Pandemic underscores value of culturally sensitive Indigenous health care, say experts

Doctors and front-line agencies say COVID-19 has underscored the value of culturally sensitive and community-based health-care services for Indigenous people and the need to continue them past the pandemic.

When Manitoba reported its first case of the novel coronavirus on March 12, 2020, places like the Ma Mawi Wi Chi Itata Centre had to shut their doors.

The Winnipeg-based family-resource organization is a fixture for residents in the city’s downtown and surrounding areas.

When regular programming was suspended or shifted online, the organization pivoted its efforts to support the community.

It set up a rapid-test site at one of its locations and operated one of two urban Indigenous vaccination clinics.

The clinic provided a bridge between the communities it serves and the health-care system.

“It’s a hard barrier to break because it’s so ingrained and it’s so systemic. It’s coming from such a real, raw place of trauma,” said Rosalyn Boucha, the centre’s communications manager.

“We truly believe that there are people who came in to get tests and their vaccines that wouldn’t have otherwise. Because we were able to remove barriers that exist, whether it’s transportation or barriers with booking.”

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The clinic also offered a culturally safe space for people to ask questions, get traditional medicine and have a meal.

Past negative experiences, including residential schools and medical experimentation on Indigenous peoples, have resulted in a general mistrust in health care, medical experts say, as have ongoing colonization and mistreatment in care settings.

Dr. Marcia Anderson, medical lead with the Manitoba First Nations pandemic response team, said vaccination rates for people off-reserve in the province are lower than for on-reserve.

She wonders if that’s because of a more direct role First Nations people have in their communities’ public health.

“It is just harder when there is not Indigenous leadership and Indigenous health services to overcome those barriers,” she said.

The top doctor with Indigenous Services Canada says the department relied on Indigenous leadership to help guide the federal government’s support.

“There’s no question that the efforts of the chiefs and council, the elders, and all the front-line workers in the communities have resulted in many lives saved,” Dr. Tom Wong said in an interview.

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There need to be more training opportunities for First Nations people living on-reserve to become health workers in their communities, he added.

“Parachuting health professionals in and out … is a stopgap measure. It is not a long-term solution. The long-term solution is to support communities to have their own workforce.”

For Dr. Shannon McDonald with the First Nations Health Authority in British Columbia, witnessing the success of partnerships has been the most powerful aspect of her work throughout the pandemic.

McDonald is the acting chief medical officer for the authority, which delivers First Nations health programs and services.

Work has included cultural safety and advocacy for equitable and safe health care.

The authority worked with communities, the province, and the federal government on vaccine rollout and communication, especially around vaccine hesitancy.

“We have to go in with kindness and understanding and be willing to listen to people’s concerns. I’m often told the health system has not earned the trust of individuals.”

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In Manitoba, the First Nations pandemic response team worked with the government, the First Nations Health and Social Secretariat, and communities to help deliver services and provide information.

Anderson said access to data underpinned all planning and advocacy work and led to changes in the vaccine rollout and eligibility criteria.

On-reserve case counts have been highest on the Prairies. Federal data shows Manitoba has had the most at more than 22,000 reported infections.

Wong links the disproportionately higher rates of COVID-19 and hospitalizations among First Nations people on-reserve to colonization, social determinants of health, poor housing, lack of access to clean drinking water, and underlying medical conditions.

Future outcomes will not change unless systemic issues are addressed, said Anderson.

“We haven’t seen a shift in those underlying structural risk factors, which means we’re not going to see shifts in other health outcomes or be differently prepared for the next pandemic.”