Building an egalitarian relationship with Indigenous people

What if southern Quebec had to learn from the North this time? If we reversed for a rare occasion the flow of expertise to benefit, along the St. Lawrence, from the achievements developed in cultural safety in health care in James Bay.

An approach which, far from being a panacea, would reduce prejudices and unconscious biases. A skill that is developed primarily by listening, by listening to the other. Towards his history, his culture, towards what makes him who he is, to ultimately deconstruct these preconceived ideas that mark our brain. Listening, therefore, in large quantities. Empathy too. Without forgetting a good dose of humility to succeed in putting oneself back in the position of the learner.

“By truly understanding what Indigenous people have gone through, their daily challenges, but also the strengths and resilience intrinsic to their culture,” racist incidents could be avoided in the health system, says Darlene Kitty, family physician at he Cree origin at the Chisasibi hospital in James Bay and a leader in native care.

My patients were my neighbors, they were the people I worked out with, whom I ran into at the grocery store. I sewed with them, we shared meals, we went hunting and fishing together.

At the Cree Board of Health and Social Services of James Bay (CCSSSBJ), which has administered health care in the Cree territory of James Bay since 1978, the concept of cultural security is applied to Aboriginals, but it can just as well for any other culture.

Social skills much more than know-how which opens the door to a more egalitarian relationship between professional and patient, argues Dre Kitty, also a professor at the University of Ottawa and McGill University. “Cultural security is about putting an end to the imbalance of power between the professional and the patient,” she points out. The professional is no longer here, above, and the patient, there, below. A real partnership for health can thus be built. “

A rebalancing of power that at the same time refocuses the spotlight on the patient by moving away from cultural generalizations. Of course, we think back to those documented cases of Indigenous patients who arrived in distress in the emergency room who were thought to be intoxicated from the outset. But beyond these unconscious biases, it is also seeing the positive in a culture portrayed more by its pangs rather than its charms.

“Yes we are seeing higher rates of diabetes, yes we are seeing a higher prevalence of mental health problems, but what about the good sides? [Les professionnels de la santé] must also learn the strength of this culture, the beauty of the relationship of the Aboriginal people with the land, their talents as fishermen and hunters, ”says Dre Kitty.


A department, called Nishiyuu – which means human being in the Cree language – has been created at CBHSSJB to ensure that all programs and services offered are in tune with Cree culture and values. A kind of reflex, second nature forged over time and efforts to build a culturally safe environment.

The first training courses on cultural safety – a concept that appeared in medical literature in the 1980s – were born in James Bay about five years ago. The ultimate goal is that 100% of health professionals who practice in James Bay – whether they are doctors, nurses, or even dentists and occupational therapists, for example – follow one or the other. of these training courses, explains Virginie Hamel, assistant director of human resources at the CCSSSBJ.

An approach that would improve the state of health of patients. “In a health relationship, the patient must be confident with the professional to feel comfortable explaining what is wrong. If the patient does not feel judged and has the confidence to be well taken care of, there will certainly be positive results, ”she thinks.

Cultural security initiatives can be found in many ways in Baie-James. Last year on Fort George Island off the coast of Chisasibi, medical professionals gathered in the old church to listen to a residential school survivor. ” [Les professionnels] were seated in history. They listened to the story, “argues Dre Kitty.

In another training, the history of indigenous peoples was presented from the point of view of the colonized, rather than that of the colonizer. “They told us about the actions of the settlers and we were asked how we felt. It was very powerful. It brews ”, explains Virginie Hamel who followed this training. A reverse reading that opens the door to awakening to the history of the Other.

Systemic racism

Seeds are therefore being sown in James Bay in an attempt to patch up these broken meshes in the relationship between Aboriginal people and the health system, without becoming absolute bulwarks against racism. In a statement released in the wake of Joyce Echaquan’s death, the CBHSSJB declared “that no health organization is immune to systemic racism.”

Ingrid Kovitch, who worked for 20 years in Waskaganish in Cree territory in James Bay, believes that the creation of personal and emotional ties with the Aboriginals makes it possible to reduce the risk of abuses. “I used to live there,” she says. There were about 2000 inhabitants. My patients were my neighbors, they were the people I worked out with, whom I ran into at the grocery store. I sewed with them, we shared meals, we went hunting and fishing together. My experience was therefore totally different from that of someone for whom the only contact with the natives is in an emergency room when they are probably not at their best. “

Stereotypes, preconceived ideas and excessive generalizations are fertile ground when contact with the targeted minority is tenuous. “Almost invariably the first question I was asked in the South was: You must see a lot of cases of alcohol and drug addiction. People never told me: you must see incredible hunters, people who live in harmony with the land, fantastic craftsmen, extraordinary athletes, inspiring leaders. It never came. “A deconstruction of the a priori which would thus be profitable not only for health professionals, but also for the entire population.

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