Module 6: The Inclusion of Traditional or Indigenous Health

1. Module 6: The Inclusion of Traditional or Indigenous Health

2. Welcome to The Inclusion of Traditional or Indigenous Health. This course takes 45 minutes to complete. There is a quiz at the end of each chapter and a link to handouts and resources at the end of the learning module. There is a quiz at the end of each chapter and a link to handouts and resources at the end of the learning module. Select the arrow keys at the bottom of your screen to move forward and move back, or to stop and start the module.

3. Course Learnings By the time you complete this learning module, you will be able to understand: The Definition of Traditional Medicine Wellness in an Aboriginal Context Root causes of First Nations, Inuit and Métis Health The Inclusion of Traditional or Indigenous Health

4. Course Learnings By the time you complete this learning module, you will be able to understand: Family and the Community’s Role in Aboriginal Health How the Landscape is Changing with Governments How to Bridge Treatment Differences The Inclusion of Traditional or Indigenous Health

5. Course Learnings By the time you complete this learning module, you will be able to understand: The Impact of the Changing Nature of Disease The Impact of Global Cases on Healers Professional Development for Elders/Healers The Inclusion of Traditional or Indigenous Health

6. Insert Pre-Test Quiz slide Q: Traditional indigenous medicine is the same as traditional medicine practiced in parts of Asia. A:  Yes  No  I’m Not Sure Move forward to begin Chapter 1

7. Part I: The Indigenous ModelPart I of the course offers an in-depth look at the Indigenous model including: • a non-linear perspective, • oneness with nature, and a • holistic approach: spiritual, physical, emotional, intellectual, and a health/wellness focus

8. Chapter 1: Overview - Health in Balance • In this chapter, we will briefly touch on western or modern medicine, and provide some additional insight into First Nations, Inuit and Métis (FNIM) definitions of health and healing practices.

10. Oneness with Nature FNIM people had respectful relationships with one another, with the land, other living beings as well as all the land had to offer (flowers, trees, etc.). They developed ways and means of relating to each other and to the earth and land. For centuries, FNIM people adapted their life and living to regionally specific environments. It was based on a very simple understanding of their presence on earth. The changing seasons paralleled the changes in our lives from birth to old age. This relationship with earth is a respectful relationship with all living things. If they didn’t consider what the environment had to offer, they would simply not survive.

11. Holistic Approach

12. The Aboriginal Path of Well-being Traditional medicine and Aboriginal health and wellness are rooted in a holistic approach. Active choice: one’s ownership for health decisions Joint and personal responsibility: health and well-being is the duty of the individual, family and community Holistic approach: balance the mind, body, and spirit with community and environment Health in balance: giving equal importance to all aspects of health Understand root causes: past and present aspects that impact health Wellness: both emotional and spiritual

13. Some FNIM people follow the medicine wheel. It includes physical, emotional, intellectual, and spiritual aspects. • Each of these areas is connected to Mother Earth. It also focuses on balance. • When one area is not working
as well as it should, the other three areas are also affected. • The medicine wheel symbolizes the interconnection of all life, the various cycles of nature, and how life represents a circular journey. • The number four is sacred to many FNIM people in Canada and can represent many things: the four seasons, the four parts of a person (physical, mental, emotional and spiritual); • The four kingdoms (animal, mineral, plant and human); the four sacred medicines (sweetgrass, tobacco, cedar and sage). The quadrants of the wheel are often coloured red, yellow, black, white or green. You may see the medicine wheel presented in several different ways:

14. #1: The four points of the compass, each with a guiding spirit, symbolize stages in the life journey. Taking on responsibility for community health care is complicated for many communities. It is not uncommon for a community to be located across two or more regional health authorities, each with its own way of doing business The East, direction of the daily birth of the sun, represents a person's birth and early years. The South relates to childhood and intellectual growth. The West symbolizes adulthood and introspection. The North represents the old age, wisdom and the spiritual aspects of life The Centre of the wheel is symbolic of Mother Earth and the Creator, and their role in the beginning and continuation of life.

15. #2 The four points can also represent the balance between four different aspects of health: • Spiritual: (The East) • Mental: (The North) • Physical: (The West) • Emotional: (The South)

16. # 3 The wheel can also represent values and decisions. Values (drawn in the East, where the sun rises) influence decisions taken in the mental realm (drawn in the North, at the top). Then, decisions are implemented in the physical realm (West), and actions produce reactions in the emotional realm (South). Finally, these reactions provide feedback into the value system, completing the circle of value - action – evaluation.

17. Move forward to begin the quiz for this Chapter For a traditional healer: an imbalance, e.g. the loss of traditional values, perhaps resulting from experiences in residential schools, may affect health decisions such as alcohol dependence. Source: The University of Ottawa, 2009 http://www.med.uottawa.ca/sim/data/Aboriginal_Medicine_e.htm

18. Insert Quiz slide: Test for Part I, Chapter 1 This chapter consists of one fill in the blank question. Q: A holistic approach encompasses a balance of the mind, _________ and spirit with community and environment. A:____________________________________________

19. Chapter 2: Wellness-Both Emotional and Spiritual In this chapter, we will spend time reviewing the emotional and spiritual aspects of the wellness model.

20. The Westrepresents physical healing, and requires the balance and harmony between four things: • water (hydration), • air (breathing), • food (diet), • and movement (exercise). The north represents mental healing. It is in the north that the individual needs to think, reason, articulate ideas, and to reflect on, and make sense of, the environment around her or him.

21. It is important that the mental aspect of the self is given sufficient stimulation and proper rest. Most individuals have a difficult time shutting out their thoughts and properly relaxing the mind so that it can rest. • True mental healing would more resemble memory work than psychotherapy. • As well as some educational goal setting.

22. An Overview of the Emotional and Spiritual Aspects of Wellness in the ModelThe south is the direction of emotional healing in the Model.

23. South: Direction of Emotional Healing Source: Monte, 1991

24. One method of emotional healing is a process called "discharging" or "letting go". This process is used by several healing programs and allows individuals to "acknowledge the harm they have experienced and discharge their feelings of grief, anger and despair". Individuals seeking emotional healing need to tell their stories in safe and trusting environments in order to move past the intense emotions toward a new understanding of their selves and their purpose. While talking is one method of emotional healing, it is generally insufficient to heal the pains and traumas of FNIM people because the mental aspect of the self keeps the emotional aspect in check, thereby inhibiting expression. Source: Understanding Indigenous Canadian Traditional Health and Healing (Gus) Louis Paul Hill, 2008:

25. Insert Non-Scoring Exercise Slide This is a non-scoring exercise. [Think of some resources or tools you candiscuss with your FNIM patient(s) to enhance emotional well-being.] A:____________________________________________

26. There are seven natural ways of emotional healing in FNIM cultures: • Shaking • Crying • Laughing • Voicing (talking, singing, hollering, yelling, screaming, etc.) • Kicking (in a constructive manner so as to not harm another spirit) • Hitting (in a constructive manner so as to not harm another spirit)

27. The seven ways of healing generally occur in conjunction with one another, and the process of letting go calls all seven ways into service. Nature, near water, because of the powerful spiritual and healing forces of the water. The person can yell, scream or holler nameless sounds or words if healing needs to be directed toward a specific person, process, or place. The process of discharging requires the company of a deeply trusted person to facilitate, and is best done immersed in: Seven Ways of Natural Healing The process requires the individual to voice at the top of her or his lungs until he/she has no more breath.

28. Spiritual: The Eastern Direction in the Model

29. FNIM people believe that we are all spirits in a physical world that relate to the spirits of other sacred parts of Creation such as animals, plants, rocks, water and each other. Our spirits are sacred and must be protected, honored, and shared. The spiritual aspect of the self requires constant nurturing, connection, and re-connection with the spiritual aspects of the Creation around the self. FNIM people have long practiced spiritual connection in the form of ceremonies, both personal and collective, prayers, rituals and celebrations.

30. Spiritual: The Eastern Direction in the Model

31. It is in the east where the individual needs to connect or reconnect with Creation and the Creator. This encompasses all aspects of Creation surrounding the individual, including animate objects such as people, animals, and guiding or protective spirits, as well as inanimate objects such as grandfathers (rocks), trees, the earth under foot and the water that provides life for all beings. The east is where the individual needs to use prayer, ceremonies and rituals to transcend the physical and mental worlds to communicate with the spiritual world.

32. In the east, it is important for the individual to begin to learn how to honor her or his spirit. This means fasting for her or his spirit, feasting for her/his spirit, fasting and feasting her or his namesake, and nurturing her or his spirit at ceremonies such as • the sweatlodge, • sundance, • full moon ceremonies, • pow wows, • naming ceremonies of relatives, and giveaways. • To name some of the ceremonies. Move forward to begin the quiz for this Chapter

33. Insert Quiz slide: Test for Part I, Chapter 2 This chapter consists of one question. Q: Name three ceremonies that represent part of the spiritual healing process. A:____________________________________________ _____________________________________________ ______________________________________________

34. Part II: The Role of Family and the CommunityPart II of the course explores the traditional healing network, roles and responsibilities and how to bridge the barriers between traditional and contemporary health care providers to promote holistic health services to FNIM people. Holistic means using an approach that is not individualistic. Health and well-being can include that of the individual, family, community, neighbourhood, and nation, across many demographics: Elder, adult, youth, child and infant.

35. Chapter 1: Overview of the Family and the Community Place in Aboriginal Health As the 6th part of the Aboriginal Path to Health and Well-being outlined in Part I, Chapter 1: Health and well-being is the responsibility of the individual, family and community.

36. Family Family and extended family is of fundamental importance to many FNIM people. The concept of family may extend beyond the nuclear or biological family concept. Family support is often crucial to the FNIM patient’s well-being. In some communities, members of the same clan are considered family, linked through a common ancestry. Examples of clans include: Bear Clan, Fish Clan, and Crane Clan. Depending on the situation of your client, the term may only refer to immediate relatives, such as a spouse, parents, siblings or children. However, “family” may also include an extended network: grandparents, aunts, uncles and cousins.

37. Some Examples: #1For Inuit, the family is more than just the parents and their offspring it includes parents, children, grandparents, grandchildren, aunts, uncles and cousins-blood relatives. There is also the "outer family" which, can sometimes overlap with family circle by also including uncles, aunts, cousins, brothers, sisters, grandparents and grandchildren but also includes nephews, nieces, great uncles and great aunts.

38. Some Examples: #2 The Cree concept of "being alive well" is informed by historical, contemporary events and cultural practices (Ibid). This definition extends highlights the importance that various relationships have on health. These relationships, in particular those to the land, are explored in Kirmayer et al. (2009, p. 22). They are expressed through the concept of the "ecocentric self", which sees the ego as just one piece in a web of relationships that includes extended family, kin, clan, ancestors, for some also animals, elements of the natural world and spirits. The idea of these interconnected relationships is central to a healthy social environment.

39. Health Decisions

40. Community FNIM Community: A group of First Nations, Inuit or Métis people who share similar beliefs, traditions and cultural identity. These groups exist through shared political, cultural, spiritual and /or other affiliations. In rural clans, where membership has remained stable over time, family and community often represent the same group. Aside from descent and marriage, FNIM Ontarians may also be related through adoption.

41. The KishkAnaquot Health Research conducted by Kim Scott in 2007 determined: “Successful communities cultivate social climates where individual members thrive, develop a sense of self-efficacy and are able to actualize their potential spiritually, emotionally, physically and intellectually. Environments that support human potential honour their Elders and have employment, business, youth mentoring and early learning opportunities. A critical mass of individuals who are physically healthy, excel in cultural teachings or academic endeavours were also considered bench- marks of success . . . First Nations success is also obvious when collaboration and cohesion . . . A strong sense of community identity and pride was also commonly cited as a characteristic of successful community. Widespread understanding of cultural history and a sense of empowerment reflected such pride and identity”.

42. In FNIM cultures a widespread belief is that human beings are largely interdependent and have their greatest potential to live in health, happiness and prosperity when they congregate and cooperate in communities, large or small. Source: Volume 3 of Report of the Royal Commission of Aboriginal People (RCAP), 1996

44. Let’s Review the Impact of a Community’s Health on FNIM Peoples’ HealthRCAP identified three measurements of community health as particularly important to the health status and well-being of FNIM people: • poverty and social assistance, • adequacy of the environment, primarily shelter, water and sanitation facilities, but extending to the broader community infrastructure, and • environmental conditions including pollution and land and habitat degradation.

45. Spiritual: The Eastern Direction in the Model

46. Concerns, such as mental health issues often occur in the form of social burdens such as family violence, substance abuse and suicide. Although FNIM communities differ in their response to the trauma of marginalization and oppression; many FNIM communities: • have been plagued by problems of family violence, substance abuse, incarceration and suicide. Move forward to begin the quiz for this Chapter Sources: Canada, 2006a; Frank, 1992; Kirmayer, et al., 2003; Warry, 1998

47. Insert Quiz slide: Test for Part II, Chapter 1 There is one True or False question in this chapter. Q: In the event that substitute decision makers are needed, for example for an FNIM cancer patient, it may be important that the health care provider work with the family to select one person to be included in the decision making process. A:  True  False

48. Chapter 2: Impact to Aboriginal Health Impact Family and Community Has To the Health Decisions Individuals Make

49. Overview

50. Overview