"I have learned from the Elders on our group that relationships and trust are foundational, and are the most important activity when coming together as a group." – Dr Christina Boucher (photo: left)
"I would like to see a health care system that puts aside personal biases, and provides care in a safe environment that includes dignity and respect. It is only through acknowledging our past can we move forward to a better future."
– Lucy Duncan, Elder, Member of Binche Keyoh First Nations / Lhojuboo (Bear) clan, Central Interior Native Health (photo: right)
The University Hospital of Northern BC (UHNBC) in Prince George is in a unique position to address health inequity issues that affect Indigenous people and others seeking care. It is the largest teaching hospital in Northern BC for health care providers of the future, and is located in the region with the highest Indigenous population in the province.
Building towards more equitable and culturally safe care is a key priority Prince George Medical Staff Physician Association (PGMSPA) and Northern Health, who are supporting the Emergency Department project – often the first point of entry for many people accessing medical care and inpatient treatments, and when patients are at their most vulnerable.
Our story
In 2018 when Dr Terri Aldred pioneered the PGMSPA’s Cultural Safety and Humility work (subsequently led by Dr Todd Alec). In 2019, emergency department physician Dr Christina Boucher connected with Dr. Aldred to help guide a new cultural safety and humility project in the UHNBC Emergency Department (ED).
Dr. Boucher and Elder Lucy Duncan share their steps to building relationships for change, below.
Getting started
• A review of the EQUIP research to better understand specific health equity issues in the ED. (The EQUIP research provides insights for EDs across BC.)
• Insights from In Plain Sight “Addressing Indigenous-specific Racism and Discrimination in B.C. Health Care” that reports on issues of inequitable health care access and outcomes endured by Indigenous peoples in BC health care settings
Learning about initiatives and resources offered by Northern Health’s Indigenous Health team to support learning and self-reflective practice among all physicians and employees.
Northern Health Cultural Safety and Humility offerings (a snapshot): www.indigenoushealthnh.ca
• Cultural safety and humility training, resources, and support: a menu for physicians, provided by Northern Health and partners: Indigenous Cultural Safety Collaborative (free), First Nations Health Authority / BC Patient and Safety Quality Council (free), Northern Health Indigenous Health (online curriculum available free to medical staff and Northern Health employees), Northern Medical Program / UNBC Health Arts Research Centre (free or cost-sharing).
• Cultural Safety Implementation Framework and System Change Assessment Tool for the organization to embed cultural safety and humility across the organization.
• Cultural Safety Education strategy and working with Northern Health Human Resources Department to launch an Indigenous employee community of practice.
• Ongoing partner work with the Northern First Nations Partnership Committee and opportunities for communities to submit funding proposals related to community-based health, holistic health and bringing Indigenous knowledge into these opportunities.
• Videos narrated by Dr Evan Adams: ‘Building Respectful Relationships in the Context of COVID’ and ‘Compassion Informed Care.’
A key component to create a foundation for relationship-building has been the engagement of Lucy Duncan, an Elder working at the Central Interior Native Health Society, and contributor to the EQUIP Health Care work which seeks to ensure health equity within BC’s health care system, and who further spread the word to Indigenous community members to add their voices.
About Lucy Duncan and Dr Boucher:
Lucy Duncan is an Elder and Member of Binche Keyoh First Nations belonging to the Lhojuboo (Bear) clan - and works with Central Interior Native Health as an Elder and provides cultural education to health providers and medical students. She initiates a safe space for clients such as cultural practices, spiritual guidance, family support, and connects people with other health or community resources.
Dr. Christina Boucher is an ER physician at UHNBC and a non-Indigenous person who seeks to be an ally and advocate for issues of inequity in health care delivery concerning Indigenous people.
• Identification of all vested voices needed to come together, source and articulate issues, work together on solutions, and foster and sustain change.
• Inclusion of trusted voices from the Indigenous community and members who rely on the ED and who have lived experiences with care in the ED.
• Engagement of all interdisciplinary positions working in the ED, and health authority managers.
Working Group members
• Elder, Central Interior Native Health Society
• 2 MSA physicians
• Northern Health staff: ED Program Leads (x2), Social Worker, ED Nurse, Acting ED Manager
• Indigenous Psychiatry Resident
• Indigenous patient
• Indigenous artist
• College of New Caledonia Aboriginal Resource Centre representative
• Former Chief, Stellat’en
• Elder Teacher, Lheidli T’enneh
• Aboriginal Patient Liaison
• Central Interior Native Health Services, Nurse Health Care Coordinator
• University of Northern BC / EQUIP researcher / Nurse Practitioner
Building relationships
The group agreed to monthly meetings that focus on creating an authentic foundation for change, through:
Using an intentional meeting structure that emphasizes connection before content. Meetings start with introductions and check-ins, followed by open space and time for Elders and Indigenous community members to talk and share.
Emphasizing the importance of truth-telling to build understanding and support for action to address Indigenous-specific inequities in care.
Creating space and time to build trust, create understanding, and shift beliefs before talking about details and processes. Talking about cultural safety and cultural humility can be challenging on a social and emotional level, and cannot be rushed.
Checking in between meetings with working group members about their thoughts and feelings, as each will react differently as personal and emotional stories are shared.
Forming action items arising from the discussion.
Taking action
Discussions have led to the following action items:
• Plans to redesign the ED space to be more inviting to the Indigenous community; for example, working with a local artist to create drums and relevant artwork.
• Advocating with Northern Health for an ED-specific Indigenous Patient Liaison position to assist indigenous patients to navigate through the ED and access care.
• A proposal for cultural safety training for the security company working in the ED.
• Using video monitors in the ED to display information about community resources and supports.
• Sharing culturally significant learnings from the monthly meetings with ED doctors and nurses, and community urgent care clinics and physicians in other Northern Health hospitals and communities.
I see the activities of the working group prompting people in our department to engage in the self-reflective process of developing cultural humility. – Dr Christina Boucher
