Indigenous Digital Storytelling As Pedagogical Tool for Cultural Safety in Health Care Settings

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