RNAO has a reputation for seeking out experts so it can gain the authority to advocate for better health care. When it comes to its work with Indigenous communities that have endured centuries of racism and colonialism, RNAO has learned the path to advocacy begins by acknowledging that pursuit must be grounded in a sense of cultural humility. After generations have been stripped of culture, language and identity, many Indigenous peoples distrust those promising modern solutions to third-world conditions. If we are to build relationships and foster trust, we must listen and learn the history and perspective of each Indigenous community. This ongoing effort was the focus of a lively panel discussion at an RNAO staff education day in Toronto in January.

The discussion built upon work that has continued for more than a decade at RNAO. The association has lobbied government to support Indigenous communities by replacing the shackles of colonialism with the freedom of self-governance. Policy change will help to combat poverty and overcome generations of mistreatment and living conditions that have left some Indigenous populations bearing a disproportionate share of illness and hardship, including the scourge of youth suicide.

RNAO has also joined directly with Indigenous leaders, and launched a formal partnership in 2016 with the Chiefs of Ontario.

RNAO senior policy analyst Lynn Anne Mulrooney, who has been involved in this work for many years, would never be accused of lacking empathy. She listens intently and tackles tough issues with equal shares of heart and head. Her deep commitment to help others was put to the test when, early in her nursing career, she spent time as a community health nurse in Nunavut. It was only after her work there that she came across a book that documented how the government used World War II hospital ships to screen and transport Indigenous people suspected of having tuberculosis. Children were sometimes sent far from their families, never to return home again.

“How much more empathetic would I have been of those reluctant to trust the new nurse? How much sooner could I have started the project of decolonizing myself?” Mulrooney says.

That need to learn and listen rather than proclaim solutions is apparent for several other RNAO staff members who have taken leadership roles working with Indigenous communities to promote best practice guidelines (BPG) and create Best Practice Spotlight Organizations (BPSO).

“I’ve felt embarrassed at our unintended lack of sensitivity with the use of western health-care language and perspectives,” says Deborah Flores, a methodologist who is developing RNAO’s first BPG for Indigenous health, which is aimed at learning why pre and postnatal women use commercial tobacco and reducing its use. 
Flores has spent months interviewing Indigenous peoples and learning from their health teams, whom she says show remarkable resilience despite a legacy of oppression. “We are hearing about the catastrophic suffering and injustices forced upon Indigenous peoples caused by colonization, and the resulting impact today on mental, emotional, spiritual and physical health and wellness,” she says.

The toll of colonial legacy is staggering. Half of First Nations children live below the poverty line, a 2013 study concluded. Suicide rates are five to seven times higher for First Nations youth than for non-Aboriginal youth, and 11 times higher among Inuit youth, according to Indigenous Services Canada. The rate of diabetes is three to five times higher on First Nations reserves than the national average, Diabetes Canada says.

As the program grows and strengthens, RNAO will continue to listen to and support Indigenous peoples, and we hope this work will mark one of many steps on the way to honouring and supporting the healing of Indigenous communities.

But while the national figures both shock and disturb, efforts to seek improvement must be adapted to the diverse range of Indigenous peoples across Canada, says Sabrina Merali, an RNAO BPG program manager. “Indigenous is used as an umbrella term to represent First Nations, Inuit and Metis peoples. Even within these sub-populations, there is richness in diversity in terms of culture, traditions and languages,” she says.

Merali is working with Flores and an expert panel to co-create a BPG to reduce the use of commercial tobacco, and is adapting the BPSO designation with Indigenous organizations and communities to honour their knowledge, beliefs and values. These BPSOs are required, in their three-year pre-designation phase, to adopt two guidelines: the tobacco BPG, and one other BPG of their choice. Eight organizations in Thunder Bay, Sioux Lookout, Ottawa, Simcoe/Muskoka and Toronto 
are currently working on their contracts with RNAO.

“Our team has heard of the devastating effects that many Indigenous people across Canada continue to experience. Yet, the sense of hope and resilience is so powerful and really speaks to their way of life. As the program grows and strengthens, RNAO will continue to listen to and support Indigenous peoples, and we hope this work will mark one of many steps on the way to honouring and supporting the healing of Indigenous communities,” Merali says. 

Just as RNAO has learned to listen to Indigenous communities, it is also trying to support individuals who are not Indigenous to forge better relationships with those who are. Tossing aside stereotypes, says Maureen Norton, an RNAO membership associate who describes herself as an “urban native,” creates trust and forges friendships. 

Norton enjoys her life in Toronto, and also feels a sense of belonging when she visits her home on Georgian Bay's Christian Island. “It is important for me to know where I come from and who I am as an Indigenous woman,” she says. 

That pursuit of understanding drives BPG program manager Grace Suva, who creates professional development workshops to guide nurses on what they need to learn to better serve First Nations communities. Her work is part of a partnership forged with the federal government’s First Nations and Inuit Health Branch to address chronic conditions such as mental health and addiction, diabetes and respiratory illnesses.

“Cultural humility is a journey, and self-reflection is key to developing it. I read as much as I can about the history and experiences of the Indigenous peoples of Canada, yet understand that as a non-Indigenous person, I can never be an Indigenous expert,” Suva says. “I have learned that culture is central to the well-being of Indigenous peoples and I am in awe of the richness and diversity of Indigenous culture across Ontario.” 

Correction: An earlier version of this article incorrectly noted that RNAO membership associate Maureen Norton’s home is Manitoulin Island, north of Lake Huron. In fact, Georgian Bay’s Christian Island is the island she calls home. We apologize for the error.