VANCOUVER — When Dr. Evan Adams walked into an emergency room in Vancouver with a cut finger, a clerk taking his information made a racist remark that stung.
“She said, ‘Oh, you’re First Nations.’ I said yes, and she said, ‘I hear you guys get everything for free.’”
“Was she trying to humiliate me? Was she having verbal diarrhea? Was she having a bad day? I don’t know what it was but I didn’t need that,” said Adams, medical officer of the First Nations Health Authority in British Columbia.
That recent experience was further confirmation of the “cultural humiliation” Adams said First Nations patients are familiar with as part of a health-care system they can’t trust ‚Äî from front-line workers in clinics to nurses and doctors providing long-term cancer treatment.
The Canadian Partnership Against Cancer has identified the elimination of racism as a priority after a campaign last fall seeking feedback to update a national plan established in 2006 to tackle all aspects of cancer care.
Cindy Morton, CEO of CPAC, said 7,500 responses, including from patients, health-care workers and cancer agencies, as well as consultations across the country helped the non-profit organization establish overall priorities. Those include enhanced prevention and screening, faster diagnosis, adapting care for the specific needs of underserved groups, better support for patients and families and addressing unequal access to palliative and end-of-life care.
The new strategy for cancer control also prioritizes the needs of Indigenous Peoples, who were not consulted when the plan was initiated 13 years ago by CPAC, which will forward a report on Tuesday to federal Health Minister Ginette Petitpas Taylor.
First Nations, Inuit and Metis require delivery of “culturally safe” care closer to home, with all three groups involved as partners in cancer care that has been inequitable for them to start with, especially in rural and remote communities, Morton said.
“All three peoples told us that they still remain with a sense of discomfort and a lack of safety when they are dealing with non-Indigenous or not-culturally trained medical professionals. That is their number one priority, that we have to create a system where they feel they are treated in a non-discriminatory and respectful way.”
Mistrust of the system often prevents Indigenous groups from disclosing everything about their illness or their cultural beliefs that may include use of traditional medicine, Morton said, adding patients sometimes feel their symptoms are dismissed or they’re not taken as seriously when they complain of pain or get delayed access to care.
“There really is a systemic concern that there needs to be a different way to pay attention to the concerns and the needs of the Indigenous population when they’re going into a mainstream treatment system.”
Morton said she was struck by the challenges faced by people heading from Iqaluit to Ottawa for cancer treatment as she recently sat at the airport in the capital city of Nunavut.
“Many of them had never left Nunavut and many had never been on a plane, and suddenly they’re about to land in Ottawa.”
Residents of Nunavut said during consultations that they’d rather get cancer care in their own communities so they have the support of family and don’t have to travel hundreds of kilometres away, Morton said.
“It’s a very different world and we haven’t figured out yet how to meet their needs,” she said, adding mobile vans providing screening for breast and lung cancer, for example, could be one way to address the needs of remote communities where patients need to feel respected, first and foremost.
As part of its cancer strategy, CPAC has funded the Canadian Indigenous Nurses Association to develop a curriculum that would help deliver culturally appropriate care across the country, likely starting in 2022, Morton said.
Marilee Nowgesic, executive director of the association, said the curriculum would also provide training for social workers who often make travel arrangements for patients needing escorts to explain multiple issues involving cancer treatment to people whose languages don’t have words for chemotherapy and radiation, for example.
“They don’t understand how the white world works,” Nowgesic said.
“We’re saying to the non-Indigenous partner in the health-care profession, ‘You have a responsibility to look at how you’re going to engage authentically, meaningfully with patients.’ They’re looking at us and saying, ‘We have no idea.’
“We’re saying, ‘We’ll work with you.’ “
Nowgesic said culturally appropriate content should be a mandatory part of the nursing curriculum, not an elective, for care providers who are often shocked to hear about issues including the residential schools system and its legacy of racism for Indigenous communities.
She said the Canadian Indigenous Nurses Association is also working with the Royal College of Physicians and Surgeons of Canada and the Indigenous Physicians Association of Canada as it develops a curriculum it wants adopted in 96 nursing schools across the country, with an aim to also have it used as a model for doctors in training.
“What we don’t want to see is when an Indigenous student is involved in the program that they’re expected to be the teacher.”