Cultural safety and Indigenous health care
First Nations patients have reason to distrust system, writes Hazel Magnussen.
When Canada 150 celebrations began in July, Indigenous people reminded Canadians that they were here long before Confederation. As Canadians consider the impact of colonization on Indigenous people, stories about Indigenous health care are emerging.
In his compelling book, Medicine Unbundled: A Journey through the Minefields of Indigenous Health Care, Gary Geddes reports elders’ experiences in segregated, under-staffed, overcrowded Indian Hospitals where some were subjected to experimental treatments. Inadequate nutrition reduced patients’ immunity to TB and other diseases. Geddes balances the disturbing evidence of systemic racism with elders’ stories of courage and hope that “we can learn to live together as equals.”
A news report revealed that as recent as 2008, Indigenous women were coerced into being sterilized after giving birth in a Saskatoon hospital. On National Aboriginal Day this July, the Canadian Association of Perinatal and Women’s Health nurses released a “statement of cultural safety and humility” that acknowledges nurses’ contribution to “the current social and health inequities among First Nations, Metis and Inuit women.” The association is working with Indigenous nurses and other organizations to raise awareness about discrimination in health care.
Cultural safety describes an approach to health care that recognizes Indigenous peoples’ experiences of trauma and subsequent mistrust of systems dominated by colonialism. It fosters greater understanding and respect for Indigenous people, their history, traditional health and spiritual practices and Indigenous ways of knowing.
A framework for “Cultural Competence and Cultural Safety in Nursing Education” developed in 2009 by the Aboriginal Nurses Association of Canada, Canadian Association of Schools of Nursing and Canadian Nurses Association, states: “Cultural safety offers further opportunities in which unequal power relations are exposed and managed. Cultural safety is action oriented and it is in alignment with the advocacy role of nurses and the nursing profession.”
Other Indigenous health care professionals are also calling for change. Speaking at the University of Alberta last January, Jaris Swidrovich, First Nations doctor of pharmacy from the University of Saskatchewan, recommended the guideline, “Nothing about us without us” for Indigenous health care.
He is leading initiatives to “Indigenize” health-science curricula noting that “people who feel culturally safe are more likely to access care or access education than those who don’t feel safe.”
Dr. Alika Lafontaine, Indigenous physician and collaborative team lead of the Indigenous Health Alliance asks “Why are Indigenous people so sick?’ He claims that “cognitive bias” blinds us to systemic inequities in Indigenous health care and is the leading cause of death among Indigenous people. He stresses that racism and discrimination are real and can have negative consequences for patient care.
The document on racism and health equity developed by the National Collaborating Centre for Determinants of Health for its Let’s Talk series provides suggestions for a decolonizing and anti-racist strategy for systemic and political change.
The aim of anti-racist practice is “to reveal how racism is at work and proactively develop alternative practice (to) transform the attitudes, beliefs, behaviours, laws, norms and practices that create power imbalances.”
Health professionals, guided by relational ethics and appreciation of Indigenous history, are more likely to respect people’s dignity in a system freed from entrenched colonial habits. Respectful, reciprocal relationships are necessary as Indigenous and non-Indigenous health professionals and communities work together toward reconciliation and health for all.
The inaugural Schattschneider Nursing Ethics Lectureship will feature U of A scholars Vera Caine, Jean Clandinin and Sean Lessard. Drawing on their research with Indigenous youth and families, they contemplate ethical challenges for narrative inquirers when leaving relationships.
The public is invited to: Relational Ethics in Narrative Inquiry: (Re) imagining Exits, 3-5 p.m., Nov. 28, ECHA, University of Alberta.