Above: Kim Delisle (left) and Dr. Stephanie Marsan (right)
For some members of Montreal’s Indigenous community, getting the care they need means being able to trust the institutions that can help them — and those institutions learning to better understand that community and earn its trust.
“Because of intergenerational trauma, there's a lot of fear and mistrust,” says Kim Delisle, Community Health Coordinator with Projets Autochtones du Québec and one of the leaders of the project. PAQ offers shelter, housing options and other services to First Nations, Inuit and Métis people, and advocates for the health and housing rights of urban Indigenous Peoples.
Delisle says a combination of discrimination, bad past experiences and other things have often made Indigenous people — especially those experiencing homelessness — unwilling to seek treatment for their health problems.
PAQ partnered in 2021 with the Centre hospitalier de l’Université de Montréal (CHUM) to help overcome that mistrust and improve health outcomes.
The project — called Indigenous wellness with, by and for Indigenous Peoples — aims to create “an inclusive and equitable environment where patients can receive highly specialized holistic care that is sensitive to the cultures and values of Indigenous communities.”
The initial phase of the project was implemented in emergency medicine, internal medicine, and addiction medicine and psychiatry. Over the next five years, the goal is to expand the services to other departments at CHUM, and eventually to hospitals across the province.
Scotiabank has announced it will donate $1 million over five years to the CHUM Foundation to support the project. The donation is part of ScotiaRISE, Scotiabank’s $500-million commitment and social impact initiative aimed at promoting economic resilience among disadvantaged groups.
“Facilitating access to health care for people who come from Indigenous communities is an integral part of a reconciliation process,” says Pierre Laboursodière, Vice-President, Wealth Management, Private Banking for Eastern Canada, Scotiabank. “By supporting this program, we are helping to improve the lives of those impacted and building stronger, more resilient communities.”
‘Two-eye seeing’ approach
PAQ and CHUM adopted a “two-eye seeing” approach that combines Indigenous and Western health care knowledge to provide patients with culturally sensitive care.
Delisle and her PAQ colleagues, called navigators, offer support services to Indigenous people getting treatment at the CHUM. They accompany them to appointments, provide translation, offer psychosocial support and have Elders come to provide additional comfort.
“What we've really tried to do is enhance the care trajectory and circle of care so we can make sure people are coming back to their appointments, that they're accompanied, that we’re working with all the community organizations to make sure that we all come together to support community member,” said Dr. Stephanie Marsan, medical chief of the Addiction Medicine Service at CHUM and one of the leaders on the project.
The clinical and research components of the project aim to identify and overcome critical obstacles that Indigenous people face in accessing care within the CHUM, and ultimately, in all hospitals across the province, Marsan said.
Because of intergenerational trauma, there's a lot of fear and mistrust.”
Big city challenges
Delisle said Indigenous people from all over Quebec, and even farther afield, are drawn to Montreal for work, for school, for medical or other needs, or just because of the lure of the big city. What they get when they arrive isn’t always what they hoped for.
“Unfortunately, with the big change from coming from remote communities, they come here and it would be like going to Vegas, all the bright lights and all the excitement. And then it takes them in the wrong direction.”
That wrong turn can happen as soon as they get off the plane in Montreal, Delisle says. Bad actors target flights arriving from northern Indigenous communities, talk to the new arrivals with a few words of Inuktitut and try to draw them into drugs or prostitution.
“They fall through the cracks, and that’s when they end up coming to us,” Delisle says. “They’re looking for detox, they’re looking for medical care, which they’re not getting because they’re living on the streets.”
Marsan is familiar with the challenges the hospital has had in trying to connect meaningfully with the Indigenous community.
She recalls an incident more than 10 years ago, when a woman from the Kahnawake Mohawk Territory, just south of Montreal, came to the hospital for addiction treatment. She wanted to do her traditional beading, which helped ground her and control her anxiety. But because the addiction medicine unit shared its space with addiction psychiatry, there were strict safety protocols about taking anything sharp away from patients. The woman’s beading tools were taken away from her until she left.
“That caused a lot of distress among members of the community, and it really brought up the fact that we needed to do differently,” Marsan said. “We needed to change the way we offered services and there was really a lack of understanding about all that.”
One of the results of that self-reflection was the partnership with PAQ. Since it launched in 2021, Delisle and her colleagues, whose offices are just five minutes from the hospital, interact on a daily basis with hospital staff and Indigenous patients.
The interaction can be as simple as making sure a person waiting in the emergency department doesn’t miss their turn because the person calling out their name doesn’t pronounce it correctly. Or it can be more involved, such as making sure a patient understands the often-complex medical terms they’ll hear, or ensuring they go to vital follow-up appointments.
Delisle and her team have become recognized figures in the emergency ward and elsewhere.
“When I first started the position, I wasn’t looked upon as equal to CHUM staff,” she said. “But as time went by, it changed. So now doctors know me and the ER staff know who I am. I have social workers calling me saying, ‘hey, we have a community member here, we need your assistance, can you come over?’ So yes, it's a big change. It's not perfect yet, but we're working on it.”
Understanding values and culture
A big part of the change is in training staff and management at the hospital to better understand the values, cultures and particular needs of their Indigenous patients, and to build those into their care plans. That wasn’t easy at first, Marsan said.
“I was a little naive and thinking, ‘OK, we’ve got this program working with PAQ, we're just going to offer it and everything will go well’. But it was a bit of a bumpy road. There was pushback from medical teams who were used to doing things a certain way.”
“But that's part of the process and I think there's more of an understanding and more willingness now to work together and people are realizing we need to change things.”
Marsan said health professionals recognize that Indigenous people are afraid and mistrustful of institutions like hospitals, often for good reason. Just a few weeks ago, the Canadian Medical Association apologized for past and ongoing harms the medical profession has inflicted on Indigenous Peoples.
Health professionals also often feel like they’re not equipped to deal with those situations in the best way, she said.
“What I also heard a lot from the hospital teams is that they are scared of not saying the right thing, not doing the right thing, saying something that's going to make things worse,” Marsan said.
“So we're really trying to change that and to provide the confidence and the knowledge to be able to provide the care in a culturally sensitive way.”
The training takes the form of conferences and workshops, as well as one-on-one support and guidance. Tours of PAQ’s shelter facilities have also been organized to give CHUM staff a better understanding of the challenges those patients face.
Marsan’s goal is that holistic, culturally safe health care services will eventually become an organic part of the culture of not just CHUM, but hospitals across the province.
“It shouldn’t be considered a special project. It should just be the way things are. That would be a dream come true.”
