Ensuring culturally safe care for Indigenous peoples

When we think about the health and care needs for Indigenous peoples in Canada, we often are drawn to the mental and emotional challenges resulting from the intergenerational trauma of residential schools. The fallout of this trauma, as we are familiar with and have heard in the media, includes increased substance misuse and addictions.

It is important that health care providers are aware of the impacts of this trauma. With this knowledge, they can provide more appropriate care based on empathy and compassion for those still needing healing in the physical, emotional, mental and spiritual realms.

Ensuring that health care providers understand the ongoing impact of colonization on Indigenous peoples in Canada can help them provide the trauma-informed care that will support healing among Indigenous patients. At the same time, we need to ensure that this messaging about intergenerational trauma is not perpetuating stereotypes about Indigenous peoples. Understanding that Indigenous patients may be suffering from emotional trauma should not lead health care providers to assume that all of their Indigenous patients are suffering from addictions.

In my AMS fellowship researching with care providers in London, Ontario as well as in studies I carried out in BC, I found that too often this assumption is made. We have heard the media reports of the Indigenous woman who suffered a stroke being turned away from hospital emergency rooms, each in turn assuming she was just drunk. Although this story seems an extreme example, this form of stereotyping is not uncommon, and its consequences are significant for patient care.

Hospital personnel I spoke with noted that often this assumption around addictions has resulted in Indigenous peoples not being provided with adequate pain management, even when facing terminal cancer. I was told of an incident where an Indigenous man was only given Tylenol 3 after surgery to remove a cancerous tumour, as the care provider was concerned he may have addictions issues and did not want to provide stronger pain medications.

All patients are entitled to pain management that can help ease their suffering. Care providers should support patients to make choices appropriate for their needs. Choosing to limit Indigenous patients’ options around pain management is inequitable and compromises good care. Health care staff should engage in a caring relationship with their Indigenous patients based on respect that ensures every patient’s dignity. If the physician is concerned that an Indigenous patient may have addictions issues, it is the responsibility of that physician to have that conversation in a respectful way.

Care providers should start off by ensuring that the patient’s care plan includes an approach to effectively deal with physical pain, through presenting and exploring options based on patient choice, informed by expert advice on the pros and cons of each option. Demonstrating this respect, which empowers Indigenous patients to make informed decisions about their care plan, is key to establishing a relationship of trust.

Once this trust is there, and the patient feels genuinely cared about, it will be easier for the doctor to engage in a discussion about the emotional pain that their Indigenous patients may also be suffering, and whether this may have resulted in substance misuse issues for which they need additional support.

A healthcare workforce that understands that Canada’s colonial history, including residential schools, has resulted in intergenerational trauma among Indigenous peoples and communities is an important element of trauma informed practice that can ensure appropriate care. This must be complemented with a respectful approach that does not make assumptions, but rather respectfully engages every patient about the issues they are facing and empowers them to make an informed choice.

Only through this type of respectful engagement that avoids stereotyping and disempowering can we ensure our health care institutions are providing trauma informed culturally safe care that can move to more equitable health services for Indigenous peoples. This is the essence of compassionate care.

– Lloy Wylie, February 2016