State dependency and the lingering impacts of colonialism dancing with Aboriginal peoples are known realities across the Canadian health care landscape. However, delving into the discourses of how to reduce health disparities of a colonized population is a sophisticated issue with many factors to consider. Specifically, nurses can play a central role in the delivery of essential health services to the ‘Other’ within isolated Northern Aboriginal communities. As an extension of the state health care system, nurses have a duty to provide responsive and relevant health care services to Aboriginal peoples. The conducted qualitative research, influenced by a postcolonial epistemology, sought to explore the roles and challenges of nurses working within rural, remote, and Northern Canadian Aboriginal communities, as well as individual, organizational, and system level factors that supported or impeded nurses’ work in helping to meet Aboriginal peoples’ health needs with meaningful care. Theorists include the works of Fanon on colonization and racial construction; Kristeva on semiotics and abjection; and Foucault on power/knowledge, governmentality, and bio-power were used in providing a theoretical framework to help enlighten the research study presented within this dissertation. Critical Discourse Analysis of twenty-five semi-structured interviews with nurses, physicians, and regional health care administrators was deployed to gain a better understanding of the responsibilities and challenges of nurses working in Northern Canada. Specifically, the research study was conducted in one of the three health regions within Northern Saskatchewan. Major findings of this study include: (1) the Aboriginal person did not exist without being in a relation with their colonial agent, the nurse, (2) being ‘Aboriginal’ was constructed as a source of treating illnesses and managing diseases, and (3) as a collective force, nursing was utilized as means of governmentality and as provisions of care situated within colonial laws. Historically, nurses functioned as a weapon to ‘save’ and ‘civilize’ Aboriginal peoples for purposes of the state. Primarily, present day nursing roles focused on health care duties to promote a decency of the state, followed by missionary tasks. In turn, the findings of this research study indicate that nurses must have a better understanding of the impact of colonialism on Aboriginal peoples’ health before they engage with local communities. Knowledge development through postcolonial scholarship in nursing can help nurses and health service providers to strengthen their self-reflective practice, in working towards de-signifying poor discourses around Aboriginal peoples’ health and to help create new discourses.

<p>Urban Aboriginal health and health-related issues are steeped within the sociohistorical, sociocultural, and sociopolitical experiences of Aboriginal peoples since European contact. Thus, urban Aboriginal health issues are very complex in that they consist of aspects associated with collective as well as individual cultural and political life experiences. Therefore, in order to adequately address Aboriginal health issues a comprehensive and multidisciplinary approach is required.</p> <p>This study examines how Anishnawbe Health Toronto, an urban Aboriginal community health centre, addresses the specific healthcare needs of the urban population through a multidisciplinary culturally appropriate healthcare model. As my research evolved, a few themes emerged from the data. First, the health issues experienced by the clientele were inherently complex and simultaneously infused with a culturally collective and individualistic quality. Second, practitioners acknowledged and addressed the complex nature of the clients’ health problems through a unique model of health care created at the centre. Third, the philosophy, infrastructure, and model of health care at Anishnawbe Health Toronto goes beyond the notion of merely offering access to both systems of health care, and instead constitutes an innovative and culturally appropriate system of care which is under Aboriginal control, development and implementation. Therefore, through my analysis of these themes, I conclude that the model of health care developed at the centre is an example of complex solutions designed to address complex Aboriginal health issues and as a result, facilitate the embodiment of self-determination in the area of health care.</p> / Doctor of Philosophy (PhD)

This thesis examines how traditional medicine workshops offered by an Aboriginal health centre contribute to capacity re-building through self-care in two local communities in Manitoulin Island, Ontario. Health disparities that exist between Aboriginal people and the rest of the population have prompted a need to better understand health determinants that are of relevance in these communities including the importance of culture, tradition, and self-determination. A variety of qualitative methods were employed in this work including in-depth interviews, focus groups and “art voice.” The use of art voice on Manitoulin Island advances decolonizing methodologies by emphasizing how the incorporation of locally and culturally relevant methods or “methods-in-place,” is an effective way to engage communities in the research process. Results show the need to approach traditional teachings, health programs, and research from an Aboriginal worldview and indicate that more frequent workshops are required to empower youth and adults to practice and share traditional knowledge. Furthermore, a continuum exists in which the interest in language, culture, and tradition increases with age. Capacity can therefore be re-built over time within communities promoting autonomy and self-determination through self-care. Findings can be expected to further inform the traditional programming in participating communities, enhance existing Aboriginal determinants of health models by including traditional medicine as an element of self-care, and can act as a springboard for the inclusion of unique place-based methods into community-based research projects in the future.

Hedekeyeh Hots’ih Kāhidi – “Our Ancestors Are In Us,” describes a Tahltan worldview, which is based on the connection Tahltan people have with our Ancestors, our land, and our language. From this worldview, I have articulated a Tahltan methodology, Tahltan Voiceability, which involves receiving the teachings of our Ancestors and Elders, learning and knowing these teachings, and the sharing of these teachings with our people. By giving voice to our Ancestors and Elders, as well as to all of our people, it sets the stage for research that is useful, relational, and transformative. Tahltan Voiceability speaks not only to the methodology of this study, but also the way in which the voices of my people can gain strength and healing from the revitalization of our language. Conversations with fluent speakers, language teachers, educators, administrators, and language learners informed this investigation with their ideas and experiences regarding Tahltan language revitalization. The learnings from the research are presented in such a way as to honour all voices, using different modes of written expression woven throughout the dissertation. The organization of the dissertation is based upon physical manifestations – examples of art – that have played key roles in my Tahltan journey. This investigation addressed the following questions: How can Tahltan language revitalization positively affect the lives of my people? In the past and present, what has been done to maintain, preserve, and revitalize our Tahltan language? In the future, what do my people need to do to continue to maintain, preserve, and revitalize our Tahltan language? In terms of positive effects, language revitalization can be the start of a process in which we begin to heal from the impacts of past losses by reclaiming our language, culture, and identity, thereby allowing our voices to become stronger and healthier. My people need to identify the steps and actions we need to take in the areas of health, education, social development, and Aboriginal rights and title, so that we can revitalize our language and heal at the same time. From what I learned from co-researchers, scholars who have worked with our Tahltan communities, other Indigenous community language revitalization experts, and international language revitalization scholars, I have provided suggestions to a newly formed Tahltan Language Authority dealing with the assessment of the language, community support, and language revitalization programs being used in British Columbia and other parts of the world. Finally, I speak about Tahltan identity, the process of language revitalization, and the connection between language revitalization and healing as forms of empowerment for my people. / Graduate

This thesis examines how traditional medicine workshops offered by an Aboriginal health centre contribute to capacity re-building through self-care in two local communities in Manitoulin Island, Ontario. Health disparities that exist between Aboriginal people and the rest of the population have prompted a need to better understand health determinants that are of relevance in these communities including the importance of culture, tradition, and self-determination. A variety of qualitative methods were employed in this work including in-depth interviews, focus groups and “art voice.” The use of art voice on Manitoulin Island advances decolonizing methodologies by emphasizing how the incorporation of locally and culturally relevant methods or “methods-in-place,” is an effective way to engage communities in the research process. Results show the need to approach traditional teachings, health programs, and research from an Aboriginal worldview and indicate that more frequent workshops are required to empower youth and adults to practice and share traditional knowledge. Furthermore, a continuum exists in which the interest in language, culture, and tradition increases with age. Capacity can therefore be re-built over time within communities promoting autonomy and self-determination through self-care. Findings can be expected to further inform the traditional programming in participating communities, enhance existing Aboriginal determinants of health models by including traditional medicine as an element of self-care, and can act as a springboard for the inclusion of unique place-based methods into community-based research projects in the future.

This thesis examines how traditional medicine workshops offered by an Aboriginal health centre contribute to capacity re-building through self-care in two local communities in Manitoulin Island, Ontario. Health disparities that exist between Aboriginal people and the rest of the population have prompted a need to better understand health determinants that are of relevance in these communities including the importance of culture, tradition, and self-determination. A variety of qualitative methods were employed in this work including in-depth interviews, focus groups and “art voice.” The use of art voice on Manitoulin Island advances decolonizing methodologies by emphasizing how the incorporation of locally and culturally relevant methods or “methods-in-place,” is an effective way to engage communities in the research process. Results show the need to approach traditional teachings, health programs, and research from an Aboriginal worldview and indicate that more frequent workshops are required to empower youth and adults to practice and share traditional knowledge. Furthermore, a continuum exists in which the interest in language, culture, and tradition increases with age. Capacity can therefore be re-built over time within communities promoting autonomy and self-determination through self-care. Findings can be expected to further inform the traditional programming in participating communities, enhance existing Aboriginal determinants of health models by including traditional medicine as an element of self-care, and can act as a springboard for the inclusion of unique place-based methods into community-based research projects in the future.

Le mode de vie des Cris de la Baie James a changé radicalement au cours des dernières années. La carie dentaire est maintenant un problème de santé publique important, et des données montrent que les Cris utilisent les services dentaires en situation d’urgence plutôt qu’en prévention. Il apparaît donc important de savoir si les Cris sont satisfaits des services dentaires publics qui sont disponibles et de mieux comprendre leurs besoins. Ce projet aborde les deux questions suivantes : Quelles sont les attentes des résidants des localités cries pour les services dentaires? Est-ce que les services existants répondent aux attentes des gens? Nous avons mené une recherche qualitative descriptive basée sur des entrevues semi- structurées (n = 13). Les entrevues ont été enregistrées et transcrites. Nous avons ensuite procédé à une analyse inductive-déductive des transcriptions. Les résultats montrent que les participants ont des attentes très variées, mais que celles-ci sont rarement satisfaites. Premièrement, ils veulent accéder rapidement aux services lorsqu’ils en ressentent le besoin, par exemple en présence de douleur dentaire. Les participants désirent aussi transiger avec des professionnels dentaires attentionnés et expérimentés, ce qui n’est pas toujours le cas, selon eux. En conclusion, nous aimerions faire trois principales recommandations : améliorer l’accès aux services dentaires, en particulier en situation d’urgence; entraîner les professionnels dentaires en approches centrées sur le patient et pour en savoir plus sur la culture crie; et dialoguer avec les Cris pour développer, mettre en place et évaluer les services de santé dentaire. / The James Bay Cree have endured significant changes in their way of living. Dental caries is now a major public health concern, and data shows that Cree people tend to use dental services in emergency situations rather than in a preventive way. It is thus important to know if Cree people are satisfied with the public dental services that are provided and what their needs are. This project aims to respond to the following two questions: What are people’s expectations for dental services? Do current dental services meet people’s expectations? We conducted a qualitative descriptive research that was based on individual semi-structured interviews (n = 13). The interviews were audio-recorded and transcribed. We then performed an inductive-deductive thematic analysis. The results revealed that participants had a wide range of expectations, but that these expectations were rarely met. First, they wanted to be able to quickly access services when they felt a need to consult, for instance when having a toothache. Participants also wanted to deal with caring and experienced dental professionals, which was not always the case according to them. They wished that large families and the elderly could access dental hygiene counseling and support in their homes and gathering places. In conclusion, we would like to make three key recommendations: to improve access to dental services, especially in emergency situations; to train dental professionals in patient-centered approaches and to know more about the Cree culture; and to dialogue with Cree people in developing, implementing and evaluating oral health services.

Le mode de vie des Cris de la Baie James a changé radicalement au cours des dernières années. La carie dentaire est maintenant un problème de santé publique important, et des données montrent que les Cris utilisent les services dentaires en situation d’urgence plutôt qu’en prévention. Il apparaît donc important de savoir si les Cris sont satisfaits des services dentaires publics qui sont disponibles et de mieux comprendre leurs besoins. Ce projet aborde les deux questions suivantes : Quelles sont les attentes des résidants des localités cries pour les services dentaires? Est-ce que les services existants répondent aux attentes des gens? Nous avons mené une recherche qualitative descriptive basée sur des entrevues semi- structurées (n = 13). Les entrevues ont été enregistrées et transcrites. Nous avons ensuite procédé à une analyse inductive-déductive des transcriptions. Les résultats montrent que les participants ont des attentes très variées, mais que celles-ci sont rarement satisfaites. Premièrement, ils veulent accéder rapidement aux services lorsqu’ils en ressentent le besoin, par exemple en présence de douleur dentaire. Les participants désirent aussi transiger avec des professionnels dentaires attentionnés et expérimentés, ce qui n’est pas toujours le cas, selon eux. En conclusion, nous aimerions faire trois principales recommandations : améliorer l’accès aux services dentaires, en particulier en situation d’urgence; entraîner les professionnels dentaires en approches centrées sur le patient et pour en savoir plus sur la culture crie; et dialoguer avec les Cris pour développer, mettre en place et évaluer les services de santé dentaire. / The James Bay Cree have endured significant changes in their way of living. Dental caries is now a major public health concern, and data shows that Cree people tend to use dental services in emergency situations rather than in a preventive way. It is thus important to know if Cree people are satisfied with the public dental services that are provided and what their needs are. This project aims to respond to the following two questions: What are people’s expectations for dental services? Do current dental services meet people’s expectations? We conducted a qualitative descriptive research that was based on individual semi-structured interviews (n = 13). The interviews were audio-recorded and transcribed. We then performed an inductive-deductive thematic analysis. The results revealed that participants had a wide range of expectations, but that these expectations were rarely met. First, they wanted to be able to quickly access services when they felt a need to consult, for instance when having a toothache. Participants also wanted to deal with caring and experienced dental professionals, which was not always the case according to them. They wished that large families and the elderly could access dental hygiene counseling and support in their homes and gathering places. In conclusion, we would like to make three key recommendations: to improve access to dental services, especially in emergency situations; to train dental professionals in patient-centered approaches and to know more about the Cree culture; and to dialogue with Cree people in developing, implementing and evaluating oral health services.

Continued documentation of the disproportionate burden of ill health faced by Aboriginal Peoples in Canada raises questions about the gap between what is known and what action is being taken to improve Aboriginal health in Canada. In order to explore this puzzle of knowledge translation (KT), a conceptual framework was developed by synthesizing the KT literature with the Aboriginal health research literature. Using this framework as a guide, this study explored the idea of KT within one Aboriginal health research context – the Network Environments for Aboriginal Research British Columbia (NEARBC). Concepts, ideas, and patterns drawn from the systematic thematic analysis of semi-structured qualitative interviews highlight the complexity of Aboriginal KT and the challenges that lie ahead. The lessons learned from these challenges are reviewed and opportunities for KT to help transform the discourse and practice of Aboriginal health research and policy in Canada discussed.

This institutional ethnography relies on observations, interviews, and textual analyses to explore the experiences of mothers and children who attend a women-centered agency in Vancouver, Canada where a hot lunch, child care in the emergency daycare, and participation in group activities are vital forms of support. Mothers who come to the centre have many concerns related to their need for safe housing, a sustainable income, adequate food, child care, and support. And like mothers anywhere, they have concerns about their children. While many of the children, the majority of them First Nations, have never had a diagnostic assessment for fetal alcohol syndrome (FAS) or for the relatively new umbrella category, ‘fetal alcohol spectrum disorder’ (FASD), a number of the mothers were concerned or even knew that their children had FAS. This thesis asks – how does it happen that mothers have come to know their children in this way? The study critically examines how FASD knowledge and practices actually work in the setting and what they accomplish. My analysis traces how ruling practices for constructing and managing ‘problem’ mothers and children coordinate work activities for identifying children deemed to be ‘at risk’ for FASD. In their efforts to help their children and improve their opportunities for a better life, mothers become willing participants in group activities where they learn how to attach the relevancies of the FASD discourse to their children’s bodies or behaviours. They also gain instruction which helps them to confess their responsibility for children’s problems. While maternal alcohol use as the cause of FASD is contested in literature and in some work sites it is, in this setting, taken as a fact. This study discovers how institutional work processes involving government, medicine, and education actually shape and re-write women’s and children’s experiences into forms of knowledge that make mothers and children institutionally actionable. It is only by exposing the relations of power organizing mothers’ work that it may be possible to re-direct attention to mothers’ and children’s embodied concerns and relieve mothers of the overwhelming responsibility for which they are held and hold themselves to be accountable. / Graduate