What are some considerations for physicians caring for Indigenous patients during the pandemic? 

Posted on June 2, 2020 by Tomas Rapaport

Summary

Primary consideration is the concept of “Cultural Humility”, a process of self-reflection to understand the personal and systemic biases and develop and maintain respectful processes and relationships based on mutual trust. It involves acknowledging oneself as a learner when it comes to understanding another’s experience (1). More specific considerations include history of epidemics in First Nations’ communities, disease in residential schools, Indian Hospitals, distrust in government policies, remote communities with different worldviews, systemic racism, relationships with elderly population (1). The First Nations Health Authority in British Columbia has published thorough resources for providers and patients who identify as Indigenous. Highlights relevant to the question can be seen below, however, all resources warrant a closer look. 

I.   First Nations Health Authority information & resources:

 

Culturally relevant strengths-based model to remain connected (2)

 

  • The current COVID-19 pandemic may remind us of past stories or activate blood memories of relatives impacted by colonization and intergenerational trauma. Some of our relatives may have been deliberately exposed to infectious disease or experienced inadequate health care and health resources.
  • Highlights leaning on cultural strengths and knowledge that First Nations have a long history of resilience
  • Gives ideas of ways to spend time with one’s kids and connect with Elders and other community members

 

COVID-19 FAQs (3)

 

 

  • Answers to common COVID-19 questions regarding transmission and symptoms
  • Addresses safety of specific cultural gatherings, “It is no longer safe to participate in cultural gatherings…”, and advices to suspend sweat lodges and pipe ceremonies 
  • Speaks to issues of medical transportation for individuals living in remote communities

 

CPD Rural COVID-19 Rounds: Indigenous Health and Cultural Safety in a Pandemic April 30, 2020 (4)

 

  • Recall, this is not the first experience with a pandemic: H1N1 hit First Nations harder than other communities
  • Smallpox, Tuberculosis, other diseases affected First Nations more than settler populations and these events are still remembered in community and distrust exists towards Western health care systems
  • Current pandemic is in the context of an Opioid Emergency in BC which disproportionately affects Indigenous people
  • Wildfire and flood season has begun in many First Nations communities

II.   UBC Center for Excellence in Indigenous Health presentation on Cultural Safety: Historic & Contemporary Realities through a Trauma Informed Lens April 17, 2020 (1):

  • Issues to keep in mind: history of epidemics, disease in residential schools, Indian Hospitals, distrust in government policies, remote communities with different worldviews, systemic racism, relationship with elderly population

III.   Resources from the Government of British Columbia for all Indigenous Peoples (5):

IV.   Resources from the Government of Canada for designated Indigenous communities:

 

  • Handwashing during water advisories. If a community is on a boil water advisory, you may still use the water with soap for personal hygiene. If a community is on a do not use advisory, it is not safe for any use and bottled water should be used with soap (6)
  • Guide to accessing additional supports for First Nations communities  is available online with step-by-step instructions on how to apply (7)

 

 

Note: the original question came from a provider in British Columbia, and as such, our review focused on considerations and resources in this geographical location.

Questions? Comments? Does this need to be updated? Do you have valuable points to add ? Please email ask.reakt@ubc.ca.

References

    1. April 16th, 2020 –  Cultural Safety in the Face of a Pandemic: Historic and Contemporary Realities through a Trauma Informed Lens with Harley Eagle | UBC Learning Circle [Internet]. Learningcircle.ubc.ca. 2020 [cited 2020 May 6]. Available from: https://learningcircle.ubc.ca/2020/01/24/mar312020-harley-eagle/
    2. First Nations Health Authority. Staying Connected during the Pandemic: Drawing on Indigenous Strengths to Stay Connected and Well [Internet]. British Columbia: First Nations Health Authority; [cited 2020 May 6]. Available from: https://www.fnha.ca/Documents/FNHA-Staying-Connected-During-the-COVID-19-Pandemic.pdf
    3. First Nations Health Authority. Frequently Asked Questions About COVID-19 [Internet]. British Columbia: First Nations Health Authority; [cited 2020 May 6]. Available from: https://www.fnha.ca/Documents/FNHA-COVID-19-Frequently-Asked-Questions.pdf
    4. Rural COVID-19 Rounds: Indigenous Health and Cultural Safety in a Pandemic | UBC CPD [Internet]. Ubccpd.ca. 2020 [cited 2020 May 6]. Available from: https://ubccpd.ca/rural-covid-19-rounds-indigenous-health-and-cultural-safety-pandemic
    5. COVID-19: Information for First Nations and Indigenous Peoples in B.C. – Province of British Columbia [Internet]. Gov.bc.ca. 2020 [cited 2020 Jun 2]. Available from: https://www2.gov.bc.ca/gov/content/governments/indigenous-people/covid19 
    6. Government of Canada; Indigenous Services Canada. Coronavirus (COVID-19) and Indigenous communities [Internet]. Sac-isc.gc.ca. 2014 [cited 2020 Jun 2]. Available from: https://www.sac-isc.gc.ca/eng/1581964230816/1581964277298#chap6
    7. Government of Canada; Indigenous Services Canada. COVID-19: First Nations community guide on accessing additional supports [Internet]. Sac-isc.gc.ca. 2020 [cited 2020 Jun 2]. Available from: https://www.sac-isc.gc.ca/eng/1584819394157/1584819418553

Disclaimer

The above is intended to serve as a rapidly-created, accessible source of information curated by medical students and healthcare professionals. It is for educational purposes only and is not a complete reference resource. It is not professional medical advice, and is not a substitute for the discretion, judgment, and duties of healthcare professionals. You are solely responsible for evaluating the information above.