Indigenous-led team at Brantford General Hospital aims to provide better care for First Nations patients

When Cheryl Miller spent eight days at Brantford General Hospital (BGH) just outside her home in Six Nations, Ontario in December, she had a surprise visit to her hospital room that made her stay so much better.

One of the nurses had asked Miller if it was okay for Leigh Staats, the hospital’s new Aboriginal Patient Advocate, to come by. And because Miller hadn’t had any visitors due to COVID-19 restrictions, she welcomed the idea, which also came with a much-appreciated toiletry bag.

“We chatted back and forth and of course found out we were related,” Miller said.

Staats explained to Miller what was happening with her health, answered her questions, and told her about the Indigenous family space she could visit to cleanse herself if she wanted to.

Before Miller was released, Staats offered to call her family, help with paperwork, and handed her a business card with her contact information, in case Miller had any medical questions after returning home. the House.

The service was part of a new program at BGH, where members of the Mississaugas of the Credit and Six Nations of the Grand River go for emergencies and health care.

Six Nations does not have its own hospital, although it does have a community health centre, Gane Yohs. Some nearby hospitals have Indigenous Patient Navigators and an Indigenous Health Committee, but BGH’s Indigenous Health Services Department, which launched in September 2020, is now one of the few similar hospital programs in Canada. It aims to provide better and more culturally safe care to First Nations, Métis and Inuit patients who come through the hospital’s doors.

Miller said the care made a difference.

“Being myself a social worker and health promoter for several years, I knew [the health-related information], but it comforted me because I was now in a place where I had no right to my family connections and community connections because of COVID, and it put a big wall of loneliness up there. That little chat we had, she spent like 15-20 minutes with me… I was really grateful for that,” Miller said.

The program is multi-pronged, with access to herbal medicines and traditional ceremonies, an Indigenous family space, and the creation of a more communal environment for Indigenous patients.

This little chat we had, she spent about 15-20 minutes with me… I was really grateful for that.-Cheryl Miller

“This work is so important especially with [the hospital] located so close to two Indigenous communities and the large urban Indigenous population of Brantford,” Christina Ingram, Chair of the BGH Indigenous Cultural Safety Committee, wrote on the BGH website after the program launched.

The initiative aligns with BGH’s strategic plan to improve the experience of Indigenous patients – a population that several studiessuffered discrimination and unfair treatment in urban health facilities.

“The Western system was not built for us”

The program was also started due to a shortcoming noted by a local doctor while serving his community.

Amy Montour, a Six Nations physician, came to BGH in 2010 as a medical student and is now Acting Chief and Medical Director of the Department of Hospital Medicine.

The Six Nations community had relied on Montour to help them navigate the hospital or watch over their loved ones inside the hospital, and they felt like they were running into obstacles imposed by nature. regulatory rules.

“As a doctor, you tend to get involved because you’ve been asked to do it at the request of another doctor, but in the case of Indigenous families, I was getting phone calls in the community that [said] ‘so and so is in the hospital, can you go check them out and make sure everything is ok,’ [or] ‘Can you help us understand what’s going on?'” Montour said.

“I quickly realized there was a bit of a forensic issue there, in the sense that I couldn’t access people’s information. [because] all health professionals have regulatory colleges and there are many health information rules you may be involved in. »

She turned to Dr. Anirudh Goel, Vice President of Medical Affairs and Chief of Staff of the BGH, who was the Chief Hospitalist at the time, and told him about the extra work she was doing with the members. from the community to the hospital.

He helped Montour develop a proposal for what became the Indigenous Medicine Program, which allows the organization to set parameters around who accesses information, why they access it, and allows physicians like Montour to get consultations for patients and families in a way that facilitates meaningful to indigenous communities, she said.

“The western system was not built for us. We are very family-oriented, very community-oriented,” says Montour.

She applauds BGH’s leadership for adapting to ensure regulatory issues are met, protecting people’s health information and privacy, while meeting community needs.

Goel hopes these changes are just the beginning of efforts to ease the historic tension between hospitals and Indigenous patients.

“We are looking to solve this problem in a very collaborative spirit. We recognize that as institutions and as Western providers, we do not necessarily understand the perspectives of Indigenous peoples and communities, and we rely on these communities to help us learn to better meet their needs,” says -he.

“Having experts like Amy, Dr. Karen Hill [co-lead for Indigenous Health Services] and Leigh Staats, who is the Aboriginal Patient Navigator, transformed the organization. »

Access to traditional medicines, ceremonies and post-hospital care

The program is modeled after the Indigenous cancer care program at the Juravinski Cancer Center in Hamilton, where Montour worked for three years.

Staats is in the hospital Monday through Friday, taking consultations, taking phone calls from people in the Six Nations community with concerns, and being a resource and patient advocate.

For Indigenous patients, who self-identify to hospital staff, or those whom an ER doctor or nurse recognizes as having cultural needs, Staats will be invited. She is the first point of contact, connecting with a patient to see what their needs are and will ensure that the healthcare team knows which family and community members should be involved in discussions about the patient.

She also connects the patient to Montour, to interpret medical language or offer supportive care, or to Hill for traditional medicine or some type of ceremony.

“A big part of our healing is reclaiming those elements of our own culture that have somehow been eroded or pushed into the background,” Hill says.

“Our service understands that it’s not just about addressing the medical need that arises, that there’s more going on with an Indigenous person, that often it’s an illness that will trigger it…it there’s trauma she carries.”

When a patient asks for herbal medicine, Hill complies. Or she sits down with someone who wants to reconnect with their culture and what that journey beyond the hospital might look like. With those who know their ceremonies and make this request, Hill helps them “to feel whole so they can get through what they’re facing right now.”

Montour says they’re also there for people on discharge, whether it’s connecting them with community resources or helping them understand what the next steps are for them if they return to the system. Western medicine.

Indigenous staff also do a lot of work to help their colleagues understand Non-Insured Health Benefits (NIHB), the Indigenous Services Canada program that provides status First Nations and recognized Inuit with health care coverage.

As part of a pan-Canadian collaboration of Indigenous physicians

Awareness of the program in the community has begun to spread through word of mouth and social media, and posters line the walls of the medical unit at BGH, but the Indigenous Health Services team also wears beaded cords in the hospital, which often raises the question of “are you from the rez?” then a conversation is initiated about how the patient can access culturally appropriate care. They work to keep spreading the word.

Hill adds that the work they do does not stay within the walls of BGH. She is currently helping a family at a hospital in Hamilton. “That’s what makes it a bit different from a western system is that even though we are housed within BGH, BGH is not our only place where we work. We have to meet the needs of our people when they ask to be met.”

We have to lead the way in many ways here.– Dr. Karen Hill

This work also includes weekly meetings with other Aboriginal physicians from across Canada. The core group includes seven clinicians working at the community level, seeking solutions to issues like anti-Indigenous racism within the healthcare system. Guests at previous meetings have included former Minister of Indigenous and Northern Affairs Carolyn Bennett and former Minister of Indigenous Services Marc Miller.

“There is nothing that supports me as a doctor, other than the United Nations Declaration on the Rights of Indigenous Peoples and the Truth and Reconciliation Commission which say that I have the right, as an Indigenous person, to my own Indigenous knowledge — and, to me, that includes in my practice as a physician,” says Hill. “I only did [know of] five other doctors in this country who are actually doing this. We have to lead the way in many ways here. »

BGH CEO David McNeil believes the work done by Hill and Montour will be a model for other hospitals.

“We just give them the lab space to develop this concept and take it forward,” he says. “We recognize that as a hospital, more resources need to be added before having these conversations with Ontario Health.”

“We’re not looking to fix the system,” adds Hill. “We want to make space to bring our indigenous knowledge and our ways of doing what we know we need to do for our people.