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Anishinaabe elder calls for cultural safety training of temporary hospital staff in Ontario’s north

A well-known Anishinaabe elder who’s been in a northern Ontario hospital for three months and says he’s faced problems he attributes to staffing shortages is calling for stepped-up cultural safety training, especially for temporary health-care workers.

Garnet Angeconeb, 66, of Lac Seul First Nation has Kennedy’s disease, a rare neuromuscular disorder that causes progressive deterioration of muscles, especially in the legs, arms, mouth and throat. It has no cure.

Since February, Angeconeb has been at the Sioux Lookout Meno Ya Win Health Centre (SLMHC) in the town of 5,200 people. Sioux Lookout, about 400 kilometres northwest of Thunder Bay, is a key hub for services for remote and surrounding First Nations.

“I basically live inside a body that’s numb, and I need a lot of help, you know, repositioning and even to feed myself,” said Angeconeb, a residential school survivor, member of the Order of Canada and Sioux Lookout’s first Anishinaabe municipal councillor. 

The Sioux Lookout Meno Ya Win Health Centre (SLMHC) opened in 2010 after years of negotiations between representatives of Ontario, federal and Indigenous governments. (Matt Prokopchuk / CBC)

“I’ve had experiences where I’ve not had a meal because nobody was around to help me … and, I’m not itching to say this — I need help going to the bathroom, and one night I was in a soiled diaper for about seven hours before I got help.”

Angeconeb said these issues point to the way staffing shortages affect patient care, and added there have been experiences that left him “scared” for his well-being.

CBC News was unable to independently verify the details of Angeconeb’s experience, and a statement on Friday from SLMHC’s president and chief executive officer, Heather Lee, said they don’t comment on individual patient care.

The statement added, “The staffing and physician shortages are absolutely impacting everyone in our region, and here … we are definitely seeing the impacts.”

Elder says he was told he wasn’t on priority list

Angeconeb recalled that in 1997, provincial, federal and Indigenous government negotiators came together and agreed to build a new regional hospital in Sioux Lookout. The SLMHC, which opened in 2010, was designed to end the segregation of Indigenous and non-Indigenous patients in the region, and sought to become a centre of excellence in culturally safe care.

But he shared two experiences in recent months that he says show how the hospital is not living up to this promise.

Thinking back to the night he spent hours in a soiled diaper, Angeconeb said he kept calling for help from a nurse, but wasn’t getting help.

He said he was later told by one nurse that he “was not on the list of priority patients to see,” and they were working with a palliative-care patient who was dying.

“It certainly made me feel guilty in terms of taking services away from someone in more need,” Angeconeb said. But he added the fact he was unable to receive care for so many hours is unacceptable and demonstrates the need for more staffing.

On another day in hospital, Angeconeb said, he asked a nurse for juice because he was hypoglycemic and needed something to raise his blood sugar level. Instead, he said, the nurse didn’t believe him, and only after considerable self-advocacy did he get what he needed.

“I can’t move, I can’t get up to be able to help myself … and so that was one night that I was really scared, not listened to,” Angeconeb claimed.

Angeconeb said both incidents involved agency nurses — meaning they work for a third-party organization that sends staff to temporarily fill holes in the permanent workforce.

The SLMHC said there are internal processes for addressing patient concerns, and won’t comment on any individual patient or their care. The health centre also did not confirm if the nurses involved were agency nurses or which private companies the health centre contracts with in order to fill nursing positions.

‘Cultural barriers’ affect care, elder says

Angeconeb said many of the agency nurses who have cared for him have come from large urban centres, mostly in southern Ontario, and “cultural barriers” have affected his care.

An independent report commissioned by the B.C. government in 2020 points to how cultural barriers can impact the care of Indigenous people. The “In Plain Sight” report found Indigenous patients face “common and widespread” stereotyping and discriminatory behaviours, including long wait times, denial of service, unacceptable personal interactions and staff not believing or minimizing concerns.

It’s not unreasonable to ask that the health-care providers that are coming to work in northwestern Ontario have Indigenous cultural safety training so they can provide care in a way that is more acceptable and respectful.– Dr. Sarah Newbery, Northern Ontario School of Medicine University

“It’s a situation where some don’t understand our culture, our way of life and vice versa … and that could cause some challenges in terms of how patient care is delivered,” said Angeconeb.

He said he met with some of the SLMHC’s board of directors to bring forward his concerns and requested that all staff at the centre receive cultural safety training. That training could include education about the history of colonialism and residential schools, and the intergenerational impacts and racism and discrimination Indigenous people face in Canada.

The SLMHC didn’t respond to questions about if it requires or will consider requiring contract staff to complete such training.

‘Agency nursing’ a new issue

Dr. Sarah Newbery is a rural family physician and associate dean of the physician workforce strategy for the Northern Ontario School of Medicine (NOSM) University.

Newbery said northern Ontario has been disproportionately impacted by health-care staffing shortages.

She said there’s been growing reliance on temporary physicians and nurses coming into communities to fill gaps. While locum physicians — doctors, often from a different region, who come in to temporarily fill a position — have been common, “the phenomenon of agency nursing, as it’s often referred to, is actually very new for us,” said Newbery. 

Dr. Sarah Newbery, associate dean of the physician workforce strategy for the Northern Ontario School of Medicine University, says hospitals in the region have become increasingly dependent on contract nurses to fill permanent positions. (Dr. Sarah Newbery/Twitter)

“It’s not unreasonable to ask that the health-care providers that are coming to work in northwestern Ontario have Indigenous cultural safety training so they can provide care in a way that is more acceptable and respectful,” said Newbery.

Janet Gordon agrees. She’s the chief operating officer for the Sioux Lookout First Nations Health Authority (SLFNHA), which provides a range of health services to 33 First Nations in Treaties 3, 5 and 9 in northern Ontario.

While many SLFNHA staff have longstanding relationships with the communities they serve, Gordon said, “the problem lies with the turnover and having new nurses, so it does pose whether people in the communities are receiving that culturally safe care.”

Gordon added that the SLFNHA tries to provide orientation to staff, but with the rapid turnover and attempts “to plug in the holes,” that hasn’t always happened.

“As locums become more and more difficult to bring in, it certainly is a gap that will need to be looked at and get addressed.”

A shift is beginning

It’s an issue Michelle Bernier, a Northern Tutchone woman from Selkirk First Nation in the Yukon, is trying to fix. She’s chief executive officer of Northern Nursing Solutions, an Indigenous-owned nursing placement agency.

Bernier said she has even experienced racism and prejudice when seeking health care.

“When it comes to primary health care, [First Nations people often] avoid it. And when it comes down to it, it’s because of the nurses and the care that we receive [from them],” she said. The “In Plain Sight” report out of B.C. said Indigenous people often avoid health-care settings because of potential racism and discrimination.

Bernier said that in starting her business in 2017, she made it policy for any nurses to complete the courses before being sent out to fill contracts.

“The goal is that [non-Indigenous nurses are] more empathetic and you’re more educated and aware [of Indigenous history].”

Michelle Bernier, a Northern Tutchone woman from Selkirk First Nations located in the Yukon, started her own nursing placement agency in 2017 to improve the care Indigenous patients receive from temporary health-care staff. (Supplied by Michelle Bernier)

She said some of their newer contracts also require staff to have cultural safety training — but that’s still not the norm.

“We are seeing a shift there.”

It’s a shift that can’t happen fast enough for Angeconeb, who remains in hospital in Sioux Lookout.

Angeconeb said the pandemic has caused significant challenges for everyone, but it’s time to “put everything back on track the way they were intended to when this place was built.”

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