navigating health care - syilx...our individual health and wellness cannot be looked at in...

NAVIGATINGHEALTH CARE

PARTICIPANT HANDBOOK Updated 2013 Edition

Participant Handbook | 2

Navigating Health Care: A Community Curriculum

Participant Handbook © Okanagan Nation Alliance 2010, 2013

BACKGROUND: Information can be like medicine – it puts the powerful tools of awareness and choice in our hands. This health promotion project was undertaken by the ONA with initial funding from the Aboriginal Health Transition Fund to increase the capacity of Okanagan people to access existing health services and act as self advocates within a context of cultural identity and practices related to health and wellness. This training informs participants of their options and rights as health care consumers; gives participants a chance to practice how to communicate effectively with health professionals; and helps identify steps in their own health journey.

Okanagan Nation Alliance 101 – 3535 Old Okanagan Hwy Westbank, British Columbia Canada, V4T 3J6 Tel: (250) 707o 0095 Website: www.OkanaganNation.com


TABLE OF CONTENTS Table of Contents ................................................................................................................... 3

Acknowledgements ................................................................................................................ 5

Background ............................................................................................................................ 5

Module 1: Weaving Our Beliefs on Health & Wellbeing ......................................................... 7 What Does ‘Being Healthy & Well’ Mean to Me? ................................................................................... 7 A First Nations View of Holistic Health .................................................................................................... 8 What influences our health as First Nations people? .............................................................................. 8 ‘Sharing One Skin’ — Jeannette Armstrong ............................................................................................ 9 Taking Control of My Health & Wellbeing ............................................................................................. 10

Module 1: Weaving the Strands of Mainstream Health Care ............................................... 11 The Culture of Mainstream Health Care ................................................................................................ 11

Module 2: The Landscape of Mainstream Health Care ........................................................ 13 Why Is It Important to Know About Consumer Health Rights? ............................................................. 13 What Are My Health Rights? ................................................................................................................. 13 What Should I Expect From a Health Care Professional? ...................................................................... 14 Overview of Interior Health ................................................................................................................... 14 First Nations People in the Interior Health Region ................................................................................ 15 Federal & Provincial Health Care Funding for First Nations .................................................................. 16 BC Medical Services Plan (MSP) ............................................................................................................ 16 BC Care Card: How to Get One? ............................................................................................................ 16 Non-‐Insured Health Benefits: How do I get them?............................................................................... 17 Non-‐Insured Health Benefits: what is covered? ................................................................................... 17

MOdule 2: Paths to Good Health .......................................................................................... 20 Aboriginal Patient Navigators (APNs) .................................................................................................... 22 Community Health Nurses (Band Nurses) ............................................................................................. 24 Family Doctors ....................................................................................................................................... 25 Walk-‐In Clinics ....................................................................................................................................... 26 Community & Primary Health Care Centres .......................................................................................... 26 Mental Health & Addiction Services ...................................................................................................... 27 Addictions Programs & Services ............................................................................................................ 29 Mainstream Addictions Services ........................................................................................................... 29 Band/Friendship Centre -‐ Alcohol & Drug Abuse Programs .................................................................. 30 Community Rehabilitation & Care Services ........................................................................................... 31 Occupational Therapist (O.T.) ................................................................................................................ 31 Physiotherapist (P.T.) ............................................................................................................................ 32 Respiratory Therapist (R.T.) ................................................................................................................... 33 Homecare Equipment & Supplies .......................................................................................................... 34 Home & Community Care for Seniors (over 65 years) .......................................................................... 35 Hospital-‐based Services ......................................................................................................................... 36 BC Cancer Agency Centre for the Southern Interior .............................................................................. 38


Screening Mammography Program ....................................................................................................... 38 You & Your Pharmacist .......................................................................................................................... 39 Healthlink BC – Dial 8-‐1-‐1 ...................................................................................................................... 40 Medical Health Info Lines ...................................................................................................................... 40

Module 3: Empowered & Resilient ....................................................................................... 42 What does it mean to be resilient? ....................................................................................................... 42 Being an Effective Communicator in Health Care ................................................................................. 44

Module 3: Rights & Responsibilities ...................................................................................... 47


ACKNOWLEDGEMENTS The project has benefited from the generous input of many Okanagan Nation community members and Interior region health professionals. The ONA and the authors wish to extend a sincere thank you all those who participated in making this a meaningful community-based curriculum.

BACKGROUND Discussions among community health staff in ONA communities had raised concerns that ONA members were not making full use of existing health care services. This health promotion project was undertaken by the Okanagan Nation Alliance to increase the capacity of Syilx people to access existing health services.

VISION To improve the health of Syilx adults, Elders and their families by increasing and supporting their ability to navigate health care programs and services in the Interior Health region while maintaining their Syilx identify and traditional beliefs and practices related to health and wellness.

GUIDING VALUES

Syilx values & beliefs are the starting point for knowledge and at the centre of all aspects of the project: the methodology, curriculum and learning model.

Community development builds on the successes and strengths of the Syilx peoples, and promotes self-determination, capacity building, and self-sufficiency in navigating and fully utilizing existing mainstream health care services and programs.

Cultural safety: Syilx peoples will experience “cultural safety” in their encounters with mainstream health care professionals and services as they become more informed, empowered, and active in their own health care decisions. COMMUNITY ENGAGEMENT The content of this guide and the curriculum reflects extensive community consultation with Syilx peoples from all ONA communities, and with mainstream health managers and service providers in Interior Health.


COMMUNITY WORKSHOPS The community workshops inform participants of their options and rights as health care consumers; gives participants a chance to practice how to communicate effectively with health professionals; and helps identify steps in their own health journey. The curriculum emerged from extensive community engagement, and was developed into three modules that are connected by the theme of weaving, filling and strengthening a basket for Syilx people to take on their health care journey.

Module 1 – Weaving the Basket Promotes reflection about who is responsible for our health and increases awareness of the cultural nature of health care.

Module 2 – Filling the Basket Provides an overview of the health care landscape, including funding, as well as different professions and their services.

Module 3 – Strengthening the Basket Increases awareness and develops skills to create resilient health care consumers.

ADDITIONAL RESOURCES As part of the project, Community Handbooks have been developed that list health resources specific to each band in the ONA. The Handbooks have been updated to reflect current services available in 2013.


MODULE 1: WEAVING OUR BELIEFS ON HEALTH & WELLBEING

“Everything we do, or don’t do affects everything around us and in turn we are being influenced by everything and everyone around us.”

(The Spider’s Web. Bill Cohen, 2001)

Our individual health and wellness cannot be looked at in isolation.

We must also understand that a long history of colonization plays a major role in the

current health of ourselves, our families, and our Nation.

We continue to be influenced by centuries of being colonized - our culture and

language threatened, especially because of the residential schools.

Colonization (where one society attempts to dominate/control another) has had a

negative impact on our level of education, employment, income, housing, and food

security. All of these are closely related to how healthy we are both individually and

as a whole community. In mainstream health care these are called ‘social

determinants of health’.

However we know that cultural pride and cultural identity and knowledge are

important to our individual health and the health of our families, community and land.

WHAT DOES ‘BEING HEALTHY & WELL’ MEAN TO ME? Being healthy means different things to different people – it is influenced by many

factors including – your age, gender, family, where you live, education, income,

employment, your values and beliefs etc.

What you think of as being healthy may not be the same as what a Western trained

health care professional thinks of as being healthy.

In this workshop we will look at what health and wellness means in relation to our

family, our community, our Nation and our land.


A FIRST NATIONS VIEW OF HOLISTIC HEALTH

WHAT INFLUENCES OUR HEALTH AS FIRST NATIONS PEOPLE?

“Everything we do, or don’t do affects everything around us and in turn we are being influenced by everything and everyone around us.”

(Bill Cohen, 2001)

A long history of colonization, systemic discrimination, the degrading experience of

residential schools, and other experiences are the root causes of negative health

effects for generations of First Nations families.

Research has shown that the health status of individuals is closely associated with

their level of education, income, and employment (these are examples of – social

determinants of health).

Education is perhaps the most important, since it is a determinant of a person’s

future employment and income. This is why the lower graduation rate and lower

level of postsecondary participation of First Nations students are major concerns –

Although there is not one First Nations view of health and wellbeing – most First Nations beliefs support a more holistic worldview of health. This means that “each member enjoys health and wellness in body, mind, heart, and spirit…with mutual support of each other, and community leadership committed to whole health, empowerment, sensitivity to interrelatedness of past, present, and future possibilities, and connected between cultures.

All four elements of life, the physical, emotional, mental, and spiritual, are represented in the four directions of the medicine wheel. These four elements are intricately woven together and interact to support a strong and healthy person.

Traditional teachings and knowledge provide a basis for positive self-image and healthy identity” Cultural pride, identity and traditions are integral components of First Nations’ holistic approach to health and well-being.


they have long term implications on individual, family and community health and

wellbeing.

Poor housing and food insecurity due to poverty or living in a remote area are other

powerful ‘social determinants of health’ for First Nations peoples.

‘SHARING ONE SKIN’ — JEANNETTE ARMSTRONG

Community in Okanagan is a word that has the meaning that we are ‘of one skin’.

The one skin is not referring so much to the idea that we’re biologically related as

to the idea that we share something which gives us a covering, a security, a

protection – in the same way that our skin, stretched over our blood and bones

protects us from dissipating back into our larger selves which is the external

world. Your skin holds you together.

This means that the bond of community and family includes the history of the

many who came before us and the many ahead of us who share our flesh. We

are tied together by those who brought us here and gave us blood and gave us a

place. Our most serious teaching is that community comes first in our choices,

then family, and then ourselves as individuals, because without community and

family we are truly not human.

From the Okanagan sense, your responsibility is to understand how the health

and wellbeing of the community are sustained. Traditionally when we greeted

each other in Okanagan it went something like this – Is that you? (Are you you?)

If the person says ‘Yes it is me’ then everything is fine and everything is where it

should be. If the person says ‘no it isn’t me’ then the next part of the process is

to find out what the situation is that has caused you not to be you today. So

we’re actually asking about the person’s health and well-being – both their

physical and psychological. We’re asking ‘Can I be of assistance to you in some

way?’ because your emotional well-being is important to me and this community.


If you’re not emotionally healthy, then things are going to go wrong in my

community because you affect my community and you affect me.

Community is that instinctual yearning for something deeper and longer lasting.

We are the land and because we’re the land, the land wants to be us. We are

loved by that land in a way in which we have come to understand for many

generations. Community and land to us is inseparable.

—Jeanette Armstrong, Penticton Indian Band

TAKING CONTROL OF MY HEALTH & WELLBEING

Historically the health of First Nations has been under the colonial control of initially the

Federal government, and is now shared with the Provincial government. However, there

is a growing shift towards returning self-governance and determination back to

community leaders and members.

“When I first started working here, I’d tell people, I’ll give you the information, but then

you have to decide. They’d say, but you’re the nurse, tell me what to do! Fundamental question to ask yourself: Who’s responsible?”

—Community Health Nurse

SELF-‐DETERMINATION: The right to make your own informed decisions and choices. Self-

determination has been linked with health both at an individual and community level.


MODULE 1: WEAVING THE STRANDS OF MAINSTREAM HEALTH CARE THE CULTURE OF MAINSTREAM HEALTH CARE

Health care is ‘cultural’ in nature. Just like a different country, Western health care has

its own beliefs, values, and scientific knowledge. It has its own ‘medical language’,

behaviors, expectations, physical locations, customs and appropriate ways to dress.

Familiarity with the culture of health care can help us make fuller use of the services

available.

A Western bio-medical model:

Sees health as the absence of illness or disease

Views a person’s physical, emotional and mental health as separate and

therefore requiring different health professionals and ‘treatment’

Considers a person’s spiritual wellbeing and needs as largely unimportant

Views the role of patient/client as being co-operative and compliant

Embodies an unspoken hierarchy of power

Places a high value on Independence and autonomy

Understands knowledge as scientific, proven through Western forms of research

“Just because you go to the hospital and are seen by someone, perhaps you

have a heart attack, but you also have a kidney disease, and the specialists don't always talk together....You need to make sure that your other specialist is

informed that you are there otherwise they will go ahead and treat you. I don't know how this happens.....just completely ignoring that

you are having this other health issue.” —Community Consultation


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MODULE 2: THE LANDSCAPE OF MAINSTREAM HEALTH CARE WHY IS IT IMPORTANT TO KNOW ABOUT CONSUMER HEALTH RIGHTS? As an adult, you have a personal responsibility to seek and advocate for the best health care for yourself and your family. To ensure that you are treated fairly and with respect, consumer health rights have been established under Canadian and BC law.

WHAT ARE MY HEALTH RIGHTS? Under Canadian law, you have the right to –

Visit a doctor

Visit the hospital

Receive emergency care

Question health care

professionals’ treatment

Receive sufficient information

regarding treatment

Give informed consent to

treatment

Seek a second opinion

Refuse treatment, unless you

have a serious communicable

disease that could harm other

people

Be free from verbal, physical,

sexual abuse and/or neglect

Have a friend or family member

with you during appointments and

examinations

Refuse students, residents and

those otherwise “in training”

present during appointments and

examinations

Be compensated for injury

Privacy and confidentiality

Access to your records

Your rights have been violated if you have been discriminated against because of your ancestry, age, appearance, sex, religion, sexual orientation, disabilities, or marital status.


WHAT SHOULD I EXPECT FROM A HEALTH CARE PROFESSIONAL? YOUR HEALTH CARE PROFESSIONAL SHOULD:

Respect your rights

Tell you his/her name & job/position

Treat you fairly - with dignity & respect

Provide explanations about your illness,

treatment, & tests in words you can understand

Keep your files & personal information private &

confidential

Note: You can access your personal medical files. They should not be shared without your permission. Complaints: If any health care professionals do not provide you with appropriate care or has not followed these expectations you can take action. Ask your Aboriginal Patient Navigator or Band Nurse on how to make a formal complaint. Or contact Interior Health as follows:

Patient Care Quality Office Phone: 1-877-442-2001 (toll-free) 220-1815 Kirschner Road Kelowna BC V1Y 4N7 Email: [email protected] Website: www.interiorhealth.ca

OVERVIEW OF INTERIOR HEALTH British Columbia (BC) is currently divided up into five separate health authorities. Interior Health (IH) is one of the largest - responsible for planning and delivering a full range of health care services to over 700,000 people. Interior Health has a large and growing population, spread over a wide area. The total population of the IH region is expected to increase by over 4% between 2009 and 2014 – placing an ever-increasing demand for health care services.

Who Are Health Care Professionals? Health care professionals are people who give health care services to the public. These include doctors, nurses, dentists, pharmacists, physiotherapists, psychologists and other health practitioners who are licensed and are bound by standards of practice and codes of ethics.


FIRST NATIONS PEOPLE IN THE INTERIOR HEALTH REGION Interior Health has a large population of First Nations and Aboriginal peoples. Almost a quarter of the total Aboriginal people in BC, on and off reserve, live in the Interior Health region. Northern Health is the only region with a larger Aboriginal population in BC.

The total number of Aboriginal people (both on and off reserve) living in the Interior

Health region is approx. 45,000.

The ‘health delivery service area’ of the Thompson/Cariboo & Shuswap service area

has the highest percentage of Aboriginal people in the province – nearly 12% of the

total population in this area is Aboriginal.

In the Okanagan health delivery service area - just over 7% of the total population

are Aboriginal.

Planning and delivering health care programs for this large (and increasing)

population, spread over such a wide geographical area, is extremely complex and

ever changing.

Accessing and using the health care services can be challenging for everyone.

Source & for more information: First Nations Health Council (2009) Regional Profiles of First Nations Communities: According to Current Provincial Health Authority Regions

Interior Health Region & ONA Territories The Interior Health region covers over 214,000 km2– from Williams Lake to the U.S. border and from Kleena Kleene in the Chilcotin to the Alberta border. The Interior Health region is divided up into 4 separate health delivery service areas:

• Thompson/Cariboo & Shuswap • Okanagan • Kootenay Boundary • East Kootenay

The geographical area for the Okanagan Nation Alliance covers two separate health service area: the Upper Nicola Band is in the Thompson/Cariboo & Shuswap health service area; the other 6 Bands are in the Okanagan health service area. Source: First Nations Health Council (2009) Regional Profiles of First Nations Communities: According to Current Provincial Health Authority Regions


FEDERAL & PROVINCIAL HEALTH CARE FUNDING FOR FIRST NATIONS The federal government has a constitutional responsibility for the health of Status Indians. Federal and provincial governments share responsibility for providing health services to First Nations in Canada. Until recently, a branch of Health Canada called the First Nations Inuit Health Branch, has been responsible for the delivery of programs and services on reserve. Now, however, we are in the process of transitioning to the First Nations Health Authority (FNHA). The FNHA will plan, design, manage, and fund the delivery of First Nations health programs and services in BC. These community-based services are largely focused on health promotion and disease prevention:

• Primary Care Services • Mental Health and Addictions Programming • Health Infrastructure • Environmental Health and Research • Non-Insured Health Benefits

The FNHA will not replace the role or services of the BC Ministry of Health and the Regional Health Authorities. The First Nations Health Authority will collaborate, coordinate, and integrate our respective health programs and services to achieve better health outcomes for First Nations.

BC MEDICAL SERVICES PLAN (MSP) This provincial program ensures that all eligible residents of BC have access to medical care. Medical Service Plan (MSP) premiums are paid by Health Canada to British Columbia on behalf of all First Nations residents in BC. As of July 2013, the First Nation Health Authority has assumed responsibility for these payments, acting as an MSP group administrator for eligible First Nations residing in BC.

BC CARE CARD: HOW TO GET ONE? If you do not have a BC Care Card (for the MSP), application forms are available from local community band offices, or from the First Nations and Inuit Health Branch in Vancouver.


NON-‐INSURED HEALTH BENEFITS: HOW DO I GET THEM? This federal program provides a range of medical goods and services that supplement benefits provided through the BC Medical Services Plan (MSP) or through private medical insurance programs. As of July 2013, the First Nations Health Authority has assumed responsibility for NIHB provided by Health Canada to First Nations in BC.

WHO IS ELIGIBLE FOR HEALTH BENEFITS PROGRAM? • Eligibility for the FNHA Health Benefits Program extends to First Nations people that

are resident of BC and have a status number. • Residency is defined as having an active BC Health Care card and living in BC. • For those clients who premiums are paid for by FNHA and live in BC, they will

automatically be added to FNHA Eligibility List. • First Nation clients that have their MSP premiums paid by their employer or through

another source, are encouraged to contact the regional office (1-800-317-7878) to ensure they are on the FNHA Eligibility List.

• If a non-resident First Nations person uses health services in BC they will continue to be covered by Health Canada.

NON-‐INSURED HEALTH BENEFITS: WHAT IS COVERED? DRUGS: Certain prescription drugs, over-the-counter drugs and proprietary medicines are available through the program. They are listed on the NIHB Drug Benefit List, which is posted on their website. DENTAL CARE: Specified dental services are available from dental practitioners. The following dental services do not require prior approval, but there may be a limit on how frequently they can be accessed: Cleanings, denture repairs, exams, simple extractions, fillings, open & drain emergency procedure, preventive services, root canals for adult front teeth, x-rays. Dental services that require prior approval include: Crowns, dentures, complicated or surgical extractions, orthodontic services including braces, root canals for back teeth, and sedation. VISION CARE: Eye glasses (new, replacement or repair) are available if the item has been prescribed within the last 12 months and meets minimum eligibility criteria. This assumes the item is unavailable under any provincial or third party health plan.


MEDICAL SUPPLIES AND EQUIPMENT: Specific supplies and equipment are available including items such as hearing, mobility and bathing aids. For a complete list of equipment and supplies, and details on approval and replacement guidelines visit the website. MENTAL HEALTH: Limited short-term mental health services are available. These include crisis intervention counselling with a qualified mental health professional. This service is primarily available to registered First Nations and Inuit living off reserve. MEDICAL TRANSPORTATION: When specific medical service is not available locally, the program covers travel costs to and from the nearest health care facility offering those services. BC MEDICAL INSURANCE PREMIUMS: Costs for your MSP coverage are paid for through the NIHB program if you are a registered Status Indian. This entitles you to access a full range of provincial health services. FIRST NATIONS COMMUNITY PROGRAMS: The federal government provides funding to First Nations communities for a range of locally-delivered health programs including tobacco reduction, Aboriginal Head Start, disease prevention/control and Brighter Futures/ Building Healthy Communities. These and other health promotion programs are available in many First Nations communities. Adapted from the Chiefs’ Health Examiner Special Edition Non-Insured Health Benefits. Spring 2001

NIHB – NEED MORE INFO?

First Nations Health Authority has taken over responsibility for NIHB but questions should still be directed to

First Nations and Inuit Health Branch of Health Canada

Anywhere in BC (toll free): 1-800-299-9222 Vancouver and Lower Mainland: 604-666-3331

Dental (toll free): 1-888-321-5003

Website: http://www.hc-sc.gc.ca/fniah-spnia/nihb-ssna/benefit-prestation/index-eng.php


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MODULE 2: PATHS TO GOOD HEALTH

To keep as healthy as possible, it is important to get information, advice, help, and treatment for a physical or mental condition as early as possible. If you have a health concern and wait too long to ask for help, your health may suffer more and you may need more specialized treatment or time in hospital.

By getting help as soon as possible you increase your chances of staying healthier and avoiding time in hospital.

IF YOU ARE IN NEED OF URGENT CARE, you should call 911 or go to your nearest emergency services immediately. If the situation is not urgent, then there are other more efficient paths by which you can meet your health care needs.

Getting the right health care as soon as possible involves knowing about the different pathways that exist in the health landscape in your area.

Some pathways may be very simple to follow, such as dropping by to visit

your Band nurse.

Some pathways may be well trodden, such as going to your usual walk-in

clinic or doctor in town.

Some pathways may be unfamiliar, such as having a visit with a

physiotherapist in your home.

Some pathways may lead to other parts of the landscape that you haven’t

been to before, such as visiting a doctor at a community health centre or

going for tests, or talking with a dietician.

These paths through the health landscape (funded through Interior Health) are based on the Western medical model of health that we talked about in our first workshop. This approach to health can include the prevention, diagnosis and treatment of illness and injury, and health education and promotion. Finding the right path to take can be confusing! The goal of the following information is to help you learn more about the different paths available to you so that then you can make informed choices about which path you prefer or need to use.


The paths available may look different depending on where you live in the region. To find the specific services and resources available in your community, consult the COMMUNITY HANDBOOK for your Band that is provided along with this workshop. WHAT HAPPENS IF I’M UNSURE WHICH PATH TO TAKE? WHAT HAPPENS IF I GET LOST? Health situations are often complex and any of us can sometimes feel lost and confused. In the next section, you’ll learn more about the role of Aboriginal Patient Navigators, who are here to help you find your way, as well as Health Care Partners.

Paths to Health: Often people find that by taking one path, it leads to learning about and using more specialized health care services and programs. This section provides an overview of the following possible health care paths:

Aboriginal Patient Navigators

Community Health Nurses

Public Health Nurses

Walk-in Clinics

Family doctors

Public Health Units

Primary & Community Health Centres

Mental Health & Addiction Services

Community Care & Rehabilitation Services

Homecare Equipment & Supplies

Home & Community Care for Seniors

Hospital-based Services


ABORIGINAL PATIENT NAVIGATORS (APNS) Aboriginal Patient Navigators are partners in care. They are in place to act as a bridge between you, your family and the health care system. APNs usually meet face-to-face with patients and their families. Patients can access APNs directly or can be referred to an APN by their doctor or health care provider. The role of the APN is to provide referrals, act as an advocate, and provide support to ensure patients are able to access appropriate health care and community services. Their assistance can include:

• helping get prescription drug coverage • escorting patients to medical appointments • making recommendations and supporting discharge planning.

THERE ARE BENEFITS TO IDENTIFYING YOURSELF AS A MEMBER OF YOUR NATION/BAND. One benefit is that you can access the supports and knowledge of Aboriginal Patient Navigators both in the community and in the larger hospitals, such as the Royal Inland Hospital in Kamloops.

“I had a Chief ask me what I was doing now. I told him I was an APN and he said, ‘I would never go to the hospital, I don't trust them, I would never go.’

I said, ‘Well, that is why we are there.’ Give us a chance: Phone an APN and start a relationship so that when you need someone, you feel comfortable to share.”

—Aboriginal Patient Navigator Ø APNs know First Nations communities and builds relationships with First Nations

health care centres and organizations. They provide an important bridge between mainstream health care and our Nation.

“A member of the Westbank First Nation who had a long history of depression was

admitted into the psychiatric unit of our local hospital. The family and Band members were getting very frustrated as they couldn't get any information from the hospital. The APN knew the social worker at the hospital who worked in the psychiatric unit.

She was able to talk with her by phone, find out how the person was doing and what the plans were for their care. She provided a valuable bridge between

the Band health staff, family members and the hospital.” —Band Health Care Worker

Ø APNs support First Nations people with finding and using mainstream health services and programs as soon as the need is identified.


“‘There is a lot of confusion over what health services are available on reserve. Unless you have a family member who you can call and say,

“Hey is there something for this?” then they'll tell you. But if you don't have that, you don't know whom to call.

You don't know a lot about health services until you have to use them.” —Community Consultation

Ø APNs act as a resource to ensure care is culturally safe. They support patients to ensure they are able to access traditional practices as requested, and they present training on cultural safety to health professionals.

Ø APNs participate in the discharge planning process when a First Nations person is coming home from hospital.

“When my friend's husband was in the hospital in his dying days, the APN from our community came in a lot and really helped to make sure that he could spend his

last days as comfortable as possible. They moved him into a room where they could fit more family, and they arranged a smudge room for all the family members.

I didn't know that you could do that in the hospital but the APN knew who to ask.” —Community Consultation

Ø APNs advocate for respectful and culturally safe care and communication with

hospital staff.

“‘At the Royal Inland Hospital we have a burning pot. If someone wants to have a smudge, they can. If they want to have someone brought in to pray or to have a

ceremony, then we (the APNs) can do that. We can coordinate that with the Spiritual Care Coordinator, who is very aware of these ceremonies,

and that they exist for the Aboriginal people.” —Aboriginal Patient Navigator

“There was an elder sitting in the hospital hallway and he told me, ‘I don't like being out here in the hallway when I am eating. There are lots of sick people walking by. I want to eat in my own space. I don't want to be eating in the hallway where

people are touching me, they are touching my food’.

I explained to the nurse that the Elder would like to eat in his room, and said, ‘You also need to understand that he believes in certain things. He doesn't want people walking

by, people are dying in their state of mind...he believes that they could spiritually contaminate his food.’ The nurse didn’t agree with what I was saying, but she brought

the Elder into his room and he started to eat there, without that other interference.” —Aboriginal Patient Navigator


COMMUNITY HEALTH NURSES (BAND NURSES) Another equally important and easy pathway to find in your community is your Community Health Nurse or Band Nurse. If you live in a larger community, then you may have more than one. This pathway is close to home. It is an important first path to follow because the nurse can help lead you to other, perhaps less familiar paths based in local health centres or hospitals that are located off reserve. For more information about the nurse in your community, consult the COMMUNITY HANDBOOK for your Band.

“When my husband had a stroke and was discharged home from hospital, our Band Nurse came to visit him at home. She explained in plain language how the stroke had

affected him, as I didn't always understand what the nurses were saying in hospital. She showed me how to help get him in/out of his bed and

checked that he was using his walker okay.

She thought it would be useful to have someone called an OT come in and do a home visit. I agreed and she made all the arrangements and was there when the OT turned up. The OT watched my husband walk around our house and do things like get in and

out of his favorite chair. She also had a look at our bathroom and said that he needed a raised toilet seat with some grab bars and a bath seat. I was worried where we would get these from, but the nurse told me that this was the OT's job and she would write a

letter to NIHB. The Band Nurse still pops in now and again, and if I have any questions I just give her a call on her cell phone.”

—Community Member

“There was a young man in our community who had severe mental health problems, and his family was really worried about him as he had gone missing. Our Band Nurse knew the hospital social worker on the psychiatric unit and contacted him to see if she

could find out any more information. It turns out that the young man had ended up in the emergency and had been admitted but hadn't been able to tell the hospital staff who to

contact. Because the Band Nurse knew the hospital social worker, they were able to make sure that his family knew he was safe and being taken care of.”

—Community Member


FAMILY DOCTORS Family doctors and GPs (general physicians) are usually the first to diagnose and treat a health problem, illness or disease. They play an important role in finding out what might be wrong and getting you the treatment you need as early as possible. Following this path has several benefits, which is why it’s recommended that you see the same family doctor or GP whenever you or someone in your family has a health care concern. Your family doctor can request specific tests, prescribe medications, request medical supplies or equipment (through NIHB), provide advice, and refer patients to other health professionals in order to help diagnose or manage a mental or physical health care problem. Some family doctors are able to admit their patients directly into hospitals if necessary, while others are not able to do this and must refer the patient to a doctor who has ‘hospital admitting privileges’. For some of us, this pathway doesn’t get walked too often. It can be hard to find a family doctor and there may be some reluctance, fear or cultural risk involved with going this route (perhaps due to past experience).

Frank had been having stomach problems and was in a lot of pain, especially when he ate certain foods and was feeling stressed. Frank hardly ever went to the doctor,

but the pain was so intense his wife finally made him go see their family doctor. The doctor had known Frank’s family - many of them go to see him. His records

showed that Frank had been to see him several years before with a similar problem, and that he had family history of diverticulitis. The doctor thought that there could be

a pattern of this condition in his family and arranged for Frank to go to the local hospital to have some tests. Having a family doctor who knew the family made it a

lot quicker to figure out what was going on.

Benefits of having a family doctor:

You can build a relationship over time with the same doctor and clinic staff

All members of the your family can be seen by the same doctor

It is easier for your family doctor to track your health history – including medications, results of tests, reports from specialists, etc.

You do not have to keep re-telling your health history


WALK-‐IN CLINICS

A path that is frequently taken when you don’t have a family doctor or when the doctor’s office is closed, is the one that leads to a walk-in clinic. These clinics tend to have longer hours and are usually open at least one day during the weekend.

A walk-in clinic gives you easy access to a doctor/physician who can refer you fairly quickly, if needed, to see a specialist (e.g. a psychiatrist, an orthopedic surgeon, etc.). Doctors in walk-in clinics can also recommend and co-ordinate tests, such as x-rays, diagnostic imagining (CT scan, MRI), and laboratory tests. Doctors can also write prescriptions, and refer you for additional health care services such as to see an occupational therapist, physiotherapist, or help with a WCB claim.

A disadvantage of always using walk-in clinics is that you may see a different doctor on each visit. You will likely have to tell your story each time, and so there is less continuity of care and less opportunity to develop a relationship.

COMMUNITY & PRIMARY HEALTH CARE CENTRES There are several community or primary health care centres near ONA Bands that are important paths in your health care landscape. Consult your COMMUNITY HANDBOOK. These health centres provide a wide range of “one stop shop” services that may include:

Basic laboratory and x-ray services Urgent care Outpatient ambulatory care procedures (e.g. day surgery ) Community services (e.g. public health nurse or physiotherapy) Long term residential care services Mental health and addictions counseling On-site doctors’ offices Referral to other specialist services

Nurse Practitioners Some walk-in clinics have a nurse practitioner. This is a relatively new nursing profession (regulated in BC since 2005). They are able to do many of the tasks a doctor can do – refer for further tests, refer to specialists, and write prescriptions. This frees up the doctor to see people who have more complex health care needs.


MENTAL HEALTH & ADDICTION SERVICES Here is a visual summary of Interior Health Mental Health & Addiction Services for adults and Elders.

In the Interior Health landscape there are local pathways that can take you directly to a range of Mental Health & Addictions services. Paths to these services can be found in primary and community health care centres, hospitals, family doctor’s offices, outpatient clinics or by phoning your local mental health and addiction centre. Once you are on the mental health & addiction services path, you will be guided by the team to the service that is right for your needs.


ADULT COMMUNITY SUPPORT SERVICES are for people with a serious and persistent mental illness, such as bipolar disorder, chronic depression. This program provides treatment, rehabilitation, maintenance, support services and residential care.

ADULT SHORT-‐TERM ASSESSMENT & TREATMENT SERVICES provide short-term intervention for people with suicide/life-threatening behaviors, severe depression or anxiety, eating disorders, severe adjustment problems or acute symptoms related to trauma.

SENIORS MENTAL HEALTH SERVICES for people who are 65 years and over with mental health disorders including dementia with related behavior problems. Services include assessments, short-term treatment, education, case management, residential and community liaison, caregiver support as well as Elder abuse intervention and prevention.

Our Band Social Worker was worried about the mental health of an Elder, who he had been visiting for several weeks. The Elder’s family was also concerned as she

was not taking care of herself and had become very forgetful The Social Worker contacted (with the family’s permission) the local mental health team – asking for their help. A mental health professional from this team arranged to visit the Elder

together with a family member for an initial visit.

My grandmother was diagnosed a few years ago with dementia, but had been getting steadily worse and I was really worried about her. I contacted the person

whose name I had at the mental health centre who specializes in working with people over 65 years of age and who have dementia. They really helped me to

understand what was happening to my grandmother and to get her more help. I didn't find myself getting so angry at my grandmother once I knew that her behaviors

were part of her dementia, and that she wasn't doing those things on purpose.

MENTAL HEALTH EMERGENCY SERVICES provide mental health crisis intervention to people of all ages. Services include crisis interventions, telephone interventions, short-term follow-up and referrals to community services.

HOSPITAL-‐BASED PSYCHIATRIC SERVICES provide admission to regional hospitals in Vernon, Penticton and Kelowna.


ADDICTIONS PROGRAMS & SERVICES There are two main paths that you may travel in order to access addictions programs and services – these are described in more detail in your COMMUNITY HANDBOOK.

1. Mainstream Addictions Services 2. Band or Friendship Centre - Alcohol & Drug Abuse Services

MAINSTREAM ADDICTIONS SERVICES The addiction team (counselors, social workers, support workers, psychologist) ensures that the type of service offered is the right one for you and your situation. These may include: PREVENTION focuses on encouraging people to learn to make healthy lifestyle choices.

OUT-‐PATIENT SERVICES offer counseling, support and educational services for people wishing to reduce or quit their use of substances.

WITHDRAWAL MANAGEMENT includes support and supervision to help minimize the physical and psychological effects of withdrawal from alcohol and other drugs.

DAY TREATMENT can be day and/or evening programs offered to people requiring intensive therapy in a group over a period of several weeks.

RESIDENTIAL TREATMENT is intensive short-term therapy for people ready to make significant changes to their substance use in a safe, alcohol and drug free living environment. Source & for more information: http://www.interiorhealth.ca/uploadedFiles/Health_Services/Mental_Health_and_Addictions/OkanaganServicesGuide.pdff

Partners in Health: Aboriginal Patient Navigators

Finding the right mental health or addiction service for you and your family can be a

scary journey. BUT you don’t have to go by yourself – contact your local Aboriginal

Patient Navigator to support you on your journey. In many areas of the Interior Health

region, all you have to do is identify yourself as Aboriginal (on your first phone

call or visit), and then an easier and streamlined process is available through your

local Mental Health & Addictions Centres, as well as through Interior Health contracts

with local friendship centres.


BAND/FRIENDSHIP CENTRE -‐ ALCOHOL & DRUG ABUSE PROGRAMS Addiction services are also available through programs organized through your Band or the local friendship centre. Health Canada gives funds to First Nations communities and organizations to set up and run treatment programs to help heal abuse of alcohol, drugs and solvents. This is through the National Native Alcohol & Drug Abuse Program or NNADAP. The programs offered vary, based on the size and needs of each community and the availability of skilled workers, but they generally fall into 3 key areas:

PREVENTION ACTIVITIES are aimed at preventing serious alcohol and other drug abuse problems (e.g. school programs, cultural and spiritual events etc.).

INTERVENTION ACTIVITIES are aimed at dealing with existing abuse problems at the earliest possible stage (e.g. discussion groups, cultural and spiritual programs).

AFTER-‐CARE ACTIVITIES are aimed at preventing alcohol and drug abuse problems from re-occurring (e.g. sharing circles, detox referrals, counseling etc.). Source and for more general information go to the: Health Canada, FNIHB website

How can counseling help the mental health & wellbeing of First Nations people in BC?

A 1996 study1 found that some First Nation peoples in BC described a successful counseling approach as one that included -

• Culturally-based in local tradition, • Native rules of behavior such as respect & non-interference • Input of Elders.

The study suggested that counselors should be educated in terms of cultural notions of Indigenous mental health if they wish to meet Aboriginal clients’ needs. A 2008 study2 described an Indigenous health promoting counseling model based on cultural values and perspectives, and an understanding of mental health as wellness and as a process of healing, involving – community, cultural identity, interdependence & a holistic approach. Source: 1McCormick, RD (1996) Culturally appropriate means and ends of counseling as described by the First Nations of British Columbia. International Journal for the Advancement of Counseling, 2Stewart, SL (2008) Promoting Indigenous mental health: Cultural perspectives on healing from Native counselors in Canada. International Journal of Health Promotion & Education.


COMMUNITY REHABILITATION & CARE SERVICES This is an important path that is not well trodden by many First Nations communities – possibly because (1) some people don’t know that this pathway exists, (2) it has a strange name, or (3) they are not sure what they will find at the end of it! Taking this path gives you access to a range of different health care professionals who are experts in community rehabilitation. COMMUNITY refers to health care services that are available in your home, local centre, clinic or community setting – as opposed to services that are offered in a hospital type setting.

REHABILITATION refers to the process of restoring skills, safety and independence following an illness or injury with the goal of regaining maximum self-sufficiency and function in a normal or as near normal manner as possible. For example, rehabilitation after a stroke may help a person walk and speak clearly again. The name of these services and what they include varies but usually includes the following health care professionals: Ø Occupational Therapist Ø Physiotherapist Ø Respiratory Therapist These services can be used simply by contacting these professionals directly by phone. You do not need a doctor’s referral.

OCCUPATIONAL THERAPIST (O.T.) Everyday activities like eating, dressing, toileting, showering, driving, hobbies and work activities can all be impaired by physical and mental health conditions, diseases and injuries. Occupational therapists help people to do as much as possible in their typical activities of daily living.

Ø An OT supports a person to participate in the activities of daily living that are important to them.

Ø This may involve education, treatment, and the use of special equipment.

Ø OTs can prescribe medical supplies and equipment through NIHB (you do not need to be referred by a doctor).

Ø To learn more about occupational therapy or to find an OT near you, go to: www.cotbc.org or phone 250-386-6822 or 1-866-386-6822 (toll free).


A STORY ABOUT COMMUNITY OCCUPATIONAL THERAPY Reason for Referral - Mrs. Archibald is from the Penticton Indian Band, and has been recovering in hospital for several weeks following a stroke. Discharge Planning - On discharge home, the hospital staff felt that Mrs. Archibald needed follow up with a community OT for wheelchair and a home safety assessment. The hospital OT forwarded a referral to 'Community Rehab Services' to do a home visit with Mrs. Archibald and her family and assess for an appropriate wheelchair and other equipment she might need in order to be safe and able to get around. OT On-Reserve - The community OT arranged a time to visit Mrs. Archibald and her family. During the visit, the OT explained to Mrs. Archibald and her family that she was able to provide an assessment and recommendations for a wheelchair and certain other equipment such as a bath bench and raised toilet seat. A letter requesting funding was sent to NIHB, and a copy of this letter was given to Mrs. Archibald. A follow up visit was made once the equipment was received to confirm that everything was in place and being used correctly and safely.

PHYSIOTHERAPIST (P.T.) Physiotherapists look at how an injury, disease or disorder impacts a person’s ability to move and function. PTs help people to improve, restore or maintain their physical fitness and independence. To learn more about P.T. or to find one near your community go to: www.cptbc.org or phone: 604-730-9193.

A STORY ABOUT COMMUNITY PHYSIOTHERAPY Reason for Referral - A 70-year-old Elder called Bill Ward from the Okanagan Indian Band was admitted to his local hospital following a fall in the night. He had got out of bed to use the bathroom, lost his balance, and fell down banging his right hip against the bathtub. Hospital PT - Whilst in hospital, Bill saw a physiotherapist who helped him with walking and provided some exercises. When Bill was ready to be discharged home, the hospital physiotherapist arranged for him to borrow a walker from the Red Cross. PT on Reserve - When he was discharged home, the hospital staff asked the community physiotherapist to visit Bill in his home. The community physiotherapist saw Bill in his home with his daughter and did an assessment of his muscle strength and balance. Bill and his daughter were shown how to do some exercises that would strengthen the weak muscles as well as improve his balance, and reduce the risk of falling again. The physiotherapist also suggested that Bill continue to use the walker in his home, and wrote a letter to NIHB on his behalf recommending that he have his own permanent walker as his poor balance put him at risk for another fall. The PT also


suggested to Bill and his family that they remove some loose floor rugs as they were a tripping hazard. The physiotherapist left her contact information with Bill and his family so that they could contact her in the future if they had any questions or concerns. RESPIRATORY THERAPIST (R.T.) When people experience breathing difficulties, Respiratory Therapists are often the first health care professionals involved. RTs are health care professionals who monitor, evaluate and treat individuals with respiratory and cardio-respiratory disorders. To find an RT near you, contact your Band Nurse or local home care office.

A STORY ABOUT COMMUNITY RESPIRATORY THERAPY Reason for Referral - Mr. Williams is in his mid-60s and a member of the Osoyoos Indian Band. He has a long history of breathing problems - called ‘chronic obstructive pulmonary disease (COPD)’. His doctor arranged for him to be admitted to the local hospital where a chest x-ray showed that he had pneumonia. In the hospital, Mr. Williams was seen by a respiratory therapist who monitored his breathing and lungs. Discharge Planning - Before he was discharged home, the hospital-based respiratory therapist carried out an assessment and decided that Mr. Williams would need to have some home oxygen. The oxygen is covered by NIHB and the vendor does all the paperwork. The RT made arrangements for a company to deliver an oxygen tank to Mr. Williams home, and also referred him to the community-based RT. RT in the Home - The community-based RT visited Mr. Williams in his home and went over how to use his medication (puffers), the oxygen, and the warning signs for COPD. Several weeks later the RT did a follow-up home visit and a lung function test to make sure that Mr. Williams was fully recovered from his pneumonia. RT on Reserve - The community-based RT then arranged for Mr. Williams to join a local educational course on COPD that was twice a week for one month. Mr. Williams completed the course, learnt how important it is to keep exercises and how to keep his lungs as healthy as possible. Mr. Williams had the telephone number of the community RT so that he can contact her for a follow-up visit if needed.


HOMECARE EQUIPMENT & SUPPLIES It is sometimes necessary for a person to have special medical or rehabilitation equipment or supplies for use at home to maintain independence, health, safety and quality of life. An occupational therapist or a physiotherapist can come onto the reserve and do an assessment with a person and their family members to help decide what type of rehabilitation equipment is necessary. A nurse/doctor can also recommend certain medical supplies.

John is a senior member of the Penticton Indian Band and was in the Royal Inland Hospital where he had his leg amputated following complications due to his diabetes.

John wanted to return home but was too frail to walk and get himself in/out of his chair. The hospital occupational therapist (OT) contacted the Band Nurse and talked about getting John his own wheelchair and cushion, and some other equipment that would

help him to get on and off the toilet safely. The OT met with John’s family and with their permission wrote a letter to NIHB requesting the funding. When the funding was

approved the OT and the Band Nurse followed up with John and his family to make sure everything fit and was being used safely.

Medical supplies & equipment currently funded through NIHB include:

Prosthetic limbs Oxygen therapy equipment Hearing aids Walking aids Custom made footwear

Toileting & bathing aids/equipment

Dressing & feeding aids Wheelchair cushions & parts

Medical equipment NOT currently funded through NIHB includes:

Scooters Hospital beds, mattresses and

bedding Permanently fixed equipment (e.g., grab bars, ceiling

tracks for lifts, stair lifts, etc. that are fixed to a wall/ceiling)

Lift chairs Pressure relief mattresses

If funding is not available through NIHB, ask these health professionals to help you find funding or a short-term loan through other non-government organizations.

For more information on current funding guidelines go to: (Health Canada/FNIB): http://www.hc-sc.gc.ca/ahc-asc/branch-dirgen/fnihb-dgspni/nihbd-dssna/index-eng.php


HOME & COMMUNITY CARE FOR SENIORS (OVER 65 YEARS) Interior Health provides a range of health care options for older adults (65 years & over) that are aimed at supporting INDEPENDENCE, CHOICE AND DIGNITY. These ‘Home and Community Care’ programs help seniors remain independent in their own homes for as long as possible. The eligibility requirements are the same for First Nations people living on reserve as for all British Columbians. Seniors living on reserve can receive home care nursing, and home support services through the Band. Discuss this with your Band Nurse. For seniors living on reserve, Home & Community Care programs may be able to help with accessing:

REHABILITATION THERAPISTS (Physiotherapist, Occupational Therapist etc) v Individualized treatment plans to promote independence, safety and quality of

life v Home visits for accessibility & safety

RESPITE PROGRAMS v Provide caregivers temporary relief from caring for a friend or family member

ADULT DAY PROGRAMS v Support for Elders still living at home or with family who require some

supports in maintaining their independence and quality of life v Apartments that provide 24 hour response, meals, and help with activities of

daily living.

CARE IN A RESIDENTIAL FACILITY v 24 hr nursing & personal care v Short-term for respite, convalescence, palliative (end of life) care v Long-term stays


HOSPITAL-‐BASED SERVICES The paths already discussed here have all traveled through the health care landscape at the community level. Taking some of these community paths may sometimes lead you to services that are based in hospitals.

DON’T FORGET! ABORIGINAL PATIENT NAVIGATORS ARE THERE TO HELP WHEN YOU NEED TO USE HOSPITAL SERVICES! Interior Health has three different types of hospitals that provide different levels of services and care: (1) community hospitals, (2) regional hospitals and (3) service area hospitals.

The hospital you go to will depend on the type of health care services you require, and this decision is usually made when talking with a doctor.

COMMUNITY HOSPITALS:

Ø Nicola Valley Health Centre Ø South Okanagan General Ø Princeton General Hospital

Community hospitals tend to be smaller, with their in-patient and out-patient services designed to meet the needs of the people living in their local area. ONA members are served by three Community Hospitals.

Why do First Nation peoples use hospital-‐based services more than the general population?

Statistics in 2000 suggest that First Nations in the Western provinces (BC, Alberta, Saskatchewan & Manitoba) use hospital-based services more than the general population. This may be due to the availability and use of other medical services, social factors, and transportation particularly for remote and isolated communities. The most common reasons for First Nations in the Western provinces to use hospital-based services include - pregnancies, childbirth, heart disease, stroke, diabetes, chronic obstructive pulmonary disease; pneumonia and influenza, injury (eg. falls, car accidents), and lung, colorectal and cervical cancers. Source: Health Canada (2009)A Statistical Profile on the Health of First Nations in Canada: Health Services Utilization in Western Canada, 2000.


Community Hospital services vary but may include: Laboratory and x-ray services Emergency services - may be available 24 hours per day Acute care beds admissions for:

v General medicine v Observation v Assessment v Convalescence v Palliative (end of life) care.

Low-risk obstetrical care in rural or remote areas. Outpatient ambulatory care procedures.

SERVICE AREA HOSPITALS

Ø Vernon Jubilee Hospital The in-patient and out-patient health care services available at Service Area Hospitals are more varied and specialized than in Community Hospitals. Services are available to everyone living within the health service area. These hospitals provide all the services you can expect at a Community Hospital, plus the following:

Laboratory and x-ray/diagnostic imaging services (eg. MRI) 24-hour emergency services, ideally with in-house physicians. Emergency

services at a service area hospital provide a higher level of trauma care than at a community hospital.

Core physician specialties such as internal medicine, general surgery, orthopedics, anesthesia, obstetrics, gynecology, pediatrics, psychiatry, radiology, pathology and emergency medicine.

Some sub-specialized, physician services for medical and surgical programs. REGIONAL HOSPITALS

Ø Kelowna General Hospital Ø Penticton Regional Hospital Ø Royal Inland Hospital, Kamloops (NOTE: CURRENTLY HAS 2 APNS)

There are 3 regional hospitals serving the ONA Bands. These hospitals can be used by everyone living in the Interior Health Authority region who requires the specialized services they provide. These services include:

24-hour emergency services Advanced diagnostic services (eg. magnetic resonance imaging/MRI) Higher levels/more sub-specialties of almost all medical and surgical services Services for patients with complex, multi-system failure and those requiring

vascular surgery, thoracic surgery or neurosurgery


BC CANCER AGENCY CENTRE FOR THE SOUTHERN INTERIOR The centre of cancer research, education, prevention, diagnosis and treatment in the Southern Interior of British Columbia is based in Kelowna. The centre has a staff of more than 120 health professionals. The centre is part of the BC Cancer Agency. Phone: 250-712-3900 Toll-free: 1-888-563-7773 For more information: http://www.bccancer.bc.ca/RS/CentrefortheSouthernInterior SCREENING MAMMOGRAPHY PROGRAM WOMEN AGES 40 TO 79 Age is the highest risk factor for breast cancer. Regular screening mammograms are one of the best ways to monitor your breast health because they can find most types of breast cancer early, usually before it has spread. Screening mammograms are for women with no sign of a breast problem. To book a free screening mammogram call: 1-800-663-9203 (toll-free) Monday to Friday 8 am to 5 pm & Saturday 8 am to 2 pm. Have your Care Card number available. An appointment takes about 15 minutes. SEE YOUR DOCTOR IMMEDIATELY IF YOU FIND A LUMP OR ANY UNUSUAL CHANGES IN YOUR BREASTS. SCREENING MAMMOGRAPHY MOBILE VAN Mobile vans equipped to do mammograms visit approximately 100 additional communities throughout BC at least twice a year including in the Okanagan.

To book an appointment call: 1-800-663-9203 (toll free). The schedule for Interior Region is available on the website:

http://www.screeningbc.ca/Breast/default.htm Source: www.bccancer.bc.ca/breastscreening

First Nations women less likely to have mammograms

First Nations women aged 40 years and over are less likely than women in the general Canadian population to have had at least one mammogram done in their lifetime. Source: Health Canada (2009) A Statistical Profile on the Health of First Nations in Canada: Determinants of Health 1999-2003


YOU & YOUR PHARMACIST Pharmacists are experts on how a drug will work inside your body. Your pharmacist can help you and your doctor choose the best medications to look after your health.

Studies have shown that half of all Canadians do not take their prescription medications exactly as prescribed. Every year thousands of people are admitted into hospitals because they did not follow the instructions on their medication container.

Do not leave the pharmacy/hospital until you fully understand how to use your medication properly.

EMERGENCY CONTRACEPTION HOT LINE – 1.888.Not.2.Late provides names and phone numbers of pharmacies that can provide emergency birth control contraception.

For more information: http://www.bcpharmacists.org/about_us/index.php

Questions to ask your pharmacist Why am I taking this medication?

How and when should I take this medication?

Am I supposed to swallow my medicine with food or water?

Is there anything I should or should not eat or drink while I am taking this medication?

What should I do if I miss my dose, or take two doses close together?

How will I know if this medication is working?

Are there any side effects I should watch for?

Will it make me sleepy?

Will my medication interact with other drugs?


HEALTHLINK BC – DIAL 8-‐1-‐1 HealthLink BC provides easy access to non-emergency health information. Simply by dialing 8-1-1 you can:

Speak with a nurse about your symptoms Speak with a pharmacist about your medication questions Get healthy eating advice from a dietitian Find the health services and resources closest to you by typing in your postal code

TO REACH A HEALTH NURSE AT ANY TIME, DIAL 8-‐1-‐1. This service can also be reached online at http://www.healthlinkbc.ca

MEDICAL HEALTH INFO LINES These information lines provide reliable info about health issues that you or your family may encounter as well as resources and services you can access. MENTAL HEALTH INFO LINE 1-800-661-2121 ALCOHOL & DRUG INFO LINE 1-800-663-1441 BC CRISIS LINE 1-800-784-2433 KIDS HELP PHONE 1-800-668-6868 NATIONAL YOUTH CRISIS HOTLINE 1-800-448-4663 BC NURSE LINE 1-866-215-4700


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MODULE 3: EMPOWERED & RESILIENT WHAT DOES IT MEAN TO BE RESILIENT? Being resilient is what keeps people strong in the face of adversity and stress. The very fact that Aboriginal people have survived our recent history of colonization demonstrates that FIRST NATIONS PEOPLE ARE RESILIENT! For many First Nations people using mainstream health care programs and services can be stressful. There may be feelings of ‘cultural risk’, insecurity, lack of trust, racism and discomfort. For some people, these feelings and negative past experiences are enough to prevent them for using health care services or contacting health care professionals. THIS CAN HAVE SERIOUS CONSEQUENCES FOR THE HEALTH OF THE INDIVIDUAL, THEIR FAMILY AND THEIR COMMUNITY.

But it is important to remember that we have strong blood running through our veins. We all have our own personal examples of how our people are reversing the negative impacts of colonization and are becoming even stronger from it.

'It took me a long time to complete my nursing degree after many obstacles, many diversions down paths that weren't really where I wanted to go. But I obediently

walked down them because I didn't know how to make decisions for myself. Residential school takes that away from you. I got so used to having other


people make all my decisions that I became incapable of making my own. When I tried going to public school one year I couldn’t' handle the pressure of deciding which courses

to take, I panicked and ran back to residential school where they made all decisions for you. Upon graduating from high school I was told that I wasn't smart enough to go the academic route, so when the counselor said, hey you'd be a good secretary I was like

okay, I guess I’ll do that. and then years later someone said, hey you should take this home care aid training, you'd be good at it, so again I listened to what others told me

to do. Finally years later I had someone tell me that I was intelligent and that I should follow my dream of becoming a nurse. I always tell people it took me 20 years to complete but I did it and now I’m working as a fulltime nurse and I love it. I know residential school experiences robbed me of many things but I have managed to

overcome those challenges and still reach my dreams. I am living a fulfilling life, I have a big family, I am helping my people."

—Band Nurse

My grandson went into hospital and we rushed there to see him. I went to the volunteer desk and they said that he wasn't in the hospital. Instead of arguing I just said thanks

and went to another information desk. They found his name in the computer system and told me which floor he was on. When I got to the ward the person at the front desk told

me that he wasn't there, and sent me somewhere else. Finally we found him - it took about half an hour.

I was determined to find him and was going to keep asking until I did.” —Community Member

Being resilient may mean different things to different people. It can mean:

Spiritual connections Cultural continuity Historical continuity Ties with family & community Ties with the land

For the hummingbird in the story we watched, resiliency meant finding her inner strength and doing whatever was necessary to reach her goal of saving the forest. The story shows that - no matter how big or small you are, you can still make a difference.


BEING AN EFFECTIVE COMMUNICATOR IN HEALTH CARE In the first workshop, we observed that Western health care is like a different country and culture with its own ways of knowing, being and doing. It has its own ‘medical language’ and ways of communicating. When you visit a different country you can likely get by if you don’t speak the language. But, if you can communicate in the country’s language then you are more likely to be successful in getting your message across. In the Western health care system, if you communicate in a way that is expected in this setting then you are also going to more successful in getting your message across and having your health care needs met.

“Doctors/specialists have an expectation...that everyone should agree with them and go along with them and if they don’t...then they’re being a difficult patient. It might be that

they just don’t agree, but don’t feel comfortable to discuss this with their doctors upfront. Then the doctor is like: Well you said you were going to do this, why didn’t you? The

patient is thinking: Well because I didn’t feel safe enough to tell you what I really thought so instead I just shrug my shoulders or say I don’t know.”

—Community Member

“They don’t listen to me.” “They don’t hear me.” —Community Member

Being an effective communicator in health care is an important skill to practice when talking with health care professionals. What you say and how you say it can make a big difference to your health outcomes. This may involve you adapting the way that you usually communicate with your family and friends (who speak the same language!)

INEFFECTIVE COMMUNICATION SKILLS

Not looking at the person talking Very quiet voice Not asking any questions Nodding although you don’t agree

Aggressive body language and posture

Raised voice Not listening


“I know myself sometimes when you go to the doctors; you do feel like you’re wasting their time if you can’t get it out in two seconds. I’m thinking ‘Oh my god – I got four

minutes – I better remember everything I want to ask the doctor.” —Community Member

EFFECTIVE COMMUNICATION SKILLS

Remember your rights! Be prepared (take a note with information/questions etc) Looking at the health professional’s face when they are talking Speak clearly and to the point Be an interested listener Ask questions – repeat the question if it is not answered or you didn’t understand

the health professionals’ answer Summarize out loud what the health provider has suggested before leaving to

make sure that what you are hearing is what the health professional is saying. For example, “So what you are saying is that I need to ……”

“If health professionals were to take the time to engage more in casual conversation, then you might get the Elder telling a story, which would give more

information about their condition/needs. But the reality is they don’t have that kind of time. With all the cutbacks to the health care system, there is more and

more pressures on the health care staff. Even if the intent is there to communicate properly and respectfully, develop relationships, they don’t have

time to sit like they were trained to do.” —Community Member

Participant Handbook| 46

What do I need to remember for my next doctor’s visit?

ü Remember my rights

ü Tell the doctor and his staff that I am a member of my First Nation

ü Be prepared - Have any information I need with me

ü Know my family history on major health conditions

ü Have my questions ready. Having them on a piece of paper can be helpful.

ü Use my assertive communication skills – get to the point, keep it short and ask for what I want

ü Ask the doctor to explain what any medical words that I don’t understand

ü Understand why I need to take certain medication

ü Don’t apologize

ü Ask what is going to happen next

ü Be sure to summarize out loud what the doctor has told me before I leave


MODULE 3: RIGHTS & RESPONSIBILITIES

It’s my right and responsibility… Ø To take a family member or friend with me

Ø To expect that all my medical and health information will stay confidential

Ø To ask questions

Ø To be treated with respect by all health professionals

Ø To have access to the best health care there is

…To be as healthy as possible Ø To make my own decisions about my own health

…To take control of my health Ø To understand what the health professional is saying and ask for an

explanation of what ‘medical words’ mean

Ø To understand why I need to take a medication

Ø To let health professionals know that I am a member of my Nation

…To ask: What happens next? Ø To make a list of questions and concerns

Ø To ask for a second opinion when making big decisions about my health

…To refuse treatment Ø To see my health records

Ø To ask why a certain test is necessary

…To contact an Aboriginal Patient Navigator Ø To say: NO

Ø To learn as much as I can about my health

…It’s my health.


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