Health systems transformation takes time and care
This has been a phenomenal year of expansion for the Centre for Wise Practices in Indigenous Health (CWP-IH), in gratitude to a strong network of partnerships and collaborators within Women’s College Hospital (WCH) and beyond. This growth reflects the ongoing advocacy and commitment by the Centre and allied practitioners to respect and value First Nations, Inuit, and Métis identities (nation-to-nation and gender diverse) and approaches to health and wellness, governance, education, and research. Through continued strategy development, a comprehensive approach to health system change has been implemented to enable the right to access cultural ceremonial practices and deliver high-quality, culturally appropriate, and trauma-informed care for Indigenous peoples that is free from discrimination and racism.
Reflections on Serving Communities Together: Centering Indigenous Wellness
Providing culturally relevant trauma-informed care and programming is not simply about incorporating Indigenous teachings or cultural ceremonies, it also requires a shift in how we come to understand and conceptualize health and its relationship to wellness. “Health is not confined to the individual or to the services offered at the hospital or clinic. Genuine health and well-being, particularly for Indigenous peoples, is holistic,” says Dr. Lisa Richardson, Strategic Lead for the Centre. “It includes the individual and the health system, but it also incorporates community, the environment, education, and ancestral wisdom. It requires reshaping our healthcare system to respect Indigenous knowledge and provide culturally safe care, free from discrimination.” This view of health and wellness continues to guide and ground the Centre’s work, as well as its ongoing commitment to holding space to center diverse Indigenous approaches to health, wellness and ways of being.
Expanding the Circle of Care: Patient Care and Health Services
This year the Centre, in partnership with WCH, expanded its team to include two new roles for community-based practitioners (Indigenous Peer Support and Relations Advocate and Elder-in-Residence) who work directly with Indigenous patients and their loved ones, and support healthcare providers across the hospital to strengthen and deepen their ability to deliver high-quality care and support restorative circle of care pathways with WCH Quality of Care and Patient Relations.
Hope: Indigenous Peer Support and Relations Advocate
Speaking about her daily work as Peer Support and Patient Advocate Christine Monague explains that her role entails “supporting and advocating for First Nations, Inuit, and Métis patients and families which involves coordinating access to services, providing peer support and addressing cultural or spiritual needs.” Part of supporting Indigenous peoples to feel safe in the hospital, she adds, entails not simply providing services but also fostering “a collective sense of community for individuals, that draws on cultural teachings and resources to help patients create care plans that account for their physical, mental, emotional and spiritual health.”
Welcoming Elder-in-Residence Cindy White
The Centre officially welcomed Kawennanoron Cindy White as Elder-in-Residence in June 2022. Cindy is Onondaga Snipe Clan from the Mohawk community of Akwesasne, currently living in the Six Nations Grand River Territory. Cynthia has been actively engaged in her personal healing and spiritual training since 1996. She attended the State University of New York at Plattsburgh where she studied nursing and received a Bachelor of Science degree.
Kawennanoron is a Ceremonial Leader and Traditional Healer and sits on the Council of Soul of the Mother Lodge, a spiritually trained and Creator-centered team led by one of CWP-IH’s Decision-Making Council Elders, Kahontakwas Diane Longboat, M.Ed. The Council has travelled among First Nations and across the globe to bring the Sacred Fire. As she works, she creates a sacred space for individuals to meet with spirit for healing and transformation, sharing: “If there is no love, there is no healing.”
In her role as the Elder-in-Residence, Cindy will provide guidance for program development and implementation of practices and protocols specific to Indigenous peoples, personal consultation, and mentorship to learners, and staff at WCH. Cindy and Christine are in the process of socializing available supports and resources across departments and clinics within WCH, as well as responding to urgent referrals for community members receiving care at other partnering hospitals until more healthcare institutions hire Indigenous leaders, admin staff, educators, Elders, and patient support navigators.
Communities: Learning to Do Better Together
Committed to strengthening cultural safety, the CWP-IH team continues to offer Indigenous-led training workshops across the hospital. Currently, they are in the process of expanding educational offerings to include resources for learners and healthcare providers to learn more about the work of decolonizing healthcare, Indigenous healing strategies, and key components of cultural competency necessary to provide trauma-informed care. Speaking about the key aspect of the program’s philosophy, Education Lead Nadia McLaren points out that, “reconciliation and the work which it encompasses requires the restoration of Indigenous knowledge systems and wellness frameworks, led by Indigenous people and their communities.” A vital part of reconciliation requires strengthening our shared commitments to fostering care that is free from anti-Indigenous racism and discrimination and centering Indigenous leadership and ways of knowing and being. She adds that “advancing an inclusive form of healthcare requires that we collectively find strategies that address stigmas and outdated viewpoints.”
Nadia continues to offer leadership and support to the staff at WCH and beyond. The WCH community can expect new programming that tends to the Indigenous Art Collection at WCH while developing educational and interactive materials for each piece. Nadia has also developed partnerships with the Centre for Truth and Reconciliation to document Digital Health Stories and collaborating on a Learning Management System; a central education hub, where programs and individuals can sign up for workshops and other learning opportunities while the hub maintains the data of each Indigenous education experience.
Maad’ookiing Mshkiki (Sharing Medicine) Update
In February 2021, the CWP-IH, in partnership with the Indigenous Primary Health Care Council (IPHCC), Anishnawbe Health Toronto (AHT), and The Indigenous Health Program at University Health Network (UHN) and Shkaabe Makwa (CAMH) publicly launched Maad’ookiing Mshkiki (Sharing Medicine). This Knowledge Translation initiative provides culturally relevant information about COVID-19 care for First Nations, Inuit, and Métis. In its third phase, this community-centered initiative has added to its library of digital educational tools (interactive PDF’s) and Fireside Chat mini-documentaries to include (1) COVID Vaccine Q&A for kids ages 5-11, (2) parents, guardians & caretakers with Métis Pediatrician Ryan Giroux and Anishinaabe Puppeteer Chad Solomon of Rabbit & Bear Paws led by our Project manager and Strategic Communications Consultant, Selena Mills. In an additional partnership with the IPHCC, all interactive PDF guides and educational tools were translated into six Indigenous languages: Eastern-Ojibwe, Inuktitut, Ojibwe-Cree, Cree, Mohawk, and Michif. All resources continue to receive uptake at several Indigenous health and social service agencies and care settings.
Meaning: Supporting Future Health Leaders
In partnership with the Office of Access and Outreach and the Office of Indigenous Health at the University of Toronto, the CWP-IH is in the second year of offering the Zka’an Ni-bmiwdoowin Gchi-kinoomaadwinan (Building the Fire, Walking the Medicine), summer youth program, and has more recently partnered with Kapapamahchakwew – Wandering Spirit School for enrollments into the program, as well as develop host programming and mentorship year-round. This two-week immersive program honours the vision and leadership of Indigenous youth (grades 9-10) interested in exploring careers in healthcare. This community-based effort engages trusted healthcare practitioners, Elders, Knowledge Keepers, Faith Keepers, Indigenous Medicine People, Healers, and Land-Based Practitioners. With greater exposure to Indigenous leadership, knowledge(s), governance systems, and healing practices reflected in the environment around them. The hope is that Indigenous youth will be empowered to carve their meaningful paths forward, walking with confidence, a greater sense of connection, purpose and community.
The Center has welcomed two new learners—and future leaders, to the team! Victoria Lopez-Garcia (El Salvador, Nahuatl Nation, Nahuizalco community), has joined the CWP-IH through the Emily Stowe Scholars Program. As a Nurse’s Assistant and experienced personal support worker, she brings a wealth of expertise to the team. She is currently a student at the University of Toronto where she majors in Indigenous Studies and Critical Equity Studies. She looks forward to completing her degree and pursuing her dream to become a physician. Victoria shares, “my favorite component of working at CWP-IH is learning about research and advocacy from an Indigenous perspective, and my goal is to improve my research skills.”
Tekanenhorens Brass (Mohawk-Saulteaux from Kahnawake), joined the team as a Research Assistant who first began her work on a Knowledge Translation guide as a sister-project to the Maad’ookiing Mshkiki (Sharing Medicine) initiative in partnership with UHN, exploring patient COVID-19 protocol when receiving a test result; she collaborated with the CWP-IH Research Manager and Strategic Communication Consultant on, “What Do I Do When I Have Covid-19”.
Her focus is now on supporting and leading the seeding of environmental health justice initiatives designed to bring the impacts of racism into clinical focus and foster more accountable research relationships between Indigenous communities and researchers, while also supporting data collection for the More Than Words (National Indigenous History Month & Peoples Day) hub. Tekanenhorens has a Bachelor’s Specialization in Biology from Concordia University and grew up living within her community—keenly aware of the political and health-related issues in Kahnawake and sister community of Akwesasne. She is a passionate learner and critical thinker and her work at CWP-IH allows her to work with her home communities while building her skills as a researcher. She hopes to continue work in the field(s) of environmental health justice.
“I hope to gain valuable research and critical thinking skills, the work here is a much different learning environment than university. I am asking questions that allow me to deeply think about topics and am introduced to peoples of many diverse Indigenous backgrounds with whom I can share knowledge and learn. I know that I have already gained so much from working at the Centre, and will use these skills for all my future endeavours.”
Principles & Accountability: Opportunities for Growth
Despite the incredible growth and important gains made this year, much work remains to be done. A key project that is underway is being led by Tammy MacLean (RN, PhD.), a Canadian Institutes for Health Research Health System Impact Post-Doctoral Fellow at CWP-IH, with members from the CWP-IH team to audit and understand WCH’s commitment and capacity to implement Indigenous cultural safety.
Through an allied collaborative quality improvement approach, this work aims to achieve the following objectives: 1) understand the challenges and opportunities to advance Indigenous cultural safety and wellness at WCH; 2) explore the perceptions, experiences and influences of organizational executives, management and practitioners in relation to the everyday work undertaken by Indigenous health experts at the CWP-IH; and 3) identify areas for future direction and opportunities for collaboration between executives, management, and practitioners and our team at the CWP-IH. This project will run from June 2022-May 2023 and findings will be made available by Aug 2023. Tammy has been collaborating with CWP-IH members to successfully submit to the Research Ethics Board (REB) which has been approved and processed through the University of Toronto to inform this Institutional Ethnography and Evaluation Approach/Protocols as a guide. This evaluation will include an Environmental Scan (including ethics in Indigenous health research and data sovereignty) of work and influence through CWP-IH and partners.
Belonging: The Future of Virtual Care and Digital Health
Led by Research Manager Emily Simmonds, the CWP-IH is partnering with the Canadian Network for Digital Health Evaluation (CNDHE) to strengthen capacity in the field of digital health evaluation. Drawing on its connections to Indigenous communities, researchers and healthcare providers, the Centre is recruiting Indigenous partners in the CNDHE’s network so that they can share their experiences with virtual care and digital health tools. The Centre’s outreach work with CNDHE stresses the importance of Indigenous data sovereignty, relationship building and respect for Indigenous knowledge translation.
Additional initiatives include the development of an environmental health justices research portfolio which aspires to bring environmental racism, including the adverse impacts of climate degradation, into clinical focus. This expanded focus on best practices for the ethical involvement and meaningful research partnerships with Indigenous peoples has resulted in several new education initiatives designed to support non-Indigenous researchers to understand the principles for research engagement with First Nation, Metis, and Inuit Peoples, co-designing meaningful research engagements: (e.g., OCAP [Ownership, Collaboration, Access and Possession of Data], Principles of ethical Metis Research, National Inuit Strategy of Research [ITK], Developing ceremonial research agreements and the [National] Tri-Council Policy statement around research with Indigenous peoples).
Connection Through Innovation
The Project Manager and Strategic Communications of CWP-IH (Selena Mills), has completed the Pathfinding (Phase 1) of its website and application build of an innovative and ground-breaking virtual resource hub that hosts trauma-informed, culturally sensitive health information and tools for Indigenous communities from trusted Indigenous sources. “We want to make sure the new virtual hub interconnects with our governance systems in a dynamic way that is engaging and accessible for diverse demographics. I am passionate about harnessing technology tools to uplift Indigenous sophistication, joy, and brilliance,” says Selena.
This initiative is leveraging world-leading models of technology in partnership with Indigenous-owned and operated Design De Plume. With the support of a $200,000 donation from the TELUS Friendly Future Foundation to Women’s College Hospital Foundation, the virtual hub and app will directly support healthcare practitioners, hospital staff, learners, students, patients, partners, and as many as 10,000 community members through direct partnerships and at least 50,000 indirectly. The virtual space is destined to launch near the end of September 2022 to coincide with National Day for Truth & Reconciliation (Orange Shirt Day).
Orange Shirt Day Designs by CWP-IH