Indigenous-Led Healthcare Partnerships Help Heal Wounds of Colonization

By Anne Harding

March 10, 2020

NEW YORK (Reuters Health) - Indigenous-led healthcare partnerships across Canada, the United States, Australia and New Zealand are aiming to heal indigenous communities after centuries of oppression and racism at the hands of government - and often, Western medicine.

"Health professionals often do not speak our language and are not able to relate to our people. Indigenous People often feel that they need to leave their identity at the door," Elder Dave Courchene, founder of the Turtle Lodge Central House of Knowledge in Sagkeeng First Nation, Manitoba, told Reuters Health.

"Our understanding of wellness as Indigenous Peoples is that to be healthy, we need to be rooted in our identity, which is very spiritual and land-based," Courchene said in an email. "We regard the land as a living entity with an intelligence that can be accessed to help heal and guide us. We want doctors to understand that, and to be more sensitive to the trauma that our people have been through, that has threatened our identity."

In a paper in CMAJ, Courchene and colleagues describe Indigenous-led healthcare partnerships and suggest ways for healthcare providers and researchers to better serve Indigenous populations, which presently have lower life expectancies, worse quality of life and higher rates of many chronic illnesses compared to whites.

Colonization and racism are at the root of these disparities, Courchene and colleagues write.

They note that Indigenous-led health care partnerships at hospitals and clinics in rural and urban areas feature traditional healers and elders, teaching circles and ceremonies, plant medicines and traditional foods and land-based care including fishing, hunting, memorial walks and community gardening.

The authors cite quantitative data showing Indigenous-led health partnerships can improve access to care, adherence to care plans and health outcomes. But they say evaluating Indigenous knowledge by Western standards is problematic.

"We need to respect the idea that the standards, tools and approaches of biomedical evaluations lose meaning, relevance, and value when used in Indigenous healing contexts," coauthor Dr. Andrew Hatala of the Max Rady College of Medicine at the University of Manitoba in Winnipeg told Reuters Health by email.

Coauthor Dr. Sabina Ijaz told Reuters Health, "There needs to be more Indigenous leadership in setting research priorities, in following Indigenous ceremonial protocols of knowledge seeking, and in engaging in community-centered research that actually provides benefit to indigenous communities."

"Supporting healing and a restoration of cultural identity should be a prime research goal," said Dr. Ijaz, a volunteer medical consultant at the Giigewigamig First Nation Health Authority and Giigewigamig Traditional Healing Centre in Pine Falls, Manitoba.

One Indigenous value that's difficult to measure by Western methods is intergenerational connectedness, said Dr. Donald Warne, director of the Indians Into Medicine Program and the Public Health Program at the University of North Dakota's School of Medicine and Health Sciences in Grand Forks. Dr. Warne was not involved in the CMAJ paper.

While having elders and youth spend more time together would be considered "a great outcome through an Indigenous lens, that would be discounted ... from a Western European lens, but through an Indigenous lens we know that has value in promoting the long-term health of that child," Dr. Warne said in a phone interview. "Because it is difficult to measure and attach a number to it, it is discounted by modern medicine."

He added: "There really is a movement internationally focused on utilizing Indigenous knowledge to improve the health of Indigenous populations, and in truth if the modern scientific quantitative medical system was adequate we would not face such terrible health disparities in Indigenous populations."

Many Indigenous people have a well-founded mistrust of the medical system, Dr. Nicole Redvers of the School of Medicine and Health Sciences at the University of North Dakota in Grand Forks told Reuters Health by phone. Dr. Redvers, who did not participate in the CMAJ paper, is helping to lead North America's first PhD program in Indigenous health, which will enroll its first class this July.

"I'm really excited to start seeing groups of students coming through our institution learning from what we would call a two-eyed seeing approach that was originally defined by Mi'kmaw Elder Albert Marshall," Dr. Redvers said. This means using one eye to look from the perspective of Western medicine, and the other from the perspective of Indigenous ways of knowing, she explained.

She added: "I have no doubt in my mind that the only way we're going to improve outcomes in Indian country is by having Indian-led health programs."

SOURCE: CMAJ, online March 2, 2020.