Weaving Relationships through Storytelling

VNHS Positive Outlook Program

Doreen Littlejohn and Viola Antoine

Vancouver Native Health SocietyVancouver Native Health Society

•1991 - 1995

•Small team of outreach:

-1 nurse and 1 social worker

•Outreach in Downtown Eastside; inviting marginalized First Nations people to VNHS for coffee and hot soup

•1995-1997

•Clinic and outreach team, then known as Kathy and Vi, were soon overwhelmed with over 500 positive people accessing services

•Program grew to include home nursing, referrals, outreach with community physician, weekly foodbank, and links with other ASOs to provide advocacy and help with disability applications

BackgroundBackground

•1997

•VIDUS published results showing that Vancouver was the epicenter of the worst epidemic of HIV in North America

•VRHB declares a public health emergency in response to the dual epidemics of HIV and drug use

Downtown Eastside:Downtown Eastside: Public Health EmergencyPublic Health Emergency

Penny Penny Priddy Priddy published her paperpublished her paper“No Place to Sleep, No Place to Eat, No place to Call

Home”

•Provincial government responded to the crisis with a $3 million dollar AIDS Action Plan

•Prioritizing Research on HIV/AIDS

•Coordinate the integration of HIV/AIDS framework with the BC Aboriginal HIV/AIDS strategy and the Canadian Strategy on HIV/AIDS

•Vancouver Native Health Society was funded to provide low-threshold, drop-in utilizing a multi-disciplinary, holistic team approach

Action PlanAction Plan

Positive Outlook ProgramPositive Outlook Program

••CommunityCommunity--based, grassroots HIV/AIDS modelbased, grassroots HIV/AIDS model

••Emphasizing multidisciplinary careEmphasizing multidisciplinary care

••Mandate to provide treatment services to HIV Mandate to provide treatment services to HIV positivepositive participantsparticipants

••Flexible approaches recognizing complexities of Flexible approaches recognizing complexities of needsneeds

•Understanding health and illness in relation to the historical relations between colonizers and the colonized

•Health and illness are shaped by economic, political and historical processes (I.e., gentrification, contemporary limitations of the Indian Act, discrimination)

•Direct links between Aboriginality and negative experiences accessing health-care

•A paucity of services that adequately address the complex social and health needs of urban Aboriginal peoples

•A lack of culturally-sensitive or culturally competent health-care

Aboriginal Health and ColonialismAboriginal Health and Colonialism

•Marginalized people are not good self-advocates, thus healthcare providers become their advocates and social change agents.

•Non-discriminatory approaches lead to the increase of life chances in the form of access to health services, education, and decent housing.

•DTES services and service providers must not ‘ghettoize’ Aboriginal people or “open a system of apartheid”

•Our response: holistic culturally-competent health care at one site

•Includes Primary Care, Infectious Diseases, Dental Services, Aboriginal Diabetes Awareness and Prevention, Opthalmology, Nutritionist, Aboriginal Child and Family Support Services, and Sheway.

Vancouver Native Health

at 449 East Hastings St.

MIND BODY

SPIRIT

PERSON

The Medicine Wheel represents the unity and harmony of mind, body and spirit within each of us. In providing effective healthcare, it is essential that

all aspects of a person are touched upon. This requires an understanding of the Aboriginal culture.

Reflecting on family, support, history and kin as part of story telling

FamilyFamily

•Acknowledge the need for cultural diversityHave First Nations people on staff and actively recruit First Nations volunteers ie: Aunties in Action

•Increase the role of traditional healing practices•Hold talking circles•Have space available for healing circles•Hold traditional funeral ceremonies,•smudges, burnings

•Oral tradition•“Nursing by Stories”

““Where you from?Where you from?””

MusicMusic•Song nourishes the spirit

•Helps reconnect with their spirituality and culture

ArtArtArt is very important in First Nations culture for self expression and story telling, which allows people to open up and share their stories

PapaloozaPapalooza

OutreachOutreachGo to their safe place rather than have them come to an unfamiliar, possibly unwelcoming establishment

Meeting them on their “turf” allows for more trust and better communication

Towards Aboriginal Health and Healing:Towards Aboriginal Health and Healing:

Intensive Case Management ProjectIntensive Case Management Project

Towards Aboriginal Health and Healing (TAHAH) is part of the Positive Outlook Program (Vancouver Native Health Society)

We are one part of the spectrum of services provided through thedrop-in space. TAHAH is a program designed to provide intensive support and assistance to Aboriginal and Métis, HIV + people living in the Downtown Eastside, who are currently not accessing adequate community supports and who’s health is poor.

••Aboriginal Health and Healing (AHAH) is a communityAboriginal Health and Healing (AHAH) is a community--based research partnership between Vancouver Native based research partnership between Vancouver Native Health Society and researchers from the University of Health Society and researchers from the University of British Columbia and Simon Fraser University.British Columbia and Simon Fraser University.

••The project was developed to explore and document The project was developed to explore and document didisparities in access to HIV and Hepatitis C (HCV) sparities in access to HIV and Hepatitis C (HCV) treatment among urban Aboriginal peoples living in treatment among urban Aboriginal peoples living in Vancouver with an emphasis on capacityVancouver with an emphasis on capacity--building and building and participatory action research (PAR).participatory action research (PAR).

Aboriginal Health and HealingAboriginal Health and Healing

•This project engages four local Aboriginal residents in a comprehensive research assistant training program as a means to meaningfully engage politically, economically and educationally disadvantaged residents in the research process.

•The primary goals of this research project are to identify structural and/or ideological barriers in access to and up-take of antiretroviral therapy and HCV treatment among urban Aboriginal peoples living in Vancouver’s Downtown Eastside and to evaluate the need for culturally-competent HIV/HCV treatment for urban Aboriginal peoples.

•Our research methodology is primarily qualitative drawing on social epidemiology, medical anthropology and sociology. We utilized a participatory action research (PAR) approach that emphasizes a partnership model that focuses on the creation of social change rather than on merely gathering information.

MethodologyMethodology

Rod Rod RockThunderRockThunder

Building Capacity:Building Capacity:

Research Assistants and Peer CounselorsResearch Assistants and Peer Counselors

Team Building and Mutual RespectTeam Building and Mutual Respect

•Local Aboriginal residents were trained to become skilled research assistants, with the long-term goal of increasing their marketability in the local research industry as part of self-identified career goals to engage in HIV research and outreach.

•Through involvement in every aspect of design, implementation, analysis, dissemination and evaluation of this project, the research assistants are learning how to undertake research - beyond simply acting as “peers” who normally implement previously designed research questions that come from ‘experts’ outside of the community.

•Research training included guest speakers, workshops, and field trips that addressed research and health indirectly and directly. The process emphasized mutual learning -- sharing knowledge between university-based researchers and community research assistants.

Capacity buildingCapacity building

MappingMapping

RecommendationsRecommendations

•There is an on-going need for urban HIV/AIDS programs to adopt models of care that emphasize autonomy, inclusiveness, low-barriers, and which are culturally-sensitive to the specific history of Aboriginal peoples

•the diversity of the Downtown Eastside complicates the development of culturally-competent health care, however, our findings clearly indicate that there is a lacuna in public health services in the community that account for the specific needs and histories of Aboriginal peoples living in the inner city

Thanks to the staff and participants at VNHS’s Positive Outlook Program, Tahah, Ahah and to Dr. Denielle Elliott.

The End