RESPONSIBLE HEALTHCARE DELIVERY TO INDIGENOUS PEOPLES POST TRC 2019

RESPONSIBLE HEALTHCARE DELIVERY TO INDIGENOUS PEOPLES POST TRC 2019

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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, [1999] 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, if there is a willingness for it. 

That Time I was a Brave girl

A time when I was brave

E ANGELINA PRATT·SATURDAY, 23 FEBRUARY 2019

Once when I was student at the University of Alberta, I read a line in our student paper that said why not study in Poland? And, I said to myself why not?

I knew nothing about Poland. All I knew was it is behind the Iron Curtain. Of course this was before the fall of the Berlin Wall and eastern Europe was a deeply mysterious place under the sway of the USSR. I didn’t even know anyone from there, but I filled out my application and applied to the University of Warsaw to study Polish Art and culture. No one was more surprised than me when my application was accepted. There were 40 other university students from across Canada who were going. The next thing I knew I was on the plane to Montréal, I overnighted at a hotel, and the next morning I was on a flight to Warsaw.

I walked to the plane and moved the curtain back and then it hit me what I had done, and there was no turning back now. I was so nervous because I don’t like flying. The old Aeroflot plane was old and musky smelling. During the flight I asked to see the pilot. I was allowed, and when I saw him I asked where are we? He gave me the latitude numbers, but I said no, what I meant to ask is are we over the ocean? He said yes, of course but we are not far from land. My fear more than anything was of the ocean.

It was an uneventful flight, arriving in Warsaw in the early morning. A bus picked us up at the airport and took us to the Metropolitan Hotel where we would be staying for the duration of our course. We were told we couldn’t drink the water from the taps and bottled water were supplied to us. It was a spring and summer course and we would be walking to the University from our hotel to attend classes. We were assigned a Polish translator who would accompany us because all lectures were in Polish.

I had an awesome time, touring the countryside, I went to many, many, churches and castles, even went to visit Chopin’s home town and toured his home. We attended four symphony concerts, and toured three of the major concentration camps. It was a real eye opener to see how the evil in the heart of one man could create these horrible atrocities. We went to a salt mine that held a church where even the statues and chandeliers were made of salt.

Our final exam was open book, thankfully. I made many friends and learned about an amazing country. I took a side trip to Gdansk with 3 other students to talk with a priest involved in the Solidarity Movement in a church basement. I also went rafting, which was a bit scary because our professor got drunk and could barely hang on. He passed out on the bus back to Warsaw.

I must have been brave then because my youthful curiosity and sense of adventure had to overcome my many fears. Fear of flying, fear of the Soviet Bloc, fear of the unknown generally. I would like our members to share their experiences of taking a risk. What was the journey? What did you risk? Why did you do it? And what did you take away from the adventure it led you to?

CAN WE TALK?

MR. DERANGER TRAPPER HUNTER DENE

Unless you have been basking in the sun on a beach on some isolated island and not following the American news cycle you are likely left out of a very important national conversation. 

February 2019 is proving to be a challenging month for US elected officials, in light of documentation and photos that revealed that some decades ago a number of high-ranking elected officials in Virginia posed with blackface, and another presidential candidate claimed American Indian heritage on an American Bar legal form.    

These elected officials are scrambling to hire high profile PR firms to contest these negative stories. The outrage is palpable.  Has this behaviour suddenly become unacceptable? Or is it simply political grandstanding?  Did it come to light purposefully or as a political stunt to shame and hurt the opposition? Or have standards just changed since the 1980s?  Which begs the question: has the public finally lowered its tolerance for racism and, if there was not an upcoming presidential election, would that outrage still exist?

Cultural appropriation, in my opinion, has never been accepted by the Indigenous population in Canada. First Nations have vehemently fought against this type of racism in the public arena, and in the courts. From the Washington Redskins, the Cleveland Indians, the fans’ pretending to Tomahawk the opposition at baseball stadiums, sexy ‘Indian Princess’ and ‘Indian Chief’ costumes being sold at Halloween, fashion models wearing ‘Indian’ headdresses, we have seen endless examples of racism.  This racism is sometimes shrouded under the veil that they are attempts to honour Indians.  But indigenous activists have stood up against it.   

Racism should always be called out for what it is.  In Canada, we have begun a conversation around truth and reconciliation.  When Canada created residential schools it was a blatant attempt to remove all traces of Indigenous culture that left in its midst a horrific legacy by attempting to assimilate first Nations.  In an attempt to rectify this shameful legacy, which some have correctly described as cultural genocide, the government of Canada created the process of truth and reconciliation.  The Prime Minister of Canada publicly apologized for the mistreatment of first Nations in residential schools.   However, his apology fell flat as racist policies embodied in the Indian Act continue to exist.

The incidents in the United States has started a conversation around racism that needs to be continued, not just for elected officials, but among regular individuals, and academics, grassroots people, and professionals.    

Racism is systemic and weaved into the fabric of both the US and Canada, and there is simply no denying it. Most students in the Canadian school system have not been taught the real history of Canadian First Nations. It is only through individual research that one will uncover the real Canadian Indian history.

What are your thoughts on this particular subject? Do you think that First Nations should forget the past? The injustices were deep and cruel. Living under a colonization created much of the problems that exist today. 

Fortunately, the Canadian government's goal to wipe out all traces of indigenous culture, spirituality and governance, failed. 

Where do we go from here? Colonization exists and we are fundamentally caught in a cycle that began when we were colonized. In order to go forward we must accept our history and create a new way forward one that unshackles us from colonization. If we continue to ignore the fact that we have been colonized it makes it more difficult to carve out a new stronger reality of self-governance.