Registered Nurse Valerie McLeod was deciding on a topic for her master’s project, when she was approached by Saulteaux Elder Gilbert Kewistep, who suggested she address the systemic pressures Indigenous women sometimes face after giving birth.
“There were tubal ligations that happened unethically, without (proper informed consent) from Indigenous mothers … (and) red alerts. The Ministry of Social Services would come in and just take the babies after mom signed a document,” said McLeod, who is a member of Lac La Ronge Indian Band and a senior co-ordinator for health programs at Northlands College in La Ronge.
She and Kewistep, who had a longstanding working relationship, engaged in traditional ceremony and met with the Chief and council of Yellow Quill First Nation to determine what information they needed and how to use it to help their families.
The resulting relationship-based, community-led research project, which created an information and resource package that helps expecting mothers know their rights, is a good example of, “authentically engaged participatory research,” said McLeod’s academic advisor, Dr. Vivian Ramsden (PhD), who teaches clinical research methods at the University of Saskatchewan’s College of Medicine.
“The process started with community… all of the research processes, including the questions and how we were going to actually engage the community in the process, and ethical approval were received from Yellow Quill before it went to the ethics board at the university,” she said.
“This is exactly what Primary Health Care was designed to do: to bring the system to the people rather than the people to the system.”
McLeod completed and passed her project, Apinoche Tahkosin (The child has arrived): A community engagement story, in August 2021. She expects to qualify for her Master of Governance and Entrepreneurship in Northern and Indigenous Areas (GENI) through Johnson Shoyama Graduate School of Public Policy by spring 2022.
Kewistep, who taught social work at First Nations University of Canada, also served as a cultural support worker in the First Nations, Métis Health Service with the former Saskatoon Health Region, where McLeod was the lead in 2015.
He recalls seeing mothers, alone and crying as they faced teams of social workers trying to persuade them to sign over custody of newborns. The mothers were often told their babies would be taken into foster care for three months before getting their baby back. They didn’t realize that signing a consent form created a file that would follow them and jeopardize the mother’s custody indefinitely, he said.
“I’d challenge them. I said, ‘You have a code of ethics that you have to follow. You must never leave your client in a state of trauma. What are you doing?” Kewistep said.
McLeod also heard of nurses and doctors pressuring reluctant patients to have tubal ligations.
“They (didn’t) even think twice that what they’re doing is not right, is unethical,” she said.
The Health Region has changed its policy to prevent sterilization without prior discussion and Social Services has stopped using birth alerts, but many Indigenous mothers are still in need of support in hospital while dealing with birth certificates, Indian status registration and social insurance numbers.
The team, comprised of Yellow Quill members in the lead, Kewistep as the vital link between community and the university, researcher McLeod, and Ramsden, produced a helpful welcome package, which also includes the codes of ethics for nurses, doctors and social workers.
The project emphasizes the need for Indigenous organizations and communities to have support workers to advocate for new mothers in the health-care system, ensure mothers know their rights, and never sign documents without understanding what they mean.
The package has already prevented newborns from being apprehended by Social Services, Kewistep said.
Yellow Quill First Nation holds the copyright on the work but actively invites other Indigenous communities and organizations to adopt it and customize it to meet their needs.
McLeod is well aware of racist and unethical treatment of Indigenous patients. Early in her career she witnessed a physician perform a treatment on a mute Indigenous woman without anesthetic, despite protestations of three nurses who could see the pain it was causing her.
As a young nurse feeling powerless, McLeod moved to a job with a First Nations organization. She said that if she’d known then what she knows now, she’d have reported the doctor to the College of Physicians and Surgeons.
The incident ignited a determination in her to ensure Indigenous people receive fair and ethical health care.
McLeod supplemented her training with four years of week-long summer camps at Peguis First Nation in Manitoba, where she learned traditional Indigenous treatments and medicines.
“I feel very humbled to be chosen by Creator to do this work … To be a part of the change that needs to occur, to help be a part of that voice for those that have been voiceless.”
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