Journey Home Palliative Care Project: Honouring Indigenous Culture at the End of Life
On June 21st, people across Canada will be celebrating National Indigenous People’s Day. This day encourages Canadians to recognize the unique history and culture of Inuit, First Nations, and Metis peoples, as well as acknowledge their contributions to society. June 21, the summer solstice, is a day that holds great significance for Indigenous communities and is often when they celebrate their own culture and history. While projects and initiatives are all well under way across the country, Saanich Peninsula Hospital is also doing its part to protect and promote the rich heritage of our Indigenous peoples.
Several years ago, Dr. Leah Norgrove, a devoted family physician and the palliative care physician consultant at SPH, wanted to find out from the WSÁNEĆ people if they were content with the palliative care they were receiving on the peninsula. After several meetings with Indigenous communities, she concluded that Indigenous peoples wanted the ability to provide palliative care for themselves. More specifically, they wanted to have the option for their family members to be at home, in the presence of family, while passing over to the spirit world. With this is mind, Dr. Norgrove, along with Jane Fox, Heather Hastings, and Jon Rabeneck, structured a five-month learning experience for both Indigenous and non-Indigenous peoples to educate one another on palliative care. They named the project “Journey Home: Working towards Cultural Safety in Palliative Care Services for Four First Nation Communities”. They created it with the intent of increasing cultural safety in services provided by non-Indigenous health care workers, as well as improving the capacity for palliative care within the four WSÁNEĆ First Nation communities. In the following two years, Elders, community members, and health directors met to discuss home care and support, as well as the barriers in providing such services. After receiving a grant from Island Health, the core planners were able to put this incredible project into place.
Before commencing the education program, all non-Indigenous participants were required to partake in two evenings of cultural competency training to ensure a safe and open environment. Indigenous communities then selected four members each to register for Journey Home, and in October of 2017, roughly 60 core participants began the program, which consisted of several community learning circle sessions per week. Each gathering took place in the Indigenous communities around the peninsula, with eight physicians, ten nurses, four elders and approximately twenty community caregivers participating. Jane Fox, SPH’s Aboriginal Nurse Liaison, explained the two main outcomes of the program: First, an understood palliative care team to support communities was developed, and second, the non-Indigenous people – who anticipated being the teachers – learned a considerable amount from the Indigenous peoples. The second outcome was the biggest surprise, she says. “The Journey Home education really ended up being a co-learning experience, and that surprised me. It was really encouraging to see how interested the non-Indigenous people were to work with and learn about how Aboriginal people want to be cared for at the ends of their lives.”
In February of 2018, the program was complete, and it has proven to be a huge success. However, the initiative has not stopped there – plans have already been implemented to keep the ball rolling. The Journey Home Project Team has now initiated a palliative review every six to eight weeks. This enables the nurses who are in each community to best determine and communicate who, out of the individuals they have seen, would benefit most from a palliative-approach. Furthermore, a Circle of Care document has been created, in cooperation with community members, which is designed to educate both family members and healthcare providers on the patient’s current situation. Personal details such as the patient’s traditional Aboriginal name, and their hopes and dreams, are included to enable the physicians to personalize their care approach as much as possible. These documents are kept with the patient at all times and allows those caring for them to access important information quickly and easily.
The Journey Home Project does an exceptional job of recognizing the culture and spiritual practices of Indigenous peoples across the peninsula. By creating a co-learning environment, both Indigenous and non-Indigenous people have come out of the project with a substantial amount of knowledge, along with a new understanding of personalized palliative care.