1. CULTURAL DIFFERENCES
When we raised the question about challenges or concerns related to cultural differences, two topics emerged in multiple patient/supporter and staff interviews: visitor restriction policies, and the use of traditional Indigenous healing practices.
➤ Visitor restriction policies
Visitor restriction policies were raised by staff as a challenge for some families to adhere to, and by patients as a barrier to traditional family healing practices. From the perspective of health care providers, including the APNs, the policies are sometimes breached by Indigenous families and this causes disruption to the functioning of in-patient units.
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[Having too many family members accompany the patient to Eastern Health] has actually become an issue on several different occasions where we were contacted [and told] that too many of the family members were in the room. Obviously, you know, some rooms have three other people in them, and then here you have a family of ten people here around this one bed. I mean the others are feeling overwhelmed, saying “Okay you’re being too loud” and kids are running around and you know, we’ve been contacted numerous times [being asked] “Can you come and fix this situation, make them understand that there are only two people allowed per visit at a time?” [APN]
For some patients, having the family gather round the bed of a sick loved one is an important part of healing.
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An easy solution to the dilemma of how to accommodate large families who have come from far away to be with a sick or dying loved one is to create a family space. The APNs explain:
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➤ The incorporation of traditional healing practices into health care
There is an interesting dichotomy in terms of how traditional Indigenous healing modalities are described and discussed by health care providers and decision-makers. Traditional healing practices are valued and treated with significant respect and care by many practitioners and healthcare decision-makers. For example, the Cancer Care Program’s Big Land Project led to greater awareness about the needs of Indigenous patients with respect to staff levels of cultural competency.
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However, equally as many patients report feeling their cultural healthcare practices have been dismissed or ignored by front-line staff. Patients report not telling their physicians about their use of complementary and alternative medicines. Comments submitted through the Indigenous patient survey indicated that health care providers are not always receptive to the idea of patients using alternative healing modalities.
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These interactions can lead to that a loss of trust in the health care system, feeling that requesting traditional healing practices will result in marginalization or discrimination. The lack of accommodations made for traditional healing practices can be considered one expression of the much larger topic of anti-Indigenous racism and marginalization that must be addressed in our healthcare systems.
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"Sometimes we have those [rules] here in the hospital ... so many patients in one room. It’s only two people that can visit ... but when someone is really sick, then we need the whole family .... because we come from Labrador, way far, but we need to stick together and support our patient because that’s how we support each other, right." [Indigenous patient 1: Innu man – patient, patient supporter, and interpreter]
"What we wanted was to have family space, an Aboriginal family space, where they could come in and sit down, have a cup of tea, just to relax and wait ... an Aboriginal space where they could just do smudging, have maybe a bed or two there for them to rest, if they’d been up all night, and go in and just have a rest and stuff like that." [APN]
"We knew a fair bit about holistic medicine, but we need to understand how important the earth and the land and the culture, and even you know, working – trying to provide health care services to those who leave their communities and they go into the woods or they go wherever they go for three months and don’t understand why they’re not coming back for their chemo. So it helped us develop strategies so that we could even target people’s treatments in a more appropriate way." [EH decision maker 3]
"Some people are relying on remedies ... like myself, I know from those remedies from my mom when I grew up ... No I wouldn’t tell the doctor my remedies no, no. If they’re doctors I don’t have to tell them anything." [Indigenous patient 7: Innu man – patient, patient supporter and interpreter]
"A patient should be able to smudge if needed, or light the Kullik, or have traditional medicines brought in by a family/community member or Elder." [Anonymous respondent to Indigenous patient survey]
"Every time I go to the doctor I am told to take a pill for something and that any other medicine, holistic or natural, cannot be counted on to help in any way." [Anonymous respondent to Indigenous patient survey]