Picturing health: health advocates for Indigenous communities in British Columbia, Canada

Online First Perspectives Joanna Palmer Published: 22 February 2018 PlumX Metrics DOI: https://doi.org/10.1016/S0140-6736(18)30468-9 | showArticle Info Photographer Philomena Hughes, working with Nadine Caron and Indigenous communities in northern British Columbia, Canada, has taken this series of photographs of people involved in supporting the health and wellbeing of Indigenous communities in this region. All the pictures were taken around Prince George, BC. Philomena Hughes was born and raised in Prince George. Nadine Caron, a general and endocrine surgeon, Associate Professor, University of British Columbia (UBC), Department of Surgery, Northern Medical Program and Co-Director of the UBC Centre for Excellence in Indigenous Health, has lived in Prince George since starting her surgical and academic career in 2005. All the people in these photographs, apart from the research nurse and some individuals in the group circle, are of Indigenous ancestry. The text that accompanies each picture is written by the person featured in the photograph and highlights their work and motivations. Opens large image Warner C Adam, Chief Executive Officer, Carrier Sekani Family Services, Prince George, BC “Having grown up on the Indigenous reserve of the Lake Babine Nation, adjacent to a small town in Northern British Columbia, Canada, I witnessed the challenges facing Indigenous people and committed my life's work to closing the socioeconomic and health gaps that exist between Indigenous and non-Indigenous people of British Columbia. In large part, this was done through the creation of Carrier Sekani Family Services (CSFS), an organisation established as a response by Carrier and Sekani First Nation Elders to reassert control over justice, health, and social services. I was the founding CEO of CSFS. When we first started, in 1990, we had a staff of three people. Today, I provide leadership and vision to a staff of more than 200 people in a Northern British Columbia over 76 000 km2 of territory. Administering human and financial resources is the easier part of the job; the challenge is to develop meaningful and far-reaching programmes that are sustainable, improve the health outcomes for all Indigenous people, and ultimately reduce the evident health and social inequities facing the Indigenous population. As a passionate advocate, I work closely in partnership with provincial, federal, and Indigenous levels of government to inform innovative and transformative health-care practices across the lifespan, to advance self-determination, governance, and individual capacity for the CSFS Member Nations and their people. The key issues facing Indigenous health outcomes are intimately linked to the disparities found within the social determinants of health, namely, poverty in many of the Indigenous communities. Poverty perpetuates the negative cycle of dependency upon the social welfare system that Indigenous people have been subjected to for centuries. The impact of this cycle has shaped the health and wellness landscape of the Indigenous people and their communities, resulting in a population often deprived of basic access to food, education, and health-care services. Through the positive work being completed, the desired outcome is to help Indigenous people break the cycle of poverty and dependency. Recently, governments have begun to recognise the benefit of collaboration and partnership with Indigenous people. My work is guided by the body of evidence that shows where there exist solid and sound governance structures, strong leadership, and culturally appropriate systems, there is increased success in self-determination and self-government. Improving current health standards of the Indigenous people still requires adequate infrastructure, culturally based programmes, and services balanced with the building of human capacity and community mobilisation among the Indigenous population. We are currently on that path.” View Large Image | View Hi-Res Image | Download PowerPoint Slide Opens large image Weekly team and clinical meeting at Central Interior Native Health Society, Prince George, BC According to Shobha K Sharma, Central Interior Native Health Society's Executive Director, “Central Interior Native Health Society is a primary health care site. ‘Primary health care’ refers to a method of delivering health care services that is team based—and the ‘patient’ is a valued member of the team. The clinic staff work as a team, sharing a commitment to learn how to deliver the best care possible with Indigenous culture as a foundation to care. Our organisation and team are committed to providing cultural and trauma informed care following a harm reduction model that is patient centred. Every week our interdisciplinary team of primary care providers (family nurse practitioners and general practitioners), registered nurses, wellness counsellors, social workers, physiotherapists, outreach and support workers, and our elder come together to meet in a circle for strategic planning and individual case management to ensure wraparound services for complex patients. The clinic is also committed to being part of an enhanced broader community. As a teaching institute, we train students and community in an approach to health and healing that incorporates an Indigenous worldview. We strive to be champions for improved access and services both inside and outside of the clinic and to be partners with other leaders seeking changes and improvements for the health of Indigenous and vulnerable people. The clinic works with sympathetic and visionary professions in the health community to improve access for vulnerable people.” View Large Image | View Hi-Res Image | Download PowerPoint Slide Opens large image Jane Inyallie, Wellness Counsellor, Central Interior Native Health Society, Prince George, BC “I work with patients who access the health services of the Central Interior Native Health Society (CINHS) who use substance to deal with difficulties they face in their lives. I see them for counselling or refer them to outside resources, such as the detox unit, treatment centres, or mental health in our community. I am part of the interdisciplinary team at CINHS: we work together to give wrap around health care to the patients who access our services. The team consists of doctors, nurse practitioners, nurses, social workers, wellness counsellors, support and outreach workers, as well as the administrative team…I believe people use various substances as a coping strategy to deal with pain they have accumulated in their bodies. The pain is from various traumas experienced over periods of time. I work with patients to find ways to release this pain from their spiritual/mental/emotional/physical bodies. We do this through talking, art, traditional practices, education, movement, and various ceremonies as well as referral to services in-house or outside resources. Working with our interdisciplinary team is necessary to achieving the highest potential of wellness for people who access the health services of our clinic.” View Large Image | View Hi-Res Image | Download PowerPoint Slide Opens large image Preston B Guno, Provincial Director, Indigenous Cancer Care, BC Cancer Agency, sharing sacred items of traditional medicine “As the Provincial Director of Indigenous Cancer Care, it is my job to ensure the cancer care system acknowledges, respects, and provides meaningful engagement with Indigenous people and cancer patients and ensure the cancer system provides a culturally relevant and safe model of service delivery. This would include the role of spirituality, cultural teachings, ceremony, and traditional indigenous medicines. The blueprint to achieve these goals falls in line with the Provincial Indigenous Cancer strategy that was developed with key partnerships with the First Nations Health Authority, BC Association of Friendship Centres, and Métis Nation BC…It is important and motivates me to see Indigenous cancer patients and their families receive culturally relevant and safe care that honours and respects traditional ways of healing and creates the space within the current system to guide and teach cancer agency staff the importance of building meaningful relationships and incorporating traditional practices in the care and treatment of and with indigenous people.” In this photograph, Preston shares an eagle fan, smudge bowl, sweet grass, and sage. These items are for ceremonial use and are an integral part of traditional medicine, spirituality, and healing. View Large Image | View Hi-Res Image | Download PowerPoint Slide Opens large image Earl Henderson, Adjunct Professor at the University of Northern British Columbia and a respected Elder in the Prince George community “In the western world I am acknowledged for having a BA with a major in First Nations and Anthropology, an Interdisciplinary MA in First Nations, Anthropology and Education, and a Certificate in Métis Studies. I currently teach at the University of Northern British Columbia (UNBC) and have a private consulting business called Four Winds that contracts with Ministry of Children and Family Development-Youth Corrections to provide cultural awareness services for youth. I am a board member of the Cedar Project and a contributor or coauthor to their articles…I am a Veteran and stand as a Veterans representative for our region with Métis Nation British Columbia. In the Indigenous world I am (Apihtaw Kosisan)—“half-breed”, which in Cree is not a derogatory term but indicates mixed blood. I am Métis, Cree, Sioux, Scots, Irish, and French…My Elders and teachers are the late Joe Cardinal from Saddle Lake Cree Nation in Alberta and Phillip and Betty Gladue from BC. I am a Pipe Carrier and Sweat Lodge Holder who is acknowledged by the community as an Elder…I am a husband, a father, and have 15 grandchildren and two great-grandchildren. I have always had struggles with mainstream institutions who look at my tattoos and long braid and decide I am ‘less than’. In university, and especially in health care, racism is still thriving. I have had my own chronic health issues for a number of years, so I have had a lot of interaction with the health-care system. Often they have trouble believing that someone who is so externally visibly Indigenous does not have a drug problem or is not homeless, despite the fact I have a Masters degree, have never done drugs, and own my own home.” View Large Image | View Hi-Res Image | Download PowerPoint Slide Opens large image Wilfred Adam, Chief of Lake Babine Nation, BC “My job as Chief is to be the spokesman and leader of the Nation. I chair our Council meetings and lead or appoint individuals to hold discussions with other governments on the business of the Lake Babine people. Also, I negotiate and carry out agreements for the betterment of the Lake Babine people. I approve policies and financial issues on behalf of the Lake Babine people. What really matters to me is to support Lake Babine Nation (LBN) citizens to be able to lead healthy lives and assist LBN citizens improve their livelihood and assist them in getting the services they need…What is very important to me is the safety and timely health services that are needed by all our LBN citizens. We must assist and advocate for the betterment of the best health care our citizens need.” View Large Image | View Hi-Res Image | Download PowerPoint Slide Opens large image Sharon A Springer, Cedar Research Nurse at Cedar Project “The Cedar Project is guided by our Elders, who bring knowledge, wisdom, and traditional teachings to ensure that we are ‘doing things in a good way’. Cedar Project staff provide a safe and non-judgmental environment for our participants to share their personal stories, while giving them a voice to make change in our communities. Acknowledging the challenges and accomplishments of each individual is vital to their healing journey. I am motivated by the strength, determination, and courage of each and every participant. My role within Cedar Project is to provide a safe and confidential space for our participants to share their personal stories, without judgment. Provide education and information on health issues. Provide support and advocacy. Assist with navigating the health-care system to enable participants to address their health-care needs in a safe and respectful process and liaise with health-care providers to bridge gaps for participants to optimise their health-care experience. The limited health-care resources, lack of housing availability, and the daily stigma and discrimination are ongoing challenges that our participants face on a daily basis.” View Large Image | View Hi-Res Image | Download PowerPoint Slide Opens large image Victoria M Thomas, Cedar Project Coordinator “The Cedar Project provides our communities with hope and healing. Cedar is nested in the teachings that the intergenerational trauma of residential schools plays a large role in abuse, addiction, poverty, homelessness, mental health, and communicable disease that our people and communities face today. It is our responsibility to listen and record the stories of our young people without blame or shame. I am honoured to go to work every day and listen to our young people who share extremely private and sensitive information. It is a safe way for our young people to effectively make change without having to worry about the consequences of expressing their opinions/experiences. We would not be able to complete this work without the guidance of the Elders and teachings of our people—our young people would never share so openly (our Elders call this ‘doing things in a good way’). This research has come full circle. We started off as an observational health study; now we have taken the stories of our young people and designed specific health studies. The lack of health-care resources and properly trained staff are the two biggest issues Indigenous people face when trying to access health care. Our role is to create allies and safe pathways in a health-care system that is free of stigma, racism, and lack of empathy.” View Large Image | View Hi-Res Image | Download PowerPoint Slide Opens large image Amanda M Kupp, Cedar Case Manager “My job as case manager is to assist, initiate, and address barriers to health care in a client-centred, culturally sensitive way. The most important thing to me in relation to my job is advocating and supporting our participants while they navigate the health-care system. I think what's important about our job is the level of trust and communication we have with our participants. What motivates me is witnessing their personal growth while they take this healing journey. Key health issues I have seen are the lack of health-care choices, stigma, and discrimination against people living with addictions or mental health issues.” View Large Image | View Hi-Res Image | Download PowerPoint Slide Opens large image Megan A Hunt, Director, Primary Care, First Nations Health Authority, BC “As the Director of Primary Care, it is my job to provide leadership and guidance to support the development and implementation of primary care services within our First Nations communities. Addressing the inequities of timely, culturally safe access to care that is received closer to home and meets individual and community needs is vitally important as part of the journey towards increased health and wellness outcomes among our First Nations population in BC. Commitment to working together at the community, local, regional, and provincial levels to jointly develop meaningful relationships, partnerships, and opportunities to positively impact and change the manner in which primary care is developed and delivered to meet the unique and sometimes complex needs is a priority. What I have learned to be one of the most important components of my job is to ensure there is a true investment of time to developing and maintaining relationships among the health-care system and community. Community driven and owned processes create ownership, pride, and longevity in the delivery of services. Strong and trusting relationships create an important foundation to work together, plan, and problem solve together and helps to develop deep and true knowledge exchange and understanding to support culturally safe and meaningful care.” View Large Image | View Hi-Res Image | Download PowerPoint Slide Opens large image Lester (Todd) Alec, Family Practice Resident “I am a Family Practice resident, which means that I am training to provide primary care to patients. This is a difficult process as we have to learn as much as possible and consolidate previous information from medical school into a short 2-year residency. I chose Family Medicine because I enjoyed the scope of practice and I think that this role has the greatest influence in preventive care measures with the most points of contact for upstream interventions. I think we can do better in preventative care so that we can decrease the incidence of modifiable factors in chronic disease. Successes such as smoking cessation campaigns after the Lalonde Report have had a lasting impact on smoking rates, but we continue to see higher than average rates in First Nations Peoples. Access to health care is another area for improvement, particularly in rural and remote communities. I am excited to have the opportunity to work with organisations and communities to help fill this gap once I am done. Key challenges are the lasting effects related to trauma caused by residential schools, and an interdisciplinary approach to the reconciliation process.” View Large Image | View Hi-Res Image | Download PowerPoint Slide Opens large image Marshal Robert German Johnson, Program Manager, Centre for Excellence in Indigenous Health, University of British Columbia, Vancouver, BC “My job is focused on creating training opportunities in public health that are relevant to Indigenous communities and beneficial to the current and future Indigenous leaders who will pave the path towards self-determination in health. At large, the entire system of public health curriculum, education, research, funding, and interventions has been hostile to the health of Indigenous peoples. Communities taking control of their own health systems and solutions, on their terms, under policies and legislation they envision, is the only way forward. I can only hope that the training programmes we're developing will provide one link in this process. I had a lot of brutal experiences in social work and public health at the University of Toronto. The quality of education, in relation to what was important to me and the people I care about, was horrendous. The level of knowledge regarding the historic and contemporary disadvantages forced upon Indigenous peoples was non-existent, both in the teaching and other students. These two factors created an environment that was very difficult for me personally but, more importantly, was clearly producing health professionals who would continue to perpetuate systemic failings that I see impacting so many people I love…So pushing for spaces that are for Indigenous scholars, students, and allies gives me extreme motivation. For me, all of the issues we see manifest from a persistent denial of inherent Indigenous Rights, Aboriginal Rights, and Treaty Rights. Increasing awareness of the rights of Indigenous peoples, and their strong correlation to Indigenous health, is necessary to address the endless circle of disadvantage we see at policy levels across all national institutions.” View Large Image | View Hi-Res Image | Download PowerPoint Slide Opens large image Drew St. Laurent, Senior Operations Manager, Centre for Excellence in Indigenous Health, University of British Columbia (UBC), Vancouver, BC “I am of Métis (Cree) descent from Treaty 1 territory in Winnipeg, Manitoba, Canada. As Senior Operations Manager at the Centre, I am able to provide support to our team and oversee the day to day operations of the Centre. My job matters to me because I am able to work with other Indigenous staff and students to better the experiences of Indigenous students at UBC for years to come, all the while providing important programming to shape the health sciences leaders of tomorrow. It is important to promote what Indigenous leaders in health-care-related fields are accomplishing. Providing communities with professional development and career progression opportunities drives me to push forward and challenge historical institutional norms. The most glaring challenge that I see is the lack of Indigenous students in health sciences programmes. Indigenous knowledge and ways of knowing need to be incorporated into the admissions processes with Indigenous faculty or community members part of the review process.” View Large Image | View Hi-Res Image | Download PowerPoint Slide Opens large image Nadine R Caron, general and endocrine surgeon, Associate Professor, University of British Columbia (UBC), Department of Surgery, Northern Medical Program; Co-Director UBC Centre for Excellence in Indigenous Health “I have the incredible honour of being able to wear many hats all for the hope of having an impact on the health and wellness of Indigenous individuals, communities, and populations. As a surgeon, I am blessed to hear from individuals every day who trust me enough to share their stories with me. We then work as a team, often with family members, to discover what lies behind their presenting symptoms to hopefully find a way to cure or alleviate them. As a health researcher, I work with amazing colleagues and community members who share a question and join together to at least find a piece of the puzzle that will one day be solved. The puzzle I work on the most is cancer. As a teacher, I feel a responsibility to be part of the next generation of physicians who will realise that cultural safety and humility are vital components of being a Canadian health-care provider—some things are no longer negotiable. As an advocate for Indigenous health, I feel honoured to be in a position to make voices too often marginalised heard at tables and boardrooms where decisions are made. I do all of this with the knowledge that where I am today cannot be separated from where I am from. This is what I hope our daughter grows up to learn. Being Indigenous is a true gift—a part of our history that we can proudly celebrate because of the resilience my mother has demonstrated to me throughout my life. Indeed, resilience that Indigenous Peoples in Canada have demonstrated throughout history. We are still here. All my Relations.” View Large Image | View Hi-Res Image | Download PowerPoint Slide For the Lancet Canada Series see http://www.thelancet.com/series/Canada For more on Philomena Hughes see http://www.phughesphotography.ca/