A Guide for Working with Aboriginal People of Northwestern Ontario

A Stroke Resource for Healthcare Providers

NORTHWESTERN ONTARIO A Guide for Working with Aboriginal People of Northwestern Ontario A Stroke Resource for Healthcare Providers

Preface

My dad once said “The White people yet another group may decide to use were given the gift of their medicines. Aboriginal medicines only. The last We were also given the gift to know group will use non-Aboriginal medicines. our medicines. Do not reject either one. What is common among the group is Both are good”. they are seeking to be healthy in all aspects of their lives. So, I believe all My dad was a wise, humble and loving the medicines are all equally important human being. My dad was in his late 90’s and play a role in gaining our health and when he passed away. My dad will always well-being. be in my heart as well his life teachings which I hope I am living his teachings. My dad had also said “all those things we used to make medicines came from all For most of the Aboriginal people, the sources available to us and we were all meaning of the medicine goes beyond given what we need to live on earth from prescription that a regular doctor may our Creator” As my dad said “all is good” prescribe to their patients to, hopefully, heal or control a physical illness. For Today, there is more and more many Aboriginal people, the definition information about Aboriginal people, of medicine includes the following: their beliefs, values, practices, traditional connection to mother earth, going for a teachings, ceremonies and medicines are walk in the bush, a smudging ceremony, available to explore and read. To be able a gathering with a community, a sunrise, to provide the best health care to the playing with a child, sitting down with an Aboriginal population, it is a good thing Elder to share is medicine. to have some knowledge and insight into From what I have seen, there are more who we are and where we come from. and more Aboriginal people returning to To the health care providers, it might their medicines and traditional healing be a good idea to ask questions of your ways. The uses and the practices of the patients what they practice and use. The medicines among all Aboriginal people knowledge will assist you to provide the can be similar but unique as well. best health care and treatment. There are Aboriginal people, who Brenda M. Mason, Elder have chosen to utilize both Aboriginal Revised March 5, 2012 and non-Aboriginal medicines. And

A Guide for Working with Aboriginal People of Northwestern Ontario - A Stroke Resource for Healthcare Providers A Guide for Working with Aboriginal People of Northwestern Ontario A Stroke Resource for Healthcare Providers

Purpose Acknowledgements This toolkit provides clinical and These documents could not have been educational tools, Aboriginal history, assembled without the dedication and stroke information and best practices, contributions of many. Special thanks to which can assist health service these individuals for their assistance in providers to engage and offer effective the compilation of this toolkit: stroke-related education and care to Aboriginal individuals and families. Kelly Brownbill & Greg McGregor Aboriginal Health Circle Barrie Ontario is home to a diverse mix of Native Advisory Circle Aboriginal groups and cultures. There are three main Aboriginal groups in Marilyn Morley Ontario; First Nations, Inuit and Métis. Ontario Aboriginal For this toolkit, the term “Aboriginal” Friendship Centre refers collectively to these Aboriginal groups and cultures living in Ontario. Cheryl Moher & Alda Tee Central East Stroke Network

Target Audience Darren Jermyn This toolkit was designed for Northeastern Ontario healthcare professionals (e.g., Stroke Network clinicians, healers) and health providers (e.g., family health teams, Donna Cheung, Jacqueline Willems community agencies, healing & Ross Graham centres and hospitals) that work South East Toronto Stroke Network with Aboriginals, their families and Marilyn Erwin communities at any stage of stroke Stroke Prevention Clinic prevention, care or recovery. Fort Frances, ON This toolkit refers to these audiences collectively as health Cathy Creighton & Donna Simon service providers. Anishnawbe Mushkiki Contact Brenda Mason Information First Nations Elder Diane Hiscox, Pauline Bodnar All feedback on the content of & Sandi Homeniuk this toolkit should be directed to Northwestern Ontario Regional the Northwestern Ontario Stroke Network (NWORSN) Regional Stroke Network at [email protected]. This document Robert Fenton was published by the Northwestern Chair, Aboriginal Advisory Ontario Regional Stroke Network Committee (NWORSN) in March 2012. Helen Cromarty Sioux Lookout Meno Ya Win Health Centre

Deanne Lee Thunder Bay Regional Health Sciences Centre

A Guide for Working with Aboriginal People of Northwestern Ontario - A Stroke Resource for Healthcare Providers 2 A Guide for Working with Aboriginal People of Northwestern Ontario A Stroke Resource for Healthcare Providers Table of Contents Preface Purpose 2 Acknowledgements 2 Section 1: Canadian Aboriginal History 4 Introduction 5 Historical Events 5 Summary 7 Section 2: Aboriginal Health Status 8 Social Determination of Health 9 Demographics 10 Section 3: Aboriginal Health Beliefs 11 Philosophies on Health and Wellness 12 Medicine Wheel Teachings 13 Traditional Medicines 14 Aboriginal Families and Communities 16 Section 4: Aboriginal Culture - Tools, Considerations and Guidelines for Cultural Safety 17 Cultural Safety 18 Cultural Amplifiers 21 Additional Considerations for the Clinical Encounter 21 Your Beliefs and Lens 22 Collaborating with Aboriginal Communities 22 Section 5: Stroke Information and Best Practices 23 Stroke in Aboriginal Populations 24 Risk Factors 24 Canadian Best Practice Recommendations for Stroke Care 25 Section 6: Additional Resources 26 Introduction 27 Aboriginal Knowledge Centres 27 Aboriginal Services & Community Agencies 27 Aboriginal Health Related Strategies/Initiatives 28 Listing of Aboriginal Organizations 29 Stroke Education Resources 30 Related Resources 31 Stroke Services and Agencies 32 Stroke Prevention Clinics and Tele-Stroke Sites in NW Ontario 32 Glossary of Terms 33 References 34 Map of Treaties and Health Facilities 36 Human Body 37

A Guide for Working with Aboriginal People of Northwestern Ontario - A Stroke Resource for Healthcare Providers 3 Section 1: Canadian Aboriginal History

A Guide for Working with Aboriginal People of Northwestern Ontario - A Stroke Resource for Healthcare Providers 4 Section 1: Canadian Aboriginal History

First European Introduction Contact 1492 It is widely accepted that Canada’s history of colonization and assimilation practices toward Aboriginal People Indian Residential The Royal has negatively impacted their ability Schools Settlement and Official Government Proclamations to maintain traditional ways of life Apology - 2006 1763 (King, Smith & Gracey, 2009). These negative impacts include loss of land, culture and language, and have The Indian Act been shown to have had a lasting The Indian Act and Bill C-31 1897 impact on Aboriginal individuals’ 1985 quality of life (Hill, 2003). As a health service provider working with Aboriginal individuals, it is important Forced Indian Residential to understand their history and Sterilization Schools Legacy health issues. It is equally important 1960 (1840-1996) to remember that each individual is unique (whether Aboriginal or not) and that these events may or may not be relevant. (Government of The “60s Scoop” Saskatchewan, 2009) 1960

Historical Events

Before European Arrival considered human). However, in 1512, This legislation was designed to assimilate Aboriginal people were living in North Pope Julius II declared that “Indians are Aboriginal people into European culture. America long before Europeans arrived. truly men...they may and should freely Aboriginal people became wards of the While difficult to determine, it is and legitimately enjoy their liberty and state, and their land became “reserves.” believed that there were approximately possession of their property; nor should Previously signed treaties were ignored 500,000 people living in what is now they be in any way enslaved.” and Indian Agents were hired to enforce the new legislation. The intent of the Canada (with estimates ranging from The Royal Proclamation (1763) 200,000 to 2,000,000) (O’Donnell, Indian Act is best summed up in the 2008). These people were organized The Royal Proclamation of 1763 words of Duncan Campbell Scott, the into approximately 600 communities established British protection over Deputy Superintendent of Indian Affairs (also known as tribal groups or bands). unsettled land belonging to Aboriginal from 1913 to 1932: Many of these communities had similar communities, and recognized I want to get rid of the Indian problem… characteristics, including being divided Aboriginal ownership of land not Our objective is to continue until there into clans based on lineage (i.e., the already colonized. This Proclamation is is not a single Indian in Canada that has line of descendants of a particular considered to be one of the strongest not been absorbed into the body politic and there is no Indian question and no ancestor), and holding the belief that guarantees of Aboriginal land rights. Indian department (Leslie, 1978). all elements of nature were sacred. As clan members married into other Struggle to Maintain Christianity was imposed on Aboriginal clans, these communities grew. It is Aboriginal Identity people as a means of civilizing them. also believed that Aboriginal people By the 19th century, government policies Cultural ceremonies, such as Sweat enjoyed relatively good health during changed to reflect “colonial dominance” Lodges and Shaking Tent were outlawed this period, including control of disease, of the Aboriginal nations. The new in 1884. Persons caught celebrating these as well as high levels of physical and Dominion of Canada no longer needed events could be imprisoned. Banning these mental wellness. Aboriginal people as allies in war, or traditional gatherings assisted missionaries required their skills for the fur trade. in their attempts to replace Aboriginal First Interactions (1492) Instead, the Dominion needed land for beliefs with Christian beliefs. When Christopher Columbus arrived in new settlers. This led to a new goal for The right to vote was a major feature South America in 1492, the Aboriginal the Dominion: Aboriginal assimilation of the Indian Act. If an Indian person people were welcoming. The Spanish though legislation. accepted the right to vote (or own however, tortured, abused, killed The Indian Act (1867) property or serve in the military), he or and enslaved Aboriginal people. It is she had to relinquish their Indian Status. The Indian Act describes the estimated that the Aboriginal population This was not changed until 1960, when administration of almost every aspect was reduced by half during the first two the Federal Elections Act was amended of Aboriginal life. It had three main years of Columbus’ rule. The Europeans to allow Indian people to vote. also had doubts as to whether principles: 1) to civilize Aboriginal Aboriginal people in the Americas were people, 2) to manage Aboriginal people human (at this time only Christians were and their lands; and 3) to define who could and could not hold “Indian Status.”

A Guide for Working with Aboriginal People of Northwestern Ontario - A Stroke Resource for Healthcare Providers 5 Section 1: Canadian Aboriginal History

From then on, an Aboriginal person Many ran away from school and were Forced Sterilization could retain Indian Status and be a severely punished upon their return. In the sixties, British Columbia and Canadian citizen at the same time. Others encountered sexual abuse by Alberta developed policies to stop The Indian Act also spelled out school officials and/or suffered severe “mental defectives” from having children. conditions for being an Indian woman. psychological harm as a result of their These policies stipulated consent was no It considered any woman married to suppressed Aboriginal identity. longer required to perform sterilizations an Aboriginal man to be an Indian, Within these institutions, Aboriginal when a client was deemed mentally fully allowed to live and be buried on a children lost their culture, identity and defective or “incapable of intelligent reserve (i.e., she gained Indian Status). traditions, as well as trust and respect parenthood.” Aboriginal women However, an Aboriginal woman married for others and themselves. These were became targets under this policy and to a European man was considered a replaced with feelings of shame and a disproportionately high number of member of Canadian society (i.e., she low self-worth. Furthermore, those Aboriginal women were sterilized. and their children lost Indian Status). who were not direct victims of abuse were often witnesses, and suffered the The Sixties Scoop (1960-1985) effects of intergenerational trauma. The sixties scoop (also known as the stolen generation) refers to the A Shaking Tent rite was a popular Residential schools began a legacy of despair for Canadian Aboriginal adoption, under the expanded Children ceremony among the Ojibwa, Innu, Welfare Act, of approximately 20,000 Cree, Penobscot and Abenaki. The communities. The schools had nearly destroyed Aboriginal communities by Aboriginal children by non-Aboriginal client would pay a Shaman to build families across North America. To his or her tent and the Shaman suppressing traditional language, culture and spirituality. It has been argued “protect” Aboriginal children, welfare would enter it at dark. Singing and workers removed them from their Drumming was used to summon that many Aboriginal people lost their knowledge of traditional parenting families rather than trying other the Shaman’s spirit helpers, whose interventions or counseling. These arrival was signaled by the shaking practices during this era. The last of the 130 residential schools closed in 1996. children were often apprehended from of the tent and animal cries. The their homes without the knowledge or spirits were used to cure the ill and Reserves consent of their families or communities for anti-sorcery. and had no mechanism to contact their In order to develop land across Canada, Sweat Lodge birth families (Philip, 2002). The has been called “the the government pressured Aboriginal most powerful structure in the world.” people to settle on reserves. Reserves Bill C-31 and Bill C-3 (1985, 2010) It is a place specially constructed to were kept far enough apart to discourage conduct ceremony. Sweats vary from communities from forming alliances According to the Indian Act, Aboriginal purification and cleansing to healing against the government. Indian Agents women lost their Indian status if they sweats. It is said that the Sweat Lodge were sent to reserves, where they lived married a man who did not also have during ceremony “responds” to what and were heavily involved in many aspects Indian Status. Her children would also the participants need. of Aboriginal life such as: not receive Indian status. However, (Anishinawbe Health Toronto) this was in conflict with the Canadian • Education, law and order Charter of Rights and Freedoms which • Granted permission for Indians guaranteed protection of rights equally to leave the reserve (doing so for men and women. Bill C-31 (passed Residential Schools (1840-1996) without permission could result in in 1985) amended the Indian Act to imprisonment) give these women and their children The Indian Act required Aboriginal status. By 1992, over 81,000 people had During this time, the federal government parents to send their children to regained status. residential schools. These schools also had control over the financial had three objectives: 1) to convert transactions of Aboriginals. This meant On March 11, 2010, the Federal Aboriginal people to Christianity, 2) to that any sales and purchases were Government introduced legislation to teach reading, writing and arithmetic, strictly monitored under a permit enhance gender equity in the Indian and 3) to develop Aboriginal children system. Aboriginals needed a permit to: Act. Bill C-3 ensures that grandchildren of women who lost status as a result of into farmers and housekeepers. • Sell cattle, grain, hay, firewood, lime, marrying non-Indian men gain Indian charcoal and produce grown on Children were forcibly removed from Status in accordance with the Indian the reserve their families and placed in schools Act (INAC, 2010). located in remote areas. The use of any • Buy groceries or clothes Aboriginal language was prohibited, and children were punished severely As Aboriginal communities developed for speaking their language, even if their own elected governments during they did not speak/understand English. the fifties and sixties, they eventually did As a result, many children died of away with the role of the Indian Agent poor health conditions at the schools. and the permit system.

A Guide for Working with Aboriginal People of Northwestern Ontario - A Stroke Resource for Healthcare Providers 6 Section 1: Canadian Aboriginal History

Residential School Apology (2008) Summary Two years after the federal government reached a $1.9 billion settlement with Knowledge regarding the devastating the survivors of residential schools, impact of colonization and other the Prime Minister (Stephen Harper) historical events on Aboriginal formally apologized to the survivors and communities is critical to understanding their families on June 11, 2008. Excerpts the current Aboriginal physical, from his speech: emotional, mental and spiritual health The treatment of children in Indian status. These events have resulted in Residential Schools is a sad chapter loss of culture, values, language and in our history…I stand before you, in kinship between communities. They this Chamber so central to our life as have been shown to contribute to high a country, to apologize to Aboriginal incidence of family violence, sexual people for Canada’s role in the Indian abuse, substance abuse, suicide, social Residential Schools system…The issues and widespread chronic disease government now recognizes that the for Aboriginal Canadians. consequences of the Indian Residential Schools policy were profoundly Today, Aboriginal leaders are taking negative and that this policy has responsibility for healing the grief and had a lasting and damaging impact loss in their communities. As well, Elders on Aboriginal culture, heritage and continue to pass on the knowledge and language. While some former students wisdom to keep Aboriginal culture and have spoken positively about their traditional healing methods alive for experiences at residential schools, these future generations. stories are far overshadowed by tragic accounts of the emotional, physical and sexual abuse and neglect of helpless children, and their separation from powerless families and communities. The legacy of Indian Residential Schools has contributed to social problems that continue to exist in many communities today (Canada, 2009).

A Guide for Working with Aboriginal People of Northwestern Ontario - A Stroke Resource for Healthcare Providers 7 “I just want to be accepted, respected and honoured for who I am and what I do”. Brenda Mason, Elder

Section 2: Aboriginal Health Status

A Guide for Working with Aboriginal People of Northwestern Ontario - A Stroke Resource for Healthcare Providers 8 Section 2: Aboriginal Health Status

As a health service provider, one Social Determination of Health of the ways you can provide care in a culturally sensitive manner is A recent Health Canada report indicated that Aboriginal Canadians have poor health, by becoming familiar with each when compared with the rest of the Canadian population. Furthermore, these health client’s customs, beliefs and values. outcomes are likely somewhat due to poor social, living and economic conditions For example, when working with an (listed below). There is also evidence that Aboriginal Canadians have more negative Aboriginal who is either at-risk of health behaviours than the rest of Canadians (e.g., higher rates of smoking). having a stroke or a stroke survivor, a general understanding of their culture, beliefs and values will likely facilitate Aboriginal Canadian Social Determinant of Health improved communication. It will also be Population Population useful to have awareness of the social determinants of health which directly Overall smoking rate 58.8% 24.2% impact Aboriginal communities. This section of the toolkit will provide a Report heavy drinking on a weekly basis 16% 7.9% summary regarding the health status Body Mass Index (BMI) = at least overweight 73% 48% of Aboriginal People across Canada, as well as their culture and beliefs 50-59 year olds who have had a mammogram 73.3% 88.3% regarding health and medicine. Holding a university certificate, diploma or degree* 5.1% 22.7%

Graduated from high school by age 20* 36% 84.6%

Social Determination of Health is Unemployment rate* 27.7% 7.3% the premise that one’s health is determined by complex interactions Employment rate* 37.4% 61.7% between social and economic factors (e.g., family size, wealth Median annual income* $10,631 $22,274 and education), the physical environment (e.g., living conditions) Households below CMHC adequacy standards* 22.4% 2% and individual behaviour (e.g., smoking, level of physical activity) *Compared on-reserve Aboriginals with general Canadian population (Canada, 2009). (Canada, 2009).

Beyond the social determinants that Many Indigenous groups believe that affect the health of all Canadians, the the devastation of their lands through negative impact of certain historical globalization and commercial exploitation events (e.g., residential schools) on and climate change is equivalent to a the current health status of Aboriginal physical assault… Kirmayer and colleagues thus point out that the widespread Canadians is widely accepted. A destruction of the environment through literature review by King, Smith & commercial developments should be Gracey (2009) reported that historical understood as attacks on Aboriginal factors including colonization, individuals and communities that are globalization and migration equivalent in seriousness to the loss of have created some unique social social role and status in a large-scale urban determinants of health for Aboriginal society. As traditional custodians of the Peoples, including loss of language, land, dispossessed Indigenous peoples loss of culture and disconnection from have lost their primary reason for being. the land; all of which have negatively Additionally, these investigators, in their impacted the health of Aboriginal studies of the Inuit of northern Canada, showed that mental health and healing can Canadians. As an example, having a be powerfully affected by eating country strong “connectedness with the land” food, hunting, and camping on the land has been shown to positively affect the (King, Smith & Gracey, 2009, p.81). health of Canada’s Inuit communities (Kirmayer, Fletcher & Watt, 2009).

A Guide for Working with Aboriginal People of Northwestern Ontario - A Stroke Resource for Healthcare Providers 9 Section 2: Aboriginal Health Status

Demographics

The 2006 census indicated that In Ontario in 2006, the census indicated there were 242,495 self-identified the number of Canadians with self- Aboriginal individuals (representing 2% of the Ontario population). The table reported Aboriginal ancestry was 1.17 below reports the Canadian population and Thunder Bay Aboriginal population million (representing 4% of Canada’s (Statistics Canada, 2006). population). It also indicated that the First Nations population grew by 45% from 1996 to 2006. The biggest Total Population Size contributing factor to this growth was Total % that is Census Area First fertility, as the Aboriginal birth rate was Population Aboriginal Métis Inuit 1.5 times the overall Canadian rate. This Nations growth is nearly six times greater than Canada 31,241,030 4% 698,025 389,780 50,480 that of the non-Aboriginal Canadian population, making Aboriginals one of Thunder Bay 121,055 8% 7,420 2,370 40 the fastest growing population groups (Statistics Canada, 2006). *Ontario only (Statistics Canada, 2006)

In 2006, approximately 65% of Aboriginal people lived in an urban area. Another Aboriginal 2006 % Increase 18.3% lived in non-reserve rural areas. The 2006 Ontario Aboriginal population Group Population (1996-2006) was much younger than the non-Aboriginal population. The median age of the Aboriginal population was 29.7 years, compared with 38.9 for non-Aboriginal First people (Statistics Canada, 2006). Nations 698,025 45%

Métis 389,785 91% 2006 Population Total Male Female Inuit 50,485 26% Total Ontario 12,028,900 5,877,875 6,151,020 Total 1,172,790 9% Total Aboriginal Ontario 242,490 117,585 124,900 Multiple 34,500 34% & other* First Nations (single response) 158,400 75,955 82,440 Métis (single response) 73,610 37,025 36,580 *Includes persons who reported >1 Aboriginal identity group and those who reported being Inuit (single response) 2,035 940 1,100 a Registered Indian and/or Band member without reporting an Aboriginal Identity Multiple Aboriginal Responses 1,905 885 1,025 (Statistics Canada, 2006) Other Aboriginal Responses 6,540 2,785 3,755 Numbers may be limited as they are based on individual Who actually identified self as Registered Indian Status Total Male Female Aboriginal. Data collection in 2006 differed from previous data collection. Use with caution Registered Indian 123,595 58,780 64,815 for growth percentage. Not a registered Indian 11,905,300 5,819,095 6,086,205 Characteristics of Aboriginal Total Male Female Population

Median Age 29.7 28.5 30.8

(Statistics Canada, 2006)

A Guide for Working with Aboriginal People of Northwestern Ontario - A Stroke Resource for Healthcare Providers 10 Section 3: Aboriginal Health Beliefs

A Guide for Working with Aboriginal People of Northwestern Ontario - A Stroke Resource for Healthcare Providers 11 Section 3: Aboriginal Health Beliefs

Philosophies on Health and Wellness

Ontario is home to a variety of Wholistic Perspective knowledge and wisdom to Aboriginal people: Algonquin, Ontario’s Aboriginal population has a keep Aboriginal culture and traditional Mississauga, Ojibway, Cree, Odawa, wholistic perspective on health and healing methods alive for future Pottowatomi, Delaware, and the wellness. This means that physical, generations. Haudenosaunee (Mohawk, Onondaga, emotional, mental and spiritual wellness Aboriginal Connectiveness – Aboriginal Onoyota’a:ka, Cayuga, Tuscarora, and are each a component individuals, families, communities and Seneca) (Spotton, 2007). Northwestern of good health. Furthermore, nations are connected in the Sacred Ontario is home to Ojibway, Oji-Cree when these components are balanced, Circle. An emotional, physical, mental and Cree. It is important to remember an individual is in harmony with nature. and spiritual imbalance affects everyone. that each Aboriginal community in Aboriginal culture also includes the It is important to recognize that every Ontario has unique characteristics concept of connectiveness, which treatment has a cultural component. and needs. These include different describes the connection between the Western medicine is primarily focused languages, spiritual beliefs, history and Aboriginal people and Mother Earth. cultural teaching. However, there are on diagnosis as an outcome, whereas a number of common, fundamental Today, Aboriginal leaders are Aboriginal medicine focuses more on traditions and cultures that are listed taking responsibility for healing the the environment in which the patient below. Understanding and respecting grief and loss in their communities. As may recover. the cultural practices of an Aboriginal well, Elders continue to pass on the client will help support an effective treatment plan.

Nation It is important to remember that within the Aboriginal population there are hundreds of tribes. Each one of these tribes is somewhat the same but have a variance in their Community tribal belief systems, community practices and different languages Family

Self

Religion: Please do not assume that all Aboriginal people are practicing traditional ways. Some Aboriginal people are Christian, some are traditional and some are a combination of both.

A Guide for Working with Aboriginal People of Northwestern Ontario - A Stroke Resource for Healthcare Providers 12 Section 3: Aboriginal Health Beliefs

The Sacred Medicine Wheel Numbers have always played a significant role in traditional Aboriginal culture. The number four, for example, is one of the most sacred. The Medicine Wheel is a ceremonial healing tool built White around the number four. The Aboriginal population values the Medicine Wheel as a wholistic and sacred symbol, given to them by the Creator. The Medicine Wheel can be expanded Black Yellow to include other wheels, such as the emotions wheel, or the mind wheel. These wheels may be used to explain or examine emotions that impede personal growth. It requires many years to learn each wheel’s teachings. Collectively, the wheels symbolize that an individual must Red balance wellness of mind, body and spirit, as well as live in harmony with the natural environment. An Aboriginal client may consider illness to be the result of an imbalance in one or more of these areas. It is important to recognize that every treatment has a cultural component. Western medicine is primarily focused How it works: The wheel revolves on diagnosis as an outcome, whereas endlessly in a clockwise direction, Aboriginal medicine focuses more on symbolizing the continuous cycles of life. It also symbolizes the Powers the environment in which the patient of the Four Directions and the may recover. interrelatedness of all life’s elements. How it was taught: The Medicine Wheel was originally explained with a circle being drawn in the earth. The symbols were then gradually drawn as their meanings were explained by an Elder. The Elder would begin with an explanation of the four directions: north, east, south and west. He may then have gone on to explain some of the following concepts: • The changing seasons: early fall, fall, winter, early spring, spring and summer. • The four stages of life: childhood, adolescence, adulthood and old-age. • The races: red, white, black and yellow. • The four elements: water, air, fire, and earth. • The four sacred medicines: tobacco, cedar, sage and sweetgrass.

A Guide for Working with Aboriginal People of Northwestern Ontario - A Stroke Resource for Healthcare Providers 13 Section 3: Aboriginal Health Beliefs

Traditional Medicine The following are examples of plant medicines used primarily in Northwestern Ontario: Aboriginal populations use a variety of natural resources to create medicines. The four sacred medicines include Plant / Medicine Use Preparation Medicinal Content tobacco, cedar, sage and sweetgrass, and can be used as part of a healing practice Balsam Fir Colds Inhale Vapors Nasal Stimulant or ceremony. These medicines, healing Mountain Ash Allergies Tea From Bark Antihistamine practices and ceremonies are often collectively referred to as traditional Cedar Allergies Tea From Boughs Antihistamine Aboriginal medicine. The World Health Poplar Back Pain Tea From Roots Analgesic Organization (WHO) defines traditional Aboriginal medicine as: The sum total of knowledge, skills and It is important to note that most substances (e.g., traditional medicines/medication) practices based on the theories, beliefs have active ingredients which can affect health and interact with other medicines/ and experiences Indigenous to different medication. Similar to the health service providers who practice western medicine cultures, whether explicable or not, used in the maintenance of health as (i.e., modern practices aimed at restoring and maintaining health by preventing well as in the prevention, diagnosis, and treating illness), traditional medicine is usually provided by a number of improvement of treatment of physical specialized Aboriginal practitioners. A publication by Canada’s National Aboriginal and mental illness. Health Organization (NAHO) describes the roles of these practitioners (Hill, 2003). The Helper description was gathered from the Alberta College of Social Workers’ Aboriginal medicine contains folk Aboriginal Social Work Committee (Gladue et al., 2008). remedies and treatments passed down over time. Many formed the basis and can be found in Western pharmaceutical treatments. “You have to use them (tobacco plants) with The Four Sacred Medicines respect, as prayers and offerings in ceremonies, Tobacco (the East) is always used so they’ll reward you. But if you use them without first as an offering for everything and in every ceremony. Tobacco is given respect, if you smoke them like cigarettes, their to the Aboriginal people so they may communicate with the spirit world. power will kill you.” It opens up the door to allow that Winters, Solomon, Hill, Pego and Victoria, 2000 communication to take place. Offering Sacred Tobacco is a way of giving For further information, please go to: thanks in advance of a request. Tobacco http://www.med.uottawa.ca/sim/data/Aboriginal_Medicine_e.htm is generally not smoked, except on special ceremonial occasions. Sweetgrass (the North) is used for purification of thoughts and the environment. Cedar (the South) is used for purification DID YOU KNOW? of the home and protection. It also has Aboriginals discovered the first restorative medicinal uses. Cedar grows chewing gum, which was collected during the winter months reminding the from spruce trees. Some of these Aboriginal people that medicines are “chewing gums” were used to relieve always available. When cedar is put into toothache, headache, and indigestion. the fire with tobacco, it crackles, calling www.aadnc-aandc.gc.ca the attention of the spirits. Sage (the West) is used to prepare people for ceremonies and teachings. Sage is used for releasing what is troubling the mind and for removing negative energy. It is also used for cleansing the homes and sacred items. Adapted from Aboriginal Perspectives on Health and Wellness, Marilyn Morley, Webinar Series, 2009

A Guide for Working with Aboriginal People of Northwestern Ontario - A Stroke Resource for Healthcare Providers 14 Section 3: Aboriginal Health Beliefs

Herbalist – A practice that emphasizes Midwife – Often, these practitioners are botanical and pharmacology knowledge women with specialized knowledge in of the indigenous plants and fauna. Often prenatal care, birthing assistance and these individuals work closely with other aftercare. The midwife may employ Indigenous doctors and assist in providing the use of massage, diets, medicines remedies for individuals whom they or and ritual, prayers and/or counseling. others have diagnosed. Their practice can Traditional midwifery exists worldwide be highly specialized in one field, such as and involves a variety of skills, often remedies for snakebites, or as diverse as biophysical, but can also include spiritual the illnesses themselves. and ritual activity as well. Medicine man/woman – A practice that Helper/Natural Helper – Aboriginal may and often does possess all of the Helpers are identified by the community, previously listed gifts and more. Their Elders or family. Aboriginal community work usually engages in ritual, ceremonial members all have responsibilities to activity and prayer. In some societies society as “helpers” and work in various they are identified as “medicine men/ environments ranging from spiritual to women” because they possess sacred community without boundaries by sector. bundles, sacred pipes, sacred masks, and Aboriginal people may utilize both the rights to rituals, songs and medicines traditional and western health services to that have been inherited from their meet their wellness needs. These needs parents, grandparents, or that they earned include broad aspects of Aboriginal through apprenticeship with a respected health, such as culture, language and medicine man or woman. Depending on geographical location. This is true to their nation, they are also conductors of the extent that a 2002 survey by NAHO community ceremonies such as Healing found that 60% of the Aboriginal sample Circles, Shaking Tent, and Sweat Lodge, indicated loss of land and culture to be a to name a few. It is normative for these significant contributor to poor health. individuals to sacrifice their daily lives to ritual, prayer and healing. Healer – A gifted individual who may heal in a variety of ways, including all of the above and or a “gift” of touch, or energy work – meaning that ritual is not always needed. Healers can be ritualistic, but also may have an ability to use a variety of therapies to heal people spiritually, emotionally or physically.

A Guide for Working with Aboriginal People of Northwestern Ontario - A Stroke Resource for Healthcare Providers 15 Section 3: Aboriginal Health Beliefs

Aboriginal Families and Communities

In many Aboriginal communities, members of the same clan are considered family, linked through a common ancestry. Examples of clans include: Bear Clan, Fish Clan, and Crane Clan. Depending on the situation of your Aboriginal client, the term “family” may only refer to immediate relatives, such as a spouse, parents, siblings or children. However, “family” may also include an extended network of grandparents, aunts, uncles and cousins. According to the rules of clan membership, each member is required to marry outside the clan to which they belong. Over generations, this may result in each family in a community being related by descent or marriage. In rural clans, where membership has remained stable over time, family and community often represent the same group. Aside from descent and marriage, Aboriginal Ontarians may be related through adoption. It is still common practice in many communities for parents to give a child to another family in the clan. In some cases, a Elders Decision Making fertile couple would agree to have one Aboriginal communities have great Every Aboriginal family member of their children adopted at birth by respect for the wisdom gained over the usually has a responsibility in decision a childless couple. These two families course of one’s life. Individuals recognized making. Furthermore, there may be would then contract a special bond as Elders have earned the respect of their no family leader who makes decisions with each other for life. community and are people whose actions independently. In the event that an Similar to contemporary Canadian and words convey consistency, balance, Aboriginal stroke survivor requires a families, each Aboriginal family is harmony and wisdom in their teachings. substitute decision-maker, it may be responsible for nurturing children and They hold invaluable knowledge and skills important that all family members are preparing them to function well in (NAHO, 2009). included in the process, understand what society. While this goal is similar, the decision needs to be made and are given process is likely different: Chief time for contemplation. The Chief is the elected leader of an When a young man goes out on a hill to seek the vision of who he is to be Aboriginal community or clan (similar to and what gifts are uniquely his, it is not a mayor for non-Aboriginal communities). because he is preparing to go out into Along with the other elected council the world and seek his fortune. Rather, members, the Chief leads all governance, he comes back to the camp or the decision-making and administration of village to obtain advice from his uncles various community services. The Chief or grandfather on the meaning of his also represents the community’s interests experience, and to exercise his medicine at the provincial/territorial level. (or personal power) in the service of his family and community (Brenda Mason, First Nations Elder).

A Guide for Working with Aboriginal People of Northwestern Ontario - A Stroke Resource for Healthcare Providers 16 Section 4: Aboriginal Culture - Tools, Considerations and Guidelines for Cultural Safety

A Guide for Working with Aboriginal People of Northwestern Ontario - A Stroke Resource for Healthcare Providers 17 Section 4: Aboriginal Culture - Tools, Considerations and Guidelines for Cultural Safety

Cultural Safety/Cross-Cultural Safety

Definition and Value 1. Communication rapport, focus attention toward As a Canadian health service provider, Establish a common factors that are controlled by the the services you provide to clients communication method. client, such as personal autonomy, should be patient or client-centered. personal goals and growth, the • An Aboriginal individual’s comfort According to the Institute for ability to change one’s path. with eye contact, touch and personal Healthcare Improvement (IHI), space, as well as conversation pacing • Assist the client to recount their client-centered care refers to: may be different than the typical successes in overcoming past issues. Care that considers clients’ cultural non-Aboriginal person. Wherever possible, discuss their traditions, their personal preferences options while outlining the pros and and values, their family situations, and • Emotional control is also common cons of each option, and let the their lifestyles. It makes the client and among Aboriginal people. This client make a decision based on the their loved ones an integral part of means that certain types of speech information presented. the care team who collaborate with intonation or body language may not health service providers in making have the same meaning for you and During the encounter clinical decisions. Client-centered your Aboriginal client. • Identify personal goals care puts responsibility for important aspects of self-care and monitoring • Aboriginal people may listen passively • Recognize and reinforce in clients’ hands - along with the to information you are sharing with personal strengths them. This does not necessarily mean tools and support they need to • Identify social/community networks/ carry out that responsibility. Client- they are unengaged. resources and encourage building of centered care ensures that transitions • Recognize that your discussion with between providers, departments, and social supportive networks an Aboriginal client or their family health care settings are respectful, • Identify the client’s options and rights coordinated, and efficient. may have a slower pace than what you are accustomed to. Furthermore, 3. Understanding Health Given the cultural diversity of the you may need to accept some Beliefs and Practices Canadian population, client-centered conversation pauses or silences. care often includes elements of cultural Show respect for traditional safety. While it is difficult to define • You may encounter a client or family approaches to healing. the scope of cultural safety, Canada’s member that makes little or no eye • Aboriginal clients bring their personal National Aboriginal Health Organization contact. In some Aboriginal cultures history, including their cultural (NAHO) cites the definition of culturally eye contact is considered rude. values and beliefs to the healthcare unsafe practices as “any actions that • Pictures may be a helpful method of system. Learn about your client, and diminish, demean or disempower the explaining or educating a client or the Aboriginal community you are cultural identity and well being of an their family. serving, in order to teach and offer a individual” (2006). Cultural safety • Ensure a translator is available bicultural approach to care. can also be extended to include an for both verbal and written examination of the power imbalances • Be aware of the important aspects communication. and institutional discrimination that of Aboriginal history and the cultural amplifiers that may affect the occur in Canadian society, or an Know when to use direct and indirect relationship between you and understanding of historical elements communication. and their relationship to current your client. • Your client may exhibit a type of Aboriginal health status. • When compiling a client history, find communication requiring you to read out what band(s) or tribe(s) they Practicing Cultural Safety/ between the lines. Explain to your belong to. Cross-Cultural Safety client that you will ask questions to better assess and serve his/her • Without requesting details, ask your There are some practical ways to needs, and that it is not your intent client if they use traditional healing provide culturally safe and culturally to be insensitive or offensive when services and medicines. sensitive care. These are of course asking questions. above and beyond the professional • Be aware that an Aboriginal client courtesies which you would show • Encourage your client to tell their may believe in causes and cures that anyone at-risk of having a stroke, a story rather than conducting a do not fit with established western stroke survivor or their family. The formal assessment medical practices. guidelines for practicing culturally • Be aware that some Aboriginal 2. Building Rapport sensitive care presented below were people believe that speaking about compiled from three sources: Bird, Connecting with your client illness may lead to its occurrence. 2002; NAHO, 2008; and Consultation with our local Aboriginal partners. • An Aboriginal client may feel as • Understand that for Aboriginal though they have no control over clients, the concept of “next of kin” These guidelines are presented in their care. To assist in building may be broadly interpreted. the following themes:

A Guide for Working with Aboriginal People of Northwestern Ontario - A Stroke Resource for Healthcare Providers 18 Section 4: Aboriginal Culture - Tools, Considerations and Guidelines for Cultural Safety

Explore the client’s comfort with • Remember that an Aboriginal client Be aware and respectful of sacred/ healthcare. may be coming from one jurisdiction ceremonial items and discuss any to another (federal to provincial) handling requirements with the client • An Aboriginal person may feel which brings additional limitations. and/or their family. uncomfortable questioning authority. They may agree to something • Participate in education and training Refrain from judgment regarding when they would actually prefer to opportunities around sacred and traditional healing services and decline or are unsure. The decision ceremonial processes. medicines the client may have maker(s) should be encouraged to accessed. A judgmental response could • Give the family member or an speak frankly with you about their harm the trust and confidence you have Aboriginal staff member the option of preferences and opinions. established with your client. caring for any items. • Recognize that an Aboriginal person • Discuss western medicine and its • Exercise particular care with gender- may be more comfortable with uses, and encourage the use of both specific protocols for ceremonial uncertainty regarding the long-term western medicine and traditional items. effects of illness and disability than medicine whenever possible. the general population. • Inform the client and/or family • Suggest to your client that member of the location and any risk(s) • Be aware that some Aboriginal traditional healing and western regarding storing the items. people will consistently minimize medicine are more effective health problems. together, than separate. • Creating an Aboriginal-friendly • Encourage and validate your environment (including Aboriginal client’s effort to access Aboriginal- Moon Time art and design) may improve your specific resources. The women are honoured and client’s and their family’s comfort respected for the gift they have with healthcare. They may need 5. Family and Decision Making been given as life givers. Women to see themselves reflected in the must keep themselves of good Encourage and support the Aboriginal healthcare environment. mind, body, and spirit at all times. client and their family. Include them in There is a natural cleansing cycle all aspects of care, decision-making, that occurs for women each month and education. that helps them stay healthy. Some Many Aboriginal people will • With the client’s permission, share people call this the menstrual cycle, the period, or the menses. listen quietly and intently to a copy of the care plan with the the information being shared Aboriginal client and family. Very often amongst the Aboriginal with them. It is important not people you will hear of a time called • Ask the client and/or family if they “ the moon time”. The name is to interpret this response as wish to nominate a person to speak being “passive”. understood to be symbolic of the on behalf of the family. Acknowledge grandmother moon that travels the and involve the person nominated. sky at night. The moon is honoured by the women in different ways and • Include appropriate Aboriginal staff as she becomes full once a month in the client’s care (if available). They so do women. This is a time when 4. Information and Support may provide assistance with the the blood flows from a woman decision-making process, if this is Ensure the client and their family and she is considered to be at her agreed to by the client and family. greatest strength. It is a time for understands the healthcare system, as women to stay quiet, to think, and well as the resources and supports that 6. Ceremony, Song and Prayer to meditate about who they are as are available to them. Offer the Aboriginal client the choice of women. This is also a time when the women should be looked after • Be aware of available Aboriginal having a healing ceremony and cared for. Women are powerful resources, support groups and (eg. Smudging is the first thing in ALL accommodation services in your area. during this time and, out of respect ceremonies) throughout their care. for that power, they do not attend • An Aboriginal client may feel isolated • For many Aboriginal people, ceremonies, feasts, and Pow-wows and alone especially if stroke support ceremony is essential in protecting where sacred items such as drums, outfits, feathers, eagle whistles, services are not available in his/her and maintaining spiritual, mental, rattles, and pipes will be present. In area. If possible, create these support emotional and physical health. systems within your practice in a safe this same manner the women do environment. • Allow time for ceremony and do not not wear their outfits to dance in interrupt unless the physical care of the circle of life at the Pow-wow. • Be aware that Aboriginal resources the client is compromised. (Harold Flett) and support systems are almost always limited in rural or remote areas. • If there are concerns of why ceremonies cannot occur within your facility, discuss possible options with the team, client and family.

A Guide for Working with Aboriginal People of Northwestern Ontario - A Stroke Resource for Healthcare Providers 19 Section 4: Aboriginal Culture - Tools, Considerations and Guidelines for Cultural Safety

7. Food Become familiar with the basic principles regarding treatment of your client’s food, access to traditional food and practical ways of respecting these principles. • For example, in some cultures, menstruating women should not prepare or serve food due to their spiritual power. •`In many cases, these principles/beliefs will align with good health and safety procedures that should be practiced by staff. They should not cause excessive burden or variation from usual practices.

8. Body Parts, Tissues or Substances Fully communicate procedures and options regarding removal, retention, return or disposal of body parts/ tissue/substance. • Record and carry out the wishes of the Aboriginal client and/or family regarding these issues. 9. Pending and Following Death • In some cultures, the body is not to • Different protocols can exist for Learn about any Aboriginal family be left unattended following death. remains such as placentas and specific customs related to death. The • Some Aboriginal communities bodily fluids. family should be notified, supported believe when someone is ailing, two and involved where death is expected. care givers should attend. If only • Be aware that large numbers of one attends, the ailing person may family members may be present. think they are dying which may result in agitation. • Provide opportunities for the family to perform cultural and spiritual rites • Be aware that the family may also for the deceased. gather and sing at the bedside prior to death and upon death to help the • Be respectful of ceremony and soul travel. protocols, and allow time for their performance. • There may be a belief that when someone passes, the family or • Work with the family to appoint a contact community must open a window or person, thus minimizing the amount of door to let the spirit go home. communication required. Be aware that community leaders may get involved and act as the non-family contact person.

Belief that death involves passage into a world that is not feared; one will meet with ancestors in the spirit world to live for eternity; dying is a time to communicate, settle differences and make peace (Turner-Weeden 1995, cited in Hotson et al 2004). An understanding of these beliefs are important so that health service providers do not accept a stereotype that Aboriginal fatalism means that Aboriginal patients are more likely to “give up” when confronted with a life threatening diagnosis.

A Guide for Working with Aboriginal People of Northwestern Ontario - A Stroke Resource for Healthcare Providers 20 Section 4: Aboriginal Culture - Tools, Considerations and Guidelines for Cultural Safety

Cultural Amplifiers

While the approaches mentioned above 3. Fear of Breach of Confidentiality 6. Mortality can assist you to provide culturally safe • Breaches of confidentiality have been • High rates of mortality are a part care, it may be valuable to consider a serious issue in many Aboriginal of most family and community some barriers and issues which can clinics. This often occurs in reserve/ experiences for Aboriginal people. impede these approaches. Some of rural communities where rumors can It is not unusual for an individual to these barriers may be referred to as spread quickly, although comparable have someone in his or her family cultural amplifiers (i.e., cultural factors breaches also occur in urban clinics. commit suicide, be a victim of a that magnify the difficulties faced by homicide, or lose a relative in a fatal Aboriginal people when accessing 4. Modesty automobile accident. healthcare [Bird, 2002]). • Many Aboriginal people are • Youth suicide is a major problem for Barriers to Accessing Healthcare modest about their bodies and Aboriginal communities. Statistics find it uncomfortable to undress, show an Aboriginal suicide rate 1. Travel discuss their bodies or perform two to three times higher than the self-examinations. Consequently, an • Aboriginal people may travel daily, non-Aboriginal rate for Canada, individual may not notice or wish to weekly or several times a year from and within the youth age group the discuss personal bodily changes. reserve/rural areas to urban areas. Aboriginal suicide rate is estimated to be five to six times higher than Travel occurs for many reasons, 5. Language and Culture including family visits, ceremonies, that of non-Aboriginal youth . job and educational opportunities, • Many cultural elements are contained (Health Canada 2003) substance abuse and illness. within the context of an Aboriginal language. Many words and concepts 2. Distrust of Authority are not easily translated into English, and some cannot be translated. • Aboriginal people have a long history of mistrust of the government as a • Northwestern Ontario has 3 main result of broken treaties, lost land, languages: Ojibway, Oji-Cree and Cree. reserves and residential schools, as There are 19-20 dialects. Check your well as ongoing experiences with local hospital for language resources. racial and ethnic discrimination.

Additional Considerations for the Clinical Encounter

A number of models have been developed to assist health service BELIEF Model* LEARN Model** ETHNIC Model*** providers conduct clinical interviews Health Beliefs: What caused Listen to the client’s Explanation: How do you with Aboriginal clients. Note: While your illness/problem? perspective explain you illness? these can help frame your clinical interview, they may not collect all the Explanation: Why did it Explain and share one’s Past Treatment: What necessary information, or may include happen to me? own perspective treatment have you tried? questions/areas that are irrelevant: Learn: Help me to Acknowledge differences Healers: Have you sought Use as appropriate. understand your and similarities between any advice from belief/opinion these two perspectives traditional healers?

Impact: How is this illness/ Recommend a Negotiate mutually problem impacting your life? treatment plan acceptable options Empathy: This must be Agree on Intervention difficult for you Negotiate a mutually agreed Feelings: How are you upon treatment plan Collaborate with client, feeling about it? family and healers

*Dobbie et al. (2003), **Berlin & Fowkes (1983) and ***Levin et al. (2000)

A Guide for Working with Aboriginal People of Northwestern Ontario - A Stroke Resource for Healthcare Providers 21 Section 4: Aboriginal Culture - Tools, Considerations and Guidelines for Cultural Safety

Your Beliefs Collaborating with and Lens Aboriginal Communities

Another component to delivering As a health service provider, you • Consider what facilitates interaction culturally safe and culturally sensitive may find yourself working with the with community members. Aboriginal client, their family and care is understanding the preconceived • Enjoy and allow humor. notions and beliefs that you bring to community in a group setting. This can the clinical encounter. The following be both an effective and challenging There may also be an opportunity for questions and thoughts may help you way to provide education and care you and an Aboriginal community reflect upon, and understand your (Crosato & Leipert, 2006). There are to collaboratively develop a stroke “lens” as a health service provider. some important considerations when program or service. To guide these working with an Aboriginal community types of collaborations, Ontario’s 1. What kind of energy are you (Kowalsky et al., 1996) and have been Aboriginal Healing and Wellness emitting? Is it positive? Does it come adapted for this document. Strategy (AHWS) published New from a place of compassion? Is it in Directions: Aboriginal Health Policy the spirit of caring? Specific Guidelines for Working with for Ontario (1994). This document 2. What prejudices do you have that Aboriginal Communities stresses the need for mutually could potentially block you from respectful relationships with Aboriginal • Recognize that the Aboriginal providing client-centre care? individuals and communities. community is in charge. These relationships will hopefully 3. What is the tone and rhythm of • Consider the implications of the aid the development of effective your voice? Are you speaking in a number of clinicians. and appropriate stroke services. calm manner? • Be honest about your motives. Furthermore, these relationships 4. Do you understand the social issues may help mobilize the community’s affecting this person • Recognize and respect the spiritual involvement in your stroke initiative. (e.g., social situation, housing component. Below are some other collaboration and transportation)? • Respect confidence and guard principles from the AHWS: 5. Has the client been treated against taking sides. • Incorporate Aboriginal cultural with respect, care, compassion • Follow the lines of authority and sensitivity training as a and dignity? show respect. preliminary stage to community engagement activities. 6. Have you understood the client’s • Be aware of general etiquette spiritual/religious philosophies? expectations. • Develop an understanding of historical colonization and its General Guidelines for Community impacts on the health, wellness, and Collaboration spirituality of Aboriginal people, in Health empowerment in • Be yourself and participate in the context of stroke. Aboriginal communities the community. • Encourage an empowerment encompasses health services • Monitor your feelings. process with Aboriginal that are community-driven and collaborators, and recognize their developed by, for and with • Be ready to teach and to share ideas. right to decision-making. Aboriginal communities. • Be prepared for the unexpected. • Encourage the development of • Allow for time. Aboriginal-driven health programs and services. • Be sensitive.

A Guide for Working with Aboriginal People of Northwestern Ontario - A Stroke Resource for Healthcare Providers 22 Section 5: Stroke Information and Best Practices

A Guide for Working with Aboriginal People of Northwestern Ontario - A Stroke Resource for Healthcare Providers 23 Section 5: Stroke Information and Best Practices

Stroke in Aboriginal Populations

Research has shown that Canadian Definitions Warning Signs for Stroke & TIA Aboriginal people are twice as likely Stroke - A stroke is a brain attack. It occurs to die from stroke (71.5 per 100,000) when blood flow to the brain is interrupted when compared with the general or when a blood vessel ruptures. Cells Sudden weakness, Canadian population (34.2 per 100,000). in and around the stroke site begin to numbness or tingling Aboriginal people are also more prone die and part of the brain stops working. to obesity with a risk just over 1.5 Basic functions, such as communicating, times that of the general population. walking, thinking, and personality, may be Sudden trouble speaking Furthermore, the rate of diabetes changed. among Aboriginal people in Canada is or understanding three to five times that of the general Ischemic Stroke - Ischemic stroke is population (HSF, 2010). Consequently, caused by an interruption in the flow it is important to understand not of blood to the brain (as from a clot only the warning signs for stroke, but blocking a blood vessel). Sudden vision changes also the risk factors for stroke and Hemorrhagic Stroke - A hemorrhagic the impact of stroke on the person, stroke is a stroke caused by the rupture their family and the community. This of a blood vessel with bleeding into the information presented below has been tissue of the brain. Sudden headache independently researched, written and reviewed by the Heart and Stroke Transient Ischemic Attack (TIA, also Foundation (2010, 2010a) and is based known as a “mini-stroke”) – TIA is a sudden but temporary period of on scientific evidence. Sudden loss of balance decreased blood flow somewhere in the brain causing stroke-like signs and symptoms (e.g. difficulty speaking or moving one side of the body) from a few minutes up to 24 hours. Also known as a “TIA”, this is a major warning sign of a potential full stroke.

Risk Factors

Non-Modifiable Factors Modifiable Factors and smoking (which are associated with (Meaning they cannot be controlled) (Meaning they can be controlled) higher rates of hypertension) make high 1. Age 6. High Blood Pressure (also known blood pressure a significant risk factor Although stroke can occur at any age, most as Hypertension) for stroke in Aboriginal communities. strokes affect people aged 65 and older. High blood pressure occurs when the 7. Lack of Physical Activity 2. Gender force of blood pushing against artery People who do not participate in walls is too high. Constant high pressure Until women reach menopause they regular physical activity have a higher will eventually cause damage to the have a lower risk of stroke than men. risk of stroke. An active, healthy artery wall and weaken it. A person As time goes on, more women than lifestyle can assist in managing high cannot tell they have high blood pressure. men die of stroke. blood pressure, high blood cholesterol, It must be measured by a health service excess weight and stress. Adults 3. Family History provider. High blood pressure is the should participate in 30 to 60 minutes Risk of a stroke is higher if close family number one risk factor for stroke and of moderate physical activity every such as parents, sisters or brothers have therefore it must be kept in control to day. It is important to start an exercise had a stroke before the age of 65. reduce the risk of stroke. Medications program slowly and increase the 4. Family Background must be taken exactly as prescribed. level of activity over time. Consider First Nations, Inuit or Métis are more FACT: High blood pressure has been choosing activities that are enjoyable likely to have high blood pressure and found to be almost twice as common and fun and can be done with family Type II diabetes, and as a result are at or slightly less common in Canadian and friends. greater risk of heart disease and stroke Aboriginal Peoples when compared to FACT: Only 21.3% of First Nations adults than the rest of the population. the rest of Canada, depending on the living on-reserve get sufficient physical 5. Prior heart attacks, strokes or TIAs Aboriginal subgroup being surveyed activity (i.e., greater than 30 minutes of (Macmillan et al., 1996). Regardless of moderate to vigorous activity for four or this discrepancy, higher rates of obesity more days per week) (Canada, 2009).

A Guide for Working with Aboriginal People of Northwestern Ontario - A Stroke Resource for Healthcare Providers 24 Section 5: Stroke Information and Best Practices

8. Overweight The bad health effects of blood vessel in the body. Damaged blood Being overweight places more strain smoking include: vessels can cause problems with heart on the heart and is associated with • The buildup of plaque in the arteries disease, strokes, eye damage, kidney high blood pressure. People that are disease and nerve damage. overweight carry a higher risk of having • Higher risk of blood clots FACT: First Nation, Inuit and Métis are a stroke. Some of the things that • Lower oxygen levels in the blood at higher risk of developing Type II people trying to lose weight should diabetes, a serious medical condition consider include: eating a healthy diet • Strain on the heart that may lead to heart disease and including foods that are lower in fat, Smokers should be encouraged to quit stroke. It is important for Aboriginal losing weight slowly, avoiding “fad” and provided with the appropriate adults to be tested for Type II diabetes diets, using less fat in cooking and resources/tools. every one or two years if they are managing the size of food portions. FACT: In 2003, only 41.6% of First overweight or obese, if they are FACT: Approximately 37% of Nations adults living on-reserve were not physically active, or if they eat Aboriginals over 18 years old are non-smokers, whereas 75.8% of the unhealthy foods. Individuals with a waist overweight, and another 36% are rest of Canadians were non-smokers measurement more than 40 inches/102 obese. This is striking when compared (Canada, 2009). cm for men, and 35 inches/88 cm to the rest of Canada, where 33% are for women are at high risk for Type II 10. Diabetes overweight, but only 15% are obese diabetes. Furthermore, a 1996 study (Canada, 2009).Overweight and obesity Diabetes develops when the body has a found that diabetes (both type one and ranges are determined by using weight problem with a hormone called insulin. two) affects 6% of aboriginal adults, and height to calculate a number called Insulin helps move sugar (known as compared with 2% of all Canadian adults the “body mass index” (BMI). glucose) in food from the blood into the (MacMillan et al., 1996) 9. Smoking cells of the body where it can be used as energy. If the body cannot produce insulin People that smoke or are exposed to or does not respond properly to insulin, second-hand smoke have an increased then glucose builds up and damages risk of stroke.

Canadian Best Practice Recommendations for Stroke Care

The evidence-based Canadian Best The updated Best Practice Recomm- Practice Recommendations for Stroke endations 2010 content focuses on: Care are intended to help reduce • Public Awareness of Stroke practice variations and close the gaps between evidence and practice. The • Prevention of Stroke purposes of the recommendations are • Hyper acute Stroke Management to ensure that stroke care continues to reflect contemporary stroke research • Acute Stroke Management evidence and expert opinion. • Stroke Rehabilitation • Managing Stroke Care Transitions • Cross-Continuum Topics in Stroke Management These guidelines can be found on-line at: www.strokebestpractices.ca

A Stroke Resource for Healthcare Providers - A Guide for Working with Aboriginal People of Northwestern Ontario 25 Section 6: Additional Resources

A Guide for Working with Aboriginal People of Northwestern Ontario - A Stroke Resource for Healthcare Providers 26 Section 6: Additional Resources

Introduction

This section presents a variety of resources that will assist you to provide care and education for an Aboriginal at-risk of stroke, stroke survivor, and their family. These resources include educational material, best practice guidelines and a list of community service agencies that can be accessed for client support or programs.

Aboriginal Knowledge Centres

Za-geh-do-win Information Information Centre on Aboriginal Clearinghouse Health (ICAH) This centre collects, compiles, catalogues ICAH is a service provided by the and distributes Aboriginal-specific National Aboriginal Health Organization information, resource materials, (NAHO). ICAH is a database of research and documents to Aboriginal information on bibliographic and web- communities and groups regarding based resources, programs and services, family violence, family healing and health. health careers, and scholarships and Website: www.za-geh-do-win.com bursaries. Website: http://www.naho.ca

Aboriginal Services & Community Agencies

Aboriginal Health Access Centres Métis Nation of Ontario (MNO) Aboriginal Canada Portal (Government of Canada) These centres offer a blend of traditional MNO celebrates and advocates for Aboriginal approaches to health and Métis culture, heritage and values. MNO The Aboriginal Canada Portal provides wellness and contemporary primary provides programs on employment, information related to First Nations, health care in a culturally appropriate education, health (including long-term Métis and Inuit online resources and setting. Programs include: pre and post- care, healing, wellness, pediatric and child government programs and services. The natal care, nutrition, health education, health, responsible gambling, diabetes website contains government and non- disease prevention, and counseling. awareness), economic development, government reports, projects and services Ontario’s Aboriginal Health Access housing and community access. Website: in the health and social services fields. It Centres are listed below. www.metisnation.org also contains links to Aboriginal health- related associations and research centres. Ontario Federation of Indian Friendship National Aboriginal Health Website: www.aboriginalcanada.gc.ca Centres (OFIFC) Organization (NAHO) First Nations, Inuit and Aboriginal Health OFIFC is a provincial Aboriginal NAHO is an Aboriginal body committed (Health Canada) organization representing the collective to influencing and advancing the health interests of the 27 centres located and well-being of Canadian Aboriginal This website provides information on throughout the province. The OFIFC Peoples by carrying out research, Health Canada’s work to improve the administers a number of programs (which advocacy and education. Website: health of First Nations and Inuit people. are delivered by local Friendship Centres) http://www.naho.ca/ Together with Aboriginal organizations supporting health, justice, family support, and communities, Health Canada employment and training. Friendship Ontario Native Women’s carries out activities focused on health Centres also develop and deliver local Association (ONWA) promotion, infection control and chronic initiatives in areas such as education, ONWA was established to promote the disease prevention. Website: www.hc-sc. economic development, children’s and advancement and equality of Native gc.ca/fniah-spnia/index-eng.php youth initiatives, and cultural awareness. women. Founded in 1972, ONWA works Aboriginal Affairs and Northern Website: http://www.ofifc.org to address political, social, educational, Development Canada economic and justice issues. ONWA has Keewaytinook Okimakanank over 80 volunteer groups, made up of AANDC supports both Aboriginal Telemedicine (KOTM) both on and off reserve communities. Canadians and northerners to improve KOTM deliver clinical, educational and ONWA offers programs related to social well-being and economic administrative videoconferencing and diabetes awareness, gambling awareness, prosperity, develop healthier, more communication services to First Nation human resource development, aboriginal sustainable communities, as well as communities in Ontario. Website: women’s leadership development, participate more fully in Canada’s http://telemedicine.knet.ca housing, aboriginal and healing wellness, political, social and economic health policy, mental health, community development. Website: www.aandc- health outreach, community wellness and aadnc.gc.ca community development. Website: www.onwa-tbay.ca

A Guide for Working with Aboriginal People of Northwestern Ontario - A Stroke Resource for Healthcare Providers 27 Aboriginal Health Related Strategies/Initiatives

Aboriginal Healing & Wellness Aboriginal Tobacco Program (ATP) Strategy (AHWS) Led by Cancer Care Ontario, the ATP The goal of the AHWS is to improve the works with Aboriginal communities to health of Aboriginal individuals, families, decrease and prevent the misuse of communities and nations. The AHWS tobacco. Many Aboriginal communities is designed, delivered and controlled have a unique and sacred relationship by Aboriginals, but administered by with traditional tobacco. In those the Government of Ontario. The AHWS communities, the ATP does not seek informs health policy and health service to create “tobacco free” communities; delivery regarding Aboriginal services in rather they want to create “tobacco wise” Ontario. Website: www.ahwsontario.ca communities that use tobacco in a sacred way and do not feed a powerful and Chiefs of Ontario deadly addiction. Website: The Chiefs of Ontario is an organization www.tobaccowise.com that discusses the planning, implementation and evaluation of all local, regional and national matters affecting the First Nations people of Ontario. Website: http://chiefs-of-ontario.org

A Guide for Working with Aboriginal People of Northwestern Ontario - A Stroke Resource for Healthcare Providers 28 Section 6: Additional Resources

Listing of Aboriginal Organizations in NW Ontario Atikokan Geraldton Sunset Women’s Thunder Bay Métis Council Aboriginal Circle (Aboriginal Healing and Atikokan Native Thunderbird Wellness Strategy - AHWS) Friendship Centre Friendship Centre 72 Front St, 2nd Floor Sioux Lookout 226 May Street South P.O. Box 1510 301 Beamish Ave. West ON P8T 1A5 Thunder Bay P7E 1B4 307-309 Main Street W P.O. Box 430 Atikokan, ON P0T-1C0 Geraldton, ON P0T-1M0 Tel: (807) 737-7922 Tel: (807) 624-5022 Fax: (807) 737-7031 Toll Free: 1-800-265-2595 Tel: (807) 597-1213 Tel: (807) 854-1060 (807 area only) Fax: (807) 597-1473 Fax: (807) 854-0861 Sioux Lookout First Nations Fax: (807) 623-7036 www.ininewfriendshipcentre.ca Kenora Health Authority Aboriginal Responsible Atikokan & Surrounding 61 Queen Street Waasegiizhig Gambling Strategy (ARGS) Area Interim Métis Council Nanaandawe’iyewigamig P.O. Box 1300 Sioux Lookout, ON P8T 1B8 100 Backstreet Road Box 1630, 33 Birch Rd. 212 Fourth Ave S Unit #200 Atikokan, ON P0T 1C0 Kenora, ON P9N 1Y9 Tel: (807) 737-1802 Toll free: 1-800-842-0681 Thunder Bay, ON Tel: (807) 597-2954 Tel: (807) 467-8770 Fax: (807) 737-1076 Tel: (807) 623-8228 Dryden Tel: (877) 224-2281 www.slfnha.com Direct line: (807) 625-4930 www.kahac.org Dryden Native Equay-wuk (Women’s Group) Anishnawbe-Mushkiki Friendship Centre Kenora Métis Council 16 Fourth Avenue N. (Aboriginal Health 53 Arthur Street 70 Park St. Kenora, ON Sioux Lookout, ON P8T 1C4 Access Centre) Dryden, ON P8N 1J7 Tel: (807) 468-2034 Tel: (807) 737-2214 29 Royston Court Tel: (807) 223 4180 Fax: (807) 468-1979 Toll Free: 1-800-261-8294 Thunder Bay, ON P7A 4Y7 Fax: (807) 223-6275 Fax: (807) 737-2699 Tel: (807) 343-4843 Ne’Chee Native http://ofifc.org www.equaywuk.ca Fax: (807) 343-4728 Friendship Centre www.anishnawbe-mushkiki.org Northwest Métis Council P.O. Box 241, The Jeremiah McKay 34A King Street 1301 Railway Street Kabeshewikamik Biidaaban Healing Lodge Dryden, ON P8N 1B4 Kenora, ON P9N 3X3 60 Seventh Ave PO Box 219 Tel: (807) 223 8082 Tel: (807) 468-5440 Sioux Lookout, ON P8T 1H5 Heron Bay, ON P0T 1R0 Fax: (807) 223-8083 Fax: (807) 468-5340 Tel: (807) 737-1676 Tel: (807) 229 3592 www.metisnation.org Fax: (807) 229 0308 Red Lake Thunder Bay Fort Frances www.biidaaban.com Red Lake Indian Thunder Bay Native Fort Frances Métis Nation Friendship Centre Friendship Centre Dilico Anishinabek (Aboriginal Healing and Family Care Box 244, 1 Legion Road 401 N. Cumberland St Wellness Strategy - AHWS) Red Lake, ON P0V 2M0 Thunder Bay, ON P7A 4P7 200 Anemki Place PO Box 403 Thunder Bay, ON P7J 1L6 Tel: (807) 727-2847 Tel: (807) 345-5840 (426 Victoria Avenue) Fax: (807) 727-3253 Fax: (807) 344-8945 Tel: (807) 623-8511 Fort Frances, ON P9A 3M7 http://ofifc.org/centres/Red_ www.tbifc.com Toll Free: 1-800-465-3985 Tel: (807) 274-1386 Lake_Friendship_Centre.php Fax: (807) 626-7999 Toll Free: 1-888-793-3334 Nishnawbe Aski Nation www.dilico.com Fax: (807) 274-1801 Sioux Lookout 100 Back Street. Unit 200 Matawa First Nations Nishnawbe-Gamik Native Thunder Bay, ON P7J 1L2 United Native Friendship Centre 233 S. Court St. Friendship Centre Tel: (807) 623-8228 Thunder Bay, ON P7B 2X9 P.O. Box 1299 Fax: 807 623-7730 P.O. Box 752, 52 King Street www.nan.on.ca Phone: 807-344-4575 516 Portage Avenue Sioux Lookout, ON P8T-1B8 Toll Free: 1-800-463-2249 Fort Frances, ON P9A 3N1 Ontario Native Women’s Fax: 807-344-2977 Tel: (807) 737-1903 Tel: (807) 274-3762 Association (ONWA) www.matawa.on.ca Fax: (807) 737-1805 Fax: (807) 274-4110 http://ngfcreceptionslkt. 380 Ray Boulevard Thunder Bay, ON P7B 4E6 Gizhewaadiziwin myknet.org Access Centre Tel: (807) 623-3442 Toll Free: 1-800-667-0816 P.O. Box 686 Fax: (807) 623-1104 Fort Frances, ON P9A 3M9 www.onwa-tbay.ca Tel: (807) 274-3131 Fax: (807 274-6280 www.gizhac.com

A Guide for Working with Aboriginal People of Northwestern Ontario - A Stroke Resource for Healthcare Providers 29 Section 6: Additional Resources

Stroke Education Resources

Heart and Stroke Foundation of Ontario (HSFO) HSFO offers a wide variety of resources related to stroke and cardiovascular health for education and clinical practice. Some specifically address Aboriginal issues, and all are available online, free of charge. Below is a sample of HSFO resources. Website: www.heartandstroke.com

Taking Control: Health Are you at HSFO Lower your Information risk of heart Professional risk of heart Catalogue attack or Resource disease and stroke? guide stroke: A Guide for Aboriginal Peoples

Let’s Talk Get your Living with About Blood cholesterol Stroke Pressure Under Control

Northwestern Ontario Regional Stroke Network In partnership with HSFO and the Ontario Stroke Network (OSN), the Northwestern Ontario Regional Stroke Network produced videos addressing Aboriginal stroke. These videos are available online, free of charge. Website: www.nwostroke.ca

Heartbeat of the Anishnawbe Nation As the Rivers Flow: Brain Attack Learning about stroke and blood Following the path of the river, this DVD pressure management by means of uses Aboriginal (or the animal system) both medical and Aboriginal traditions. and medical teachings to understand The video will help you to understand the symptoms of a stroke. The nature how stroke and blood pressure is of warning signs and where to go for affected by smoking, diet, exercise, help are also discussed. The available alcohol and medication. The language languages of the video are Ojibwe, of the video is Ojibwe and dubbed in Oji-Cree and English. (17 Minutes) Oji-Cree and English. (19 Minutes)

ACT FAST 1-2-3! Youth of the Anishnawbe Nation Learn About Stroke The “Talking Stick” passed from one community to another, helps children understand: what a stroke is, what are the warning signs and symptoms, stroke prevention, and where/how to seek help in case of a stroke. (11 Minutes)

A Guide for Working with Aboriginal People of Northwestern Ontario - A Stroke Resource for Healthcare Providers 30 Section 6: Additional Resources

Related Resources

Nutrition & Hypertension

www.hypertension.ca/chep

Diabetes (Government of Canada)

sc.gc.ca/fniah-spnia/pubs/diseases- Aboriginal Diabetes Initiative: maladies/_diabete/2001_evidence_ Prevention and Promotion Program faits/index-eng.php www.hc-sc.gc.ca/fniah-spnia/pubs/ diseases-maladies/_diabete/2000_ moauipp-ppmahrimu_program/ index-eng.php

Diabetes Fact Sheet: First Nations and Inuit Communities http://www.hc-sc.gc.ca/fniah- spnia/pubs/diseases-maladies/_ diabete/2000_reserve-program/ index-eng.php

A Guide for Working with Aboriginal People of Northwestern Ontario - A Stroke Resource for Healthcare Providers 31 Section 6: Additional Resources

Stroke Services Stroke Prevention Clinics and & Agencies Tele-Stroke Sites in NW Ontario

March of Dimes / Stroke City/Area Hospital Address Type Website Recovery Canada 201 - 980 Oliver Road North Western March of Dimes is the largest Thunder Bay Regional Thunder Bay, ON, Ontario Regional www.nwostroke.ca rehabilitation organization in Ontario, and Thunder Health P7B 7C7 Stroke Network Bay serves people with physical disabilities of Sciences 807-684-6702 Stroke all ages. Their mission is “to maximize the Centre 807-684-6700 prevention clinic independence, personal empowerment 28 Peninsula Road and community participation of people Wilson P.O. Box W Memorial with physical disabilities”. Stroke Marathon, ON Stroke www.wmgh.net General P0T 2E0 prevention clinic Recovery Canada® was created to help Hospital stroke survivors and their families regain 807-229-1740 independence, find support and learn to 21 Sylvan Street West survive and thrive after stroke. Each local Lake of the Stroke Kenora, ON prevention clinic Woods District P9N 3W7 www.lwdh.on.ca program is offers peer and post recovery Hospital support, education and community 807-468-9861 Telestroke site integration services for stroke survivors, 110 Victoria Avenue their caregivers, families and health care Riverside Stroke Fort Frances, ON prevention clinic http://riverside providers. Website: www.marchofdimes.ca NW Health Care P9A 2B7 healthcare.ca Ontario Facilities, Inc. Telestroke site Ontario Stroke System (OSS) 807-274-3266 OSS is a Ministry of Health and Long 1 Meno Ya Win Way P.O. Box 909 Term Care initiative that promotes Sioux Lookout Meno Ya Win Sioux Lookout, ON Stroke www.slmhc.on.ca access to evidence-based care and Health Centre P8T 1B4 prevention clinic strives to improve outcomes for 807-737-2877 stroke survivors. The OSS spans the continuum of care from prevention to P.O. Box 3003 Dryden 58 Goodall Street community re-integration. The OSS Regional Dryden ON Telestroke www.dh. is made up of 11 regions and provides Health Centre P8N 2Z6 site dryden.on.ca services through regional stroke centres, 807-223-8200 district stroke centres and secondary prevention clinics. Regional and district stroke centres provide expertise in stroke care, and access to hyper-acute treatment. These centres also have a coordination and leadership role in the creation of an integrated stroke system. Secondary prevention clinics provide interdisciplinary stroke prevention services to those people who have had a transient ischemic attack (TIA) or are at high risk for a stroke. The clinics also provide triage for urgency cases, assessment services, treatment plans and patient education. Services vary by location. Feel free to contact the appropriate centre or clinic below to access specific services or resources in your area. Website: www.ontariostrokenetwork.ca/

A Guide for Working with Aboriginal People of Northwestern Ontario - A Stroke Resource for Healthcare Providers 32 Section 6: Additional Resources

GLOSSARY OF TERMS

Aboriginal Community: A group of personal health practices, coping skills, Métis: Metis are one of three recognized Aboriginal people who share similar health child development, biology, Aboriginal people in Canada, along with beliefs, traditions and cultural identity. genetic endowment, health services and the Indians (or First Nations) and Inuit. These groups exist through shared gender. These health determinants come Approximately one third of all Aboriginal political, cultural, spiritual and /or together to help people and communities people in Canada identify themselves other affiliations. reach a state of complete physical, as Métis. Census data from 2006 shows mental and social well being. Because Métis as the Aboriginal group that Band: A body of Indians for whose all of these determinants of health are experienced the highest growth at 91%, collective use and benefit lands have been linked together, many people experience reaching 389,785 people. set apart or money is held by the Crown, specific or structural challenges to or declared to be a band for the purposes Status Indian: A person who is accessing equitable health services and of the Indian Act. Each band has its own registered as an Indian under the resources. They may lack access for many governing band council, usually consisting Indian Act. The act sets out the reasons such as poverty or homelessness of one Chief and several councillors. requirements for determining who is and/or racism or discrimination. Community members choose the Chief an Indian for the purposes of and councillors by election, or sometimes First Nation: A term that came into the Indian Act. through custom. The members of a band common usage in the 1970s to replace Non-Status Indian: An Indian person generally share common values, traditions the word “Indian,” which some people who is not registered as an Indian under and practices rooted in their ancestral found offensive. Although the term First the Indian Act. heritage. Today, many bands prefer to be Nation is widely used, no legal definition known as First Nations. of it exists. Among its uses, the term Treaty Indian: A Status Indian who “First Nations people” refers to the Indian belongs to a First Nation that signed a Cultural Sensitivity: Cultural Sensitivity people in Canada, both Status and non- treaty with the Crown. is getting to know and understand other Status. Many communities also use the cultures and perspectives. It involves Indian status: An individual’s legal term “First Nation” in the name of their recognizing the lived experiences of all status as an Indian, as defined by the community. Currently, there are 615 First people, including aspects similar and Indian Act. Nation communities, which represent different to our own and that our actions more than 50 nations or cultural groups Reserve: Tract of land, the legal title to affect other people. and 50 Aboriginal languages. which is held by the Crown, set apart for Determinants of Health: In 1948, the the use and benefit of an Indian band. Inuit: World Health Organization (WHO) Inuit are the Aboriginal people of Arctic Canada. About 45,000 Inuit Tribal council: A regional group of First declared that more than the absence of Nations members that delivers common disease, health is, “a state of complete live in 53 communities in: Nunatsiavut (Labrador); Nunavik (Quebec); Nunavut; services to a group of physical, mental and social well-being and the Inuvialuit Settlement Region of First Nations. and not merely the absence of disease the Northwest Territories. Each of these or infirmity.” In 1998, Health Canada Wholistic: Rather than “holistic”. Many four Inuit groups have settled land claims. developed a list of social factors and residential school survivors view the These Inuit regions cover one-third of conditions that lead to healthy people term “holistic” as holy and may have bad Canada’s land mass. The word “Inuit” and communities called determinants feelings about the term. They view the means “the people” in the Inuit language of health. These factors include culture, term “wholistic” as the “whole” body and called, Inuktitut and is the term by which social support, education, literacy, income, all encompassing. Inuit refer to themselves. The term employment and working conditions, “Eskimo,” applied to Inuit by European social and physical environments, explorers, is no longer used in Canada.

A Guide for Working with Aboriginal People of Northwestern Ontario - A Stroke Resource for Healthcare Providers 33 Section 6: Additional Resources

References

Aboriginal Affairs and Northern Gladue, B., English, K., Redcrow, M., Kirmayer, L.J., Fletcher, C. & Watt, R. Development Canada. Published online Alexson, W. & Gladue, K. (2008). Aboriginal (2009). Locating the ecocentric self: Inuit at: www.aadnc-aandc.gc.ca Social Work Committee Presentation. concepts of mental health and illness. In: Presented on March 14, 2008. Kirmayer LJ, Valaskakis GG, eds. Healing Aboriginal Healing and Wellness Strategy. traditions: the mental health of Aboriginal (1994). New Directions: Aboriginal health Health Canada. (2003). Acting on what peoples in Canada. Vancouver: UBC policy for Ontario: Executive Summary. we know: Preventing youth suicide in Press. 289-314. Published: 1994 (pp. 9). First Nations. Report of the advisory Kowalsky, L.O., Verhoef, M.J., Thurston, Anishinawbe Health Toronto. Published group on suicide prevention. Ottawa: W.E. & Rutherford, G.E. (1996). Guidelines online at: http://aht.ca/ Health Canada, nd: 23. for entry into an Aboriginal community. Heart and Stroke Foundation. Berlin, E.A. & Fowkes Jr, W.C. (1983). A The Canadian Journal of Native Studies. (2010). Virtual visits shrink the teaching framework for cross-cultural 16(2):267-282 distance in stroke rehab. Published health care. The Western Journal of online at: www.heartandstroke.com/ Leslie, J. (1978). The historical Medicine. 139:934-938. site/apps/nlnet/content2.aspx?c development of the Indian Act: Second Bird, M. (2002). Clinician’s guide: =ikIQLcMWJtE&b=6074245 &ct=8424947 edition. Department of Indian Affairs Working with Native Americans living and Northern Development, Treaties and Heart and Stroke Foundation. (2010a). with HIV. National Native American AIDS Historical Research Branch: Ottawa. Taking Control: Lower your risk of Prevention Center. Oakland, CA. (pp.78). heart disease and stroke: A guide for Levin, S.J., Like, R.C. & Gottlieb, J.E. Canada. (2009). Statement of Apology. Aboriginal Peoples. Published online at: (2000). ETHNIC: a framework for Indian and Northern Affairs Canada. www.heartandstroke.ab.ca /site/pp.aspx? culturally competent clinical practice. In: Published online at: www.ainc-inac.gc.ca/ c=lqIRL1PJJtH&b=3650783&printmode=1 Appendix: Useful clinical interviewing ai/rqpi/apo/index-eng.asp mnemonics. Patient Care. 34(9):188-9. Hill, D.M. (2003). Traditional medicine in Canada. (1996). Royal commission on contemporary contexts: Protecting and MacMillan, H. L., MacMillan, A. B., Offord, aboriginal peoples: People to people, respecting indigenous knowledge and D. R. & Dingle, J. L. (1996). Aboriginal nation to nation: Highlights from the medicine. National Aboriginal Health health. Canadian Medical Association report of the royal commission on Organization. March 19, 2003 (pp. 52). Journal. 155(11):1569-1578. aboriginal peoples. Indian and Northern History of Canada Online (HCO). (2011). Mowbray, M. (2007). Social determinants Affairs Canada. Catalogue no. Z1-1991/1- First Nations: Health and Demographics. and Indigenous health: the international 6E. Published online at: www.ainc-inac. Published online at: http://canadachannel. experience and its policy implications. gc.ca/ap/pubs/rpt/rpt-eng.asp ca/HCO/index.php/ 4._First_Nations:_ International symposium on the social Canada. (2009). A statistical profile on Health_and_Demographics determinants of Indigenous health. the health of first nations in Canada: Adelaide. Geneva: World Health Hotson, K.E., MacDonald S., M., et al determinants of health: 1999 to 2003. Organization, 2007. (2004) “Understanding death and dying Health Canada. Catalogue no. H34-193/1- in select first nations communities in National Aboriginal Health Organization. 2008. Published online at: www.hc-sc. northern Manitoba:issues of culture and (2008). An overview of traditional gc.ca/fniah-spnia/pubs/aborig-autoch/ remote service delivery in palliative care.” knowledge and medicine and public index-eng.php Int J Circumpolar Health 63(1): 2- 38 health in Canada. National Aboriginal Chiefs of Ontario. (2008). First Health Organization. January, 2008. Indian and Northern Affairs Canada. Nations directory: Map. Published Ottawa, Ontario. (pp. 18). (2010). History of Bill C-3. Published online at: http://chiefs-of-ontario.org/ online at: www.ainc-inac.gc.ca/br/is/bll/ National Aboriginal Health Organization. PageContent/Default.aspx?SectionID hst/index-eng.asp (2009). Interviewing elders guidelines. =3&SectionHeadlineID=211 Published online at: www.naho.ca/ Institute for Healthcare Improvement. Crawford Shearer, N.B. (2009). Health english/media_Guidelines.php (2011). Patient-centered care. empowerment theory as a guide Published online at: www.ihi.org/ National Aboriginal Health Organization. for practice. Geriatric Nursing. 30(2 IHI/Topics/PatientCenteredCare/ (2006). Fact sheet: Cultural safety. Suppl):4–10. PatientCenteredCareGeneral Published: January 31, 2006. (pp. 3). Crosato, K.E. & Leipert, B. (2006). Rural Justice Education Society of BC. (2010). National Aboriginal Health Organization. women caregivers in Canada. Rural Indian Residential Schools. Published (2008). Cultural competency and safety: Remote Health. 6(2):520. online at: www.survivingthepast.ca/ A guide for health care administrators. Dobbie, A.E., Medrano, M., Tysinger, J. & aboriginal.html Published: January 12, 2008. (pp. 31). Olney, C. (2003). The BELIEF instrument: National Adult Literacy Database. a preclinical teaching tool to elicit King, M., Smith, A. & Gracey, M. (2009). patients’ health beliefs. Family Medicine. Indigenous health part 2: the underlying O’Donnell, C.V. (2008). Native Population 35:316-319. causes of the health gap. Lancet. of Canada. In, Handbook of North 374:76-85. 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References children. The Globe and Mail. Saturday, Varekamp, I., Heutink, A., Landman, S., December 21, 2002. (pp. F4). Koning, C.E.M., de Vries, G. & van Dijk, F.J.H. (2009). Facilitating empowerment Saskatchewan. (2009). First Nations in employees with chronic disease: history. Government of Saskatchewan. Qualitative analysis of the process Published online at: www.fnmr.gov.sk.ca/ of change. Journal of Occupational community/fn-history/ Rehabilitation. 19:398-408. Spotton, N. (2007). A profile of Unkown Authour. (2010). Native Aboriginal Peoples in Ontario. Taken Medicines. The Canadian Encyclopedia. from: research papers commissioned Historica-Dominion. Institute. Published by the Ipperwash Inquiry. Available online at: www.thecanadianencyclopedia. online at: www.attorneygeneral.jus.gov. com/index.cfm?PgNm=TCE&Params=A1 on.ca/inquiries/ipperwash/index.html ARTA001185 Statistics Canada. (2006). Aboriginal Winter, J. C.et al (2000). Tobacco use Peoples highlight tables: 2006 Census. by Native North Americans: Sacred Statistics Canada. Catalogue no. smoke and silent killer. Civilization of 97-558-XWE2006002. Published the American Indian series vol. 236. online at: www12.statcan.ca/census- University of Oklahoma Press, Norman. recensement/2006/dp-pd/hlt/97-558/ index.cfm?Lang=E World Health Organization. (2000). General guidelines for methodologies The Canadian Encyclopedia. (2011). on research and evaluation of traditional Sun Dance. Published online at: www. medicine. World Health Organization. thecanadianencyclopedia.com/index.cfm Geneva: Switzerland. (pp. 80). ?PgNm=TCE&Params=A1ARTA000778 Turner-Weeden, P.(1995) “Death and dying from a Native American Perspective.” Hosp J 10(2): 11–3 Tweedie, A. (1999). Gifting and Feasting in the Northwest Coast Potlatch. Peabody Museum Online Exhibit: Harvard University. Published online at: http://140.247.102.177/potlatch

A Guide for Working with Aboriginal People of Northwestern Ontario - A Stroke Resource for Healthcare Providers 35 Section 6: Additional Resources

Map of Treaties and Health Facilities

Fort Severn

Legend No rth West LHIN Nursing Stations / Health Facility Ontario Breast Screening Program Manitoba Friendship Centres No rth East LHIN Aboriginal Health Access Centres Hospitals Big Trout Lake Metis Consultation Wapekeka LHIN Boundary Sachigo Lake Bearskin Lake Kasabonika Lake Wawakapewin Webequie Muskrat Dam Koocheching Kingfisher Lake James Bay Sandy Lake Kee-W ay-Win North Caribou Lake Nibinamik Wunnummin Treaties Weagamow Lake North Spirit Lake Deer Lake Robinson-Superior: 1850 Whitewater Lake Tr eaty #3: 1873 McDowell Lake Poplar Hill Tr eaty #5: 1875-76 Cat Lake Lansdowne House Tr eaty #9: 1905-06Shoal Lak Pikangikum Slate Falls Pickle Lake Marten Falls Tr eaty #9: 1929-30 Fort Hope

Red Lake Mishkeegogamang

Wabasseemoong Saugeen Nation Ear Falls Grassy Narrows Wabauskang Whitesand Wauzhushk Onigum Lac Seul Minaki Iskatewizaagegan #39 Sioux Lookout Armstrong Aroland Vermillion Ba y Nakina Keewatin Kenora Dryden New Post Shoal Lake #40 Eagle Lake Naotkamegwanning Beardmore Long Lake #58 Sioux Narrows Wabigoon Gull Bay Nestor Falls Longlac Ginoogaming Northwest Angle #33 Ignace Geraldton Whitefish Bay Constance Lake Northwest Angle #37 Animbiigoo Zaagiigan Greenstone Fort Severn Biinjitiwaabik Zaaging Ojibways of Onigaming Seine River Rocky Bay Hornepayne Naongashiing Lac Des Mille Lacs Big Grassy Big Island Nipigon Naicatchewenin Manitouwadge Rainy River Lake of the Woods Red Rock Rainy Lake Legend Atikokan Schreiber Couchiching Nicickousemenecaning Emo Terrace Bay Stanjikoming Fort Frances Mine Centre No rth West LHIN Nursing Stations / Health Facility Pays Plat Marathon Lac La Croix Pic Mobert Ontario Breast Screening Program Manitoba White Rive r Thunder Bay Friendship Centres Pic River No rth East LHIN Flying Post Wahgoshig Aboriginal Health Access Centres Dubreuilville Missanabie Cree Hospitals Fort Severn Big Trout Lake Chapleau Chapleau Cree Beaverhouse Metis Consultation Wapekeka Michipicoten Brunswick House Wa wa Matachewan LHIN Boundary Sachigo Lake Bearskin Lake Kasabonika Lake Chapleau Ojibway Wawakapewin Webequie Muskrat Dam Matagami Koocheching Kingfisher Lake James Bay Sandy Lake Lake Superior Kee-W ay-Win North Caribou Lake Nibinamik Wunnummin Legend Treaties Weagamow Lake North Spirit Lake DeerNo Lak rthe West LHIN Nursing Stations / Health Facility Robinson-Superior: 1850 Whitewater Lake Ontario Breast Screening Program Tr eaty #3:Manitoba 1873 McDowell Lake Poplar Hill Friendship Centres Tr eaty #5: 1875-76 Cat Lake No rth East LHIN Aboriginal Health Access Centres Lansdowne House Tr eaty #9: 1905-06Shoal Lak Pikangikum Slate Falls Hospitals Pickle Lake Marten Falls Tr eaty #9: 1929-30 Big Trout Lake Fort Hope Metis Consultation Wapekeka Red Lake Mishkeegogamang LHIN Boundary Sachigo Lake Bearskin Lake Kasabonika Lake Wawakapewin Webequie WabasseemoonMuskrat gDam Saugeen Nation Kingfisher Lake Koocheching Ear Falls James Bay Sandy Lake Grassy Narrows Kee-W ay-Win North Caribou Lake NibinamikWabauskang Whitesand Wunnummin Treaties WWeauzhushkagamow Onigum Lake Lac Seul North Spirit Lake Minaki Deer Lake Iskatewizaagegan #39 Sioux Lookout A Guide forRobinson-Superior: Working 185with0 Aboriginal People of Northwestern Ontario - A Stroke Resource for Healthcare ArmstrongProviders Aroland 36 Whitewater Lake Vermillion Ba y Kenora Nakina Tr eaty #3: 1873 McDowellKeewati Lake n Dryden New Post Shoal Lake #40 Eagle Lake Poplar Hill Naotkamegwanning Beardmore Long Lake #58 Sioux Narrows Wabigoon Tr eaty #5: 1875-76 Cat Lake Gull Bay Ginoogaming Nestor Falls Northwest Angle #33 Geraldton Longlac LansdowneIgnace House Constance Lake Tr eaty #9: 1905-06Shoal Lak Pikangikum Whitefish Bay Slate Falls Pickle LakeNorthwest Angle #37 Greenstone Tr eaty #9: 1929-30 Marten FallAnimbiigoos Zaagiigan Fort Hope Biinjitiwaabik Zaaging Ojibways of Onigaming Seine River Hornepayne Mishkeegogamang Rocky Bay Red Lake Naongashiing Lac Des Mille Lacs Big Grassy Big Island Naicatchewenin Nipigon Saugeen Nation Manitouwadge Wabasseemoong Rainy River Lake of the Woods Red Rock Ear Falls Rainy Lake Atikokan Schreiber Grassy Narrows Couchiching Nicickousemenecaning Wabauskang Emo Whitesand Terrace Bay Stanjikoming Fort Frances Mine Centre Pays Plat Marathon Wauzhushk Onigum Lac Seul Lac La Croix Pic Mobert White Rive r Minaki Iskatewizaagegan #39 Sioux Lookout Thunder Bay Pic River Wahgoshig Armstrong Aroland Flying Post Vermillion Ba y Dubreuilville Nakina Missanabie Cree Keewatin Kenora Dryden New Post Eagle Lake Chapleau Shoal Lake #40 Long Lake #58 Chapleau Cree Beaverhouse Naotkamegwanning Beardmore Michipicoten Brunswick House Sioux Narrows Wabigoon Gull Bay Wa wa Matachewan Nestor Falls Longlac Ginoogaming Chapleau Ojibway Northwest Angle #33 Ignace Geraldton Whitefish Bay Constance Lake Matagami Northwest Angle #37 Animbiigoo Zaagiigan Greenstone Lake Superior Biinjitiwaabik Zaaging Ojibways of Onigaming Seine River Rocky Bay Hornepayne Naongashiing Lac Des Mille Lacs Big Grassy Big Island Nipigon Naicatchewenin Manitouwadge Rainy River Lake of the Woods Red Rock Rainy Lake Atikokan Schreiber Couchiching Nicickousemenecaning Emo Terrace Bay Stanjikoming Fort Frances Mine Centre Pays Plat Marathon Lac La Croix Pic Mobert White Rive r Thunder Bay Pic River Flying Post Wahgoshig Dubreuilville Missanabie Cree Chapleau Chapleau Cree Beaverhouse Michipicoten Brunswick House Wa wa Matachewan Chapleau Ojibway Matagami Lake Superior Section 6: Additional Resources

The Human Body Use this image as a guide to show various body parts and their relationships to one another. The use of this type of tool may be of particular benefit to individuals who are visual learners.

A Guide for Working with Aboriginal People of Northwestern Ontario - A Stroke Resource for Healthcare Providers 37 NORTHWESTERN ONTARIO

A condensed version of this document can be found at www.nwostroke.ca