The New Reality of Culturally Safe Practices in Healthcare During COVID-19

Jun 17, 2020

Kelly Brownbill
Educator, Facilitator, Consultant 

Wawaynaboozhoo. Wabunnoongakekwe ndishnikaaz, Waabizhashi Dodem.

Greetings. I am writing to you today from the traditional territory of the Anishinaabek, specifically of the Three Fires Confederacy. It is my privilege to work and live on this sacred ground and I strive to appreciate that that privilege came at a high cost paid by the original inhabitants.

This post is a continuation of the Spotlight Webinar hosted by Jennifer Zelmer from the Canadian Foundation on Healthcare Improvement on June 3, 2020, where Marion Crowe and I talked about cultural safety in a pandemic environment. As 100% of the participants agreed that this was a meaningful engagement, and that the conversation should be continued, it seems appropriate we carry on here.

During the webinar, Marion Crowe, CEO of the First Nations Health Managers Association, and I spoke about our observations of the impact recent events have had on First Nation communities and people. Marion shared the concerns her membership is currently facing, and what is being done to help. Her organization has mobilized to provide incredible resources to health managers working in First Nation communities and responding to the challenges we are all faced with today. She spoke of the Town Hall web presentations FNHMA has been offering weekly, to give people a chance to speak to the variety of different issues arising from the current reality. FNHMA has gathered a number of different resources, including a list of what Indigenous held businesses can supply PPE, as well as a “Helpful Desk”, where people can talk or email with someone in order to find the help they need.

I spoke about the triggering effects social distancing can have on a people still coping with historical trauma. Masks, line-ups, family isolation and closed reserves are all difficult enough to cope with for anyone, but exponentially more so when those activities strike at the core of personal and community trauma.

I think it’s also important to mention the difficulties the healthcare system off reserve faces in servicing Indigenous community members. While we, through our amazing Health Managers, are providing exemplary culturally based services, our community members still have to go off reserve to access certain services. And services on reserve don’t help those living off reserve. As Indigenous people of every definition, we are reliant on the healthcare system to respond to our specific needs. Like you didn’t have anything else to do.

And it’s hard work. You have to engage with your neighbouring First Nation communities, as needs change community to community. You have to engage with off-reserve communities like Friendship Centres, Native Women’s Associations, Métis Locals, to name a few. You have definite rules about who can be where, and how far away, which does not allow for culturally important gatherings of family so inherent in an Indigenous way of being. And you have finite resources, especially of the human variety.

And I’ll bet you have staff at a variety of different places on the cultural competency continuum. Some may not even have started down the path at all. As well, recent events have drawn racial issues blindingly into the spotlight, fanning tensions already in place that can be a barrier to true learning. So, what’s a well-meaning, intelligent and compassionate person working in some fashion in health care to do? I’m so glad you asked…..

First, don’t not start. People watching the webinar seemed to really like that sentence. No matter how much else is going on, it’s important that you don’t put off any longer your first steps towards cultural competency, safety and humility. Ideally, look for training with a competent facilitator who can engage with you in dialogue concerning these issues. This sort of training transcends knowledge transfer and moves into paradigm shifting; that can’t happen without a conversation. Personally, I would also say insist that the training not start at contact, which leaves out a huge amount of information, but that’s me. I would also say, as important as it is for us to understand the horror that was the Indian Residential School System, it did not exist in isolation. Make sure your materials cover not just residential schools, but the 60s Scoop (and the Millennial Scoop), Indian Day School, the pass system, the treatment of Indigenous veterans, and so much more.

Next, don’t stop. I believe that allyship is a life-long commitment to understanding; it’s doesn’t happen with one cultural safety course. Go to as many trainings as you can. Read as many books as you can. We now have so many movies about Indigenous issues by Indigenous writers, directors and producers that can help educate us as well.

Support your staff. You need to be able to ask questions and get advice. Every large system like a hospital should have an advisory circle, a resident elder, or cultural advisor to run things past. No one should be expected to do this work unsupported and I urge to you make those connections with neighbouring communities.

Above all, please understand that the world isn’t the same for everyone. As Indigenous people in what we now call Canada we carry historical trauma that is crippling. We continue to face racism and minimizing policies over and over and over again. We don’t want you to experience those things. We don’t expect you to understand what it means to live with those things. We do expect you to be globally conscious enough to listen to us when we explain our perspectives and our needs. Our health care system needs to be based on equitable access to services for everyone, no matter what barriers stand in the way.

I have every confidence that we as a society can achieve this. I believe we have caring, compassionate and intelligent people, both Indigenous and non, ready and able to do this work. Let’s find a way to recognize our past, work hard now in the present, to create a future worthy of our children who stand to inherit it.

All my relations.