We are Welcome Here: Changing Hospital Care in Canada

View our slideshow above to see how hospital care in Canada is changing in Ontario, in Saskatchewan and in the Yukon.
June 2011 - An ailing Elder used to a traditional diet of moosemeat, caribou and bannock would be welcome here. So would a patient who, with the support of a medical doctor, drinks traditional balsam tea for an ailment. 
 
At Whitehorse General Hospital in the Yukon, innovative programming has been changing how care is delivered for First Nations, Inuit and Métis patients since 1993.
 
Director Rhonda Holway-McIntyre said the programs are now recognized as a 'leading practice' in Canadian health care, following independent assessment of the hospital's services by Accreditation Canada, which wrapped up its site visit in June 2011.  Seven programs, ranging from traditional medicine and nutrition to a special healing room, are helping meet the needs of both Aboriginal and non-Aboriginal patients.
 
After two decades of partnership involving the Council of Yukon First Nations, Health Canada and the Yukon territorial government, an evolution in acute care structure and practice is now beginning to shape services in other hospitals throughout the Yukon territory.

 


 

A Growing Trend

The Na'Ku Healing Room at Whitehorse General Hospital is open for use by all people as a space for traditional methods of healing. 

Photo: Cathie Archbould.
Transforming the highly clinical world of hospitals to a culturally safe home away from home for an Elder who may never have been in a hospital, or a residential school survivor uncomfortable in institutional settings, is a significant challenge. It's also a key step in addressing health status disparities associated with a lack of access to appropriate and equitable treatment for Aboriginal peoples in Canada.

 

More and more municipalities and organizations across Canada are working with First Nations, Inuit and Metis leaders and communities to better serve patients who are members of Canada's diverse Aboriginal communities. For instance:

  • In June, an "All Nations' Healing Room" was opened at Royal Jubilee Hospital in downtown Victoria, BC, the first in the province to accommodate traditional First Nations healing practices such as smudging, drumming and burning cedar boughs. Similarly, the North Bay Regional Health Centre recently created a non-denominational Spiritual Lodge for smudging ceremonies, and included many First Nations elements in the newly opened hospital's design.
  • Last year, the new state-of-the-art Sioux Lookout Meno Ya Win Health Centre opened in northwestern Ontario, where 80%of clients are Aboriginal. Meno Ya Win offers an integrated model of care and a cross-cultural patient safety framework in virtually all clinical and support services, and was designed by renowned architect Douglas Cardinal to reflect a holistic vision of 'health from the inside out.' The centre provides cultural competency training for a staff of 300 and is serving 30,000 outpatients annually.
  • In Saskatchewan, the All Nations Healing Hospital in Fort Qu'Appelle is owned and operated by the 34 First nations who signed Treaty 4. It, too, has been architecturally designed to integrate aspects of First Nations culture, and offers programs from acute care and residential schools support, to water quality testing and traditional ceremonies. 
  • In downtown Ottawa the non-profit Ottawa Health Services Network Inc. (OHSNI) supports Inuit residents of Qikiqtani Region of Nunvaut receiving medical treatment in Ottawa, providing a range of services, from interpreters to escorts on flight transfers. OHSNI links with Larga Baffin residence, a culturally-sensitive, Inuit-owned boarding home serving residents of Baffin region with a supportive place to stay. (See related Ottawa Citizen article).

These changes to non-conventional roles for health services delivery require new ways of thinking, innovative alliances, commitment, time and resources. Integration of services at Weeneebayko Area in Ontario, for instance - where 87% of the 11,500 residents are Aboriginal - involved resolutions from the federal and provincial ministers of health, five communities of the Weeneebayko Area and the town of Mooseonee, Ontario. Together they worked to merge hospitals in the region in 2010, and to integrate planning, management and delivery of health care services. Such shifts also typically require flexibility in regulations, new legislation and changed approaches to governance.   

 

 


Access to Critical Care is at Stake

 

Staff at Whitehorse General Hospital gather by the Na'ku
healing room; together they advocate for and guide
Aboriginal people through the acute
care health system. Photo: Cathie Archbould
At stake is access to an acute care system that has fallen short in meeting the needs of First Nations, Inuit and Metis patients in Canada. Barriers include lack of services in remote and rural locations; the need to accommodate the language and cultural contexts of patients; and jurisdictional issues that often impede access to timely and appropriate care. In Inuit Nunaat for instance, most of the region's 52 communities face critical shortages of medical personnel. Communities like Garden Hill First Nation in northern Manitoba, which is served by one doctor, a small nursing station and no hospital, recently saw two people die from the common flu in 2010, raising concerns about the level and quality of care.

 

Meanwhile, alarm bells about the treatment of Aboriginal people in the hospital care system were sounded across the country in 2008 when a homeless wheel-chair bound First Nations patient died while waiting for 34 hours in the emergency room of Winnipeg's Health Sciences Centre. The patient, Brian Sinclair, received no attention and as a result succumbed to a bladder infection that had spread to his bloodstream. His story continues to be followed by the media and publications like the Canadian Medical Association Journal. Sinclair's death, as well as the deaths of two other patients in the same year, led the Indigenous Physicians Association of Canada to recommend a "systematic review for multilevel racism" within the health care system.  

 

Growing interest in cultural competency training for health care professionals, along with support for hospital staffing that better reflects the population served, is a significant step in providing appropriate and responsive care. (See, for instance, Dream Catcher: Find Your Future In Health, a manual for youth about careers in health prepared by the Council of Yukon First Nations and the Aboriginal Human Health Resource Initiative). So, too, is creating more culturally relevant services and settings, supported by greater Aboriginal control of health service design and administration.

 

 


The Path to Change

 

Ms. Holway-McIntyre has been involved in the evolution of Whitehorse General Hospital and the Yukon hospital system since 1994. She said patients in the territory were facing a multitude of barriers preventing their access to the health care system – many simply unwilling to “darken the door of a hospital” unless forced to by their medical conditions, which were often worsened by the lack of timely attention. The Canadian Medical Association Journal noted in 1999 the concerns raised about the "alarming health status" of Aboriginal people in the region, who were facing some of the highest death rates in the country.

However, discussions to better meet the needs of the predominantly First Nations clientele of the hospital system began in 1990. That's when health services were being transferred from the government of Canada to the Yukon territorial governance. First Nations recognized the opportunity to ensure their voices were heard, building on a long evolving trend in the Yukon toward First Nations involvement in major initiatives in their territories.

By 1993, funding was designated for a First Nations Health program. The Hospital Act ensured strong First Nations representation on the board of trustees, and a First Nations Health committee was struck to oversee relevant programs.

“None of this was common at the time in Canada, to have First Nations input at that level. That had a huge impact on services,” said Ms. Holway-McIntyre.

Seven programs were initiated through the Tripartite Agreement with the Council of Yukon First Nations, leading to both structural change and changes in practice.

 

The traditional food program, for instance, receives donations of big game from local hunters, and is supported by a dedicated kitchen area separate from conventional food preparation sites, as well as regulations that accommodate non-conventional food preparation and storage. Ms. Holway-McIntyre said her father, who was in hospital recently for gall-bladder surgery, was visibly strengthened when the typical hospital fare of bland codfish and low-fat chicken breast was replaced by moosemeat stew and caribou broth. “It was a complete turn-around.  It was the food he was used to at home and was just right up his alley!” she said.

 

 

The Na'Ku healing room was completed in 1996 and is used for cleansing ceremonies, particularly for patients in recovery, or for ceremonies and prayers, providing an opportunity for families to have a space to be together. Structurally, a sprinkler system allows for ceremonial smoke without setting off fire alarms, while vents allow for smudges to take place in a patient's room.

 

 

The traditional medicine program supports behavioural change as physicians voluntarily learn about native plants and medicines, balancing their use with conventional medicine. The program was originally championed by the late Dr. Frank Timmermans, the medical officer of health and a surgeon at the hospital for 20 years, and continues to support improved communications between patients, families and doctors.

The evidence that the shift is making a difference? In the 1990s, with one liaison worker on staff, First Nations patients were overrepresented in the hospital system, comprising 40% of the patient population although making up 25% of the territorial population. Today, said Ms. Holway-McIntyre, the Aboriginal patient population ranges between 25 and 33%.

"There is no doubt that the bridge has been built and that people are crossing it," she said. “But there is still a lot to be done to make people feel truly welcome...” 

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