The difference a stone’s throw can make: barriers to access experienced by First Nations and Metis in Manitoba by Elizabeth Cooper and S Michelle Driedger
Recognizing the uniqueness of different Indigenous communities and groups is essential towards ensuring that research, policies, programming and services truly meet relevant needs. While these divisions are necessary, it can become problematic when multiple cultural groups live within the same geographic region, and are part of the same family units. Within Manitoba, Metis and First Nations people often live side-by-side, but have unequal access to health services and supports due to differences between federal and provincial fiduciary responsibilities. These different fiduciary responsibilities reproduce health inequities and challenges the uptake of research, policies, programming and services. In this chapter, we explore some of the challenges we have faced when working in community-based research with such communities. We explore some of the key challenges research participants have raised during the past decade, and discuss how we have approached these issues with varying degrees of success.
Water and well-being by Lalita Bharadwaj
In Canada, a nation recognized for its natural wealth of fresh water supplies, the provision of safe drinking water is a pressing public health issue confronting Indigenous communities. Many communities in Canada live with long-term drinking water advisories, high-risk drinking water systems and experience health status and water quality below that of the general population. A mixed-method community-based participatory research approach was applied to heighten understanding, and gather information from the voices of the communities on the nature of existing drinking water issues and associated health related challenges. Drinking water quality and supply were key challenges identified. Health consequences, extend from the individual to community levels and beyond physical impacts. Inadequate drinking water has widespread implications to the well-being of Indigenous people. To better inform policy decisions for drinking water provision, a more holistic understanding of the relationship between drinking water challenges and Indigenous well-being is needed.
Key Words: Indigenous Communities, Drinking Water, Community-Based Participatory Research, Health and Well-Being.
eHealth as a support in remote areas by Päivi Juuso
In several industrializes countries, healthcare and social services are challenged by the growing and aging population. An increased number of older adults leads to increased need of help and support in daily life. A shortage of younger people who can care for the aging population, especially in remote areas, necessitates better and more effective health care systems and technologies. eHealth can be a complement to traditional health- and social services. For a sustainable and long-term plan for the person in need of support, it is important to reason about values affected when implementing and using eHealth as support at home. Implementation should therefore, always be done based on the individuals’ needs. This paper focuses on challenges when implementing eHealth solutions as support for older adults in remote areas.
At a Crossroads: Understanding the Determinants of Northern and Indigenous Peoples’ Health by Julie Bull
This chapter provides an overview of the intersection of determinants of health for Northern and Indigenous Peoples. Though a pan-northern (or pan-Indigenous) approach is not recommended, this chapter will highlight key themes that weave together the interconnectedness of health and wellbeing by drawing on elements such as economics, education, employment, food availability, geographic location, cultural variance, and systemic barriers. All of these collective level determinants are critically important in understanding both community-health and individual wellbeing and are integral in addressing health disparities and inequities in health care access in Northern and Indigenous Communities. It is only when these multiple factors are included, analyzed, and understood, that meaningful research, health care delivery, policy development, and program design can occur. We cannot artificially separate some components from others and must approach health in a wholistic manner, inclusive of a myriad of determinants.
An Ethical Imperative for Working with Northern and Indigenous Communities by Julie Bull
Indigenous Peoples around the world have been mobilizing to (re)assert their inherent right to self-determination, a movement that has both shaped and been reshaped by globally significant developments, such as the UN Declaration on the Rights of Indigenous Peoples (UNDRIP) and the Truth and Reconciliation Commission (TRC) in Canada. Innovations in policies to enhance the ethical conduct of research involving Indigenous Peoples have led many around the world to look to Canada to understand how we are creating policy in this area. Despite increased documentation about what to do in research involving Indigenous Peoples, there is little description of how to do it. Through the lens of both academic and grassroots Indigenous initiatives at the intersection of multiple knowledge systems, and the movement to decolonize research by Indigenizing methods and ethics, this chapter provides contextual and practical information with actionable suggestions for researchers to implement immediately.
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.
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.
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.
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.
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.
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).
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.
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.
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.
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.