After a year of operating on the Enoch Cree Nation in Alberta, the monthly diabetes clinic has a steadily growing number of patients. That success, says Enoch Cree member Joanne McDonald, who also serves as community health representative at the local health centre, is due to the visiting physician’s no-nonsense attitude and understanding.
Dr. Jeff Winterstein, who makes the regular trip from Edmonton to the nearby First Nation, says commitment and trust – both on his part, as a non-Indigenous physician, and the part of his First Nations patients – is part of the reason for the clinic’s success.
“First Nations population, I think, they’ve been through a harder medical experience than the rest of the population. They just don’t trust medicine as much,” said Winterstein. “A lot of times it’s just sitting and listening. It’s a come-as-you-are. I’m going to be here to treat it with you if you want to be part of the team. I will come back, I promise, every month and we will sit and deal with all of the problems.”
And that, says Dr. Lynn Wells, vice-president academic with First Nations University of Canada, is what is meant by a “culturally safe” environment.
“That sounds absolutely perfect. It’s not necessary that they have to be Indigenous health care practitioners, but … they have to have knowledge about Indigenous practise, to have that kind of respect for the world view and to learn how to work in clinical settings so the patient feels comfortable and to develop that trust, because if that doesn’t exist, it’s very difficult,” said Wells.
Training health practitioners to be aware of the issues around cultural safety and how to implement those practises in clinical settings is just one aspect of a laboratory that will be established at the First Nations University of Canada.
Dr. Carrie Bourassa, a professor of Indigenous health studies at FNUniv, recently received $205,178 from the Canada Foundation for Innovation to develop the cultural safety evaluation, training and research laboratory.
The dollars from CFI are 40 per cent of the total funding that will drive the five-year project.
“What cultural safety is really designed to address are those inequities in the health care system that put Indigenous people in situations where they don’t feel as comfortable, where they don’t feel that sense of trust with physicians or other health care providers,” said Wells.
That feeling can be a result of numerous factors including real or perceived racism or discrimination, lack of acceptance or acknowledgement of their cultural or traditional practices around healing or spirituality.
Wells points out that cultural safety is not a concern unique to Canada, noting that the term was coined in New Zealand. She says research will consist of reviewing existing literature in the field and working with colleagues, both nationally and internationally. While research will look at historical practices, Wells says the focus will be on contemporary practices “because that’s really what needs to be addressed.” To that end, Bourassa will conduct focus groups, both at the university and in the community.
After determining what is currently occurring in the health care system, the next step will be to evaluate those systems and then determine how to train health care providers in order to combat the deficiencies so culturally safe practices may be provided for Indigenous peoples.
“Research will be ongoing throughout the life of the lab, but at the same time, of course the idea is to develop training and evaluation practices that can go into effect fairly quickly,” said Wells.
While some jurisdictions are both more aware of and implementing culturally safe principles, Wells says there is still great room for improvement.
“Like everything around Indigenous issues in this country, it takes time,” she said.
She relates a story of where family members brought sacred objects from the community and placed them in the patient’s hospital room. The cleaning staff removed them, not understanding this was part of the healing process for that person.
“The hope is that we will have a positive impact on the health care system, that there will be more practitioners who are aware of the issues around cultural safety and will be able to implement these practices in clinical settings and that this will improve the overall health of Indigenous people,” said Wells.
That impact is already being realized on the Enoch Cree Nation. Winterstein says before the monthly clinics, the above and below the knee amputations, caused by untreated diabetes, had been unusually high for the population size. Since the clinic began there have been no amputations. As well, diabetic comas, blood sugar levels and trips to the hospital have all decreased.
Winterstein refers to Enoch Cree Nation as the “perfect storm:” supportive infrastructure and a community approach that breeds trust and commitment.
McDonald adds that Winterstein’s easy rapport with patients is also part of that “perfect storm.”