Expectations in the Healthcare Setting

Healthcare workers are expected to provide compassionate and competent care, ensuring the well-being and dignity of their patients. Find out more about the expectations specific to the North here.

Meeting New Patients

Introduce yourself, smile, and say where you are from. In our communities, knowing someone’s name and community tells us what family they are connected to, what lands we are coming from, and how we are related. It’s also part of establishing a trusting relationship. Feel free to adopt the custom.

Call me by my name.

Practice my name before you call it out in the waiting room. When you stand there, looking for someone of the right age and gender as the chart you hold, I feel less than human.

Look at me in the eye and speak to me.

Don’t look at my whiter family members or the interpreter. Ask me for consent. Ask me if I understand and agree with the treatment plan.

I want to trust you. Don’t rush me. Please be kind. Sometimes we may sit quietly and It may appear that we are not saying very much. One of our values is to be watchful and observing. I am trying to determine if you are trustworthy and if speaking to you will be helpful.

Accept that my culture and the way I express myself is different, even in English.

When I finally book an appointment, it’s because I have been dealing with the issue for too long. When I describe the symptoms, especially pain, recognize that it is wrong in Inuit culture to complain. I am describing my situation in the least offensive terms possible.

It may sound like it is minor. To me, it is important.

Sometimes we tell stories to get our point across. Some of the beauty of our language, and the way we speak and understand, is that the collective knowledge of our people is embedded in a story. We often speak indirectly, through stories, to make our point or to share a relevant piece of information. Sometimes these stories are dismissed as irrelevant because they don’t contain a direct answer to a question, but they really contain the essence of the issue. One must be a skilled listener to become accustomed to this way of communicating.

It was not so long ago that the Residential School system for Indigenous children has been part of Canadian history since the late 19th century, when a shift in government policy resulted in what we know today as the process of forced assimilation of Indigenous children. The first government-regulated school for Inuit opened in 1951 in Chesterfield Inlet. These schools were often far away from the new Inuit settlements which resulted in the separation of children and youth from their parents, kinship networks and traditional ways of life. The Residential School experience has had far reaching and deep impact. Inuit language, culture and spiritual beliefs were eroded because of the assimilation process.

The traumas and consequences of colonialism are still deeply felt today. Inuit children are disproportionately taken from their families and their communities. They are often placed in non-Inuit foster care and are often even taken out of the territory to live in southern provinces.

We often have to repeat ourselves to every new practitioner that we see. Please be mindful of the fact that we may have explained this condition and the steps taken to alleviate it, to 5 or 6 or more practitioners who have cycled through on locum contracts. Please review my chart in advance and please take good notes.

We are all dealing with significant changes. Your job here is important and together we will contribute to a better future through understanding and compassion.

A note to my clinician by Karen K. Kablona

I have an appointment with you today and I am worried.
I have avoided making this appointment for as long as possible.
I need it, but I dread it.
All day, I have visualized what I will tell you and how to respond to your skepticism.
It is not you as a person.
It’s my history with medical care.

It is my way of expressing my symptoms and expectations.

As a child, my grandfather went to the health centre with stomach pains for months.

One time he did not come home.

As a post-secondary student studying far from home, a dear family member was sent home with acetaminophen for breathing problems. When he was medivaced with pneumonia four long months later, I was too far away to help and was torn apart.

When my infant was medivaced, clinicians spoke to my blonde mother and handed her the consent forms for my daughter. I was in the room.

Decades of these interactions have created layers of doubt and skepticism.
I know that I feel this way.
That’s why I visualize our appointment and prepare myself.

I also ask someone else to accompany me, to witness our interaction and calm me.

You can help too.

Karen Kilikvak Kabloona does not have an upcoming appointment.
This is an opinion piece, one that I welcome your thoughts on by email to: kkabloona@gov.nu.ca

World Views

Our healthcare system is situated within 2 different worldviews with regard to health and wellness: the biomedical worldview and the Inuit worldview.

Current biomedical models operate under the assumption that illness is secondary to disease, i.e., that we are sick because a disease is making us sick (Wade and Halligan 2004).  Therefore, if one treats the disease, the illness will go away as well.

Indigenous wellness perspectives are formulated on understandings of the world, which are based on interactions between people, as well as interactions with the land, animal, and spirit worlds (Chilisa 2012, Deloria 1995, Wilson 2008). Inuit society is based on a system of kinships, relationships, and values. Core values, include (but are not limited to):

Inuuqatigiitiarniq

being respectful of all people

Pittiarniq

to be good or kind or moral

Ikajuqatigiinniq

to be helpful to others, to provide assistance to those who need it

Tunnganarniq

to foster an environment of kindness by being open, welcoming and inclusive

Pijitsirniq

to demonstrate leadership qualities by being in service to the community,

When these two world views come together in a clinic setting, there can be misunderstandings which cause frustrations for both the patient and the health care provider. Below, we have shared an opinion piece which helps to provide the perspective of a patient in our health care setting when meeting with a new provider. We have also included helpful strategies to keep in mind when meeting new patients, below.

Pink flowers stands alone on a rocky hillside

Inuit Health Perspectives and History

In a thematic report from the Qikiqtani Truth Commission entitled “Aaniajurliriniq: Health Care in Qikiqtaaluk”, the authors stated the following about Inuit health:

 Inuit health knowledge is holistic in its approach and upholds that all aspects of a person’s needs, including the psychological, physical, and social, are connected. For Inuit, healing injuries and sickness goes hand in hand with developing a strong mind and resilient body; for this reason, health is closely tied to personal identity. Adults are expected to act independently with the interests of themselves and their families in mind. Sick people are treated with love and care, and satisfying the patient’s needs and desires is considered paramount for recovery. Inuit health knowledge also refers to more than general healing techniques—it concerns knowledge of the body and its social environment.

Trauma-Informed Practice

Trauma-informed practice is working in ways that demonstrate an understanding of the needs of people who have experienced trauma. There are 4 key elements to trauma informed practice:

Understanding the trauma context of the community you are working in; understanding that trauma has an impact on development, and understanding the relationship between trauma, substance use, physical health, and mental health,

Ensuring the safety of the clients means thinking about physical, emotional and cultural safety, being aware of power dynamics. ensuring informed consent, creating crisis plans and scheduling appointments consistently. Ensuring safety of practitioners means knowing and understanding vicarious trauma, preventing burnout, and knowing that a client’s behaviours might be a trigger for a practitioner’s own previous trauma.

This means communicating openly, equalizing power imbalances in our interactions, allowing the expression of feelings without judgement, and providing choices as to treatment preferences.

This means helping clients to identify their strengths and teaching skills for recognizing triggers if this is appropriate for your context.

More information on the trauma context in Nunavut and on trauma-informed practice in general and Indigenous communities.

Vital Role of the Interpreter in Healthcare

Inuit interpreters are key people in the provision of care for Nunavut patients and families. This work requires expertise and specialized training in English and Inuit medical terminology to negotiate linguistic challenges. Inuit interpreters are also navigators of two different health and wellness systems: a biomedical wellness model and a holistic Inuit wellness model.

Cultural differences between medical institutions and Inuit communities can lead to value conflicts and moral dilemmas as interpreters navigate how best to transmit messages of care, particularly regarding end of life, death, tragedy, or other emotionally intensive aspects of care to their fellow community members.

French language interpreters also play a vital role in the provision of services to Nunavut’s francophone population. It is important to be mindful of the essential role interpreters have in Nunavut’s primary care model.

Family Members as Interpreters

Asking family members to translate information that is sad or emotional places a lot of stress on family members. Often people don’t know the medical terminology involved. It’s also very difficult, in our communities, when a young person is asked to convey bad news to an older family member. We recognize that sometimes this is the only option, and we ask that you explain things with as much kindness as possible, recognizing that the family member may not know the terminology to translate the condition, treatment, or medication regimen with precision.