Student research gives voice to Elders affected by trauma

Lisa Weighton

Last summer, halfway through her Master of Arts in Leadership—Health Specialization program, Eunice Joe’s mother was admitted to the West Coast General Hospital in Port Alberni with debilitating pain and compounding health challenges. It was a painful time for Joe’s family. But it was one comment Joe wasn’t meant to hear that hurt the most.

“I overheard her Intensive Care Unit doctor talking at the nursing station,” Joe says. “He said that she was ‘suffering from the pathology of obesity.’ Deep inside, my gut was saying, ‘No. It’s actually the pathology of trauma.’”

Joe’s mother remained in hospital and long-term care until she died last winter.

Lived experience paves way for research

Joe is both an elected band council member for the Tseshaht First Nation and the regional manager for the First Nations Health Authority (FNHA), the body in charge of planning, designing and delivering First Nations health programs across the province. She has long been passionate about improving health outcomes for Indigenous Peoples in BC, but her mother’s experience in hospital ignited her passion further.

For her master’s research, Joe is working in collaboration with Island Health and Elders within the Nuu-chah-nulth community in Port Alberni under the supervision of Prof. Elizabeth Hartney, director of the Centre for Health Leadership and Research as well as program head for the MA in Leadership—Health Specialization program. Joe’s research aims to improve trauma-informed care for Elders when they attend the emergency department at West Coast General Hospital. Elizabeth Hartney

Effects of trauma run deep

“It’s very well recognized that Indigenous people in BC have not only experienced great trauma, but they have experienced intergenerational trauma as well,” says Hartney.

There are about 1400 residential school survivors in BC—the second highest number in Canada according to the FNHA.

Hartney’s work focuses largely on health care policy in BC as well as patient-centred care for vulnerable populations. She was the Ministry of Health’s consulting psychologist for the development of the Trauma-Informed Practice Guide on behalf of the BC Provincial Mental Health and Substance Use Planning Council in 2013, now used in health authorities across BC.

For survivors of the Canadian government’s residential school system, Hartney says institutions like hospitals can be especially triggering. That’s one of the reasons Elders have chosen not to seek emergency care when needed.

Hartney says trauma-informed practice, an approach that recognizes trauma and is sensitive to the way it manifests, has become more recognized in the health care system.

Two years ago, Island Health approached Hartney to lead a project to improve trauma-informed care within the emergency departments of West Coast General Hospital in Port Alberni and the Victoria General Hospital.

With Indigenous Education and Student Services Manager Asma-na-hi Antoine, Hartney received a $100,000 grant from the Canadian Institutes of Health Research to develop a collaborative research strategy to improve supports for Elders seeking emergency treatment. Joe is leading the work in Port Alberni.

Innovative research methods give voice

The research methods Joe has chosen will give voice to Elders in order to find ways to include trauma-informed practice in hospitals through their perspectives.

In part, she will collect their stories using PhotoVoice, a participatory research method that allows participants to capture and share images of what they want to convey. The photos serve as a starting point for dialogue. Joe will continue to engage with Elders throughout the process so they have ownership over their stories.

While her mother didn’t attend a residential school, Joe says she was aware of past trauma and abuse in her family. But it was something Joe’s mother never spoke about.

“I know there are things that happened within my family. My mother was the eldest of her siblings. I know that there’s no way she could not have been affected,” she says.

Institutional discrimination

Hartney says one of the reasons Indigenous Elders avoid seeking emergency care is because of institutionalized racism, which is sometimes unintentional.

“What very often happens is people come in with a head injury or they are having a stroke or experiencing another serious health condition and they are perceived to be drunk, so they are just left to sober up when in fact they need urgent care,” she says. “That’s a perception that happens due to Indigenous status which is frustrating and upsetting and sometimes people die because of it.”

Before Joe’s mother died in January, it took three trips to the ER before her mother was finally admitted for stroke.

“She was showing signs of a stroke and we kept telling them, ‘there’s something off, there’s something wrong’ and they weren’t hearing us,” Joe says.

Hartney says ER staff work under tremendous pressure and are forced to make quick decisions.

“Nobody means to leave somebody having a stroke without care. They have to triage people and some people do come in drunk. So they make a lot of assumptions that are based on racism as opposed to clinical decision making,” Hartney says.

“Looking at our biases”

Joe says she hopes her research will help health care providers to look beyond the surface level symptoms of patients like her mother.

“If the health care providers understood some of the things that happened to my mother, they might understand what caused the obesity and the progressing mobility issues and health conditions.”

 “It’s about looking at our own biases as individuals and looking at how we can help educate and be open to learning about others in a respectful way,” she says.

Joe has been nominated as a finalist in the 2018 Top 20 Under 40 Business & Community Achievement Awards for her outstanding leadership in her community. The awards ceremony takes place April 21 in Nanaimo.