Movement Forward with Truth and Reconciliation within Hospital Pharmacy 

June 6, 2023
By Amber Ruben with contributions from Amy Lamb
Article originally posted on Hospital News
As an Inuvialuk pharmacist, born and raised in a small community in the Northwest Territories, with the integration of Dene, Cree, Métis, Inuit, and white people throughout the community, it was difficult to move to southern Alberta. There was no integration of First Nations into the urban community, and unfortunately, many of the First Nations who were visible in the downtown core were visible because they fit negative stereotypes. Although I had grown up in many ways blissfully unaware of the impacts of colonization and assimilation in my hometown, the Indigenous social and health disparities seemed very visible in seemingly stark contrast to home. In hindsight, the signs of colonization and assimilation were evident where I grew up, but not visible to me because they were normal. I didn’t grow up with ceremony or traditional culture, or with my extended family because my dad went to residential school at a young age. Many people at home had similar experiences, and as an adult, I can see the health and social impacts of colonization on the community.    

When I started developing presentations about Indigenous health within the context of historical and current colonization, it was a difficult process. I kept reflecting upon all   the people I know who have experienced the negative impacts of these systems and are incorporated into the statistics for health and social inequity. It is particularly distressing to connect historical and current racist systems to impacts on my community. With each presentation, I am aware of those we have lost in life or spirit, including those who have chronic diseases and those who battle with substance use disorders, -violence, and suicide. Within a small community these losses are felt by everyone, and communal grief often amplifies the intergenerational traumas that lead to these inequities. These people from my home are not just numbers or statistics, they are people with stories, feelings, personalities, who have families who love them.  

Thankfully, my research also has connected me to the strengths of my ancestry and all Indigenous Peoples. My own resilience is strengthened as I too continue learning more about Indigenous worldview, wisdom, and Indigenous strengths.   There are also so many Indigenous Peoples that I grew up with that have strength, resilience, happiness, and success and being able to think of them helps to ease that heaviness you’re left with when you are focusing on the health and social deficits. 

You may wonder how my story fits with current Indigenous issues in hospital pharmacy. Every Indigenous patient has their own story, family, community, and likely their own hurt and resiliency. Cultural safety for pharmacy professionals means being aware and sensitive to these pasts that have shaped our present. Trauma - informed care should be the standard of care for every patient but is especially important for Indigenous patients as many have had a traumatic experience or have intergenerational trauma. Patients must be recognized as individuals with their own experiences. As health care professionals, we must create safe and trusting environments, acknowledging patient-centric factors that facilitate that safety.  It is our responsibility to be honest, compassionate, and consistent in intention and delivery, while making space to adapt to the unique needs of an individual or community. Patients must be given choice and collaboration to help empower them and we must focus on individual’s strengths. Healing and recovery must be viewed and supported as a possibility, formed in partnership with the patient’s environmental factors, and in consideration to their personal and cultural motivations and values. When I consider people who have a trauma response,   the most powerful concept that I integrate is recognizing that people’s behaviours are an adaptation to past experiences. In other words, something bad has happened to them and they are responding to that hurt. Behaviours form to create safety or withdrawal in response to trauma, fear, pain, and grief and not as a result of being a “bad person.”          

I have seen a significant improvement of the intentions of pharmacy professionals to improve Indigenous health over my 17 years of practice. Colleagues are now interested in learning the truth about Canadian history as it relates to the health consequences of Indigenous patients and are participating in reconciliation discussions and efforts.  What is emerging are questions from the pharmacy community on how to proceed with these intentions.”  What does reconciliation look like? “How do you participate in this vast and, at times, overwhelming idea?” “How do you continue to do this work in meaningful ways that involve more than taking the required module?”  “How do we incorporate Indigenous holistic healing and ways of viewing the world into our health care systems?”  Although these are not questions with easy, or static answers, continuous reflection on them, and adapting to our evolving roles in reconciliation are foundational to progress our individual and systemic impact on Indigenous Health.  We must shift our focus to Indigenous strength and resilience. Indigenous Peoples, including my community, have survived a lot over the past few hundred years. Our Peoples are thriving in culture, ceremony, art, research, and self-governance, with growing momentum that leads to intergenerational healing and empowerment. To prevent further harm from colonization, we must proceed with the idea “Nothing about us, without us”, and accept and include Indigenous guidance and consultation in all decisions, at all levels of our healthcare and pharmacy systems. Educational standards, training standards, and policies for organizations and research must include Indigenous consultation and leadership. All health professionals require training in Canada’s colonial impact on Indigenous wellness, cultural safety, and trauma-informed care, again in partnership with the Indigenous community. 

For pharmacy professionals, connecting with Indigenous patients starts with cultural awareness and humility. Learn more about the Indigenous communities you serve. Advocate to leadership within your hospitals to make connections with local communities. Attend free Indigenous community events. Join a local Indigenous social media page. Read Indigenous authors. Do the hard work of learning the colonial history by watching YouTube residential school survivors, or The Unforgotten video by the Canadian Medical Association and Government of Northwest Territories, or read stories from the Truth and Reconciliation Report. Engage with Indigenous Pharmacy Professionals or traditional Knowledge Keepers to learn more about Indigenous ways of knowing and how you can integrate those concepts into your practice for the benefit of Indigenous and non-Indigenous patients alike. 

I leave you with the challenge to look at every Indigenous patient you have as someone who has been negatively affected by assimilation, prejudice, and structural racism, but with cultural, community, familial, and individual strengths. Challenge yourself to find and accept the Truth. Only then will you be able to contribute to Reconciliation.

Amber Ruben (BSc Neuroscience, BSc Pharm, APA) is a clinical hospital pharmacist and a MSc student at the University of Alberta with a focus on Indigenous health.