Indigenous-led team at Brantford General Hospital aims to offer better care for First Nations patients

When Cheryl Miller spent eight days at the Brantford General Hospital (BGH) just outside of her home in Six Nations, Ont., in December, she had a surprise visit to her hospital room that made her stay so much better.

One of the nurses had asked Miller if it was OK for Leigh Staats, the hospital's new Indigenous patient navigator, to come by. And because Miller hadn't had any visitors due to COVID-19 restrictions, she welcomed the idea, which also came with a much-appreciated toiletry kit.

"We gabbed back and forth and of course we come to find out we're related," Miller said. 

Staats explained to Miller what was going on with her health, answered her questions, and told her about the Indigenous Family Space that she could visit to smudge if she wanted to. 

Before Miller was discharged, Staats offered to call her family, help her with paperwork, and handed her a business card with her contact information, in the case Miller had any medical-related questions after returning home. 

The service was part of a new program at BGH, where members of both Mississaugas of the Credit and Six Nations of the Grand River visit for emergencies and health care. 

Six Nations does not have a hospital of its own, though it does have a community health centre, Gane Yohs. Some neighbouring hospitals have Indigenous patient navigators and an Indigenous health committee, but the Indigenous Health Services department at BGH, which launched in September 2020, is now one of only a few similar hospital programs in Canada. It is out to provide better, more culturally safe care to the First Nations, Metis and Inuit patients who enter the hospital's doors. 

Miller said the care made a difference. 

"Being a social worker myself and the health advocacy officer for a number of years, I knew [the health-related information], but it felt comforting to me because I was now in a place where I wasn't allowed my family connections, and my community connections because of COVID, and that put a big loneliness wall up there. That little chitchat that we had, she spent about 15-20 minutes with me … I was really grateful for that," Miller said. 

The program is multi-pronged, with access to traditional plant medicines and ceremonies, an Indigenous Family Space and the creation of a more community-based environment for Indigenous patients. 

That little chitchat that we had, she spent about 15-20 minutes with me … I was really grateful for that.- Cheryl Miller

"This work is so important especially with [the hospital] situated so close to two Indigenous communities and the large urban Indigenous population of Brantford," Christina Ingram, chair of the BGH's Indigenous cultural safety committee, wrote on the BGH website after the program launched. 

The initiative aligns with BGH's strategic plan to improve the experience of Indigenous patients — a population that, according to several studies, has faced discrimination and unfair treatment in urban healthcare settings.

'The Western system wasn't built for us'

The program also launched because of a gap that one local doctor saw when serving her community. 

Six Nations doctor Amy Montour came to BGH in 2010 as a medical student, and is now the interim chief and medical director of the department of hospital-based medicine.

The Six Nations community had been leaning on Montour to help them either navigate the hospital, or to check on loved ones inside the hospital, and it felt like they were bumping into barriers that were imposed by the nature of regulatory rules. 

"As a physician, you tend to be involved because you've been asked to at the request of another physician, but in the case of Indigenous families, I was getting phone calls in the community that [said] 'so and so is in hospital, can you go and check on them and make sure everything's okay,' [or] 'can you help us understand what's happening?'" says Montour. 

"I quickly realized that there was a bit of a medical legal issue there, in that I couldn't access people's information [because] all health professionals have regulatory colleges and there are a lot of rules around whose health information you could be involved in."

She turned to Dr. Anirudh Goel, the vice president of medical affairs and chief of staff at BGH, who at the time was the chief hospitalist, and told him of the additional work she was doing with community members in the hospital. 

He helped Montour develop a proposal for what became the Indigenous Medicine Program, which allows the organization to put parameters around who is accessing information, why they're accessing it and allows doctors like Montour to get consults for patients and families in a way that makes sense to Indigenous communities, she says. 

"The Western system wasn't built for us. We're very familial, very community-oriented," says Montour. 

She applauds BGH leadership for adapting to ensure that regulatory issues are met, protecting people's health information and privacy, while also meeting the needs of the community.

Goel hopes that these changes are just the beginning of efforts to heal the historic strain between hospitals and Indigenous patients. 

"We're looking to address this in a very collaborative spirit. We recognize that as institutions, and as Western-based providers, we don't necessarily understand the perspectives of Indigenous peoples and Indigenous communities, and we defer to those communities to help us learn so that we can meet their needs better," he says. 

"Having experts like Amy, Dr. Karen Hill [co-lead for Indigenous Health Services] and Leigh Staats, who is the Indigenous patient navigator, has been transformative for the organization."

Access to traditional medicines, ceremony and post-hospital care

The program is modelled after Juravinski Cancer Centre's Indigenous Cancer Care Program in Hamilton, where Montour worked for three years. 

Staats is in the hospital Monday to Friday, taking in the consults, receiving phone calls from people in the Six Nations community who have concerns, and is a resource and advocate for patients. 

For Indigenous patients, who either self-identify as such to the hospital staff, or those an ER physician or nurse recognize as having some cultural needs, Staats will be brought in. She is the first point of contact, touching base with a patient to see what their needs are, and will ensure that the health care team is aware of the family and community members that need to be involved in discussions about the patient.

She also connects the patient to Montour, to interpret medical language or offer supportive care, or to Hill for traditional medicine or a type of ceremony. 

"A big part of our healing is to pick up those things of our own culture that have been sort of eroded or moved to the background," says Hill. 

"Our service has that understanding that it's more than just treating the medical need that is presenting itself, that there's something more that's happening with an Indigenous person, that oftentimes it is an illness that will trigger them … there's traumas that they're carrying."

When a patient asks for plant medicines, Hill obliges. Or she sits with someone who wants to reconnect with their culture and what that journey might look like beyond the hospital. With those that know their ceremonies, and make that request, Hill assists them "to make them feel whole so that they can come through what it is that they're dealing with right now." 

Montour says they're there for people at discharge, too, whether it's connecting them to community resources, or to help them understand what the next steps for them are if they're returning to the Western medical system. 

The Indigenous staff also does a lot of work helping their colleagues understand Non-Insured Health Benefits (NIHB), the Indigenous Services Canada program that provides registered First Nations and recognized Inuit with health benefits coverage.

Part of a cross-Canada collaboration of Indigenous physicians

Knowledge of the program in the community has begun to spread through word-of-mouth and social media, and posters line the medical unit walls at BGH, but the Indigenous Health Services  team also wear beaded lanyards in the hospital, which often prompts the question of "are you from the rez?" and then a conversation is launched about how the patient can access culturally based care. They are working to continue to get the word out.

Hill adds that the work they do doesn't stay between the walls of BGH. She is currently helping a family in a Hamilton hospital. "That's what makes it a little bit different than a Western system is that even though we're housed within the BGH, the BGH is not our only place that we work. We have to meet the needs of our people when they ask to be met."

We have to blaze the trail in many ways here.- Dr. Karen Hill 

That work also includes weekly meetings with other Indigenous physicians from across Canada. The grassroots group includes seven clinical physicians working at the community level, seeking solutions to issues like anti-Indigenous racism within the healthcare system. Past meeting guests have included former Minister of Indigenous and Northern Affairs Carolyn Bennett and then-Minister of Indigenous Services Marc Miller. 

"There isn't anything that supports me as a physician, other than the United Nations Declaration on the Rights of Indigenous people and the Truth and Reconciliation Commission that say I have a right as an Indigenous person to my own Indigenous knowledge — and, to me, that includes within my practice as a physician," says Hill. "I only [know of] five other physicians in this country that actually do that. We have to blaze the trail in many ways here."

BGH's CEO David McNeil believes that the work being done by Hill and Montour will be a model for other hospitals. 

"We're just giving them the lab space for them to develop this concept and move it forward," he says. "We recognize as a hospital more resources have to be added before having those conversations with Ontario Health."

"We're not out to fix the system," Hill adds. "We're out to make the space to bring in our Indigenous knowledge and ways to do what we know we need to do for our people."