A Guide for Working with Aboriginal People of Northwestern Condensed Version

A Stroke Resource for Healthcare Providers

NORTHWESTERN ONTARIO

A Stroke Resource for Healthcare Providers 1 Map of Treaties and Health Facilities A Guide for Working with Aboriginal Fort Severn People of A Stroke Resource for Healthcare Providers

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 Preface Big Trout Lake Metis Consultation Wapekeka LHIN Boundary Sachigo Lake Bearskin Lake Kasabonika Lake My dad once said “The White medicines. And yet another group Wawakapewin Webequie Muskrat Dam people were given the gift of their may decide to use Aboriginal Koocheching Kingfisher Lake James Bay Sandy Lake Kee-W ay-Win North Caribou Lake Nibinamik medicines. We were also given the medicines only. The last group will Treaties Wunnummin Weagamow Lake gift to know our medicines. Do not use non-Aboriginal medicines. What North Spirit Lake Robinson-Superior: 1850 Deer Lake Whitewater Lake reject either one. Both are good”. is common among the group is Tr eaty #3: 1873 McDowell Lake Poplar Hill they are seeking to be healthy in all Tr eaty #5: 1875-76 Cat Lake My dad was a wise, humble and Lansdowne House aspects of their lives. So, I believe Tr eaty #9: 1905-06Shoal Lak Pikangikum loving human being. My dad was in Slate Falls Marten Falls all the medicines are all equally Tr eaty #9: 1929-30 Fort Hope his late 90’s when he passed away. Mishkeegogamang important and play a role in gaining Red Lake My dad will always be in my heart as our health and well-being. Wabasseemoong Saugeen Nation well his life teachings which I hope I Grassy Narrows Wabauskang Whitesand am living his teachings. My dad had also said “all those things Wauzhushk Onigum Lac Seul Minaki we used to make medicines came Iskatewizaagegan #39 For most of the Aboriginal people, Armstrong Aroland Vermillion Ba y Fort Severn Nakina from all sources available to us and Keewatin Dryden New Post the meaning of the medicine goes Shoal Lake #40 Eagle Lake Naotkamegwanning Beardmore Long Lake #58 we were all given what we need to Sioux Narrows Wabigoon Gull Bay Ginoogaming beyond prescription that a regular Nestor Falls Northwest Angle #33 Geraldton Longlac Constance Lake live on earth from our Creator” As my Whitefish Bay doctor may prescribe to their patients Northwest Angle #37 Animbiigoo Zaagiigan Greenstone Biinjitiwaabik Zaaging dad said “all is good” Ojibways of Onigaming to, hopefully, heal or control a physical Rocky Bay Hornepayne Naongashiing LegendLac Des Mille Lacs Big Grassy Big Island illness. For many Aboriginal people, Today, there is more and more Nipigon Naicatchewenin Manitouwadge No rth West LHIN Rainy River Nursing Stations / Health Facility Red Rock the definition of medicine includes information about Aboriginal people, Atikokan Schreiber Couchiching Nicickousemenecaning Ontario Breast Screening Program Manitoba Emo Terrace Bay Stanjikoming Fort Frances Mine Centre the following: connection to mother their beliefs, values, practices, Pays Plat Marathon Lac LaFriendship Croix Centres Pic Mobert No rth East LHIN White Rive r earth, going for a walk in the bush, a Aboriginal Health Access CentreThunders Bay traditional teachings, ceremonies and Pic River Flying Post Wahgoshig Hospitals DubreuilvilleFort Severn smudging ceremony, a gathering with Missanabie Cree Big Trout Lake medicines are available to explore Chapleau Metis Consultation Chapleau Cree Wapekeka Beaverhouse Michipicoten Brunswick House a community, a sunrise, playing with Wa wa Matachewan and read. To be able to provide the LHIN Boundary Sachigo Lake BearskinChapleau Lake Ojibway Kasabonika Lake Wawakapewin Matagamia child, sitting down with an Elder to Webequie best health care to the Aboriginal Lake Superior Muskrat Dam Koocheching Kingfisher Lake share is medicine. James Bay Sandy Lake population, it is a good thing to have Kee-W ay-Win North Caribou Lake Nibinamik Legend Treaties Wunnummin some knowledge and insight into Weagamow Lake From what I have seen, there are North Spirit Lake Robinson-Superior: 1850 DeerNo Lak rthe West LHIN who we are and where we come Nursing Stations / Health Facility Whitewater Lake more and more Aboriginal people Ontario Breast Screening Program Tr eaty #3:Manitoba 1873 McDowell Lake from. To the health care providers, Poplar Hill returning to their medicines and Friendship Centres Tr eaty #5: 1875-76 Cat Lake No rth East LHIN it might be a good idea to ask Aboriginal Health Access Centres traditionalLansdowne House healing ways. The uses and Tr eaty #9: 1905-06Shoal Lak Pikangikum Slate Falls Hospitals Pickle Lake Marten Falls questions of your patients what they Tr eaty #9: 1929-30 Big Trout Lake the practicesFort Hope of the medicines among Metis Consultation Wapekeka practice and use. The knowledge will Red Lake Mishkeegogamang all Aboriginal people can be similar LHIN Boundary Sachigo Lake Bearskin Lake Kasabonika Lake assist you to provide the best health Wawakapewin Webequie but unique as well. WabasseemoonMuskrat gDam Saugeen Nation Kingfisher Lake Koocheching Ear Falls James Bay care and treatment. Sandy Lake Grassy Narrows Kee-W ay-Win North Caribou Lake NibinamikWabauskang Whitesand There are Aboriginal people, Wunnummin Treaties WWeauzhushkagamow Onigum Lake Lac Seul North Spirit Lake Minaki who have chosen to utilize both Brenda M. Mason, Elder Deer Lake Iskatewizaagegan #39 Sioux Lookout Robinson-Superior: 1850 Armstrong Aroland Whitewater Lake Vermillion Ba y Revised March 5, 2012 Kenora Aboriginal Nakinaand non-Aboriginal Tr eaty #3: 1873 McDowellKeewati Lake n Dryden New Post Shoal Lake #40 Eagle Lake A full version of this document,Poplar including 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 references, can be found at www.nwostroke.ca 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 2 A Guide for Working with Aboriginal PeopleBig Grassy of NorthwesternBig Island Ontario A Stroke Resource for Healthcare Providers 3 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 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 Table of Contents Purpose Acknowledgements Preface This toolkit provides clinical and These documents could not have educational tools, Aboriginal been assembled without the Purpose 1 history, stroke information and dedication and contributions of Acknowledgements 1 best practices, which can assist many. Special thanks to these health service providers to engage individuals for their assistance in Section 1: and offer effective stroke-related the compilation of this toolkit: Aboriginal History 2 education and care to Aboriginal Kelly Brownbill & Greg McGregor Introduction 2 individuals and families. Aboriginal Health Circle Barrie Historical Events 3 Ontario is home to a diverse mix Native Advisory Circle of Aboriginal groups and cultures. Marilyn Morley Summary 7 There are three main Aboriginal Ontario Aboriginal Section 2: Aboriginal groups in Ontario; , Friendship Centre Health Beliefs 8 Inuit and Métis. For this toolkit, the Cheryl Moher & Alda Tee term “Aboriginal” refers collectively Central East Stroke Network Philosophies on Health and Wellness 8 to these Aboriginal groups and Darren Jermyn cultures living in Ontario. Medicine Wheel Teachings 10 Northeastern Ontario Traditional Medicines 11 Target Audience Stroke Network Aboriginal Families Donna Cheung, Jacqueline Willems This toolkit was designed for and Communities 14 & Ross Graham healthcare professionals (e.g., South East Toronto Stroke Network clinicians, healers) and health Section 3: Aboriginal Culture - Marilyn Erwin Tools, Considerations and providers (e.g., family health Stroke Prevention Clinic Guidelines for Cultural Safety 16 teams, community agencies, Fort Frances, ON healing centres and hospitals) Cathy Creighton & Donna Simon Cultural Safety 16 that work with Aboriginals, their Anishnawbe Mushkiki Cultural Amplifiers 22 families and communities at any stage of stroke prevention, care Brenda Mason Additional Considerations for or recovery. This toolkit refers to First Nations Elder the Clinical Encounter 23 these audiences collectively as Diane Hiscox, Pauline Bodnar Your Beliefs and Lens 24 health service providers. & Sandi Homeniuk Collaborating with Northwestern Ontario Regional Stroke Network (NWORSN) Aboriginal Communities 25 Contact Information Robert Fenton Section 4: Stroke Information Chair, Aboriginal Advisory and Best Practices 26 All feedback on the content of Committee (NWORSN) this toolkit should be directed to Stroke in Aboriginal Populations 26 Helen Cromarty the Northwestern Ontario Sioux Lookout Meno Ya Win Risk Factors 27 Regional Stroke Network at Health Centre [email protected]. This document Canadian Best Practice Deanne Lee was published by the Northwestern Recommendations for Stroke Care 28 Thunder Bay Regional Health Ontario Regional Stroke Network Sciences Centre Stroke Services in in March 2012.. Northwestern Ontario 28 Glossary 29 The Human Body 31

A Stroke Resource for Healthcare Providers 1 Section 1: Section 1: Canadian Aboriginal History Canadian Aboriginal History Historical Events Before European Arrival Aboriginal people were living lineage (i.e., the line of descendants in North America long before of a particular ancestor), and Europeans arrived. While difficult to holding the belief that all elements determine, it is believed that there of nature were sacred. As clan were approximately 500,000 people members married into other clans, living in what is now Canada (with these communities grew. It is also estimates ranging from 200,000 believed that Aboriginal people to 2,000,000) (O’Donnell, 2008). enjoyed relatively good health These people were organized into during this period, including control approximately 600 communities of disease, as well as high levels of (also known as tribal groups or physical and mental wellness. bands). Many of these communities had similar characteristics, including being divided into clans based on

First European Contact 1492

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

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

First Interactions (1492) The Indian Act (1867) Residential Schools (1840-1996) When Christopher Columbus The Indian Act describes the From then on, an Aboriginal person The Indian Act required Aboriginal arrived in South America in administration of almost every could retain Indian Status and be a parents to send their children to 1492, the Aboriginal people were aspect of Aboriginal life. It had Canadian citizen at the same time. residential schools. These schools welcoming. The Spanish however, three main principles: 1) to civilize The Indian Act also spelled out had three objectives: 1) to convert tortured, abused, killed and enslaved Aboriginal people, 2) to manage conditions for being an Indian Aboriginal people to Christianity, Aboriginal people. It is estimated Aboriginal people and their lands; woman. It considered any woman 2) to teach reading, writing and that the Aboriginal population was and 3) to define who could and married to an Aboriginal man to arithmetic, and 3) to develop reduced by half during the first could not hold “Indian Status.” be an Indian, fully allowed to live Aboriginal children into farmers and two years of Columbus’ rule. The This legislation was designed to and be buried on a reserve (i.e., she housekeepers. Europeans also had doubts as to assimilate Aboriginal people into gained Indian Status). However, Children were forcibly removed whether Aboriginal people in the European culture. Aboriginal people an Aboriginal woman married to a from their families and placed in Americas were human (at this time became wards of the state, and their European man was considered a schools located in remote areas. only Christians were considered land became “reserves.” Previously member of Canadian society (i.e., she The use of any Aboriginal language human). However, in 1512, Pope signed treaties were ignored and and their children lost Indian Status). was prohibited, and children were Julius II declared that “Indians are Indian Agents were hired to enforce punished severely for speaking truly men...they may and should the new legislation. The intent of the their language, even if they did not freely and legitimately enjoy their Indian Act is best summed up in the speak/understand English. As a liberty and possession of their words of Duncan Campbell Scott, A Shaking Tent rite was a popular result, many children died of poor property; nor should they be in any the Deputy Superintendent of Indian ceremony among the Ojibwa, Innu, health conditions at the schools. way enslaved.” Affairs from 1913 to 1932: Cree, Penobscot and Abenaki. The Many ran away from school and client would pay a Shaman to build The Royal Proclamation (1763) I want to get rid of the Indian were severely punished upon their his or her tent and the Shaman return. Others encountered sexual problem…Our objective is to would enter it at dark. Singing and The Royal Proclamation of 1763 continue until there is not a single abuse by school officials and/ established British protection Drumming was used to summon Indian in Canada that has not been the Shaman’s spirit helpers, whose or suffered severe psychological over unsettled land belonging absorbed into the body politic and arrival was signaled by the shaking harm as a result of their suppressed to Aboriginal communities, and there is no Indian question and no of the tent and animal cries. The Aboriginal identity. recognized Aboriginal ownership Indian department (Leslie, 1978). spirits were used to cure the ill and Within these institutions, Aboriginal of land not already colonized. This Christianity was imposed on Aboriginal for anti-sorcery. children lost their culture, identity Proclamation is considered to be people as a means of civilizing them. The Sweat Lodge has been called “the and traditions, as well as trust and one of the strongest guarantees of Cultural ceremonies, such as Sweat most powerful structure in the world.” respect for others and themselves. Aboriginal land rights. Lodges and Shaking Tent were It is a place specially constructed to These were replaced with feelings conduct ceremony. Sweats vary from Struggle to Maintain outlawed in 1884. Persons caught of shame and low self-worth. celebrating these events could be purification and cleansing to healing Furthermore, those who were not Aboriginal Identity sweats. It is said that the Sweat Lodge imprisoned. Banning these traditional direct victims of abuse were often during ceremony “responds” to what By the 19th century, government gatherings assisted missionaries in the participants need. witnesses, and suffered the effects policies changed to reflect “colonial their attempts to replace Aboriginal of intergenerational trauma. dominance” of the Aboriginal beliefs with Christian beliefs. (Anishinawbe Health Toronto) nations. The new Dominion of Residential schools began a legacy Canada no longer needed Aboriginal The right to vote was a major of despair for Canadian Aboriginal people as allies in war, or required feature of the Indian Act. If an Indian communities. The schools had nearly their skills for the fur trade. Instead, person accepted the right to vote destroyed Aboriginal communities the Dominion needed land for new (or own property or serve in the by suppressing traditional language, settlers. This led to a new goal for military), he or she had to relinquish culture and spirituality. It has been the Dominion: Aboriginal assimilation their Indian Status. This was not argued that many Aboriginal people though legislation. changed until 1960, when the lost their knowledge of traditional Federal Elections Act was amended parenting practices during this era. to allow Indian people to vote. The last of the 130 residential schools closed in 1996.

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

Reserves The Sixties Scoop (1960-1985) Residential School Apology (2008) In order to develop land across The sixties scoop (also known Two years after the federal of the Indian Residential Schools Canada, the government pressured as the stolen generation) refers government reached a $1.9 billion policy were profoundly negative Aboriginal people to settle on to the adoption, under the settlement with the survivors and that this policy has had a lasting reserves. Reserves were kept expanded Children Welfare Act, of of residential schools, the Prime and damaging impact on Aboriginal far enough apart to discourage approximately 20,000 Aboriginal Minister (Stephen Harper) formally culture, heritage and language. While some former students have communities from forming alliances children by non-Aboriginal families apologized to the survivors and their spoken positively about their against the government. Indian Agents across North America. To “protect” families on June 11, 2008. Excerpts experiences at residential schools, were sent to reserves, where they lived Aboriginal children, welfare from his speech: these stories are far overshadowed and were heavily involved in many workers removed them from their The treatment of children in Indian by tragic accounts of the emotional, aspects of Aboriginal life such as: families rather than trying other Residential Schools is a sad chapter physical and sexual abuse and interventions or counseling. These • Education, law and order in our history…I stand before you, neglect of helpless children, and children were often apprehended in this Chamber so central to our their separation from powerless • Granted permission for Indians from their homes without the life as a country, to apologize to families and communities. The to leave the reserve (doing so knowledge or consent of their Aboriginal people for Canada’s role legacy of Indian Residential Schools without permission could result in families or communities and had no in the Indian Residential Schools has contributed to social problems imprisonment) mechanism to contact their birth system…The government now that continue to exist in many recognizes that the consequences communities today (Canada, 2009). During this time, the federal families (Philip, 2002). government also had control Bill C-31 and Bill C-3 (1985, 2010) over the financial transactions of Aboriginals. This meant that any According to the Indian Act, sales and purchases were strictly Aboriginal women lost their Indian monitored under a permit system. status if they married a man who Summary Aboriginals needed a permit to: did not also have Indian Status. Knowledge regarding the Today, Aboriginal leaders are taking • Sell cattle, grain, hay, firewood, Her children would also not receive devastating impact of colonization responsibility for healing the grief lime, charcoal and produce grown Indian status. However, this was in and other historical events on and loss in their communities. As on the reserve conflict with the Canadian Charter Aboriginal communities is critical well, Elders continue to pass on the of Rights and Freedoms which to understanding the current knowledge and wisdom to keep • Buy groceries or clothes guaranteed protection of rights Aboriginal physical, emotional, Aboriginal culture and traditional As Aboriginal communities developed equally for men and women. Bill mental and spiritual health status. healing methods alive for future their own elected governments during C-31 (passed in 1985) amended the These events have resulted in loss of generations. the fifties and sixties, they eventually Indian Act to give these women and culture, values, language and kinship did away with the role of the Indian their children status. By 1992, over between communities. They have Agent and the permit system. 81,000 people had regained status. been shown to contribute to high On March 11, 2010, the Federal incidence of family violence, sexual Forced Sterilization Government introduced legislation abuse, substance abuse, suicide, In the sixties, British Columbia and to enhance gender equity in the social issues and widespread chronic Alberta developed policies to stop Indian Act. Bill C-3 ensures that disease for Aboriginal Canadians. “mental defectives” from having grandchildren of women who lost children. These policies stipulated status as a result of marrying non- consent was no longer required Indian men gain Indian Status in to perform sterilizations when accordance with the Indian a client was deemed mentally Act (INAC, 2010). defective or “incapable of intelligent parenthood.” Aboriginal women became targets under this policy and a disproportionately high number of Aboriginal women were sterilized.

6 A Guide for Working with Aboriginal People of Northwestern Ontario A Stroke Resource for Healthcare Providers 7 Section 2: Section 2: Aboriginal Health Beliefs Aboriginal Health Beliefs Wholistic Perspective Ontario’s Aboriginal population has a wholistic perspective on health and Religion: Please do not assume wellness. This means that physical, “I just want to be accepted, respected and that all Aboriginal people are emotional, mental and spiritual practicing traditional ways. Some honoured for who I am and what I do”. wellness are each a component Aboriginal people are Christian, Brenda Mason, Elder of good health. Furthermore, some are traditional and some are when these components are a combination of both. balanced, an individual is in harmony with nature. Aboriginal culture also includes the concept of connectiveness, which describes the Nation connection between the Aboriginal people and Mother Earth. Community Today, Aboriginal leaders are taking responsibility for healing the grief and loss in their communities. Family As well, Elders continue to pass on the knowledge and wisdom to keep Aboriginal culture and traditional healing methods alive for Self future generations. Aboriginal Connectiveness – Aboriginal individuals, families, communities and nations are connected in the Sacred Circle. An emotional, physical, mental and spiritual imbalance affects everyone. It is important to recognize that every Philosophies on Health and Wellness treatment has a cultural component. Western medicine is primarily Ontario is home to a variety of fundamental traditions and cultures focused on diagnosis as an outcome, Aboriginal people: Algonquin, that are listed below. Understanding whereas Aboriginal medicine focuses Mississauga, Ojibway, Cree, Odawa, and respecting the cultural practices more on the environment in which Pottowatomi, Delaware, and of an Aboriginal client will help the patient may recover. the Haudenosaunee (Mohawk, support an effective treatment plan. Onondaga, Onoyota’a:ka, Cayuga, Tuscarora, and Seneca) (Spotton, 2007). Northwestern Ontario is It is important to remember that home to Ojibway, Oji-Cree and within the Aboriginal population Cree. It is important to remember there are hundreds of tribes. that each Aboriginal community in Each one of these tribes is Ontario has unique characteristics somewhat the same but have and needs. These include different a variance in their tribal belief languages, spiritual beliefs, history systems, community practices and cultural teaching. However, and different languages there are a number of common,

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

The Sacred Medicine Wheel Traditional Medicine The Four Sacred Medicines Numbers have always played Aboriginal populations use a Tobacco (the East) is always used a significant role in traditional variety of natural resources to first as an offering for everything Aboriginal culture. The number create medicines. The four sacred and in every ceremony. Tobacco is four, for example, is one of the medicines include tobacco, cedar, given to the Aboriginal people so most sacred. The Medicine Wheel White sage and sweetgrass, and can be they may communicate with the is a ceremonial healing tool built used as part of a healing practice or spirit world. It opens up the door to around the number four. The ceremony. These medicines, healing allow that communication to take Aboriginal population values the practices and ceremonies are often place. Offering Sacred Tobacco is Black Yellow Medicine Wheel as a wholistic and collectively referred to as traditional a way of giving thanks in advance sacred symbol, given to them by Aboriginal medicine. The World of a request. Tobacco is generally the Creator. Health Organization (WHO) defines not smoked, except on special traditional Aboriginal medicine as: ceremonial occasions. The Medicine Wheel can be Red expanded to include other wheels, The sum total of knowledge, Sweetgrass (the North) is used for such as the emotions wheel, or the skills and practices based on the purification of thoughts and the mind wheel. These wheels may theories, beliefs and experiences environment. Indigenous to different cultures, be used to explain or examine Cedar How it works: The wheel revolves whether explicable or not, used in (the South) is used for emotions that impede personal the maintenance of health as well purification of the home and growth. It requires many years endlessly in a clockwise direction, symbolizing the continuous as in the prevention, diagnosis, protection. It also has restorative to learn each wheel’s teachings. cycles of life. It also symbolizes improvement of treatment of medicinal uses. Cedar grows during Collectively, the wheels symbolize the Powers of the Four Directions physical and mental illness. the winter months reminding the that an individual must balance and the interrelatedness of all Aboriginal medicine contains folk Aboriginal people that medicines are wellness of mind, body and spirit, life’s elements. remedies and treatments passed always available. When cedar is put as well as live in harmony with the How it was taught: The Medicine down over time. Many formed the into the fire with tobacco, it crackles, natural environment. An Aboriginal Wheel was originally explained basis and can be found in Western calling the attention of the spirits. client may consider illness to be with a circle being drawn in the pharmaceutical treatments. Sage (the West) is used to the result of an imbalance in one or earth. The symbols were then prepare people for ceremonies more of these areas. gradually drawn as their meanings were explained by an Elder. and teachings. Sage is used for The Elder would begin with an releasing what is troubling the mind explanation of the four directions: and for removing negative energy. north, east, south and west. He It is also used for cleansing the may then have gone on to explain homes and sacred items. some of the following concepts: Adapted from Aboriginal Perspectives • The changing seasons: early fall, on Health and Wellness, Marilyn Morley, fall, winter, early spring, spring Webinar Series, 2009 and summer. • The four stages of life: childhood, adolescence, adulthood and old-age. “You have to use them (tobacco plants) with respect, as prayers and offerings in ceremonies, so they’ll reward you. • The races: red, white, black and yellow. But if you use them without respect, if you smoke them • The four elements: water, air, like cigarettes, their power will kill you.” fire, and earth. Winters, Solomon, Hill, Pego and Victoria, 2000 • The four sacred medicines: tobacco, cedar, sage and sweetgrass. For further information, please go to: http://www.med.uottawa.ca/sim/data/Aboriginal_Medicine_e.htm

10 A Guide for Working with Aboriginal People of Northwestern Ontario A Stroke Resource for Healthcare Providers 11 Section 2: Aboriginal Health Beliefs Section 2: Aboriginal Health Beliefs

The following are examples of plant medicines used It is important to note that most ceremonies such as Healing Circles, primarily in Northwestern Ontario: substances (e.g., traditional medicines/ Shaking Tent, and Sweat Lodge, to medication) have active ingredients name a few. It is normative for these which can affect health and interact individuals to sacrifice their daily lives Plant / Medicine Use Preparation Medicinal Content with other medicines/medication. to ritual, prayer and healing. Similar to the health service providers Inhale Healer – A gifted individual who Balsam Fir Colds Nasal Stimulant who practice western medicine (i.e., Vapors may heal in a variety of ways, modern practices aimed at restoring including all of the above and or and maintaining health by preventing Tea From a “gift” of touch, or energy work – Mountain Ash Allergies Antihistamine and treating illness), traditional Bark meaning that ritual is not always medicine is usually provided by a needed. Healers can be ritualistic, Tea From number of specialized Aboriginal Cedar Allergies Antihistamine but also may have an ability to use Boughs practitioners. A publication by a variety of therapies to heal people Canada’s National Aboriginal Health spiritually, emotionally or physically. Tea From Poplar Back Pain Analgesic Organization (NAHO) describes the Roots roles of these practitioners (Hill, 2003). Midwife – Often, these practitioners The Helper description was gathered are women with specialized from the Alberta College of Social knowledge in prenatal care, birthing Workers’ Aboriginal Social Work assistance and aftercare. The midwife Committee (Gladue et al., 2008). may employ the use of massage, diets, medicines and ritual, prayers Herbalist – A practice that emphasizes and/or counseling. Traditional botanical and pharmacology midwifery exists worldwide and DID YOU KNOW? knowledge of the indigenous plants involves a variety of skills, often and fauna. Often these individuals Aboriginals discovered the biophysical, but can also include work closely with other Indigenous first chewing gum, which was spiritual and ritual activity as well. collected from spruce trees. doctors and assist in providing Some of these “chewing gums” remedies for individuals whom they or Helper/Natural Helper – Aboriginal were used to relieve toothache, others have diagnosed. Their practice Helpers are identified by the headache, and indigestion. can be highly specialized in one field, community, Elders or family. (www.aadnc-aandc.gc.ca) such as remedies for snakebites, or as Aboriginal community members diverse as the illnesses themselves. all have responsibilities to society as “helpers” and work in various Medicine man/woman – A practice environments ranging from spiritual that may and often does possess to community without boundaries all of the previously listed gifts and by sector. more. Their work usually engages in ritual, ceremonial activity and prayer. Aboriginal people may utilize both In some societies they are identified traditional and western health as “medicine men/women” because services to meet their wellness needs. they possess sacred bundles, sacred These needs include broad aspects pipes, sacred masks, and the rights of Aboriginal health, such as culture, to rituals, songs and medicines language and geographical location. that have been inherited from their This is true to the extent that a 2002 parents, grandparents, or that they survey by NAHO found that 60% of earned through apprenticeship with the Aboriginal sample indicated loss a respected medicine man or woman. of land and culture to be a significant Depending on their nation, they contributor to poor health. are also conductors of community

12 A Guide for Working with Aboriginal People of Northwestern Ontario A Stroke Resource for Healthcare Providers 13 Section 2: Aboriginal Health Beliefs Section 2: Aboriginal Health Beliefs Aboriginal Families and Communities In many Aboriginal communities, communities for parents to give a members of the same clan are child to another family in the clan. In considered family, linked through some cases, a fertile couple would a common ancestry. Examples of agree to have one of their children clans include: Bear Clan, Fish Clan, adopted at birth by a childless and Crane Clan. Depending on the couple. These two families would situation of your Aboriginal client, then contract a special bond with the term “family” may only refer each other for life. to immediate relatives, such as a Similar to contemporary Canadian spouse, parents, siblings or children. families, each Aboriginal family is However, “family” may also include an responsible for nurturing children extended network of grandparents, and preparing them to function well aunts, uncles and cousins. in society. While this goal is similar, According to the rules of clan the process is likely different: membership, each member is When a young man goes out on a required to marry outside the hill to seek the vision of who he is clan to which they belong. Over to be and what gifts are uniquely generations, this may result in his, it is not because he is preparing each family in a community being to go out into the world and seek related by descent or marriage. In his fortune. Rather, he comes rural clans, where membership has back to the camp or the village remained stable over time, family to obtain advice from his uncles and community often represent the or grandfather on the meaning of his experience, and to exercise his same group. Aside from descent medicine (or personal power) in the and marriage, Aboriginal Ontarians service of his family and community may be related through adoption. (Brenda Mason, First Nations Elder). It is still common practice in many Elders leads all governance, decision- Aboriginal communities have great making and administration of various respect for the wisdom gained over community services. The Chief also the course of one’s life. Individuals represents the community’s interests recognized as Elders have earned at the provincial/territorial level. the respect of their community and Decision Making are people whose actions and words convey consistency, balance, harmony Every Aboriginal family member and wisdom in their teachings. They usually has a responsibility in decision hold invaluable knowledge and skills making. Furthermore, there may be (NAHO, 2009). no family leader who makes decisions independently. In the event that an Chief Aboriginal stroke survivor requires a The Chief is the elected leader of substitute decision-maker, it may be an Aboriginal community or clan important that all family members are (similar to a mayor for non-Aboriginal included in the process, understand communities). Along with the other what decision needs to be made and elected council members, the Chief are given time for contemplation.

14 A Guide for Working with Aboriginal people of Northwestern Ontario A Stroke Resource for Healthcare Providers 15 Section 3: Section 3: Aboriginal Culture - Tools, Considerations and Guidelines for Cultural Safety Aboriginal Culture - Tools, Considerations Practicing Cultural Safety/ • You may encounter a client or family Cross-Cultural Safety member that makes little or no eye and Guidelines for There are some practical ways to contact. In some Aboriginal cultures Cultural Safety provide culturally safe and culturally eye contact is considered rude. sensitive care. These are of course • Pictures may be a helpful method above and beyond the professional of explaining or educating a client courtesies which you would show or their family. anyone at-risk of having a stroke, a • Ensure a translator is available stroke survivor or their family. The for both verbal and written guidelines for practicing culturally communication. sensitive care presented below were compiled from three sources: Bird, Know when to use direct and indirect 2002; NAHO, 2008; and Consultation communication. with our local Aboriginal partners. • Your client may exhibit a type of These guidelines are presented in communication requiring you to the following themes: read between the lines. Explain to your client that you will ask 1. Communication questions to better assess and Establish a common serve his/her needs, and that it is communication method. not your intent to be insensitive or • An Aboriginal individual’s offensive when asking questions. comfort with eye contact, touch • Encourage your client to tell their Cultural Safety/Cross-Cultural Safety and personal space, as well as story rather than conducting a Definition and Value Given the cultural diversity of conversation pacing may be formal assessment different than the typical non- As a Canadian health service the Canadian population, client- Aboriginal person. 2. Building Rapport provider, the services you provide to centered care often includes clients should be patient or client- elements of cultural safety. While • Emotional control is also common Connecting with your client it is difficult to define the scope of centered. According to the Institute among Aboriginal people. • An Aboriginal client may feel as cultural safety, Canada’s National for Healthcare Improvement (IHI), This means that certain types though they have no control over Aboriginal Health Organization client-centered care refers to: of speech intonation or body their care. To assist in building (NAHO) cites the definition of language may not have the rapport, focus attention toward Care that considers clients’ culturally unsafe practices as “any same meaning for you and your factors that are controlled by cultural traditions, their personal actions that diminish, demean or preferences and values, their family Aboriginal client. the client, such as personal disempower the cultural identity situations, and their lifestyles. It autonomy, personal goals and and well being of an individual” • Aboriginal people may listen makes the client and their loved growth, the ability to change (2006). Cultural safety can also be passively to information you ones an integral part of the care are sharing with them. This one’s path. team who collaborate with health extended to include an examination does not necessarily mean they service providers in making clinical of the power imbalances and • Assist the client to recount decisions. Client-centered care puts institutional discrimination that are unengaged. their successes in overcoming responsibility for important aspects occur in Canadian society, or an • Recognize that your discussion past issues. Wherever possible, of self-care and monitoring in clients’ understanding of historical elements with an Aboriginal client or their discuss their options while hands - along with the tools and and their relationship to current family may have a slower pace outlining the pros and cons of support they need to carry out that Aboriginal health status. than what you are accustomed each option, and let the client responsibility. Client-centered care to. Furthermore, you may need to make a decision based on the ensures that transitions between information presented. providers, departments, and accept some conversation health care settings are respectful, pauses or silences. coordinated, and efficient.

16 A Guide for Working with Aboriginal People of Northwestern Ontario A Stroke Resource for Healthcare Providers 17 Section 3: Aboriginal Culture - Tools, Considerations and Section 3: Aboriginal Culture - Tools, Considerations and Guidelines for Cultural Safety Guidelines for Cultural Safety

During the encounter Explore the client’s comfort with 4. Information and Support 5. Family and Decision Making healthcare. • Identify personal goals Ensure the client and their family Encourage and support the Aboriginal • An Aboriginal person may feel understands the healthcare system, client and their family. Include them in • Recognize and reinforce as well as the resources and supports all aspects of care, decision-making, personal strengths uncomfortable questioning authority. They may agree to that are available to them. and education. • Identify social/community networks/ something when they would • Be aware of available Aboriginal • With the client’s permission, share resources and encourage building of actually prefer to decline or are resources, support groups and a copy of the care plan with the social supportive networks unsure. The decision maker(s) accommodation services in your area. Aboriginal client and family. • Identify the client’s options and rights should be encouraged to speak frankly with you about their • An Aboriginal client may feel • Ask the client and/or family if 3. Understanding Health preferences and opinions. isolated and alone especially if they wish to nominate a person Beliefs and Practices stroke support services are not to speak on behalf of the family. • Recognize that an Aboriginal available in his/her area. If possible, Acknowledge and involve the Show respect for traditional person may be more comfortable create these support systems within person nominated. approaches to healing. with uncertainty regarding the your practice in a safe environment. long-term effects of illness • Include appropriate Aboriginal • Aboriginal clients bring their and disability than the general • Be aware that Aboriginal resources staff in the client’s care (if personal history, including their population. and support systems are almost available). They may provide cultural values and beliefs to the always limited in rural or remote areas. assistance with the decision- healthcare system. Learn about • Be aware that some Aboriginal making process, if this is agreed • Remember that an Aboriginal your client, and the Aboriginal people will consistently minimize to by the client and family. community you are serving, in health problems. client may be coming from one jurisdiction to another (federal order to teach and offer a bicultural • Creating an Aboriginal-friendly 6. Ceremony, Song and Prayer approach to care. to provincial) which brings environment (including Aboriginal additional limitations. Offer the Aboriginal client the choice • Be aware of the important aspects art and design) may improve your of having a healing ceremony of Aboriginal history and the client’s and their family’s comfort Refrain from judgment regarding (eg. Smudging is the first thing in ALL cultural amplifiers that may affect with healthcare. They may need traditional healing services and ceremonies) throughout their care. the relationship between you and to see themselves reflected in the medicines the client may have • For many Aboriginal people, your client. healthcare environment. accessed. A judgmental response ceremony is essential in protecting could harm the trust and confidence • When compiling a client history, and maintaining spiritual, mental, you have established with your client. find out what band(s) or tribe(s) emotional and physical health. they belong to. • Discuss western medicine and its Many Aboriginal people will • Allow time for ceremony and do • Without requesting details, ask your uses, and encourage the use of both not interrupt unless the physical listen quietly and intently to western medicine and traditional client if they use traditional healing the information being shared care of the client is compromised. services and medicines. medicine whenever possible. with them. It is important not • If there are concerns of why • • Be aware that an Aboriginal client to interpret this response as Suggest to your client that ceremonies cannot occur within being “passive”. may believe in causes and cures traditional healing and western your facility, discuss possible options that do not fit with established medicine are more effective with the team, client and family. western medical practices. together, than separate. • Be aware that some Aboriginal • Encourage and validate your people believe that speaking about client’s effort to access illness may lead to its occurrence. Aboriginal-specific resources. • Understand that for Aboriginal clients, the concept of “next of kin” may be broadly interpreted.

18 A Guide for Working with Aboriginal People of Northwestern Ontario A Stroke Resource for Healthcare Providers 19 Section 3: Aboriginal Culture - Tools, Considerations and Section 3: Aboriginal Culture - Tools, Considerations and Guidelines for Cultural Safety Guidelines for Cultural Safety

Be aware and respectful of sacred/ 9. Pending and Following Death ceremonial items and discuss any Moon Time Learn about any Aboriginal family • In some cultures, the body is not to handling requirements with the client The women are honoured and specific customs related to death. The be left unattended following death. and/or their family. family should be notified, supported and respected for the gift they have • Some Aboriginal communities involved where death is expected. • Participate in education and been given as life givers. Women believe when someone is ailing, two must keep themselves of good training opportunities around • Be aware that large numbers of care givers should attend. If only sacred and ceremonial processes. mind, body, and spirit at all times. There is a natural cleansing cycle family members may be present. one attends, the ailing person may • Give the family member or an that occurs for women each • Provide opportunities for the family think they are dying which may Aboriginal staff member the option month that helps them stay to perform cultural and spiritual result in agitation. of caring for any items. healthy. Some people call this the rites for the deceased. • Be aware that the family may also menstrual cycle, the period, or • Exercise particular care with gather and sing at the bedside the menses. • Be respectful of ceremony and gender-specific protocols for protocols, and allow time for prior to death and upon death to ceremonial items. Very often amongst the help the soul travel. Aboriginal people you will hear their performance. • Inform the client and/or family of a time called “ the moon time”. • Work with the family to appoint a • There may be a belief that when member of the location and any The name is understood to be contact person, thus minimizing someone passes, the family or risk(s) regarding storing the items. symbolic of the grandmother the amount of communication community must open a window or moon that travels the sky at required. Be aware that community door to let the spirit go home. 7. Food night. The moon is honoured by the women in different ways leaders may get involved and act Become familiar with the basic principles and as she becomes full once a as the non-family contact person. regarding treatment of your client’s food, month so do women. This is a access to traditional food and practical time when the blood flows from ways of respecting these principles. a woman and she is considered • For example, in some cultures, to be at her greatest strength. It Belief that death involves passage into a world that is not feared; one is a time for women to stay quiet, menstruating women should not will meet with ancestors in the spirit world to live for eternity; dying is a to think, and to meditate about time to communicate, settle differences and make peace (Turner-Weeden prepare or serve food due to their who they are as women. This spiritual power. 1995, cited in Hotson et al 2004). An understanding of these beliefs are is also a time when the women important so that health service providers do not accept a stereotype • In many cases, these principles/ should be looked after and cared that Aboriginal fatalism means that Aboriginal patients are more likely to beliefs will align with good health for. Women are powerful during “give up” when confronted with a life threatening diagnosis. and safety procedures that should this time and, out of respect for that power, they do not attend be practiced by staff. They should ceremonies, feasts, and Pow- not cause excessive burden or wows where sacred items such variation from usual practices. as drums, outfits, feathers, eagle whistles, rattles, and pipes will be 8. Body Parts, Tissues or Substances present. In this same manner the Fully communicate procedures and women do not wear their outfits options regarding removal, retention, to dance in the circle of life at the return or disposal of body parts/ Pow-wow. (Harold Flett) tissue/substance. • Record and carry out the wishes of the Aboriginal client and/or family regarding these issues. • Different protocols can exist for remains such as placentas and bodily fluids.

20 A Guide for Working with Aboriginal People of Northwestern Ontario A Stroke Resource for Healthcare Providers 21 Section 3: Aboriginal Culture - Tools, Considerations and Section 3: Aboriginal Culture - Tools, Considerations and Guidelines for Cultural Safety Guidelines for Cultural Safety Cultural Amplifiers Additional Considerations for While the approaches mentioned 4. Modesty the Clinical Encounter above can assist you to provide • Many Aboriginal people are A number of models have been developed to assist health service culturally safe care, it may be modest about their bodies and providers conduct clinical interviews with Aboriginal clients. Note: valuable to consider some barriers find it uncomfortable to undress, While these can help frame your clinical interview, they may not collect and issues which can impede these discuss their bodies or perform all the necessary information, or may include questions/areas that are approaches. Some of these barriers self-examinations. Consequently, an irrelevant: Use as appropriate. may be referred to as cultural individual may not notice or wish to amplifiers (i.e., cultural factors that discuss personal bodily changes. magnify the difficulties faced by Aboriginal people when accessing 5. Language and Culture BELIEF Model* LEARN Model** ETHNIC Model*** healthcare [Bird, 2002]). • Many cultural elements are Health Beliefs: What Listen to the client’s Explanation: How do you Barriers to Accessing Healthcare contained within the context of caused your illness/ perspective explain you illness? an Aboriginal language. Many problem? 1. Travel words and concepts are not easily translated into English, and Explanation: Why did Explain and share one’s Past Treatment: What • Aboriginal people may travel some cannot be translated. it happen to me? own perspective treatment have you tried? daily, weekly or several times a year from reserve/rural areas • Northwestern Ontario has 3 main Learn: Help me to Acknowledge differences Healers: Have you to urban areas. Travel occurs languages: Ojibway, Oji-Cree and understand your and similarities between sought any advice from for many reasons, including Cree. There are 19-20 dialects. belief/opinion these two perspectives traditional healers? family visits, ceremonies, job Check your local hospital for Impact: How is this and educational opportunities, language resources. Recommend a Negotiate mutually illness/problem substance abuse and illness. treatment plan acceptable options 6. Mortality impacting your life? 2. Distrust of Authority • High rates of mortality are a part Empathy: This must Agree on Intervention • Aboriginal people have a long of most family and community be difficult for you Negotiate a history of mistrust of the experiences for Aboriginal people. mutually agreed government as a result of broken It is not unusual for an individual to Feelings: How are upon treatment plan Collaborate with client, treaties, lost land, reserves and have someone in his or her family you feeling about it? family and healers residential schools, as well as commit suicide, be a victim of a ongoing experiences with racial homicide, or lose a relative in a *Dobbie et al. (2003), **Berlin & Fowkes (1983) and ***Levin et al. (2000) and ethnic discrimination. fatal automobile accident. • Youth suicide is a major 3. Fear of Breach of Confidentiality problem for Aboriginal • Breaches of confidentiality communities. Statistics show have been a serious issue in an Aboriginal suicide rate two many Aboriginal clinics. This to three times higher than the often occurs in reserve/rural non-Aboriginal rate for Canada, communities where rumors and within the youth age group can spread quickly, although the Aboriginal suicide rate is comparable breaches also occur estimated to be five to six in urban clinics. times higher than that of non-Aboriginal youth . (Health Canada 2003)

22 A Guide for Working with Aboriginal People of Northwestern Ontario A Stroke Resource for Healthcare Providers 23 Section 3: Aboriginal Culture - Tools, Considerations and Guidelines for Cultural Safety Collaborating with Aboriginal Communities

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

24 A Guide for Working with Aboriginal People of Northwestern Ontario A Stroke Resource for Healthcare Providers 25 Section 4: Section 4: Stroke Information and Best Practices Stroke Information and Transient Ischemic Attack (TIA, also known as a “mini-stroke”) Warning Signs for Stroke & TIA Best Practices – TIA is a sudden but temporary period of decreased blood flow Sudden weakness, somewhere in the brain causing numbness or tingling stroke-like signs and symptoms (e.g. difficulty speaking or Sudden trouble speaking moving one side of the body) or understanding from a few minutes up to 24 hours. Also known as a “TIA”, this is a major warning sign of a Sudden vision changes potential full stroke.

Sudden headache

Sudden loss of balance

Risk Factors

Non-Modifiable Factors Modifiable Factors Stroke in Aboriginal Populations (Meaning they cannot be controlled) (Meaning they can be controlled) Research has shown that Canadian Definitions 1. Age Aboriginal people are twice as - Although stroke can occur 1. High Blood Pressure Stroke - A stroke is a brain attack. It at any age, most strokes affect likely to die from stroke (71.5 per (also known as Hypertension) occurs when blood flow to the brain people aged 65 and older. 100,000) when compared with the is interrupted or when a blood vessel general Canadian population (34.2 ruptures. Cells in and around the stroke 2. Gender - Until women reach per 100,000). Aboriginal people are site begin to die and part of the brain menopause they have a lower risk of also more prone to obesity with a 2. Lack of Physical Activity stops working. Basic functions, such as stroke than men. As time goes on, risk just over 1.5 times that of the communicating, walking, thinking, and more women than men die of stroke. general population. Furthermore, the personality, may be changed. rate of diabetes among Aboriginal 3. Family History - Risk of a stroke is Ischemic Stroke - Ischemic stroke people in Canada is three to five higher if close family such as parents, 3. Overweight times that of the general population is caused by an interruption in the sisters or brothers have had a stroke (HSF, 2010). Consequently, it is flow of blood to the brain (as from a before the age of 65. important to understand not only clot blocking a blood vessel). 4. Family Background the warning signs for stroke, but - First Nations, Hemorrhagic Stroke - A Inuit or Métis are more likely to have also the risk factors for stroke and hemorrhagic stroke is a stroke high blood pressure and Type II 4. Smoking the impact of stroke on the person, caused by the rupture of a blood diabetes, and as a result are at greater their family and the community. This vessel with bleeding into the tissue risk of heart disease and stroke than information presented below has of the brain. the rest of the population. been independently researched, written and reviewed by the Heart 5. Prior heart attacks, strokes or TIAs 5. Diabetes and Stroke Foundation (2010, 2010a) and is based on scientific evidence.

26 A Guide for Working with Aboriginal People of Northwestern Ontario A Stroke Resource for Healthcare Providers 27 Section 4: Stroke Information and Best Practices GLOSSARY OF TERMS Canadian Best Practice Aboriginal Community: A group of child development, biology, genetic Recommendations for Stroke Care Aboriginal people who share similar endowment, health services and beliefs, traditions and cultural identity. gender. These health determinants The Canadian Stroke Strategy The updated Best Practice Recomm- These groups exist through shared come together to help people evidence-based Canadian Best endations 2010 content focuses on: political, cultural, spiritual and /or and communities reach a state of Practice Recommendations for other affiliations. complete physical, mental and social • Public Awareness of Stroke Stroke Care are intended to help Band: A body of Indians for whose well being. Because all of these • Prevention of Stroke reduce practice variations and collective use and benefit lands have determinants of health are linked close the gaps between evidence • Hyper acute Stroke Management been set apart or money is held by together, many people experience and practice. The purposes of the specific or structural challenges to • Acute Stroke Management the Crown, or declared to be a band recommendations are to ensure for the purposes of the Indian Act. accessing equitable health services that stroke care continues to reflect • Stroke Rehabilitation Each band has its own governing band and resources. They may lack access contemporary stroke research for many reasons such as poverty • Managing Stroke Care Transitions council, usually consisting of one Chief evidence and expert opinion. and several councillors. Community or homelessness and/or racism or • Cross-Continuum Topics in members choose the Chief and discrimination. Stroke Management councillors by election, or sometimes First Nation: A term that came through custom. The members of a into common usage in the 1970s These guidelines can be found on-line at: www.strokebestpractices.ca band generally share common values, to replace the word “Indian,” which traditions and practices rooted in their some people found offensive. ancestral heritage. Today, many bands Although the term First Nation is Prevention Clinics and Tele-Stroke prefer to be known as First Nations. widely used, no legal definition of Sites in NW Ontario Cultural Sensitivity: Cultural it exists. Among its uses, the term Sensitivity is getting to know and “First Nations people” refers to the City/Area Hospital Address Type Website understand other cultures and Indian people in Canada, both Status and non-Status. Many communities North Western perspectives. It involves recognizing also use the term “First Nation” Thunder Bay 201 - 980 Oliver Road Ontario the lived experiences of all people, Regional Thunder Bay, ON, Regional Stroke in the name of their community. Thunder www.nwostroke.ca including aspects similar and different Health P7B 7C7 Network Currently, there are 615 First Nation Bay Sciences 807-684-6702 to our own and that our actions affect Stroke communities, which represent more Centre 807-684-6700 prevention other people. clinic than 50 nations or cultural groups Determinants of Health: In 1948, 28 Peninsula Road and 50 Aboriginal languages. Stroke Wilson Memorial P.O. Box W the World Health Organization prevention www.wmgh.net Inuit: Inuit are the Aboriginal people General Hospital Marathon, ON P0T 2E0 (WHO) declared that more than 807-229-1740 clinic of Arctic Canada. About 45,000 Inuit the absence of disease, health is, “a Stroke live in 53 communities in: Nunatsiavut Lake of the 21 Sylvan Street West state of complete physical, mental prevention (Labrador); Nunavik (Quebec); Woods District Kenora, ON P9N 3W7 www.lwdh.on.ca and social well-being and not merely Hospital 807-468-9861 clinic Nunavut; and the Inuvialuit Settlement Telestroke site the absence of disease or infirmity.” Region of the Northwest Territories. In 1998, Health Canada developed a Riverside Stroke Each of these four Inuit groups have 110 Victoria Avenue http://riverside NW Health Care prevention list of social factors and conditions Fort Frances, ON P9A 2B7 healthcare.ca settled land claims. These Inuit regions Ontario Facilities, Inc. 807-274-3266 clinic that lead to healthy people and Telestroke site cover one-third of Canada’s land communities called determinants 1 Meno Ya Win Way mass. The word “Inuit” means “the Sioux Lookout Stroke of health. These factors include P.O. Box 909 Meno Ya Win prevention www.slmhc.on.ca people” in the Inuit language called, Sioux Lookout, ON P8T 1B4 culture, social support, education, Health Centre clinic 807-737-2877 literacy, income, employment and Inuktitut and is the term by which Inuit refer to themselves. The term P.O. Box 3003 working conditions, social and Dryden Regional 58 Goodall Street Telestroke www.dh. physical environments, personal “Eskimo,” applied to Inuit by European Health Centre Dryden ON P8N 2Z6 site dryden.on.ca explorers, is no longer used in Canada. 807-223-8200 health practices, coping skills, health

28 A Guide for Working with Aboriginal People of Northwestern Ontario A Stroke Resource for Healthcare Providers 29 GLOSSARY OF TERMS The Human Body Métis: Metis are one of three Treaty Indian: A Status Indian who Use this image as a recognized Aboriginal people in belongs to a First Nation that signed guide to show various Canada, along with the Indians a treaty with the Crown. body parts and their relationships to one (or First Nations) and Inuit. Indian status: An individual’s legal another. The use of Approximately one third of all status as an Indian, as defined by the this type of tool may Aboriginal people in Canada identify Indian Act. be of particular benefit themselves as Métis. Census data to individuals who are from 2006 shows Métis as the Reserve: Tract of land, the legal title visual learners. Aboriginal group that experienced to which is held by the Crown, set the highest growth at 91%, reaching apart for the use and benefit of an 389,785 people. Indian band. Status Indian: A person who is Tribal council: A regional group of registered as an Indian under the First Nations members that delivers Indian Act. The act sets out the common services to a group of requirements for determining who First Nations. is an Indian for the purposes of Wholistic: Rather than “holistic”. the Indian Act. Many residential school survivors view Non-Status Indian: An Indian person the term “holistic” as holy and may who is not registered as an Indian have bad feelings about the term. under the Indian Act. They view the term “wholistic” as the “whole” body and all encompassing.

30 A Guide for Working with Aboriginal People of Northwestern Ontario A Stroke Resource for Healthcare Providers 31