Chapter 4: Indigenous Peoples, Communities, and Cultural Safety
Early in her work term, Mikaela was observing her workplace supervisor as she checked in clients and processed payments. Midmorning, a client came in with her two children. Her supervisor greeted the clients and asked for their names. When her supervisor pulled up the file and read the details, she exclaimed to the parent, “Oh my goodness! You haven’t brought your kids in for over a year! Don’t you care about your children’s health?” Then, she turned to Mikaela and muttered, “You know those people get free dental care just because they are Indigenous, and they still don’t come.”
Mikaela was distressed. What had just happened? How should she respond? She looked over at the family. The parent looked shocked and taken aback. She shrunk back from the counter, clearly hurt. Mikaela wanted to do something, but didn’t know what to do. She looked from the upset parent back to her angry supervisor. This was not okay, but Mikaela felt that there was nothing she could do because she was just a student. She couldn’t risk losing her placement. She felt shamed into silence. As she observed for the rest of the morning, she tried to reflect on how she could have handled the situation better.
- How should she confront her supervisor about her inappropriate behaviour?
- How could she support the client and help them feel welcome?
- What issues were underpinning her supervisor’s statements?
- What role did she play in enabling her supervisor’s behaviour?
Even though healthcare is supposed to be a place people come for healing and support, Indigenous people frequently encounter blatant, overt, and systematic racism. Indigenous people commonly report that the discrimination and racism they have experienced has led them to feel unsafe when accessing healthcare (Turpel-Laford, 2020). This feeling of being unsafe is only one expression of multiple oppressions that impact the level of healthcare that they receive. The legacy of colonialism, social inequality, oppression, and trauma all have a direct impact on the current experiences that Indigenous communities have when they access health care. The primary finding in a 2020 investigative report on healthcare was “[w]idespread Indigenous-specific stereotyping, racism, and discrimination exist in the B.C. health care system” (Turpel-Laford, 2020, p.36). Northern Health (2017), the health authority for Northern BC, recently apologized for both their “actions and inaction in righting wrongs” in contributing to the stereotyping, racism, and discrimination in the healthcare system (n.p).
These experiences don’t just hurt people’s feelings, they have real impacts on every aspect of a person’s health. The First Nations Health Authority (2016) write that “[a] Status First Nations person in BC is expected to live 7.5 fewer years than a non-Aboriginal BC resident born in the same period” (p. 11). Seven and a half years is an unacceptable disparity in life expectancy. Change needs to happen, and we should all be a part of it.
Mikaela is extremely uncomfortable with what she witnessed at work. She emails her supervisor to ask to talk and writes up a reflection on her experience for her work integrated learning teacher. She takes the time to brainstorm actions and to learn more about some of the comments her new co-worker made. She determines that the comments are untrue and racist. She wants to do more. She learns that many health professionals are engaging in a social media campaign called #itstartswithme. She takes the time to express the changes she plans to make using the hashtag on her Instagram. Her boss works with the leadership at Smiles Dental to engage in a larger effort to make change. Smiles Dental staff attend San’yas Indigenous Cultural Safety Training through BC’s provincial health authority.
Cultural Safety and #itstartswithme
Broader Canadian society, Canadian workplaces, and Canadian government services like healthcare systems need to change to do a much better job of ensuring that Indigenous people feel safe. It is the practitioners and providers, including students in workplace integrated learning placements, who need to lead this change by making safety a priority in their interactions. To accomplish this, the First Nations Health Authority reminds us that change can only happen when we all commit, and began the hashtag #itstartswithme for health professionals to make their own personal commitments to improving the quality of care they offer to Indigenous populations.
One of the main agents of change is to learn and implement cultural safety so that all people accessing healthcare can feel safe while receiving care. The First Nations Health Authority (2016) defines cultural safety as “an outcome based on respectful engagement that recognizes and strives to address power imbalances inherent in the healthcare system. It results in an environment free of racism and discrimination, where people feel safe when receiving health care” (p. 5). This means changing behaviours and attitudes that lead to racism and discrimination in the workplace. How do you know if you are practicing cultural safety? That indicator is determined by each person based on each interaction they have within the bigger healthcare system. So, the only way to know for sure is to look to your clients, co-workers, or other Indigenous stakeholders.
What is Cultural Humility?
One of the first steps of providing cultural safety is learning how to practice cultural humility. Cultural humility “is a process of self-reflection to understand personal and systemic biases and to develop and maintain respectful processes and relationships based on mutual trust. Cultural humility involves humbly acknowledging oneself as a learner when it comes to understanding another’s experience” (FNHA, 2016, p. 7). To engage in cultural humility means that you need to start by understanding that you hold biases within you that you need to work to unlearn. Sometimes, it is even about trying to identify what you don’t know you don’t know.
Here are some questions you can use to start your own reflection process:
- What cultures do you consider to be your own?
- What cultures do you interact with in your workplace?
- What beliefs do you have about each of those cultures?
- Where did you learn those beliefs?
- How might your beliefs impact the healthcare service you provide?
Strategies for Cultural Humility
Cultural humility will require a process of lifelong learning. You are going to have to unlearn and relearn ideas and values that you may have held onto for a long time. This process is hard, and may leave you feeling demoralized or uncertain what to do next. Don’t give up! Instead, focus on a useful next step that you can take on your own, at school or at work.
Things You Can Do
Public commitments/declarations. The First Nations Health Authority encouraged all BC health professionals to take part in the #itstartswithme campaign. Consider using social media, or a group of family and friends, to make your pledge. They can help keep you accountable and will give you a safe place to track your progress.
Self-Reflection Journal. Check in with yourself at regular intervals in writing, or using audio or video. Self-reflection can be a fantastic way to respond to questions and to help you track your growth. Don’t forget to go back and re-read your own entries. You can use them to help you see what is changing and what have you have learned.
Counselling. Oppression and racism are very triggering topics that impact all of us. If you are struggling with your mental health as you engage in this work, consult an expert who can help you. You don’t have to do this work alone! Mental health professionals may have tools and techniques that can help you with your own experience with these challenges.
Things You Can Do in Class
Class Discussion. As a student, bring these topics up when you discuss your professional practice and ethics. Use your teacher and your classmates to help you engage in cultural humility and in engaging more deeply with other cultures. Learn together!
Role Play. Take part in simulations where you play the role of healthcare professional and client. Do the hard work of imagining what it might be like to be the other person. Reflect on how it feels as you move throughout the patient-healthcare professional interaction at each stage of the process.
Report. Formally describe your experience. There may even be templates you can use that are designed for this process. If you encounter blatant acts of discrimination and oppression, tell an authority you trust. A teacher can be a good choice in a work integrated learning context. They may have resources and be able to work with your workplace to improve the situation.
Debrief. Throughout your work placement, take the time to debrief with your classmates and your teacher. If you can, try to do this in different forms. Talk, write, reflect on your experience.
Things Your Workplace Can Do
Disclose or report. Though you may feel uncomfortable telling on your co-workers, talk to your supervisor when you experience or witness microaggressions, covert, or overt examples of racism. Prioritize and protect vulnerable community members.
Engage in policy review. As a work-integrated learning student, you won’t be leading these kinds of efforts. However, you may participate in them. Let your boss know you are interested in this topic and offer to flag policies that may negatively impact Indigenous workers, clients, or customers.
Attend training, workshops, and events. Many workplaces offer additional professional development. These activities might focus on reconciliation, cultural safety, promotion of Indigenous cultures, cultural competency, or anti-racism efforts. For example, you might choose to participate in a blanket exercise. Your workplace may also choose to bring in external speakers or experts or engage in a reading circle.
- “Figure 4.2 Leading a Framework for Cultural Safety for First Nations in BC” © First Nations Health Authority is for personal, non-commercial use only.