EDI, Fall 2020, From the Archives

Ask, Listen, Learn: Understanding Opportunities to Enhance Care for Indigenous Patients

Banner Fall 2020 - Jaris Interview
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An Interview with Jaris Swidrovich, Canada’s first self-identified First Nations Doctor of Pharmacy

In September 2019, the College’s Board approved the adoption of three opportunities to cultivate Indigenous cultural competency amongst non-Indigenous Board members, College staff and registrants. This commitment includes identifying ways to address cultural inequities to improve patient outcomes and highlighting resources for registrants to enhance the care they provide to Indigenous patients and communities.

As part of this work, the College was pleased to interview Dr. Jaris Swidrovich, a member of Yellow Quill First Nation and Canada’s first self-identified First Nations Doctor of Pharmacy. Dr. Swidrovich is a clinical pharmacist and an Assistant Professor of Pharmacy in the College of Pharmacy and Nutrition at the University of Saskatchewan. He is dedicated to educating healthcare workers and students on Indigenous topics and reconciliation, in addition to undertaking educational and clinical work related to HIV/AIDS, mental health, and substance use disorders.

Q: What have you observed about pharmacy and the role of pharmacy professionals when it comes to caring for Indigenous peoples and communities in Canada?

There have clearly been gaps in our education—all the way from kindergarten to becoming a pharmacist. Those gaps are really prevalent. In every presentation I’ve given over the last few years, over 90% of the audience can’t tell me what the Sixties Scoop was, for example.

The Sixties Scoop, as a single example, is directly connected to why so many Indigenous folks are accessing the healthcare system or why they might be in the hospital, or why they might be dealing with depression, anxiety, or substance use, and are therefore presenting to community pharmacy for medication. Those traumas are not even on the radar for many pharmacy professionals.

Terminology is not well known. So, I usually focus a lot on terminology in the presentations I do so we know who we are talking about, as well as move away from that monolithic representation of Indigenous Peoples as one people.

Because Indigenous voices are not well-represented in our profession, there hasn’t been an opportunity for change from the inside. It’s tough to share Indigenous experiences with professionals when they haven’t witnessed it from the inside. Racism is prevalent and that is a big barrier. For many folks in pharmacy, the only Indigenous peoples they see or talk to are the patients they interact with in their professional setting—so those situations subconsciously, sometimes even consciously, become the representation of who Indigenous people are, which is not true. We get a very one-sided image in our walk of life as pharmacy professionals. It creates barriers as it labels everyone else as something different.

Q: When thinking about individual pharmacy professionals, and what they do on a daily basis, are there any examples of how these barriers typically happen?

One barrier is that incorrect terminology can often be used. Another is that there can be assumptions that everything is provided to First Nations patients. Or there can be an idea that Indigenous patients are always struggling—there seems to be this rhetoric that we are living in mayhem. Which is not true, there are absolutely thriving Indigenous communities.

One example I often refer to in order to illustrate barriers to care: patients will present with a status card that enables them to receive payment of their medication under the Non-Insured Health Benefits Program (NIHB). Navigating the NIHB system can be quite a pain sometimes. In cases where a pharmacy professional is frustrated with the NIHB system, that experience can sometimes lead to a negative interaction with the patient; there’s a sense of “ugh” or “oh, great” coming from the professional when they know they will need access to the system. So that can lead to a negative experience or exposure.

Our limited understanding, as pharmacy professionals, of Indigenous medicine and practices can create an awkward power imbalance. The concept of cultural safety is addressing and breaking down that hierarchy that exists in healthcare and addressing the inherent power imbalance in our system. When we aren’t able to entertain questions or concerns about Indigenous medicine and practices, again we are upholding Western knowledge as superior and either disregarding or de-valuing Indigenous practices and medicines. If a patient feels that their pharmacist doesn’t care, this can affect their level of engagement.

Q: What are some things that pharmacy professionals should be thinking about now to address these issues and overcome these barriers and challenges?

There is a lot of learning that needs to happen. Unfortunately we need to fill in those gaps in knowledge of Indigenous peoples and history in Canada that were not presented to us in all of our schooling. That’s not the fault of people. For pharmacists who are not aware of terminology, of history, or of best practices, I don’t blame them at all because that probably wasn’t provided to them. But now the professional responsibility lies with that individual to learn and to make up for those gaps.

The messaging that I share frequently is that pharmacists are the most accessible healthcare professional and often ranked the most trusted. The greatest gaps in health outcomes experienced by people in Canada are between Indigenous and non-Indigenous peoples. So arguably, within the healthcare sector, pharmacy professionals have the greatest opportunity to effect change in this area.

Quite often, pharmacies are the first point of access to the healthcare system as a whole—we are really that gateway. That single interaction can really make or break the healthcare experience for people. In a world and sector where racism is rampant, that’s our opportunity to show that we are different, that we care, that we are not racist, that we are anti-racist.

Q: You’ve mentioned terminology and language a few times as an area for learning and awareness. Why is proper language and naming so important?

If I mis-gendered you, that wouldn’t make you feel great because that’s not who you are. By using incorrect terminology, you are disregarding someone’s identity and sometimes incorrectly labelling someone. Terminology also plays an important role in our pharmacy world because it is only certain First Nations and some Inuit people who have access to Non-insured Health Benefits (NIHB).

Indigenous is an umbrella term; it applies to all of First Nations, all of Métis and all of Inuit. Native and Indian should not be used to describe First Nations people, though some First Nations people may have reclaimed those names or use it in their own way.

You can go more specific than First Nations. For example, I’m Saulteaux but depending on the situation, I may not refer to myself as that. For Métis folks, they are often excluded from the consciousness of people when they say Indigenous—but they are Indigenous peoples. Inuit means “people” and is a collective term for Inuk people.

Q: Knowing the commitment pharmacy professionals in Ontario have to the Code of Ethics and the principles on Justice/Respect for Persons, is there anything that they can and should be doing when applying this principle?

I think it would be difficult to apply those principles in action, if we’re not even aware of who in our society is marginalized or why they are marginalized and how and why they need to be treated equitably.

For example, how can you treat a First Nations patient equitably if you don’t know what the residential schools were, if you don’t know what the Sixties Scoop was, if you don’t know that most children in the province who are apprehended are First Nations because of colonial views of what families are supposed to be and how they are supposed to function. We just simply can’t fully enact that principle without knowing more.

And also, spending more time asking questions than speaking is a great practice to honour the individuality of people. We need to be able to hear their story and understand who they are without making any snap judgments. Which can sometimes be difficult in a really fast paced pharmacy environment, I get that.

Q: What should organizations, institutions and corporations, from academic institutions, to professional bodies to pharmacy owners and operators be thinking about and doing to help support pharmacy professionals in their role? And how can we increase Indigenous representation in pharmacy?

Number one, more can be done to provide and facilitate education; education always.

Secondly, there should be a concentrated and dedicated effort to recruit, retain and centre Indigenous pharmacy professionals. Sometimes that will need very different practices than how we normally might recruit and reach folks.

We need to take a step back and think about if we are doing things for Indigenous people or with and by Indigenous people. And it really should be with and by.

Even ensuring representation in everything-in images from corporations. I don’t recall seeing a visibly Indigenous person in the materials from corporations, regulatory bodies, advocacy groups. The message that current or prospective Indigenous pharmacy professionals receive is that this isn’t a place for us. If we don’t see ourselves, it is a really quick write off.

There are very few pharmacies on-reserve so that opportunity for us to make an impact in the community is limited when we aren’t even there. It is difficult for people to consider pharmacy as a profession if they are rarely or never exposed to it, they don’t even see pharmacists and pharmacy technicians in the community.

If we provide more of a presence in both urban and rural Indigenous communities, perhaps those ripples of change will start to be noticed and pharmacy will be on the radar as a potential career aspiration.

Q: Are there any final thoughts that you wanted to convey to Ontario pharmacy professionals?

I would encourage folks to always be curious. By being curious, that would perhaps prompt seeking educational resources or seeking learning or even introspection on their own biases and beliefs that might exist.

I would even just personally thank them for reading my words; it means the world. I’m conscious of and thankful for the platforms that I do have, like this magazine; it’s really special. I think about my family members whose voices were just diminished and lost and suppressed. Whereas what I have to say is being uplifted and shared. And I thank all the readers for engaging in this content and area and seeking to learn more.

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