5 tips on how to provide culturally safe care
Guidance on how understanding cultural context is key for treating Indigenous patients with COVID-19
When public health interventions are working, they are almost invisible. Sarah Funnell, MD, FRCPC, was drawn to public health in its ability to affect change on a systems level that can have positive outcomes for entire communities, and not focused solely on individual interactions as a clinician.
“Public health is really about improving the health of the community, from clean water, safe neighbourhoods and more. These building blocks for health we tend to take for granted,” says the Algonquin-Tuscarora family physician, whose mixed practice involves treating First Nations patients, working at Ottawa Public Health as an associate medical officer and serving as the director of Indigenous health with the Department of Family Medicine at Queen’s University.
Her passion for affecting change at a systems level for Indigenous Peoples led her to become a member of the Indigenous Health Committee (IHC) at the Royal College, an independent body made up of Indigenous physicians, scholars and other health care professionals. Together, they developed cultural safety guidance for clinicians during the COVID-19 pandemic to educate specialists on how to provide culturally safe care when treating or assessing Indigenous patients with COVID-19.
The Indigenous experience with pandemics
The legacy of past pandemics on Indigenous communities has been top of mind for IHC since spring, with members acknowledging that the experience for Indigenous Peoples with COVID-19 was going to differ from that of non-Indigenous patients.
“Indigenous communities are carrying the recent trauma of loss and illness around H1N1,” says Dr. Funnell. Also, the long lasting effects of residential schools in Indigenous communities continue to impact how Western medical advice is interpreted, received and followed by Indigenous patients.
To help address these barriers, the guide focuses on five themes:
- the effects of long-term trauma;
- advocacy for culturally safe community-based testing;
- the importance of building relationships with patients, families and communities;
- how to share sensitive test results; and
- the role accessibility plays in treatment.
The culture factor
COVID-19 has revealed many hidden truths in society, and Dr. Funnell thinks this includes the important role culture plays in health. Without understanding someone’s cultural context, she explains, physicians will miss details that provide insight into how an individual prioritizes their wellness – which in turn can affect how a physician treats a patient.
“With COVID-19, we’re told to social distance and stay in our homes, that this is what we need right now to be healthy and safe. But that might not mean the same thing to me if I come from a different place, such as living with a large family, or if being on the land and practising my cultural traditions is what I identify with being well,” she says.
Her hope for a post-pandemic future is an understanding, in medicine, that Indigenous Peoples know what they need to be well and to use this understand to re-invent health policies with a patient-centred focus.
“When you understand what someone values and how they see wellness, you have an opportunity to have more impact,” says Dr. Funnell. “It takes a bit longer, but if we can have more physicians move in this direction, we are promoting health in a better way.”