Author abstracts

OER Project Directory Northern & Indigenous Health And Healthcare
21

Local-based midwives as part of the indigenous maternal health team by Lisa Schwarzburg

Aim: This article reviews the capacity of a unique research and policy development model created by joining indigenous knowledge systems and public health and community development paradigms.

Methods: Developed from an asset-building approach, involving community members and leaders as stakeholders and participants, this framework gathers, analyzes, disseminates, and evaluates the components of local-based women’s and family wellness practice in Alaska Native villages.

Results: Instead of springing strictly from a biomedical-based knowledge system, this community-driven health policy can simultaneously become self-driven research and caregiving components of indigenous communities and respective health care systems.

Conclusions: Partnerships will have to form among:

  • Alaska Native Tribal Councils’ representative caregivers
  • Obstetric and Midwifery groups (CNMs) in Alaska’s tribal health program
  • Alaska Native Tribal Health Consortium
  • State of Alaska health care agencies and organizations.

Both concepts of indigenous knowledge systems and State-based health policies are integrated as of components of this community-based model.

22

Cultural attunement in maternal health care by Lisa Schwarzburg

Aim: Describe the importance of ‘cultural attunement’ in indigenous maternal healthcare systems.

Methods: A case approach to describe the urgency of striving for cultural attunement in indigenous maternal care.

Results: Current applications in Alaska’s tribal health and other indigenous systems are presented —showing the effectiveness of using this type of protocol.

Conclusions: As stated in 2011 Pathways Into Health Conference, Tucson, Arizona: “The process of cultural attunement involves constant communication, sensitivity to the dynamics of relationships within a culture, and respect for the values and beliefs of a culture. It comes from a position of cultural humility, but it represents active attention and ongoing mindfulness.”

This is called for to incorporate indigenous authority and a midwifery model of care into an indigenous maternal health care system. The benefits of using this protocol in providing maternal care should be considered a primary component to any successful indigenous maternal health system.

23

Improving access to maternal care through local-based midwifery by Lisa Schwarzburg

Aim: To explore and develop use of local, specialized Direct-Entry Midwives operating in Alaska Native villages.

Methods: After an Introduction with WHO article, The Lancet, and others calling for increased use of locally-based midwifery care in maternal and interconceptual women’s health care programs, a unique, specialized Certified Direct-Entry Midwife program is proposed involving the training and use of locally-based village midwives in Alaska Native villages.

Results: A discussion of midwifery groups in a biomedical model currently practicing in Alaska’s tribal health program—showing a gap in this type of care for Alaska Native villages.

Conclusions: Training locally-based Maternal and Women’s Health Aides could build capacity for decentralized health education and improved health care access in these northern indigenous communities. It is further argued that local, specialized Direct Entry Midwives operating in the villages can build on traditionally-based midwifery practices, as incorporated into training and practices from respective cultural groups.

24

Indigenous Midwifery by Lisa Schwarzburg

Aim: To increase the knowledge and deepen the understanding of the importance of including indigenous midwifery in northern and Indigenous maternal healthcare models.

Methods: After proposing incorporation of community-based midwifery into indigenous maternal healthcare systems, a description of the elements and benefits of an indigenous midwifery model of care will be presented.

Results: Case studies provide examples of how indigenous midwives are currently meeting their communities’ maternal and infant care needs, while bolstering effective community-based care, overall.

Conclusions: With groups like National Aboriginal Council of Midwives as an example of how effective indigenous midwives are in supporting and promoting resilience of their communities, and “the restoration of midwifery education, the provision of midwifery services, and choice of birthplace for all Aboriginal communities consistent with the U.N. Declaration on the Rights of Indigenous Peoples—“,
similar healthcare councils and providers are called for across the indigenous communities of the Arctic.

25

What does it mean to be a nurse in Canada’s northern territories? By Martha MacLeod, Leana Garraway, Steinunn Jonatansdottir, Pertice Moffitt

Although there are anecdotal reports about nursing in Canada’s arctic, the experiences of nurses who live and work in northern communities have seldom been systematically examined. The aim of this chapter is to illuminate what it means to be a nurse in Canada’s northern territories. The chapter is based on findings from a nation-wide study of the nursing practice in rural and remote Canada. A total of 365 participants (nurse practitioners, registered nurses, licensed practical nurses and registered psychiatric nurses) from the Yukon, Northwest Territories, and Nunavut provided narrative answers to the question, what does it mean to be a nurse in rural and remote Canada? The answers, which ranged from a few words to lengthy descriptions of experience, were analyzed thematically. This chapter outlines the themes, and highlights what stands out for the nurses’ in their experiences of living and working in northern communities.

26

Reflections on culturally safe health care, health-education and health-care work-places by Helle Møller

Historically, recruiting and retaining local health care professionals and educators in Circumpolar regions generally, and in Nunavut and Greenland specifically, has been and continues to be challenging. As a result, many practitioners and educators are recruited from the South, where norms, cultures and languages may be very different from those prevailing in the North. This chapter focuses on cross-cultural health education and health care. It takes departure from work conducted in Greenland and Nunavut with Canadian and Greenlandic Inuit nursing students and nurses, and reflects on how we, as southern health care professionals and educators, may work towards supporting and providing the most culturally safe care/education/health care workplace possible. Recognized in this reflection is that culture is plastic and politically charged (Woods 2010) and rather than being about “habits or customs” (Ramsden 2002), it is a “complex network of meanings enmeshed within historical, social, economic, and political processes” (Anderson and Reimer-Kirkham 1999: 63). Cultural safety shifts the focus from the “Other” (here the Greenlandic/Canadian Inuit patient or nurse) to the healthcare provider (here mostly Euro-Canadian/Danish) (Browne and Varcoe 2006; Ramsden 2002) and transfers the power to define the meaning of cultural safe care [education and work] from the provider [and educator] to the client [student or co-worker] (Ramsden 2002).

27

Establishing trustful relationships between marginalized indigenous people and researchers/health workers by Snefrid Møllersen, Tonje Haanæs-Rensberg, and Inger Marit Eira-Åhrén

The Sami reindeer-herders’ historical marginalization in the Norwegian society implies a lack of knowledge about their health and health-related life conditions. In conjunction with the first Nordic health study among the Sami population that used a participatory research model and ethical guidelines for research among Indigenous people, we conducted a qualitative evaluation, which addressed the Sami reindeer-herders’ experiences throughout the research process. As a result, the reindeer-herders accentuated the importance of research objectives, which correspond to self-defined challenges and problems, the acceptance and inclusion of reindeer-herding knowledge, and the importance of developing a trusting relationship with the researchers. Developing genuine cooperation with the indigenous target population is fundamental in order to initiate health promotion at the individual and structural level. To reverse marginalization within health services, there is a need for a greater focus on ethical issues and integration of cultural knowledge.

28

Indigenous Birth by Angela Bowen

Research has shown that childbirth can be a positive, empowering experience for a woman. However, if the care she receives during childbirth lacks cultural security, it can cause confusion, anxiety, depression, and trauma that stays with her throughout her life, it can impact how she parents her child/children, which can affect their growth and development. Indigenous women may feel particularly vulnerable during childbirth, as they often must leave their communities and families, especially their mothers, and can find themselves in situations that do not incorporate traditional, culturally- secure practices or ceremonies into their birth experiences. Birth has been medicalized in the Western way for many Indigenous women, resulting in a loss of traditional birth practices and rituals; however, there is a renewed interest in reviving these traditions, with many Indigenous women wanting to reclaim their birth experiences.

Indigenous people are affected by chronic diseases, such as cancer, cardiovascular disease, diabetes, and mental illness, more than non-Indigenous people, and many of these conditions have their origins in early life (conception, pregnancy, birth, and early childhood). Improving access to midwifery and culturally-secure maternal care is considered best practice for the health of Indigenous communities, to support the regeneration of strong families. The Society of Obstetricians and Gynecologists of Canada (SOGC) acknowledges the gaps between birth outcomes for Indigenous and non-Indigenous women. The SOGC supports returning birth to women’s home communities as one way to improve their health through the promotion of traditional and cultural practices. They stress that women birthing in their home community establishes roots for the mother, her infant, and the family, and children born in their home community develop a clear sense of identity that helps them to become resilient and responsible. However, not all women can give birth in their home community for accessibility or medical/obstetrical reasons, pointing to an urgent need to provide culturally-competent care not only where the woman gives birth, but also during and after pregnancy.

In a study of Indigenous women giving birth in a large tertiary care facility, women identified a lack of choice in place of birth, the type of delivery, and no say in their birth decisions caused them distress. They reported lack of support from staff and trauma associated with going through labour without support from their partner, family, or culture. In contrast, mothers who were able to birth in their home community said they appreciated the care and follow-up that their midwives provided to them.

Engagement of Indigenous people in health care can be viewed as a continuum, that begins with cultural awareness and progresses through cultural sensitivity, and competency, ending with cultural security. Learning about different peoples and cultures is a key component of cultural competence; therefore, increasing our understanding about Indigenous birthing experiences from women will promote cultural safety and increased engagement in their prenatal and postpartum care and improved outcomes.

29

Role of nurses in the prevention of tuberculosis in remote communities in the North by Nikolay Diachkovsky and Aleksandra Obutova

Tuberculosis (TB) continues to be a global healthcare problem and is the leading cause of death among infectious diseases. In 2007, a Global Report by the World Health Organization (WHO) declared a decision on worldwide elimination of TB by the year 2035.

Russian Federation is one of the countries with a high TB burden, and the worst situation of TB has been observed in the regions of the Extreme North of Russia. Control measures against TB are influenced in complex ways by living conditions and specifics of lifestyles, which all stem from extreme weather and climate conditions. For instance, residents of the Extreme North were observed to develop ‘polar stress syndrome’, leading to increased vulnerability of the organism to exposure to environmental factors. Simultaneously, traditional way of life and interpersonal relations are changing due to migrant influx and the extensive use of the lands home to indigenous peoples. All of these factors have left a deep imprint on the life of indigenous population.

The only available medical care in the Extreme North, with its sparse population and absence of all-season roads, is often provided solely by nurses, especially in remote villages, located far from administrative centers. Therefore, nurses are forced to take on a more important role, as an autonomous element within the rural TB control service.

In this context, it is becoming increasingly important to explore social and health-related aspects of TB and the prevention of TB in the indigenous populations, which takes into consideration the conditions of the Extreme North when discussing about the task to eliminate TB set up by WHO.

30

Off-Campus Nurse Education - Education Model Impacting Regional Health Care Services by Sirkka Saranki-Rantakokko, Eija Jumisko, and Outi Hyry-Honka

From 2015-2017, Lapland University of Applied Sciences executed a project called Off-Campus Nurse Education, financially supported by the European Social Fund (ESF). The purpose of this article is to describe the methods used to ensure regional impact of the project. These methods include close cooperation between working life and educators, facilitation of study at the workplace, and research. The acquired experiences and evidence–based information contribute to further development of off-campus nursing education and its regional impact in sparsely populated areas.

The data for this article was collected from students, their mentors, and employers. The project aimed to foster professional competence of the regional health care providers and the professional skills of practical nurses in their local regions. This article describes the methods that fostered success and impact of the project, and the methods that are still being used and maintained.

31

Ethical and Leadership Challenges for Healthcare Providers in the Canadian North by Kathie Pender

The opportunity for employment in the Canadian North appeals to healthcare providers as adventurous and idyllic. The resource-challenged, independent workplace presents unique practice opportunities and tests personal and professional ethics and leadership competencies. Novice clinicians in the North may struggle to identify their role as a leader. Ethically, professionalism is challenged, safety questioned and boundaries stretched. This chapter will examine the complexities of working in the Northwest Territories from an ethical and leadership perspective.

Keywords: ethic, leadership, healthcare, clinician, Northwest Territories

32

The Role of Personal Support Workers in Remote Northern Communities in the Northwest Territories, Canada by Wanda Roberts

Personal support workers are integral members of the health care team in remote northern communities. They are typically Indigenous women native to the community, and often speak their first language. The scope of their role in communities is broad, and unique, when compared with the southern concept of home care services; their communities rely on them as liaisons for health care services due to their close ties with community members. This chapter will highlight some of the challenges and successes of support workers employed in remote northern communities of the Northwest Territories, Canada.

33

The Personal Support Worker program: A Public Health Initiative for Indigenous Women by Wanda Roberts

Colonization, racism, intergenerational trauma caused by residential schools, racist and sexist policies and legislation have had a detrimental impact on the health and well-being of Indigenous women. Through the completion of the Personal Support Worker program at Aurora College in Yellowknife, Northwest Territories, and attainment of employment, Indigenous women improve their socioeconomic and health status. They are role models for their children and communities, as well as care givers for the elders in their communities. Their enhanced knowledge of health impacts their communities and future generations. This chapter will highlight anecdotal experiences of support workers and their perceived influence within their families and communities.

34

Intimate Partner Violence in Northern Canada by Heather Fikowski

Intimate partner violence (IPV) in Northern Canada is a major public health issue that continues to impact women, families and communities and consistently demonstrates the highest rates in the country. A five-year study conducted between 2011 and 2016 investigated the community and frontline response to IPV in the Northwest Territories. Several dominant themes emerged that facilitated frontline worker’s sense of having their “hands tied” when trying to support women who are experiencing violence in their intimate relationships. The culture of violence and silence was identified as a theme pivotal in maintaining the social process of women shutting up about the violence. This chapter will explore the culture of violence and silence, both in terms of how it contributes to “hands tied”, as well as moving forward, towards communities that are free from violence.

35

Community Development in Canada’s North by Kerry Lynn Durnford, Cathy Bradbury, Susan Starks, Marnie Bell, Pertice Moffitt

Community development is an essential component of community health nursing. Community health nursing in Canada’s north is unique due to the transient nature and diverse scopes of practice of health care providers. Expectations related to interprofessional and intersectoral collaboration heighten the complexity of northern nursing practice. The rural and remote location of many communities also increases the cost of professional development and continuing competence. Particularly important is the rich diversity of northern people, but also knowledge and recognition of the legacy of residential schools and colonial practices which have created health disparities for indigenous people. Community development approaches built upon collaborative, respectful and egalitarian relationships with both indigenous people and the intersectoral team are essential to an efficient health care system. The purpose of this chapter is to discuss community health nursing competencies necessary for the practice of community health nursing in the north.

36

Childhood sexual and physical violence and the impact on mental health by Siv Kvernmo

Sexual and physical violence in childhood are acknowledged as major risk factors for mental and physical health in children as well as adults. As these type of assaults are associated with silence and shame, they are often underreported and, therefore, considered hard to prevent. Indigenous peoples are known to be at higher risks for several adversities such as sexual abuse and violence compared to non-indigenous populations. The knowledge of sexual and physical violence among arctic indigenous children and adolescents is sparse and in particular among the Sami. This chapter will draw a picture of sexual and physical violence in Sami youngsters and the impact on their mental and somatic health.

37

Cultural issues of mental health in indigenous children and adolescents by Siv Kvernmo

The risk and protective factors influencing mental health in Indigenous children and adolescents may vary from non-Indigenous peers due to their Indigenous status and upbringing in cultural different contexts. The impact of cultural factors such as Indigenous identity, cultural activities and Indigenous language competence on Indigenous children’s health is sparsely studied. In previous studies, cultural determinants accounted for significant variation in mental health in Sami high school students, and mainly for emotional problems. Later studies have broadened our knowledge of the effect of cultural issues´ impact on Sami youngsters. The aim of this chapter is to present which specific features of the Sami culture and the Indigenous status which are important to consider in the treatment and prevention of health problems in Sami youngsters.