What nurses can do

As frontline health care workers, nurses are pivotal in initiating change. In each interaction you can actively decide if you are going to treat each person as an equal or provide some sort of substandard care. I’m hoping you choose the first option.

As a nurse, you have the privilege of not only directly impacting the health of another person through education and nursing interventions, but in advocating for the best standard of care they can receive and helping patients to navigate the health care system. As a front line worker, you witness disparities in care and can speak up against them. Accessible health care requires the delivery of culturally sensitive care.

I am incredibly grateful for the knowledge that has been shared with me throughout this course. I thank Ashlee for facilitating the interactions, my classmates for participating and all of our guest speakers for making me a better future nurse. I truly believe that in learning more about Aboriginal culture, health and wellness I will provide better care than I would have otherwise provided. In an attempt to share this feeling with everyone, I have created a list of what I felt were the key messages that I have taken from this course.

As a nurse:

– Understand that in traditional Aboriginal cultures, health care involves a holistic approach that includes all aspects of well-being including physical, spiritual, emotional and mental health. If you are going to provide holistic care you need to assess all aspects and provide/advocate for necessary holistic interventions. Don’t isolate the physical.

– Language differences can lead to ineffective communication. Trying to understand medical jargon, diagnostic procedures, tests and medication regimens is difficult enough without a language barrier. The next time you think someone may be ‘non-compliant’ consider the possibility that there is a need for more culturally appropriate education.

– View clients as individuals and take the time to fully understand their situation. Actively choose to convey kindness, compassion and respect. Remember communication is much more than just verbal exchange.

– Take the time to learn more about the Aboriginal culture and history of the people you are working with. Although the various Aboriginal cultures have many similarities they also have many aspects that make them each unique. Knowing the culture and history will provide you with a better understanding of why an individual may be in their current state of health. One of the best ways to find out about the culture, history and traditions is to ask key informants such as community Elders.

– Recognize your own stereotypes and prejudices, and question why you have them. Question their credibility. Put in the time to find out why you make some of these assumptions and search for the truth.

– When presented with statistics, question the background. Why might a statistic like this exist? Are there events in history that contribute to this? Is health care equally accessible for the people described? You cannot change a statistic without knowing why it exists. Think upstream, be proactive and don’t accept a statistic as being an unchangeable fact.

‘What do you mean the poor Natives? They have everything’

I recently had the pleasure of sitting down with an Aboriginal nurse who had recently graduated to ask her to discuss some of the challenges she faced as a student or some of the problems she saw within the nursing programs. An excerpt that I had included in the podcast is as follows:

“Majority of white people are told when they are growing up ‘Indians get this for free, they don’t pay tax, they get free houses’ and they get all those stereotypes … and then they come to [nursing] school and the [professor] is like ‘the poor natives’ and [the students] are like ‘what do you mean the poor Natives? They have everything. Even the ones that are here are here for free’.”

During the interview, I didn’t know how to respond when this was said. I quickly reflected and came to the conclusion that there was a very large and sad truth within that statement. These are statements that you hear far too often. The lack of knowledge leaves people with the false idea that Aboriginals are provided with absolutely every tool they may ever need to excel and that they are somehow doing something wrong, and thus begins this cycle of blame. When this blaming attitude occurs, there is a lack of empathy, meaning people cannot seem to put themselves in the shoes of the other person. A lack of empathy for anyone, Aboriginal or otherwise, means there is a lack of understanding of the barriers that may exist. The only way to begin to change this blaming attitude is to correct these fallacies.

In an attempt to break some of these stereotypes and clarify some of these myths I have found the following truths presented by the Hospital Employees’ Union (HEU) in Burnaby, British Columbia. More fact sheets presented by the HEU regarding Human Rights can be found by clicking here. Each of the fact sheets presented below can be accessed by clicking on the title of the myth.

Aboriginal people don’t pay taxes:

• Inuit, Métis and non-status Indians are required to pay all taxes
• Registered (status) Indians who work for a company that is located on the reserve do not pay federal or provincial income tax. This is federal law and part of First Nation treaty rights in exchange for the land that was given up
• An Aboriginal person who works for a business or company that is located off the reserve is required to pay income tax.
• Status Indians do not have to pay the GST on goods that are delivered to the reserve. If the goods are purchased off-reserve and are not delivered to the reserve, the GST is payable.
• An Aboriginal person who works and lives off-reserve pays all taxes- income tax, sales tax and GST.

Aboriginal people receive free post-secondary education:

• Métis and non-status Indians do not receive free post-secondary education
• The federal government provides limited funding to local band councils to assist with post-secondary education costs for Aboriginals living on-reserve or status (registered) Indians.
• Many band councils allocate this limited funding to the students through a selection process
• Inuit and status Indians are not eligible to receive provincial financial assistance for post-secondary education (i.e. student loans)

Aboriginal people receive free housing

• Métis and non-status Indians do not receive free housing
• Registered (status) Indians who live on-reserve can apply for funds through their local band council to build or renovate their homes. In many cases, they repay these loans over a number of years.
• To be eligible for these funds, the house must be on the reserve
• These funds vary by reserve
• On some reserves, there is no successorship of ownership
• On many reserves, the house is owned by the land is not- therefore it cannot be sold
• There is limited space available for housing. Once the reserve is full, there is no room for more, even if there is population growth.

The Legacy of Language

Language plays an extremely large role in many different cultures. Aboriginal cultures are no exception. Unfortunately however Aboriginal language proficiency has deteriorated throughout Canadian history – consider the impacts of Residential Schools. For many years, Aboriginal children were forced to leave their homes and attend Residential Schools where they were shunned and sometimes abused for speaking their mother tongue. Because of this, there were generations who were unable to communicate with their families when they returned home from Residential Schools and unable to fluently pass their mother tongue onto their children. To read more about the impacts of Residential Schools you can visit my first blog. Thankfully, the Aboriginal Languages Initiative is resisting the loss of languages. In fact, the program has supported a resurgence of Mi’kmaq language in Nova Scotia. This support will assist in educating and cultivating a language that has been in some ways neglected in recent history. This is also a great opportunity for people from different cultures to learn the language.

It is vitally important to invest in saving these languages now, while there are still individuals proficient in the language and capable of handing it off to new generations. With Mi’kmaq language being among the 10 most commonly spoken Aboriginal languages there is still a number of Mi’kmaq speakers capable of developing training programs. According to the 2011 Census, in Nova Scotia approximately 4, 840 individuals consider Mi’kmaq one of their spoken languages.

As with many languages, dialects differ among different communities and regions. However, many of the basic principles remain the same. As I have learned while picking the brains of some Mi’kmaq friends, many Mi’kmaq words cannot be directly translated into English words as they often serve to represent a larger concept. Mi’kmaq language is also spoken with a much more cyclical pattern than the linear thought progressions described in English.

In knowing these potential language barriers, a few adjustments that I will apply to my nursing practice include to give patients the time to tell their story. Consider the cyclical thought pattern and some of the challenges with direct translation into English words. Asking someone who may speak Mi’kmaq at home to describe the story of what has brought them to the emergency department may take some extra time, not only to find the English words but to try and translate a cyclical thought into a linear statement. It may also be necessary at times to consider arranging a translator to assist in the conversations.

For your own practice, interest and enjoyment, I had a friend translate some phrases that you may find helpful in your healthcare practice. Remember- different communities may have different spelling or pronunciation of these phrases.

Hello/Hi – Kwe’

Thank you – Wela’lin

How are you? – Me’tal-wlein?

I’m sorry – Meskeyi

Where is it sore? – Tami Kejimqwan?

Where does it hurt? – Tami Kesa’sik?

You’re welcome – Weliaq

Can I help you? – Kisi Apoqnmultis?

Let me help you – Ke Apuqnmulap

Thank you – Wela’lin

To hear these phrases click here

 

 

Applying Two-Eyed Seeing to Health

Two-eyed seeing is a concept presented by Eskasoni elder Albert Marshall that describes the need to adopt a world view that recognizes differences in individual perspectives. There are different ways of looking at the world. The beauty of two-eyed seeing is to take the strengths of different perspectives and combine the views to become something much more powerful. Two views that we are focusing on most are the Western view and the Indigenous perspective. If we take a two-eyed seeing approach and consider the strengths of each perspective we could create a very powerful mindset.

 Western science has the strength of analysis. It breaks down larger concepts into smaller more tangible units to manipulate. Through controlled observation, they decide how manipulation of different units impacts the outcome of the larger concept. Western science often examines the physical world and attempts to create technological solutions to any problems.

An Indigenous perspective looks at the bigger picture when viewing problems and attempts to come to more holistic solutions. Instead of picking problems apart, Indigenous perspective considers relationships between variables and patterns within problems.

In a Western health care system we break people down into components. Individuals specialise in different systems of the human body. Science delves deep into the core underpinnings that are causing your body to be distressed right down to specific DNA codes and sequences. They decide what part of the human body is malfunctioning and then use very complex technologies to solve these problems such pharmaceutical or biotechnological interventions.

An Indigenous health perspective looks at the whole person in search for balance between all aspects of wellbeing including physical, mental, emotional, and spiritual well-being. A disruption in balance causes distress.

 

So what does it mean to take a two-eyed seeing approach to health?

As a health care professional you could actively decide to apply many of these key messages to your practice. To begin, recognize that individuals have different views of what it is to be healthy. Health is a very difficult concept to define and a person’s definition of health may change with changes in their own health status. Remember that views that differ from your own view (or the view which your education has instilled in you) should not be seen as inferior. Apply the two-eyed seeing approach and consider taking the strengths of both the Western medical model and the Indigenous perspective. The Western view has provided us with great advances in technology and knowledge of our physical being that has saved many lives and greatly increased our life expectancy. However, it struggles to work with elements of health that are not tangible. The indigenous perspective better recognizes the interplay between all aspects of wellbeing and takes a much more holistic view of health. If we combine the strengths of both of these models we could create something beautiful- a truly holistic health care approach.

We Were Children

I am incredibly embarrassed and ashamed to say that I was once so ignorant to the reality of Residential Schools in Canada. In a way, I feel as if many aspects of my education have failed me for leading me to believe that Residential Schools were in some way not as horrific as many were. I think this was partly due to the discomfort people have when discussing sensitive topics, such as the brutality of abuse that had occurred, and have a hard time discussing grave mistakes that may be associated with their culture.

I had recently had a discussion with a close friend about Residential Schools and in my ignorance made an incorrect statement regarding the timeline of their history. As I proceeded to describe how this was “so long ago”, I was rightfully corrected and I thank him for that. The last Residential School in Canada had only closed in 1996- maybe not so long ago as one may think. My friend had encouraged me to watch a heart-wrenching documentary on Indian Residential Schools called “We Were Children” (which is currently on both Netflix and the National Film Board)

 

We Were Children provides the accounts of two Indian Residential School students, Lyna and Glen, and the abuse they had suffered. The documentary begins by giving you the horrific statistic that for over 130 years, Canada’s First Nations children were legally required to attend residential schools. Residential schools transformed children into numbers, and degraded a rich and respectful culture. As the documentary unfolds it discloses many of the appalling truths of losing your family, language and culture to an environment of humiliation, neglect, physical, mental and sexual abuse. As much as I encourage watching this film, I do feel I have to provide some level of a viewer discretion warning. This film provides such honest and raw accounts of the realities of Residential Schools.

After watching this film, I thought deeply about how my life would be different if I had experienced such trauma. How would I feel toward learning, toward my family, and toward love? How would I cope? To be honest, I didn’t come to answer those questions as I feel the experience would be something you wouldn’t know unless you lived it. I apologize deeply for my ignorance and I strongly encourage all readers to take the time to become educated on the harsh realities and last impacts of Residential Schools. From a healthcare standpoint, it is important to take this information and approach people with a trauma centered lens. Remember that some of the actions health care providers may have normalized are not so normal to many people and may be incredibly traumatic to some. This concept really applies to all people – not just those affected by residential schools.