STRONG MEDICINE FOR AN AILING SYSTEM
FROM DECEMBER 2019 ISSUE OF WEST END PHOENIX
From left: Selena Mills, Dr. Lisa Richardson and Senator Constance Simmonds are working to help Women’s College Hospital meet the needs of Indigenous patients.
Racism in doctors’ offices and emergency rooms is a fact of life for Indigenous people living in the GTA. But this trio of women – a communications mastermind, a doctor and strategist, and an Elder in residence – have set out to change that
Several years ago, Joy Henderson was at home alone, indulging in a rare nap, when a cyst in her ovary ruptured. As her symptoms intensified, her in-laws happened to drop in, and they drove her to Scarborough General Hospital. Doubled over in pain, she says, she was received by a white female doctor who was annoyed that Henderson was crying.
“She was like, ‘Oh you’re just here to get drugs,” says Henderson, a child and youth worker who is Afro-Indigenous. She was only able to get proper care when her mother-in-law, who is white, went “full Karen,” as Henderson describes it, asking to see the doctor’s higher-ups.
Henderson has since divorced; no longer having a white advocate to help her in future health emergencies, she asks hypothetically, “If another cyst ruptures, am I shit outta luck?”
“While we cannot speak to the specifics of this case,” says Elizabeth Buller, president and CEO of the Scarborough Health Network, when asked for comment, “we are working to create an environment where every patient feels welcome and included.”
The need for such work is pressing in hospitals across the GTA. As Dr. Lisa Richardson, the strategic lead of Indigenous Health at Women’s College Hospital (WCH) and the co-lead in Indigenous Medical Education at the University of Toronto, explains, “If we look at Indigenous health outcomes more broadly, we know there are massive disparities that are actually getting bigger rather than getting narrower.”
Dr. Richardson and her colleagues, however, have a plan to turn that around, through projects that improve the experience of Indigenous patients entering the mainstream medical system. For Dr. Richardson, an Anishinaabe clinician educator, it’s about cutting off the problem at the pass. Working at the university level, she trains med students to deliver care that is culturally safe and “trauma-informed.”
That means working from the assumption that any patient may have experienced trauma, as Richardson explains, and that coming into the health care system – an institution that has been particularly unwelcoming and unsafe for Indigenous Peoples – can be retraumatizing. Training involves teaching future doctors to introduce themselves first, to explain what each step of a physical examination will entail, even asking for consent before putting their hand on a patient.
She teaches the approach to practising physicians, too. Alongside Naana Jumah, an obstetrician-gynecologist at the Thunder Bay Regional Health Sciences Centre and researcher at the Northern Ontario School of Medicine, Richardson developed a program called Hearing Our Voices: An Indigenous Women’s Reproductive Health Curriculum. Offered nationally online to health care providers and students, the modules cover self-reflection, white privilege and systemic racism.
“It starts with understanding who you are as a provider and how we all carry biases,” says the doctor, who reports that 320 people have completed the course so far.
She says the course, being used in a half-day Indigenous Health program, will be mandatory for all 255 fourth-year medical students at U of T.
“Most people go into medicine to make a difference, wanting to help people. And what happens is that you can become absorbed into the system, into a way of behaving that you’re not even aware of,” she says. “When I teach about why our institutions have not been inclusive, and I give that background and that context, and then some really practical tools and tips, I find people are receptive.” Talking about developing an anti-racist practice, on the other hand, can make people “quite defensive. That can be an uncomfortable conversation,” she says.
And yet, racism in doctors’ offices and emergency rooms is a fact of life for Indigenous women living in the GTA. That’s why, in addition to offering training at the university level, Dr. Richardson has joined forces with WCH. In 2018, the hospital recruited her to help make it a more inclusive organization. She brought with her a blueprint she’d already created, called Bringing Reconciliation to Healthcare in Canada: Wise Practices for Healthcare Leaders, which the hospital now uses in its Indigenous Health Education Group’s training program.
“It really walks non-Indigenous health care organizations through some important steps to be thinking about in order to put the TRC [Truth and Reconciliation Commission] health-related calls to action into effect,” says Richardson. “And Women’s said, ‘We want to actually do this.’”
On a cold December morning, I meet Selena Mills inside the atrium of Women’s College on Grenville Street. As we walk together along the first and second floors, she gives me a tour of artwork made by Indigenous and female-identifying creators, beginning with a painting by acclaimed artist Shelley Niro entitled “Day One Too”; its vibrant strawberries symbolize life and health. There’s also one by Bonnie Devine: “The North Shore Line,” which pushes off against a colonial land purchase agreement. In another, by Lisa Boivin, a vividly coloured woman is depicted in a hospital bed set against a black background. Together, the 20 pieces in the collection, co-curated by Sara Roque and Elwood Jimmy, make a statement that this is a safe space for Indigenous patients. The message is “We see you, and we’ll care for you.”
Mills, who has been overseeing Indigenous Strategic Communications and Partnerships at WCH since April, understands the importance of that message firsthand. A week before we met, she was in another GTA hospital for pneumonia, and had an experience that wasn’t as culturally appropriate as it could’ve been.
“They have an Indigenous navigator there and smudging policies, but nobody knew about it, because there isn’t department-to-department education,” recalls Mills. “I was, as the patient, informing my doctor and my nurse that they do have Indigenous staff there, [and] navigators,” – individuals who can translate services in the appropriate language, offer patients support throughout their stay, give quick referrals to community resources, and serve as a liaison or advocate with the health care team – “and access to medicine for Indigenous patients.”
That negative experience solidified the work she’s doing at WCH, to “plant the seeds of knowledge,” alongside her colleagues Dr. Richardson and Elder in residence Senator Constance Simmonds.
Simmonds has joined Mills and me in the second-floor library, where they show me the shelves dedicated to medicine and traditional healing titles, colonial and confederate history books and more. She later determines I’m sitting with a lot of information and offers to get her medicines, and the three of us smudge.
“To be able to come here, and see their culture, their traditions and their own people ready to serve, there’s a different kind of a bond that would take place rather than what usually [happens] in a clinical setting,” says Simmonds, who is doing consultations with doctors, students and patients, giving teachings and offering traditional medicines; she is also supported by two other Elders. “So people are more willing to bring their children forward, and men are beginning to come forward to address their health issues.”
In this first phase of Indigenizing spaces at WCH, Mills, Simmonds and Richardson are busy moving through every department of the hospital, to teach staff about Indigenous healing before it’s offered to the community. An Indigenous Cancer Care screening clinic is already underway. So is an Indigenous HIV clinic, led by Dr. Mona Loutfy, who is prioritizing the hiring and training of Indigenous women living with HIV as research associates. The reach of this trio is all-encompassing: In the new year, they’ll be speaking with the hospital’s security team. No department will go unmet.
There are also plans afoot to create an Elders room on the second floor – where traditional medicines will be stored – and next to it, a gathering place for Indigenous students from the University of Toronto’s faculty of medicine, as well as a spot where small symposia will take place. At the moment, it’s little more than a locker room, a kitchenette and a nondescript office. Mills points to several blank hallway walls, where a vinyl wrap of greetings in various Indigenous languages will go, and the place where the smudging alcove will be. The rooms are set to be completed by January 27. Then it’s on to hiring an Indigenous healthcare navigator to assist patients and to create a network with Northern Ontario healthcare partnerships.
Simmonds says the new year will see her travelling to Northern Ontario reserves to form alliances between their community centres – which serve as hubs for health care services – and WCH. Mills and Richardson are also working on establishing a partnership with the Northern Ontario School of Medicine, and with Keewaytinook Okimakanak’s eHealth telemedicine services.
After the library stop, Mills and Simmonds and I sit down around a circular table inside that almost empty second-floor office. It’s stripped-down, bright and unwelcoming, an indication of how much work is left to do. Mills says the Women’s College Foundation has been fundraising to support their day-to-day operations, while the Indigenous Health Education Group works behind the scenes to build the internal structures to support the coming initiatives.
“As boring as talking about governance and developing protocols is, we need that, because this is a colonial institution at the end of the day,” says Mills.
“No matter how powerful the support might be from executives, you can’t make everybody be an ally,” she adds. “There is still going to be that pushback, so we need to have a strong structure to do this work in a good way. Because the last thing we want to do is establish trust with our communities, start to offer services and then they experience the pushback.”
Mills and Simmonds are self-described “kind disrupters.” “We’re trying to break down and disrupt the molecules in a kind way,” Simmonds explains. Her work has been focused on forming relationships with each department, having conversations about our traditional medicines and an Indigenous world view. Meanwhile, Mills, Simmonds and Richardson are spreading those relationships further with the Toronto Regional Cancer Program's Indigenous Cancer Program, which has spearheaded the Toronto Indigenous Ceremonial Practices Alliance. This Alliance is composed of representatives from Toronto hospitals, including WCH, working together to create and share an Indigenous Ceremonial Wise Practices Guideline for the region's healthcare institutions. That refusal to silo itself off from other hospitals – specifically their Indigenous healthcare initiatives — is an example of “kind disrupting.”
When I ask Joy Henderson for her perspective as a patient, she tells me the WCH programs sound like “a great start.” To her, it’s the leadership that matters most. “It’s important to have Indigenous people in decision-making roles to ensure that programming is truly centred around Indigenous people and our health care needs.”
It is hopeful for me, too, as one Indigenous person among an estimated 70,000 in the city, to see the positive work being done for our people at WCH, without a doubt. But visiting the hospital, and being shown where Indigenous space will be carved out, is quite different from the feeling I get as I enter the Queen and Sherbourne location of Anishnawbe Health Toronto (AHT). Two young Indigenous women exit the building together as I’m buzzed in, and it’s clear that this a haven for people like me.
In the new year, as it was recently announced, construction will begin on a sprawling new central location for AHT, a unique primary health care centre that offers both traditional healing and Western modalities of health care, including mental health and addiction services. Its executive director, Joe Hester, oversees about 100 staff across all three of its current locations, which will be consolidated in the new building.
From his office, where the wall behind him is lined with art, Hester describes the model the centre employs as the meeting of two approaches, which together bring a lot to the healing process.
“The health status of our people needs the best of both,” he says. For example, if a client with fetal alcohol syndrome comes in, the circle of care providers could include a physician, a psychologist, a social worker, a nurse, a traditional healer and an outside specialty. According to Hester, it’s a model that other primary health care centres across Canada want to emulate.
The challenge at the moment, he says, is logistical. “We have three different locations [at the moment], and that’s [difficult] for our clients – to have to possibly go to two or three different [places]. That’s an economic hardship,” says Hester. “And by the same token, in terms of our providers, we want to work together. It’s easier if you’re in one facility.”
He says there shouldn’t be too great an interruption in services during the move to the new building. Or at least those disruptions have been built into the planning process; alternative arrangements will be made for clients if needed until the move-in is complete. In the meantime, he’s got his head down, ensuring that AHT is offering a full spectrum of services in a range of areas including addictions, mental health, dental, primary care, a prenatal program and support for patients in need of long-term care.
It’s an organization Richardson admires, even if it’s working with a different model than hers.
“I always say to people, we’re not trying to replicate becoming an Indigenous Health Access Centre. But we know that our people will at some point have to enter into non-Indigenous institutions, whether it be for their cancer screening, or their appointment with a cardiologist or other kinds of testing, and we want to make sure that when they do make that journey, that it’s a better one than it has been.”