Physicians and Healers Educating Towards Culturally Safe Health

Physicians and Healers Educating Towards Culturally Safe Health Care for Urban Indigenous Peoples INIHKD October 7 th, 2014 D. Behn Smith on behalf of P&H team

Introductions • • • Territorial acknowledgment Our Elders - Roberta Price & Doris Paul Our team

Project Context • • • Coast Salish territory Vancouver Native Health Society UBC Aboriginal FP residency site

What we hoped to learn. . • What are the impacts of working with an Aboriginal Elder on culturally safe practice? • How does a FP resident’s sense of confidence in culturally safe practice shift?

What we hoped to learn. . . • What are the strengths, weaknesses and lessons learned from having an Elder provide longitudinal mentorship to Family Practice Residents?

Study Design • Qualitative description • Five interviews (2 Elders, 1 resident, 2 preceptors) • Nine Elder-lead case conference minutes • Three researchers coded and performed thematic analysis

Strengths • Nawtsamaat Shqwualuwun • Learner openness, reflexivity and assimilation • Elder openness, generosity and spiritual wisdom • Physician openness and humility • Safe spaces and relationship

Learner openness, reflexivity, assimilation we have • “After each of the meetings that • “And just becoming more of reflection that comfortable and – there is a huge amount confident about asking patients both me • goes on for aremakesand[developing to “Part of what and really drives me it where they from if they identify reflect upon what canhappen is their culturally safe care] I do better to be with any traditional beliefs or if they providing culturally safe care, to be better willingness to learn, their openness and participate in ceremony or anything like for my respect. ” (Elder) been really their patients. That’s that. I definitely do that more often than I important in my learning process. ” did previously. ” (Resident)

Physician openness and humility • “We haveclinicians have felt that we “We as • provide culturally safeoccasions that had several and competent having an elder on site when somebody it's • “Icare but in ofnot until we've is that it'shad think one the strengths actually has been some form of crisis has been Elders here for the residents to they clearly better and witnessed how learn incredibly powerful. I’ve witnessed this a work, how they expect to work, and how about cultural practices from the elders couple of times and it’s been humbling for they is from us” (Physician) than it expect to be treated that we’re me to see this happen in the context of a getting a better sense of what that really medical clinic” (Physician) means. ” (Physician)

• • Elder openness, generosity & spiritual wisdom “So my experience with the training has “I think too that the understanding and “Residents can of It has made me want to gain an appreciationthat into been ateachings the Elders will be the good one. the workings of a spiritual practice with of share my culture and my teachings we don’t say things directly, we don’t healinga First Nations in aform. trust, say (gratitude, forgiveness, way. It them as say things in bullet point good We faith, prayer, love)” (observation from has been asgood experience. ” (Elder) things a we’ve been taught from our rounds discussion on co-managed Elders through stories” (Elder) patients)

Safe spaces foster good relationships • “The abilitymany Indigenous communities “I think in • “There is a huge gap inby spoken words, to present complicated or • “Iknowledge is spread in and Robertathe bringing some situations • difficultpeople intotothingandjust having think the biggest Doris is so ill lessons that you them very many of these care making learn has been helpful a that it’s a safe way ability to develop in relationship with the along the way, the elders can help to feel safe here. Ifits information that you that I can that I question. And get some Elders so ask a feel comfortable asking close that just read in a book, it needs to couldn’t gap in terms of relationship guidance and seeking their guidance. ” questions with people that I have become be taught, you need to understand the building, that is a valuable piece of the comfortable (Resident) asking questions with. ” picture. ” while you are leaning it. That context (Physician) (Resident) makes this invaluable. ” (Resident)

Navigating tension filled spaces • Respect • Time • Place

Tension filled spaces Respect • “What Ibe more beneficialthis model is really love about • “It would for the trainees “To that the physicians … even that weto have those discussions offering end to have some time to work 1: 1 withmidall of up starting and end up stopping pray and bless the food. It is spreading. the Elders or with one of the Elders and They’re willing to participate in the way. Where we feel cut off, we Before feel receive those cultural teachings. blessing of we feel our voice or disrespected; the food or the table is not in we even start working in relationship and opening withto prayer. Those are a – by that time frame. being listened patients. “ (Elder) partnership with strengths. ” (Elder) 1 hour. ” (Elder)

Tension filled spaces Place • “The residents are participating in the dialogue around culture. It would be great for them to have a chance to actually participate in the culture itself – via ceremony, a nature walk in the Squamish Valley. Etc. ” (Elder)

Tension filled spaces Time • “Hard to get patients to understand that they are on a 1 -hour timeline… when • “Ithey get started andathey are be wish the timing (of meeting) addressed – that we come together and heartbroken and they are crying – and to meld both of our ways would be to in our culture we don’t shut them down have 1 time/month for the Elders just to and say ok an hour is up, I have to let be on Elders time. ” (Elder) them go until they cry where they can’t cry no more. ” (Elder)

Tensions filled spaces Resources • Lack of sustainability • Grant chasing • ? FNHA advocacy

What we are learning • Nawtsamaat Shqwualuwun • Bring service and teaching into culture • Long-term supportive relationships between residents / elders / preceptors is beneficial • Careful planning and respectful listening helps navigate challenges

Miigwetch Hay Huy tseep q’u Masi Cho Merci Thank you