The disproportionate burden of disease in the Aboriginal population in Canada has become so great that it is now being referred to as a health ‘crisis’. Evidence suggests that the answer to these ills lies not in the western biomedical model of heath care, but within the Aboriginal traditions of self-determination and holism (RCAP, 1996; O’Neil, Lemckuk-Favel, Allard & Postl, 1999; Romanow, 2002; CIHI, 2004; Maar, 2004; First Nations & Inuit Regional Health Survey, 2004). To this end, First Nations communities have been negotiating with the federal government and transferring responsibility for their community-based health services since 1986, despite the limitations of the federal Health Transfer Policy (Gregory, Russell, Hurd, Tyance & Sloan, 1992; Lavoie, et al, 2005; RCAP, Vol 3, Chp 3, 1996; Speck, 1989). These self-determination initiatives in health attempt to improve the health status of community members. Thus, determining an approach to health service delivery that contributes to positive health outcomes is of particular significance. Examining Island Lake’s evolving model of health service delivery indicates the success of the intergovernmental, interdepartmental, and intersectoral partnership approach they have taken; as evidenced by the Regional Renal Health Program, with dialysis treatment services, that has been established, perhaps for the first time in the country, in a remote First Nations community without existing hospital services. There remains work to be done in creating a holistic system of health service delivery that reflects their unique worldview within a context of health promotion and self-determination; however, their accomplishments to date, established processes, willingness to put their dreams into action and build what has not been built before demonstrate a potential to improve community health and well-being.

First Nations foodways have been altered through systemized efforts of colonization and were effectively reduced in part from the creation of stores and through limiting reserve systems. The current research seeks to understand the dietary choices and changes among three generations of Fist Nations women. Research takes place in a remote First Nation community in Northern Ontario. The differing food practices among the three generations of women highlight transformations resulting from a traumatic history. Decreases in the consumption of traditional, land based foods, as well as the practices around these foods (procurement, preparation, knowledge exchange and social engagement) alter the experiences of the younger generations. The conversations/exchanges around food take place within the culturally significant space of the teepee. The teepee is a core element. These exchanges have a tremendous bearing on the overall wellness of these women and their efforts to reclaim and remain culturally resilient.

The purpose of this study was to interview elite First Nations, Inuit, and Métis athletes to gain an in-depth understanding of their personal journeys to excellence. Semi-structured interviews were conducted and a narrative analysis was used to analyze the research findings. The three objectives were to find success strategies, obstacles and advice the elite athletes would provide to Aboriginal youth. The main success strategies were found to be Aboriginal elements, focus, mental preparation for competition, parental support, passion, and positive self-talk. Multiple obstacles were faced by the athletes in this study, with racism and leaving home being the commonalities. The advice they provided for young First Nations, Inuit, and Métis athletes was rich and inspiring. The findings of this study provide useful information for aspiring Aboriginal athletes, and for future ongoing meaningful research, that may lead to reducing the gaps in the literature.

This paper reports on a qualitative exploratory study focusing on the childbirth experiences of women and their families from a northern isolated community in Manitoba - who had to leave or were about to leave home to give birth. Perspectives from critical medical anthropology, cultural relativism and human ecological theory provided the theoretical foundation for this study. This study utilized ethnographic approaches to explore the perspectives of the women, their families and “significant others” and how they have been affected by policies, practices and structures at all levels of their environment in an attempt to gain a better understanding of the type of support and services that could potentially improve this experience. Presently, women from northern, rural and/or isolated communities leave home from a period of a few days up to 10 weeks to deliver their babies in an urban tertiary centre. They stay in boarding homes with others who have left home to obtain medical care, or with family and friends. During this period of time the women often do not access prenatal support or services within the regional health authority, other than medical care from a primary care provider (whom they may not have seen prior in their pregnancy) or to receive specialized medical intervention and monitoring. The boarding homes where they often stay do not offer any prenatal support or outreach services and are not conducive to housing women so close to delivering a baby. The women spoke of their experiences of giving birth marred by memories of fear, anger, frustration, tears and longing for family. They also spoke of a renewed sense of hope and excitement at the opportunity to share their ideas about possible ways that their experience could be improved. This paper breathed life into their thoughts and brought their ideas together to develop a new vision towards a system of supportive childbirth care for First Nation women in Manitoba, and more specifically, for women who are medically evacuated from the north to deliver their babies in urban Manitoba. For the Faculty of Medicine, it is a Master’s thesis, but for me and the many women and residents of Berens River, it is an opportunity for First Nation women to participate in shaping policy and influencing the direction for care and services that is created for them. It is important to acknowledge that evacuation and temporary relocation for birth is not an issue unique to First Nation women, it impacts hundreds of other northern and rural Métis and non-First Nation women every year. However, their experience is not included in this study. This paper suggests immediate and interim solutions for women who must leave home to give birth, albeit, the ultimate aim is to return birthing services closer to home.

Fritillaria camschatcensis L. Ker Gawl (Liliaceae), is a herbaceous flowering plant that grows in estuarine and subalpine habitats within its range from the northern limit in Alaska to its southern limit in western Oregon. This plant holds cultural significance in the Pacific Northwest as an important root vegetable that was cultivated in estuarine root gardens by many Indigenous Peoples. The bulbs of F. camschatcensis offered an important source of carbohydrates to a traditional diet that was high in protein, fats, oils and fibre. Lhásem is the Squamish name for F. camschatcensis, commonly known as northern riceroot, or chocolate lily. The Squamish Nation is very interested in restoring traditional plant foods into the community along with the traditional knowledge linked to them. Lhásem is a plant that many Squamish people were interested in learning about, thus it was an excellent candidate for ethnoecological restoration. Ethnoecological restoration brings cultural context, practices and technologies together with contemporary ecological restoration approaches and offers culturally relevant ways to restore a plant to the landscape. The east side of the Squamish Estuary, which borders the town of Squamish, has been impacted by a range of human-disturbances over the past century including: draining for agriculture, redirection of the Squamish River, dredging and the presence of industrial sites in close proximity to the estuary. All of these impacts have likely contributed to the decline of lhásem populations on the east side of the estuary. Through an ecological survey of the east and west sides of the Squamish Estuary I determined that the populations of F. camchatcensis are present and thriving on the west bank of the Squamish River. I collected vegetation and abiotic data and found that salinity is the most important abiotic factor affecting lhásem habitat. A logistic regression showed that salinity and the presence of lhásem are negatively correlated. Results of the vegetation data analysis indicated that Maianthemum dilatatum was an indicator for where lhásem is found growing on the west side of the Squamish Estuary and Aster subspicatus was the indicator for lhásem on the east. Lhásem restoration gardens were planted to explore the growth within one growing season across two restoration treatments, terrestrial sites and estuarine sites. The results indicate that terrestrial garden sites were more successful than estuarine garden sites and that whole bulbs were more successful than bulblets in the first year of growth. Through community interviews with elders, adults and youth, I documented the contemporary interests in the restoration of lhásem and found that the major interest of the community was focused on health, traditional food revitalization and knowledge renewal. I facilitated educational events in which Squamish Nation youth and community members learned about the plant and how to manage it in the Squamish Estuary gardens. Overall this research provides information for the future restoration of lhásem in the Squamish Estuary as well as a template to restore other culturally important plants. / Graduate

Background: A novel mutation (V205M) within the KCNQ1 gene was previously delineated and confirmed to predispose to long QT syndrome (LQTS) in a First Nations community in Northern British Columbia (Gitxsan). LQTS is an autosomal dominant genetic disease that is named for the elongation of the ECG (electrocardiogram) Q-T interval, corrected for rate, but is reflective of delayed repolarization predisposing to LQTS. Clinically, LQTS presents as sudden loss of consciousness (fainting, seizures) and sudden death. KCNQ1 is responsible in part for IKs the slow rectifying potassium channel in the heart, and also accounts for about 30% percent of all genetically confirmed cases of LQTS. The KCNQ1 gene is also expressed in the pancreas, and recent Genome Wide Association Studies (GWAS) have identified variants found within the KCNQ1 gene to be strongly associated with type 2 diabetes (T2D) in Asian and European populations. In Canada, and around the world, Indigenous populations have the higher rates of T2D. We set out to determine if the V205M mutation could influence the development of T2D in this First Nations population. Methods: Participants were recruited from a contact data base from the original study (entitled ‘The Impact of Long QT on First Nations People of Northern British Columbia’) and invited to determine if their KCNQ1 mutation status influenced their HbA1c values, and therefore risk for diabetes. Body mass index (BMI), waist circumference (WC), exercise levels and HbA1c test values were collected from each participant. Sixty-five participants (18 mutation positive and 47 mutation negative) were included in this sub-study. Results: Adjusting for anthropometric measurements, V205M+ participants were almost ten times more likely to attain an ‘at-risk’ (or ‘pre-diabetic’) HbA1c value (adjusted OR: 9.62; p=0.002; CI: 2.23-41.46). Although there was no difference in average HbA1C levels (p=0.963). The distribution of values was markedly different between those in the mutation positive vs mutation negative group. Conclusion: Although it is premature to declare a true risk for diabetes in this cross-sectional study, our results suggest that HbA1C levels are influenced by the presence of the V205M mutation, and further study is indicated to determine if insulin secretion is affected in these individuals. This work has potential implications for others with LQTS who might have altered glycemic control as a result of mutations in KCNQ1. Furthermore, in this First Nations population, broader health implications might need to be considered for those with the V205M mutation. / Graduate

Much of the curatorial and anthropological literature on museology has oversimplified museum spaces as monolithic colonial entities. However, recent developments in museum practice as a process of collaborative and public cross-cultural exchange are changing the way these spaces are interpreted and used. In this thesis, I examine contemporary curatorial endeavors at a number of museums and galleries in Vancouver, British Columbia, that attempt to revitalize the ways in which the cultural expressions of Indigenous artists and their communities are represented. The artists whose works are examined in this thesis locate their traditional territories along the coastline of B.C. As both separate and similar institutions, museums and art galleries are useful venues from which one may examine and chart ongoing processes of cross-cultural exchange. A curatorial exhibition project of my own: Understanding Place in Culture: Serigraphs and the Transmission of Cultural Knowledge will explore some of the obstacles and benefits of engaging in cross-cultural conversations of cultural representation. The exhibit looks at a selection of prints by Indigenous artists from the Smyth and Rickard Collections of Northwest Coast Prints from the University of Victoria Art Collections (UVAC) chosen specifically because they concern the artists’ perspectives of place as it relates to physical locations, identity, and cultural practice. The relationship between the organization of knowledge and culturally specific attachments to space and place are central to understanding how we think about, and engage with, the world around us. The relationship between places and local knowledge connects the content of the images with the space in which they are to be exhibited: the Maltwood Prints and Drawings Gallery in the McPherson Library at the university. Through interviews with artists and curators, and a review of the literature surrounding these issues, I have attempted to create an argument for the importance of space and place in support of an agentive curatorial practice. As an attempt to decolonize the museum/gallery space, this thesis argues that diverging perspectives of place are essential to the way we understand the world and our position within it. / Graduate

Objective The use of telehealth to provide health service delivery to rural and remote First Nations populations Canada-wide has greatly increased in recent years. Telehealth provides a mechanism for these disadvantaged and underserved communities to access timely healthcare services that would otherwise be expensive, delayed or unavailable due to geographic and resource limitations. There are numerous benefits, challenges and cultural issues that must be understood from a healthcare professional perspective when providing telehealth care to First Nations communities. Once educated with respect to these issues and experienced in providing care, healthcare professionals are well poised to provide feedback with respect to improving telehealth mediated health care delivery. This thesis examines these issues in the context of using telehealth for patient care, specifically cancer care. Methods This thesis is divided into two phases. Phase one is a literature review assessing the use of telehealth, specifically in rural and remote First Nations communities in Canada. Phase 2 is a study using a survey to assess healthcare professionals who provide telelehealth mediated patient care (in particular cancer care) to Northern BC First Nations communities. The participants were contacted through the use of an online survey tool to assess their perceptions of benefits, challenges, and cultural awareness when providing patient care. The survey population consisted of onsite health professionals and urban health professionals providing patient care to Northern BC First Nations communities via telehealth. Specific participant groups of interest were (1) onsite cancer care professionals, (2) onsite other (non-cancer) care professionals, (3) urban cancer care professionals, and (4) urban other (non-cancer) care professionals. Results The participant population of 45 was too limited a sample size for inferential statistics to be conducted. Therefore our survey data was interpreted by comparing the mean composite scores of the participants groups within each category. Our survey data implied that onsite cancer care providers found fewer benefits and more challenges with respect to telehealth than the other participant groups. We did not see any differences between the participant groups with respect to cultural awareness. Conclusion Based on the literature we reviewed telehealth can reduce costs and extend health care services in a timely manner while at the same time complement conventional care to build stronger health care community relationships. Despite these positive benefits found in literature, our survey found onsite cancer care professionals did perceive fewer benefits and more challenges regarding telehealth use. Specific issues raised by our survey participants that need to be addressed are the physical disconnect associated with telehealth and the perception that telehealth is a replacement for conventional care. / Graduate

This study explores the stories of Executive Directors of Delegated Aboriginal Child Welfare Agencies in regards to cultural planning for Aboriginal children being adopted into non-Aboriginal homes in British Columbia. This qualitative study used an Indigenous methodology to describe and interpret the elements of cultural planning for adopted Aboriginal children by interviewing Executive Directors of Aboriginal child welfare agencies in the province of British Columbia. The purpose is to provide knowledge about cultural planning and safety agreements in conjunction with Aboriginal agencies and to also gain an understanding of how Aboriginal agencies are able to meet their commitment to retain their adopted children’s’ Aboriginal identity and maintain their connections to culture, community and or family. Semi-structured interviews were conducted with six Executive Directors who volunteered for this study. Their stories were audio taped and analysed utilizing a thematic analysis. Two main themes emerged from the analysis were 1). Funding and 2), Legalizing Cultural Agreements. Ceremony was stressed throughout the interviews and is an integral part of Indigenous people and adequate funding needs to be re-addressed to support Aboriginal children in their best interests. Training continues to be a factor for adoptive parents to learn about the history of Aboriginal people and learning ways to best support the children they are adopting by learning about the rich cultures they belong to and how they will be able to make those connections. Funding of operational dollars for Aboriginal agencies appears to be at the fore front in every aspect of the cultural planning process. / Graduate

As the province of British Columbia seeks to rapidly develop an extensive natural gas industry, it faces a number of challenges. One of these is that of ensuring that development does not disproportionately impact some of the province’s most marginalized communities: the First Nations on whose land extraction will take place. This is particularly crucial given that environmental problems are often caused by unjust and inequitable social conditions that must be rectified before sustainable development can be advanced. This research investigates how the BC Oil and Gas Commission’s consultation process addresses, and could be improved to better address Treaty 8 First Nations’ concerns regarding shale gas development within their traditional territories. Interviews were conducted with four Treaty 8 First Nations, the Treaty 8 Tribal Association, and provincial government and industry staff. Additionally, participant observation was conducted with the Fort Nelson First Nation Lands and Resources Department. Findings indicate that like many other resource consultation processes in British Columbia, the oil and gas consultation process is unable to meaningfully address First Nations’ concerns and values due to fundamental procedural problems, including the permit-by-permit approach and the exclusion of First Nations from the point of decision-making. Considering the government’s failure to regulate the shale gas industry in a way that protects ecological, social and cultural resilience, we argue that new governance mechanisms are needed that reallocate authority to First Nations and incorporate proposals for early engagement, long-term planning and cumulative impact assessment and monitoring. Additionally, considering the exceptional power differential between government, industry and First Nations, we argue that challenging industry’s social license to operate is an important strategy for First Nations working to gain greater influence over development within their territories, and ensure a more sustainable shale gas industry. / Graduate / 0768 / 0615 / kgarvie@uvic.ca