Prior to colonization, Indigenous healers and midwives held significant roles in their communities, serving with their knowledge of harvesting, preparing and administering local medicinal plants, reads an article published by the Canadian Nurses Association (CNA).

Even with Indigenous people’s rich history of traditional medicines and healing practices, Western healthcare systems have a longstanding past of alienating First Nations people from the sector. 

“The genesis of healthcare in Canada was a direct result of the relationship that the Jesuit missionaries had with our First Nations healers when they first came to the land,” said Lisa Bourque Bearskin of Beaver Lake Cree Nation, who is an associate professor for the School of Nursing at the University of Victoria (UVic). “When the settlers came over, they introduced disease. It was the First Nations healers and helpers that helped cure them and give them access to all of that traditional knowledge that's on the land.”

The use of medical plants and ointments, such as willow bark which carries a chemical similar to Aspirin, and petroleum jelly, also known as Vaseline, had been utilized by First Nations for centuries.

“That was all invented by First Nations people because they were already practicing, they were already taking care,” Bourque Bearskin said.

According to the CNA article, up until the 1930s, Indigenous women were “largely barred” from attending nursing school in Canada.

Charlotte Edith Anderson Monture of the Mohawk tribe became Canada’s first Indigenous Nurse in the early twentieth century, reads a biography published by the National Women's History Museum. But Monture obtained her education in America at New Rochelle Nursing School in New York, after being rejected from a number of nursing schools in Ontario.

She would later become a First World War veteran after serving in the US Army Nursing Corps on the frontlines.

In 1955, Rose Casper of St’at’imc Nation, a survivor of the Kamloops Indian Residential School, became the first Indigenous nurse in Western Canada.

But from the 1930s to 1980s the establishment of racially segregated Indian hospitals spread across the country. Three major hospitals were opened in British Columbia, with one in Nanaimo, which operated for roughly two decades after the Second World War, closing its doors in the mid ‘60s.

According to the University of British Columbia’s Indian Residential School History and Dialogue Centre, the hospitals, initially a means to isolate tuberculosis patients from the general public, stemmed from the missionary hospital movement in the late 19th and 20th centuries.

These hospitals were frequently overcrowded with patients and understaffed with employees that were often under qualified, the Indian Residential School History and Dialogue Centre stated. Experimental treatments and “painful and disabling surgeries” were also conducted on patients at the hospital.

“Our Indian hospitals removed that autonomy, and that recognition of our traditional healers,” said Bourque Bearskin. “We’ve got this longstanding history of genocide that continues.”

“When I think about the Indian hospitals, nurses, ourselves, were complicit in implementing those,” added Bourque Bearskin. “We were complicit in sustaining the system of systemic racism.”

She notes that it is likely that many older Indigenous patients have experiences with the Indian hospitals.

“Families have those memories,” she said.

Bourque Bearskin and Victoria Dick of Tseshaht are currently working on creating a curriculum, “from the ground up”, called the Indigenous Graduate Education and Nursing (IGEN) program for UVic.

“What we're trying to do is... to rewrite nursing back into healthcare [and] into the history,” said Bourque Bearskin. “Nurses are always at the bedside, nurses are always in the home, but we don't find our nursing leaders at those decision-making tables where they really need to be to help systems transformation.”

“[Nurses] understand the significance of working with the people,” she added. “And I think the people trust them.”

For Bourque Bearskin and Dick, the work they’ve been doing over the last few years, including the development of the master’s program, is better aligning healthcare with the principles of UNDRIP.

“[It] clearly articulates that First Nations, Inuit, Métis, are afforded the opportunity to design and deliver their own health care approaches,” Bourque Bearskin said.

When asked what it means to nurse the Nuu-chah-nulth way, Dick reflects on the words from a guest speaker for an IGEN course, who shared that Indigenous and Nuu-chah-nulth nurses have inherent knowledge from growing up in their communities.

For Dick, it’s important for Indigenous nurses to tie in their background and connection to their community to be an effective nurse.

“I can go into most of our nations and practice relationally and be effective in practice,” she said. 

Dick notes that because of this connection to her background, she can go in and out of communities with trust.

“Which isn’t very easy,” she added. “There’s lots of mistrust.”

Especially with high turnover rates, she added.

Nursing the Nuu-chah-nulth way, shared Dick, is focused on health promotion.

“When you’re healthy in the first place, let’s keep it that way,” said Dick, which includes promoting a healthy diet, exercise, community and spiritual wellness.

Dick goes on to share that prioritizing a relationship-focused approach means the patient “is the expert in their healthcare”, which entails approaching clients with respect and non-judgement.

“I feel like most people just want you to listen to them,” said Dick. “So often, they're not heard in the healthcare system, so just taking that time to listen to them goes a long way.”

According to Jess McConnell, manager of Indigenous Health at West Coast General Hospital, positions such as Indigenous Liaison Nurses (ILN) and Indigenous Patient Navigators (IPN), who support Aboriginal patients and their families while they navigate the healthcare system, are available to clients at most hospitals on Vancouver Island.

In recent years, the First Nations Health Authority (FNHA), alongside the Health Standard Organization, developed the British Columbia Cultural Safety and Humility (CHS) standard. This is the first of its kind in Canada, according to Monica McAlduff, FNHA chief nursing officer.

The standard aims to improve the health care system for First Nation patients by creating culturally safe environments, encouraging providers to care for their clients with humility, and ending Indigenous racism, she wrote in an email to Ha-Shilth-Sa.

According to the In-Plain-Sight survey, a review of Indigenous-specific racism throughout B.C.’s health care system, of 2,780 Indigenous respondents, only 16 per cent reported to have not been discriminated against while seeking care. 

Meanwhile, 35 per cent of health-care workers reported witnessing discrimination against an Indigenous patient.

“[It’s] critical for workers of the Western health-care system to understand the systemic barriers and work towards minimizing these inequities and influence policy change for our people to access culturally safe health care,” wrote McAlduff. 

“We're the only health professional that's trained with this generalist knowledge,” said Bourque Bearskin. “We know how to work with communities, we know how to work with populations, but we're never brought to that table to help facilitate that.”