Imagine hearing the words “you have cancer.” Consider the emotions and fear associated with this phrase. Hearing these words are difficult for any patient and their family members. But for many First Nations, Inuit and Métis (FNIM) communities in Labrador, there are additional hurdles they can experience.

For some, English is not their first language. In the Inuktitut language, the old term used for “cancer” meant “incurable” – the same term used to describe HIV.

Many communities in Labrador are remote and isolated. A journey from Nain (a fly-in only community) to St. John’s will likely take two days, require an overnight in Happy Valley-Goose Bay, and can be significantly delayed depending on the weather.

With these things in mind, in the fall of 2013 cancer survivors, caregivers, support workers, and health-care providers in Labrador, along with cancer specialists and administrators from Eastern Health and Labrador-Grenfell Health met at a forum in Labrador. This was their first opportunity to exchange their experiences and to collaborate on ways to enhance cancer services for Labrador FNIM.

Journey in the Big Land

Led by our partners and the concerns they identified, Eastern Health’s Cancer Care program started work on Journey in the Big Land in March 2014. With funding from the Canadian Partnership Against Cancer, the initiative set out to address the identified areas of action:

• improvements to transitions in care,
• enhancements in tele-oncology services, and
• enhancing cultural safety.

Community and clinic profiles were one of the first pieces of collective work that were completed. These profiles were developed with the assistance of countless contributors among our stakeholder partners – including Mushuau Innu First Nation, Sheshatshiu Innu First Nation, Nunatsiavut Government Department of Health and Social Development, NunatuKavut Community Council, Labrador-Grenfell Health, Eastern Health, and cancer patients and caregivers from Labrador.

The profiles provide an overview of each FNIM community, including a description of their health facility and contact information for staff. This helps to familiarize the health-care team with supports and resources available to their patients at the local community level.

Journey in the Big Land has supported patient, family, and community voices to be heard. There have been countless champions working with us who truly believe in the project and the benefit it will provide to Labrador patients.

When discussing Journey in the Big Land, Sophie Pamak, a home care nurse working in Hopedale observed: “It is important because people travel long distances to a strange land, where there may be language barriers. For someone on the coast of Labrador, a trip from Upper Lake Melville can be an adjustment and stressful. To travel so far and to see images and crafts from home helps you have a sense of calm, even though you’re far from home you are recognized and you are important.”

Aboriginal art unveiling supported by the Dr. H. Bliss Murphy Cancer Care Foundation on National Aboriginal Day, June 21, 2016.

Aboriginal Patient Navigators

In 2008, Eastern Health and the St. John’s Native Friendship Centre (SJNFC) launched a pilot project called the Aboriginal Patient Navigator (APN) program. Prior research indicated that Aboriginal people faced barriers when receiving health services in St. John’s. Those obstacles sometimes resulted in missed appointments or a poor understanding of diagnosis and/or treatment instructions. The APN program was developed to help address the identified barriers and provide Aboriginal patients with a resource to make their health-care experience in St. John’s a positive one.

(l-r) Jennifer Shea and Katie Dicker with Rosie the Robot in Nain

The APN program currently employs two navigators – Katie Dicker from Nain, and Solomon Semigak from Makkovik. APNs assist patients and their family navigate the health-care system in a variety of ways including: arranging transportation and accommodation, helping to source medical supplies, as well as providing translation and support services. The APNs are also a valuable resource for staff at Eastern Health and are able to help with any questions or concerns they may have regarding Aboriginal patients.

Cultural Safety Training

In February 2016, the Department of Health and Community Services released a training package “Aboriginal Culture and Health – Understanding Cultural Safety in Health Care” to all the regional health authorities. With funding from the Canadian Partnership Against Cancer, the Cancer Care Program is offering cultural safety training to its employees – not just those in cancer care, but staff throughout the organization who provide care or support to aboriginal patients, clients or residents.

To date, over 350 Eastern Health staff have participated in the training sessions since they became available in April 2016. Many participants have reached out to share their feedback. Participant Callista Silver said: “There seemed to be unanimous appreciation of the session within my group.” Further training will take place in the fall.

To assist in the delivery of this program, we have partnered with the SJNFC to provide facilitation for the training sessions. Now in its 33rd year, the SJNFC has grown significantly, with 38 staff members and more than 33,000 client contacts last year. SJNFC has become the central hub for urban-Aboriginal people living in or travelling to St. John’s and surrounding areas.

Danielle Sullivan with a display used in cultural safety training sessions

As an organization, the SJNFC recognizes that the needs of urban-Aboriginal people are complex and multi-faceted. “Sometimes people don’t fully understand these needs,” said Danielle Sullivan, communications officer at SJNFC. “For example, when medical clients have a long-term stay in the Shanawdithit shelter, they often have more than just accommodation needs. Often these clients will need support with their mental health, child care and youth activities, and also to be connected with a community to help support them through challenging times.”

With that in mind, SJNFC has created a space that provides programs and services to meet the many needs of the provinces urban-Aboriginal people. “We try to take a holistic approach to serving the population. To do that, we try to provide wrap-around services to the clients. If there are services we don’t currently provide, we do our best to make sure we have trusted community partners like Eastern Health where clients can receive culturally-safe services,” said Danielle. ■

This story was written by Jennifer Shea, project lead for the First Nations, Inuit and Métis Cancer Control Initiative and Danielle Sullivan, with the St. John’s Native Friendship Centre.