“We’re all on a long, imperfect path together”: PHSA leaders share their work making health care safer for Indigenous people

21/06/2021

Find out how three leaders from across PHSA have worked to make their program areas safer and more accessible for Indigenous people.

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June 21 is Indigenous Peoples Day, an occasion to recognize and celebrate the culture, history and accomplishments of First Nations, Métis and Inuit people. This year, Indigenous Peoples Day falls just a few weeks after the discovery of the remains of 215 children on the former site of a residential school on Tk'emlúps te Secwépemc territory.

This heartrending evidence of the brutality of the colonial system in Canada was shocking to some, but for many Indigenous people, particularly survivors of residential schools and their families, it was merely a confirmation of truths they already knew.

The last year also saw the release of “In Plain Sight” and the subsequent data report, which detail the ongoing reality of anti-Indigenous racism in B.C.’s health care system. In response to the report, PHSA has committed to a number of actions to make health care services safer and more accessible for Indigenous people. This includes the creation of a number of Indigenous Patient Liaison roles across clinical programs and a new Human Resources position that supports the recruitment and retention of Indigenous people across PHSA.

The Indigenous Health program team is also currently in the final stages of developing its Anti-Racism Response Training course that will help train staff on how to identify and address racism in the health system.

We all have a part to play in addressing systemic racism. Sometimes anti-racism work involves large-scale institutional changes, but it can also consist of many smaller actions, from taking a training course, to using more inclusive language, to recognizing and calling out racist assumptions embedded in policies, systems and procedures.

Three leaders from across PHSA who have taken significant steps in making their program areas safer and more accessible for Indigenous people spoke to us about the work they’ve done and the advice they have for others who may be embarking on these crucial efforts in health care and beyond.

“I have worked in the health system for many years and it is clear to me that addressing racism, especially anti-Indigenous racism, is both complex and challenging,” says Cheryl Ward, Executive Director, Indigenous Health. “Changing an organizational culture is hard work. It necessitates taking risks, being prepared for the discomfort of not knowing, and having the willingness to learn. Only then can we take definitive steps towards being the organizations we espouse to be, safe for everyone. Anti-racism work is in desperate need of heroes, advocates, and allies and we invite people to step into this work.”

Supporting paramedics to engage with Indigenous communities - Blaine Wiggins, BC Emergency Health Services

‎Blaine Wiggins, a member of the Mohawks of the Bay of Quinte First Nation, wears two hats at BC Emergency Health Services (BCEHS). He’s both the manager of the Medical First Responder Program, whereby fire departments can provide basic first aid and emergency health services in support of BCEHS, and the manager of Indigenous Health.

In his Indigenous Health role, he assists with patient care quality reviews, collaborates with Indigenous partners at both a regional and local level, and works directly with Indigenous communities, particularly those in rural and remote areas.

“A really important part of my role is helping a big organization like ours be able to reach First Nations and collaborate with them and understand their needs,” Blaine explains.

Blaine sees one of his biggest successes as creating a First Nations engagement course to help train those working in BC Emergency Health Services’ Community Paramedicine program. In this innovative program, paramedics support health care in rural and remote communities through outreach, health promotion, wellness clinics and home wellness checks for seniors and others who need them.

Community paramedicine requires a level of engagement and relationship building that paramedics had not been required to do before, and Blaine knew that this course would be key to ensuring that paramedics could work effectively with Indigenous communities across B.C.

“The goal of training is really to allow our paramedics to go into First Nations communities and see all the wonderful things about those communities. We want people to remove their biases, remove their comparative lens, and see how resilient and functional First Nations communities are,” Blaine says. “We want to help our paramedics appreciate First Nations communities for not only for their culture and customs but for the amazing strength and capacity these communities have.”

The fourteenth cohort is now going through this training, and Blaine has seen some amazing developments as the community paramedics engage more deeply with First Nations knowledge and culture.

“One of our community paramedics started doing research and gathering traditional medicines and putting that into a training bank that other community paramedics could draw from,” Blaine says.

“It’s been great to see how even from a clinical perspective we’re starting to engage and acknowledge and share information within our organization.”

Blaine notes that addressing systemic racism cannot and should not be the work of just one person. He notes the progress made at BCEHS is the result of many people within the organization recognizing the importance of taking action.

“You can’t do it alone,” he says. “Make connections and be part of something bigger. There’s strength in a common voice, particularly when you need to have tough conversations.”

Holding space for Two-Spirit stories - Lorraine Grieves, Trans Care BC (TCBC)

Trans Care BC was established in 2015 to coordinate, improve and enhance access to gender affirming care and services for trans, gender diverse and Two-Spirit people. Since its inception, provincial program director Lorraine Grieves and colleagues have worked to incorporate Indigenous understandings of gender diversity and improve access to culturally safe care and gender affirming care for Indigenous people.

Lorraine notes the inclusion of Two-Spirit people in the list of populations TCBC works alongside. “A decolonizing act has been noting that there’s examples of gender diversity that exist across Indigenous nations, both historically and currently. We’ve really tried to hold space and lean into making sure our work is relevant and accountable to Indigenous people.”

Two-Spirit is a term that reflects the complex Indigenous understandings of gender roles, spirituality, and the long histories of sexual and gender diversity in Indigenous cultures. You can learn more about the meaning of the term Two-Spirit, the history of Two-Spirit people, and how the roles of Two-Spirit people are being reclaimed in Indigenous communities on the TCBC website.

In the two years after TCBC was established, Kāhui Tautoko Consulting was engaged to support Two-Spirit consultants and staff from the program to travel to meet with Indigenous communities all over B.C. Their goal was to introduce TCBC and its objectives and services to Indigenous communities while also learning from the communities about their knowledge of gender diversity and their needs for gender-affirming health care support.

“Over time, we realized we need to be less at the front of the room and instead gathering with communities in a more circular way,” Lorraine says. “We really just wanted to hear from people about their Two-Spirit stories and their understandings of Two-Spirit people. It became a very important process for us and provided us with equally important actions in terms of improving our programs.”

Among the actions that came out of this work is a video-based Two-Spirit training course that TCBC currently plans to launch in the fall.

“A key piece we found is that there’s lots to learn,” Lorraine says.
“Colonization has netted an erasure of Two-Spirit stories that are often documented through oral tradition. The course will profile the stories and perspectives of Two-Spirit people, with the aim of teaching health care providers how to lean in and get to know the unique story of each Two-Spirit person and what they might need.”

Lorraine is a Two-Spirit person, a registered Métis citizen with family ties to Nisga'a nation and an adoptee on a long personal journey of self and family discovery.

“Meeting my birth family has helped me come into my identity as a Two-Spirit person,” says Lorraine. “I’ve also been able to find historical and archival information about the roles Two-Spirit people played in at least one of the Indigenous communities my family comes from. “It’s been a journey of slowly piecing the story together over time.”

Lorraine and other members of the TCBC staff who identify as Two-Spirit have also held a circular teach-in to share their Two-Spirit stories with their TCBC colleagues.

“I’m really proud of the rich cultural knowledge exchange that happened as a learning experience on our team, and I know many team members found it very useful,” Lorraine says.

Lorraine notes that learning is an important first step for everyone who wants to undertake deeper anti-racism work.

“Take San’yas training, get to know the recommendations of the Truth and Reconciliation Commission, and the Missing and Murdered Indigenous Women and Girls Report,” Lorraine says. “Reach out to the Indigenous Health team and learn about what they have to offer.”

Lorraine also emphasizes that the journey towards addressing systemic racism is a long one that requires humility as there are inevitability mistakes and setbacks along the way.

“I would never want it to seem like our team has it all figured out,” Lorraine says. “There’s so much more we could do; this is about taking little steps that really count. We’re all on a long, imperfect path together but we try to make a difference with every small step we take and move in the right direction.”

Addressing systemic racism in cancer care – Warren Clarmont, BC Cancer

Having cancer is one of life’s most challenging experiences, and structural racism and the legacy of colonisation have created additional barriers for Indigenous people confronting a cancer diagnosis. This is especially challenging for Indigenous people who live in rural and remote locations. Travelling to and from cities for treatment is time consuming, expensive and requires the patients to leave behind their local support network.

The ongoing reality of anti-Indigenous racism in the health care system can also result in Indigenous people being reluctant to seek screening and treatment, which may result in cancer being diagnosed at a later stage when it’s more difficult to treat.

In recognition of these challenges, BC Cancer worked with Indigenous and health system partners to engage patients, families and communities to develop an Indigenous cancer strategy that launched in 2018. Warren Clarmont, now the Provincial Director of Indigenous Cancer Control was there from the beginning.

A member of the Gitanmaax Band of the Gitksan First Nation and a cancer survivor, Warren came to BC Cancer to implement the Indigenous Cancer Strategy in which he helped develop in his previous role at the BC Association of Aboriginal Friendship Centres (BCAAFC).

In 2017, after several years of relationship building and engagement with Indigenous patients and families, BC Cancer launched B.C.’s first Indigenous Cancer Strategy. It was during this time that tragedy struck, and Preston Guno of the Nisga’a Nation, who had served as the first Provincial Director of Indigenous Cancer Control through the development of the Strategy, was diagnosed with late stage cancer the same month the strategy was launched, and passed away not long after.

That same year (2018), Warren applied and was successful in assuming the role of Provincial Director where he could bring his knowledge and personal experience as an Indigenous cancer survivor to BC Cancer and continue with the implementation of the Strategy that Preston began. Since stepping into his current position, Warren has developed an implementation plan for the Strategy which includes hiring three Indigenous Patient Navigators (IPNs) who will support Indigenous cancer patients once they receive a diagnosis and are referred to BC Cancer. The IPNs will also engage in community outreach to promote cancer screening and work to improve timely access to culturally safe cancer services.

“Once we have these important resources on the ground so to speak, they will be our eyes, ears and hearts and help us at BC Cancer to improve cancer care experience for Indigenous people,” Warren says.

Warren and his team are also working to improve BC Cancer’s data on cancer screening, incidence and survival rates amongst Indigenous populations. They’ve been instrumental in working with the First Nations Health Authority and Metis Nation BC to use the First Nations and Metis client identifiers to ‘link’ into BC Cancer’s Registry and Screening database so BC Cancer will soon have Indigenous-specific data to help inform outreach and education efforts and addressing screening disparities.

“This part of the work is so important because once we get this information, we’ll be able to target specific regions to address disparities” Warren says. “For example, let’s say we look at the screening data and see that colorectal screening amongst Indigenous people in Northeast B.C. is much lower than we would expect compared to the non-Indigenous population. We can then target our efforts and send our Patient Navigators up there to work with communities to promote and support screening efforts.”

When it comes to cancer care for Indigenous people, Warren notes the importance of recognizing that historical injustices against Indigenous people are not confined to the past, they continue to have very real ramifications on lives today.

“If we look at hereditary cancers, there are different screening guidelines for people who have a family history of cancer versus those who don’t,” Warren says. “But those who were taken away from their families either through the existing child welfare system, residential schools or 60’s scoop often do not know their family medical histories. If they don’t get screened regularly, particularly with a family history of cancer, it can be too late for treatment to be effective.”

Warren notes that for those who want to do the important work of confronting anti-Indigenous racism, the first step is to learn.

“My advice for people is to learn the true history of this country and reach out to those who have answers. There are no dumb questions,” he says. “We’re all continuously learning, myself included, and that’s a beautiful thing. But to learn, we have to humble ourselves and accept that we don’t know everything, even as care providers and physicians. It’s alright to acknowledge that we need to learn, and our system of care would improve if more people did that.”