How Quebec's Minowé clinic is improving Indigenous access to health care

A clinic in Val-d'Or, Que., is being looked to as a province-wide model for improving health-care services to urban Indigenous populations but its director says recognition and funding are still a challenge.

The Minowé clinic is a partnership that started in 2009 between Val-d'Or Native Friendship Centre and the public health authority (CISSS) of the Abitibi-Témiscamingue region. 

Édith Cloutier, director general of the friendship centre, said integrating frontline health services at the friendship centre is what has made the clinic successful. The friendship has had a presence in the city of 45 years.

"The purpose of that partnership with the CISSS is to increase access to health services, but also to address that rupture of trust in the system," she said.

"It's to rebuild that trust through a clinic that is integrated in a friendship centre through an Indigenous governance of services."

Quebec's Viens Commission, which looked into treatment of Indigenous people by the public service, called for sustainable funding for services and programs based on cultural safeguard principles developed for Indigenous peoples.

Retired judge Jacques Viens, who presided over the commission, wrote in his final report last year that the Minowé Clinic was a model that other health and service institutions should be encouraged to adopt. Similar clinics have been implemented elsewhere, including most recently at the friendship centre in Quebec's Lanaudière region.

"We worked really hard on having Commissioner Viens understand and hear about this initiative," said Cloutier, who testified multiple times to the commission along with other members of Regroupement des centres d'amitié autochtone du Québec (the provincial association of Indigenous friendship centres).

"When it was stated as a recommendation, we said 'Mission accomplished.' We were heard."

However, she said they are still seeking formal recognition from the Quebec government, along with sustainable funding. The vision for the clinic is to add holistic cultural healing approaches to the conventional frontline services. 

"We need to officialize what we're doing within the general Quebec public services sphere," said Cloutier.

"We don't have permanent funding. We're still struggling by projects, by initiatives that are being supported for a year, for six months. We've been working like that for 10 years."

On Nov. 6, Quebec's Indigenous affairs minister Ian Lafrenière announced a $15-million plan to teach health-care workers how to better provide services to members of Indigenous communities. The announcement came in the wake of the death of Joyce Echaquan, a 37-year-old woman from the Atikamekw community of Manawan, Que., who died in a hospital in Joliette, Que., after recording medical staff hurling racial slurs. 

"How come it takes a tragedy, another death?" said Cloutier.

"We saw it live but how many others died without us knowing that racism killed them?"

Cloutier said Echaquan's death and discussions around systemic racism that ensued have reignited conversations about needing to involve Indigenous people in their own health and wellness services. That sentiment has been echoed not only in the Viens Report, said Cloutier, but in the national inquiry into missing and murdered Indigenous women and girls, the Truth and Reconciliation Commission, and the Royal Commission on Aboriginal Peoples.

"Putting Indigenous people at the heart of their own decision making capacity to bring changes, our own governance, our own visions, our own ways to work at wellness and health contribute to reconciliation," said Cloutier.

"You have Indigenous institutions like friendship centres in Quebec that have the capacity. We've been in that Indigenous service landscape in urban areas all over Quebec for the past 50 years building healthy communities in the cities. We've been demonstrating for 15 years the model that works."

A spokesperson for Lafrenière's office said they recognize the importance of clinics like Minowé.

"Every recommendation of the Viens Commission is important to us, including the ones who will improve access to health care services for Indigenous people," an emailed statement said.

"We are working very closely with the Regroupement des centres d'amitié autochtone du Québec and with key stakeholders in such way."