Healthcare inclusion and Indigenous people

Being an RMT in Canada means having the immense privilege of treating many people from many different cultures. 

With that privilege comes the responsibility of ensuring all patients feel culturally safe accessing our services. Specifically, as all Canadian land belonged to the First Nations, Inuit, and Métis (FNMI) peoples before colonization, it is extremely important to understand what that means in the context of present-day society and health care. Historically, the relationship between Indigenous and non-Indigenous peoples in regards to health care has resulted in a system steeped with racism, bias, stigma, and unequal treatment and access for Canada’s first peoples (such as the Anishinaabe). As a society, we have been taught and told many untrue facts about Indigenous peoples and culture. It is critical for all health care providers (HCPs) to reflect and implement a practice that is inclusive and fully accessible for Indigenous people, one where we build relationships, understanding, and trust.

I am Anishinaabe (Ojibway) and a proud member of Beausoleil First Nation in Georgian Bay, Ontario, Canada. I belong to the Eagle clan, and my Anishinaabe spirit name is “Healing Hands Woman.” I am also of European ancestry, and I grew up outside of the culture. 

Walking in both worlds
I have had the unique honour of walking in both worlds and also working directly in the field with FNMI communities and people for the past 16 years. Before I became an RMT, it was important to me to learn about my Indigenous ancestry, so in my early 20s I went to college for Indigenous studies and also started attending ceremonies, such as the pow wow and sweat lodge. It was in college that I learned the unsettling truth of colonization, the legacy of residential schools, and how our history has had a negative impact on the health of FNMI peoples. I also started to view the world from a different perspective, as the Indigenous way of living and being is completely different from Western perspectives.

An indigenous perspective
Western medicine often follows a biomedical approach to treating illness. When I was in massage school, we also learned mostly from a clinical and biomedical perspective. Most people have heard of the concepts of body, mind, and spirit, but this is not something that is emphasized in most of our current health care settings in Canada. From the Indigenous perspective, everything is all connected and affects the health and wellness of the individual, family, community, and nation. These sacred teachings are told within the context of a circle or the “medicine wheel”; Western thinking is often very linear and not encompassing of a holistic approach to healing. To be accessible and inclusive of Indigenous peoples, an understanding of these vast differences must be learned, and some things must be unlearned.

Early on in my practice, I would go to an Indigenous healing lodge where they ran specific residential healing programs for various treatment options. In particular, I would massage people who were participating in the trauma recovery program. In this instance, trauma was an all-encompassing term that could include intergenerational trauma, residential school survivor trauma, being a victim of abuse and violence, and not being able to cope with the effects of colonization. My role was to provide massage on participants’ self-care day, near the end of the program, and to leave them with a positive physical experience and tools to take home. We would always start the day in a sharing circle, where we would cleanse with sacred herbs (smudging) and then self-reflect on what we were feeling and going through at the time. This allowed for the participants to meet me on a more intimate and personal level and for me to share in their healing journey. This approach to patient care enabled a greater sense of trust and cultural understanding.

Listening and learning
Working at the healing lodge allowed me to learn to be more inclusive of the unique needs of Indigenous people. I was able to listen and learn from their experiences and knowledge. I was practicing cultural awareness, cultural sensitivity, cultural competence, and cultural safety, all while providing trauma-informed care. These key concepts are essential to providing services that are accessible to Indigenous people. I was also very humbled working on many of these brave souls at the lodge, as I grew up outside of the culture and had no idea about the hardships and barriers they had to face. I had to come to terms with my own implicit bias about what I thought I knew about Indigenous people. Then I had to learn about how they view health and illness to become a better therapist.

Elder Dr. David Courchene once said that the best way to create Indigenous partnerships is to “get out of the box and back into the circle” (Allen et al, 2020). He was referring to the holistic viewpoint that Indigenous peoples follow. When looking at health and well-being, the physical, emotional, mental, and spiritual aspects of the person should be all looked at equally, in addition to the relationships one has to the land, family, and community (First Nations Health Authority, 2022). At the centre of the circle is always the individual, and to thrive in wellness, one must always look to all aspects of the circle for balance and guidance. It is important to understand the beliefs of your patients, their stories, their families, and their preferences, and to share your own story; storytelling is one of the main ways Indigenous peoples have passed on knowledge from generation to generation. Unfortunately, they have also passed on their stories from intergenerational trauma and colonization. Understanding the history of the people will help guide them into a healthier future.

Even though I’m part Indigenous, I had to recognize that I still grew up in a life of privilege and that I had many things to learn about what life is like for Indigenous people in Canada. I became an ally for Indigenous people, and the more truth I uncovered, the more I was able to help people correct their own implicit biases.

A variety of settings
I have also been doing work at a community health center that offers Indigenous-specific programming, as well as massage to Indigenous patients with diabetes. I also go to my own home reserve twice a month and offer massage and reflexology services. Over the past decade, I have gained invaluable experience working in a variety of settings that cater to Indigenous people. Many Indigenous people, like me, have grown up away from their culture and in urban areas, so putting everyone in the same category does not work well. The most important thing is taking interest in the stories of Indigenous people. Sometimes, hard topics like suicide, addiction, violence, and abuse come up, but these are all part of the factors that affect their health. There does seem to be a disproportionate number of Indigenous people affected by chronic disease. It is not uncommon to hear about people experiencing racism or barriers to accessing health services, even in urban areas. There is a lot of work that needs to be done in making Indigenous people feel included and not marginalized.

Simple ways to make your practice more inviting could include greeting people in their own language and being open to talking about cultural practices regarding traditional medicines or healers who patients may be seeing. Having an open heart and open mind about a more holistic treatment plan that looks beyond just the physical body of the person can also be helpful. Become an ally for Indigenous people and take up a space around the medicine wheel as part of their circle of care. Change outdated biomedical practices that are not designed to get to know patients on a personal level. Look at how you can incorporate trauma-informed care into your practice. Always practice self-reflection and commit to new values of respect, diversity, and inclusivity. We can all do better, but we can get stuck in a certain routine or mindset, so challenging ourselves to “step outside the box” is what all HCPs need to do.

Giving relief and hope
Bringing massage therapy to Indigenous people over the years has been one of the most rewarding experiences of my career. Many of them have not had insurance coverage or access to funds to pay for alternative therapies. Most are stuck with taking prescription medications to cope with whatever ails them or are left feeling like there are no options. Many times, I have witnessed people overcome a fear of physical touch and become very appreciative of someone caring enough to make them feel good or listening to their story. Giving relief and hope to people who have had so much taken away from them is a humbling experience. The Anishinaabe people really do have a rich and vibrant culture and so much to share and teach everyone. They can show us how to live in balance and how to walk life in a good way, in harmony within ourselves and with the world around us. The choice to become part of the solution, instead of prescribing according to the same outdated system, is within all of us to make. 

Charmaine Whitman is an RMT that focuses her massage therapy career on the health of the Indigenous community.

Reprinted with permission from Massage Therapy Today.

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