Indigenous health care moves beyond conventional medicine

A new video released by the Nuu-chah-nulth Tribal Council sheds new light on the delivery of effective and culturally-informed health care to Indigenous peoples living both in First Nations communities and in the city.

Employees of the NTC Hupiimin Wiiksaḥiiyap (Helping us to be well) Nursing Services celebrated National Nursing Week on May 6 through 12. The 14-minute video, Nursing the Nuu-chah-nulth, was produced locally by Shape Shyfter Studios.

Shaunee Casavant, former NTC Manager of Nursing Services, who oversaw a care network that covers the 14 Nuu-chah-nulth Nations over a wide swath of Vancouver Island and beyond, spells out the Hupiimin Wiiksaḥiiyap vision in the opening segment:
“The NTC Nursing Program upholds that each life is a precious journey. Together we hold life’s sacred gifts, acknowledging our strengths, surviving on land and sea. Each life connects.”

That concept is best expressed in a familiar Nuu-chah-nulth term that is slowly being adopted in the science community: Hishukish Ts’awalk: (everything is connected).

Nursing the Nuu-chah-nulth outlines the four departments within the program (Home & Community Care, Community Health, In-Town Services and Health Promotion), and features interviews with members from each service.

Jeannette Tremblay is a Registered Nurse and serves as Home Care Supervisor. Tremblay said NTC Nursing has evolved by developing close relationships with the clients and incorporating traditional knowledge.

“Life is a journey. Our Nursing Framework was developed with Elders and First Nations people. Life has a beginning; life has a middle and life has an end. So how can we support people through their life journey?”

Nursing Indigenous peoples also means adapting to social conditions that can be difficult, and, at all times, showing respect, Tremblay said.
Health Promotion, for example, is just that: educating people on how to stay healthy. But you can’t walk in with a hard-and-fast lesson plan and a Big-Teacher Attitude.

“You go to an Elders’ Lunch, by invitation, and you may have a topic, like blood pressure. But they may not want to hear about blood pressure today. They want to talk about something different. It’s about meeting the people and talking about what their needs are… today.”

Diane Bradford is a Home Care nurse in the remote island community of Ahousaht, near the tourist town of Tofino. In the video, Bradford emphasized that need to stay focused on the most critical issues as they arise.

“It’s about staying as healthy as you can be in your own environment,” Bradford explained.

“If your life is devastated, you don’t care much about eating too much ice cream. You have to tackle all those aspects of your life at the same time: your emotions, your spirit and your body. It is all so connected, and, obviously, NTC [Nursing] understands this in a way Western medicine could never explain.”

NTC Nursing covers the full spectrum of life.

“Community Health nursing focuses on the mother-child relationship. That’s from pre-conception to 18 years and beyond,” Tremblay explained.

That Nuu-chah-nulth newborn is set on an immunization track that will extend into adulthood and, ideally, into Elderhood, along with a support network to cover both sickness and wellness.

“Community Health deals with healthy clients. So, having a baby is a healthy event. Immunization is a healthy event,” she said. “Home & Community Care is about delivering services for those who are ill or at risk.”

The goal is for people to continue to live in their own home, safely. Mostly, the clients are Elders, but NTC Nurses do make visits for post-surgical care.

In-Town Services covers a range of programs in the Central Island city of Port Alberni, including Maternal Health Services. There is also a liaison nurse at West Coast General Hospital to advocate for First Nations clients.

Out on the streets, NTC Nursing works in partnership with the provincial health authority, Island Health, to deliver outreach services to marginalized Nuu-chah-nulth.

In her interview, RN Cynthia Fitton outlines how that outreach works. The service is based at both the Port Alberni Health Unit (Island Health) and at the Bread of Life soup kitchen, which serves the low-income community “uptown.”

“Primarily, I am working with people who are at risk of HIV, STIs (sexually-transmitted infections) and tuberculosis,” Fitton said. Her team does testing, administers treatments and provides case management for people who are by nature hard to manage.

Known as harm reduction, this work is conducted in partnership with the provincial Mental Health Service and the Integrated Health Network.

“Harm reduction is about meeting people where they are and helping them where they’re at, rather than them coming to me,” Fitton said. “I can work on the pieces that are most important to them. I believe it coincides with the Nuu-chah-nulth way of nursing. We are here to serve the people and they are in control of the health care they receive.”

Tremblay said nurses who come to NTC Nursing to do their practicum quickly learn that nursing by the book just doesn’t cut it. And they are invariably impressed.

NTC Nursing has partnered with West Coast General Hospital to create a Cultural Safety Committee, with representatives from Island Health and the First Nations Health Authority. But it is getting out in the field that provides the best sensitivity training, Tremblay said.

“We have [Island Health] nurses that come to shadow us in the field, to get them to have an understanding of the difficulties for clients just to get to the hospital, or to appointments, and the difficulties for doctors to get to those communities. They see how we practice. And it’s a real eye-opener for them.”