by BR Hartle

A few years ago, Dr. Sara Goulet was in a Northern First Nation in Manitoba, seeing patients at the nursing station. An elder walked in, a woman, who was a local school teacher. She had a lesion on her leg and Dr. Goulet asked when she first noticed it. The elder looked up at the ceiling and spoke to herself in Anishininew, then told Dr. Goulet it was about three weeks ago when there was a big community event. 

In that moment when the elder looked up and spoke to herself in her language, Dr. Goulet remembered an earlier point in her career working in the North. Back then, she had an interpreter to help communicate with patients. She would often ask the interpreter how long the patient had been experiencing pain, and there would be a few minutes of dialogue until she got a response with a specific time frame. Dr. Goulet would ask the interpreter what they were talking about for those few minutes, and the interpreter would tell her that she didn’t need to know.

Back with the elder at the nursing station, Dr. Goulet had a realization. She asked the elder if Anishininew had the same categories of time as English — weeks, months, etc. — and the elder told her no. 

“She told me that it’s all relational,” said Dr. Goulet. ​“She was thinking about what was going on in the community when this happened, and then she was able to translate that back to me because she had a Western education, as a teacher. Now, when I ask people when something started, I try to ask if it was when the ice broke up, or when people visited for that holiday. I use relational knowledge as opposed to fixed times. Nobody taught me that in medical school — I learnt it from the community.”

Indigenous-centred health care

Dr. Goulet works for Ongomiizwin Health Services (OHS), which is an inter-professional health services agency led by a team of Indigenous and non-Indigenous health professionals. It provides health care to Northern and rural communities in Manitoba through hospital-based service, nursing stations and community visits from health care specialists. 

OHS is part of Ongomiizwin — Indigenous Institute of Health and Healing, within the Rady Faculty of Health Sciences. Formed in 2017, Ongomiizwin replaced three separate entities: the Northern Medical Unit, the Centre for Aboriginal Health Research, and the Centre for Aboriginal Health Education. As Northern health services in Manitoba evolved into Ongomiizwin, the organization placed a central focus on Indigenous leadership. 

“We took that opportunity to elevate the Indigenous health portfolio,” said Executive Director of OHS and head of Ongomiizwin, Melanie MacKinnon. ​“We wanted to ensure that the services we provide weren’t just reflective of the work we’re trained in — the biomedical, psychosocial model — but that there’s also a spiritual and cultural component.”

The name Ongomiizwin is Ojibwa. ​“For some,” said Ms. Mackinnon, ​“it means clearing the path for generations, or making room, making space, making it easier. It’s also used when someone is leaving their home community, for education or health services; the family will say, ​‘Ongomiizwin,’ which is like ​“Be careful.” We thought that was also really important. In health care, a lot of what we do is risk mitigation. So, the name also suggests the need to be careful, especially when dealing with people’s lives.”

Indigenous experiences and teachings are embedded in the core of Ongomiizwin. All physicians sign a one-of-a-kind charter. The charter is written by Ongomiizwin physicians and based on 13 Indigenous grandmother teachings.

“We recognize that our physicians are very powerful,” said Ms. MacKinnon. ​“The health and wellbeing of everyone is at stake, and our physicians have a responsibility with that power. That’s what the charter reminds us to do and how to be.” 

Working with Ongomiizwin

For Dr. Courtney Leary, a member of the Norway House Cree Nation and Chief of Staff at Norway House Hospital, Ongomiizwin’s focus on Indigenous-led care just makes sense. 

“I am from Norway House. I am Indigenous. This is how I was raised. This is not an organization teaching me how to be, it’s an organization taking in all of the things that I’ve already been taught and putting that into their operations. For me, it makes sense that in Indigenous communities we would incorporate the ways that we talk to people, the ways we live, and the ways we support each other.” 

To be sure, many of the physicians with OHS are not Indigenous, but the organization does work with physicians to help them better understand the people and communities OHS serves. 

“I would never expect anybody to come in and know how Indigenous communities’ relationships work,” said Dr. Leary. ​“I don’t expect people to know things they’ve never been taught. All you have to do is be willing to adapt, be willing to learn and be open to different ways of thinking.”

In exchange for an openness to learn, physicians with Ongomiizwin have the opportunity to work in welcoming communities, close to nature, on supportive teams. 

As one of Dr. Leary’s physicians in Norway House recently said about why they work with OHS, ​“It’s the love of the people. I have never seen people who have endured so much yet can still laugh and love. Rarely will you see the sense of community you see in the North, and then there’s the love for nature and relatively untouched parts of nature that you can’t get in city settings.”

Dr. Goulet agrees. ​“People might be fearful to come and work here because they worry they will be by themselves. They aren’t. You are never alone. In fact, I felt much more alone working at Health Sciences Centre (HSC) than I ever have in the North. From a recruitment perspective, I encourage people to reach out and get a better sense of what it’s like. People think it’s going to be busy like HSC, but with no support, and that couldn’t be further from the case.”

Challenges and opportunities

Ongomiizwin serves some of the most isolated and understaffed communities in Manitoba. 

For instance, Dr. Goulet looks after almost 15,000 people in her area, which includes Garden Hill, St. Theresa Point, Wasagamack, and Red Sucker Lake. These communities have road access a couple of months of the year, during the winter road season, otherwise everyone flies in and out. The ongoing staffing shortage in these communities also means that Dr. Goulet and her colleagues spend most of their time meeting the more acute needs of the communities, with less time to spend on prevention and primary care. With more resources and staffing, that could change. 

In Norway House, where staffing levels are more stable, this is exactly what Dr. Leary has been able to do. To address the continued youth mental health crisis in her community, she implemented a wellness clinic in local schools, an innovative approach to get ahead of the crisis. She dedicates three days a month and can meet directly with more than 2,000 youth.

“Youth suicide continues to plague us,” said Dr. Leary. ​“I had an idea to try and respond to the crisis in some sort of way, and I asked OHS leadership if it was okay for me to take time out of the clinic and go to the schools to provide that preventative care. And OHS was like, of course, do what you think is right.”

For Dr. Leary, it’s the trust and support she gets from Ongomiizwin that makes her work so rewarding. It’s one of the key ways that OHS puts Indigenous knowledge into practice — by enabling local health leadership to enact the changes their experiences tell them will help. 

“There’s that freedom that anybody who works for us, who has an idea of how to meet a need, the organization will support you,” Dr. Leary said.

This is one of the critical shifts in Northern medical care that has taken place with Ongomiizwin. Indigenous people are at the table, in key decision-making positions. 

The challenges of delivering care in Northern and remote communities continue, but there is a strong feeling among Ongomiizwin physicians that the focus on integrating Indigenous culture into their practices is making a difference. 

As Dr. Leary put it, ​“Knowing you’re on the right path is rejuvenating.”