemicRacism toward Indigenous Peoples” and “Wisdom of the Elders: Honouring Spiritual Laws in Indigenous Knowledge,” which address significant determinants of Indigenous Peoples’ health, and issues in health systems here in Canada and globally.

Gum yan asing Kaangas giidaay han hll guudang gas ga. I Will Never Again Feel That I Am Less Than: Indigenous Health Care Providers’ Perspectives on Ending Racism in Health Care

Racism toward Indigenous Peoples continues to permeate throughout the health care system, a reality the authors know all too well in their shared and yet unique personal and professional experiences. Although acknowledging and speaking up against racial injustice is daunting, and is often met with disregard or inaction, the authors contend that this is a necessary undertaking to redress the ongoing harms of colonialism. Correspondingly, those who do not speak up must not have their voices silenced. Instead, the perspectives that Indigenous Peoples have regarding their own experiences of racism must be heeded seriously and produce real and tangible solutions. In narrating their own encounters of confronting and challenging racism, the authors juxtapose activism and resistance with the preservation of Indigenous Knowledge as a catalyst for propelling the necessary changes forward within health care to end racism. To be truly impactful, all efforts taken to address racism must occur alongside advancing equity of care and human rights for and by Indigenous Peoples at individual, community, and systemic levels. Changes are not needed after more evidence. The time to act is now.

Paddling Together for Culturally Safe Emergency Care for Elders

This paper describes a wise practice for collaborative change through the Trauma- Informed and Culturally Safe Emergency Care for Nuu-chah-nulth Elders project. For decades, Nuu-chah-nulth Elders have been avoiding emergency care due to colonial trauma and a lack of culturally safe care. To begin addressing this community priority, the First Nations Health Authority, in partnership with Island Health and university partners, organized a two-day workshop in September 2017 with Nuu-chah-nulth Elders, community members, and health partners. Key to ensuring the process was culturally sensitive was following the guidance of the West Coast General Hospital Cultural Safety Committee, a partnership between Nuu-chah-nulth people and health providers. Respect and trust were developed by centring the voices of Elders and giving them a safe space for discussion before developing recommendations with health partners. Feedback from participants was gathered from notes and audio recordings and thematically analyzed into eight major recommendations (i.e., increase engagement and relationship building; develop action plans; increase education and awareness; increase advocacy and support; incorporate First Nations medicine, healing, and foods; provide culturally safe spaces; develop policy and protocol; and link to comprehensive community support), with attention to preserving Elder voices. The recommendations were validated by returning and new participants at a gathering in June 2019. Elders noted that while experiences of unsafe care continue, noticeable improvements in cultural safety are being made and they feel heard.

Strengthening Indigenous Australian Perspectives in Allied Health Education: A Critical Reflection

While professional education in medicine and nursing in Australia has been implementing strategies to increase accessibility for Indigenous Australians, allied health professions remain underdeveloped in this area. Failure to improve the engagement of allied health professions with Indigenous Australians, and failure to increase the numbers of Indigenous staff and students risks perpetuating health inequities, intergenerational disadvantage, and threatens the integrity of professions who have publically committed to achieving cultural safety and health equity between Indigenous and non-Indigenous people. Knowing this, leaders in the allied health professions are asking “What needs to change?” This paper presents a critical reflection on experiences of a university-based Indigenous Health Unit leading the embedding of Indigenous perspectives in allied health curriculum, informed by Indigenous community connections, literature reviews, and research in the context of an emerging community of practice on Indigenous health education. Key themes from reflections are presented in this paper, identifying barriers as well as enablers for change, which include Indigenous community relationship building, education of staff and students, and collaborative research and teaching on Indigenous Peoples’ allied health needs and models of care. These enablers are inherently anti-racism strategies that redress negative stereotypes perpetuated about Indigenous Australians and encourage the promotion of valuable Indigenous knowledges, principles, and practices as strategies that may also help meet the health needs of the general community.

Improving Dementia Care for Gitxsan First Nations People

This project originated from nursing staff’s learning need for knowledge, approach, attitude, and skills in dementia care that was identified by the Gitxsan Health Society. In collaboration with the First Nations Health Authority, the Gitxsan Health Society sought to educate nurses on how to provide culturally appropriate care to older Gitxsan persons living with dementia, and also to increase the understanding of nurses, family caregivers, and the wider community about dementia as a chronic condition. This project involved a mixed-methods approach (multiple qualitative approaches, as well as a quantitative component). The team was guided at each stage by a Cultural Advisory Council of four Elders recognized as Knowledge Holder from the community. The project involved a strong element of reciprocal co-learning and knowledge exchange. From discussions and exchange with community members, three large interlinking themes emerged to guide the researchers: (a) loss and grief; (b) relationality; and (c) access and connection. These themes gave voice to the gaps and needs in care, but also highlighted the potential areas of strength that can be built on to improve care for the older Gitxsan person living with dementia. Family and other community members identified the need for more information regarding dementia, the need to access in-community and external supports, and the need to inform nurses about what considerations are required when caring for Gitxsan people living with dementia. A better understanding of the Gitxsan ways of knowing about dementia can help nurses incorporate more culturally safe practices into the care of persons living with dementia.

Forced or Coerced Sterilization in Canada: An Overview of Recommendations for Moving Forward

Between 2015 and 2019, over 100 Indigenous women from six provinces and two territories have come forward to say that they were forced or coerced to undergo a sterilization procedure in Canada. Despite this, government action is lacking. Through this paper, the research team aims to collect and synthesize the recommendations that have been made in response to the recent cases of forced or coerced sterilization of Indigenous women in Canada. Through a secondary analysis of data, we outline the findings of a thematic analysis of 162 recommendations from four selected sources: (a) Tubal Ligation in the Saskatoon Health Region: The Lived Experience of Aboriginal Women, an external review by Senator Yvonne Boyer and Dr. Judith Bartlett, July 22, 2017; (b) a meeting of the Senate Committee on Human Rights, April 3, 2019; (c) meetings of the House of Commons Standing Committee on Health, June 13 and 18, 2019; and (d) a letter from Bill Casey, Member of Parliament and Chair of the House of Commons Standing Committee on Health, to three federal ministers, August 2, 2019. Seven themes emerged following the thematic analysis of the 162 recommendations: (a) Services and Supports (b)Accountability, (c) Training and Education, (d) Legislation and Policy, (e) Criminalization, (f) Data Collection, and g) Investigation. These themes represent seven areas where immediate government action is required to meaningfully and appropriately respond to the recent cases of forced or coerced sterilization of First Nations, Inuit, and Metis women in Canada.

Collaborative and Systems Approach to Transforming Primary Health Care in Manitoba First Nations Communities

The models of primary health care currently operating in First Nations communities are rooted in policies that were crafted without prior appropriate consultations. Many have continued to be applied even though they no longer adequately serve the needs of First Nations communities and people, if they ever did. Transforming primary health care will necessarily involve community- inclusive and self-determined reviewing of existing policies with a goal of implementing opportunities to update policies and models of care. This study was a partnership with university-based researchers, a First Nations health and social development entity separately established by a regional organization of First Nations Chiefs, and eight First Nations communities. A multi-pronged methodology was used in which five concurrent studies employing qualitative, quantitative, and case-study methods provided information on the primary health care experiences of First Nations and rural and remote communities. The program of research took a community-based participatory approach to engage participants in designing and carrying out data gathering while strengthening local capacity and encouraging long-term ownership of the process of research for change. Participating communities pointed out key setbacks to community- based primary health care, including differing models of care, jurisdictional complexities, funding that creates isolated programs within the same community, lack of promotion of cooperation among health care services, and a general acute approach to health care service delivery in the community. These barriers are both problems and opportunities for change. A borderless health care system that is jurisdictionally seamless and that promotes collaboration through cooperative funding models that reflect community priorities is recommended and advocated for all Manitoba First Nations communities.

Collaborative Data Governance to Support First Nations-Led Overdose Surveillance and Data Analysis in British Columbia, Canada

First Nations Peoples in the province of British Columbia (BC), Canada, have been disproportionately affected by the overdose crisis. In 2016, a public health emergency was declared by BC’s Provincial Health Officer (PHO) in response to the significant rise in opioid-related overdose deaths reported in BC. New surveillance systems were required to identify trends in overdose events and related deaths in the province as a whole, and for First Nations Peoples. Data sharing and analysis processes that adhered to the principles of OCAP® (ownership, control, access, and possession), and to the Truth and Reconciliation Commission of Canada’s Calls to Action, needed to be developed. The First Nations Health Authority (FNHA), BC Centre for Disease Control, PHO, and the BC Ministry of Health have worked collaboratively to facilitate identification of First Nations persons in surveillance data for appropriate analysis by FNHA. This paper outlines the data stewardship and governance context, principles, and operational considerations for creating overdose surveillance systems to measure overdose events among First Nations Peoples in BC.