I have had a long and varied career in physiotherapy, starting in the early years with an enriching experience working at Baragwanath paediatric clinic at Soweto, outside Johannesburg. This was during Apartheid and South Africa had not yet trained any African physiotherapists.
My physiotherapy colleague and I were the only two white people at the centre. The nursing staff and sister in charge were all African from Soweto, as were all the children. The staff were experienced and ran the clinic smoothly.
The paediatrician was white South African and held clinics every Wednesday afternoon. On those days our roles were reversed. The paediatrician addressed us physiotherapists deferentially but bossed around the African sisters, our bosses. The nurse in charge was fluent in seven languages and was held in high regard in our clinic but on Wednesday afternoons she was not shown the respect she deserved. She and the other nurses did not have the freedom to travel and certainly did not have the vote. This was my first introduction to the state of colonialism in Africa and the blatant racial discrimination.
Several years later, I emigrated from England to Canada. I lived in Montreal during the FLQ crisis before travelling west to British Columbia. There I worked for CARS as a travelling therapist and met many Indigenous clients but was totally unaware of their culture. I remember one man telling me he had fallen off his cat, when I asked him how he had broken his leg. I laughed, and he looked surprised then explained to me that cat was short for caterpillar and a cat was what I’d always called a bull-dozer!
I worked with Indigenous communities around Burns Lake and Fort St James then settled at Prince George Regional Hospital, where I worked for 30 years. During this time, I took a year’s leave of absence and worked as a physiotherapy trainer in a rural Community Based Rehabilitation (CBR) program in South India during the height of their polio epidemic. In India I was a visible minority, being the only white person on staff and working in rural villages whose populations had never seen white people.
I learnt a lot of humility in India witnessing the dedication of the staff and the appreciation of the families we worked with. I learnt early to fit in with the culture as best I could – wearing Indian clothing, eating hot spicy food three times daily and always with the fingers – no utensils. I worked through an interpreter and got used to sitting x-legged on the floor most of the day and using Asian style toilets and no hot running water.
I grew to love this lifestyle and after completing my year in India, I then set up a charity in Prince George to support their work and started returning there every year to further develop the program and do more training for the CBR team. For the last fifteen years I’ve been taking Canadian physiotherapy and OT students to India for international placements, so they too can experience this cultural diversity.
My most recent work in Canada has been as an itinerant paediatric therapist back in the same rural communities where I started – Burns Lake and Ft. St. James, as well as more remote Indigenous communities of Ft. Babine, Takla Landing and Tachie. The cultural humility I learnt in India has helped me working as a paediatric therapist with Indigenous families, but we still have a long way to go.
In India, we first met with the village council. After that, we met with all the different cultural groups together in their village making sure that all the women were also equally represented. Only after this process did we start working with families in these communities. In our Indigenous context here in Canada we need to make sure we are inclusive of all families and cultural groups and that we always come to these opportunities with humility.
The Global Health Division of CPA has expanded to form an Indigenous Health sub-committee. Our sub-committee has recently established our goals which are:
Goal: To contribute to improving the health of Indigenous peoples and reducing Indigenous-settler inequities by:
- Nurturing engagement and connection among Indigenous physiotherapists in Canada as a step toward Indigenous leadership within PT in Canada.
- Supporting non-Indigenous physiotherapists in Canada (i.e., settlers) to mitigate Indigenous-settler inequities through building capacity in:
a. how to provide culturally safe, humble, and responsive health care that respects the uniqueness of Indigenous peoples and communities; and
- understanding their complicity in the systems of inequality that produce Indigenous-settler health inequities, primarily settler colonialism and racism.
Celebrating and showcasing examples of Indigenous-settler collaborations in physiotherapy that exemplify solidarity and authentic partnerships.
It is important that we all recognize our roles in perpetuating the colonial mindset and accept our complicity in attitudes that have led to inequities in health and health-care in Canada.
The Truth & Reconciliation Commission’s Report recommended several actions specific to health-care and education. In particular #22 asks us to recognize the value of Aboriginal healing practices and use them in the treatment of Aboriginal patients. #23 asks us to increase the number of Aboriginal professionals working in the health care field and to provide cultural competency training for all health care professionals. #24 Calls upon all medical and nursing schools in Canada to require all students to take a course dealing with Aboriginal health issues and cultural competency. The detailed calls to action can be found online at www.trc.ca.
Several schools of physiotherapy across Canada are well on their way to establishing relevant aspects of curriculum as well as initiatives towards recruitment and mentoring of Indigenous students and therapists. We all need to learn cultural safety and humility.
An example of Indigenous-settler collaboration can be found in the Central Interior Native Health Service Society (CINHS) in Prince George. Terry Fedorkiw, a Prince George physiotherapist, has been providing services there for the last five years as well as offering student practicums. She states that the most important aspect for both therapists and students is that they should take a cultural competency course before working with Indigenous peoples.
CINHS is a primary care, inter-professional facility. It is situated in downtown Prince George. It provides services to those who live on or close to the street, the majority of whom are Indigenous. The professionals and staff bear equal weight in patient advocacy and provide a holistic approach to care. CINH has weekly meetings where a client’s needs including housing, mental health, medications, mobility issues can be discussed.
CINHS incorporates traditional practices in the day to day operations of the clinic. Staff invite patients to join them in gathering sage for their ceremonies and Devil's Club to make traditional topical medication. The weekly meetings start with a smudging ceremony and prayer. Staff and patients also take part in "letting go" ceremonies for deceased members of their personal and professional families.
Outreach care is provided to people’s homes, hospital, jail and to the reservations. The students learn about cultural safety, which is important for the rest of their career, wherever they may work. They learn about respect and how to listen. Important relationship building can take time, but Terry says that if students ask the right questions and really listen, their patient will tell them everything they need to know and trust them.
Without this service, these people would have no access to rehabilitation services, which is so true for all those living in remote communities. Terry has built a network of support including with the Child Development Centre for those needing paediatric support and with the Hospital for the use of their gym and pool, which her patients love, and with community rehabilitation services.
Terry said, “Because of the high incidence of medical conditions e.g., chronic pain and arthritis, the students and I have developed tailor-made programs to suit our particular population.”
Terry has had a distinguished career in physiotherapy. She founded the first two private clinics in Prince George and has taken specialised courses in acupuncture, women’s health and manipulations. However, Terry states, “this has been the most rewarding aspect of my career. Firstly, patients who have never experienced rehab, are so very grateful for the least thing we do to help their mobility, and secondly mentoring students in the interprofessional care of indigenous population.”
It would be wonderful if others would share their stories which exemplify Indigenous-settler collaboration to inspire more of us to embrace this work to enhance Indigenous health and alleviate the inequities in our health system.
The Indigenous Health sub-committee of CPA’s Global Health Division would be happy to mentor physiotherapists as they work to improve their practice and to embrace cultural diversity and humility. Resources can be found on the Global Health Division website