Teachings around Self-care and Medicine Gathering in Manitoulin Island, Ontario: Rebuilding Capacity Begins with Youth

L. Barwin M. Shawande E. Crighton L. Veronis Abstract Introduction Aboriginal community leaders and health researchers in Our vision for improved health revolves around Canada have recently looked to self-determination, self- a controlled and sustainable health governance, and capacity building as solutions to reducing system that builds effective capacity and asserts the gap in health disparities particularly among youth. First Nations jurisdiction in health, aligned with a Yet little research has investigated how the promotion holistic and culturally appropriate approach.… The of autonomy and self-determination through self-care role of research in further informing First Nations’ could directly contribute to improved health and well- united efforts to improve the health and well-be- being. This paper examines how traditional workshops ing of our peoples cannot be underestimated. (Phil offered by an Aboriginal health centre on Manitoulin Fontaine, former Grand Chief of the Assembly of Island contribute to individual and community health First Nations, 2005, p. S6). via self-care, and in turn to the rebuilding of capacity. Aboriginal health research in Canada has reached We investigated how traditional teachings may support individual, community, and environmental health for a critical turning point in recent years. With dis- youth in two Anishnabe communities using a variety mal health conditions in many First Nations, , of community-based participatory qualitative methods. and Métis1 communities now well documented Results show the need to approach traditional teachings, (Adelson, 2005; Loppie Reading and Wien, 2009; health programs, and research from an Aboriginal world Waldram et al., 2006), there has been a push by gov- view, and that more frequent workshops are required to ernment, academia, and communities themselves to empower both youth and adults to practice and share . Furthermore, a continuum exists better understand what factors contribute to health in which the interest in language, culture, and tradition disparities. As suggested above by former Assembly increases with age. Capacity can therefore be rebuilt over of First Nations leader Phil Fontaine, one of the sig- time within communities promoting autonomy and nificant findings that has come from the existing self-determination through self-care. Findings can be research is that self-determination and capacity expected to further inform the traditional programming may be among the most important determinants in participating communities and to enhance our understanding of the role , as one contributing to good health in Aboriginal peoples element of self-care, plays in determining health. (Healey and Meadows, 2008; Minore and Katt, 2007; Keywords: Aboriginal health, traditional medicine, Loppie Reading and Wien, 2009; Smith et al., 2008). self-care, capacity (re)building, Indigenous world view, Recent research has shown how self-determina- decolonizing methodology, self-determination tion and capacity-building affects population health This article is dedicated to our colleague and friend Marjory Shawande in Aboriginal communities (Healey and Meadows, who passed into the spirit world on April 2nd, 2013. Marjory was a 1 First Nations, Métis, and Inuit, descendants of the original inhabit- nurse, teacher, facilitator, manager, forward thinker, researcher, trad- ants of North America, comprise three separate peoples with unique itional Anishnabe woman, healer, mother, grandmother, mentor, and heritages, languages, cultural practices, and spiritual beliefs. The a friend. She will continue to inspire and influence those whose lives Canadian Constitution collectively recognizes these distinct groups she touched. as Aboriginal People (Indian and Northern Affairs Canada, 2010)

© Pimatisiwin: A Journal of Aboriginal and Indigenous Community Health 11(3) 2013 323 324 © Pimatisiwin: A Journal of Aboriginal and Indigenous Community Health 11(3) 2013 Teachings around Self-care and Medicine Gathering: Rebuilding Capacity Begins with Youth 325

2008; Maar and Shawande, 2010; Minore and Katt, abuse, mental illness and high rates of suicide par- etic predisposition (Evans and Stoddart, 1990; and Healing, the need for Aboriginal people to de- 2007; Mottola et al., 2011), but the practicing of ticularly among youth. In this region, rates of youth Lalonde, 1974, Loppie Reading and Wien, 2009). termine their own path to health and well-being has traditional medicine as a form of self-care and its drug and alcohol abuse are significantly higher than Socioeconomic determinants such as income, social been recognized as well as the fact that traditional subsequent impact on community health is not well the national average (Sudbury and District Health status and support, education, employment, gender, medicine may represent a type of self-care. understood. Our research attempts to fill this gap by Unit, 2007). and culture are now universally understood as con- The values of traditional medicine encourage self- exploring how traditional medicine workshops of- Determining the underlying factors that con- tributing to a more holistic definition of health and care and personal responsibility for health and fered by an Aboriginal Health Centre on Manitoulin tribute to poor health and ways to promote good have thus become the focus of public health agen- well-being. This contribution is particularly im- Island, Ontario, contribute to self-care and to the health among the Anishnabek of Manitoulin Island das (Public Health, 2011). Poor health among First portant at a time when Aboriginal people are em- rebuilding of capacity in two First Nations com- has been the subject of numerous research projects in Nations youth and adults has been linked to social phasizing the need to find their own solutions for munities. Based on the findings of this collaborative recent years (Jacklin and Kinoshameg, 2008, Jacklin, determinants including education, housing, infra- persistent personal and social problems. (RCAP, research, we argue that the practice of traditional 2009; Maar et al., 2005; Maar et al., 2007; Maar et al., structure, employment, social capital, and economic 1996, Volume 3, p. 351) medicine, as one aspect of self-care, represents a sig- 2009; Maar and Shawande, 2010; Manitowabi and status (Adelson, 2005; Dyck, 2009; NAHO, 2008). In clinical terms, self-care typically refers to per- nificant element of self-determination and ultim- Shawande, 2011; Manitowabi, 2009; Wilson, 2000). Many of these factors are believed to relate to issues sonal health maintenance through activities such as ately can contribute to the health and well-being Jacklin (2009) concluded that varying colonial hist- around structure, community breakdown, and the eating well, self-medicating, practicing good hygiene, of Aboriginal populations. Below, we first provide ories in Wikwemikong Unceded on loss of control associated with colonial histories avoiding health hazards such as smoking, preventing 3 some background by reviewing significant issues in the eastern side of Manitoulin, have resulted in an and residential schools experiences (Adelson, 2005; ill health, and taking care of minor ailments or long Aboriginal health and specifically establishing links “inter-play” of health determinants and a diverse set Czyzewski, 2011; Jacklin and Kinoshameg, 2008; term conditions after discharge from secondary between traditional medicine and self-care, capacity of health care needs between neighbouring com- Richmond and Ross, 2009). Disempowerment it- and tertiary health care (Gantz, 1990; Kemper et rebuilding and self-determination, before returning munities. Manitowabi and Shawande (2011), re- self is viewed as an influential social determinant of al., 1992; Kickbusch, 1989). Self-care in the context to our methodology and case study. viewing traditional programming on the Island, health. Thus, the struggle for self-determination and of traditional services offered at Noojmowin Teg determined that a holistic approach to health, in- control may be the underlying cause of poor health Health Centre includes life skills such as traditional Background tegrating traditional medicine in a contemporary in many Aboriginal communities in Canada and medicine gathering. There are physical, emotional, Aboriginal populations are among the unhealthiest context, is required to address illness stemming internationally (Kirmayer et al., 2003; Mignone and and spiritual benefits associated with being out in in Canada, facing life expectancies 5–7 years below from historical disempowerment due to colonial- O’Neil, 2005; Obomsawin, 2007; Waldram et al., the natural environment gathering medicine as well the Canadian average, rates of diabetes 3–5 times ism and the legacy of residential schools. Maar and 2006). These broad social determinants are relevant as with the positive health benefits of having control the national average, and rates of youth suicide 5–6 Shawande (2010) assessed traditional mental health in all populations, although there may be some de- over one’s life choices (Noojmowin Teg, 2011). times higher than in non-Aboriginal youth (Adelson, services for First Nations on Manitoulin Island de- terminants such as discreet culture and traditions, Over fifteen years after the publication of the 2005; Ontario Aboriginal Diabetes, 2011; Health termining that successful integration, benefiting connection to the land, self-care and self-determin- RCAP (1996), the “personal and social problems” re- Canada, 2009). According to the Royal Commission both client and provider, is possible in a clinical set- ation, agency, and language that are particularly im- ferred to above and the related negative health con- Report on Aboriginal Peoples (RCAP, 1996, Vol. 3, ting. This research concluded that portant to Aboriginal people in Canada. sequences are still prevalent in many First Nations p. 119), the term health “crisis” is no exaggeration. further investigation of integrative approaches to Self-care and Traditional Healing communities. Self-determination has been touted Since the Aboriginal population in Canada is grow- traditional programming at the Noojmowin Teg In the context of Aboriginal determinants of health, as the solution to these problems, but the realiza- ing twice as fast as the rest of the population and the Health Centre (NTHC) on Manitoulin Island was the concept of self-care is particularly significant. In tion of this goal and all it entails is complex. The mean age is approximately 10 years younger than the required to improve [the] understanding of client experiences with this integrated approach and the the following excerpt from the Royal Commission loss of traditional medicines through colonization national average (Ball, 2005; Kirmayer et al., 2003), impact on wholistic health and well-being. (Maar on Aboriginal Peoples’ (RCAP) section on Health led to disempowerment and its subsequent influ- it is crucial to understand the underlying causes of and Shawande, 2010, p. 18) ences on the well-being of Aboriginal people (Maar ill-health among Aboriginal youth. While detailed 3 Over 130 Indian residential schools were established by Christian or- and Shawande, 2010; Robbins and Dewar, 2011). The Our study stems from this recommendation, ganizations across Canada with a total of over 150,000 First Nations, data are lacking, it appears that the Anishnabek2 reintegration of traditional medicines as a form of building on this body of research by focusing on the Inuit, and Métis students attending until the closing of the last resi- of Manitoulin Island face many of the same health dential school in the mid-1990s. It is believed that the implications self-care must be included in discussions around role of traditional medicine as a form of self-care of taking Aboriginal young people away from their families and issues as other Aboriginal peoples. Health work- communities for residential school students themselves, their par- Aboriginal determinants of health. ers have observed ongoing problems of substance using community-based culturally relevant methods. ents, and subsequently their children, are far-reaching and still being felt today in terms of mental, spiritual, cultural, and social health. The Commission describes traditional healing as: There are many survivors of residential schools living on Manitoulin 2 Anishnabek is the plural form of Anishnabe meaning “First Peoples” Aboriginal Determinants of Island today, some of whom have been involved with programs sup- … practices designed to promote mental, physical (Wilson, 2003). Anishnabek/Anishnabe or Ojibwe refers to the ported by the Indian Residential School Cultural Support Funding and spiritual well-being that are based on beliefs larger First Nations group to which all seven First Nations com- Health to help heal from the lasting effects of assimilation and displace- which go back to the time before the spread of munities on Manitoulin Island belong. Anishnabe has numer- ment (Noojmowin Teg, 2011). Some participants in our research in- ous variations in spelling including Anishnawbe and Annishnabe. It is widely accepted that health is determined by formed us that although they did not attend a residential school, western ‘scientific’ bio-medicine. When Abori­ Anishinaabemowin, also known as Ojibway, refers to the traditional more than just physiological factors such as gen- many attended day schools that had a similar agenda and were simi- ginal Peoples in Canada talk about traditional language spoken. larly harmful. 326 © Pimatisiwin: A Journal of Aboriginal and Indigenous Community Health 11(3) 2013 Teachings around Self-care and Medicine Gathering: Rebuilding Capacity Begins with Youth 327

healing, they include a wide range of activities, indicated, allowing individuals access to “the best of with an Aboriginal world view as part of the funda- offering tobacco, or prayer before meetings. from physical cures using herbal medicines and both worlds.” Traditional medicine may therefore be mental foundation (Alfred, 2009; Brant Castellano, Aboriginal scholars are calling for the incorporation other remedies, to the promotion of psychological one element of self-care which contributes to broad- 1993). Self-government is often equated with the of an Aboriginal world view in every aspect of life, and spiritual well-being using ceremony, counsel- ing and the accumulated wisdom of elders. (RCAP, er determinants of health in communities including injection of money into First Nations communities including communications, negotiations, research, 1996, Volume 3, p. 348) capacity rebuilding and self-determination. to settle longstanding land claims or to provide so- law, governance, and health (Alfred, 2009; Brant Capacity Rebuilding and Self- cial assistance where suffering is believed to be the Castellano, 1993; Kovach, 2009; Martin-Hill, 2009; Despite the historical and continued practice of result of disempowerment, particularly through Obomsawin, 2007; Wilson, 2008; Zolner, 2003). traditional healing, traditional medicine has only re- determination the legacy of residential schools. While it is crucial Self-determination and self-government must also cently been integrated into clinical settings in con- Capacity building is defined by the National for the Canadian government to address the leg- be framed from an Aboriginal world view to truly be junction with conventional medicine in these com- Aboriginal Health Organization (NAHO) as acy of colonization, it is evident that money in it- effective. Approaching problems from this paradigm munities (Maar et al., 2009; NAHO, 2008; Waldram increasing the ability of individuals, communities self will not heal the damage done to communities. may be the key to reestablishing healthy commun- et al., 2006; Wilson and Young, 2008). Initiatives to and nations to learn and to do. Capacity building Financial security contributes to the path to health ities. One important aspect of an Indigenous world integrate tradition have gained momentum in part in health planning can involve developing and ap- through self-determination, but a community is au- view is the vital physical and spiritual relationship as a reaction to loss of traditional knowledge and plying governance models, making informed de- tonomous only when First Nations themselves are to the land. cisions, strategic planning, identifying and setting loss of culture after European colonization (Adelson, in control of that money, making choices to spend it 2005; Richmond et al., 2005; Waldram et al., 2006). priorities, evaluating, managing human and fiscal resources, and assuming responsibility for success in ways that best address their specific community’s Aboriginal Relationships to Despite the strength of these colonizing forces, and failure of health programs and interventions. needs. As two Aboriginal scholars write: the Land many Aboriginal groups in Canada have demon- (NAHO, 2007)4 strated their resilience by preserving or reinventing We do not need to wait for the colonizer to pro- Well-being in Aboriginal communities has been as- vide us with money or to validate our vision of a aspects of traditional culture over time. Bridging the Taiaiake Alfred dislikes the term “capacity building” sociated with close ties to the land. Physical health as he believes it puts the blame on First Nations free future; we only need to start to use our phil- disconnect between western and traditional medi- osophies to make decisions and to use our laws relates to environmental health via interconnect- cine systems may allow for a more integrative mod- people rather than on the behaviour of the state. and institutions to govern ourselves. (Alfred and edness and interdependency; people rely on the el of health care, a model that is increasingly being Therefore building capacity does not address the Corntassel, 2005, p. 614, emphasis in original) land for food, medicine, and shelter and it is the implemented in Aboriginal Health Access Centres “underlying colonial causes of unhealthy and de- responsibility of people to look after Mother Earth Taiaiake Alfred (2009) believes that when throughout Ontario and other provinces. structive behaviours in First Nations communities” (Davidson-Hunt and O’Flaherty, 2007; Grim, 2001; Aboriginal people depend on handouts from the (Alfred, 2009, p. 45). Hay, 1998; Richmond et al., 2005; Richmond and Recuperating these traditions therefore recon- colonizer and the laws, structures, and organiza- The fact that communities have the capacity to Ross, 2009; Wilson, 2000; Wilson, 2003). Aboriginal nects contemporary Aboriginal peoples to their tions of supposedly self-governing communities are heal themselves is not disputed, but understanding scholar Stan Wilson (2001, p. 91) describes why he historical traditions and mobilizes rituals and controlled by national governments, the healing of practices that may promote community solidarity. how best to tap into this capacity is less straight- is obligated to protect the natural environment: Aboriginal peoples will never commence. Loss of (Kirmayer et al., 2003, p. S16) forward. It has been argued that the primary deter- “Because the life surrounding me is part of me land, loss of autonomy, political, cultural, economic, minant of a healthy community is “the capacity of a through my ancestors, I must consider and care for There is, however, some unease over the no- and social disenfranchisement are in part respon- community to govern itself, to have some measure all its constituents.” This inherent connection to the tion of integration. Proponents of traditional prac- sible for health disparities and widespread illness in of self-determination or autonomy” (Richmond et land means that loss of land through appropria- tices are skeptical that this approach to medicine is Aboriginal communities (Adelson, 2005). If control al., 2005, p. 358). Communities have actively fought tion, treaties, and environmental devastation could validated by mainstream practitioners (Maar and is one of the most critical factors affecting health for their right to self-determination since the 1970s. have a far-reaching impact on the maintenance and Shawande, 2010; RCAP, 1996; Robbins and Dewar, (Riecken et al., 2006), it follows that autonomy Self-governance is a key component of self-determin- transmission of traditional knowledge and practices 2011). Some Aboriginal academics feel that the two and control via self-determination will improve the ation. However, some Aboriginal scholars feel the and subsequently on health and well-being in many systems could never be fully integrated as they are health status of these populations. Minore and Katt current approach to self-determination is ineffective communities (Alfred, 2009; Grim, 2001; Richmond fundamentally at odds philosophically (Alfred and (2007) suggest that self-determination in itself will and must be approached from an Indigenous con- and Ross, 2009; Wilson, 2000). The impact on youth Corntassel, 2005). Thus, reincorporating traditional not alter social factors such as poverty, poor hous- sciousness and not structured according to current in these communities should also not be minimized. practices directly into communities (as opposed to ing, and lifestyle choices that affect Aboriginal health colonial models mired in bureaucracy. Rather than To ensure that the relationships to the land are being an aspect of health care programming) may arguing that addressing specific cultural needs could searching for ways to “fit” Aboriginal ways of know- maintained and protected, and traditional know- result in increased self-care, capacity rebuilding, and improve Aboriginal health in Canada. ing into the existing frameworks, the organizing ledge is passed on, Elders need to engage youth the subsequent health benefits associated with com- Addressing culture in Aboriginal health has ex- of self-determining and self-governing Aboriginal in traditional medicine teachings. The role that munities regaining control over their own health. At 5 communities should be built from the bottom up panded beyond token elements such as smudging, the same time, modern medical technologies are 5. Smudging refers to a ceremony in which a combination of sacred dialogue or cleanse a space or for purification. The smoke from the 4 We use the term capacity rebuilding since capacity already exists in traditional plants typically cedar, sage, tobacco, and sweetgrass are burning plants is usually brushed over oneself, inviting health into a also available to provide necessary clinical care when the communities and traditional workshops are only a conduit to burned. It is used as part of many Aboriginal ceremonies to open person’s life (Anishnawbe Health, 2011). rebuilding capacity lost through years of trauma. 328 © Pimatisiwin: A Journal of Aboriginal and Indigenous Community Health 11(3) 2013 Teachings around Self-care and Medicine Gathering: Rebuilding Capacity Begins with Youth 329 youth play in community health is important as cine use could be reestablished among the youth in by a community-based decolonizing methodology medicine teachings by Marjory Shawande, an “art they are a conduit for the transmission of trad- the communities. (Denzin et al., 2008; Fletcher, 2003; Kovach, 2009; voice” session7 with Art Facilitator Mark Seabrook, itional knowledge and continuity of culture, repre- Building on major themes identified in this Lavallée, 2009; Smith, 1999). Barwin (2012) provides and were followed by a focus group. The format senting hope for the future of Aboriginal people in background, the specific objectives of this research a detailed discussion on incorporating place-specif- of the research workshop was based on a “heal- Canada (Robbins and Dewar, 2011). Jessica Ball’s are to: (1) understand how traditional medicine ic culture, language, and history into the choice of ing through art” program that has been offered at work (2005) looking at early childhood care in three workshops offered through Noojmowin Teg con- methods, whenever possible, for the best under- Noojmowin Teg to address the lasting and intergen- First Nations in British Columbia stresses the vital tribute to capacity rebuilding through self-care standing of local knowledge. erational damage resulting from Indian residential place of children in Aboriginal culture and the im- among youth in two First Nations communities This research was conducted in two commun- schools. The art facilitator from this program agreed portance of nurturing their role in the future of a of Manitoulin Island; (2) investigate how learn- ities on Manitoulin Island (Figure 1) between July to assist us in our data collection by doing a “gather- community. The Elders’ role of passing down know- ing about medicines retrieved from the land con- and September 2010. Manitoulin Island, located at ing of information” session utilizing art as responses ledge to younger generations is critical to cultural tributes to a greater awareness of local habitat and the northern tip of Lake Huron, Ontario, is home to research questions. We posed four questions to continuity and a vital part of the extended family subsequent interest in protecting the environment; to over 12,000 year-round inhabitants, nearly half of participants in the art component based on major social structure of many Aboriginal communities. (3) examine the role of language, tradition, and cul- whom are First Nations (Manitoulin Tourism, 2010) themes including herbal knowledge, self-care, shar- Fostering the relationship between Elders and youth ture as determinants of health in First Nations com- of primarily Ojibway, Pottawatomi and Odawa, ing, and the environment; participants were asked is imperative for supporting healthy First Nations munities, particularly for youth; and, (4) evaluate and Anishnawbek of Manitou Minissing descent. to draw four separate pictures based on these ques- communities. For example, in one study, pregnant best methodological practices for local community- Colonial contact history included forced migration, tions and were later asked to elaborate on their pic- women who consulted with Elders were less likely based health research. the legacy of residential schools, social inequity, and tures during focus groups. to smoke and use alcohol and were more likely to the marked health disparities which resulted. The The choice to use workshops as an information- attend prenatal classes and breastfeed (Andersson Methodology two communities are located on opposite sides of gathering tool reflected a knowledge translation and Ledogar, 2008). Our research acknowledges this Self-determination may lead to improved health in Manitoulin, one more geographically remote with approach already being used at Noojmowin Teg. important relationship; many workshops offered Aboriginal communities and efforts should be made less than 100 members, and the other located on Conventional mentor-apprentice relationships for by Noojmowin Teg Health Centre are conducted by to promote community control of research about one of the Island’s major throughways with over passing on traditional knowledge are less prevalent Elders and geared toward youth. One of the themes health to achieve a better understanding of health 600 members. The health centre offers traditional in the contemporary context and traditional medi- we investigated was how medicine teachings were inequities. Recognizing the need for Aboriginal services to all seven First Nations on the island. cine workshops have been an effective alternative brought home and shared with family to determine people to control and conduct research using cul- The participation of these communities was for sharing. Conducting research via focus groups if the capacity for self-care through traditional medi- turally relevant methods, our research was guided based on their interest in traditional medicine pro- in a more casual workshop setting was an efficient grams and their longstanding relationship with way to address many participants simultaneous- Figure 1. Map of Manitoulin Island, Ontario, Including Location of Seven First Nations Communities. project collaborator and Traditional Coordinator ly and also had the potential to foster a degree of of Noojmowin Teg, Marjory Shawande, through comfort in numbers, particularly helpful with chil- whom entrance into the communities was made dren (Darbyshire et al., 2005). As well, the use of art possible. Guided by OCAP (Ownerships, Control, and circle sharing as a way to relate ideas is more Access, Possession) principles6 (NAHO, 2007), a cul- culturally appropriate in Indigenous research and a turally appropriate research protocol was followed familiar means for participants to share experiences and ethics approval was received from both the (Lavallee, 2009). While protocols congruent with a University of Ottawa’s Research Ethics Review Board true “sharing circle” were not used in the end, shar- and the Manitoulin Anishnabek Research Review ing in a group setting appeared to promote comfort Committee. among the participants. In the first stage of the project, we conducted In the second stage of the project, we conducted three workshops in the two communities with a to- eight in-depth, open-ended interviews with key in- tal of 15 participants (8 youth ranging from 4–17 formants from the band councils and health centres. years old, and 7 adults) who were selected via conve- 7 See Barwin (2012) for a detailed explanation of the art voice meth- nience sampling. Sessions included traditional plant od; we found art voice, a variation on photovoice, to be an ideal method to use with youth and adults on Manitoulin Island given 6 OCAP (Ownership, Control, Access, and Possession) guidelines pub- its rich history and contemporary culture of art. Given the com- lished by the National Aboriginal Health Organization (NAHO) have plexity and abstract nature of some of the ideas being discussed, become the gold standard to guarantee health research is conducted the importance to the research of engaging youth, combined with collaboratively and respectfully and that First Nations communities the rich history and contemporary cultural importance of art to (Original map created using GIS Jing Feng and Lynn Barwin, Department of Geography, University of Ottawa) have access and intellectual property rights to any information the Manitoulin Anishnabek, art voice was seen as an appropriate which comes out of research projects (NAHO, 2007). research method (Barwin, 2012). 330 © Pimatisiwin: A Journal of Aboriginal and Indigenous Community Health 11(3) 2013 Teachings around Self-care and Medicine Gathering: Rebuilding Capacity Begins with Youth 331

Participants were recruited via purposive sampling using art (Koch and Fuchs, 2011). These ideas are how traditional knowledge connects them to the be the case, possible explanations may include com- aimed at gaining insight from particular community in line with some Aboriginal spiritual world views land and to the Creator. placency or indifference, workshop burnout, sched- experts. In addition to questions about traditional which propose that objects can be infused with the The Need for Repetition of Traditional uling issues, or they simply have different priorities workshops, key informants were asked what they spirit of those that created them and therefore, that in terms of the importance of tradition or culture thought about non-Aboriginal researchers coming artistic works can reflect symbolic meaning beyond Workshops to Foster Confidence and relative to other activities in which their children into their communities and what methods they words (Lavallée, 2009). Interest among Youth could be participating. If parents were encouraged considered more culturally relevant. Art voice as a research tool may be informed Participants in this project were unanimously in sup- to get more involved with promoting teachings, re- Interviews and focus groups were digitally by literature on Arts-Based Research (ABR), a di- port of continued traditional medicine workshop cruitment might be more effective. This opinion is recorded with permission and transcribed ver- verse and evolving methodology that uses various programming at Noojmowin Teg Health Centre. expressed plainly in the following statement: batim, then deductively coded according to themes forms of artistic expression including poetry, cre- Many had requested and attended workshops in the past for different youth programs or cultural out- And it’s adults too that need to be involved — the and analyzed in NVivo 8 (QSR International Pty ative writing, photography, painting, theatre, film, parents have to be involved — when something’s Ltd.,Version 8, 2008). As well, over 50 art voice pieces dance, music, etc. to collect data or perform analy- reach activities and understood their value in the going on, the parents have to go — take their chil- were scanned and inputted into NVivo and system- sis (Canhmann-Taylor, 2008; Leavy, 2009). ABR is transmission of Anishnabe culture. Participants also dren and go to … them workshops. (Alison, key atically coded according to general and specific practiced today in education research and beyond, felt that frequent repetition of teachings is neces- informant) sary. More regular workshops would help them re- themes which emerged throughout the research. and includes new methods such as poetry-based re- As this quote suggests, it is not enough for par- member to use medicines, which ones to use, and, Focus groups were recorded and transcribed ver- search where data collected is transformed into ori- ents to send their children to traditional programs, in turn, would foster confidence so they could bring batim and analyzed similarly. To protect the iden- ginal poetry, and ethnodrama, where ethnography they need to be involved themselves. According to this knowledge into their communities as demon- tity of focus group participants and key informants, and theatre are combined (Leavy, 2009). Our re- the Regional Health Survey (RHS), First Nations strated by the following account: pseudonyms are used in the data presentation. Since search supports these bodies of work by concurring youths’ understanding of culture comes predomin- research questions were determined in collabora- that place of research can play a significant role in If I don’t hear it in a couple weeks, I’ll forget how antly from their immediate and extended family, and tion with Noojmowin Teg’s traditional coordinator, the choices of methods and subsequently in research to say it so then, you know a month later … he’ll therefore it is essential that this instructional role [say], ‘oh, did you pick that — whatever-it-may- major themes such as self-care, sharing knowledge, results. In the case of Manitoulin Island, using art as be encouraged (First Nations Information, 2012). and the environment were predetermined. A num- a tool for qualitative inquiry was supported by its be’? — and I’ll [say] … ya, ya … and I’ll get it — just like that. (Martha, key informant) A study based in rural northern British Columbia, ber of new themes emerged upon analysis includ- cultural and historical context. which looked at integrative service models in three ing language, the impact of residential schools, and Martha’s comment suggests that it is important First Nations communities, found that parental in- Aboriginal world views. Attempts were made at all Results and Discussion to have regular workshops in order to remember the volvement is beneficial for both youth and adults; stages of the project to get feedback from both com- In this section we present the key themes identified teachings. Similarly, a focus group participant, Tanya, parents who bring their children to programs that munities and from representatives of the health cen- through analysis in this project. These are organ- also expresses the need for repetition of workshops promote wellness for youth tend to make use of tre. Final results were presented to the Noojmowin ized starting with practical results about the use- in the following quote where she proposes the cre- programs geared towards adult healing and well-be- Teg Traditional Advisory Committee, the members fulness of the workshops and moving towards the ation of a book to help her remember the teachings: ing (Ball, 2005). We suggest that traditional medi- of which offered suggestions and were generally value of self-care and ultimately to understandings It’s almost something that you have to be at all cine workshops can contribute to the transmission comfortable that results accurately reflected the of Aboriginal world views. The results and recom- the time because you forget and then when I sit of Anishnabe culture (and language) and can even 8 situation in their communities. mendations developed are of particular relevance with Marjory I’m reminded about ‘oh ya, that’s play a significant role in reinforcing its mainten- Interpretation of art voice results can be in- to the traditional workshops in the local context of what that’s used for’ and I almost need like a ance among families and members of different age book where it’s all written down so I know what formed by the art therapy literature (Edwards, 2004; programming at Noojmowin Teg but may apply to groups. Ferrara, 2004). Art therapy works in part because the Aboriginal health access centres elsewhere. Themes it’s used for … because I forget what to use it for. (Tanya, adult workshop participant) Some key informants in our project felt that act of creating the art is therapeutic and further heal- related to self-care and capacity rebuilding, the youth are eager to learn but instruction must be ing can occur when patients discuss their art pieces Aboriginal world view, and the value of language are Interview participants also felt that adults need framed the right way, initiated by them rather than with therapists (Ferrara, 2004). As the research par- not specific to communities on Manitoulin Island to take a more active role in facilitating their chil- being forced. Adelson and Lipinski (2008) in their ticipants draw the “answer” to research questions, and may reflect values shared in many different dren’s participation in workshops. Some key in- report on the “Community Youth Initiative Project” they think further on their feelings. Given the op- Aboriginal communities. Results reveal a continuum formants believed that because youth are so vulner- in a Mi’kmaq community in New Brunswick learn- portunity to explain their drawing, a deeper level of in which age plays a role: young participants engage able, they must be given guidance in their search to ed that if they did not emphasize the “healing” part understanding can be gleaned. Art is useful for ther- in traditional teachings in a superficial way, learn- understand their culture and tradition. Yet one key of their project, youth were more likely to want to apy and for research because patients can translate ing how to use common medicines; adult workshop informant said that often it is the parents who pre- participate. Similarly, we found that youth may have the psychological expressions through their bodies participants showed that they are starting to think vent their children from attending programs. While negative associations with programs framed around 8 An overview of the project was presented in February 2012 at the about sharing knowledge with their children and this participant did not elaborate as to why this may poor health and the need for healing. Focusing on MAARC research conference in Whitefish River First Nation, ON. 332 © Pimatisiwin: A Journal of Aboriginal and Indigenous Community Health 11(3) 2013 Teachings around Self-care and Medicine Gathering: Rebuilding Capacity Begins with Youth 333 positive terms such as “leadership” and “initiative” “life-long learning” and it is natural that children their answers to the art voice and focus group ques- once I cleaned up, my life has changed. (Jane, adult may more effectively engage young people in health will process the teachings differently from adults. tions about the value of traditional medicines: focus group participant) care programming and research, as well as fostering According to these authors: [T]hey help me heal, heal quicker and stop the It is typical for teenagers to question their iden- confidence in their ability to make use of traditional Communities, families and individuals vary in swelling and it’s better to use it than having to go tity or to rebel. Kirmayer et al. (2003) propose that practices. their comfort level and understanding of tradi- to the doctor and all that.… I drew some pictures the lack of interest in tradition, such as reflected like cedar and sweetgrass and all that.… (Gemma, tional healing. It is therefore also seen as impor- Jane’s comments, may be related to the difficulties Sharing the Knowledge 11-year-old focus group participant) tant to offer a variety of ongoing learning oppor- Aboriginal youth experience in negotiating their An important theme emerged concerning sharing tunities geared towards community members as Gemma remembers some of the common medi- role in contemporary society. Connecting with their practices among users of traditional medicine work- well as Aboriginal and non-Aboriginal health care shops. For our participants, the most frequent shar- providers. (Maar and Shawande, 2010, p. 22) cines from workshops and recognizes their value as Anishnabe identity may have become more difficult ing of teachings occurred between family members an alternative to going to the doctor. Though she since European contact because “[a]dolescence and as a result of the level of comfort in families, espe- This life-long learning can come from many sources. is still young, this knowledge may help form the young adulthood have become prolonged periods cially with children. Passing traditional knowledge Traditional workshops offer Anishnabek the oppor- foundation of her medicine toolkit. As she attends with ambiguous demarcation and social status” on to their children is natural for many adults as tunity to be empowered by sharing what they have more workshops and information is repeated, she (Kirmayer et al., 2003, p. S20). Prior to contact, indicated by Mike’s art voice answer to questions learned with others. may develop a greater interest in using and shar- youth participated in activities associated with heal- about sharing: It is fitting that in the Noojmowin Teg tradition- ing these medicines. We observed a transition be- ing, had more responsibilities and were consequent- al health program, patients are known as “relatives” tween childhood and adulthood regarding an inter- ly more valued in the community. They learned skills I just kept it to myself because I’m … learning so reflecting the idea that in Anishnabe tradition, the est in traditional medicines and the desire to share essential for survival including traditional medicines I don’t really know enough about anything yet to really say anything to anyone … so I keep it to healer-patient exchange is a two-way interaction the knowledge and pass it on. Upon reaching adult- from their parents and Elders (Kirmayer et al., 2003; myself. But I mean if my daughter wants to know where both are equally valued. In this way, “relatives” hood, especially once they became parents, some Marlowe and Parlee, 1998). This changing role may what’s going on, I tell her what I’m doing so she are not considered passive recipients of medicine participants were more interested in defining and in part be a result of the active suppression of cul- helps me but … she’s [young] so she’s just getting but are rather directly involved in their own heal- channeling cultural and spiritual identity. Mandy ture via residential schools, but Kirmayer (2012) the hang of it.… (Mike, adult focus group partici- ing regime (Maar and Shawande, 2010; Manitowabi, expresses how she experienced this transition: suggests that changes in the degree of “local root- pant) 2009). edness,” resulting from globalization, may also have I’ve always learned — ever since I was a kid I’ve at- Mike is only willing to share teachings with his From Youth into Adulthood tended ceremonies and different … fasts and stuff a strong impact on parenting practices and subse- quently on the role of Aboriginal youth in modern daughter at this stage of learning. This speaks to a Many workshops at Noojmowin Teg are specifically like this recently … since … I’m a little older in my life — I’ve found to use it more — like when I was society. Youth participants in our study live in a discomfort sharing knowledge with others outside geared towards youth to promote an understanding a teenager … I knew it was there but I never used contemporary context in which their role in society the family circle and may reflect part of Anishnabe of traditional medicines early on. Another import- it so today I use it every day, and practice with my is not always clear, and this may account for why culture where sharing traditional knowledge oc- ant theme that emerged through analysis was that a children. (Mandy, adult focus group participant) young people experience difficulty finding meaning curs with family members who might become fu- transition occurs from youth to adulthood regarding and interest in culture. One key informant reflected ture knowledge carriers. The need for more frequent an interest in culture, tradition, and language. Key Mandy’s renewed interest in traditional medi- that picking plants for medicinal use was: workshops to increase the comfort level with shar- informants and adult focus group participants were cine is supported by national statistics which indi- ing knowledge is thus reinforced. Below Tanya dis- committed to raising awareness about incorporating cate that over 75% of First Nations adults claimed … the responsibility of kids; we’d pick the medi- cusses her feelings about sharing: an Indigenous perspective into all aspects of com- that traditional spirituality was important in their cine when they taught us where to go pick and daily lives and over 80% indicated that cultural that’s how I remember the medicine — and then I’m not doing enough to try to share my know- munity life. Alfred and Corntassel (2005, p. 612) ex- later on I learned that’s why they had us actually ledge — maybe it’s just a comfort level with it.… plain that transcending starts with in- events were important (First Nations Information, picking — we were pure — so no contaminants are I am passing on some of what I know but I know 2012). dividuals and radiates out to the “family, clan, com- in the medicine. (Pat, key informant) that there’s lots more to learn so I’m trying to just munity, and into all the broader relationships that Some adults were aware of the teachings when be comfortable with a few plants — so I know a form an Indigenous existence.” The continuum be- they were young but were involved in behaviours Pat explains how young people had an impor- little about them — and I’ve noticed that when I ginning with the young person at the level of the in- that prevented them from being interested in this tant role in communities in the past. Kirmayer et al. attend Marjory’s workshops I’m always learning knowledge. More recently they have come to under- something but it helps me because then I start to dividual and moving through the family, community, (2003) suggest that disempowerment could be one look up more, try to find more information about society, planet, and eventually to the cosmos or the stand the importance of these traditions: explanation for increasing health problems includ- the plants and so that I can learn more. (Tanya, spiritual, was a pattern also noted through responses I know there’s a lot of youth struggling with drugs ing mental illness and high rates of suicide among adult focus group participant) to research questions. Child and youth participants and alcohol addictions and … when I was a youth, youth in some Aboriginal communities. on the other hand tended to have more literal inter- I knew it was there but it was my choice, I didn’t Maar and Shawande (2010) determined that [M]ental health programs orientated toward em- pretations of research questions as demonstrated by want nothing to do with it because I was too in- traditional teachings should be part of a process of volved with the drugs and alcohol and that … and powerment aim to restore positive youth men- 334 © Pimatisiwin: A Journal of Aboriginal and Indigenous Community Health 11(3) 2013 Teachings around Self-care and Medicine Gathering: Rebuilding Capacity Begins with Youth 335

tal health and a strong sense of cultural identity It’s not enough to be grounded, to have cultural It has a different meaning when you speak the lan- that learning the language should be a priority in by giving youth an active role in designing and knowledge and historical knowledge, it has to be guage and then you’re in another … part of … who their communities. Anishnabe children on the island implementing programs that meet their needs. connected and rooted in the language also … to you are when you speak your language, it’s totally have the opportunity to learn Anishinaabemowin (Kirmayer et al., 2003, p. S21) say you’re a distinct Indigenous group … is only different … the meaning comes in clearer. (Serena, a relevant statement when it’s … rooted in the key informant) at public schools but respondents felt that instruc- Adult participants felt strongly about the need language.… You don’t really have a culture unless tion was inadequate to learn how to speak fluently. to practice and maintain culture and tradition and you have language.… Someone had approached Serena proposes that communicating culture Furthermore, there was some debate regarding who 9 to pass it on to young people. At the same time, an Elder in a country and said ‘what makes you and tradition in the language goes beyond preserv- should be instructed in the language. Some partici- recognizing that all cultures change over time, one Indigenous?’ … and they don’t refer to their cul- ing it, tapping into a different world view or realm. pants believe that it is up to the individual to learn ture, they don’t refer to their drums or their dance must find innovative ways to integrate culture in a Thus, having ceremonies or learning about trad- the language and forcing children may be ineffective. style or their food or any of that, they refer to the itional medicines and conducting workshops at changing world and consult with young people on language, it’s my language that makes me distinct One key informant suggested that maybe the wrong how best to do so. as an Indigenous person — so it’s rooted in that. least in part in the language may allow a deeper people are being targeted for language instruction (Steve, key informant) understanding: since older youth and adults are more committed to The Transmission of Culture and learning the language while children are less inter- The issue regarding the role of language in the You know, the ceremonies, you have to talk in Language your language to them spirits — that’s what they ested or are too busy: While traditional medicine workshops can help to maintenance of culture and in turn to well-being is hear, that’s what they understand … because if you Well I can tell you right now, I don’t see … kids up transmit culture to younger generations, our find- still debated in academia. One argument proposes don’t know the language, how can you participate ’til 17 trying to learn the language cuz they got so that preservation of language further isolates com- in the ceremonies? (Alison, key informant) ings also revealed a broader link between Aboriginal much other stuff going on. It’s a person that’s in munities from the mainstream, decreasing socio- health and the maintenance of culture and trad- In a paper on Native American cosmology, their 20’s, 30’s.… So are we targeting the wrong economic status (SES) and health through a type ition. Whereas youth participants are only starting John Grim (2001) explains how language connects people? Probably. (Eric, key informant) of “ghettoization” (McIvor et al., 2009; O’Sullivan, to think about their traditions and culture, adults Aboriginal people directly to a greater spiritual en- 2003). The other perspective is that “Aboriginal lan- Although there was some debate as to when the who participated in our research felt that it was im- tity. The use of the language and particular sounds guage use promotes identification with and pride language should be introduced to young Anishnabek portant for community members to have a strong can evoke the sacred; particular songs and rhythms in Aboriginal ethnic identity, which in turn im- and how to do so in a way that is relevant to them, sense of Anishnabe identity. When asked to discuss “can act as a mystical trope for activating a range of proves SES in Aboriginal communities” (O’Sullivan, our findings suggest that language is considered the value of culture and tradition in her community, bioregional, spiritual, and mythical images” (Grim, 2003, p. 136). The latter view was more prevalent critical to the continuity of culture. Most partici- one of our key informants, Tina, responded: 2001, p. 129). In many Aboriginal communities, the among participants in our study. They reported that pants in our study believe that loss of language con- oral tradition, in which language and culture are One of the big issues that I see in the commun- a true connection to the culture, the history, and tributes directly to the loss of culture and tradition ities is about a sense of identity and having cul- passed on through storytelling, may have allowed its traditions may only be fully experienced in the and is responsible for negatively affecting well-being tural identity of who you are and that’s part of this for the preservation of these profound connections Anishinaabemowin language. in many First Nations communities. In this con- thing we’re talking about is knowing who you are via language. Grim suggests as a Nishnabe person and, I think, if you can have The view that promoting Anishinaabemowin text, traditional medicine workshops can support some understanding of where you fit and know- language and culture in communities directly leads such mystical experiences are first of all prepared Aboriginal well-being in two ways: directly through ing where you come from, knowing some type of to spiritual and emotional health is not unique to for, and conditioned by, lifelong participation in the gathering and use of medicinal plants, and indi- stream, knowing so that you can walk down the our key informants. In her research with Anishnabek a particular spoken language that bears sacred rectly by transmitting and maintaining culture and street and be proud of who you are and not be power through its vocabulary, structure, and cat- tradition. ashamed of being a Nishnabe person. (Tina, key on Manitoulin Island, Wilson (2000) found a com- egories of thought, and serves as a vehicle for a informant) mon belief that language gave people a direct con- large body of orally transmitted traditions. (2001, Relationships with the Land nection to the Creator, Mother Earth, and to the p. 131) Traditional medicine gathering can also play an im- Through interviews and focus groups, the val- spirits. According to her participants, “if an individ- Looking at language this way can only be interpreted portant role in transmitting and maintaining culture ue of language to culture and the transmission of ual cannot speak the language they are lacking a sig- from an Indigenous framework as Western scientif- and tradition by reinforcing the relationship to the knowledge was repeatedly emphasized. Participants nificant part of their Anishnabe identity” (Wilson, ic approaches to knowledge do not take sacred or land. Indigenous understandings of the land and en- in our study believed that language is essential in 2000, p. 135). spiritual forces into account. vironment and how they relate to health and heal- their community and should be conserved. One key Building on the value of language in the main- The issue of language was widely discussed ing may only be fully understood within the context informant summarized these ideas persuasively as tenance of culture, other key informants in our among our participants. Although many of our key of an Indigenous world view. When asked what they follows: study indicated that traditional knowledge had to informants do not speak the language, most of them learned from past herbal teachings, participants fre- We all know the statistics on how many lan- be passed down in the Anishinaabemowin language said that they want to be able to do so, and all believe quently responded that “medicine is everywhere.” guages are dying on a daily basis out there and to be fully internalized and that it is critical to learn Most focus group participants were impressed that how many we’re gonna be left with in a … short the teachings and the names of medicines in the 9 The use of the (common) term “the language” is intentional here period of time … language needs to be priority. since that is how Anishnabek tend to refer to Anishinaabemowin language: (Ojibway). 336 © Pimatisiwin: A Journal of Aboriginal and Indigenous Community Health 11(3) 2013 Teachings around Self-care and Medicine Gathering: Rebuilding Capacity Begins with Youth 337 medicine grows all around them as represented by ing less). We found that more teachings about and movement but unfortunately it’s not coming from with traditional knowledge and Indigenous ways the following art voice drawing and explanation: greater use of medicines from the local environment a traditional perspective and I believe there would of knowing and thus in turn they are beginning to may contribute to a desire to protect the land. For be more people involved in it in First Nations, or redefine their identity, determining for themselves In my backyard there’s all kinds of stuff growing globally, if they had an Indigenous perspective of right there that I just was walking on all the time example, there was a commitment to keeping the how important the environment is in terms of their own course of action in terms of health and and I didn’t realize that it was all good stuff — so Earth green and concern about litter and pollu- that family connection … being Mother Earth, con- well-being. To this extent, traditional medicine gath- [in the drawing] I put ‘medicine growing here, tion, especially among children. This was expressed necting it in terms of her being our mother and ering corresponds to a holistic view of self-care, which there, everywhere’.… (Mike, adult focus group through their drawings and verbal responses dur- seeing it from that light. (Steve, key informant) includes looking after oneself physically, spiritually, participant) ing focus groups. One child, in response to the ques- and emotionally. In the following quote we see that More frequent traditional teachings which take In our study, we were interested in uncovering tion “How does gathering medicine make you think this participant has thought about ways that the use place out on the land may not only reinforce aware- whether the process of learning about the omni- of protecting and being in harmony with Mother of the medicines connects her to community, to the ness of and connections to the Earth, but actually do presence of medicines in their immediate environ- Earth?” said: creator, and fosters a sense of self-care: so from an Aboriginal viewpoint. Steve’s concerns ment might naturally lead to a desire to protect it. I drew a scene on top that shows all cleanness about the need to approach environmental issues I have a … smudge bowl with all the medicines, Although there was some recognition of the trad- with no garbage and I drew, sort of a happy face from a traditional perspective have been expressed tobacco, cedar, sweetgrass, and sage. I use that ev- itional value of the land, some participants suggested ery morning — or try to use it every morning to sun and the bottom one there’s another scene of often by Aboriginal scholars who feel that only when the existence of a tension between an Aboriginal almost the same thing except the sun is bad and purify my mind, my eyes, my nose, my mouth, so I the fundamental connection with the Earth is rec- and a Western perspective on environmentalism. there’s garbage everywhere. (Cindy, child focus can see good things, speak good things, be kind to ognized, rather than attempts to tame and control other people, everything I touch not to take with- Whereas the former considers cyclical patterns in group participant) it, will society be on the right course to repairing the out asking … so that’s how I use my medicines for nature, holism, spirituality, and validates tradition- Cindy expresses the connection to the Earth in global environmental crisis (Augustine, 1997; Cajete, self-care. (Sarah, adult focus group participant) al knowledge, in contrast, the latter more typically simple terms but intuitively recognizes the recipro- 1994). Validating the direct relationship between the Sarah has made the choice to use traditional revolves around individual choices that help limit cal relationship between people and the environ- health of the planet and the health of those who medicine almost daily as a way of caring for herself. human impacts on the planet (e.g., recycling, driv- ment. Madison, an adult respondent, refers to the inhabit it is part of an Indigenous knowledge para- Although it was not the purpose of our study to re- Figure 2. Mike’s Art Voice Answer to the Question spiritual connection between caring for the planet digm (Augustine, 1997; Cajete, 1994). Kirmayer et al. “What have You Learned from Past Herbal cord details about which medicines were used for and the Creator: (2003) suggest that taking part in traditional activ- Teachings?” what purpose or how frequently, we learned through ities on the land may not only lead to better indi- Mother Earth is a big place and so, I just do what participants’ comments that plant medicines exist in I can where I am and so … if there’s garbage lay- vidual health by healing specific ailments but could their daily lives and that they are aware of the option ing around there … I can pick it up and get rid of “have healing value both for troubled individuals to gather and make use of them. The opportunity to it to take care of Mother Earth and I do that … and whole communities” (2003, p. S16) in terms learn about traditional medicines regularly may re- because you’d be there all day picking up all the of their inherent relationship to the Earth. Alfred create daily use practices. The choice to participate garbage on the railroad track … you can’t get it all, (2009) believes that a move away from individual- but you can at least do something about where in plant gathering and use, and the associated sense istic approaches to health and a return to cultural you are right in the immediate area … so that’s a … of agency and control it may bring, could in itself return of the favour … to the Almighty. (Madison, practices that are land-based contributes to spirit- act as a determinant of good health and, in turn, adult participant) ual, physical, and psychological health at the level contribute to self-determination in Aboriginal com- of the community. As people rebuild the capacity to munities, leading to further improved Aboriginal The quotations by Cindy and Madison illus- use medicines from their local environment for their health. Smith et al. (2008) stress that control over trate answers to the question about Mother Earth self-care, to in turn care for the earth as an aspect healthcare in Aboriginal communities is crucial to in terms of garbage and preventing littering, which of this self-care, they are contributing to the bigger the reduction of health inequities. It is not enough reflect the influence of a Western perspective to the goal of achieving self-determination. to claim that health programs are governed by environment. One key informant explained that a Aboriginal people, when the Canadian government Western approach to environmentalism, which in- From Self-care to Self-determination maintains ultimate control from the outside. A pro- cludes ways of dealing with waste and recycling, and Capacity Rebuilding gression towards self-care for preventive and chronic tends to be more prevalent today in many First Our findings also suggest that traditional medi- health issues in communities thwarts the govern- Nations communities. He feels that true environ- cine teachings/workshops/gathering may contrib- ment’s ability to dictate and control healthcare ex- mental health can only come from the resurgence of ute to self-determination and rebuilding capacity. penditures. There is a growing movement calling for an Indigenous world view. We argue that traditional medicine gathering is an a complete overhaul and reframing of power struc- important element of self-care. Through traditional The larger global issues that everybody sees on tele- tures (Alfred and Corntassel, 2005). medicine teachings, community members reconnect vision, they want to do something to help out that 338 © Pimatisiwin: A Journal of Aboriginal and Indigenous Community Health 11(3) 2013 Teachings around Self-care and Medicine Gathering: Rebuilding Capacity Begins with Youth 339

Manitowabi’s report, Assessing the Institutionali­ their life (Brascoupé and Waters, 2009; Hunter et an Indigenous paradigm. Nevertheless, it is import- the money and then once the program is there, zation of Traditional Aboriginal Medicine, asserts that al., 2006; Wilson, 2000). Others among our partici- ant to point out that there is no single Indigenous where’s the cultural stuff? Or they’ll be one token thing like a smudging or whatever and there’s the “Anishinabek have the innate ability to promote and world view and that world views may vary from one pants also used drawings of the medicine wheel to cultural content. (Tara, key informant) provide healing for Anishinabe relatives” (2009, p. answer research questions, which can be interpreted Aboriginal community to another. This is import- 2) and that traditional knowledge can be rediscov- as their way of expressing an Aboriginal perspective ant when it comes to service delivery, for example. Tara expressed frustration that integration of ered in communities. Traditional healers should be of the world. In their research, Maar and Shawande (2010) found traditional practices amounts only to lip service and available to community members through a gov- Medicine wheel symbolism is an example of that offering traditional services does not neces- fears that health funding is being misdirected. In ernment-funded health centre, and capacity rebuilt Indigenous ways of knowing. Indigenous know- sarily mean that care will be culturally competent. British Columbia, the Health Integration Planning to encourage knowledge keepers from inside com- ledge is believed to be transmitted and received in Healers must be not only committed to seeing the Committee (HIPP) discussed issues around harmon- munities, thus contributing to self-determination a different way than Western knowledge including world from an Indigenous perspective, but must do ization of traditional medicine in the clinical setting associated with self-care. We argue that traditional through cosmological forces that cannot be quanti- so while being sensitive to a community’s particu- in one First Nations community. In this case, they medicine gathering and workshops can provide an fied. Lynn Lavallée (2009) explains that traditional lar understanding and local knowledge (Jacklin and proposed that Indigenous knowledge can comple- important entry point for individuals and commun- knowledge can transcend generations through what Kinoshameg, 2008; Maar and Shawande, 2010). ment mainstream scientific knowledge, but the ities, and at a smaller, more practical scale, to initi- has been called “blood memory” and can thus be In this line of thought, some of our participants “placement of Indigenous knowledge in a second- ate the process of this more significant overhaul. tapped into when rebuilding capacity in a commun- commented that providing traditional services in ary position” (Anderson et al., 2011, p. 44) must be avoided. These findings support the importance of Incorporating an Aboriginal World ity. “Knowledge acquired through revelation, such a token way does not incorporate this Aboriginal as dreams, visions, and intuition, is sometimes re- world view which is required for a truly integrated funding traditional programming that is controlled View garded as spiritual knowledge, which is understood model. Our key informants added to this argument by First Nations and reframed from an Aboriginal Finally, one aspect of reframing power is allowing as coming from the spirit world and ancestors” (G. by articulating the need for health care administra- paradigm; otherwise the insertion of the words the incorporation of an Aboriginal perspective or Atone and V. Harper, personal communication in tors to really believe that traditional methods are “tradition” and “culture” is only token. world view. The status quo is not healing commun- Lavallée, 2009, p. 22). Also called “cellular memory,” valid and legitimate and not just incorporate them ities, and key informants in our study felt that an these inexplicable connections some feel to their an- as a token call out to culture: Conclusion Aboriginal world view is needed in self-governance cestors when they hear their or This paper discusses the results of collaborative models, in research, and in health care. Health and [The] traditional program should be the big- feel the vibration of a drum beat, are thought to ori- gest program in that building. The nursing and health research conducted with two Aboriginal the environment need to be viewed through an ginate from “the molecular structure of our being” everything else is great — but, if it’s going to be communities on Manitoulin Island, Ontario. By Indigenous lens, recognizing that this may mean (Wilson, 1995). This “awakening of knowledge” (Pat, … a Native … healing centre, then Native medi- answering questions about traditional health work- adopting an approach that does not conform to key informant) comes from that cosmological place cine, Native culture should be the top, [the] big- shops, self-care, sharing knowledge, and the en- mainstream biomedical models of health. Most of gest thing in that building … and not just a token. vironment, participants communicated better ways and is awaiting rediscovery. (Eric, key informant; emphasis added) our key informants felt that the integration of trad- One key informant explained that unlike to approach traditional workshops in the future to itional teachings into daily life can only be realized Western perceptions of knowledge, in an Indigenous Maar and Shawande (2010) explain that part rebuild capacity in their communities. The gradual within the context of an Indigenous perspective or world view knowledge is less commonly seen as an of this tokenism stems from a lack of resources to implementation of these themes into traditional world view. Some of the participants understood at individual pursuit; it is not seen as being owned but support the centre’s traditional program. There is programming could improve health and well-being an elemental level what constitutes this world view. rather belongs to the cosmos. Researchers can be money for acute, clinical, and primary care, but through self-care. It is felt that through this process Martha, an adult focus group participant, said: interpreters of this knowledge (Wilson, 2008) and traditional services are chronically underfunded. of empowerment healthy individuals and commun- So I have a picture of what everybody knows to be traditional healers in communities are knowledge Another issue is that some community members ities can be reestablished. a medicine wheel … this is … protecting my men- carriers. According to Maar and Shawande: may not adhere to the integrative model practiced Since self-determination, capacity, and control tal, spiritual, physical, and emotional being of ME by many Aboriginal Health Centres. They do not are seen to be crucial to individual and community … using it all — and trying to find that balance [W]estern-based knowledge frameworks are still trust that non-Aboriginal caregivers believe in the generally inadequate to engage with and make well-being, the results of this project may offer prac- and to live in harmony with all those different ele- traditions so they are uncomfortable requesting ments that sit in those directions — and of course, sense of the wholistic aspects of traditional heal- tical value to the communities involved by further- I’m in the middle of the universe. (Martha, adult ing. In addition, Western-trained researchers often traditional services. Cultural sensitivity is then only ing the understanding that a continuum exists be- focus group participant) have difficulties collaborating across different token and not a true integration of an Aboriginal tween childhood and adulthood in terms of interest knowledge systems such as traditional Aboriginal world view (Maar and Shawande, 2010). The follow- in, confidence about, and willingness to share tradi- The medicine wheel symbol is an integral part of healing. (2010, p. 3) ing key informant reflected similar ideas: tional teachings. The likelihood that youth will use Anishnabe culture, representing well-being through Based on these authors’ experiences working with traditional teachings for their self-care and to share the balance between emotional, physical, spiritual, I’ve been involved in different projects over the the NTHC, it could be argued that there may be years and I’ve seen a lot of times when people put this knowledge comes with increased capacity and and mental health; total health is part of a circu- benefits to approaching health and health care from in proposals for money and they stick in this … cul- confidence. One way to rebuild this capacity may lar journey on which a person travels throughout tural stuff — it’s almost like as if it’s just to access 340 © Pimatisiwin: A Journal of Aboriginal and Indigenous Community Health 11(3) 2013 Teachings around Self-care and Medicine Gathering: Rebuilding Capacity Begins with Youth 341

be to offer more frequent workshops in a manner munity. We close with the insightful words of Dr. Andersson, N. and Ledogar, R.J. (2008). The CIET Davidson-Hunt, I.J. and. O’Flaherty, R.M. (2007). and location that engages young people. To help en- Raymond Obomsawin who is a leading specialist on Aboriginal Youth Resilience Studies: 14 years of Researchers, , and place- sure their success, traditional medicine workshops Aboriginal traditional medicine and health research. capacity building and methods development in based learning communities. Society and Natural for youth should: offer opportunities to grow in Obomaswin eloquently sums the value of self-care Canada. Pimatisiwin: A Journal of Aboriginal and Resources, 20, 291–305. Indigenous Community Health, 6(2), 65–88. a way that is seamless and unforced; integrate ac- and its potential to contribute to self-determination Denzin, N.K., Lincoln, Y.S. and Tuhiwai Smith, L., eds. tivities that build self-esteem and confidence; and, for the future health of Indigenous peoples in this Anishnawbe Health Toronto (2011) The Four Sacred (2008). Handbook of Critical Indigenous Method­ engage participants in a relevant way, keeping in country: Medicines. Retrieved 10 December 2012, from ologies. Los Angeles, CA: Sage Publications, Inc. . http://www.aht.ca/images/stories/TEACHINGS/ mind that culture and traditions evolve. We also Dyck, M. (2009). Social Determinants of Metis Health. Surely a positive restitution of sound health FourSacredMedicines.pdf. learned that workshops should include as much among Canada’s first peoples will not be accom- Ottawa, ON: National Aboriginal Health Organiza­ Anishinaabemowin language as possible, offering plished through pouring more resources into the Augustine, S. (1997). Traditional Aboriginal Knowledge tion, Metis Centre. teachings from a world view that is specific and rel- multiplication of medical schools, hospitals, clin- and Science Versus Occidental Science, 8. Ottawa: Edwards, D. (2004). Art Therapy. London: Sage. evant to Anishnabe on Manitoulin Island. ics, and expanded government sponsorship of pal- Environment Canada, Biodiversity Convention There are numerous questions that remain un- liative disease care services. The solution will not Office. Evans, R.G. and Stoddart G.L. (1990). Producing health, be in trying to patch up the present system.…The consuming health care. Social Science and Medicine, answered and practical or cultural barriers which Ball, J. (2005). Early childhood care and development solution will … come in educating and encourag- 31, 347–63. may have prevented us from answering them. Our ing the people in the sacred principles of how to programs as hook and hub for inter-sectoral ser- research sheds light on how existing medicine work- maintain their health, thus preventing the on- vice delivery in First Nations communities. Journal Ferrara, N. (2004). Healing through Art: Ritualized Space shops at Noojmowin Teg influence youth and adults slaught of both infectious and degenerative diseas- of Aboriginal Health, March, 36–50. and Cree Identity. Montreal, QC: McGill-Queens es. This education will need to focus on improved University Press. in two Anishnabe communities and might be help- Barwin, L. (2012). Places of tradition, places of research: nutrition, regular moderate exercise, the import- ful for the planning and implementation of pro- The evaluation of traditional medicine workshops First Nations Information Governance Centre .(2012). gramming in the future. While better participation ance of positive mental-spiritual attitudes, bal- anced and purposeful living, and stress reduction. using culturally and locally relevant methods. MA First Nations Regional Health Survey (RHS) Phase in our workshops may have yielded stronger results Indeed the greatest breakthrough in Aboriginal thesis, University of Ottawa, ON. 2 (2008/10) National Report on Adults, Youth and on the significance of self-care, our findings confirm health and health care is to be found in the certain Brant Castellano, M. (1993). 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health unit Area. Retrieved 3 October 2011 from Healing Foundation looking at traditional health and http://www.sdhu.com/uploads/content/listings/ healing. SnapshotCancerSDHU2007Final.pdf. [email protected] Waldram, J.B., Herring, D.A., and Young, T.K., eds. Marjory Shawande was a member of the Wikwemikong (2006). Aboriginal Health in Canada. Toronto, ON: Unceded Indian Reserve on Manitoulin Island, Ontario, University of Toronto Press. Canada. She was the coordinator of the Traditional Aboriginal Medicine Program at the Noojmowin Wilson, K. (2000). The role of Mother Earth in shaping Teg Health Centre and a member of the Manitoulin the health of Anishinabek: aA geographical explora- Anishinabek Research Review Committee, an Aboriginal tion of culture, health and place. Unpublished PhD research ethics board on Manitoulin Island. Over the past thesis, Queen’s University, Kingston, ON. 40 years Shawande worked in the social and health fields. Marjory passed away on April 2nd, 2013. She is greatly Wilson, K. (2003). Therapeutic landscapes and First missed. Nations peoples: An exploration of culture, health Eric Crighton is a health geographer and an Associate and place. Health and Place, 9, 83–93. Professor in the Department of Geography at the University Wilson, K. and Young, K. (2008). An overview of Aboriginal of Ottawa where he focuses his teaching and research on health research in social sciences: Current trends environmental determinants of heath, environmental and future directions. International Journal of risk perceptions and behaviours, psychosocial impacts Circumpolar Health, 67, 179–189. of environmental and infectious disease hazards, and environmental health equity. Eric’s recent projects include Wilson, S. (1995). Honoring spiritual knowledge. a study examining environmental risk perceptions among Canadian Journal of Native Education, 21 (supple- new mothers, patterns and determinants of asthma and ment), 61–69. COPD in Ontario, and prevalence and determinants ——— (2001). Self-as-relationship in Indigenous research. of chronic respiratory diseases among Canada’s First Canadian Journal of Native Education, 25(2), 91–92. Nations and Métis. ——— (2008). Research is Ceremony: Indigenous Research [email protected] Methods. Halifax, NS: Fernwood Publications. Luisa Veronis is a social geographer concerned with questions of social and spatial inequality, the experiences Zolner, T. (2003). Going back to square one and find- of marginalized groups, and social justice in the city. Her ing it’s a circle: (Not) doing university research in research and teaching interests address issues of identity Indian country. Pimatisiwin: A Journal of Aboriginal and community formation, struggles for citizenship and Indigenous Community Health, 1(1), 91–113. and equal rights, governance and the nonprofit sector. Lynn Barwin is a research consultant, with a More specifically, her work examines processes of particular interest in traditional Aboriginal medicine, inclusion/exclusion in and through space and the harmonized and complementary medicine, decolonizing everyday experiences of belonging of immigrants and methodologies, and alternative research paradigms. Her minority groups using an intersectionality approach. Master’s thesis was the result of a collaboration with Luisa is currently involved in a range of collaborative Noojmowin Teg Health Centre on Manitoulin Island and and interdisciplinary projects examining the everyday traditional coordinator Marjory Shawande and examined experiences of minority groups in the transborder city capacity rebuilding and self-care through traditional of Ottawa-Gatineau, the influences of environmental medicine workshops for youth. Lynn has a background in factors on international migration to Canada, and the plant biology and herbal medicine and is currently part consumption and production of multicultural media. of a community-based research project for the Aboriginal [email protected]