Clinical Pearls: Student reflection on AFPC’s Indigenous History Month Information Series

July 15, 2022
By Jessica Sheard

For this year’s Indigenous History Month, the Association of Faculties of Pharmacy of Canada’s Truth & Reconciliation Special Interest Group held a series of educational webinars. These sessions, presented by pharmacists Dr. Jaris Swidrovich and Amber Ruben, discussed important terminology tips as well as how to create a meaningful territorial acknowledgment.  Although these information sessions were not developed to address clinical issues, much of what was discussed can be applied to hospital pharmacy practice to provide culturally competent and sensitive care to Indigenous patients. 

Medicine vs. medication

One terminology tip shared that would be relevant and useful to hospital pharmacists was the difference between the terms medicine and medication. In our healthcare system, based on principles of Western medicine, the words medication and medicine are often used interchangeably. However, in the information sessions I learned that these words could have different meanings for Indigenous People. Dr. Swidrovich explained that the word medication can carry the context of being manufactured, whereas in the Indigenous health context the word medicine can encompass something that is in its natural state, or a natural item such as a plant or herb. This can be an important communication component when collecting medication histories from patients in the hospital. Asking each patient specifically about whether they use traditional medicines can help pharmacy staff gain a complete medication history while providing culturally aware care. Adding this simple, but important, question can encourage Indigenous patients to share their complete medicine and health history. 

Two-Spirit individuals

During the information session, Dr. Swidrovich went into detail about Two-Spirit individuals and their importance in Indigenous communities. Having previously only briefly learned about Two-Spirit individuals, I appreciated the ability to learn more about these individuals, especially the importance of their roles in Indigenous communities. During this discussion, I learned that prior to colonization, Two-Spirit individuals held very important roles in their tribes, including medicine people, chiefs, caregivers, protectors, and knowledge keepers. I also learned that what it means to be Two-Spirit can vary between Indigenous communities and individuals. Indigenous communities embraced their people for having a range of gender identities and sexual orientations, and Two-Spirit people were loved and accepted as being unique individuals. I found this to be an important detail in the context of providing culturally competent care, as we can learn and integrate practices of culturally competent care through both an Indigenous health lens and a 2SLGBTQ+ lens. With both Pride Month and Indigenous History Month occurring together in June, we can reflect on providing gender-affirming, culturally aware care to Two-Spirit individuals by learning the histories of colonialism and residential schools, and their effects on Two-Spirit individuals.

Territorial acknowledgements

As it becomes more common that territorial acknowledgments are made before meetings, events, and presentations, it was useful to learn about the importance of making these intentional and meaningful. I learned through these sessions that although it is positive that territorial acknowledgments are becoming more common, the most important part of a territorial or land acknowledgment is the learning and reflection that occurs before drafting it. Delivering a land or territorial acknowledgment is intended as a small step toward Truth and Reconciliation, which requires education and reflection on the histories of Indigenous Peoples prior to colonization, as well as on the continued ramifications of colonization, residential schools, racism and discrimination faced by Indigenous Peoples living in Canada. I learned the importance of research when preparing a territorial acknowledgment, to determine which nations had previously and are currently living on that land, whether a treaty exists, or if you are residing on unceded land. The term unceded in terms of territorial acknowledgement and general learning is an important point of reflection. I learned in the information series that the term unceded, when referring to areas of land without treaty, means that the land had never reached an agreement between settlers and Indigenous People, and as such the land remains stolen. Although it is still appropriate to use the word unceded when describing an area, or to include it in land acknowledgements, it is important to reflect on the histories behind the unceded territory. Reflecting on the interpretations of treaties between settlers and First Nations Peoples is another important aspect I have learned about drafting territorial acknowledgements. It is important to realize that treaties were thought by the First Nations People to be an agreement of hunting and fishing rights, education, health, money for necessities, housing, sharing the land, and maintaining their spiritual and cultural beliefs. It is also important to realize that treaties were conducted in English. As Amber Ruben had described during her session, treaties that do exist are still not being lived up to in many ways, including continued health disparities faced by Indigenous People, and a continued lack of clean drinking water on many reserves.

In her information session, Amber Ruben clarified the difference between land and territorial acknowledgments. Land acknowledgements are statements that are focused on the physical land, land use, or spiritual connection to the land. Often, land acknowledgements express thanks or connectedness of the event, workplace, meeting, or ceremony to the land on which the events are taking place. Territorial acknowledgments differ in that they recognize and pay respect to the First Nations, Inuit, and Métis people and their traditional and current geographical territories on which we all work and live upon. An associated treaty or treaties are often included in territorial acknowledgments. During these sessions I learned that aside from your own reflection prior to drafting a land or territorial acknowledgment, it is appropriate to ask Indigenous People for guidance on delivering the acknowledgement, depending on the event or meeting taking place. However, it is also important not to  impose more responsibility and emotional or academic labour these same individuals. As non-Indigenous people, we are in a position of privilege to be learning and reflecting on Indigenous history and current contexts and are responsible to become educated ourselves. 

Summary and resources

This information series was a great opportunity to learn and reflect for Indigenous History Month. There were many important points, tips, and contexts to be learned, but the above reflection were areas that stood out to me most in the context of providing patient care and the practice of giving territorial acknowledgements. I encourage pharmacists to reflect on their own knowledge and biases in providing care to Indigenous patients, not only during Indigenous History Month in June each year, but regularly and consistently. Indigenous education resources from the Association of Faculties of Pharmacy of Canada can be found here (Indigenous Educational Resources | AFPC). 

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