Indigenous Success Stories: Métis

University of Saskatchewan: Dr. Alexandra King, Cameco Chair in Indigenous Health and Wellness in the College of Medicine, and Professor Malcolm King, Department of Community Health and Epidemiology and the scientific director of the Saskatchewan Centre for Patient-Oriented Research, are part of a Government of Canada-funded network of 100 researchers from across Canada, led by Dr. Jean-Lucien Rouleau of the Montreal Heart Institute. The funded research, called the Canadian Heart Failure Transformation Alliance (CHF Alliance), will strive to halt the progression of HF and understand the mechanisms involved in improving the lives of Canadians at all ages living with HF and other heart conditions.

“We are thrilled to be providing leadership nationally. We have a team that combines rich and diverse Indigenous research expertise and patient-oriented research expertise, especially that involving Indigenous people with lived and living experience,” said Dr. King.

The Kings, working with Indigenous Elders and Knowledge Holders, will develop Indigenous-led approaches to improving the diagnosis and care of HF in Indigenous people. Using etuaptmumk (Two-eyed Seeing), they will interweave Indigenous ways of knowing, being and doing with Western science, working with Indigenous peoples to improve prevention, early diagnosis and treatment of HF. 

“Our vision is to find the harmonies between the Indigenous and Western approaches to create sustainable, community based, culturally safe and responsive approaches to HF services,” said Prof. King.

The Canadian Heart Failure Transformation Alliance spans eight provinces and one territory, and involves 12 patient/caregiver partners, 13 Indigenous partners, and 132 investigators (42 per cent women; 24 early-career investigators). Six university-based research hubs will form the backbone of the Canadian Heart Failure Transformation Alliance, and at USask, which is one hub, the Kings will lead this critical research.

The “Our Health Counts” project will contribute to the priority area of Applying the “Two-Eyed Seeing” Model in Aboriginal Health, specifically utilizing “Two-Eyed Seeing” in assessing and improving the health of urban Aboriginal people. The study design provides an opportunity to address the broad gaps in urban Aboriginal health assessment across health domains and lifecycle stages with a focus on a key health care utilization indicator (ER use)

Our over-all goal is to improve urban Aboriginal health data by documenting many aspects of people’s health and well-being – as a baseline. At all stages of this project many and diverse partners work collaboratively to make health services effective, relevant and efficient for urban Aboriginal peoples. To date, the urban centres included in this project are Ottawa, Hamilton, Toronto, London, and Kenora. An urban Indigenous health information, knowledge, and evaluation (HIKE) network has formed. The HIKE network includes influential representatives from each urban community and members of the research team to share ideas, findings, tools, and resources.
http://ourhealthcounts.ca

Toronto Star – Anishnawbe Health Toronto’s Indigenous Health Centre broke ground on its new location in downtown Toronto. Its partners on the site include Miziwe Biik Training Institute for services around education and employment; a child-care and family centre operated by the city, a mixed-use condo building; a restored heritage building and a rental building.

The Indigenous community centre will be completed by 2022 and the remainder of the hub will be finished by 2024. The hub represents a place to celebrate with others, where Indigenous people can gather as a community…And there’s hope that the launch of the hub will inspire groups and businesses across Canada to partner with Indigenous communities to create spaces that will address the systemic discrimination Indigenous people face in Canada’s institutions.

News at Medicine: Memorial University – Dr. Jennifer Shea, Community Health and Humanities, Faculty of Medicine, along with a team of community partners, hopes to make cancer care delivery more culturally responsive and more respectful. Supported by the Canadian Partnership for Cancer at $866,000 for four years, the project is led by the Nunatsiavut Government, in partnership with Memorial University, the NunatuKavut Community Council, Sheshatshiu Innu First Nation and the Mushuau Innu First Nation.

Their project, “Courage, Compassion, and Connection, The Journey to Healing: Exploring Cancer Pre-diagnosis for Indigenous Peoples in Labrador” came from a stakeholder session held in Happy Valley-Goose Bay in 2018. Two main themes emerged: Challenges during both pre-diagnosis and transitions in care and Cultural Safety

Participants in the session expressed concerns about:

• the high costs of travel for tests;
• continuity in care due to a high turnover of health professionals
• communities without a physician;
• delays in getting test results.
• transitions in care around discharge planning, such as patients being released without awareness of the remoteness of their community and expectations on family/caregivers to provide palliative care once they return.

“For First Nations, Inuit and Métis, a cancer diagnosis has obvious health implications, but also social, financial and interpersonal challenges,” said Dr. Shea.

“Often people living in rural and remote communities have to leave their homes and familiar surroundings for health services in unfamiliar territory. Add to that language barriers and misunderstandings of cultural practices and beliefs, which can make communication difficult.

BC Association of Aboriginal Friendship Centres – Indigenous patients can now report health system concerns anonymously using Safespace Networks on the B.C. Association of Aboriginal Friendship Centres’ (BCAAFC) website. Safespace Networks is a community-led, nationwide initiative to create change in the health care system by holding individuals, organizations and institutions accountable to addressing racism.
The app’s design follows the advice of Te′ta-in (Sound of Thunder) Shane Pointe, Knowledge Keeper within Mary Ellen Turpel Lafond’s “In Plain Sight” report to focus on change, rather than a “shame and name” approach.
Dr. Alika Lafontaine founded Safespace Networks in 2019 with the vision of a social enterprise and learning platform for patient advocacy. To learn more, please visit http://safespace.healthcare/

“COVID-19 and the Decolonization of Indigenous Public Health.” Canadian Association of Medicine Journal – First Nations, Inuit and Métis communities in Canada have had lower rates of COVID-19 overall and a lower case fatality rate than non- Indigenous Peoples despite structural inequities and social determinants that are generally related to poorer health outcomes. First Nations on-reserve have had a COVID-19 case rate:

• 4 times lower than that of the general Canadian population
• with 3 times fewer fatalities and
• a 30% higher recovery rate.

This is vastly different from outcomes during the H1N1 pandemic where rates of the infection were 1000 per 100 000 population among Inuit, and 24 per 100 000 population among non-Indigenous people in Canada Current strategies for Indigenous public health practice, grounded in self-determination, are an important reason for the relative resilience of Indigenous communities in Canada during COVID-19.

In Canada, almost all Indigenous communities have pre-existing emergency preparedness plans, and they have been updated and implemented to deal with the current pandemic. Furthermore, innovative educational materials and public health campaigns have been created by many different First Nations, Inuit and Métis communities. These materials build on prevention, isolation and containment measures put forward by public health institutions but are grounded in the local context of each community, including its language, culture, and physical and social environments.

Examples include the Qikiqtani Inuit Association’s educational materials, which illustrate hygiene practices, social distancing and isolation procedures in Inuktitut, using common examples from the daily lives of their local community members, as well as frameworks for wellness in the COVID era that draw on the knowledge of Elders and knowledge keepers from specific nations. The adaptation by the Centre for Wise Practices at Women’s College Hospital in Toronto of the Four Directions Medicine Wheel for a holistic approach to pre- venting and building physical, emotional, mental and spiritual resilience during COVID-19, is an example of the latter.

Anticipating further waves of COVID-19, it is important that the design, implementation and leadership of public health by First Nations, Inuit and Métis communities continue in Canada. At its foundation, Indigenous public health must be self-determined:

• adapted for the needs of specific nations and grounded in local Indigenous language, culture and ways of knowing;
• developed, implemented and led by Indigenous Peoples; and
• informed by ongoing monitoring of data as governed by appropriate data sovereignty agreements.

Moreover, all levels of government in Canada must address the social determinants of health both in the short term — to facilitate prevention, control and containment of COVID-19 — and in the long term through investments in infrastructure, food security and chronic disease prevention and management. This will require the decolonizing of health care at individual, organizational and policy levels. Governments, policy- makers and public health providers must embrace the know- ledge, expertise and strong leadership of Indigenous communities to face COVID-19.
https://www.cmaj.ca/content/cmaj/192/38/E1098.full.pdf

The article “Indigenous-led health care partnerships in Canada” raises four key points:

1. Indigenous Peoples in Canada benefit from regaining access to and strengthening traditional cultural ways of life, including health and healing practices.
2. Many Indigenous communities are working to strengthen cultural healing practices that were marred through colonization and oppressive government policies.
3. Indigenous-led health care partnerships provide innovative models of interprofessional collaboration, be it in community-based healing lodges, remote clinics or urban hospitals.
4. Emerging evidence suggests that Indigenous-led health service partnerships improve holistic (inclusive of mind, body, emotion and spirit) health outcomes for Indigenous Peoples, as well as access to care, prevention uptake and adherence to care plans.

The paper discusses specific Indigenous-led health practices in multiple jurisdictions. The paper concludes with specific suggestions for health care providers, managers and researchers across three dimensions:

• Personal practice
• In public forums and systems
• In research
• Indigenous healers and Elders are sometimes reluctant to build partnerships with physicians out of concern about:
  • the potential overharvesting of plant medicines,
  • disrespectful treatment,
  • cultural appropriation
  • commercialization,
  • unbalanced funding schemes,
  • tokenism and loss of autonomy.

Furthermore, from the patient’s perspective, a survey conducted in eastern Canada reported that 92% of the Indigenous respondents who use tradi¬tional medicine feared disclosing this information to health pro¬fessionals. Better understanding is needed on how to protect Indigenous medicines, healing practices and knowledge in their full integrity while developing and promoting self¬-determination in Indigenous-led health care services and systems that foster cultur¬ally safe spaces for patients, Elders and healers.
https://www.cmaj.ca/content/cmaj/192/9/E208.full.pdf

CBC – “M-174 National Suicide Prevention Action Plan” passed unanimously in House of Commons. M-174 establishes a “national suicide prevention action plan, including among its provisions (i) commitment to the actions and resources required to establish culturally appropriate community-based suicide prevention programs as articulated by representative organizations of the Inuit, First Nations, and Métis peoples. Timmins-James Bay MP Charlie Angus says crises in northern Ontario First Nations prompted motion.

On May 8, 2019, parliamentarians voted unanimously in favour of a national suicide prevention action plan. The Motion M-174 calls on the Government of Canada to establish a national suicide prevention action plan, including among its provisions:

• commitment to the actions and resources required to establish culturally appropriate community-based suicide prevention programs as articulated by representative organizations of the Inuit, First Nations, and Métis peoples;
• establishment of national guidelines for best practices in suicide prevention based on evidence of effectiveness in a Canadian context;
• the creation of a national public health monitoring program for the prevention of suicide and identification of groups at elevated risk;
• creation of programs to identify, and to attempt to fill, gaps in knowledge relating to suicide and its prevention, including timely and accurate statistical data;
• development of tools to promote responsible and safe reporting of suicide and its prevention by media;
  establishment of national standards for the training of persons engaged in suicide prevention, whose contact with potentially vulnerable populations provides an opportunity to identify at-risk individuals and direct them to appropriate assessment and treatment;
• creation of a national online hub providing essential information and guides to accessing services, in English, French, selected Indigenous languages, and other languages spoken widely in Canada for suicidal individuals, their families and friends, people bereaved by a loved one’s suicide, workplaces and other stakeholders concerned with suicide prevention;
• conducting within 18 months comprehensive analyses of high-risk groups of people, and the risk factors specific to each such group:
  • the degree to which child sexual abuse and other forms of childhood abuse and neglect have an impact on suicidal behaviour,
  • the barriers to Canadians accessing appropriate and adequate health, wellness and recovery services, including substance use, addiction and bereavement services,
  • the funding arrangements required to provide the treatment, education, professional training and other supports required to prevent suicide and assist those bereaved by a loved one’s suicide,
  • the use of culturally appropriate suicide prevention activities and best practices,
  • the role that social media plays with respect to suicide and suicide prevention,
  • means to reduce stigma associated with being a consumer of mental health, bereavement and other associated services, and ways in which society can reduce access to means and methods for people to harm themselves; and,
• report to Parliament annually on preparations for and implementation of the national action plan for suicide prevention, including data on progress over the previous year, and a comprehensive statistical overview of suicide in Canada for the same year.

Nunatsiaq News – In a move partly influenced by work done by Inuit Tapiriit Kanatami and the governments of Nunavut and Quebec, members of all parties in the House of Commons said yes to the idea of a national suicide prevention action plan. “Our government is working closely with Indigenous leadership to encourage and promote Indigenous-led strategies to address suicide prevention in their own communities,” Dan Vandal, parliamentary secretary to Indigenous Services Minister Seamus O’Regan said. Vandal also gave a detailed description of ITK’s National Inuit Suicide Prevention Strategy, listing its six priorities.

But at the same time, Vandal said ITK’s strategy may not be a good fit for other Indigenous peoples. To that end, he said the federal government is working with the Métis Nation to develop “a Métis Nation specific approach” to suicide prevention. And the federal government is also working with First Nations on a First Nations mental wellness continuum framework directed at First Nations communities, Vandal said.

The motion calls for the following:

• The establishment of national guidelines for best practices in suicide prevention.
• A national public health monitoring program to identify groups at elevated risk of suicide.
• Culturally appropriate, community-based suicide prevention programs for Inuit, First Nations and Métis.
• Creation of programs aimed at filling in gaps in knowledge related to suicide and its prevention.
• National standards for training people in suicide prevention.
• Development of tools to promote safe and responsible reporting of suicide by media.

The motion also calls for a comprehensive analysis on how child sexual abuse and other forms of childhood abuse and neglect contribute to suicidal behaviour. And it calls for an analysis of the barriers that Canadians face in gaining access to health, wellness and recovery services, including substance use, addiction and bereavement services.

The Indigenous Peoples’ Health Research Centre (IPHRC) and the Saskatchewan Centre for Patient-Oriented Research (SCPOR) – have developed an in-person training module for Health researchers. ”Building Research Relationships with Indigenous Communities” (BRRIC), is the first of its kind in Canada. It seeks to provide researchers with the basic tools and knowledge to build meaningful research relationships in a good way with Indigenous peoples and their communities.

BRRIC also incorporates traditional Indigenous knowledge and the Truth and Reconciliation Commission’s Calls to Action. It is designed to provide researchers with the necessary policies, frameworks, and Indigenous ethical standards needed to respectfully engage with Indigenous communities and patients including:

• the history of Indigenous health and research in Saskatchewan;
  existing policies and frameworks guiding research with Indigenous communities such as OCAP™,
• Truth and Reconciliation Commission Calls to Action,
• Tri-Council Policy Statement Chapter 9 and;
• protocol on how to respectfully and meaningfully engage communities in research projects.

https://www.schoolofpublicpolicy.sk.ca/news-events/news-articles/2019/iphrc-and-scpor-launch-first-of-its-kind-training-for-health-researchers-engaging-with-indigenous-communities.php

Assembly of Manitoba Chiefs – Today’s resurgence of the Bear Clan Patrol is in response to the need in Winnipeg to protect the women, children, elderly and vulnerable community members. Originally started in 1992, a reconstituted Bear Clan Patrol hit the streets after the murder of Tina Fontaine in 2014 with 12 members that now boasts 980 people in Winnipeg alone. It has also spread outside Winnipeg, spanning across 24 different communities in 12 cities in five provinces all the way from Ottawa to East Hastings in Vancouver.
So far in 2018 35 tonnes of food has been donated. They clocked 21,000 volunteer hours in 2017 and forecast 33,000 volunteer hours this year. They have collected almost 30,000 needles so far in 2018. They have seven paid full-time and part-time staff workers. In June, they had $50,000 in temporary work placements. They are janitors, first responders, neighbours, ambassadors but most importantly they do this because they care about the people who call the North End home. (Assembly of Manitoba Chiefs)