OPOP Conference Cultural Competence For First Nations

Sept 19/08

Paul G.G. Mulzer MD FRCPC

I perceive no conflict of interest with this presentation.

I have provided speakers’ bureau services, consultation and/or received unrestricted grants from the following corporations;

Eli Lilly Canada Janssen Ortho Astra Zeneca Wyeth Canada

First Nation Initiative

Mae Katt Brenda Mason David Moonias Mary Ann Mountain Paul Mulzer Betty Perreault

SHARING TEBWEWIN

CULTURAL COMPETENCY

DISCLAIMER I’m not an expert in aboriginal culture. I’m a learner and facilitator who continues to

expand my understanding through cultural engagement.

I’m often impatient to proceed quickly and this can produce conflict when attempting to collaborate.

All initiatives require dialogue with the community to ensure inclusion and not imposition

CREDIBILITY GAP?

Q). Should a bold (European ancestry), non-aboriginal present on the topic of cultural competence?

Absolutely, Yes Caring, interest, cultural respect, sensitivity

and awareness are colour-blind! MYTH BUSTING IS IMPORTANT!

ISSUES FOR DIALOGUE 1.TRUST IS HARD WON, EASILY LOST 2. DROPOUT RATES ARE UNACCEPTABLY

HIGH IN NON-ABORIGINAL AGENCIES, BUT NOT ALWAYS!

3. HIGHER ABORIGINAL REPRESENTATION IN STAFF HIRED IS A GOOD OBJECTIVE

4. “ONLY ABORIGINAL PROVIDERS CAN PROVIDE OPTIMAL CARE.”

1. “They Brought this on themselves.”

2. “ Why don’t they stop drinking and get a job.”

3. “ This blockade is preventing progress… if they don’t like it they can leave Caledonia.”

4. “ Let’s abolish the reserve system that should solve the problem.”

MYTHS ABOUT FIRST NATIONSMYTHS ABOUT FIRST NATIONS

“Why All the Fuss about Natives?” 1. Quality of Life and

Health requires our attention.

2. We are participants in their reality.

3. Growing demographic that should not be ignored.

4. We are here to serve.

How Are Aboriginals Different Than Other Ethnic Groups?

Original Inhabitants Not immigrants or settlers in

the classic sense. Alliances among equals Never conquered Elaborate society of oral history

and traditions. Deep bound to their ancestral

lands.

National Aboriginal population 1,172,790 (3.8%)

From 1996 to 2006 the aboriginal population grew by 45% or 6X the non-aboriginal population.

46% are 24yrs old or younger versus 31% in the general population.

Statistics Canada 2006 Census

What do these statistics mean for Thunder Bay?

How should this impact LHIN expenditure?

The Human Face Of Mental The Human Face Of Mental Health and Mental Illness in Health and Mental Illness in Canada 2006Canada 2006

40% of Aboriginals surveyed reported overt and covert racism in the prior year.

This took the form of poor service in many venues including healthcare.

Mental health patients spoke of being ‘victimized’ by a culturally insensitive and ‘culturally unsafe’ system.

MISUNDERSTANDING

The myth of the “Lost Generation”. Look to the language of the media Often cultural dissention is encouraged Passive acceptance of our current state A lack of initiative for change A belief that this is someone else’s duty.

What Prompted this Foray Into Film?What Prompted this Foray Into Film?

A lack of resources that were culturally relevant for Aboriginal patients with mental health concerns

A recognition of the tremendous impact of media in reaching this ‘digital’ generation.

A proud story-teller tradition in First Nation communities.

A naive belief that the passionate and sincerely motivated will be rewarded.

A desire to advocate for the disadvantaged.

HEALTH CANADA STATISTICS Suicide rate 2-3X non-aboriginal rate in

general Suicide rate 5-6x non-aboriginal age 15-24. Inuit suicide rate age 15-24yrs 11x the rate

in the same non-aboriginal age category. Rates of greater than 120/100,000 makes

these some of the highest suicide rates in the world.

WHAT IS CULTURAL COMPETENCEWHAT IS CULTURAL COMPETENCE

Used interchangeably with cultural safety Dr.Dignan defined it best. A sense of your patient’s reality An awareness of diversity and possible

different strategies that may exist. An appreciation of the historical challenge

of establishing trust.

OUR VERY TALENTED CAST

BRENT ACHNEEPINESKUM BRITTANY ANGECONEB

CANDACE TWANCE

KRISTEN FLETT

History Of The Indian Act

1. Until 1830’s British Indian Dep’t was a directorate of military.

2. 1844 Administration transferred to the Protectorate of Upper Canada

3. 1850 Two statutes involving protection of the Lands and Property of Indians in Lower Canada and established a commissioner of Indian Affairs.

4. 1857 Civilization of Indian Tribes Act expressly made assimilation its clear objective.

5. 1876 Indian Act consolidated all existing legislation

Objectives Of The ActObjectives Of The Act Assimilation ‘Enfranchisement’ Civilization Cultural integration Far reaching implications. Impact included Residential Schools, 60’s

scoop, etc.

DUNCAN SCOTT CAMPBELL

DISTRIBUTION OF RESIDENTIAL SCHOOLSDISTRIBUTION OF RESIDENTIAL SCHOOLS

RESIDENTIAL SCHOOLS

HERITAGE AND LEGACY

Woodland Spirits

AMAZING ROCK PAINTINGS

Land Claims

THIRD WORLD STANDARDS

Ecoli Contamination

Communities in northern Ontario and BC with boil water advisors for 9yrs.

GRASSY NARROWS and controversy of Mercury Poisoning.

Relocation due to flooding or contamination takes aboriginal people from their ancestral lands.

Where Do We Search For SolutionsWhere Do We Search For Solutions

SUICIDE DATAWhat Health Canada data fails to

present is the fact that some aboriginal communities have not had a suicide in 2 decades while other communities have a raging epidemic.

Statistics Canada Aboriginal Survey, 2001

Screening Survey of the Inuit population Estimated depression at about 3%

Suicide rate is the highest in the country and one of the highest in the world.

What is wrong with our screening instruments?

WHAT IS RESILIENCE?

How is it clinically defined? OR In First Nation communities is it more effectively defined at a societal level?

How can resilience be fostered?

FILM OBJECTIVES Target population female age 18-23 yrs old Demonstrate diversity within the culture Address the challenges of aboriginal youth

in a thoughtful manner. Highlight cultural diversity re Christian and

traditional spirituality. Explore Resilience

The Challenge Culturally Relevant Educational Resources. A drama and a documentary with the highest

production quality. Respect for aboriginal diversity. A therapeutic tool that would be versatile. Highlight 10 major themes. A resource for public education?

COLLABORATIONTraditional Youth Dancer

A vibrant film community thanks to Confederation CollegeThunderstone Pictures Dave Clement and Michelle DerosierShebandowan Films- Kelly SaxbergFrom conception to completion required two years and over thirty-five cast and crew as well as an equal number of community partners.

DAVE CLEMENT-CINEMATOGRAPHY

KELLY SAXBERG MICHELLE

DEROSIER

““Spencer caters to the Spencer caters to the star”star”

A TYPICAL DAY ON A SHOOT

COMMUNITY PRIDE These productions were filmed on location in

Thunder Bay. The intention of our cinematographer was to

include as much Thunder Bay content into these films so that they could not possibly be confused for any other setting.

Apart from transfer and colour editing all technical processing was performed in TB.

96% of production funds totaling $ 99,400.00 were spent locally.

COMMUNITY PRIDECOMMUNITY PRIDE

Sharing Tebwewin: Culturally Competent Health Care for First Nations

Thunderstone Pictures Inc. & Shebandowan Films

N. Wieman

WHERE DO WE GO FROM HERE?

We anticipate at least eight additional productions tackling recovery in aboriginal communities, SCZ, Addictions and vicarious trauma to focus on a few areas of interest. WORKBOOK; REEL THERAPY MENTORSHIP MENTORSHIP THE HEALING LENS THE HEALING LENS

A POINT FOR REFLECTION

“WE WILL NOT BUILD AWARENESS OR CREATE A NOBLE AND A JUST SOCIETY BY BEING INSENSITIVE TO THOSE WHO APPROACH US WITH COMPASSION, GENUINE CURIOSITY AND A WILLINGNESS TO LEARN.”

HOLOCAUST SURVIVOR

WHICH CITY HAS THE WHICH CITY HAS THE LARGEST URBAN LARGEST URBAN

ABORIGINAL ABORIGINAL POPULATION?POPULATION?

QUESTION

Culturally Safe Care

for Aboriginal Peoples

Dr. Paul MulzerMedical Director, Outreach Services

Lakehead Psychiatric Hospital &Dr. Cornelia Wieman

Co-Director, Indigenous Health ResearchDevelopment Program, University of Toronto

McMaster University, Department ofPsychiatry & Behavioral NeurosciencesGrand Rounds – January 23, 2008

IPAC-AFMC Aboriginal Health Task Group

First Nations, Inuit & Metis health core competencies: a curriculum framework for undergraduate medical education + initiation of work with RCPSC

cultural awareness: the acknowledgment of difference cultural sensitivity: the recognition of the importance

of respecting difference cultural competence: focuses mainly on the

knowledge, skills & attitudes of practitioners cultural safety: requires an understanding of the

power differentials inherent in health service delivery & redressing these inequities.

N. Wieman

National Aboriginal Health Organization: 2002 Opinion Poll

69 84

0

50

100

%

First Nations People* & Canadians** who provided a positive rating for the quality of

health care received

FN CAN

* - n=1209; age >18** - CCHS 2000/01; age >15 N.Wieman

24% in NAHO poll rated their care as worse than other Canadians

Discrimination in thehealth care system

FNIRHS 1997: In Manitoba,16% felt they had been discriminated against byhealth care workers insidethe community; 30% byhcw outside the community

in Labrador, 96% felt they were treated with respect by hcw inside the community; 89% by hcw outside the community N.Wieman

The assault on Aboriginal healing traditions

traditional medical systems subjected to oppressive measures

healing practices & relationship to culture thought to be barriers to assimilation

legislation against potlatch ceremonies & the Sun Dance

Midewiwin Medicine Society goes underground

N.Wieman

the ‘Sixties Scoop’

“triply painful identity crisis” of being adolescent, Aboriginal & adopted (Fournier & Crey, 1997)

N.Wieman

www.stolengenerations.ca

Guidelines for practicing cultural safety: First Nations, Inuit & Metis contexts

create Aboriginal rooms ceremony, song & prayer sacred / ceremonial items information & support family support food / toiletries / constitutions body parts / tissues / substances impending & following death N. Wieman

“Cultural Competency and Safety: A Guide for Health Care Administrators,Providers and Educators” – NAHO, January 2008

First Nations Regional Health Survey 2002/2003

Barriers relevant to First

Nations-specific needs: 13.5% felt health services

were not culturally

appropriate 16.9% felt health care

provided was inadequate 13.4% had difficulty getting traditional care / traditional

healing N. Wieman

n = 9991 - 10539

QUESTION

WHICH CULTURAL GROUP REPRESENT THE LARGEST PROPORTION WITHIN THE ABORIGINAL POPULATION?