Chapter 22: Indigenous Health & Nursing Practice

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You know, there's a very specific story we tell ourselves about health care in Canada.

It's almost part of the national DNA.

It is.

It's a point of pride.

Yeah, a huge point of pride.

We think of the system as benevolent.

We think of it as universal.

And really, we think of it as a place of safety.

If you get sick, the system is there to catch you.

It's the operational definition, for a lot of people, of what it means to be Canadian, this idea that we take care of one another.

Exactly.

But then you pick up a document, like the one we're covering today, Chapter 22 of Community Health Nursing, A Canadian Perspective, the fifth edition.

And that whole story just, it cracks.

It shatters.

It does, because you realize that for the original inhabitants of this land, health care wasn't historically a tool for healing.

It wasn't a safety net.

No.

For a very long time, and the text makes this brutally clear, health care was a tool for assimilation.

It was a mechanism of control.

And in many ways, a weapon.

It was.

That is a heavy realization to start with, but it's really the only honest place to begin.

Welcome back to the Deep Dive.

Hello, everyone.

Today, we are unpacking Indigenous Health and Community Health Nursing.

And I want to set the stage here.

Yeah.

Our mission isn't just to help nursing students pass an exam, though we are definitely going to help you do that.

We are.

This is for anyone who wants to understand the fault lines in our society.

Precisely.

If you're looking at the health statistics today, I mean the massive gaps between Indigenous and non -Indigenous health outcomes, and you're asking why,

yeah, you cannot answer that question without looking at the architecture of the system.

Right.

This chapter serves as a blueprint of that architecture.

We are going to guide you through the history, the legislation, the hard data, and the future frameworks necessary to provide what the text calls culturally safe care.

And just a quick note on the source material before we jump in.

This isn't your standard dry medical text.

It's surprisingly eclectic.

Oh, very.

We've got hard government statistics and legal analysis, but then we also have traditional stories, oral history, and even blessings.

Which is a signal in itself, isn't it?

It tells us that to understand this topic,

Western science alone isn't enough.

You need a much broader toolkit.

So let's start right where the chapter starts, because the authors make a very specific choice here.

Usually, you open a textbook chapter, and you get a bulleted list of learning objectives.

The standard stuff, yeah.

But chapter 22 opens with a blessing.

It does.

A blessing by Elder Gwen Campbell MacArthur.

Why do that?

I mean, why do you think they made that choice?

Is it just decorative?

Not at all.

It's a pedagogical strategy.

It's setting the epistemological stage, which is just a fancy way of saying it's setting the rules for how we are going to learn.

In Western academia, we are trained to extract facts.

We want to grab the data and run with it.

But starting with a blessing, it forces the reader to slow down.

It grounds you in a spirit of inquiry and respect.

There is a line in that blessing that I underlined three times.

She writes,

take only what you need, leave what you do not.

And that is such a countercultural instruction for a student, isn't it?

Usually, you're told to memorize everything to conquer the material.

But this indigenous perspective suggests that learning is a relationship.

It implies humility.

It says, you are a visitor in this knowledge system.

Take what serves your spirit and your practice to help others and respect what you might not be ready for.

It's a totally different starting point.

It is.

It's not, here are the facts you must master.

It really is.

It changes the posture of the student from a master to a learner.

And speaking of learning,

we need to tackle the vocabulary right away.

The text spends a significant amount of time right up front decoding the terminology.

Which is so important.

And I know sometimes listeners might feel like, oh, is this just about being politically correct?

Why does it matter which word I use?

The text is very firm on this.

This is not about PC culture.

Accuracy in terminology is about two things.

Legal precision and decolonization.

OK, unpack that.

Well, words in this context carry legal rights and historical weight.

If you use the wrong word, you aren't just being impolite.

You might be misidentifying someone's legal standing or literally erasing their identity.

So let's break down the big three terms the text distinguishes.

Aboriginal, indigenous, and First Nations.

We hear them used almost interchangeably in the media.

But the text draws some pretty hard lines.

Let's start with aboriginal.

OK, so aboriginal is described in the text as a colonial term.

It's a legal definition.

It comes specifically from the Constitution Act of 1982.

It's the umbrella term the Canadian government created to encompass First Nations, Metis, and Inuit peoples.

So when I say aboriginal, I'm using the government's language.

Essentially, yes.

You are referencing a constitutional category.

OK, so contrast that with indigenous.

Indigenous is the preferred international term.

It's the language of the United Nations.

And what it does is connect the peoples here to a global community of original inhabitants, you know, in New Zealand, Australia, South America.

Oh, I see.

It emphasizes inherent rights that exist outside of Canadian law.

It's a term of solomality and self -determination.

So aboriginal is what the government calls them.

Indigenous is what represents their global rights and humanity.

That's a really good way to frame it.

And then under that umbrella, we have the specific distinctions.

You have First Nations, which refers to the original nation south of the Arctic.

You have Inuit, which means the people in Inuktitut, the indigenous peoples of the Arctic.

And then you have the Metis.

OK, I want to spend a moment on the Metis, because I think this is the most common point of confusion.

I've heard people say, well, I have one indigenous great grandparents, so I guess I'm Metis.

And the text works really hard to correct that exact misconception.

Being Metis isn't a math equation about blood quantum or just having mixed ancestry.

The Metis are a distinct sociological and political nation.

Yes.

They emerged in the Red River area in the 18th and 19th centuries, largely from unions between First Nations women and European fur traders.

But, and this is the absolute pee, they didn't just assimilate into one side or the other.

They developed their own culture.

They have their own language, right?

Yes, mid -chief.

They have their own flag, their own music, their own governance structures.

They were recognized in the 1982 Constitution as a distinct people.

So it's not a catch -all term for mixed ancestry.

Not at all.

Simply having mixed blood doesn't make you Metis.

Being part of the historic Metis nation and community makes you Metis.

It's about political and cultural belonging, not just your DNA.

That is a crucial distinction.

OK, so we have our vocabulary set.

Now we need to look at the history.

And the text makes a point of starting pre -contact.

Why start there?

Why not just start when the settlers arrived?

Because if you start with the settlers, you implicitly accept the myth of terra nullius.

Terra nullius, empty land.

Right.

This was the legal fiction used to justify colonization.

The idea was that Europeans arrived on a continent that was basically a vacant lot just waiting to be developed.

But the text provides data that completely shatters that myth.

But early.

The numbers are staggering.

The text cites estimates of 18 million inhabitants on the continent before contact.

18 million.

And it wasn't a monolith.

They mentioned over 2 ,200 distinct languages.

That is more linguistic diversity than all of Europe has today.

Far more.

And these weren't people just struggling to survive.

The text emphasizes that they had fully functioning, complex societies.

They had governance, trade networks, and most importantly for our discussion, they had a health system.

Whale health system.

Absolutely.

They had traditional knowledge, what they call IK, medicinal pharmacopias, even surgeries and holistic practices connecting mind, body, and spirit.

These were healthy, thriving societies.

And then we get to what the outline calls the colonial onslaught.

The text details the arrival of the fur trade and missionaries and the immediate impact is biological.

This is the first wave of devastation.

The introduction of smallpox, tuberculosis, and measles.

The indigenous populations had no prior exposure, so zero immunity.

The text states that populations were decimated by up to 90%.

I just wanna pause on that number, 90%.

It's hard to even wrap your head around what that means for a civilization.

It's apocalyptic.

It truly is.

Imagine your own community.

Now imagine nine out of 10 people you know die within a few years.

It's unthinkable.

You lose your political leaders, you lose the parents, but critically in an oral culture, you lose the library.

The elders are the holders of medical knowledge, of history, of ceremony.

When they die en masse, it causes a fragmentation of culture that is almost impossible to quantify.

And the text points out that this wasn't just bad luck with germs, it was coupled with resource depletion.

Right, the settlers systematically depleted the food sources, the buffalo, the beaver.

So you have a population that is sick reeling from plague and now they are starving because their entire economic engine has been destroyed.

And while they are in this state of extreme vulnerability, the British crown steps in with what the text calls the legal machinery of assimilation.

It starts with the Royal Proclamation of 1763.

Which is often cited as a document protecting indigenous rights, but the text highlights the fundamental misunderstanding.

How so?

Well, First Nations viewed the treaties that came from it as land sharing.

We live here, you live here, we share the bounty.

The British viewed them as land session.

Meaning?

Meaning you sign here, you leave, and we own it.

Two completely different worldviews.

And that misunderstanding paved the way for the Indian Act of 1876.

If there is one document the text frames as the villain of the story, it's this one.

The Indian Act is the mechanism of control.

It consolidated all previous laws into one totalitarian rule book.

It defined who was an Indian and who wasn't.

It controlled the reserve lands.

But the phrase that really chills me is that it treated indigenous people as wards of the state.

Wards that legally infantilize them.

Completely.

It deemed them legally incapable of managing their own affairs.

The government became the parent.

And this allowed for policies like the PASS system.

The PASS system.

The text describes this.

And I think for people who think of Canada as this free country, this is shocking.

It is.

It effectively turned reserves into open air prisons.

For decades, if an indigenous person wanted to leave their reserve, to go to the market, to visit a relative, even to go see a doctor,

they needed a written pass signed by the Indian agent.

The Indian agent being the white government bureaucrat assigned to watch them.

Exactly.

And he could say no, arbitrarily.

No, you can't go sell your wheat.

No, you can't visit your dying aunt.

It controlled their movement, their economy, and their family connections.

And the goal of all this control wasn't just management.

It was erasure.

It was explicitly erasure.

The text includes a quote from Sir John A.

MacDonald, Canada's first prime minister.

And hearing it, it's just undisguised racism.

It's necessary to read it to understand the intent.

He explicitly said the goal was to withdraw the Indian child from the parental influence.

He called the parents savages.

He believed that if you left the child with the parents, the child would remain a savage.

So the only way to civilize them was to sever the bond between parent and child.

That was the philosophy.

And that philosophy built the residential schools.

The IRS system.

The text lays out the scope.

135 schools,

150 ,000 children taken.

But the statistics don't capture the reality.

These were institutions designed to kill the culture in the child.

They were punished for speaking their languages.

Their hair was cut, which the text notes is a symbol of mourning in many indigenous cultures.

So you take a child, you cut their hair, you forbid their language, and you tell them their parents are evil and their culture is worthless.

And that's before you even get to the abuse.

The abuse.

The text doesn't shy away from it at all.

Physical, sexual, spiritual abuse.

It was rampant.

But I think the most powerful thing in this section of the chapter is photo 22 .1.

It's a picture of a letter regarding a man named J .B.

Gambler.

Tell us about that letter.

It really anchors the bureaucracy in a human story.

J .B.

Gambler was a father.

In 1935, he removed his children from the Waboska Residential School.

We don't know exactly why, maybe they were sick, maybe they were being beaten, maybe he just missed them.

But he took them home.

As any parent would want to.

And the Indian agent wrote a letter to a local store clerk ordering that J .B.

Gambler's rations be cut off.

They use starvation as a punishment.

The letter says, do not give him any food until he returns the children.

That is the level of coercion we are talking about.

Parents didn't willingly send their children away for a better education.

They were forced, often under threat of imprisonment or starvation.

And the result of this system, which ran for over a century, the last one closed in 1996.

1996, it's not ancient history.

No, the result is what the text calls intergenerational trauma.

This is a key concept for nurses.

It's absolutely critical.

Trauma isn't just something that happens to one person.

If you raise generations of children in institutions without love, without parenting models, and subject them to abuse, they do not learn how to parent.

So they return to their communities broken.

Broken, and that trauma ripples down.

It manifests in the next generation as addiction, as family violence, as mental health struggles.

It is not a genetic failure.

It is a historical injury that keeps bleeding.

And just when the schools started to fade out, the system just, it shifted tactics.

The text discusses the 60s scoop.

This was the transition from the education system to the child welfare system.

Social workers applying white middle -class standards to indigenous families living in enforced poverty would label the homes neglectful.

Then they would take the kids.

En masse.

The text notes that by 1977, 20 % of all children in care in Canada were indigenous.

20%, that is a massive overrepresentation.

Huge.

And these kids were scooped and adopted out into non -indigenous families, often thousands of miles away.

It achieved the exact same goal as the schools, severing the child from the culture.

Now, we need to talk about the healthcare institutions specifically, because there is a term the text uses,

Indian hospitals.

And I think if you just hear that term, you might think, oh, specialized care, that sounds good.

That is the assumption, right?

But the text clarifies that these were not hospitals in the sense of service and healing.

They were tools of segregation.

Segregation.

They were established largely to isolate tuberculosis patients.

The fear wasn't indigenous people are sick, we must help them.

The fear was indigenous people have TB, and they might infect the white population, so we must contain them.

And the text lists some truly horrific practices within these hospitals.

It does, it mentions forced sterilization, it mentions medical experimentation, and it notes that under the Communicable Disease Control Act, people could be arrested and held in these hospitals against their will.

So if you're a nurse today, and you have an older indigenous patient who seems terrified of the hospital, or who is resistant to your advice.

You have to look at it through this lens.

For that patient, the white coat isn't a symbol of help.

It's a symbol of the jailer.

It's the uniform of the people who sterilized their aunt, or experimented on their grandfather.

That mistrust is earned.

It is not irrational.

It is a survival mechanism based on evidence.

That is such a vital reframing.

We so often label patients non -compliant, then they're actually just historically aware.

Exactly.

Okay, let's move to the current system.

Because if the history is tragic, the current bureaucracy is just a maze.

The text calls it the maze of healthcare delivery.

And it all stems from that distinction of status versus non -status.

This is the bureaucratic nightmare.

The Indian Act defined who had status.

But you could lose that status through a process called enfranchisement.

Enfranchisement usually sounds like a good thing, like getting the vote.

Here, it was a trap.

The text explains that for a long time, if a status Indian wanted to be treated as a full person in Canadian law to vote, to own property off reserve, they had to give up their status.

And who did this happen to?

Anyone who became civilized in the eyes of the government.

If you became a doctor, a lawyer, a clergyman, or if you joined the military, you lost your status.

You were no longer considered an Indian.

Wow.

And devastatingly, if a status Indian woman married a non -status man, she lost her status, and her children lost theirs.

So the system was literally designed to shrink the number of people the government was responsible for.

Precisely.

And today, this creates what you called jurisdictional football.

Here is the breakdown the text provides.

If you are First Nations and you live on reserve, or if you are Inuit, your health services are funded by the federal government, specifically Indigenous Services Canada, or ISC.

Okay, federal, got it.

But if you are Metis, or if you are First Nations but live off reserve, say you move to Toronto for a job, you are generally the responsibility of the province.

Wait, so if you move house, your entire healthcare funding structure changes.

Yes, and this creates huge gaps.

The text discusses Jordan's principle here.

This is named after Jordan River Anderson, a young boy from Norway, House Cree Nation, born with complex medical needs.

Tell us his story.

He spent his entire life five years in hospital.

Not because he needed to be there medically for that long, but because the federal and provincial governments were arguing over who should pay for his specialized home care.

They were fighting over the bill while he was stuck in a hospital.

Yes, he died in the hospital while they fought over the invoice.

That's, that is just heartbreaking.

It's unconscionable.

Jordan's principle is a legal rule that was established to stop this from happening again.

It says, the child gets the care first, the government departments can fight about who pays for it later.

It's tragic that we needed a law to enforce that basic level of humanity.

But the text does offer some hope here regarding governance.

It talks about the transfer of control.

Yes, and this is a really positive shift.

We are seeing a move towards self -governance.

The text highlights the First Nations Health Authority, the FNHA in British Columbia.

That's different about that.

It's a health system run by First Nations for First Nations.

It takes the federal government out of the driver's seat.

It allows communities to design care that actually fits their unique needs and cultural values.

I wanna shift now to a visual model in the text that I found incredibly helpful.

It's figure 22 .1, the determinants of health tree.

This is a brilliant visualization.

I wish every nursing textbook used something like this.

So if you're listening, imagine a tree.

At the top, you have the leaves.

The text calls these the proximal determinants.

The leaves are the visible health outcomes.

This is what you see in the clinic.

Diabetes, suicide, addiction, skin infections.

Western medicine is obsessed with the leaves.

We try to treat the leaf.

We ask, why is this leaf withering?

And we try to inject it with something.

But then you look down at the trunk of the tree, the intermediate determinants.

Right, the trunk supports the leaves.

These are the systems.

The text lists things like poverty, education systems, food security, and environmental stewardship.

You cannot have healthy leaves if the trunk is rotting.

So if the housing is full of mold, which is the trunk.

Then the child will have respiratory issues, which is the leaf, exactly.

But the most important part, the part we usually ignore, is the roots.

The distal determinants.

The roots are deep underground.

They anchor the entire thing.

The text identifies these as colonialism, racism, social exclusion, and self -determination.

So the argument is that you cannot fix the diabetes, the leaf, without acknowledging the colonialism, the root, that destroyed the traditional food systems in the first place.

Exactly.

If you only treat the leaf, the disease will just come back because the root is still poisoning the tree.

A nurse needs to understand that the non -compliant patient isn't failing, they are living on a tree with damaged roots.

Let's look at some of those leaves, the hard statistics mentioned in the text, because they are startling.

Let's talk about tuberculosis, TB.

TB is often thought of as a Victorian disease, right?

Something from the past.

But the text notes that TB rates are six times higher in indigenous populations generally.

And for the Inuit,

they are 38 times higher.

38 times, that's not a disparity, that's an epidemic.

It is, and it connects directly to that intermediate determinant of housing.

The text notes that almost 20 % of indigenous homes need major repairs.

We're talking about overcrowding, poor ventilation, mold.

In the Arctic, you often have multiple generations living in small, sealed homes to keep out the cold.

The perfect environment for TB transmission.

Exactly, it's not a biological susceptibility, it's a housing crisis.

Diabetes is another major one mentioned.

The text calls it of epidemic proportions.

First Nations women have mortality rates from diabetes that are five times higher than the national average.

And historically, this disease was virtually non -existent in these communities.

It's a disease of colonization, really.

It's a direct result of the loss of traditional lands and the introduction of cheap, processed, high -sugar foods.

There's also a section on an ER study.

This was a qualitative study mentioned in the text that looked at why indigenous people delay seeking care.

This is so crucial for any listener working in healthcare.

The study found that indigenous patients often expect racism.

They encounter what the text calls discourses of blame.

What does that mean, discourses of blame?

It means that when they walk into an ER, they feel they are being judged.

Are they drunk, are they just looking for drugs?

Even if they are having a diabetic emergency or a heart attack, they feel that immediate judgment.

Does it wait?

They wait until the pain is unbearable.

And by the time they come in, their condition is critical.

And then tragically, the staff might say, why did you wait so long?

You clearly don't care about your health.

And it just confirms the bias.

It becomes a self -fulfilling prophecy.

It does.

We have to address the sidebar in the text titled Yes, But Why.

It addresses the crisis of missing and murdered indigenous women and girls, MMIWG.

This is a national tragedy.

The text states that violence rates against indigenous women are four times the national average.

That's the what?

But the yes, but why part is the analysis.

Right, it doesn't just say violence happens.

It attributes it to sexualized racism.

How does the text explain that term?

It links it back to colonial policy.

Historically, in many indigenous societies, women held significant power.

They were clan mothers, they were landholders, decision makers.

The Indian Act and Colonial Society imposed a patriarchal system that stripped women of that status.

It legally devalued them.

The text argues that this historical devaluation makes them targets for violence today.

So protecting indigenous women isn't just about policing.

It's about restoring their status and value in society.

Exactly, it's about decolonizing gender roles.

We've covered a lot of darkness, a lot of really tough history, but the chapter pivots to the future.

It talks about reconciliation, and it points to the Truth and Reconciliation Commission, the TRC.

The TRC is the roadmap.

It documented the truth of the schools and it issued 94 calls to action.

For nursing students listening, call to action number 24 is their mandate.

I have it right here.

We call upon medical and nursing schools in Canada to require all students to take a course dealing with indigenous health issues, including the history and legacy of residential schools, the United Nations Declaration on the Rights of Indigenous Peoples, treaties and indigenous rights, and indigenous teachings and practices.

That is why this chapter exists.

That's why we're having this conversation.

It's not an elective.

It is a requirement for ethical practice in Canada today.

You mentioned the UN Declaration UNDRI.

The text highlights Article 24 specifically.

This is a game changer.

Article 24 states that indigenous peoples have the right to their traditional medicines and health practices.

What does that mean in a practical sense?

It legitimizes traditional knowledge alongside Western medicine.

It means that smudging or a cedar bath are not alternative medicine.

They are a human right.

They have a right to access those practices as part of their healthcare.

So how does a nurse put all of this into practice?

The text draws a really important line between cultural competence and cultural safety.

Yes, and this is a key evolution in thinking.

Competence was the old buzzword.

It implies you can take a class, learn a checklist of indigenous traits, and then you are an expert.

Right, like you've mastered their culture.

Exactly.

It treats culture like a static object you can master.

And it often leads to stereotyping.

Oh, you're from this nation, so you must believe X.

And cultural safety.

How is that different?

Cultural safety is about power.

It focuses on the interaction.

And here is the absolute key.

The nurse doesn't get to decide if the care was safe.

Only the patient decides.

Did they feel respected?

Did they feel their identity was valued?

Did they feel safe?

If the patient says no, then the care was unsafe, regardless of your good intentions.

That shifts the power completely to the patient.

As it should be.

There's a framework for integrating this called two -eyed seeing.

It comes from Mi 'kmaq elder, Albert Marshall.

Itu 'at munk.

Two -eyed seeing.

Imagine looking at the world.

One eye represents the best of Western science anatomy, pharmacology, evidence -based practice.

We need that eye, it's powerful.

But you open the other eye.

You open the indigenous eye.

This represents connection to the land, to spirit, to community, and to ancestors.

The goal isn't to pick one or to merge them into one gray eye.

The goal is to use both eyes at the same time to get a complete picture.

The text gives an example of treating addiction.

Right.

With the Western eye, you might prescribe methadone to manage the physical withdrawal.

That treats the biology, the leaf.

With the indigenous eye, you might facilitate a sweat lodge ceremony to reconnect the patient with their spirit and their community.

That treats the root.

You have to treat the whole person.

The chapter ends with a story.

Coyote,

keeper of memories.

And I think stories sometimes stick with us more than stats.

This story is essentially a case study in narrative form.

It's beautiful.

I'll try to recount it briefly.

So Coyote is tired because his children are needy.

They rely on him for everything.

So he asks the son for help, and the son tells him to teach the children to be self -sufficient.

So he teaches them to fish, to build, to make clothes.

But then there's an unintended consequence.

Right.

The children become greedy.

They start hoarding.

They stop sharing with the bear and the beaver.

They want to be like the eagle, solitary and powerful.

They embrace individualism, which is contrary to the community values of reciprocity.

So Coyote tries to trick them.

He says, give me back the teachings, and I'll teach you to be like eagle.

They agree.

He puts all the teachings back in his basket.

But in his haste, he accidentally takes their memories too.

And chaos ensues.

Complete chaos.

They forget who they are.

They forget their relations.

They're lost.

So Coyote goes back to the son, panicked.

And son explains,

memories and teachings are woven together like a grass basket.

You can't pull one strand without pulling the other.

This is such a powerful metaphor for nursing.

You cannot treat the teaching, the medical condition, without understanding the memory, the patient's history, their trauma, their context.

If you only pull at the disease, you unravel the person.

You have to treat the whole basket.

It also feels like a perfect metaphor for colonization, doesn't it?

The schools tried to take the memories to fix the Indian.

And in doing so, it broke the community.

That's it, exactly.

Wow.

We have covered so much ground today, from the pre -contact world to the devastation of the Indian Act, through the maze of jurisdiction, up the determinants tree, and finally, to two -eyed seeing.

It's a journey from understanding the harm

to seeing the resilience.

And I think that's the final point the text makes.

Indigenous health is about resilience.

It's about a people who have survived an apocalypse and are actively reclaiming their wellness.

That's a powerful place to end.

What is one final thought you want to leave our listeners with?

Something for them to mull over.

I want you to go back to that tree model.

We agreed that colonialism is a root determinant of health.

It literally makes people sick.

Right.

So if colonialism is a cause of disease,

does that mean a nurse needs to know how to prescribe decolonization?

Prescribing decolonization.

That sounds radical.

It does, but think about it.

If advocacy and fighting for justice and creating culturally safe spaces can heal the roots of the tree,

then advocacy isn't just politics.

It's a clinical skill.

It's a health intervention.

It's a health intervention.

It's just as important as knowing how to give an injection.

That changes the job description quite a bit.

It certainly does.

Well, thank you for guiding us through this deep dive.

This was a tough one, but so necessary.

It was an honor.

Thank you.

And thank you to everyone listening.

A warm thank you from the last minute lecture team.

We hope you take only what you need, but that you carry it with you.

See you next time.