New approach needed to deliver health care to Indigenous patients

Panel discussion offers solutions to avoid systemic racism in health-care system

Bernie Poitras - 27 January 2017

Nothing about us without us.

For Jaris Swidrovich, these five words describe the approach health professionals should take to improve health-care delivery to Indigenous patients.

"If we want to improve the health of Indigenous people, we need to include them as part of the process," says Swidrovich, Canada's first self-identified First Nations Doctor of Pharmacy. "This means we must consult with our communities, families, youth and elders. We need to learn from everyone - that's the Indigenous way to learn."

Swidrovich spoke about the challenges and offered strategies for improving health care for Indigenous patients during a panel discussion organized by the Faculty of Pharmacy and Pharmaceutical Sciences and the Office of Alumni Relations.

Swidrovich's maternal grandmother was a residential school survivor and his mother is a Sixties Scoop survivor. A lecturer at the University of Saskatchewan in the School of Pharmacy, he is a member of Yellow Quill First Nation and was born, raised and lives in Saskatoon, Saskatchewan.

Other panelists who took part included Jean Triscott, Director, Division of Care of the Elderly, University of Alberta's Department of Family Medicine and Allyson Jones, physiotherapist, Faculty of Rehabilitation Medicine and a clinician at the Indigenous Wellness Clinic and Cheryl Sadowski, Pharmacy and Pharmaceutical Sciences.

Challenges for Indigenous people in health care

Swidrovich offered personal examples, including those from his own family, detailing how previous government policies like residential schools, where Indigenous children were taken from their homes and placed in religious schools, have directly impacted the mental and physical health of Indigenous people.

"The last residential school wasn't closed until 1996, so it's still having an impact today," he says. "There is also a gap in the knowledge that health care professionals have about Indigenous people. The gaps also include Indigenous history, communities and health experiences about Indigenous people."

Swidrovich says a lot of people still do not understand what the terms First Nations, Indigenous or Métis mean.

"How we are graduating people in universities who don't know what these terms mean is beyond me," he says.

He points to several barriers in the First Nations education system that led to low enrolment of Indigenous students in universities. He challenged health disciplines to encourage Indigenous students to enrol in their program.

In Alberta, university enrolment for Indigenous students (47 per cent) still lags behind non-Indigenous students (65 per cent). He attributes this difference to factors such as poor infrastructure, low funding and overcrowding, among others.

Swidrovich says this discrepancy starts early on in an Indigenous child's education. "On average, First Nations schools get $2000-3000 less per child than other schools, so an Indigenous person starting a university degree isn't starting in the same spot as other students."

He noted that with the growing Indigenous populations in Alberta and other provinces, health-care professionals need to be responsive to and educated about their needs. Sixteen per cent of Indigenous people in Canada live in Alberta and one in four Indigenous Albertans live in Edmonton.

Strategies to improve Indigenous health

Cultural safety is a factor for improving Indigenous patient outcomes and attaining more education. "People who feel culturally safe are more likely to access care or access education than those who don't feel safe," he says. "So, we need to make the health care system more safe for Indigenous patients and post-secondary schools more safe for students, so they feel empowered and more at ease."

Swidrovich pointed to the Truth and Reconciliation Commission of Canada (TRC) as a means to improve the situation. Of the 94 actions that came out of the TRC, seven related specifically to improving health care for Indigenous people. "These aren't suggestions or recommendation; they are call to actions," he says.

The actions range from recognizing that the current state of Indigenous health is a direct result of previous Canadian Government policies and implementing health-care rights for Indigenous people to setting measurable goals to identify and close gaps in health outcomes like maternal health, chronic diseases among others. He says these actions lay the foundation for improving Indigenous health care.

As a practicing pharmacist, Swidrovich says he approaches Indigenous patients with the perspective of respecting their need for a cultural component to their care. "I have a medicine wheel pin I wear on my jacket to remind me of my culture and that I'm a being made of many parts. I use this wheel as a counselling strategy for Indigenous clients who request a cultural component to their care."

Swidrovich points to the medicine wheel as a metaphor for all parts of a patient's health - physical, spiritual, emotional, etc. He advises patients to take medicine to restore their physical health first, then their spiritual and emotional health will return after soon after.

He says a key component to how Indigenous people learn is that Indigenous culture values literature differently than non-Indigenous cultures. "Indigenous people grow up learning to process information based on their experiences, background, knowledge and culture," he says. "They don't learn by writing down on paper or taking multiple choice tests."

Taking into account this learning difference, Swidrovich says the process of indigenizing curriculum across health science disciplines has to start by consulting with communities, elders, families and youth.

He has proposed a learning-outcomes module for entry-to-practice pharmacy programs across Canada and outlined five layers of "indigenizing" the classroom. By the end of their fourth year, Swidrovich says pharmacy students should be able to complete tasks such as listing the three distinct groups of people who are defined as Aboriginal in Canada, describing the medicine wheel, describing what it means to provide culturally safe care and summarizing the protocol for inviting an elder to speak, among other outcomes.

"We need to talk to elders more - they have great solutions," says Jean Triscott, one of the panel members. "We need to have more Indigenous students in our health science faculties - they know the Indigenous people better than anyone else."

Panel members also discussed bringing more social determinants into health science classrooms and not just treating the disease. "There is a disconnect between health care, education and social services and I think if we can join them together, we will come up with better solutions for improving health care for Indigenous people," says Triscott.

Swidrovich says there is a long way to go in meeting Indigenous health care needs both in treating patients and attracting Indigenous students into the profession but he says health science professionals need to recognize and respond to the TRC calls to action to help improve the situation.

The panel discussion was sponsored by the Pharmacy Alumni Association and the Canadian Society of Hospital Pharmacists - Alberta Branch.

View videos of presentation

1. Introduction and Blessing (14:00)
2. Jaris's Keynote Lecture (1:06:00)
3. Panel Discussion (40:00)

Download Jaris' presentation

View photos from the panel discussion event