Providing access to care and connecting First Nations, Inuit and Métis communities with trauma-informed, culturally relevant COVID-19 information
As the pandemic amplified health inequities faced by targeted, neglected and marginalized communities, the Centre for Wise Practices in Indigenous Health (CWP-IH) at Women’s College Hospital quickly pivoted to build a network of community partnerships supporting the development and implementation of community-led COVID-19 public health responses for urban Indigenous communities. The partnerships, which were initially borne out of an immediate response to the pandemic, would ultimately transform into long-term programs and supports for the community.
Respect, Responsibility, Reciprocity and Relevance
The Women’s College Hospital COVID-19 Assessment Centre was among the first to open in Toronto’s downtown core. Understanding that regular testing was critical to protecting some of the city’s most vulnerable populations, one of the priorities for the Assessment Centre was to provide culturally safe and trauma-informed care.
To support this, Women’s College formed a COVID-19 Equity Committee, which included members of the CWP-IH team. Through this work, CWP-IH collaborated on the hospitals COVID-19 Assessment Centre’s Equity Framework, Demographic Information Collection and participated in Wave 2 Working Groups to ensure that an equity lens was applied to the overall pandemic response.
CWP-IH provided resources and training, such as in-house Indigenous Cultural Safety & Relationship-Building Sessions, for both Women’s College Hospital teams to ensure Indigenous patients felt safe accessing services. These sessions covered the social determinants of health, Indigenous policy, and how to best use this information to provide culturally safe, trauma-informed care.
“As a clinician representing myself and Women’s College Hospital, I will strive to work with awareness of my own power and privilege in community engagements. I recognize that in each patient and community interaction I have a chance to heal part of a broken relationship between institutions and historically marginalized people and communities.” – excerpt from Expectations for Participation in Community Outreach
The same principles were applied for clinical teams preparing to work within communities that have been historically marginalized and underserved. Many of the resources and wise practices developed by CWP-IH were shared extensively outside the organization as well, such as the Expectations for Participation in Community Outreach and Creating a Culture of Safety in COVID-19 Community Outreach, wherein all members of the mobile outreach teams committed to the principles of respect, responsibility, reciprocity and relevance.
To extend their reach beyond the walls of the hospital, CWP-IH team members also collaborated to create the COVID-19 Community Rounds. The Community Rounds provided a platform for dialogue and to share experience and information between hospital and grassroots community advocates and healthcare providers. With topics ranging from Indigenous Healthcare for and by Indigenous peoples to Black Community Led Vaccination Clinics: Thinking Beyond the Pandemic, the community rounds prioritized honouring diverse sources and traditions of knowledge and understanding in health and healing.
Collaborating to Bring Care into the Community
Early in the pandemic, Women’s College Hospital’s Mobile COVID-19 Assessment Team visited Nishnawbe Homes and Na-Me-Res residences. In partnership with Urban Native Ministries, the mobile teams also provided testing for staff and residents at the Sanctuary Day Shelter and Holy Trinity Church outdoor living sites.
Beginning in December, the Centre for Wise Practices team and leaders from the Women’s College pandemic response teams also partnered with Anishnawbe Health Team (AHT) as they led virtual educational workshops for parents and faculty at Kâpapâmahchakwêw – Wandering Spirit School, answering questions about COVID-19, testing and vaccination. Under AHT’s leadership, teams also visited classrooms (K-8) to provide information on infection prevention and control, as well as live demonstrations on how to use take-home COVID-19 testing kits
With the arrival of vaccines in Ontario, the province began a targeted rollout to priority populations, which included segments of First Nations, Inuit and Métis communities. Guided by CWP-IH, the Women’s College COVID-19 mobile vaccination team partnered with the AHT Mobile Healing Unit to deliver vaccines to urban Indigenous communities, such as the residents at Wigwamen Terrace and at the Native Canadian Centre of Toronto.
The partnership and knowledge shared between CWP-IH, the Women’s College vaccination teams and Anishnawbe Health at these early clinics would lay the groundwork for the Anishnawbe Health Team to become a leader in providing innovative Indigenous-led vaccination clinics and outreach.
A Safe Place to Access Care
In April 2020, the CWP-IH team partnered with the Indigenous Pathways Ad Hoc Group to support the creation of the Call Auntie hotline. The phone-in hotline was initially formed to provide Indigenous community members, organizations and programs with access to information and resources around COVID-19 testing, housing, mental health support, as well as sexual and reproductive health access. However, over the course of the year, Call Auntie grew to include an in-person clinic where Indigenous community member can safely visit and access wrap around support and healthcare grounded in Indigenous ways of knowing and being.
Knowing that Indigenous peoples can be disproportionately impacted by COVID-19 and are likelier to experience barriers in accessing services, including systemic racism in healthcare, CWP-IH and community partners recognized the importance of community-led clinics that centre Indigenous ways of knowing. The creation of the Auduzhe Mino Nesewinong Indigenous COVID-19 testing centre was an Indigenous-led public health response to these disparities.
Auduzhe Mino Nesewinong opened in October 2020 with the aim of providing Indigenous peoples with integrated COVID-19 testing, including case management, contract tracing, outreach supports, and referrals. The centre would also evolve to offer information and access to COVID-19 vaccines for First Nations, Inuit and Métis community member as well as home visits.
In the Anishinaabe language, Auduzhe Mino Nesewinong means “Place of Healthy Breathing.” Collaboration between Indigenous community organizations, clinicians and professionals is at the heart of the for-Indigenous-by-Indigenous centre, which is the result of a partnership led by Na-Me-Res, Seventh Generation Midwives Toronto (SGMT), Well Living House at St. Michael’s Hospital with support from CWP-IH. Auduzhe Mino Nesewinong’s services are informed by the urban Indigenous community and designed specifically for that community – and the outreach and supports are based on Indigenous kinship systems of inclusion, care and self-determination.
Members of CWP-IH were also part of the reference group for We Count COVID-19, an Indigenous community-owned database about First Nations, Inuit and Métis COVID-19 spread running in tandem with Auduzhe Mino Nesewinong.
Maad’ookiing Mshkiki – Sharing Medicine
Due to the historical and ongoing mistreatment faced by First Nations, Inuit and Métis in the health care system, the CWP-IH team recognized that truly supporting communities needed to extend beyond providing access to vaccines. Barriers to the uptake of COVID -19 vaccinations remained for numerous complex and context-specific reasons. One of these barriers identified by Indigenous community members and service providers was the lack of culturally safe and relevant educational materials about vaccination.
In February 2021, the Maad’ookiing Mshkiki – Sharing Medicine virtual hub was launched to unpack biomedicine, traditional knowledges and healing practices though oral storytelling and visualizations to support First Nations, Inuit and Métis in making informed choices about the COVID-19 vaccine. The community-centered resources were developed by CWP-IH in partnership with the Indigenous Primary Health Care Council (IPHCC), Anishnawbe Health Toronto, The Indigenous Health Program at University Health Network (UHN) and Shkaabe Makwa (CAMH).
Maad’ookiing Mshkiki – Sharing Medicine provides Indigenous communities across the province with access to videos, fireside chats, community resources, infographics and other materials that are culturally and contextually relevant for First Nations, Inuit and Métis communities. The resources provided draw upon the expertise, wisdom and kinship relations of trusted community members, Elders, Knowledge Keepers, Traditional Practitioners, Indigenous physicians and health service providers.
Looking to the future, the CWP-IH team aims to continue working alongside community partners to expand the many collaborations, clinics and resources beyond the pandemic in order to support reconciliatory transformation within our health system.