Download Contemporary First Nation Health Issues

Contemporary First Nation Health
Issues
Melanie MacKinnonMelanie MacKinnon – Owner/Consultant, Medicine Creek Solutions &
Senior Director, First Nation, Metis & Inuit Health, Faculty of Medicine, University of Manitoba
Traditional Health
• 
Self-determining – ability
to make decisions and
follow through with
healing options and
healer
• 
Self-care – knew when
were sick and took care
of self and others
• 
Sustainable – affordable
and available
• 
Safe – “clinically” and
“culturally”
Historic Health System Design
(50 year old model)
Universal health for all based on:
}  Legislation and policy
}  Economic and insurance models
}  Programs framed as “absence of disease”
}  Pathology or disease responsiveness
Current Health System Design – 6 Ps’
1. 
2. 
3. 
4. 
5. 
6. 
Policy – legislation/law (Treaties, Indian Act, CHA, MHA,
Professional Acts, 1964 Agreement)
Payments – who pays and how much?
Partnerships – inter-jurisdictional responsibility &
sustainability
Programs – illness or wellness paradigm (health
promotion, prevention, treatment or maintenance)
Providers – inter-professional and integrated teams,
right provider, right time, right cost
Patients – experience of care (quality, access, safety –
clinical and cultural)
Current Health Issues
Where and how money is being spent – not really about
how much
}  Tremendous time, money and energy spent on ineffective
partnerships and power plays between jurisdictions
}  Archaic program design – deficit or illness model driven
}  Persistent deflections from real issues
}  Band-aide medicine focussed on the body (physical
aspect) not on social, emotional or spiritual wellness and
balance
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SOAP Note – Method of Assessment &
Communication
The SOAP note was first generated by Dr. Lawrence
Weed, MD in the 1970’s, under the acronym POMR
(‘Problem Oriented Medical Record’). At the time, there
was not an objective method of documentation, which
lead to physicians making unscientific decisions about
patient treatment.
}  SOAP notes gave physicians rigor, structure, and a way for
practices to communicate with each other. In the early
1970’s, the adopters of SOAP notes were able to retrieve
all patient records for a given medical problem.
}  Before standardized SOAP notes, providers
communicated with each other in unstructured formats,
leaving patient care up to great chance.
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SOAP Note – Western Medical Model
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Subjective
Describes the patient’s current condition in narrative form. This section usually
includes the patient’s chief complaint, or reason why they came to the physician.
Includes: Onset, Chronology, Quality, Severity, Modifying factors, Additional
symptoms or any Treatment to date)
Objective
Documents objective, repeatable, and traceable facts about the patient’s status.
Includes: Vital signs, Findings from physical examinations, such as posture, bruising,
and abnormalities, Results from laboratory, Measurements, such as age and weight
of the patient
Assessment
The Provider’s medical diagnoses for the medical visit on the given date of a note
written.
Plan
This describes what the health care provider will do to treat the patient – ordering
labs, referrals, procedures performed, medications prescribed, etc.
Subjective First Nation Health Issues
Chief Complaint
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Onset (when and mechanism of
injury – if applicable)
Chronology (better or worse
since onset, episodic, variable,
constant, etc.)
Quality (sharp, dull, etc.)
Severity (usually a pain rating)
Modifying factors (what
aggravates/reduces the complaint
– activities, postures, drugs, etc.)
Additional symptoms (un/related
or significant symptoms to the
chief complaint)
Treatment (has the patient seen
another provider for this
symptom?)
The Nation’s Narrative
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Between 100-500 years ago
Suffering and disease is getting
worse, for most it is constant – not
dying from viruses today but
chronic disease instead
It’s a dull ache or agony
On a scale of 1 – 10, its at least an
8
Some money, a clean – mold free
house, healthy & affordable meals…
Unfulfilled promises and
implementation of Treaty Rights
Negotiated/consulted with many
lawyers, different levels of
governments, & corporations
Objective First Nation Health Facts
Repeatable & Traceable
Facts
Observed facts
Vital signs
}  Findings from physical
examinations, such as
posture, bruising, and
abnormalities
}  Results from laboratory
}  Measurements, such as
age and weight of the
patient
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“Research Syndrome”
Mountains of research on
pathology or disease specific
processes – more deficit
than strength focused
Mortality or death rates still
far worse than average
Canadian – dying younger
Morbidity or illness rates
continuing to rise or worsen
Leading causes of Morbidity & Mortality
Usually measured as:
}  Morbidity rate - the incidence of disease or the the rate
of sickness (as in a specified community or group)
}  Mortality rate – susceptibility to death or death rate
Three major causes of illness and death
1.  Addictions – alcohol, drugs, solvents and gambling
2.  Violence – self, child, domestic and lateral
3.  Obesity – leading cause of diabetes, hypertension,
cardiac disease and GI issues
Which really means...
}  We
are drinking
our GUILT
}  Eating our
SHAME; and
}  Fighting our
FEARS
}  All causing PAIN &
SUFFERING
leading to a
DIS-EASED life
Assessment – The Nation Diagnosis
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Forgot the TRUTH about the spirit and intent of life – focused
on the spirit and intent of man-made “law” drawn from fear;
Limited self-RESPECT due to confused understanding of self
or identity issues due to someone else’s definitions/labels;
Lack of COURAGE related to oppression, systemic
discrimination and racism;
Little self-LOVE due to severed relationships with Creator and
Creation;
Misconstrued understanding of HUMILITY as evidenced by
limited confidence and sense of worth;
Deep feelings of shame, guilt and anger due to lack of
HONESTY with self and others
Limited WISDOM related to accepted beliefs and dogmas as
facts instead of trusting inherent truths
Plan - Healing the Soul Wound
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Author Eduardo Duran says, “We are treating the symptoms
instead of the source of the wound – allowing them to fester
deep inside”
Elders have been telling us for years, decades or centuries that
a spiritual intervention is needed to cure a spiritual illness
All medicine people (western or traditional know that you
must use the right medicine to treat the source of the wound
otherwise you are just covering it up)
Unfortunately the health care system hasn't been designed to
respond in this matter; although some programs have been
established in an attempt to be more relevant
Meaning of Pathology - Wikipedia
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Pathology is the precise study and diagnosis of disease. The
word pathology is from Ancient Greek πάθος, pathos which
may be translated into English as either "experience" or
"suffering", and -λογία, -logia, "an account of" or "the study
of". Pathologization, to pathologize, refers to the process of
defining a condition or behavior as pathological, e.g.
pathological gambling. Pathologies (or pathoses) is
synonymous with diseases. The suffix "path" is used to indicate
a state of disease, and may be used to indicate psychological
(eg. psychopath) or physical disease (eg cardiomyopathy).[1] A
physician practicing pathology is called a pathologist.
Pathology addresses four components of disease: cause/
etiology, mechanisms of development (pathogenesis), structural
alterations of cells (morphologic changes), and the
consequences of changes (clinical manifestations).[
Need a contemporary definition aligned with
the Medicine Wheel
The STUDY of PATHs or
ways of being to find the
center of yourself and
remain in balance
1.  Spiritual
2.  Physical
3.  Mental/intellectual
4.  Emotional/social
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Wikipedia’s definition of the Red Road
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The red road is a pan-Indian concept of the right path of life, as inspired by some
of the beliefs found in a variety of Native American spiritual teachings. Native
Americans' spiritual teachings are diverse, and while there are sometimes common
elements, the ceremonies and many of the beliefs are unique to the people of these
diverse bands, tribes and nations
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Black Elk, a widely known medicine man of the Oglala Lakota people (1863–1950),
believed he had an obligation to "help to bring my people back into the
sacred hoop, that they might again walk the red road in a sacred manner pleasing to
the powers of the universe that are one power."[2]
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"Hear me, four quarters of the world--a relative I am! Give me the strength to walk the
soft earth, a relative to all that is! Give me the eyes to see and the strength to understand,
that I may be like you. With your power only can I face the winds.
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Great Spirit, Great Spirit, my Grandfather, all over the earth the faces of living things are all
alike. With tenderness have these come up out of the ground. Look upon these faces of
children without number and with children in their arms, that they may face the wind and
walk the good road to the day of quiet.
This is my prayer; hear me!"
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- "Black Elk's Prayer for All Life"[3]
SOUL Note – Holistic Lens
S – Connection/relationship between Source and Self –
reconciliation between You and You
}  O – the circle of life or sacred hoop representing eternity
between all worlds and all beings – remove fear of death
}  U – understanding and accepting your imperfections and
your gifts – the blessings and the burdens
}  L – life lessons learned to grow and create from
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All My Relations
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Concern for the cost of severing one's relationship with
the earth has been echoed by many modern, leading
Western thinkers such as Carl Jung and Joseph Campbell,
as well as the environmental movement.Vine Deloria, Jr.
wrote:
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"The first and great difference between primitive religious
thought and the world religions ... is that primitive peoples
maintain an air of mystery through their bond with nature; the
world religions sever the relationship and attempt to establish
a new, more comprehensible one."[1]
Our Shared Mission
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We need to accept our unique blessings and gifts and understand how to
use them to serve ourself, our family, community and nations. Our
contribution as a Co-Creator in this world is our giveaway – our purpose
and our legacy.
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Our reason for being is more than you could have ever imagined, we have a
personal and a collective purpose as so eloquently stated by Chief Arvol
Looking Horse, the 19th Generation Keeper of the Sacred White Calf
Buffalo Pipe:
“Each of us is put here in this time and in this place to personally decide the future
of humankind. Do you think that the Creator would create unnecessary people in
this time of such terrible danger? Know that you are essential to this world. Believe
that! Understand both the blessing and the burden of that. You are desperately
needed to save the soul of this world. Did you think you were put here for
something less? In a Sacred Hoop of life, there is no beginning and no end - the
fate of future generations rests in our hands”.
Need a Paradigm Shift to Transform our
Lives and Live Experiences
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Shift the conversation from
“Health Care” to “Healing”
– our cultural and spiritual
teachings are the bridge or
the path to lead us there
Incorporate our inherent
ways of knowing and being
into everything you do – be
an expression of spirit
Be the storytellers, teachers,
healers and co-creators you
came here at this time to
be…be tomorrow’s
ancestors!!!