Northern Public Affairs

August 2020 Volume 6, Special Issue 3

Changing NWT’s health system to improve Indigenous health outcomes DEBBIE DELANCEY

Perspectives on health research in the NWT PERTICE MOFFITT

Evaluating on-the-land programs MARY OLLIER & OTHERS

Training Tłįchǫ citizens in community-based research SOPHIE ROHER & Hotıì ts’eeda ANITA DANIELS-BLACK Working together Cultural safety through Indigenous digital storytelling SHELLEY WIART for good health

Community-university partnerships Research, resurgence, and Indigenous health for research and action DR. DONNA MAY KIMMALIARDJUK ANDREW SPRING & OTHERS LIANNE MANTLA-LOOK on community nursing Reviving the Įdaà Trail with TOM ANDREW, & JOHN B. ZOE What happens after the diamonds? REBECCA HALL An interview with KIMBERLEY FAIRMAN on knowledge translation and community health research DR. SANGITA SHARMA discusses community-based health research Canada $9.99 SAFE ON THE LAND

Artist: Melaw Nakehk’o

FOR MORE INFORMATION: HSS.GOV.NT.CA CANADA.CA/CORONAVIRUS Northern Public Affairs August 2020

Hotıì ts’eeda – Working together for good health 6 Dr. Stephanie Irlbacher-Fox

Research, resurgence, and Indigenous health 8 Dr. Donna May Kimmaliardjuk

ICHR’s Kimberley Fairman on knowledge translation and community based 12 approaches to health research Rachel MacNeill

Community research, community priorities: An interview with Dr. Sangita Sharma 15 Rachel MacNeill

Reviving the Įdaà Trail: Interview with Tom Andrew and John B. Zoe 19 Jessica Simpson

Dene Heroes: How the Sahtú is strengthening literacy and leadership 23 Jessica Simpson, with files from Mary-Anne Neal

Bridging the gap between two world views: Perspectives of an Indigenous nurse 25 Lianne Mantla-Look FEATURES

Changing the system: Improving Indigenous health outcomes in NWT through policy and practice 29 Debbie DeLancey

Conducting research in the Northwest Territories: Perspectives from a health 39 and social science researcher Pertice Moffitt

Project Jewel: Innovation in evaluating an on-the-land program 45 Mary Ollier, Audrey R. Giles, Meghan Etter, Jimmy Ruttan, Peggy Day, Nellie Elanik, Ruth Goose, Esther Ipana, Sarah Rogers,Evelyn Storr, Francine Darroch, & Tricia McGuire-Adams

Strengthening health and wellness through community-based research in the Tłįchǫ region 51 Sophie Roher & Anita Daniels-Black

Decolonizing health care: Indigenous digital storytelling as pedagogical tool for 55 cultural safety in health care settings Shelley Wiart

Building community-university research partnerships to enhance capacity for 63 climate change and food security action in the NWT Andrew Spring, Kelly Skinner, Sonia D. Wesche, Jennifer Fresque-Baxter, Meghan Brockington, Gina Bayha, Warren Dodd, Jessica Dutton, Myriam Fillion, Tiff-Annie Kenny, Brian Laird, Alex Latta, Jullian MacLean, Kaitlyn Menard, Sonja Ostertag, Mylene Ratelle, Melaine Simba, & John B. Zoe

After the diamonds: “Blue sky” visions 68 Rebecca Hall This special issue of Northern Public Affairs was produced in partnership with:

This issue of Northern Public Affairs is distributed with the support of: Northern Public Affairs Volume 6, Special Issue 3 August 2020

Founding Editorial Team Joshua Gladstone Sheena Kennedy Dalseg Jerald Sabin

Managing Editor Joshua Gladstone

Guest Editors Stephanie Irlbacher Fox Rachel MacNeill

Editorial Team Stephanie Irlbacher-Fox Rachel MacNeill Jessica Simpson

Layout and Production Mark Finn

Copy Editing Alex Merrill

COVER IMAGE: By Amos Scott

LETTERS TO THE EDITOR: Letters should be sent with the writer’s name, address, and daytime phone number via email to [email protected], or by mail to Northern Public Affairs 57 Balsam St., Ottawa, ON CANADA K1R 6W8. Letters may be edited for length and clarity, and may be published in any medium. All letters become property of Northern Public Affairs and will not be returned.

VOLUME 6, SPECIAL ISSUE 3, August 2020. NORTHERN PUBLIC AFFAIRS (ISSN 2291-9902) is published three times a year by Northern Public Affairs.

NORTHERN PUBLIC AFFAIRS IS A TRADEMARK OF NORTHERN PUBLIC AFFAIRS. COPYRIGHT © 2020 NORTHERN PUBLIC AFFAIRS. ALL RIGHTS RESERVED. PRINTED IN CANADA. INTRODUCTION Hotıì ts’eeda – Working together for good health

Dr. Stephanie Irlbacher-Fox

his special issue of Northern Public Affairs on Department of Medicine’s Global and Indigenous Working Together for Good Health is pub- Health Research Group. lishedT in partnership with Hotıì ts’eeda. “Hotıì ts’eeda” (pronounced Ho-tee’ t’say-dah) Hotıì ts’eeda is funded by the Canadian In- in the Tłı̨chǫ language roughly translates into: stitutes of Health Research Strategy for Patient working together for good health, in a way that we Oriented Research (SPOR), and is one of 11 such leave each other in a state of grace. health research support units in each province In the NWT, Indigenous Peoples have suffered and the NWT (with Yukon and Nunavut units in a long history of overcoming colonization and its planning stages). SPOR SUPPORT (Support for impacts. As an organization, Hotıì ts’eeda involves People and Patient-Oriented Research and Trials) patients in health research primarily by building units are meant to promote and establish best prac- health research capacity with a focus on Indige- tices and their uptake, by involving patients in all nous Peoples and communities, in ways that build stages of health research, and ensuring that health on Indigenous strengths. research results make it into the hands of health Themes explored in this issue include how to policy makers. build trust between Indigenous communities and In the provinces, SPOR SUPPORT Units look the health system. Building trust requires working and function differently from Hotıì ts’eeda: Those in a way that supports Indigenous reclamation of units focus mainly on health research being done in Indigenous governance and control of health re- hospitals or by scientists, health sciences research- search, acknowledging and valuing Indigenous ers and medical practitioners, and in the context knowledge and methods, and changing common- of larger scientific and Western medical initiatives. place and harmful approaches to conceptualizing, The provinces have significant physical infrastruc- interpreting, and deploying research in ways that utre (hosptials, univerisites) and health researchers are harmful to Indigenous Peoples and commu- and professionals, as well as university students nities. It means transforming research paradigms involved in unit activities. In the NWT, only four grounded in non-Indigenous perspectives, values, communities have hospitals, and there is no uni- and priorities that emphasize deficits, and instead versity. The context for doing research, and doing supporting research that builds on Indigenous cul- research in a good way, is completely different. tures and realities, recognizing them as strengths. Hotıì ts’eeda is the only SPOR SUPPORT Too often the stories we hear about Indigenous Unit in Canada that is hosted by a self-governing health and Indigenous Peoples highlight deficits. Indigenous government, the Tłı̨chǫ Government. Programs and services often require Indigenous It is the only one with a governing council made Peoples to change to fit into what is being offered. up of a majority of Indigenous governments work- Hotıì ts’eeda’s partners and Governing Council ing together toward a vision that sees building have been clear: this organization is one that must health research approaches and health research meet Indigenous people where they are at, and it capacity with a focus that incorporates Indigenous must recognize and build on the strengths in Indig- knowledges and ways of knowing. The Governing enous communities. This is an orientation of re- Council of Hotıì ts’eeda includes representatives spect, and it is in contrast to approaches that mar- of the Tłįchǫ Government, the Inuvialuit Region- ginalize Indigenous Peoples. al Corporation, the Gwich’in Tribal Council, the The name of our organization is also our mis- Délı̨nę Got’ı̨nę Government, the Government of sion: To establish norms in health research where the Northwest Territories Department of Health the work undertaken and accomplished is done in and Social Services, and the University of Alberta a way that researchers and their partners, commu-

6 Northern Public Affairs, August 2020 nities and policymakers, organizations and funders This special issue highlights examples of ex- leave each other in a state of grace. That is the cellence and innovation, where communities are foundation of any good relationship: Respectful leading the way on their health priorities and collaboration that lays the ground work for a con- partnerships are being created that embody the text of trust and ongoing relationship. Colonization meaning of working together for good health. and colonial approaches to research leave no one Some examples describe areas where more needs in a state of grace. Dominant-subordinate power to be done, and others highlight where momen- relations, in whatever context they are found, leave tum is growing across the NWT. The intention of no one in a state of grace. Working respectfully, in this volume is to provide readers with a deeper partnership, and in ways that create spaces for In- understanding and appreciation for the impor- digenous control and decision making, is central to tance of Indigenous cultural resurgence as a ba- Hotıì ts’eeda’s mandate. sis for good health. And an appreciation of the Some of the contributions in this volume are importance of working together in ways that sup- drawn from keynote addresses to partners at- port wellness for all individuals and communities tending Hotıì ts’eeda’s annual Ełèts’ehdèe which in the Northwest Territories. Y was held on Chief Drygeese traditional territory of the Yellowknives Dene in May 2019. The Stephanie Irlbacher-Fox is the founding Scientific Direc- Ełèts’ehdèe (Tłı̨chǫ for “Gathering,” and pro- tor of Hotıì ts’eeda. Stephanie grew up in Inuvik, NT, nounced Eh-chhlet’s -ay-day) is a central part of graduating from Samuel Hearne Secondary School. She Hotıì ts’eeda’s governance, modeled on annual went on to earn a BA and MA in Political Science at the gathering of NWT Indigenous peoples as a way University of Alberta, and received a PhD from Cam- to provide in-person accountability in a context bridge University during 2005, where she was a Ma- of reciprocity and relationship. At the Ełèts’eh- jor Scholar at Magdalene College during her studies. She dèe, researchers, cultural knowledge holders, El- is the author of numerous academic books and articles, ders, and Indigenous experts gather to share their including Finding Dahshaa: Self Government, Social stories and best practices, receive Hotıì ts’eeda’s Suffering and Aboriginal Policy in Canada (UBC Press, oral annual report, and provide direction on pri- 2009), a standard text in Indigenous Studies programs orities for the upcoming year. The contributors at many Canadian universities. For the past two decades in this volume embody approaches to Indige- Stephanie has worked for Indigenous Peoples’ organiza- nous health that are based on honouring the re- tions across the NWT on treaty negotiations and treaty surgence of Indigenous culture and Indigenous implementation. She has a long-standing interest in the strengths. The work they do is a testament to the effects of government policy choices for social determinants potential of Indigenous Peoples to redefine their of health. She is an Adjunct Professor at Carleton Univer- present and futures, in the face of both historical sity’s School of Public Policy and Administration. and ongoing colonization and its impacts.

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Northern Public Affairs, August 2020 7 NORTHERN VOICES Research, resurgence, and Indigenous health

Dr. Donna May Kimmaliardjuk

“Research, Resurgence, and Indigenous Health” was a public thing that resonates with me on a personal level as speaker event held on May 22, 2019 at the Northern Arts it has been my guiding mentality in my life. As we and Cultural Centre in Yellowknife, Northwest Territories, look at how Indigenous culture and health inter- Chief Drygeese traditional territory of the Yellowknives Dene. sect, I really do think it is the new mantra of the The event was part of the 2019 Hotii ts’eeda Elets’ehdee 21st century. Because if you were to ask the gener- Gathering, hosted by the Tlicho Government. It focused on the al Canadian population or maybe even some folks ways that Indigenous culture and health intersect, and how the in here, “In what ways do Indigenous culture and transformative effects of strengths-based approaches to Indig- health intersect?” or ask Canadians to give exam- enous health and health research could be realized. Dr. Donna ples of how they do [intersect], I hate to say that I May Kimmaliardjuk from the University of Ottawa Heart wouldn’t be surprised to hear if people would say Institute and the first Inuk heart surgeon, was keynote speaker. or give examples of: the statistics of TB rates are The following is an edited transcript of her speech. 290 times higher in Inuit in Nunavut compared to the rest of the country, or the suicide rates for ood evening. Thank you and qujannamiik, Inuit men in Nunavut are nine times higher than how we say in Inuktitut, for having me speak that of the international average. Or, you would hereG tonight. It really is a pleasure to be here. It’s my even get responses from some people that are, first time coming to Yellowknife, and to be able to quite frankly, racist: the drunk native, you’re all spend yesterday and today speaking with youth in drinking and drunks and substance abuse and the community and community members and really mental health problems, or still the number of learning and listening to peoples’ stories and shar- reservations that have drinking water advisories. ing has been really, really special. As you’ve heard, There are all these negative connections between my name is Donna May Kimmaliardjuk, and I’m Indigenous culture and Indigenous people and a physician. I’m still technically in training to be a health. But I would argue that out of these same board-certified heart surgeon, but that’s what I do Canadians that would give these examples, proba- every day, heart surgery. I’m Inuk – that’s singular bly very few of them also realize that these health for Inuit, for those who don’t know. From Ottawa, statistics and the current state of our health are but as mentioned, I’m originally from Chesterfield direct results of colonization. Of the relocation Inlet in Nunavut. Being recognized as “the first” of and placing people into artificial settings in newly this, that or the other, has really come with some established communities far from their traditional amazing platforms to be able to share my story and territories. Of residential schools. Of intergener- speak with people and go to Parliament and Senate ational trauma. Of how our ancestors’ lives were and the House of Commons and meet really im- forcibly changed out of harmony and into disar- portant folks in the country. I must admit, I do suffer ray. And this is as recent as just one generation from imposter syndrome. Especially at times like this ago. I mean, my mother went to residential school where it’s like, “Okay, they want me to speak, but and believe you me, I have felt and suffered the who wants to listen? What do I have to say?” Espe- consequences of that. cially because I’m very early in my career, that’s a And so, when I think about our current state comment I get from a lot of people. I look younger of health and where we’ve come from or what the than I am and I feel older than I am. But nonethe- past has been, I have this analogy in mind that less, here I am tonight and here you are. I’ve had for a few years and never really shared it. When asked to come and speak tonight, I was I tried to Google search it and I don’t think any- looking at previous talks and previous themes, and one’s published on this, so I really hope no one’s I saw that the theme for this year’s gathering is ever heard this analogy before. Bear with me, be- Building on Strengths, which I love. That’s some- cause when I told my partner who’s non-Indig-

8 Northern Public Affairs, August 2020 enous what I was going to be talking about, he a parasite, they quickly took over and multiplied, said, “Oh my God, you can’t be talking about infecting the functionality of the healthy hosts, that, that’s way too radical, what if you get quot- our communities. Quickly using up the host re- ed saying this?” And I said, “I’m fine with that.” I sources, literally using up our resources, and de- think I can explain it out, so bear with me. It’s my stroying the normal function of the host. Weaken- analogy of how I think about our current state of ing it and taking its nutrients. This is exactly how health and what’s happened. a parasite works. The host Indigenous peoples, Let’s go back to colonization because that’s Indigenous cultures and communities have been when things all got changed, right? When we look sick. And it takes time to recover from that. It at colonization and the Europeans, or specifically doesn’t just happen overnight. It doesn’t just hap- the British, let’s say, that came over here to Turtle pen within a generation. But I do think that the Island, it is analogous to a parasite infecting a host host is slowly and surely adapting to the parasite body. As a physician, I think of things very clin- and evolving to function with it. And I carefully ically and so once I learned about parasites and chose the word “adapt” here rather than “fight,” infections in medical school I thought, “Oh my because I think fighting it has been futile and I Photo credit: Amos Scott Photo credit:

God, this is what has happened to our country.” do think it will continue to be futile. Maybe not I don’t know if anyone’s heard this, but hopeful- in the future, maybe we’ll fight this parasite, this ly it will make sense. And please, please, please, I colonization and totally go back to the way things do not want anyone leaving this talk and saying, were, one, two, four, five hundred years ago, but “Well, Donna thinks Europeans are parasites” – realistically I don’t think that’s going to happen – that’s not the point, I have nothing against Eu- I mean, I love having my smartphone, and my car ropean people themselves. I’m talking about the and the modern amenities of today. So, we adapt. actual migration of people from Europe leaving And so, for communities to become healthy again, their natural host environment, coming to an un- we turn to our immune cells. Just like when you’re known environment and taking over. And so they sick with an infection, a virus, a parasite, your im- came to a foreign environment, a healthy host – mune cells turn on. So, what is that? Those are our communities, our lands were healthy. And like the tools we have to enable our body, our commu-

Northern Public Affairs, August 2020 9 nities, to be strong and healthy. Using what is in- We, as Indigenous people, are so fortunate grained in us, which is our culture, our language, that we come from cultures that are family-ori- our ceremonies, our families and communities. To ented and are rooted in community, because give us strength and allow us to cope with this par- that, too, greatly has an impact and improves our asite. And then I think of the use of antiparasitic health and well-being. Again, what we’ve known agents, or something like antibiotics as our allies. for millennia – that we need to take care of our These are the non-Indigenous Canadians who Elders and have them involved in community and “get it.” Who understand reconciliation. Who are family, what we’ve known, Western medicine is there to advocate for our rights and fight for our only now realizing and publishing about it. For rights. And have the goal of helping us. So this is example, it’s been published a lot that when you how I have seen colonization by the Europeans, look at elderly folks, those that are well connect- by the British, in my mind. I think it sets the mind ed to their family or to their community and are frame to understand how and why our communi- involved in social activities and get out of their ties have been suffering. Why people are unwell, room or get out of their house and see people live and why we aren’t 100% well yet. longer compared to folks who are socially isolated, With this in mind, thinking about today, I do alone in the nursing home and don’t have visits see Indigenous culture and health on the mend, with people – they don’t live as long. Or for people on the upswing. It’s far from perfect and there’s who are affected by chronic illnesses, those who a long way to go. I mean this parasite got us so are involved in their community and are well sup- sick, we were in the intensive care unit. We were ported by their family do better than those who on the brink of death and have been sick for so don’t have that. So Indigenous culture and being long that the recovery is going to be just as long connected to it is vital to our well-being and to if not longer. But as we reclaim our cultures, we our health. can shift our energies and our focus from solely When I was asked to speak tonight and to on the negatives or solely on just surviving, and speak to the ideas about what the transformative change it to recovery and regaining our strength effects of strengths-based approaches and un- and even thriving with rich culture. Taking things derstandings of Indigenous health and health re- into a bit of a more positive light perhaps, what search mean, or examples of that, I first thought, we’ve known as Indigenous cultures – what we’ve “What the heck does that even mean?” That’s known forever – is that health is about wellness, such a long thing that I had to break this down not illness. In Western medicine we are so focused and I’m sitting there like, “Oh my God.” So, I on illness and on a diagnosis. I’m a heart surgeon. did a Google search. Thank goodness for Goo- I’m focused on the heart, focused on the block- gle. What do strengths-based approaches mean? ages and focused on the diabetes, the obesity, the I’m going to share it with you, because I hope kidney problems, the diagnosis. Too often we for- I’m not the only one who didn’t know what that get that we aren’t just treating a disease or a diag- means. Google told me that it’s a type of positive nosis but we’re treating a person. A person, which psychotherapy and counselling that focuses on includes not only the physical ailment but also the your internal strengths and resourcefulness and mental, emotional and spiritual health. Our El- less so on your weaknesses, failures and short- ders, our connections to our cultures, to our land, comings. It also sets up a positive mindset that have taught us this. We’ve known this forever. And helps you build on your best qualities and im- I do think Western medicine is finally now catch- prove resilience. And I found that a listed benefit ing on to this. I was taught in medical school just of strengths-based approaches is to look at how a few years ago that when you see a patient you systems are set up, especially where power can have to see the patient as a person. What a radical be out of balance between the system and the thought, that you have to see them as a person. people it’s supposed to serve. So, all in all it’s There is this slow shift, or even a push, in med- a healthy coping mechanism if you think about icine to focus now on wellness. This is what we it. And I feel like the wise people that I’ve met call in health care primary prevention, which is in my life, my parents, grandparents, Elders, making sure the person is well and taking care of they’ve taught me this, to use this mindset when themselves so that you prevent [them from] get- I’ve been going through something difficult in ting sick with diabetes or heart disease or stroke or my life. And I think this is something that our you name it. So, we’re now trying to ensure that communities and cultures are focusing on now we’re making our patients healthy and well. too, and this is completely demonstrated by the

10 Northern Public Affairs, August 2020 cultural programming and services initiated by are they struggling with, what do they need more Indigenous communities and being offered by of ?” Asking those questions and doing the re- Indigenous communities. The resurgence of search to find out, and putting that information practicing our culture, of being connected to out there, the public can then be informed about our traditions, being connected to our land, are the illness that has been present: colonization examples of strengths-based approaches to im- and its effects. And can be informed about the proving our health and well-being. The host, the positive changes that are occurring. Indigenous peoples and Indigenous communi- Today I was at the youth engagement session, ties, is using its strong immune cells, our culture, and met with young women in their late teens languages, traditions, ceremonies, focusing on and early 20s and heard about all this program- the positive – the strengths – to improve. On a ming that’s going on throughout the territory and grander scale, as I think about that question some other provinces that are getting folks and young more, the question also becomes how do we get people connected back to their land and getting others, non-Indigenous Canadians, to transform them connected with Elders, amazing program- their views, to view us in strengths-based ways? ming coming out and the positive effects it is Because we know we have strengths, and often having on our people – get that out there so that when they say truth and reconciliation, [it’s] like: non-Indigenous Canadians can learn about that “What do I have to reconcile? I didn’t do this.” and they can see what they can do as allies. You It’s the white people that need to reconcile, they can get them engaged, get them encouraged, get need to learn, so how do we change that? How do buy-in. But without any of that knowledge, it is we get their views to change from viewing us as impossible to act. And so, moving forward, what stereotypes, or from seeing news stories of poor I see or what I hope for is a strong connection be- Indigenous health outcomes, not as an annoying tween Indigenous culture and health, with buy- news story but as something that’s relevant and in from the systems that serve us, which [are] important to them? How do we get them to have government, health care, programming. Not just buy-in and see that the current system set-up, i.e. buy-in but implementation of Indigenous values, government health care, provincial and federal, ways and culture into the services being provid- FNHIB [First Nations and Inuit Health Branch], ed and also having Indigenous values reflected that they’re not adequately helping the people in our health research. My hope is that the host that they’re meant to serve, which is us? How do (our communities and people) regains our health we get folks to feel engaged and encouraged by with an increase in our immune cells (our cul- the strengths and resiliency of Indigenous Cana- tural practices, traditions and languages) and dians, to focus on creating positive outcomes, to anti-parasitic agents (our allies in government be our anti-parasitic agents? I mean that’s a big, and health care) to come together and get to that big question, and I think it’s where we are now level of what we call in science “homeostasis” – and I definitely do not have all the answers. But that term for balance, for well-being, that things I do think the first step is knowledge. are right. Knowledge is power. As cliché as that sounds, So, thank you so very much for listening to it’s cliché for a reason – because it’s true. So, by me speak tonight. It’s a huge, huge topic to talk continuing to do Indigenous health research, to about and I feel like I’ve perhaps just skimmed increase the number of our Indigenous scientists, the surface, but I hope that I’ve gotten the juic- social scientists, researchers, doctors, to increase es flowing, those brain juices flowing and think- the amount of quality research done by Indige- ing and perhaps set the stage for the rest of the nous Canadians about Indigenous Canadians is speakers to really dive into some of these topics the first step. Or if it’s research that’s not being in great detail and get you guys engaged and ex- done by Indigenous Canadians, have us involved cited about Indigenous health and research. Y in the ethics review and in the protocol and in the dissemination and writing of the papers. Dr. Donna May Kimmaliardjuk is Chief Resident Cardiac Have the research done in a way that reflects Surgery at University of Ottawa Heart Institute and Can- the values and the needs of the people that are ada’s first Inuk heart surgeon. being researched. And so, having the research out there, looking at and asking these questions, “What are their needs, what are the top three priorities for this community to be healthy, what

Northern Public Affairs, August 2020 11 IN CONVERSATION ICHR’s Kimberley Fairman on knowledge translation and community based approaches to health research

Rachel MacNeill

he Institute of Circumpolar Health Re- also governed by a board where all members are search (ICHR) has been conducting com- from or live in the NWT. I think that Northern munity-basedT health research in the NWT since leadership is critical to the way we run. 2006. ICHR works with partners across the North Our list of partners has grown over the years on community health and wellness concerns and to include community governments, the terri- drawing connections between local issues and torial government, and regional governments. global public health realities. The organization is Having all these people at the table is always a also dedicated to knowledge translation, or put- nice thing to see. What strikes me about ICHR is ting knowledge into action to improve peoples’ that we provide leadership in the health research health and wellness. Hotıì ts’eeda’s Rachel Mac- area primarily through these partnerships, which Neill sat down with ICHR’s Executive Director allow us to understand community issues. That Kimberly Fairman to chat about the organiza- understanding allows us to advance Northern pri- tion’s unique approach to community-based re- orities. My point is that sometimes governments search and knowledge translation. develop programs based on their understanding of the issue, which doesn’t always align with what Rachel MacNeill (RM): What is knowledge the communities think the priorities are. By being translation? that central organization that works with every- Kimberley Fairman (KF): Knowledge transla- one, we’re able to find those areas where there is tion is when research results are used to impact synergy, find a common language and help people programs, policies and practices to improve indi- understand the links between their priorities and vidual and community health. Knowledge trans- other issues. That’s knowledge translation. We lation can include things like systematic reviews, provide a lot of leadership in those areas. practice guidelines, policy advocacy, or raising public awareness. A key part of knowledge trans- RM: How did you get involved in conduct- lation in community-based research is ensuring ing research? that community members are involved in the re- KF: I was trained as a nurse 25 years ago. As a search at every stage, from defining the program Nunavummiut nurse, from Inuvik, I struggled with to analyzing the data. This ensures that the re- being an Indigenous care provider in the health search is relevant to the community and its con- system. I was at the intersection of two different cerns. ways of seeing health and wellness, and wasn’t sure that my work was necessarily supporting the RM: What do you think makes ICHR so goals of Indigenous peoples around health. So, I successful in conducting community-based moved into working in policy, on Indigenous land research across the NWT? claims with the federal government. Some of my KF: ICHR stems from a few dedicated North- work involved social determinants of health, and erners who saw a gap in, or should I say a com- I was exposed to the policy and legislative mecha- plete absence of, Northern health-based research nisms that make the government function. capacity. They conducted a number of consulta- The bottom line, as I saw it, is there’s a lack of tions in all the Northern regions, which continue good evidence to support the kinds of programs to this day, where we ask communities about spe- and policies that we need to bring Northerners, cific and general health issues to make sure we’re especially Indigenous Northerners, the services targeting our work effectively. The organization is they need. These services are embedded in broad

12 Northern Public Affairs, August 2020 policy decisions and frameworks like the Canadi- tions. That’s where I see that I can make a real an Constitution and the Health Act. So in conver- contribution. There’s still a shift happening in sations with Susan [Chatwood, Scientific Director that definition of what is research, and that’s a of ICHR], I became really interested in the idea really exciting place to be working. of health systems research. Even now, I consider Community-based research methods work. myself more of a community Indigenous person It’s critical for us to ensure that the work we do who plays a role on a research team, rather than has tangible benefits in communities. Operation- as a researcher. I bring my perspective on how to ally and administratively, we use memorandums ask questions in a better way, how to determine of understanding with regional or community or- underlying values behind behaviours, and things ganizations to set out what the relationship looks like that. I see it as a knowledge translation role. like from the beginning. These agreements set out an ethical framework for how we do our work, so RM: How does ICHR put Indigenous com- that we ensure the relationship comes first. Then, munities and priorities first? and only then, we define the project. That way, KF: I’ve seen over the past decades an in- we’re partners in more than just name. We de- creasing acknowledgment of the critical impor- fine the question together, then talk about differ- tance of Indigenous people setting the agenda, ent ways we could approach it to find answers. and recognition of the legitimacy of Indigenous It’s truly an iterative process. We have to be really knowledge systems and ways of maintaining those flexible and creative. knowledge systems. There is a real need to recog- At the end of the project, we follow the com- nize that contribution on an equal level to more munity’s lead. Sometimes, when working with classical Western research methods and organiza- governments, there can be a tension between Photo credit: Amos Scott Photo credit:

Northern Public Affairs, August 2020 13 what comes out of the research and what people as sophisticated and valuable as academic and in- want to hear. So we have to walk that line between stitutional ways. That reminds me of work that’s research and advocacy, depending on what the is- been done on ethical space, specifically Willie Er- sue is. Research results have implications, and it’s mine’s work. Certain institutions have so much important that all sides understand what is going power in legitimizing knowledge systems, and it’s to come out of the research in terms of recom- all coming to a head now in a constructive way. mendations at the outset. People are recognizing that other systems are both valid and actually add another dimension of un- RM: What more needs to be done? derstanding. It’s uncomfortable for people, but I KF: One of the biggest barriers to having think it’s a necessary next step. meaningful partnerships and effective community-based research is the focus on publication in the RM: What’s next for ICHR? academic world. For example, this summer ICHR I can’t see into the future, but I know one key had summer students working on a project that area of focus for us coming up is training and edu- included a literature review. In a classical sense, cation with the view of increasing research capac- there’s a formal way to do a literature review, with ity in the North. We’re thinking about opportuni- set steps and a way to present your findings. But ties to get Northerners into the roles of students, the reason that our team was undertaking this lit- researchers and faculty members, towards the erature review was so the community could un- broad objective of enhancing Northern capaci- derstand the links to some of the issues they had ty for research. We’ll also be focussed on build- identified. To present that in a published article ing more partnerships and promoting traditional of classic review wouldn’t have been helpful to the knowledge and methods to visiting students and community, so we looked at other ways to present researchers. The ultimate goal for us is to ensure the information that would be more appropriate. that those we work with come away with a full However, for researchers working in the academ- understanding of the importance of traditional ic world, it’s critical to publish. That’s how they knowledge and methods, and what they can bring legitimize their methods and their findings. The to understandings of health and wellness. Y current system produces students and researchers who need to publish in order to succeed. But that Rachel MacNeill is Communications and Knowledge doesn’t always fit with the community need, which Translation Advisor for Hotıì ts’eeda is a challenge. Linked to this is another point – that communities have legitimate knowledge systems and ways of maintaining those knowledge systems that are

14 Northern Public Affairs, August 2020 IN CONVERSATION Community research, community priorities: An interview with Dr. Sangita Sharma

Rachel MacNeill

esearcher Dr. Sangita Sharma, head of the knowledge and perspectives on consulting with University of Alberta Indigenous and Glob- communities, navigating local cultures in a re- alR Health Research Group, has been conducting spectful and appropriate manor. We’re also trying circumpolar public health research for the past to take the university out of the four walls of the 20 years. The group’s research programs touch University of Alberta, and bring that knowledge, on diverse subjects, but each has community commitment and enthusiasm to the Arctic. We’ve health concerns and priorities as a guiding prin- encouraged students, faculty and policy-makers ciple. Hotıì ts’eeda’s Rachel MacNeill sat down from the south to experience the North, exposing with Dr. Sharma to learn more about how she southerners to culturally-appropriate research sets her research priorities. methods and ways of knowing. It’s more than doing research, it’s mentorship and listening to the Rachel MacNeill (RM): You were working community. That’s something that’s not measur- all over the world and based in Hawaii be- able, but is so important. fore you narrowed your focus to Northern And it’s a reciprocal relationship – we’re ac- Canadian research. How did that come knowledging and integrating what the Arctic and about? Indigenous communities see as important into Dr. Sangita Sharma (SS): I was traveling our research programs. Through our partner- around the world, doing research in multiple ships and consultations in the North we receive places. My family expressed concern and want- invaluable insights and perspectives on commu- ed me to slow down, and stop traveling as much. nity priorities, which inform the direction of re- I reflected on what was the most important to search and ensures interventions are applicable me, and what I realized was I could never give and useful. I think that is absolutely crucial for up working with the Canadian Arctic. It’s such a our work. I think we and the communities bring unique place with its beautiful environment, cul- a lot to each other. We’re not just doing research ture, and traditions, which affect health in really to publish papers. interesting ways. It’s also just an amazing place with respect to the receptiveness of people and RM: Reading through your list of health the potential for great work, training, capacity projects, it strikes me that you cover so building, and creating local employment. many different health topics. Why does your focus jump around so much? RM: Speaking of capacity building, I know SS: For us it all begins with the relationship to your team has fostered a few Northerners the community. We’ve worked in certain commu- to get into research as a career. Can you nities for so long that community members come tell me about that? to us now with health concerns and research SS: For many people in remote and rural ideas. For example, we’ve recently received communities, the attitude towards universities is bridge funding for a project exploring vitamin D very much that they seem to be an unapproach- levels and related health impacts. Vitamin D is able “ivory tower.” One thing I think we’ve done an important health concern, and incredibly per- really well is inviting community members from tinent to anybody living in the North. It’s some- the North into the research setting as equal part- thing people asked us for, and people are really ners, and presenting it as an accessible tool that excited about this work. We continue to look for can benefit a community. In my group specifi- funding that supports what each community has cally, we have staff members from Nunavut and determined to be a priority. Fort Good Hope who share extremely important

Northern Public Affairs, August 2020 15 RM: What are some of the challenges to overstretched organizations for letters of support, working on such a large research program and the grants aren’t always successful. We try to in the North? mitigate that work as much as possible, and to SS: Learning how to navigate the Northern ensure that projects that do go through have a research environment was really challenging, but significant positive impact on the organizations. now that we’ve done all that work up front, we’re Lastly, some funders may be new to the able to expand on the foundation we’ve built Northern research environment, presenting chal- and the great relationships we have. It has been lenges in terms of contextualizing procedures, a wonderful experience and opportunity to build costs, timelines and cultural norms. Indeed, up partnerships and learn the lay of the land, like many of our reviewers have assumed that Indig- all the different governments and groups. At the enous communities in the Arctic are the same as community level, we always find great people to Indigenous communities outside of the Arctic; work with, we’ve built opportunities for knowl- we frequently receive comments on grants that edge transfer, we’ve had people facilitate intro- ask us why we can’t drive between communities, ductions for us. or question the importance of capacity building, One of the challenges of running a large re- and our travel budgets are often said to be far too search program in the North is simply the vol- high. However, Dr. Michael Strong’s recent visit ume of work that comes along with continuously to Hotıì ts’eeda in Yellowknife and Behchokǫ̀ was applying for funding. Not for us, but for partner really important in showing communities that organizations. We’re continually asking small, this might be changing. Photo credit: Amos Scott Photo credit:

16 Northern Public Affairs, August 2020 RM: How has the research landscape nous governments, communities, and physicians changed since you’ve been involved in and nurses as well. That positive reception is re- Northern research? ally special. In all the years I’ve worked in the SS: For one thing, there’s a data discussion Arctic, I’ve never seen it as gelled and moving happening now that wasn’t happening before. forward like it is now. It isn’t just research any- We have engagements with both the Govern- more – it’s research to improve the programs ment of Northwest Territories and Hotıì ts’ee- for the community, with the community, and da, as well as the communities we work in, about find opportunities for training and employment data. For example, there are restrictions from along the way. university ethics requirements when it comes to There’s also a level of openness that has housing and sharing data. But our preference, changed over the years. When we first started and that of the communities, would be for that talking about cancer in Fort Good Hope, for data to be housed in the communities them- example, there was a fear around the subject. selves. Now, because we’ve been there and have been In the Northwest Territories specifically, talking about it for so long, people are interest- I’ve seen more and more governments and or- ed, people are seeing benefits, and people are ganizations throwing full support behind health bringing up new ideas and issues to be looked research. It is spectacular that we can get the at. Community members feel ownership over Minister of Health and Social Services to give the research, so it’s much more sustainable. An- us a letter of support, if not financial support other example is the Goba group, a local cancer for our projects. The access to government of- support group that started with one of our re- ficials and decision-makers, from both Indige- search projects but is now running independent- nous governments and the territorial govern- ly. Other communities are even bringing Goba ment, is amazing as an academic. in to learn from the experience. There’s also a The reason for that is that governments and lot of excitement and interest in the research communities are really seeing how research can world for people to work with Indigenous peo- contribute directly to improving their health ples to improve health and wellness. This can be system. For example, one of our research proj- attributed partially to the Truth and Reconcilia- ects looked at why people in the Northwest Ter- tion Commission, which made average Canadi- ritories had really low numbers when it came ans much more aware of the historical context to getting screened for colon cancer. So our including residential schools and other ongoing team looked at it, and we discovered that in the colonial legacies. We get people asking all the North, where there’s a good chance people are time to come and work and volunteer with us. living in a multi-generational home that may There’s more interest in and awareness of the be crowded, people tended to feel that it was North than there has ever been before. inappropriate to undertake the previous stool sampling, which was the standard way of test- RM: What’s next for your team? ing. We were able to share that information with SS: We have a big research trip planned for the government health officials, who changed this winter, and have just received bridge fund- the way they did the test – and it’s made a big ing for the CARE project in the Northwest Ter- difference for people getting tested across the ritories to look at utilization and patient expe- territory. riences with healthcare services. We’re going to We’ve had a lot of government interaction continue following the community interests, the especially when it comes to knowledge transla- community priorities, and finding opportunities tion. Our team created a series of videos about to work with new partners in the Arctic. We are cancer screening processes. Then we went to also undertaking research related to women’s Yellowknife, Fort Good Hope, and Inuvik and experiences accessing maternal health care as had the opportunity to sit with community well as looking at the challenges seniors may be members, government, and organizations and facing in the North. It’s an exciting time to be a discuss our methods, our messaging, and how circumpolar researcher. Y these videos could be used. There’s time and willingness to sit at the table that I don’t think Rachel MacNeill is Communications and Knowledge you see in other jurisdictions. And not just from Translation Advisor for Hotıì ts’eeda the territorial governments – it’s from Indige-

Northern Public Affairs, August 2020 17 Some of the University of Alberta Indigenous and Global Health Research Group’s initiatives.

CARE:

Maternal Health Project Cancer The Maternal Health Project is aimed at im- Attitudes Towards Cancer in Indigenous Com- proving maternal and infant health among munities & Examining Uptake of Cancer Indigenous women and families in Northern Screening Services Canada, in partnership with the communities ACCESS: and health care professionals of Yellowknife, Indigenous people living in Northern Cana- Inuvik and Fort Good Hope. The team will da have low use of cancer screening services, develop an evidence-based program to improve especially in remote communities where there maternal and infant health in partnership with are limited health services and facilities. Cancer local governments including the Inuvialuit Re- ACCESS aims to learn the thoughts and atti- gional Corporation, Nihtat Gwich’in Council, tudes of Arctic communities towards cancer and Gwich’in Tribal Council, Northwest Territories cancer screening, as well as identify barriers to Department of Health and Social Services, and screening and ways to reduce them. The study the Hotıì ts’eeda Strategy for Patient-Oriented took place in Inuvik and Fort Good Hope. Research (SPOR) SUPPORT Unit.

CAPRICORN: Healthy Foods North Indigenous seniors in Northern Canada are the Healthy Foods North worked with Inuit and fastest growing age group and their proportion Inuvialuit communities to reduce chronic dis- among the population is expected to continue ease by improving dietary intake. The program to increase. The CAPRICORN project is based addressed the specific needs of each community in Inuvik and Yellowknife and aims to assess and incorporated traditional cultural values, and Indigenous seniors’ perspectives on health, con- led to improved diets in communities where the ditions, and experiences with health care. The program took place, especially among women of study will identify barriers to, and opportunities reproductive age. Community members had the for, improvements of Indigenous seniors’ health. opportunity to present results at forums across Canada, and educational resources were developed based on the findings. CCSRI Knowledge to Action: Education program for breast, cervical, and col- Why Act orectal cancer. Wellness & Health in Youth – Aboriginal Com- This project builds on previous work by the munities in Transition NOW. team on identifying Indigenous knowledge, This program, based in Alberta and shared with attitudes and behaviours towards cancer screen- the Department of Health and Social Services, ing. The project is based in Inuvik and Fort Government of the Northwest Territories, is Good Hope and aims to transform knowledge aimed at improving quality of life for Indige- to action by developing and evaluating a cultur- nous youth and identifying the unique barriers ally appropriate education program, including and opportunities to achieving good health. a series of eleven videos, to improve knowledge around cancer and cancer prevention as well as utilization of cancer screening services among Northern Canada’s Indigenous peoples.

18 Northern Public Affairs, August 2020 IN CONVERSATION Reviving the Įdaà Trail: Interview with Tom Andrew and John B. Zoe

Jessica Simpson

etween 1990 and 1993, a trio travelled the Įdaà When the [Dene-Métis Agreement in Principle] Trail, the traditional trail our Tłichǫ ancestors was voted down in 1989, the Dene Nation shut down Btravelled before contact with Kwetı̨ı̨1. The trio ex- all of its research jobs and I lost my job. But soon af- plored, experienced, and recorded the stories of ter I moved to Yellowknife to take up position as the the trail in the form of an innovative archaeolog- Subarctic Archaeologist at the Prince of Wales and ical survey: The Įdaà Trail Heritage Resource In- Northern Heritage Centre and I had a new mandate ventory. The trail, which runs between Great Slave to do research. So, it was at that point that I decided, Lake with Great Bear Lake, links thousands of place “Well, maybe I should seek out Harry, we’ll pick out names, each with a narrative inextricably bound to a trail and ask him to teach me the place names and the landscape. stories that go with all of those, and we’ll use that as It had been many years since people had been a way of doing archaeology.” I didn’t speak Tłichǫ on the land in this way. Harry Simpson, Tom An- and I needed somebody, a research partner, to help, drew, and John B. Zoe travelled the trail, learning so I approached John (B. Zoe) and asked him if he the ancient history of the land by experiencing and would join us, and together we would map trails. recording the stories from Elders who had been And that’s really how it all got started. there before. Offshoots of this project include Trails of Our Ancestors2, The Birchbark Canoe Project3, JS: Tell me more about the late Harry Simp- the Caribou Skin Lodge Project4, and the “Scottish” son. What was he like? Project, where museum items were brought back John B. Zoe (JBZ): Harry’s father originally from Scotland to Tłichǫ Ndé so that people could came from Fort Simpson, and at the time that we see it and learn the history. started the project he was around 58 years old. If we Below, Tom Andrew and John B. Zoe share heard something, we would tell Harry, and he would their experience bringing the Įdaà Trail back to life. be able to figure out or remember the story. I can remember one evening, we were walking Jessica Simpson (JS): So, how did you two get round Gamètì, we were walking past Fred Mantla’s started on your projects? house, he let us know that he knew we were in town Tom Andrew (TA): Between 1980-89 I worked and his wife Marie, who is also Harry’s sister, had on the Dene Mapping Project, which was the Dene said that she would like to talk to us, and now that Nation’s traditional land use and occupancy proj- we were here we should go in and see her. So, we ect which they were using to help advance the land did that and she told us this incredible story about claim with the federal government. Part of that work when she was a young lady coming back from Beh- required me to provide regular updates about how choko after getting married. On her way back from things were going to the communities. In 1982 I vis- Behchoko, the water froze over so they had to stop ited Gamètì, we were in the old Octagon, the com- their journey and leave their canoes before continu- munity centre of Gamètì, and I made my presenta- ing by dog team. We later told Harry Marie’s story, tion. At end of it, Harry Simpson stood up and he so before going anywhere near the area of the story, said, “Thank you very much for your work, you’re Harry went and talked to her. doing good work. Though, now that you’ve learned The thing about traditional place names is that the trails, it’s time for you to learn the place names they are so detailed, people talk to each other and and the stories that go with them.” In those days, the know exactly where they are talking about. And Dene Nation wasn’t really interested in that. They place names have stories attached to them, and that’s didn’t need that information to be able to advance what happened. Marie’s story was so detailed that their land claim – but I remembered that. when we got to Bea Lake, Harry made a bee line,

Northern Public Affairs, August 2020 19 straight to where the canoes were – the evidence was noes. Her dad started making a sled and gathered there! And that’s when it hit me, the importance of up the dogs and they continued by dog team when place names and describing the landscape. Place there was enough snow. names are not just place names, they’re navigational To me, it was a really important moment as an tools, they also tell a story of what happened during archaeologist because here we have the remains of a specific time. And, the other thing with traditional two birch bark canoes, and you can still see they’re place names is that you can keep adding to the story. still laying on the ground, they’re in pretty bad shape TA: It’s interesting that you (John) picked that but you can make them out. There was a direct con- story because it taught me some other things too. nection to Harry but then this whole other story as That was the story of Harry’s older sister Marie re- well. member[ing] something that he didn’t remember There’s lots of other places on the trail where because he was so young and yet there’s this physical the traditional name talks about an event that hap- place that he was at when he was a little boy. So, for pened thousand years ago, but this was an event that him it was a moment of discovery as well as it was happened 65 or 70 years ago. It really gave to me a just for you and I. And for her it was a really unique sense of time-depth – we could be there today, be kind of thing because that’s the summer when she connected with somebody to it today, but yet it’s con- got married and they were on their way back from nected to this whole archaeology that goes beyond. being married in Rae (Behchoko) and taking their So, to me, you’re right, it was a really unique time. I remember her saying that the dogs ran along spot. And, Harry couldn’t have led us there, it had to the shore line and right when they got to their spot, have come from his sister. He had to be able to learn it froze that night and so they had to leave their ca- that. So, it was really an instructive place. Photo credit: Amos Scott Photo credit:

20 Northern Public Affairs, August 2020 JS: What did you get out of that project on a people? All we’re doing is going to these empty personal level? campsites and seeing what people used to do, where TA: Well, for me it was a life-altering experi- kids used to run around, where dogs used to be tied, ence. I’m a different human being now after spend- we could see the old fish sinkers, handgame sticks ing those thousands of miles in a canoe with John – everything that they use to use was there. There and Harry than I was before I started and I learned were place names but no people. And there hadn’t a whole new way of how to be respectful to the land- been people out there for a long time. scape we live in by learning from Harry and other After this project, what we went away with is that Elders and John too. It really changed me complete- we need to get our young people out on the land. ly in many ways. [Harry] and I were on the school board so we start- It also extended beyond this project too – I ed to talk to Jim (Martin) about it. Jim said “well, I’ll worked with Harry for another 15 years or so, he look into it.” So, he did – we purchased about five and I taught at the Tundra Science Camp out at the canoes at the time and in 1995 was the first launch barrenlands every year. We became very, very, very of Trails of Our Ancestors. close, we all did. TA: Right, you know, to think the first couple of One day we were out with the students out on years that we were out we met more geologists than the barrenlands, we’d been there a couple of years, we met anyone else. Part of that story is because we and we had this thing that we did where we would were right at the beginning of the diamond explo- walk to a caribou crossing with all of the high school ration. The second summer we went out, we heard students, from all over the NWT, some from as far an explosion somewhere almost every day. Lots of away as Fort Good Hope. It was the perfect spot to planes, lots of geologists, and we met that crazy pad- sit down and talk about archaeology and tradition- dler too. al hunting practices and how people would move in JBZ: Place names tell a story of before contact, and out of the barrenlands. Harry and I had this they tell the story of the impacts, and about where thing we would do introducing ourselves, and we we’re heading to in the future because it’s all part of did the same thing every year. And, all of a sudden, the same story in the same landscape. Harry would one year he just started introducing me as his son. say almost every summer, “We got to get the young That’s why, I guess, I learned that the work that we people out here.” That’s where the Trails of Our do builds families, builds relationships, and it can be Ancestors comes in. quite emotional and I think that’s a good thing. I think it’s important to be emotional in the work and JS: How does this project relate to the health to have emotions about the work that you are doing, of people? ya know? TA: Well, I’ll start and I know John can take this a lot further than I can. JS: Yeah, for sure. John, what was the work In the old days, children were educated and like for you as someone who is Tłįchǫ, hav- socialized through life on the land, through travel. ing grown up with these Elders and place They would travel in canoes and sleds with their names? moms and dads and their grandparents and aunts JBZ: The only thing that I knew about land was and uncles. They learned the daily practice of living that people go to the barrenlands every fall time – by travelling across the landscape, helping to set nets we would go out seasonally, but most of our living is and make dry fish, do all of those thousand things in a community and I couldn’t see beyond that. [All] that you have to do every day to live healthy and I knew was that Hozi was a trail that they would securely on the land. have traveled on and that’s all I really knew, and I By travelling, they would encounter all of the really wanted to go. places that have names. John is absolutely right, The whole thing [of people travelling on the names are knowledge of the landscape – it chang- land] had stopped. It had stopped for many years, es, it grows, new names are added, new stories are and all of a sudden this project comes around. It was added, but the old stories are important too because something I had been waiting for, so I quickly decid- they contain information about how to live a good ed to get on it! And we did it over three summers. life as a person on the land. Those place names and One year, on the trail, we met with this old guy the stories in them tell people about marriage, about who had been travelling in the area since the 1960’s. where the game is, they tell them all of the informa- That encounter really stuck with Harry – we were tion that is embedded in those stories. So children seeing people on the land, but what about OUR were educated and socialized through the means

Northern Public Affairs, August 2020 21 of travel. They became healthy individuals through self up physically really well and very quickly be- their life on the land. cause you’re moving all the time and you’re learning The Įmbè program today, Trails of Our Ances- all the time, your mind is expanding all the time, tors, and all of those things that bring youth and El- you’re learning about everything you see. ders together in a learning atmosphere on the land- In terms of healthy spirit, everything has a spir- scape all touch the whole issue of well-being. Harry it. The water has a spirit, the land has a spirit, the used to say that the land is like a book. He was say- fish has a spirit. So, we have to make offerings on ing that to me because he wanted me to understand, the land, and hearing those creation stories, like of and that’s a really important part of being happy Yamǫǫ̀zha5, the landscape just full of ever-expand- and healthy in the Ndé. ing stories. JBZ: The thing is we’ve got to get young people TA: It’s totally true. It’s a full person experience on the land, that’s what Harry was saying. His gen- living mind, body, and spirit – all of them are made eration was always on the land, they only moved into better by being out on the land, and made better the community in the 1960’s – he was talking from by being with other people out on the land because real experience. His observation on community liv- only then you can share all of that and learn from ing is that young people have adopted this self-de- them too. structiveness through new things that are introduced that has nothing to do with us. A lot of it is being JS: Any last words you want to say? mixed up between a new way of life, we’re being JBZ: For me, the story about our project on the asked to become something else to be successful and Įdaà Trail is that it captures what was never cap- that what we have is not worth anything. We’re be- tured before because it was “traditional.” We were ing led to believe that. engaging with people who were not influenced by [Being on the land] is a mind-body experience. Western ways of thinking – they didn’t even speak When we (John, Tom, and Harry) first left in 1990 English. What these Elders have is the platform that the last time I remember real paddling out in the we (Tłichǫ) are continually pushing when develop- bush was for muskrats in 1969 – that’s almost 25 ing project management tools. And now we’ve come years, and so when we started paddling there, it full circle, and we can portray the Tłichǫ identity in was a little bit awkward in the beginning and then our work and governance and have a sense of self- it started to come back within an hour. That was worth. the real beginning, for me, adjusting the mind, body, TA: I have to say Masi. I have to say Masi to and spirit. Harry and John and to all the other Elders that’s A lot of the “shifting” is because I grew up when spent time with us to teach us, they taught us so you were “good for nothing.” If you watch Rich- much. I’m so grateful for having that opportunity ard Finnie’s film of 1970-71 or ‘72, he captured a and do my little part. I know that Harry saw me, I voice, an Elder saying “the kids nowadays are good was like I was a pencil for him. I would write stuff for nothing, they don’t know what they have, they down that he would tell us, I just hope that we’ve don’t know how to hunt, they don’t know how to done a good job at that. Y fish, all they want is to do is play, play, play.” That’s the type of mentality that I grew up with – that we Jessica Simpson is currently a research advisor at Hotii ts’ee- don’t fit into a Western world, we don’t even fit into da, the NWT SPOR SUPPORT UNIT. She is a Tłı̨chǫ our own world. We’re stuck in the middle and the citizen from Whatì First Nations, born and raised in Yellow- only escape is in your own mind. That’s when the knife, NT. Jessica spent several years working for co-man- self-destructiveness comes in, which has to do with agement and environmental monitoring agencies doing research mental health. In our project, Harry was the tradi- and communications. tional knowledge holder, Tom was the scientific focus, and I was straddling both worlds – the ethos of 1. Kwetı̨ı̨: White person, or English-speaking person. 2. https://www.tlicho.ca/government/departments/cul- what Elizabeth Mackenzie coined “Strong like two ture-lands-protection/cultural-practices/trails-our-ancestors people.” Harry was also part of those meetings to 3. https://www.pwnhc.ca/item/dogrib-birchbark-canoe/ develop that ethos. 4. https://www.pwnhc.ca/item/dogrib-caribou-skin-lodge-proj- In terms of physical health, when we were out ect/ there, we took a picture of Tom lying flat on a rock 5. https://tlichohistory.ca/en/stories/yamoozha with your belly up – it was a mound, and then we took another picture after the trip was over it was flat! That’s a real measurement, you can build your-

22 Northern Public Affairs, August 2020 ARTS AND CULTURE Dene Heroes: How the Sahtú is strengthening literacy and leadership

Jessica Simpson, with files from Mary-Anne Neal

“I believe that true heroes are the people in our lives that make a difference each and everyday.” - Tyra Drybone, My Dene Heroes in Dene Heroes of the Sahtú, Volume 1

ducation that honours Dene culture is a prior- The needs assessment is what led to the Dene ity for Dene people of the Sahtú. Upon com- Heroes Publication Project. David Codzi says that Epleting high school, students often need to upgrade he wants to see the history of the Dene and their their knowledge and skills in order to reach grade 12 contributions to society represented in the North- standards. west Territories education curriculum. “When I When David Codzi of Colville Lake first became went to school, it was always taught that somebody president of the Ayoni Keh Land Corporation, he else came to this part of the world and started all of commissioned a needs assessment for the education these great things. This project is to get something system in Colville Lake and Fort Good Hope. That personal into the literature available [to Dene stu- needs assessment found that Sahtú Dene residents dents].” David believes that when youth see them- wished to build self-esteem in Dene youth as a foun- selves reflected in the literature, they are more likely dation for the leadership skills required for self-gov- to build self-esteem and pride in Dene heritage – im- ernment. portant qualities in future leaders. Photo credit: Amos Scott Photo credit:

Northern Public Affairs, August 2020 23 The premise of the project is simple and direct: able to expand to include leadership training for Each year, contributors write, draw, or take pho- the youth. During 2019, Project Editor Mary-Anne tographs about a Dene person who has inspired Neal trained Indigenous youth in Colville Lake and them, and who has displayed heroic qualities. The Délı̨nę in the knowledge and skills required to take contributions are then compiled, edited, formatted, responsibility for annually publishing the Dene He- and published in a book that is distributed to all of roes of the Sahtú books. Each community has a the contributors. Copies are also sold for $10 each, “champion” who gets the word out about the publi- and distributed widely to schools, libraries, and the cation, and collects the stories. According to Orlias, general public. Each story is a lesson of courage, “Just communicating with people and getting the strength, and resilience of Dene people. word out about what I’m working on and answering The first volume in the project, Dene Heroes of questions is making me a better [leader] in general.” the Sahtú, was published in 2017. It features stories, The Dene Heroes Publication Project has been drawings, and photographs of 58 school-aged con- instrumental in rekindling Indigenous pride by accu- tributors. Over the last three years, the project has rately representing Dene history and culture. Codzi grown to focus not only on strengthening education believes it also strengthens future leaders. “Right and literacy, but also on strengthening leadership now,” he says, “we have a system in Colville Lake amongst community members, especially youth. that my generation built. Now that it has been built Over the last three volumes, and a fourth to be pub- and fought for, for the well-being of our communi- lished in January 2020, the project has grown to in- ty, we have to make sure the next leadership base is clude over 150 Indigenous authors from all five com- trained…If we don’t do something about it, we’re munities of the Sahtú. “Eventually,” says Dakota waiting for other people to have the answers.” Y Orlias, a Coleville Lake youth and Team Leader of the project, “I’d like for the book to get more publici- Jessica Simpson is currently a research advisor at Hotii ts’ee- ty across Canada and be in schools for history on In- da, the NWT SPOR SUPPORT UNIT. She is a Tłı̨chǫ digenous peoples in Canada to get more awareness citizen from Whatì First Nations, born and raised in Yellow- of Indigenous people, knowledge and practices.” Al- knife, NT. Jessica spent several years working for co-man- though the books are not for sale in bookstores, they agement and environmental monitoring agencies doing research can be found in the Northwest Territories libraries, and communications. and the Library of Canada. In 2018, the Dene Heroes Publication Project 1. The Arctic Inspiration Prize encourages, identifies, funds, and celebrates breakthrough Northern initiatives that have was awarded a $100,000 Arctic Inspiration Prize measurable impact on improving the lives of people across the to build leadership and literacy among Indigenous North. youth. With the prize money, the project has been

24 Northern Public Affairs, August 2020 ARTS AND CULTURE Bridging the gap between two world views: Perspectives of an Indigenous nurse

Lianne Mantla-Look

Do you find it hard to work there?” that? She asked who my parents were and after I It’s a question I get asked a lot after tell- explained whose daughter I was, we got on with her ing“ people that I worked in my home community reason for coming to the health centre. She was so as a registered nurse. It can be challenging at times. happy to be examined by a Tłı̨chǫ nurse and not have Occasionally, a select few make it difficult by having to go through an interpreter and explain through a unrealistic and unethical expectations of me such as third party the reason she was at the health centre requests for narcotics or sick notes. There are others that day. At the end of the visit, this Elder shook my who assume I’m going to tell my family about who I hand and thanked me profusely and told me how saw that day at work and what for. And finally, there happy she was to have a Tłı̨chǫ nurse in Behchokǫ̀. are the people who make putting up with all the neg- It was a humbling experience and probably the best ative experiences worthwhile: The Elders. They are day at work I’ve ever had. ecstatic about a Tłı̨chǫ-speaking nurse working in The inability to speak English is a huge obstacle the community and they make my career a reward- in accessing health care. Interpreters are common- ing one. If I can use my first language to help people place in remote health centres for people who do not navigate their health care experience then I feel I’ve speak English, such as the Elders of the community. provided the best care to my patients and have done A language barrier can result in having incorrect or what most people cannot do. I embody the Tłı̨chǫ misleading information given to health care provid- philosophy of “Being Strong Like Two People”: I ers and to the patient. Patients can feel uncomfort- am able to function in both the traditional Tłı̨chǫ able and unable to fully express themselves. world and the mainstream Canadian world. In my nursing practice, I’ve acted as the inter- I was always considered the outlier or an anom- preter for doctors who treated people from my re- aly in my community. I was a good student and I gion. This was beneficial for the doctors because I didn’t live up to the stereotype of being from a small was able to complete the history portion of their First Nations community. I didn’t do drugs and wait- exam for them in Tłı̨chǫ and thus saved time while ed until I was 21 to have my first alcoholic drink. putting the patient at ease. Other discussions I have I was conscious of my personal choices because of been involved with have been about code status – negative stereotypes about Native people. I graduat- [“Code status” essentially means the type of emer- ed high school a year early, and went away to college gency treatment a person would or would not receive and then university. Then, I began this incredible if their heart or breathing were to stop] – and end- career in health care. I worked hard for what I ac- of-life care, where a person plans for a time when complished, and though there were some people they cannot make decisions for themselves. It was who were immensely proud of me, there were others during a discussion about one such issue that I no- who begrudged this hard-won success. ticed something rather alarming – family members During my first month of work at the Behchokǫ̀ interpreting for the patient withheld critical infor- Community Health Centre, I called a woman El- mation from the patient regarding the patient’s code der into my exam room from the waiting room. She status. The risks and benefits of CPR and intubation seemed a little nervous and when I closed the exam were explained to the interpreter (the family mem- room door, she asked me in Tłı̨chǫ: “Aren’t you go- ber) but the interpreter did not relay this informa- ing to need an interpreter?” to which I replied in tion to the Elder, for example, that the risks of CPR Tłı̨chǫ “What for? I can understand you just fine.” include fractures to the rib, sternum and spine and The look on her face was priceless, she was so hap- CPR sometimes results in injuries to the liver and py and so incredibly relieved! Then she laughed and spleen, damaged airways, internal bleeding, heart said, “You’re a Tłı̨chǫ person? I thought you were contusions and pulmonary complications. White!” We both laughed because, how funny was An example of this was when a Tłı̨chǫ Elder

Northern Public Affairs, August 2020 25 was admitted to hospital after having a stroke. Giv- As much as I respected my culture and our ways, en the patient’s age and severity of the stroke, the I struggled internally to remain “neutral” whenever doctor wanted to have a family meeting to discuss I had to care for a cancer patient from my region, the care plan and code status in the event of an- because I believed in medicine and science. I strug- other stroke. The patient’s son and daughter refused gled between who I was as a Tłı̨chǫ woman, and a medical interpreter and relayed the information as a nurse who believed in science. In my region, to the patient. I was present as the witness for the at least, many people distrust Western medicine doctor who did not know that I spoke the same lan- and seek out alternative cures for cancer. Too often, guage as the patient. The son told his father that if I’ve seen patients and families spend time and mon- his heart stopped or he stopped breathing, the doc- ey trying to find a cure for cancer, losing valuable tor was going to hook the patient up to a machine to time with their loved ones. I became especially jaded heal the patient. The patient agreed and was ready when an immediate family member was diagnosed to sign the consent form agreeing to be a full code with stage 4 pancreatic cancer when they were 37. – which meant that all resuscitative and aggressive My family spent thousands of dollars looking for a curative treatment are provided. I pulled the doctor cure and seeking help from traditional healers who aside and informed him of the miscommunication were known to “cure cancer.” I tried to make my and that the risks of being a “full code” were not family see that all of these interventions were going properly explained at all to the patient. This family to cost us precious time that we had so little of al- did not understand that relaying incorrect informa- ready. But my arguments fell on deaf ears. We were tion to the patient was highly unethical and that they given a prognosis of 4-6 months, much of which my put their father and the doctor at risk. The end re- immediate family member spent being driven all sult was the doctor called a medical interpreter to be over Alberta trying to find medicine people to cure present and had the same discussion with everyone their late stage cancer. I hate to think of the lost time again. with their three children. By the time they gave up, When other situations like this arose, the doctor my family member was getting weaker and weaker. would often ask the family directly why they provid- They died just weeks after their 38th birthday, al- ed the patient with incorrect information. The an- most exactly four months after the diagnosis. swers usually included: “The patient is too weak or Then I received my own cancer diagnosis in frail to deal with the situation” or “we don’t want 2015. I was 34 years old. What was supposed to the patient to lose hope and get depressed” or “we have been an overnight trip to Edmonton with my don’t want the patient to panic.” Putting the burden husband became a week-long hospital stay. What do of medical translation on families is unfair to both you do when your doctor calls you to tell you that the families and the patient. It’s unethical not to use you have cancer? First you cry and then ask you ask a medical interpreter for consent and procedures. questions: What kind of cancer? What’s the plan? Doctors and nurses need to trust that their informa- Then you cry with your husband. You cry some tion is being relayed correctly. more during your assessment with the surgeon who Throughout my career, I have had the privi- tells you the plan. You cry again as you call your lege of providing end-of-life care to many Elders mom to tell her that her youngest child was diag- and helping to guide families during the palliative nosed with cancer eight years after her eldest suc- process. I did this for my own family as well when cumbed to this terrible disease. an immediate family member died of cancer; it was Despite being emotional about this sudden news, then that I saw first-hand how challenging it was to I was quite practical with my next steps. I notified navigate the medical system for my family, where for my employer right away, I cancelled our flight home me it was second nature. I’m not sure if this is the to Yellowknife, extended our hotel reservation and case in other First Nations communities, but in my arranged for a friend to look after our pets. I believe own professional and personal experience, cancer it was my nursing education and years of experience was always spoken about in hushed tones in my re- that allowed me to accept the news initially. Then gion. Typically, no one knows much about cancer the reality set in and I became a patient with a tough except that it often leads to death. pill to swallow. It took me several months over the There is no Tłı̨chǫ word for cancer. When I was course of my recovery to be okay with relinquishing growing up, cancer was described as “Tada natso” my role as caregiver. which meant “strong disease,” and then the official During my initial hospital stay, I had two gas- Tłı̨chǫ dictionary translation for cancer became troscopies and 53 biopsies taken from my stomach “parasitic disease” or “gòo at da.” before being sent home to Yellowknife to await the

26 Northern Public Affairs, August 2020 biopsy results. A week later I received confirma- It is critical that Indigenous patients be empow- tion that I did indeed have stomach cancer. I would ered and informed enough to begin advocating for require the total removal of my stomach and sur- themselves. For many, obtaining medical or nursing rounding lymph nodes as well as parts of my esoph- training is not an option; the chances of having a agus and intestines. It was not going to be a simple nurse who speaks their language fluently is rare to surgery or recovery, but my surgeon was confident non-existent. How are health care providers sup- that I would pull through. My surgery took approx- posed to provide the best care if they can’t com- imately ten hours. The recovery was the most pain municate with their patients? And how are patients I had suffered in my life. Most of my life I’ve taken supposed to communicate with health care workers care of other people and this time it was me in the when they aren’t culturally safe and supported? We hospital bed. I did not know how to deal with it. need to close linguistic and cultural communication I hated every moment of being a patient, but gaps between Indigenous patients and the health tougher still was being a Tłı̨chǫ patient. I clashed care system. To do that, we need the system to bet- with my mother about sharing my diagnosis with the ter understand and work with Indigenous people to rest of my region. When someone from the Tłı̨chǫ build trust. Trust is the first step in creating a system community becomes sick, everyone is supposed to that better serves Indigenous communities in Can- be informed “for support,” my mom said. At that ada. point in what was to me a very new and difficult situation, I needed privacy. Therefore, I chose in- So, how do we build trust? stead to tell my close friends and a couple of family We build trust by understanding culture and allow- members, rather than all 70 first cousins and their ing there to be a place for differing cultural identi- families. I requested that my relatives refrain from ties in the health care system. That can be through sharing anything on social media. I didn’t want ev- critical services like medical interpretation, but also ery Tłı̨chǫ citizen knowing my business. My mother through things like traditional foods and making could not understand it; for her it was not the Tłı̨chǫ room for ceremonies in care. We build trust not only way of doing things. Unlike a typical Indigenous pa- by understanding the history and systemic biases tient, I was able to draw on my knowledge of health that exist in health care but also by training health care to ask nurses to perform specific care tasks, and care workers to address their own internalized biases expected detailed information from my team. This to build individual cultural competency. experience caused me to wonder: How often are In- Finally, we build trust by building up Indigenous digenous patients given sub-par care when they are people to enter careers in the health care system. unable or afraid to speak up, especially if they aren’t This is a critical piece of the puzzle. My nursing ed- familiar with southern hospitals and are far from ucation and knowledge of the health care system is home and family? what gave me the confidence to advocate for myself. As a frontline nurse, I always encouraged pa- Until people are seeing themselves reflected in the tients to advocate for themselves and to always ask system, how can they fully trust it? And how do they questions about their care. When it came to my own see themselves in a system they can barely communi- care, I am not sure where I would be if I didn’t push cate in without a translator? How can they advocate my doctors for that colonoscopy referral when I for themselves? By encouraging and supporting In- knew there was something wrong with me. Where digenous people to enter the health system, we can would I be if the gastroenterologist hadn’t ordered reduce perceived tensions between Indigenous ways the gastroscopy as a precaution after he found three of knowing and Western medicine. We can create polyps – the same gastroscopy which led to the dis- a system where both complement each other. This covery of my cancer? Probably dead. My cancer would be a system that would truly serve Indigenous was a slow-growing one that would not have pre- people and improve health across Canada. Y sented itself until I began showing symptoms. The fact that my cancer was caught so early was a total Lianne Mantla-Look is a registered nurse from fluke. Even the surgeon who did the first biopsy of the Tłı̨chǫ community of Behchokǫ̀, NT. She has a Di- my stomach said she “didn’t think it was anything ploma in Nursing from Aurora College and a Bachelor of sinister.” It was my own self-advocacy – a direct re- Science in Nursing from the University of Alberta. She has sult of my nursing training and experience – that been nursing since 2003. In 2014 Lianne received Health enabled me to receive the level of care that would Canada’s Award of Excellence in Nursing from the First directly contribute to early detection and survival. Nations and Inuit Health Branch.

Northern Public Affairs, August 2020 27 FEATURES Hotıì ts’eeda – WORKING TOGETHER FOR GOOD HEALTH Changing the system: Improving Indigenous health outcomes in NWT through policy and practice

Debbie DeLancey

ndigenous Peoples in Canada experience pro- tions with the government service providers gen- found disparities in health outcomes and other erally, and particularly with health systems, and a socialI determinants of health as a result of the lack of access to health care that is both culturally incremental multi-generational impacts of coloni- safe and culturally appropriate. Together, these zation, dispossession of lands, residential schools, factors create reluctance on the part of many In- the systematic removal of children from families, digenous people to interact with the public health and on-going systemic racism in the health sys- system.1 tem. There is no shortage of literature addressing The history of health care in the NWT is char- the multi-dimensional impacts of structural vio- acterized by all of these issues. In addition, the lence and social suffering on Indigenous popula- provision of access to equitable care in the NWT tions in Canada and worldwide (Allan & Smylie, is made more difficult as the system is challenged 2015; United Nations Human Rights Council, to provide services to a relatively small population 2014). This is equally the case in the Northwest living in remote communities dispersed across a Territories (NWT), where First Nations, Métis large geographic area, with unique transportation and Inuvialuit residents demonstrate generally needs, high infrastructure costs and recruitment poorer population health outcomes as compared and retention challenges – all compounded by to the non-Indigenous population. operating within a chronically constrained fiscal Systemic racism in publicly provided health environment. services contributes to poor health outcomes. This In this paper I will draw on the academic lit- is compounded by a history of negative interac- erature as well as my own experience to provide Photo credit: Debbie DeLancey Debbie Photo credit: In 1981, the author’s family spent the fall trapping season on a lake southwest of Fort Good Hope in the foothills of the Mackenzie Mountains – known in Denekeh as Luge lo tue, which translates roughly to “Soft Fish Lake”. This photo shows our storage tent with dry meat hanging outside.

Northern Public Affairs, August 2020 29 an overview of the evolution of the NWT health Good Hope, where I was living at the time, in a care system over the past 50 years, identify chal- Twin Otter float plane, and once the ice started to lenges to improving Indigenous health outcomes form, the only option for transportation back to in the NWT, and propose opportunities for im- the community would be by helicopter until the provement. The perspectives that I share in this lakes and rivers froze enough to travel by skidoo, article are informed by my experience and ob- or for a plane to land on the ice. As a new parent servations as a non-Indigenous resident of the with a five-month old baby, I sought advice from NWT for more than 40 years, and particularly my the nursing staff on what symptoms should worry experience in the positions of Associate Deputy me enough to seek medical advice. The advice I Minister, and subsequently Deputy Minister, of received was very clear – if the baby ran a fever Health and Social Services in the Government of for more than 48 hours with no sign of the fever the Northwest Territories (GNWT) from 2000- breaking, that would be a cause for concern and I 2002 and 2011-2017. During my tenure as Dep- should contact the health centre. uty Minister, I was privileged to travel to many Less than a month later, after my baby experi- communities, to hear the stories of staff, patients enced a fever that lasted for two days, I requested and families, and to learn on the ground about the to speak to the nurse by bush radio. In spite of successes and failures of the public health system her initial advice, she told me not to worry and in the NWT. did not feel that the situation required a medevac. Not surprisingly, given her original advice, I re- The legacy of a colonial system mained anxious and eventually the Band Coun- Until authority for the delivery of health care was cil paid for a helicopter to bring us back to town. transferred to the Government of the Northwest (This was not unusual, and even today it remains Territories (GNWT) in 1988, the NWT health common practice for Indigenous governments to system was still operated by the Government of support their membership by covering the costs of Canada, and the delivery of culturally safe or a range of services not fully covered by the pub- appropriate care was not a priority. My first di- lic system, including transportation to land-based rect experience with this health system came in camps, search and rescue, and funerals.) My son September of 1981, when I was preparing to go recovered with no ill effects but the experience left into the bush for the three-month fall trapping me with my confidence in the local health system season. We would be flown 90 miles out of Fort undermined. While I had previously believed that Photo credit: Debbie DeLancey Debbie Photo credit: This is another shot of the camp, with a beaver pelt drying and laundry hanging outside the wall tent that was home to six people for those three months.

30 Northern Public Affairs, August 2020 I had some understanding of how colonial beliefs outright distrust and hostility towards the nursing and attitudes could impact Indigenous residents, station staff and were generally reluctant to seek this experience provided insight at a more visceral medical advice except in emergency situations. level about the distrust and skepticism voiced by Countless academic articles have analyzed the many Indigenous people. impacts of colonization and systemic racism on A second experience during those three the social determinants of health and specifical- months in the bush highlighted another way that ly on health outcomes for Indigenous people, in the health system was failing to meet the needs of Canada and elsewhere. Browne and others (2016) Northern Indigenous Peoples. I had a small cut describe how structural violence, in the forms of that I tried treating with antibiotic ointment and dispossession of Indigenous people from lands the penicillin provided in our bush kits, with little and the apprehension of Indigenous children by success. My mother-in-law spread a small amount the state, has had profound multi-generational ef- of melted spruce gum on a piece of moose hide fects. Irlbacher-Fox (2009) uses the term “social to put on the cut and in less than 24 hours, the suffering” to convey how the social pathologies infection had been drawn out and the wound was associated with events related to colonization, healed. This use of traditional medicine brought on-going injustice, and institutional racism cre- home the reality that traditional healing practices ate unwellness at the individual and community were not a thing of the past, but represented a level. All of these constructs are helpful in shed- depth of rich knowledge and expertise which is ding light on the broad socio-political forces that still seen by many Indigenous people as the first cumulatively impact the social determinants of course of action when faced with injury or illness health of Indigenous Peoples in Canada. But de- – but which is neither acknowledged nor accom- veloping a theoretical understanding of the forces modated by the current health system.2 that have influenced individual behaviors does not During my years in Fort Good Hope, I ob- necessarily equip one to deal effectively with ev- served numerous interactions of Indigenous resi- eryday situations or lead to solutions. dents and the health system which starkly illustrat- My training in anthropology did not enable ed how concepts of cultural safety or culturally me to accurately decipher the complex relation- appropriate health care had yet to take root. At ships that were at play in the community. I strug- the time, the term “cultural safety” was not yet in gled to understand how the toxic dynamics could common parlance, and concepts like “cross-cul- be improved while I lacked even the appropriate tural awareness” fell far short of the mark. terminology to describe the deep disconnection Health care delivery was provided based on that I observed between the health system and policies and procedures developed elsewhere. In- residents of Fort Good Hope. But clearly the digenous people were largely regarded by prac- health system was not meeting the needs of the titioners as uncooperative and generally lacking community, and what was most baffling to an ob- individual responsibility, and the nurses didn’t server was the extent to which well-intentioned, hesitate to exercise the authority that came with open-minded people on both sides of the divide their position of privilege in the community, seemed unable to communicate effectively with even to the point of sending the RCMP to bring one another. Fadiman (1997) has written on this in “non-compliant” patients. Of course, there issue in the context of Hmong refugees negotiat- were exceptions. There were nurses and others ing the health system in the United States. Her who were eager to fit into the community and to analysis illustrates that not only cultural and epis- learn more about Dene culture, who wanted to temological differences, but also the power differ- provide care that was meaningful and relevant, entials underlying this mutual non-understanding, and who wanted to understand how they could are decisive factors in how personal experiences better respond to the needs of their patients. But of health care play out. even these well-intentioned individuals were often frustrated by behaviors on the part of patients NWT health care system today that the nurses found baffling and frustrating; for Responsibility for the delivery of health care was example, patients would fail to take medications transferred from Canada to the GNWT in 1988. as prescribed, fail to show up for appointments, The GNWT also administers the Government of fail to provide western standards of care to their Canada’s Non-Insured Health Benefits program children. At the same time, almost without excep- for First Nations and Inuit residents, through an tion, Indigenous community residents expressed administrative agreement with Canada, so that

Northern Public Affairs, August 2020 31 eligible Indigenous residents of the NWT access mendations – which included improved processes this program through the territorial Department to respond to patient and family concerns, imple- of Health and Social Services (DHSS). Complet- mentation of mandatory and on-going cultural ed self-government agreements include provisions safety training, and incorporation of Indigenous for jurisdiction over some elements of health care healing practices within the system – were seen delivery, but at the time of writing all core health by many to confirm the validity of these percep- programs remain under GNWT management tions.4 and delivery. In 1988, when responsibility for health was Systemic racism is still endemic in the NWT transferred from the Government of Canada to health and social services system today. Indigenous the Government of the Northwest Territories, re- Peoples in the NWT lack trust in the system, are gional health and social services authorities were often reluctant to seek medical treatment, are frus- established in an effort to ensure that health care trated by lack of access to traditional medicines would be responsive to local needs and priorities. and traditional healing practises, are often not A major review of the NWT health and social ser- able to receive care in their Indigenous languag- vices system in 2001 identified service delivery and es, and experience insensitivity or outright rude- efficiency issues associated with that fragmented ness in their interactions with staff.3 System-wide structure, while acknowledging that the structure policies that govern provision of services, such as responded to the need to accommodate emerging medical travel, have historically been centrally Indigenous self-government arrangements. These driven and not grounded in Indigenous communi- two competing priorities – the need to ensure ty values and priorities. Visit any community and quality and cost-effective care while responding to you will hear stories of people whose symptoms the need for local/Indigenous input and control – were dismissed or misdiagnosed, resulting in se- have become focal points in discussions about the rious illness or death. Whether or not these out- structure of health care delivery in the NWT, and comes were in fact the result of systemic racism, it will be addressed further below. is widely believed by Indigenous residents across Additional attempts have been made to ensure the NWT that racism continues to be the cause that program and service delivery is informed by of poor treatment and poor outcomes. This be- Indigenous knowledge and values; for example, lief was supported by the recommendations from the 1992 Traditional Knowledge Policy commit- an external investigation conducted by the DHSS ted to Indigenous knowledge being incorporated in 2017. Details of the incident that spurred the into government decisions and actions where ap- investigation were not released by the department propriate (Government of Northwest Territories, due to privacy considerations, but the 16 recom- 1992). Major initiatives like the GNWT’s Social Photo credit: Debbie DeLancey Debbie Photo credit:

The author’s mother-in-law, Mary Caesar, working on a moosehide in their tent.

32 Northern Public Affairs, August 2020 Agenda Conference in 2000 sought to incorpo- Calls to Action called on all levels of government rate community input into government decisions to acknowledge that “the current state of Aborigi- about resource allocation and programming (Gov- nal health in Canada is a direct result of previous ernment of Northwest Territories, 2001). Canadian government policies”(18). They called However, GNWT focus on Indigenous health for systemic recognition of the value of tradition- issues specifically was lacking until very recent- al healing practices (22), and for cultural com- ly. A 1998 Strategic Plan for Health and Well- petency training for all health-care professionals ness published by DHSS reflected themes that (23) (Truth and Reconciliation Commission of resonate today – the need for improved mental Canada, 2015). These explicit statements linking health and addictions services, early childhood the legacy of colonization and residential schools intervention, and promotion of healthy lifestyles to contemporary health outcomes influenced the – but contained no references to the importance public discourse at a time when DHSS had only of culture in providing effective care aside from a recently begun to acknowledge these issues (Wohl- single reference to developing partnerships with berg, 2013). Aboriginal organizations (Government of North- In 2016 DHSS tabled in the Legislative As- west Territories, 1998). A discussion of the root sembly a public commitment to Building a Cul- causes of poor health and social problems in that turally Respectful Health and Social Services Sys- document made no mention of social determi- tem, the first published document by the GNWT nants of health or the impacts of colonization and acknowledging that poorer health and social out- residential schools. The DHSS Strategic Plan for comes experienced by Indigenous Peoples in the 2011-2016 did not include any reference to health NWT are attributable, at least in part, to racism disparities between Indigenous and non-Indige- both inside and outside of the system (Govern- nous residents, although it did speak to the need ment of Northwest Territories, 2017). The 2017 for culturally relevant programming and the in- Strategic Plan, Caring for Our People, made ex- clusion of traditional values in program design plicit reference to the significant disparities in (Government of Northwest Territories, 2011). health status between Indigenous and non-Indig- Only in the past few years has the GNWT, enous residents, identified the need to incorporate and specifically DHSS, explicitly acknowledged equity into service delivery, and committed to that disparities in health outcomes between In- working in partnership with Indigenous govern- digenous and non-Indigenous Northerners are a ments to ensure culturally respectful delivery of direct result of the legacies of colonization and services (Government of Northwest Territories, residential schools, and that action is needed to 2017). Building on this, the 2019 Cultural Safe- address systemic racism in the NWT system. The ty Action Plan explicitly acknowledges systemic Truth and Reconciliation Commission’s 2015 racism within the system and lays out a plan to Photo credit: Debbie DeLancey Debbie Photo credit:

This photo shows the author and her two children on the Mackenzie River, upstream from Fort Good Hope, heading out to camp somewhere on the river, summer of 1983.

Northern Public Affairs, August 2020 33 increase Indigenous Peoples’ trust in the system vice delivery must be moved beyond the individual by creating an organizational culture of cultural practitioner level to the institutional level in order safety, honouring traditional knowledge and heal- to have a real and lasting impact. They note that, ing approaches in care, and improving the overall “The impact of a single good doctor or nurse who client and community experience (Government of builds respect, equality and trust into the relation- Northwest Territories, 2019). ship is not enough if the underlying policies and In any discussion of systemic racism it is im- structures are culturally unsafe.”5 Systemic racism portant to recognize that the NWT health and in today’s NWT health care system may not man- social service system is staffed by many caring ifest itself as overtly through racist statements and and committed practitioners who strive to pro- actions as was common less than 50 years ago; yet vide high quality, safe and respectful care, some- the system is still grounded in Western culture and times in very challenging circumstances, who belief systems, and still lacks any formal system- invest considerable effort in developing cultural ic acknowledgement of the validity of traditional competence, and seek to ensure that services they healing methods. deliver are culturally appropriate. In addition, nearly 25% of the employees of DHSS and the Looking to the future Northwest Territories Health and Social Services There are no easy solutions to address institution- Authority are Indigenous NWT residents, as are al racism that has resulted from centuries of colo- 64% of the Tłı̨chǫ Community Services Agency nization and oppression of Indigenous Peoples in staff who deliver health services (Government of Canada. Acknowledging that there is a problem Northwest Territories, 2018). and making a commitment to change are critical But systemic racism can’t be overcome by good first steps. The DHSS Cultural Safety Action Plan will at the individual level. The most enlightened contains a number of specific actions to be un- and well-meaning practitioners are still operating dertaken in 2019 and 2020 designed to advance within a colonial power structure. Brascoupe and the plan’s four objectives. But is this commitment Waters (2009), among others, have described how sufficient to achieve the goal of a health and social the concepts of cultural safety and equitable ser- services system that is trusted by Indigenous res- Photo credit: Debbie DeLancey Debbie Photo credit:

A picture of the author’s family’s spring hunt tent at the confluence of the Hume and Mackenzie Rivers, 1985.

34 Northern Public Affairs, August 2020 idents, respects Indigenous knowledge and meth- ministration and delivery of territorial and fed- ods, and achieves equitable population health eral health care programs and services. To date, outcomes? The problem is multi-dimensional, no NWT Indigenous government has acted on the and it takes more than culturally competent prac- ability to draw down these powers. If the GNWT titioners to break down the barriers that impede acts on the newly-stated priority of the 19th Leg- effective care. Also necessary are an understand- islative Assembly to implement UNDRIP, this ing and appreciation of the validity of cultural may result in changes to current GNWT negoti- beliefs and protocols, recognition and acceptance ating mandates and broaden the scope of future of traditional healing practices and the opportu- self-government agreements.6 nity to access them, and a willingness on the part In the event that one or more NWT Indige- of practitioners and policy-makers to acknowl- nous governments choose to exercise their author- edge that they bring not only privilege and power ity over some components of health care delivery, but their own world view and cultural lens to their their ability to do so will be constrained by the work. size of their beneficiary population relative to the Indigenous governments in Canada are in- resource-intensive demands of delivering health creasingly asserting their right to control health care services. Currently, GNWT faces challenges and wellness programming as the only means to in delivering health services to a small popula- eradicate systemic racism and ensure that care is tion distributed over a large geographic area with safe and appropriate. The United Nations Decla- transportation and infrastructure limitations. In ration on the Rights of Indigenous Peoples (UN- 2014, DHSS conducted an internal assessment DRIP) asserts that Indigenous Peoples have rights of the success of the fragmented regional man- to improve their social and economic conditions agement system for health and social services that (Article 20), to determine and develop priorities had been in place since the 1988 health transfer and be actively involved in developing and deter- from Canada, and determined that the approach mining health and other programs (Article 23), actually contributed to poorer health outcomes and to use their traditional medicines and main- for NWT residents, resulting in a system where tain their health practices (Article 24.1) (United clinical standards and clinical practice guidelines Nations Human Rights Council, 2014). Research varied among regions, where regions competed confirms that Indigenous groups with a higher de- for staff and were not equipped to share resourc- gree of self-determination enjoy better health out- es during times of crisis, where emergency pro- comes. Several models of Indigenous-led health tocols were unclear and inconsistent, and where care delivery systems have been implemented in patients often fell through the cracks when mov- North America, with demonstrated success in im- ing from one region to another for advanced care proving Indigenous health outcomes. (Government of Northwest Territories, 2014). There is potential for increased Indigenous The assessment also noted that in today’s world control of health and social program delivery in of increasingly complex and costly technology, NWT, but the transition will not be quick or easy, increased specialization of practitioners, and in- and there is no clear roadmap for how it can take creased regulatory requirements, it is simply not place. NWT faces substantial challenges to trans- feasible for small regional systems to deliver the forming governance of health care, including the full range of health services independently. This scope of current self-government agreements, the analysis identified integration of health and social complex Indigenous governance landscape in the services management structures as the means to NWT, and the operational realities of delivering improving health outcomes, resulting in the es- modern health services to a small, geographically tablishment in 2016 of the Northwest Territories dispersed population. Health and Social Services Authority. Indigenous governments in the NWT have This is the conundrum facing the NWT: there negotiated, or are in the process of negotiating, is compelling evidence to support the establish- self-government agreements that include juris- ment of Indigenous-controlled health service de- diction over some aspects of health and well-be- livery, and a commitment to implement UNDRIP ing, generally including child and family services, which acknowledges Indigenous Peoples’ right to adoptions, early childhood programs, and tra- do so; but there are equally compelling operation- ditional healing services; these agreements also al considerations which argue for health service include provisions to enable Indigenous govern- delivery to be managed on a broader scale to ments to negotiate a role in the management, ad- achieve quality care. (There are many definitions

Northern Public Affairs, August 2020 35 of what constitutes “quality care” but it is general- united front to federal or other governments when ly assumed to include achieving better population negotiating funding and service delivery agree- health outcomes and an improved patient expe- ments. rience while keeping health care delivery fiscally Such an approach may have potential in the sustainable.) Obviously, the NWT is not the first NWT, but given the current status of self-govern- jurisdiction to face this challenge, and we can look ment negotiations, it is not likely to be feasible in to best practices elsewhere for guidance. Howev- the short term. However, there is nothing to stop er, just as each jurisdiction is unique with respect Indigenous governments with completed self-gov- to its service delivery landscape and diversity of ernment agreements from assuming control over Indigenous peoples and cultures, so too must the programs and services that fall within the scope of solutions be home-grown. their agreements and that make sense given each The Assembly of First Nations’ Health Trans- government’s capacity and priorities. formation Agenda addresses this issue by ac- In the meantime, it is imperative that the knowledging the need to consider the unique cir- GNWT continue to advance its efforts to improve cumstances of every jurisdiction in the design and Indigenous health outcomes and embed cultural delivery of Indigenous health services, and noting safety in the current system. DHSS can look to the need for Indigenous governments to seek op- proven strategies for building trust and increas- portunities for shared decision-making with pro- ing Indigenous influence within a public health vincial and territorial health systems based on the care system. Based on a study of successful prac- principle of shared responsibility (Assembly of tices at Canadian Indigenous-led health practic- First Nations, 2017). Two successful models of In- es, Browne and others (2016) propose that there digenous-led health service delivery are the First are three dimensions to delivering truly equitable Nations Health Authority in B.C. and the Alaska primary health care within primary care systems: Native Tribal Health Consortium. In both these Culturally safe care, trauma and violence-in- cases, a diverse group of Indigenous governments formed care, and contextually tailored care, i.e. and organizations have joined forces in collabo- delivery of services that are explicitly tailored to rative governance structures which allow them to the local communities and populations that they deliver health services at scale and to present a serve.7 They outline strategies that have proven Photo credit: Debbie DeLancey Debbie Photo credit:

The author’s children riding in a sleigh behind the skidoo in 1983, going out to haul wood with their dad.

36 Northern Public Affairs, August 2020 successful as a means by which to operationalize This group, comprised of members appointed by these dimensions, some of which are reflected in Indigenous government organizations, does not the DHSS’ Cultural Safety Action Plan. As an appear to have any real authority or jurisdiction; over-arching strategy, they recommend the nego- its real value is in providing an opportunity for tiation of partnerships with Indigenous Peoples. all Indigenous groups and the DHSS to collab- More specifically, they identify the following as oratively identify issues, share ideas and develop critical components of building an equitable sys- common approaches. While this collaboration at tem: scale provides an opportunity to influence GNWT policy and practice, it does not open the door to • making explicit policy commitments to equity, sup- increased Indigenous authority. ported by organizational policies and processes; At the front lines, increasing the number of • creating a welcoming milieu in public spaces where Northern Indigenous health and social service people come to receive care and services; providers will play a critical role in the provision • ensuring that practitioners have the flexibility to of culturally safe and equitable care. Indigenous take the time that each patient or client requires; staff are also well positioned to influence the insti- • ensuring that service providers are aware of, and tutional and policy changes that will be required sensitive to, power differentials in their relation- to eliminate systemic racism. ships with patients and clients; These strategies will only succeed if the • tailoring service delivery to the needs and contexts GNWT is genuinely committed to negotiating of local communities; agreements with Indigenous governments that • actively countering systemic racism; result in much greater Indigenous influence and, • creating opportunities for meaningful engagement in some instances, control, over the delivery of of patients and community leaders in strategic health and wellness programs. The GNWT can planning processes; and also look to other external partners to provide • addressing trauma, violence and social determi- expertise and assistance, including, for example, nants of health in the delivery of care. the Arctic Indigenous Wellness Foundation, Hotıì ts’eeda, and the Institute for Circumpolar Health In the absence of truly Indigenous-led sys- Research. tems, best practices such as these from other systems can continue to inform the transition to a Conclusion more equitable health care delivery system in the Achieving the goal of an NWT health system NWT. that is trusted by Indigenous residents, that re- An essential step towards building trust is to flects Indigenous knowledge and culture, and that shift power relationships. Fadiman (1997) points provides access to Indigenous traditional healing to the lack of trust between Hmong refugees and practices, will not happen quickly or easily. In western practitioners and notes that trust cannot the longer term, it will be achieved through mov- be established when the westerners hold all the ing to Indigenous control of at least some com- knowledge. Brascoupe and Waters (2009) speak to ponents of health care delivery. In the interim, the need for “mutual empowerment” where In- NWT’s unique circumstances require the design digenous communities and individuals are equal of innovative solutions. This can be achieved if partners in developing solutions. Shifting power the GNWT commits to sustained investment requires non-Indigenous practitioners and poli- in developing a culturally competent workforce cy-makers not only to understand and acknowl- and makes a genuine commitment to negotiating edge the privilege that they hold, but also to rec- agreements with Indigenous governments that ognize that the cultural protocols and beliefs they move towards shared responsibility for health and bring to their work are not inherently more valid wellness-related service delivery. Success will also than those of Indigenous cultures. require commitment and engagement by Indige- DHSS has taken cautious first steps towards nous governments and communities. sharing power with the establishment of an In- There is no quick fix that will overturn system- digenous Advisory Body with members appoint- ic racism in the health and social services system. ed by Indigenous governments in the NWT to Today’s situation is the product of more than two guide policies, programs and overall implementa- centuries of colonialism in Canada, and system tion within the health and social services system improvements will take place over decades. But (Government of Northwest Territories, 2018). the ingredients for success are present: public ac-

Northern Public Affairs, August 2020 37 knowledgement that change is needed, GNWT’s Browne, A. J., Varcoe, C. M., Wong, S. T. et al. (2012). Clos- commitment to building cultural safety, self-gov- ing the health equity gap: Evidence-based strategies for primary health care organizations. International Journal for ernment agreements that provide the opportunity Equity in Health 11, 59. for enhanced Indigenous control, and active and Browne, A. J., Varcoe, C. M., LaVoie, J. et al.. (2016). En- engaged Indigenous governing organizations that hancing health care equity with Indigenous populations: want to improve the quality of life for their ben- evidence-based strategies from an ethnographic study. BMC Health Serv Res 16, 544. eficiaries. Y Fadiman, A. (1997). The Spirit Catches You and You Fall Down. New York: Farrar, Straus and Giroux. Debbie DeLancey has worked in the Northwest Territories Government of Northwest Territories. (1992). Traditional with Indigenous organizations and the Government of the Knowledge Policy. Yellowknife: Government of Northwest Territories. Northwest Territories for more than 40 years. Debbie has Government of Northwest Territories. (1998). Strategic Plan for an MAE in evaluation from the University of Melbourne Health and Wellness. Yellowknife: Government of Northwest and holds the Credentialled Evaluator designation with the Territories. Government of Northwest Territories. (2001). Social Agenda: Canadian Evaluation Society. Her interests include health A Draft for People of the NWT. Yellowknife: Government of systems policy, land-based programming and advancing the Northwest Territories. utilization of Indigenous evaluation approaches. Government of Northwest Territories. (2011). Building on Our Foundation 2011-2016: A Strategic Plan for the NWT Health and Notes Social Services System. Yellowknife: Government of Northwest Territories. 1. Government of the Northwest Territories (2018) defines Government of Northwest Territories. (2014). Caring for our cultural safety as, “…an outcome where Indigenous peoples People: Improving the Northwest Territories Health and Social Ser- feel safe and respected, free of racism and discrimination, vices System. Yellowknife. August 2014. when accessing health and social services programs and Government of Northwest Territories. (2017). Building a Cul- services.” turally Respectful Health and Social Services System. Yellowknife: 2. Nicole Redvers has provided a contemporary discussion of Government of Northwest Territories. the validity of traditional medicines and healing practices Government of Northwest Territories. (2017). Caring for Our in her recent book, The Science of the Sacred. People: Strategic Plan for the NWT Health and Social Services 3. These experiences are well documented in other jurisdic- System 2017-2020. Yellowknife: Government of Northwest tions. See, for example, Allan & Smylie (2015). My asser- Territories. tion about their prevalence in NWT is based primarily on Government of Northwest Territories. (2017). Recommendation having had the opportunity over many years to hear from from Critical Incident Investigation. News release: February 28, NWT Indigenous residents about their experience with the 2017. Retrieved from https://www.gov.nt.ca/en/news- NWT health system, in both public and private discussions. room/news/recommendations-critical-incident-investiga- 4. See “Recommendations from Critical Incident Investiga- tion tion,” GNWT News Release, February 28, 2017. Government of Northwest Territories. (2018). Public Service 5. Brascoupe, Simon and Waters, Catherine. (November Annual Report 2017-2018. Yellowknife: Government of 2009). Cultural Safety: Exploring the Applicability of the Northwest Territories. Concept of Cultural Safety to Aboriginal Health and Com- Government of Northwest Territories. (2019). Caring for Our munity Wellness. Journal of Aboriginal Health, 6-41. People: Cultural Safety Action Plan 2018-2020. Yellowknife: 6. On October 25, 2019, the Caucus of the newly elected Government of Northwest Territories. 19th Legislative Assembly of the Northwest Territories re- Irlbacher-Fox, S. (2009). Finding Dahshaa. Vancouver: UBC leased its priorities for action, one of which is to implement Press. the United Nations Declaration on the Rights of Indige- Legislative Assembly of NT. (2019). Caucus Identifies Proirities for nous Peoples. the 19th Legislative Assembly. News release: October 25, 2019. 7. This reference is particularly relevant to this discussion Retrieved from: https://www.assembly.gov.nt.ca/docu- because it presents findings of a recent Canadian study that ments-proceedings/news-releases included primary research grounded in Indigenous episte- Redvers, N. (2019). The Science of the Sacred: Bridging Global mologies as well as drawing on an extensive bibliography Indigenous Medicine Systems and Modern Scientific Principles. that includes recent Canadian work in this area. Berkeley, CA: North Atlantic Books. Truth and Reconciliation Commission of Canada. (2015). References Truth and Reconciliation Commission: Calls to Aaction. Winnipeg: Allan, B & Smylie, J. (2015). First Peoples, Second Class Treatment: Truth and Reconciliation Commission of Canada. The role of racism in the health and well-being of Indigenous peoples United Nations Human Rights Council. (2014). Report of the in Canada. Toronto. ON: The Wellesley Institute. Special Rapporteur on the rights on indigenous peoples, James Anaya: Assembly of First Nations. (2017). The First Nations Health The situation of indigenous peoples in Canada. Transformation Agenda. Ottawa: Assembly of First Nations. Wohlberg, M. (2013, November 4). NWT ‘dropping the ball’ Brascoupe, S. & Waters, C. (2009). Cultural Safety: Explor- on Aboriginal health, deputy minister admits. Northern ing the Applicability of the Concept of Cultural Safety Journal, p. 1. Retrieved from: https://norj.ca/2013/11/ to Aboriginal Health and Community Wellness. Journal of nwt-dropping-ball-on-aboriginal-health-deputy-minis- Aboriginal Health, pp. 6-41. ter-admits/

38 Northern Public Affairs, August 2020 Hotıì ts’eeda – WORKING TOGETHER FOR GOOD HEALTH Conducting research in the Northwest Territories: Perspectives from a health and social science researcher

Pertice Moffitt

ell-developed and executed research proj- interest, and courage). I want to share two research ects conducted in the Northwest Territories projects that were both conducted when I was learn- (NWT)W are important activities. Research is vital to ing to be a researcher as a graduate student (Moffitt identify critical issues, needs, and gaps in knowledge & Wuest, 2002; Moffitt, 2007). Both of these studies about the realities of our context. It measures health were completed in our territory with local people outcomes and social responses so that we can better and both of them inform my understanding and be- our health care system. It helps us describe possibili- liefs about community and relationship. ties and then take actions to move forward while recognizing the important role that relationships with Spirit of the Drum local people play in the research process. When I began graduate studies, I was an educator In this paper, I describe research studies I have at Aurora College. Nursing faculty were all nurses conducted in the territory, illustrating the relevance from southern Canada (including myself) while the of four themes through photographs and stories. nursing students in our classes were a diverse group These themes are building community relation- of Indigenous men and women, newcomers to Can- ships; designing research according to community ada, and settlers to the territory. Our nursing world- priorities; drawing on the strengths of community views were developed from biomedical perspectives members and Indigenous knowledge; and locating that contrasted greatly with the distinct worldviews oneself as a non-Indigenous researcher. From these of the Indigenous and newcomer students. From highlights, best practices for research in the NWT this nursing education context, a research question will be developed and shared. grew on how to integrate non-Western culture into nursing practice. Through “fourth generation evalu- Building community relationships ation”1 (Guba & Lincoln, 1989), I was able to iden- Building relationships takes time, effort, commit- tify concerns, issues, and claims from 16 participants ment, authenticity (being the real you), and being re- (graduates, faculty and patients) about the inclusion lational (interacting with kindness, humility, genuine of non-Western culture in care and my findings were Photo credit: Pertice Moffitt Pertice Photo credit:

Dr. Pertice Moffitt

Northern Public Affairs, August 2020 39 described in a model called “Spirit of the Drum” of this research was a focused ethnography that rec- (Moffitt & Wuest, 2002). ommends living and interacting with people in the At the centre of the model that I developed is course of their everyday lives, a process called pro- care and caring. Fundamental to every relationship longed engagement. I spent a great deal of time with is care. Care involves heartfelt and mindful inten- mothers, for example, attending prenatal classes, tion with the meeting of each new person. Then, going with them for their health visits to the com- surrounding the care are ways of being (interactive, munity health nurse, being with them during labour receptive, inquisitive, and reflective) to enact a con- and delivery, and attending special events such as versation, hold appreciation for another human, and baptisms. I was able to develop close relationships create a relationship. Northern knowledge for nurs- that are still present today. These relational activities ing was identified as integrating knowledge from four helped me come to know the community and creat- sources: Traditional knowledge (Elders’ teachings, ed a familiarity and comfort for women to volunteer healing circles, language usage and revitalization, In- to participate in the study and invite other women to digenous medicine, land experiences); individual and participate. This became a “snowball process” de- community values (diverse healing methods, good veloped by community women who, along with their and bad medicine, role of interpreters, consensus, networks, agreed to participate in the research. self-government); nursing curriculum (make connections, validate experiences, role model and mentor, Designing research to address community Kleinman’s [1978] explanatory model, relevant case priorities studies); and, scientific knowledge (caring, nursing, Community participation is a process that enables a learning). From this early theorizing about nursing researcher to design a study in collaboration with the practice, the inclusion of difference and traditional community. Participation occurs throughout the re- knowledge were operationalized into open dialogue, search process by including decisions about research sharing circles, conflict resolution and a process of needs or priorities, who will do the research, how the spirit expressed as heart, caring and love, identified study will be conducted, and how the findings from as necessary to establish healthy relationships. the study will be shared and given back to the community. In this section, I will describe this process Keep myself well through three examples of research projects that I During doctoral research with pregnant Tłıchǫ conducted with colleagues focusing on quality of life women, I began a process of coming to know the for older adults in the territory, intimate partner vi- community prior to beginning the study. I visited olence, and cultural practices around breastfeeding. the community and spoke with Jim Martin, Chief Executive Officer, Tlicho Health and Education Au- Quality of life of older adults thority at the time, who offered good advice for de- The health and well-being of older adults is a pri- veloping a relationship by working with Indigenous ority in Canada (Muscedere et al., 2017; Nykifo- women attending prenatal classes. I was encouraged ruk, Rawson, McGetrick, & Belon, 2019) and in the to hire a translator to bridge the language difference NWT where Elders are valued as knowledge keepers and receive more specific understandings of local (Brooks-Cleator & Giles, 2016). I was approached stories. After just a few days in the community, the by the NWT Seniors Society to complete a study on translator said that Elder Elizabeth Mackenzie would quality of life of older adults (Moffitt & Timpson, like to talk with me. This speaks to the smallness of 2015). The mandate of the NWT Seniors Society the community and the community’s awareness of is “to promote the independence and well-being of the presence of strangers. I went to the meeting with older citizens through the provision of programs a sense of nervousness that was quickly put to rest and services in partnership with responsible govern- when I was welcomed by the Elder. She wanted to ment departments and other organizations.” The know about who I was, what I hoped to accomplish, idea and question for this research came from older and why this would be important to her community. adults across the territory when they came together The Aurora College Learning Centre in the for meetings of the Seniors Society. They wanted to community employed a local adult educator, Mary document both positive and negative influences on Richardson, who I visited and spent time with while older adults and asked generally, “What are the in- in the community. Although I knew the nurses at the fluences on older adults in our territory?” Because Marie Adele Bishop Health Centre, I chose to im- these older adults proposed the question and re- merse myself with local meetings and local people, quested the research, they were invested in the study as community people recommended. The method and volunteered to participate to share their stories

40 Northern Public Affairs, August 2020 of living as an older person in our territory. In ad- seven strategies to address IPV with specific ac- dition, they wanted the concerns of older adults to tions under each strategy. These strategies included be described so that they could carry the report to knowledge mobilization, education and awareness, the government and get their concerns addressed. stable, adequate funding, coordinated response strat- This is how a community-based participatory action egy, assessment and screening, social supports and research (CBPAR) project is born: the research ques- community healing (Moffitt& Witkowski, 2017). tion comes from the community. With this process, the participants were frontline In this study, focus groups and personal inter- service providers. Community engagement involved views were conducted with older adults in NWT special permissions to access statistical databases for communities (Moffitt & Timpson, 2015). Through mapping the incidence of violence from the RCMP a snowball and purposive sampling technique, older and to request approval to interview frontline work- adults assisted with the recruitment of participants. ers across the territory. The stories were difficult to Data were analyzed by the researchers and validated tell and hard to hear, requiring a safe space to talk through the Seniors Society. When the report was and attention to the well-being of people who shared written and disseminated, the Seniors Society took their personal suffering. Telling stories is healing for the report to the Legislative Assembly2 where it was participants and their stories feed into a means of tabled on behalf of the Society by the MLAs. This is addressing family violence in the territory. Learning the action piece of the research that was led by older about the local context of violence, interventions can adults for older adults. At all steps of the research be implemented that are targeted and relate to local process, the community was engaged so the research needs, thus improving health outcomes. itself was participatory, collaborative, empowering and socially just. Drawing on strengths of community members and Indigenous knowledge Rural and Northern community response to Traditional knowledge is integral to communi- intimate partner violence ty-based research in the remote communities of the From 2011-2017, a study on intimate partner vio- territory, particularly with women’s traditional prac- lence (IPV) in the Canadian prairie provinces and tice of breastfeeding. As knowledge keepers, women the NWT was funded by the Social Sciences and shared their skills, abilities, and knowledge through Humanities Research Council (Moffitt & Fikows- generations of this natural practice to promote the ki, 2017). This study was a collaboration between health and well-being of their children and to sur- community groups (shelters) and academics (com- vive in what Elders referred to as harsh climates on munity-based anti-violence researchers). The local the land. community groups and academics came together to write the proposal; thus, the research process was Breastfeeding studies in the NWT community-based in each jurisdiction. In the NWT, During my doctoral research, it was apparent that the partnership3 was between Aurora College and many new parents were opting to bottle-feed their the NWT YWCA. The research questions for the new infants even though most Elders in the Tłįchǫ study were 1) What are the unique needs of victims region told me they breastfed their babies and health of IPV? 2) What are the gaps that exist in meeting professionals’ promotion efforts were aimed at exclu- these needs? and 3) How do we create non-violent sive breastfeeding for the first six months. Elders in communities? The design of the study was geared the community questioned this change from breast to these research questions. We used geographic in- to bottle, and also noticed that new mothers were not formation system (GIS) mapping to create an inter- comfortable breastfeeding their babies in public plac- active tool that provided a stimulus for conversation es. They wondered why this change had occurred. I around the number of incidents of IPV compared proposed a study to investigate breastfeeding experi- to the available resources. As well, we interviewed ences in Behchokǫ̀, that included interviewing new frontline service workers to create a narrative de- mothers, collecting infant feeding statistics, and cre- scribing the community response and profiling IPV ating and implementing knowledge translation tools in the NWT. We completed two focus groups con- (Moffitt & Dickinson, 2016). The findings of this sisting of frontline service providers in remote NWT study identified low rates of exclusive breastfeeding. communities. We then created an action plan based Because of these findings, I was approached to con- on the model of community responses in the territo- tinue the work across the territory. ry to IPV and to the specific needs and gaps identi- In 2017-2018, a study on the nature of breast- fied through the research. The action plan identified feeding in the territory utilized three methods: Ex-

Northern Public Affairs, August 2020 41 amination of health records, individual interviews, Elder, Jane Dragon, and I presented the findings on and sharing circles4 with Indigenous grandmothers the radio. Having these Elders co-present established and great-grandmothers (Moffitt, 2018). An adviso- the knowledge, wisdom and guidance that Elders ry group of Indigenous Elders and a steering com- brought to the study. As well, Elders are recognized mittee of Indigenous health officials directed the by the community as the knowledge keepers and study. Having an Indigenous steering committee their presence as knowledge co-producers validated was essential for designing, conducting, and ensur- the findings and connected this knowledge back to ing the relevance of the research project for those local women, where it belongs. All of these events targeted for participation. For example, advice and strengthened the relationship between me as a re- direction was given by the committee on all aspects searcher, and the Elders, as we each came to know of the research including elements such as the data each other. collection tool (protocol, approach), the revision of the way that questions were phrased and asked, and Locating oneself as a non-Indigenous re- the addition of more questions to ensure that all of searcher the information needed was sought in a good way. Research must be conducted in an ethically sound The committee members were a conduit to their and culturally safe manner that accounts for who we communities, helping to bring other community are and how and where we live as fundamental to women into the study. (The relationship between the research process and our journey as researchers. the researcher and the community is strengthened Throughout my career as a researcher, I have main- when your entry to the community is through a well- tained a reflective, mindful and enquiring stance known community member.) In addition, the Elders within the studies I am a part of. This began when on the advisory group were experienced mothers I was a graduate student working on a publication and were able to transmit their knowledge and ex- where a group of fellow colleagues questioned the pertise within the study. As well, local Indigenous institutional ethical review standards with our com- women from six distinct cultural groups shared sto- munity research experiences and the limited guid- ries of birthing and mothering their children that ance that these standards provided in a Northern provided robust historical birthing stories and tradi- context (Davison, Brown & Moffitt, 2006). We rec- tional breastfeeding knowledge. In Tulita, four gen- onciled the standards with community realities in erations of Dene mothers took part in the develop- the way we were negotiating consent, navigating ment of a breastfeeding video. When the findings of our community relationships, and seeking rapport the research were reported to the public at the Great with participants and community. Hall of the Legislative Assembly, two Elders, Rosa Today, I continue to think about my position Mantla and Florence Barnaby, reported with me, as a non-Indigenous researcher and my perspec- co-producing the knowledge translation. Another tive on being an ally and co-learner as I generate Photo credit: Pertice Moffitt Pertice Photo credit:

Figure 4. Seniors Society hear their report at the Legislative Assembly.

42 Northern Public Affairs, August 2020 knowledge that answers Northerner’s questions. Community priorities Of utmost importance is maintaining humility and Research in the territory must address a need or openness to work in partnership with Indigenous help to improve a current situation leading to pos- Northerners to define research questions, priorities, itive outcomes for the residents of the territory. In solutions and actions to improve the well-being of the examples used above, the studies evolved from all Northerners. This means practicing research such a need. As well as communities identifying in a way that respects traditional knowledge, oral their priorities, the research institutes and govern- traditions, Indigenous methodologies and strength- ments in the territory, in consultation with commu- based processes. In the same way, I must bring for- nities, identify research agendas based on feedback ward what I can offer the territory as an ally. These from local people. Once a polytechnic university is are: Recognizing historical legacies and current re- established in the territory, it will be important for siliency and work of Indigenous scholars; creating students and faculty to be attuned to these priorities. partnerships that are mutually respectful; and acknowledging that I am an ally for improved health Strength-based and capacity-building ap- outcomes. proaches Involving local people in research at all levels of the Best practices for Northern research process will enhance the rigour of the study in terms From the three studies described above, I have de- of credibility, transferability, dependability and con- veloped an understanding of best practices that firmability. By working with Indigenous Northern- may serve as reference for academics, government ers on an ongoing basis, the researcher establishes planners and students conducting research in the prolonged engagement and mentoring that works NWT. both ways, between researcher and participants. Recognizing the knowledge that local people hold to Partnership, collaboration and trust solve local problems respects community strengths. One overarching aim for conducting research is to In addition, collecting and the data and sharing the create ethical space of partnership, collaboration analysis process enhances individual and communi- and trust. This was created by building my relation- ty capabilities and capacities of both researcher and ship with Northern communities by frequent visits, participants. telephone calls or meetings in Yellowknife. Some- times meetings are happenstance, but with each Knowledge translation/mobilization meeting, community people come to know you so Evidence from studies in the territory must have a that each interaction builds on the next. D’souza plan, action or outcome that feeds the results back and others (2018) describe this as a negotiation pro- to the community. In the studies shared in this pa- cess, since inherent power imbalances are present per, a variety of tools have been used, including vid- based on colonial legacies, structural inequities, eos, booklets, infographics, reports and livestream- patriarchy, and the positionality of researcher and ing through, for example, a “LegTalk” organized participants. Ongoing consent is essential and pro- through the Legislative Librarian. Live streaming fessional boundaries must be forged. This means vehicles, in particular, allow the talk to be broad- that “negotiating and renegotiating is an ongoing cast across the territory and reach more community part of the research process…to achieve a balance people. As well, a large audience can gather at the in dealing with issues of power, access and respect” talk to ask questions that help to improve under- (D’souza, 2018, p.35). For that reason, during the standing. research process we must intentionally reflect on interactions with participants, check in with their Reflection comfort, and make every attempt to maintain a safe Critical thinking about how the research process is space for sharing. developed and conducted is essential to decoloniza- Absolon (2011) identifies spirituality as a guide- tion and reconciliation. If we are to avoid repeating post for researchers. She describes creating cultural- harmful research approaches in terms of structural, ly congruent spaces through prayer, ceremony and systemic and institutional power imbalances, then protocols and a worldview shared with local people. researchers must develop authentic relationships Research conducted in this way, she states, involves with participants and communities. This means we working from the heart and with Elders who can as researchers must examine our own assumptions, guide the process and create an ethical space for biases and processes from an equitable and open sharing. standpoint that invites participation and sharing,

Northern Public Affairs, August 2020 43 and a willingness to change approaches as we are 4. The breastfeeding study in the Tłı̨chǫ region in 2013 was given instruction and guidance from participants. a follow-up study to doctoral work. Through an internship opportunity with PHAC, Raissa Dickenson, a UBC graduate student, was hired and worked with Pertice in Behchokǫ̀. Conclusion The sharing circles in the 2017/2018 study Learning from Over the years, I have learned and continue to learn Mothers, Grandmothers and Great-Grandmothers about about conducting research. The stories and pho- Breastfeeding in the NWT occurred in four regions of the NWT (Beufort-Delta, Sahtu, DehCho ad South Slave). The tographs of my journey as a Northern researcher grandmothers (n=48) self-identified as Indigenous (Dene demonstrate a way to know, how to be, and how to [60%], Métis [5%], Inuvialuit [30%], Inuit [1%]). do research. My research uses methods that build relationships, address priorities, and honour and References respect the strengths of Indigenous people. I locate Absolon, K.E. (2011). Kaandossiwin: how we come to know. Winni- peg, CA: Fernwood Publishing. myself within the research process as an ally for im- Brooks-Cleator, L.A., Giles, A.R. (2016). Culturally relevant proved health outcomes. Every project tells new sto- physical activity through Elders in Motion: physical activity ries and it is both exciting and rewarding to know programming for older Aboriginal adults in the Northwest that I am contributing to finding solutions to com- Territories, Canada. Journal of Cross-cultural Gerontology 31, 449- 470. doi:10.1007/s10823-016-9307-z Y plex problems. Davison, C.M., Brown, M., & Moffitt, P. (2006). Student researchers negotiating consent in Northern Aboriginal Dr. Pertice Moffitt is Manager/Instructor, Health Research communities. International Journal of Qualitative Methods, 5(2). Re- Programs, with Aurora Research Institute. She teaches nursing trieved from http://www.ualberta.ca/~iiqm/backissues/5_2/ HTML/davison.htm at Aurora College and has conducted research locally, nation- D’souza, N.A., Guzdar, J., Hickling, F., & Groleau, D. (2018). ally and internationally for the past twenty years. Her research The ethics of relationality in implementation and evaluation interests include women’s health, Indigenous health, and rural research in global health: reflections from the Dream-A-World and remote nursing using community-based and qualitative program in Kingston, Jamaica. BMC Medical Ethics, 19(Suppl 1) 50. https//doi:org/10.1186/s12910-018-0282-5 methods. Guba, E.G., & Lincoln, Y.S. (1989). Fourth generation evaluation. Newbury Park, CA: Sage Publications. Notes Moffitt, P. (2018). Learning from mothers, grandmothers and great-grand- 1. Fourth generation evaluation (Guba & Lincoln, 1989) is a mothers about breastfeeding in the Northwest Territories. Retrieved from method that aligned well to the evaluation of the cultural https://www.hss.gov.nt.ca/sites/hss/files/resources/learn- component of our Northern nursing program. This method is ing-_mothers-grandmothers-breastfeeding-nwt.pdf an interactive, dialectic approach that engages all three groups Moffitt, P., & Fikowski, H. (2017). Northwest Territories research project of stakeholders (graduates and faculty from the program and report for territorial stakeholders: rural and Northern community response patients) to reach consensus about the topic under review, to intimate partner violence. Yellowknife: Faculties of Nursing and which was cultural care. The process itself is circular and Social Work, Aurora College. involved the following steps: explored the different views of Moffitt, P., & Timpson, B. (2015). Influences on quality of life of the stakeholders, summarized the constructions of each group, older adult in the Northwest Territories. Retrieved from http://www. developed a consensus on the emerging model through several nwtseniorssociety.ca/wp-content/uploads/2013/11/QOL- negotiations, first at the group level and then with representa- Report-Updated-on-Jan-12-2015.pdf tives of each of the three groups. Moffitt, P. (2007). “Keep myself well”: Perinatal health beliefs and health 2. The report was tabled on March 6, 2015 and can be found promotion practices of pregnant Tlicho women. Dissertation: Univer- here: https://www.assembly.gov.nt.ca/sites/default/files/ sity of Calgary, Calgary, AB. td215-175.pdf Moffitt, P., & Wuest, J. (2002). Spirit of the drum: the develop- 3. This partnership between academics and community groups ment of cultural nursing praxis, Canadian Journal of Nursing occurred in each of the four jurisdictions (NWT, Alberta, Sas- Research, 34(4), 107-116. katchewan, Manitoba). Dr. Mary Hampton, Luther College/ Muscedere, J., Kim, P., Aitken, P., Gaucher, M., Osborn, R., University of Regina, was the Principal Investigator. She is a Farrell, B., Holroyd-Leduc, J., …Burry, L. (2017). Proceedings feminist and social justice advocate who led the collaborations of the Canadian Frailty Network Summit: medication optimi- in a participatory manner. The academics and community and zation for frail older Canadians, Toronto, Monday, April 24, family justice partners worked together to develop the research 2017. Canadian Geriatrics Journal, 20(4), 253-263. https://doi. questions and met annually to further plan and share progress org/10.5770/cgi.20.293 over the five years. The overall research strategy followed was Nykiforuk, C.I.J., Rawson, D., McGetrick, J.A., & Belon, A.P. community-based participatory action research that adhered (2019). Canadian policy perspectives on promoting physical to the common elements of a collaborative approach: equal activity across age-friendly communities: lessons for advocacy status of participants; research questions defined by commu- and action. Ageing and Society, 39, 307-339. https://doi: nity participants; and analysis and interpretation of results in 10.1017/So144686X17000939 affiliation with community participants toward taking action Wallerstein, N., & Duran, D. (2008). The theoretical, historical, (Wallerstein & Duran, 2008). Through these steps, we gained a and practical roots of CBPR. In M. Minkler & N. Wallerstein better understanding of existing community responses to inti- (Eds.). Community-based participatory research for health from process to mate partner violence and generated policy recommendations outcomes (2nd ed.) pp22-46. San Francisco, US: Jossef-Bass. to meet the needs of communities. The NWT action plan was disseminated to government officials, community participants and local frontline service workers (Moffitt & Fikowski, 2017).

44 Northern Public Affairs, August 2020 Hotıì ts’eeda – WORKING TOGETHER FOR GOOD HEALTH

Project Jewel: Innovation in evaluating an on-the-land program

Mary Ollier, Audrey R. Giles, Meghan Etter, Jimmy Ruttan, Peggy Day, Nellie Elanik, Ruth Goose, Esther Ipana, Sarah Rogers,Evelyn Storr, Francine Darroch, & Tricia McGuire-Adams

We don’t need doctors and hospitals for the most part to heal our human condition. We need each other. – Project Jewel participant

here is a growing demand for land-based pro- camp, participants receive aftercare through regu- grams, which deliver services that promote lar check-ins with the aftercare coordinator either positiveT well-being outside of community settings in in-person, over the phone, or through social media the North. But with this demand has come pressure (i.e., Facebook). for accountability and evaluation. Do these pro- Project Jewel staff partnered with a diverse team grams work? If so, how? Should they be funded? If of researchers to collaborate on a research project so, by whom? to understand three things. First, could Project The results of program evaluation can be Jewel be evaluated in a way that promotes cultural used to understand whether a land-based program safety (i.e., in a way that addresses the social, his- achieves its goals, to improve the program, and to torical, and cultural contexts that shape partici- justify why it should receive funding. Nevertheless, pants’ experiences)? Second, what are the specific Western approaches to evaluation that prioritize elements that participants identified as being nec- non-Indigenous values and worldviews have a his- essary for Project Jewel’s success? And finally, what tory of reinforcing colonialism because such ap- are the benefits that Project Jewel participants ex- proaches do not prioritize cultural protocols within perienced as a result of their participation in the communities, such as including Elders as the pri- program? To answer these questions, we used a mary determiners of the quality of the evaluation community-based research (CBR) approach to design (LaFrance & Nichols, 2010). In Canada, a identify appropriate evaluative research methods. settler colonial country, Western approaches to eval- This included semi-structured interviews, sharing uation are dominant, even for land-based programs circles, and photovoice with Project Jewel partici- that are rooted in Indigenous ways of knowing. pants and semi-structured interviews with Project Currently, there are no evaluation frameworks for Jewel staff, stakeholders, and past participants. We land-based programs from Inuvialuit perspectives. then piloted these methods by attending five Project Project Jewel is a land-based wellness program Jewel camps and meeting with Project Jewel staff, for the residents of the Inuvialuit Settlement Region stakeholders, and past participants in person or over (ISR). It offers one- to ten-day on-the-land camps the phone. Through the consequent activities, we approximately six times per year. The camps are created an evaluation framework that included the open to all residents of the ISR. Each camp tar- following key elements: centring the land, building gets residents who may be struggling with a certain relationships, working with pictures and words, and issue (e.g., addiction, trauma, poverty), in order to promoting benefits by minimizing harms through improve health and wellness by engaging partici- aftercare. pants in Inuvialuit traditions on the land (i.e., trap- Below, we share the process that we went per training, whaling, berry-picking). Camps are through to create an Inuvialuit-informed evaluation attended by no more than 12 participants. They framework for Project Jewel that promoted cultur- are led by the on-the-land coordinator, aftercare al safety by centring Inuvialuit values and ways of coordinator, and support staff including Elders and knowing. We also present what we learned about cultural support workers. After participating in a Project Jewel through the iterative process of ap- Northern Public Affairs, August 2020 45 plying and refining this framework. We present the the guidance of Elders, we first participated in Proj- results from our research in this article for the first ect Jewel camps alongside participants. Towards time. the end of each camp, we tried out our research methods. By participating in the camp, we were Our evaluation process able to build relationships with participants on the A diverse research team of Indigenous and non-In- land before asking them to participate in research. digenous members, we sought to use CBR to ground In total, we attended five camps over a two-year our approach in community and Indigenous owner- period. During the same time period, we collected ship. Importantly, as the team included non-Indig- data with 13 Project Jewel participants: Three past enous members, we have not labelled our approach Project Jewel participants, and 10 stakeholders, in- as a form of Indigenous evaluation. In CBR, com- cluding IRC staff and health professionals from the munity members meaningfully contribute to the re- community of Inuvik who had worked with Project search so that they can co-create, co-determine, and Jewel camps in the past. All research data are owned participate in the project. By approaching research by the IRC; participants provided informed consent in this way, we made sure that Inuvialuit access, before participating, and gave consent to have their ownership, and control over data and information data, including photos, included in the research re- were respected, which is a priority in the National sults. We were committed to meaningful collabora- Inuit Strategy on Research (NISR) (Inuit Tapiriit tion at all stages of the CBR process, including data Kanatami, 2018). analysis. Elanik, Goose, Ipana, and Ollier themati- A community advisory board guided the proj- cally analyzed all transcripts by going through them ect. The board included Sarah Rogers, an Inuvialuit line-by-line and discussing codes that were then Elder, Nellie Elanik and Esther Ipana, two Inuvial- grouped to determine key themes. The themes were uit Project Jewel participants, Peggy Day, an Inuvi- then taken back to the research team and communi- aluit IRC aftercare coordinator with a counselling ty advisory board members and finalized. background, and Ruth Goose, an Inuvialuit and Gwich’in Elder working for IRC. The community Co-creating an Inuvialuit-informed ap- advisory board worked with the research team to proach to evaluating Project Jewel make decisions about how the research would be In our analysis, we identified four themes that pro- conducted. Their expertise complemented the re- moted cultural safety within our evaluation frame- search knowledge of members of our research team. work: Centring the land, building relationships, After identifying and discussing our options, we working with pictures and words, and promoting decided to try three evaluation methods with Proj- benefits by minimizing harms through aftercare. ect Jewel participants to see which might be the best For the purposes of this article, we selected sin- fit for our eventual evaluation framework: Sharing gle quotes to demonstrate each theme below; the circles, semi-structured interviews, and photovoice. themes are supported robustly in the data. To use photovoice, participants were given camer- The land is at the centre of Project Jewel pro- as to use throughout their participation in a Project gramming. During a sharing circle, a Project Jewel Jewel camp, and asked to take photos that they felt participant emphasized that being on the land was expressed what Project Jewel meant to them. crucial to well-being: “The land is so important and Our research process was iterative. Following the Elders always tell us, you know, to continue go- Photo credit: Inuvialuit RegionalPhoto credit: Corporation

Photo 1. “Being out on the land is where we feel comfortable, and we do anything out here. So what we’re trying to do in this world is survive, and what better place to do it than out on the land. It’s easier to talk out here.” – Project Jewel participant.

46 Northern Public Affairs, August 2020 ing out on the land.” Another program participant that were shared through these methods provided used photovoice to describe the importance of the rich feedback about Project Jewel. For example, land to their experiences (Photo 1). Nellie, a Project Jewel participant and community Based on these statements, we decided that advisory board member, used photovoice to de- Project Jewel’s evaluation needed to reflect how im- scribe her experience of the program. portant it is for participants to be out on the land; We also identified that it is important for Proj- it should be guided by their discussions of the land, ect Jewel to promote benefits for participants while how they feel on the land, and their needs and com- minimizing harms through effective aftercare. Af- fort on the land. tercare is a crucial part of making sure that par- Relationships must be built between staff and ticipants benefit from land-based programming. For participants during the course of a camp before any example, Eva, a past Project Jewel participant, ex- kind of program evaluation takes place. Ruth, an plained how aftercare helped her: IRC staff member for Project Jewel, said that participants feel more comfortable sharing their thoughts It was actually quite easy for me [to have aftercare] when a relationship exists with staff: “Relationship because, well, I work in the [IRC] department. So, building is one of the first things that needs to hap- it was more easily accessible for me because Peggy pen [for evaluation], and that happens really good [Aftercare Coordinator for Project Jewel] was here, on the land [during a camp].” Jimmy [On-the-land Coordinator for Project Jewel] We also found that participants were able to was here – if I wasn’t feeling quite right – I don’t share their personal stories by taking photos and know how to word it, I’ll just go to them. But yeah, discussing them in an interview during photo- they’ve helped me … occasionally I will come to voice, and during sharing circles and one-on-one them for something. Just to either talk with them or semi-structured interviews. The pictures and words even just to sit and cry.

We found that it is important for Project Jewel staff to consider how to promote effective aftercare for each participant and to ensure that participants can access it. Sometimes it is challenging to deliver aftercare to participants who do not have phone or internet access, or who are experiencing homeless- ness. The program evaluation needs to address these challenges for each participant so that Project Jewel can tailor aftercare to meet participants’ needs. The four themes were used to create an evaluation tool for Project Jewel with the goal of ensuring that the evaluation approach reflects and respects Inuvialuit values. The research team, including the advisory committee, developed a pre- and post- camp semi-structured interview guide, a sharing circle guide, and a photovoice guide to be completed during Project Jewel camps (see tables below). The intention was to confirm tools for use at every Proj- ect Jewel camp, and that the data collected should be analyzed once per year. The tool will require

Photo credit: Nellie Elanik Photo credit: designated staff to invest the time and energy that is needed to produce meaningful, high-quality eval- Photo 2: “It’s been difficult for the past year, but I took my uations. selfie. I felt so good when I came out [to the program]. I love these kinds of programs…seeing the other people from [past What we learned about Project Jewel camps Project Jewel programs] coming together and discussing how From the process of developing an evaluation the programs help them, it showed a lot you know, like, it’s framework that promotes cultural safety, we learned not just me that’s hurting. There are other people that are more about the parts of Project Jewel camps that hurting too, and these programs really do help.” participants thought were effective. We also learned -Nellie, Project Jewel participant about the benefits that Project Jewel participants felt

Northern Public Affairs, August 2020 47 Table 1. Pre-camp and Post-camp Interview Guide Prompt Questions

Pre-camp 1. What do you want to get out of this program? 2. Why are you here? 3. How do you feel about going on the land?

Post-camp 1. What were the highlights of the camp? 2. What helped you the most during this camp? 3. How would you feel about going on the land again? 4. What would make you feel more comfortable if you come back? 5. What do you expect to get out of the next follow-up camp? 6. What was the most difficult partor f you? 7. How do you feel about going home today? What do you need to feel comfortable going home? 8. Did the program meet your expectations, what was missing?

Table 2. Sharing Circle Guide Prompt Questions 1. Why did you attend Project Jewel? 2. What were your expectations and desired outcomes of attending a PJ workshop? 3. Do you think the land plays a role in the healing process for people? 4. Is it important to re-connect with the land to learn? Why? 5. Does being on the land connect you to your culture? 6. What role does this program play in connecting participants to the land? 7. What challenges do you have to access land-based programs? 8. How does being on the land make you feel? How does it help you think through problems you may be having in your daily life? 9. How would this program be different if it were offered in a community centre or another location (not out on the land)? 10. What was the best part about the program for you? 11. What changes would you like to see in the program? 12. What is/are the best way/ways to capture this experience? 13. Did Project Jewel impact your wellness long-term, if at all?* 14. Did you receive aftercare?*

*indicates prompt questions to be asked during a sharing circle at a follow-up camp (participants have already attended one or more camps with Project Jewel).

Table 3. Photovoice Guide Prompt Questions 1. Can you describe three to five photos that you took that are most important to you? Why are they important to you?

48 Northern Public Affairs, August 2020 Photo credit: Sarah Rogers Sarah Photo credit: Photo 3: “And for me, it’s just…just so peaceful, I forget everything, I forget about everything that’s going on at home like paying bills, or just not feeling healthy sometimes in town. But when I come out on the land it’s so calming for me – even in this storm I feel peaceful.” – Sarah, Inuvialuit Elder who provides cultural support for Project Jewel camps they gained as a result of participating in camps. The most important elements for success included Coming out to the land really heals a person I think local programming and a distraction- and judge- and their whole environment, their self-esteem, yeah ment-free environment. that’s what it did for me and my wife, brought us During a sharing circle, a Project Jewel partici- closer together again, more talking between each pant explained how she preferred health and well- other, uh more open to each other, that’s what we ness programs offered on local land: didn’t have for a while in our marriage, yeah so, really helped us out. It’s better, rather than giving some [health and wellness program] down south…and then you don’t get Shirley, a Project Jewel participant, described anything, you…it’s like you’re going on a holiday, how learning to make dry-meat during a camp af- but if you come out [to Project Jewel]…you have fected her skills and self-esteem: so much freedom, live healthy, sleep good, help and share, talk just like long ago, how the Elders and I enjoyed [making dry-meat], it’s the first time I’ve Inuvialuit and Gwich’in used to get together, talk, tried cutting up dry meat, and I feel really proud. share, help each other, do everything. My daughter learned how to work with meat… hopefully with me learning to cut up this dry meat, The participants emphasized that being on the we can work together. land with Project Jewel took away in-town distrac- tions like technology, work, or alcohol, and provid- Through this research, we learned that an Inu- ed a space where they did not feel judged by others. vialuit approach to evaluating Project Jewel is root- For example, Rogers, an Inuvialuit Elder who works ed in the land, relationality, and oral culture. We with Project Jewel, used photovoice to describe the are confident that the evaluation tool we developed environment on the land at a Project Jewel camp. enabled us to better understand the successful el- Through our thematic data analysis, we identi- ements and benefits experienced by Project Jewel fied a number of benefits that Project Jewel partici- participants. Not every research participant report- pants said resulted from their experience of the Proj- ed the same benefits; however, all participants re- ect Jewel program: (re)connection to land, culture, ported experiencing some form of benefit. identity and heritage; strengthened systems of social support; and enhanced skills and self-esteem. Zeni- Final thoughts phia, a Project Jewel participant, used photovoice to By fully partnering with the IRC and having local show that re-connecting to the land during a camp at community members in the community advisory Reindeer Station helped her connect to her grandfa- board, this project met an IRC research priority: ther and cultural heritage. finding a way to evaluate Project Jewel using an ap- Daniel, a Project Jewel participant, described proach that was informed by Inuvialuit values. Thus, during an interview the effect of attending a camp through this project, the IRC learned the elements on his relationship with his wife and their self-esteem: that make their program successful and that will in-

Northern Public Affairs, August 2020 49 Photo 4: “It’s interesting where [Project Jewel] is holding these kind of workshops out on the land, and it’s interesting to Zeniphia Kimiksana Photo credit: me because in our old ways we used to…I know my Grandpa was here one time, and I could just picture myself seeing my Grandpa here as one of the reindeer herders. I feel connected here. Coming here, it felt like home.” -Zeniphia, Project Jewel participant form future land-based programming. We empha- uvik, NT. size that the evaluation tool that we created should not be seen as static. The needs and values of the Nellie Elanik, Inuvialuit, is a past Project Jewel participant, Inuvialuit and Project Jewel will change over time. and lives in Inuvik, NT. As a result, it is important to continually re-visit the tools and test their effectiveness with participants as Ruth Goose, Inuvialuit and Gwich’in Elder, is a staff member the program evolves. of the IRC in Inuvik, NT.

Recommendations for other land-based Esther Ipana, Inuvialuit, is a past Project Jewel participant, programs and lives in Inuvik, NT. We recommend that evaluators for land-based programs like Project Jewel tailor their evaluation tools Sarah Rogers, Inuvialuit Elder, provides Elder support for to specific programs and communities. In this re- Project Jewel camps and lives in Inuvik, NT. gard, we strongly emphasize that the evaluation tool we created cannot be generalized to other commu- Evelyn Storr, Inuvialuit Elder, is the IRC director of communities and programs. Rather, evaluation frameworks nity development in Inuvik, NT. for land-based programs like Project Jewel should be designed and implemented in partnerships with Francine Darroch, non-Indigenous, is an assistant professor at Indigenous rights holders to ensure that cultural Carleton University. safety is a priority. Y Tricia McGuire-Adams, Anishinaabe, is an assistant profes- Mary Ollier, non-Indigenous, is an MA student at the Uni- sor at the University of Ottawa. versity of Ottawa. References Audrey Giles, non-Indigenous, is a full professor at the Uni- Gerlach, A. J. (2012). A critical reflection on the concept of cultural safety. Canadian Journal of Occupational Therapy, 79(3), versity of Ottawa. 151–158. Government of the Northwest Territories (2017). GNWT health Meghan Etter, non-Indigenous, is the manager of IRC Coun- and social sciences research agenda. Retrieved from http://www. selling Services in Inuvik, NT. hss.gov.nt.ca/sites/www.hss.gov.nt.ca/files/resources/gnwt- health-and-social-services-research-agenda.pdf Inuit Tapariit Kanatami. (2018). National Inuit strategy on Jimmy Ruttan, non-Indigenous, is the IRC on-the-land ser- research. Retrieved from https://www.itk.ca/wp-content/up- vices coordinator in Inuvik, NT. loads/2018/03/National-Inuit-Strategy-on-Research.pdf

Peggy Day, Inuvialuit, is the IRC aftercare coordinator in In- 50 Northern Public Affairs, August 2020 Hotıì ts’eeda – WORKING TOGETHER FOR GOOD HEALTH Strengthening health and wellness through community-based research in the Tłįchǫ region

Sophie Roher & Anita Daniels-Black

he Tłįchǫ Government is an Indigenous ed, a Community Action Research Team (CART) government in the Northwest Territories was recruited and formed in 2009 to respond to (NWT)T that is leading its own health priorities the surveys. Not only did CART’s analysis of the by training its social and justice program coor- survey data provide important in-depth informa- dinators in community-based research. The co- tion about community members’ sexual health ordinators, who are all Tłįchǫ citizens, will run behaviors and knowledge, but CART members an action research project about substance use, also used the findings to directly inform programs addictions, and community wellness in the four and services offered by the Community Wellness Tłįchǫ communities and will use the findings to Programs Department. inform government programs and policies. Based on the survey results, the department This article discusses the training and re- developed resource videos on sexual health, search program in three parts. First, we recount handed out educational pamphlets about STIs, the Tłįchǫ Government’s history with communi- which were translated into Tłįchǫ and English, ty-based research. Second, we describe the cur- and partnered with the health centre and pub- rent project that is underway to train social and lic health nurses to educate people in the Tłįchǫ justice program coordinators at Tłįchǫ Govern- region about sexual health. The Community ment in community-based research. In this sec- Wellness Programs Department also developed tion, we consider the impact that we hope to have a condom distribution program. CART made with the project, what the training looks like, and recommendations to the Department of Health what we believe to be its strengths. Third, we out- at Tłįchǫ Community Services Agency to carry line the next steps for the project. popular brands of condoms at the health centre, handed out kits to people in the community, and The Tłįchǫ community’s history with com- supplied condom distribution baskets to party munity-based research homes. CART also ran an outreach van that drove Our current research project builds off of the around at active times on weekends (11pm-3am) Tłįchǫ Government’s history with communi- to distribute sexual health kits, food, clothing, ty action research. The Tłįchǫ region is made and condom baskets. These programs spurred up of four communities – Behchokò, Gamètì, more initiatives as CART members heard stories Wekweètì, and Whatì – with a total of approx- and learned from youth, Elders, and community imately three thousand people (Government of members. The project became about more than the Northwest Territories, 2018). In 2006, the just STIs; it expanded to programs like puberty sexually transmitted infection (STI) rates in the camps and a safe house over the winter holidays. NWT were eight times higher than the national In May 2009, as these activities were being rate and STI rates in the Tłįchǫ region were three carried out, CART conducted a follow-up survey. times that of the NWT (Edwards et al., 2013). In In preparation for the survey, they partnered with order to address the high rates of STIs, the Com- Centro de Investigación de Enfermedades Trop- munity Wellness Programs Department at Tłįchǫ icales (CIET) Canada. CART staff learned re- Community Services Agency started a commu- search skills including research design and meth- nity-based research initiative to find out more ods, ethical issues, data entry, and analysis. As about sexual health knowledge and behaviors in part of the project, the team carried out “kitchen the Tłįchǫ region. A baseline survey was carried table talks” where they would go door-to-door, out, reaching over two thousand people from 9 share information about sexual health practices, to 99 years old. After the surveys were conduct- and hand out the surveys, which were available

Northern Public Affairs, August 2020 51 in Tłįchǫ and English. CART’s initiatives had the researchers are Tłįchǫ residents since they a substantial impact; the second survey showed know their culture and their communities’ needs that STI rates had declined and that condom use and values, strengths that ground Tłįchǫ research had improved amongst people who participated methods. Additionally, since every community in CART activities (Edwards, Gibson, Martin, has different needs, it is critical to have Tłįchǫ Mitchell, & Andersson, 2011; Edwards et al., researchers from each of the four Tłįchǫ com- 2013). munities.

The current project to train social and What does training look like? justice program coordinators in commu- Since May 2018, the Tłįchǫ Government and nity-based research ICHR have partnered on four community-based In 2012, the Community Wellness Programs research training workshops. The workshops Department was transferred from the Tłįchǫ were designed collaboratively and iteratively. Community Services Agency to the Tłįchǫ Gov- Each workshop built off the next with oppor- ernment as part of the 2004 self-government tunities to learn, share experiences, and reflect agreement, so that wellness programs and ser- on presentations. We are particularly grateful to vices would be run by the Tłįchǫ people for the have had the Healing Wind Advisory Committee Tłįchǫ people. Recently, there has been a turnover (the Tłįchǫ Government’s Elder Advisors) join for in staff. Social and justice program coordinators all of the workshops. For the first two workshops, have been hired as the new CART members. The the Tłįchǫ Government and ICHR partnered Tłįchǫ Government invited academic partners with REACH 2.0 and Universities Without Walls from the Institute for Circumpolar Health Re- to build on the organizations’ successes with com- search (ICHR) to support research training and munity-based research training. As part of the activities. In partnership with ICHR, the training training program, the social and justice program and research has focused on substance use and coordinators at the Tłįchǫ Government also took addictions in the Tłįchǫ region. the University Without Walls’ six-week online “Tools for Community-Based Research” course Why focus on drug and alcohol use? in order to learn tangible research skills. For the Community members know that drug and alcohol third and fourth workshops, the Tłįchǫ Govern- use is a problem in Tłįchǫ communities. Howev- ment and ICHR partnered with the University er, more needs to be understood about communi- of Alberta and began developing a relationship ty members’ knowledge about drugs and alcohol, with Thunderbird Partnership Foundation in or- how many people are using drugs and alcohol, der to prepare for our own community-based re- which drugs are being used, which age groups are search project. At each workshop, organizational affected, and the impact of substance use on peo- partners and community-based researchers were ple’s lives. invited to discuss their experiences in community-based and substance use research. In addition, Why is community-based research import- we brought in a public health nurse to run edu- ant in this project and what is the intended cational sessions about substance use and addic- impact? tions. The goal of the project is to educate social and justice program coordinators in community-based Strengths of the project research in order to have researchers in each of The strengths outlined below are based on Anita the four Tłįchǫ communities. Tłįchǫ people have Daniels-Black’s and Sophie Roher’s (the authors’) been conducting research for countless genera- reflections and experiences with the project. tions, therefore the “training” aspect of this project is to combine Tłįchǫ research methods with • Guided by the Healing Wind Elder Advisory useful tools from the Western research practic- Committee es, particularly community-based research. The As with any project in the Tłįchǫ region, it is im- hope for this project is that the tools and resourc- portant to involve Elders. Most of the Elders who es from community-based research will extend are a part of the advisory committee have been and deepen the social and justice program coor- working on research projects for over 30 years dinators’ knowledge and skills in research related and offer valuable history and information about to substance use. It is especially important that how research projects should be designed and de-

52 Northern Public Affairs, August 2020 livered. Along with their wisdom, they also bring self-governed, ensures Tłįchǫ autonomy in deci- their joy and energy. They are open and fun to sion-making. The Tłįchǫ Government has the work with and love to laugh and joke around. funds, resources, and staff to support this project and, as a result, is able to make all of the decisions • A deep knowledge about the land, culture, about how the research should be carried out in and traditions support of its vision. Tłįchǫ knowledge of the land is important to this project because land-based knowledge is all • Anita Daniels-Black’s leadership about respecting ancestors, the Tłįchǫ culture, Daniels-Black’s clear vision and focus for this and future generations. Anita Daniels-Black ex- project has been critical. Her passion for the proj- plains that Tłįchǫ people used to be strong in ect and for improving the well-being of Tłįchǫ their health, traditional teachings, language, and citizens is echoed amongst her staff. She sees this identity. Back then, there were no addiction is- project as deepening her connection with her sues. In this project, we hope to interweave the community and each of the people in the region. information that we gather in a research project According to Daniels-Black, in order for the youth with Elders’ teachings and cultural and traditional to become successful later on, Tłįchǫ people need knowledge. In order for Tłįchǫ people to thrive, to help each other, educate each other, and be we need to bring these different forms of knowl- there for each other. Educating youth about drug edge together. use is important because it strengthens the future of Tłįchǫ communities. • Prior knowledge and experience with previous surveys • Partnerships and collaboration There are a handful of current CART members Throughout this project, the Tłįchǫ Government (including Anita Daniels-Black) who have had ex- has partnered with various organizations and uni- perience implementing surveys in CART’s previ- versities, including the ICHR, REACH 2.0, the ous STI research and who bring knowledge about University without Walls, the University of Al- what works well, including values that help guide berta, and, more recently, Thunderbird Partner- the project and specific logistical elements that ship Foundation. Daniels-Black believes that the may be useful. For instance, they have shared that partners’ diverse perspectives about how to carry it is key to build trust with community members out training and conduct research enhances the and fellow community-based researchers. When overall project. Not only do Tłįchǫ staff gain a collecting data, it is helpful to work in teams so better understanding of different aspects of and that there is one Tłįchǫ speaker and one English approaches to research, but also, through these speaker and to debrief the data collection process partnerships, both participants and partners learn with the entire CART group at the end of each from each other’s experiences and work together day. to build stronger programming to strengthen and heal their respective communities. • Fluency and attention to dialect Tłįchǫ communities are strong in the Tłįchǫ lan- Next steps for the project guage. According to the 2009 census, approxi- The next step is to implement a region-wide sur- mately 90% of people in the Tłįchǫ region aged vey through which the social and justice program 15 years and older were Tłįchǫ speakers (Tłıchǫ coordinators will apply their skills and knowl- Research and Training Institute, 2013). Addition- edge. They will carry out the surveys, gather and ally, some Elders are unilingual and only speak analyze data, and use that information to assist Tłįchǫ. Even though all four communities are part the government in making program and policy of the Tłįchǫ region, there are little differences decisions. Building from the results of the survey, in dialect among communities. It is important to programs and initiatives will be developed tai- have people from each of the communities trans- lored to the communities’ needs. The ICHR is late the survey in writing and to have individuals also looking at ways to enhance community-based interpret the survey in-person to participants. research training. Ultimately, this project seeks to improve the health and well-being of Tłįchǫ peo- • Tłįchǫ is self-governed ple by better understanding substance use and Community-based research requires plenty of re- addictions in the Tłįchǫ region and developing sources and time. The Tłįchǫ Government, being programs that respond to the specific needs of

Northern Public Affairs, August 2020 53 Tłįchǫ peoples. In Daniels-Black’s words: Research is an opportunity for us to educate our References people. The more we educate our people, the Edwards, K. E., Gibson, N., Martin, J., Mitchell, S., & An- dersson, N. (2011). Impact of community-based interven- more they are able to practice making healthier tions on condom use in the Tlicho region of Northwest decisions in their lives. When we educate each Territories, Canada. BMC Health Services Research, 11(Suppl other and support one another, we promote a 2), S9. https://doi.org/10.1186/1472-6963-11-S2-S9 sense of belonging and connection, which helps Edwards, K., Mitchell, S., Gibson, N., Martin, J., Wans- brough, P., Zoe-Martin, C., & Daniels, A. (2013). Up Y people find strength within themselves. North they’re talking sex: A collaborative and community driven model for sexual health knowledge mobilization. Anita Daniels-Black is a member of the Tłįchǫ First Na- Journal of Health Disparities Research and Practice, 6(2), 80–90. tion and is the Director of Community Programs with the Government of the Northwest Territories. (2018). Popula- tion estimates by community. Retrieved July 9, 2019, from Tłįchǫ Government. https://www.statsnwt.ca/population/population-estimates/bycommunity.php Sophie Roher is a PhD candidate in Public Health at Tłıchǫ Research and Training Institute. (2013). Gonàowo t’a the University of Toronto’s Dalla Lana School of Public Nàts’etso; Ełets’àts’edı t’a Nàts’etso Tłı̨chǫ language, culture and way of life: A report from the Cultural Coordinator 2010-2013. Health and was a 2018-2019 CIHR Health System Behchokǫ̀. Retrieved from https://www.tlicho.ca/sites/ Impact Fellow at the Institute for Circumpolar Health default/files/CC Report 2010-2013.pdf Research in Yellowknife, Northwest Territories.

54 Northern Public Affairs, August 2020 Hotıì ts’eeda – WORKING TOGETHER FOR GOOD HEALTH Decolonizing health care: Indigenous digital storytelling as pedagogical tool for cultural safety in health care settings

Shelley Wiart

ndigenous women’s health stories are complex ues to contribute to health inequity and reinforces due to their intersecting identities of race and disparities (GNWT, 2018). In order for health care gender,I their experiences of colonialism, and social providers to have respectful relationships with In- determinants of health. All of these factors can digenous Peoples, they must honour the diversity make it challenging for them to access culturally among cultural groups and have an appreciation appropriate health care. of the depth of First Nations, Métis, and Inuit con- Indigenous Peoples make up approximately fif- cepts of “good health.” ty percent of the population of the Northwest Ter- Historically, through colonial policies like the ritories (Government of the Northwest Territories Indian Act and the imposition of patriarchy on ma- [GNWT], 2018). They experience a higher bur- triarchal societies, Indigenous women have been, den of some chronic illnesses and a wider gap in and continue to be, marginalized by mainstream health disparities in comparison to other residents society (Dodgson & Struthers, 2005). A conse- (GNWT, 2018). Health care providers often fail to quence of this marginalization is health disparities create an environment of cultural safety, defined as between Indigenous and non-Indigenous woman outcome where Indigenous Peoples feel respect- en. Indigenous women experience higher rates of ed and safe from racism and discrimination when chronic illnesses such as diabetes and heart disease, they interact with the health care system (GNWT, and have lower life expectancy, elevated morbidity 2018). Moreover, health care providers may not and suicide rates in comparison to non-Indigenous understand the holistic health needs necessary women (Bourassa et al., 2004). Indigenous women to support Indigenous Peoples, and the systemic past the age of 55 are more likely to report fair or racism within the health care system that contin- poor health compared to non-Indigenous women Photo credit: James O’Connor Unlimited James Photo credit:

The premier of Legacy: Indigenous Women’s Health Stories took place on August 15, 2019 at the Northern United Place in Yellowknife, Northwest Territories.(Front row l to r): Maxine Desjarlais, Elder & co-emcee, Gail Cyr, Dorothy Weyallon, Sheryl Liske & Tanya Roach. (Back row l to r): Beatrice Harper & Shelley Wiart.

Northern Public Affairs, August 2020 55 Photo credit: James O’Connor Unlimited James Photo credit:

Maxine Desjarlais, Beatrice Harper, Sheryl Liske, Dorothy Weyallon, and Tanya Roach at the Legacy event. in the same age group (Bourassa et al., 2004). Fur- tegral to sustaining traditional knowledge systems thermore, social determinants of health for Indig- and healing practices, and to decolonizing knowl- enous Peoples reflect major disparities in relation edge production (Kermoal & Altamirano-Jimenez, to non-Indigenous Canadians including “higher 2016). levels of substandard and crowded housing condi- In this paper I examine how the use of Indig- tions, poverty, and unemployment, together with enous digital storytelling within the framework of lower levels of education and access to quality Indigenous research methodology allows Indige- health-care services” (Greenwood et al., 2018). nous women to share their health stories in a safe In order to close the gaps in health outcomes and respectful context. This decolonizing method- between Indigenous and non-Indigenous commu- ology allows for self-representation that challenges nities in Canada, it is critical that Indigenous Peo- stereotypes and allows Indigenous communities to ple’s voices are central to the process of reconcili- prioritize their own social and community needs ation in health care1. Reconciliation in health care and to protect their identities and cultural values in aims to close the gaps in health outcomes that exist the process (Iseke & Moore, 2011). Furthermore, it between Indigenous and non-Indigenous commu- is essential to the decolonization process that “In- nities, and support Indigenous Peoples as they heal digenous people speak with our own voices about from colonization, the legacy of residential schools, our histories, culture, and experiences as we con- and the ongoing systemic racism embedded in our tinue to resist the onslaught of colonial structures, institutions. Indigenous women’s knowledge is in- policies and practices” (Regan, 2010). The digital

Fragmented by Self-identifies as éM tis and was raised on Fishing Lake Métis Settlement. Maxine Desjarlais Broken Trust by Member of Onion Lake Cree Nation, Saskatchewan. Beatrice Harper Secrets Revealed by Member of Yellowknives Dene First Nations. Sheryl Liske Living Our History Member of the Tłı̨chǫ Nation & a resident of Behchokǫ̀. by Dorothy Weyallon Tuqurausiit by Yellowknife resident formerly from Rankin Inlet, Nunavut. Tanya Roach

Figure 1: The digital health stories titles & participant’s self-identification

56 Northern Public Affairs, August 2020 stories that I discuss below allow participants and The relationship-building process and trust audiences to reflect on Indigenous women’s health. between my digital storytelling participants and I These stories also advance an understanding of were central to this project (Wilson, 2008; Iseke & holistic health and promote Indigenous women’s Moore, 2011). I had previous relationships with the views on reconciliation in health care. women in Lloydminster/OLCN because they had participated in Women Warriors. Due to the fact Digital storytelling as an Indigenous wom- that we had a good level of rapport, they felt com- en’s health advocacy tool: Empowering In- fortable exploring the legacy of residential schools digenous women to frame their health sto- in their lives and how it affects their health. In Yel- ries lowknife I was fortunate to have a summer student From May to June 2019 I co-created two digital health who was a member of Yellowknives Dene First Na- stories with Indigenous women from the Women tions and grew up in the community. She helped to Warriors2 programs in Lloydminster and Onion recruit one of our participants and establish rap- Lake Cree Nation (OLCN), on the border of Alber- port. Our last participant was recommended by a ta and Saskatchewan. I relocated to Yellowknife for connection I had through Women Warriors, and the months of July and August and co-created three both my summer student and I approached her to digital stories with Indigenous women there. I con- participate. ceived of this project as community-based, partici- There are several ways that I created a safe en- patory action research carried out through the lens vironment for these women to share their health of Indigenous feminism, which centres the partici- stories. First, I was clear they had total control over pant as the person most knowledgeable about their every aspect of their stories. They chose every de- own experiences (Green, 2017). The objectives of tail of their digital story, including writing their these health stories were to allow Indigenous wom- first-person narration, and picking out the personal en to share, with a medical audience3, their tradi- photos and music that accompanied them. My role tional knowledge and Indigenous healing practices, was to hold space for their stories, which meant and to help them conceptualize and communicate listening with non-judgment, and offering support about their own health stories and service needs. It however they asked for it. For example, one of my also served to educate non-Indigenous people about digital storytelling participants asked me to go with traditional healing practices for different Indigenous her to the site of the residential school that her groups, bridging the gap between biomedical West- mother attended. I felt it was a healing experience ern medicine and traditional healing. for her, and we had a spiritual experience during Photo credit: James O’Connor Unlimited James Photo credit:

Shelley Wiart (podium). Speakers panel (l to r): Maxine Desjarlais, Beatrice Harper, Sheryl Liske, Dorothy Weyallon and Tanya Roach.

Northern Public Affairs, August 2020 57 Coded Themes Individual Responses Engage in • Had more time per patient to simply listen. deep listening • Stop rushing and LISTEN. • Listening and asking what is important to you? • Engaged in active and respectful listening. • Create the time and space for listening and being willing to talk about multiple issues and recognize complexity and interconnectedness. • Always listen first (really listen and learn and listen some more). • Engaged in active and respectful listening. • Listen and check their prejudices and discrimination at the door. • Listen with patience and humility/not impatience and judgment.

Practice cultural • Take cultural competency training as part of their formal education. competency & cul- • Take the initiative to become more aware of health inequities with tural safety • Indigenous populations and take the time and effort to provide culturally safe care. • Educate themselves about cultural diversity. Listen. Provide holistic care. • To have the time as part of their workday to reflect on their responsibilities in cultural competency and develop specific methods and actions to achieve a culturally competent health system. • Care from a place of understanding rather than from a place of assumptions and bias. • Understand our cultural difference. Show more respect to our Elders. • Greet First Nations in their languages. To question their own learned perceptions. To prioritize Elders coming into the health care. • Spend time learning about the settler/colonial history to better understand the context of those who experienced it and were impacted by it. And then to hold up a mirror to themselves and explore their own relationship to power and privilege. How does that show up in their health provision? Practice values of • Treat all people with respect and equally. patience, humility, • Treat all patients with respect and dignity. respect, reciprocity • Treat all people with respect and equally. & relationships • Have humility and practice reciprocity when planning a person’s care and include person in decisions. • Begin to understand that wellness and healing journey is a partnership! • To ask everyone how they can respect their culture. What practices they may do? View health as • Understand that health care is more than about physical health. holistic Understand health • Universal access to free medication for anyone who identifies as Indigenous, especially in relation to the for children. Priority given to Indigenous Peoples for a regular family doctor over other social determinants people living in Yellowknife and fix the lack of family doctors. Offer evidence-based of health approaches for increased access to all (i.e. advanced access). • See Indigenous women as whole women: multifaceted, resilient, dignified contributors to our society. To see health challenges as social barriers as mostly being a “function” of systemic violence and discrimination.

Build long-term • Specifically, orf smaller Indigenous communities that don’t have regular access to doctors relationships and nurses to build long-term relationships with communities.

Increase • Looked visibly Indigenous…like me! Indigenous health care professionals

Figure 2: I Wish Tree community member responses

58 Northern Public Affairs, August 2020 our visit that I am not going to discuss in detail. As knowledge translation workshop where we screen an Indigenous researcher I understand that there the digital stories with health care professionals, are certain things, such as sacred dreams, that are then host talking circles, and have a group discus- not appropriate to include in my formal research sion on reconciliation in health care. I am in the findings. Also, I demonstrated that I valued these process of searching for academic or health care women’s time, knowledge, and emotional labour by conferences that we can attend as presenters. paying living wages while we worked on their stories, which took approximately one week. Two digital storytelling presentations I incorporated an integrated knowledge trans- Two events help to illustrate the scope and impact lation plan that allowed the participants to share of the Indigenous digital storytelling methodolo- ideas and input about how to disseminate the re- gy. At the first event, called “Legacy: Indigenous search and their digital stories to the community. I Women’s Health Stories,” we premiered five digital also have a continual consent process with my par- health stories on Thursday, August 15, 2019 at 6 ticipants, which means I keep them informed when pm-8 pm at Northern United Place, Yellowknife, I present their digital stories at academic confer- NT (Figure 1). ence or events. I will continue sharing with them There were approximately fifty-five communi- how their stories are impacting audiences, even ty members in attendance for the free community after my formal research is done. I take direction meal of bannock and chili, followed by welcoming from the project participants when they suggest remarks by Dr. Irlbacher-Fox, Scientific Director spaces to share their digital health stories. For ex- of Hotıì ts’eeda, and Lesa Semmler, the Inuvialuit ample, one of the participants emailed me to sug- Regional Corporation representative of the Hotıì gest we approach APTN to share the digital stories. ts’eeda Governing Council. Gail Cyr, the co-emcee I contacted Yellowknife video journalist Charlotte of the event and community Elder, shared mean- Morritt-Jacobs to share the details of this research. ingful insights about Indigenous women’s health. I She interviewed me and one of the co-creators, provided context for the screening of the stories by Tanya, for a story that was featured on the APTN sharing the importance of storytelling and listening National News on Monday, November 18, 20194. in Indigenous culture. It was my intention to create We are also considering creating an Indigenous a decolonized space by asking those in attendance

Coded Themes Individual Responses Understanding the • Better understanding of the lasting effects of residential schools on these who were legacy of residential forced to go to them. schools • Better understanding of multigenerational effects of residential schools and loss of culture suffered by Indigenous Peoples. • Understanding the intergenerational impact of the suppression of physical and emotional affection will help with better understanding in care situations. • Presentations are well paced, visually compelling, and really share well the person’s difficult journey and the impact of their trauma.

Understanding the • Understanding how differently Indigenous women approach health treatment is very diversity between important for health care providers. each cultural group • These videos provide great visual and short story for health care professionals to gain a little perspective of the different personal stories of our Indigenous women. It’s good to see and hear about the different cultures and experiences.

Increased cultural • Very good initiatives for new employees like me from another country to understand competency and Indigenous culture. cultural sensitivity • Thank you for the opportunity to learn more and to improve my awareness and sensitivity.

Figure 3: Stanton Territorial Hospital health care provider evaluation feedback

Northern Public Affairs, August 2020 59 – both Indigenous and non-Indigenous people – to (Rieger et al. 2018). These digital health stories be responsible, reflexive listeners.5 also served to open space for conversations about This community event featured a speaker’s reconciliation in health care. Audience members at panel with all five digital storytelling participants. the Legacy event, which consisted of health care The panel discussed three questions: What was the professionals, academics, post secondary students, impact of residential school on your physical, spir- government employees, non-profit executive direc- itual, mental, and emotional well-being? How did tors, City of Yellowknife employees and Indigenous the process of digital storytelling affect you? What artists, healers, and Elders were asked to fill out a does good health mean to you from your own per- leaf for the “I Wish” Tree. They completed the sen- spective? (Métis, Cree, Dene, Tłı̨chǫ and Inuit)? tence, “I wish health care providers would…” and Prior to the event we collectively discussed hung their leaves on an ornamental tree. This tree what type of questions the panel felt comfortable was representative of community connection and answering and decided not to open the floor for “growing” our ideas together to close the gaps in questions and answers. I explained to the audience health disparities between Indigenous and non-In- that it was my responsibility as the lead Principal digenous Peoples. Furthermore, it is my intention Photo credit: James O’Connor Unlimited James Photo credit:

Audience at the Legacy event Investigator of this research to keep my participants to share the themes of the I Wish Tree with health safe from colonial violence during their time with care professionals when I screen the stories at vari- me. I explained that a seemingly innocent question ous events (Figure 2). Sharing this community feed- might be perceived as impolite, cruel or violent. As back may significantly decrease the time between well, there are very few spaces for Indigenous wom- knowledge generation and knowledge implementa- en-only voices and decolonizing this space means tion by directly sharing grassroots ideas with health Indigenous women’s voices take precedence over care professionals (Rieger et al., 2018). everyone else’s voices. This community event was At the second event I hosted a screening at the about creating a space where Indigenous women Stanton Territorial Hospital on August 8th and 9th, felt empowered to advocate for themselves, and 2019. There are several uses for digital storytelling safe enough to be vulnerable as they shared their in health care settings, including educating health health stories. care professionals, and engaging them in critical Digital health stories have the potential to reflection of their practice (Rieger et al., 2018). An initiate community dialogue about issues that are important part of my research methodology is cap- concerning to the participants and the audience turing the medical community’s awareness of their

60 Northern Public Affairs, August 2020 own perceptions of Indigenous People’s health, health care providers can incorporate Indigenous and reflecting on how they can incorporate infor- knowledge and healing practices into patient care mation from the digital stories into their practice. plans so that Indigenous women feel respected and At the Stanton event there were 15 employees can build safe health care relationships. Moreover, from a variety of backgrounds including admin- sharing Indigenous women’s stories opens space istration, registered nurses, respiratory therapists, for reconciliation in health care conversations, medical interpreters, and members of the Aborig- supporting collaboration to transform health care inal Wellness program. After watching the stories, systems, policies, and practices to improve Indig- they were asked to provide feedback on a quality enous women’s health outcomes. These stories are improvement evaluation that I provided. Their re- an innovative way to decolonize health care, build sponses demonstrated that the digital stories served relationships and trust with health care providers, as a pedagogical tool for understanding the legacy and seek collaborative solutions to reconciliation in of residential schools and increasing their cultural health care. safety skills. The goal of cultural safety is for all This research suggests that the methodology people to feel respected and safe when they interact of digital storytelling is adaptable in the follow- with the health care system (GNWT, 2018). Cultur- ing ways: It can facilitate a deeper level of self-ex- ally safe health care services are free of racism and pression for the participants, and empower them discrimination, and people are supported to draw by sharing their health stories and advocating for strengths from their identity, culture and commu- their own service needs. Screening the digital sto- nity (GNWT, 2018). A culturally competent and ries with health care professionals can engage them safe health care system can help improve health to reflect on their own clinical practices, thereby outcomes and quality of care, and can contribute increasing cultural safety in health care settings. to the elimination of racial and ethnic health dis- In community settings, screening the digital health parities (Figure 3). stories can open space for dialogue about reconcili- The Stanton Territorial Hospital and the Leg- ation in health care and allow for community-driv- acy events allowed Indigenous women to showcase en solutions that have the potential to be heard their resilience and strength while shifting main- by those in decision-making roles. Furthermore, stream stereotypes and deficit-based stories towards digital storytelling facilitators can be trained in In- asset-based stories about their health, communi- digenous communities to create their own digital ties, and culture. These events encouraged health storytelling projects, thereby increasing community care professionals to better understand Indigenous capacity and decolonization of health care. These women’s unique lived experiences and elicit cultur- stories can feature region-specific healing practices al perspectives with respect to health issues, diag- and can locate the barriers to quality care in each nosis, and treatments. A community member from region. the Legacy event stated that she would be better Digital storytelling allows Indigenous women able to respond to her Indigenous clients needs to share how colonization and the loss of cultur- in “ways that are more meaningful and truly sup- al identity have negatively affected their health. At portive.” Furthermore, it directed me to further the same time, it highlights how Indigenous wom- focus my presentations to health care profession- en have managed to maintain their holistic health als, attending to deep listening (to their patients), practices and what that means for the health of promoting cultural competency and cultural safe- their families and communities. The health care ty training as part of their formal education, and providers’ feedback from the screenings suggests sharing the values that patients most want from that they want more opportunities to connect with their providers (patience, humility, respect, reci- communities to better understand Indigenous procity, and relationships). worldviews and healing practices. The most important aspect of this research Conclusion has been the formation of empathetic connections Indigenous women’s health stories can serve as a between health care providers and Indigenous pedagogical tool to teach cultural safety in health women’s stories of cultural genocide such as the care settings. Indigenous digital health stories in- forced removal of Indigenous children to residen- form solutions that are community-driven, cultur- tial schools, and how it manifested in Indigenous ally relevant to Indigenous Peoples and based spe- Peoples’ physical, spiritual, mental and emotional cifically in local knowledge. Indigenous women’s health. Indigenous women’s health stories are a digital health stories fill a gap in research on how form of reconciliation in health care because they

Northern Public Affairs, August 2020 61 assist medical professionals in understanding their References own positionality and reflect on the ways they may Bourassa, C., McKay-McNabb, K., & Hampton, M. (2004). Racism, sexism, and colonialism: The impact on the disrupt the systemic racism embedded in our insti- health of Aboriginal women in Canada. Canadian Woman tutions. Y Studies, 24(1), 23-29. Dodgson, J. E., & Struthers, R. (2005). Indigenous women’s Shelley Wiart is Métis and a member of the North Slave voices: Marginalization and health. Journal of Transcultural Nursing, 16(4), 339-46. Retrieved from: https://journals. Métis Alliance, Yellowknife, Northwest Territories. She is sagepub.com/doi/10.1177/1043659605278942 currently enrolled full-time at Athabasca University in her Government of the Northwest Territories. (2018). Caring fourth year of a four-year B.A. degree with a concentration for Our People: Cultural Safety Action Plan 2018-2020. in sociology. She is the co-founder of an Indigenous-focused Retrieved from: https://www.hss.gov.nt.ca/sites/hss/files/ resources/cultural-safety-action- plan.pdf holistic health program, Women Warriors, which is aimed at Green, J. A. (2007). Making space for Indigenous feminism. Black improving Indigenous women’s health outcomes. These digi- Point, N.S.: Fernwood Publishing., 2007. tal health stories can be viewed at www.womenwarriors.club Greenwood, M., de Leeuw, S., & Lindsay, N. (2018). Comment: Challenges in health equity for Indigenous Peoples in Cana- da. The Lancet, 391(10131),1645-1648. Notes Iseke, J., & Moore, S. (2011). Community-based Indigenous 1. Reconciliation in health is recognized in two documents digital storytelling with Elders and youth. American Indian that serve as a framework for reconciliation across Canada Culture and Research Journal, 35(4), 19-38. and internationally: The United Nations Declaration on the Kermoal, N. J., Altamirano-Jiménez, I., & Horn-Miller, K. Rights of Indigenous Peoples (UNDRIP), Article 24, and (2016). Living on the land: Indigenous women’s understanding of The Truth and Reconciliation Commission of Canada’s place. Edmonton, Alberta: AU Press. Calls to Action (2015), #’s 18-24. Regan, P. (2010). Unsettling the settler within: Indian residential 2. Women Warriors is an Indigenous-focused holistic health schools, truth telling, and reconciliation in Canada. Vancouver, program aimed at improving Indigenous women’s health British Columbia: UBC Press. outcomes. Shelley co-founded the program in 2015 in Lloyd- Rieger, K., West, C., Kenny, A., Chooniedass, R., Demczuk, minster and it expanded to Onion Lake Cree Nation, on L., Mitchell, K., Scott, S. (2018). Digital storytelling as a the border of Alberta and Saskatchewan, and to the City of method in health research: A systematic review protocol. Calgary in 2018-2019. Systematic Reviews, 7(41). doi:10.1186/s13643-018-0704-y 3. The Alberta Indigenous Mentorship in Health Innovation Truth and Reconciliation Canada (2015). Honouring the truth, (AIM-HI) network sponsored the Alberta portion of this reconciling for the future: summary of the final report of the Truth research. This network is associated with the University of and Reconciliation Commission of Canada. Winnipeg: Truth and Calgary’s Cumming School of Medicine and as part of Shel- Reconciliation Commission of Canada. ley’s research dissemination she will present these stories to United Nations. (2013) United Nations Declaration on the medical residents. Rights of Indigenous Peoples (UNDRIP). Retrieved from 4. The APTN National News Story can be viewed at: https://www.un.org/esa/socdev/unpfii/documents/ HTTPs://www.youtube.com/watch?v=MlPoOzcdzjs&fea- DRIPS_en.pdf ture=youtu.be Wilson, S. (2008). Research is ceremony: Indigenous research methods. 5. Regan (2010) states that a responsible listener poses ques- Halifax and Winnipeg: Fernwood Publishing. tions about the content of the information being presented, in addition to posing questions about our own questions. This type of self-reflexivity is essential to the reconciliation process as colonial-settlers examine their roles and responsibility in the process of colonization. Cultural sensitivity training often places Indigenous Peoples as the focus of the training, when instead it should teach settlers to reflect on their own history, cultural practices, worldviews and values.

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62 Northern Public Affairs, August 2020 Hotıì ts’eeda – WORKING TOGETHER FOR GOOD HEALTH Building community-university research partnerships to enhance capacity for climate change and food security action in the NWT

Andrew Spring, Kelly Skinner, Sonia D. Wesche, Jennifer Fresque-Baxter, Meghan Brockington, Gina Bayha, Warren Dodd, Jessica Dutton, Myriam Fillion, Tiff-Annie Kenny, Brian Laird, Alex Latta, Jullian MacLean, Kaitlyn Menard, Sonja Ostertag, Mylene Ratelle, Melaine Simba, & John B. Zoe

limate change is a reality faced by communi- sult in greater reliance on market (store-bought) ties across Canada’s North, with wide-reaching food. This has been linked to increases in diet-related Cimplications across all sectors, including health and health issues, socio-economic challenges, and food well-being. While on-going discussion, debate, and insecurity (Kuhnlein, 2014; Power, 2008; Willows, program development on both territorial/provincial 2005). As such, it is imperative that food security and and federal levels has generated some positive ad- climate change adaptation measures be informed by vances in climate change adaptation and mitigation, community needs and addressed at local scales, with- support for local-scale action is necessary for com- in the context of an enabling governance structure. munities that are most severely impacted. In Cana- This requires Indigenous communities and partners da’s Northwest Territories (NWT), understanding to work together at different scales (local, region- climate change impacts and building adaptive capac- al and territorial) in ways that promote community ity is critical, since livelihoods, food systems, Indige- action and self-determination, enhance community nous health, and long-term community sustainability capacity, and support the development of sustainable are tightly linked with the health of the environment. local food systems and livelihoods in the face of rapid Here, we highlight an emerging, collaborative re- change. search project that works with multiple NWT com- This article highlights a collaborative, pan-terri- munities to address these issues, using a bottom-up torial, federally funded1 research project developed approach. through an iterative process of open communication Food systems in Northern Indigenous commu- and relationship-building, involving research part- nities rely heavily on the harvesting of country foods ners from multiple academic institutions, six NWT (wild-harvested foods, such as fish, game, and plants) communities across four land claim regions, and re- from the land and waterways. Hunting, gathering, gional and territorial organizations/governments.2 and consumption of country food are foundational Together, we aim to identify, develop, and implement to the physical, cultural, spiritual, and mental health community-defined and -driven initiatives with the of Indigenous Northerners; procurement of these goal of enhancing local capacity to plan for and ad- foods fosters a connection to the land, generates dress food security issues in the face of climate change cultural benefits from sharing the harvest, and pro- and other stressors. Our approach, centred on the vides a nutritious food source (Council of Canadian core principles of fostering community leadership, Academies, 2014). However, climate change is a key and community involvement and engagement, also stressor that affects both access to, and availability of, highlights an innovative way forward for other types country food species. It also challenges the continui- of health-related research in the North. ty of harvesting practices, including the transmission Our collaborative research project uses a partic- and sustained application of harvester knowledge, ipatory action research (PAR) methodology, an ap- skills, and safety. proach grounded in stakeholder participation and In a region where lack of fresh and affordable action to address the needs of partner communities. food drives alarming rates of food insecurity (Coun- PAR ensures that the research responds to practi- cil of Canadian Academies, 2014; FSC, 2016), the cal and locally-identified concerns through the ac- impacts of climate change are further stressing an tive collaboration of researchers and participants in already stressed system. Environmental factors, cou- co-learning (Gilmore, Krantz, & Ramirez, 1986). It pled with shifts toward wage-based economies and affirms the importance and legitimacy of experience changes in other social determinants of health, re- and community knowledge for informing actionable

Northern Public Affairs, August 2020 63 change. Here, the PAR approach will foster opportu- focus, potential case studies, and overall goals of nities for community engagement and participation the proposed project; and to ensure alignment with (Minkler & Wallerstein, 2011) to help build trust and community needs. While community representatives open, transparent communication for local bene- guided conversations about community needs, re- fit (Angell & Parkins, 2010; Tondu et al., 2014). As search ideas, and methods, the university researchers such, it will support and enhance the development took the lead in drafting proposed project delivera- and implementation of strategic action that will lead bles around these community visions. to stronger community-led food security and climate The workshop process underscored the impor- change initiatives in the NWT. tance of taking a holistic approach to addressing This project evolved from many years of collab- food systems; of working across scales, while empha- orative work and relationship building among the sizing place-based and community-level approaches; participating academic, community, and policy part- and of linking community-based action to health ners3. Each research team member has experience and well-being outcomes (Fig. 1). Furthermore, par- with community-engaged research in the NWT, and ticipants identified four cross-cutting themes to con- brings his or her own partnerships into this project, sider throughout all aspects of the research, namely: some of which have fostered new and developing Traditional Knowledge (TK), governance, youth, networks with groups and organizations throughout and gender. As such, these themes and their relation- the territory.4 As the research team focuses on build- ship to country food procurement, food security, and ing relationships and developing research products climate change are central to the project, as discussed that promote positive change in communities, we col- further below. lectively foster trust and generate new opportunities for connection and collaboration. Theme 1: Traditional Knowledge As part of the research co-development pro- As the majority of communities across the NWT de- cess, the team held a grant development workshop pend on country foods for their health and well-be- in Waterloo, Ontario, on March 25-26, 2019. The ing, supporting the transfer of TK around country workshop hosted 32 participants, including commu- food procurement, distribution, preparation and nity members and government policy-makers from consumption is a key focus of this project. TK can across the NWT and researchers and students from provide insight into historic and current-day climate five universities. Team members worked together to impacts and adaptation activities, adding a key ele- share knowledge; to identify core areas of research ment to community food security planning and in-

Figure 1: Research project themes, components and outcomes from the March 2019 grant development workshop

64 Northern Public Affairs, August 2020 forming opportunities and activities vital to ongoing connections between climate change, the health of climate change adaptation. Community partners the land, and community well-being, and empower highlighted the importance of language in under- youth with appropriate knowledge and skills to be- standing and transferring traditional knowledge and come future leaders in their communities. skills; as such, the project will support opportunities to record and teach youth about their Indigenous Theme 4: Gender language. Traditional place-names within the land- Recognizing that many food system dynamics and scape can hold important information about species challenges are inherently gendered, our research and harvest conditions, information that is import- will consider the role of gender in all aspects of the ant to document, map, and share through work with project. Gender plays an important role in how com- community partners and Elders. This knowledge will munity members access, distribute, prepare, and support more sustainable harvesting practices, in- consume country foods. Likewise, gender influences cluding a more diverse use of both species and loca- participation in market food procurement and en- tions, and encouraging reconnection with traditional gagement in local agriculture. We know that food sites that are currently underused. security is experienced differently between men and women, and that a gender disparity exists in food se- Theme 2: Governance curity statistics, with women reporting higher rates Food security challenges are driven largely by gaps of food insecurity. Additionally, households with an in the fulfillment of both individual and collective adult male report higher rates of country food con- rights, such as those recognized by the 2007 Unit- sumption. Women make up a larger proportion of ed Nations Declaration on the Rights of Indigenous employees in the wage-based economy, which may Peoples. Specific to food security, these rights protect limit their ability to participate in traditional roles; Indigenous country food systems as part of cultural however, they may be better able to afford the tools heritage (Damman, Eide, & Kuhnlein, 2008), and and materials needed to procure country food, a key address land tenure and self-determination as the to climate change adaption in Northern Canada. basis for food sovereignty (Wendimu, Desmarais, & This research will seek to understand and account Martens, 2018). With this in mind, this research will for gender diversity in its food system activities and examine how communities can govern their own initiatives, ensuring benefits for all genders within food systems through policy shifts and innovations communities. at local, regional and territorial scales. Furthermore, by working with a range of partner organizations, Building relationships and transferring including regional Indigenous governments and ter- knowledge for a larger impact ritorial government departments, we will identify Sharing knowledge is a key aspect of this research. As actors, barriers, and opportunities for scaling-up lo- local-scale research activities are based on communi- cal initiatives to inform policy, with the potential for ty-specific issues, the lessons learned from each case regional-scale impacts on food security in the NWT. study will offer valuable insight for other communi- This understanding of the diversity of legal and ties engaged in similar work. Sharing information institutional contexts, policy tools, and available re- across communities and regions is an ideal way to sources across the NWT will shed light on a diversity build stronger relationships and promote scaling-up of potential approaches to climate adaptation within and -out of local initiatives to regional and territo- existing food systems. rial levels. As such, while we have planned for large biennial knowledge sharing events for all communi- Theme 3: Youth ty partners, we will also engage additional networks Youth are important stakeholders in the North. As throughout the project to reach a wider audience. the next generation, it is imperative that they under- This will help communities that have led local food stand the challenges associated with a rapidly chang- production projects as part of this research, such as ing climate, and that they are empowered to lead ef- small-scale agriculture or country food processing, forts to measure, monitor, and adapt to its impacts. share experiences with other interested communities. Through our research, we will take every opportu- This way, the research will have a broader impact nity to engage youth in planning and implementing across the NWT. activities, in training and employment opportunities, The research team has existing relationships and in building mentorship relationships. By bring- with the Government of the Northwest Territories ing together both TK and western science perspec- (On the Land Unit), and organizations such as Hotıì tives, we can promote a deeper understanding of the ts’eeda (a CIHR Strategy for Patient-Oriented Re-

Northern Public Affairs, August 2020 65 search [SPOR] Support Unit), Ecology North (a Meghan Brockington is Project Manager for the Northern principal territorial environmental non-governmen- Water Futures project at Wilfrid Laurier University. tal organization), and other regional organizations (e.g. the NWT Association of Communities) that Gina Bayha is Director of Environment at the Delı̨nęGotine have placed an emphasis on climate change and Government. health programming. Their robust networks of communities and actors will provide additional key chan- Warren Dodd is Assistant Professor in the School of Public nels for knowledge-sharing. Furthermore, events Health and Health Systems at the University of Waterloo. such as Hotıì ts’eeda’s annual Ełèts’ehdèe gathering provides an ideal forum to bring research partners Jessica Dutton is Manager, Research Ethics and Regional together from communities throughout the NWT, Programs, South Slave Research creating additional opportunities for knowledge Center at the Aurora Research Institute in Fort Smith, NWT. sharing. We will emphasize the use of social media, blogs, podcasts, and digital storytelling as ways to dis- Myriam Fillion is Professor in the Science and Technology seminate information and share stories through these Unit at Teluq University in Montreal, QC. networks. Graduate students will receive training in these techniques prior to travelling to communities, Tiff-Annie Kenny is Postdoctoral Fellow in the Faculty of and will help share these skills with community mem- Medicine at Laval University in Quebec City, QC. bers, particularly youth. Finally, through our close working partnerships Brian Laird is Associate Professor in the School of Public with regional and territorial government agencies Health and Health Systems at the University of Waterloo and departments, this project has the unique ability in Waterloo, ON. to directly inform policy-makers about community values, priorities, and actions, as well as overall re- Alex Latta is Associate Professor, Department of Glob- search findings. The addressing of food security is al Studies, Department of Geography and Environmental a priority, not only for the immediate well-being of Studies at Wilfrid Laurier University. people in the NWT, but also as a basis for building strong, resilient communities in the face of climate Jullian MacLean is Project Director, Health Methods and change. The inclusion of policy actors in research Data for the NWT SPOR processes and knowledge sharing activities provides SUPPORT Unit: Hotiì ts’eeda, and for the Inuvialuit Re- a direct pathway for research outcomes to influence gional Corporation in Inuvik, NWT. priorities for policies, programs, services, and funding at multiple scales. Y Kaitlyn Menard is Climate Change Program Coordinator in the Department of Health and Social Services of Govern- Andrew Spring is Adjunct Professor in the Department of ment of the NWT. Geography and Environmental Studies, and Associate Di- rector of the Laurier Centre for Sustainable Food Systems at Sonja Ostertag is Postdoctoral Fellow in the School of Public Wilfrid Laurier University in Waterloo, ON. Health and Health Systems at the University of Waterloo.

Kelly Skinner is Assistant Professor in the School of Pub- Mylene Ratelle is Project Manager and Research Associate lic Health and Health Systems and Program Lead for the in the School of Public Health and Health Systems at the Master of Health Evaluation at the University of Waterloo. University of Waterloo.

Sonia Wesche is Assistant Professor in the Department of Melaine Simba is Environment Coordinator for the Ka‘a’gee Geography, Environment and Geomatics and with the Insti- Tu First Nation and Aboriginal Aquatic Resource and tute of Indigenous Research and Studies at the University of Oceans Management (AAROM) Program Technical Advi- Ottawa in Ottawa, ON. sor in Kakisa, NWT.

Jennifer Fresque-Baxter is Manager of the On the Land John B. Zoe is Chairperson for the Board of Directors for Unit, with the Department of Environment and Natural the Dedats’eetsaa: Tłı̨chǫ Research and Training Institute Resources, Government of the Northwest Territories, based for the Tłı̨chǫ Government, and an Adjunct Professor in the in Yellowknife, NWT. School of Public Health at the University of Alberta.

66 Northern Public Affairs, August 2020 Notes Kenny, T.-A., Fillion, M., Simpkin, S., Wesche, S. D., & Chan, 1. Funding for this research project comes from the Canadian H. M. (2018b). Caribou (Rangifer tarandus) and Inuit Nutrition Institutes of Health Research (CIHR). Security in Canada. EcoHealth, 15(3), 590-607. doi: 10.1007/ 2. This project, entitled “Learning from and enhancing Commu- s10393-018-1348-z nity Capacity for Climate Change and Food Security Kenny, T.-A., Hu, X. F., Kuhnlein, H. V., Wesche, S. D., & Chan, (C4FS) action in the NWT” is funded by a four-year CIHR Team H. M. (2018c). Dietary sources of energy and nutrients in the Grant (2019-23), led by Skinner (University of Waterloo), contemporary diet of Inuit adults: results from the 2007-08 Spring (Wilfrid Laurier University), and Wesche (University of Inuit Health Survey. Public Health Nutrition, 21(7), 1319-1331. Ottawa), in collaboration with Fresque-Baxter (Government of doi: 10.1017/s1368980017003810 the Northwest Territories). Kenny, T.-A., Maclean, J., Gale, P., Keats, S., Chan, H. M., & 3. Spring and Simba, for example, have worked on food security Wesche, S. D. (2018d). Linking health and the environment and climate change initiatives in the community of Kakisa through education – A Traditional Food Program in Inuvik, for more than six years, building community capacity to grow Western Canadian Arctic. Journal of Hunger & Environmental Nu- food, monitor the environment, and engage youth (Spring, trition, 13(3), 429-432. doi: 10.1080/19320248.2017.1420330 Carter, & Blay-Palmer, 2018; Spring & Simba, 2017). Spring Kenny, T.-A., Wesche, S. D., Fillion, M., Maclean, J., & Chan, and Bayha have collaborated to build research and monitor- H. M. (2018e). Supporting Inuit food security: A synthesis ing networks to protect Great Bear Lake and support ongo- of initiatives in the Inuvialuit Settlement Region, Northwest ing activities in the UNESCO Tsá Tué Biosphere Reserve Territories. Canadian Food Studies, 5(2), 73-110. doi: 10.15353/ in Délı̨ne. Wesche, Kenny, Ostertag, Fillion, and MacLean cfs-rcea.v5i2.213. have collaborated on a long-term research program with Kuhnlein, H. V. (2014). Food system sustainability for health and the six communities of the Inuvialuit Settlement Region on well-being of Indigenous Peoples. Public Health Nutrition, 18(13), understanding and addressing food security challenges and 2415-2424. doi: 10.1017/s1368980014002961 priorities through both local and regional-scale food security Minkler, M., & Wallerstein, N., editors. (2011). Community-based planning and programming (Fillion et al., 2014; Kenny et al., participatory research for health: From process to outcomes (2nd ed.). San 2018a,b,c,d,e; Ostertag et al., 2018). Skinner, Ratelle and Laird Francisco, CA: John Wiley & Sons. have worked with several communities in the Sahtú and Deh- Ostertag, S. K., Loseto, L. L., Snow, K., Lam, J., Hynes, K., & cho regions on risk communication related to contaminants in Gillman, D. V. (2018). “That’s how we know they’re healthy”: country food (Ratelle et al., 2018a,b). Fresque-Baxter, through The inclusion of traditional ecological knowledge in beluga her positions with the Environment and Natural Resources health monitoring in the Inuvialuit Settlement Region. Arctic Division of the Government of Northwest Territories (most Science, 1-29. doi: 10.1139/as-2017-0050 recently as Manager of the new “On the Land” unit), has Power, E. M. (2008). Conceptualizing food security for Aboriginal worked collaboratively with many on the research team to sup- people in Canada. Canadian Journal of Public Health, 99(2), 95- port food security research driven by Indigenous communities 97. doi: 10.1007/bf03405452 and regional governance bodies. Dutton, a community-based Ratelle, M., Laird, M., Majowicz, S., Skinner, K., Swanson, H., researcher with the Aurora Research Institute, has conducted & Laird, B. (2018). Design of a human biomonitoring com- research across the territory on country food systems and food munity-based project in the Northwest Territories’ Mackenzie as a social determinant of health. Valley, Canada, to investigate the links between nutrition, con- 4. For example, an emerging relationship with Hotıì ts’eeda - taminants, and country foods. International Journal of Circumpolar which maintains an active, health-research-focused network of Health, 77(1), 1510714. doi: 10.1080/22423982.2018.1510714 communities and actors in the NWT - connected the team to Ratelle, M., Skinner, K., Laird, M., Majowicz, S., Brandow, D., Zoe, a Tłı̨chǫ leader who brought communities from his region Packull-McCormick, S., Bouchard, M., Dieme, D., Stark, K., into the project. Henao, J., Hanning, R., & Laird, B. (2018). Implementation of human biomonitoring in the Dehcho Region of the Northwest References Territories, Canada (2016-2017). Archives of Public Health, 76(1). doi: 10.1186/s13690-018-0318-9. Angell, A. C., & Parkins, J. R. (2010). Resource development and Spring, A. & Simba, M. (2017). Growing a garden in Kakisa. Aboriginal culture in the Canadian north. Polar Record, 47(1), Northern Public Affairs, 5(1), 24-26. 67–79. doi: 10.1017/s0032247410000124 Spring, A., Carter, B., & Blay-Palmer, A. (2018). Climate change, Council of Canadian Academies. (2014). Aboriginal food security community capitals, and food security: Building a more sus- in Northern Canada: An assessment of the state of knowledge. tainable food system in a northern Canadian boreal communi- Ottawa, ON: The Council of Canadian Academies. Retrieved ty. Canadian Food Studies, 5(2), 111-141. doi: 10.15353/cfs-rcea. from https://cca-reports.ca/reports/aboriginal-food-securi- v5i2.199 ty-in-northern-canada-an-assessment-of-the-state-of-knowl- Tondu, J. M. E., Balasubramaniam, A.M., Chavarie, L., Gantner, edge/ N., Knopp, J. A., Provencher, J. F., Wong, P. B. Y, & Simmons, Damman, S., Eide, W. B., & Kuhnlein, H. V. (2008). Indigenous D. (2014). Working with northern communities to build collab- Peoples’ nutrition transition in a right to food perspective. Food orative research partnerships: Perspectives from early career Policy, 33(2), 135-155. doi: 10.1016/j.foodpol.2007.08.002 researchers. Arctic, 67(3), 419-429. doi: 10.14430/arctic4416 Fillion, M., Laird, B., Douglas, V., Van Pelt, L., Archie, D., & Wendimu, A.M., Desmarais, A. A., & Martens, T. R. (2018). Chan, L. (2014). Development of a strategic plan for food Access and affordability of “healthy” foods in northern Mani- security and safety in the Inuvialuit Settlement Region, Cana- toba? The need for Indigenous food sovereignty. Canadian Food da. International Journal of Circumpolar Health, 73(1), 25091. doi: Studies 5(2), 44-72. doi: 10.15353/cfs-rcea.v5i2.302 10.3402/ijch.v73.25091. Willows, N. D. (2005). Determinants of healthy eating in Aborig- Gilmore, T., Krantz, J., & Ramirez, R. (1986). Action based inal peoples in Canada: The current state of knowledge and modes of inquiry and the host-researcher relationship. Consulta- research gaps. Canadian Journal of Public Health 96 (Supplement tion: An International Journal, 5(3), 160-176. 3): S32-S36. Kenny, T.-A., Fillion, M., Maclean, J., Wesche, S. D., & Chan, H. M. (2018a). Calories are cheap, nutrients are expensive – The challenge of healthy living in Arctic communities. Food Policy, 80, 39-54. doi: 10.1016/j.foodpol.2018.08.006

Northern Public Affairs, August 2020 67 Hotıì ts’eeda – WORKING TOGETHER FOR GOOD HEALTH After the diamonds: “Blue sky” visions

Rebecca Hall

What do we do after the diamond mines close?” for mine training and clean-up. Territorially, econom- This question hangs in the air in many commu- ic development strategies have also emphasized re- nities“ of the Northwest Territories (NWT). Opening source extraction (GNWT, 2014); however, pressures a mine often comes with fanfare, funding, attention to pursue Indigenous-driven and green development and resources that communities can leverage to mit- alternatives are increasingly visible at territorial and igate the harmful public health impacts a mine can federal levels. have. Closing a mine has traditionally been a quiet- Community-based research can reveal the ex- er affair, though the socio-economic and health im- isting and emerging alternatives to resource devel- pacts are no less severe. Researchers have document- opment that grow in communities impacted by ex- ed the social and interpersonal consequences of job traction. These are alternatives focused on the health loss and community ways of life, including strained and wellness of people and the land, wherein de- personal relationships and mental health, depressed velopment is rooted in respect and responsibility for familial and community economies, and depleted the well-being of the land, people and animals, and community social services (Keeling & Sandlos, 2015; where community needs shape development ideas. Pini et al., 2010). These decolonizing alternatives can interrupt scholar- The diamond industry holds a central place in ly, policy, and popular narratives of “boom and bust,” the NWT economy, and its contraction and eventual which assume that the “bust” of one extractive proj- closure are sure to reverberate through the territory; ect requires the “boom” of another. Enthusiasm for however, what the NWT economy looks like “after di- the promise of decolonizing development strategies amonds” is a question rather than a foregone conclu- is what motivates us in the research project discussed sion. The first NWT diamond mine opened in 1998, below, Post-Extractive Futures. Before turning to a and since then, the diamond mines have dominated discussion of this project, in the next section I provide territorial GDP, with contributions ranging from 30- a background to resource extraction in the NWT. 50% annually (GNWT, 2019a). The diamond mines operate through a fly-in/fly-out (FIFO) structure, Diamond mines in the mixed economy which means that employment stretches beyond the At a territorial economic summit held in Inuvik in extractive site to communities throughout the terri- October 2018, former Premier Bob McLeod warned tory and southern Canada. However, just as quickly that, “The diamond mines – currently the engine of as they arrived, the diamond mines will leave: Of the the Northwest Territories economy – will not last for- four diamond mines, Snap Lake closed unexpectedly ever” (GNWT, 2019b). According to his prediction, in 2015, and Diavik has opted for a planned closure in diamond mine closure would shrink the economy 2025, with major layoffs beginning in just three years. by, give or take, $1.1 billion and 3,300 jobs. Across Ekati and Gahcho Kué are pursuing expansions with Northern governments and political ideologies, there the hope of extending their mine life, but the most is no quibbling with the suggestion that diamond mine optimistic projections suggest these mines will close by closure will rock the Northern economy. And in early 2035. It is no wonder, then, that the question on many research interviews with politicians and community a mind is, “What next?” organizers for this project, the common refrain was a The answer for many federal and territorial pol- plea for planning for this transition. However, in cred- icy-makers has been deceptively simple: More re- iting diamond mines as the “engine” of the NWT source extraction. The federal government has repro- economy, Premier McLeod’s concern is in line with a duced Canada’s resource-driven economy through diamond mine narrative that posits the industry as the permissive legislation that privileges exploration and savior of the Northern economy. There is a long tra- staking (Hoogeven, 2015), and well-funded programs dition of bolstering this narrative, often adorned with

68 Northern Public Affairs, August 2020 diamond puns. In industry, territorial and federal re- Lake) to targets of 26 and 31%, respectively, from porting alike, the diamond industry has been lauded Diavik and Ekati. In actual hires, from 1996 to 2017, as bringing “lustre” (Canada, 2003), “shine” (Cana- the direct workforce (not including contract labour) da, 2006), and “sparkle” (Northern Miner, 2016) to has consistently been around 50% Northern, approx- the NWT economy. imately half of which has been Northern Indigenous. Extractive industries in Canada, and especially In 2017, this worked out to 1,592 direct Northern Northern Canada, bring with them the heavy weight jobs across three mines, of which 819 went to North- of the status quo. Settler Canada was born of re- ern Indigenous people (GNWT, 2019). source extraction (Innis, 1927) activities – from the Certainly, diamond mine work has been an im- fur trade and forestry to oil and gas and mineral de- portant source of employment for plenty of North- velopment – that are reliant upon the dispossession of erners, but this source of employment must be under- Indigenous land and the extraction and export of the stood in the context of thriving land-based activities, land’s resources. The role of resource extraction in a robust social and community service industry, In- economic development is only intensified in the North digenous, territorial and federal public service, and (Keeling & Sandlos, 2015; Parlee, 2015). However, the hospitality industry. In 2018, for example, 14% the boom and bust rhythm of extractive economies of the NWT workforce was employed in fishing, for- plays out within, and is mitigated by, the Northern estry, mining, oil and gas while a full 86% worked in “mixed economy” (Asch, 1977). The mixed econo- service-producing industries, including 24% in pub- my – denoting the economies of Indigenous commu- lic administration (GNWT, 2018). These numbers nities, involving a reliance on both wage labour and do not capture informal land-based activities, which land-based subsistence economic activity – persists contribute significantly to the social reproduction of because, despite centuries of settler colonial interven- Northern communities. This rich tapestry of wage tions, Indigenous communities have protected and and land-based work and relationships offers ample sustained their longstanding connections to the land inspiration for discussions of the post-diamond econ- through a combination of land-based activities such omy. as wildlife harvesting, wage labour, and government transfers. With respect to mining specifically, this Post-extractive futures: Project overview means that land-based activities operate alongside, Post-Extractive Futures is a collaborative project sup- and in relation to, extractive operations, exemplifying ported by Hotıì ts’eeda, a Canadian Institutes for an approach to Northern resources profoundly dis- Health Research (CIHR)-funded community research tinct from the imperatives for extraction. Extractive support centre housed within the government of the imperatives include a focus on primary, profit-driven Tłı̨chǫ Dene. Thus far, the project has involved the extraction activity, yielding high-margin profits over Yellowknives Dene First Nation, the Tłı̨chǫ, Ecology short timelines. These are facilitated for example, by North, and Dr. Rebecca Hall, the author of this piece. operating mines 24 hours per day, 7 days a week. A In May 2019, as part of the pilot phase of this project, relational approach to resource development would, four community focus groups and 12 interviews were in contrast, be grounded in reciprocity with respect to completed, with approximately 135 participants from economic actors and the resources in question, rather Yellowknife (31 participants), Behchokǫ̀ (32), N’dilo than the short-term drive for profit. (38) and Dettah (22). Interviews were with commu- Since opening, the diamond mines have made up nity leaders/community development workers from the largest share, by far, of extractive revenue and ex- the four towns, and self-selected participants from tractive jobs in the NWT. However, high GDP inputs Behchokǫ̀ (these interviews supplemented the focus do not necessarily translate into a similarly high em- group, which some interested residents were not able ployment in the local economy. The diamond mines to attend). The focus groups were open sessions adver- have minimized their workforce needs through long tised through community networks, radio and social shifts (Gibson, 2008) and short-term contracts. This, media. Participants were residents of the four towns, combined with the industry’s ability to hire from out- both women and men, ranging in age from youth to side the territory, leads to relatively weak local em- elders. Focus groups and interviews were conducted ployment linkages. To be sure, the four diamond with the purpose of identifying research foci: Specif- mine operators have made commitments to Northern ically, we wanted to hear about key community con- and Northern Indigenous direct hires. These range cerns regarding diamond mine closure, and shared across the mining companies from 35-66% targets for goals and hopes for the post-diamond economy. The Northern hires, and from no targets for Northern In- chair of Hotıì ts’eeda, John B. Zoe, a Tłı̨chǫ elder digenous hires (in the case of Gahcho Kué and Snap and research expert, provided direction in early dis-

Northern Public Affairs, August 2020 69 cussions about research questions and methodologies, the perceived inevitability of the extractive Cana- helping to develop an approach grounded in respect dian political economy. Discussions of the violent for community knowledge. impacts of mining – while certainly important – by Interviews and focus groups have been tran- their very nature contribute to the heavy weight of scribed and are currently being analyzed through extractive discourse; to put it another way, even crit- thematic coding by student researchers at Queen’s ical analysis of mining can add to the over-emphasis University, under the guidance of Dr. Hall. These on mining’s current and future role in the Northern preliminary findings will be shared and co-analyzed and Canadian economy. For example, it is common with community research partners. The key questions for policy makers to respond to negative revelations and themes emerging from this first research phase about mining by supporting impact mitigation, a re- will direct the project as it expands to more NWT sponse which can easily be co-opted and moulded communities and to oil-sand affected communities into the state-sanctioned approach to “responsible in Alberta in the coming year. This article articulates extraction.” This contributes to a cycle in which min- the motivations and methodologies driving the re- ing problems are solved with more mining. Further- search, as well as the early themes that resulted from more, while research critical of extractive industries focus groups and interviews. Because these were pilot (my own included) focuses its critique on the violent sessions held with a limited segment of the North- processes of settler dispossession, there is potential for ern population, and because analysis is ongoing, the these critiques to inadvertently contribute to harmful themes discussed are not generalizable conclusions; deficit-based understandings of Indigenous commu- rather, we are using the preliminary insights and early nities themselves (Simpson, 2014). analysis from this first phase of the project to shape For these reasons, in our early conversations, we our current research questions and foci. tried to do two things: One, reflect on how experienc- The focus groups were open events, offering es with and lessons learned from the diamond mines members of the Yellowknife, Behchokǫ̀, N’dilǫ̀ and will inform community development moving for- Dettah communities an opportunity to discuss con- ward; and two, take a “blue sky” approach, imagining cerns regarding the transition away from diamond what post-diamond development could be. In pursu- mines, and how they imagine development in the ing both of these objectives, we did not preclude the post-diamond economy. I was introduced to these re- possibility of further mineral development; instead, search questions during my doctoral project, which we focused on community conceptions of and goals assessed the impact of the diamond mines on North- for development and explored potential pathways to- ern women. One of the most common unsolicited wards these goals. themes raised in interviews and talking circles with Indigenous women living in the NWT, conducted as Looking back and looking forward part of my PhD research (2014), was the question of Political and economic analyses describing diamonds diamond mine closure. Some research participants as bringing “sparkle” to the NWT economy are more recounted the social and economic depression that than just a particular framing of the past: the “dia- came with past closures of extractive projects in their monds as development” story offers a prescription of home communities (for example, the relatively recent the future – quite simply, more of the same. How- closure of the gold mines in Yellowknife), while oth- ever, this view of diamonds is aerial footage: show- ers discussed their reliance on high wage diamond casing GDP inputs without attending to the nuanced mine jobs to pay household costs and service debts, processes of production and distribution that truly like mortgages. In a talking circle hosted at the Native define an economy, looking beyond the numbers to Women’s Association of the NWT, research partic- the qualitative experiences of mine workers, their ipants agreed that forward-thinking about diamond families, and their communities. Thus, in our focus mine closures would be crucial for community health, groups, looking forward also meant looking back: we in general, and for advancing Indigenous and wom- discussed what diamond mines meant for the com- en-driven approaches to community development. munity participants and what lessons can be taken for For this reason, in this project, we shifted our re- a post-diamond future. search agenda away from impacts of mining econo- In our pilot discussions in Behchokǫ̀, N’dilǫ̀ and mies towards a proactive inquiry into post-extractive Dettah, past and present workers in the diamond futures. The shift in orientation from past to future mines shared a range of experiences shaping their was also motivated by my concern that, in my posi- feelings about mine closure. While not a complete tion as an academic researcher, by focusing on the rendering of the many nuanced experiences shared impact of mines I was inadvertently reproducing by research participants, dominant themes demon-

70 Northern Public Affairs, August 2020 strate a fear of job loss alongside a recognition of Indigenous activists, writers and scholars – from envi- the social and ecological burden the diamond mines ronmental justice warriors to science fiction writers to have imposed. For some respondents, primarily but the carriers of traditional knowledge that ties together not exclusively male, diamond mine work had been past, present and future.1 This powerful assertion re- steady and lucrative; a dominant theme in the Beh- sists racist and colonial discourse that relegates Indig- chokǫ̀ focus group and interviews was concern for job enous belief systems and ways of life to the past. The loss caused by industry decline. Often these concerns second is the concern expressed by diverse grassroots were exacerbated by big mortgages and other forms movements, including Indigenous movements, that of debt, as many mine workers moved from public share a desire for a people-centred, regenerative econ- to market housing over the course of their employ- omy and “just transitions” away from extractive-led ment. For others, particularly those who had worked development. intermittently at the diamond mines or not at all (both Asking a group of people to talk about the future, women and men), the diamond industry brought with and, more than that, to imagine a better world, is no it personal, social, and ecological hardship, including small request. It involves a leap of faith, at least in the strained family relations and burdens upon mental moment, and an “unsticking” of one’s thoughts from health as a result of isolation and exhaustion at camp. the way things are. Coming up with approaches that Among the concerns raised were the time away from were appropriate to each focus group was a collabo- home and community that FIFO work requires, and rative effort. Each focus group was co-designed and the resulting strain on those – often women – who led by a community partner (Lena Black of YKDFN, were left to manage household and community re- John B. Zoe of the Tłı̨chǫ Government and their sponsibilities. Participants in all four focus groups em- traditional knowledge advisors, and Will Gagnon phasized their concern over the impact the diamond of Ecology North) and the author, with the ongoing mines have on the health and well-being of Northern guidance of Hotıì ts’eeda. For example, in Behchokǫ̀ people and the land, both in terms of immediate eco- and Dettah meetings, we posted images of a river, logical impact of the mines and gaps in land-based wherein the river bank represents the post-extractive knowledge transmission. Indeed, both Elders partici- economy, asking participants to discuss what travel- pating in focus groups and community leaders partic- ling the river might look like and what they imagine ipating in interviews worried about the gap in inter- on the other side. In our Yellowknife focus group, generational traditional knowledge sharing as a result which included both non-Indigenous and Indige- of young people’s time away at camp. nous Yellowknife residents, we asked participants to Just as research participants expressed a wide imagine a future community-driven, sustainable and range of experiences with the diamond mines, the decolonizing Northern economy and to write news- feelings about post-diamond development are simi- paper headlines for the year 2035 reflecting what larly mixed. There was a real concern for economic they hope for. We then used these headlines as a ba- depression, at both household and community levels. sis for discussing community development strategies. At the same time, in these pilot meetings, a message In N’dilǫ̀, we held our event in the community gym. came out loud and clear: The post-diamond economy We posted more than 10 poster board-size pages of is also a time of opening, of possibility. The answer to community development ideas generated from our mine closure need not be restricted to the “boom and conversation, and listened as community members bust” mentality, but rather could be informed by, as dropped in, read the ideas and offered their own one participant in the Yellowknife focus group put it, contributions. the wealth of knowledge and skills and the diversi- The quality and scope of ideas to emerge from ty of labours already existing in the NWT. As such, these four meetings was stirring: From increased local the orientation towards the future must recognize and agriculture to traditional craft stores to clean energy respect the real fear and prospect of economic de- production. The level of analysis ranged from sectoral pression facing those working in the diamond mines, discussions around, for example, bolstering Northern and honour the existing and potential opportunities post-secondary education institutions and Northern for post-extractive development that is decolonizing tourism, to granular discussions of development ac- and community-driven. tivities that could build upon existing community We aimed to enact this orientation through our strengths; for example, retraining programs for com- “blue sky” approach. Our blue-sky orientation is in- munity members with decades of experience in the formed and inspired by the overlapping social justice diamond mines; or land-based programs based on concerns that motivate and shape our methods. The community expertise of local medicines. These are a first is the concern for Indigenous futures asserted by small sample of the development ideas that surfaced

Northern Public Affairs, August 2020 71 in discussions; however, in analyzing across focus the form of a more extensive round of interviews and groups and interviews, some common themes have focus groups, and a community survey. At the same emerged. In all of the meetings, participants empha- time, we are expanding our scope by developing re- sized the importance of the land-based economy and search partnerships in Alberta, with the ultimate aim brainstormed ways of protecting the land and grow- of knowledge sharing between communities facing ing relationships to it. Participants shared a range of the “bust” of extraction on both sides of the 60th perspective about future development scenarios, from parallel. Y “never another mine,” where future development is rooted in activities more complementary to Dene re- Rebecca Hall is an assistant professor of Global Development lationships to land, to approaching new mining ven- Studies at Queen’s University in Kingston, Ontario. tures through the lessons learned from the diamond era by ensuring greater attention to community needs Notes (for example, with greater Indigenous leadership at all 1. See, for example, the work of Taiaiake Alfred, Jeff Corntassel, Glen Coulthard, Danis Goulet, the Kino-nda-niimi Collective, stages of negotiation and mine development). Nota- Rauna Kuokkanen and Waubgeshig Rice. bly, in the three focus groups and interviews in Dene communities, many participants focused on the im- References mediate need for Indigenous-led mine remediation. Asch, M. (1977). The Dene Economy. In M. Watkins (Ed.), Dene And across perspectives regarding the “whither min- Nation: The colony within. Toronto: University of Toronto Press. Gibson, V. (2008). Negotiated spaces: Work, home and relationships in the ing” question, concern regarding Indigenous leader- Dene diamond economy. (Dissertation). Submitted to the Faculty of ship and participation was strong. Graduate Studies (Mining Engineering), University of British Columbia. Conclusion Government of Canada. (2006). Diamonds: Still shining brightly for Canada’s North. (Byrd, C) Ottawa: Statistics Canada, Internation- In these early meetings, our purpose was not to search al Trade Division. for a unified vision, but rather to listen to the values, Government of Canada. (2004). Diamonds: Adding lustre to the goals and curiosities that drove participants’ visions Canadian economy. (Santerossa, B.) Ottawa: Statistics Canada, of the future, and take these as our guide in this proj- International Trade Division. Government of the Northwest Territories. (2019a). 2018 socio-eco- ect. What emerged among participants was a shared nomic agreement report for diamond mines operating in the Northwest idea of what “development” means. Economic and Territories. Tabled in NWT Legislature May 28, 2019. community development are often artificially separat- Government of the Northwest Territories. (2019b). NWT Economic ed, or, even more dangerously, it is assumed that eco- Symposium: Northern strengths, northern prosperity, October 1-3, 2018, Inuvik, symposium summary report. NWT Legislature, Tabled Docu- nomic development will naturally lead to community ment 396-18 (3). Tabled March 14, 2019. development. In our discussions, this relationship was Government of the Northwest Territories. (2018). Labour force flipped: Participants built ideas for economic develop- data. Bureau of Statistics. Yellowknife. ment around the existing skills, needs, and aspirations GNWT and NWT and Nunavut Chamber of Mines. (2014). NWT mineral development strategy. Yellowknife: Department of of their communities, and their relations with the Industry, Tourism and Investment. land. For example, small business suggestions rooted Hoogeveen, D. (2015). Subsurface property, free-entry mineral in traditional harvesting (e.g., commercial prepara- staking, and settler colonialism in Canada. Antipode, 47: 1. tion and distribution of dried meat) were a recurring Innis, H. (1927). The fur trade in Canada: An introduction to Canadian economic history. Toronto: University of Toronto Press. suggestion in the N’dilǫ̀ and Dettah focus groups. Par- Keeling, A. & Sandlos, J. (2015). Mining and communities in North- ticipants justified these ideas through their ability to ern Canada: History, politics and memory. Calgary: University of contribute to community health first and their poten- Calgary Press. tial economic success, second. The common interest The Northern Miner. (2016). Diamonds add sparkle to NWT economy. https://www.northernminer.com/news/ in increased Northern agricultural activities across all diamonds-add-sparkle-%E2%80%A8to-nwts-econo- four focus groups was articulated through a similar my/1003783521/ orientation. Parlee, B. (2015). The Social Economy and Resource Devel- In this way, the existing NWT mixed economy opment in Northern Canada. In C. Southcott (Ed.), Northern communities working together: The social economy of Canada’s North. offered no shortage of inspiration for what might Toronto: University of Toronto Press. come next. Research participants’ contributions have Pini, B., Mayes, R., & McDonald, P. (2010). The emotional ge- helped to ground and illustrate the rather abstract ography of a mine closure: a study of the Ravensthorpe nickel notions of “blue-sky thinking” in our future-orient- mine in Western Australia. Social & Cultural Geography, 11(6), 559-574. ed research. They offer concrete foci, from which we Simpson, L. (2014). Not murdered, not missing. Nations Rising. are taking direction in our second research phase. Posted on March 5, 2014. As we continue to co-analyze the pilot data, we are preparing for further data collection in the NWT in

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