Indigenous Knowledge to Close Gaps in Indigenous Health | Marcia Anderson-DeCoteau | TEDxUManitoba

kimitaka pea potatoes ran amok EIA tante wash day now pay to use a pee we are here today on treaty one territory which is the territory of my ancestors and of my descendants my great-great-great grandpa was 41 in 1871 when treaty one was signed he lived on the st. Peter's reserve and was represented at the treaty negotiations by chief Henry Prince I believe from our teachings that when chief Prince was deliberating on the treaty that he was sinking seven generations down the line in my family the seventh generation from the signing of treaty one is the generation of my children it's also the generation of children like Tina Fontaine and Jordan Anderson both of whom experienced the tragic reality of the gaps in indigenous health Sheena Fontaine was a youth in CFS care when she was murdered put in a garbage bag and dumped in the Red River Jordan when Anderson was a child from Norway house with complex medical needs who died in the hospital having never been to his home community while the federal and provincial government fought over who would pay for his health care expenses if he left the hospital these gaps are not the full filth hope of our ancestors and we will not allow it to be another seven generations before we are as healthy as the people we've agreed to share this land with let me share just two statistics with you to highlight the general pattern of indigenous health and health care gaps in Canada among First Nations people in Manitoba the rate of diabetes is 203 per thousand this is over four times greater than the rate of diabetes in the non First Nations population the rate of amputation due to diabetes and outcome largely preventable through proper medical care is even greater the rate amongst First Nations people is 3.39 per thousand and zero point one nine person Asians population this means that a First Nations person living with diabetes is 18 times more likely than a non First Nations person to have part of their Lake cut off how do we make sense of this the Truth and Reconciliation in Commission of Canada calls on us to understand the gaps in indigenous health as a result of previous government policies from a population health perspective the mechanisms by which these gaps are created are largely through the entrenchment of poverty the chronic underfunding of education and child welfare inadequate overcrowded housing and other such social and economic policy choices it would be fair to say however that the health care system has to a large extent been complicit in the maintenance of these gaps and at times an active contributor through multi-level racism now for most people when we think of racism our immediate understanding is of personally mediated racism we can easily see interpersonal racism in the words and actions of people who have come to believe that a certain group of people is inferior to another group of people this bias can be conscious or unconscious and even if unconscious can influence behavior and clinical decision-making as done in research largely documented in the u.s. recently the College of Family Physicians of Canada released a report on the health and healthcare impacts of systemic racism on four on indigenous peoples in Canada they refer specifically to the case of Bryan Sinclair an indigenous man who was referred to the emergency room by a community physician he waited 34 hours to receive care vomiting on himself and with other ER visitors asking nurses and security guards to help him when they finally checked on him they found that he had been dead for several hours of an untreated but completely treatable bladder infection the next level of racism I want to discuss is institutional racism institutional racism is differential access to the goods services and opportunities of society by race there need not be an identifiable perpetrator and it has generally evolved over time through historic actions like the implementation of colonial policies examples of institutional racism in healthcare can be found in the spring 2015 Auditor General's report on health care access and remote First Nations there are many serious issues identified in the report I'm only going to highlight one today of the 45 nurses that they examined only one had completed the five quote-unquote mandatory training courses for nurses to practice in nursing stations one of those courses is certification and advanced cardiac life support ACLs essentially keeping you alive or resuscitating you if you are critically ill or injured only 33 percent of those nurses the only health care professionals in the only health care facility in these remote mostly flying communities 33 percent had their ACLs training comparatively 79 percent had completed the training on controlled substances or narcotics priorities right let me ask you this where else in Canada will be tolerate and inadequately prepared health care workforce at a time when we need it most as we continue to look at health care through this lines of multi-level racism I next want to discuss the pista McCray sysm all of racism centers around the idea of one group of people being inherently superior to another group of people and then using it using its power to maintain a societal position of advantaged access and control of power money and resources epistemically ism focuses on the belief that the knowledge and ways of knowing of one people are superior to another now our healthcare system is based within a Western Eurocentric Western and value framework with specific rankings of knowledge according to what type of Western scientific inquiry produced the knowledge an easy way to look at this is to look at clinical practice guidelines most of which describe the strength of a recommendation according to the type of evidence that produced it so class 1 recommendations are the result of multiple large randomized controlled trials these are the gold standard of evidence class two recommendations are the result of a single randomized control trial or non randomized clinical trials class three recommendations are based on the of experts case studies or case reports or if it's occur in a standard of care without any evidence there is no place or grade for indigenous knowledge now I'm a general internist and I do made a mainly cardiology in my clinical practice and I rely on these forms of evidence and these guidelines to guide my treatment of ischemic heart disease but they didn't help me when the First Nations woman was having difficulty reconciling the medical treatment of her heart disease with her residential school experiences they didn't help me when the First Nations man disclosed that the chest pain he had was linked with the panic attacks he's had since his sexual abuse as a child they don't help indigenous peoples when the health care system doesn't meet their needs either because they can't get into the system or when they do they are treated as less than fully human by a system built on a concept of health and healing that was privileged over their own I read a quote the other day by Marie batiste and what it said was this education can either maintain domination or it can liberate it can sustain colonization in neo-colonial ways or can decolonize every school is either a site of reproduction or a site of change and I want to share a story today of how health care can be different and can be a site of change of liberation and of decolonization because I believe that quote is just as true of health care as it is of Education so manage Hui quake a geek way started as the mothering project and as a program that operates out of mount carmel clinic to support women who use substances and are pregnant or early parenting my role with the program is to lead the evaluation team and briefly here's how I got involved I was presenting at a conference a couple years ago in Winnipeg on maternal child health the nurse lead for the program Margaret Brian's I was also presenting this was early in program development and she discussed the intention for the program to be culture based a leading American maternal child health specialist stood up and praised this approach particularly because it would include an evaluation component and thus would evaluate this indigenous knowledge to see if it was in fact valuable and valid to the health indigenous woman children and families I took my turn of the microphone to respectfully challenge his comment it was respectful what I said was that requiring one set of knowledge to be validated by another knowledge system presumes that second knowledge system to be superior and to have the power to proclaim it valid or not this is what some have referred to as cognitive imperialism and what I have referred to today as a pista McCrae sysm according to United Nations declaration on the rights of indigenous peoples it is indigenous communities families and individuals who have the right to define what knowledge Westerner traditional or both is relevant to their health and healing so I got asked to do the evaluation the Anishinabe name of the program which was received through ceremony is mana to equate Kagi Quay spirit woman teachings this was taught to us as meaning that women carry all of the teachings within them that they need and the role of the program is to walk with them gently and remind them that they know women have traditional roles as caregivers and knowledge keepers and it is of critical importance to reclaim those roles our evaluation at this phase was mainly qualitative and focused on the stories that women told us about the program we looked for ways that the meaning of the name and the seven sacred teachings were present listen to these words which capture the essence of the name when you have a space and a place and a time and none of those issues that people label you with where you get to go and none of those things are what confine you or limit your ability or your heart or your spirit then you have a real chance to grow into come into growing who you are and who you want to become the first teaching is wisdom neva Cohen to these women wisdom means knowledge that is based on lived experience by people who are willing to learn from the choices that they have made it is knowledge that is shared in a way that treats every one is equals and that helps people to uncover their own knowledge and the woman told us about how they support one another through crises they offer advice and then make decisions for the program all based on the experiences that they've had the second teaching is humility da by dint is a wit humility is being yourself without thinking you are better or worse than anyone else it is being able to make mistakes and be accountable to them it is sharing what you have without needing credit or recognition when someone else succeeds humility is a critical aspect of what makes this program a safe space for these women who are often highly stigmatized in health care and society in general and are often labeled as hard-to-reach woman woman said I see a lot of the struggles like all of these women they have their own stories but I see a little bit of myself in them and that's what keeps me going we all have our stories we all struggle but we're all similar in little ways the third teaching is respect men addenda Moen respect means that everyone's knowledge and value is recognized and treated as equal it is treating others how you want to be treated and really importantly it's that no one is treated with discrimination or with judgment one woman made me think about how where it was for her to be treated with respect when she said this I guess it just kind of makes it more like on an even basis they're not looking down on everyone the fourth teaching is love sucka edewin to these women love is an unbreakable connection undivided attention leading first and foremost with kindness it is sharing what you have and it is showing appreciation and caring when you share what you have you don't expect anything back I'm going to share two quotes from the evaluation one from a staff member and one from a client and I want you to make the link between how we hire people and what people experience so the staff person said this we hired for kindness and we hired for actually we hired for kindness we don't do kindness well in health care or social services and so we worked really hard to find people who would just like shower people with love I want you to take a moment and just think about your own health care experiences and think about if you have ever felt showered with love I want you to keep that reflection but I want you to also imagine that you are a racialized indigenous woman in Winnipeg you have kids in care and you need health care for your pregnancy while you're still using substances now the health care experience you might have in this program is this we're like a little family I love all of these staff workers I love these girls the clients or like a little family and I love it we're all related in some way just even through the streets whatever we're all related in some way and we all relate to the same things v teaching is bravery aqua David bravery is revealing yourself without knowing what the outcome will be it's setting goals and following through it's being willing to try out new solutions and in this context it's getting your kids back in parenting this is bravery I guess the other thing that was hard or that was difficult me for me in the beginning that I just recently learned to deal with was this as my old stomping grounds this is my old using area so even when I was coming down here even from downtown I used to get really bad anxiety I knew where I was going I knew there was a safe place I knew there was women I trusted but bringing myself into the area that was really difficult for me to do in the beginning the last two teachings are truth Deb way win and honesty why aqua doesn't win the quotes I share already highlight concepts of both including staying true to your principles doing what you say you're going to do sharing the hard truths no sugarcoating but with kindness I think the quotes have also already begin to begin giving you a picture of how this health care experience is different from the usual health care experience but I will share a few more to highlight some of the outcomes that women are experiencing one woman said we have our own space we have our own time where find our own voices and in that were gathering strength that is an incredibly valuable health outcome another woman said I used to hate myself I used to hate everyone around me I used to hate my life I don't feel like that anymore I love the people around me now I love myself I'm proud of Who I am I'm not ashamed of myself anymore I'm proud of Who I am and I wouldn't have got this far without these women you have likely heard in the media that one baby a day is apprehended from the hospitals in Winnipeg all of the women who have kids in the program either have or have had kids in care at least some of them now are getting their kids back or going home from the hospital with their babies one woman shared this I was ready to let him go I was ready to let him go but the women helped me with the social workers they helped guide me into like bringing my son home and stuff I'm so thankful I stayed in the program I can't imagine my life without my son another woman shared I never thought it would be this big I mean it's unreal it's amazing it's amazing and it's right in front of my face every day because my daughter is right in front of my face every day I don't want to say that I feel like I owe them everything but they've given me everything I have this program respected indigenous self-determination in a local context by giving decision-making power and leadership to the indigenous woman who would be accessing the program these indigenous woman said that indigenous knowledge of health and healing was essential to them so the program based its operations in indigenous cultures and teachings with the grounding in the seven sacred teachings is one example this has this intersection coexistence Western healthcare with indigenous knowledge has created outcomes that the women themselves judges valuable strengths pride voice being cleaner reducing the harms of substance use family friends and parenting relationships with their children for some if we want to close indigenous health gaps part of the answer is reexamining the assumptions of Western healthcare evidence-based medicine and the definition of essential services and ensuring that all indigenous people are able to access Western and traditional knowledge 'as of Health and healing as they define essential to them the dhaumya and toxin


  1. Teachings: Determination,Diet and motivation. Setting personal goals and start moving. Why do people make it about racism??.. death by a urinary tract infection sounds like uncontrolled diabetes and late medical help. If everyone took control of their personal health care..our A1Cs would improve and decrease cost of healthcare.

  2. I watched this a day after the arrests at the Wetswetin blockade. It's important to me to educate myself on the lies and pain that my people have committed in the over 200 years my ancestors have been on the continent. Thank you for this.

  3. Powerful, Informative and all round brilliant!!!!! More people like you please Marcia. Diolch yn fawr iawn i chi o Gymru (Sending thanks to you from Wales). We all need to keep sharing such knowledge and opening peoples eyes to the racism and prejudice!!!!


  5. I just took part in an inquiry about how aboriginal mother's and their children receive treatment and services in the health care system in Ontario. Turns out I wasn't alone…many are ignored or dismissed when we have concerns, racism is SO PREVALENT and in your face at times. I had concerns and took my daughter to a pediatrician who didn't ask questions right away, she literally striped my baby and examined her from head to toe, as my husband and I stood trying to figure out why the doctor hasn't asked any questions, she looked us in the eye and said " I'm looking for bite marks, burns and bruises" my stomach dropped. I decided to do the inquiry because not only have I experienced this treatment but my mother died 6 years ago because her doctor refused to send her to a specialist when he cut her toe nails to short and she developed gangrene, when I went to visit my mother in ICU the tube that drains feces was full and about to go back into her, Tests came back that my mother haf human feces on her freshly amputated leg and died 6 days later on my brother's birthday. We need to speak up for our elders and babies, the treatment first Nations people get at times by doctors and nurses is inhumane. As a great onkwehon:we woman once said " don't fear the fight, fear standing still because courage is getting knocked down but getting back up, standing still is far more dangerous" Nya:Weh for this video

  6. I think the diabetes in us (the first nations people) is because our bodies arnt used to digesting all the white man foods and man made gmo's and ect.

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