Indigenous-led health care partnerships in Canada

Western medicine has always been our gold standard, all-encompassing way of life in the healthcare world. It is referred to as mainstream medicine, biomedicine, conventional medicine, and even orthodox medicine. Western medicine is seen as the be-all and end-all, however, taking in the trends towards traditional medicine, it is time to be open to change.
This article identifies the benefits regarding Western medicine and traditional healing practices when they are used together. However as healthcare providers, we are also confronted with barriers to simply implementing this into our Canadian healthcare system with lack of research in this area being a common reason for this absence of widespread implementation[1]. Much of the research that does exist on Indigenous persons in healthcare points to culturally unsafe experiences reported by this population, and a lack of trust in the Western healthcare system[4]. On the other hand, Western-taught healthcare providers are yearning to be more culturally aware and inclusive of Indigenous people[1,4,5]. So, what can we do to bridge this gap in acute care?
Upon admission to the hospital, healthcare is focused largely on the medically acute needs of the patient. These hospital-like settings are intimidating for many Indigenous persons as many of their traditions are not able to be performed, they have had to leave their community to seek care, and the hospital is associated with uncomfortable treatments, disease, and death[3,4]. To top it off, frontline staff often lack awareness and cultural education on colonization adding to systematic oppression[3]. Nurses as well as Physicians are in a prime position to take the lead and address this health equity issue.
The Truth and Reconciliation Commission presented specific calls to action that address Aboriginal issues in Canada and as healthcare providers, we have a professional responsibility to provide culturally sensitive care to all. To follow these particular calls to action, education systems as well as healthcare organizations, must offer Indigenous education to all students and staff, frontline to managerial, to shift organizational culture and remove associations of Western-only medicine attitudes. We must address our privilege and practice cultural humility with hopes that Elders, Knowledge Keepers, and healers will be willing to share their invaluable knowledge with us. By beginning to address these issues, we can systematically uncover the root of our oppressive healthcare system and become inclusive of Indigenous healing practices.
How do we do this practically? To start, I challenge healthcare organizations to make their Indigenous policies more accessible to frontline staff, identify their areas for improvement, listen and hear our Indigenous persons recommendations, and be held accountable for our past mistakes. This will allow us to move forward to our overall goal of providing culturally safe care with Indigenous communities.

The CMAJ runs a monthly print version of their weekly online journal, and this excellent analysis deservedly ran as the cover story for their June 2020 issue. I was moved to see this timely analysis of systemic anti-Indigenous oppression and the early steps taken towards eradicating anti-Indigenous barriers in modern Canadian health care on the cover of the national medical journal. And yet, I was shocked. What lay before me was an obstructed view of the cover photo; an Indigenous Elder’s face exactly blocked by a permanent half-cover pharmaceutical ad for Lixiana. Not only have drug companies historically failed our most marginalized communities in Canada, they also represent an antithesis to traditional knowledge, therapies, and healing practices. This construct of Indigenous practices as scientifically inferior continues to influence deeply held stereotypes that perpetuate discriminatory health inequities against Indigenous peoples. What ensued was an attempted correspondence between myself and the editor-in-chief, Dr. Andreas Laupacis, to acknowledge and reconcile this oppressive handling of an important analysis. Although Dr. Laupacis insisted the permanent half-advertisements had been cancelled in March, I argued for the importance of public accountability as a means of creating space for owning discriminatory harms and resolving to strengthen anti-discrimination policies. Notwithstanding expressed support from the authors of this analysis to publish my response, Dr. Laupacis relayed that the letter would be irrelevant to online subscribers as they "won’t have a clue what you are talking about in the letter.” Despite redundant efforts to have this letter reach a broader audience and engage a larger dialogue about Indigenous representation, Dr. Laupacis told me to not “always assume maliciousness when simple stupidity could explain something that is dumb or insensitive.” We could chalk thousands of years of oppressive and racist behaviour up to "simple stupidity", or we can own our unconformable mistakes and resolve to eliminate health disparities and dismantle anti-Indigenous rhetoric. Learning and healing will take more than cancelling the sale of permanent half-page advertisements; we need to transform society by outwardly challenging oppressive ideologies and systems, and acknowledge when we get it wrong. To not do so maintains the status quo, perpetuating trauma and undermining health equity. To not do so says that what happened doesn't matter. To quote the 2015 Calls to Action of the Truth and Reconciliation Commission of Canada, those who can effect change within the Canadian health care system must recognize the value of Indigenous health practices. If these types of dialogues are considered futile by the editor-in-chief and irrelevant to readers, then we must ask ourselves to what are we subscribing? I implore the CMAJ to take their national responsibility seriously.

The analysis has shown the disparity in health access between indigenous peoples and the general population in Canada.

Reviewing the brazilian literature on this topic, we find a similar situation: the predominantly biomedical approach does not fully meet the needs of the indigenous population, distancing them from this basic right not only by not including practices and rituals inherent to their ethnicity, but also because of the absence of interpreters that allow their communication with the health team and even due to discrimination by some professionals[1]. In an attempt to overcome these obstacles, governmental measures were implemented to allow greater indigenous participation in the management of the health services offered to their communities. Among these measures there is the establishment of councils formed equally by indigenous peoples and workers involved in the administrative and medical part of the service[2] (aiming to discuss and better meet the demands of the native patients), and the creation of the role of indigenous health agent[3], a native-born professional who work not only as a translator but also promotes the integration between the knowledge of his tribe and the biomedical science, acting in a similar way to the Indigenous-led health care partnerships. However, unlike the Canadian initiative, the projects applied here offer little autonomy to the indigenous people, since they are previously established by the State (which determines from the scope to the forms of aboriginal participation, and constantly ignores the cultural particularities of each tribe), which perhaps explains the unsatisfactory outcome of these policies in some regions of Brazil[1] in contrast to the good results achieved in Canada.

1. Gomes, Esperidião. Acesso dos usuá... Cad Saúde Pública 2017;33:e00132215.

2. Cruz, Coelho. A saúde indigen... Saude soc 2012;21:185-198.

3. Langdon, Diehl, Wiik, et al. A participação d... Cad. Saúde Pública 2006;22:2637-2646.