To commemorate Indigenous History Month, Health System News recently spoke to Kahontakwas Diane Longboat, Elder, Senior Manager, Strategic Initiatives at Shkaabe Makwa at the Centre for Addiction and Mental Health (CAMH), and a member of the Turtle Clan, Mohawk Nation at Six Nations Grand River Territory and a citizen of the Haudenosaunee Confederacy. Diane is a professional educator, ceremonial leader, traditional teacher and healer with wide national and international experience. She also led the development of CAMH’s Ceremonial Grounds, including the policy development required to support traditional Indigenous healing as a standard of practice. Today, her work also focuses on organizational strategy for system transformation to enhance culturally grounded services to First Nations, Inuit, and Métis peoples.
Since the fall of 2023, Diane also began serving as the Ontario Hospital Association’s (OHA) strategic advisor for Indigenous Health, a key priority within its strategic plan. While still early in its journey, the OHA is committed to becoming a trusted ally and advocate for First Nations, Inuit and Métis patients, families and communities to address inequities in the health system and foster improved health access and outcomes for Indigenous Peoples in Canada.
In this recent interview, Diane shares her reflections and advice for health care organizations at different stages in their journeys to address health inequities faced by First Nations, Inuit and Métis patients, and how health care providers can begin to provide culturally responsive, linguistically appropriate, and safe care and improve the health and wellness of Indigenous peoples. Important insights include recognizing Indigenous patients as Rights Holders, what it means to be a true ally and advocate, the vital role of cultural fluidity, and why care informed by the patient experience is integral to addressing long-standing challenges.
Why is the work of centres like Shkaabe Makwa so important for driving culturally responsive systems, achieving health justice, and improving the health and wellness of Indigenous peoples?
I believe that Shkaabe Makwa is a necessary first step to inspire hospitals in Ontario to establish similar centres within. In the long run, my vision leans toward the concept of Two Row Medicine, the establishment of an “Indigenous hospital within a hospital”, sharing clinical services, but more importantly, having Indigenous health professionals and staff members serve our people in a safe, anti-racist environment where culturally and linguistically well-founded services meet the health and well-being needs of our people as a matter of practice. The services should, by their very nature, include traditional healing, medicines, ceremonies, language learning, connection to land and water, and traditional teachings as foundational to well-being.
Shkaabe Makwa’s evolution over the past four years has been nothing short of an incredible innovation in the system because we have been supported by our Board of Trustees and executive leadership team, and certainly, by qualitative data from community stating the critical importance of having culturally responsive services within the system. Shkaabe Makwa is dedicated to research as well as wellness innovation and training with one of the pillars being clinical care.
But beyond just culturally based services, what is key to supporting system transformation is to recognize – First Nations, Inuit and Métis – as Rights Holders within this province so that we can walk into any health care facility, such as a hospital, and expect to receive the best care available that is culturally respectful and appropriate, and provided by staff who are well-versed not only on the trauma that our people have suffered historically and inter-generationally as a result of colonialism, but who also understand the strengths-based parts of our cultures that enrich us as Nations of Indigenous peoples and enable us to heal within the Western-trained system. Ontario’s Human Rights Code specifies our rights along with other pre-Confederation inherent rights, Treaty Rights, the Canadian Constitution, the United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP), and other legal instruments that support the use of our own traditional healing practices, cosmologies, beliefs, ceremonies, and of course, languages. Language is a key factor in Indigenous healing, as is song, dance, and drumming. Many of our people coming into the hospital system speak Cree, Oji-Cree, Cayuga and Mohawk as their first language in Ontario, and hospitals require the translation capabilities to accommodate advocacy and translation in those specific languages.
As I noted, Shkaabe Makwa is a necessary first step, but it’s not the only step. I encourage hospitals to begin this journey by reflecting on the quality of their relationships with First Nations, Inuit and Métis communities, organizations, families and patients in their particular regions, and develop, first and foremost, an equitable, respectful, reciprocal relationship with those parties. From this relationship, talks can begin about how to walk together, mutually support one another, identify what’s needed in terms of systems change and where we can join hands and walk the journey together, or where our paths divide to accommodate distinctions. The alignment of Western medicine and traditional Indigenous medicine has found its genesis.
Based on your experience, what do you think are the biggest challenges to establishing such centres within hospitals and to anti-Indigenous racism efforts within Canada’s health care organizations?
I think that one of the biggest challenges is political will. I’m not confident that hospital administrators truly understand the rights-based perspective of First Nations, Inuit or Métis. However, this is not to cast blame on health system leaders for any shortcomings. The rights-based perspective is something that we, as Indigenous Nations of people in this province, have a responsibility to state and put forward through position papers or other documents. As previously mentioned, we are rights holders under our Treaty Rights, both pre-Confederation and numbered treaties, under title claims, the Canadian Constitution, the UNDRIP, and the Ontario Human Rights Code which speaks specifically to our traditional healing practices and medicines and the importance of hospitals attending to the needs of our people in this regard.
The other challenge is resourcing, but I believe that “if you build it, they will come”. In this case, the philanthropists and funders will come. They’re interested in innovation, especially transformative changes with implications for the health and well-being of society as a whole. I believe that Indigenous wisdom, knowledge systems, and traditional healing practices have an incredible contribution to make in this regard. What I’m seeing globally is that traditional Indigenous wisdom and healing practices are drawing the philanthropists to us. They’re seeking out programs that will have a multi-generational impact on the health and well-being of populations and those transformative actions that will heal the land in conjunction with healing the people. In fact, there’s an international group of Indigenous philanthropists funding Indigenous initiatives. I think that when the wealth of our own people cycles back to support the innovations that we develop on the ground, there’s something both very challenging and really exciting about this partnership.
For example, some years ago, a philanthropist witnessed the work we’re doing at Soul of the Mother, a healing lodge that we’re part of at Six Nations Grand River Territory. She was inspired by our work at healing ceremonies for children, families and community members. We teach children about who they are, the gifts they carry, the connection they have to the spirit of the land, the love that they have for plant and animal life. She donated $400,000, and being a small, not-for-profit that continues to have a budget of about $25,000 a year, that was a huge influx of funds for us. Although we weren’t able to provide a tax receipt, she assured us that her goal was to create a foundation for children to understand who they are and that each of us has a responsibility to fulfill – that we are put here for two reasons: to take care of the earth and each other.
Can you explain what you mean by Rights Holders, as it seems to be critical to supporting the transformation that’s needed?
The rights-based discussion in health care is a foundational piece for understanding Two Row medicine, the culturally responsive services and traditional medicines that can work alongside one another in harmony. We need a paper that documents Indigenous Nations’ rights in health care. We also need a very strong communications effort to go along with this paper, so that health care leaders throughout the province, including hospitals, gain a firm understanding of Indigenous Nations of people as Rights Holders.
I don’t think we’ve done enough in this regard. For example, some hospitals may only serve First Nations, Inuit or Métis population and wonder why they should invest in specific services for such a small number of people. My response remains, if you have just one Rights Holder walking through the doors of your organization, be it a hospital, research centre or school, you have a duty and responsibility to attend to the rights of that individual for the best care or education possible. We have a responsibility to ensure that their rights are upheld within our facilities, and that they receive culturally responsive care so that they feel welcome and safe when they arrive at the hospital and are assured that there will be no racism in the system.
”I often ask myself, what does an anti-racist hospital look like? I think we need more opportunities to discuss these issues in an open environment where there is no blame, shame or guilt. We simply say, what can we do together now to create an anti-racist environment within health care?”
– Kahontakwas Diane Longboat
We’ve learned that hospitals are at different stages with respect to supporting their Indigenous patients. Some are just taking their first steps in this area of work. Can you offer some reflections on the opportunity hospitals have to help achieve health justice, and improve the health of Indigenous peoples?
One of the things that can spur hospitals to action is responses from patients and families. We don’t spend enough time in relationship with patients and families to gather their experiences, complaints and suggestions to improve services. We need to focus on the patient experience and re-adjust to their complaints. We often talk about creating an Ombudsperson for anti-Indigenous racism that’s independent of government, hospitals, and First Nations, Inuit and Métis organizations, and that works to resolve the critical issues that are a continuous challenge to us and still unattended. When our people approach the health care system, we’re trying to find the very best care for ourselves and our families. Often, we are met with attitudes of bias or discrimination. This can result in harm on many different levels and can create an unwillingness to turn to the system for care because of past harm.
I also want to offer words of encouragement to hospitals that are just beginning to develop strong relationships with the Indigenous Nations that are close by. First, they must develop active listening with Indigenous partners. I think it’s important for hospitals to reach out and ask questions, learn and take what they’re hearing to eventually co-create with partners an action plan. At CAMH, we have a Truth and Reconciliation Action Plan because it brings systemic change to the organization. Ultimately, it also improves services for Indigenous Rights Holders who come through our doors. But every hospital is at a different stage, and when I think about CAMH’s action plan, we’ve had 24 years of relationship with First Nations, Inuit and Métis patients, families, organizations, and communities in Ontario and beyond. Other hospitals may not have this history, and are just starting out, building relationships, listening, and with their partners, co-creating a plan that will serve them in their particular region. Each region of the province is unique, and different kinds of services are required. Build slowly and do it well.
Do you have any specific advice for health care leaders?
Having the board of trustees, the CEO and other executive leaders involved in these early discussions with First Nations, Inuit and Métis leadership is key to setting a process in motion where we can look toward the creation of a multi-year action plan that identifies what we want to start doing – the milestones, timelines, resources required, time for reflection and a re-set if necessary. We should also reach out to philanthropists for help.
Some hospitals may start out by understanding that they need patient advocates within the system, or patient navigators. In all instances, when you come to a hospital often not at your best, and perhaps alone, these advocates are a welcoming and skilled group of individuals who become key people who help you understand the care being offered to you, the meaning of certain tests or medications, and assist with follow-up appointments. This is especially true if you come in through the emergency room, where staff and physicians are overworked, trying to do their best, and there’s a high degree of tension. We need patient advocates to help us within the system. Some hospitals may place them there, but some may not understand why Indigenous patient needs are different from those of other Canadians. In this case, we may start out with training.
I’m a big fan of San’yas core health and core mental health training, and on-the-land training. On-the-land training with Elders and Indigenous health leaders really helps board members and executive leaders understand our people, worldviews, and cultural needs more effectively. There are many opportunities now in Ontario, through First Nations and some research departments like the Dalla Lana School of Public Health in Toronto, the Waakebiness Institute for Indigenous Health. We can no longer say that we don’t know what to do, or who can help us. There’s a whole learning journey that can be put together which includes some very basic training from Dr. Kimberly TallBear-Dauphine at the University of Alberta and her Indigenous history online training program which is free. It helps you understand Indigenous Nations before contact, what happened after contact and at the time of colonization, the Treaties, unceded lands and title lands processes, as well as all the colonial impacts on our people – scorched-earth policies, military takeovers of our territory, removal from our homelands, the oppressive nature of the Indian Act, and the removal of our traditional governments to replace them with elected Band Councils, still in place today. Other pieces that people are more familiar with nowadays are residential schools, Indian hospitals, TB Sanitoriums, medical experimentation on our children and missing and murdered Indigenous women and girls. Colonialism is not dead and presently exists in many different manifestations, primarily as economic colonialism, both in Canada and the U.S., and in many parts of the world as experienced by Indigenous peoples.
What do you think are the most meaningful things we can do as individuals and organizations to become true allies?
I think true allies are advocates. They are very much aware of their positionality and privilege and are unafraid to use their personal influence or to advocate for the needs of our people to bring systemic change. I like to think of systemic change as transformation, and when a part of the system transforms to accommodate the needs of a certain group of patients, whether it’s our relatives who are Black or Asian, the changes benefit everyone. So, when we acknowledge the rights of First Nations, Inuit and Métis as Nations, we’re doing something that benefits everyone because we’re learning what I call the tenets of cultural fluidity. By that, I mean we’re learning humility, that we don’t know everything about a particular culture, are unafraid to ask questions and don’t feel less for asking the question, we are eager learners and believe that learning more about each other and different cultures and nations, makes us a richer individual, and makes for richer Canadians.
Part of this perspective also goes back to our Origin Story which says that every human being is sacred. Nations of people have something to contribute to Mother Earth that she needs for her to be healthy and flourish. Each nation has a right to be here, and more importantly, we have something necessary to contribute for the next seven generations to continuously build on. Our Origin Story talks about the four original families that the Creator made. The human family is often described as the trunk of a tree, with its branches representing different groups of people, all loved equally by the Creator. In the long run, learning about each other is a critical piece of being a good human being.
Poet and author Maya Angelou has said that you can’t really know where you’re going until you know where you have been. As we commemorate Indigenous History Month, how can we draw on our collective experience, and those of our ancestors, to inspire hope for the future?
I think we have to own the past. That’s where truth and reconciliation come in, but we can’t sit there. We need to envision a future for a new model of excellent health care for our people that’s culturally, and especially, linguistically grounded. I’d also like to think that we’ve evolved as a human family, that we’re strong enough to face the truth of what has happened in the past with colonialism and confront the continued colonialism of today.
I want to have hope for the future through young people. In my life, I’ve dedicated my prayers, both in ceremonies and daily personal prayers, to advocate for young people to have a really beautiful life, to fall in love with and defend creation, and understand what it is to care for one another as sacred beings. When I think about hope for the future, I’ll say that in every human being that I meet and interact with in my life, I see the beauty of their spirits. Never mind the challenges they’ve gone through, the hurts they’ve tolerated or the pain that continues to plague them. There’s a beauty in their spirits and the gifts they carry that need to manifest in the world.
