One of the most important lessons I’ve learned while working in First Nations communities is understanding the difference between neglect and avoidance of care. For individuals who have experienced trauma in a medical setting, overcoming that fear and re-engaging with health services can be a massive challenge. Visiting spaces that are reminiscent of places of past abuse can be very triggering, as the brain has learned that these are not safe places, and the body responds accordingly. For parents and caregivers who have lived these experiences, those learned fears can manifest as a hesitation to bring children to appointments out of a desire to protect. As a health care provider I have a duty to report cases wherein I “believe that a child or youth under 19 has been or is likely to be…neglected and that the parent is unwilling or unable to protect the child”(1). That would mean that if a child has many missed appointments and treatment is not being completed in a timely manner, it could be perceived as neglect.
As these cases began to surface in my practice, I felt in my heart that there were bigger challenges happening then I could navigate on my own, and I wondered if there was a culturally informed way that I could be supporting these children and families. I knew that in order to achieve positive outcomes, I needed to approach these sensitive situations from a capacity-building, relationship-centered way, and be cautious of tactics that might provoke fear or shame, or cause families to further retract from accessing services. I reached out to my dear friend and Culturally Committed Mentor, George Harris Jr. of Stz’uminus First Nation seeking guidance, and I am so glad that I did. George works for his Nation as a Family Advocate and liaises between agencies when Stz’uminus children have open files, and his words and influence have transformed how I navigate these cases.
“When outsiders come into our communities to provide care, there is a lot of distrust to overcome. Many individuals have experienced a legacy of abuse and harm, and those experiences continue to influence service access. Gaining trust can only start when providers are willing to participate in relationship with community members, and show up not only as a clinician, but also as a human being.”
George goes on to share, “First Nations communities traditionally operate as a unified group. The concept of family is broad, and there are many individuals who help support in the family structure. I don’t mean to be condescending, but for a health provider to feel that they alone can help families achieve desired outcomes is a bit ego-centric. Providers have a responsibility to learn how communities function, what supports are available, and learn ways to blanket families in safety and understanding to help achieve supportive outcomes. Here in Stz’uminus, that might mean engaging with a Family Advocate, who can help pull in the appropriate cultural teachers, grandparents, aunties and uncles, who can then work alongside families to help cultivate understanding, and reinforce the need for the necessary care that has been recommended by the health provider. Relationships are EVERYTHING in First Nations culture.”
Last week while I was attending a meeting in Vancouver, I was introduced to the term ‘cognitive imperialism’, which is defined as a “system of knowledge superiority that…focuses on the belief that the knowledge and ways of knowing of one people are superior to another”(2). George’s words made me realize that prior to learning from him, I really was centering myself as the expert in these situations. I have come to realize that I only play a small role in supporting families in achieving positive oral health outcomes, and that when the conversation is shared in a community-supported way, the outcomes are so much more positive and holistic. It is my hope that I can be part of supporting affected children and families in understanding that attending oral health appointments can be positive and rooted in good feelings, with the intention of changing the narrative for future generations.
Kim at Culturally Committed
https://www2.gov.bc.ca/assets/gov/publicsafety-and-emergency-services/public-safety/ protecting-children/ childabusepreventionhandbook_serviceprovi der.pdf
Anderson-DeCoteay. M, 2016.