RESPONSIBLE HEALTHCARE DELIVERY TO INDIGENOUS PEOPLES POST TRC 2019
This brief blog is my personal observation from while I was a patient at Elizabeth Bruyère Hospital Physical Medicine and Rehabilitation Clinic and Ambulatory Stroke Services, and the excellent care I received after suffering a stroke. I subsequently became an outpatient under the care of Dr. Hillel Finestone. I also, make some recommendations to address the issue of shortfall to meet the needs of Indigenous patients whose first language is not English.
On February 21, 2019 I completed a 9 week Goal Management Training Course delivered by, that hospital in Ottawa. It was an intensive course Designed to improve memory and cognitive thinking.
I acknowledge Dr. Finestone for his referral to Dr. Valérie Mertens and recommending me to take this course. My participation in this course has sharpened my memory and enhanced my response to problem-solving. I am grateful for the opportunity this afforded me.
I recall my first session, which involved an intensive four-hour psychological assessment which exhausted me both emotionally and mentally when completed. Following that we scheduled 90-minute sessions over a four-month period. The initial session identified specific areas which needed improvement and created a baseline of my abilities. The program was designed to strengthen my working memory. And pointed me in a direction that would improve my coping skills by teaching me techniques, in planning, problem solving, processing, and execution of tasks.
Like anything, you can have the best designed program, but if you don't put in individual work into it you will not achieve the success the program is designed for. My intention when I agreed to take the course was to be in it 100%. I worked diligently on the assignments and was engaged completely in all of the 90-minute sessions. Likewise, it was clear to me that Dr. Mertens also gave her all to the sessions. I was impressed with her approach to our sessions. She showed up enthusiastically which I observed in her demeanor she was a joy to work with. I jokingly referred to our sessions as “playtime” because we had so much fun without losing sight of the fact that it had an important function and that we had to achieve particular goals in each session.
At the conclusion of the course I thought that the occasion should be marked with a certificate of sorts. Perhaps it is my training as a former teacher. But her efforts needed to be acknowledged in appreciation for her dedication to my healing. Therefore I gave her a certificate to mark the occasion, along with a book I thought she would enjoy as a neuroscientist, called The Circadian Code.
Overall my experience with Elizabeth Bruyère Hospital Physical medicine and rehabilitation Clinic and Ambulatory Stroke Services was excellent. Admittedly, there were some issues I identified in earlier blogs here, here, and here regarding cultural insensitivity in particular in my situation as a former residential school student, with my memories of disempowerment being triggered by some of the institutional processes. I believe that this experience hampered my recovery to some degree.
I am grateful for this experience, and I couldn't imagine what the cost of this care would have been if not for our Canadian universal healthcare system. And, I highly recommend it be offered to other stroke patients.
The delivery of healthcare to Indigenous patients continues to preoccupy me. It matters a great deal to me especially as an Indigenous patient myself, and it could mean substantially quicker recovery and better reintegration back into a patient’s former life if outstanding issues relating to a better understanding of Indigenous culture is undertaken by healthcare professionals. The way to do this is to improve communication and for the health care system to understand better the experiences that Indigenous patients have encountered.
Some of my initial ideas towards addressing the communication gap between doctors, physiotherapists, occupational therapists and nurses, is to design a protocol for the professionals to assist them in their day to day interactions with Indigenous patients. Something similar to a process adopted in the criminal justice system when dealing with an Indigenous person to ensure they are being understood and understand the process. Special rules for sentencing of Indigenous offenders are set out in the Criminal Code, and were expanded upon by the Supreme Court of Canada in R. v. Gladue,  1 SCR 688.
Once such a framework has been embraced, the next step logically would be to offer a 2 hour cultural sensitivity workshop. it might be the first time professionals are exposed to the unique history of indigenous peoples.
As I see it, the main obstacle is not so much the lack of sensitivity or interest towards an Indigenous patient, because those professionals I interacted with conveyed an keen interest and willingness to be sympathetic. However, the problem is quite simply the technical difficulty in communication between the health professionals and the Indigenous patients who do not speak English. For many patients coming from isolated Indigenous communities in the North, English is not their first language. and certainly for those patients they would be reluctant to even speak up about something that didn't make sense to them.
It is clear to me having experienced rehabilitation, when one interacts with others of a foreign language, it is emotionally exhausting, and for a stroke patient this impact is even more severe. Some cultural references would be alien to an Indigenous speaker. The results of those types of interactions will leave the patient feeling inadequate, inferior, and perhaps constantly anxious.
As I explained in a previous blog post the reason Indigenous languages are important is largely due to the impact of residential schools systems that forced more than 150,000 children across Canada from their homes into residential schools and were indoctrinated into mainstream society, many being brutally punished if they attempted to use their Indigenous language. The explicit goal of the residential school system was to interrupt the transmission of language from generation to generation thereby effectively extinguishing Indigenous languages, along with their beliefs and cultural worldview.
Some hospitals in Alberta (where I am from) that have a high demographic of Indigenous patients have incorporated Indigenous translators on staff, either for the initial intake or as part of ongoing care as required to explain technical medical procedures in the Indigenous language of the patient and to get informed consent for these procedures.
I believe the success of these programs are evident in the recovery of patients returning to their Indigenous community. They understand their specific medical issue and have a better understanding of their responsibility for their own care when they leave the hospital. In particular for stroke victims, it is crucial to ensure that the patient have continued success in recovery when they leave the hospital. To that end, communication is vital, at the onset, during rehabilitation and after they are discharged.
This is an important issue not only because of the resources for patient’s recovery but more importantly in light of the Truth and Reconciliation Commission’s Report recommending that Canada do more to recognize the disparity of service levels to Indigenous population. Due to the fact that many Indigenous people have an understandable mistrust of government (and by extension any person in authority) and are skeptical of any change, a program should be developed including Indigenous input.
I have high confidence that a program could be developed and successfully executed by the excellent professionals on the stroke floor of Elizabeth Bruyère Hospital.