Manitoba Hospitals are going to be collecting race, ethnicity and Indigenous identity data starting this Thursday, May 11. We're the first province to see such a plan put in place. It's to provide hard evidence that racism exists in the health care and treatment of Indigenous patients, showing contrasts between wait times for non-Indigenous and Indigenous patients, for example. This will allow for steps to be made to more adequately provide equity for everyone.
AHTF Project Consultant Brenda Blom says this raises the question as to how that information is going to be specifically used, and what benefits it poses. She notes parameters need to be set for the use of the information.
"Anything outside of those parameters that have been agreed upon would be the strict ownership of the First Nations, and cannot be used in agreement through an MOU for anything but those objectives," says Blom. "Certainly, there may be things that come along that you can use them for, but they need to be mutually agreed-upon circumstances where that information might be used in a different profile or for a different reason."
She explains whenever you evaluate something, you want to "drill down" and ask, "Why am I doing this?"
"Because, if you're not, then you're just making a big fat work project and it just sits on a shelf," continues Blom. "It's kind of like having a quality improvement plan as an outcome for services like the accessibility, wait times, and quality of care. Having surveys that identify how the folks are actually feeling and experiencing the care that they get, may be able to get something, and maybe be able to identify some of those race gaps and some of those service gaps by omission or not by omission -- by system omission. All of that should have a time frame attached to it."
Blom adds one of the main challenges Indigenous people face almost every day is discrimination.
"Discrimination goes to all ends of the spectrum," says Blom. "People who come in, who may have addictions problems, who have used the mental health process and the medical process over and over and over again, are ignored because they have reputations, or whatever it might be. Those individuals who have not used these systems before, are treated very differently than a non-First Nations person -- for example, a threatened pregnancy. You'd have to be able to differentiate between client satisfaction in both circumstances. There are variances between the two."
She says the Winnipeg Regional Health Authorities had the Aboriginal Health Services Department for a number of years, and correctly did many things.
"They've had folks that they can call right away for individuals who don't have an advocate with them," notes Blom. "Unfortunately, one of the biggest things is the language barriers. When clients go into the hospital situation or into a health situation where they're not allowed to have advocates, because of transportation rules, or they're being transported by non-insured health benefits, there's not enough money to provide an escort for that individual. Winnipeg Regional Health Authority attempted to do that by having individuals who are available on a full-time basis that spoke the language, whether it be Oji-Cree, Dakota or Anishinaabe."
Blom says that's a fairly good model. However, more flexibility for having an advocate is required.
"I think, if you were to take even you or me going into the hospital right now, they talk a language that you don't understand. You're just putting your full 100 per cent trust in them. If you don't have an advocate, many First Nations people are really shy and won't speak up for themselves. Availability to a patient advocate would be a really, really key thing. Hitting the ground running with an implementation plan before you actually decide to do it, gives you outcomes. This is what we want to get, and these are our minimum outcomes so that you get something out of it and it just doesn't become another study."
She adds client advocacy is extremely vital. To not have an Indigenous-speaking advocate to go with any given patient, rather than somebody who's been sent and cannot speak it very well, usually makes the uninsured patient fend for themselves.