Montreal Hospital, Indigenous Partner takes a holistic approach to health care for Indigenous peoples

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 learn to better understand this community and earn their trust.

“Because of the intergenerational trauma, there is a lot of fear and mistrust,” says Kim Delisle, community health coordinator for Projects Autochtones du Québec and one of the project’s leaders. PAQ provides accommodation, 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 Center hospitalier de l’Université de Montréal (CHUM) to help overcome this mistrust and improve health outcomes.

The project, called indigenous wellness with, for 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 services to other CHUM departments and eventually to hospitals throughout the province.

Scotiabank has announced that 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 social impact and engagement 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 of Wealth Management, Private Banking for Eastern Canada , Scotiabank. “By supporting this program, we are helping to improve the lives of those affected and build stronger, more resilient communities.”

“Two eyes vision” approach.

PAQ and CHUM adopted a “two-eyed vision” approach that combines Indigenous and Western health knowledge to provide patients with culturally sensitive care.

Delisle and his PAQ colleagues, called navigators, offer support services to indigenous people receiving treatment at the CHUM. They accompany them to appointments, provide translation, offer psychosocial support, and bring in the elderly to provide comfort.

“What we’ve really tried to do is improve the care pathway and the circle of care to be able to make sure that people go back to their appointments, that they’re accompanied, that we’re working with all the community organizations to make sure that that we all come together to support community members,” said Dr. Stephanie Marsan, chief medical officer of CHUM’s Addiction Medicine Service and one of the project’s leaders.

The clinical and research components of the project aim to identify and overcome critical barriers indigenous people face in accessing care within the CHUM and eventually all hospitals in the province, Marsan said .

The city’s biggest challenges

Delisle said Indigenous people from all over Quebec, and even further afield, are drawn to Montreal for work, school, medical or other needs, or just the appeal of the big city What they get when they arrive is not always what they expected.

“Unfortunately, with the big change of coming from remote communities, they come here and it would be like going to Las Vegas, with 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 step off the plane in Montreal, Delisle says. Bad actors target flights arriving from indigenous communities in the north, speak to the newcomers with a few words in Inuktitut, and try to lure them into drugs or prostitution.

“They fall through the cracks, and that’s when they end up coming to us,” says Delisle. “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 meaningfully connect with the indigenous community.

He recalls an incident more than 10 years ago, when a woman from the Mohawk territory of Kahnawake, just south of Montreal, came to the hospital for addiction treatment. She wanted to make her traditional beads, 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 to keep anything sharp away from patients. The woman’s beading tools were taken from her until she left.

“That caused a lot of angst among community members and really brought up the fact that we needed to do things differently,” Marsan said. “We had to change the way we deliver services and there was really a lack of understanding about all of this.”

One of the results of this self-reflection was the collaboration with PAQ. Since launching in 2021, Delisle and her colleagues, whose offices are just five minutes from the hospital, interact daily with hospital staff and Indigenous patients.

The interaction can be as simple as making sure a person waiting in the emergency room doesn’t miss their turn because the person calling 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 making sure they go to vital follow-up appointments.

Delisle and his team have become recognized figures in the emergency room and elsewhere.

“When I started the position, I was not considered the same as the CHUM staff,” he said. “But over time, it changed. So now the 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 help, can you come?” So yeah, it’s a big change. It’s not perfect yet, but we’re working on it.”

Understand values ​​and culture

A large part of the change involves training hospital staff and management to better understand the values, cultures and particular needs of their Indigenous patients and incorporate them into their care plans. That wasn’t easy at first, Marsan said.

“I was kind of naive and thought, ‘OK, we’ve got this program running with PAQ, we’ll just offer it and everything will be fine.’ But it was a bit of a bumpy road. There was pushback from the medical teams that they were used to to do things a certain way.”

“But that’s part of the process and I think now there’s more understanding and more willingness to work together and people realize we need to change things.”

Marsan said health professionals recognize that Indigenous people are fearful and distrustful of institutions like hospitals, often with good reason. Just a few weeks ago, the Canadian Medical Association apologized for the past and ongoing harms the medical profession has inflicted on Indigenous peoples.

Health professionals also often feel they are not equipped to best deal with these situations, he said.

“What I’ve also heard a lot from hospital teams is that they’re afraid of not saying the right thing, of not doing the right thing, of saying something that’s going to make things worse,” Marsan said.

“So we’re really trying to change that and provide the confidence and knowledge to be able to provide care in a culturally sensitive way.”

Training takes the form of conferences and workshops, as well as individual support and guidance. Guided tours of the PAQ reception facilities have also been organized so that CHUM staff can better understand the challenges these patients face.

Marsan’s goal is for holistic, culturally safe health services to become an organic part of the culture not only at CHUM, but at hospitals across the province.

“It should not be considered a special project. It should just be the way things are. That would be a dream come true.”