Finding the headwaters: — Perspectives on Global Health

Identifying upstream factors affecting trauma and surgical resource shortages in Indigenous communities in Canada

by Allyson Kis

I would like to acknowledge the beautiful land on which I am writing - the traditional territories of the Anishinabewaki and the Omàmìwininìwag. This land has long served as a site of meeting and exchange amongst nations since time immemorial and has provided me a space for reflection, creativity and proximity to nature. The land on which my heart lies is unceded Tsimshian and Nisga’a territories.

I grew up in Terrace - a small town in northern British Columbia with close relations to the Nisga’a Nation of the Nass River Valley as well as the Kitselas and Kitsumkalum First Nations. After providing medical care to the Sim'oogit (chief) of the Ganada pdeek (tribe) of the Nisga’a Nation, my father was adopted as a brother into their pdeek and given the name Wii Milit (big steelhead). Living in rural Canada and interacting with members of the Nisga’a Nation has opened my eyes to different barriers in accessing health care and has enriched my understanding of the importance of community and a reverence for nature.

There is something magical about kayaking down the Kitsumkalum river that flows behind my home and crossing paths with the resident eagle perched up high at the mouth of the canyon, the big moose swimming across the strong current, and the resilient steelhead making their way upstream. They welcomed us and accepted us as visitors in their home day after day.

The Ganada pdeek identify themselves by the raven and the frog, which are seen as “the holders and messengers of knowledge. Ganada communicate direction, the presence of animals or danger nearby, and even death. Ganada also brings good news and encouragement. The Ganaaw (frog), another teacher in the tribe, inhabits lakes and ponds and are linked to weather, change, and abundance” (Nisga’a Lisims Government).

The Nisga’a system of beliefs recites the creation story as K’am Ligii Hahlhaahl (Chief of Heavens) who sent people down to earth and regrouped them into four clans: the Laxsgiik (Eagle), the Laxgibuu (Wolf), the Ganada (Raven) and the Gisk'aast (Killerwhale) along with the Owl. They were placed by the Chief of Heavens along Lisims, the Nass River.

I have a core memory of preparing fresh oolichan and salmon with the members of the pdeek by the river. I was in awe of their resilience and strength in the face of unpredictable access to resources, long-lasting impacts of colonization, and, at times, challenging environmental conditions. More specifically, I admired their rich culture and mindfulness towards nature and wildlife.

A few years later, Marsha Moore— a social worker at the Nisga’a Child and Family Services— welcomed me onto her team as a volunteer. I visited communities on the Northwest Coast, spoke with Nisga’a children, youth, and families, as well as assisted in preparation and documentation of family group and youth transition conferences. The resilience that I once again witnessed in these families and youth sparked my interest to pursue medicine at McGill in order to become an advocate for Indigenous and rural health and to have the opportunity to make tangible contributions towards improving access to health care in these communities. Though my influence as an individual may be limited, I look up to how my father and Marsha Moore impacted the lives of those around them. I strive to continue to become more culturally sensitive and mindful and hope to help bridge the gap in access to health care in rural Canada.

Over the past year, I had the opportunity to work towards that goal by evaluating trauma, surgical and telemedicine capacity in Indigenous communities in Northern Quebec under the supervision of Dr. Evan G. Wong—the appointed lead for Trauma and General Surgery in Nunavik.

Delivery of acute care in Nunavik is extremely challenging due to scarcity of resources, unpredictable weather conditions, underdeveloped transport systems, and a population spread out across a vast terrain.

Indigenous communities, who make up the majority of Canada’s remote sites are confronted with additional barriers in accessing health and social services. Ongoing disparities in Indigenous health, such as a lower life expectancy due greater prevalence of chronic conditions and higher deaths from motor vehicle accidents, suicide and other traumatic injuries, are multifactorial and stem from a colonial context of historical and intergenerational trauma as well as social determinants of health.

In this project, we explored the availability of current trauma and surgical resources as well as the need of telemedicine through the use of validated assessment tools. Key findings of the study included adequate availability of equipment and supplies, although, a strong need for telemedicine as well as health care professionals with a skillset needed to perform life-saving trauma and surgical procedures. To address these resource shortages, quality improvement initiatives that focus on remote access to specialists from urban centres, encouraging training and retention of staff, recruitment of trainees through incentive programs and early exposition to rural medicine should further be prioritized. On the telehealth developmental aspect, efforts should focus on funding, quality improvement initiatives, establishing administrative support and physical spaces for consults. Findings of this study may further be applied to similar settings in other rural regions of Canada.

There is no doubt that disparities in Canadian health care still exist, but such gaps can be diminished by projects of this sort that add to existing medical literature and can in turn influence and reform capacity-building initiatives on a governmental level. One of the Truth and Reconciliation Commission’s Calls to Action describes the importance of publishing annual progress reports and establishing measurable goals to identify and close gaps in health outcomes between Indigenous and non-Indigenous communities. Furthermore, continuing to strengthen collectiveness, unity, and commitment to renewing nation-to-nation relationships with all peoples of Canada is an essential part of this journey to Truth and Reconciliation.